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70S JOURNAL.

THE CROONIAN LECTURES ON


EVOLUTION AND DISSOLUTION OF THE NERVOUS SYSTEM.
Delivered By at the Royal College of Physicians, March, 1884. F.R.C.P., J. HUGHLINGS F.R.S., JACKSON, M.D., Physician to the London Hospital. Lecture -So far I have, for the most .states and nervous states. III.

between mental part, ignored the distinction I now pay particular it regard to it. Here " as Spencer is well to remark the doctrine of evolution} that, says, under its purely scientific form, does not involve materialism, though its opponents it as doing so." He speaks of the represent persistently as being "utterly materialistic To describe Spencer, futile." hypothesis as materialists, and Tyndall is as absurd as speaking of Sir Huxley, Lister as an opponent of antiseptic be. surgery would Joseph Spencer insists on the absolute difference between states of conscious frequently ness and nervous states. Here is a most explicit declaration. After a of increasing complication of mental states and nervous ' vol. i, p. 403) : Of course, I do not .states, he writes (Psychology, mean actions thus become mental that material actions. As was said ' in Sections mind 41-51, 62, 63 : No effort enables us to assimilate' consideration a parallelism" lam merely and motion, in original) (Italic showing a certain physical "'between evolution and the correlative psychical to be thoroughly If any one wish as to evolution." materialistic the nervous let him not be materialistic what is material, at all system, as to mind, which is not material at all. A man has both a mind and .a body. one of doing On the principle thing at a time, I shall, in this A man, is lecture, first, speak of the body only. physically regarded, a sensori-motor mechanism. to insist that the I particularly wish or of mind basis consciousness?have this highest ?entres?physical that they represent of constitution, kind innumerable im different movements of all of the and indi very parts pressions body, although as that the lumbar as certainly com Tectly, enlargement represents few of a limited region of the body directly. It may be paratively centres are "for mind." this, in ?rejoined that the highest Admitting the sense that they form the physical basis of mind, I assert that they " are for body," too. If the doctrine of evolution be true, all nervous must be of sensori-motor centres constitution. A priori, it seems to suppose reasonable centres have the same com that, if the highest as the lower, being, like the lower, made up of cells and fibres, position It would be marvellous if, at a cer they have also the same constitution. or not, there were a sudden tain level, whether we call it one of evolution Is it not enough ?change into centres of a different kind of constitution. that the highest centres of one nervous difference system are greatly more complicated than the lower ? Some years ago, I asked the ques ' " can the organ of mind be substance' un tion : Of what composed, movements and impressions less of processes representing ? And how .can the convolutions differ from the inferior centres, except as parts intricate co-ordinations of impressions and move ?representing more in time and space than they do ? Are we to believe ments that the is built on a plan fundamentally different from that of the hemisphere tract ?" motor Andrew's Med. Grad. [and sensory] (St. Reports, 1870.) since the researches It is accepted, of Hitzig and Ferrier, that convolu of the brain (which I call middle motor centres) tions in the mid-region It mav, not without do represent movements. reason, be asked : Why not also the more anterior should frontal lobes parts of the brain, I motor call movements ? centres) represent (which highest Recently, and Gerald Yeo (Pro. Royal Soc, January 24th, 1884) indeed, Ferrier on monkeys, from experiments that the frontal lobes have concluded, some movements, and significantly these are lateral move represent most representative ments of the eyes and head?the (in another sense of all movements. of the word represent) This is all the more signifi in some cant, since many (the discharge epileptic paroxysms beginning centres) begin by turning of the eyes and head to part of the highest one side ; and the more significant still when we bear in mind Beevor's cases of postepileptic observationst coma, there is very hat, in many lateral deviation of the from the side to which transitory they eyes the in turned Ferrier agrees with prior paroxysm. Whilst, however,

