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.     

Gilles de la Tourette: The man behind the syndrome

French neuropsychiatrist Georges Gilles de la Tourette first described in 1885 the “Maladie des Tics” which earned him eponymous fame. Both his colleagues at La Salpêtrière hospital in Paris and medical historians report that he was a highly intelligent, if irascible, character. The Gilles de la Tourette syndrome was only a very minor contribution of its author, at the time. Gilles de la Tourette's main and continued contributions were on hysteria and hypnotism. This article concentrates on his life and includes previously untranslated passages from authors of the time and, for the first time, a full English translation of his obituary written by Henry Meige.     

Living his writings: The example of neurologist G. Gilles de la tourette

Gilles de la Tourette is known for the disease which now bears his name. 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. His activities in the management of hysterics and in hypnotism helped build his reputation during his lifetime, but are now largely forgotten. Gilles de la Tourette had an unusual personality, with hypomanic and histrionic traits. We present some ignored aspects of his life based on the discovery of personal letters which illuminate the hidden side of this famous neurologist. © 2010 Movement Disorder Society     

Histoire d’une biographie,celle consacrée à Georges Gilles de la Tourette

This article reports on the author's experience of preparing his biography of the neuropsychiatrist Georges Gilles de la Tourette, a student of Jean-Martin Charcot at La Salpêtrière Hospital. Covering the biography's earliest origins to its final book form, the author explains how he conducted his historiographical research, then went through the long and complex proceedings with his publisher, Oxford University Press in New York. He hopes to share and inspire, or provide help to anyone interested in writing a historical biography of a scientist.     

Freud and the diagnosis of Gilles de la Tourette's illness

A number of observers recently have taken Freud to task for failing to have diagnosed both Frau Emmy von N.'s (1888-9) involuntary ticcing and vocalizations and Daniel Paul Schreber's (1911) coprolalia and convulsive tics as Tourette's syndrome. None of Freud's critics, however, has placed Freud's understanding of motor and vocal tics in historical context. None seems aware of the contests over the classification of tic symptoms in the 1880's and 1890's, nor do they appreciate the extent to which Charcot and Gilles de la Tourette had conceded that motor and vocal tics, as well as coprolalia, could also appear as symptoms of hysteria. By 1893 (when Freud first wrote out his case of Frau Emmy von N.), both Gilles de la Tourette and Charcot had defended themselves against Guinon's claim that conculsive tics were always a symptom of hysteria by distinguishing those tic symptoms that should be classified as "maladie des tics" from those that accompanied hysteria. Yet Charcot and Gilles de la Tourette had agreed by 1890 that tic symptoms were possible outcomes of either maladie des tics or of hysteria. What separated those afflicted with "hysteria", were particular inherited factors and whether or not the patient could be cured of tics and vocalizations. Thus, within Charcotian terms, Freud was hardly obligated to conclude that his ticcing and cursing patients should have been diagnosed with maladie des tics de Gilles de la Tourette.     

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.     

Neurology and photographic illustration in the medical book

The mutual influence between G. B. A. Duchenne (de Boulogne) (1806-1875), who published in 1862 the first known medical books illustrated with photographs, and J.M. Charcot (1825-1893), whose appointment as "Médecin de la Salpêtrière" occurred in the same year, has been of great importance for the history of medical illustration. The development of medical photography at the Salpêtrière has been continuous, absorbing also a stream sprung from another Paris hospital, the H?pital Saint Louis (A. Hardy and A. de Montmeja, 1868). The first Department of Medical Photography was installed by the "Assistance Publique" at the Salpêtrière (1878). The books and journals were for the greater part published by two publishing houses: J. B. Baillière and Delahaye and his successors. Attention is drawn to the fact that the third edition of Duchenne's major work (1872) is no longer illustrated by photographs but contains engravings from those photographs. Other books and articles are illustrated with photographs but one is increasingly confronted with a great number of drawings of engravings made from photographs. The reasons for this change are discussed. It appears that a photograph may serve as an illustration but that for an educational or a research purpose it has another function: to preserve the image to be studied, the authors preferring to sort out the essential information (or what was thought to be so) in the form of drawings or engravings.     

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.     

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.     

Neuropathology in Pitié-Salpêtrière hospital: Past,present and prospect

Pitié and La Salpêtrière, both founded in the17th century, were for long two distinct hospitals until they merged in 1964. The name La Salpêtrière is inherited from the initial purpose of the buildings designed to produce saltpeter for gun powder. But the place was soon transformed into an asylum to shelter the poor and the insane. From the care of this underprivileged population, alienists such as Pinel have paved the way for modern medicine for the mentally ill at the time of the French Revolution. In the second half of the 19th century, Jean-Martin Charcot and his students laid the foundations of modern neurology from the observation of the large population hosted in La Salpêtrière, mostly women with severe chronic diseases. Charcot led clinicopathological studies in almost all the fields of nervous system disorders. His successors (including Raymond, Dejerine, Pierre Marie) maintained the same close relationship between clinical neurology and neuropathology. In parallel with the development of neurosurgery at Pitié hospital, neuropathology first spread through small laboratories attached to clinical departments. The merger of the two hospitals in the early '60s coincided with the creation of a large university hospital in which the care and study of diseases of the nervous system were preponderant. An independent laboratory of neuropathology was created, led by Raymond Escourolle. This period was on the eve of important developments in neuroscience around the world. Today, the Pitié-Salpêtrière neuropathology laboratory still plays a central role between neurology and neurosurgery clinics and major research institutes such as the Brain Institute, callled Institut du Cerveau et de la Moelle (ICM), and the Institute of Myology.     

