March 29, 1884.

THW BRITISH

MEDICAL

JOURNAL.

591

THE CROONIAN LECTURES ON

EVOLUTION AND DISSOLUTION OF THE
NERVOUS SYSTEM.
College of Physicicans, Physician to the London Hospital. Deliwred at the Royal March, 1884.

that it is only half as well organised. 3. Evolutioni is a passage from the most automatic to themost voluntary. The triple conclusion come to is that the higlhest centres,which are
and which make the climax of nervous evolution, are the mind " (or physical basis of consciousniess) up the " organ of least organised, the

BY J. HUGHLINGS JACKSON, M.D., F.R.S., F.R.C.P., LECTUPRE I.

the first place, I most hcartily me to give these lectures. mitting Is The simply is most we nervous doctrine of Evolution with His helped daily synonymous importanit system Darwinism. thank you, Mlr. President, adherents. It for per is liot

most complex, and themost voluntary. So muclh for the positive pro "-Evolution. cess by which the nervous system is "put togetlher Now for the negative process, the " taking it to pieces "-Dissolution. Dissolution being the reverse of the process of evolution just spoken of, little need be said about it here. It is a process of undevelopment ;
it is a " taking most simple, to pieces " in the order from the least organised, the word froni

themost complex and most voluntary, towards the most organised,

and most automatic. I have used " towards, " for,

new gailis Herbert

all orders

of phenomena.

for medical

application men. in our

it to Spencer applies of it to the -nervous systemii I have long thought that of diseases of the of evolutioni, that is, from Spencer as a name years. About half a

if dissolution were up to and inclusive of the most organised, etc., if, in other Nwords, dissolution were total, the result would be deatl. I say nothing of total dissolution in these lectures. Dissolution beicg partial, the condition in every case of it is duplex. The symptomato logy of nervous diseases is a double condition; there is a negative and there is a positive element in every case. Evolution not being entirely reversed, some level of evolution is left. Hence the statement, "to undergo dissolution " is rigidly the equivalent of the statement, "to
be reduced to a lower level of evolution." In more detail: loss of the

shall be very muclh

investigations

as Dissolutions. The century subject

by considering Dissolution has been

them as reversals is a term I take at for many

for the reverseof the process of evolution.

worked ago, Laycock of aphasia, (Stimulants applied have the doctrine out of reflex action that to the brain. from of

Sir Charles Bell, in speaking of degrees of drunkenness, and Baillarger,

in speaking researches poinited there is a reduction the most valuable

the voluntary towards the most automatic. The late Dr. Anstie'5
and Narcotics) are perhaps

all contributions towards the study of diseases of the'nervous'system as examples of dissolutioln, althoughl he did not use [that terni. I refer, also,with great respect to themost valuable and highly original
work which great value Ross, Ribot, ways, anid Mercier lhave done in'the same direction. the

The brilliant researches of Hitzig and Ferrier, besides thseirobvious

in other are of very great value in supporting

loctrinesof evolutiolnandldissolution of the nervous system. In this connection, I gladly mention with great respect a recent valuable paper on cerebral localisation by Dr. Sharkey.
as soon as possible, Wishing, uswake the necessary preliminary to give illustrations of dissolutioni, I will remarks as short as I can. I speak only

