Founding Years of Clinical Neurology in Berlin Until 1933

During the so-called “Gründerjahre” 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 built between 1877 and 1912. The new building of the University 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. Hugo 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 Löwenstein (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.     

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.     

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)

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 Burgh?lzli 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.     

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.     

"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.     

A Brief Exploration of Neurological Art History

The invention of realistic portraiture to reveal "inner life" is attributed by some art historians to Jan van Eyck who worked in Flanders from 1420 onwards. We show, using clinical neurological examination of the gold mask of Agamemnon dating from 1550-1500 BC and of the portraits of Henry III and his son Edward I - important English royals - painted between 1216 and 1307, that realistic portraits were made well before the 15th Century. Thus artists unwittingly used neurology as part of their realistic approach to the presentation of the face. Because neurological diagnosis is often visual, neurology, in turn, has a rich potential to unveil examples of realism in art. We consider the art pieces examined here also pertinent to art historians, as they assess the role of art in documenting history.     

Pierre Marie: gifted intellect,poor timing and unchecked emotionality

Pierre Marie was a prominent member of the French neurological world of the early twentieth century. Having been trained by the celebrated physician, J-M Charcot, Marie remained influenced by his teacher throughout his career. Because of this influence, his career can be logically divided into three phases: first, the early years under the direct mentorship of Charcot (1878-1893); secondly, the aftermath of Charcot's death when Marie left his teacher's institution, the Salpêtrière hospital and established himself at the Bicêtre hospital in southern Paris (1893-1918); and finally, Marie's return to the Salpêtrière to assume the original Charcot chaired professorship, albeit as an aged man (1918-1925). This essay examines Marie's career with an emphasis on documentation of the combined attributes of a gifted intellect as well as a heated emotionality. In the context of his time, these elements prompted Marie to enter into controversies and medico-political battles that advanced neurological knowledge, but likely disadvantaged him in his career successes.     

A brief exploration of neurological art history

The invention of realistic portraiture to reveal "inner life" is attributed by some art historians to Jan van Eyck who worked in Flanders from 1420 onwards. We show, using clinical neurological examination of the gold mask of Agamemnon dating from 1550-1500 BC and of the portraits of Henry III and his son Edward I -- important English royals -- painted between 1216 and 1307, that realistic portraits were made well before the 15th Century. Thus artists unwittingly used neurology as part of their realistic approach to the presentation of the face. Because neurological diagnosis is often visual, neurology, in turn, has a rich potential to unveil examples of realism in art. We consider the art pieces examined here also pertinent to art historians, as they assess the role of art in documenting history.     

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.     

Pierre Marie: Gifted Intellect,Poor Timing and Unchecked Emotionality

Pierre Marie was a prominent member of the French neurological world of the early twentieth century. Having been trained by the celebrated physician, J-M Charcot, Marie remained influenced by his teacher throughout his career. Because of this influence, his career can be logically divided into three phases: first, the early years under the direct mentorship of Charcot (1878-1893); secondly, the aftermath of Charcot’s death when Marie left his teacher’s institution, the Salpêtrière hospital and established himself at the Bicêtre hospital in southern Paris (1893-1918); and finally, Marie’s return to the Salpêtrière to assume the original Charcot chaired professorship, albeit as an aged man (1918-1925). This essay examines Marie’s career with an emphasis on documentation of the combined attributes of a gifted intellect as well as a heated emotionality. In the context of his time, these elements prompted Marie to enter into controversies and medico-political battles that advanced neurological knowledge, but likely disadvantaged him in his career successes.     

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.     

Emergence and early development of Russian neurosurgery (1890s-1930s)

This paper is a case study of specialization in clinical medicine - it is a story of the difficult and complicated birth of a neurosurgery clinic in Russia and the Soviet Union. It demonstrates the futile attempt to institute a new specialty as surgical neurology advocated by neuro(patho)logist V.M. Bekhterev (1857-1927) and implemented by his pupils L.M. Pussep (1875-1942) and A.G. Molotkov (1874-1950). However, surgical neurology was gradually replaced by neurological surgery performed by general surgeons N.N. Burdenko (1875-1946), A.L. Polenov (1871-1947), and V.N. Shamov (1882-1962). Part of my paper is dedicated to the institutional history (emergence of the Institute of Surgical Neurology in Leningrad (in 1926) and the Central Institute of Neurosurgery in Moscow (in 1934). The Moscow Neurosurgical School was focused on lesions of the central nervous system whereas the Leningrad neurosurgical school dealt primarily with peripheral nerve surgery. In the 1930s neurosurgical clinics were established beyond the two capitals - in Rostov-on-Don, Kharkov, and Gorky. Similar to the centralized five-year planning in the Soviet economy, a new discipline of neurosurgery was also centralized and planned from Moscow in the 1930s. It was characterized by kompleksnost' - concentration of several auxiliary disciplines (neuroradiology, neuroophthalmology, neurophysiology, etc.) within neurosurgical research institutions in Leningrad and Moscow. Particular stress was made on the experimental nature of a new discipline, which was viewed as a sort of applied neurophysiology.     

Roots and routes of Russian neurosurgery (from surgical neurology towards neurological surgery)

Regular and purposeful neurosurgical interventions started at the end of the nineteenth century. Both surgical and neurological roots of the emerging speciality could be traced. The surgical roots of neurosurgery were the invention of anaesthesia, aseptics and antiseptics which made brain operations relatively safe and markedly reduced postoperative mortality. The neurological roots were the improvement of topical diagnosis in neurology and the understanding of the anatomy and physiology of the nervous system. The first operating room at the neurology department of the Russian Military Medical Academy was established in 1897 by the famous Russian neurologist and psychiatrist Vladimir Bekhterev (1857-1927). According to Bekhterev, neurology should become a surgical speciality like gynaecology or opthalmology and "neurologists will take a knife in their hands and do what they should do". Bekhterev's pupil Ludwig Puusepp (1875-1942) became the first full-time Russian neurosurgeon ("surgical neurologist"). He headed the first university course in surgical neurology in the world organised in 1909 at Bekhterev's Psychoneurological Institutte in St. Petersburg and bacame professor of surgical neurology in 1910. The role of neurologist might be illustrated by the development of a sterotactic instrument named "encephalometer" designed by D. Zernov in 1889 and improved by G. Rossolimo in 1907. The idea was to map cerebral structures in degrees of latitude and longitude similar to mapping the terrestrial globe in order to localise the brain lesion and enhance its minimally invasive removal....     

‘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.     

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.     

The history of the neurological examination. Part 1: ancient and pre-modern history--3000 BC to AD 1850

Every time a physician conducts a neurological examination the process continues a biomedical search for understanding the nervous system which is as ancient as the earliest civilizations in human history. Most of the modern neurological examination evolved in a short time span, between 1850 and 1914, but the origins of neurology as a medical quest for knowledge date to the first evolution of urban life, in the valleys of the Euphrates and the Nile. This paper reviews this history in two chronological segments: part 1 up to 1850 and part 2 the subsequent period.     

Exercise of royal power in early medieval Europe: the case of Otto the Great 936–73

Current scholarly orthodoxy holds that the German kingdom under the Ottonians ( c. 919–1024) did not possess an administration, much less an administrative system that relied heavily upon the 'written word'. It is the contention of this essay that the exercise of royal power under Otto the Great (936–73) relied intrinsically on a substantial royal administrative system that made very considerable use of documents, particularly for the storage of crucial information about royal resources. The focus of this study is on Otto I's use of this written information to exercise royal power in the context of confiscating and requisitioning property from both laymen and ecclesiastical institutions.