Freiburger historische Bestände - digital

There are two characteristical peculiarities by which this
quite important degree of compression is distinguished. —
First, — when the motory centres are compressed, it gives
origin to a number of morbid phenomena which were, clini
cally known for a very long time, their internal connexion,
however, has only been cleared by the experiments of
compression. These phenomena which I have designated by
the name of »phenomena of compression«, are: Spasms
(hemiclonus); tensions (hemispasmus); paralyses (hemiplegia)
and trembling movements on the side of the body opposite
to the compressed cerebral hemisphere.

Secondly, the phenomena which are proper to the second
degree of compression can be suppressed by the removal of
the pressure by which they are produced.

Surgery has with a great zeal taken possession of the
fact of the curability of my »compression phenomena«, and in
the otherwise dark territory of the cerebral pathology it has
found a well circumscribed area for its successful inter-
ference.

Indeed, there were already many cases on record in
which the surgeons have succeeded in causing »compression-
phenomena« to disappear by removing the tumours which
were compressing the brain.

In the interest of suffering mankind it is to be desired
that such Operations might continually be carried out on a
larger scale and with increasing success.

For this purpose, however, two conditions were ne-
cessary, the correct diagnosis of the compression-pheno-
mena« — and the exact appreciation and fixation of the
spot in the skull over which surgical Operation should be
undertaken and the compressing tumour removed.

As to the first point only a rieh clinical experience
and a critical analysis of the observed morbid phenomena
can help to the aim.

Minute knowledo-e exists as to the localisation of the
brain on the living subject, but this is not proper for prompt
and precise information, so that the surgeon is obliged in
the critical moment to guide himself by chance.

To meet these requirements I have devised the tables
under consideration.

The tables show the brain of the full-orown man in
its natural size and in its normal position.

It is to be seen from four sides:

On the table I from the frontal side (frontal-view).

» » » II from the temporal side (temporal-

view).

» » » III from the occipital side (occipital-

view, the head being slightly bent
forwards).

» » » IV from the parietal-side (sagittal-view).

An exact localisation of the cerebral surface could, in
the best way, be obtained over the very skull when, over
the projection-image of the same a quite natural drawing of
a skull could be made which, besides all anatomical cletails

would also possess the particular property of being transparent
. The required spots over the surface of the brain could
then be seen to look through the corresponding and well
characterized parts of the skull.

This might be attained, if a cap of glass was adapted
to the brain to be projected, which would represent in any
detail an exact and quite natural imitation of the skull.

It is, impossible to manufacture such a cap and a
good painter could not, of course, paint an object which
does not exist.

I could however, obtain the conviction that it was not
necessary to imitate the whole skull in order to be able to
localize the cerebral surface over it.

It was, sufficient for this purpose to draw over the pro-
jected brain certain fixe lines which can be controlled
in the living human subject, and by means of such an
image to trace with great exaetness over the skull of the
living human subject.

These lines are the cranial sutures. I could ascertain
that these could be quite distinctly feit in man through the
skin of the head.

When these lines were transferred to the projected
brain — and I did this by placing the skull over the brain
which had served for the drawing, and over the drawing
just now referred to, I had the lines of the skull projected
with mathematical exaetness, and thus six areas were obtained
over its surface which were seperated from each other
by the four cranial sutures, the frontal, sapittal, occipal and
temporal sutures.

Within these areas the localisation was, of course, six
times as exact as without the sutures. Within the cranial
sutures, however, the localisation could be traced still more
exactly, even with absolute certainty.

By the mathematical exaetness of the tables under
consideration one is able to find any corresponding part of
the brain by measure and circle. To facilitate such a localisation
I have markeel the cerebral convolutions and the
sulei of the brain with types of different colours, and, in an
extra-page I have given a short explanation of these types.

A look on the image of the brain and the tables
under consideration is sufficient to give anyone in a few
seconds — an exact idea of the importance of any part of
the skull — and thus it becomes possible — by the aid of
these tables — not only to find any area of the cerebral
surface through the skull, but also — to determine on any
piece of the skull the corresponding segment of the cerebral
surface with the greatest exaetness.

I do not wish to dwell here upon the importance which
a rapid and exact localisation over the skull must have for
| the physician and particularly for the surgeon. I wish only to add
that any increase of our knowledge of the brain represents
a valuable contribution to science, and that it must have an
interest not only for the anatomist, the physiologist and the
| physician but also for the psychologist as well as any edu-
cated man —- to know in which part of his skull the various
j psychical funetions have their seat, which — as was known
— have their material seat in the cerebral cortex.

VIENNA, January 1892.

THE AUTHOR.