Brains; More Brains

Funny but disturbing - that should be the maxim of the era of the "cerebral subject."

NeuroCulture Watch

Lucid Thoughts has the scoop.

Argentina on the Collective Mind

BrainBlog notes this conference.

Featured Neurologist: José María Ramos Mejía

Nerve doctor, scientist, writer, journalist, sociologist, and politician, José María Ramos Mejía (1849-1914) was born to a wealthy family in Buenos Aires, the son of Colonel Matias Ramos Mejía and donna Francisca Madero. Although it is unclear in the published secondary sources where Ramos Mejía was educated, it seems that by the time he had graduated as a doctor in medicine, he had founded the Círculo Médico Argentino and published his first and perhaps most famous (if somewhat polemical) work, titled: La neuroses en los hombres públicos de la historia argentina (translated as The Neuroses of Public Men in Argentina). In 1885, Ramos Mejia was appointed to the Hospital San Roque in Buenos Aires, Argentina’s first service devoted to nervous conditions. Two years later, he was appointed to a professorship devoted to neurology at the University of Buenos Aires. His career, however, was not simply as an academic and physician: he was at one time MP; vice president of the Municipal Commission of Buenos Aires; and Chairman of the Board of Education (1908-1912). He published several books on scientific, sociological and historical themes, including an important work of collective psychology titled The Multitudes Argentinas (1899). He also published in prominent magazines and newspapers – “La Prensa,” El Nacional,” and “Freedom”. Some have described him as the “Father” of South American neurology. Such a label, however, restricts too narrowly the diverse professional eclecticism of his life - those are details that should most interest us.

This article is part of an on-going series of biographies published in this blog.

Mariana Soffer posts a succinct essay on depression - thoughtful, eloquent, and theoretically engaged.

A single neuron

Santiago Ramón y Cajal, 1899

Featured Neurologist: William Ritchie Russell

William Ritchie Russell was born in Edinburgh, where he trained under Edwin Bramwell. His father was William Russell, Professor of Medicine, Edinburgh, and colleague to Bramwell’s father, Byrom Bramwell. Educated at Edinburgh University, Russell qualified in 1926. He was Resident Medical Officer at the National Hospital for Nervous Diseases (1928-1930). In 1934, he was appointed Assistant Physician to the Royal Infirmary, Edinburgh. Subsequently, he became Lecturer in Neurology at the University (1938). In 1945, Ritchie Russell became Neurologist at the United Oxford Hospitals, and was First Professor of Neurology at Oxford (1966-1970). Editor of the Journal of Neurology, Neurosurgery and Psychiatry (1948-1969) and Consultant Neurologist to the RAMC (1940-1969), Ritchie Russell published on learning, aphasia, and amnesia. He married Jean Low in 1932, and they had two children.

This article is part of an on-going series of biographies published in this blog.

Primary Source: The Integrative Action of the Nervous System

Sir Charles Scott Sherrington (1857-1952) was born in Islington, London. His father died while he was still very young, and his mother remarried a physician in Ipswich. Subsequently, Sherrington went to Ipswich Grammar School. From there, he matriculated to St Thomas’s Hospital and Cambridge, graduating with high honors and eventually completing the Cambridge ScD in 1904. While at Cambridge, he trained under the renowned physiologist Michael Foster, and as a result of Foster’s influence became interested in the physiology of the nervous system. In 1895, Sherrington had been appointed Holt Professor of Physiology at the University of Liverpool. In 1913, he was offered, and accepted, the Waynflete Chair of Physiology at Oxford. Awarded numerous honors throughout his life, Sherrington was created OM in 1924, and later shared the 1932 Nobel Prize for physiology and medicine with Edgar Douglas Adrian. Although he published numerous articles, essays, and books, his most influential work was a 1906 publication of a series of lectures he gave at Yale University in 1904. These lectures were collected under the title The Integrative Action of the Nervous System.



