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 Previously unpublished drawings emphasize Charcot's talents in caricature, including autoderision.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.     

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 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.     

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 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.     

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.     

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.     

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.     

Charcot's son, commander Jean-Baptiste Charcot: from neurology to "Pourquoi Pas?"

Charcot name became very famous around the world, firstly because of the work of Professor Jean-Martin Charcot, the founder of Clinical Neurology, and, secondly, because of his son, Jean-Baptiste, the world famous maritime explorer.     

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.     

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.     

Hysteria: the history of an idea

Hysteria has long been recognized as a condition involving multiple somatic symptoms and resulting from a state of the emotions. By the time of Charcot, it became possible to attribute a hysterical symptom to an idea. It appears that the first detailed statement to this effect was made by Russell Reynolds (1) and it was adopted by Charcot (2), particularly because of his experience that hypnosis could be used to suggest hysterical symptoms. These concepts provided the starting point for Freud's theories.     

Pierre Briquet: 19th century savant with 20th century ideas

This paper describes what is known about Briquet's life and character based on obituaries published in medical literature shortly after his death. It reviews his later writings on hysteria and integrates these with the Treatise published in 1859. Finally it summarizes the opinions of his immediate successors such as Charcot, Richer, de la Tourette and Janet; all of whom referred favourably to Briquet in the course of their writings on hysteria.     

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.     

François-Amilcar Aran (1817–1861) and the recognition of spinal muscular atrophy

Jean-Martin Charcot coined the term Duchenne-Aran atrophy. The inversion of names compared to standard practice shows the respect Charcot had for Guillaume Duchenne de Boulogne, who had encouraged him to study nervous disease. Using innovative localised electrification, Duchenne identified various types of muscular atrophy which he distinguished from paralysis. But it was François-Amilcar Aran who, published the observations that he had compiled and studied with Duchenne's help first in 1848 and again in 1850. The result was the seminal articles that led to the eponym “Aran-Duchenne hand”. Focusing on the second half of the nineteenth century in Paris, this article will explore how knowledge evolved around the nosography of different types of muscular atrophy, starting with Duchenne and Aran and then with Charcot and his students, notably Albert Gombault, Joseph Babiński, Fulgence Raymond, and Jean-Baptiste Charcot. This historical overview is accompanied by a biographical account aimed at rescuing Aran from the sea of oblivion and covering the other subjects he wrote about, especially in neurology: including cerebral hydatid disease, skull base fractures and “cancer of the dura mater”.