Artistic Thinking in the Schools

Towards Innovative Arts in Education

Research for Future Ready Learners
Pamela Costes-Onishi
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Pamela Costes-Onishi Editor

Artistic
Thinking in
the Schools
Towards Innovative Arts /in/ Education
Research for Future-Ready Learners
Artistic Thinking in the Schools
Pamela Costes-Onishi
Editor

Artistic Thinking
in the Schools
Towards Innovative Arts /in/ Education
Research for Future-Ready Learners

123
Editor
Pamela Costes-Onishi
National Institute of Education
Nanyang Technological University
Singapore, Singapore

ISBN 978-981-13-8992-4 ISBN 978-981-13-8993-1 (eBook)

https://doi.org/10.1007/978-981-13-8993-1
© Springer Nature Singapore Pte Ltd. 2019
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Foreword

I would urge all of those interested in future of the arts and aesthetic education to
take note of this book. The need to give meaningful, relevant and wide-ranging
empirical research to support the arts in education is addressed here, going beyond
mere advocacy. Artistic Thinking in the Schools: Towards Innovative Arts /in/
Education Research for Future-Ready Learners is a timely book that not only
examines questions that relate to the arts in education, it also identifies and asks
new questions. It is informed by a wide-ranging exploration of the subject area from
an international group of expert practitioners. Of particular value is the way that
authors in this book challenge orthodoxies and question the basis upon which
assertions are made.
In a subject area that in many countries is often marginalized, this collection of
readable and scholarly papers helps establish a sound basis for meaningful devel-
opments in arts education. In so doing, it also helps bring the value of the arts to the
attention of policy-makers and those in a position to bring the arts from the
periphery to a more central place in the curriculum. Artistic thinking and the
pedagogical processes and practices associated with the arts have much to offer
other subject areas; these practices are well articulated here.
There are many ways in which an arts-rich education can enhance young
learners’ lives and prepare them for the future. Introducing the arts into learning
environments helps strengthen cognitive development and the acquisition of life
skills such as creative thinking, critical reflection and interpersonal skills. The arts
also enhance social adaptability and cultural awareness for individuals, enabling
them to build personal and collective identities as well as tolerance and appreciation
of others. Through developing a knowledge and understanding of one’s cultural
heritage and that of others, the arts are well placed to accommodate the growing
need for trans-cultural understanding. The arts, in addition, have a central role to
play in understanding the world of feelings and imagination; through the arts, young
people can explore feelings and be guided by their intuition in a way that is not
easily achieved elsewhere. While promoting individuality and uniqueness amongst
learners, the subject area helps develop an awareness of the spiritual dimension of
life in addition to a sense of achievement and self-esteem. While it is said that we

v
vi Foreword

know more than we can say, in these days of high dependence on the written word,
artistic thinking can help young people learn to say what cannot be said.
Involvement in the arts, or to be more specific, creating and conferring aesthetic
significance, is a fundamental part of human life and has been since the dawn of
time. Recent archaeological investigations have discovered evidence of aesthetic
activity that goes back further and further in time, well before the famous images at
Lascaux and the musical instruments crafted from mammoth bones found in the
upper Danube. This precious legacy needs to be nurtured, and it is through nations’
public education systems—schools, universities and museums—that such nurturing
is provided. This collection of authoritative texts goes a long way towards giving
leadership and direction to such institutions.

Cambridge, UK Richard Hickman

Emeritus Professor
of Aesthetic Development
University of Cambridge
and Dean of Homerton College
Preface

The relevance of the arts in education has long been a point of discourse in edu-
cational policies. As a subject matter in the curriculum, it has often suffered a minor
role compared to the sciences, mathematics and language literacy (Cawelti, 2006;
Ewing, 2011; Hetland & Winner, 2001; Russell-Bowie, 1993, 2009; Stowasser,
1993; Winner & Cooper, 2000). Indeed, one of the most relevant advocacies for arts
education is to demonstrate their usefulness in academic achievement (Butzlaff,
2000; Eisner, 1998; Krug & Cohen-Evron, 2000; Podlozny, 2000; Vaughn, 2000;
Vaughn & Winner, 2000). However, there remains a gap in policies and imple-
mentation with regard to equity ascribed to core subjects globally despite evidences
that point that education can learn from arts practices, specifically in nurturing
habits of mind for real-life challenges (Krug & Cohen-Evron, 2000; Lorimer, 2011;
Marshall, 2014; McPherson & O’Neill, 2010; Robinson, 2013). In their OECD
report, Winner, Goldstein and Vincent-Lancrin (2013) identified, as a foremost
reason, the lack of empirical research in the arts that would demonstrate strongly the
transference and nurturance of the claimed skills, competencies and dispositions
that are developed within these domains. The report concludes that because of the
scarcity of true experimental research on the topic, the claims made by the majority
correlational studies that the arts indeed have a positive impact on non-arts skills
should not be accepted as conclusive. The few experimental studies reveal no
significant causal impact.
In line with this thinking of the importance of empirical research that could
provide evidences to the value of the arts in education, Gadsden (2008, p. 34) posed
several questions: What is the nature of the empirical work that should be con-
ducted? What are the questions that must be framed? What are the contexts to be
studied and with what approaches? What interpretive lenses will emerge, and with
what accuracy? What are the other ways (e.g. approaches, continua) that we can use
to learn about, chart and understand change? She contends that the big question on
the “effect of the arts on student achievement” should be re-conceptualized and that
the concept of academic achievement itself be understood as “the broad and
nuanced learning and teaching opportunities that prepare students to think broadly
while honing in on the foundational abilities of reading, writing, and arithmetic and

vii
viii Preface

the thinking, social, and emotional dispositions that allow for learning” (Ibid). This
is similar to the recommendations in the OECD report cited above (Winner,
Goldstein & Vincent-Lancrin, 2013) and the study by Hetland, Winner, Veenema
and Sheridan (2006, 2013) that emphasize the imperativeness of examining
empirically the “kinds of habits of mind developed in the arts” and how this affects
two learning outcomes: acquisition of artistic skills and possible transfer of skills to
other domains.
Artistic Thinking in the Schools: Towards an Innovative Arts /in/ Education
Research for Future-Ready Learners is a book that documents and analyses the
current trends and developments in arts research, both arts education and arts in
education, which answers the big question of why the arts need centrality in edu-
cational policies globally. This book will be vital to global concerns in preparing
students who are able to think broadly regarding real-world issues and who are
equipped with social and emotional dispositions that are applicable in real-world
situations. These shared global concerns, which are beyond education, make this
book important to all stakeholders seeking to nurture future-ready learners, workers
and thinkers that exhibit adaptive capacities for critical knowledge and innovation.

Singapore Pamela Costes-Onishi

Research Scientist

References

Butzlaff, R. (2000). Can Music Be Used to Teach Reading? Journal of Aesthetic Education,
34(3/4), 167–178. doi: 10.2307/3333642.
Cawelti, G. (2006). The Side Effects of NCLB. Educational Leadership, 64(3), 64–68.
Eisner, E. W. (1998). Does Experience in the Arts Boost Academic Achievement? Arts Education
Policy Review, 100(1), 32–40. doi: 10.1080/10632919809599448.
Ewing, R. (2011). The Arts and Australian Education: Realising Potential. Victoria: Australian
Council for Educational Research.
Gadsden, V. L. (2008). The Arts and Education: Knowledge Generation, Pedagogy, and the
Discourse of Learning. Review of Research in Education, (32)29, 29–61. doi: 10.3102/
0091732X07309691.
Hetland, L., & Winner, E. (2001). The Arts and Academic Achievement: What the Evidence
Shows. Arts Education Policy Review, 102(5), 3–6. doi: 10.1080/10632910109600008.
Hetland, L., Winner, E., Veenema, S., & Sheridan, K. (2006). Studio Thinking: How Visual Arts
Teaching Can Promote Disciplined Habits of Mind. In P. Locher, C. Martindale, & L. Dorfman
(Eds.), New Directions in Aesthetics, Creativity and the Arts (189–205). New York: Baywood
Publishing Company, Inc.
Hetland, L., Winner, E., Veenema, S., & Sheridan, K. (2013). Studio Thinking 2: The Real Benefits
of Visual Arts Education (2nd ed.). New York: Teachers College Press.
Krug, D. H., & Cohen-Evron, N. (2000). Curriculum integration positions and practices in art
education. Studies in Art Education, 41(3), 259.
Lorimer, M. R. (2011). Arts-Infused Learning in Middle Level Classrooms. Journal for Learning
through the Arts, 7(1).
Preface ix

Marshall, J. (2014). Transdisciplinarity and Art Integration: Toward a New Understanding of

Art-Based Learning across the Curriculum. Studies in Art Education, 55(2), 104–127.
doi: 10.1080/00393541.2014.11518922.
McPherson, G. E., & O’Neill, S. A. (2010). Students’ motivation to study music as compared to
other school subjects: A comparison of eight countries. Research Studies in Music Education,
32(2), 101–137. doi: 10.1177/1321103x10384202.
Podlozny, A. (2000). Strengthening Verbal Skills through the Use of Classroom Drama: A Clear
Link. Journal of Aesthetic Education, 34(3/4), 239–275. doi: 10.2307/3333644.
Robinson, A. H. (2013). Arts Integration and the Success of Disadvantaged Students: A Research
Evaluation. Arts Education Policy Review, 114(4), 191–204. doi: 10.1080/10632913.2013.
826050.
Russell-Bowie, D. (1993). Where is Music Education in Our Primary Schools?: An examination
of the current and practice of music education in NSW state primary schools. Research Studies
in Music Education, 1(1), 52–58. doi: 10.1177/1321103x9300100106.
Russell-Bowie, D. (2009). What me? Teach music to my primary class? Challenges to
teaching music in primary schools in five countries. Music Education Research, 11(1), 23–36.
doi: 10.1080/14613800802699549.
Stowasser, H. (1993). Music Education and the School Curriculum: A Question of Survival.
Research Studies in Music Education, 1(1), 13–21. doi: 10.1177/1321103x9300100103.
Vaughn, K. (2000). Music and Mathematics: Modest Support for the Oft-Claimed
Relationship. Journal of Aesthetic Education, 34(3/4), 149–166. doi: 10.2307/3333641.
Vaughn, K., & Winner, E. (2000). SAT Scores of Students Who Study the Arts: What We Can and
Cannot Conclude about the Association. Journal of Aesthetic Education, 34(3/4), 77–89.
doi: 10.2307/3333638.
Winner, E., Goldstein, T. R., & Vincent-Lancrin, S. (2013). Art for Art’s Sake?: The Impact of
Arts Education, Education Research and Innovation, OECD Publishing.
Winner, E., & Cooper, M. (2000). Mute Those Claims: No Evidence (Yet) for a Causal Link
between Arts Study and Academic Achievement. Journal of Aesthetic Education, 34(3/4),
11–75. doi: 10.2307/3333637.
Acknowledgements

