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BITS OF HISTORY BMJ: first published as 10.1136/bmj.307.6919.1589 on 18 December 1993. Downloaded from Charcot and his visits to Britain Raymond Hierons Until the second world war, Charcot was widely achievements of his English colleague and introduced recognised as one of the leading medical men in the name Jacksonian epilepsy. Europe, an outstanding neurologist and teacher, These neurological contributions made Charcot whose lectures were attended not only by doctors but known throughout the medical world, but it was his also by distinguished lay people. His renown was studies on hysteria and hypnotism that brought his largely due to The Story of San Michele, the autobio- name before the general public. His conclusions were graphy of Axel Munthe, a medical practitioner, which flawed but came about as a result of the administrative had a chapter devoted to Charcot (although it pre- changes at the Salpetriere when the hysterical patients sented a derogatory picture of him).' As with many were transferred to the wards of the chronic epileptic medical students of my generation, Munthe's book patients. As Pierre Marie wrote 40 years later, made a deep impression on me, and this was reinforced "Charcot, involuntarily by force of circumstances, was when, shortly after the second world war, I visited plunged into hysteria. As a result La Grande Hysterie Charcot's old hospital, the Salpetriere, in Paris. Now, of the Salpetriere came into existence. It did not exist 100 years after Charcot's death, it is an appropriate anywhere else."3 time to remember him and to record his love of the Charcot was constantly preoccupied by the differen- English language and his visits to Britain. tiation of the organic from the hysterical. He greatly influenced Freud and expressed the idea in his presence that hysteria is based on repression and Life and work always has a sexual content. Jean-Martin Charcot was born in modest circum- stances on 29 November 1825 in Paris. He entered the Paris faculty of medicine and spent his internship Charcot's personality mainly at the Salpetriere, where he and his friend, Axel Munthe's autobiography describes Charcot as Vulpian (who was later to achieve fame as a pathologist "short of stature, with the chest of an athlete and the and physiologist), recognised the immense possibilities neck of a bull . .. a most imposing man to look at. A for clinical research in that vast institution for the old, white clean-shaven face, a low forehead, cold pene- infirm, and deranged. trating eyes, an aquiline nose, sensitive cruel lips, the The part of Charcot's life was devoted to mask of a Roman emperor." The account goes on to early http://www.bmj.com/ general medicine. He detected the excessive amount of consider him "a tyrant who was feared by his patients teachers-J7ean-Martin Charcot uric acid in gout; recognised the lobular structure of and his assistants, for whom he seldom had a kind word the lung, liver, and kidney; introduced routine tem- of encouragement in exchange for the superhuman perature taking in everyday hospital practice; and first amount of work he imposed upon them. He was described the periodic fever following gall stone colic. indifferent to the sufferings of his patients; he took Charcot also first described intermittent claudication, little interest in them from the day of establishing the which he recognised in an account of a horse that diagnosis until the day of the post mortem examina- started to hobble after a few minutes of trotting, but tion."' walked normally after a brief rest, only to hobble Reading this book again after half a century, I doubt on 24 September 2021 by guest. Protected copyright. again. its accuracy. As a medical student in Paris, Munthe From about 1868 Charcot turned his attention to the would certainly have attended Charcot's lectures and nervous system. Before he described the clinical mani- demonstrations, but he never had any close association festations of multiple sclerosis this diagnosis was never with Charcot. He did not pass the competitive examina- considered during life. He recognised the lesions in the tion to be an intern or hold any junior hospital post in olfactory nerves and in the spinal nerve roots, findings Paris. Munthe's attitude to Charcot may also have been that have received attention and confirmation only affected by an incident in which he took a young recently-as have his observations on the miliary hysterical woman to live in his home-to escape, as he aneurysms responsible for cerebral haemorrhage. said, from Charcot's ward. When Charcot heard about Charcot's wide reading included Parkinson's small this he threatened police action, but instead had monograph of 1817, and it was he who named paralysis Munthe taken outside the hospital and ordered that he agitans after the Shoreditch