314 



SCIENCE 



[Vol. Y., No. 115. 



Fluhrer proceeded with his attempt to follow the 

 course of the ball with the probe. The patient's 

 head was now placed in such a position that the pre- 

 sumed track of the ball was perpendicular to the 

 horizon. A perfectly straight Nelaton's probe was 

 then passed perpendicularly into the brain to a depth 

 of about six inches, when a soft resistance was felt, 

 which no effort was made to overcome. The depth 

 to which the probe had passed supported the hypoth- 

 esis that the bullet had gone completely through the 

 brain, and had struck the opposite side of the skull. 

 In order to ascertain the probable locality of the im- 

 pact, the probe was left standing in the brain, and 

 the point on the back of the head was noted at which 

 the probe would emerge if projected through the 

 brain. This was presumed 

 to be the point of interior 

 impact. An opening was 

 then made in the skull at 

 a point three-quarters of 

 an inch lower down in the 

 supposed plane of the path 

 of the bullet, and the mem- 

 brane covering the brain 

 was carefully slit so as to 

 admit the end of the index- 

 finger. A resistance was 

 felt in the brain at the 

 depth of about half an inch, 

 which was believed to be 

 the bullet. Instead of ex- 

 ploring this resistance with 

 a needle, it was decided to 

 continue the opening in 

 the skull upwards until 

 the point of impact was 

 reached, and then extract 

 the bullet through the 

 opening it had itself made. 

 This was successfully ac- 

 complished. 



The patient's head was 

 then placed in the same 



position as at first, and the probe was again intro- 

 duced through the opening in the forehead, and, as 

 before, it encountered a soft resistance at about the 

 depth of six inches. Leaving the probe standing 

 upright, the finger was carefully introduced into the 

 brain from the opening at the back of the skull, and 

 the discovery was made that the obstruction to the 

 passage of the probe was due to the dura mater alone. 

 This was remedied by slitting the membrane, and 

 the end of the probe then appeared at the opening in 

 the back of the head. A small-sized rubber tube was 

 attached to this end, and drawn through the brain by 

 the removal of the probe. The tube was left in the 

 brain for drainage-purposes, and the patient's wounds 

 were then dressed. 



The operation, which had been conducted through- 

 out with antiseptic precautions, was completed in 

 about four hours from its commencement, the greater 

 portion of the time having been spent in stopping the 

 cerebral hemorrhage. 



Fig. 2. 



In addition to Dr. William F. Fluhrer, the follow- 

 ing members of the house staff were present, and 

 witnessed the operation: Drs. R. T. Morris, J. R. 

 Conway, jun., W. W. French, J. H. Woodward, H. 

 N. Williams, P. Oppenheimer, H. S. Wildman, H. 

 Herman, H. Biggs, E. Hurd, C. F. Roberts, and W. 

 G. Rutherford. 



On May 22, 1884, Dr. Fluhrer exhibited Knorr at 

 Bellevue hospital to a number of physicians. He 

 was then, so far as could be judged, in perfect health. 

 Apart from the scars upon the patient, the only ab- 

 normality discoverable was a limitation of the visual 

 field for green and red, observed by Dr. W. F. Mit- 

 tendorf. Inasmuch as this feature was common to 

 both eyes, it is questionable whether it was caused 

 by the injury. 



The engraving, fig. 2, is 

 from a photograph of the 

 patient taken at that time. 

 The light line marks the 

 position of the fissure of 

 Rolando. The bullet en- 

 tered at the centre of the 

 forehead, an inch and a 

 quarter above the upper 

 level of the eyebrows: it 

 passed in a straight line 

 through the brain, from a 

 to b, and was deflected to 

 c, where it lodged. 



The patient left the hos- 

 pital, where he had for a 

 long time been retained 

 simply for observation, on 

 June 30, 1884, and in a 

 month went back to work 

 at his old employment in 

 a butcher's shop. He re- 

 mained at work during the 

 exceptionally hot weather 

 in the early part of Sep- 

 tember. 



On Sept. 12, between 

 twelve and one o'clock in the morning, Knorr re- 

 ceived a heavy blow in the anterior scar from the 

 elbow of the man with whom he was sleeping. Knorr 

 states that he suffered intense pain in the head for 

 half an hour, when it died away, and he fell asleep 

 again. He awoke at about four o'clock, and no- 

 ticed, with wonder, his right forearm beginning to 

 flex upon the arm. He tried to hold it down with 

 his left hand, but failed. Then his right leg was 

 drawn up. Then his left upper and lower extremi- 

 ties respectively became affected in the same manner. 

 He remembered being asked what was the matter, 

 and that he could not speak, but screamed, and then 

 lost consciousness. The convulsive movements were 

 so energetic, that the patient was thrown from his bed 

 upon the floor; nevertheless, he was able to return to 

 work the same day. 



On Oct. 1, while delivering a parcel at the house 

 of a customer, he was seized with a slight rigidity, 

 followed by a short convulsive movement of the 



