Fig. 2), i.e. a brain containing only the fissures present in every brain of. posterior composite convolutions, cannot be represented.

Transcription

1 310 E. KLEN. REPORT ON THE PARTS DESTROYED ON THE LEFT SDE OF THE BRAN OF THE DOG OPERATED ON BY PROF. GOLTZ. BY E. KLEN, M.D., F.R.S. Plate X. THE injury on the left side of the brain, as it presents itself on the dorsal aspect of this latter, appears of a smaller extent than it actually is. This is due to the fact, that part of the brain belonging to the mesial aspect and also to a certain extent that belonging to the lower and posterior aspect are by the cicatrix drawn towards the dorsal aspect of the brain. This fact comes out strikingly on vertical and sagittal sections through the injured parts, although in the dorsal aspect of the brain of Prof. Goltz's dog it is not conspicuous. Thus for instance in the dorsal aspect the area of injury to the superior convolution appears less in extent than is shown by vertical sections; these latter show, that part of the mesial aspect of this convolution, i.e. the splenial convolution', is altogether displaced, i.e. drawn towards the dorsal surface of the brain. The same is the case with the posterior composite, and also-but to a less degree-with the lateral lower aspect, i.e. the inferior and sylvian convolutions. n the diagram 1 the outline of the injury is represented in the same extent as was mentioned in the preliminary Report published in Vol. i. p. 24 of the Transactions of the nternat. Med. Congress of London, And it will be understood that this does not actually embrace the whole extent of the injury, the outline being drawn on the dorsal aspect of a normal brain whereas it ought to be drawn on a brain in which the displacement of the splenial and posterior composite convolutions is marked. This of course could not be done since the unaltered dorsal aspect of this particular brain, i.e. with displaced splenial and posterior composite convolutions, cannot be represented. Following my friend Mr Langley's plan and taking as an ideal model the dorsal surface of a normal typical brain (see Langley, p. 293, Fig. 2), i.e. a brain containing only the fissures present in every brain of dog, and tracing the outline of the injury on the left side of Prof. Goltz's dog, in its apparent extent, we obtain the diagram 1. The outline (vertically striated) starts a little behind the crucial sulcus (cr), passes backwards across the anterior end of what appears to 1 n the nomenclature of the fissures and convolutions, shall followv Mr Langley's exhaustive description, as published in the preceding part of this report.

2 LEFT BRAN OF DOG OPERATED ON. 311 be the ansate fissure (an), intersects the lateral fissure (lat) and under a very oblique angle crosses the posterior end of the ento-lateral fissure (en. 1) and having reached the mesial end of the posterior margin of the hemisphere curves round this latter. t then takes a forward course s.or OR.\ a. s.s. ft syl rj-- X,iat.. 2' pr. prorean. s. or. supra-orbital. cr. crucial. cor. coronal. an. ansate. OR. Orbital. PR. Prorean. A. s. G. Anterior sygmoid gyrus. P. s. G. Posterior sygmoid gyrus. A. c. Anterior composite. c. o. Coronal. A. E. s. Anterior ecto-sylvian. M. E. s. Middle ecto-sylvian. P. E. s. Posterior ecto-sylvian. PR. V. Fissures: a. 8. s. anterior supra-sylvian. p. s. s. posterior supra-sylvian. a. e. s. anterior ecto-sylvian. p. e. s. posterior ecto-sylvian. syl. sylvian. lat. lateral. e. 1. ecto-lateral. p. 1. post-lateral. en. 1. ento-lateral. Convolutions: A. s. Anterior sylvian. P. a. Posterior sylvian. M. Middle convolution. P. s. s. Posterior supra-sylvian. E. L. Ecto-lateral. En. L. Ento-lateral. s. sp. Supra-splenial. P. sp. Post-splenial. 23

3 312 crossing the ecto-lateral (e. 1) and the posterior supra-sylvian (p. s. s) fissure. t then runs, still keeping a forward direction, across the posterior ecto-sylvian fissure (p. e. s), and just touches the dorsal end of the sylvian fissure (syl). Crossing then the anterior ecto-sylvian fissure (a. e. s) it turns in an oblique direction mesially across the anterior supra-sylvian (a. s. s) and the coronal fissure (cor) and finally joins the place of starting. Thus it is seen that the following convolutions appear involved in the injury: The middle part of the posterior sigmoid gyrus (P. s. G); of the fourth or superior convolution it comprises the greater part of the entolateral (EN. L), the greater portion of the posterior part of the postsplenial (P. s); of the third or middle convolution it comprises the whole of the ecto-lateral (E. L) and almost the whole of the posterior suprasylvian (P. s. s), and the posterior part of the coronal (COR); of the second or inferior convolution it involves the mesial portion of the posterior ecto-sylvian (P. E. s) the whole of the median ecto-sylvian (M. E. s) and a good bit of the anterior ecto-sylvian (A. E. S); of the first or sylvian convolution it involves a small mesial portion of both the anterior (A. s) and posterior (P. s) sylvian. n addition to these convolutions, as it appears from vertical sections, the injury comprises part of the supra-splenial as well as the dorsal part of the posterior composite convolution. n diagram 1 inside and parallel with the striated line representing the extent of the injury as just described is seen a double-dotted line, this is the outline of a thick cicatrical membrane covering, but not extending completely to the outline of the defect. This is better shown in vertical sections, see Plate X. Figs. 1, 2, 3 and 4. Vertical E. KLEN. Transverse Sections. shall describe now the appearances presented in transverse sections through the injury and adjoining parts in four different regions, and shall preface this by saying that microscopical examination of the structural details of the adjoining parts, i. e. the convolutions left, is very incormplete owing to the unsatisfactory condition of the brain, the repeated, handling of the brain by photographers and wood-engravers (in their attempt to give a representation of the brain while still fresh or imperfectly hardened, and afterwards the very prolonged hardening) has no doubt greatly interfered with the preservation of the struictuiral elements.

