"Spanish flu," encephalitis lethargica, and COVID-19: Progress made, lessons learned, and directions for future research

One hundred years ago, an influenza pandemic swept across the globe that coincided with the development of a neurological condition, named "encephalitis lethargica" for the occurrence of its main symptom, the sudden onset of sleepiness that either developed into coma or gradually receded. Between 1917 and 1920, mortality of the flu was >20 million and of encephalitis lethargica approximately 1 million. For lessons to be learned from this pandemic, it makes sense to compare it with the COVID-19 pandemic, which occurred 100 years later. Biomedical progress had enabled testing, vaccinations, and drug therapies accompanied by public health measures such as social distancing, contact tracing, wearing face masks, and frequent hand washing. From todays' perspective, these public health measures are time honored but not sufficiently proven effective, especially when applied in the context of a vaccination strategy. Also, the protective effects of lockdowns of schools, universities, and other institutions and the restrictions on travel and personal visits to hospitals or old-age homes are not precisely known. Preparedness is still a demand for a future pandemic. Clinical trials should determine the comparative effectiveness of such public health measures, especially for their use as a combination strategy with vaccination and individual testing of asymptomatic individuals. It is important for neurologists to realize that during a pandemic the treatment possibilities for acute stroke and other neurological emergencies are reduced, which has previously led to an increase of mortality and suffering. To increase preparedness for a future pandemic, neurologists play an important role, as the case load of acute and chronic neurological patients will be higher as well as the needs for rehabilitation. Finally, new chronic forms of postviral disease will likely be added, as was the case for postencephalitic parkinsonism a century ago and now has occurred as long COVID.

A Historical Overview of the Neurological Disorders Associated with Gastrointestinal Ailments from the Viewpoint of Avicenna

Reviewing historical medical manuscripts shows that neurological disorders have been previously described in the Islamic Golden Age. Ibn Sina, also known as Avicenna (980-1037 AD), was one of the most renowned scientists during this period. He widely practiced medicine, especially those disorders related to neurology, neurosurgery, and psychiatry in conventional medicine. In his extant book al-Qānūn fī al-Tibb (the Canon of Medicine), he claimed that some types of brain diseases can be related to the "marāqq" and called them marāqq-related disorders. From Avicenna's viewpoint, "marāqq" is considered a membranous structure in the abdomen. Ibn Sina has illustrated the association between the "marāqq" and the brain through some direct and indirect pathways. As a result, some disturbances in the "marāqq" can influence the brain, which can contribute to the pathogenesis of a number of brain diseases. Accordingly, those patients who regularly had gastrointestinal discomforts experienced a higher prevalence of headache, melancholia, and epilepsy. This study aimed to explore the relationship between abdominal and brain diseases from Avicenna's viewpoint. Furthermore, the definition, clinical manifestation, and therapeutic strategies of marāqq-related disorders were described.

History and Evolution of the Tuning Fork

This paper is a summary of the evolution of the tuning fork, a crucial part of the cranial nerves and auditory examination. The tuning fork is a two-pronged fork that resonates at a specific pitch when struck against a surface and has been proven to be incredibly useful in diagnosing and detecting hearing disorders. The tuning fork, an unassuming device in modern medicine, traces its origins back to an era when scientific understanding and medical diagnostics were in their nascent stages. Since its inception, this unpretentious instrument has played a pivotal role in the hands of healthcare practitioners, aiding in the diagnosis and assessment of various medical conditions. This paper embarks on a captivating journey through time to explore the origin, evolution, and significant milestones in the development of the tuning fork. From the first suggestion of differentiating hearing disorders to present-day tuning forks, this paper maps the different stages that the tuning fork has gone through and how its use has changed over time. Along the way, we will discover how the tuning fork has harmonized with music, medicine, and various scientific pursuits, enriching our understanding of sound and resonance while leaving an indelible mark on the course of human history. Delving into the historical context of its creation, this review uncovers the ingenious minds that birthed this innovative device and the pivotal moments that brought it to the forefront of human endeavors.

Pliny the Elder: Lessons from the Naturalist as an Early Neuroscientist

Pliny the Elder was a prolific Roman author, naturalist, and military leader. Yet, his impact on modern-day neuroscience, psychiatry, and neurology has been little explored. Here, we aimed to trace the origins of our current understanding of the brain in ancient Rome through Pliny and his work, Natural History. As his magnum opus, this 37-book tome catalogs the facts and observations of natural life collected by Pliny, reflecting the knowledge of his time. Following the cephalocentric school of thought, Pliny places the brain as an agent for consciousness and details its diseases. Further, we explore Pliny's methods, which allow him to build a thorough collection of clinical descriptions and remedies. This body of work serves as an important lesson for future neuroscientists on the power of observation, the role of the humanities, and the necessity of understanding the origin of modern scientific thinking.