This book will not come to fruition without the valuable comments of the following
reviewers: Flavia Maria Cunha Bastos (Professor, University of Cincinnati),
Alfredo Bautista (Research Scientist, Nanyang Technological University), Chloe
Brushwood-Rose (Associate Professor, York University), Richard Hickman
(Professor Emeritus, University of Cambridge), Lisa Hochtritt (Associate Professor,
University of Arizona), Ami Kantawala (Lecturer, Columbia University), LEE Shu
Shing (Research Scientist, Nanyang Technological University), Chee Hoo LUM
(Associate Professor, Nanyang Technological University), Mary-Elizabeth Manley
(Professor, York University), Charlene Delia Jeyamani RAJENDRAN (Assistant
Professor, Nanyang Technological University), Robert Santiago de Roock
(Research Scientist, Nanyang Technological University), Kawai Shiu (Composer–
Director at Aflote Inc.), Connie Stewart (Professor, Northern Colorado University),
Cheryl Stock (Professor, Queensland University of Technology), TAN Cheng Chye
Marcus (Assistant Professor, Nanyang Technological University), TAN Liang See
(Senior Research Scientist, Nanyang Technological University), Michael TAN
(Research Scientist, Nanyang Technological University), TENG Siao See
(Research Scientist, Nanyang Technological University) and WONG Hwei Ming
(Research Scientist, Nanyang Technological University).
Heartfelt thanks goes to the research assistants at the National Institute of
Education, Nanyang Technological University, who assisted in proofreading and in
the tasks needed in my other projects so I can focus on my writing and the com-
pletion of this book: GANESON Danya Lakshmi, PEACOCK Alistair Jun Nan,
Nur Latifah Binte SHAIK MOHAMED SHAFIEE and TAN Yingying Victoria.
I would specially like to thank Dennis KWEK (Senior Research Scientist and
Associate Dean, National Institute of Education, Nanyang Technological
University) for the encouragement in the initial conceptualization of this book and
for facilitating the connections to possible publishers.

xi
xii Acknowledgements

I would also like to acknowledge the support and inspiration given to me by my

husband Hideaki Onishi and our beautiful daughter Maya Onishi. You two are the
greatest gifts bestowed upon me by the grace of God.

Pamela Costes-Onishi
Contents

Part I Setting the Context

1 Introduction: Finding Evidences of Artistic Thinking
in the Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Pamela Costes-Onishi
2 Arts Policy, Practice and Education: Questions
of Use/r Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Eugene Dairianathan

Part II Preparing Future-Ready Teachers and Students Through

the Arts /in/ Education: Teacher Learning and Professional
Development
3 Art Teachers as Reflective Practitioners in the Classroom . . . . . . . 41
Bee Lian Kehk
4 Enhancing Professional Knowledge and Professional Artistry
of Art and Music Teachers Through Teacher Inquiry . . . . . . . . . . 61
Siew Ling Chua and Ai Wee Seow

Part III Preparing Future-Ready Teachers and Students Through

the Arts /in/ Education: Pedagogical Frameworks
5 Art Inquiry: Creative Inquiry for Integration
and Metacognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Julia Marshall
6 Teaching Contemporary Choreography: A Research
and Inquiry-Based Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Caren Carino

xiii
xiv Contents

7 Playing with Pedagogy: Teaching Dance and Embracing

Play as a Pedagogical Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Deanna Paolantonio
8 What Do We Expect from In-depth Arts Integration? Criteria
for Designing “Aesthetic Teaching” Activities . . . . . . . . . . . . . . . . . 139
Marina Sotiropoulou-Zormpala

Part IV Preparing Future-Ready Teachers and Students Through

the Arts /in/ Education: Artistic Processes
9 Nurturing Future-Ready Learners Through the Arts:
A Case Study of an Exemplary Primary School Band . . . . . . . . . . 161
Leonard Tan and Pamela Costes-Onishi
10 Nurturing Personal and Collaborative Creativity Through
Group Playing by Ear from Recordings in Formal Music
Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Maria Varvarigou
11 Community Music-Based Structures of Learning
(CoMu-Based SL) Framework: Nurturing Critical Musicality
and Artistic Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Pamela Costes-Onishi and Imelda S. Caleon

Part V Preparing Future-Ready Teachers and Students Through

the Arts /in/ Education: Benefits to At-Risk Students
12 Frameworks and Methodologies for Understanding Arts
Integration with Culturally Diverse and Struggling Learners . . . . . 215
A. Helene Robinson
13 The Role of Music-Based Activities in Fostering Well-Being
of Adolescents: Insights from a Decade of Research
(2008–2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Imelda S. Caleon

Part VI Preparing Future-Ready Teachers and Students Through

the Arts /in/ Education: Out-of-School Learning Contexts
14 Museum Education as Arts Education: Enhancing Museum
Experience and the Learning of Art Through the Vargas
Museum Education Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Louise Anne M. Salas
Contents xv

15 Playbuilding: A Platform for Re-imagining and Re-thinking

Identities and Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Jennifer Wong

Part VII Synthesis

16 Conclusion: Evidences of Artistic Thinking in the Schools . . . . . . . 299
Pamela Costes-Onishi
Editor and Contributors

About the Editor

Pamela Costes-Onishi (Ph.D. in Ethnomusicology, University of Washington,

Seattle) is a Research Scientist (Lecturer) at the Center for Research in Pedagogy &
Practice (CRPP) at the National Institute of Education, Nanyang Technological
University (Singapore). Her research interests and publications include inquiry-based
learning, arts in education, diversity in education, Southeast Asian music & cultures,
teacher learning & professional development, and community arts.

Contributors

Imelda S. Caleon National Institute of Education, Nanyang Technological

University, Singapore, Singapore
Caren Carino Nanyang Academy of Fine Arts, Singapore, Singapore
Siew Ling Chua Singapore Teachers’ Academy for the aRts, Singapore,
Singapore
Pamela Costes-Onishi National Institute of Education, Nanyang Technological
University, Singapore, Singapore
Eugene Dairianathan National Institute of Education, Nanyang Technological
University, Singapore, Singapore
Bee Lian Kehk National Institute of Education, Nanyang Technological
University, Singapore, Singapore
Julia Marshall San Francisco State University, San Francisco, USA
Deanna Paolantonio York University, Toronto, Canada

xvii
xviii Editor and Contributors

A. Helene Robinson University of South Florida Sarasota-Manatee, Sarasota, FL,

USA
Louise Anne M. Salas University of the Philippines (Diliman), Quezon City,
Philippines
Ai Wee Seow Singapore Teachers’ Academy for the aRts, Singapore, Singapore
Marina Sotiropoulou-Zormpala University of Crete, Rethimno, Greece
Leonard Tan National Institute of Education, Nanyang Technological University,
Singapore, Singapore
Maria Varvarigou Canterbury Christ Church University, Canterbury, UK
Jennifer Wong Nanyang Technological University, Singapore, Singapore
 Part I
Setting the Context
Chapter 1
Introduction: Finding Evidences
of Artistic Thinking in the Schools

Pamela Costes-Onishi

Abstract Scholarship claimed that the arts bear affordances in nurturing skills,
dispositions and competencies that are increasingly needed in the education for the
future. However, the evidences remain to be inconclusive. This chapter presents the
main arguments and intentions forwarded in this book. It outlines how the chapters
address current research and approaches to the arts in education that provide strong
empirical evidences in establishing the claim that the arts indeed nurture
future-oriented thinking skills and habits of mind. The intention is not necessarily to
offer cause–effect links to address this gap in the current literature, but more
importantly, to chart how research in arts/in/education responds to global needs
through ground-based evidences using different methodological and pedagogical
approaches that are rooted in a breadth of contexts: cultures, teaching and learning
environments, disciplinary and interdisciplinary, student levels and student abilities.

The notion of academic achievement as measurable and achievable through

domains that can be objectively tested is increasingly being challenged. There
appears to be a consensus among policy makers, scholars, educators and practi-
tioners that post-industrial and globalized economies of the twenty-first century
require a distinct set of knowledge and skills necessary to compete in an increas-
ingly knowledge-based society. The European Commission has identified seven
“key competences” for tomorrow’s world (European Commission, 2018). Other
international initiatives such as the “New Commission on The Skills of the
American Workforce” (NCEE, 2012), the “Partnership for 21st Century Skills”
(P21, 2007) and the “Assessment & Teaching of 21st Century Skills” (Griffin,
McGraw, & Care, 2012) have also done the same under the label of
“twenty-first-century skills.” While scholars such as Acedo and Hughes (2014) note
that STEM learning, information literacy and concepts-focused learning are fun-
damental areas of knowledge in the twenty-first century, others believe that we need
skills and dispositions beyond these in order to succeed professionally, personally,

P. Costes-Onishi (&)
National Institute of Education, Nanyang Technological University, Singapore, Singapore
e-mail: pamela.onishi@nie.edu.sg

