Johann Bernhard Aloys von Gudden (original) (raw)

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- A dictionary of medical eponyms

Born 1824
Died 1886

German psychiatrist and neuroanatomist, born June 7, 1824, Kleve; died June 13, 1886, Starnberger See, near Schloss Berg, München.

Biography of Johann Bernhard Aloys von Gudden

Johann Bernhard Aloys von Gudden was born in Kleve, in Lower Rhineland near the Dutch frontier, the third of seven sons of Johannes Gudden, a landed proprietor, and Bernadine Fritzen. His feeling for exact observation and his aptitude for study became evident at an early age. After passing the final secondary school examination in the fall of 1843, von Gudden from 1844 studied at Bonn, Berlin, and in Halle. He received his doctorate at Halle in 1848, and the same year passed the state medical examination with distinction in Berlin. That year he also commenced his one-year of military service.

In 1848 Gudden obtained a position at the Siegburg asylum as an intern under Karl Wigand Maximilian Jacobi (1775-1858), one of the leading German somatic psychiatrists. He married the latter’s granddaughter Clarissa Voigt in 1855; they had nine children. From 1851 to 1855 Gudden worked with Christian Friedrich Wilhelm Roller (1802-1878) in the mental asylum at Illenau in Baden, a hospital known even outside Germany for its outstanding organization.

In 1855 Gudden was appointed director of the newly founded Unterfränkische Landes-Irrenanstalt in Werneck, northeast of Würzburg in Unterfranken. This palace had been built for the prince-bishop about 1733-1745 by Johann Balthasar Neumann (1687-1753), the German architect who was the foremost master of the late Baroque style. Von Gudden supervised the transformation of the Episcopal palace into Germany’s most modern asylum, an achievement that earned him a reputation as an excellent organizer.

In the treatment of the mentally disturbed he rejected the methods of the older psychiatric schools at Siegburg and Illenau. Despite their human conceptions these schools had continued the use of physical force and believed that “moral influence” and “educational» strictness” were beneficial. An advocate of the principle of no restraint, Gudden championed, earlier than Wilhelm Griesinger (1817-1868) and Ludwig Meyer (1827-1900), a liberal and humane orientation in the treatment of the mentally ill. Going beyond even John Conolly (1794-1866), he granted his patients an unprecedented measure of personal freedom. He insisted that proper treatment required communal social life for the patients, constant contact between physicians and patients, and a well-trained staff with s strong sense of duty.

In this period he turned down an invitation to become professor and director of the Kreisirrenanstalt in Munich.

In 1869 Gudden became director of the recently constructed cantonal mental hospital Burghölzli, near Zürich, and professor of psychiatry at the University of Zürich. Following the death of Karl August Solbrig (born 1809) in 1872 he was named Obermedicinalrath and director of the Oberbayerische Kreis-Irrenanstalt Haar in Munich. Soon afterward he was also named professor of psychiatry at the University of Munich. The hospital, built by Solbrig in 1859, was enlarged and reorganised under Gudden’s supervision, as was a second institution in Gabersee, Oberbayern, in 1883. Both were distinguished by the rational arrangement and distribution of their facilities.

From 1870 Gudden was a co-editor of the Archiv für Psychiatry und Nervenkrankheiten. He was knighted in 1875, and that same year was appointed physician to the mad king Ludwig II of Bavaria.

The death of a king
On June 9, 1886, von Gudden, Hubert von Grashey, Hagen (probably Friedrich Wilhelm Hagen 1814-1888), and Hubrich delivered an opinion on the mental illness of Ludwig II. They diagnosed it as paranoia, what would now be called the paranoid form of schizophrenia. On the basis of this diagnosis, the king was relieved of all official duties. On June 12, 1886, he was taken by Gudden, who treated him with great consideration, to Schloss Berg, on Lake Starnberg, which was to serve as the king’s residence. The following morning Gudden took a quiet walk with the king, accompanied by several attendants.

There are many versions of what then happened. From Ingrid Kane, who is writing a book about the life, and especially the death, of King Ludwig II, we have received this description of the following events:

"Von Gudden and the King took another walk in the evening, leaving the castle at 6:45 pm. Gudden firmly told the orderlies they were not to come along or follow during their evening walk. It is believed that the king died at about 7:00 pm (that's when his watch stopped and when he was found at 11:00 pm rigor mortis had set in). Two officers patrolling at a distance but not too far from the scene, claim to not have heard or seen anything. Dr. Gudden and the king were found a few feet from each other, Gudden's watch had stopped a little after 8:00 pm.

The servants were told to remain inside the castle for the time being. An autopsy was performed on the king before he was buried. Although the official statement was "death by drowning", the autopsy report contains only one sentence about the condition of the king's lungs. It does not state if there was or was not water in the lungs.

For some incomprehensable reason no autopsy was ever performed on Dr.von Gudden to determine the cause of death."

As there were (officially) no witnesses, we shall probably never know what really happened. There are many theories, some of them gaining in popularity, that the whole incident was the result of a conspiracy.

