Ugo Cerletti

Ugo Cerletti (born September 26, 1877 in Conegliano , † July 25, 1963 in Rome ) was an Italian psychiatrist and neurologist . In 1938 he was the first to use electroconvulsive therapy in humans.

Life

Alois Alzheimer with the employees of his laboratory in Munich (1909/10). Ugo Cerletti (1st row, 2nd from left)

The son of an oenologist studied medicine in Rome from 1895 and in Turin from 1896 . In Turin he developed his interest in the pathology of the nervous system . In 1898 he returned to Rome, where he worked in Giuseppe Mingazzini's neuroanatomical laboratory . In 1900 he studied with Emil Kraepelin and Wilhelm Erb in Heidelberg and worked with Franz Nissl . In 1901 Cerletti received his doctorate in Rome. He then became an assistant to Ezio Sciamanna at his clinic, where he set up a laboratory for pathological anatomy. At the suggestion of his successor Augusto Tamburini , Cerletti studied again in Munich with Kraepelin and Alois Alzheimer . Cerletti also went to Paris to study with Pierre Marie and Ernest Dupré . In 1906 he was appointed private lecturer in Rome. With the support of Tambourini, he became a preparatore at the Roman psychiatric clinic in 1907, following the example of the German prosecution .

During the First World War , Cerletti volunteered as a staunch war advocate after Italy entered the war in May 1915. As a captain in a medical unit of the 6th Alpini Regiment, he was deployed first on the Ortler front and later on the Dolomite front in the area of ​​the Three Peaks . During his wartime, he dealt with things that made him known in military circles. So he introduced the white camouflage coverings for the mountain warfare in snow and ice with the Alpini . But he became known in particular for his work on a delay fuse for artillery shells , which detonated the projectiles minutes and even hours after they were fired behind enemy lines. The delay was achieved by the slow decomposition of a membrane made of organic materials using an acidic liquid, which triggered the firing pin of the detonator . The idea was presented to a technical commission in Rome in 1917. After further experiments and coordination, the detonator was able to go into series production in 1918 and was taken to the front at the end of the war, but was no longer used before the end of the war. After he was denied official recognition, Cerletti turned back to medicine, disappointed. He recorded his work on the delay detonator in a diary-like recording (Scoppio differito) , which was published posthumously in 1977.

From 1919 to 1924 Cerletti headed the neurobiological institute of the psychiatric clinic in Mombello near Milan . From 1925 he worked as a professor of psychiatry and clinic director in Bari , from 1928 in Genoa . In 1935 he became director of the Department of Mental and Neurological Diseases at La Sapienza University in Rome. In 1943 Cerletti was elected a member of the Leopoldina in the Psychiatry, Medical Psychology and Neurology Section . During the Second World War , Cerletti struggled with the poor supply situation in his clinic and turned down lectures. After he had previously sympathized with fascism and had also written for the fascist magazine Gerarchia , he became a city councilor in Rome in 1946 and in 1948 joined the Fronte Democratico Popolare , an alliance of communists and socialists . In 1947 a study center for the physiopathology of electric shock was set up for him, where he continued to work after his retirement in 1948. He received honorary doctorates from the Universities of Sorbonne (1950), São Paolo , Rio de Janeiro (1953) and Montreal (1961) and was twice nominated for the Nobel Prize in Medicine .

Development of electroconvulsive therapy

Cerletti conducted studies on the role of the hippocampus in epilepsy . To do this, he provoked seizures in dogs from 1933 onwards by using an electric current . The process itself was not new and was often fatal for the test animals. In 1936, Cerletti had his assistant Lucio Bini design electrical devices that were safer for animals and with which the supply of electricity could be better controlled. When research by Ladislas J. Meduna became known in 1935 that one could treat schizophrenia with convulsions triggered by camphor , Cerletti came up with the idea that the seizures could also be provoked with electricity without the patients having to suffer from the side effects of the drug administration.

After Cerletti and his colleagues had found out about Manfred Sakel's new insulin shock therapy and Meduna's cardiazole cramp therapy , they visited slaughterhouses in Rome. Here they found that pigs there were not killed with electricity but anesthetized, which led to unconsciousness and a generalized epileptic seizure . They tried to determine the strength at which electrical current would be fatal.

