History as a biomedical matter: recent reassessments of the first cases of Alzheimer’s disease

Abstract

This paper examines medical scientists’ accounts of their rediscoveries and reassessments of old materials. It looks at how historical patient files and brain samples of the first cases of Alzheimer’s disease became reused as scientific objects of inquiry in the 1990s, when a genetic neuropathologist from Munich and a psychiatrist from Frankfurt lead searches for left-overs of Alzheimer’s ‘founder cases’ from the 1900s. How and why did these researchers use historical methods, materials and narratives, and why did the biomedical community cherish their findings as valuable scientific facts about Alzheimer’s disease? The paper approaches these questions by analysing how researchers conceptualised ‘history’ while backtracking and reassessing clinical and histological materials from the past. It elucidates six ways of conceptualising history as a biomedical matter: (1) scientific assessments of the past, i.e. natural scientific understandings of ‘historical facts’; (2) history in biomedicine, e.g. uses of old histological collections in present day brain banks; (3) provenance research, e.g. applying historical methods to ensure the authenticity of brain samples; (4) technical biomedical history, e.g. reproducing original staining techniques to identify how old histological slides were made; (5) founding traditions, i.e. references to historical objects and persons within founding stories of scientific communities; and (6) priority debates, e.g. evaluating the role particular persons played in the discovery of a disease such as Alzheimer’s. Against this background, the paper concludes with how the various ways of using and understanding ‘history’ were put forward to re-present historic cases as ‘proto-types’ for studying Alzheimer’s disease in the present.

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Notes

  1. 1.

    In general, medical publications pseudonymise or abbreviate patients’ names to ensure medical confidentiality. The full names of Auguste D and Johann F have, however, been used in books and articles, exhibitions, and even in the Wikipedia, and are, therefore, given here, too. On broader ramifications of masking a patient’s identity versus providing his or her name when working with these and other psychiatric sources, see Keuck (2016).

  2. 2.

    The opposition of ‘historians’ and ‘scientists’ should not obscure the pluralism of historiographical approaches both among historians and among scientists or physicians (see Brush 1995; Huisman and Warner 2004). Furthermore, many historians and philosophers of science, including Thomas Kuhn, started their careers as scientists. On notions of ‘science history’, see Debus (1971) and Brush (1995). They are closely related to notions of history of disease and retrospective diagnosis; see Latour (2000) and Cunningham (2012) on this topic. For an overview of different ways in which histories of disease are written, many of which crisscross the junction between ‘medical history’ and ‘history of medicine’, see Jackson (2017); see also Labisch’s account of “history in medicine” as referring to the “self-reflection on the conditions of medical knowledge and practical medical action in the special light of their change over time” in order to help “solve current medical problems” (Labisch 2004, p. 424).

  3. 3.

    For an introduction into Imperial German psychiatry, see Engstrom (2003). For the role of the different types of psychiatric institutions in Frankfurt and Munich, in which Alois Alzheimer worked, while diagnosing and posthumously examining the case of Auguste Deter, see Engstrom (2007).

  4. 4.

    See, for instance, Wailoo and Pemberton (2006), and Schramm et al. (2012).

  5. 5.

    ‘Biomedical facts’ hints at Fleck’s (1979 [1935]) Genesis and Development of a Scientific Fact, and his famous argument that a scientific fact has to be articulated within the contemporary thought style of a given scientific community in order to become accepted.

  6. 6.

    Thus, science history is often accused of presentism and whiggishness. Brush (1995, p. 220) distinguishes between presentism and whig history as follows: “The present-minded historian asks questions about the past inspired by concerns of the present; the whig historian gives answers that are distorted by those concerns”. The notion of a Whig interpretation of history draws on Butterfield (1931). For an overview on various notions of presentism in history, see Moro-Abadía (2009).

  7. 7.

    Like other material things, microscope slides can also be scrutinised as sources in ‘proper’ historical studies, e.g. for understanding how the slides were used, stored, and presented in the past (see Löwy 2011b, 2013). Bettina Bock von Wülfingen (2017) examines how neuropathological collections were organised in the late nineteenth and early twentieth century. She emphasises that the historical labelling and note-keeping practices form a central precondition for ‘reactivating’ old histological preparations, including the slides of the Alzheimer cases that Manuel Graeber rediscovered and reassessed.

  8. 8.

