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.

H. — Height, 4 feet 3 inches ; weight 52 pounds.

Head Measurements. inches. 

Circumference iSyi 

Naso-occipital arc gj-i 

Binauricular arc 10^ 

Antero-posterior diameter 5^ 

Greatest transverse diameter 45^ 

Binauricular diameter 45^ 

Facial length S^ 

Cephalic index 79 

Craniectomy was performed in his fifth year, the incision being 
made through the skull in an antero-posterior diameter, beginning at 
the occipital crest and coming forward to the root of the hair. 

A mute when Ire entered school at six years of age, has learned to 
make his wants known in single words and short phrases. Was wild 
and unmanageable, but responding to discipline, is now fairly 
obedient to simple commands. Has learned to hold chalk, and pencil, 
and to erase black-board, to string beads and match primary colors, 
to lace a shoe, and to recognize pictures, such as horse, cow, dog, etc., 
associating and calling name, when he sees the living animal. 
Can execute a few simple movements in drill and march a little. 
Recognizes members of his family when seeing them after long 
intervals ; is fond of his brother, of his nurses and of animals. Is 
much diverted by music, which always excites him to rhythmic 
movements.

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