Neurology

The study of the brain is as old as Hippocrates, but neurology as a science and as a clinical field was born in the 19^th century. The manufacture of new and newly precise instruments for physical examination, surgery, and autopsy enabled doctors to make direct connections between behavior and the brain, and between reflex actions and the nerves.¹

While the foundations of neurological localization were laid by Antoine Laurent Bayle and Paul Broca (namesake of the brain's language center), it was Jean-Martin Charcot who popularized the idea that behavioral abnormalities in a living patient could be traced to anatomical defects or 'lesions' in particular parts of the brain.² With frequent collaborator Alfred Vulpian, Charcot described the pathological anatomy of a whole catalog of nervous system disorders and mentored most of a generation of French neurologists and psychiatrists, including Joseph Babinski, Pierre Janet, Pierre Marie, Jules Cotard, and Georges Gilles de la Tourette, ensuring that his influence remained pervasive long after his death in 1893.³ Charcot's school believed that most neurological illness, including hysteria and neurosyphilis, were chronic and hereditary.⁴ During WWI, French soldiers exhibiting symptoms similar to what today's doctors call PTSD were often diagnosed with hysteria or accused of malingering; neurosurgeon Clovis Vincent pioneered electroconvulsive therapy for such 'hysterical' soldiers.⁵ Neurologists Jean Georges Guillain, Jean Alexandre Barré, and André Strohl (the same team to name the autoimmune disease Guillain-Barré syndrome)⁶ manned a military neuropsychiatric center during the war.⁷ French neurology also fed contemporary European ideas about la dégénérescence or 'degeneration,' the theory that society was in continual decline because criminal tendencies were passed down genetically. Proposed by Parisian doctor Bénédict Morel in 1857 and later popularized by philosopher Max Nordau, la dégénérescence permeated the late 19^th and early 20^th century scientific world, influencing psychiatry, anthropology, criminology, and, eventually, the eugenics movement.⁸

Jules Cotard (namesake of Cotard's syndrome, a delusion disorder colloquially called 'walking corpse syndrome') studied partial brain atrophy in his 1868 thesis. The illustrated brain, with atrophied right hemisphere, belonged to one of Charcot's patients .

De l’anatomie pathologique et du traitement de l’ataxie locomotrice progressive

Microscopic examination of spinal tissue from a patient diagnosed with progressive locomotor ataxia. They show amyloid bodies, which are associated with neurodegenerative disease.

$Étude sur quelques points de l'ataxie locomotrice progressive[:] arthropathies, fractures et luxations consecutives$

Patient with progressive locomotor ataxia, a neurological condition now known to be a manifestation of neurosyphilis. Signed at bottom left by Paul Richer, medical artist at the Salpêtrière.⁹

Des troubles nerveux dans l'intoxication mercurielle lente

An attempt to identify lesions on the specific areas of the brain that caused a patient's hemiplagia and hemichorea. The author notes that mercury poisoning was involved.

Étude anatomique, physiologique et clinique sur l'hémianesthésie, l'hémichorée et les tremblements symptomatiques

Diagram of the right hemisphere from the thesis of Fulgence Raymond, who was chair of neurology at Paris from 1874 to 1910.

Du role de l’inflamation dans le ramollissement cérébral

Charcot, who was deeply involved in studying cerebral softening and apoplexy, chaired Poumeau’s committee on a thesis that delves into the subject.

Sur la paralysie agitante et la sclérose en plaques généralisée

The hands and nervous system lesions of patients with paralysie agitante, or Parkinson's disease, from the thesis of one of Charcot's students.

Études expérimentales sur les traumatismes cérébraux

The leftmost figure shows cerebral hemorrhage in a concussed human brain. Other figures show traumatic injuries in the brains of dogs.

Abnormal hand positions (some neurological, others not). Diagnoses include: atrophy (Figure 2); paralysis (Figure 10); osteomalacia (Figures 3 and 4); permanent hysterical muscle contraction (Figure 9); "monkey hand," a condition in which the thumb cannot be moved away from the hand (Figure 1); benediction hand (literally "emphatic preacher hand"), an effect of median nerve injury (Figure 6 and 7).

Études pour servir a l’histoire de l’affection décrite sur le noms de goutte asthénique primitive, nodosités des jointures, rhumatisme articulaire chronique (forme primitive)

Charcot's own illustrations for his thesis show the hands of patients with gout, a form of arthritis characterized by swollen, inflamed joints.

"Hysterogenic" or "erotogenic" zones, areas of the body believed by Charcot to be particularly involved in hysteria, either as sites of pain or potential catalysts of paroxysmal attacks.

Études cliniques & physiologiques sur la marche. La marche dans les maladies du système nerveux étudiée par la méthode des empreintes (avec 31 figures)

For his thesis, under Charcot's direction, Gilles de la Tourette (namesake of the tic disorder Tourette's syndrome) analyzed the gait of neurologically normal and abnormal patients by having them step in ink and walk across a long sheet of paper.¹⁰

Étude sur le tabes dorsal spasmodique, sclérose primitive des faiscaux latéraux

Cross-section of the spinal cord in a patient diagnosed with tabes dorsalis.

Des atrophies de la main, consécutives aux lésions du nerf cubital, avec une planche a l'eau forte

This etching shows atrophy of the hand brought on by lesions to the ulnar nerves.