Few works can compare in importance in the history of the biological sciences to Charles Darwin’s On the Origin of the Species by Means of Natural Selection, which appeared in 1859. In many respects, however, The Integrative Action of the Nervous System can be considered its equal in elegance, argumentation, and generality. Moreover and importantly, Sherrington’s Lectures provided a powerful example of the applicability of Darwinian thought for generating testable hypotheses, focused experimental inquires, and finally for producing rational conclusions about the selection and behaviour of biological structures as well as the intact organism.

Sherrington’s text is infused with two fundamental postulates. Firstly, sensory neurons converge from a multiplicity of directions into one firm, patterned response. He wrote, “The organism, to be successful in a million-sided environment, must in its reactions be many-sided.” In other words, some mechanism in the body takes and summates those signals into “a common final pathway” in order to react to that which endangers the organism the most. Secondly, he argued that those converging neurons and many-sided reactions could be seen through experimentation to be reducible to single units, called reflex arcs. The integrative function of the nervous system is to co-ordinate, connect, control, and respond to the effect the whole external world exerts on those single units.

Sherrington’s scientific work reached a wide academic audience, and his intellectual contemporaries – especially philosophers, physiologists, physicians, and psychologists – found in it a powerful line of reasoning, which connected physiology to emotional states and implied implicit and explicit connections between physiology and psychology. Because of these views, the book has been seen as the cornerstone of the modern neuroscientific doctrine. It is that, but it is much more as well. The book was a model for the ways in which physiological experiments and thought could directly influence clinical medicine. It demonstrated the power of weaving together knowledge from such disparate fields as comparative zoology, pathology, histology, chemistry, and psychiatry. Most of Sherrington’s contemporaries and students would have read the book, and for them the theory of integration would have been more than a theory of the nervous system. It would have been an account of how reductionist thinking could produce knowledge of the whole. It would also have been an example of the ways in which medicine and the life sciences were inextricable and convergent. Thus, The Integrative Action of the Nervous System not only demonstrated principles of biology, it indicated a direction and ideal for what would become biomedicine and biomedical research.

Two of my favorite passages

Lecture IV: Interaction between Reflexes, p. 114

"We have hitherto dealt with reflex reactions under the guise of a convenient but artificial abstraction, -- the simple reflex. That is to say, we have fixed our attention on the reaction of a reflex-arc as if it were that of an isolable and isolated mechanism, for whose function the presence of other parts of the nervous system and of other arcs might be negligible and wholly indifferent. This is improbable. The nervous system functions as a whole. Physiological and histological analysis finds it connected throughout its whole extent."

Lecture VII: Reflexes as Adapter Reactions, p. 235

"It is of course as impossible to disprove as to prove that psychical events accompany, or that they do not accompany the nervous reactions of the spinal animal. It is significant, however, that the best-known controversy (Pfluger, Lotze) as the psychical powers of the spinal cord, occurred prior to the advent of the Darwinian theory of evolution. This latter suggests how purposive neural mechanisms may arise. If furnishes a key to the genesis and development of adapted reactions and among these latter, reflexes.

That a reflex action should exhibit purpose is no longer considered evidence that a psychical process attaches to it; let alone that it represents any dictate of choice or will. In light of Darwinian theory every reflex must be purposive. We here trench upon a kind of teleology. It is widely and wisely held that natural knowledge pursues the question "how" rather than the question "why". The "why" involves a judgment whose data lie so beyond present human experience and comprehension that self-abnegation in regard to the desire to attempt it is not only prudent, but to the unbiased judgment a necessity.

Older writings on reflex action concerned themselves boldly with the purpose of the reflexes they described. The language in which they are couched shows that for them the interest of the phenomena centred in their being regarding as manifestations of an informing spirit resident in the organism, lowly or mutilated thought that might be. Progress of knowledge has tended more and more to unseat this anthropomorphic image of the observer himself which he projected into the object of his observations. The teleological speculations accompanying such observations have been proportionately discredited.

