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 ECONOMIC INEQUALITY,
NEOLIBERALISM,
and the AMERICAN
COMMUNITY COLLEGE

Patrick Sullivan
Economic Inequality, Neoliberalism, and the
American Community College
 Patrick Sullivan

Economic Inequality,
Neoliberalism, and
the American
Community College
Patrick Sullivan
Manchester Community College
Manchester, Connecticut, USA

ISBN 978-3-319-44283-9    ISBN 978-3-319-44284-6 (eBook)

DOI 10.1007/978-3-319-44284-6

Library of Congress Control Number: 2017934510

© The Editor(s) (if applicable) and The Author(s) 2017

This work is subject to copyright. All rights are solely and exclusively licensed by the
Publisher, whether the whole or part of the material is concerned, specifically the rights of
translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on
microfilms or in any other physical way, and transmission or information storage and retrieval,
electronic adaptation, computer software, or by similar or dissimilar methodology now
known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information
in this book are believed to be true and accurate at the date of publication. Neither the
­publisher nor the authors or the editors give a warranty, express or implied, with respect to
the material contained herein or for any errors or omissions that may have been made.
The publisher remains neutral with regard to jurisdictional claims in published maps and
institutional affiliations.

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The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
 Permissions

Chapter 29 of this book appeared in a somewhat different form as

“Measuring ‘Success’ at Open Admissions Institutions: Thinking Carefully
About This Complex Question.” College English 70.6 (2008): 618–32.
Copyright 2008 by the National Council of Teachers of English. Used
with permission.

Portions of Chap. 19 and the Conclusion originally appeared in a

somewhat different form as “The Two-Year College Teacher-Scholar-­
Activist.” Teaching English in the Two-Year College 42.4 (2015): 227–43.
Copyright 2015 by the National Council of Teachers of English. Used
with permission.

Chapter 25 originally appeared in a slightly different form as ‘“Ideas about

Human Possibilities’: Connecticut’s PA 12-40 and Basic Writing in the
Era of Neoliberalism.” Journal of Basic Writing Spring 2015. Copyright
2015. Used with permission.

v
 ma già volgeva il mio disio e ’l velle
sì come rota ch’igualmente è mossa,
l’amor che move il sole e l’altre stelle.
but my desire and will were moved already—
like a wheel revolving uniformly—by
the Love that moves the sun and the other stars.
—Dante, Paradiso 33.143–45

*****

To
Susan,
Bonnie Rose,
Nicholas,
and Marigold Hope
—my sun and stars
American colleges and universities must envision a much larger role for
higher education in the national life. They can no longer consider them-
selves merely the instrument for producing an intellectual elite; they must
become the means by which every citizen, youth, and adult is enabled and
encouraged to carry his education, formal and informal, as far as his native
capacities permit.

This conception is the inevitable consequence of the democratic faith; uni-

versal education is indispensable to the full and living realization of the
democratic ideal. No society can long remain free unless its members are
freemen, and men are not free where ignorance prevails. No more in mind
than in body can this Nation or any endure half slave, half free. Education
that liberates and ennobles must be made equally available to all. Justice to
the individual demands this; the safety and progress of the Nation depend
upon it. America cannot afford to let any of its potential human resources
go undiscovered and undeveloped.

—The Truman Commission Report, 1947

ix
 Acknowledgments

This book is dedicated to Martin Luther King’s essential premise articu-

lated so memorably in his Nobel Lecture on December 11, 1964—that a
great nation is a compassionate nation:

The rich nations must use their vast resources of wealth to develop the under-
developed, school the unschooled, and feed the unfed. Ultimately a great
nation is a compassionate nation. No individual or nation can be great if it
does not have a concern for “the least of these.” Deeply etched in the fiber
of our religious tradition is the conviction that men are made in the image
of God and that they are souls of infinite metaphysical value, the heirs of a
legacy of dignity and worth. If we feel this as a profound moral fact, we can-
not be content to see men hungry, to see men victimized with starvation and
ill health when we have the means to help them.

There are many ways that individuals can be hungry. If a great nation is
a compassionate nation, we cannot be content to have adult Americans
living lives without hope or promise. Especially with the disappearance of
work that pays a living wage in America (Greenhouse; Kalleberg; Shipler;
Weil; Wilson), the community college must play an important role in
engaging this essential public work in America today. At its most basic,
this work is part of our ongoing national efforts to promote equity and
social justice (Ignatieff; Rawls; Sen Development; Sen Idea).
This book, though humble, was made with great joyfulness and love,
and it has benefitted tremendously from the help of many. It is with s­ incere

xi
xii Acknowledgments

gratitude that I offer these brief words of thanks to the people who have
helped make it possible.
This book would not have been possible without the generous support
of my home institution, Manchester Community College, and the sab-
batical leave I was granted in the fall of 2015. A significant portion of this
book was completed during that time. I am deeply indebted to the college
for this time to research and write. I am deeply thankful for the college’s
enthusiastic support of my work.
My heartfelt thanks to the editorial team at Palgrave Macmillan, espe-
cially Mara Berkoff and Milana Vernikova. A special thank you to Palgrave
Macmillan for believing in this project and believing in the value of com-
munity colleges. I also wish to extend my deep thanks to the anonymous
reviewers at Palgrave for the excellent feedback and constructive criticism
they provided to me throughout the process of writing and revising this
book. Your feedback was invaluable to me.
I am indebted to my colleagues at Manchester Community College,
where I have taught now for many years. I would especially like to
thank my colleagues in the English Department. You are an inspiration
to me every day.
I would also like to thank my close friends and colleagues Andrew
Paterna, Gena Glickman, George Ducharme, Pat Beeman, David Nielsen,
Duncan Harris, Ed Hogan, Lois Ryan, Steve Straight, David Caldwell,
Wanda Haynes, Bettylou Sandy, Lucy Hurston, Brenda St. Peter, Julie
and Wes Larkin, Michelle and Jeanne Nickerson, Keri Renner, Mike
Bogdanski, Kristin Duethorn, Griz, and David Salisbury.
A special word of gratitude to Dan, Dennis, and Molly—extended fam-
ily members who I hold close in my heart.
I also wish to extend my heartfelt thanks to my great teachers at Mohegan
Community College in Norwich, Connecticut, where this journey began
many lifetimes ago, especially Jim Coleman, Jim Wright, and John Perch. A
special thank you to John Basinger, my lifelong friend and mentor.
Thank you to my inspiring friends and colleagues in the profession
affiliated with The National Council of Teachers of English and The Two-
Year College English Association, including Howard Tinberg, Sheridan
Blau, Jeff Sommers, Christie Toth, Darin Jensen, Carolyn Calhoon-
Dillahunt, Holly Hassel, Joanne Baird Giordano, Cheryl Hogue Smith,
Jason Courtmanche, Amanda Greenwell, Jessyka Scoppetta, John Pekins,
Mariolina Salvatori, Patricia Donahue, Mark Reynolds, Hope Parisi,
Cheryl C. Smith, Kathi Yancey, Muriel Harris, Alfredo Lujan, Ellen Carillo,
 Acknowledgments  xiii

John Schilb, Kelly Ritter, Leslie Roberts, Jody Millward, Sterling Warner,
Lois Powers, Lawrence McDoniel, Jeffrey Klausman, Frost McLaughlin,
Miriam Moore, Yufeng Zhang, Jonathan Alexander, and Christine Vassett.
I would also like to thank my amazing students, especially my English
93 and English 9000 students, who have taught me so much.
I offer my deepest thanks to those I have lost who would have been
delighted by this book. These include my mother and father, Barbara and
Donald Sullivan. And my lifelong friend and mentor, Victor Kaplan, a
writer and professor of English at Eastern Connecticut State University.
And finally I offer my deepest thanks to my wife, Susan, and my chil-
dren, Bonnie Rose and Nicholas, without whom none of this would have
been possible. And to my granddaughter, Marigold Hope, who is a bless-
ing every day.
I am, of course, what time, circumstance, and history have made of me,
but I am also, thanks to all of you, much more than that. Words cannot
adequately express the debt of gratitude I feel for the many gifts you have
given me over these many years.
 Contents

1 Introduction   1

Part I Journeys  15

2 No Regrets. By Scott Kiley  

 I got to my outpost in Afghanistan in January 2011.
“
It was so remote it took us about three weeks of
traveling to get to where we needed to be.”19

3 My Journey. By Julie A. Larkin  

“I had to use a camp stove to warm up water to bathe
and wash my hair. Many times I had to borrow a
flashlight or use candles to study.”25

