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indicated, and the patient recovered from the operation and received wonderful benefit to his general condition.

Case V.-This was the case of a farmer who was suffering from sickness and such intense headache that it was quite impossible for him to follow his occupation. Shortly before admission into hospital, it was found that blindness was setting in, and that attacks of unconsciousness had supervened. An operation was performed on the basis of a correct diagnosis, and a large cyst removed. The patient recovered, and eighteen months afterwards was able to work on his farm, and even to lift heavy weights of corn.

Case VI.-A man was suffering from violent fits. The fits were so frequent that he had several in the course of the examination. They were followed by unconsciousness. He had also severe headache and giddiness, and his mental condition was deteriorating. A tumour was found and removed. The patient's life was thus saved. After nine years he was in fairly good health. Very slight attacks still occurred from time to time, and there was some loss of power of the right arm and leg.

Case VII.-A boy of eight had become nearly blind, was unable to stand, and was suffering from fits. By means of physiological knowledge, the surgeon diagnosed a tumour in the cerebellum. This was found at the operation. Four years afterwards the patient was quite well.

Case VIII.-In this case the patient was a boy of fourteen, and the condition was caused by a large tumour and cyst of the cerebellum. These were duly diagnosed, found and removed. Eleven years afterwards the only sign left was a slight unsteadiness of the hand after a long bicycle ride, or similar prolonged exertion.

The above accounts are brief epitomes of the records of cases which have been published in medical journals in different countries. The gravity of the nature of each and all of these cases is obvious. The suffering of each patient almost defies description. But these records show clearly what science has been able to accomplish for the alleviation of that suffering. It may perhaps be well to mention that in cases of malignant disease the removal of the tumour does not always suffice to cure the patient. Cancer, unfortunately, tends to recur after removal in all parts of the body, and in no organ does it recur more frequently than in the brain. But even if the life is not saved, surgical intervention delivers the patient from the total blindness and agonising headache which accompany these tumours. With the growth of our knowledge of the topography of the nervous system the zone of operation is continually expanding, so that what but a few years back ranked as an impossibility, now finds a recognised place among therapeutical


This is especially the case in regard to the cerebellum, formerly believed to be inoperable, while even the dangerously and deeply situated pituitary body itself has proved not to be beyond the reach of knowledge and skill.

In The Times of the 9th of March 1909 the successful removal in Berlin of a large tumour from the pituitary gland was recorded as a wonderful achievement. Wonderful it was, but the operation had been devised and employed three years before in this country, and has since been repeated here in a considerable number of cases. We thus see the limits of the inaccessible receding from year to year, and though, from the nature of the tasks which it is called upon to undertake, the proportion of failures in cerebral surgery may perhaps always be higher than in less vital areas of operation, yet on the other hand we must remember that every successful case represents not simply the setting of a limb or the restoring of a function, but the wresting of a human being from death itself.


The same guiding lines have assisted the operator in throwing off the trammels of the past when dealing with the spinal cord as with the brain. He no longer need grope in the dark, thanks to the light thrown on the scene by animal experiment. The lesions, the seats of disease in the spinal cord, can be localised by the aid of physiological knowledge, but not without it. No amount of clinical experience will teach a surgeon where he has to explore the spine to find a tumour. Within the last few years the medical journals of every civilised country have brought accounts of attempts to remove diseased areas from the cord, anil not a few of these have been successful. Lives, not single but by tens, if not by hundreds, have been saved, the paralysed have been made to walk, and the pain of the suffering has been banished. Not in every case, it is true, for that result would be superhuman, but in a stately number, a number which represents a sensible diminution in the affliction of the race.

THE SURGERY OF THE NERVES Nerves have their diseases like the rest of the body, and some of these amenable to surgical treatment. One of these conditions-namely, facial neuralgia-and certain forms of its treatment, will be dealt with. This form of neuralgia frequently proves extremely intractable, and the pain may be so intense that the patient cannot follow any occupation, cannot think of anything else but the pain, and at last becomes distracted. Suicide is not an uncommon termination of a severe attack of this facial neuralgia. Life is a burden under its pangs, and any means of relief will be welcomed by the sufferer. Nerve stretching only eases temporarily, and applications, narcotics, and internal medication are often quite useless.

The surgeonphysiologist has considered the problem. The facial nerve derives its sensory fibres through a ganglion, named the Gasserian ganglion, which is situated deep in the face, behind and below the orbit. The ganglion lies in close proximity to the base of the skull, and is difficult and dangerous to approach. Its functions have been determined by experiment, and the capability of removing it has been assured by the same means. The removal of this ganglion has been performed for these severe neuralgic cases. The operation is difficult, but its success is certain. The neuralgia inevitably ceases, and perhaps in no class of surgery is the benefit conferred so immediate, so lasting, and so appreciated by the patient. Those only who have themselves experienced this form of torture, or have been called upon to witness it, can realise the full force of the truth of this statement.

