"Caesar of the SalpÃatriÃ ̈re" J.-M. Charcot's impact on Psychological Medicine in the 1880s

appointed Professor of Pathological Anatomy in the Faculty of Medicine and, in 1882,he was the recipient of a specially created Chair of Clinical Studies of Diseases of the Nervous System. This was in recognition of the fact that, by dint of incessant toil and meticulous clinical scrutiny of neurological cases, he had established neurology as an independent discipline. In the 1880s.his fame for research, teaching and clinical demonstrations, especially of hysteri cal patients, brought medical disciples, as well as patients, flocking to the SalpÃatriÃ ̈re from all over the world. His earlier clinical work covered a variety of medical topics such as chronic rheumatism and the diseases of old age, but the abundance and nature of the clinical material allocated to him at the SalpÃatriÃ ̈re l d Charcot inevitably to focus on neurology, neuropathology and patients suffering from epilepsy, hysteria and hystero-epilepsy (la grande hystÃ©rie). In the last 15years of his life, he became deeply interested in the controversial and ill-famed phenomenon of hypnotism, an unusual and professionally risky step, at this time, for an eminent physician. This was a period of gradual recrud escence of interest in hypnotism, after it had fallen into disfavour for two decades and had become coloured by charlatanism. Charles Richet, a Paris physiologist, contri buted to the revival with a study published in 1875entitled Du somnambulisme provoquÃ©. Charcot's interest began in

earlier clinical work covered a variety of medical topics such as chronic rheumatism and the diseases of old age, but the abundance and nature of the clinical material allocated to him at the SalpÃªtriÃ¨re led Charcot inevitably to focus on neurology, neuropathology and patients suffering from epilepsy, hysteria and hystero-epilepsy (la grande hystÃ©rie). In the last 15years of his life, he became deeply interested in the controversial and ill-famed phenomenon of hypnotism, an unusual and professionally risky step, at this time, for an eminent physician. This was a period of gradual recrud escence of interest in hypnotism, after it had fallen into disfavour for two decades and had become coloured by charlatanism. Charles Richet, a Paris physiologist, contri buted to the revival with a study published in 1875entitled Du somnambulisme provoquÃ©. Charcot's interest began in 1878, probably influenced by Richet. In 1882, he gave a notable paper on the subject to the Academy of Sciences, entitled Sur les divers Ã©tals nerveux dÃ©terminÃ©s par l'hypnotisation che: leshystÃ©riques. This was a crucial turning point, allowing the old, discredited topic of "animal magnetism" to be studied and written about again, and it spawned numerous books and articles about hypnotism. In addition to the SalpÃªtriÃ¨re school of hypnotism developed by Charcot, there was another influential school at Nancy, started by Ambroise LiÃ©beault and led in the 1880s by Hippolyte Bernheim. Over the next decade, there was to be major divergence of opinion between these two schools and the bitter dispute was well described by Pierre Janet (1925), a close observer.1 Charcot believed that hypnosis was a pathological state or neurosis closely connected with hys teria, which he regarded as a degenerative disorder of the nervous system. He also held the erroneous view that only hysterics could be hypnotised and claimed to be able to reproduce and remove typical hysterical symptoms in hys terical patients using induced hypnosis. Bernheim, on the other hand, believed hypnosis was a psychological process brought about by suggestion. The Nancy school, which was to witness the crumbling of Charcot's doctrines, also attracted its own disciples and Freud made a pilgrimage therein 1889.
