THE CLASSIC: On a Method of Investigating the Deep Ganglia and Tracts of the Central Nervous System (Cerebellum)

摘要

Robert Henry Clarke (1850-1926, Paris) (Fig 1) attended Cambridge University, received his medical training at St. George's Hospital in London, and then served as a house surgeon to Dr. Alexander Patterson at the Western Infirmary, Glasgow. After several years, he returned to St. George's. He collaborated with and joined Sir Victor Horsley (Fig 2) at University College, London in the late 1880s. He developed pneumonia in the early 90s, however, and traveled to Egypt for recovery. Cerebral localization of function had become an important issue following the work of Hughlings Jackson and others, who had stimulated the cerebral cortex with small amounts of galvanic current to plot body movements. Apparently during his time in Egypt Clarke developed the idea for a stereotaxic frame which could be clamped to an animal's head to minimize movement between the brain and probing instruments. He presented the idea to Horsley sometime after 1895. However, the first instrument was apparently not made and used experimentally until about 1906, and it is that device (Fig 3) which is reported in our Classic this month. Clarke died in Paris after a long illness, the nature of which has never been established, although he claimed it stemmed from taking a single aspirin tablet.Fig 1: Robert Henry Clarke is shown. Reprinted with courtesy of the Wellcome Library images collection, London.Fig 2: Sir Victor Horsley is shown. Reprinted with courtesy of the Wellcome Library images collection, London.Fig 3: The stereotaxic apparatus of Clarke and Horsley is shown. Reprinted with courtesy of the Wellcome Library images collection, London.Sir Victor Alexander Haden Horsley (1857-1916, Egypt) received his initial education at Cranbrook School, then studied medicine and received his surgical training at University College London, where he received his first appointment in 1884. He was particularly interested in neurosurgery and neurophysiology, and was reportedly the first surgeon to remove a spinal tumor through a laminectomy. He authored a number of publications in various aspects of neurophysiology, through which research he became acquainted with Robert Clarke. He is perhaps best remembered for his role in developing a practical stereotaxic apparatus, although he and Clarke worked in many areas of neurophysiology and published together. For unclear reasons, the two close friends and collaborators parted ways sometime after 1907, leaving some bitterness with both. Horsley volunteered for surgery duty in Mesopotamia during the First World War, and there he died of heat stroke in what is now modern Iraq in 1916. The apparatus described by Clarke and Horsley in our Classic established the principles for not only stereotaxis, but modern-day computer-assisted surgery, including navigation and robotics. Richard A. Brand, MD In the course of an investigation into the structure and functions of the cerebellum, the former by Marchi's method, the latter by observations of symptoms following artificial lesions and by excitation in normal animals, we found further progress checked by the want of a method of producing localized lesions in the deep structures-that is, nucleus dentatus, etc.-of the cerebellum without injuring neighbouring parts, and some such method was so essential for our purpose that it necessarily became for some time the principal object of our research. We were fortunate enough to find in electrolysis with insulated (glass) needles a method of producing accurately defined circumscribed excitation or lesions admirably adapted to our requirements. But to render it available for practical experiment it was necessary to find a satisfactory means of localizing deep centres and conveying the stimulation or electrolytic needle to them. The topographical methods best adapted to meet the first requirement, and the instruments to give effect to the second, had to be devised, and involved a good deal of time and experiment, which it is hardly necessary to