Neurology and Literature, 1860–1920 by Anne Stiles (ed.)

Abstract

Research from many perspectives has been made on the work of the French neurologist, J.‐M. Charcot (1825–1893) with particular reference to his fame for his studies and “construction”; of hysteria. What has not been demonstrated so far is the extent to which Charcot's construction can be explained by the perceived relationship between hysteria and epilepsy and Charcot's access to epileptic patients at La Salpêtrière. From the confusion that reigned concerning hysteria and epilepsy, both separately and in relation to each other, Charcot claimed to have isolated hysteria as a distinctive and universal pathology. This claim was partly based on the “grande attaque”;, representing the most intense degree of hysteria. A comparison with Gowers, the contemporary English neurologist suggests that diagnosis was the function of the practitioners’ preferences; and a linguistic analysis pinpoints Charcot's problems in describing an isolated pathology in terms of its relation to its neighbour, epilepsy.     

Charcot and Les névroses traumatiques: scientific and historical reflections

Between 1878 and 1893, Jean-Martin Charcot published over twenty detailed case histories dealing with what he termed 'traumatic hysteria' and what today would be labelled the psychoneurology of trauma. Charcot's cases record a highly diverse clinique tableau of symptoms. Etiologically, Charcot posited a dual model of a hereditary diathèse, or constitutional predilection to nervous degeneration, and an environmental agent provocateur. Increasingly during the 1880s, he emphasized the role of 'psychical shock'. These writings of Charcot also exhibit many of the same, superb clinical qualities that distinguish his work on other medical topics. Charcot isolated several hystero-traumatic formations and provided outstanding clinical depictions of subgenres of the disorder, most notably brachial monoplegias. His clinical demonstrations of the differential diagnosis of organic and functional post-traumatic pathologies represent Charcot the virtuoso neurologist at his finest. Taken together, these writings offer a penetrating exploration of the complex and elaborate functional sequelae of minor bodily injury and the phenomenon of traumatic psychogenic somatic symptom-formation. The revival today of medical interest in psycho-traumatic pathology, including the traumatic origins of certain dissociative states, provides an important context for the renewed appreciation of Charcot's work in this area.     

Charcot and aphasia

Whereas the beginning part of Charcot's career was occupied with a rigorous and unerring devotion to the anatomo-clinical method, his later career shared attention with physiologic and psychological analyses of hysteria. The seeming paradox between these differing approaches to neurologic study can be better understood by an analysis of Charcot's work on aphasia. This area of study grew out of Charcot's larger research effort on cerebral localization, but was not well known, because most of his lectures on aphasia were never widely published or distributed in either French or English. In analyzing aphasia, Charcot began with anatomic lesions, but gradually incorporated cases of hysterical aphasia, as evidence of dynamic lesions of the same brain areas. Although aphasia never represented a prominent area of study for Charcot, it held a particularly important place in his career first because it provided this transition between anatomic and physiologic approaches to neurologic research, and second because it permitted a natural two-way passage between the topics of cerebral localization and hysteria.     

Hysteria behind the scenes: Jane Avril at the Salpetriere

Jane Avril (1868-1943), the famous dancer of the Moulin Rouge, immortalized by Toulouse-Lautrec, left behind published Memoires (1933). Trustworthy and written with verve, they include an account of her admission to Charcot's service at the Salpetriere in December 1882. There she was kept until June 1884, not so much because of illness but to protect her from her mother's abuse. Jane Avril provides unvarnished testimony of the daily life of the women with hysteria among whom she lived. She wrongly accuses them of simulation. But she accurately portrays the rivalry of the 'crazy girls' who vied to become the center of attention, and she sheds light on the factors that came together to make hysteria contagious (she herself escaped), the loading of symptomatology and the cultivation of the ailment. Charcot has been criticized on this score, since he showed his recognition of the underlying process when he pronounced isolation to be necessary to treatment. If Charcot accommodated hysteria, the ailment amply rewarded him with a fame that continues to this day to overshadow his achievement in neuropathology that he brilliantly forged using the "anatomo-clinical method."     

