This document provides a history of neuroscience and the development of the neurological examination from ancient times through the modern period. It describes early views of the brain in ancient Egypt and Greece. Key developments included identifying the brain as the organ of thought in the 17th-18th centuries, distinguishing motor and sensory functions of the spinal cord in the early 19th century, and establishing electricity's role in nerves in the late 18th century. The neurological examination was developed in the late 19th century by scientists like Erb, Babinski, and Gowers. Several textbooks from the early 20th century helped standardize the clinical neurologic exam approach.

2. HISTORY OF NEURO-SCIENCE AND
NEUROLOGICAL EXAMINATION
Guided by –
Dr. Kamlesh . V. Gholap
BHMS, MD ( HOM.) CCMP
Principal and HOD of physiology
incl. biochemistry department.
Dr. Bhagyashri Wankhede – Rajput
BHMS, MD (HOM.) PGDEMS, DIHM, DIDM
Assistant prof. of physiology
incl. biochemistry department
at AKHMCH & R – Alephata, Pune.

3. Done by :-
51. Jayshree Maid
52. Shailendra Mali
53. Gargee Manke
54. Saraswati Mendke
55. Sneha Mishra
56. Darshani More
57. Vaishnavi Naikwadi
58. Suraj Nanaware
59. Swagat Padole
60. Insiya Pagarkar

4. History of Neuroscience
From the ancient Egyptian mummifications to 18th-century
scientific research on "globules" and neurons, there is
evidence of neuroscience practice throughout the early periods
of history. The early civilizations lacked adequate means to
obtain knowledge about the human brain.
Their assumptions about the inner workings of the mind,
therefore, were not accurate. Early views on the function of
the brain regarded it to be a form of "cranial stuffing" of sorts.
In ancient Egypt, from the late Middle Kingdom onwards, in
preparation for mummification, the brain was regularly
removed, for it was the heart that was assumed to be the seat of
intelligence.
According to Herodotus, during the first step of mummification: "The
most perfect practice is to extract as much of the brain as possible with
an iron hook, and what the hook cannot reach is mixed with drugs." Over
the next five thousand years.

5. The earliest reference to the brain occurs in the Edwin Smith Surgical
Papyrus, written in the 17th century BC The for brain, occurring eight
times in this papyrus, describes the symptoms, diagnosis, and
prognosis of two patients, wounded in the head, who had compound
fractures of the skull. The assessments of the author (a battlefield
surgeon) of the papyrus allude to ancient Egyptians having a vague
recognition of the effects of head trauma. The author of the passage
notes "the pulsations of the exposed brain" and compared the
surface of the brain to the rippling surface of copper slag (which
indeed has a gyral-sulcal pattern). The laterality of
injury was related to the laterality of symptom, and both aphasia ("he
speaks not to thee") and seizures ("he shudders exceedingly") after
head injury were described.

6. ISLAMIC medicine in the middle ages was focused on how the mind and
body interacteda and emphasized a need to understand mental health.
Circa 1000, lizarin living in Islamic Iberia, evaluated neurological patients
and performed surgical treatments of head injuries, skull fractures, spinal
injuries, hydrocephalus, subdural effusions and
headache.In Persia, Avicenna (Ibn-Sina) presented detailed knowledge
about skull fractures and their surgical treatments. Avicenna is regarded
by some as the father of modern medicine. He wrote 40 pieces on
medicine with the most notable being the Qanun, a medical Encyclopedia
that would become a staple at universities for nearly a hundred years. He
also explained phenomena such as, insomnia, mania, hallucinations,
nightmares, dementia, epilepsy, stroke, paralysis, vertigo, melancholia
and tremors.
He also discovered a condition similar to schizophrenia, which he called
JUNUN MUFRIT characterized by agitation, behavioural and sleep
disturbances, giving inappropriate answers to questions, and occasional
inability to speak.
Avicenna also discovered the cerebellar vermis, which he simply called
the vermis, and the caudate nucleus. Both terms are still used in
neuroanatomy today.
He was also the first person to associate mental deficits with deficits in
the brain's middle ventricle or frontal

