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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4382_Библиотеки_им_академика_М_И_Перельмана
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To Robert Steven Ackley
For the encouragement, the opportunity, the mentorship, the support,
and most of all . . . the friendship.
1
Historical Perspective of Human
Rotation and Centrifugation
VERTIGO AND HERALDING
OF THE SIXTH SENSE
Aristotle (384–322 bc) was the first to introduce
the scientific study of the human senses, as well
as provide the first written account of vertigo in
bc (Ross, 1927).
330
Why is it that to those who are very drunk
everything seems to revolve in a circle, and as
soon as the wine takes a hold of them they cannot see objects at a distance? . . . objects near at
hand are not seen in their proper places, but
appear to revolve in a circle. (p. 892a)
Despite a growing body of knowledge and understanding of vestibular anatomy and physiology
beginning in the late 1700s, and extending into
the early 1800s, Aristotle’s five senses remained
unchanged and unchallenged until 1824 (Wade,
2003). During this time, the vestibular labyrinth
was believed to assist in the localization of sound
in the environment. Moreover, the perception of
vertigo was attributed to animal spirits (Thomas
Willis, 1621–1675), visual disturbances (Julien
Offray de la Mettrie, 1709–1751; William Porterfield, 1696–1771; Erasmus Darwin, 1731–1802;
Robert Waring Darwin, 1766–1848), and even the
independent rotation of the cerebellum (Jan Evangelista Purkyneˇ, 1787–1869). It was not until 1792
when Charles Wells (1757–1817) provided the
first scientific evidence that argued for the expansion of Aristotle’s original five senses to include
the perception of motion provided by the vestibular system (Wade, 2003). In his treatise entitled, “An Essay Upon Single Vision With Two
Eyes” published in 1792, Wells provided indisputable evidence supporting a link between the
patterns of eye movements in relation to the direction of post-rotary vertigo (Figure 1–1). Through
his use of afterimages following rotations, Wells
published the first accurate and objective account
of the vestibular response, describing for the
first time, the fast and slow phase of vestibular
nystagmus.
A few years after Charles Wells published his
essay, Erasmus Darwin (grandfather of the famous
evolutionist Charles Darwin) published his pinnacle, two-volume treatise “Zoonomia; Or, The
Laws of Organic Life” (Vol. 1, 1794; Vol. 2, 1796).
In the second volume, Erasmus Darwin and Robert Darwin (Erasmus Darwin’s son) extensively
wrote on vertigo. However, in their chapter on
vertigo, they retained the current thinking of the
day that strongly supported William Porterfield’s
1
2 Rotational Vestibular Assessment
B
A
earlier opinion that post-rotational vertigo was not
associated with eye movements but, rather, was
due to visual disturbances (which was in direct
opposition to Wells’ earlier report just four years
prior). Despite this opinion and growing evidence
over the next decade supporting the association
between vertigo and eye movements, the use of
rotation for the diagnosis of vertigo and investigation of vestibular function would continue to
remain absent in neurology clinics for over a century. However, secondary to Erasmus Darwin’s
treatise “Zoonomia; Or, The Laws of Organic Life,”
the application of rotation would hold a promi-
FIGURE 1–1. A. Charles Wells’ treatise entitled “An
Essay Upon Single Vision With Two Eyes” is the first
known, detailed account of nystagmus attributed to
rotation of the head. Louisa Susannah Wells (1757–
1817). B. No known picture of Charles Wells exists;
however, his sister’s portrait shown here (Louisa Susannah Wells, pictured here is the only known visual reference to Charles Wells (Wade, 2003). From Destined for
Distinguished Oblivion: The Scientific Vision of William
Charles Wells (1757–1817) by Nicholas J. Wade, 2003,
New York, NY, Springer. Reprinted with permission.
nent position in the medical literature and clinical
practice during the early ninetieth century. However, it was not for the investigation of dizziness,
but rather, for the treatment of the mentally ill.
ROTATION IN THE EARLY
NINETIETH CENTURY
Prior to heralding of the vestibular sixth sense in
the early nineteenth century by Wells and others,
the rotation of patients was most commonly found
1. Historical Perspective of Human Rotation and Centrifugation 3
in psychiatric asylums rather than neurology clinics. In 1801, Erasmus Darwin introduced his concept of a “rotating couch” (Wade, 2003) as a means
of inducing slumber in psychiatric patients (Figure 1–2). The idea of “medicinal slumber” was well
accepted at the time and motivated many in the
field of mental health to prescribe such medically
induced slumber for the treatment of psychiatric
disorders in the early 1800s. Well-known psychiatrists Joseph Mason Cox (1763–1818), of Fishponds
Private Lunatic Asylum near Bristol, England,
and William Saunders Hallaran (1765–1825), physician superintendent at the County and City of
Cork Lunatic Asylum in Cork, Ireland, developed
their own “circulating swings” for which they are
probably best remembered (Figures 1–3 and 1–4).