of the most striking aspects of evolution and dissolution, leaving entirely out of account some very important factors specially insisted on by Herbert Spencer. I regret that time renders it necessary forme is left of him (of what disease has spared), of all there then is of him to simplifymy subject by serious omissions. Spencer, to wvhomI am his illusions, etc., are his mind. uinder the deepest obligations, must not be judged by my present After this brief sketch, Imention wlhat may appear to be a draw application of his doctrines, or, ratlher,of part of them. I have to back. Scarcely ever, if ever, do we meet witlh a case of dissolution ask pardon for the use in this lecture of some popular terms. "Most whicli we caii suppose to be the exact opposite of evolution. Often voluntary," thouglhit lhasa techniicalsound, is, when used in contrast enough, however, do we ineetwith its near opposites. I will try to to " most a popuilar term ; later on, it will automatic," be discarded. dissipate any difficulties thatmay arise. We make two broad divisions I have also to acknowledge an omission ; I speak for the most part of of cases of dissolutioni,Uniform and Local. the cerebral system only, almost ignoring all divisions of the cerebellar In Uniform Dissolution thewhole nervous system is under the same system. For the presenit, I neglect tlhe absolute distinctioii which conditioi:s or evil inifluence ; the evolution of thewlhole nervous system there really is between mental nervous states. anzd is comparatively evenily reversed. In these cases the whole nervous with Beginning evolution, and dealing only witlh con time most system is " reduced,"but the different centres are not equally affecte(l. .spicuous parts of the process, I say of it that it is ail ascending de An injurious agency, suchas alcohol, taken into the system, flows to all velopment in a particulal order. I make three statements which, parts of it ; but the highest centres, being leastorganised, "give out" although from differenit standpoints, are about the very same thing. first and most ; the middle centres, being more organised, resist 1. Evolution is a passage from the most to the least organised; that longer ; anid the lowest centres, being most orgaiiised, resist longest. is to say, from the lowest wNell organised centres up to the highest Did not the lowest centres for respiration andl circulation resist much least organised centres ; putting this otherwise, the progress is from more thani thc highest do, death by alcohol would be a very commoni c emitres comparatively well organised at birth up to those, the highest thinig. Another way of stating the foregoing is to say that increasing which are conitinuiially Centres, organising through life. 2. Evolution unifolrmn dissolution follows a " compoundoraer ;" these stagesmay be is a passagge from the most complex simiiple to the most ; again, from rudely syinbolise(dthlus,usilng the initial letters of, highest, middle, and tlhe lowest to the highest centres. There is no inconsistencywlhatever lowest centres. First stage, or depth, of dissolution, h ; second stage,
in speaking of centres being, at the same time most anid complex least organised. of but two sensory and Suppose a centre to consist tw o m.otor elements ; if the sensory and motor elements be well joined, so that " currents flow " easily from the sensory into tilc motor ele a very simple that centre, rulents, then altliouglh one, is highly organised. On the otlher hand, we can conceive a cenitre consisting of four sensory and fouir motor elemenits, in which, however, the junctions the sensory an(d motor are so imperfect ')etween elemcnts that the Here is a centre twice as nierve-currents miect witli muheli resistance. complex as the one prc6iously of, but of wlhich we maiy say spoken h2 + in; third stage, A' + t12+ I ; etc. Although I shall say very

least organised,most complex, andmost voluntary, implies the reten tion of themore organised, the less complex, and the more automatic. This is not a mere truisim, or, if it be, it is one that is often neglected. Disease is said to " cause " the symptoms of insanity. I submit that disease only producesnegative mental symptoms answering to the dis solution, and that all elaborate positive mental symptoms (illusions, hallucinations, delusions, and extravagant conduct) are the outcome of activity of lnervouselements untouched by any pathologieal pro cess; that they arise durinigactivity on the lower level of evolution may be illustrated in anotherway, without remaining. The prinlciple undlue recapitulation. Starting this time with health, the assertion is that each person's normal thouglht and conduct are, or signify, survivals of the fittest states of what we may call the topmnost " layer" of his highest c *ntres: the normal highest level of evolution. Now, suppose that fromdisease the normal higlhcst level of evolution (the topmost.layer) is renderedfunctionless. This is the dissolution, to which answer the negative symptoms of the patent's insanity. I con tend that his positivemental symptoms are still the survivals of his fittest states, are survivals onl the lower, but then highest, level of evolutioim. The most absurd mentation, and mnostextravagant actions in insane people are the survivals of their fittest states. I say " fittest," not "best ;" in this coinnectionlthe evolutionist has nothing to do with good or bad. We need not wonder that anl insaneman believes inwhat we call his illusions ; they are his perceptions. His illusions, etc., are not caused by disease, but are the outcome of activity of what