The impetus given to biology by the doctrine of adaptation under natural selection, felt so strongly by morphological studies, seems hardly as yet to have begun its course as a motive force in physiology. But signs being to be numerous that such an era is at hand. The infinite fertility of the organism as a field for adapted reaction has become more apparent. The purpose of a reflex seems as legitimate and urgent an object for natural enquiry as the purpose of the colouring of an insect or a blossom. And the importance to physiology is, that the reflex reaction cannot be really intelligible to the physiologist until he knows its aim.

In general terms we may say that the effect of any reflex is to enable the organism in some particular respect to better dominate the environment. One often hears objections taken to epithets -- common in writings on biology -- "lower" and "higher" as applied to organisms, plant and animal. Such objection seems valid if the phrase assumes that the "lower" organism any less perfectly fulfils its "purpose" or "design" than does the higher, or in those respects in which it has commerced with the environment is any less admirably adjusted than is the higher. But "lower" and "higher" may be used without any connotation of that kind. In the course of evolution a number of organisms have become so adapted to the environment as to dominate it more various and extensively than do other organisms. In that sense some organisms are higher and some are lower. In that sense man is the highest organism. And if evolution be a process of gradual and more or less uninterrupted course it is obvious that the highest form achieved will also be among the latest of the forms achieved. This grading of rank in the animal scale will be nowhere more apparent than in the nervous system in its office as integrator of the individual. The more numerous and extensive the responses made by a creature to the actions of the world around upon its receptors, the more completely will the bundle of reflexes, which from this standpoint the creature is, figure the complexity of the world around, mirroring it more completely than do the bundles of reflexes composing "lower" creatures."

Pete Mandik at Blogs.com

Ten Great Brain and Mind Blogs!

Hat tip: Brain Hammer

Reflex: the history of a word

Today “reflex” refers to non-conscious responses to nervous stimuli mediated by two or more neurons along afferent and efferent nervous pathways. Reflex’s modern usage has been linked with an intellectual lineage originating with Jean François Fernel, and then subsequently changed by such luminaries as René Descartes, Johann Bohn, Robert Whytt, Marshall Hall, Charles Sherrington, and Ivan Pavlov. The word, even in usage today, is more culturally and politically complicated than this uncritical intellectualist account suggests.

Significantly reflex has a relationship with words like reflect and reflexive. Reflex originally meant a bending back, recess, or return. The reflection of an image in the mirror, the sun casting light upon earth, and a man judging himself through the eye of his soul, are all past examples of a process to which reflex as a noun referred. The difference between reflex and reflect is almost metaphysical; the process of reflecting is an example of a mental reflex where the actual action of thought is the reflex.

Similarly, as an adjective, reflex in the past referred to the state of being bent or turned back. It was applied this way by Descartes to explain the reflex motion of animal and vital spirits in the phenomenon we now call the “blink reflex.” Descartes, however, was more nuanced than today’s neurobiological definition suggests. He used the word in two ways: the physical occurrence was a metonym for the conversion of mind and thought upon itself. This signification might be claimed similar to our current understanding of “reflex act”, but it is totally dissimilar. Descartes was signaling the existence of a reflex knowledge that allows us to know what we know: “I think; therefore I am.” Reflex acts, in contrast, are not so much meta-philosophical, but are meta-psychological, and derive from recent Associational psychology. Reflex acts are not tests of ontology but are instead corporeal acts of consciousness predicated upon the belief that reality exists, a belief Descartes was less certain about.


Reflex can also be used as a verb. In the film “The Matrix” Keanu Reeves reflexes through cyber-reality to dodge bullets similarly reflexing towards him through cyberspace and cybertime. This modern example utilizes the oldest definition of reflex as an action. Here it describes an interpolative action; it is a meta-action inserted between or among real or unreal actions, objects, and spaces. To say the mirror reflex’d a person’s image is to refer to an action occurring between the act of the mirror reflecting, the act of standing before the mirror, and the act of mentally interpreting the image. Reflex identifies the action by which an image passes through time and space between the mirror and the interpreter.

