Les sources janétiennes de l’œuvre de Proust

It has been acknowledged for some time now that Marcel Proust's work had been influenced by the medicine of his time. But the scientific sources concerning two major themes from In Search of Past Time were discovered only recently. Hervey de Saint-Denys’ Les Rêves influenced Proust's interest in sleep and dream functions. In turn, experimental psychology works from the late xix century influenced the key concept of the “other self”, considered by Proust to be the real author of the books. In his work, Edward Bizub (Bull Marcel Proust 56 (2006) 41-51) has highlighted the novelist's in-depth readings about experiences in dual personality conducted by a myriad of Charcot's alumni, including Pierre Janet and… Adrien Proust. Knowledge about the division of consciousness and preFreudian laws of the unconscious allowed the hidden self of the hero of In Search of Past Time to emerge.     

Charcot and Babinski: beyond a simple teacher-student relationship

Jean-Martin Charcot (1825-1893) is now considered to be the father of clinical neurology in France. He trained a generation of eminent neurologists, among them Joseph Babinski, with whom he had a special relationship. Babinski was undoubtedly Charcot's favorite pupil and they enjoyed an excellent collaboration at la Salpétrière. Even though both men felt tremendous respect for each other, it is sad that this relationship may, in one instance, have been detrimental to Babinski. This is probably the reason why Bouchard denied him full professorship, a decision with eventual consequences for both men. In spite of this, the neurologist of Polish origin held his master in tremendous admiration, even as he pursued Charcot's research on hysteria after his death. Even though Babinski eventually contradicted his master on many fundamental issues, it did not affect his devotion to him. The relationship between the two men can be considered as more than a simple relationship between a teacher and his pupil and may be compared to a father-son relationship, which is a reminder of the original model of Hippocratic teaching.     

Figures and institutions of the neurological sciences in Paris from 1800 to 1950. Part III: neurology

We present a short historical review of the major figures, their administrative functions and their works that contributed to make Paris a renowned centre of physiology and neurology during the xixth and the first half of the xxth century. We purposely chose to focus on the period 1800-1950, as 1800 corresponds to the actual beginning of neurosciences, and 1950 marks their exponential rise. Our presentation is divided into four chapters, matching the main disciplines which have progressed and contributed the most to the knowledge we have of the brain sciences: anatomy, physiology, neurology, and psychiatry-psychology. The present article is the third of four parts of this review, and deals with neurology. A special credit should be given to Jean-Martin Charcot who founded the Salpêtrière School of neurology and became one of the world's most important neurologists of the xixth century. We provide below the biographical sketches of Armand Trousseau, Guillaume Benjamin Amand Duchenne, Jean-Martin Charcot, Alfred Vulpian, Désiré-Magloire Bourneville, Paul Richer, Henri Parinaud, Albert Pitres, Jules Joseph Dejerine, Mrs. Augusta Dejerine-Klumpke, édouard Brissaud, Pierre Marie, Georges édouard Brutus Gilles de la Tourette, Joseph Babinski, André Thomas, Georges Marinesco, Achille Alexandre Souques, Georges Guillain and Charles Foix.     

Aphasia: debates]

