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cular movements in conformity with the resistance to be overcome, and which are ordinarily classed under the head "muscular sense," are the ones conducted by these columns. In order to become appreciated, however, these columns must be connected with higher centres than the nuclei of GoU and Burdach ; the regulation of these movements which are most constantly aff"ected in locomotor ataxia, while not altogether removed from cerebellar control,* is a function of the cerebral hemi- spheres. It is evident, Antibiotics Biaxin therefore, that after interruption — for some thus far inscrutable purpose — in the nuclei of Burdach and GoU, another tract must leave these sta- tions to reach the cerebrum. This tract is the one just described and visible in its decussation in Figs. 3 and 4, that is, the mterolivary layer of Flechsig. Meynert long ago recognized the necessity of estab- lishing a connection between the posterior columns of > From the supposed connecrion with Me>-nert's stratum intermedium I Biaxin Xl ap- plied that name to the mterolivar>- extension. I have resolved for the present to discontinue its employment, as the same designation has been employed in such different ways by Wernicke and Meynert himself. ' Upper fine-bundled or sensor>' decussation of the pyramids of MeynerL 3 Ii has been lately shown that the columns of Clarice, which are by Fleclisig sup- posed to have a relation to the posterior roodels, are similarly involved m ad- vanced cases of this disease. < On comparing a number of types of this disease it will Biaxin Xl 500 be found that in some the ata.xia has an actual cerebellar character, hut in others not. In the latter the same complaint found in cortical ataxia, that distance is misjudged or the Purchase Biaxin length of the limb or a segment of it seems increased or decreased, is made. the spinal cord and the cerebrum. The method he fol- lowed in delineating his projection system was to take physiological and pathological facts as so many guides in the labyrinth of cerebral fibre-tracts, and then to fit the demonstrable nerve-strands that happened to corre- spond, as he supposed, to the required physiological paths into the maps thus constructed. Knowing that the posterior part of the internal capsule conveyed sensory functions, and that the posterior columns of the cord did likewise, he traced the required connection between them through his so-called upper or sensory pyramidal decus- sation into the lateral part of the pyramids, along these into the lateral part of the pes pediinculi, and thence by an easy transition into the posterior division of the in- ternal capsule. A diagram representing this supposed tract is extant in Huguenin, whose work is in the main a popularization of Meynert's system, and in many places evidently inspired by the black-board diagrams which this great master of modern cerebral anatomy illustrated his lectures with. Grossly erroneous as Meynert's representation just detailed is now known to be, in many features it is cor- rect ; and this has been (intentionally or unintentionally) overlooked by those who have condemned his views. It is a fact that the continuation of certain portions ot the sensory tract from Biaxin Cost the cord to the brain decussates, in the upper fine-bundled decussation called by Meynert the "upper decussation of the pyramids." The view held to-day differs from Meynert's chiefly in regard to topographical nomenclature : i. As the decussation in question is not connected with the pyramid tract proper, it is no longer called the upper " pyramidal " decussa- tion. Flechsig's followers might perhaps term it the " decussation of the interolivary stratum." In want of any other brief designation, and recognizing that it could no longer be considered a part of the pyramidal decussa- tion, I termed it the piniform decussation.' Certainly it resembles in section nothing Biaxin 500 so much as a fir-cone (Fig. 4, near ;• ; Fig. 3, near Dr). 2. Meynert was partly correct in tracing the fibres of this decussation to the lateral part of the pyramids, as these bodies were consid- ered at the time he wrote his treatise. The pyramid tract of to-day covers a much more limited area than the one assigned to it by anatomists of the last decade. Even Henle, who wrote after Meynert, represents them as extending dorsad, between the raphe and the roots of the twelfth pair, nearly to the floor of the fourth ventri- cle, making them include the strata interolivaria and the inner division of the reticular field of Biaxin Xl 500mg Meynert.^ 3. Even as the pyramids are demarcated to-day there is some little justification for Meynert's theorem. Fibres from the nuclei of GoU and Burdach do pass iftto a field con- nected with the true pyramid tra:t. I expressed a sur- mise to this effect in the description of the case of sec- ondary degeneration repeatedly referred to in the course of this paper. It was doubtful to me then whether the fibres thus traced by their degeneration {Ds*, Fig. 3) rep- resented a communication of the interolivary and the pyramidal tracts, or whether they were the fibres which, leaving the pyramids, pass to the hypoglossal nuclei, and (subjected to the pressure of the shrinking field of the interolivary layer through which they passed ?) under- went a slight retrograde degeneration.' Opposed as this latter alternative appeared to be by the general rule sup- posed to govern secondary degenerations, it became defi- nitely disposed of to my mind after a complementarj' study of secondary degeneration of the pyramidal tracts. Not only is it Biaxin Online impossible to trace degenerated fibres to the hypoglossal nuclei in any such situation as that indi- cated by Ds*. but the very fasciculi 7oithiti the pyramid 1 Architecture and Mechanism of the Brain, Chicago Journal of Nervous and Mental Diseases, J879, 1880. ^ It is only on this .assumption that his designation of the mesal accessory olive as a " nucleus p^Tamidalis " is comprehensible. 