What caused Joan of Arc's neuropsychiatric symptoms? Medical hypotheses from 1882 to 2016

Between 1882 and 2016, the medical literature offered a variety of etiologic hypotheses to explain Joan of Arc's voices, visions, and unwavering belief that she was the instrument of God. Although Joan lived from 1412 to 1431, there is extensive primary documentation of her life, including transcripts of her testimony during the Trial of Condemnation. Once this source material was compiled and made available, physician-authors began to theorize about Joan's neuropsychiatric symptoms in the context of her remarkable achievements. This article summarizes all papers written by physician-authors about Joan of Arc. The historical flow of diagnostic speculation in the medical literature reflects the cultural context in which it was produced as well as the emergence of novel ideas and new technologies in psychiatry, neurology, and neuropsychiatry. The early literature offered psychological theories and addressed the question of whether Joan was sane. The later literature focused on the possibility that Joan might have had epilepsy, with discussions of seizure etiology and possible cerebral focus, and also reflections on the purview of science as well as spirituality and the brain. This article offers the first comprehensive review of the medical literature about Joan of Arc, making this scholarship more accessible.

The Pioneer Neuropharmacologist Alfred Fröhlich (1871-1953) and the Origins of Neuroendocrinology: A Sesquicentennial Remembrance

The birth of neuroendocrinology as a scientific discipline is traced back to 1900-1901, when Joseph Babinski, Alfred Fröhlich, and Harvey Cushing independently identified adiposogenital dystrophy (Fröhlich syndrome), and related gonadal underdevelopment and obesity to a tumor near the pituitary gland. This discovery prompted decades of research into the brain mechanisms responsible for the control of peripheral metabolism and endocrine functions. On the occasion of the 150th anniversary of Fröhlich's birth, this study traces the origins of his intellectual formation and his association with renowned contemporaries in Austria, England, Italy, and finally Cincinnati, Ohio, where he sought refuge after Austria's annexation by Nazi Germany. Fröhlich interacted with seminal figures in biomedicine, including Lothar von Frankl-Hochwart, Hans Horst Meyer, Ernst Peter Pick, Harvey Cushing, John Newport Langley, and the Nobel laureates Charles Scott Sherrington and Otto Loewi. Alfred Fröhlich, one of the 20th century's most emblematic physicians, left his mark on neurophysiology and neuropharmacology with important works, and published authoritative manuals of drug dispensing and clinical therapy. He confronted the calamities of two World Wars with remarkable resilience like many of his Viennese colleagues who, overcoming the constraints of National Socialism, settled overseas to fulfil their calling as physicians, researchers, and teachers.

Between Moscow and Berlin: The Russian connections behind Flatau's "Law of Eccentric Location of Long Pathways in Spinal Cord"

The origins of Edward Flatau's "The Law of Eccentric Location of Long Pathways in Spinal Cord" are discussed, considering newly examined archival documents from Central State Archive of Moscow and Museum of the I. M. Sechenov University (former medical faculty of Imperial Moscow University [IMU]). These documents, together with German and Polish records, illustrate the international character of Flatau's education and shed light on the bigger question of interactions between Moscow and Berlin fin de siècle neurologists. Flatau's peregrinations between these two cities are documented, together with difficulties encountered due to his nationality and the changing political environment.

The Moro reflex: insights into the pathophysiology of generalized tonic-clonic seizures and infantile spasms

The Moro reflex (MR) is a primitive reflex that disappears after the first three months of life. It was described by the Austrian paediatrician Ernst Moro (1874-1951) in 1918, although the earliest visual representation of the MR dates back to the first half of the 14th Century, in a fresco by Ambrogio Lorenzetti (1290-1348). The neural centre underlying the MR is located in the lower part of the brainstem since it can be elicited also in anencephalic infants, as shown by the Austrian neurologist Eduard Gamper (1887-1938) in the first medical description of anencephaly (1926). The MR is due to the activation of an archaic neural circuit present in the newborn, the activity of which is later inhibited by the upper brain structures. Given their semiological resemblance, epileptic spasms and generalized tonic-clonic seizures might be due (at least partly) to the pathological activation of the same neural archaic circuit involved in the genesis of the MR. The neuronal network underlying these different phenomena might be located in the pons. In these seizure types, the activation of the same neural circuitry involved in the MR could occur through either direct excitation or through an indirect "liberating" mechanism, secondary to epileptic disruption of cortical inhibitory control on subcortical structures. The movements of the upper extremities in epileptic spasms, in the initial phase of generalized tonic-clonic seizures, and the MR might involve a distinct neural circuitry, which is (or becomes) hyperexcitable as a consequence of a pathological condition (epilepsy) or physiological brain immaturity (the MR).

Two faces of the teacher: Comparing editions of Charcot's Leçons du mardi

Jean-Martin Charcot, renowned teacher and clinical neurologist of the nineteenth century, held a unique set of impromptu "show and tell" case presentations that were transcribed as professor-patient dialogues. These lessons, known as the Leçons du mardi, were hand transcribed by his students and published as a limited-edition lithograph in 1887-1888, but reprinted for wider circulation with modifications in 1892, one year before Charcot died. This study highlights several important differences between the two versions of the work, with interpretative commentary on the importance of studying them side by side to more completely understand Charcot, his career, and the development of early clinical neurology.

