The Principles of Psychology, Volume 1 · William James
THE LOCALIZATION OF FUNCTIONS IN THE HEMISPHERES.
_In man_ we have more exact results, since we are not driven to interpret the vision from the outward conduct. On the other hand, however, we cannot vivisect, but must wait for pathological lesions to turn up. The pathologists who have discussed these (the literature is tedious _ad libitum_) conclude that the occipital lobes are the indispensable part for vision in man. Hemiopic disturbance in both eyes comes from lesion of either one of them, and total blindness, sensorial as well as psychic, from destruction of both. Hemiopia may also result from lesion in other parts, especially the neighboring angular and supra-marginal gyri, and it may accompany extensive injury in the motor region of the cortex. In these cases it seems probable that it is due to an _actio in distans_, probably to the interruption of fibres proceeding from the occipital lobe. There seem to be a few cases on record where there was injury to the occipital lobes without visual defect. Ferrier has collected as many as possible to prove his localization in the angular gyrus.[23] A strict application of logical principles would make one of these cases outweigh one hundred contrary ones. And yet, remembering how imperfect observations may be, and how individual brains may vary, it would certainly be rash for their sake to throw away the enormous amount of positive evidence for the occipital lobes. Individual variability is always a _possible_ explanation of an anomalous case. There is no more prominent anatomical fact than that of the 'decussation of the pyramids,' nor any more usual pathological fact than its consequence, that left-handed hemorrhages into the motor region produce right-handed paralyses. And yet the decussation is variable in amount, and seems sometimes to be absent altogether.[24] If, in such a case as this last, the left brain were to become the seat of apoplexy, the left and not the right half of the body would be the one to suffer paralysis.
The _schema_ below [Fig. 15], copied from Dr. Seguin, expresses, on the whole, the probable truth about the regions concerned in vision. Not the entire occipital lobes, but the so-called cunei, and the first convolutions, are the cortical parts most intimately concerned. Nothnagel agrees with Seguin in this limitation of the essential tracts.[25] * * * * * A most interesting effect of cortical disorder is _mental blindness_. This consists not so much in insensibility to optical impressions, as in _inability to understand them_. Psychologically it is interpretable as _loss of associations_ between optical sensations and what they signify; and any interruption of the paths between the optic centres and the centres for other ideas ought to bring it about. Thus, printed letters of the alphabet, or words, signify certain sounds and certain articulatory movements. If the connection between the articulating or auditory centres, on the one hand, and the visual centres on the other, be ruptured we ought _a priori_ to expect that the sight of words would fail to awaken the idea of their sound, or the movement for pronouncing them. We ought, in short, to have _alexia_, or inability to read: and this is just what we do have in many cases of extensive injury about the fronto-temporal regions, as a complication of _aphasic_ disease. Nothnagel suggests that whilst the _cuneus_ is the seat of optical _sensations_, the other parts of the occipital lobe may be the field of optical _memories and ideas_, from the loss of which mental blindness should ensue.
In fact, all the medical authors speak of mental blindness as if it must consist in the loss of visual images from the memory. It seems to me, however, that this is a psychological misapprehension. A man whose power of visual imagination has decayed (no unusual phenomenon in its lighter grades) is not mentally blind in the least, for he recognizes perfectly all that he sees. On the other hand, he _may_ be mentally blind, with his optical imagination well preserved; as in the interesting case published by Wilbrand in 1887.[26] In the still more interesting case of mental blindness recently published by Lissauer,[27] though the patient made the most ludicrous mistakes, calling for instance a clothes-brush a pair of spectacles, an umbrella a plant with flowers, an apple a portrait of a lady, etc. etc., he seemed, according to the reporter, to have his mental images fairly well preserved. It is in fact the momentary loss of our _non_-optical images which makes us mentally blind, just as it is that of our _non_-auditory images which makes us mentally deaf. I am mentally deaf if, _hearing_ a bell, I can't recall how it _looks_; and mentally blind if, _seeing_ it, I can't recall its _sound or its name_.
