Jean-Martin Charcot and his vibratory chair for Parkinson disease

Christopher G. Goetz,MD

ABSTRACT

Vibration therapy is currently used in diverse medical specialties ranging from orthopedics tourology to sports medicine. The celebrated 19th-century neurologist, J.-M. Charcot, used vibra-tory therapy to treat Parkinson disease (PD). This study analyzed printed writings by Charcot andotherwritersonvibratorytherapyandaccessedunpublishednotesfromtheSalpeˆtrie`reHospital,Paris. Charcot lectured on several occasions on vibratory therapy and its neurologic applications.He developed a vibration chair for patients with PD after he observed that patients were morecomfortableandsleptbetterafteratrainorcarriageride.Hereplicatedthisexperiencebyhavingpatients undergo daily 30-minute sessions in the automated vibratory chair (fauteuil tre´pidant).His junior colleague, Gilles de la Tourette, extended these observations and developed a helmetthat vibrated the head on the premise that the brain responded directly to the pulsations. Al-though after Charcot’s death vibratory therapy was not widely pursued, vibratory appliances arereemerging in 21st century medicine and can be retested using adaptations of Charcot’s neuro-logic protocols.

Neurology

2009;73:475–478

Jean-Martin Charcot (1825–1893) was the most celebrated and powerful clinical neurologistof the 19th century.

His neurologic service at the Salpeˆtrie`re Hospital in Paris was the Meccaof clinical neurology, drawing worldwide students and visitors to his classroom lectures anddemonstrations. His teaching sessions on which his published lectures were based were pivotalfor the international recognition of new diagnoses and the discussion of promising therapies.Primarily an expert observer and pathologist, Charcot focused most of his teaching on theclear delineation of diseases. He was known for his dispassionate, emotionally distant, and evencold public demeanor.

As an extension of this image, one of his students, Le´on Daudet, son of the celebrated French author, stated: “He disdained therapeutic interventions, considering theirregularities of the human body as an astronomer would watch the movements of thestars.”

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This statement regarding therapy, however, is not accurate, and Charcot investedsubstantial energy to the testing of promising therapies.

He was likely the first to suggest theuse of anticholinergic drugs for the tremor of PD and also energetically advocated bromides foruse in epilepsy. He was willing to try therapies described by others, but quickly rejected boththe new suspension therapy imported from Russia and the longstanding tradition of bloodlet-ting as ineffective and dangerous. Though criticized as dictatorial and Napoleonic in posture,he was humble therapeutically and resisted desperate interventions, advocating observation andthe admission of failure if no reasonable and safe therapy was available.

In 1892, near the end of his career, Charcot delivered a lecture on the topic of vibratory therapy in neurologic disorders:

Vibration therapeutics: Application of rapid and continuous vibrations to the treatment of certain nervous system disorders

. The lecture was published in the widely circulated French journals,

Le Progre `s Me ´dical

and

La Semaine Me ´dicale

, then revampedand enlarged by his assistant, Gilles de la Tourette, and also translated into English.

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In hislecture, Charcot summarized the historical background of vibration therapy, and then focusedon his own clinical experience in PD. Charcot died 1 year later, and although Gilles de la

From the Department of Neurological Sciences, Rush University Medical Center, Chicago, IL.

Disclosure:

Author disclosures are provided at the end of the article. Address correspondence andreprint requests to Dr.Christopher G. Goetz, 1725 W.Harrison Street, Suite 755,Chicago, IL 60612cgoetz@rush.edu

HISTORICALNEUROLOGY

Tourette continued to study vibration ther-apy, Charcot’s observations were largely for-gotten. In the context of the availability of many vibration machines and their increasinguse in contemporary orthopedics, urology,and sports medicine, this article focuses onCharcot’s views on vibratory therapy, specifi-cally in regards to PD, the disorder he felt wasmost benefited from whole-body vibration.The source materials for this study includepublished works by Charcot and others, as well as archival documents in the Bib-liothe`que Charcot in Paris.

VIBRATION AS A THERAPEUTIC TOOL

Basedon earlier observations by his French colleagues, R.Vigouroux and M. Boudet, as well as the monographby Mortimer-Granville, Charcot noted that vibra-tions applied to the skin, joints, or full body could beuseful in ameliorating a number of neurologicdisorders.

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He cited these colleagues’ experience with neuralgias, the pains of tabes dorsalis, and head-aches. Tools included a wide variety of oscillatingmachines and equipment, some small and easily ap-plied to single body spots and others designed forshaking larger body parts or even the full body. Char-cot’s interest in PD and its potential sensitivity tovibration therapy was anchored in his observation:

I had long been told by patients with paralysis agitansthat they derived great relief from prolonged journeysby railroad or carriage. During these travels, the un-comfortable and often painful sensations implicit tothis disorder seemed to almost completely disappear,and the benefit persisted for some time after the journey.

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With this background, he suggested to his stu-dents that they could simulate the rocking of the car-riage cars in the Salpeˆtrie`re, and a Dr. Je´gu, with theassistance of an engineer, devised an armchair knownas the Chaire Tre´pidante (Fauteuil Tre´pidant) or Vi-bratory Chair (figure 1). The chair was provided witha special mechanism which, in Charcot’s words:

. . . Communicated rapid movements of oscillationaround anterior and lateral axes. These additive andopposing movements produced a trembling very close to what you experience when riding on the seatof an open wagon, as you yourself can judge by sit-ting in the chair.

