History of neurology 1536547 221057370 2008-06-22T21:38:57Z DOI bot 6652755 Citation maintenance. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. The study of [[neurology]] dates back to prehistoric times, but the academic discipline did not begin until the [[16th century]]. From an observational science it developed a systematic way of approaching the nervous system and possible interventions in neurological disease. ==Early history== [[Image:Galen-Pig-Vivisection.jpg|thumb|right|Galen demonstrating the recurrent laryngeal nerves in public]] An [[ancient Egyptian]] treatise concerning [[Physical trauma|trauma]] surgery, the [[Edwin Smith papyrus]], contains descriptions and suggests treatments for various injuries, including some of neurological nature. Specifically, there are descriptions of the [[meninges]], the external surface of the [[brain]], the [[cerebrospinal fluid]] and the [[intracranial pulsations]]<ref name="wilkins">Wilkins, 1964</ref>. Not only are these neurological features mentioned, but it is also noticed that some bodily functions can be impaired by brain injuries or injuries to the cervical spine<ref name="wilkins"/>. There are many other examples of observations of neurological phenomena throughout history. The [[Sumer]]ians illustrated [[paraplegia]] caused by physical trauma in a [[bas relief]] of a lion with an arrow in its back{{Fact|date=April 2008}}. Neurological disorders not caused by physical disorder were also investigated. For example in the medicine of the [[Vedic period]] of ancient India, the Ayurvedic text [[Charaka Samhita]] discusses [[epilepsy]], with a discussion of both symptoms and of possible treatments. Slightly later, the [[ancient Greek]] physician [[Hippocrates]] was convinced that [[epilepsy]] has a natural cause, not a sacred one<ref name="who">World Health Organization, Fact Sheet #168</ref>. The ancient Greeks also dissected the nervous system. For example, [[Aristotle]] (although he misunderstood the function of the brain) describes the meninges and also distinguishes between the [[Telencephalon|cerebrum]] and the [[cerebellum]]<ref>von Staden, p.157</ref>. Slightly later, in Rome, [[Galen]] performed many dissections of the [[nervous system]] in a variety of species, including the ape. One particular discovery he made was of the importance of the [[recurrent laryngeal nerve]]s. Originally, he cut through them accidentally while performing an experiment on the nerves that control breathing by [[vivisection]] of a strapped-down, squealing pig. The pig immediately stopped squealing, but continued struggling. Galen then performed the same experiment on a variety of animals, including dogs, goats, bears, lions, cows and monkeys, finding similar results each time. Finally, to publicise this new result, Galen demonstrated the experiment on a pair of pigs to a large audience in Rome, telling them: "there is a hairlike pair [of nerves] in the muscles of the larynx on both left and right, which if ligated or cut render the animal speechless without damaging either its life or functional activity"<ref>Gross, 1998</ref>. ==Anatomy and physiology== Along with most other sciences, the first real advances in neurology after the Greeks occur in the [[renaissance]]. The invention of the printing press allowed the publication of anatomical textbooks, allowing the dissemination of knowledge. An early example is [[Johann Peyligk]]'s ''Compendium philosophiae naturalis'', published in [[Leipzig]], [[Germany]] in [[1499]]. This work contained 11 woodcuts, depicting the [[dura mater]] and [[pia mater]] as well as the [[Ventricular system|ventricles]]<ref name="tessman">Tessman & Suarez, 2002</ref>. A revolution took place in both neurology in particular and in anatomy in general when [[Vesalius|Andreas Vesalius]] published his ''[[De humani corporis fabrica]]'' in [[1543]]. It includes detailed images depicting the ventricles, [[cranial nerves]], [[pituitary gland]], meninges, structures of the [[eye]], the vascular supply to the brain and spinal cord, and an image of the peripheral nerves<ref name="tessman"/>. Vesalius also exposed the non-existence structures that had been believed to be in the brain since Galen's (revered) work, such as the ''[[rete mirabile]]''. Galen's dissections were all on animals - in particular, the ''rete mirabile'' is only well developed in [[ungulates]]<ref>Singer 1956</ref>. Vesalius, unlike many of his contemporaries, did not subscribe to the then common belief that the ventricles were responsible for brain function, arguing that many animals have similar systems of ventricles to those of humans, but had no true intelligence<ref>Gross 1998, p. 38</ref>. It appears that he rarely removed the brain from the [[skull]] before cutting it, most of his diagrams showing the brain sitting inside a severed head<ref>See the scanned copy at [http://archive.nlm.nih.gov/proj/ttp/vesaliusgallery.htm]</ref>. [[Thomas Willis]] in [[1664]], published his Anatomy of the Brain, followed by Cerebral Pathology in [[1676]]. He removed the brain from the [[cranium]], and was able to describe it more clearly, setting forth the [[circle of Willis]] – the circle of vessels that enables arterial supply of the brain. He had some notions as to brain function, including a vague idea as to localization and [[reflex]]es, and described epilepsy, [[apoplexy]] and [[paralysis]]. As already mentioned, he used the word neurology. A beginning of the understanding of disease came with the first morbid anatomists, morbid anatomical illustration, and the development of effective colour printing. [[Matthew Baillie]] (1761-1823) and [[Jean Cruveilher]] (1791-1874) illustrated the lesions