Carl (or Karl) Wernicke (; ; 15 May 1848 – 15 June 1905) was a German
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
,
anatomist
Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having it ...
,
psychiatrist and
neuropathologist. He is known for his influential research into the pathological effects of specific forms of
encephalopathy
Encephalopathy (; from grc, ἐνκέφαλος "brain" + πάθος "suffering") means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but r ...
and also the study of
receptive aphasia
Wernicke's aphasia, also known as receptive aphasia, sensory aphasia or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernicke's aphasia demonstrate fluent ...
, both of which are commonly associated with Wernicke's name and referred to as
Wernicke encephalopathy
Wernicke encephalopathy (WE), also Wernicke's encephalopathy, or wet brain is the presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine (vit ...
and
Wernicke's aphasia
Wernicke's aphasia, also known as receptive aphasia, sensory aphasia or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernicke's aphasia demonstrate fluent ...
, respectively. His research, along with that of
Paul Broca
Pierre Paul Broca (, also , , ; 28 June 1824 – 9 July 1880) was a French physician, anatomist and anthropologist. He is best known for his research on Broca's area, a region of the frontal lobe that is named after him. Broca's area is involve ...
, led to groundbreaking realizations of the localization of brain function, specifically in speech. As such,
Wernicke's area
Wernicke's area (; ), also called Wernicke's speech area, is one of the two parts of the cerebral cortex that are linked to speech, the other being Broca's area. It is involved in the comprehension of written and spoken language, in contrast to B ...
(a.k.a. Wernicke's Speech Area) has been named after the scientist.
Biography
Wernicke was born on May 15, 1848, in
Tarnowitz, a small town in
Upper Silesia
Upper Silesia ( pl, Górny Śląsk; szl, Gůrny Ślůnsk, Gōrny Ślōnsk; cs, Horní Slezsko; german: Oberschlesien; Silesian German: ; la, Silesia Superior) is the southeastern part of the historical and geographical region of Silesia, locate ...
,
Prussia
Prussia, , Old Prussian: ''Prūsa'' or ''Prūsija'' was a German state on the southeast coast of the Baltic Sea. It formed the German Empire under Prussian rule when it united the German states in 1871. It was ''de facto'' dissolved by an ...
,
now
Tarnowskie Góry
Tarnowskie Góry (German: ''Tarnowitz''; szl, Tarnowske Gōry) is a town in Silesia, southern Poland, located in the Silesian Highlands near Katowice. On the south it borders the Upper Silesian Metropolitan Union, a megalopolis, the greater Si ...
, Poland. He obtained his secondary education at the gymnasium in Oppeln, which is a school near the university of Breslau. Wernicke then studied medicine at the University of Breslau and did graduate work studying language and aphasia at Breslau, Berlin, and Vienna.
After he earned his medical degree at the
University of Breslau
A university () is an institution of higher (or tertiary) education and research which awards academic degrees in several academic disciplines. Universities typically offer both undergraduate and postgraduate programs. In the United States, th ...
(1870), he worked in Breslau at Allerheiligen Hospital as an assistant to an ophthalmology professor
Ostrid Foerster for six months. Unfortunately in 1870, the Franco-Prussian War broke out, where Wernicke served as an army surgeon. After serving in the war, he returned to the Allerheiligen Hospital and worked in the psychiatric department as an assistant under Professor Heinrich Neumann. Neumann sent him to
Vienna
en, Viennese
, iso_code = AT-9
, registration_plate = W
, postal_code_type = Postal code
, postal_code =
, timezone = CET
, utc_offset = +1
, timezone_DST ...
for six months to study with neuropathologist
Theodor Meynert
Theodor Hermann Meynert (15 June 1833 – 31 May 1892) was a German-Austrian psychiatrist, neuropathologist and anatomist born in Dresden. Meynert believed that disturbances in brain development could be a predisposition for psychiatric illness a ...
,
who would have a profound influence upon Wernicke's career.
In 1875, Wernicke was appointed the first assistant in the Berlin Charite clinic under Karl Westphal, where he stayed until 1878 studying psychiatry and nervous diseases.
In 1878 Wernicke founded a private neuropsychiatric practice in Berlin and published numerous articles until he left the practice in 1881. In 1885, he succeeded his mentor Professor Neumann and served as associate professor of
neurology
Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...
and psychiatry at Breslau, where he also attained a conference chair. By 1890 Wernicke became the director of the psychiatric wing at the Allerheiligen Hospital, and he also became head of the University Hospital's Department of Neurology and Psychiatry. In 1904, Wernicke worked at the
University of Halle
Martin Luther University of Halle-Wittenberg (german: Martin-Luther-Universität Halle-Wittenberg), also referred to as MLU, is a public, research-oriented university in the cities of Halle and Wittenberg and the largest and oldest university in ...
, heading its Psychiatry and Neurology Clinic.
