Belong: Find Your People, Create

Community, and Live a More Connected

Life Radha Agrawal
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 Praise for Belong
“If you want to belong, read this book.”
—Deepak Chopra, MD

“Radha wrote a book that’s fun to read, easy to digest,

and embodies deep wisdom. I couldn’t wait to finish reading
my copy so I could give it to one of my friends
to read the same day.”
—Tony Hsieh, CEO of Zappos and author of Delivering Happiness

“This year America’s happiness dropped as healthcare costs

continue to soar. Radha has a solution for both. Her engaging,
high-energy approach to connecting people and helping them
provide purpose and find their community is an antidote more
powerful than any pharmaceutical. Belong combines engaging
storytelling, solid research, and an easy prescription for finding
your tribe and harnessing its incredible healing powers.
Read it and live longer, better!”
—Dan Buettner, National Geographic fellow and New York Times–
bestselling author of the Blue Zones books

“Few people know how to live life with such authentic expression
as Radha does. In this book she shows us, in a clear and fun way,
how and why this way of life can lead us all to the very thing
we as humans desire the most: to belong.”
—Alexander Ljung, Founder and Chairman, SoundCloud

“Radha Agrawal is at the center of building one of the most

important movements in America: the creation of deep community
among a population of increasingly disconnected citizens. Belong
takes the powerful lessons she’s learned through her remarkable
entrepreneurial journey and creates an essential guidebook for
anyone who wants to create or be part of a thriving community among
any group or around any cause.”
—Ben Rattray, Founder and CEO, Change.org
“Radha was born to write this book. She has spent the last decade
maniacally focused on figuring out the blueprint for community
building, and this book cracks the code. Her illustrations make the
book approachable and fun to read. I am so unbelievably proud of
her achievement. It will help everyone find their tribe.”
—Miki Agrawal, Founder, Tushy, THINX, Wild,
and author of Disrupt-her and Do Cool Sh*t

“When I was orbiting the earth every ninety minutes,

I felt an incredible connection with the planet and all the earthlings
living and working below. Reading Belong reminded me of that
feeling of connectedness. I am certain this book will help readers
reestablish meaning and purpose, together.”
—Leland Melvin, astronaut, S.T.E.A.M. Explorer, and author of
Chasing Space
 Find Your People, Create Community &
Live a More Connected Life

BELONG
RADHA AGRAWAL
CEO & Co-founder Daybreaker
& Co-founder THINX

WO R K M AN PU BLI S HI NG • NE W YORK
Copyright © 2018 by Radha Agrawal

Illustrations copyright © by Radha Agrawal

Illustrated by Ryan LeMere and Radha Agrawal
Cover art by Tomas Garcia

All rights reserved. No portion of this book may be reproduced—

mechanically, electronically, or by any other means, including
photocopying—without written permission of the publisher.
Published simultaneously in Canada by Thomas Allen & Son Limited.

Library of Congress Cataloging-in-Publication Data is available.

ISBN 978-1-5235-0205-9

Design by Ryan LeMere, Janet Vicario, and Lisa Hollander

Workman books are available at special discounts when purchased in

bulk for premiums and sales promotions as well as for fund-raising or
educational use. Special editions or book excerpts can also be created
to specification. For details, contact the Special Sales Director at the
address below, or send an email to specialmarkets@workman.com.

Workman Publishing Co., Inc.

225 Varick Street
New York, NY 10014-4381

workman.com

WORKMAN is a registered trademark of Workman Publishing Co., Inc.

Printed in China
First printing July 2018

10 9 8 7 6 5 4 3 2 1
 This book is dedicated to the
courageous and generous souls—
old and young—
who wake up every day to create and
serve their communities.
Thank you for enjoying the process,
not only the destination.
And to my future children,
I promise to create a world with you
in which you feel a deep sense
of belonging.
 You Have to Go In
to Go Out
Foreword by John Mackey. . . . . viii

PAR T I

GOING IN. . . . . . . . . . . 1

1 My Epiphany
How Community Changed My Life. . . .3

2 Gentle Self-Awareness
How Are You Showing Up?. . . . . . . . . . . . 19

3 Intention
Write It Down and Dig Deep. . . . . . . . . 49

4
Energy
Set the Temperature, Why FYFs
Are Friend Magnets, and How to
Release Your Natural D.O.S.E.
. . . . . . . . . . . . . . . . . . . . . . . . . . 65
 PAR T II

GOING OUT ������������������� 100

Where to Find Your People

The Four Stages of Community. . . . . . . . . 103 5
The CRAWL Method
How to Build Your Dream Community 6
from Scratch. . . . . . . . . . . . . . . . . . . . . . . . 131

Nurture Your Community

Ten Foolproof Ways to Keep Them 7
Coming Back for More . . . . . . . . . . . . . . 161

Reframe and Embrace Conflict

Life Languages, the Friendship Cycle,
8
Avoiding FOBLO, and Eradicating
Gossip. . . . . . . . . . . . . . . . . . . . 177

Belonging and Aging

Live It Up as a Master Citizen . . . . . 199 9
10
The Future of
Belonging
What Happens Next? . . . . . . 209

Acknowledgments . . . . . . . . 217

About the Author. . . . . . . . . . 221

Foreword

I
think I should start out by declaring my bias up front: I absolutely love
this book! Radha Agrawal has written a book that is a reflection of who
she is as a person—authentic, wise, adventuresome, and loving. Belong
takes us on a journey to discover who we are, what we like and don’t like,
our purpose in life, and what gives us joy and happiness. It is our guidebook
for exploration, and it shows us how to genuinely connect with others and
create communities that we will nurture and which, in turn, will nurture us.
All of us were born into and grew up in various communities—our
families, neighborhoods, schools, clubs, friends, religious groups, cities,
our larger nation, and indeed the entire human race and perhaps even all
sentient beings. We truly are tribal animals, and we can only fully flourish
within communities where we truly belong. Despite our need and desire
for authentic community, many of us no longer experience it in our lives.
Many Americans are no longer close to their biological families, and the
neighborhoods and communities that we grew up in may no longer be
relevant to our lives. We all too frequently go forward on our life journey
with little conscious understanding about the importance that belonging
to various communities has for our health and happiness. Belong brilliantly
shows us how to know ourselves better and find, create, and connect
with the people and communities with whom we will find the greatest
fulfillment. Belong is an incredibly empowering book because it puts the
responsibility for finding and creating the communities that will fulfill us
squarely on our own shoulders, while simultaneously teaching us the skills
we need to do exactly that.
One of things I like best about Belong is that Radha shares her
own life journey with us, and she does so with genuine warmth. Far from
boasting about her many accomplishments, Radha tells us about the
mistakes she has made and the lessons she has learned, turning us into the
beneficiaries of her hard-earned wisdom. Often I felt her saying, “This is

