Cruveilhier's Unrecognized Case (c1831) of Dyke-Davidoff-Masson Syndrome.

In his serially published atlas of pathology, Anatomie Pathologique du Corps Humain (1829-1842), French anatomist and pathologist Jean Cruveilhier (1791-1874) provided an early clinical-pathologic description of Dyke-Davidoff-Masson syndrome. Cruveilhier's case was initially published around 1830, more than a century before the clinical and radiologic report of Dyke and colleagues in 1933 based on a series of patients studied with pneumoencephalography. Although Dyke and colleagues were apparently unaware of Cruveilhier's prior description, Cruveilhier's case manifested all of the key osseous and neuropathological features of Dyke-Davidoff-Masson syndrome as later elaborated by Dyke and colleagues: (1) cerebral hemiatrophy with ex vacuo dilation of the lateral ventricle, (2) ipsilateral thickening of the diploe of the skull, and (3) ipsilateral hyper-pneumatization of the frontal sinuses. In addition, Cruveilhier noted crossed cerebral-cerebellar atrophy in his case and correctly inferred a "crossed effect" between the involved cerebral hemisphere and the contralateral cerebellum. Cruveilhier's pathological case from 1830 clearly anticipated both the cases reported more than a century later by Dyke and colleagues based on pneumoencephalography and the more recent case reports recognized with computed tomography or magnetic resonance imaging.

Charcot's erroneous double-semidecussation scheme for the retinocortical visual pathways.

Jean-Martin Charcot, often lauded for his seminal contributions, is seldom critiqued for his blunders. One such blunder was his double-semidecussation scheme for the retinocortical visual pathways, proposed in 1875 to explain, on neuroanatomic grounds, cases of hysteria that manifest hysterical amblyopia accompanied with ipsilateral hemianaesthesia. Charcot's scheme was inconsistent with the older, broadly correct scheme of Prussian ophthalmologist Albrecht von Gräfe. Charcot failed to perform clinicopathologic correlation studies. His analysis relied on a series of mistaken conclusions he made in conjunction with Swiss-French ophthalmologist Edmund Landolt: (1) only an optic tract lesion could produce a homonymous hemianopsia; (2) cerebral lesions, if they ever produced homonymous hemianopsia, did so by secondary effects (e.g. pressure) on the optic tracts; and (3) damage to the cortical projections from the lateral geniculate produces a crossed amblyopia. Challenges to Charcot's theory came from within France by 1880. By 1882, Charcot recognized that his scheme was erroneous, and he approved a thesis by his pupil Charles Féré that reverted to Gräfe's scheme with an ill-conceived modification to accommodate Charcot's concept of hysterical cerebral amblyopia. A critique by American neurologist Moses Starr in 1884 argued for Gräfe's scheme and refuted Charcot's erroneous scheme and its subsequent derivatives.

The conflicts of Ray Adams and Joe Foley with Abe Baker: The neurology and neuropathology of liver failure (1949-1963) and the founding of the American Academy of Neurology (1948).

This article examines disagreements among three giants of twentieth-century American neurology: Raymond Adams, Joseph Foley, and Abraham Baker. The disagreements Adams and Foley had with Baker concerned two issues: (1) the neurologic and neuropathological manifestations of liver failure with hepatic encephalopathy as expounded from the late 1940s to the early 1960s, and (2) the founding of the American Academy of Neurology in 1948 as an inclusive medical society under the principal leadership of Baker. The conflicts are examined from transcribed meeting debates (1949-1963), salient original publications (1949-1963), public addresses of protagonists touching on these issues (1971, 1984), and oral histories and less formal interviews of the protagonists and their associates (1979-2014). Contributing to these conflicts were contrasting personalities and outlooks on American neurology in the mid-twentieth century. Adams and Foley prevailed with their characterization of the neurologic and neuropathologic features of liver failure, whereas Baker triumphed with the need for and importance of an inclusive neurological society that would develop continuing medical education for neurologists at a national level, garner federal financial support for neurology training programs, and facilitate the development of neurology as a strong, independent medical discipline in the United States.

The collaboration of Francis Forster and Wilder Penfield in the management of a girl with 'reflex epilepsy'.