© Springer Nature Singapore Pte Ltd. 2019 3

P. Costes-Onishi (ed.), Artistic Thinking in the Schools,
https://doi.org/10.1007/978-981-13-8993-1_1
4 P. Costes-Onishi

societally and globally. For example, Gardner (2008) proposes five minds for the
future, namely the disciplining, synthesizing, creating, respectful and ethical minds.
Additionally, the “OECD Skills Outlook” (2013, 2017), “OECD Skills Strategy”
(2011) and the “OECD Innovation Strategy” (2010) have emphasized, among other
things, the importance of fostering individual skills critical to personal growth and
well-being in future societies.
Arts education is increasingly seen as a means to foster skills, competencies and
dispositions conducive to innovation necessary in knowledge-based societies.
Several initiatives are being implemented all over the world that acknowledge the
significance of engagement in, through and with the arts in preparing future-ready
learners (Comunian & Ooi, 2016; Hentschke, 2013; Long, 2015; Marshall, 2014;
Robinson, 2013; Sirayi & Nawa, 2014). However, despite these efforts there still
remains unanswered questions in how learning and teaching the arts can effectively
nurture these much-needed skills, competencies and dispositions. Studies that
present strong evidence that the arts indeed caused the development of such skills,
competencies and dispositions are lacking. Thus, it is imperative that arts research
be supported by all stakeholders in order to gain more understanding of education
in each art form that can provide theoretical basis on the kinds of thinking inherent
in artistic processes. Supporting research on arts/in/education will facilitate reaching
their most effective impact in general education.
A metasynthesis of research in arts education (Winner, Goldstein, &
Vincent-Lancrin, 2013) revealed that there are evidence-based studies that arts
education improves academic skills such as IQ (intelligence quotient), verbal skills
and geometrical reasoning; however, most of these studies were correlational and
very few were conclusive. Likewise, empirical evidences on the impact of arts
education on dispositions such as creativity and critical thinking have limited sta-
tistical power for generalization. Furthermore, effects on behavior such as moti-
vation lack experimental studies that can solidify the claims that engagement in the
arts causes positive behavior and social skills. In short, there is no causal evidence,
yet, that links arts education to the following: overall academic performance,
nurturance of creative and critical thinking dispositions and social and behavioral
skills.
This book was conceptualized to look at current research and approaches to the
arts in education that provide strong empirical evidences in establishing the claim
that the arts indeed nurture future-oriented thinking skills and habits of mind. It is a
conscious effort to highlight current research that responds to the changes in global
needs for educating in the twenty-first century and beyond. As Bresler (2007)
noted, research in arts education has always been affected by global trends, attesting
that scholarship in the arts is entrenched within a larger perspective. The chapters in
this book place the artistic thinking processes and creation in visual and performing
arts at the center of learning, thus addressing the concern that advocating for the arts
simply under the premise of twenty-first-century skills, competencies and dispo-
sitions would reduce them to an instrumental role catering to the “exigencies of
economic globalization” (Choo, 2018; Logsdon, 2013). All chapters do carry a
sense of advocacy for learning in, through and with the arts, but the importance of
1 Introduction: Finding Evidences of Artistic Thinking … 5

these works rest on their thoughtful discussions through evidence-based research on

what practices work in specific contexts and their outcomes in learning. The
research approaches may not necessarily resort to experimental methods in order to
provide causal evidence, but the intention is not simply to find cause–effect links to
forward the claims that the arts can nurture future-ready educators and learners;
rather, the intention is to examine how current research in the arts in various settings
and practices provide answers to critical questions as posed by Gadsden (2008,
p. 34): “What is the nature of the empirical work that should be conducted? What
are the questions that must be framed? What are the contexts to be studied and with
what approaches? What interpretive lenses will emerge, and with what accuracy?
What are the other ways (e.g., approaches, continua) that we can use to learn about,
chart, and understand change?” Thus, this book is a way to chart the direction that
arts/in/education research took ten years hence. It is with sincere intentions that the
evidences presented in the chapters would address the lack of empirical research
that would place centrality to artistic thinking in the schools.

Artistic Thinking as Evidenced in the Arts/in/Education

In a UNESCO-commissioned study of worldwide research on the impact of

arts-rich programs on the education of children and young people, Bamford (2006)
explained the distinction between arts education and arts in education based on the
actual implementation and perspectives articulated in more than 60 countries. Arts
education is a “sustained, systematic learning in the skills, ways of thinking and
presentation of each art forms,” and the impact is on “attitudes to school and
learning, enhanced cultural identity and sense of personal satisfaction and
well-being” (Bamford, 2006, p. 71). Arts in education is evident when art is used as
a basis to teach various other subjects such as numeracy, literacy and technology,
and it is said to enhance “overall academic attainment, reduce school disaffection
and promote positive cognitive transfer” (Ibid.). Based on this compendium, as
generally understood and practiced in various global contexts, arts education is
learning in the arts with the aim of developing skills and ways of thinking in each
art form, while arts in education is learning through the arts with the aim of
enhancing academic achievement and promoting cognitive transfer.
Gadsden (2008) stated that the reciprocal and interactional relationship between
arts and education enable us to weigh the meaning of teaching and learning in and
through the arts. She drew attention to the “role of the arts as a (re)source in
educational theory, research and practice.” Under this perspective, arts/in/education
denotes the “centrality of art as both precipitator and repository of learning,
teaching, and schooling” (Gadsden, 2008, p. 30). This means when we talk about
the arts’ relationship to education, regardless of learning in and through the arts, we
are delving into how the arts and the associated thinking and behavior that ensue
from its unique teaching and learning processes become the catalyst for educational
theory, research and practice. Consequently, the intrinsic value of the arts in
6 P. Costes-Onishi

education lies in the artistic habits of mind that are developed when students engage
in them, and not so much in specific technical skills (although developing this is
essential in any artistic process) related to specific domains. These habits of mind
may have some collateral benefits for other subjects, but the latter should not be the
sole purpose why the arts should remain vital in the curriculum. This implies that in
doing research, it is more beneficial to focus on the habits of mind nurtured within
the arts because their relevance to education is located precisely there. This is true
whether, or not, the objective is to nurture the skills, competencies and dispositions
for the changing needs of the globalized economies of the twenty-first century.
Artistic habits of mind constitute the “hidden curriculum” of arts/in/education
(Hetland, Winner, Veneema, & Sheridan, 2013). However, in order for research on
engagement in the arts to become meaningful for educational theory, research and
practice, the unique learning within the domains (music, visual arts, theatre and
dance) must be empirically understood first before any studies on transfers can be
effectively carried out. As the authors of studio thinking stress, before we can make
a case for the importance of the arts in education or conduct successful studies on
transfers, it is first necessary to “find out what the arts actually teach and what art
students actually learn” (Ibid., p. 1).
There is an agreement in the extant literature that the impact of the arts in
education manifests effectively when there is quality arts education pedagogy in the
schools (Bamford, 2006; Winner, Goldstein, & Vincent-Lancrin, 2013). According
to Bamford (2006, p. 89), “quality arts education is the result of interplay of
structure and method” and that “content is of less relevance to quality than method
and structure.” This has several conditions such as active partnerships should be
sustainable and long term (recommended at least 2 years); students should have
access to high arts standards not only in their arts classes or cocurricular activities
but also in their other subjects through an arts-rich curricula; in-service professional
development should be provided to improve pedagogy in and through the arts;
strong partnerships should exist between schools and cultural organizations through
flexible boundaries in terms of schooling and planning for an arts-rich curricula;
and the evaluation process of arts programs in the schools should be consistent.
This book is organized into topics of research on all forms of arts/in/education in
order to ascertain whether “the role of the arts as a (re)source in educational theory,
research, and practice” is being addressed by current trends in scholarship.
Specifically, each chapter included in the book sought to demonstrate how arts/in/
education effectively nurtures future-oriented competencies by responding to the
general question, “How is research in the arts moving in the direction that would
provide conclusive evidence of their centrality in nurturing skills, competencies and
dispositions needed for the future orientations in education?” Contributions came
from perspectives of scholars in the arts from different countries, while providing a
deeper introspection of arts/in/education research in Singapore as a more-focused
case through ensuring representation of studies in each art form. Having a country
in focus also allows for a close introspection on how policy in the arts is specifically
enacted and met by different stakeholders at various levels, albeit limited by
1 Introduction: Finding Evidences of Artistic Thinking … 7

context. The global perspectives offered in this book allow for a more balanced
analysis on the quality of research currently invested in the arts. They allow us to
look at the alignment between policies and research, both ways: whether research is
responding to gaps identified in the literature to present evidences to policy; and
whether policy is responding to the recommendations presented by evidence-based
research in order to achieve its goals.
Finally, “artistic thinking” in the schools as argued in this book refers to the habits
of mind nurtured through pedagogical processes, or the teaching methods and
learning structures, that result from engagement in, through and with the arts.
Teaching and learning can take place within the arts subjects or using the arts as an
integrated component in the mastery of other subjects. As the chapters in this book
argued and demonstrated, artistic thinking manifests in all forms of education—
formal, informal, non-formal—when the teaching methods and learning structures are
rooted in the processes of creating and engaging in the art forms. Artistic Thinking in
the Schools: Towards Innovative Arts/in/Education Research for Future-Ready
Learners is about developing within the students the skills, competencies and dis-
positions that innovative artists intuitively apply in their creations, which includes the
interdisciplinary scientific thinking that merges during the process.

Examining the Impact of Policies in the Arts/in/Education:

The Case of Singapore

Coherence is said to be important in mobilizing educational change (Fullan &

Quinn, 2016). There are four right drivers in order to achieve Coherence: capacity
building, collaboration, pedagogy, and systemness (coordinated policies) (Ibid.,
p. 3). A coherent system starts with a large number of people and sectors under-
standing what needs to be done and them finding ownership in making things
happen. It does not end when goals are achieved, as it is a continuous process of
“efforts to make their systems, structures, and resources more compatible and their
approaches to budgeting, staffing, and academic programming mutually supportive
and reinforcing” (Johnson, Marietta, Higgins, Mapp, & Grossman, 2015, p. 161).
Singapore is known to be a highly efficient country where a coherent ecological
system makes it the success story that it is now. The reason behind the success is in
the continuous efforts to align national goals with policies and the responsiveness of
different sectors, including education, in order to accomplish the visions. For
example, educational reforms in Singapore have always been interlinked to national
policies that respond to the pressing needs at the social, cultural, political and
economic levels in order to stay competitive globally (Sharpe & Gopinathan, 2002).
The following four main educational reform transitions in Singapore illustrate this
link in the system (Goh & Tan, 2009; Heng, 2015): (1) Building a post-colonial
education system: social cohesion and skill-building—“Survival-Driven Education”
(1965–1978); (2) Building a system for an industrial economy—“Efficiency-Driven
8 P. Costes-Onishi

