Lectures on the diagnosis of diseases of the brain, delivered at University College Hospitals.

  • William Richard Gowers
Date:
1887
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Licence: Public Domain Mark

Credit: Lectures on the diagnosis of diseases of the brain, delivered at University College Hospitals. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    in diagnosis. Here also, however, we meet -with con- tradictious ; and here also more has been ascertained than we can at present apply. Our guide in this department must be the facts of clinical and pathological observation. We must beware of ap];)lying wliolesale to the liimian brain the conclusions derived from experiments on animals. The latter are of value to us only as indications for observation on man, and by enabling us to give a fuller interpretation to the facts we learn by our study of disease during life and after death. Some of the experimental facts have at present received no confirmation, and on some points we especially need information, which, from their nature, experiment cannot give. Before we enter on those details regarding the structure and functions of the brain that are of chief importance for diagnosis, I must remind you of certain important ele- mentary facts. We speak of nerve-cells and nerve-fibres as if they were merely connected structures, essentially distinct. They are not really so. The axis-cylinder of each nerve- fibre is the prolonged process of a nerve-cell, sharing all changes of nutrition that the nerve-cell undergoes, suffering with it when the cell is damaged. This is the secret of the secondary degeneration. If a fibre, or part of a fibre, is cut off from its parent cell, it degenerates ; the part still in connection with the cell does not degenerate. If the cell is destroyed, the whole fibre perishes. Although I have said that every fibre is a nerve-cell process, I need hardly tell you that the fact is not proved. It never can be proved by observation. But the relation can be observed of some cells in various parts of the nervous system; the contrary has never been observed; and we may therefore infer, with con- siderable probabiHty, that the fact is true of all nerve-fibres. We do not know whether any nerve-fibres unite directly the undivided processes of two nerve-cells. It is probable that, as a rule, they do not, because we usually find that only one process of a cell becomes directly an axis-cylinder; the other processes divide and ramify in a branching network