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Although total body cooling has now been under scientific study for about a century and has been of particular neurological interest during the last decade, it has not yet met with universal neurosurgical acceptance. We do not have precise indications for its present clinical use, nor do we have a clear idea of its future.Many significant facts, however, have been established. Hamsters have been frozen until ice crystals have formed in their tissues; mice, monkeys and dogs have been reduced to nearly O C, until all detectable heart and respiratory action have ceased, yet all these animals have survived.1 Man has been shown to withstand temperatures between 29.4 and 32.2 C for as long as 10 days and temperatures above 25 for a shorter period, but the safe lower limits of human hypothermia have not yet been established.3During this total body cooling, oxygen consumption of the

"We now consider," wrote Hughlings Jackson1 in 1880, "certain psychical states during the onset of epileptic seizures which are much more elaborate than crude sensations.""I speak first," he continued, "of certain highly elaborate mental states, sometimes called 'intellectual aurae.'... The state is often like that occasionally experienced by healthy people as a feeling of 'reminiscence.'... It is sometimes called 'dreamy feelings' or is described as 'dreams mixing up with present thoughts,' 'double consciousness,' 'feeling of being somewhere else,' 'as if I went back to all that occurred in my childhood.' These are all voluminous mental states and yet of different kinds; no doubt they ought to be classified."In recent years we have studied these "psychical states" clinically, as Jackson did. They may appear in the onset of an epileptic seizure that originates in temporal regions of the brain, and they may, in fact, constitute the only clinical

Recent years have witnessed a renewed interest in the surgical treatment of some of the symptoms of Parkinson's disease,1 and, as in most developing fields of therapeutic endeavor, there are still many unanswered questions. A more accurate conception of the surgical target, a greater precision of method, and, above all, a further understanding of the physiological mechanism of tremor and rigidity are all required.In the production of tissue necrosis we have used two agents, alcohol and the betaemitting isotopes. It has been demonstrated in animals that a 20 mc. source of palladium-109 (Pd109) will produce in brain an area of complete necrosis 5-6 mm. in maximum diameter.2 This necrosis is first visible after 45 minutes' irradiation and reaches its maximum size after 90 minutes. Transition between necrosis and normal tissue is abrupt, and there is no evidence of neurological damage outside this area either immediately

Scaphocephaly, the result of fusion of the sagittal suture during the period of maximum growth of the skull, is the commonest of the cranial stenoses. Clinically significant fusion probably commences before birth. It occurs more commonly in males (80% approximately); there is a certain hereditary tendency; frequently there are associated congenital anomalies.Mental retardation and ocular difficulties, such as poor vision, diplopia, and nystagmus, undoubtedly occur in the more severe forms of synostosis cranii, but in pure scaphocephaly their incidence and their relationship to the deformity are still matters of speculation. In fact, ocular symptoms have rarely been reported. Mental defect has been described, but whether it exists independently as yet one more congenital anomaly or is really secondary to the synortosis is uncertain. The failure of a great many children with brachycephaly to improve mentally after apparently adequate surgical treatment of their skull deformity lends support to the belief

Surgical interruption of pain-conducting nerves in the treatment of cancer of the head and neck is a small but useful aspect of total management. It should generally be considered before resort to narcotics for relief of pain. At early stages of disease, it is virtually devoid of mortality or morbidity.

In 100 recent consecutive cases of brain tumors, which were treated surgically by the author, the case mortality was 3%. There were 116 operations, resulting in an operative mortality of 2.6%. All 3 deaths were related to procedures which were essentially biopsies. Of 34 patients with benign tumors, 26 (76%) have returned to their former useful occupations; of 28 with slowly progressive infiltrative tumors, 19 (68%) have returned to work; of 38 with malignant tumors, either primary or metastatic, only 4 (10%) have returned.