and thirty cases collected by Walshen, of which seventy-five were cured, eighteen improved, seven unimproved, thirty died. cites thirty cases operated on by Briggs, of which twenty-five were cured, three improved, one unimproved and one died.

Dr. C. F. McDonald also reports a case of insanity following gun shot wound of the skull involving the frontal lobe, the wound not having entirely closed. The hypodermic syringe was introduced into the wound and serous fluid was found, two drams of which were removed. The patient soon after entirely recovered from his insanity. The writer's conclusions from this case are, first, that lesions of the prefrontal lobes are not accompanied by any motor or sensory disturbance. Second, that when not in a state of inflammation the brain substance can be punctured without danger. Third, that the recovery in this case was directly due to the operation. Fourth, that the prognosis in cases of traumatic insanity is not necessarily bad if surgical interference is allowed.

CASTRATION IN NERVOUS DISEASES.

The American Journal for October 1886, contains articles by Spencer Wells, Alfred Hegar and Robert Batty on this subject. Spencer Wells consideres that in some forms of uterine disease the operation is advisable, but for the cure of nervous disease he condemns its use except in rare cases. His conclusions are as fol· lows: First, the operation for the removal of the ovaries is advisable in some cases of uterine fibroids and in uncontrollable uterine hemmorrhage. Second, that it may be resorted to in certain malformations of the pelvic organs. Third, that the right to use it is limited in cases of ovarian dysmenorrhoea or neuralgia and only then when they have resisted all treatment, and life and reason are endangered. Fourth, that in nearly all cases of nervous excitement and insanity the operation is inadmissable. Fifth, that it should never be done withont the consent of the sane person to whom its consequences have been explained. Sixth, that the excision of the morbid ovaries should be distinguished from oophorectomy and ought not to be done without authority and only after consultation as in most other cases of abdominal section. Seventh, that in nymphomania and mental diseases it is, to say the least, unjus tifiable. Dr. Hegar concludes that castration is indicated in all cases of mental disorder that are induced or maintained by morbid

condition of the sexual organs.

Dr. Batty says:

"Within my knowl

edge it has not been the practice of American surgeons to attempt the cure of mental or nervous diseases by the removal of healthy ovaries or tubes. The ovaries removed, and tubes as well, have presented visible signs of disease-signs which are evident to the naked eye and palpable to the sense of touch. For the misconception on this point still existing, my own ignorance of the histology and pathology of the ovaries is largely responsible, in that, during the early history of the operation I removed ovaries which I erroneously supposed to be healthy, and gave to the operation the unfortu nate and now obsolete name of normal ovariotomy. The operations now under consideration have been done for the relief of mental and nervous disorders, and may be divided into three classes: First, those for hysteromania; second, those for hysteroepilepsy; third, those for ovarian neuralgia. The time required for the disappearance of the nervous disorders after the operation, is variable. Epileptic seizures have usually ceased at once." His cases of mania have all been chronic and the improvement slow. Ovarian neuralgia has in a few instances been immediately and permanently cured; in a majority of cases recovery has been slow. He reports thirty-six cases which were operated on two years ago or more. Of these twentythree recovered, seven were improved, six were unimproved.

BRAIN PHYSIOLOGY.

Prof. Hitzig, at a meeting held in Baden in 1883, stated that he had performed further experiments in relation to the localization of cerebral functions. He stated that from the centres in the brain proceed motor and sensory, and perhaps other fibres, and that it is the motor fibres that are affected by the electric stimulus "I still hold," he says, “that the centres discovered by me are nothing else than gathering places," whatever he may mean by this; and he says he applies this theory to the other centres since discovered. He opposed Munk's view that no special organ is needed for the higher intellectual faculties. "It is true," he says, "that intelligence exists in all parts of the cortex, or rather, in all parts of the brain, but I hold that abstract thought needs a separate organ and seek for it in the frontal lobe." At the medical congress at Baden in 1885 Dr. Gudden reported experiments which he had performed bearing upon localization of cerebral functions. These experiments consisted in

the removal of motor and sensory centres, and his results were practically negative. The only centre of which he is disposed to admit the existence is the centre for the faculty of speech. At the congress of scientific men and physicians held at Strassburg in 1885 Goltz reported the results of experiments which he had performed on the brains of dogs. His results were largely negative. The most thorough and apparently reliable investigations in cerebral physiology are those of Dr. Ferrier, and I will recapitulate briefly the conclusions which are the result of his most recent work. In regard to the cerebellum he says that it is a complex arrangement of individually differentiated centres, the associated action of which regulate the muscular adjustments that serve to maintain bodily equilibrium. He holds that the mechanism of the cerebellar co-ordination is essentially independent of consciousness and volition. Every form of active muscular exertion necessitates the co-operation of an immense assemblage of muscles throughout the body to secure steadiness and to maintain the general equilibrium. On the hypothesis that the cerebellum is the centre of these unconscious adjustments we should expect it to be developed in proportion to the motor activities of which the animal is capable. The facts of comparative anatomy and development are entirely in harmony with this hypothesis. In reptiles and in the amphibia, whose movements are of the simplest order, the cerebellum is of the most rudimentary character, while in mammals it is richly laminated and the lateral lobes are highly developed in proportion to the motor capabilities represented in the cerebral hemispheres. He rejects the hypothesis advocated by Weir, Mitchell and Luys that the cerebellum is a reservoir of energy for the reinforcement of the movements throughout the body. He holds that the functions of the cerebellum are outside the sphere of mind proper and that it is not immediately concerned with the men. tal functions.