    See Chapman and Wylie (2015, 2016) for in-depth analyses of how archaeologists use material remains as repositories of evidence. I want to thank an anonymous reviewer for pointing me to the comparison of my case study to archaeology.

  9. 9.

    On medical ways of knowing, see Ilana Löwy (2011a) who draws on Pickstone’s (2000) Ways of Knowing.

  10. 10.

    Interview with Konrad and Ulrike Maurer, conducted by L.K., 31 July 2014.

  11. 11.

    The Max Planck Institute of Neurobiology used to form the theoretical section of the Max Planck Institute of Psychiatry. It moved to the new campus in Martinsried in 1984, and achieved an independent status in 1998 (https://www.neuro.mpg.de/2341/history, accessed 9 February 2016). Georg Kreutzberg became a director of the Max Planck Institute of Psychiatry in 1979, and founded the Department of Neuromorphology in 1984 (https://www.neuro.mpg.de/kreutzberg/de, accessed 9 February 2016).

  12. 12.

    Graeber (2003, p. 1). The article closes with the following dedication: “I would like to dedicate this article to Professor Georg W. Kreutzberg, Munich, and to the memory of the ‘Munich School of Neuropathology’” (Graeber 2003, p. 7).

  13. 13.

    For a contemporary critique of these developments within medicine, see social gerontologist Tom Kitwood (1997), who coined the phrase “Alzheimerization of dementia” and blamed the strong attention for the biomedical underpinnings of the concept of Alzheimer’s disease for misleading therapeutic approaches to disregard the individual patient. In a similar vein, though originally being himself heavily involved in biomedical research on Alzheimer’s disease, neurologist Peter Whitehouse spoke of the making of “a disease of the century” that was “worthy of massive research efforts”, and that was actively marketed to journalists and politicians, noting that the “aggressive medicalization of brain aging” was accompanied with “military metaphors” and popular references to the fear that, as Alzheimer’s patients, we might “lose ourselves” (Whitehouse and George 2008, pp. 91–109).

  14. 14.

    Katzman (1976). The major classification systems of diseases and mental disorders, the International Statistical Classification of Diseases and Related Health Problems and the Diagnostic and Statistical Manual of Mental Disorders, officially omitted the ‘pre-senility’ criterion in the early 1990s. The taxonomic changes mirrored the change in meaning of ‘senility’ or ‘old age’: while considered an exclusion criterion in the mid-century, old age is nowadays regarded as the major risk factor for Alzheimer’s disease (see, e.g., Ballenger 2006; Keuck 2011; Lock 2013).

  15. 15.

    An English translation of the first case report of Alzheimer’s disease appeared already in 1912, but was subsequently forgotten (Fuller 1912; see also Bick 1994; Hamann 1997). Another one by Robert Wilkens and Irwin Brody was published under the rubric “Neurological Classics” in Archives of Neurology in 1969 (Wilkens and Brody 1969).

  16. 16.

    In an edited volume of proceedings from a symposium that took place in Alzheimer’s birthplace Marktbreit in 1997, featuring Konrad Maurer, Manuel Graeber, and Luigi Amaducci amongst others, the editors write about Amaducci’s hypothesis: “Though Amaducci did not persuade many of his colleagues on this point, his argument was plausible enough that it had to be reckoned with. (…) Sadly, Amaducci did not live long enough to see the discovery of the original slides of Auguste D.’s brain tissue prepared by Alzheimer” (Whitehouse et al. 2000, p. 17).

  17. 17.

    “Eine eigentümliche Gruppe von Fällen mit sehr schweren Zellveränderungen hat Alzheimer beschrieben. Es handelt sich um die langsame Entwicklung eines ungemein schweren geistigen Siechtums mit den verwaschenen Erscheinungen einer organischen Hirnerkrankung.” (Kraepelin 1910, p. 624, translation L.K., original emphasis spaced out).

  18. 18.

    “Im Jahre 1906 habe ich einen Fall von Erkrankung des präsenilen Alters beschrieben, welcher während des Lebens ein von den bekannten Krankheiten abweichendes Bild bot und bei der mikroskopischen Untersuchung Veränderungen in der Hirnrinde aufwies, die damals noch unbekannt waren.” (Alzheimer 1911, p. 356, translation L.K.).

  19. 19.

