Wilhelm Erb's Electrotherapeutics and Scientific Medicine in 19th Century Germany Thesis submitted for the degree of PhD at University College, University of London by Bettina Alexandra Bryan ProQuest Number: 10017275 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10017275 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract Wilhelm Heinrich Erb (1840-1921) was the co­ discoverer of the knee jerk response and is often referred to as the German counterpart of the French neurologist Jean Charcot. Erb advocated the use of electricity as a therapeutic agent, particularly in nervous diseases. He belonged to the first generation of German physicians educated in the spirit of Virchow's programme of naturwissenschaftllche Medizin. Among them were his mentor Nikolaus Friedreich, who exerted the most decisive and singular influence upon Erb, Albert Eulenburg, Eduard Hitzig and Hugo von Ziemssen. They were all reputable scientifically minded clinicians with a keen interest in advancing medical therapy and among the most ardent supporters of 'scientific' electrotherapy. My thesis is not intended to be a comprehensive biographical account of Erb's life but aims to explore the broader reasons for his advocacy of electrotherapy during the first phase (1860-1880) of the implementation of natural scientific medicine in Germany. Part I portrays the contemporary social, political and institutional context at Heidelberg University located in the German State of Baden where Erb received his medical training and spent almost exclusively his entire professional career. Part II illustrates the intellectual roots and 3 epistemological objectives of Rudolf Virchow's concept of naturwissenschaftllche Medizin, I emphasize the political and social significance of Virchow's medical reform and its appeal to a generation of medical men raised in the aftermath of the failed 1848 Revolution. Erb is characterised as a "typical child of his time." I also discuss the aesthetic appeal of electricity which helped to promote its medical utilisation. Part III provides a history of German electrotherapy and investigates the intra-scientific rationale for the momentary enthusiastic employment of medical electricity. It concludes with an analysis of Erb's chief electrotherapeutic publications and actual practice. Table of Contents Introduction p. 9 Chapter Summary p.14 Chapter 1: Wilhelm Erb's Biography p.18 Part I Heidelberg Chapter 2: Heidelberg University - the hotbed of the kleindeutsche national unification movement General Introduction p.25 Politics in Baden and at Heidelberg University p.37 Chapter 3: Institutional History of the Badenese University Heidelberg and its Medical Faculty General Introduction p.47 The Medical Faculty and University Hospitals in Heidelberg p.57 Chapter 4: Erb's attempts to establish an electrotherapeutic ward p.75 Part II Naturvissenschaftliche Medizin and "the poetrv of reality" Chapter 5: The German school of Naturwissenschaft- liche Medizin: Scientia est Potentia General Introduction p. 88 The role of medical diagnosis and therapy in 'naturvissenschaftliche Medizin' p.118 Chapter 6: Biography of Nikolaus Friedreich p.146 Chapter 7: Zeitgeist and Electrotherapy p.160 Part III Electricity and Medicine Chapter 8: The Context of contemporary Electrophysiology p.179 Chapter 9: Short History of Electrotherapy and Electrodiagnosis in German Medicine p.210 Chapter 10: Analysis of Wilhelm Erb's electrotherapeutic publications and practice Introduction p.242 I. Galvanotherapeutische Mittheilungen p.245 II. Electrotonische Erscheinungen am Menschen p.261 III. Electro-otology a. Die galvanische Reaktion des nervosen Gehorapparates im gesunden and kranken Zustand p.270 b. Zur galvanischen Behandlung von Augen-und Ohrenleiden p.278 IV.Zur Pathologie und pathologischen Anatomie peripherischer Paralysen p.286 Conclusion p.316 Bibliography p.333 Acknow1edgements It is a pleasure to thank some of the many people who have helped me during the course of my work on this thesis. Above all, my sincere thanks to Professor Bynum who has been a patient and most supportive supervisor. My research has been made possible thanks to a generous grant from the Wellcome Trust. 1 am grateful for the time, friendship and advice from so many students at the Wellcome Institute. 