LETTERS
Dr. Heath
Replies
Dr. Turner
points.
We onigi-
definition, lished in 1954 in Studies in Schi:ophrenia(I), was on the basis of its function. None of the data from
first pubformulated our contin-
uing
the
SIR:
nated
the
term
studies
makes “septal
with
some
provocative
region,”
human
and
and
the
animal
subjects
over
past
THE
EDITOR
degeneration and degenerating terminals. Staining of normal axons is often very similar to that of degenerating axons. With considerable work and experimentation, we are now able to more cleanly distinguish between normal and degenerating axons.
20
has indicated that the original definition was inaccurate. In 1954, the boundaries of this large and heterogeneous brain region were precisely defined. Its caudal aspect is the anterior commissure, its rostral aspect is the tip of the anterior horn of the lateral ventricles, its lateral bonder includes some of the yentro-medial aspect of what is conventionally considered to be pant of the caudate nucleus, its medial border is the midline, its dorsal extent is the septum pellucidum, and its ventral aspect is the orbital cortex. I think Dr. Turner is mistaken in applying the term “septal region” to the septum pellucidum. To the best of my knowledge. “septal region” has never been used synonomously with “septum pellucidum” in primates. As one moves up the phylogenetic scale, the gray matter between the anterior horns of the lateral ventricle in lower species moves forward and downward. Some but not all of the specific nuclei of the septal region were cited in my original definition. Early studies suggested that this heterogeneous region functioned as a unit, and subsequent stud-
TO
REFE
R EN C ES
years
ies
have
supported
this
Dr. Turner
contention.
criticizes
ways-pathways
that
experimentally
mapped
ducing
a lesion
and
cannot
be
tential
techniques
applied
our
schematic
obviously
have
in man. subsequently
to patients’ that
brains,
non
can
histologic by
of brain
path-
and could not be techniques for inaxonal degeneration
been
Experimental studying
require
trode placements. It is only peniments that brain pathways
diagram not
we
use
evoked
verification
extrapolation
of
from
tigial
nucleus
is
to
mistaken
the
earlier
papers
by
We too were
(2).
These
well-known anatomists, University. Turner contests were
Fink-Heimen
less than
and
the
Tulane
University
Studies
University Press, 1954 Heath RG, Harper JW: Ascending tigial nucleus to the hippocampus,
2.
lobe sites: evoked cats.
Exp
potential
Neurol
Department
in Schizophrenia.
45:268
projections amygdala,
studies
in monkeys
HEATH,
G.
M.D.,
D.M.S’I.
New
for Tardive
animal
and
1974
ROBERT
Surgery
Harvard
of the cenebellar fasand other temporal
and histological 287,
of Psychiatry
Cambridge,
Orleans,
La.
Dyskinesia?
SIR: Recently. a patient of mine underwent a right colectomy. Subsequently hen tandive dyskinesia of several years’ duration disappeared. Hen surgeon, Kenneth L. Wiebe, M.D. (650 Hobson Way, Oxnard, Calif. 93030), told me that the only nerves tnanssected in the surgery were the autonomic nerves leading to the right colon. Preanesthesia included atropine and pentobanbital. Dr. Wiebe told me that he would be glad to comespond with interested individuals.
poJOHN
M.D.
ACKERMAN,
M.
Santa
cx-
findings
have
satisfied
What
Should
including
Dr.
demonstrated
in
look at the results
Barbara,
Calif
studies
and
by
with our early
photographs.
working continuously to improve them. Dr. aware of the difficulties in the Fink-Heimen as its superiority for demonstrating axonal
Test?
APA
is
pressure toward some to me that we should
and conclusions
reported
kind take
by Hugh
appears
that
a great
the
developers
of knowledge
deal
of
the
gained
test
of the
assumed
during
of pena hard
T. Canmi-
M.D., and associates in their article “Results Self-Assessment Program” (June 1974 issue).