viii BELONG
who I am. This is what I love and care about. This is what I want to do.
This universe is beautiful and amazing! I want to share it with you. Let’s
create a fun and nurturing community together. Let’s create a better world
together.”
Belong is overflowing with great ideas, wonderful stories, memorable
quotes, and a depth of wisdom. I could quote dozens of lines I loved,
but I’ll limit myself to two of my favorite ideas, beautifully expressed
here: “Energy is a great equalizer in life. It doesn’t matter what you do
for a living or how much money you have—the energy you put out is the
energy you get back. Negative energy breeds negative community. Positive
energy breeds positive community. It’s that simple.” And I also loved this:
“As with everything in life, nothing stays the same. All communities and
relationships evolve and change. When you sense it happening, rather than
thinking, ‘This isn’t what it used to be,’ consider this: It’s never supposed
to be what ‘it used to be’! Everything evolves, including communities and
relationships, and it’s a beautiful thing! Let’s learn to embrace that!”
Belong is an extraordinary book by an extraordinary person. It can
be read quickly, but it should be read slowly, and, above all, it should be
practiced. It is a book that will change your life for the better if you allow
it to. I believe it has already done that for me; it has inspired me to lead
my life adventure with more intentionality, more courage, and more love.
I hope it does the same for you.
—John Mackey
Co-founder & CEO Whole Foods Market

“We shall not cease from exploration.

And the end of all our exploring will be to
arrive where we started and know the place
for the first time.”—T. S. Eliot

FOREWORD ix
 PA RT I

We are born in community—fully connected

to another human. Without connection, we
cannot survive. It’s in our DNA to belong.
 I d i d n ‛ t a l wa y s u n d e r s t a n d
t h e i m p o r t a n c e o f c o m m u n i t y.
M y e p i p h a n y c a m e a t a g e t hi r t y.
 CHAPTER 1

My Epiphany
How Community Changed
My Life

W
hen I turned thirty, I realized I didn’t belong. I was in
my bathroom on a snowy Saturday in January in New
York City, brushing my perpetually knotted hair and
getting ready to go out, when I had an epiphany while looking at
myself in the mirror: I didn’t look happy.
Other than with my identical twin sister, Miki, and a small
group of friends whom I loved but rarely saw because they were
scattered around the globe, I didn’t really feel a strong sense of
belonging anywhere. I found myself stuck at the same sports bar
every Saturday with friends who talked about stuff I didn’t care about,
and I frequently drank until I blacked out. I had just broken off an
engagement, and I was not respecting myself or my body. And I was
about to go out and do it all over again that night.

3
 In that moment I knew something
had to change. “What do I actually
want?” I asked myself. “What matters
to me? Is this what life’s all about? Am
I just a weekend warrior getting drunk
with people who don’t inspire me?
Am I spending my time the way I want,
or am I just numbing my loneliness and lack
of deep connections?” I realized I was so tired of
just c o a s t i n g .
Growing up, community had been at the center of my
family’s values. My parents immigrated to Canada in the 1970s—
Dad is from India; Mom is from Japan. After meeting and falling in
love in graduate school, they married and raised my sisters and me
with little support from their families, who were thousands of miles
away. Looking back, I now see how much they taught us about the
importance of community, and how vulnerable and courageous they
had to be to build their own community from scratch, especially with
English as their second language.
You could say I’ve been part of a community since I was in my
mother’s womb, splishing and splashing around with my identical
twin, Miki. My older sister, Yuri, was less than a year older than Miki
and me (363 days older, to be exact), so from the very beginning I had

4 BELONG
two sisters to play with, learn from, fight against, and make up with
every day. It was always exciting—traumatic when we ganged up on
one another and empowering when we stuck together.
Even when finances were tight, our parents threw the most
amazing birthday celebrations and dinner parties, where we invented
games for our friends and designed a signature fruit punch every year.
I remember going downstairs to our basement during a party my
dad threw for his engineering team and everyone was laughing at the
dramatic poetry readings led by his British colleagues. All this stuck
with me. Fun was very important in our family (once the copious
amounts of chores and homework were completed, of course), and
community organizing, including throwing events, has always been an
integral way of life.

So when did that all change? How did I

end up at thirty feeling like I didn’t belong?
I knew there had to be more to life.

MY EPIPHANY 5
Thinking back, I realized that for the past decade, I had placed making friends in
the “if I have time” category. Work always came first and canceling on friends
became normal. I spent time with people who were fine but not inspiring,
just because it was easier. I would often delay or avoid the opportunity
for a deeper connection with someone in real life because I
wanted to catch up on social media. With Facebook and
Instagram, I thought the more “friends” and “followers”
I had, the better and more full my life would be. But
it was more of an addiction, a rush, driven by ego, with
insecurities bubbling up everywhere and offering
very little satisfaction in the end. I was too
proud (aka insecure) to reach out to potential
new friends to see if anyone wanted to
hang out, for fear of rejection. And I
know now that I’m not alone in
feeling these things. Being a
thinking, feeling human is
challenging—especially
in the digital age!

6 BELONG
MAYBE TURNING THIRTY WOKE ME UP, but it really wasn’t
an “event” or a “low point” that I hit. It was a simple recognition.
A realization. And I had to do something about it.

That night at the sports bar, I looked

around and realized that almost everyone
was avoiding their feelings the same way
I had been.

People were looking around the room and not at one another.
Half the bar was buried in their phones, and the other half was
belligerently drunk and shouting at one another, grossly making out,
or doing shots. I couldn’t believe I had been a part of this and let it
go on for so many years! I had nothing in common with these people!
What was I thinking? I left my untouched beer and ran home with
my head spinning, determined to make a change once and for all.

For the first time in my adult life,

I was going to be intentional about
my people.

MY EPIPHANY 7
As I grew more passionate about creating a
community, I learned that isolation and a lack
of belonging were becoming A CRISIS:

• One in four Americans report that they have ZERO friends to

confide in and discuss important matters with; this number has
tripled in the last thirty years, according to a 2006 study published
in American Sociological Review.

• One in three Americans over the age of sixty-five is socially isolated;

for those over the age of eighty-five, the number increases to one in
two. This was heartbreaking to learn. The people who
worked so hard to create the world we currently
live in are being shoved into isolation instead of
being celebrated?! I couldn’t believe it!

• Another study found that having weak social ties is as harmful to

our health as being an alcoholic and twice as harmful as obesity. Sit
with that for a second: Having poor social connections is as bad as being an
alcoholic and twice as bad as being obese.

• Another study found that isolation sets off a cellular chain reaction
that increases inflammation and suppresses the body’s autoimmune
response to disease. We are sick from loneliness!

8 BELONG
• But then I learned about the “Blue Zones,” the
communities that live the longest—Okinawans
in Japan, Sardinians in Italy, Costa Ricans, and
Seventh-Day Adventists. They attribute their
health and longevity to strong family ties,
enjoyable social engagements, regular
exercise, and eating mostly vegetables,
usually in community.

