Article

Jean-Martin Charcot´s medical instruments: Electrotherapeutic devices in La Leçon Clinique à la Salpêtrière

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  • Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
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Abstract

In the famous painting La Leçon Clinique à la Salpêtrière (A Clinical Lesson at the Salpêtrière) by André Brouillet (1857–1914), the neurologist Jean-Martin Charcot (1825–1893) is shown delivering a clinical lecture in front of a large audience. A hysterical patient, Marie Wittman (known as “Blanche”; 1859–1912) is leaning against Charcot’s pupil, Joseph Babinski (1857–1932). Lying on the table close to Charcot are some medical instruments, traditionally identified as a Duchenne electrotherapy apparatus and a reflex hammer. A closer look at these objects reveals that they should be identified instead as a Du Bois-Reymond apparatus with a Grenet cell (bichromate cell) battery and its electrodes. These objects reflect the widespread practice of electrotherapeutic faradization at the Salpêtrière. Furthermore, they allow us to understand the moment depicted in the painting: contrary to what is sometimes claimed, Blanche has not been represented during a hysterical attack, but during a moment of hypnotically induced lethargy.

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In June 1870, Jean-Martin Charcot (1825-1893) delivered his first lecture on hysteria, a lesson on hysterical contractures, at the Salpêtrière in Paris, France.2 His lecture emphasized a scientific approach to hysteria and focused on not only the physical features but also the psychological aspects. Thus, he expressed doubt about reports of miraculous religious cures and likened them to the sudden recovery of hysterical patients. Charcot was influenced by the work of Pierre Briquet (1776-1881),3,4 who in 1859, based on clinical assessments, published a systematic epidemiologic study describing 430 cases of hysteria seen over a 10-year period. Briquet considered “hysteria as the product of suffering of the part of the brain destined to receive affective impressions and feelings,”4(p60)suggested a role for heredity, proposed a predisposing temperament, and identified male cases but noted that they were far less common than female cases. The previous July, Charcot attended the British Medical Society meeting in Leeds, England, where Russell Reynolds delivered a paper that had intrigued him, “Paralysis, and other disorders of motion and sensation, dependent on idea.”5 Reynolds wrote “that some of the most serious disorders of the nervous system, such as paralysis, spasm, pain, and otherwise altered sensations, may depend upon a morbid condition of emotion, of idea and emotion, or of idea alone . . . they sometimes associate themselves with distinct and definite diseases of the nervous centres, so that it becomes very important to know how much a given case is due to an organic lesion, and how much to morbid ideation.”5(p483)
Article
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Article
This historical review presents the advances made mostly during the last 200 years on the description, concepts, theories, and (more specifically) cure of patients suffering from hysteria, a still obscure entity. The denomination of the syndrome has changed over time, from hysteria (reinvestigated by Paul Briquet and Jean-Martin Charcot) to pithiatism (Joseph Babinski), then to conversion neurosis (Sigmund Freud), and today functional neurological disorders according to the 2013 American Neurological Association DSM-5 classification. The treatment was renewed in the second half of the 19th century in Paris by Paul Briquet and then by Jean-Martin Charcot. Hysterical women, who represented the great majority of cases, were cured by physical therapy (notably physio-, hydro-, and electrotherapy, and in some cases ovary compression) and 'moral' therapies (general, causal therapy, rest, isolation, hypnosis, and suggestion). At the turn of the 19th and 20th centuries, psychotherapy, psychoanalysis, and persuasion were established respectively by Pierre Janet, Sigmund Freud, and Joseph Babinski. During World War I, military forces faced a large number of posttrauma neurosis cases among soldiers (named the 'Babinski-Froment war neurosis' and Myers 'shell shock', in the French and English literature, respectively). This led to the use of more brutal therapies in military hospitals, combining electrical shock and persuasion, particularly in France with Clovis Vincent and Gustave Roussy, but also in Great Britain and Germany. After World War I, this method was abandoned and there was a marked decrease in interest in hysteria for a long period of time. Today, the current treatment comprises (if possible intensive) physiotherapy, together with psychotherapy, and in some cases psychoanalysis. Antidepressants and anxiolytics may be required, and more recently cognitive and behavioral therapy. Repetitive transcranial magnetic stimulation is a new technique under investigation which may be promising in patients presenting with motor conversion syndrome (motor deficit or movement disorder). Functional neurological disorders remain a difficult problem to manage with frequent failures and chronic handicapping evolution. This emphasizes the need for therapeutic innovations in the future. © 2014 S. Karger AG, Basel.
Article
In this chapter, excerpts from famous or little-known works of French literature are used to illustrate how eighteenth- and nineteenth-century physicians tried to treat neuropsychiatric illnesses. Although the causes were unknown to them, they did not hesitate to inflict suffering on their patients, who were often in an appalling condition to begin with. Novelists such as Gustave Flaubert, Alphonse Daudet, the Goncourt brothers, Georges Siménon, and Céline applied their writing talents to describing the use of leeches, bloodletting, vibratory treatments, suspension of the body, multiple painful injections, and brutal electrotherapy. These writers reveal how physicians used their imaginations not only boundlessly but also without pity, to treat their patients. Each literary work is presented with the medical justifications of the time, for example, the explanations of Cruveilhier, Charcot, Brown-Sequard, Sollier, Vincent, and Roussy.
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In 1886 Sigmund Freud returned from Paris with the lessons taught to him by Jean-Martin Char cot. In 1889 Freud returned from Paris with an image ofCharcot teaching. This essay analyzes three images—or three different versions of that one image: the original painting of 1887 by André Brouillet, the 1888 reproduction of it as a lithograph by Eugène Pirodon, and a photographic “installation shot” of one copy ofthat lithograph by Nick Bagguley as it appears on a postcard of the Freud Museum. “The picture over the couch” in Freud's consulting room is examined both for the demonstration it depicts and for what it cannot show, that is, the scene of analysis which took place beneath it. Seeing how the image functions for Brouillet in Paris and for Freud in Vienna, the question arises how it functions f or us—those called by Freud and psychoanalysis—in London. In giving us an image of what we want but can never see of Freud, the picture may at least in fantasy be seen as the primal scene of psychoanalysis.
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