10 and 8 years at time photograph was taken. Superficial excitable 
idiots. Brown hair and eyes. Sight, hearing, taste, and smell nor- 
mal, so far as can be judged. Alveolar arches wider than normal, 
and the palates almost flat ; sialorrhoea. Teeth fair. Right-handed. 
Circulation poor ; hands and feet always cold. Began to walk at end 
of first year, drag feet, but are very active children. Are uncon- 
scious of danger, excitable, and destructive; quick-tempered, and 
when angry bite fingers, slap faces, and, throwing themselves down, 
will beat heads upon the floor. Are egotistical, fond of attracting 
attention, obstinate, selfish, and jealous. Powers of attention, imita- 
tion, and memory rather remarkable for children of this grade. 
Nervous and in perpetual motion ; unclean in habits, incapable of 
self-help. Pleads microbrachycephalic.

M. — Height, 4 feet i inch; weight, 46^4 pounds.

Head Measurements. inches. 

Circumference 15^ 

Naso-occipital arc 9?'8 

Binauricular arc 954 

Antero-posterior diameter 4^4 

Greatest transverse diameter 45-2 

Binauricular diameter 4% 

Facial length SH 

Cephalic index 96 

Craniectomy was performed in his third year, an incision having 
been made through the skull in an antero-posterior direction, begin- 
ning at the occipital crest and coming forward to the root of the 
hair, then curving to the right, a piece of bone one inch wide being 
removed. 

Body well formed, hands abnormally large. Has excessive muscu- 
lar development, especially at wrists, enabling him to lift himself by 
hands and to cling to a pole. If his hands are supported, will climb 
with wonderful agility and peculiar monkey-like movements. Ner-

vous and active. He never walks, but runs in a peculiar " tip-toe "

fashion. Vocabulary limited to a very few words. 

Devoted to his brother, is fond of other children, but mischievous, 
likes to tantalize them, which he does in a variety of ways. Will 
strike in jest, unconscious of the violence of a blow. Can call his 
brother and nurses by name, say " good-bye," kissing and waving 
his hand, but attempts nothing further than the two short phrases : 
" I'll kill you," and " What's that?" 

More mischievous and destructive, with less powers of attention 
than his brother, M. has never been a fit subject for school training. 
Is a good mimic. Imitates the barber stropping razor, lathering 
face and shaving. Can fall and imitate a spasm perfectly, and 
enjoys the fun of it with his playmates, but when a boy falls in a 
true spasm, will run quickly to place a pillow under his head. Has 
learned to " back-fold " his arms, and understands that when he is 
turned face to the wall, placed in a corner, or forced to stand on 
a stool that it is for discipline. Knows the name of every boy in 
his dormitory — 34 in all — and can also select a particular key from a 
large bunch. 

Family history good ; it is claimed that there is no nervousness on 
either side. Both boys were born at full term; labor in each case 
extremely difficult but without the aid of instruments. Father, a 
merchant by occupation, 24, and mother 28, at time of H.'s birth; 
AI. born two years later. Both children nourished bv mother. Both 
heads were observed at birth to be unusually small ; the fontanels 
had closed, and there was bulging of the cranial vault, extending in 
antero-posterior direction. 

A constant source of interest to those in charge, both have re- 
ceived for over six years more than the usual amount of individual 
attention, yet the result attained has not been even capacity for self- 
help without assistance. These cases offer therefore still another 
practical refutation of the claims made by the advocates of craniec- 
tomy. This refutation is further emphasized by a comparison be- 
tween these cases, and the second one described under microcephalus 
(Case B, p. 296). Of the same age as the older of these brothers and 
possessing practically the same mental capacity, with head measure- 
ments closely approximating, P. who has received the same care and 
training for about the same length of time — the three boys having 
grown up together — is really both physically and mentally rather in 
advance of the other two boys who have had the advantage ( ?) of