in [[stroke]], in [[1799]] and [[1829]] respectively. ==Microscopy== Only when cells were identified microscopically was it possible to progress beyond the crudest anatomical notion. [[Jan Evangelista Purkyně|J.E. Purkinje]] (1787-1869) in [[1837]] gave the first description of [[neuron]]es, indeed a very early description of [[Cell (biology)|cell]]s of any kind. Later [[Golgi]] and [[Santiago Ramón y Cajal|Cajal]] stained the ramifying branches of nerve cells; these could only touch, or [[synapse]]. The brain now had demonstrated form, without localised function. The famous philosopher [[René Descartes]] (1596-1650) speculated that every activity of an animal was a necessary reaction to some external stimulus; the connection between the stimulus and the response was made through a definite nervous path. [[Luigi Galvani]] (1737-1798) demonstrated that electrical stimulation of nerve produced muscle contraction, and the competing work of [[Charles Bell]] (1774-1842) and [[Francois Magendie]] (1783-1855 ) led to the view that the [[ventral horn]]s of the [[spinal cord]] were [[motor neuron|motor]] and the [[dorsal horn]]s [[sensory neuron|sensory]]. A [[hemiplegic]] patient who could not speak led [[Paul Broca]] (1824-1880) to the view that functions in the [[cerebral cortex]] were anatomically localised. [[Ivan Pavlov]] (1849- 1936) realised as his dogs dribbled that a [[reflex action|simple reflex]] could be modified by [[higher brain functions]]. These neurological ideas were coordinated and integrated by the neurophysiologist [[C.S. Sherrington]] (1857-1952). ==Diagnostics== Doctors could use the ideas of neurology in practice only if they developed proper tools and procedures for clinical investigation. This happened step by step in the [[nineteenth century]] -- [[tendon hammer]], [[ophthalmoscope]], pin and [[tuning fork]], [[syringe]] and [[lumbar puncture]]. [[X rays]], the [[electro-encephalography]], [[angiography]], and [[CAT scan]]s were to follow. The clinical neurologists correlated their findings after death with those of the [[neuropathologist]]. The best known was [[William Richard Gowers|W.R. Gowers]] (1845-1915) who owned a major text in two volumes, of a [[cerebrospinal tract]]. By the end of the nineteenth century, the connection was established between stroke and hemiplegia, between [[Physical trauma|trauma]] and paraplegia, between the [[spirochaete]] and the paralysed [[demented|demency]] people who filled the [[mental hospital]]s. The first chemotherapeutic cure of a serious infection was [[Arsphenamine|salvarsan]] for [[syphilis]], followed by the induction of [[fever]] in [[neurosyphilis]]. The treatment of neurosyphilis became highly effective when [[antibiotic]]s were introduced. ==Neurosurgery== In [[1878]], [[William McEwen]] (1848-1924) removed a [[meningioma]], and the patient survived for many years. The first Englishman who did it was [[Victor Horsley]] (1857- 1916) five years later. The Americans did it even later, the surgeon was [[Harvey Cushing]] ( 1869-1939). Cushing in 1909 successfully removed a [[pituitary adenoma]] from an [[acromegalic]]. Treating [[endocrine]] hyperfunction by [[neurosurgery]] was a major neurological landmark. [[Egas Moniz]] (1874-1955) in Portugal developed [[Psychosurgery|neurosurgical treatment]] of severe [[psychiatric disorder]]. (Though it is often said that the development of lobotomy was inspired by the case of [[Phineas Gage]], a railroad worker who had an iron bar driven through his frontal lobe(s) in 1848, the evidence is against this.) ==References== <references/> ==Bibliography== *{{cite book | last=Gross | first=Charles G. | title=Brain, Vision, Memory: Tales in the History of Neuroscience | origyear=1998 | publisher=MIT Press | isbn=0-262-57135-8 }} *{{cite journal | last = Gross | first = Charles G. | year = 1998 | title = Galen and the Squealing Pig | journal = Neuroscientist | volume = 4 | issue = 3 | pages = 216–221 | publisher = SAGE publications | doi = 10.1177/107385849800400317 | url = http://nro.sagepub.com/cgi/content/refs/4/3/216 | accessdate = 2008-04-08 }} *{{cite journal | last = Singer | first = Charles | year = 1956 | title = Brain Dissection Before Vesalius | journal = Journal of the History of Medicine and Allied Sciences | volume = 11 | issue = 3 | pages = 261–274 | publisher = Oxford Journals | doi = 10.1093/jhmas/XI.3.261 | url = http://jhmas.oxfordjournals.org/cgi/reprint/XI/3/261 | accessdate = 2008-04-10 | pmid = 13346072 }} *{{cite book |last=von Staden |first=Heinrich |title=Herophilus: The Art of Medicine in Early Alexandria |origyear=1989 |publisher=Cambridge University Press |isbn=0-521-23646-0 }} *{{cite journal | author = Tessman, Patrick A. | coauthor = Suarez, Jose I. | date = 2002 | title = Neurosurgical Classic - XVII Edwin Smith Surgical Papyrus | journal = Archives of Neurology | volume = 59 | issue = 12 | pages = 1964–1969 | url = http://archneur.ama-assn.org/cgi/content/extract/59/12/1964 | accessdate = 2008-04-09 | pmid = 12470188 | doi = 10.1001/archneur.59.12.1964 }} *{{cite journal | author = Wilkins, Robert H. | date = March, 1964 | title = Neurosurgical Classic - XVII Edwin Smith Surgical Papyrus | journal = Journal of Neurosurgery | pages = 240–244 | url = http://www.neurosurgery.org/cybermuseum/pre20th/epapyrus.html (Reprint) | accessdate = 2008-04-07 }} *{{cite web | title = Fact sheet #168: Epilepsy: historical overview | work = WHO Fact Sheets | publisher = World Health Organization | accessdate = 2008-04-07 | url = http://www.who.int/mediacentre/factsheets/fs168/en/ }} {{Refimprove|date=April 2008}} [[Category:Neurology]] [[Category:History of medicine]] [[fr:Histoire de la neurologie]]