SPINAL CORD, in anatomy, that part of the central nervous system in man which lies in the spinal canal formed by the vertebrae, and reaches from the foramen magnum to the lower margin of the first lumbar vertebra. It is about 18 in. long, and only occupies the upper two-thirds of the spinal canal. The cord is protected by the same three membranes which surround the brain. Outside is the dura mater, which differs from that of the brain in not forming a periosteum not to the bones, in sending no processes inward, and in having no blood sinuses enclosed within its walls. In other words the spinal dura mater is the continuation of only the inner or cerebral layer of the dura mater of the skull. Inside the dura mater is the arachnoid, which is delicate and transparent, while between the two lies the sub-dural space, which reaches down to the second or third sacral vertebra. The pia mater is the innermost covering, and is closely applied to the surface of the cord into the substance of which it sends processes. Between it and the arachnoid is the sub-arachnoid space, which is much larger than the sub-dural and contains the cerebro-spinal fluid. Across this space, on each side of the cord, run a series of processes of the pia mater arranged like the teeth of a saw; by their apices they are attached to the dura mater, while their bases are continuous with the pia mater surrounding the cord. These ligaments, each consisting of twenty-one teeth, are the ligaments denticulata, and by them the spinal cord is moored in the middle of the cerebro-spinal fluid.
(From Gray's Anatomy, Descriptive and Surgical.)
Fig. 1.—Transverse Section of the Spinal Cord and its Membranes.
The spinal cord itsefl is a cylinder slightly flattened from before backward. In the cervical region it is enlarged where the nerves forming the brachial plexus come off, while opposite the lower thoracic vetebrae the lumbar enlargement marks the region whence the lumbo-sacral nerves are derived. (See fig. 2.) Opposite the second lumbar vertebra the cylindrical cord becomes pointed and forms the conus medullaris from the apex of which a glistening membranous thread runs down among the nerves which form the cauda equina, and after blending with the termination of the dural sheath, is attached to the back of the coccyx.
In a transverse section of the cord two median fissure are seen; the antero-median (see fig. 3, A) is wide, and reaches about a third of the way along the antero-posterior diameter of the cord; it is lined by the pia mater, which at its orifice, is thickend to form a glistening band, known as the linea splendens; in front of this lies the single anterior spinal artery.
The postero-median fissure (fig. 3, P.) is much deeper and narrower, and has no reflection of the pia mater into it. Where the posterior nerve roots emerge (fig. 3, P.R.) is a depression which is called the postero- lateral fissure, while between this and the postero-median a slight groove is seen in the cervical region, the para median fissure (fig. 3, P.M; see also fig. 2). On looking at fig. 3 it will be seen CVi that the anterior nerve roots (A.R.) do not emerge from a definite fissure.
The spinal cord, like the brain, consists of grey and white matter, but, as there is here no representative of the cortical grey matter of the brain, the white matter entirely surrounds the grey. In section the grey matter has the form of an H, the cross bar forming the grey commissure. In the middle of this the central canal can just be made DVn out by the naked eye (see fig. 4). The anterior limbs of the H form the anterior cornua, while the posterior, which in the greater part of the cord are longer and thinner, are the posterior cornua. At the tips of these is a lighter-coloured cap (fig. 3, S.G.) which is known as the substantia gelatinosa Rolandi. On each side of the H is a slighter projection, the lateral cornu, which is best marked in the thoracic region (see fig. 4).
On referring to fig. 4 it will be seen that the grey matter has different and characteristic appearances in different regions of the cord, and it will be noticed that in the cervical and lumbar enlargements, where the nerve to the limbs comes off, the anterior horns are broadened.
(From D. J. Cunningham, in Cunningham's Text-Book of Anatomy.)
Fig. 2.—Diagram of the Spinal Cord as seen from behind.
CVI shows the level of the 1st cervical vertebra; CVv of the 5th cervical vertebra; Dvii of the 2nd dorsal vertebra; DVx of the 10th dorsal vertebra; DVxii of the 12th dorsal vertebra; LVii of the 2nd lumbar vertebra.
Fig. 3.—Diagram to show the Tracts in the Spinal Cord.
A. Antero-median fissure.
P. Postero-median fissure.
A.R. Anterior nerve roots.
P.R. Posterior nerve roots.
P.M. Paramedian fissure.
S.G. Substantia gelatinosa.
G.T. Tract of Goll.
B.T. Tract of Burdach.
C.T. Comma tract.
O.A. Oval area.
L.T. Lissauer's tract.
D.C.T. Direct cerebellar tract.
T.G. Gowers' tract.
C.P.T. Crossed pyramidal tract.
L.B.B. Lateral basis bundle.
A.B.B. Anterior basis bundle.
D.P.T. Direct pyramidal tract.
Histologically the grey matter is made up of neuroglia, medullated and non-medullated nerve fibres, and nerve cells (for details see Nervous System). The nerve cells are arranged in three main columns, ventral, intermedio-lateral and posterior vesicular. The ventral cell column has the longest cells, and these are again subdivided into antero-mesial, antero lateral, postero-lateral and central groups. The intermedio lateral cell column is found in the lateral horn of the thoracic region.
The posterior vesicular or Clarke's column is also largely confined to the thoracic region, and lies in the mesial part of the posterior cornu. It is the place to which the sensory fibres of the sympathetic system (visceral afferents) run. The white matter, as has been shown, surrounds the grey. and passes across the middle line to form the white cornmissure, which lies in front of the grey. It is composed of neuroglia and medullated nerve fibres, which are arranged in definite tracts, although in a section of a healthy cord these tracts cannot be distinguished even with the microscope. They have been and are still being gradually mapped out by pathologists, physiologists and embryologists.
On tracing a sensory nerve into the cord (fig. 3, P.R.) through the posterior nerve root it will be seen to lie quite close to the mesial side of the posterior horn of grey matter, where most of it runs upward. The next root higher up takes the same position and pushes the former one toward the middle line, so that the lower nerve fibres occupy an area close to the postero-median fissure known as the tract of Goll (fig. 3, G.T.), while the higher lie more externally in the tract of Burdach (B.T.). The greater part of each nerve sooner or later enters the grey matter and comes into close relation with the cells of Clarke's column, but some fibres run right up to the nucleus gracilis and cuneatus in the medulla (see Brain), while a few turn down and form a descending tract, which, in the upper part of the cord, is situated in the inner part of the tract of Burdach and is known as the comma tract (fig. 3, C.T.), but lower down gradually shifts quite close to the postero-median fissure and forms the oval area of Flechsig (fig. 3, O.A.). It will be obvious that both these tracts could not be seen in the same section, and that fig. 3 is only a diagrammatic outline of their position.
A few fibres of each sensory nerve ascend in a small area known as Lissauer's tract (fig. 3, L.T.) on the outer side of the posterior nerve roots, and eventually enter the substantia gelatinosa.
To the outer side of Lissauer's tract and lying close to the lateral surface of the cord is the direct cerebellar tract (fig. 3, D.C.T.), the fibres of which ascend from the cells of Clarke's column to the cerebellum. As Clarke's column is only well developed in the thoracic region this tract obviously cannot go much lower.
In front of the last and also close to the lateral surface of the cord is another ascending tract, the tract of Gowers (fig. 3, T.G.), or, as it is sometimes called, the lateral sensory fasciculus. It probably begins in the cells of the posterior horn, and runs up to join the fillet and also to reach the cerebellum through the superior cerebellar peduncle. The crossed pyramidal tract (fig. 3, C.P.T.) lies internal to the direct cerebellar tract, between it and the posterior cornu. It is the great motor tract by which the fibres coming from the Rolandic area of the cerebral cortex are brought into touch with the motor cells in the anterior cornu of the opposite side. This tract extends right down to the fourth sacral nerve.
In front of the crossed pyramidal tract is the lateral basis bundle (fig. 3, L.B.B), which probably consists of association fibres linking up different segments of the cord.
The anterior basis bundle (fig. 3, A.B.B.) lies in front and on the mesial side of the anterior cornu, and through it pass the anterior nerve roots. Like the lateral bundle it consists chiefly of association fibres, but it is continued up into the medulla as the posterior longitudinal bundle to the optic nuclei.
The direct pyramidal tract (fig. 3, D.P.T.) is a small bundle of the motor fibres from the Rolandic area, which, instead of crossing to the other side at the decussation of the pyramids in the medulla, runs down by the side of the antero-median fissure. Its fibres, however, keep on gradually crossing to the opposite side through the anterior white commissure of the cord, and by the time the midthoracic region is reached it has usually disappeared.
The roots of the spinal nerves in the upper part of the canal rise from the cord nearly opposite the points at which they emerge between the vertebrae, but the farther one passes down the higher the origin of each root becomes above its point of emergence. Consequently the lumbar and sacral nerves run a long way down from the lumbar enlargement to their spinal foramina and are enclosed in the dural and arachnoid sheaths to form a mass like a horse's tail, which is therefore known as the cauda equina. The relation between the origin of each nerve and the spinous processes of the vertebrae has been worked out by R. W. Reid (Journ. Anat. and Phys., xxiii. 341).
Fig. 4.—Sections of Spinal Cord, twice scale of nature.
1. Cervical enlargement.
2. Thoracic region.
3. Lumbar enlargement.
4. Sacral region.
Embryology. - The early development of the neural tube from the ectoderm is outlined in the article on the Brain. When the neural groove becomes a tube it is oval in section with a very large laterally compressed central canal (see fig. 5). The original ectodermal cells elongate and, radiating outward from the canal, are now known as spongioblasts, while the inner ends of some of them bear cilia and so the canal becomes ciliated. A number of round cells, known as germinal cells, now appear close to the central canal, except at the thin mid-dorsal and mid-ventral laminae (roof-plate and floorplate). From the division of these the primitive nerve cells or neuroblasts are formed and these later on migrate from the region of the canal and shoot out long processes - the axons. The permanent central canal of the cord was formerly said only to represent the ventral end of the large embryonic canal, the dorsal part being converted into a slit by the gradual closing in of its lateral walls, thus forming the postero-median fissure. A. Robinson, however, does not believe that the posterior fissure is any remnant of the central canal, and there are many points which bear out his contention (Studies in Anatomy, Owens College, 1891). The most modern view (1908) is that the fissure is formed partly by an infolding and partly from the original central canal. The antero-median fissure is caused by the ventral part of the cord growing on each side, but not in the mid-line where no germinal cells are.
(From D. J. Cunningham in Cunningham's Text-Book of Anatomy.)
Fig. 5.—Schema of a Transverse Section through the Early Neural Tube (Young).
The left side of the section shows an earlier stage than the right side.
The anterior nerve roots are formed by the axons of the neuroblasts in the developing anterior cornua, but the posterior grow into the cord from the posterior root ganglia (see Nerve: Spinal), and, as they grow, form the columns of Goll and Burdach. That part of the grey matter from which the ventral, anterior or motor nerve roots rise is known as the basal lamina of the cord, while the more dorsal part into which the posterior nerve roots enter is the alar lamina. These parts are important in comparing the morphology of the spinal cord with that of the brain.
In the embryo up to the fifth month there is little difference in the appearance of the grey and white matter of the cord, but at that time the fibres in the columns of Burdach acquire their medullary sheaths or white substance of Schwann, the fatty matter of which is probably abstracted from the blood. Very soon after these the basis bundles myelenate and then, in the sixth month, the columns of Goll. Next follow the direct cerebellar tracts and, in the latter half of the eign Lh month the tracts of Gowers, while the fibres of the pyramidal and Lissauer's tracts do not gain their medullary sheaths until just before or after birth. At first the spinal cord exends as far as the last mesodermal somite, but neuroblasts are only formed as far as the first coccygeal somite, so that behind that the cord is non-nervous and degenerates later into the filum terminale. After the fourth month the nervous portion grows more slowly than the rest of the body and so the long cauda equina and filum terminale are produced. At birth the lower limit of the cord is opposite the third lumbar vertebra, but in post-natal development it recedes still farther to the lower level of the first.
For further details see Quain's Anatomy, vol. i. (London, 1908); J. P. McMurrich, Development of the Human Body (1906). Most modern descriptions are founded on the writings of W. His, references to which and to other literature will be found on p. 463 of McMurrich's book.
Comparative Anatomy. - In the Amphioxus there is little difference between the spinal cord and the brain; the former reaches the whole length of the body and is of uniform calibre. It encloses a central canal from which a dorsal fissure extends to the surface of the cord and it is composed of nerve fibres and nerve cells; most of the latter being grouped round the central canal or neurocoele, as they are in the human embryo. Some very large multipolar ganglion cells are present, and there are also large fibres known as giant fibres, the function of which is not clear.
When the reptiles are reached the cord shows slight enlargements in the regions of the limbs and these become more marked in birds and mammals.
In the lumbar region of birds the dorsal columns diverge and open up the central canal, converting it into a diamond-shaped space which is only roofed over by the membranes of the cord, and is known as the sinus rhomboidalis.