In the era after World War II, Francis (Frank) Forster (1912-2006) became a preeminent American neurologist and epileptologist, with international prominence in the study of reflex epilepsy. Forster's interest in reflex epilepsy began with a chance observation of the condition, in 1946, in a four-year-old girl. When medical measures failed to control her somatosensory-evoked seizures, Forster recommended surgery, and then facilitated transfer to Canadian neurosurgeon Wilder Penfield (1891-1976) at the Montreal Neurological Institute. Forster traveled to Montreal for the child's surgery. The surgery on February 27, 1948, proved to be curative for the child, and Forster's interactions with Penfield and epileptologist Herbert Jasper (1906-1999) made a lasting impression. This study reviews the medical and surgical history of this case, which strongly influenced Forster's career.

The discovery of niacin, biotin, and pantothenic acid.

The aim was to describe the discovery of niacin, biotin, and pantothenic acid. By the 1920s, it became apparent that 'water-soluble B' (vitamin B) is not a single substance. In particular, fresh yeast could prevent both beriberi and pellagra, but the 'antipolyneuritis factor' in yeast is thermolabile, while the antipellagra factor is heat stable, suggesting that there are at least two water-soluble vitamins. Various terms were proposed for these water-soluble factors, but vitamins B(1) and B(2) were most widely used to refer to the thermolabile and heat-stable factors, respectively. Although vitamin B(1) proved to be a single chemical substance (thiamin), vitamin B(2) was ultimately found to be a complex of several chemically unrelated heat-stable factors, including niacin, biotin, and pantothenic acid. Recognition that niacin is a vitamin in the early 20th century resulted from efforts to understand and treat a widespread human disease - pellagra. American epidemiologist and US Public Health Service officer Joseph Goldberger (1874-1929) had been instrumental to elucidating the nutritional basis for pellagra. Goldberger conducted a classic series of observational and experimental studies in humans, combined with an extensive series of experiments with an animal model of the condition (black tongue in dogs). In contrast, recognition that biotin and pantothenic acid are vitamins occurred somewhat later as a result of efforts to understand microbial growth factors. The metabolic roles in humans of these latter substances were ultimately elucidated by human experiments using particular toxins and by studies of rare inborn errors of metabolism. Symptomatic nutritional deficiencies of biotin and pantothenic acid were, and continue to be, rare.

On old Olympus? Oliver Wendell Holmes and the origin and evolution of a mnemonic couplet for the cranial nerves.

A mnemonic couplet to help students learn the names of the cranial nerves has been in use in the United States since the mid-nineteenthth century. The original in iambic tetrameter is attributed to Oliver Wendell Holmes, Sr. Using a systematic search, more than 40 variants have been identified and, where possible, ordered in time. Variations depended in part on evolving preferred names for individual cranial nerves, regional geographic features, and idiosyncratic choices. Some inferior variants ignored critical features of the original (e.g., meter, number of poetic feet, or even the rhyme). Others strove to have a memorable couplet with the basic features of the original but without resorting to disparaging phrases. However, with the modern names for the cranial nerves, few of the extant versions of the mnemonic make sense, or preserve iambic tetrameter and rhyme, while avoiding derogatory or lewd expressions. Two new versions are suggested that meet these constraints.

Eugène-Louis Doyen and his Atlas d'Anatomie Topographique (1911): Sensationalism and gruesome theater.

French surgeon and anatomist Eugène-Louis Doyen (1859-1916) was a focus of controversy and scandal throughout his career, an innovative surgeon of great technical skill whose unsurpassed abilities were offset by narcissistic and frequently unethical behavior. Doyen produced the most controversial atlas of human anatomy of the early-twentieth century, his Atlas d'Anatomie Topographique. He used a chemical process to fix whole cadavers, then used a motorized band saw with a sliding table to precisely cut sequential slices in all three anatomic planes. His intentionally arresting images of the nervous system in situ (using heliotypes in his atlas and projected images of prepared specimens in his lectures) made for gruesome theater, directed more at the public than the medical profession, which Doyen disdained and delighted in antagonizing. Although photography and photomechanical reproduction facilitated the rapid production of Doyen's atlas, many of the fine details were lost. In addition, although he developed tissue fixation techniques that preserved the natural colors of tissues, this was not evident in the monochrome images of the printed atlas. Doyen's atlas is compared with other anatomic atlases of the late-nineteenth century that included serial sections of the central nervous system, either from sections of entire cadavers, the isolated head, or the excised brain. In retrospect, Doyen's fevered activity, including his efforts to depict the topographic anatomy of the nervous system, produced only modest benefits, and often produced significant costs for his patients, his colleagues, the medical profession, and his own reputation.

