second group are manifold, and have diverse clinical significations. I will refer here only to convulsions of cortical origin, commonly known as partial epilepsy, or Jackson's epilepsy. A French author, Bravais, first described, in 1827, under the name of hemiplegic epilepsy, a variety of epileptiform convulsions that begin in one member, or on one side of the face, and which continue to be limited to one of the lateral halves of the body. Bravais did good service in isolating the clinical type, but to Hughlings Jackson, of the London Hospital, belongs the credit of having shown its significance and of having brought to light the relations between partial epilepsy and lesions of the cortex of the brain. I give a few details. Partial epilepsy consists sometimes of simple tremor, again of violent convulsions like those of true epilepsy, and producing a condition that may in a moment end in death. The general characteristic of the spasms is, that they begin in some isolated group of muscles, and are thence gradually propagated to other muscles of the same member, or of the whole body, before the patient loses consciousness. The loss of consciousness, however, is not fatal, as in true epilepsy; it may continue during the lifetime. Clinicians are now fully agreed as to the semeiological value of partial epilepsy, and the latest observers have confirmed the fundamental propositions put forth by me in 1883, in a work in which I had as collaborateur Mr. Pitres. The following points may be regarded as fully established: In the great majority of cases partial epilepsy results from lesions of the cortex. It but seldom follows lesions of the central portions of the brain. The affections which most readily produce it are limited affections with quick and progressive evolution (neoplasm, superficial encephalitis, meningitis, whether acute or chronic). Partial epilepsy is never observed in cases of extensive lesions that suddenly overspread the whole area of the motor zone. The lesions which produce it are usually in the motor zone itself, but they may lie outside of it, provided the affection is capable of irritating the elements of the motor convolutions. Thus, then, the topography of the lesions in this case is less fixed than in the case of permanent paralysis. That is why cortical paralysis can exist either with or without epileptiform convulsions, and vice versa. The principles that should

guide the clinician are as follows: When, in the intervals between attacks, the patient subject to epileptiform convulsions presents no sort of paralytic phenomena, then the lesion is in the vicinity of the motor zone of the cortex. Partial epilepsy begins either in the arm or in the leg or in the face; but we cannot fix by an absolute rule the seat of the cerebral lesion in its relation to the way the convulsions make their appearance. Still, the epileptiform convulsions which begin in the muscles of the members are generally produced by lesions situate at the level of the upper two-thirds of the motor zone, or in its vicinity; those which begin in the muscles of the face are commonly the result of lesions occupying the inferior extremity of the motor zone, or the neighboring parts.

It is seen that, from the point of view of exact topographic diagnosis, the epileptiform convulsions have less value than the paralysis, yet they authorize us to affirm almost with certainty that they have to do with a lesion of the cortex.

The first fact clearly established in cortical localization was, as I have said, that published by Broca in 1861. That author showed that disturbance of the faculty of articulate speech, since called aphemia, motor aphasia, and logoplegia, depends on a lesion of the foot of the third left frontal convolution. Latterly, the question of affections of speech, of aphasia, has been thoroughly investigated again. A more searching and a more exact clinical analysis has shown that there is ground for thinking that there are four sorts of affections corresponding to the loss, partial or total, of one of the four processes by means of which we enter into relations with our fellow men. These four processes are speaking, writing, hearing (of words), and reading. The former two serve us in expressing and transmitting our thoughts; the other two serve us in understanding and receiving the thoughts of others. Each of these four mental operations may be impaired, either separately or in conjunction with the others. Abolition of articulate speech is called Broca's aphasia, or motor aphasia; abolition of the power of writing is agraphia; of that of hearing words is word deafness; of that of reading, word blindness. Now, as each of these operations has its physi cal independence, so each has its organ, its special center in the

cortex. The lesion which produces motor aphasia is not that which produces word blindness; the one on which depends word deafness is not that which causes agraphia. As yet the precise seat of the four centers cannot be fixed. As regards two of them localization may be regarded as certain; for the other two it is still hypothetical, or, at least, only probable.

Before we point out these different localizations it is important to remind the reader that the left hemisphere of the brain, to the exclusion of the right hemisphere, governs the functions of speech. This fact, glimpsed by Dax, brought clearly to view by Broca with respect to aphemia, holds good also with regard to the other forms of aphasia. Sometimes, indeed, motor aphasia has been found to result from lesion of the right hemisphere, but in such cases the patients are invariably left-handed persons, that is to say, persons in whom the right cerebral hemisphere predominates. But such cases are exceptional; apart from them the rule is, that we speak, write, read, understand words with the left brain. Nor is this surprising, when we consider that, as Gratiolet has shown, the left brain develops earlier than the right; hence, when the infant begins to understand and to utter words, it must use rather the hemisphere that is better fitted for performing these functions.

