on the uncertain ground of naked-eye dissection of human anatomy, as commissural between the two lateral lobes of the cerebellum, is now known to constitute chiefly a cerebro-cerebellar decussating path. Certain cerebellar cells send processes down to the cell-group in the bulb known as the nucleus of Deiters, which latter projects fibres down the spinal cord. Whether there is any other or direct emergent path from the cerebellum into the spinal cord is a matter on which opinion is divided.
Injuries of the cerebellum, if large, derange the power of executing movements, without producing any detectable derangement of sensation. The derangement gradually disappears, unless the damage to the organ be very wide. A reeling gait, oscillations of the body which impart a zigzag direction to the walk, difficulty in standing, owing to unsteadiness of limb, are common in cerebellar disease. On the other hand, congenital defect amounting to absence of one cerebellar hemisphere has been found to occasion practically no symptoms whatsoever. Not a hundredth part of the cerebellum has remained, and yet there has existed ability to stand, to walk, to handle and lift objects in a fairly normal way, without any trace of impairment of cutaneous or muscular sensitivity. The damage to the cerebellum must, it would seem, occur abruptly or quickly in order to occasion marked derangement of function, and then the derangement falls on the execution of movements. One aspect of this derangement, named by Luciani astasia, is a tremor heightened by or only appearing when the muscles enter upon action—“intention tremor.” Vertigo is a frequent result of cerebellar injury: animals indicate it by their actions; patients describe it. To interpret this vertigo, appeal must be made to disturbances, other than cerebellar, which likewise occasion vertigo. These include, besides ocular squint, many spatial positions and movements unwonted to the body: the looking from a height, the gliding over ice, sea-travel, to some persons even travelling by train, or the covering of one eye. Common to all these conditions is the synchronous rise of perceptions of spatial relations between the self and the environment which have not, or have rarely, before arisen in synchronous combination. The tactual organs of the soles, and the muscular sense organs of limbs and trunk, are originating perceptions that indicate that the self is standing on the solid earth, yet the eyes are at the same time originating perceptions that indicate that the solid earth is far away below the standing self. The combination is hard to harmonize at first; it is at least not given as innately harmonized. Perceptions regarding the “me” are notoriously highly charged with “feeling,” and the conflict occasions the feeling insufficiently described as “giddiness.” The cerebellum receives paths from most, if not from all, of the afferent roots. With certain of these it stands associated most closely, namely, with the vestibular, representing the sense organs which furnish data for appreciation of positions and movements of the head, and with the channels, conveying centripetal impressions from the apparatus of skeletal movement. Disorder of the cerebellum sets at variance, brings discord into, the space-perceptions contributory to the movement. The body’s movement becomes thus imperfectly adjusted to the spatial requirements of the act it would perform.
In the physiological basis of sense exist many impressions which, apart from and devoid of psychical accompaniment, reflexly influence motor (muscular) innervation. It is with this sort of habitually apsychical reaction that the cerebellum is, it would seem, employed. That it is apparently devoid of psychical concomitant need not imply that the impressions concerned in it are crude and inelaborate. The seeming want of reaction of so much of the cerebellar structure under artificial stimulation, and the complex relay system revealed in the histology of the cerebellum, suggest that the impressions are elaborate. Its reaction preponderantly helps to secure co-ordinate innervation of the skeletal musculature, both for maintenance of attitude and for execution of movements.
Sleep.—The more obvious of the characters of sleep (q.v.) are essentially nervous. In deep sleep the threshold-value of the stimuli for the various senses is very greatly raised, rising rapidly during the first hour and a half of sleep, and then declining with gradually decreasing decrements. The muscles become less tense than in their waking state: their tonus is diminished, the upper eyelid falls, and the knee-jerk is in abeyance. The respiratory rhythm is less frequent and the breathing less deep; the heart-beat is less frequent; the secretions are less copious; the pupil is narrow; in the brain there exists arterial anaemia with venous congestion, so that the blood-flow there is less than in the waking state.
It has been suggested that the gradual cumulative result of the activity of the nerve cells during the waking day is to load the brain tissue with “fatigue-substances” which clog the action of the cells, and thus periodically produce that loss of consciousness, &c., which is sleep. Such a drugging of tissue by its own excreta is known Theories of Sleep. in muscular fatigue, but the fact that the depth of sleep progressively increases for an hour and more after its onset prevents complete explanation of sleep on similar lines. It has been urged that the neurons retract during sleep, and that thus at the synapses the gap between nerve cell and nerve cell becomes wider, or that the supporting cells expand between the nerve cells and tend to isolate the latter one from the other. Certain it is that in the course of the waking day a great number of stimuli play on the sense organs, and through these produce disintegration of the living molecules of the central nervous system. Hence during the day the assimilatory processes of these cells are overbalanced by their wear and tear, and the end-result is that the cell attains an atomic condition less favourable to further disintegration than to reintegration. That phase of cell life which we are accustomed to call “active” is accompanied always by disintegration. When in the cell the assimilative processes exceed dissimilative, the external manifestations of energy are liable to cease or diminish. Sleep is not exhaustion of the neuron in the sense that prolonged activity has reduced its excitability to zero. The nerve cell just prior to sleep is still well capable of response to stimuli, although perhaps the threshold-value of the stimulus has become rather high, whereas after entrance upon sleep and continuance of sleep for several hours, and more, when all spur to the dissimilation process has been long withheld, the threshold-value of the sensory stimulus becomes enormously higher than before. The exciting cause of sleep is therefore no complete exhaustion of the available material of the cells, nor is it entirely any paralysing of them by their excreta. It is more probably abeyance of external function during a periodic internal assimilatory phase.
Two processes conjoin to initiate the assimilatory phase. There is close interconnexion between the two aspects of the double activity that in physiological theory constitute the chemical life of protoplasm, between dissimilation and assimilation. Hering has long insisted on a self-regulative adjustment of the cell metabolism, so that action involves reaction, increased catabolism necessitates after-increase of anabolism. The long-continued incitement to catabolism of the waking day thus of itself predisposes the nerve cells towards rebound into the opposite phase; the increased catabolism due to the day’s stimuli induces increase of anabolism, and though recuperation goes on to a large extent during the day itself, the recuperative process is slower than, and lags behind, the disintegrative. Hence there occurs a cumulative effect, progressively increasing from the opening till the closing hours. The second factor inducing the assimilative change is the withdrawal of the nervous system from sensual stimulation. The eyes are closed, the maintenance of posture by active contraction is replaced by the recumbent pose which can be maintained by static action and the mere mechanical consistence of the body, the ears are screened from noise in the quiet chamber, the skin from localized pressure by a soft, yielding couch. The effect of thus reducing the excitant action of the environment is to give consciousness over more to mere revivals by memory, and gradually consciousness lapses. A remarkable case is well authenticated, where, owing to disease, a young man had lost the use of all the senses save of one eye and of one ear. If these last channels were sealed, in two or three minutes time he invariably fell asleep.
If natural sleep is the expression of a phase of decreased excitability due to the setting in of a tide of anabolism in the cells of the nervous system, what is the action of narcotics? They lower the
