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Ambrose L[oomis] Ranney.

The applied anatomy of the nervous system, being a study of this portion of the human body from a standpoint of its general interest and practical utility online

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The applied anatomy of
the nervous system

Ambrose Loomis Ranney



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THE



APPLIED ANATOMY



OP THE



NERVOUS SYSTEM,



BEING A STUDY OF THIS PORTION OF THE HUMAN BODY

FROM A STANDPOINT OF ITS GENERAL INTEREST AND

PRACTICAL UTILITY, DESIGNED FOR USE AS A

TEXT-BOOK AND A WORK OF REFERENCE,



BY
AMBROSE L. RANNEY, A. M., M. D.,

AXkJnrcT PBoncssoB ow anatomt and latk LBorrBm oif thb disbases of thb OBifiro-inKiNABT

OB6A1C8 AND OW MIKOB BUBGBBT IN THB MBDICAL DBPABTMBKT OF THB UKIVBBSITT OP

TBB crrr op nrw tqbk ; late scBeEoif to thb kobthern and nobtuwestbbx

DiePBNBABIES ; BBSIDBITT PBLLOW OP THB NBW YOBK ACADBMT OP IIBDI-

OIMB; MBMBBB op thb MBDIOAL SOCIBTT op thb COUKTT op NBW

TOBK; AUTUOB op a ^PBAOTICAL TBBATIBB on SITBOICAL

DIAOMOeiS," **TUB B88BNTIALS OP ANATOMY/' BIG.



WITH miMEROm ILLUSTRATIOXS,



** Tlie greBteet thinif * homan soul erer does in this world is to see something, and teU what he saw in
a plain way. Handrads of people ean Ulk for one that can think, but thousands can think lor one who
can s«e. To see dearly Is poetry, prophecy, and religion all In one.*'— John Suskin.



NEW YORK:
D. APPLETON AND COMPANY,

1, 8, kVD 6 BOND STREET.

1881.



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HARVARD MEDICAL LIBRARY

MTHE
FRANCIS A. COUNTWAY

UBRARY OF MEDICINE



coPTSioirr by
D. APPLETON AND COMPANY.

1881.



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TO

THE FACULTY
OF THE MEDICAL DEPARTMENT

OF THE

UNIVERSITY OF THE CITY OF NEW YORK,

TJNDEH THE GUIDANCE OF SOME OF WHOM

I PURSUED MY EABLY MEDICAL 8TCDIE8,

AND TO WHOSE INDU8TBY AND TALENT

IS DUE MUCH OF THE SUCCESS

WHICH HAS CROWNED THEIR EFFORTS AS INSTRUCTORS,

THIS VOLUME

IS RESPECTFULLY DEDICATED

BY THE AUTHOR.



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PEEFACE.



This volume comprises a course of lectures whicli were
delivered by me before the students of the Medical Depart-
ment of the University of the City of New York during
the winter of 1880 and 1881. They are presented to the
reading public, with few alterations, as they were originally
reported for some of the medical journals, and for the
private use of the author. The same colloquial style in
which they were delivered has been retained, since it is
believed that it will thus better fill the requirements of a
text-book. I am well aware that the highest type of lit-
erary composition is not of this conversational character,
and that it may be to some readers a drawback rather than
an attractive feature in the volume ; but the fact is also
recognized that the best style, theoretically, is not always
the clearest and the most forcible, and that successful
teachers have often to sacrifice beauty of rhetoric in order
to impart their knowledge.

I have departed somewhat from the custom of anatom-
ical authors in making diagrammatic illustrations — ^which
it is my habit to draw upon the black-board before my
classes, in order to make the listener use the eye as well as
the intelligence as a means of gaining information — a prom-



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vi PREFACE.

inent feature of this volume. I have found, for some years,
that the drawing of illustrations of this character before
the eyes of the student gave a much clearer perception
of some obscure points than words could effect, and had
a great advantage in this respect over the most elaborate
and skillfully executed plates. I have, therefore, incor-
porated many of my own designing, and some others which
have been culled from different sources and modified to
suit the demand of the moment I have, in some instances,
allowed the text to follow and explain these diagrams, as
if the lecture were in actual progress, rather than to trust
the descriptive text of the cuts alone to interpret their
meaning.

