Dear Jasper,

I just finished reading Something Rotten, which was an absolute delight and a fitting end to the tetralogy.

There is a medical error that I caught, which has been partly but incorrectly addressed in the "upgrade" section of your website.

The error relates to the description of the gunshot wound (page 359, 360, 374 of H&S hardcover edition) and the description of the neurological deficit that Thursday notices on page 379. (US: p370) You've described a right-sided injury and a right-sided motor deficit, and someone has tried to correct that to state that Thursday should be noticing left-sided motor symptoms because the right side of the brain controls the left side of the body.

That is not wholly correct because it does not take into account the description of the injury.

You've described the bullet hole as two inches above the right eye, no exit wound, and the bullet travelling obliquely so that it lodged between the inside of the skull and the surface of the brain. You didn't describe whether the Minotaur was a right or left-hoofed shot, but it is clear that the bullet lodged on the surface of the prefrontal cortex. Depending upon the angle of the shot (ie the Minotaur's hoofedness), it was probably the right prefrontal cortex but could have lodged near the midline or even as far as the left prefrontal cortex.

There is no motor deficit, ie no hemiplegia or hemiparesis, which would result from a bullet lodging on or in the prefrontal cortex. The motor areas are deep in the brain. A shot from the side, or a shot that penetrates much deeper into the brain from the front, would be required to give a motor injury.

The prefrontal cortex controls aspects of behavior and personality - think of prefrontal lobotomy and the stereotyped result of it. Changes in behavior and personality may result, if anything. No motor deficits. Patients with gunshot wounds to the prefrontal cortex have no deficit at all, or are noticed to have subtle to moderate changes in behavior and personality.

Some of the classical changes from a prefrontal injury are lack of initiative, disinhibition, lack of concern over social consequences of acts, inappropriate joking or punning, impulsivity, impairment of attention, etc.

In the context of the Thursday Next novels, it would certainly be interesting for Thursday to suffer some disinhibition and a propensity to inappropriate punning!

In any case, I submit that the proper correction to page 379 is NOT to state that Thursday still didn't have complete control of the left side of her body. Instead, she might remark that ever since the injury, she couldn't resist the tendency to blurt out the most awful puns at inopportune moments. On the other hoof, perhaps the simpler correction is to delete that whole sentence about not having full control of any particular side of her body...

Christopher Kovacs, MD, FRCPC, FACP.

Please close this box before proceeding.