This was a huge wake-up call. I had never

realized how vital community was for my
health and happiness. . . .

Becoming a social entrepreneur—a term used for people

interested in creating a business that solves social, cultural, and
environmental issues—is what ultimately opened my eyes to
the importance of in-person communities. In 2010, I launched a
children’s nutrition education media company (à la Sesame Street)
called Super Sprowtz to inspire kids to eat their vegetables. I wrote
four children’s books, produced fifty educational videos with the
best puppeteers in the world, launched salad bar programs in
underprivileged elementary schools across the country, and worked
with some of the finest educators to create a comprehensive
curriculum to make healthy eating fun, and we were impacting

MY EPIPHANY 9
hundreds of thousands of kids around the world over the five years
that I ran it. While we were making exciting strides, it was also the
first time I saw how technology impacted the way kids connected
with one another, as well as how it made them more sedentary and
isolated.
During that period, in 2013, Miki, our friend Antonia, and
I also launched THINX, an underwear technology company,
with the intention of disrupting the market for feminine hygiene
products. Our mission was not only to invent a new way to deal with
menstruation (and serve the planet and the women in developing
countries who lacked convenient solutions) but also to unify women
and create a platform for women’s empowerment. We spent three
years tinkering with and developing our first prototype, and since
our Kickstarter campaign in 2013, we’ve amassed an incredible
community of hundreds of thousands of women who support
THINX and our mission—which in turn has helped to reinforce my
belief in the strength and importance of relationships across every
aspect of life.
That same year (2013 was the year I kept saying YES!), my
friend and coconspirator Matt and I came together over falafel late
one night. Frustrated by how nightlife had become overrun by mean
bouncers, too much alcohol, and digital divides, we wanted to get
back to the basics of dancing and good, clean fun. What started out as
a social experiment in which we gathered good friends in a basement
lounge for early-morning yoga, dance, and merriment before going
to work (several friends initially thought we were nuts!) has grown

10 BELONG
into Daybreaker, a mischievous movement that can now
be found in twenty-five cities across the world and a
dozen college campuses—with over 450,000 community
members—and we’re just getting started.
I now spend my days working as a Community
Architect, a term I coined for myself and for all those
who spend their days bringing humans together. The
best architects think about materials, design, light and
space, and Community Architects are no different.
Communities are built, person by person, through
thoughtful design and authentic, energetic connection
points.
I’ve traveled all around the country and the world
to launch Daybreaker, and throughout these travels
I’ve sought out all sorts of people to talk to—students,
teachers, engineers, hair stylists, entrepreneurs,
psychologists, retirees, kids, taxi drivers, CEOs, you name
it—in order to learn from the different communities
that exist. I learned that many people think it’s almost
shameful to want to belong—they view it as “needy.”
Of course it’s needy . . . it’s a fundamental human need!
On Maslow’s hierarchy of basic human necessities,
belonging sits right alongside the need for love.

The need to belong is fundamental!

MY EPIPHANY 11
That said, since 1943, when Abraham Maslow
first shared the concept for his hierarchy of
Self-
needs, a lot has been discovered. Recent Actualization
studies have shown that belonging affects
not just our emotional well-being but our Esteem
physical well-being too.* So I’ve updated
Uncle Maslow’s hierarchy to reflect Love & Belonging
that belonging is in fact a basic
human need in the same category Safety
as food, water, touch, love, and
shelter. I’ve also updated his Physiological
hierarchy altogether to reflect
Maslow’s Hierarchy of Needs, 1943
our current belief systems and
new research findings. Here they are from the bottom up:

Basic Human Needs: Food, Water, Shelter, Belonging, Love, Positive

Touch**

Physical and Mental Well-Being: Physical Health, Consensual Sex,

Job, Home, Security, Presence, Cultivation of Curiosity

Purpose: Service Orientation, Finding Your Purpose on the Planet

That Benefits Humankind (Parenting, Community)

Joy: Playfulness, Creativity, Wonder, Mindfulness—you have the

satisfaction from a life of purpose to return to play, creativity, wonder
and end suffering.

*The Harvard Study of Adult Development—80-year study, 1938–present.

**Frank R. Wilson, The Hand: How Its Use Shapes the Brain, Language, and Human Culture (New York:
Vintage Books, 1999).

12 BELONG
 Joy
Playfulness,
Creativity, Wonder,
Mindfulness

Purpose
Service Orientation,
Engaging in an activity
that benefits humankind

Physical and Mental Well-Being

Physical Health, Consensual Sex, Job, Home,
Security, Presence, Cultivation of Curiosity

Basic Human Needs

Food, Water, Shelter, Belonging, Love, Positive Touch

Agrawal’s Hierarchy of Needs, 2017

 Across all four levels of my updated hierarchy of needs is one
unifying ingredient: community. Without a community supporting
you at each level, it’s nearly impossible to move up the hierarchy. As
psychologist Noam Shpancer wrote, “Human beings, fundamentally,
are distinctly, spectacularly social. Lonely and isolated, we cannot
survive, let alone thrive.”
People often ask me, “How did you do it? How did you build
these thriving communities?” These questions, along with my desire
to synthesize what I learned through my personal and professional
communities, inspired me to write this book. Sure, community and
belonging can be squishy concepts, but I’ve identified several key
principles and practices—all of which I continue to work on, both for
myself and for the organizations I’m involved with—that have served
me and hopefully will serve you too on your community building
journey.
It took me two years to finally find my people, but when I did,
every aspect of my life became more energizing, exciting, and full
of possibilities. Of course there were (and are) many moments of
learning along the way, but for the first time I felt safe to be fully me
and to be celebrated for my individuality within a collective.
Once I saw the power of community,
and felt the deep joy it brought
to me personally, it became
my mission to help create
community for others too.

14 BELONG
Ultimately, my
goal is to give you
the blueprint
to build and
nurture your own
community from
scratch so that you
find happiness,
fulfillment, and
success.
L e t’ s G O!
 WHAT DO
BELONGING AND
COMMUNITY
ACTUALLY MEAN
?
To be human is to belong.
We were literally born in community,
attached to someone else.

16 BELONG
I know, I know, we’re frequently told to seek individuality and to be
independent and strong, or to “go against the grain.” This is all great—to
a limit. Recognizing and honoring our unique qualities and authentic gifts
is key to developing self-confidence. But sharing our unique gifts with the
greater whole is vital to our humanity. Ultimately, humans are at the top of
the food chain not because we are the strongest or fastest individuals—
bears and cheetahs are much stronger and faster. We are at the top of
the food chain because we are the best at collaborating, whether through
storytelling, skill sharing, or community building. So let’s honor our
individuality and our authentic gifts by sharing ourselves with the world!

I de fi n e [ BE• LO N G• I N G] as: a feeling o f deep

re l ate dn e ss and a ccept a nce; a f eeling o f “ I w o uld
rathe r be h ere t h a n a ny wh ere e lse.”