Charcot in contemporary literature

Charcot and his medical observations remain an enduring topic of scientific study in neurology, but he is also the topic of modern literary works. This essay examines the depiction of Jean-Martin Charcot (1825-1893) as a character in late-twentieth-century literature as an index of the contemporary nonmedical literary public's interest in neurology and Charcot. It focuses on three contemporary works that involve Charcot as a central figure with comparison between primary source documents and the rendered context, character development, and plot lines of these literary works. The two French novels [Slumbers of Indiscretion and Dr. Charcot of the Salpêtrière] and one American play [Augustine (Big Hysteria)] approach Charcot and neurology with differing levels of historical accuracy. All create a figure of authority, each with a different coloration of the balance between power and its abuse. Two focus almost exclusively on his work with hysteria and inaccurately amplify Charcot's concern with symbolic sexual conflict as the origin of hysteria and fictionalize more extensive interactions with Freud than historical documents support. The three works demonstrate that Charcot retains an enduring fascination with an enigmatic personality, a controversial career, and a pivotal role in the development of studies involving the brain and behavior. Neurologists should not look to these works as replacements for more seriously composed historical studies, but as enrichments anchored in the imaginative possibilities of Charcot and his fin de siècle era.     

A perplexing document in the early history of Gilles de la Tourette Syndrome: Melotti's rendition of a "Lecture of Charcot" (including a complete translation from the Italian with commentary)

In 1885, Dr. Guilio Melotti published an Italian translation of a lecture on "Convulsive Tics with Coprolalia and Echolalia" given by Jean-Martin Charcot. Although this lecture often has been cited as an authoritative statement of Charcot's view, until now it has not been translated into English. The lecture presents a number of statements that appear nowhere else in Charcot's published corpus, including some that seem to contradict Charcot's other pronouncements on maladie des tics. Although the Melotti-Charcot lecture may portray Charcot's position accurately in many passages, the article most likely is a compilation from a variety of sources.     

Making distinctions: the contribution of Hector Landouzy to differential diagnosis in relation to hysteria and epilepsy

Hector Landouzy (1818-1864) is known for his Traité Complet de l'Hystérie (1846), which was crowned by the Académie de Médecine, but this work is not given much importance in historical accounts. It deserves more attention because it was more than an orthodox statement about the nature of hysteria. In the context of the diagnostic confusion between epilepsy and hysteria, it introduced a method of presenting criteria to facilitate diagnosis. An examination of French authors on epilepsy and hysteria in the second half of the nineteenth century suggests that this method probably set the example which was to be followed by later clinicians, including Charcot at the Salpêtrière.     

Making Distinctions: The Contribution of Hector Landouzy to Differential Diagnosis in Relation to Hysteria and Epilepsy

Hector Landouzy (1818-1864) is known for his Traité Complet de l'Hystérie (1846), which was crowned by the Académie de Médecine, but this work is not given much importance in historical accounts. It deserves more attention because it was more than an orthodox statement about the nature of hysteria. In the context of the diagnostic confusion between epilepsy and hysteria, it introduced a method of presenting criteria to facilitate diagnosis. An examination of French authors on epilepsy and hysteria in the second half of the nineteenth century suggests that this method probably set the example which was to be followed by later clinicians, including Charcot at the Salpêtrière.     

Pierre Marie: gifted intellect,poor timing and unchecked emotionality

Pierre Marie was a prominent member of the French neurological world of the early twentieth century. Having been trained by the celebrated physician, J-M Charcot, Marie remained influenced by his teacher throughout his career. Because of this influence, his career can be logically divided into three phases: first, the early years under the direct mentorship of Charcot (1878-1893); secondly, the aftermath of Charcot's death when Marie left his teacher's institution, the Salpêtrière hospital and established himself at the Bicêtre hospital in southern Paris (1893-1918); and finally, Marie's return to the Salpêtrière to assume the original Charcot chaired professorship, albeit as an aged man (1918-1925). This essay examines Marie's career with an emphasis on documentation of the combined attributes of a gifted intellect as well as a heated emotionality. In the context of his time, these elements prompted Marie to enter into controversies and medico-political battles that advanced neurological knowledge, but likely disadvantaged him in his career successes.     