physician. was not to be allowed to enter again. The neuropathic joint was invariably called Munthe's description was written more than 40 Charcot's joint in English 50 and more years ago, when years after he was expelled from the Salpetri&re. tabes was a common condition. Charcot gave the first Perhaps he took some of it from another disparaging clinicopathological account of amyotrophic lateral account written a few years earlier, with very similar sclerosis-motor neurone disease-which is still called phraseology, by Leon Daudet, son of the famous London NW1 4PS Charcot's disease in mainland Europe.2 writer, Alphonse. The father was a close friend, Charcot was opposed to animal experiments, but neighbour, and patient of Charcot, but after Charcot's Raymond Hierons, with his junior, Pitres, he made considerable contri- death a bitter feud developed between the two families, former consultant neurologist, butions, from clinical observations to the study of possibly connected with the broken engagement South East Thames Region cerebral localisation. Like Hughlings Jackson, he was between Charcot's daughter and Laon. BMJ 1993;307: 1589-91 fascinated by focal epilepsy, but recognised the greater Munthe's harsh remarks about Charcot must be BMJ voLuME 307 18-25 DECEMBER 1993 1589 open to question since accounts by others, including Freud and Osler, give a very different and most sympathetic picture of Charcot. They describe him as courteous to his assistants and kind to his patients.45 Many, however, found him to have a rather cold exterior, probably as a cover for extreme shyness. BMJ: first published as 10.1136/bmj.307.6919.1589 on 18 December 1993. Downloaded from In the famous painting by Andr6 Brouillet (fig 1) of one of Charcot's Friday lectures we see Babinski (supporting the patient) and Gilles de la Tourette (seated in the middle and wearing an apron). Most of the others present achieved distinction in medicine or neurology, including Marie, Raymond, Joffroy, Bris- saud, and Bourneville. Charcot's son, then an intern, is seen leaning against the window with his arms folded. The patient made a full recovery and then worked in the photographic department of the Salpetriere. Freud had a copy of this picture in his consulting room in Vienna and clearly treasured it, for when he fled to London in 1938 he hung it over the consulting room couch, and it remains there today. Fig 2 shows Charcot's "Lecons du mardi," when patients were brought before him whom he had not previously seen. Freud wrote of these occasions, when he would "speak extemporaneously, put aside his authority on occasion in one case that he could arrive at no diagnosis and in another that he had been deceived by appearances; and he never appeared greater to his audience than when by giving the most detailed account ofhis processes ofthought and by showing the -A "lepon du mardi,"(24MIIreproduced by permission of National greatest frankness about his doubts and hesitations; he a't4, Queen Square had thus sought to narrow the gulfbetween teacher and pupil."6 contributions was the so called "rest cure" for neurotic Charcot's personality seems to have been less disorders, which was popular well into this century. In mercurial and more deliberate than that ofmany ofhis 1873 he visited Paris and was anxious to find out what countrymen. Every thought was carefully matured; he manner of man was Charcot. He pretended to be a assembled his material and deliberated long before patient and gave an account to Charcot ofneurasthenic reaching his conclusions. All his writings contain the symptoms. When Charcot learned that this patient was most detailed analyses of the literature ranging soon to return to the United States, he urged him to see from antiquity. He covered science, art, history, and Weir Mitchell, saying that he knew more about this literature. condition than anyone else.7 His knowledge of British publications was truly amazing. Particularly impressive are his references to Thomas Willis at a time when Willis was neglected and Visits to Britain somewhat denigrated in his own country (largely due Charcot spoke extremely good English and was an http://www.bmj.com/ to the physiologist Sir Michael Foster). Charcot makes honorary member of the BMA and several medical many references to Sydenham, Parkinson, Todd, societies on this side of the Channel. The first of his Graves, Brodie, Hilton, and Paget. His knowledge of visits was in the early 1860s, when he came to a number the international literature can be appreciated by a of London teaching hospitals and the Hunterian prank carried out by Weir Mitchell. Weir Mitchell was Museum of the Royal College of Surgeons. In 1869 he an impressive figure in nineteenth century American accompanied Brown-Sequard to the annual BMA neurology and a talented poet and novelist.

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