Anglo-French neurological interactions in the 19th and early 20th centuries: Societies and Journals.

We have reviewed seminal interactions between British and French physicians prior to and following the establishment of the Paris and London Schools of Neurology from the mid-19th to the early 20th centuries. Our first article focused on British and French physicians, places and events. In this second part of our review we have examined the interactions between British and French Neurological Societies and Journals, including: (1) The Neurological Society of London founded in 1886, which became the Section of Neurology of the Royal Society of Medicine; (2) The Société de Neurologie de Paris founded in 1899, later renamed as The Société Française de Neurologie; (3) The journal Brain and its precursors and successors; (4) The journal Revue Neurologique and its precursors. We illustrate the constructive influence of Anglo-French interactions on the early development of neurology by the distinguished physicians who were corresponding members respectively of the British and French Neurological Societies and the scientific articles published by French authors in Brain and by British scientists in Nouvelle Iconographie de la Salpêtrière, Archives de Neurologie and Revue Neurologique.

Anglo-French neurological interactions in the 19th and early 20th centuries: Physicians, places and events.

The development of neurology as an independent discipline in the mid-19th century was considerably influenced by the almost simultaneous foundation of the Charcot School at the Salpêtrière Hospital in Paris and the National Hospital for the Paralysed and Epileptic and it's School at Queen Square in London in the 1860's. We have reviewed the early interactions between Charcot's school and the leading neurologists at the National Hospital and also discussed their neurological antecedents and subsequent links up to the outbreak of World War 1 in 1914. Earlier interactions involved Trousseau and Duchenne in France and Graves, Todd, Laycock and Allbutt in Britain. The French Brown-Séquard was one of the first two physicians appointed to the National Hospital. Charcot was a frequent visitor to Britain culminating in his influential role in the 1881 International Medical Congress in London. He first suggested the terms "Parkinson's Disease" and "Jacksonian Epilepsy". He attracted numerous British visitors to Paris and his studies of hysteria were influenced by Laycock, Todd and Russell Reynolds. Hughlings Jackson drew upon the anatomical studies of Gratiolet in his interactions with Broca and Charcot which influenced French views on aphasia, epilepsy and cortical localisation. Ball, an Englishman, was the first Professor of mental and brain diseases in Paris in 1877. Bruce in Edinburgh and Kinnier Wilson in London both maintained frequent contacts with Paris, where the latter first presented his studies of hepatolenticular degeneration in 1912. The Entente Cordiale of 1904 led to further interactions with the leading role of the French and British physicians Raymond and Duckworth. Two outstanding British women, Elizabeth Garrett and Blanche Edwards, qualified in Medicine in Paris with neurological interests. Our review emphasises the constructive influence of the French and British Schools on each other and thus on the development of neurology. The French influence was primarily the establishment of the anatomo-clinical method and the use of photographic illustrations in publications. The British School influence was its Clinical Assessment Skills and scientific studies of newly recognised diseases and concepts and its early development of neurosurgery.

Allbutt of Leeds and Duchenne de Boulogne: Newly discovered insights on Duchenne by a British neuropsychiatrist.

It is well-established that Guillaume-Benjamin-Amand Duchenne de Boulogne (1806-1875), and Jean-Martin Charcot (1825-1893) were the founding fathers of Parisian and French neurology during the second half of the 19th century, although much more is known about Charcot than about his "master" Duchenne. In Britain, Thomas Clifford Allbutt (1836-1925) was Leeds' most distinguished physician of the 19th century, eventually becoming Regius Professor of Physic at Cambridge. Allbutt's 1860-1861 year of postgraduate study in Paris and his friendship with Duchenne profoundly influenced his own contributions to nervous system and mental diseases, partly in collaboration with his colleague James Crichton-Browne (1840-1938) at the nearby West Riding Lunatic Asylum in Wakefield, Yorkshire. The present report briefly recalls the careers of Duchenne and Allbutt, and also presents a unique account by Allbutt of Duchenne in action at the height of his powers, investigating and defining the previously uncharted field of neuromuscular diseases with the aid of his localized electrization techniques. This account is discussed in relation to: Duchenne's personality and pioneering neurological achievements; the origins of French neurology; and the development of Anglo-French neurological relationships during the 19th century. Interestingly, both Duchenne and Crichton-Browne separately made important and much-appreciated contributions to the third major book by Charles Darwin (1809-1882), The Expression of the Emotions in Man and Animals, published in 1872.

A brief history of hysteria: From the ancient to the modern.

In this paper we discuss the history of hysteria from the Babylonian and Assyrian texts through to the situation as it appears to us at the end of the 19th century. We note the shifting emphasis on causation, earlier ideas being linked to uterine theories, later speculations moving to the brain, and then the mind. We note the persistence of the condition referred to as hysteria over the millennia and the fascination that the condition has held for physicians, neurologists, and psychiatrists since the origins of known medical texts.

What is the safe upper intake level of folic acid for the nervous system? Implications for folic acid fortification policies.

