American pediatrics: the social dynamics of professionalism 1880–1980

Wernicke's aphasia, Wernicke's encephalopathy, Wernicke-Mann hemiplegia, Wernicke's area, Wernicke's bundle, Wernicke's fissure .. .: such monuments to the localization of mental disorders in cerebral pathology are familiar to every student of psychiatry and higher cortical function. In this workman-like, if brief, biography, Lanczik shows how Wernicke exemplified the achievements of the German-Austrian materialist traditions pre-eminent in the study of "nervous diseases" in the late nineteenth and early twentieth centuries. A Silesian, trained in the neurological clinics of Griesinger's Berlin and Meynert's Vienna, Wernicke was singularly well-qualified, and well-placed, when he took up his professorship in Breslau in 1885, to capitalize on the geographical advantages which made this university town open to both Prussian and Austro-Hungarian influences. Convinced that psychological states and processes could be localized to precisely demarcated areas of the brain, Wernicke went beyond meticulous clinical and anatomical description, of which he was a master, to classify and schematize his observations, and thence to over-simplify them. Lanczik pays little attention to the rumblings of dissent from strict cerebral localization in the medical literature of Wernicke's time. He confirms, however, that shortly after Wernicke's death, when the rumblings had swelled to a roar, the dogmas of localization fell into disrepute. Wernicke's many distinguished pupilsBonhoeffer, Heilbronner, and Liepmann, among them-made plain that his lasting contribution lay in his masterly observations, which called for supplementation and systematic interpretation rather than the rejection of all localization, as the anti-materialist critics would have it, as so much "cerebral mythology". With recent advances in the study of higher cortical function in the neurosciences, principally in the field of vision and perception, the pendulum has swung back towards "materialism". But analysis is at a different level to that practicable in Wernicke's time and the focus is now not on cortical areas but on their cellular architecture, functional organization, and neurochemical and neurogenetic correlates. With the emergence of a new precision in the description of cortical structure and function, clinical observation and its interpretation in the light of the "new" neuroanatomy has become even more instructive. We would do well to follow Wernicke's lesson in this regard. This little book, in cataloguing the distinctive contributions ofWernicke, with a sketch of their subsequent history based on a modest selection of the voluminous sources available, demonstrates the need for broader intellectual biography which would illuminate a decisive chapter in the history of the search for a physical basis of mind.