Quarrels over aphasia are no recent phenomena and have not always been explicit. Lordat and Gall can be cited in this respect as well as Dax and Bouillaud. Reference is also made to Broca-Dax and Trousseau-Lordat. The creation of the Chair in honour of Charcot, which contributed so greatly (thanks to Charcot himself, the others Masters and their students) to the birth of neurology, then to that of the neurological sciences and eventually to that of the neurocognitive sciences. Next, the most explicit of quarrels on aphasia is dealt with, namely that in which, during three meetings of the French Society of Neurology in 1908, Joseph Jules Dejerine and Pierre Marie crossed swords. Their duel in the Bois de Boulogne in 1893 having fortunately been cancelled, it was in 1908 merely a battle of words. Fulgence Raymond was soon to retire. Dejerine and Pierre Marie each put forward their proposal to the Society for a discussion program and Dejerine's was accepted following a vote. The meeting on 11th June, in accordance with the program proposed by Dejerine, was largely restricted to clinical facts. Fulgence Raymond was not present. Dejerine always spoke first, but some of the replies from Pierre Marie received a degree of approval from the audience. It was during this meeting that Achille Souques, the future founder of the history of neurology, cleverly defended the ideas of Pierre Marie. A little later, Dejerine went on the defensive and agreed to a change in the program along the lines suggested by Pierre Marie: he then presented his ideas on the manifest clinical difference between Broca's aphasia and that of Wernicke. After Souques, Edouard Brissaud also came to the rescue of Pierre Marie by mentioning the Leborgne case published by Broca in the spring 1861. Matters were unresolved and André-Thomas, the future founder of neuropaediatrics, produced a highly intelligent deference of his Master Dejerine. Gilbert Ballet and Ernest Dupré also came down largely on his side. The meeting of 9th July (27th anniversary of the Charcot Chair) was dedicated to cerebral anatomy and the "quadrilateral". The subject of Dejerine's questionnaire was again raised. Accompanied by Georges Guillain, Fulgence Raymond was present on this occasion (but refrained from speaking). This time the star was Augusta Dejerine Klumpke, born on a Spanish sand dune now known as San Francisco, U.S.A. Mrs Dejerine contested the "lenticular zone" and gave it a quite different dimension by proving that its anterodorsal part included associative axons originating in or projecting to Broca's area, the remainder of the "Pierre Marie quadrilateral" being called into question. Brissaud was impressed by the performance of Madame Dejerine, and Pierre Marie found himself in an awkward position. His student Fran?ois Moutier, present at his request, discussed his own clinical cases and then, on the subject of "Lelong's" brain' (autumn 1861), let it be known that Broca had scratched it with his finger nails while removing the meninges. André-Thomas and Georges Guillain took part in the discussion. At the last meeting, on 23rd July, Brissaud was absent. Fulgence Raymond was again present but remained silent. The only subject on the agenda was "physiological pathology", but several points that had not been resolved on the 9th July were brought up again. On this occasion, Pierre Marie opened the debate and adopted a very cautious approach. However, his patience eventually ran out and he replied sharply to the comments of Dejerine on "images of language" and those of Dupré on "mental representations". Metaphorically speaking, it might be said that the gold medal was not awarded, Augusta Dejerine Klumpke took the silver, Dupré and André-Thomas shared the bronze, and Souques and Moutier each deserved a special mention. It might also be suggested that in 1908 the Society sketched out to a large extent the programme for research on aphasia for the century to come. (ABSTRACT TRUNCATE     

The impossible succession of Charcot - the quest for a suitable heir

With the death of Jean-Martin Charcot (1825-1893) in 1893 came the impossible task of finding a suitable successor. The clinical chair for nervous system diseases was temporarily entrusted to édouard Brissaud (1852-1909). There were a number of potential successors, but only three were officially declared: Brissaud, Jules Déjerine (1849-1917) and Fulgence Raymond (1844-1910). In the final vote, Raymond was appointed as Charcot's successor. Although this succession would prove too great a challenge for him, Raymond's work in neurology, which is often unrecognised, made him one of the most important French neurologists of the early 20th century.     

An early image of hemifacial spasm: Édouard Brissaud contribution

Édouard Brissaud (1852–1909) was a French neuropsychiatrist of the Charcot school who provided in 1893 the first picture of a patient suffering from hemifacial spasm. Brissaud already suggested several possible etiologies for the involuntary movements of his patient, including the possibility of arterial malformations compressing the origin of the facial nerve. We also discuss the role of other early European authors (Schültze, Gowers, Babinski, and Negro) who contributed to the definition of hemifacial spasm in the late 19th and early 20th centuries. © 2010 Movement Disorder Society     

The Charcot-Bouchard controversy

Charles Bouchard, an ambitious and industrious man, was one of Jean Martin Charcot's first pupils. With his mentor's support, he rapidly ascended the academic ladder and became a full professor at the school of medicine in Paris. After Bouchard attained professorship, his relationship with Charcot gradually deteriorated. Their strong personalities, their ambition to have schools of their own, and their competition to become the most influential man in the medical school resulted in antagonism between them. The most tragic consequence of this antagonism took place in 1892 when Bouchard presided over the competitive examinations for agrégation, in which Joseph Babinski, one of Charcot's youngest pupils, was a candidate. Charcot wanted his pupil to be nominated but Bouchard eliminated him in order to nominate his own pupils. The nominations were appealed but finally Bouchard's decision was upheld. Babinski did not retake the examination and never became a professor at the medical school.     

