HISTORY OF NEUROLOGY

DR. PIYUSH OJHADM RESIDENT

DEPARTMENT OF NEUROLOGYGOVT MEDICAL COLLEGE, KOTA

• Edwin Smith papyrus(1700 B.C)-ancient Egyptian treatise concerning trauma surgery.

• Contains descriptions and suggests treatments for various injuries, including neurological.

• Descriptions of meninges, external surface of brain, cerebrospinal fluid and intracranial pulsations.

• Also noticed that some bodily functions can be impaired by brain injuries or injuries to cervical spine.

• Sumerians(4000 B.C) –observed paraplegia caused by physical trauma in bas relief of lion with arrow in back.

• The literature of medicine of Vedic period of ancient India, Charaka Samhita discussed epilepsy - both symptoms and of possible treatments- etiology (? Sacred).

• Later Hippocrates, 4th Century B.C., stated that epilepsy has a natural cause, not a sacred one. He also suggested that Brain is a seat of mental processes and functioned by distributing air to different parts of body(a.k.a. Neurotransmission)

• Aristotle in his work De motu animalium, 4th Century B.C., described meninges and distinguished between cerebrum and cerebellum. Brain acts as a radiator for cooling of blood overheated by seething heart.

• Galen-Founder of NEUROANATOMY.• Performed various dissection experiments on animals.• Showed that "there is a hair like pair [recurrent laryngeal

nerves] in muscles of larynx on both left and right, which if ligated or cut render animal speechless without damaging either its life or functional activity”.

• Galen's Hypothesis:1. Cerebrum receives sensations,2. Cerebellum controls movements3. The ventricles hypothesis.• Limitation-reliance on animal studies.

Galen demonstrating the Recurrent laryngeal nerves in public on pig

Neuroanatomy according to Galen

Renaissance Period• Andreas Vesalius- published his work De humani corporis

fabrica in 1543 containing 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

• Brain was made up of seven pairs of 'brain nerves', each with a specialized function.

• Exposed non-existence structures that had been believed to be in the brain since Galen's work, such as the rete mirabile mostly see in in ungulates.

• Did not subscribe to the then common belief that ventricles were responsible for brain function, arguing that many animals have similar systems of ventricles to those of humans, but had no true intelligence.

One of Leonardo Da Vinci's sketches of the human skull

• Leonardo da Vinci(1504) produced wax cast of human ventricles.

• Thomas Willis(1664)-described in great detail structure of brainstem, cerebellum, ventricles and cerebral hemispheres, circle of Willis.

• Also described epilepsy, apoplexy and paralysis.

• René Descartes(1648) proposed theory of dualism to tackle issue of brain's relation to mind.

• He suggested that pineal gland was where mind interacted with body after recording brain mechanisms responsible for circulating cerebrospinal fluid.

• 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.

• Steven Hales(1730) and Robert Whytt(1755) first demonstrated spinal segmental reflex action.

• Felice Fontana(1755) and J Aldini described responses to electrical stimulation in animals and decapitated criminals.

• Johann Unser(1777) introduced first use of word “reflex”.

• Benjamin Franklin(1751) published “Experiments and Observations on Electricity”

• New understanding of electrical phenomenon• Galvani & du Bois-Reymond (1800s) demonstrated1)Electrical stimulation of nerves twitches muscles2) Brain itself can generate electricity• Unidirectional Hypothesis (1810, Bell & Magendie)

ventral roots are motor and dorsal roots carry sensory information.

17th century neurophysiology18th century neurophysiology

• Samuel von Summerring (1778) demonstrated all 12 cranial nerves.

• Francesco Gennari and Felix Vicq d’ Azyr(1782) demonstrated laminar structure of cortex and details of internal brain structure by alcohol fixation of brain allowing recognition of most details of gross brain and peripheral nerves anatomy.

• Domenico Cartugno (1764) discovered spinal fluid.

• J.E. Purkinje in 1837 gave first description of neurones, indeed a very early description of cells of any kind.

• Matthew Baillie (1761–1823) and Jean

Cruveilher (1791–1874) illustrated lesions in stroke, in 1799 and 1829 respectively.

• Gall 1809(Phrenology) – Bumps on skull correlate with gyri .

• Flourens, 1823 - made two important contributions:

1. Showed experimentally (using ablation) that cerebrum(sensation & perception) and cerebellum (movement) perform different functions2. Against Phrenology: Particular traits are not isolated to regions ascribed by phrenology, and bumps do not correlat with gyri.

• Paul Broca(1861) Had a patient “Tan” who could understand language but couldn't speak, discovered a lesion in left frontal lobe, and concluded this region was responsible for production of speech.

• Karl Wernicke found that damage to left posterior, superior temporal gyrus resulted in deficits in language (Wernicke’s Aphasia)

Evolution Theory of Nervous Systems• Darwin(1809-1882) introduced theory of evolution• Evolution led to development of traits that

distinguish species today• Rationale behind animal experiments: idea that nervous system of different species evolved from common ancestors and may have common mechanisms.

• The Taylor or tomahawk reflex hammer was designed by John Madison Taylor in 1888 and is the most well known reflex hammer till date.

• Camillo Golgi(1873)-introduced Golgi Stain (Silver Chromate) thus allowing to view a small percentage of neurons in their entirety with clearly visible soma, axon and dendrites.