In all these lower vertebrates except the Anura (frogs and toads), the cord fills the whole length of the spinal canal, but in the higher mammals (Primates, Chiroptera and Insectivora) it grows less rapidly, and so the posterior part of the canal contains the cauda equina within its sheath of dura mater. In mammals below the anthropoid apes there are no direct pyramidal tracts in the cord, since the decussation of the pyramids in the medulla is complete. Moreover, the crossed tracts vary very much in their proportional size to the rest of the cord in different animals. In man, for example, they form 11. 87% of the total cross area of the cord, in the cat 7.7 6%, in the rabbit 5.3%, in the guinea-pig 3%, and in the mouse 1.14 / o. In the frog no pyramidal tract is found. It is obvious, therefore, that in the lower vertebrates the motor fibres of the cord are not so completely gathered into definite tracts as they are in man.
A good deal of interest has lately been taken in a nerve bundle which in the lower vertebrates runs through the centre of the central canal of the cord, and takes its origin in the optic reflex cells in close relation to the posterior commissure of the brain. More posteriorly (caudad) it probably acquires a connexion with the motor cells of the cord and is looked upon as a means by which the muscles can be made to actively respond to the stimulus of light. It is known as Reissner's fibre, and its morphology and physiology have been studied most carefully in cyclostomes and fishes. It is said to be present in the mouse, but hitherto no trace of it has been found in man. It was discovered in 1860, but for forty years has been looked upon as an artifact.
See P. E. Sargent, " Optic Reflex Apparatus of Vertebrates," Bull. Mus. Comp. Zool. Harvard, vol. xlv. No. 3 (July, 1904); also for general details R. Wiedersheim, Comparative Anatomy of Vertebrates (London, 1907); Lenhossek, Bau des Nervensystems (1895). (F. G. P.)
Surgery Of The Spine And Spinal Cord
Fracture of the spine may occur from indirect violence, as when a man falls from a height upon his head, or in a sitting position; or it may result from direct violence, as when he is hanged, or as when he is run over by a loaded van, or in a fall from a height across a beam. The vertebrae above the fracture being displaced from those below it, the spinal cord is generally torn across, and the parts of the trunk, or the limbs, which are supplied by the spinal nerves passing out from the cord below the seat of injury are of necessity cut off from their connexion with the brain, and at once deprived of sensation and of the power of voluntary movement. In some cases of fracture of the spine there is at the time marvellously little constitutional disturbance. The higher up the column that the fracture occurs the more quickly does death ensue. If .the fracture is in the middle of the back the patient may linger for several weeks, but even if he is lying upon a water-bed, and even if every care is taken of him, inflammation of the bladder and intractable bed-sores are apt to make their appearance, and his existence becomes truly miserable. Operative surgery is unable to effect much in these cases on account of the spinal cord being generally torn across or hopelessly crushed.
Curvature of the spine may be due to deformity of the bodies of the vertebrae caused by irregular pressure, or to the disintegration of their anterior parts by tuberculous ulceration, known as Pott's disease or spinal caries. Thus the causes of spinal curvature are very different, and it is necessary that the actual condition be clearly recognized or treatment may prove harmful. Briefly, the curvature which is due to tuberculous disease requires absolute and continuous rest; the other calls for well-regulated exercises.
Lateral or rotatory curvature of the spine is a deformity which comes on during the developing period of life, before the bodies of the vertebrae are solidly formed. In young people who are growing rapidly, and whose muscular system is weak, the bad habit of standing, and throwing the weight of the body constantly on one leg, gives rise to a serious tilting of the trunk; or, if, when writing at a desk, they sit habitually in a twisted position, a lateral curvature of the spine is apt to take place. By constant indulgence in these bad habits the spinal column gets permanently set in a faulty position. Sometimes the tilting of the base of the trunk is due to a congenital or acquired difference in the length of the legs. In the concavity of the curve there is increased pressure, and, necessarily, diminished growth; in the convexity of the curve there is diminished pressure with increased growth. The patient's friends probably notice that one shoulder is higher than the other, or that " the hip is growing out," and unless means are taken to alter the abnormal distribution of pressure, the condition becomes worse, until complete ossification checks the further progress of the deformity. The growth of the subject being completed, the deformity ceases to increase. And when the growth is completed and the bones are solid and misshapen the condition is quite incapable of improvement. The usual curvature is one in which there is a convexity of the spine in the chest-region towards the right, with the right shoulder higher than the left. Compensatory curves in the opposite direction form in the loins and neck. Along with the lateral bending of the spine a rotation of the bodies of the vertebrae towards the convexity of the curve takes place, the spinous processes turning towards the concavity of the curve. Since the line of the spinous processes of the vertebrae can be easily traced through the skin, their deviation may mislead the superficial observer as to the actual amount of the curvature.
To counteract this deformity in the earliest stages (and it is in the early stage that treatment effects most), the patient (generally a girl) should be encouraged to walk perfectly erect. Systematic exercises, to strengthen the muscles of the back, ought to be strictly and persistently carried out under the direction of a surgeon with the assistance of a skilled instructor of gymnastics. During the intervals of rest the child should lie upon her back on a firm board, and should avoid taking exercise which gives rise to weariness of the muscles; for whenever the muscles become wearied she will attempt to take up a position which throws the strain on to her ligamentous and bony structures. One of the best exercises is to lay the patient on her face, fix her feet, and encourage her to raise herself by using the muscles of the back. Whilst she hangs from a trapeze the weight of the lower limbs and pelvis will help to straighten the spine as a whole, necessarily diminishing the increased pressure upon the cartilaginous bodies of the vertebrae towards the concavity, and increasing the pressure between the sides of the bodies towards the convexity. It is often a good thing to remove a girl with commencing lateral curvature from the sedentary life of school or town and to let her run wild in the country, exercising her muscles to the full.
If the deformity is due to inequality in the length of the legs, a high boot on the short leg may correct it. In some cases of lateral curvature a tilted seat is useful. Mechanical " spinal supports " are as expensive as they are inefficient. As a rule, indeed, they are positively harmful, in that they add to the weight of the trunk and hinder needful muscular development.
By kyphosis is meant an exaggerated degree of roundness of the shoulders. It can be effaced only by constant drillings and exercises whilst the spinal column is still plastic. When once the bones are solid no great improvement is possible. The deformity is sometimes due to short sight. It is well, therefore, to have the child's vision duly tested.
Lordosis is an exaggeration of the normal concavity of the loin-region of the spine. It is most often met with in those cases in which from congenital displacement of the head of the thigh bone, or from old disease of the hip-joint, the subject has acquired the habit of throwing the shoulders back in order to preserve the balance.
Tuberculous disease of the spine (Pott's disease), is the result of a deposit of tubercle-germs in the body of the vertebra. Inflammation having thus been set up, ulceration (caries) of the vertebra, or of several vertebrae, occurs, and if the case runs on unchecked extensive abscesses may form in the thigh, loin or groin. The trouble is often begun by a blow or by a sprain of the spine, which, by lowering the power of resistance of the delicate bone, prepares it for the bacillary invasion. The earliest symptoms are likely to be a dull aching in the back with stiffness of the spine. The child complains of being tired, and is anxious to lie down and be left quiet whilst his little companions are running about. If the disease is in the middle part of the spine, pains are complained of in the front of the chest or at the pit of the stomach. Unfortunately such pains are often ascribed to indigestion. If the disease is in the upper part of the spine the pains may be in the head, the shoulders or the arms. If in the loin-region of the spine they are in the lower part of the trunk, the thighs or the legs. (These obscure peripheral pains are often misunderstood and are apt to be attributed to rheumatism). The back is stiff so that the child cannot stoop. In trying to pick up anything from the floor he keeps his back straight and bends his knees. If the disease is in the neck-region he cannot easily look upwards, and, instead of turning his head to look sideways, he wheels round his whole body. In some cases, though the disease is far advanced, there have been no complaints of pain in the back. As the bodies of the vertebrae crumble away, the spine bends forwards under the influence of the weight of the head and of the upper part of the trunk, and a projection may appear in the middle, line of the back. In the neck, and in the loinregion, the projection is rarely well marked, but in the chest-region a conspicuous boss may make its appearance - the " hump-back." The projection is often spoken of as an angular curvature - a contradiction in terms, for a thing which is angular is not curved. When the deformity is great there may be pressure upon the spinal cord with more or less paralysis in the parts below.
The treatment of tuberculous disease of the spine demands absolute and uninterrupted rest. The best thing is to put the patient flat on his back for as many months as may be found necessary, but not in a close bedroom. If he is compelled to lie in a bedroom the windows should be open night and day. If the patient is a child, he should be laid flat in a box-splint, or upon a thin horsehair mattress, and should be carried out of doors every day - but always lying flat. When the pressure-symptoms, such as the pains in the legs, thighs or arms, the " belly-ache," or the pains in the chest or neck have passed away, a firm leather splint may be moulded on to keep the parts quiet until consolidation has taken place, or a cuirass of poroplastic felt or of plaster of Paris may be applied. The danger in these cases is of leaving off treatment too soon: they must not be hurried, or the trouble will be likely to come back again with, perhaps, increased deformity. If the disease is in the upper part of the dorsal spine, or in the neck-region, a cervical collar of leather, or a double Thomas's hip-splint may be found useful.
In cases of advanced tuberculous disease of the spine, in which the spinal cord is compressed within its bony canal either by the posterior parts of the vertebral bodies or by inflammatory products, or in which, after severe injury, the cord is pressed upon by a displaced piece of bone, the surgeon may think it expedient to open the spinal canal from behind, removing in the procedure the posterior arches (laminae) of the vertebrae. The operation is called by the hybrid word laminectomy. Sometimes in the case of tuberculous disease, where the propriety of resorting to the operation is being discussed, the symptoms of the compression begin to clear off and the child makes a complete recovery without being operated on; the moral is that we should wait patiently and give Nature a full chance of doing her work in her own way. The operative treatment of these cases is not highly'satisfactory. Still, there are a certain small number of cases in which it may be given a trial.
The treatment of spinal abscess has been greatly influenced by the Listerian method. The collection of broken-down tuberculous material or fluid is not an abscess in the usual sense, for it does not contain " pus " or " matter," being, as a rule, destitute of septic micro-organisms. A spinal abscess is therefore no longer drained: it is incised, scraped, washed out, and swabbed dry, the opening being carefully and permanently sewn up. In this way septic germs are effectually excluded from the cavity, and the patient is spared the depressing and tedious discharging of the cavity which so often followed the old methods of treatment. It must be clearly understood, however, that every spinal abscess does not undergo cure after being subjected to the evacuation and closure treatment mentioned above, but that the surgeon is sometimes compelled to use irrigation and drainage.
In 1897 Dr Calot of Berk-sur-Mer reintroduced the method of straightening out the hump of the back, so often left after disease of the spine, by stretching the child on a flat table and dealing with the hump, under chloroform, with what is commonly known as " brute force." A considerable number of hump-backed children on the Continent as well as in England and America were thus dealt with, but it is doubtful whether the records of those cases, could they all be collected and published, would be found to justify the enthusiasm and publicity with which the method was inaugurated and its details were spread abroad. It is scarcely necessary to say that the forcible straightening of a spine which has developed a hump because tuberculous disease has wrecked the front of the vertebral segments is in no sense a curative operation. Diminishing the size of the projection does not cure the tuberculous ulceration of the bones; indeed, it may increase the ulcerative process or determine a scattering of the germs of tubercle throughout the body. The operation has not been accepted by British and American surgeons. In the practice of the foreign surgeon death ensued in three cases out of thirteen that were operated on, and an English surgeon reported fourteen cases " in all of which the deformity had recurred although the spines had been fixed in plaster of Paris after the straightening." Being deeply placed in the mass of the muscles of the back, and, moreover, being jealously locked within the bony canal of the vertebral column, the spinal marrow or spinal cord was, until the last few years, generally considered to be beyond the reach even of the most enterprising surgeon. Still, like other tissues, it was liable to diseases and injuries. The exact situation of a tumour pressing upon the spinal cord can now be located with great precision by noting the areas of pain and numbness, and the height in the limbs or trunk to which loss of power of voluntary movement ascends, and by noting also whether these effects are symmetrical upon the two sides or appear more upon one side than on the other. By cutting away the posterior parts of certain segments of the vertebral column, tumours of various sorts have been successfully removed from the interior of the canal. Displaced fragments of bone in tuberculous affection of the spine, abscess-contents and inflammatory tissue have also been similarly dealt with. Sir William Macewen of Glasgow and Sir Victor Horsley of London have been pioneers in this development of surgery. In cases of fracture of the spine, with displacement of the vertebrae and compression of the spinal cord, surgeons have also been trying what relief can be afforded by the adoption of bold operative measures, but as in most of these cases of fracture-dislocation the spinal cord is torn right across or crushed beyond hope of repair, active measures cannot be undertaken with much prospect of success.