Even the twentieth-century neuro-definition is more ambiguous than is commonly realized. It is, for example, divided between geopolitical, socio-cultural conceptions of mind and body. Thus when Sherrington, following Platonic traditions of the English School of Physiology, argued reflexes were involuntary and not connected to mind, the Russian Pavlov criticized him for holding an “Idealist” position. This was, Pavlov argued, the position espoused by a ‘bourgeois’ seeking to deny materialist circumstances; the mind could be reduced to matter only – a point Pavlov believed he had proven through his study of conditioned reflexes.

A combination of all these views has arguably become culturally and metaphorically transcendent today. It is typical to say that society behaves reflexively. In this usage, reflex becomes a socio-psychological metaphor bridging the gab between human action and human morals. Social and cultural assumptions become reflexes involuntarily driving violent human behavior.

What is interesting about these past definitions and the modern neurobiological correlate is that reflex remains a word referring to a passageway between multiple dialectics. It is the object, action, and description of a sublime meta-space between mind and body neither sensible nor scientifically describable. It can only be described philosophically; it is located at once within reason but also beyond it. It can only be subjectively sensed and interpretively reasoned.

An Amusing Exploration of Neurosurgery

Critical Response: FKD Nahm, "Neurology, Technology, and the Diagnostic Imperative," Persp. Biol. Med. (2001) 44: 99-107

In his essay exploring the rise of technology in neurological medicine and the philosophical attitudes that underlie the use of that technology by physicians, Frederick Nahm offers several proposals for consideration. He suggests firstly that no one would argue with the claim that diagnostic technologies like CT and MRI offer an important supplement to the physical exam. Nahm judges that this claim might imply that patients are the chief beneficiaries of these diagnostic technologies, but he proposes the more nuanced perspective that these technologies also offer direct and indirect benefits to neurologists. If Kahn is correct in his view, then broader economic considerations enter into the picture. Does management, for example, have an obligation to prevent the needless use of these technologies when diagnosis is all but certain? Kahn never takes a stand on this question. He prefers instead to state simply that his paper demonstrates that physicians and managers evaluate the usefulness of diagnostic technology in terms of both direct benefit to the patient and direct and indirect benefits for neurologists.

What ought we to make of this argument? Like so many arguments that seek to answer bioethical questions through historical analysis, Nahm's argument places limits so substantial on the structure of his paper that many of the most interesting questions are ignored. He supposes, for instance, that it is obvious that all neurologists have a strong diagnostic imperative. That is, that their single largest motivation is to provide the sick patient with a diagnosis.

While there is no reason to disqualify this view as the ideal, Nahm presents little evidence that indicates that this goal extends in practice to all patients, scenarios and contexts. In any case, we know that it does not, because there are several gates through which patients must pass before they reach the neurologist. In American medicine, for instance, they must pass the basic economic thresholds that demonstrate their ability to pay for their medical care. Secondly, the patient must pass beyond the level of primary care provider to the neurologist, and it is thus likely that many physicians other than neurologists will have conducted these diagnostic tests on the patient before their referral to the neurologist. Without effort, we could identify other gates as well.

The curious feature of Nahm’s argument is that while its logic ostensibly pertains to neurological patients and practitioners, its intentions are to resolve economic questions for management. From a managerial perspective, the important question is how to generate revenue. To this goal, the direct benefits of scanning in hospitals are threefold: They generate fast revenue simply in-and-of themselves. They move patients quickly to those medical divisions of labour best suited to provide diagnosis, prognosis and care, and thereby move them more quickly out of the hospital. They mitigate charges of inaction or incompetence, and thus save capital otherwise paid in consequence of litigation. In other words, the question is not what does technology do or not do for patients, but what does it do for management? As so often happens in bioethical arguments, the author fails to recognize the sources of his question and thereby reduces ethical questions to economic imperatives. The ethical can only be the economic when profit motives are not in the picture.

