COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX00025097 :^ ON THE STRUCTURE OF THE Central Nervous System FOR PHYSICIANS AND STUDENTS. ' DR. LUDWia EDINGER, I^'xa.n.lcfoit-ora-ttiÄ-IXEain. SECOND REVISED EDITION. WITH n^ ILLUSTRATIONS. TRANSLATED BY WILLIS HALL VITTUM, M.D., St. I=s.xil, OXEiian. EDITED BY C. EUGENE RIGGS, A.M., M.D., Professor of Mental ai^d Nekvous Diseases, University of Minnesota; Mhmbek of the American Neurological Association. PHILADFCM'HIA AND LONDON: F. A. DAVIS, PUBTJSHER, 1891. Kntered according to Act of Congress, in the yeai VSU, By F. A. DAVIS, In the Office of the Idhraxian of Congress, at 'Washington, D. C„ Ü. 8. A Philadelphia, Pa., U. S. A.: The Medical Bulletin Printing Honse, 1231 Filbert Street. AUTHOR'S PREFACE TO FIRST EDITION. The following lectures were delivered during the winter of 1883-4, before an audience composed of practicing physicians. It was the endeavor of the author to lay before his hearers (who were already familiar with the coarser anatomy of the brain) all that had been discovered in regard to its finer structure. It vvas important, too, to present this, so far as possible, as a harmo- nious whole. Much that was in controversy could barely be mentioned, while here and there only one view of a disputed question was gi^'en, — that view which appeared most likely to be correct, either from the author's own investigations or from the writings of trustworthy authors. This would be absurd if this work pretended to be anything more than an introduction into the study of the structure of the central nervous system. He, however, who wishes to inform himself still more accurately in this direction will find all that he desires in the magnificent volume of Wernicke, and particularly in the superb works of Meynert and Flechsig. Besides these, we possess in Schwalbe 's Quain-Hotfmann's hand-book a very clear and comprehensive exposition of the anatomy of the brain. The student may also consult with great benefit the work of Henle, which is based mainly on his own views and investigations. After searching these authors, he will find still further sources of knowledge in the works of B. Stilling, KöUiker, Gudden, Clarke, and others. The author has in his own work (the results of which can- not at present be published in extenso) followed principally the method of investigation introduced by Flechsig, and has thereby come to entertain some views which difi'er from those commonly accepted. He has ventured, however, to introduce the results of his own investigations into tliis little monograph only so far (iii) IV AUTHOR S PREFACE TO FIRST EDITION. as that could be done without the addition of numerous cuts and prolonged explanations, which the limits of the work would not permit. Inasmuch as it would be impossible to give even an incom- plete list of the authors who have written on this subject, the writer has almost wholly ignored names. Only in the first chapter has he tried to mention those who began the structure at which we are still laboring. The author, in common with all those who have actually worked in this difficult field, well knows that very few facts are indisputably settled, and that no region of anatomy is more subject to change than the one under consideration. He, therefore, himself calls attention to the fact that possibly here and there a line or point may be laid down a little too confi- dently. This, however, has nowhere been done in the interests of didactic clearness alone. The Author. Fkankfort-on-the-Main, May, 1885. f^OOT-NOTE TO AuTHOB's ORIGINAL PREFACE. The student who may be anxious to keep himself posted on the advances made in the study of cerebral anatomy will do well to consult Dr. Edinger's annual reviews of the current literature of the subject in Schmidt's Jahrbücher. These reviews have been published regularly since 1886. The Editor. AUTHOR'S PREFACE TO SECOND EDITION. The work on the central nervous system, which now for the* second time appears before the pubhc, has undergone many changes and been added to in some respects. Much that is new has been discovered during the last four years. The author lias endeavored to embody the most important of these discoveries in this book. The chapters on histology and histogenesis have been entirely rewritten. At some points nothinsr new has been added, but the old facts have been presented in a new form (fornix, cornu ammonis, etc.). Continued investigations have led the author to modify his views in many respects. In accordance with this, the sections on the oculomotor, the acoustic, and the fibres of the deep marrow have been entirely rewritten. The discoveries which were published shortly before the appearance of this book concerning the course of the tracts in the posterior roots per- mitted us to adopt a much more simple plan of the structure of the spinal cord tlian was possible in the first edition. The wish expressed on many hands that this little work should be adapted to the needs of those who wished to practice under its guidance has been complied with, in that the number of cuts has been increased and the description of individual regions been made mo¥e exhaustive. A treatise on the comparative anatomy of the nervous system, based on personal investigation, has been embodied in the work. This addition, which permits us to take a more general morphological view of the macroscopic structures, will also serve as a guide to those who wish to pursue independent courses of study in this most important portion of brain anatomy. No comprehensive description of tlie finer brain-structure (V) VI AUTHOR S PREFACE TO SECOND EDITION. in the lower animals can as yet be given ; still, matter bearing on this subject .will be found scattered here and there throughout these pages. Even now, when, by reason of unsatisfactory methods of investigation, little is known of the brains of the lower animals, still, enough has been ascertained to show that a careful study of the conditions there prevailing will enable us to penetrate farther into the finer structure than when the mammalian brain was the principal object of investigation. There must be a certain number of anatomical conditions which are common to all vertebrates — those which permit the simplest expressions of the activity of the central organ. It only remains, to discover some animal or some stage of develop- ment in which this or that mechanism exists in such a simple form that it can be easily and clearly comprehended. If we have thus once discovered the course of some tract of fibres or the arrangement of some group of cells, we can ordinarily recog- nize them in situations where the picture is blurred by the presence of other structures. The search after these fundamental lines in the structure of the brain is the present task of brain anatomy. Once we have accomplished this, it will be easy to understand the com- plicated conditions present in the more highly organized brain. Edinger. i'EANKt'OET-OW-THB-MAlN, May. 1889. AUTHOR'S PREFACE TO ENGLISH EDITION. Modern Neurology owes so much to the labors of Ameri- can physicians that the author deems it a special honor that his book is considered a fit guide for physicians across the ocean in their studies ©f the most difficult branch of anatomy. My best thanks are due to the translators, Dr. C. Eugene Riggs and Dr. Vittum, for their efforts in bringing the author into relation with English-speaking physicians. If this book, in its new form, prove an incentive to further work, and if it be productive of some good, considerable praise is due to the translators. Edinger. Frankfokt-on-the-Main, 20 GÄrtnerweg, May, 1890. (vii) EDITOR'S PREFACE TO AMERICAN EDITION. The great desire to find for my class in the State University an authoritative treatise on the structure of the central nervous system first suggested to me the translation of Dr. Edinger's work. I feel, in presenting these twelve lectures to the English- speaking profession, that the student and progressive practitioner are assured of a reliable guide to a more thorough comprehen- sion of this most difficult and intricate subject. Their scope and character are best explained by the author in his own preface. Most fully do I appreciate the cordial indorsement given by Dr. Edinger to the American edition. I Avish, especially, to extend to my friend, Dr. B. Sachs, my sincere thanks for the hearty encouragement and the assistance without which this work would never have been undertaken ; and gladly do botli Dr. Vittum and myself acknowledge his valuable aid in over- looking translation and proof Thanks are also due to the publisher, Mr. F. A. Davis, for his untiring effort to render this American edition wortliy of the original, C. Eugene Riggs. 586 Dayton Avenue. St. Paul, Augutit 1, 1800. (ix) TABLE OF CONTENTS. LECTUEE I. PAGE A Review of the History and Methods of Investigating the Central Nervous System, 1 LECTUEE IL Embryology and Comparative Anatomy of the Brain, . . 13 LECTUEE III. The General Conformation and Histology of the Brain, . 31 LECTUEE IV. The Convolutions and Fissures of the Surface of the Cere- brum, 45 LECTUEE V. The Cortex of the Fore-Brain, the White Substance of the Hemispheres, the Commissures, and the Corona Radiata, 63 LECTUEE VL The Corona Radiata, the Corpus Striatum, the Thalamus, and the Subthalamic Region. The Structures at the Base of the Brain .85 LECTUEE VII. The Subthalamic Region, the Corpora Quadrigemina and the Origin of the Optic Nerve, 103 LECTUEE VIII. The Pons and the Cerebellum, 127 (xi) xll TABLE OF CONTENTS. ' LECTUEE IX. PAGE The Roots of the Peripheral Nerves, the Spinal Ganglia, and THE Spinal Cord, 147 LECTUEE X. The Spinal Cord and the Commencement op the Medulla Ob- longata, 173 LECTUEE XL The Medulla Oblongata and the Tegmentum of the Pons, . 195 LECTUEE XII. The Pons — Final Review, .215 Index 227 structure of the Central Nervous System. LECTURE I. A REVIEW OF THE HISTORY AND METHODS OF INVESTIGATING THE CENTRAL NERVOUS SYSTEM. Gentlemen : The anatomy of the central nervous system, with the main features of which these lectures are to make you familiar, has engaged the serious attention of numerous investi- gators since the renaissance of anatomical science. Vesalius, Eustachio, Aranzio, Varolio, and Fallopia laid the foundations upon whicli it was possible to build in a later age. As early as the seventeenth century several good-sized mono- graphs appeared, which, considering the methods of investigation then pursued, may be regarded as exhaustive. Such are the books of Th. Willis, of Raim, and of Vieussens. And yet at this time WilUs could describe such structures as the corpus striatum, the anterior commissure, the pyramids, and the olivary bodies as new. Important contributions to the anatomy of the brain were made by F. D. Sylvius, J. J. Wepfer, and Van Leu- wenhoeck. It was the latter, indeed, who first instituted micro- scopic examination of the brain. Toward the end of the last century v. Malacarne, in Italy; S. Th. von Sömmering, in Ger- many; and Vicq d'Azyr and Rolando, in France, materially increased our knowledge of the brain. At the beginning of the present century hardly anything of importance remained to be added to the description of the coarser structure of tlic nervous system. Nevertheless, hardly any advance had been made in what we to-day regard as tlie most imporbint part of our knowledge of brain anatomy ; tliat is, the minute connections of the different parts of the brain and the course of nerve-tracts. Even comparative anatomy, the study of which was taken up during the first part of this (1) !2 LECTURES ON THE CENTRAL NERVOUS SYSTEM. century, added nothing to this knowledge. Whatever it was possible to discover by the coarse, macroscopic methods of in- vestigation was discovered by Reil, Gall and Spurzheim, F. Arnold, C. B. Reichert, Foville, Burdach, and others. Reil, in particular, who first brought into general use the process of artificially hardening the brain, discovered a number of anatomical facts, which were the result of closest observation. As his most important discoveries must be reckoned the arrange- ment of the corona radiata, the nerve-tracts of the crus cerebri, whose relation to the fibres of the corpus callosum, which pass transversely through it, he was the first to recognize. The lemniscus and its origin in the corpora quadrigemina, the len- ticular nucleus, the island, and many other parts were first made known through his investigations. As a landmark at the end of this older period, we may regard Burdach's work on "The Structure and Life of the Brain," which appeared in 1819 and contained all that had been discovered up to that time, be- sides adding much new material. Up to about the middle of this century the most prominent methods of investigation were anatomical dissection with the knife and teasing out fibres from hardened specimens of brain with forceps. By the latter method Gall, Burdach, Reil, F. Arnold, and Foville discovered much that was new. To Tiede- mann and Reichert is due the chief credit of introducing the study of embryology, from which we have learned much con- cerning general morphological conditions. But after Ehrenberg (1833) proved that "the organ of mind " consisted of innumerable microscopic " tubules ;" after Remak (1838) had given a more accurate description of the ganglion-cells, and Hannover (1840) had shown their connec- tion with the nerve-fibres, it was plain that a simple process of teasing could never give the desired insight into the structure and arrangement of the central nervous system. To B. Stilling is due the great credit of originating and bringing into use a new method, viz., the preparation of thin sections, or, rather, of HISTORY AND METHODS OF INVESTIGATING. 3 whole series of sections, which are made in different but in definite directions through the organ to be examined.* The sections so prepared were carefully examined through- out, the pictures they presented combined, and thus the structure and arrangement of the central nervous system were determined. By means of tliis method and the studies which he instituted by its use, Stilling laid the foundation of the modern anatomy of the spinal cord, the oblongata, the pons, and the cerebellum. On the 25th of January, 1842, Stilling froze a piece of spinal cord at a temperature of 13° R., and then, with a scalpel, made a moderately thin cross-section. "When I placed this under tlie microscope," lie writes, "and, with a power of 15 diam., saw the beautiful transverse striations (central nerve-tracts), I had found a key which would reveal the mysteries of the wonder- ful structure of the spinal cord. Not more joyfully did Archi- medes cry out, ' Eureka!' than I, at the first sight of these fibres." Stilling's method is the one now most used in investigations of the central nervous system. It is rendered very much easier by the splendid hardening which these organs undergo in dilute chromic acid, or in a solution of chromic salts, — a discovery of Hannover and Eckhardt. The sections are made " free-hand," with a razor, or, better, with a microtome, which cuts much more exactly and enables us to make larger and more even sections. Welcker, llivet. Weigert, Thoma, Gudden, SchiefFerdecker, and others have been of service in constructing microtomes adapted to the purpose. We can now divide an entire human brain into an unbroken series of sections, less than y^^ millimetre in thickness. These sections may be examined unstained. All that Stilling discovered was found in such unstained sections. It is bettor, howev(!r, to use staining fluids. To (ierlacli is due tlie credit of first calling attention (1858) to the advantages to be derived from staining the sections in •Thin K<:ctioiiH of tlie cr^ntral riervouH System lia the posterior roots grow centrally from, the cells of the spinal ganglion. "(Com- bined from designs by His. ) 20 LECTURES ON THE CENTRAL NERVOUS SYSTEM. It is, however, of no small interest to examine the manner in which the development of the brain takes place in animals, proceeding from the lowest to the highest vertebrates. The limits set to these lectures will not permit us to enter the some- times very important details of the course of fibres and the finer structure. You will, perhaps, most easily get an idea of the difference in arrangement, and see how now this and now that portion of the brain is most prominently developed, if you will examine the figures, 1 1-1 7. These figures represent, in a shghtly diagrammatic form, sagittal sections through the brains of the various vertebrate classes. If you will first make yourselves Fig. 11. Diagram of a sagittal section through the brain of a vertebrate. Hinterh.. Hind-brain. Prim. V. H., Primary fore-brain. Mittelhhm, Mid-brain. ScJtluss Platte, Embryonic terminal lamina. Nachh., After-brain. Secund. Vorilerli., Secondary fore-brain. ZiD. Him, Inter-brain. familiar with the general diagram of a vertebrate brain (Fig. 11) you will easily understand the other figures. You here see that the primary fore-brain gives origin to the secondary fore-brain (hemispheres), by a bulging out of the lateral portions of the embryonic terminal lamina. You see how it protrudes ventrad into the infundibulum, and how its dorsal wall (driven inward by blood-vessels) forms the choroid plexusy/ Farther back the roof is elongated into two sacs, of which the anterior is called the cushion of the epiphysis, and the pos- terior the epiphyseal tube. We recognize next the roof of the mid-brain (the corpus opticum or corpora quadrigemina), and adjoining this the involuted layer of the cerebellum. This EMBRYOLOGY AND COMPARATIVE ANATOMY OF BRAIN. 21 passes caiulad in a thin lamella, the velum medulläre posticum, to the dorsal region of the spinal cord. The lateral portion of the inter-brain, the tlialamus, is not visible in the plane of Fig. 11. Secondary fore-brains developed from the primary fore-brain vesicle are not found in all animals. In the ray the anterior wall of this vesicle simply becomes enormously thick- ened, until it is a large structure which also contains the corpus striatum (Fig. 12). But in many sharks we can see little swell- ings on each side in front of this mass, the first rudiments of tlie hemispheres. The fore-brain of bony fishes contains a large corpus striatum, but the dorsal portion of this vesicle, the pallium, lias not advanced beyond the embryonic state of a simple layer of Fig. 12. Braiii of a i-ay. Verdickte Schlusujilalle, Thickened embryonic terminal lamina. epithelium. From the fish up to the human being, the corpus striatum does not materially change its position or its relative size. / In the same region we find the same aggregation of gan- glion-cells. In every case there arises from these cells a bundle of fibres which passes backward and terminates partly in the inter- brain, and in part passes farther back into the oblongata (basal fore-brain bundle). TIk; pallium, however, must pass through many stages of development before there is evolved from the simple epithelial layer which we have just seen in fishes that massive structure which, in human beings, we call the hemi- sphere. 22 LECTURES ON THE CENTRAL NERVOUS SYSTEM. Even in the case of the amphibians, where two large, flat hemispheres, of an oval shape, spring from the primary fore- brain vesicle, their wall, composed of an outer layer of glia and an inner granular layer, contains only few and irregularly-dis- tributed ganglion-cells. In reptiles we first meet with a deposit of pyramidal cells, disposed in several layers and covering most of the surface, — a true brain-cortex. Fig. 13. Sagittal median section through the brain of a bony fish. This is most extensively developed in the median wall, and there are grounds for believing that this, the lowest cortical Fig. 14. Amphibian brain. Diagram of a sagittal section. Sinterhim, After-brain. Mitlelhirn, Mid-brain. Nachh., After-brain. formation, is the representative of the cornu ammonis in mammals (origin of the fornix, etc.). From this point on, the development of the fore-brain takes place in two different ways. In birds the corpus striatum attains a relative size and complexity found in no other class of animals, while the formation of cortex does not much increase. In mammals, however, the pallium, with its cortical layer, becomes a large structure, which causes the EMBRYOLOGY AND COMPARATIVE ANATOxMY OF BRAIN. 23 corpus striatum to disappear in its depths, and, growing back- ward, envelops the more posteriorly situated inter- and mid- brains (in the human being the cerebeUum as well). Fig. 15. Brain of reptile. Diagram of a sagittal section. The cortical layer which covers the pallium at almost all points must, on account of its great expanse, lie in numerous folds. These are absent only in the lowest mammals (lissencephalous Fi(i. 16. Brain of bird. Diagram of a sagittal section. MitUlliimdach, Mid-braia roof. mammals). In all otliers they are present in more or less abundance (gyrencephalous mammals). The arrangement of these folds, which is constant for the separate classes of animals, 24 LECTURES ON THE CENTRAL NERVOUS SYSTExM. depends on two factors, — the extent of the cortical layer which the particular class has acquired during the process of evolu- tion, and the capacity of the skull. This does not always keep even pace with the growth of the brain, inasmuch as it depends on other factors. The whole pallium of mammals not only grows backward, but it curves and swells downward as well (not visible in figure). That portion of the hemisphere lying farthest forward, the frontal lobe, only comes into special prominence in the higher mammals, particularly man (Meynert). From this extensive cortical layer of the mammalian pallium arise a great mass of Fig. 17. Mammalian brain. Diagram of a sagittal section. fibres, — the' corona radiata. These pass out of the hemisphere to terminate in the inter-brain, the hind-brain, the after-brain, and the spinal cord. Other large bundles pass through the hemi- spheres, connecting their different regions with one another. All these taken together form a great deposit of medullary matter under the cortex. The extent of this is relatively largest in human beings. In lower mammals it is only small. Tn the mouse, for example, it is insignificant. Besides this, there is developed in the cortex of all animals a thick net-work of medul- lary fibres, which serves to connect all parts with each other. In all vertebrates, from the cyclostomata up to human beings, EMBRYOLOGY AND COMPARATIVE ANATOMY OF BRAIN. 25 there springs iiom the base of the fore-brain, on each side, a process whose cavity at first communicates with the cavity of the ven- tricles. These are the olfactory lobes. They are always cov- ered witli a cortex of peculiar structure, from which the non- m-edullary fibres of the olfactory nerves arise in many bundles. In the case of only a few animals (the cyclostomata, for example), a single olfactory nerve springs from each olfactory lobe, and, passing to the organ of smell, is divided into many branches. In mammals the anterior portion of the lobes becomes separated from the rest of the brain, and is known as the olfactory bulb. This is connected with the lobe proper by a long, slender process containing both cells and fibres, — the olfactory tract. In many mammals, and particularly in human being-s, the olfactory lobe becomes atrophic, and little more is visible on the under surface of the brain than the olfactory bulb and tract. The inter-brain is in all animals an elongated body, whose lateral walls contain, in the case of the lower vertebrates, two, and in higher several " thalamic ganglia." The walls thickened by these ganglia reduce the third ventricle, which lies between them, to the dimensions of a narrow slit. In the bony fishes the mid-brain grows to such a degree that it completely covers up and hides the inter-brain. The base of the inter-brain bulges out to form the infundibulum, which is a large process in the lower vertebrates, and which does not always become fused Avitli the hypophysis, which grows toward it from the pharyngeal epithelium through the base of the skull. In many fishes, particidarly tlie selacians, numerous blood-vessels grow into the infundibulum, and, pushing the epithelium before them, form the "saccus vasculosus," — apparently a secreting organ. The roof of the inter-brain is formed anteriorly of the choroid plexus. Farther back it becomes elongated into a tube, which is directed forward, — the tube of the epiphysis. In some sela- cians, and in many reptiles, this passes through an opening in the skull to an organ of special sense, which strikingly resem- bles an eye. We can recognize a cornea and a lens, a retina 26 LECTURES ON THE CENTRAL NERVOUS SYSTEM. and a pigmentary layer lying in and under the latter, in this '• parietal organ." We owe its discovery to Graaf and Spencer. In the other vertebrates we detect no relation between the epi- physeal tube and the organ of special sense in the adult animal. The tube has disappeared in the depths of the skull, and the parietal eye, as is shown by transitional forms in amphibians and reptiles, is so completely lost that no trace of it can be found in birds or mammals. The blunt, knotted end of the tube remains as a nodule, the " pineal gland," in front of the mid-brain. One of the thalamic ganglia, the ganglion haben- ulse, demonstrable in all animals, is united with its fellow of the opposite side by a commissure. This commissura thalami dorsalis forms a part of the roof of the inter-brain in front of the epiphysis. In all animals the optic tract, lying on the outside of the inter-brain, passes in a gradual descent from the mid-brain to the base of the brain. Between it and the inter-brairi proper there is found, in fishes, amphibians, reptiles, birds, and mammals, another ganglion which lies more or less firmly imbedded in the mass of the thalamus (corpus geniculatum laterale). It is one of the poii^ts of origin of the optic nerve. The main point of origin of these nerves, however, is the roof of the mid-brain. This roof changes less in the different classes of animals than any other part of the brain. Only its relative size changes, and he who has only seen the small corpora quadrigemina of the human brain will be astounded when he sees the huge optic lobes of a fish or a bird ; but the finer structure is always the same. From the dorsal layer of the hemispherical lobe, which is somewhat flattened by a sagittal furrow, the optic nerve always takes its origin. From the deeper layers arises a system of sensory fibres, — the deep marrow. The latter forms a net- work around the aqueduct of Sylvius, and the greater part of it passes caudad as the lemniscus, or fillet. In the posterior part of the mid-brain roof there is in all animals a separate nucleus, fibres from which associate them- EMBRYOLOGY AND COMPARATIVE ANATOMY OF BRAIN. 27 selves with the deep marrow. This is the corpus qiiadrigeminum posticum. In mammals, in whom the anterior portion of the roof remains relatively small, this posterior quadrigeminal body reaches nearly the size of the anterior one. In all the figures it is marked by shading. Not only in the bony fishes, but also in birds, the roof of the mid-brain has undergone special development. The simple hollow hemisphere grows outward and downward on both sides, so that the lengthened roof closes around the lateral portion. Inasmuch as this condition, peculiar to birds, would not be visible in a sagittal section, the mid-brain in Fig. 16 is not divided, but is left so as to show it as it appears in the uncut brain. The base of the mid-brain is formed by masses of fibres which come from the fore- and inter- brain to pass farther back. To these masses are added the fibres springing from the roof of the mid-brain, and, lastly, there are found in this situation a number of nuclei from which bundles of fibres arise, which in part pass to the cerebellum, and in part reach the surface of the brain as peripheral nerves (oculomotor, trochlear). One con- dition, which is rudimentary in birds, is more developed in mammals. Many fibres from the cortex of the hemispheres are massed together and lie ventrad of the fibres at the base of the mid-brain. This mass, called the pes of the crus cerebri, or crusta, is very strongly developed in primates and in man. In sucli brains we call all that lies dorsad of it and beneath the roof of the mid-brain the tegmentum. Fishes, reptiles, and amphibians possess only the tegmental tracts ; the fibres of the <-rusta are wanting, because in them no fibres pass downward from the cortex. The majority of the fasciculi of tlie crusta and tegmentum pass on to the base of the cerebellum and medulla oblongata, where many terminate. A part pass into the roof of the hind-brain. This roof, which is continuous in front with the layer of the corpora quadrigemina, and behind, through the intervention 28 LECTURES ON THE CENTRAL NERVOUS SYSTEM. of a thin membrane (velum medulläre posticum), passes into the posterior part of the spinal cord, contains the rudiments of the cerebellum. If you look at the sections shown in Figs. 12 to 17, it will strike you that with, perhaps, the exception of the fore- brain, no part of the brain shows so many changes in develop- ment as this. But the cerebellum is not, like the cerebrum, more developed in the higher classes of animals than in the lower. We find very remarkable differences in animals very nearly related to each other, and, on the other hand, in the lower selacians, for instance, an extremely good development of the organ. In the amphibians we meet with the cerebellum in its simplest form. The side of the roof of the hind-brain which faces the mid-brain is thickened into the form of a plate lying across the ventricle. Reptiles do not possess this organ in a very high state of development, but in those of them that swim (alligators) this plate is twice as thick as ordinary, and extends as far backward as the caudal side of the roof. Large swimming animals, the bony fishes and the selacians, possess a cerebellar organ which is so enormously developed that it must lie in huge transverse folds (Fig. 12), and even at times pushes itself forward under the roof of the mid-brain into the aqueduct of Sylvius (Fig. 13). Fishes living in mud (dipnoi) have a smaller cere- bellum. In fishes, amphibians, and reptiles, bundles of fibres pass from the inter- and mid- brain to the cerebellum, and from the spinal cord. We find these same bundles in birds and mammals, but in the former there are added very small, and in the latter very large, bundles of fibres from the fore-brain. These termi- nate in structures which we now meet for the first time, devel- oping on each side of the middle portion of the cerebellum the hemispheres of the cerebellum. In birds these are still small, but in mammals they increase along with the development of the middle portion (from now on called the worm, vermis) until they far exceed the latter in size. The^vermis, however, even in the human being, retains the transverse foldings which have EMBRYOLOGY AND COMPARATIVE ANATOMY OF BRAIN. 29 characterized the cerebelhim in all classes above the selacians. Directly caudad of the cerebellum in the roof of the hind-brain we meet with ganglionic masses, which give off fibres to the trigeminal and the acoustic nerves. Fused closely with the cerebellum they are only small nuclei in mammals, but in fishes they form quite respectable lobes. From the thalamic region to the end of the spinal cord the central cavity (ventricle, central canal) is surrounded with masses of gray substance, rich in ganglion-cells, and caudad of the mid-brain w^e find in this gray matter the peripheral nerves arising from their nuclei. In the gray substance of the floor of the hind- and after- brain arise a great portion of the fibres of the trigeminal and abducens, a part of the acoustic and of the vago-glosso-pharyngeal. Somewhat nearer the surface lies a column of nuclear cells, from the upper part of which the motor root of the fifth pair arises, and farther caudad the facial nerve. From the hind-brain to the sacral portion of the spinal cord there is an unbroken series of nuclei. There are really two series, one more ventral (zone of anterior horn, His) and the other more lateral (lateral zone). From the former arise the liypoglossal and all the anterior roots of the spinal nerves going to the muscles of the trunk. From the latter there arise (Gaskell) fibres which are concerned in the innervation of the muscular coat of the viscera. These lateral fibres leave the central organ along with the anterior-horn fibres, except in the region of the medulla, where they go to form the motor vagus and the accessory nerves. Farther down they leave the spinal cord in company with the other fibres of the anterior roots. According to Gaskell the latter pass into the mixed nerves, while the former are connected with the sympathetic. In the ventral portion of the pons and oblongata there are situated many aggregations of ganglion-cells and nerve-fibres, whose relations, varying widely throughout the animal kingdom, cannot be discussed hero. It is of importance that all the nerve- fibres which connect the brain with the centres situated below 30 LECTURES ON THE CENTRAL NERVOUS SYSTEM. pass through these parts. Through the presence of all these structures this portion of the brain is thicker than the' spinal cord, which comes next to it. The latter forms a column from the segments of which there arise anteriorly the motor and posteriorly the sensory nerves. The space to the outside of the nuclei of the nerves is occupied by fibres which connect the spinal cord with the brain, and the different portions of the spinal cord with one another. In the oblongata and spinal cord of certain animals we find peculiar structures, wliicli have resulted from hypertrophy of some pre-existing organ. I will only mention, as examples, the great hypertrophy of the motor nucleus of the trigeminal in the ray, — the lobus electricus ; the enormous nucleus of the vagus of fishes, projecting high into the fourth ventricle, which, together with the trigeminal, provides for the sensation of the skin ; and the hypertrophy of the posterior horns of the spinal cord in certain fishes (Trigla). LECTURE ITT. THE GENERAL CONFORMATION AND HISTOLOGY OF THE BRAIN. Gentlemen: Although these lectures are not addressed to beginners, but to those who have a general acquaintance witli the coarser anatomy of the brain, it will not be entirely superfluous to review our knowledge and to form a clear image of brain-structure in our minds. The outlines of the map in which, later, we intend to mark out all the points and by-ways which are of importance, will be definitely fixed by a recapitida- tion of what has already been learned. Taught by embryology, you will easily understand the morphological conditions presented by the organ of the adult individual. A fresh brain is laid oil its base. You will easily discover the great fissure which separates the two hemispheres and the fissure of Sylvius which was originated by the growth of the temporal lobe. Inasmuch as the hemispheres have grown over most of the other portions of the brain (Fig. 5), we could get a view of the latter posteriorly by raising up the hemisplieres and uncovering them. This could also be accomplished by removing a portion of the hemispheres. The latter method has the ad- vantage of giving us a view of the lateral ventricles and the corpus striatum, and we Avill therefore follow it. Tlie linife lield horizontally passes through both hemi- spheres at once and removes layers from 2 to 3 milHmetres in thickness. The first and second of these layers contain much cortical matter and relatively little of the inclosed white sub- stance ; but in removing the third layer we have uncovered a large white field of mocUdlary matter in the middh; of each hemi- sphere, the centrum semiovale. In it run all those fibres which pass from the cortex downward, and a part of tliose fibres which connect the different portions of the cortex with one another. (31) 32 LECTURES ON THE CENTRAL NERVOUS SYSTEM. On looking at Fig. 6, we should expect that on removing another layer we should find the hemispheres separated from the ventricle only by a thin layer of epithelium. This, however, is not the case. At a later period of embryonic development, thick masses of fibres have developed and pass from one hemi- sphere to the other at a point shown by the letter a in Fig 6. Sim Ccl Fig. 18. Fore-brain from above. The liemispb€*es have been removed at the level of the corpus callosum (Ccl). The white space between Ccl and the cortex is the centrum semi- ovale. Lt, ligamentum tectum or striae longitudinales Lancisi, a part of the cortex which borders on tlie corpus callosum. 8lm, strise longitudinales mediales, white , bundles of fibres which interlace on the middle Of the corpus callosum. (After Henle.) Thus, at the bottom of the great fissure we do not find the ven- tricle, but the corpus callosum, as the mass of transverse fibres is called. The corpus callosum is now divided, and after the white substance which lies over the ventricles on each side has been removed it is cut off before and behind. Then it is seen that GENERAL CONFORMATION AND HISTOLOGY OF BRAIN. 33 its under surface is connected with some delicate masses of white fibres wliich, aichiiio- over the cavity of tlie ventricle, pass down- ward to the floor of the same before and behind. They belong to the fornix. After they and tlie adherino- choroid plexus are divided and removed, we find ourselves looking into the cavity Cerc\>c»>»n>. FlO. 19. The brain oi)ene(l by a liorizontal setaioir. \'iewecl from ubove. Th.; two hemispheres are drawn somewhat apart. VtitKrhorn, Inferior horn. of the ventricle. The middle space is tlie cavity of the primary fore-brain, now called the third ventricle. From the depths of its anterior end ascends the margin ol' the secondary fore-brain, the fornix. It is directly continuous with the median wall. The latter is traversed by the fibres of the corpus callosiim. 