3 A Contribution to the Morbid Anatomy of Pons Lesions : being No. i. Series III., of Contributions to Neuropathology', based on researches conducted in the author's laboratory. Reprinted from the American Journal of Netirology and Psychiatrj' for November, 1883. 'J October i8, 1884.] THE MEDICAL RECORD. 423 field 7uhich are affected in degeneration of the interolirary stratum were found comparatively normal in a case of intense double descending ide generation of the pyramid tracts.^ Whether these fibres, after leaving the inter- olivary layer, re-enter it, abandoning their intra-pyramidal course, I am at present unable to determine. But the fact here stated shows that there was much more basis for Meynert's view than , Flechsig seem to have been aware of. Flechsig assumes, for the sake of simplifying Biaxin Buy Online matters, that the fibres of the posterior columns which represent the cephalic continuation of the posterior roots of the spinal nerves abut in the nuclei of the columns of Goll and Burdach, without committing himself directly to the view that Biaxin Order all of them do so. If we believe that the laws of secondary degeneration are invariable, that the course of such degeneration is always in the direction of functional transmission,^ then, undoubtedly, the columns of Goll and Burdach must terminate in the nuclei named after them, with that portion of their fibres which, in my opinion, represent Flechsig's interolivary layer continued down (after nuclei interruption) ; for in my case of a secondary degeneration of six years' duration not a degenerated fibre could be traced beyond the nuclei, though Buy Biaxin these themselves were atrophic. In speaking of these fibres, Flechsig battles with an imaginary opponent. He says,^ " The view that the pos- terior columns pass to the cerebrum chiefly through the mediation of the interolivary layer (and the longitudinal fibres of the reticular formation ?) has much more in its favor than the view that the posterior columns are exclu- sively connected with the cerebellum." He does not inform us who announces such a view. The one gener- ally Biaxin Antibiotic held up to the time of Flechsig's writings, was that of Meynert, who traced a part of the posterior columns (correctly) to the cerebellum, and another portion to the cerebrum, through his so-called " upper fine-bundled de- cussation of the pyramids." Flechsig was destined to confirm this view of Meynert's, with some topononiical corrections above referred to, to demonstrate much more satisfactorily than Meynert ever dreamed of doing that Order Biaxin this decussation embodied the continuation of posterior column fibres, and to correct some erroneous Biaxin 500mg details in Meynert's scheme. All this does not justify his repeated innuendoes against the latter on the one hand, and the suppression of its meritorious features on the other. In- deed, it would not be difficult 'to show that if Flechsig does not owe to Biaxin Antibiotics Meynert the hint which led to his follow- ing the embryological method with such signal and ac- Cheap Biaxin knowledged success, he would be compelled to confess to having had but an imperfect knowledge of the cerebral anatomical literature extant when he undertook his great work.* The "atrophy method," and the "development method " of Flechsig have undoubtedly cleared up much in the cerebral labyrinth which other methods were in- adecjuate to unravel ; and if it Antibiotic Biaxin be true, as I have repeat- edly stated to my class, that the progress made in cere- bral anatomy during the last ten years, iiuantitatively speaking, exceeds that made during the previous one hundred and fifty years, it is to these two methods Biaxin 500 Mg that the credit is chiefly due. But while recognizing the ser- vice which Gudden, Flechsig, and their pupils jiavo done and are doing, it is not yet demonstrated that tlieir * This I found to b« as; described in specimens of another's itnpubhshed case of f adults. Vox the same reason the /^es'^fduncuti oi the new-born is gray inttemi of -.vhiU, The un^imuttaneous drt'flo/imfntof the iiuiiuUary white in differ- ent tarts of thr hraiii is imierii a most important subject 'or searchinc sludy^^ (Strieker's Collection, vol. ii., pp. 770-71). methods are as exact as their advocates allege. To show the justice of this doubt it would suffice for me to refer to the various controversies which Mayser and Forel, on the part of the Gudden school, and Flechsig have in- dulged in. The results derived by both methods ought to be identical, if both were absolutely correct. They differ, however, in some respects and several details ; and notwithstanding that it has been implied — and par- ticularly by one who has undertaken to interpret and re- port Biaxin Price the results of industrious continental laborers, after a hurried visit to their laboratories — that the day of mi- croscopic sections is past, I believe that neither the re- sults of the atrophy method nor those of the embryonic method should be accepted unless they are gauged by a study of sections and made to harmonize with their rev- elations.' In order to show that those who have most severely criticised Meynert, and at the same time most sedulously belittled the extent of our indebtedness to him, are not themselves free from errors, often far more serious than those committed by that authority, I will refer for a moment to the latest proclamations made by Flechsig regarding the cerebellum. Flechsig is undoubtedly justified in attaching great im- portance to the peculiarities of tract development, ob- served in a child born without a cerebellum. It is diffi- cult to understand, however, how he can state : " This brain united the advantages of developmental and degen- erative difterentiation of the central white masses, inas- much as all fibre-tracts connected with the cerebellum were absent or atrophic, while all others were developed to an extent corresponding to the end of the period of foetal life, being partly myelinic and in part amyelinic." The cerebellum is too important an ingredient of the

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