Neurologists during Wars Tatu L, Bogousslavsky J (eds): War Neurology. Front Neurol Neurosci. Basel, Karger, 2016, vol 38, pp 107–118 (DOI: 10.1159/000442597) French Neurologists during World War I a b c Olivier Walusinski · Laurent Tatu · Julien Bogousslavsky a b Family physician, Brou, and Department of Neuromuscular Diseases and Department of Anatomy, CHRU Besançon, University c of Franche-Comté, Besançon , France; Center for Brain and Nervous System Diseases, Genolier Swiss Medical Network, and Department of Neurology and Neurorehabilitation, Clinique Valmont, Glion/Montreux , Switzerland Abstract ing the Great War, including Charles Foix (1882–1927), The Great War accelerated the development of neurolog- René Cruchet (1875–1959), Georges Guillain (1876– ical knowledge. Many neurological signs and syndromes, 1961), Jean Lhermitte (1877–1959), Clovis Vincent (1879– as well as new nosological entities such as war psycho- 1947), Gustave Roussy (1874–1948), and Paul Sollier neuroses, were described during the conflict. The period (1861–1933). © 2016 S. Karger AG, Basel between 1914 and 1918 was the first time in which many neurologists were concentrated in wartime neurology centres and confronted with a number of neurological patients never seen before. This concentration led to the ‘So many empty seats, dear colleagues, for a first publication of papers concerning all fields of neurological autumn session!’ It was with these words that Au- sciences, and these reports pervaded scientific journals gusta Dejerine-Klumpke (1859–1927) opened the during the conflict and the post-war years. The careers of 5th November 1914 meeting of the Société de French neurologists during the war were highly varied. Neurologie de Paris. ‘More than half of our mem- Some were mobilised, whilst others enlisted voluntarily. bers have joined the Army, heroically ministering They worked as regiment physicians at the front or in war- to the wounded amongst our valiant soldiers and time neurology centres at the front or at the rear. Others freely dispensing their science, their talent, their were academics who were already authoritative names courage, their fraternal devotion, their joyous in the field of neurology. Whilst they were too old to be bravery […]. May every one of them be present officially mobilised, they nevertheless worked in their on the day of their return’ [1] . Augusta Dejerine militarised neurology departments of civil hospitals. We had no idea how long the war would last, how present here the careers of a few French neurologists dur- cruel it would be, or the extent to which it would Downloaded by: Verlag S. KARGER AG, BASEL 172.16.6.1 - 4/13/2016 11:06:53 AM enrich neurological knowledge, as Pierre Marie Neurologists in Militarised Civil Hospitals (1853–1940) foresaw a few months later: ‘The war will have been an inexhaustible source of new The university neurologists in large French cities knowledge for us in the most varied of fields. In were too old to be officially mobilised. However, particular, neurologists must recognise that they most of them continued to serve in the militarised have learned a great deal, in a domain where they neurology departments of large hospitals. Jules had much to discover, that of war neurology’ [2] . Dejerine (1849–1917), Pierre Marie, Achille Numerous papers based on the work of mobilised Souques (1860–1944) and Henry Meige (1866– neurologists would be submitted to medical jour- 1940), for example, treated injured soldiers in nals, particularly La Revue Neurologique. Be- Paris. tween 1914 and 1918, major clinical and paraclin- In October 1914, the La Salpêtrière hospital ical advances were made and new nosological en- was transformed into a military neurology centre, tities were described, none of which were strictly where Jules Dejerine and his spouse Augusta De- limited to the field of war neurology. It was the jerine-Klumpke would work. By the end of 1915, first time that so many neurologists were sur- the centre had close to 300 beds [3] . Although his rounded by so many cases of neurological injury health was fragile, Jules Dejerine worked relent- and disease in specialised hospitals or wartime lessly to provide care to the wounded soldiers: ‘He neurology centres. These specialised centres were refused to rest, a necessity at his age, and because officially created in October 1914 at the head- he overworked himself, at a time when the symp- quarters of military regions, at regional hospitals toms of the disease that would take his life were and in university cities where the most well- making themselves felt, he, too, could be considered known neurologists were mobilised. In the spring a victim of national duty, a war victim. He had his of 1915, neurology centres were created near the first attack of uraemia upon returning from the front to facilitate the management of neurologi- meeting of military neurologists in Doullens on cal patients and to avoid