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

  • Ferrier, David, Sir.
Date:
1878
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Licence: Public Domain Mark

Credit: The localization of cerebral disease : Gulstonia lectures of the Royal College of Physicians for 1878. Source: Wellcome Collection.

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    There are, however, difficulties in the way, for lesions of this region are not uncommon, whereas insolated affection of the levator palpebral is a comparatively rare occurrence, or at least has not been so obvious as to call for remark. This absence of paresis or paralysis therefore requires explanation. It seems to me not improbable that the intimate bilateral association of the oculo-motor nuclei may account for this, and that the escape of the levator palpebrse from paralysis in cases of unilateral lesion is simply a higher degree of that which is seen in the orbicularis oculi in facial paralysis of cerebral origin. The question, however, is one which deserves further inves- tigation. In the case, however, of the bilateral and antagonistic move- ments of the head and eyes, it would be natural to look for lateral distortion should the centre in one hemisphere be sud- denly removed ; and the distortion would be towards the side of lesion, owing to the unantagonised action of the centre which remains. This affords a sufficiently satisfactory explanation of the conjugate deviation of the head and eyes observed in the early stages of hemiplegia, whether of cortical or ganglionic origin. But, apart from conjugate deviation of the eyes in connec- of the pli courbe, no causal relationship can be considered as established between the two, any more than between such lesions and general hemiplegia of the opposite side, as in the case reported by Chavanis. As to the evidence from experimental physiology, I regard it as being opposed to the localisation of a motor centre for the levator palpebrse superioris in the angular gyrus. My experiments are frequently adduced in support of this view, but, as I consider, erroneously. It is true, that on stimulation of a neighbouring region— the superior temporo-sphenoidal convolution—along with other phenomena, marked elevation of the eyelids occurs ; but, as I have indicated, these reactions are to be taken only as reflex or associated indications of sensory stimulation. Destruction of the angular gyrus in the monkey causes no motor paralysis whatever, whether of pupils, eyelids, &c. Hence I see no good grounds for regarding this region as a motor one. In regard to unilateral ptosis there is one source of fallacy which may be over- looked. I have observed that in a large majority of persons one eyelid (generally the left) droops over the cornea more than the other, a condition which is greatly intensified by prostration and fatigue, so as in some cases to result in almost complete ptosis. In one case of this kind, well known to me, the droopingof the left eyelid, not obvious in health, occurred to such an extent during a prostrating illness, as to lead another physician to suspect lesion of the third nerve. With returning strength the ptosis disappeared.