About Medicine and the Arts Charcot and French Literature at the fin-de-siècle

The relationship between medicine and the arts, literature in particular, has many aspects. One of the most obvious relations is the use of literature as a source for historical studies. Jean-Martin Charcot and his school often appear in French literature at the end of the 19th century. Several aspects will be highlighted in this study, including (1) the ideas about degenerative diseases in the work of Emile Zola, the main author of the naturalistic movement; (2) decadence and spiritism in two transitional novels by Joris Karl Huysmans, who, once supporter of the naturalistic movement, changed his ideas following observations of disease and cure that could not be explained in a scientific way. Charcots work on hysteria and hypnosis, as well as Brown-Séquards rejuvenation experiments with testicular extracts played an important role with this respect; (3) Charcots relationship with the Daudets, in particular his treatment of Alphonses tabes dorsalis and the ambivalent attitude of his son Léon Daudet towards Charcot; (4) the influence of the lectures at the Salptrire on the work of Guy de Maupassant, who attended the lessons in the mid-1880s. The reading of novels and biographies of these authors provides a part of the social context and the cultural atmosphere in Paris at the “fin-de-siècle” when Charcot and his school played an important role in medicine. Moreover, it shows the influence of medicine and science on society as recorded by writers.     

Pierre Marie: Gifted Intellect,Poor Timing and Unchecked Emotionality

Pierre Marie was a prominent member of the French neurological world of the early twentieth century. Having been trained by the celebrated physician, J-M Charcot, Marie remained influenced by his teacher throughout his career. Because of this influence, his career can be logically divided into three phases: first, the early years under the direct mentorship of Charcot (1878-1893); secondly, the aftermath of Charcot’s death when Marie left his teacher’s institution, the Salpêtrière hospital and established himself at the Bicêtre hospital in southern Paris (1893-1918); and finally, Marie’s return to the Salpêtrière to assume the original Charcot chaired professorship, albeit as an aged man (1918-1925). This essay examines Marie’s career with an emphasis on documentation of the combined attributes of a gifted intellect as well as a heated emotionality. In the context of his time, these elements prompted Marie to enter into controversies and medico-political battles that advanced neurological knowledge, but likely disadvantaged him in his career successes.     

Hallucinations and pathological visual perceptions in Maupassant's fantastical short stories--a neurological approach

Maupassant excelled as a realist writer of the nineteenth century, with fantastical short stories being an outstanding example of his literary genius. We have analysed four of his fantastical stories from a neurological point of view. In "Le Horla," his masterpiece, we have found nightmares, sleep paralysis, a hemianopic pattern of loss and recovery of vision, and palinopsia. In "Qui sait" and in "La main" there is also an illusory movement of the objects in the visual field, although in a dreamlike complex pattern. In "Lui," autoscopy and hypnagogic hallucinations emerge as fantastical key elements. The writer suffered from severe migraine and neurosyphilis involving the optic nerve, which led to his death by general paralysis of the insane (GPI). Visual loss and visual hallucinations affected the author in his last years, before a delirant state confined him to a nursing home. Our original hypothesis, which stated that he could have translated his sensorial experiences coming from this source to his works, had to be revised by analyzing some of his earliest works, notably "Le Docteur Héraclius Gloss" and "La main d'écorché" (1875). We found hallucinatory symptoms, adopting the form of autoscopy and other elaborated visual misperceptions, in stories written at age 25, when Maupassant was allegedly healthy. Therefore, we hypothesize that they may be related to his hypersensitive disposition, assuming that no pathology is necessary to experience such vivid experiences. In addition, Maupassant's abuse of drugs, as illustrated in "Rêves," could have provided an additional element to outline his painstaking visual depictions. All these factors, in addition to his up-to-date neurological knowledge and attendance at Charcot's lectures at "La Salpêtrière," armed the author for repetitive and enriched hallucinatory experiences, which were transferred relentlessly into his works from the beginning of his career.     

George Sigerson: Charcot's translator

Senator George Sigerson (1836-1925), Dublin's first neurologist, was also a significant contributor to Anglo-Irish literature. His medical career and literary accomplishments are outlined, the focus of the article being Sigerson's friendly relationship with Charcot (with whom he corresponded), and whose Le?ons sur les maladies du système nerveux he translated.     

The role of Herman Hoppe of Cincinnati in the initial clinical recognition of myasthenia gravis

One of the earliest papers describing a case of what came to be known as myasthenia gravis was written in 1892 in the German language by an American, Herman Hoppe, who at the time was an assistant in the Berlin polyclinic of the prominent German neurologist. Hermann Oppenheim. At Oppenheim's instigation, Hoppe published the pathology of a case that Oppenheim had diagnosed during life; he collected all the reported similar cases and tried to establish a symptom-complex, for which he was given credit in Oppenheim's great neurology textbook of 1894. Upon his return to Cincinnati, Ohio, Hoppe's European experience qualified him as a specialist in nervous and mental diseases. His private practice of "neuropsychiatry" was his main occupation, but he also volunteered to teach as Professor of Nervous and Mental Diseases at the University of Cincinnati. In 1901 Oppenheim published the first monograph about what he called "Die Myasthenische Paralyse (Bulbarparalyse ohne anatomischen Befund)", summarizing 60 cases described in the medical literature up to that time. Hoppe, on the other hand, wrote on myasthenia gravis only once again, a review article in 1914 in a Cincinnati weekly, giving Oppenheim credit for the establishment of the disease as a clinical entity.     