Belonging is the opposite of loneliness. It’s a feeling of home, of “I can

exhale here and be fully myself with no judgment or insecurity.” Belonging
is about shared values and responsibility, and the desire to participate in
making your community better. It’s about taking pride, showing up, and
offering your unique gifts to others. You can’t belong if you only take.

I de fi n e [ COM• MU • N I •TY] a s: a gro up o f th ree o r

m o re p e o ple wit h wh om y ou sh are similar values
an d i n te rest s and wh ere y ou ex p erienc e a sense
o f be l o n g ing.

Take a moment and sit with these definitions. Then let’s move on.

MY EPIPHANY 17
G e n t l y, g e n t l y.
A l w a y s g e n t l y.
Another random document with
no related content on Scribd:
and a moderate amount of health may be good. A gummy
intracranial or spinal growth, giving rise to alarming symptoms, may
vanish as by magic upon prompt treatment. The symptoms of these
frank, specific growths are, as a general thing, characteristic and
widely different from those of the more insidious destructive lesions.

“An intracranial gumma often heralds itself by sharp, localized

headache, gradually deepening paralysis, aphasia, epilepsy, and
optic neuritis, while destructive lesions are more apt to have diffuse,
dull headache, stationary or lessening paralysis or aphasia, rarely
epilepsy or optic neuritis. Intraspinal gummata give rise to a painful
paraplegia, while an inflammatory or destructive change gives rise to
various and atypical sensory and motor manifestations.

“As to the pathology of these cases, I can say but little, as such
discussion opens the whole subject of the pathology of syphilis. This
I will say, that, so far as can be told without autopsies, no permanent
pathological condition was present in these cases which might not
have been brought about by other etiological factors which were
often present. The periencephalitis might be caused by alcohol,
mental strain, or excesses; the arterial occlusion might be due to
previous disease not specific.”
46 Medical News, vol. xlviii. No. 3, Jan. 16, 1886, p. 64.

TREATMENT.—The surgical treatment of tumors of the brain has

recently received a great stimulus from the report of a case which
occurred in the practice of A. Hughes-Bennett of London, and which
was operated on by Rickman J. Godlee. The case has been included
in the table (Case 24), where the symptoms and details of treatment
may be read. This case has served to bring into sharp outline many
of the difficulties and dangers of such an operation on the one hand,
and the few possible and exceptional advantages of it on the other. It
must be apparent, in the present state of knowledge and with the
additional light of this interesting case, that success must largely
depend upon the following conditions: The tumor must be
exceptionally localized—i.e. not very large—and non-multiple; it must
be cortical, or at least not very deep-seated; it is also quite essential
that it be in the motor zone, in order to admit of accurate diagnosis. It
would seriously impair the usefulness of the operation and the
prognosis if the case were of long standing with much necrosis of
brain-tissue, or if the growth were malignant and recurring. The
secondary complications, as inflammation and sepsis, are of course
possible in all surgical cases, and may be guarded against, as well in
cerebral as in other surgery. If such a criticism narrows the field for
the operation into almost hopeless limits, it may be reflected that one
or two successful cases are better than a hundred experimental
failures; that cases do occur in which the tumor is just so localized,
single, and superficial; that the urgency of distressing symptoms, as
pain and convulsions, urge the operation for palliation as well as
cure; and that these cases, without relief, are necessarily fatal, and
hence justify large risks.

By exclusion and a careful study of the symptoms we believe it may

become possible hereafter in some cases to localize in two other
accessible regions brain tumors with sufficient accuracy for purposes
of operation: these are the antero-frontal region and the postero-
parietal region.

The case of Bennett and Godlee was a most successful test of

diagnosis, and as a surgical endeavor might have been more
successful, as the operator himself suggests, if more careful
antiseptic precautions had been used. In the discussion of this case
before the Royal Medical and Chirurgical Society47 it was stated by
Hughlings-Jackson that three indications were of special importance
for this diagnosis: (1) local persisting paralysis; (2) epileptiform
convulsions, those beginning locally; (3) double optic neuritis, which
is diagnostic of tumor as distinguished from a sclerotic patch. It is
probable that permanent palsy would be left after a successful
operation in which the cortical tissue were destroyed, but as this is
compatible with life and comfort, it is not likely that, as an alternative,
it would be rejected by the patient. McEwen's case, also given in the
table (Case 25), is not as accurately reported48 as Bennett's, but was
partially successful. At the opening over the Rolandic region false
membrane was removed, and an incision made which let out
grumous red-colored fluid: this was followed by a decrease in the
paralysis and improvement in other brain symptoms. It is difficult to
understand why the opening was made in the occipital region. The
necessity for antiseptic measures is to be especially considered in
cerebral surgery. In a recent operation for a case of traumatic
epilepsy, under the care of Mills and White, in the Philadelphia
Hospital, in which quite extensive injury was done to the membranes
in removing fragments of bone, rigid antisepsis was employed; and it
is not too much to assume that the risks of the operation were much
diminished by it and its success ensured in an old and crowded
hospital building.
47 Brit. Med. Journ., May 16, 1885, p. 988.

48 Glasg. Med. Journ., xxi., 1884, p. 142.

In the medication of tumors of the brain we can unfortunately do but

little more than treat the symptoms and ameliorate the various
conditions as they arise. There is no specific for these growths,
unless the syphilomata be an exception; and experience shows that
specific treatment is usually disappointing even when applied to a
syphilitic brain tumor. The dietetic and hygienic rules laid down by
some are only such as are invariably recommended as routine
practice in all kinds of disease; and it almost seems a mockery to
offer them to a patient with an intracranial tumor with the same
gravity and detail as we suggest them in a curable fever or a hopeful
surgical case. It is possible that local depletion and revulsives, by
controlling irritation and hyperæmia, may be beneficial, though we
should hesitate to add to the sorrows of the patient the action of
tartarized antimony, even, with Obernier, in special cases. Hot or
cold effusions and the ether spray are worthy of mention. Local
applications of the galvanic current might be tried for its catalytic
action, but the observations are too few and the theory too
inapplicable to allow us to attach much importance to the suggestion.
The use of electricity to the limbs for paralytic symptoms certainly
does not promise much in the case of an obstinate neoplasm in the
brain.
Morphia and bromide of potassium are the two drugs which offer the
most promise in these fatal cases. They can often control the most
urgent and frightful symptoms. The headache, the obstinate
vomiting, the epileptic seizures, are all more or less amenable to one
or other of these remedies or a combination of them. Although the
vomiting is of centric origin, it is possible that remedies addressed to
the stomach might occasionally afford relief, just as we apply
medicines to that viscus in reflex irritation, in pregnancy, and in
debilitating diseases. The remedies which suggest themselves are
the salts of bismuth and cerium, the more stimulating wines, as
champagne, in small frequent doses, and cracked ice.

