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.

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.

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.

Early Observations on Facial Palsy.

Before Charles Bell's eponymous account of facial palsy, physicians of the Graeco-Roman era had chronicled the condition. The later neglected accounts of the Persian physicians Abu al-Hasan Ali ibn Sahl Rabban al-Tabari and Abu Bakr Muhammad ibn Zakariya Razi ("Rhazes") and Avicenna in the first millennium are presented here as major descriptive works preceding the later description by Stalpart van der Wiel in the seventeenth century and those of Friedreich and Bell at the end of the eighteenth and the beginning of the nineteenth centuries.

Before Charcot.

From the time of Greco-Roman Medicine, the uncertain nature of hysterical illness was a fertile source of controversy. Because there were no testable objective signs of disease, the diverse ideas relating hysteria to the uterus and to psychological and physiological causes generated persisting polemics. Theories fluctuated chaotically, influenced by social changes of prosperity or deprivation, current attitudes, and issues of gender. Faced with a large number of patients with such illnesses as well as many with epilepsy, mental illnesses, and organic nervous disorders, Charcot set about investigating hysterics to determine what neurological abnormalities might explain them. His many predecessors, from Sydenham and Willis in the 17th century to Briquet and Bourneville in the 19th century, whose views are outlined in this chapter, both conditioned and influenced his efforts. Charcot succeeded in promoting his work at Salpêtrière, which for a time was respected throughout the world.

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.

John Fothergill: a biographical sketch and his contributions to neurology.

John Fothergill was a remarkable but largely forgotten physician, plant collector, and philanthropist, born of Quaker parents in Yorkshire. This article summarizes the legacy of his work on trigeminal neuralgia and migrainous "sick headaches," and his seminal studies on angina, scarlatina, and diptheria. He became hugely influential and fostered both education and many medical careers in Britain and America.

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 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).

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.

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.

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.