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Visual Art in the Neurologic Career

of Jean-Martin Charcot
Christopher G. Goetz, MD

\s=b\ Jean-Martin Charcot, the world's first Charcot's incorporation of art into were often long-winded, the drawings
chaired professor of neurology, incorpo- neurology guided and misguided his rapidly communicated a patient's
rated visual art into his daily practice of individual career and established a vi¬ changing neurologic state (Fig 1). Us¬
neurology. Art served as scientific docu- sual tradition in neurologic study that ing art, Charcot documented unusual
mentation and was a pivotal tool in the de- persists today, although in new tech¬ cases of dramatic amputees, pock¬
velopment and dissemination of Charcot's nologic forms. marked victims, and contracted hémi¬
clinicoanatomic method. Although Char- plégies as well as more typical cases of
cot drew extensively in clinical and labo- ART AS SCIENTIFIC DOCUMENTATION
vascular and neurodegenerative dis¬
ratory studies, very few of these visual Charcot's dual devotion to art and eases (Fig 2).
documents have ever been published or science was reportedly lifelong, and he The second step of the clinicoana¬
are currently available for public study. had wrestled between medicine and tomic method, which focused on ana¬
Charcot was central to the incorporation art as careers.1 Charcot finally chose tomic and microscopic analyses, oc¬
of medical photographs into the study of medicine and enrolled in the national curred after the patient died. Here,
neurologic disease and relied heavily on medical school in Paris in 1842. There too, Charcot used his artistic skills and
visual material in his capacity as an inter- is almost no documentation of his stu¬ later engaged professional artists. He
national teacher. Art also misguided Char- dent years, and his first known medical traced lesions throughout the neuraxis
cot's career when he relied heavily on art- drawings date from when Charcot and documented vascular anomalies in
work in his attempt to convince critics that came to the Salpêtrière as a junior detail (Fig 3). His early drawings were
disorders seen at the Salp\l=e^\tri\l=e`\reHospital, faculty member. Almost none of Char¬ among the first to document the mi¬
Paris, France, were independent of his cot's clinical drawings have ever been croscopic changes of multiple sclerosis
suggestive influence. published, and they are not available and the spinal changes of amyotrophic
(Arch Neurol. 1991;48:421-425) for public viewing. lateral sclerosis (Fig 4).
After arriving at the Salpêtrière, Charcot's self-appointed charge was
Asa physician at the Salpêtrière Charcot's first task was to examine and to be an objective observer, articulate
**
Hospital, Paris, France, and the categorize the thousands of patients and clear, independent of preconceived
world's first chaired professor of neu¬ haphazardly housed together through¬ prejudice or expectation.3 His personal
rology, Jean-Martin Charcot consid¬ out the walled hospital village of the artistic preferences focused primarily
ered art and science to be pivotally Salpêtrière. With his colleague, Vulpi- on the Dutch masters, whose realism

complementary in his effort to de¬ an, Charcot gathered a massive clini¬ revealed the world with simplicity and
scribe and categorize neurologic dis¬ cal database of neurologic and geriat¬ unadorned clarity.4 His own personal
ease. Science nourished art as Charcot ric diseases. This material became the artistic style reflected his scientific
used his own patients as models in his core of Charcot's clinicoanatomic approach to clinical neurology. His
neurologic sketches and photographs; method, the hallmark of his Salpêt¬ most distinguishing clinical charac¬
art nourished neurology as Charcot rière school.2 teristic was a keen ability to see the
used art objects from past ages to con¬ The two-step clinicoanatomic essential features of diseases, culling
vince critics that certain of the disor¬ method involved artistic documenta¬ them from among the confusion of de¬
ders he sometimes described were nei¬ tion in both phases. The first step tail. He likewise sketched with an
ther new nor of his own creation. focused on clinical description of neu¬ economy of line that permitted view¬
rologic disease, and Charcot's patient ers to grasp essential features at a
Accepted for publication September 13, 1990.
From the Department of Neurological Sciences,
drawings documented the static defor¬ glance. Whereas his artworks showed
mities of chronic cases as well as evolv¬ little artistic refinement, they were ef¬
Rush-Presbyterian-St Luke's Medical Center,
Chicago, Ill. ing signs of acute illnesses. Whereas fective documents of immediate visual
Reprints not available. the notes accompanying the drawings impact. He drew patients wherever he

