CEREBRAL LOCALIZATION. 



101 



the faculty of speech is affected to any extent, 

 it is safe to conclude that the lesion must he in 

 one of three places nearly connected with each 

 other the island of Reil, the base of the third 

 frontal convolution, or the white substance ly- 

 ing between the third frontal convolution and 

 the base of the cerebrum. It will also, in most 

 cases, be upon the left side, as already shown. 

 Paralysis of motion affecting only the upper 

 extremity, leads to a location of the lesion on 

 the side of the brain opposite the affected arm, 

 and either confined to or involving the ascend- 

 ing convolutions of the frontal and parietal 

 lobes. In the same way, the affected point 

 may be predicted, with an approach to cer- 

 tainty, in paralysis of the leg, of the muscles of 

 the face, of ithe eyes, etc. Supposing, now, that 

 a patient affected with certain forms of paraly- 

 sis, either of motion or sensation, with diffi- 

 culty of speech, or with a certain variety of 

 strabismus, gives a history of an injury at some 

 time long passed, to the head. The surgeon 

 concludes that as a result of such injury the 

 bones of the skull have become gradually 

 thickened until the pressure of new bone upon 

 the brain-substance is causing the symptoms 

 which he observes. From the muscles and 

 parts affected he is enabled, in some cases with 

 almost absolute exactness, to predict where 

 the thickened bone on the inner surface of the 

 skull will be found, and by the use of the tre- 

 phine upon this point he may cure the disease 

 a result which could not be obtained with- 

 out the accurate knowledge which has resulted 

 from the study of cerebral localization. Ab- 

 scess in the substance of the brain, following 

 a few weeks after an injury is by no means 

 uncommon. Such abscesses may be treated as 

 abscesses are in other parts of the body, by 

 opening them and allowing pus to escape, pro- 

 vided only thay can be located with sufficient 

 exactness, so that the trephine may first be 

 used to remove a portion of the skull and thus 

 allow the plunging of a knife into the brain- 

 substance and reaching the abscess-cavity. 

 Suppose that a person who has been injured 

 on the head develops aphasia, or the loss of 

 words, after a few weeks. The indications are 

 all in favor of the diagnosis of an abscess in 

 the anterior part of the brain on the left side, 

 and -an operation at this point may save the 

 patient's life, and has done so. 



The surgical importance of these discoveries 

 may be still further exemplified. Thus, if a 

 person receive a severe injury on one side of 

 the head, and there follows a paralysis of the 

 hand and arm on the same side of the body, 

 instead of on the opposite side, any surgical 

 interference is contraindicated ; for the reason 

 that, were the injury to the brain confined to 

 the seat of the wound, the paralysis would be 

 on the opposite side of the body ; but, being on 

 the same side, it is proved that the brain-injury 

 must be on the opposite side ; in other words, 

 that the brain has been extensively damaged, so 

 extensively that the side opposite the point of 



injury is also deeply affected, and therefore sur- 

 gical interference is probably useless. Again, 

 the completeness of the paralysis may indicate 

 that the brain-disease is not confined to the 

 surface, but has involved the deeper portions, 

 and that the operation of trephining is likely 

 to do little if any good. 



The celebrated " American crow-bar case," 

 which was for a time looked upon with incre- 

 dulity as a " Yankee invention," has recently 

 been appealed to as an argument against the 

 fact of cerebral localization, and as a proof that 

 the most extensive injury may be done to that 

 portion of the brain supposed to be the center 

 of voluntary motion, without causing paraly- 

 sis. The case was that of a man, aged twen- 

 ty-five years, who was tamping a blasting- 

 charge in a rock with a pointed iron bar three 

 feet seven inches long, 1 inch in diameter, 

 and weighing 13J pounds. The charge ex- 

 ploded prematurely, and the bar entered with 

 its pointed end at the left angle of the patient's 

 jaw, passed through the skull and out at the 

 forehead, and was picked up at some distance, 

 covered with blood and brain. The patient 

 was stunned, but within an hour after the ac- 

 cident he was able to walk up a long flight of 

 stairs, and give an intelligent account of the 

 injury to the surgeon who attended him. He 

 ultimately recovered, after an illness which it 

 was supposed must necessarily end fatally, and 

 lived twelve and a halt years, dying of epilep- 

 tic convulsions, without medical supervision. 

 The skull was subsequently exhumed, and may 

 now be seen in the Medical Museum of Harvard 

 University. 



The case is generally cited as one in which 

 the man suffered no permanent damage from 

 the injury, either mental or bodily ; but a more 

 careful study of it, made by Charcot, proves 

 quite the contrary, and in fact brings it within 

 the ranks of the proofs of cerebral localization. 

 An examination of the parts of the brain which 

 must have been lacerated by the projectile, 

 proves that the whole track of the bar was 

 in the prse-frontal region, and that the absence 

 of paralysis was exactly what should have been 

 anticipated from experimental research. The 

 outer root of the olfactory bulb may also have 

 been injured, and if such were the case there 

 should have been a partial loss of the sense of 

 smell ; but on this point the history is silent. 

 There should have been also more or less intel- 

 lectual disturbance, and on this point the his- 

 tory by Dr. Harlow is conclusive : " His con- 

 tractors, who regarded him as the most efficient 

 and capable foreman in their employ previous 

 to his injury, considered the change in his mind 

 so marked that they could, not give him his 

 place again. The equilibrium of balance, so to 

 speak, between his intellectual faculties and 

 animal propensities seems to have been de- 

 stroyed. He is fitful, irreverent, indulging at 

 times in the grossest profanity (which was not 

 previously his custom), manifesting but little 

 deference to his fellows, impatient of restraint 