Evolution of the myth of the human rete mirabile traced through text and illustrations in printed books: The case of Vesalius and his plagiarists.

Andreas Vesalius initially accepted Galen's ideas concerning the rete mirabile in humans. In 1538, Vesalius drew a diagram of the human rete mirabile as a plexiform termination of the carotid arteries, where the vital spirit is transformed into the animal spirit, before being distributed from the brain along the nerves to the body. In 1540, Vesalius demonstrated the rete mirabile at a public anatomy, using a sheep's head (due to his nascent realization that he could not demonstrate this adequately in a human cadaver, potentially eliciting ridicule). By 1543, Vesalius had fully reversed himself, denied the existence of the rete mirabile in humans, and castigated himself for his prior failure to recognize this error in Galen's works. Vesalius nevertheless illustrated both the Galenic conception of the rete mirabile in humans and a schematic of the rete mirabile in ungulates. He intended the 1543 diagram of the human rete mirabile as an example of a mistake that resulted from Galen's overreliance on animals as models of human anatomy. However, in spite of Vesalius's intentions, for more than a century afterward, his figure was repeatedly and perversely plagiarized by advocates for Galenic doctrine, who misused it as a purportedly realistic representation of human anatomy and generally omitted the contrary opinions of Berengario da Carpi and Vesalius. The protracted use of stereotyped representations of the rete mirabile in extant printed illustrations provides tangible documentation of the stagnation in anatomical thought in the sixteenth and seventeenth centuries.

The medieval cell doctrine: Foundations, development, evolution, and graphic representations in printed books from 1490 to 1630.

The medieval cell doctrine was a series of related psychological models based on ancient Greco-Roman ideas in which cognitive faculties were assigned to "cells," typically corresponding to the cerebral ventricles. During Late Antiquity and continuing during the Early Middle Ages, Christian philosophers attempted to reinterpret Aristotle's De Anima, along with later modifications by Herophilos and Galen, in a manner consistent with religious doctrine. The resulting medieval cell doctrine was formulated by the fathers of the early Christian Church in the fourth and fifth centuries. Printed images of the doctrine that appeared in medical, philosophical, and religious works, beginning with "graphic incunabula" at the end of the fifteenth century, extended and evolved a manuscript tradition that had been in place since at least the eleventh century. Some of these early psychological models just pigeonholed the various cognitive faculties in different non-overlapping bins within the brain (albeit without any clinicopathologic evidence supporting such localizations), while others specifically promoted or implied a linear sequence of events, resembling the process of digestion. By the sixteenth century, printed images of the doctrine were usually linear three-cell versions with few exceptions having four or five cells. Despite direct challenges by Massa and Vesalius in the sixteenth century, and Willis in the seventeenth century, the doctrine saw its most elaborate formulations in the late-sixteenth and early-seventeenth centuries with illustrations by the Paracelsan physicians Bacci and Fludd. Overthrow of the doctrine had to await abandonment of Galenic cardiovascular physiology from the late-seventeenth to early-eighteenth centuries.

Summarizing the medieval anatomy of the head and brain in a single image: Magnus Hundt (1501) and Johann Dryander (1537) as transitional pre-Vesalian anatomists.

Of the early-sixteenth century pre-Vesalian anatomists, Magnus Hundt in 1501 and Johannes Eichmann (known as Johann Dryander) in 1537 both attempted to summarize the anatomy of the head and brain in a single complex figure. Dryander clearly based his illustration on the earlier one from Hundt, but he made several improvements, based in part on Dryander's own dissections. Whereas Hundt's entire monograph was medieval in character, Dryander's monograph was a mixture of medieval and early-modern frameworks; nevertheless, the corresponding illustrations of the anatomy of the head and brain in Hundt (1501) and Dryander (Dryandrum 1537) were both essentially medieval. This article examines in detail the symbology of both illustrations within the context of the medieval framework for neuroanatomy and neurophysiology. These two woodcuts of the head and brain provide the most detailed pictorial representation of medieval cranial anatomy in a printed book prior to the work of Andreas Vesalius in 1543.

Representations of the olfactory bulb and tracts in images of the medieval cell doctrine.