It
degeneration
Reassessments
SIR: In view of the general odic reassessment, it seems chad,
been
evoked potential techniques. Subsequently. there have been neports of the anatomic connection between the fastigial nucleus and pants of the limbic system, some of which were prompted by our original studies. (Abstracts ofthese reports appear in the program of the October 20 -24, 1974, meeting of the Society for Neunoscience, which is located at 9650 Rockville Pike, Bethesda, Md. 20014.) The fact that Dr. Turner is ‘unaware of these pathways does not mean that they do not exist. Had they been known and descnibed in textbooks previously, it would have been purposeless for us to demonstrate them and report them in the literature. The connection between the interpeduncular nucleus and the septal region by way of the medial forebrain bundle has been cited in the literature and is generally accepted. Almost all of the studies on self-stimulation allude to this pathway, since it is important in the reward (self-stimulation) mechanism of animals. and we have been Turner is no doubt technique, as well
RG,
Neurology:
in
hippocampus
demonstrated to some Fred Mettler ofColumbia Other pathways Dr.
and
dcc-
have been postulated in man. several of his points about anatomic pathways. Connections from the septal region to the yentral lateral thalamus have been demonstrated in our laboratonies by degeneration studies and by evoked potential techniques. (These studies were referenced in our article.) In addition, we have published a paper demonstrating connections from the fas-
Dr. Turner
1. Heath
1972
that
residency
there
that
gradually authors
lost oven the years after completion of training. talk of a gradual falloff in psychiatric knowledge attempts to demonstrate “blind spots” in the knowledge
their
practicing I
psychiatrists.
thought
which
is not
scious
that
is The in of
falls
the
we could
we all agreed
that
used
life
in
rather
rapidly
conclusions
show
daily
oven
drawn
that
retention on
incorporated
a period
oftime.
by the authors
psychiatrists
of factual into
It would
would
as a group
knowledge the uneonfollow
be valid
practice
only
if
in the same
way that residents do at the completion of training. Only under those circumstances would something analogous to the Amencan Board of Psychiatry and Neurology exam have very much meaning. However, if it is the ease that psychiatrists quite generally get involved in some specific aspect of the specialty, e.g., psychoanalysis,
forensic
mental health, tual knowledge
This
would,
psychiatry,
child
psychiatry,
then we might expect compared with the
however,
crease ofknowledge could assume that and less.
be accompanied
in the particular psychiatrists learn
AmJ
Psychiatry
or
community
a certain attrition end of residency
of factraining.
by a corresponding area ofexpertise. more and more
/32:3,
March
/975
Thus, about
inwe less
299
Dr. Heath
Replies
Dr. Turner
points.
We onigi-
definition, lished in 1954 in Studies in Schi:ophrenia(I), was on the basis of its function. None of the data from
first pubformulated our contin-
uing
the
SIR:
nated
the
term
studies
makes “septal
with
some
provocative
region,”
human
and
and
the
animal
subjects
over
past
THE
EDITOR
degeneration and degenerating terminals. Staining of normal axons is often very similar to that of degenerating axons. With considerable work and experimentation, we are now able to more cleanly distinguish between normal and degenerating axons.
20
has indicated that the original definition was inaccurate. In 1954, the boundaries of this large and heterogeneous brain region were precisely defined. Its caudal aspect is the anterior commissure, its rostral aspect is the tip of the anterior horn of the lateral ventricles, its lateral bonder includes some of the yentro-medial aspect of what is conventionally considered to be pant of the caudate nucleus, its medial border is the midline, its dorsal extent is the septum pellucidum, and its ventral aspect is the orbital cortex. I think Dr. Turner is mistaken in applying the term “septal region” to the septum pellucidum. To the best of my knowledge. “septal region” has never been used synonomously with “septum pellucidum” in primates. As one moves up the phylogenetic scale, the gray matter between the anterior horns of the lateral ventricle in lower species moves forward and downward. Some but not all of the specific nuclei of the septal region were cited in my original definition. Early studies suggested that this heterogeneous region functioned as a unit, and subsequent stud-
TO
REFE
R EN C ES
years
ies
have
supported
this
Dr. Turner
contention.
criticizes
ways-pathways
that
experimentally
mapped
ducing
a lesion
and
cannot
be
tential
techniques
applied
our
schematic
obviously
have
in man. subsequently
to patients’ that
brains,
non
can
histologic by
of brain
path-
and could not be techniques for inaxonal degeneration
been
Experimental studying
require
trode placements. It is only peniments that brain pathways
diagram not
we
use
evoked
verification
extrapolation
of
from
tigial
nucleus
is
to
mistaken
the
earlier
papers
by
We too were
(2).
