J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.23.3.185 on 1 August 1960. Downloaded from J. Neurol. Neurosurg. Psychiat., 1960, 23, 185.

RELATIONSHIPS BETWEEN BRITISH AND RUSSIAN MEDICINE AND NEUROLOGY, AND THE ROLE OF THE NATIONAL HOSPITAL, QUEEN SQUARE, LONDON, IN THE DEVELOPMENT OF RUSSIAN NEUROPATHOLOGY* BY N. I. GRASHCHENKOV Moscow, U.S.S.R.t The links between Russian neuropathologists and between the Tsar and Lady Hastings. Robert also the National Hospital are only a historical and enjoyed Elizabeth's confidence in equal measure and logical continuation of the fruitful relationships she entrusted him with some very responsible which have long existed between the medical pro- diplomatic missions at the Moscow court. Jacob fessions in the two countries. These are rooted in Robert became so steeped in the Russian life and

the distant past. One of the first English doctors to customs of that time that he was even called by a guest. Protected by copyright. visit Russia was Jacob Robert in the sixteenth Russian name, Roman Elizarov. century. He was sent in 1581 by Queen Elizabeth to At the very end of the sixteenth century (1598) the Russian Tsar, Ivan the Fourth, better known during the reign of Ivan the Terrible's son, Theodore, as Ivan the Terrible, as a personal physician for the another English doctor, Mark Ridley, was sent to Tsar himself, his family, and the Court. In Russia serve as the Tsar's personal physician. at that time there were no European-trained A number of features in the historical develop- physicians, although there were "healers", most of ment of England and Russia at that time made the them attached to the monasteries, who, in the treat- seventeenth century less favourable for the continua- ment of their patients, made wide use of the tion of extensive interchanges between the two medicinal herbs in which Russia, with her multitude countries. of different climatic and geographical conditions, From the very beginning of the eighteenth cen- has always abounded. The lore connected with the tury, however, as a result of the changes wrought by preparation and use of these herbs had come from Peter the Great in Russia, particularly his intro- Byzantium and had been considerably extended in duction of the European system of training phy- Kiev Rus. After the fall of Kiev Rus and the sicians, Holland and England were the favourite renaissance of Central Russian Slavdom, this countries from which experienced doctors were experience was inherited by Muscovite Russia. drawn for training Russians in the Russian medical England "discovered" Muscovy in the sixteenth schools, and to which Russians were sent to learn century through the northern sea route and de- medicine or to extend their knowledge of it in the http://jnnp.bmj.com/ veloped extensive trading and, at the same time, universities. Among these Russians, one example cultural relationships with Muscovite Russia. These who might be quoted is Daniel Pischekov, son of a relationships were particularly fruitful and extensive priest. He was to train in the medical school of the at the time of Elizabeth and Ivan the Terrible. It Moscow Hospital founded by Peter the Great. was at this time that the English physician, Jacob After graduation, Pischekov was sent for further Robert, was sent to Russia. He lived there for a training to London, Edinburgh, and Aberdeen, long period and enjoyed great influence over the where he studied obstetrics. Yuri Bakhmetyev

Tsar. In addition to his activities as a physician, studied medicine in London and Edinburgh and was on September 25, 2021 by Jacob Robert fulfilled various diplomatic com- given a degree of Doctor of Medicine. missions, including the negotiations for a match Still wider use was made of British universities and hospitals for the medical education and further * This paper was prepared for the celebrations to mark the centenary training of Russian doctors in the first half of the of the National Hospital, Queen Square, London. t In choosing historical material for the article, the author was nineteenth century. As an example, I could give helped by his colleagues, Drs. Vein, Hekht, and Fishman. the names of just a few outstanding Russian 185 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.23.3.185 on 1 August 1960. Downloaded from 186 N. I. GRASHCHENKO V medical men trained in Russia but who went to developed and carried out the idea of training in the England for further study and trained there in Academy scientific research workers from the ranks preparation for work as professors, in the first of doctors and biologists and of giving further instance in Moscow University. Thus Professor training to physicians and to other scientists. This Ilya Gruzinov, the anatomist, at the very beginning new system of training scientific and professorial of the nineteenth century (1801-04) carried on staff within the Academy from among particularly postgraduate studies in England under the famous gifted students who had graduated from it was anatomist, Willis. After this, Gruzinov returned to responsible for the training of a number of out- Moscow and took over and developed the Depart- standing Russian professors of medicine, among ment of Anatomy and Physiology in Moscow them Vladimir Bekhterev, whose name is well known University. Another outstanding medical man was to this audience. Among the pupils of Glebov Ivan Glebov, who graduated from Moscow Uni- while he was still at Moscow University