Biographies de neurologues
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chapitre IX V16
His studies of reflexology and tubercular meningitis were to have a greater impact on the science of medicine. Whytt was the first to ascribe a reflex - Whytt's reflex, a dilation of the pupil brought on by pressure on the optic thalamus - to a specific part of the body. He also demonstrated that the spinal cord, rather than the brain, could be the source of involuntary action. His description of "dropsy of the brain" (tubercular meningitis) was the first methodical and accurate definition of the disease, and it would have been impossible to define to a more accurate extent with the instruments available in at that time.
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mise à jour du
 31 mars 2005
Robert Whytt
1714 - 1766
Observations on the Nature, Causes and Cure of Those Disorders Which Have Been Commonly Called Nervous, Hypochondriac or Hysteric, (1767)
extrait de : John Talbott (1970)
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 Les biographies de neurologues
 robert whytt
ROBERT WHYTT, the predecessor of William Cullen in the chair of medicine at Edinburgh, is less well known, but his contributions to clinical medicine and particularly to the pathogenesis of reflex action place him firmly among the foremost physicians of Edinburgh in the 18th century. His clear description of tuberculosis meningitis, his explanation of the sentient (sensitivity) principle in involuntary action, and the significance of emotions in the natural history of organic diseases easily offset his mistaken emphasis on the value of lime-water in the treatment of urinary tract concretions. Whytt (pronounced White) was born four years after Cullen. His father, a member of the Scottish bar and proprietor of the estate of Bennochie, died six months before Robert was born. His mother died when he was six years old. He must have been blessed with wise and good guardians who made it possible for him to obtain an excellent education. Following graduation with a master of arts degree from St. Andrews in 1730, he spent the next four years studying medicine at Edinburgh, concentrating in anatomy under Monro Primus. He then went to London, became a pupil of Cheselden, and walked the wards of the city hospitals. After London, he made his pilgrimage to the Continent, spent time in Paris at La Charité and Hôtel Dieu, and in Leyden audited the lectures of Albinus, who was in his midmaturity and those of Boerhaave, who was in his retiring years.
Whytt took the degree of medicine at Rheims in 1736. Rheims, though seldom mentioned among the great schools of France, enjoyed a short term of popularity with the physicians of Edinburgh, several of whom graduated MD from this school in the 18th century. Whytt received a second MD degree from St. Andrews and became a licentiate of the Royal College of Physicians of Edinburgh. He presented both degrees. for fellowship in the College in 1738 and immediately began practice. At the age of 33, he was appointed professor of the theory of medicine at Edinburgh and held the chair until his death in 1766. Cullen did not succeed to the post until seven years later. In 1752, Whytt was elected a fellow of the Royal Society of London and in 1761 was appointed physician to the king of Scotland.
Before succeeding to the chair in Edinburgh, Whytt published a treatise on the use of alicant soap and lime-water in the treatment of urinary tract calculi. Since bladder stones were encountered frequently in the practice of his time, effective measures for preventing or dissolving the concretions appealed greatly. Whytt, by his chemical studies, exploited the possibilities of the secret formula developed by Mrs. Joanna Stephens, which had been purchased by the British government and which consisted of calcined egg-shells, soap, and aromatic bitters. The therapeutic value of limewater was attributed to a peculiar property of the solvent, when used as a bladder irrigant, rather than to its alkaline reaction. It is possible that large quantities of an alkaline fluid might have caused some inhibition of formation of uric acid stones; whereas a high fluid intake in persons who had previously been on a low fluid intake might have brought slight benefit. Probably the most enduring consequence of the limewater misconception was the attention given to the subject by Joseph Black, who, in searching for a solvent for stones a decade later, discovered "fixed air" or carbon dioxide.
In the chair of medicine, Whytt devoted much time to physiological investigation. The Essay on the Vital and Other Involuntary Motions of Animals is primarily concerned with reflex action, his best contribution to scientific medicine. It was published in 1751 and presented the concept of a sentient principle which received the afferent stimulus and dispatched the efferent response in involuntary motions. Descartes, Robert Boyle, and Stephen Hales had previously discussed reflex action, which knowledge was extended by Whytt, who demonstrated in physiological experiments that only a small segment of the spinal cord was necessary for reflex action. Reflex function was shown to depend neither upon the integrity of the brain nor upon the intact and entire spinal cord. This physiological explanation was quite contrary to the rational, conscious soul concept advanced by Stahl. Whytt also localized the reflex action of the pupil (Whytt's reflex), noting the afferent pathway in the optic nerve and the efferent pathway in the third nerve. Also, he suggested that persistent dilatation of the pupil could be produced by compression of the optic thalamus. «From this case it seems probable that the dilatation of the pupil soon after the coming on of the coma, was owing to the compression of the thalmami nervorum opticorum, by the water collected in the brain, which rendered the retina insensible of the stimulus of light».
This presentation of sensibility and irritability, which could be demonstrated by a number of involuntary actions, brought a rebuke from von Haller, who contended that irritability of a muscle was independent of nervous influence and sensation. Whytt remained firm in his conviction that muscular contraction was under nervous control. One of the best illustrations of the sentient principle is the rhythm of the heart.
«How far the mind is really concerned in the motion of the heart, may easily appear from what has been already in the preceding Sections; where, if I mistake not, it has been shewn beyond doubt, that the contraction of the heart is owing to the returning venous blood acting as a stimulus upon it; and made highly probable, both from reason and analogy, that a stimulus excites our muscles into motion, only as they are animated by a sentient principle. Whence it must follow, that the alternate contractions of the heart are in no other sense owing to the irritation of the returning blood, than as the mind or sentient principle is, by this, excited to increase the action of the nerves upon its fibres.
