Centres parietal lobule alone, or not much besides, there is loss of muscular sense in the opposite limbs, with paresis or without. The impairment of the muscular sense or the loss of remembrance of residua of muscular movement, is shown by coarse incoördination, not true ataxia, and by the testimony of the patient in response to tests by passive movements, weights, and attempted movements without the aid of vision. Other series of facts bearing upon the question whether the gray substance of the motor area is really motor, are barely referred to. We refer to the facts that descending degeneration follows the removal of the motor cortex, and that faradization of the fasciculi underlying and connecting with the motor cortex produces movements in the limbs of the opposite side. It seems to us that a comparison of this discussion with the papers of Nothnagel and Naunyn, with the classic collection of cases by Charcot and Pitres, and with Nothnagel and Exner's volumes on the localization of cerebral diseases, goes to show that we must expect more progress from further exact clinical studies supplemented by autopsies than from physiological experimentation, which of course has its place and value in the complex study of the brain, which we are just opening up. THE MOTOR CORTICAL CENTRES. The Facial Centre.-Three instructive instructive cases have been reported during the year. The first, by Drummond, is especially interesting, as it strengthens the conclusions of human pathology vs. experiments upon animals. A female, æt. 29 years, admitted with pleurisy, developed empyema and repeated attacks of localized pneumonia. Operation for empyema. Three months after admission convulsions occurred, some of which were accurately observed by the house surgeon. The spasm began in the right eyelid, conjugate deviation of eyes to right, followed at once by deviation of the head to the right, twitching of the nostril, drawing up of the right angle of mouth (limbs still flaccid), rigidity and spasm of the right arm, rigidity and spasm of the right leg; then spasms in left side of face and limbs; general spasm. There were loss of consciousness and dilated pupils; repeated attacks, followed by conjugate deviation to left, and paralysis of right arm and leg. As it was probable that an abscess had formed in the left hemisphere, an operation was performed by Mr. Waldy, which resulted negatively, no abscess being seen or pus withdrawn by a hypodermic syringe. At the autopsy the source of failure was demonstrated. The operation had been made over the foot of the third frontal gyrus and the basal ends of the pre- and postcentral gyri. The abscess was found in the base or caudal part of the second frontal gyrus where it becomes confluent with the pre-central. The causes of error in this operation seem to us to be, first, a strict belief in Ferrier's doctrine that the facial centre adjoins the speech centre, and, second, faulty projections upon the patient's skull. If the induction from human cases had been strictly followed, and the caudal part of the second frontal gyrus ROUNDED SPACE, SEAT OF ABSCESS. SQUARE SPACE, PLACE WHERE ABSCESS sought for by means of Broca's projections, the abscess would have The cal Centres ficially situated, compressing the caudal ends of the second and third frontal gyri of the left side and extending under the frontal lobe. This case by itself is not of great value for localization study, but taken along with others it has weight. We know the function of the base of the left third frontal gyrus exactly; we also know that lesion of the orbital gyri produces no marked symptoms; and we may thus refer the buccal paralysis on the right side to the lesion of the caudal end of the left second frontal gyrus. The third case is by the reviewer. A boy æt. 7 years, after a mild attack of measles, showed paresis of the right cheek with dribbling of saliva from the angle of the mouth, and paresis of the right No aphasia. A few days later there occurred an attack of arm. PATCH OF LOCALIZED ADHESIVE MENINGITIS OVER THE clonic spasm, limited to the right cheek, with suspension of speech and deviation of eyeballs to right. This monospasm continued for more than two hours. After this attack there remained marked paresis of cheek, and slight weakness of right hand; no aphasia or choked disk. For five or six months right hemiparesis remained, LEFT HEMISPHERE IN CASE 1.-(4m. Jour. Med. Sci.) much more marked in the cheek; no return of spasm. Оссаsionally there was some (subjective) numbness, with formication in right hand, beginning in forefinger. It is to be noted that although numbness several times occurred first in the right hand only, the spasm and the paresis were most marked throughout in the lower facial muscles. In April of the next year, 1881, the child died of tubercular meningitis. The autopsy revealed the signs of this fatal illness, and also a patch of simple adhesive meningitis, intimate adhesion between the inner aspect of the duramater and the pia over a round area about 25 mm. in diameter (evidently of ancient formation), covering the caudal extremity of the left second frontal gyrus and a part of the pre-central at this level. There was no appreciable lesion of the cerebral substance. Centres Centre for Lateral Movements of the Eyeballs.