we may versity and then trained for a further three years mention Ivan Sechenov, who subsequently founded abroad in various laboratories, such as Claude modern Russian physiology of the nervous system Bernard's, and in Bouillaud's' clinic in Paris, the (he was a forerunner of Pavlov), as well as the out- laboratory of Johannes Muller in Berlin, and standing clinician, Sergei Botkin. Both were closely Rokitanski's laboratory in Vienna. In 1839, linked by personal friendship and a unity of ideas in Glebov worked in various London hospitals, in their views on science, particularly concerning laboratories of pathological anatomy, in a depart- questions of experimental and clinical proof of the ment of comparative anatomy, and in the laboratory leading role of the nervous system in physiological of the famous Hunter. During his work abroad, and pathological processes in animals and man. particularly in London, Glebov set up what was for They both developed the concept of "nervism" (the that time a wonderful collection of comparative leading role of the nervous system), and the im-guest. Protected by copyright. anatomical preparations covering 500 different portance of reflexes in physiology and pathology, an animals. On his return from abroad, Glebov taught idea which guided the experimental research and human physiology, general and comparative theoretical generalizations of I. P. Pavlov throughout anatomy and histology, and also general and special his life. After three years' advanced training abroad therapy in Moscow University. He was the first and while they were still very young, Sechenov and man in Russia to establish and begin the teaching of Botkin were invited by Glebov to become professors comparative physiology, and he also reformed the in the Medico-Surgical Academy in St. Petersburg. teaching of general physiology. In particular, he They swiftly won great authority and became lead- introduced a more extensive course of practical ing professors, Sechenov in physiology and Botkin training, including training in the physiology of the in clinical medicine. Botkin was the leading nervous system and comparative physiology, and clinician in Russia and not only in Russia, and he brought in the practice of demonstrations being established at his clinic an experimental physio- given at lectures. His contemporaries classed him logical laboratory and called upon the young as an excellent lecturer. Among his many dicta is physiologist, Pavlov, who had only just begun his his statement that the teaching and learning of scientific activities, to run it. For 10 years Pavlov physiology must be based on a knowledge of was head of the laboratory and within its walls he physics, chemistry, and natural history. The completed his first stage in physiology, the study of leitmotiv of his statements and personal researches the physiology of blood circulation. In this was the demonstration of the role of the nervous laboratory, under the direct influence of Botkin and http://jnnp.bmj.com/ system in regulating the animal and human organ- Sechenov, the views of Pavlov on nervism were ism. His doctorial thesis, for example, was on the formed and consolidated. These were reflected in theme of "Mental phenomena from the physio- his experimental physiological research on the cir- logical, therapeutic and pharmacological points of culation of the blood and subsequently in his view". Glebov was subsequently appointed vice- completely new treatment of the physiology of president of the St. Petersburg Medico-Surgical digestion (his second stage in physiology). His Academy, as a result of the need for a sharp im- researches were crowned by his work on the provement in its teaching and scientific activities. physiology ofthe cerebral hemispheres or physiology on September 25, 2021 by He soon made the Academy into a first-class of the higher nervous activity (Pavlov's third stage teaching and research establishment. In particular, in modern physiology). Consequently, the idea of he founded an institute of anatomy and physiology nervism, originated by Glebov, worked upon and and promoted the establishment of various well- developed by Botkin and Sechenov, was provided equipped nervous and mental disease clinics and with extremely firm experimental and theoretical many other teaching and research laboratories. He foundations by the brilliant research of I. P. Pavlov J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.23.3.185 on 1 August 1960. Downloaded from RUSSIAN NEUROPATHOLOGISTS AND THE NATIONAL HOSPITAL 187 and his many pupils and followers in Russia and word had no less an influence on the development abroad. of Russian neuropathology.