While morphia and bromide of potassium are, on the whole, the most
useful remedies for the relief of pain and irritating symptoms of brain
tumor, other remedies can often be used with great advantage as
adjuvants. Ergot in the form of the solid or fluid extract has a
beneficial influence in relieving the congestive symptoms. Cannabis
indica in the form of the fluid extract in doses of five to ten minims, or
the tincture in doses of fifteen to thirty minims, may be
advantageously combined with morphia and a bromide, or
sometimes may be tried alone. Hyoscyamus, either the fluid extract
or tincture, in somewhat larger doses may also be tried. The great
severity of the headache and the imperative demand, however, will
usually compel the physician to fall back at last upon morphia in
large dose by the mouth or hypodermically.

Leeches to the temples or behind the ears or to the mucous

membrane of the nose, either wet or dry cupping to the back of the
neck, and bladders or compresses of ice, or very hot water, may be
used to the head.

The various serious complications which so often accompany

intracranial tumors should be most carefully managed. Among the
most important of these are such affections as the conjunctivitis and
trophic corneitis, with anæsthesia, present in a few cases, usually
when the trigeminal is directly or indirectly involved. Cystitis and
pyelitis must be appropriately treated, and patients must be carefully
watched in order to prevent injurious consequences of over-
distension of the bladder or enormous fecal accumulations.

TABLE OF ONE HUNDRED CASES OF BRAIN TUMOR.

Sex
Pathology and
No. and Clinical History. Remarks.
Location.
Age.
Superior Antero-frontal Region.
1 M. 35. Syphilis and traumatism. Fibroma. C. K. Mills,
Philada. Med.
Headache; vertigo; mental slowness; Anterior superior Times, Jan. 18,
loss of attention; hysterical. Nystagmus. half of second 1879 and Arch. of
Tonic spasm of neck and forearm. frontal and anterior Med., vol. viii. No.
Movements weak and uncertain. superior and inner 1, Aug., 1882.
Explosive speech. Gradual blindness; half of first frontal;
choked discs. Conjunctivitis and anterior segment of
corneitis of left eye. Anæsthesia of gyrus fornicatus,
conjunctiva. Polyphagia. Constipation and anterior half
alternating with involuntary evacuations inch of corp.
and urination. Temperature 97°-101°. callosum.
Head-temperature above normal;
highest at frontal station; average, 96.5.
2 M. 50. Headache, dizziness, and slight right Fibroma. C. K. Mills. Not
facial paralysis. Dimness of vision. Day before published.
before death had an attack of One and a half
unconsciousness, from which he inches in diameter
emerged in half an hour. In two hours in the left antero-
had another attack; became comatose; frontal lobe, located
Cheyne-Stokes respiration; temperature so as to involve the
102.3°; pulse 150. Reflexes completely middle portions of
abolished. the first and second
frontal convolutions
and white
substance beneath
them almost to the
orbital surfaces.
White matter
 softened posterior
to tumor. Adherent
to pia mater.
3 M. 16. Frontal headache, vertigo, staggering Glioma. Petrina.
gait toward right. Later, paresis of Vierteljahrschr. f.
sphincter of bladder. Some muscles of Frontal convolutions die Prakt. Heilk.,
right face paretic. Some weakness of flattened; brain- 1 Bd., 1877, p.
mind: emotional. Choreic movements of substance doughy; 126.
right arm, increased with mental cortex gray-red;
excitement. No deafness, loss of taste, medullary
or of tactile or heat sense. Slight traces substance reddish-
of sugar. Blurring of papilla and white. Corpus
hyperæmia of retina. Later, vomiting. callosum arched
Urine sp. gr. 1031. Irritability of mind, upward; lateral
with erotic conduct. Reduction of pulse ventricles enlarged
—54. Progressive emaciation and in posterior horns.
mental failure. Tremor in both arms, and Tumor in medullary
in right arm automatic movement. Boil substance of both
on left hand. Scaphoid abdomen. Later, frontal lobes,
temperature below normal; also pulse springing from
and respiration. Right facial paralysis septum and
unchanged. Still later, contracture of radiating toward
both elbows. Pupils react tardily. parietal lobes,
Apathetic. Very late, small quantity almost filling both
albumen, no sugar. anterior lobes, and
also adhering to
walls (apparently) of
ventricles. At base
extended backward
full extent of frontal
lobe.
4 M. 36. History of injury to the head. Frontal and Endothelioma. Philipson,
occipital headache. Vomiting and Medical Times
giddiness. Memory much affected. In right frontal lobe and Gazette, vol.
Double internal strabismus with unequal anterior portion. ii., for 1882, Sept.
pupils. Double optic neuritis. Hearing Three inches in 16, 1882, p. 355.
unaffected; sense of smell lost. Lies on diameter.
 back. Stumbles on trying to walk. Surrounded by soft
Answers questions with difficulty; diffluent cerebral
speech slow and hesitating. Pain in tissue. Right frontal
head, apparently increased by bone had on its
percussion to right frontal region. internal surface a
much greater
concavity than the
left, and at its upper
and outer part was
rough, deeper in
color, and thin. Dura
mater adherent.
5 F. 32. History of chancre with secondary and Gumma. H. Knapp, Arch.
tertiary lesions of syphilis. Frontal node. of Ophthalmology
Constant headache. Epileptiform From dura mater and Otology, vol.
convulsions. Marked exophthalmus, into the brain- iv. p. 245.
with impairment of sight in both eyes. substance at the
Improved under iodide of potassium. anterior portion of
Grew worse again. Dimness of vision; the anterior lobe of
pain in head constant, and worse at the left hemisphere.
night. Ophthalmoscope revealed neuro- Brain-substance
retinitis with commencing atrophy of softened around
optic nerves. tumor. Left ventricle
dilated, and filled
with fluid.
Inferior Antero-frontal or Orbital Region.
6 M. 27. Loss of sight, increasing to total Fibro-sarcoma. L. Howe, Buffalo
blindness. Gradually increasing loss of Med. and Surg.
hearing, of smell, and of taste, in order Involving inferior Journ., xxi. p.
named. No anæsthesia. No paralysis portion of right 299.
mentioned. anterior lobe. The
first and second
pair of nerves were
involved, but no
other nerves.
7 F. 33. Paralysis and wasting of right leg since Cholesteatoma. Petrina, op. cit.,
childhood. Sudden severe general p. 126.
 convulsions with loss of consciousness, Growing from pia
followed by paresis of right upper mater at the base
extremity. No facial or ocular paralysis. between both
Special and general sensibility normal. frontal lobes,
Recurrent convulsions, both tonic and extending to
clonic. Severe frontal headache; anterior margin of
continued paresis of right arm. corpus callosum
Apathetic. Right face partially paretic, and to optic chiasm.
and right oculo-motor weakened.
8 F. 20. Vomiting. Loss of sight and hearing; Under left anterior E. Williams, Med.
inability to speak. Somnolence. Pupils lobe and extending Record, 1868, pp.
widely dilated. Later, all special senses from falx cerebri, to 29-31.
involved. Tongue protrudes to right. which it was
Pulse irregular. Right face anæsthetic. adherent, over the
Neuro-retinitis in both eyes, worse in cribriform plate of
right; left eye retained some vision. the ethmoid,
Hearing and taste perfect; smell involving left
impaired. No paralysis. Pain constant olfactory nerve,
over eyes. No convulsions. backward and
diagonally across
the sella turcica to
right petrous bone,
where the end of it
pressed on fifth
nerve of right side
at its point of exit.
Pressed upon optic
chiasm.
9 M. 49. Vertigo. Always excessively stupid, Tumor the size of a Obernier, Virch.
allowing himself to be made a fool of. large walnut to the Arch., vol. xxxvi.
Violent bleeding from the mouth and right of the middle p. 155, and
nose ten years before death, followed line, external to the Ziemssen's Cycl.
by nasal discharge. Frontal headache, dura mater at a Pract. of
especially on left side. Failure of sight. point corresponding Medicine, Am.
Small tumor in inner upper angle of left to position of right ed., vol. xii. p.
orbit, which dislocates left eye outward; olfactory bulb. 268.
right eye also deviated outward without Vitreous table of the
 any apparent mechanical reason. Pupils frontal bone and
dilated and sluggish. Sight much crista galli of the
diminished. Mouth slightly drawn to one ethmoid completely
side. Speech slow, but not hesitating. destroyed. On the
Gave replies to questions slowly, and inner side of dura
did not usually keep to the point, but mater another
clothed his answers in general remarks. tumor fills the right
A certain amount of self-esteem anterior fossa and a
pervaded his conversation. Continuous large portion of the
headache. Very late, had convulsions left.
which began on the left side and
extended to the right.
10 M. —. Diminution of vision. At first much Sarcomata. Saemisch, Klin.
reduced, without any ophthalmoscopic Monatsblätter,
changes. Slight headache; loss of Two tumors: one 1865, p. 51,
appetite; restless sleep; rapid pulse. about the size of a quoted by
Vision sank rapidly until completely pigeon's egg Obernier,
extinguished. Remained thus for between the optic Ziemssen's Cycl.
nineteen days; then sight began to trunks in front of the of the Pract. of
return, first in the right eye, and then in chiasm, surrounded Medicine, Am. tr.,
the left. Increased, so that an by the optic nerve in vol. xii. p. 269.
examination of the eccentric fields could a forked manner,
be undertaken; this showed absence of the nerve-fibres
the external halves of the fields of vision being parted by it. A
—hemianopsia. “The transition of the second tumor
existing portions of the fields of vision to situated beneath
the lost portions was effected by a the pons, raising
region which, by a low light, should be the dura mater. It
reckoned to the latter, so that then the had probably
boundary-line of the defect fell originated in
somewhat to the outside of the fixation- cavernous sinus.
point running in the right eye in a
vertical direction, and in the left
diagonally from the inside and above
downward and outward. Within the next
four weeks the central vision increased
in the right to V = 1/2, and in the left to V
 = 1/20, while the defect in the eccentric
vision continued in the way described.”