-In favor of the existence of such a centre in the frontal lobe, only one case is reported, by Delbet,23 vide summary under Brachial Centre. The lesion in this case is too large and its topography too loosely described to give it much weight as against several negative cases in which the movements of the eyeballs remain normal in spite of large destructive lesions of the gyri in front of the pre-central gyrus. The Brachial Centre.-Salessi1o reports the case of a male æt. 32 years who died of dementia paralytica. Nineteen years before he had suffered amputation of the right arm. Among other lesions there was found at the autopsy atrophy of the upper part of the left pre-central gyrus. Second case: Dr. Joseph Coates16 relates an interesting traumatic case. A male adult received a compound fracture of the left fronto-temporal region which, after removal of bony fragments, left an aperture three inches long by one inch wide above and one half an inch below. Two cerebral hernias were removed. As symptoms there were almost complete and permanent paralysis with contracture of the right arm; temporary paralysis of the right face and lingual deviation to right; paresis of right leg; more or less aphasia, purely motor. No anesthesia (muscular sense good). Later he had convulsive attacks beginning in the right cheek and arm, leg, and whole of right side, also others with loss of consciousness, in which general convulsions followed the right-sided spasm. After healing of the wound there remained only marked paralysis with contracture of the right arm and partial motor aphasia. The principal scar extended from above the middle of the left eyebrow to the coronal suture. Evidently the middle portion of the pre-central gyrus was injured, though the second frontal perhaps the third were also torn. The case is perhaps of most value as against the existence of a cortical motor centre for movements of the eyeballs in the second frontal gyrus as claimed by Ferrier and by Horsley. A third case, by P. Delbet,23 is one of abscess secondary to chronic empyema in a man æt. 24. Sudden onset of brain symptoms by a general epileptic attack (tongue bitten), followed by several localized seizures involving the lateral ocular muscles (deviation to the left, in spite of patient's efforts to look the other way), and the flexors of the left arm. No facial spasm noted; pupils normal; speech slow. Death on Left arm paralyzed and somewhat contractured. eleventh day with high temperature. Autopsy showed an abscess, wholly subcortical, under the posterior extremity of the first frontal gyrus as far as the fissure of Rolando. The ventricles were filled with pus. From the not-very-clear topographical description, it would appear that the lesion was clear above the facial centre, and involved chiefly the centre for the upper arm. Its anterior extremity was 2 cent. in front of the pre-central sulcus, but its relations to the second frontal gyrus are not given. A fourth and very instructive case, almost equivalent to an experiment, is by Bottard,26 of Havre. A healthy laborer æt. 22 years was struck on the right side of the head by a falling brick, which made a triangular compound fracture of the skull above and behind the ear. After momentary loss of consciousness it was found that the left arm was completely paralyzed and slightly anæsthetic. No other paralysis until later, when symptoms of meningitis set in. Trephining was put off until the eighth day, when, the patient being comatose, the operation was done! Death on the eighth day after operation. The autopsy showed, besides general purulent meningitis, a large contused and lacerated wound of the right hemisphere, involving transversely the upper (?) third of the pre- and post-central gyri, extending from the base of the first frontal to the first or second parietal gyri. Between the top of the brain (edge of median fissure) and the lesion there was healthy substance 2.5 cent. (1 in.) wide. The injury to the brain was therefore exactly in the centres for the shoulder and arm. It is probable that this life would have been saved by a timely thorough operation. The Crural Centre.-Case IV. of Hun's valuable paper" furnishes a striking piece of evidence in favor of the existence of a cortical motor centre for the leg. A female, aet. 42 years, a year after a fall in which she struck the back of her head on the sidewalk, began to have epileptiform attacks beginning always in the left foot, affecting the whole left side, with loss of consciousness. Later there developed left hemiparesis, with tactile anæsthesia and paresis in face, arm and leg, double neuro-retinitis. At a later stage the paralyzed left limbs were flexed and somewhat rigid. Autopsy showed a hard ovoid tumor (37 by 30 mm.) upon the upper extremity of the post-central gyrus near the longitu |