Wepfer (1620-1695) wrote a book on the vascularization of the brain and on .... tioning the following: Observationes anatomicae ex caahveribus eorum, quos sustulit apoplexia ... became quite angry because people considered him crazy.
Pergamon
J. Neurolinguistics. Vol. 9, No. 3, R. 157-164, 199516
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JOHANNES SCHENCK AND JOHANNES JAKOB WEPFER: CLINICAL AND ANATOMICAL OBSERVATIONS IN THE PREHISTORY OF NEUROLINGUISTICS AND NEUROPSYCHOLOGY CLAUDIO LUZZATTI* and HARRY WHITAKER~ *Istituto di Psicologia della Facolti Medica, Universita di Milano, Italy; tD6partement de Psychologie, UQAM, Montr&l, Canada Abstract-Historical observations of disorders of language have been reported from Pharaonic medical texts circa 3ooO nc, the Hippocratic corpus circa 400 BC, Latin texts circa 1st century AD, through the Renaissance and in various 17th and 18th century texts. In none of the extant historical papers, however, have certain critical elements of aphasia been discussed, i.e. the distinction between a disorder of language and a deficit in its articulatory realization, nor tbe relation between aphasia and a left hemisphere lesion. This paper discusses the relatively unknown aphasia studies of two 16th and 17thcentury physicians, J. Schenck and J. J. Wepfer, with respect to these critical elements. Johann= Schenck (1530-1598) assembled a collection of clinical observations from antiquity to those of his contemporaries; Vol. 1 (Obsenutiones Mediate de Chpite Humano, BaseI, 1584) discusses the pathology of the head and face, at least 16 cases of which refer to patients with aphasia. Johannes Jakob Wepfer (1620-1695) wrote a book on the vascularization of the brain and on apoplexy; in addition he wrote (published posthumously) a collection of neurological cases (Observationes Medico-practicae de Afectibus CopirisIntemis & fitemis, SchalTbausen, 1727). In the latter he reported on 222 neurological and neurosurgical cases, at least 15 of which had an overt aphasia, almost all due to a left hemisphere lesion. The level of functional and anatomical detail in these case studies invites comparison with the best of the late 19th century classical aphasia literature. Copyright 0 1996 Elsevier Science Ltd
INTRODUCTION
Benton and Joynt [ 1] traced reports of aphasic disorders from the Edwin Smith surgical papyrus [ 21, the Hippocratic corpus [ 31, the classical Latin period (Valerius Maximus [ 41 and Pliny the Elder [5]), through the medieval and renaissance medical traditions (e.g. Guainerius [ 61). They mentioned a few observations from the 17th century (Schmidt [ 71 and Rommel [ 8]), and a few more from the 18th century (Linnaeus [ 91, Morgagni [lo] and Gesner [ 111). We present here the work of two medical scientists of the 16th and 17th centuries, Johannes Schenck and Johann Jakob Wepfer, whose research has not previously been adequately analysed with regard to the history of aphasia studies. Schenck was occasionally mentioned (e.g. Gesner [ 111, Dax [ 121 and Trousseau [ 131) in the 18th and 19th centuries. O’Neil [ 141 used Schenck as a primary bibliographic source; she discussed several of Schenck’s cases to illustrate her thesis of how models of the central control of speech-ventricular vs meningealchanged during the 16th century. Bouton [ 151 also mentioned Schenck (p. 122) but his footnote indicates that his source was Trousseau (see below) and not the original. The full description Address for correspondence: Dr Luzzotti, Department of Psychology, School of Medicine, University of Milano, Via Tomaso Pini, 1 20134 Milano, Italy. 157
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Fig. 1. Schenck’s picture (from Schenck, J. Paratiriseon, sive, Obsentationum Medicarum, Rararum, No+larum, Admirabilium & Mostruosarum. Volumen Tomis septem de foto Homine fnstitutum, Frankfurt am Main, 1609).