" Concussion of the Spine." - Occasionally one hears persons, whose professional education should have taught them better, speaking or writing of concussion of the spine as if that were in itself a disease. It is an expression which is not infrequently used in an equally comprehensive and incorrect way when the ill-informed person is speaking of the injuries, real or imaginary, of which an individual makes complaint after having met with a severe shake when travelling on a railway. One might as well speak of concussion of the skull as of concussion of the spine, for the spine is but the bony envelope of the spinal cord, as the skull is of the brain. The violent shaking of the spinal cord and the spinal nerves in a serious accident may, however, be followed by some functional disturbance, which may be .associated with pains in the back, by numbness and tingling in the limbs, or with muscular weakness. In some cases the disturbance is due to slight haemorrhages into the nerve sheaths, which may clear up with rest and quiet. But when the presence of these obscure symptoms, after a railway accident for instance, becomes the subject of an action-at-law, there is a great chance that they will not pass off until the case is settled in one way or the other. Not, perhaps, that the individual concerned is dishonest in his estimation of them, but because the anxiety of the overhanging lawsuit has so grievously disturbed his mind and altered his perspective that his sense of proportion is for a time in abeyance. After the action-at-law the symptoms may clear up with a rapidity which to some people appears surprising. (E. O.*)
Physiology of the Spinal Cord
The name spinal cord, given by early morphologists to the nervous mass lying in the tubular chamber enclosed by the vertebral column, was doubtless given under the supposition that the organ so named could be treated as an entity. Scientifically, however, it cannot be so treated, either as regards its structure or its function. It is merely a part of that great nervous structure which throughout the length of the body forms the central meeting-place of the nerve-paths arriving from and issuing to all regions with which nerve fibres are in touch. To separate from the rest of this system the part which lies within the spine is an artificial and in many ways misleading provision. This artificial treatment is the outcome of crude ideas drawn from the study of merely the gross form of the bodily parts. But crude as the distinction is, its historic priority has influenced the study of the vertebrate nervous system, not only in regard to morphological description but also in regard to exposition of the functional reactions of the nervous system and even up to the present day. Hence it is still customary arbitrarily to detach certain of the reactions of the nervous system into a separate group and describe that group by itself, simply because they occur in nervous arcs whose central courses in the great central nervous organ lie within that part of it extending along the spine. An additional inconvenience attaching to the mode of description of the nervous system customary in works on human anatomy, is that in such works the parts of the nervous arcs outside the central organ are described apart from it under the term peripheral nerves. This severs artificially structures which are functionally indissolubly united. The study and description of the working of the nervous system is hampered by this unphilosophic subdivision of its structural parts.
To gain a broader and truer point of view as starting-point for understanding the working of the spinal cord one must prepare the exposition by a short reference to the general function of the nervous system in the bodily economy.
Relation to General Nervous System. - An animal of microscopic size may continue throughout its life to be constituted entirely by one single cell. Animals of larger bulk, although each begins its existence as a single cell, attain their development by the multiplication of the original single cell, so that from it there comes to be formed a coherent mass of cells very many millions in number. In these multicellular animals each of the constituent cells is a minute self-centred organism, individually born, leading its own life and destined for individual death. The corporate power of the complex animal is the sum of the powers of those manifold individual existences, its cells. In the complex animal the several organs, even the most homogeneous, such as muscles or glands, are each composed of many thousands of cells similarly specialized but living each per se. The solidarity of action which a complex animal thus built up exhibits is the result of the binding together of the units which compose the compleisorganism. Of the agencies which integrate the complex animal, one of the most potent is nervous action. A certain number of the unit cells composing the animal are specially differentiated from the rest to bind the whole together by nervous action. These specially differentiated cells are called " neurones." They constitute living threads along which waves of physico-chemical disturbance are transmitted to act as releasing forces for the energy in distant cells, where they finally impinge.
It is characteristic of this nervous system, the system of neurones, that, although ramifying far and wide through the body, it is a continuum from end to end. The peripheral nerves are formed of bundles of neurones lying side by side, but these, although packed close together, are strictly isolated one from another as conductors and remain isolated throughout the whole length of the nerve. The points of functional nexus of the neurones one with another are confined to one region only of the whole system. All their conductive connexions one with another take place solely in the central nervous mass which constitutes the so-called central nervous system, a nervous organ extending axially along the length of the body midway between the body's lateral halves. Thither the neurones converge in vast numbers, those of each body segment converging to that fraction of the central organ which belongs to their body segment. The central nervous organ thus receiving these neurones is, where it lies in the head, called the brain, the rest of it is called in vertebrates the " spinal cord," in vermes and arthropods the " nerve-cord." The central organ not only receives neurones which converge to it from outside, but many of its own neurones thrust out their conductive arms from it as nerve fibres carrying nervous influence outwards to regulate the activity of glands and muscles. In the vertebrata the ingoing neurones for each segment and similarly the out-going neurone fibres are collected into a segmental nerve. To the spinal cord these are each attached by two roots, one dorsal, consisting of the afferent fibres, the other ventral, consisting of the efferent fibres.
The Reflex. - Analysis of function of this nervous system leads to what is termed " the reflex " as the unit of its action. The simplest complete reaction of the system is a reflex. There are many reflexes which are extremely complex, being built up of a number of simpler reflexes combined together. A reflex is a reaction started by the environment acting as a stimulus upon some nerve which communicates the excitement thus started in itself to other nerves by means of its connexions with these in the central nervous organ. The excitement so generated and transmitted finally travels outward from the central organ by one or more of the efferent nerves and through these reaches muscles or glands producing in them its final effect. The muscles and glands are from this point of view termed effector organs. The reaction is therefore " reflected " from the central organ. The nerve structures along which it runs in its trajectory are spoken of as a nervous arc. The whole purpose of the central nervous organ is therefore to bring afferent neurones into touch with efferent neurones. The whole purpose of reflex arcs is to bind one part of the organism to another part in such a way that what the environment is doing to the organism at one place may appropriately call forth or restrain movement or secretion in the muscles or glands possessed by the organism.
Receptor Cells. - There is one condition for the due performance of these reactions which is not provided by the nervous system itself. The afferent neurones are not in most cases so constituted as to be excitable themselves directly by the environment - for instance, they cannot be stimulated by light. Their amenability to the environment, their sensitization to environmental agencies, is effected by special cells adjunct to their peripheral ends. These cells from organs are called receptors. They are delicately adapted to be stimulated by this or that particular agent and are classifiable into various species, so that each species is easily excited by a particular agent which is " adequate " for it, and is quite inexcitable or only excitable with difficulty by agencies of other kinds. Thus in the skin some receptors are adapted for mechanical stimuli (touch) and not for thermal stimuli, while others (cold spots, warm spots) are adapted for thermal stimuli and not for mechanical. As far as it is known each afferent neurone is connected with receptors of one species only. The receptors thus confer upon the reflex arcs selective excitability. Each arc is thus tuned to respond to certain stimuli, while other arcs not having that kind of receptor do not respond. The receptors, therefore, while increasing the responsiveness of the organism to the environment, prevent confusion of reactions (inco-ordination) by limiting to particular stimuli a particular reaction.
Proprioceptors. - The system of neurones is thus made accessible to the play of the external world acting on the body. And in addition to those receptors which are stimulated directly by the external world, are others lying within the mass of the organism itself, which are excitable by actions occurring in the organism itself. These are called proprioceptors. They are distributed preponderantly in the muscles and structures functionally adjunct to muscle, such as joints, ligaments, fasciae, &c. The reactions induced in such motor structures reflexly in response to environmental stimuli tend therefore secondarily to be followed and accompanied by reflex reactions initiated from proprioceptors.
Conduction. - The process by which the excitement generated in the afferent neurone travels along the reflex arc is known as conduction. Conduction along afferent and efferent nerves xxv. 22 differs in some important respects from that obtaining in the nerve centre, i.e. in the piece of the central nervous system connecting the afferent nerve with the efferent nerve. In a nervetrunk the excited state set up in it by a stimulus travels along its fibres as wave-like disturbance at a speed of about thirtythree metres per second, and does not alter in intensity or speed in its travel. A nerve-trunk when excited (artificially) at some point along its length transmits the " impulse," i.e. the wavelike excited state in both directions, i.e. both up and down each fibre, from the point stimulated. This is true whether the fibre is afferent or efferent. The speed of travel of the nervous impulse along the nerve-trunk is practically the same whether the state of excitement, i.e. nervous impulse, is weak or intense. The nerve-trunk shows practically no delay in its response to an effective even though weak stimulus and its response ceases practically at once on cessation of the exciting stimulus. When excited by repeated brief stimuli the rhythm of the response corresponds closely with that of the stimuli, even when the frequency of the latter is as high as Ioo per second. With momentary stimuli a response even so brief as 20" can be given by the nerve-trunk. Finally, nerve-trunk conduction is singularly resistant to fatigue, to impoverished blood supply, and to many drugs which powerfully affect reflex actions.
In conduction through the central nervous organ the travel of the nervous impulse exhibits departure from these features. Its intensity is liable to be altered in transit. Its time of transit, especially if it be weak, is much longer than for a similar length of nerve-trunk. Its direction of transmission becomes polarized, that is, confined to one direction along the nervous path. The state of excitement engendered does not subside immediately on cessation of the stimulus, and may outlast the stimulus by many seconds. The rhythm of response to a rhythmic stimulus does not change in correspondence with change in the stimulus-rhythm. A response, however brief the stimulus, is probably never shorter than 50 in duration.
These are striking differences, and morphological study of the structural features of the central organ does not at present suggest how they for the most part arise. It seems certain, however, that in the central organ it is that part which consists of so-called grey matter which forms the place of their occurrence. There the spread of the impulse from one nerve-fibre to others seems clearly due to the fact that each afferent fibre breaks up into branching threadlets which ramify in various directions and terminate in close apposition with other neurones. There has been much dispute as to whether the termination is one of contiguity with the next neurone or of actual continuity with it. The result of recent investigation seems to show that in the vast majority of cases contiguity and not actual homogeneous continuity is the rule in the spinal cord. The point of nexus of one neurone with another is termed the synapse. If synapsis occurs by contiguity and not homogeneous continuity, it is fair to suppose that at it the transmission of nervous impulses must be different from that observable in the homogeneous conducting threads of nerve fibres. The conduction must traverse something of the nature of a membrane. To the properties of synaptic membranes many of the features peculiar to conduction in the grey matter may be due, for instance, the feature of irreversible direction of conduction.
Reflex Reactions. - When the spinal cord is severed at any point the reflex arcs of the portion of the body behind the transection are quite cut off from the rest of the nervous system in front, including the brain. The reflex reactions elicited from the thus isolated region cannot therefore be modified by the action of the higher nervous centres. It is important to see what character these reflexes possess. The higher centres in the brain exercise powers over the motor machinery of the body and in doing so make use of the simpler nervous centres that belong to the segments severally, that is the local nervous centres existing for and in each body segment itself. In the head the local centres are overlaid by higher centres which cannot by any simple severance be separated from them. By studying, therefore, the powers of the cord behind a complete spinal transection we can obtain in a comparatively simple way information as to the powers of the purely local or segmental reflex mechanisms.
The so-called " flexion-reflex " of the limb is one of the most accessible of the local reflex reactions which can thus be studied with an isolated portion of the spinal cord as its centre.
Let it be supposed that the limb observed is the hind limb. The three main joints of the limb are the hip, the knee and the ankle. Each of these joints is provided with muscles which flex or bend it, and others which extend or straighten it. It is found that the reflex throws into contraction the flexor muscles of each of these joints. It matters little which of all the various afferent nerves of the limb is stimulated, whichever of these the afferent nerve may be, the centrifuged discharge from the cord goes to practically the same muscles, namely, always to the flexors of the joints.
The centrifuged discharge does not go to the extensor muscles of the limb. However strong the stimulus and however powerful the afferent nerve chosen the spinal centre does not discharge impulses into the extensor muscles, though these muscles receive motor nerves issuing from the very same region of the cord as that supplying motor nerves to the flexor muscles. Not only does the reflex action not discharge motor impulses into the nerves of the extensor muscles, but if the spinal cord happens to be discharging impulses into these nerves when the reflex is evoked this discharge is suppressed or diminished (inhibited) . The result is that when the reflex occurs not only are the flexor muscles made to contract, but their antagonists, the extensors, are, if in contraction at the same time, thrown out of contraction, that is, relaxed. In this way the latter muscles are prevented from impeding the action of the contracting flexors. This inhibition occurs at the beginning of the reflex action which excites the muscles and continues so long as the flexion-reflex itself continues. It thus prevents other reflexes from upsetting for the time being the due action of the flexionreflex, for it renders the muscles opposing that reflex less accessible to motor discharge through the spinal cord whatever the quarter whence incitation to that discharge may come.
A feature of this reflex is its graded intensity. A weak stimulus evokes in the flexor muscles a contraction which is weak and in the extensor muscles a relaxation which is slight. Not only is the contraction weak in the individual flexor muscles, but it is limited to fewer of them, and in large muscles seems to involve only limited portions of them.
The duration of the reflex similarly varies directly with the duration of the exciting stimulus applied to the afferent nerve. The time relations of electrical stimuli can be controlled by the experimenter with much precision. In the single induction shock he has at command a stimulus of extreme brevity, lasting only a few millionths of a second. With such stimulus a lower limit is soon found to the brevity of the reflex effect as expressed 1;,y muscles, It is found difficult to evoke with brief stimuli reflex contractions so brief as those evoked from the muscle by similar stimuli applied direct to the motor nerve of the muscle. There is reason to think that such stimuli applied to a nerve may evoke one single nerve-impulse. A single nerve impulse generated in a motor nerve causes in the muscle a brief contraction which is called a twitch, and lasts a tenth of a second. A single nerve impulse generated in an afferent nerve sometimes fails on arriving at the spinal centre to evoke any observable reflex effect at all, but if it is effective the muscle contraction tends to be longer than a " twitch," often much longer. It is therefore questioned whether the spinal centre when excited even most briefly ever discharges one single centrifugal impulse only; it seems usually to discharge a short series of such impulses.
