Milestones in the development of neurology and psychiatry in Europe

Abstract

In this article, I review the work of the pioneers in neurology and psychiatry in Europe in the 19th and 20th century and the significant scientific advances that changed the face of both specialties. The history of Swiss Neurology, which has been the subject of numerous previous articles in this journal, is not discussed here. Some of the most famous pioneers in neurology are presented, such as Jackson, Gowers, Duchenne, Charcot and Alzheimer, who all made extraordinary contributions to the nosology of neurologic diseases and played a pivotal part in establishing neurology as a clinical specialty. Prominent pioneers in psychiatry are Griesinger, Meynert, Kraepelin, Bleuler and Freud. They introduced pathological anatomy into clinical psychiatry and described new disease entities. Major milestones and discoveries in neurology and psychiatry are presented. Sakel was the discoverer of insulin shock therapy for schizophrenics and other mental patients. Moniz invented cerebral angiography and developed a surgical technique to interrupt the nerve fibres which connect the thalamus to the prefrontal cortex (already known at the time as a brain structure involved in higher intellectual functions of the brain, and in emotions as well). Actually, the Swiss psychiatrist Gottlieb Burckhardt performed the first attempts at psychosurgery. Delay was the first psychiatrist to recognise the therapeutic value of chlorpromazine in the treatment of schizophrenia. It was a major factor in the clearing and opening of psychiatric wards, allowing many inpatients to function effectively as outpatients. Following the discovery of the catecholamines and the loss of dopamine in the striatum of Parkinson's patients, Birkmayer was the first to try L-Dopa in the therapy for Parkinson disease, but the breakthrough in L-dopa treatment came from the work of Cotzias. L-Dopa is still, today, the mainstream drug in the treatment of Parkinson disease. Modern medicine can hardly be conceived without imaging techniques. Since its introduction in the clinic, MRI has assumed a role of unparalleled importance in diagnostic medicine. With the emergence of functional MRI (fMRI), research in cognitive neuroscience has been transformed. It would be presumptuous to fore-see where neurology and psychiatry are going. If the past gives us any clue about the future, we can guess that psychiatry and neurology will be shaped by clinician-scientists that view the boundary between both specialties, not as a territorial line, but as a broad and mostly unexplored terrain.