Brain Vol. 127 No. 10 © Guarantors of Brain 2004; all rights reserved
Editorial |
Editorial
In ‘Wherefore to explicate the uses of the brain’ (page 2373), William Feindel reviews ‘Soul Made Flesh: the Discovery of the Brain—and How It Changed the World’ by Carl Zimmer. This is an account of that astonishing period in the late 17th century when neuroscience moved from the theoretical to the empirical, and the word neurology was coined. It is the story of Thomas Willis. Languishing for over two centuries in the doldrums of a second class reputation, based on the waspish contemporary opinion of Anthony Wood, Willis was rehabilitated first by Sir Charles Sherrington, and then (in the 1960s) by Sir Charles Symonds and Dr Feindel—the doyen of Willis scholars in the modern generation. He provides a modern synthesis of who did what in the circle around Willis, supplemented by an important list of secondary sources. After Willis, neurology makes scant progress until the period of renewed creativity at the beginning of the 19th century. But the science of the late 17th century clearly did not go unnoticed. In her review of ‘Flesh in the Age of Reason’ by the late Roy Porter, the writer (and unashamed admirer of Roy Porter) Valerie Grosvenor Myer considers changing views on the nature of ‘soul’ beyond Willis and into the 18th century (page 2378). With Porter, she traces the subtle shift away from the spiritual and towards the physical formulation of ‘soul’ and ‘mind’, as writers and other architects of contemporary thought gradually re-shaped the views of society leaving the doctor not the clergyman routinely at the bedside of the dying by the end of the 18th century.Disorders of the brain, nerve and muscle, occurring as remote effects of cancer, have been recognized since the 1960s. Many syndromes are now described and, in most, details of the immuno-pathogenesis are largely elucidated. However, in the clinical setting, finding the tumour may not be so easy. Samia Younes-Mhenni and colleagues from Lyon (page 2331) add precision to the anecdotal evidence that PET may identify reticent tumours responsible for paraneoplastic disorders. [18F]fluorodeoxyglucose (18FDG)-PET directed investigators to a tumour in 18 out of 20 cases, leading to histological confirmation in 14. However, although sensitive, 18FDG-PET lacks specificity, showing uptake in several areas evidently not containing malignant tissue. Maurizio Pocchiari, writing on behalf of collaborators responsible for 10 regional registries of human transmissible spongiform encephalopathy, mostly in western Europe, correlates survival in 2304 sporadic and additional iatrogenic, new variant and prion gene mutation forms of the disease (page 2348). They describe clinical and laboratory biomarkers associated with improved survival that may prove invaluable in comparing future therapies against population-based natural history survival data.
It is a paradox that war contributes disproportionately to our knowledge of order and disorder in the nervous system. Silas Weir Mitchell's ‘Injuries of nerves and their consequences’ (1872), Tatsuji Inouye's ‘Visual disturbances following gunshot wounds of the cortical visual area’ (1909; 2000 in English), Walter Poppelreuter's ‘Disturbances of lower and higher visual capacities caused by occipital damage’ (1917; 1990 in English) and Alexander Luria's ‘Traumatic aphasia’ (1947; 1970 in English) were based on accounts of injuries sustained during the American Civil War, the Russo-Japanese War, and the First and Second World Wars, respectively. Others wrote scientific articles on the medical experiences of these and other conflicts—notably, the studies of Sir Gordon Holmes on wounds of the cerebral hemispheres and cerebellum published in this journal following the Great War.
This issue contains three papers describing the neurophysiological consequences of spinal cord injury. Janell Beres-Jones and Susan Harkema (page 2232) characterize the ability of the spinal cord to interpret afferent signals of stepping and generate electromyographic activity in the muscles of walking. Volker Dietz and Roland Müller (page 2221) show that the electromyographic response to passive stepping exhausts more easily in individuals with chronic spinal cord injury (up to 33 years) due to failure of sustained activity in intra-spinal circuits. Since the pattern cannot be recovered by training, it is important to maintain rehabilitation therapy so as not to lose the possible benefit from application of biological methods for spinal cord regeneration, once these become available. Monica Gorassini and colleagues (page 2247) use indirect methods to measure the voltage-dependent persistent inward calcium currents that amplify spinal cord synaptic inputs and drive motoneurons, to show that slow spontaneous firing associated with muscle spasms recruits motor units and so, presumably, maintains some potential for restoration of voluntary activity. In each of these accounts, the spinal cord injuries were sustained during civilian life. In 1917, we published an article by Henry Head and George Riddoch on the automatic bladder and reflex autonomic features associated with gross injuries of the spinal cord. The same issue contained (spread over 138 pages) the classic account of reflex functions in the partially injured and transected spinal cord resulting from high-velocity rifle or shrapnel injuries in previously healthy young adults. A historical look at Riddoch's account follows in ‘From the archives’ (see next page).
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