Alzheimer's Disease

One of the peculiar features of Alzheimer's disease is that few historians have realized how intrinsically interesting the condition is beyond the basic story of its discovery and subsequent construction in medical discourse. Only Jesse Ballenger has made a serious attempt to consider the topic. And he did so only through the lenses of dementia.

Many features of the disease are fascinating and worthy of close examination. The condition is hard to diagnose with certainty. Its aetiology is uncertain. It is unclear whether the characteristic plaques and tangles of the condition are causative of the symptoms, or alternatively whether they are pathological indicators of some underlying and unknown condition. Furthermore, there are genetic abnormalities in some cases. Some patients had mutations of genes that cause the disease to appear very early in life. In others, however, the condition appears spontaneously. One remarkable historical question is therefore how the familial types became synonymous with the non-familial condition.

There are also complex cultural issues: medical anthropologists have long noted that populations in non-Western cultures treat people with conditions that appear similar to dementia with reverence rather than concern. This finding implies that Western responses to Alzheimer's disease are as much a cultural phenomenon as a medical one.

Finally, it would not be appropriate to ignore the economic and social issues surrounding this disease. Patients with the condition need constant monitoring. Patients without private healthcare in the United States, for example, have almost no ability to pay for the little medical treatment that exists to alleviate the symptoms and stresses that follow from the progressive degeneration associated with it. Welfare states, by contrast, are forced to decide how much to allocate to patients with this terminal condition.

Underlying all of these historical questions remains one final one: what is it to be human without memory? Will we stop seeing these patients as living subjects and begin describing them as bodies without selfhood? Only time will tell.

21st Century Zeitgeist

Someday historians will compare the 21st Century art movements that had interests in the neurosciences with those of the Surrealists in the early 20th Century. I suspect that the Surrealists will prove the more substantive. In any case, this site promises to keep track of the manifestations of contemporary NeuroCulture. “The Neuro Times” will too.

Neuroscience Resources

There are many websites with important, critical resources to the neurosciences. The Brainhood Project is a joint venture between the Max Plank Institute for the History of Science (Berlin, Germany), the Institute of Medicine (Brazil), and the State University of Rio de Janeiro (Brazil). This website offers a number of important critical papers in fulltext. "The Neuro Times" will eventually publish "critical responses" to these papers and others.

Featured Neurologist: E. D. Adrian

The co-winner with Charles Sherrington of the 1932 Nobel Prize in Physiology and Medicine, Edgar Douglas Adrian was born in London, the son of Alfred Douglas Adrian, a prominent civil servant. Educated at Cambridge, St Bartholomew’s Hospital, and the National Hospital for Paralysis and Epilepsy, Adrian was a distinguished student, achieving the highest marks ever given to a Trinity Student. At Cambridge, he was Foulerton Research Professor from 1929 to 1937, later became Master of Trinity College from 1951 to 1965, and then Chancellor of the University (1968-1975). His research ranged from studies of sensory neurons to observations on the Berger rhythm. In 1942 Adrian was awarded the Order of Merit, and in 1955 created Baron. Edgar Adrian was one of the most prominent and powerful scientists of his generation, both in Britain and abroad. He was the only non-American in history to become a member of the Board of Trustees of the Rockefeller Foundation. Margaret Thatcher described him as one of her greatest influences as a student. In 1923 Adrian married Hester Pinsent; they had three children. During the Second World War, the Adrian's sent the younger two - twins - to stay with Detlev Bronk in the United States. Adrian used his twins as an excuse to visit the United States, where he engaged in War-time activities related to the scientific and medical defense of Britain.

This article is part of an on-going series of biographies published in this blog.

