Historical review: a short history of German neurology - from its origins to the 1940s.

This paper aims at reconstructing the development and role of German neurology between 1840 and 1940. Therefore a couple of original sources as well as selected material form the scattered secondary literature were assessed and reviewed. Since the middle of the nineteenth century, an intricate process of separation from internal medicine and psychiatry gradually led to forming a self-conscious community of German neurologists. While Moritz Heinrich Romberg had constructed a cognitive basis for neurology, scientific founders such as Wilhelm Erb, Carl Wernicke, Alois Alzheimer, Hermann Oppenheim, Max Nonne, and many others established the new discipline within modern medicine. In 1891, the first generation of "pure" neurologists succeeded in founding the German Journal for Neurology (Deutsche Zeitschrift für Nervenheilkunde) followed by an autonomous professional organisation, the Society of German Neurologists (Gesellschaft Deutscher Nervenärzte) in 1907. A variety of external factors, however, hampered the institutional evolution and thus the implementation of chairs and departments remained quite modest. In 1935, only 2 years after the National Socialists had seized power, the regulatory merger with the psychiatrists' society caused the cautious attempts of German neurologists for autonomy to end in complete failure. The imprisonment, murder and expulsion of neuroscientists declared as Jewish or non-Aryan caused profound changes in neurology, medicine, academic life, and health care in general. Further historical research is needed to reconstruct in detail the involvement of German neurologists in racial-hygienic and eugenic research as well as the institutional and scientific development of German neurology after World War II.

Dental care in modern art (1914-2014).

Background Representations of 'dentists in action' in modern art have never been systematically researched. This paper surveys and analyses these portrayals for the first time.Methods Relevant paintings, prints, sculptures, and installations were identified by means of keyword searches in search engines, OPACs and picture libraries as well as handsearch.Results Between 1914 and 2014 more than 75 works of art with dental treatment as a motif appeared across the globe. Virtually every modern style from post-impressionism to 'crossover art' are represented, including world famous artists such as Dubuffet or Dalí. Syringes, Doriot's transmissions and contra-angle handpieces are worked into an iconographic code. In contrast, elements of an increasing hygiene consciousness (gloves, face masks and protective glasses) are integrated only fragmentarily. The dentist-patient relationship is predominantly portrayed professionally and realistically and the stereotype of the male dentist dominates.Discussion For almost a century it has been argued that dentists in action had largely disappeared from artistic production after 1900. The results presented here force a revision of this idea and encourage the further discovery of pictorial sources. Only in this way can the fascinating theme of 'dentistry in art' become an attractive part of dental humanities.

[The worlds of gods in medicine]. / Götterwelten in der Heilkunde.

BACKGROUND: A number of designations for diseases, medicines and human body structures derive from classical mythology. To date, these eponyms have not been systematically investigated. OBJECTIVES: This paper provides an overview of this fringe component of medical vocabulary, looks at the history of several terms and formulates hypotheses as to why such creative etymologies have come into being. MATERIALS AND METHODS: In addition to relevant texts on ancient mythology, a variety of medical textbooks from the early modern period were analyzed. RESULTS: Between the 16th and the 20th centuries some 30 figures from Greek and Roman literature made their way into the terminology of medical sciences. A few of these expressions can be encountered in clinical use (e. g., Caput Medusae, Proteus, Oedipus complex) and remain official anatomical (atlas, Achilles tendon) or pharmaceutical nomenclature (atropine, morphine). The choice of these designations has often been similarity of form or analogies in function. Classical eponyms have gained acceptance on account of their succinctness, conciseness and scholarly veneer. Finally, this vocabulary shares its origin with other relevant terminology. CONCLUSIONS: In clinical classes, mythological designations can serve as a point of departure for digressions into literary, art and medical history in order to provide an understanding of cultural traditions and enhance education.

[German neurology and neurologists during the Third Reich: brain research and "euthanasia"]. / Neurologie und Neurologen in der NS-Zeit: Hirnforschung und "Euthanasie".

