Hans von Bülow: creativity and neurological disease in a famous pianist and conductor.

Hans von Bülow (1830-1894) was a conductor and pianist of worldwide reputation and founder of many stylistic interpretations of classic and romantic symphonies. The close friendship with Richard Wagner, but not the enthusiastic admiration of his dramatic musical opus, ended abruptly when Hans von Bülow became aware of the betrayal of his wife Cosima and Richard Wagner. Hans von Bülow reported symptoms and signs of neurological disease in many letters that were kept and edited by his second wife Marie. For decades he suffered from chronic neuralgiforme headaches, which were caused by a tumor of the cervical radicular nerves. At the age of 45 years, he suddenly developed a motorsensory deficit in the right arm and hand and a contralateral facial deficit, suggestive of brainstem infarction. He recovered and celebrated even greater successes as a musician, although phases of major depression also interfered with his professional life. In the last, phase of his life, he experienced the consequences of generalized atherosclerosis and cerebral microangiopathy. It was a second cerebrovascular accident of the brainstem that caused his death, only 10 months after his last concert performance. Although his death occurred in Egypt, an autopsy was performed by Professor Ludwig Edinger and the results will be presented.

The enigma of Lenin's (1870-1924) malady.

The health of heads of states is not always handled in the same way as an incapacitating disability in ordinary professionals. Instead of suspension of responsibilities, the health status of political leaders is concealed, especially when the illness is perceived as stigmatizing, such as organic mental impairment or sexual disorder. The objective of the present paper is to analyse the malady of Lenin (1870-1924) in the light of relevant and new medical information. It is hoped that this will accentuate the need for transparency when the health of a statesman is concerned.

[Neurology in Paris hospitals, particularly the Salpêtrière before Charcot: Rostan on brain softening]. / La neurologie à l'Assistance Publique et en particulier à la Salpêtrière avant Charcot. L'exemple de Rostan et du ramollissement cérébral.

In the beginning of the 19th century, many studies were devoted to the diseases of the nervous system in France, long before the work of Charcot. The researches of Léon Rostan on the cerebral softening (1819, 1823) were based on the anatomoclinic method developed by the School of Paris whose most famous representatives were Corvisart and Laennec for the study of heart and lung diseases. The researches of Rostan were performed in the Salpêtrière hospital which was, at this time, an hospice for old women. Rostan was appointed Inspector of the Health service in the Salpêtrière hospital in 1812 then Head of a department in 1818. He was 28 year old when he published his book "Researches on the cerebral softening" in 1819. Rostan was the first to describe the spontaneous cerebral softening as a special anatomoclinic entity distinct from encephalitis and apoplexy. He compared this entity to the senile gangrene and stated that it was related to the ossification of cerebral arteries. He described the pathologic features of the brain softening and also its clinical symptomatology in opposition to that of apoplexy. The concept of brain softening according to Rostan was harshly fought by the followers of the Broussais's physiological medicine (from Lallemand, 1830 to Calmeil, 1859) who claimed that all brain softenings were due to the inflammation process and thus should be described as encephalitis. In opposite, the ideas of Rostan were accepted and developed by others such as Carswell in England (1835), Abercrombie in Scotland (1836) and Andral in France (1827, 1840). These authors agreed that some type of cerebral softening was related to a disease of the arterial system. Nevertheless, the modern concept of brain softening was not definitively accepted before the description of the thromboembolic mechanisms by Virchow in Germany (1856) with the help of the microscope, and the anatomoclinic studies of Proust, Laborde and Prevost and Cottard in France (1866). The book of Rostan was dedicated to the "Conseil Général des Hospices" which was created in 1801 to unify the administration of the hospitals in Paris and became the "Administration Générale de l'Assistance Publique à Paris" in 1849. One hundred and fifty years after its publication, the work of Léon Rostan was outstanding by its modernity of the form as well as the substance.

[Binswanger's disease: evolution of thought and a proposed diagnostic triad]. / Enfermedad de Binswanger: evolución de las ideas y propuesta de un trípode diagnóstico.

We review the evolution of the concept of Binswanger's disease from his original description in 1894 to our days. We emphasize the conceptual impact caused by CAT scan. Finally, we propose a diagnostic triad based on clinical, neuropathological and radiological trends. We believe Binswanger's disease has a clear identity despite the lack of solid diagnostic criteria.

Enfermedad de Binswanger: evolucion de las ideas y propuesta de un tripode diagnóstico / Binswanger's disease: thought's evolution and a proposal of diagnostic triad

Estudamos a evoluçäo do conceito de doença de Binswanger a partir de 1894, ano de sua descriçäo inicial. Observamos que, posteriormente a uma fase com escassos relatos, com a introduçäo da tomografia computadorizada de crânio, há uma fase de sobrediagnóstico e de perda dos conceitos básicos, levando a confusäo na literatura. Propomos a utilizaçäo de um tripé diagnóstico - clínico, radiológico e anátomo-patológico - que ajudará o correto posicionamento médico perante essa doença

[The beginnings of the history of atherosclerosis in mental disorders]. / Pocátky historie aterosklerotických dusevních poruch.

Atherosclerosis and its relationship with mental disorders, in particular in advanced age, arouses vivid interest of specialists at home and abroad. In their paper the authors focused attention on the historical development of the term dementia in the work of European doctors, starting in the second century after Christ, on the genesis of the term atherosclerosis and some discoveries associated with disease. Special attention is devoted to circumstances of the nosological differentiation of atherosclerotic mental disorders. The authors emphasize the importance of Binswanger's and Alzheimer's work in this area and draw attention to progressive elements in the work of K. Kuffner.

[The life of Joseph Haydn from a medical point of view (author's transl)]. / Joseph Haydns Leben aus medizinischer Sicht

Joseph Haydn (1732 to 1809) had hardly been troubled by any illness of note, apart from a chronic nasal polyp until 1799. During the composition of the oratoria "The Seasons" (1799 to 1801), the signs of cerebral arteriosclerosis with cardiac insufficiency made their appearance. Haydn's creative strength subsequently declined rapidly and he was virtually unable to compose any more after he had finished "The Seasons" until his death in 1809. The plan to compose a third oratoria "The Last Judgement" ended abortively. Haydn himself suffered acutely from the inactivity imposed on him by the illness, as documented by various sources. Hadyn remained fully conscious right up to the time of his death, which presumably resulted from cardiac failure. Haydn's grave was ransacked only a few days after the funeral and his skull was snatched. It has been finally restored to his resting place in Eisenstadt only as recently as 1954 after a protracted and devious journey.