As a matter of fact, I should have to be not merely mentally blind, but stone-blind, if all my visual images were lost. For although I am blind to the right half of the field of view if my left occipital region is injured, and to the left half if my right region is injured, such hemianopsia does not deprive me of visual _images_, experience seeming to show that the unaffected hemisphere is always sufficient for production of these. To abolish them entirely I should have to be deprived of both occipital lobes, and that would deprive me not only of my inward images of sight, but of my sight altogether.[28] Recent pathological annals seem to offer a few such cases.[29] Meanwhile there are a number of cases of mental blindness, especially for written language, coupled with hemianopsia, usually of the rightward field of view. These are all explicable by the breaking down, through disease, of the _connecting tracts_ between the occipital lobes and other parts of the brain, especially those which go to the centres for speech in the frontal and temporal regions of the left hemisphere. They are to be classed among disturbances of _conduction_ or of _association_; and nowhere can I find any fact which should force us to believe that optical images need[30] be lost in mental blindness, or that the cerebral centres for such images are locally distinct from those for direct sensations from the eyes.[31]
Where an object fails to be recognized by sight, it often happens that the patient will recognize and name it as soon as he touches it with his hand. This shows in an interesting way how numerous the associative paths are which all end by running out of the brain through the channel of speech. The hand-path is open, though the eye-path be closed. When mental blindness is most complete, neither sight, touch, nor sound avails to steer the patient, and a sort of dementia which has been called _asymbolia_ or _apraxia_ is the result. The commonest articles are not understood. The patient will put his breeches on one shoulder and his hat upon the other, will bite into the soap and lay his shoes on the table, or take his food into his hand and throw it down again, not knowing what to do with it, etc. Such disorder can only come from extensive brain-injury.[32] The _method of degeneration_ corroborates the other evidence localizing the tracts of vision. In young animals one gets secondary degeneration of the occipital regions from destroying an eyeball, and, _vice versâ_, degeneration of the optic nerves from destroying the occipital regions. The corpora geniculata, thalami, and subcortical fibres leading to the occipital lobes are also found atrophied in these cases. The phenomena are not uniform, but are indisputable;[33] so that, taking all lines of evidence together, the special connection of vision with the occipital lobes is perfectly made out. It should be added, that the occipital lobes have frequently been found shrunken in cases of inveterate blindness in man.
_Hearing._ Hearing is hardly as definitely localized as sight. _In the dog_, Luciani's diagram will show the regions which directly or indirectly affect it for the worse when injured. As with sight, one-sided lesions produce symptoms on both sides. The mixture of black dots and gray dots in the diagram is meant to represent this mixture of 'crossed' and 'uncrossed' connections, though of course no topographical exactitude is aimed at. Of all the region, the temporal lobe is the most important part; yet permanent absolute deafness did not result in a dog of Luciani's, even from bilateral destruction of both temporal lobes in their entirety.[34] _In the monkey_, Ferrier and Yeo once found permanent deafness to follow destruction of the upper temporal convolution (the one just below the fissure of Sylvius in Fig. 6) on both sides. Brown and Schaefer found, on the contrary, that in several monkeys this operation failed to noticeably affect the hearing. In one animal, indeed, both entire temporal lobes were destroyed. After a week or two of depression of the mental faculties this beast recovered and became one of the brightest monkeys possible, domineering over all his mates, and admitted by all who saw him to have all his senses, including hearing, 'perfectly acute.'[35] Terrible recriminations have, as usual, ensued between the investigators, Ferrier denying that Brown and Schaefer's ablations were complete,[36] Schaefer that Ferrier's monkey was really deaf.[37] In this unsatisfactory condition the subject must be left, although there seems no reason to doubt that Brown and Schaefer's observation is the more important of the two.
