The Gulstonian lectures on secondary degenerations of the spinal cord : delivered at the Royal College of Physicians, March, 1889 / by Howard H. Tooth.

Date:
1889
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Licence: Public Domain Mark

Credit: The Gulstonian lectures on secondary degenerations of the spinal cord : delivered at the Royal College of Physicians, March, 1889 / by Howard H. Tooth. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    to spring from the anterior column of one side, to pass into the corresponding column or anterior horn of the opposite side. And yet the most careful examination fails to discover a single degene- rated fibre in the commissure. The destination of this tract i& therefore at present conjectural. Development Developmentally the direct pyramidal tract Pyramfdal resembles the crossed ; that is, the fibres are Tract. meduUated late, and therefore these two tracts- remain as unstained patches by osmic acid or Weigert's hsematoxylin, when all the rest of the white matter is stained black. It is also developed from below upwards, but generally speaking it is farther advanced in development at birth than is the crossed pyramidal tract. Recrossed I cortical lesions of the motor area another Fibres. descending tract in the lateral tract of the same side as the lesion has been often noticed. Pitres,* in the im- portant paper just referred to, brings forward ten out of forty cases of hemiplegia from unilateral brain lesions, many with contractures and increased tendon jerks. In all he found a de- generation of the pyramidal tract on the same, as well as on the opposite side. In several of these the degenerations on the two sides were of equal intensity; in others it was less mtense on the same side. In six cases the direct pyramidal tract was also affected, and in three both direct pyramidal tracts. The pyramid of the opposite side was quite unaffected. He re- marks also that there is clinical ground for the suspicion of this double degeneration; that in many hemiplegias we find loss of power, slight, it is true, of the same side. He moreover draws attention to the very common occurrence of increased re- flexes and the less common occurrence of contractures on the same side. It must be said, however, that in many of his reported cases these symptoms are not noted, though the de- generation was obvious after death. He considers that these fibres come from the pyramid of the same side; that is, that the fibres of that pyramid may pass into of medullated fibres from one side to the other. The fibres seem * Pitres, op. cit.