Hans Förstl


Karl Philipp Moritz:

Neurologic Disease Described in the Journal of Empirical Psychology

Know Thyself or Journal of Empirical Psychology (Gnothi Sauton oder Magazin zur Erfahrungsseelenkunde), 1783-1793, was the first of its kind - concentrating on nervous and mental disturbances and marking the beginning of periodical neuropsychiatric publications. The edi-tor, Karl Philipp Moritz, and the contributors, many of them lay people, were particularly in-terested in disturbances of language and consciousness. Descriptions of epilepsy, Sydenham's chorea, jargon aphasia, and dementia are briefly summarized. The case material from the Journal was soon translated and integrated in later work. The Journal itself and its "empirical" approach became a model for publications that followed.
(abbreviated from: Arch Neurol.1992;49:187-188)

Karl Philipp Moritz (1757-1793) was one of the most influential characters of the Enlighten-ment in Germany. He was born in Hameln near Hanover. Due to his parents' poverty, he was forced into an apprenticeship as a hatter until a grant allowed him to study theology. He aban-doned the university temporarily to become an actor. Later on he worked as a private teacher in Dessau, Potsdam, and at a grammar school in Berlin. He traveled to England and to Italy and wrote reports, novels, and several works on aesthetics and language. In 1789, he became Professor of Aesthetics and Archaeology at the Academy of Arts in Berlin.
In 1783, he founded Gnothi Sauton oder Magazin zur Erfahrungsseelenkunde (ie, Know Thy-self or Journal of Empirical Psychology), which can be considered as the first journal special-izing in psychologic issues and related fields, eg, neurologic and neuropsychologic case stud-ies (2,3).

NEUROLOGIC CASE REPORTS
Case reports form the core of the Journal. By standards of modern diagnostic criteria, 124 of them can be considered as reports of pathologie conditions. The majority of the patients suf-fered from psychiatrie disorders that have been rediagnosed using current criteria.Two neu-rologic conditions were described in great detail, although diagnoses can, at best, be tentative. Cerebrovascular disorders are likely in eight cases, meningitis or encephalitis in four, and epilepsy in five. The following paragraphs can only present brief excerpts translated from several lengthy reports. The following disturbance was observed in a young theologian:

... He developed seizures lasting several minutes during which he did not know what he was doing. Sometimes, when he attended a social gathering he raised from his chair and said: 'it is time to go to bed!' and began to undress. But soon became aware of the situation and left ashamed and sad. [Reiske EC, 1785;3]

Because of these spells, which also occurred during church services, the patient was forbidden to preach, became depressed, paranoid, drank too much brandy, developed "epileptic" sei-zures, and died in an asylum.

The next excerpt describes an epileptic aura preceding a probable grand-mal seizure in a 17-year-old boy:

... I asked him how he would feel when the paroxysm was about to come. He answered that it always begins in the stomach which feels very hot, then the heat seizes the head
and then he becomes increasingly stunned and everything becomes dark before his eyes before he completely loses consciousness.
This was, as I could observe myself, the moment when the convulsions started and lasted at least eight minutes, often however up to half an hour. [Mauchart JD, 1784;2]

For 6 months, an 8-year-old girl showed a movement disorder reminiscent of Sydenham's chorea:

... She could not stand still although her mother held her by her left hand. She moved her hands, feet and even her head continuously and sometimes so vigorously as if she wanted to dance. Her speech was volatile, wild and mostly incomprehensible. [Gädicke, 1786;4]
The author recommended a bloodletting and "asa foetida" as a purgative, because he sus-pected that the cause of illness was an infestation by worms. Allegedly she passed a large number of Ascares for 6 weeks and after 12 weeks "her physical and mental health was restored completely."

NEUROPSYCHOLOGIC DISTURBANCES

Detailed descriptions of neuropsychologic disturbances were one of the Journal's strengths. These contributions were encouraged by the editor's particular interest in the field. Several of the neuropsychologic cases first published in the Journal were soon translated into English (5). Some of them have gained attention in recent accounts on the history of aphasiology"':
a case of motor aphasia and agraphia probably due to a transitory ischemic attack (1783;1);
a case of phonemic paraphasia in a patient substituting z for f (1789;7); a case of semantic paraphasia in a patient mixing up the words for chair and table, book and glass (1789;7); and the case of pure word deafness (or hysteria) in an artillery officer who could read aloud, but who could neither speak spontaneously nor repeat spoken words (1790;8).

