Jean-Martin Charcot was certainly eccentric. For example, he was reputed to have better relationships with animals than with people. He was also brilliant and his work has tremendously influenced the neurological sciences well beyond his lifetime. Not only did he leave a mark through his individual contributions, he mentored others. Notable among these were Joseph Babinski, Georges Gilles de la Tourette, Pierre Marie and even Sigmund Freud.
The early years
Charcot was born in Paris, the city where he would spend the rest of his life, on November 29th, 1825. His father was a coach builder of modest means. Charcot and his three brothers always knew that the brightest among them would have the opportunity to pursue higher education. It was fortunate for clinical neurology that he was able to secure this opportunity. Despite his talent for drawing and painting, he chose medicine around 1843.
Charcot graduated from the University of Paris at the age of 23 and became an extern in 1846. He was not nominated to become an internat des hôpitaux until 1848, after passing his second attempt at the competitive exam. Charcot completed his doctorate in 1853. His impressive work on gout and rheumatism lead to a rapid recognition of his abilities and an appointment as professeur agrégé in 1860. In 1863, Charcot was assigned as Médecin de la Salpêtrière or senior physician to the now famous hospital.
Charcot’s roots at the Salpêtrière
The land upon which the Salpêtrière was situated was previously a gunpowder (saltpeter) factory on the right bank of the Seine River. The factory and arsenal had to be moved by royal decree owing to its proximity to residential areas at the time. The land then became a dumping ground for the physically and mentally ill and poor — old and young, but especially women. Many charitable institutions came together at this time and the hospital was built in the mid 17th century by order of Louis XIV. During the French Revolution, the hospice became the largest hospital in the world. The term “hospital” is perhaps not appropriate, however, since the Salpêtrière housed not only patients, but also over 3000 prisoners, prostitutes and social outcasts.
When Charcot arrived, the Salpêtrière was a chaotic institution housing some 5000 inmates. In spite of breakthroughs in patient care in the 18th century, living conditions remained dismal. The “badly organised museum of living pathology,” as Charcot described it, had to be structured systematically so that those who deserved medical attention were able to receive it. It was here that Charcot began the work that would occupy nearly all of his life. In fact, Charcot transformed the institution into one of the most respected teaching hospitals in Europe.
Personal life
While Charcot came across as an aloof and private individual, he presented a commanding and charismatic presence amongst fellow physicians. His wife, Augustine Victoire Durvis, a rich widow, understood her husband’s needs well. They married when Charcot was 39 years old. Their shared interests in drawing and painting were perhaps instrumental in bringing them closer. During the later years of their marriage, his dependence on her grew as she seemed to understand and anticipate his thoughts.
The couple had two children: Jeanne and Jean-Baptiste. Charcot strongly encouraged his son Jean-Baptiste to enter medicine, which he did, but after Charcot’s death he pursued his true interest and became a famous Arctic explorer.
It’s ironic that this remarkable physician, who provided care to many, did not take care of himself. His sedentary lifestyle, along with excessive smoking and poor eating habits, left him predisposed to heart disease. While on a trip with two of his old pupils, Professor Debove and Professor Straus, to the province of Morvan, Charcot passed away on August 16, 1893 of pulmonary edema.
the man himself
Charcot, in his own words, valued observation above all else: “If the clinician, as observer, wishes to see things as they really are, he must make a tabula rasa of his mind and proceed without any preconceived notions whatever.” He had the ability to observe and analyse finer details in patients, and his remarkable talent in drawing enabled him to portray these details to others. Charcot considered himself a “visuel” for his ability to see minutiae often overlooked by others. This unique gift presumably gave him the ability to recognize clinical associations between signs and symptoms.
His eccentricities, however, made him appear demanding and impersonal. He was intimidating to his students, being a perfectionist in work. He was considered a tyrant by some, his inability to tolerate opposition caused resentment in a few. However, Charcot remained a respected and revered figure by most of his students.
Charcot’s personality was introverted, which made him appear distant in his interactions with patients. In fact, he rarely spoke to them at all during physical examinations. At the Salpêtrière, he was a silent observer; often limiting himself to a few words to his students. In spite of this, he had the ability to observe and analyse the subtle aspects in cases and offer precise diagnoses.
He was famous for his public lectures given on Tuesday (Leçons du Mardi). Although not known for his oratory skills, he was always clear and concise because of hours of preparation and memorization. To make his lectures more effective, Charcot brought patients who had not yet been assessed. During the lesson, he would establish a diagnosis and develop a management plan. He would perform visual and auditory impressions of tremors, gait abnormalities seen in neurological disorders. These creative efforts lent flair to his teaching as well as a sense of immediacy and precision, which made a lasting impression on his students. On Fridays, he would present prior consultations, sharing the results of his most recent studies and insights.