Charcot was an industrious writer, his most famous works including: Lectures on the Localisation of Cerebral and Spinal Diseases (English edition, 1883, by the New Sydenham Society); Lectures on the Diseases of the Nervous System (English editions, 1877-1889, by the New Sydenham Society) and the LeÃ §ons du mardi a la SalpÃªtriÃ¨re (1889-1892), one of two works by Charcot which Freud translated into German.2 Charcot founded the Archives de Neurologie and edited other journals. He was a charismatic, authoritarian figure with a strong likeness to Napoleon. He had wide intellectual and cultural interests, especially in art and archaeology. The breadth of his reading is clearly demonstrated in the core of what was once a remarkable personal library, now preserved at the SalpÃªtriÃ¨re. From the outset, Charcot's influence on Freud was remarkable and this is recorded graphically in Freud's letters to his future wife, Martha Bernays, during the course of the Paris visit. On 24 November 1885, for example, he wrote: "Charcot, who is one of the greatest of physicians and a man whose common sense borders on genius, is simply wrecking all my aims and opinions. I sometimes come out of his lectures as from out of Notre-Dame, with an entirely new idea about perfection. But he exhausts me; when I come away from him I no longer have any desire to work at my own silly things; it is three whole days since I have done any work, and I have no feelings of guilt. My brain is sated as after an evening in the theatre. Whether the seed willever bear any fruit, I don't know; but what I do know is that no other human being has ever affected me in the same way".3 Freud was clearly determined to catch the great man's attention and wrote excitedly to Martha about his contacts with him, the pros pects of translating some of his works and of visiting his home.
Charcot died in August 1893and obituarists eulogised his life's work. But he had generated also bitter enemies and critics, and it was his absorption in hysteria and hypnotism that evoked most disparagement. E.G. Seguin, for example, did not wait long after Charcot's death before observing at a meeting of the New York Neurological Society that, "his work in hypnotism, by which he was greatly fascinated in his later years, can only be regarded as a mere fragment, a digression which in the future would count as nothing.4 In fact his reputation did wane rapidly. In his attempts to investigate and explain the phenomena of hysteria and hypnotism, he adhered too rigidly to the same methods he employed in neurological disorders, and his belief in the organic model led him to underestimate the importance of suggestion. Methodological defects in his research emerged and it became clear that manipulation of patients by some of his pupils had played a part in the production of the hypnotic phenomena that were essential to his doctrine. He was largely disowned by disciples, such as Joseph Babinski, who later revised Charcot's concept of hysteria and coined the alternative term "pithiatism". Even Janet, one of his illustrious pupils and collaborators, whose thesis entitled Contribution Ã l'Ã©tude des accidents mentaux chez les hys tÃ©riques completed Â¡usi before Charcot's death, added to the mounting body of criticism. The vogue of hypnotism was over and the number of books and articles on the subject declined rapidly. In the 1925centenary celebrations of his birth by the Neurological Society of Paris, Charcot's studies of hysteria and hypnotism were given relatively little atten tion, and only brief mention in French medical weeklies, such as Paris MÃ©dical and La Presse MÃ©dicale. Similarly, the Commemoration at the Royal Society of Medicine in June 1925only referred in passing to hysteria and the psy chiatric implications of Charcot's work were ignored. There has not yet been a definitive biography of Charcot in which an objective evaluation is attempted of his influences on medical thought. Guillain's work (1959)5 is closest to a 'standard' biography. He attempts a rehabilitation of Charcot's work on hysteria and hypnotism, but the detailed account of his life and achievements lacks critical evalu ation. Owen's monograph (1971)6 emphasises Charcot's investigations into the neuroses, hypnotism and the psychology of suggestion and, amongst numerous other studies, Ellenberger (1970)7 andChertok (1984) Edinburgh had also been to Paris and was equally enthusi astic although T.S. Clouston, the Editor of the Journal, and Physician Superintendent of the Royal Asylum, Edinburgh, expressed "great distrust of the whole of Dr Charcot's conclusions". In fact, he went on to say he regarded "the motor phenomena as the best example yet described in medicine of suggested motor action in hysterical subjects with unstable brains, diminished voluntary inhibition, and a marked craving for notoriety". Such sceptical views were voiced individually all over Europe but they were not sufficient to dampen the chorus of acclaim for Charcot until the last few years of his life.