Education” (1979–1996); (3) Building a system for a knowledge-based economy

—“Ability-Driven Education” (1997–2011); and (4) Building a system for social
cohesion—“Student-Centric Values-Driven Education” (2012–Present). Given this
history, and its relatively new efforts to focus on the arts, Singapore is a good case
to examine how coherence is achieved in forwarding local interests with a global
perspective. It is an interesting case because of its resolve in steadily arriving at
similar global goals within a short time frame, despite the internal tensions between
intended reforms and enacted classroom practices (Curdt-Christiansen & Silver,
2012; Kadir, 2017; Wong & Apple, 2002).
Efforts to focus on culture and the arts started with a series of strategic long-term
mapping contained in policy documents that resulted into important infrastructures
and government bodies tasked to oversee the growth and direction of the arts in
Singapore. The 1989 Advisory Council on Culture and the Arts (ACCA) has seen
the establishment of the National Arts Council (NAC), National Heritage Board
(NHB) and the National Library Board (NLB), along with fine art galleries and
museums (RCP III, 2008). Ten years later, three Renaissance City Plans
(RCP) were released in 2000, 2005 and 2008 that intensified the impact of the arts
in education. This was followed later on with the Arts and Culture Strategic Review
(ACSR) that seeks to map the growth and direction of the arts until 2025 (ACSR,
2012). In the RCP papers, Singapore established the goal of becoming a global arts
city “where there is an environment conducive to creative and knowledge-based
industries and talent” (RCP I, 2000, p. 4). It is believed that there are economic
benefits accruing from creative industries and that to create a milieu that is con-
ducive to innovations, new discoveries, and creation of new knowledge, local and
foreign artistic and creative talents are needed. Subsequent reports identified seven
areas of focus for the next phase of arts and cultural development formulated in
RCP III (2008, p. 15). Of these, three areas resonate strongly with arts education in
Singapore: (1) creating and promoting original and home-grown Singaporean
works that highlight our diverse and unique heritage and traditions; (2) developing
future audiences by putting more emphasis on the arts in education and arts edu-
cation in schools; and (3) improving Singapore’s tertiary arts education to give it
more depth and providing better training for arts teachers in schools.
As a response to RCP III, there was a stronger investment in Singapore’s edu-
cational infrastructure to support the arts (Comunian & Ooi, 2016) from 2008 to
2015. This led to the establishment of Singapore’s first pre-tertiary school dedicated
to the arts, School of the Arts (SOTA), in 2008; increase in funding for LaSalle
College of the Arts and the Nanyang Academy of Fine Arts (NAFA) as the gov-
ernment officially recognized them as tertiary institutions; and the development of
other creative infrastructure at higher-education level like the Yong Siew Toh
Conservatory of Music (YSTCM). There were also new partnerships with inter-
national universities like the Glasgow School of Art and the Goldsmiths College of
the University of London.
Complementing the RCP III, the Primary Education Review and Implementation
(PERI) Report views the need for art, among other performance-based subjects, to
be a mandatory curriculum subject in order to attain the goals of lifelong learning
1 Introduction: Finding Evidences of Artistic Thinking … 9

and holistic education at primary schools where development of talents should start.
It also articulates the objective of adding depth to arts education and increasing the
quality of arts teachers in schools in its recommendation that “MOE needs to ensure
that all schools have qualified teachers who are optimally deployed to teach these
subjects” (MOE, 2009, p. 32). As a result, measures were taken at enhancing the
educational landscape that include the establishment of niche areas in some schools
which now take the form of Applied Learning (ALP) or Lifelong Learning
(LLP) Programs that strongly support the focus on developing twenty-first-century
competencies and values in students (MOE, 2018). Music and performing arts are
believed to be one of the focus areas in which, specifically, LLP can be developed
(Ibid). In 2011, two programs were established for the professional development of
in-service visual art and music teachers. These are the Advanced Diploma Program
in Visual Arts and Music offered by the National Institute of Education (NIE) in
collaboration with MOE Curriculum Planning and Development Division (CPDD)
and the MOE Singapore Teacher’s Academy for the aRts (STAR).
Given the national goal of a distinctive global city for culture and the arts and the
timely responses from educational sectors, it would seem like the arts are becoming
entrenched within the Singapore society and steps are being taken to ensure that
they remain anchored for the future development of the nation. Are similar tensions
in the general educational reforms between the intended policies and classroom
enactment present in these specific mappings for the arts in education? It is within
this landscape that Eugene Dairianathan’s Chapter resonates. This chapter provides
a focused case study of an educator–musician whose personal artistic journey
explores and examines the ways stakeholders view arts education and the different
pathways that shape and impact an individual’s growth and direction for special-
izations and lifelong learning in the arts. Dairianathan provides context on the
choice of Singapore as the country in focus in which comparable issues in other
contexts could be examined. As the author expressed, “Murale’s individual expe-
rience—albeit in the singular—is potential and promise for further and future
Educational research—Singapore as one of many case studies—to illustrate prob-
lems and prospects Arts education have around the world.”

Preparing Future-Ready Teachers and Students Through

the Arts/in/Education

Parts II to VI of this book were organized according to shared and connected

themes. The overarching theme in which the chapters resonate is Preparing Future-
Ready Teachers and Students through the Arts/in/Education. Most of the chapters
can belong to one or more of the themes, and so each theme can offer insights that
cut across the others. For the interest of organization, each theme would have two to
four chapters under it. The themes offer evidences of the specific impact of the arts
in education in nurturing future-ready teachers and students. The themes were
10 P. Costes-Onishi

organized from teacher preparation to informal learning settings outside of the

school. This would allow for a structured presentation and discussion of the
research evidences beginning from how teachers are prepared to be future-ready;
creating arts-based thinking pedagogical frameworks for classroom applications;
examining implicit artistic processes in arts practices; impact of arts engagement to
at-risk students; and ending on arts education in non-school settings.

Part II: Preparing Future-Ready Teachers and Students

Through the Arts/in/Education: Teacher Learning
and Professional Development

Teachers need new competencies and forms of thinking in the twenty-first century.
There is a need to shift from traditional approaches such as cognitive-oriented
teaching to more innovative pedagogies that are cognizant of interpersonal and
intrapersonal skills, competencies and dispositions (Darling-Hammond &
Bransford, 2005; Deng & Gopinathan, 2016; Schleicher, 2012, 2014; Scott, 2015).
Teachers are now expected to teach higher-order thinking and performance skills to
all types of learners, placing demands on teacher education “to design programs that
help prospective teachers to understand deeply a wide array of things about
learning, social and cultural contexts, and teaching and be able to enact these
understandings in complex classrooms serving increasingly diverse students”
(Darling-Hammond, 2006, p. 302).
The chapter by Bee Lian Kehk stated that reflective practice is a key disposition
that visual art teachers must develop to address the “ill-structured” nature of the art
as a discipline; that is, it would require multiple ways of responding to situations in
the classrooms in order to craft an effective lesson that would nurture artistic
thinkers among the students. She argued that the development of a teacher’s
Pedagogical Content Knowledge (PCK) is anchored on situated experience and
reflection. Kehk also drew attention to the congruence of reflective practice and
artistic thinking and learning. She said, “Reflective thinking, a core component to
be found in artistic thinking, calls for sensitive seeing, detailed analysis, careful
decision-making and the courage to experiment.”
Similarly, the chapter by Siew Ling Chua and Ai Wee Seow emphasized the
importance of teacher reflective practice through teacher inquiry. They stated the
importance of teachers investigating their own practice in order to improve. Teacher
inquiry projects, according to the authors, could enhance teacher professional
knowledge and professional artistry; two concepts that are linked to PCK as they
require competence in teaching according to the demands of specific contexts and
knowing the reasons for choosing certain pedagogies. The authors examined how
teacher inquiry projects assisted in the holistic development of music and visual art
teachers, which included pedagogic shifts in perspectives and their artistic practices.
1 Introduction: Finding Evidences of Artistic Thinking … 11

Part III: Preparing Future-Ready Teachers and Students

Through the Arts/in/Education: Pedagogical Frameworks

As has been established in the opening discussion, the twenty-first century spurned
a growing interest in education on the nurturance of skills, competencies and dis-
positions that would prepare teachers and students for the demands of the new
globalized economy. This focus has received criticisms that the spread of
twenty-first-century education frameworks is predominantly informed by Human
Capital Theory (HCT), which shows positive correlation between education and
economic growth, and that they have been conceptualized by transnational and
governmental organizations (Choo, 2018). Likewise, in the field of arts education,
there are concerns that advocating for a place of the arts in the curriculum through
emphasizing their relevance to nurture the needed twenty-first-century skills,
competencies and dispositions would reduce them to a utilitarian role for national
economic goals (Logsdon, 2013). It was posited that the focus in advocating for the
arts in education should be in the “habits of arts-centered inquiry” that would
require the development of skills in the arts because “the acquisition of skills is a
necessary part of becoming an artistically literate inquirer. With practice, skills
develop into habits of inquiry, generating wider possibilities for further inquiry and
growth” (Ibid., p. 52).
In Julia Marshall’s chapter, she proposed the Art Inquiry Integration
(AII) framework, developed from arts-based research, as a form of arts integration
for K-12 education. The initiative provides a new direction in education, which is a
shift from learning about facts to an emphasis on meaning-making. This means the
approach stresses that “art practices and thinking provide fresh ways of seeing as
well as new and imaginative ways of thinking about and exploring academic
knowledge.” AII is “based on the notion that art practice is a form of inquiry, a way
of exploring, interpreting and coming to understand any idea, topic or phenomenon
through the lens and practices of art.”
Caren Carino also proposed a research and inquiry-based approach in teaching
tertiary contemporary choreography in dance. Her objectives include using the
framework to develop critical and creative thinking skills. In this framework, she
links the critical thinking “processes of observation, documentation, investigation
and analysis” and the “creative thinking processes of conceptualization, explo-
ration, experimentation, development and making.” Through these processes, the
students apply arts-based thinking skills and inquiry that dance choreographers use
in order to create.
In another chapter on dance, Deanna Paolantonio introduced the Work It Out
program to teach dance to girls using self-reflexive practices. Her framework allows
teenage girls to see dance as a means to personal introspective expression through
the body. According to the author, this strategy makes use of the “inherently
expressive nature of dance and choreography to assist girls in conveying their
experience of girlhood and how it is affected or related to their bodies and body
image” (my italics).
12 P. Costes-Onishi

Finally, Pamela Costes-Onishi and Imelda S. Caleon offered a framework for

teaching multicultural music content based on the processes of community music
teaching and learning. The framework facilitates students to develop artistic
thinking dispositions through critically engaging and developing skills in com-
munity music. Evidences were presented that showed how arts-based structures of
learning underpin the teaching of arts-based habits of mind. The approach
emphasized how active music-making is necessary to develop artistic thinking in
the primary and secondary music classrooms. The chapter provided context-specific
evidences, which supported the theory that “when community music-based struc-
tures of learning (CoMu-based SL) is used as a framework in teaching general
music education, twenty-first-century skills (critical musicality) and dispositions
(artistic thinking) are effectively nurtured in the process.”