According to one popular theory Ludwig and Dr Gudden were murdered. Either a group of Ministers, or some of Ludwig's family arranged to have him murdered so that the new Regime would not be threatened.

Gudden’s work
In an early work, Beiträge zur Lehre von den durch Parasiten bedingten Hautkrankheiten, Gudden conclusively verified through skilful clinical observations that scabies is a parasitic disease caused by mites. His major scientific work was, however, in three fields: care of the mentally ill, craniology, and cerebral anatomy. The last two were closely related, both by common experimental procedures and by the results obtained.

Through his practical work as well as through his publications on treatment of the mentally ill, most of which dealt with hospital administration, Gudden contributed significantly to liberating mental patients from treatment by physical force. In therapy his main concerns were that the hospital be rationally organized, that the personnel be properly trained, and that the curable - and even the incurable - patients be able to move about as freely as possible. Gudden’s research did not deal with clinical psychopathology, an area that was investigated by his student Emil Kraepelin. Gudden was sceptical of systematic reflections that went beyond the individual case. In nosology he followed Griesinger’s classification.

Gudden published his Experimentaluntersuchungen über das Schädelwachstum in 1874. In this work he showed that the growth of the cranium is essentially the result of interstitial processes; and he discovered that when sense organs and parts of the brain are extirpated, the cranial bones are also affected.

Gudden was very cautious in drawing physiological conclusions from his research. He confined himself for the most part to recording morphological data, which he constantly re-examined under altered experimental conditions. His writings are characterized by their conciseness and by a wealth of carefully observed detail. It took some time, however, for the scientific reliability of his findings to be recognized. He lacked the kind of intuitive inspiration possessed by, for instance, Theodor Hermann Meynert (1833-1892) whose research on cerebral anatomy he approved. Gudden’s students Emil Kraepelin (1856-1926), Franz Nissl (1860-1919), Auguste-Henri Forel (1848-1931), and Sigbert Josef Maria Ganser (1853-1931) all described him as having a commanding and magnetic personality. At the time of his death he was editing the results of his neuroanatomical research, the majority of which were still unpublished.

In his articles Ueber die Entstehung der Ohrblutgeschwülst and Ueber die Rippenbrüche bei Geisteskranken, Gudden demonstrated that reddening of the ears, rib fractures, and bedsores (which he considered an attendant symptom of mental illness, produced by injury to the «trophic nerve») were the consequences of mechanical therapy and insufficient care.

Through his research based on extirpation Gudden was the first to set forth many of the neuroanatomical facts generally accepted today concerning the paths, origins and termini of the nerves, as well as many concerning the nuclei of the cranial nerves (the crossing of the optic nerve, the tractus opticus, the fornix, corpus mamillare, interpenduncular ganglion, and nuclei of the nerves of the eye muscles, among others).

von Gudden is perhaps best known for his studies on the partial decussation of the optic paths, a subject that occupied him for some thirty years. His method of producing secondary atrophy of central structures following removal of sense organs or cranial nerves in young animals ushered in a fresh advance in experimental neurology. In full-grown animals from which eyes had been removed when they were young, he demonstrated not only crossed and uncrossed optic fibres, but also a supraoptic commissure and the transverse peduncular tract, both of which now bear his name. He also was the first to describe the interpeduncular nucleus. Not only that, but also the tegmental nuclei, known of all who work in the midbrain today as the dorsal and ventral nuclei of Gudden. The observation that lesions of the cerebral cortex do not cause atrophy of peripheral laws came to be known as Gudden’s law. But one of Gudden’s greatest contributions was his observation in 1970 that destruction of certain areas of the cerebral cortex leads to atrophy of specific thalamic nuclei.

In 1876 von Gudden devised a microtome for sectioning the whole human brain. His student, Forel, relates that this enabled him to make the first complete serial sections.

Gudden’s eldest son, also in medicine, died of typhus. Another son died from burns of his arms. One of his daughters married his successor, Hubert von Grashey.

Von Gudden enjoyed great prestige and made a powerful impression on the scientific world of his day. His laboratory was the Mecca for anatomists and psychiatrists, among them Forel, who came to Gudden in 1874. In his autobiography, published posthumously by his son-in-law Grashey in 1889, Forel relates that von Gudden was an unpredictable genius. “If one could make an ensemble of all the contrasts and the contradictions possible,” he wrote, “one would obtain a Gudden.”

Now and again von Gudden showed no regard for anyone or anything, defects of which he was conscious, for he often said in a vexed tone: “Every one of my errors revenges itself bitterly.” He was free from all pedantry and in discussions permitted his assistants the greatest liberty: he was interested in their scientific growth, but was completely unconcerned for their future. Although his conversation was punctuated by flashes of brilliance, he would drop the most artless remarks, for instance, that he disbelieved that somnambulism existed, for he (von Gudden) always slept well without dreaming. “I learned enormously while with Gudden,” wrote Forel, but above all how not to direct an asylum, for,” as he added, “his tendency to let everything drift resulted in incredible disorder.

Bibliography

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