In the review of Lectures on the Localisation of Cerebral and Spinal Diseases in the Journal of 1884,it was noted that, "M. Charcot's treatises have long been favourites with English physicians" and complimentary remarks were made about the "original research, remarkable insight, and those powers of generalisation and of expression which are essential to a successful teacher."10 This high reputation was reflected again in a review, in 1888, of LeÃ §ons sur Â¡es Maladies du SystÃ¨meNerveux in which it was claimed that his investigations were familiar to all and "no one now alive has done more than M. Charcot to foster the spirit of research into the obscure problems of the nervous system".
The second part of this lengthy review was concerned largely with hysteria, especially traumatic male hysteria, a subject that fired Freud's imagination." Charcot had a remarkable gift for interpreting works of art from a neuro logical viewpoint. Reviews in 1888and 1890drew attention to two books written with Paul Richer on 'Les DÃ©moniaques dans / '/lÂ«'(1887), which arose out of his attempt to explain demoniacal possession as a form of hysteria, and Les Difformes et les Malades dans l'Art (1889). In this field, he also founded the journal, the Iconographie de Â¡a SalpÃ©triÃ¨re.

BULLETIN OF THE ROYAL COLLEGE OF PSYCHIATRISTS, VOL 1 1, MAY 1987
Apart from two further medical references, the last mention of Charcot in the Journal is a report in 1892,of a visit to the SalpÃªtriÃ©re, as well as to Nancy, by George M. Robertson, Assistant Medical Officerto the Royal Edinburgh Hospital, acting as the representative of Clouston.12 Robertson gave a lengthy account of how Charcot demonstrated the lethar gic, cataleptic and somnambulistic stages of hypnotism, and conducted experiments to display physical phenomena associated with hypnosis, "which worked with the precision that one expects in physics, but which one is quite unpre pared for in physiology". He attempted to explain the differences between the rival schools, concluding wisely that, "the phenomena of hypnotism vary according to the subject operated on". He recognised clearly that Charcot's cases were highly selected from patients suffering from pro found hysteria or hystero-epilepsy and that this was likely to influence the experimental findings. Robertson's paper was included in the documentary evidence in the final report (1893) of the Committee set up by the British Medical Association in 1891 "to investigate the nature of the phenomena of hypnotism, its value as a therapeutic agent, and the propriety of using it".
Neurologically-minded asylum doctors might have turned to Brain, first published in 1878.An original contri bution by Charcot and Richer appeared in 1885, "On a muscular phenomenon observed in hysteria, and analogous to the 'paradoxical contraction' ". Incidentally, in the same volume, there was a short paper by Freud describing a new histological method for studying nerve tracts, illustrating the importance of his neuro-anatomical researches, right up to the time of his visit to Charcot. There were a number of complimentary reviews of Charcot's books, but it was in a review of Paul Richer's seminal work, Ã‰tudes Cliniques sur l'hystÃ©ro-Ã©pilepsie, ou grande hystÃ©rie (1881) that particu larly interesting comments were made about Charcot's research weaknesses. Here, the editor of Brain, A. De Watteville observed, "much has been said about the influence of simulation and expectant attention in the causation of the phenomena attending hysterical manifes tations. Several writers in England, and elsewhere, who, by the way, did not always take the trouble of going over to Paris to investigate personally the question, have assumed that Professor Charcot and his disciples were entirely ignor ant of the sources of fallacy attending their researches". '3 It is difficult to know how fair the chiding comments were, although it is the case that there were few published accounts of visits to the SalpÃªtriÃ©re. More ambitious readers may have turned to the Journal of Nervous and Mental Diseases, in which there were frequent references to Charcot's work in the early 1880s. In 1883, for example, there was a joint paper with Richer, "Note on certain facts of cerebral automatism observed in hysteria during the cataleptic period of hypnotism".