Between 1945 and 1959 it was convincingly documented that folic acid can precipitate or aggravate the neurological and haematological consequences of vitamin B12 deficiency by increasing the demand for vitamin B12. Since then there has been much misunderstanding of the issues, mainly by advocates of folic acid fortification who have been inclined to minimise or even dismiss the risks by misinterpreting the evidence as only a 'masking' of the anaemia of pernicious anaemia. Recent studies in the era of fortification are rediscovering the risks to the nervous system, especially cognitive function, of excess folate in the presence of vitamin B12 deficiency. I have reviewed the Reports of four Expert Advisory Committees in Europe and the USA, which suggest that the safe upper tolerable limit (UL) for folic acid is 1 mg in adults. These reports are unsound and there is already evidence of neurological harm from long-term exposure to doses of folic acid between 0.5 and 1 mg in the presence of vitamin B12 deficiency. There is an urgent need to review the safe UL for folic acid and to consider the addition of vitamin B12 to folic acid fortification policies.

The neurology of folic acid deficiency.

The metabolism of folic acid and the metabolism of vitamin B12 are intimately linked such that deficiency of either vitamin leads to an identical megaloblastic anemia. The neurologic manifestations of folate deficiency overlap with those of vitamin B12 deficiency and include cognitive impairment, dementia, depression, and, less commonly, peripheral neuropathy and subacute combined degeneration of the spinal cord. In both deficiency states there is often dissociation between the neuropsychiatric and the hematologic complications. There is a similar overlap and dissociation between neurologic and hematologic manifestations of inborn errors of folate and vitamin B12 metabolism. Low folate and raised homocysteine levels are risk factors for dementia, including Alzheimer's disease, and depression. Even when folate deficiency is secondary to psychiatric illness due to apathy or poor diet it may eventually aggravate the underlying disorder in a vicious circle effect. Clinical responses to treatment with folates are usually slow over weeks and months, probably due to the efficient blood-brain barrier mechanism for the vitamin, perhaps in turn related to the experimentally demonstrated excitatory properties of folate derivatives. The inappropriate administration of folic acid in the presence of vitamin B12 deficiency may lead to both neurologic and, later, hematologic relapse. Impaired maternal folate intake and status increases the risk of neural tube defects. Periconceptual prophylactic administration of the vitamin reduces, but does not eliminate the risk of neural tube defects even in the absence of folate deficiency. Folates and vitamin B12 have fundamental roles in central nervous system function at all ages, especially in purine, thymidine, neucleotide, and DNA synthesis, genomic and nongenomic methylation and, therefore, in tissue growth, differentiation and repair. There is interest in the potential role of both vitamins in the prevention of disorders of central nervous system development, mood, dementia, including Alzheimer's disease, and aging.

A film of patients with movement disorders made in Queen Square, London in the Mid-1920s by Samuel Alexander Kinnier Wilson.

BACKGROUND: Through Edward Reynolds' collaboration with Samuel Alexander Kinnier Wilson's (SAKW) son, James, on Babylonian neurology and psychiatry, and his contact with James' nephew, Jim, grandson of SAKW, a remarkable film of patients with movement disorders, made by SAKW in the mid-1920s, has come to light. METHODS/RESULTS: The 20-min silent film with captions by SAKW includes patients with senile tremor, Parkinson's disease and postencephalitic parkinsonism, hemiballismus, Huntington's chorea, Sydenham's chorea, hysterical palsy and tremor, multiple sclerosis, and progressive lenticular degeneration. Most of the patients are filmed in the square outside the National Hospital. The British Film Institute dates the film to 1924 and the captions to 1925. The case records of 6 of the 14 patients, who were admitted to the National Hospital, Queen Square, under the care of Dr. SAKW have been identified and summarized. DISCUSSION: SAKW may have been stimulated and facilitated to make this film through his personal contact with Charlie Chaplin with whom he stayed at his Californian estate, probably in the summer of 1924. The first films of neurological patients were made in Europe and USA at the beginning of the 20th century, although most have perished. This may be one of the oldest examples from UK. It is also notable for the inclusion of Wilson's disease and a brief shot of SAKW himself.

Benefits and risks of folic acid to the nervous system.

During three decades of neurological practice I have witnessed a remarkable change in attitudes to the benefits and risks of folic acid therapy in nervous system disorders. In the 1960s all that was known and taught was that folic acid was harmful to the nervous system, especially in precipitating or exacerbating the neurological complications of vitamin B12 deficiency. So deeply held was this view that the possibility of neuropsychological benefits from this vitamin was initially viewed with considerable scepticism.

The impact of epilepsy on Graham Greene.

As a young man, Graham Greene (1904-1991) experienced several episodes of loss of consciousness, which were confidently diagnosed as epilepsy by a Harley Street specialist who saw him on two occasions during the 1920s. The diagnosis was initially concealed from him by his family and the specialist, but when it was revealed, it had a profound effect such that he contemplated suicide. He was particularly concerned about his impending marriage and the risk of having children. His anxiety was not relieved by being told that the famous author, Dostoevsky, had epilepsy. Graham Greene is the only public figure in the United Kingdom, of whom I am aware, who has admitted and discussed the impact of epilepsy, even though this was more than 40 years later when there was some doubt about the diagnosis.