x THE FOKE-BKAIN 591 



they thought it an exaggeration to assume that destructive lesions 

 of the motor area are invariably accompanied by disturbance 

 of sensibility. In their final publication (1895), which gives a 

 very lucid summary of the results of clinical observations as a 

 whole, they came to the following conclusion : 



" Paralysis of cortical origin may be accompanied by disturbances 

 of cutaneous and muscular sensibility, but these sensory troubles 

 which are sometimes associated with the motor paralysis are in 

 no constant and inevitable relation with the lesions of the motor 

 zone. The cortical motor centres of the Eolandic area are not 

 therefore sensory-motor organs." 



Luciani and Seppilli (1885) concluded after a critical ex- 

 amination of 47 clinical cases that : " There is a vast area, 

 including the anterior part of the frontal, lobe, the temporal 

 lobe, and the occipital lobe, which is in no relation with 

 cutaneous and muscular sensibility. As disease of the posterior 

 parts of the three frontal, the two ascending or central convolu- 

 tions, the paracentral lobule and the two parietal gyri produces 

 disturbances of cutaneous and muscular sensibility, we rightly 

 ascribe a sensory function to them, and regard them as belonging 

 to the centre of cutaneous-muscular sensibility in man. As we 

 can see, this centre is more extensive than the so-called motor 

 area, since in addition to the Kolandic convolutions it also com- 

 prises the two parietals and the posterior portions of the three 

 frontal convolutions. 



" Disturbance of cutaneous sensibility may occur unaccompanied 

 by any alteration of muscular sensation. On the other hand, in 

 three of our cases there was disturbance of the muscle - sense 

 without paralysis of movement and with no alteration of cutaneous 

 sensibility, so that it seems as if in man the areas of the brain 

 surface, lesions of which produce alteration of movement and dis- 

 turbance of muscular and cutaneous sensibility, are not identical." 



Mills, too (1890-1901), asserted that many cases had been 

 published in which there were lesions of the motor area with no 

 disturbance of sensibility. In several cases of lesions of the cortex 

 of the Eolandic area after the surgical extirpation of tumours, 

 careful examination of the patient showed that sensibility was 

 intact. 



In his review of the whole clinical literature Schafer (1900) 

 stated that the cases of more or less circumscribed lesions in the 

 Eolandic area, in which sensibility was not disturbed, amounted 

 to 66 per cent. 



Von Monakow (1902) from his most recent observations con- 

 firmed the conclusion of Luciani and Seppilli. He states expressly 

 that lesions of the cortex of the precentral gyrus occasionally, but not 

 always, nor permanently, cause alterations of sensibility associated 

 with motor paralysis or paresis. On the other hand, he states 



