The localisation of cerebral disease : being the Gulstonian lectures of the Royal College of Physicians for 1878 / by David Ferrier.

Date:
1878
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Licence: Public Domain Mark

Credit: The localisation of cerebral disease : being the Gulstonian lectures of the Royal College of Physicians for 1878 / by David Ferrier. 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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    be certain to hear of them. In the lower animals, every physiologist who has seen paralysis produced by cerebral lesion, has seen it on the opposite side, with the single exception, I believe, of Brown-Sequard. Such being the experience of physicians and physiologists, it is surely more natural to suspect sources of fallacy, or to con- clude that there is something very abnormal, than attempt to overthrow a law which has such a preponderance of evidence in its favour. That direct paralysis may occur I am prepared to admit, not only on the evidence of recorded facts, but on anatomical grounds. To overthrow the absoluteness of the rule of the cross action of the cerebral hemispheres, one well authen- ticated case, in which the paralysis occurred on the same side, is sufficient. But we require clear evidence, not merely of the existence of a lesion in the hemisphere of the same side (for, as we shall see, lesions of a very extensive nature may exist in certain regions without causing paralysis), but of the existence of a lesion in what we recognise as a motor region. A solution of continuity of the fibres of the internal capsule, or a complete separation of the corpus striatum from its hemispherical connec- tions, we should look upon as a necessary cause of paralysis, and we should look for it on the opposite side. If such a lesion can be shown to have existed with paralysis on the same side, I should regard that as a satisfactory proof of direct paralysis. And such seems to have been established by Morgagni. In a case which he had carefully observed and ex- amined post-mortem, he was astonished to find paralysis appa- rently on the same side as the lesion ; but, distrusting his recollection and the accuracy of his records, he asked of his students on which side the paralysis had existed. 'All in general and each one in particular answered without hesitation that it was the right side [the side of the disease, which was separation of the corpus striatum from the cortex]; and for this reason,' said he, ' it is clear to me that sometimes the paralysis occurs on the same side as the lesion.' * I do not here intend to enter on the question whether some apparent cases of direct paralysis may not be capable of expla- ' Quoted from Baylo, Maladies du Cerveau, p. 321.