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Vladimir Mikhaylovich Bekhterev, (1857-1927)

Posted in History on 6th Jan 2020

JMS Pearce MD, FRCP, Emeritus Consultant Neurologist, Department of Neurology, Hull Royal Infirmary, UK.
Correspondence to: J.M.S. Pearce, 304 Beverley Road Anlaby, East Yorks, HU10 7BG, UK. Email: jms.pearce@me.com
Conflict of Interest statement: None declared.
Date first submitted: 19/12/18
Acceptance date: 10/1/19
Published online: 6/1/20
Published under a Creative Commons license


Neurologist Bekhterev

Figure 1

Among many Russian neuroscientists (who included Vladimir Betz, Konstantin Tretiakoff, and Alexander Luria) was Vladimir Mikhaylovich Bekhterev, (1857-1927) (Fig 1., left). Neurologist, morphologist and experimental psychologist, he was a most industrious, inventive and inexhaustible physician. Born in Sorali, a remote village between the Volga and the foothills of the Ural mountains, he became a distinguished neurophysiologist and psychiatrist who advanced the functional anatomy of the brain, experimental psychology, clinical neurology, and conditioned reflexes.1 Paradoxically, Bekhterev’s disease (ankylosing spondylitis) is better known than his neurological works where he described: the acromial reflex, Bekhterev’s superior vestibular nucleus, labyrinthine nystagmus, the pectoralis reflex, a paradoxical reflex: pupillary dilatation to light, and several arcane reflexes in the limbs.

As a child Bekhterev spent much of his time reading the natural sciences. Aged 16, he enrolled at the Military Medical Academy in St Petersburg, and graduated in medicine in 1878. Already curious about the workings of the brain, from 1884-5 he secured a travelling scholarship to study under Flechsig in Leipzig and there described the superior vestibular nucleus—another Bekhterev-bearing eponym. When he visited Meynert, Westphal, Wundt, and Charcot, stimulated by their work he widened his enquiries. In his 1928 autobiography, he explained his curiosity about the brain:

 That time the old expression “textura obscura, functiones obscurissimae [an obscure texture, and the most obscure functions]’ could be fully applied to our knowledge of the brain. My desire to light this darkness was the reason to study the brain structure and functioning 2

When in 1885 he returned to Russia he had already secured a considerable reputation.  Aged only 28 he became Professor of Psychiatry at the University of Kazan, where he established the first laboratory of experimental psychology in Russia. In 1893, having published more than a hundred papers, he became Professor of Psychiatry at the Military Medical Academy in St. Petersburg, continuing both neuropathology and neuropsychology studies.3  As well as his discovery of the superior vestibular nucleus, succeeding Freud’s work he described the central tegmental tract, the connections of the olivary nucleus and cerebellar peduncles.4

The second edition of his Conduction Paths in the Spinal Cord and Brain 1896 was the most comprehensive anatomical description of the time. So famous had Bekhterev become that the German anatomist Friedrich Kusch, said,

There are only two persons who know the anatomy of the brain perfectly—God and Bekhterev

He founded the first Russian journal on nervous disease, Nevrologichesky Vestnik in 1896 and set up the Leningrad Psychoneurological Institute in 1907. Here he furthered his investigation of the relationship between human brain physiology and behaviour. In politically troubled times he was forced to resign his Chair in 1913; it was restored following the Russian Revolution of 1917 when he headed the department of psychology and reflexology at the University of Petrograd in St. Petersburg.

Bekhterev wrote ceaselessly with extraordinary endurance: he was said to need only five hours of sleep. The result over 50 years was more than 600 scientific papers and 10 books. His book on reflexology (1921) was translated into German and English.5 Among his more significant writings are Conduction Paths in the Brain and Spinal Cord (1882; 2nd ed., 1896) and Objective Psychology (1907). His lasting legacy was on brain morphology, function, conditioned reflexes and several original clinical papers.

In the same decade as Strümpell and Pierre Marie,6 Bekhterev in 1893 described ankylosing spondylitis: known both as Bekhterev’s disease, and Marie-Strümpell disease,7  observing the rigidity and curvature of the spine, and the ‘Ankylosing inflammation of the spine and the large extremity joints.’