Book Review: Lewis P. Rowland, The Legacy of Tracy J. Putnam and H. Houston Merritt: Modern Neurology in the United States

With publication of The Legacy of Tracy J. Putnam and H. Houston Merritt: Modern Neurology in the United States, Lewis P. Rowland has produced both a valuable addition to the history of neurology and a scholarly, entertaining and highly readable work. The general narrative of this book contrasts Tracy J. Putnam and H. Houston Merritt’s discovery of the anticonvulsant drug “Dilantin” with a wider analysis of the institutionalization of twentieth-century American neurology. In so doing, Rowland’s book provides details about interwar neurology at the Boston City Hospital, Massachusetts General Hospital, and the New York Neurological Institute, three of the most significant centers for neurology in interwar and post-war North America. Putnam and Merritt warrant this close attention. So too does Rowland’s broader theme, the development of neurology, a topic that has been given short shrift in the secondary literature on the history of psychiatry, psychology, and neuroscience.

Tracy J. Putnam (1894-1975) was born in Boston, Massachusetts. The son of a physician and descended from a family that could trace its lineage back to the Revolutionary War era. Rowland describes Putnam as a Bostonian Brahmin. Putnam’s choice of career likely derived from influences in his father’s generation. In 1873, Harvard University Medical School had appointed his uncle, James Jackson Putnam (1846-1918), lecturer on the application of electricity in nervous disease, and he had subsequently became professor of the diseases of nervous system there in 1893. James Jackson Putnam had retired by the time Tracy Putnam completed his undergraduate degree at Harvard, and he was deceased by the time his nephew completed his medical degree at the medical school. From Harvard, Putnam trained in pathology at Johns Hopkins (1920-21), held a surgery residency at Massachusetts General Hospital until 1923, and then studied neurosurgery with Harvey Cushing at the Peter Bent Brigham Hospital until 1924. Following a wanderjahr in Amsterdam with Bernard Brouwer in 1925, Putnam joined Stanley Cobb’s neurology unit at the Boston City Hospital, where he developed a joint expertise in neurosurgery and neurology. When Cobb moved in 1934 to become head of psychiatry at the Massachusetts General Hospital, the Faculty at Boston City Hospital appointed Putnam chief of Neurology. Perhaps attracted by the larger neurology service there, Putnam moved to the New York Neurological Institute in 1939, where he became Director of Neurosurgery and Neurology at the Institute and Professor of Neurology in Columbia Medical School. For reasons likely related to his principled stand against institutionalized anti-Semitism, Putnam found himself ousted from his Directorship by 1947. He spent the remainder of his days practicing in Los Angeles, where he became interested in multiple sclerosis. Rowland produces substantial evidence that Putnam died deeply embittered by the way he was treated in New York, and that treatment was likely the reason for his distinct coldness towards H. Houston Merritt, his one time “faithful Chef de Clinique” and replacement at Columbia (p. 9).

Hiram Houston Merritt (1902-1979) contrasted in every way from his collaborator. Born in Wilmington North Carolina of Methodist stock, Merritt’s father was manager for a local railroad company. A brilliant student, Merritt had attended the University of North Carolina, transferred to Vanderbilt University, where he completed his undergraduate work, and by 1926, at the age of 24, had completed medical school at Johns Hopkins. Following an internship at Yale, Merritt moved to the Boston City Hospital. He spent time in Munich, studying under Walther Spielmeyer, and then the Harvard faculty appointed him in 1931, where he eventually becoming full professor. Throughout the 1930s, Merritt retained his appointment at the Boston City Hospital. There he and Putnam began their collaborative research on anticonvulsants around 1935, and when Putnam left for New York; Merritt became the interim director of the neurology unit, and would have become director had they not hired Derek Denny-Brown (1901-1981). Merritt joined Columbia Medical School in 1944, and after Putnam’s unceremonious removal, became Director of the Neurology department. He remained there until 1970. Merritt’s textbook of neurology, rivaled in America only by Raymond Adams’, was widely adopted and is now in its twelfth edition.