The connection between systematic killing of the mentally ill and disabled, euphemistically called "euthanasia" in the National Socialism ideology, and German brain research has been thoroughly investigated and in detail; however, the impact of this criminal nexus on the image and self-perception of German neurologists as well as the status of neurology as a medical discipline is still the subject of controversial debates.Between 1939 and 1945 the Kaiser Wilhelm Institute (KWI) in Berlin along with other research centres were insofar enmeshed in the "euthanasia" program as brains of killed patients were dissected in the guise of "concomitant research" in order to generate medical knowledge. Affected were mainly individuals suffering from oligophrenia, early childhood brain atrophy, cerebral palsy and epilepsy. According to current historical research, collegial networks were instrumental in receiving brains of killed patients. Furthermore, civil research units were supplemented by military ones at the KWI. These, too, were concerned with the collection of medical knowledge, for instance on injuries of the brain and spinal cord. The historical approach to consider the Nazi organizations and medicine as "resources for each other" seems, therefore, at least in part applicable to neurology.

[German neurology and neurologists during the Third Reich: Preconditions and general framework before and after 1933]. / Neurologie und Neurologen in der NS-Zeit: Voraussetzungen und Rahmenbedingungen vor und nach 1933.

This article focuses on the institutional development of neurology in Germany up to the rise to power of the National Socialists and the radical sociopolitical changes after 1933. A wide range of scattered secondary literature was assessed and evaluated. Additionally, some original sources are literally quoted and interpreted according to the context. Since the end of the nineteenth century a complicated process of separation from internal medicine and psychiatry led to the formation of a self-conscious discipline of neurology. The first generation of German neurologists succeeded in founding the German Journal for Neurology ("Deutsche Zeitschrift für Nervenheilkunde") in 1890 and their own neurological association, the Society of German Neurologists ("Gesellschaft Deutscher Nervenärzte", GDN) in 1907. On an international scale, however, the institutional implementation of neurology with only a small number of chairs and few neurology departments remained more than modest. The ambitions for autonomy ended 2 years after the change of power in 1933. Regulatory interventions by the government and psychiatric interests led to the fusion of the GDN with the psychiatric specialist society, the new association being called the Society of German Neurologists and Psychiatrists ("Gesellschaft Deutscher Neurologen und Psychiater", GDNP) in 1935. In this group psychiatrists dominated the discourse. The expulsion, imprisonment and murder of physicians declared as non-Aryan or Jewish along with the forced consolidation ("Gleichschaltung") at the universities prompted profound changes in medical and academic life. It remains an ongoing challenge of neurological historical research to measure the impact of this upheaval on the few neurology departments in hospitals and private practices.

[German neurology and neurologists during the Third Reich: exemplified by research on epilepsy]. / Neurologie und Neurologen in der NS-Zeit: Das Beispiel der Epilepsieforschung.

There are only a small number of studies dealing with the impact of eugenic theories and practices on the research of particular neurological diseases during the Third Reich. Thus, this contribution to the special issue on neurology in Germany between 1933 and 1945 focuses exemplarily on epilepsy research. By drawing on primary sources and secondary literature the article tries to reconstruct the scientific discourse of the time and consider the implications for patients. National socialistic ideology was based on eugenic thinking and the implementation of eugenic policies was a major political objective. An immediate effect of this policy was the passing of the Law for the Prevention of Genetically Diseased Offspring (Gesetz zur Verhütung erbkranken Nachwuchses) in 1933. According to this law "hereditary epilepsy" along with various other neurological and psychiatric disorders was regarded as a mandatory indication for forced sterilization. Subsequently, funding of epileptological research was generously increased and extended, e. g. at the German Research Institute (Deutsche Forschungsanstalt) in Munich and the Rheinische Provinzial-Institut in Bonn. The main focus was placed on idiopathic forms of the disease, which were a priori considered as hereditary. At the annual meetings of the Society of German Neurologists and Psychiatrists (Gesellschaft deutscher Neurologen und Psychiater), lectures and debates on epilepsy repeatedly constituted a key topic. Some participants opted for a broad interpretation of "endogeneity" and thus favored an extension of the practice of sterilization but others advocated a more differentiated and restricted attitude. Several neurology researchers showed a penchant for self-mobilization in line with the doctrine of the new government.