* In this case the role Another remarkable worker was a contemporary of the National Hospital, now celebrating an of Glebov, Vassili Basov, who also spent one year outstanding centenary, was very appreciable. To in England (1844) out of three years' advanced confirm this statement, let us turn to Aleksei training abroad, working in hospitals on general Kozhevnikov (1835-1902), founder of the Moscow surgery, particularly the surgery of the gastro- (and to some extent the Russian) school of intestinal tract. On his return to Moscow, Basov neuropathologists. had a decisive influence on the development of Graduating in 1860 from Moscow University, surgery in Moscow and other university cities in Kozhevnikov worked in the sphere of clinical Russia. However, even before he went abroad for medicine and began to concentrate his main atten- further training, Basov in 1842 had described a new tion on diseases of the nervous system. As early as method of forming a gastric fistula with an outlet 1865 Kozhevnikov wrote his thesis for the degree outside the body which made it possible to observe of Doctor of Medical Sciences on the theme of the work of the stomach (its motor functions and its tabes dorsalis. Subsequently, Kozhevnikov went secretions) which up to that time had been unknown. abroad to gain further experience and in particular This method was widely used and modified by I. P. worked in various neurological establishments and Pavlov and made it possible for him to give a com- clinics. He also worked at the National Hospital, pletely new interpretation of the physiology of devoting great attention to the anatomy, physiology, digestion. As you know, Pavlov was given the and histology of the nervous system and particularly Nobel Prize for this work, which he described in a to the organization of neuropathology as an in- book published in 1897. At the same time, this dependent clinical discipline. In this connexion he branch of research by Pavlov and his pupils proved had a brilliant example to follow in the shape of the guest. Protected by copyright. decisive for further research on the physiology of National Hospital, which at that time was beginning the higher nervous activity. A contemporary of to emerge as an independent clinical establishment Basov was yet another outstanding Moscow pro- for neuropathology. On the basis of what he saw fessor, Aleksei Polunin. After graduating from and learnt in London, Kozhevnikov, on his return to Moscow University he went for four years' further Moscow, founded two independent clinics, a clinic training abroad, over a year of which he spent for nervous diseases and a clinic for mental diseases, working in various clinics and laboratories in Lon- attached to the Medical Faculty of Moscow Uni- don (1847). After his return to Moscow, Polunin versity, both of them still existing and active at the founded in 1849 the Department of Pathological present time. It is interesting to recall that Anatomy and Pathological Physiology, and in 1869 Kozhevnikov who, before his visit to London, had the Department of General Pathology. He con- worked in a number of laboratories and clinics in sidered that human pathology or general pathology Germany and France, took the London National must include pathological anatomy, pathological Hospital as his model for the establishment of physiology, and pathological chemistry. In the neuropathology in Russia as an independent clinical newspaper Moskovskiye Vedomosti (Nos. 102-104, discipline. Kozhevnikov did not follow in the 1848), Polunin published a series of articles on the footsteps of his colleagues in Germany and Austria, medical establishments of Paris and some re- where of course even today combined nervous and markable medical establishments in London. In mental disease clinics still exist and where, especially England, Polunin consolidated his broad biological in Germany, neuropathology for a long time re- http://jnnp.bmj.com/ views and ideas, which he expressed in his lectures mained within the framework of general therapy or on the characteristics of man as a part of nature. medicine (a good example of this is Strumpell The ideas of evolution or the development ofall living himself). Kozhevnikov considered that clinical creatures were already widely put forward in England neuropathology should be separated not only from even before the masterly work by Charles Darwin, general medicine as an independent clinical subject which included the ideas and research of his pre- but also from psychiatry, as the two subjects, despite decessors as well as his own research over many their many common features, have many differences years. in their tasks and methods. In the same way, on September 25, 2021 by While the links between English and Russian Kozhevnikov considered that clinical neuro- medicine were very fruitful and the influence of pathology should be closely linked with general English medicine on the development of various anatomy, with the pathological anatomy and theoretical and clinical concepts in Russian medicine and neurology was very great, English neuro- * In Russia, we mean by "neuropathology" clinical neurology pathology or neurology in the broad sense of the including the neuropathology of nervous diseases. J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.23.3.185 on 1 August 1960. Downloaded from 188 N. L GRASHCHENKO V histology as well as the physiology and patho- Kozhevnikov school. I consider that the facts physiology of the nervous system, and that it must I have listed show the noble role played by the be based on the comparative anatomy and physiol- National Hospital, now celebrating a glorious ogy of the said system. He devoted a great deal of anniversary, in the development of Russian work to the establishment of two separate clinics. neuropathology. He himself became head of the clinic for nervous To complete my demonstration of the close ties diseases and entrusted the psychiatric clinic to his between Britain and Russia in medicine in general talented pupil, Sergei Korsakov, who was essentially and in neuropathology in particular, I should like the founder of modern psychiatry in our country to give a few more examples. At the end of the and whose name the clinic rightly bears. Kozhevni- nineteenth century and