Merritt and Putnam began collaborating sometime in 1935, and they published seven papers together between 1937 and 1941. Bromides and Phenobarbital were then the only treatments available for epilepsy, and both had unpleasant hypnotic side-effects. Merritt and Putnam’s research thus had the simple goal of alleviating the side-effects while increasing anticonvulsant activity. Using an animal model of epilepsy, and examining 19 chemicals structurally similar to Phenobarbital and provided by the company Parke-Davis, Putnam and Merritt were able to demonstrate that the palliative properties of Phenobarbital could be separated from the hypnotic effects. In their second paper, they reported that the most active substance – Phenytoin – appeared highly anticonvulsant and less hypnotic that Phenobarbital. They were subsequently able to demonstrate similar effects in epileptic patients, and “Dilantin” soon became the best antiepileptic available in the market, and in many respects contributed to a broader shift in the ethos underlying drug development. And that, of course, is the larger story absent from Rowland’s otherwise outstanding effort to tell this story.

As many histories built ultimately on biographical foundations, Rowland’s generally wonderful work is uneven in some places and struggles whenever issues and questions about context arise. His analysis of anti-Semitism, for instance, is strikingly pragmatic and largely avoids delving too deeply into the substantial secondary literature now available on this topic. On the evidently less controversial history of drug development and standardization, Rowland’s book comes up equally short. Though hardly detrimental to the quality of his story, I nevertheless found myself regretting such lapses, especially the lack of attention to the history of drug development. Without an awareness of that history, the reader cannot fully appreciate the significance of Merritt and Putnam’s achievement for neurology.

Among the more significant and generally under-appreciated discoveries of the industrial revolution in the nineteenth century were natural and synthetic dyes that could selectively color biological tissues. These dyes, which were initially used to produce a wider array of colors in silk, cotton, and wool goods, were soon found useful in histological research, because they would selective bind to some tissues but not others. The implications of this observation was that chemicals existed that could be targeted to specific organ systems. Moreover, some of those chemicals might even possess therapeutic benefits.

With the further development of a model of cellular membrane chemistry (derived largely from Paul Ehrlich’s Nobel Prize winning research on side-chain theory and his work on Salvarsan), many clinical researchers began attempting to isolate and purify the biologically active components of these larger compounds. Simultaneously, purification and examination of bodily products like hormones and enzymes had also begun, most famously in the Nobel Prize winning research on insulin conducted by Frederick Banting and Charles Best in the early 1920s. Pharmaceutical companies like Pfizer, Burroughs-Wellcome, Lilly and Company, and Parke-Davis were at the forefront of these developments.

Putnam and Merritt’s separation of therapeutic properties and side-effects was an important demonstration of the multiple types of biological activity possessed by large compounds. But their research was significant beyond that demonstration. Their work indicated that the psychical and organic effects of compounds might be distinct, a finding with profound meaning for neurology and psychiatry. The implications were two-fold: firstly, clinical research could remove the nasty side-effects of some drugs without jeopardizing their curative properties. Secondly, certain chemicals could be isolated precisely for their psychical properties. In addition to these demonstrations, Putnam and Merritt’s work was, as Rowland does note, also among the first studies to apply “basic science results in laboratory animals to disease in humans” (p. 11). In sum, Putnam and Merritt’s work, much in harmony with the times, rooted neurological treatment in a new clinical configuration and thus aided-and-abetted the subsequent rise of psychotropic drugs like chlorpromazine, which was also first discovered in the 1930s.

Even if this more subtle historical picture is missing from Rowland’s history of modern neurology in the United States, his book nevertheless remains important and useful. It represents one of a few works that have ventured into the almost completely neglected terrain of American neurology in the interwar and post-war period. It is a “must-have” for the historian of modern neurology and will be an equally useful book for those historians of medicine interested in the rise of the modern pharmaceutical industry. As a case-study, the work may also be useful for undergraduate teaching, since it addresses multiple salient issues in the history of medicine.