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.     

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.     

Visual art in the neurologic career of Jean-Martin Charcot

Jean-Martin Charcot, the world's first chaired professor of neurology, incorporated visual art into his daily practice of neurology. Art served as scientific documentation and was a pivotal tool in the development and dissemination of Charcot's clinicoanatomic method. Although Charcot drew extensively in clinical and laboratory studies, very few of these visual documents have ever been published or are currently available for public study. Charcot was central to the incorporation of medical photographs into the study of neurologic disease and relied heavily on visual material in his capacity as an international teacher. Art also misguided Charcot's career when he relied heavily on artwork in his attempt to convince critics that disorders seen at the Salpêtrière Hospital, Paris, France, were independent of his suggestive influence.     

Charcot at the Salpêtrière: ambulatory automatisms

Jean-Martin Charcot, as professor of neurology at the Salpêtrière Hospital in Paris, delivered a series of dialogue case presentations on general neurology in 1887-1889. These cases, never before translated into English, provide a first-hand view of Charcot's renowned teaching method and his opinions on many neurologic topics. One patient with bizarre ambulatory spells probably representing absence status was recognized by Charcot as an epileptic. This otherwise healthy young man, without a history of generalized epilepsy or hysteria, experienced multiple spells during which he suddenly became unaware of his surroundings, rambled throughout Paris and its outskirts, and had complex interactions with other people. As Charcot unraveled the diagnostic mystery, he traced the patient's wanderings and analyzed the differential diagnosis, treatment, and pathophysiology of these intermittent spells.     

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.     

Jean-Martin Charcot at the birth of Russian neurology

Russian neurology was virtually nonexistent in the middle of the 19th century which made a traineeship abroad an absolute necessity. Charcot and his school did not just offer professional training, but created the best minds, which would determine the direction of neurology and psychiatry in Russia for many decades. After returning home, young Russian doctors not only implemented everything they had learned in Western Europe, but proceeded to make their own original contributions. The most talented pupils of Charcot, including such prominent names as Kozhevnikov, Korsakov, Minor, Bekhterev and Darkshevich, became the founders of neurological schools in Russia. They laid the basis for the further development of neurology and psychiatry. Remarkably, though trained by the same teachers, each of these future 'founding fathers' of these neurological and psychiatric schools followed his own individual path which resulted in an undeniable diversity in Russian neurology and psychiatry during the period of their formation.     

The Martín Larios affair and the beginnings of neurology in Spain. Charcot refuted by Escuder, Vera and Simarro

Jean Martin Charcot travelled to Spain in December 1887 in the company of Alfred Hardy for the medical examination of Martin Larios y Larios, a member of the Spanish parliament. Martín Larios had shown behavioral disturbances and had married secretly for the second time against the advice of his family, one of the richest and more dominating families in Spain during the 19th century. In their report Charcot and Hardy gave a diagnosis of mental insanity probably due to general paresis, as they had noted memory deficits and delusion of grandeur. With this and other medical reports, the family tried to obtain the legal incapacity of Martín Larios. Initially the judgements favoured the incapacity, but Martín Larios and his wife appealed with the support of the Spanish doctors José María Escuder, Jaime Vera and Luis Simarro. They demonstrated, in an exhaustive and clinically rigorous report, the normality of the mental status of Martín Larios, and refuted the diagnosis given by Charcot and Hardy. This report is one of the first examples of the clinical evaluation of a neurologic patient in Spain and shows the high clinical standards achieved by the precursors of the neurological school of Madrid. The great influence of Charcot's own school over Spanish neurology in its beginnings stands out in this report. Charcot and Hardy wrote a second report in reply to Escuder, Vera and Simarro. After a complex lawsuit, the opinion of the Spanish doctors finally prevailed against the legal incapacity of Martín Larios.     

