Pourfour du Petit (1664-1741).

François Pourfour du Petit was a Parisian experimental neuro-anatomist, and ophthalmologist, who investigated his extensive wartime experiences of brain and spinal injuries and verified his conclusions by animal experiments. His results showed with great originality that brain injuries caused weakness or paralysis of the opposite limbs. He also clarified the anatomy of the spinal cord and decussation of the pyramidal tracts, and demonstrated the anatomy and clinical significance of the cervical sympathetic chain.

Early contribution of Alexandria medical school to the anatomy, physiology and pathology of the nervous system.

Alexandria's famous medical school was established about 300 BC. It was the seat of learning for many Greco-Roman physicians. The physiologist Erasistratus, the anatomist Herophilus - named the Father of Anatomy were outstanding pioneers. Their work and discoveries of the nervous system, its structure and function, are described. In the 2nd century AD they were succeeded by Rufus of Ephesus - the medical link between Hippocrates and Galen, - and Aretaeus a leading anatomist and physician in this period.

The "split brain" and Roger Wolcott Sperry (1913-1994).

The concepts of cerebral localization were established in the early 19th century. From these arose the idea that the dominant (usually left) hemisphere mainly subserved functions of cognition and language. The "relatively retarded right hemisphere" by contrast was mute, agraphic, apraxic, and lacking generally in higher cognitive function. This essay sketches the import of the work of Sperry and colleagues on patients subjected to callosal section eg., "split brain". They showed that the minor hemisphere possessed considerable capacity for cognitive understanding and language. His Nobel prize-winning "Split-Brain Experiments"confirmed the role of the corpus callosum in interhemispheric transfer of information.

The neuroanatomy of herophilus.

Herophilus (ca. 330 to ca. 260 BC) was one of Hellenistic -Alexandria's renowned scholars, a leading physician, often named the 'Father of Anatomy'. From cadaveric dissections and possibly vivisection Herophilus considered the ventricles to be the seat of the soul, intelligence and mental functions. Herophilus introduced the term rete mirabile found in ungulates but not in man, as opposed to Galen, who erroneously believed it a vital human network. A founder of the principles of observations in science, and an exponent of measurements in medicine, his accurate dissections resulted in original anatomical discoveries. He distinguished nerves that produce voluntary motion from blood vessels, and motor from sensory nerves; the nerves of the spinal cord were directly linked to the brain. He identified at least seven pairs of cranial nerves. Herophilus demonstrated the meninges, and ventricles, regarding the fourth as most important. His name is perpetuated by his accounts of the calamus scriptorius and the confluence of venous sinuses the torcular Herophili.

The neurology of aretaeus: radix pedis neurologia.

Aretaeus (Aretaios) was a physician born in Cappadocia in about the 2nd century AD, a student of medicine and physician in Alexandria. His works are found in eight books which espoused the physiological and pathological views of the Hippocratic principles derived from the pneumatists and the eclectic schools. Though he has been called the forgotten physician, it has been said that: 'after Hippocrates no single Greek author has equalled Aretaios'. In order to give an indication of his neurological legacy, this paper offers a summary of and quotations from his principal neurological contributions: migraine, vertigo, tetanus, epilepsy, melancholia, strokes and paralysis. One of his most important discoveries was the notion that the pyramidal tract decussates.

The Monro Bell controversy.

Amongst the contributions in anatomy and surgery of the celebrated Monros was the contentious "discovery" by Monro Secundus of the interventricular foramen. Monro's account (1783) was vehemently criticized in London, especially by Charles Bell for presuming to describe something which was already well known and for inaccuracies. Monro with some justification in 1797 disputed this attack, although his anatomical description was shown by later anatomists to be mistaken.

Brain disease leading to mental illness: a concept initiated by the discovery of general paralysis of the insane.

