Highland Lodge,Kilkelly, County Mayo: An Autobiographical Sketch

Fragments of neurology can be found in the oldest medical writings in antiquity. Recognizable cerebral localization is seen in Egyptian medical papyri. Most notably, the Edwin Smith papyrus describes hemiplegia after a head injury. Similar echoes can be seen in Homer, the Bible, and the pre-Hippocratic writer Alcmaeon of Croton. While Biblical writers thought that the heart was the seat of the soul, Hippocratic writers located it in the head. Alexandrian anatomists described the nerves, and Galen developed the ventricular theory of cognition whereby mental functions are classified and localized in one of the cerebral ventricles. Medieval scholars, including the early Church Fathers, modified Galenic ventricular theory so as to make it a dynamic model of cognition. Physicians in antiquity subdivided the brain into separate areas and attributed to them different functions, a phenomenon that connects them with modern neurologists.     

Experimental and clinical studies of localisation before flourens

Abstract

Experimental studies in the localisation of brain function did not begin with Flourens, nor did clinical studies with the phrenologists or physicians like Auburtin, Bouillaud, or Dax, shortly afterward. Although the pre‐1820 literature is moderate, some of it is worth examining because of the problems associated with interpreting it.

There are three separate but related problems: philosophical, methodological, and conceptual. Philosophically, whether one saw the brain as the main organ of sensibility, as did the Hippocratic writers and Galen, or the heart, as did Aristotle, determined the attention given to the brain. The methodological problems arose from the gross structure of the brain not being immediately obvious and the dominant technique of dissecting the brain in transverse sections revealing the ventricles and their immediately associated structures more readily than other structures. Conceptually, the ventricles were seen as the sites through which sensations were transferred to the muscles. Observations relevant to localisation were thus related to the ventricles or to structures lying outside the cerebrum.

What are now considered major structural landmarks were not discovered until late: the Sylvian fissure in about 1640 and the fissure of Rolando in 1829, the former being dependent on new methods of dissection. In general, it was not until the first half of the nineteenth century that the cerebral structures were properly differentiated. Consequently, calls for comparative clinical studies of the effects of lesions in different parts of the brain inevitably fell on ears tuned to a framework which could not incorporate them. So, did the results of the earlier experimental studies.     

Experimental and clinical studies of localisation before Flourens

Experimental studies in the localisation of brain function did not begin with Flourens, nor did clinical studies with the phrenologists or physicians like Auburtin, Bouillaud, or Dax, shortly afterward. Although the pre-1820 literature is moderate, some of it is worth examining because of the problems associated with interpreting it. There are three separate but related problems: philosophical, methodological, and conceptual. Philosophically, whether one saw the brain as the main organ of sensibility, as did the Hippocratic writers and Galen, or the heart, as did Aristotle, determined the attention given to the brain. The methodological problems arose from the gross structure of the brain not being immediately obvious and the dominant technique of dissecting the brain in transverse sections revealing the ventricles and their immediately associated structures more readily than other structures. Conceptually, the ventricles were seen as the sites through which sensations were transferred to the muscles. Observations relevant to localisation were thus related to the ventricles or to structures lying outside the cerebrum. What are now considered major structural landmarks were not discovered until late: the Sylvian fissure in about 1640 and the fissure of Rolando in 1829, the former being dependent on new methods of dissection. In general, it was not until the first half of the nineteenth century that the cerebral structures were properly differentiated. Consequently, calls for comparative clinical studies of the effects of lesions in different parts of the brain inevitably fell on ears tuned to a framework which could not incorporate them. So, did the results of the earlier experimental studies.     

Vesalius on the Anatomy and Function of the Recurrent Laryngeal Nerves: Medical Illustration and Reintroduction of a Physiological Demonstration from Galen

The purpose of this article is to review the anatomical illustrations and physiological demonstrations of sixteenth-century Flemish-born anatomist and physician Andreas Vesalius concerning the recurrent laryngeal nerves. Although Vesalius was primarily an anatomist, he also used vivisection as a pedagogical device to help his students understand the function of structures within the fabric of the body that they had previously studied in anatomical detail. Vesalius’s masterwork, De humani corporis fabrica or simply the Fabrica (1543, 1555), was ostensibly an anatomy text, but Vesalius included textual and figural references to his use of vivisection to explicate the function of specific structures. Even as he began to criticize the errors in Galen’s anatomical works, Vesalius nevertheless adopted some of Galen’s classic physiological demonstrations, in particular the ligation (and subsequent release) of the recurrent laryngeal nerves of a pig to demonstrate their role in generating the pig’s squeal. Vesalius’s illustrations concerning the recurrent laryngeal nerve in the Fabrica were of two types: elegant anatomical woodcut plates—unsurpassed for their clarity, accuracy, and detail — and the distinctly inelegant historiated initial Q, depicting a throng of putti busily engaged in vivisecting a pig. Vesalius’ anatomical plates were heavily plagiarized while the historiated initials, showing the rough work of an anatomist or surgeon, were largely ignored and remain little recognized today. While Vesalius’ anatomical illustrations of the recurrent laryngeal nerves contained some errors, they were a dramatic departure from prior meager efforts at medical illustration and indeed far surpassed all contemporary published illustrations by others. Vesalius was also influential in reviving Galen’s approach to vivisection, at least for pedagogical purposes, if not really then yet as a full-fledged investigative technique.     

