Sunday, November 29, 2015

The father of neurology

‘The floor is made of tile mosaics as are the walls - no seat - only a hole which seems narrow to me at ground level. One has to be agile - but the Arabs certainly are in this respect. They do everything squatting. It is perfect, a paradise for the sense of sight and smell.’ This is Jean-Martin Charcot, born 190 years ago today, the great physician of France’s early Belle Epoque, the so-called ‘father of neurology’ and/or the ‘Napoleon of the neuroses’, writing about a Moroccan toilet in his one and only significant diary.

Charcot was born in Paris on 29 November 1825 into a modest artisan family. He seems to have been a gifted school child, mastering several languages, and was selected by his father as the one child to receive a higher education and enter medical school. He received his M.D. from the University of Paris in 1853 with a dissertation on arthritis. In 1860, he was named associate professor in medicine, and two years later, he was appointed head of a hospital service at Salpêtrière, a complex in the 13th arrondissement near the Seine. Aged 39, he married Augustine-Victoire Durvis, a young widow, with whom he had two children.

Charcot began to publish many books and articles on infectious illnesses, geriatrics, diseases of the internal organs. And, in 1872, he was elected to the Paris Medical Faculty as professor of pathological anatomy. During the 1870s, he turned increasingly to the new discipline of neurology, becoming one of the world’s foremost experts on the subject, publishing on a wide range of neurological conditions, MS, Parkinson’s disease, Tourette’s, aphasia etc. He was the first to describe several conditions, including multiple sclerosis and the disintegration of ligaments and joint surfaces (Charcot’s disease, or Charcot’s joint) caused by locomotor ataxia and related diseases or injuries. In particular, he was known for his work on hysteria, and he developed the practice of using hypnosis as a means to study his patients, often using the technique in public demonstrations.

This - the early years of the Belle Epoque - was a heyday for the medical profession in France, as a group  progressive physician-scientists - among whom Charcot was the most famous - sought to modernise medicine more in line with scientific understanding. Apart from his medical discoveries, he also pioneered the art and science of medical photography. Charcot’s second-to-none reputation as a teacher attracted students from all over the world, not least, in 1885, Sigmund Freud.

Meanwhile, in their grand home on the boulevard Saint-Germain, the Charcots would give lavish parties, attracting the cream of Parisian society, politicians, artists, writers and, of course, other physicians. In 1882, Charcot was named Chair for the diseases of the nervous system, the first such professorial post in the world. Financing followed his fame, with the government resourcing a new neuropathological institute at Salpêtrière. Charcot died, relatively young, in 1893. Further information is available at Wikipedia, National Center for Biotechnology Information, Science Museum, and inside Medical Muses: Hysteria in 19th-Century Paris by Asti Hustvedt (some pages of which about Charcot are viewable at Googlebooks).

Charcot was not a diarist, though he did occasionally keep note-books when on holiday or travelling. One such note-book so stood out from the rest for Toby Gelfland (Department of History, University of Ottawa) that he decided to translate, edit and publish it - as Charcot in Morocco (University of Ottawa Press, 2012). In July 1887, Charcot went south to Spain for his annual summer holiday, but, on this occasion, concluded the voyage with a week in Morocco, and while there kept a detailed personal diary, amounting to 14,000 words, 95 manuscript pages, and various sketches, maps and watercolours.

The journal is a unique document, says Gelfand, because of its sheer length and detail but also because of ‘the intimate, relaxed, colorful, at times frankly exuberant quality of a first-person narrative written primarily for oneself, even if it were later to be shared with family and friends’. Furthermore: ‘The journal offers rare access to an otherwise elusive figure who said little of a spontaneous nature in public. [. . .] Historians, following most contemporary accounts, tend to portray Charcot as an authoritarian and rather austere medical leader, a “grand patron” who was at once intimidating and shy, if not secretive. The Moroccan journals reveals a less pretentious figure possessed of a rough and ready sense of humor, someone who did not always take himself or others so seriously.’

