Jean-Martin Charcot (1825–1893): a Treatment Approach Gone Astray?

H i s t o r i c a l N o t e Eur Neurol 2017;78:296–306 Received: July 13, 2017 DOI: 10.1159/000481940 Accepted: October 3, 2017 Published online: October 20, 2017 Jean-Martin Charcot (1825–1893): A Treatment Approach Gone Astray? Olivier Walusinski P r i v a t e P r a c t i c e , B r o u , F r a n c e K e y w o r d s “ To the joy of believing, he preferred the Jean-Martin Charcot · Paul Richer · Fulgence Raymond · intoxication of knowing” [1]. History of neurology · Tabes · Parkinson’s disease · Hysteria · Vibratory medicine · Suspension technique · Jean-Martin Charcot (1825–1893) epitomises the Metallotherapy · Moral treatment 19th-century Parisian hospital physician who successful- ly combined clinical practice, teaching and research ( Fig. 1 ). In his day, neurological nosography was develop- A b s t r a c t ing and gaining in precision; clinical practices were grow- Jean-Martin Charcot’s reputation remains that of a physi- ing more rationally founded and sophisticated. Treat- cian who took little interest in treatments for the neuro- ment, however, was little more than the “poor relation” logical diseases he did much to identify. After reviewing of these developments. the limited number of medicinal remedies of slight effec- Leon Daudet (1867–1942), an embittered ancient pu- tiveness at Charcot’s disposal, we analyze in this review pil, portrayed Charcot this way in 1922, near to 30 years the numerous therapeutic tests that he conducted: vibra- after the death of the Master: tory medicine for Parkinson’s disease, treatment of tabes by suspension technique, metallotherapy and moral A brilliant clinician, Charcot was totally unconcerned with treatment for hysteria. Understanding that he fully and healing and curing, or even treating. Therapeutic medicine was of completely adhered to the far-reaching heredity-based little interest to him; his prescriptions were generally limited to a few basic rules of hygiene, together with bromide, chloral and theories of his day makes it possible to perceive his natu- sending patients to Lamalou (i.e., spa town) [2] . ral and fundamental pessimism. By drawing on both ancestral traditions and innovative approaches, Charcot On the other hand, Fulgence Raymond (1844–1910), “combined genius with charlatanism” in a surprising way: Charcot’s successor and admirer, had this to say: he demonstrated genius in the area of nosology, and a sort of charlatanism in the area of treatments. © 2017 S. Karger AG, Basel All translations provided by the author. © 2017 S. Karger AG, Basel Olivier Walusinski Private Practice 20 rue de Chartres E-Mail [email protected] FR–28160 Brou (France) www.karger.com/ene E-Mail walusinski @ baillement.com and olivier @ walusinski.com Downloaded by: 78.236.141.68 - 10/26/2017 6:58:52 PM tic efficacy for these diseases, but there is still a lack of curative treatments, 125 years after his death. This observation can be seen as a response to the question Charcot himself posed in writing the introduction to his lesson on “diseases of the elderly”: “Do you cure more patients now than were cured in the past?” [5] . Expectant Treatment On April 17, 1857, Charcot, a young physician work- ing in the Central Office of the Paris hospitals, presented his thesis for the agrégation exam (to become an associate professor). Its title – De l’expectation en médecine – indi- cates Charcot’s expectant approach, from which his scepticism about the therapeutic means available to him can be inferred: “Daily observation demonstrates that animal economies are very often adequate for remedying disor- ders and recovering their health through the regular ex- ercise of their functions” [6] . Charcot, drawing inspira- Fig. 1. Only known photo of Charcot examining a patient, around tion from the disquisition of Ignace-Vincent Voullonne 1875 (albumen print mounted on card. Author’s personal collec- (1755–1807) [7] , concluded his thesis this way: “The ex- tion). pectant approach generally applies to diseases, and their circumstances, in which active methods would be useless, ineffective or harmful.” He fails this first competitive ex- Charcot has been misrepresented as having neglected, as a mat- ter of principle, therapeutic treatment, and some have even denied amination. Was his approach considered too archaic? he had the skills necessary for the art of healing. What a fundamen- “Some diseases are extremely benign, others are incur- tal error, what profound injustice! [...]. He tacitly resigned himself able; there are diseases that respond to medicines, as well to being powerless when dealing with organic diseases, whose le- as diseases for which a cure would be dangerous.” Char- sions, too often irreversible, he had come to know better than any- cot thus took up the refrain of a Montpellier physician one else; to me this is not only wise, but proof of the utmost hon- esty [...]