The liberality of the publishers has enabled me to fur-
ther ornament the work with the beautiful cuts of Sap-
pey and Hirschfeld, some of which, to my knowledge, have
never appeared in any American work, while I am indebted
to my friend Professor Austin Flint, Jr., for some, culled
from the same authors, which have appeared in his work
upon physiology, and to my colleague and friend Professor
William A. Hammond for some of the admirable photo-
graphs and woodcuts in his elaborate treatise on nervous
diseases. I desire also to express my indebtedness to my
friend Professor E. C. Seguin for some late monographs
and some excellent diagrams, and to the works of Charcot,
Ferri^r, Brown-S6quard, Rosenthal, Hammond, Foster, Hil-
ton, Flint, and others, as well as to the authors of such
valuable monographs as those of Tiirck, Hughlings-Jack-
son, Vulpian, Pitres, Duret, Dodds, Nothnagel, Duchenne,
Lockhart Clarke, Flechsig, and Erb, for the valuable as-
sistance which I have derived from their labors. It has
been my intention, as far as possible without disfiguring
the text, to give all credit to those authors who have a



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PREFACE. vii

just claim to priority, where the originality of any matter
is discussed, and to acknowledge my indebtedness to authora
for extracts in foot-notes scattered throughout the volume.

The rapid strides which are being made in the inter-
pretation of the symptoms of nervous diseases and the
introduction of many new terms which must embarrass the
reader of late treatises, unless he be educated up to the
present standard of knowledge in this field of medicine,
seem to the author a reasonable ground for belief that there
is a demand for a volume which shall fit the practitioner
and student to pursue his studies in this special line with-
out embarrassment, if not with increased interest.

I have endeavored not to lose sight of the fact that
the basis of the work was an anatomical one, and that,
while the clinical points could be explained chiefly by anat-
omy, the treatment of nervous diseases had no place in the
volume. For the reason, also, that the aim of the work
is of a practical character, much detail of a purely de-
scriptive kind has been deemed unimportant in some in-
stances ; while, again, facts which are too often slighted in
descriptive treatises have been here given with unusual
detail, as they seemed to me to suggest points of inter-
est which had been overlooked or intentionally omitted
by others.

It is not to be expected that many points stated in the
physiology, symptomatology, or even in the anatomy, will
not be open to discussion, and, possibly, to contradiction.
It is almost impossible, to-day, for any two disputants upon
nervous affections or nervous physiology to fail to find
support for either side in the literature of the subject;
but the statements which this volume contains will, it is
to be hoped, receive the concurrence of those most ad-
vanced in this line of study. .



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viii PREFACE.

With what merits or demerits the volume may possess,
I intrust it to the public, conscious that an effort to clear
up a field made obscure by visionary theories and endless
speculation can not but contain some ground to which ex-
ception may be taken. To what extent it will supply the
place of a guide in this — ^the labyrinth of medical science
— experience alone must decide.

Ambrose L. Ranney.

New York City, 156 Madison Avenue,
ApHl 10, 1881.



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TABLE OF CONTENTS.



GENERAL INTRODUCTION 1-16

The kebtous system considered as a whole.

Its component parts.

The general axioms of nerve distribution.



PART I.

THE BRAIN 16-92

Its anatomy, functions, and clinical aspects.
Its general construction.
Its weight, and that of its component parts.
Its rapidity of growth and alterations with age.
Its individual ganglia.
The cebebbum ....... 25-54

Its situation and construction.

Its converging and commissural fibebs.

Its general functions and special centers.

Centers of motion ; of speech ; of vision ; of hearing ; of touch ;
of smell ; of taste.
The frontal lobe.

Its functions ; motor centers ; white substance.
The motor area.

Parts of the cerebrum comprised within it : situation of the spe-
cial motor centers; diagnosis of cortical motor paralysis;
effects of irritative lesions of the motor area.
The sensory area.

Paints of the cerebrum comprised within it; effects of lesions
within it
The occipffal lobe.

Its relation to vision ; psychical functions.
The temporo-sphenoidal lobe.

Its relation to vision ; to ocular movements ; to hearing ; to ol-
factory sense ; to taste ; to tactile sensation.
The corpus striatum and optic thalamus . . . 54-58

Situation of the "basal ganglia."
Functions of the "basal ganglia."



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TABLE OF CONTENTS.