Louis Ranvier (1835-1922): the contribution of microscopy to physiology and the renewal of French general anatomy

The French neurohistologist Louis-Antoine Ranvier (1835-1922), somewhat neglected in classical histories of nineteenth-century studies on the nervous system, developed a personal style, traditionally referred to as a synthesis between histology and physiology. Ranvier's research was not centered on the brain. Rather, he remained attached to the intimate nature of minute structures, with a style marked by the concept of generality. Ranvier's original style and role in the development of French histology and anatomie générale are analyzed, and their significance evaluated. Ranvier is reassessed as a prominent figure and as the leader in the renewal of the French anatomy.     

Galen's ideas on neurological function

Galen was the leading physician of the Roman empire during the last half of the second century. Unlike some of his predecessors, Galen concluded that the brain controlled cognition and willed action. The initial evidence for this doctrine was that the brain was the site of termination of all of the five senses: touch, taste, smell, sight, and hearing. Galen presumed that the information from these five senses was organized by a part of the brain that generated a concept of an object common to all senses; this part of the brain he considered to be the area of common sense. Galen thought that he could differentiate sensory from motor nerves (not nerve fibers) by palpation. Sensory nerves were soft because they needed to be impressed with the essence of the object seen, heard, felt, smelled, or tasted. Motor nerve fibers were very hard because they needed to carry the force of the will from the brain to the muscles. Strong willed people had especially firm motor nerve fibers; hence, the modern term that a person with great bravery has 'nerves of steel'. Galen considered that common sense, cognition, and memory were functions of the brain. Personality and emotion were not generated by the brain, but rather by the body as a whole (or perhaps by the heart and liver). Galen's studies of respiration and of the recurrent laryngeal nerve solidified the knowledge that the brain, not the chest, was the site of the rational power that guides human behavior. This doctrine has continued from Galen's time to the present.     

Medieval Descriptions and Doctrines of Stroke: Preliminary Analysis of Select Sources. Part I: The Struggle for Terms and Theories - Late Antiquity and Early Middle Ages (300-800)

This first of a series of papers on the history of stroke presents an examination of a number of exemplary Greek and Latin sources, ranging from late antiquity to the dawn of the Middle Ages. We first establish a chronological order of various groups of texts and, whenever possible, ascertain the relationship of one group of writings to another. In the second century A.D., Galen had used the Hippocratic concept of humoral imbalance as a fundamental explanatory mechanism for the interpretation of clinical manifestations of apoplexy. Galen definitely rejected the Aristotelian precept of the primacy of the heart. According to his teaching, stroke resulted from the accumulation of a thick and dense humor in the ventricles of the brain blocking the passage of the animal spirit. Galen's Greek texts became axiomatic for compilers of the Byzantine period (Aetius of Amida, Alexander of Tralles, Paulus of Aegina). But his ideas contrasted starkly with the theories of the Methodical School which exerted – through the Latin writings of Caelius Aurelianus – a certain influence on authors of the Latin West (Cassius Felix, Theodorus Priscianus). References to stroke can also be found in many theological writings of the early Middle Ages.     

The search for a sixth sense: the cases for vestibular,muscle, and temperature senses

The five senses of sight, hearing, smell, taste, and touch, enumerated by Aristotle, were incremented in the early-nineteenth century by the muscle sense, multiple dimensions of touch, and a movement sense. Aristotle explicitly excluded a sixth sense, and five remains the number of senses in popular imagination. The division of touch into several sensations was entertained and rejected by Aristotle, but it was given anatomical, physiological and psychophysical support in the late-nineteenth century. A separate muscle sense was proposed in the late-eighteenth century, with experimental evidence to support it. However, before these developments, behavioral evidence of the vestibular (movement) sense was available from studies of vertigo, although it was not integrated with the anatomy and physiology of the labyrinth until the nineteenth century. The history of the search for a sixth sense is outlined, and the evidence adduced to support the divisions is assessed. Behavioral evidence generally has been accorded less weight than that from anatomy and physiology.     

