Sir William Osler (1849-1919) and neurology in his time.

Sir William Osler, physician in Montreal, in Pennsylvania, at Johns Hopkins and in England, promoted clinical medicine and its interpretation through clinical and pathological observation. He was a keen bibliophile and medical historian. He taught at the bedside and wrote a textbook that was a standard work in his time and for several decades after he died. As a generalist he practised the emerging speciality of neurology and knew many of the early clinicians in that field. The neurology of his time and his contributions to the subject are explored here.

John Goodsir (1814-1867) and his neurological illness.

John Goodsir, conservator and professor of anatomy at the University of Edinburgh, suffered an unidentified illness described by experts after his death as tabes. The features that led to this diagnosis, the understanding of tabes at that time and its relationship in some cases to syphilis, are discussed. It is concluded that the most likely diagnoses are subacute combined degeneration of the cord as a result of malnutrition or tabes dorsalis resulting from earlier syphilis. The presence of 'lightning pains' leans towards the latter diagnosis but evidence for a means of acquisition of syphilis is lacking. The disadvantages of retrospective diagnosis are discussed.

Charles Bell's (1774-1842) contribution to our understanding of facial expression.

The human face reflects a person's character and emotions, both in health and disease. Charles Bell, published in 1806 Essays on the Anatomy of Expression in Painting in which he stressed the importance of understanding anatomy when studying art. He concluded that emotions were revealed in facial expression and that these expressions were only to be found in humans, not in lower animals. Charles Darwin in 1872 published The Expression of the Emotions in Man and Animals, where he acknowledged Bell's contribution to facial expression especially the role of the nervous system, but questioned Bell's conclusion, that animals were incapable of showing emotions through facial expression. Darwin reasoned that human facial expressions reflected emotions, some from our primeval state, some from habit but most were universal and controlled by an involuntary nervous system, described by Bell, and now known as the parasympathetic system. This paper explores Bell's contribution to the understanding of facial expression. We conclude that his understanding of neuroanatomy along with his artistic ability enhanced our comprehension of human facial expressions, although his theological interpretation of the reason for facial expressions and emotions needs to be seen more in the context of nineteenth century Natural Theology.

Charles Bell (1774-1842) and Natural Theology.

Sir Charles Bell, a 19th century surgeon, anatomist and artist, was heavily influenced by the religious practice of Natural Theology, a belief which implied that the world is created by an Intelligent Designer. In the 18th century, William Paley, later Rector of Bishop Wearmouth, wrote the seminal book about Natural Theology. Charles Bell who practised in London and Edinburgh used his artistic skills to underline his teaching of anatomy and surgery. Later, Bell wrote one of the eight Bridgewater Treatises on the Hand. Bell went on to illustrate the final edition of Paley's Natural Theology in which he demonstrated that proof of Design were to be found in the animal frame, reflecting his earlier work on art and human structure. It is concluded that Charles Bell and William Paley's ideals were in harmony with each other, holding the same belief about Creation. This paper argues that Bell's understanding and devotion to Natural Theology allowed him to accurately explain function, realism and expression in the human body, all revealing the direct influence of the Divine Creator.

Neurology, poetry and the first world war of 1914-1918.

The First World War of 1914-1918 produced a wealth of disability and death and much has been written of this catastrophe for mankind. Prose is prolific and much poetry has been written too, some of it discussed here; it consists of works by healthcare workers and also about the effects of the war upon those who fought and those who were left behind. Some of the work is by neurologists and some deals with the neurological disorders of those who fought.

John Bell (1763-1820): brother artist and anatomist.

John Bell, brother-surgeon of Charles Bell, was, like Charles, an outstanding surgeon and a good artist. John was one of the few who illustrated his work with their own drawings in the days before audiovisual aids were available and without the benefit of reliable drawing aids, photography and computer-aided design. Charles, on the other hand, was the better artist and illustrated much of the normal anatomy of the nervous system. Each brother undertook extensive surgery of men who had been wounded in war; John Bell left us his engravings from the textbooks, more numerous perhaps than Charles, but Charles left us a series of oil paintings and watercolours in addition to the illustrations in his textbooks.

Mutations in TTBK2, encoding a kinase implicated in tau phosphorylation, segregate with spinocerebellar ataxia type 11.

The microtubule-associated protein tau (encoded by MAPT) and several tau kinases have been implicated in neurodegeneration, but only MAPT has a proven role in disease. We identified mutations in the gene encoding tau tubulin kinase 2 (TTBK2) as the cause of spinocerebellar ataxia type 11. Affected brain tissue showed substantial cerebellar degeneration and tau deposition. These data suggest that TTBK2 is important in the tau cascade and in spinocerebellar degeneration.

Erasmus Darwin (1731-1802): neurologist.

Erasmus Darwin was the founder of evolutionary biology, a renown poet, an inventor, and a general medical practitioner. Erasmus Darwin wrote specifically about the evolutionary and phylogenetic development of the nervous system, neuroembryology, psychiatric illness (including delusions and depression), and electrical therapy for childhood hemiplegia. He conducted experiments in neuro-ophthalmology and wrote about color vision, afterimages, the blind spot, and visual memory.