Harold G Wolff
2015; Elsevier BV; Volume: 14; Issue: 10 Linguagem: Inglês
10.1016/s1474-4422(15)00184-2
ISSN1474-4465
Autores Tópico(s)Neurology and Historical Studies
ResumoPioneer in headache research and psychosomatic medicine. Born in New York, NY, USA on May 26, 1898, he died on Feb 21, 1962, aged 63 years.The pathophysiology of migraine has puzzled scientists and clinicians for centuries. In the 18th century, migraine was often attributed to dysfunction of visceral organs rather than the brain. The origins of a neurovascular hypothesis of migraine can be traced back to Thomas Willis in the 17th century, who speculated that migraine headache was caused by increased arterial blood flow in the meninges. Over the centuries, other proposed mechanisms have included venous congestion, autonomic dysfunction, and even so-called nerve storms, like those described in epilepsy by Edward Liveing. It wasn't until the early 20th century that neurologists such as Harold Wolff were able to investigate systematically the underlying pathogenesis of this complex, multifaceted disorder, and the era of modern headache research began.Wolff was born in New York in 1898, the only child of Emma Recknagel Wolff and Louis Wolff. After some deliberation following his graduation from New York City College in 1918—he briefly considered becoming a priest—Wolff trained in medicine at Harvard Medical School, graduating in 1923. After completing his internship in New York, Wolff returned to Harvard from 1926 to 1928 to work as a research fellow with Stanley Cobb, a pioneer in the field of biological psychiatry. It might have been under Cobb's influence that Wolff became interested in the distinction between functional and organic disease; Cobb believed that there was no dichotomy between the mind and body, and was troubled by the attempts of medical science to differentiate between psychic and somatic disease.In 1928, Wolff travelled to Europe, working with two Nobel Prize winners—Otto Loewi in Austria and, a few years later, Ivan Pavlov in Russia. On his return to the USA, Wolff joined the psychiatrist Adolf Meyer at Johns Hopkins Hospital, where he revisited the issue of psychic versus somatic causes of disease. “His interest was in moving beyond the typical Cartesian mind/body divide to understand how psyche, personality, and biology could simultaneously contribute to nervous disorders”, writes Joanna Kempner in her book Not Tonight: Migraine and the Politics of Gender and Health.In 1932, Wolff took up the post of chief neurologist at the newly established Cornell Medical Center, where he would remain for the next 30 years. It was at Cornell that Wolff did groundbreaking experiments on the vascular theory of migraine. He developed an experimental set-up to measure both intracranial and extracranial changes during a migraine attack induced by the injection of histamine. Wolff showed that migraine aura could be temporarily interrupted by vasodilation. One of his medical students came to the lab with a pre-migraine scotomata, and “Doctor Wolff had him whiff a small amount of amyl nitrate, just enough to dilate cerebral vessels with no change in blood pressure, and the scotomata disappeared—to return shortly thereafter”, wrote Helen Goodell, Wolff's research assistant throughout his time at Cornell. After a visit from a flying trapeze artist, who told Wolff her headaches were alleviated by standing on her head, Wolff had other patients and members of his research team stand on their heads to see what effect this unusual intervention might have. “Never a day without an experiment was the motto written large upon our bulletin board”, remembers Goodell.Wolff became renowned for his experiments, even appearing on the cover of iconic Time magazine. “His interpretation of the mechanism of migraine was a real advance over previous interpretations, in that he added to the idea of cranial vasoconstriction causing the aura and vasodilation the subsequent (often throbbing) headache the concept of posterior neck muscle tightening mediating the later stages of the headache”, Mervyn Eadie (University of Queensland, Brisbane, Australia) commented to The Lancet Neurology. “There were forerunners to the vasoconstriction–vasodilation idea, including Peter W Latham in the early 1870s, but Wolff provided good human experimental evidence for the vascular changes that he described.”Like so many migraine researchers before him, Wolff had migraine himself. Wolff's belief in a psychosomatic basis of illness led him to propose a migraine personality, which fitted the many patients that he saw on the wealthy Upper East side of Manhattan, as well as friends and colleagues who were similarly