This article presents a collection of previously overlooked, stereotyped, abstract, anatomical representations of the olfactory bulbs and tracts that were printed as part of schematic woodcuts of the medieval cell doctrine, generally in the early-sixteenth century but extending into the seventeenth century and, in at least one case, to the mid-nineteenth century. A representation of the olfactory bulbs is incorporated into many of these woodcuts, beginning with an illustration by German physician, philosopher, and theologian Magnus Hundt in 1501 in his Antropologium, which showed central projections of the two olfactory bulbs joining in the meshwork of the rete mirabile. German physician and anatomist Johann Eichmann, known as Johannes Dryander, modified Hundt's figure for his own monograph in 1537 but retained the representation of the olfactory bulbs. In 1503, German Carthusian humanist writer Gregor Reisch published an influential and highly copied woodcut in his Margarita philosophica, showing connections from the olfactory bulbs overlying the bridge of the nose (as well as from other special sense organs) to the sensus communis in the anterior cell or ventricle. In the following centuries, numerous authors derived similar figures from Reisch's original schematic illustration of the medieval cell doctrine, including Brunschwig (1512, 1525), Glogowczyk (1514), Romberch/Host (1520), Leporeus/Le Lièvre (1520, 1523), Dolce (1562), Lull/Bernardus de Lavinheta (1612), and Elliotson (1835). Similar representations were provided by Peyligk (1518) and Eck (1520). These stereotyped schematic images linked the olfactory bulbs to olfaction before the advent of more realistic images beginning in the mid-sixteenth century.

Cross-sectional representations of the central nervous system in Pirogov's "Ice Anatomy".

Russian surgeon Nikolay Ivanovich Pirogov (Pirogoff; 1810-1881) introduced the teaching of applied topographical anatomy in Russia. Pirogov's monumental four-part atlas, Anatome topographica sectionibus per corporis humanum congelatum triplici directione ductis illustrate (An Illustrated Topographic Anatomy of Saw Cuts Made in Three Dimensions Across the Frozen Human Body), colloquially known as the "Ice Anatomy," was published in Latin in folio in the 1850s. Pirogov sought to investigate "the normal and pathological positions of different organs and body parts using sections made in the three principal directions [anatomical planes] … throughout all regions." To accomplish this, he froze cadavers "to the density of the thickest wood" and then cut them into thin plates with a special mechanical saw. His approach was reportedly inspired by his observations of butchers sawing across frozen pig carcasses at the meat market in St. Petersburg during winter. Pirogov systemically obtained full-size representations of more than 1,000 sections. A painter made a representative copy of the cross-sectional contours of each section, using ruled glass overlain on the sections. The final lithographs were of high artistic quality and execution, resembling modern high-resolution medical imaging (i.e., CT or MRI). Moreover, structures were serially sectioned and systematically illustrated along all three anatomical planes, something that had never previously been attempted. This allowed clinicians and anatomists to scrutinize the spatial relationships of structures from multiple perspectives and at a much more detailed level than was previously possible, although the cost, massiveness, and complexity of the completed work precluded wide dissemination.

Neuropathological images in the great pathology atlases.

In the period between Morgagni's De Sedibus (1761) and Cruveilhier's Anatomie pathologique (1829-1842), six pathology atlases were published, in which neuropathological subjects were discussed and depicted. It was a period of transition in medical, technical, and publishing areas. The first three (by Matthew Baillie, Robert Hooper, and Richard Bright) were mainly atlases derived from pathological museum specimens. They were selective rather than comprehensive. Of the other three (by Jean Cruveilhier, James Hope, and Robert Carswell), most of the observations were made during autopsies. These illustrations required special arrangements so they could be executed during the autopsies. These were available in Paris rather than in London, which is the reason why Hope and Carswell made many of the drawings in France. The plates in these three were color lithographs. Baillie's book contains only figure descriptions. Bright's and Cruveilhier's atlases provide case descriptions. Hooper and Hope provide theoretical texts and figure legends. Carswell's book has 12 theoretical sections, each followed by plates. The relative cost of the atlases varied with the number of plates. Although the authors made use of artists and engravers, several were talented artists themselves. Many common neurological diseases were depicted.

Raymond D. Adams and Joseph M. Foley: Elaborating the neurologic manifestations of hepatic encephalopathy (1949-1953).

