ME. J. L. CLAEKE ON THE INTIMATE STEUCTTJEE OF THE BEAIN. 
317 
apparently partial paralysis of the facial supplying the orbicularis oris. I have already 
shown that some of the roots, both of the spinal-accessory and vagus nerves, may be traced 
directly into the hypoglossal nucleus, and that, on the other hand, numerous nerve-cells 
of the hypoglossal nucleus, as may be seen in fig. 31, Plate X., send their processes deeply 
into the vagal nucleus. Moreover, we have seen in fig. 25, Plate X., just below the oli- 
vary body, that a small column of cells (K') mixed with numerous longitudinal fibres, 
ascends, and increases as it ascends to the facial nucleus. It is first situated between 
the spinal-accessory and hypoglossal nuclei, then between the latter nucleus and the 
vagus (H, fig. 38, Plate XI.), and higher up (fig. 39), where the hypoglossal nucleus 
ceases, it lies at the inner side of the glossopharyngeal (t) and inner auditory nucleus (i), 
with both of which it is connected, as well as with the motor nucleus of the trige- 
minus (U). Now it is not at all improbable that this column of cells (K') at fig. 26, Plate 
X., and a little higher up, is the channel of communication for that portion of the facial 
nerve which supplies the muscles about the lips and mouth. We know that this portion 
of the facial is frequently paralyzed alone, and must therefore be, to a certain extent, 
independent of the rest of the nerve ; and we also know how closely and frequently it is 
associated alone in function with the spinal-accessory and hypoglossal nerve in the opera- 
tions of articulation and vocalization. By now referring to fig. 2.5, Plate X. (which of 
course is considerably magnified*), it will be understood that in this section and in others 
a little higher up, a small spot of lesion — either a clot or a disintegration in the spinal- 
accessory nucleus (H) — would more or less paralyze the voice. A similar lesion in the 
hypoglossal nucleus (J) would paralyze one side of the tongue. One which destroyed 
K', would cut off the mouth and lips from co-operation with the voice and tongue ; and 
a lesion that injured, more or less, all three of these nuclei, which are in such close ap- 
position, would paralyze, more or less, at the same time, the voice, tongue, and lips. 
But of course when I state that the small column (K') is subservient to the movements 
of the muscles about the mouth in the co-ordinate movements of articulation, the state- 
ment is wholly conjectural, although probably true. 
(83) Now there is a form of disease which was first distinguished from ordinary facial 
paralysis, by Duchenne (de Boulogne), and which has been called by Trousseau “ Pa- 
ralysie Glosso-labio-pharyngee.” It consists of paralysis of the orbicular muscle of the 
lips, of the tongue, of the velum palati, and of some of the muscles of the larynx. The 
patient gradually loses all power of articulation ; he is unable to protrude the tongue ; 
deglutition becomes difficult ; the velum palati is insensible to the influence of different 
kinds) of stimulants ; the posterior nares can no longer be closed by the velum and mus- 
cles of the posterior palatine arch, so that the voice becomes nasal ; the mucous mem- 
brane of the larynx frequently becomes insensible to irritation, and fits of suffocation 
ensue. It is evident, therefore, that in this curious disease, the hypoglossal, the spinal- 
accessory, part of the vagus, and part of the facial, are together more or less injured. 
* I may here state that this figure is an almost photographically exact representation of all the parts of the 
preparation from which it was drawn. 
