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FARADIC STIMULATION OF THE CEREBRAL CORTEX IN CONSCIOUS PATIENTS.
FARADIC STIMULATION OF CEREBRAL CORTEX IN CONSCIOUS PATIENTS.
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93
promiscuouswould immediately be aroused in a practice which now can deaths andonly be regarded as a lawful eccentricity, and we may be carrying injuries, both criminal and accidental, even in the British sure that information would often be given voluntarily upon Isles, due to this improper practice. DHINGRA went to the which the executive would gladly take proceedings. Can "At Home"of the National Indian Association armed anyone who reads of the crimes in which revolvers play a with two loaded revolvers, and legally if he had a part formulate an objection to a law which would enable the licence he had as much right to do so as he had to police, acting upon trustworthy information, to invite into a carry a watch, a pencil-case, and spectacles. If he had suitable place and search a person suspected of going into neglected to comply with the one restriction imposed by law, the streets armed like a desperado in one of BRET HARTE’S and had not provided himself with a licence, he could have stories ? Would any decent citizen be likely ever to find put himself in the right with but little trouble and by the himself inconvenienced thereby, or would he not cheerfully expenditure of half a sovereign. If we leave out of the run the risk in view of the greater protection which he question the naval and military service, a pistol is of no use would enjoy against crime? We have not ascertained except to a man desiring either to perpetrate a crime or to the opinion of the police on the subject, but we can protect himself or others against one, and we do not believe hardly believe that they would not gladly have their that the acquiescence of the law in the possession of lethal hands strengthened against a class of crime of which they weapons by any person of whatever character or antecedents are not infrequently the victims, as witness the savage is necessary or right, though we consider that the arming of murders which not long ago were committed by alien ruffians our police with revolvers could be defended. We do not in broad daylight at Tottenham. The recent tragedy is one suggest that the ownership of revolvers by determined and which, owing to the prominent position occupied by its cunning criminals can be prevented, but we assert victims and to the circumstances in which it was perpetrated, emphatically that it can and ought to be rendered has attracted exceptional attention. There are, however, In our view a heavy duty on revolvers of other persons in the kingdom who offer themselves almost less easy. call the
We refer to the
attention.
gravest
of revolvers and to the
all
kinds
would
drive
numerous
of
existence the cheap responsible for so many of
out
daily
as more
conspicuous
marks to the murderous fanatic
than did Sir WILLIAM CURZON WYLLIE, and we believe it weapon which has been or that we from the disasters, purposive to be desirable to minimise, as far as it is possible to do so, accidental, time to time record ; and if the duty, which should be a a risk which, we admit, cannot be altogether abolishedreally high one, were remitted to persons purchasing and and to do so without delay. using their weapons in the course of naval, military, and
police service,
or
for lawful purposes by anyone. Such
would be incurred to be
intercepted
pistols from foreign countries.
abroad, a
duty
no
hardship
would enable
at the Custom House when
Householders desirous of
brought protecting
Annotations. "
Ne
nimis.""
