comparing these measurements with fig. 8, of Robert's Operative Surgery of the Brain, it would seem that the first and second parietal, angular, and second occipital convolutions were all more or less involved in the lesion.

By reproducing this injury in the brain of a cadaver, I have found that the lateral ventricle is opened just over the hippocampus minor.

Motion and sensation, in all its forms, seemed to be unimpaired. The intelligence, so all the friends testified, was unaffected. The special senses were also normal, except vision. There was complete hemi-anopsia, involving the right half of each retina: the eye being fixed on any object, nothing was visible to the left of that object, but everything appeared distinct to the right. In other words, the visual center of the right brain had been destroyed, or its connections with the retina severed.

January 15, the sixty-second day; the wound into the brain has entirely healed; a few drops of pus still issue from a small sinus leading to a little bare margin of bone at the upper border of the fracture. The patient says he feels practically entirely well, and his bodily functions are all normal.

February 18, the ninety-sixth day; slit up the sinus, and removed a small bit of loose bone. The wound thus made I found entirely healed, when I called a week later, and I then dismissed the case.

The Treatment of the wound consisted in a daily washing out with a solution of corrosive sublimate, and a dusting of Wyeth's boracic acid powder. The wound was then protected by a pad of absorbent wool, held in place by a night-cap. No constitutional treatment was necessary, except a laxative for the bowels and a few small doses of morphia at night. After the first two weeks, the sublimate was discontinued. During this period, being that when the danger of meningitis was greatest, his temperature never rose above 991⁄2°, nor his pulse above 60. In truth, there seemed to be no inflammatory reaction whatever.

I present the patient to you to-day, a little more than twenty weeks since the injury. The deep depression at the site of the fracture indicates fairly well what an amount of brain substance has been lost. His friends assure me that he has suffered no loss of intellectual power, nor has any change in temper or character beer observed. There is no evidence of paralysis or paresis ; sensation in its various forms seems to be perfect; his special senses are normal, excepting vision.

The only effect of his injury is the production of complete half

blindness, the right half of each retina failing to give any response to light. The condition is technically known as homonymous hemianopsia.

In the Jour. of Mental Dis. (N. Y.) for January, 1886, Dr. E. C. Seguin gives a succinct tabulation, with a resume of the lessons to be gathered from the same, of the 46 reported cases of hemianopsia; the cases are grouped as follows:

Four were indefinite or useless for the study of localization; three were produced by pressure upon optic tracts or chiasm; six were due to lesion of the corpus geniculatum laterale, or the thalamus opticus, or both; 12 were caused by lesion of the white substance of the occipital lobe; five by traumatic lesions of the occipital region of the skull; 16 by lesions of the cortex, or of the cortex and subjacent white substance. The objects sought from the study are, of course, two-fold: I. The diagnostic value of hemianopsia alone or joined with other symptoms, such as cutaneous anesthesia, hemiplegia, etc., as pointing out the position and nature of the cerebral lesion. 2. The location of the psychic centre for vision. Concerning the latter point the views of Munk and Ferrier are alone considered as authoritative; according to Munk this centre, as is well known, is held to be in the occipital lobes, each visual area having connections with both retina. Ferrier held it to be in the angular gyrus. The conclusive cases of the table show Munk's view to be the more trustworthy, and the author finds reason to harmonize the more general position of the two investigators by calling attention to the route of the optic fasciculus of Gratiolet and Wernicke, which, as it passes close under the inferior parietal lobe of the angular gyrus on its way to the occipital lobe, is extremely liable to be severed or interfered with by any injury to the angular gyrus, whence may have arisen Ferrier's error. Charcot's view of a second decussation of the lateral fasciculi through the corpora quadrigemina is discarded as wholly inconsistent with the clinical facts, and it is intimated that Charcot himself has abandoned it: An illustration of the course of the optic tracts without secondary decussation beyond the chiasma is shown, with the ultimate psychic centre for vision located in the cunei and subjacent gyri of the occipital lobes. The following diagnostic laws are tentatively offered by the author as a result and summary of the teachings of the whole dis

cussion :

"1. Lateral hemianopsia always indicates an intracranial lesion on the opposite side from the dark fields.

"2.

Lateral hemianopsia with pupillary immobility, optic neuritis,

Vol. V.

