6th Annual Meeting of the International Society for the History of the Neurosciences (ISHN) and 8th Meeting of the European Club for the History of Neurology (ECHN)

Cologne, Germany
13-16 June 2001

Go to Meeting Program

Return ticket to Cologne: Theodor Schwann, wandering and melancholic genius

Geneviève AUBERT
Department of Neurology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium

The life and career of Theodor Schwann (1810-1882) can be followed along the German-Belgian-French Thalys route. Born in Neuss near Düsseldorf, Schwann was in secondary school at Cologne. He attended university in Bonn, Würzburg and Berlin, where he studied and worked in Müller's famous laboratory. He then began microscopic and physiological studies on nerves, muscles, and blood vessels. While studying peripheral nerves, he first described the specialized supporting cell that bears his name since then. It was certainly appropriate that he is associated with a particular type of cell, since he was one of the founders of the cell doctrine. This theory revolutionized biology by establishing that the cell is the elementary unit of life. All anatomy and physiology of the nervous system rests on this basic concept. However, Schwann cannot be reduced to one structure and one theory. His interests were broad. He made important studies on digestion, alcohol fermentation and putrefaction processes. Throughout his life, he showed an interest in photography and other technical developments.

Schwann's brilliant debut was followed by an austere academic career in Belgium. In 1839, the Universit&eacue; Catholique de Louvain offered him the chair of anatomy. The same year Schwann expressly traveled to Paris to learn Daguerre's technique. In 1848, he left Louvain for the University of Liège, enticed by his compatriot Spring, whom he succeeded to the chair of anatomy and later of physiology. This Belgian period appears disappointing from a scientific point of view. Schwann's profoundly Catholic mind was tortured by intense philosophical questioning and existential doubts. He went through a mystical phase, with marked neurotic traits. He began the composition of a vast treatise. This Theoria, which should have been a general system of organisms, started from cell theory, going through brain function and psychology to theoretical considerations. nevertheless, Schwann remained an attentive observer of scientific as well as technical advances. In 1875, he became a member of the Association belge de Photographie. His forty years of teaching were marked, by and international celebration, in Liège in 1878. Schwann was offered a splendid photographic album with 263 pictures of all the great scientists of his time. In 1882, three years from his retirement, he died in Cologne.

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

Medical cinematography: Birth and early neurological application

Geneviève AUBERT and Christian LATERRE
Department of Neurology, Université Catholique de Louvain, Bruxelles, Belgium

This lecture will present the beginnings of medical cinematography and particularly its early use in neurology. Paris had been the hub of the rich interactions between nascent neurology, photography and chronophotography. At the Salpêtrière Charcot and his co-workers, particularly the photographer Albert Londe, had used photography extensively. The role played by the French physiologist Marey in the development of chronophotography and later cinematography had been decisive. Finally it is again in Paris that the Cinématographe of the Lumière brothers was first shown. Very soon cinematography became a popular entertainment but medical applications were being developed simultaneously. As early as 1898, Doyen, surgeon in Paris, had himself filmed while operating. The screening of these films in non-medical circles and at fairgrounds brought cinematography into disrepute in official French medical society. At the same period, the Romanian Georges Marinesco, with his assistant Popescu, began to film neurological patients with various gait disorders, in Bucharest. He published several papers illustrating the interest of this technique in clinical research. He was followed in 1905 by Arthur Van Gehuchten, Belgian neuroanatomist and neurologist. Van Gehuchten underlined the pedagogic and documentary interest of this technique. He used it extensively up to his death in 1914. Examination of the neurological patient, highlight of clinical signs of various muscular disorders, and evolution of symptoms after surgical treatment were among the many subjects which he documented in his films. They are preserved at the Cinémathèque Royale de Belgique.

Session X -- New Approaches in 19th Century Neurology
Saturday, 16 June 2001, 2:30 pm

From Duchenne's de Boulogne "electric" localism to J. M. Charcot's clinical experimentation: Computational linguistic analysis of "electric" lemmas in both Parisian clinician's lexicon

Seminario di Storia della Scienza, Dipartimento di Filosofia, Università di Bari, Italy

Aims and purposes:   This work, part of a largest research plan, accomplished by the "Institute of History of Science", at Bari University, intends to verify the value of a computational and linguistic approach to scientific "corpora" in order to show and to study the originality and those linguistic "emergences" in relation to fundamental and conceptual "nuclei". This report, particularly, tries to focus in Duchenne's de Boulogne works, his use of a specific lexicon, connected to the application of electricity in medicine and its commensurability with the same lexicon, used by J. M. Charcot , Duchenne's student (as he admitted) in this specific domain.

Materials and methods:   The first 3 volumes of Charcot's Oeuvres Complètes (ed. by Delahaye and Lecroisnier in 1873, 1877, 1887) and Duchenne's work De l'électrisation localisée et de son application à la Physiologie, à la Pathologie et à la Thérapeutique (1855) were reduced in machine readable form, by scanning them and parsed by a lemmatisation software: INTEX, produced by Max Silberstein, at the "Laboratoire d'Automatique Documentaire et Linguistique" - Paris 7 University.

Results and explanatory proposals:   Personal and scientific relations between Duchenne and Charcot were shortly described by a several authors, from Charcot's official biographer, George Guillain, to J. Gasser's, and Goetz's, Bonduelle's and Gelfand's important works. This report aims to point out a particular aspect, not so studied till now, probably because of its features of Bachelard's "outdated science": neuro-muscular excitation techniques and their use from Duchenne and Charcot, not only as a technique but also regarding those general ideas about the relation between electricity and nervous fluid and those methodological questions regarding the use of those techniques. Duchenne's and Charcot's agnosticism about identification between electricity and nervous impulse comes out. Duchenne, for his part, proposes an idea of "conscience musculaire", that becomes in Charcot "muscular innervation sense" as an hypothesis to save his organic localism from difficulties where his study on hysteria drove him. We outline Duchenne's exclusive use of faradisation against Charcot's revival of others electrisation's techniques, a point of view closer by a modern electro-physiological exploration of degenerative reaction. At the end we suggest a Duchenne's portrait, equipped with his volt-faradic instruments, resulting as the "Laennec" of neuro-myology, engaged to plan an electric pathologic anatomy, in opposition to Charcot's eclectic use of these techniques, included an experimental use, directed to demonstrate through the faradisation the pathogenesis of particular syndromes.

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

The brain as technology

Otniel E. DROR
History of Medicine, The Hebrew University-Haddasah Medical School, Jerusalem, Israel

This paper studies the convergence of brain research with the physiology of emotions during the twentieth century. It argues that the twentieth-century brain entered the laboratory of emotions not as an object of knowledge, but as a technology that promised to overcome the laboratory's resistance to emotions. The brain as emotion-technology restructured the relationships between physiological and psychological forms of knowledge, embodied a new physiological-type emotion, responded to contemporary concerns with the status of animals in physiological laboratories, and excluded the experiencing subject from the physiological study of "emotion." The constitution of the brain as a technology was one central site in which modern physiology of the brain abandoned the psychological, and construed a purely biological role of human experience. The paper also makes a brief excursion into the social history of pain, in order to show that the reactions of physiologists to local political events were instrumental for the construction of the brain as a technology. The constitutive elements that were assembled in creating the brain-as-technology were instrumental for the important studies of James Papez, Paul Maclean, and for the modern concept of Limbic System.

Session I -- 20th Century Brain Research and Emotions
Thursday, 14 June 2001, 9:30 am

The first in vitro model of concussive head injury

The Center for Applied Research in Head Injuries, Department of Neurosurgery, Rambam (Maimonedes) Medical Center, Faculty of Medicine, The Technion - Israel Institute of Technology, Haifa, Israel

In 1705 Littré reported to the French Academy of Surgery the case of a criminal who had killed himself by rushing and striking his head against the wall. On the examination of the head and the brain no abnormal findings could be perceived. This report is considered to open the era of investigation of concussion. Past surgeons realized that they encountered an important yet not comprehended phenomenon in which "there may be changes and alterations of structure which the senses are incapable of detecting." J.-P. Gama, a French surgeon (1775-1861), in an attempt to make these minute structural alterations perceivable, sought a then entirely novel approach -- in vitro physical modeling of the brain. The model consisted of a round bottom glass flask having a long neck in which several strands of wire in different directions were hung and that was filled with a solution of isinglass to have the consistency of the brain. Gama hit the flask from various directions and tried, by studying the movements of the wires, to examine the spread of forces within the jelly and to correlate his observations with various clinical situations. His theory of oscillatory and vibratory movements of the brain produced by the percussive impact introduced and element not yet considered in the study of head injuries--the spread of forces into the depth of the brain and their impact on the function of the deep structures. Gama's report was not graphically illustrated, the wires' vibratory movements were not recorded and the percussive forces were not measured. The skull was regarded as a non-elastic structure, and the acceleration and deceleration were not considered; nevertheless, he was the first to employ an hypothesis-driven entirely novel approach. Nearly a century elapsed until modern technology and advanced computations enabled the proper study of physical and mathematical models of head injury. These models were developed to answer problems unsolved by animal experiments, some of which confirmed while others negated Gama's concepts. reviewing the history of the development of this line of experimental approach reveals that some of the questions raised by Gama's experiment still wait for final elucidation.

