Samuel Wilks on the need for multidisciplinary neurologic research (in 1864)

A history of dementia often starts in 1907 with the work of Alois Alzheimer, but in reality it should start much sooner. In 1864 Samuel Wilks wrote “Clinical Notes on the Atrophy of the Brain,” which was one of the first studies to point out gross atrophy of the sulci in the brains of persons who had dementia prior to death. This is a great paper! I loved the intro:

WERE an occasional comparison instituted between the experiences of those who practise in special but different departments of the profession, it would conduce not only to the fulfilment of some higher general truths than we now possess, but afford to the individual labourer in his department a more just and less narrow view of the field of observation which is always more immediately before his eye. A close observance to one section of medicine may produce much accurate and minute knowledge, but since the division of our art into branches is artificial rather than real, the knowledge therein obtained is regarded apart from its natural relations, and becomes so distorted as to lose much of its value as truth. If the various sciences into which we divide nature for the purposes of study are artificial, and it be true that an exclusive devotion to one of them can never give to its follower a correct insight into the operations of nature, so more true must it be that the general laws of human pathology can scarcely be gleaned in an exclusive practice in one single department.

It may seem almost impertinent to make these remarks in a Journal devoted to a special object, nor were they, indeed, intended to apply to the study of mental disorders, which must be undertaken in an almost isolated manner; and yet an opinion has obtained hold of me (which, however, may be erroneous) that even here some too narrow views may be held of cerebral pathology, and this opinion, right or wrong, has suggested the remarks in the present communication. To be more explicit: I have thought that those who are occupied in the practice and study of any one department might possibly look upon some morbid condition or other feature in a case, as peculiar to a certain form of disease. Thus, in connection with the subject on which I purpose to make a few remarks, it has seemed to be inferred that a certain morbid phenomenon has been found exclusively in lunatic asylums; and, at the same time, to be inferred by a writer on infantile diseases, and who is probably destitute of the knowledge just mentioned, that this phenomenon is intimately connected with the cerebral affections of children. So, also, with the general subject of the following observations, atrophy of the brain: this has appeared to me to have been regarded by some as a condition attaching to those who have died of mental affections, and not only so, but of some special form of insanity; others would describe a similar condition as resulting from repeated attacks of delirium tremens; whilst others write of a state not distinguishable from these as the ordinary result of old age. From having no inclination towards any of these special departments, I have endeavoured to take a comprehensive view of such pathological changes, and, as regards the subject before us, to discover at what stage our knowledge has reached of this morbid condition, and what is its true pathological significance; leaving it for further research to elucidate its varieties and the different methods by which these are brought about.

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