7. Charles scott sherington work focused strongly on reflexes and his
experiments led up to the discovery of motor units. His concepts centered
around unitary behaviour of cells activated or inhibited at what he
called synapses.
Sherrington received the Nobel prize for showing that reflexes require
integrated activation and demonstrated reciprocal innervation of muscles
(Sherrington's law) Sherrington also worked with Thomas Graham
Brown who developed one of the first ideas about central pattern
generators in 1911. Brown recognized that the basic pattern of stepping
can be produced by the spinal cord without the need of descending
commands from the cortex

8. Acetylcholine was the first neurotransmitter to be
identified. It was first identified in 1915 by Henry Hallett
Dale for its actions on heart tissue.
It was confirmed as a neurotransmitter in 1921 by Otto
Loewi in Graz. Loewi demonstrated the ″humorale
Übertragbarkeit der Herznervenwirkung″ first in amphibians.
He initially gave it the name Vagusstoff because it was
released from the vagus nerve and in 1936 he wrote no
longer hesitate to identify the Sympathicusstoff with
adrenaline

9. Typical changes in neurons assoKenneth Cole joined Columbia University in 1937 and remained there
until 1946 where he made pioneering advances modelling the electrical properties of nervous tissue.
Bernstein's hypothesis about the action potential was confirmed by Cole and Howard Curtis, who
showed that membrane conductance increases during an action potential.
David E. Goldman worked with Cole and derived the Goldman equation in 1943 at Columbia
University.
Alan Lloyd Hodgkin spent a year (1937–38) at the Rockefeller Institute, during which he joined Cole to
measure the D.C. resistance of the membrane of the squid giant axon in the resting state. In 1939 they
began using internal electrodes inside the giant nerve fibre of the squid and Cole developed the voltage
clamp technique in 1947.
Hodgkin and Andrew Huxley later presented a mathematical model for transmission of electrical
signals in neurons of the giant axon of a squid and how they are initiated and propagated, known as
the Hodgkin–Huxley model.
In 1961–1962, Richard FitzHugh and J. Nagumo simplified Hodgkin–Huxley, in what is called
the FitzHugh–Nagumo model.
In 1962, BernardKatz modeled neurotransmission across the space between neurons known
as synapses. Beginning in 1966, Eric Kandel and collaborators examined biochemical.

10. Modern period:-
The role of electricity in nerves was first observed in dissected frogs by Luigi
Galvani, Lucia Galeazzi Galvani and Giovanni Aldini in the second half of the 18th
century. In 1811, César Julien Jean Legallois defined a specific function of a brain
region for the first time. He studied respiration in animal dissection and lesions, and
found the center of respiration in the medulla oblongata.
Between 1811 and 1824, Charles Bell and François Magendie discovered
through dissection and vivisection that the ventral roots in spine transmit motor
impulses and the posterior roots receive sensory input (Bell-Magendie law).
In the 1820s, Jean Pierre Flourens pioneered the experimental method of carrying out
localized lesions of the brain in animals describing their effects on motricity, sensibility
and behavior.
He concluded that the ablation of the cerebellum resulted in movements that “were
not regular and coordinated".Heinrich Obersteiner in 1887 founded the ‘‘Institute for
Anatomy and Physiology of the CNS’’, later called Neurological or Obersteiner
Institute of the Vienna University School of Medicine.
It was one of the first brain research institutions in the world. He studied the cerebellar
cortex, described the Redlich–Obersteiner's zone and wrote one of the first books on
neuroanatomy in 1888.
Róbert Bárány, who worked on the physiology and pathology of the vestibular
apparatus, attended this school, graduating in 1900. Obersteiner was later
superseded by Otto Marburg

11. Emil du Bois-Reymond, Johannes Peter
Müller, and Hermann von Helmholtz showed
neurons were electrically excitable and that
their activity predictably affected the electrical
state of adjacent neurons.

12. History of nervous system with
physiology:-
In the early B.C. years, most studies were of different natural sedatives like alcohol and
poppy plants. In 1700 B.C., the Edwin Smith surgical papyrus was written.
This papyrus looked at different case studies about injuries to different parts of the
body, most notably the head. Beginning around 460 B.C., Hippocrates began to
study epilepsy, and theorized that it had its origins in the brain.
Hippocrates also theorized that the brain was involved in sensation, and that it was
where intelligence was derived from. Hippocrates, as well as most ancient Greeks,
believed that relaxation and a stress free environment was crucial in helping
treat neurological disorders.
In 177 Galen theorized that human thought occurred in the brain, as opposed to the
heart as Aristotle had theorized.
The optic chiasm, which is crucial to the visual system, was discovered around 100 C.E.
by Marinus. Circa 1000, Al-Zahrawi, living in Iberia, began to write about different
surgical treatments for neurological disorders.
In 1216, the first anatomy textbook in Europe, which included a description of the brain,
was written by Mondino de Luzzi.

