Schroeder van der Kolk: the soul and epilepsy

Jacobus Schroeder van der Kolk (1797-1862) 1 showed his intellectual abilities when a student at Groningen. He became Professor of Anatomy and Physiology at Utrecht in 1826. More than 100 scientific contributions followed. They were devoted to the management of the mentally ill in asylums to which he had devoted his labours, clinical studies of neurology, lung diseases, blood disorders, embryology, zoology and later in his life he considered philosophical issues of the nature of the soul. His major work was entitledBody and Soul in which he described psychic processes and material disorders as the outcome of a higher spirit (spiritus animalis ).

His writings, evolved from primitive Galenic ideas, have to be seen in their historical context; but throughout he emphasised the miraculous aspects of natural history, and of life itself. He initiated investigations of the causes of disease using morbid anatomy, publishing an important work Anatomy of the Cord and Medulla.

Van der Kolk performed autopsies and used a primitive microscope on the brains of epileptics. His conclusions were given in the Sydenham Lecture of 1859, On the minute structure and functions of the medulla oblongata and the proximate causes and rational treatment of epilepsy. He found "dilatation of the veins which appeared filled with blood in the cortex, medulla and spinal cord". The medulla "showed a fatty degeneration with albuminous intracellular fluid." Those who bit their tongues during a fit had dilated vessels feeding the hypoglossal nucleus whereas those without a bitten tongue had dilated vessels of the vagal nucleus.

"The first cause of epilepsy . . . is exalted sensibility and excitability of the medulla oblongata. . . ." These caused the medulla to be "liable to discharge upon itself" and these discharges caused spasms in blood vessels leading to hyperaemia followed by involuntary reflex movements . . ." Frequent or repeated fits caused inflammation of the cortex leading to "incurable dementia" due to "thickening and dilatation of blood vessels." 2

This problem of the prime seat of the epileptic fit was a major source of controversy. 3 4 The distinguished American neurologist Hammond cited van der Kolk's work in his A treatise on the diseases of the nervous system (1871), and claimed "no one has been more thorough in the search for the essential cause of epilepsy than he."

The researches of Brown Sequard and Kussmaul suggested that convulsions may take origin in the pons and medulla, having shown that they occur when other parts of the brain had been removed. Nothnagel had referred to "the convulsive centre" adjacent to the centre for respiration. Hammond too, thought the seat of epilepsy lay in the medulla, and that the demonstrated lesions in the cortex of certain epileptics excited the medulla to produce the convulsive fit.

By contrast, Gowers, although acknowledging the prevailing ambivalence, clearly favoured the cortex as the essential source of epilepsy:

"On the other hand, of all the regional diseases of the brain, lesions of the convolutions stand incomparably first as a cause of convulsions, and the experiments of Ferrier and Luciani also demonstrate that irritation of the cortex in the motor region has the same effect. . . . The teaching of experiment, then is that both the cortex and the medulla (sic) may originate convulsions. The teaching of pathology is, as Wilks long ago insisted, that epileptiform convulsions have, in most cases, their origin at the surface of the brain." 3

It was left to Jackson, Ferrier, and Horsley to show the primacy of the cortex in epilepsy.

Van der Kolk's work was not confined to the brain and mind. Brown-Séquard 4 refers to his description of "very minute longitudinal white columns surrounded by gray substance in the cord, first described by Lockhart Clarke, . . . channels for sensitive impressions or for the orders of the Will to muscles." In Lecture 5. Brown-Séquard refers to the mysteries of decussating fibres from the posterior roots that "pass from one lateral half of the cord into the other one", an observation already made by this brilliant Dutchman, and several others.

References

1 Haas LF ( 1994 ) Jacobus Ludovicus Shroeder van der Kolk (1797-1862). J Neurol Neurosurg Psychiatry. 57: 1164.

2 Fine EJ Fine D ( 1997 ) JS van der Kolk's influence on American concepts of epilepsy. Proceedings of the 2nd meeting of the International Society for the History of the Neuro Sciences. ( IJHNS, Leiden ), p 29.

3 Gowers WR ( 1885 ) Epilepsy and other chronic convulsive diseases: their causes, symptoms and treatment. ( William Wood, London ), pp 167-175.

4 Brown-Sequard CE ( 1860 ) Course of lectures on the physiology and pathology of the central nervous system. ( Collins, Philadelphia ), Lecture 2 p24, lecture 5 p54..