The enigma of Gerstmann's syndrome (The William Gowers lecture delivered on 2 December 1965). By Macdonald Critchley. Brain 1966: 89; 183-198

Abstract

As a young neurologist, (Sir) William Gowers (1845–1915), working in collaboration with John Hughlings Jackson (1835–1911), described the case of Eliza Joad. First designated as ‘imperception’, the term ‘agnosia’ was subsequently introduced to describe her inability to perceive or interpret items that nonetheless were sensed. With the naming of ‘apraxia’ by Hugo Liepmann (1863–1925), ‘neurologists … began to unravel the complicated tangle of frontal, temporal, parietal and occipital dysfunction’. Macdonald Critchley introduces his William Gowers lecture with a quote from Andre Maurois: ‘The members of the medical fraternity can at least classify our ailments in carefully labelled compartments, and that, in itself, is reassuring. To be able to call a demon by its name is half-way to getting rid of him’. Noting Gowers’ dislike of descriptive papers, Critchley opens his lecture with an account of the patient described by Josef Gerstmann (1887-1969), writing from Vienna in 1924 ( Wiener Klinische Wochenschrift 1924: 37; 1010–1012), who—amongst other deficits—is unable to name her fingers and identify her own or the examiner’s individual digits on request. He calls this symptom ‘finger-agnosia’ which Critchley considers to be ‘an ill-chosen expression’. In 1927, Gerstmann describes two new cases and proposes that difficulty with writing forms part of the emerging syndrome. Further observations add yet more phenomena and, by 1930, the descriptive tetrad is complete: ‘Gerstmann’s syndrome’ now consists of finger-agnosia, dysgraphia, dyscalculia and right–left disorientation; and it localizes to the left angular gyrus—a region assumed by Gowers to be a higher visual centre. A quote from Oscar Wilde, aimed at those interested in cerebral localization, who find ‘a curious pleasure in tracing the thoughts and passions of men to some pearly cell in the brain, or some white nerve in the body, delighting in the absolute dependence of the spirit on certain physical conditions, morbid or …