I come now to the localization of the centers. Two of them, as I have said, those the destruction of which is followed by agraphia and word blindness, have not yet been determined with absolute certainty. The observations hitherto made must be multiplied, but as far as they go they lend the highest probability to the inference that the center which presides over writing is situate at the foot of the second frontal convolution, and that the center which presides over reading occupies the inferior parietal lobule, with or without the co-operation of the lobule of the pli courbe. We have far more decisive data with regard to the seats of the other two centers. Broca's researches have proved indisputably that the center for articulate speech occupies the foot of the third frontal convolution; the observations that are brought forward to contradict this cannot stand criticism. for the region of the cortex, lesion of which produces word deafness, that certainly, as Nothnagel held as early as 1879, occupies

As

the first frontal convolution. An analytical comparison of the seventeen cases recorded by Seppeli justifies this conclusion.

Such are the most important and the best-grounded of the localizations discovered through the anatomo-clinical method. At first they were not received without calling forth some opposition; and though most clinicians were quick to accept these localizations, at least with regard to motility and the functions of language, there were, as a matter of course, a few who rejected them. But the apparently contradictory facts brought forward by these few opponents could not bear methodical and rigorous criticism. To-day one need but consult the principal medical journals, and in particular the publications of the Paris Anatomical Society, in order to form a just estimate of the number and the force of the data on which are based the localizations of which I have spoken. New observations are daily confirming these localizations, and these observations would surely be more numerous still, but just now the publication of facts confirmatory of the propositions we have formulated is neglected. These propositions no longer meet with any serious contradiction among clinicians. A few physiologists still call them in question, but they do so on the ground of certain purely theoretical conceptions which, as I have shown, have nothing to do with the very definite results of the anatomo-clinical method. As Vulpian justly said:

"All the progress pathology has made remains as a permanent acquisition, whatever opinion be held as to the cortical centers of cerebration. Whether these centers exist or do not exist, it is henceforth indisputable that a lesion of the posterior portion of the left third frontal convolution causes impairment of language; that a destructive lesion of the superior portion of the ascending convolutions produces paralysis of the leg of the opposite side; and that lesion of the middle parts of the same convolutions is followed by paralysis of the arm of the opposite side. No less indisputable is it that certain irritative lesions of these same parts give rise to convulsive symptoms. These facts are highly important for the clinician, and their value is entirely independent, I repeat, of all questions as to the existence of centers of motor cerebration or other centers in the gray cortex of the brain."

It is well to recall these words of a savant who was at once a great physiologist and a great clinician.

CHARCOT.

WHAT SHALL THE NEGRO DO?

1. THIS paper is addressed directly to the colored people of the United States. A large mass of them, of course, will not see it; yet others of them will. Nothing more forcibly illustrates the great progress of our times than the fact that already one may safely count on reaching a considerable body of readers, wholly or partly of Negro blood, through the pages of a monthly publication adapted to the highest popular intelligence of the Anglo-Saxon race. The explanation of this is, that although the colored man in America enters the second quarter-century of his emancipation without yet having attained the full measure of American freedom decreed to him, he has, nevertheless, enjoyed, for at least twenty years, a larger share of private, public, religious, and political liberty than falls to the lot of any but a few peoples-the freest in the world.

man.

It would be far from the truth to say that other men everywhere, or even that all white men, are freer than he. No subject of the Czar, be he peasant or prince, however rich in privileges, dares claim the rights actually enjoyed by an American freedThe Negro's grievance is not that his liberties are few; it is that, in a land and nation whose measure of every man's freedom is all the freedom any one can attain without infringing upon a like freedom in others, and where all the competitions of life are keyed on this idea, his tenure of almost every public right is somehow mutilated by arbitrary discriminations against him. Not that he is in slave's shackles and between prison walls, or in a Russian's danger of them, but that, being entered in the race for the prize of American citizenship, in accordance with all the rules of the course, and being eager to run, he is first declared an inferior competitor, and then, without gain to any, but with only loss to all, is handicapped and hobbled.

Without gain to any and with loss to all. For in this con