Founding years of clinical neurology in Berlin until 1933

During the so-called "Gründerjhare" or "founding years" in Berlin it became necessary to build new hospitals because of the rapid growth of population. As a result, several infirmaries, asylums for the insane and institutions for epileptics were build between 1877 and 1912. The new building of the University of Neuropsychiatric Clinic ("Nervenklinik") of the Charité was opened in 1905 according to plans made by Friedrich Jolly (1844-1904), the physician who named myasthenia gravis pseudoparalytica. A "Neurological Central Station", under the direction of Oskar and Cecil Vogt, in existence since 1898, was a research center dedicated more to morphology. There the study of the structure of the cerebral cortex by Korbinian Brodmann (1868-1925) and research into basal ganglia diseases by the Vogts began. The Kaiser-Wilhelm Institute for Cerebral Research, which moved into a new building in 1931, also had its origin here. Hermann Oppenheim (1858-1919) promoted independent clinical neurology, as did his younger contemporary, Max Lewandowsky (1876-1918), who was already advising physician for neurology at the Berlin-Friedrichshain Hospital. Hug Liepmann (1863-1925), the creator of apraxia theory, worked at the asylums for the insane in Dalldorf (Berlin-Wittenau) and Berlin-Herzberge. In 1911, the first neurological unit was established in the large hospital in Berlin-Buch under the direction of Otto Maas. Not until after World War I were further neurological hospital units founded, under the direction of Paul Schuster (1867-1940), Kurt Goldstein (1878-1965), Kurt L?wenstein (died in 1953) and Friedrich Heinrich Lewy (1885-1950). These Jewish physicians, as well as C.E. Benda and Otto Maas, had to leave their posts in 1933 and emigrate. The clinical institutions and scientific achievements of these pioneers of independent clinical neurology will be presented up to the point of its violent dissolution.     

Yorkshire’s influence on the understanding and treatment of mental diseases in Victorian Britain: The golden triad of York,Wakefield, and Leeds

In the late-eighteenth and nineteenth centuries, a more humane approach to the care of the insane in Britain was catalyzed in part by the illness of King George III. The Reform Movement envisaged “moral” treatment in asylums in pleasant rural environments, but these aspirations were overwhelmed by industrialization, urbanization, and the scale of the need, such that most asylums became gigantic institutions for chronic insanity. Three institutions in Yorkshire remained beacons of enlightenment in the general gloom of Victorian alienism: the Retreat in York founded and developed by the Quaker Tuke family; the West Riding Lunatic Asylum in Wakefield led by Sir James Crichton-Browne, which initiated research into brain and mental diseases; and the Leeds Medical School and Wakefield axis associated with Sir Thomas Clifford Allbutt, which pioneered teaching of mental diseases and, later, the first Chair of Psychiatry. Three other Yorkshiremen who greatly influenced nineteenth-century “neuropsychiatry” in Britain and abroad were Thomas Laycock in York and Edinburgh, and Henry Maudsley and John Hughlings Jackson in London.     

Neurognostics Answer

Although many individuals contributed to the development of the science of cerebral localization, its conceptual framework is the work of a single man—John Hughlings Jackson (1835–1911), a Victorian physician practicing in London. Hughlings Jackson's formulation of a neurological science consisted of an axiomatic basis, an experimental methodology, and a clinical neurophysiology. His axiom—that the brain is an exclusively sensorimotor machine—separated neurology from psychiatry and established a rigorous and sophisticated structure for the brain and mind. Hughlings Jackson's experimental method utilized the focal lesion as a probe of brain function and created an evolutionary structure of somatotopic representation to explain clinical neurophysiology. His scientific theory of cerebral localization can be described as a weighted ordinal representation. Hughlings Jackson's theory of weighted ordinal representation forms the scientific basis for modern neurology. Though this science is utilized daily by every neurologist and forms the basis of neuroscience, the consequences of Hughlings Jackson's ideas are still not generally appreciated. For example, they imply the intrinsic inconsistency of some modern fields of neuroscience and neurology. Thus, “cognitive imaging” and the “neurology of art”—two topics of modern interest—are fundamentally oxymoronic according to the science of cerebral localization. Neuroscientists, therefore, still have much to learn from John Hughlings Jackson.     