Allied to this character is the tendency which even simple spinal reflexes exhibit to continue discharging for a certain time after their exciting stimulus has ceased to be applied. This after-discharge succeeding a strong stimulus may persist even for several seconds.
Refractory Phase. - Besides characters common to all or many spinal reflexes certain spinal reflexes have features peculiar to themselves or exhibited by them in degrees not obvious in other reflexes. One of these features is refractory phase. The scratchreflex exemplifies this. In the dog, cat, and many other animals the hind limb often performs a rapid scratching movement, the foot being applied to the skin of the shoulder or neck as if to groom the hairy coat in that region. This movement is in the intact animal under control of the brain, and can be executed or desisted from at will. When certain of the higher centres in the brain have been destroyed, this scratching action occurs very readily and in, as it were, an uncontrolled way. When the spinal cord has been severed in the neck this scratching movement of the hind limb can be elicited with regularity as a spinal reflex by merely rubbing the skin of the side of the neck or shoulder, applying there a weak electric current to the skin. In this reflex the stimulus excites afferent nerves connected with the hairs in the skin and these convey impulses to the spinal centres in the neck or shoulder segments, and these in turn discharge impulses into nerve fibres entirely intraspinal passing backward along the cord to reach motor centres in the hind limb region. These motor centres in turn discharge centrifugal impulses into the muscles of the hind limb of the same side of the body as the shoulder which is the seat of irritation. The motor discharge is peculiar in that it causes the muscles of the hind limb to contract rhythmically at a rate of about four contractions per second, and the discharge is peculiar further in that it excites the flexor and extensor muscles of the joints alternately so that at the hip for instance the limb is alternately flexed and extended, each single phase of the movement lasting about an eighth of a second. Now this rhythmic discharge remains the same in rate whether the exciting stimulus applied to the skin be continuous or one of many various rates of repetition. Evidently at some point in the reflex arc there is a mechanism which after reacting to the impulses reaching it remains for a certain brief part of a second unresponsive, and then becomes once more for a brief period responsive, and so on. And this phasic alternation of excitability and inexcitability repeats itself through the continuance of the reflex even when that endures for minutes. The phase of inexcitability is termed the refractory phase. It is important as an essential element in the co-ordination; without it the scratching movement would obviously not be obtained for alternation of flexion and extension is essential to the act. A similar element almost certainly forms part of the co-ordinating mechanism for many other cyclic reflexes, including those of the stepping of the limbs, the movement of the jaw in mastication, the action of the eyelids in blinking, and perhaps the respiratory movements of the chest and larynx.
Fatigue. - Nerve trunks do not easily tire out under stimulation even most prolonged. Reflex actions on the other hand relatively soon tire. Some are more resistant, however, than are others. The flexion-reflex may be continued for ten minutes at a time and the scratch-reflex can be maintained so long. As a reflex tires, the muscular contraction which it causes tends to become less intense and less steady. The relatively rapid onset of fatigue in reflexes is counterbalanced by speedy recovery in repose. A long flexion-reflex, when from fatigue it has become weak, tremulous and irregular, will recommence after 30 seconds' repose with almost the same vigour and steadiness as if it had not recently been tired out.
This character of reflexes is in accordance with their executing movements which for the most part are not under natural circumstances required to last long. Such movements are the taking of a step by a limb, the movement of the jaw in mastication, the descent of the diaphragm in breathing, the withdrawal of the foot or the pinion from a noxious stimulus or the movement of the eyelids to wash off a particle touching the cornea, in all these no very prolonged reflex discharge is required. These natural movements to which the artificially provoked reflexes seem to correspond do not demand prolonged motor activity, or when they do, demand it in rhythmic repetition with intervening pauses which allow repose.Reflex Postures. - But there are certain reflexes which do persist for long periods at a stretch. These are reflex postures. The hind limbs of the " spinal "frog assume an attitude which is reflex, for it ceases on severance of the afferent spinal roots. This attitude is one of flexion at hip, knee and ankle, resembling the well-known natural posture of the frog as it squats when quiet in the tank. Similarly in the " spinal " dog or cat certain muscles exhibit a slight but persistent contraction. This is seen well in the extensor muscles of the knee. These tonic reflexes are related to attitudes. In the dog and cat they are exhibited by those muscles whose action antagonizes gravity in postures which are usual in the animal, thus the extensors of the knee and hip and shoulder and elbow are in tonic contraction during standing. The reflex arcs concerned in reflex maintenance of this tonic contraction of muscles have been shown in several cases to arise within those muscles, and in those very muscles which themselves exhibit the tonic contraction, It is not, however, certain that all muscles exhibit a reflex tonus: for instance, it is not certain that in the dog the tail muscles exhibit such a tonus. And in those muscles which do exhibit the spinal reflex tonus attempts to obtain a similar untiring slight steady reflex contraction by artificial stimuli applied to receptive organs or nerves have failed.
The Spinal Reflex Arcs of the Hind Limb. - When the skin of the limb is stimulated the flexion-reflex already described is evoked. The reflex is excited by nocuous stimuli such as a prick or squeeze applied to the skin anywhere in the limb, but most easily when applied to the foot. Electrical stimuli wherever applied evoke the same reflex. Similarly electrical stimuli applied to any afferent nerve of the limb evoke this reflex, whether the afferent nerve be from skin or from the muscles. Since the reflex always provokes excitation of the flexor muscles and inhibition of the extensor muscles, the result is that central stimulation of the afferent nerve of a flexor muscle excites its own muscle and inhibits its antagonist (reciprocal innervation), while similar stimulation of the afferent nerve of an extensor muscle inhibits its own muscle and excites its antagonist (reciprocal innervation). The reflex flexion of the ipselateral hind limb is commonly accompanied by reflex extension of the opposite hind limb. If the reflex spreads to the fore limb, it produces extension of the same side fore limb with flexion of the crossed fore limb sometimes, but sometimes extension of both fore limbs.
In the dog and cat extension of the ipselateral hind limb can, however, be excited by stimulation of the skin in three limited regions. One of these is the sole of the foot; smooth pressure between the pads excites a strong brief extension. This is called the extensor thrust. It is accompanied by a similar sudden brief extension of all three other limbs. This reflex may be related to the action of galloping, and the pressure which excites resembles that which the weight of the body bears on the pads against the ground.
The two other regions are the skin of the front of the groin supplied by the crural branch of the genito-crural nerve, and the skin just below and mesial to the buttock. These always excite the extensor muscles, not the flexors. They may be concerned with sexual acts.
Reflexes of the Fore Limb. - These resemble those obtainable from the hind limb. The ipselateral reflex is flexion at shoulder, elbow and wrist. The contra lateral fore limb at the same time is extended at shoulder, elbow and wrist. When the reflex spreads to the hind limbs the hind limb of the same side is extended at hip, knee and ankle, that of the crossed side is sometimes flexed at hip, knee and ankle, but sometimes is instead extended at hip, knee and ankle. The reflex sometimes spreads to the neck, causing the head to be turned toward the fore limb, which is the seat of the stimulation.
The Scratch Reflex. - This has already been partly described above. The area from which it can be excited by appropriate stimulation is a large one, namely, a field of skin which is somewhat saddle-shaped having its greatest width transversely across the shoulders. It extends from close behind the pinna back to the loin. The stimuli which are effective are rubbing the skin or lightly pricking it, or lightly pulling on the hairs: also faradisation by a needle electrode whose point is only just inserted among the hairs but not deeper than their roots. If the stimulus be applied to the right hand of the mid-line the right hind limb is flexed at hip and performs the rapid scratching movement described above, and the left hind limb is thrown into steady extension. And conversely, when the stimulus is to the left side of the mid-line.
Each of these reflexes is a co-ordinate reaction. It is seen, therefore, that through the medium of the spinal cord the body behind the head has at command a certain number of reflexes and that each of these manages the skeletal musculature in a co-ordinate way. It will also be clear from the facts mentioned above about these separate reflexes that the fields of muscles worked by these several reflexes is to a large extent common to them all. Thus the reflex excited from the skin of the right hind limb acts on the muscles of that limb and also on those of the three other limbs. So similarly the reflex excited from the left hind limb, and from each fore limb. Study of the inter-relationship between these reflexes shows that by means of the spinal cord not only is co-ordinate action of the muscles ensured for each reflex, but that also the separate reflexes are co-ordinated one with another.
When we examine the relationship holding between individual reflexes we find that some resemble one another in regard to their action upon a particular muscle or group of muscles. On the other hand, some act in opposite ways upon a particular muscle or muscle group. In order to follow the co-ordination effected by the spinal cord in corresponding reflexes together we have to turn to a certain feature in the scheme of construction of the nervous system. This feature is embodied in what is termed the principle of the common path.
Interaction between Reflexes. - At the commencement of every reflex-arc is a receptive neurone extending from the receptive surface to the central nervous organ. This neurone forms the sole avenue which impulses generated at its receptive point can use whithersoever be their destination. This neurone is therefore a path exclusive to the impulses generated at its own receptive point, and other receptive points than its own cannot employ it. A single receptive point may play reflexly upon quite a number of different effector organs. It may be connected through its reflex path with many muscles and glands in many different regions. Yet all its reflex arcs spring from the one single shank or stem, i.e. from the one afferent neurone which conducts from the receptive point at the periphery into the central nervous organ.
But at the termination of every reflex arc we find a final neurone, the ultimate conductive link to an effector organ, (muscle or gland). This last link in the chain, e.g. the motor neurone, differs obviously in one important respect from the first link of the chain. It does not subserve exclusively impulses generated at one single receptive source, but receives impulses from many receptive sources situate in many and various regions of the body. It is the sole path which all impulses, no matter whence they come, must travel if they are to act on the muscle fibres to which it leads.
Therefore, while the receptive neurone forms a private path exclusively serving impulses of one source only, the final or efferent neurone is, so to say, a public path, common to impulses arising at any of many sources of reception. A receptive field, e.g. an area of skin, is analysable into receptive points. One and the same effector organ stands in reflex connexion not only with many individual points, but even with many various receptive fields. Reflexes generated in manifold sense-organs can pour their influence into one and the same muscle. Thus a limb muscle is the terminus ad quem of many reflex arcs arising in many various parts of the body. Its motor nerve is a path common to all the reflex arcs which reach that muscle.
Reflex arcs show, therefore, the general features that the initial neurone of each is a private path exclusively belonging to a single receptive point (or small group of points); and that finally the arcs embouch into a path leading to an effector organ; and that their final path is common to all receptive points wheresoever they may lie in the body, so long as they have connexion with the effector organ in question. Before finally converging upon the motor neurone the arcs converge to some degree. Their private paths embouch upon internuncial paths common in various degree to groups of private paths. The terminal path may, to distinguish it from internuncial common paths, be called the final common path. The motor nerve to a muscle is a collection of final common paths.
Certain consequences result from this arrangement. One of these is the preclusion of essential qualitative difference between nerve-impulses arising in different afferent nerves. If two conductors have a tract in common there can hardly be essential qualitative difference between their modes of conduction; and the final common paths must be capable of responding with different rhythms which different conductors impress upon it. It must be to a certain degree aperiodic. If its discharge be a rhythmic process, as from many considerations it appears to be, the frequency of its own rhythm must be capable of being at least as high as that of the highest frequency of any of the afferent arcs that play upon it; and it must be able also to reproduce the characters of the slowest.
A second consequence is that each receptor being dependent for final communication with its effector organ upon a path not exclusively its own but common to it with certain other receptors, such nexus necessitates successive and not simultaneous use of the common path by various receptors using it to different or opposed effect. When two receptors are stimulated simultaneously, each of the receptors tending to evoke reflex action that for its end-effect employs the same final common path but employs it in a different way from the other, one reflex appears without the other. The result is this reflex or that reflex, but not the two together.
In the simultaneous correlation of reflexes some reflexes combine harmoniously, being reactions that mutually reinforce. These may be termed allied reflexes, and the neural arcs which they employ allied arcs. On the other hand, some reflexes, as mentioned above, are antagonistic one to another and incompatible. These do not mutually reinforce, but stand to each other in inhibitory relation. One of them inhibits the other, or a whole group of others. These reflexes may in regard to one another be termed antagonistic; and the reflex or group of reflexes which succeeds in inhibiting its opponents may be termed “prepotent” for the time being.
Allied Reflexes.—The action of the principle of the final common path may be instanced in regard to “allied arcs” in the scratch-reflex as follows. If, while the scratch-reflex is being elicited from a skin point at the shoulder, a second point distant 10 mm. from the other point but also in the receptive field of skin, be stimulated, the stimulation at this second point favours the reaction from the first point. This is well seen when the stimulus at each point is of subminimal intensity. The two stimuli, though each unable separately to invoke the reflex, yet do so when applied both at the same time. This is not due to overlapping spread of the feeble currents about the stigmatic poles of the two circuits used. Weak cocainization of either of the two skin poles annuls it. Moreover, it occurs when localized mechanical stimuli are used. It therefore seems that the arcs from the two points, e.g. Ra and R have such mutual relation that reaction of one of them reinforces reaction of the other, as judged by the effect on the final common path.
