Observations on the physiology and pathology of hemi-chorea / by J. Hughlings-Jackson, M.D.

  • John Hughlings Jackson
Date:
1868
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the physiology and pathology of hemi-chorea / by J. Hughlings-Jackson, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    In other words, using a term borrowed from Spencer, the corpus striatum is a series of Physiological Units—each unit representing not some one part of the limb^ but potentially the whole of the limb. (I have entered further into this point as regards Localization of Faculties,—Ifet/. Times and Gazette^ Dec. 14 and 21, 1867, Aug. 15 and 22, 1868; London Hosp. Reports^ vol. ii. p. 238; and Roy. Lond. Ophth. Hosjp. Rep.^ Dec. 1866.) Still these nerve-units are not supposed to be mere repetitions one of another, but each is supposed to represent some special leading movement of the whole limb. Bat although destruction of a small part of the corpus striatum need not produce any symptoms, or at least any permanent symp- toms, it is plain that mstability of a small part must result in symptoms, and it is equally plain that the whole of the arm must suffer when any considerable part of the corpus striatum is unstable. Thus becomes more simple the apparent paradox, that with ex- tensive gross disease of the cerebrum or cerebellum (for instance an abscess) destroying a large tract of nerve-tissue, there are sometimes no obvious motor or mental symptoms ; and that, on the other hand, when a patient dies insane, or of disease so dramatic as acute chorea, we cannot discover the morbid change which is to blame for the symptoms. The word instability has been objected to. Its use is, of course, a mere verbal artifice. It names a condition of nerve-tissue of which none of us have a clear notion. It is pretty much like excitability, a word freely used in a similar way. But insta- bility, as I use the w^ord, differs from excitability, as the latter is generally used. Instability is supposed to be caused by defective nutrition. The ^^exaggeration of normal function depends, I suppose, on the changes being permanently spread over a wider area than the temporary changes which allow the usual orderly move- ments of health. There is one thing which is not easily accounted for; namely, how it comes to pass that chorea rarely occurs in infants and in people of middle life. It may be said that in infants there is not so often a condition for embolism. Since—at least so it seems to me—the disorder in chorea is of movements which are acquired, and which are probably only fully learned by a very long apprenticeship, I used to suppose that the nervous arrangements for these movements were but partially de- veloped in children, and that the motor processes involved, and their arterial integration, would be, so to«peak, caught in a stage of incomplete development—in short, that these centres were diseased when ^a//^educated. However, movements very like—I think quite like—those of chorea in children, do occur, but yet most rarely, in infants and in old people. I have used above the term arterial integration. My speculation is, that the cerebral arteries in health have to do with the orderly development of the functions of nervous centres, and that their con-
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