Historical aspects of the neonatal neurological examination: why child neurologists are not 'little' adult neurologists

The origins of the neonatal neurological examination are described with their common basis attributable to evolutionary theory, the classical neurosciences, clinical neurology, and developmental psychology. It is shown that not only have the techniques of the bedside examination changed over the past half century but the purpose of the examination has also evolved; initially the examination was used to assess maturation of the developing infant, now it is used to determine whether cerebral pathology may be present and whether examination abnormalities are helpful in outcome assessment. The development of several of the current neonatal neuroogical examinations are reviewed and their cllinical and scientific basis examined.     

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.     

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.     

Perkins’s patent metallic “Tractors”: Development,adoption, and early dissemination of an eighteenth-century therapeutic fad

ABSTRACT

The metallick Tractors were patented by Elisha Perkins, a Connecticut physician, in 1796, for the treatment of various ailments, particularly those associated with pain. They were subsequently rapidly and widely disseminated on the basis of testimonials and aggressive marketing tactics. Dissemination was facilitated by endorsements from prominent physicians, politicians, and clergy, by quasi-theoretical explanations of efficacy based on then-current experiments of Galvani and others, and by the apparent simplicity and safety of the procedure. Abandonment of this ineffective therapy was later prompted by the application of blinded placebo-controlled trials using sham devices.     

The development and evolution of “cerebral thermometry”: Clinical applications of a nineteenth-century approach to cerebral localization and neurological diagnosis

ABSTRACT

Surface thermometers were developed in the latter half of the nineteenth century. In 1877, Broca, already famous for his contributions to the cerebral localization of nonfluent aphasia, presented his first clinical observations on cranial surface temperatures: In two cases, cranial surface temperatures were decreased over a middle cerebral artery infarction, and increased in surrounding areas, which Broca attributed to “compensatory hyperaemia.” As Broca made apparent in a later report in 1879, he had used a “thermometric crown,” an apparatus consisting of six to eight large-reservoir mercury thermometers strapped against the head. Following Broca’s report, American neurologists reported cases in which cranial surface temperatures were increased either locally over a superficial brain tumor or globally with a cerebral abscess. Despite promising anecdotal reports, contemporaries recognized that significant technical and practical problems limited its accuracy, reliability, and clinical utility. Advocates never demonstrated that this technology provided significant marginal benefit to the medical history and physical examination. The technique fell out of fashion before 1900, though some early advocates promoted it into the early twentieth century. It was ultimately replaced by more effective technologies for cerebral localization and neurological diagnosis.     

The assessment of Perkins’ patent metallic “tractors”: Abandonment of an 18th-century therapeutic fad following trials using sham instruments

ABSTRACT

From 1799 to 1801, with the instigation of John Haygarth, physicians in England evaluated the claims of Elisha and Benjamin Perkins that their patented “metallic tractors” could cure a wide variety of disorders. Previous therapies were typically judged based on experience and authority, whereas Perkinism was evaluated using a series of clinical trials of varying methodological sophistication, most employing sham instruments (all but those involving infants or horses), with a variety of trial designs, inconsistent use of contemporary controls, and different approaches to blinding subjects to the treatment administered. Haygarth and his colleagues collectively demonstrated that tractors and sham instruments produced equivalent effects in adults, and, by inference, that the tractors had no special therapeutic properties. Other trials using only genuine tractors demonstrated no effects in infants and horses, subjects who could not reasonably be influenced by suggestion and the imagination. These collective results provided strong support for the rival hypothesis that the observed effects were due to suggestion and the imagination of the subjects. Despite fallacy-laden counterattacks and counterarguments from Benjamin Perkins and his supporters, the trials eroded support for this therapy and led to abandonment of the “Metallic Practice” as a treatment in Britain and elsewhere.     

Georg Friedrich Handel's strokes*

Abstract

Although there is no definite proof, it seems most likely that Georg Friedrich Handel suffered from cere‐brovascular disease, which caused two or three minor strokes and weakness of his eyesight in his last years. His etiologically important risk factors and the symptoms of Handel's strokes are presented and evaluated by primary sources; various diagnoses are discussed. In Handel's musical work, no direct impact from his illness can be found, but there are some indirect outflows of Handel's pathography on his compositions, especially the Messiah.     