the first half of the twentieth, kov became the first professor of neuropathology in there was a very great increase in the numbers of Russia. In his research work he devoted particular short and long visits by scientists and medical attention to the study of the anatomy and histology practitioners, both young and experienced, between of the nervous system and partikuiarly to a study of the two countries to gain further experience, to the cells of the cerebral cortex and cerebellum. He master new methods, to read papers and lectures, was also led by his general ideas on the importance to take part in anniversary meetings and scientific of the comparative anatomy of the nervous system to conferences and congresses. The relations between do a great deal of work on anthropology. As a those concerned with physiology in general and the result of these scientific interests, Kozhevnikov set physiology of the nervous system in particular have up a neurological museum in the clinic for nervous been and remain particularly fruitful. Everybody diseases, which was remarkable for its period and knows the friendly relationships between Sir Charles which consisted of preparations on the anatomy, Sherrington and Nikolai Vvedenski, the neuro- histology, and comparative anatomy of the nervous physiologist and electrophysiologist. A goodguest. Protected by copyright. system. This museum still exists and bears example of this was that when Sherrington applied Kozhevnikov's name. In addition Kozhevnikov for the Chair of Physiology at Liverpool University, founded the Moscow Society of Neuropathologists Vvedenski sent in a scientific appreciation of his and Psychiatrists, and, together with Korsakov, work. These friendly relations between two great started in 1900 the Journal of Neuropathology and physiologists were continued between Pavlov and Psychiatry, which also still exists and is known as Sherrington. Everyone knows what a positive the Korsakov Journal. Kozhevnikov took an active influence they had on each other in their formulation part in international medical and neurological of general neurophysiological laws such as the laws activities. In 1897 he was Vice-President of the of inhibition and excitation, induction, and a num- Twelfth International Congress and was elected a ber of others. The Soviet neurophysiologist Ivan member of the Vienna Society of Neuropathologists Beritov worked with success in Sherrington's and Psychiatrists, and of various scientific bodies in laboratory at Oxford. There were also many his own country. In the sphere of clinical neurology friendly exchanges between the Russian physiologist Kozhevnikov bequeathed to us a number of classical Alexander Samoilov and Professor Adrian, now works which still retain their importance. These Lord Adrian. From 1911 to 1912 in the Cambridge include his work on amyotrophic lateral sclerosis Physiological Laboratory, Pavlov's senior pupil, and on the type of epilepsy, of which he studied a Leon Orbeli, worked successfully under Langley's particular form now known as Kozhevnikov's leadership. Orbeli afterwards became one of the epilepsy. He considered that this form of epilepsy leading Soviet physiologists. It is well known that http://jnnp.bmj.com/ was of infectious origin in some way. Only when Langley's teachings on the sympathetic system were tic-borne encephalitis of viral aetiology was studied extensively developed by Orbeli and made an integral were a number of research workers in our country, part of modern physiology and clinical medicine. including myself, able to establish that Kozhevni- Among other things Orbeli laid the foundations of kov's epilepsy was a form of this encephalitis, neurohumoral physiology on the basis of the work although I do not exclude the possibility that viral of Levy and Dale. Leon Orbeli and many of his inflammatory lesions of the brain, especially in predecessors who studied in Britain developed the young patients, may also occur as a residual theory and methods ofcomparative physiology of the on September 25, 2021 by phenomenon of classical Kozhevnikov epilepsy. nervous system and embodied Darwinian ideas of The majority of outstanding Russian neuro- evolution and development in physiology and pathologists were direct pupils of Kozhevnikov. pathology. Before devoting himself entirely to new Among them I might name Rot, Darkshevich, branches of physiology, and before he went to work Minor, and others. Most contemporary Soviet in Langley's laboratory, Leon Orbeli, after gradu- neuropathologists were trained in and belong to the ating from the Academy of Military Medicine, had J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.23.3.185 on 1 August 1960. Downloaded from RUSSIAN NEUROPATHOLOGISTS AND THE NATIONAL HOSPITAL 189 served as a medical officer in the Navy and then, the outcome of therapy, and objective prognosis when working at Cambridge, regularly visited the and assessment of residual conditions. National Hospital in London, attended the lectures All this is characterized by the skilful accumula- there, and took part in case analysis. The author tion of experimental and clinical facts and their of this article is indebted to Leon Orbeli, his adviser wide generalization for the purposes of neurology, and mentor, as, when he went to work in Pro- primarily on the basis of evolutionary ideas. The fessor Adrian's electrophysiological laboratory in careful accumulation of experimental and clinical Cambridge in 1935-36 