_In man_ the temporal lobe is unquestionably the seat of the hearing function, and the superior convolution adjacent to the sylvian fissure is its most important part. The phenomena of aphasia show this. We studied motor aphasia a few pages back; we must now consider _sensory aphasia_. Our knowledge of this disease has had three stages: we may talk of the period of Broca, the period of Wernicke, and the period of Charcot. What Broca's discovery was we have seen. Wernicke was the first to discriminate those cases in which the patient can _not even understand_ speech from those in which he can understand, only not talk; and to ascribe the former condition to lesion of the temporal lobe.[38] The condition in question is _word-deafness_, and the disease is _auditory aphasia_. The latest statistical survey of the subject is that by Dr. Allen Starr.[39] In the seven cases of _pure_ word-deafness which he has collected, cases in which the patient could read, talk, and write, but not understand what was said to him, the lesion was limited to the first and second temporal convolutions in their posterior two thirds. The lesion (in right-handed, i.e. left-brained, persons) is always on the left side, like the lesion in motor aphasia.
Crude hearing would not be abolished, even were the left centre for it utterly destroyed; the right centre would still provide for that. But the _linguistic use_ of hearing appears bound up with the integrity of the left centre more or less exclusively. Here it must be that words heard enter into association with the things which they represent, on the one hand, and with the movements necessary for pronouncing them, on the other. In a large majority of Dr. Starr's fifty cases, the power either to name objects or to talk coherently was impaired. This shows that in most of us (as Wernicke said) speech must go on from auditory cues; that is, it must be that our ideas do not innervate our motor centres directly, but only after first arousing the mental sound of the words. This is the immediate stimulus to articulation; and where the possibility of this is abolished by the destruction of its usual channel in the left temporal lobe, the articulation must suffer. In the few cases in which the channel is abolished with no bad effect on speech we must suppose an idiosyncrasy. The patient must innervate his speech-organs either from the corresponding portion of the other hemisphere or directly from the centres of ideation, those, namely, of vision, touch, etc., without leaning on the auditory region. It is the minuter analysis of the facts in the light of such individual differences as these which constitutes Charcot's contribution towards clearing up the subject.
Every nameable thing, act, or relation has numerous properties, qualities, or aspects. In our minds the properties of each thing, together with its name, form an associated group. If different parts of the brain are severally concerned with the several properties, and a farther part with the hearing, and still another with the uttering, of the name, there must inevitably be brought about (through the law of association which we shall later study) such a dynamic connection amongst all these brain-parts that the activity of any one of them will be likely to awaken the activity of all the rest. When we are talking as we think, the _ultimate_ process is that of utterance. If the brain-part for _that_ be injured, speech is impossible or disorderly, even though all the other brain-parts be intact: and this is just the condition of things which, on page 37, we found to be brought about by limited lesion of the left inferior frontal convolution. But back of that last act various orders of succession are possible in the associations of a talking man's ideas. The more usual order seems to be from the tactile, visual, or other properties of the things thought-about to the sound of their names, and then to the latter's utterance. But if in a certain individual the thought of the _look_ of an object or of the _look_ of its printed name be the process which habitually precedes articulation, then the loss of the _hearing_ centre will _pro tanto_ not affect that individual's speech. He will be mentally deaf, i.e. his _understanding_ of speech will suffer, but he will not be aphasic. In this way it is possible to explain the seven cases of _pure_ word-deafness which figure in Dr. Starr's table.
If this order of association be ingrained and habitual in that individual, injury to his _visual_ centres will make him not only word-blind, but aphasic as well. His speech will become confused in consequence of an occipital lesion. Naunyn, consequently, plotting out on a diagram of the hemisphere the 71 irreproachably reported cases of aphasia which he was able to collect, finds that the lesions concentrate themselves in three places: first, on Broca's centre; second, on Wernicke's; third, on the supra-marginal and angular gyri under which those fibres pass which connect the visual centres with the rest of the brain[40] (see Fig. 17). With this result Dr. Starr's analysis of purely sensory cases agrees. In a later chapter we shall again return to these differences in the effectiveness of the sensory spheres in different individuals. Meanwhile few things show more beautifully than the history of our knowledge of aphasia how the sagacity and patience of many banded workers are in time certain to analyze the darkest confusion into an orderly display.[41] There is no 'centre of Speech' in the brain any more than there is a faculty of Speech in the mind. The entire brain, more or less, is at work in a man who uses language. The subjoined diagram, from Boss, shows the four parts most critically concerned, and, in the light of our text, needs no farther explanation (see Fig. 18).