Part IV: Preparing Future-Ready Teachers and Students

Through the Arts/in/Education: Artistic Processes

Artistic processes are said to be intuitive. It is therefore difficult for an artist to

articulate these processes and their effects through an end product. This is where
research becomes important. Through these processes, the desired
twenty-first-century skills, competencies and dispositions are nested. It is important
to unpack these outcomes through empirical research in order to translate them for
classroom learning. There are different artistic processes observed through research,
and even though these processes may not fall into neat stages, they tend to be
circular until the end product is created (Lichtzier & Peters, 2017). These artistic
processes are believed to develop twenty-first-century skills such as creativity,
critical thinking, communication and collaboration (Schuler, 2011) and habits of
mind reflective of studio thinking such as Stretch and explore, observe, develop
craft, engage and persist, reflect, express, envision (Hetland et al. 2013).
The chapter by Leonard Tan and Pamela Costes-Onishi aimed to make
explicit those implicit artistic processes of learning in a school band in order to
address the autocratic approaches prevalent in its pedagogy and implementation.
The authors drew attention to the band as a performing arts ensemble as the point to
examine its potential for developing twenty-first-century competencies.
Maria Varvarigou’s chapter looked at how informal learning approach in the
classrooms based on the artistic processes of popular musicians develops personal
and collaborative creativity. She considers collaborative creativity as a salient
twenty-first-century skill that musicians practice, especially popular musicians.
Finally, Marina Sotiropoulou-Zormpala offered an approach to arts integration
constituting aesthetic teaching. She contends that aesthetic teaching is a new
concept in which “the necessity of integrating the arts in all parts of curricula is
substantiated by the unique and indispensable benefits that flow from the artistic
process” (my italics). It is an approach to the curricula, wherein any academic
1 Introduction: Finding Evidences of Artistic Thinking … 13

subject is taught aesthetically or more like art classes. For the author, “aesthetic
literacy contributes to the formation of an individual’s aesthetic identity, stimulates
social and internal conversations which can lead the individual to cognitive changes
and meta-cognitive processes, promotes lifelong learning and thus contributes to
consciousness of one’s existence.”

Part V: Preparing Future-Ready Teachers and Students

Through the Arts/in/Education: Benefits to At-Risk Students

The benefits of engaging in the arts to at-risk students have been noted in the literature.
There is a wealth of research available in art therapy and psychotherapy found in
journals dedicated to the topic, and we could also find evidences presented in edu-
cation such as the impact of arts integration (Moyer, Klopfer, & Ernst, 2018) and
arts-based research (Li, Kenzy, Underwood, & Severson, 2015) to at-risk students.
In her chapter, Helene Robinson developed an arts integration framework called
Arts Integration Engagement Model (AIEM) for culturally diverse students. She
defines culturally diverse students as those “who have a disability, are English
language learners, low socioeconomic students, ethnic minority students, as well as
other marginalized student populations.” She pointed how in the artistic process,
failure becomes a positive feature and this helps in the school success of culturally
diverse students. It is the environment cultivated in arts integration that is focused
on the process rather than on the product that facilitates success in learning and
engagement through providing students the ability to express their vulnerabilities.
Imelda S. Caleon conducted a metasynthesis of group music-based intervention
activities aiming to foster well-being among adolescents. Her objective is to find out
the underlying mechanisms and outcomes of these interventions to adolescents
exposed to stress and risk factors. She found the following themes to be salient in
current literature: (1) music-based activities as catalyst for relationship building,
(2) music-based activities as means for self-expression and self-regulation, and
(3) music-based activities as a resource for self-transformation.

Part VI: Preparing Future-Ready Teachers and Students

Through the Arts/in/Education: Out-of-School Learning
Contexts

Learning spaces are now extended in informal contexts, whether they be in a literal
physical space or inside the classroom using informal approaches. Jagušt, Botički,
and So (2018) defined the different forms of learning—formal, informal,
non-formal—as below.
Defining the notion of formal and informal learning is challenging, and there is no
straightforward way of doing so. Learning happens in a variety of settings and due to
14 P. Costes-Onishi

different reasons and can be delivered by different sources of knowledge. In general, formal
learning is organized, structured, and intentional, typically takes place in a school, and is
delivered by a trained teacher (Werquim, 2010). In contrast, informal learning happens in
life situations that come about spontaneously (Maarschalk, 1988), whereas non‐formal
learning emerges somewhere along the spectrum between the two aforementioned forms—
it is partially structured and can have learning objectives (Werquim, 2010). Adding to the
complexity, these forms of learning can occur across a variety of settings, with informal
learning appearing in formal settings (e.g., students in school unintentionally learning out‐
of‐school curriculum matters) or formal learning appearing in non‐formal settings (e.g., a
class trip to the museum; Sefton‐Green, 2004). (p. 417)

In the context of the arts, such learning spaces also exist. For example, in music,
informal learning is gaining ground using learning structures and processes of
real-world musicians in the formal setting of the schools (Costes-Onishi, 2016;
Folkestad, 2006; Green, 2008; Hallam, Creech, & McQueen, 2018; Rodriguez,
2009; Jaffurs, 2004; Vitale, 2011). In visual art, informal learning through museum
pedagogy is seen as one of the viable educational directions for the modern,
knowledge-based societies (Tišliar, 2017).
In the chapter by Louise Salas, the educative function of museums is explored
and discussed. She argues that in the “wake of a constantly changing art scene and a
challenging formal education program” confining to one form of learning is not
sufficient to overcome the challenges of delivering quality arts education in the
twenty-first century. Thus, holistic arts education is delivered in different learning
spaces—formal, informal and non-formal.
Pui Ching Jennifer Wong looked at how playbuilding in an informal space of
the neighborhood enables “a process to re-imagine and re-think identity and agency
in children from low-income families in Singapore.” Her chapter offers a narrative
that illuminates the future challenges of young people and how through the col-
laborative and improvisatory processes in theatre-making, shifts in perspectives in
how they can shape future identities that they embody become evident.

Part VII: Synthesis

The concluding chapter synthesizes the findings presented by the authors and reflects
on the question posed in this book: “How is research in the arts moving in the
direction that would provide conclusive evidence of their centrality in nurturing
skills, competencies and dispositions needed for the future orientations in educa-
tion?” Through the research evidences, methodological and pedagogical approaches
presented in this book, we hope to find answers to this and other questions as
inspired by Gadsden (2008) ten years ago. Thus, we now reformulate the questions
as follows: What kind of empirical work was conducted and what else should be
done? What are the questions that were framed and what else should we be asking?
What are the contexts we have studied and with what approaches? What interpretive
lenses have emerged, and with what accuracy? What are the ways (e.g., approaches,
continua) that have been used to learn about, chart and understand change? In
Another random document with
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disturbances of bladder function have been described as vesical
crises, and recent French observers have observed so-called crises
clitoridiennes in female tabic patients which were characterized by
voluptuous sensations. All of these symptoms have these in
common: that they last but a short time, that their disappearance is
as rapid as their advent, and that they depend for their distribution on
the attitude of the disease in the cord. The vesical crises are more
apt to occur early than late in the disease and where the belt
sensation is in the hypogastric region. The gastric and enteric crises
are usually found when the belt is in the epigastric level, and the
bronchial, cardiac, and laryngeal crises when it is in the thorax and
neck. Some connection has been observed between the occurrence
of the lightning-like pains and these crises. Thus, a sudden cessation
of the former is sometimes the forerunner of the latter. It is also
found that one variety of these crises disappears to give way to
another: this is particularly noticed with the bronchial crises, which
often cease suddenly, to be followed by vomiting.
22 Krause, in a paper read before the Society of Neurologists at Berlin
(Neurologisches Centralblatt, 1885, p. 543), found either laryngeal crises or other
laryngeal symptoms, such as demonstrable ataxia of movement of the vocal cords, in
13 out of 38 cases. This proportion would be far too high for tabes in general; his
cases were probably advanced ones. He established the interesting fact that the
laryngeal crisis may sometimes be provoked by pressure with a probe on the superior
laryngeal nerve at its laryngeal entry-point. Jastrowitz claims to have determined the
existence of actual paralysis of the vocal cords with the crises, but Krause concludes
from the experimental inductibility of the crisis that it cannot be due to a posticus
paralysis. In a discussion on the subject Remak affirms that a unilateral paralysis of
the crico-arytenoideus posticus may be an early or the earliest symptom of tabes. It
seems, however, that in all cases where he determined such paralysis there had been
disturbances of function of other cranial nerves in unusual severity at about the same
time.

23 They must be extremely rare: they have not occurred in a single one of my 81
private cases, nor do I recall one in clinic or dispensary experience.
There is some analogy between the exceptionally-occurring mental
disturbance of tabic patients and the crises. Like them, it resembles
a disturbance of innervation, in this instance the centres regulating
the cerebral circulation appearing to be at fault. It also seems as if in
cases of this character the direction of the mental disturbance were
determined in some sense by the emotional relations of the
oblongata, for the insane outbreak usually consists in a brief but
extreme outburst either of a depressed and melancholiac or an
expansive maniacal or delirious outburst. It is a very rare occurrence,
and usually limited to the latest stages. Much more common is the
development of paretic dementia, but this is to be regarded rather as
a complication than an integral feature of tabes. Most tabic patients
retain their mental equilibrium to the last moment; some develop
truly heroic resignation to their terrible sufferings and gloomy
prospects; and a few, becoming irritable, petulant, and abnormally
selfish, show the effect of invalidism manifested equally with other
chronic diseases.

In addition to the visceral crises there are other disturbances of

innervation of a nutritive or trophic character which are characteristic
of tabes. There is scarcely one of the eruptions or other changes
which are attributable to central nervous disease which may not
occur at some one or other period of this disease. Thus, herpetic
eruptions may occur independently or in conjunction with lancinating
pains, in one case even corresponding to the area of the belt
sensation. Discoloration of the skin or hair, the latter turning gray or
white in circular24 or in irregular patches, spontaneous falling of the
nails, spontaneous hemorrhages in the matrix of the nail,
ichthyosis,25 purpura, diffuse œdemas, localized perspiration
sometimes associated with sudamina and accompanied by
ecchymoses, muscular atrophies, bullæ, and pemphigus-like
eruptions, have been noted by various observers. As yet, they are to
be regarded rather as clinical curiosities than as constant features,
as diagnostic criteria, or as presenting special indications for
treatment. The trophic disturbances affecting the bones and joints
and a peculiar ulcerative process known as the perforating ulcer of
the foot are better studied, and, ranking among the most formidable
and striking manifestations of tabes, merit special consideration. The
tabic joint affection, first described by Charcot as a trophic
manifestation of tabes, is usually located in the hip or knee, but
almost any joint, including the temporo-maxillary articulation, may be
its seat. The earlier or lighter forms consist in serous exudations with
or without active local manifestations resembling those of synovitis;
but the commoner and graver form consists in actual deformity of the
articular surfaces, such as enlargement or atrophy, sometimes
supplemented by the formation of osteophytes. In addition,
spontaneous dislocations occur in a manner which is often quite
surprising.26 As a type of such an occurrence the following may
serve: A tabic patient presented a synovial swelling of the left knee
of truly enormous dimensions; as soon as this became reduced a
distinct crepitus was elicited, and both the femoral and tibial articular
surfaces found enlarged. The whole process occupied only a few
days; the lateral ligaments were then found so relaxed that the leg
could be freely moved in every direction.
24 Rossolymmo, Archiv für Psychiatrie, xv. p. 727. I have never observed this
symptom as beautifully developed as in a case of spinal irritation, in which the
possibility of the existence of any organic disease could be positively excluded.
Bulkley has observed albinism.

