FISSURE OF twenty-one was admitted to the infirmary in October, 1891. She said that her attacks of epilepsy, from which she had suffered for two years and a half, always began in the right thumb. This fact having been verified, it was decided to remove the centre for the thumb, for the same reason as in the last case,―i. e., to stop the very beginning of the fit. It was especially desired to remove only the centre for the thumb, and not that for the hand, in order not to interfere more than was necessary with the usefulness of her hand, upon which she depended for her support, as she was a mill girl. This was an unusual and minute attempt at localization, and a very severe test of the accuracy of the mapping of the brain by vivisection. On October 6, 1891, the fissure of Rolando was first located, and a disk of bone an inch and a half in diameter was removed, the centre of it being two and five-eighths inches to the left of the middle line. Both the bone and the brain, when exposed, seemed to be normal. The fissure of Rolando was seen crossing the middle of the opening, downwards and forwards (Fig. 9). By the battery the brain was stimulated at certain definite points until the thumb centre was recognized, and also the face centre, which lay somewhat below it, and the wrist centre, which lay THUMB Fig. 9. The circle represents the opening in the skull disclosing the thumb centre almost at its middle. The shaded area represents the part of the brain which was removed. -as shown by experiments on the monkey's brain—a little above it. Each of these centres was recognized by the movement of the part supplied by it (thumb, face, wrist) when the centre was touched by the poles of the battery. Stimulation of the thumb centre produced a typical epileptic fit, such as she had suffered since her admission, beginning in the thumb, as she had asserted. The portion of brain corresponding to the thumb centre, a piece about half an inch in diameter, was removed, and by the battery it was determined that the portion removed was the whole of the thumb centre. She recovered promptly and without disturbance from the operation. It was necessary in this case to be unusually accurate, and not to remove any portion of the brain other than the centre for the thumb, and for three reasons: First, if too much were removed upwards and backwards, the wrist and fingers would be paralyzed; second, if too much were removed forwards, the muscles of the face would be involved; third, a little further down lies the centre for speech, and had this part of the brain been injured, this important faculty would have been destroyed, thus producing serious and unnecessary trouble. Note now the accuracy of experimental cerebral localization. As soon as the patient had recovered from the ether and was in a suitable condition, her ability to move the face and hand was tested. All the muscles of the face were entirely intact, and could be moved with absolute ease. Her speech also was unaffected. She had absolute and perfect control of all the muscles of the shoulder, elbow, wrist, and hand, with the single exception of the muscles of the thumb, every one of which was paralyzed. In order to understand how curious this paralysis is in relation to the thumb centre in the brain, the reader must observe that only a small piece of the brain, half an inch square, was removed, whereas the muscles of the thumb lie as follows: some of them in the ball of the thumb on the hand, one between the thumb and forefinger, one on the front of the forearm reaching almost to the elbow (the great flexor of the last joint of the thumb), and three of them on the back of the forearm, extending halfway from the wrist to the elbow; and yet the removal of so small a portion of the brain paralyzed these muscles of both widely different situation and widely differing functions (flexion, extension, abduction, adduction, and circumduction). By June, 1892, she had entirely recovered the strength of her thumb, as shown by the dynamometer, both sides then registering the same number of degrees. This history illustrates one of the most curious problems of cerebral surgery. The removal of any portion of the motor region of the brain is, of course, followed by palsy of the part of the body supplied by that brain centre; but though I have frequently removed portions of the brain, I have never yet seen this paralysis permanent. I have seen a right hand. wholly paralyzed after such an operation, and in three months it had regained its strength and dexterity sufficiently to enable its owner to play baseball. But while this is true of the careful removal of small parts of the brain by operation, the wide-spread injuries which result from accident are not seldom followed by extensive palsies which remain throughout life. In the case just related not only has strength returned equally, but such delicate movements as are involved in the use of a needle have been preserved, or rather restored. Usually, however, weakness, to a greater or less extent, will remain in the part of the body controlled by the portion of brain removed. Whether there is actual reproduction of brain tissue or not is as yet uncertain, because after such operations there have been almost no deaths at a period sufficiently remote to enable us by post-mortem examination to determine whether such a reproduction has occurred or not. It is possible that the similar centre on the opposite side of the head is capable of doing double duty; for although normally the right side of the brain controls and moves the left side of the body, and vice versa, yet apparently there is a latent power which when necessary is called into play, and enables the right side of the brain to innervate and control the same side of the body as well as the opposite side, just as, for instance, the left hand, which is unused to writing, can acquire the faculty of writing if the right hand loses it. There has also been performed a very remarkable operation on animals which may hereafter produce important results. Several experimenters have opened the heads of two dogs (both under an anesthetic, and both as carefully and as tenderly cared for as any human being could be, the operations being attended with but little pain,* as they were done with the most careful antiseptic precautions), have taken a bit of the brain from the head of each dog and transferred it to that of the other dog. The pieces so transferred have grown in place, and have caused at least no mischief. Whether it will ever be possible to transfer brain tissue from the lower animals to man, and whether if so transferred it will properly perform its function, are problems as yet unsolved. It would be, I think, unwise to test its effects in man except as applied only to the motor regions at first, for we have every reason to believe that the motor cells in an animal's brain subserve precisely the same function as the motor cells in the human brain. Moreover, nothing of this kind would ever be done excepting perhaps in case of an accident where a considerable portion of the human brain was destroyed, when possibly this loss could be made good from an animal's brain. It is unnecessary, however, to discuss this question at present, for all the facts in the case, the needful precautions to be taken, and all the possible results, must first be determined in much greater detail and by much larger experimentation on animals than has yet been done before it will ever be considered in man. But it is not at all impossible that in this way we may see hereafter one of the most brilliant achievements of modern cerebral surgery. * Most operations on the brain are followed by very little pain, and sometimes it may truthfully be said by none. It is not an uncommon result for the patient to take no medicine, or at most a single small dose of an anodyne on the first day, be out of bed in three to five days, and entirely well in a week or ten days. But we must return again to our last patient, for her subsequent history as to her epilepsy is quite as interesting as, and to her no doubt even more important than, the condition of her thumb. On December 17, 1891, seven weeks after the operation, she had one slight attack. January 13 and 30, 1892, there were two; then she had none until March 12th; another very slight one came on May 19th; and the last to date were two on July 8th (a slight one) and 10th, making in all seven attacks in eight months. The intervals, therefore, were growing longer, and the attacks, as a rule, were less severe, while before the operation the attacks were growing more severe and far more frequent, for at the time she entered the infirmary they were tending to become daily.* The antivivisectionists constantly parade the few physicians who are in accord with their views, and by frequent reappearances make an apparent army upon the stage. As a matter of fact, Mr. Lawson Tait is the only one who has an international reputation; the rest are but little known. Even Mr. Tait recently changed his views, and in a speech in favor of the objects of the British Institute of Preventive Medicine, which are largely attained through vivisection, has declared that “bacteriological experiments on animals had proved of great value." What the real opinion of the medical profession of Great Britain is as to the value of vivisection is seen by the following resolution, which was passed in August, 1892, at the Nottingham meeting of the British Medical Association, and passed unanimously. The weight of such an authority can be best measured when I state that it is the largest and most important association of physicians in the world, and numbers over 15,000 members, including most of the distinguished men of the profession in Great Britain. *Since this was written her attacks have become somewhat more frequent, but are still far less frequent and severe than before the operation. |
