Richmond dispatch. [volume] (Richmond, Va.) 1884-1903, 1886-09-12
BRAIN SURGERY.
SUCCESSFUL TREATMENT OF THREE
PATIENTS WHO SUFFERED PROM
EPILEPTIC PITS.
The Precise Seat Of the Disease Heated
by Its Effect Upon Certain Muscles.
Localization.

and surgeon To the National Hospital
for the Psralyzed and Epileptic, in
Queen Square, Bloomsbury, exhibited
three patients treated in that hospital,
whose recovery may be said tn mark
the commencement of new era in sur
gerry. They are men who have been
suffering from severe epileptic fits, and
in whom Mr. Horsley has opened the
skull and has removed diseased struc-
ture or new growth from the brain
itself. A similar operation was
reported at the close Of 1884 froM
another institution, and it will be
remembered that correspondent who
sikned himself" IF. r. s." called atten-
ton to it in our columns at the time,
and claimed it as direct result of ex-
perimeDts performed on living animals.
The case, as regarded from this point Of
view, occasioned considerable contro-
versy; but, unfortunately, the publica-
ton was premature, for the patient died
when his recovery was thought to be
well assured. The fatal result was
attributed by his medical attendants to
cause independent Of the nature
Of the. orsration, and tha1
dib@hot discourage f1Nse at
tempts in the same direction. The
next opportunities for such attempts
were afforded at the National Hospital,
and advantage was at once taken Of
them. In the most recent Of the three
the operation was performed on the
18th of July, so that complete month
has since elapsed, and the patient was
sufficiently we'll to take the Journey to
Brighton, and to bear the fatigue Of
being exhibited to the large audience
attracted by Mr.. Horsley's paper. The
other two cases were operated upon,
one week or two and the other
several, weeks earlier and in none Of the
three has there been any symptom to
interfere with prompt and complete
recovery. So far, also, the men are
cured of their epilepsy, but considera-
BILE time must be permitted to elapse
before any claim for permanence Of re-
suit can be established. What is actu-
ally proved at present is that it has be-
come possible, by observation Of
symptoms, not only to determine the
fact of the existence Of some morbid
growth within the skull, but also to de-
termine its precise position with such
accuracy that it can be cut down upon
and removed. 1t is also proved that
the necessary operations can be per-
formed, by the aid Of certain precau-
tons, with a very small degree of risk
to life, and that considerable portions
of brain may be removed without in
jury, the functions to which these por-
lions are su0servient being performed
after a while, very possibly, by cor
responding parts of the opposite henis-
phere.
There has in former times been
good deal of what may be called BRAIN
surgery, but, as rule, it has been ac-
cidental rather than designed. Until
the occurrence Of the fatal case in 1884
it was not generally known, even in
the medical profession, that DR.. Mac.
Even, of Glasgow, had operated Sue
cessfully in an instance of somewhat
similar kind, besides having repeatedly
trephined, or opened the skull, with
good results. Many severe fractures
Of the skull have been followed by pro-
trusion and removal of even large por-
tons of brain substance, and in some
of these cases recovery has fol
lowed; while trephining has often
been performed for the relief Of cpl
lepsy which has distinctly followed upon
injury. In mono Of these cases, how
ever, has the removal OF brain substance
been designed as remedial measure;
and the trephining for epilepsy has been
last resource, usually undertaken in
the hope Of finding some depression OF
bone at the seat Of injury, the situation
of which, therefore, and not the symp-
toms Of the case, has determined the
locality of the operation. In two OF
Mr.. Horsley's patients there had been
injuries, and one Of them had been pre-
yiously trephined for the purpose Of
eleyating portions OF bone which were
depressed by fracture Of his skull so
! that in both of these the localization
was assisted by manifest external indi-
cations; but in the third there was no.
thing Of this kind, and the point at
which the skull should be opened was
determined solely by the fact that the
fits commenced in a particular group Of
museles--those, namely. which act upon
the left thumb. The physician in
charge of the case was able to say that
this manner Of commencement pointed
certainly to a continuing source Of IRA
tation near the surface Of the brain at a
definite spot and the surgeon having
opened the skull at the point indicated,
tumor was found imbeded in
the brain substance, and, to.
gether with portion of brain
surrounding it, was removed, so far
with absolute cessation Of the fits,
which were previously not only very
frequent, but, as might have been ex-
pected, were also increasing alike in
frequency and in severity, and were
such as to disable the patient from fol-
lowing any occupation, not to say that
they placed his life in constant jeopardy
from accident. Epileptics of this class
are not infrequently burnt or other
wise severely injured during their at
tacks, and can never be said to be in
safety when unattended. There are
two contingencies in relation to the
cases which render it impossible to
predict with certainty the permauence
OF the results obtained, and these
are First, that the scar which mast
form in or upon the brain-tissue may
possibly itself become a source of irri-
tation in timo; and secondly, that a
certain proportion Of brain tumors, as
of tumors in other parts of the body,
are Of nature to render recurrence
possible or probable. The likelihood Of
any difficulty arising from the first con-
tingency is greatly diminished by cir
cumstances to which We shall presently
advert and when all possible allowance
is made for failures incidental to the sec.
ond the cases must still remain as per-
IL