Saturday, 21.09.2019

Johan Schioldann: Carl Lange (1834 – 1900) a founding father of neurology, psychophysiology and lithium therapy
Samuel Gershon’s comment


            Firstly, I would like to welcome this work to the discussions that have been under way for some time on this history network. In addition, this present work by Schioldann   is a valuable addition to the classic volume first published by Schioldann in 2009: History of the Introduction of Lithium into Medicine and Psychiatry

            Carl Lange and his brother Frederick (Fritz)worked together on some of their clinical patients and some of the important publications that were published. Carl Lange, in a treatise related to his work on the James–Lange Theory,came close to formulating alternating periods of mania and depression as a nosological entity,years before Kraepelin offered his concept of Manische-Depressive Irresein in 1899.

            Lange went on and described the clinical features in more detail, as quoted in Schioldann’s paper. Lange had previously presented his cases of recurrent depressive disorder and it was in this earlier group that he studied the use of lithium as a treatment for the individual depressive phase and then went onto state that the desired treatment in these cases was to maintain lithium treatment to prevent recurrence of the depressive episodes.

            At this point I wish to summarize that the Langes were the first workers in the world to propose and carry out lithium treatment to treat firstly the depressive phase of the disorder and to go on to employ protracted lithium treatment to prevent recurrent episodes of the depression.In this phase of his work Carl presented two unique findings for psychiatric treatment:the acute treatment of an episode of illness and the quite new concept of prophylactic treatment. Furthermore, his psychiatric brother, Frederick Lange published the first textbook of psychiatry in the Danish language, in which he made reference to Jean-Pierre Falret’s 1851 Folie Circulaire and Jules Bailarger’s 1854 la folie à double forme.

            In 1886 Carl Langepresented“On Periodical Depressions and their Pathogenesis”to the Medical Society of Copenhagen.

            It is important to record one other perhaps minor point: in Carl Lange’s writings he included a copy of the actual prescription he gave to his patients treated with lithiumthe exact dose of lithium he used. Thus, the therapeutic dose from these experiences was available in the open literature.                                                                                                                

            The other major aspect in Johann’s document is his description of the historical picture that surrounded the lives of the Lange brothers;descriptions of their relatives;the surrounding psychiatric scene;and the fact that their families were from the educated and academic groups of the society.We also get some insight into the personalities. Carl Lange seemed to be a remarkably reticent person; for example, he declined to accept the RoyalOrder of Dannebrog which theDanish King wished to bestow on him.

            I personally find that such historical perspective of the cultural,social and academic backgroundof historical figures helps illuminate and understand them better.

            In conclusion, I would like to say that this contribution by Schioldann is a valuable contribution in its own right, but even more it is an elegant and memorable historical document which helps to highlight the discussions that have been going on for some time and especially since the appearance of Schioldann’s first book on these topics in 2009.




November 22, 2018