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is motor, and that the whole anterior part of the.''brain inthinking a in the last analysis, must mental that, to us$ his words, operations, be merely the subjective side of sensory and motor substrata" (Func as I have long earnestly he does not tions of the Brain), contended, and into'middle in thinking there to be a divisi?n agree with me call the highest cerebral motor centres ;and he thinks that what! highest motor centres represent only movements of the eyes and head, and not movements of all parts of the body, as I do. In further exposition, shall for the most part, of movements I speak, re that no one has ever denied that convolutions only ; for I believe (or, as is sometimes said, sensations, inaccurately present impressions or ideas made up of combinations centres If the highest of sensations). of do not represent movements, it seems to me that the phenomena an ordinary I think that the Moreover, epileptic fit are unintelligible. of all parts of the and movements centres represent highest impressions seems to me to be sup this position body. Neglecting impressions, ported by very different kinds of evidence. is lost 1. I postulate that in an epileptic seizure, since consciousness in some part of the at or soon after its onset, the discharge begins I do not say that basis of consciousness. centres, the physical highest motor in all epileptic in some part of the seizures it begins highest dis centres ; these no doubt be put in secondary activity may by it I think in parts of the highest sensory centres. charges beginning are not, and that certain that epileptic attacks epileptiform quite in parts of the mid-cortical seizures are, owing to discharges beginning A consideration of the facts of epileptic region (middle motor centres). centres to the conclusion that the highest leads, I submit, paroxysms and lowest the middle of intermediation the represent, through in most is re-re-represent?all Centres?that parts of the organism a. We see in a severe epileptic fit that all the intricate combinations, are put in vigorous skeletal muscles develop activity?simultaneous of all parts of the body. of innumerable ment different movements b. If we take a slighter case, one of le petit mal, we see that the effects distributed are very widely, if not universally, of the central discharge as spasm over the body ; there are, in such cases, effects so various of ocular and hand muscles, pallor of the face, flow of saliva, perspi of the heart's ration, changes in the circulation (sometimes stopping is and arrest of respiration has insisted), ; there action, as Moxon a discharge of faeces and often in, or just after, these fits, slight of the voluminous urine. The existence, in some cases of le petit mal, mental intellectual aura, spoken of in the last lecture states, so-called effected by an epileptic guaran (first depth of dissolution discharge), to of are owing tees, so to speak, that the cruder effects just spoken states centres. The elaborate mental abnormal of the highest activity to ascribe to activity of I suppose, no one will hesitate mentioned, which, so far as I have ob "th? organ of mind" never, centres), (highest of middle seizures served, occur in or after epileptiform (discharges c. Then, if we take only the "warnings" " of epilepsy, motor centres), ' occur from, or rather of many different which warnings epilepsies, we find them ex or attend, of the central discharge, the beginning of ocular various ; there is giddiness, spasm implying ceedingly sensa muscles," or of some of those of the head ; there are "crude these we find Besides and taste. of smell, tions sight, hearing, and a peculiar to the referred sensation epigastrium, palpitation, d. and shivering, of tingling, referred sensations shuddering, widely is that, when a severe Another kind of evidence from cases of epilepsy so fit is over, there is some universal ; at least, I contended paralysis ol evidence to the in my last lecture. point Surely the several kinds basis of conscious that the highest centres?the conclusion physical the whole organism. ness?represent to the 2. There is a totally different kind of evidence which points same conclusion. Some medical writers speak of centres of volition, of centres for reasoning of ideational (?), and of emotional centres, not believ Whilst centres ; all four, of course, being cerebral centres. centre for each of these four ing in the least that there is a separate were. as if there of exposition, I will speak, for simplicity "faculties," states them not the mental to analyse, very briefly, I now proceed are in which arrangements, selves, but their physical bases?nervous of I submit, sensori-motor, indirectly representative each, triply I need, however, of parts of the body. and movements impressions for I suppose it will not be denied. of the sensory element, say nothing re a. The physical consists of nervous arrangements, basis of volition of the movement movements volition is, on ; the particular presenting . the of the whole of the Attest movement side, the survival physical The "centre of the centre for volition. activities during organism " of of movements, is a centre representative of volition particularly b. Ideational of the arms, legs, face and eyes. movements centres, or to the simple cases of tactual centres of memory. Limiting myself is that the ideiation?l cet?tre and visual ideas, or images, the assertion

THE BRITISH $M
of

MEDICAL

JOURNAL.

[April

12, 1884.

and eyes. movements That it of the hands represents necessity and retinal manual ; but is, of course, certain represents impressions on. one ever No that it also movements needs insisting represents his touched tactual (had a vivid image) without anything moving no one saw ever and ; (had a vivid visual fingers anything image) iu the anatomical ot* substrata without moving "his eyes ; therefore, or better, "faint what are called there ideas of objects," images," c. I and of the eyes. of the hands will be represented movements of a centre for reasoning confess that 1 never heard ; any one speak were the if for in of there warrant existence but, believing 1 other think there should centres for the faculties, separate to in a centre be warrant for believing for reasoning. greater serve us during in all Words ; reasoning they are necessarily required abstract ; this being so, the centre for words or for reasoning thought of nervous would consist arrangements representing highly especially * d. The emotional centre. and special articulatory movements. complex all parts of the body are manifestations In strong emotional nearly the the and involved?not limbs, vocal, facial, only respiratory internal organs. The emotional centre will but also many muscles, an exceedingly movements. wide of then represent range During are pallor, palpitation, and hurried ; occasion respiration fright there a of is heces there is there mouth there is increased ; ; passage dry ally, of skin.* coldness The popular would sweat with be that explanation centre which is not representative of the parts there is an emotional iu the manifestations, its activity but that concerned the produces whicli manifestations alone represent those by acting on lower centres, more an The realistic I is centre that emotional view, submit, parts. con itself represents, the parts of the body very indirectly, although in different emotional cerned and that the emotion manifestations, the central arises during activities of the which, through subagency and lowest centres, middle the manifestations. produce in the existence of the four separate "Now, not believing faculties, are simply but holding that will, memory, and emotion arti reason, one a of state of consciousness. I aspects distinguished thing, ficially are four of instead there centres ; and that, centres, say that, highest of these and reason, centres, memory, will, activity during are simultaneously emotion in strictly ; or, displayed equivalent a there state arises of that If consciousness. words, so, then, the "four and their motor centres," putting together representa we obtained centres tions, have, altogether, highest represent of the arms, face ; (2) especially ing (1) movements, legs, and movements of the hands and eyes ; (3) articulatory movements ; and of many animal and organic. The (4) movements parts of the body, from this evidence, conclusion and very imperfectly incompletely I admit, is that the highest stated centres at any rate, very represent, and certainly most different, many, parts of the hotly. The two utterly same to different kinds of evidence the conclusion. converge Taking see that there is no incongruity we them in asserting that together, arc diseases and both of the highest centres. In ernlepsy insanity a state reason, and emotion, or, in other words, will, memory, health, arise during of consciousness, of sensori-motor activities slight sequent nervous of the highest centres, all parts of the arrangements representing a An seizure is sudden and excessive epileptic body. owing to discharge of very many of these sensori-motor nervous simul arrangements nearly such consciousness and from ceases, taneously. During discharges, into account downward of middle them, taking secondary discharges and tertiary discharges of lowest centres?there results that contention movements of innumerable of all parts of the body, which we call uni a case of insanity versal convulsion. like epilepsy, is which, Taking a disease of the highest the averment is that the negative centres, defect of consciousness, loss of, or loss of function element, implies of, for illustration, the topmost centres. This, layer of the highest on the hypothesis are that the highest centres is causa sensori-motor, tive pf some trifling widely distributed The ele paralysis. positive meut or is on mentation consciousness (illusions, etc,) going during of the lower level remaining, second activity the This, layer. highest occurs during mentation then possible, than nor activities, stronger of sensori-motor nervous activities but incom mal, arrangements, 1 It is not meant that a word, which is a an is psychical thing, activity of any nervous arrangements fur highly special and complex articulatory movements, but nervous arrange that such nervous arrangements (ort rather, audito-articulatory I believe that ments) are the physical bases or anatomical substrat* of words. are represented largely in Broca's region, but yet these articulatory movements over again in the highest motor centre,?*. 2 I believe that the of nerve positive effects are owing indirectly to exhaustion sudden discharge, holding that ttiere is a negative and a fibres effected by a prior positive element in the physical condition for fright; for example, the palpitation may be owing indirectly to exhaustion of the inhibitory fibres of the vagus, the pas*4ge of fieces indirectly to exhaustion of the splanchnic? ; the two positive of lower centres, consequent on symptom!*! arc owing to permitted over-activity removal of control.