General medical journals like the Practitioner and the British Medical Journal would have been major sources of information. In fact, Charcot's name featured regularly, throughout the 1880s, often several times a year in these two journals. He was an honorary member of the British Medical Association, attending a number of annual meet ings and he belonged also to the Royal Medical and Chirurgical Society of London. In the edition of the British Medical Journal carrying his obituary, there was a major leading article on "Charcot and Hypnotism", which dis cussed in detail the acrimonious struggle between the SalpÃªtriÃ©re and the Nancy schools. '* In his contribution to the British Medical Journal obituary, Sir Thomas Clifford Allbutt, Regius Professor of Physic at Cambridge and one of Charcot's old friends observed, "No Continental physician was ever more cordially esteemed by Englishmen â€"¿ not even Trousseauâ€"because none had been more open to English ideas or more familiar with English work, some of whichâ€"asthat of John Weirâ€"heedited in France. Often have I heard him indignantly repudiate the ignorant abuse of England which appears occasionally in the journals of France".15 In Britain in the 1880s, hypnotism tended to be looked upon with suspicion by the medical profession, despite the experimental work of the Society for Psychical Research established in 1882. The small number of physicians in psychological medicine who were keenly interested in cluded Daniel Hack Tuke, an Editor of the Journal of Mental Science and President of the Medico-Psychological Association in 1881.He wrote several articles on hypnotism in the Journal, he was a member of the Committee on hypnotism of the British Medical Association and referred to it fully in his books illustrations of the Influence of the Mind upon the Body in Health and Disease (2nd Edition, 1884) and Sleep-Walking and Hypnotism (1884). He was another friend of Charcot and, not surprisingly, he pre sented the great neurologist's doctrine in his Dictionary of Psychological Medicine (1892). This included sections on "Hypnotism in the Hysterical" and "Hysteria mainly Hystero-epilepsy", written jointly by Charcot with Gilles de la Tourelle and Pierre Marie respectively.16 It is interesting to note, however, that Tuke retained a "mainstream" entry on hysteria by Horatio Donkin, physician to the Westminster Hospital and the intention of asking Charcot "to contribute an article on hystero-epilepsy was to present English readers with the description of an affection which M. Charcot has made his own in an especial manner".
There is no doubt that, in the 1880s, Charcot was an influential figure in British medical circles, if only for his description of tabetic arthropathies (Charcot's joints). As this brief review has suggested, his pioneering clinical investigations in neurology and neuropathology would have been well known to regular readers of the medical journals, and his spectacular lectures and demonstrations must have made a popular talking point. But British asylum doctors definitely did not follow the Paris fashion of falling under his spell, and contemporary journals indicate that his pronouncements on hysteria and hypnosis were received with caution, often tinged with scepticism. Although British physicians did visit the SalpÃªtriÃ©re, the list of Charcot's famous pupils is notably lacking in any English names.
The international recognition of Charcot's work that followed his death bears testimony to his contemporary

History of the College
The College has recently published The Royal College of Psychiatrists, a short history written by Henry R. Rollin. It begins with a glimpse at the socio-economic history of the late 18th and early 19th centuries which provided the backcloth against which the Association of the Medical Officers of Asylums and Hospitals for the Insane came into being in 1841. The Association was translated into the Medico-Psychological Association in 1865 and then in 1926, having received a Royal Charter of Incorporation, it became entitled to style itself the Royal Medico-Psychological Association, the RMPA as it was known. In 1971, after lengthy negotiations with the Privy Council, a Supplemental Charter was granted and the Royal College of Psychiatrists came into being.
The booklet is elegantly produced and printed on fine art paper. The front cover is printed from an original watercolour by Dr J. Horder, and the text is illustrated by many reproductions of photographs and drawings of the College's founding fathers who have become the folk heroes of our specialty.
The publication is modestly priced at Â£2.00. Copies may be purchased from the Journal office.

Stoke Park Studies: Mental Handicap
The second supplement to the Stoke Park studies of 1930 and 1961 has recently been published. Written by Dr J. Janear, it updates the record of research and other contri butions to knowledge made by staffof the Stoke Park group of hospitals (Bristol) in the period 1981-1986.