1.1. What is neurology?
1.2. History of neurology
2.1. How neurosurgery began
2.2. First scientific knowledge
2.2.1. The case of Phineas Gage
2.2.3. Qui, non, trois, toujours
2.3. Clinical brain surgery
3.1. History of psychiatry
3.2. “Moral treatment”
3.3. “Alienists” vs. neurologists
3.4. The Fascination of psychiatry
People have always been interested in the human brain and mind. In the past, mental illness was considered a disease of personal or spiritual failing. Lunatics were regarded as incurable, subhuman creatures, more animal than humanlike. They were thought to be possessed by evil spirits, under the spell of witchcraft or simply influenced by the moon. The mentally ill were despised and feared by society. Therefore, they were locked in almshouses or prisons. This catastrophic situation began to change at the beginning of 19th century when mapping of the functional areas of the brain first began and understanding of the causes of conditions such as epilepsy improved. Basic knowledge of the brain and nervous functions came mainly from studies of animals, neurosurgery, post-mortem examinations and the analysis of human nerve cells under the microscope. However, in many cases, physicians used drugs as well as torture-like treatments such as electroshock therapy, insulin shock therapy (which induced comas in patients by the injection of insulin), Metrazol (induced seizures), hydrotherapy (such as the wet sheet pack, the continuous bath), fever therapy and lobotomy. Professionals hoped that these largely experimental treatments would help the mentally ill patient.
Moreover, many new inventions like the development of electroencephalography (EEG) helped to diagnose neurological diseases such as tumors and infections. Besides, numberless works of important neuroscientists such as Paul Pierre Broca or Karl Wernicke helped to show that areas of the brain have specific functions. Neurotransmitters were discovered and investigated by many scientists, including for example Otto Loewi. Later techniques, such as brain imaging allowed scientists to study the brain in living humans and animals in ways that their predecessors could not.
1.1. What is neurology?
Neurology is a branch of medicine concerned with the diagnosis and treatment of disorders of the nervous system. It is unique among medical specialities in its intersection with psychiatry.
Neurological disorders are disorders of the central nervous system (brain, brainstem and cerebellum), the peripheral nervous system and the autonomic nervous system. Major conditions include:
- dementia such as Alzheimer's disease
- stupor and coma
- movement disorders such as Parkinson's disease
- seizures and epilepsy
- sleep disorders
- cerebral palsy
- demyelinating diseases such as multiple sclerosis
- spinal cord disorders
- disorders of peripheral nerves, muscle and neuromuscular junctions
Many mental illnesses are believed to be neurological disorders of the central nervous system. However, they are classified separately. They are not traditionally listed as neurological diseases because their causes are not definitely determined as biological, although there are good reasons to suspect that for instance schizophrenia has neuro-chemical causes.
1.2. History of neurology
The first scientific studies of nerve function were done in the 18th century. Neurology started with the Swiss scientist Albrecht von Haller who published in the 1760’s an eight-volume textbook about human physiology. Haller ascertained for instance that muscles are sensitive. Haller’s examinations were continued by the German physician Franz Joseph Gall who gave lectures on human physiology since 1796. Gall proved that nerves not only lead to the brain but to a “grey substance” on the surface of the brain. Moreover, he supported the idea of Haller that specific parts of the brain control specific parts of the body. He was of the extreme opinion that certain parts of the brain would not only be responsible for certain sensory perceptions and muscle movements but for all possible emotions and character traits. This belief was developed by his followers into the absurd pseudo-science of phrenology.
Phrenology is an old object of study. Even the Greek scientist Aristotle tried to locate faculties of personality within the human head. Moreover, the study of the face, the so called physiognomony, was studied by the Swiss priest and author Johann Kaspar Lavater. However, Franz Joseph Gall created the statements on which phrenology was built. He was one of the first to believe that the brain is the home of all mental activities. The basic statements of Gall's doctrine were:
1. The brain is the organ of the mind.
2. The mind is composed of multiple distinct, innate faculties.
3. Because they are distinct, each faculty must have a separate seat or "organ" in the brain.
4. The size of an organ, other things being equal, is a measure of its power.
5. The shape of the brain is determined by the development of the various organs.
6. As the skull takes its shape from the brain, the surface of the skull can be read as an accurate index of psychological aptitudes and tendencies.
One of Gall’s most important supporters was Johann Spurzheim, who coined the expression phrenology. Besides, Spurzheim successfully disseminated the pseudo-science of phrenology in Great Britain as well as in the United States of America. Other essential collaborators of Gall were the Scottish brothers George and Andrew Combe and the American brothers Lorenzo Niles and Orson Squire Fowler. Especially in the middle of 19th century, phrenology was very popular. Many people went to a practical phrenologist to get advice in nearly all matters of life. However, the theory of phrenology never achieved the status of an accredited science.
Nevertheless, neurology remained virgin territory until the mid 19th century when mapping of the functional areas of the brain first began and understanding of the causes of conditions such as epilepsy improved. Basic knowledge of the brain and nervous functions came mainly from studies of animals, neurosurgery, post-mortem examinations and the analysis of human nerve cells under the microscope. Moreover, many new inventions like the development of electroencephalography (EEG) helped to diagnose neurological diseases such as tumors and infections. Electroencephalography is a technique to measure and record electrical activity in the brain by means of electrodes on the scalp. The electrodes transmit signals to a machine called electroencephalograph, which records them as peaks and troughs on an electroencephalogram (EEG). The electroencephalograph was invented in the 1920s by the German psychiatrist Hans Berger. It was and still is today an important machine to diagnose neurological disorders, especially epilepsy.
The 19th century was a time of considerable optimism for neurologists. They used post-mortem and microscopic techniques to make clinical correlations between neurological syndromes and neuropathologic changes. Notable progress was made at the London school (focused at University College and the National Hospital at Queen Square), the Paris school (at the Salpetrière) and the North American school, which was focused at Harvard, the University of Pennsylvania and Columbia-Presbyterian Hospital.
In 1817, the English physician James Parkinson published his famous work “Essay on the Shaking Palsy”, a description of the disease which is today known as Parkinson's disease. He studied patients who were disabled by difficulties with walking and posture associated with tremulousness. Parkinson was also interested in improving the general health of the population. Therefore, he wrote several medical doctrines which exposed a similar zeal for the health and welfare of the people that was expressed by his political activism. Moreover, he was a crusader for legal protection for the mentally ill, as well as their physicians and families. Other physicians in London focused on epilepsy and a variety of other neurological disorders as described by W.R. Gowers “Handbook of clinical neurology”, which was published in 1888.
In France, Jean Martin Charcot and his group at the Salpetrière made descriptions of multiple sclerosis as well as spinal cord and nerve disorders. Charcot’s colleague Georges Gilles de la Tourette described in 1885 the “maladie des tics”, which is today known as the Tourette syndrome. This neurological disease is characterized by spontaneous movements, so called tics, and sudden sounds such as puffing or spitting. Charcot himself distinguished two syndromes characterized by tics. One he considered to be “degenerate”, meaning a brain that was structurally and functionally abnormal and incapable of full neural functioning. The other form he associated with hysteria. Charcot believed that hypnosis was capable of separating the two syndromic disorders.
 retrieved from: http://en.wikipedia.org/wiki/neurology (07.09.2004)
 see also image 1
 Retrieved from http://pages.britishlibrary.net/phrenology/overview.htm
 Retrieved from: http://en.wikipedia.org/wiki/James_Parkinson (07.09.2004)
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