Featured Neurologist: Edward Farquhar Buzzard (1871-1945)

Edward Farquhar Buzzard was born in London, the son of Thomas Buzzard, a founder of British neurology. Initially more renowned for his athleticism than his academics, he attended Oxford University's Magdalen College and received his medical training at St. Thomas’s Hospital, eventually qualifying in 1898. Training under his father, Thomas Buzzard and John Hughlings Jackson, whom he had known as a boy, Buzzard became Physician to Out-Patients in 1905 at the National Hospital for Epilepsy and Paralysis. He held various positions including a lecturer at the Royal Free Hospital and a position at the Belgrave Hospital for Children. From 1910 until 1926, he was Physician at St Thomas’s, a position he held until being appointed Regius Professor of Medicine at Oxford. He also served in a medical capacity in WWI. A shooter and fisherman, the unusually silent Buzzard was created Baronet in 1929. He was also appointed Physician Extraordinary to the King in 1924 and 1932. He was a member of many organizations including the Association of British Neurologists (ABN), the Royal Society of Medicine (RSM), the British Medical Association (BMA) and the Association of Physicians. He eventually became president of the ABN, RSM and BMA. He was awarded the Osler Medal in 1940. Although his writing skills were valuable and sound, he was regarded as a somewhat ponderous lecturer. Nevertheless, though he was primarily a neurologist, he excelled as a clinician in every branch of medicine. He eventually published a monograph on the pathology of the nervous system. He married May Bliss; they had five children.

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

Pet Peeves about Psychological Testing

It often happens that a psychologist will make some new discovery using a test. The discovery will usually involve some neurological observation. The psychologist will then pronounce that his or her test has proved that the nervous system has made or can make a mistake and that this proves or suggests x, y, or z. That’s a wholly spurious conclusion. The nervous system does not make mistakes. Evidence of abnormal functioning is evidence of an underlying state of being. The brain or nervous system is doing precisely what it is supposed to do under the new conditions discovered by the psychologist. Thinking that the brain has made a mistake can lead to many strange conclusions that are all products of the experimenter’s mind. The right question to ask is: “what is the brain doing now?” And proceed from there.

"Imaging tests are now responsible for half of the overall radiation Americans are exposed to..."

Lyotard remarks somewhere that its possible for things to seem like they are getting better and better even as they get worse and worse. Perhaps this is especially true in medicine. And the rise of the CT and MRI are likely to blame. In the New York Times, Abraham Verghese discusses the way in which computers have transformed the hospital, hospital practice, and the doctor-patient relationship. He makes several interesting claims, among them this:

Imaging the body has become so easy (and profitable, too, if you own the machine). When I was an intern some 30 years ago, about three million CT scans were performed annually in the United States; now the number is more like 80 million. Imaging tests are now responsible for half of the overall radiation Americans are exposed to, compared with about 15 percent in 1980.

He also observes that:

Of course, we still teach medical students how to properly examine the body. In dedicated physical diagnosis courses in their first and second years, students learn on trained actors, who give them appropriate stories and responses, how to do a complete exam of the body’s systems (circulatory, respiratory, musculoskeletal and the rest). Faculty members stand by to assess that the required maneuvers are performed correctly.

But all that training can be undone the moment the students hit their clinical years. Then, they discover that the currency on the ward seems to be “throughput” — getting tests ordered and getting results, having procedures like colonoscopies done expeditiously, calling in specialists, arranging discharge. And the engine for all of that, indeed the place where the dialogue between doctors and nurses takes place, is the computer.

The consequence of losing both faith and skill in examining the body is that we miss simple things, and we order more tests and subject people to the dangers of radiation unnecessarily.

The deskilling process Verghese describes here fits with deprofessionalization models commonly described by sociologists in the 1970s. Deprofessionalization occurs when professionals lose the facility to control their practices. They tend to lose exclusive rights to their work. Their work becomes more routine and thus less obviously "expert".