[Autonomous Neurology within the University Hospital of LMU at 50 years]

Establishment of the Chair of Neurology at the University of Munich in 1971 as well as the opening of the Neurology Department at the newly built Großhadern campus (1974) provide an occasion to review the 50 years that have passed since. Further, the early history of Munich neurology is described, with its slow pace of separation (in comparison to e.g. Heidelberg, Frankfurt and Hamburg) from the parent disciplines, psychiatry and internal medicine. In Munich, they were long shaped by psychiatrists such as Bernhard von Gudden, Emil Kraepelin, Kurt Kolle and Hanns Hippius and by Friedrich von Müller and, in particular, by Gustav Bodechtel in internal medicine.Once independent, further development of neurology in Munich was characterized by fast-paced, almost revolutionary changes in neuroimaging, electrophysiology, sonography, and engineering as well as in basic neuroscience, neurogenetics included. The new department thrived under the leadership of Adolf Schrader (from 1971), Thomas Brandt (from 1984) and Marianne Dieterich (from 2008) who enjoyed the support of an ever-increasing specialised clinical-scientific staff.Evidence-based treatment of neurological disorders became the overarching and internationally visible focus of Munich neurology, with respect to both practical implementation and to research. The exemplary diseases and syndromes of multiple sclerosis, epilepsy, stroke, movement disorders, dizziness and disorders of balance and gait as well as diseases of the musculature and peripheral nerves are cared for not only within the inpatient and outpatient sections of the Neurology Department but also by units such as the Friedrich Baur Institute (FBI), the German Dizziness and Balance Centre (DSGZ), the Institutes for Stroke and Dementia Research (ISD) and for Clinical Neuroimmunology as well as in the interdisciplinary Department of Palliative Care.

[Historical aspects of the study of dementia]

Currently, life expectancy is increasing every year, and with it the diseases that are characteristic of the elderly. Dementia is one such condition. According to statistics, there are 9 people with dementia per 100 healthy people aged 60 and over. However, it is important to understand that dementia can also be viewed in a historical context. Over time, ideas about this condition, approaches to its management, as well as the attitude of society towards patients with dementia have changed. The article describes the history of the study of dementia, which went along with the development of medicine, anatomy, neurology and psychiatry. In different historical periods, people's understanding of the mechanisms of development, etiology and pathogenesis of this condition has changed. Ethics and deontology gradually developed, which undoubtedly played an important role in improving the life of not only patients with dementia, but also the relationship between the doctor and the patient as a whole. The main stages in the study of dementia have become the basis for the modern understanding of this condition.

René Cruchet (1875-1959), beyond encephalitis lethargica

René Cruchet (1875-1959) was a pediatrician from Bordeaux known for his seminal description of encephalitis lethargica during World War I, at the same time as Constantin von Economo (1876-1931) in Vienna published his own description, which, unlike Cruchet's description, provided precious anatomopathological data in addition to the clinical data. Cruchet was interested in tics and dystonia and called for treatment using behavioral psychotherapy that was, above all, repressive. Cruchet was also a physiologist and an innovator in aeronautic medicine-notably, he helped pioneer the study of "aviator's disease" during World War I. Moreover, he possessed an encyclopedic knowledge, while publishing in all medical fields, writing philosophical texts as well as travel logs.

Western European influence on the development of Russian neurology and psychiatry, part 1: Western European tours of early Russian neurologists and psychiatrists

Beginning in the 1860s, two major centers of neurology and psychiatry arose in Russia: Imperial Moscow University (IMU) and Imperial Medical and Surgical Academy in St. Petersburg (IMSA). Both centers were strongly influenced by Leading Western European schools and specialists, through the clinical and research training regimes of both Russian universities, strongly influenced these centers of learning. In this study, we elaborate the Western European training of the first Russian specialists in the fields of neurology and neuropsychiatry from IMU and IMSA during the period from the late 1850s to 1900. Although prior studies emphasized the influence of French mentors and institutions, the Western European tours of early Russian specialists often included multiple destinations in Germany, France, and Austria. The most commonly visited cities (in descending order) were Paris, Berlin, Leipsig, and Vienna. The most commonly visited training centers (in descending order) were Hoôpital Salpêtriêre (Paris), Friedrich-Wilhelms-Universität (Berlin), Charité (Berlin), Universität Leipzig, First Psychiatric Clinic (Vienna), and Hôpital Sainte-Anne (Paris). The most commonly visited mentors, in descending order, were Charcot (Paris), Flechsig (Leipzig), Westphal (Berlin), Meynert (Vienna), and Magnan (Paris). Training of Russian specialists in Western Europe facilitated the emergence and development of the neurological and psychiatric schools in Moscow and St. Petersburg.