less strong than those productive of convulsion. parably "Were, in the case of insanity, the second layer, or part of it, to discharge suddenly as occurs in an even and excessively, insane mentation epileptic fit, cease during the discharge, would and convulsion would result from it. as the This is an old conclusion, shows. At that following quotation not the advantages time I did not, of the researches of Hit2i> having and Fcrricr, divide the brain into middle and centres. As the highest words now intercalated show, I /lid not then distinguish clearly the from the physical. mental '' is irresistible, that mental from Surely the conclusion symptoms, are [on the physical of the hemisphere, disease like side] fundamentally and however chorea, convulsions, different. hemiplcgia, specially or must be to all due lack to of, They disorderly development of, scnsoii-motor (had. Tranx., (St. Anil. Med. processes." 1870.) It may be objected there are no move that, during most mentation, ments. It will bo borne in mind that I said that the nervous arrange ments of the four centres, the highest centres, together represent parts of the body triply The middle and lowest are not centres indirectly. " " of "reservoirs but also All that only resisting positions. energy," for is, to is contended take the case of visual ideation, and neglecting are that the sensory there excitations of nervous clement, slight movements of the ocular arrangements triply indirectly representing not strong but excitations overcome to the muscles, resistance enough centres. of the middle "When ideation rises into perception, there is, a stronger of the same nervous of physically, discharge arrangements so that the middle the higher centres, and then the lowest centres arc overcome. I speak of this subject after reflex again, considering in which the highest centres are engaged. actions I now speak of of to the again degrees organisation, especially*as are the which least organised. I have out centres, highest pointed in supposing that there is no difficulty that these centres may be the same most at the least the If the and, time, complex, organised. centres were already organised, there could be no new organisa highest I will now illustrate the process of disso tions, no new acquirements. to degrees of organisation. lution with It may be contended regard in a small quantity, that alcohol, it is granted "excites," although it produces coma. It may be said that the that, in a large quantity, man conduct of a drunken occurs boisterous because alcohol has nervous certain of his highest centres into arrangements goaded it is as and that Anstie the result of not, activity, per supposed, increased activity of a lower and more organised mitted level of evolu on exhaustion tion consequent of the higher, the less organised. Let us take a case free from ambiguity?a case of simple A vory fatigue. " " of what would be popularly called increased good example " activity from debility," of the brain is given in ti renter Britain. "This after five sleepless 1 felt most the peculiar evening, nights, terribly form of fatigue that we had experienced after six days and nights upon the the plains." writer his calls condition Observe, fatigue. "Again into two ??arts, thinking the brain seemed divided and independently, one side putting while the other answered them but this ; questions a time there was also a sort of half not insanity, altogether disagree of the brain, a replacing able wandering of an actual by an imagined we say that the condition was ideal scene." caused hv Popularly, ; but I submit that the more reasonable fatigue ?five sleepless nights is that caused state, fatigue explanation only the negative physical to tho negative of the mental the loss ol answering part condition, " " and the "actual scenes that the ideal which scenes," "replaced" them occurred of lower, more nervous during activity organised, uncontrolled the seems to me exhausted It arrangements, highest. by that Anstie's a more I may instance principle applies clearly here. extreme case. sets in during starvation Delirium it cannot be ; surely nervous contended that from total withdrawal of food certain arrange attain ments ? If they do, we have still to account greater activity for the negative of the starved man's delirious Does condition. part " " cause two diametrically innutrition and yet co-existing opposite nervous states of the ? Anstie's for accounts system principle lx>th. The next pair of terms I consider are voluntary and automatic. The " " most is very objectionable. It is a com expression voluntary a a of and of term. of Instead pound it, psychological physiological I suggest the expression "least which is rigidly automatic," equivalent to what is called "most is stated This in effect Her voluntary." by in the remark that the "cessation bert Spencer of automatic action and are one and the same the dawn of volition vol. (Psych., i, p. thing" arises during Volition of the least automatic nervous 497). activity . arrangements; "a kind is. of mental action arises which or, rather, one of memory, or will, according to tho side of it we reason, feeling, look at" (Spencer, we vol. i, p. 495). now So tho progress say that in evolution is from the most to the least automatic, and thus that the

