Theoretical change and therapeutic innovation in the treatment of syphilis in mid-nineteenth-century France

This article examines changes in the treatment of venereal disease in mid-nineteenth-century France in light of theoretical developments in the understanding of these diseases. It focuses on three theories of venereal disease: the orthodox theory of the "unity" of gonorrhea and syphilis; the physiological theory of Fran?ois Broussais, which essentially denied the actual existence of such a disease; and Philippe Ricord's new doctrine of venereal disease, a theory that is often credited with having established the distinction between syphilis and gonorrhea. The argument is that theoretical considerations played a major role in the evaluation of the relative merits of these theories and that any understanding of the appeal of Ricord's new doctrine must consider not only its pathological claims but its therapeutic implications as well. This was not, however, simply an instance of theory applied. These two aspects of Ricord's new doctrine, its pathology and its therapeutics, were inextricably bound up with one another, so that judgment of the one necessarily entailed judgment of the other. The argument is that therapeutic practice should not be seen simply as a downwind consequence of changes in the theoretical understanding of disease, but rather as an integral part of the process of change. These were the kinds of developments that led doctors to believe that French medicine was making very real progress at mid-century.     

Friedrich Heinrich Lewy (1885-1950) and his work

In 1912, Friedrich Heinrich Lewy first described the inclusion bodies named after him and seen in paralysis agitans (p.a.). Tretiakoff had found (1919) that the nucleus niger is most likely to be affected but in a subsequent large-scale series of post-mortem examinations (1923). Lewy was able to confirm this for a minority of cases only, with the exception of those that displayed postencephalitic Parkinsonism (and an unknown number of atypical Parkinson syndrome cases not identified until the 1960s). In a speculative paper (1932), he saw similarities between inclusion bodies in p.a. and viral diseases like lyssa and postulated a viral genesis of p.a. In a historical review of basal ganglia diseases (1942), he did not mention the putative significance of the inclusion bodies for the post-mortem diagnosis. It seems that their importance was seen only after Lewy's death, long after Tretiakoff's initial naming of the 'corps de Lewy'. Lewy, however, had already described their diffuse and cortical distribution (1923). An identification of diffuse Lewy body disease or dementia followed much later. Lewy's career in many diverse branches of neurology and internal medicine was strongly affected by World War I and the difficult situation faced by Jews in Germany. Shortly after the Neurological Institute was founded in Berlin in 1932 (as a clinic and research institute), he was forced, in 1933, to emigrate. His exile in England and the United States mirrors the fate of many German Jews and academics in the first half of the 20th century.     

Louis Muskens: a leading figure in the history of Dutch and world epileptology

In the history of Dutch neurology Muskens has a place in his own right. Elderly neurologists still attest to the special fame of Muskens. He held a strong opinion on developing the specialty of neurology independent of psychiatry. At the same time he maintained that surgery of the nervous system also should be included in the realm of neurology. These views met with considerable opposition from colleagues and led to Muskens' isolation. To the field of epileptology he contributed both clinical and experimental neurological studies. With Donath he was the co-founder of the International League Against Epilepsy in 1909. In addition he held a lifelong interest in the pathophysiology of forced movements, which he studied both in human pathology and in experimental studies throughout the vertebrate series. This resulted in his magnum opus on the supravestibular system in 1935. His scientific work was well received in scientific societies all over Europe.