A Note on Marinus of Alexandria

Abstract

Neurology in its modern sense was first studied in the well‐known neurological institutions of France and England. In America, however, this new field of medicine was developed by a physician in a private practice, Dr. William Alexander Hammond. This article addresses the question how Hammond was able to limit his practice to neurology. It is argued that Hammond was a famous military physician before becoming the first practitioner of clinical neurology in America. This fame translated into a large referral base.     

‘On mind‐blindness (optic agnosia)’, a classical clinico‐pathological report,and its author Wilhelm von Stauffenberg (1879–1918)*

Abstract

Two photographs from the beginning of our century still instructively illustrate the phenomenon of visual agnosia: the perplexed face of an old lady confronted with objects clears after touching them. This patient with bilateral posterior cerebral infarction was followed for seven years at the Munich Medicine Department of Friedrich von Müller (1858–1941) who had a strong interest in neurology. His assistant Wilhelm von Stauffenberg (1879–1918) reported the case in great detail, including anatomical analysis performed under Constantin von Monakow (1853–1930). Promoted to “Privatdozent”; in 1913 on the basis of this report, Stauffenberg's work included several additional, similarly extensive clinico‐anatomical case studies but was not limited to problems of cerebral localisation. Under the influence of the Burghölzli group in Zürich he started to practice psychotherapy. Stauffenberg, deeply interested also in the arts and in literature, was the physician of the poet Rainer Maria Rilke (1875–1926) from 1914. He succumbed to pneumonia in 1918.     

The first career of William Alexander Hammond

Neurology in its modern sense was first studied in the well-known neurological institutions of France and England. In America, however, this new field of medicine was developed by a physician in a private practice, Dr. William Alexander Hammond. This article addresses the question how Hammond was able to limit his practice to neurology. It is argued that Hammond was a famous military physician before becoming the first practitioner of clinical neurology in America. This fame translated into a large referral base.     

William Rutherford Sanders (1828–1881) and his neurologically fertile years (1865–1868)

ABSTRACT

William Rutherford Sanders (1828–1881) was an Edinburgh physician who occupied the Chair of Pathology at the University of Edinburgh from 1869 to 1881. All of his published output between 1865 and 1868 was concerned with neurology. In arguing that a patient did not have paralysis agitans, Sanders (1865) employed the term “Parkinson’s disease” for the first time in the English-language literature to distinguish between the disorder that Parkinson (1817) termed “paralysis agitans” and other types of shaking palsies. He contributed a major chapter on the same topic to Russell Reynolds’s A System of Medicine (1868). Sanders also investigated the innervation of the palate and facial muscles (1865), and in 1866 recorded the autopsy findings in two cases of aphasia. Here, for the first time in the English-language literature, he described findings that supported Broca’s location of the representation of speech to a particular area of the left cerebral hemisphere.     

Three Twentieth-Century Multiauthored Neurological Handbooks – A Historical Analysis and Bibliometric Comparison

The emergence of neurology as a separate specialty from internal medicine and psychiatry took several decades, starting at the end of the nineteenth century. This can be adequately reconstructed by focusing on the establishment of specialized journals, societies, university chairs, the invention and application of specific instruments, medical practices, and certainly also the publication of pivotal textbooks in the field. Particularly around 1900, the German-speaking countries played an integral role in this process. In this article, one aspect is extensively explored, notably the publication (in the twentieth century) of three comprehensive and influential multivolume and multiauthor handbooks entirely devoted to neurology. All available volumes of Max Lewandowsky's Handbuch der Neurologie (1910–1914) and the Handbuch der Neurologie (1935–1937) of Oswald Bumke and Otfrid Foerster were analyzed. The handbooks were then compared with Pierre Vinken's and George Bruyn's Handbook of Clinical Neurology (1968–2002).

Over the span of nearly a century these publications became ever more comprehensive and developed into a global, encompassing project as is reflected in the increasing number of foreign authors. Whereas the first two handbooks were published mainly in German, “Vinken & Bruyn” was eventually published entirely in English, indicating the general changes in the scientific language of neurology after World War II. Distinctions include the uniformity of the series, manner of editorial involvement, thematic comprehensiveness, inclusion of volume editors in “Vinken & Bruyn,” and the provision of index volumes. The increasing use of authorities in various neurological subspecialties is an important factor by which these handbooks contrast with many compact neurological textbooks that were available at the time.

For historiographical purposes, the three neurological handbooks considered here were important sources for the general study of the history of medicine and science and the history of neurology in particular. Moreover, they served as important catalyzers of the emergence of neurology as a new clinical specialty during the first decades of the twentieth century.     