[German neurology and neurologists during the Third Reich: the aftermath]. / Neurologie und Neurologen in der NS-Zeit: Auswirkungen und Folgen von 1945 bis heute.

The article discusses the consequences for neurology as a discipline which resulted from neurologists' participation in the crimes committed under National Socialism (NS). Chronologically, the current literature distinguishes mainly four overlapping stages: (1) a first phase was characterized by legal persecution and "denazification", which was also the time of the Nuremberg doctors' trial in which no neurologists were on trial. A detailed documentation of the trial for the German medical profession was published by Alexander Mitscherlich. (2) In the subsequent practice of wide amnestying and reintegration of former Nazi followers during the 1950s, neurologists were no exception as its elite continued in their positions. The year 1953 was the year of the Lisbon scandal, when chiefly Dutch representatives protested against the participation of Julius Hallervorden in the International Congress of Neurology. The newly founded societies, the German Society for Neurology (Deutsche Gesellschaft für Neurologie, DGN) and the German Society for Psychiatry and Neurology (Deutsche Gesellschaft für Psychiatrie und Neurologie, DGPN), unanimously supported their member. (3) The next period was characterized by a nascent criticism of the prevailing attitude of covering up the crimes committed by physicians during the Nazi period. The discovery of incriminating brain sections at various Max Planck Institutes brought neurology to the focus of the debate. (4) Since the 1980s and 1990s historians (of medicine) have been systematically examining medicine's Nazi past in a professional way, which resulted in a noticeable increase of knowledge. Additionally, a new generation of scholars provoked a change of mind insofar as they recognized medicine's responsibility for the crimes committed between 1933 and 1945. We expect that future historical research will further elucidate the history of neurology during the NS regime and have consequences for our current understanding of research ethics.

[A short history of thrombosis: concepts and therapies from ancient to modern times]. / Zur Geschichte der Thrombose: Theorien und Therapien von Hippokrates bis heute.

BACKGROUND: Historians of thrombosis usually cover a period from mid-19th to late 20th century, thus highlighting the era of scientific progress. The present study, however, follows history farther back to its earlier stages which harbour crucial elements for understanding later epochs and the present-day state of the art. METHODS: Relevant primary sources and secondary material as well as selected illustrations were identified and interpreted in their historical context. RESULTS: Early concepts drew upon the doctrine passed on by the Greeks that thrombosis originated form "metastases" formed by phlegm and black bile. Whereas scholars of the Middle Ages concerned themselves with haematoscopy as a "prototype" of diagnostic investigation, those of early modern times focused on mechanistic and morphological factors when formulating aetiological concepts of thrombosis and embolism. With Rudolf Virchow and his consolidated findings the modern age of positivist research began. During the following era of technological progress, new and scientifically tested treatments as well as prophylactic interventions replaced empirically based cures. CONCLUSIONS: The history of thrombosis is characterized by a multitude of different paradigms. Time will tell if innovative therapeutic strategies developed during the last two decades will lead to the next important paradigm change.

Wilhelm Fabry's 1614 report on a giant condyloma of the penis.

For many years it has been the work of Buschke and Löwenstein that has justified calling the exophytic, locally destructive tumour of the anogenital mucosal surface 'giant condyloma of Buschke and Löwenstein' or GCBL. In order to investigate the early history of this rare disease we examined the writings of the barber-surgeon Wilhelm Fabry (1560-1634) who had a serious interest in dermatological disorders and their treatment. We analysed Fabry's 600 Latin case reports and identified the case of a 'monstrous penile tumour'. We then translated this text into English and compared it point by point with later publications. This was followed by a cursory review of surgical treatises from the 16th to the 18th centuries. In 1614 Fabry described and depicted a tumour of the penis; the clinical characteristics (gradual formation of a warty lesion, considerable size, invasive growth, absence of metastases) indicated it was a giant condyloma. His mention of the urethral fistulization enables discrimination from 'common' condylomata acuminata, and the survival period of 10 years after amputation allows exclusion of a 'true' carcinoma. This report is singular among 17th-century case histories. The neoplasias described 300 years later are most probably biologically identical. Thus, Fabry's is the first clinical report; the histological classification, however, belongs to Buschke and Löwenstein. From now on the disease should be designated with the eponym giant condyloma of Fabry-Buschke-Löwenstein or GCFBL.

