Page:Popular Science Monthly Volume 74.djvu/567

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563
CEREBRAL SURGERY WITHOUT ANESTHETICS

tacks already described. For three months early in the year 1903, the headaches were particularly intense, and this period of intense pain in the head ushered in a period of definite occular symptoms, consisting of momentary attacks of blindness, followed by diplopia for two or three days. The headaches suddenly disappeared, but there was permanent loss of visual acuity, weakness of the left leg, and general nervousness.

At the time the patient entered the hospital, careful examination of the nervous condition gave the following results: The optic nerves seemed atrophied and there was some constriction of the visual fields. There was distinct hemiplegic limp on the left side, a slight weakness in the dorsal flexion of the left ankle, and possibly also in the flexion of the knee and hip. The reflexes of the left leg were also somewhat exaggerated. On the contrary, sensation seemed to be normal over the arm and hand. The deep reflexes in the arms and right leg were normal. The sensibility of the right leg and foot were without discoverable abnormality.

The conclusion of the diagnosis made at this time affirms: "It was evident that the patient was suffering from an organic lesion situated in the upper part of the Rolandic region, involving the cortex itself or lying just below it."

Four different operations were performed for relief of this patient, between the dates of November 22, 1906 and March 21, 1907. These were all unsuccessful and did not even reveal the cause of the malady, and this unfavorable result was chiefly due to the fact that the patient bore anesthetics—both chloroform and ether—so badly and the cyanosis was so profound and threatening as to compel the surgeons to abandon their attempts at further exploration of the brain, lest it might lead to a fatal result. Moreover these operations served to show that the exposed surface of the brain was entirely normal in appearance; and when this part of the cortex was faradized, there was no abnormality of motor response. "Clean-cut movements were elicited in the toes, lower leg and thigh." In the same way movements were also obtained in the thoracic muscles, in the lateral abdominal muscles and in the muscles of the shoulder; and from still lower centers were obtained flexion of the elbow and flexion of the wrist. Posterior to the central fissures no motor responses could be elicited.

Following the third operation, or on and after December 23, 1906, the seizures increased in severity. Aggravated by the weakness following an attack of bronchial pneumonia in January, 1907, the nervous symptoms increased to one or more daily, consisting of severe epileptiform fits which involved the entire body, and always with loss of consciousness.