Some Practical Observations Upon the 
Origin, Communications and Distri- 
butions of the Cranial Nerves. 
BY 
CHAS. C. ALLISON, M. D., 
OMAHA, NEB. 
Professor of Physiology and Genito-Urinary Surgery 
Omaha Medical College. 
Reprint from The Omaha Clinic. May, 1893. SOME PRACTICAL OBSERVATIONS UPON THE ORI- 
GIN, COMMUNICATIONS AND DISTRIBUTIONS 
OF THE CRANIAL NERVES. 
By Charles Allison, M. D. 
Professor of Physiology and Genito Urinary Surgery- 
Omaha Medical College. 
Lecture, March 2, 1893. 
Gentlemen .--We have dwelt at some 
length upon the exact physiological anat- 
omy of the cranial nerves, and to aid the 
memory we will now summarize the lead- 
ing associations and make clinical applica- 
tions. 
Of the nerves distributed to the eye we 
find the deep origin of the Optic to be on 
the posterior inferior part of the optic 
thalamus, just external to the nates. The 
Third supplying all the muscles of the eye 
except the superior oblique and external 
rectus has its origin in the floor of the 
sylvian aqueduct, just internal to the 
nates. The fourth supplying the oblique 
has its deep origin in the Valve of Viussens 
which forms the anterior part of the roof 
of the fourth ventricle and is continuous 
with the optic thalamus through tne testes 
and superior peduncles, while the inferior 
root has its origin in the floor of the Aqueduct of Sylvius just beneath the origin 
of the motor occuli. The Sixth supplying 
the external rectus can be traced to the 
floor of the fourth ventricle at the post 
extremity of the Aqueduct of Sylvius. 
In other words all these nerves have 
their origin from the posterior inferior part 
of the Optic Thalamus or from nerve cen- 
ters immediately continuous with the optic 
center. 
Furthermore the Seventh supplying all 
the superficial muscles of the face can be 
traced to the nucleus, common to it and 
the Sixth, in the Fasciculus Teres, which is 
immediately behind the deep origin of the 
Third and the inferior root of the Fourth. 
Through this nerve are supplied the 
muscles which surround the orbit and pro- 
tect the eye; while through ascending 
branches of the spheno-palatine ganglion 
branches are distributed to the periosteum 
of the orbit, the Vidian uniting the spheno- 
palatine ganglion with the Seventh. There- 
fore, the functional harmony suggested by 
the almost common origin of these nerves 
is somewhat beautifully verified in their 
distribution. 
In studying another group of nerves 
please remember that the gray tubercles of 
Rolando which give origin to the Fifth are 
found in the anterior border of the resti- 
form body, and in the line of union of the 
2 restiform and olivary bodies immediately 
below the gray tubercles, we find the deep 
origin of the Glosso-Pharyngeal and the 
Pneumogastric and at the inferior extremity 
of the olivary body we find the deep origin 
of the Hypoglossal. Note the following 
attractive distribution : 
The Fifth supplies all the muscles of 
mastication including the mylo-hyoid and 
anterior belly of the digastric which de- 
press the lower jaw, and what is more 
noteworthy it supplies the orbiculaxis oris, 
a muscle important in the first act of 
alimentation, viz: prehension; it supplies 
furthermore the salivary glands, the teeth, 
the articulation of the lower jaw, and with 
the glosso-pharyngeal the tongue with 
sensation and sense of taste and also acts 
as a reflex nerve of deglutition. 
The Glosso-Pharyngeal supplying sensa- 
tion to the pharynx and tongue, and 
through the pharyngeal plexus aids in 
supplying the constrictors of the pharynx, 
while the Hypoglossal gives motion to the 
tongue and to the elevators and depressers 
of the os hyoides and pharynx, and the 
Pneumogastric sends branches to the 
pharynx through the pharyngeal plexus- 
sensory branches to supra laryngeal region 
(protective to the air passages in deglution) 
branches also to aesophagus, stomach and 
through solar plexus to the entire abdomi- 
3 nal and pelvic viscera. (Wood-Bernard.) 
Superiority, moreover, the Pneumogas- 
tric joins with branches of the spheno- 
palatine ganglion in supplying the naso 
pharynx and with the superior cervical 
ganglion of the sympathetic in supplying 
the inferior pharyngeal (constrictors) and 
supra laryngeal and vocal regions. The 
application will presently be made. 