quid against burglars would not complain at having to pay such a duty, while it is our belief FARADIC STIMULATION OF THE CEREBRAL that the number of persons who keep revolvers for such a CORTEX IN CONSCIOUS PATIENTS. legitimate object is, even now with no duty to pay, exUNDER the modest title, "A Note upon the Faradic Stimutremely small. But the armed burglar is a danger against lation of the Post-central Gyrus in Conscious Patients," which it is legitimate to be armed, and there is no reason Professor Harvey Cushing of the Johns Hopkins Hospital, why careful citizens should not obtain, after suitable Baltimore, contributes to the latest number of Brain a paper formalities, licence to arm themselves, if they like to which may well prove to be epoch-making, both from the undertake the risks attendant on the procedure. physiological and the surgical points of view. The employThe carrying of a revolver in any place, public or private, ment of the unipolar method of faradisation by Sherrington and Grunbaum in their classic experiments on the anthropoid not in the occupation of the person carrying it, unless a brain has enabled them accurately to delimit the electrically reasonable explanation were forthcoming, might well be excitable motor area to the anterior wall of the fissure of made an offence against the law and one severely punish- Rolando and a strip of the adjoining surface of the preable in suitable circumstances, thus limiting the use of the central convolution, and their results have been completely weapon to self-defence. We do not anticipate that such corroborated for man by Krause and by Frazier; further, Cushing himself says that he has had the occasion to an enactment would prevent altogether those meditating stimulate the cortex of more than 50 anæsthetised patients crimes from obtaining firearms or from using them, but with precisely identical results. This simple statement is of it would render both the obtaining and the possession the deepest significance. By experiment on the human of them comparatively difficult and unsafe. Possibly no cortex the motor area has been exactly delimited and found one knew that DHINGRA carried revolvers, but, even if to correspond strictly to the excitable motor area of the a fellow student or an inquisitive landlady had become anthropoid ape. The justification-were any neededwhich these facts afford for the prosecution of scientific aware that he was in the daily habit of going out armed to the teeth, in the present state of the law it would experimentation on animals is so obvious that we do not to labour the point. The experimental study of not havebeen his or her concern, and if the matter require
themselves and their property
had
been
reported
to
the
ference would have been such weapons
were a
police possible.
no
effective
If the
inter-
carrying
of
.. substantive offence" then interest
sensation in animals, however, is difficult and unsatisfactory, depending as it does so much on the interpretation of reflex actions. Professor Cushing has in the course of the past year had two opportunities of making observations on the
94
THE BOON OF THE BY-ROAD.-" HEART."
patients, and the record which he these cases is fascinating from its very plainness and directness. A sturdy and intelligent boy, aged 15 years, came under observation suffering from Jacksonian attacks in the right arm and face, attacks preceded by a sensory aura of numbness, tingling, and " gonenessin the right hand, No loss of more particularly the ulnar fingers, and arm. consciousness accompanied the seizures. Certain indications suggested the possibility of a cerebral tumour, and an operation was decided on. Under chloroform the central area of the left hemisphere was exposed by the usual osteoplastic craniotomy, and the situation of the precentral gyrus assured by unipolar stimulation, sharp movements in wrist, elbow, shoulder, and face being readily obtained. No cause for the attacks being discovered at this stage, it was determined to make a more radical attempt to disclose their source of origin. Three weeks later, after a preliminary injection of one-eighth of a grain of morphia and under primary anaesthesia by chloroform, the bone-flap was quickly reopened and the dura mater exposed. The patient promptly regained complete consciousness, and without occasioning him the least discomfort the dura mater was incised and reflected. The same movements as before were then elicited by mild faradisation of the precentral cortex. The boy was perfectly aware of these movements, and said that they gave him a sort of drawing sensation as if the muscles were being pulled " by an electric battery. In other words, they gave him the sensation of active muscular contraction alone. Stimulation over an area to the roughly corresponding upper two-thirds of the postcentral gyrus with the same strength of current produced a sensation in the hand, arm, and little finger, said by the patient to be exactly akin to the sensation that inaugurated his attacks. Stimulation lower down on the post-central gyrus occasioned a sensation of warmth in the arm. No painful sensations whatever resulted. At a spot higher up on the gyrus the electrode produced an attack precisely similar to his usual attacks without loss of A number of small vessels crossing the consciousness. convolution at that level were accordingly ligatured and a subcortical exploration was made, but without disclosing No sensation