Functions op the caudate nucleus.
Functions of the lenticular nucleus.
The corpora quadrigemina ..... 58-59

Theib relation to vision.
Their relation to ocular movements.
Their relation to coordination of movement.
The crura cerebri and pons Varolii . . . 59-61

Their relation to coordination of muscular movement.
Their relation to crossed paralysis.
Their relation to the sensation of pain.
Their probable functions.
The cerebellum ...... 01-65

Its numerous connections.
Effects of lesions within its substance.
Cerebellar ataxia.
Its relation to hearing and sight.
The medulla oblongata ..... 65-68

Its relation to cranial nerves.
Its physiological centers:

Respiratory; salivary; vaso-motor; diabetic; cardio-inhibitory ;
for deglutition ; for vomiting ; for movements of (psophagus
and stomach ; for digestive secretions.
Its relations to coordination of movement.
The surgical bearings of cerebral topography . . 68-74

Guides to the fissure of Rolando.
Guides to the external parieto-occipital fissure.
Guides to the fissure of Sylvius.
Guides to the limits of the "basal ganglia."
Guides to the motor centers.
Guides to the center of speech.

Indications and contraindications for trephining of the skull.
The clinical significance of anaesthesia after an injury to the ^kull ;
of convulsive movements; of the Cheyne-Stokes respiration ;
of " choked disk " after an injury ; of vomiting after an
injury ; of aphasia alter an injury ; of monoplegia after an
injury.
General summary of the anatomy op the brain and

its clinical aspects .... 74-92

Summary of its gross anatomy.

The lobes of the brain.

The fissures of the braix.

The lobules of the brain.

The gtri of each lobe.

The clinical subdivisions of the brain.

Symptoms referable to the base of the cerebrum ; to the basal
ganglia ; to the white center of the hemispheres ; to the in-
ternal capsule ; to the cortex of the hemispheres ; to the cere-
bellum.



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TABLE OF CONTENTS. xi



SUMMABT OF THE PHT8I0L00Y OF THE CEBBBRAL OOBTEX AND THE
EFFECTS OF LESIONS INVOLVING IT.

The excitable portion (motor area) — its special centers and their
action; the frontal convolutions; the parietal convolutions;
the angular gyros (probable center of vision); the superior
temporo-sphenoidal gyrus (probable center of hearing) ; the
center of speech.
Clinical deductions of pbaotioal value.

Types of monoplegia and the special significance of each ; con-
vulsions of cerebral origin (Jacksonian epilepsy); embolism
of middle cerebral artery and its effects ; clinical significance
of late rigidity of paralyzed muscles ; general paralysis of the
insane ; lesions of the basal ganglia of the cerebrum : lesions
of the internal capsule of the cerebrum ; lesions of the white
center of the hemispheres.



PART 11.
THE CRANIAL NERVES 93-287

ThEIB anatomy, PHYSIOLOGY, AND CUNICAL VALUE.
EnUMEBATION, FBOM BEFOBE BACKWABD, AS THEY ESCAPE FBOM
THE CAVITY OF THE CBANIUM.

The olfactory neeve ..... 95-103

Its obigin and constbuction.
The PECuuABrriES of its filaments.
The limits of its distbibution.
The physiology of olfaction.
The act of sneezing.

Reflex acts dependent upon the olfactoby nebve.
Functions of olfactoby nebve in animals.
Relations of the sense of smell to that of taste.

CUNICAL points AFFOBDED BY THE OLFACTOBY NEBVE.

"Hyperosmia," its tests and causes; "anosmia," its tests and
causes.
The optic nerve ...... 103-127

The OPTIC tbacts, theib obigin and attachments.
The optic chiasm, its constbuction and physiology.
Distbibution of optic nebve.
Reflex acts excited by optic nebve.
Decussation of oi»tic fibers and its physiology.
Relations of the optic nerve in the orbit.
Anatomical defects of vision and theib consequences.

"Hyperopia," its tests, causes, and results; "myopia," its
tests causes, and results ; " astigmatism," its tests, causes, and
resuJts.
Changes obsebved in the pupil.

Dilatation, its causes and physiology ; contraction, its causes
and physiology.



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xii TABLE OF CONTENTS.

PAG 16

Visual sensations and theib modifications.

Mu8C8B volitantes; the '^ blind spot" of the retina; insensibil-
ity of the retina after firm pressure.
The perception of color.

Yisaal purple and its probable functions; rods and cones of
the retina ; Young-Helraholtz theory of color yision ; limits
of different color perceptions ; color blindness.
Apparent vision of objects not really seen.

