The Kimball graphic. (Kimball, Brule County, Dakota [S.D.]) 1883-1905, 1886-11-19
BRAIN SURGERY.
Successful Treatment Of Three
Patients Who Suffered from
Epileptic Fits.
Che Precise Seat Of the Disease Indicated
by Its Eject Upon Certain
Muscles.

40uoOAOos
At the meeting on Friday last of the
British Medical association at Brighton,
says The London Times of Aug. II,
Mr.. Victor Horsley, F. r. S., professor
superintendent of the Brown institu-
ton, and surgeon to the National Hos
pital for the Paralyzed and Epileptc,
in Queen square, Bloomsbury, exhibit
ed three patients treated in that hos
pital, whose recovery may be said to
mark the commencement of a new era
in surgery. They are men who have
been suffering from severe epileptic
fits, and in whom Mr.. Horsley has open
ed the skull, and has removed diseased
structure or new growth from the brain
itself. Asimilar operation was report
ed at the close of 1884 from another in
stitution, and it will be remembered
that correspondent who signed him
self ''F. r. S." called attention to it in
our columns at the time, and claimed it as
a direct result of experiments perform
ed on living animals. The case, as re-
garded from this point of view, occa-
stoned considerable controversy; but,
unfortunately, the publication was pre-
mature, for the patient died when his
recovery was thought to be we'll assur-
ed. The fatal result was attributed by
his medical attendants to cause in
dependent of the nature of the opera
ton, and therefore did not discour-
age future attempts in the same direc-
ton. 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 pa
tient was sufficiently well 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 ope-
rated upon, one aweek 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 consider
able time must be permitted to elapse
before any claim for permanence of re-
suit can be established. What is act
ually proven at present is that it has
become possible, by observation OF
symptoms, not only to determine the
fact of the existence of some morbid
growth within the skull, but also to
determine 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 performed,
by the aid of certain precautions,
with very small degree of risk of life,
and that considerable portions of brain
may be removed without injury, the
functions to which these portions are
subservient being performed after a
while. very possible, by the cores
ponding parts of the opposite hemis-
phere.
There has in former times been q
good deal of what may be called brain
surgery, but as rule it has been acci-
dental rather than designed. Until the
occurrence of the fatal case in 1884 il
was not generally known, even in the
medical profession, that DIR. MacEwen,
of Glasgow, had operated successfully
in an instance of somewhat similar
kind, besides having repeatedly tire.
pinned, or opened the skull. with good
results. Many severe fractures Of the
skull have been followed by protrusion
and removal of even large portions Of
brain substance, and in some of these
cases recovery has followed; while tire,
phining has often been performed for
the relief of epilepsy which has distinct
ly followed upon injury. In none o.
| of brain substance been designed as 8
remedial measure; and the trephinine
for epilepsy has been last resource
usually undertaken in the hope of find
ing some depression of bone at the sea,
| of injury, the situation of which. there
fore, and not the symptoms of the case
determined the locality of the operation
In two of Mr.. Horsley's patients there
had been injuries, and one of them hae
been previously trephined for the pur
pose OF elevating portions of bon,
which were depressed by fracture of thu
skull; SO that in both of these the local
ization was assisted by manifest exter
nal indication; but in the third ther,
was nothing of this kind, and the poin
at which the skull should be opene,
was determined solely by the fact tina
the fits commenced in particula
group of fmuscles-thos namely. whicl
act upon the left thumb. The physi
clan in charge of the case was able Il
say that this manner of commencement
pointed certainly to the presence of
continuing source of irritation near tn
surface of the brain at a definite spot
and. the surgeon having opene,
the skull at the point indicated,
tumor was found imbeded in th
brain substance, and, together with
portion of brain surrounding it, was re
moved, go far with absolute cessatio
of the fits, which were previously nc
only very frequent, but, as might hav
been expected, were also increasin
alike in frequency and in severity. an
were such as to disable the patien
;. from following any occupation, not
, say that they placed his life in constar
jeopardy from accident. Epileptics {
i. this class are not frequently burnt {
T otherwise severly injured during the
attacks, and can never be said to be
4 safety when unattended. There al
t two contingencies in relation to til
: cases which render it impossible
predict with certainty the permanens
of the results obtained, and these ar
]. first, that the scar which must form
or upon the brain tissue may possib
j. itself become source of irritation
time, and. secondly, that certain pr
portion of brain tumors. rs Of tumo
in other parts Of the body, ar0 of a n
!. ture to render recurrence possible
y probable. The likelihood of any dif
4 Guilty arising from the first contingent
is greatly diminished by circumstaac