This reinforcement is really an instance of summation in the final common path. So also is the effect to which Exner has given the name of “bahnung” a phenomenon of frequent occurrence in reflex reactions. Suppose a stimulus (A) be applied which is too weak to elicit the reflex which were it stronger it could evoke. It is found that a second stimulus (B) also of itself too weak to evoke the reflex, will evoke the reflex if applied at a short interval after the application of (A). The two stimuli sum in their effect upon the final common path. The “receptive field” of a reflex is really the common area of commencement of a number of allied arcs. And reflexes whose arcs commence in receptive fields even widely apart may also have “allied” relation. In the bulbo-spinal dog stimulation of the outer digit of the hind foot will evoke reflex flexion of the leg, and stimulation of each of the other digits evokes practically the same reflex; and if stimulation of several of these points be simultaneously combined the same reflex as a result is obtained more readily than if one only of these points is stimulated. And to these stimulations may be added simultaneously stimulation of points in the crossed fore foot; stimulation there yields by itself flexion of the hind leg; and under the simultaneous stimulation of fore and hind foot the flexion of the leg goes on as before, though perhaps more readily; that is, the several individual reflexes harmonize in their effect on the hind limb. Further, to these may be added simultaneous stimulation of the tail and of the crossed pinna; and the reflexes of these stimulations all coalesce in the same way in flexion of the hind limb. Exner has shown that, in exciting different points of the central nervous system itself, points widely apart exert “bahnung” for one another’s reactions and for various reflex reactions induced from the skin. Thus reflexes originated at different distant points, and passing through paths widely separate in the brain, converge to the same motor mechanism (final common path) and act harmoniously upon it. Reflex arcs from widely different parts conjoin and pour their influence harmoniously into the same muscle. The motor neurones of a muscle of the knee are the terminus ad quem of reflex arcs arising in receptors not only of its own foot, but from the crossed fore foot and pinna and tail, also undoubtedly from the otic labyrinth, olfactory organs and eyes. Thus, if we take as a standpoint any motor nerve to a muscle it consists of a number of motor neurones which are more or less bound into a unit mechanism among the reflex actions of the organism a number can all be brought together as a group, because they all in their course converge together upon this motor mechanism, this final common path, activate it, and are in harmonious mutual relation with regard to it. They are in regard to it what were termed above “allied” reflexes.
Antagonistic Reflexes.—But not all reflexes connected to one and the same common final path stand to one another in the relation of “allied reflexes.” Suppose during the scratch-reflex a stimulus be applied to the foot not of the scratching side, but of the opposite side. The left leg, which is executing the scratch-reflex in response to stimulation of the left shoulder skin is cut short in its movement by the stimulation of the right foot, although the stimulus at the shoulder to provoke the scratch movement is maintained unaltered all the time. The stimulus to the right foot will temporarily interrupt a scratch-reflex, or will cut it short or will delay its onset; which it does of these depends on the time-relations of the stimuli. The inhibition of the scratch-reflex occurs sometimes when the contraction of the muscles innervated by the reflex conflicting with it is very slight. There is interference between the two reflexes and the one is inhibited by the other. The final common path used by the left scratch-reflex is also common to the reflex elicitable from the right foot. This latter reflex evokes at the opposite (left) knee extension; in doing this it causes steady excitation of extensor neurones of that knee and steadily inhibits the flexor neurones. But the scratch-reflex causes rhythmic excitation of the flexor neurones. Therefore these flexor neurones in this conflict lie as a final common path under the influence of two antagonistic reflexes, one of which would excite them to rhythmical discharge four times a second, while the other would continually repress all discharge in them. There is here an antagonistic relation between reflexes embouching on one and the same final common path.
In all these forms of interference there is a competition, as it were, between the excitatory stimulus used for the one reflex and the excitatory stimulus for the other. Both stimuli are in progress together, and the one in taking effect precludes the other's taking effect as far as the final common path is concerned; and the precise form in which that occurs depends greatly on the time-relations of application of the two stimuli competing against each other.
Antagonistic Reflexes.
Again, if, while stimulation of the skin of the shoulder is evoking the scratch-reflex, the skin of the hind foot of the same side is stimulated, the scratching may be arrested. Stimulation of the skin of the hind foot by any of various stimuli that have the character of threatening the part with damage causes the leg to be flexed, drawing the foot up by steady maintained contraction of the flexors of the ankle, knee and hip. In this reaction the reflex arc is (under schematic provisions similar to those mentioned in regard to the scratch reflex schema) (i.) the receptive neurone, noci-ceptive, from the foot to the spinal segment, (ii.) the motor neurone to the flexor muscle, e.g. of hip (a short intra-spinal neurone); a Schalt-zelle (v. Monakow) is probably existent between (i.) and (ii.) but omitted for simplicity. Here, therefore, there is an arc which embouches into the same final common path, FC. The motor neurone FC is a path common to it and to the scratch-reflex arc; both these arcs employ the same effector organ, namely, the knee-flexor, and employ it by the common medium of the final path FC. But though the channels for both reflexes embouch upon the samefinal common path, the excitatory flexor effect specific to each differs strikingly in the two cases. In the scratch-reflex the flexor effect is an intermittent effect; in the noci-ceptive flexionreflex the flexor effect is steady and maintained. The accompanying tracing shows the result of conflict between the two reflexes. The one reflex displaces the other at the common path. Compromise is not evident. The scratch-reflex is set aside by that of the noci-ceptive arc from the homonymous foot. The stimulation which previously sufficed to provoke the scratchreflex is no longer effective, though it is continued all the time. But when the stimulation of the foot is discontinued the scratchreflex returns. In that respect, although there is no enforced inactivity, there is an interference which is tantamount to, if not the same thing as, inhibition. Though there is no cessation of activity in the motor neurone, one form of activity that was being impressed upon it is cut short and another takes its place. A stimulation of the foot too weak to cause more than a minimal reflex will often suffice to completely interrupt, or cut short, or prevent onset of, the scratch-reflex.
The kernel of the interference between the homonymous flexion-reflex and the scratch-reflex is that both employ the same final common path FC to different effect - just as in the interference between the crossed extension-reflex and. the scratchreflex. Evidently, the homonymous flexion-reflex and the crossed extension-reflex both use the same final common path FC. And they use it to dif f erent effect. The motor neurone to the flexor of the knee being taken as a representative of the final common path, the homonymous flexion-reflex inhibits it from discharging. Hence if,. while the direct flexion-reflex is in progress, the crossed foot is stimulated, the reflex of the knee-flexor is inhibited. The crossed extension-reflex therefore inhibits not only the scratch-reflex, but also the homonymous flexion-reflex.
Further, in all these interferences between reflexes the direction taken by the inhibition is reversible. Thus, the scratch-reflex is not only liable to be inhibited by, but is itself able to inhibit either the homonymous flexion-reflex or the crossed extensionreflex; the homonymous flexion-reflex is not only capable of being inhibited by the crossed extension-reflex, but conversely in its turn can inhibit the crossed extension-reflex. These interferences are therefore reversible in direction. Certain conditions determine which reflex among two or more competing ones shall obtain mastery over the final common path and thus obtain expression.
Therefore, in regard to the final common path FC, the reflexes that express themselves in it can be grouped into sets, namely, those which excite it in one way, those which excite it in another way, and those which inhibit it. The reflexes composing each of these sets stand in such relation to reflexes of the same set that they are with them " allied reflexes." But a reflex belonging to any one of these sets stands in such relation to a reflex belonging to one of the other sets that it is in regard to the latter an " antagonistic " reflex. This correlation of reflexes about the flexor neurone in the leg, so that some reflexes are mutually allied and some are mutually antagonistic in regard to that neurone, may serve as a paradigm of the correlation of reflexes about every final common path, e.g. about every motor nerve to skeletal muscle.
As to the intimate nature of the mechanism which thus, by summation or by interference, gives co-ordination where neurones converge upon a common path, it is difficult to surmise. In the central nervous system of vertebrates, afferent neurones A and B in their convergence toward and impingement upon another neurone Z, towards which they conduct, do not make any lateral connexion directly one with the other - at least, there seems no clear evidence that they do. It seems, then, that the only structural link between A and B is neurone Z itself. Z itself should therefore be the field of coalition of A and B if they transmit " allied " reflexes.
It was argued, from the morphology of the perikaryon, that it must form, in numerous cases, a nodal point in the conductive lines provided by the neurone. The work of Ramon-y-Cajal, van Gehuchten, v. Lenhossek and others, with the methods of Golgi and Ehrlich, establishes as a concept of the neurone in general that it is a conductive unit wherein a number of branches (dendrites) converge towards, meet and coalesce in a single out-going stem (axone). Through this tree-shaped structure the nervous impulses flow, like the water in a tree, from roots to stem. The conduction does not normally run in the reverse direction. The place of junction of the dendrites with one another and with the axone is commonly the perikaryon. This last is therefore a nodal point in the conductive system. But it is a nodal point of particular quality. It is not a nodal point where lines meet to cross one another, nor one where one line splits into many. It is a nodal point where conductive lines run together into one which is the continuation of them all. It is a reduction point in the system of lines. The perikaryon with its convergent dendrites is therefore just such a structure as spatial summation and immediate induction would demand. The neurone Z may well, therefore, be the field of coalition, and the organ where the summational and inductive processes occur. And the morphology of the neurone as a whole is seen to be just such as we should expect, arguing from the principle of the common path.
With the phenomenon of " interference " the question is more difficult. There it is not clear that the field of antagonism is within the neurone Z itself. The field may be synaptic. We have the demonstration by Verworn that the interference produced by A at Z for impulses from B is not accompanied by any obvious change in excitability of the axone of Z. Z, if itself the seat of inhibition, might have been expected to exhibit That inhibition throughout its extent. This, as tested by its axone, it does not. There exist, it is true, older experiments by Uspensky, Belmondo and Oddi, &c., according to which the threshold of direct excitability of the motor root is lowered by stimulation of the afferent root. This points to an extension of the facilitation effect through the whole motor neurone, conversely to Verworn's demonstration for central inhibition. Verworn's experiment and its result is very clear. It leads us to search for some other mechanism common to A and B to which might be attributable their mutual influence on each other's reactions. But if we admit the conception, argued above, that at the nexus between A and Z, i.e. at synapse A Z, and similarly between B and Z, i.e. at synapse B Z, there exists a surface of separation, a membrane in the physical sense, a further consequence seems inferable. Suppose a number of different neurones A, B, C, &c., each conducting through its own synapse upon a neurone Z. The synapses A Z, B Z, C Z, &c. are all surfaces or membranes into which Z enters as a factor common to them all. A change of state induced in neurone Z might be expected to affect the surface condition or membrane at all of the synapses, since the condition of Z is a factor common to all those membranes. Therefore a change of state (excitatory or inhibitory) induced in Z by any of the neurones A, B, C, &c., playing upon it would enter as a condition into the nervous transmission at the other synapses from the other collateral neurones. In harmony with this is the spread of refractory state in the neurones as mentioned above. A change in neurone Z induced by neurone A playing upon it, in that case seems to effect its point of nexus with the other neurones B, C, &c., also. It is conceivable that the phenomena of interference may be based in part at least on such a condition. The neurone threshold of Z for stimulation through B will be to some extent a function of events at synapses A Z.
Factors Determining the Sequence. - The formation of a common path from tributary converging afferent arcs is important because it gives a co-ordinating mechanism. There the dominant action of one afferent arc, or set of allied arcs in condominium, is subject to supercession by another afferent arc, or set of allied arcs, and the supercession normally occurs without intercurrent confusion. Whatever be the nature of the physiological process occurring between the competing reflexes for dominance over the common path, the issue of their competition namely, the determination of which one of the competing arcs shall for the time being reign over the common path, is largely conditioned by four factors. These are spinal induction, relative fatigue, relative intensity of stimulus, and the functional species of the reflex.
1. The first of these occurs in two forms, one of which has already been considered, namely, immediate induction. It is a form of " bahnung."Spinal Induction. The stimulus which and lower the threshold for reflexes. allied to that which it particularly excites. A constellation of reflexes thus tends to be formed which reinforce each other, so that the reflex is supported by allied accessory reflexes, or if the prepotent stimulus shifts, allied arcs are by the induction particularly prepared to be responsive to it or to a similar stimulus.
Immediate induction only occurs between allied reflexes. Its tendency in the competition between afferent arcs is to fortify the reflex just established, or, if transition occur, to favour transition to an allied reflex. Immediate induction seems to obtain with highest intensity at the outset of a reflex, or at least near its commencement. It does not appear to persist long.
The other form of spinal induction is what may be termed successive induction. It is in several ways the reverse of the preceding.