13. In 1402, St Mary of Bethlehem Hospital (later known as Bedlam in Britain) was
the first hospital used exclusively for the mentally ill.
In 1621, Robert Burton published The Anatomy of Melancholy, which looked at
the loss of important characters in one's life as leading to depression.
In 1649, René Descartes studied the pineal gland. He mistakenly believed that
it was the "soul" of the brain, and believed it was where thoughts formed. In
1658, Johann Jakob Wepfer studied a patient in which he believed that a
broken blood vessel had caused apoplexy, or a stroke.
In 280 B.C., Erasistratus of Chios theorized that there were divisions in
vestibular processing in the brain, as well as deducing from observation that
sensation was located there.

15. Institute or Organization
1887 Obersteiner Institute of the Vienna University School of Medicine[48]
1903 The brain commission of the International Association of Academies[49]
1907 Psychoneurological Institute at the St. Petersburg State Medical Academy
1909
Netherlands Central Institute for Brain Research in Amsterdam,
now Netherlands Institute for Neuroscience
1947 National Institute of Mental Health and Neurosciences
1950 Institute of Higher Nervous Activity
1960 International Brain Research Organization
1963 International Society for Neurochemistry
1968 European Brain and Behaviour Society
1968 British Neuroscience Association[50]
1969 Society for Neuroscience
1997 National Brain Research Centre
Neuroscience Institutes and Organizations

16. History of neurological examination
In the late 1800s, Wilhelm Erb, Joseph Babinski, William Gowers, and others
developed the neurologic exam as we know it today. Examination techniques were
described in their articles and neurologic texts. Erb was one of the first to
emphasize a detailed and systematic neurologic exam (1). Erb and Carl Westphal
first reported the muscle stretch reflex in 1875, and it has been an integral part of
the neurologic exam since. Babinski focused on finding reliable signs that could
differentiate organic from hysterical paralysis and emphasized the exam over the
history, unlike his mentor Jean-Martin Charcot (2). Charcot, the father of French
neurology, focused primarily on intense observation and “knew how to see” (3).
Babinski's “toe phenomenon” (1896) is the best known of the signs separating
organic from hysterical paralysis, but he also chronicled exaggerated flexion of the
forearm, combined flexion of the thigh and trunk, and the platysma sign in patients
with organic hemiplegia. Concerning Gowers, Spillane noted:
When Gowers took up his pen [1880s] there had been … some recent fundamental
developments … [including] the growing realization of the importance of the physical
examination of the patient, particularly stimulated by the discovery of the ophthalmoscope
[1851] and the deep reflexes [1875]

17. RESULTS
The Clinical Examination of the Nervous System
Georg Monrad-Krohn (1884–1964) was a Norwegian neurologist. He qualified in
medicine in Norway and trained in neurology at the National Hospital, Queen Square,
and the Maida Vale Hospital, both in London, England. While training, he completed
his thesis on the abdominal reflexes (7) and also worked out his systematic approach
to the neurologic exam (espousing the tenets of the full exam, writing out the
findings, and proposing the location and nature of the lesion). Monrad-Krohn
published Den Kliniske Undersokelse av Nervesystemet in Oslo in 1914 and returned
to Norway in 1917. In 1920, a London publishing house asked him to translate his
abdominal reflexes thesis into English, but he refused and instead offered his
manuscript of Clinical Examination of the Nervous System, which was published in
1921 (8). This was an original work in English, not just a translation from the
Norwegian. Monrad-Krohn called it an enlarged edition of his Norwegian book in the
preface. The guiding motto of the monograph was a quote from Claude
Bernard: “Recueillir les faits et ne s'asteindre à les interpréter qu'ensuite est la
condition indispensable pour arriver à la vérité” [Collect the facts and force oneself to
explain them only then, is the necessary condition for reaching the truth]
Psychiatric-Neurologic Examination Methods
August Wimmer (1872–1937) was a Danish psychiatrist and neurologist. He wrote two
tomes on epidemic encephalitis