The Search for a Sixth Sense: The Cases for Vestibular,Muscle, and Temperature Senses

The five senses of sight, hearing, smell, taste, and touch, enumerated by Aristotle, were incremented in the early-nineteenth century by the muscle sense, multiple dimensions of touch, and a movement sense. Aristotle explicitly excluded a sixth sense, and five remains the number of senses in popular imagination. The division of touch into several sensations was entertained and rejected by Aristotle, but it was given anatomical, physiological and psychophysical support in the late-nineteenth century. A separate muscle sense was proposed in the late-eighteenth century, with experimental evidence to support it. However, before these developments, behavioral evidence of the vestibular (movement) sense was available from studies of vertigo, although it was not integrated with the anatomy and physiology of the labyrinth until the nineteenth century. The history of the search for a sixth sense is outlined, and the evidence adduced to support the divisions is assessed. Behavioral evidence generally has been accorded less weight than that from anatomy and physiology.     

Instrument transfer as knowledge transfer in neurophysiology: François Magendie's (1783-1855) early attempts to measure cerebrospinal fluid pressure

Fran?ois Magendie's (1783-1855) experimental model for measuring blood pressure in animals, which he developed in 1838, had a major impact on French physiology in the nineteenth century, especially upon Etienne-Jules Marey (1830-1904) in Paris. In due course it was also adopted by other European investigators, such as the Leipzig physiologist Carl Ludwig (1816-1895), and by clinicians who developed it into a major measuring tool. Historians of science, however, have paid hardly any attention to Magendie's further laboratory investigations conducted with the assistance of Jean-Louis Marie Poiseuille's (1799-1869) sphygmomètre (blood pressure meter). After having used the apparatus to conduct his experiments on a variety of blood vessels, Magendie also applied the sphygmomètre in 1840 to the ventricular system of the brain in order to measure cerebrospinal fluid (CSF) pressure. But the scope of this new procedure had yet to be defined: the new measuring device invited many speculative interpretations about the meaning of CSF flow for the physiology of the ventricular system in healthy and diseased brain function. As such, Magendie's experiments produced phenomena in very heterogeneous knowledge areas, and CSF measurement was situated at the interface of quite disparate investigative spaces regarding the structure and function of the brain. In his textbook Le?ons sur les Fonctions et les Maladies du Système Nerveux (Lectures on the Functions and Diseases of the Nervous System), Magendie described extending application of the measuring "apparatus of Poiseuille" from blood vessels to parts of the brain. The instrument thus became something of a liquidodynamomètre (liquor dynamometer), that paved the way for later applications, including (after 1896) diagnostic intracranial pressure (ICP) measurement by Theodor Kocher (1841-1917) and Harvey Cushing (1869-1939). The current paper focuses on the experimental contingencies that prompted the instrument transfer in Magendie's laboratory and opened up new epistemological perspectives for research in neurophysiology.     

Vladimir Mikhailovich Bekhterev

V.M. Bekhterev (1857-1927) was an outstanding Russian neurologist, psychiatrist, psychologist, morphologist, physiologist, and public figure, who authored over 1000 scientific publications and speeches. At the beginning of the twentieth century he created a new multidimensional multidisciplinary scientific branch - psychoneurology, which included the objective knowledge of the anatomy and physiology of the nervous system, psychology, psychiatry, neurology, philosophy, sociology, pedagogy, and other disciplines. Psychoneurology in V.M. Bekhterev's understanding has furthered the introduction into the idea of a "biosocial" essence of man of a third - psychological - component, thus having created a "biopsychosocial" model in the interpretation of human diseases.     

Some contributions of Robert Bentley Todd

A Dubliner by birth and education, Robert Bentley Todd (1809-1860) settled in London, achieving success as physician and educator. He was professor of anatomy and physiology at King's College, and a founder of King's College Hospital. His publications were numerous; he edited a Cyclopaedia of Anatomy and Physiology in which he introduced the terms afferent and efferent and pointed to the location of the major lesion of tabes dorsalis. He described postictal paralysis in his Lumleian Lectures (1849); the features of "Todd's paralysis" are discussed. He appeared for the prosecution at the Smethurst murder trial (1859). He prescribed wine and brandy copiously for fevers.     