4 A New Beginning. By Eddie Rivera  

“My father, Eddie Rivera Senior, was born on July 14,
1964, in Santurce, San Juan Puerto Rico. He was the
first of eight children, four boys and four girls.
Growing up he remembers playing with his brothers
and sisters outside along with his childhood friends
and watching his favorite superhero crush Wonder
Woman on their first black and white television.”31

xv
xvi Contents

5 Everything in Life Has a Cost. By Sarah Brihan  

“I was accepted into six different schools at the end of
my senior year.”35

6 Survival and Resilience. By Chhan D. Touch, MS, FNP  

“I do not remember the exact year of my birth or
the zodiacal symbol. My mother died while I was just
a young child. This is my story and a legacy of a
Killing Fields survivor.”39

7 The Accident of My Career and Academic Life.

By Bethany Silver  
“The accident of my career and my academic life began
with a high school dream that crashed and burned.”59

8 The Path I Didn’t Choose. By Michelle Nickerson  

“I should not be here today telling you that I have
completed this master’s degree.”67

9 Head Start. By Mikey Palacios-Baughman  

“My entire life I was homeschooled. Before you ask, yes
I had friends, no it wasn’t difficult to meet people, no
I never wanted to go to public school and yes I loved it.”71

10 Sabina’s Story. By Sabina Mamedova  

“In my difficult childhood, I had been forced to leave
two countries, my father was murdered, I was forced
to learn several languages, and I experienced many
forms of discrimination.”75
 Contents  xvii

11 No Longer Trapped. By Jenn Nguyen  

“To my innocent youth, I thank you for falling in love
with words. With books. To my rebellious teenage years,
I thank you for drowning my sorrows with hopeless
remedies. To my immature adulthood, I thank you for
the beautiful baby that I absolutely adore.”89

12 Coming in from the Cold. By Tanya Knight  

“It was in 2006, while driving to work knowing I was
going to be terminated or laid off soon I was struck by
a song I heard by T.I. and Rihanna. One line said, ‘be
grateful for the life you have and not worry about the
life you don’t have.’”93

13 Slim Chances. By Anton Pettiford  

“I wasn’t until my best friend received a 35-year prison
sentence that I realized my life was critically weighing
in the balance, headed toward destruction in need of
serious change.”97

14 Recovery. By Abigail Welles 

“I was one of two in a graduating class of 896 to
graduate with honors from the Honors College.”101

15 Writing My Way to College. By Ashley Riddlesworth 

“The drama of the Hollywood world was consuming,
however, and I started to realize that celebrity gossip
was just that—gossip.” 111
xviii Contents

16 Journey. By Yanira Hernandez 

“As little girls, my sister and I had lots of fun inside
too. We played all sorts of things, but my favorite
was playing teacher. I always had to be ‘the teacher.’”123

17 What Do These Student Success Stories Tell Us? 131

Part II Democracy’s Unfinished Business 143

18 The Truman Commission Report 145

19 Economic Inequality and Higher Education 153

20 “Socialism Means Slavery” 165

21 Unfreedom 177

22 Opportunity Differentials 195

23 Different Psychological Worlds, Part 1 205

24 Different Psychological Worlds, Part 2 221

25 “Ideas About Human Possibilities”:

Connecticut’s PA 12–40 and Developmental Education
in the Era of Neoliberalism 241

Part III The Public Good  273

26 A Brief History of the Public Good 275

 Contents  xix

27 The Consequences of a Deified Market Model 295

28 Development as Freedom 311

29 Measuring “Success” at Open Admissions Institutions 323

30 Diverted Dreams, Cruel Hoaxes, and Institutional

Ineffectiveness: The Community College
“Failure” Narrative 341

31 The Developmental Education Crisis 357

Part IV Conclusion  373

32 Conclusion: “To Do” List 375

Bibliography  399

Index 427
 About the Author

Patrick Sullivan teaches English at Manches-

ter Community College in Manchester, Con-
necticut. He has taught a wide range of basic
writing, composition, and literature classes, and
has written articles for a variety of journals,
including Teaching English in the Two-Year Col-
lege, College English, College Composition and
Communication, The Journal of Basic Writing,
Academe, The Journal of Adolescent and Adult
Literacy, The Journal of Developmental Educa-
tion, The Community College Journal of Research
and Practice, Innovative Higher Education, The Chronicle of Higher Edu-
cation, and English Journal.
Sullivan is the editor, with Howard Tinberg, of What Is “College-Level”
Writing? (2006) and, with Howard Tinberg and Sheridan Blau, of What
Is “College-Level” Writing? Volume 2: Assignments, Readings, and Student
Writing Samples (2010) and Deep Reading: Teaching Reading in the Writing
Classroom (2017). He is also the author of A New Writing Classroom:
Listening, Motivation, and Habits of Mind (2014). Sullivan has also edited,
with Christie Toth, Teaching Composition at the Two-Year College: Background
Readings (2016), a book in the Bedford/St. Martin’s Professional Resources
series. He serves as a member of the Editorial Board of College Composition
and Communication.

xxi
 List of Figures

Fig. 19.1 Equity indicator 5a: Distribution by family income quartile

of dependent family members, aged 18–24, who attained
a bachelor’s degree by age 24: 1970–2014 (2016, 60) 158
Fig. 19.2 Accuplacer reading scores and family income for
new students who applied for financial aid,
Fall 2011, 2012, 2013, 2014, and 2015  159
Fig. 21.1 Stowage of the British slave ship ‘Brookes’
under the regulated Slave Trade Act of 1788  189
Fig. 24.1 A 1916 leaflet promoting a voter referendum
to segregate St. Louis. This referendum was approved  230
Fig. 25.1 My gradebook pages for English 9000, fall 2014 253
Fig. 25.2 The attendance record for my English 9000 class, fall 2014 254
Fig. 26.1 Sharecropper Bud Fields and his family at home.
Hale County, Alabama. 1936 279
Fig. 26.2 Cotton pickers, Arkansas, on the Alexander plantation
at 6:30 a.m., waiting for the workday to start, 1935 280
Fig. 26.3 Eighteen-year-old mother from Oklahoma, now a
California migrant, 1937 281
Fig. 29.1 Graduation rate (within six years) from first institution
attended for first-time, full-time bachelor’s degree-seeking
students at four-year postsecondary institutions,
by acceptance rate of institution: Cohort entry year 2007 328
Fig. 31.1 New first-time MCC students: Graduation and transfer status 360
Fig. 31.2 The cover of Complete College America’s report,
Remediation: Higher Education’s Bridge to Nowhere. 2012  363

xxiii
xxiv List of Figures

Fig. 31.3 Graduation ceremony at Manchester Community

College, May 2016. Approximately 60 percent of the
students in this graduating class owe their success
to developmental English or math courses. In 2016,
896 students graduated with degrees and certificates 364
Fig. 31.4 Photo from graduation ceremony at Manchester
Community College, May 2015. Approximately
60 percent of the students in this graduating class owe
their success to developmental English or math courses 365
Fig. 31.5 Photo from graduation ceremony at Manchester
Community College, May 2015. Approximately
60 percent of the students in this graduating class owe
their success to developmental English or math courses 366
Fig. 31.6 Photo from the graduation ceremony at Manchester
Community College, May 2016. Approximately
60 percent of the students in this graduating class owe
their success to developmental English or math courses 366
Fig. 31.7 Recent graduates from Pierce College in Woodland Hills,
California—one of California’s 113 community colleges,
May 2015. Approximately 39 percent of the students
in this graduating class owe their success to developmental
English or math courses 367
Fig. 31.8 Graduation ceremony at Southwestern College
in Chula Vista, California—one of California’s
113 community colleges, May 2015. Approximately
39 percent of the students in this graduating class owe
their success to developmental English or math courses  367
Fig. 31.9 MCC’s first graduating class in 1965 368
 CHAPTER 1

Introduction

“Education that Liberates and Ennobles”

In 1947, President Truman’s Commission on Higher Education issued a
landmark report, Higher Education for American Democracy: A Report of
the President’s Commission on Higher Education, Volumes I–VI, one of the
most important documents ever produced about education in America.
No longer content for colleges to serve as bastions of privilege and wealth,
the Commission called for a radical new approach to higher education
and the establishment of a national system of community colleges across
America. The rationale for this new approach to higher education was
articulated with some of the most stirring language ever formulated about
the role of higher education in a democracy:

American colleges and universities must envision a much larger role for
higher education in the national life. They can no longer consider them-
selves merely the instrument for producing an intellectual elite; they must
become the means by which every citizen, youth, and adult is enabled and
encouraged to carry his education, formal and informal, as far as his native
capacities permit.
This conception is the inevitable consequence of the democratic faith;
universal education is indispensable to the full and living realization of the
democratic ideal. No society can long remain free unless its members are
freemen, and men are not free where ignorance prevails. No more in mind
than in body can this Nation or any endure half slave, half free. Education

© The Author(s) 2017 1

P. Sullivan, Economic Inequality, Neoliberalism, and the American
Community College, DOI 10.1007/978-3-319-44284-6_1
2 P. SULLIVAN

that liberates and ennobles must be made equally available to all. Justice to
the individual demands this; the safety and progress of the Nation depend
upon it. America cannot afford to let any of its potential human resources
go undiscovered and undeveloped. (101)

