Jean-Martin Charcot and the epilepsy/hysteria relationship

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 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with symbolic sexual conflict as the origin of hysteria and fictionalize more extensive interactions with Freud than historical documents support.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.     

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."     

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.     

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.     

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.     

Brown-Séquard and cerebral localization as illustrated by his ideas on aphasia

Brown-Séquard's concept of localization was built on the phenomena of inhibition and dynamogenesis, constituting a dynamic system in which reflex mechanisms, that played a part not only in the spinal cord but in the brain as well, were considered of particular importance. The use of this concept is considered in Brown-Séquard's discussion of the subject of cerebral localization, and especially of aphasia. The origin and development of Brown-Séquard's ideas on aphasia from 1861 onwards are discussed, as is the part he possibly played in the transfer of knowledge from Paris to London (Broca and Jackson). In the 1870's Brown-Séquard debated on cerebral localization with Charcot before the Société de Biologie. Opposing the cluster theory of localization, Brown-Séquard developed the theory of "réseau de cellules anastomosées", a kind of network theory in which scattered cells subserving the same function are connected by nerve fibers. This was to him a plausible theory, with which he was able to explain the fact that damage in several locations may produce the same effect, and, to account for observations that some functions remain unimpaired despite extensive brain-injury. Although Brown-Séquard's arguments were not always valid, because they were based on imprecise observations, his dynamic model, nowadays, seems valuable. He influenced "anti-localizers" such as Goltz, but also Jackson and probably Von Monakow and Sherrington.     

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.     

Biological and Epistemological Models of Localization in the Nineteenth Century: From Gall to Charcot

In the latter half of the nineteenth century, the localizationist doctrines became closely associated with the memory trace paradigm. The analysis of the texts dealing with the localization and the nature of ‘the loss of articulated speech’ (motor aphasia) by Bouillaud, Lordat, Dax, Broca, Trousseau, Baillarger, Charcot and Wernicke shows how the biological paradigm of localization presented by Gall and based on the notion of organ-function correspondence was transformed into a model based on localizable memory traces. This change resulted in the theoretical unification of the mechanisms of motor and non-motor forms of aphasia. These forms, which the earlier authors tended to separate in their analyses of the underlying mechanisms, were now regarded as involving similar mechanisms related to the loss of mnestic images. The crucial step in this development was taken by Broca who presented the hypothesis that the faculty of coordination of speech movements, which according to his predecessors was the faculty lost in motor aphasia, was actually an intellectual faculty and a specific form of memory, and motor aphasia consequently a selective kind of amnesia. Theorists like Charcot and Wernicke generalized this idea into a comprehensive theory of the nature of localization based on the notion of memory traces. Thus, the localization of function was reduced to the localization of representations. Instead of biological paradigms, this model of localization is rooted in the epistemological tradition of psychology represented by Locke and Condillac, who were primarily interested in the problem of representation. In physiology, this approach usually resulted in attempts at localizing representations instead of functions.     

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.     

On the life and work of Korbinian Brodmann (1868–1918)

This study describes the life and work of early-twentieth-century German scientist Korbinian Brodmann (1868–1918). His medical training at universities in Munich, Würzburg, Berlin, and Freiburg and his further education are illustrated. His early Leipzig career and cooperation with brain researchers Oskar and Cécile Vogt in Berlin are portrayed, as are his contributions to a localization theory of the cerebral cortex—namely, Brodmann’s cytoarchitectonic approach—and the invention of a cortex area nomenclature, further developed until the beginning of World War I. His Tübingen professorship and being nominated to manage a major department of Emil Kraepelin’s Munich research unit represent further aspects of this study, a promising career ahead, harshly interrupted by an early and unexpected death.     

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.     

