The localization of cerebral disease : Gulstonia lectures of the Royal College of Physicians for 1878.

  • Ferrier, David, Sir.
Date:
1878
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Credit: The localization of cerebral disease : Gulstonia lectures of the Royal College of Physicians for 1878. Source: Wellcome Collection.

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    of the paralysis;. for distortion, consequent on the cessation of an antagonist, is always most marked at the commencement, whereas, in the rigidity of hemiplegia, it is usually weeks or months before it sets in. And if it were cerebellar influx, I should further look for the rigidity in the extensor muscles of the trunk and legs, owing to the more especial relation of the cerebellum to these movements as indicated by experiment; whereas the very contrary holds, as the rigidity is most marked, and, in a large majority of cases, is confined to the arm and flexors more especially. The rigidity, in fact, seems to affect those muscles most which are most paralysed by destructive lesions of the hemispheres. If it be objected—and this seems to be the main objection—that the remittent or intermittent character of the late rigidity, in its early stages, militates against the idea of its being dependent on a permanent organic lesion, we can find analogous phenomena. The neuralgic pains which are associated with progressive sclerosis of the posterior columns of the spinal cord are not constant, but remit, intermit, or vary under different conditions, which modify the nutrition and activity of the nerve-centres. So we may account for vari- ations in the state of contracture, depending as we may regard it on irritation induced by the chronic myelitis of the motor tracts. It is possible also that in some cases reflex contracture may be superadded, by the irritation extending to sensory tracts. Duret1 is inclined to attribute late rigidity exclusively to reflex irritation ; but it is not the recognised character of reflex spasm to be tonic or continuous, but rather clonic and intermittent. And if irritation of the sensory tracts existed to such an extent as to keep up such constant and marked contraction, we should certainly observe more clear indications of sensory disturbance than are discernible in old standing hemiplegia with rigidity. It is true, as Charcot2 has pointed out, that in protopathic lateral sclerosis, joined with amyotrophy, there are sensory dis- turbances such as spontaneous pains, formication, &c, and also very marked pain on pressure or traction on the muscles, but in this disease the sclerosis does not remain limited to the lateral columns, but extends into the grey matter. 1 Brain, 1877, Part i.' On the Role of the Dura Mater in Cerebral Traumatism.