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brary, Boston, Mass. Such pictorial
documents formed the foundation of
two of Charcot's major neurologic en¬
terprises, the Iconographie Photo¬
graphique and the Nouvelle Iconogra¬
phie de la Salpêtrière. The former was
a limited edition of hand-pasted pho¬
tographs documenting the various dis¬
orders, primarily epilepsy and hyste¬
ria, seen in the Charcot service. The
latter replaced this set with a larger
circulation journal with neurologic ar¬
ticles based specifically on photo¬
graphic or artistic documentation. In
the introduction of the first volume of
the Nouvelle Iconographie de la Sal¬
pêtrière, the editors wrote:
When a patient demonstrates signs of par¬
ticular interest—various atrophies, con¬
tractures, special postures or deformities-
he is immediately drawn or photographed.
With the aid of this immediate record, we
are able to freeze the abnormality, to de¬
Fig 1.—A drawing from a series of sketches in the hospital record of a patient with a cerebrovas¬ compose the various abnormal movements
cular accident, stressing here the head and eye deviation with prominence of the stemocleido- one by one, and thereby capture the disor¬
mastoid muscle (original drawing in Bibliothèque Charcot, Salpêtrière Hospital, Paris, France). der with precision. These vignettes from
the Salpêtrière complement the clinical ex¬
amination to form a collection of great
significance.7
Contemporary journals based on pho¬
tography or videotape (eg, Movement
Disorders) are modern descendants of
this Charcot tradition.
ART AND TEACHING

The incorporation of an artistic ef¬


fort in the Charcot service had impor¬
tant consequences not directly linked
to scientific documentation. Visual
material, by nature, extends beyond
language barriers and bypasses tech¬
nical medical terminology. It can at¬
tract attention and provoke inquiry
that might be passed over in a dry ac¬
count of written neurologic descrip¬
Fig 2.—Patient with decerebrate rigidity (original drawing in Bibliothèque Charcot, Salpêtrière tion. When Charcot started his faculty
Hospital, Paris, France). career, he was acutely aware that the
Salpêtrière was considered far from
central Paris and that it carried the
saw them, and even when he was on of their neurologic evaluation. stigma of an academic wasteland, "an
vacation or on foreign travel, neuro¬ Whereas those with static findings exile in a lost land where the patholo-
logic disease did not escape his eyes. were photographed only once or twice gists and clinician had very little to
For example, he sketched a North Af¬ at differentangles, the photographers see."8 To attract students, Charcot
rican with Parkinson's disease, cap¬ became increasingly adept at docu¬ compiled a series of rehearsed-to-per-
turing in his hasty strokes the hand menting dynamic disorders with se¬ fection lessons on selected medical top¬
posture, body attitude, joint deformi¬ quential and time-lapse photography ics. He incorporated all his resources
ties, and masked facies typical of the methods (Fig 6). Charcot even spoke of in these efforts, and each year their
disease (Fig 5). himself in photographic terms: "I only appeal grew wider. His drawings,
CHARCOT AND PHOTOGRAPHY observe, nothing more," and "I am a charts, and theoretical constructs
photographer."6 were presented in multicolored spec¬
Charcot's artistic interests were un¬ The Salpêtrière photographs were tacle. Fifteen years before the better
doubtedly at the core of his immediate printed on positive silver plates, and known aphasia diagrams of Lichteim
appreciation of the new art of photog¬ several thousands of them were gen¬ were created, Charcot presented his
raphy. Under his direction, a photo¬ erated during Charcot's career. Some audience with an elaborate series of
graphic service at the Salpêtrière was of these and many more from the drawings involving a bell as the cen¬
established 'by Londe,5 and patients period after Charcot's death are today tral theme (Fig 7). Charcot was among
were regularly photographed as part housed in the Countway Medical Li- the first teachers to use slide projec-

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Fig 4. Denuded axons and maintained neu¬
rons multiple sclerosis. Drawn by Charcot
in —

and published in his Oeuvres Complètes.

Fig 3.—Charcot's autopsy diagram of an aneurysm, drawn in red and black, and accompanying
clinical notes and medical drawings of the patient (original drawing in Bibliothèque Charcot, Sal¬
pêtrière Hospital, Paris, France).

Fig 5.—A drawing by Charcot of a Moroccan


with Parkinson's disease (1889). "I have seen
such patients everywhere, in Rome, Amster¬
dam, Spain, always the same picture."3

cine was weak, the visual material was


Fig 6.—Londe5 photographing a patient in her room at the Salpêtrière Hospital, Paris, France. The
photographic service was a regular part of the neurologic evaluation and research effort under undoubtedly pivotal to effective com¬
Charcot's direction (from La Nature, No. 536; Paris, France: Bureaux du Progrès Médical; 1892. munication. As the American Alan
Starr recalled when he first saw Char¬
cot in a classroom:
But grant that it was theatrical; it left on
tors in his classroom. He brought stat¬ Paris medical system to the foreign the mind of the student a series of mental
ues, photographs, and patients them¬ medical world and to nonmedicai Paris pictures of patients and of lessons which no
selves asvisual documents. He also society. Especially in the 1880s and in amount of private study could possibly pro¬
was an excellent mime and recreated his last years, Charcot's classroom was duce. It taught man so that they could not
clinical syndromes for his audience, a mélange of doctors from eastern and fail to remember; and what higher result
can a teacher wish?9
including gait abnormalities, parkin¬ western Europe and the Americas, as
sonism, tic disorders, and various well as Parisian artists, journalists, Clearly Charcot was not the first or
types of weakness.2 politicians, and social commentators. the only investigator to use medical il¬
Charcot's reputation of magnetic For many of these people, whose fa¬ lustration and visual arts as a means
presentations extended beyond the miliarity with French or with medi- of medical documentation. His con-

