Brain surgery . s, and has always been slow in his speech and men-tally dull. For several years subsequently to the fall he wassubject to slight attacks of the nature of petit mal; two yearsago he had his first attack of grand mal, and since that timehas had several recurrences. The fits begin by twitch-ing of the eyes and head, the right side being alwaj^smore affected than the left side in the convulsion; andhe loses consciousness. He was examined by me on the 22d of November, condition of right hemiparesis with athetosis of the TREPHINING FOR EPILEPSY. 39 right hand was found, the pa
Brain surgery . s, and has always been slow in his speech and men-tally dull. For several years subsequently to the fall he wassubject to slight attacks of the nature of petit mal; two yearsago he had his first attack of grand mal, and since that timehas had several recurrences. The fits begin by twitch-ing of the eyes and head, the right side being alwaj^smore affected than the left side in the convulsion; andhe loses consciousness. He was examined by me on the 22d of November, condition of right hemiparesis with athetosis of the TREPHINING FOR EPILEPSY. 39 right hand was found, the paralysis being greater in thehand than in the face or leg. Mentally he was very defi-cient, being able to read but little and being very dull andstupid; his speech was slow but he was not aphasic; therewas no affection of sensation in the paralyzed limbs. The diagnosis was made of a traumatic hemorrhage ora cyst in the cortex of the brain in the motor zone affect-ing especially the arm area. Trephining was recom-. Fig. 16.—The Situation of the Opening made in the Skull in Case V. mended with a view of removing the clot or the cystwhich was considered the cause of the symptoms. On December 2d, 1892, he was trephined by Dr. McBur-ney at Roosevelt Hospital, an opening of one and one-halfinches in diameter being made over the arm area (Fig. 10).The bone and the dura appeared to be normal. On exposingthe brain the fissure of Rolando was seen crossing theopening; the cortex appeared to be normal, but palpationindicated a collection of fluid beneath, and puncture with 40 BRAIN SURGERY. a hypodermic needle resulted in the evacuation of about adrachm of clear serous fluid from a cavity three-fourths ofan inch below the cortex. Incision through the summit ofthe anterior central convolution gave entrance to this cav-ity, and an attempt to drain it was made by inserting asmall bit of rubber tissue. The dura was replaced but notstitched and the scalp was left open over the part of brainexp
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