Instrument Transfer as Knowledge Transfer in Neurophysiology: François Magendie's (1783–1855) Early Attempts to Measure Cerebrospinal Fluid Pressure

François Magendie's (1783–1855) experimental model for measuring blood pressure in animals, which he developed in 1838, had a major impact on French physiology in the nineteenth century, especially upon Etienne-Jules Marey (1830–1904) in Paris. In due course it was also adopted by other European investigators, such as the Leipzig physiologist Carl Ludwig (1816–1895), and by clinicians who developed it into a major measuring tool. Historians of science, however, have paid hardly any attention to Magendie's further laboratory investigations conducted with the assistance of Jean-Louis Marie Poiseuille's (1799–1869) sphygmomètre (blood pressure meter). After having used the apparatus to conduct his experiments on a variety of blood vessels, Magendie also applied the sphygmomètre in 1840 to the ventricular system of the brain in order to measure cerebrospinal fluid (CSF) pressure. But the scope of this new procedure had yet to be defined: the new measuring device invited many speculative interpretations about the meaning of CSF flow for the physiology of the ventricular system in healthy and diseased brain function. As such, Magendie's experiments produced phenomena in very heterogeneous knowledge areas, and CSF measurement was situated at the interface of quite disparate investigative spaces regarding the structure and function of the brain. In his textbook Leçons sur les Fonctions et les Maladies du Système Nerveux (Lectures on the Functions and Diseases of the Nervous System), Magendie described extending application of the measuring “apparatus of Poiseuille” from blood vessels to parts of the brain. The instrument thus became something of a liquidodynamomètre (liquor dynamometer), that paved the way for later applications, including (after 1896) diagnostic intracranial pressure (ICP) measurement by Theodor Kocher (1841–1917) and Harvey Cushing (1869–1939). The current paper focuses on the experimental contingencies that prompted the instrument transfer in Magendie's laboratory and opened up new epistemological perspectives for research in neurophysiology.     

A History of Depressed Skull Fractures from Ancient Times to 1800

The story of managing depressed fractures illustrates how knowledge of proven value does not always get handed down. Celsus was the first to describe sensible management for depressed fractures. As he wrote in Latin this was forgotten. Galen’s Greek writings survived forming the basis of management until the sixteenth century. In 1517, Hans von Gersdorff published a formidable illustrated surgical text. One illustration depicts an instrument for elevating depressed bone fragments. It looked dramatic but could not work and its defects were finally defined in the eighteenth century. Ambroise Paré used a bone punch just as we do today, but no later surgeon mentions this, though the instrument was well known. Elements of chance, fashion, emotionally powerful illustrations, and perhaps stubbornness had a profound effect on management delaying rational treatment for centuries.     

A history of anatomy theaters in sixteenth-century Padua

The history of anatomy includes not only professors and the support of their institutions but also medical students. Because medical students were quick to assess a teacher's pedagogy, their complaints tell us a great deal about the transition from Galenic to Aristotelian projects of anatomy. When Fabricius of Aquapendente instituted a new style of anatomical inquiry, one based on Aristotle and the search for universal principles, students repeatedly complained that his demonstrations did not provide technical education in structural anatomy (as demonstrations employing a hands-on, Galenic pedagogy did). Within the new anatomy theater (the second of its kind in Padua), however, students were persuaded to accept Fabricius's demonstrations. Fabricius's philosophical orientation combined with the formal atmosphere and aesthetic features of the new theater to create anatomy demonstrations that relied on orations and music for their structure (rather than on the progressive stages of human dissection). A place that emphasized a discourse of anatomy as the study of the "secrets of nature," the new theater so effectively publicized a new style of anatomy that a larger, more diverse group of spectators attended subsequent demonstrations and participated in the celebration of leading academic figures as well as the institution of the university.     

Midwives as expert witnesses in the 18th-century Finnish courts of justice

ABSTRACT

In this article, I will explore how legalized Finnish midwives acted as expert witnesses in court hearings before 1809, how they worded the statements they gave in court, on what grounds they decided a woman was pregnant or had given birth, and what signs they considered as indicating a miscarriage or the birth of a full-term infant. Their work as expert witnesses relied on their midwifery training as well as their learned knowledge of the anatomy of the female body and the physiology of birth. Ultimately, their knowledge was supported by contemporary guidebooks on midwifery and forensic medicine. As expert witnesses, the trained and legalized midwives of the eighteenth century can be seen as having been legally literate women, who had a duty to provide oral or written evidence to the court and other instances who demanded it. Midwives were capable of using understandable medical and legal terminology in terms of the processing of the court case in their testimony. The forensic examinations carried out by legalized midwives and the expert witness statements they gave also demonstrate the professional skills and expertise of these women.. Their testimonies also show that they were familiar with the characteristics of infanticide referred to in the Swedish medical and forensic literature.