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Cerebral pathology, psycopathology and psychiatric heredobiology, after Kleist

Three special events in an outstanding scientific career are to be honored in 1959. On the 31st of January, 1879, was born at Mülhausen one of the founders of contemporary psychiatry, Karl Kleist; he celebrates his venia legendi jubilee (1909) and also published 25 years ago his Gehirnpathologie (1934), a landmark in brain pathophysiology. His work means a combination and a refinement of Meynert's, Wernicke's and Kraepelin's diverse principles. In Kleist's thinking, brain pathology and psychopathology are always bound together; and his clinical researches are set along three lines: the pathogenesis, the heredological implications and catamnestic follow-up. On the other hand, pathogenic analysis of the symptoms as well as of the whole clinical patterns must take in account the role played by brain stem and by cortex. Within the cortical functioning itself, symptoms resulting from troubles of frontal areas to be distinguished from their similar ones coming from posterior regions. In this way were described the agrammatical and paragrammatical disturbances, alogical and paralogical ones, by analogy with aphasia and paraphasia regards the speech. Kleist was the first author to demonstrate Wernicke's conductive aphasia (1905) and to describe two new forms of apraxia: limb-kinetic and constructive apraxia. Other now classical disturbances were described by him: the loss of initiative, initiative apraxia, apraxia of the coordinated action (Handlungsfolge), spatial blindness (Ortsblindheit), color agnosia - which involves the abstract meaning of colors and not their discrimination - and patterns coming from the cingulate-orbital region. Six intermixed spheres are to be distinguished in the psychic functions of the self (Table 1). Kleist's functional plan - structure-conditioned - of brain mantle has no similar until now, as far as penetrating analysis and sense of reality are concerned. As shown in Figs. 1 and 2, even one and the same area may perform quite different functions, a fact which one anatomic-clinical observation of ours was able to demonstrate (Fig. 3). Other aspects of that most remarkable map may be supported, in our mind, by the physiological neuronography of Dusser de Barenne's school (Figs. 4, 5 and 6). The clinical contributions are not overshadowed by his doctrine on cerebral pathology. He described many single psychoses as "involution paranoia", psychogenic "terror psychosis" during World War I, and discussed the "post-operative" and influenza psychoses. And, most of all, he described and minutely studied, seconded by his school, two large sets of psychoses: the several forms of schizophrenia and the degeneration psychoses. The first named of these represent autonomous clinical entities that may be recognized by diverse interplay of the psychic systems (Table 2). The last ones are autocthonous in origin, due to latent genetic traits, essentially benign as for outcome and genetic implications. However (Table 3), they may be missed under the diagnosis of schizophrenia or of maniac-depressive psychosis, what indeed often happens. The large and exhaustive catamnestic follow-up supports the reality of both groups of psychoses.


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