George Sigerson: Charcot's translator*

Abstract

Senator George Sigerson (1836–1925), Dublin's first neurologist, was also a significant contributor to Anglo‐Irish literature. His medical career and literary accomplishments are outlined, the focus of the article being Sigerson's friendly relationship with Charcot (with whom he corresponded), and whose Leçons sur les maladies du système nerveux he translated.     

Did Herbert Spencer have reading epilepsy?

Herbert Spencer, the nineteenth-century philosopher, has frequently been dismissed as a "fantastical hypochondriac" (as his most recent biographer, Mark Francis, terms him). Yet he left a record in his Autobiography of symptoms that suggest a very different diagnosis. Abruptly at age 35, he found that the activity of reading, previously indulged in without difficulty, triggered paroxysmal episodes of disturbing "head-sensations" including "giddiness" (so Spencer described them); these severely curtailed his ability to carry out his philosophical studies. Of all possible explanations for such episodes, none seems as likely as reading epilepsy. Enduring preconceptions about Spencer's presumed neurosesmay have kept modern historians from appreciating that Spencer suffered from a legitimate, if esoteric, neurological malady.     

The psychiatric works of Emil Kraepelin: a many-faceted story of modern medicine

A new English language edition of some of the major works of Emil Kraepelin (1856-1926), the famous German psychiatrist, appeared in 2002. This essay has been written to mark the occasion. Kraepelin is famous for his psychiatric nosology, specifically the demarcation of dementia praecox (schizophrenia) and manic-depressive insanity (bi-polar disorder). This essay deals not only with these topics but with many other aspects of Kraepelin's psychiatry: his talents as a writer and teacher; his unusual and intense concern with volition; his lack of psychological empathy with his patients, on the one hand, and on the other, his humane care for their physical well-being; his tangled involvement with psychoanalysis; his war on alcohol; his tradition-bound treatment of hysteria; his reflective attempt to understand paranoia; some criticisms of his work; the debate over the role played by his famous diagnostic cards (Z?hlkarten); his misuse of his psychiatric beliefs in the public arena. A conclusion addresses both his shortcomings and his assets.     

Broca and Charcot’s Research on Jacques Inaudi:The Psychological and Anthropological Study of a Mental Calculator

In the nineteenth century, French scientific institutions became interested in young “mental calculators,” arithmetical prodigies able to quickly and accurately perform complex mental calculations. The first scientists to study mental calculators were phrenologists who sought to prove the existence of a calculating organ in the frontal lobe. Paul Broca introduced one such mental calculator, Jacques Inaudi, to the Anthropological Society of Paris in 1880. Broca attributed extraordinary faculty for mental calculation to memory functioning (the psychological hypothesis) rather than physiological difference (the phrenological hypothesis). In 1892, prominent French Academy of Sciences member Jean-Martin Charcot produced a noteworthy study of Inaudi on the organization’s behalf. Charcot observed that Inaudi called upon auditory memory rather than visual memory in his mental calculations, unlike most mental calculators who preceded him. Like Broca, Charcot was skeptical of the phrenological hypothesis, though he noted that Inaudi’s skull was markedly plagiocephalic. Interestingly, anthropological examination of Inaudi is consistent with the themes of modern cognitive neuroscience. Thus, Charcot seems to have anticipated present research on the localization of mental calculation and memory for numbers.     

The Idea of Epilepsy as a Disease Per Se

In the 1850s Delasiauve and Russell Reynolds independently introduced the idea that the previously more inclusive concept of “epilepsy” should be restricted to that of an idiopathic disease manifesting epileptic seizures not caused by detectable brain pathology. This idea was rather widely accepted, though with some modification, over much of the next century. However there was increasing opposition to the idea from those, including John Hughlings Jackson, who perceived that all epileptic seizures must be symptoms of underlying brain disease. With increasing identification of structural brain pathology in what had been regarded as instances of idiopathic epilepsy, the latter view has increasingly prevailed.