Clinical lectures on intra-cranial tumours. Lecture 2 / by Byrom Bramwell.

  • Byrom Bramwell
Date:
[1881]
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Licence: Public Domain Mark

Credit: Clinical lectures on intra-cranial tumours. Lecture 2 / by Byrom Bramwell. Source: Wellcome Collection.

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    position. To-day I propose to direct your attention to some symptoms which result from the presence of tumours in particular parts of the brain, or cranial cavity. These symptoms are commonly termed, “localizing,” because they serve to indicate the position of the growth. Let us, then, in the first place, consider the alterations in the motor nerve apparatus which may be caused by the presence of an intra¬ cranial tumour. Spasms and paralyses, the symptoms which result from alterations in the motor nerve supply of muscles, are of frequent occurrence, and, from an anatomical and physiological point of view, are the most interesting of all the symptoms. An intra-cranial tumour may be regarded as a foreign body which, as soon as it attains to sufficient size, presses upon and injures nerve tissue. The symptoms which result from the pressure of a tumour on motor nerve tissue depend upon— 1. The function of the particular portion of motor nerve tissue which is injured, i.e., upon the position of the tumour. 2. The manner in which it is injured, viz., whether it is irritated, or destroyed. 3. (In the case of destroying lesions) the rapidity of the destruc¬ tion. 1. The Position of the Tumour.—In order that you may thoroughly understand the important influence which the position of the tumour exercises upon the symptoms (the extent and distribution of the resulting spasm or paralysis), allow me very briefly to direct your attention to the arrangement of the motor nerve tract within the encephalon. Recent researches, more particularly the clinical researches of Dr Hughlings Jackson on the human subject, and the experimental researches of Hitzig, Ferrier, and others on the lower animals, go to show, that the convolutions in the neighbourhood of the Fissure of Rolando (more especially the ascending frontal and ascending parietal convolutions) are concerned in the production of voluntary movements, and that individual movements and groups of move¬ ments are, specially, (observe, I do not say entirely) represented in particular portions or centres of this motor area. In this diagram, which is copied from Professor Ferrier’s splendid work, The Functions of the Brain, you will see the exact position of these motor centres (see Fig. 1). These centres functionate—i.e,} discharge or liberate motor nerve force—in obedience to the commands of the will. (The centre for the will has not as yet, and probably never will be exactly, localized. It is probably scattered over an extensive area of the cerebral cortex.) From the motor cerebral cortex conducting fibres pass downwards, and convey the motor nerve force, which has been liberated by the generating centres, to the muscles on the opposite side of the body. VOL. xxvi.—no. ix. 5 M