Patient died of symptoms of acute

meningitis.
Rolandic Region—Motor Cortex.
11 F. 38. History of syphilis. Blows on the head. Gumma. C. K. Mills, Arch.
Headache, with agonizing paroxysms. Med., vol. viii. No.
Top and right side of head sensitive to Attached to the 1, August, 1882.
percussion and headache severest in fused membranes
these regions. Vomiting; vertigo. Great of the right
mental irritability. Severe left-sided convexity. Involved
spasms, beginning with twitchings in left the upper fourth of
toes and foot. Partial paralysis of right the ascending
leg and arm, most marked in leg. frontal and a
Hyperæsthesia. Impaired sight. Choked smaller segment of
discs. Head-temperature taken once: the ascending
right parietal region, 97.2° F.; left parietal convolution,
parietal region, 96° F. crossing Rolandic
fissure at its upper
extremity. A good
example of strictly
cortical lesion.
12 F. 30. No history of causation. Headache Carcinoma. C. K. Mills,
continuous, sometimes agonizing. reported at the
Percussion of head caused most pain in The tumor involved meeting of the
right parietal region. Vomiting when the middle portion American
headache was most severe. Vertigo. of the ascending Neurological
Mind clear, but acted slowly: emotional. parietal convolution Association,
Spasm, beginning with twitching of and the upper part June, 1881, Arch.
fingers of left hand: most severe on left of the inferior Med., vol. viii. No.
side, and especially in left arm. Upper parietal lobule, 1, Aug., 1882.
as well as lower fibres of left facial nerve pushing aside the
partially paralyzed; nearly complete interparietal fissure.
paralysis of left arm; slight paralysis of The anterior
left leg. Bowels and bladder partially extremity of the
paralyzed. Impaired sensibility in limbs tumor was about
 of left side. Left patellar reflex one-fifth of an inch
diminished. Sight very imperfect. back of the centre
Choked discs. Hearing defective in right of the fissure of
ear. Rolando. On the
inner side of the
tumor the white
matter of the brain
was broken down.
Adherent to the pia
mater; the pia and
dura mater were
united by strong
adhesions.
13 M. 31. Evidences of tuberculosis. Headache Tubercular tumor. C. K. Mills, Arch.
continuous, with severe exacerbations; Med., vol. viii. No.
most severe at vertex. Vertigo. Some Dura and pia mater 1, Aug., 1882.
irritability and emotionality; hallucination adherent over the
that some one was going to come and tumor, which
take him away. Spasm confined to left involved the
arm. Partial paralysis of left arm and leg, posterior
and, late in his illness, of left side of extremities of first
face. Left hemianæsthesia, at first and second frontal
partial, but later complete and and upper thirds of
persistent. Sight impaired; right pupil both ascending
dilated and left contracted before death. convolutions of right
No ophthalmoscopic examination. hemisphere. Interior
Hearing defective in left ear; tinnitus of hemisphere
aurium. Head-temperature taken once: broken down; the
right frontal region, 98° F.; left frontal parts destroyed
region, 96.3° F. Cheyne-Stokes included white
breathing on day of death. matter of the
parietal lobe, the
posterior third of
lenticular nucleus,
and the adjacent
portion of internal
capsule. Miliary
 tubercles in pia
mater around and
near the tumor.
14 M. 19. First symptom, headache; then vertigo. Gumma. C. K. Mills, Med.
Sudden right brachial monoplegia; and Surg. Rep.,
possibly some paresis of leg. A large tumor in the vol. li., Aug. 2,
Recovered use of arm; went to work; ascending frontal 1884, p. 119.
was kicked by a mule, and became convolution, at
worse. Headache and right-sided junction of middle
paresis returned. Increasing stupor; and upper thirds:
paralysis of right arm complete; of leg one-third of mass
almost; right facial paresis; ptosis of on convexity of
right side. Partial anæsthesia on right convolution, the
side of face; pain on right side. Slight remainder in fissure
clonic spasms of right arm. Paralysis of of Rolando. Smaller
bowels and bladder in last week. tumor at inferior
Tendency to Cheyne-Stokes respiration. angle of right lobe
No vomiting. Eyes not examined. of cerebellum.
Some basal
meningitis with
effusion.
15 M. 56. Sickness began with an epileptiform Glioma. Samt, Arch. gén.
seizure lasting about ten minutes; de Méd., Jan.,
flexing movements of right arm. Next In the left ascending 1876, from Berlin.
day dragged his right leg slightly. Partial frontal convolution, klin.
convulsions, without loss of occupying the Wochenschr.,
consciousness, followed, and became upper third of this Nos. 40, 87.
very frequent. Two months before death convolution. The
convulsions ceased, but absolute tumor extended
paralysis of the arm and paresis of the backward to the
leg remained. One month later complete fissure of Rolando,
palsy of right half of face occurred. Mind and in front was
became impaired. Complete aphasia. bounded by a
Right-sided anæsthesia. Reflexes of vertical line which
right foot less marked than those of the would meet the
left. Rectal temperature, 100.4° F. At upper extremity of
times deviation of the head and eyes to the vertical frontal
 the left. Left frontal and temporal fissure. The inferior
regions tender to pressure. Very late boundary was
nystagmus. No headache. distant about one
and three-quarter
inches from the
longitudinal fissure.
Surrounding
convolutions
flattened and
widened.
16 M. 49. Irritability and loss of memory. Paresis, Glioma. A. Hughes
passing to paralysis, of left arm; paresis Bennett, Brain,
of left leg. Slight left-sided paralysis of Involving the middle vol. v., 1882, p.
tongue. No facial paralysis; no optic portion of the right 550.
neuritis. Ankle-clonus and exaggerated ascending frontal
knee-jerk on left side. No wasting of convolution and
muscles or abnormal electrical posterior end of
reactions. Toward end paroxysmal middle frontal
twitchings of left side, including side of convolution,
face, with left-sided paresis of face. extending as a
Hebetude. Visual hallucinations. spheroidal mass
Complete left hemiplegia. Paralysis of downward to roof of
sphincter. Vomiting. Strong contraction lateral ventricle.
of pupils. Duration about two months.
17 M. 30. Convulsions for twelve years prior to Glioma. J. Hughlings-
death. Character of fit: first, cramping of Jackson, Brain,
right big toe, then twitching of calf- Left hemisphere, vol. v., 1882, p.
muscles and drawing up of leg and including posterior 364.
knee. Most of the fits stop here, without half of superior
loss of consciousness. In some fits the frontal convolution
arm is convulsed after the leg, and upper half of
beginning in fingers, and consciousness ascending frontal
is lost. Paralysis of right leg. Slight convolution, except
convulsive action of left leg. Sensation the extreme end.
of right leg unimpaired. Temporary The superficial area
aphasia at beginning of attack; on one was defined by
occasion the aphasia was present fissure of Rolando
 without fit. The right arm probably posteriorly, superior
paretic after each seizure. No facial frontal fissure
palsy. Has as many as thirty fits daily. externally, and
Marked cessation of seizures at one longitudinal fissure
time. Three days before death became internally. Anteriorly,
hemiplegic, with exaggerated deep the tumor gradually
reflexes on paralyzed side; also ankle- merged into normal
clonus. During later years fit sometimes brain. In the
began in hand. No optic neuritis while longitudinal fissure
under observation. the growth
extended to calloso-
marginal fissure.
18 F. 58. General headache, most marked in the Alveolar carcinoma. E. C. Seguin,
occipital region, and always worse at Opera Minora, p.
night. Sore, stiff feeling in neck; at times An ovoid tumor in 495, and Journal