Marcel Proust's lifelong tour of the Parisian Neurological Intelligentsia: from Brissaud and Dejerine to Sollier and Babinski

In Search of Lost Time, the main novel of Marcel Proust (1871-1922) gives prominence to medicine, especially to neurology. Proust possessed excellent medical knowledge and maintained lifelong contact with neurologists. From 1881 onward, he experienced recurrent attacks of asthma, a condition which, at the time, was considered belonging to 'neurasthenia'. Marcel's father, Adrien Proust, was a famous physician who had written papers on stroke, aphasia, hysteria and neurasthenia, and who introduced his son to Charcot's pupil, Edouard Brissaud, the founder of the Revue Neurologique. Three years later, Brissaud published a landmark book on asthma with a preface by Adrien Proust. In 1905, when Proust intended to undergo a 'cure' in order to improve his asthma and other symptoms, he first considered treatment by Jules Dejerine, who was to become Charcot's second successor. He also considered two Swiss physicians who had studied with Charcot and Vulpian: Henry Auguste Widmer, founder of the Clinique Valmont above Montreux, and Paul Dubois, a schoolmate of Dejerine, who practiced in Berne. Brissaud recommended Paul Sollier, under whose care Proust followed a 6-week 'isolation cure'; Sollier, along with Babinski, was considered the cleverest of Charcot's followers. He had studied memory extensively, in particular affective memory, which caused him to reject Bergson's theories and now makes his work a major precursor. Sollier attempted to trigger 'emotional revivals' (reviviscences), 'reproducing the entire state of the personality of the subject at the time of the initial experience'. This concept was integrated by Proust into his novel, with emphasis on 'involuntary memory'. Proust's last neurologist was Joseph Babinski, whom he consulted repeatedly because he feared becoming aphasic, like his mother. Proust's unusual life journey with the most celebrated neurologists of his time highlights aspects of his literary work and also provides a unique perspective on the neurological intelligentsia at the turn of the 19th century.     

Charcot and the myth of misogyny.

OBJECTIVE: To evaluate Jean-Martin Charcot's attitudes toward women and evaluate contemporary and modern accusations of misogyny. BACKGROUND: During the last quarter of the nineteenth century, issues of women's health and feminism became increasingly a medical and political priority. Early neurologists, and specifically Charcot, have been criticized for retarding the advancement of women, but the issue has never been studied in detail. METHODS: Review of original documents from the Bibliothèque Charcot, archives of the Sorrel-Dejerine and Leguay families, and materials from the Académie de Médecine, Paris. RESULTS: Several lines of evidence demonstrate that Charcot, although highly authoritarian and patronizing toward patients and colleagues in general, fostered the concepts of advancing women in the medical profession and eliminating former gender biases in neurologic disorders. The first woman extern in Paris, Blanche Edwards, worked directly under Charcot, and he later became her thesis advisor. When women lobbied for entrance rights to the intern competition, Charcot was one of the few professors to sign the original petition of support. Charcot worked extensively with hysteria and female patients, although he energetically rejected the idea that the disorder was restricted to women. He categorically deplored ovariectomy as a treatment for women with hysteria. His most important scientific contribution in the study of hysteria was his identification of the disorder in men. CONCLUSIONS: Although overtly apolitical throughout his life and certainly not a feminist in the modern definition of the term, Charcot worked to incorporate women professionally into neurology, advanced areas of women's health through his long-term commitment to work in a largely women's hospital (the Salpêtrière), and dispelled the prejudice that hysteria was a woman's malady.     

Shakespeare in Charcot's neurologic teaching

Charcot frequently used Shakespearean references in his neurologic teaching sessions. With these citations, he emphatically stressed how objective observation and an attention to detail were essential to expert clinical diagnosis. At the same time, Charcot presented his personal credentials as a cultured man. Charcot's interest in Shakespeare permeated many aspects of his professional work, and also his private and family life.     