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part?-i[ot<his b%he&6*erj^ryi*ce'nj^^ nervousifeyt?i?I<Aighe3t?cen*ifes>?l??iiig t?Q^f*h^h|gh03ti tefm aad- attiothecobje?te 3ia^^ wil? le*$stiratftomat?Q?J.^ ^esjibo&bbfingithi*: r, a w: J I? -1 li-f^l relation ?fr?te th? t?olonjr., ; j 'Tfa?i^p]9-of;-?tt(io!lqJ^ib]t]Mi into oouBftedionisa ,;a?psyc&opi.state, purely phyjsi^rsphjei?Q.? > are is a; There: itsel? several positibiris -?n?rto*another:7 ?oux [knowledge! c^^itMa ;*tre?ationiiaiby ,i4i'Perf??t; automaton, t?ingifthatt^esotmjb^ case; nervous almost movements ocular; in.this go -on/by dftg?eeBr1 ?rom those aHmg^ifa??%?twhii?h' movements* :(ayaaholis?B^ ?someimoirer m?ntsof the hands).4 byfj the. aid bfiotheiy By.currents passing firomifther'behest sensofy tcoimei^i?tdiaofivityt ^hj$mselv?!s-to those which more organised, ?ejpvt?ua To' say; tha4; nervous to the:h?fghest;motor ?entres,:,so to.speaki JoWeCjv, f?across" c?hfreB?iancl;fri*H? iaMaa^efa??ntSi. are? on means well that thesd motor lowest jniddl?i?nd go doWjiwards, .organ* arrangeants by?; themselves^ they; ce?tres?tair^uficu-lar through ' ? : on !of the,h eyeballs if with there is development of .movements ised; ; :and .to say that nervous 5 !;fch? go arrangements periphery difficulty^ Hence -to: is to isay.th?? they this? the in the least at all? by themselves^ ?j^ilit?e. &from ; process most,-?tganiaed,?ifro?iithe stage organised.^ from most.t?; most mo4ifi*ble to the. least modifiable leastra?tomatio? arey ohnanother ;-there is, alimitation aspect;; degrees degrees of-energy* of organisation what has> -been im the.higinriat and thus: from, wide from, the ?most? to?.? the least. libea?tions excitations idowntvatds, Repeating; to a pait, of : centimes were perfectly the. peripSery? there result movements eBntros limited already said in. effect*; if ;the highest " automatic there Would be ru? such thing as a "voluntary and sitrong reflex action, Here, we have complete oojmplete because all "operation :r iall'being -r. are, engaged in new corfect and -strong, .be ?there,would'be orders of centres, organised, sensory and motor, adjustments no*possibilityfar ' cause the highest to pariiciilarexternal con? centres arein great activity, th??mul-? circumstances ; -we should be ready adapted c?nsequem?ton . ?a \. J i /. to new conditions'r cauldoccuar.?!\ :,.;;, j.-?. Ttoie ?f energy-liberations, ditions,!'but;;??n&w up wards. adaptations tiplication ; ?more ; and ;the becoming morei automatic, The vivid, This is. a purely becoming jierfectly; organised, .physical process. im^g?f t?e vmi?ntal iillustration i? sides of one thing ; a commonplace aire! .onljf j?i?tsreirt state toe have, arises during condition-m-the (not from) the physical: two dfvisiona and defini*efy of the highest is strongly There are degrees of a?tomati?ity&dm/those cen^resy- and leariiingj?Offtriti?. operas ? it seems part.;of ;so to ?speak,! the tiona Mal??nte? the. lower centres are,engaged;; comparatively ?Sprojected,"i because perfect,? through,: an we can for its absence* the tiirter world. Nexti day, trj the-activities of? those thiiikiof Jslm brick/in secondai^nutomatic?writingi example.).up are concerned/during have Man idea of, it," or, as I prefer to say, .'haver;;a) faint; images one's least?utomat?cnervous arrangementsiwhich > ? we, a and We vivid that/s there ara degrees had the reflex Ifa.thi?-case, fffhere^ yesterday;: present image. thinkings .maysay doings. and most automatic* the lowest and the-?middle and weak; from-most sensory organised acti-on,is;incompleitie nervpus.;arrang?nient?/-upiito nervous centres" and the middle and lowest motor are not engag?di-, The Mghest firsti time, tarrangements just begun?nerve-stuffbeing^forfth?; . ?;.r.?,; ,.;.;*: .there >is < :-.,,i .' sens'ojry and motor i; r t s.-: stiE ?eflex travelled by nerve-currents. centres are' alone engaged*; To illustrate dissolution,.chain are ?n> fiwm this point of view!, would be esseri4 action* but. only, the central. links of .the sensori-motor ! .of former> illustrations, [pTo?ess which ?ofde* after ;speaking tially a repetition gaged?; the central, ??rt only, of. the. whole occurred iin given? ! I-,would in; Jiising such an is done over again,' and, the excitations, observe here: that, grees of .organisation.! hting &Ughtt/th? perception " " as; the automatic we must bear in mind that what is very is fainty and, the .Ibwser reehtree --not-'being -engaged^ it expression image arising , :/,< ; This is either & .* seems moi? to one man is not automatic of to. anotherv and automatic ourselves^] isfeebly projected, jiact indefinitely truth or a truism, as we apply it. When a patient th? aVucidation Let us see how the doctrine of reflex actioa applies/in is delirious, say of an epileptic of the-phenomena fit, and thukr i-llu?trate: agaiiai^oh.a during acate non-oerebral disease, and goes throraghV inpantomime, ? of his trade, although are exceed small scale, th? dit?tum ithat an epileptic fit is, owing! tonaaiuexcessiste these the manipulations operations .elaborate i substrata of ;00M in .some part of the ; anatomical-to him. in: themselves, discharge beginning they are \not, elaborate Piey ingly > not believe, have become deeply automatic,! owin partit foi my -do j Let* us imagine*] which and' go on very much sciqusness. jto by themselves releerla centre ?and;nothing that there is a centre for visual/ideation health <; in:cdnseque?ee,.in spite ofthejr; elaborateness^the peifeistenee :a deepey dissolution of onty such, actions- implies IWie '-store-?jp'f of visual: imag-esionly. made up of the, anatomic?Lbasiea than the persistence in anothfcr ^patient of aetionsi ?ach;o? whi?k bas-?oine coloui had' not]- i? 