Editorial
During his lifetime, Sir Henry Wellcome (1853–1936) made a great fortune selling practically everything from magic ink to the tabloid. An insatiable collector, he acquired more than 1.5 million items with which to form a museum relating to the history of medicine. Dr CJS Thompson was employed to acquire material and curate the Wellcome Historical Medical Museum. Anticipating that his estate would provide a surplus, over and above that needed to maintain the pharmaceutical business, Wellcome created a Trust that, in addition to ‘advancing research bearing on medicine conducive to the improvement of mankind’, empowered the Trustees to ‘establish a Museum or Library ... for conducting research connected with the history of medicine, surgery, chemistry, bacteriology, pharmacy and allied sciences’. In the second of two Brain essays on medicine and literature, Dr Stephen Jacyna from the Wellcome Trust Centre for the History of Medicine in London uses his background as an expert in the history of neurology in the late-nineteenth and early-twentieth century to review Nervous Acts: Essays on Literature, Culture and Sensibility by George Rousseau, The Doctor in Literature: Satisfaction or Resentment? by Solomon Posen, and Madame Bovary's Ovaries: A Darwinian Look at Literature, by David Barash and Nanelle Barash (page 2997). As an historian, Dr Jacyna is concerned with the additional sources of evidence from literature on attitudes of society to the physician, tracing accounts of ‘consumption’, ‘mental illness’ and ‘hysteria’ that raised these disorders out of the Petri dish and wards of the Salpêtrière to become metaphors for the human condition—‘the consciousness of a given era’—and, in turn, to consider how medical theory influenced literature. He traces historical roots for the modern concept that consciousness and identity are the outcome of the workings of the nervous system. In an earlier period, Renaissance artists had forced the development of a true anatomy by arguing that proper depiction of the outside configuration of the human body could only be accomplished through accurate knowledge of its internal structures. With his special interest in language and the brain, Stephen Jacyna selects, as examples, the accounts of aphasia from Emile Zola's Thérèse Raquin, and George Simenon's The Patient. Not even a witty title can save Madame Bovary's Ovaries from the critical pen of our reviewer: for Dr Jacyna, the attempt at an evolutionary taxonomy of literature makes for some mighty strange bedfellows, a far from convincing literary lineage, and some banal and gratuitously cheap conclusions.Amongst the papers on cerebral function in the current issue, Carlo Reverberi and colleagues from Pavia and Udine, Italy, test Chris Frith's suggestion that the prefrontal cortex sets responses to non-routine tasks, using the matchstick arithmetic task devised by Günter Knoblich (which normal people find rather tricky) in patients with frontal lesions: counter-intuitively, but in line with the theory, patients do much better than controls (page 2882). Daniel Tranel and collaborators from Iowa, United States (page 2872), follow-up an earlier hint that the right ventromedial prefrontal cortex determines social functioning and decision making, but only in men, with a formal assessment of gender-related lateralisation: again, men seem to use the right prefrontal hemisphere to make decisions, women the left. Rik Vandenberghe and a group from Leuven, Belgium (page 2843), show that patients with a tendency to neglect visual stimuli in the contralateral hemifield are more easily distracted by an irrelevant stimulus than other patients having lesions in the non-dominant parietal lobe, or controls: functionally distinct parietal regions are implicated in successfully managing to ignore these distractors, and those who cannot resist the paired stimulus tend to have lesions along the right horizontal intraparietal sulcus. How to find objects lost in a visual field defect is the aim of rehabilitation strategies described by Nadia Bolognini and colleagues from Bologna, Cesena and Ancona, Italy (page 2830): after training patients to locate a visual stimulus by linking this to an auditory cue having varying degrees of spatial and temporal symmetry with the visual target, in 4 h daily sessions for 2 weeks, there was a progressive improvement in visual search and this proved useful and stable for activities of daily living over one month. Amongst three papers on multiple sclerosis, Philippe Cabre and investigators from the French West Indies provide evidence supporting the hypothesis that environmental factors determine the frequency and phenotype of multiple sclerosis (page 2899): compared with expected numbers, there is an excess of cases amongst West Indians who have lived for a time in France and then returned to Martinique and Guadeloupe, especially if residence abroad is before the age of 15 years, and irrespective of ancestry; furthermore, the clinical features differ markedly from the usual pattern of recurrent neuromyelitis optica, seen invariably in the non-migrant population but in only 18% of those returning from western Europe. Although not an environmental hazard for the academics of Newcastle-upon-Tyne, Surisak Prasarnpun and the group of John Harris describe the molecular pathology of neuromuscular blockade by the krait venom, ß-bungaratoxin, in the rat as nerve terminals are systematically denervated over the 12 hours after envenomation, and with regeneration complete by 7 days: comparisons are made with the human experience in south-east Asia (page 2987).
We publish four papers that inform the study of cell-based therapies for neurological disease. On behalf of colleagues from Lund (Sweden), Marburg (Germany), and Imperial College and the Institute of Neurology (London), Paola Piccini brings up-to-date an analysis of prognostic features in cases treated by embryonic mesencephalic cell implantation (page 2786): an adverse outcome is associated with selective reduction in 18Fluoro-dopa activity outside the grafted areas; patients tolerate withdrawal of immunosuppression 2.5 years after transplantation but, whereas post-surgical dyskinesias appear not to be associated with abnormal dopamine release-identified by 18Fluoro-dopa uptake and metamphetamine-induced 11C-raclopride binding-these cases show more involuntary movements. In the 6-hydroxydopa toxicity model of Parkinson's disease, Saga Johansson and investigators from the Karolinska Insititute in Stockholm, Sweden (page 2961), use a cocktail of olfactory ensheathing cells and mesencephalic tissue to show enhanced dopamine cell survival, improved striatal connectivity and reinnervation in the substantia nigra compared with the ventral tegmentum, and functional recovery of amphetamine- and apomorphine-induced rotation, compared with embryonic mesencephalic cells alone. On (page 2951), we publish a preliminary description of the first human cell implantation studies designed to improve outcome after spinal cord injury using autologous olfactory bulb ensheathing cells (see cover): Francois Fèron and colleagues from Griffith University and Woolloongabba, Australia, describe the procedure, and radiological outcome, safety and adverse effects, and neurological status at 1 year in a single-blind Phase 1 study due to last 3 years. These studies bring closer the hopes of many who have suffered spinal cord injury and damage from other causes. If the social and personal ramifications of these events are far-reaching so, too, are the structural and functional consequences. Steven Cramer and a team from University of California, Irvine, (page 2941) challenge the assumption that people with spinal cord injury have normal brain function: compared with controls, cases who attempt to wiggle their foot, or imagine such movements, showed smaller areas but with abnormal patterns of brain activation in the motor system, and less modulation in the context of real compared with perceived movements; thus, strategies for restoring structure and function after spinal cord injury should not ignore the brain. The clinical neuroscience of spinal cord injury was ‘advantaged’ by observations made in the two World Wars of the 20th century (see Brain 2004; 1237: 2150). These studies marked the culmination of observations made earlier in civilian life. In From the Archives, we review the series of cases described by James Collier who, with H Charlton Bastian, considered that the completely isolated but intact spinal cord never regains muscle tone and reflex activity (Collier J. The effects of total transverse lesion of the spinal cord in man. Brain 1904; 27: 38–63).
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