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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    Since the publication of Turck's four cases, in 1859, of the association of hemianesthesia with lesion of the posterior part of the internal capsule, there have been recorded at least twenty others, all establishing the same fact.1 The symptoms of cerebral hemianaesthesia, which correspond with those of that strange and, as regards its therapeutics, mysterious affection termed hysterical hemianaesthesia, are such as to clearly differentiate it from anaesthesia of spinal or mesen- cephalic origin. The special diagnostic feature is, that all the forms of sensibility, general or special, are impaired or abolished; the organs of sense whose nerves take origin above the medulla oblongata being equally affected with those which arise here. W hereas in mesencephalic anaesthesia, in addition to the usual association of alternate paralysis, sight and smell remain un- affected.2 In cerebral hemianaesthesia, tactile sensation is affected uni- laterally up to the middle line of the face and trunk; there being more or less complete insensibility to touch, pain, tem- perature, and also abolition of muscular sensibility, with complete retention of electro-motor contractility. The con- junctival, nasal, buccal, cutaneo-mueous membranes are also anaesthesic. The viscera, however, remain sensitive, and deep pressure, as on the ovary, &c, is felt as before. In hysterical hemianaesthesia, there is usually hyperaesthesia in the ovarian region, and frequently also the condition termed by Charcot hystero-epilepsy. Taste, smell, and hearing are deficient, or almost entirely abolished in a similar manner on the one side. As regards vision, the symptoms are especially noteworthy. The eye on the anaesthetic side is rarely rendered completely blind. There is rather a condition of amblyopia or diminution of the acuteness of sight, and a very remarkable contraction of the field of vision, more especially as regards the perception of colour. Landolt has found that the field of colour-perception becomes contracted in a manner corresponding to the relative extent of the colour-field in the normal state. Normally the 1 For references, &c, see Grasset, Localisations dans les Maladies Cerebrates. MontpeUier, 1878. 2 See Couty, ' De l'Hemianesthesie Mesocephalique, Gas. Hebd., 1877, p. 30 et seq. I