CORRESPONDENCE BETWEEN GEO. COMBE, ESQ., PROFESSOR REID, AND DR. LAYCOCK, ON THE REFLEX ANATOMY AND PHYSIOLOGY OF THE BRAIN.

231 i a brownish crust at their basis ; abdomen meteorized, not by no means so easy to appreciate; then, also, it is, that difference ofsenting on pressure. 1 opinion as to the interpretation of the symptoms begins to be en- painful tertained. Internal convulsions are partial convulsions, occupyThis state persisted on the 3rd and 4th. On the 4th, slight ing more particularly the muscles of the globe of the eye, of thedelirium appeared. No spots or ecchymosis on the skin, univerpharynx, of the larynx, and of the apparatus of respiration. Thesally of an orange-yellow. On the 6th, the state of the patient most ordinary form of internal convulsion is characterized by seemed improved. A number of small conical elevations appeared turning of the globe of the eye with mobility, nearly total loss of on every part of the body, similar to those of variola in its first consciousness, or at least, a certain amount of stupor, extreme stage. On the 7th, these elevations had formed so many red ecchydifficulty or impossibility of deglutition, and by respiration un- motic spots, like those of haemorrhagic roseola. There was, howeven, sometimes scarcely perceptible, sometimes deep and blow- ever, no symptom of roseola. The patient appeared, indeed, better, ing-in a word, by an attenuation of most of the phenomena of although still in a state of semi-somnolence. On the 8th, the epilepsy, and by the absence of the violent convulsions of the somnolence had increased ; an eschar appeared on the sacrum ; limbs and face. the stools were still sanguinolent. On the I itb, the eruption disapSometimes the diaphragm and the inspiratory muscles of the peared ; somnolence and general depression increased; nausea, abdomen and of the chest alone act, and then, for one, two, or but no vomiting. On the 12th, he remained in a state of comatose three minutes, a peculiar laryngeal blowing sound is heard, as if sleep, and died suddenly on the 13th. there existed an obstacle to the entrance and to the exit of the air. Autopsy twenty-eight hours after death.-The body is in a state of If the proper muscles of the larynx are at the same time convulsed, advanced putrefaction; the epidermis separating with the greatest as their motions do not coincide, the disordered condition of the ease; icteric tinge of the skin the same as during life ; no effusion respiration appears alarming, although it is only really so when of blood in the intermuscular spaces ; lungs healthy, but containthis state is much prolonged. Such is the real explanation of ing a considerable quantity of mucus and blood ; heart soft, conthose states of disordered respiration which have been called thymic taining black blood ; the mucous membrane of the stomach asthma, or laryngismus stridulus. A want of harmony between softened, of the colour of dregs of wine; the duodenum presents the spasmodic motions of the diaphragm, and of the muscles traces of sanguineous suffusion, and contains yellow bile ; the which move the arytaenoid cartilages, is sufficient to produce rest of the intestines contain mucus coloured with bile; Peyer’s the laryngeal sibilus, the orthopneea. In the regular act of in- glands are not enlarged ; no morbid alteration in the large intesspiration, the superior part of the larynx opens at the same time tine ; the liver presents the usual volume; it is soft, of an uniform that the diaphragm descends, and produces a vacuum in the chest. icteric tinge; the vena porta, vena cava, and its principal diviIf the contraction of the diaphragm takes place too rapidly, and sions, are healthy, and contain black fluid blood ; the biliary if, at the same time, there is spasm of the larynx, as in hooping- vesicle contains a considerable quantity of blood ; the spleen is cough, the inspiration becomes nearly impossible, and is accom- soft, of normal volume ; the kidneys soft, yellow, nearly diffiuent; panied by a violent sibilus. In the case which we are examining, the brain soft, and presenting the icteric tinge. ,

however, it is

not necessary to call to our assistance a want of between the movements of the diaphragm and those of the muscles of the larynx ; it is sufficient to suppose that the will or the instinct no longer preside, for a moment, over the movements of the arytsenoidean cartilages ; the muscles which move them, no longer obeying any nervous impulsion, are for the time in the condition of those of animals in whom the recurrent laryngeal nerve has been divided. The above details explain how it is that thymic asthma, so frequent in the eyes of some observers, is never found by others. The former attribute to an increase in size of the thymus, accompanied by paroxistic accidents, what the latter consider to be merely one of the forms of convulsions in children. The thymus, like the supra-renal capsules, is an organ of transition, destined to become atrophied after the birth of the human foetus, and less than any other organ likely to be hypertrophied. During the six years that M. Trousseau has been at the head of important wards for very young children, he has not once met with ihe thymus gland sufficiently enlarged to give rise to the slightest