34 LECTURES ON THE CENTRAL NERVOUS SYSTEM. That part of the median hemisphere-wall which lies below the corpus callosum (it appears behind it in the cut) is called the septum pellucidum. That part of the original fissure be- tween the hemispheres which remains between the right and left layers of the septum is called the ventriculus septi pel- lucidi. If you will imagine the corpus callosum removed from Fig. 19, the continuation of the hemisphere wall into the septum and the significance of the ventriculus will at once become apparent. It is no real ventricle, but only that portion of the fissure between the hemispheres which is covered in by the corpus callosum. On each side of the fornix lies a passage from the third ventricle to the two lateral ventricles, — the foramen of Monro. That part of the lateral ventricle which lies in the frontal lobe is called the anterior horn, that which lies in the occipital lobe the posterior horn, and that lying in the temporal lobe the in- ferior horn. You can easily insert your finger into each of these horns. The basal regions of both hemispheres are connected with each other by the anterior commissure. You can see its bundles of white medullary fibres passing in front of the pillars of the fornix. The nucleus caudatus emerges from the floor of the lateral ventricle. Farther back, however, parts come into view which no longer belong to the hemisphere, — the thalamus (inter-brain) and the corpora quadrigemina (mid-brain). Behind these ap- pears the upper surface of the cerebellum (roof of the hind- brain). Along the whole inner border of the hemispheres runs the thick mass of white fibres constituting the fornix. It arises from the boundaries between the hemispheres and the mid-brain on either side from the floor of the ventricle, and passes over the optic thalamus into the apex of the temporal lobe. In removing the corpus callosum we removed also the middle portion of this arch of the fornix ; so that we only see, anteriorly, close to the septum Dellucidum, the ascending portion GENERAL CONFORMATION AND HISTOLOGY OF BRAIN. 35 of the arch (crura fornicis), and, posteriorly, the descending portion, — a white Une of medullary jnatter, which, passing along the border of the hemisphere, bounds the temporal lobe on its inner aspect. If you connect the points i^./and F.II, in Fig. 19, with a gentle curve which passes over the optic thalamus, you* will have restored the course of the fornix^ In the accompany- .ing median section of an embryonic brain you can easily dis- tinguish the course of the fornix. In our dissection (Fig. 19) you can see the thalamus behind the nucleus caudatus. It belongs to the inter-brain, and has developed from its lateral walls. The space between the two thalami is the cavity of the former inter-brain vesicle. Of its roof only a thin layer re- mains, the most important part . of which is the pineal gland. Fig. 4 sliows how this arose by a process of protrusion. All the rest of the roof of the former vesicle is only present in the form of a thin epithelium, be- longing to a plexus of vessels which cover the middle ventricle. The floor of the inter-brain, which is, of course, formed an- teriorly of the embryonic terminal lamina, consists of a mass of gray matter, which is prolonged in a funnel-shaped manner toward the base of the skull. This projection is called the tuber cinereum, and its cavity the infundibulum. It is not shown in Fig. 19, but can be clearly seen in tlie median section (Fig. 17). At its extreme end tlie tuber cinereum is fused into the fold of pharyngeal mucous membrane which grows toward it, as shown in Fig. 4. At a later stage the latter is cut off from the pharynx and n^mains in the cavity of the skull, wlierc, in con- nection with the tuber cinereum, it forms the liypophysis, — an SftSt wo Xorderhim und Ziüisdienhim Fig. 20. Inner aspect of the embryonic hemi. sphere, shown in Fig. 7. Shows the inner lower border of tlie liemispbere, which be- comes thickened into the white medullary line of the fornix. The latter, however, only becomes medullary after birth. Stelle wo Vorderhirn und ZwUchenhim zusam- mensloaiien. Point where the fore-brain and mid-brain meet. 36 LECTURES ON THE CENTRAL NERVOUS SYSTEM. irregular, roundish, ball-shaped body, the size of a cherry, which is attached to the base of* the inter-brain by a slender pedicle. The thalamus is slightly separated from the nucleus cau- datus by a bundle of fibres, called the stria terminalis. On tlie anterior portion of its surface the anterior tubercle is usually seen as a rounded swelling. It corresponds to a separate gan- glion within. Still another ganglion belonging to the thalamus will be found if we follow up the white line which runs along the median ridge of the thalamus (stria medullaris). This gan- glion is a small, club-shaped mass lying far back, just in front of the corpora quadrigemina, and is called the ganglion habenulse. From this there arises on each side a thin, white bundle of fibres which passes to the pineal gland, — the pedunculus conarii. The gray mass of the thalamus is overlaid with white fibres (stratum zonale), which, in part, pass to the optic nerve. A principal point of origin for this nerve is a protuberance on the posterior part of the thalamus, — the pulvinar. Macroscopic observation alone would place the source of the optic nerve in this ganglion and in two nodules on its under side (corpus geniculatum mediale and laterale). Between the thalami there extends a thin, gray lamina, — the middle commissure. I have never failed to find it if the brain was carefully taken out. The nerve-tracts from the hemispheres which lie deep down between them and the thalamus emerge, for the most part, caudad of the thalamus from the main mass of the cerebrum. They form thick strands, and lie exposed on the ventral surface of the mid-brain, — the corpora quadrigemina ; taken together, they are called the crura of the brain (pedunculi cerebri). Behind the pineal gland begins the roof of the mid-brain. We regard the posterior commissure as the most anterior por- tion of this roof, as, arising in the thalamus, it passes caudad through the mid-brain. The corpora quadrigemina, which ap- pear just behind this commissure, we shall examine later on. If the brain is opened from above, as we have done, only the inner portion of the corpus striatum — the nucleus caudatus — GENERAL CONFORMATION AND HISTOLOGY OF BRAIN. 37 can be seen. The outer portion — the lenticular nucleus — lies deeper, and is covered with medullary masses, which pass over it into the internal capsule. We could expose it by opening downward outside of the nucleus caudatus, but you will get a better idea of its form if a frontal section is made transversely through the whole brain at the point in Fig. 19 where the thala- Frontal section tlirough the adult brain. Explanation in the text. Ballan, CorpuB ciill>>8iim. Marklmjer, While siibstanc«. mus begins, just behind the thickest part (caput) of the nucleus caudatus ; that is to say, just behind the ascending pillars of the fornix. It is not difficult to understand the cross-section (Fig. 21) if we keep in mind tlio conditions shown in Fig. 6. The brain- wall is decidedly thicker than at the fcctjil pfMJofl. but the corpus 38 LECTURES ON THE CENTRAL NERVOUS SYSTEM. striatum rises from the floor just as shown in that section. The outer fissure has now disappeared, but it may be considered as occupying the situation shown by the dotted hne on the right side. « At the bottom of the great fissure you can see the ventricle covered by the thick cross-fibres of the corpus callosum. To these there pass from below the two pillars of the fornix, leaving the ventriculus septi pellucidi free between the thin layers of the septum pellucidum. They project freely into a cavity, the lateral ventricle. This cavity is bounded exteriorly by the corpus striatum. Just here you can see beautifully how the corpus striatum is penetrated by and apparently divided into two ganglia by the thick masses of fibres of the internal capsule. In the lenticular nucleus, that is, in the outer portion of the corpus striatum, you can easily distinguish three divisions. Only one of these three parts — the external, shown most deeply shaded, called the putamen — may be regarded as a source of origin of fibres, together with the nucleus caudatus. The function of the two internal divisions (globus pallidus) is still uncertain. The globus pallidus sometimes consists of three or more divisions. External to the lenticular nucleus there lies a thin, gray mass in the wall of the hemisphere, — the claustrum. The space between it and the lenticular nucleus is called the external capsule. Farther out still lies the cortex of the island of Reil. The gray mass on the floor of the middle ventricle belongs to the wall of the infimdibulum, — the tuber cinereum. It and its continuation are called the central (ventricular) gray substance. At the point where this and the cortex of the tem- poral lobe become continuous there lies a large, roundish nucleus, — the nucleus amygdalae. It probably stands in some relation to the origin of the olfactory nerve. In its finer structure it re- sembles the claustrum (Mendinol). Between the pillars of the fornix you see the anterior commissure. Its fibres curve back- ward as they pass through the corpus striatum. For this reason we again meet them on cross-sections of the brain, just below GENERAL CONFORMATION AND HISTOLOGY OF BRAIN. 39 the outer part of the lenticular nucleus (Fig. 21, l)elow and to the right). I cannot urge you too strongly, gentlemen, to look up in the fresh brain all the parts mentioned in to-day's lecture, and learn the situation of each by your own dissection. The repre- sentation by word and picture may give you a good idea of them, but it can never take the place of that which may be obtained by study of the fresh specimen. The difference in colors which you have observed to-day in the fresh brain specimens is caused by differences in their finer structure. To this, the histology of the central nervous system, we will now, for a short time, turn our attention. The brain is made up of nerve- tissue and a matrix. This matrix is composed of the walls of numerous blood-vessels which pass in every direc- tion through the organ, and of the neuroglia, most delicate cells, with a net-work of fine ciliary processes, which, fig. 22. V • • i • 1 1 -iU it- c Isolated neuroglia cells. becommg nitermmgled with those 01 neighboring cells, are matted together into a sort of dense felt. This structure may well be likened to a mass of burrs stuck together witli a few thicker strands, the blood-vessels, passing among them. The nerve-fibres are imbedded in the free spaces between the cells of the neuroglia. The net-work of neuroglia is somewhat differently con- stituted in different parts of the central nervous system, and forms here and there thick masses, altogether free from nerve- substance. Thus, for instance, a broad zone of almost immixed neu- roglia is spread over the whole surface of the brain and spinal cord. The larger ganglion-cells are often so entangled in neu- roglia that they seem to be lying in a fine-meshed basket. 40 LECTURES ON THE CENTRAL NERVOUS SYSTEM. The nerve-substance proper which fills out the spaces m the above-described net-work consists of ganglion-cells and nerve- fibres. The form of the ganglion-cells is extremely varied. Round- ish, almost spherical bodies of small size are seen, together with multipolar cells with many processes, and twenty times the size of the smaller cells. Fig. 23. From a piece of spinal cord. A and ß, ganglion-cells ; at D, axis-cylinder ; p, protoplasmic process ; c, neuroglia-cells. (After Ran vier.) In the lobus nervi vagi of the torpedo and in the medulla oblongata of the river lamprey are found such enormous ganglion- cells that they can readily be seen with the naked eye. In the spinal cord of the electric eel, the malaterus, are two isolated ganglion-cells of such a size that the huge single nerve-fibre which each gives off is sufficient to supply the very large elec- tric organ of the animal. GENERAL CONFORMATION AND HISTOLOGY OF BRAIN. 41 The nerve-fibres arise from the ganglion-cells. R. Wagner first showed that but a single process of these cells could be traced directly into the nerve, and other investigators have con- firmed this. The relations which the other processes of a multi- polar cell and the processes of the cells which do not possess this '•axis-cylinder" process have to the nerve-fibres remained in darkness until Gerlach, in 1870, showed that these processes form a net-work with each other, and that from this net-work nerves arise. It is only during the course of the past year that Bellen ci first, and later, in a still more convincing manner, Golgi and Bela Haller succeeded in showing the method of origin of nerve-fibres from th(* central ganglionic cells. Golgi conducted his investi- gations on the cortex of human beings and of other animals, and, by frequent combinations of very com- plicated microscopical pic- tures, arrived at the same conchisions with Haller, who worked on mollusks, where the conditions were more simple, and the relations could be plainly seen. The most important of these discoveries, which, moreover, have been con- firmed for otlier parts of the central nervous system by Golgi's ])upils, is the now well-established fact tliat tlie nerve-fibres arise from the cells of tlie central nervous system in two ways; that there is a direct and an indirect origin of nerves. The former we have already montion(>d as liaving been dis- <;ov(rc(l by Wagner. The axis-cylinder process of a ganglion-cell Fig. 24. From a section through the pleiiro-cerebral ganglion of the flssurella. 1, net-work of nerves; 2, ganglion-oells ; 3, nervi'-fihies. (After Henle.) 42 LECTURES ON THE CENTRAL NERVOUS SYSTEM. passes directly into a nerve-fibre. Recent investigations have shown that before passing off it gives rise to minute fibrils, which form a fine net-work. This direct form of nerve-origin has been recognized in the great pyramidal cells of the cortex, and in the cells of Purkinje in the cerebellum, in the nuclei of the motor nerves in the brain and spinal cord, and in othgr places. In many other cells, however, ''tte processes, soon after leaving the cells, break up to form a fine net-work, which re- ceives, also, the lateral fibrils of the axis-cylinder processes before mentioned, and from this net-work the nerve takes its origin. This net-work may contain the off'shoots of a great number of ganglion-cells. In the accompanying section through the pleural ganglion of a snail you may see both methods of nerve-origin taking place side by side (Fig. 24). What part is played by the cell processes which do not become connected with the nervous system — Golgi calls them protoplasmic processes — is not yet determined. There is ground for believing that they are connected with the fine net-work composed partly of glia and partly of connective tissue, w^hich surrounds the blood- and lymph- vessels of the central nervous system ; that is, that they bear some relation to the nutrition of the cells themselves. The fact that this fine net-work, which consists of all these processes of ganglion- and glia- cells, is so difficult to disentangle has naturally led to other views as to its composition than the one I have given you, but it is important to notice that all the later authors, whatever their differences of opinion in regard to the net-work (Leydig, Nassen), have ob- served the double method of origin of nerve-fibres. It is probable that the difference in origin denotes a differ- ence in function. We know that the motor roots of a peripheral nerve arise directly from the axis-cylinder of the cells, and it was in the sensory posterior roots that Gerlach observed the breaking up of the nerves into this minute net-work. The in- vestigations of His, to which I referred in the last lecture, bear out the views we have adopted. GENERAL CONFORMATION AND HISTOLOGY OF BRAIN. 43 The nerve-fibres in the brain and spinal cord are of varying size in adult mammals, and all are probably surrounded with medullary sheaths. Every nerve-fibre, as it enters tlie central organ, loses its sheath of Schwann. Only a thin layer, first seen by Ranvier, and which is present even in peripheral nerves, is left to cover the nerve-marrow after it enters the brain or spinal cord. In general, the parts which consist only of medullary fibres appear white (white substance); those composed mainly of A B /J 3? E Tzt ecu Fig. 25. Different nerve-flbres isolated from the spinal cord of a dog. ca, axis-cylinder ; -mg, medullary sheath ; <■/, peripheral membrane ; c, nucleus and protoplasm to be seen on the surface o"f a few fibres. (After llanvier.) neuroglia, axis-cylinder, and ganglion-cells, gray (gray matter). The gray matter is more vascular than the white. During life it exhibits, in the presence of sensitive reagents, a slightly acid reaction. We owe our first accurate knowledge of the histology of the central nervous «ystern, as was staled in the first lecture, to Ehrenberg, Keniak, and Hannover. After Hannover, Ilelmholz, in 1842, recognized in invertebrates the true relations between ganglion-cells and nerve-fibres. In 1844, KöUiker discovered that a double-contoured nerve might arise from a cell. In 1850 Rudolph Wagnc^r dis- 44 LECTURES ON THE CENTRAL NERVOUS SYSTEM. covered, in working on the electric organ of the torpedo, that a single ganglion- cell may send out two sorts of processes, of which only one, the axis-cylinder process, is continued into a nerve ; and in 1854 Remak observed the same thing in the great ganglion-cells of the spinal cord. Deiters, in 1865, proved that this was true of all ganglion-cells. Our knowledge of these conditions has been in- creased by the labors of Gerlach, Max Schultze, Waldeyer, Jolly, A. Key and G-. Retzius, Betz, Bevan Lewis, Obersteiner, Freud, and many others. So many have turned their attention and efforts to this most difficult region of histology that a memoir which appeared at the beginning of 1887 (Napsen) enumerated 341 works on nerve-fibres and ganglion-cells. More recent and profound works on the neuroglia are those of Boll, Ranvier, and Gierke. LECTURE IV. THE CONVOLUTIONS AND FISSURES OF THE SURFACE OF THE CEREBRUM. ' Gentlemen : It is not so very long ago that the study of the structure of the brain surface possessed very little interest for the anatomist and none at all for the practicing physician. Nor is it a very long time since order was brought out of the seeming chaos of the convolutions of the brain, so that clear and definite cuts have taken the place of the old plates, concerning which an author pertinently remarked that they were a better representation of a dish of macaroni than of the brain. Interest was first awakened in regard to the human brain after physiology and pathology had shown the dif- ferent results of irritation, extirpation, and Brain ot^human embryo !• • !• i i.1, i'ü* i. of 13 weeks. disease, varyuig according to the dmerent convolutions attacked. It is, therefore, of importance, gentlemen, that you learn to know thoroughly the arrangement of these con- volutions and the course of the fissures which separate them. By word and diagram alone it will be impossible for me to make you as thoroughly acquainted with these structures as you should be. Here again it is necessary for you to take a fresh brain, and, following my lecture, trace out for yourselves sulcus after sulcus and convolution after convolution. The primarily lens-shaped hemispheres grow, as you know, toward tlio front and backward. Only in the middle, at a point corresponding to the corpus striatum within, the surface docs not expand as rapidly, and, hence, becomes more depressed than the surrounding parts. The depression which thus exists near the point of origin of the hemispheres is called the fossa or fissure of Sylvius, and that part which lies in the depression the (45) 46 LECTURES ON THE CENTRAL NERVOUS SYSTEM. island of Reil. The island is, therefore, that part of the cortex which immediately adjoins the ganglia of the cerebrum. At first it lies on the surface, but Httle by little it is covered in by the overlapping hemispheres. You will easily find the fissure of Sylvius in the adult brain. It is the largest of the sulci, and on separating its walls you will discover the island, and see that it is traversed by a number of perpendicular and oblique sulci. In the sixth month Gca Sc Fig. 27. The left hemisphere with the Assure of Sylvius drawn apart in order to show the con- volutions in the island of Reil (In). Se, sulcus centralis; Gca, Ocp, gyrus centralis, anterior and posterior ; Fop, flssura parieto-occipitalis. (After Henle.) of pregnancy the two divisions of the fissure of Sylvius — the anterior and posterior — are plainly to be seen. All the rest of the brain is still smooth. (Compare Fig. 7.) After this period, furrows (sulci or fissures) are developed on the surface of the hemispheres by means of local elevations which increase more and more during the later months of foetal life until birth, at which time almost all the fissures and convo- lutions which the adult brain will possess are clearly marked out. The following purely diagrammatic drawings may serve as CONVOLUTIONS AND FISSURES OF SURFACE OF CEREBRUM. 47 a guide in your study of the surface of the brain. Only the most important constant convolutions and fissures are therein considered. The simple diagram of Ecker, of which they are reproductions, impresses itself more easily on the memory than a representation of a real brain which shows all the shallower fissures, which are inconstant, alongside the deeper and more constant ones. First, let us look up the fissure of Sylvius; it divides the Fig. 28. Lateral view of the brain. The convolutions and lobes are marked in Roman letters, the fissures and sulci in italics. (After Ecker.) greater part of the temporal lobe from the rest of the brain. We can observe two branches — a long anterior and a short posterior and ascending branch. The mass of brain which lies at their junction and covers the island is called the operculum. If we separate those portions of the brain which surround the fissure of Sylvius, as is done in Fig. 27, the island lies in full view. We see that it is traversed by a deep fissure, passing obliquely upward and backward, — the sulcus centralis insula?, — whicli 48 LECTURES ON THE CENTRAL NERVOUS SYSTEM. divides it into two lobules. The anterior lobule is divided by several perpendicular fissures into 3-4 gyri breves insulae. The posterior lobule is, apparently, one single longer convolution, — the gyrus longus. It borders directly on the temporal lobe. In the operculum there begins an important fissure which ascends to the margin of the hemisphere, but is separated from the latter, as well as from the fissure of Sylvius, by brain-substance. This is the sulcus centralis, or central fissure. Observe it in Fig. 28 ; it divides the frontal from the parietal lobe. All that lies below the fissure of Sylvius is called the temporal lobe. In front of the central fissure lies the anterior central convolution ; behind it, the posterior central convolution.* The resfion in front of the anterior central convolution, the frontal lobe, is divided by two fissures, the superior and inferior frontal fissures, into three convolutions, — superior, middle, and inferior frontal convolutions. These are not always sharply defined along the whole length of the frontal lobe, inasmuch as the frontal fissures are often interrupted in their course by lüis de passage. You will easily discover these three divisions of the frontal lobe lying next to each other in all brains, and will observe that the lower frontal convolution (also called third frontal convolution) takes part in forming the operculum. Very often there is found at the posterior end of the inferior frontal fissure another fissure at right angles to it, which bounds the anterior central convolution in front and is called the prse-central fissure. [The lower frontal convolution is broader in Europeans than in other races. In the brain of Gambetta, who was a great orator, it was twice as broad as usual.] The temporal lobe is traversed by several fissures, which run parallel to the fissure of Sylvius and divide the lobe more or less sharply into an upper (or first), a middle (or second), and a lower (or third) temporal convolution. Generally only the two first of these are clearly distinguishable throughout their whole length. % * Circonvolutlon frontale ascendente. ^ ^^ ^^^ ^^^^^^^ ^^.^^^^^ Circonvolution parietale ascendente, S CONVOLUTIONS AND FISSURES OF SURFACE OF CEREBRUM. 41) Observe now the region caudad of tlie central fissure and above the temporal lobe. It is called the parietal lobe. It is divided into a superior and an inferior parietal lobe by a sulcus, which passes in a curve around the end of the fissure of Sylvius and the end ol' the first temporal fissure, and is called the inter- parietal fissure. There is nothing to mark the division between the superior parietal lobe and the posterior central convolution, unless, as often happens, a branch of the interparietal fissure Fig. 29. Lateral view of the brain. For explanation, see Fig. 28. (After Ecker.) passes upward toward the margin of the hemisphere. In this case, of course, the connecting convolution is much narrower. That part of the inferior parietal lobe which surrounds tlie fissure of Sylvius is called the gyrus marginalis.* The part lying just back of this, and arching around tlie end of the superior temporal fissure is called the gyrus angu- laris. The former you will discover at once in every brain ; the • Marked "(J. Hupra-marginulis" in the cut (Fig. 28). 4 50 LECTURES ON THE CENTRAL NERVOUS SYSTEM. latter you will have to be at some pains to distinguish. You will find it in the space which is bounded above by the inter- parietal fissure and below by the superior temporal fissure, its posterior portion, indeed, surrounding the end of the latter. Do not always expect, gentlemen, to find the interparietal fissure running its whole course without a break. Often enough it is broken into two or more parts by pZis de passage^ which are usually found in its posterior third. Its posterior portion extends into the occipital lobe. This occipital lobe is not in all brains so uniformly divided by its sulci that we can always find the three convolutions described by writers, viz., first (upper), second (middle), and third (lower) occipital convolu- tions, easily and without arti- ficial refinement. It is often separated from the parietal lobe by an addi- tional occipital fissure (not shown in the figure), which passes up perpendicularly be- hind the gyrus angularis. The line of division from the temporal lobe is a horizontal fissure, appearing like a continuation of the inferior temporal fissure, and called the inferior occipital sulcus. The angle be- tween these occasionally continuous fissures bounds the temporal lobe. At the upper and anterior part it is continuous with the parietal lobe. This connection is divided into the bridging con- volutions by the interparietal fissure, which passes through it longitudinally. After noting all these convolutions and fissures, divide the brain into halves by cutting down through the great fissure and study the median surface. ^SleBc HO Vorderhirn und Iwisdiaihim. tusaiuaeaslassen.. Fig. 30. Inner aspect of the embryonic hemi- sphere, shown in Fig. 7. Shows the inner lower border of the hemisphere, which be- comes thickened into the white medullary line of the fornix. The latter, however, only becomes medullary after birth. Stelle wo Vorderhim und Zwischenhirn zusam- menxlnsKen, Point where the fore-brain and mid-brain meet. CONVOLUTIONS AND FISSURES OF SURFACE OF CEHEBKUM. 51 The most important parts of the median hemisphere-wall have been described in the preceding lecture, while we were studying- its development. I will only remind you that we then learned that the margin of the hemisphere thickened into the ibrnix, followed the growing hemisphere in a curve ; that for- ward, where the corpus callosum passes through, that portion of tlie inner wall which lies between the latter and the fornix, remains as the septum pellucidum. Taught thus by the history of its development, you will fimbria or forni*. Fig. 31. Sagittal section thruugh the middle of an adult brain. The posterior portion of the tbalamu.s, the pedunculus cerebri, etc., have been removed in order to show the inner surface oif the temporal lobe. understand the sections made through the adult brain. In the s])ecimen from wliich Fig. 31 is taken, as well as in the embry- onal brain (Fig. 30), all parts lying caudad of the middle of the tlialamus are cut off, because they cover the under side of the temporal lobe and prevent us from following up the course of the fornix. Now, on the longitudinal section, you see in the centW3 the inter-brain, or, rather, the tlialamus, which has developed from its lateral wall. Along the boundary between it and the cere- brum Hes the curved margin of the hemisphere, thickened to a 52 LECTURES ON THE CENTRAL NERVOUS SYSTEM. white band of medullary substance, — the fornix. Near the junction of the thalamus and mid-brain it rises close to the base of the brain, passes dorsad as the pillars of the fornix, accompanies the margin of the hemisphere still farther, curves around it into the temporal lobe, and ends in the apex of the latter. The horizontal mass of transversely divided fibres above it belongs to the corpus callosum. In its anterior part you will distinguish the knee, in its posterior part the splenium, and be- fiihbfta or lotn'm. Fig. 32. For explanation, see Fig. 31. tween the two the body. Between the fornix and the corpus callosum lies the triangular field of the septum. Besides this, you can see, just in front of and below the fornix, the anterior commissure, and in the middle the commissura media, — both, of course, in cross-section. That portion of the hemisphere-wall which lies above the corpus callosum is traversed by few and rather constant fissures. First, parallel with the corpus callosum, is the sulcus calloso- marginalis. Behind, it turns upward to the crest of the hemi- sphere and terminates in a little indentation behind the posterior CONVOLUTIONS AND FISSURES OF SURFACE OF CEREBRUM. 53 central convolution. That part lying in front of and above this fissure is considered as belonging to the superior frontal convo- lution. The convolution between it and the corpus callosum is called the gyrus fornicatus. A glance at a specimen, or at our cut, shows that the gyrus fornicatus becomes widened posteriorly, and passes up over the crest of the hemisphere to become con- tinuous with the superior parietal lobe. This widened portion is called the praecuneus. Directly in front of the praecuneus lies a region of the cortex which, exteriorly, is continuous with both central convolutions and connects them. It is called the paracentral lobule. Posteriorly, the praecuneus is bounded by a deep fissure, which usually passes over somewhat to the exterior surface of the hemisphere. It is called the parieto-occipital fissure. This parieto-occipital fissure sometimes passes beyond the inner surface of the brain, and runs out over the outer surface as a deep perpendicular fissure. This is especially apt to occur in the brains of idiots. The fissura calcarina joins the parieto-occipital sulcus at an acute angle. This fissure lies exactly in the wall of the posterior horn of the lateral ventricle, which has been mentioned before. Tlie brain-wall, displaced inward by it, can be seen as an elongated swelling in the posterior horn. This swelling is known as the calcar avis or pes hippocampi minor. The tri- angular portion of cortex inclosed between the fissures last described is known as the cuneus. Examine the point of this region and, superficially or deeply, you will find a little convo- lution connecting it with the gyrus fornicatus, which passes by in front of the wedge-shaped cuneus. Notice this comparatively narrow part of the gyrus fornicatus. You see that it passes on as a rapidly-broadening convolution to the apex of the temporal lol)e, where it ends in a hook-shaped process, — the uncus or gyrus uncinatus. This ])art of the gyrus fornicatus lying in the tem- ])oral lobe is called the gyrus hippocampi. Posteriorly (as you see in tlie cut), a small, longish convolution of the occipital lobe joins the gyrus hippocampi. It is called the lobus lingualis. 54 LECTURES ON THE CENTRAL NERVOUS SYSTEM. . As I showed you before, the fornix forms the margin of the hemispheres. The first convolution outside of this margin — a convokition, therefore, which lies close to the fornix — is the gyrus hippocampi just mentioned. To the other side of it lies the cavity of the ventricle, — the inferior horn. At this point the ventricle is separated from the general cavity of the skull by a thin membrane, bearing the continuation of the choroid plexus, which is attached to the fornix throughout its entire course. The gyrus hippocampi may be regarded as the marginal convolution of the hemisphere. This margin, a long, thin, white stripe, is directly continuous with the fornix above. It is called the fimbria (Fig. 19, F.I). The gyrus hippocampi is pushed out into the cavity of the inferior horn by a fi.ssure on its outer surface, — the fissura hip- pocampi. The swelling which is thus produced and which ex- tends along the whole floor of the inferior horn has for ages been called the cornu ammonis, or pes hippocampi major. From the fact that the cortex of the gyrus hippocampi is doubled in by the fissura hippocampi before it ceases and leaves the medullary matter bare, ^ peculiar and complicated appear- ance is presented on cross-section. Over the general surface of the brain the gray matter is continuous, as shown in Fig. 33 A; but on the gyrus hippocampi it ceases close to the ventricle, as shown in Fig. 33 B, and leaves the white, somewhat curved edge (the fimbria) free. The bending or doubling in which it undergoes before it ceases is shown in Fig. 33 B. Between the gyrus hippocampi and the free medullary margin of the hemisphere (fimbria — fornix) there lies a small convolution (pur- posely not mentioned before), which passes from the end of the corpus callosum to the apex of the temporal lobe, and therefore takes part in the configuration of the cornu ammonis. You will please look up this convolution in the sagittal section (Fig. 32) in order to make clear its situation in relation to the fornix and the cornu ammonis. It is called the gyrus dentatus, or CONVOLUTIONS AND FISSURES OF SURFACE OF CEREBRUM. 55 fascia dentata. As you see, it lies just in front of the involution of the cortex of the gyrus hippocampi, by the fissure of the same name, and its cross-section, therefore, is not correctly represented by Fig. 33 B, but rather by Fig. 34. The cornu ammonis is, therefore, the bulging in the floor of the ventricle, Avhich is caused by the pushing in of the gyrus hippocampi by the fissure of the same name. From the cessa- tion of the cortex just at this point, from the fact that the margin of the hemisphere (fimbria and gyrus dentatus) runs along over this involution, arises the comulicated cross-section of the coniu ammonis. l^»^V.Ji»_ HHto ~- "^^IZZ. 1 k^- I 1 mm^ ^^ J ■ho - ■ 1 1 [>£: ~- HI ■ id Fig. SS a . Fig. 33 B. Unfer, Inferior. Fig. 34. The relation of the gyrus hippocampi to the inferior horn of the lateral ventricle is made clear by Figs. 19, 32, and 38. The gyrus fornicatus and its continuation, the gyrus hip- pocampi, are developed early in fcetal life. Dorsad of the margin of the hemisphere (arch of the fornix), there is devel- oped in all mammals a furrow which lies parallel with the fornix and accompanies it into the temporal lobe, — the fissura hippo- campi. The convolution between it and the fornix is the gyrus hippocampi. Anteriorly, the fibres of the corpus callosum pass transversely through it, and in this region it is called the gyrus fornicatus. Farther back, however, it is called the; gyrus hip- pocampi, and lies next to the foniix. In the lower animals the 56 LECTURES ON THE CENTRAL NERVOUS SYSTEM. corpus callosum and the gyrus foniicatus are very short. Only in men and apes is the corpus callosum so long that the begin- ning of the gyrus hippocampi lies in the temporal lobe. If you will look at the upper surface of the corpus callosum, you will see on each side of it a thin, gray, longitudinal line (Fig. 18, Lt). It is the continuation of the atrophic convolution met in the pes hippocampi major, — the gyrus dentatus. We call it the stria longitudinalis Lancisi. All the convolutions which lie near the margin of the hemi- sphere — the gyrus foniicatus, the gyrus hippocampi, the stria longitudinalis Lancisi, and the fascia dentata — are very strongly developed in animals having highly perfected organs of smell. In those which, like human beings, have small olfactory lobes, they are somewhat atrophied, and in the dolphin, which has no olfactory lobe, they are totally undeveloped (Zuckerkandl). At the posterior end of the corpus callosum we sometimes see a short convolution which passes in the direction of the fornix and be- comes incorporated with it ; it is the gyrus callosus, which is only present in man as a very atrophic, imperfect, and inconstant structure. On a fresh brain you may see the gyrus unciatus at the apex of the temporal lobe, and from there follow the gyrus hip- pocampi upward. Then observe the prominent arch of the fornix as it passes over the posterior part of the thalamus, and note how it ends in the fimbria, which is visible nearly to the end of the gyrus hippocampi as a white medullary line. Lastly, make a cross-section, which may explain the relations of the foregoing structures. On the base of the brain, with the exception of the hippo- campal fissure, which really belongs to the median surface, there are few sulci of importance. On the under surface of the frontal lobe are the orbital and the olfactory fissures. The convolutions between them are regarded as continuations of the frontal con- volutions, and receive the names of the frontal convolutions with which they are respectively continuous. The under surface of CONVOLUTIONS AND FISSURES OF SURFACE OF CEREBRUM. 