Session V -- Neurosurgery Across the Centuries
Friday, 15 June 2001, 10:30 am

History of the physiological analysis of tremor

Edward J. FINE1 and Linda A. LOHR2
1Department of Neurology and 2Robert L. Brown, M.D. History of Medicine Library, State University at Buffalo, New York, USA

Until the publications of William Gowers (WG) in 1886 from England and Fredrick Peterson (FP) in 1889 from America, almost nothing was known about the frequency and physiology of tremors. Gowers attached a metal rod to the tremoring part and positioned the sharpened end to trace a line on a spring motor driven revolving drum with smoke-blackened paper. WG found that alcoholics had an irregular, fine tremor activated by movement with a frequency of 8.1-11 cycles/sec (cps). The tremor of Parkinson disease (PD) was regular, 4-7 cps, appeared at rest, diminished or stopped with movement. WG described the PD tremor as alternating contractions in opposing muscle causing a rhythmical movements of the parts to which they were attached.

FP used an Edwards sphygmograph (EDS), originally designed to record arterial pulses, to record tremor. FP pressed the rubber plunger of the EDS on a tremoring part and the up and down motion was transferred to a fine wire stylus through levers. The stylus wrote on smoke-blackened paper. The paper was advanced by friction rollers at a moderately precise speed, driven by a spring wound motor. FP noted alcoholics had fine, irregular, 8.5-11 cps tremors activated by action. The tremors of delirium tremens were 5.6-6.8 cps, moderate amplitude. FP described PD tremor as appearing at rest and rarely in action, regular, small amplitude, 5.0-5.4 cps coarse waves. WG and FP described hysterical tremors as irregular, small amplitude, 4-9 cps oscillations. FP postulated that cerebral cortex was the center of action for hysterical tremor.

In 1894 FP constructed apparatus to overcome the potential dampening effect of the EDS upon the tremoring part. FP placed a subject's tremoring finger on a mercury filled Marey tambour (MT) that transduced oscillations into fluid waves. A second MT connected to a mercury filled rubber tube transferred the waves to a stylus that moved up and down against the smoked drum of a Ludwig kymograph. A second stylus, driven by an electric motor, marked off seconds precisely. He varied the drum's rotation speed to analyze waves for sub-harmonic frequencies. Tremor of PD had a frequency of 5 cps, and hyperthyroidism of 10 cps. HE found that some PD patients had sub-harmonic tremors.

Mary A.B. Brazier (MB) used a multichannel electroencephalograph with sensitive amplifiers, filters, electrical motors attached to rollers driving the recording paper and ink pens to mark on the paper the pattern of the action potentials from tremoring muscles in 1994-5. MB found that PD tremor consisted of alternating bursts of agonist and antagonist muscles of 4-7 cps and for combat neurosis, the bursts were synchronous, irregular up to 10-12 cps. Shahani and Lefebvre (1978) found that the EMG activity in alcoholic tremor were either synchronous or continuous and ranged from 8 to 12 cps. Thus FP and WG had made valid and prescient observations with simple and rather crude instruments.

We will present brief biographies of FP, WG, and MB and show that modern tremor analysis by electromyography confirms that WG, FP and MB presciently and accurately described the tremors of PD, alcoholism, hysteria and delirium tremens.

Session X -- New Approaches in 19th Century Neurology
Saturday, 16 June 2001, 2:00 pm

E.G. Squier and the recognition of ancient cranial trepanation: the diplomat-archeologist and his Peruvian skull

Stanley FINGER and Hiran R. FERNANDO
Department of Psychology, Washington University, St. Louis, Missouri, USA

In the 1860s, after completing a diplomatic mission to Lima, Peru for the United States, Ephraim George Squier visited Cusco, where he was shown an Inca skull cap with an unusual rectangular opening. Squier, who had a long-standing interest in New World archeology, knew that the opening had to have been made by human hands, and he believed that man had survived his cranial surgery for some time. He was able to bring his unusual specimen back to the United States, where it was seen by members of the New York Academy of Medicine (1865) and others, and to France, where it was studied by Paul Broca (1867). It caused an immediate sensation. Not only did it represent the very first case of trepanation widely recognized as such, but it showed that the Peruvians practiced an advanced form of surgery prior to the European conquest.

In our presentation, we shall provide overlooked biographical information on Squier and chronicle the events that led him to the eponymic skull fragment. We shall also discuss why Squier wrote so little about the trepanned skull and why nothing appeared for more than a decade since he "discovered" it. We shall also present notes and articles written by those who viewed the skull fragment in the United States and France, including commentaries by Squier, Nott, and Broca, the first two of whom correctly concluded that trepanation was performed in Pre-Columbian Peru to treat head injuries sustained in war.

Session V -- Neurosurgery Across the Centuries
Friday, 15 June 2001, 11:30 am

Duboisia, the Australian belladonna

Faculty of Biology, Institute for the History of Medicine, Clinical Neurochemistr, Department of Psychiatry, University of Würzburg, Germany

Alkaloids derived from solenaceous plants were the subject of intense scrutiny by chemists and pharmacologists in the second half of the 19th century, and new members of the class were eagerly sought for use in the clinic. Nevertheless, it was somewhat unexpected when it was discovered in the 1870s that an Australian bush, Duboisia myoporoides, long employed by Aborigines as a hunting poison and medication, contained an atropine-like alkaloid, promptly dubbed "duboisine". A colorful history ensued, in which duboisine was initially confused by leading chemists with "piturine" (nor-nicotine), extracted from another Duboisia species, and the identify of duboisine with hyoscyamine and hyoscine was debated with similar uncertainty. Duboisine was quickly adopted in Australia and Europe as a more convenient mydriatic than atropine; within a few years, its value as a potent sedative in the management of psychiatric patients had also been recognized, especially in Germany. As with other solanaceous alkaloids, this led to its successful introduction into the therapy of parkinsonism. It would eventually prove that the active component of duboisine was, in fact, hyoscine (scopolamine); as it had always been an expensive drug to import, this led to a rapid decline in its use in Europe. With the outbreak of World War II, however, its fortunes rose once more; a replacement for German scopolamine was urgently required for application in surgical anesthesia and to combat sea-sickness, leading to the establishment of plantations in Queensland which continue to supply the bulk of the world's raw scopolamine. Duboisia myoporoides was also the source of another alkaloid, tigloidine, which showed greater promise in the therapy of parkinsonism in the 1950s and 1960s before its cost and the advent of L-DOPA therapy led to its demise.

Session VII -- Pharmacological and Magical Aspects of Neurology
Friday, 15 June 2001, 3:00 pm

Wine and neurology

Jean-Pierre GOUBERT
Paris, France


On tetany: 19th century research activity in the Vienna Medical School

Helmut GRÖGER <helmut.groeger@univie.ac.at>
Institute for the History of Medicine, Vienna, Austria

Salomon Levi Steinheim (1789-1866) and Jean Baptiste-Hippolyte Dance (1797-1832) were the first to describe the clinical symptoms of tetany; Francois Remy Lucien Corvisart (1824-1882) coined the term tetany. It was Armand Trousseau (1801-1867) who actually discovered the phenomenon that was named after him. In the German-speaking area it was mainly a paper by Franz Riegel (1843-1904) and a study by Wilhelm Erb (1840-1921) about electrical hyperexcitability which paved the way; this observation had also been mentioned by Moritz Benedikt (1835-1920). The detailed study of tetany in the Vienna Medical School was started by Franz Chvostek the elder (1835-1884); in his venie docendi he was the first to deal with electrotherapy and since 1876 he had published a number of case studies on this disease. It was he who discovered mechanical hyperexcitability, a most significant means to diagnose latent tetany. Chvostek's Sign (twitching of the respective facial side after percussing the facial nerve) is based on this discovery. Nathan Weiss (1851-1883)--although he submitted his venia docendi on the subject of internal medicine--nevertheless dealt only with questions of neuropathology. He was appointed Head of the Department of Electrotherapy and Neuropathology at the General Hospital in Vienna. In 1880 he reported about a fatal case of tetany. Weiss was the first to do respective systematic studies of the spine including medulla oblongata and the stem ganglia, where he discovered changes in the anterior cells of the spinal medulla as well as in the motor nuclei of the oblongata. As early as 1881, i.e., before the discovery of the epithelial bodies, Weiss found a causal relationship between tetany and strumectomy.

The most detailed work on tetany was carried out by Lothar Frankl-Hochwart (1862-1914). At the Medical Department of Hermann Nothnagel (1841-1905), he was in charge of an Outpatient Unit for Neurology and Electrotherapy which was run parallel to the Outpatient Unit for Neurology at the Department of Psychiatry under Theodor Meynert (1833-1892). In 1887 Frankl published a paper on electrical and mechanical excitability of nerves and muscles affected by tetany. As a result of further experimental and clinical studies, Frankl published a monograph, Tetany, in 1891. It was the first comprehensive monograph dealing with this disease; further editions and contributions in manuals were published. Frankl-Hochwart--since 1891 he had been recipient of a venia docendi in the field of neuropathology--pleaded for neurology as an independent discipline and favoured establishing a separate department. He was also the co-founder of the Society of German Neurologists. Under Frankl's influence, Hermann Schlesinger (1866-1934) and Rudolf Jaksch (1855-1947) at the Nothnagel Medical Department also focused on tetany. Although at the Medical Department of Otto Kahler (1849-1939) there was interest in neuropathological issues--same as at Nothnagel's--it was Franz Chvostek the younger (1864-1944) who did the studies on tetany. As evident, tetany research in the Vienna Medical School at the outgoing 19th century was widely spread, reaching out to internal medicine but focusing mostly on neuropathology; this discipline was about to gain independence and, particularly as far as tetany research was concerned, supplied valuable contributions.

