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The specialty of surgical neurology developed out of general surgery in the second half of the 19th century. It was aided by the development of general anesthetics, the advent of aseptic methods, and the emerging theory of cortical localization of function. This chapter examines the history of "modern" brain surgery, the leaders in this pursuit, and the landmarks that changed when and how these surgeries were conducted. It is stressed that the surgeries conducted by Broca, Macewen, Godlee, Horsley and others not only saved lives and ultimately created a new field, but also contributed to the basic sciences, fostering an improved understanding of the functional organization of the brain.

The theory of cortical localization of function holds that different cerebral cortical territories serve different functions, such as vision and language. This theory began to be entertained in the mid-1700s, but it had no impact until Gall made it central to his thinking in the early 1800s. Gall's organology, with its emphasis on cranial bumps, soon fell into disrepute, but in the decades that followed Bouillaud, Aubertin, and Broca advanced the concept by turning to clinical cases of speech loss, and in 1870 Fritsch and Hitzig demonstrated its validity, studying motor functions with animals. The theory of cortical localization of function served as a guiding factor in changing the practice of neurology, and clinicians encountered new material supportive of the doctrine. Surgical neurology, anatomy, and physiology also supported the new way of thinking, contributing to a better understanding of the functional organization of the cerebral cortex and to clinical neurology.

Cranial trepanations began to be performed more than 5000 years ago in Europe and as early as the 5th century BC in the New World. It was only in the mid-19th century, however, that men of medicine began to realize that the openings in some of the unearthed ancient skulls were made by individuals skilled in surgery, and that the practice was routinely performed on the living. Some of the first reports on these unusual skulls and their significance came from pioneer neurologists and neurosurgeons, including Paul Broca and Victor Horsley. However, from the start, Broca and Horsley did not agree on why the operations were performed, and the logic behind these early cranial surgeries has continued to generate debate. In Peru, where more trepanned crania have been found than anywhere else, numerous skulls have been associated with head injuries from battles, a finding of special significance for neurologists, neurosurgeons, and neurohistorians.

Edward Bancroft was a medical apprentice in Connecticut before running off to Guiana in 1763. While in South America, he practiced medicine and collected material for a lengthy book on the region, which he published after he settled in London. Bancroft's Essay (1769) contains a description of the "torporific eels" found in the warm rivers of Guiana, along with a series of experiments suggesting that the eel's powers are electrical. It also calls for studies to determine whether saltwater torpedo rays might demonstrate the same properties, which Bancroft expected would be the case. Today, Bancroft is best remembered for serving Benjamin Franklin and the American delegation in France during the War of Independence, and for being a double agent. But what this colorful man wrote about the South American eels helped to make an early case for animal electricity and stimulated Franklin to encourage John Walsh to conduct his landmark electrical experiments on torpedoes and electric eels in the 1770s. These efforts led to new way of thinking about the physiology of the nervous and muscular systems, even in nonspecialized fish.

Although torpedoes and Malopterurus, a Nile catfish, had been described and even used medically in antiquity, their discharges were poorly understood before the second half of the eighteenth century. It was then that their actions, along with those of certain South American "eels," became firmly associated with electricity. The realization that an animal could produce electricity marked a turning point in the history of neurophysiology, which had long described nerve actions with recourse to animal spirits. By examining The Gentleman's Magazine during the period when electric fish were becoming electrical, one can begin to appreciate how new discoveries about these unusual creatures captured the imagination of scientists and were filtered down to the literate public.

Benjamin Franklin's medical history shows that he suffered from repeated attacks of gout and a large bladder stone. These conditions caused him considerable pain, markedly decreased his mobility, and likely contributed in indirect ways to his decline and eventual death from a pulmonary disorder. This article examines Franklin's risk factors for gout and stones, both as Franklin understood them and as we know them today. Significantly, both of these disorders are associated with high blood levels of uric acid, a metabolic by-product. Franklin's risk factors included his gender, genetics, diet, drinking, advanced age, psoriasis, and exposure to lead. Although it is impossible to assign a weight to each of these factors, it can be shown that a number of factors, each capable of raising uric acid levels, converged and conspired against him.