57 the occipital and temporal lobes is fissured mainly in an antero- posterior direction. A third and fourth temporal sulcus is often found. The latter, which extends over into the temporal lobe, is called the occipito-temporal fissure. It separates the gyrus hippocampi from the convolutions of the temporal lobe. The temporal convolution lying just outside of this fissure (fourth temporal convolution) has received the name of gyrus occipito- temporalis. Our knowledge of tlie course of the convolutions comes from Burdacli {median surface^, Leuret, Gratiolet, Meynert {com- parative anatomy), Bischoß\ Ecker, Pansch {growing and adidt brain). Besides these there are numerous investigators as to separate localities, e.g., Broca and Zucherhandl on the convolu- tions near the margin of the hi'ain, Eherstaller and Giddherg on the island^ and Rüdin ger on the interparietal fissure. Agaiii^ n:e possess a cmisiderahle 7iumher of monographs on the surface of the hrain of many mammals. {Anthropomorphous apes, hy Bischojf ; lemurs, hy Flower and hy Gervais; tohales, hy Guldherg ; ungulates, hy Krueg ; carnivoi^ous animals, hy Meynert and Pansch, and many others.) Tlie numerous varia- tions in the course of the individual convohitions and fissures irhich may occur in man are not only mentioned hy a majority of the ahove writers, hut have found an investigator of their own in D. Sernow. It does not lie within the scope of these lectures, gentle- men, to impart the rich store of facts which physiology has brouglit to liglit respecting the various cerebral structures. Our knowledge of the functions of the cortex is, as yet, in its infancy, and is in no respect complete. I must refer you to the text-books of physiology, in many of which you will find ex- cellent chapters on the subject. In general, it may be said that, NO far as the phenomena which follow an injury to the cortex are concerned, more is positively known a})out human beings than about animals. The following is a short summary of these .symptoms: — 58 LECTURES ON THE CENTRAL NERVOUS SYSTEM. Injuries which involve the normal structure and function of the cortex give rise in the human being to symptoms differ- ing according to the part injured. Up to the present time there have been several hundred carefully observed cases of disease of the cortex, and by comparing them with one another we can arrive at the following conclusions: — Fig. 35. The convolutions on the base of the brain (diagrammatic). (After Ecker.) Motor symptoms of irritation (from the twitching of single muscles up to epilepsy) may arise from any part of the cortex, but there exists a zone of the brain embracing both central convolutions, injury to which is almost always accompanied by motor disturbances on the opposite side of the body. The dis- turbances may be divided into symptoms of irritation and symp- CONVOLUTIONS AND FISSURES OF SURFACE OF CEREBRUM. 59 toms of degeneration. The symptoms of irritation are shown by convulsive movements ; the symptoms of degeneration by a greater or less inability to set the muscles in motion at w^ill, oftentimes only in a sense of weakness, or by awkwardness in executing some complicated movement. From careful analysis of known cases of disease, it is cer- tain that, in injury of the upper part of both central convolutions and the paracentral lobule, the motor disturbances are most Fig. 36. liateral view of brain. The " motor region " shaded. (After Exner.) prominent in the legs, that when the lower end of the central convolutions is involved the regions supplied by the facial and hypoglossus suffer most, and that motor disturbance of tlie upper extremities follows when the middle and a part of the upper third of these convolutions are involved. The divisions between these separate " centres " are not sharply drawn. Comph^te destruction of separate portions of the cortex in the liuman being may lead to permanent paralysis of the muscles 60 LECTURES ON THE CENTRAL NERVOUS SYSTEM. standing- in relation to the affected part. The paralyzed muscles almost always fall into a contractured state. Injuries which involve the cortex of the inferior frontal convolution or the island of Reil, if situated on the left side, generally result in the more or less complete loss of speech, although the vocal organs may still be normally innervated and the person affected may perfectly understand all said by others. It appears that the ability to understand whatever is said in a loud voice is lost when the superior temporal convolution is involved. Disease in the region of the occipital lobe may lead to dis- turbances of vision, which may be present only as a dimness of vision or as a blindness on the outer side of the eye on the affected side and on the inner side of the opposite eye. Sensibility may also suffer from affections of the cortex of the brain. The most commonly observed symptoms are feelings of numbness, heaviness, and marked disturbance of the muscle sense. The sense of touch is, as a rule, dull so far as the judg- ment of the patient is concerned, but very slight sensory irrita- tions may still be felt, if they are of a simple character (touching with a feather, point of a needle, etc.). We do not know of any particular parts of the cortex disease of which especially leads to disturbances of sensation. At all events, such disturbances may follow diseases of the central convolutions and their vicinity. The paralyses which follow disease of the cortex are hardly ever so complete as those which are caused by destruction of the peripheral nerves or their proximal end in the spinal cord. In animals it is generally impossible to produce a permanent paralysis by removing the cortex of the motor zone or the whole portion of the brain which contains that zone. We can, how- ever, almost without fail, produce contractions of definite muscles by irritating certain circumscribed portions of the cortex. This much, however, has been made certain by experiments upon animals and by pathology, that the actual motor centres CONVOLUTIONS AND FISSURES OF SURFACE OF CEREBRUM. 61 lie far back between the corpora quadrigemina and the spinal cord ; that they are, however, so connected with centres situated in the cortex that irritation of the latter gives rise to movements. There is a conflict of opinion as to the nature and importance of the influence exercised by the higher centres over the lower. For this reason we study with the utmost scrupulousness those phenomena which follow the removal of portions of the cortex. Doubtless the importance of the role played by the cortex difters in dift'erent animals. While in the lower animals the removal, even of the whole cerebrum, does not prevent the vigorous exe- cution of coarser movements, yet in mammals the destruction of even circumscribed portions of the motor zone gives rise to temporary paralysis, and in the human being disease of rela- tively small parts of the cortex often leads to a permanent paralysis. It is evident that all motor and many sensori-psychic functions may start from deep-lying centres, but the higher we ascend in the scale of animal life the more is the cortex con- cerned in cerebral activity, and consciousness plays a more prominent part. Man has reached a stage in this connection in which many of the functions cannot be performed without the participation of the cortex. In mammals all possible degrees of variation are observed. Thus is explained the fact that irri- tation of certain tracts of cortex will give rise to muscular action, and yet movements may be executed after those particular parts of cortex have been removed. In man the greater part of the surface of the hemispheres has become indispensable to the proper performance of such movements. LECTURE y. THE CORTEX OF THE FORE-BRAIN, THE WHITE SUBSTANCE OF THE HEMISPHERES, THE COMMISSURES, AND THE CORONA RADIATA. Gentlemen : In the previous lecture you were taught the appearance of the surface of the brain, the fissures which traverse it, and the convolutions situated thereon. To-day's lecture is intended to give you a more intimate knowledge of the structure of the cortex, and to place before you a general view of the connections of the various cortical regions with one another and with the deeper-lying structures. We know the elements only which go to make up the finer structure of the cortex. The actual connections between these elements are still hidden from us, and therefore, unfortu- nately, vve are deprived of the very essentials for a correct un- derstanding of the anatomical substratum of the great organ of the mind. There is scarcely a doubt but that the cortex, taken as a whole, may be regarded as the region where most of the conscious mental processes take place ; that in it is the seat of thought, and that from the cortex all conscious voluntary acts proceed. The whole hemisphere is covered by the cortex. This, however, has not the same structure at all points of the con- vexity, and although we can make out a sort of fundamental type, yet there is a wide departure from this type in different parts of the cortex, particularly in those layers which contain the ganglion-cells and nerve-fibres. One structural type never passes abruptly into another. Inasmuch as the significance of these anatomical variations is unknown, let us to-day only con- sider the cortex of one region, — of the frontal lobe. Here, just under the pia mater, lies a layer of neuroglia with numerous glia-cells. It contains a tliick net-work (/ in the accompanying 64 LECTURES ON THE CENTRAL NERVOUS SYSTEM. cut) of very fine medullated fibres. Not until we pass this layer of neuroglia do we meet with the real ganglion-cells of the cortex. They all have a more or less clearly defined pyramidal shape, and send out apex processes, lateral proc- esses, and axis-cylinders. The location and appearance of the first two are made clear in the cut, but it is more difficult to recognize that process which becomes an axis-cylinder. Ac- cording to Golgi there are everywhere in the cortex cells with branched and those with unbranched axis-cylinders. The majority of the processes are directed inward toward the white substance of the hemi- spheres. The deeper we go into the cortex, the larger do the pyramidal cells become and the longer are their apex processes. We can divide the cortex into several layers, ac- cording to the size of the cells. Under the glia layer (marked i) comes the layer of small cells (2). This passes imper- FiG. 37.— Section through the cortex of a frontal convolution. On the right the cut is taken from a specimen stained by Weigert's hematoxylin method ; on the left, from specimens treated, according to Golgi, with suhhmate. On the right only the fibres, on the left only the cells, are to be seen. The latter were present in greater abundance than as shown m the cut. Inasmuch as the spaces around the cells are filled in when Golgi' s method is used, the latter appear larger than they really are. Gennarischer Streif, Line of Gennari. Interradiäres Flechtwerk, Inter-radial net-work. Superradiäres Flechtwerk, Super-radial net-work. Tangentialfasern, Tangential fibres. THE CORTEX OF THE FOHE-BKAIN, ETC. 65 ceptibly into the third layer (3), which contains 'the large corti- cal pyramids. The next layer (4) consists of smaller and irregu- larly pyramidal cells. Possibly, however, these may be similar to those lying- more supcn-ficially, except that they have not reached their full development, for they lie wedged in between the masses of medullary fibres which pass into the cortex. These fibres, after reaching the cortex, break up into numerous fine fibrils, and are gradually lost in finer and more superficial net-Avorks, or become continuous with the axis-cylinders of the cells. Aside from these we see a ast numbers of other medullated nerve-fibres in the cortex. Whence they come or whither they go is still utterly unknown. Even though the explanation of the ultimate mechanism of the organ of mind is wanting, still we have of late years come nearer to it, chiefly by means of the finer technical methods in use. As long as we cannot give all these fibres a name cor- responding to tlieir function, it will be better for the sake of clearness (for instance, in researches in pathological anatomy) to give them provisional names. Let us distinguish (1) radiating medullary fibres, (2) inter-radial net-work consisting mostly of fibres j)arallel to the surface, (3) super-radial net-work, and (4) tangential fibres. Along the boundary between the inter-radial and super-radial net-works the former becomes markedly thick- ened. This layer, everywhere visible as a white line, is so strongly marked in the vicinity of the cuneus as to be easily recognized. It is called the line of Gennari or, after its later describers, the line of Baillarger, and, in the vicinity of the cuneus, the line of Vicq d'Azyr. In the occipital lobe this line lies deep in the third layer, nearer the fourth than is shown in Fig. 37, whic:h represents the frontal lobe. As was pn'viously stated, the cortex has not the same struc- ture at all points of the surface. Besides the peculiarities im- parted to it in the vicinity of the calcarine fissure by the line of Gennari, the cortex of the gyrus hippocampi presents a character- istic appearance on account of the involution in the region of the Db LECTURES ON THE CENTRAL NERVOUS SYSTEM. coriiu ammoiiis and the intercalation of the atrophic cortical bundle of the gyrus dentatus. The pyramidal cells of the cornu ammonis are not directly continuous with those of the gyrus dentatus, as might be Fig. 38. Section through the base of the brain and the subjacent gyrus hippocampi. The choroid plexus is drawn somewhat simpler than it really is in the adult. JSTotice how it separates the ventricle from the cavity of the skull. Oberflächliches Mark, Superficial medullary matter. expected from the diagram, Fig. 34. They end rather by being massed irregularly together (at a in Fig. 38), and this irreg- ular mass is surrounded by the regularly placed cells in the curve of the gyrus dentatus. These and the other layers which THE CORTEX OF THE FORE-BRAIN, ETC. 67 arise from the involution have, unfortunately, received special names. As we, however, know what portions of the general cortex are represented by the different structures of the cornu ammonis, it is better to regard the latter genetically and not dis- turb our comprehension of its arrangement by using the old names. Let us follow the cortex from below upward in the ac- companying figure. You see that the superficial layer of medul- lary fibres becomes thickened far ventrad of the point where it is rolled in. Nowhere else in the brain so well as at this point can it be seen that these fibres, which in great part run in the longitudinal axis of the brain, originate in the radiating fibres below. Near the gyrus dentatus a portion of these fibres pass to a somewhat deeper layer of the cortex, while the rest remain superficial and become blended with the adjoining analogous layer of that structure. Here, as everywhere else, the radiating fibres pass inward from the cortex. In the vicinity of the gyrus hippocampi, however, so few of these fibres arise that they do not form a thick medullary deposit underneath the cortex, but only -a thin layer. This thin coating covers the side of the cornu ammonis which is toward the ventricle, and at the tip of the fold is gathered up, into a medullary bundle, no longer covered with gray matter. This is the fornix. Into it pass also the few fibres which spring from the little gyrus dentatus. The course of many of the cortical fibres differs in the cornu ammonis from their course in other regions of the cortex. Inasmuch, however, as the origin and significance of the whole net-work shown in Fig. 37 is so uncertain, you will not be specially interested in the analogous structures of the cornu ammonis. Of the greatest importance was the discovery of Tuf;zcck, that in progressive paralysis of the insane the net-work of fibres in layer 1 is destroyed, and that tlie fibres in the deeper layers, down to layer 4, successively disappear. The nerve-fibres of the cortex receive their medullary in- vestment at a very late period. Tins takes place first in the superior parietal lobe during the ninth foetal month. In the 68 LECTURES ON THE CENTRAL NERVOUS SYSTEM. first month of post-foetal life a few fibres of the anterior central convolution receive their medullary sheaths. Later, in the second to third month, the medullary sheaths are developed in the cortex of the occipital lobe. It is probable that these conditions correspond to the time when the individual first begins to retain memory-pictures in the different regions of the brain ; that, for instance, the cortex of the visual centres is developed a^ soon as conscious visual impressions are received. In later life still more extensive tracts become medullary. After the third year it is impossible to trace this increase for the reason that the medullated fibres have already become too univer- sal. Nevertheless, there is a great probability that this additional development of medullated fibres continues for many years, and that new nerve-tracts are continually developed as new regions cff the cortex are brought into activity. Below the cortex lies the white substance of the hemi- spheres. The homogeneous white mass which is revealed by a section through the centrum semiovale is resolved by the micro- scope into a great number of fibres crossing each other in every direction, and defying our attempts to differentiate them. Let us endeavor to ascertain what is at present known about these white fibres. If we make a section through the fresh brain of a newborn child we shall see that below the cortex there lies almost every- where a peculiar, glistening, reddish-gray mass, in which at only one point — underneath the posterior central convolution and its vicinity — medullary fibres can be found. It is only in the course of the first months of the post-natal period that other nerve- tracts become invested with medullary substance. This takes place first in those bundles of fibres which pass downward from the cortex, afterward in those which connect the different regions of the cortex with each other. The latter, the fibrse proprise of the cortex, are especiall)^ abundant in the adult brain. They extend everywhere, from convolution to convolution, connecting* parts which lie near each other as well as those which are widely THE CORTEX OF THE FORE-BRAIN, ETC. 69 separated. They connect whole lobes with one another. Appar- ently these "association-fibres " are developed when two different rejrions of the cortex are associated in a common action, or thev are developed into medullary fibres from among the surrounding mass of indifferent bundles when they are brought into more continuous use than the latter. The association-fibres lie, in great part, close under the cortex; some of them also lie partly in the white substance of the hemispheres. This system of fibres is, as you see, especially adapted to bring all parts of the brain into communication with each other. The manifold processes of association which are indispensable to thought, motion, and sensation possibly have their anatomical substratum in these elements of the brain. It is not improbable that these fibres play an important part in generalizing the movements of epileptic seizures. It is possible, in animals, to produce contractions of the asso- ciated muscles by irritating certain regions of the cortex, and, by in- creasing the irritation, to produce fig. 39. ^ '^ Diagram of tlie flbrae propriae of the convulsions of the wliole affected cortex. side. The order of these convulsions corresponds to the ar- rangement of the affected centres in the cortex. As this irri- tation extends it never skips a neighboring motor centre. The convulsions, when they have affected one-half of the body, pass over to the other half "(nnder certain conditions, 'intensity of the irritation, dis])osition of the animal experimented on, etc.). Removal of single motor centres from the cortex causes the muscles directly controlled by them to be omitted from the general convulsive seizure. It is not neces.sary that the point of cortex so irriUitod shovdd belong to the motor region. The coinulsions thus brought about show the greatest gihalogy to a partial or general epileptic attnt with forceps the fibres of the jjosterior extremity of the corpus «tallosum (splenium Cci') is shown. The round nia.ss under the corjjus io"llosuni is tlie thalamus opticus, Thu. From tlie wall of the Hurrounfling ventricle the tapetum, 7'ap, passes to the corpus callosuni. In the «;ut too. is shown a portion of the fasciculus loiiRitudinalis inferior, Fli. Beneath the thaianins is tlie crusta, Ji. The other letters refer to parts whicli will be explained in the t«;xt later on. Jid/, Vieq d'Azyr'.s bundle; Ka/, fornix; Ccu, corpus candicans ; //', optic nerve. The bundle of (ibies called the forceps, J<'cp, belongs to the radiation of the corpus callosuni. (After Henle. ) ammonis (ruiiiiin^ tlicir course in the fornix). A part of the bundles of the corona radiata, however, do not go to the thala- mus, but pass in front to the outside and back of it, to termina- tions which li(,' deeper. 74 LECTURES ON THE CENTRAL NERVOUS SYSTEM. The corona radiata, therefore, consists of fibres which pass to the thalamus, and of fibres which pass to deeper regions. Fibres pass to the thalamus from almost all the surface of the cortex, and not in a few bundles merely, as is shown in the following diagram. They unite near the thalamus to form thick strands, which are called the pedicles (stilus) of the thalamus. Among fibres passing farther caudad are: — 1. Fibres from the cortex of the central convolutions and the paracentral lobule ; that is, from the motor region of the brain to the nuclei of the motor nerves in the brain and the spinal cord (pyramidal tract). 2. The speech-tract, to the nuclei of the nerves in the oblongata which have to do with speech. Its origin in the cortex of the third frontal convolution, its course through the white sub- stance to the outside of the tail of the nucleus caudatus, and its termi- FlG. 43. Diagram of the fibres of the corona radiata, espe- cially the coronal fibres to the thalamus, u.s., inferior . . , ., . pedicle. uatioii HI the nuclci Sehhügel, Thalamus. above mentioned, have all been inferred from carefully-observed clinical cases, verified by autopsies. It has not yet been actually demonstrated by dissection. The speech-tract in passing over the anterior portion of the nucleus lentiformis lies very near the central hypoglossal tract. 3. Bundles from the cortex of the frontal lobe to the pons or, rather, to its ganglion-cells (anterior cortical tract to the pons). They pass, in all probability, from the pons into the cerebellum. 4. Bundles from the cortex of the occipital and temporal lobes, also ending, apparently, in the ganglion-cells of the pons (posterior cortical tract to the pons). THE CORTEX OF THE FORE-BRAIN, ETC. 75 5. Bundles run from tlie cortex of the superior parietal lobe (and the posterior central convolution 1) and perhaps, also, from more posterior cortical regions, to the internal capsule, and in part pass under the thalamus to the spinal cord, and partly enter the lenticular nucleus. They pass through both inner divisions of the latter, and become united near the base of the brain to form a thick strand, whose course we shall have occasion to study later on (tegmental radiation). These latter are the first cerebral fibres to receive their investment of medullary sheaths. They alone at the eighth to ninth foetal month may be recognized as a thin, white bundle in the internal capsule, which latter, at this period, appears gray. 6. Fibres pass from the occipital lobe to the points of origin of the optic nerve. They connect the real optic nucleus with the cortex. In Fig. 44 this optic radiation is shown in a hori- zontal section of the brain of a nine-week-old child. Its destruction in human beings leads to disturbances of vision, which will be described later on. In animals it does not appear to be so important, for in them the occipital cortex can be destroyed on both sides without producing blindness. The actual centres for the sense of sight lie deeper; sight continues if only they are preserved intact, but it is diminished to a certain extent if the connection between these lower centres and the cortex is destroyed. This connection, which evidently subserves some psychic process, is most important in human beings; it is apparently less so in the other mammals. In the lower animals, fishes, for instance, it is altogether wanting. These latter see, at least in the case of teleostians, without anything more than a thin, epithelial vesicle in place of a cerebrum. Doubtless there are a great number of other systems in the corona radiatii. Observations bearing on this point must be undertaken on the brains of very young children. The fibres receive their medullary investment at difierent periods, and, so. far as we know, the whole corona radiata is medullary at the end of the second year. 76 LECTURES ON THE CENTRAL NERVOUS SYSTEM. On their passage downward, the fibres of the corona radiata enter into important relations with the corpus striatum and the optic thalamus. They naturally converge, and so reach the space outside the thalamus. The fibres from the anterior portion of the brain must, in order to reach this point, pass through the corpus Fig. 44. Horizontal section tlirough tlie brain, trending downward on each side. Balken, Corpus callosura. Opticus Strahlung, Optio radiation. striatum. Tliis is made clear in the accompanying horizontal section through the cerebrum. This section is made about a finger's breadth lower down than the one shown in Fig. 19. You must understand that the two hemispheres have been partly removed, and that their coronal . fibres pass from above downward tlirough the knee-shaped white line of the inner capsule. That portion of the capsule which comes from the frontal and occipital lobes lies partly in the plane THE CORTEX OF THE FORE-BRAIN, ETC. 77 of this section. A few words now in explanation of this figure. You will at once recognize the frontal, occipital, and tem- poral lobes. The latter is placed over the island of Eeil and in part covers it. As in Fig. 19, you see, in front, the transversely divided corpus callosum, the septum pellucidum adjoining, and, at the posterior termination of the latter, the ascending pillars of the fornix. Anterior and external to the septum is the head of the nucleus caudatus, which, in this section, has been cut into. Its tail, which, in Fig. 19, passes along the side of the thalamus. Fig. 45. Nucleus caudatus dissected out along its wliole length. (Diagrammatic.) Ammmuhom. Cornu ammonis. Riechlappen, Olfactory' lobe. Vtuliihel, Ventricle. can no longer be seen. It lies in the part of the brain which has been removed. A small portion of it only is left, pos- teriorly and exteriorly, near the cornu ammonis. The above cut, which represents a nucleus caudatus dissected out, shows how this condition is brought about. The tail of the nucleus caudatus is b(Mit in a curve around the whole brain-axis, and can be traced almost to the apex of the inferior horn of the lateral ventricle. The wliolc nucleus, therefore, must appear twice on any deep horizontal section of the brain, as is shown by the line a to b, in Fig. 45. Outside the head of the nucleus caudatus we see some 78 LECTURES ON THE CENTRAL NERVOUS SYSTEM. thick masses of white fibres. They come from the frontal lobe, and contain the corresponding portions of the coronal fibres to the thalamus (thalamic radiations) and the anterior cortical tract to the pons. These fibres must, as you see in the cut, in order to reach the thalamus and the pons, pass through the interposed corpus striatum. The part which remains lying nearer the Fig. 46. Frontal section through the fore-hrain just back of the ascending pillars of the fornix. Balken, Corpus calloBum. Marklager, White substance. median line is the nucleus caudatus ; the external part is the nucleus lenticularis. The two are not absolutely and totally divided by these frontal-lobe fibres ; on the contrary, numerous connecting fibres pass between them. The above-named thala- mic radiations, the anterior cortical tract to the pons, the bun-' dies passing between the head of the nucleus caudatus and the THE CORTEX OF THE FORE-BRAIN, ETC. 79 lenticular nucleus, and, lastly, fibres from the nucleus caudatus to the inner divisions of the lenticular nucleus, all go to make up the internal capsule, — the white mass of fibres shown in the liorizontal section. Fig. 46 is intended to complete the picture of those parts <>iven in the horizontal section. It strikes the ganglia of the corpus striatum far forward, and clearly shows the manner of tlieir separation by the interposed fibres of tlie internal capsule. The form and situation of the nucleus caudatus will now be clear to you, but it will be more difficult to form an idea of the peculiar wedge-shaped figure of the lenticular nucleus. A study of the horizontal and of the vertical sections shown in Fig. 46 will materially aid you. This ganglion is intimately associated internally with two somewhat lighter, grayish gan- glionic masses, which are closely connected to it by nerve-fibres. AVe speak ordinarily of the three divisions of the lenticular nucleus, whereas it is probable that only one — the broad, dark, outer portion (the putamen) — is morphologically analogous to the nucleus caudatus. The latter, as above stated, sends its fibres through the anterior branch of the internal capsule to the two inner divisions of the lenticular nucleus, and, perhaps, through them and farther caudad. The fibres of the putamen nm an exactly similar course.* In all vertebrates, from fishes up to birds, a thick bundle of fibres can b(,' seen, arising in the corpus striatum and ending partly in a thalamic nucleus and partly passing farther back. It can only be found with difllculty in human beings, because too many bundles from the cortex are united with it. Still, I have recogiiiz(.'d tliis l)asal fore-brain bundle in early embryos, and it is api)arently these fibres which Wernicke and Flechsig have described as springing from the corpus striatum. The latter, indeed, recognized their connection with the thalamus, •Thf! flbrPH arJHini; in the ganglia of the corpu« striatum receive tlieir iiiediillary slieaths at a much later period tlian th(; tegmental radiation which i)asM»;H through the inner divisions of the nucleus lentifnrmis. Hence, we have nucceeded in distinguishing these twosetsof fibres, which are closely intermingled in the adult. 80 LECTURES ON THE CENTRAL NERVOUS SYSTEM. External to the corpus striatum lies the cortex of the island of Reil. In the narrow band of white substance which lies be- tween the ganglion and the cortex — that is to say, in the exter- nal capsule — is placed an elongated collection of ganglion-cells, — the claustrum, — which is anatomically somewhat diiferent from the neighboring cortex. Caudad of the nucleus caudatus the horizontal section (Fig. 44) passes tlirough the thalamus, — the inter-brain. In front of this the pillars of the fornix ascend from below ; the Fig. 47. Diagram of the internal capsule. The situation of most of the tracts of fibres which compose it is indicated by the names. Extremitäten mot. Bahn, Motor tract to the extremities. Fasern aus Nucleus Caudatus, Fibres from nucleus caudatus. Fasern aus N. leiiti/ormi-s. Fibres from nucleus leutiformis. Frontale Brückenhahn, Anterior cortical tract to the pons. '• Opticus/asern, Optic fibres. Sensoriaclie Fasern, Sensory fibres. Stabkranz zum Thalamus, Coronal fibres to the thalamus. Temporo-occipitale Brückenbahn, Posterior cortical tract to the pons. commissura media, a thin band of gray matter, extends from one thalamus to the other. External to the thalamus passes the posterior branch of the internal capsule. The point where the two branches meet is called the knee (genu). Impress this peculiar angular form of the inner capsule well upon your memory. The relation of the different coronal bundles to the two angles is particularly important and very nearly constant. In the posterior branch, not far from the knee, lie the fibres from the motor zone to the extremities (pyramidal tract); just THE CORTEX OF THE FORE-BRAIN, ETC. 81 in front of them are situated bundles which connect with the nuclei of the facialis and hypogiossus, and have their origin in the lower portion of the anterior central convolution. Behind the pyramidal tract, near the last third of the pos- terior branch, or, perhaps, somewhat more anteriorly, Ave meet with the bundles known as the tegmental radiation, and back of and adjoining them the tract from the occipital lobe to the origin of the optic nerve. Judging from clinical facts there must be in this region fibres passing from the temporal lobes to the auditory nuclei, and others, also, which are related in some way to the sense of smell. Thus, in the terminal third of the posterior branch of the internal capsule there is a confluence of all the sensory fibres and of the fibres to the nerves of special sense. Besides these, moreover, we here find coronal fibres to the thalamus from the cortex of the temporal and occipital lobes, and the occipito-temporal tract to the pons. The preceding figure gives a diagrammatic view of the separate bundles which compose the internal capsule. Numerous investigators have turned their attention to the histology of the cortex and to the conditions of its finer structure. However great the labor ex- pended in this field, by just so much does the difficulty of the problem appear to increase. Newer and more complicated conditions are continually being dis- covered. Baillarger, Bevan Lewis, Clarke, Gerlach, Meynert, Golgi, Bellonci, and many others have attempted to throw light upon the most important points. The cortex of the cornu ammonis in particular has been investigated by Kölliker, Henle, and Duval. Many facts concerning the course of fibres in the white- substance of the hemispheres were discovered by F. Arnold, Reil, and Burdachu by the teasing method ; while the microscopic investigations of Meynert, and more particularly the embryological studies of Flechsig, and the numerous ex- perimental works of Gudden, Löwenthal, Monakow, and many others have materially advanced our knowledge in this respect. We must not undervalue the advantages wliich have accrued to this portion of brain anatomy from patliological investigations. Such investigations have been instituted by Wer- nicke, Charcot, Fere, Pitres, Friedmann, Sioli, Monakow, Richter, and others. All the masses of fibres emerge from the cortex and con- verge toward the region external to the thalamus. A portion of them enter the thalamus (corona radiata of the thalamus) ; another portion, and that the larger, pass under the thalamus to terminate in ganglia there situated, or to run still fartlier 6 82 LECTURES ON THE CENTRAL NERVOUS SYSTEM. caudad to the spinal cord. Any foci of disease, therefore, which are situated in the centrum semiovale must involve some of the coronal fibres. They, however, do not always give rise to symptoms which would lead us to suspect a break in the con- ductivity from cortex to periphery. This may be because the coarser and more striking lesion-symptoms, the only ones which can be detected by our present means of diagnosis, require for their development the destruction of the whole tract involved. Apparently a small remnant of a tract suffices to conduct ^^oluntary impulses from the cortex to deeper-lying points, and to convey sensory impressions from the periphery to the cortex. Lesions, in particular, which do not lie in the white sub- stance under the central convolutions — that is to say, lesions which involve the tract from the cortex to the pons and the tegmental radiation — often give rise to no symptoms. On the other hand, lesions which involve the pyramidal tracts produce paralyses of the opposite half of the body. Disease of the white substance under the cortex of the inferior frontal convo- lution often leads to aphasia. In addition to these there are a number of conditions known which make it very probable that an interruption of the tegmental radiation may bring about a loss of sensibility in one-half of the body. It is pretty well established that diseases which involve the region just back of the knee of the internal capsule, diseases, at least, which render the fibres incapable of conveying nervous impulses, suspend the motility of the entire opposite half of the body, and that lesions situated in the terminal two-thirds of the posterior branch may destroy the sensation of the opposite side of the body, or at least very much diminish it. In most cases the sense of sight also suffers, and occasionally the sense of hearing. The injury to the sense of sight takes the form of hemiopia. If you bear in mind that, as has been repeatedly stated, all the fibres converge radially from the cortex to the capsule, you will easily understand that a small lesion in the capsule may give rise to the same symptoms which would be produced by a THE CORTEX OF THE' FORE-BRAIN, ETC. 83 larger one in the centrum semiovale, or by a still more extensive one in the cortex. In the capsule the fibres are crowded closely tojj^ether, which, higher up, are spread over a greater surface. For example, a great extent of cortex (both central convolutions and the adjoining portions of the frontal and parietal convolu- tions) would have to be destroyed in order to produce a complete opposite hemiplegia. The same effect might be caused by a smaller lesion in the centrum semiovale under the central con- volutions, whereas the symptom-complex in question could be produced by a very small lesion in the posterior branch of the inner capsule. In cases of hemiplegia, therefore, we at once Cr us cerebri. Fig. 48. suspect that the disease is located in the neighborhood of or in the internal capsule, unless additional symptoms point directly to some other region of the brain. Hemiplegias from disease of the cortex are very rare. Hemiplegias arising from diseased foci in the deeper-lying portions of the central nervous system are still rarer, and are generally associated with cranial-nerve symptoms, whicli indicate the scat of the lesion. On the other hand, both anatomical considerations and clinical experience teach us that cerebral diseases which affect single members of the body (one hand, for instance) very seldom have their seat in tlie capsule, because the fibres there are so 84 LECTURES ON THE -CENTRAL NERVOUS SYSTEM. closely crowded together that a focus of disease could scarcely involve individual fibres without affecting others. Disease of the cortex, however, not infrequently causes monoplegias and monospasms. In this portion of the brain a relatively large area may be involved without impinging on an adjoining centre. The accompanying diagram will effectually impress these state- ments upon your mind. It shows why monoplegias most frequently have a cortical origin, whereas hemiplegias generally result from disease of the deeper-lying portions of the brain. We see at a glance that a lesion of a given extent, situated in the cortex, may easily affect only one centre, whereas the same focus, more deeply situated, might affect the radiating fibres of many centres. We have not yet learned what symptoms would arise from involvement of the association-fibres alone, because these fibres are so closely blended with those of the corona radiata. Pos- sibly certain forms of disturbance in speaking, reading, and hearing belong in this category. We know, too, very little con- cerning the symptoms arising from destruction of the corpus callosum. It appears that this may, under certain circumstances, be entirely destroyed without giving rise to disturbances of motility, of co-ordination, of sensibility, of the reflexes, or of the special senses, and without any material disturbance of the intellect. One case of disease of the corpus callosum has been observed accompanied by an uncertain gait, but without vertigo or ataxia. LECTURE VI. THE CORONA RADIATA, THE CORPUS STRIATUM, THE THALAMUS, AND THE SUBTHALAMIC REGION. THE STRUCTURES AT THE BASE OF THE BRAIN. Gentlemen : As you saw in the last lecture, a great part of the coronal fibres terminate in the inter-brain, in the optic thala- mus. The rest pass farther caudad and ventrad in tlie capsule. Thus they reach the region back of the thalamus and for the most part lie free on the under surface of the brain. This thick bundle of white fibres emerging from the base of the brain is called the foot of the crus cerebri, pes pedunculi, or crusta. As you see in the accompanying frontal section, this free portion of the capsule, whose fibres curve backward in the crus cerebri, lies ventrad of the thalamus. Into this, the pes pedun- culi or crusta, pass the fibres of the frontal tract to the pons, of the temporal tract to the pons, and of the pyramidal tract. The coronal optic fibres and the tegmental radiation do not enter the crusta. Farther back under the corpora quadrigemina, just over the crusta, in the same relative position here occupied by the thalamus, He the fibres wliich spring from tlie thalamus and other regions of the brain, and the fibres of the tegmental radiation. At this point the mass of fibres from the fore-, inter-, and mid- brains are divided into a ventral portion (the pes or crusta) and a dorsal portion (the tegmentum). First let us turn our attention to the crusta. The accompanying cut (Fig. 50) is an endeavor to show you the transition of the internal capsule into the pes l)y a diagrammatic horizontal section. The thalamus is rei)rescnted as transparent. Posteriorly the section tn^nds sharply downward; otherwise it would not show the crusta, which is situated at the base of the brain. (85) 86 LECTURES ON THE CENTRAL NERVOUS SYSTEM. In the diagram you see a tract descending from the gangUa of the corpus striatum. It Hes above the tracts from the cortex. In all probability this terminates in the pons. The relations borne by the fibres from the ganglia of the Fig. 49. Frontal section through the fore- and inter- brains at that point where the fibres of the internal capsule become the crusta. Balken, Corpus callosum. Hirnschenkel, Pedune. cerebri. Unlerhorn, Inf. horn. corpus striatum to those from the cortex are in many respects still unknown. The foUowmg are the most important points which have been definitely settled. The nucleus lentiformis consists of an outer division (the putamen) and two or more inner THE STRUCTURES AT THE BASE OF THE BRAIN. 