Ever since the political shift towards deregulation occured in Anglo-America, forces working towards deskilling and breaking professional monopolies in medicine have grown. The rise of PAs and nurse-practitioners, while good for those professional groups, signals not jurisdiction disputes between medicine and its allied sciences, but the movement towards deprofessionalization.

Technology in the hospital has exerted similar pressures. And, of course, insurance companies and hospital administrators, themselves working under crushing structural forces, have placed an ever-firmer boot on doctors and surgeons (especially young ones in training). The phenemena described by Verghese have thus been widely-acknowledged in academia.

But probably no one has been more aware than patients of these changes. And for all of medicine's successes in some areas - e.g. cancer - there has not been a major shift in epidemiological terms. Medicine is good at getting you to age 80. After that it is genetetics and luck.

And getting the patient to 80 only describes a circumstance of health. Ask difficult questions such as how did that patient pay for those medical services, what is the quality of their life in material terms, and what was their experience of medicine like, and the answers will be uniformly disquieting. (Don't believe me? Visit five nursing homes, five out-patient clinics, or five emergency rooms and stay in each for an eight hour period. You will believe me then.)

Curiously, however, few have acknowledged the decline in medical care that has accompanied these trends. Certainly, medical practitioners' unrelenting belief in the progress of science doesn't help. It shuts down critique of the order of things. The mantra appears to be "keep up appearances."

But that places too much blame on medical practitioners. The problem is simply deeper. While technology not only deskills and depersonalizes, it also operates in the service of the illusion that something futuristic is happening in the hospital. It claims that the banality of illness can be offset by the innovative, the mechanical, and the 'screenshot' of the body.

Technology, to crib from Paul Forman, is about "ends, lots and lots of ends". But I think medicine is factually about means. Treatment, the healing process, doctor-patient relationships, placebo effects: these are all phrases conjuring up the notion that the ends of medicine are health and the practices of medicine must thus be means.

Not only does technology disturb those relations, it moves doctors further away from their patients. It alienates doctors and surgeons (and nurses and PAs) from their labor. Technology turns the hospital into a techno-marketplace. The hospital ceases to be a house of healing, and becomes marketplace for manufactuors to sell their wares.

This game costs hospitals. It taxes civilian electrical grids. It stymies the profits of insurance companies. It causes medical school tuition to raise. It drives up healthcare costs. It causes social welfare systems to become insolvent. And probably most important, it costs healthy people.

Meanwhile as the process of deskilling and depersonalization accompanies these empirical realities, few doctors understand what they have given up and few patients realize how little changed their prospects are. Everything looks better, fancier, newer, and flashier. Bright lights, harmonic beaps, and the silent hum of hydraulics all contribute to the spectacle. Ask the tech users what they think and they'll voice disquiet, concern, and worry that their patients imagine too much from all of the equipment.

But for all of those complaints the equipment in the hospital continues to be used. It does little more than measure better what could already be known by the hand and time but that assumes that the medical practitioner has both time and access to the "art" of medicine. They don't. Their time is now managed.

Gandhi once observed that the health of a society was inversely proportional to the size of its hospitals. Depressed? Don't worry, there's a pill for that. But just to be safe and certain that its not something else, why not get a second opinion and some scans first? Everyone will be happier.

Cell Phones Do Something

http://jama.ama-assn.org/content/305/8/828.full

Contemplating Theories of Everything

Garret Lisi's use of coral to help articulate his theory of the structure of reality led me to substitute the word "neuron" for "coral" and then contemplate how this might relate to consciousness. Part of the challenge that strikes me as worthy for consideration is visualizing beyond four dimensions. 4D tesseracts are very hard to understand without resorting to optical illusion language. Most of us lack the mathematical background to come even close to understanding these models.



It strikes me that the challenge to understanding the E8 model is in part the dominance of our visual system. It is difficult to put all of our senses together into a coherent model of "being". Invariably developmental psychologists and neuroscientists focus on one of the systems, with the visual or auditory systems attracting the most attention.

Bennett and Hacker's study of the philosophical foundations of the neurosciences is very good on this point.