In peripheral inhibition, exemplified by the vagus action on the heart, the inhibitory effect is followed by a rebound aftereffect opposite to the inhibitory (Gaskell). The same thing is obvious in various instances of the reciprocal inhibition of the spinal centres. Thus, if the crossed-extension reflex of the limb of the " spinal " dog be elicited at regular intervals, say once a minute, by a carefully adjusted electrical stimulus of defined duration and intensity, the resulting reflex movements are repeated each time with much constancy of character, amplitude and duration. If in one of the intervals a strong prolonged (e.g. 30") flexion-reflex is induced from the limb yielding the extensorreflex movement, the latter reflex is found intensified after the intercurrent flexion-reflex. The intercalated flexion-reflex lowers the threshold for the aftercoming extension-reflexes, and especially increases their after-discharge. This effect may endure, progressively diminishing, through four or five minutes, as tested by the extensor reflexes at successive intervals. Now, as we have seen, during the flexion-reflex the extensor arcs were inhibited: after the flexion-reflex these arcs are in this case evidently in a phase of exalted excitability. The phenomenon presents obvious analogy to visual contrast. If visual brightness be regarded as analogous to the activity of spinal discharge, and visual darkness analogous to absence of spinal discharge, this reciprocal spinal action in the example mentioned has a close counterpart in the well-known experiment where a white disk used as a prolonged stimulus leaves as visual after-effect a grey image surrounded by a bright ring (Hering's "Lichthof "). This bright ring has for its spinal equivalent the discharge from the adjacent reciprocally correlated spinal centre. The exaltation after-effect may ensue with such intensity that simple discontinuance of the stimulus maintaining one reflex is immediately followed by " spontaneous " appearance of the antagonistic reflex. Thus the flexion-reflex, if intense and prolonged, may, directly its own exciting stimulus is discontinued, be succeeded by a " spontaneous " reflex of extension, and this even when the animal is lying on its side and the limb horizontal - a pose that does not favour the tonus of the extensor muscles. Such a " spontaneous " reflex is the spinal counterpart of the visual " Lichthof." To this spinal induction, as it may be termed, seems attributable a phenomenon commonly met in a flexion-reflex of high intensity when maintained by very prolonged excitation. The reflex flexion is then frequently broken at irregular intervals by sudden extension movements. It would seem, therefore, that some process in the flexion-reflex leads to exaltation of the activity of the arcs of the opposed extension-reflex. An electrical stimulation of the proximal end of the severed nerve of the extensor muscles of the knee (cat), though it does not, in the present writer's experience, directly excite contraction of the extensors of the knee is on cessation often immediately followed by contraction of them.
As examples of the rebound exaltation following on inhibition the following may also serve. The so-called " mark-time " reflex of the " spinal " dog is an alternating stepping movement of the hind limbs which occurs on holding the animal up so that its limbs hang pendent. It can be inhibited by stimulating the skin of the tail. On cessation of that stimulus the stepping movement sets in more vigorously and at quicker rate than before. The increase is chiefly in the amplitude of the movement, but the writer has also seen the rhythm quickened even by 30% of the frequence.
This after-increase might be explicable in either of two ways. It might be due to the mere repose of the reflex centre, the repose so recruiting the centre as to strengthen its subsequent action. But a similar period of repose obtained by simply supporting one limb - which causes cessation of the reflex in both limbs, the excites a reflex tends by central spread to facilitate y p stimulus being stretch of the hip-flexors under gravity - is not followed by after-increase of the reflex.
Or the after-increase might result from the inhibition being followed by a rebound to superactivity. This latter seems to be the case. The after-increase occurs even when both hind limbs are passively lifted from below during the whole duration of the inhibitory stimulus applied to the tail. It is the depression of inhibition, and not the mere freedom from an exciting stimulus, that induces a later superactivity. And the reflex inhibition of the knee-extensor by stimulation of the central end of its own nerve is especially followed by marked rebound to superactivity of the extensor itself.
Again, the knee jerk, after being inhibited by stimulation of the hamstring nerve, returns, and is then more brisk than before the inhibition.
By virtue of this spinal contrast, therefore, the extensionreflex predisposes to and may actually induce a flexion-reflex, and conversely the flexion-reflex predisposes to and may actually induce an extension-reflex. This process is qualified to play a part in linking reflexes together in a co-ordinate sequence of successive combination. If a reflex arc A during its own activity temporarily checks that of an opposed reflex arc B, but as a subsequent result induces in arc B a phase of greater excitability and capacity for discharge, it predisposes the spinal organ for a second reflex opposite in character to its own in immediate succession to itself. The writer has elsewhere pointed out the peculiar prominence of " alternating reflexes " in prolonged spinal reactions. It is significant that they are usually cut short with ease by mere passive mechanical interruption of the alternating movement in progress. It seems that each step of the reflex movement tends to excite by spinal induction the step next succeeding itself.
Much of the reflex action of the limb that can be studied in the " spinal " dog bears the character of adaptation to locomotion. This has been shown recently with particular clearness by the observations of Phillipson. In describing the extensor thrust of the limb the writer drew attention at the time to its significance for locomotion. Spinal induction obviously tends to connect to this extensor-thrust flexion of the limb as an aftereffect. In the stepping of the limb the flexion that raises the foot and carries it clear of the ground prepares the antagonistic arcs of extension, and, so to say, sensitizes them to respond later in their turn by the supporting and propulsive extension of the limb necessary for progression. In such reflex sequences an antecedent reflex would thus not only be the means of bringing about an ensuing stimulus for the next reflex, but would predispose the arc of the next reflex to react to the stimulus when it arrives, or even induce the reflex without external stimulus. The reflex " stepping " of the " spinal " dog does go on even without an external skin stimulus: it will continue when the dog is held in the air. The cat walks well, when anaesthetic in the soles of all four feet.
Each reflex movement must of itself generate stimuli to afferent apparatus in many parts and organs - muscles, joints, tendons &c. This probably reinforces the reflex in progress. The reflex obtainable by stimulation of the afferent nerve of the flexor muscles of the knee excites those muscles to contraction and inhibits their antagonistics: the reflex obtainable from the afferent nerve of the extensor muscles of the knee excites the flexors and inhibits their antagonistics.
Where a reflex by spinal induction tends to eventually bring about the opposed reflex, the process of spinal induction is therefore probably reinforced by the operation of any reflex generated in the movement. This would help to explain how it is that a reflex reaction, when once excited in a " spinal " animal, ceases on cessation of the stimulus as quickly as it generally does. Such a reaction must generate in its progress a number of further stimuli and throw up a shower of centripetal impulses from the moving muscles and joints into the spinal cord. Squeezing of muscles and stimulation of their afferent nerves and those of joints, &c., elicit reflexes. The primary reflex movement might be expected, therefore, of itself to initiate further reflex movement, and that secondarily to initiate further still, and so on. Yet on cessation of the external stimulus to the foot in the flexion-reflex the whole reflex comes usually at once to an end. The scratch-reflex, even when violently provoked, ceases usually within two seconds of the discontinuance of the external stimulus that provoked it.
We have as yet no satisfactory explanation of this. But we remember that such reflexes are intercurrent reactions breaking in on a condition of neural equilibrium itself reflex. The successive induction will tend to induce a compensatory reflex, which brings the moving parts back again to the original position of equilibrium.
2. Another condition influencing the issue of competition between reflexes of different source for possession of one and the same final common path is fatigue.Fatigue. A spinal reflex under continuous excitation or frequent repetition becomes weaker, and may cease altogether. This decline is progressive, and takes place earlier in some kinds of reflexes than it does in others. In the " spinal " dog the scratch-reflex under ordinary circumstances tires much more rapidly than does the flexion-reflex.
A reflex as it tires shows other changes besides decline iri amplitude of contraction. Thus in the flexion-reflex, the original steadiness of the contraction decreases; it becomes tremulous, and the tremor becomes progressively more marked and more irregular. The rhythm of the tremor in the writer's observations has often been about so per second. Then phases of greater tremor tend to alternate with phases of improved contraction as indicated by some regain of original extent of flexion of limb and diminished tremor. Apart from these partial evanescent recoveries the decline is progressive. Later, the stimulation being maintained all the time, brief periods of something like complete intermission of the reflex appear, and even of a replacement of flexion by extension. These lapses are recovered from, but tend to recur more and more. Finally, an irregular phasic tremor of the muscles is all that remains. It is not the flexor muscles themselves which tire out, for these, when under fatigue of the flexion-reflex they contract no longer for that reflex, contract in response to the scratch-reflex which also employs them.
Similar results are furnished by the scratch-reflex, with certain differences in accord with the peculiar character of its individual charge. One of these latter is the feature that the individual beats of the scratch-reflex usually become slower and follow each other at slower frequency. Also the beats, instead of remaining fairly regular in amplitude and frequency, tend to succeed in somewhat regular groups. The beats may disappear altogether for a short time, and then for a short time reappear, the stimulus continuing all the while. Here, again, the phenomena are not referable to the muscle, for when excited through other reflex channels, or through its motor nerve directly, the muscle shows its contraction well. Part of the decline of these reflexes under electrical stimulation in the " spinal " dog may be due to reduction of the intensity of the stimulus itself by physical polarization. That does not account in the main for the above described effects. The graphic record of fatigue of the flexion of the scratch-reflex obtained by continued mechanical stimulation does not appreciably differ from that yielded under electrical stimulation. The different speed of the decline due to fatigue proceeds characteristically in different kinds of reflex, and in the same kind of reflex under different physiological conditions, e.g. " spinal shock ": this indicates its determination by other. factors than electrical polarization. Polarization has in a number of cases been deferred as far as possible by using equalized ,alternate shocks applied in opposite directions through the same gilt needle; this precaution has not yielded, results differing appreciably from those given by ordinary double shocks or by series of make or break shocks of the same direction. The slowing of the beat in fatigue is also against the explanation by polarization, since merely weakening the stimulus does not lead to a slower beat.
When the scratch-reflex elicited from a spot of skin is fatigued, the fatigue holds for that spot, but does not implicate the reflex as obtained from the surrounding skin. The reflex is, when tired out to stimuli at that spot, easily obtainable by stimulation two or more centimetres away. This is seen with either mechanical or electrical stimuli. When the spot stimulated second is close to the one tired out, the reflex shows some degree of fatigue, but not that degree obtaining for the original spot. This fatigue may be a local fatigue of the nerve-endings in the spot of skin stimulated, to which in experiments making use of electric stimuli some polarization may be added. Yet its local character does not at all necessarily imply its reference to the skin. It may be the expression of a spatial arrangement in the central organ by which reflex arcs arising in adjacent receptors are partially confluent in their approach toward the final common path, and are the more confluent the closer together lie their points of origin in the receptive field. The resemblance between the distribution of the incidence of this fatigue and that of the spatial summation previously described argues that the seat of the fatigue is intraspinal and central more than peripheral and cutaneous; and that it affects the afferent part of the arc inside the spinal cord, probably at the first synapse. Thus, its incidence at the synapse Ra - Pa and at R - P would explain its restrictions, as far as we know them, in the scratch-reflex.
The local fatigue of a spinal reflex seems to be recovered from with remarkable speed, to judge by observations on the reflexes of the limbs of the " spinal " dog. A few seconds' remission of the stimulus suffices for marked though incomplete restoration of the reaction. In a few instances there may be seen return of a reflex even during the stimulation under which the waning and disappearance of the reflex occurred. The exciting stimulus has usually in such cases been of rather weak intensity. In the writer's experience these spinal reflexes fade out sooner under a weak stimulus than under a strong one. This seeming paradox indicates that under even feeble intensities of stimulation the threshold of the reaction gradually rises, and that it rises above the threshold value of the weaker stimulus before it reaches that of a stronger stimulus. The scratch-reflex which has ceased to be elicited by a weak stimulus is immediately evoked - often without any sign of fatigue in its motor response - by increasing the intensity of the stimulus applied at the same electrode. The occurrence of fatigue earlier under the weaker stimulus than under the stronger also shows that the fatigue consequent under the weaker stimulus may often be, relatively to the production of the natural discharge, greater than when a stronger stimulus is employed. This, which has been of frequent occurrence in the writer's observations on the leg of the "spinal" dog, if obtaining widely in reflex actions, has evident practical importance.
It is easy to avoid in some degree the local fatigue associated with excitation of the scratch-reflex from one single spot in the skin by taking advantage of the spatial summation of stimuli applied at different points in the receptive, field. When this was done, a curious result met the writer. The provocation of the reflex has been made through ten separate points in the receptive field, the distance between each member of the series of points and the point next to it being about four centimetres. Each point is stimulated by a double-induction shock delivered twice a second. When this is done a series of scratch movements is elicited, and continues longer than when the stimuli are applied at the same interval, not to succeeding series of skin points but to one point. Thus three or four hundred beats can be elicited in unbroken series. But the series tends somewhat abruptly to cease. If, then, in spite of the cessation of the response, the stimulation be continued without alteration during three or four minutes or more, the scratching movement breaks out again from time to time and gives another series of beats, perhaps longer than the first. These experiments indicate that physical polarization at the stigmatic electrode is not answerable for the fading out of the scratch-reflex. It shows also the complexity of the central mechanisms involved in the reflex. The phenomenon recalls Lombard's phases of briskness and fatigue in series of records obtained with the ergograph.
It is interesting to note certain differences between the cessation of a reflex under fatigue and under inhibition. The reflex ceasing under inhibition is seen to fade off without obvious change in the frequency of repetition of the beats, or in the duration of the individual beats. The reflex ceasing under fatigue is seen to show a slower rhythm and a sluggish course for the latter beats, especially for the terminal ones.
Among the signs of fatigue of a reflex action are several suggesting that in it the command over the final common path exercised for the time being by the receptors and afferent path in action becomes less strong, less steady and less accurately adjusted. Under prolonged excitation their hold upon the final common path becomes loosened. This view is supported by the fact that its connexion with the final common path is then more easily cut short and ruptured by other rival arcs competing with it for the final common path in question. The scratchreflex interrupts the flexion-reflex more readily when the latter is tired out than when it is fresh.