8T divisions (the globus pallidus). From the putamen and from the nucleus caudatus übres arise which pass through both the inner divisions and emerge from the base and apex of the nucleus lentiformis. You will remember from the second lecture that the nucleus caudatus and the putamen are genetically related to Vorderer d. Capsel. bt'jjihtppin . ^ueii the thalami. Ventrad of th(>m appears, on each side, a thick strand of fibres from the depths below, which extend into the cerebellum. They are the anterior or superior peduncles of the cerebellum. In Fig. 53 you can see how they arise in the red nucleus, which is situated in the tegmentum beneath the thalamus and the corpora quadrigemina. Behind 106 LECTURES ON THE CENTRAL NERVOUS SYSTEM. the latter bodies it emerges from the tegmentum and lies on the surface. We distinguish the anterior and the posterior quadri- geminal bodies. This distinction is only visible to the naked \entrtculus tertius. i Zmisciienhirn ■A', irochkaris Hinifrhirn md-earm.. Hütkenmark . )bu. j^äserüjscy Fig. 60. The brain-structures from the thalamus to the sphial cord. The cerebellum is divided and the left half removed. Bindearm, Peduncle. Kleinhirn, Cerebellum. Ncichhim, After-brain. ninterhim. Hind-brain. Mittelhirn, Mid-brain. Ruckenmark, Sp. cord. Birnschenkel, Pedunc. cerebri. Zwischenhim, Inter-brain. eye in the case of some mammalians ; in all other vertebrates the anterior quadrigeminal bodies are so large that the posterior ones disappear beneath thpm, and seem like a little ganglion THE SUBTHALAMIC REGION, ETC. 107 attached to the anterior pair. (Compare Lecture II, Figs. 11- 17.) From the anterior quadrigemliial bodies arise a large por- tion of the optic nerve-fibres. They, Uke the thalamus, receive fibres from the region of the occipital lobe, which run in the optic radiation to the internal capsule, and from there pass up- ward to the thalamus in the brachium of the anterior quadri- FiG. CI. Thalamus and corpora quadriireinina seen from the side. The fore-brain ha-s been removed at the point where the fibres of the corona radiata enter the mternal pears as a separate bundle of transversely divided fibres. To Fig. 65. A frontal section ma» Hark, Deep marrow. the inner and outer sides of it the fibres of the lower fillet are joined to it. Thus it comes that there is a wide area of trans- versely divided fibres just above the substantia nigra, and tliis is called the layer of the fillet (stratum lemnisci). The greater part of the layer of the fillet can be traced caudad to the nuclei of the sensory nerves and of the posterior column. Meynert first showed that this was a portion of the sensory tract. Embryology and comparative anatomy equally bear out this view. We shall study the course of the fillet later. 8 114 LECTURES OlSr THE CENTRAL NERYOUS SYSTEM. The stratum lemnisci, then, contains two elements, — the upper and the lower fillets. The lower (better, mid-brain) fillet arises chiefly from a system of fibres which has not been men- tioned before, the deep marrow of the roof of the mid-brain ; but it also arises in part from the ganglion of the posterior quadri- geminal body. This is clearly shown in an oblique section down- ward through both pairs of quadrigeminal bodies, as represented in Fig. 65. The ganglion above mentioned consists of a large, roundish nucleus permeated by a net-work of fine fibres. This is the only ganglion situated in the posterior quadrigeminal body ; the latter, therefore, does not present that stratified ap- pearance, alternately gray and white, which is characteristic of the anterior quadrigeminal body, — the ganglion opticum. It is connected with its fellow of the opposite side by the fibres run- ning over the aqueduct of Sylvius. Phylogenetically the deep marrow is a very old system. It is present even in the simple brains of the lower vertebrates, and in these, as in the human being, early receives its medullary sheaths. Its fibres arise in the roof of the mid-brain, springing from layers which lie beneath the origin of the optic nerve. From this point they at first radiate inward, but, on reaching the central gray matter, they turn and run ventrad. The most lateral of these fibres, united with those which come from the opposite side, pass into the lemniscus ; the more median fibres, however, pass down around the aqueduct of Sylvius and declis- sate with the analogous fibres of the opposite side. In human beings the termination of these fibres has not yet been made clear. We call them by the name proposed by Forel, the " fountain-like" decussation of the tegmentum (Figs. 66, 70, 72). In fishes and birds these particular fibres of the deep marrow are so extensively developed that their course is much more readily recognizable. In them, as well as in amphibians and reptiles, we see that, except so far as they pass into the fillet, this system of fibres is contained wholly in the mid-brain and terminate in cells situated both on the same and on the opposite THE SUBTHALAMIC REGION, ETC. 11; sides. In human beings we find groups of cells at points cor- responding to these terminal cells of birds, fishes, etc. (lateral and median ganglion. Fig. 66). In the central gray matter, under the corpora quadrigemina, we first meet with ganglion-cells which give origin to a cranial nerve, — the oculo-motor. From their union, which forms the oculo-motor nucleus, the roots of that nerve pass ventrad through the tegmentum and the crusta to the anterior surface of the brain, and emerge in thick bundles. (See Fig. 72.) The Fig. 66. The fibres arising in the mid-brain roof. Dorsad the optic tract, ventrad the deep marrow. The diagram also shows the other optic roots. oculo-motor nerve contains fibres to several internal and external muscles of the eye. From tlie fact that nuclear paralyses of single muscles from the group supplied by this nerve have been observed, it is probable that this nucleus consists of a complex of small nuclei somewhat separated from each other. In human beings, indeed, a distinct demarcation can be made out in several parts. Far forward, lying partly in the lateral wall of the third ventricle on each side, is a small nucleus, — the nucleus anterior. It sends a few fibres caudad to the main portion of the nerve. Behind it lies the nucleus posterior. It extends the whole 116 LECTURES ON THE CENTRAL NERVOUS SYSTEM. length of the aqueduct of Sylvius, and is composed of large multipolar ganglion-cells. In this nucleus we observe a certain tendency in the cells to become separated into groups. One collection of cells lying dorsad of the rest is plainly distinguish- able. While all the other oculo-motor fibres emerge from tlie side on which they originate, the fibres from this group of cells, as was first shown by Gudden, pass in a median direction and decussate with those from the corre- sponding group on the opposite side. Besides this dorsal group a median group can be distinguished, just in the middle line, which gives off fibres on each side. Fig. 67 represents, partly in diagram, the nuclei in the floor of the aqueduct and their relations to the nerve-roots. You will notice in the cut two small nuclei situated one on each side of the median line, and connected with each other ante- riorly and below. They are marked a and h. These two nuclei, which were first observed by myself in foetal brains, and later by Westphal, dur- ing a painstaking exg^iination of the adult brain, lie in a «thick net- work of nerve-fibres. It is not yet known whether they stand in any relation to the oculo-motor, and, if they do, what the rdation is. We possess such an array of clinical facts and discoveries made by careful post-mortem dissections that we may venture to desig- nate the particular spot in the nucleus which supplies each individual ocular muscle. I will give you Starr's table, the latest result of these researches which were so happily begun by Kahler. According Fig. 67. The floor of the aqueduct of Syl- vius looking upward. The nuclei of the oculo-motor and trochlear nerves. (Partly diagrammatic.) THE SUBTHALAMIC REGION, ETC. 117 to this table, the nuclei of the individual muscles are arranged in the order given below, from before backward, thus : — Sphincter iridis. Musculus ciliaris. G> Levator palp. Rectus int. S i Rectus sup. Rectus inf. Obliquus inf. The nerves to the internal muscles of the eye apparently spring from the anterior nucleus. The crossed track and, per- haps, also the median division of the posterior nucleus are accredited to the rectus internus. Although clinical experience teaches that there is both a direct and a crossed communication between the oculo-motor nerve and the centres of the optic nerve, yet the anatomical basis of this fact has not been dis- covered. Net-works and bundles of fibres which might com- plete the communication are to be found in this region. As yet, however, no experlmentinn cnicis has been performed, nor has there been made any clinical observation supported by post- mortem examination which would clear up this point. The nucleus of the ocido-motor lies ventrad of the aque- duct of Sylvius ; that is to say, in its floor. Later on, as we pass gradujilly backward in our study of the tegmentum, we shall find the nuclei of most of the other cranial nerves in the region of this floor. The cranial nerves all arise directly from their nuclei. To each of these nuclei fibres pass from higher parts of the brain. They come from the opposite side and decussate in the middle line before entering the nucleus. Clinical experience goes to show that the upper part of the cranial-nerve tracts — that is, above the nucleus — extends to the cerebral cortex. The course of the fibres in the vicinity of tlie thalamus and in the regio subthalaniica is less certainly known than in most other parts of the brain. Amons the workers in this difficult field, Meynert, Forel, Gudden, Flechsig, Wernicke, and the author are to be mentioned. Tlie origin of the optic nerve has been piincipally worked out by Meynert, J. Stilling, Tartuferi, Gudden, IJelloiici, and Monakow. You will, gentlemen, have a better comprehension of many pathological nervous phenomena if you will, for the time, adopt 118 LECTURES ON THE CENTRAL NERVOUS SYSTEM. the following diagram of an innervation tract. Every peripheral nerve — at least, every motor nerve — ends in the central organ in a nucleus. Nerve-roots and the nucleus form the first part of the tract. To the nucleus there pass fibres of the corona radiata from the cortex of' the hemispheres, and thus is formed the second link in the chain : nerve, nucleus — corona radiata, cortex. Diagram of an innervation tract from the cortex to a (motor) cranial nerve. Bahn in Stabkranz u. Capsula, Tract in corona radiata and capsule. Hinteres L'dngsbUndel, Post, longitud. fascicnlua. Kern, Nucleus. Periph. Nerv, Peripheral nerre. Rinde, Cortex. So long as the first part of the tract is intact, the muscles can be brought into action by electric, mechanical, or reflex irri- tation, and, in animals, to a certain extent by the influence of the will. If either nerve or nucleus is destroyed we have abso- lute paralysis. In order, however, to obtain the full effect of a conscious voluntary act, the second part of the tract must also be intact ; this is particularly true of the highly-developed human THE SUBTHALAMIC REGION, ETC. 119 brain, for, if tlie second part is interrupted, there can no longer be a voluntary motion of any kind. In a case of apoplectic rupture of the internal capsule the muscles of tlie opposite side of the body are not really paralyzed ; they simply cannot be made to contract by the will. This, however, can readily be accomplished by other forms of stimulation. It is otherwise in a case, for instance, of infantile paralysis, where a nerve-nucleus itself is destroyed. In this case we have a true paralysis, gener- ally irremediable, which leads to atrophy, and the muscles Vent Fig. 69. Longitudinal section through the quadrigeminal region of a human embryo of 28 weeks, near the median line. The outer wall of the aqueduct of Sylvius has been cut into. Termination of the fasciculus longitudinalis posterior in the nucleus of the oculo- motor. All medullary fibres stained with haematoxylm. Hint. LänijsbUndel, Posterior longitudinal fasciculus. Hirnschenkel, Feduncalus cerebri. Vierhiigelplatte, Quadrigeminal laminu. respond very little, if at all, to reflex or any other stimulation. It makes a great difference, so far as the prospect of a restora- tion of function is concerned, whether the cerebral or the deeper portion of the innervation tract is affected. The diagram Fig. 68 is an aUempt to represent the most important fibres passing to the nucleus of a cranial nerve. Besides the above-described central tract, the nucleus, and the peripheral tract, you will notice fibres connecting the nerve-nucleus w^ith deeper-lying nuclei of other nerves, and, in addition to these, »till other fibres arising from the nucleus, but emerging from the central organ in the nerve of the opposite side. 120 LECTURES ON THE CENTRAL NERVOUS SYSTEM. Ill the begimiing of to-day's lecture you learned that cer- tain fibres of the posterior commissure curved backward. These fibres, together with others which arise in the depths of the inter-brain, are met with as a fine fasciculus ventrad of the anterior oculo-motor nucleus. As we pass back, this fasciculus progressively increases in size. There are added to it numerous fibres from the nucleus of the oculo-motor. We shall, from now on, meet with the triangular cross-section of this bundle, which is composed of fibres from such various regions on every transverse section of the brain, from the level of the corpora quadrigemina down to the beginning of the spinal cord. This bundle is called the fasciculus longitudinalis posterior. Inasmuch as fibres are given off" along the whole course of this bundle to the nerve-nuclei, as can be plainly seen in embryos of the sixth to seventh month, when few other fibres are medullated, and, as this bundle projects farther back than the nucleus of the abdu- cens, it is probable that the fasciculus longitudinalis posterior not only contains the fibres of communication between the nuclei of the ocular muscles, but that it also contains fibres to other cranial nerves. Flechsig is also of this opinion. I have never succeeded in tracing this fasciculus farther than the nucleus of the oculo-motor previous to the ninth month. Series of longi- tudinal sections stained with hsematoxylin (one of which is represented on preceding page) are decisive. Not all fibres of the fasciculus longitudinalis posterior receive their medullary substance at the same time. In the neighborhood of the posterior quadrigeminal body there is an interchange of fibres between the two fasciculi longi- tudinales posteriores. By this means there is established a com- munication between the oculo-motor and the trochlear on one side and the opposite abducens. The numerous systems of fibres which run their course in the region of the corpora quadrigemina can only be differen- tiated by studying the development of their medullary sheaths. I should therefore dislike extremely, gentlemen, to close these THE SUBTHALAMIC REGION, ETC. 121 lectures witliout demonstrating to you a specimen which has a bearing upon this subject. In Fig. 70 we liave a section through the anterior quadri- geminal body, close to the posterior commissure, from a child born during the ninth foetal month. Every one of the fibres which are medullary at this period is stained black by heema- toxylin. You will easily make out the features which we have just described. Here your attention is, for tliQ first time, called to a '"CrACt opt Fig. 70. Frontal section through the anterior quadrigeminal body of a 9 months' foetus. Binl. Langnh., Posterior longitudinal fasciculus. O. S., Upper fillet. U. S.. Lower fillet. little circular binidle of transversely divided fibres lying between the red nuclei, and marked b. It arises in the ganglion habe- nulse and passes baclcward to a small ganglion which lies be- tween the crura cerebri, and is called the ganglion inter- pedunculare. In that situation the fibres decussate with those of the opposite bundle before entering the ganglion. This bundle is called the fasciculus retroflexus, or Meynert's bundle. Its course is shown in Fig. 71. Compare also Fig. 59. You see in Fig. 70 a mass of fibres belonging to the lem- niscus and passing around outside the red nucleus to the region over the substantia nigra. In the crusta there is at the ninth 122 LECTURES ON THE CENTRAL NERVOUS SYSTEM. month, only one small fasciculus, which has become medullary. It lies externally, and is not shown in the cut. It emerges probably from the ansa lenticularis. In Fig. 72 we have a picture which represents most of the structures which can be seen in a section just behind the ante- rior quadrigeminal body. This cut is prepared from specimens at various periods of development. We will make use of it for a review of to-day's lecture, and look up the following important points : — 1. Roof of mid-brain : Anterior quadrigeminal body; from Fornk. Fig. 71. Diagram of a sagittal section through the thalamus and the corpora quadrigemina. Bindearm, Sup. cerebellar pedunc. Haubenbiindel, Tegmental fasoicnlus. Viq. d'Azyr. B., Viq. d'Azyr's bundle. this there arises dorsad the brachium to the optic nerve, ventrad the deep marrow, the decussation of the latter over the aque- duct, the central gray matter surrounding the aqueduct. On the outer border of the central gray matter a small nucleus, unmen- tioned before, whose vesicular cells will be found in the same relative position throughout the entire mid-brain. From it arises a slender bundle of fibres which, progressively increasing in size, passes downward to the pons and there associates itself with the emerging fibres of the trigeminus. It is the descend- ing root of the fifth nerve. 2. Tegmentum : In the ventral portion of the central gray THE SUBTHALAMIC REGION, ETC. 123 matter the nucleus, posterior medialis, and lateralis of the oculo- motor ; to it are added fibres from the deep marrow and from the fasciculus longitudinalis posterior ; external to and continu- ous with the latter the fibres ol' the posterior commissure. Ex- FlG. 72. Section just back of the anterior quadrigeminal body, combined from specimens at different stages of medullary development. Hsematoxylin staining. Au« Corput ftriat.. From the corpus striatum. Aus L*ih. tnnporatijt und pariHali»^ From the temporal andparietal lobes. Au» Lub.frtmt., From the frontal lobe. Auk TttnlamuK, From the thalamus. Centr. Höklenijrau, Central (ventricular) gray matter. TUfe» Mark. Deep marrow. tenial to this a medullary tract, which apparently extends hither from the thalamus, from which it took its departure in the form of the lamiricJü medulläres. Tlie fillet from the corpora quad- rigemina, and that i'rom the tegmental radiation ; internal to 124 LECTURES ON THE CENTRAL NERVOUS SYSTEM. tlie fillet is the nucleus ruber tegmenti, from which the numerous fibres of the superior cerebellar peduncles arise. Near the median line is that decussation of the fibres of the deep marVow Avhich has been named the " fountain-like " decussation of the tegmentum. Between the latter and the pedunculus superior cerebelli is seen a portion of the descending fasciculus retro- fiexus. Fig. 71 shows how it reached this region. 3. On the boundary between the crusta and the tegmentum we recognize the substantia nigra Sommeringi, in which run many fibres, — stratum intermedium, — which arises in the len- ticular nucleus. 4. Pes pedunculi : The pyramidal tract is shown still non- medullary, as it appeared in the specimen from a 4-week-old child. The fibres lying internal to it come from the frontal lobe ; those on its outer side from the parietal lobe. At about this level one bundle leaves the pyramids, and, passing along the border of the pes, becomes associated farther back with the fillet, and forming the most median layer of that fasciculus. Spitzka has shown that most probably this bundle contains the cerebral tracts of the cranial nerves. Internal to it, in the cut, emerge the roots of the oculo-motor nerves. Shortly before their exit they pass through the pedunculus corporis mamillaris. We have now only to mention those symptoms which may with reasonable certainty be taken as indicating disease in the region of the corpora quadrigemina. Lesions in the regio subthalamica involve such a tangle of different sorts of fibres that their symptoms are of the most manifold description. A certain diagnosis can hardly be made. Foci in the vicinity of the pes pedunculi involve the motor fibres to the opposite side of the body and the neighboring cranial nerves. Sensory and vasomotor disturbances may also be present. Generally, not only the muscles of the extremities and one or more of the cranial nerves are paralyzed, but there are also present disturbances of the oculo-motor nerve of the side of the lesion. If there is a simultaneous paralysis of one oculo-motor THE SUBTHALAMIC REGION, ETC. 125 nerve and of the opposite half of the body we may suspect trouble under the corpora quadrigemina. Such patients have either wholly or in part lost control of the limbs on one side of the body, the upper lid droops, the pupil is dilated, and the whole eye turned outward by the rectus externus. The same symptoms might come from a tumor at the base of the brain, as is evident from Fig. 57. It is, therefore, important for diagnostic purposes to know whether the ocular paralysis appeared simul- taneously with the paralysis of the extremities, — a condition ol* thhigs which could only very rarely occur in the case of a tumor at the basis cerebri. If anaesthesia appear, it is only present in the side opposite the disease. The sensory fibres run to a great extent in the lemniscus. If a disease-centre extend farther dorsad and involve tlie corpora quadrigemina themselves, there appear, as may be easily understood from a glance at our cross-section, paralyses of the oculo-motor, which may involve either one or both nerves. In disease of the anterior quadrigeminal body there is amaurosis; in some cases the ophthalmoscope reveals absolutely nothing. In tumors, of course, as in tumors in other regions of the brain, we may have choked disk, atrophy of tlie optic nerve, etc. Generally, the pupil does not react either way. We do not know what symptoms are caused by disease of the posterior quadrigeminal body. Disturbances of equilibrium and co-ordi- nation have been observed in such cases. We shall most strongly suspect disease of the corpora quadrigemina if, in cases of paralysis of the oculo-motor, wc- can exclude peripheral causes (on the base of tlie brain), or when only a part of the oculo-motor (for instance, the fibres to tlie internal muscles of the eye) is injured. In affections of a peri plieral origin this would be impossible ; such paralyses are nuclear. LECTURE VIII. THE PONS AND THE CEREBELLUM. Gentlemen : We learned in the last lecture that the bundles of fibres from the fore- and inter- brains arranged them- selves into two layers in the region of the mid-brain. These layers were called the crusta or pes pedunculi and the tegmen- tum. Back of tlie corpora quadrigemina the aqueduct becomes markedly broader. Both pes and tegmentum pass under it and farther back into the liind-brain. Only one division of tlie teg- mentum, the anterior peduncles of the cerebellum, arising in the red nucleus, now passes dorsad from the floor of the mid- brain to the roof of the hind-brain. From this roof has been developed the cerebellum in adults. The space lying under it, the continuation of the aqueduct, is called the ventriculus quartus. The prolongations of the crusta and tegmentum are contained in the floor and lateral portions of the hind-brain. Let us first see what becomes of the fibres of the pes. Not far back of the corpora quadrigemina a thick mass of white fibres is laid across the crusta. Arising from tlie cerebellum, they pass down, surround, and cover the region of the pes in a thick layer. Taken together, these fibres are called the pons. Only a portion of these fibres cover in the surface of the crusta (stratum superficiale pontis) ; the majority of them dip in between the fibres of the latter, and divide them into isolated bands (stratum complexum et profundum pontis). You will remember that of the fibres which pass downward from the brain in the crusta a part could only be traced as far as the pons. They were the fasciculi from the frontal, parietal, and temporal lobes. The pyramidal tract from the central con- volutions passes tlirough and below tlie pons. Almost the (127) 128 LECTURES ON THE CENTRAL NERVOUS SYSTEM. whole inner and the whole outer thh'd of the pes go no farther than the pons. Below this point only the fibres of the middle third, the pyramidal tract, appear. The accompanying figure shows this and gives a front view of the pons, together with the crura cerebri and the cerebellum. The pyramidal tract is shaded dark. Fig. 74 shows in diagram the arrangement and course of fibres in a section through the pons. The fasciculi come from above on each side, out of the cerebellum, surround and pene- Fig. 73. The pedunculus cerebri and the pons seen from in front. That tract of the crusta which does not terminate in the pons is shaded dark. Hirnschenkel, Peduncrdus cerebri. Kleinhirn, Cerebellum. Pyramide, Pyramid. träte the fibres of the pes, and, crossing over to the opposite side, are associated with the longitudinal bundles of the latter. It is pretty well established that they are connected with a good share of the fibres of the pes and serve to establish a communi- cation' between them and the cerebellum. How this is effected is not known. Numerous ganglion-cells lie among the fibres of the pons. These are caught in a fine net-work of medullary fibres, and to this net-work only can the fibres of the pes be traced on the one hand, and the fibres of the pons on the other. This much is certain, that bundles arise from the region of THE PONS AND THE CEHEBfXLUM. 121) the pons which pass at right angles to those oi' tlie crusta over to the opposite cereheUar hemisphere. Aside from this it is not certain, and not even prohable, that all the fibres of the |)ons are to be regarded merely as con- tinuations of the cerebral fibres. The arms of the pons (brachia pontis) contain more fibres than are conveyed to it by the crusta. Moreover, many of them acquire medulkiry sheaths at a time Fig. 74. Diagram of a .section through the pons and cerebellum. Baube, Tegmentum. Faseni aus tl. Vorderhirn, Fibres from the fore-brain. when no single fibre of the crusta is so enveloped. This con- dition I have seen in cats. Although the pes peduncuU is pierced through and through by the fibres of tlie ])ons, and in part diverted into the cere- bellum, yet tlie tegmentum is continued through the region of the pons with very little change. In the last section througli the quadrigeminal region we distinguish the following as the principal structures of the tegmentum (compare Fig. 62) : — 1. The gray substance around the aqueduct, together with its nerve-nuclei. 130 LECTURES ON THE CENTRAL NERVOUS SYSTEM. 2. Below it the fasciculus longitudinalis posterior, and' external to this — 3. The fibres of the posterior commissure. 4. The fibres from the strise medulläres thalami. 5. The red nuclei in the midst of the tegmentum, and spring- ing from them the superior or anterior cerebellar peduncles. 6. The lemniscus. 7. The pedunculus corporis mamillaris. 8. Fibres from the deep marrow near the median line. 9. Fibres from the stratum intermedium. Before reaching the region of the pons, the red nucleus begins to diminish in size, the an- terior cerebellar peduncles arising from them pass more and more toward the periphery, and here form two thick, white strands, which lie between the region of the red nucleus and the fillet. In Fig. 15 we see the first traces of them at B, and in sections made a little farther back, but which still pass through the corpora quadrigemina, they are already found somewhat farther toward the periphery (Fig. 76). In Fig. 77, which represents ä section through the velum medulläre posticum, they form the outside margin of the cut. Soon after this they pass into the cerebellum. The region which is left unoccupied by the disappearance of the red nucleus is filled in by the increasing fibres of the sub- stantia reticularis, which we shall study later on. The aqueduct, as before stated, becomes expanded into the fossa rhomboidalis. The gray matter surrounding it also increases in area. A new nerve-nucleus, that of the nervus trochlearis, is met with in this region. Its fibres, however, do FKx. Commencement of the pons and the decussation of the cerebellar peduncles. B, anterior cerebellar peduncles ; L, fillet of a newborn child. The medullary fibres of the tegmentum are stained with hsema- toxylin. THE PONS AND THE CEREBELLUM. 131 not, like those of the oculo-niotor, pass backward through the tegmentum. They run directly caudad from their point of origin, then turn upward and decussate with the corresponding fibres of the opposite side in the velum medulläre anticum. Thus they emerge from the brain on its dorsal aspect, just behind the corpora quadrigemina. Portions of the course of the trochlear fibres are shown in Figs. 76 and 77. According to J Stilling, the nerve also receives a rootlet from the cerebellum. Tlie whole course of the nerve, as obtained from dissections, is shown in Fig. 67. Oculo-motor fibres are no longer given off N-tfoehL Fig. 76. Fig. 77. (From a newborn child. Haematoxylin stain.) Fro. 76.— Section througli the ending of the corpora quadrigemina. The decussation of the cerebellar peduncles almost completed, the red nucleus very small. Fibres of the trochlear nerve to be seen above. Fio. 77.— Section through the velum medulläre anticum, in which can be seen the trochlear nerve. The red nucleus has disappeared, the cerebellar peduncles lie almost at the periphery. The substantia reticularis occupies the situation formerly held by the red nucleus. In the pons is a little fasciculus or medullary fibres. All the rest of the fibres of the crusta are non-medullary, and are only shown in outline. at this level. The posterior longitudinal fasciculus and the stratum lemnisci, however, are continued down to this level. They still occupy the same relative positions which they did in the quadrigemiual region, as may be seen by comparing Figs. 72, 75, 76, and 77. In sections through the commencement of the pons the substantia nigra has disappeared from view. Thus it comes that the layer of the fillet is no longer separated from the pes, but lies directly upon it. If we have once formed a clear idea of the diffbrent struc- tures to be se(Mi in a good section through the quadrigemiual region, we shall have no difficulty in recognizing and locating 132 LECTURES ON THE CENTRAL NERVOUS SYSTEM. them in a section through the upper part of the pons. The main points of difference are the changed position of the cere- bellar peduncles and the altered shape of the gray matter under the broadening aqueduct, where new nerve-nuclei now appear. In sections lower down, however, the whole appearance of things is changed. This comes from the fact that the roof of the ventricle, caudad of the velum medulläre anticum, is devel- oped into the cerebellum, and tliat fibres from both the tegmentum and the crusta enter into intimate association with the latter. The anterior peduncles and the fibres of the pons disappear into the cerebellum. From the medulla oblongata and the spinal cord below come fibres which are first interwoven with the tegmentum and then pass to the cerebellum. It is, therefore, better for us to abandon temporarily the study of the tegmental fibres at this point, just behind the corpora quadrigemina, and to turn our attention to other parts of the central nervous system, whose processes and prolonga- tions all meet just here. You will, unquestionably, be better prepared to understand a section through the tegmentum after you have learned the arrangement of fibres in the cerebellum, and have obtained an insight into the structure of the medulla oblongata and the spinal cord. The cerebellum consists of a median portion, or " worm "" (vermis), and the two hemispheres. It is connected with the inter-brain by its anterior peduncles from the red nuclei, with the fore-brain through the brachia pontis, — median peduncles. Through the former it receives fibres from the thalamus and the region of the tegmental radiation, through the latter fibres from the cortex of the frontal, parietal, and temporal lobes. A third connection is effected through the posterior peduncles (corpora restiformia, which we shall consider later), with the medulla oblongata and the spinal cord. In the accompanying figure, which shows the cerebellum as seen from above, we observe — 1. The situation with respect to the corpora quadrigemina, from beneath which the anterior peduncles pass to the cere- bellum. THE PONS AND THE CEREBELLUM. 133 2. The general form of the organ, the vermis in the middle and the hemispheres on eacli side. Both vermis and hemispheres are divided into several good-sized lobes. Those of the vermis are arranged around the central white substance like the fans of a steam-ship's screw. (This is shown in Fig. 81, wliich rep- resents a sagittal section through the middle of the vermis.) The vermis is connected on each side with the white sub- stance of the hemispheres, which is divided into lobes by deep Fig. 7«. The cerebelluni. Dorsal surface. Biwlearm, Anterior ceruljellar podiinclea. fissures, and into ridges by shallow ones. The dorsal surface of the vermis is called the superior vermiform process. It is divided into — 1. The lingnla, far forward between the anterior peduncles. 2. Tlie lobulus (tentralis (central lobe). This passes over into the ala^ lobuli centralis on each side. 3. The monticulus, of which we call the anterior portion the culinen and the ])ostorior portion tlie declivity. 134 LECTURES ON THE CENTRAL NERVOUS SYSTEM. 4, The folium cacuminis, at the posterior extremity of the vermis. On the dorsal surface of the hemispheres we can distinguish: 1. The anterior upper lobe, also called the lobus quadran- gularis, on each side of the monticulus. In front of it are the alse lobuli centralis. 2. The posterior upper lobe (lobus semilunaris superior). Both posterior upper lobes are connected by the folium cacumi- nis. The following cut shows the lobes of the under surface of the cerebellum. It presents a somewhat complicated appearance. Fig. 79. The cerebellum. Ventral surface. Binde A., Anterior cerebellar peduncles. In order to obtain a good view we must first sever the connec- tions of the cerebellum with the mid-brain, the pons, and the medulla oblongata. Thus, on each side are the three cut sur- faces of the three cerebellar peduncles. Between the anterior peduncles lies a thin membrane, the velum medulläre anticum, which is a part of the roof of the hind-brain. It is shown cut through in the figure. The lobes on the under surface of the vermis are called — 1. The nodulus. 2. The uvula. THE PONS AND THE CEREBELLUM. 135 3. The pyramis (pyramid). 4. Tuber valvulae, far back, and extending partly over on the dorsal surface. In the hemispheres lie — 1. The flocculus, on each side of the nodulus. 2. The tonsilla, on each side of the uvula. . 3. External to the last mentioned, the lobus cuneiformis. 