The Neurological Study Unit: "A Combined Attack on a Single Problem from Many Angles"

In the 1920s, neurology was a fledgling discipline. Various attempts were made to establish programs relating to neurological care and research. One such initiative was the Neurological Study Unit (NSU) at the Yale School of Medicine. My aim is to chronicle the early years of the NSU (1924-40): the motivations for establishing the unit, its structure, its challenges, and its evolution. I have studied all documents related to the NSU at Manuscripts & Archives, Yale University Library. The NSU was heralded as a "combined attack on a single problem from many angles." It was slow to develop, however, and had a number of missing elements. While some of this may have been due to a lack of funds and the absence of a dedicated neurologist, it was also the result of a failure to conceptualize a neurological unit, the slow evolution-into-existence of a nascent and fledgling medical discipline, growing pains and frictions within the leadership, a university-based rather than a hospital-based model of operation, and turf wars between neurology and allied disciplines.

Hysteria or epilepsy?

Hysteria and epilepsy have long been compounded by the term "hysteria-epilepsy" among neurologists and physchiatrists, including Jean Martin Charcot. In a 114 page unpublished manuscript written circa 1815, Jean-Baptiste Louyer Villermay, French physician and student of Philippe Pinel, considered the signs that would differentiate hysteria from epilepsy. This differential diagnosis approach was proposed long before Charcot's lecture in 1868 at Salpêtrière hospital.

The mysteries of hysteria: a historical perspective

Jean-Martin Charcot started his main work on hysteria around 1870, until his death in 1893. Désiré Bourneville had triggered Charcot's interest in hysteria during his stay as an interne in his department, while Charles Richet's 1875 article on somnambulism was the trigger for Charcot to develop hypnotism. Charcot's collaborators Paul Richer, Georges Gilles de la Tourette, Paul Sollier, Joseph Babinski, Sigmund Freud and Pierre Janet subsequently became most famous in hysteria. In 1908, a "quarrel of hysteria" opposed several of Charcot's pupils, from which Babinski, who had developed the concept of "pithiatism", was considered victorious against Charcot's first successor Fulgence Raymond. There was a surge of interest in hysteria associated with war psycho-neuroses in 1914-1918, and Babinski's pupil Clovis Vincent developed a treatment called torpillage (torpedoing) against war hysteria, associating painful galvanic current discharges with "persuasion". After World War I, the neurological and psychiatric interest in hysteria again faded away, before a renewed interest at the turn of the last century. Contrary to a common view, the modernity of several of Charcot's concepts in hysteria is remarkable, still today, mainly for: (1) his traumatic theory, which encompassed psychological and certain sexual factors several years before Freud; (2) his personal evolution towards the role of emotional factors, which opened the way to Janet and Freud; (3) his claim of specific differences vs. similarities in mental states such as hypnotism, hysteria, and simulation, which has recently been confirmed by functional imaging; and (4) his "dynamic lesion" theory, which now correlates well with recently established neurophysiological mechanisms.

The concepts of heredity and degeneration in the work of Jean-Martin Charcot

Transcripts of the Tuesday Lessons at La Salpêtrière Hospital show that Jean-Martin Charcot often asked his patients about their family history. The information gathered on patients' heredity played also a significant role in the diagnostic reasoning he instructed his students in. Again and again, he included in his teachings the concept of degeneration to suggest an etiology for observed pathologies. This article analyzes the origin of Charcot's knowledge, imparted in the Tuesday Lessons, by examining the theories of heredity and degeneration successively developed by Prosper Lucas (1808-1885) in 1847, Bénédict-Auguste Morel (1809-1873) in 1857, and Jacques-Joseph Moreau de Tours (1804-1884) in 1859. I will review examples taken from the Tuesday Lessons to illustrate how Charcot assimilated the ideas of these alienists. Two of his students, Charles Féré (1852-1907) and Georges Gilles de la Tourette (1857-1904), known for championing their master's work, went on to publish their own books that developed theories of heredity and degeneration. I will conclude my review, which aims to examine a little known facet of Charcot's work, with a few examples from these authors' writings.

The Mary Walker effect: Mary Broadfoot Walker

Mary Broadfoot Walker (1888-1974) was the first to demonstrate the 'Mary Walker effect' describing the weakness of other muscle groups following release of the arteriovenous occlusion of an unrelated exercising muscle group in patients with myasthenia gravis, which led to the search for a circulating causative agent for myasthenia gravis. She was the first to clearly demonstrate that strength temporarily improved in patients with myasthenia gravis with physostigmine or Prostigmin (neostigmine). This dramatic treatment response has been erroneously termed the 'Mary Walker effect'. Further, she noted hypokalaemia during attacks of weakness in familial periodic paralysis, pioneering treatment with potassium chloride. Although Mary Walker practiced in a nonacademic setting and trained at a time when women were not allowed to train alongside men, she was the first to convincingly demonstrate three life-changing treatments in the field of neuromuscular medicine, a feat that few physicians of any era can claim.