Sixty-five years into this grand experiment, the community college has
become central to America’s system of higher education, serving millions
of students across the nation. As the authors of a recent Two-Year College
English Association document note, community colleges now “enroll the
majority of African-American, Latino, and Native American college stu-
dents in addition to returning adult students, dual-enrolled high school
students, multilingual and ‘Generation 1.5’ students, veterans, and stu-
dents with disabilities” (Calhoon-Dillahunt, Jensen, Johnson, Tinberg,
and Toth). Despite significant and demonstrable success across a broad
range of indicators, there remains much confusion and misunderstanding
about the community college. This book seeks to address these misunder-
standings systematically and methodically.
Following psychologists Edward E. Jones and Richard E. Nisbett’s
landmark work on perception, I have attempted to explore in this book
what we might have to gain by adopting an “actor’s perspective” of the
community college, rather than an “observer’s perspective.” In so doing,
I seek to move our scholarly conversation beyond a purely statistical
model of the community college in order to promote a more qualita-
tive, “student-­present” (Bishop 199) understanding of this institution.
There is much that we can gain from listening to students themselves as
they discuss what the community college and its open door policy has
meant to them. Here we will learn about students’ goals and family his-
tories, and their ideas about education and democracy. In engaging this
important qualitative work, we will be privileging a theory of the commu-
nity college that seeks to be fundamentally informed, to borrow a phrase
from economist Amartya Sen, by the lives that people actually “manage—
or do not manage—to live” (Idea 18; Development 142–145). Following
Sen, we will also be formulating a “freedom-centered” understanding of
the community college and the nature of the social justice in America
that is “very much an agent-oriented view” (Development 11). In some
ways, following Ellen Langer’s work on mindfulness, it appears that we
have become “trapped by categories” (11–12) in our understanding of
the community college and victims of “acting from a single perspective”
(16–18). Our reliance on the statistical model of success developed by
 INTRODUCTION 3

residential, selective admissions institutions perpetuates a misunder-

standing about the nature of the community college and its place in the
American system of higher education. This book seeks to address this mis-
understanding directly.

“Student-Present” Research
This book features a unique combination of data and research about com-
munity colleges and provides an innovative approach for assessing the
value of community colleges in America. This book also provides a coun-
ter-narrative to the deficit models of community colleges currently enjoy-
ing a renaissance now in our legislatures and in much current scholarship
devoted to community colleges. Much of what is currently written about
student aspirations and community colleges is misleading and misguided—
often the result of a deep unfamiliarity with these institutions and the stu-
dents they serve.
Part I of this book features a selection of student-authored essays from
The Community College Success Stories Project, a research project I began
in 2015 to draw attention to the good work being done at America’s com-
munity colleges. This project features essays at an online website written
by community college students about their journeys to and from open
admissions institutions. We are currently in the beginning stages of imple-
menting this project, but it is my hope that eventually this website will
include essays written by students from across the nation. This project
received a Conference on College Composition and Communication
(CCCC) Research Initiative Grant in 2016, from my professional organi-
zation, the National Council of Teachers of English (NCTE). This project
has been established to document and preserve for the reading public the
many remarkable life stories that are created every day at our nation’s com-
munity colleges.
The website is located here:
http://www.communitycollegesuccessstories.org/
The primary goal of The Community College Success Stories Project
is very simple: To build an archive of thousands of community college
success stories that can be searched and accessed by new community col-
lege students looking for inspiration and that can serve as a resource for
scholars and researchers seeking qualitative data about students who have
attended open admissions institutions.
4 P. SULLIVAN

In some important ways, these stories are all literacy narratives of one
sort or another, documenting student achievement across a variety of
cultural contexts, academic disciplines, and life trajectories. This project
privileges writing by college students themselves and therefore provides
a unique, personal, and rare glimpse into the kinds of lives being lived by
community college students in America.
We see in these artifacts accounts of college life not often studied by edu-
cational researchers. It is my hope that this archive of essays (and the small
sample of student essays featured in this book) will help readers develop a
more informed, sympathetic, and personal understanding of community
colleges and the students who attend them. In so doing, I am attempt-
ing to reshape our understanding of the modern community college and
tell a more complete story about our ongoing efforts to democratize the
system of higher education in America. These stories will add evidence
to our ongoing discussion that has not been provided before—students
telling their own stories and speaking directly to scholars, researchers,
and policymakers about their experiences at open admissions institu-
tions. Here I am drawing on the work of Susanmarie Harrington, Wendy
Bishop, and Carole Center, who have called for more scholarship that is,
to use Bishop’s phrase, “student-present” (199). This book is an attempt
to honor that call. Harrington defines this type of research as devoting
“serious attention to student voices”: “In student-present scholarship, the
focus is on how students experience broad curricular trends” (96–97).
I also seek to help further Sheryl Fontaine and Susan Hunter’s work by
helping students “write themselves into the story” we are in the process
of creating in America about community colleges. My approach here also
seeks to support the work of Nobel Laureate Svetlana Alexievich and her
commitment to privileging listening as a form of research and knowledge-­
making—and from this process, forging a new “genre where human voices
speak for themselves,” telling stories that “are impossible to imagine or
invent” (Voices from Big Utopia; see also Voices from Chernobyl).
In sharing these stories, I also seek to help document the history of
the community college and to capture some of the powerful emotions
and uniquely American life stories that pulse beneath the surface of the
statistics and graduation rates that have too often been asked to speak for
these institutions. In embracing this as an important form of qualitative
research, we are privileging the value of listening as a path to wisdom, fol-
lowing Oliver Wendell Holmes, Sr.: “It is the province of knowledge to
speak, and it is the privilege of wisdom to listen.”
 INTRODUCTION 5

Parts II and III of this book examine the economic model that is driv-
ing much of the discussion in higher education today—neoliberalism.
There is a great deal to discuss here, including a variety of largely invisible
forces that help shape the lives of many community college students. The
chapters in this section of the book seek to make visible these power-
ful and often unacknowledged contingencies. In these chapters, I seek to
assess the community college’s contributions to promoting equity, social
justice, and the public good in America. This has long been a controver-
sial subject, and I seek to engage it carefully, bringing new evidence and a
fresh perspective to this long-standing debate in the scholarship devoted
to the community college.
I position my work here as a seasoned community college teacher and as
a scholar with a deep commitment to the community college and to issues
related to social justice. I have taught English at my home institution
in Connecticut, an open admissions community college in Manchester,
Connecticut, for almost 30 years. I have also devoted a significant portion
of this time to teaching developmental reading and writing classes, so I
am therefore very familiar with the controversies that have accompanied
developmental education over the years.
The need to write this book comes from my dissatisfaction with cur-
rent scholarly treatments of the community college. To my mind, most
academic scholarship devoted to this subject misses what is transforma-
tive and revolutionary about this great American institution. In this book,
I seek to theorize a more balanced, broadly research-based, progressive
understanding of America’s community colleges.
This book seeks to build on and advance the work of scholars like
Mike Rose (Back to School), Marilyn Sternglass (Time to Know Them),
Mina P. Shaughnessy (Errors and Expectations: A Guide for the Teacher of
Basic Writing), Nell Ann Pickett (“The Two-Year College as Democracy
in Action”), John S. Levin (Nontraditional Students and Community
Colleges: The Conflict of Justice and Neoliberalism), John S. Levin and
Susan T. Kater (Understanding Community Colleges), and Edward St.
John, Shouping Hu, and Amy S. Fisher (Breaking Through the Access
Barrier: How Academic Capital Formation Can Improve Policy in Higher
Education) who have all championed the community college. My goal is
to promote progressive thinking about—and provide scholarly support
for progressive legislation designed to strengthen—the American com-
munity college.
6 P. SULLIVAN

“Closer to an Ideal Society”

