|Born||29 November 1823
|Died||16 August 1893 (aged 67)
Lac des Settons, Nièvre, France
|Fields||Neurologist and professor ofanatomical pathology|
|Known for||Studying and discovering neurological diseases|
Jean-Martin Charcot (/ʃɑrˈkoʊ/; 29 November 1825 – 16 August 1893) was a French neurologist and professor of anatomical pathology. He is known as “the founder of modern neurology” and is associated with at least 15 medical eponyms, including Charcot-Marie-Tooth disease andamyotrophic lateral sclerosis (motor neurone disease). Charcot has been referred to as “the father of French neurology and one of the world’s pioneers of neurology”.
His work greatly influenced the developing fields of neurology and psychology. He was the “foremost neurologist of late nineteenth-century France”and has been called “the Napoleon of the neuroses“.
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. In 1882, he established a neurology clinic at Salpêtrière, which was the first of its kind in Europe. Charcot was a part of the French neurological tradition and studied under, and greatly revered, Duchenne de Boulogne.
Charcot’s primary focus was neurology. He named and was the first to describe multiple sclerosis. 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 asCharcot’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.
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.
Charcot’s studies between 1868 and 1881 were a landmark in the understanding of Parkinson’s disease. Among other advances he made the distinction between rigidity, weakness and bradykinesia. He also led the disease, which was formerly named paralysis agitans (shaking palsy), to be renamed on behalf of James Parkinson.
Studies on hypnosis and hysteria
Charcot is best known today, outside the community of neurologists, for his work on hypnosis and hysteria. He believed that hysteria was a neurological disorder for which patients were pre-disposed by hereditary features of their nervous system. Charcot’s interest in hysteria and hypnotism “developed at a time when the general public was fascinated in ‘animal magnetism’ and mesmerization‘ … 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”.
The Salpêtrière School’s position on hypnosis was sharply criticized by Hippolyte Bernheim, a leading neurologist of the time. 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, and that the quarrel with Bernheim, furthered mostly by his pupil Georges Gilles de la Tourette, had “damaged” hypnotism.
Charcot thought of art as a crucial tool of the clinicoanatomic method. He used extensively 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. He is considered key in the incorporation of photography to the study of neurological cases.
Charcot’s name is associated with many diseases and conditions including:
- Charcot’s artery (lenticulostriate artery)
- Charcot’s joint (diabetic arthropathy)
- Charcot’s disease (amyotrophic lateral sclerosis, the most-common subtype of motor neurone disease – also known as Lou Gehrig’s disease.)
- Charcot-Marie-Tooth disease (peroneal muscular atrophy), named with Pierre Marie and Howard Henry Tooth.
- Charcot-Wilbrand syndrome (visual agnosia and loss of ability to revisualise images), named with Hermann Wilbrand.
- Charcot’s intermittent hepatic fever (intermittent pain, intermittent fever, intermittent jaundice, and loss of weight)
- Charcot-Bouchard aneurysms (tiny aneurysms of the penetrating branches of middle cerebral artery in hypertensives), named with Charles-Joseph Bouchard.
- Charcot’s triad of acute cholangitis (right upper quadrant pain, jaundice, and fever)
- Charcot’s triad of multiple sclerosis (nystagmus, intention tremor, and dysarthria)
- Charcot-Leyden crystals due to the lysis of eosinophils in cases of allergic diseases, named with Ernst Viktor von Leyden.
- Souques-Charcot geroderma: a variant of Hutchinson-Gilford disease, named with Alexandre-Achille Souques.
- Charcot-Gombault necrosis: a biliary infarct, named with Albert Gombault.
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. This led to the first clear delination of various neurological diseases and classic description of them. For example, amyotrophic lateral sclerosis.
Charcot is just as famous for his students: Sigmund Freud, Joseph Babinski, Pierre Janet, William James, Pierre Marie, Albert Londe, Charles-Joseph Bouchard, Georges Gilles de la Tourette, Alfred Binet, and Albert Pitres. Charcot bestowed the eponym for Tourette syndrome in honor of his student, Georges Gilles de la Tourette.
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”. However, 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. After his death, the illness “hysteria” that Charcot described was claimed to be nothing more than an “artifact of suggestion”.
However, the negative judgment of Charcot’s work on hysteria is influenced by a significant shift in diagnostic criteria and conception of hysteria which occurred in the decades following his death. 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).
In fact, Charcot argued vehemently against the widespread medical and popular prejudice that hysteria was rarely found in men. He taught that due to this prejudice these “cases often went unrecognised, even by distinguished doctors” 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.
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.” 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 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.