Making Distinctions: The Contribution of Hector Landouzy to Differential Diagnosis in Relation to Hysteria and Epilepsy

Hector Landouzy (1818-1864) is known for his Traité Complet de l'Hystérie (1846), which was crowned by the Académie de Médecine, but this work is not given much importance in historical accounts. It deserves more attention because it was more than an orthodox statement about the nature of hysteria. In the context of the diagnostic confusion between epilepsy and hysteria, it introduced a method of presenting criteria to facilitate diagnosis. An examination of French authors on epilepsy and hysteria in the second half of the nineteenth century suggests that this method probably set the example which was to be followed by later clinicians, including Charcot at the Salpêtrière.     

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.     

Babinski's Anosognosia for Hemiplegia in Early Twentieth-Century French Neurology

In 1914, Babinski first described “anosognosia”; a term he coined for a phenomenon involving unawareness of disability in hemiplegia. Historical roots of contemporary perspectives on anosognosia after stroke may be found in early discussions among French neurologists. Current notions and debate regarding the roles played by cognition, emotional factors, sensory loss and somatosensory neglect in anosognosia, and the distinctness of anosognosia as a symptom echo the theoretical dilemmas of an earlier past. Historical overview of the development of perspectives on anosognosia enriches our understanding of unawareness of disability.     

Neuroanatomy in Art: Leonardo da Vinci's Senso Comune

Crossed brainstem syndromes consist of ipsilateral impairment of cranial nerves III–XII and contralateral impairment of the pyramidal and sensory tracts. Gasperini's syndrome, described in 1912 Goetz, CG. 2002. Jean-Martin Charcot and the aging brain. Archives of Neurology, 59: 1821–1824.  [Google Scholar] by the Italian internist Ubaldo Gasperini, is one of them. It results from a lesion of the caudal pontine tegmentum and is most frequently defined as ipsilateral impairment of cranial nerves V, VI, VII, and VIII and contralateral sensory loss. Since no autopsy was performed to confirm Gasperini's clinical observations, we analyzed all elements of his syndrome from a current perspective as well as in the light of the anatomical knowledge available to him. This resulted in a historical survey of the development of neuroanatomy over the last 300 years.     

The man behind the syndrome: Sigvald Refsum

The authors attempt to solve the enigma about the possible aphasia of the Byzantine Emperor Manuel II Palaeologus (1391–1425) in the 3-year period between his first and his second and fatal stroke. The texts of historians and chroniclers reveal that Manuel remained semi-paralyzed at bed and his motor disability alienated him from the state affairs and condemned him to isolation from all embassies and contact with others, except his family. Only the funeral oration of the Bishop Bessarion raises the suspicion of a speechless emperor. All testimonies referring to this infirmity are examined.     

Beyond descriptive neurology: Broca,cerebral hemodynamics,and cortical function

Pierre-Paul Broca’s studies in neurobiology remain of interest. I review a previously neglected aspect of Broca’s work in which he presages the use of modern scanning techniques. Broca’s goal was to correlate cerebral metabolism to regional cerebral blood flow (CBF) using a novel method, to which he referred as cerebral thermometry. Broca attempted to measure changes in temperatures from the ischemic area and across the watershed regions during a stroke, and the increased CBF produced by performing a cognitive task such as reading aloud. The method involved measurements of local temperatures at specific points about the head with an array of strategically placed thermometers much as EEG electrodes are arrayed to record the electrical activity of the brain. Although his technique was inaccurate and unreliable, the concept of measuring CBF as a diagnostic aid and as a cognitive research tool was prescient. Broca’s limitation was not conceptual but purely technological. Broca’s attempt to measure CBF as a surrogate for cerebral metabolism was conceptually valid but premature because he lacked the technology necessary to do so.     

President Wilson's Brain Trust: Woodrow Wilson,Francis X. Dercum,and American Neurology

On October 2, 1919, President Woodrow Wilson suffered a stroke that paralyzed the left half of his body. Wilson's stroke forced the American public to confront stroke, and laypeople came to identify stroke as a nervous disorder, rather than a condition rooted solely in psychological phenomena. His medical care was overseen by Cary Grayson, his personal internist, and Francis X. Dercum, a remarkably accomplished neurologist from Philadelphia. Dercum was very involved in the treatment of the President, from the day of the stroke until years later. While the medical records have been destroyed, some basic facts of Wilson's treatment and rehabilitation can be inferred from the literature. Although Woodrow Wilson was an exceptional patient, his care, albeit administered by some of the most famous physicians of the era, was typical of the time. Therefore, this paper's approach to Wilson's 1919 stroke contextualizes the President's case into the larger scheme of early twentieth-century neurology.