The following two cases have not been published in English before. The 78-year-old farmer Samuel Klose presented with what might be considered as a typical example of jargon aphasia in the late 18th century:

... He could recite 31 long morning songs and the common prayers rather intelligibly one after the other, and he could at most say the names of God and such formulas, but to his relatives or visitors he could not say any comprehensible words in reasonable association.... He felt this incapacity, cried, became upset and showed his indignation uttering `Christus Jesus God's Son: ..[Mr. K. in T., 1784;2]

"Over-working" as a serious risk factor for neurological or psychiatric disease was stressed in several reports of the Journal and until the mid-19th century[8]. In the next example it is said to have caused "final feebleness," which may be a euphemistic term for dementia.

My husband, who, as is well-known, had worked a lot with his head, and who had known many languages, mixed them altogether in his final feebleness. Sometimes he made up his words from all of them, and there was not one which would have expressed what he in-tended to say. Often he said one single German word twenty times or more, or a lot of in-consistent words without being able to find the one he needed. Then he said anxiously `Cannot!' So one could sec that he had reason and that he heard what he said. However, as I know all his ideas and his needs, I could always guess what he wanted to say, and he showed me his gratitude most tenderly. [Reiske EC, 1785; 3]

COMMENTARY
The novel "empirical" approach, the collection of "unbiased" case material in a periodical attracted immediate interest [2, 3, 4]. Translations of the original studies into English in-creased its international influence. More than 50 years later, this continuing impact was documented further by Winslow's volume On Obscure Diseases of the Brain and Disorders of the Minds that, again, presented several of the Journal's reports. The Journal was the model for numerous periodicals published after 17902 The first of them, the General Repertorium of Empirical Psychology and Related Sciences (1793-1801; Allgemeines Repertorium für em-pirische Psychologie und verwandte Wissenschaften') was founded by Immanuel David Mauchart, one of Moritz's former contributors. The Journal of Psychological Medicine and Mental Pathology, published after 1848, continued Moritz's example explicitly [8]. Journals which preferentially presented neurologic material did not develop before the second half of the 19th century. Karl Philipp Moritz' Journal of Empirical Psychology marks the beginning of a continuously increasing flow of neurologie and psychiatrie journals.

References

1. Moritz KP. Gnothi Sauton oder Magazin zur Erfahrungsseelenkunde als ein Lesebuch für Gelehrte und Ungelehrte, Vol I-X. Berlin, Germany: August Mylius; 1783-1793. (Vol l, Part 1 translated by Förstl H, Howard R in: Hist Psychiatry)
2. Förstl H, Angermeyer M, Howard R. Karl Philipp Moritz' Journal of Empirical Psychology (1783-1793): an analysis of 124 case reports. Psychol Med. 1991;21:299-304.
3. Eng E. Karl Philipp Moritz's Magazin zur Erfahrungsseelenkunde (Magazine of Empirical Psychology) 1783-1793. J Hist Behav Sei. 1973; 9:300-305.
4. Crichton A. An Inquiry Into the Nature and Origin of Mental Derangement: Comprehending a Concise System of the Physiology and Pathology of the Human Mind und a History of the Passions and Their Affects. London, England: T Cadell, Junior & W Davies; 1798.
5. Winslow FB. On Obscure Diseases of the Brain and Disorders of the Mind: Their Incipient Symptoms, Pathology, Diagnosis, Treatment and Prophylaxis. London, England: John Churchill; 1860.
6. Benton AL. Contributions to aphasia before Broca. Cortex.1964/65;1:314-327.
7. Benton AL, Joynt RJ. Early descriptions of aphasia. Arch Neurol. 1960;3:205-222.
8. Winslow FB. On softening of the brain arising from anxiety and undue mental exercise and resulting in impairment of mind. J Psychol Med. 1849;2:32.
9. Mauchart JD. Allgemeines Repertorium für Empirische Psychologie und Verwandte Wissenschaft. 1792-1801.