Charcot: Constructing Neurology

by Christopher G. Goetz, Michel Bonduelle, Toby Gelfand

In the second half of the 19th century, Paris became an international center for neurological studies largely because of Jean-Martin Charcot and his Salpetriere School. Charcot was named Professor of Diseases of the Nervous System at the University of Paris in 1882, and thus helped institutionalize neurology as a medical specialty. By then he had already published widely and had assembled a team of research specialists and students who approached the study of the nervous system through the celebrated methode anatomo-clinique that correlated specific neurological signs with discrete lesions in the central nervous system. Pushing beyond the bounds of anatomical study, Charcot went on to study hysteria, attracting both scientific and social notoriety.
This book provides the best account of the life and contributions of Jean-Martin Charcot. It gives a fascinating picture of the man and his milieu, and clearly defines his role in establishing the new medical specialty of clinical neurology.

416 pages, Hardcover

First published November 2, 1995

Reviews

[Robert · Rating 4 out of 5]

Charcot: Constructing Neurology is an excellent academic book published by Oxford University Press in 1995; in effect, it is a critical biography, exploring the science as much as the man who generated the science.

Jean-Martin Charcot was, at the end of the 19th century, on a par with Louis Pasteur in terms of both fame and prestige. In many ways, he did create the field of neurology by using clinical observation as a means of identifying numerous major neurological disorders and also by promoting the field through developing many associates and through a relentless publishing/publicity regime.

Charcot was, in a sense, a master builder. At the height of his power and influence he directed the massive hospital for women, the Salpêtrière, in Paris as a vehicle for extensive clinical research, employing photography, electrical stimulation, medicine, and hypnotism as a trial-and-error means of pinning down the associated symptoms of given maladies and naming them.

Today Charcot remains a significant figure in the history of medicine with a bit of an asterisk...or perhaps a large asterisk. He focused intensively toward the end of his career on the phenomenon known as hysteria. That's where the asterisk comes in, large or small. No one today believes (and many in Charcot's time disbelieved) in hysteria as Charcot presented it. Hysteria in Charcot's sense was a variable but fundamentally 4-stage illness that brought on seizures, or attacks, or spells. These spells typically began with a phase of paralysis, then yielded to a phase of extraordinary physical expressions (involving the whole body), then yielded to a phase called "passionate," which might be erotic, or fearful, or sad, and finally ended in delirium. That was Charcot's schema, which he demonstrated for the public with the aid of his patients, and which he triggered by first hypnotizing those patients.

Charcot believed that susceptibility to deep hypnosis was, in fact, evidence of hysteria, which he did not, by the way, limit to women (prior to his times, women were thought to be the only hysterics). As a neurologist, he further believed that hysteria must be caused by some lesion in the nervous system. Most likely, he thought, all neurological disorders were hereditary, but he allowed that certain disorders might remain latent without a triggering trauma (a young woman being repeatedly assaulted sexually, for example, often was found in cases of hysteria.)

There is no question that Charcot was dishonest in his research on hysteria or that he was cynical in publicizing it. He insisted that in the case of hysteria the critical lesion ultimately would be found (as would be the case in other neurological disorders)...and admitted that he simply had not found it yet. One limiting factor in all of his work was his aversion to what might be called exploratory surgery (or, in the case of animals, vivisection). He theorized that surgery might disrupt the phenomenon being sought. Post-mortem, yes, Charcot studied the physical body down to the cellular level, but pre-mortem, as it were, hysteria only could be known through case studies and hypnotism.

The most valuable scientific aspect of this book is pinpointing the exact nature of Charcot's errors with regard to hysteria, the first being his resistance to what is termed psychogenic causation, i.e., psychological trauma, not heredity, being the primary force generating many somatic irregularities--paralysis uncontrollable mood swings, a loss of sensory faculties, etc., etc. Freud studied with Charcot briefly. Along with others, we can say he pushed past Charcot's insistence on physical lesions in the case of hysteria.

More broadly, the book does not step back and assess a bigger problem in Charcot's work (bigger even than his questionable mastery of hypnosis). To my mind, the bigger problem is how could any lesion typically generate such a complex sequence of symptoms, sweeping through the four phases of hysteria, and sometimes doing so dozens and hundreds of times a day when a patient was most severely afflicted?

It began to be obvious, but was not obvious to Charcot and his associates, that the diagnosis of hysteria had to come apart at the seams and that the Charcot's theater of hysterical symptoms was an implausible hypothesis. Over time we have seen all kinds of symptoms, some alone, some in multitudes, present themselves as human reactions to trauma of a psychogenic nature. Thus, the master theory of hysteria, the bringing together of w, x, y, and z states, has fallen apart without necessarily extinguishing those states alone or in combination after a single or many traumas.

And we still don't know how trauma enters into and controls the physical organism of a person...how it persists...how it mutates...how it becomes, in Charcot's sense, a lesion.

As a master builder, Charcot overreached. He constructed a disorder out of many disorders; the winds of time and further research blew his structure down.

The fantastic intellectual error of proposing hysteria as Charcot proposed it...and as it persisted for a few decades...remains fascinating to me, at least.

This is not a book for casual readers. I suppose it's not necessary to say that. But it's still a good book for many reasons that exceed my comments here.

[Sharon · Rating 5 out of 5]

As a neurology APP, I enjoyed this book tremendously. Highly recommend.

[William Nist · Rating 4 out of 5]

Neurology is a relatively new specialty in Medicine. Dr Charcot of Paris France is considered the founder thru his work at the Salpetriere hospital. This books details his life and work. He is the first to classify a lot of neuro diseases, like ALS, MS, etc. He also used a methodology that attempted to correlate clinical presentation with anatomical lesions. (as opposed to Psychiatry in which the 'lesions' were considered part of the mental process, and as opposed to religious interpretations of some diseases like hysteria, which were thought to have supernatural causes). I think he actually thought that the causes of many if not most of these diseases was located in heredity (a view later disputed by many of these 'sporadic' illnesses). His public exposition of female hysterics, and his use of hypnotism caused eyebrows to be raised even back in the 1890's. Most of this work has passed to psychiatry or Las Vagas magicians. (He thought the cure, apparently, for hysteria was pressing on the female ovaries.)

In his time, he was not only a doctor, but a wealthy. well traveled, celebrity doctor like Dr OZ...lol. Anyone interested though in the history of medicine, should find this read absorbing and informative.