4. Behind this, the posterior lower lobe, lobus posterior inferior. Its anterior part is called the lobus gracilis and its posterior part the lobus semilunaris inferior. Fig. 80. The three peduncles arising in the mid-brain, the pons, and the spinal cord, and pass- ine into the .erebellnin. Afier Hirs.hfcld and Leveille (Sappey) p:merKing from heiif-atli the corpora .) Througliout the wliole cervical and the upper part of the dorsal regions, in the angle between the intermedio-lateral tract and the posterior horn, the gray matter is not sharply defined, but projects out into the white substance in the form of a net-work of gray bands and fasciculi. This net-work is called the processus reticularis. At the terminal cone the gray matter is covered only by a thin layer of white substance (6'o, Fig. 91). 154 LECTURES ON THE CENTRAL NERVOUS SYSTEM. The root-fibres of the motor nerves pass by the spinal ganglia directly into the spinal cord, traverse the white substance, and enter the anterior horn. It is very probable that the axis- cylinders of all these fibres are connected with the large ganglion- FiG. 91. Sections through the spinal cord at different heights. The letters and figures show the spinal nerves at the level of whose exit the section is made. (After Quain.) cells as shown in Fig. 92. These cells, which constitute the first station of the motor innervation-tract, are so distributed over the section of the spinal cord that we can make out (to the left at m in Fig. 90) more or less distinctly a median and a THE ROOTS OF THE PERIPHERAL NERVES, ETC. 155 lateral group in front, and, behind the latter, a central group. In the cervical cord there is also a group in the lateral horn. On making a longitudinal section we see that these cells are somewhat more plentiful opposite the entrance of each root ; that is to say, they are arranged in segments. We call such an aggregation of cells, together with the root arising from it, a Fig. 92. From the anterior border of a section through thi- anterior horn of the gray matter. Passage of the cell processes into nerve-roots. Carmine stain *p. (After Itenle.) segment of the spinal cord. In human beings the segmentation of the cord is almost obliterated, but it is more pronounced in the lower animals. Nothing is certainly known as to the course of those pro- cesses of the ganglion-cells which do not terminate in axis- cylinders: a few app(?ar to extend directly to other ganglion- cells; the majority, however, are lost in a fine n(;t-work of most 156 LECTURES ON THE CENTRAL NERVOUS SYSTEM. delicate fibrils, which permeates all the gray matter, and of which it is still doubtful whether or not it is nervous tissue. The sensory roots, after passing through the spinal ganglia, — - Cp Cc Caa Ra Fig. 93. ■' ■ Half of a section through the lumbar cord. Äa, anterior I'oot ; iZp, posterior root ; ■ Rip, inner portion of the posterior root ; Cp, posterior commissure ; Caa, anterior com- : missure : Ce, central canal. The fine net-work of medullary fibres in the gray matter and the net-work of medullary fasciculi in the otherwise gray posterior commissure are not shown. (After Deiters.) run in part direct to the posterior horn and in part to the posterior white columns. The cell-complex of the spinal gan- glion is the real source from whieh these fibres arise. You recollect that embryology shows that the cells of this ganglion THE ROOTS OF THE PERIPHERAL NERVES, ETC. 157 grow peripherally toward the nerves and centrally in the direction of the spinal cord. The centripetal processes form what we call the posterior root. It is, however, joined by fibres which do not originate in the cells of the spinal ganglia. These are apparently the fibres which we see passing to a peculiar group of cells which resemble Fig. »4. Cross-section of the vesicular column (v). Fp, funiculus post. (After Henle.) those of the spinal ganglia. This group, columna vesicularis, or column of Clarke (Fig. 90), lies about at the junction of the anterior and posterior horns. Besides these cells it contains a small bundle of extremely fine nerve-fibres, which run in tlie long axis of the spinal cord. The vesicidar column can only be distinctly traced from about the end of the cervical to the beginning of the lumbar 158 LECTURES ON THE CENTRAL NERVOUS SYSTEM. enlargement; it probably, however, extends high up into the medulla oblongata. At the tip of the posterior horn there is found a glassy, semi-transparent body, — the substantia gelatinosa E-olandi. As has been shown by Corning, this is the remains of a tissue which was present throughout the spinal cord during' the embryonal period. Its cells strongly resemble ganglion-cells, but their nature is still unknown. Many fibres of the posterior root pass through it (Fig. 93). At several points in the gray matter there can be seen but few nerve-fibres, and scarcely any ganglion-cells. At these points the neuroglia is the only constituent, and they therefore present a pale-grayish, translucent appearance to the naked eye. A very plentiful deposit of neuroglia is situated around the central canal, and is called the substantia gelati- nosa centralis. The whole periph- ery of the spinal cord is also cov- ered with a thin mantle of almost Fig. 95. t i i • Part of cross-section of the white puro ncuroglia, — the gelatmous cor- Substance of one of the lateral columns. • t i The transversely-divifled nerve-fibres, tical laver. in the centre of each of which is an ;, •' ' roglia containing Deiters' ceUs. (After ihowhlte SUbstaUCe SUrrOUUd- ing the gray matter consists prin- cipally of fibres running lengthwise of the spinal cord, of the obliquely-ascending roots of the nerves, and of fibres which run more or less perpendicular to the long axis of the cord, from the gray matter into the white substance. The nerve-fibres have an axis-cylinder and a medullary sheath. The width of the latter varies greatly. The sheath of Schwann is wanting. Between the fibres lies the neuroglia, which at many points is continuous with a fibrous connective tissue. In this connective tissue, which is continuous externally vi^ith the neuroglia and with the pia mater, are situated blood-vessels which have a some- what radial arrangement. The neuroglia consists here, as in the THE ROOTS OF THE PERIPHERAL NERVES, ETC. 159 gray matter, of numerous cells with long, slender processes. The body of the cell is usually so small that the processes have the appearance of springing from the nucleus. Occasionally, how- ever, it is larger. These cells are called the spider-cells, or cells of Deiters. (See Fig. 95, at left). The spinal cord is, as a glance at a transverse section will show, divided into several columns by the entering nerve- roots and the longitudinal fis- sures. Internal to the spinal nerve-roots are situated the anterior or posterior columns, as the case may be, and exter- nal to them the lateral columns. The study of embryology and the investigation of cer- tain diseases of the spinal cord show that the anterior, lateral, and posterior columns are not uniform masses of fibres of equal importance, as might appear from a section through the adult organ, but that they are composed of several dif- ferent divisions. You remember the pyra- midal tract, whose course we traced fro.m the cortex of the motor zone through the capsule and the crusta to the ventral ])art of the pons. Let us ascertain in what part of the spinal cord this tract is situated. It is not diffif;ult to discover this. If a destructive disease involves any part of this extensive tract the nerve-fibres disappear, and are replaced by connective tissue. This process, which is called secondary degeneration, continues downward Fig. 90. Diagram of descendiiig degeneration in the pyramid, with a lesion in the left internal capsule. 160 LECTURES ON THE CENTRAL NERVOUS SYSTEM. into the spinal cord. Here it occupies two regions, — ^first, the innermost portion of the anterior column on the side of the brain-lesion, and, secondly, a large area in the lateral column of the oppo- site side. High up, at the commencement of the oblongata, we see that the crossed de- generation passes back to the side of the un- crossed degeneration ; that is, the degenerated tract decussates with the normal pyramidal tract. The tract which, in this instance, is involved in the descending degeneration is called, as in the brain, the pyramidal tract. In the spinal cord it is divided into the anterior (columnar) pyramidal tract (most median part of anterior column) and the lateral (columnar) pyramidal tract (in the posterior portion of the lateral column). There are grounds for believing that these pyramidal tracts contain most of those fibres from the brain to the spinal cord which con- vey the impulses for conscious movement. They degenerate only downward ; their nerve- fibres always disappear if the cross-section of the tract is destroyed at any point of its course in the brain or spinal cord. In human beings all the tracts in the^ spinal cord have their medullary sheaths at the time of birth. The pyramidal tract is the only exception to this rule. On a section taken from the spinal cord of a newborn child, therefore, the pyra- midal tracts appear gray in the midst of the Secondary descending whitC lateral ColumUS. degeneration following a . « ,i • ^ ^ j lesion in the left cerebral 1 he cross-scctiou 01 tlic pyramidal tract hemisphere. (After Erb.) '- •' diminishes gradually toward the lumbar- region. In the lower dorsal region the pyramidal tract of the THE ROOTS OF THE PEKIPHEHAL NKHVES. ETC. 161 anterior column can no lono^er be seen, because its fibres are lost in tlie regions from which the motor nerves issu(\ In Fig. 100 the points 7 and 7' give a general idea of tlie pyramidal tract at different levels of the spinal cord. Tli(^ examination of spinal cords affected by secondary degeneration throws still more light upon their structure. If Ave make sections of spinal cord whose continuity has been in- terrupted in the dorsal portion by pressure or any other violence, we shall find, as might be expected from what has already been Fig. 98. Cross-sfction tlirouffh the cprvical cord of a newborn child. The pjTamidal tracts without medullary filties aiijx'ar iilisteuing and clear. The direct i>yrauiidal tract in the anterior column cncroaclics uiarkedly upon theanti-ro-lateral cr>lumii. Grenzftrhii-ht, Limitinj^ layer. Griintlhiintlfl. Ur»iitiil-liiiii(Ile. Kleinltirniit:iOn.itriiii;i-hiilin. I-utcral cereVjellar tract. Sfilennfranii, Lateral column. Vnrrlirnlrinifi, Anterior column. Witrzfl Ziiiir, Zone of the roots. said, that the pyramidal tracts on each side have become degen- erated downward. But there is also a degeneration upward from the level of the injury. At first this degeneration occupies the whole area of the posterior c;olumn, but at a point a lew seg- ments higher up it is limited to that part of the column which lies along the posterior median fissure. In such specimens we can easily divide the posterior column into an inner and an outer one. The parts affected by this ascending degeneration (which extends into the oblongata) are fibres of the posterior 162 LECTURES ON THE CENTRAL NERVOUS SYSTEM. roots, which have been divided from their gangiion-cells in the spinal ganglia. If we divide these posterior roots experiment- ally jnst outside the spinal column (Singer) we shall produce an exactly similar degeneration. Just abo\ e the divided point both the outer and tlie inner posterior columns are degenerated; farther up new and liealthy root-fibres enter and arrange them- selves to the outside of the injured ones, so that the area of degeneration is gradually puslied farther and farther toward the median line as we pass higher up in the cord. The study of the development of the medullary sheaths confirms the conclusion reached by the investigation of secondary degeneration. It teaches tliat there are here, at least, two sets of fibres, — an outer one, ordinarily called the fmidamental bundle of the posterior column, also called wedge-shaped column, or column of Burdach, and an inner one, which is called the slender column (funiculus gracilis), or Goll's tract. In the normal adult cord the two divisions of the posterior column* are separated from each other by a septum of connective-tissue only in the cervical region. In sections made lower down we can only distinguish them when one or the other is degenerated, and therefore is differently stained. Goll's tract increases in size from below upward as far as the upper dorsal region, probably because portions of the pos- terior nerve-roots are continually entering it on their way to the medulla oblongata. It is not improbable that still furtlier sub- divisions of the posterior columns will be made in the future. The manner of extension of certain diseases, and occasional rare forms of secondary degeneration, lead us to anticipate tliis. Fig. m. Ri^condary ascending and descending degenera- tion followiiig a" trans- verse division of tlie eord in tlie upper dorsal re- gion. (After Strümpell.) * Funiculus cuneatus and funiculus gracilis in Fi postero-internal columiis. B, also called pnstero-external and THK HOOTS OF THE PEKJl'HEKAL NERVES, ETC. 1()3 The region near tlie gray coinmissun', wliich is mark(Ml A in Fig. 98, on the left, must contain a distinct system of fibres, because, for example, it never becomes involved in cases of tabes, even tliougli tlie other parts of the posterior columns degenerate. We may call this the ventral field of the posterior column. The posterior columns consist of the entering fibres of the 1 Ficf. IW. Section« tlinnigh tlie spinal cord in the upper cfrvical region, the dorsal region, and the middle of the lumbar region. Boundaries of the ditf'erent cfdumns of tlie white sabstance. 1. Basal hiiiiille of the anterior column. 2. Basal bundle of posterior cf)luinn, the wedge-shajied coluiim or column of IJurdacti. ?,. Anterior mixed zone of lateral column. 1. Ijateral boundary -layer of gr:iy substance. .5. The delicate column, or column of fjoll. ft. r^ateral cerebellar tract. 7. Oossed pyramidal- tract in lateral column. 7'. Direct i)yiamidal tract in anterior column. «, anterior roots. The gray substance is shown black. (After Flechsig.) posterior roots. Tlieso roots are arranged in such a way tliat when they first enter tlie cord they lie on the outer side near the posterior lioni, ;iiid those entering Jifterwnrd (ij-., aljove tlietn) crowd th(;ir predecessors inward. Thus it ]Ki[)pens tliat in the cervical region tlie fibres from the lower extremities are found principally in the colmnii of (ioll, while the colii^n of IJurdMcli contains very many fibres from the u})[)er (.'xtremities. You must not imngine, gentlemen, that these divisions of the posterior 164 LECTURES ON THE CENTRAL NERVOUS SYSTEM. columns convey upward all the fibres of any posterior root. Many of the fibres pass into the gray matter directly after the root has entered the spinal cord, and others pass, first into the posterior horn and then into the gray matter. Therefore, rela- tively few of those fibres which entered the posterior columns below are to be found in the upper part of the, cord. Experi- mentally we have ascertained that the area of degeneration due to section of a posterior root becomes continually smaller as it is traced upward. At the same time it moves inward. At the upper part of the spinal cord the funiculus cuneatus receives fibres which do not come directly from the posterior roots. Their origin is uncertain. But, as you have been told before, all the sensory fibres do not terminate in the cells of tlie spinal ganglia ; a part pass through the ganglia apparently to end in the cells of the column of Clarke, their first terminal station. These fibres remain normal when the root is cut across, for the reason that they are not divided from their own cells in that experiment. They do degenerate, however, if the continuity of the spinal cord itself is broken. In fact, in the latter case (Fig. 99), we see still another tract of fibres degenerate. It is that shown in tlie peripheral portion of the lateral columns at 6, in Fig. 100. This tract can be traced as far as the worm of the cerebellum. It is owing to embryological researches (Flechsig) that we are able to recognize and distinguish this direct lateral cerebellar tract from other tracts in the lateral column. In the first weeks of life, before the pyramidal tract has become medullated, the cerebellar tract lies like a delicate white border along one-half of the periphery of the lateral column. Just in front of the cerebellar tract lies a tract which projects like a wedge from the periphery of the lateral column toward the centre. It is not indicated in the diagrams, but is apparently independent, for it may degenerate (upward) by itself It is called the fasciculus antero-lateralis. By the study of secondary degeneration and embryology, therefore, we have discovered the following systems of white THE ROOTS OF THE PERIPHERAL NERVES, ETC. 165 fibres. To these .sul)cli\ isious we have given the general name of cohimnar systems. In the anterior columns the anterior direct pyramidal tract ; in the lateral columns the lateral crossed pyramidal tract, and the direct cerebellar tract ; in the posterior columns the ground-biuidles and the funiculi graciles. If you will look at Fig. 100 you will observe, aside from the above-named, two areas in the section which have been left white. They are marked 1 and 3, and are situated in the anterior and lateral columns. They are probably a region \vhich is only traversed by the anterior roots, and have received the name of remnant of the antero-lateral column. The part lying in the anterior column is also called the anterior ground-bundle (1, in figure). The part lying in the lateral column has received the name of anterior mixed zone of the lateral column (3, in the figure). The fibres of the remnant of the antero-lateral column arise in part in the anterior roots and in part in the gray matter. They come principally from the centripetal pro- cesses of the sensory tract. The field marked 4 in Fig. 100 (lateral limiting layer of the gray matter) contains the direct continuations of the nerve-roots which, after passing transversely through tlie posterior horn (see Fig. 98), ascend in this layer. L(3t us, now that we have learned the general arrangement of the structures of tlie spinal cord, see what becomes of the entering root-fibres, tlie examination of which we abandoned for a time. Let us see how far their course within the central organ has been investigated. We are no longer considering the form and arrangement of the different parts of the central nervous system ; that which now demands our attention is the intimate connection between its constituent elements, the relation of fil)re to fibre and of fibre to cell. The fasciculi of the antcnior roots pass in a gentle ascent through the midst (jf the antero-lateral columns. Each fasciculus is spread out over a large extent of the white substance. For tins reason any injury to the column must involve a certain number r)f the anterior root-fibres, and it is therefore impossible 166 LECTURES ON THE CENTRAL NERVOUS SYSTEM. to arrive at any conclusion concerning the function of the antero- lateral column proper by section experiments on animals. The anterior roots, which contain motor fibres, and also exert a trophic influence on both muscle and nerve, are an important constituent of the columns now under consideration. The accompanying drawing and Fig. 102 will give you an idea of the central course of the anterior roots. On reaching the gray substance the component fibres of each bundle separate. There are many and conflicting state- ments as to the ultimate destiny of these fibres. The following explanation, which is based largely on my own investigations, is an at- tempt to harmonize the most important of these statements. First, we may consider it as settled that the fibres of the anterior roots pass to the ^:^\y^li ganglion-cells of the anterior horn, or, rather, ^^^^^^•'^ become continuous with their axis-cylinder process (see Fig. 92). A few of these fibres pass to the cells of the opposite anterior horn by way of the anterior commissure. The nuclei of the anterior roots are con- nected by nerve-fibres with the pyramidal tracts. We see large numbers of these fibres at the bottom of the anterior median fissure passing across the middle line of the anterior direct pyramidal tract. The fibres, from the anterior horn to the lateral crossed pyramidal tract, are less easily demonstrated on account of the obliquity of their course and the extreme difliculty of making a section exactly in their plane. In Fig. 102 these central portions of the motor tract are indicated by fine lines, the peripheral (gan- glion-cells of the roots) with coarse ones. The nature of union between the ganglion-cells and the pyramidal fibres is unknown. Fibres pass from the anterior horn to the lateral and median portions of the ground-bundle of the antero-lateral column. Fig. 101. Passage of the ante- rior roots through the substance of the spinal cord. (Diagrammatic.) THE ROOTS OF THE PERIPHERAL NERVES, ETC. 167 The anterior commissure is composed of the central fibres from the root-nuclei to the opposite anterior pjTamidal tract, the fibres from the roots to the corresponding cells of the opposite side, and of fibres from the posterior horn. All these fibres are surrounded and enclosed by an extra- ordinarily close tangle of fibres, the unraveling of wliich has never been accomplished. This mass of fibres, without doubt, contains other nerve-tracts of which we know nothing. Tliat portion of this net-work, which is medullary at birth, is correctly depicted in Fig. 98. The investigation of the relations of the posterior roots presents peculiar difficulties. We never see a fibre connect unmistakably with a cell-process : there is always a net- work between the two. We must bear in mind, too, that the greater part of these roots is made up of central fibres ; that is, of fibres which liave already passed their first terminal station (the spinal ganglion). AVe have made out tlie course of some of tliese central fibres by the study of secondary degeneration. We have seen that they pass directly into the column of Bur- dach along with the root-fibres, and that they show a tendency to pass more and more to the median line, so that in levels above tlieir point of entrance they lie nearer the middle line in the cohimn of Goll. But we have also seen that, while tliey were working toward tlie median line, they were continually giving off fibres to the gray matter. If I am to succeed in giving you a clear explanation of the complicated relations existing at the entrance of the posterior roots, I must particularly request you to study the following text with continuous reference to Fig. 102. On a trans\(;rse section of tlie spinal cord we see that the posterior root divides into at least four parts. The most median bundle (1, in Fig. 102), which consists of coarse fibres, passes almost entirely and directly into the white posterior columns at the same l(!vel with thtjir point of entrance. These are the before-mentioned central tracts ; along with these, fibres of equal 168 LECTURES ON THE CENTRAL NERVOUS SYSTEM. size (2, Fig. 102) pass into the spinal cord, which do not run directly toward the median line, but pass in a curve through the white substance laterally toward the columns of Clarke, where they are lost sight of. A few fibres run directly through the posterior horn \entrad of the substantia gelatinosa, and then Fig. 102. Diagram of a transverse section of the spinal cord, showing the central course of some of the most important tracts. Compare Fig. 98, which is not diagrammatic. Grenzschicht. Limiting layer. Grund Bündel, Ground bundle. Kleinhirn-Seitenstrunff-Bahn, Lateral cerebellar tract. Pyramid. Vnrd-St. B., Anterior pyramidal tract. Pyramiden-Seitenatr. B., Lateral pyramidal tract. Seitenstr., Lateral column. Vorderstr., Anterior column. continue their course into the limiting layer of the lateral column. They are shown with peculiar distinctness in Fig. 98. The two last-described portions of the posterior roots lie on the median side of the apex of the posterior horn. Laterally from these lie the bundles which are distributed to the latter ; we can distinguish both coarse and fine fibres. Neither of them terminate at the level of their entrance into the cord. The larger THE ROOTS OF THE PERIPHERAL NERVES, ETC. 169 fibres (o, in Fig. 102) pass directly through the substantia gela- thiosa Rohmdi, which Hes at the tip of the posterior horn, and at once turn upward and downward, and only pass farther into the gray substance at other levels. The fine fibres (4, in Fig. 102) become separated from the coarse immediately after the entrance of the root, and pass as a separate bundle upward and downward between the tip of the substantia gelatinosa and the periphery. The cross-section of this fasciculus was called zona terminalis by Lissauer, to whom we are mainly indebted for our knowledge on this point. Fibrils are continually given off" from the zona terminalis to a net-work lying between it and the sub- stantia gelatinosa. This net-work is called the zona spongiosa, and from it fine fasciculi arise, which pass into the substantia gelatinosa and are lost in the maze of fibres which make up the main mass of the posterior honi. From this intricate maze of fibres are developed new fasciculi, which pass across to the opposite side through the anterior and posterior commissures, and, emerging from the gray matter, are continued upward to the 1)rnin in the ground-bundles of the anterior and lateral columns. We have, therefore, distinguished two paths in which the fibres of the posterior roots are continued upward, — a direct one, in the posterior columns, and an indirect path by which, after passing through the posterior horn, in some un- kn.own manner, the fibres cross to the opposite side. We shall see later that the direct fibres, alter passing through a nucleus in the medulla oblongata, also decussate. It would not have been possible for me to recognize this arrangement of tlie fibres of the posterior root were it not for the fact that, in tlie lower vertebrates, the order of the; fibres in the spinal cord is a very simple one: I might almost call it V«i' •■ N' • /,' //■'^ .^^\^ ■' Horn fyrar Fig. 109. Section through the commencement of the medulla oblongata taken fi-om a human embryo of the 20th week. Notice the tracts from the columns of Burdach to the decus- sation of the fillet, and the flbrse arciformes externae posteriores from the column of Goll, which will be described later on. Observe the situation of the dh'ect lateral cere- 'bellar tract. Kleinhirn Bahn. Cerel)ellar tract. Vorderhorn, Anterior horn. Oliv.-Zwineh.-ScMcht, Inter-olivary layer. Vorder-Strang-Rest, Remains of anterior column. funiculi gracilis et cuneati their respective nuclei have appeared, and both are continuous with the gray matter. External to these lies the substantia gelatinosa of the posterior horns, surrounded by a thin stratum of medullary fibres (ascending root of fifth nerve). The space in front of them, which, in Fig. 108, is oc- cupied by the dark pyramidal fibres, appears clear because these fibres have not yet become medullary. The remnant of the SPINAL CORD AND COMMENCEMENT OF MEDULLA OBLONGATA. 183 antero-lateral column and the direct lateral cerebellar tract at the periphery of the lateral column have become medullated. Fig. no. Rection throuff!) tho nifdulla ol>lniieata of an embryo of the 20th week. The medul- lary fibres an- .stameü with liieiiiatoxvlin. The left iiiter-olivary layer and the ascending root of the trigeminus are not showi'i. In tlie restifonn body only that portion which is derived from the spinal cord is medullary. Fibrie arci formes = fi brae arciformes externae anteriores. The jiosterior external arciform filires can be seen, outside and above, be- tween the restiforni body aii(l the posterior column. BintTftranfi. PoBt«rior cohimn. Jlint. Ni^ben Otioi; Posterior accessory olivary process, /nn. Neben Olive, Internal accessory clivary process. Oliven Zu:inrlien.irliirJil, Inter-olivary layer. Seitenttr. Balm, Lateral (cerebellar) tract. We now see fibres arising from tlie nuclei of tlic posterior cohimns, which pass in a curve tlirough the gray matter (fibrae arciformes interna)), decussate in front of the central canal, and 184 LECTURES OX THE CENTRAL NERVOUS SYSTEM. lie iu a tliick stratum dorsad of the pyramids, which have, at this level, completed their decussation. The region in which they lie is the one which was occupied by the antero-lateral columns in the spinal cord. The main mass of crossed sensory tracts which ascended in the latter is crowded backward and outAvard by these new-comers. Thus, the now united crossed sensory tract fills up all tlie space between the olivary bodies (olivae inferiores). The latter are gray masses, which first appear in the medulla oblongata at this level. The higher we pass in the medulla oblongata, the fewer fibres are there found in the posterior columns. Gradually, all of them pass, by way of the arciform fibres, to the decussation of the lemniscus, and extend to the opposite side near the middle line, where they form the inter- olivary layer, or, as we wül call it from now on, the layer of the fillet. The fibres of this layer pass to the fillet of the mid-brain. It has been frequently claimed that the fibres of the pos- terior columns do not follow this course, but rather pass into the olivary bodies, and from there through the posterior peduncles of the cerebellum into that body. My investigations have shown, however, that they all, or nearly all, follow the course I have described. At the embryological period of which I was speaking, both the olivary bodies and their whole vicinity are destitute of medullary fibres. We can therefore prove, in the most convincing manner, that the fibres of the posterior columns have no connection whatever with them, but only pass through them. Fig. 110 represents a section through the same foetal oblongata shown in Fig, 109. This section is made somewhat higher up than the latter, and shows clearly the point of which I speak. You see that the fibres pass through the olivary bodies (which at this level have the appearance of plicated medullary laminae) to the decussation in the middle line (^raphe^ continuation of the decussation of the fillet). Fig. Ill is a diagram of the course of the sensory fibres. Let us, with the aid of this diagram, trace out the course of the separate tracts, and ascertain what location in the medulla is SPINAL CORD AND COMMENCEMENT OF MEDULLA OBLONGATA. 185 assigned to each. Please notice in this, as in the hist figure, how tlie tracts which decussated in the spinal cord and those wliich ascended directly are united to form a single body. We have now met with two important decussations, — that of the pyra- mids and that of the lemniscus. The former is composed of motor fibres, while the latter contains the sensory tracts. There are formed, therefore, two new large tracts of fibres, which lie in the ventral portion of the oblongata, viz., the pyra- midal columns, and, dorsad of these, the layer of the fillet, or inter-olivary layer. We shall find them both occupying the same relative positiov^ as far up as the corpora quadrigemina. The transverse area of tlie layer of the fillet is, in adults, much richer in fibres than is shown in the illustrations, which have been prepared from sec- tions taken from the foetus. In the latter none of the sensory fibres from the antero-latcral columns are medullary, and only those bundles which come from the nuclei of the posterior fobimns can be seen. The whole configuration of the section is changed by these two decussations. In addition to this the gray matter, as I will presently show you, varies its outline. New masses of gray matter appear in the oblongata. We have already met three Fk;. hi. Diat!;raiu of the course of the sensory tract from the posterior roots to the medulla ohlongata. Kl'inhirn-Seiten B.. lateral cerebellar tract. Vonlcr-Seitennlr., Antero-lateral column. 186 LECTURES ON THE CENTRAL NERVOUS SYSTEM. of these on each side, — the two nuclei of the posterior columns * and the olivary body. The greatest difference is in the outer conformation of the section. The fibres of the posterior columns tniiearm JV'achkirn. :^' j^eis^njiij^. Fig. 112. The hind- and after- brains opened by removing their roof. The velum medulläre anticum and the cerebellum can still be seen. The velum medulläre posticuni has been removed along the dotted line a b: Bindearm, Peduncle. Hinterhirn, Hind-brain. Hirnschenkel, Pedunc. cerebri. Kleinhirn, Cerebellum. Mittelhim, Mid-brain. Nachhim, After-brain. Rückenmark, Sp. cord. Zwischenhim, Inter-brain. are pushed gradually forward by the interposed nuclei, so that at last the latter are wholly uncovered and lie almost free on the dorsal surface of the medulla. The posterior columns SPINAL CORD AND COMMENCEMENT OF MEDULLA OBLONGATA. 187 diverge somewhat in the reoion of the obloiiiiata, so that the central gray matter lies exposed on the po'sterior surface of the spinal cord. Only a thin membrane of gi'ay matter divides the central canal from the free surface. This canal expands along' with the diverging posterior columns, and from now on is called the fourth ventricle. The thin membrane which covers it is called the velum medulläre posticum, and is continuous anteriorly with the cerebellum. In the sagittal section, Fig. 66, you can see how the hind-brain roof is formed by the velum medulläre posticum, the cerebellum, and the velum medulläre anticum. Just at the commencement of the fourth ventricle is an opening- through the velum medulläre posticum, which leads from the outside into the ventricular cavity. It '\ß the previously-described foramen of Magendi. Through this the fluid in the ventricles communicates w-ith that which lies outside between the pia and the medulla, and, in the cavity of the arachnoid, bathes the whole central nervous system. In Fig. 112 this whole roof is removed, so that we are looking directly into the fourth ventricle. Its floor is bounded behind by the diverging posterior columns and in front by the anterior cerebellar peduncles, which converge toward the corpora quadrigemina. This condition of things has given it the peculiar shape from which it has received its name, — fossa rhomboidalis. The posterior view of the oblongata (Fig. 112) shows that the posterior columns disappear above, and that the posterior cerebellar peduncles, the corpora restiformia (see below) take their place. The enlargement in the upper portion of the mnor posterior column is called the clava, and is caused by the nucleus funicvdi gracilis. A front (ventral) view of the medulla oblongata (Fig. 113) shows first the thick pyramidal columns ascending from the spinal cord. External to them, imb(>dded in the prolongntions of the lateral columns, are two good-sized enlargements. — tlie olivary bodies. Not far above them the thick masses of fibres which constitute the pons pass across in front of the pyramids. 188 LECTURES ON THE CENTRAL NERVOUS SYSTEM. In the prolongation of the line of exit of the anterior roots, between the olivary bodies and the pyramids, the hypoglossal nerve {XII) emerges from the medulla oblongata. The spinal accessory nerve of Willis (X/) arises by numerous radicles, which are given off along the side of the cervical cord, and high up in the oblongata, external' to the olivary bodies. Above and in line with it emerge the vagus (X) and the glosso- pharyngeal {IX). Laterally, close behind the fibres of the M.cerv, Fig. 113. Medulla oblongata, pons, cerebellum, and pedunculus cerebri seen from in front. To show the origin of the cranial nerves. pons, are given off the acoustic ( F///) and the facial nerves ( VII). The sixth cranial nerve, the abducens, lies internal to the point of origin of the two last mentioned. The trigeminus ( V) arises from the depths of the pons. The origins of the trochlear {IV) and the oculo-motor (///) have already been given. The first emerges from the velum medulläre posticum behind the corpora quadrigemina, and the second from the ventral surface of the pedunculi cerebri. Spinal cord and commencement of medulla oblongata. 189 \\'(^ lel't oft' studying- tlio isectiou of the oblongata at the point where the central canal expands mto the rhomboidal fossa. The first nuclei of tlie cranial nerves had begun to appear below this point. The fibres of the acoustic arise from cells in the lateral portion of the anterior horn. From a point some- what ventrad pf the latter, perhaps representing the position of the former anterior liorn, arise the fasciculi of the hypoglossal ner\-e. This is diagrammatically shown in the accompanying figure. FKi. n4. Section tliroiiKli tlie itici1u11;i oldongata at the 'level of tlie most posterior roots of the h ypofrlossiil nerve. ( 1 )ia};ranimatic. ) All" II, sir. K'-ni'iit, From tlio nuilei iif tlie finsterifir columns. Anx l}Url-ni»inrh; Frnin tlie spinal PorJ. ly.ifli. liiiltii, Lateral cerebellar trait. JUnliihoni, I'osUM'ior Imrn. HiiiliTKlriiniif, l'ciütericir eolunins. .S'-liIri/', Fillet. Viiiili r-Sr'ilinhtirn, Anteni-lateral horn. If. looking at this diMgrnm. you will remember tliat tlie central canal broadens out jdong witli I he diverg(>nce of the posterior columns and becomes tlie fourth \entricle. you will ensily under- stMiid thnt nil nerve-nuclei developed in the floor of the ventricle nbove this j)oiiit must lie on the floor of the rhomboidal fossa. Tlie following rut (l''ig. 11 5) shows this clearly. I'iXternal to the nerve-nuclei lie tlie ])osterior columns (now nearly devoid of fibres), with tbeir respective^ nuclei. TIk; postxn'ior horn, recognizable by the substantia gelatinosa of its head, is entirely 190 LECTURES ON THE CENTRAL NERVOUS SYSTEM. severed from, the compact portion of the gray matter. The basal portion of the lateral horns, from which arise the fibres of the motor accessory, are also separated from it a short distance above the level of this section. The latter continues ventrad of the former, as an independent column of gray matter, rich in ganglion-cells, high upward into the pons ; and wjien the fibres to the accessory are no longer given off it sends fibres to the Fig. 115. Section through the medulla oblongata at the level of exit of the vagus nerve. (Diagrammatic .) Hinterhorn, Posterior horn. Hinterx/ni'iige, Posterior cohimns. 