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Fig 7.—Diagram of a bell used by Charcot in Fig 8.—Cover from Charcot's and Richer's Fig 10.—Charcot and his patients. This picture
his presentations on aphasia. IC indicates Demonios in Art, showing one of the drawings was on the cover of the Paris tabloid Revue Il¬
center for ideas; CAC, auditory center; CVC, used by the authors to support their thesis that lustrée and shows the extent to which Charcot
visual center; CAM, auditory center for words; hysterical epileptic fits were not a new disorder became a popularized figure in nonmedicai so¬
CVM, visual center for words; CPM, phonetic nor were they behaviors found only, or pre¬ ciety (from Countway Medical Library, Harvard
center for words; and CGM, graphic center for dominantly, at the Salpêtrière Hospital, Paris, University, Boston, Mass).
words." France.

and befuddled physicians before


him.10·" In working with hysteria and
attempting to apply the clinicoana¬
tomic method to a condition with an
elusive lesion, Charcot drifted in the
eyes of his contemporaries. Visiting
physicians did not recognize the spells
he demonstrated in the amphitheater
of the Salpêtrière, and, because the
spells were too dramatic to be missed
if they actually existed elsewhere, crit¬
ics contended that they must be
feigned or created by Charcot's own
powerful suggestion. Charcot was
keenly aware that hysteroepilepsy be¬
came derisively known as the Salpêt¬
rière illness.6
To address this criticism and rescue
his compromised scientific reputation,
Charcot called on art in a way he had
never previously used it. While lectur¬
ing to his students that hysteria "must
henceforth become a household
Fig 9.—A clinical lesson at the Salpêtrière Hospital, Paris, France, by Brouillet, prepared for the word,"12 he looked to art to demon¬
1887 Paris Salon and showing Charcot, Babinski, Marie, Tourette, and other physicians, as well strate that the behaviors he saw were
as artists, social commentators, and government officials in attendance. independent of him. He went outside
the Salpêtrière, beyond medicine, and
indeed out of the time constraints of
temporaries Gowers and Hughlings ART AS SCIENTIFIC JUSTIFICATION his own era to j ustify his stand that the
Jackson included their own medical signs of hysteria were implicit to the
drawings in their text. Charcot, how¬ In the sphere of organic neurology, disease and not to the observer. At a
ever, used visual arts in every aspect of Charcot's clinicoanatomic method met time when he relegated much of his
his daily work effort. Art at the Sal¬ with repeated successes and estab¬ publication material to students, he
pêtrière was inseparable from the sci¬ lished him and his school as the inter¬ embarked on two major works on neu¬
entific effort and was as much the em¬ national pillars of clinical neurology. rologic disease in art, The Disease and
bodiment of the clinicoanatomic In the 1870s and thereafter, however, Deformed in Art and The Demonios in
method as any other neurologic activ¬ he increasingly devoted his attention Art, both largely focusing on hysteria
ity under Charcot's direction. to hysteria, a topic that had haunted (Fig 8). These works were pointedly

