sign in sign up
<<
Home , Vladimir Bekhterev

s p e c i a l f e a t u r e – h i s t o r y o f n e u r o l o g y

Vladimir Mikhaylovich Bekhterev (1857-1927)

and Objective (1907). His lasting JMS Pearce MD, FRCP legacy was on brain morphology, function, Emeritus Consultant Neurologist, Department of conditioned refexes and several original clin- , Hull Royal Infrmary, UK. ical papers. Correspondence to: In the same decade as Strümpell and Pierre J.M.S. Pearce, 304 Beverley Road Anlaby, Marie,6 Bekhterev in 1893 described ankylo- East Yorks, HU10 7BG, UK. sing spondylitis: known both as Bekhterev’s E: [email protected] disease, and Marie-Strümpell disease,7 Confict of Interest statement: None declared observing the rigidity and curvature of the Date frst submitted: 19/12/18 spine, and the Acceptance date: 10/1/19 Article frst published online: 6/1/20 'Ankylosing infammation of the spine To cite: Pearce JMS, ACNR 2020;19(2);26-27 and the large extremity joints.'

But these accounts were long after the convin- cing 17th century instance in a skeleton mong many Russian neuroscientists discovered in a French graveyard reported by A(who included Vladimir Betz, Konstantin Bernard Connor to the Royal Society: Tretiakoff, and Alexander Luria) was Vladimir Mikhaylovich Bekhterev, (1857-1927) (Figure Vertebrae and ribs “were so straightly 1). Neurologist, morphologist and experi- and intimately joined, their Ligaments mental psychologist, he was a most indus- Figure 1 perfectly Bony, and their Articulations so trious, inventive and inexhaustible physician. effaced, that they really made but one Born in Sorali, a remote village between the uniform continuous Bone; so that it was Volga and the foothills of the Ural mountains, he established the frst laboratory of experi- as easy to break one of the Vertebrae into he became a distinguished neurophysiologist mental psychology in . In 1893, having two, as to disjoint or separate it from the and psychiatrist who advanced the functional published more than a hundred papers, he other Vertebrae, or the Ribs”.8 anatomy of the brain, experimental psych- became Professor of at the Military ology, clinical neurology, and conditioned Medical Academy in St. Petersburg, continuing Benjamin Brodie (1783-1862) also had refexes.1 Paradoxically, Bekhterev's disease both neuropathology and neuropsychology described a probable case observed in 1841, (ankylosing spondylitis) is better known than studies.3 As well as his discovery of the superior who complained of pain and stiffness in the his neurological works where he described: vestibular nucleus, succeeding Freud's work dorsal and lumbar spine, buttocks, and knee the acromial refex, Bekhterev's superior he described the central tegmental tract, the joint, plus iritis.9 vestibular nucleus, labyrinthine nystagmus, connections of the olivary nucleus and cere- In his studies of conditioned refexes he the pectoralis refex, a paradoxical refex: bellar peduncles.4 competed with (1849-1936) pupillary dilatation to light, and several arcane The second edition of his Conduction Paths who won the Nobel Prize in Physiology or refexes in the limbs. in the Spinal Cord and Brain 1896 was the most Medicine in 1904. Bekhterev independently As a child Bekhterev spent much of his comprehensive anatomical description of the developed his own theory though it differed time reading the natural sciences. Aged 16, he time. So famous had Bekhterev become that little from Pavlov's notions. After their early enrolled at the Military Medical Academy in the German anatomist Friedrich Kusch, said, years of friendship there developed consider- St Petersburg, and graduated in medicine in able personal acrimony and disagreement. 1878. Already curious about the workings of There are only two persons who know the He insisted on a purely objective approach the brain, from 1884-5 he secured a travelling anatomy of the brain perfectly—God and to the study of behaviour. He was convinced scholarship to study under Flechsig in Leipzig Bekhterev. that complex behaviours could be explained and there described the superior vestibular through the study of refexes, a notion that nucleus—another Bekhterev-bearing eponym. He founded the frst Russian journal on nervous infuenced the growing behaviourism that When he visited Meynert, Westphal, Wundt, disease, Nevrologichesky Vestnik in 1896 and surfaced in America. and Charcot, stimulated by their work he set up the Leningrad Psychoneurological Bekhterev married twice, and had six chil- widened his enquiries. In his 1928 autobiog- Institute in 1907. Here he furthered his inves- dren with his frst wife Natalya Bazilevskaya. raphy, he explained his curiosity about the tigation of the relationship between human While she was living abroad after the Russian brain: brain physiology and behaviour. In politically revolution, Bekhterev met the much younger troubled times he was forced him to resign Berta Gurdzhi. After Natalya died in 1926, he “That time the old expression “textura his Chair in 1913; it was restored following the married Gurdzhi at the age of 70. The circum- obscura, functiones obscurissimae [an of 1917 when he headed stances of his sudden, unexpected death in obscure texture, and the most obscure the department of psychology and refexology 1927 are much debated. He was summoned functions]' could be fully applied to our at the University of Petrograd in St. Petersburg. to the Kremlin to perform a medical examin- knowledge of the brain. My desire to light Bekhterev wrote ceaselessly with extra- ation on Stalin and reported: “I examined a this darkness was the reason to study the ordinary endurance: he was said to need only paranoid with the dry hand”. This comment, brain structure and functioning”.2 fve hours of sleep. The result over 50 years was reaching Stalin (who had a left arm deformity more than 600 scientifc papers and 10 books. after childhood injury and infection), angered When in 1885 he returned to Russia he had His book on refexology (1921) was translated him, as he would not admit rumours about his already secured a considerable reputa- into German and English.5 Among his more mental state. Within a day or two, on Christmas tion. Aged only 28 he became Professor of signifcant writings are Conduction Paths in the eve 1927, Bekhterev was dead. The day before Psychiatry at the University of Kazan, where Brain and Spinal Cord (1882; 2nd ed., 1896) his death he had chaired a congress of Soviet