Most essentially, I seek to address in this book matters related to equity,
social justice, and economic inequality—key issues now in our national
conversation about public higher education. Here I seek to address a key
question economist Thomas Piketty asks in Capital in the Twenty-First
Century related to democracy and the public good: “What public poli-
cies and institutions bring us closer to an ideal society?” (574). The com-
munity college provides one indisputable, emphatic, and inspiring answer
to this question. This book also seeks to address, following Adrianna
J. Kezar, Tony C. Chambers, and John C. Burkhardt, “one of the most
significant challenges confronting higher education: the shift, and per-
haps loss, within some institutions and sectors in the role higher education
plays in serving the public good” (xiii). We will be spending a considerable
amount of time discussing the many different ways we might theorize the
idea of the public good in America.
Drawing on the work of Linda Adler-Kassner, Edward Said, and others,
I also seek to challenge the persistent, popular, and often alarmist main-
stream “failure” narrative about community colleges. For Adler-Kassner,
a writing scholar and teacher, the key variable in much debate about
higher education involves “narrative” and the need “to work from dif-
ferent stories” (2). At my college this spring (2016), 896 students gradu-
ated with degrees and certificates. Graduates came from 101 towns across
Connecticut as well as from ten other states. Graduation ceremonies like
this occur every year around the nation at America’s 1,108 community
colleges. This must certainly be regarded as compelling evidence of the
important work being done at “democracy’s college,” especially when we
consider the great diversity of students who enroll at open admissions
institutions. It may well be that this failure narrative is fueled and sus-
tained, following Stiglitz and Greenwald, by prior beliefs, confirmatory
bias, and perceptions that are not necessarily “consciously constructed”
(460). This book will examine how certain kinds of narratives have come
to dominate public discourse about higher education and community col-
leges, and we will seek to examine—and challenge—the highly politicized
narrative about community colleges currently enjoying great popularity.
Contemporary academic scholarship devoted to the community college
has often focused primarily on extending existing theories within higher
education and within particular specializations. This has included a focus
 INTRODUCTION 7

on students, finance, student services, organizational strategies, and

­governance. Unfortunately, this approach has produced a form of r­igidity
that entrenches certain kinds of perspectives and ideas and leaves funda-
mental questions and assumptions unexamined. It also perpetuates the
failure to adequately account for the many unique features of the open
admissions institution. This approach to theorizing the community col-
lege has had the effect of privileging long-held assumptions and protecting
them from critical examination. As theories become rigid, the ideas they
contain become self-evident truths that are perpetuated across genera-
tions. This book will examine two such theories in considerable detail—the
“cooling out” function of the junior college and the so-called “failure” of
developmental education—to show this process at work. As times change
and data sets are updated, theorists must periodically and systematically
reassess cherished beliefs and long-held views and submit them to careful
scrutiny. As theorists studying higher education, we must be committed
to periodic regeneration and reconstruction. This book seeks to engage
in this kind of regenerative and reconstructive scholarly process, especially
as it relates to neoliberal economic theory, applying a market model to
higher education, and understanding the public good as it relates to the
­community college.
Unfortunately, community colleges have been defined in public dis-
course and by a great deal of academic scholarship primarily in terms of
“failure.” In fact, a “failure” narrative much like the Puritan jeremiad has
developed within this body of scholarship that has been remarkably long-­
lived and resistant to new data, ideas, and assessment. This community
college “failure” tradition continues to be robustly appealing, and it has
now spanned over 55 years (and counting). A list of representative works
in this tradition might read this way:

1960: Clark, Burton. “The ‘Cooling-Out’ Function in Higher Education.”

American Journal of Sociology 65.6 (1960): 569–76.
1972. Karabel, Jerome. “Community Colleges and Social Stratification.”
Harvard Educational Review 42.4 (1972): 521–62.
1976. Zwerling, L. Steven. Second Best: The Crisis of the Community
College. New York, McGraw-Hill, 1976.
1986. Zwerling, L. Steven, ed. The Community College and Its Critics. San
Francisco: Jossey-Bass, 1986.
8 P. SULLIVAN

1989: Brint, Steven, and Jerome Karabel. The Diverted Dream: Community
Colleges and the Promise of Educational Opportunity in America,
1900–1985. New York: Oxford UP, 1989.
1991. Dougherty, Kevin. “The Community College at the Crossroads:
The Need for Structural Reform.” Harvard Educational Review 61.3
(1991): 311–37.
1994. Traub, James. City on a Hill: Testing the American Dream at City
College. New York: Da Capo, 1994.
1995: Rouse, Cecilia Elena. “Democratization or Diversion? The Effect of
Community Colleges on Educational Attainment.” Journal of Business
& Economic Statistics 13.2 (1995): 217–224.
2001: Dougherty, Kevin J. The Contradictory College: The Conflicting
Origins, Impacts, and Futures of the Community College. Albany, SUNY
Press, 2001.
2011: Beach, J. M. Gateway to Opportunity? A History of the Community
College in the United States. Sterling: Stylus, 2011.
2011. Flores, Roy. “False Hope” Inside Higher Ed, February 17, 2011.
2012. Complete College America. Remediation: Higher Education’s
Bridge to Nowhere. Washington: Complete College America, 2012.
2014: Scherer, Juliet Lilledahl, and Mirra Leigh Anson. Community
Colleges and the Access Effect: Why Open Admissions Suppresses
Achievement. New York: Palgrave Macmillan, 2014.
2015: Bailey, Thomas R., Shanna Smith Jaggers, and Davis Jenkins.
Redesigning America’s Community Colleges: A Clearer Path to Student
Success. Cambridge: Harvard University Press, 2015.

How we judge the value of community colleges will depend in some

very important ways on what kinds of benchmarks we establish to measure
“success,” who sets these benchmarks, and what these benchmarks assume
about students attending college. A lot will also depend on the perspec-
tive we take and the kind of data we collect and privilege. Using the
traditional national benchmark established by selective admissions insti-
tutions, it therefore might appear to some observers, as Bailey, Jaggars,
and Jenkins note in their recent book, Redesigning America’s Community
Colleges (2015), that community colleges are “poorly designed to facilitate
completion of high quality college programs” (13). We will examine what
is problematic about this claim and document the many ways this perspec-
tive is inaccurate and misleading.
 INTRODUCTION 9

“This Imaginary Universe of Perfect Competition”

Part of my goal is also political—to engage vitally important questions
for our democracy about equity, social justice, and the public good and
to examine the many ways that the community college helps promote
these foundational democratic ideals. Here I will be building on conclu-
sions drawn by Pierre Bourdieu and his essay, “The Forms of Capital.”
Bourdieu suggests that entrenched social, economic, and cultural contin-
gencies serve to make any simple understanding of success and failure—in
the marketplace and in the classroom—highly problematic. These various
“forms of capital” help determine one’s life chances in very potent ways,
and they must be regarded as key variables when we seek to measure stu-
dent success at community colleges. Bourdieau challenges a key principle
of neoliberal economic theory, which supposes a radically free market-
place unencumbered by history or class, and posits instead an economic
world heavily determined by accumulated capital and wealth:

Roulette, which holds out the opportunity of winning a lot of money in

a short space of time, and therefore of changing one’s social status quasi-­
instantaneously, and in which the winning of the previous spin of the wheel
can be staked and lost at every new spin, gives a fairly accurate image of this
imaginary universe of perfect competition or perfect equality of opportu-
nity, a world without inertia, without accumulation, without heredity or
acquired properties, in which every moment is perfectly independent of the
previous one, every soldier has a marshal’s baton in his knapsack, and every
prize can be attained, instantaneously, by everyone, so that at each moment
anyone can become anything. Capital, which, in its objectified or embod-
ied forms, takes time to accumulate and which, as a potential capacity to
produce profits and to reproduce itself in identical or expanded form, con-
tains a tendency to persist in its being, is a force inscribed in the objectivity
of things so that everything is not equally possible or impossible. And the
structure of the distribution of the different types and subtypes of capital
at a given moment in time represents the immanent structure of the social
world, i.e., the set of constraints, inscribed in the very reality of that world,
which govern its functioning in a durable way, determining the chances of
success for practices (81).
10 P. SULLIVAN

This book seeks to help illustrate this claim by carefully documenting the
operation of very powerful social factors—including family income, inher-
ited wealth, and social class—that create extreme opportunity differentials
for individuals in America. Following Bourdieu, I seek to illustrate that
every moment is not “perfectly independent of the previous one,” that
not “every soldier has a marshal’s baton in his knapsack,” and that the
social world is constructed in a way that not “every prize can be attained,
instantaneously, by everyone, so that at each moment anyone can become
anything.”
This understanding of the social world and the operation of various
forms of capital has vitally important implications for those who make
decisions about community colleges and developmental education pro-
grams. Neoliberal ideas about the public good and the power of the
market economy have often been used to simplify these very complex eco-
nomic realities. As P.L. Thomas has observed, this ascendant neoliberal
economic model has, in fact, produced two competing narratives about
public education in America:

“No Excuses” Reformers insist that the source of success and failure lies in
each child and each teacher, requiring only the adequate level of effort to
rise out of the circumstances not of her/his making. As well, “No Excuses”
Reformers remain committed to addressing poverty solely or primarily
through education, viewed as an opportunity offered each child and within
which … effort will result in success.
Social Context Reformers have concluded that the source of success and
failure lies primarily in the social and political forces that govern our lives.
By acknowledging social privilege and inequality, Social Context Reformers
are calling for education reform within a larger plan to reform social ineq-
uity—such as access to health care, food security, higher employment along
with better wages and job security. (qtd. in Porfilio, Gorlewski, Carr, and
Thomas 1)