In the hind limb of the " spinal " dog the extensor-thrust is inelicitable during the flexion-reflex. That is to say, when the flexion-reflex is evoked with fair or high intensity the writer has never succeeded in evoking the extensor-thrust, though the flexed posture of the limb is itself a favouring circumstance for the production of the thrust if the flexion be a passive one. But when the flexion-reflex is kept up by appropriate stimulation of a single point over a prolonged time, so that it shows fatigue, the extensor-thrust becomes again elicitable. Its elicitability is, then, not regular nor facile, but it does become obtainable, usually in quite feeble degree at first, later more powerfully. In other words, it can dispossess the rival reflex from a common path when that rival is fatigued, though it cannot do so when the rival action is fresh and powerful.
Again, the crossed extension-reflex cannot inhibit the reflexion of the flexor-reflex under ordinary circumstances if the intensity of the stimulation of the competing arcs be approximately equal; but it can do so when the flexion-reflex is tired.
The waning of a reflex under long-maintained excitation is one of the many phenomena that pass in physiology under the name of fatigue. It may be that in this case the so-called fatigue is really nothing but a negative induction. Its place of incidence may lie at the synapse. It seems a process elaborated and preserved in the selective evolution of the neural machinery. One obvious use attaching to it is the prevention of the too prolonged continuous use of a common path by any one receptor. It precludes one receptor from occupying for long periods an effector organ to the exclusion of all other receptors. It prevents long continuous possession of a common path by any one reflex of considerable intensity. It favours the receptors taking turn about. It helps to ensure serial variety of reaction. The organism, to be successful in a million-sided environment, must in its reaction be many sided. Were it not for such so-called fatigue, an organism might, in regard to its receptivity, develop an eye, or an ear, or a mouth, or a hand or leg, but it would hardly develop the marvellous congeries of all those various sense-organs which it is actually found to possess.
The loosening of the hold upon the common path by so-called fatigue occurs also in paths other than those leading to muscle and effector organs. If instead of motor effects sensual are examined, analogous phenomena are observed. A visual image is more readily inhibited by a competing image in the same visual field when it has acted for some time than when it is first perceived (W. Macdougall).
One point, on a priori grounds, is a natural corollary from the " principle of the common path," as indicated by the experimental findings relative to the incidence of fatigue. The reflex arcs, each a chain of neurones, converge in their course so as to impinge upon and conjoin in links (neurones) common to whole varied groups - in other words, they conjoin to common paths. This arrangement culminates in the convergence of many separately arising arcs in the final efferent-root neurone. This neurone thus forms the instrument for many different reflex arcs and acts. It is responsive to them in various rhythm and in various grades of intensity. In accordance with this, it seems from experimental evidence to be relatively indefatigable. '46--ft thus satisfies a demand that the principle of the common path must make regarding it.
3. In the transition from one reflex to another a final common path changes hands and passes from one master to another. A fresh setIntensity. of afferent arcs becomes dominant on the Intensity. supersession of one reflex by the next. Of all the conditions determining which one of competing reflexes shall for the time being reign over a final common path, the intensity of reaction of the afferent arc itself relatively to that of its rivals is probably the most powerful. An afferent arc that strongly stimulates is caeteris paribus more likely to capture the common path than is one excited feebly. A stimulus can only establish its reflex and inhibit an opposed one if it have intensity. This explains why, in order to produce examples of spinal inhibition, recourse has so frequently been made in past times to strong stimuli. A strong stimulus will inhibit a reflex in progress, although a weak one will fail. Thus in Goltz's inhibition of micturition in the " spinal " dog a forcible squeeze of the tail will do it, but not, in the present writer's experience, a weak squeeze. So, likewise, any condition which raises the excitability and responsiveness of a nervous arc will give it power to inhibit other reflexes, just as it would if it were excited by a strong stimulus. This is much as in the heart of the Tunicate. There the prepotent spot whence starts the systole lies from time to time at one end and from time to time at the other. The prepotent region at one end which usually dominates the common path is from time to time displaced by local increase of excitability at the other under local distension of the bloodsinuses there.
In judging of intensity of stimulus the situation of the stimulus in the receptive field of the reflex has to be remembered. One and the same physical stimulus will be weak if applied near the edge of the field, though strong if applied to the focus of the field.
Crossed reflexes are usually less easy to provoke, less reliable of obtainment, and less intense than are direct reflexes. Consequently we find crossed reflexes usually more easily inhibited and replaced by direct reflexes than are these latter by those former. Thus the crossed stepping-reflex is easily replaced by the scratch-reflex, though its stimulus be continued all the time, and though the scratch-reflex itself is not a very potent reflex. But the reverse can occur with suitably adjusted intensity of stimuli.
Again, the flexion-reflex of the dog's leg is, when fully developed, accompanied by extension in the opposite leg. This crossed extensor movement, though often very vigorous, may be considered as an accessory and weaker part of the whole reflex, of which the prominent part is flexion of the homonymous limb. When the flexion-reflex is elicitable poorly, as, for instance, in spinal shock or under fatigue or weak excitation, the crossed extension does not accompany the homonymous flexion and does not appear. But, where the flexion-reflex is well developed, if not merely one but both feet be stimulated simultaneously with stimuli of fairly equal intensity, steady flexion at knee, hip and ankle results in both limbs, and extension occurs in neither limb. The contralateral part of each reflex is inhibited by the homolateral flexion of each reflex. In other words, the more intense part of each reflex obtains possession of the final common paths at the expense of the less intense portion of the reflex. But if the intensity of the stimuli applied to the right and left feet be not closely enough balanced, the crossed extension of the reflex excited by the stronger stimulus is found to exclude even the homonymous flexion that the weaker stimulus should and would otherwise evoke from the leg to which it is applied.
It was pointed out above that in a number of cases the transference of control of the final common path FC from one afferent arc to another is reversible. The direction of the transference can caeteris paribus be easily governed by making the stimulation of this receptor or that receptor the more intense. A factor largely determining whether a reflex succeed another or not is therefore intensity of stimulus.
4. A fourth main determinant for the issue of the conflict between rival reflexes seems the functional species of the reflexes. Reflexes initiated from a species of receptorSpecies of reflex. apparatus that may be termed noci-ceptive appear to particularly dominate the majority of the final common paths issuing from the spinal cord. In the simpler sensations we experience from various kinds of stimuli applied to our skin there can be distinguished those of touch, of cold, of warmth and of pain. The adequate stimuli for the first-mentioned three of these are certainly different; mechanical stimuli, applied above a certain speed, which deform beyond a certain degree the resting contour of the skin surface, seem to constitute adequate stimuli for touch. Similarly the cooling or raising of the local temperature, whether by thermal conduction, radiation, &c., are adequate for the cold and warmth sensations. The organs for these three sensations have by stigmatic stimuli been traced to separate and discrete tiny spots in the skin. In regard to skin-pain it is held by competent observers, notably by V. Frey and Kiesow, that skin-pain likewise is referable to certain specific nerve-endings. In evidence of this it is urged that mechanical stimuli applied at certain places excite sensations which from their very threshold upward possess unpleasantness, and as the intensity of the stimulus is increased, culminate in " physical pain." The sensation excited by a mechanical stimulus applied to a touch-spot does not evoke pain, however intensely applied, so long as the stimulation is confined to the touch-spot. The threshold value of mechanical stimuli for touchspots is in general lower than it is for pain-spots; and conversely the threshold value of electrical stimuli for touch-spots is in general higher than it is for the spots yielding pain. Similarly it is said that stimulation of a cold spot or of a warm spot does not, however intense, evoke, so long as confined to them, sensations of painful quality. But pain can be excited not only by strong mechanical stimuli and by electrical stimuli, but by cold and by warmth, though the threshold value of these latter stimuli is higher for pain than for cold and warm spots. If these observations prove correct there exist, therefore, numerous specific cutaneous nerve-fibres evoking pain.
A difficulty here is that sensory nerve-endings are usually provided with sense organs which lower their threshold for stimuli of one particular kind while raising it for stimuli of all other kinds; but these pain-endings in the skin seem almost equally excited by stimuli of such different modes as mechanical, thermal conductive, thermal radiant, chemical and electrical. That is, they appear anelective receptors. But it is to be remarked that these agents, regarded as excitants of skin-pain, have all a certain character in common, namely this, that they become adequate as excitants of pain when they are of such intensity as threatens damage to the skin. And we may note about these excitants that they are all able to excite nerve when applied to naked nerve directly. Now there are certain skin surfaces from which, according to most observers, pain is the only species of sensation that can be evoked. This is alleged, for instance, of the surface of the cornea - a modified piece of skin. The histology of the cornea reveals in its epithelium nerve-endings of but one morphological kind; that is, the ending by naked nerve-fibrils that pass up among the epithelial cells. Similar nerve-endings exist also in the epidermis generally. It may therefore be that the nerve-endings subserving skinpain are free naked nerve-endings, and the absence of any highly evolved specialized end-organ in connexion with them may explain their fairly equal amenability to an unusually wide range of different kinds of stimuli. Instead of but one kind of stimulus being their adequate excitant, they may be regarded as adapted to a whole group of excitants, a group of excitants which has in relation to the organism one feature common to all its components, namely, a nocuous character.
With its liability to various kinds of mechanical and other damage, in a world beset with dangers amid which the individual and species have to win their way in the struggle for existence, we may regard nocuous stimuli as part of a normal state of affairs. It does not seem improbable, therefore, that there should under selective adaptation attach to the skin a so-to-say specific of its own injuries. As psychical adjunct to the reactions of that apparatus we find a strong displeasurable effective quality in the sensations they evoke. This may perhaps be a means for branding upon memory, of however rudimentary kind, a feeling from past events that have been perilously critical for the existence of the individuals of the species. In other words, if we admit that damage to such an exposed sentient organ as the skin must in the evolutionary history of animal life have been sufficiently frequent in relation to its importance, then the existence of a specific set of nerves for skin-pain seems to offer no genetic difficulty, any more than does the clotting of blood or innate immunity to certain diseases. That these nerve-endings constitute, a distinct species is argued by their all evoking not only the same species of sensation, but the same species of reflex movement as regards " purpose," intensity, resistance to “shock,” &c. And their evolution may 'well have been unaccompanied by evolution of any specialized end-organ, since the naked free nerve-endings would better suit the wide and peculiar range of stimuli, reaction to which is in this case required. A low threshold was not required because the stimuli were all intense, intensity constituting their harmfulness; but response to a wide range of stimuli of different kinds was required, because harm might come in various forms. That responsive range is supplied by naked nerve itself, and would be cramped by the specialization of an end-organ. Hence these nerve-endings remained free.
It is those areas, stimulation of which, as judged by analogy, can excite pain most intensely, and it is those stimuli which, as judged by analogy, are most fitted to excite pain which, as a general rule, excite in the “spinal” animal—where pain is of course non-existent—the prepotent reflexes. If these are reactions to specific pain-nerves, this may be expressed by saying that the nervous arcs of pain-nerves, broadly speaking, dominate the spinal centres in peculiar degree. Physical pain is thus the psychical adjunct of an imperative protective reflex. It is preferable, however, since into the merely spinal and reflex aspect of the reaction of these nerves no sensation of any kind can be shown to enter, to avoid the term “pain-nerves.” Remembering that the feature common to all this group of stimuli is that they threaten or actually commit damage to the tissue to which they are applied, a convenient term for application to them is nocuous. In that case what from the point of view of sense are cutaneous pain-nerves are from the point of view of reflex-action conveniently termed noci-ceptive nerves.
In the competition between reflexes the noci-ceptive as a rule dominate with peculiar certainty and facility. This explains why such stimuli have been so much used to evoke reflexes in the spinal frog, and why, judging from them, such “fatality” belongs to spinal reflexes.
One and the same skin surface will in the hind limb of the spinal dog evoke one or other of two diametrically different reflexes according as the mechanical stimulus applied be of noxious quality or not, a harmful insult or a harmless touch. A needle-prick to the planta causes invariably the drawing up of. the limb - the flexion-reflex. A harmless smooth contact, on the other hand, causes extension - the extensor-thrust above described. This flexion is therefore a noci-ceptive reflex. But the scratch-reflex - which is so readily evoked by simple light irritation of the skin of the shoulder - is relatively mildly noci-ceptive. When the scratch-reflex and the flexion-reflex are in competition for the final neurone common to them, the flexion-reflex more easily dispossesses the scratch-reflex from the final neurone than does the scratch-reflex the flexionreflex. If both reflexes are fresh, and the stimuli used are such as,, when employed separately, evoke their reflexes respectively with some intensity, in my experience it is the flexionreflex that is usually prepotent. Yet if, while the flexion-reflex is being moderately evoked by an appropriate stimulus of weak intensity, a strong stimulus suitable for producing the scratch reflex is applied, the steady flexion due to the flexion-reflex is replaced by the rhythmic scratching movement of the scratchreflex, and this occurs though the stimulus for the flexion-reflex is maintained unaltered. When the stimulus producing the scratch is discontinued the flexion-reflex reappears as before. The flexion-reflex seems more easily to dispossess the scratchreflex from the final common paths than can the scratch-reflex dispossess the flexion-reflex. Yet the relation is reversible—by heightening the intensity of the stimulus for the scratch-reflex or lowering that of the stimulus for the flexion-reflex.