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

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.

Abe Baker: Visionary and organizational leader of the American Academy of Neurology

American neurologist and neuropathologist Abraham Bert (Abe) Baker (1908-1988) was instrumental in founding the American Academy of Neurology and served as a catalyst for the emergence of neurology as a strong, independent medical discipline in the United States in the second half of the twentieth century. Baker served as the first president of the Academy from 1948 to 1951. He was also instrumental in garnering support for the National Institute of Neurological Diseases and Blindness, which was founded in 1950 and later evolved into the National Institute of Neurological Disorders and Stroke. Baker's leadership was also essential in developing continuing medical education for neurologists at a national level and in garnering federal financial support for neurology training programs.

The Four Horsemen (and their Nags): Recollections of the founding and early years of the American Academy of Neurology

"The Four Horsemen" was the nickname given to the four neurologists-Abraham Baker, Francis Forster, Russell DeJong, and Adolph Sahs-who were most instrumental in founding and developing the American Academy of Neurology (AAN) beginning around 1948. Forster later humorously added "and their nags" to the epithet to reflect the cohesion of the founders and their wives. This article presents the personal recollections of these founders from correspondence and oral histories. When the AAN was founded, private-practice neurologists and residents were excluded from the academically oriented and restrictive American Neurological Association (ANA). Baker conceptualized the AAN as an inclusive professional society that would accept all neurologists of whatever age and level of training, and that would strive to strengthen their knowledge, competencies, and skills through continuing medical education and guideline development. Baker recruited supportive colleagues to help create and develop the organization. Their intention was not to compete with or subvert the ANA, but to offer an inclusive professional organization for all neurologists. Nevertheless, their efforts produced opposition among ANA members. To defuse the antagonism, neurologist Alphonse Vonderahe proposed an influential House-Senate formulation of the AAN-ANA relationship, modeled after the U.S. Congress, both as a supporting rationale for the AAN and as a conceptual model for the functional relationship between the two organizations. The inclusive approach greatly augmented the ranks of the fledgling AAN, whereas those of the ANA stayed relatively stagnant, with the AAN ultimately becoming the dominant neurological society. These neurologic pioneers laid the groundwork for an invigorated, well-trained, scientifically based specialty of neurology in the second half of the twentieth century.

Pearce Bailey: The "Fifth Horseman" and the National Institute for Neurological Diseases and Blindness

Pearce Bailey (1902-1976) had an active career focused on the growth and development of neurology as a specialty in the post-World War II era. He was a founding member of the American Academy of Neurology (AAN) and its second president from 1951 to 1953. In 1951, he was also appointed as the first director of the National Institute for Neurological Diseases and Blindness (NINDB), which is now the National Institute of Neurological Disorders and Stroke. Known as an excellent politician, Bailey's role at the NINDB helped bolster the AAN in its early days. Prominent neurologists in the AAN, especially A. B. Baker, also helped shape the NINDB as early advisors. Bailey continued working to move neurology forward globally, including cofounding the World Federation of Neurology with Ludo van Bogaert in 1957 and becoming director of the NINDB International Research Program in 1959. Bailey retired in 1971, having been dubbed by Baker as "one of the smartest politicians that ever came to Washington."

Francis Forster, the last Horseman: A career in academic neurology

American neurologist and epileptologist Francis M. Forster (1912-2006) was the last survivor of the "Four Horsemen," a nickname given to the four neurologists-Forster, Abe Baker, Russell DeJong, and Adolph Sahs-who were most instrumental in founding the American Academy of Neurology under Baker's leadership in 1948. Forster was a consulting physician for many high-profile patients, including President Dwight Eisenhower, President Quirino and Archbishop Reyes of the Philippines, Provisional President Lonardi of Argentina, and Cardinal Albert Meyer of Chicago. Forster was also an expert witness for the prosecution in the trial of Jack Ruby, who killed Lee Harvey Oswald. Forster's greatest legacy, though, was as a teacher: During his career as chairman of two robust academic neurology departments, he trained more than 100 residents, at least 17 of whom went on to become chairmen of neurology departments in the United States, Europe, Asia, and South America.

The founding of neurology as a specialty: The American situation in context

With few exceptions, neurology in Europe as well as in the United States emerged from internal medicine and psychiatry, and neurology and psychiatry in particular have long remained connected in clinical practice and teaching. When the American Board of Psychiatry and Neurology (ABPN, 1934) and the American Academy of Neurology (AAN, 1948) were founded, the emancipation of neurology as an independent specialty was still evolving. During the First International Neurological Congress (Berne, Switzerland, in September 1931), a special conference was organized on the "Relation of Neurology to General Medicine and Psychiatry in Universities and Hospitals of the Various Countries," at which representatives from several countries described the situation in their countries. Their statements were made around the time of the founding of the ABPN and not long before that of the AAN. They show that neurology in most countries was still struggling to become independent and only in a few cities flowered as an independent specialty. In the second part of this article, specialist regulation (training, examination, and certification) in European countries (Germany, France, England, and The Netherlands) will be compared to that of the ABPN. It appears that Germany was among the early countries where this occurred, following the Bremen Ärztetag (physicians day) in 1924. Comparable to the American situation, it was professionally controlled, in contrast to the French state certification, which occurred later. The British specialist regulation was much later and more complicated.