The Manuscript Books of Emily Dickinson



Manuscript pages from 280 ("I felt a Funeral, in my Brain")

I felt a Funeral, in my Brain,

And Mourners to and fro

Kept treading - treading - till it seemed

That Sense was breaking through -

And when they all were seated,

A Service, like a Drum -

Kept beating - beating - till I thought

My mind was going numb -

And then I heard them lift a Box

And creak across my Soul

With those same Boots of Lead, again,

Then Space - began to toll,

As all the Heavens were a Bell,

And Being, but an Ear,

And I, and Silence, some strange Race

Wrecked, solitary, here -

And then a Plank in Reason, broke,

And I dropped down, and down -

And hit a World, at every plunge,

And Finished knowing - then -

(original here)

Exhibits in Science, Technology, and Medicine

Biomedicine on Display offers an amazing manifesto on creating exhibits focused on science, technology, and medicine. Two "rules" struck me as being particularly important for public humanities projects:

Reject most exhibition ideas: Exhibitions represent the meeting point between subjects and material culture, and can be approached from either end – themes or objects first, or a mixture of the two. But often, topics that seem promising will not be worth developing because there simply aren’t good enough objects with which to explore or support them.Similarly, many areas of material culture end up just not being interesting enough to make a show about. Too often, exhibitions are made from empty ideas of stupid objects. It is worth searching for a topic and a set of objects that harmoniously amplify and mutually enrich each other.

And also:

Make exhibitions for inquisitive adults: If you aim at educationally under-achieving primary school children, it will be impossible to engage anyone else (and you are unlikely to engage even your target audience). Many children and teenagers are keenly attracted to adult culture, but very few adults see the attraction of young material. Never make exhibitions for educational purposes – other media and methods are more effective. It’s also worth bearing in mind that exhibitions are, by their nature, a “childish” medium, bringing out playfulness in all of us. This should be encouraged, but to focus deliberately on young audiences reaps diminishing returns.

It is striking how many museums are guilty of making both of these mistakes. I have noticed that many museums in the United States often assume that the people attending their exhibits have a junior school education only and accordingly "lower the tone". Yet part of what makes museums "entertainment" is the uncertainty and ambiguity. Cultivate those qualities in your visitors and they will come back for more. Patronize them, and next time they'll ask whether its worth the price of admission.

Reflections on Melville’s “Bartleby”

Numerous literary critics have now contemplated the meaning of Melville’s story. Why is the location “Wall-Street”? Why is the protagonist of the story so charitable to the eccentric, seemingly-mad Bartleby? What is the story about?

The short story opens with the narrator, a lawyer and an owner of a scrivener’s trade, confessing that he has always looked for the paths of least resistance. It is for this reason that he keeps “Turkey,” an old, overweight and “energetic” man prone to outbursts of rage. It is also for this reason that he keeps “Nippers,” a man at once ambitious and at the same time indigestive. Then there is the boy: "Ginger Nut". Ginger Nut is largely useless, but costing little, there seems not the slightest point in getting rid of this young apprentice. And lastly enters the character of Bartleby, the best scrivener of them all, but a man who works only as a copyist and expresses an on-going preference to nothing else. Bartleby is always there. He never leaves. He hides. And eventually he prefers to do nothing at all.

The narrator astonished at Bartleby’s evolution, finds that he is unable to conjure up the will to remove the man from his office, which, it soon becomes apparent, Bartleby actually inhabits. Circumstances become so unsettled in the narrator’s mind that he eventually moves his offices to another place, leaving Bartleby behind, to unsettle the next tenants, who shortly return the passive but non-compliant Bartleby to the narrator. Dejected by Bartleby’s return and uncertain of his next course of action, the narrator leaves Bartleby on the stairs of his office. By the next morning, Bartleby has been sent to the “tome,” a prison complex in old New York City. It is there that he dies to be with “kings and councilors”.