10 August 1887
‘Soon we reach the 1st Moroccan doorway, a square house, which sits atop a high hill. Two Moors of the Emperor who are to accompany us emerge; one carries a gun, the other a bag. These 2 do not join in with our group. Sometimes they approach, then at other times they disappear - only to reappear a little afterwards at a turn in the way . . . they are definitely strange; as well they have a rather unhealthy look about them with their caped robes that seem to be soaked with sweat.

We have been walking perhaps 2 hours when suddenly the plain widens out. In the middle we see a castle in ruins covered with ivy - not far off, some stones are piled up in a way that marks off an oval shape of earth. It is a tomb. There are many others. On a few of the tombs, red rags hang from sticks planted in the ground, rags now faded which must have formerly had a beautiful red color. They mark the tomb of a chieftain, more or less canonized and elevated to the level of a saint. It was here that the battle against the Moroccans took place which led to the march on Tetuan. More than 20 years ago, all that. The name Prim returns to mind. We walk on and keep on walking. From time to time I look at my watch. We’re going to get to the Moor’s place soon, no doubt! By this time hunger and thirst have set in. But where is this the devil of a house of the Moor? We don’t see it. Here are a few trees and rocks. We have lost sight of the sea. Anxiously, we walk on for nearly an hour; devil of a house gone astray. We begin to berate the Moors of the Emperor who led us down this wrong path. At last, there it is, a hut scarcely above the ground, hidden among the underbrush and tall cactus. [. . .]

I get up and rejoin the group drinking water, who are sharing a watermelon. On the mound where they are sitting, there is no more space. One of the Moors of the King noticed; he goes up to my son and, tapping him gently on the shoulder, says to him, in Spanish, “Your father is not seated.” My son gets up and I sit down in his place. An example of Arab manners that is in sum very edifying and which demonstrates that, even if we are among the people of Barbary, we are not with barbarians.’

11 August 1887
‘Soon we arrive at one of our “wealthy Moors”. [. . .] The young ladies go into the women’s quarters. Employing a searching gaze, we look into everything open to us. I think they were expecting us; most certainly, they were waiting for us. However a flurry of emotion, doubtless feigned, a pretended surprise, took place when we entered. A lady of mature years, who appeared beautiful to me, quickly fled, but not before showing us her face. That left 4 or 5 negresses, who shamelessly stayed where they were. Moreover, they were very beautiful, their arms and legs nude, their bodies lightly clothed in a clear fabric. They certainly do not belong to the religion whose acolytes cover up. As always, the first floor with balcony is just about the same as the lower floor. But it seems we cannot visit since the private living quarters are there. I look everywhere for a certain spot which interests me from a hygienic perspective. Instinct guides me. Here water flows on the ground - one certainly cannot go in without clogs. The floor is made of tile mosaics as are the walls - no seat - only a hole which seems narrow to me at ground level. One has to be agile - but the Arabs certainly are in this respect. They do everything squatting. It is perfect, a paradise for the sense of sight and smell.’

12 August 1887
‘It is agreed that I will give a few medical consultations; they implored me to do so. A few people have been referred by the consul, or by M. Alvans, the military envoy, who never tires of being helpful.

Here come the patients, 5 or 6 of them, all Jews. They file into the patio. I sketch one who presents a beautiful case of Parkinson’s. Nothing very interesting from the point of view of diagnosis. But all are nervous cases. Yesterday, on the square, they showed me a Jew who remained mute, so they say, during his entire childhood but who eventually began to speak. Was he a case of hysteria?

The consultation is over. I must see the town some more so as to take with me an indelible visual impression. Along the way, on one of the most densely inhabited streets, we hear in the distance a sort of chanting, mixed and monotonous at the same time: the voices of men. They appear in a cortege of about a hundred persons; they are walking quickly, they seem to be in a hurry. “The dead go quickly.” In fact it is a burial. The deceased is carried on a kind of cot, nude in a white shroud which hides him completely, the head too. It seems to me that no one stirs nor extends greetings. We don’t either: that is not the custom here. We let the cortege pass, we will meet it again momentarily, in the cemetery.’

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