FRUSTRATED SEXUALITY IN ROBERT KROETSCH'S THE STUDHORSE MAN

Robert Kroetsch's The Studhorse Man is not simply the “passionate and comic celebration of fertility–in man and beast” that the paperback cover promises. In fact, generative impulses are regularly misdirected or thwarted, and the course of true sex never does run smooth. From the beginning of the book (saved and seduced by Polly Cockburn) to the end (saved and seduced by Marie Eshpeter), Hazard Lepage, the studhorse man, is a man more laid against than laying, a man whose entanglements are more often an ordeal than an adventure. And even though the thirteen year engagement to the voluptuous Martha Proudfoot comes, finally, to its long-fantasied conclusion, that climax begins with Hazard “on ice”–ostensibly dead–and ends with Demeter, the “professionally” insane narrator of the novel, prompted to action, an action that entails Hazard's actual death. Furthermore, the studhorse man mismanages the affairs of his studhorse almost as pervasively as he mismanages his own. The only local practitioner of his trade, he still cannot find “one farm with a mare that wanted covering.” The very survival of the Lepage horse is at stake. Yet Hazard's attempts to achieve his chief objective are comically inept. For example, at one point, dickering for a necessary mare, Hazard mistakenly trades away his stallion. Yet Demeter, eighteen, inept, and certifiably insane, easily supplies Poseidon with suitable mares, and the oafish Eugene Utter sees how many more can be provided. But even here Hazard is thwarted. Poseidon becomes the “busiest creature in Alberta” not to produce more Lepage horses but to turn every available mare into a PMU (Pregnant Mare's Urine) producing machine.     

"Confinement of the higher orders": the social role of private lunatic asylums in Ireland, C. 1820-60

The period 1820-60 marked an era of transition and diversity in Ireland that rapidly transformed the face of Irish society. Inextricably linked with these processes was the expansion of Ireland's private asylum system. This system diverged from its British counterpart both in the socioeconomic cohort it served and in the role it played within the mental health-care system as a whole. The implementation of the 1842 Private Asylums (Ireland) Act, the first legislative measure geared exclusively toward the system, highlighted the growing importance of private care in Ireland as well as providing for the licensing and regulation of these institutions for the first time. To date, historians of Irish medicine have focused almost exclusively on the pauper insane. This article aims to shift this emphasis toward other categories of the Irish insane through exploration of the Irish private asylum system, its growth throughout the period, and the social profile of private patients. I shall also interrogate the trade in lunacy model through exploration of financial considerations, discharge and recovery rates, and conditions of care and argue that while Irish private institutions were a lucrative business venture, the quality of care upheld was apparently high. Finally, I shall argue that Irish private asylums catered primarily for the upper classes and briefly explore alternative provisional measures for other non-pauper sectors of society.     

Hallucinations and Pathological Visual Perceptions in Maupassant's Fantastical Short Stories- A Neurological Approach

Maupassant excelled as a realist writer of the nineteenth century, with fantastical short stories being an outstanding example of his literary genius. We have analysed four of his fantastical stories from a neurological point of view. In “Le Horla,” his masterpiece, we have found nightmares, sleep paralysis, a hemianopic pattern of loss and recovery of vision, and palinopsia. In “Qui sait” and in “La main” there is also an illusory movement of the objects in the visual field, although in a dreamlike complex pattern. In “Lui,” autoscopy and hypnagogic hallucinations emerge as fantastical key elements.

The writer suffered from severe migraine and neurosyphilis involving the optic nerve, which led to his death by general paralysis of the insane (GPI). Visual loss and visual hallucinations affected the author in his last years, before a delirant state confined him to a nursing home. Our original hypothesis, which stated that he could have translated his sensorial experiences coming from this source to his works, had to be revised by analyzing some of his earliest works, notably “Le Docteur Héraclius Gloss” and “La main d’écorché” (1875). We found hallucinatory symptoms, adopting the form of autoscopy and other elaborated visual misperceptions, in stories written at age 25, when Maupassant was allegedly healthy. Therefore, we hypothesize that they may be related to his hypersensitive disposition, assuming that no pathology is necessary to experience such vivid experiences. In addition, Maupassant's abuse of drugs, as illustrated in “Rêves,” could have provided an additional element to outline his painstaking visual depictions. All these factors, in addition to his up-to-date neurological knowledge and attendance at Charcot's lectures at “La Salpêtrière,” armed the author for repetitive and enriched hallucinatory experiences, which were transferred relentlessly into his works from the beginning of his career.     