Session VIII -- Poster Session 2
Saturday, 16 June 2001, 9:00 - 9:30 am

The dawn and development of neuropsychology in Japan during the last 150 years

Toshihiko HAMANAKA
Department of Neuropsychiatry, Nagoya City University, Nagoya; and Rehabilitation and Care Facility for the Elderly, Daiyukai Medical Foundation, Dosha, Japan

It is well known that the modern neuropsychology began with a hypothesis concerning the cerebral localization based upon craniological ideas (1810-19) by F.J. Gall (1758-1828) which lead to the pioneering works to aphasiology by P. Broca (1861), J.M. Charcot (1863-88) in France, being followed by C. Wernicke (1874-86) with his Breslau school in Germany and by J.H. Jackson (1879) in Great Britain. This paper intends to elucidate the dawn and development of neuropsychology in the second half of the 19th and the first half of the 20th century, taking into consideration how a series of important contributions in Europe and America were assimilated by early Japanese scientists who had to introduce new European trends neuropsychology with German medical teachers (Th. Hoffmann, E. Baelz, etc.) since the Meiji Imperial Restoration (1868) coinciding with internationalization and cultural transformation of Japan after long periods dominated by Chinese medicine since the Antiquity and Dutch medicine since ca. 250 years. H. Miyake (1878/94) probably the first who introduced such neuropsychological terminology as "Broca's & Wernicke's aphasia" (with Japanese translation), while D. Onishi (1893) proposed his own aphasiological schema revising Lichtheim-Wernicke's (1885/86) one in the same year when the first case report of "cortical motor aphasia" by E. Watanabe (1893) was published. The first Japanese textbook of neurology by H. Kawahara (1897) discussed in detail a series of such other aphasiological concepts as "paraphasia, agraphia, alexia, optic aphasia, asymbolia, asemia" as well, mentioning even the problem of hemispheric laterality in the context of a personally observed case of crossed aphasia in a dextral. The problem of "phrenology" was treated by T. Inoue (1881), S. Sato (1890) and R. Mori (1900). The foundation of "Japanese Society of Neurology [& Psychiatry]" with its official organ [Psychiatria et] Neurologia Japonica (1902) gave a further scientific impact to the following generation who was so successful as to publish a number of important contribution to the problems concerning the function of corpus callosum (S. Imamura 1903: Pfluegers Arch.) and the specific characteristics of aphasia in Japanese language (T. Asayama 1912/14: Deutsches Archiv; T. Imura 1943) and the first monograph treating "Apraxia" (H. Akimoto 1939). These basic efforts lead to the first comprehensive text of neuropsychology by H. Ohashi (1960) after the 2. World War, who later founded the Japan Society of Neuropsychology (1977) with other colleagues.

Session VIII -- Poster Session 2
Saturday, 16 June 2001, 9:00 - 9:30 am

Friedrich Heinrich Lewy (1885-1950) and his work

Berlin, Germany

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 postmortem examinations (1923), Lewy was able to confirm this for a minority of cases only, with the exception of those that displayed postencephalytic 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 postmortem 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 had, however, 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 the First World War 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 force, 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 twentieth century.

Session VI -- Biographical Issues
Friday, 15 June 2001, 2:30 pm

The man behind the Troxler Effect: I.P.V. Troxler (1780-1866) -- The philosopher as neurophysiologist and vice versa

Gesundheitszentrum Fricktal, Rheinfelden, Switzerland

Concepts of visual perception and its modes and deficiencies have become a field of particular interest and intensive research effort throughout the international scientific community. Modern methods of neurophysiological research along with ever refined neuropsychological approaches produce an ever growing host of publications on subjects asuch as inattention blindness or peripheral fading. The first description of the latter phenomenon has been attributed to an obscure author who, in 1804, had published his observations in Ophthalmologische Bibliothek (edited by Karl Himly and Joh. Adam Schmidt), the first ophthalmological journal in history.

The aim of this contribution is to draw the attention of the modern research community to the simple but remarkably well structured experimental settings used by this author 200 years ago and to encourage in-depth reevaluation of his concepts from a modern point of view.

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

Albucasis is the pioneer of neurosurgery during the Middle Ages

Abdul Nasser KAADAN
Institute for the History of Arab Science, History of Medicine Department, Aleppo University, Aleppo, Syria

Albucasis has lived in Andalus (Spain), and died there in 1013. He is considered one of the most celebrated surgeons during the Middle Ages. The influence of his book (Kitab al-Tasrif) in the field of surgery development in general and neurosurgery in particular was tremendous. Guy de Chauliac, the "restorer of Surgery" quotes Albucasis more than 200 times. The arrangement of the work, the clear diction, and lucid explanations, all contributed to its great success. It soon became an authority quoted by medieval European physicians and surgeons more frequently than Galen himself. Albucasis describes some neurosurgical operative procedures and instruments which do not appear in extant classical writings and which may be regarded as his own. In the chapter related to Hydrocephalus treatment, Albucasis says: "If the humidity is beneath the bone, and the sign of that is that you will see the sutures of the skull gaping on all sides, you should make three incisions in the middle of the head, in this pattern. After incising, drew out all the humidity, then bind up the incision with pads and bandages, and over the bandages foment with wine and oil till the fifth day". To remove the depressive fracture in the skull, he says: "As to the manner of perforation round the fractured bone, you apply the drill to the bone and revolve it with your fingers until you know that the bone is pierced, then you transfer the drill to another place, making the distance between the perforations about the thickness of a probe. Then with the chisels cut out the bone between the perforations, using the utmost delicacy, as we have said. Then take out the bone, either with your hand or with some other instrument we have ready for the purpose, such as forceps or fine tongs. You will have to observe the utmost caution that neither drill nor chisel touch any part of the membrane".

The aim of this work is to shed light on Albucasis neurosurgery, to reveal his accomplishment and contribution in this field of surgery.

Session V -- Neurosurgery Across the Centuries
Friday, 15 June 2001, 10:00 am

Vladimir Mikhailovich Bekhterev (1857-1927) and the Psycho-neurological Institute in St. Petersburg

Medizinische Fakultät der Universität Leipzig, Karl-Sudhoff-Institut für Geschichte der Medizin und der Naturwissenschaften, Leipzig, Germany

Bekhterev, after having studied medicine at the Medical-Surgical Academy in St. Petersburg, went straight into the clinic run by the psychiatrist J. P. Merzheevskii, a follower of Charcot. His journey abroad, which started in 1884 and lasted for eighteen months, was very important for him. He visited Berlin, Leipzig, Paris and Vienna, being particularly influenced by his time at Leipzig University. In 1885, Bekhterev started his teaching career as professor of psychiatry in Kazan', and in 1893 he took over the Chair of Mental and Nervous Diseases in the Military Medical Academy in St. Petersburg, and it was here, in 1907, that the Psycho- neurological Institute (since 1925 "Bekhterev Institute") was founded. The original idea of such specialist institutes came from the Leipzig scientists Wilhelm His, sen. and Paul Flechsig, who had put forward plans for specialist institutes for research into the activities of the brain. Their suggestion was then presented to the General Meeting of the International Association of Academies in London in 1904. Bekhterev took part in this meeting as the Russian representative. Back to Russia, he campaigned for a research institute for psycho- neurology, and in 1907, Czar Nicholas II confirmed the foundation of the Psycho- neurological Institute in St. Petersburg. The institute's organization and further development is described up to 1927, the year of Bekhterev's unexpected death.

The aim of this contribution is to draw the attention of the modern research community to the simple but remarkably well structured experimental settings used by this author 200 years ago and to encourage in-depth reevaluation of his concepts from a modern point of view.

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

The correspondence between Bernard Brouwer and John Fulton

Department of Neurology, Atrium Medical Centre, Heerlen, The Netherlands

In 1933 Bernard Brouwer (1881-1941), first professor of neurology in Amsterdam following the division of the chair for neurology and psychiatry (1923), made his second lecture tour in the USA, invited by the Association for Research in Nervous and Mental Disease in New York. There and at Yale University, he met John Fulton (1899-1960), who had recently assumed the position of professor of physiology (1931), and was working at the same laboratory as J.G. Dusser de Barenne (1885-1940), who had moved from the Netherlands in 1930. Next to clinical neurology, Brouwer had become well known by his clinical-anatomical (central visual pathways, spinal conducting pathways of sensation), experimental neuroanatomical (projection of retinal fibers), and comparative neuroanatomical (on the cerebellum and inferior olive) work at the Central Institute for Brain Research in Amsterdam. At the time, John Fulton, pupil of Sherrington and Cushing, was particularly interested in research of the primate central nervous system.

