| SUGGESTIONS FROM TWO CASES OF CEREBRAL SURGERY WITHOUT ANESTHETICS |
By Professor GEORGE TRUMBULL LADD
YALE UNIVERSITY
FOR the first time, so far as I am aware, there have been placed on record two cases of cerebral surgery, accompanied by somewhat extensive explorations of the brain-substance, without the use of anesthetics. The suggestions afforded, and the problems further opened, by these cases are so interesting from the psychological point of view that it seems to be desirable at least to call to them the attention of this association. Only one of these cases has as yet been reported in print;[1] for some of the facts connected with the other case I am indebted to correspondence with the operating surgeon, Dr. Harvey Cushing, of Johns Hopkins University.
Briefly described, the case of which we have the fullest report was as follows. The patient, R. C, was 32 years of age, unmarried, a farmer and teacher, a man quite up to the average of his class in intelligence, and of excellent moral habits. Previous to the beginning of his present trouble he had been in excellent health. When nine years of age he received a slight blow on the head; later, he received a blow from a baseball bat which fractured his nose. No other causes of possible cerebral injury were discoverable. About the year 1895 he began "to suffer from curious nervous attacks, which came on without cause." These consisted of strange sensations in the head, and twitchings of the left calf. But there was no loss of consciousness and the seizures lasted only a few minutes. With these symptoms there subsequently became associated tingling sensations, which sometimes spread up the left leg even to the thorax and the left arm, and more extensive twitching of the muscles, spreading itself in the same direction. These seizures were followed by numbness in the parts involved; but until July, 1900, there were no fits with complete loss of consciousness; and at the time of the first operation loss of consciousness had occurred only six times, although during the ten years previous there had been several hundred seizures.
The patient had, however, been subject to headaches from childhood, and these became more and more severe after the nervous at-
- ↑ "Removal of a Subcortical Cystic Tumor at a Second-stage Operation without Anesthesia" (reprinted from the Journal of the American Medical Association, March 14, 1908, Vol. I., pp. 47-856).