Benjamin Franklin had at least two accidents that resulted in electricity passing through his brain. In addition, he witnessed a patient's similar accident and performed an experiment that showed how humans could endure shocks to the head without serious ill effects, other than amnesia. Jan Ingenhousz, Franklin's Dutch-born medical correspondent better known for his discovery of photosynthesis, also had a serious accident that sent electricity though his head and, in a letter to Franklin, he described how he felt unusually elated the next day. During the 1780s, Franklin and Ingenhousz encouraged leading French and English electrical "operators" to try shocking the heads of melancholic and other deranged patients in their wards. Although they did not state that they were responding to Ingenhousz's and Franklin's suggestions, Birch, Aldini, and Gale soon did precisely what Ingenhousz and Franklin had suggested. These practitioners did not appear to induce convulsions in their mentally ill patients, but they still reported notable successes.

Benjamin Franklin was involved not only with the nature of electricity but with its possible medical utility. He conducted electrical experiments on people with palsies, notably those caused by stroke, to see if electricity from machines could restore movement. Franklin recognized that electricity was not the miraculous cure it was hoped to be, and he presented his findings in 1757 as communication to the Royal Society. Although he did not provide names or individual case studies in this communication, subsequently published in 1758, his personal letters reveal that he treated at least two important colonists: James Logan, William Penn's secretary and a prominent public official in Pennsylvania, and Jonathan Belcher, governor of several provinces. Franklin's private letters shed light on how he conducted his clinical "tryals" and why he drew the conclusions he did in his report to the Royal Society.

Benjamin Franklin (1706-1790), who is better known in other fields, especially colonial politics and international diplomacy, was an early, major contributor to the neurosciences from the New World. Among his accomplishments are: experiments on medical electricity as a possible cure for the palsies and hysteria; the first descriptions of how electricity affecting the brain can cause a specific type of amnesia; supporting the idea that cranial shocks might provide a cure for melancholia; showing that the cures performed by the Mesmerists to remove obstructions, including nerve blockages, rest on gullibility and suggestion, and recognizing the dangers, including those to the nerves, posed by exposure to lead. Franklin?s neuroscience was firmly based on experiments, careful observations, and hard data ? and finding clinical relevance for new discoveries was always on his mind.

Shock-induced amnesia received considerable attention after Cerletti popularized electroconvulsive shock therapy in the late 1930s. Yet, often overlooked is the fact that Benjamin Franklin recognized that passing electricity through the head could affect memory for the traumatic event. Franklin described his findings on himself and others in several letters from the mid-1700s, 2 of which were published in his lifetime. What he observed was confirmed in 1783 by physician Jan Ingenhousz, who was one of his correspondents. Although Ingenhousz had lost his memory for his electrical accident and was confused immediately afterward, he felt strangely elated and unusually sharp the next morning. Hence, he called for clinical trials with patients with melancholia who were not responding to more conventional therapies. After Franklin received Ingenhousz's letter, he also called for clinical trials. Neither man, however, tied the possible new cure for melancholia to the memory loss--nor did the operators that began to treat some patients with melancholia successfully with cranial shocks. Only much later would the amnesia be thought to be associated with the cure., (2006 APA, all rights reserved)

Marc-Hector Landouzy (1812-1864) was one of the first to describe facial paralysis in newborn, through a series of case studies. By examining these four cases in the context of Landouzy's life, publications and professional circumstances, this study shows how case studies were an important part of the scientific revolution within medicine in the 19th century. Landouzy, soon followed by others, used the growing clinical populations of Parisian hospitals, patho-anatomy and cutting-edge physiologic techniques to help describe a previously ignored disease among newborns. His case studies, in particular, are a valuable example of the emerging interest in children as a clinical population and of early interest in child neurology.

In 1921, Pearl S. Buck gave birth to a daughter, Carol, who became severely retarded and was eventually institutionalized at the Vineland Training School in New Jersey. To help pay for her daughter's care, Buck wrote The Good Earth in 1931, and then other novels and biographies about her life in China, for which she was awarded the Nobel and Pulitzer Prizes, and honored around the world. Years later, she published The Child Who Never Grew, a short piece about her daughter's retardation that also revealed her desperate search for answers and good clinical care. Asbjørn Følling distinguished phenylketonuria (PKU) from other forms of childhood retardation in the mid-1930s, and new assays and biochemical findings eventually led to ways to circumvent the devastating effects of PKU. But for Carol Buck, these advances came too late. It was not until the 1960s that physicians confirmed that her severe retardation was caused by PKU.