'him' " -equally elaborat^whioii ' imatgesi?f innumerable>diffejenttobje?ts, 1 .>-. y/;. <jv?<--s> >'. <''^i -m?j i;:I>... become rautomatic: and s?m&shape.';'.tt?fe -i:\v<-:\'i jm?ans, an.?ne nhy&ml aide,'ii;l??t^?<efitte??wj? nervous> ?rlra?^ejijmtsiue^hi.-of I pass over the two antithetical are? imagining containsinnumerable "sp?cial," " terms,.'?^general":and' " " "; a and also another and >ar different ocula? which represents different and now come to retinal impression, We .pair,. complex simple. " the doctrine of reflex action. these, : The .term corresponding to most are/, anatomically, movement; sensori-motor,! (retino-ooular^ " organ '' " f aid ised most automatic nervous; is ; most that correspond During aErangei?en^ perfectly ' ' reflex;?' " ' ** from the periphery,, of and; ?? least automatic activities, this centre, unprovoked reflex. is \ least perfectly :(io> ing to ; 'least organised slight of action answer automatic and reflex ton weak of actions): we have faint ?visual idea? ;i;during Degrees complete degrees of independency nervomi arrangements, jto, reactions 'from those almost on by themselves^ activities: and I strong agencies leading! by-:peripheral provoked going' > on the periphery reflex. acti<tais)j:wel have Vivid ofall others; to those put in action (complete and strong by others, j nearly'independently on most dependent centres> all others. of the concerna; are of reflex ideas visual astion of {the parts durimgperce^? highest Degrees degrees nervous arrangements are the same). So far for two degre?ar>i?? ideation tion and during to degrees of stimuli coming going-on according to them. of No doubt the distinction of that the Hie nervous cells is to a very -great extent artificial ?some Now, suppose ; healthy activity. but it is a convenient one. In further remarks, I limit myself .of? these centres, by any pathological process,, bt?oim arrangements entirely to reflex actions in which to a degree, such as occurs The co?jBe? in epilepsy. the highest are necessarily cerebral centres highly unstable, Here we make a division of these : 1, complete and strong, occasionally engaged. disobarget quenco will be that many nervous arrangements those in which tiny highest centres ar? strongly engaged along with all simultaneously. JDu?ing?such a-disdhargev suddenly, excessively,*and lower centres and weak, those- in which ; 2j incomplete the highest there would not arise images of rmany objects; d&ffer??tly coloured aad be. crude massesno?ivi?rid centres are alone and are in but slight L shaped ; but, on the con&ary^ there would engaged, activity. Beginning with an artificially case of colour before the eyes, arid there would, also be a strong ; development simplified complete and strong reflex action, (< I suppose that I am seeing a brick : this is sometimes is to say-, convulsioaiofrtihie at once?that of many ocular movements called a per Some epileptici seizures do, begin by tjie:j>aj?e>n<fc that.I have a vivid of the eyeballs. So far muscles ;?'I prefer the expression, ception image. < we have spoken of a mental o? the aoji?js event ; now for ; spasmodic' ^he correlative vivid, colour before his>eyes turning * having purely an a '/ 1o One uncommon onset. is or rather reflex action side, is not physicali event, which Ito occurring during, I a terms'Uii The of of vast of the organism with the environment ! Therje is another matter .pairs effecting* correspondence importance. (the I I have passed overeare* I which. I have spoken, and some others' which What first happens is that'there is a peri^ process-is really double). ; in meaning, but may not seem so at first glance, the then pass through thinks1 parallel pheral impression -..jW? (upon the retina), impulses that evolution is not a necessary have to-mention and up to the highest ; it depends It lowest, through; the middle, process sensory1 centres. should b? is not an "even'" so .to speak, observed that there is> passage on (conditions. from the most Evolution, gya^Bally particularly "We develop" as'-we to ther least organised to top. centres ; from th? least modifiable to etc., from bottom organised increasing complexity, we are to what that; is, acc?rd?ri? must,: alsp^s by^inheritance}.fl>p&. w? can,;t^t There^?s?som^WriA aj$tiei becoming -more[automatic is h?t <ctis?blution;s? I believe some think' it to I is, accord ; a process whidt is, on tHe cpi^tr^ry, evolution ;"beeom^ng cpniplete. Tire highest :centres more: hgj put I will call Internal Evolution, there is what arcfthe -most, ?o/npl?xly evolving,-hut are also the. least perfectly evolved. I# othier words, tue highest centres are:" the t-veiled end." In them evolution.'is I * In iseeing; a small objje?t,i^^thef? li??ybe only exoitati?n of *nletdr,?e>*^U8 most actively going oil- whilst in some lowest the* respiratory, evo??-' iarrangenlents ' in ' ceritresVe.g'., ' the highest centres, not passing downwards "to Smi?dl?^nA " ; tion is probably nearly completed. ; ; lowest.