Its causes.
Effects of optic nerve on coordination.

Goltz^s experiments.
Effects of optic nerve on the iachrtmal apparatus.

The act of winking the eyelid ; effect of closure of eyelid upon
the lachrymal canals.

CUNICAL POINTS AFFORDED BY THE OPTIC NERVE.

Hemianopsia, temporal, its causes; hemianopsia, nasal, its
causes; hemianopsia, bi-nasal, its causes; hemianopsia, bi-
temporal, its causes ; amaurosis ; hypersBsthesia of the optic
nerve ; amblyopia ; atrophy of optic nerve.
The motob oculi neeve ..... 127-149

Its ORIGIN, COURSE, AND DISTRIBUTION.

The PHYSIOLOGY of CONTRACTION OF THE PUPIL.

Physiological reasons for the distribution of the third nerve.

Mechanism of the dilatation of the pupil.

Movements of the eyeball.

Diagnostic attitudes of the head in ocular paresis.

cunical points pertaining to the third nerve.

Megalopsia or macropsia ; micropsia ; ptosis ; motor oculi pa-
ralysis ; strabismus. Diseases of the ocular muscles : nystag-
mus; iritic spasm; contracture; paralysis; tabetic condi-
tions; diplopia; strabismus.
The trochlear or pathetic nerve . . . 149-151

Its SUPERFICIAL AND DEEP POINTS OF ORIGIN.

Its course and relations within the cranium.
Its points of clinical interest.
The trigeminus nerve ..... 151-175

Its superficial and deep points of origin.
Course of its sensory and motor roots within the cranium.
Its afferent and efferent fibers.
The effects op section of the nerve.

On sensation ; on mastication ; on taste ; on hearing ; on sight ;
on smell.
Clinical points pertaining to the trigeminus nerve.

Neuralgia (tic-douloureux) ; spasm of the trigeminus; paralysis
of its individual branches.
Diagnostic value of the trigeminus nerve.

Bleaching of the hair ; immobility of temporo-maxillary joint ;
furring of the tongue ; ulceration of the cornea ; ulceration



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TABLE OF CONTENTS.



XIU



of the auditory canal ; earache ; pain in the scalp ; conjunc-
tival distribution.
Sdbgioal anatomy of its main bbanohes.

Section of the snpra-orbital nerve ; section of the supra-maxil-
lary nerve ; section of the inferior -dental nerve.
The ganglia connected with the tbigbminus nebve.

Ophthalmic, lenticular, or ciliary ; spheno-palatine or Meckel's ;
otic; sub-maxillary.
The abducens nerve (motor oculi externus) . . 175-177

Its superficial and deep points of origin.
Its relation with the ophthalmic ganglion.
Its gunioal belations.
The facial nerve ...... 177-198

Its supebficial and deep points of origin.
Its coubse and disteibution.
Phtsiology of its main branches.

Tlie petrosal nerves; the chorda tjrmpani nerve; the "pars
intermedia" of Wrisberg; the tympanic branch; the facial
branches ; the muscular branches.
Its communications with other parts.

Branches joining the fifth nerve; branch to the otic ganglion;
branch to MeckePs ganglion; sympathetic fibers; its rela-
tion to deglutition and speech; its relation to smell; its re-
lation to hearing ; its relation to respiration.
Its filaments of distribution.

Physiological relation to deglutition; physiological relation to
facial expression ; physiological relation to mastication.
Clinical points pebtainino to the nerve.

Spasm of the facial muscles. BelPs paralysis : intra-cranial va-
riety ; auditory variety ; rheumatic variety ; traumatic vari-
ety ; syphilitic variety ; diphtheritic variety ; facial diplegia.
The auditory nerve ..... 198-220

Its superficial and deep points of origin.

Anatomical structure and peculiarities of its filaments.

Its coubse and disteibution.

Functions of its vabious bbanohes.

The mechanism of audition.

External ear, its construction and functions ; middle eflr, its con-
struction and functions. Internal ear, its construction and
functions : the semicircular canals ; the vestibule. The coch-
lea : its scalsB ; organ of Corti ; membranes and ligaments.

CUNICAL POINTS PERTAINING TO THE NERVE.

Auditory vertigo — " Meniere's disease " ; injuries to the semi-
circular canals. Neuroses of the auditory nerve : acoustic
hyperaBsthesia ; acoustic ancesthesia.
The glosso-pharyngeal nerve .... 220-236
Its superficial and deep points of obigin.
Its oanguonio enlargements.