Russell DeJong: "The most scholarly neurologist in the Academy"

Russell Nelson DeJong (1907-1990) became professor and chair of the Department of Neurology at the University of Michigan in 1950. A prolific author with more than 200 publications, DeJong wrote on virtually all areas of neurology. DeJong's classic monograph, The Neurologic Examination (1950), grew into an encyclopedic volume from lectures he gave to junior and senior medical students; DeJong saw it through four editions. He was one of the founders of the American Academy of Neurology (AAN), serving as its vice-president from 1961 to 1963 and as the first editor-in-chief of its journal, Neurology. Abraham Baker, the driving force behind the founding of the AAN, considered DeJong "the most scholarly neurologist in the Academy." DeJong was also president of the American Neurological Association, president of the American Board of Psychiatry and Neurology, president of the American Epilepsy Society, and chairman of the Scientific Advisory Board of the National Multiple Sclerosis.

Joseph Resch and the plea of the practicing neurologists: A postwar neurology resident's tale

When University of Minnesota neurology resident Joseph A. Resch complained to the department director, A. B. Baker, in 1946 about the lack of a professional neurological association open to young neurologists like himself, he set into motion a chain of events that culminated in the founding of the American Academy of Neurology in June of 1948. This provided a supportive professional organization for practicing neurologists as the traditional bond between neurology and psychiatry was broken during the postwar era. Resch went on to become a pivotal figure in the practice of neurology in the Twin Cities and succeeded Baker as chairman of the University of Minnesota neurology department.

The Four Horsemen and the American Board of Psychiatry and Neurology (ABPN)

After the gradual introduction of specialties in medicine in the United States during the late-nineteenth and early-twentieth centuries, the American Board of Psychiatry and Neurology (ABPN) was founded in 1934 to provide specialty regulation (training oversight, examination, and certification). The name reflects the combined practice of psychiatry and neurology that was still present at the time. Directors were nominated by the founding organizations: American Psychiatry Association (APA), American Neurological Association (ANA), and the Section of Nervous and Mental Diseases of the American Medical Association (AMA). Many of the early physicians who were certified by the ABPN did so for psychiatry as well as neurology. Neurologist Walter Freeman and psychiatrist Adolph Meyer played important roles in the ABPN during the early days. Following the founding of the AAN in 1948, neurological practitioners believed the AAN would better represent them in the ABPN. At first the ANA appointed AAN members to the ANA Council; but after 1972, the AAN could directly nominate directors for the ABPN. Despite this situation, the AAN had an important influence in the ABPN from its start, as is shown by the fact that all of the key organizational leaders responsible for founding the AAN-the "Four Horsemen" (Abraham B. Baker, Russell N. DeJong, Francis M. Forster, and Adolph L. Sahs-served as directors of the ABPN in the period 1951-1967. The Horsemen were able to change both examination practices that became more searching and expansive, and the basic disciplines that needed to be studied in detail.

Concussion: A History of Science and Medicine, 1870-2005

OBJECTIVE

To review the intellectual history of concussion from the mid-19th century to the opening decade of the 21st century.

BACKGROUND

Head injuries (HI) and their acute and long-term effects have been investigated for centuries, with major reviews of the topic appearing by 1870. Thus, while it has long been acknowledged that chronic traumatic encephalopathy was first described by Harrison Martland in 1928, an examination of the history of concussion research up to Martland's seminal report places his studies in a deeper historical context. This history makes clear that Martland's findings were one among many such studies showcasing the lasting dangers of blows to the head. In the years after Martland published his study, his paper was frequently cited in other papers that made clear that blows to the head, of all ranges of severity, were dangerous injuries with potentially life-changing consequences.

METHODS

The author has engaged in an historical analysis of the development and elaboration of concussion research in clinical medicine, neurology, neurosurgery, and those scientific disciplines related to clinical medicine. The author has found numerous primary sources from the history of medicine and science that describe the acute and chronic effects of single and repeated sub-concussive and concussive blows to the head.

RESULTS

This study makes clear that evidence-based methodologies inevitably short-change the knowledge of past clinicians and scientists by holding these figures to normative standards of recent invention. What criticism of this kind fails to recognize is that past investigators, many of them pioneers in their fields, published their work in ways that matched the highest normative standards of their day for the presentation of evidence.

CONCLUSIONS

It has been recognized for a long time that concussions are dangerous injuries with potentially life-changing consequences, ranging from permanent symptoms to degenerative neurological states. The intellectual history of medicine and science from 1870 to the recent past shows both a continuity of clinical observations about HI and a steady, incremental accumulation of knowledge refining our understanding of those observations from a remarkably wide sphere of scientific disciplines.