Jean-Martin Charcot. 1825 to 1893

During the 31 years of his working life, Jean-Martin Charcot built up an exceptional career in Salpétrière hospital, and was a pioneer in different fields. He developed an organized teaching and research centre, contributed to increase the medical knowledge with a systematic use of physiology and pathology besides a rigorous clinical analysis, he founded geriatry and neurology and finally tried to create a scientific psychological approach for hysteria.     

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.     

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.     

Gilles de la Tourette: The man behind the syndrome

French neuropsychiatrist Georges Gilles de la Tourette first described in 1885 the “Maladie des Tics” which earned him eponymous fame. Both his colleagues at La Salpêtrière hospital in Paris and medical historians report that he was a highly intelligent, if irascible, character. The Gilles de la Tourette syndrome was only a very minor contribution of its author, at the time. Gilles de la Tourette's main and continued contributions were on hysteria and hypnotism. This article concentrates on his life and includes previously untranslated passages from authors of the time and, for the first time, a full English translation of his obituary written by Henry Meige.     

Victor Dumontpallier (1826–1899) et l’hystérie,ou l’infortune d’un plagiaire mystifié

Victor Dumontpallier (1826–1899) was a contemporary of Jean-Martin Charcot. Both of them, along with Jules Luys, were chosen by Claude Bernard, on behalf of the French Academy of Medicine, to perform an expert assessment of Victor Burq's work on treatments for hysterical anaesthesia and paralysis involving the application of metal plates to desensitized areas. From that point forward, Dumontpallier gave up his earlier work, focused on gynecology, turning instead to hysteria and, especially, hypnotism. With the goal of out-doing Charcot and his lessons at La Salpêtrière, he opened his teachings not only to students and physicians but also to the public, which was fascinated by mysteries and the supernatural. With the help of two students, Paul Magnin and Edgar Bérillon, he imagined that he had discovered a special force in the human body, the “force neurique rayonnante” (radiating neuric force), which caused hypnosis. He supported spectacular research claims, e.g. “the functional independence of the cerebral hemispheres”. This scientific catastrophe shows how Charcot's fame led some of his Parisian colleagues to try to outdo him with phantasmagoria, tarnishing their reputations. They may have copied appearances, but they did not possess Charcot's knowledge.     

Tics: from Itard to the neuroleptics

When the six DSM-III (1980) diagnostic criteria are applied to the nine cases reported by Gilles de la Tourette in 1885, six of them are found to be in accordance with the diagnosis of Gilles de la Tourette's syndrome (cases nos 4, 5 and 7 do not involve vocal tics). Gilles de la Tourette deserves credit, not only for having regrouped fragmented observations into one remarkably well described clinical entity which held over time (such as Itard's observations nos 9 and 10 in 1825; the latter is the famous Marquise of D ... seen several times by Charcot and the only one which, along with no 1, appears in Gilles de la Tourette's paper), but also for having described the course of this chronic and fluctuating disease. Why Gilles de la Tourette did not use the term "tic", a term which had been in use for a long time in both veterinary and human medicine, to describe "the motor incoordination" of these patients? Did Charcot take some distance from his student's paper as early as 1885? He viewed tics as the basis of "the disease described by Gilles de la Tourette". In addition to coprolalia and echolalia, he alsa reported the existence of "mental tics". How have French neurologists and psychiatrists been able to perpetuate Brissaud's error who, contrary to Gilles de la Tourette, mentioned that the illness "can be associated with severe mental disorders which often lead to dementia"?(ABSTRACT TRUNCATED AT 250 WORDS)     

Charcot on Parkinson's disease

Charcot saluted Parkinson for his early observations, but condemned his use of the term "paralysis agitans." He emphasized that patients were neither dramatically weak nor were they necessarily plagued with tremor. Charcot suggested the name "Parkinson's disease," although he could not resist the comment in his amphitheater lecture series at the Salpêtrière that French physicians (unnamed) had probably described the disorder before 1817. Tremor, rigidity, postural instability, and bradykinesia were all recognized by Charcot. He classified the disorder as a "névrose," meaning a neurologic disorder without a known pathologic lesion, and found little benefit from therapies available at the time, including belladonna and ergot products.     

Multiple sclerosis From Charcot and Vulpian to the present time

The present paper reports the isolation of multiple sclerosis and the evolution of ideas about this disease since the end of the 19th century. Charcot and Vulpian were close friends during their university years and both were appointed physicians at the Salpêtrière in 1862. It is difficult to sort each other part in the beginning of researches which both devoted to "tremors". When Vulpian left the Salpêtrière in 1865 the main point was settled: a clear cut distinction between paralysis agitans vs patients whose tremor appeared during movement and in whom post-mortem had disclosed disseminated lesions "en plaques". For the 20 ensuing years Charcot built up an impressive corpus of pathological and clinical data which were the basis of his celebrated "Le?ons". This history shows the pathological clinical method at ist acme in the hands of a physician of genius. Pathogenetic hypotheses, from vascular to toxic and infectious, the role of immunological, genetic and viral factors are also briefly reviewed.