Jean-Martin Charcot

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Jean-Martin Charcot
Jean-Martin Charcot.jpg
Born (1825-11-29)29 November 1825
Paris, France
Died 16 August 1893(1893-08-16) (aged 67)
Lac des Settons, Nièvre, France
Residence France
Nationality French
Fields Neurologist and professor of anatomical pathology
Institutions Pitié-Salpêtrière Hospital
Known for Studying and discovering neurological diseases

Jean-Martin Charcot (/ʃɑrˈk/;[1] 29 November 1825 – 16 August 1893) was a French neurologist and professor of anatomical pathology.[2] He is known as "the founder of modern neurology"[3] and is associated with at least 15 medical eponyms, including Charcot-Marie-Tooth disease and amyotrophic lateral sclerosis (motor neurone disease).[2] Charcot has been referred to as "the father of French neurology and one of the world's pioneers of neurology".[4] His work greatly influenced the developing fields of neurology and psychology; modern psychiatry owes much to the work of Charcot and his direct followers.[5] He was the "foremost neurologist of late nineteenth-century France"[6] and has been called "the Napoleon of the neuroses".[7]

Personal life[edit]

Born in Paris, Charcot worked and taught at the famous Salpêtrière Hospital for 33 years. His reputation as an instructor drew students from all over Europe.[7] In 1882, he established a neurology clinic at Salpêtrière, which was the first of its kind in Europe.[2] Charcot was a part of the French neurological tradition and studied under, and greatly revered, Duchenne de Boulogne.[8][9]

"He married a rich widow, Madame Durvis, in 1862 and had two children, Jeanne and Jean-Baptiste, the latter becoming both a doctor and a famous polar explorer".[10]

Profession[edit]

Neurology[edit]

Charcot uses hypnotism to treat hysteria and other abnormal mental conditions. (All materials from "Iconographie photographique de la Salpêtrière" (Jean Martin Charcot, 1878)

Charcot's primary focus was neurology. He named and was the first to describe multiple sclerosis.[2][11] Summarizing previous reports and adding his own clinical and pathological observations, Charcot called the disease sclerose en plaques. The three signs of Multiple sclerosis now known as Charcot's triad 1 are nystagmus, intention tremor, and telegraphic speech, though these are not unique to MS. Charcot also observed cognition changes, describing his patients as having a "marked enfeeblement of the memory" and "conceptions that formed slowly". He was also the first to describe a disorder known as Charcot joint or Charcot arthropathy, a degeneration of joint surfaces resulting from loss of proprioception. He researched the functions of different parts of the brain and the role of arteries in cerebral hemorrhage.[2]

Charcot was among the first to describe Charcot-Marie-Tooth disease (CMT). The announcement was made simultaneously with Pierre Marie of France (his resident) and Howard Henry Tooth of England. The disease is also sometimes called peroneal muscular atrophy.[12]

Charcot's studies between 1868 and 1881 were a landmark in the understanding of Parkinson's disease.[13] Among other advances he made the distinction between rigidity, weakness and bradykinesia.[13] He also led the disease formerly named paralysis agitans (shaking palsy) to be renamed after James Parkinson.[13] Charcot received the first European professional chair of clinical diseases for the nervous system in 1882.[14]

Studies on hypnosis and hysteria[edit]

Charcot is best known today, outside the community of neurologists, for his work on hypnosis and hysteria. He initially believed that hysteria was a neurological disorder for which patients were pre-disposed by hereditary features of their nervous system,[7][15] but near the end of his life concluded that hysteria was a psychological disease.[16]

Charcot first began studying hysteria after creating a special ward for non-insane females with "hystero-epilepsy"; he discovered two distinct forms of hysteria among these women; minor hysteria and major hysteria.[17] His interest in hysteria and hypnotism "developed at a time when the general public was fascinated in ‘animal magnetism’ and ‘mesmerization’",[18] which was later revealed to be a method of inducing hypnosis.[19] His study of hysteria "attract[ed] both scientific and social notoriety".[20]

