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THE PRODROMES to CORTICAL LOCALIZATION* by PROFESSOR SIR GEOFFREY JEFFERSON Froml the Depar-Tmetit of Neurosurgevry, Manichester Royal Inifirmary

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THE PRODROMES to CORTICAL LOCALIZATION* by PROFESSOR SIR GEOFFREY JEFFERSON Froml the Depar-Tmetit of Neurosurgevry, Manichester Royal Inifirmary J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.16.2.59 on 1 May 1953. Downloaded from J. Neurol. Neurosurg. Psychiat., 1953, 16, 59. THE PRODROMES TO CORTICAL LOCALIZATION* BY PROFESSOR SIR GEOFFREY JEFFERSON Froml the Depar-tmetit of Neurosurgevry, Manichester Royal Inifirmary This lecture is dedicated to the memory of a man thought in the middle of the nineteenth century up who excelled as greatly in qualities of character, in to the final revolution that occurred in Godlee's probity and dignity, as in mind. University College lifetime. and its hospital has had a major share of great men and we do well to honour them. It would not Early View on Brain Function become me to try afresh a description of Rickman The history of brain function can be arranged in Godlee since entirely admirable accounts have been an overlapping pattern, in which anatomy and com- given by those better equipped with personal parative anatomy, dissection and experiment, fused knowledge than I. I can do no more than add my by degrees with clinical medicine and gross patho- respects. logy. Many of the experimenters were clinicians A suitable exercise for this occasion would be the and one finds them often in a dilemma in which the making of a journey back into the past. Its object facts of bedside observation were at war with Protected by copyright. would be to discover what sort of knowledge deductions drawn from experiment, but as usual the Rickman Godlee must have possessed at the time of latter were taken as the sounder evidence. They his famous operation on young Henderson, an were compelled therefore to propose or adopt event so perfectly described by Wilfred Trotter theories for neurological events which must have (1934) that it would be rash to venture it again. strained their credulity. I shall quote examples We know that Godlee was a well informed later. anatomist since he had taught the subject for long in It is remarkable that the anatomists were able to his earlier years. That fact, together with the form as good a picture as they did of nervous intimate knowledge of antiseptic principles learned activity by a judicious mixture of common sense from his famous uncle, fitted him as few men could with observation and by comparisons between the have been for the bold surgical adventures that he nervous structure of different animals. The matching undertook in skull and chest. But though we can of structure with potentialities of behaviour had be sure that Godlee knew the anatomy of the brain obvious merits but it was a more difficult task than very well, what of its physiology ? What could he then appeared and is far from done with yet. The have been taught or have learned about that? fact that creatures could move, eat, reproduce More particularly, by what steps had that knowledge themselves, fight, and survive with little more than http://jnnp.bmj.com/ been built up during the nineteenth century ? a double thread of nervous tissue and ganglia of There is much to examine. There is no tract in the various sizes and shapes would suggest strongly that cord or brain-stem, no nucleus, no aggregation of the cerebral hemisphere of the higher species had cells, no sulcus, no convolution but has a history of mental rather than motor properties. There seemed its own, a history in all cases still uncompleted. In to Herbert Mayo in 1827 to be a " principle of the present conspectus it will be difficult to make improvement" in the nervous system plain to the more than a regrettably cursory survey of much and a to the eye, this gave particular point researches on October 1, 2021 by guest. fascinating material, of discoveries by men famous in in comparative anatomy of Cuvier, Vicq D'Azyr, their day and famous still. We shall find con- Arnold, Tiedemann, Newport, Robert Owen, and firmation of Frederic Bartlett's (1950) statement that Carpenter. At the same time dissections of the an element of doubt is present in all beliefs, that no brain by those men and by Rolando, Charles Bell, man believes what he believes all the time. We shall Reil, Gall and Spurzheim, Serres, Mayo, and a host see doubt increasingly invading neurophysiological of others, led to a useful working plan of the * The Godlee Lecture delivered at University College on October relationship of the hemispheres to the brain-stem 23, 1952. and spinal cord. It came to be generally conceded 59 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.16.2.59 on 1 May 1953. Downloaded from 60 PROFESSOR SIR GEOFFREY JEFFERSON Protected by copyright. FIG. l.