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The case to which your attention is directed is of interest because of the apparent sudden onset of the convulsions; their strictly localizable character; the entire absence of febrile reaction, save just before death, optic neuritis or other symptoms of cerebral compression; together with the absence, in the history, of injury, middle ear or antrum disease, or suppurating foci, the result of local or general infection. The case was diagnosed as one of tumor of the right motor area lying upon or just beneath the cortex. J. E. H. Aged 52, married. Farmer by occupation, entered the Samaritan Hospital, February 17, I9oo, under the care of Dr. E. D. Ferguson, who kindly asked me to see the case in reference to the possibility of an operation. His father died from rheumatism. Mother is living but is rheumatic. One brother is living and is well. No history of cancer, tuberculosis, insanity, or nervous disease in family. Patient had had the usual diseases of childhood. During the past two years has had several attacks of indigestion. Denies venereal disease of any sort. Present illness began suddenly January 5, 7900, with a severe unilateral convulsion, followed by unconsciousness. The attack began with convulsive movements of the head and eyes toward the left side, then the whole body became convulsed and the patient lost consciousness. The effects of this attack passed away in a short time and none other occurred until January 37, 7900, the patient appearing perfectly well during the interim. On the before-mentioned date the second attack occurred very similar in character to the previous one. Neither

In the present series of 192 cases definite information is available in eighty-five of the 157 in which operation was performed prior to January 1, 1927. Twentyseven patients (32 per cent) have had no urinary complaint since the operation. In thirty-nine cases (46 per cent) there is improvement in the symptoms of obstruction, although there is a degree of frequency which is definitely less than before operation; therefore, in a total of sixty-six cases (78 per cent) there was improvement; in nineteen (22 per cent) no improvement. A review of the data in these cases previous to operation may throw some light on the cause of failure. In nine of the nineteen unimproved subsequent prostatectomy was performed and lateral lobe enlargement discovered; in seven others there was hypertrophy of the lateral lobes in addition to the median obstruction. In all but two of the nineteen unsuccessful cases the pathologic diagnosis of the tissue removed was “inflammatory.” This would indicate that in groups of cases of atrophic inflammatory prostatic obstruction, considered best suited for the punch operation, the poorest results were obtained; however, one must not overlook the fact that such cases not only offer technical difficulty but are notorious for the disappointing results following total prostatectomy. In all of the cases in which treatment was a failure (except three), symptoms have persisted following operation or recurred within six months. In the three exceptional cases there was no recurrence of trouble until from ten to twelve months later. This would again emphasize the belief of Caulk that a patient's condition a few months after operation is a fair indication of the final results of the operation. We have heard from twenty-six patients operated on last year. The Braasch knife instrument was used in all of these cases and the bleeding points subsequently electrocoagulated. Fourteen of these patients are entirely relieved, ten are definitely improved, and two are no better. We believe these figures are fairly indicative of the percentage of relief obtained by using the punch operation in any properly selected series of cases.

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