_Smell._ Everything conspires to point to the median descending part of the temporal lobes as being the organs of smell. Even Ferrier and Munk agree on the hippocampal gyrus, though Ferrier restricts olfaction, as Munk does not, to the lobule or uncinate process of the convolution, reserving the rest of it for touch. Anatomy and pathology also point to the hippocampal gyrus; but as the matter is less interesting from the point of view of human psychology than were sight and hearing, I will say no more, but simply add Luciani and Seppili's diagram of the dog's smell-centre.[42] Of _Taste_ we know little that is definite. What little there is points to the lower temporal regions again. Consult Ferrier as below. _Touch._
Interesting problems arise with regard to the seat of tactile and muscular sensibility. Hitzig, whose experiments on _dogs' brains_ fifteen years ago opened the entire subject which we are discussing, ascribed the disorders of motility observed after ablations of the motor region to a loss of what he called muscular consciousness. The animals do not notice eccentric positions of their limbs, will stand with their legs crossed, with the affected paw resting on its back or hanging over a table's edge, etc.; and do not resist our bending and stretching of it as they resist with the unaffected paw. Goltz, Munk, Schiff, Herzen, and others promptly ascertained an equal defect of cutaneous sensibility to pain, touch, and cold. The paw is not withdrawn when pinched, remains standing in cold water, etc. Ferrier meanwhile denied that there was any true anæsthesia produced by ablations in the motor zone, and explains the appearance of it as an effect of the sluggish motor responses of the affected side.[43] Munk[44] and Schiff[45], on the contrary, conceive of the 'motor zone' as essentially sensory, and in different ways explain the motor disorders as secondary results of the anæsthesia which is always there, Munk calls the motor zone the Fühlsphäre of the animal's limbs, etc., and makes it coördinate with the Sehsphäre, the Hörsphäre, etc., the entire cortex being, according to him, nothing but a projection-surface for sensations, with no exclusively or essentially motor part. Such a view would be important if true, through its bearings on the psychology of volition. What is the truth? As regards the fact of cutaneous anæsthesia from motor-zone ablations, all other observers are against Ferrier, so that he is probably wrong in denying it. On the other hand, Munk and Schiff are wrong in making the motor symptoms _depend_ on the anæsthesia, for in certain rare cases they have been observed to exist not only without insensibility, but with actual hyperæsthesia of the parts.[46] The motor and sensory symptoms seem, therefore, to be independent variables.
_In monkeys_ the latest experiments are those of Horsley and Schaefer,[47] whose results Ferrier accepts. They find that excision of the hippocampal convolution produces transient insensibility of the opposite side of the body, and that permanent insensibility is produced by destruction of its continuation upwards above the corpus callosum, the so-called _gyrus fornicatus_ (the part just below the 'calloso-marginal fissure' in Fig. 7). The insensibility is at its maximum when the entire tract comprising both convolutions is destroyed. Ferrier says that the sensibility of monkeys is 'entirely unaffected' by ablations of the motor zone,[48] and Horsley and Schaefer consider it by no means necessarily abolished.[49] Luciani found it diminished in his three experiments on apes.[50] _In man_ we have the fact that one-sided paralysis from disease of the opposite motor zone may or may not be accompanied with anæsthesia of the parts. Luciani, who believes that the motor zone is also sensory, tries to minimize the value of this evidence by pointing to the insufficiency with which patients are examined. He himself believes that in dogs the tactile sphere extends backwards and forwards of the directly excitable region, into the frontal and parietal lobes (see Fig. 20). Nothnagel considers that pathological evidence points in the same direction;[51] and Dr. Mills, carefully reviewing the evidence, adds the gyri fornicatus and hippocampi to the cutaneo-muscular region in man.[52] If one compare Luciani's diagrams together (Figs. 14, 16, 19, 20) one will see that the entire parietal region of the dog's skull is common to the four senses of sight, hearing, smell, and touch, including muscular feeling. The corresponding region in the human brain (upper parietal and supra-marginal gyri--see Fig. 17) seems to be a somewhat similar place of conflux.