harmony

CORRESPONDENCE BETWEEN GEO. COMBE, ESQ., PROFESSOR REID, AND DR. LAYCOCK, ON THE REFLEX ANATOMY AND PHYSIOLOGY OF THE BRAIN. LETTER FROM GEORGE COMBE, ESQ., TO PROFESSOR ST. ANDREWS.

REID,

Edinburgh, March 15th, 1845.

My DEAR SIR,-Ibeg to return you my best thanks for the information contained in your note of the 13th March. I read your paper in No. 146 of the Edinburgh Medical and Surgical Jow’nal at the time when it was published, and have no doubt of the accuracy of your description of the decussation of the pyramidal columns in the upper part of the spinal cord. I shall, however, look into it again. If you have Frederick Arnold’s " Anatomical Tables," part 1, containing " Icones cerebri et medullse spinalis," at your hand, would you be so good as inform me how far you accident. agree with his representations of the spinal cord and its prolonM. Trousseau concludes his essay by promising, in a future gations or extensions into the brain, in his table 9, and with his article, to point out the connexion which exists between convul- representations of the commissures in table 10, particularly fig. 5 sions and laryngismus stridulus and the acute asthma of children. of plate 10. At the same time, he thinks it right to state, that these diseases My object is this phenomena are presented by the brain and mind closely analogous to the reflex actions manifested by the are not mere forms of infantile convulsions, as is the case with spinal cord, and I want to find a structure that will account for thymic asthma. For example:-If we offer an unexpected insult to a them. YELLOW FEVER OBSERVED IN PARIS. The Gazette des Hôpitaux for August, contains the account of a man in whom self-esteem and combativeness are large, and cautiousness and reflection small, he will instantaneously strike a case of typhus which has recently occurred in the wards of M. without one moment’s reflection. The action will be as purely and which at the most of the blow, Charite, presented Rayer, symptoms as purely instinctive, and as little dependent on the will, as peculiar to the yellow fever of tropical climates. It may also be reflex, the reflex actions of the spinal marrow on applying a stimulus compared to the fever recently observed in Scotland, and so are to the peripheral expansion of the nerves of sensation. Again: admirably described by Dr. Cormack. On the 30th of June, 1845, a man named Thomas, of strong when, in a state of asphyxia, the undecarbonized blood reaches constitution, entered M. Rayer’s male ward. He had been ill forthe central grey matter of the spinal cord, convulsions are proa few days only. The following were the symptoms presented:-duced by this central excitement of the ends of the nerves of Yellow orange tinge of the entire body; skin dry and hot; the! motion. Parallel to this we observe, that when some morbid ineyes, and inferior surface of the tongue yellow; the superior sur-fluence excites the organ of destructiveness, the patient is stimuface of the tongue covered with a mucous fur; nausea; slightlated to homicide or suicide, as a result of this central excitement, tympanitis of the abdomen, which is painful, on pressure, in the often in direct opposition to his will. is-By what nervous or medullary fibres do these right hypochondrium; liver of normal size, on percussion; the The question stools coloured by bile, not abundant ; urine deeply tinged withcentral influences reach the anterior column of the spinal cord? bile; no abnormal thoracic symptom, but acute pain is felt in the. Again: We know that the intellectual faculties, when vigorous hepatic region on deep inspiration. Pulse full, frequent, butt and sound, possess, to a certain extent, the power of controlling regular. The patient only complains of pain in the right hypo-these central excitements. Thus, if the insult is given in an chondrium, and of intense cephalalgia. Venesection to twelve august assembly, and if the individual insulted have large reflectBlood presents a thick buff. ounces. ing organs, and large cautiousness and veneration, he may feel July,lst.-Same state. To be cupped on the hepatic region;, and have a vivid consciousness of the central it.excitement to strike a blow, but by those faculties he may control The intellectual blister on the same region. Saline purgative. 2nd.-Vomiting sets in; the matters vomited are black andfaculties are situated in the anterior lobe, and it controls the by sanguinolent. The stools, liquid and abundant, contain black( manifestations of the emotional faculties. The structureThe blood and fseces tinged with bile. The pulse is very frequent;; means of which this is accomplished is clear enough. cephalalgia ; somnolence ; tongue dry and cracked ; teeth pre- central action of the anterior lobe is transmitted by the medullary ,

.