The correspondence between Brouwer and Fulton, preserved at the Manuscripts and Archives Division of Yale Library1, extends over the years 1930-1949. The first letter (1930) deals with their mutual interest in the optic tracts, in particularly the crossing of fibres in the chiasm. They had already met during the first International Congress of Neurology in Berne in 1931, where they discussed the anatomy of optic tracts. Next to this subject, the correspondence in that year dealt with the crossed and uncrossed pyramidal tracts. During the subsequent years they exchanged books and papers. Brouwer's visit at Yale (1933) was well appreciated as appears from their correspondence as well as from Fulton's diary. Fulton sent several students to Amsterdam, including Margaret Kennard (1899-1976) who visited Amsterdam in order to "receive further neuroanatomical and clinical training of the type that only you can give". She stayed at Brouwer's laboratory for two years (1934/35). The correspondence between Brouwer and Fulton ends in 1949, the year in which Brouwer died and Fulton sent a message of condolence to Mrs. Brouwer.

1John F. Fulton Papers, Box 23, Folder 333

Session VI -- Biographical Issues
Friday, 15 June 2001, 2:00 pm

Max Nonne (1861-1959): Founder of the Hamburg school of neurologists

Praxis für Nervenheilkunde, Freiburg, Germany

Max Nonne was one of the most important German clinical neurologists in the first decades of the 20th century. He founded the first independent department of clinical neurology in Germany (in 1896) and was the "father of the Hamburg school of neurologists". His scientific interests lay especially in the fields of neurosyphilis and liquor diagnosis, to which he made important contributions. His position against the "traumatic diagnosis" of H. Oppenheim and for an independent neurologic discipline also became very influential. Nonne's academic pupils became numerous and received important clinical positions as heads of departments or teachers themselves.

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

The brain of the 'porpess': Edward Tyson's description and the interpretation of the gross anatomical features of the cerebral coretx in the 17th century

Lawrence KRUGER
Department of Neurobiology, Brain Reearch Institute; and 17th and 18th Century Studies Center, University of California, Los Angeles (UCLA), Los Angeles, California, USA

The first comprehensive monograph describing a mammal and the earliest monograph published with the imprimatur of the Royal Society was Tyson's Anatomy of a Porpess, a relatively rare book, published in London in 1680. This landmark description details the "land-quadruped" main features of the various organ systems of cetaceans and comments on the history of research on these animals that appear to resemble fish only externally.

The two plates lack depiction of the brain although the osseous anatomy, including the skull, is shown with remarkable accuracy and with insightful homologies discussed in the text. Considering the relatively crude surgical instruments with which these dissections must have been carried out, the account of the brain and of the auditory system is astonishingly correct. The complex convolution pattern displayed by the cerebral cortex must have been perplexing to Tyson who subsequently described and illustrated the human brain (including a racial variant from Africa), contained in Collins' Systeme of Anatomy in 1685, and the brain of the "orang-utan" (actually a chimpanzee) in 1699.

This report provides a detailed account of the descriptions in the context of later knowledge and terminology, and attempts to interpret the impact of Tyson's findings on the interpretation of the significance of cerebral anatomy in relation to distinctive human characteristics.

Session IX -- Early Neurosciences
Saturday, 16 June 2001, 11:30 am

Life and work of the German psychiatrist and neurologist Alfred Hauptmann

Ekkehardt KUMBIER and Kathleen HAACK
Psychiatric Department, Martin-Luther-University Halle-Wittenberg, Halle, Germany

The mostly unknown biography and the scientific development of Alfred Hauptmann (1881-1948) as Jewish psychiatrist and neurologist are described. During the Nazi era some Jewish German psychiatrists and neurologists emigrated to the United States and worked there for the a number of years or the rest of their lives. Thus there are man individual life histories of former German psychiatrists and neurologists in the U.S.A.. We intend to review Hauptmann's life and work before and after emigration, complemented by some interesting details.

In Freiburg, Hauptmann started his scientific work as Alfred Hoch's assistant at the hospital of psychiatry and neurology at Freiburg University. In 1912 the clinical use of phenobarbital in epileptic therapy was first mentioned by Hauptmann. In memory of this most important work, the Alfred-Hauptmann-Prize for research on epilepsy is awarded by the International League against Epilepsy.

This poster focuses on Hauptmann's life and work as director of the Clinic for Nervous Diseases at Halle University from 1926 to 1935 and his subsequent emigration in connection with the historical conditions after 1933. Hauptmann was dismissed in 1935 and arrested in 1938 in the Dachau concentration camp. With the help of Felix Georgi, a Swiss Jewish neurologist, he emigrated to Switzerland, England, and finally to the United States. After emigration he lived and worked until his death in Boston.

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

Neuropsychiatry and the deauthorization of pain and suffering

Emory University, Atlanta, Georgia, USA

The biological revolution in psychiatry of the past quarter century has made remarkable strides in both the reclassification and treatment of a number of idiopathic illnesses. Even where effective interventions have yet to be developed, biological substrates have been theorized to the extent that expectation run high that both the organic etiology and pharmacological/genetic interventions will soon be uncovered to alleviate the pain and suffering of these disorders. But, the same revolution has served to deauthorize pain and suffering in a number of syndromes where no identifiable organic substrate has been identified. The DSM category of somatoform disorders is suggestive of the assumption that, without identifiable or putative physiological mechanisms, there can be no "real" pain or suffering. Today it appears that pain and suffering are only considered legitimate if informed by yet to be uncovered organic conditions. A psychogenic etiology of pain is viewed as synonymous with an accusation of malingering. As a result, those suffering from idiopathic pain syndromes including Gulf War illness, chronic fatigue, and fibromyalgia are adamant in insisting that their conditions are caused by yet unidentified organic mechanisms. When studies fail to uncover statistically significant organic substrate, claims of pain and suffering by the diagnosed are diminished in the eyes of often skeptical practitioners and the lay population at large. The idea that the social and psychological stress of work and family could, in itself, cause physical pain and suffering seems to have lost all validity. Yet, thirty years ago pain and suffering, as well as a variety of clinical signs were understood as common sequelae of emotional trauma and family tensions. Although psychosomatic frames have not entirely disappeared, they have become increasingly suspect especially in the face of triumphant psychopharmacology. Ironically, the rejection of psychological etiology has occurred at the very moment when findings in neuroscience have implicated the role of social stress and cultural conditions on a variety of "normal" or developmental neurobiological outcomes ranging from handedness to learning and language. Moreover, earlier assumptions that environmental influences last only during the plastic period have been revised. Even without these findings, enough has been learned over the past three decades to suggest that formative experience, especially those associated with learning and language have a major influence on the way individuals experience later stress. Although thebiological revolution in psychiatry has been very much influenced and shaped by the revolution in neuroscience, this has not necessarily been the case when it comes to pain and suffering. The reason for this comes in great measure from the fact that the psychiatric revolution has drawn mainly on psychopharmacological discoveries, which are only part of much larger neuroscientific contributions to issues of human consciousness. It would seem that these findings provide the interdisciplinary approach necessary for a reauthorization of a psychobiological theory of pain and suffering.

Session I -- 20th Century Brain Research and Emotions
Thursday, 14 June 2001, 10:00 am

Neurosurgery in Paris from 1933 to 1940

Russian Postgraduate Medical Academy, Moscow, Russia

There is a surprising discrepancy between the leading position of French neurology in the late 19th- early 20th century and the late development of neurosurgery (neurologie chirurgicale) in France. The idea of surgery of the nervous system as a specialty arrived before 1900. In 1896-1901 a surgeon Antoine Chipault edited six volumes of Travaux de Neurologie Chirurgicale et Ortopedie. However, the first cerebral tumour was operated upon in Paris in 1909 and first medullary tumour - as late as 1911 (both cases were diagnosed by J. Babinski) - about 25 years after the similar operations in UK by R. Godlee and V. Horsley).

There were two key figures in the development of neurosurgery clinic in France - Clovis Vincent (1879-1947) and Thierry de Martel (1876-1940). De Martel practiced at his private clinic at rue Versingetorix until his suicide in 1940 after German occupation of Paris. He operated under local anaesthesia in a sitting position. Clovis Vincent was a neurologist who worked together with de Martel for many years. In 1927 he spent less than a month with Cushing and in 1928 at the age of fifty made his first neurosurgical intervention (when de Martel was absent). That was the end of their friendship. In 1933 a first neurosurgical department was created at la Pitiè. It was headed by Clovis Vincent, who was a neurologist without any formal surgical training. Harvey Cushing watched Vincent operate in 1933 and later remarked: "You have in Paris someone who without doubt is the world's best neurosurgeon." In 1938 he made 491 big operations and mortality did not exceed 16% (at the earlier period the mortality in frontal lobe tumours achieved 60%). Vincent's idea was to create not only a centre of neurosurgical treatment but a research centre as well. He employed ophthalmologists, ENT doctors, and radiologists. For a six-year period (from 1933 until May 1939) 1435 ventriculographies and 2060 operations were performed. Neuropathology lab was headed by Prof. del Rio Hortega. In 1938 the neurosurgery department at la Pitiè was transformed into the Chair of a Neurosurgery Clinic (Chaire de Clinique neurochirurgicale) with the help of the Rockefeller Foundation. Vincent's pupils (M. David, P. Puech, G. Guiot and others) later became leading French neurosurgeons.

