AND MKI.K INI:, UKCENT ADVANCES IN. 



703 



The entire leg is amputated at the hip joint by 

 one or more established operations, notably 

 \\ \ ! h's ami Semi's, wit hout danger of tin- lia-iu- 

 orrhagv which had been oitener than otkerviM 



fatal. Internal ailments, too obscure for clear 

 diagnosis, are unhesitatingly investigated with 

 the knife if necessary. The perils and horrors 

 of childbirth in cases where a small pelvic orifice 

 or an overgrown foetus absolutely prevent deliv- 

 ery are substantially done away by the impunity 

 which perfected asepsis and anaesthesia afford in 

 ('a'-aivaii section, and in a newer operation per- 

 formed with greater ease and less injury, sym- 

 physiotomy, namely separating the pubic bones 

 at the symphvsis, and pressing them sufficiently 

 apart. The bones grow together again without 

 difficulty, and there seems no reason why bovi- 

 nine sponge-grafting or transplanted bone might 

 not fill the gap and allow adequate passage for 

 future deliveries without a second resection. 



Fortified with modern operative impunity, and 

 guided by the map of the brain with its branches 

 and distributive functions so far as made out by 

 the investigations of vivisectionists, the surgeon 

 attacks tumors, abscesses, haemorrhages, etc., in- 

 side the skull with as direct and certain aim in 

 most cases as if the brain had no covering ; re- 

 moves or repairs them, and patches up both skull 

 and scalp as good as new. To be more explicit, 

 the greater number of symptoms produced by 

 lesions in the brain indicate unerringly to mod- 

 ern science, by their character and the parts and 

 functions affected, the precise area of the brain 

 from which the disturbance proceeds, |o that the 

 surgeon can lay his finger over the hidden sar- 

 coma, abscess, blood clot, or whatever, and cut 

 down to it as confidently as a navigator would 

 steer for a port or past a sunken rock by his 

 chart. 



By exploring the uncovered brain of the living 

 monkey with the stimulus of the electric battery, 

 and noting the exact muscular motions so pro- 

 duced from each point in the brain, it has been 

 found practicable to define the precise area of 

 the brain from which each of the motor im- 

 pulses proceeds, also the areas that control most 

 of the senses, and the areas concerned in some 

 of the mental faculties and emotions, such as 

 recognition of the uses of objects physically per- 

 ceived. The mental expression of animals is so 

 obscure to us that little further progress in 

 phreno-topographv may be expected from ani- 

 mal vivisection, hut the great number of hu- 

 man vivisections now performed for the relief of 

 cerebral and nervous troubles, epilepsy, etc., will 

 incidentally and gradually reveal at length the 

 knowledge that is wanted to enable us to go to the 

 root of many a disorder now mysterious, under 

 the guidance of morbid mental phenomena which 

 will have been tracked to their several lairs in 

 the brain, and forms even of insanity that can 

 be extirpated or laid open to therapeutic treat- 

 ment by the surgical armament will be brought 

 to light in growing numbers, and will be vastly 

 better understood. Some of the mental processes 

 related to sensation have already been located, 

 but much remains to be done by observation on 

 the regular line of surgical practice, or " human 

 vivisection," before the phreno-topographic chart 

 of the brain will be so complete that brain sur- 

 gery can " have its perfect work." Among pion- 



eer explorations for the centers of mental action 



in the brain, the most, satisfactory us yet is tin- 

 location of certain mental proccs,,-, connected 

 with sensation, including the recognition of ob- 

 jects seen (or what is called psychical sight) in a 

 small convolution of the brain known a- the an- 

 gular gyms. By means of this datum the cele- 

 brated surgeon MacKwen, of Glasgow, cured a 

 case of melancholia with homicidal impulses which 

 had originated in an injury of the skull. Among 

 other consequences of the accident, the patient 

 had been unable to recognize the use or nature 

 of familiar objects which he distinctly saw, al- 

 though he could still recognize it fully through 

 the sense of touch. Taking, therefore, the an- 

 gular gyrus for his guide, MacEwen cut out a 

 button of bone from over it, and found on the 

 inner side a splinter that had been struck off 

 from it and had been pressing, partially im- 

 bedded, on the precise area of " psychical sight." 

 This having been removed, the patient's intel- 

 lectual infirmity disappeared, and with it also 

 the impulse to kill his wife and children. 



Epilepsy, by its marked motor symptoms, has 

 guided the surgeon to its centers in the brain in 

 hundreds of operations already, and with gener- 

 ally very beneficial, though more rarely decisive, 

 results. The initial movement of the fit is taken 

 for a guide ; and if the electrical test on the cor- 

 responding motor area of the brain produces the 

 epileptic fit as well as the characteristic move- 

 ment, the extirpation of that area, accurately 

 defined, proves a curative success. Otherwise it 

 is necessary to explore farther to find the source 

 of the coincident symptoms. In a case (reported 

 by Dr. W. W. Keen, of Philadelphia, among 

 other valuable data herein employed) of epileptic- 

 attacks which always started in the right thumb, 

 it was sought to define precisely the extent of 

 the thumb center in the brain by cutting out a 

 button from the skull of an inch and a half 

 diameter (covering the hand, arm, and face cen- 

 ters), and then stimulating the brain from the 

 electrical battery at different points and noting 

 the effects on different muscles until, point by 

 point, the exact area for each set of muscles was 

 circumscribed, precisely as the animal vivisec- 

 tionists had made the original discoveries. The 

 thumb center thus accurately delimited was 

 found to be about half an inch square. It was 

 excised, the exactitude of the operation being 

 tested by the means before used. The immedi- 

 ate effect was the typical epileptic fit, together 

 with complete paralysis of the muscles of the 

 thumb five groups, certain of which extend 

 well up toward the elbow without in the least 

 affecting any other muscles. In a few months 

 the muscles of the thumb also recovered their 

 functions. Whether the removed thumb center 

 had been repaired by a fresh growth is uncertain. 

 It has been reported, in a case of injury to the 

 left side of the head which impaired the dexter- 

 ity of the right hand, that the right motor center 

 came to the rescue, concentrating faculty in the 

 left hand to the full extent of the impairment in 

 the right. This would seem to show, at least, 

 that the usual inferiority of the left hand is 

 merely the result of one-sided exercise of the 

 hand centers in the brain. 



In a recent case of Dr. J. W. Kime. United 

 States army surgeon at Fort Dodge, Iowa, where 