We will be examining the foundational neoliberal thinking that informs

these two very different approaches to theorizing the role of higher educa-
tion in a democracy and seeking to determine if this “no excuses” reform
serves the public interest and promotes the public good—or instead serves
the interests of the already rich and powerful.
In this book, we will be actively embracing the advice of economist
F.A. Hayek himself, one of the founders of neoliberalism. In perhaps his
most well-known essay, “The Intellectuals and Socialism” (1949), Hayek
 INTRODUCTION 11

advocated for coordinated, focused, and long-term efforts to help shape

public opinion about the free market and about neoliberal approaches
to public policy. Hayek outlined a strategy that targeted “intellectuals”
(journalists, teachers, ministers, lecturers, publicists, radio commentators,
writers of fiction, cartoonists, and artists) as a way to effectively transmit
ideas to a wider audience. Hayek lived and worked at a time when democ-
racy and freedom itself appeared to be at stake. The same might also be
said about us now, although in very different ways. These intellectuals,
Hayek suggested, “are the organs which modern society has developed
for spreading knowledge and ideas, and it is their convictions and opin-
ions which operate as the sieve through which all new conceptions must
pass before they can reach the masses” (225). This neoliberal project, as
we will see, is obviously well underway in America and worldwide. In the
conclusion of this essay, Hayek champions the “courage to be Utopian”
as a key tactical and rhetorical strategy, an approach to activist and public
relations work that can provide important guidance for advocates of com-
munity colleges as well:

The main lesson which the true liberal must learn from the success of the
socialists is that it was their courage to be Utopian which gained them the
support of the intellectuals and therefore an influence on public opinion
which is daily making possible what only recently seemed utterly remote.
Those who have concerned themselves exclusively with what seemed prac-
ticable in the existing state of opinion have constantly found that even this
had rapidly become politically impossible as the result of changes in a public
opinion which they have done nothing to guide. Unless we can make the
philosophic foundations of a free society once more a living intellectual issue,
and its implementation a task which challenges the ingenuity and imagina-
tion of our liveliest minds, the prospects of freedom are indeed dark. But if
we can regain that belief in the power of ideas which was the mark of liberal-
ism at its greatest, the battle is not lost. The intellectual revival of liberalism
is already underway in many parts of the world. Will it be in time? (237)

Those who care about social justice must embrace the responsibility to
help shape public opinion about the nature of the American community
college and the many social and civic benefits of higher education. This
work can be informed by the power of our ideals—access, opportunity,
and the public good—and by translating our research and scholarship for
a new generation of Americans. This book is designed to help move this
important work forward.
Another random document with
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lesion is in the cerebellum, so that, if continuous, it is not likely to
mean that anything worse is coming. It has been said to be strongly
significant if occurring without the digestive derangements or
circulatory disturbances likely to cause it, and be unconnected with
disease of the ear. Unfortunately for diagnosis, but fortunately for the
patients, the so-called vertigo a stomacho læso, may arise in cases
where the stomach trouble is very difficult or impossible to detect,
and it often continues for weeks or months after the most careful
regulation of the diet, and yet is followed by no cerebral lesion.
Although a vertigo for which every other cause can be excluded
certainly justifies a suspicion of cerebral trouble, the tendency to
exaggerate its prognostic importance should not be encouraged by
the physician, as it may exist a long time, and disappear without
another sign of the catastrophe which has been keeping the patient
in dread.

Among the more significant and immediate symptoms are to be

reckoned paræsthesiæ of the side about to be paralyzed, such as
numbness or tickling. Headache of great severity is often, but not
invariably, present. It has nothing characteristic about it, except that
it may be different from those the patient has been in the habit of
having, or may be of unusual severity, so that the patient says it is
going to kill him. Such a headache in a person in whom there is good
reason, from age, interstitial nephritis, or other symptoms, to suspect
the existence of vascular lesions is likely to be an immediate
precursor of a hemorrhage. Persistent early waking with a slight
headache, which passes off soon after rising, is said by Thompson29
to be a somewhat frequent premonition. Vomiting is hardly a
premonitory, but may be an initial, symptom, especially in
hemorrhage of the cerebellum.
29 N. Y. Med. Record, 1878, ii. p. 381.

Reference is had in these statements chiefly to the ordinary form of

cerebral hemorrhage. Of course if, during a leucocythæmia or
purpura, large hemorrhages occur elsewhere, it may be taken as a
hint that possibly the same thing may take place in the brain.
These signs of arterial disease must be considered as of the highest
importance among the (possibly remoter) premonitory signs, not only
of cerebral hemorrhage, but of the other lesions treated in this
article. Atheroma and calcification of the tangible arteries place the
existence of peri-endarteritis among the not remote possibilities.
High arterial tension has already been spoken of in connection with
etiology, and its presence should be sought for. An irregular and
enfeebled cutaneous circulation has been spoken of as an indication
of value.

OCCLUSION OF THE CEREBRAL ARTERIES may take place from several

causes other than those which concern us here, as from the
pressure of tumors or endarteritis, usually syphilitic. Thrombosis and
embolism are grouped together from their great anatomical
resemblance and their frequent coexistence, but the symptoms
produced, although ultimately the same, are often different enough
to make it necessary to bear in mind the fact that there is a
distinction—that is, that embolism is rapid and thrombosis is slow.

A cerebral artery may be occluded from the presence of a plug of

fibrin more or less intermixed with the other elements of the blood.
This plug may have been formed in situ, and is then somewhat firmly
attached to the walls of the vessel, and partly decolorized at its
oldest portion, while on each side of it, but especially on the side
away from the heart, it is prolonged by a looser and darker clot of
more recent origin. This is a thrombus.

When the plug has been transported from elsewhere it is embolus.30

It may consist of various substances, as described in the article on
General Pathology, but is usually of fibrin which has formed a
thrombus or vegetation elsewhere, and, having been broken off, is
carried by the blood until it comes to a place too narrow for it to pass,
or where it lodges at the bifurcation of a vessel. The piece of fibrin
thus lodged has a strong tendency to cause a still further deposition
—that is, a secondary thrombus—which may progress until it comes
to a place where the blood-current is too strong for the process to go
on any farther. It may in such cases not be obvious at the first glance
whether the whole process is thrombosis or whether it started from
an embolus.
30 The Greek word εμβολος (εν, in, and βαλλω, to throw) signifies the beak or rostrum
of a ship of war. Εμβολον signifies wedge or stopper, and would certainly seem the
appropriate form to be adopted for anatomical purposes. As uniformity of
nomenclature, however, seems more to be desired than etymological accuracy, the
writer has conformed in this article to the general usage.

It is probable that a thrombus forming at one point in a cerebral

vessel may break to pieces and its fragments be carried farther
along, forming a number of small emboli. (See Capillary Embolism.)
Embolism or thrombosis may take place anywhere in the brain or
body generally, but has certain points of preference. Of these, the
most usual in the brain is in the neighborhood where the internal
carotid divides into the anterior and middle cerebral, or in either of
these arteries, especially the middle, beyond this point. The plug
may be situated in the carotid just before this point, or even as low
down as its origin from the common trunk. Emboli lodge in this
region, somewhat more often upon the left side. The brain is said to
be third in the order of frequency with which the different organs are
affected by embolism, the kidneys and spleen preceding it. It has
been found that small emboli experimentally introduced into the
carotids are found in much larger numbers in the middle cerebral
than elsewhere. It is the largest branch, and most nearly in the direct
line of the carotid. Position undoubtedly influences the point at which
an embolus lodges, as it probably moves slowly along the vessels
and along their lower side. It has been remarked that, on account of
this course of the embolus, it is doubtful whether it can get into the
carotid when the patient is standing, but it certainly can do so when
he is sitting up; which, so far as the direction of the carotids is
concerned, is the same thing. The frequency with which a
hemiplegia is observed when a patient awakes in the morning may
perhaps be accounted for by the position favoring the passage of an
embolus into the carotid, which otherwise would reach organs more
remote.
The vertebrals and basilar are not infrequently affected.

The sources whence cerebral emboli may spring are various, but
cannot be found outside a certain range. They may, in the first place,
be torn off from vegetations upon either the mitral or aortic valves;
and this source is probably the most common. The appendix of the
left auricle may furnish a plug from the thrombi formed among its
trabeculæ, or the aorta from an aneurism or from parietal thrombi
formed, upon spots roughened by atheroma. The pulmonary veins
are occasionally the source of the embolus, though this is not very
common.

It is rather doubtful whether an embolus can find its way from the
systemic veins through the lungs to the brain, but it is possible that
small emboli may do so, and increase in size from the addition of
fresh fibrin when floating in the blood-current. The occurrence of
pyæmic abscesses in the brain would suggest the possibility of this,
though it is, on the other hand, possible that the brain abscesses are
secondary to older ones in the lungs. In some cases, however, a
careful examination does not disclose the source of the embolus.