• Santiago Ramón y Cajal (1892)-Used Golgi stain to work out the circuitry of many regions of brain. Proposed Neuron Doctrine – Neurons adhere to cell theory.• Golgi and Ramón y Cajal shared Nobel Prize in Physiology or Medicine in 1906 for their work.

Golgi stain of a Neuron

• In late 19th century, Emil du Bois-Reymond, Johannes Peter Müller, and Hermann von Helmholtz showed neurons were electrically excitable and that their activity predictably affected electrical state of adjacent neurons.

• Sigmund Freud(1900) published “The Interpretation of Dreams”.

• M. Lewandowsky(1900) coined the term "blood-brain barrier" (Bluthirnschranke).

• Oskar Vogt and Cecile Vogt(1902) coined the term “NEUROPHYSIOLOGY “.

• Ivan Pavlov(1903)coined the term Conditioned reflex.

• John Newport Langley(1905) coined the phrase “Parasympathetic nervous system”

• Alois Alzheimer(1906) describes Presenile degeneration

• Oberga(1908) introduced cisternal puncture.• Korbinian Brodmann(1909) described 52 discrete

cortical areas.• Phenobarbital was introduced in market in 1912.• George Guillain, Jean Alexander Barre and Andre

Strohl describe an acute inflammatory demyelinating polyneuropathy (Guillain-Barre Syndrome) in 1916.

• Hans Berger published his findings about the first human electroencephalogram in 1929.

• Levodopa was first successfully used to treat Parkinsonism in 1961.

• John O'Keefe, Edvard Moser, and May-Britt Moser shared the Nobel Prize for their discoveries about cells that constitute a positioning system in the brain in 2014.

INDIAN PERSPECTIVE

• Charaka Samhita(physician) and Sushruta Samhita(surgeon) 6th century B.C

• Due to deranged humor (Vata) which enters tissues (dhatu) such as muscles (Mans), ligaments (Snayu), etc.

• Exacerbation or deficiency of this energy (vata) can cause disturbance in the form of hyperactivity or weakness of nervous system.

• Around 80 neurological diseases described.

• Apasmara/Apasmrti (Epilepsy)• Kampavata (Parkinson's Disease)• Shiroruk (Headache)• Foot Drop (Paada Bhramsa)• Brachial plexopathy (Baahu soshana)• Tinnitus (Asabdasravanam)• Temporal Headache (Shankha Bhedascha)• Bell's Palsy (Arditam)• Monoplegia (Ekanga roga or vata)• Quadreplegia (Sarvangavata)

• Hemiplegia (Pakshavadha)• Convulsions (Akshepaka vata)• Syncope or Blackouts (Tamaha)• Giddiness or Vertigo (Bhrama)• Tremors (Vepathu)

• First Neurosurgery in India was performed as a Transsphenoidal hypophysectomy performed by Lt. Col. Frederick Jasper Anderson in Madras(1935).

• First Neurological training facility established in 1948 at Christian Medical College, Vellore by Dr. Jacob Chandy-Department of Neurosurgery.

• Department of Clinical Neurosciences established at Postgraduate Institute, Chandigarh in 1962.

• Department of Neurology established at Institute of Medical Science BHU in 1966 with Dr. BC Katiyar as head of department.

• In 1974, All India Institute of Mental Health, started in 1954 as a mental hospital and asylum, converted to autonomous National Institute of Mental Health and Neurosciences (NIMHANS).

PIONEERS OF INDIAN NEUROLOGY

• Dr. Eddie Barucha- first practicing clinical neurologist in Bombay (1951).

• Dr. Chandy-started first Department of Neurosurgery in India

• Dr. S. T. Narasimhan-first Indian neurologist to institute his private practice at the EEG clinic, instrumental in formation of Neurological society of India (NSI).

• Dr. Baldev Singh, who received his neurological training in Chicago, USA- First Neuroscience professor in India, referred as “Papa Neuron”.

• Instrumental in formation of NSI, led Department of Neurology at All India Institute of Medical Sciences in 1965.

• Regarded as Father of Indian neurology.• Professors K.P.Bhargava, B. N. Dhawan, M. Hasan, S. S.

Parmar and P. K. Seth collectively formed Indian Academy of Neurosciences in 1982.

• Dr. Noshir Wadia -neurological training from London

• Created Department of Neurology at Grant Medical College, Bombay in the 1960s.

• Professor K. Jagannathan and Professor G. Arjundas-essential to progress of Neurology in Madras.

• Our country has approximately 172 DM Neurology and 203 M.Ch Neurosurgery seats in various medical colleges across the country.

• Two prominent societies are present in the country working in the field of Neurology – Neurological Society of India and Indian Academy of Neurology.

NEUROLOGY IN RAJASTHAN

• Superspeciality courses are conducted in various medical college across the state.

COLLEGE DM NEUROLOGY M.Ch NEUROSURGERY

SMS MEDICAL COLLEGE JAIPUR

08 12

GMC KOTA 02 -

SNMC JODHPUR 02 01

RNT MC UDAIPUR - 02

NEUROLOGY AT KOTA

• Professor Dr. Vijay Sardana started Dept. of Neurology at GMC Kota.

• First stroke unit of its kind in Rajasthan (04th October 2009).

• DM course started in 2013.• Neuro-interventional Lab is currently under

construction under the department of Neurology.

THANK YOU