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The following case is reported as a contribution to our knowledge of the aetiology of " congenital" hemiplegia. Case Report A baby girl, I.

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I N 194~, Cone, Pudenz and Odom I published an experimental study on the use of resorbable animal membranes such as amnioplastin, allantoic and Cargile membranes, as well as tantalum, as a means of preventing meningo-cerebral adhesions. They state: "On the basis of these findings none of the materials studied is considered as ideal for the prevention of meningocerebral adhesions. However, until a better material is described, we would recommend tantalum for this purpose."Because of this statement we have used tantalum in dogs to see for ourselves if one was justified in using it in man to prevent meningo-cerebral adhesions. METHODUnder general anaesthesia 1~ dogs were operated upon with the same care and operating room facilities utilized on patients. We feel that the results obtained in these dogs would be comparable to the results that we would obtain on a patient.* Tantalum foil was placed in the sub-dural space over a traumatized area of cerebral cortex. The animals were sacrificed at periods varying from 16 days to 4 89 months after the operation.Using 4 burr holes a large quadrilateral plate of bone was elevated, exposing, symmetrically, the dura mater covering the vertices of both cerebral hemispheres. The dura was incised at ~ to 4 widely separated points and the underlying cortical tissue was traumatized to an approximate depth of 5 mm. At first two areas of cortex were damaged in each hemisphere but, as it was noted that these animals rapidly developed epileptic seizures, only r traumata, one in each hemisphere, were inflicted on the later animals of the series. The usual plan of dealing with these symmetrically placed and approximately equal cortical injuries was to suture the dura over the damaged cortex on one side, whereas on the other, a square of tantalum was placed in the sub-dural space over the traumatized cortical area and the dura mater was sutured over it. The bone flap was then replaced and firmly anchored in position.Apart from the fact mentioned above that a few of the earlier experimental animals with multiple cortical traumata died in a few weeks with severe epileptic seizures, the post-operative course of these dogs was uneventful. RESULTSIn all these animals there was marked reactive thickening of the dura mater overlying the tantalum. This was beginning to be evident in an animal that died only 16 days after operation. Fig. 1 shows dura mater 4 mm. thick overlying tantalum foil placed in the sub-dural space over the animal's right * The operations were carried out by Captain Delarue while Resident on Doctor McKenzie's service. The assessment of the results was made by Professor Linell and Doctor McKenzie after Captain Delarue's departure overseas.~39

AN UNUSUAXJ CAUSE OF DEATH FROM CANCER. )I~ã nd apparently composed of pleura which is thickened in that region. Through this clear area the details of the ribs and scapula can be made'out.; tllere is very little evidence of dMtail of 'the lung. Tlle lower margin is irregular and ill defined, and slhows strands of denser tissue with clear areas between. The general 'appearance is strongly suggestive of air in the pleural cavity. It has not tlle typical appearance of a large pneumothorax, and is more typical of gas within a distended' viscus. The nature of the appearances described was clearly indicated when an opaque meal was given to the patient and a series of radiograms composed. The wlhole of the meal was seen to be retained on the left side, extending from a sharply defined point at the level of the first lumbar vertebra, and extending upwards to a point at tlle level of the seventlh dorsal vertebra. The opaque shadow, with tlje gas-distended. space above it, occupied about ''to-thirds of the total thoracic space on the left' side. Above the shadow of the' opaque material in the viscus was a clear area, antl at a still hiigher level a dome-shaped structure representing the limitations of the above-described air space. This structure most probably consisted of tllickened pleura, and formed a limiting membrane for the herniated stomaclh.IThe x-ray examination with the opaque food showed clearly that the stomach was situated in tlle thoracic cavity; the irregularity of the diaphragm and the gas formation seen in tlhe earlier pictures are suggestive of tlhe diagnosis, but no positive opinion could be expressed nntil the stomach lhad been filled witlh the opaque food. It is interesting to note that later negatives showed that limitiug structure of tlle air space was capable of contracting to some extent upon the stomach, and -tlhis is shown-by the negatives, in wllich the stomach is seen to contain less of thje food than in those of an earlier period..The radiogramns taken on June 28th, 1921, after the patient had been operated upon, slhow a different appearance from those taken when he was first examined.The upper suilaces of thle diaplhragm are practically on the same level. On both sides of the chest thle lung detail is well seen; there is no sign of the gas, the heart now occupies a normal position, in strong contrast to tlhe position it assumed in the first pictures, in which it was displaced well over to the righ-t. The lungs show an increase of the root shadows, and there is evidence of enlarged glands at tlle roots with peribronchial thickening extending into the lung substance.