THE FICTION OF THE "GERSTMANN SYNDROME"

Abstract

The problem with which this study is concerned can be stated as follows. A patient with parieto-occipital disease may show one or more of a relatively large number of diverse behavioural deficits. When he presents with two, three, or more of these symptoms, the latter may be viewed by the clinical observer as forming a naturally occurring combina-tion of deficits and given the status of a syndrome, this status implying that the concurrence of deficits is not a chance one, that there is an underlying factor responsible for it, and that it possesses a distinctive neuropathological significance. Once such a special combination or syndrome is esta-blished, not only is it used in the observation and description of subsequent cases but it may also determine which aspects of a patient's behaviour are selected for study and which are not. The "Gerst-mann syndrome" represents such a combination of behavioural deficits. The study to be reported examines the question of whether, as is usually assumed, this "assembly of unlikely and unexpected symptoms" (Critchley, 1953) is a naturally occurring combination or whether it is only one of a very large number of more or less fortuitous combinations of behavioural deficits which may be encountered in patients with cerebral disease. The history of the Gerstmann syndrome has been recounted in detail elsewhere (cf. Critchley, 1953; Benton, 1959); only a few major points need be mentioned to introduce the present investigation. Before the end of the nineteenth century, the four behavioural deficits comprising the syndrome-right-left disorientation, acalculia, agraphia, and finger agnosia-had been described as occurring in patients with cerebral disease. The first three were