    “Special funding will be necessary, however, since a pertinent search seems likely to take not only months but years of detective work.” (Graeber 1999, p. 239, quoting his letter, dated 17 November 1992, to Henry de F. Webster, then Chief of the Laboratory of Experimental Neuropathology at the National Institutes of Health in Bethesda, Maryland).

  20. 20.

    For a brief history on brain banks, see Gere (2005).

  21. 21.

    Lindee’s (2005, pp. 58–89) chapter on ‘Provenance and the Pedigree’ examines Victor McKusick’s field work on constructing the pedigree of the hereditary disease Ellis-van Creveld syndrome in Pennsylvania Amish in the early 1960s. This kind of ‘provenanceprovenance research,’ which aims to follow the transmission of a disease throughout generations, was also applied to trace founder cases of familiar forms of Alzheimer’s disease in the 1990s (see Pollen 1993).

  22. 22.

    Indeed, another way to frame ‘technical biomedical history’ would be to contextualise it as a form of historical experimentation (for an overview, see Chang 2011). Since the focus in the present case study was, however, not on the replication of an experiment but on the replication of a preparation, I think the analysed approach to history has more in common with technical art history than with historical experimentation.

  23. 23.

    http://www.brainnet-europe.org/index9ffc.html?option=com_content&view=article&id=19&Itemid=19, accessed 15 March 2017. The original photograph is on display at the exhibition of the history of the Munich psychiatric clinic.

  24. 24.

    I would like to thank Kat Maxson for pointing me to priority debates as an additional way of using history writing within biomedicine. Her example was the recent “war” over the discovery of CRISPR-cas9, which makes the divisive aspects of priority debates much more tangible than the Alzheimer’s case. In the CRISPR-cas9 “war”, scientific prizes and patents are at stake, and “who claims them will be decided in part by what version of history becomes accepted as ‘the truth’” (Comfort 2016, not paged).

  25. 25.

    I cannot discuss all of the reasons for the disease’s concept being a moving target here. The notion of a mental disorder as a moving target draws on Ian Hacking’s argument that classification in the human sciences works differently from classification of things that cannot consciously react to the classification of their properties (see, e.g. Hacking 1986).

  26. 26.

    For a discussion of accounts of models, exemplars, prototypes and experimental systems in the historiography of the life sciences, see Creager (2002, pp. 317–333); for an assessment of their functions in ‘science without laws’, see Creager et al. (2007). For an account of materialised models of and for Alzheimer’s disease, see Huber and Keuck (2013).

  27. 27.

    Space does not permit to give a full account of the exhibition of objects, documents, books, and photographs of the clinic’s history. The conference-exhibition room is not openly accessible. Within the publications of the clinic, the display is sometimes referred to as a “museum”, sometimes as an “exhibition”, and the door sign says “Psychiatriehistorische Sammlungsstelle”. For a general introduction into the musealisation of science, and the often lacking distinction between archive, museum, collection, and exhibition, see te Heesen and Vöhringer (2014).

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Acknowledgements

Earlier versions of this paper were presented at the conference ‘New Perspectives in the History of the Life Sciences’ at the Ludwig-Maximilians-Universität München, the ‘History of Science Program Seminar’ at Princeton University, the ‘Nachwuchsforum Wissenschaftsgeschichte’ at the Leopoldina in Halle, the lecture series ‘Recycling in den Wissenschaften’ at the Georg-August-Universität Göttingen, and at the Colloquium of the Chair of the History of Technology at the Swiss Federal Institute of Technology in Zurich (ETH Zürich). I would like to thank the participants of these events as well as two anonymous reviewers, and the editors Robert Meunier, Kärin Nickelsen, and Staffan Müller-Wille, for many helpful comments. Alfred Cheesman and Christof Sendhardt patiently proofread various versions of this paper.  Special thanks go to Konrad and Ulrike Maurer for meeting me in Frankfurt, and the Max Planck Institute for the History of Science as well as ‘The Branco Weiss Fellowship - Society in Science’, administered by ETH Zürich, for funding this research.

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Correspondence to Lara Keuck.

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Keuck, L. History as a biomedical matter: recent reassessments of the first cases of Alzheimer’s disease. HPLS 40, 10 (2018). https://doi.org/10.1007/s40656-017-0177-7

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Keywords

  • Alzheimer’s disease
  • Auguste Deter
  • Biomedical research
  • Neuropathology
  • Retrospective diagnosis
  • Science history