70S tt^^AJTEEtT^X^
; in the highest On centres. account of its great goes ob most actively in the highest centres of man, he differs so greatly from preponderance lower animals. We acquire numerous ideas : that is to say, different there is, on the physical of many different nervous side, an organisation of our highest actual converse with the centres, during arrangements as in sleep andina environment. this actual con reflection," When, verse ceases, the quasi-spontaneous sensory slight activity of the highest with by the environment, centres is uninterfered they being protected from it by the lowest and middle and, consequently, sensory centres; on the environment, there are no reactions the highest motor-centre centres in such case (sleep, resisted the middle and lowest ; by being of the reflection, reverie, etc.); the very highest nervous arrangements can be made, centres, those in which highest entirely new organisations wul be in least activity, and the next lower of those centres in greater The nervous of the highest centres, or some activity. arrangements " elements of them, are left to fight it out among themselves ;" new combinations new, although arise, the survival of the fittest. Manifestly are made evanescent ; but I contend combinations, during dreaming are made during that permanent (internal evolutions) rearrangements of that the late Dr. Symonds, eo.-catled dreamless sleep (I believe stated this in effect). evolution Internal is supposed to go on Bristol, as to some centres, such as tnose for mictu in all centres ; perhaps, we may say that it has been almost completed; rition and defalcation, at birth, and are but slightly, I imagine, they are nearly autonomous over again in the higher centres, but are much under their represented I submit, accounts for The doctrine of internal evolution, inhibition. seems at first glance, of fibres from the inadequate number what, centres will be a great lowest centres towards highest. In the highest answer number of sensori-motor to any do not which combinations, and which with the environment, actually experienced correspondencies on their normal excitations do not lead to actual movements; and, in nervous the case of many lowest centres, there will be sensori-motor " for purely local affairs," which will, I imagine, arrangements require little re-representation in the higher centres. Since most mentation, so on is carried in visual and tactual called, ideas, or in ordinarily internal evolution centres leads to a great mul in the highest words, of nervous arrangements and ocular, manual, tiplication representing muscles in another way the statement ; this is repeating articulatory are very largely represented in the highest that small muscles centres.5 are (Spencer) Mentation involves emotion emotions ; as the highest out of the lower, there will be, on the physical side, in compounded a large man centres of the organic in his highest re^representation statements emotional manifestations. These parts concerned during as to very large representations, of small muscles and of organic parts in-the highest centres accord with the facts that in slight epileptic fits in parts of the highest ?comparatively beginning slight discharges, are the small muscles centres?the skeletal muscles chiefly convulsed a of the involvement of; and that there is very extensive spoken ?-We have, I think, in the doctrine of internal evolu organic parts. an of the disproportionate of organic involvement tion, explanation in attacks.6 of motor In those the middle parts slight epileptic parts centres especially small muscles, there are (Bevan Lewis) representing most small cells these will be (I suppose paths of least resistance). Whether the like obtains or not in the highest motor centres, I do not know. as possible, a man as a mere So far, I have, as much considered machine. I have often, it is true, in preceding remarks, used psycho terms ; but I have really been dealing the nervous logical only with of the physical been speaking conditions system?have underlying mental states. nervous Now, I speak of the relation of cdnsciousness'to states. The doctrine I hold is : first, that states of consciousness (or, states of mind) are utterly different from nervous states ; synonymously, for every mental state second, that the two things occur together?that there is a correlative nervous state ; third, that, although the two things occur in parallelism, there is no interference of one with the other. This may be called the doctrine of Concomitance. in the case Thus, of visual perception, there is an unbroken circuit, complete physical reflex action, from sensory periphery centres back to through highest muscular a The visual state, occurs image, purely mental periphery. in parallelism with?arises activities of the two during (not from)?the 5 It iswell known that, after amputation of a limb, the patient retains a phantom limb, or part of one. According to Weir Mitchell, the parts most often remaining are the terminal The part spectrally parts?theparts having most small muscles. or the limb above up to the stump often does not remain spectrally. Here is some ltirther ?vidence of the especially great representation of parts having small m iscles in the highest centres. 6What I have described as internal evolution is, I think, essentially the process O" which Spencer speaks in chapter 6, Physical Synthesis, Psych., vol. i. I particu larly refer to section 246.