-Dissection of pyramid running supposedly to the corpus striatum (Herbert Mayo, 1827). that in the carnivores and in man the posterior sensory. As late as 1869 the curious reader will columns of the cord were sensory and the anterior find in Carpenter's Physiology (7th edition) a motor, leaving the lateral columns indeterminate. designation of the corpus striatum as the motor The posterior columns were traced to the thalami ganglion, the optic thalamus as the sensory. Of and the anterior to the corpora striata. This con- discrete limb localization there was nothing. It is clusion was not arrived at without pain for in con- true that Saucerotte (1778) in his essay presented for http://jnnp.bmj.com/ temporary engravings the artists failed to make the the prize offered by the Academie Royale de Chirurgie pyramid end in the corpus striatum as can clearly on contrecoup, concluded that the striata were be seen in Solly's diagram and in Mayo's beautiful motor to the hind-limb, the thalami to the fore-limb. dissections (so much admired by Elliot Smith). This view found experimental confirmation from Bell too speaks of the pyramids as streaming either Serres and Loustan (1826) and clinico-pathological through or past the striate bodies towards the cortex. endorsement by Foville and Serres independently. To some the apparent continuity of the posterior The proposal met with little support in England, but columns with the cerebellum suggested a sensory the existence of a theory for the independent cerebral on October 1, 2021 by guest. function there, but this view was not held by many. representation of arm and leg indicates clearly the Alexander Walker (1834) wrote a long and quarrel- need felt by clinicians for an explanation of the some book in which he contended that the posterior monoplegias. Bouillaud (1830) voiced their unrest. columns were motor and the anterior columns After Saucerotte's abortive attempt to find a sensory but on the whole at that date the best separate localization for limb movements nothing opinion agreed that the striata and anterior columns very positive happened for the best part of 100 were motor, the thalami and posterior columns years. In the meantime the physiologists by experi- J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.16.2.59 on 1 May 1953. Downloaded from THE PRODROMES TO CORTICAL LOCALIZATION 61 ment crystallized all knowledge into a formula that than Magendie who proved to his own entire satis- confirmed anatomical results and was accepted for faction that injury to the cerebellum made the decades. It was based on the fact that experimental animal run backwards, whereas injuries to both excitation of the brain-stem from the quadrigeminal corpora striata made it run forwards as if propelled tubercles downwards as far as and including the by an irresistible force. spinal cord led to movements, frequently con- Looking back over this period, one in which a vulsive. The cortex itself was inexcitable and indeed surprisingly large number of important books on movement was the more easily caused the further neurophysiology and neurology were written, we the experimenter descended from it along the see that the experimenters, frustrated by the failure neuraxis. From Haller (1755) and Lorry (1760) to of their crude cerebral stimulations, turned more and Legallois, onwards to the best observer of them all, more to ablations. We shall see later why their Flourens, and on again to Magendie aDd everyone stimulations failed. In the meanwhile we must be else, all were agreed upon this-the brain was un- content with the general inference that the corpus responsive except at the lower and lowest levels. striatum was first choice as a motor organ. A few The hemispheres were the seat of the " will" ; they writers recorded movement following its stimulation, excited movement by playing on these motor but as many denied it. One thing was certain, that mechanisms. But how they did so no one knew hemiplegia followed its destruction in man, or so and no nice man would ask ! So we find even as they held. late as 1886 Hughlings Jackson writing, " When I first began the investigation of nervous disease I The Phrenologists supposed, as most other physicians then did, as Before proceeding further we must pause for a perhaps most still do, the seat of epilepsy to be in glance at the phrenologists. 'Iheir work from the the medulla oblongata ". The impressive words time of the Napoleonic wars onwards played a most here are " as most still do "-so deep was the important part in all scientific thinking. The Protected by copyright. imprint of the physiological teachings of the past on proposition of Dr. Gall, supported by Dr. Spurz- his contemporaries' minds. Their reluctance to heim, that the hemispheres were not functionally accept evidence that swerved abruptly away from univalent but were a mosaic of special properties, tradition would have amused, and I fear delighted, mental or emotional, that they were in fact a Wilfred Trotter.
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