Part 15

_Visual Region of the Cortex._--There is a region of the cortex especially connected with vision. The _optic nerve_ and _tract_ constitute the second link in the chain of neurones joining the retina to the brain. They may therefore be regarded as the equivalent of an intraspinal tract connecting the deep ends of the afferent neurones from the skin with higher nervous centres. In the bony fishes the optic tract reaches the grey matter of the optic lobe, a part of the mid-brain, to which the so-called anterior colliculus is equivalent in the mammalian brain. In the optic lobe the axones of the neurones of the optic tract meet neurones whose axones pass in turn to the motor neurones of the muscles moving the eyeballs, and also to other motor neurones. But in these fish the optic tract has no obvious connexion with the fore-brain or with any cerebral pallium. Ascending, however, to the reptilian brain is found an additional arrangement: a small portion of the optic tract passes to grey matter in front of the optic lobe. This grey matter is the lateral geniculate body. From this geniculate body a number of neurones extend to the pallial portion of the cerebrum, for in the reptilian brain the pallium is present. The portion of pallium connected with the lateral geniculate body lies above and behind the olfactory or archipallium. It is a part of what was mentioned above as neopallium.

In the mammalian brain the portion of the optic tract which goes to the optic lobe (_ant. colliculus_ of the mammal) is dwarfed by great development of the part which goes to the geniculate body and an adjoining grey mass, the pulvinar (part of the optic thalamus). From these latter pass large bands of fibres to the occipital region of the neopallium. In mammals this visual region of the cortex is distinguished in its microscopic features from the cortex elsewhere by a layer of myelinate nerve-fibres, many of which are the axones of neurones of the geniculate body and pulvinar. Thus, whereas in the bony fishes all the third links of the conductive chain from the retina lead exclusively to the final neurones of motor centres for muscles, in the mammal the majority of the third links conduct to grey matter of the cortex cerebri.

The application of electric stimuli to the surface of the cortex does not for the greater part of the extent of the cortex evoke in higher mammalian brains any obvious effect; no muscular act is provoked. But from certain limited regions of the cortex such stimulation does evoke muscular acts, and one of these regions is that to which the neurones forming the third link of the conductive chain from the retina pass. The muscular acts thus provoked from that region are movements of the eyeballs and of the neck turning the head. In the monkey the movement is the turning of both eyeballs and the head away from the side stimulated. In short, the gaze is directed as to an object on the opposite side. The newer conductive chain traceable through the cortex does therefore, after all, like the older one through the optic lobe, lead ultimately to the motor neurones of the eye muscles and the neck, only it takes a longer course thither and is undoubtedly much more complex. What gain is effected by this new and as it were alternative and longer route, which takes a path up to the cerebral cortex and down again, we can only conjecture, but of one point we may rest well assured, namely, that a much richer inter-connexion with other arcs of the nervous system is obtained by the path that passes via the cortex. The functional difference between the old conductive circuit and the new can at present hardly indeed be stated even in outline. A natural inference might be that the phylogenetically older and less complex path is concerned with functions purely reflex-motor, not possessing sensation as an attribute. But fish, which possess only the older path, can be trained to seize bait of one colour and not of another colour, even against what appeared to be an original colour-preference in them. Such discrimination individually acquired seems to involve memory, though it may be rudimentary in kind. Where motor reaction to visual stimuli appears to involve memory--and without memory the training could hardly be effective--some germ of consciousness can hardly be denied to the visual reactions, although the reactions occurred in complete absence of a cortical path and indeed of a visual cortex altogether.

Removal of the visual pallium in the tortoise produces little or no obvious defect in vision; but in the bird such a lesion greatly impairs the vision of the eye of the side opposite to the lesion. The impairment does not, however, amount to absolute blindness. Schrader's hawk, after removal of the pallium, reacted to movements of the mice with which it was caged. But the reactions were impaired: they lacked the sustained purpose of the normal reactions. The bird saw the mice; that was certain, for their movements across its field of vision made it turn its gaze towards them. But on their ceasing to move, the reaction on the part of the bird lapsed. Neither did their continuing to move excite the attack upon them which would have been the natural reaction on the part of the bird of prey towards its food. The bird apparently did not recognize them as prey, but saw them merely as moving objects. It saw them perhaps as things to which mental association gave no significance. Similarly, a dog after ablation of the occipital lobes of the cortex is able to see, for it avoids obstacles in its path; but if food is offered to it or the whip held up to it, it does not turn towards the food or away from the whip. It sees these things as if it saw them for the first time, but without curiosity, and as if it had no experience of their meaning. It gives no hint that it any longer understands the meaning of even familiar objects so long as these are presented to it through the sense of vision. Destruction of the visual cortex of one hemisphere alone produces in the dog impairment of vision, not as in the bird practically exclusively in the opposite eye, but in one lateral half of each eye, and that half the half opposite the hemisphere injured. Thus when the cortex destroyed is of the right cerebral hemisphere, the resultant visual defect is in the left half of the field of vision of both eyes. And this is so in man also.