nausea and vomiting. Trembling of left the upper part of of Nervous and
hand; later, paresis. Two sorts of the ascending Mental Disease,
movements of left arm—one, a fine frontal convolution vol. viii. No. 3,
tremor; the other, attacks of jerking. and in its subjacent July, 1881.
Paresis of left arm increasing, with white matter. It
some contracture; slight paresis of left extended well
leg. Sight failing; later, semi-stupor; across the fissure of
pupils small and fixed, the right larger. Rolando.
Right internal rectus weak. Left lower
face paretic. Strong contractures of left
arm and hand. Good knee-jerk. Choked
discs. Some days bright, others almost
moribund. Case advanced to complete
paralysis of left arm and leg; involuntary
evacuations; divergent strabismus and
ptosis; indistinct speech; delirium and
coma.
19 M. 50. History of syphilis and severe fall on the Gumma. H. C. Wood,
head. Vertigo. Prickling sensation in left “Proceedings of
foot, extending to thigh, finally to arm One-third of an inch the Philada.
and head, followed by unconsciousness in thickness at the Neurological
and convulsion. Stupor after convulsion. middle of the Society,” Medical
 After this, convulsive attacks at ascending frontal News, vol. xlviii.
intervals. Eighteen months before death convolution. No. 9, Feb. 27,
an apoplectic attack, in which was Membranes fused; 1886, p. 248.
unconscious for several hours. tumor adherent to
Spasmodic attacks, preceded by a them. Œdema of
peculiar twisting of the fingers of the left the brain. Gumma
hand. Paresis of the right hand and arm. in the lungs.
Some diminution of sensation, not well
made out. Slight want of use of the left
leg.
20 M. 59. Gradual loss of speech—aphasia. Myxo-glioma. Petrina, op. cit.
Gradual paralysis of right side. No
headache prior to this. No anæsthesia. In front of the left
Taste, smell, hearing, and sight intact. ascending frontal
Apathetic face. Middle branch of facial convolution,
nerve paralyzed, especially the muscles bounded below by
of the right corner of the mouth. the Sylvian fissure
Wrinkles of forehead less strongly and the upper
marked. Right upper and right lower convolution of the
extremity in strong contracture. Leg island of Reil;
swollen. Increasing torpor of bladder. seems to
Normal electrical reactions, except immediately enter
speedier and increased reaction of the into the structure of
right facial nerve. Reactions of the island. Left optic
convulsibility in the right arm with ten to thalamus and
twenty cells. Very late, unconsciousness corpus striatum
and paralysis of bowels and bladder. moist, but
completely
separated from the
tumor. Convolutions
flattened.
21 M. 35. Had epileptic fits for two years before Gumma. F. H. Martin,
his death. Occasionally the spasms Chicago Med.
began in the left half of the face and Arising from the Journ. and
extended to the arm and leg, but did not membranes, two Exam., vol. xlvi.
become general. After such attacks inches in diameter, 21.
sensation was lost in the left arm, and but very thin,
 the arm was paretic for some hours. involved the gray
Toward the close of life the paresis matter of the
became permanent, and extended from posterior
the arm to the leg, and sensibility was extremities of the
somewhat impaired in these limbs. The first and second
temperature was 2.5° F. higher over the frontal convolutions,
right parietal eminence than over the the upper and
left. middle thirds of the
ascending frontal
convolution, and the
adjacent border of
the ascending
parietal convolution
of right hemisphere.
22 F. 57. After excitement lost consciousness. Fibro-glioma. Petrina, op. cit.
Paresis and heaviness of the right upper
extremity. Aphasia; used words Tumor size of fist
inaccurately; short of words and occupied the whole
enunciation impaired. Second attack of of the lower and
loss of consciousness. Twitching in right middle portion of
half of body and face. Paralysis of right the parietal lobe,
upper extremity. Severe pains in right imbedded in both
arm and leg. Another attack of loss of ascending
consciousness, with spasms of right half convolutions.
of body. Right lower extremity and right Ascending frontal
lower face paretic. Slight trismus; right convolution pushed
masseter contracted. Dull headache. aside; the
Organs of sense not affected. annectant gyrus
Understands all that is said to her, and island of Reil
although aphasic. Sensibility good. compressed and
Right-sided pneumonia; œdema of lung. flattened. Fissure of
Sylvius arched over
by tumor. White
substance also
pushed toward the
corpus striatum.
Meninges
 congested. Left
parietal bone
somewhat
excavated.
23 F. 39. Began to suffer with epilepsy two weeks Gumma. H. B. Sands,
after a blow on the left parietal region. Med. News, April
The fits were preceded by formication in A gumma one inch 28, 1883.
the right hand and tongue, and began in diameter was
with spasm in the right hand, which was found on the
weak for some hours afterward. A surface of the left
permanent right facial paresis hemisphere, at the
developed one month after the blow, junction of the
and two months later the tongue, arm, middle and lower
and hand were also paretic on the right thirds of the
side. Disturbance of vision due to ascending parietal
choked discs had developed, and convolution, and
temporary attacks of aphasia occurred involving also the
after the frequent convulsions. She sank convolution
into a condition of stupor and aphasia posterior to this.
four months after the first symptoms. The membranes
The skull was then trephined at the seat were adherent to
of the old injury in hopes of evacuating a the gumma.
chronic abscess, but no pus was found.
One week after this she died.
24 M. 25. Four years previous to death had Glioma. Hughes-Bennett
received a blow on the left side of the and Rickman
head. A year later, twitching in the Meningitis was Godlee, British
tongue and the left side of the face. found at the lower Medical Journal,
Twitching of the left arm. Twitching border of the Nov. 29, 1885.
increased. Paroxysmal spasm and wound, spreading
general convulsions, with loss of downward toward
consciousness. Paresis, and then the base of the
slowly-developed paralysis, of the brain.
forearm and hand. Some paresis of left
leg. Double optic neuritis. Violent
headache.
 This patient was in charge of Hughes-
Bennett at the Hospital for Epilepsy and
Paralysis, London. He diagnosticated
brain tumor, and suggested its removal.
Rickman Godlee trephined over
suspected region, and removed a
glioma of the size of a walnut. The
operation was performed November
25th. The patient did well until
December 16th, when he was seized
with a rigor, followed by fever, sickness,
and pain in the head. A hernia cerebri of
large dimensions supervening, he died
December 23d.
25 F. —. Syphilitic history. Tingling sensation and After antisyphilitic Macewen,
numbness of the left arm and leg, which treatment and “Proceedings of
increased until it ended within six weeks counter-irritation, Path. and Clin.
from its commencement in complete trephining was Soc. of Glasgow,”
motor paralysis, with a deficiency in the performed over the Glasgow Med.
perception of touch. Left side of the face middle of the Journ., vol. xxi.,
also slightly paretic. Mental confusion ascending parietal 1884, p. 142.
and loss of memory. and frontal
convolutions.
Internal table of the
disc removed was
found softened and
thicker than usual,
having on its
internal surface
projections or
roughnesses. A
second opening
was made over the
occipital region, and
a similar thickening
was found.
Opposite first
 opening the dura
mater pale and
thickened. It was
elevated, and a
false membrane of
yellow color was
removed. An
incision was made
in the direction of
the paracentral
lobule, when a gush
of grumous, red-
colored fluid
escaped.