The Sherrington–Cushing connection: A bench to bedside collaboration at the dawn of the twentieth century

ABSTRACT

British physiologist Charles Sherrington (1857–1952) and American neurosurgeon Harvey Cushing (1869–1939) were seminal figures in the history of neuroscience. The two came from different worlds, one laboratory-based and the other largely clinical. Their scientific intersection, beginning in July 1901, provides a glimpse into a nascent form of “bench to bedside” collaboration, which carried with it the potential to extend the arm of neurophysiological experimentation from Sherrington’s laboratory to Cushing’s operatory. I reviewed extensive primary source materials archived at Yale University School of Medicine Library. Sherrington viewed Cushing’s bedside work as an opportunity, in humans, to extend his bench-side physiological observations on higher primates, at times almost directing Cushing in the clinic. Cushing would indeed take Sherrington’s observations on apes and extend them to his patients, and the work would eventually overturn the prevailing notion that the motor and sensory cortex were intermixed across the Rolandic fissure.     

Conceptual Mediation: Philosophy between the History of Physiology and Contemporary Neuroscience

Summary

In the 1780s the anatomist Vincenzo Malacarne discussed the possibility of testing experimentally whether experience can induce significant changes in the brain. Malacarne imagined taking two littermate animals and giving intensive training to one while the other received none, then dissecting their brains to see whether the trained animal had more folds in the cerebellum than the untrained one. This experimental design somewhat anticipated one used 180 years later by Mark R. Rosenzweig at the University of California, Berkeley. This paper explores some methodological aspects of the case study just outlined by pointing out that our grounds for being interested in it are neither merely neuroscientific (for, strictly speaking, Malacarne's proposal was false) nor narrowly historical (for there is no causal chain linking Malacarne's ideas to Rosenzweig's experiment). Rather, the really interesting point here is to what extent Malacarne's ideas are similar to Rosenzweig's, a point that we can better investigate by employing certain conceptual tools borrowed typically (but not exclusively) from (a certain kind of) philosophy. If we do not handle the analogy with care, we run the risk of ‘discovering’ nothing but void platitudes or anachronistically misleading common features.     

Next Emperor,Please! No End to Retrospective Diagnostics

Abstract

The beginning of the seventeenth century marked the start of a scientific revolution, which had consequences for medicine. Vesalius in anatomy, and Harvey in physiology, were important figures who gave the Hippocratic and Galenic traditions new impulses. In this period of change in medical thought, Nicolaas Tulp (1593–1674) wrote his ‘Observationes Medicae’ (Tulp, 1641). A controversy existed in The Netherlands, concerning the circulation, with many doctors still adhering to the Galenic tradition. The following analysis discusses some of the neurologic cases from Tulp's book, seen in the light of modern medical thought.     

Textual context in the history of political thought and intellectual history

ABSTRACT

We can easily misread historical texts if we take ideas and passages out of their textual contexts. The resulting errors are widespread, possibly even more so than errors through reading ideas and passages out of their historical contexts. Yet the methodological literature stresses the latter and says little about the former. This paper thus theorises the idea of textual context, distinguishes three types of textual context, and asks how we uncover the right textual contexts. I distinguish four kinds of textual-context error, and offer practical tips for avoiding these errors. However, the beating heart of this paper is the history–philosophy debate: in contrast to the prevailing assumption that historical and philosophical analysis are fundamentally different, I show that a commitment to textual context, which should be entirely uncontroversial, also commits one to think philosophically.     

Theory and the history of cartography

Abstract

Cartographic history has been dominated by an empiricism that treats the nature of maps as self‐evident and which denies the presence of any theory. In contrast, this paper argues that theories lie at the root of all empirical study whether or not they are acknowledged. The linear, progressive model of cartographic development, for example, is not a law deduced from historical evidence; if it were it would be easily and quickly dismissed. It derives instead from our cultural beliefs concerning the nature of maps, which is to say from our unexamined theories. Historians of cartography need to be critical of their assumptions and preconceptions. Theoretical discussions in the history of cartography must address not whether we should use theory at all but to which theories we should adhere. It is inadequate simply to knock theories down. We must establish a debate in which old understandings of maps, of their creation, and of their use are replaced by better (that is, more consistent and coherent) theories.     

Did Herbert Spencer Have Reading Epilepsy?

Herbert Spencer, the nineteenth-century philosopher, has frequently been dismissed as a “fantastical hypochondriac” (as his most recent biographer, Mark Francis, terms him). Yet he left a record in his Autobiography of symptoms that suggest a very different diagnosis. Abruptly at age 35, he found that the activity of reading, previously indulged in without difficulty, triggered paroxysmal episodes of disturbing “head-sensations” including “giddiness” (so Spencer described them); these severely curtailed his ability to carry out his philosophical studies. Of all possible explanations for such episodes, none seems as likely as reading epilepsy. Enduring preconceptions about Spencer's presumed neurosesmay have kept modern historians from appreciating that Spencer suffered from a legitimate, if esoteric, neurological malady.     

