The diagnosis and treatment of auditory-nerve vertigo / by W.R. Gowers.

  • William Richard Gowers
Date:
1877
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Licence: Public Domain Mark

Credit: The diagnosis and treatment of auditory-nerve vertigo / by W.R. Gowers. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the equilibrium of the body.* The theory of their function is, that they give information of the position of the head to a coordinating centre which presides over the equilibrium of the body, and which ex- perimental physiology has located in the cerebellum. Into the question of the mechanism of the action and disturbance of the semicircular canals it is not necessary here to enter. Although the theory of vary- ing pressure of the endolymph, originated by Goltz, and rendered more precise by later writers, appears highly probable, its application to the details of the normal action of the canals is still surrounded by uncer- tainties which render it difficult to frame a satisfactory detailed explana- tion of the phenomena of the disease, f All that we can conclude is, that their morbid condition causes a morbid aciion of the centre of equilibration, vphich may so disturb the equilibrium of the body as to throw the sufferer to the ground, or may merely result in a sense of corresponding movement or of mere instability. It is important, for a clear comprehension of the symptoms of these cases, to remember that the sense of movement and an actual movement, subjective vertigo and actual rotation or falling, are aspects of the same process. It is the motor tendency to turn which is felt as subjective vertigo. This was pointed out long ago by Dr. Reynolds, J and its significance has been insisted upon from many points of view by Dr. Hughlings Jackson.§ * An abstract of the facts, with references to the chief sources of information, has been given by Dr. Hughlings Jackson {Medical Times a7id Gazette^ August 17th, 1S72, and London Medical Kccord, 1S74, pp. 238 and 254). The experimental evi- dence ban been fully described and discussed by Dr. Ferrier {F?uictions of the Brain, p. 69. and West Riding Asylum Reports, vol. v). t Assuming the theory of Mach, Breuer, and Crum-Brown to be correct, that the variation in the pressure of the endolymph in the ampullae of the several canals, pro- duced by the movements of the head, constitutes the means of their stimulation, it is reasonable to suppose that the equilibrium centre is influenced by vtinus as well as by plus variations in the pressure of the endolymph in the ampulla;. The excitation of the several ampuUary nerves in various movements will therefore be a very complex matter, involving probably the mutual action of several canals, just as the guiding information as to the position of the eyeball, by which the equilibrium centre is also influenced, depends on the degree of contraction of several muscles, oblique and straight. It must be remembered, also, that the free communication between the canals will increase the comple.xity of their mutual relations. X Generally, in man, the tendency to movement is arrested by an efli'ort of the will per se, or by grasping some object for support. The sensation of its production remains, and is projected onwards into the objects of the material world (On U'er- tigo, 1854, p. 41). § Giddiness is objectively a motor symptom, and the 'sensation' it is attended by is a state of consciousness accompanying the outgoing current (Clinical and Physiological Researches on the Nervous System, Preface, p. xxv ; see also Medical Press and Circular, December 2nd, 1874, p. 477.
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