18. Wimmer helped found clinical psychiatry as a scientific discipline in Denmark (18). He
published a psychiatric-neurologic exam book in Danish in 1917. This work was
translated into English and released as Psychiatric-Neurologic Examination Methods,
With Special Reference to the Significance of Signs and Symptoms, in 1919 (19). The
translator, Andrew Hoisholt, hoped that “the book [would] be found useful to the
American student in psychiatry, especially in connection with his work in mental clinics”
(19). The text included 61 pages on the examination of the psychic state and 86 pages
on the somatic state. Wimmer covered the psychiatric exam more thoroughly than
Monrad-Krohn did. In addition, the monograph included a scheme of examination for
the neurologic patient. He commented that “the subject of simulation has deliberately
been omitted…. Compendious references to ‘unmasking tricks’ can do mischief in the
hands of a ‘nonspecialist’” (19). One reviewer noted that Wimmer's contribution was “a
useful, short and convenient précis of case examination methods for the psychoses,
psychoneuroses, and in part for sensorimotor disturbances” (20). Another stated that
“hitherto there has been no equivalent for it in English, and thanks are due Dr. Hoisholt
for making it available”

19. The Examination of the Central Nervous System
Donald Core (1882–1934) was a neurologist at the University of Manchester and the
Manchester Royal Infirmary. He trained in Manchester but also studied in Paris with Babinski
(26). Core published The Examination of the Central Nervous System in 1928 (27), after
releasing a book in 1922 on functional nervous disorders (28). Core nicely outlined a plan for
the routine examination of the nervous system, emphasizing the motor and sensory systems,
cranial nerves, speech, and mental state. This monograph did not make much of an impact,
possibly because it was narrowly focused on
Introduction to Clinical Neurology
Gordon Holmes (1876–1965) went to medical school in Ireland and then spent 2 years doing
research with Edinger and Weigert in Frankfurt. He completed his neurology training at the
National Hospital, Queen Square, and eventually became physician and director of research
there. Holmes was consultant to the British Expeditionary Force in World War I, editor of the
journal Brain, and knighted in 1951. He felt that “the elicitation of scientific data at the
bedside required a discipline of method as rigid as that of the laboratory” (31) and was
known for his remarkable bedside teaching ability and examination skill

20. The Neurologic Examination
Russell DeJong (1907–1990) went to medical school and completed his neurology training
at the University of Michigan. He became chairman of the Department of Neurology at his
alma mater, was one of the founding members of the American Academy of Neurology,
and was the original editor of the journal Neurology. He was president of the American
Board of Psychiatry and Neurology and the American Neurological Association (33).
He published the massive 1079-page The Neurologic Examination in 1950 (46). The book
was “designed to present, in some detail, the information necessary for a complete
neurologic examination” (46) and followed the lectures on the neurologic exam given to
students at the University of Michigan Medical School
Clinical Examinations in Neurology
Clinical Examinations in Neurology was published in 1956 by members of the Sections of
Neurology and Physiology at the Mayo Clinic in Rochester, Minnesota (62). The book was
dedicated to Henry Woltman and Fred Moersch (the second and third neurologists in the
history of the institution) on their retirements. In addition to honoring Woltman and Moersch,
the work was meant to guide the trainees in neurology at the Mayo Clinic, “to facilitate their
mastery of the clinical neurologic examination”

22. References
https://emedicine.medscape.com/article/1147993-overview?reg=1#a6
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365111/
1. McHenry LC. Garrison's History of Neurology. Springfield, IL: Thomas; 1969.
2. Philippon J, Poirier J. Joseph Babinski: A Biography. Oxford: Oxford University Press;
2009.
3. Goetz CG, Bonduelle M, Gelfand T. Charcot: Constructing Neurology. New York:
Oxford University Press; 1995.
4. Spillane JD. The Doctrine of the Nerves: Chapters in the History of Neurology. London:
Oxford University Press; 1981.
5. Gowers WR. A Manual and Atlas of Medical Ophthalmoscopy. London: Churchill; 1879
6. Gowers WR. A study of the so-called tendon-reflex phenomena. Med Chir
Trans. 1879;62:269–305.
7. Monrad-Krohn GH. Om Abdominalreflexerne; et Klinisk Bidrag til Reflexlæren Paa
Grundlag av Unders⊘kelser av 472 Kasus. Kristiania, Norway: Steenske Bogtrykkeri;
1918.