Cerlettis and Bini's apparatus for delivering electric shocks

On April 11, 1938, from 11:15 a.m., Cerletti performed the first electroconvulsive therapy in Rome on a person, Enrico X, a patient suffering from schizophrenia. It was a man picked up by the police as a tramp who, according to eyewitnesses, was unable to express himself clearly. Fearing the patient might die, the first attempt was conducted in secrecy in a remote treatment room. Electricity with a voltage of 80 volts was administered three times for different lengths of time through electrodes placed on the skull . Contrary to what Cerletti described in later publications, this first attempt did not achieve the desired result. However, eyewitnesses reported that Enrico X uttered his first coherent sentence after the first few applications, asking to stop the treatment. Nevertheless, Cerletti ordered a continuation with a higher current intensity. However, a seizure did not occur and the patient remained conscious. On April 20, 1938, the treatment was repeated with a higher current intensity. This time a seizure was provoked. By May 1938, patient X had been subjected to a total of 11 treatments, which Cerletti himself described as "electric shock". On May 28, 1938, Cerletti presented the patient and the new therapy to the specialist public. Enrico X was released on June 17, 1938 as having improved significantly. According to Cerletti's communication, further tests on 36 patients led to eleven healed and 20 experienced significant improvement.

In July 1938, a device for electroconvulsive therapy was made ready for series production in collaboration with the Milan-based company Arcioni and with Bini as the patent holder. Since this was a therapy that led to convulsions being triggered much more reliably and cost-effectively than other methods, electroconvulsive therapy quickly found widespread use in Italy and largely replaced pharmacological convulsive therapy . In the United States , Cerletti's assistant Lothar Kalinowsky , who emigrated before the Italian race laws in 1938 , made the new therapy known. Outside Italy, it was first used in late summer 1939 by Max Müller in Münsingen, Switzerland . In Germany that same year, Friedrich Meggendorfer in Erlangen and Anton von Braunmühl in Eglfing-Haar were among the pioneers.

By 1940, Cerletti had come to the conclusion that the therapeutic results for depressive illnesses were even better than for psychotic ones . He himself was not entirely convinced of electroconvulsive therapy. He later looked for ways to provoke convulsions without the administration of electricity and made statements that electroconvulsive therapy was cruel. He also feared that the easy availability and low cost of electroconvulsive therapy would lead to it being used carelessly. Basically, he believed that the treatment dynamic biochemical and endocrine processes in the midbrain trigger that would not due to the administered electricity but by the subsequent coma. The improvement of the mental state of illness would be brought about by the resulting antibodies, which he called "acroagonine / acroagonine". To prove his theory, he carried out research by subjecting pigs to strong electric shocks and injecting patients with emulsions made from the brains of these pigs. The therapeutic results, however, lagged behind those of electroconvulsive therapy, and the “acroagonins” could not be chemically isolated.

Critics of electroconvulsive therapy have characterized it as fascist, while proponents argue that the therapy has caught on worldwide, speaks for its effectiveness. For the psychiatrists Rudolf Meyendorf and Gabi Neundörfer, the history of electroconvulsive therapy does not begin with Cerletti's attempts at therapy in April 1938, but with Ladislaus Meduna 's first therapeutic convulsions in schizophrenics with a camphor injection on January 23, 1934. Electroconvulsive therapy is merely the continuation of this idea and Cerletti and Bini merely pioneered a new method of inducing an epileptic fit. It was Cerletti's merit to have used electroconvulsive therapy successfully and made it a successful therapy method, even if he downplayed Bini's merit. Psychiatry historians Edward Shorter and David Healy argue that Cerletti did not claim to have the idea of ​​a convulsion treatment for schizophrenia. Rather, Cerletti had the vision of therapeutically used epileptic seizures that could be triggered by electricity and the courage to implement this. This was more Cerletti's merit than Binis. Since electroconvulsive therapy is based on hypotheses that have since been rejected, such as an assumed biological antagonism between epilepsy and schizophrenia, Jonathan Sadowsky describes its development as an example of accidental medical progress.