afflicted. “Wolff described the migraine personality as ambitious, successful, perfectionist, and efficient”, writes Kempner. “Without a doubt, Wolff had his own obsessive and perfectionist tendencies in mind.” The unrealistic expectations that the person with migraine imposed on themselves aligned perfectly with Wolff's vascular theory—tension caused vasoconstriction and fatigue caused subsequent vasodilation. From studies of families affected by migraine, Wolff identified a hereditary component of the disorder. “Migraine headaches commonly occur when hereditarily susceptible persons attempt to control feelings of anxiety and resentment by means of organized and intense activity”, wrote Goodell. “Headache is thus a cranial vascular consequence of a way of life.” Wolff extended his theory that the body responded to stress in a manner that was often self-destructive to other disorders such as hypertension and peptic ulcer.A tall, gaunt figure, Wolff was an imposing presence in the lecture theatre and at the hospital bedside. “His neurological conferences were models of precision, clarity and objectivity”, wrote Louis Hausman, president of the New York Neurological Society, at the time of Wolff's death. “In the presentation of patients, the house staff was expected to be brief and factual. The common neurological clichés were promptly exposed for what they were.” Wolff was held in high regard by students and peers alike, and he trained many notable neurologists, including Fred Plum (who succeeded him as Chief of Neurology at Cornell) and Stewart Wolf (who continued Wolff's research in psychosomatic medicine).Wolff's life and work were prematurely cut short in 1962 by a catastrophic cerebrovascular thrombosis, the premonitory symptoms of which he could have mistaken as migraine. At the time of his death, Wolff held several prestigious posts and had just completed his term as President of the American Neurological Association. Wolff's Headache and Other Pain became a seminal text and his theories dominated the field of migraine research until the early 1970s. On Jan 9, 1962, in what was to be his last speech at the New York Academy of Medicine, Wolff remarked rather prophetically: “…in man's pathological reactions his goals, purposes, and aspirations are of utmost importance … the individual had best know the cost of his values … he may choose to pay the price in personal comfort, health, and even survival”. Pioneer in headache research and psychosomatic medicine. Born in New York, NY, USA on May 26, 1898, he died on Feb 21, 1962, aged 63 years. The pathophysiology of migraine has puzzled scientists and clinicians for centuries. In the 18th century, migraine was often attributed to dysfunction of visceral organs rather than the brain. The origins of a neurovascular hypothesis of migraine can be traced back to Thomas Willis in the 17th century, who speculated that migraine headache was caused by increased arterial blood flow in the meninges. Over the centuries, other proposed mechanisms have included venous congestion, autonomic dysfunction, and even so-called nerve storms, like those described in epilepsy by Edward Liveing. It wasn't until the early 20th century that neurologists such as Harold Wolff were able to investigate systematically the underlying pathogenesis of this complex, multifaceted disorder, and the era of modern headache research began. Wolff was born in New York in 1898, the only child of Emma Recknagel Wolff and Louis Wolff. After some deliberation following his graduation from New York City College in 1918—he briefly considered becoming a priest—Wolff trained in medicine at Harvard Medical School, graduating in 1923. After completing his internship in New York, Wolff returned to Harvard from 1926 to 1928 to work as a research fellow with Stanley Cobb, a pioneer in the field of biological psychiatry. It might have been under Cobb's influence that Wolff became interested in the distinction between functional and organic disease; Cobb believed that there was no dichotomy between the mind and body, and was troubled by the attempts of medical science to differentiate between psychic and somatic disease. In 1928, Wolff travelled to Europe, working with two Nobel Prize winners—Otto Loewi in Austria and, a few years later, Ivan Pavlov in Russia. On his return to the USA, Wolff joined the psychiatrist Adolf Meyer at Johns Hopkins Hospital, where he revisited the issue of psychic versus somatic causes of disease. “His interest was in moving beyond the typical Cartesian mind/body divide to understand how psyche, personality, and biology could simultaneously contribute to nervous disorders”, writes Joanna Kempner in her book Not Tonight: Migraine