In the early 19th century the prevailing alienist (psychiatrists') view was that organic lesions did not cause madness. The history of general paralysis of the insane (GPI) rests on four early publications which changed this concept: Haslam's Observations on insanity, Bayle's Recherches sur l'arachnitis chronique, Calmeil's De la paralysie considérée chez les aliénés, and Esmarch and Jessen's Syphilis und Geistesstörung. Haslam's account is unconvincing, but Bayle's report linking mental alienation with organic brain disease was a polemic that opposed established teachings. Calmeil and Delaye emphasised clinicopathological correlation and stressed the importance of white matter disease in causing dementia. GPI was to prove a crucial starting point in which the causes of mental illness were slowly transformed from psychogenic disturbances of mind and spirits to organically determined diseases.

Disease, diagnosis or syndrome?

The advance of medical semantics is, in general, towards causation. As knowledge increases, the common consequence is the re-definition of disease. This starts with symptoms then a disorder of structure or function, abnormalities of images, genetics or biochemistry, the ultimate aim being a specific aetiological mechanism which replaces broader descriptions. But medical terminology of diseases, diagnoses and syndromes is inherently imprecise. Careless nomenclature causes confused dialogue and communication. Symptoms of uncertain cause are commonly lumped together and given a new 'diagnostic' label which also may confuse and produce false concepts that stultify further thought and research. Such medicalisation of non-specific aggregations of symptoms should be avoided. The defining characteristics of diseases and diagnoses should be validated and agreed. The pragmatic diagnoses of 'symptom of unknown cause' or 'non-disease' are preferable to falsely labelling patients with obscure or non-existent diseases. "I tried to unveil the stillness of existence through a counteracting murmur of words, and, above all, I confused things with their names: that is belief." Jean-Paul Sartre (The Words, 1964).

Henry Charlton Bastian (1837-1915): neglected neurologist and scientist.

Henry Charlton Bastian was born in Truro, Cornwall. He graduated in 1861 at the University College, London, where he worked most of his life. He was one of the first neurologists appointed to the National Hospital, Queen Square. There, he conducted original investigations and pursued wide interests both in medical and biological sciences. He was elected a Fellow of the Royal Society in 1868. In addition to his reputation as a neurological diagnostician and intellectual, he became an advocate of the vexed doctrine of abiogenesis.

Early observations on optic neuritis and Uhthoff's sign.

For much of the 19th century, even after the discovery of the ophthalmoscope, the diagnostic clinical signs and the identity of primary optic nerve disease were confused and inaccurate. Amongst many contributions aimed at clarifying this muddle, those of Wilhelm Uhthoff and Edward Nettleship were of outstanding importance and are outlined here.

Broca's aphasiacs.

After Gall, Bouillaud and Auburtin had localized the function of language to the frontal lobes in the early 19th century, Paul Broca's famous patient, M. Leborgne (known as 'Tan'), was described to the Anthropological Society of Paris and his case was published in the Bulletin de la Société Anatomique, in 1861. Broca relied on the uncut brain for his clinicopathological inferences. A few months later, his second case, M. Lelong, yielded similar pathological details and confirmed Broca's localization of language. The subsequent controversies with Dax and Pierre Marie are summarized. More recent imaging of the brains of Lelong and Leborgne has partly vindicated Broca's controversial conclusions. Most papers on Broca's work contain only brief, derivative references to his 1861 paper; the actual contents, translated into English, are reproduced here.

Central pontine myelinolysis.

In 1949, Victor and Adams observed an alcoholic patient who developed quadriplegia and pseudobulbar palsy, and inability to chew, talk or swallow. A post-mortem confirmed their suspicion of 'a large, symmetrical, essentially demyelinative lesion occupying the greater part of the basis pontis.' This paper follows the historical evolution of central pontine myelinolysis and the changing concepts of its metabolic aetiology. Too rapid a rate of correction of hyponatraemia is the most common, but not invariable aetiology.

Sir Samuel Wilks (1824-1911): 'the most philosophical of english physicians'.

This paper retells some of the achievements and personal attributes of Sir Samuel Wilks, one of the great Guy's Hospital physicians and neurologists of the second half of the 19th century. He was a fellow of the Royal Society, president of the Royal College of Physicians, and physician extraordinary to Queen Victoria. A prolific author and original observer of clinical and pathological diseases, he was renowned for his Lectures on Pathological Anatomy, and his original descriptions of syphilis, epilepsy, inflammatory bowel diseases, and myasthenia gravis.