Wernicke died on June 15, 1905, due to injuries suffered from a bicycle accident in the
Thuringian Forest
The Thuringian Forest (''Thüringer Wald'' in German), is a mountain range in the southern parts of the German state of Thuringia, running northwest to southeast. Skirting from its southerly source in foothills to a gorge on its north-west side i ...
.
Studies in aphasia
![Wernicke's area animation](https://upload.wikimedia.org/wikipedia/commons/b/b2/Wernicke%27s_area_animation.gif)
Wernicke was heavily inspired by the research on language and communication coming from Paris, France, specifically from Paul Pierre Broca. Broca's work on motor aphasia influenced Wernicke's interests in psychophysiology and aphasiology relating to language. Wernicke began to question the relationship between dysphasia and the location of lesions that caused brain damage resulting in language problems.
While studying with Meynert in 1874, Wernicke published ''Der Aphasische Symptomencomplex''. In his book, Wernicke described sensory aphasia, which is now known as Wernicke's aphasia, as being distinctly different from motor aphasia, described by Broca. He categorized sensory aphasia as fluent but disordered speech, impaired understanding of speech, and impaired silent reading. Incorporating Broca's findings on motor aphasia, Wernicke described both forms of aphasia as being results of brain damage. However, the location of damage determined which aphasia a patient developed. He described sensory aphasia as a result from lesions to the left temporal lobe and motor / Broca's aphasia as a result from lesions to the left posterior frontal lobe. These two concepts were the foundation for his theory on the neural bases of language.
Wernicke hypothesized that motor activity was accompanied by sensory stimulation and that there were fibers connected the motor and sensory cortexes in the brain, so there must also be a connection between the lesioned areas contributing to sensory and motor aphasia. He discussed the problems with severing this connection, assuming both structures remain intact. The area affecting sensory aphasia would still function, so a patient could hypothetically retain comprehension of oral speech and silent reading. However, the connection to Broca's area would be broken, causing prevention of effective translation of mental processes into verbal speech.
Wernicke additionally discussed the dangers of mistaking sensory aphasia with a confused or psychotic state, and he emphasized the importance of distinguishing between aphasia and agnosia, the failure to recognize objects, which was described by Sigmund Freud in 1891.
Wernicke proposed a theory of localization and suggested that different identifiable regions of the brain control different behaviors and these areas interact to produce more behaviors. This is the case with Broca's and Wernicke's areas interacting to produce language. Broca and Wernicke's work paved the way for others to study and identify localized areas of the brain, including the identification of the motor homunculus as well as the theory that brain damage in specific areas is responsible for different disorders, diseases, and abnormal behaviors.
Ludwig Lichtheim, a professor of medicine at Bern University Hospital, wrote his work "Über Aphasie," which was influenced by Broca, Wernicke and Adolf Kussmaul. Lichtheim's work analyzed language abilities and categorized language disorders into seven different aphasias, Wernicke's aphasia being one of them. Wernicke then adopted Lichtheim's aphasia classification and became the Wernicke-Lichtheim model.
The Elementary Symptom
At the 59th Breslau conference in 1892, Karl Kahlbaum described paranoia based on a case study that Wernicke was familiar with. Wernicke described the case study as an example of what he called the "elementary symptom," which is the notion that there is a single, fundamental symptom and all other symptoms are derived from the elementary symptom.
Karl Leonhard also followed Wernicke's studies. Although Leonhard rejected the "elementary symptom" theory because it overgeneralizes symptoms of disorders, he did incorporate Wernicke's psychopathological categories of disorders into Emil Kraepelin's binary system of classification. For example, Leonhard renamed Wernicke's "anxiety-psychosis" as "cycloid psychosis," which does resemble schizophrenia and Bipolar cycling. Kraepelin also rejected the elementary symptom theory by describing all of the clinical aspects of a particular disorder (nosology) in contrast to Wernicke's theory, which attempted to home in on the key symptom instead of looking at each disorder as a whole.
The theory of elementary symptom was generally rejected and is not a well-known concept today because of the lack of supporting evidence for the theory. Although the theory itself is not supported in modern nosology and etiology, it does have a general influence in psychopharmacology practices with its notion of a target symptom. Clinical psychopharmacology typically treats particular symptoms instead of disorders and diagnoses as a whole. Modern psychiatry does rest on assumptions that some symptoms result from other symptoms, parallel to Wernicke's theory.
Wernicke himself did not pursue research on the elementary symptom theory because of his devotion to aphasiology. One of the fundamental problems with the elementary symptom theory is that Wernicke described anxiety as the elementary symptom of many disorders. This was problematic for the theory because anxiety, to some extent, is seen in almost all psychiatric disorders. This caused the elementary symptom to fail at categorizing clinical descriptions and proper treatments. Another difficulty for Wernicke and other psychologists was determining which symptom was the elementary symptom and given priority over other symptoms that might be just as important to treat and might not be a direct result of another symptom. Lastly, Wernicke preserved traditional German psychiatry and described clinical vignettes, being unable to distinguish between physical and psychological causes of symptoms instead of using Kraepelin's approach of delineation of syndromes and disorders.