ofmiddle anid lowest centres, in cases little, later on, of involvemiienlt of uniform dissolution, it ismost importanit,especially with regard to clear nlotionson localisationi,to recognise that the order of dissolution is a compound order. The next division isLocal Dissolution. Obviously, disease of a part of the nervous systemiicouldinot be a reversalof the evolution of the whole; all that we canl expect is a local reversalof evolution, that there should be loss in the order from voluntary towardsautomatic ill what the part diseased repiresenits.Repeatinc, in effect,what was said

[1213]l

592

T1-.gRITZTSH

MEDICAL

YOVVUYAZ

[March 29, 1884.

on uniform dissolution, it is only when dissolution occurs in all divi

sions of the highest centres that we can expect a reduction, from the

persistence of emotional, themore automatie language. In detail, the

patient is of a very simpleqkind; cannot 4peak, and his pantomime yet, on the other hand, he smiles, frowns, varies the tones of his voice (he may

most voluntary of all, towards themost automatic of all. Dissolution may be local in several senses. Disease may occur on any evolutionary level, on one side or on both sides; itmay affect the sensory elements chiefly, or the motor elements. chiefly. It must be particularly men tioned that there are local dissolutions of the highest centres. It will
be granted that, in every case of insanity, the highest centres are mor

be able to sing), and gesticulates as well as ever. Gesticulation, which is an emotionalmanifestation, must be distinguished fromi pautomi;&e,
-which is part of intellectual language. b. The frequent persistence of "yes" and "nio" in the casa of patients who are otherwise enltirely is a fact of extremle significance. speechless We see that ther patient has lost all speech, with the exception of the two most automatic of all

bidly affected. Since there are different kinds, as well as degrees, of insanity (for examples, general paralysis andmelancholia), it follows of necessity that different divisions of the highest centres aremorbidly affected in the two cases. Different kinds of insanity are different local dissolutions of the highest centres. I now come to give examples of dissolution. I confess that I have selected caseswhich illustrate most definitely, not pretending to be
able to show that all the diseases of which we have a large clinical

verbal utterances.
they assent to, or

"Yes" and "no" are eviflently most general, for

dissent from, any statement whatever. In conse

quence of being frequently used, the correlative nervous arrangements are of necessity highly organised; and, as a further consequence, they are deeply automatic. c. A more important thouglh not more signifi
cant illustration is, that the patient, who cannot in get out a word speech, nevertheless understands all that we say to him. Plainly, this shows loss of a most service of word's, with voluntary per sistence of a more automatic service of words. d. Tllere arc three degrees " no " by aphasics. of the utterance A patient may use it emotionally only; most automatic service. Another patient may also be able to

knowledge exemplify the law of dissolution. However, I instance very common cases, or cases in wvhich the pathology has been well
worked out; they are cases dependent on disease at various levels from

the bottom to the top of the central nervous system. Mfost of them are examples of local dissolution. 1. Starting at the bottom of the central nervous system, the first example is the commonest variety of progressive muscular atrophy.
We see here that atrophv the most begins in the most part of

reply correctlywith it; a less automatic, but still very automatic, ser
vice (here there is some real speech). There is still a higher use of it, which some aphasics have not got. A patient who can reply " no" to a question, may be unable to say " no " when told to do so. You " Is your name Jones ?" He ask the aphasic, replies, You "No." tell him to " say no ;" he tries and fails. You next ask, "Are you a hundred years old ?" He replies, " No." You tell him to "sav no

it affects, first, the most voluntary part of that limb, the hand, and,
first of all, voluntary the hand; it then spreads to

voluntary

limb,

the armn

the trunk, in general to themore automatic parts.