Rett Syndrome Turns 50: Themes From a Chronicle: Medical Perspectives and the Human Face of Rett Syndrome

BACKGROUND

Fifty years ago Andreas Rett first described in great detail what came to be known as "Rett syndrome." Understanding girls and women with this syndrome and their families helped in many ways to revolutionize modern neurodevelopmental medicine. For some people the identification of the genetic underpinning of the syndrome and the ongoing biological research into this condition represented the peak of the scientific accomplishments in Rett syndrome. For others, it was developments in clinical research methodologies that were especially important. Above all, the patient- and family-oriented empathetic and collaborative approach to care by professionals collaborating with families has led to immense achievements, both scientific and humanistic.

AIM

The aim of this narrative was to describe the medical and personal life story of a young woman with Rett syndrome and to offer a history that highlights developments in the unraveling of this condition from its initial recognition to our current understanding.

CONCLUSION

We believe that much can be learned from the humanistic style of care provision combined with the best possible level of assisted autonomy and life enjoyment of the young woman with Rett syndrome. In addition, the approach to collaborative research by dedicated and often charitable leaders in the field can teach us many important lessons about the ethics of clinical and health services research.

British Romantic Generalism in the Age of Specialism, 1870-1990

This essay explores the impact of 'generalism' and 'general practice' on the specialisation of British medicine using the case of neurology in Britain to reveal characteristics of British 'generalist medical culture' from 1870 to 1990. It argues that 'generalism' represented a particular epistemological position in Victorian medicine, one that then created a natural bridge between science and medicine over which almost all physicians and scientists were comfortable walking. The legacies of that Victorian 'generalist preference' exerted an enduring impact on the specialisation process as physicians experienced it in the twentieth century and as this case of neurology reveals so clearly. Neurologists and general physicians would still be arguing about the relative merits of a general medical education into the 1980s. By then, however, the emergence of government bodies promoting specialist labour conditions would have rendered the process seemingly inexorable.

Joseph Godwin Greenfield: The father of neuropathology (1884-1958)

The systematic study of neuropathology was initiated by Godwin Greenfield in the early part of the 20(th) century. He worked at the National Hospital, Queen Square, London for the major period of his life and worked on various subjects like cerebrospinal fluid, intracranial tumours, cerebellar ataxias, dystrophia myotonica, disseminated sclerosis, subacute combined degeneration of the spinal cord, and the like. After his retirement he visited the National Institute of Neurological Diseases and Blindness in Bethesda, Maryland, USA, from time to time and there he died suddenly from myocardial infarction.

[Jean-Baptiste Vincent Laborde (1830-1903), forgotten neurologist and neurophysiologist]

Jean-Baptiste Vincent Laborde (1830-1903), native of Buzet, in Gascony, undertook his medical studies in Paris and was nominated "externe" (1854) then "interne" (1858) of Paris hospitals. His main "patrons" were Alfred Velpeau (1795-1867), Auguste Nélaton (1807-1873), Jean-Baptiste Bouillaud (1796-1881), Pierre-Olive Rayer (1793-1867), Joseph-François Malgaigne (1806-1865), Pierre Carl Edouard Potain (1825-1901), Ernest Charles Lasègue (1816-1883) and Léon Rostan (1790-1866). In 1864 he defended his thesis on the essential paralysis of childhood. He then worked in the physiology laboratory of Professor Jules Auguste Beclard (1818-1887), and became "chef des travaux" of physiology at the Paris faculty of medicine. In 1890, he was nominated to the chair of Biological anthropology at the Paris school of anthropology. His main works focused on the rhythmic tractions of the tongue in cases of apparent death, the understanding of the etiology of brain softening he attributed to vascular occlusions by atheroma and the discovery of connections between the cranial nuclei of common (III) and external (VI) oculomotor nerves and the struggle against the use of ceruse, against tuberculosis and especially against alcoholism. In addition, he made a career in journalism: since 1874 he had been the founder, director and editor-in-chief of the weekly newspaper The Medical Tribune, whose aim was to "combine to a fair extent, science and progress with the practice of medicine." Finally, Laborde was a convinced Republican, a friend of Léon Gambetta's (1838-1882). For him, democracy was the "ideal of civilized nations" and he showed deep hatred for the "Commune of Paris". Finally, he was a determined free thinker, who ran the Society for mutual autopsy for a while and who was attached to civil funerals and cremation.