3fot. Vagus etc. Kern, Motor vagus, etc., nucleus. OHv. Zwhch. ScMcht., Inter-olivary layer. fSchhifenfa/iern, Fibres of fillet. Seitc.nstranfil-ern, Nudeui; of lateral column. Vni-derhornrent, Remnant of anterior horn. vagus (and hypoglossal X ), which at first pass dorsad and then bend back to the respective nerves (motor vagus, etc., nucleus). Still higher, we meet it as the nucleus of the facial nerve. You will notice that, with the exception of the hypoglossal and the nerves to the ocular muscles, all the motor fibres of the cranial nerves originate in this upward prolongation of the basis of the lateral horns of tlic spinal cord. SnXAL CORD AND COMMENCEMENT OF MEDULLA OBLONGATA. 191 Please notice in Fig. 115 the position of the remnant of the anterior horn and the great increase in volume of the olivary bodies. When the lateral horn is divided from the rest of the gray matter there appears, at the point where, lower down, the posterior liorn was attached (a region, therefore, which, in the spinal cord, was occupied by the nuclei of sensory nerves), a large new nucleus with spindle-shaped cells much lilie those of the posterior horns. This is the sensory nucleus of the vagus. It lies on the floor of the rhomboidal fossa, internal to the ala cinerea (Fig. 112), and extends forward to about the middle one of the transverse white lines which you see crossing the fossa. From this anterior end arises the glosso-pharyngeal nerve. The nucleus of the glosso-pharyngeal is not sharply divided from tliat of the vagus. AVe now see that there are two nuclei for tlie vagus, — a vcnitral one. which, from its situation (prolongation of a portion of the anterior horn) and from its cells (multipolar Mitli axis-cylinders), we judge to be motor, and a dorsal ouo, wliich, from its situation in the prolongation of the gray matter at the base of tlie posterior horn and from its structure, we take to be sensory. Tlie first mentioned of these is also called the nucleus aml)iguus. The fibres arising from it all pass dorsad, and unite and turn at angle to join the straight sensory root, which is much larger. (See Fig. 115.) Besides these two nuclei the vagus receives fibres from at least two other regions. There is a small fasciculus wliich can be traced from the cervical medulla up to the point in the oblongata, where the last roots of th(^ glosso-pharyngeal arise. On its median side is a column of gelatinous substance containing a few cells. The fibres from tlK'se all pass to the fasciculus just mentioned. At the level of the vagus-roots it begins to send oft" fibres to them, and this it does to all the roots of the vagus and the glosso-pharyngeal. This fasciculus is called the common ascending vago-pharvngeal root.* , It can be seen in Figs. 110 jiiid 1 LS, dorsad of the \agus- • (jiierkc's lespiratory luiiMlle. 192 LECTURES OX THE CENTRAL NERVOUS SYSTEM. roots. In addition to this the vagus and glosso-pliaryngeal apparentlv receive a descending root. It arises in the cere- belhim. where we met it under the name of direct sensory cerebellar tract. These particular fibres, passing from it to the vagus, are hard to demonstrate in the human being. Apparently ,}hLcleusX Pibrae. propriae TtiicleiXn- lfu:leu3 XII. FibraeafrerenUa ruhclei Xß - -NtuUllsXHRoRo- •Kervus XII Fir. 116. Frontal seotion tlirouo;li the niulins d, both with regard to their relations to the central gray ganglia and to their course iVom the fore-brain down to the termination of the mid-brain, or from the spinal cord up to the same level. Still, it seems advisable again to examine a few of them brieiiy, either because they are of particular importance in connection with physiology or pathology, or because the comprehension of their whole course was rendered more difficult on account of their being traced, for didactic reasons, in an opj)Osite direction after Lecture \U. Let this short recital serve as your guide in a sort of re\ iew, which you can easily undertake with the aid of the illustrations. 1. The pyramidal tract: The most important -tract of notor innervation arises from the upper two-thirds of the central ••on volutions and the paracentral lobule, and runs to a point l)ehiud the knee of the internal capsule. From there it passes into the pe> peduncuh. where it occupies the middle third. In the pons its fibres are but little divided by the transverse hbres of the latter. After (mierging from tlic pons its fibres lie in two thick bundles on tlie ventral surlace of the oblongata. In this position tluy pa>s to tlie spinal cord. Here the great mass of the fibres cross to the op))osite lat(Mal cohunns; a smaller portion (anterior ])yramidal tract) remains on the same side. Both these masses of fibres enter into relations witli the cells of tlie anterior horns of tlie side opposite their cortical origin in the brain. From tliese cells tlie motor n^ots arise. Compare Figs. 44, 47, 56, 62, 220 LECTURES ON THE CENTRAL NERVOUS SYSTEM. 72, 73, 96, 97, 98, 99, 100, 102, 103, 104, 108, 113, lU, 115, 120, 125, and 127.) 2. The central tract of the motor cranial nerves is only accurately known in the case of the facial and hypoglossal. The facial tract arises in the vicinity of the lower third of the central convolutions. Apparently this supplies the lower hranches only ; the cortical centre of the frontal branches is not known (gyrus angularis'?). It then passes inward across the lenticular nucleus, and is finally found in tlie internal capsule, very close to the pyramidal tract. It cannot he (clinically) distinguished from the latter. Its fibres then abandon the general motor in- nervation tract apparently in company with the " bundle from the pes to the tegmentum," which has been frequently men- tioned. They certainly are separated in the pons (see diagram. Fig. 68). It is not known how it reaches the nucleus. At all events it reaches the opposite liicial nucleus, which lies in the caudal part of the pons. From this the nerve is given off. (See Figs. 47, 121, 122, 124, 125, 126, and 132.) In the most ventral portion of the anterior central convolu- tion is apparently situated the cortical centre of the hypoglossal nerve. At all events bundles pass from this region, ventrad of those going to the facial, whose destruction is followed by bilateral disturbances of the hypoglossal. On its way from the cortex to the internal capsule it passes over the upper edge of the lenticular nucleus, and must lie very near the speech- tract, just outside the commencement of the tail of the nucleus caudatus. In one case, which came under my observation, a diseased spot not larger than a 5-cent piece broke down both tracts at this point. In the internal capsule the hypoglossal tract probably lies between that of the facial and that of the extremities. Inside the pons its fibres must become separated from the pyramids. They apparently withdraw from the latter on the median side of the fillet, and pass upward and backward in the raj)he. It is only on reaching the oblongata that they pass to the nucleus of the opposite (and the one on the same"?) THE PONS FINAL REVIEW. '2'2l side. From these nuclei arise the nerve. (Compare Figs. 47, 108, 110, lU, 115, 116, and 132.) 3. The motor speech-tract. We possess certain knowledge of only a fen' points along this tract, — the point of origin in the lower frontal convolution, the terminal point in the nuclei of the facial and hypoglossal, and, between tlie two, a point out- side the tail of the nucleus caudatus. Apparently (Wernicke) the tract passes somewhat toward the median line from Broca's convolution — third frontal — and pursues an almost horizontal course under the island, dorsad of the internal capsule. Its fibres then pass into the internal capsule behind the motor tracts, and from there run to the crusta. In the pons they must gradually pass up into the tegmentum. Disturbances of speech have been observed in disease of all the above-mentioned points. (See Figs. 27 and 28.) 4. The coronal fibres to the pons arise from the cortex of the fore-brain, particularly from the frontal and parieto-occipital lobes. They pass through the internal capsule into the crusta, and from there into the pons (Fig. 56). From here they pass either directly or through interpolated ganglion-cells into the middle peduncles of the cerebellum, or brachia pontis. 5. The tegmental radiation arises in the parietal lobe, pos- sibly in the same regions as the pyramidal fibres, and passes into the posterior third of the internal capsule. In this situation it is very closely approached by the optic radiation from the oc- cipital lobe, and by the central tract of the acoustic. (As regards the latter tract, this has been demonstrated clinically, but not anatomically). A part of the tegmental tract passes into and through the lenticular nucleus, and a part passes directly into the fillet. Probably these two portions become united on the median side of the body of Luy's, — upper fillet. (Compare Figs. 47, 51, 52, 54, 56, and 59.) 6. The largest part of th(^ fillet arises from the deep marrow oi" the corpora quadrigemina and Irom the nucleus of the pos- terior quadrigeminal body. In all likelihood it represents the 222 LECTURES ON THE CENTRAL NERVOUS SYSTEM. central sensory tract, or at least contains a good share of it. (Figs. 62, 65, 66, 70, and 72). The fillet then passes back in the tegmentum of the cms, the pons, and the oblongata. On its way it gives off fibres to the opposite nuclei of the trigeminus, the acoustic, the glosso- pharyngeal, and the vagus. (Figs. 127, 126, 125, 122, and 121). In the medulla oblongata a large share of the fibres branch off and pass dorsad over the middle line to the nuclei of the posterior columns, — internal arciform fibres. (Figs. 120, 117, 115, lU. Ill, 110, and 109.) • The fibres of the posterior columns run caudad from the nuclei of these columns. Opposite each spinal-nerve root a few fibres are given off, which emerge with the root and enter the cells of the spinal ganglion. From these cells the sensory nerve arises. Those fibres of the fillet which are left after the tracts to the nuclei of the posterior columns have been given off run backward in the anterior and lateral columns of the spinal cord. A number of these fibres pass off to the gray matter opposite each sensory spinal nerve, traverse it, and enter the opposite posterior horn. They are lost in the net-work of cells and fibres at that point; from this net- work, however, a great number of the sensory fibres arise. They all terminate directly in the spinal ganglion, and from this the sensory fibres arise. (Figs. 102. 100, and 88). In this way connections are established between all the fibres of the layer of the fillet and the nuclei which lie on the opposite side. A portion decussate in the oblongata, the rest only do so after reaching the spinal cord. From these nuclei the fibres of the posterior roots are given ofi'. You have seen that the motor nerves are connected directly with the cells of the anterior horn, and have learned that a central tract, partly direct and partly crossed (the pyramids), arises from the anterior horns. The direct part (lateral pyramidal tract) passes across to tlie opposite side in the oblongata, and so THE PONS FINAL REVIEW. 223 joins the other part which had ah*eady crossed in the spinal cord. The two, united, form the pyramids of the oblongata. We also know that the sensory nerves have aij analogous central course. The nerve first passes to its nucleus in the spinal ganglion. From the nucleus a direct tract is developed, Avhich passes upward in the posterior columns. In the oblongata it passes over to the other side. Their course differs from that of the motor nerves in that they pass through a nucleus (nucleus of the posterior column) before decussating. In addition to this, there is given off from the spinal ganglion a tract which decussates directly after entering the spinal cord, but this tract must also pass through the unknown mechanism of the posterior horn. There is an important and characteristic difference between the ways in which the two sets of nerves are connected with their prolongations into the brain. The connection is always a crossed one, but, in the case of the sensory nerve, an additional apparatus is interposed in the cord, between the nucleus of origin, which lies outside the cord, and tlie central tract. With a motor nerve the case is different ; its nucleus of origin already lies in the cord. 7. The central course of the trigeminus from the cortex to tlie capsule is unknown. Its fasciculi must, according to patho- logical experience, lie in the posterior third of the capsule. From here a tract must pass to the tegmental nuclei, the most anterior of whicli lies under the corpora quadrigemina, in the lateral wall of the aqueduct, the middle one in the midst of the pons, and tlie most posterior extends from the cervical cord u\) to tlie point of exit of the nerve. Near the point of exit is situated the motor nucleus of the nerve. Patholoiiv tf^aches us that the ascending root contains the sensory fibres for the face. The central tract reaches all these from the fillet of the opposite side. These fibres are well known and were described in Lec- ture XI. From the tri'^r'minal nuclei ;irise the roots whose Bcnsory portions pass into ganglia ((jasseriaii ami ciliary ganglia. 224 LECTURES ON THE CENTRAL NERVOUS SYSTEM. etc.), just like the posterior roots of the spinal nerves. The nerves arise from these ganglia. (Compare Figs. 47, 72, 86, 109, 110, 113, 114, 115, 125, 127, 128, and 132.) 8. .As to the cerebral source of the acoustic nerve, we may assume that it is situated somewhere in the temporal lobe, that from here it is connected, in some way, with the posterior por- tion of the capsule, and that the acoustic tract passes on in that portion of the fillet which originated in the nucleus of the posterior qnadrigeminal body. On reaching the level of the acoustic nucleus it passes to the opposite of these structures in the striae acusticae. There are two acoustic nuclei, — a dorsal, Avhich resembles a sensory nucleus, both in situation and structure, and a ventral, which has a somewhat similar structure to tliat of the spinal ganglia. From its relations it may, perhaps, be compared to one of the latter. Through its ventral nucleus, the acoustic . nerve is connected with the upper olivary body. From the latter, fasciculi run to the cerebellum and to the nuclei of the ocular muscles, and probably farther up to more anterior regions of the brain. (Compare Figs. 47, 65, 85, 113, 121, 122, 125, and 126.) The trigeminus and the acoustic both receive fibres from the cerebellum. 9. Nothing is known about the central course of the vagus in the fore-brain. If the often-mentioned region in the posterior portion of the capsule is destroyed, no symptoms appear which can be attributed to the vagus. Disturbance of the sense of taste (glosso-pharyngeal) is present. Reference has been made to the course of the fibres from the fillet to the opposite nuclei of the vagus and glosso-pharyngeal. These nerves also apparently receive a tract from the cerebellum. 10. The central course of the optic nerve has been explained in all its relations. (Compare Figs. 56, 57, 61, 62, 66, and 70.) I will again remind you that this nerve arises from the pulvinar thalami, the corpus geniculatum laterale, the tuber THE PONS FINAL REVIEW. '2'2') cinereum, and, mainly, from the corpora quadrigemiha. Fibres iVom the optic radiation, which commences in the occipital lobe, pass to all these sources. This radiation passes along- the outer side of the posterier horn of the lateral ventricle, and, therefore, in its passage from the cortex to the ])rimary optic centres, it runs under the lower parietal lobule. Hence, in diseases of the latter, or when it has been experimentally destroyed in animals, disturbances of vision arise which resemble those of cortical origin. The fibres of the optic tract run to the chiasm. There the greater part of tliem cross to the opposite side. A small portion, which, however, are not gathered into a distinct bundle, remain on the same side. The conflict which was carried on for vears over the chiasm has lately been definitely settled by Singer and Münzer, with the results given above. The optic tract must contain pupillary fibres coming from the oculo-motor nerve. It is not yet known by what course they reach the former. INDEX. Abducens nerve, 188, 207 Accessory nerve, 178, 188 Accessory olivary process, internal, 200 posterior, 200 Ala cinerea, 191 Amputation, spinal-cord, 7-10 Ansa peduncularis, 91 lentiformis, 88, 113 Anterior coUimns, 159 horn of ventricle, 15 horns, 152 mixed zone of lateral column, 165 Aqueduct of Sylvius, 96 Arbor vit:B, 136 Arms of tlie pons, 43, 132 Association fibres, 69 Axis-cylinder, 41 Baillarser's line, 65 Basal fore-brain bundle, 21, 79 Brain, emljrj'olotrv of, 20 peduncles of, "27, 36. 85 Brain-cortex, comparative anatomy, 22 phvsiolosrv, 58 histology." 63, 137 Brain-sand, 96 Broca's convolution, 221 Burdacb, 2, 12 Burdach's column, 162 Calcar avis. 53 Capsule, external, 38 internal, 18, 37, 76, 80 Central convolutions, 48 ventricular gray matter, 38, 91 Centrum semiovale, 31 Cerebellar peduncles, 132 anterior, 105, 111, 132, 142 middle. 132. 142 posterior, 132. 142 Cerei)ellum, 14, 2!), 34, 132 Cei^vical enlargement of spinal cord, 150 Chiasm, 100 (choroid plexus (fore-brain), 14 Cafter-brain;, 137 Cingulum, 71 Clarke, columns of, 157, 170 Claustrum, 38, 80 ClavH, iHl Columna fornicis Csee also Fornix), 52 vesiculariH, 157. 170 Commissura, anterior (fore-brain), 38, 52, 71 (spinal cord), 167 media, 36, 52, 91 posterior, 36, 104 thahimi dorsalis, 26 Conarium (see Pineal gland) Conus terminalis, 150 Convolutions of cerebrum, 45 Cornu ammonis, 54, 55 Corona radiata, 24, 85 Corpora quadrigemina, 14, 34, 95, 105, 106, 114, 121 Corpus callosum, 32, 52, 71 ciliare (dentatum), 138 geniculatum laterale, 26, 36, 89, 108 geniculatum mediale, 36, 108 maraillare (candicaus), 92, 93, 99 opticum, 20 restiforme, 132, 142, 195-198 striatum, 16. 21, 78 subthalamicum (Luys), 93, 104 trapezoides, 205 Cortical epilepsy, 70 Crura fornicis, 35 Crusta, 27. 85, 97, 124, 126 Culmen, 133 Cuneus, 53 Declivity, the, 133 Decussating commissure, anterior, 139, 143, 144 posterior, 144 zone, 142 Degeneration, secondary, 6, 147, 159, 162 Deiter's nucleus, 208 cells, 159 Dendritic tracts, 142 Direct sensory cerebellar tract, 143, 192, 203 Ehreiiberg, 2 Embolus, 138 " Embryolo;;;y of central nervous system, 13 Embryonic lamina terminalis, 13 Epiphysis, 20, 25, 35, 96 Facial nerve. 188. 204, 207 Fascia dental a, 55 Fasciculus anlero-lateralis, 164 (227) '228 INDEX. Fasciculus arcuatis, 71, 73 longitudinalis, inferior, 71 posterior, 120, 300 retroflexus, 131 uncinatus, 41 Fibrse arciforuies, 142, 195 intern 86, 183 proprise (of the cortex), 68 Fifth nerve, ascending root, 177 descending root, 122 Fillet, 36, 95, 104, 113, 321 Filuiu terminale, 150 Fimbria, 54 Fissura calcariua, 53 hippocampi, 54 occipito-temijoralis, 57 parieto-occipitalis, 53 Sylvii, 15, 45 Flechsig, 7 Fleece, the, 143 Flocculus, 135 Folium cacuminis, 134 Foramen of Magendie, 138, 187 of Monro, 34 Fore-brain, secondary, 14 Formatio-reticularis, 302 Fornix, 16, 35, 51 Fountain like decussation of the teg- mentum, 114, 124 Frontal lobe, 24, 48 Funiculus gracilis, 163 cuneatus, 162 Furrows of cerebrum, 45 Ganglion-cells, 40 Ganglion habenulse, 26, 36 Ganglionic ridge, 19 Gaskell, 39 Gasserian ganglion, 323 Gelatinous cortical layer, 158 Gennari, line of, 65 Gland, pineal, 30, 35, 35, 96 Globus pallidus, 38, 86 Glosso-]>haryngeal nerve, 188, 191, 234 Goll's tract, 163, 182 Granular layer, 138 Ground-bundle of posterior column, 162 of anterior column, 165 Gudden, 7 Gudden's commissure, 108 Gyrencephalous manigials, 23 Gyri insulse, 48 Gyrus angularis, 49 centralis ant. et post., 48 dentatus, 54 formicatus, 53-55 hippocampi, 53-55 marginalis, 49 occipito -temporalis, 57 uncinatus, 52 Hannover, 3 Hearing, nerve of, 108, 188, 304, 331 Hemispheres of cerebellum, 134, 135 History of investigation of the brain, 1-11 Horns of lateral ventricle, 15 Hypoglossal nerve, 188, 193, 201, 220 central tract of, 74, 220 Hypophisis, 35, 100 Inferior horn of ventricle, 15, 199 Inferior longitudinal fasciculus, 71 Infundibulum, 35, 38, 100 Inter-brain, 13, 14, 25, 74, 89 Inter-olivary layer, 184, 198 Intumescentia cervicalis, 150 lumbalis, 150 Island of Reil, 38, 46 Knee of corpus callosum.. -^2 of internal capsule, 80 Lamina medullaris thalami, tL'# terminalis, 101 Laqueus, 26, 95, 104, 113, 321 Lateral cerebellar tract, 164, 195 columns, 159 Latticed layer, 90 Lemniscus (see Laqueus) Lenticular nucleus, 18, 38, 78 divisions of, 86, 87 Limiting layer of gray matter, 165 Lingula, 133 Lisencephalous mammals, 23 Lobes of cerebellum, 133 Lobi optici, 26 Lobus centralis, 133 cuneiformis, 135 frontalis, 24, 48 gracilis, 135 ■ lingualis, 53 occipitalis, 50 olfactorius, 100 parietalis, 49 posterior inferior, 135 quadrangularis, 134 semilunaris inferior, 185 superior, 134 temporalis, 48 Localization and symptomatology of disease in: — the cortex, 57 the central ganglia, 102 the cerebellum, 145 the quadrigeminal region, 134 the spinal cord, 150, 173 the oblongata and pons, 315 the white substance, 81 Locus cceruleus, 310 Longitudinal fissures (spinal cord), 152 Lumbar enlargement " " 150 Luys, body of,' 93, 104 INDEX. 229 Margin of hemisphere, 14 Mai riuul convolution, 55 Marrow, deep, 27, 114 Medulla oblongata. 29, 176 spinalis, 27, 150 Medullary sheath in spinal-cord, 158 structure of, 8 Methods of investigating the central nervous system, 4-14 Meynert's bundle, 121 Mid-brain, 1:3, 84, 95, 120 Motor area of tegmentum, 199 nuclei of cranial nerves, 190, 222, etc. roots, 147, 201, 222 speech-tract, 74, 221 Nerve-fibres, 40 two forms of origin of, 41 Neuroglia, 39 ** Nodulus, 134 Nuclei acustici, 204 Nuclei of the thalamus, 89 of trigeminus, 209, 210 of trochlear nerve, 130 Nucleus ambiguus, 191 amygdalae, 38 arciformis, 196 caudatus, 18, 34, 77 dentatus, 138 fastigii, 144 funiculi gracilis. 181, 182 cuneati, 181, 182 globosus, 138 lemnisci, 212 lentiformis, 18, 38, 78, 86 of abducens, 207 of accessory nerve, 178 of facial nerve, 204 of glossopharyngeal nerve, 191 of oculo-motor nerve, 115 of hypoglossal nerve, 193 pyramidalis, 201 reticularis tegmenti, 203 ruber, 93, 94" Oblongata, 29, 176 Occipital lobe, 50 sulci, 50 Oculo-motor nerve, 115, 188 Olfactory nerve, 25, 100 bull), 25 Olivary body, inferior, 176, 184, 197 superior, 205 0|»erculum, 47 Optic nerve, 26, 100, 108, 224 Pallium, 21 Paracentral lobule, 53 Parietal lobe, 49 oriran, 26 Pedicle of thalamus, 74 Pedunculi cerebelli, 132 , cerebri, 27, 36, 85 conarii, 36, 96 corporis mamillaris, 92 Pes hippocampi major, 54 minor, 53 pedunculi, 27, 85, 97, 124, 126 Plexus choroideus (fore-brain), 14 (after-brain), 137 Pons, 14, 29, 74, 98, 127, 215 Posterior columns, 159 nuclei of, 181, 182 Posterior horns, 152 head of 177 neck of, 177 roots of spinal cord, 147, 156, 167, 224 Pnecuneus, 53 Processus protoplasmalici, 42 reticularis, 153 Pulvinar, 36. 89 Purkinje, cells of, 138 Putamen, 38, 79, «6 Pyramidal column, 180. 198 tract, 74, 98, 111, 219, 222, etc. ♦ in anterior column, 160, 222 in lateral column, 160, 223 Pyramis cerebelli, 135 Raphe, 199 Rays, 21 Red nucleus, 93, 94 Regio subthalamica, 88, 93 Reil, 2 Remak, 2 Remnant of antero-lateral column, 165 Respiration bundle, 191 Rhomboidal fossa, 96, 175. 187 Saccus vasculosus, 25 Secondary degeneration, 6, 160, 161 Sensory nuclei of cranial nerves, 191, 200. 201. 223 roots, 18, 147, 156, 223 Septum pellucidum, 16, 34, 51 Speech -tract, 74, 221 Spider-cells, 159 Spinal cord, 28, 149 segmentation of, 151, 155 ganglia, 147 Splenium, 52 Stilling, 2-4 Stratum complexum et profundum pontis, 127 intermedium (Meynert's), 111 sui)erficiale pontis, 127 zonale, 89 Stria medullaris, 36 longitudinalis F.ancisi, 56 terminal is, 36 StriiP acMsticie, 207 Substantia gelatinosa centralis, 158 230 INDEX. Substantia gelatinosa Rolandi, 158 innominata, Ql nigra, 95 perforata, anterior, 100 posterior, 98 reticularis, 130 Sulcus calloso-marginalis, 53 centralis, 48 insulae, 47 interparietalis, 50 olfactoi-ius, 56 orbitalis, 56 prsecentralis, 48 Sylvius, fissure of, 15, 45 Tangential fibres of cortex, 65 Tapetum, 73 Tegmental bundle of corpus mamillare, 93 radiation, 75, 87, 91, 113, 331 tract, central, 301 Tegmentum, 37, 85, 111, 133, 139 motor area of, 199 Temporal convolutions, 48 lobe, 48 Thalamic s;anglia, 85 Thalamus," 14, 34, 74, 89 Tonsilla (cerebelli), 135 Tractus intermedio-lateralis, 153 olfactorius, 35, 100 Tractus opticus, 26, 89, 100 Trigeminus nerve, 188, 209, 333 Trochlear nerve, 130, 188 Tuber cinereum, 35, 38, 100 olfactorium, 100 valvulse, 135 Tuberculum acusticum, 204 anterius, 36 Uvula (cerebelli), 134 Vagus. 188, 191, 334 Velum medulläre anticum, 134, 136 posticum, 31, 137,. 187 Ventricle, 14, 15, 33 Ventriculus lateralis, 14, 15, 33 quartus, 96, 127, 140, 176, 187 septi pellucidi, 34 Vermis, 132, 133 Vicq d'Azyr's bundle, 93 White substance, 158 of cerebrum, 31 of hemispheres of cerebellum, 135 of vermis, 133 Worm, 133, 133 Zona spongiosa, 169 terminalis, 169 Zone of anterior horn (His"i. 29 SEASON OF 1891-1892. @ ATALOGUE In place of repeated revisions. Supplements to tliis Catalogue will be issued at intervals of about every three months. These supplements will be regularly mailed to all those who will favor us with their name and address. OF THE Medical Publications OF r. A. DAVI5, Medical Pcjbli5Her ^h^ B00K5ELLER, 1231 riLBERT 5TREET, PHILADELPHIA, PA. Branch Offices: NEW YORK CITY— 117 W. Forty-Second St. CHICAGO— 24 Lakeside Building. 214-220 S. Clark Street. ATLANTA— 69 Old Capitol. LONDON, ENG.— 40 Berners Street, Oxford Street, W. Order from Nearest Office. For Sale 1>y all Booksellers. SPECIAI^ NOTICE. PRICES of books, as given in our catalogues and circulars, include full prepayment of postage, freight, or express charges. Cus- tomers in Canada and Mexico must pay the cost of duty, in addition, at point of destination. N. B.— Remittances should be made by Express Money-Order, Post-Oflace Money-Order, Reg-istered Letter, or Draft on New York City, Philadelphia, Boston, or Chicago. "We do not hold ourselves responsible for books sent by mail ; to insure safe arrival of books sent to distant parts, the package should be registered. Charges for registering (at purchaser's expense), ten cents for every four pounds, or less. INDEX TO CATALOGUE. PAGE Annual of the Universal Medical Sciences ....'. 27, 28, 29 Anatomy. Practical Anatomy — Boenning 4 Structure of the Central Nervous Sys- tem — Edinger 8 Charts of the Nervo- Vascular System — Price and Eagleton 17 Synopsis of Human Anatomy — Young . . 25 Bacteriology. Bacteriological Diagnosis — Eisenberg . . 8 Clinical Charts. Improved Clinical Charts — Bashore ... 3 Consumption. Consumption : How to Prevent it, etc. — Davis 7 Domestic Hygiene, etc. The Daughter : Her Health, Education, and Wedlock — Capp 5 Consumption : How to Prevent it, etc. — Davis 7 Plain Talks on Avoided Subjects- Guernsey 9 Heredity, Health, and Personal Beauty — Shoemaker 21 Electricity. Practical Electricity in Medicine and Surgery— Liebig and Rohe 12 Electricity in the Diseases of "Women — Massey 13 Fever. Fever : its Pathology and Treatment — Hare 10 Hay Fever— Sajous 19 Gynecology. Lessons in Gynecology— Goodell 9 Heart, Lungs, Kidneys, etc. Diseases of the Heart, Lungs, and Kidneys— Davis 7 Diseases of the Heart and Circulation in Children— Keating and Edwards ... 12 Diabetes : its Cause, Symptoms, and Treatment— Purdy 17 Hygiene. American Resorts — James 11 Text-Book of Hygiene— Rohe 18 Materia Medica and Thera- peutics. ■ Hand-Book of Materia Medica, Phar- macy, and Therapeutics— Bowen ... 4 Ointments and Oleates— Shoemaker ... 21 Materia Medica and Therapeutics— Shoe- maker 22 International Pocket Medical Formulary — Witherstine 26 Miscellaneous. PAGE Book on the Physician Himself— Cathell . 5 Oxygen — Demarquay and Wallian .... 7 Record-Book of Medical Examinations for Life Insurance— Keating 11 The Medical Bulletin, Monthly 13 Physician's Interpreter 15 Circumcision— Remoiidino 18 Medical Symbolism— Sozinskey 23 International Pocket Medical Formulary —Witherstine 26 The Chinese : Medical, Political, and Social— Coltman 31 A, B, C of the Swedish System of Educa- tional Gymnastics — Nissen 32 Lectures on Auto-Intoxication — Bouchard 32 Nervous System, Spine, etc. Spinal Concussion — Clevenger ..... 6 Structure of the Central Nervous System — Edinger 8 Epilepsy : its Pathology and Treatment- Hare 10 Lectures on Nervous Diseases— Ranney . 39 Obstetrics. Childbed : its Management : Diseases and Their Treatment— Manton 13 Eclampsia— Michener and others 15 Obstetric Synopsis— Stewart 24 Pharmacology . Abstracts of Pharmacology— Wheeler . . 25 Physiognomy. Practical and Scientific Physiognomy — Stanton 39 Physiology, Physiology of the Domestic Animals — Smith 23 Surgery and Surgical Operations. Circumcision — Remondino 18 Principles of Surgery— Senn 20 Swedish Movement and Massage. Swedish Movement and Massage Treat- ment — Nissen 15 Throat and Nose. Journal of Laryngology and Rhinology . 11 Hay Fever— Sajous 19 Diphtheria, Croup, etc. — Sanne 19 Lectures on the Diseases of the Nose and Throat— Sajous 31 Venereal Diseases. Syphilis : To-day andän Antiquity— Buret 4 Neuroses of the Gen ito-Uri nary System in the Male— Ultzmann 24 Veterinary. Age of the Domestic Animals— Huide- koper 32 Physiology of the Domestic Animals — Smith 23 Visiting-Lists and Account- Books. Medical Bulletin Visiting-List or Physi- cians' Call-Record 14 Physicians' All-Requisite Account-Book . 16 (2) Bäshore's Improved Clinical Chart. For the SEPARATE PLOTTINa of TEMPERATURE, PULSE, and RESPIRATION. ( Convenient, Accurate, and Permanent Daily Recorc Hospital and Private Practice. By HARYEY B. BASHORE, M.D. Designed for the Convenient, Accurate, and Permanent Daily Recording of Cases in Hospital and Private Practice. OOPTRIOHTED, 1888, BY F. A. DAVIS. SO OlJ-a-rts, iix TaTolet r'orm.. Size, S 2E 12 ixicls.es. Prioe, in the United States and Canada, Post-paid, 50 Cents, Net ; Great Britain, 2s. 6d. ; France. 3 fr. 60. The above diagram is a little more than one-fifth (1-5) the actual size of the chart and shows the method of plouinR, the upper curve being the Temperature, the middle the Pulse, and the lower the Respiration. By iHi« method a fulJ record of each can easily be kept with but one color ink It is so arranged that all practitioners will find it an invalimble ;iid in tho treatment of their patients. f)n the back of each chart will be found ample space conveniently arranged for recording "Clinical History and Symptoms" and "Treatment " , .1 .- By its use the physician will secure such a complete record of his ca.ses as will enable hirri to review them at any time. Thus he will always have at hand a source of individual improveuient and benelil m the practice of hi» profession, the value of which can hardly be overestimated. (F. A. D Alf IS. Medical Publisher. Philadelphia, Pa., U.S. A.) Medical Publications of F. A. Davis, Philadelphia, A Text-Book on Practical Anatomy. Including a Section on Surgical Anatomy. B}^ Henry C. Boenning, M.D., Lecturer on Anatomy und Surgery in the Philadelphia School of Anatomy ; Demonstrator of Anatomy in the Medico-Chirurgical College ; Demonstrator of Anatomy in the Philadelphia Dental College ; Lecturer on Diseases of the Rectum in the Medico-Chirurgical College, etc, etc. Fully illustrated throughout with about 200 Wood-Engravings. In one handsome Octavo volume, printed in extra-large, clear ty\)e., making it specially desirable for use in the dissecting room. Nearly 500 pages. Substantially bound in Extra Cloth. Also in Oil-Cloth, for use in the dissecting-room without soiling. Price, post-paid, in the United States, $2.50, net; Canada (duty paid), $2.75, net; Great Britain, Us. ; France, 16 fr. 20. BOWEJ!>r Hand-Book of Materia Medica, Pharmacy, and Therapeutics. By CuTHBERT BowEN, M.D., B.A., Editor of" Notes on Practice." The second volume in the Physicians'' and Students'' Ready Refer- ence Series. One i2mo volume of 370 pages. Handsomely bound in Darli-Blue Cloth. Price, post-paid, in the United States and Canada, $1.40, net; in Great Britain, 8s. 6d. ; in France, 9 fr. 25. EXTRACT FROM THE PREFACE — " While this is essentially a Student's Manuai,, a large amount of matter has been incorpoi-ated which, it is hoped, will render it a useful refer- ence-book to the Young Graduate who is just entering on his professional career, and more particularly the individual whose sphere of work demands a more practical acquaintance with pharmaceutical processes than is required of the ordinary city practitioner. Great care has been taken throughout the book to familiarize the student witli the best methods of administer- ing the various drugs he will be called upon to use, and with this object a large number of standard prescriptions have been selected from the works of the most eminent authorities, which he can either adopt, with modifications to suit particular cases, or use as models on which to construct his own formulae." This excellent manual comprises in its 366 pages about as much sound and valuable information on the subjects indicated in its title as could well be crowded into the com- pass. The book is exhaustively and correctly indexed, and of a convenient form. The paper, press-work, and binding ai-e excellent, and the typography (long primer and brevier) is highly to be commended, as opposed to the nonpareil and agate usually used in eompends of this sort, and which are destructive to vision and temper alike. — 8t. Louis Med. and Surg. Jour. In going through it, we have been favorably impressed by the plain and practical sugges- tions in regard to prescription writing, and the metric sy.stem, and the other things which must be known in order to write good and ac- curate prescriptions. — Medical and Surgical Heporter BURET Syphilis : To-day and in Antiquity. By Dr. F. Buret (Paris). Translated from the French, with the author's permission, by A. H. Ohmann-Dumesnil, A.M., M.D., Professor of Dermatology and Syphilology in the St. Louis College of Physicians and Surgeons. To be completed in three 12mo volumes. Volume I, Syphilis in i"tiquity. In Press. Ready in October, 1891. (4) Medical Publications of F. A. Davis, Philadelphia. CAPP Her Health, Hducation, and ^Wedlock. The Daughter. Homely Suggestions to Mothers and Daughters. B}' William M. Capp, M.D., Philadelphia. This is just such a book as a fainil}- i)hysician would advise his lady patients to obtain and read. It answers man}' questions which ever}' busy practitioner ot" medicine has put to him in tlie sick-room at /i time when it is neither expedient nor wise to impart the information sought. It is complete in one beautifully printed (large, clear type) 12mo volume of 150 pages. Attractively bound in Extra Cloth. Price, post-paid, in the United States and Canada, $1.00, net ; In Clreat Britain, 5s. 6i ; France, 6 fr. 20. In the 1-14 pages allotted to liim he has com- pressed an axiiount of homely wisdom on the pliysicaL, inent:il, and moral "development of the female child from birth to maturity which is to be found elsewhere in only the great book of experience. It is, of course, a jjook for mothers, but is one so void of otfense in expression or ideas that it can safely be recom- mended for all whose minds are sufficiently developed to appreciate its teachings. — Phila- delphia Public Ledger. Many delicate subjects are treated with skill and in a manner which cannot strike any one as inipi'oper or bold. The absolute ignor- ance in which most young girls are allowed to exist, even until adult life, is often pnjductive of much misery, both mental and physical. Quite a number of books written by physi- cians for popular use have been prepared in such a way that the professional man can read between the lines strong bids for popular favor, etc. These objectionable features will not be found in Dr. Capp's brochure, and for this reason it is worthy the confidence of physicians. — Medical News. CATHBLL Book on the Physician Himself And Things that Concern his Reputation and Success. By D. W. Cathell, M.D., Baltimore, Md. Being the Ninth Edition (enlarged and thorouglil}' revised) of the " Physician Himself, and what he should add to his Scientific Acquirements in order to Secure Success." In one handsome Octavo Volume of 298 pages, bound in Extra Cloth. Thousands of physicians have won success in their chosen profession tlirough the aid of this invaluable work. This remarkable book has passed through eight (8) editions in less than five years. It has just undergone a thorough revison by the autlior, who has added much new matter covering many points and elucidating many excellent ideas not included in former editions. Price, post-paid, in the United States and Canada, $2.00, net; in Great Britain, Us. 6i; France, 12 fx. 40. I am most favorably impress<'d with the wi.sdoni and ('orce of the points m;idc, in "Tlie Physician Himself," and believe the work in the hands of a young graduate will greatly en- hance his chanees foi- profcKsional success. — From Prof. D. Hayes Aynew, Philu., Pa. We strongly advise every actual and intend- ing practitioner of medicine or surgery to have " i he Physician Himself," and the more it in- fluences his future conduct the lictter he will be. — from the ('anadu Medical and Surgical Journal, Montreal. In the present edition the entire work has been revised and some new matter introduced. The pulilislier's part is well done; paper Is good and the print birgo ; altogether it is a very r<-ahowH in a pliilomiphical mann<;r how mufdi au'alo.r good phvHifian» nii«ht 'lo 'f th«y nioi f! fully apprf;<;ia'ti--tca?) Journal of Obstetrics. His literary style is peculiarly charming. There is a directness and sinjplicity about it which is easier to admire than to copy. His chain of plain words and almost blunt expres- sions, his familiar comparison and homely illustrations, make his writings, like his lec- tures, unusually entertaining. The substance of his teachings we regard as equally excel- lent. — Philadelphia Medical and Surgical Reporter. Extended mention of the contents of the book is unnecessary; suffice it to say that every important disease fouml in the female sex IS taken up and discussed in a common- sense kind of a way. We wish every physician in America could "read and carry out the sug- gestions of the chapter on "the sexual rela- tions a.s causes of uterine disorders — conjugal onanism and kindred sins." The department treating of nervous counterfeits of uterine diseases is a most valuable ouc— Kansas City Medical Index. GUERNSEY Plain Talks on Avoided Subjects. By Henry X. Guernsey, M.D., formerly Professor of Materia Medici and Institutes in the Hahnemann Medical College of Philadi'Ii)hia ; author of Guernsey's " Obstetrics," including the Disorders Peculiar to Women and Young Children ; Lectures on Materia Mcdica, etc. The following Table of Contents shows the scope of tlie book: Contents. — Cliapter I. Introductory. II. The Infant. III. Child- hood. IV. Adolescence of the Male. V. Adolescence of the Female. VI. Marriage: The Husband. VII. The Wife. VIII. Husband and Wife. IX. To the Unfortunate. X. Origin of the Sex. In one neat IGmo volume, bound in Extra Cloth. Price, post-paid, In the United States and Canada, $1.00 ; Glreat Britain, 63. ; France, 6 fr. 20. (») Medical Publications of F. A. Davis, Philadelphia. HARJE Epilepsy: Its Pathology and Treatment. Being an Essay to which was Awarded a Prize of Four Thousand Francs by the Academie Royale de Medecine de Belgique, December 31, 1889. By HoBART Amory Hare, M.D. (Univ. of Penna.), B.Sc, Professor of Materia Medica and Therapeutics in tlie Jefferson Medical College, Phila. ; Physician to St. Agues' Hospital and to the Children's Dispensary of the Chil- dren's Hospital ; Laureate of the Royal Academy of Medicine in Belgium, of the Medical Society of London, etc. ; Member of the Association of American Physicians. No. 7 in the Physicians' and Students' Beady -Reference Series. 