5 May 2016

Hans Berger: The Man Who Read Our Minds

Clinical Neurology

 

By the nineteenth century it was widely accepted – but only after a long struggle – that the mind was located in the brain

The race was then on to get the brain to reveal its secrets. The key to this was electricity, the magic fluid that promised so much. That nerve transmission occurred by electrical conduction was a first step, but further progress was limited. The brain was determined to remain mysterious. Head injuries and laboratory animals gave some clues. Russian researchers came close to getting electrical readings from the scalp, but no one paid attention to them. Neurophysiologists concentrated on peripheral nerves and mortgaged the brain to the future. There the matter would have stayed but for one man.

Hans Berger was an unlikely hero, let alone scientific pioneer, who forever changed the view we have of ourselves. His story goes to show that great discoveries not only arise in the context of the times, but often reflect the personal quirks of the person who makes them. And in regard to the latter, Berger excelled.

The son of a German doctor who ran a country lunatic asylum, Berger looked to the stars and wanted to be an astronomer. A career that focussed on a very big picture but required intense attention to detail was to provide the template for his later work. However a fortuitous event deflected Berger from following this path. Doing military service as a student, he was nearly killed in a riding accident. His sister, 100 kms away, had an intense premonition that he was in danger and contacted him. Berger, convinced that this was an example of telepathy, decided to change to psychology by doing medicine and then psychiatry as the only viable career path.

He ended up at the University of Jena as a conscientious – to a fault – department head who systematically did clinical work in the day, then disappeared into his laboratory in the evening. From 1903 he tried to find a way to measure brain activity. Pathologically secretive, he never discussed his work and only reluctantly allowed in volunteers to be tested. After many failures, he embarked on measuring the electrical current on the surface of the brain.

To anyone else it would have seemed a hopeless task. The technology of the time, essentially galvanometers, was crude and simplistic, even though Germany was a world leader in the field. Berger seemed immune to failure; it was as if he did not know anything other than pressing on.

It took until 1924, aided by a vacuum tube that gave 100 times amplification of the electric current, before Berger got the first flickering electrical traces from the surface of the brain of patient K who had lost part of his skull. He named the procedure electroencephalography (electroenkephalography in German), which we today know as the EEG. He was able to diagnose a brain tumour. He named the Alpha-wave and was able to detect some forms of epilepsy. He showed that the brain was never entirely at rest but functioning at different levels of activity.

Thanks to Berger, the brain was finally yielding up its secrets.

It was a measure of his obsessional approach that Berger spent a further five years confirming the results before publishing his findings in 1929. His suspicions proved right; he was ignored although there was some interest in far-off America. In academic terms, he was a nonentity and to most researchers the idea of measuring brain activity was simply untenable. If Berger was upset by the lack of response, he gave no indication, continuing to publish until 1938 a total of 14 papers; each paper had the same name, only numbered between 1 and 14.

Six years later Edgar Adrian, the leading researcher in the field, did a study with the intention of finally dismissing Berger’s work. In a very rare example of scientists eating, indeed choking, on their words Adrian was forced to admit that Berger had been right; the EEG had arrived.

For Berger this was belated recognition. He was invited to conferences and saw the widespread adoption of the EEG as a routine tool in psychiatry and neurology.

It proved to be a short-lived triumph. The Nazis came into power and Berger, despite party membership, was not reappointed to his post in 1938, replaced by a hack. He had to settle for running a private nursing home and his research ended. Worse was to follow. War broke out and international scientific and medical contacts stopped. Berger was nominated for the Nobel Prize but awards were suspended for the duration. He developed what he thought (incorrectly) was an incurable illness and hanged himself in 1940, unaware of the accolades he would receive.

There is a lesson in how we take discoveries for granted. Medicine deprived of its history is merely an applied technology, not an art and science. Today the EEG is used in neurology, intensive care, neurosurgery, sleep medicine, psychiatry and experimental psychology without a second thought as to the hard-fought course that led to its discovery or the tragedy of its finder. Without it there would be no sleep medicine and epilepsy would still depend on vague clinical observations. It is now essential for confirming brain death in seriously injured patients.

And what of Hans Berger? He was, in many ways, his own worst enemy. Guarded, uptight and pedantic, he did not encourage collegial friendship. His juniors found him unpleasant to work with. He refused to share his research with others who, in any event, would have paid no attention. His guarded obsessionality – he may have been paranoid – antagonised many but made him push on where others would have long given up. If he had not waited those five years, earlier recognition of the EEG would have changed everything and possibly even saved his life.

What is it about creative people, driven researchers, lonely pioneers, that makes them pursue the long road in the face of sustained resistance, hostility and obstacles? They are, more often than we recognise, different to the rest of us and not particularly in a socially acceptable way. Tilting at unscaleable peaks brings with it the penalty that reaching the summit only leads to the realisation that further challenges lie ahead. Self-destruction and suicide are all too common. Berger joins so many others who were consumed by their mission, leaving them broken. This we should never forget.

Robert M Kaplan, after an incident with his Russian friend Miss Tatiana, had an EEG but the neurologist refused to tell him the findings and hurriedly left the room, muttering about joining a cult.