25 In three cases by Ballet et Dutil, Progrès médicale, May 19, 1882.

26 Boyer (Revue de Médecine, 1884, p. 487) records a case where the hip became
luxated spontaneously as an early symptom.

The connection between the morbid process in the spinal cord and
these remarkable arthropathies is as yet unexplained; and as
Charcot's original proposition, that they can be always referred to
lesions in the anterior horns of the gray matter, has not been
sustained, some of the German clinicians, notably Strümpell, are
inclined to attribute them, in part at least, to ordinary results and
accidents due to the anæsthesia and its disturbing effect on
voluntary and automatic joint protection. A controversy arose which
was participated in by the Clinical Society of London,27 and evoked
opinions from nearly all the eminent neurologists of Europe. The
result of this thorough discussion has been to establish the joint
affection as a true tabic symptom due to the same morbid process
which underlies the less enigmatical symptoms of the disease. One
of the best reasons for regarding these joint lesions as of trophic
origin is the fact that they are associated with textural bone-changes
by which they become either unduly soft or brittle, and therefore
exposed to apparently spontaneous fracture. Cases of fracture of
almost every long and some of the short bones are recorded, among
the most remarkable being one by Dutil,28 where fracture of the
radius occurred without adequate cause in the initial period of tabes;
and one by Krönig,29 in which the patient, who had been tabic for
eight years, broke a lumbar vertebra while catching himself in the act
of falling down stairs.
27 The question was formally raised by Morrant Baker at the December meeting in
1884, and the discussion participated in by Charcot himself. Among the opponents of
Charcot's theory were Jonathan Hutchinson and Moxon, the latter of whom
administered a sound and well-merited criticism regarding some of the premature, if
not sensational, announcements of the distinguished French neurologist. He
compared the joint lesions of tabes to decubitus: just as the latter can be avoided by a
proper protection of the exposed parts, so the former would not occur if the joints
could be kept in a, surgically speaking, normal state. Moxon seems to have forgotten,
in suggesting this comparison, that there is a form of decubitus which will occur
independently of the greatest care and in spite of every measure taken to arrest it,
and which can be attributed only to an obscure but active perversion of nervous
nutritive control. Barwell, Paget, Herbert Page, Broadbent, and McNamara agreed
that the joint lesions are not of surgical or rheumatic origin, but essentially signs of the
nervous affection. Although Barwell's claim, that the rheumatic and tabic joint
diseases are essentially different, because the former is hyperplastic and the latter is
atrophic, is not borne out by all cases of tabic joint disease, some of which are
certainly hyperplastic, yet the other reasons advanced for regarding these affections
as distinct, and considering the joint affection of Charcot as a trophic disorder, far
outweighed those advanced by the opponents of this view. In fact, the only ground the
latter had to stand on was the fact that Charcot's asserted anatomical foundation was
found to be chimerical.

28 Gazette médicale de Paris, 1885, No. 25.

 29 Zeitschrift für klinische Medizin, 1884, vii., Suppl. H.

Another reason for considering the arthropathies as of central origin

is their chronological association with other signs whose trophic
origin cannot be disputed, such as unilateral sweats and œdemas
and visceral crises. They are also found to correspond in many
cases to the lancinating pains both in location and time.

The feet of an advanced tabic patient usually appear deformed; the

extremities of the bones, particularly at the metacarpo-phalangeal
articulation, are thickened, and the axis of the foot as a whole is
bent. It is a question how far this deformity may be due to persistent
faulty innervation of the muscles going to the foot and to ensuing
mechanical influences. A most pronounced deformity found in a few
cases has been designated by Féré as the tabic foot.30 It consists in
the thickening of the tissues on the inner side of the foot, obliterating
its arch in such a manner that in standing the plantar surface is
everywhere in contact with the floor. With this the tarso-metatarsal
and the metacarpo-phalangeal joints of the great toes appear greatly
swollen.
30 Pied tabétique—Revue de Médecine, 1884, p. 473.

There is less dispute concerning the nature of the so-called

perforating ulcer of the foot. This lesion occurs only in cases where
the central or peripheral nervous apparatus is diseased; thus, it may
occur with neuritis, and it is therefore unanimously regarded as due
to morbid nervous influences. In tabes it may follow an exacerbation
of the fulminating pains. It consists in a swelling of the tissues of the
foot; the skin becomes firm and thickened; deep sinuous ulcers are
then developed, showing but slight if any tendency to granulate, and
which extend down to the bone, the latter usually remaining
unaffected.31 In a few cases more remarkable accidents due to
disturbed nutrition have been noted. Thus, J. Hoffmann records a
subcutaneous rupture of the Achilles tendon, and in another case the
spontaneous discharge of all the teeth of the upper jaw within about
a week's time.32
 31 Like most of the manifestations of advanced tabes, the perforating ulcer may occur
exceptionally as a pre-ataxic symptom. Thus, Suckling (British Medical Journal, 1885,
April 4, p. 693) mentions its preceding the development of tabes proper by one year.

32 Berliner klinische Wochenschrift, 1885, No. 12. In this unique case the loosening
and falling out of the teeth preceded the tabes by a year. Demange, who observed the
same phenomenon in two cases, found that the ascending root of the fifth pair was
involved. The only analogous observation in my experience relates, like the bleaching
of the hair in circular patches, to a case of spinal irritation: here the gums and alveolar
borders underwent atrophy, exposing the roots of the teeth to beyond the normal
alveolar border: first the right upper row, then the right lower row, and finally the teeth
on the left side in the same order, showed this condition; only the most posterior fell
out.

COURSE.—Tabes dorsalis is to be regarded as an extremely chronic

affection. Its development, as previously stated, is insidious,33 and
the symptoms demonstrating the advent of the disease may be so
slight for many years that the patient does not regard himself as ill or
as likely to become so. In this condition he may remain for ten or
more years; and there are cases recorded where the exact signs of
the incipient stage were well marked, and yet no ascertainable
progress was made in a period of such long duration that the
inference naturally follows of a much longer prospective period in
which the patient would not have become ataxic. There may be
distinguished two forms of invasion: the more frequent is marked by
the development of the terebrating, fulgurating, and fulminating
pains, to which, sooner or later, the abolition of the pupillary and
certain other deep reflexes is added. In the vast majority of cases
they are found absent when the physician's attention is directed to
the question of the existence of spinal disease. In about one-fifth of
the cases pain is at no time a prominent feature of the disease, and
may be, as is established by the cases cited, entirely absent. In
these patients the first symptoms noted are muscle-tire on slight
exertion. Usually, the evidences of disturbed sensation and
innervation begin in one extremity or preponderate in it, but
symmetry is soon established. The same is noticed in the extension
of the morbid process: when the ulnar distribution is involved—which
is the first danger-signal on the part of the cervical enlargement of
the cord—usually one side is first involved, but the other soon
follows, and becomes affected in equal or nearly equal degree. In
the overwhelming majority of cases the disease manifests itself in
the lower extremities first, remaining limited to them for a long
period, and if extending to the upper extremities doing so in much
slighter intensity than in the lower. Gull, Leyden, and others have
observed cases where the arms were first and chiefly involved; but
this is extremely rare. Cases of a simultaneous involvement of the
upper and lower extremities are more frequently noted. The
symptoms detailed above are developed in varying order in different
patients, and the line has been already indicated which separates
the progressive from the episodial features of the disease. Even in
the ataxic period the patients may remain in a comparatively
stationary period for many months and years.34 The general bodily
nutrition is usually good, and the muscular strength, as such, rarely
affected to any noteworthy extent until the extreme phase of the
disease is reached. Even the formidable-appearing crises and
trophic disturbances, though occasionally fatal, are not always so.
The direct danger from the disease proper, so far as life is
concerned, is in the possible development of cystitis and pyelitis, of
the malignant bed-sore, and of delirium and coma, the latter of which
is occasionally found to be due to cerebral hemorrhage—a lesion
which some writers regard as possibly due to some impalpable
influence of the spinal disease on the cerebral circulation.35
33 Cases of acute locomotor ataxia have been described. In no instance are they pure
or typical, and the last case of the kind published in America, beginning, as it is
evident from the account, with signs of general myelitis, illustrates the impropriety of
utilizing one or a few symptoms as determining nomenclature.

34 Thirteen patients are now under my observation, or I have been able to obtain
reliable medical information concerning their condition, who have been in the ataxic
period since the date of my first examination, varying from a year to seven years ago.
Not one of these patients is materially much worse than at that time. Two only died,
both being bedridden at the time they came under observation. Of the first group,
 three have shown more or less lasting improvement in respect to special symptoms,
as will be detailed in connection with the treatment.

35 In a case of sudden death, with an asthma-like seizure, of a tabic patient under the
charge of T. A. McBride, I found an intense injection of one (the right) vagus nucleus,
the color of the ala cinerea and of the nucleus on section being almost black.

MORBID ANATOMY AND PHYSIOLOGY.—Our knowledge of the structural

disease underlying the symptoms which comprise the clinical picture
of tabes dorsalis is perhaps the clearest in the domain of spinal
pathology. Not alone the commencement of the morbid process and
every stage of its subsequent encroachment on the spinal cord, but
also its relations to special symptoms, have been demonstrated in
numerous cases by some of the most careful German and French
investigators.

