The Lumleian Lectures on the Aetiology of Phthisis
Authors: J. Andrew
Journal: BMJ (1884)

The lectUrer th-stated his opinions as.to Localiation, liUmiting considerationbo.movements.For illustrtion, he imgiedla ¢ent for the arm and the leg.The" Univerallmr:' wouI say that every part of the centre represented both the ami and the.leg in the same way; the "Localiser" would say that one )part of it: repsented the arm only, and another part the leg, only--would, indeed~wake two centres.*This is the current hypothesis The lecturer did not take either of these views; he restated the opinion which he had held as to localisation, both before and since the, recent experiments of Hitzig,.Ferrier, and others on the mid-cerebral cortex."It may be said that one convolution will represent only the move- ments of the arm, another only those of speech, another only those of the leg, and so on.The facts above stated show that this is not the plan of structure of the nervous system.Thus, to take an illustra- tion, the external parts, x, y, and i, are each.represented by units of the corpus striatum.But the plan of representation is not that some units contain x largely only, as x,, others y largely only, as y,, but that each unit eoantains x, y, and z-sonme, let us.say, as x, Y2, z; others as x2, Ys, z, etc. When, we come to the still higher evolution of the cerebrum,7 we 'can easily understand that, if the same plan be carried out, a square inch of convolution may be wanting, without palsy of the face, arm, and leg, as x, y, and z are represented in other convo- luitions; and we can also easily understand that discharge of a square inch of convolution must pu.t in excessive movemnent the whole region;for it contains processes representing x, y, and z, with grey matter in exact proportion to the degree of complexity."(St.Andrew's Medical Grad.Trans., 1870.)This is only.anotherway of stating the doc- trine of compensation and its "inversion," co-operation in excess (see second lecture).This double doctrine, he thinks, applies to represen- tation of movements in the mid-cerebral region of dogs.Destruc- tion of a part of the dog's mid-cortex entails no permanent paralysis, but discharge of any part of it produces convulsion.Ferrier, Charcot, and others have shown, since the part quoted was written, that destruc- tive mid-cortical lesions in monkeys and men entail some permanent local paralysis; in these animals, it would seem that there is less com- pensation than in dogs.The important question is-Is there some recovery, and thus some compensation, in the case of man?The lecturer did not now suppose compensation for any destructive lesion to be ever absolute.His hypothesis was that the so-called centre for the arm represents that partlery specially, but that italsorepresents the leg and face more generally, and the parts on the other side of t*e body still more generally; similarly, mutatis mutandis for the other centres.According to this view, destruction of the arm-centre should entail some decided paralysis of that limb, and very little, if any, of the leg and face, which two parts would have also a large representation in, so to speak, their own more particular centres.On the other hand, excessive discharge limited to the arm-centre should produce convul- sion, beginning in that limb, and yet spreading beyond it to the leg, face, etc.The currents developed would, however, not be limited to one centre; they would, no doubt, spread to collateral centres, and discharge them; thus a convulsion beginning in the arm and becoming universal, was no evidence that a single centre-the arm-centre-represents all four limbs."Yet certain experiments by Franck and Pitres on dogs tended, the lecturer thought, to show that his view of locali- sation-that every centre represented all parts, but that each centre represented some one very specially-held m the case of those animals.They conclude from these experiments: "Elles d -montrent, en effet que l'epilepsie peut se generaliser bien que l'excitation provocatrice ait ete limitee nun seul centre cortical [they isplated the arm-centre, and by stimulation of it produced convlision of all four limbs] et que la destruction pr6alable d'un centre cortical [they cut out the arm-centre in another experiment] n'empeche pas l'extension des convulsions aux muscles correspondant au centre prealablement detruit."It must be said that these distinguished physicians believe, as stated in the.first lecture, that, "Le cerveau commence l'attaque, la protu- berance, le bulbe et la moelle la generalisent."Ablation of the cor- tical centre, "primitivement excite" does not (Albertoni, Franck, and Pitres) stop the convulsions.Franck and Pitres' argument is very able and powerful; their contention deserves most respectful consideration.No doubt centres in the pons, medulla, and spinal cord (lowest centres), are discharged by. the prior cortical discharge.At. any rate, the ex- perimnents mentioned go towards showing that all the lowest centres 7 At that time, I arranged centres morphologically, and did not then make a