Neurosurgery – Contemplation of the Future
When I was a medical student 42 years ago my neurological textbooks were replete with diagrams of the motor, sensory, visual, and speech areas of the cerebral cortex. It occurred to me then that perhaps the viscera might also have cortical representation and therefore why not try to find out if this were so? Sad to say I was dissuaded from investigative attempts on the grounds that time in medical school should be spent only on learning. (In this respect, I would urge that any of you with promising investigative ideas should put them to the test and not be persuaded to forget them. For sad experience has shown that if you don’t do the job, someone else will!). Since my early days, much has been learned about the visceral representation in the cortex of the brain, to part of which I eventually contributed. It is now known, for example, that the vagus nerve nucleus has a representation in the subfrontal cortex, bladder and bowels in the juxtamotor cortex, cardiac and respiratory control in the cingulate and medial temporal cortex, and sex organs also in the latter. Pupillary changes may be elicited by stimulating the anterior cingulate gyri, intussception by stimulating posterior cingulate gyri, while blood pressure alterations may be induced on stimulation of numerous parts of the cerebral cortex. All this adds up to the now well-known fact that in addition to a motor and sensory cortex, there is also what might be termed a “ visceral brain” in man and beast(9).
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