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Charcot’s studies involved a series of patients withPD who underwent different durations of therapy atdifferent intervals. Based on these studies, he pre-scribed sessions lasting 30 minutes and daily to theextent of feasibility. The sense of well-being and itspost-treatment duration were proportional to thelength of the vibration therapy, but the 30 minuteslimit was important because patients risked develop-ing fatigue with longer treatments.The vibratory chair could be powered manually,but was easier to manage when powered by naturalgas, steam, electricity, or compressed air. He favoredpower mechanisms and designs that allowed the cli-nician to modify the frequency, direction, and inten-sity of the vibrations and was sensitive to individualpatient responses: “You know how individually PDpatients react and therefore it is essential to tailor thetreatment according to each subject.”

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Demonstrable improvement occurred after thefifth or sixth session and usually focused on the sen-sory symptoms and discomfort endured by patients with PD. Although this was shaking therapy for theshaking palsy, tremor itself was not prominently in-fluenced. The documented changes predominated ina feeling of greater lightness, less stiffness, and walk-ing improvements. Additionally, parkinsonian noc-turnal symptoms, discomfort, and sleep impairmentimproved. “An almost constant phenomenon—thenights become good; the patient who before was agi-tated incessantly in bed sleeps peacefully whichbrings him great satisfaction.”

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Charcot was encouraged by his observations, especially inlight of the very modest treatments otherwise avail-able. As he summarized, “It is no small gain to beable to relieve the sufferers of paralysis agitans, a dis-ease for which ordinary remedies have, as you know,so little efficacy.”

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Figure1Vibratorychair,variouslyknownasfauteuiltre´pidant,chairetre´pidante,tre´moussoir,orfauteuildeposte,wasdevelopedbyCharcotandutilizedattheSalpeˆtrie`rehospitaltotreatpatientswithParkinsondisease

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The international press embraced Charcot’s dis-covery. An article in the October 22, 1892,

Scientific American

reported on his findings in relation to PD:

These motions produce a series of very strong trepi-dations. It is the motion of the sieve for the sifting of industrial materials. There could be nothing moreinsupportable for a well person than such shakes which demolish you, put you out of order, and shakeup your intestines, and after a half minute’s experi-ence, you would ask for mercy. The invalid on thecontrary, lolls in the chair as you would on a soft sofa.The more he is shaken the better he feels. After asitting, he is another man. His limbs are relaxed, thefatigue has disappeared and the following night hissleep is perfect.

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HISTORICAL PRECEDENTS

The historical back-ground of the Vibratory Chair dated back to the18th century. The Abbe´ de St. Pierre developed thetre´moussoir or fauteuil de poste (vibrator or coachchair) after noting that patients with melancholia,liver disease, or other ailments improved in theirsymptoms after riding in a carriage over severaldays.

He constructed a stationary apparatus thatcould be mechanically shaken as a type of contempo-rary gymnastic equipment that could be used athome to provide physical activity to sedentary pa-tients. The device became popularized in reign of Louis XV, and Voltaire lauded its benefits in a letterto the Compte d’Argental in September 1744, writ-ing: “I am on the road to Champs, my dear friend;instead of dining, I spent some time in the vibratory chair of the Abbe´ of St. Pierre, and feel a bit better.”

Other references to the tre´moussoir can also befound in Flaubert’s

Bouvard and Pe ´cuchet

The physiologic relationship between vibrationand nervous system function was extensively dis-cussed in pre-19th century works, including the writings of Sir Isaac Newton and David Hartley,

as well in writings from Charcot’s era.

Charcot,however, was an empiricist and consistently steered away from abstractions and physiologictheories. His only comment on the mechanism of action of vibratory therapy was a succinct, but un-developed, conclusion: “It is certain that vibrationis acting as a powerful sedative force on the ner-vous system.”

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LATER AND FUTURE STUDIES

Charcot died in1893 and did not document further studies of vibra-tory therapy. His younger colleague, Gilles de laTourette, whose career Charcot fostered, pursued vi-bratory therapy, moving away from body shakingand focusing perhaps simplistically on brain vibra-tion instead. He developed a motorized helmet lined with adjustable steel plates to fit snuggly onto theskull (figure 2). Electrically powered on top, the mo-tor moved at a rate of 600 revolutions/minute to de-liver a constant vibration “naturally delivered to theentire cerebral apparatus.”

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Reports of its ap-plication in neurasthenia and migraine exist, butthere is no report of studies on patients with PD.Gilles de la Tourette’s career was short-lived after hismentor’s death, and he produced little scientifically important work; he was involved in a number of scandals and became erratic and mentally de-ranged. He was removed from medical service,likely dying of neurosyphilis.

Vibration therapy has not been pursued exten-sively in the treatment of PD since these 19th-century studies. Specific vibration therapy iscurrently used in diverse medical specialties rangingfrom orthopedics to urology to sports medicine.

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A number of vibrating products, some with seatingcapacity, are actively marketed on the premise of im-proving overall health, bone mass, and balance. Onestudy involving a small series of patients with PDfound that whole body vibration improved balancemeasures similarly to conventional physical therapy,but quantitative dynamic posturography measuresimproved only in the vibration group.

Further, in a1-day study of 5 1-minute full body vibrations inter-spersed with 1-minute rests, parkinsonian impair-ment scores improved by approximately 15% withsubscores for tremor and rigidity most affected.

Given that vibration equipment and objective ratingscales to test changes in parkinsonism and fatigueexist today, Charcot’s observations can be confirmedor refuted in a modern context. Clearly, such testing,however, requires both vigilance and scientific rigor,for as Charcot warned: “If you do not have a proventreatment for certain illnesses, bide your time, do what you can, but do not harm your patient.”