4 LEFT BRAV OF DOG OPERATED ON. 313 Making vertical transverse sections through the regions of the brain at 1, 2, 3 and 4 of diagrami 1, and looking at these sections under a very low power, the following conditions are noticed: Section 1 (Plate X. Fig. 1). The surface of the injured part is covered with a thick fibrous membrane (m), underneath this are seen almost vertical trabeculae of fibrous tissue (c) radiating towards the depth, where they bound a few large cavities (e). These fibrous trabeculae include numbers of round cells, and are continued into the white matter beneath. Numerous large blood-vessels are met with in this part and they can be traced into the surrounding white matter. But not the entire parts covered by the superficial membrane (in) are replaced by cicatrical tissue, since corresponding-to its mesial and lateral margin we notice masses of grey brain matter left (P. s. G) being evidently part of the grey matter of the posterior sigmnoid gyrus in the depth of the coronal sulcus, while on the other side cor being evidently part of the coronal convolution bounding the coronal sulcus. These two masses of grey matter, as far as from the unsatisfactory condition of the brain can be made out, contain neuroglia and numerous nerve cells and do not appear of different structure from the other intact convolutions. At the lateral side of the superficial membrane (mn) we see that the white matter appears exposed to the surface; on careful examination it is ascertained that this is also cicatrical tissue, dense fibrous tissue continued into the depth into the white substance. Beyond this, i.e. laterally, we see that part of coronal convolution bouniding the anterior supra-sylvian sulcus is left intact. Summing up, we have then here loss of the superficial part of the posterior sigmoid gyrus, a deep portion beinig left intact; loss of the superficial part of the coronal convolution. The cicatrical tissue (c) would thus really occupy the place of the coronal sulcus. The white matter bounding the lesion, that is to say the superficial strands of white matter belonging to the posterior sigmoid gyrus and to the coronal convoluition, show distinct sclerosis, their tissue being chiefly dense neuroglia with numerous round cells, but rno nerve fibres can be made out in them. As regards the intact convolutions no alteration is perceptible. Section 2 (Fig. 2). On the surface of the injured parts we find here the same cicatrical membrane (m) as in Section 1, it does not cover the whole defect, since a good bit of the adjoining parts right and left, although probably not directly injured by the operation, is degenerated. Thus we see that the part of the ento-lateral convolution next to the 23-2

5 314 E. KLEN. ento-lateral fissure (not seen) is occupied by sclerosed tissue marked dark like the white substance. Almost the whole of the grey matter of this ento-lateral convolution is wanting, except a very minute bit left at the bottom of the ento-lateral sulcus. Of the middle convolution the superficial grey matter is absent, but a good bit is left in the depth of the ento-lateral fissure. Of the middle ecto-sylvian and anterior sylvian convolutions the whole of the grey matter is absent, except the very smallest bit in the depth of the anterior supra-sylvian fissure. The other convolutions appear intact. The white substance next to the injured parts appears all sclerosed, only dense neuroglia with numerous round cells but no nerve fibres being present. This is the case in the superficial strands of white matter belonging to the ento-lateral and middle convolutions as well as of that belonging to the middle and anterior ecto-sylvian convolutions. Section 3. The surface of the injury is covered with the same cicatrical membrane (m) as before, but much thicker and very firmly adhering to the parts beneath. The convoluitions that are destroyed are part of the supra-splenial, the whole of the ento-lateral, ecto-lateral, posterior supra-sylvian and part of the posterior ecto-sylvian. Of this latter convolution the deep portion of the grey matter next to the posterior supra-sylvian fissure is left. As is seen in the Figure (3) the mesial part of the supra-splenial convolution (s. sp) belongs almost to the dorsal aspect of the brain, and the same is the case with the posterior composite convolution (P. c), these parts being drawn towards the surface. The inflammatory membrane (mn) does not cover on the mesial aspect the whole of the injury, whereas at the ventral it extends beyond it. The white matter immediately underneath the injury is sclerosed but that bounding the lateral ventricle appears unaltered. Section 4. The cicatrical membrane (m) does not cover entirely the injured parts, since both mesially and ventrally a small bit of the defect appears uncovered by it. The injury extends from the mesial aspect of the supra-splenial convolution to the most lateral portion of the ecto-lateral convolution, it includes consequently the whole of the grey matter of the post-splenial, and the greater part of the grey matter of the ecto-lateral convolution, except a very small bit left in the depth of the posterior supra-sylvian fissure. Also here the part of the white matter immediately underneath the defect is sclerosed. Suich is also the case with the superficial parts uncovered by the mesial and lateral end of the cicatrical membrane.

6 LEFT BRAN OF DOG OPERATED O 31 n all these four figures representing transverse sections the grey matter is slightly shaded, whereas the white matter, both the degenerated (sclerosed) and unaltered, is marked by a deep uniform tint. The ependyma of the lateral ventricle and its lining epithelium appears well preserved, but in the descending cornu there is a dense infiltration with round cells and this tissue can be also traced between the thalamus opticus and the white matter of the crusta. As regards the structure and aspect of the cerebral ganglia, as far as it is possible to ascertain in this left half of the brain, nothing abnormal can be made out, if compared with a normal brain similarly prepared.

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