To speak of a lower level of evolution a barren, truism; at stage when the anterior higher horn, anterior in this case, small muscles

are wasted, there is, centrally, atrophy of the first or second dorsal however, is worth making, for it shows clearly that, by higher and lower, ismeant anatoinico-physiologically higher or lower. 2. Going a stage higher, we come to hemiplegia, owing to destruc tion of part of a plexus in the mid-region of the brain. Choosing
the commonest variety of hemiplegia, we see that and the lower level of evolution is made horns for the muscles of the arm.. This up df the statement,

is almost to state of the handl only

he cannot. Whilst not asserting that the inability to say " no " when
told is a failure in language, it is asserted that such inability, with

retention of power to use the word in reply, illustrates dissolution.

c. A patient, who is speechless, may be unable to put out his tongue when told to do so ; that he knows wuhat is wanted, is sometimes shown by his putting his fingers in his mouth to help out the organ. That the tongue is not paralysed in the ordinary sense is easily proven; the patient swallows well, which he could not do if his tongue were so much paralysed as " it pretends to be ;" besides, on other occasions, he sticks to catch a stray crumb. the tongue out, for example Here is a reduction to a more automatic there is no move condition; of the tongue more voluntary ment than that of putting it out when

more or fewer of the most voluntary movements of one side of the body; we find that the arm, themore voluntary limb, suffers themore and longer; we find, too, that the most voluntaly part of the face suffersmore than the rest of the face. Here, we must speak particu larly of the lower level of evolution remaining; strictly, we should say
collateral and; lower. We note that, although the unilateral move

there

is

loss

of

told.
[The lecturer then remarked on swearing, and on the utterance of other

ments (themore voluntary) are lost, themore automatic, the bilateral, value ; the patients could not repeat wlhat under excitement they are retained. Long ago, thiswas explained by Broadbent; subsequent uttered glibly and well. lie spoke next of the frequent retention of
clinical researches are in accord with his hypothesis. The

and innocent ejaculations by aphasics, remarking that some of these utterances have elaborate propositional structure, but no propositional

is that the bilateral movements escape in cases of hemiplegia, in spite of destruction of some of the nervous arrangements representingthem thesemovements are doubly represenlted,are represented in each half
of the brain. Hemiplegia is a clear case of dissolution, loss of the

point

of it

most voluntary movements of one side of the body, with persistence of the more automaticmovements. half of the nervous system on different levels. Coming to the highest 3. The next illustration is paralysis agitans. Apart from all specu centres, I speak of uniform dissolutions, of cases in which all divisions lation as to the seat of the disease, the motorial disorder illustrates of these centres are subjected to the same evil influence. I choose some dissolution well. In most cases, the tremor affects the arm first, cases of insanity. In doing am this, I taking up the miiost difficult
in the hancd, and in the thumb begins and torial disorder in this disease becomes bilateral. dissolution.

some recurring utterances 'by aphasics, such as "Comlie ol 'to me." Thlese wrere not, from the mouth of the aphasic, of any propositional value, they were not speech. He had no explanation to offer' of them; but stated the hypothesis the words that they were the patient was or was about to utter, at the time he was taken ill.] uttering, 8. So far I have spoken of local dissolutions on occurring but one

paralysis agitans is double hemiplegia with rigidity-is

The mo index-finger. In an advanced stage,

of all nervous, of these most it in general.

diseases.

' I grant

that

it is not possible

to show

in detail illustrate in acute

a two-sided

that theyexemplify the principle of dissolution, but choosing the simplest

complex cases, we may show I take a very commonplace clearly that the. example, delirium

4. Next we speak of epileptiform seizures,which are unquestionably owing to disease in the'mid region of the brain (middlemotor centres). Taking the commnonest variety, we see that the spasm mostly begins
in the- arm, nearly always in the hand, and most frequently in the

non-cerebral disease.

This, scientifically regarded, is a 'case of

In this, as in all other cases of insanity, insanity. it is imperative to take into account not only the dissolution, equally but also the lower level

thtimb or index-finger, or both. These two digits are the most volun tary parts of the whole body. 5. [The next illustrationwas by cases of temporaryparalyses after epiloptiform seizures.]
6. Chorea is a disease in which are affected more thaii the trunk, the limbs (the most the more automatic

of evolution that remains. The patient's condition is partly negative

and partly positive. Negatively, he ceases to know that he is in hos

pital, and ceases to recognise persons about him.

