Book Review

Minds Behind the Brain: A history of brain pioneers and their discoveries

N Engl J Med 2000; 342:1616May 25, 2000

Article

Minds Behind the Brain: A history of brain pioneers and their discoveries
By Stanley Finger. 416 pp., illustrated. New York, Oxford University Press, 2000. $35. ISBN: 0-19-508571-X

What makes a book great? Essentially, a great subject and a great writer combined. Finger's book is in that league. The author, a psychologist and a historian of neuroscience, has chosen a biographical approach to explain how our knowledge of brain function developed. In the introductory pages, readers may feel that they are being put back in the classroom, with phrases such as “our journey” and “we shall see that.” In the chapters that follow, however, one cannot help but be captivated and even enchanted by Finger's great storytelling. He combines narrative gifts with a wealth of background knowledge. This combination results in a clever weaving of the history of ideas among the biographical accounts of great scientists.

Finger succeeds with this approach even in the first chapter, about Egyptian medicine. Obviously, there is a dearth of information about persons from that era, but Finger enlivens the narrative by telling the story of how the Egyptologists Edwin Smith and James Breasted helped decipher the “surgical papyrus.” He continues with chapters on Hippocrates, Galen, Vesalius, Descartes, and Willis. During the centuries when these men lived, but of course especially after the Renaissance, increased knowledge of the structure of the brain radically changed rooted ideas about its function. Brain function is the leading theme in the subsequent chapters, on Galvani, Gall, Broca, Ferrier, and Hitzig. Even stories that many readers will have heard before are told so well that they seem fresh. An example is the controversy between Ferrier and Goltz, at the World Medical Congress of 1881 in London, about the localization of brain functions (I would like to have been a fly on the wall), with its legal aftermath provoked by the British antivivisectionists.

The chapter on Charcot is fine, but regrettably, it is the only chapter on patient care. That is my main criticism of this book: clinical neurology is largely neglected. Of course, Charcot was a giant in that he brought some order to the field of neurology by classifying diseases according to their anatomical characteristics (e.g., amyotrophic lateral sclerosis and multiple sclerosis) rather than their manifestations (e.g., paralysis and insanity). But it is worth noting that he built on an already established movement, in which holistic notions of disease had been largely replaced by the organ-based approach. This approach had been initiated by Morgagni (1682–1771) in Padua, Italy, and it was carried forward in London by Baillie (1761–1823) and in Paris by Desault (1738–1795) and Bichat (1771–1802). It received a strong impetus from the French Revolution, which abolished traditional barriers between medicine and surgery. Among Charcot's forerunners in identifying structural brain diseases were Bright (1789–1858) and Rostan (1790–1866).

Nor did the story of clinical neurology end with Charcot. Pathologic changes in the nervous system, once recognized, were correlated with physical signs by the next generation of neurologists: Babinski (1857–1932), whose name appears only in the caption of an illustration, Gowers (1845–1915), and Oppenheim (1858–1919), to mention only a few. One looks in vain for a section about these founders of the neurologic examination.

To conclude my critique with a completely different issue, can Finger and I agree, on the authority of eminent historians such as Norman Davies (Europe: A History. Oxford University Press, 1996), that “Caucasian” is not only an evasive term for “white” but also a historical misnomer, perpetuating the myth that white people have a single origin?

The discussion of Charcot is an invisible turning point in the book, because the subsequent focus is on nerve cells, or nerve-cell systems, and their interactions. Accordingly, the closing chapters are dedicated to experimentalists: Cajal, Sherrington, Adrian, Loewi, Dale, Sperry, and Levi-Montalcini. All were awarded the Nobel prize — and none were practicing physicians. Again, Finger shows his talents in bringing to life not only the people, but also the scientific problems they faced. Even clinicians with no particular affinity for basic science cannot fail to be fascinated by the persistent efforts of these neuroscientists and the elegance of the solutions they found.

Throughout the chapters of this book, the story line remains visible — a major feat that makes the book much more valuable than a collection of biographical anecdotes. The text is elegantly displayed, the illustrations are of good quality, the proofreading has been meticulous, and the book has a nice smell. A-1, Osler would have said.

J. van Gijn, M.D.
University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands