d, but
could be straightened to about 3/4 range on effort. The
shoulder could be slightly abducted, but wide movements were
made by the scapular muscles.

Sensation was dull over the left side of the face, also over
the left side of the neck. There was complete loss of cutaneous
sensibility over the lower half of the forearm and hand, and a
similar patch in the left axilla. Over the rest of the
extremity the sensation was better on the flexor than on the
extensor aspects. There was little alteration in the common
sensation elsewhere, except that the contrast between that of
the dorsum and sole of the foot was somewhat more marked than
usual. The temperature of the insensitive axilla was one degree
higher than that of the right.

The left knee jerk was somewhat exaggerated.

On December 15 an incision was made through the old cicatrix
directly over the defect in the skull. On separating the skin
it was found directly adherent to the cicatrised dura, and when
this was incised a large vicarious arachnoid space was opened
up. The space was crossed by a number of strands of connective
tissue, and the cavity had no epithelial lining. The fluid ran
out freely, and the space was evidently in free communication
with the general arachnoid cavity. A trephine crown was taken
out at the posterior end of the gutter, and the surface of the
brain explored, but no fragments of bone were found. I
therefore replaced the crown, and closed the bony defect in the
floor of the gutter with a plate of platinum fitted into a
groove made in the bony margin. The wound was then sutured.
Primary union took place, and there was no constitutional
disturbance beyond one temperature of 100 deg. on the evening of
the second day; otherwise the temperature remained normal, and
the pulse did not rise above 75.

On the second evening a fit occurred, coming on while the
patient was apparently asleep. It lasted about a quarter of an
hour and was general, the patient becoming for a short time
unconscious, and passing water involuntarily.

On the third morning two similar fits occurred, the first a
severe one, during which the patient passed a motion
involuntarily. The commencement of all three fits was observed
by the nurse only, but in each the convulsions appar