Day after the

operation much
better; on third day
moved her toes;
within a week lifted
her leg; fingers
moved within a
week. Mind greatly
changed for the
better.
Centrum Ovale—Fronto-parietal Region.
26 F. 16. Fell when sixteen months old from the Fibro-glioma. Osler, Medical
table on her head. Left hand, five News, vol. xliii.,
months later, noticed at times to be stiff In the white matter, Jan. 19, 1884, in
and firmly closed. Three months later but touching upon “Proceedings of
the leg became similarly affected, and the gray at several Medico-
two months later general paroxysms. spots at the position Chirurgical
Many seizures for periods of weeks or of the upper end of Society of
months, then intervals of freedom. the ascending Montreal;” also,
Spasm began by contraction of the left frontal convolution Am. Journ. Med.
hand: she would lie down and jerk for a of the right Sci., N. S. vol.
half minute or minute, laughing or hemisphere. The
 talking all through it, never losing tumor occupied lxxxix., Jan.,
consciousness. In about six years left largely the anterior 1883, p. 31.
leg became paretic. Seizures became portion of the
much worse and more frequent; paracentral lobule.
unconscious for six weeks, and fifty to
eighty spasms in twenty-four hours. Ten
months without spasms until a week
before death, when they returned with
great violence. Spasms always began in
the left hand; appeared to extend to the
leg first, and then to the face. Intellect
clear.
27 M. —. Severe fall, followed by insensibility. Sarcoma. E. C. Seguin,
Paralysis of the left side followed injury, Opera Minora, p.
but improved. Three years later, Larger than a hen's 215; reprinted
epileptic convulsions: sudden fall, egg in white from the
general spasm, biting tongue. These substance of right Transactions of
attacks replaced by partial or localized hemisphere, the Amer. Neurol.
epilepsy without loss of consciousness: occupying the Ass., vol. ii.,
tonico-clonic spasm of muscles of left whole thickness of 1877.
side of face and neck and of left upper the hemisphere
extremity, especially of the thumb and above the opto-
index finger. Left pupil a trifle larger than striate bodies.
right; left cheek paretic, left arm and Exerted much
forearm absolutely paralyzed; left leg pressure upon
weak. Marked tactile anæsthesia on left these bodies, on
side. Ophthalmoscope showed fulness convolutions near,
of veins, but no neuro-retinitis. Late, and even upon the
some opisthotonos. Deafness in right inner surface of the
ear; axillary temperature, 36.4° C. Pain left hemisphere.
in right arm and leg and in posterior part Adherent to the
of head on right side. Conjugate dura mater. Right
deviation of head and eyes from palsied half of the brain
side. No neuro-retinitis. Localized and much enlarged, and
general convulsions recurred from time lateral ventricle and
to time. septum lucidum
forced over to the