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central mechanism to be eliminated without producing far-reaching defects in development elsewhere. It is not probable that the remote centres connected with the cerebellum were, as such, normally developed ; the men- tal disturbance noted with defective development of the cerebellum is probably to be explained on the ground that its absence is associated with other defects, indeed, that it is only an intensified expression of a general defect in cerebral development. This is the proper explana- tion of the intellectual deficiency noted with cerebellar atrophy, and not the wild and startling tentative sugges- tion of Flechsig," who asks whether the existence of the commisural cortical gray of the cerebellum does not ex- plain (by vicariation) the absence of mental disturbance noted in cases where the corpus callosum is absent ! This suggestion exceeds in fancifulness, and in lack of foundation, anything ventured by Meynert, who is harshly criticised by Flechsig, but who rarely abandoned the channels of log. \\ reasoning based on the facts as known, or supposed to be known, in his daj', to such a grievous extent, at least not before Flechsig wrote. It is an interesting and important cjucstion, one requir- ing great care and a comparison of numerous anatomical and experimental facts to determine, what cjualities of sen- sation are transferred to the brain by the piniforni, or upper (sensory) decussation of the interolivary stratum. Wernicke ' first formally considered the inconsistency be- tween the well-known phenomenon of crossed hemi- anesthesia in si)inal hemisection and the assumption of a redecussation in the oblongata. Many who have never published their Generic Bupropion doubts probably raised the above questio i in their minds. More recently Starr' has reviewed th • entire question and collected a number of valuable an 1 not generally accessible cases, which justify his arriving rt 1 I refer here only to studies made on the human subject, when speaking of s. - tual discrepancies. ' Plan of the Human Brain, page 43, loot-note. It may serve to show that iVc day of speculation as to this terra incognita of brain anatomy is far from wapinp. that while Flechsig suggests a possible vicariation of the cerebellum for deficiency of the intellectual organ par tjccellince, .Starr, with all the wellesublishcd facis elucidated by Flechsig at his disposal, concludes that it is in part a centre con- nected with vegetative life (The Sensory Tract in the Central Ncr\'0us Systciii, Alumni Prize Lssay, College of Physicians and .Surgeons, by M. Allen Starr). • Lehrbuch der Gehimkrankhellen, cd.ll., 1881. Not in American hands till t88>. * Loc. cit., p. 5a. 424 THE MEDICAL RECORD. [October i8, 1884. conclusions, as he supposes, very different from those of Wernicke and my own ; ' my own position having been to some extent misapprehended by Starr, as he has since recognized in a note to the Jouitial of NerTous and Men- ial Diseases, in which his article appeared. AV^ith regard to Wernicke, I think he has fallen into a similar misun- derstanding. He says that his results of a study of cases is opposed to the course of the sensory tracts as described by Wernicke, for several reasons, among them, because "these tracts are supposed to leave the medulla and to pass by way of the cerebellum to the pons." The further text of his article shows that Starr attributes to Wernicke the view that ali sensory tracts pass by way of the cere- bellum, and none by way of the pons. In reality Wernicke's position is very conservative, he discusses the entire ijuestion, and concludes that there are several possible channels by which sensory paths may reach the cerebrum, which he details under the headings 1. and II., Buy Cheap Bupropion A. [a and b), B. ((7, b, c). Of these, all but the first Bupropion Online are enumerated by Starr, who implies that Wernicke rejects the Order Bupropion alterna- tive under I., namely: apath of single decussation (running through) the most lateral portion of fibres of the lateral "motor" field of the tegmental part (of the oblongata and pons), then above the exit-level Buy Bupropion Online of the trigeminus in the neighborhood of the ascending trigeminus root, (situated) in the spinal cord, in the "lateral layer bounding the gray substance," (then) ^decussation in the gray substance im- mediately above the respective posterior roots.' I do not think that the language of Wernicke on page 262, where he discusses his own and Kahler's case, necessarily implies the interpretation Starr has given to it. If so, it is difficult to see why ^Vernicke should enu- merate the above tract in his conclusions. He simply discusses a number of " important considerations and doubts," ' which are encountered by him in his attempt to consider the tract mentioned as the one. In the very paragraph where he expresses these doubts he says that " there must be separate (distinct) sensory paths in the oblongata," a conclusion at which I arrived some years ago,' and which seems to me to-day to be the only one that can be harmonized with those facts stated in the in- roductory remarks of the present paper. Starr's con- clusion as to the course of the tracts for tactile perception repeats the hypothetical tract deduced by Wernicke in very many particulars. The doubts which troubled Wer- nicke are based on facts which have not been disputed to this day. They are as much a subject for considera- tion now as then. The collection of cases made by Starr is accompanied by the following conclusions (p. 6i) : " Those sensory impulses which have not decussated in the spinal cord cross the median line in the sensory decussation of the medulla, and pass upward through the interolivary tract to the lemniscus, in which they ascend to the internal capsule. These are the sensations included under the term muscular sense." This proposition would seem to be as well based as the dictum that lesion of the motor tract in the internal capsule produces contralateral Purchase Bupropion Online pa- ralysis. The cases of Kahler and Pick, Meyer, Senator, and my own, cited, prove that lesion of one interolivary layer produces contralateral ataxia ; indeed, in my case the anatomical proof of the decussation — the degenera- tion crossing in the direction of functional involvement — was as complete as the clinical evidence. This fact is furthermore in harmony with a statement of Brown Se- quard, that in his puzzling symptoms of spinal hemisection the muscular sense does not follow the rule of spinal de- cussation, Buy Bupropion but suffers on the same side with the motor function. If Ferrier's recent contradiction ' of Brown- * The Sensory Tract to the Fore-brain, note in the Chicago Medical Review, July II, 1881 ; and Morphological Kelalions of the Cerebellum, ibid., July 5th. ' Wernicke : I.oc. cit., vol. i., p. 265, lines 12-17. 3 'I Wichtige Bedenkcn.'' " Bedcnken " is best rendered as a mixture of '* reflec- bon " and " douot," for which there is no accurate equivalent in English ; it implies hesitation. * Architecture of the Oblongata, New York Medical Journal, September, The view of separate tracts for muscular and -tactile sense is expressed ir article, but has been much modified in detail since. ' He claims that the muscular sense path decussates in the cord. S6quard's theorem stands, then we are in the same quan- dary as before with regard to the alternative stated by Wernicke, that if the sensory paths all decussate in the oblongata, they must redecussate twice in the cord, if the facts of capsular and spinal hemianesthesia are to be harmonized. As far as the tract we are now Cheap Bupropion considering is traced from the nuclei of Burdach and Goll to the anterior (cephalic) Order Bupropion Online end of the pons is concerned, our knowledge is very satisfactory. Above this point it is involved m some obscurity. Flechsig believes that a part of the lemniscus, as far as 1 can glean, the one he believes to correspond to our tract, passes directly into the internal capsule. This would appear to be the simplest solution. Elsewhere he stales that fibres derived from the puta- men ' and the nucleus candatus, after coursing through the internal capsule, pass through the dorsal part of the jies pedunculi, being crowd- ed against and pressed be- tween the ventro-lateral pro- cesses of the substantia nigra. He considers it ])ossible that this fasciculus is connected with the substantia nigra, for a large portion Buy Bupron Sr of it be- comes lost here. The remainder he traces cordward as a ventro-medial accompaniment of the lemniscus layer, and supposes that it is ultimately united with the gray matter of the pons. This tract degenerates in the descending direction when diseased in the adult. Elsewhere " he speaks of the same fibres as intruding themselves \j] between the lemniscus layer and the raphe "lower down," and as leaving the pes to enter the tegmentum. Cer- tainly his first declaration, as to a prob- able connection with the nucleus pontis, is contradicted, not alone by the second statement, viz., that it passes into the teg- mentum, but also by the course of the tract as indicated in his diagram, which is made to run quite parallel with his " interolivary layer," and into it. The interolivary layer of Flechsig is, according to him, the continuation of the interolivary layer upward. Two-thirds of this fibre system is represented in that part of the interolivary layer which is in im- mediate contact with the olives. He adds, with a query of Purchase Bupropion his own, " and has no (?) connection with the upper pyramidal decussation." This query was certainly a sav- ing afterthought. The secondarj' degeneration described * The outer of the three (or four, and in some subjects five) " articuli " of the Bupron Sr Tablets len- ticular nucleus. - Plan uf the Human Brain, p. 20. October i8, 1884. J THE MEDICAL RECORD. 425 in a case of pons lesion by myself appears to dispose of this question. In it the degeneration was limited to that very portion of the interolivary layer, and the corre- sponding half of the upper pyramidal decussation was al- most entirely eliminated. Another statement of Flechsig's demonstrates that he has confounded the relations of the two divisions he has made. He says the smaller division — that is, the part remaining of the lemniscus after the larger portion adjacent to the olive is subtracted — is connected with the upper pyramidal decussation, and that its fibres do not degenerate for any distance downward." Now, it is the very part which does connect with the pyramids, but which lies adjacent to the olives, which degenerates down- ward (cordward) for its entire ana- tomical e.xtent, as shown in the dia- grams and fac-similes on the opposite page. Flechsig is also wrong in as- serting that the greater part of the lemniscus (two-thirds) degenerates downward,' giving, as he does, the im- pression that this is an invariable rule. In my case the ascending degenera- tion monopolized by far the larger lem- niscus field, all of it, in fact, with the

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