It is an uncertain story and a treasure of American literature. But as I was reading it, I found myself wondering: “Is there not a “Bartleby” in all of us?” I doubt that Melville intended his depiction of madness to offer that meaning. But if there is a “Bartleby” in all of us, then it is not merely a rejection of social or economic yokes. Nor is it our own version of “madness”. The “Bartleby” in us rejects, objects, and ends up “abject” because to do otherwise is to surrender to something that is abject, objectionable, and worthy of rejection.

Tempting as it is to conjure here allusions to original sin, Calvanist predestination, Diderot’s fatalism, Marx’s alienation, or Camus’s absurdity, it strikes me that the important quality of Melville’s story is the ambiguity. It is strange that so many narratives – religious, literary, metaphysical, or scientific – attempt to unmask the essence of that ambiguity. How wonderful it must be to tame our own inner “Bartleby” with religious injunction, cultural certainty, and social conformity. How wonderful to exercise power over the “Bartleby” in others.

Perhaps Melville is onto something. Strip away modern values or pre-modern atavisms. Ignore the will-to-power too. Then what is left of the man? Stripped bare of everything, I think Melville is saying the mystery of resistance remains. “I’d prefer not to,” a quote for the ages; an heir apparent to the voice of noncompliance.

It is a cliché of science fiction to say “resistance is futile”. It seems to me that Melville suggests via Bartleby that resistance is everything. To be human is to resist. We are all Bartleby now.

When Did Government Support of Neurology Research Begin?

Government patronage of full time biomedical researchers was largely without precedent in Interwar Britain. The full time clinical investigator was rare. Young doctors often conducted research towards their higher medical degree (MD), which in part established their reputations as practitioners in a special area of medicine. From there, however, it was rare that these doctors continued clinical investigations. Their time was almost wholly given over to hospital medicine with the ultimate goal being private practice.

Thus it was often and widely remarked that many of the most important discoveries in British medicine had occurred during long unrecognized evenings of labor, often taking place in dark basements or other poor facilities that served as ad hoc laboratory space. While such rhetoric obviously served to fashion a heroic narrative about the advance of British medicine, it also spoke to the reality that research facilities in medicine, as well as funds to support them, were rare indeed.

It appears that Britain’s first full time clinical neurological researcher was Edward Arnold Carmichael, Director of the Medical Research Council’s Clinical Neurology Research Unit at the National Hospital, Queen Square from 1933-on. Carmichael’s career perhaps best exemplifies the challenges to creating government positions for biomedical research. In the absence of precedents, no one was entirely certain how achievement and excellence in research performance could be measured. That problem haunted Carmichael and his unit throughout his career. It is a problem that seemingly remains a commonplace even today. Carmichael's strategy might be described as the "publish or perish" attitude. He became editor of Kinnier Wilson's Journal of Neurology and Psychopathology which he renamed the Journal of Neurology and Psychiatry. That organ became the default place of publication for research conducted in his unit.

When did government supported neurology research develop in other countries? Were there earlier precedents in Britain? Questions like these remain to be answered. But they point to the larger problem of definitions: what precisely counts as neurological research? Haymaker and Schiller tried to answer this question in their Founders of Neurology, but letters in their archives indicate that the definitions were not obvious to them. Nor should they be for us.

Chart of the Day

Examining keywords in the history of neurology and neuroscience reveals the rapid emergence of several specialties connected to the science and medicine of the nervous system.

Where did the silver spoons go?

One of the first biographies published in this dictionary was for Dr. Wilfred Harris. An anonymous commentator answers the antiquarian question of where Harris's collection of silver spoons went by pointing us to his BMJ Obituary:

One of Harris's great interests was the collection of early
English silver spoons, a hobby which he took up when only
18. At the dinner held at St. Mary's to celebrate his 80th
birthday, the gift to him by his colleagues of two spoons
for his collection was obviously -one which touched him
deeply. His collection of 80 choice specimens was sold at
Christie's in 1957 and fetched no less than £14,876. Among
them was an Edward IV spoon of 1463 which is probably
the earliest example of English silver bearing a date letter;
it was bought for £1,600, a record price for any spoon. His
interest in other types of antique craftsmanship is witnessed
by his presentation to Caius College of an antique mahogany
clock made by Tutet in 1765.