In advanced cases of tabes the disease of the spinal cord is so

evident that it was noted even by earlier observers, the region of the
cord lying between the posterior nerve-roots being altered in color,
consistency, and dimensions. It is gray instead of white, hard instead
of soft, and considerably shrunken. The gray discoloration of the
surface appears to be complete in the lumbar and lower dorsal
region; it is less intense in the upper dorsal and cervical part of the
cord; and often shows a division into three streaks, of which one, in
the middle line, occupies both columns of Goll, while on either side
another extends in the inner side of the posterior root-entry. The
posterior roots themselves are frequently atrophied, and exhibit a
firmer consistency and darker color than in health. On making cross-
sections of the spinal cord it is found that the gray discoloration
extends inward, involving more or less of the posterior columns in
well-defined areas. Microscopic examination shows that the myelin
of the nerve-tubes is either destroyed or atrophied, and the axis-
cylinder is found to be affected in the same way, usually presenting
alterations in its refraction and diameter where it is not entirely
destroyed. In the maximum foci of disease the conducting elements
of the cord are nearly destroyed, and their place is occupied by a
firm connective substance made up of wavy bundles, enclosing here
and there a few atrophied axis-cylinders with wasted myelin-sheaths.
The blood-vessels participate in the morbid process, at least as far
as the larger vessels are concerned: these are sclerotic, their lumen
appears contracted, the adventitial sheath is hypertrophied and
occupied by a nucleated, fibrillar connective substance. The
capillaries are sometimes normal, or participate in the morbid
process to the extent of a thickening of the extra-endothelial sheaths
which is either hyaline or fibrillary, and may show inflammatory cell-
proliferation. It is evident that the increase of connective tissue in the
posterior columns is not merely a relative one, due to the
condensation of the normal neuroglia after the disappearance of the
normal nerve-tubes, but is the result of actual proliferation. Opinion is
somewhat divided as to whether this is to be considered as an
inflammatory interstitial proliferation or as a more passive
development of tissue compensating for the destroyed conducting
elements. My own observations incline me to the belief that in
syphilitic tabes the morbid process is essentially interstitial, while in
non-syphilitic tabes it is parenchymatous, the disease beginning in
the nerve-tubes proper. Perhaps the controversies between
pathologists as eminent as Schultze, Tuczek, Rumpf, Zacher,
Kahler-Pick, Rosenstein, and Adamkiewicz—who are rather evenly
divided into opposing camps, one maintaining the parenchymatous,
the other the interstitial, origin of the disease—may be solved when
we learn to distinguish between the non-syphilitic and syphilitic
cases, which is clinically, as yet, impossible. The difficulty of deciding
what is a parenchymatous and what is an interstitial disease of the
cord is considerably enhanced by the fact that the neuroglia, which
by some at least is regarded as an interstitial connective tissue, is
derived, like the nerve-substance proper, from the upper or neuro-
epidermic germ-layer of the embryo, and not from the mesoblast,
which furnishes all other connective substances in the body.

It is regarded as well established that the sclerosis of the areas of

the spinal cord which are affected is preceded by a stage of granular
degeneration.36 This is supported by the facts that the sclerotic areas
are surrounded by a zone in which sclerosis has not yet developed,
but which is in a state of granular degeneration, and that in more
advanced tabes this belt is also found sclerosed. In paretic
dementia, a disease whose complicating cord affection closely
resembles that of locomotor ataxia, a granular degeneration of the
posterior columns is very common in earlier periods, while in later
periods a sclerotic tissue is found in the same locality.
36 Westphal, Archiv für Psychiatrie, ix. p. 725.

I regard these observations as opposed to the assumption of

Strümpell that tabes is a system-disease of the cord in the sense in
which he employs that term. In his fascinating and suggestive thesis
on the systemic affections he cites the observations of Tuczek made
on the posterior sclerosis ensuing from ergotism as confirming his
view that special systems of nerve-fibres are separately vulnerable
to special morbid influences. The remarkable correspondence
between the topographical distribution of the lesion of ergotin tabes
described by Tuczek and the characteristic areas of sclerosis found
in the column of Burdach in ordinary tabes, seems to justify a very
different conclusion. Ergot exerts its morbid influence through a
disturbance of nutrition. Just as it produces gangrene by constriction
of the nutritive vessels of the fingers and of whole extremities, so it
produces interference with nutrition of those nerve-elements in the
cord which are most liable to suffer from general arterial constriction.
These are presumably those portions which are supplied by the
longest and narrowest arterial stems—a condition obtaining in
precisely those parts of the cord which are affected both in ergotin
tabes and in ordinary tabes.

It has also been supposed that the morbid process began in the
posterior roots and crept in with these, thence extending upward.37
This view is opposed by the fact that there is no constant relationship
between the root lesion and the cord lesion; the sclerosis of the root-
zones within the columns of Burdach I found to be absolute in at
least one case where the outer nerve-roots were not distinctly
affected.38
37 Takacs is the most recent defender of this view.
 38 The root lesion may, like that of the column of Goll, according to a minority of the
interpreters, be a secondary process, for in ergotin tabes (Tuczek) both are usually
intact.

In typical tabes the sclerotic process begins in a special triangular

field of the posterior column in the lumbar enlargement of the cord.
The innermost of the posterior rootlets run through this field, which
has been designated by the French school as the posterior root-
zones, and the rootlets become exposed to all the vicissitudes which
the conducting tracts are destined to undergo in consequence.
Throughout the remainder of the cord it is the involvement of the
root-zone which indicates the advance of the affection upward. At a
time when the lesion is comparatively slight in the cervical level,
manifesting itself by a slight grayish or reddish streak to the naked
eye, a faint, pale discoloration in chromic-acid specimens, a deeper
stain in carminized, and a pallor in sections stained by Weigert's
method, the affected part in the lumbar region has undergone great
shrinkage; scarcely a single myelin-tube is preserved to receive
Weigert's stain within the affected area; the latter involves nearly the
entire field between the cornua, and absorbs carmine deeply, so that
it is difficult to differentiate the gray and white substance in
carminized sections. A small part of the posterior column which most
closely adjoins the posterior (gray) commissure remains free in all
cases; so also does a small laurel-leaf-shaped field bisected by the
posterior median septum. Examination with higher magnifying
powers, aided by the modern improved methods of preservation and
staining, reveals that the gray substance of the posterior segment of
the cord is usually more or less diseased. In advanced cases the
gelatinous as well as the spongy part of the posterior gray horn, and
even the posterior gray commissure, undergo such considerable
atrophy that they may occupy but half the normal area. In some
cases the columns of Clarke appear to be involved quite early in the
disease.39
39 Leyden discovered the degeneration in the fibres which in part make up these
columns and correctly traced its origin to the posterior rootlets. Lissaner and Zacher
(Archiv für Psychiatrie, xv. p. 437) confirmed him, the latter finding, as Leyden was the
 first to discriminate, that the cells may escape while the fibres are materially
diminished. Krause claims that the columns of Clarke are constantly affected, but not
necessarily in their entire length, the higher levels appearing quite normal at a time
when the lower are severely involved (Neurologisches Centralblatt, 1884, p. 50).

The triangular field in the lumbar part of the posterior column, which
is one of the typical starting-points of the affection, contains those
ascending nerve-bundles which in their cephalic course emancipate
themselves from the column of Burdach and constitute the slender
columns of Goll. The result is that the degenerative process creeps
up these columns at the same time that it ascends in the root-zones
and deep portions of Burdach's columns. Some authorities regard
this as a mere extension by contiguity;40 others incline to consider it
a secondary degeneration. It may extend to the medulla oblongata,
becoming lost in the level where the nucleus of the column of Goll
terminates, and is accompanied, at least in those advanced cases in
which the upper extremities are involved, by a comma-shaped area
of degeneration in the adjoining part of the column of Burdach, which
similarly extends into the oblongata and terminates slightly more
cephalad. In typical advanced tabes, therefore, the cross-section of
the cord exhibits a characteristic distribution of the sclerosis in each
level. As this distribution is associated with certain constant
symptoms, it is permissible to attempt bringing certain features of the
lesion in relation with special features of the disease symptoms. The
posterior gray horns and the posterior white columns, together with
other fibre-systems connected with them, are much more
complicated in structural and physiological relations than the
corresponding anterior structures. The relations of the anterior
rootlets to the gray substance, and those of the motor ganglionic
elements to their controlling tracts, are comparatively simple; those
of the posterior roots are very intricate. They run up, in great part, at
an angle to the longitudinal tracts; a few pass in directly, and still
fewer dip to a lower level. The result is that a section of the cord
made in the longitudinal direction through the root-zones, so as to
pass from the root-entry to the anterior commissure, shows the
column and root-fibres to be woven into each other like a plait.
Trabeculæ of connective tissue, dragged in as it were with the
posterior roots, fill up the interstices of this labyrinth. They are
particularly dense in the lowest part of the lumbar enlargement of the
cord, constituting the so-called posterior processi reticulares. It is
reasonable to suppose that the overlapping of ascending and
descending root-fibres, associated with the presence of an extra
amount of connective tissue, imbedded as this fibre-maze is in that
part of the cord which is most distant from its lymphatic emunctories,
affords a favorable soil for slow inflammatory trouble. This is the
primary field of tabic sclerosis, and in it the disease may remain most
intense for years, extending but slowly and with diminishing intensity
upward, hand over hand, as it were, on the natural ladder which the
intertwined fasciculi and their matrix constitute. The longitudinal
tracts which lie in and near the root-zones belong to the so-called
short fibre systems, uniting the segments of higher and lower levels
of the cord with each other. As the sclerotic process ascends it
involves the caudal ends of these systems: they consequently
undergo secondary degeneration, and, shrinking in their turn, affect
the caudal part of the next system above in the same manner. The
morbid process in the column of Burdach may therefore be
considered as a combination of inflammatory and degenerative
changes, the inflammatory products causing a series of short
ascending degenerations, and the vulnerable path thus established
being followed by a cirrhotic condition in which the connective and
vascular structures participate actively. With regard to the reasons
for regarding the degeneration of the column of Goll and that of the
comma-shaped field near it as a secondary process due to the
cutting off of its apparent nerve-supply at the caudal end, and of the
posterior nerve-roots or their provisional terminations, they may be
stated in this way: When the lesion of the primary field is limited to
the lower lumbar or sacral part of the cord, the degeneration of the
column of Goll is limited to its postero-internal part; when the upper
lumbar and lower dorsal cord is involved, the entire tract is affected;
and when the cervical portion is diseased, the supplementary
comma-shaped area degenerates. In other words, the projection
tract of the sciatic nerve, as far as it is represented in Goll's column,
suffers in the first, that of the crural nerves in the second, and that of
the brachial nerves in the third instance. In all advanced cases of
tabes the affection of the column of Goll is in direct proportion to the
altitude of the lesion in the primary field. Symptomatically, it bears an
equally constant relation to the ataxia.41 No case is on record in
which these columns were totally degenerated without some motor
inco-ordination of the lower extremity having been observed during
life; and no case is recorded in which brachial ataxia had been a
marked and persistent feature in which the comma-shaped area—
area of the column of Burdach—was healthy.
40 It is held by them that the histological character of the change of the columns of
Goll is not different from that in the column of Burdach. Zacher (Archiv für Psychiatrie,
xv. p. 435) urges that it does not resemble true secondary degeneration, beginning in
the vessels and connective substance instead of the nerve-fibres. Schultze (ibid., xiv.
p. 386), on the other hand, recognizes a primary involvement of the nerve-fibres in
both of the areas of fascicular degeneration in tabes. The observation of intact axis-
cylinders by Babinski in the sclerotic fields is in conflict with the latter's claim, and the
various differences of observation and interpretation seem to be reconcilable only on
the assumption that there are two different modes of origin, both leading to nearly the
same results and occasionally combined in one and the same case.