JOmX-?L._[April

IS, 1894

links of this purely physical' chain ; so to speak, it "stand* highest these links. outside" that the doctrine of concomitance It seems to me is, at any rate*, in the study of nervous convenient diseases. It? or an essentially is held by Hamilton, similar doctrine, JYS. Mill, Clifford; Spencerr Max M?ller, Du Bois Kaymond, Bain, Huxley, Laycock, Tyndall, and David Ferrier. of con Those who accept the doctrine Herman, dt? not believe comitance that volitions, ideas, and emotions produce or any other physical movements states. not say that an They would woman did not do this or that because she lacked will ; hysterical that an aphasie did not speak because he had lost the memory of words ; did not move and that a comatose because he had lost con patient On the contrary, sciousness. they would give, or try to find, material I do not try to show what is of physical inabilities. istic explanations the nature of the relation between mental ^nd nervous states. is as to range of concomitance. "far The next How question " in the nervous does consciousness down extend ? Lewes system " " or that some degree of consciousness attended sensibility thought of even the lowest centres. view activities The current it is, that ot the highest system," al only attends activities parts of the nervous un Some, indeed, speak of though no lower limit is agreed upon. as if, below consciousness, states of mind," conscious there were some I am not sure that I state this view with verbal faint mental states. as I do not understand of the highest, it. That activities least correctness, nervous or most consciousness, organised, arrangements, during which are more or vivid consciousness determined of lower, arises, by activities nervous I firmly believe. As I have said, in ganised, arrangements, states of attend survival of the states of consciousness fittest effect, as one whole. centres representing all parts of the organism Roughly nervous states are determined from below, and not the highest speaking, by autocratic faculties acting upon the highest parts of the highest centre. have attend Butwhether the activities of the lower nervous arrangements ant states of mind, however faint or not, is disputable. Less conscious ness attends activities and the more organised of nervous arrangements least that the highest, automatic they are or have become, which means are the reflex centres, least automatic, most imperfectly organised, or of most vivid consciousness. bases of consciousness physical which [The lecturer then spoke of those disorders of co-ordinations were attempted?started occurred only when movements by volition, of the in parts or, speaking by discharges realistically, beginning in centres. that there Was a difference (He did not believe highest kind between and movements, inferior centres representing impressions co and superior centres them ; the so-called superior co-ordinating one where and movements centre was repre impressions ordinating more in sented in the inferior centre were complex and re-represented spoken of, he ) All the disorders of co-ordination special combinations. were cases in the sense of of paralysis ; that is, thought, essentially there being loss of some movements ; there was also an over-develop on greater energising ment of other movements, of healthy consequent con nervous arrangements and positive, ; the two elements, negative stituted Here the disorder of co-ordination. again was seen, but in another way, the importance of taking note not only of the dissolu re or collateral) tion, but of the levels of evolution (lower, or higher, as to the disorders of co-ordina He illustrated his hypothesis maining. external rectus of the right tion mentioned by the case of paralysis of this purely out that, as an indirect consequence muscle, pointing effect on the internal rectus state, there was an over-positive negative of the left eye (secondary ; an ordinary deviation) starting discharge in the highest there being a centres failed to turn out the right eye ; there was still no effect on the right eye, but the stronger discharge, lesion left turned in too much. Here the direct effect of the negative seen nakedly and its indirect effect, were separate ; but over-positive where the same he believed of co-ordination, that in cases of disorder muscles were involved, held ; there may be loss of some the principle of of other movements movements of a set of muscles, and retention them. He supposed that in writers' cramp there was some paralysis, of in the sense of loss of but a few of the most movements special in some lowest centres, from atrophy of their cells represented writing, a on abuse. As over-use?that result, there was greater is, consequent centres coming down to compel the atrophie of the highest energising on of the lowest centres elements to act. No effect being produced were of writing these the most elements, special of the movements not developed, of the more general but there was an over-development in the same and movements of the same and other muscles, represented other lowest centres. condition of things He thought that the essential in the reel in destruction of part of the middle lobe of the cerebellum was loss of some movements some paralysis; the of the spine, was on dis of the legs were, erratic movements he thought, consequent nervous elements. charges of healthy

April

12, 1884.)

,_THE.

MUTISM

MSMCAJr
are under

JM#F4?>,

._Wl_

as to Localisation, The lecturer then stated his opinions limiting to movements. a centre consideration For illustration, "he imagined *' for the arm and the leg. The Universaliser would, eay that every both the aran and the leg in the same part of the " centre represented " Localiser would the way ; the say that; one ?paart ?of it represented arm only, and another part the two indeed^ make leg only^-would, 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 both before and since the recent experiments of Hitzig,. localisation, and others on the mid-cerebral. cortex. Ferrier, " 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 of the nervous Thus, to take an illustra system. plan of structure tion, the external parts, x, y, and te, are each represented by units of the corpus striatum. But the plan of representation is not that some units contain x largely only, as xSf others y largely only, as y%, but that each unit contains x, y, and 3?some, let us say, as x3, y2i z ; others as x_, yst 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 inch of convolution without out, a square may be wanting, palsy of the face, arm, and leg, as a?, y, and z are represented in other convo and we can also easily understand that discharge of a square lutions; inch of convolution must put in excessive movement the whole region; for it contains matter in x, y, and processes representing " z, with grey exact proportion to the degree of complexity. (St. Andrew's Medical Grad. This is only.another the doc Trans., 1870.) way of stating " trine of compensation and its in excess (see inversion," co-operation second This double doctrine, he thinks, lecture). applies to represen in the mid-cerebral tation of movements Destruc region of dogs. tion of a part of the dog's mid-cortex entails no permanent paralysis, of any part of it produces but discharge 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, seem that there is less com it would than in dogs. The there some is?Is question pensation important in the case of man ? The lec recovery, and thus some compensation, turer did not now suppose compensation for any destructive lesion to be ever absolute. was that the so-called centre for the His hypothesis arm represents that part very specially, but that it also leg representsJhe and face more generally, and the parts on the other side of the body still more generally; for the other centres. similarly, mutatis mutandis to this view, destruction of the arm-centre entail should According some decided paralysis of that limb, and very little, if any, of the two parts would have also a large representation leg and face, which centres. On the other hand, in, so to speak, their own more particular excessive limited to the arm-centre should produce convul discharge in that limb, and yet spreading beyond it to the leg, sion, beginning etc. currents The to not be limited face, however, developed would, one centre ; they would, no doubt, and centres, spread to collateral a them arm thus convulsion in the and ; discharge beginning becoming was no evidence that a single centre?the universal, arm-centre?repre sents all four limbs.8 Yet certain experiments Franck and Pitres by on dogs tended, the lecturer thought, to show that his view of locali sation?that all but that each centre every centre represented parts, some one very specially?held m the case of those animals. represented from these experiments: en effet, "Elles They conclude dimontrent, bien que l'excitation ait que l'?pilepsie peut se g?n?raliser provocatrice ?t? limit?e ? un seul centre cortical [they isplated and the arm-centre, of it produced of all four limbs] convulsion et que la by stimulation destruction pr?alable d'un centre cortical [they cut out the arm-centre in another aux des convulsions pas l'extension experiment] n'emp?che au centre pr?alablement muscles d?truit." correspondant It must be said that these distinguished as stated believe, physicians in the first lecture, that, "Le cerveau commence la protu l'attaque, le bulbe et la moelle la g?n?ralisent." of the cor Ablation b?rance, tical centre, "primitivement excite" does not (Albertoni, and Franck, the convulsions. Franck and Pitres' argument is very able Pitres) stop and powerful their contention deserves most respectful consideration. ; No doubt centres in the pons, medulla, and spinal cord (lowest centres), are discharged the cortical At. by prior any rate, the ex discharge. centres the lowest go towards showing that all periments mentioned 7At that and did not then make a time, I arranged centres morphologically, division into highest and middle motor centres. I used to speak of convolutions the striatum a to "raised corpus being higher power." As stated in the second I now arrange centres on basis. lecture, " an anatomico-physiological 8Of course, the term i% centre is an arbitrary expression ; but using the term "centre for the arm," there would in it, one must suppose (judging from the mode of spreading of convulsion in that limb from discharge beginning in part of the centre), be subcentres.

