The world of neurology began the decade 1910-1919 optimistically, in the conviction of the primacy of science. It ended the decade discouraged and uncertain. In between it participated in a war unparalleled in futility.
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Wassily Kandinsky, Untitled (1911)
Kandinsky's paintings matched his writings on the spiritual aspects of modern art. This watercolor, often considered the first completely abstract painting, expresses the daring and confidence of the golden age of modernism. The avant garde opened new vistas in art, music, science and medicine. Pencil, watercolor and India ink, 49.6 x 64.8 cm. Inscription on verso: Watercolor, 1911. Musee National d'Art Moderne, Centre Georges Pompidou, Paris. |
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In the beginning of the decade, amid studies of neurosyphilis and brain tumors, the American Neurological Association engaged in a contentious debate about the place of Freudian psychoanalysis in the practice of neurology. As practical physicians, many neurologists found the time required for couch therapy onerous. Harvey Cushing, Ramsay Hunt, Bernard Sachs, Foster Kennedy and Charles Dana presented important papers at nearly every annual meeting of the ANA.
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Title page of the 1910 edition of the Transactions
of the American Neurological Association
The concentration of neurologists in Boston, New York, Philadelphia and Cincinnati was reflected in the officers of the ANA. At the Washington meeting, Harvey Cushing spoke on eye signs in patients with brain tumors, James J. Putnam presented his personal experiences as a practitioner of Freudian psychoanalysis, and Charles K. Mills discussed his cases of spinal cord tumors. Dementia praecox was the subject of three presentations, and Burt G. Wilder described a man with average intelligence whose brain was half the normal size. |
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William Osler, Adolph Meyer and James Jackson Putnam graced the masthead of the Journal of Nervous and Mental Disease, joining Transactions of the American Neurological Association as two official organs of the ANA. Clinical, pathological and methodological studies were to be found in the pages of the international journals Brain, Revue Neurologique and the Archiv für Psychiatire und Nervenkrankenheiten. In 1912, S.A. Kinnier Wilson published his classical description of hepatolenticular degeneration. As the cataclysm approached, Robert Barany was awarded the 1914 Nobel Prize for physiology or medicine for his work on the vestibular system.
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Wilson's Disease
The entire March 1912 issue of Brain was devoted to S. A. Kinnier Wilson's description of familial hepatolenticular degeneration. On the left is one of Wilson's original patients, demonstrating the characteristic posture of the arms and hands and fixed facial features with involuntary mouth opening. On the right is the cut brain of one of Wilson's patients, showing bilateral degeneration of the lenticular nuclei. |
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As the American Civil War had provided Silas Weir Mitchell with a rich source of patients with nerve injury, so the outbreak of hostilities in August 1914 gave neurologists an unmatched, if unwanted, research opportunity. Technological advances in the treatment of shock and the prevention of infection meant that many more people survived war wounds. Neurologists made use of this gruesome natural experiment to learn the impact that bullets, bombs and shrapnel had on the human nervous system, including wounds of the cerebellum and spinal cord. Trench warfare also generated a large number of soldiers with unexplained tremor, blindness, and paraplegia, known collectively as shell shock. Debating the neurology of shell shock, some members of the ANA claimed that it is the "neurology of degeneracy", caused by pre-existing psychological inadequacy. Other more sensitive members observed that shell shock was induced by experiences of unimaginable horror, that it could occur in anyone, and that its origin lay in the psychological conflict between the sense of duty and the instinct for self-preservation.
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World War I
The world marched proudly into war in August 1914, each side sure of quick and glorious victory. Sadly, technological advances had outstripped tactical innovation, leading to trenches, machine guns and artillery. The world's confidence and optimism perished in the mud, along with the youth of Europe. On the left, German soldiers dig a trench in the Ardennes. On the right is Ypres, 1917. |
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Twenty-nine members of the ANA were commissioned in the armed services in World War I, and the U.S. Army created a division of neurology and psychiatry, headed by Pearce Bailey, to supervise the examination of recruits and the rehabilitation of the wounded. Henry Head, in an address delivered three days after the armistice, recalled the oppressive horror of the previous four years. He observed that the cataclysmic events of the war had shaken the younger generation's belief in the pervasive positivism of the old order. Saying that the charm of neurology lies in the way it forces us into daily contact with principles, he called for an end to the obsessive study of static anatomical and topographical detail and a return to the neurophysiological principles of Sherrington and Hughlings Jackson.
Encephalitis lethargica spread from its outbreak in Vienna in 1917 to engulf the world, leaving in its wake post-encephalitic parkinsonism. Hard on the heels of encephalitis lethargica, influenza struck the malnourished and fractured world in 1919, killing 20 million people, twice as many as had perished in the war. Post-war neurology considered the topics of racial hygiene and constitutional criminality, topics, which were soon to be used to justify atrocity and annihilation. Behind it all, the greatest scientific minds of the century explored the physics of the atom and the universe.
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Epidemic Encephalitis and Encephalitis Lethargica
Even as the war reached it's bloody conclusion, a strange new illness arose in Eastern Europe. The sleeping sickness, encephalitis lethargica, spread around the globe, and its complications attracted the interest of neurologists. Von Economo wrote in 1918: It seems strange when sleep appears as a symptom of an illness. "Sleeping sickness", where people fall asleep while eating or working was first described in two cases in our clinic inVienna in 1916. Usually headache, nausea and fever were followed, often within one day, by sleeping that frequently occurred in the most uncomfortable positions." Photograph (left) from Barcelona clinic of L. Barraquer Ferré (c. 1930). Among the late sequelae, post-encephalitic parkinsonism was particularly common. Von Economo wrote, "the amyostatic-akinetic form…characterized by a rigidity, without a real palsy and without symptoms arising from the pyramidal tract….To look at these patients one would suppose them to be a state of profound secondary dementia. Emotions are scarcely noticeable in the face, but they are mentally intact." Photograph (right) from Barcelona clinic of L. Barraquer Ferré (c. 1919). |
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