The idea that damage to one part of the nervous system can have effects at a distance was popular during the 19th century. Constantin von Monakow, MD, accepted this idea and blended it with the newly formulated neuron doctrine early in the 20th century to account for ipsilateral paralyses and recovery of function. He called his theory of neural depression caused by loss of inputs to structures tied to the damaged area diaschisis. In this article, we examine the origins of diaschisis and the goals of Monakow. Credit is given to Monakow for drawing needed attention to the dynamics of the nervous system, remote lesion effects, and recovery of function, even though the fine details or specifics of his theory have had a mixed reception.

In 1877 Thomas Barlow, a London physician, published a remarkable case of functional recovery of speech following brain damage. It involved a 10-year-old boy who had lost his speech, regained it, and lost it again before he died from a disorder that affected his heart and produced embolisms that subsequently affected other organs, including his brain. Examination of the boy's brain revealed two focal regions of softening; one that affected Broca's area and the left facial-motor area, and another, which occurred weeks later, in the homologous regions of the right hemisphere. Although Barlow was most concerned with motor deficits, others at the turn of the century began to cite this case as strong evidence that the corresponding region of the right hemisphere can take over speech functions for Broca's area on the left. Whether this case really provides good support for functional takeover or vicariation theory is critically evaluated in the light of contemporary research, including PET scan studies involving damage to Broca's speech region.

EARLY REPORTS OF phantom limbs by Ambroise Paré and René Descartes were based on second- or third-hand descriptions provided by amputees. William Porterfield (ca. 1696-1771) was a prominent Scottish physician and was possibly the first man of medicine to write about his experiences after having a leg amputated. Porterfield was an authority on vision; he devised the first optometer and examined accommodation after cataract operations. Rather than using the phenomenon of a phantom limb to question the veracity of the senses (as Descartes had done), Porterfield integrated his phantom limb experiences into his general account of sensory function.

PHANTOM LIMB WAS described long before American physician and surgeon Silas Weir Mitchell coined the term and drew attention to the disorder in the 1860s. The early descriptions of Ambroise Paré, René Descartes, Aaron Lemos, Charles Bell, and then Mitchell of this strange consequence of amputation are presented in historical and cultural context. These five men described phantom limbs for various reasons. They also differed when it came to explaining and dealing with these illusory sensations. The rich history of phantom limbs can begin to be appreciated by viewing the contributions of these individuals in perspective and by realizing that their writings represent only a fraction of what was published about phantom limbs more than 130 years ago.

In this, our continuation paper on Helmholtz and Müller, we examine Helmholtz's contributions to sensation and perception, with emphasis on his extension and modification of Müller's theory of specific nerve energies. The material is again presented in biographical-chronological context. We also examine Helmholtz's views on depth and space perception, and his empirical theory of knowledge, which are also compared to Müller's views. It will be shown that Helmholtz remained stimulated by the thoughts and doctrines of Johannes Müller in the sensory-perceptual part of his career, which began early in the 1850s and ended with his death. Nevertheless, Helmholtz's own experiments and new discoveries by others sometimes led him to quite different conclusions.

Hermann Helmholtz made monumental contributions to the neural sciences in the second half of the nineteenth century. Among his earliest achievements were experiments that challenged vitalism, microscopic studies on the structure of the nerve cell and its processes, and the first reasonable estimates of the speed of nerve transmission based on physiological experiments. In this, the first of a two-part article, we review Helmholtz's early contributions in biographical context and with reference to Johannes Müller's own thoughts. We reveal how Johannes Müller, considered by many to be the greatest physiologist of the first half of the nineteenth century, helped to launch and shape Helmholtz's career. We also show that Helmholtz was only willing to accept some of his mentor's theories, even though he had great admiration for Müller. The point will be made that Helmholtz owed a great debt to Müller, but even from his student days in Berlin he was an independent thinker with his own agenda, and never his strict disciple.

Since the closing decades of the nineteenth century, women have been contributing in a significant way to the neurosciences. This article looks at the contributions of some of the leading women pioneers in this field. It also deals with women who have written on the history of the neurosciences and the representation of women in the International Society for the History of the Neurosciences, the largest neuroscience history organization. Trends suggest that books and articles from and about women in the history of the neurosciences will increase markedly in the future.