whatever accompanied any gross lesion. the making of this exploration. The dura mater was reclosed, and under a second primary chloroform ana3sthesia the scalp wound was quickly sutured. In the other case, also one of Jacksonian epilepsy confined to the right arm, with a sensory aura, the same procedure was adopted. At the second stage the patient was narcotised with morphia, from which he readily recovered, and during the stimulation he remained perfectly composed, eager to assist in every way in his power. Using a weak faradic current, the middle of the left post-central gyrus was lightly touched for the briefest moment of time with the tip of a coiled platinum wire electrode. He immediately responded, saying that he a experienced sensation as though someone had touched or stroked the index finger of the right hand. From points lower down on the same gyrus, touching or stroking as though on the back of the hand was felt. On stimulating the precentral convolution at a point opposite prompt flexion of the thumb into the palm of the hand followed, without any associated cutaneous sensation. The significance of these briefly recorded phenomena is not easy of interpretation beyond a certain point, inasmuch as we are still ignorant of the real relation of afferent impulses to motor responses. They suggest that the post-central gyrus has a sensory function; of what kind and of what degree of completeness we cannot say. Surgically, in each case the operator was able to delimit the area from which attacks such as the patients had been suffering from could be elicited, and to act in accordance with this knowledge. The entire absence of any sort of pain or even of discomfort on sensory cortex in conscious
gives of
the part of the patient is not the least interesting part of the record. In skilful hands, but in skilful hands alone, the opportunity of increasing our knowledge of cerebral function might be remarkable. It must be emphasised that Professor Cushing applied his electrode for the particular purpose of determining the localisation of the area of excitability producing his patients’ attacks, and for that purpose alone. The experiments were conducted from the patients’ standpoint, and their intelligent cooperation renders the result the more valuable. __
THE BOON OF THE BY-ROAD. IT is undeniable that the motor-car is rapidly extinguishing the pleasure of cycling, not merely because of the clouds of dust, of the petrol fumes, or of the menacing pace, but because the main roads are in so many instances reduced from the smooth surface, which at one time characterised them, to a state of fine grit and sharp particles which make riding hard and play havoc with an unprotected pneumatic tyre. The motor-car appears to suck out the binding material of the road, and to leave spicules of flint behind which readily penetrate the unprotected tyre of the bicycle. Cycling has attractions for so many people, is undoubtedly a healthy pastime, and is so often a source of convenience, that anything which threatens to hinder its practice and enjoyment must be a matter for regret. We inquire, therefore, why a new roadbook is not issued setting forth, where it is possible, the route between place and place along by-roads which escape the traffic of the motor and are not direct, while their narrowness and curves obviously would not appeal to a man in possession of a machine capable of running over 20 miles an hour. We feel sure that some such road-book could be easily furnished, and in fact we have had proof of this. There are very often some excellent but relatively narrow by-roads which run almost parallel with the trunk road for miles, and yet there will be no decided indication of them in the present maps sufficient to induce the cyclist to take them. What is wanted, it seems to us, is a map marking very prominently the roads which are not main roads, say with a strong-coloured broad line, leaving the main roads as uncoloured lines. This would mean an informal survey of the roads of the country on behalf of the cyclist, and, need we add, on behalf of the motorist also, for there is little doubt that allocation to separate roads would please the motorist and cyclist equally. We are sure, at all events, that such new maps would meet with the hearty approval of a number of cycling people, who have abandoned this pleasurable and healthful form of travelling owing to the increased dangers of the road and to the destruction of its good cycling surface due to motor traffic.
"HEART." WE welcome this week the first appearance of a periodical entitled Heart,l which has been founded to render the like service to the diffusion of recent knowledge on the physioand pharmacological problems of the circulation as our admirable contemporary Brain affords in the cause of neurology. Heart, which is edited by Dr. Thomas Lewis, displays upon its title-page the names of an advisory staff formed by a group of British and American physicians and physiologists who may confidently be said to ensure scientific success for the new journal, the objects of which are stated to be "the progress of knowledge of the mechanism by which the blood circulates in health and disease....... To know the pump, which Harvey revealed to us, more intimately; to understand more
logical, dynamical,
1
Heart: A Journal for the Study of the Circulation, Vol. i., No. 1. London: Shaw and Sons. Pp. 82. Price 5s. 6d. net (subscription price, 20s. per volume).
