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Pick’s disease
  1. J M S Pearce
  1. 304 Beverley Road, Anlaby, Hull HU10 7BG; jmspearce{at}freenet.co.uk

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Arnold Pick (1851–1924)1 was born of German-Jewish parents on 20 July 1851 in Velké Mezirici, in Moravia.2 He studied medicine in Vienna, where Theodore Meynert (1833–1892) stimulated his neurological interests. As with many medical scholars of his time, he was trained in clinical neurology, psychiatry, and neuropathology, a wide spectrum of disciplines now seldom feasible. In 1874 he trained in Berlin with Westphal, and from 1875 he worked at the later infamous asylum of Wehnen. Then he became lecturer in neurology and psychiatry in Prague where he met Otto Kahler, with whom he published papers on oculomotor palsies, cortical localisation, and syringomyelia. They established ‘Kahler-Pick’s law’—incoming fibres in the posterior columns of the cord from a higher level displace medially those that enter at a lower level.

He found promotion to the chair of neuropsychiatry in Prague but encountered many problems related to academic teaching in both German and Czech languages, controlled by the Austro-Hungarian empire. Essential provisions were often lacking and he met with much hostility and resentment1 that often hampered his work. Despite this, his remarkable ability to communicate with patients with psychoses and aphasia was admired, and his history-taking became legendary.

An intellectual man, Pick loved classical music and in his home his books in many languages were piled from floor to ceiling. He was described as a “noble minded, excessively modest but fearless man, the essence of calm serenity”.2 He retired in 1921, but continued some work, despite troublesome cataracts and urinary tract stones. On 4 April 1924, at the age of 73, he died of urinary sepsis following bladder surgery.

Pick published about 350 papers on diverse topics. Many were case reports dealing with neuropsychology and behavioural neurology. He was among the first to give reliable descriptions of visual hallucinations, micrographia, palilalia, and reduplicating paramnesia. He wrote important papers on apraxia and aphasia.3 He described the fibre bundles in the medulla oblongata (Pick’s bundle). His 1898 book on neuropathology was a landmark in this field.4

In his work on aphasia he introduced the term agrammatism. Agrammatical speech was the basic defect of aphasic disorders. Wernicke influenced his views on language but Jackson probably had a greater influence on his concepts of how language was disrupted. They had great mutual respect and shared a distaste for speculation; both wrote in terse prose.

Pick’s disease

In 1892, Pick described a 71 year old man who presented with progressive loss of language and a failing mind.5 After death, the brain showed asymmetrical atrophy as opposed to the more diffuse atrophy of Alzheimer’s disease. The condition described by Pick “on the relationship between senile atrophy of the brain and aphasia”6 was often confused with Alzheimer’s and vascular dementias. Pick published three further papers, in which he showed patients with severe aphasia and apraxia who had a “progressive circumscribed atrophy” of the cortex.7–,9 He regarded these patients as suffering from a variant of senile dementia. Attention was drawn to the aphasic and later the apraxic side of the syndrome, but eventually the distinctive pathology established it as an entity.

Alzheimer in 1911 confirmed the circumscribed cortical (lobar) atrophy,10 and found the characteristic Pick bodies: ovoid, homogeneous, smooth-edged, and intensely argyrophilic neuronal inclusions. Gans introduced the name Pick’s disease in 1922.11

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