The early stages of neurosurgery development in Paris provide us a remarkable example of the impact of international tendencies and national traditions on specialisation in modern medicine.

Session V -- Neuroscience Across the Centuries
Friday, 15 June 2001, 12:00 pm

Ischialgy: a study of the disease from a medical-historical view

Klinik für Allgemeine Neurochirurgie der Universität zu Köln, Cologne, Germany

The first historically verifiable description of ischialgy can be traced back to Hippocrates, who describes the illness as a hip pain at the end of the coccyx and in the gluteal area with radiation into the thigh. Detailed descriptions of the syndrome are to be found in the accounts given by Caelius Aurelianus (fifth century AD), including a description of sensibility disturbances and functions of vegitavum.

For several centuries the view has been taken that the origin of nervus ischiadicus lies in the hop area. In keeping with humoral pathological assumptions of ancient medicine, the illness is taken to be due to an accumulation of pathologically modified juices of a mucous and bilious nature. Since an unhealthy lifestyle--e.g., heavy wine drinking or sexual excesses--also was regarded as causing the disease, therapeutic measures included, first of all, body-cleansing (e.g., in the form of blood-letting).

Knowledge about pathophysiology has made only slow progress over the centuries. Equally slow in coming has been the emergence of adequate therapy. Only gradually has painkilling been resorted to, first in the form of stretching devices (e.g., stretching chairs) as well as physiotherapy. Progress in therapy has become possible only since it was realized that that suffering had its origin in a nerve compression, mostly resulting from degenerative intervertebral disc protrusion. Thanks to this insight, an operative therapy based on animal models has been developed. But it was not until 1909 that the first removal of an intervertebral disc was successfully performed, by F. Krause and H. Oppenheim.

Session VIII -- Poster Session 2
Saturday, 16 June 2001, 9:00 - 9:30 am

The cerebellar vermis through the ages

Faculty of Philosophy, Erasmus University Rotterdam, The Netherlands

In his De usu partium, Galen asserted that the vermis ("worm") of the cerebellum controls the flow of pneuma between the middle ventricle (third ventricle in modern terminology) and the posterior (fourth) ventricle and denied that the pineal gland plays this role. This view played an important role for a long time; we will trace its development. Some highlights: 4th ct. Oribasius condenses Galen's De usu partium. Galen's criticism of the pineal gland theory is left out. 9th–10th ct. Hunain (9th ct.), Costa ben Luca (10th ct.), Ibn al-Jazzar (10th ct.) and Haly Abbas (10th ct.) combine Galen's theory about the movements of the vermis with the ventricular localisation theory first described by Posidonius of Byzantium and Nemesius of Emesia (end 4th ct.) and possibly invented by Porphyry (3rd ct.), according to which fantasy is located in the anterior ventricle (lateral ventricles in modern terminology), reason in the middle ventricle, and memory in the posterior ventricle. Apparently following Oribasius rather than Galen, Hunain and Ibn al-Jazzar confuse the vermis with the pineal gland. Costa's theory is very picturesque; he views the vermis as a valve that regulates the alternation between thinking and remembering. 11th ct. Avicenna refines the ventricular localisation doctrine (he distinguishes five faculties) and says that "the worm" controls the flow of spirit between the anterior and middle ventricles. 11th ct. The works of Hunain, Ibn al-Jazzar and Haly Abbas are translated into Latin and echoed by William of Conches (12th ct.) and others. 12th ct. The works of Costa ben Luca and Avicenna are translated into Latin and become very influential. 13th ct. Following both Avicenna and Costa ben Luca, Albert the Great maintains that there are two interventricular valves, one between the anterior and middle ventricles (Avicenna), and another one between the middle and posterior ventricles (Costa ben Luca). 1316 Following Avicenna, Mondino identifies the vermis with the choroid plexus in the anterior ventricle. This is the dominant view until the Renaissance. 1536 Massa points out that Mondino's vermis is different from the vermis described by Galen. He is silent about the possibility of movement of either vermis, maintains that the ventricles are filled with aqueous liquid rather than spirit, and does not mention any ventricular localisation theory. 1543 Vesalius rejects all ventricular localisation theories as well as the idea that the cerebellar vermis functions as a valve. 1637 Descartes resurrects the view criticised by Galen and expounded by Hunain and Ibn al-Jazzar: he says that the pineal gland regulates the flow of the "esprits animaux" in the ventricles. This view is rejected by everyone except Jean Cousin (1641). 1990+ The vermis turns out to play a role in cognition and affect after all. It is a part of the "limbic cerebellum"; surgery that involves the vermis leads to the so-called "posterior fossa syndrome" (see J.D. Schmahmann, Journal of Neurolinguistics 13 (2000) 189–214, for references).

Session IX -- Early Neurosciences
Saturday, 16 June 2001, 11:00 am

"Quel Pitres!" or, The history of pure agraphia

1Birkbeck College, London, UK <m.lorch@bbk.ac.uk>; and 2University of Hertfordshire, Herts, UK

In 1861, Broca made persuasive arguments regarding the localization of language in the brain. Over the next 3 decades clinicians throughout Europe actively investigated the clinico-pathological correlations in aphasic disorders, the description of which typically implied the assumption that written language paralleled spoken language and that agraphia was not deemed to be a significant theoretical entity. Trousseau, Gairdner, and Hughlings Jackson all assumed that aphasics' writing was as defective as their speech.

In 1856, Marcé had described a number of cases where spoken and written language disorders were not parallel. Similar observations were published by Ogle (1867) which included one case of aphasia without agraphia taken as evidence "that the faculty of speech and the faculty of writing are not subserved by one and the same portion of cerebral substance"(1867: 106). However, these observations had little impact on the early formulations of neurolinguistic organization. The merit of Ogles and Marcé was to have argued for the independence of these two modalities. Bastian (1869), Exner (1881) and Charcot (1884) subsequently postulated separate faculties for speech, writing, listening and reading in their models of cerebral function. However it was not until Pitres published a detailed clinical case study of pure agraphia in 1884 that the modular nature of the language faculty was seriously debated. This paper examines the contribution of Pitres to the determination of the neuroanatomical organization of language functions.

Session VIII -- Poster Session 2
Saturday, 16 June 2001, 9:00 - 9:30 am

Remarks on the development of neuro-urology

Department of Urology, Cologne Medical Center at Holweide Hospital, Cologne, Germany

During the middle of the nineteenth century, operative medicine saw a change from the philosophical deductive methods of the so-called Romantic Era to inductive and scientifically orientated ways of working. The previously limited scope of operative medicine abruptly altered then. Simultaneously, organ-related thinking gained acceptance. The development of urology as an independent subject area paralleled the rise of gynecologic and abdominal surgery as well as traumatology. As classic surgery remained within an anatomical theory up to the thirties of the 20th century, raising urology developed a physiological way of thinking. Here, bladder function was in the focus of investigation. The establishment of experimental physiology during the nineteenth century was of vital importance to the development of scientific medicine in the twentieth. Based on the experiments of Charles Bell (muscle contractions) at the beginning of the 19th century ,1858 Rudolf Haidenhain (1834-1897) of Breslau, Silesia and August Colberg (1829-1868) made studies on the tonus of bladder muscle in 1858. These experiments were completed by Eugen Rehfisch, a disciple of famous Leopold Casper (1859-1959) of Berlin, who was the first to measure the phenomena of bladder pressure and flow simultaneously within a living person. This was the basis in the development of modern urodynamics. If analyzing difficulties micturition of several neurological disorders are analyzed, tabes dorsalis proofed to be the most important neurologic disorder. After Word War I. urologists focused their interests on the rehabilitation of spinal cord injuries and the paralyzed bladder. There is no doubt that there were US urologists like famous H. H. Young (1870-1945) of Baltimore or Frank Hinman ( 1870-1961) of San Francisco founding neuro-urologic research extensively. Establishing clean intermittent self-catheterization in the 50th by Sir Ludwig Guttmann (1899-1980) of Edinburgh, a former native of Germany and expellee due to nazi racism was a milestone in the development of a distinguished subspecialty. At last investigations on neurotransmitters enabled urologists to develop sophisticated therapy modalities.

Session VIII -- Poster Session 2
Saturday, 16 June 2001, 9:00 - 9:30 am

Swordsman's blood in the cure of epilepsy: New contributions to an old form of magical treatment

Ferdinand Peter MOOG
Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany

Magical rituals, often involving blood, have traditionally been an integral part of epilepsy treatment in ancient and medieval times (Temkin, 1971). the Roman Encyclopedist Celsus (1 AD) is the first author to mention the blood of a slaughtered gladiator as a remedy to be employed with caution. Celsus' sources, however, are unknown.

One of the next medical authors to refer to swordsman's blood was Alexander of Tralles, although the relevant passage in his Medical Books is not widely known. It is greatly surprising that even Theodor Puschmann, the 19th century editor of Alexander's writings, was unable to identify the sources of this important Byzantine compiler.

