154 SECTIONAL ADDRESSES. 



Colonel Sir William Hale White. My pupil fell wounded at 6.50 a.m. 

 on 20th of November 1917. As far as is known, he lay insensible 

 for about two hours. Picked, up five hours after the wound, he 

 could not move either upper or lower extremity. Thirty-six hours 

 after the wound he underwent an operation wliich showed that the 

 superior sagittal sinus was blocked, happily not by a thrombus, but by 

 being torn and having pieces of the inner table of the skull thrust into 

 it, so that for this peiiod of time the motor areas on both sides down 

 to the face area were asphyxiated, the right being much moi'e affected 

 than the left. Six days after the wound the cerebration was still slow, 

 with typically vacant look. 



In the left upper extremity the muscular power was much improved ; 

 he could raise his arm to his mouth, but he prefeiTed to be fed. 



In the right upper extremity there were no movements in the 

 shoulder, elbow, or wrist, but he could flex and extend the fingers 

 weakly. 



In the left lower extremity there were fair movements of hip and 

 knee, no movements of ankle and toes. 



In the right lower extremity there were no movements of hip, knee, 

 ankle, or toes. 



Six weeks after the wound he first walked, although with difficulty ; 

 absolutely the last place in which the paresis remained was in the 

 muscles of the right toes. Four months after the injury these toes 

 were spread out and could not be brought together voluntarily. 

 Gradually this has become less, but even now, two and a-half years 

 later, all these muscles ai-e weaker than those on the other side. 



Such, then, is the wreckage of the machine caused by thirty-six 

 hours' blockage of the blood-flow through the motor areas of the brain; 

 wreckage enough but not irreparable. 



I pass to the second case. It is that of the child of a well-known 

 Professor of Physiology and a first authority on the subject of respira- 

 tion. I am indebted to him for the following notes : 



In this child, a male twin, bom about twelve weeks too early, it was 

 noticed about twenty-four hours after birth that the breathing during 

 sleep was in'egular and of a very pronounced Cheyne Stokes type, six to 

 ten breaths being followed by a pause during which no respiratory move- 

 ment occurred. Usually the pauses were of fifteen to twenty seconds' 

 duration, but occasionally (two to ten times a day) the breathing remained 

 suspended for a prolonged peinod, extending in some cases to ten and 

 fifteen minutes, and in one accurately observed case even to twenty-five 

 minutes, intemipted by one single breath and a cry about the middle of 

 the period. The breathing invariably started again before the heart- 

 beats ceased. 



Cases in which the anoxsemia has been uncomplicated are to be 

 found among those who have been exposed to low atmospheric pres- 

 sures ; for instance, balloonists and aviators. Of these quite a con- 

 siderable number have suffered from oxygen want to the extent of being 

 unconscious for short intervals of time. 



No scientific observer has pushed a general condition of anoxaemia 

 either on himself or on his fellows to the extent of complete unconscious- 