In man disturbances of sensation can be better studied because it is possible to obtain from him his description of his condition. The relation of the _cortex cerebri_ to human vision can be summarized briefly as follows. The visual cortex is distinguishable in higher mammals by a thin white stripe, the stripe of Gennari, seen in its grey matter when that is sectioned. This stripe results from a layer of nerve-fibres, many of which are axones from the neurones of the lateral geniculate body and the pulvinar, the grey masses directly connected with the optic nerve-fibres. In the dog, and in such monkeys as the Macaque, the region of cortex containing this stripe traceable to optic fibres forms practically the whole occipital lobe. But in the man-like apes and in man this kind of cortex is confined to one region of the occipital lobe, namely, that of the calcarine fissure and the _cuneus_ behind that. This region of cortex thus delimited in man is one of Flechsig's areas of earlier myelinization. It is also one of his areas possessing projection fibres; and this last fact agrees with the yielding by this area, when under electrical stimulation, of movements indicating that impulses have been discharged from it into the motor neurones of the muscles of the eyes and neck. Evidence from cases of disease show that destruction of the cortex of the upper lip of the calcarine fissure, say in the right half of the brain, causes in man impairment in the upper right-hand quadrant of both retinae: destruction of the lower lip of the fissure causes impairment in the lower right-hand quadrants. Destruction of the calcarine region of one hemisphere produces therefore "crossed hemianopia," that is, loss of the opposite half of the field of vision. But in this hemianopia the region of central vision is always spared. That is, the piece of visual field which corresponds with the yellow spot of the retina is not affected in either eye, unless the calcarine regions of both hemispheres are destroyed. This central point of vision is connected therefore not with one side of the brain only but with both.

The impairment of sight is more severe in men than in lower animals. Where the destruction of the visuo-sensory cortex in one calcarine region is complete, a candle-flame offered in the hemianopic field cannot even be perceived. It may hardly excite a reflex contraction of the pupil. In such cases the visual defect amounts to blindness. But this is a greater defect than is found in the dog even after entire removal of both occipital lobes. The dog still avoids obstacles as it walks. Its defect is rather, as said above, a complete loss of interest in the visual images of things. But a dog or monkey after loss of the visual cortex hesitates more and avoids obstacles less well in a familiar place than it does when entirely blind from loss of the peripheral organ of vision. In man extensive destruction of the visual cortex has as one of its symptoms loss of memory of localities, thus, of the paths of a garden, of the position of furniture, and of accustomed objects in the patient's own room. This loss of memory of position does not extend to spatial relations ordinarily appreciated by touch, such as parts of the patient's own person or clothing. There is nothing like this in the symptoms following blindness by loss of the eye itself. Those who lose their sight by disease of the retina retain good memorial pictures of positions and directions appreciated primarily by vision.

Cases of disease are on record in which loss of visual memory has occurred without hemianopia. Visual hallucinations referred to the hemianopic side have been observed. This suggests that the function of visual memory in regard to certain kinds of percepts must belong to localities of cortex different from those pertaining to other visual percepts. The area of cortex characterized by the stripe of Gennari occupies in man, as mentioned, the calcarine and cuneate region. It is surrounded by a cortical field which, though intimately connected with it by manifold conducting fibres, &c., is yet on various grounds distinct from it. This field of cortex surrounding the visuo-sensory of the calcarine-cuneate region is a far newer part of the neopallium than the region it surrounds. Both in the individual (Flechsig) and in the phylum (Bolton, Campbell, Mott) its development occurs far later than that of the visuo-sensory which it surrounds. Flechsig finds that it has no "projection" fibres, that is, that it receives none of the optic radiations from the lower visual centres and gives no centrifugal fibres in the reverse direction. This field encompassing the visuo-sensory region differs from the latter in its microscopic structure by absence of the lower layer of stellate cells and by the presence in it of a third or deep layer of pyramidal cells (Mott). Its fibres are on the average smaller than are those of the visuo-sensory (W.A. Campbell). This zonal field is small in the lower apes, and hardly discoverable in the dog. In the anthropoid apes it is much larger. In man it is relatively much larger still. The impairment of visual memory and visual understanding in regard to direction and locality is said to be observed in man only when the injury of the cortex includes not only the calcarine-cuneate region but a wide area of the occipital lobe. From this it is argued that the zonal field is concerned with memories and recognitions of a kind based on visual perceptions. It has therefore been termed the _visuo-psychic_ area. It is one of Flechsig's "association-areas" of the cortex.