This paper introduces new findings and hypotheses about the magical tradition which emerges in both classical authors. A detailed examination of Alexander's text leads to the following conclusions: Marinus, a bishop from Thracia (4th century AD), was mostly the author of a magical formula for epilepsy which was an important source for Alexander. In this way, an important missing link between pagan rituals for epileptics and early Christian treatment can be identified for the first time. Furthermore, Marinus, a controversial figure who played an important role in ecclesiastical history, can be regarded as one of the first clergymen to act as powerful healers against the falling sickness.

Session VII -- Pharmacological and Magical Aspects of Neurology
Friday, 15 June 2001, 3:30 pm

Vesalius, Paré and the Death of Henri II

Ynez Violé O'NEILL
Medical History Division, Department of Neurobiology, UCLA, Los Angeles, California, USA

In 1559, the king of France sustained several cerebral trauma while participating in a jousting tournament. Despite expert care by the most skilled practitioners of the time, the king died twelve days later. Less than a decade ago, neurosurgeons at UCLA were confronted with a comparable case.

Vesalius, Paré and the Death of Henri II will analyze and contrast the diagnoses and treatment of head trauma in two cases, four centuries apart. The objective of our study is to acquaint medical practitioners as well as medical historians with one of the most complete accounts of the diagnosis and treatment of brain trauma surviving from the pre0modern era. Our purpose is to demonstrate how prior conceptions about neurophysiology, though clinically derived, misled some of the greatest minds of the time. We shall compare and analyze the thinking and therapeutic management of the king's case with that initiated by a team of modern neurosurgeons who treated the modern patient successfully. The richness of the contemporary graphic sources and depictions will contribute to the understanding of both cases and therefore our findings will be presented in a visual format on videotape. We expect that this format will stimulate discussions among medical professionals and historians.

Video Presentation
Saturday, 16 June 2001, 12:00 - 1:00 pm

Neurology and immunology: a tale of two systems

The Max Planck Institute for the History of Science, Berlin, Germany

While the respective histories of both neurology and immunology are quite well studied, hardly any attention has hitherto been given to the historical and epistemological relations between the immune system (IS) and the central nervous system (CNS). Both immunology and neurology were established as independent experimental sciences in the same time period, namely ca. 1900. This period, it will be argued, was characterized by an intensive attempt to make sense of seemingly idiosyncratic physiological phenomena in terms of experimentally demonstrable agents and their effects. The definition of synapses and the newly conceived notion of a reflex (notably as employed by Sherrington) enabled the experimentalisation of neurophysiology and the construction of the notion of a "nervous system". At the same time, Emil von Behring, Ilya Metchnikoff and Paul Ehrlich instituted a science of immunity--itself a highly idiosyncratic phenomenon--conceived in terms of specific reactions between the antigen and its corresponding antibodies (and, possibly also specific cells).

The paper will argue that throughout the twentieth century, attempts to reconcile the IS with the CNS stumbled over the inability to reconcile the notion of the reflex with that of a specific immune reaction. Charles Richet's work towards the discovery of anaphylaxis between 1890-1902 will be the first to be discussed. His discovery of this averse immune reaction, for which he was awarded the Nobel prize, is a well known fact. Yet historians have hardly realised that Richet actually arrived at anaphylaxis while attempting to establish a new notion of a "reflex", which he had conceived as a bodily defense mechanism with a neurological underpinning. Some thirty years later, Serge Metalnikov, a disciple of Ilya Metchnikoff, has attempted to reverse this logic, and to make sense of a well established cellular immune response (phagocytosis) in terms of Pavlovian reflexes. Finally, the paper will discuss the recent revival of "neuroimmunology" as exemplified by the work of Robert Ader and Nicholas Cohen in the 1980s, who attempted to integrate conditioning experiments with newly discovered facts about similar binding sites (e.g., for ACTH or TSH) in cells of both the IS and CNS. Characterising all these historical episodes was the failure to translate the notion of a reflex (and its related conceptions, e.g., CS.UCS), into the language of immunological specificity, and vice versa.

Session II -- 19th/20th Century Approaches to the Nervous System
Thursday, 14 June 2001, 11:30 am

Duchenne's study of the physiology of movement

M.S. RAFII <Michaal_Rafii@brown.edu> and S.H. GREENBLATT <Samuel_Greenblatt@brown.edu>
Department of Neuroscience, Brown University School of Medicine, Providence, Rhode Island, USA

Among G.B.A. Duchenne's (1806-1875) contributions to neurology are his descriptions of Duchenne muscular dystrophy (1852), Duchenne-Aran motor neuron disease (1849), locomotor ataxia (1858), the muscle biopsy technique (1868), Duchenne-Erb palsy (1872), and the first use of photography to illustrate neurological disease (1862). There exists however, Duchenne's lesser known study of specific muscles and their relations to movements, including facial expressions. The basis for this work came out of Duchenne's desire to diagnose and treat patients stricken with neuromuscular disorders using electrical stimulation. Drawing on the rapid understanding of electric fish physiology, Duchenne combined faradic stimulation with photography, both recent inventions, to analyze muscle action in a unique and powerful way. Duchenne spent twenty-two years (1848-1870) at the Salpêtrière hospital in Paris performing rigorous stimulation studies and compiling photographic patient records. The hospital was fertile ground for his work as it had over 20,000 patients including the ill, insane and indigent. It was through studying and classifying some of these people, using the combination of physical examination, electrical stimulation, and photographic analysis that Duchenne began to catalogue various neurological disorders. Duchenne also described the normal functional anatomy of muscles in a way which had not been possible. Namely, he placed the electrically-induced contractions of certain muscles in the context of defined movements. In his study of facial expression, emotional meaning was systematically added to nerve and muscle groups. Consequently, Duchenne undertook a comprehensive study of human movement and neurologic pathophysiology while on a quest to find a use for electrical therapy and photography in medicine.

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

Galen's brain

Julius ROCCA
Medical Humanities, Karolinska Institute, Stockholm, Sweden

The work of Galen of Pergamum (129-c.216AD) on the nervous system is reasonably well known. However, such knowledge is usually restricted to his considerable and undoubtedly impressive series of experiments which empirically determined the structure and function of the spinal cord and nerves. Perhaps less well understood and appreciated are Galen's anatomical and physiological endeavours on the brain itself. For Galen, the brain is the controlling centre (principatus or hegemonikon) for sense perception and voluntary motion. In order to demonstrate the brain's principal role in orchestrating these modalities, Galen carried out his famous experiments of hemisection of the spinal cord, and cutting and ligating motor and sensory nerves. Yet these experiments served to augment another, more fundamental series, carried out on the ventricles of the brain. These involved a quite sophisticated and ingenious combination of ventricular incsion as well as applying pressure to the ventricles in living animals. These results were at times combined with clinical observations of brain injured patients. The purpose of this paper is to summarise this impressive body of work on the ventricles, the focal point of Galen's anatomical science of the brain.


The Sacred Disease as a pradigm of mental disease in Greek tragedy

Department of Neurology, University of Köln, Cologne, Germany

In the late 5th century B.C., the author of the Hippocratic treatise On the Sacred Disease is the first to offer a rational explanation concerning the aetiology of a disease that the majority of his contemporaries still considered to be due to supernatural powers. Based on his description of its characteristic symptoms and signs, since then, the term Sacred Disease has often been interpreted as a synonym of grand-mal epilepsy. However, the pathology attributed to the Sacred Disease is much more ample than the description given by the author of the Hippocratic treatise, as it also comprises an ample spectrum of psychotic symptoms and behavioral abnormalities. The Sacred Disease is a part of the inherited conglomerate of magical, theurgic and animistic concepts of disease aetiology in Greek antiquity that in the course of time gradually will be replaced by mechanistic, rational, "scientific" concepts.

A comprehensive description of the symptoms and signs of the Sacred Disease is not found in ancient Greek medical literature. However, elements of the pre-rational concept of the Sacred Disease may be identified in the Greek literature of the 5th century B.C., especially in the description of tragic heroes driven insane by divine influence. The Sacred Disease as a paradigm of mental and behavioral dysfunction caused by supernatural powers is the ideal foil for the description of abnormal behavior in classic Greek tragedy. Both aggressive (e.g., the protagonists of Sophocles' Aias or Euripedes' Heracles) and paranoid tragic heroes (e.g., Io in Aischylos' Prometheus Bound or Orestes in Euripedes' Iphigenia in Taurus or Orestes) are described (or shown on scene) with a pathology that contains--in a variable combination--both "epileptic" (initial cry, distorted eyes, salivation, spasms, postictal sleep and amnesia) as well as "psychotic" (anxiety, agitation, scenic and acoustic hallucinations) symptoms. For all these different characters and situations, the tragedians provide a uniform disease description, i.e., that of the Sacred Disease. The use of symptoms and signs of the Sacred Disease to depict tragic heroes that have lost their mental sanity makes divine influence as a supernatural cause of the mental disturbance obvious to the spectators of the 5th century B.C.. The implementation of isolated symptoms of the grand-mal ictus indicates the paradigmatic role of the Sacred Disease for the dramatic presentation and does not justify the assumption that the Greek tragedians intended to show "epileptics" on stage.

From the 4th century B.C., a continuous differentiation between the concepts of epilepsia (grand-mal epilepsy), mania (non-febrile psychotic diseases) and phrenitisCorpus Hippocratum and later medical works, and this development gradually enters public awareness. Consequently, tragedians of late antiquity are able to refrain from using epileptic symptoms for the description of tragic heroes driven insane by supernatural powers, as they are able to rely exclusively on the description of psychotic symptoms to convey the impression of a tragic hero arbitrarily driven insane by divine powers (e.g., Hercules' madness in Seneca's Hercules furens).