This doctrine of the alternate motion of the heart as proceeding from the power of the mind, excited into action by the stimulus of the returning venous blood admitted into its cavities, is greatly strengthened by the account we have given of the alternate motions of respiration, of the contractions of the muscles of the internal ear and of the pupil. These we have clearly shewn to proceed from the mind, as affected by a stimulus, and to be altogether inexplicable upon principles merely mechanical.
The mind, therefore, in carrying on the vital and other involuntary motions, does not act as a rational, but as a sentient principle; which, without reasoning upon the matter, is as certainly determined by an ungrateful sensation or stimulus, affecting the organs, to exert its power, in bringing about these motions, as is a balance, while, from mechanical laws, it preponderates on that side where the greatest weight prevails».
Whytt's neurophysiological discussions were complemented by clinical observations on nervousness, hypochondriasis, and hysteria. The extent that emotional factors penetrate into or become an integral factor in the pathogenesis of clinical disorders, not usually classified primarily nervous, is exemplary and modern.
«The disorders which are the subject of the following Observations, have been treated of by authors, tinder the names of Flatulent, Spasmodic. Hypochrondriac or Hysteric. Of late, they have also got the name of NERVOUS; which appellation having been commonly given to many symptoms seemingly different, and very obscure in their nature, has often made it be said that Physicians have bestowed the character of nervous on all those disorders whose nature and causes they were ignorant of. To wipe off this reproach, and, at the same time, to throw some light on nervous, hypochrondriac and hysteric complaints, is the design of the following Observations; which are also intended to shew, how far the principles laid down in my Essay on the vital and other involuntary Motions of Animals, may be of use in explaining the nature of several diseases, and consequently, in leading to the most proper method of cure.
Since, in almost every disease, the nerves suffer more or less, and there are very few disorders which may not in a large sense be called nervous, it might be thought that a treatise on nervous diseases should comprehend almost all the complaints to which the human body is liable».
The monograph on tuberculosis meningitis, published posthumously by his son with the title Observations on the Dropsy in the Brain, has been adjudged his most important clinicopathological study. The natural history of the disease was divided into three stages according to the pulse rate, alternating from rapid to slow to rapid.
«Children who have water in the ventricles of the brain begin to have many of the following symptoms, four, five, or six weeks, and in some cases much longer, before their death.
At first they lose their appetite and spirits; they look pale, and fall away in flesh; they have always a quick pulse, and some degree of fever.
While the feverishness continues or increases, they lose their appetite more and more; ... They are thirsty, and frequently vomit once or twice in a day, or once in two days. They complain of a pain in the crown of their head, or in the forehead above their eyes . . . . Their spirits being low, they incline mostly to lie in bed, aitho' they are often more disposed to watching than to sleep. They cannot easily bear the light, and complain when a candle is brought before their eyes.
I date the beginning of the second stage from the time the pulse, from being quick but regular, becomes slow and irregular. This sometimes happens about three weeks, often a fortnight or less, before the death of the patient.
During the second stage, most of the symptoms mentioned in the first continue. The sick are then unable to sit up, tho' generally they sleep little, till towards the end of this period, when they begin to grow drowsy. They moan heavily, yet cannot tell what ails them. Their eyes are often turned towards their nose, or they squint outwards, and sometimes they complain of seeing objects double. Some, towards the end of this stage, grow delirious, and cry out in a wild manner, as if they were much frightened.
In the third stage, the patient, who before was little disposed to sleep, becomes then drowsy and comatose. When roused, he utters only a fev, incoherent words, and appears to be insensible. The beginning of the coma is uncertain; it is often about the end of the second stage before the pulse grows quicker for the second time.
Frequently one eye-lid loses its motion, and afterwards the other becomes also paralytic.
In this stage, the patients are sometimes observed to be constantly raising one of their hands to their head; and are generally troubled with convulsions of the muscles of the arms, legs, or face, as well as with a subsultus tendinum.
Upon opening the heads of ten of those patients from whom I have collected the symptoms above mentioned, I found in all of them a clear thin fluid in the anterior ventricles of the brain, immediately below the corpus callosum. There was frequently the same kind of liquor in the third and fourth ventricles; but whether this is always the case, I cannot say, as I had not attended sufficiently to this circumstance».
1. Seller, W.: Memoir of the Life and Writings of Ifobert Whytt, M.D., Trans Roy Soc Edinburgh 23:99131, 1864.
2. Whytt, R.: An Essay on the Vital and Other Involuntary Motions of Animals, 2nd ed, Edinburgh: J. Balfour, 1763.
3. Whytt, R.: The Works of Robert Whgtt, M.D., published by his son, Edinburgh: j. Balfour, 1768.
4. Whytt, R.: Observations on the Nature, Causes, and Cure of Those Disorders Which Have Been Commonly Called Nervous, Hypochrondiac, or Hysteric, Edinburgh: J. Balfour, 1765.
5. Whytt, R.: Observations on the Dropsy in the Brain, Edinburgh: J. Balfour, 1768
Robert Whytt was physician to King George III in Scotland from 1761.
Notable Publications:
Essay on the Vital and Other Involuntary Motions of Animals, (1751)
An Essay on the Virtue of Lime-Water in the Cure of the Stone, (1752)
Physiological Essays, (1755)
Review of the Controversy Concerning the Sensibility and Moving Power of the Parts of Men and Other Animals, (1761)
Observations on the Nature, Causes and Cure of Those Disorders Which Have Been Commonly Called Nervous, Hypochondriac or Hysteric, (1767)
Observations on Dropsy of the Brain, ( 1768)