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1. Auguste D.: The History of Alois Alzheimer’s First Case
- Johns Hopkins University Press
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1 Auguste D. The History of Alois Alzheimer’s First Case Konrad Maurer, Stephan Volk, and Hector Gerbaldo The year 1997 marked the ninetieth anniversary of Alois Alzheimer ’s remarkable publication, ‘‘A Characteristic Disease of the Cerebral Cortex’’ (Alzheimer 1907). This two-page article, and the subsequent publications by Bonfiglio (1908), Perusini (1909), and again Alzheimer in 1911, led to the eponym Alzheimer’s disease first used by Emil Kraepelin in his 1910 textbook of psychiatry. In his 1906 and 1907 papers, Alzheimer described Auguste D., a 51-year-old woman from Frankfurt who had exhibited progressive cognitive impairment, focal symptoms, hallucinations, delusions, and psychosocial incompetence. At postmortem she exhibited arteriosclerotic changes, senile plaques, and neuro- fibrillary tangles. Although the eponym Alzheimer was originally used to describe ‘‘presenile’’ dementia, it was later also applied to dementing processes of old age. This chapter describes the discovery and the contents of the longlost file of Auguste D. and provides some biographical data on Alois Alzheimer and information on the derivation of the eponym. The type of Auguste D.’s dementia will also be reviewed in this context. Parts of the file and its content have been published by Maurer, Volk, and Gerbaldo (1997). 6 Konrad Maurer, Stephan Volk, and Hector Gerbaldo ALOIS ALZHEIMER’S LIFE AND WORK Alois Alzheimer was born on June 14, 1864, in Marktbreit, a small town in lower Franconia on the Main river in Bavaria, southern Germany . His father was a Royal Bavarian Notary. When he graduated from high school in the district capital of Aschaffenburg, Alzheimer’s teachers certified that he was ‘‘excellent in the sciences.’’ Science was also his hobby. Alzheimer studied medicine in Berlin, Würzburg, and Tübingen. He returned to Würzburg, where he graduated in 1888 after writing a doctoral dissertation, ‘‘On the Ceruminal Glands of the Ear.’’ His doctoral adviser was the famous Swiss-born physiologist Albert Koelliker. Alzheimer completed his state medical exams in the same year. After graduation Alzheimer worked for a short period in Koelliker’s histologic laboratory in Würzburg. The young Alzheimer quite likely acquainted himself with the topical problems of the microscopic construction of the nervous system and was involved in the neurohistologic discussions of that time. In 1888 Alzheimer went to Frankfurt to work in the Municipality Asylum for the Mentally Sick and Epileptics, directed by Dr. Emil Sioli, an open-minded, liberal psychiatrist. The young Alzheimer, at this time assistant house-officer, continued to be very fond of working with the microscope, a fascination that remained with him all his life. He was especially interested in researching the cortex of the human brain. At the turn of the century, the number of mentally ill patients was increasing rapidly in Germany as elsewhere. Sexually transmitted diseases were widespread, and the number of patients with neuropsychiatric complications of progressive paralysis was increasing. In this atmosphere Alzheimer gained abundant clinical practice as a psychiatrist. He was in close contact with his patients and ‘‘wanted to help psychiatry with the microscope’’ (Kraepelin 1924). Dr. Franz Nissl, Alzheimer’s superior, who had arrived in Frankfurt in April 1889, discovered better tissue-staining techniques. Nissl and Alzheimer became friends and close colleagues. During the day they worked together in the hospital, and in the evening they sat side by side in the laboratory doing research and discussing their results. Alzheimer believed that clinical practice and laboratory research complemented each other. ‘‘Why should not the physician improve his competence by enlarging scientific knowledge of psychiatry besides doing his daily clinical practice?’’ he once wrote (Maurer and Maurer 1998). In 1894 Alzheimer married Cecilie Geisenheimer, née Wallerstein, [54.172.169.199] Project MUSE (2024-03-19 05:55 GMT) Auguste D.: Alzheimer’s First Case 7 FIGURE 1. Alois Alzheimer with his wife, Cecilie, and their children, Gertrude, Maria, and Hans. a wealthy Jewish widow. They had three children: Gertrud (who married the psychiatrist Georg Stertz), Hans, and Maria (Figure 1). When his young wife died in 1901, Alzheimer’s younger sister, Maria, came to take care of the three children. As a result of his marriage, Alzheimer had gained considerable financial independence. While in Frankfurt, Alzheimer expressed the desire to have a position in which he could combine research and clinical practice. In 1895 Alzheimer’s friend Nissl moved to Heidelberg, where Emil Kraepelin held the chair of psychiatry. Kraepelin heard of Alzheimer’s application for the post of managing director of a mental asylum...