the. ?command of-4f they are not; all, as the lecturer th|nJcsfi; " in^-each part of the The order of the ,4jsr; re-represented mid-qprtex. charge of all the lowest centres is determined by the particular part of r < .. ;. the mid-cortex primarily discharged. the way of acceptance of his hypothesis difficulties;in Admitting ?pf the lecturer the current hypothesis ouA opt ac localisation, thought count for all the facts. had for to account Any ad?quate hypothesis : (1) that from a destructive the following lesion of motor centres, ?jw of the more voluntary, paralysis was especially etc.; (2) that from f?4tyf,; of movements lesion, the development charging (convulsion) wasv?t??e,', same: an epileptiform seizure starting in the arm began, first of [$l,, one starting in the hand; in the leg began in the foot; one starting. in the face, in the side of the mouth in each ? ; (3) that the progress was and a in compound;order be perma-t (1 ; (4) that 2) part might and yet the whole of it might be occa-t nently imperfectly paralysed, ; (5) that recovery, or some recovery, follows on perma sionally convulsed nent destructive lesions producing paralysis there at is often least some ; lesion of a motor ; (6) that a small destructive compensation centre or no entail little a obvious whilst and sudden may excessive paralysis, in such part produces con discharge beginning very great (indirectly) vulsion in different ; (7) that from discharges beginning parts of the we have fits the same regions, but their parts in mid-cortex, affecting different order ("isomeric seizures"); (8) that a patient, who has no; before a convulsion, has much after j$. paralysis (temporary) paralysis after a convulsion] (Cases of monoplegia [the paralysis only existing must not be adduced as evidence to show that any ksion found post had produced mortem, say a tumour, paralysis by its direct, its de structive, action.)]

THE LUMLEIAN ONLECTURES


THE ETIOLOGY
Delivered By J. at the Royal

OF PHTHISIS.
jCollege of Physicians.

):: The causes

ANDREW, M.D., F.R.C.P., Physician to St. Bartholomew's Hospital. ' ' > -II. Lecture ',' come next under consideration of phthisis which with modes of life and industrial

'!- "'' are those

A mere occupations. will be almost in the case of the majority enumeration sufficient of. the members of this group. It is all but impossible to separate the of the day-workshops and of the occupations influences from that of and especially of the sleeping-rooms, the houses, of the operatives, so on either side might that whatever be drawn by a confident arguments statistician could be of little value. The conclusions could scarcely be of greater weight than the premisses. Still, as the influence of the is probably about the same as all occupations are which paid at the same rate, except, of course, those which must, from their it would be nature, be carried on in specially localities, unhealthy to attribute, in part at least, to the occupation reasonable any great in either direction variation from the phthisis-mortality it ; although to determine the exact proportion in which be impossible the might to it. of labour and of home-life contribute conditions Still more it be to do so in cases where general rules, such, for justifiable would as that phthisis is more frequent among in country districts example, are interfered with. these limitations, I would With divide women, ' , viz. : . into two subgroups, this group of life in which 1. Those occupations and modes there is the possi that direct contagion may come into if you will, the likelihood bility, play ; than 2. Those in which there is no greater danger of such contagion of life. intercourse all of us are exposed to in the ordinary are carried on indoors, of life, all occupations which 1. All modes The naked contrast with outdoor savage, pursuits. unfavourably ills he may have to bear, rarely finds phthisis whatever among them; to and to of tree the comfort his addition his but with every clothing, or cave, his proneness in an advanced to it increases. In this respect, or luxury of the rich and the necessities of the effeminacy civilisation, even the same result. the poor bring about Sometimes, perhaps, are forgetful, in the advice they, give, of our own profession members than one I remember more of an onen-air life. of the advantages to medical student with compelled by circumstances incipient phthisis, in a bleak district, who, instead .of being (undertake country practice home-life

connected

BMJ Publishing Group

The Croonian Lectures On Evolution And Dissolution Of The Nervous System Author(s): J. Hughlings Jackson Reviewed work(s): Source: The British Medical Journal, Vol. 1, No. 1215 (Apr. 12, 1884), pp. 703-707 Published by: BMJ Publishing Group Stable URL: http://www.jstor.org/stable/25266145 . Accessed: 26/05/2012 10:00
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