Session IX -- Early Neurosciences
Saturday, 16 June 2001, 9:30 am

Localizationism and equipotentialism: A dialogue between Russian and American neurophysiological schools

Alexey Olegovich SAPETSKY
Department of Functional Neuromorphology, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia

This communication returns us to the events of the thirties when a serious contradiction arose in the science of brain. On the one hand, numerous experiments on stimulation and damaging the separate cortical areas of the cerebral hemispheres showed a definite specialization of neural centres, especially in man and higher animals, and on the other hand the observations made by physiologists and clinical physicians pointed to the fact that functional disturbances as a result of damaging the separate cortical zones were often of a temporary, reversible nature. These data constituted the basis for two diametrically opposite conceptions explaining the mechanisms of brain activity: narrow localizationism and equipotentionalism. The first trend was headed by I.P.Pavlov; the representative of the second one was K.S.Lashley. For this reason lively polemics between them appeared on the pages of Psychological Review. Nevertheless, despite the incomplete communication which inevitably takes place between the supporters of different theories, both Pavlov and Lashley demonstrated to each other the concrete technical results which could be obtained within the framework of each theory. Thus, revealing the drawbacks of the existing concepts, they contributed to the formation of principally new theoretical fundamentals of neuroscience. In spite of an apparent polemical character of the articles, this discussion often took the form of a constructive dialogue and in the course of the dialogue new ideas of brain functions (dynamical organization) appeared in the place of those two incompatible brain activity concepts. The historical significance of this dialogue resides in the fact that it pre-determined the trends in the development of Russian and American neurophysiological school on long time forward.


Life spiritì, stomach and brain: Paracelsus, van Helmont and the visceral neuropsychiatry

Bonn, Germany

The historiography of psychiatry generally starts with the period of Enlightenment and the French Revolution (Pinel) focusing mainly the establishment of lunatic asylums and the founding of scientific (academic) psychiatry on the basis of neuroscience since the early 19th century. The paper goes back to the early modern times, when the idea of a "visceral neuropsychiatry" predominated the theory and therapy of psychiatric disorders, best known in regard to the classical concept of melancholy. This approach was generally due to the tradition of humour pathology (Galenism). Paracelsus (Theophrast von Hohenheim, 1493/94-1541) emphasised the visceral viewpoint even more by pointing out, that the life spirit (archeus) in the stomach worked like an "inner alchemist" (vulcanus). Disorders, especially mental and neurological disorders, would be produced by an injured or weakened archeus. Johann Baptist van Helmont (1679-1744), the most important Paracelsian scholar of the 17th century, developed the idea of Paracelsus to a very sophisticated - in a certain sense psychosomatic - concept, wherein spleen and stomach were supposed to be the location of the life spirit constituting there the so-called "double government". All diseases including the mental diseases originated by imagination, when an evil image (idea morbosa) was activated by the misled archeus. Some hidden consequences respectively analogies of the Paracelsian "visceral neuropsychiatry" can be followed until medicine and neuropsychiatry about 1800 (e. g. Mesmer, Reil, Broussais).

Session III -- Psychiatric and Philosophical Aspects of the Neurosciences
Thursday, 14 June 2001, 1:30 pm

Descartes and la Mettrie on the brain

C.U.M. SMITH <c.u.m.smith@aston.ac.uk>
Vision Sciences, Aston University, Birmingham, UK

René Descartes' L'Homme has often been taken as the origin of mechanistic brain theory. Julien Offray de la Mettrie's best known publication, a century later, was entitled l'Homme Machine in conscious reference to Descartes. In this contribution I shall compare and contrast Descartes' neuropsychology (l'Homme (1628/1662), Passions de l'Ame (1649) with that of la Mettrie (l'Homme Machine (1747), Traité de I'áme (1751)). I show that whereas Descartes' theory can be, and has been, construed as leading to what la Mettrie called the "ridiculous opinion" that animals were "mere machines", la Mettrie's is built on what seems to be the equally counter-intuitive premiss that all matter is imbued with feeling. It is, perhaps, appropriate to re-examine la Mettrie's neurophilosophy in the year which marks the 250th anniversary of his early death. We shall see that in spite of the provocative title of his major work and his outcast status in the eighteenth century his thought was in many ways ahead of its time. His biographer remarks that we can recognise in him "an obscure predecessor of Lamarck and an inspired prophet announcing the birth of a new epoch." 1

1 Boissier, R., 1931, La Mettrie: Médicin, Pamphlétaire et Philosophe, Paris, p.64

Session III -- Psychiatric and Philosophical Aspects of the Neurosciences
Thursday, 14 June 2001, 2:00 pm

Making the brain plastic: early neuroanatomical bench strategies to adapt behavioural changes to morphology

Institute of Anatomy, Department of Cell- and Neurobiology, Humboldt University (Charité), Berlin, Germany

As Edward Jones has recently mentioned, the concept of neuronal plasticity is widely used but seldom defined in the neurosciences. It may signify a vast amount of different phenomena from behavioural adaptations to the alteration of synapse formation in dendrites. This historical paper will explore how the concept of neuronal plasticity and some of its precursors entered the field of neuroanatomy and became popular with recent work on the hippocampal formation.

Early morphological research on the de- and regeneration phenomena in the late 19th century is well documented and linked with the works of Albrecht Bethe (1909) and Augustus Waller (1850). Although already concentrated on the cell-level, these studies were almost exclusively based on peripheral nerve tissue. Probably Ioan Minca (in 1909) in Bucharest was the first neurologist to actually use the term plastic reactions already popular with material sciences and biology. Taken up by Santiago Ramón y Cajal (1913/14), it became associated with regenerative capacities, but not widely used. The term rested regeneration or Sprossbildung (Hermann Stieve, 1952). However, it was time form a conceptual change, when Cajal transferred the idea of regenerative capacities from PNS to CNS, posing hypotheses on scarce evidence that cortical and cerebellar tissue would also display sprouting phenomena.

Yet until the 1970s the leading opinion of neuroscience still regarded the CNS as more or less incapable of regeneration under in vivo conditions. "Wired" once, morphological alterations after lesions were regarded only as "clearing processes" of the brain to get rid of cell detritus. Now, this conventional view has undergone important theoretical changes which have been attributed to the basic works of Geoffrey Raisman and Carl W. Cotman since the latter part of the 1960s. Drawing on published anatomical literature, I would like to fill in some of the gaps in how morphological research has regained its interest in regenerative "plastic" phenomena in CNS.

Session II -- 19th/20th Century Approaches to the Nervous System
Thursday, 14 June 2001, 9:30 am

Motora's unevaluated theory of nerve conduction, or, What psychologists thought about nerves a hundred years ago

Miki TAKASUNA <takasuna.hara@nifty.ne.jp>
Psychology Laboratory, Yamano College of Aesthetics, Tokyo, Japan

Yujiro Motora (1858-1912) is regarded as the founder of modern psychology in Japan. He acquired his Ph.D. under G. Stanley Hall in 1888 at Johns Hopkins University, then returned to Japan and, in 1890, became a professor of psychology at Tokyo Imperial University. It was there that he made a series of unique experiments in collaboration with physiologists involving nerve conduction or, more precisely, a way to simulate nerve conduction using rubber tubes. In 1903, his results were published in two journals: the Journal of Neurology (Shinkei-gaku Zasshi) in Japanese and the American Journal of Psychology in English.

American psychologist C.E. Price (Psych. Bull., 1904) wrote a brief review of this paper, but he did not evaluate the theory. In fact, no one could evaluate his experiments with written words even in Japanese. Still, the photos showing the apparati used in the experiments were printed in the Illustrated Picture Book of Instrumentation in Experimental Psychology (1910).

Motora's theory of nerve conduction used virtually hydraulic model, and since everyone could easily recall the model by Descartes, this type of model was outdated. Though it seemed so, Motora suggested that the phenomena of attention and inhibition could be conveniently explained by the supposition of a plastic tube and, moreover, his theory did not necessarily require continuity of the path of conduction. This point would fit in the neuron doctrine. In the end, Motora's theory of nerve conduction was really a strange mixture of old and new theories about nerves.

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

The Renaissance encounter of the separations of Greek psychobiology with the new chemistry of the Arab world

Gerald S. WASSERMAN <codelab@purdue.edu>
Sensory Coding Laboratory, Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA

Chemical techniques (e.g., medicating, smelting) existed at the dawn of history but their early understanding was radically different from that given by modern chemistry; its origins have only been traced as far back as the quantitations of Geber of Persia (d. 803). Hence, Greek psychobiology was based on a prechemical paradigm so different from ours as to render their thoughts quite obscure for us. Of present interest is its concept of the separation of materials by the application of moist heat. Often called concoction, it appears to have been conceptualized in fairly physical terms as being akin to the filtration of a mixture into components.