Optical aphasias and motor and tactile disturbances all result from its injury, especially when that is on the left side.[53] The lower we go in the animal scale the less differentiated the functions of the several brain-parts seem to be.[54] It may be that the region in question still represents in ourselves something like this primitive condition, and that the surrounding parts, in adapting themselves more and more to specialized and narrow functions, have left it as a sort of _carrefour_ through which they send currents and converse. That it should be connected with musculo-cutaneous feeling is, however, no reason why the motor zone proper should not be so connected too. And the cases of paralysis from the motor zone with no accompanying anæsthesia may be explicable without denying all sensory function to that region. For, as my colleague Dr. James Putnam informs me, sensibility is always harder to kill than motility, even where we know for a certainty that the lesion affects tracts that are both sensory and motor. Persons whose hand is paralyzed in its movements from compression of arm-nerves during sleep, still feel with their fingers; and they may still feel in their feet when their legs are paralyzed by bruising of the spinal cord.
I must add a word about the connection of aphasia with the tactile sense. On p. 40 I spoke of those cases in which the patient can write but not read his own writing. He cannot read by his eyes; but he can read by the feeling in his fingers, if he retrace the letters in the air. It is convenient for such a patient to have a pen in hand whilst reading in this way, in order to make the usual feeling of writing more complete.[57] In such a case we must suppose that the path between the optical and the graphic centres remains open, whilst that between the optical and the auditory and articulatory centres is closed. Only thus can we understand how the look of the writing should fail to suggest the sound of the words to the patient's mind, whilst it still suggests the proper movements of graphic imitation. These movements in their turn must of course be felt, and the feeling of them must be associated with the centres for hearing and pronouncing the words. The injury in cases like this where very special combinations fail, whilst others go on as usual, must always be supposed to be of the nature of increased resistance to the passage of certain currents of association. If any of the _elements_ of mental function were destroyed the incapacity would necessarily be much more formidable. A patient who can both read and write with his fingers most likely uses an identical 'graphic' centre, at once sensory and motor, for both operations.
The existence of separate speech and writing centres in the left hemisphere in man; the fact that palsy from cortical injury is so much more complete and enduring in man and the monkey than in dogs; and the farther fact that it seems more difficult to get complete sensorial blindness from cortical ablations in the lower animals than in man, all show that functions get more specially localized as evolution goes on. In birds localization seems hardly to exist, and in rodents it is much less conspicuous than in carnivora. Even for man, however, Munk's way of mapping out the cortex into absolute areas within which only one movement or sensation is represented is surely false. The truth seems to be rather that, although there is a correspondence of certain regions of the brain to certain regions of the body, yet the several _parts_ within each bodily region are represented throughout the _whole_ of the corresponding brain-region like pepper and salt sprinkled from the same caster. This, however, does not prevent each 'part' from having its _focus_ at one spot within the brain-region. The various brain-regions merge into each other in the same mixed way. As Mr. Horsley says: "There are border centres, and the area of representation of the face merges into that for the representation of the upper limb. If there was a focal lesion at that point, you would have the movements of these two parts starting together."[59] The accompanying figure from Paneth shows just how the matter stands in the dog.[60]
Ideas discussed in this chapter
Text from Project Gutenberg, public domain in the United States.