-

232 fibres passing through the corpora striata and crura cerebri to the corpora pyramidalia, and by these to the anterior column of the spinal cord. If there be a set of medullary fibres proceeding from the organs of self-esteem, combativeness, &c., directly to the column for motion, these reflex actions also could be reconciled with structure. The posterior and middle lobes are clearly enough connected by such fibres with the posterior column, or that for sensation ; and this corresponds with the functions, because one object ! of many of the propensities and sentiments is, to excite to instinctivee acts, for beneficial ends, on receiving a sensation. The child that ’, feels pain from knocking his head on the table, will strike the latter if he have large organs of combativeness and destructiveness. If we feel burning heat, cautiousness will prompt us instinctively to withdraw the limb. All the impressions made on our senses are transmitted by the afferent nerves, and these all terminate in the region of this posterior column. So much, therefore, seems clear; but when the reflex action of the propensities and sentiments co-existing with voluntary action of the intellect to control them, (as in the case of the man insulted in an assembly,) or the centric action, (as in the case of the involuntary suicide or murderer,) comes to be accounted for, we must find medullary fibres by which each organ of propensity and sentiment can act directly for itself, on the motor spinal column, simultaneously with the action of the anterior lobe on the same column. The necessity for such a set of fibres, or rather, the reasons for inferring that they must exist, increase when we attend to the natural expressions of the propensities in looks and attitudes. Innoluntary muscular actions proceed unattended by fatigue. Now, when self esteem greatly predominates, a man never tires of carrying his chin in the air, with the back of his head drawn backwards, so that an apple dropped from it would fall behind his heels. A secretive man never tires of keeping his eyes half closed, his mouth shut, and his head slightly bent forward and to the side. A lady with an overwhelming love of approbation carries her head gently backwards and to the side, and will sit during her whole iife, at home and abroad, with it in this attitude, and never tire. The excitement to persevere, without fatigue, in these attitudes, (the result of muscular action,) proceeds from the organs, as nervous centres, on which the corresponding feelings depend; and because the motions and attitudes are instinctive, common to all nations, and unattended by fatigue, it is a fair inference that there is a direct medullary apparatus, apart from that of the voluntary functions, by which this central excitement is brought to bear on the motor spinal cord. It is not necessary, in order to form an opinion on the subject, that you should adopt my opinions in regard to the functions of The mental the organs of the propensities and sentiments. phenomena, and the actions consequent on them, are certain; and you may assume, for the sake of trying this hypothetical- explanation of them, that the organs are real. Under such an assumption, am I correct in thinking that Foville’s view of the continuation of the inferior band of medullary fibres in the crus cerebri, which, after passing the corpora striata, divides into two bands, which proceed to the periphery of the convex and lateral surfaces of the hemispheres, may serve as the means of communicating the central action of the organs in the middle and posterior lobes to the anterior motor column? I remain, my dear Sir, yours very truly and obliged, GEORGE COMBE. PROFESSOR REID TO GEORGE COMBE, ESQ. St. Andrews, 26th March, 1845. DEAR time in arrangements for

MY SiR,-The and delivering two lectures

required

making

a day, and the pressure of some other duties, have prevented me from answering your last letter I have not Arnold’s plates here at present, and I have sooner. not a sufficiently vivid conception of them to enable me to answer the question you put to me regarding them. The band of medullary fibres, marked B B in Foville’s 18th plate, is one which he calls the ourlet, or hem, and he describes it as commencing in the substantia perforata anterior, or what he calls quadrilatere perfor6, where it is connected with the posterior bundle of the crus cerebri, (the sensiferous column.) You are completely justified, according to Foville’s view of the structure of the hemispheres of the brain, in supposing that the ascending fibres ofthe anterior column of the crus cerebri (motiferous column) pass to the phrenological organs of self-esteem, combativeness, and destructiveness. In fdct, if I understand his views and description right, every convolution on the surface of the brain is connected both with the motiferous and sensiferous columns of the spinal cord. The medullary fibres marked N N n n in plate 18th, are the radiating fibres of the motiferous column, or what he calls the region fasciculee of the tronçon pedonculaire or crus cerebri. He