Although variant formulations existed, Europeans derived four concoctions from Galen's synopsis of Greek psychobiology: 1) Food separated into chyle and excrement in the gut. 2) Chyle separated into natural spirits and excrement in the liver. 3) Natural spirits separated into vital spirits and (excretory) exhalations in the heart and lungs. 4) Vital spirits separated into animal spirits and (excretory) phlegm in the brain. The difficulty for moderns is the implication that the most rarified animal spirits putatively used by the nervous system are already present in food.

The arrival of the new Arab chemistry in Europe evoked a prolonged comparison of "chymical" and "galenical" methods. Distillation was particularly successful in refining traditional herbal medicines into useful and noxious parts. But the obvious success of the new ideas and methods did not immediately overthrow Greek psychobiology. Indeed, excellent scientists strove to incorporate the new into the old. Thus, even after Harvey's (1628) discovery of the circulation, Willis (1664), studying cortex, explicitly assimilated the old concoctions with the new distillations.

This was then a remarkably slow paradigm shift. And the conceptual issue is still relevant, because ancient Greek psychobiology provided rationalizations for fasts, emetics, and purgatives, practices currently in vogue in some quarters.

— I thank the Huntington Library for providing access to its collection of early printed works.

Session VIII -- Poster Session 2
Saturday, 16 June 2001, 9:00 - 9:30 am

Where once was horror, can there be hope? The history of "psychosurgery" and its modern development to "nervous treatment of mental disorders"

Cologne, Germany

Illustrated by slides and original texts, the history of "psychosurgery" in the 20th century will be outlined.

There is no other form of neurosurgery which has ever been so closely related to public interest and in which the influence of social ideals was sometimes stronger than the influence of medical facts. Early forms of psychosurgery as a cult act may reach back about 40,000 years, when trepanations first seem to have been done. The first rational approaches to the operation of "the psyche" by destroying frontal lobes of patients, however, can be found in the 1890s. At this time the frontal lobe as a part involved in emeotions was known from clinical cases where this area was destroyed by accidents or tumors. Observations in the laboratories of Fulton and Jacobson in 1935, on "experimental neurosis" in chimpanzees relieved by frontal lobectomy, inspired Moniz and Lima in Portugal to perform "frontal leukotomy", later called "lobotomy". This procedure consisted of incisions that destroyed connections between the prefrontal region and other parts of the brain to treat patients with schizophrenia, affective disorders and obsessive-compulsive states. The treatment became popular all over the world and Moniz received the Nobel Prize in 1949. Freeman and Watts adopted this technique as "psychosurgery" and called it "standard lobotomy". Developing a quick and easy "trans-orbital" procedure which could be done in a medical office, they laid the practical groundwork for the popularization of leucotomy, which was used as a tool to control undesirable behavior across hospitals and psychiatric clinics in the USA. In the 1940s and 1950s more than 50,000 persons all over the world were subjected to lobotomy--in many cases without an appropriate indication or enough evidence for a scientific basis but with severe side effects in terms of personality changes. With the introduction of effective pharmacotherapy for mental disorders in the mid-1950s, psychosurgery decreased drastically and, due to evidence of its widespread abuse in problem children, rebel adolescnets and political opponents, it was banned in the 1960s and 1970s. Today the term psychosurgery still has the power to recall the nightmare of lobotomy. Since the late 1970s, however--after a long period of counter-effect against the past--there is evidence that psychosurgery can be useful for certain forms of untreatable depressions, anxiety disorders or obsessive-compulsive disorders. Modern techniques in functional and stereotactic neurosurgery may help, for example, cingulotomy to find its place as an effective and minimally-invasive method in the new non-political "neurosurgical treatment of mental disorders."

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

Peter of Abano (c.1250-c.1316) on intersensory coordination in speech

New York, New York, USA

Hearing is obviously the principal sense involved in speech perception. Yet the acoustical signal provides far too much information to be directly useful for speech. To pick the speech signal out of the maze of acoustic information requires the cooperation of the sensory modalities of hearing, sight, and tactile-kinesthesis, along with a rhythmic entrainment of attention not unlike that needed for catching a ball. According to a widely accepted though still controversial point of view, the motor theory of speech perception, an evoked potential or sub-movement of the speech organs is a necessary accompaniment to listening in order for speech perception to occur.

Medieval conceptions of neuropsychology and physiology were based chiefly on the works of Aristotle, Galen, Avicenna and other Arabic/Persian writers. The coordination of speech and hearing came up in discussing why the deaf do not speak, and how young children are able to repeat new words they hear. The functional answer, that the deaf do not speak because they never have heard words, whereas normal children can repeat even difficult words because they do hear them, was widespread, but unsatisfying to physicians, who sought an organic explanation, although Galen confessed that he was unable to find one. But the question raised the issue of the inner coordination of the sense of hearing with the action of speech.

Peter of Abano, a natural philosopher and professor of medicine at Padua who represents the pinnacle of thinking attained in these fields in the late 13th-early 14th centuries, addresses this question and provides a very interesting way of understanding it, with both psychological and neuroanatomical comparisons.

Session III -- Psychiatric and Philosophical Aspects of the Neurosciences
Thursday, 14 June 2001, 3:00 pm

Hughlings Jackson: Philosopher?

George K. YORK <gkyork@ucdavis.edu>
The Såa Institute, Fiddletown; and Kaiser Permanente Medical Center, Stockton, California, USA

This study examines John Hughlings Jackson's philosophic ambition and motivations, both in youth and maturity. Many commentators have stated that, as a junior doctor, Hughlings Jackson intended to leave medicine to study philosophy. Others have seen an explicitly philosophic motivation in his evolutionary analysis of the structures of the nervous system and the mind. The story of Hughlings Jackson's youthful crisis of intention is found only in Jonathan Hutchinson's 1911 British Medical Journal obituary, and Hughlings Jackson's discussion of his mature scientific motivation in found in published defenses of his theory of cerebral localization.

Hughlings Jackson arrived in London, at age 24, in the summer of 1859--18 months later, in January 1861, he had his first joint byline with Hutchinson in the Reports of Hospital Practice in Medicine and Surgery, a weekly column in the Medical Times and Gazette. Between these dates he considered renouncing the professiton. In his 1911 obituary Hutchinson wrote, "... in the belief that it did not afford attractive scope for mental powers of which he was not unconscious, he was on the point of abandoning it, intending to engage in a literary life." Hutchinson says he persuaded his friend to remain in medicine, hut wondered whether it might have been better for the world at large "...if Hughlings Jackson had been left to devote his mind to philosophy." However, Hughlings Jackson left school at age 15 to become an apprentice, and did not have any higher education in literature, classics or philosophy. In 1860 he lacked the training, the social standing and the money to enter academic philosophy. He must have been contemplating a literary rather than a philosophical career.

Hughlings Jackson's mature work has indisputable philosophic importance, hut he repeatedly denied both a philosophical motivation and any a priori philosophical position. He was led to his various theoretical stances by the demands of practical medicine. For example, his doctrine of concomitance was devised to improve bedside diagnosis. His application of evolutionary principles to the mind was similarly motivated. He made no claims for the philosophical importance of his theories though he was aware of their metaphysical implications.

A consideration of Hughlings Jackson's writings in their institutional and intellectual milieu reveals a number of barriers to his pursuit of an expressly philosophical program. He was, first and foremost, a practicing physician. His work was intended to serve medicine; its philosophical significance lies in its place as the conceptual cornerstone of scientific neurology.

Session III -- Psychiatric and Philosophical Aspects of the Neurosciences
Thursday, 14 June 2001, 2:3 pm

Migraine with aura: The "fortification spectra" historically revisited

Headache Centre, Department of Neurology. University of Padua, Italy

The most frequent type of aura preceding the migraine headache is the visual one. Its pathogenic mechanism is identified with the so-called "spreading depression" described by Leao, that is a cortical irritation followed by a depolarising wave with transient depression of neuronal activity, moving through the occipital lobe at a 2-3 mm/min speed.

The visual perception of the migraineur can be variegated, the most common being a zig-zag pattern of luminous lines. This was compared to Reinassance fortifications by John Fothergill (1712-80). In 1870 Hubert Airy, reporting on his own attack of migraine with aura, compared the visual disturbance to a fortified town with its bastions of a colourful appearance. Moreover, realising the illusory nature of these images, he called them "fortification spectra". Later on, William Gowers (1845-1915), with reference to "its projecting and reintrant angles bearing resemblance to the plan which the French engineer Vauban first described as the most effective for the defence of a fortress", introduced the term "fortification of Vauban", that since then has been largely used.

Historically, these kinds of fortifications were first developed in early sixteen century in Italy, when medieval circular towers were substituted with the lower and thicker bastions, to face the destroying power of the new mobile siege guns. Only later Sébastien Le Prestre De Vauban (1633-1707), at the service of Louis XIV, the Sun King, greatly contributed to the development of this branch of military engineering.

The first person who extensively applied this defensive system was Michele Sanmicheli (1484-1559), a Venetian military engineer. Since the beginning of the sixteen century he protected with such a building technique the most important towns of the Serenissima.

Therefore, with reference to the visual aura, the eponime "fortifications spectra of Sanmicheli" should be substituted for that "of Vauban".

Session IX -- Early Neurosciences
Saturday, 16 June 2001, 10:00 am

ISHN-ECHN 2001 Annual Meeting -- Abstracts

Last updated 1 June 2001