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(e.) Insanity due to softening. That portion of the cortical substance most prone to embolic and thrombotic softening is that which is supplied by the parieto-sphenoidal branch of the middle cerebral, or Sylvian artery, the left being much more frequently affected than the right. That softening of the brain —even of quite limited extent—often gives rise to insanity has for many years been a well-established fact; but the proposition to trephine in such cases is, so far as I know, wholly original with me, as I can nowhere find record of cases similar to my own. By the term "softening," I do not mean cerebral abscess—all surgeons would trephine for abscess if its location could be determined—nor to that condition formerly called "red softening," which is in reality only the initial stage of a suppurative inflammation and which if not arrested leads to destruction of the nerve fibers and
LANPHEAR E. LECTURES ON INTRACRANIAL SURGERY. XI.—THE SURGICAL TREATMENT OF INSANITY. JAMA. 1895;XXIV(23):883–886. doi:10.1001/jama.1895.02430230017002
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