[Personality in old age]. / Persönlichkeit im höheren Lebensalter.

Modern developmental psychology tends to draw a positive, resource-based picture of human aging. We will however focus on more difficult aspects of personality in old age which are of psychiatric relevance: the persistence of cluster A and C personality disorders, antisocial personality in the elderly; the interaction of personality and a detection of mild cognitive impairment (MCI); personality features as risk or protective factors or early signs of Alzheimer's dementia; changes of personality in Parkinson's disease and frontotemporal dementia. We will briefly mention recent neuroimaging studies which appear to suggest a functional neuroanatomy of personality. A quote from Cicero's cato major, de senectute indicates that some of his perceptions regarding classic personality characteristics of the elderly can be recognized in our patients and can be prevented or treated with modern interventions.

Retrospective diagnosis: use and abuse in medical historiography.

Medical papers on diseases of famous persons, sometimes called pathographies, constitute the by far largest section of publications dealing with historical diagnosis. The procedure of attaching modern diagnostic labels to illustrious personalities of the past, i.e. retrospective diagnosis, has stimulated an ongoing theoretical debate among clinicians and medical historians. The purpose of this paper is to clarify some of the issues involved. Key problems of retrospective diagnostics are reviewed and analysed. In addition, the case history of the Polish composer Fryderyk Chopin is used to highlight problems and pitfalls of this method. Whereas contemporary physicians are used to apply present-day nosological categories to individuals of the past or historical epidemics, medical historians are more cautious to do so. They argue that in the absence of definite proofs retrospective diagnoses often are nothing more than mere speculation. Another important counter-argument is that medical knowledge itself varies over time and historical changes in nosology must not be ignored. Future pathographies should use primary sources extensively, focus on historical context and minimize the pursuit of retrospective diagnoses or causes of death. Only with a fundamentally revised method, a more critical approach to retrospective diagnostics, and far more serious objectives will medical biographies be in a position to break new ground.

[The portrayal of multiple sclerosis in television series]. / Die Darstellung der Multiplen Sklerose in Fernsehserien.

BACKGROUND: An increasing number of television series deal with neurological disorders, including fictional portrayals of multiple sclerosis (MS). The aim of this paper was to analyze every available TV episode with an MS character. MATERIAL AND METHODS: Productions were identified by film databases and by hand search. Each episode was evaluated along neurologic and cinematic lines. RESULTS: Between 1985 and 2006, portrayals of MS appeared in 17 episodes produced in Germany, the US, and the UK. The frequency of symptoms shown onscreen strongly differed from epidemiological data. In particular sensory, cognitive, and bladder symptoms as well as difficulties with sexual function were under-represented. The authenticity of the disease depiction was strongly dependent upon the genre. Coping stories could be identified as the most prominent genre. Television patients were often portrayed as "brave fighters", "refined characters", and "afflicted without symptoms". CONCLUSIONS: Television series attract millions of viewers and thus shape the public image of a disease. Sound knowledge of how symptoms, diagnosis, and therapeutic options are presented in mass media is therefore indispensable for all who deal with MS patients, relatives, and caregivers.

[Early history of Pick's disease]. / Zur Frühgeschichte der Pickschen Erkrankung.

The development of the concept of Pick's disease can be divided into three periods. From 1892 on Arnold Pick reported a series of patients presenting cognitive disturbances, personality changes and focal symptoms such as aphasia and apraxia. Pick, however, like his contemporaries, did not conceive of a new nosological entity. The major event during the second period was the outline of histological characteristics like argentophilic inclusion bodies by Alois Alzheimer. During the 1910s however, Alzheimer's extremely important observation remained unnoticed. Further historical research is necessary to clarify why Alzheimer's subtype of dementia was hurriedly regarded as a disease, whereas Pick's was not. Political factors such as Kraepelin's strategic considerations seem to have played an essential role. In accordance with major research criteria of German neuropsychiatry, Pick's atrophy was constructed as a full-blown disease entity in the 1920s. This concept gained acceptance in the German and Anglo-American scientific community and was the starting point for further investigations in the 1950s and 1960s.