Researching dementia in imperial Germany: Alois Alzheimer and the economies of psychiatric practice

Imagining the brain as a book: Oskar and Cécile Vogt's "library of brains"

In 1927, the German popular science magazine Die Koralle published an article entitled "The Library of Brains." The article was about the Kaiser Wilhelm Institute for Brain Research in Berlin, established in 1914 as the continuation of the "Neurological Central Station" founded by Oskar Vogt (1870-1959) in 1898. The library metaphor plays on the huge collection of human and animal brains Oskar and his wife Cécile (1875-1862) had gathered over several decades. For examination, the brains were cut into paper-thin slices and embedded in paraffin: from one single organ, up to 30,000 slices could be extracted, which were to be "read" and studied like the pages of a book. In this chapter, we take the metaphor at face value, arguing that Vogt's institute actually functioned as a library. Numerous publications have emphasized the role of the Vogts and, in particular, of the brain collection for the constitution of modern neuroscience. The "library," however, has never been closely investigated. How was it designed? How was it filled? According to which criteria were the brains collected and ordered? How did the order and the collection itself reflect the Vogts' research program? Through a detailed investigation of the collection and the Vogt Archive, we will examine this "library" and reconstruct the order of the Vogt brains. The mutual relationship between collecting, sorting, examining and publishing about the brain will be discussed.

History as a biomedical matter: recent reassessments of the first cases of Alzheimer's disease

This paper examines medical scientists' accounts of their rediscoveries and reassessments of old materials. It looks at how historical patient files and brain samples of the first cases of Alzheimer's disease became reused as scientific objects of inquiry in the 1990s, when a genetic neuropathologist from Munich and a psychiatrist from Frankfurt lead searches for left-overs of Alzheimer's 'founder cases' from the 1900s. How and why did these researchers use historical methods, materials and narratives, and why did the biomedical community cherish their findings as valuable scientific facts about Alzheimer's disease? The paper approaches these questions by analysing how researchers conceptualised 'history' while backtracking and reassessing clinical and histological materials from the past. It elucidates six ways of conceptualising history as a biomedical matter: (1) scientific assessments of the past, i.e. natural scientific understandings of 'historical facts'; (2) history in biomedicine, e.g. uses of old histological collections in present day brain banks; (3) provenance research, e.g. applying historical methods to ensure the authenticity of brain samples; (4) technical biomedical history, e.g. reproducing original staining techniques to identify how old histological slides were made; (5) founding traditions, i.e. references to historical objects and persons within founding stories of scientific communities; and (6) priority debates, e.g. evaluating the role particular persons played in the discovery of a disease such as Alzheimer's. Against this background, the paper concludes with how the various ways of using and understanding 'history' were put forward to re-present historic cases as 'proto-types' for studying Alzheimer's disease in the present.

Slicing the cortex to study mental illness: Alois Alzheimer's pictures of equivalence

Alois Alzheimer (1864-1915) was a German physician who specialized in psychiatry, and who is today known for the first description of a-in his own words-peculiar ailment (eigenartige Erkrankung), which was named after him. In his time, however, he was foremost recognized for his work in refining histopathological techniques and thereby contributing to the methodological arsenal for differential diagnosis in clinical psychiatry. In his laboratory that was based at the renowned Munich Psychiatric University Clinic led by Emil Kraepelin (1856-1926), Alzheimer, his assistants, and students conserved, prepared, and studied slices of deceased patients' brains under the microscope. How could histological postmortem research better clinical diagnoses? Against what norm should the pathologies be compared? What was the normal brain in a context of highly invasive preparation techniques and the artifacts that they produced? In an unpublished lecture series, Alzheimer explicitly addressed these questions and framed them in terms of practical problems and possible solutions: where to get normal brains from; how animal studies could help to enlighten the normal brain and infectious mental disorders; how the study of hereditary idiocy might yield knowledge about normal brain development and general brain pathology. This chapter offers a close reading of parts of Alzheimer's lectures, his habilitation thesis, and his programmatic opening paper of a journal that he cofounded. These sources provide us with an introduction into the making of the normal and the pathological brain in histopathology that focuses more on problems and controversies than providing an undisputable, easy-to-use framework. I examine the premises of Alzheimer's conceptualization of "pictures of equivalence" (Aequivalentbilder) to elucidate how the epistemological gap between postmortem research and clinical psychiatry was managed in this particular context. The excavation of this historical epistemology not only fills a gap in the rich history of brain research that has mostly focused on brain localization theory, of which Alzheimer and Kraepelin were skeptical. It also provides a case study for how "the normal" and "the pathological" were put to work, and were, literally, pictured. In conjunction with the other chapters of this volume, this contribution thereby raises the historiographical and philosophical question of what to include into an assessment of the making and use of models of the brain.

The evolving classification of dementia: placing the DSM-V in a meaningful historical and cultural context and pondering the future of "Alzheimer's"

Alzheimer's disease is a 100-year-old concept. As a diagnostic label, it has evolved over the 20th and 21st centuries from a rare diagnosis in younger patients to a worldwide epidemic common in the elderly, said to affect over 35 million people worldwide. In this opinion piece, we use a constructivist approach to review the early history of the terms "Alzheimer's disease" and related concepts such as dementia, as well as the more recent nosological changes that have occurred in the four major editions of the Diagnostic and Statistical Manual since 1952. A critical engagement of the history of Alzheimer's disease and dementia, specifically the evolution of those concepts in the DSM over the past 100 years, raises a number of questions about how those labels and emergent diagnoses, such as Neurocognitive Disorders and Mild Cognitive Impairment, might continue to evolve in the DSM-V, due for release in 2013.