Many thanks! The historical question, of course, is why do facts like this continue to be remembered. We could point to a whole host of unremarkable trivia about neurologists that we nevertheless know. Gordon Holmes interests in Gothic architecture. William Gooddy's interests in fonts and the making ceramic tiles. Hughlings Jackson's love of penny novels. T. Grainger Stewart's mountaineering. Wasn't E.G. Robertson renowned for his love of iron-making? Countless others are available. Add your own if you like.

Are sports fans just more primitive?

Wray Herbert, at The HuffingtonPost, describes what happens in the brain when sports fans see a player from a team they hate make a mistake.

Whether it was the joy of a favored player's home run or the joy of a rival's strikeout, the fans' brains lit up in the same spot -- the ventral striatum. This region is associated with the subjective experience of pleasure, and indeed the fans described both personal victory and schadenfreude as pleasurable. What's interesting -- and new -- here is that these were the brains of fans, not the players themselves: The brain's pleasure centers are known to fire up over a competitor's personal victory, but here they were showing the identical response on behalf of a team, a group.

From here, the Herbert follows this line of thought straight to evolutionary explanations:

Pleasure over another's misfortune may be an ancient and evolved aspect of group identity, so it's understandable even if it's unbecoming. But the link between schadenfreude and extremely aggressive thoughts about "them" is worrisome, since many group rivalries are far more emotional and perilous than a day on the diamond -- even if that diamond is at Fenway Park or Yankee Stadium. Indeed, that natural tendency may be a curse more consequential and enduring than the "Curse of the Bambino."

In recent years, such psychological research has become commonplace and merited publication in prestigous organs like Science.In an article entitled "When Your Gain Is My Pain and Your Pain Is My Gain: Neural Correlates of Envy and Schadenfreude" Takahashi et. al. demonstrated with fMRI that an area of the brain called the anterior cingulate cortex became activated when people feel envy for another's successes. The corrolary, however, was that they also felt joy when misfortunate happened to the same person, and that corresponded to activation of the ventral striatum.

What to make of studies like these? There are so many tempting historical quips: Spurzheim rejoiced at Gall's disappointments comes to mind. But, of course, the serious problem here is not neo-phrenology, but rather how psychologists extend these insights from a circumscribed population to the population writ large. And don't think that they don't!

But what does this mean for us? What if, for example, you don't feel schadenfreude at all. The first time I'd even heard the expression was at a viewing of the off-broadway show "Avenue Q". (As an aside, I suspect that the word really entered English mainstream parlance through that politically conservative show.)

"Schadenfreude" as measured by Google Ngram Viewer. Usage increases after 1980.

Obviously many native-English speakers had felt emotions like envy and jealosy before and perhaps they had even experienced happiness - and how sad for them! - at the misfortunes of others. But that is a far cry from claiming either a) that we all experience these emotions, or b) that only certain groups of us experience these emotions. Yet ultimately that is the conceit studies like the above force us to assume: either the phenomenon they describe are ubiquitous throughout all populations or they are more strongly held by some groups. Contemplate all of the ugly possibilities both scenarios create (or just read this article by George Lakoff)! Reducing people to their neurobiology is neither scientifically sound nor politically smart. And the sad part is the whole project can be pithily answer with two questions: "what's an emotion anyway?" and "are humans only their brains?" But hell, who care's about questions like those anyway when we've got fMRI images that tell us everything we need to know.

Rarely do I find myself in agreement with Fukuyama - but he's right on this one. Check out:

Our Posthuman Future: Consequences of the Biotechnology Revolution

And now for something slightly different

While working on a bit of research about how physiologists were involved in the creation of "Big Science," I stumbled upon an interesting story about British medical students who came to American medical schools during the Second World War. I published this article in the BMJ on the topic. Enjoy.