Babinski's clinical differentiation of organic paralysis from hysterical paralysis: effect on US neurology

BACKGROUND: The formalized neurological examination developed near the end of the 19th century, and clinicians searched for signs to differentiate weakness due to structural lesions of the central nervous system (organic paralysis) from weakness caused by hysteria. Joseph F. F. Babinski worked in the shadow of his mentor, Jean M. Charcot, until 1893, but then developed independent studies to examine patients with both types of weakness. OBJECTIVES: To elucidate the role of Babinski in differentiating organic paralysis from hysterical paralysis and to describe his influence on 2 US neurologists, Charles Gilbert Chaddock and Charles Franklin Hoover. DESIGN: Primary and secondary sources were studied to outline the discoveries of Babinski and to determine his influence on US neurology. RESULTS: Babinski described toe extension in cases of organic paralysis and specifically stated that this sign did not occur in cases of hysterical paralysis. Chaddock and Hoover were influenced by the work of Babinski and disseminated his discoveries to US neurologists, each developing additional techniques to differentiate the 2 forms of paralysis. Each considered his technique superior to the Babinski toe sign. CONCLUSIONS: Although Babinski was only modestly appreciated by his contemporary peers of French neurology, his influence on US neurology was substantial. The Babinski, Chaddock, and Hoover signs that demonstrate whether structurally related upper motor neuron weakness exists continue to be useful maneuvers in separating these forms of paralysis from psychogenic weakness.     

History of the extensor plantar response: Babinski and Chaddock signs

The testing of reflexes involving the lower extremities is a pivotal part of the modern neurological examination. The normal response to noxious stimulation of the foot is plantar flexion of the toes, causing them to curl downward toward the undersurface of the foot. In 1896, Joseph Babinski described an extensor toe response that he claimed was a consistent finding among patients with pyramidal tract lesions of the cortex, subcortex, brain stem, or spinal cord. He considered it a distinct sign of organic disease and found it to be absent in cases of hysterical weakness. Charles Gilbert Chaddock admired the work of Babinski and described a modification of the Babinski technique, demonstrating that stimulation of the lateral surface of the foot could induce the same type of toe extension in patients with pyramidal tract lesions. The two reflexes are complementary, and each can occur without the other, although both are usually present in cases of pyramidal tract impairment. Although these two reflexes are the most commonly described pathological reflexes indicative of pyramidal tract disruption, the names of other celebrated neurologists are also linked to the study of extensor toe signs, each having identified a variant of the Babinski sign.     

The articles of Babinski on his sign and the paper of 1898

In 1896 Joseph Fran?ois Felix Babinski described for the first time the phenomenon of the toes; nevertheless in this first paper he simply described extension of all toes with pricking of the sole of the foot. It was not until the second paper of 1898 that he specifically described the extension of the hallux with strong tactile stimulation (stroking) of the lateral border of the sole. Babinski probably discovered his sign by a combination of chance observation and careful re-observation and replication. He also had in mind practical applications of the sign, particularly in the differential diagnosis with hysteria and in medico-legal areas. Several of the observations and physiopathological mechanisms proposed by Babinski are still valid today, e.g, he realized since 1896 that the reflex was part of the flexor reflex synergy and observed that several patients during the first hours of an acute cerebral or spinal insult had absent extensor responses. He also found that most patients with the abnormal reflex had weakness of dorsiflexion of the toes and ankles and observed a lack of correlation between hyperactive myotatic reflexes and the presence of an upgoing hallux. He discovered that not all patients with hemiplegia or paraplegia had the sign but thought erroneously that some normal subjects could have an upgoing toe. Between 1896 and 1903 Babinski continued to think on the sign that bears his name and enrich its semiological and physiopathological value.     

The debate over "hysteria"]

The debate on hysteria at the "Société de Neurologie" in 1908 signed the official death certificate for Charcot's hysteria, which even in his day had started to come under attack. The article by Babinski in 1901 had delivered the "coup de grace". The debate paints an astonishing picture of the medical world of the day, and also of hysteria, which would never again present the spectacular clinical picture seen up to that point. Babinski, dominating the debate with his strong personality, prevented a discussion on the mental basis for hysteria, requested by several participants, in favour of pithiatism, which in his view offered an acceptable definition of hysteria. It is surprising that more was not made of the contradiction in terms in the expression "auto-suggestion", and of the fact that Babinski was begging the question when he asserted that it could not be asserted that a patient had been subject to suggestion! This debate effectively banished hysteria from the columns of the neurological press, whose pages it had tended to overburden. It cannot however be blamed for not having made a positive contribution to our understanding of this neurosis which, even today, remains enigmatic. It does our Society credit to have ruled out "for ethical reasons" the hypothesis of simulation.     