describes these fibres as proceeding to the whole of the convex andupper surface of the brain, even to its posterior extremity. The ascending fibres of the sensiferous column G L, are seen passing onwards to the substantia perforata anterior, and becoming cannected with the two nerves of special sensation attached to this part of the encephalon-viz., the olfactory and optic. These sensiferous fibres also form the medullary covering of the floor of the lateral ventricles. The connexion of the sensiferous fibres with the convolutions of the hemispheres, takes place in the following manner:-The grey layer placed upon the surface of the convolutions, and forming their periphery, consists of alternate layers of grey and white medullary matter. Proceeding from the surface inwards, these layers are arranged as follow:1st, Medullary, or white; 2nd, grey; 3rd. white; 4th, grey; 5th, white; 6th, grey. This last layer ofgrey is placed on a layer of white. These white layers entering into what is called the grey matter on the surface of the brain, are continuous with the lining medullary membrane of the floor of the lateral ventricles-in other words, with the sensiferous fibres. If this view be correct, the sensiferous fibres extend in the form of a medullary expansion in contact with the grey matter, over the surfaceof all the convolutions of the brain. This connexion between the medullary layers in the cortical substance on the surface of the hemispheres and the sensiferous fibres of the medulla oblongata,. takes place at the substantia perforata anterior. The ascending motiferous fibres of the medulla occupy the centre of the hemispheres, send ramifications into all the convolutions on the lateral aud upper surfaces of the hemispheres, and penetrate the internal layers of the cortical substance covering the external surface of these convolutions. The radiating fibres of the motiferous portion of the crus cerebri have therefore their peripheral extremities covered by these expanded layers of the sensiferous column,which are intermixed with, and form a part of, the grey cortical substance on the surface of the convolutions. You will find that Foville, in his resume of the structure of the brain, given at p. 487 of his work, states that the cerebral prolongations of the posterior column occupy in this organ the situation which the skin and mucous membranes do in the body, and that upon these two tegumentary membranes numerous branches of the sensiferous nerves connected with this posterior column are ramified, while none of the motiferous nerves reach it. The cerebral prolongations of the anterior column contained in the interspace between.. the membranous expansions of the posterior column, occupy in the brain the place which the muscular system, animated by thenerves attached to the anterior column, holds in the body. I hope I have here given such a general notion of Foville’s views of the structure of the brain as will serve your purposes. If his views be correct, all the phrenological organs of the sentiments and passions are connected with the motiferous columns of the spinal cord. Foville’s descriptions of the different parts of thebrain are very minute, and in many cases difficult to follow ; but I believe I am not mistaken in supposing that the above account of his views is correct, as far as it goes. It appears to me that Dr. Laycock’s paper, to which you refer, is very deficient in some respects. He does not sufficiently distinguish between the excito-motory movements of Dr. Marshall Hall, and the sensational and emotional muscular movements. The cases he quotes, of hydrophobic and tetanic patients being thrown into convulsions by the sight or sound of water, is not a simple reflex movement, but is much more complicated. The sound or the sight of water causes certain sensations in the brain, and after these have been thus excited, a reflex action is sent downwards along the motiferous column of the spinal cord. In these cases the excitation of a seen-.’ sation precedes the transmission of the motive influence downwards along the motiferous column of the spinal cord. This, then, is merely an example of a morbid sensiferous reflex movement. We have a good example, both of a healthy sensational and emotional reflex movement, in the combined action of the muscles of respiration and of the muscles of expression of the face in laughter. When the flanks or soles of the feet are tickled, a peculiar sensation is excited, and no sooner is this sensation produced, than a motive influence is transmitted downwards along the motiferous column, and rapid inspirations and expirations, and the peculiar facial expression which constitute laughter, immediately follow. The same phenomena attend the excitation of This motive influence, which a ludicrous idea in the mind. passes downwards along the motiferous column of the spinal cord, and from it proceeds outwards along the motiferous nerves distri-. buted in the muscles moved, may be termed, to distinguish it from the motive influence of volition and from the motive influence of the true excito-motory movements, the motive influence of the sensational and emotional muscular movements. The true excitomotory movements do not require the presence of the cerebrum for their manifestation; the sensational and emotional reflex muscular