But these accounts were long after the convincing 17th century instance in a skeleton discovered in a French graveyard reported by Bernard Connor to the Royal Society:

Vertebrae and ribs

were so straightly and intimately joined, their Ligaments perfectly Bony, and their Articulations so effaced, that they really made but one uniform continuous Bone; so that it was as easy to break one of the Vertebrae into two, as to disjoint or separate it from the other Vertebrae, or the Ribs.8

Benjamin Brodie (1783-1862) also had described a probable case observed in 1841, who complained of pain and stiffness in the dorsal and lumbar spine, buttocks, and knee joint, plus iritis.9

In his studies of conditioned reflexes he competed with Ivan Pavlov (1849-1936) who won the Nobel Prize in Physiology or Medicine in 1904. Bekhterev independently developed his own theory though it differed little from Pavlov’s notions. After their early years of friendship there developed considerable personal acrimony and disagreement. He insisted on a purely objective approach to the study of behaviour. He was convinced that complex behaviours could be explained through the study of reflexes, a notion that influenced the growing behaviourism that surfaced in America.

Bekhterev married twice, and had six children with his first wife Natalya Bazilevskaya. While she was living abroad after the Russian revolution, Bekhterev met the much younger Berta Gurdzhi. After Natalya died in 1926, he married Gurdzhi at the age of 70. The circumstances of his sudden, unexpected death in 1927 are much debated. He was summoned to the Kremlin to perform a medical examination on Stalin and reported: “I examined a paranoid with the dry hand”. This comment, reaching Stalin (who had a left arm deformity after childhood injury and infection), angered him, as he would not admit rumours about his mental state. Within a day or two, on Christmas eve 1927, Bekhterev was dead. The day before his death he had chaired a congress of Soviet neurologists in Moscow. Many believed that the Russian authorities poisoned him,10 though there was ‘no proof.’11 However, the Kremlin authorities insisted on cremation11 and, his name and all of his works were erased from Soviet literature until Stalin’s death in 1953.12 The most plausible explanation of Stalin’s late paranoia is ‘the dimming of a superior intellect and the unleashing of a paranoid personality by a multi-infarct state.’13

Bekhterev was a dynamic, gifted man who explored new fields in psychology and brain morphology in a career marked by vagaries and incident. Eventually, a sculpture was erected in the Volkovo cemetery at St Petersburg in the 1970s and a 5-ruble stamp in 2007 commemorates him. (Fig 2.)

References

  1. Yakovlev PI. Vladimir Bekhterev (1857–1927). In W. Haymaker and F. Schiller (eds), The Founders of Neurology (Springfield, IL: Charles Thomas), 1970;167–71.
  2. Bekhterev VM. (1928) Avtobiografiya (Postmertnaya). In: Biblioteka “Ogonyok” (Moscow: Pravda) cited by Lerner et al. 12
  3. Bozhkova E. Vladimir Mikhailovich Bekhterev. Lancet Neurology. 2018;17(9):744.
  4. Bechterew V. Ueber die functionelle Beziehung der unteren Oliven zum Kleinhirn und die Bedeutung derselben für die Erhaltung des Körpergleichgewichts. Archiv für die gesammte Physiologie des Menschen und der Thiere. 1882;29:257-264.
  5. Bechterev VM. General Principles of Human Reflexology: An Introduction to the Objective Study of Personality. (London: Jarrolds Publishers). 1933.
  6. Pearce JMS. A note on Pierre Marie (1853–1940). Journal of Neurology, Neurosurgery & Psychiatry 2004;75:1583.
  7. Bekhterev V M. Ueber ankylosirende Entzündung der Wirbelsäule und der grossen Extremitätengelenke. Deutsche Zeitschrift für Nervenheilkunde, 1899, 15 :37-45.
  8. Connor B. Philos.Trans. 1695;19,21. Cited In: Inman R, Sieper J. Oxford Textbook of Axial Spondyloarthritis. Oxford University Press, 2017
  9. Brodie BC. “Diseases of the Joints.” 5th Ed. London: Longman, Brown, Green, 1850.
  10. Kesselring J. Vladimir Mikhailovic Bekhterev (1857–1927): Strange Circumstances Surrounding the Death of the Great Russian Neurologist. Eur Neurol 2011;66:14–17.
  11. Topolyansky VD. (1989) Noch’ pered rozhdestvom v 1927 godu [The night before Christmas in 1927]. Ogonyek, 9–10, 27. Cited by Lerner et al.
  12. Lerner V, Margolin J ,Witztum E. Vladimir Bekhterev: his life, his. work and the mystery of his death. History of Psychiatry 2005; 16(2): 217–227.
  13. Hachinski V. Stalin’s last years: delusions or dementia? European Journal of Neurology 1999;6:129–32.
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