Clinical results were well accepted throughout
many countries by numerous physicians and psychiatrists. The success of “Hallaran’s Circulating
Swing” in 1818 (Breathnach, 2010) was adopted
by many at the time and, in particular, by Anton
Ludwig Ernst Horn (1774–1848), of the CharitéHospital in Berlin, Germany. Horn developed
his own ceiling-suspended, 13-foot rotating bed,
which was capable of spinning 120 revolutions
per minute (Belofsky, 2013) and producing up
to four to five times the force of gravity (Harsch,
2006) (Figure 1–5). Horn’s “psychiatric centrifuge”
was also well accepted and widely used between
1814 and 1818 to treat mental disorders. He specifically reported excellent success for the use of
his “psychiatric centrifuge” in patients with hysteria (Harsch, 2006). Medicinal slumber continued
through the late nineteenth century, including the
FIGURE 1–2. James Watt’s proposed drawing of the “rotating couch” that he designed at the request of Erasmus
Darwin. However, it is very likely the “couch” was never constructed (Wade, 2003). From Zoonomia; Or, the Laws of
Organic Life (3rd ed.), Vol IV, by E. Darwin, 1801, London, England, Thomas & Andrews, J. T. Buckingham, printer.
A B
FIGURE 1–3. A. Cover of the first edition of Dr. William Saunders Hallaran’s textbook entitled An Enquiry into
the Causes Producing the Extraordinary Addition to the Number of Insane Together with Extended Observations
on the Cure of Insanity: with Hints as to the Better Management of Public Asylums for Insane Persons by W. S.
Hallaran, 1810, Cork, Ireland, Edwards & Savage, Cork, printer. B. Dr. Joseph Mason Cox’s “circulating swing.”
From Practical Observations on the Causes and Cures of Insanity, (2nd ed.), by W. S. Hallaran, 1818, Cork, Ire-
land, Edwards & Savage, Cork, printer.
4
A
FIGURE 1–4. A. Photograph of Dr.
Joseph Mason Cox’s “circulating swing”
in the Hospital Museum at Vadstena,
Sweden. B. A model of the same chair.
From “Cox’s Chair: ‘A Moral and a Medical Mean in the Treatment of Maniacs’”
by N. J. Wade, U. Norrsell, and A. Presley, 2005, History of Psychiatry, 16(1),
73–88. Reprinted with permission.
B
5
A
FIGURE 1–5. A. Dr. Horn’s “Human Centrifuge” at
La Charité Hospital used for psychiatric swinging for
the induction of “medical slumber.” Horn, 1818. B. Circulating Swing device possibly used by Jan Evangelista Purkyneˇ. Hayner, 1818. From “The Physiology of
the Vestibuloocular Reflex (VOR)” by B. Cohen and T.
Raphan, 2004. In F. M. Fay and A. N. Popper (Eds.), The
Vestibular System, New York, NY: Springer. Reprinted
with permission.
B
6
1. Historical Perspective of Human Rotation and Centrifugation 7
use of a human centrifuge in 1898 by Dr. F. R. von
Wenusch to investigate the therapeutic potential of
acceleration (Figure 1–6) (White, 1964). However,
the transition of using rotation for the treatment of
psychiatric disease to the diagnosis of vertigo and
dizziness would not take hold until the vestibular
system’s role was redefined from that of audition
to one of motion perception. Many scientists of
the time, including Jan Evangelista Purkyneˇ, continued to believe the vestibular labyrinth’s role
was one of audition and sound localization, not
motion perception.
In the first few decades of the nineteenth century, concurrent to the time when “ceiling swings”
and “psychiatric centrifuges” were being used,
the Fathers of Vestibular Science — most notably
Charles Wells (1757–1817), Robert Waring Darwin
(1766–1848), Jan Evangelista Purkyneˇ (1787–1869),
and Jean Pierre Flourens (1794–1867) (Figure 1–7)
— published numerous reports citing evidence for
the expansion of Aristotle’s original five senses to
include a (vestibular) sixth sense of motion perception. Reports were frequently contentious and
often provoked the well-known feud between
Charles Wells and Erasmus Darwin regarding the
origin of vertigo, and the exact role of the vestibular system (Wade, 2003). However, despite such
feuding, there was one underlying hypothesis that
almost all vestibular scientists of the time slowly
began to acknowledge — that the vestibular system was likely not responsible for audition, but
rather, was indeed, somehow, related to the perception of motion.
Although the early nineteenth century brought
a significant amount of scientific evidence corroborating the existence of a sixth sense (most
FIGURE 1–6. Dr. F. R. von Wenusch’s Human Centrifuge for inves-
tigation of therapeutic potential of acceleration. From A History of the
Centrifuge in Aerospace Medicine, by W. J. White, 1964, Santa Monica,
CA, Douglas Aircraft Company, Inc.
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