Sir samuel wilks (1824-1911): on epilepsy.

Samuel Wilks was one of that remarkable era of great physicians and syndrome creators based at Guy's Hospital in the mid 19th century. He made signal contributions to the concept that epilepsy derived from surface lesions affecting the cortex, as opposed to the medulla. After Locock, he was largely responsible for the general use of bromide--in his day the only effective anticonvulsant.

The ophthalmoscope: Helmholtz's Augenspiegel.

The origins of Helmholtz's invention of the ophthalmoscope are found in the ancient observation that the back of the eye appeared black. In 1703, Jean Méry reported that the luminosity of the cat's eye could be seen when the animal was held under water, and Mariotte observed that a dog's eye was luminous but erroneously thought this was because its choroid was white. Prévost made a breakthrough when he deduced it was incident light and not light coming out of the eye. Purkinje and von Brucke used lenses to attempt to see the fundus and almost succeeded. However, it was Helmholtz who created the first useable ophthalmoscope, whose development and clinical application are traced in this paper. One of the greatest physical scientists in many spheres of learning, his biography is briefly sketched.

Richard Bright and his neurological studies.

Richard Bright was one of the famous triumvirate of Guy's Hospital physicians in the Victorian era. Remembered for his account of glomerulonephritis (Bright's disease) he also made many important and original contributions to medicine and neurology. These included his work on cortical epileptogenesis, descriptions of simple partial (Jacksonian) seizures, infantile convulsions, and a variety of nervous diseases. Most notable were his reports of neurological studies including papers on traumatic tetanus, syringomyelia, arteries of the brain, contractures of spinal origin, tumours of the base of the brain, and narcolepsy. His career and these contributions are outlined.

Marie-Jean-Pierre Flourens (1794-1867) and cortical localization.

The child prodigy Marie-Jean-Pierre Flourens received his medical degree at Montpellier when aged 19. As a young promising physician Flourens was asked to investigate Gall's controversial views on cerebral localization. To test Gall's assertions, Flourens developed ablation as a procedure to explore the workings of the brain. By removing anatomically defined areas of the brain of an animal and watching its behaviour, he thought he might localize certain functions. Flourens did not favour the idea of cerebral localization and concluded that the brain functioned as a whole and thus arose the concept of 'cerebral equipotentiality'. This culminated in his 1824 Recherches expérimentales sur les propriétés et les fonctions du système nerveux. His techniques were, however, crude and imperfect, and his experiments were mainly on birds. Much criticism and debate ensued. A gifted man, Flourens also advanced the physiology of the vestibular apparatus and described the anaesthetic properties of ether.

'Les ictus amnésiques' and transient global amnesia.

In March 1909, R. Benon was probably the first to report a typical case of what we now call transient global amnesia. In 1956, Bender, and independently, Guyotat and Courjon described clinical and epidemiological features of transient amnesic attacks. The condition achieved general recognition after the term transient global amnesia (TGA) was introduced by Fisher and Adams in 1958. Their historic work is the main focus of this review. They reported 17 patients, with an abrupt anterograde amnesia of short duration. Classification and criteria are outlined. Various aetiologies have been postulated, but although TGA remains a clinically distinct syndrome, usually with a good prognosis, evidence of neither ischaemia nor epilepsy is demonstrable in most patients. Theories of jugular venous reflux may be relevant in some but probably not in most cases of this heterogeneous disorder.

Hugo Karl Liepmann and apraxia.

John Hughlings Jackson (1835-1911) first clearly described apraxia in 1861, though he did not provide the specific name. Apraxias are subtle motor disorders in which there is an interruption of the organisation of movement mainly located in the left hemisphere. Hugo Karl Liepmann (1863-1925) was responsible for their elucidation, distinguishing ideomotor, limb-kinetic or innervatory, and ideational apraxias that affect distinct central associational areas of the cortex with characteristic clinical results. This notion was later expanded and clarified by Geschwind's 'disconnection syndromes'. This article summarises the history of this important and common pattern of motor dysfunction.