The 1888 dissertation of a female medical student, Ueber Character-Veränderungen des Menschen in Folge von Laesionen des Stirnhirns (On character changes of man as a consequence of lesions of the frontal lobe)

Abstract

A case of brain injury with a transient syndrome of mainly disinhibited behaviour (Franz Binz) was the subject of the 1888 medical dissertation of Leonore Welt (∗1859 Chernivtsi, Ukraine; †1944 Geneva, Switzerland) which came to be discussed quite controversially. Although Binz was never fully forgotten, the similar "American crow-bar case" (Phineas Gage) attracted more interest. Welt's study, in contrast, provides not only well-illustrated neuropathological findings but also more detailed clinical data. Here, the clinical report and sections of its analysis are translated from the German original. Through comparison with similar cases, Welt proposed the straight gyrus (gyrus rectus) as the main area responsible. The transient nature of the behavioural alteration was taken as indicating a peculiar disease process at that location. She stressed that disinhibited behaviour suggests fronto-orbital lesions, but that the conclusion is not to be reversed. She had noted the absence of symptoms in the majority of similarly situated injuries: normal behaviour thus being no proof of an intact fronto-orbital region. Along with two sisters, Rosa Welt-Straus (1856-1938) and Sara Welt-Kakels (1860-1943), Leonore Gourfein-Welt was among the first females from then Austria to graduate in medicine - against considerable resistance. After her thesis work, she turned to practising ophthalmology in Geneva.

Keywords: Brain-behaviour relationship; Disinhibition; Equal access; Franz Binz; Historical paper; Orbitofrontal cortex; Phineas Gage.