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March 14, 1908


JAMA. 1908;L(11):883. doi:10.1001/jama.1908.02530370049011

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It has long been recognized that the brain substance is, in great part at least, insensitive to pain, but not that this lack of sensibility is shared by the dura. In fact, this envelope of the brain has been commonly credited with a special sensitiveness to irritation and with being the chief active factor in the local pain production of cerebral disease. The statement by Thomas and Cushing in this issue of The Journal1 that the whole operation of incision and reversion of this membrane and the cutting down to and shelling out of a subcortical cyst could be carried out without any apparent inconvenience to the conscious, unanesthetized patient is a rather striking one that may be of decided value in future cases of brain surgery. The fact that momentary discomfort was produced by experimental tension of the dura is significant, however, and may, as Cushing says, lead

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