41 Krause's case and others show that the ataxia of movement is not influenced by
lesion of the column of Clarke; but we are not informed as to the static equilibrium of
the patients in whose cords these columns were found intensely affected.

It is scarcely necessary to seriously consider the suggestion of

Strümpell, that the lesion of the column of Goll is in relation with the
bladder disturbance.42 Cases are on record by Wolff and others
where this lesion was intense and there was little or no bladder
disturbance.43
42 Archiv für Psychiatrie, xii.

43 The column of Goll is not present in those mammals which, like the porpoise, have
no developed hind limbs, but these animals have urinary bladders.

If the disease of the column of Goll were a primary systemic affection

independent of the disease of the root-field, it would be difficult to
understand why it, as well as the likelihood of finding a
corresponding degeneration of the direct cerebellar tract, increases
with the extent to which this field is involved. This occurrence
becomes quite clear when we remember that both the direct
cerebellar tract and that of Goll, being centripetal, are under the
trophic dominion of the posterior nerve-roots. The opinion is not
distinctly expressed, but implied in some writings, that the column of
Goll degenerates because of a general transverse cord lesion at a
low level; this is not the case in the tabic cord. There is a difference
in appearance between that part of the primary field which
corresponds to the column of Goll in the lumbar cord and the
surrounding sclerosis in early cases: it is more intensely
degenerated, more homogeneous in appearance, and more evenly
stained. The other part of the triangular field presents a more
trabecular appearance. In the specimen represented in the
accompanying figure this is easily recognized: the darker field
corresponds exactly with the ascending degeneration, which follows
compression of the cauda equina,44 and is the sciatic equivalent of
the column of Goll.
 FIG. 31.

Trans-section of Upper Lumbar Cord of a Patient moderately advanced in

Tabes: f, ventral or anterior fissure; g, caput gelatinosum; r r′, entry and
deep course of the posterior rootlets; d, degenerated field, including the
origin of the tracts which in higher levels form the columns of Goll; n, field
near the posterior commissure which remains free from degeneration,
both in the lumbar and cervical cord; s, sharply marked leaf-shaped field,
bisected by posterior septum, which, as claimed by Strümpell and shown
in this case, remains free from disease; z, zone of nearly normal
consistency around it; a, diseased field, suspected to be related to the
analgesia, not usually affected in early tabes; v, fibres running up and
down in front of the gelatinous substance; *, region where the tabic
process sometimes begins.

44 I have also found that this field corresponds to the column of Goll in its myelinic
development: the lumbar part of this column—designated as such by Flechsig—is an
entirely different tract, which enjoys a remarkable immunity from disease in tabes.

As illustrating the bearing of the lesion of the column of Goll on the motor ataxia I may
refer to two cases which happen to be related side by side by Strümpell (Archiv für
Psychiatrie, xii. p. 737, Cases 1 and 2). As far as the lumbar segment of the cord is
 concerned, the distribution of the lesion is similar; but in the one presenting marked
motor ataxia the triangular field was slightly diseased, and there was no upward
extension of the lesion in the column of Goll. In the other, with marked ataxia, the
triangular field was intensely diseased, and ascending degeneration (?) occurred in
the sciatic fields of the latter.

In support of the view that the comma-shaped area in Burdach's columns is

homologous with the fibres of the column of Goll, it is to be advanced that
degeneration of this field bears the same relation to symptoms in the distribution of
the ulnar nerve that degeneration of the column of Goll bears to sciatic and crural
symptoms. Where the initial pains and subsequent tactile and locomotor disturbance
were severe, this field was found affected, and most so in the side where the
symptoms had been most intense (Friedreich-Schultze's cured cases, Archiv für
Psychiatrie, xii. p. 234). This area has no direct connection with the root-fields.
Secondly, in a primary system disease of the column of Goll, associated with
degeneration of the nucleus of the column of Goll, described by Scoli, an irregular
encroachment of the column of Burdach was noted. Third, the innermost fibres of the
column of Burdach (those belting the nucleus in the oblongata) have the same
relation to the interolivary layer which the column of Goll has through its provisional
nucleus of termination.

While the evidence of high lesion of the cerebral continuation of the column of Goll,
and, what I regard as its homologue, the comma-shaped area of Burdach, together
with the constant association of marked degeneration of these columns with motor
ataxia, is strong positive proof of its relation to this symptom, there is equally strong
evidence negativing its relation to any other of the prominent symptoms of tabes
dorsalis. Thus Babesin (Virchow's Archiv, lxxvi. p. 74) found degeneration of the
posterior columns limited to the column of Goll, and the patellar reflex was not
destroyed; the root-fields at the upper lumbar levels were intact. That the columns of
Goll have been found profoundly affected without bladder disturbance has been
stated previously, and constitutes a stronger argument against Strümpell's view than
the frequent observation of bladder trouble in spinal diseases, along with which these
columns may be entirely free.

Among the various constituents of the posterior columns which

appear to present a relative immunity to the disease, aside from the
area near the posterior commissure and the laurel-leaf-shaped area
of the posterior septum, Strümpell noted one which is situated at the
periphery of the cord, bordering on the entry-line of the posterior
roots and the inner contour of the posterior roots. In the few cases
where it was found destroyed there was, what is a comparatively
rare thing in moderately severe tabes, complete analgesia. It is not,
however, certain that there is a necessary connection between the
pathological and clinical fact here. The nerve-roots themselves are
involved within the diseased area of the root-zones. The lesion is
one of a kind which, affecting a nerve-trunk, would produce first
irritation of, then impediment to, and ultimately destruction of, its
function. The clinical parallel to this is the occurrence of the lightning-
like pains in the earlier phases of the disease, which are followed by
delayed pain-conduction, and finally by loss of sensation. Of the
rootlets or fibres subservient to the various sensory and reflex
functions mediated by the posterior roots, those which convey the
centripetal impression normally evoking the patellar jerk appear to be
the most vulnerable, or, because of their limited number, the earliest
to be destroyed or compressed, with the result of total functional
paralysis.45
45 It is now conceded that, as Westphal claimed, the patellar jerk is always abolished
when the upper lumbar level of the root-zones (bandelettes externes of Charcot) is
involved. Tshirijew has shown that the translation of the knee-jerk reflex occurs in a
single segment of the rabbit's cord at the homologous level. In transverse sections a
distinct fascicle may be seen coursing from the innermost root-fibres toward the
antero-intermediate cell-group of the anterior horn; it furnishes a pictorial substratum,
if not anatomical proof, for the patho-physiological observation, and harmonizes with
the fact that it is the innermost rootlets which usually suffer first. Perhaps the delicacy
of this tract accounts for the frequent disappearance of the jerk in old people as a
result of senile sclerosis.

With regard to the interpretation of the various tactile sensory

disturbances of tabes and the delayed pain-sense conduction little
positive advance has been made. That the lesion of the root-zones
and gray substance is responsible for them seems to be the general
conclusion of French and German observers. Recent researches
have shown that disease of the peripheral nerves (multiple neuritis)
may produce sensory phenomena which it had previously been
customary to regard as pathognomonic of disturbance of their
intraspinal terminations and continuations. At the same time, we are
confounded by the observation of Erb, that even retardation of
conduction of the pain-sense, which the dictum of Schiff taught us to
regard as a sign of disturbed function of the spinal gray matter, is
also produced by peripheral neuritis.

Immediately adjoining the gelatinous apex of the posterior horn there

is a column of vertical fibres which bear a relation to it resembling
that of the ascending root of the fifth pair in the oblongata to the
tuber cinereum of Rolando. Sclerosis of this column, as well as of
the ascending root in question (Demange), has been found in tabes,
and usually in association with pronounced trophic disturbances. In a
number of cases (Oppenheim, Eisenlohr, and others) where
spasmodic laryngeal crises had been a marked feature during life,
lesion of the floor of the fourth ventricle, or atrophy of the
pneumogastric nerve, or even of its nucleus, was found. In one case
with marked gastric crises I found sclerotic changes of the arteries in
the ala cinerea.

With regard to the involvement of the peripheral nerves proper, aside

from the optic, opinion is somewhat divided. The discovery of
multiple neuritis, and the recognition of the fact that it had been
erroneously confounded with tabes, led Dejerine to claim that tabes
might be of peripheral origin. He even proposed to account for the
oculo-motor trouble on the basis of an affection of the oculo-motor
nerves. This explanation has been repudiated by Westphal and
sound authorities generally. That the peripheral nerves are
occasionally involved in tabes was already known to Friedreich in
1863,46 and later Westphal found the cutaneous branches in an
advanced tabic patient to present similar changes to those
discovered by Friedreich: these findings are confirmed by his
Japanese pupil, Sakaky. The nerve-tubes are atrophied, the axis-
cylinder being often preserved, and the interneural connective
substance is proliferated. But there is no constant relation between
these changes and the symptoms of the disease; in one of Sakaky's
cases the nerves of an extremity which had been the seat of severe
sensory symptoms were entirely normal. The findings in the
peripheral nerves of tabic subjects lose much of their value in view of
their recent discovery in marantic persons47 advanced in life, but who
had no nervous disease whatever.
46 Virchow's Archiv, vol. xxvi. pp. 399-452.

47 Krause, Neurologisches Centralblatt, 1885, p. 53.

It has been attempted to bring the tabic process in relation to a

supposed primary meningitis. Tabes is a rather common nervous
affection, and primary spinal meningitis is one of the very rarest. The
leptomeninges are found considerably thickened in one out of ten
tabic cords, and those who defend the meningitic origin of the
disease base their theory on this inconstant finding, and allege that
in the cases where it is absent the meningitis has disappeared while
the cord lesion progressed. It is a fatal objection to this view that the
part of the posterior columns immediately adjoining the pia is often
quite free from disease. A meningitic affection, either as an
etiological or a complicating factor, can be admitted in those cases
only where there is a marginal sclerosis.

The changes in the optic nerve resemble those of the white columns
of the cord in their naked-eye and minute character as well as in the
controversial nature of the various interpretations made. When
affected, the nerve is found to be firmer than normal, and discolored;
later it becomes quite gray, and may eventually shrink to two-thirds,
and even less, of its normal diameter. It is generally believed that, as
in the cord, the myelin undergoes wasting before the axis-cylinder
disappears, and that the latter may survive a long time, thus
explaining why the patient may retain his visual power for a
considerable period after the ophthalmoscope determines the
existence of atrophy. No satisfactory explanation has as yet been
offered for the optic-nerve affection of tabes. There is no direct
continuity of the spinal and optic sclerosis. Two theoretical
possibilities suggest themselves. The first is that the lesion of the
cord exerts a remote effect upon the physiological, and through this