he, like Orbeli, visited the facts, together with a cautious attitude towards National Hospital regularly every Thursday, them and a skilful evaluation and generalization of attended the lectures there, and took part in case them, typical of the work of our British colleagues, analysis. Consequently, in his development as a was taken over from them in its entirety by research clinical neurologist, he is likewise very much in- workers in our country. It is well known how debted to the National Hospital, now celebrating cautiously I. P. Pavlov approached facts and what a its anniversary, and to Gordon Holmes and others, high value he set upon them. It was he who used its leading workers of that time. As a neuro- the striking phrase "I present to you Mr. Fact. Take physiologist, bringing this branch of neurology into off your hats to him!" Without the careful and line with the tasks of modern clinical practice, he sometimes tedious accumulation of facts and their is much indebted to Lord Adrian and his pupil analysis, it would have been impossible for the Sir Bryan Matthews. generalizations mentioned above to be made and to I have quoted numerous facts concerning the become a basis of all our further experimental and links and mutual relations between British and clinical work, nor would the facts have been so Russian medicine, physiology, and neurology, and unshakable if new proofs in support of them had I would like to end by generalizing to some extent, not been found at every further stage of research. guest. Protected by copyright. and in particular by pointing out the basic tendencies The mutual influence between the two countries adopted by Russian scientists from their British goes far beyond mere personalities and personal colleagues and which, in many respects, have relationships at various points of history. The role become part of the general achievements of medical of scientific laboratories and clinical establishments science and neurology all over the world. has been extremely great, particularly in the training (I) The general biological concept, and particu- of international cadres, in the dissemination of larly the notions of evolution in biology, medicine, scientific and clinical literature, in the convening of and neurology, both in the pre-Darwin time during scientific and clinical symposia, conferences, and his creative life and, subsequently, during the lives congresses and in the participation in such meetings of many of those who continued his work in various of scientists from the various countries. In this countries of the world, including Russia. connexion the National Hospital, whose glorious (2) Comparative anatomy and physiology in anniversary we are now celebrating, has played an general and the anatomy and physiology of the extremely important part, and a truly international nervous system in particular, including the anatomy one. In the second century of the life of this re- and physiology of the autonomic or vegetative markable neurological institution, we anticipate that (sympathetic and parasympathetic) nervous system. it will play an even greater role in the formation and (3) Numerous facts indicating the importance of development of theoretical and clinical neurology the nervous system in the mechanism of physio- both in our country and on an international scale. logical and pathological processes in animals and At the present day, when the distance between the http://jnnp.bmj.com/ man subsequently developed in Russia into a countries furthest away from one another in the harmonious system showing the leading role of the geographical sense has been reduced to a small nervous system in the processes mentioned. number of hours-10 at most-and social and (4) On the basis of a new technique (radio valves) economic conditions no longer appear to be an as a result of interpenetration and creative associa- obstacle to close cultural and scientific relations, tion between Russian and British electrophysiologists both direct personal contacts and numerous indirect the study of new data on the biological or electrical contacts will increase in

numbers. on September 25, 2021 by currents in the sense organs, in sensory and motor For all the healthy criticism of neurological nerve endings, the spinal cord, and the brain in expansionism in modem medicine and physiology, animals and man. one fact established and confirmed by our British (5) The application of all the facts mentioned and Russian predecessors remains unshakable, the to current requirements in the clinical practice of fact that the nervous system plays a leading role in nervous diseases, particularly for improving diag- the physiology and pathology of animals and man. nosis by means of instruments, objective checks on Despite the importance of this role, as a result of 2 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.23.3.185 on 1 August 1960. Downloaded from 190 N. I. GRASHCHENKO V the natural tendency to attach greater importance complex physico-chemical aggregate. Nevertheless, to physico-chemical and biochemical changes in even in this case, the nervous system retains its physiological and pathological processes, the nervous trigger function, its corrective and, to a considerable system itself, at its highest level, that is, in the brain, degree, its organizational role in the processes is gradually being regarded as a more and more mentioned. guest. Protected by copyright. http://jnnp.bmj.com/ on September 25, 2021 by