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.     

Appeals for European solidarity as calls for colonial violence: British and German public debates around 1900

Abstract

While recent scholarship has emphasized the role of the colonial experience in the development of the idea of Europe and European integration, notions of European solidarity in the age of imperialism have largely been ignored. This paper investigates the specific context in which journalists and politicians voiced such pleas for solidarity, explores the motivations for them, and probes their limits in times of tension. A closer look at the actors involved illustrates the strictures placed on ideas of European solidarity and illuminates the limited potential of projects of integration prior to 1914. However, latter considerations notwithstanding, a discourse on European solidarity in a colonial context did emerge in the decades before the First World War, allowing early proponents of integration to view colonialism as a field for common European action.     

Images of the defeated: a good death in late Bronze Age Greece?

Abstract

Warriors engaged in combat are characteristic images of Late Bronze Age Greece, depicting both the victors and the defeated. An examination of Early Mycenaean and Mycenaean images of the defeated, and of the presentation of the deceased by their funerary offerings, suggests that a death in battle was not perceived as a disgrace. Furthermore, a display of respect towards the fallen enemy may have enhanced the victor. The surviving images from Late Bronze Age Greece celebrate skill in warfare, both for the victor and also for the defeated. The images suggest that death in battle was considered to be a good death throughout the Late Bronze Age on the Greek mainland, whether victor or loser.     

The Emergence of Multiple Sclerosis as a Nosological Category in France, 1838–1868

Neurologists have retold a story about the discovery of multiple sclerosis (MS) in essentially the same form from the 1870s to the present. Upon close analysis this narrative was found to be problematic. Once the nosological category of MS came into existence in 1868, physicians reread the scientific past through this new category and created a linear story. Following generations received this story uncritically, rereading the past through the conceptual lens of their own times. Writers selected the earlier cases, illustrations, and medical writings in the literature for inclusion in the discovery narrative and did not analyze them in their original historical contexts. The author offers an alternative account of the discovery of MS. The creation of the disease category of MS by Charcot in France was the result of several converging factors including a new histopathological technology, a unique relationship between patient and physicians in the clinic, a unique relationship between the clinic and the autopsy room, and a neurological culture emphasizing disease specificity.     

Restoring Phineas Gage: A 150th Retrospective

September 13 1998 marked the 150th anniversary of the accident to Phineas Gage, one of the most famous cases of survival after massive injury to the brain, and certainly the most famous case of personality change after brain damage. For this article a sample of the current literature about Gage was examined. It was found that although his case is mentioned in about 60% of introductory textbooks in psychology, there is a good deal of inaccuracy in what has been written about him. Similar inaccuracy was found in a smaller sampling of the psychiatric, medical, physiological, linguistic, and general neuroscientific literature. The main basis of the inaccuracies is an ignorance or disregard of what is contained in the primary sources about Gage, coupled with a tendency to attribute to him characteristics that belong to other cases of frontal damage. The errors and their bases are discussed in an endeavour to restore the picture of Gage to its original state. The paper includes an Appendix of verbatim quotations from the primary sources that can be compared with the later, inaccurate renditions.     

The Diffusion of Sovereignty

Summary

The transmission of ideas about sovereignty and its related practices from one time, place, or intellectual context to another is sometimes characterised as a process of ‘diffusion’ or even ‘contagion’. Intellectual historians may use such metaphors but the explanations they provide are historical, not scientific. Sovereignty was transmitted when European states brought their forms of government to other peoples and when those peoples embraced such forms in declaring their independence from imperial rule. It was also transmitted when the idea of sovereignty was itself transformed in the course of these and other historical passages. In Foundations of Modern International Thought, David Armitage explores some of these historical passages, the outcome of which he sees as the world of sovereign states that defines the modern period and the disappearance of which would signal its end. In doing so, he illuminates the larger enterprise of writing the history of international thought or, as he prefers to call it, international intellectual history, inviting reflection on its relationship to other kinds of historical inquiry and the opportunities and dangers it poses.     

Conquests,family traditions and the First Crusade

ABSTRACT

This article investigates the family backgrounds of aristocratic participants in the First Crusade. Through an examination of these it explores the ways in which their decision to join the crusade was influenced by the examples of the previous generation of conquerors, the participants in the invasion of Sicily in 1061, the expeditions to England in 1066 and the conflicts on the Iberian peninsula. In this way it opens a discussion about the motives and expectation of the First Crusaders. It argues that dreams of conquest and the desire to match an older generation’s martial and political achievements may have been as important a factor in motivating crusaders as religious ideals.