a. AROHTE ST OCR WET J 
4f>0 
tolerant, and the drain of sloughing (within limits) less taxing to 
the economy at large. 
Cerebral hernia is never of immediate or early occurrence, as 
it would be if the claim set up by Nancrede and his supporters 
were true; it is invariably a secondary complication, and com¬ 
monly attendant upon suppurative and reparative processes. All 
support has frequently been removed from considerable areas of 
healthy brain, and without the slightest indication of falling, 
sinking or protrusion of the injured surfaces; aud in the case of 
the canine before alluded to, above all others, there should have 
been such collapsing of cerebral walls, yet the wound not only 
retained its original form and contour until healed, but the lost 
substance of the brain was replaced by act of granulation pre¬ 
cisely the same as with muscular tissue. Again, the hernia is 
often found protruding from small openings, giving evidence of 
considerable force behind, as in the case of the unfortunate 
wounded by a 22-100 bullet, and this force can only be a pow¬ 
erful effort on the part of nature to free the brain from impend¬ 
ing fatal pressure dependent upon inflammatory products; it is 
the 'pouting of the abscess in fact, and the merest tyro in pathology 
need not be told that compression would but illy compensate for 
the knife in furuncle or paronychia. Yet, without classifying 
causes, we are told that in this one, the most severe and fatal 
form of abscess, and where absorption positively cannot take 
place, the knife must be avoided, and compression alone re¬ 
sorted to ! 
It would seem to me, at least, that further hesitation or doubt 
as to the propriety of employing knife, aspirator, cautery or liga¬ 
ture, as occasion may suggest, for the removal of cerebral hernia 
that is already giving evidences of mischief, is most reprehensi¬ 
ble ; personally, I would not delay or await such manifestations. 
Witness the case of Doctor-’s* daughter, reported in the 
Journal of the American Medical Association during February 
of the current year, and the happy sequel to ligation of such a 
* The name has escaped me, and my copy of the Journal is not at the mo 
ment available. The account is of a large cerebral tnrnor remoyed by ligation* 
and occurs on page 150 of the Eighth Volume. 