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of the work of these two authors and the relevance of their work for the history of neuropsychology will be the object of a more extensive study (Luzzatti and Whitaker, in preparation). In this paper we will consider some of the cases that are more specific to the history of aphasiology . JOHANNES
SCHENCK
Johannes Schenck (born Grafenberg, 1530; died Freiburg, 1598; Fig. 1) assembled a collection of clinical observations and therapeutic recommendations from antiquity up to his own time from (Observufiones medicue de cupite humuno [ 161). The book summarizes contributions 568 authors (20 Greek, 5 classic Latin, 11 medieval Arabic and Jewish, 37 barbarian Latin, 292 recent Latin and 139 classic non-medical authors). Also included are 64 unpublished cases reported by his contemporaries. In Vol. 1, Schenck discusses the entire pathology of the head, including the skin, teeth and face. We note that Trousseau in his 1865 edition of the Clinique Medic&e (Vol. 2, p. 593) [ 131 cited Schenck (von Grafenberg) as being one of the early physicians who appreciated the essential nature of aphasia. He cites the following passage from the Observutiones, seemingly attributing the words to Schenck himself: On the tongue; on language and voice: disrupted use of language as n consequence of (I memory disorder. and similar major diseases of the brain that, although the tongue I have observed in many cases of apoplexy was not pralysed, the patient could not speak because, the faculty of memory being abolished, the words were not retrieved.
The observation, however, is clearly not by Schenck himself: it is quoted as a personal communication (de observ. propriis) made by a contemporary physician, Jakob Oetbaeus from Eichstatt in Wiirttemberg. * This is merely one of many observations which Schenck collected; the first volume of his book is a gold mine of neurological as well as neuropsychological descriptions, containing at least 16 observations on language disorders. Schenck’s case descriptions are sometimes superficial, but on other occasions they include very clear observations, showing that medical knowledge was more advanced in the 17th century than one might have expected. For example, on the matter of the ventricles as the site of cognitive functions (medieval cell doctrine), we may consider the following observation, which furnishes a clear counter-example to the early Greek (Herophilus) and late medieval traditional ventricular theory of cognitive functions, and in particular the notion that the fourth ventricle is the site of memory skills. The observation comes from a 13th-century manuscript of Teodotico Borgognoni, an Italian surgeon (Lucca, 1205-1298): Wounds of the brain ventricles: the 4th ventricle which is &voted to memory, completely cut out by a wound, wirh memory sparing. I knew of a man, from whom one of the cells (ventricles) had been completely evacuated . . The lesion involved the ventricle devoted to memory, his memory, however, was the same as before. He was actually a saddler and he did not lose his art.
If memory were located in the ventricles, more precisely in the fourth ventricle, how is it possible that a patient with a lesion in this structure did not have any memory disorder? Another point against the ventricular location of cognitive functions is drawn from the following observation describing “memory loss” as a consequence of a parenchymatous occipital lesion, without any ventricular involvement. It was written by AmaNs Lusitanus, a Portuguese scientist of the 16th century (Castelbranco, 1511-1568): *This quotation had earlier been cited by Dax (1865), who was in fact aware that the observation by Schenck.
had not been written
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Hit by a terrible wound, a loss of memory followed. One who received a severe wound in his occipital bone, and of both meninges which he lost together with a part of the medullary substance, and was cured: but he completely lost his memory.
Some of Schenck’s observations on aphasia following brain lesions come from his chapters on ‘Traumatic lesions of the skull and brain’, some from his chapter on ‘Memory disorders’, and others from the chapter on ‘Diseases of the tongue’. Out of the 16 cases with clear language disorder we note several interesting ones. The first is a case described by Gentile da Foligno ([?I -1348): A wondrous example of loss of the faculty of reading and writing (litterarum memoria), ajier the sectioning of a vein. Wondrous beyond doubt was an event that happened in the time of Frederick II to a German cleric, originally from St. Michael’s Rock. After bloodletting from a vein, he forgot only the alphabet, his memory for other things remaining; he was no longer capable of reading or writing, as if he had never learned.
We then find a case of aphasia with alexia and agraphia after a fever, with full recovery in about 1 year. The case comes from the De Arte medendi of Cristobal de Vega (Alcala de Henares, Spain, 1510-1573): As he recovered from an acute fever a certain man suddenly lost his memory and all his faculties connected with reading and writing. I met a Franciscan friar who had suffered an acute fever, and almost immediately after being cured had lost his memory; even though he was an expert theologian he could no longer recognise the letters of the alphabet and did not remember the names of the things most familiar to him. For four whole months he remained in this condition making every effort to relearn the first rudiments, but as soon as the appropriate remedies were applied, and at the end of this period, he returned with wondrous speed to his earlier degree of knowledge.