Considérations sur les lésions traumatiques des sinus de la dure-mère

The superior longitudinal (or sagittal) sinus, in blue, drains blood away from the brain.

Thesis from 1852 on nerve tumors. Fig.1 shows a fibroplastic tumor of the sciatic nerve sheath; Figs.5&6 show a cancerous tumor of the external popliteal nerve.

La Constitution physique des paralytiques généraux, contenant un essai sur les tempéraments

Patients diagnosed with paralysie générale or "general paresis or the insane," a term used in the late 19th and early 20th centuries to describe the psychiatric and neurological aspects of neurosyphilis. Symptoms included dementia, paranoia, and a host of neurological and motor problems.

Étude anatomique du crane chez les microcéphales

Skulls exhibiting characteristics of microcephaly, the condition of having a smaller-than-normal head. These drawings were made from skulls held in the private collections of French phrenologists Franz Joseph Gall, Pierre Marie Dumoutier, and Emmanuel Patrix. The pseudoscience of phrenology could be called a precursor to scientific neurology.¹¹

Recherches sur les rapports anatomiques du cerveau avec la voute du crane chez les enfants

The cranial vault in an infant skull, 1876.

Children suffering from craniostenosis, or premature fusing of the skull plates, circa 1969.

Sur la pathogénie de quelques affections de l’axe cérébro-spinal, choix d’observations prises dans l’Hopital de Bordeux

Cerebrospinal abnormalities observed by the author, many of which are complications from tuberculosis or Pott's disease, circa 1834.

Étude sur les ganglions nerveux périphériques

Lithograph showing peripheral nervous system ganglia.

Senile atrophy of the skull.

De l'epilepsie dans l'hémiplégie spasmodique infantile

An epileptic woman's body contorts during a seizure, circa 1883.

Étude clinique sur les troubles trophiques de la névralgie trifaciale

A patient of Charcot's diagnosed with 'trifacial' or trigeminal neuralgia, a condition involving muscle spasms and pain in the face around the trigeminal nerve.

Étude sur les circonvolutions cérebrales chez l'homme et chez les singes

Diagram of the furrows in an orangutan brain, from an 1874 comparative study of human and simian brains.

Granulations in the meninges causing blain inflammation, circa 1853.

Notes

Bogousslavsky, "Birth of Modern Psychiatry," 1; Guenther, Localization and its Discontents, 4.
Bogousslavsky, "Birth," 4; Clarac and Boller, "History of neurology in France," 634-5, 645; Hustvedt, Medical Muses, 12-13, 20-21; Veith, 228-230.
Bogousslavsky, "Birth," 3; Goetz, Bonduelle, and Gelfand, Charcot, 319-323; Veith, Hysteria, 244-5.
Goetz et al, Charcot, 260-3.
Bogousslavsky and Tatu, "French Neuropsychiatry in the Great War," 145, 148-151; Bogousslavsky, "Hysteria after Charcot," 151-156; see also unchsl, "Mental Ill-Health in the Great War."
Guillain-Barré syndrome was in fact first documented in 1859 by Jean Landry and is alternatively called Landry's ascending paralysis. See Clarac and Boller, "History," 642 and Schott, "Histoire du syndrome de Guillain et Barré," 932-4.
Bogousslavsky and Tatu, "French Neuropsychiatry," 148
Pick, Faces of Degeneration, 2-3, 9, 24-27; Goetz et al, Charcot, 262-3.
See Goetz et al, Charcot, 108-9, 147-8.
See Goetz et al, Charcot, 144.
See Clarac and Boller, Charcot, 632-3.

Bibliography

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Bogousslavsky, Julien. "Hysteria after Charcot: Back to the Future." In Following Charcot: A Forgotten History of Neurology and Psychiatry. Karger, 2011: 137-159.
Bogousslavsky, Julien and Laurent Tatu. "French Neuropsychiatry in the Great War: Between Moral Support and Electricity." Journal of the History of the Neurosciences 22.2 (2013): 144-154.
Clarac, François and François Boller. "History of neurology in France." In History of Neurology, edited by Stanley Finger, François Boller, and Kenneth L. Tyler. Vol.95 of Handbook of Clinical Neurology. Amsterdam: Elsevier, 2010: 629-656.
Goetz, Christopher G., Michel Bonduelle, and Toby Gelfand. Charcot: Constructing Neurology. Oxford University Press, 1995.
Guenther, Katja. Localization and its Discontents: A Genealogy of Psychoanalysis and the Neuro Disciplines. University of Chicago Press, 2016. DOI: 10.7208/chicago/9780226288345.001.0001.
Hustvedt, Asti. Medical Muses: Hysteria in Nineteenth-Century Paris. W.W. Norton & Company, 2011.
Pick, Daniel. Faces of Degeneration: A European Disorder, c.1848-1918. Cambridge University Press, 1989. DOI: 10.1017/CBO9780511558573.
Schott, B. "Histoire du syndrome de Guillain et Barré." Revue Neurologique 138, no.12 (1982): 931-938. [Article in French]
unchsl. "Mental Ill-Health in the Great War." Tumblr post, March 15, 2018.
Veith, Ilza. Hysteria: The History of a Disease. University of Chicago Press, 1965.