Adjoining the antero-lateral border of the just-described _visuo-psychic area_ lies another region separate from it and yet related to it. This area is even later in its course of development than is the visuo-psychic. It is one of Flechsig's "terminal fields," and its fibres are among the last to ripen in the whole cortex. This terminal field is large in man. It runs forward in the parietal lobe above and in the temporal lobe below. Its wide extent explains, in the opinion of Mott, the displacement of the visuo-sensory field from the outer aspect of the hemisphere in the lower monkeys to the median aspect in man. To this terminal field all the more interest attaches because it includes the angular gyrus, which authorities hold to be concerned with the visual memory of words. Study of diseased conditions of speech has shown that the power to understand _written_ words may be lost or severely impaired although the words may be perfectly distinct to the sight and although the power to understand _heard_ words remains good. This condition is asserted by many physicians to be referable to destruction of part of the angular gyrus. Close beneath the cortex of the angular gyrus runs a large tract of long fibres which pass from the visual cortex (see above) to the auditory cortex (see below) in the superior temporal gyrus and to the lower part of the frontal lobe. This lower part of the frontal lobe is believed--and has long been believed--to be concerned intimately with the production of the movements of speech. A difficulty besetting the investigation of the function of the angular gyrus is the fact that lesion of the cortex there is likely to implicate the underlying tract of fibres in its damage. It cannot be considered to have been as yet clearly ascertained whether the condition of want of recognition of seen words--"word-blindness"--is due to cortical injury apart from subcortical, to the angular gyrus itself apart from the underlying tract. Word-blindness seems, in the right-handed, to resemble the aphasia believed to be connected with the lower part of the frontal lobe, in that it ensues upon lesions of the left hemisphere, not of the right. In left-handed persons, on the contrary, it seems to attach to the right hemisphere.

_Auditory Region of the Cortex._--Besides the two great organs of distance-receptors, namely, the nose and eye, whose cerebral apparatus for sensation has just been mentioned, those of a third great distance-receptor have to be considered. The agents of stimulation of the two former are respectively chemical (olfactory) and radiant (visual); the mode of stimulation of the third is mechanical, and the sensations obtained by it are termed auditory. Their cerebral localization is very imperfectly ascertained. Electric stimuli applied to a part of the uppermost temporal gyrus excites movements of the ears and eyes in the dog. Destruction of the same region when executed on both hemispheres is argued by several observers to impair the sense of hearing. To this region of cortex fibres have been traced from the lower centres connected with the nerve-fibres coming from the cochlea of the ear. From each cochlear nerve a path has been traced which passes to the _insulae_ and the above-mentioned _temporal_ region of cortex of both the cerebral hemispheres. The insula is a deeper-seated area of cortex adjoining the uppermost temporal convolution. To it Flechsig's chronological studies also impute a connexion with the nerves of the ear. Early myelinization of fibres, presence of ascending and descending "projection" tracts to and from lower centres outside the cortex, calibre of fibres, microscopic characters of its cortical cells, all those kinds of indirect items of evidence that obtain for the visual cortex likewise mark out this insular-temporal area as connected fairly directly with a special sense-organ, as in fact a sensory field of the cortex; and the suspicion is that it is auditory. Clinical observation supports the view in a striking way, but one requiring, in the opinion of some, further confirmation. It is widely believed that destruction of the upper and middle part of the uppermost temporal convolution produces "word-deafness," that is, an inability to recognize familiar words when heard, although the words are recognized when seen.

