Diagnosis of disorders of the cerebellar apparatus / by Tom A. Williams.

  • Williams, Tom A. (Tom Alfred), 1870-
Date:
1910
Catalogue details

Licence: In copyright

Credit: Diagnosis of disorders of the cerebellar apparatus / by Tom A. Williams. 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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    What Sherrington calls the ejicient function of the cerebellum is that in virtue of which it coordinates and harmonizes body, head and eye movements by means of its efferent fibers. It is in this way that the equilibrium of the body is automatically regulated. Thus, the disorders of the cerebellar apparatus lead to dis- orientation and disequilibrium. And it is the disorder of these to- gether which constitutes vertigo. This is defined by Grasset^ as “a subjective psychical phenomenon constituted by the transmission to the center O* of a double basilar sensation (mesencephalic and cerebellar), a false sensation coming from the apparatus of orienta- tion, and a sensation of insufficience of the automatic centers to assure the equilibrium.” Pierre Bonnier,^® on the other hand, sepa- rates the two elements thus united by Grasset, and distinguishes vertigo from a vertiginous sensation, while Hughlings Jackson^^ gives the name of vertigo only to the motor element, that is the beginning of the fall. However, intellectual assent to the illusion of displacement of objects or autorotation cannot be regarded with Pierre Bonnier as essential. The real essential is not an intellectual belief in one’s dis- orientation, but a sentiment of loss of equilibrium; for this may be felt in bed when the patient knows perfectly that he is not falling. Thus true vertigo cannot occur except from disorder of the cere- bellar apparatus, which is the organ of both the functions the per- turbation of which constitutes vertigo. In addition to these essentials, accessory and inconstant phe- nomena may accompany vertigo. Some of these are due, following Bonnier, to the overflow of highly charged nerve centers when powerfully stimulated, their ensemble constituting the bulbar syn- drome^^ which he described. For instance, when the vestibular nerve is powerfully irritated, as by extension of otitis media to the *By the symbol O, Grasset'’ represents what he calls the superior psychical •center or centers in which consciousness is achieved. He distinguishes these from other cortical centers which only subserve sensibility and psycho- motricity and even coordinate action and ideation when these are only automatic or subconscious and which he designates by the symbol O. the polygon. He believes that this schema represents a real hierarchy of the nervous centers. It is a restatement of the “high and low-level” hypothesis of Hughlings Jackson. Recent studies of apraxia have added concreteness to this conception; but the phenomena of hysteria and so-called psychical