1 am especially indebted to Katharina Rowold, Carole Reeves and Cornelius Borck. During my research on this study 1 have constantly relied upon the following libraries in London: the Wellcome Library for the History of Medicine, the British Museum Library, the library at the Institute of Neurology Queen's Square, the library of the Royal Society of Medicine, the library of the Royal College of Surgeons and the library of the German Historical Institute. In Germany 1 visited the Generallandesarchiv Karlsruhe and the University Archive of the University of Heidelberg. 1 am grateful to all the library staff for their assistance and kindness. 1 thank especially Lindsay Lardner at the Wellcome Library for her patience in tracking down material. I also want to thank Dr Hugh Bostock from the Institute of Neurology at the National Hospital for Neurology at Queen's Square, London for his advice on chapter 8. Last, but not least, I thank my husband Nicolas for his patience, tolerance and encouragement. Introduction This thesis examines the practice of electrotherapy during the early stages of the emergence of naturwissenschaftllche Medizin (natural scientific medicine) in Germany. I have chosen to focus on the early electrotherapeutic publications and practice of Wilhelm Heinrich Erb (1840-1921). Not only has Erb been hailed as Germany's first and foremost neurologist and one of the founding fathers of modern electrotherapy^ but also as the epitome of a 19th century reputable physician of natural scientific persuasion. However, my thesis is not intended to be a full blown biographical account of Erb's life and career. Many aspects of Erb's work have already been discussed by medical historians. Erb is often characterised as a gifted nosologist for he unearthed many neurological disease entities. He wrote extensively on muscular dystrophy, spastic spinal paraplegia and was among the first to recognize the relationship between tabes dorsalis and syphilis. He also described the upper brachial plexus lesion and the clinical aspects of 'myasthenia gravis'.^ Wilhelm Erb ^ F.Schiller, 'Neurology: The Electrical Root', in Bynum and Rose (eds.) Historical Aspects of the Neurosciences. New York, Raven Press, 1982, pp.1-11, p.8; F.Garrison, Historv of Neuroloav, Springfield Illinois, Charles C. Thomas Publ., 1969, p.298 ^ W.Haymaker, The Founders of Neuroloav, Springfield Illinois, Charles C. Thomas Publ., 1953; J.Ibeling, 'Wilhelm Erb und seine Bedeutung filr die Neurologie', 10 is probably best known for the discovery of the patellar tendon reflex in 1875. This aspect of his work has already been covered by a medical dissertation.^ Less attention has been paid to his ardent advocacy of electrotherapy in clinical medicine and neuropathology. One reason might be that medical electricity never quite rid itself from the less progressive image of mesmerism and animal-magnetism. To be sure during Erb's time the image of medical electricity never quite ceased to be tarnished by the popular perception of electricity as a panacea. This perception was further promoted by advertisements in popular magazines praising the beneficial effects of electrical gadgets like Pulvermacher's electric chain. Erb was anxious to stress that he had "no acquaintance with such things and that they played an unduly prominent part in the jugglery of quacks and charlatans. Despite some residual misgivings towards medical electricity a significant number of contemporary reputable physicians started to promote electrical medicine. They insisted that electrotherapeutics was a Inaug.Diss., Ludwigs-Maximilians-Universitàt München, 1940, pp.5-37; K.Kolle, Grosse Nervenarzte, Stuttgart, Thieme, 1970 ^ H.B.Wolf, 'Zur Entdeckung des Patellarsehnen- reflexes durch Erb und Westphal', in Rothschuh und Toellner (eds.) Münster'sche Beitraae zur Geschichte und Theorie der Medizin. Nr.11, Münster, 1976 " W.Erb, Handbook of Electrotherapeutics, London, Smith & Elder, 1887, p.286 11 creditable specialty and stressed its scientific character. Among them were Nikolaus Friedreich, Wilhelm Erb, Albert Eulenburg, Eduard Hitzig and Hugo von Ziemssen. They all belonged to Virchow's school of naturwissenschaftllche Medizin. I intend to show that the rising interest in electrotherapeutics was closely linked to the rise of Virchow's programme of naturwissenschaftliche Medizin which aspired to regenerate German medicine. It was closely associated with an optimistic revival of medical therapy, aimed at the demise of therapeutic nihilism, and thus to emancipate the 'Klinik' in the face of a rapidly institutionalising physiology. One less well known part of Virchow's objective consisted in the activation and renewal of clinical