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XIV



TABLE OF CONTENTS.



Its corRSE and belatiotis.

Its effebent ob motob fibers.

Its afferent ob sensobt fibers.

Its fibers of taste.

Effects of section of the nerve.

On special sense of taste ; on deglutition.

Mechanism of the act of deglutition.

First period ; second period ; third period ; nerves involved ;
importance of soft palate ; the nerve center for the act.

Clinical points pertaining to the nerve.

Glosso-labio- laryngeal paralysis — Duchenne^s disease; hyper-
geusia; ageusia.
The pneumogastbic nerve ..... 236-259

Its superficial and deep points of origin.

Its intimate affiuation with the glossophabtngbal nbbve.

Its ganglionic enlabgements.

The inhebent fibebs of its tbtjne.

Its bbanches of distbibution and theib functions.

The pharyngeal branches: effects on deglutition; effects on
voice. The laryngeal branches: their relation to phona-
tion ; their relation to respiration ; their relation to spinal
accessory nerve. The branches to alimentary canal : their
relation to peristaltic action; their relation to secretion.
The cardiac branches: depressor nerve of heart's action;
effects of galvanism. Vaso-motor fibers: effects on blood-
vessels. The pulmonary branches : their relation to respi-
ration — acceleratory fibers ; inhibitory fibers.

The coubse and belations of the nebve on each side of

THE body —

"With carotid artery ; with jugular vein ; with oesophagus; with
the lungs ; with the abdominal viscera.
Effects of section of the pneumogastric trunk.

Upon the larynx ; upon the lungs; upon the heart. Upon the
digestive tract : stomach ; hver ; intestinal canal.
Clinical points pertaining to the nerve.

Pharyngeal anaesthesia ; pharyngeal spasm ; pharyngeal paral-
ysis; laryngeal spasm (Kopp's asthma); whooping cough;
aneurismal cough ; pulmonary asthma ; pulmonary vaso-mo-
tor paralysis ; angina pectoris ; cardiac neuralgia ; gastrody-
nia ; boulimia ; polydipsia ; dyspeptic vomiting ; polyphagia.
The spinal accessory nebve .... 259-272

Its superficial and deep points of origin.
Its course and distribution.
Its filaments of communication.
Its relations to the production op voice.
The effects of section of the nerve —

On phonation ; on respiration ; on deglutition ; on the action
of the heart ; on singing.



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TABLE OF CONTENTS.



XV



Clikioal points pbrtainino to thb mertb.

Tonic spasm of sterno-mastoid mnscle ; tonio spasm of trape-
zius; clonic spasm of sterno-mastoid and trapezius mus-
cles ; salaam convulsion of Newnham ; unilateral paralysis
of sterno-mastoid and trapezius muscles ; bilateral paralysis
of sterno-mastoid and trapezius muscles.
The hypo-glossal nebve (sub-lingual nerve) .
Its supbbficial axd deep points of origin.
Its coubse and distribution.
The desgendens noni branch.

Functions of the nerve : on deglutition ; on articulation.

CUNIOAL POINTS PERTAINING TO THE NERVE.

Duchenne^s disease : abnormalities of speech ; abnormalities of
voice ; impairment of deglutition ; facial deformity ; lingual
tremor. Lingual spasm : lingual paralysb.



272-286



PART in.

THE SPINAL CORD ......

Its ANATOMICAL CONSTRUCTION, PCN0TI0N8, AND CUNICAL BEAB-
INGS.

Its cervical and lumbar enlargements.

Its fissures and columns.

Its nerves (their roots and general construction).

Its membranes and the gerebro-spinal fluid.

Their functions and situation.
Appearance of a transverse section of the cord.

Its gray matter; its white matter; its central canal; its
comminsures. Pathological subdivisions of the cord: col-
umns of Goll ; columns of Burdach ; columns of Tttrck ;
fundamental columns ; direct pyramidal columns ; anterior
root zones; posterior root zones; crossed pyramidal col-
umns; direct cerebellar columns.
Functions of the spinal cord.
(i) Organ of conduction.

Paths of motor impulses; paths of sensory impulses;



Online LibraryAmbrose L[oomis] RanneyThe applied anatomy of the nervous system, being a study of this portion of the human body from a standpoint of its general interest and practical utility → online text (page 1 of 43)