In the blood-current the embolus may give rise to no symptoms

whatever, and even after its arrival in the cerebral circulation it may
lodge in such a way as not entirely to obstruct the current. In most
instances, however, it does not stop until it plugs the vessel
completely and arrests the current of blood beyond it for a moment.
Whether it shall completely deprive the portion of brain to which it is
distributed depends upon its situation as regards anastomoses and
upon the formation of secondary thrombus. Hence the knowledge of
the distribution of the arteries supplying the brain—that is, the two
carotids and two vertebrals—is of more importance in reference to
embolism and thrombosis than to cerebral hemorrhage, where the
effusion takes place from quite small branches.

The anterior portion of the brain, including the anterior and posterior
central convolutions and the first temporal, are supplied with blood
by the two terminal branches of the internal carotid, the anterior and
middle cerebral, the ganglia underlying these portions of the cortex
being supplied, as already stated, by small branches arising near the
origin of these two trunks, and principally the second. The anterior
cerebrals of the two sides are connected by the anterior
communicating, which is a short and usually wide vessel. Sometimes
one anterior cerebral branches in the longitudinal fissure, and
supplies a part of both sides. Hence in plugging of one internal
carotid which does not reach its bifurcation a collateral supply may
be received from the other side. If, however, an embolus or thrombus
has penetrated beyond the origin of the middle cerebral, this vessel
can no longer receive a supply from the anterior.

The posterior communicating arteries are two small vessels which

connect on each side the posterior cerebrals and either the carotid,
just as it gives off its two chief cerebral branches, or else the middle
cerebral close to its origin. These arteries may be of quite unequal
size, that upon the right usually being the larger, and sometimes so
large as to give the appearance of being the principal origin of the
posterior cerebral. When this happens the part of the posterior
cerebral which arises from the basilar may be reduced to a minute
arteriole, and the basilar, almost entire, goes to supply the left side of
the brain. This condition of the posterior communicating may exist to
some extent on both sides in the same brain. It is probable that in
many cases these arteries are too small to be of great value in re-
establishing the circulation in the anterior portion of the brain when it
is suddenly interrupted by an embolus.

When the large trunks leave the circle of Willis to be distributed upon
the surface of the brain, after giving off from the first centimeter or
two of their course the nutrient arteries for the deep-seated ganglia,
they break up into several branches which ramify upon the surface,
but, as Duret has shown, undergo very few anastomoses. Instead of
forming, as was once supposed, a richly inosculating network, small
branches penetrate into the brain-substance perpendicularly from
the superficial vessels, but these do not communicate freely with
each other by vessels larger than capillaries.
From these anatomical conditions it happens that when a vascular
territory is deprived of its normal supply by an embolus, it cannot be
supplied with blood from surrounding districts. A certain limited
amount of collateral supply is possible through the capillaries and the
rare anastomoses, but it is only around the edges, and the centre of
the territory becomes destitute of circulating blood. Thus an embolus
does not in the brain produce, as it does in other organs with more
abundant collateral supply, a large hemorrhagic infarction.

Small hemorrhages may, however, take place around the edges of

the softening, and when a number of small emboli are present, so as
to afford a number of overlapping areas with their borders of
congestion, a red softening may be the result. When the emboli are
very small, and at the same time not numerous enough to occlude all
the ultimate ramifications of a trunk, the vascular compensation may
be rapidly completed.

The change produced in the cerebral substance from cutting off its
supply of blood is known as anæmic necrosis, and includes what has
been known as white softening, with probably some yellow, and
possibly a little red softening, the latter in case where simple
softening has been complicated by hemorrhage.

When the circulation ceases the substance that should have been
nourished loses its firmness and acquires a custard-like consistency.
The gray and white substances are no longer so distinct in
appearance, the latter losing its milky-white color, the whole surface
of a section becoming of a dirty yellowish-white, somewhat shining,
and looking as if it contained more moisture than normal. When a
considerable portion of the interior of the hemisphere is thus
affected, the brain outside, with its membranes, bags down, looks
swollen, and feels to the fingers as if there were present a sacful of
fluid. The boundaries of such an area of softening are marked off
from the healthy substance with some distinctness, though less than
that of a hemorrhage. There may be some hemorrhage around the
edges or into the cavity, so that the presence of a little blood-pigment
is no proof that the original lesion was not softening from occlusion.
In the further progress the contents of the cavity become more fluid,
and finally a somewhat distinct cyst is formed, not unlike that from a
hemorrhage, with an internal areolar structure from the remains of
connective tissue, and contents of a slightly yellowish or brownish
color, or often of a chalky white. These cysts have little to distinguish
them, when old, from similar ones left by hemorrhage, except the
much greater amount of pigment in the latter. The smaller spots of
softening may after a time lose their fluidity, and remain as yellowish
patches as firm as, or firmer than, the surrounding brain. The region
of the brain involved becomes atrophied, the convolutions shrink,
and the membranes become filled with serous fluid, to compensate
for the sinking of the surface.

The microscope shows gradually increasing fatty degeneration,

disorganization of the nervous tissue, and degeneration of its
elements. The pyramidal cells are sometimes distinctly recognizable
by their form, and show gradual transition into the indeterminate
round granulation-corpuscles. The vessels exhibit fatty degeneration
of their coats, as well as accumulation of fatty granules between the
vessel and the lymphatic sheath. The clot which blocks the artery
becomes adherent to its walls, and the vessel with its contents forms
a round solid cord.

In a few instances the thrombi have become perforated through the

centre, so that a channel is formed for a renewal of the circulation.
There is no reason to suppose that this takes place soon enough to
be of any advantage in restoring the nutrition of the necrosed
portions of brain.

The region involved in softening depends upon the artery which is

plugged and the location of the obstructing body. The place of
election seems to be the carotid near its separation into its large
branches, or these branches after the separation, especially the
middle cerebral, this being peculiarly liable because it is the largest
branch and is the continuation in a direct line of the carotid. It is more
frequent upon the left side. Cases have been observed where the
whole of one hemisphere was softened from obstruction of the
carotid at its bifurcation; which may be accounted for, as Charcot
suggests, by an unusual distribution of the arteries, as described
above, the posterior cerebral as well as the other two being derived
almost entirely from the carotid. In a case recently observed by the
writer the whole right cerebral hemisphere, with the exception of the
tip of the frontal and tip of the occipital lobes, was softened to the
consistency of custard, a thrombus extending from the bifurcation of
the common carotid into all the ramifications of the middle cerebral.
The most common form, however, is where more or less of the brain
around the fissure of Rolando and fissure of Sylvius, with or without
the underlying ganglia, is softened. This happens from a lodgment of
the embolus in the middle cerebral. If the obstruction be close to the
origin of the artery, the corpus striatum suffers, from the mouths of its
small nutrient arteries arising in this part of its course being stopped,
while if it have passed along a little farther, these remain open, and
the cortex, to which the larger branches are distributed, alone is
softened.

The anterior cerebral is not infrequently affected, either alone or with

the middle, and in these arteries as well as the posterior the
embolus, if of small size originally, may penetrate so far as to give
rise only to quite a limited anæmia. The basilar is an artery not very
rarely occluded, though more commonly by thrombus than embolus.
This occlusion may be so limited as to affect only the nutrient
arteries of the pons and cause a very limited softening, the parts
before and behind it being supplied by the unobstructed portion or by
collateral circulation from the carotids. Occlusion of the cerebellar
arteries and softening of the cerebellum are among the rarer forms.
The vertebrals themselves are sometimes plugged. A thrombosis
has been observed in the only inferior cerebellar artery which
existed, causing softening in both lobes. There was atheroma of the
heart and arteries, and a thick calcareous plate in that which was
occluded.31
31 Progrès méd., 1876, 373.
In a general way, it may be said, with many exceptions on both
sides, that thrombosis and embolism tend to affect the cortex, and
hemorrhage the central ganglia.

What has just been written applies to the simple mechanical action
of emboli. If, however, they have a septic origin, as notably in cases
of ulcerative endocarditis, the region in which they lodge becomes,
instead of a simple spot of necrosis, a septic focus or abscess, with
its results of compression or irritation. In such a case there are likely
to be abscesses of similar origin in other organs, and the cerebral
lesion is only a part of the general pyæmic condition.

ETIOLOGY.—So far as the lodgment of an embolus in an artery is

concerned, it can hardly be said that there is any etiology, for the
detachment of the plug from its place of origin is purely a matter of
accident, and may take place at any time. As to its origin in the form
of fibrinous deposit on the valves of the heart or a roughened spot on
the aorta, we must refer to the article on General Pathology. The
most important condition for embolism is disease of the valves of the
heart, rheumatic or otherwise. Next comes arterial disease,
producing roughening of the inner coat and subsequent deposition of
fibrin. So far as we can tell, the causes leading to endarteritis or
atheroma are essentially the same as those which produce the
periarteritis described in connection with cerebral hemorrhage, and
we may therefore put down old age, alcohol, and strain as among
the causes of cerebral embolism. Injuries of the lungs leading to
thrombosis of the veins may be considered as possible sources for
the formation of an embolus, and we might suppose that phthisis and
pneumonia would furnish plugs which would lodge in the brain,
though as a matter of fact they seldom do so.