In other words, he

themore voluntary limbs, suffermore than the legs. The localisation of this disease has not been made out. Symptomatically, however, it illustrates dissolution. Chorea has a peculiar interest for me. The gre&t elaborateness of the moVements points, I submit, to disease
" high up"-to disease on a high level

voluntary parts) part*s; the arms,

is lost to his surroundings, or, in equivalent terms, he is defectively con scious. We must not say that he does' not know where he is, because he is defectively conscious. His not knowing where he is is itself defect

of consciousness. The negative mental state signifies, on' the physical

or loss of function side, exhaustion, somehow caused, of sonie highest of his highest nervous arrangements 'centres., We may conveniently say that it shows loss of function of the topmost " layer " of his highest No one, of course, believes centres. that the, highest or any centres, other centres, are in layers; but the supposition will simplify exposition. The other half of his condition is positive. Besides his not knowings, there are his wrong knowings. He imagines himself to be at home or at work, and acts, as far as practicable, as if he were. to re Ceasing cognise his nurse as a nurse, he takes her to be his wife. the This, positive part of his condition, shows activity of the second layer of his

ago; from thinking on its peculiarities, it occurred to me that convo ]utions represent movements-a view I have taken ever since.
7. Aphasia well illustrates intellectual, the doctrine of

of evolution.

Twenty

years

several ways.
a. There

dissolution, language,

We

consider a case of complete speechlessness.

the more voluntary with

and'

-in

is loss of

March 29, $4.] 1

THE BRITISH

MEDICAL

JOURN.

I hope later to show that explanations highest centres,. but which, now that the normal to Aot layer is out " second " side of his body. of function, is the then highest layer. His deliri .um is the " survival ofmaterialistic states by psychical states are invalid. I lhave long of the fittest stlates" on his then highest evolutionary level. Plainly I wish here to bring evidence in support of the opiilions he isreduced to a more automatic condition., Beiig, ndgatively, lost held-that in each all parts of both sides' of the body are represented to -his present "r eal ' surroundinigs, from loss of funetion of the highestm half of tl,ae brain. The view I take is simply ait extension of Broad latest develope4l,and least organised, he positively talks and acts as if bent's hypothesis, already referred to. Mly supposition is that the adjusted to some former ",ideal" surroundings, necessarily the more limbs of the two sides are very unequally represented in each half of orga;nised. the brain, whilst the bilaterally acting muscles are very nearly equally I now make some general remarks on tlhe eight illustrations, in order

to prevent, certaini iisunderstainding. It is asserted again that each of the eight cases is a different dissolution. All that ismeant is, that each shows a reduction from the volunltary towardis the auitoumatic, in
what the cenitre, or part of it, which is diseased represenits. If we take

represented in each half. Evidence that at least some parts of both sides of the body are represented in each half of the brain is that, con

secutive to a negative lesion of one internal capsule, there iswasting

of nerve-fibres " desceelding" into both sides of the spinal cord.

Degrees of epileptiform seizuiresillustrate different depths of disso extreme cases, the case of progressive musculat atrophy, and the case lution. There ar-cdegrees of these, from-to take an example-spasm of insanity (deliriumn in acute non-cerebral disease), we say that the of the thumb and index-finigerto unliversalconvulsion.1 That these two are alike, because in each there is reduction to a more automatic degrees are compounldis very evidenit. rThe first stage of the fit is, to
conidition; adid we say, too, that they a're very unlike, the parts of the

nervous systemmorbidly affected being exceedingly different.