Fonts

• Sulle recenti concezioni dell'isteria e della suggestione a proposito di una endemia di possessione demoniaca. [Tip. operaia romana], [Roma] 1904.
• and Bruno Brunacci: Sulla corteccia cerebrale dei vecchi. Ricerche. Premiata tipografia Artigianelli, Foligno 1906.
• and Gaetano Perusini: L'endemia gozzo-cretinica nelle famiglie. Tipografia operaia romana cooperativa, Roma 1907.
• The mast cells as a regular finding in the olfactory bulb of the normal dog. F. Bohn, Haarlem 1911.
• with Augusto Murri: About the traumatic neuroses. Lecture given in the Associazione Sanitaria Milanese on February 12, 1912. Fischer, Jena 1913.
• Sulla struttura della nevroglia. R. Accademia dei Lincei, Roma 1915.
• Gaetano Perusini. Quindici anni di lavoro per la scienza nell'Italia prima della guerra. Cooperativa fra lavoranti tipografi, Reggio Emilia 1916.
• Contro un grave flagello d'Italia, l'endemia gozzo-cretinica. [Sn], Roma 1922.
• La psichiatria tra i normali. Discorso. L'Edizione, Bari 1927.
• Speciali contributi bellici. P. Fiani, Roma 1928.
• The first attempt with electric shock. F. Hoffmann-La Roche & Co, Basel 1940?
• L'elettroshock. Poligrafica Reggiana, Reggio-Emilia 1940.
• Riassunto delle lezioni di clinica delle malattie nervose e mentali. Edizioni universo, Roma 1946.
• Memories of Franz Nissl. In: Munich medical weekly; Volume 101, No. 51, 1959.
• Scoppio differito. Edizioni del Ruzante, Venezia 1977 (posthumous).

literature

• Arnaldo Novelletto:  Cerletti, Ugo. In: Alberto M. Ghisalberti (Ed.): Dizionario Biografico degli Italiani (DBI). Volume 23:  Cavallucci-Cerretesi. Istituto della Enciclopedia Italiana, Rome 1979.
• Roberta Passione: Electricity and Life. Cerletti's Electroshock and the "Acroaginine" Theory. In: Paola Bertucci, Giuliano Pancaldi (eds.): Electric Bodies: Episodes in the History of Medical Electricity . ( Bologna Studies in History of Science , 9) Alma Mater Studiorum, Bologna 2001, pp. 264-265.
• Roberta Passione: Italian Psychiatry in an International Context. Ugo Cerletti and the Case of Electroshock. In: History of Psychiatry. 15, No. 1 2004, pp. 83-104. doi : 10.1177 / 0957154X04039347 .
• Roberta Passione: Ugo Cerletti. Scritti sull'elettroshock. Franco Angeli, Milano 2006, ISBN 9788846478238 .
• Edward Shorter and David Healy: Shock Therapy. A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press, New Brunswick, NJ 2013, ISBN 9780813560526 .

Individual evidence

1. ↑ Centro studi Cerletti - La spoletta a scoppio differito (Italian), accessed on March 28, 2018
2. ↑ La spoletta Cerletti (Italian) (PDF; 244 kB) accessed on March 28, 2018
3. ↑ Ugo Cerletti's membership entry at the German Academy of Natural Scientists Leopoldina , accessed on March 27, 2018.
4. ^ Edward Shorter and David Healy: Shock Therapy. A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press, New Brunswick, NJ 2013, ISBN 9780813560526 , p. 37.
5. ^ Edward Shorter and David Healy: Shock Therapy. A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press, New Brunswick, NJ 2013, ISBN 9780813560526 , pp. 37-43; Jonathan Sadowsky: Electroconvulsive Therapy in America. The Anatomy of a Medical Controversy . Routledge, New York 2017, p. 32 f.
6. ^ Edward Shorter and David Healy: Shock Therapy. A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press, New Brunswick, NJ 2013, ISBN 9780813560526 , p. 44.
7. ^ Meyendorf and Neundörfer: The history of electroconvulsive therapy. In: Thomas C. Baghai et al. (Ed.). Electroconvulsive therapy. Clinical and Scientific Aspects. Springer Vienna, Vienna 2004, ISBN 9783709137529 , pp. 3–21, here p. 11.
8. ^ Jonathan Sadowsky: Electroconvulsive Therapy in America. The Anatomy of a Medical Controversy . Routledge, New York 2017, p. 33.
9. ^ Bangen, Hans: History of the drug therapy of schizophrenia. Berlin 1992, page 69 ISBN 3-927408-82-4
10. ^ ^{A b} Jonathan Sadowsky: Electroconvulsive Therapy in America. The Anatomy of a Medical Controversy . Routledge, New York 2017, p. 34.
11. ^ Meyendorf and Neundörfer: The history of electroconvulsive therapy. In: Thomas C. Baghai et al. (Ed.). Electroconvulsive therapy. Clinical and Scientific Aspects. Springer Vienna, Vienna 2004, ISBN 9783709137529 , pp. 3–21, here pp. 3, 8, 10 f.
12. ^ Edward Shorter and David Healy: Shock Therapy. A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press, New Brunswick, NJ 2013, ISBN 9780813560526 , pp. 45 f.