"Charcot and his school considered the ability to be hypnotized as a clinical feature of hysteria ... For the members of the Salpêtrière School, susceptibility to hypnotism was synonymous with disease, i.e. hysteria, although they later recognized ... that grand hypnotisme (in hysterics) should be differentiated from petit hypnotisme, which corresponded to the hypnosis of ordinary people".[18]

The Salpêtrière School's position on hypnosis was sharply criticized by Hippolyte Bernheim, a leading neurologist of the time.[18] Charcot himself long had concerns about the use of hypnosis in treatment and about its effect on patients. He also was concerned that the sensationalism hypnosis attracted had robbed it of its scientific interest,[20] and that the quarrel with Bernheim, furthered mostly by his pupil Georges Gilles de la Tourette, had "damaged" hypnotism.[18]

Arts[edit]

Charcot demonstrates hypnosis on a "hysterical" Salpêtrière patient, "Blanche" (Blanche Wittmann), who is supported by Dr. Joseph Babiński (rear).

Charcot thought of art as a crucial tool of the clinicoanatomic method. He used photos and drawings, many made by himself or his students, in his classes and conferences. He also drew outside the neurology domain, as a personal hobby. Like Duchenne, he is considered a key figure in the incorporation of photography to the study of neurological cases.[21]

Eponyms[edit]

Charcot's name is associated with many diseases and conditions including:[2]

Legacy[edit]

One of Charcot's greatest legacies as a clinician is his contribution to the development of systematic neurological examination, correlating a set of clinical signs with specific lesions. This was made possible by his pioneering long-term studies of patients, coupled with microscopic and anatomic analysis derived from eventual autopsies.[24] This led to the first clear delination of various neurological diseases and classic description of them. For example, amyotrophic lateral sclerosis.[25]

Charcot is just as famous for his students: Sigmund Freud,[7] Joseph Babinski,[2] Pierre Janet,[7] William James, Pierre Marie, Albert Londe, Charles-Joseph Bouchard,[2] Georges Gilles de la Tourette,[2] Alfred Binet,[7] Jean Leguirec[2] and Albert Pitres. Charcot bestowed the eponym for Tourette syndrome in honor of his student, Georges Gilles de la Tourette.[6][26]

Although by the 1870s, Charcot was France's best known physician, according to Edward Shorter, his ideas in psychiatry were refuted, and France did not recover for decades. Shorter wrote in his A History of Psychiatry that Charcot himself understood "almost nothing" about major psychiatric illness, and that he was "quite lacking in common sense and grandiosely sure of his own judgement". This perspective overlooks that Charcot never claimed to be practicing psychiatry or to be a psychiatrist, a field that was separately organized from neurology within France's educational and public health systems.[27] After his death, Shorter said the illness "hysteria" that Charcot described was claimed to be nothing more than an "artifact of suggestion",[28] however American psychologist Gardner Murphy referred to Charcot's position in French psychiatry and psychology as "prominent".[29]

After Charcot's death, Freud and Janet wrote articles on his importance.[30] The Charcot-Janet school, which formed from the work of Charcot and his student Janet, contributed greatly to knowledge of double and multiple personality, before being extended by Morton Prince's Dissociation of a personality (1905).[31] The judgment of Charcot's work on hysteria is influenced by a significant shift in diagnostic criteria and understanding of hysteria which occurred in the decades following his death.[32] The historical perspective on Charcot's work on hysteria has also been distorted by viewing him as a precursor of Freud (whose markedly different conception of hysteria was extensively addressed by feminist historians in the last decades of the 20th century).