This article compares and contrasts different versions of the pioneering work Raymond Adams and Joseph Foley concerning the neurological and neurophysiological manifestations of liver disease. These versions were presented by the protagonists in publications from 1949 to 1953, and later in various oral histories conducted separately from 1988 to 2014. The general framework of the various versions is fairly consistent, but numerous differences in the details emerged over time, some reflecting the vagaries of memory over periods as long as six decades (e.g., with fluctuations in the versions told by a single protagonist in different interviews, under different circumstances, and at different ages), others reflecting a form of egocentric recall bias (as, for example, when both of the protagonists recalled that they were responsible for a particular observation).

Clarence J. Gibbs Effect and the "Creutzfeldt-Jakob Disease" Eponym.

In 2014, American neurologist and Nobel laureate Stanley Prusiner reported that microbiologist Clarence Joseph Gibbs at the US NIH had intentionally, systematically, and mischievously used the eponym Creutzfeldt-Jakob disease, rather than Jakob-Creutzfeldt disease, because of the correspondence with Gibbs' own initials, to imply "Clarence Joseph disease." The present study examines temporal trends in the use of "Creutzfeldt-Jakob" and "Jakob-Creutzfeldt" in scientific articles and monographs from 1946 to 2019 to assess whether there was a "Clarence J. Gibbs effect" that influenced the general use of a specific eponym by the scientific community. During Gibbs' period of publication on Creutzfeldt-Jakob disease (CJD), there was an abrupt, dramatic, and steady increase in use of the CJD eponym while use of the Jakob-Creutzfeldt disease (JCD) eponym remained at a low level. In the period after Gibbs ceased to publish, there was a corresponding marked fall-off in use of the CJD eponym. Surviving collaborators thought Gibbs may have been joking, but in 1991 Gibbs had admitted what Prusiner reported. Regardless of motive, Gibbs strongly influenced the preferred eponym for this human prion disease by (1) publishing a seminal and highly referenced initial article in a high-profile journal; (2) sustained output of further important studies published in high-quality journals over more than 30 years; (3) professional affiliation with an esteemed national laboratory where he worked with a large number of high-profile colleagues; and (4) extensive collaborations with a large number of colleagues, who published multiple further articles using the eponym Gibbs preferred.

Western European influence on the development of Russian neurology and psychiatry, part 1: Western European tours of early Russian neurologists and psychiatrists.

Beginning in the 1860s, two major centers of neurology and psychiatry arose in Russia: Imperial Moscow University (IMU) and Imperial Medical and Surgical Academy in St. Petersburg (IMSA). Both centers were strongly influenced by Leading Western European schools and specialists, through the clinical and research training regimes of both Russian universities, strongly influenced these centers of learning. In this study, we elaborate the Western European training of the first Russian specialists in the fields of neurology and neuropsychiatry from IMU and IMSA during the period from the late 1850s to 1900. Although prior studies emphasized the influence of French mentors and institutions, the Western European tours of early Russian specialists often included multiple destinations in Germany, France, and Austria. The most commonly visited cities (in descending order) were Paris, Berlin, Leipsig, and Vienna. The most commonly visited training centers (in descending order) were Hoôpital Salpêtriêre (Paris), Friedrich-Wilhelms-Universität (Berlin), Charité (Berlin), Universität Leipzig, First Psychiatric Clinic (Vienna), and Hôpital Sainte-Anne (Paris). The most commonly visited mentors, in descending order, were Charcot (Paris), Flechsig (Leipzig), Westphal (Berlin), Meynert (Vienna), and Magnan (Paris). Training of Russian specialists in Western Europe facilitated the emergence and development of the neurological and psychiatric schools in Moscow and St. Petersburg.

Historical perspective: neurological advances from studies of war injuries and illnesses.

Early in the 20th century during the Russo-Japanese War and World War I (WWI), some of the most important, lasting contributions to clinical neurology were descriptive clinical studies, especially those concerning war-related peripheral nerve disorders (eg, Hoffmann-Tinel sign, Guillain-Barré-Strohl syndrome [GBS]) and occipital bullet wounds (eg, the retinal projection on the cortex by Inouye and later by Holmes and Lister, and the functional partitioning of visual processes in the occipital cortex by Riddoch), but there were also other important descriptive studies concerning war-related aphasia, cerebellar injuries, and spinal cord injuries (eg, cerebellar injuries by Holmes, and autonomic dysreflexia by Head and Riddoch). Later progress, during and shortly after World War II (WWII), included major progress in understanding the pathophysiology of traumatic brain injuries by Denny-Brown, Russell, and Holbourn, pioneering accident injury studies by Cairns and Holbourn, promulgation of helmets to prevent motorcycle injuries by Cairns, development of comprehensive multidisciplinary neurorehabilitation by Rusk, and development of spinal cord injury care by Munro, Guttman, and Bors. These studies and developments were possible only because of the large number of cases that allowed individual physicians the opportunity to collect, collate, and synthesize observations of numerous cases in a short span of time. Such studies also required dedicated, disciplined, and knowledgeable investigators who made the most out of their opportunities to systematically assess large numbers of seriously ill and injured soldiers under stressful and often overtly dangerous situations.

