This report deals with the current view of painconducting pathways and their mutual relation in the medulla and the thalamus, which makes it possible to understand the basis of central pain. It is stressed that a thalamotomy for parkinsonism does not give rise to a thalamic syndrome in spite of the fact that the surgical lesion is placed in the region of thalamus, where this syndrome has its origin; it is also stressed that thalamotomies in the medial nuclei of thalamus are able to combat intractable pains and central pains, even a thalamic syndrome.

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It iiiag be very d.ifficult, sometimes, in a patient with se-(~u e l i~ after trauma capitis to eNtirnate wliether or not tliere is iiii iiitri.eane in the iiitra.craiiia1 p't?ssni*ejust like i t may he difficiil t to decide whether or not there is any organic: cliarige in the braill. It is of tlie greatest pract.ica1 and social as well as scientific interest, however, that in cases of irijrwy to head -1 have in i i i i i i t l espetrially pitieiitn who 1i;ive liatl R coiiciissioii of the brilin, or a. traurnatic injury to the head without concussion of the brain or fracture of the skullevery effo1.1: is made to ;I sctei4xin whether tliwe is any evitlentre, 01' even a mere suggestion, of an organic lesioii of tlie br*ainthat ist to find out in such cases there is aiiy siibstaiitiiil hisis for tlie t:oniplaints of headache, dizziness, erethism, amnesia, in,wninia, etc. And there is an increasing tendency to ascribe these syinptoiiis substantial cause ( rniliaxny IiecIwis, vascular changes, etc.) .French authorsin particillair CZn.zr.de, Lamachc, and 1'urgowluhave demonstrated that an incrcuse of tAc .+tm.l pressure subsequent to a trauma of the head is considerably more common than generally assumed. The rather frequent occurrence of increased spinal pressure after a inore severe traurriu is a well-known fact. It looks, however, as if pressuiae increase may be ascertaiiiecl in a good many iiiore cases of this kind by detttrmination of FROM THE NEUROLOGICAL DEPARTMENT OF K O M M U N E -HOISPITALET, COPENHAGEN CHIEF-PHYSICIAN: PROF. AUQ. WIMMER, M . D .

The remarks I want to make have in particular been called forth by the works of Sjiiqvist, his thesis, and the paper he has read on this occasion on tractotomy in case0 of trigeminal neuralgia. As we have already heard, this tractotomy is a severing of the descending root of the trigeminal nerve, the bulbo-spinal tract. This operation, which Dr. Sjiiqvist has first worked on, interests me intensely. I n the first place it is a very effective therapemtical measure resting on a scientific basis, and the courage shown by Dr. Sjiiqvist and Professor Olivecrona in carrying out the operation is admirable; but the operation is also of interest as an exact experiment concerning lesions of the medulla oblongata.For several years I have been working on the pathology of the medulla oblongata, and of course nr. Sjiiqvist's work has given me much reason for thought. To my opinion some of the problems involved by this work are of general importance also as regards the explanation of atypical trigeminal neuralgias, -use of which they deserve to be discussed. I shall therefore be 80 free a8 to present some of these problems here, even though they are perhaps somewhat outside the scope of to-day's subject. The most remarkable fact is that an operative lesion of the medulla oblongata may cause trigeminal neuralgia to disappear,