the outside of the skull this A-shaped convolution (Fig. 6, shaded area), known as the "angular gyrus," and found, on removing a button of bone, that a portion of the inner layer of the bone had become detached and was pressing on the brain, one corner of it being embedded in the brain substance. The button of bone was removed from the brain, and, after removing the splinter, was replaced in its proper position. The man got well, and, although still excitable, lost entirely his homicidal tendencies and returned to work.

Case VII. Epilepsy.—If I were to gather together the operations which have been done for epilepsy since we have been able to locate the centres, especially for motion, I should perhaps have to record 150 cases or more. The great majority of these patients have recovered from the operation, or, in surgical parlance, have made an "operative recovery," but in a very large proportion the disease has returned, generally, however, with a lessened intensity. In a small proportion recovery has taken place from the disease itself. But it is evident that as cerebral surgery covers practically only the last eight or ten years, it is much too early to formulate definitely a statement of what the results may be when a longer time has elapsed.

In the "American Journal of the Medical Sciences" for December, 1891, Dr. Charles K. Mills, of Philadelphia, has reported the case of a young lady twenty-seven years of age, who suffered for some time from numbness and a sense of weight in the left hand, arm, and foot. After about five years these attacks developed into distinct epileptic fits, and had become extremely frequent at the time when Dr. Mills first saw her, in November, 1890. The attacks occurred both in the daytime and at night, and were as frequent as ten to fifteen in the twenty-four hours. Dr. Mills himself often saw them. The left arm was first raised, the motion beginning in the shoulder and including also the elbow. From this the attack extended over the entire body. On the out

side of the head, after it had been shaved, absolutely nothing was found which could be a guide to the site of the trouble. The diagnosis was some source of irritation the character of which was unknown, but which was located on or in the centre for the left shoulder. Accordingly the fissure of Rolando was mapped out on the shaven head, and a button of bone an inch and a half in diameter was removed, the centre of which was an inch and three-quarters to the right of the middle line. Fig. 7 shows the button of bone, the inner surface being uppermost. The bone was very thick, from five

Fig. 7.-The button of bone removed in Case VII. The pits in the bone were produced by the tumor. They were almost precisely in the centre of the button, and thus show how exactly the tumor was located. (Mills.)

to seven-sixteenths of an inch, and was also very dense. As soon as the bone was removed, a small tumor resembling in shape a minute bunch of grapes was found, the apex of the tumor being within one-sixteenth of an inch of the point where it was believed to exist. By its pressure it had produced several pits on the inner surface of the bone, and these holes, as well as the groove for a large blood-vessel which supplied the tumor with blood, are well shown in the middle of the button. The tumor, with the membrane of the brain to which it was attached, was removed, and the battery was then applied to the brain immediately underneath it. Fig. 8 shows the fissure of Rolando as a line running downward and forward across the circle. The circle represents the button of bone removed, and the numbers 1 to 4 represent the points at which the poles of the battery were applied to the brain. On stimulating the brain at the point marked 1, movements of the arm at the shoulder and elbow were reproduced; and

again at point 2 precisely the movements of her attacks followed. This point was the portion of the brain pressed upon by the tumor. Along with the movements of the shoulder at point 1 the elbow was involved, and at point 2 it was found that the hip and knee were both flexed, and the entire leg carried away from its fellow, the toes and foot being extended. It was very evident, then, that point 1 corresponded to the shoulder and elbow centres, and point 2 corresponded to the upper edge of the shoulder centre and also to the edge of the leg centre. Excitation at point 3 was followed by more de

Fig. 8.-The brain in Case VII. The circle shows where the button of bone was removed, and the growth found almost exactly at the centre of the button. (Mills.)

cided movements of the lower arm, and at point 4 the leg alone moved, the shoulder not being involved.

Could any better illustration be found of the accuracy of localization? The leg centre here, when compared with the leg centre in Fig. 1 of the monkey's brain, is found exactly where it ought to be, the arm centre directly below it, with the shoulder, elbow, wrist, and hand movements precisely in the same relative positions as in the monkey's brain. Unfortunately the lady has not been cured. But the fits have been greatly moderated, so that when the case was reported,

nearly a year after the operation, she had usually only about three attacks in the twenty-four hours instead of ten or fifteen, and the attacks had never attained the same severity as before the operation. Moreover, after the operation, in about half the attacks she did not lose consciousness, and so was far less exposed to the danger of falling down stairs, into the fire, and other similar perils to which epilepsy with unconsciousness exposes a patient.

Case VIII.-Another case, which is fortunately more favorable in its result, is published in the "Medical News" of April 12, 1890. A little boy, six and a half years old, at the age of fourteen months fell about ten or twelve feet from a hay-mow upon a plank flooring. He was unconscious for some time. No decisive evidence of injury could be found either on his head or other parts of his body, but from his prolonged unconsciousness it was presumed that he had struck his head. Soon after this accident his disposition changed materially for the worse. He became irritable, obstinate, and ill tempered, and very frequently kicked, bit, and scratched, and offered other violence to his playmates. His room had to be padded, his clothes had to be sewed on him every morning, and he would kill any small animals, such as cats or chickens, that came in his way. When two and a half years old his first epileptic fit occurred. He had from three to six attacks a day, with some intervals of comparative freedom. His father, an intelligent clergyman, estimated that in the four years since his epilepsy began he had had over five thousand fits! Of these, about eighty per cent. began in the right hand. The attacks were observed with great care in the Jefferson Medical College Hospital by a special nurse, and the statement of his father that they usually began in the right hand was verified. When the attacks began the child had a vocabulary of about forty words, but gradually these were reduced, word by word, until his speech consisted only of three words and a little jargon, the words being "papa,"

"mamma," and, characteristically "no," rather than "yes." Examination of the head revealed nothing that could locate any injury; but as the attacks began so constantly in the right hand, it was resolved to remove the centre for this part of the body, in the hope that if the fits were prevented at their initial spot they would not begin elsewhere. The fissure of Rolando was first located, then the position of the hand centre was marked, and a disk of bone an inch and a half in diameter was removed. The membranes of the brain were then opened, and the brain itself exposed. Nothing abnormal was perceptible either by eye or by touch. The battery was applied to the portion of the brain exposed, producing movements of the hand, showing that the centre had been correctly mapped from the outside of the skull. Excitation of the brain further upwards produced elbow movements (elbow centre). These centres were therefore exactly where they ought to lie, as shown in the monkey's brain (Fig. 1). The portion of the brain that moved the hand was then removed, and when the battery was applied to the parts around it, it was found that all the centre for the hand and wrist had been removed.

The boy made a speedy recovery from the operation. Three years have now elapsed since the operation. Most of the time he has been and still is in Misses Bancroft and Cox's School for Feeble-minded Children, at Haddonfield, New Jersey. He has had there very painstaking care, and to this is to be attributed very much of his mental improvement. During the last six months of 1892 he has had only one attack for about every sixty before the operation. This improvement can be attributed only to the good effects of the operation.

Case IX.-The third and last case to which I shall refer has not been published, but can be found in the records of the Orthopaedic Hospital and Infirmary for Nervous Diseases in Philadelphia, Record Book S. 9, p. 123. A young girl of about