Charcot argued vehemently against the widespread medical and popular prejudice that hysteria was rarely found in men, presenting several cases of traumatic male hysteria.[33] He taught that due to this prejudice these "cases often went unrecognised, even by distinguished doctors"[34] and could occur in such models of masculinity as railway engineers or soldiers. Charcot's analysis, in particular his view of hysteria as an organic condition which could be caused by trauma, paved the way for understanding neurological symptoms arising from industrial-accident or war-related traumas.[35]

A 2012 French historical drama film, Augustine, is about a love affair between Charcot and a patient. The New York Times film review describes Chartcot as "a complicated figure in retrospect, at once a charlatan and a pioneer, a monster and a modernizer".[36][37]

Charcot appears, along with Maria Skłodowska-Curie (Madame Curie) and Charcot's patient "Blanche" (Marie Wittman), in Per Olov Enquist's 2004 novel The Book about Blanche and Marie (English translation, 2006, ISBN 1-58567-668-3). He also appears in the 2005 novel by Sebastian Faulks, Human Traces, and in Axel Munthe's 1929 autobiographical novel The Story of San Michele. In a letter to the New York Times Book Review of January 18, 1931, however, Charcot's son wrote that "Dr Munthe never was trained by my father."[citation needed] And in his 2008 biography of Munthe (ISBN 978-1-84511-720-7), Bengt Jangfeldt says that 'Charcot is not mentioned in a single letter of Axel's out of the hundreds that have been preserved from his Paris years.'[page needed] Distorted views of Charcot as harsh and tyrannical have arisen from some sources that mistakenly identify Munthe as Charcot's assistant and take Munthe's autobiographical novel[2] as a factual memoir. In fact, Munthe was just a medical student among hundreds of others. Munthe's most direct contact with Charcot was when he helped a young female patient "escape" from a ward of the hospital and took her into his home. Charcot threatened to advise the police and ordered that Munthe not be allowed on the wards of the hospital again.[38]

A collection of his correspondence is held at the United States National Library of Medicine.[39]

Charcot Island in Antarctica was discovered by his son, Jean-Baptiste Charcot, who named the Island in honor of his father.[40]

Quotations[edit]

  • "In the last analysis, we see only what we are ready to see,what we have been taught to see. We eliminate and ignore everything that is not a part of our prejudices".[41]
  • "To learn how to treat a disease, one must learn how to recognize it. The diagnosis is the best trump in thescheme of treatment.[41]
  • "Symptoms, then, are in reality nothing but a cry from suffering organs."[41]
  • "If you do not have a proven treatment for certain illnesses, bid [sic] your time, do what you can, but do not harm your patients."[42]
  • "... perfectly legitimate pathological phenomena, in which the will of the patient counts for nothing, absolutely nothing"; in reference to the clinical features of hysteria".[43]

Notes[edit]

