CONTRA CTURE. 7 3 1 



if a lesion be confined to a part of the cortex which is purely motor, 

 there would be produced indirectly but at no long interval of time both 

 functional and organic changes in parts which are purely sensory, and 

 the extent to which these would be perceptible would probably depend 

 largely upon the extent of the lesion in the motor region. 



Eedlich 1 has collected and analysed 132 cases of cerebral hemiplegia, 

 with especial reference to the question of the condition of the muscular 

 sense. In only twenty-eight out of the 132 was there any clear de- 

 ficiency, and in all these there was defective general sensibility as well, 

 although not always proportional to the defect of muscular sensibility. 

 The large number of cases in which no defect of muscular sense can be 

 determined, speaks strongly against the idea that cerebral hemiplegia is 

 merely due to loss of that sense. 2 



Contracture. — There sometimes results after removal of the motor 

 centres of the limbs in the monkey, and after lesions of the correspond- 

 ing part of the brain in man, a condition of permanent contraction of 

 some of the muscles, to which the term " contracture " has been applied. 

 It is not found in other animals besides monkeys, and not always in 

 these, being most frequently met with in those animals which are kept 

 closely confined. According to H. Munk, 3 contractures are of two 

 kinds, namely — (1) those due to irritation of the cortical substance as 

 the result of injury with incomplete removal — these are rare ; and 

 (2) those which occur after complete removal, and which are associated 

 with the complete disuse of the limb. The condition appears to be due 

 to the existence of a state of hypertonicity in the muscles affected, and 

 has been compared by Soury 4 to that which obtains in the congenital 

 malady known as Thomsen's disease, in which the voluntary movements 

 are characterised by prolonged tonic contractions of the muscles, the 

 cause of the disease being in all probability due to some defect of the 

 cells of the cortex. 5 But, on the other hand, the hypertonicity may be 

 due to a totally different cause, namely, the cutting off from the lower 

 centres of the inhibitory impulses which they habitually receive from 

 the cortex cerebri, while excitatory impulses which reach them from the 

 cerebellum are still passing. Hence also it is found in man (and to a 

 less degree in the monkey), that whereas in hemiplegia due to cerebral 

 lesions, both contracture and exaggeration of spinal reflexes is liable 

 to occur, in total transverse lesions of the spinal cord contracture 

 never occurs, and the spinal reflexes are diminished or altogether 

 abolished. 6 



1 Wien. klin. Wchnschr., 1893, Nos. 24-30. 



2 Legroux and de Bran, loc. cit., and Brain, London, 1885, vol. viii. p. 554, classify 

 the disorders of sensation met with in cerebral hemiplegia into five groups — (1) Sensation 

 unaffected, the paralysis purely motor ; (2) anesthesia affects the whole side ; (3) 

 anesthesia is absolute in one extreme segment of a limb, less in the middle segment, and 

 still less in the other extreme segment (c.;/. absolute in foot or thigh, less in leg, still 

 less in thigh or foot) ; (4) external (lateral) half of a limb, normal sensation, mesial half 

 antesthetic ; (5) anaesthesia is in patches, which may shift from day to day. They find 

 that the anesthesia, when it occurs, has no constant relation either of time or place to the 

 motor paralysis, and are inclined to refer it to alterations in the cerebral circulation. 



• ! Verhandl. d. physiol. Gesellsch. zuBerlinia Arch. f. Physiol., Leipzig, 1895. 



4 Article "Cervean," in Richct's " Dictionnaire de physiologic," Paris, 1897, tome ii. 

 p. 891. J h 



"Thomson, Arch./. Psychiat., Berlin, 1879; ibid., 1892, Bd. xxiv. S. 918. 



'' That this is the true explanation of many of these phenomena was first shown by 

 Bastian (Med.-Chir. Trans., London, 1890, ' p. 151). See further on this subject, 

 Brims, Arch. f. Psychiat., Berlin, 1893, Bd. xxv. S. 759 (literature); and in Kevrol. 

 C'ciUralbL, Leipzig, 1897, S. 72. 