Anthropological Neurology: Symptoms and Their Meanings According to Joseph Prick (1909–1978)

This article describes the life and work of the Dutch neurologist Joseph Prick (1909–1978) and his idea of an anthropological neurology. According to Prick, neurological symptoms should not only be explained from an underlying physico-chemical substrate but also be regarded as meaningful. We present an outline of the historical and philosophical context of his ideas with a focus on the theory of the human body by the French philosopher Maurice Merleau-Ponty (1908–1961) and the concept of anthropology-based medicine developed by Frederik Buytendijk (1887–1974). We give an overview of anthropological neurology as a clinical practice and finally we discuss the value of Prick's approach for clinical neurology today.     

The Conservative Critique of the Enlightenment: The Limits of Social Engineering

The conservative, mainly Anglo-Saxon, critique of “social engineering” in Enlightenment thinking, which goes back to Edmund Burke and David Hume, among others, has recently resurfaced in the works of Michael Oakeshott, Roger Scruton, and Friedrich Hayek. This article focuses on their conservative critiques and more specifically on two common issues: the unintended negative consequences of political planning, and the institutions in civil society that act as a positive counterpart to this form of engineering.     

Frank Clifford Rose Memorial Lecture: The tale of three trephines: Surgeons and their surgical-instrument makers in Britain,France, and America in the nineteenth century

ABSTRACT

Trephines and trepanning date to ancient times, but a “modern” form of instruments was codified by the seventeenth century. This did not preclude efforts to “improve” the trephine in the late-eighteenth and nineteenth centuries. Surgeons and instrument makers in Britain (Jardine and Savigny), France (Thomson and Charrière), and America (Galt and Otto & Reynders) endeavored to make the trephine safer and more precise. In exploring their interactions, this presentation shows the evolving role of the instrument makers not only as fabricators of tools, but as creative design collaborators of surgeons and physicians.     

More than a Disease: The History of General Paralysis of the Insane in Turkey

This article explores the history of general paralysis of the insane (GPI) and its treatment in Turkey. GPI was considered as “a disease of civilization” at the end of the nineteenth century. From the early years of the twentieth century, Turkish psychiatrists discussed and interpreted the causes of GPI and followed the European diagnostic and treatment methods of the disease. Austrian psychiatrist Julius Wagner-Jauregg (1857–1940) introduced and developed “malaria fever therapy” for general paralysis in 1917. Malaria fever therapy spread to other countries and, during the 1920s, the treatment was also used in Turkey. This article not only aims to illuminate an unnoticed aspect of the history of psychiatry in Turkey but also uses GPI as a model to illustrate how psychiatry in Turkey was influenced by the developments in Europe.     

Carl J. Friedrich's Legacy: Understanding Constitutionalism as a Political System

Carl J. Friedrich (1901–1984) defined constitutionalism as something more than can be expressed by the dominant behavioralist paradigm of modern political science and the typical academic focus on law and courts. A leading but now neglected post-WWII authority on constitutionalism, Friedrich argued that it should be understood as an institutionally-based, interactive system for deliberating the meaning and legal application of the norms of a political community. His approach shares much with the contemporary “historical institutionalist” call to situate law and courts within a broader, more normative, and more interactive conception of constitutionalism. Accordingly, a reconsideration of Friedrich's work may help current efforts to better articulate the full richness and complexity of constitutionalism as a distinctive way of ordering political life.     

Bishop Bickersteth’s Visitation Returns for the Archdeaconry of Craven,Diocese of Ripon, 1858

Abstract

In 1868, an article in the Yorkshire Post about the West Riding Pauper Lunatic Asylum drew attention to Yorkshire's pivotal role in the history of mental health care. It was because of this history, it was claimed, that Yorkshiremen had a special interest in the treatment of the insane. The purpose of this paper is to explore critically this assumption in light of the recent work on the Poor Law's relationship with the asylum. The growth and development of two asylums in the neighbouring North and West Ridings of Yorkshire will be compared and contrasted. The first part of the paper offers a brief explanation of Yorkshire's pivotal role in the history of the institutional approach to the problems of mental health and the growth of institutions in the counties. Central to the paper will be an examination of how each county responded to the differing demands on its resources and how this impacted on the nature of care at each institution. Ultimately, this paper aims to show how Poor Law finances contributed significantly to the development of each institution.