Pictures of pain: their contribution to the neuroscience of empathy

The study of empathy, a translation of the term 'Einfühlung', originated in 19th century Germany in the sphere of aesthetics, and was followed by studies in psychology and then neuroscience. During the past decade the links between empathy and art have started to be investigated, but now from the neuroscientific perspective, and two different approaches have emerged. Recently, the primacy of the mirror neuron system and its association with automaticity and imitative, simulated movement has been envisaged. But earlier, a number of eminent art historians had pointed to the importance of cognitive responses to art; these responses might plausibly be subserved by alternative neural networks. Focusing here mainly on pictures depicting pain and evoking empathy, both approaches are considered by summarizing the evidence that either supports the involvement of the mirror neuron system, or alternatively suggests other neural networks are likely to be implicated. The use of such pictures in experimental studies exploring the underlying neural processes, however, raises a number of concerns, and suggests caution is exercised in drawing conclusions concerning the networks that might be engaged. These various networks are discussed next, taking into account the affective and sensory components of the pain experience, before concluding that both mirror neuron and alternative neural networks are likelyto be enlisted in the empathetic response to images of pain. A somewhat similar duality of spontaneous and cognitive processes may perhaps also be paralleled in the creation of such images. While noting that some have repudiated the neuroscientific approach to the subject, pictures are nevertheless shown here to represent an unusual but invaluable tool in the study of pain and empathy.

Epilepsy in Dostoevsky

Fyodor M. Dostoevsky (Moscow, 1821-Saint Petersburg, 1881) suffered epilepsy throughout his whole literary career. The aim here is to understand his condition in light of his novels, correspondence, and his contemporaries' accounts as well as through the eyes of later generations of neurologists. From Murin (The landlady, 1847) to Smerdyakov (The brothers Karamazov, 1880), Dostoevsky portrayed up to six characters with epilepsy in his literature. The first symptoms of the disease presented in early adulthood, but he was only diagnosed with epilepsy a decade later. In 1863 he went abroad seeking expert advice from the famous neurologists Romberg and Trousseau. Dostoevsky made an intelligent use of epilepsy in his literature (of his experiential auras or dreamy states particularly) and through it found a way to freedom from perpetual military servitude. His case offers an insight into the natural history of epilepsy (a cryptogenic localization related one of either fronto-medial or temporal lobe origin using contemporary medical terms), thus inspiring later generations of writers and neurologists. Furthermore, it illustrates the good use of an ordinary neurological disorder by an extraordinary writer who transformed adversity into opportunity.

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.

[James Parkinson (1755-1824) revisited]

The name of Parkinson is universally famous because of the eponymous disease. But as a man, James Parkinson (1755-1824), is poorly known. He was born, married and passed away in his St-Leonard parish in Shoreditch (London). After having studied Latin, Greek, natural philosophy, and stenography (shorthand), which he considered as the basic tools of any doctor, he studied for six months at the London Hospital Medical College, and served his apprenticeship as an apothecary-surgeon with his father for six years. Then he was qualified as a surgeon in 1784 at the age of 29 years. His activity has been deployed in three areas: 1) medicine, 2) political activism and social reformism, 3) paleontology and oryctology. As a physician, Parkinson has published several books, the most important concerned paralysis agitans (future Parkinson's disease), gout, complications of lightning (future Lichtenberg figures and keraunoparalysis), acute appendicitis (with his son John Parkinson) and hernias (diagnosis, development, dangers of hernia ruptures, and design of a simple truss). Its ideological and political commitment was manifested by joining two secret societies and publishing numerous pamphlets, many of which are signed by the pseudonym Old Hubert; he campaigned for a better representation of the people in Parliament, for greater social justice, for the defense and recognition of the rights of the poor, the insane, the children, and against children abuse. He published a small compendium of chemistry, he was one of the thirteen members who create the British Geological Society and is recognized as one of the founders of paleontology; as was Georges Cuvier (1769-1832), he remained a strong supporter of creationism and catastrophism. Distinguished oryctologist, he gave his name to several fossils, mainly molluscs.

Early Controversies over Athetosis: I. Clinical Features, Differentiation from other Movement Disorders, Associated Conditions, and Pathology

BACKGROUND

Since the description of athetosis in 1871 by American neurologist William Alexander Hammond (1828-1900) the disorder has been a source of controversy, as were many aspects of Hammond's career.

METHODS

Primary sources have been used to review controversies in the 50-year period since the initial description of athetosis, in particular those concerning clinical features, differentiation from other movement disorders, associated conditions, and pathology. Controversies concerning treatment will be addressed in a subsequent article.

RESULTS

Hammond struggled to establish athetosis as a distinct clinical-pathological entity, and had successfully predicted the striatal pathology in his initial case (albeit somewhat serendipitously). Athetosis was, nevertheless, considered by many neurologists to be a form of post-hemiplegic chorea or part of a continuum between chorea and dystonia. European neurologists, and particularly the French, initially ignored or discounted the concept. Additional controversies arose over whether the movements persisted during sleep, whether athetosis was, or could be, associated with imbecility or insanity, and how it should be treated.

DISCUSSION

Some controversies concerning athetosis served to identify areas where knowledge was insufficient to make accurate statements, despite prior self-assured or even dogmatic statements to the contrary. Other controversies illustrated established prejudices, even if these biases were often only apparent with the greater detachment of hindsight.