[
93
promiscuouswould immediately be aroused in a practice which now can deaths andonly be regarded as a lawful eccentricity, and we may be carrying injuries, both criminal and accidental, even in the British sure that information would often be given voluntarily upon Isles, due to this improper practice. DHINGRA went to the which the executive would gladly take proceedings. Can "At Home"of the National Indian Association armed anyone who reads of the crimes in which revolvers play a with two loaded revolvers, and legally if he had a part formulate an objection to a law which would enable the licence he had as much right to do so as he had to police, acting upon trustworthy information, to invite into a carry a watch, a pencil-case, and spectacles. If he had suitable place and search a person suspected of going into neglected to comply with the one restriction imposed by law, the streets armed like a desperado in one of BRET HARTE’S and had not provided himself with a licence, he could have stories ? Would any decent citizen be likely ever to find put himself in the right with but little trouble and by the himself inconvenienced thereby, or would he not cheerfully expenditure of half a sovereign. If we leave out of the run the risk in view of the greater protection which he question the naval and military service, a pistol is of no use would enjoy against crime? We have not ascertained except to a man desiring either to perpetrate a crime or to the opinion of the police on the subject, but we can protect himself or others against one, and we do not believe hardly believe that they would not gladly have their that the acquiescence of the law in the possession of lethal hands strengthened against a class of crime of which they weapons by any person of whatever character or antecedents are not infrequently the victims, as witness the savage is necessary or right, though we consider that the arming of murders which not long ago were committed by alien ruffians our police with revolvers could be defended. We do not in broad daylight at Tottenham. The recent tragedy is one suggest that the ownership of revolvers by determined and which, owing to the prominent position occupied by its cunning criminals can be prevented, but we assert victims and to the circumstances in which it was perpetrated, emphatically that it can and ought to be rendered has attracted exceptional attention. There are, however, In our view a heavy duty on revolvers of other persons in the kingdom who offer themselves almost less easy. call the
We refer to the
attention.
gravest
of revolvers and to the
all
kinds
would
drive
numerous
of
existence the cheap responsible for so many of
out
daily
as more
conspicuous
marks to the murderous fanatic
than did Sir WILLIAM CURZON WYLLIE, and we believe it weapon which has been or that we from the disasters, purposive to be desirable to minimise, as far as it is possible to do so, accidental, time to time record ; and if the duty, which should be a a risk which, we admit, cannot be altogether abolishedreally high one, were remitted to persons purchasing and and to do so without delay. using their weapons in the course of naval, military, and
police service,
or
for lawful purposes by anyone. Such
would be incurred to be
intercepted
pistols from foreign countries.
abroad, a
duty
no
hardship
would enable
at the Custom House when
Householders desirous of
brought protecting
Annotations. "
Ne
nimis.""