I have so far almost ignored the distinction nervous between states and meutal states. Now, if the case of insanity be considered as a series of mlental only, it would be absuir(d to compare, or phenomena

speak roughly, that the arm that the aim

that the aril- is a little affected ; the second stage is is mnore affected and the face a little ; the third stage is is most the face muchl, and the leg a little. affected,

eveln to cointrast,it with progressivemuscular atrophy, which is a series

of physical phenlomenia only. But no difficulty can arise, if it be unider stood that insaniity or "disease of the mind" is, with medical men, disease of the highlest niervous centres, itself in a series of revealing

This compounidorder of spreading,which any adequate doetrinie of localisationhas to account for,may be symbolised thus: a, then a2+f
then a3 + boay f2 + 1, etc. There are degrees of beyond the brain. this to universal Certain spasm;

these cases, I submit, supply further evidence that both sides of the
are represented in eaca half experiments

of Franck and Pitres (Arch. de Phys., August 15th, 1883, No. 6) bear mental plhenomiiena. We compare and contrast disease of the highest in amost importantway on the question as to double representation. centres with disease of some anterior horlns (somiie lowest centres), re After exposing the so-calledmotor region2of each half of the brain of vealing itself in atroplhyof certaiin muscles. But, acknowledging this, a dog, they removed the imotor region on one half aind then found that
it mnay be sai(d that the two thinigs are so exceedingly that it different, is fiivolous to compare or even to contrast them on anly basis. Yet no one deniies that each is a morbid of the central niervous sys affection tem. This the rejoinder being grainted, to those who insist on the extreme unlikeness is, that the lesion in one is at the very bottom, in the other at the very top, of the central nervous systemi * two lesions cannlot possibly be further apart in the central nervous system. Still, it may be said that classification, on the prinlciple of dissolution, if true, is of nio value ; that it is of no use making, an orderly asceniding series, froma progressive muscular atrophy to insanity-of no use showinig that fara&isationi of the "armii-centre " on tIle half intact (left) produced uniiversal ; they found, too, that the spasmB followed a par convulsion ticular order-that it affected the right arm (so to call it), then the done se generaliser malgre la destruction pre'alable de la zone motricc

right leg, then the left ler,, and then the left arm. "L'epilepsie peut d'un cote, malgre la section longitudinal comiplete du corps calleux" (Franck and Pitres). Here seems to be evidence that both sides of
the body are represcited in eaclh half of the brain, and also that the

two sides are differently represented in caell half. The distinguished Frenclhphysicians towhose observatioinsI have referred hold, I must Le cerveau commence l'attaque, la protuberance, le piogressivemuscular atrophy is reduction to amore automatic conidi mention, that ." tioni, a small corner on the lowest level ; that lheiiplegia is such a re bulbe, et lamoelle la g6neralisent." If this be so, still proof is given
duction on a largeri scale, higher up ; and that insanity is such a tioIn on the topimost level, and on the largest scale-that, even kind of work could be thorouglily well done, it is not worth any while to do it. I grant that such a classificationi is niot of reduc if this one's direct that movements of all parts of the body are under comtmanid of, if not fully in, each half of the brain. This is a matter, of represented

extreme impoortance for the doctrines of evolution and dissolution.

The evi(lence, as I read it, is, that the middle mnotor centres (a dis

v alue, but yet, I thinik, of much indirect value, for clinical purposes. We require in our professioln two kinds of classification. The use of
two kilnds of classificationi tical purposes, and(I there may be easily illustrated. of plants There by is a classi the botanist

charge beginniing in parts wlhich causes epileptiform seizures) of each

half of the brain of both sides of the boly. represenit movements Other facts wvill, I think, sliow that the Iigahest inotor centres (frontal