CEREBRUM.

In regard to the motor centres the views of Ferrier are in substantial agreement with other investigators, or at least with those investigators who believe in any cortical localization. The motor convolutions are those that bound the fissures of Rolando, viz., the ascending frontal, the superior parietal lobe, the ascending pari etal and the medial aspect of these on the inner side of the hemisphere, viz., the paracentral lobule and precuneus. The leg is chiefly

represented in the upper third of this region, the arms in the middle third, and the face, lips and tongue in the lower third. Ferrier locates hearing in the first temporal convolution and the sense of smell in the hippocampal lobule. Common sensibility he finds resides in the falciform lobe. He says the effects of destruction of the falciform lobe are exactly like those observed in hemi-anesthesia of cerebral origin in all that relates to common sensibility. For here also there is an analgesia or an anesthesia, not only of the skin but of the cutaneo-mucus membranes, together with the loss of the so-called muscular sense. The falciform lobe, therefore, is the cortical centre of those fibres of the internal capsule, destruction of which is the cause of hemi-anaesthesia of organic origin. In regard to the function of sight, Ferrier's earlier investigations led him to believe that this function was located in the angular gyrus Later investigations have led him to conclude that the centre for this function is located in the angular gyrus and the occipital lobe. As the centre for sight is in immediate relation physiologically with the speech centre, it will be interesting to notice the results of recent investigations in regard to the localization of the faculty of speech. The first attempt to locate the speech centre was made by Broca, who, from his own investigations, concluded it was located in the third left frontal convolution. Subsequent investigators found, however, that certain forms of aphasia were produced by disease of other convolutions than the third left frontal. The investigations of Ferrier and others have apparently established the following, in relation to the speech centre: The third left frontal convolution is the centre for the memory of the muscular co-ordination of speech, or in other words, it is the motor speech centre. The memories of spoken words, or for those ideas that are derived through the sense of hearing, depend upon the activity of the first temporal convolution. The angular gyrus and the occipital convolution form the centre for all those ideas that originate through the sense of sight. Destruction of the third left convolution causes motor aphasia; destruction of the first temporal, causes auditory aphasia or word deafness; destruction of the angular gyrus or occipital convolution, causes that form of aphasia known as word-blindness, that is, an inability to express ideas that depend upon the sense of sight. In regard to the functions of the corpora striata and optic thalami, Ferrier says that the results of lesions of these centres, provided the fibres of the

internal capsule are not directly or indirectly injured, lead to the conclusion that neither voluntary motion or sensation is permanently impaired or abolished. He says that the corpora striata are the centres for those movements that are differentiated in the cerebral cortex, but are of a lower grade of specialization. The innervation of the limbs and all that relates to their employment as instruments of consciously discriminated acts is dependent upon the cortical centres, while for all other purposes involving more strength or automatism, the corpora striata are sufficient. In man almost every movement has to be laboriously acquired by conscious effort through the agency of the cortical centres. Hence the destruction of the corpora striata adds little if anything to the completeness of the paralysis that results from destruction of the cortical centres alone. In regard to the optic thalamus, he says it appears to be related to the function of sensation.

Bianchi has also extripated the motor zone of the cortex in newborn dogs, and has observed the results after one or two years. The symptoms produced in all cases were permanent changes in the power of the limbs opposite to the hemisphere operated on; there was also disturbance of sight, but no change of mental functions. The disorder of motion was a true paresis with some contracture. Voluntary motion was lost, automatic movements were impaired. Examination of the brain showed the original injury to have been limited to the gray cortical layers. A degenerative atrophy was traceable through the internal capsule, the crus, the pons and in the opposite lateral column of the chord, and there was some atrophy in the corpus callosum. The conclusions reached by these experiments were: First; Since the fibres beneath the cortex were not injured, the degeneration of the tract must have been due to the cortical lesion. Second; Since the degeneration started in the cortex, the cortex and the affected fibres must be considered as a functional unit. Third; The corpus striatum is intimately connected with the motor zone. Fourth; If the pyramidal tract is motor, its centre of origin must also be motor. Fifth; The motor area of the cortex is not only a motor centre for the highest evolved movements, but is also the source whence all motions issue, since walking, running, jumping, are all imperfectly performed after its extirpation. Sixth; Dogs whose motor cortex only is removed preserve the same instincts as normal dogs; they are intelligent, faithful and playful, and can prop