The control of muscle tone, reflexes, and movement

My pleasure at being invited to give the Wartenberg lecture this year was enhanced by the admiration I hold for the writings of Wartenberg, who pruned the eponymous tree in which so many clinicians of the past had sought to roost forever. Vast numbers of named reflexes evoked by stroking, squeezing, or tapping some bodily appendage were shown to be different ways of testing the same mechanism.’S2 Wartenberg’s analysis simplified neurology by clearing away unnecessary and confusing terminology. Robert Wartenberg was born in the Russian city of Grodno in 1887, graduated in medicine with distinction from the University of Rostock in Germany and became Physician-in-Chief of the Nerve Clinic in Freiburg before fleeing from Germany in the dark days of 193!X3 For 20 years, until his death in 1956, Wartenberg served American neurology well, becoming Clinical Professor of Neurology at the University of California School of Medicine, San Francisco, in 1952. He was a fellow of the American Academy of Neurology and an associate editor of Neurology. To those who knew him, he combined precision of thought and a sharp critical faculty with a capacity for warmth and humor. Dr. Robert Aird recalls his rejecting compromise with the zestful cry “By the great Babinski, Professor Sigvald Refsum told me of an occasion when Wartenberg was demonstrating the physical signs of a patient with double athetosis. Wartenberg commented that the patient’s facial movements resembled those of someone chewing gum. He was startled when the patient said, “But I am chewing gum,” removing the gum from his mouth and displaying it to the laughing audience. Wartenberg promptly retorted, “Then this is double double athetosis.” In honored memory of such a man, it is my privilege to dedicate this lecture. My own interest in neurology was aroused as a medical student because the explanation of many physical signs did not ring true. Was spasticity really the same as decerebrate rigidity? Was the cogwheel phenomenon in Parkinson disease caused by the combination of the classical tremor and rigidity when some patients did not have a perceptible tremor? How could degeneration of the dorsal columns abolish tendon jerks in Friedreich ataxia? Why did so many muscles contract when the radius was tapped in a spastic patient? My opportunity to study the motor system arrived when Dr. Peter Bishop, now Professor of Physiology in the Australian National University, Canberra, started a brain research unit in the University of Sydney and encouraged me to work on the pyramidal tract. The outcome of those early years was the finding of two groups of fibers with distinctive properties in the cat pyramidal tract,* the mapping of their origin from the ~ o r t e x , ~ their distribution in the cord6 and the fact that they made no attempt to regenerate after the pyramidal tract was sectioned.’ It is probable that the more slowly conducting group is related to the maintenance of posture and the rapidly conducting group to phasic movement8 but the interaction of the two groups may be comple~ .~