These
well-known anatomists, University. Turner contests were
Fink-Heimen
less than
and
the
Tulane
University
Studies
University Press, 1954 Heath RG, Harper JW: Ascending tigial nucleus to the hippocampus,
2.
lobe sites: evoked cats.
Exp
potential
Neurol
Department
in Schizophrenia.
45:268
projections amygdala,
studies
in monkeys
HEATH,
G.
M.D.,
D.M.S’I.
New
for Tardive
animal
and
1974
ROBERT
Surgery
Harvard
of the cenebellar fasand other temporal
and histological 287,
of Psychiatry
Cambridge,
Orleans,
La.
Dyskinesia?
SIR: Recently. a patient of mine underwent a right colectomy. Subsequently hen tandive dyskinesia of several years’ duration disappeared. Hen surgeon, Kenneth L. Wiebe, M.D. (650 Hobson Way, Oxnard, Calif. 93030), told me that the only nerves tnanssected in the surgery were the autonomic nerves leading to the right colon. Preanesthesia included atropine and pentobanbital. Dr. Wiebe told me that he would be glad to comespond with interested individuals.
poJOHN
M.D.
ACKERMAN,
M.
Santa
cx-
findings
have
satisfied
What
Should
including
Dr.
demonstrated
in
look at the results
Barbara,
Calif
studies
and
by
with our early
photographs.
working continuously to improve them. Dr. aware of the difficulties in the Fink-Heimen as its superiority for demonstrating axonal
Test?
APA
is
pressure toward some to me that we should
and conclusions
reported
kind take
by Hugh
appears
that
a great
the
developers
of knowledge
deal
of
the
gained
test
of the
assumed
during
of pena hard
T. Canmi-
M.D., and associates in their article “Results Self-Assessment Program” (June 1974 issue).
It
degeneration
Reassessments
SIR: In view of the general odic reassessment, it seems chad,
been
evoked potential techniques. Subsequently. there have been neports of the anatomic connection between the fastigial nucleus and pants of the limbic system, some of which were prompted by our original studies. (Abstracts ofthese reports appear in the program of the October 20 -24, 1974, meeting of the Society for Neunoscience, which is located at 9650 Rockville Pike, Bethesda, Md. 20014.) The fact that Dr. Turner is ‘unaware of these pathways does not mean that they do not exist. Had they been known and descnibed in textbooks previously, it would have been purposeless for us to demonstrate them and report them in the literature. The connection between the interpeduncular nucleus and the septal region by way of the medial forebrain bundle has been cited in the literature and is generally accepted. Almost all of the studies on self-stimulation allude to this pathway, since it is important in the reward (self-stimulation) mechanism of animals. and we have been Turner is no doubt technique, as well
RG,
Neurology:
in
hippocampus
demonstrated to some Fred Mettler ofColumbia Other pathways Dr.
and
dcc-
have been postulated in man. several of his points about anatomic pathways. Connections from the septal region to the yentral lateral thalamus have been demonstrated in our laboratonies by degeneration studies and by evoked potential techniques. (These studies were referenced in our article.) In addition, we have published a paper demonstrating connections from the fas-
Dr. Turner
1. Heath
1972
that
residency
there
that
gradually authors
lost oven the years after completion of training. talk of a gradual falloff in psychiatric knowledge attempts to demonstrate “blind spots” in the knowledge
their
practicing I
psychiatrists.
thought
which
is not
scious
that
is The in of
falls
the
we could
we all agreed
that
used
life
in
rather
rapidly
conclusions
show
daily
oven
drawn
that
retention on
incorporated
a period
oftime.
by the authors
psychiatrists
of factual into
It would
would
as a group
knowledge the uneonfollow
be valid
practice
only
if
in the same
way that residents do at the completion of training. Only under those circumstances would something analogous to the Amencan Board of Psychiatry and Neurology exam have very much meaning. However, if it is the ease that psychiatrists quite generally get involved in some specific aspect of the specialty, e.g., psychoanalysis,
forensic
mental health, tual knowledge
This
would,
psychiatry,
child
psychiatry,
then we might expect compared with the
however,
crease ofknowledge could assume that and less.
be accompanied
in the particular psychiatrists learn
AmJ
Psychiatry
or
community
a certain attrition end of residency
of factraining.
by a corresponding area ofexpertise. more and more
/32:3,
March
/975
Thus, about
inwe less
299
