xci'v Journal of Comparative Neurology. 



cases of brain surgery from which the following suggestions are 

 copied : 



1. When there has been a blow upon the head and hemiplegia, 

 aphasia, or hemianopsia follows, there is nearly always a hemorrhage 

 which may be cured by opening the cranium at the point indicated by 

 the cerebral localization. 



2. Paralysis of the third, fourth or sixth pairs of nerves indicates 

 a lesion in the pons and contraindicates operation. 



3. A slight premonitory attack, affecting speech temporarity, or 

 producing a heaviness of hand or foot for a few moments, if followed 

 by hemiplegia, may be taken as a good point in favor of operation, as 

 the bleeding vessel is probably on the surface or very superficial. 



4. Paralyses of very limited extent, especially if complete, are 

 not often due to hemorrhages — being local palsies rather than the 

 peripheral indicatives of cerebral desease. 



5. A very severe headache, followed by gradually but rapidly 

 deepening coma and hemiplegia becoming more and more complete, 

 means a hemorrhage into the great basal ganglia — probably beyond 

 surgical help. 



6. When the case presents a history of moderate loss of power 

 or complete hemiplegia without unconsciousness, followed in a few 

 hours by sudden appearance of coma, marked fall of temperature suc- 

 ceeded by some fever, a hemorrhage has broken into the ventricles or 

 beneath the membranes, is still progressing, and indicates immediate 

 trephining. 



7. Very sudden and complete hemiplegia and coma usually 

 means embolism; heart lesions, endoarteritis and syphilis enhances the 

 probability. 



8. Bilateral hemianopsia appearing suddenly probably indicates 

 hemorrhage in the occipital lobe of the oposite side and justifies ex- 

 ploratory operation. 



9. Profound coma and relaxation without any hemiplegia usual- 

 ly depend upon injury to the pons and decide against operation. 



10. Vomiting, severe occipital headache and vertigo, with or 

 without a distinct paralysis render a cerebellar hemorrhage probable ; 

 ocular symptoms, like nystagmus and strabismus are apt to accompany 

 these symptons of cerebellar lesion. Exploratory operation is justi- 

 fiable. 



11. According to Hughlings Jackson, convulsions, early rigidity 

 and conjugate deviation of the eyes of a splastic form are conclusive 