quid against burglars would not complain at having to pay such a duty, while it is our belief FARADIC STIMULATION OF THE CEREBRAL that the number of persons who keep revolvers for such a CORTEX IN CONSCIOUS PATIENTS. legitimate object is, even now with no duty to pay, exUNDER the modest title, "A Note upon the Faradic Stimutremely small. But the armed burglar is a danger against lation of the Post-central Gyrus in Conscious Patients," which it is legitimate to be armed, and there is no reason Professor Harvey Cushing of the Johns Hopkins Hospital, why careful citizens should not obtain, after suitable Baltimore, contributes to the latest number of Brain a paper formalities, licence to arm themselves, if they like to which may well prove to be epoch-making, both from the undertake the risks attendant on the procedure. physiological and the surgical points of view. The employThe carrying of a revolver in any place, public or private, ment of the unipolar method of faradisation by Sherrington and Grunbaum in their classic experiments on the anthropoid not in the occupation of the person carrying it, unless a brain has enabled them accurately to delimit the electrically reasonable explanation were forthcoming, might well be excitable motor area to the anterior wall of the fissure of made an offence against the law and one severely punish- Rolando and a strip of the adjoining surface of the preable in suitable circumstances, thus limiting the use of the central convolution, and their results have been completely weapon to self-defence. We do not anticipate that such corroborated for man by Krause and by Frazier; further, Cushing himself says that he has had the occasion to an enactment would prevent altogether those meditating stimulate the cortex of more than 50 anæsthetised patients crimes from obtaining firearms or from using them, but with precisely identical results. This simple statement is of it would render both the obtaining and the possession the deepest significance. By experiment on the human of them comparatively difficult and unsafe. Possibly no cortex the motor area has been exactly delimited and found one knew that DHINGRA carried revolvers, but, even if to correspond strictly to the excitable motor area of the a fellow student or an inquisitive landlady had become anthropoid ape. The justification-were any neededwhich these facts afford for the prosecution of scientific aware that he was in the daily habit of going out armed to the teeth, in the present state of the law it would experimentation on animals is so obvious that we do not to labour the point. The experimental study of not havebeen his or her concern, and if the matter require
themselves and their property
had
been
reported
to
the
ference would have been such weapons
were a
police possible.
no
effective
If the
inter-
carrying
of
.. substantive offence" then interest
sensation in animals, however, is difficult and unsatisfactory, depending as it does so much on the interpretation of reflex actions. Professor Cushing has in the course of the past year had two opportunities of making observations on the
94
THE BOON OF THE BY-ROAD.-" HEART."
patients, and the record which he these cases is fascinating from its very plainness and directness. A sturdy and intelligent boy, aged 15 years, came under observation suffering from Jacksonian attacks in the right arm and face, attacks preceded by a sensory aura of numbness, tingling, and " gonenessin the right hand, No loss of more particularly the ulnar fingers, and arm. consciousness accompanied the seizures. Certain indications suggested the possibility of a cerebral tumour, and an operation was decided on. Under chloroform the central area of the left hemisphere was exposed by the usual osteoplastic craniotomy, and the situation of the precentral gyrus assured by unipolar stimulation, sharp movements in wrist, elbow, shoulder, and face being readily obtained. No cause for the attacks being discovered at this stage, it was determined to make a more radical attempt to disclose their source of origin. Three weeks later, after a preliminary injection of one-eighth of a grain of morphia and under primary anaesthesia by chloroform, the bone-flap was quickly reopened and the dura mater exposed. The patient promptly regained complete consciousness, and without occasioning him the least discomfort the dura mater was incised and reflected. The same movements as before were then elicited by mild faradisation of the precentral cortex. The boy was perfectly aware of these movements, and said that they gave him a sort of drawing sensation as if the muscles were being pulled " by an electric battery. In other words, they gave him the sensation of active muscular contraction alone. Stimulation over an area to the roughly corresponding upper two-thirds of the postcentral gyrus with the same strength of current produced a sensation in the hand, arm, and little finger, said by the patient to be exactly akin to the sensation that inaugurated his attacks. Stimulation lower down on the post-central gyrus occasioned a sensation of warmth in the arm. No painful sensations whatever resulted. At a spot higher up on the gyrus the electrode produced an attack precisely similar to his usual attacks without loss of A number of small vessels crossing the consciousness. convolution at that level were accordingly ligatured and a subcortical exploration was made, but without disclosing No sensation