Gilles de la Tourette's criminal women: The many faces of fin de siècle hypnotism

Gilles de la Tourette is now known for the disease which now bears his name, but his activities in the management of hysterics and in hypnotism, which gained him most of his lifetime reputation, have been largely forgotten. As one of the closest followers of Jean-Martin Charcot, he always remained faithful to his mentor's views, and was one of the most vehement defenders of La Salpêtrière school during the quarrel with Hippolyte Bernheim and the Nancy school on the question of the specificity of hypnotic susceptibility in hysteria. This controversy became critical during medico-legal assessment of crimes supposedly committed under hypnotic suggestion. Gilles de la Tourette's involvement in criminal hypnotism was striking, as shown by his own experiments, the most famous of which being his suggested poisoning of a colleague by Blanche Wittman, the celebrated Charcot's hysteric patient in the 1887 Brouillet's painting. Gilles de la Tourette also acted as expert in murder trials, and his Épilogue in the Gouffé’s trunk case, where he affirmed that no murder in real life could be due to hypnotism, and considered that Gabrielle Bompard, the murderer's accomplice, was not under hypnotic suggestion, had a considerable impact. Finally, he was confronted to the issue of murder under hypnotism in his private life, since in 1893, a former patient, Rose Kamper, came and shot him in the head at his home, claiming that hypnotism sessions had changed her own person, and that she had been hypnotized “at distance”. These acts from three very different “hysterical” women highlight the Salpêtrière's theories on hypnotism and their inner contradictions in the fin de siècle ambiance, a few years before Joseph Babinski renewed the concepts on hysteria.     

Charcot and art: from a hobby to science

Jean-Martin Charcot not only was one of the founders of modern neurology, but he displayed an exceptionally developed visual perception and memory, with special artistic gifts, which he used first as a hobby and subsequently as a tool in his profession. Previously unpublished drawings emphasize Charcot's talents in caricature, including autoderision. One of the best achievements of Charcot in correlating the clinic with art includes his thorough study of artistic representations of "possessed states", which allowed him to refine his work on hysteria. The artist and the scientist are two unique facets of Charcot, whose permanent coexistence help to understand his legacy.     

The Salpêtrière in the wake of Charcot's death

After Charcot died in 1893, the students of his immediate circle did not fare well academically in the French medical system. Fatigue and bitterness toward the authoritarian Charcot may have contributed to the change in the scientific and social ambience of the Salpêtrière of Paris in the generation after Charcot died. Clearly, however, the faculty were not invested in energetically overturning the system that Charcot had established, and their choice of Fulgence Raymond as Charcot's successor was an effective means of permitting a passive waning in the Salpêtrière's magnetic influence in world neurology.     

Creation of Charcot's chair

A decree signed by the President of the French Republic on the 2nd of January 1882 provided for the creation of the first chair in the world for the teaching of neurology at the Faculty of medicine in Paris. The chair was named: Clinic for Diseases of the Nervous System and was attributed to J. M. Charcot. The historical and political circumstances related to the creation of this chair are reviewed. J. M. Charcot's hospital and university careers are retraced, emphasis being placed on the turning point in 1867 when J. M. Charcot, having been refused the chair of Medical Pathology, dedicated his time to the study of hysteria and nervous system diseases. The birth of neurology is therefore situated in relation to that of psychiatry. But this chair is also and still that of Charcot; it was thus convenient to remind the man, his origins, his personality, his ideas, and his social role.     

Charcot revisited: the case of Bruegel's chorea

Since Jean-Martin Charcot's time, Pieter Bruegel has been invoked as a famous contributor to the iconography of chorea. This is based not on a picture by Bruegel himself but on a 19th century engraving declared by Charcot to depict St Vitus' dance or chorea germanorum, a form of mass hysteria. A search through the art history literature did not find chorea or St Vitus' dance as a subject of any of Bruegel's works. However, the picture presented by Charcot appeared to be based on a composition that features a pilgrimage of patients suffering from St John's disease or falling sickness, one of the many names applied to epilepsy. This study traces the history of Charcot's allusions to Bruegel's picture and explores the little-known works--drawings, engravings, and paintings--based on Bruegel's composition in the context of chorea, epilepsy, and hysteria. The conclusion of this study is that while Charcot ignored the precise details of Bruegel's composition, his overall interpretation was correct. Beyond any specific diagnosis, Bruegel's work remains universal, giving a unique and compelling picture of human suffering and of the plight of devoted caregivers.