As uncomfortable as he was with people, he loved animals and even owned a pet monkey. Charcot enjoyed art, music and classical literature, and would often be heard quoting from Shakespeare. Interestingly, in art, he preferred the precision of Flemish and Dutch masters, compared to the Impressionists of his time (Manet, Monet and Renoir). He was known to draw caricatures, sketches and even fine paintings.
Charcot’s career was heavily influenced by many people — his colleagues, mentors, and friends all helped him achieve fame. In particular, the clinicians who had the most impact on Charcot’s career were Pierre Rayer, Guillaume Duchenne and Edmé Félix Alfred Vulpian.
Charcot’s contributions to neurology
Charcot himself noted: “Symptoms, then, are in reality nothing but the cry from suffering organs.” He developed this concept and went on to classify and distinguish diseases from each other so systematically that his student Joseph Babinski declared: “Indeed, in a neurologic service, not a single day passes in which we do not use some of the notions he introduced; his thinking is always with us.”
Charcot’s name is associated with so many neurological conditions and complications: Charcot joint, the naming of Parkinson’s Disease and distinction from Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Charcot-Marie-Tooth Disease, cerebral/spinal localization of function, the naming of grand mal/petit mal seizures, and in psychiatry: hysteria and the condition “hysteroepilepsy.”
During the Franco-Prussian war of 1870-1871, Charcot was limited in his research due to the need to provide care for the sick with typhus and the war wounded. Following the war, Charcot was made professor of pathological anatomy and was elected to the French Académie de Médecine. It was around this time that he began to devote attention to the problems of cerebral localization of neurological symptoms utilizing his méthode anatomo-clinique through the recording of behaviour in a patient and following it up with a post-mortem when the patient died.
Between 1884 and 1887, Charcot’s assistant, Georges Gilles de la Tourette had begun work on classifying movement disorders. Tourette recognized the similarities between descriptions of a condition known as “Jumping French men of Maine” in North America and “latah” in Malaysia and other cases in France that had been classified as chorea. Charcot emphasized the importance of the tics and the relationship to obsessions and compulsions. He introduced the term la maladie des tics de Gilles de la Tourette in honour of his assistant.
Charcot on hysteria and neuroses
The reorganization of patients at the Salpêtrière forced the separation of the hysterics and epileptics from the insane. As the senior of the two physicians, Charcot inherited the former group. His studies on hysteria brought him a fair measure of controversy and embarrassment, and he became known as “Napoleon of the Neuroses.” He differed from the prevailing views of hysteria: that the condition involved only women who were never pregnant or had in some way abused the pleasures of sex. He identified its frequent association with minor trauma of an emotional nature. Charcot’s detailed descriptions and observations permitted the distinction of epileptic seizures from hysterical crises.
In his later years, Charcot experimented with hypnosis as a treatment for hysteria. He began to use hypnosis in his demonstrations to the public. His patients were repeatedly asked to reproduce the signs and symptoms of their condition before an audience. His methods were decidedly unconventional and drew great criticism from other schools. Just prior to his death, Charcot had himself begun to feel that the neurological approach to hysteria merited a complete revision. Nevertheless, his ideas and teachings inspired many. Of these, Sigmund Freud, who spent a year between 1885 and 1886 at the Salpêtrière, returned to Vienna with a lifelong interest in the study of hysteria, hypnotism and development of the human psyche.
A genius at work
Charcot astounds us through the sheer force of his intellect, his observational skills, and his ability to see beyond the ordinary and the mundane. The depth and breadth of his studies utilizing clinical and anatomical correlation laid the foundation of the study of neurological disorders in modern times. He inspired many students and peers to further the cause of clinical neurosciences. Little wonder that he is called the Father of Modern Neurology.
One can never know if he truly, according to Professor Pick (of Prague), “…personified the national genius” or if “he was the glory of [the] faculty and the brightest jewel of its crown” (Professors E. Brissaud and Pierre Marie). The truth can be stated simply, however, as it was by Professor J.
Dejerine: “We no longer speak the language of the clinician of 1850, but rather we speak the language of Charcot.”
Dr Asuri N. Prasad is an associate professor in pediatrics and clinical neurosciences at the Schulich School of Medicine and Dentistry at the University of Western Ontario (UWO), and a pediatric neurologist at the Children’s Hospital, London Health Sciences Centre. His daughter, Charushree Prasad, is a fourth-year student at UWO. She is working towards her BMSc with an honours in physiology. A longer version of this article was presented to the London History of Medicine Society.
Acknowledgements
The authors would like to thank Professor Paul Potter, History of Medicine, Faculty of Medical Sciences, and the University of Western Ontario.