Experience shows that embolism, unlike hemorrhage, is not specially

a disease of advanced life, but is distributed over different periods,
with preference for old age less marked than with hemorrhage.
Andral gives the ages of patients with softening—which, however,
includes thrombosis as well as embolism—as follows: the average
would undoubtedly be displaced in the direction of youth if
thrombosis could be taken out of the list:

Andral: Andral: Cases (with autopsies) of

Beginning of softening Death with softening embolism, thrombosis, and
in 27 cases. in 153 cases. softening—25 cases.
17–20 4 15–20 10 20–30 4
27 2 20–30 18 30–40 3
30–37 2 30–40 11 40–50 3
43–45 2 40–50 19 50–60 1
53–59 4 50–60 27 60–70 5
63–69 7 60–70 34 70–80 2
76–78 6 70–80 30 Young 1
80–89 4 Middle-aged 1
Old 5

In the etiology of cerebral arterial thrombus there seem to be two

factors of prime importance, although there are cases which seem to
demand a third, and Charcot32 suggests the possibility of some
hæmic dyscrasia favoring the formation of a thrombus, and relates a
case of thrombosis of the middle cerebral, with three others of the
same process in other arteries, occurring in patients with uterine
cancer, where all the usual sources of emboli were explored with
negative results. The first of the two is disease of the cerebral
arteries, not necessarily extensive, but sufficient to form a starting-
point on the inner wall for the deposit of fibrin. In this respect the
etiology of thrombosis may be various. Syphilitic endarteritis, for
instance, may very easily give rise to this lesion, but it is likely to be
accompanied by others, and has a symptomatology more or less
peculiar to itself. It is not, of course, to be included with the form we
are considering.
32 Comptes Rendus Soc. de Biol., 1865, p. 24.

The second factor—one which is perhaps capable of giving rise to

coagulation of the blood or deposit of fibrin without any arterial
disease—is weakness of the heart, connected or not with anæmia.
The causes of this condition may be manifold, and are likely to lead
to many other consequences than cerebral thrombosis. A thrombus
may form upon a very small basis of atheroma. Several of these
points are illustrated in the following case: A lady, aged about sixty-
five, had had for many months vague symptoms of want of strength,
fatigue, want of appetite, and so on, with complaints of distress and
fulness in the abdomen, for which no special cause could be found.
On one occasion she was unusually long in dressing, and her
expression was noticed to be changed and her voice altered for a
few moments. The pulse was habitually 60 or less, and at times
irregular, but nothing abnormal could be detected in the sounds or
position of the heart. Fatty degeneration was suspected. One
morning, after going to bed in her usual health, she was found on the
floor of her room unconscious and with left hemiplegia. She lived
about thirty-six hours. The autopsy showed nothing abnormal in the
abdomen except a considerable accumulation of fat; and in the
thorax the heart appeared normal, and was not fatty. There was very
little atheroma. In the end of the internal carotid artery was a
thrombus, of which the lower and firmest part was connected with a
very small spot of roughening just at the point where the artery
comes through the base of the skull. It extended just beyond the
origin of the middle cerebral artery, which was of course occluded.
The corresponding region of the brain was converted into a vast
mass of softened tissue.

The SYMPTOMS of the lodgment of an embolus in the brain may

closely resemble, or even be precisely the same as, those of
hemorrhage. Unless, however, an embolus makes a pause on its
journey, giving rise to a partial obstruction before there is a complete
one, or unless the obstruction is not absolute until after the formation
of a secondary thrombus, the attack may be absolutely sudden.

A thrombus, however, is slower in its formation, and may produce

gradually increasing anæmia of the region of brain supplied before it
is absolutely complete, with a gradually increasing paralysis and loss
of consciousness slowly approaching. Thus we may have the early
symptoms in the form of headache, vertigo, heaviness, and
drowsiness, peculiar sensations in the limbs about to be paralyzed or
in the head, delirium of various kinds, or hysterical manifestations.
Prévost and Cotard33 lay special stress upon the importance of
severe vertigo (étourdissement) as a prodrome or warning of
softening, especially in the aged. It is dependent upon anæmia of the
brain, and this, in its turn, upon atheroma of the arteries, and
sometimes at least upon feebleness of the circulation, both of these
being conditions likely to cause the deposit of a thrombus. As,
however, the thrombus does not necessarily result from these
conditions, and as the vertigo may arise from other sources, as
stated under the head of Cerebral Hemorrhage, it is to be looked
upon with special suspicion chiefly in those cases where other
symptoms might lead in the same direction, and when other causes
can be excluded.
33 Mémoires de la Soc. de Biol., 1865, p. 171.

The same authors also speak of less defined symptoms, like delirium
and stupor, occurring among the inhabitants of the Salpêtrière (old
women), with intervals of comparative health, as being premonitory.

It is possible, however, for the symptoms of thrombus to be

developed rapidly when, as in the case last described, the thrombus
begins to form in a place which does not entirely interrupt the
current, but afterward reached the mouth of a large vessel, which it
closes.

The loss of consciousness, coma, and all the phenomena of the

apoplectic attack, with the possible exception of early rigidity, may be
as fully developed from occlusion of the cerebral vessels as from
their rupture; but it must be said that it is more common to meet with
them in cases of large hemorrhage than with either embolism or
thrombosis.

The general functions are even less disturbed than with a

hemorrhage producing an equal extent of paralysis. The temperature
follows nearly the same course as in hemorrhage, except that the
initial fall, if present—which is not always the case—is said to be less
than with cerebral hemorrhage. To this succeeds a rapid rise, which,
even in cases which are to terminate fatally, gives place to a fall to
the neighborhood of normal, and another rise before death. These
are the statements of Bourneville. The rise is said not to be so high
as with hemorrhage.

The annexed chart is from a man (W. I. W.) who was in the hospital
with ill-defined nervous symptoms, and was suddenly attacked with
convulsions, vomiting, and unconsciousness. He had a small tumor
at the point of the right temporal lobe, and softening of the left corpus
striatum. The apoplectic symptoms occurred on the 15th—that is, as
will be seen by the chart, one day after the temperature began to
rise. The pulse and respiration show no characteristic changes.

FIG. 40.
It is much more common for the embolus or thrombus to give rise to
a set of symptoms less severe than a fully-developed apoplectic fit.
During such a fit—or, more clearly, as it is passing off—we find more
or less marked paralytic symptoms, but these are quite as frequently
present without the loss of consciousness. The patient states that he
waked up and found one side of his body helpless, or that he was
reading the paper when it fell from his hand, and upon trying to walk
found that he could not do so. Loss of speech may be an initial
symptom. It has been spoken of as premonitory, but it is probable
that it is in reality only the beginning, which, in some cases may go
no farther, but is usually succeeded by more extensive paralysis,
which makes its meaning unmistakable. These symptoms may be
hours or even days in developing, with occlusion as well as with
hemorrhage. Very slight attacks may occur which hardly excite
attention, and lesions are found after death in many cases to which
there is nothing in the history to correspond.

Improvement may begin very rapidly in some cases where the lesion
is small, a sufficient amount of collateral circulation being developed
to prevent the structure from being disorganized. In others a
specially favorable anastomosis may preserve even a larger area,
but in others still it is not easy to account on entirely anatomical
grounds for the amount of improvement which takes place.

From this point onward the history of hemorrhagic and of embolic

and thrombotic paralysis is essentially the same, and the description
of the principal phenomena and progress of hemiplegia will apply to
all.

SYMPTOMS AND PROGRESS OF HEMIPLEGIA DEPENDING ON CEREBRAL

HEMORRHAGE OR OCCLUSION OF THE CEREBRAL VESSELS.—The cerebral
cortex represents the centres for many of the higher nervous
functions, spread out in such a way that they may be more or less
separately affected, while the corpora striata and internal capsules
are the regions where the various conductors are crowded together,
so that embolism, when affecting small vessels and limited areas of
the cortex, more frequently gives rise to narrowly-defined groups of
symptoms than hemorrhage, which, taking place oftener in the
central ganglia, is able to cut off the communication from large
masses of cerebral tissue at once. This is a general remark, tending
to explain why aphasia, for instance, is often spoken of as especially
a symptom of embolism, while it is in reality common to all the
lesions that affect the proper locality.