Eponyms
*
Wernicke's aphasia
Wernicke's aphasia, also known as receptive aphasia, sensory aphasia or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernicke's aphasia demonstrate fluent ...
: The eponymous term for receptive or
sensory aphasia
Wernicke's aphasia, also known as receptive aphasia, sensory aphasia or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernicke's aphasia demonstrate fluent ...
. It is the inability to understand speech, or to produce meaningful speech, caused by lesions to the posterior
superior temporal gyrus.
*
Wernicke encephalopathy
Wernicke encephalopathy (WE), also Wernicke's encephalopathy, or wet brain is the presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine (vit ...
: An acute
neurological
Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...
dysfunction caused by a
thiamine
Thiamine, also known as thiamin and vitamin B1, is a vitamin, an essential micronutrient, that cannot be made in the body. It is found in food and commercially synthesized to be a dietary supplement or medication. Phosphorylated forms of thi ...
deficiency. It is characterized by the triad of
ophthalmoparesis
Ophthalmoparesis refers to weakness (-paresis) or paralysis (-plegia) of one or more extraocular muscles which are responsible for eye movements. It is a physical finding in certain neurologic, ophthalmologic, and endocrine disease.
Internal ...
,
ataxia
Ataxia is a neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in eye movements. Ataxia is a clinical manifestation indicating dysfunction of ...
and mental confusion. When combined with
Korsakoff psychosis, a
subacute dementia
Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
syndrome, it is then called
Wernicke–Korsakoff syndrome
Wernicke–Korsakoff syndrome (WKS) is the combined presence of Wernicke encephalopathy (WE) and Korsakoff syndrome. Due to the close relationship between these two disorders, people with either are usually diagnosed with WKS as a single syndrome ...
.
* Wernicke's pupillary reaction: The absence of direct reaction to light in the blind part of the
retina
The retina (from la, rete "net") is the innermost, light-sensitive layer of tissue of the eye of most vertebrates and some molluscs. The optics of the eye create a focused two-dimensional image of the visual world on the retina, which then ...
. First described by
ophthalmologist Hermann Wilbrand in 1881.
*Wernicke's centre
*Wernicke's cramp
*Wernicke's dementia
*Wernicke's disease
*Wernicke-Korsakoff disease
*Wernicke-Mann hemiplegia
Publications
In 1897, with
Theodor Ziehen (1862-1950), he founded the journal ''Monatsschrift für Psychiatrie und Neurologie''.
Conference proceedings from Breslau were published in the ''Allgemeine Zeitschrift fur Psychiatrie und Psychische-Gerichtliche Medizin''.
Principal written works by Wernicke include:
* ''Der aphasische Symptomencomplex. Eine psychologische Studie auf anatomischer Basis
he aphasic symptom complex: a psychological study from an anatomical basis'; Breslau, M. Crohn und Weigert, 1874.
*''Das Urwindungssystem des menschlichen Gehirns
he Primordial Gyral-System of the Human Brain 1876.''
*''Lehrbuch der Gehirnkrankheiten : für Aerzte und Studirende
extbook of brain diseases: for doctors and students', 1881.
* ''Über hemiopische Pupillenreaktion
hemianopsic_
hemianopsic_pupillary_response">hemianopsia.html"_;"title="n_hemianopsia">hemianopsic_pupillary_response.html" ;"title="pupillary_response.html" ;"title="hemianopsia.html" ;"title="n hemianopsia">hemianopsic pupillary response">hemianopsia.html" ;"title="n hemianopsia">hemianopsic pupillary response">pupillary_response.html" ;"title="hemianopsia.html" ;"title="n hemianopsia">hemianopsic pupillary response">hemianopsia.html" ;"title="n hemianopsia">hemianopsic pupillary response', in Fortschritte der Medicin, 1883, 1: 49–53.
[
* ''Grundriss der Psychiatrie in klinischen Vorlesungen [Foundation of psychiatry in clinical lectures]'', 1894.
* ''Atlas des Gehirns; Schnitte durch das menschliche Gehirn in photographischen Originalen [Atlas of the brain; sections of the human brain from photographic originals]'', 1897.
* ''Krankenvorstellungen aus der psychiatrischen klinik in Breslau deas on illness from the psychiatric clinic in Breslau', 1899.
;Anthologies
*
]
Notes
References
{{DEFAULTSORT:Wernicke, Carl
1845 births
1905 deaths
History of neuroscience
German neuroscientists
German pathologists
People from Tarnowskie Góry
People from the Province of Silesia
University of Breslau alumni
Physicians of the Charité