. But when we consult his writings on the treatment of writing a century before him, Dominique Raymond hysteria, which is a purely dynamic affection, we find not the (1686–1765) [8] , and presented no novel ideas of his own, slightest trace of this scepticism; what we find, in fact, is exactly the which his jury apparently judged harshly. opposite. We see him employing the most diverse methods, and not in any way disdaining those resources of real efficacy handed down by empiricism, but rather bringing the clearest rationalism to bear upon their application [3] . T r e a t m e n t s U s e d This hagiographic account calls for a more critical Examples from articles Charcot published and from view, like that of Edmond de Goncourt (1822–1896), a his well-known Leçons du Mardi [9] give us an idea of the former admirer rejected: “What is curious in Charcot’s “conventional” treatments he regularly recommended. scientific activities is that he combined genius with char- In 1862, Charcot and Alfred Vulpian (1826–1887) re- latanism” [4] . ported on their silver nitrate experiments for treating progressive locomotor ataxia, following the test per- formed by Karl August Wunderlich (1815–1877) in E f f i c a c y Leipzig: “In all of our observations, improvement was marked and indisputable during the period in which the Charcot is credited to have given an accurate depiction medication was used.” Pleased at bringing about im- of several important diseases, such as multiple sclerosis, provement in a pathology considered incurable, they amyotrophic lateral sclerosis and Parkinson’s disease. overlooked the need to understand how the medicine ac- Since his time, recent advances have improved therapeu- tually worked: “the empirical observation of facts is more Jean-Martin Charcot, Therapist Eur Neurol 2017;78:296–306 297 DOI: 10.1159/000481940 Downloaded by: 78.236.141.68 - 10/26/2017 6:58:52 PM important than any other element” [10] . In the same vein, Charcot recommended, in 1862, high doses of sodium bicarbonate to curb acute rheumatoid arthritis of the joints [11] . Nevertheless, he paid attention to the side-effects of the medications he prescribed. For example, in 1864, he Color version available online noted the sexual impotence that could result with pro- longed use of arsenic [12] , and in 1877, he warned against the risk of coma following the use of opiates for uraemia (“kidney atrophy”) [13] . In his Tuesday lesson of November 15, 1887, Charcot presented the case of a patient with “syphilis, progressive locomotor ataxia, and facial paralysis.” After questioning the patient, Charcot noted “marriage between blood rela- tions” with 5 cases of facial paralysis: “As for all nervous affections, such as chorea and ataxic tabes, here we have the question of heredity – this is the conclusion I have reached.” Despite his respect for Alfred Fournier (1832– 1924), who in 1875 attributed the aetiology of tabes and general paralysis to syphilis, Charcot made the following statement: “I do not believe syphilis to be the cause of all of the accidents which I have presented to you.” Later in this same lesson, Charcot proposed the following treatment, in front of the patient: Allow me to say that we do not have a wealth of therapeutic agents to treat his disease. However, this is not a reason to do noth- ing; we will give him ergoty rye, apply hot cauters (cautery irons) to his back, he will take silver nitrate and zinc sulfate (the effect of these medications is uncertain) – we will do what we can, but it is Fig. 2. A hand-written prescription, which Charcot addressed to a not by attempting to cure in all circumstances that a physician best Dr. Seguin for treatment of Parkinson’s disease (copyright Biblio- serves his patients [9] . thèque Charcot. BUPMC, with kind permission). On Tuesday, July 10, 1888, Charcot re-examined a patient he had already seen and whom he had sent to Ro- main Vigouroux (1831–1895) for treatment of his “ spas- cians favoured at the time, some of them containing modic torticollis .” Charcot explained to his students how coca: élixir d’Yvon 1, Mariani wine used as a tonic, and Joseph Babiński (1857–1932), who was put in charge of Colombo preparations 2 for dyspepsia. As an example, the patient, quickly obtained results: one of the items in the Charcot museum at Hôpital La Salpêtrière is a hand-written prescription, which Char- This required noting the hypertrophy of the sternocleidomas- cot addressed to a Dr. Seguin ( Fig. 2 ) for treatment of toid muscle and also the atrophy of the corresponding muscle on Parkinson’s disease: the opposite side; in addition, it required imagining or, if you will, guessing that faradisation should only affect the atrophied side, so (1) Take immediately after each meal: one granule of hyoscya- as not to have any effect on the hypertrophied muscle [9] .

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