In decerebrate rigidity, where a tonic reflex is maintaining contraction in the extensor muscles of the knee, stimulation of the noci-ceptive arcs of the limb easily breaks down that reflex. The noci-ceptive reflex dominates the motor neurone previously held in activity by the postural reflex. And noci-ceptive reflexes are relatively little depressed by " spinal shock."
Noci-ceptive arcs are, however, not the only spinal arcs which in the intact animal, considered from the point of view of sensation, evoke reactions rich in affective quality. Beside those receptors attuned to react to direct noxa, the skin has others, concerned likewise with functions of vital importance to the species and colligate with sensations similarly of intense affective quality; for instance, those concerned with sexual functions. In the male frog the sexual clasp is a spinal reflex. The cord may be divided both in front and behind the brachial region without interrupting the reflex. Experiment shows that from the spinal male at the breeding season, and also at other times, this reflex is elicited by any object that stimulates the skin of the sternal and adjacent region. In the intact animal, on the contrary, other objects than the female are, when applied to that region, at once rejected, even though they be wrapped in the fresh skin of the female frog and in other ways made to resemble the female. The development of the reflex is not prevented by removal of the testes, but removal of the seminal reservoirs is said to depress it, and their distension, even by indifferent fluids, to exalt it. If the skin of the sternal region and arms is removed the reflex does not occur. Severe mutilation of the limbs and internal organs does not inhibit the reflex, neither does stimulation of the sciatic nerve central to its section. The reflex is, however, depressed or extinguished by strong chemical and pathic stimuli to the sternal skin, at least in many cases. The tortoise exhibits a similar sexual reflex of great spinal potency.
It would seem a general rule that reflexes arising in species of receptors which considered as sense-organs provoke strongly affective sensation caeteris paribus prevail over reflexes of other species when in competition with them for the use of the “final common path.” Such reflexes override and set aside with peculiar facility reflexes belonging to touch organs, muscular sense-organs, &c. As the sensations evoked by these arcs, e.g. “pains,” exclude and dominate concurrent sensations, so do the reflexes of these arcs prevail in the competition for possession of the common paths. They seem capable of pre-eminent intensity of action.
Of all reflexes it is the tonic reflexes, e.g. of ordinary posture, that are in the writer's experience the most easily interrupted by other reflexes. Even a weak stimulation of the noci-ceptive arcs arising in the foot often suffices to lower or abolish the knee-jerk or the reflex extensor tonus of the elbow or knee. If various species of reflex are arranged, therefore, in their order of potency in regard to power to interrupt one another, the reflexes initiated in receptors which considered as senseorgans excite sensations of strong affective quality lie at the upper end of the scale, and the reflexes that are answerable for the postural tonus of skeletal muscles lie at the lower end of the scale. One great function of the tonic reflexes is to maintain habitual attitudes and postures. They form, therefore, a nervous background of active equilibrium. It is of obvious advantage that this equilibrium should be easily upset, so that the animal may respond agilely to the passing events that break upon it as intercurrent stimuli.
Results. - Intensity of stimulation, fatigue and freshness, spinal induction, functional species of reflex, are all, therefore, physiological factors influencing the result of the interaction of reflex-arcs at a common path. It is noticeable that they all resolve themselves ultimately into intensity of reaction. Thus, intensity of stimulus means as a rule intensity of reaction. Those species of reflex which are habitually prepotent in interaction with others are those which are habitually intense; those specially impotent in competition are those habitually feeble in intensity, e.g. skeletal muscular tone. The tonic reflexes' of attitude are of habitually low intensity, easily interfered with and temporarily suppressed by intercurrent reflexes, these latter having higher intensity. But these latter suffer fatigue relatively early, whereas the tonic reflexes of posture can persist hour after hour with little or no signs of fatigue. Fatigue, therefore, in the long run advantageously redresses the balance of an otherwise unequal conflict. We can recognize in it another agency working toward that plastic alternation of activities which is characteristic of animal life and increases in it with ascent of the animal scale.
The high variability of reflex reactions from experiment to experiment, and from observation to observation, is admittedly one of the difficulties that has retarded knowledge of them. Their variability, though often attributed to general conditions of nutrition, or to local blood-supply, &c., seems far more often due to changes produced in the central nervous organ by its own functional conductive activity apart from fatigue. This functional activity itself causes from moment to moment the temporary opening of some connexions and the closure of others. The chains of neurones, the conductive lines, have been, especially in recent years, by the methods of Golgi, Ehrlich, Apathy, Cajal and others, richly revealed to the microscope. Anatomical tracing of these may be likened, though more difficult to accomplish, to tracing the distribution of blood vessels after Harvey's discovery had given them meaning, but before the vasomotor mechanism was discovered. The blood vessels of an organ may be turgid at one time, constricted almost to obliteration at another. With the conductive network of the nervous system the temporal variations are even greater, for they extend to absolute withdrawal of nervous influence. Under reflex inhibition a skeletal muscle may relax to its post-mortem length, i.e. there may then be no longer evidence of even a tonic influence on it by its motor neurone. The direction of the stream of liberation of energy along the pattern of the nervous web varies from minute to minute. The final common path is handed from some group of a plus class of afferent arcs to some group of a minus class, or of a rhythmic class, and then back to one of the previous groups again, and so on. The conductive web changes its functional pattern with certain limits to and fro. It changes its pattern at the entrances to common paths. The changes in its pattern occur there in virtue of interaction between rival reflexes, " interference." As a tap to a kaleidoscope, so a new stimulus that strikes the receptive surfaces causes in the central organ a shift of functional pattern at various synapses. The central organ is a vast network whose lines of conduction follow a certain scheme of pattern, but within that pattern the details of connexion are, at the entrance to each common path, mutable. The grey matter may be compared with a telephone exchange, where, from moment to moment, though the end-points of the system are fixed, the connexions between starting-points and terminal points are changed to suit passing requirements, as the functional points are shifted at a great railway junction. In order to realize the exchange at work, one must add to its purely spatial plan the temporal datum that within certain limits the connexions of the lines shift to and fro from minute to minute. An example is the " reciprocal innervation " of antagonistic muscles - when one muscle of the antagonistic couple is thrown into action the other is thrown out of action. This is only a widely spread case of the general rule that antagonistic reflexes interfere where they embouch upon the same final common paths. And that general rule is part of the general principle of the mutual interaction of reflexes that impinge upon the same common path. Unlike reflexes have successive but not simultaneous use of the common path; like reflexes mutually reinforce each other on their common path. Expressed teleologically, the common path, although economically subservient for many and various purposes, is adapted to serve but one purpose at a time. Hence it is a co-ordinating mechanism and prevents confusion by restricting the use of the organ, its minister, to but one action at a time.
In the case of simple antagonistic muscles, and in the instances of simple spinal reflexes, the shifts of conductive pattern due to interaction at the mouths of common paths are of but small extent. The co-ordination covers, for instance, one limb or a pair of limbs. But the same principle extended to the reaction of the great arcs arising in the projicient receptor organs of the head, e.g. the eye, which deal with wide tracts of musculature as a whole, operates with more multiplex shift of the conductive pattern. Releasing forces acting on the brain from moment to moment shut out from activity whole regions of the nervous system, as they conversely call vast other regions into plays The resultant singleness of action from moment to moment is a keystone in the construction of the individual whose unity it is the specific office of the nervous system to perfect. The interference of unlike reflexes and the alliance of like reflexes in their actions upon their common paths seem to lie at the very root of the great psychical process of " attention." The spinal cord is not only the seat of reflexes whose "centres" lie wholly within the cord itself; it supplies also conducting paths for nervous reactions initiated by impulses derived from afferent spinal nerve, but involving mechanisms situate altogether headward of the cord, that is to say, in the brain. Many of these reactions affect consciousness, occasioning sensations of various kinds. In regard to the part played by spinal conduction in subserving these sensual reactions a question of practical rather than theoretical importance has been as yet the chief aim of inquiry. The inquiry has been in fact whether the impulses concerned in evoking the various species of sensations follow in their headward course along the cord certain discrete paths occupying separable fractions of the cross-area of the cord, and if they are thus confined to discrete paths in what parts of the cross-area of the cord do these parts lie. This " localiza? tion" problem has as yet been almost the sole problem attacked, and therefore, despite its limited scope and interest, the results attained in it may be briefly mentioned here.
Localization. - The sensations usually grouped under the name of touch may with advantage, as shown by Head, be distinguished from the point of view of their practical elicitation into superficial and deep. The former of these are referable to stimulation of afferent nerve-fibres distributed actually to the skin, the latter to stimulation of deeper afferents subjacent to the skin. The touch-fibres belonging to the skin proper are further subdivisible, as Head has shown, into two kinds. One kind, the protopathic, yield sensations so suffused with disagree able affective tone (skin-pain) that they may for the present purpose be considered pain-nerves, and the description of their spinal connexions be relegated to the paragraph dealing with the spinal path for pain. The other kind, the epicritic, are those which react to tangible stimuli lightly applied, such as stroking the skin with a loose pledget of cotton wool or the light touching of the skin with a pin's head or a blunt pencil point. Deep touch, on the other hand, involves afferent nerve fibres supplied by nerve-trunks not classed as cutaneous, but probably largely muscular in the sense that they run to muscles and contain side by side the afferent fibres in question and the efferent nervefibres causing muscular contraction. Head has brought forward clear evidence that though the afferent fibres subserving the epicritic tactual sense of the skin and deep touch of subcutaneous origin run so separate a course in the peripheral nerves, the spinal fibres constituting the intraspinal headward-running paths from these two kinds of peripheral touch-fibres, the epicritic and the deep, to the brain, lie together and are implicated together by injuries of the spinal cord. In this sense there is, therefore, in the cord a tactual path. The question is, therefore, what course does this path follow in the cord ? In the first place it must be noted that the path contains a synapse for the peripheral neurone whether belonging to the epicritic tactual group or to the deep tactual group ends in the cord, probably not far, i.e. not more than four or five segments, from its place of entrance. The rest of the headward path must therefore run through one secondary neurone at least, it may be through a series of such arranged as a headward running line of relays. It is, however, more probable that one long secondary neurone reaching the bulb covers the whole of the remaining spinal part of the trajectory. The part of the headward-running path formed by the intraspinal part of the peripheral neurone (primary afferent neurone) lies certainly in the dorsal column of the cord of the same lateral half as the side from which the neurone entered, i.e. in the right dorsal column if the neurone entered by a spinal root of the right side. The secondary neurone continuing the path lies, however, in the ventral column of the crossed half of the cord. The junction or synapse between the primary and secondary neurone lies, of course, in the grey matter of the spinal cord.
The spinal path of impulses which when they reach the brain occasion pain has been determined chiefly in regard to pain referred to the skin. The primary afferent neurones bringing these impulses to the cord are the protopathic of Head mentioned above. These, there is much evidence to show, terminate in the grey matter of the cord not far from their point of entrance into the cord, that is, they terminate intraspinally nearer their point of entrance than do the corresponding primary afferent neurones for touch. From the local spinal grey matter the pain-path is continued headward in the lateral white columns of the cord by secondary afferent neurones. These secondary afferent neurones run chiefly in the lateral column of the opposite half of the cord from that which the primary afferent neurones entered; but some run up the lateral column of the same side as that by which the primary neurones entered. The synapse between the primary afferent neurone and the secondary afferent neurone of this path lies probably in the grey matter called substantia gelatinosa of the dorsal horn.
The spinal path taken by the impulses concerned with sensations of heat and cold seems to agree closely with that taken by the impulses subserving skin pain. The position of the nervefibres belonging to the secondary afferent neurones of the pain and temperature path has been fairly successfully identified with that of the spinal tract called Gowers' tract. The uncrossed portion of the temperature path appears, however, to be relatively smaller as compared with its crossed portion than is that of pain.
There is much evidence that impulses contributory to " muscular sense " pass headward along the spinal cord and in their course remain for the most part uncrossed. This course would in so far agree with the course taken by the intraspinal continuations of the primary afferent neurones which form the long fibres of the dorsal columns. These are known to run to the bulb without transgressing the median plane at all. In addition to this uncrossed tract there is another, namely, that offered by the dorsal cerebellar tract, a tract of secondary neurones connected through the grey matter of the vesicular column of Clarke with primary afferent neurones of the ipselateral side. Either or both of these uncrossed tracts may be the path taken by the impulses subserving muscular sense, and there is experimental evidence in favour of such a possibility, but the question cannot be considered as definitely answered at present.
Besides the paths followed by headward-running impulses the spinal cord contains paths for impulses passing along it backwards from the brain. These paths lie almost entirely in the ventrolateral columns of the cord. The fibres of which they are composed cross but little in the cord. Their sources are various, some come from the hind brain and some from the mid brain, and in the higher mammalia, especially in man and in the anthropoid apes, a large tract of fibres in the lateral column (the crossed pyramidal tract) comes from the cortex of the neopallium of the fore brain. This last tract is the main medium by which impulses initiated by electrical stimulation of the motor cortex reach the moto-neurones of the cord and through them influence the activity of the skeletal muscles. Of the function of the other tracts descending from the brain into the cord little is known except that mediately or immediately they excite or inhibit the spinal moto-neurones by various levels. How they harmonize one with another in their action or what their purpose in normal life may be is at present little more than conjecture. Such terms, therefore, as " paths for volition," &c., are at present too schematic in their basis to warrant their discussion here.