SUGGESTIVE CASE OF NERVE-ANASTOMOSIS. 3*5 



old mechanism thrown out of its accustomed use, may have made 

 ready another center and new tracts for the same use. 



This hypothesis leads pretty directly to another which seems to be 

 demanded by some of the facts of the case under examination. A 

 more and more highly differentiated volitional control was obtained 

 over the facial muscles; the stimulus of the various emotions, with- 

 out the accompaniment of volition, met with a better response; and 

 the sight of the condition of the facial muscles as afforded by a mirror 

 was of help in gaining this increased control. All this experience 

 would seem to prove beyond doubt that the higher cortical centers 

 concerned in conscious volition, in emotion and in the perceptions of 

 sight had somehow established the necessary new connections with the 

 center, lower down, in control of the N". accessorius. In a word, 

 whereas formerty, when the accessory nerve was only concerned in 

 helping to lift the arm and shrug the shoulder, these volitional emo- 

 tional, and visual centers, had paid little or no attention to their in- 

 fluence over the cortical center of this nerve, now that this center and 

 this nerve were being called upon for unaccustomed and more elaborate 

 functions, they found out a way to get into connection, and to bring 

 the new apparatus under their control. But thase volitional, emo- 

 tional and visual centers are widely spread over the cortical area. 

 About their special connections with one another, and especially with 

 the center of the accessory nerve, under normal conditions, we are 

 much in the dark. And how they could go to work to solve, in any 

 length of time and even partially, the problem of readjusting their 

 functional relations to the new and abnormal conditions, offers a 

 problem as yet quite unanswerable by cerebral physiology. 



There is one other assumption which would seem to be at once 

 more simple, more sure, and more effective in explanation, than either 

 of those hitherto made. What was the old cortical center for the 

 control of the muscles of the face through the X. facialis doing all 

 this time? We can scarcely suppose it to have been entirely idle or 

 resting in indifference to the functions of which it had been so sud- 

 denly and rudely dispossessed. Indeed, it is as certain as anything 

 about such matters can be that the cortical center of the facial nerve 

 would not be allowed to rest. The fifth pair of nerves, whose function 

 is to transmit the sensory impulses from the facial areas, was unim- 

 paired; and since the discomfort from increased lachrymation, saliva 

 and gathering food in the flaccid cheek was very great, this cortical 

 center must have been perpetually sharply reminded of its neglect of 

 duty. Moreover, every time the faradaic current was applied to the 

 cheek, and the patient tried to get control over the facial muscles, 

 helping himself meanwhile by looking in the mirror, there was un- 

 doubtedly a very excessive demand for activity made upon this now 