Subsequently to the employment of this method, another operation, the outcome of experimental research, has also been devised for the relief of this condition. Physiological experiment having shown that alcohol exercises a paralysing effect upon the peripheral nerves, a method has been devised of injecting the affected nerves with alcohol, and so bringing about relief from the overwhelming pain.

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What has here been said only tells of a few results; but this at all events has been made clear, that even in the formidable field of nervous disease the knowledge acquired by animal experiment has been of supreme importance to mankind.

Whether a human life is to be regarded as more valuable than the life of an animal, whether the pain inflicted now on a small number of animals is not justified more than a thousandfold by the saving of human pain both now and through all the ages to come, are questions which admit of no dogmatic answer.

In the opinion of the writer, a human life is worth that of many animals. Those who have the knowledge and skill should therefore continue their experimental investigations. Consideration for the animals employed should be exercised, and free use of the blessed unconsciousness by anaesthesia should be made. Investigations carried out in that way must tend toward an increase of knowledge, and thus enable the clinician to alleviate and prevent pain and suffering, not only in human beings but also in all sentient creatures. Knowledge is power !



Handel is at once so great and so simple that it is only professional musicians who cannot understand him.-SAMUEL BUTLER's Notebook.

The twentieth Triennial Handel Festival at the Crystal Palace, held on the 25th, 27th, and 29th of June, entirely falsified the predictions of those who prophesied and apparently hoped for its failure, and ought to reassure those who wish to see its continuance in the future. Not only were the performances, in respect of the chorus-singing, perhaps the best that have been given, but the audience on the third day, when Messiah was performed, was one of the largest ever known on these occasions (it was said to have been absolutely the largest, but figures are not forthcoming), and afforded in itself an impressive spectacle; and even The Times, which for some years past has endeavoured to belittle the Handel Festivals, seems to have repented, and concluded a fairly sympathetic criticism with the reflection that it would be worth while to try it again.

As an enthusiast both for Handel and for the Triennial Festivals, I have no quarrel with that phrase. It implies what is quite true, that these performances on a vast scale can hardly be artistically perfect; that they are an attempt at something the complete achievement of which can hardly under all the circumstances be realised. But before pointing out why this is so, and what improvements are possible, let us face the adversary by a judicial statement of the reasons why the Handel Festival, with whatever unavoidable drawbacks, is nevertheless a fitting and rational celebration. In the first place, Handel, who is at all events one of the greatest of composers (I call him the greatest, though not sans phrase), was practically an English musician; he spent nearly all his life here, played his part in English society (though he never quite mastered our language), and gave us the whole fruits of his genius ; a special commemoration of him is therefore only a proper and fitting tribute on the part of a grateful country. Secondly, his choral writing is so varied and picturesque in dramatic expression, and for the most part so broad and simple in its structure, that it combines the elements of constant variety of interest with a special suitability for effective delivery by a great mass of vocalists. It may be

doubted whether any other composer would stand the double test. Thirdly, whatever may be said as to certain artistic defects inseparable from the performances as at present organised, the fact remains that choral singing on this vast scale produces effects of overwhelming grandeur and sublimity, which can be realised nowhere else, and which are well worth having for their own sake, even at the cost of some defects in regard to balance of sound and musical detail. Those who scoff at the desire for great effects of this kind, as a proof of vulgarity of taste, may be reminded that Berlioz, certainly one of the least bourgeois of musicians, had an ambition for something of the same kind in modern instrumental music, and in his treatise on Orchestration' gives 3 kind of specification for an immense band (including thirty harps and thirty pianofortes) for which compositions might be specially written, and which would produce, he said, effects' which can be compared to nothing hitherto achieved in art.'

The most serious musical defect in the Handel Festivals is one which might be remedied, the difficulty in the way being probably chiefly financial : I mean the disproportion between the numbers of the chorus and the band. At the Handel Festival given at Westminster Abbey in 1784 the relative numbers were : chorus singers, 274; band, 250 (including twenty-six oboes and twentysix bassoons). The chorus here was undoubtedly too small in proportion to the band. But at the Crystal Palace we have, roughly (precise figures are not given), a chorus of 3500 and a band of 500, a good many of the string players in the band being probably not very efficient amateurs. The result is that in the very numerous cases where Handel relieves the effect of massed harmonies for the chorus by decorative figure passages for the violins, the latter are not heard at all while the chorus are singing, and the true effect is of course not realised. In the plague of Alies chorus in Israel the whole effect depends on the violin passages, and on the delightfully humorous change to a moving bass at the point where the locusts came without number'; but at the performance hardly anything is heard but the choral passages, which are mainly adaptations from Stradella's cantata ; Handel's own hand is all in the accompaniments, which we cannot hear. A still worse failure from the same cause was in the powerful chorus ‘But the waters overwhelmed their enemies,' the climax of the discomfiture of the Egyptians; the sweeping triplet figure for the strings, by which Handel, in his characteristically direct and sledge-hammer fashion, symbolises the return of the whelming waters, was nearly inaudible, and the whole meaning of the composition obscured. The reason that the ‘Amen' chorus in Messiah


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