The making of a syndrome: The English translation of Gerstmann's first report

The label Gerstmann syndrome indicates the co-occurrence of four symptoms in persons with acquired brain lesions: finger agnosia, left–right disorientation, agraphia, and acalculia. The syndrome is often associated with a lesion affecting the posterior parietal lobe of the left cerebral hemisphere. Virtually every paper discussing this tetrad of symptoms refers back to Josef Gerstmann's (1924) first report published in German. To make it accessible to the wider community of scholars and thus enable a more in-depth appreciation of the origins of this enigmatic syndrome, here we publish, for the first time in English, a translation of Gerstmann's initial report. In this paper, the syndromal construct had not yet crystallized into its four cardinal symptoms; Gerstmann's attention was mainly focused on finger agnosia and, to a lesser extent, on left-right disorientation by virtue of their significance for the body scheme theory. Although isolated agraphia and acalculia seemed to be at least as severe as finger agnosia, Gerstmann did not consider them of consequential importance (with the exception of agraphia's localisation value). It is also worth noting that the described patient presented a picture of Gerstmann syndrome associated with other symptoms such as hemianopia, balance impairment, and light memory and reasoning disorders.