needless transfers to 26th January 1916’ [4] . Dejerine was suffering neurology centres at the rear. from terminal kidney failure and died of acute Improvisation characterised the first months pulmonary oedema on 26th February 1917. of the conflict, owing to a disorganised French Pierre Marie took his place as the head of the health service that had not foreseen the nature of militarised department at La Salpêtrière . Once he the injuries, especially those resulting from shrap- had ruthlessly and swiftly removed any memory nel and affecting the spine or the head, most often of his predecessor, he directed his students in the the skull. The metal ‘Adrian’ helmet, which re- study and treatment of war injuries. With his chef duced the severity of head injuries, was not intro- de clinique Charles Chatelin (1884–1948) and the duced until the spring of 1915, and then only pro- surgeon Thierry de Martel (1875–1940), he took gressively. The number of soldiers who suffered a particular interest in skull injuries: ‘Due to the from neuropsychiatric disturbances was both significance and frequency of skull injuries, they high and greatly under-estimated. This phenom- clearly merited special study. In my department at enon came as a totally unexpected surprise, and La Salpêtrière, we examined nearly 5,000 cases of managing these patients remained problematic skull injury in 1915 and 1916’ [5] . He emphasised throughout the conflict. the role of wartime brain injuries in understand- We present here the war careers of a few of the ing neurological pathology: ‘War injuries have French neurologists who were mobilised between shown us a different set of facts: lesions of the cor- 1914 and 1918 or who worked in militarised de- tex, with more or less complete exclusion of white partments of civil hospitals. matter. Consequently, this new pathology is infi- 108 Walusinski Tatu Bogousslavsky Tatu L, Bogousslavsky J (eds): War Neurology. Front Neurol Neurosci. Basel, Karger, 2016, vol 38, pp 107–118 (DOI: 10.1159/000442597) Downloaded by: Verlag S. KARGER AG, BASEL 172.16.6.1 - 4/13/2016 11:06:53 AM nitely closer to the data of experimental physiology than was the old cerebral pathology’ [5] . The militarised neurology department of the Parisian La Pitié hospital was directed by Joseph Babiński (1857–1932), who also served in the mil- itary hospital set up in the Lycée Buffon , where he worked alongside the neurologist Jules Fro- ment (1878–1946). Their collaboration led to sev- eral publications, in particular on nervous dis- turbances involving autonomic disorders [6] . A number of Babiński’s internes and colleagues left to serve on the front lines; some of them lost their lives. Despite all these dramatic events, the Société de Neurologie , which had been dormant, progres- Fig. 1. Georges Guillain in 1921 (private collection). sively resumed its activities at the beginning of 1915. Babiński and his Parisian university col- leagues played a major role in these meetings, which were essentially focused on war neurology entific department of the Bouleuse evacuation and presided over by Augusta Dejerine-Klumpke. hospital in Marne (north-western France), which was both a mobile hospital and a school for war medicine and surgery. Soon thereafter, he be- Georges Guillain and Jean-Alexandre Barré, came the chief physician at the neurology centre an Effective Partnership of the Sixth Army. At the end of the war, he was in charge of the Longvic medical centre for avia- After serving as an interne under Fulgence Ray- tion units [8] . Throughout the war years, Guillain mond (1844–1910) and Pierre Marie, Georges accumulated a considerable mass of new clinical Guillain (1876–1961) made the decision, rare at and biological data in all branches of neurology, the time, to complement his Parisian training which led to numerous publications during and with a visit to the neurology departments of ma- after the conflict. jor American universities [7] . He became a hospi- Guillain’s work on war neurology is indisso- tal physician in the French system in 1906 and ciable from that of Jean-Alexandre Barré (1880– passed the agrégation exam towards professor- 1967). After serving as an interne in Nantes and ship in 1910 ( fig. 1 ). completing his military service in 1901, Barré was Guillain was 38 when war was declared. Al- accepted as an interne in the Parisian hospitals in though he had been exempted from military ser- 1906. Working alongside Joseph Babiński, he dis- vice in 1899 for ‘weakness’, he voluntarily enlisted covered neurology and abandoned his plans to on 21st September 1914 and became a médecin become a surgeon. Finishing his training with aide-major de 2e classe . In January 1915, he was Pierre Marie and Achille Souques, he defended assigned to the Val-de-Grâce hospital in Paris, an innovative thesis in 1912 [9] . When war was and in March 1916, he was transferred to the hos- declared, Barré was Babiński’s assistant.