and the Politics of Gender and Health. In 1932, Wolff took up the post of chief neurologist at the newly established Cornell Medical Center, where he would remain for the next 30 years. It was at Cornell that Wolff did groundbreaking experiments on the vascular theory of migraine. He developed an experimental set-up to measure both intracranial and extracranial changes during a migraine attack induced by the injection of histamine. Wolff showed that migraine aura could be temporarily interrupted by vasodilation. One of his medical students came to the lab with a pre-migraine scotomata, and “Doctor Wolff had him whiff a small amount of amyl nitrate, just enough to dilate cerebral vessels with no change in blood pressure, and the scotomata disappeared—to return shortly thereafter”, wrote Helen Goodell, Wolff's research assistant throughout his time at Cornell. After a visit from a flying trapeze artist, who told Wolff her headaches were alleviated by standing on her head, Wolff had other patients and members of his research team stand on their heads to see what effect this unusual intervention might have. “Never a day without an experiment was the motto written large upon our bulletin board”, remembers Goodell. Wolff became renowned for his experiments, even appearing on the cover of iconic Time magazine. “His interpretation of the mechanism of migraine was a real advance over previous interpretations, in that he added to the idea of cranial vasoconstriction causing the aura and vasodilation the subsequent (often throbbing) headache the concept of posterior neck muscle tightening mediating the later stages of the headache”, Mervyn Eadie (University of Queensland, Brisbane, Australia) commented to The Lancet Neurology. “There were forerunners to the vasoconstriction–vasodilation idea, including Peter W Latham in the early 1870s, but Wolff provided good human experimental evidence for the vascular changes that he described.” Like so many migraine researchers before him, Wolff had migraine himself. Wolff's belief in a psychosomatic basis of illness led him to propose a migraine personality, which fitted the many patients that he saw on the wealthy Upper East side of Manhattan, as well as friends and colleagues who were similarly afflicted. “Wolff described the migraine personality as ambitious, successful, perfectionist, and efficient”, writes Kempner. “Without a doubt, Wolff had his own obsessive and perfectionist tendencies in mind.” The unrealistic expectations that the person with migraine imposed on themselves aligned perfectly with Wolff's vascular theory—tension caused vasoconstriction and fatigue caused subsequent vasodilation. From studies of families affected by migraine, Wolff identified a hereditary component of the disorder. “Migraine headaches commonly occur when hereditarily susceptible persons attempt to control feelings of anxiety and resentment by means of organized and intense activity”, wrote Goodell. “Headache is thus a cranial vascular consequence of a way of life.” Wolff extended his theory that the body responded to stress in a manner that was often self-destructive to other disorders such as hypertension and peptic ulcer. A tall, gaunt figure, Wolff was an imposing presence in the lecture theatre and at the hospital bedside. “His neurological conferences were models of precision, clarity and objectivity”, wrote Louis Hausman, president of the New York Neurological Society, at the time of Wolff's death. “In the presentation of patients, the house staff was expected to be brief and factual. The common neurological clichés were promptly exposed for what they were.” Wolff was held in high regard by students and peers alike, and he trained many notable neurologists, including Fred Plum (who succeeded him as Chief of Neurology at Cornell) and Stewart Wolf (who continued Wolff's research in psychosomatic medicine). Wolff's life and work were prematurely cut short in 1962 by a catastrophic cerebrovascular thrombosis, the premonitory symptoms of which he could have mistaken as migraine. At the time of his death, Wolff held several prestigious posts and had just completed his term as President of the American Neurological Association. Wolff's Headache and Other Pain became a seminal text and his theories dominated the field of migraine research until the early 1970s. On Jan 9, 1962, in what was to be his last speech at the New York Academy of Medicine, Wolff remarked rather prophetically: “…in man's pathological reactions his goals, purposes, and aspirations are of utmost importance … the individual had best know the cost of his values … he may choose to pay the price in personal comfort, health, and even survival”.
Referência(s)