Another observation comes from the Flemish scientist Tertius Damianus, whose work, Theoricue medicinae, was published in 1541 in Antwerp. It is a clear case of severe aphasia with agraphia and alexia. The case is also interesting for being one of the first descriptions of language rehabilitation: Memoria ex ignota causa amissa et restituta. In France I saw a man, already adult, who knew not only the common tongue and dialect but also spoke Latin fluently; he was very well educated, and played the bagpipes. (Following an accident), he had lost consciousness, and when he regained his senses he had lost all his knowledge, almost as if he had drunk fully of Lethe’s waters of oblivion. In fact, he could no longer name, even with the commonest words, the things he had known so well before, and just like a child in the first class, he was sent back to his study of letters.
From the chapter ‘On apoplexy’, we found a description by Conrad Lycosthenes Alsace, 1518-1561) of his own right hemiplegia and aphasia:
(Russach,
Apoplexiae in paralysin definentes: In the year 1554, on December 21st I was stuck by a horrible paralysis. I slipped slowly to the ground and found at the same time I had lost not only my voice, but also the faculty of feeling and moving my right side, from the head to the feet I could not pronounce one word for twelve days, nor stand on my feet or move even one finger for three whole months As the humors had flowed from the head through the brain, I lost my memory to such a degree-incredible as it may seem to tell it-that I forgot all the words of the mass and the symbols of all the letters.
JOHANN
JAKOB WEPFER
Johann Jakob Wepfer (Fig. 2) was born in Schaffhausen, Switzerland, in 1620. He studied humanities and medicine in Basel, where he received his Doctor’s degree in 1647. He served as army surgeon and was ‘Leibartz’ to Duke Leopold of Wiirttemberg. He died of an epidemic fever in 1695. He is the author of several papers and books, among which it is worth mentioning the following: Observationes anatomicae ex caahveribus eorum, quos sustulit apoplexia cum exercitatione de ejus loco a$ecto [ 171 and Observationes medico-practicae de affectibus cupitis internis & externis [ 181, published posthumously in 1727. Wepfer’s work is even less
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BERNARD1
NULTR,
Fig. 2. Wepfer’s picture (from Wepfer, J. .I. Historiae apoplecticorum, observationibus & scholiis 1724). anatomicis & medicis quamplurimis elaboratae & illustratae (. .). Waesberg, Amsterdam,
known than that of Schenck. In fact, in the modem literature we could trace only a few citations (e.g. ref. [ 191) and one review of the Anatomical observations [20]. A few passages of this book were translated by Clarke & O’Malley [ 211. The Medical-Practical Observations of Affectations Inside and Outside the Head is a collection of several of Wepfer’s carefully wrought case histories. It was published posthumously in 1727 by two of his descendants, Bernhard and Georg Michael Wepfer. The book is very interesting on account of its accuracy, colourful descriptions of clinical histories and its systematic organisation. At least 13 cases with a clear language disorder could be identified; here we translate some of them. Observation
98: loss of memory
This is the description of a transient language disorder with anomia (especially for proper names) and a syntactic disorder. There is no acalculia, nor other neuropsychological deficit. The language disorder disappeared 2-3 days after onset, but the patient presented additional episodes in the following months. We quote some observations made by Wepfer in his long clinical follow-up of the case. R.N.N. is a 53-year-old man in July, 1683 he complained he had suddenly forgotten all names, and in fact he could not even express his own name. He could not designate any object with its name, neither in Latin nor in German. He gave the impression he could recognise things and people, but names did not occur; he tried and tried with all his will to explain what he was thinking on various topics, but he was destitute of his words; those he could utter were alien and incoherent [August 141 Sometimes, however, he could not find proper names for people and places as quickly as customary, and from time to time he could not find some of the little words (verb&m = function word?).
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[August 171 When he was talking, I could observe him from time to time violate syntactic rules and, against the structure of German sentences, he would pre-pose one word to another and sometimes he could not complete a word (loss of morphological suffixes?)
