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In connection with the gross lesions of the brain, due to arteriosclerosis, trauma, softening, tumor or syphilis, Schilder and Stengel have observed a series of cases in which the pain reaction of the whole body was more or less incomplete. Many of these cases showed sensory aphasia. Apractic phenomena of a minor degree were not uncommon, and in some cases the postural reflexes were increased. From the clinical symptomatology a lesion in the gyrus supramarginalis seemed probable.
The first of these cases came to autopsy and showed, in addition to a small lesion of the frontal lobe, a softening in the gyrus longus insulae spreading to Heschl's transversal circonvolution and the adjoining part of the temporal lobe. The process continued in the medullary substance of the gyrus supramarginalis, especially in its basal parts, and also reached the gyrus angularis. Two tumor cases, the one studied postmortem and the other by operation, confirmed the localization in the parietal lobe, especially in the gyrus supramarginalis.
All the cases showed the following characteristic features: The patients reacted incompletely or not at all to pin pricks, blows with hard objects and the faradic current. Sometimes there was a local reaction by partial withdrawal, but there was never an efficient escape or adequate defense reaction. An expression of pain in the face was sometimes present. Some of the patients offered themselves readily to pain or even inflicted it on themselves. Their utterances hinted of