Charcot and Brazil

OBJECTIVE: To describe the relationship between Professor Charcot and Brazil. BACKGROUND: During the XIX century, French Neurology and its most prominent figure, Professor Charcot, dominated the area of nervous system diseases in the world. METHOD: We have reviewed some of the main publications about Charcot's life, the biography of Dom Pedro II, Emperor of Brazil and the development of Neurology in Brazil. RESULTS: Among the most important patients in Charcot's practice was the Emperor of Brazil. Dom Pedro II became a close friend of Charcot and he was a distinguished guest at Charcot's house, particularly at Tuesday soirées on boulevard St. Germain. In 1887, during the visit of Dom Pedro II to France, Charcot evaluated him and made the diagnosis of surmenage. In 1889, Dom Pedro II was disposed and went to Paris, where he lived until his death in 1891. Charcot signed the death certificate and gave the diagnosis of pneumonitis. Charcot had a passionate affection for animals, a feeling shared by Dom Pedro II. Dom Pedro II was affiliated to the French Society for the Protection of Animals. It is conceivable that Charcot's little monkey, from South America, was given to him by Dom Pedro II. The Brazilian Neurological School was founded by Professor A. Austregésilo in 1911, in Rio de Janeiro. At the time, of Charcot's death in 1893, his influence was still very important in the whole world. He and his pupils played a major role in the development of Brazilian Neurology. CONCLUSION: Professor Charcot had a close relationship with the Emperor of Brazil, Dom Pedro II. He was his private physician and they were close friends. The neurological school, created by professor Charcot, contributed significantly, albeit in an indirect way, to the development of Brazilian Neurology, starting in 1911, in Rio de Janeiro, by Professor A. Austregésilo.     

Alfred Vulpian and Jean-Martin Charcot in each other's shadow? From Castor and Pollux at La Salpêtrière to neurology forever

While Alfred Vulpian (1826-1887) is not completely forgotten, he cannot match the uninterrupted celebrity which Jean-Martin Charcot (1825-1893) still enjoys today. After becoming interne (residents) at the same institute in 1848, both were involved in shaping the cradle of what would become modern neurology. Both started work as chiefs at a La Salpêtrière service on January 1, 1862, making common rounds and studies, with several common publications. While their friendship remained 'for life', as stated by Charcot at Vulpian's funeral, their career paths differed. Vulpian progressed quicker and higher, being appointed full professor and elected at the Académie Nationale de Médecine and the Académie des Sciences several years before Charcot, as well as becoming dean of the Paris Faculty of Medicine. These positions also enabled him to support his friend Charcot in getting appointed full clinical professor and becoming the first holder of the chair of Clinique des Maladies du Système Nerveux in 1882. Before studying medicine, Vulpian had worked in physiology with Pierre Flourens, and his career always remained balanced between physiology and neurology, with remarkable papers. He introduced Charcot to optic microscopy during their La Salpêtrière years, indirectly helping him to become his successor to the chair of pathological anatomy in 1872. While Vulpian succeeded so well in local medical affairs, Charcot spent his time building up a huge clinical service and a teaching 'school' at La Salpêtrière, which he never left for over 31 years until his death. This 'school' progressively became synonymous with clinical neurology itself and perpetuated the master's memory for decades. Vulpian never had such support, although Jules Déjerine was his pupil and Joseph Babinski was his interne before becoming Charcot's chef de clinique (chief of staff) in 1885. This unusual switch in Parisian medicine contributed to Charcot's unaltered celebrity over more than a century, while Vulpian was progressively relegated to the studies of historians. However, Vulpian and Charcot remain inseparable in the memory of a lifelong friendship which gave birth to neurology.     

Georges Gilles de la Tourette. The man and his times

Georges Albert Edouard Brutus Gilles de la Tourette (1857-1904), one of Charcot's favourite pupils and his self-appointed amanuensis made several valuable contributions to medicine and literature. His most substantial achievements were in the study of hysteria and the medico-legal ramifications of hypnotism, but he was also a competent neuropsychiatrist with a particular interest in therapeutics. He was a dynamic, passionately outspoken man whose prodigious literary output reflected his own restless compulsions as well as the interests of his beloved chiefs Brouardel and Charcot. His love of Loudun, his ancestral home strongly influenced his subject matter which included a biography of Theophraste Renaudot and with his colleague Gabriel Legué a perceptive analysis of Soeur Jeanne des Anges' account of her hysterical illness induced by her unrequited love for the Loudun priest Urbain Grandier. In 1893 shortly after the tragic death of his young son and of his mentor Charcot, Gilles de la Tourette was shot by a deluded woman who had been a patient at the Salpêtrière. Her claims that she had been hypnotised by Gilles de la Tourette against her will causing her to lose her sanity bore a macabre resemblance to the accusation of Soeur Jeanne des Anges against Grandier. The bizarre episode became a "procès célèbre" seeming superficially to vindicate the Nancy School's views that criminal suggestion was possible under hypnotism, a view Gilles de la Tourette had vehemently rejected. Despite his colourful life and varied achievements only an incomplete biographical account by his friend Paul le Gendre, a few informative orbituaries and some caustic sketches by Leon Daudet exist.