Localization of Language Function in the Twentieth Century

In the twentieth century the method of identifying pathology in patients with aphasia has fluctuated between localizing and holistic theories. The practical localization of sensation and voluntary movement became a clinical commonplace in the beginning of the century, but the mental component of aphasia made its localization controversial. In Paris before the war, Pierre Marie made the localization of aphasia the centerpiece of his personal feud with Jules Dejerine. After the war Konstantin von Monakow used the phenomenon of recovery from aphasia to support his holistic views of localization. Henry Head, in a 1926 study that remains influential today, took a neo-Jacksonian approach to localization and the physiology of language. Kurt Goldstein led the postwar anti-localizationists, asserting that physicians must look after the whole person and that brain function was inherently unified. Norman Geschwind reflected 1960s physiological thought in analyzing aphasia as a type of disconnection of distinct functional areas. In the twenty-first century the localization of aphasia remains dependent on theory, with competition between holistic and localizing ideas.     

The development and evolution of “cerebral thermometry”: Clinical applications of a nineteenth-century approach to cerebral localization and neurological diagnosis

ABSTRACT

Surface thermometers were developed in the latter half of the nineteenth century. In 1877, Broca, already famous for his contributions to the cerebral localization of nonfluent aphasia, presented his first clinical observations on cranial surface temperatures: In two cases, cranial surface temperatures were decreased over a middle cerebral artery infarction, and increased in surrounding areas, which Broca attributed to “compensatory hyperaemia.” As Broca made apparent in a later report in 1879, he had used a “thermometric crown,” an apparatus consisting of six to eight large-reservoir mercury thermometers strapped against the head. Following Broca’s report, American neurologists reported cases in which cranial surface temperatures were increased either locally over a superficial brain tumor or globally with a cerebral abscess. Despite promising anecdotal reports, contemporaries recognized that significant technical and practical problems limited its accuracy, reliability, and clinical utility. Advocates never demonstrated that this technology provided significant marginal benefit to the medical history and physical examination. The technique fell out of fashion before 1900, though some early advocates promoted it into the early twentieth century. It was ultimately replaced by more effective technologies for cerebral localization and neurological diagnosis.     

The validity of Barlow's 1877 case of acquired childhood aphasia: case notes versus published reports

In 1877, Barlow described a ten-year-old boy with right hemiplegia and aphasia, quick recovery of language function, and subsequent left hemiplegia and aphasia, who was shown to have symmetrical left and right Broca's area lesions at autopsy. The report of this case motivated many writers in the second half of the nineteenth century to develop theories on localization, laterality, equipotentiality and development of specialization, recovery of function, and the role of the right hemisphere (see Finger et al., 2003, for review). This paper presents an analysis of the original archived case notes that have recently come to light. Examination reveals discrepancies in significant details of the history of the case and raises questions about the degree of impairment and recovery throughout his illness as reported in the published article. Consideration of these differences between the presentation of the case in the British Medical Journal publication and the documentation in the original patient records raises issues about the validity of this case as evidence for the many arguments it was to support that have persisted to the present.     

Dr. Gottlieb Burckhardt the Pioneer of Psychosurgery

The first attempt at psychosurgeryintentional damage to the intact brain for the relief of mental illness–was undertaken in 1888 by the Swiss psychiatrist Gottlieb Burckhardt. Six chronic schizophrenic patients underwent localized cerebral cortical excisions. Most patients showed improvement and became easier to manage, although one died from the procedure and several had aphasia or seizures. Burckhardt, a learned neuropsychiatrist, presented his results in 1890 and in 1891 published his scientific rationale and detailed clinical outcome in a scholarly paper. Nevertheless his approach had shocked the medical community as reckless and irresponsible. Burckhardt was ridiculed, his academic endeavors ceased and his surgical endeavor largely ignored. Nevertheless he continued practice as a fine psychiatrist and mental hospital director. Burckhardts career and interesting ideas on higher cerebral functions are reviewed and placed in perspective regarding the development of “modern” psychosurgery almost one-half century later.     

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.     

Hermann Oppenheim's observations about music in aphasia

Hermann Oppenheim was influential in many areas of neurology, but his ideas about music are relatively unknown. In 1888, he published a paper that outlined how the assessment of music skills in patients with aphasia could lead to a better understanding of aphasia and language. Oppenheim conducted the first comprehensive music assessment as part of a neurologic examination and presented the first case series of music in aphasia. His paper was widely cited and had significant influence over the next 30 years. Although largely unrecognized as such, Oppenheim was an important historical figure in the study of music and neurology.