Observation
99: loss of memory
This observation concerns a case of global aphasia with ictal onset; there were no other neurological or neuropsychological symptoms (pp. 38 I-382). The patient is a gentleman from the court of Stuttgart who: at the end of Jan. 1687, without any previous external reasons, suddenly complained of perturbation of his head: he rushed to his house and walked up the stairs. Here, he was abruptly struck by such a severe memory loss that he could not remember any name. Suddenly he could no longer name his wife, nor any of his servants nor any other thing. Sounds were well articulated. He could not read, and if some few words could be read, he could not understand them. However, he could walk to the lavatory, eat, drink
Observation
100: loss of memory with epilepsy
The story of this patient starts with an earlier right hemiparesis, followed by full recovery. One year later, he complained of a right visual disorder. * These symptoms were then followed by epilepsy and subsequent severe aphasia with comprehension disorders, alexia and agraphia with a mild right hemiparesis: In 1684 a councillor of the court of Wtirttemberg was seized by epileptic seizures accompanied by a visual aura: seeing his wife in bed, he thought her to be only half, as if it were a disorder in the right eye (sic). When the seizures ceased, he presented a memory loss: he could not designate anything by its name and neither read nor write. He could speak ah words and letters, but without any understanding. He could eat, drink and walk; he became quite angry because people considered him crazy . This disorder lasted for four days; his memory then improved progressively, but still he could not retrieve the names of many very well known objects, and often he could not finish his sentence after it was begun, either because he could not remember words, or because he forgot the antecedents (pp. 382-388).
Observation
102: loss of memory, followed
by melancholia
There is sudden onset of (global?) aphasia with alexia (p. 397) with no other neurological or neuropsychological symptoms. The patient showed some recovery in about 3 days, and a quite full recovery in another 8 days: A most reverend 44-year-old cleric sat in judgement on a controversy proposed by a peasant; however, when he tried to express his judgement, he could not find the words he wanted to communicate his thoughts . . . From that moment on, he lost his memory so much that he neither was able to call an onlooker by his name nor he could name objects any more. He clearly saw the colours and the features of objects and drawings presented to him, but he could not read or combine letters. All his remaining outward and inner sensations were normal. He recognised his loss of memory and the errors he made while speaking . There was no trace of paralysis; he could pronounce every letter, even the R
DISCUSSION Besides the remarkably detailed and accurate neurological and neuropsychological information, Wepfer’s cases are theoretically interesting, considering the general state of 17th-century medical knowledge. Compared to Schenck’s collection which is certainly more extensive, Wepfer’s cases were carefully selected; most are followed by a dissection and the aetiologicalpathogenic comments are quite sophisticated in comparison to the Zeitgeist of the period [recall that Wepfer made his observations only a few years after Decartes’ death in 16501.
*Wepfer says right eye, but from the description
it appears to be more accurately
interpreted
as right visual field.
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The majority of the language disorders discussed by Schenck are traumatic open head injuries, thus the lesion site (and side) is obvious. For this reason it is noteworthy that in none of his observations is the side of the cerebral lesion reported. Only in one case is the relation between right hemiplegia and language disorder reported (the self-report by Licosthenes). It is probable that belief in the symmetry of the human body was assumed, in which case the side of a lesion would have been considered irrelevant information in a medical report. Most interestingly, this does not seem to be the case in Wepfer’s reports: in virtually all cases he gives the side of the cerebral lesion (and/or of the paresis) and, as we would expect, left lesions predominate when aphasia is present. Wepfer’s observationes are of relevance to hypotheses on the nature of cognitive processes. Wepfer is, arguably, one of the first modem scientists to discuss the nature of cognitive functions using a neuropsychological approach, observing disorders of the components of language. He describes several language disorders. What, however, does not seem to be overtly expressed is the relation between language disorder and left hemisphere lesion. This is quite surprising when one considers how often Wepfer wrote, in his works, the clause, “paralisys dextri lateris, cum loqueiue impedimentum”. * But the scientifical and philosophical milieu in which Wepfer was studying and working did not allow him to understand the relevance of his own observations. Acknowledgements-This study is part of a research programme on the history of nemopsychology, supported by a grant to HW from the SSHRCC. We gratefully acknowledge the help of Adolf Knijpfel of the Swiss Consulate in Milan who helped in retrieving some of the original sources. We are also indebted to Christa Schnepf (University of Stuttgart) who helped in the collection of the bibliographic references in Stuttgart and Tiibingen, and to the staff of the Biblioteca - . Nazionale Braidense in Milan. We are finally grateful to Nicola Cipani who helped in the translation of the sources in Latin.