26 > ACNR > VOLUME 19 NUMBER 2 > NOVEMBER-JANUARY 2020 r e g u l a r s – b o o k r e v i e w s

neurologists in . Many believed that Deep Brain Stimulation: Techniques and Practices the Russian authorities poisoned him,10 though Vladimir Mikhaylovich Bekhterev (1857-1927) there was 'no proof.'11 However, the Kremlin authorities insisted on cremation11 and, his name and all of his works were erased from eep brain stimulation (DBS) Soviet literature until Stalin's death in 1953.12 is an area of practice within The most plausible explanation of Stalin's late DNeurology perhaps analogous to paranoia is 'the dimming of a superior intellect DMT for multiple sclerosis, and selec- and the unleashing of a paranoid personality by tion of epilepsy patient for surgery. a multi-infarct state.'13 That is, a subject with which a general Bekhterev was a dynamic, gifted man who neurologist might be familiar only in explored new felds in psychology and brain a very general sense but nonetheless morphology in a career marked by vagaries and see patients for whom the treatment incident. Eventually, a sculpture was erected in is exactly the right option to pursue, the Volkovo cemetery at St. Petersburg in the maybe sooner rather than later. While 1970s and a 5-ruble stamp in 2007 commemor- sitting in a colleague subspecialist clinic ates him (Figure 2). might appeal as a means of increasing familiarity, it is hardly realistic in view Edited by: William S Anderson of the demand on our time. Published by: Thieme This multi-author volume with Price: £65.00 contributors from The Society for Pages: 175 Innovative Neuroscience is edited by ISBN: 9781626237971 Reviewed by: William Anderson, and has the same Rhys Davies, Consultant Neurologist, Liverpool. level of polish as all the Thieme neuro- surgical textbooks. It is concise and has a reasonable price tag, and is intended primarily for practising neurosurgeons symptoms, without necessarily causing as a quick reference. For Movement weakness, although the pioneers of this Disorders neurologists contributing approach had to contend with criticism directly to DBS services, it might also be from those who held to the prevailing Figure 2. used as a basic reference text. For most wisdom that any surgery to the basal of us, it is best considered as a broad-ran- ganglia would lead to coma. While ging, accessible and authoritative update such reservations seem conceptually REFERENCES on DBS, obviously better suited to most bizarre to us, of course, it’s a mere of our diaries than arranging to sit in on a hair’s breadth from some points in the 1. Yakovlev PI. (1857–1927). In suitable colleague’s clinic. basal ganglia to parts of the brainstem W. Haymaker and F. Schiller (eds), The Founders of If we consider the volume’s poten- where damage would indeed switch Neurology (Springfeld, IL: Charles Thomas), off the lights. 1970;167–71. tial readership geographically, rather 2. Bekhterev VM. (1928) Avtobiografya (Postmertnaya). In: than by specialism, its North American As to the sequence of chapters, they Biblioteka “Ogonyok” (Moscow: Pravda) cited by Lerner readers are offered some pointers on range from sections describing DBS et al. 12. the practicalities of setting up a DBS treatment in specifc conditions, from 3. Bozhkova E. Vladimir Mikhailovich Bekhterev. Lancet neurosurgery ‘business’ in the last PD through other movement disorders, Neurology. 2018;17(9):744. chapter. It is also noticeable that some, to psychiatric conditions and epilepsy. 