233 movements do require its presence. Numerous other sensational muscles of respiration which constitute laughter, follow. These and emotional muscular movements besides those mentioned sensational muscular movements are perfectly distinct from the above, must at once occur to you. The cases you refer to, of the excito-motory movements of Marshall Hall, and require the muscular movements excited by the action of the organs of self- presence of the cerebral hemispheres, or at least some part of the esteem, combativeness, secretiveness, &c., come under the class encephalon above the optic lobes, for their performance. They of healthy emotional and sensational muscular movements. In are separated by equally distinctive marks from the voluntary treating of this part of physiology, I am in the habit of adducing, muscular movements. We have another good example of a senin illustration of these emotional muscular movements, the posi- sational muscular movement in the phenomena which attend the tion which the body assumes and the facial expression induced excitation of the sensation of nausea. In whatever way this be when the mind is strongly impressed with veneration or awe, induced, whether by the sight of a disgusting object, by certain terror, joy, grief, &c., and of stating that, when these emotions smells, by the recalling of sensations formerly felt, a motive inare excited in the mind, a reflex and motive influence is sent fluence is sent out along the spinal cord and certain motor downwards along the motiferous column and along the motor nerves, and the combined muscular movements which effect I believe that vomiting are produced. When a mirthful or ludicrous emotion nerves to the muscles thrown into contraction. this is the view adopted by all modern physiologists who have is excited in the mind, laughter may also be occasioned. On the attended particularly to the functions of the nervous system. I other hand, when certain depressing emotions, such as those of am not aware, however, that any physiologists have extended this grief and sorrow, are excited in the mind, a motive influence is -view of the functions of the nervous system so far as you propose sent outwards from the cerebral hemispheres and along the spinal to do-viz., to combativeness, destructiveness, &c., and I am cord, to the nerves which move the respiratory muscles, and satisfied that you will give additional interest and definitiveness to the combined contractions of those which constitute sighing, these muscular movements by so doing. As there appear to be sobbing, and crying, may be induced. The position of the body the mind is strongly excited by the emotions of veneration good grounds for believing that the cortical substance of the brain is the portion of the encephalon through which the mental facul- or awe, is another example of emotional muscular movements. other illustrations of sensational and emotional muSties, emotions, and passions, manifest themselves, would it not be deserving of your attention to attempt to reconcile phrenology cular movements will at once occur to you. Now it appears to with this view? Tha notion that. the 1-irpn.(Ith of a.n ore’an is anme, that the excitation of violent spasmodic muscular contracindication of power, of course readily harmonizes with it, because !1 tions, produced by the sight or noise of water, and by the sight the broader an organ is, the greater will be the extent of grey of bright objects, in hydrophobic patients, mentioned by Dr. Laymatter. The depth of an organ may also probably equally har- cock, ought to be classed among the morbid sensational muscular monize with it, for it is possible that there may be some relation movements, in the same way as we refer the violent spasms of the between the depth of an organ and the depth of the sulci passing muscles of the trunk and the limbs, which follow slight excitation between the convolutions. If this be found to be the case, the of the skin when a large dose of strychnia or nux vomica has been depth of an organ would, equally with its breadth, be an indica- exhibited, to the morbid excito-motory movements. In this last tion of the extent of the cortical substance in that organ. I made case, the excito-motory properties of the spinal cord have become several attempts to measure the extent of the cortical substance so exalted, that very slight excitations of the peripheral extrein different brains, but found that this varied so much in thick- mities of the incident nerves distributed on the skin, produce In the hydrophobic most violent excito-motory movements. ness in different parts of the same convolution, that I gave up the attempt in despair. Were I, however, in a position to renew the patients alluded to, what reason have we to doubt that the iminvestigation, I might do so. I was, however, satisfied, that in pressions made upon the optic and auditory nerves caused certain the brains of habitual drunliards and very old persons, the sensations, and that the excitation of those sensations was a congrey matter was atrophied. I have thus written very hurriedly dition absolutely necessary for the production of these muscular and without affording myself sufficient time to arrange my ideas movements? The very mention of water to the patient will cause clearly and in proper order, what I conceive to be an answer to the occurrence of the same phenomena. If, then, the interventhe questions contained in your letters. If I have expressed my- tion of a sensation be necessary for the production of these musself obscurely (and this is very likely) on any point which you cular movements-and I believe that everything is in favour of this may suppose I can give you any information, I beg you wi1l in- opinion-why should it not be described as an instance of a morbid form me of this, and I shall endeavour to be more explicit and sensational muscular movement? In the same way, I cannot see correct in my next letter. I hope you will excuse the slovenly how we should not describe those cases of hysterical weeping, and careless manner in which this letter is penned and expressed, not preceded by the depressing passions which are usually the but I was anxious to embrace the first opportunity of replying to precursors of this action, as morbid emotional muscular movements, on the same grounds that we term many of the various involuntary your letters, which have remained so long unanswered. muscular movements of the muscles of the trunk and limbs so Believe me, my dear Sir, yours very faithfully, common in that disease, morbid excito-motory movements. JOHN REID. Proceeding on this plan, I would class the phenomena you describe among the natural and morbid emotional muscular movements. FROM THE SAME TO THE SAME. Probably, on a full consideration of all the phenomena, which, as St. Andrew’s, 31st March, 1845. you proceed with your analysis, you may be able to include under MY DEAR SIR,—I wrote you a few hurried observations, some the class of which you give examples, the term emotional may not daysago, upon Dr. Laycock’s interesting paper, and upon the be strictly applicable ; yet, if they are essentially of the same contents of the letter you had the goodness to write me, and I nature, this should only induce you to select some less objectionWhen the able term, that would include the whole group. shall now endeavour to put these in a somewhat clearer form. I stated that it appeared to me that more precision might be emotion of veneration is excited, certain muscular movements are given to a part of Dr. Laycock’s paper, and to the phenomena produced, which, unless very strong, may be arrested by volition, you mention, were the facts there detailed referred to the class in the same way as the emotional movement of laughter may be of emotional and sensational muscular movements already known, arrested by volition. Suppose the portion of the brain connected at least in part, to physiologists. The term reflex employed by with the manifestation of veneration to be in a morbid condition, you, and by Dr. Laycock in many of the cases in which he uses it, slight excitations might produce strong emotions, and correappears to me objectionable, because the expression reflex action, sponding powerful muscular movements. I have, however, said when used by itself, is frequently employed to designate the purely enough to enable you to judge if the generalization I have excitomotory movements, which, in my opinion, differ essentially attempted be applicable.-Yours very faithfully, JOHN REID. from the class of actions which you and Dr. Laycock wish to