REFERENCES 1. Benton, A. L. and Joynt, R. J. Early descriptions of aphasia. Archives of Neurology and Psychiutty 3, 205-222, 1960. 2. Edwin Smith Surgical Papyrus. In: Neurological Classics, compiled by R. Wilkins. Johnson Reprint Co., New York, 1965. 3. Hippocrates. Of injuries of the head. In: Hippocratic Wrirings, pp. 63-69. Hippocrates, Galen., English translation by F. Adams. Encyclopedia Britannica, Chicago, 1952 (for the quoted sentence, see p. 69). 4. Valerius, M. Factorum ac dictorum memorabilium libri 9. Lib. 1, Cap. 6. 5. Plinius, S. G. (The Elderly). Nururalis Historiu libri 37, Cap. 24, Lib. 7. 6. Guainerio, A. opera Medicu. Carcano, Pavia, 1481. 7. Schmidt, J. Miscellunea curiosa medico-physica accudemiue nuturae curiosorum, sive Ephemeridum medicophysicumm germunicurum. Annus quartus. Frankfurt & Leipzig, 1676 (but inside 1673). 8. Rommel, P. De Aphonia ruru. Miscellanea curiosa sive Ephemeridum medico-physicarum germunicarum accudemiue nuturue curiosorum. Decuriae II, annus primus. Norimberga, 1682. 9. Von Linne, C. (Linnaeus) Gloemska of alla substantiva och isynnerhet namn. K. Swenska Wetensk. Acud. Handlungen 6, 116-117, 1745. 10. Morgagni, G. B. De sedibus et causis morborum per anathomea investigatis. Venezia, 1761; Simoni, Napoli, 1762. 11. Gesner, J. A. P. Die Sprachamnesie. In: Summlung von Beobuchtungen aus der Atzneigeluhrheir und Natwkunde 2 (but in some copies, printing error: l), pp. 109-182. Beck, Nordlingen, 1770. 12. Dax, M. Lesions de la moitie gauche de l’encephaie comcident avec I’oublie des signes de la penste. Gnzerre Hebdomuduire de Medecine er de Chirurgie, 2, 259-262, 1865 (English translation in Joynt, R. J. and Benton, A. L. The memoir of Marc Dax on aphasia. Neurology 14, 851-854, 1964). 13. Trousseau, A. Clinique Medicale de pH&el-Dieu de P&is, Edition II. Bail&e, Paris, 1865. 14. O’Neill, Y. V. Speech and Speech Disorders in Western Thought before 1600. Greenwood Press, Westport, CT, 1980. *A paralysis
of the right side with language
deficit.
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15. Bouton, C. P. Neurolinguistics. Historical and Theoretical Perspectives. Plenum Press, New York, 1991. 16. Schenck (von Grafenberg), J. Observationes medicae de capite humane. Frobeniana, Basel, 1584. (Then published in Paratin’seon, sive. Observationum Medicarum, Rararum, Novarum, Admirabilium & Mostruosamm. Volumen Tomis septem de toto Homine Institutum (Paratiriseon, or, on Rare, New, Miraculous and Monstrous Medical Observations about the Entire Human Body, in VII Volumes). Base1 & Freiburg, 1584-1597). 17. Wepfer, J. J. Observationes anatomicae ex caakveribus eorum, quos sustulit apoplexia cum exercitatione de ejus loco affect0 (Anatomical observations from the corpses of those who sustained apoplexy, with a discussion of its localisation). J. C. Suter, Schatfhausen, 1658. (Re-published in subsequent years under the title Historiae apoplecticorum, observationibus & scholiis anatomicis & medicis quamplurimis elaboratae & illustratae ( .) Waesberg, Amsterdam, 1724). 18. Wepfer, 1. J. Observationes medico-practicae de affectibus capitis internis & externis (Medical-Practical Observations of Afictions Inside and Outside the Head). Ziegler. Schaflhausen, 1727. (German translation: Medizin-prak&h~Beobachtungen von den innem und aussem Kkmkheiten a’es Kopfes. Weigand, Leipzig, 1787). 19. Isler, H. The origins of neurology in the 17th century. In Neuroscience across the Centuries, F. C. Rose (Editor). Smith-Gordon, London, 1989. 20. Donley, J. E. John James Wepfer. A renaissance student of apoplexy. Bulletin of the Johns Hopkins Hospital 20, l-9.1909. 21. Clarke, E. and O’Malley, C. D. Ihe Human Brain and Spinal Cord. A Historical Study. University of California Press, Berkeley, 1968.