Medical History

A new volume of Medical History appears and with a seemingly new mission:

This issue also signals changes in the intellectual aspirations of Medical History. Its articles, addressing the themes of transnational communication, health promotion, forensic medicine, socialism and psychology, and critique of globalisation and visual culture, suggest the wider range of subjects, discourses, and approaches we wish to encourage. While articles across time on the history of disease, institutions, and the professions involved with health and healing are still very much to be welcomed, we particularly invite those that move on historiographically as much as empirically. Indeed, we invite those that through solid historical research contribute to the better understanding of the world in which we now live and of which history writing itself must be regarded as constituent – perhaps rather more self-consciously than in the past. New ‘manifestos for history’ have been written, and we invite those who focus on health, healing, and the body to engage with them robustly, challenging and extending them. At a moment when the discipline of history and the humanities in general are under threat from forces both economic and intellectual, it is time to up the value of history as a resource in public thinking. In our biologised world, historians of medicine have the privileged expertise to do so. We invite contributors to take full advantage of it.

I especially enjoyed this article on the transnationalism of psychiaty (and "yes!" that's an immodest plug for my own work).

ISHN Calgary

The International Society for the History of the Neurosciences (ISHN) and The International Society for the History of Behavioral and Social Sciences (Cheiron) are pleased to announce their first ever joint meeting from June16-19, 2011 on the campus of the University of Calgary. A workshop following the meeting will be held in the spectacular setting of Banff, Alberta from June 19 to June 23.

Historians, neuroscientists, psychologists, psychiatrists and other professionals with an interest in the history of the neurosciences and the behavioral sciences will gather in Calgary, Alberta in June of 2011. An exciting program with unique social events is on offer. Stay tuned to this site for the upcoming Call for Papers, Registration Information and more.

For more information, visit:

Program Highlights:

In addition to the five keynote lectures the following highlights will form the framework of the conference:

- Introductory Lecture on the History of the Canadian West by the Head of the University of Calgary Department of History, Professor Warren Elofson

- Wuensche Lecture by 1981 Nobel Prize Laureate Dr. David Hubel (Harvard University) – this will be tele-transmitted, while Dr. Hubel has kindly agreed to give another lecture to ISHN and Cheiron. He will also be with the conference participants, attending the Banff Retreat with Workshops, for an evening session featuring his outstanding career in the neurosciences

- Evening lecture and piano presentation by and with Professor Axel Karenberg (University of Cologne)

- 1-2 sessions on educational and fictional films in the history of psychology and neuroscience, organized by a Cheiron committee and supported by ISHN members

- Reception in the new Taylor Family Digital Library with representatives of the Hotchkiss Brain Institute, a book viewing of collection items from the past 500 years, and poster display of student posters

- A teaching panel on the history of psychology and neuroscience to exchange experiences with our colleagues from Cheiron and to discuss strategies and programs to promote student teaching and training in our field (undergraduate, graduate and postgraduate)

- Award Banquet together with Cheiron at the Calgary Heritage Park Historical Village

- Public Lecture of Professor Elizabeth Lunbeck (Vanderbilt University) in the Calgary Downtown Centre

After our bus transfer to the Banff Centre for the Arts on June-19, 2011 the retreat in the beautiful setting of the Rockie Mountains will include the following workshops:

- "Mind and Body Medicine" Monday, June-20 (2011) - (Morning and Early Afternoon)

- "The 'Hard Problem' in History" Monday, June-20 (2011) - (Later Afternoon)

- "Eugenics and Psychiatry" Tuesday, June-21 (2011) - (One Day Workshop)

"Student History of Neuroscience Poster Workshop" - Wednesday, June-22 (2011) (Half Day or One Day Workshop -- depending on number of submissions)

Räume der Lange-weile

More self-advertisement / something for the especially bored:

A little history of neuroscience (ish) essay, called Biophysikalisches Doppelleben, 1939–1946. Oder: Räume der Lange-weile [meaning, in a not so elegant translation, Biophysical Double-lives, 1939-1945. Or, Spaces of Boredom] - of use only to those who know some German, I'm afraid. (Mostly due the fact that it deploys some very cleverly thought-out puns on the word "Langeweile" which only work in German really).