13mo. 228 pages. Neatly bound in Dark-blue Cloth. Price, post-paid, in TJnited States and Canada, $1.25, net ; in Great Britain, 6s. 6d. ; in Prance, 7 fr. 75. It is representative of tlie most advanced views of the profession, and tlie subject is pruned of the vast amount of superstition and nonsense that generally obtains in connection with epilepsj'.— 3/edicäi Age. Every physician who would get at the gist of all that IS worth knowing on epilepsy, and who would avoid useless research among the mass of literary nonsense which pervades all medical libraries, should get this work."— r^e Sanitarian. It contains all that is known of the pathology of this strange disorder, a clear discussion of the diagnosis from allied neuroses, and the very latest therapeutic measures for relief. It is remarkable for its clearness, brevity, and beauty of style. It is, so far as the reviewer knows, altogether the best essay ever written upon this important subject.— .ff^ansas City Medical Index. The task of preparing the work must have been most laborious, but we think that Dr. Hare will be repaid for his efforts by a wide appreciation of the work by the profession ; for the book will be instructive to those who have not kept abrenst with the recent litera- ture upon this subject. Indeed, the work is a sort of Dictionary of epilepsy— a reference guide-book upon the subject.— ^Wentsf and JVeurologist. HABE Fever: Its Pathology and Treatment. Being the Boylston Prize Essay of Harvard University for 1890, Containing Directions and the Latest Information Con- cerning THE Use of the So-Called Anti- pyretics IN Fever and Pain. By Hobart Amory Hare, M.D. (Univ. of Penna.), B.Sc, Professor of Materia Medica and Therapeutics in the Jefferson Medical College, Phila. ; Physician to St. Agnes' Hospital and to the Children's Dispensary of the Chil- dren's Hospital; Laureate of the Royal Academy of Medicine in Belgium, of the Medical Society of London, etc.; Member of the Association of American Physicians. No. 10 in the Physicians' and Students' Ready-Beference Series. 12mo. Neatly bound in Dark-blue Cloth. Illustrated with more than 25 new plates of tracings of various fever cases, showing beautifully and accurately the action of the Antipyretics. The work also contains 35 carefully prepared statistical tables of 249 cases showing the untoward effects of the antipyretics. Price, post-paid, in the United States and Canada, $1.25, net; in Great Britain, 6s. 6d. ; in Prance, 7 fr. 75. As is usual with this author, the subject is thorouehly handled, and much experimental and clinical evidence, both from the author's experience and that of others, is adduced in support of the view taken.— iV^ew; York Medical Abstract. The author has done an able piece of work in showing the facts as far as they are known concerning the action of antipyrin, anti- febrin, phenacetin, thallin, and salicylic acid. The reader will certaiidy find the work one of the moat interesting of its excellent group, the Physicians' and Students' Readp-Iipfer- ence Series.— The Dosimetric Medical Review. Such books as the present one are of service to the student, the scientific therapeutist, and the general practitioner alike, for much can be found of real value in Dr. Hare's book, with the additional advantage that it is up to the latest researches upon the subject.— i/mi^er- sity Medical Magazine, (10) Medical Publications of F. A. Davis, Philadelphia. JA3IES American Resorts, with Motes upon their Cllmate. By BüSHROD W. James, A.M., M.D., Member of the American Public Health Association, and the Academy of Natural Sciences, Philadelphia; the Society of Alaskan Natural History and Ethnoloacy, Sitka, Alaska, etc. With a translation from the German, by Mr. S Kauffmann, of those chapters of " Die Klimate der Erde" written by Dr. A. Woeikof, of St Petersburg, Russia, that relate to North and South America and the Islands and Oceans contiguous thereto. This is a unique and valualile work, and useful to physicians in all parts of the country. We mention a few of the merits it possesses: First. List of all the Health Resorts of the country, arranged according to their climate. Second. Contains just the information needed by'tourists, invalids, and those who visit summer or winter resorts. Third. The latest and best large railroad map for reference. Fourth. It indicates the climate each one should select for health. Fifth. The author has traveled extensively, and most of his suggestions are practical in reference to localties. In one Octavo volume. Handsomely bound in Cloth. Nearly 300 pages. Price, post-paid, in the United States and Canada, $2.00, net; Great Britain, lis. 6d. ; Prance, 12 fr. lO. Taken altogetlier, this is by far tlie most I] pathological indications and constitutional complete expo.sition of the subject of resorts i predispositions. — The Sanitarian. that ha.« yet been put forth, ana it is one that jl The book before ns is a very comprehensive every physician must needs possess intelligent ,i volume, giving all necessary information con- information upon. -/?(f/ra?o Jfert.d- iSw?-^. Jomj". j cerning climate, temperntnre, humidity, sun- The special chapter on the therapeutics of ! shine, är.d indeed everything necessary to be clin-ate . . is excellent for its precautionary \ stated for the benetit of the phy8ir.\NTON, M.D., Visiting Physician to the Detroit Woman's Hospital ; Consulting Gynfccologist to the Eastern Michigan Asylum ; President of the Detroit Gynaecological Society ; Fellow of the American Societ}' of Ob- stetricians and Gyna3cologiRts, and of the British Gynnecological Society ; Member of Michigan State Medical Society, etc. In one neat 12mo volume, iVb. in the Physicians' and Students' Ready- Reference Series. In Prep.au.\tion. Medical Bulletin. A Monthly Joirnal of Medicine and Surgery. Edited by John V. Shoemaker. A.M., M.D. Bright, original, and read- able. Articles by llie Ix^st practical writers procural)le. Every arlicle as brief a» is consistent with the preservation of its scientific value. Thera])eutic Notes by tiie leaderij of liie medical profession throughout tlu; world. , These, and nuiny other unif^ue features, ludp to kee]) 'I'lir, Mkdicai. Bui,i-etin in its lucscnt position as tlie leading low-price .Medicnl .Monthly of the- world. Subscribe now. TEEMS : $1.00 a year in advance in United States, Canada, and Mesico. Foreign Subscription Terms : England, 5s. ; France, 6 fr. ; Germany, 6 marks; Japan, 1 yen; Australia, 5s.; Holland, 3 florins. (13) Medical Puhlications of F. A. Davis, Philadelphia. The Medical Bulletin Visiting-List or Physicians' Call Record. Arranged upon an Original and Convenient Monthly and Weekly Plan for the Daily Recording op Professional Visits. Frequent Rewriting of Names Unnecessary. THIS Visiting-List is arranged so that the names of patients need be written but ONCE a month instead of four times a month, as in the old-style lists. By means of a new feature, a simple device consisting of stub or half LEAVES IN THE FORM OF INSERTS, the first Week's visits are recorded in the usual way, and the second week's visits are begun by simply turning over the half-leaf without the necessitj'' of rewriting the patients' names. This very easily under- stood process is repeated until the month is ended and the record has been kept complete in every detail of visit, charge, credit, etc., and the labor and time of entering and ti-ansferring names at least three times in the month has been saved. There are no intricate rulings ; not the least amount of time can be lost in comprehending the plan, for it is acquired at a glance. THE THREE DIFFERENT STYLES MADE. The No. 1 Style of this List provides space for the daily record of seventy different names each month for a year ; for physicians who prefer a List that will accommodate a larger practice we have made a No. 2 Style, which provides space for the daily record of lOö different names each month for a year, and for physicians who may prefer a Pocket Record-Book of less thickness than either of these styles we have made a No. 3 Style, in which "The Blanks for the Record- ing of Visits in " have been made into removable sections. These sections are very thin, and are made up so as to answer in full the demand of the largest practice, each section providing ample space for the daily record of 210 dif- ferent NAMES for two months ; or 105 different names daily each month for four months ; or seventy different names daily each month for six mouths. Six sets of these sections go with each copy of No. 3 Style. SPECIAL FEATURES NOT FOUND IN ANY OTHER LIST. In this No. 3 Style the printed matter, and such matter as the blank FORMS FOR Addresses of Patients, Obstetric Record, Vaccination Record, Cash Account, Birth and Death Records, etc., are fastened permanently in the back of the book, thus reducing its thickness. The addition of one of these removable sections does not increase the thickness more than an eighth of an inch. This brings the book into such a small compass that no one can object to it on account of its thickness, as its bulk is very much less than that of any visiting- list ever published. Every physician will at once understand that as soon as a section is full it can be taken out, tiled away, and another inserted without the least inconvenience or trouble. Extra or additional sections will 1)6 furnislied at any time for 15 cents each or ^1.75 per dozen. This Visiting-List contains calen- dars, valuable miscellaneous data, important tables, and other useful printed matter usually placed in Physicians' Visiting-Lists. Physicians of many years' standing and with large practices pronounce it THE Best List they have ever seen. It is liandsomely bound in fine, strong leather, with flan, including a pocket for loose memoranda, etc., and is furnished with a Dixon lead-pencil of excellent quality and finish. It is compact and con- venient for carrying in the pocket. Size, 4x6|- inches. * I2>T TE3:r2.ElEX ST"!rLE:S- net prices. No. 1. Regular size, to accommodate 70 patients daily each month for one year, . . . S1.25 No. 3. Large size, to accommodate 105 patients daily each month for one year, .... SSI. 50 No. 3. In which the " Blanks for Recording Visits in " are in removable sections, . . . SI. 75 Special Edition for Great Britain, without printed matter, 4s. 6d. N. B, — The Recording of Visits in this List may be Commerced at any time during the Year, (14) Medical Pahlications of F. A. Davis, Philadelphia. Hand-Book of Eclampsia ; OR, JUOXES AIV» CASES OF" PVERPERAI^ CO^SVILSIONS. By E. MiCHENER, M.D. ; J. H. Stubbs, M.D. ; R. B. Ewing, M.D. ; B. Thompson, M.D. ; S. Stebbins, M.D. 16ino. Cloth. Price, 60 cents, net ; in Great Britain, 4s. 6d. ; France, i ft. 20. JSriSSEN A MANUAL OF INSTRUCTION FOR GIVING Swedish Movement ^ Massage Treatment By Prop. H.\rtvig Nissen, late Director of the Swedish Ilcalth Institute, WasliinETton, D. C. ; late Instructor in Physical Culture and Gymnastics at the Johns Hoj»kins University, Baltimore, Md. ; Instructor of Swedish and German Gymnastics at Harvard University's Summer School, 1891. This excellent little volume treats this very important subject in a practical manner. Full instructions are given regarding the mode of applying the Swedish Movement and Massage Treatment in various diseases and conditions of the human system witli the greatest degree of effectiveness. Professor Nissen is the best authority in the United States upon the practical phase of this subject, and his book is indisjiensable to every physician who wishes to know how to use these valuable handmaids of medicine. Illustrated with 29 Original Wood-Engravings. In one 12mo volume of 128 Pages. Neatly bound in Cloth. Price, post-paid, in the United States and Canada, $1.00, net; Great Britain, 6s. ; France, 6 fr. 20. This niariiial is valuat)le to the practitioner, a.s it contains a terse description of a subject Imt too little understood in this country. . . The l)0()k is got up very creditably. — N. Y. Med. Jour. The present volume is a modest account of the apv>lication of the Swedish .Movement and Massage Treatment, in which the technique of the various procedures are clearly stated as well as illustrated in a very excellent manner. —North American Practitioner. This attractive little book presents the sub- ject in a very practical shape, and makes it possible for every physician to understand at least how it is applied, if it does not g ve liim dexterity in the art of its application. — Chicago Med. limes. Physicians' Interpreter. In Four Languages (English, French, German, and Italian). Specially Arranged for Diagnosis by M. von V. The object of this little work is to meet a need often keenly felt by the busy physician, namely, the need of some quick and reliable method of communicating intellitrildy with'patients of those nationalities and languages unfamiliar to the practitioner. The plan of the book is a systematic arrangement of questions upon the various branches of Practical Medicine, and each question is so worded that the only answer required of the patient is merely Yes or No. The cpu^stions are all numbered, and a complete Inde,\ renders them always available for quick reference. The book is written by one who is well versed in Engiisli, French, German, and Italian, being an excellent teacher in all those languages, and who has also had considerable hosi)ital experience. Bound in Full Russia Leather, for carrying in tlie pocket. Size, 5x23 inches. 206 pages. Frise, post-paid, in united States and Canada, q>1.00, net ; Great Britain, 6s. ; Prance, 6 fr. 20. Many other books of the same sort, with more extensive vocabularies, have been p\ib- lishr-d, Imt. from their size, and from their l)einK usually devoterl tr) cquivalantfl in Knp:- rwli and (me other laiißuaKe only, they have not bail the advantajre which is pre-eminent in tili»— eonvenleriee. It is hand'^omely printed, and liounrl in flexible red leather intlie form of a diary. It would scarcely make itsiOf fc^lt In one's hip-pocket, and would insure its liearcr against any ordinary conversational || Courier of Medicine, (15) difficulty in dealing with foreign-speaking jK-ople. who aie constantly cnniing into our city hospitals.— iV^'w York Medical Journal. This little volume Is one of the most inge- nious aids Ir) the i)hysician which we have seen. We hi'artily loiiimend tin; book to any one who, IxMiig without a knowleilge of the foreign languagi'S, is obliged to treat tliose who do not know our own language. — SI. Louii Medical Publications of F. A. Davis, Philadelphia. ician's All-Requisite Time- and Labor- Saying Account-Book. Being a Ledger and Account-Book for Physicians' Use, Meeting ALL THE Requirements of the Law and Courts. Design ed by William A. Seibert, M.D , of Easton, Pa. Probably no class of people lose more money through carelessly kept accounts and overlooked or neglected bills than physicians. Often detained at the bedside of the sick until late at night, or deprived of even a modicum of rest, it is with great difficulty that he spares the time or puts himself in condition to give the same care to his own financial interests that a merchant, a lawyer, or even a farmer devotes. It is then plainly apparent that a system of bookkeeping and accounts that, without sacrificing accuracy, but, on the other hand, ensuring it, at the same time relieves the keeping of a physician's book of half their complexity and two-thirds the labor, is a convenience which will be eagerly welcomed by thousands of overworked physicians. Such a system has at last been devised, and we take pleasure in ofi'eriug it to the profession in the form of The Physician's All-Requisite Time- and Labor- Saving Account-Book. There is no exaggeration in stating that this Account-Book and Ledger reduces the labor of keeping your accounts more than one -half, and at the same time secures the greatest degree of accuracy. We may mention a few of the superior advantages of The Physician's All-Requisite Time- and Labor- Saving Account-Book, as follows : — First — Will meet all the requirements of the law and courts. Second — Self-explanatory ; no cipher code. Third — Its completeness without sacri- ficing anything. Fourth — No posting ; one entry only. Fifth — Universal ; can be commenced at any time of the year, and can be continued indefinitely until every account is filled. Sixth — Absolutely no waste of space. Seventh — One person must needs be sick every day of the year to fill his account, or might be ten years about it and require no more than the space for one account in this ledger. Eighth — Double the number and many times more than the number of ac- counts in any similar book ; the 300-page book contains space for 900 accounts, and the 600-page book contains space for 1800 ac- counts. /ninth — There are no smaller spaces. Tenth — Compact without sacrificing completeness ; every account com- plete on same page — a decided ad- vantage and recommendation. Eleventh — tlniform size of leaves. Twelfth — The statement of the most complicated account is at once be- fore you at any time of month or year — in other words, the account itself as it stands is its simplest statement. Thirteenth — No transferring of accounts, balances, etc. To all physicians desiring a quick, accurate, and comprehensive method of- keeping their accounts, we can safely say that no book as suitable as this one has ever been devised. A descriptive circular showing the plan of the book will be sent on application. NET PRICES, SHIPPING EXPENSES PREPAID. D. 1. 300 Pages, for 900 Accounts per Year, Canada Size IO2I2, Bound in K-Eussia, Raised inu.s. (duty paid). Back-Bands, Cloth Sides, . . . $5.00 $5.50 fe ?. 600 Pages, for 1800 Accounts per Year, ^ize 10sl2, Bound in K -Russia, Raised ^k-Bands, Cloth Sides, . . ' 8.00 8.80 (16) Great Britain. 28s. France. 30 fr. 30 42s. 49 fr. 40 Medical Publications of F. A. Davis, Philadelphia. PBICE and BAGLETON Three Charts of the Nervo-Uascular System. Part I. — The Nerves. Part II. — The Arteries. Part III. — The Veins. A Xew Edition, Revised and Perfected. Arranged hy W. Henry Pinn:, M.D., and S. Potts Eagleton, M.D. Endorsed by leading uuutouiists. Clearly and beautifully printed upon extra durable paper. PART I. The Nerves. — Gives in a dear form not only tlie Cranial and Spinal Nerves, show- ing the formation ot the tlitt'eiend Plexuses and their branches, but also the complete distribution of the Sympathetic Nerves. PAKT II. The Arteries — (jives a unique grouping of the Arterial system, showing the divisions and subdivisions of all the vessels, beginning from the heart and trafing their COXTINUOUS distribution to the periphery, and showing at a glance the terminal branches of each artery. PART III. The Veins — Shows how the blood from the periphery of the body is gradually collected by the larger veins, and these coalescing forming still larger vessels, until they finally trace themselves into the Hight Auricle of the heart. It is therefore readily seen that "The Nervo-Vascular System of Charts'" offers the following superior advantages : — 1. It is the only arrangement which combines the Three Systems, and yet each is perfect and distinct in itself 2. It is the only instance of the Cranial, Spinal, and Sympathetic Nervous Systems being represented on one chart. 3. From its neat size and clear type, and being printed only upon one side, it may be tacked up in any convenient place, and is always ready for freshening up the memory and reviewing for examination. Price, post-paid, in United States and Canada, 50 cents, net, complete ; in Great Britain, 3s. 6d. ; in France, 3 fr. 50. For the student of anatomy there can pos- sibly be no more concise way of acquiring a knowledge of the nerves, veins, and arteries of the human system. It presents at a glance their trunks and branches in the great divis- ions of tlie body. It will save a world of tedi- ous reading, and will impress itself on the mind as no ordinary vade viecum, even, could. Its price is nominal and its value inestimable. No student shovilil be without it. — Pacific Record of Medicine and Surgery. These are three admirably arranged charts for the use of students, to assist in memor- izing their anatomical sudies. — Buffalo Med. and Surg. Jour. JPUBDY Diabetes: Its Cause, Symptoms anl^ Treatment By Chas. W. Purdy, M.D. (Queen's University), Honorary Fellow of the Royal College of Pliysicians and Surgeons of Kingston ; Member of the College of Physicians and Surgeons of Ontario ; Author of "Blight's Disease and Allied AflFection.s of the Kidneys ;." Member of the Association of American Physicians ; Member of the American Medical Association ; Member of the Chicago Academy of Sciences, etc. CoNTKNTs. — Section I. Historical, Geographical, and Climatological Con- Biderations of Diabetes Mellitus. II. Pliysiological and Pathological Considera- tions of Diabetes Mellitus III. Etiology of Diabetes Mellitus. IV. IMorbid Anatomy of Diabetes Mellitus. V. Symptomatology of Diabetes Mellitus. VI. Treatment of Diabetes .Mellitus. VII. C;iinical Illustrations of Diabetes Mellitus. VIII. Diabetes Insipidus ; Bibliography. 12uio. Dark Blue Extra Clotli. Nearly 200 pages. AVith Clinical Illus- trations. No. S in the PhynHam'' and Student»' Ready -lief crence Series. Price, post-paid, in the united States and Canada, $1.25, net; in Great Britain, 6s. 6d. ; in France, 7 fr. 75. T)ii- will prove a most entertaining as well a» most JntrTCHting treatise upon a disease which frefjnetitly falls to the lr)t r)f every jiractitloni-r. The work has been written with a Hpecial view of bringing ont the fi-atuies of the diHea>f sngar in a very large number of alcoholic lieverages, adils very consideralily to the value of the work.— iWetZtcai News. (17) Medical Publications of F. A. Davis^ Philadelphia. MEMOJ^DINO S Operation, Etc. From the Earliest Times to the Present; with a History of Eunuchism, Hermaphrodism, etc., as Observed Among all Races AND Nations; also a Description of the Different Operative Methods of Modern Surgery Practiced upon the Prepuce. By P. C. Remondino, M.D. (Jefferson) ; Member of the American Medical Association; Member of the American Public Health Association; Vice-President of the State Medical Society of California, and of the Southern California Medical Society, etc., etc. JYo. 11 in the Physicinns' and Students' Ready -Reference Berks. About 350 pages. 12mo. Handsomely bound in Dark-Blue Cloth. Just Ready. Price, post-paid, in the United States and Canada, $1.25, net; in Great Britain, 8s. 6d. ; in France, 7 fr. 75. Cheap Edition (paper hinding), united States and Canada, 50 cents, net, post-paid; Great Britain, ^s. 3d. ; France, i fr, 20. ROHE Text-Book of Hygiene. A Comprehensive Treatise on the Principles and Practice op Pre- ventive Medicine from an American Standpoint. By George H. Rohe, M.D., Professor of Obstetrics and Hygiene in the College of Physicians and Surgeons, Baltimore ; Member of the American Public Health Association, etc. Every Sanitarian should have Robe's " Text-Book of Hygiene " as a work of reference. Of this New (second) edition, one of the best qualified judges, namely, Albert L. Gihon, M.D., Medical Director, U. S. Navy, in charge of U. S, Naval Hospital, Brooklyn, N. Y.. and ex-President of the American Public Health Association, writes : "It is the most admirable, conc\&& resume of the facts of Hygiene with which I am acquainted. Prof Robe's attractive style makes the book so readable that no better presentation of the important place of Pre- ventive Medicine, among their studies, can be desired for the younger members, especially, of our profession. Second Edition, thoroughly revised and largely rewritten, with many illustrations and valuable tables. In one handsome Royal Octavo volume of over 400 pages, bound iu Extra Cloth. Price, post-paid, in United States, $2.50, net ; Canada (duty paid), $2.75, net ; Great Britain, 14s. ; France, 16 fr. 20. In short, the work contains brief and prac- tical articles on hygienic regulation of life, under almost all conditions One prominent feature is that there are no superfluous words ; every sentence is direct to the point sought. It is, therefore, easy reading, and convevs very much Information in little space. — Ttie Pacific Record of Medicine and Surgery. Truly a most excellent and valuable work, comprising the accepted facts in regard to preventive medicine, clearly stated and well arranged. It is unquestionably a work that should be in the hands of every physician in the country, and medical students will find it a most excellent and valuable text-book. — The Southern Practitioner. The first edition was rapidly exhausted, and the book justly became an authority to physi- cians and sanitary officers, and a text-book very generally adopted in the colleges throughout Araerica. The second edition is a great improve- m^it over the first, all of the matter being thor- oughly revised, much of it being rewritten, and manv additions being made. The size of the book is increased one hundred pages. The book has the original recommendation of being a handsomely-bound, clearly-printed octavo volume, profusely illustrated with re- liable references for every branch of the subject matter.— Afedieal Record. The wonder is how Prof. Rohe has made the book so readable and entertaining with so much matter necessarily condensed. The book is well printed with good, clear type, is attractive in appearance, and contains a number of valuable tables and illustration» that must be of decided aid to the student, if not to the general practitioner and health officer. Altogether, the manual is a good ex- ponent of hygiene and sanitary science from the present American Stand-point, and will repay with pleasure and profit any time that may be given to its -per-xis^X.— University Medv- cal Magazine. (18) Medical Publications of F. A. Davis, Philadelphia. HAY FEVER SAJO US And Its Successful Treatment by Superficial Organic Alteration of tbe Kasal 9IUCOUS Membrane. Bj' Charles E. Sajous, ]\LD., former]}^ Lecturer on Rliinology and Laryngology in Jefferson Medical College; Vice-President of the American Larj-ngological Association; Officer of the Academy of France and of Public Instruction of Venezuela ; Corresponding Member of the Royal Society of Belgium, of the Medical Society of Warsaw (Poland), and of the Society of Hygiene of France; Member of the American Philosophical Society, etc., etc. With 13 Engravings on Wood. 103 pages. 12mo. Bound in Cloth. Beveled Edges. Price, post-paid, in the United States and Canada, $1.00, net; in Great Britain, 6s.; France, 6 fr. 20. SAJS'NE Däphtherlä, Croup: Tracheotomy and Intubation. From the French of A. SannI Translated and enlarged hy Henry Z. Gill, M D., LL.D., late Pro- fessor of Surgery in Cleveland, Ohio. Sanne's work is quoted, directly or indirectly, l)y eveiy Avriter since its puhlictition, as the hi<;iicst authority, statistically, theoietically. and practically. The translator, having given special study to the subject for many years, has added over liity i)ages, including the Surgical Anatomy, lutidjation, and the recent progress in other branches, making it, beyond question, the most complete work extant on the subject of Dii)htheria in the English language. Facing the title-i)age is found a very fine Colored Lithograph Plate of the parts concerned in Tracheotomy. Next follows an illustration of a cast of the entire Trachea, and bronclii to the third or fourth division, in one piece, taken from a photograph of a case in which the east was expelled during life from a patient sixteen years old. This is the most complete cast of any one recorded. Over fifty other illustrations of the surgical anatomy of instruments, etc., add to tlie practical value of the work. A full Index accompanies the enlarged v<)lume, also a Tjist of Authf)rs, making altogether a very Inuulsome illustrated volume of over 680 pages. Canad.T United States. (duty paid). Great Britain. France. Price, post-paid, Cloth, - $4.00, Net $140, Net Leather, 5.00, " 5.50, " 22s. 6d. 24 fr. 60 28s. 30 fr. 30 Tlie Riilijfct of intubation, no recently ro- vlve., Professor of Materia Medica, Phar- macology, Therapeutics, and C'linical Medicine, and Clinical Professor of Diseases of the Skin in the Medico-Chirurgical College of Philadelphia, etc., etc. Tlie author concisely concludes his preface as follows : "The reader may tliu.^ obtain a conspectus of the whole subject of inunction as it exists to-day in the civilized world. In all cases the mode of preparation is given, and the tlicra- poiitical application described seriatim, hi so far as may be done without needless repetition " • Skcond EniTiON, revised and enlarged. 298 pages. 12mo. Neatly bound in Dark-Blue Cloth. No. in the Physician»' and Students' Ready -Reference Series. Price, post-paid, in the United States and Canada, $1.50, net; in Great Britain, 8s. 6d. ; in France, 9 f^. 35. the best form in which to prescribe medicines by wav of the skin the book will prove valu- able, owing to the many prescriptions and fnrniul!« which dot its pages, while the copious index at the back mateiially aids in making «lie book a useful one— Medical News. Tt !« invahiable as a ready rr^frrence wlu'ii ointments or oleates are to be used, and is Kerviceable to both druggist and ))bysiciun. — Cetmida 2Icdical Jiecord. To the physician who fccLs uncertain a."* to (21) Medical PuhUcations of F. Ä. Davis, Philadelphia. SSOBMAKER Materia IVledIca and Therapeutics. With Especial Reference to the Clinical Application of Drugs. J3eing the Second and Last Volume of a Treatise on Materia Medica, Pharmacology, and Therapeutics, and an Independent YoLUME upon Drugs. By John V. Shoemaker, A.M., M.D., Professor of Materia Medica, Pharmacology, Therapeutics, and Clinical Medicine, and Clinical Professor of Diseases of the Skin in the Medico-Chirurgical College of Philadelpliia; Physician to the Medico-Chirurgical Hospital, etc., etc. This, the second volume of Shoemaker's "Materia Medica, Pharmacology, and Therapeutics," is wholly taken up with the consideration of drugs, each remedy being studied from three points of view, viz. : the Preparations, or Mateiia Medica; the Physiology and Toxicology, or Pharmacology; and, lastly, its Therapy. It is thoroughly abreast of the progress of Therapeutic Science, and is really an indispensable book to every student and practitioner of medicine. Royal Octavo, about 675 pages. Thoroughly and carefully indexed. Price, in United States, post-paid, Cloth, $3.50; Sheep, $1.50, net. Canada (duty paid), Cloth, $4.00; Sheep, $5.00, net. Great Brit- ain, Cloth, 20s. ; Sheep, 2Ss. France, Cloth, 22 fr. 40; Sheep, 28 fr. 60. The first volume of this work is devoted to Pharmacy, General Pharma- cology, and Therapeutics, and remedial agents not properly classed with drugs. Royal Octavo, 353 pages. Price of Volume I, post-paid, in United States, Cloth, $2.50, net; Sheep, $3.25, net. Canada, duty paid, Cloth, $2.75, net; Sheep, $3.60, net. Great Britain, Cloth, Hs. ; Sheep, 18s. Prance, Cloth, 16 fr. 20 ; Sheep, 20 fr. 20. The volumes are sold separately. SHOEMAKER'S TREATISE ON MATERIA MEDICA, PHARMACOLOGY, AND THERA- PEUTICS STANDS ALONE. (1) Amonp; Materia Medica text-books, in that it includes every officinal drug and every preparation contained in the United States Pharmacopoeia. (3) ''In that it is the only work on therapeutics giving the strength, composition, and dosage of every officiiTal preparation. (3) In giving the latest investigations vt^ith regard to the physiological action of drugs and the most recent applications in therapeutics. (4) In combining with officinal drugs the most reliable reports of the actions and uses of all the noteworthy new remedies, such as acetanilid, antipyi'in, bromoform, exalgin, pyok- tanin, pyridin, soranal, spermine (Brown-Sequard), tuberculin (Koch's lymph), sulphonal, thiol, urethan, etc., etc. (5) As a complete encyclopaedia of modern therapeutics in condensed form, arranged alpha- betically for convenience of reference for either physician, dentist, or pharmacist, when immediate information is wanted concerning the action, composition, dose, or antidotes for any officinal preparation or new remedy. (6) In giving the physical characters and chemical formulae of the new remedies, especially the recently-introduced antipyretics and analgesics. (7) In the fact that it gives special attention to the consideration of the diagnosis and treat- ment of poisoning by the moi'e active drugs, both officinal and non-officinal. (8) And unrivaled in the number and variety of the prescriptions and practical formulae, representing the latest achievements of clinical medicine. (9) In that, while summarizing foreign therapeutical literature, it fully recognizes the work done in this department by American physicians. It is an epitome of the present state of American medical practice, which is universally acknowledged to be the best practice. (10) Because it is the most comjilete, convenient, and compendious work of reference, being, in fact, a companion to the United States Pharmacopoeia, a drug-encyclop»dia, and a therapeutic hand-book all in one voJume. The value of the book lies in the fact that it contains all that is authentic and trust- worthy about the host of new remedies which have deluged us in the last five years. The pages are remarkably free from useless infor- mation. The author has done well in following the alphabetical order.— i\r. Y. Med. Record. In perusing the pages devoted to the special consideration of drugs, their pharmacology, physiological action, toxic action, and therapy, one is constantly surprised at the amount of material compressed in so limited a space. The book will prove a valuable addition to the physician "s library. — Occiuental Med. Times. It is a meritorious work, with many unique features. It is richly illustrated by well-tried prescriptions showing the practical applica- tion of the various drugs discussed. In short, this work makes a pretty complete encyclo- paedia of the science of therapeutics, conve- niently arranged for handy reference.— ikfed. World. (22) Medical Publications of F. A. Davis, Philadelphia. S3IITH Physiology of the Domestic Animals. A Text-Book for Veterinary and Medical Students and Practitioners. By Robert Meade Smith, A.M., M.D , Professor of Comparative Pliysi- ology in University of Pennsylvania; Fellow of the College of Ph5\sicians and Academy of the Natural Sciences, Philadelphia; of American Physiological Society; of the American Society of Naturalists, etc. This new and important work, the most thoroughlj'- complete in the English language on this subject, treats of the physiology of the domestic animals iu a most comprehensive manner, especial prominence being given to the subject of toods and fodders, and the character of the diet for the herbivora under difTerent conditions, with a full consideration of their digestive peculiarities. Without being overburdened with details, it forms a complete text-book of phj^siology adapted to the use of students and practitioners of both veterinary and human medicine. This work has already been adopted as the Text-Book on Physioloüy in the Veterinary Colleges of the United States, C4reat Britain, and Canada, "in one Handsome Royal Octavo Volume of over 950 pages, profusely illustrated with more than 4J0 Fine Wood-Engravings and many Colored Plates. Price, Cloth, " Sheep, United States. $5.00, Net 6.00 " Canada (duty paid) $5.50, Net 6.60 " Great Britain. 283. 32s. France. 30 fr. 30 36 fr. 20 A. Li.^UTARD, M.D., H.F.R.C. V.S., Pro- fes-sor of Anatomy, Operative Surgery, and Sanitary Medicine in the American veterinary College", New York, writes:— "I have exam- ined the work of Dr. R. M. Smith on the 'Physiology of the Domestic Animals,' and (hiii- sideV it one of the best additions to veterinary literature that we have ha,d for some time." E. M. Reading, A.M., M.D., Professor of Physiology in the Chicago Veterinary College, writes: — "I have carefully examined the 'Sndth's Physiology,' pul)lishcd liy you, and like it. It is comj rehensive, exhaustive, and comi)lete, and is especially adapted to those who de.sire to obtain a full knowledge of the principles of physiology, and are not s;itislicd with a mere smattering of the cardinal points." Dr. Smith's presentment of h's subject is as brief as the status of the science iiei inits, and to this much-desired conciseness he has added an etjually welcome clearness of statement. The illustrations in the work arc exceedingly good, and must i)rove a valuable aid to the full understanding of the \e.j.t.— Journal of Comparative Medicine and Surgery. Veterinary practitioners and graduates will read it with pleasure. Veterinary students will readily acquire needed knowledge from its pages, and veterinary schools, which would be well equipped for the work they aim t© perform, cannot ignore it as their text-book in physiokigy. — Aviericaii Veterinary Review. Altogether, Professor Smith's " Physiology of the Domestic Animals" is a happy produc- tion, and will be hailed with delight in both the human medical and veterinary medical worlds. It should find its place, besides, in all agricultural libraries.— Paxil, Paqiiin, M.D., \ .S., in the Weekly Medical Jievirw. The author has judiciously made the nutri- tive funclifnis the strong point of the work, and has devoted special attention to the sub- ject ol:' foods and digestion. In looking through other sections of the work, it appears to us that a just projiortionof s|)aceis assigned to each, in view of their relative importance to the practitioner. — London Lancet. SOZINSKEY Medical Symbolism. Historical Studies in tlie Arts of Healing: and Hygiene. By TiiOMAB S. SoziN.sKKY, M.D., Ph. I),, Author of "The Culture of Beauty." "Tlie Care and Culture of Children," etc. 12ino. Nearly 200 pages. Neatly bound lit Dark-Blue Cloth. Appropri- ately illustrated with upward of thirly (:50) new Wood-Engravings. No. 