  1. ^ French pronunciation: [ʃaʁˈko]
  2. ^ a b c d e f g h i j k Enerson, Ole Daniel. "Jean-Martin Charcot". Who Named It?. Retrieved 13 October 2008. 
  3. ^ Lamberty (2007), p. 5
  4. ^ Teive HA, Chien HF, Munhoz RP, Barbosa ER (December 2008). "Charcot's contribution to the study of Tourette's syndrome". Arq Neuropsiquiatr 66 (4): 918–21. doi:10.1590/S0004-282X2008000600035. PMID 19099145. 
  5. ^ Bogousslavsky (2010), p. 7
  6. ^ a b Kushner (2000), p. 11
  7. ^ a b c d e f "Jean-Martin Charcot". A Science Odyssey: People and Discoveries. Public Broadcasting Service (PBS). 1998. Retrieved 13 October 2008. 
  8. ^ Siegel IM (Summer 2000). "Charcot and Duchenne: Of mentors, pupils, and colleagues". Perspectives in Biology and Medicine 43 (4): 541–7. doi:10.1353/pbm.2000.0055. PMID 11058990. 
  9. ^ Haas LF (October 2001). "Jean Martin Charcot (1825–93) and Jean Baptiste Charcot (1867–1936)". J. Neurol. Neurosurg. Psychiatr. 71 (4): 524. doi:10.1136/jnnp.71.4.524. PMC 1763526. PMID 11561039. 
  10. ^ Tan SY, Shigaki D (May 2007). "Jean-Martin Charcot (1825–1893): pathologist who shaped modern neurology". Singapore Med J 48 (5): 383–4. PMID 17453093. 
  11. ^ (French) Charcot JM (1868). "Histologie de la sclerose en plaques". Gazette des hopitaux, Paris 41: 554–55. 
  12. ^ Enersen, Ole Daniel. "Charcot-Marie-Tooth disease |". Whonamedit.com. Retrieved October 16, 2008. 
  13. ^ a b c Lees AJ (September 2007). "Unresolved issues relating to the shaking palsy on the celebration of James Parkinson's 250th birthday". Mov. Disord. 22 (Suppl 17): S327–34. doi:10.1002/mds.21684. PMID 18175393. 
  14. ^ Jeste (2007) p.4
  15. ^ Charcot (1889), p. 85
  16. ^ Bogousslavsky (2010), p. 108
  17. ^ Shorter (1997), p. 134
  18. ^ a b c d Bogousslavsky J, Walusinski O, Veyrunes D (2009). "Crime, hysteria and belle époque hypnotism: the path traced by Jean-Martin Charcot and Georges Gilles de la Tourette" (PDF). Eur. Neurol. 62 (4): 193–9. doi:10.1159/000228252. PMID 19602893. 
  19. ^ Plotnik (2012) p. 170.
  20. ^ a b Goetz (1995), p. 211
  21. ^ Goetz CG (April 1991). "Visual art in the neurologic career of Jean-Martin Charcot". Arch. Neurol. 48 (4): 421–5. PMID 2012518. 
  22. ^ "Souques-Charcot gerodema". Whonamedit.com. 
  23. ^ Jurado I, Andreu X, Martin J, et al. (1997). "Biliary infarct (Charcot-Gombault necrosis): CT and pathologic features". J Comput Assist Tomogr 21 (1): 106–7. doi:10.1097/00004728-199701000-00020. PMID 9022779. 
  24. ^ Goetz (1995), p. 103
  25. ^ (French) Charcot J (28 March & 4 April). "Des rapports de l'anatomie pathologique avec la clinique". Progès médical: 165, 181. 
  26. ^ Black, KJ (22 March 2006). Tourette Syndrome and Other Tic Disorders. eMedicine. Retrieved on 27 June 2006.
    * Enerson, Ole Daniel. Georges Albert Édouard Brutus Gilles de la Tourette. Who Named It? Retrieved on 28 June 2006.
  27. ^ Goetz (1995), p. 208
  28. ^ Shorter (1997), pp. 84–86
  29. ^ Gardner (1999), p. 145
  30. ^ Bogousslavsky (2010), p. 120
  31. ^ Gardner (1999), p. 389
  32. ^ Goetz (1987), p. 115
  33. ^ Bogousslavsky (2010), p. 203
  34. ^ Goetz (1987), p. 116
  35. ^ Goetz (1987), p. 117
  36. ^ Scott AO (16 May 2013). "Doctor and patient: a gothic love story". The New York Times. Retrieved 21 December 2013. 
  37. ^ Olsen M (21 May 2013). "French actress-singer Soko finds quiet showcase in 'Augustine'". Los Angeles Times. Retrieved 21 December 2013. 
  38. ^ Hierons R (1993). "Charcot and his visits to Britain". BMJ 307 (6919): 1589–91. doi:10.1136/bmj.307.6919.1589. PMC 1697759. PMID 8292949. 
  39. ^ "J.M. Charcot correspondence and draft 1870-1892". US National Library of Medicine. Retrieved 1 January 2014. 
  40. ^ Mills (2003), p. 135
  41. ^ a b c Kundu AK (September 2004). "Charcot in medical eponyms". J Assoc Physicians India 52: 716–8. PMID 15839450. 
  42. ^ Goetz CG (August–September 2009). "Jean-Martin Charcot and movement disorders: neurological legacies to the 21st century". International Parkinson and Movement Disorder Society. Retrieved July 15, 2013. 
  43. ^ Jeste (2007) p.8

References[edit]

Further reading[edit]

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