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Vignette
Medicine in Stamps Alois Alzheimer: [1] the Father of Alzheimer Disease
Ahmet Doğan ATAMAN1, Emine Elif VATANOGLU-LUTZ2
Vienna Medical Faculty, History of Medicine Department, Vienna, Avusturya 2Yeditepe
University Medical Faculty, History of Medicine and Ethics, Istanbul, Türkiye
Abstract

During the times of World War I, Germany was an important pioneer in many areas of
science and medicine. Alois Alzheimer, who lived during this period, was one of the founders
of the field of neuropathology. He described a form of dementia as a brain destroying disease
more than 100 years ago. This paper provides an overview on the discovery of the Alzheimer
disease and the physician behind this discovery, Alois Alzheimer, through philately.


INTRODUCTION
[2] Progressive mental deterioration in old age
has been known and described for a long
time. However, it was not until 1906 that a
German physician, Dr. Alois Alzheimer,
specifically identified a collection of brain
cell abnormalities as a disease. After his
contributions,the medical community
recognized Alzheimer's as a disease and
not a normal part of aging.
Over the last decade, scientists have
substantially progressed in understanding
potential environmental, genetic and other
risk factors for Alzheimer Disease (AD),
the processes leading to formation of
plaques and tangles in the brain, and the
brain regions that are affected. Specific
genes related to both the early-onset and
late-onset forms of AD have been
identified, but genetic risk factors only do
not fully explain its causes, so researchers
are actively exploring environment and
lifestyle to learn what role they might play
in the development of this disease.
However, AD is still incurable. The drugs
currently in use treat only the symptoms,
not the cause of the disorder, and they only
slow the progression of cognitive
decline.


Early Years Alois Alzheimer was born on
14 June 1864 in Marktbreit-am-Main,
Bavaria. Following secondary studies in
Aschaffenburg, he studied medicine at the
Universities of Berlin, Tübingen and
Würzburg, where he took his MD degree
in 1887. His thesis was called “On the
Ceruminal Glands of the Ear” and his
süpervisor was the famous histologist of
the period, Albert von Koelliker (1817–
1905). In 1888, he started to work at the
“Städtische Anstalt für Irre und
Epileptische” in Frankfurt am Main, the
city asylum for “Lunatics and
Epileptics”.(5)
There he worked with Emil Sioli (1852 -
1922) and Franz Nissl (1860 – 1919).
Alzheimer's work on brain pathology used
Nissl's method of silver staining of the
histological sections of the brain. Nissl and
Alzheimer became close collaborators and
lifelong friends. They were clinicians by
day and histopathologists by night. In other
areas of medicine, histopathology had
already succeeded in correlating disease
symptoms with organic causes.(3) Nissl and
Alzheimer wanted to achieve the same in
psychiatry through the use of microscopic
analysis of the brain, with a major focus on
the cerebral cortex. They believed that only
if mental disorders could be clearly
defined, would it become possible to
understand and treat them. Nissl was
mostly interested in developing novel
methods and performing experimental
studies, whereas Alzheimer's focus was on
correlating psychiatric symptoms with
histological results obtained from brain
autopsies. He published a case report on
progressive spinal muscular atrophy in
1891.(6)
Many years later, in his obituary of
Alzheimer, Nissl described his time in
Frankfurt as “the seven wonderful years
that I spent working with Alzheimer. They
were years of hard work, of learning and of
striving, underpinned by an ideal
friendship”.(4)
Alzheimer Disease
The story of
[3] Alzheimer's disease began on 25
November 1901, when Alzheimer admitted
the 51-year-old Auguste D. as a patient .
Over the previous year, she had
experienced a marked decline in her ability
to form new memories. She had developed
a fear of people who were well known to
her; she had also become paranoid and
extremely jealous of her husband.

Alzheimer followed Auguste D. until
March 1903. In 1903, Alzheimer became
the Assistant of Prof. Emil Kraepelin at the
university clinics of psychiatry
whom he followed to Munich
in 1904. Kraepelin was perhaps the most
influential psychiatrist of his time; he was
one of the founders of modern psychiatry,
is best known for his seminal work on the
nosology of schizophrenia (he called it
dementia praecox) and manic-depressive
illness.(2)
Auguste D. died at the Frankfurt asylum on
8 April 1906. Alzheimer asked for her
brain to be sent to Munich for
analysis, where it arrived on 28 April. The
work he carried out over the next 6 months
was to make medical history. Alzheimer
described his findings at the 37th meeting
of the Society of Southwest German
Psychiatrists in Tübingen on 3 November
1906. They were published in the short
paper of 1907, which is essentially a
transcript of theTübingen talk, and in the
more extensive article of 1911. The 1907
paper gives the clinicopathological
description of Auguste D.'s illness. [4] In her
cerebral cortex, Alzheimer saw abundant

plaques and neurofibrillary tangles using
the reduced silver staining methods.
Alzheimer saw increased silver staining in
many nerve cells of the cerebral cortex of
Auguste D., which he attributed to an
abnormal thickening of neurofibrils and
their alignment into bundles (the term
“neurofibril” survives to this day in the
expression “neurofibrillary tangle”). They
were found to survive the degenerationof
nerve cells (as extracellular or ghost
tangles). Alzheimer states that he could
also stain these bundles with dyes that did
not label normal neurofibrils, thus
underscoring their pathological nature.
Kraepelin separated the disease from senile
dementia and named it after Alzheimer in
the second volume of the 8th edition of his
textbook of psychiatry.