'J in the Physicians' and Students' Ready- Reference Series. Price, post-paid, in United States and Canada, $1.00, net ; Great Britain, 6s. ; France, 6 fr. 20. He who has not time to more fully study the more extended records of the past, will highly prize this little hook. It» interesting discourse up'T the past is full of suggestive thought. — Americun Lancet. IJko an oasis in a dry and dusty desert of medical literature, through which we wearily stngu'er. is this work devoted to medical sym- holifiin anrl mythology. .\h the author aptly quotec: " Whatsonie light l)rairics m.iy esteem as iooWhh toyes, deeper judgments can and will value as sound and serious matter."— Can- adiun Practitioner. In the volume before us wo have an admira- ble and successful attempt to set forth in order those medical symbols which have como down tons, and toexnlain onhistoricalgrouiids their significance. An astonishing amount of information »contained within tlio covers of the book, and every page of the work bears token of the jiainstaking genius and erudite mind of the now unhappily deceased author. — London Lancet, (28) iledical Publications of F. A. Davis, Philadelphia. STEW AMT lynopsis. By John S. Stewart, M.D., formerly Demonstrator of Obstetrics and Chief Assistant in tlie Gynaecological Clinic of the Medico-Chirurgical College of Philadelphia: with an introductory note by William S. Stewart, A.M., ]M.D., Piofessor of Obstetrics and Gynaecology iu the Medico-Chirurgical College of Philadelphia. By students this work will be found particularly useful. It is based upon the teachings of such well-known authors as Playfair, Parvin, Lusk, Galabin, and Cazeaux and Tarnier, and contains mucli new and important matter of great value to both student and practitioner. With 42 Illustrations. 202 pages. 12mo. Handsomely bound in Dark- Blue Cloth. No. 1 in the Phyücians' and Students' Beady -Reference Series. Price, post-paid, in the United States and Canada, $1.00, net ; in Great Britain, 6s.; Prance, 6 fr. 20. DeLaskie MiLiiER, M.D., Professor of Obstetrics, Rush Medical College, Chicago, 111., says : — "I have examined the 'Obstetric Synopsis,' by John S. Stewart, M.D., and it Rives me pleasure to characterize the work as systematic, concise, perspicuous, and authen- tic. Among manuals it is one of the best." It is well written, excellently illustrated, and fully up to date in every respect. Here we find all the essentials of Obstetrics in a nutshell, Anatomy, Embryology, Fhy.siology, Pregnancy, Labor, Puerperal State, and Ob- stetric Operations all being carefully and ac- curately described. — Buffalo Medical and Surgical Journal. It is clear and concise. The chapter on the development of the ovum is especially satis- factory. The judicious use of bold-faced type for headings and italics for important statements gives the book a plea.sing typo- graphical appearance. — Medical Record. This volume is done with a masterly hand. The scheme is an excellent one. The whole is freely and most admirably illustrated with well-drawn, new engiaviugs, and the book is of a very convenient size. — 8t. Louis Medical and Surgical Journal. ULTZMAJSrW The Neuroses of the Genito-Urinary System in the Male. With Sterility and Impotence, By Dr. R. Ultzmann, Professor of Genito-Urinary Diseases in the Uni- versity of Vienna. Translated, with the author's permission, by Gardner W. Allkn, M.D., Surgeon in the Genito-Urinary Department, Boston Dispensary. Full and complete, yet terse and concise, it handles the subject with such a vigor of toueh, sucli a clearness of detail and description, and such a directness to the result, that no medical man who once takes it up will be content to lay it down until its perusal is complete, — nor will one reading be enough. Professor Ultzmann has approached the subject from a somewhat different point of view from most surgeons, and this gives a peculiar value to the work. It is believed, moreover, that there is no convenient hand-book in English treat- ing in a broad manner the Genito-Urinary Neuroses. Synopsis op Contknts. — First Part — I. Chemical Changes in the Urine in Cases of Neuroses. II. Neuroses of the Urinary and of tlie Sexual Organs, classified as : (1) Sensory Neuroses; (2) Motor Neuroses ; (3) Secretory Neuroses. Second Part — Sterility and Impotence. The treatment in all cases is described clearly and minutelJ^ "^Illustrated. i2mo. Handsomely bound in Dark-Blue Cloth. No. 4. in the Physicians' and Students' Ready-Reference Series. Price, post-paid, in the United States and Canada, $1.00, net ; in Great Britain, 6s. ; in France, 6 fr. 20. minted of his delightful manner of iiresenting his thoughts, which ever sparkle with orijfinal- ity and appositeness.— TTeefc^j/ Med. Revieiv. It engenders sound pathological teaching, and will aid in no small degree in liirowing light on the management of many of the dif- ficult and more refractory cases of the classes to which these essays especially refer.— rAe Medical Age. This book is to be highly recommended, owing to its clearness and brevity. Altogether, we di) not know of any book of the same size which contains so much useful information in such a short sp2t,c&.— Medical News. Its scope is large, not being confined to the eoie condition, — neurasthenia, — but embracing all of the neuroses, motor and sensory, of the genito-urinary organs in the male. No one wbr. has read after Dr. Ultzmann need be re- (24) Medical Publications of F. A. Davis, Plnladelpliia. WHEBLJEJR Abstracts of Pharmacology. By H. A. Wheeler, M.D. (Registered Pharmacist, No. 3468, Iowa). Pre- pared for the use of Physicians and Pharmacists, and especially for the use of Students of Medicine and Pharmac3^ who are preparing for Examination in Colleges and before State Boards of Examiners. This book does not contain questions and answers, but solid pages of abstract information. It will be an almost indispensable companion to the prac- ticing Pharmacist, and a very useful reference-book to the Physician. It contains a brief but thorough explanation of all terms and processes used in practical pharmacy, an abstract of all tliat is essential to be known of each officinal drug,, its preparations and therapetic action, with doses; in Chemistry and Botany, much that is useful to the Physician and Pharmacist; a general working formula for each class and an abstract fonnula for each ofläcinal preparation, and many of the more popular unofficinal ones, together with their doses; also many symbolic formulas; a list of abbreviations used in prescription writing; rules governing incompatibilities; a list of Solvents; tests for tlie more common drugs; the habitat and best time for gathering plants to secure their medical properties. The book contains 180 pages, 5^ x 8 inches, closely printed and on the best paper, nicely and durably bound, containing a greater amount of information on Xlie above topics than any other work for the money. Price, post-paid, in United States and Canada, $1.50, net; in Great Britain, 8s. 6d. ; in France, 9 fr. 35. YOUNG Synopsis of Human Anatomy. Being a Complete Compend of Anatomy, Including the Anatomy op THE Viscera, and Numerous Tables. Bj' J.AMES K. Young, M.D., Instructor in Orthopaedic Surgery and Assistant Demonstrator of Surgery, University of Pennsylvania; Attending Orthopaedic Surgeon, Out-Patient Department, University Hospita], etc. While the author has prepared this work especially for students, sufficient descriptive matter has been added to render it extremely valuable to the busy practitioner, particularly the sections on the Viscera, Special Senses, and Sur- gical Anatomy. The work includes a complete account of Osteology, Articulations and Ligaments, Muscles, Fascias, Vascular and Nervous Systems, Alimentary, Vocal, and Respiratory and Genito-Urinary Apparatus, the Organs of Special Sense, and Surgical Anatomy. In addition to a most carefully and accurately prepared text, wherever possible, the value of the work has been enhanced by tables to facilitate and minimize the labor of students in acquiring a thorough knowledge of tiiis important subject. The section on llie teetli has also been especially prepared to meet the requirements of students of dentistry. Illustrated with 70 Wood-Engravings. äOO pages. 12mo. No. 3 in the Physicians' and Students' Ready -Reference Series. Frice, post-Tiaid, in united States and Canada $1.40, net ; Great Britain, 8s. 6d. ; France, 9 fr. 25. Every nniifcfrsHary word tia« lip.en cxchiiled, out «f VfRard to the vr-ry limited time :it tlie medical KtiirlenfH «IJKposal. It i.s alHO (^ood a.s a referenee-l»ook. a« it jireHent» tlic facts ;il)Ont whieli lie wiftlwH to refresh liin memory in tlie trriefeKt manner eoiiHiHteiit with cUianieM». — New York Mrdical Journal. Ah a eomiianioii to the dinsectinp-table, anil a convenient reference for the iiractitioner, it (2.5) lian a definite field of usefulness.— jPtifafeMj'f/ft Medical Review. The book is much more satisfactory than the "reinendiraiiecH " in voRiie, and yet is not too emiiliersome to be carried around iind road at od(l nioments^a jirojierty which the student will readily appreciate. — Weekly Medical Review. Medical Publications of F. A. Davis, Philadelphia. WITHEMSTINE The International Pocket Medical Fornnulary Arranged Therapeutically. By C. Sumner Witherstine, M.S., M.D., Associate Editor of the 'Annual of the Universal Medical Sciences ;" Visiting Physician of the Home for the Aged, Germantown, Philadelphia ; Late House-Surgeon Charity Hospital, New York. More than 1800 formulae from several hundred well-known authorities. With an Appendix containing a Posological Table, the newer remedies included ; Important Incompatibles ; Tables on Dentition and the Pulse ; Table of Drops in a Fluidrachm and Doses of Laudanum graduated for age ; Formulae and Doses of Hypodermatic Medication, including the newer remedies ; Uses of the Hypo- dermatic Syringe ; Formulae and Doses for Inhalations, N'asal Douches, Gargles, and Eye-washes ; Formulae for Suppositories ; Use of the Thermometer in Dis- ease ; Poisons, Antidotes, and Treatment ; Directions for Post-Mortem and Medico-Legal Examinations ; Treatment of Asphyxia, Sun-stroke, etc. ; Anti- emetic Remedies and Disinfectants ; Obstetrical Table ; Directions for Ligations of Arteries ; Urinary Analysis ; Table of Eruptive Fevers ; Motor Points for Electrical Treatment, etc. This work, the best and most complete of its kind, contains about 275 printed pages, besides extra blank leaves — the book being interleaved throughout — elegantly printed, with red lines, edges, and borders; with illustrations. Bound in leather, with side flap. It is a handy book of reference, replete with the choicest formulse (over 1800 in number) of more than six hundred of the most prominent classical writers and modern practitioners. . The remedies given are not only those whose eflBciency has stood the test of time, but also the newest and latest discoveries in pharmacy and medical science, as prescribed and used by the best-known American and foreign modei-n authorities. It contains the latest, largest (66 formulae), and most complete collection of hypodermatic formulae (including the latest new remedies) ever published, with doses and directions for their use in over fifty different diseases and diseased conditions. Its appendix is brimful of information, invaluable in office work, emergency cases, and the daily routine of practice. It is a reliable friend to consult when, in a perplexing or obstinate case, the usual line of treatment is of no avail. (A hint or a help from the best authorities, as to choice of remedies, correct dosage, and the eligible, elegant, and most palat- able mode of exhibition of the same.) It is compact, elegantly printed and bound, well illustrated, and of conve- nient size and shape for the pocket. The alphabetical arrangement of the diseases and a thumb-letter index render reference rapid and easy. Blank leaves, judiciously distributed throughout the book, afford a place to record and index favorite formulae. As a student, the physician needs it for study, collateral reading, and for recording the favorite prescriptions of his professors, in lecture and clinic; as a recent graduate, he needs it as a reference hand-book for daily use in prescribing (gargles, nasal douches, inhalations, eye-washes, suppositories, incompatibles, poisons, etc.); as an old practitioner, he needs it to refresh his memory on old remedies and combinations, and for information concerning newer remedies and more modern approved plans of treatment. . No live, progressive medical man can afFoi-d to be without it. Price, post-paid, in United States and Canada $2.00, net ; Great Britain, lis. 6d. ; France, 12 fr. 40. enough of incompatibilities before commenc- ing practice to avoid writing incompatible and dangerous prescriptions. The constant use of such a book by such prescribers would save the phavmacist much anxiety.— 27te Drug- gists^ Circular. In judicious selection, in accurate nomen- clature, in arrangement, and in style, it leaves nothing to be desired. The editor and the publisher are to be congratulated on the pro- duction of the very best book of its class. — Pittsburgh Medical Review. It is sometimes important that such prescrip- tions as have been well established in their usefulness be preserved for reference, and this little volume serves such a purpose better than any other we have seen. — Columbus Med- ical Journal. To the young physiciun Just starting out in practice this little book will prove an accept- able companion. — Omaha Clinip. As long as "combinations" are sought, such a book will be of value, especially to those who cannot spare the time required to learn (26) Medical Publications of F. A. Davis, Philadelphia. Annual of the Universal Medical Sciences. A Yearly Report of the Progress of the General Sanitary Sciences Throughout the World. Edited by Charles E. Sajous, M.D., formerly Lecturer on Laryngology and Rhiuology iu Jetferson Medical College, Philadelphia, etc., and Seventy Associate Editors, assisted by over Two Hundred Corresponding Editors and Collaborators. In Five Royal Octavo Volumes of about 500 pages each, bound in Cloth and Half-Russia, Magnificently Illustrated with Chromo-Lithographs, Engravings, Maps, Charts, and Diagrams. Being intended to enable any physi- cian to possess, at a moderate cost, a complete Contemporary History of Universal Medicine, edited by many of America's ablest teacliers, and superior in every detail of print, paper, binding, etc., a befitting continuation of such great works as "Pepper's SA'stem of Medicine," " Ashhurst's International Encyclopaedia of Surgery," "Buck's Reference Hand-Book of the Medical Sciences." SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING EXPENSES PREPAID. Subscription Price per Year (including the " SATELLITE " for one year) : In United States, Cloth, 5 vols., Royal Octavo, $15.00 ; Half-Russia, 5 vols., Royal Octavo, $20.00. Canada (duty paid), Cloth, $16 50; Half-Russia, $22.00. Great Britain, Cloth, £>i 7s. ; Half-Russia, £5 15s. France, Cloth, 93 fr. 95 ; Half-Russia, 12i fr. 35. The Satellite of the "Annual of the universal Medical Sciences." A Monthly Review of the most important articles upon the practical branches of Medicine appearing in the medical press at large, edited by the Chief Editor of the Annual and an able staff. Published in connection with the Annual, and for its Subscribers Only. Editorial Staff of the Annual of the Universal Medical Sciences. COXTRIBUTORS TO SERIES 1888, 1889, 1890, 1891. Editor-in-Chief, CHARLES E. SAJOUS, M.D., Philadelphia. SENIOR ASSOCIATE EDITORS. Agiiew. 1). Havfts, M.D., LL.D., Philadelphia, series of 1KH8. 18K9. Baldy, J. M.. M.D.. Philadelphia, 1891. Barton, .T. M., A.M., M.D., Philadelphia. 1889, 1S90 IJ^l BIrdsall, w'. R., M.D., New York, 1889, 1890, 18Ö1. Brown, F. W., M.D.. Detro t,1890, 1801. Bruen, PMwardT.. M.D., Philnd(li)liia, 1889. Brush, Kdward N., M.D., Philaclelphia, 1889, 1890. mn. Cohen. .1. Solis, M.D., Philadelphia, 1888, 1889, 1890, 1891. Conner, P. H.. M.D., LL.D., Cincinnati, 1888, IW«. 1890. 1891. Currier, A, K, A.B., M.D., New York, 1889, 18JW. 1891. DavidMon. C. C., M l>.. Phila/lelphia. 1888. Davit«. N. H.. A.M., .M.D., LL.D., Chicago. 1888, 1K89, 18!K). IS91. Delafteld, Francis, .M.D.. New York. 1888. Delavan. f». I'.rvson, M.D., New York, 1888, 18«». IS9f). iHffl. Dranr-r. F. Wintlirop. A.M., M.D., New York, 1S88. IKH',1. 18tW. 1891. Dudley. Fdward C, M.D., ll. William. M.D.. Philadelphia, 1888, 1889. 1890. Grav. Landon Carter, M.D., NewYork, 1890, 1891. Griffith. .T. P. Crozer, M.D., Philadelphia, 1889, 1890. 1891. Guilford, S. H., D.D.S., Ph.D., Philadelphia, Guiteras. .John, M.D., Ph,D., Charleston, 1888, 1889. Hamilton, .lohn H.. INl.D., LL.D., Washington, 1888. 1889, 1890. 1891. Hare. Hohart Aniorv. MD., B.Sc, Philadel- phia. 1888, 1889. 189«, 1891. Henrv. Frederick P., M.D., Philadelphia, 1889, 1890, 1891. * Holland, .1. W., M.D.. Philadelphia, 1SS8. 1889. Holt. li. Emniett. M.D., New Yoik, 1889, 1890, 1891. Howell. W. IT.. Ph.D., M.D., Ann Arbor, 188}». 1890, 1S91. Hun. Henry, M.D.. Albany, 1889. 1890. Hooper. Franklin H., M.D.. Boston, 1890. 1891. Innals. K. Fletcher, A.M., M.D., Chicago, 1889, 1890, 1S91. JacKard, W, W., A.M., M.D., Chicago. 1890. Johnston, Christopher, M.D., lialtiinorc, 1S88, 1889. Johnston. W. W., M.D., Washington, 1888, 1889, 1890, 1891. (27) Medical Puhlicatiom of F. A. Davis, Philadelphia, SENIOR ASSOCIATE EDITORS (continued). Keating, John M., M.D., Philadelphia, 1889. Kelsey, Charles B., M.D., New York, 1888, 1889, 1800, 1891. lieyes, Edward L., A.M., M.D., New York, 1888, 1889, 1890, 1891. Knapp, Philip Coombs, JVI.D., Boston, 1891. Laplace, Ernest, A.M., M.D., Philadelphia, 1890. 1891. Lee, John G., M.D., Philadelphia, 1888. Leidy, Joseph, M.D., LL.D., Philadelphia, 1888, 1889, 1890, 1891. Longstreth, Morris, M.D., Philadelphia, 1888, 1S89, 1890. Loomis, Alfred L., M.D., LL.D., New York, 1888, 1889. Lyman, Henry M., A.M., M.D., Chicago, 1888. McGuire, Hunter, M.D., LL.D., Richmond, 1888. Manton, Walter P., M.D., F.R.M.S., Detroit, 1888, 1889. 1890, 1891. Martin, H. Newell, M.D., M.A., Dr. Sc, F.KS., Baltimore, 1888, 1889. Matas, Rudolph, M.D., New Orleans, 1890, 1891. Mears, J. Ewing, M.D., Philadelphia, 1888, 1889, 1890, 1891. Mills, Charles K., M.D., Philadelphia, 1888. Miuot, Clias. Sedgwick, M.D., Boston, 1888, 1889, 1890, 1891. " Montgomery, E. E., M.D., Philadelphia, 1891. Morton, Thos. G., M.D., Philadelphia, 1888, 1889. Munde', Paul F., M.D., New York, 1888, 1889, 1890, 1891. Oliver, Charles A., A.M., M.D., Philadelphia, 1889, 1890, 1891. Packard, John H., A.M., M.D., Philadelphia, 1888, 1889, 1890, 1891. Parish, Wm.H., M.D., Philadelphia, 1888, 1889, 1890. Parvin, Theophilus, M.D., LL.D., Philadel- phia, 1888, 1889. Pierce, C, N., D.D.B., Philadelphia, 1888. Pepper, William, M.D., LL.D., Philadelphia, 18S8 Rannev, Ambrose L., M.D., New York, 1888, 1889, 1890. Rich.ardson, W. L., M.D.,Boston, 1888, 1889. Rockwell, A. D., A.M., M.D., New York, 1891. Rohe', Geo. H., M.D., Baltimore. 1888, 1889, 1890, 1891. Sajous, Chas. E., M.D., Philadelphia. 1888, 1889, 1890, 1891. Sayre, Lewis A.,M.D., New York, 1890, 1891. Seguin, E. C, M.D., Providence, 1888, 1889, 1890, 1891. Senn, Nicholas, M.D., Ph.D., Milwaukee, 1888, 1889. Shakspeare, E. O., M.D., Philadelphia, 1888. Sbattuck, P. C, M.D., Boston, 1890. Smith, Allen J., A.M., M.D., Philadelphia, 1890, 1891. Smith, J. Lewis, M.D., New York, 1888, 1889, 1890, 1891. Spitzka, R. C, M.D., New York, 1888. Starr, Louis, M.Ü., Philadelphia, 1888, 1889, 1890. 1891. Stimson. Lewis A., M.D., New York, 1888, 1889, 1890, 1891. Siuvgis, F. R., M D., New York, 1888. Suddutb, F. X., A.M.. M.D.. F.R.M.S., Minne- apolis, 1888, 1889, 1890, 1891. Thomson, William, M.D., Philadelphia. 1888. Thomson. Wm. H., M.D.. New York, 1888. Tiftanv, L. McLane, A.M., M.D., Baltimore, 1890, 1891. Turnbull, (;iias. S., M.D., Ph.D., Philadelphia, 1888, 1889, 1890 1891. Tyson. James, M.D., Philadelphia, 1888, 1889, 1890. Van Harlingen, Arthur, M.D., Philadelphia, 1888, 1889, 1890, 1891. Vandev Veer, Albert, M.D., Ph.D., Albany, 1890. Whittaker, .Tas. T., M.D., Cincinnati, 1888, 1889, 1890, 1891. Whittier, E. N., M.D., Boston, 1890, 1891. Wilson, James C, A.M., M.D., Philadelphia, 1888. 1889. 1890, 1891. Wirgman, Chas., M.D., Philadelphia, 1888. Witherstine, C. Sumner, M.S., M.D., Phila- delphia, 1888, 1889, 1890, 1891. White, J. William, M.D., Philadelphia, 1889, 1890, 1891. , Young, Jas. K., M.D., Philadelphia, 1891. JUNIOR ASSOCIATE EDITORS. Baldy, J. M., M.D., Philadelphia, 1890. Bliss. Arthur Ames, A. M., M.D., Philadelpliia, 1890, 1891. Cattell, H. W., M.D.. Philadelphia, 1890, 1891. Cerna, David, M.D., PbD., Philadelphia, 1891. Clark, J. Payson. M.D., Boston, 1890, 1891. Crandall, F. M., M.D., New York, 1891. Cohen, Solomon Solis, A.M., M.D., Philadel- phia, 1890, 1891, Cryer, H. M., M.D., Philadelphia, 1889. Deale, Henry B., M.D., Washington, 1891. Dolley, C. S., M.D., Philadelphia, 1889, 1890, 1891. Dollinger. Julius, M.D., Philadelphia, 1889. Dorland, W. A., M.D., Philadelphia, 1891. Freeman, Leonard, M.D., Cincinnati, 1891. Goodell, W. Constantine, M.D., Philadelphia, 1888, 1889, 1890. Gould, Geo. M., M J)., Philadelphia, 1889, 1890. Greene, E. M.. M.D., Bostoii, 1891. Griffith, J. P. Crozer, M.D., Philadelphia, 1883. Hoag, Junius, M.D., Chicago, 1888. Howell, W. H., PhD., B.A., Baltimore, 1888, 1889. Hunt, William, M.D., Philadelphia, 1888, 1889. Jackson. Henry, M.D., Boston, 1891. Kirk, Edward C, D.D.S., Philadelphia, 1888. Lloyd, James Hendrie, M.D., Philadelphia, 1888 McDonald, Willis G., M.D., Albany, 1890. Penrose, Chas. B., M.D., Philadelphia, 1890. Powell, W. M., M.D., Philadelphia, 1889, 1890, 1891. Quimby, Chas. E.. M.D., New York, 1889. Sayre, Reginald H., M.D., New York, 1890, 1891. Smith, Allen J., A.M., M.D., Philadelphia, 1889, 1890. Vickery, H. F., M.D., Boston, 1891. Warfleld. Ridgelv B., M.D., Baltimore, 1891. Warner, Frederick M., M.D.. New York, 1891. Weed. Charles L., A.M., M.D., Philadelphia, 1888 1889 Wells, ferooiis H., M.D., New York, 1888, 1889, 1890, 1891. Wolif, Lawrence, M.D., Philadelphia, 1890. Wyman, Walter, A.M., M.D., Washington, 1891. ASSISTANTS TO ASSOCIATE EDITORS. Baruch, S., M.D., New York, 1888. Beatty, Franklin T., M.D., Philadelphia, 1888. Brown, Dillon, M.D., New York, 1888. Buechler, A. F., M.D., New York, 1888. Burr, Chas. W., M.D., Philadelphia, 1891. Cohen, Solomon Solis, M.D., Philadelphia, 1889. Cooke, B. G., M.D., New York, 1888. Coolidge, Algernon, Jr., M.D., Boston, 1890. Currier, A. F., M.D., New York, 1888. Daniels. F. H., A.M., M.D., New York, 1888. Deale, Henry B., M.D., Washington, 1890. Eshner, A. A., M.D., Philadelphia, 1891. Gould George M., M.D., Philadelphia, 1888. Grandin, Egbert H., M.D., New York, 1888, 1889. Greene, E. M., M D., Boston, 1890. Guite'ras, G. M., M.D.. Washington, 1890. Hance, L H., A.M., M.D., New York, 1891. Klingenschmidt, C. H. A., M.D., Washington, 1890. Martin, Edward, M.D., Philadelphia, 1891. McKee, E. S., M.D., Cincinnati, 1889, 1890, 1891. Myers, P. H., M.D., New York, 1888. Packard, F. A., M.D.. Philadelphia, 1890. Pritchard. W. B., M.D., New York, 1891. Sangree, E. B., A.M., M.D., Philadelphia, 1890. Sears, G. G., M.D., Boston, 1890. Shulz, R. C, M.D., New York, 1891. Souwers, Geo. F., M.D., Philadelphia, 1888. Taylor, H. L., M.D., Cincinnati, 1889, 1890. Vansant, Eugene L., M.D., Philadelphia, 1884 (28) Medical Publications of F. A. Davis, Philadelphia. ASSISTANTS TO ASSOCIATE EDITORS-(CONTINUED). Vickerv, H. F., M.D., Boston, 1890. Warner, F. M., M.D., New York, 1888, 1889, 1890 Wells, Brooks H., M.D., New York, 1888. W'eiult, E. C. M.D., New York, 1SS8. Wilder, W. H., M.D., Cincinnati, 1889. Wilson, U. Meigs, M.D., Philadelphia, 1889. Wilson, W. R., .M.D., Philadelphia, 1891. CORRESPONDING STAFF. EUROPE. Antal, Dr. Gesa v., Puda-Pesth, Hungary. Baginsky, Dr. A., Berlin Germany. Baratoux, Dr. J., Paris, France. Barker, Mr. A. K. J., London, England. Barnes, Dr. Kaneourt, London, England. Bayer, Dr. Carl, Prague, Austria. Bouchut, Dr. E., Paris, France. Bourneville, Dr. A., Paris, France. Bramwell, Dr. Byron, Edinburgh, Scotland. Carter, Mr. William, Liverpool, England. Caspari, Dr. G. A., Moscow, Russia. Chiralt v Selma, Dr. V., Seville, Spain. Cordes, Dr. A., Geneva, Switzerland. D'Estrees, Dr. Debout, Contrexeville, France. Diakonoä. Dr. P. .1., Moscow, Russia. Dobrashian, Dr. G. S., Constantinople, Tur- key. Dole'ris. Dr. L., Paris,France. Doutrelepont, Prof., Bonn, Germany. Devon, Dr. II.. Lvons, France. Drzewiecki, Dr. J^os., Waisaw, Poland. Dubois-Reyniond, I'rof., Berlin, Germany. Ducrey, Dr. A.. Naples, Italy. Dujardin-Beaumetz, Dr., Paris, France. Duke, Dr. Alexander, Dublin, Ireland. Eklund, Dr. F., Stockholm, Sweden. Fokker, Dr. A. P., Groningen, Holland. Fort. Dr. J. A., Paris, France. Fournier. Dr. Henri. Paris, France. Franks, Dr. Kendal, Dublin, Ireland. Fremv, Dr. H., Nice, France. Fry, t>r. George, Dublin, Ireland Go'lowina, Dr. A., Varna, Bulgaria. Gouguenheim, Dr. A., Paris, France. Haig, Dr. A., London, England. Ramon, Mr. A., Paris, France. Harley, .Mr. V., London, England. Harley, Mr. H. R., Nottingham, England. Harley, Prof. Geo., London, England. Harpe, Dr. de la, Lausanne, Switzerland. Hartmann, Prof. Arthur, Berlin, Germany. Heitzmann. Dr. J., Vienna, Austria. Helferich, Prof.. Greifswald, Germany. Hcwetson. Dr. Bendelack, Leeds, England. Hoff, Dr. E. M., Copenhagen, Denmark. Humphreys, Dr. F. Rowland, London, Eng- land. lUingworth. Dr. C. K., Accrington, England. Jones, Dr. D. M. de Silva, Lisbon, Portugal. Knott, Dr. .1. F., Dublin, Ireland. Krause, Dr. H., Berlin, (Jcrmany. Landolt, Dr. E., Paris, France. Levison, Dr. J., Copenhagen, Denmark. Lutaud, Dr. A., Paris, France. Mackay, Dr. W. A., Huclva, Spain. Mackowen. Dr. T. C, (Japri, Italy. Manche', Dr. L., Valetta, Malta. Massei. Prof. F., N;iplcs, Italy. Mendez, Prof. R., Barcelona, Spain. 'Meyer, Dr. E.. Naj.hs, Italy. Meyer. Prof. W,, (,'oj)enhagen. Denmark. Mono«. Di'. (Jharles. Paris. France. Montefu.<*co, Prof. A., Naples, Italy. More-Madden, Prof. Thomas, Dublin, Ireland. Morel, Dr. J., Ghent, Belgium. Mygind, Dr. Ilolgci-, Copenhagen, Denmark. Mynlielf. i)r. A.. Breukelcn, Holland. Napier, Dr. A. D. Leith. London, England. Nicolich, Dr.. Trieste, Austria. OI)erIänder, Dr., Dresden, Germany. 01>er»teincr, Prof., Vienna Austria. Pampouki», Dr., Athens, Greece. Pannoni, Dr., Naples, Italy. Parker, Mr. Riishton. Liverpool, England. Pel, Prof. P. K.. Amsterdam, Holland. Pippinhkjold. Dr.. Uclsingfois. Finland. Pulido, I^rof. Angel, Madrid, Spain. Röna, Dr. S., Buda-Pesth, Hungary. Rosenbusch, Dr. L., Lvov. Galicia. Rossbach, Prof. M. F., Jena, Germany. St. Germain, Dr. de, Paris, France. Sänger, Prof. INI.. Leipzig, Germany. Santa, Dr. P. de Pietra, Paris, France. Schiffers, Prof., Liege, Belgium. Schmiegelow, Prof. JE., Copenhagen, Den- mark. Scott, Dr. G. M., Moscovv, Russia. Simon, Dr. Jules, Paris, France. SoUier, Dr. P., Paris, France. Solovvieff, Dr. A. N., Lipetz, Russia. Sota, Prof. R. de la, Seville, Spain. Sprimont, Dr., Moscow, Russia. Stockvis, Prof. B. .J., Amsterdam, Holland. Szadek, Dr. Carl, Kiew, Russia. Tait, Mr. Lawson, Birmingham, England. Thiriar, Dr.. Brussels, Belgium. Trifiletti, Dr., Naples, Italy. Tuke, Dr. D. Hack, London, England. Uhik, Dr. Axel, Copenhagen, Denmark. Unverriclit, Prof., Jena, Germany. Van der Mey, Prof. G. H., Amsterdam, Hol- land. Van Leent, Dr. F., Amsterdam, Holland. Van Millingen, Prof. E., Constantinople, Tur- key. Van Rijnberk, Dr., Amsterdam, Holland. Wilson, Dr. George, Leamington, England. W^olienden, Dr. Norris, London, England. Zweifel, Prof., Leipzig, Germany. AMERICA AND WEST INDIES. Bittencourt, Dr. J. C, Rio Janeiro, Brazil. Cooper, Dr. Austin N., Buenos Ayres, Argen- tine Republic. Dagnino, Prf)f. Manuel, Caracas, Venezuela. Desvernine, Dr. C. M., Havana, Cuba. Fernandez, Dr. ,1. L., Havana, Cul>a. Finlay, Dr. Charles, Havana, Cuba. Fontecha, Prof. R., Teguci.galpa, Honduras. Harvey, Dr. Eldon, Hamilton, Bermuda. Herdocia, Dr. E. Leon, Nicaragua. Levi, Dr. Joseph, Colon, U. S. Columbia. Mello. Dr. Vierra de, Rio .laneiro, Brazil. Moir, Dr. J. W., Belize, British Honduras. Moncorvo, Prof., Rio Janeiro, Brazil. Pia, Dr. E. F.. Havana, Cuba. Rake, Dr. Beaven, Trinidad. Rincon. Dr. F., Maracaibo, Venezuela. Semeleder, Dr. F., Mexico, Mexico, Soriano, Dr. M. S., Mexico, Mexico. Strachan, Dr. Henry, Kingston, Jamaica. OCEANICA, AFRICA, AND ASIA. Baelz, Prof. R., Tokyo, Japan. Barrett, Dr. Jas. W., Melbourne, Australia, Branfoot, Dr. A. M., Madras, India. Carageorgiades, Dr. J. G^Limassol, Cyprus. Cochran, Dr. Joseph P., Oroomiah, Persia. Coltman, Dr. Robert, Jr., Che-foo, China. Condict, Dr. Alice W., Bombay, India. Creece, Dr. John M., Sydney, Australia. Dalzell, Dr. J., Umsiga, Natal. Diamantopulos, Dr. Geo., Smyrna, Turkey. Drake-Biockman, Dr., Madras, India. Fitzgerald, Mr. T. N., Melbourne, Australia. Foreman, Dr. L., Sydney, Australia. Gaidzagian, Dr. Oban, Adana, Asia Minor. Grant, Dr. David, Melbourne, Australia. Johnson, Dr. R., Dera Ishmail Khan, Bcloo- chistan. Kiniura, Prof. J. K., Tokyo, Japan. Knaggs, Dr. S., Sydney, Australia. Manasseh, Dr. IJeshara I., Brummana, Turkey in Asia. McCandless, Dr. H. H. Hainan, China. Molonev, Dr. J., Melbourne, Australia. Neve, I^r. Arthur, Bombay, India. Perez, Dr. George V., Puerto Orotava, Tene- riife. Reid, Dr. John, Molbonrnc, Australia. Robertson, l)i-. W. S., I^)rtSaid, Egypt. Rouvier, Prof. Jules, Beyrouth, Syria. S<'ranton, Di-. William B", Seoul, Corea. Sinclair, Dr. II., Sydney, Australia. Thompson, Di-. .laines B , Pctchaburee, Siam. Wheeler, Dr. P. d'K., Jerusalem, I'alestine. Whitney, Dr. H. T., Foochow, (_'htna. Whitney, Dr. W. Norton, Tokyo, Japan. (29) Medical Publications of F. A. Davis, Philadelphia. MANNJEY Lectures on Nervous Diseases. From the Stand-Potnt of Cerebral and Spinal Localization, and THE Later Methods Employed in the Diagnosis and Treatment of these Affections. By Ambrose L. Ranney, A.M., M.D., Professor of the Anatom^y and Physiolooy of the Nervous System in the New York Post-Gradiiate Medical School and Hospital ; Professor of Nervous and Mental Diseases in the Medical Department of the University of Vermont, etc. ; Author of "The Applied Anatom}-- of the Nervous Sj^stem," " Practical Medical Anatomy," etc., etc. >^ It is now generally conceded that the nervous system controls all of the physical functions to a greater or less extent, and also that most of the symptoms encountered at the bedside can be explained and interpreted from the stand-point of nervous physiolog3\ Profusely illustrated with original diagrams and sketches in color by the author, cai'efuUy selected wood-engravings, and reproduced photo- graphs of typical cases. One handsome royal octavo volume of 780 pages. SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING EXPENSES PREPAID. Price, in United States, Cloth, $5 50 ; Sheep, $S.50 ; Half-Russia, $7.00. Canada (duty paid), Cloth, $5.05 ; Sheep, $7.15 ; Half-Russia, $7.70. Great Britain, Cloth, 32s. ; Sheep, 37s. 6d. ; Half-Russia, ^Os. France, Cloth, 34 fr. 70; Sheep, 40 fr. 45; Half-Russia, 43 fr. 30. We are glad to note that Dr. Ranney has published in book form his admirable lectures on nervous diseases. His book contains over seven hundred large pnges, and is profusely illnstrated with original diagrams and sketches in colors, and with many carefully selected wood-cuts and reproduced photographs of typical cases. A large amount of valuable information, not a little of which has but recently appeared in medical literature, is pre- sented in compact form, and thus made easily accessible. In our opinion, Dr. Ranney' s boot ought to meet with a cordial reception at the hands of the medical profession, for, even though the author's views may be sometimes open to question, it cannot be disputed that his work bears evidence of scientific method and honest opinion. — American Journal of Insanity. ST-A_i>q:TO]sr*s Practical and Scientific Physiognomy; I&Eo^xT' to IE^e:a-ci Fa.c;e;s. By Mary Olmsted Stanton. Copiously illustrated. Two large Octavo A'olumes. The author, Mrs. Mary 0. Stanton, has given over twenty years to the preparation of this work. Her style is easy, and, b}^ her happy method of illustration of every point, the book reads like a novel and memorizes itself. To physicians the diagnostic information conveyed is invaluable. To the general reader each page opens a new train of ideas. (This book has no reference whatever to phrenology.") SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING EXPENSES PREPAID. Price, in United States, Cloth, $9.00 ; Sheep, $11.00 ; Half-Russia, $13.00. Canada (duty paid), Cloth, $10.00; Sheep, $12.10; Half-Russia, $14.30. Great Britain, Cloth, 56s. ; Sheep, 68s. ; Half-Russia, SOs. France, Cloth, 30 fr. 30 ; Sheep, 36 fr. 40 ; Half-Russia, 43 fr. 30. (30) Medical FuhUcations of F. A. Davis, Philadelphia. SAJO US Lectures on the Diseases of the Nose and Throat. Delivered at the Jefferson Medical College, Philadelphia. By Charles E. Sajous, ]\[.D. Formerly Lecturer on Rliiuology and Laryngology in JeHerson Medical College ; Vice-President of the American Laryngological Association ; Officer of tlie Academy of France and of Public Instruction of Venezuela ; Corresponding Member of the Royal Society of Belgium, of the Medical Society of Warsaw (Poland), and of tlie Society of Hygiene of France; Member of the Americnn Philosophical Society, etc., etc. ^^^ Since the publisher brought this valuable work before the j)ro- fession, it hau become: 1st, the text-book of a large nuvtber of colleges; 2d, the reference book of the Ü. S. Army, Navy, and the Marine Service; and. 3d. an important and valued addition to the libraries of over 10,000 physicians. This book has not only the inherent merit of presenting a clear expose of the subject, but it is -nritten with a view to enable the general practitioner to treat his cases himself. To facilitate diagnosis, colored jylates are introduced, showing the appearance of the different parts in the diseased state as they appear in nature by artificial light. No error can thus be made, as each affection of the nose and throat has its repre- sentative in the 100 chromo-lithographs presented. In the matter of treatment, the indications are so complete that even the slightest pro- cedures, folding of cottou for the forceps, the use of the probe, etc., are clearly explained. Illustrated with 100 chromo-lithographs, from oil paintings by the author, and 93 engravings on wood. One handsome royal octavo volume. SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING EXPENSES PREPAID. Price, in United States, Clotli, Royal Octavo, $4 .00 ; Half-Russia, Royal Octavo, $5.00. Canada (duty paid). Cloth, $4.40 ; Half-Russia, $5.50. Great Britain, Cloth, 22s. 6d. ; Sheep or Half-Russia, 28s. France, Cloth, 24 fr. 60 ; Half- Russia, 30 fr. 30. It is intended to furnish the fteneral practi- I to him were they seen in the living subject. tloner not only with a guide for the treatment As a guide to the treatment of the nose and of diseases of the nose and tiiroat, but also to throat, we can cordially recommend this work, place before him a representation of the nor- —Boston Medical and Surgical Journal. mal and diseased parts as they would appear 1 1 THE CHINESE: Their Present and Future; Medical, Political, and Social. By ROBERT COLTMAN, Jr., M.D , Surgeon in Charge of the Presbyterian Hospital and Dispensary at Teng Chow Fn; Consulting Pliysician of the American Southern Baptist Mission Society; Examiner in Surgery and Diseases of the Eye for the Shantung Medical Class; Consulting Pliysician to the English Baptist Missions, etc. Illustrated with about Sixteen Fine Engravings from photographs of persons, places, and objects characteristic of China. In one Octavo volume of about 2150 pages. Ready About Deckmber 1, 1891. The author has spent many years among the Chinese; lived with them in their dwellings; thoroughlt learned the language; has become conversant with all their strange and odd characteristics to a greater extent than almost any other American. He has been a physician to all classes of this wonderful people, and the opportunities t))us afforded for a clear insight into the inner life of the Chinese, their virtues and vices, pf)litifal, social, and sanitary condition, probale destiny, and their present important position in the world today, have been ably and wisely used by Dr. Collman. (81) Medical Publications of F. Ä. Davis, Philadelphia. ' — — — — '. • ' JSTearly Ready, Will he Issued about October 1, 1891, Age of the Domestic Animals. Being a Complete Treatise on the Dentition of the Horse, Ox, Sheep, Hog, and Dog, and on the Various Other Means of Telling the Age of these Animals. By R.USH Shippen Huidekoper, M.D., Veterinarinn, Alfort, France. Professov of Sanitary Medicine and Vetei-inarj^ Jnrisprndence in- the American Veterinary College, New York ; Lieutenant-Colonel and Sur- geon-in-Chief National Guard of Pennsylvania; Fellow of the College of Physicians, Philadelphia; Honorary Fellow of the Royal College Veterinary Surgeons, London ; Late Dean of the Veterinary Department University of Pennsylvania, etc., etc. Complete in one handsome Royal Octavo volume, with about 160 Illustrations. This is one of the most important works on the domestic animals published in recent 3'ears. Heady Very Shortly, A, B, C of the Swedish System of Educational Gymnastics. A Practical Hand-Book for School-Teaghers and the Home. Bj' Hartvig Nissen, Instructor of Physical Training in the Public Schools of Boston, Mass.; Instructor of Swedish and German G3'mnas- tics at Harvard University's Summer School, 1891; Author of "A Manual on Swedish Movement and Massage Treatment," etc., etc. Complete in one neat 12mo volume, bound in extra flexible cloth and appropriately illustrated with 77 excellent engravings aptly eluci- dating the text. Lectures on Auto-Intoxication. By Prof. Bouchard, Paris. Translated from the French, with an Original Appendix by the author. By Thomas Oliver, M.D., Professor of Physiology in Universitj'^ of Durham, England. In Press. (32) COLUMBIA UNIVERSITY LIBRARIES as provided by the rulefof th. T Tl, u '"'"■<'™e. rangement with the Utarfant charZ^ °" '^ =^'=^'^' ^ 'ww- ^^ — c::^^ — ' I .'ov» 14, 1946 Intarlibrarj Loan 1 ua^^p^bjuA^A-^-f