whatever accompanied any gross lesion. the making of this exploration. The dura mater was reclosed, and under a second primary chloroform ana3sthesia the scalp wound was quickly sutured. In the other case, also one of Jacksonian epilepsy confined to the right arm, with a sensory aura, the same procedure was adopted. At the second stage the patient was narcotised with morphia, from which he readily recovered, and during the stimulation he remained perfectly composed, eager to assist in every way in his power. Using a weak faradic current, the middle of the left post-central gyrus was lightly touched for the briefest moment of time with the tip of a coiled platinum wire electrode. He immediately responded, saying that he a experienced sensation as though someone had touched or stroked the index finger of the right hand. From points lower down on the same gyrus, touching or stroking as though on the back of the hand was felt. On stimulating the precentral convolution at a point opposite prompt flexion of the thumb into the palm of the hand followed, without any associated cutaneous sensation. The significance of these briefly recorded phenomena is not easy of interpretation beyond a certain point, inasmuch as we are still ignorant of the real relation of afferent impulses to motor responses. They suggest that the post-central gyrus has a sensory function; of what kind and of what degree of completeness we cannot say. Surgically, in each case the operator was able to delimit the area from which attacks such as the patients had been suffering from could be elicited, and to act in accordance with this knowledge. The entire absence of any sort of pain or even of discomfort on sensory cortex in conscious
gives of
the part of the patient is not the least interesting part of the record. In skilful hands, but in skilful hands alone, the opportunity of increasing our knowledge of cerebral function might be remarkable. It must be emphasised that Professor Cushing applied his electrode for the particular purpose of determining the localisation of the area of excitability producing his patients’ attacks, and for that purpose alone. The experiments were conducted from the patients’ standpoint, and their intelligent cooperation renders the result the more valuable. __
THE BOON OF THE BY-ROAD. IT is undeniable that the motor-car is rapidly extinguishing the pleasure of cycling, not merely because of the clouds of dust, of the petrol fumes, or of the menacing pace, but because the main roads are in so many instances reduced from the smooth surface, which at one time characterised them, to a state of fine grit and sharp particles which make riding hard and play havoc with an unprotected pneumatic tyre. The motor-car appears to suck out the binding material of the road, and to leave spicules of flint behind which readily penetrate the unprotected tyre of the bicycle. Cycling has attractions for so many people, is undoubtedly a healthy pastime, and is so often a source of convenience, that anything which threatens to hinder its practice and enjoyment must be a matter for regret. We inquire, therefore, why a new roadbook is not issued setting forth, where it is possible, the route between place and place along by-roads which escape the traffic of the motor and are not direct, while their narrowness and curves obviously would not appeal to a man in possession of a machine capable of running over 20 miles an hour. We feel sure that some such road-book could be easily furnished, and in fact we have had proof of this. There are very often some excellent but relatively narrow by-roads which run almost parallel with the trunk road for miles, and yet there will be no decided indication of them in the present maps sufficient to induce the cyclist to take them. What is wanted, it seems to us, is a map marking very prominently the roads which are not main roads, say with a strong-coloured broad line, leaving the main roads as uncoloured lines. This would mean an informal survey of the roads of the country on behalf of the cyclist, and, need we add, on behalf of the motorist also, for there is little doubt that allocation to separate roads would please the motorist and cyclist equally. We are sure, at all events, that such new maps would meet with the hearty approval of a number of cycling people, who have abandoned this pleasurable and healthful form of travelling owing to the increased dangers of the road and to the destruction of its good cycling surface due to motor traffic.
"HEART." WE welcome this week the first appearance of a periodical entitled Heart,l which has been founded to render the like service to the diffusion of recent knowledge on the physioand pharmacological problems of the circulation as our admirable contemporary Brain affords in the cause of neurology. Heart, which is edited by Dr. Thomas Lewis, displays upon its title-page the names of an advisory staff formed by a group of British and American physicians and physiologists who may confidently be said to ensure scientific success for the new journal, the objects of which are stated to be "the progress of knowledge of the mechanism by which the blood circulates in health and disease....... To know the pump, which Harvey revealed to us, more intimately; to understand more
logical, dynamical,
1
Heart: A Journal for the Study of the Circulation, Vol. i., No. 1. London: Shaw and Sons. Pp. 82. Price 5s. 6d. net (subscription price, 20s. per volume).