fication, or strictly an arrangement, of plants by the farmer for prac

is a classificatioin

lobes) re-represent, inl more intricate combiniations,all that themiddle

centres haive represenited in simiipler combinations ; a dischlalge begin

for the acdvancement of biology. I submit that there is nomore iincon ning in part of thesemnoreevolved cenitres produces an epileptic seizure, gruity in classing together progressivemuscular atrophy and insanity, wlmich is, so to speak, a " more evolved convulsion' than' an epilepti uipon tlhebasis mnentioned, than there is in classifying the bamboo with form seizure.
or the hart's-tongue conuIInon grass, with the tree-fern in a botanist's gardeni. Such kind of classification of plants would be absurd in a farimi or kitchen-garden4; of diseases and so a classification of the nlervolus system, ulpoIn the principle of dissolution, be absurd in would an asylumii or in the wards of a lhospital. I know of no other basis, thani that supplied by the doctrinie of evolution, cases of in on which [In the remainder of t}le lecture, mDaimy degrees of aphasia were in

stanced, to illustrate again different depths of dissolutioll, and different

shallows of evolution and also to illustrate the dual sym remaining, of disease. The wrong wvords uttered by a patient -who has ptomatolocy of speech," are owing to activities "defect of healthy lnervous arrange. mnents, wlhilst the disease is answerable not say olnly for the patient's ing the riglht words. The states comparable, in a case of "defect of speech," with the states in the case of another anid who can aphasic, inabilities of the fornier to say the onlly say " no," are (1) niegatively, right wor(hs, with time latter speechlessniess the ; and (2) positively,

sanity-diseases of the highest centres-can be studiedl comparatively wvitlhnon-menital diseases of the nervous system-diseases of lower
cenitres.

I next slpeak of different depths of particular dissolutions. The dleeperthe dissolution, tlheshallower the level of evolutloli feihaining.
In hemiplegia, to a lesioil of the internal owing capsule, tllere. according to,the -gravity of the lesion, tlhree degrees or depths. are, (Of

utterance of nunmlerous wrong words by the former,with

the retention

<'ourse,the (livisioln inito tlhree degrees is albitrary.)

In the first

of "yes" and " lnO" only by the latter. In the formner, the dissolutioni is the disso sliglht, and the level of evolutioln very high ; ini the latter, lution is deep and the level of evolution very slhallow]. 1 I aii not speakiig of epileptic attacks, wliich depend, I think, on discharges A imian beginniiing in p)arts of centres of a highler, tImehighest, level of evolution. loiln subject to very limilited epileptiform seizuires may at length have seiztures beginning in the samneway anid becoming universal, but these are not epileptic seizures, they are only more severe epileptiform seizures. 2 I say "so-called motor region" not because I deny that the parts in this call tlhem the umiiddle motor centres-but because I be region are motor-T lieve the parts in front to be motor also, to be the highest motor centres.

degree, there is some paralysis of the face, arm, anid leg; iin the second, there is more paralysis of these parts, and, in addition, there is a greater rancre ofparalysis-the head and eyes are turned from patient's is the side paialysed. I Heae illustrated what call. "compound order." The diferenceq between the two degrees is, not that in the -second is nor a is theie that there only, more paralysis greater range of para lysis onlv, but in both respects-; there is nmore paralysis of thke parts

afiected in the first degree and extension of range of paralysis to parts beyond them Aa.deluate doctrine of localisation has to account for inerease of p-walysisin" compoundorder"on increasiulggrayity of lesions. In.the third dQgee, of, or,rather beyond, hemiplegia,- there iswmiVersal
has lIst consciouwness, imimobility. and _In, this degree, the patient this loss niay be said to explain why he does not move the " other'? or

are said tobe 'twelve medical periodicals published1ih JaPan. TiiE1RE

(uneil have increased the salary of- Mr. William -In 1er6.ty-MoWir. to ?200 per .annu&m. officer of health, Iliffe, the medical

BMJ Publishing Group

The Croonian Lectures On Evolution And Dissolution Of The Nervous System Author(s): J. Hughlings Jackson Reviewed work(s): Source: The British Medical Journal, Vol. 1, No. 1213 (Mar. 29, 1884), pp. 591-593 Published by: BMJ Publishing Group Stable URL: http://www.jstor.org/stable/25266023 . Accessed: 26/05/2012 09:59
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