More precise information regarding this auditory region of the cortex has recently been obtained by the experiments of Kalischer. These show that after removal of this region from both sides of the brain in the dog the animal shows great defect in answering to the call of its master. Whereas prior to the operation the animal will prick its ears and attend at once to the lightest call, it requires after the removal of the auditory regions great loudness and insistence of calling to make it attend and react as it did. This is the more striking in view of other experimental results obtained. Kalischer trained a number of his dogs not to take meat offered them except at the sound of a particular note given by an organ pipe or a harmonium. The dogs rapidly learned not to take the food on the sounding of notes of other pitch than the one taught them as the permissive signal. This reaction on the part of the animal was not impaired by the removal of the so-called auditory regions of the cortex. Kalischer suggests that this reaction taught by training is not destroyed by the operation which so greatly impairs the common reaction to the master's call, because the former is a simpler process more allied to reflex action. In it the attention of the dog is already fastened upon the object, namely the food, and the stimulus given by the note excites a reaction which simply allows the act of seizing the food to take place, or on the other hand stops it. In the case of answering the call of the master the stimulus has to excite attention, to produce perception of the locality whence it comes, and to invoke a complicated series of movements of response. He finds that destruction of the posterior colliculi of the mid-brain, which have long been known to be in some way connected with hearing, likewise destroys the response to the call of the master, but did not destroy the trick taught to his dogs of taking meat offered at the sound of a note of one particular pitch but not at notes of other pitch given by the same instrument.

_Other Senses and Localization in the Cortex Cerebri._--Turning now to the connexion between the function of the cortex and the senses other than those of the great distance-receptors just dealt with, even less is known. Disturbance and impairment of skin sensations are observable both in experiments on the cerebrum of animals and in cases of cerebral disease in man. But the localization in the cortex of regions specially or mainly concerned with cutaneous sensation has not been made sufficiently clear to warrant statement here. Still less is there satisfactory knowledge regarding the existence of cortical areas concerned with sensations originated in the alimentary canal. The least equivocal of such evidence regards the sense of taste. There is some slight evidence of a connexion between this sense and a region of the hippocampal gyrus near to but behind that related to smell.

As to the sensations excited by the numerous receptors which lie not in any of the surface membranes of the body but embedded in the masses of the organs and between them, the _proprioceptors_, buried in muscles, tendons and joints, there is little doubt that these sensations may be disturbed or impaired by injury of the _cortex cerebri_. They may probably also be excited by cortical stimulation. But evidence of localization of their seat in, and their details of connexion with, the cortex, is at present uncertain. Many authorities consider it probable that sensations of touch and the sensations initiated by the proprioceptors of muscles and joints (the organs of the so-called muscular sense) are specially related to the post-central gyrus and perhaps to the pre-central gyrus also. The clearest items on this point are perhaps the following.

Besides the regions instanced above, in the limbic (olfactory), occipital (visual), and temporal (auditory) lobes, as exhibiting precocity of development, there is a region showing similar precocity in the fronto-parietal portion of the hemisphere. This is the region which in the Primates includes the large _central fissure_ (sometimes called the fissure of Rolando). To it fibres are traced which seem to continue a path of conduction that began with afferent tracts belonging to the spinal cord, and tracts which there is reason to think conduct impulses from the receptor-organs of skin and muscles. The part of the cortex immediately behind the _central fissure_ seems to be the main cortical goal for these upward-conducting paths. That _post-central_ strip of cortex would in this view bear to these paths a relation similar to that which the occipital and temporal regions bear to afferent tracts from the retina and the cochlea. There are observations which associate impaired tactual sense and impaired perception of posture and movement of a limb with injury of the _central region_ of the cortex. But there are a number also which show that the motor defect which is a well-ascertained result of injury of the _pre-central_ gyrus is sometimes unaccompanied by any obvious defect either of touch or of muscular sense. It seems then that the motor centres of this region are closely connected with the centres for cutaneous and muscular sense, yet are not so closely interwoven with them that mechanical damage inflicted on the one of necessity heavily damages the other as well. There is evidence that the sensory cortex in this region lies posterior to that which has been conveniently termed the "motor." These latter in the monkey and the man-like apes and man lie in front of the central fissure: the sensory lie probably behind it. A.W. Campbell has found changes in the cortex of the post-central convolution ensuing in the essentially sensory disease, _tabes dorsalis_, a disease in which degeneration of sensory nerve-fibres of the muscular sense and of the skin senses is prominent. He considers that in man and the man-like apes the part of the post-central gyrus which lies next to and enters into the _central fissure_ is concerned with simpler sensual recognitions, while the adjoining part of that convolution farther back is a "psychic region" concerned with more complex psychosis connected with the senses of skin and muscle. His subdivision of the post-central gyrus is based on histological differences which he discovers between its anterior and its posterior parts and on the above-described analogous differentiation of a "sensory" from a "psychic" part in the visual region of cortex.