The assessment of Perkins' patent metallic "tractors": Abandonment of an 18th-century therapeutic fad following trials using sham instruments.

From 1799 to 1801, with the instigation of John Haygarth, physicians in England evaluated the claims of Elisha and Benjamin Perkins that their patented "metallic tractors" could cure a wide variety of disorders. Previous therapies were typically judged based on experience and authority, whereas Perkinism was evaluated using a series of clinical trials of varying methodological sophistication, most employing sham instruments (all but those involving infants or horses), with a variety of trial designs, inconsistent use of contemporary controls, and different approaches to blinding subjects to the treatment administered. Haygarth and his colleagues collectively demonstrated that tractors and sham instruments produced equivalent effects in adults, and, by inference, that the tractors had no special therapeutic properties. Other trials using only genuine tractors demonstrated no effects in infants and horses, subjects who could not reasonably be influenced by suggestion and the imagination. These collective results provided strong support for the rival hypothesis that the observed effects were due to suggestion and the imagination of the subjects. Despite fallacy-laden counterattacks and counterarguments from Benjamin Perkins and his supporters, the trials eroded support for this therapy and led to abandonment of the "Metallic Practice" as a treatment in Britain and elsewhere.

The development and evolution of "cerebral thermometry": Clinical applications of a nineteenth-century approach to cerebral localization and neurological diagnosis.

Surface thermometers were developed in the latter half of the nineteenth century. In 1877, Broca, already famous for his contributions to the cerebral localization of nonfluent aphasia, presented his first clinical observations on cranial surface temperatures: In two cases, cranial surface temperatures were decreased over a middle cerebral artery infarction, and increased in surrounding areas, which Broca attributed to "compensatory hyperaemia." As Broca made apparent in a later report in 1879, he had used a "thermometric crown," an apparatus consisting of six to eight large-reservoir mercury thermometers strapped against the head. Following Broca's report, American neurologists reported cases in which cranial surface temperatures were increased either locally over a superficial brain tumor or globally with a cerebral abscess. Despite promising anecdotal reports, contemporaries recognized that significant technical and practical problems limited its accuracy, reliability, and clinical utility. Advocates never demonstrated that this technology provided significant marginal benefit to the medical history and physical examination. The technique fell out of fashion before 1900, though some early advocates promoted it into the early twentieth century. It was ultimately replaced by more effective technologies for cerebral localization and neurological diagnosis.

The development and evolution of "cerebral thermometry": The physiology underlying a nineteenth-century approach to cerebral localization and neurological diagnosis.

Surface thermometers were developed in the latter half of the nineteenth century. From the 1850s through the 1880s, collaborations between physicians, research scientists, and instrument makers produced clear improvements in the technology to measure cranial surface temperatures, with development of self-registering mercury surface thermometers resistant to pressure and little influenced by ambient temperature, apparatus for recording cranial surface temperatures from multiple stations simultaneously, and development of thermoelectric apparatus. Physiologic studies of cranial surface thermometry were conducted over a quarter century from 1861 to 1886. Beginning in the 1860s Albers in Bonn, Germany, and Lombard at Harvard and later in England systematically investigated surface temperatures on the head using surface thermometers and thermoelectric apparatus; they demonstrated that head temperatures were variable over time and across individuals and were not clearly influenced by thinking or muscular contraction but were influenced by ambient air temperature. In 1880 Amidon in the United States claimed that cranial surface thermometry during exertion produced localized increases in surface temperature on the contralateral scalp in a specific pattern ("external motive areas") indicating underlying brain areas responsible for each movement. Amidon's results were not reproduced by experienced physiologists in England or France. Contemporaries recognized that significant technical and practical problems limited the accuracy and reliability of cranial surface thermometry. Physiological studies of cranial surface thermometry ended in the mid 1880s, although some clinicians who were early advocates promoted its use in clinical contexts into the early twentieth century.