No. 11.

-2.

or atrophy, especially if joined with symptoms of basal disease, is due to lesion of one optic tract, or of primary optic centres on one side. This diagnosis may be further strengthened and rendered quite certain by seeking for and finding one-sided pupillary reaction, as recently suggested by Wernicke. He ingeniously predicts that one lateral half of each iris will be found to contract by the reflex effect of light when one optic tract has been interrupted. He designates this as 'hemioptic pupillary reaction.'

"3. Lateral hemianopsia, or sector-like defects of the same geometric order, with hemianesthesia and choreiform, or ataxic, movements of one-half of the body without marked hemiplegia, is probably due to lesion of the caudo-lateral part of the thalamus, or of the caudal division of the internal capsule.

"4. Lateral hemianopsia, with complete hemiplegia (spastic after a few weeks), aphasia if the right side be paralyzed, and with little or no anesthesia, is quite certainly due to an extensive superficial lesion in the area supplied by the middle cerebral artery; we would expect to find softening of the motor zone and of the gyri lying at the extremity of the fissure of Sylvius, viz., the inferior parietal lobule, the supra-marginal gyrus, and the gyrus angularis. Embolism or thrombosis of the Sylvian artery would be the most likely pathological cause of the softening.

"6. Lateral hemianopsia, with moderate loss of power in one-half of the body, especially if associated with impairment of the muscular sense, would probably be due to a lesion of the inferior parietal lobule and gyrus angularis, with their subjacent white substance, penetrating deeply enough to sever or compress the optic fasciculus on its way to the visual centre.

"7. Lateral hemianopsia without motor or common sensory symptoms. This symptom alone is due, I believe, from convincing evidence, to lesion of the cuneus only, or of it and the gray matter immediately surrounding it on the mesial surface of the occipital lobe, in the hemisphere opposite to the dark half fields. Most surgical cases come at once, or after convalescence, within this rule, or in 6."

In all cases coming under 3 to 7 inclusive, the pupils react normally; and rarely does the ophthalmoscope show any lesion of the optic nerve, except, of course, in some tumor cases, when neuro-retinitis may be expected. In the August number of the same periodical Dr. Seguin reports nine bases of hemianopsia in which no post-mortem examination existed to confirm the results of the study of the cases previously examined.

Pathological diagnoses are put forward according to the analysis of previous cases submitted to post-mortem investigation. Two notable symptoms are discussed: the existence of hallucinatory images in the half fields that had just become blind, explained as the irritation of the cortical visual center just previous to its destruction; the preservation of central vision in all cases of hemianopsia, the hemianopic half field always stopping just without the macula.

The case before us, then, would seem to come under the seventh division. But we can almost certainly exclude any injury of the cuneus. We must therefore conclude either that Ferrier was right in placing the visual center in the region of the angular gyrus, or that an injury in this region may effect division of the fibres of the optic fasciculus, on their way to the cuneus, without producing either paralysis or anesthesia.

The real lesion in this case can be only approximately determined from the data I have been able to give; but it is to be hoped that ultimately, when our patient pays the debt of nature, an opportunity will be afforded for a thorough investigation.

Showing the size and shape of the fragments of bone removed. The waving line shows the occipito-parietal suture. A and B show the portions lying in close proximity, respectively, to the longitudinal and right lateral sinuses.

the depression now existing A and B represent respectdotted line the normal contour

Showing the depth and general outline of at the seat of injury, from above downward. ively the upper and lower borders of bone, and the of the skull. The degree of depression varies greatly, depending on the state of the blood-supply of the brain.

RIGOR mortis is generally ascribed to the hypothetical coagulation of myosin after death. In a recent communication to the French Academy of Science, Brown-Sequard shows that if blood is injected in rigid limbs the rigor disappears immediately, and reappears when the introduction of blood ceases. He has noticed the phenomenon even twenty-eight days after death. If a limb is kept in a state of constant agitation by means of some mechanical contrivance, during the first eight hours after death, no rigidity appears. He also notes the fact that cadaveric rigidity does not affect nervous excitation. While Brown-Sequard does not believe in the myosin coagulation theory, he does not give us any very definite theory in its stead; but he thinks that muscular tissue retains after death a particular sort of vitality.