Brain surgery . her on May 15th, 1891. A piece of bone,about two inches in diameter, was removed from the skullover the lower part of the motor area and Brocas convo-lution, and this opening was then enlarged upward andbackward. There was no bulging of the dura and noevidence of increased cranial pressure. When the durawas divided the cortex of the posterior part of the thirdand second frontal convolutions and the lower half of theanterior central convolution were exposed to view andrecognized. No clot was found, no evidence of meningi- TREPHINING FOR IMBECILITY. 145 tis, and the brain present
Brain surgery . her on May 15th, 1891. A piece of bone,about two inches in diameter, was removed from the skullover the lower part of the motor area and Brocas convo-lution, and this opening was then enlarged upward andbackward. There was no bulging of the dura and noevidence of increased cranial pressure. When the durawas divided the cortex of the posterior part of the thirdand second frontal convolutions and the lower half of theanterior central convolution were exposed to view andrecognized. No clot was found, no evidence of meningi- TREPHINING FOR IMBECILITY. 145 tis, and the brain presented a normal appearance. Thewound was therefore closed, the bone being left out, andit healed promptly without any complication. For sixweeks after the operation no change was apparent in thecondition, and the fits continued as before, from six totwenty daily. Then a marked improvement began. Atpresent, sixteen months after the operation, the child talksfreely, names objects at once, can answer simple questions,. Fig. 45.—Diagram of the Opening in the Skull in Case XV. and sing childrens songs. The hemiplegia has disap-peared entirely, but effort with the left hand producesassociated motions in the right hand. All rotary move-ments of the head have ceased. Sensation seems keen inthe right hand. There seems to be traces of right hemi-anopsia, but she is watchful of tests, though too stupid togive any accurate replies. She has been taught to keepherself clean, and is certainly more observant and obedientthan formerly, though still imbecile. She is still having10 146 BRAIN SURGERY. fits, about six daily. They do not yield to bromide or tochloral. I am wholly unable to explain the very markedimprovement which has followed the operation, especiallyas there was nothing accomplished by it at the time inthe relief of local disease or of general pressure. In both cases it is interesting to observe that no grossdefect of brain substance, no marked atrophy was discov-ered, and if lesions
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