Organic and functional nervous diseases; a text-book of neurology . nd ankle clonus, were easily produced. He controlled hissphincters perfectly. There were no scars upon the head. It seemed probable that, as a result of the fall, there had been arupture of a small vessel from which very slow hemorrhage had takenplace; the vessel was thought to be a vein rather than an artery, MENINGEAL HEMORRHAGE. 711 because of the very slow development of the symptoms. The situa-tion of theclot was thought to be upon the surface and not within theleft hemisphere, and it was located upon the posterior part o
Organic and functional nervous diseases; a text-book of neurology . nd ankle clonus, were easily produced. He controlled hissphincters perfectly. There were no scars upon the head. It seemed probable that, as a result of the fall, there had been arupture of a small vessel from which very slow hemorrhage had takenplace; the vessel was thought to be a vein rather than an artery, MENINGEAL HEMORRHAGE. 711 because of the very slow development of the symptoms. The situa-tion of theclot was thought to be upon the surface and not within theleft hemisphere, and it was located upon the posterior part of the thirdfrontal convolution and over the anterior central convolution in itsmiddle third, as shown in the diagram. A flat clot in such a situationmight fail to compress the face area and could produce an absolutelytotal motor aphasia, while a subcortical or capsular clot could hardlyproduce total permanent motor aphasia and paralysis of the arm with-out producing paralysis of the face and tongue. On the strength ofthis diagnosis it was thought best to Meningeal hemorrhage. The situation of the clots causing aphasia and right resulted in recovery. (Starr and McBurney.) On December 13, 1889, McBurney trephined the skull. The tre-phine was applied at a point one and seven-eighths inches behind, andseven-eighths of an inch above the external angular process of thefrontal bone, and the opening was then enlarged by the rongeurforceps upward and backward, the dura being laid bare over an ovalarea three by two inches. The dura did not pulsate. On opening thedura the pia was found to be very oedematous and discolored, and thesurface of the brain was separated from the dura by a space half aninch in depth, and did not pulsate. The clot was seen lying beneaththe pia upon the posterior part of the third frontal convolution andextending over the anterior central convolution in a thin layer (markedin lines on the diagram) into the fissure of Rolando, which was
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