An Outline of Psychiatry in Clinical Lectures The Lectures of Carl Wernicke Robert Miller · John Dennison Editors Translated by John Dennison · Robert Miller 123 An Outline of Psychiatry in Clinical Lectures Robert Miller • John Dennison Editors An Outline of Psychiatry in Clinical Lectures The Lectures of Carl Wernicke Translated by John Dennison and Robert Miller Editors Robert Miller, ONZM, B.A., B.Sc., Ph.D. John Dennison, J.P., M.Sc., B.A. Freelance Researcher, and Honorary Research Fellow Fellow Department of Anatomy Otago University Otago Medical School Department of Psychological Medicine Dunedin , New Zealand University of Otago School of Medicine Wellington , New Zealand ISBN 978-3-319-18050-2 ISBN 978-3-319-18051-9 (eBook) DOI 10.1007/978-3-319-18051-9 Library of Congress Control Number: 2015942521 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Dedication for This Translation We want to dedicate this edited translation fi rst to the memory of Valentin Braitenberg, still a source of inspiration. We also dedicate it, a trifl e late perhaps, to the many persons whose lives at times of crisis are depicted so graphically in Wernicke’s accounts of his patients. Robert Miller and John Dennison F o r e w o r d 1894 Foreword It was not originally my intention to let the present introduction to the clinical presentation of mental illnesses stand-alone. While its primary aim is to describe the organ within which such illness is expressed, it also conveys opinions that have developed very gradually, infl uenced by many years of clinical experience. Therefore its foundation and its integration lie within the facts taught in Pathology. Through the infl uence of an advocate of theoretical natural science, I let myself be persuaded to compile a stand-alone volume. His opinion, that the broader scientifi c community might take a lively interest in it, must be acknowledged as authoritative, compared with my own more reticent opin- ion. Thus, when this revered man of undoubted competence, and perhaps great foresight, sets his eyes on these apologetic intentions, may he at the same time receive my thanks for his stimulation and guidance over the hours and days of a chance encounter. Breslau, August 1894 Carl Wernicke ix F o r e w o r d 1906 Editor’s Foreword In the middle of preparing this second edition, Carl Wernicke was overtaken by sudden death. His revision had proceeded only to the end of the second section. It was limited to a large number of small alterations and additions, entered in pencil alongside and beneath the text, without the form and content undergoing any other major metamorphosis. The review copy underwent a collaborative revision by Senior Physician Dr. Knapp, Wernicke’s fi rst Adjunct in Halle, and myself, and obviously pri- vate notes, not intended for publication, were removed. During this task I submitted our output to the widow of the deceased. As for the third, unrevised section, the unchanged copy came from the author himself. That Wernicke had nothing major to alter, and that this section still corresponded with the position of his previous opinions, was testifi ed by some few words, those of the mortally wounded man, worried about the fate of his life’s work, uttered on his deathbed: ‘Second edition as is’. Any introductory words about the work are superfl uous. It speaks for itself. H. Liepmann xi Preface to Thi s Translation This translation of Wernicke’s Grundriss der Psychiatrie grew from the long friendship one of us (R.M.) had with Valentin Braitenberg, born in 1926, and who died in October 2011. Valentin visited Otago, New Zealand, in 1993, and both of us (R.M. and K.J.D.) knew him and recognized in him a person of great generosity, wisdom, and integrity. On his bookshelf in Tübingen were many interesting volumes, some of historic signifi cance. One of them was the 1900 edition of Grundriss . The process of producing this translation was as follows: K.J.D. who is fl uent in German produced, lecture-by-lecture, a very literal translation of what Wernicke wrote and sent his versions to R.M., who has basic German, but wide knowledge of many areas of psychiatry and neuroscience. His task was to render these initial versions into fl uent modern scientifi c prose, aware of some of the scientifi c and clinical nuances which might not emerge in a literal translation. Sometimes, at this stage, words or concepts were unclear, so there were further exchanges of messages between the two of us to resolve uncertainties. In translating and editing Wernicke’s text, it has also been nec- essary to learn a great deal about the life and times when he was writing, and the existing knowledge upon which he drew. In the end, we both contributed to resolving uncertainties about concepts. As we went through Wernicke’s text, a number of editorial comments were inserted, initially as footnotes, to convey such understanding as we could gain, but which might not be obvious to today’s reader. These com- ments varied in length and subject matter from one lecture to another. We soon realized that many themes in the lectures recurred in successive lectures, gradually evolving and being developed. This makes his thinking appear fragmented, if the lectures are read sequentially. This is inevitable, given the context in which any series of clinical lectures has to be delivered, where the lecturer’s ideas must be presented in coordination with clinical cases as avail- able (which may arise somewhat opportunistically). The fragmented appear- ance may also refl ect what was certainly a very pressured existence for the author, who probably preferred to spend his time on the ward, talking with patients, and analyzing clinical records, rather than perfecting the write-up of his ideas. We gain this impression from inaccuracies in some of his cited references, inconsistencies in his reasoning, and what seems to be a continu- ing struggle to fi nd adequate defi nitions for concepts which accounted best for what he saw in the clinic. As delivered, the lectures probably were not so fragmented for his original audience, for whom, we guess, each lecture would xiii xiv Preface to This Translation have been followed by discussions which are not recorded. Nevertheless, the 1906 edition of Grundriss was a ‘work in progress’, which sadly never reached completion. It is plausible to suggest that he might have intended to write a comprehensive textbook of psychiatry, to fulfi l what was latent in Grundriss , just as his thought on the entire fi eld of neurological disorders was presented as his 1881 textbook, Lehrbuch der Gehirnkrankheiten . The fact that most of his thoughts on psychiatry are contained in the sometimes diffi - cult pages of Grundriss , rather than in a textbook, may have contributed to the neglect of his work, but it is also the reason why we have felt it necessary to write the extended editorial commentary, which follows the translation of Wernicke’s 41 lectures. To give what we hope is a clearer account of Wernicke’s thought, we decided that the editorial comments on each lecture should be re-grouped according to their subject matter and coordinated into this substantial edito- rial essay. This begins with a series of synopses about the subjects dominat- ing each lecture, followed by discussion sections dealing with the numerous matters arising across the lecture series. These topics move from the medical scene in which Wernicke worked, clinical concepts of the day, Wernicke’s clinical, didactic, and personal style as far as we could discern it, the scientifi c concepts he used, his views on underlying philosophical issues, and, most important, a lengthy section on his unique clinical concepts. After that we move to Wernicke’s approach to classifying mental disorders and his style of reasoning, including what we identify (from a modern perspective) as fl aws in his reasoning. Later parts of the essay give details on his contemporaries whose work is cited, comments to clarify allusions made (mainly by his patients) to matters which would have been familiar in their day, and lastly, to clarify specifi c issues of terminology. This section came together at the very end of our work, when we compiled a long list of ‘problem words’ in both German and English and discussed how we could render them in a way which conveyed most accurately Wernicke’s intended meaning.