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aimed at repudiating suspicions of ma¬ this dimension to his career should not CHARCOT'S NEUROLOGIC ARTISTIC
nipulation of falsification of clinical be underestimated, for Charcot came LEGACY
medicine. from very humble origins. If a certain
In them, Charcot demonstrated that underlying cultural insecurity existed, In 1893, when Charcot died, the Sal¬
behaviors similar to those seen at the his extensive literary references to po¬ pêtrière service included artists, sculp¬
Salpêtrière could be found in medieval etry and Shakespeare and his artistic tors, photographers, and a team of
and mannerist paintings and other allusions that spanned the centuries of young neurologists well versed in vi¬
artworks depicting demonic posses¬ western culture obviously helped sual documentation. Thereafter, the
sion or spiritual ecstacy. Charcot, how¬ Charcot to present himself as a man of photographic wing actively continued
ever, did not succeed in accomplishing Renaissance dimension.215 He also for several generations, and the Nou¬
his goal, and he did not convince scien¬ posed as the focal point for an im¬ velle Iconographie de la Salpêtrière
tific skeptics that his personality was mense group portrait by Brouillet, "A was published until 1929. In the 1950s,
not intimately connected to the behav¬ Clinical Lesson at the Salpêtrière" however, the Charcot Museum, with
iors seen at the Salpêtrière.13 In fact, (Fig 9), a painting that became part of its extensive documentation of the Sal¬
Charcot's mere reliance on religious the celebrated 1887 Paris Salon, the pêtrière visual effort, was dissolved
art that was doubtfully conceived or focal point of artistic Paris at the and the collection was lost or
executed with objectivity as its guiding time.16 His name was known to the dispersed.2 A pivotal investment in vi¬
force and the glaring lack of historical public, and he was even pictured on the sual medical documentation is no
or genre painting to support his thesis cover of a popular street tabloid sur¬ longer specifically linked to the Salpêt¬
suggest a certain intellectual despera¬ rounded by his patients (Fig 10). These rière, nor has it been for the past 70
tion in a man otherwise so perceptu¬ documents demonstrate that by the years, and more recent international
ally acute. In the end, Charcot appar¬ close of his career, Charcot, the Sal¬ generations have developed innovative
ently recognized that his efforts had pêtrière, and neurology had entered applications of scanning devices, vid¬
failed. The last night he worked on into the current social consciousness of eotaping, and other technologies that
scientific material before he died, he the time. In these ways, art served continue Charcot's tradition of visual
reportedly told Guiñón14: "Our concep¬ Charcot directly to broaden his image neurologic documentation. These tech¬
tion of hysteria has become obsolete. A and to solidify him as a cultural as well niques are pivotal to the continued ap¬
total revamping of this area of neuro¬ as a scientific figure of French society plication of the clinicoanatomic neu¬
logic disease is required." in the glittering close of the 19th cen¬ rologic method and to the refinement
ART AS SOCIAL VEHICLE tury. Without this dimension and the of modern neurologic nosology. As the
close political ties that Charcot culti¬ centenary of Charcot's death ap¬
In spite of his failure to justify sci¬ vated with Gambetta and other gov¬ proaches and the neurologic world in¬
entific credibility through art, Char¬ ernmental figures of the third French vests increasingly in reexamining his
cot's artistic projects were of signifi¬ Republic, one could question whether written legacy, the "visual Charcot"
cant personal and social benefit. With the original chair of neurologic dis¬ deserves emphasis because it coalesces
them, he effectively presented himself eases would ever have been established neurologist, teacher, social figure, and
as a multitalented and culturally so¬ as early as 1882, and specifically in private citizen without needed gram¬
phisticated man. The importance of Paris at the Salpêtrière. matical translation or language study.

References

1. Guillain C; Bailey P, trans. J. M. Charcot: His ber 30, 1888.


Life\p=m-\His
Work. New York, NY: Hoeber; 1959. Richer P, Tourette G, Londe A. Advertisse-
1888.
7. 13. Gowers WR. Epilepsy and Other Chronic
2. Goetz CG. Charcot: The Clinician\p=m-\The ment. Nouv Iconogr Salp\l=e^\tri\l=e`\re.1888;1:i-ii. Convulsive Disorders. London, England:
Tuesday Lessons. New York, NY: Raven Press; 8. Raymond F. Le\l=c;\ond'ouverture. Prog Med. Churchill; 1881.
1987. 1894;20:399-407. 14. Guinon G. Charcot intime. Paris Med.
3. Charcot JM. Le\l=c;\onsdu Mardi, 1887-88. Paris, 9. Starr A. Charcot. In: The Physician 1925;26:511-526.
France: Bureaux du Progr\l=e`\sM\l=e'\dical;January 31, Throughout the Ages. New York, NY: Capehart\x=req-\ 15. Goetz CG. Shakespeare in Charcot's neuro-
1888. Brown; 1928:559-562. logic teaching. Arch Neurol. 1988;45:920-921.
4. Meige H. Charcot\p=m-\artiste.Nouv Iconogr 10. Trillat E. Histoire de l'hyst\l=e'\rie.Paris, 16. Signoret JL. Une le\l=c;\onclinique \l=a`\la Salp\l=e^\t-
Salpetriere. 1898;2:489-516. France: Seghers; 1986. ri\l=e`\re(1887) par Andr\l=e'\Brouillet. Rev Neurol
5. Londe A. Le service photographique de la 11. Laseque C. Etudes m\l=e'\dicales.Paris, France: (Paris). 1983;139:687-701.
Salp\l=e^\tri\l=e`\re.Paris,
France: Doin; 1892. Asselin; 1884. 17. Charcot JM. Differenti forme d'afasia. Mi-
6. Charcot JM. Le\l=c;\ons du Mardi,1887-88. Paris, 12. Charcot JM. Le\l=c;\onsdu Mardi, 1887-88. lan, Italy: Casa Editrice Dottore F. Vallardi; 1884.
France: Bureaux du Progr\l=e`\sM\l=e'\dical;February 7, Paris, France: Bureaux du Progr\l=e`\sM\l=e'\dical;Octo-

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