The motor paralysis, more or less complete, which has been

described under the head of Hemorrhage continues indefinitely. It
may disappear rapidly, so that motion begins to return in a day or
two, and goes on to complete recovery in a short time. On the other
hand, it may be months before the flexion of a finger or a toe gives
the slightest token of the will resuming its control. The face often
recovers its symmetry before the limbs are fully restored, but the leg
may be used in locomotion before the complete recovery from
paralysis, since the tone of the muscles is sufficient to keep the knee
straight enough for support, as if the leg were all in one piece, while
it is swung around at each step by the pelvic muscles. We may meet
with all degrees of recovery—from that which is absolutely complete
and comparatively rare, through the case where a little want of play
upon one side of the face, a little thickness of speech, a feeble or
awkward grasp of the hand, betrays what has happened, or that of
the man so often seen in the streets with a mournful or stolid face,
the arm in a sling or dangling straight down by the side, and
swinging one leg awkwardly around, to the helpless paralytic lifted in
and out of his chair or lying almost motionless in bed, and living only
to be fed and be kept clean.

Involuntary movements may take place in limbs entirely incapable of

voluntary ones, and may occur under conditions of excitement or
with other involuntary movements, such as gaping. On the other
hand, the patient often moves the well hand while making utterly
ineffectual attempts on the paralyzed side. Involuntary twitching of
the feet may be annoying. Reflex movements, especially of the feet,
are often exaggerated, and in fact the twitching just spoken of is
often excited by some trifling, perhaps unperceived, irritation. A
touch with the point of a penknife upon the sole of the foot may call
out a movement which the patient is utterly incapable of executing by
the force of the will, and the appearance of volition is often increased
by the grimace or exclamation of pain or annoyance.

Epileptiform attacks may be a sequence of hemiplegia, occurring at

irregular intervals, and not of great severity. Sometimes the patient
seems depressed or less talkative for a day or two previously, and
relieved after the fit has occurred, as in true epilepsy.

Comparatively little attention has been given to the condition of

sensation in hemiplegia. In the more complete apoplectic stupor it is
apparently abolished, like nearly all the functions above those of
respiration and circulation, but it often happens when the patient is
unable or unwilling to make any voluntary response to the voice, and
lies apparently perfectly indifferent, that any moderate irritation like a
pinch will bring out evidence of sensation. It is often stated that in
hemiplegia the sensation is not at all affected; and this is probably
true of many cases, but a more attentive examination will often
disclose a decided diminution on the affected side. Broadbent, who
has tested with pricking, touch, the compasses, and hot substances,
says that it is frequently diminished, and often greatly so, and not
only in the limbs, but in the face, chest, and abdomen. Tripier34 says
that a lesion of the larger part of the fronto-parietal region determines
at the same time a paralysis of motion and a diminution of sensibility;
and one may conclude that this region holds under its dependence
sensitive as well as motor phenomena intimately connected with
each other. The zone called motor, of which the limits are difficult to
fix, may with more reason be called sensori-motor.
34 Revue mensuelle de Méd. et Chir., 1880, p. 18.

Anæsthesia probably in most instances disappears more rapidly

than motor paralysis, which accounts for its being frequently
overlooked. The more common location of lesions causing motor
paralysis—i.e. the corpus striatum and the motor portion of the
cortex—is one not likely, unless extensive, to concern sensation; but
there are cases where a very complete hemianæsthesia, including
the special senses, may be found; and when, in such cases, the
motor paralysis is slight, a picture is presented almost identical with
that of hysterical hemianæsthesia with great diminution or abolition
of the special senses, hearing, taste, smell, with concentric
diminution of the field of vision and of the color-field, or complete
color-blindness on the affected side.

A man aged thirty-five while at work suddenly felt a prickling

sensation upon his left side, and became unconscious. The
bystanders say he was convulsed. On returning to consciousness
after three hours he had lost his speech, which, however, was rapidly
recovered, and his left side was not so strong as his right, though
there was no distinct history of paralysis. Two or three days
afterward it was noticed that sensation was much diminished upon
the left side, two sharp points of the æsthesiometer being felt as one
at two inches on the forearm and three-quarters of an inch on the
tongue. He could feel the touch of a spoon, but could not tell whether
it was cold or hot. Odors were not recognized upon the left side of
the nose, except faintly ammonia and chloroform, and a watch was
heard on that side only when in contact with the ear. The field of
vision was much diminished and color-blindness was almost
complete. A few days later the field of vision had increased, and
there was color-sense, the field of perception for the different colors
being arranged almost exactly as laid down by Charcot, vision for
red being largest, but not so large as for simple perception of
objects; those for blue, green, and yellow nearly the same and
smaller; and that for violet limited to a small space in the centre of
the field.

Less regular forms of anæsthesia may be met with, as well as

hyperæsthesia. These are said to be especially connected with
various lesions of the pons.35 A case is recorded36 of complete
hemianæsthesia in a man, coming on like a blow. There was no loss
of motor power; the face was symmetrical, sight and hearing
unimpaired. Taste was lost and smell doubtful. There was aortic and
mitral disease. Hughlings-Jackson speaks of a man who
experienced a severe apoplectiform attack which it was thought
would be fatal in a few hours. He recovered, however, with almost
complete loss of hearing.
35 Conty, Centralblatt f. d. Med. Wiss., 1878, 571.

36 Med. Times and Gaz., 1871, i. 246.

Neuralgic pains of long continuance are not infrequent

accompaniments of hemiplegia, and may be lasting even after nearly
complete recovery from the paralysis. A peculiar restlessness, a
constant desire for change of position, has been referred to
derangement of the muscle-sense. It is sometimes very distressing,
and causes much annoyance to attendants as well as to the sufferer,
as the patient is no sooner placed in one position, no matter how
comfortable, than he desires to change it.

The mental condition seldom fails to suffer more or less in cases of

hemiplegia, but the limits are very wide between a slight emotional
excitability on the one hand and almost dementia on the other. This
is, of course, applicable to cases where the lesion is a single or
limited one, and not where a hemorrhage or thrombus is merely a
part of a general vascular degenerative change with chronic
meningitis or atrophy of the brain, where the mental decay can
hardly be called the result of any single lesion. In cases of aphasia
the mental condition is harder to make out, from the peculiar inability
to communicate ideas if present. It is very safe to say, however, that
many such patients possess much greater intelligence than would
appear to a casual observer, and yet the apathy with which they
often bear the deprivation of speech and consequent isolation
speaks more strongly in favor of some blunting of the perceptions
than of Christian resignation. A patient whose general appearance is
that of tolerable comfort is likely to cry when attention is called to the
helpless condition of the hand. It is probable that memory suffers in
such cases, if not the reasoning faculties.

Trousseau cites the case of Lordat, who became aphasic, and after
recovery described his own case. The learned professor claims to
have been in full possession of his faculties, and to have arranged a
lecture with the divisions and subdivisions of the subject, and all this
without the thought of a single word passing through his mind.
Trousseau ventures to doubt the possibility of carrying on
complicated mental processes without words, and thinks Lordat may
have overestimated the precision of his mental processes. It appears
in confirmation of this view that after his attack he always read his
lectures, whereas before he had been distinguished as an
extempore speaker.

McCready, in an excellent article in the New York Journal of

Medicine (September, 1857), discusses this subject at length, and
details a number of cases where it was evident that paralytics and
aphasics (who, however, he did not know by that name, nor the
special lesion connected with their condition) possessed not only
ordinary intelligence, but excellent business judgment and ability. He
says that the confusion of mind and difficulty in pursuing a train of
thought of which apoplectics are apt to complain is, to a great extent,
the mere result of diminished nervous energy—that they
comprehend well and judge correctly. It is fair to say that while the
mind is almost certainly impaired, it is not necessarily in exact
proportion to the severity of other symptoms, aphasia included. The
memory, either special or general, is most apt to be impaired.

The testamentary capacity of a person who has had an apoplectic fit

or who is paralyzed at the time of making a will may be called in
question. The only general remark to be made is that these facts
alone are not sufficient to prove incapacity; neither should the
presence of aphasia or agraphia do so without further evidence of
want of comprehension of the meaning of language used by others;
so that if, for instance, a person were seized with hemiplegia and
aphasia between the drawing up of a will and its signature, it should
not be invalidated unless there be further evidence to show that the
testator was incapable of understanding it when read over to him. In
cases of word-blindness, a patient, like one described by Magnan,
may be able to draw up a will with full comprehension of what he is
doing, and yet be unable to read it understandingly. Inability to
signify intelligibly assent or dissent would, of course, entirely
disqualify one from signing a will.

It is seldom that a paralytic attack fails to leave its mark, though

perhaps slight, for years, if not for the remainder of life. An extreme
ease of shedding tears is a very common symptom, and sometimes
laughter comes on very slight provocation.

Among the most interesting groups of phenomena connected with

hemiplegia, and sometimes the sole representative of this condition
—that is, existing alone without any motor paralysis—is that
embracing the means of communicating with the outer world by
means of language spoken or written. Corresponding to, and usually