4. Bechterew V. Ueber die functionelle Beziehung der unteren Oliven zum Kleinhirn und die Bedeutung derselben but not all, of the individual chapters’ The ordering seems reasonable, but it für die Erhaltung des Körpergleichgewichts. Archiv für die authors adopt the style of referring to would have felt more natural for me gesammte Physiologie des Menschen und der Thiere. authorities of past and present by title, if tic disorder has been grouped with 1882;29:257-64. i.e. Dr Smith rather than just ‘Smith’ the movement disorders rather than 5. Bechterev VM. General Principles of Human Refexology: after the psychiatric ones. A factual An Introduction to the Objective Study of Personality. having done or written such-and-such. (London: Jarrolds Publishers). 1933. I think that may be a North American tidbit I won’t forget, not least because 6. Pearce JMS. A note on (1853–1940). practice. That quaintness and slight I should have been able to work it out Journal of Neurology, Neurosurgery & Psychiatry inconsistency aside, the chapters read for myself, is that the internal segment 2004;75:1583. very well, and the volume as whole is of the globus pallidus is a bigger thing 7. Bekhterev VM. Ueber ankylosirende Entzündung der Wirbelsäule und der grossen Extremitätengelenke. very coherent. than the subthalamic nucleus and, Deutsche Zeitschrift für Nervenheilkunde, I was about make note of an omis- therefore, technically easier as surgical 1899;15:37-45. sion for this review, that the role of DBS target. But of course, there are other 8. Connor B. Philos.Trans. 1695;19,21. Cited In: Inman in status dystonicus was not mentioned. interesting, practical insights. R, Sieper J. Oxford Textbook of Axial Spondyloarthritis. Holistically, the volume’s ethos is Oxford University Press, 2017. But, while it is not covered in the 9. Brodie BC. "Diseases of the Joints." 5th Ed. London: Dystonia chapter, I found that it was very much pro-DBS, which is obviously Longman, Brown, Green, 1850. described in the chapter on DBS in fair enough for the business-minded 10. Kesselring J. Vladimir Mikhailovic Bekhterev (1857– Paediatric practice. DBS neurosurgeon in jurisdictions other 1927): Strange Circumstances Surrounding the Death of In the historical introduction, I was than ours! I must say, I think that ethos the Great Russian Neurologist. Eur Neurol is also appropriate for clinicians on the 2011;66:14-17. interested to hear that Horsley in the 11. Topolyansky VD. (1989) Noch’ pered rozhdestvom early 1900s treated a patient suffering front line of managing a whole range of v 1927 godu [The night before Christmas in 1927]. involuntary movement of one hemi- ‘DBS-able’ diagnoses, be they neurolo- Ogonyek, 9–10, 27. Cited by Lerner et al. body, by contralateral resection of the gists, other physicians or psychiatrists. 12. Lerner V, Margolin J ,Witztum E. Vladimir Bekhterev: motor cortices, i.e through causing On the whole, I think we should be his life, his work and the mystery of his death. History of Psychiatry 2005;16(2):217-27. paralysis. By the 1930s, however, more alert to the suitability and avail- 13. Hachinski V. Stalin’s last years: delusions or dementia? lesions of the basal ganglia were ability of DBS for our patients, and this European Journal of Neurology 1999;6:129-32. deployed to relieve movement disorder volume contributes usefully to that.

ACNR > VOLUME 19 NUMBER 2 > NOVEMBER-JANUARY 2020 > 27