when

.

Numerous

.

illustrate.

I shall select the following as examples of sensational and emo- ON MEMORY—ITS INFLUENCE AND IMPORTANCE tional muscular movements. When a body is thrust near the eye, AS A SOURCE OF ACTION IN ANIMALS. the orbicularis palpebrarum muscle is instantly thrown into contracBy J. JOHNSTON KELSO, M.D. Lisburn. tion. No sooner is the sensation of an object approaching the eye felt, than a motive influence is transmitted outwards along the portio the several powers or principles of action-for, contrary dura nerve, and the muscle is stimulated to contract. The sensa- to the view of Mr. Dugald Stewart, and several others, the tion of a loud sound causes an involuntary start; or, in other words, position we assume at present as granted, that instinct, physical when this sensation is felt, a motive influence is transmitted out- or mental, or some modification of instinct, is not the sole-imwards from the brain along the spinal cord to the nerves leading pelling and regulating force-which stimulate and guide the to the muscles moved. When the soles of the feet are tickled, a lower animals; were these, I observe, anywhere nearly as fully and distinctly defined and understood, as are those peculiar sensation is excited in the encephalon, and a motive influence is transmitted outwards along various motor nerves, and which actuate and govern ourselves, I should very much hesitate, the peculiar facial expression and the various contractions of the indeed, even in these days of rapid march of universal know-

( WERE

developed,