Personal Life By all accounts, Alzheimer
was a gentle and considerate man. Nissl
described him as fortiter in re, suaviter in
modo (resolute in deed, gentle in manner).
In his 1920 article about the lives of
Alzheimer, Korbinian Brodmann (1868–
1918) and Nissl, who all died young,
Kraepelin provided a vivid portrait of
Alzheimer as a very dedicated individual
who worked without pay and only rarely
took a break.
In 1894, Alzheimer had married Cäcilie
Geisenheimer,the widow of a wealthy
industrialist, with whom he had three
children. Following his wife's early death
in 1901, he became financially
independent. In Munich, Alzheimer lived
with his children and his sister in an
apartment near the Clinic . From the 1880s
onwards, the medical establishment in
Germany (and several other countries)
became increasingly preoccupied with
social Darwinism, monism, theories of
degeneration and racial hygiene.(9)
Psychiatrists played an important part in
this movement. Racial hygiene was
considered an applied science based on the
Figure 3: A special cancellation from India
J.Neurol.Sci.[Turk]
898
laws of genetics which was necessary for
improving the health of the population by
preventing genetic defects. It was believed
to be complementary to personal hygiene.
At the root of racial hygiene lay a strong
belief in biological determinism. The
inherited nature of some disorders was
already well known. In addition, more
diffuse ideas of inheritance and
degeneration gained in popularity,
especially following the publication of the
influential book Traité des
dégénérescences physiques, intellectuelles
et morales de l'espèce humaine (Treatise of
the physical, intellectual and moral
degeneration of the human species) by the
French psychiatrist Bénédict Augustin
Morel (1809–1873) in 1857.(8) [5] He believed
that mental disorders were inherited
in
such a way that degeneracy was
cumulative and that as a result a worsening
of symptoms occurred in subsequent
generations. What was present as
nervousness in the first generation could
manifest itself as neurosis in the second
generation, psychosis in the third
generation and mental retardation, physical
deformity and sterility in the fourth
generation.
Over-consumption of
alcohol,tobacco and opium was thought to
weakenthe genetic material and lead to
degeneration.(8)These ideas had a strong
influence on the Italian psychiatrist Cesare
Lombroso (1835–1909), who linked
organic disease with social deviancy and
put forward the concept of the
“delinquente nato” (born criminal). Moral
decadence,social deviancy, tuberculosis
and venerealdiseases were all seen as
symptoms of hereditary degeneration.
Alzheimer appears to have shared many of
these views.(5) They were also held in other
walks of life and influenced some of the
major literary works of the period, such as
Henrik Ibsen's “Ghosts”, Emile Zola's
cycle of novels “Les Rougon-Macquart”,
Robert Louis Stevenson's “The Strange
Case of Dr Jekyll and Mr Hyde”, Gerhart
Hauptmann's “Vor Sonnenaufgang”
(Before Sunrise) and Thomas Mann's
“Buddenbrooks”.(7)
It is against this background that one
probably has to view Alzheimer's
membershipof the “Deutsche Gesellschaft
fürRassenhygiene” (German Racial
Hygiene Society).(7) His name appears on
the list of members for 1913, at a time
when the Society was still in its infancy .
On 9 January 1912, he lectured on the
brain to an audience of 300 people for the
Munich chapter of the Racial Hygiene
Society. Unfortunately, many years after
Alzheimer's death, the views espoused by
the Racial Hygiene Society had a
significant impact on Nazi ideology and a
number of psychiatrists helped to prepare
and implement some of the terribleevents
of the 1930s and 1940s.(9)
Figure 4: Special cancellation of a station for Alzheimer patients
J.Neurol.Sci.[Turk]
899
Death Kraepelin believed that Alzheimer's
heavy workload contributed to his early
death. A bacterial infection that he
contracted during the move from Munich
developed into a subacute endocarditis,
which weakened him physically and forced
him to take lengthy breaks from work. In
1913, he organized the annual meeting of
the German Society of Psychiatry in
Breslau. Kraepelin, who saw Alzheimer
there for the last time, noted that he no
longer was the tower of strength he had
been in Munich.(2) By now, he was
suffering from chronic heart and kidney
problems. Alzheimer's physical decline
coincided with the beginning of World
War I, with ensuing deprivations, an
increased workload and personal worries
(both his son and son-in-law were drafted
into the army). His condition worsened
markedly during the second half of 1915.
Alzheimer died in Breslau on December
19, 1915, aged 51 years.
He was laid to
rest next to this wife in Frankfurt's main
cemetery.

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