The middle cervical (sympathetic) also 
meets the superior and recurrent laryngeal 
nerves in the larynx, while its inferior 
branches of distribution form the great 
accelerator cardiac nerves; therefore both 
the superior and inferior sympathetic gan- 
glia communicate with the vagus, which, 
through its motor filaments from the 
Spinal Accessory gives inhibitory supply to 
the heart, and finally the Vagus also sup- 
plies the larynx, trachea and lungs. 
The motor filaments to the vocal cords 
come from the Spinal Accessory, and Hilton 
points out that the spinal accessory, the 
phrenic and the Posterior Thoracic (the 
tripod sustaining respiration and voice) 
have origin in the cord between the third 
and sixth cervical nerves. We may appro- 
priately add that the muscular branches of 
the brachial plexus which supply the 
scalini, the rhomboid andsub clavius mus- 
cles, which aid the sterno-mastoid and 
trapezius in fixing the first rib, also come 
4 from the fifth and sixth cervical and are 
important in controlling prolonged vocal 
efforts, and the recurrence of the inferior 
laryngeal, allows a distribution to the in- 
trinsic muscles of the larynx in the direc- 
tion of the volume of expired air which 
produces sound. 
I beg, gentlemen, to repeat that the Fifth 
presides over the prehension, mastication 
and deglutition of food, that it is assisted 
in this function by the Glosso-Pharyngeal 
and Hypoglossal, and that the Pneumogas- 
tric is also a reflex nerve of deglution and 
is also distributed to the entire alimentary 
tract, that it supplies the heart (inhibitory 
filaments) through the Spinal Accessory, 
and that it communicates in a dual way 
with the accelerator (sympathetic) fibers 
from the middle cervical ganglion and 
finally, that it supplies the respiratory 
system and presides mainly over the pro- 
duction of voice. It affords, therefore, an 
elaborate field for clinical deductions, par- 
ticularly since the organs highly supplied 
by sympathetic and Vagus associations, 
viz: genito-urinary and pelvic viscera, 
stomach, heart and upper air passages 
present numerous ganglionic cells which 
are highly susceptible of impressions from 
local or distant irritants, and while pain is 
generally expressed at the end of a nerve: 
the analogue of this seems to be manifest 
5 6 
in the fact that the most distant associa- 
tions of sympathetic and cerebro-spinal 
systems are most intimate in their func- 
tional relations. To illustrate, you are all 
aware that genito-urinary abnormalities are 
not infrequently accompanied by symptoms 
in the upper air passages. My history book 
records a case of a man in whom sneezing 
or marked nasal irritations always accom- 
panied sexual excitement. Carpenter re- 
cords a case where copious discharges of 
nasal mucus attended the same condition 
and I have reported a case of a young lady 
with hemorrhoids, whose only symptom 
for months was persistent vomiting which 
resisted every intelligent effort on the part 
of the physician, and the cure of the 
hemorrhoids was attended by prompt and 
permanent relief from the vomiting. You 
are familiar with the change in voice which 
sometimes attends menstruation and cas- 
tration (Carpenter), and with the func- 
tionally demoralized heart, which accom- 
panies digestive or genito-urinary disorders. 
I would point out that in either case the 
impression of the irritant is taken cogniz- 
ance of by the solar plexus and transferred 
by the middle cervical ganglion, which not 
only furnishes the cardiac accelerator 
fibers, but communicates with the fifth and 
sixth cervical of the bronchial plexus, and 
therefore, a heart lesion may produce pain 
in the arm. Another symptom of a uterine or ovarian 
lesion is headache, caused by the appreci- 
ation of the lesion by the superior end 
organs of the sympathetic branches of the 
external and internal carotid plexus from 
the superior cervical ganglion with its 
pneumogastric affiliations; the same irri- 
tant may be conveyed along the great 
splanchnic to its superior origin, viz: the 
sixth dorsal with filaments from the fourth 
allowing a transfer to the mammary gland. 
Bear in mind, gentlemen, these salient 
points for the practical value they teach. 
Remember the main trunk lines and chief 
depots which bring distant organs into 
close clinical associations, but avoid if you 
please the way of the latest novelty and 
greatest disgrace to our profession-the 
orificial surgeon-who stretches the ori- 
fices, cuts the physiological pockets and 
prostitutes a great calling with the hope 
that he may obtain temporary relief in 
obscure cases, while the main motive is a 
conscienceless desire for a fee. 
7