From hysteria to gait dementia: History of the concept of astasia-abasia

Paul Blocq (1860-1896) and his teacher Jean-Martin Charcot (1825-1893) introduced the expression "astasia-abasia" into medical terminology in 1888 to designate a pathology they believed to be caused by hysteria. This condition makes it impossible to remain erect and to walk, whereas the ability to move the legs while lying down remains normal. At the turn of the 20th century, and now almost exclusively, this motor disturbance is recognised as a syndrome with multiple possible organic causes, and now described as "higher-level gait disorder". After briefly mentioning earlier descriptions by other authors, I will review Charcot's Tuesday lessons in 1889 that covered astasia-abasia and elucidated the beginnings of the breakdown into organic aetiologies: medial-frontal and corpus callosum tumors, damage to the cerebellar vermis, lacunar state as described by Pierre Marie (1853-1940), Parkinson's disease, and Parkinson-plus syndrome. The long history of astasia-abasia reveals a cluster of neurologists, often emerging from oblivion herein and all of whom, through the precision of their clinical examinations and their pathophysiological findings, helped advance the understanding of the mechanisms by which human beings are the only erect, constantly bipedal mammals, whether immobile or walking.

Voices from the past: The pioneering use of the phonograph in neurology

Since its discovery by the American inventor and industrialist Thomas Alva Edison (1847-1931) in 1877, the phonograph attracted much interest in the field of medicine. This article describes the earliest pioneering examples of the use of the phonograph in neurology. In France, the use of the phonograph for obtaining audio recordings of delusions and speech or language disturbances was first proposed by Victor Maurice Dupont (1857-1910) in 1889 and in Italy by the physician Gaetano Rummo (1853-1917), who had studied at La Salpêtrière under Jean-Martin Charcot (1825-1893). The applicability of the phonograph to the record of speech disturbances was illustrated in England by John Hughlings Jackson (1835-1911) and William Halse Rivers (1864-1922), and by William Hale White (1857-1949) and Cuthbert Hilton Golding-Bird (1848-1939) in 1891. Since then, audio recordings have been used rarely in neurology, a branch of medicine where the visual aspects dominate, to the extent that inspection can be enough to reach a definite clinical diagnosis. In the mid-20th century, the advent of audio and video recordings supplanted audio recordings alone, relegating them to a very marginal role.

The locked-in syndrome: The early French descriptions

The classic 1966 description of locked-in syndrome was performed by Plum and Posner. Here, we revisit the world's first case report of this condition, which was presented in 1875 by Camille Darolles, an intern supervised by François Damaschino, at a monthly meeting of the Société Anatomique de Paris chaired by Jean-Martin Charcot. We also review the fascination of classic writers with this syndrome, including Alexandre Dumas, a genius of literature and known admirer of the medical sciences who, in the book "The Count of Monte Cristo" published in 1846, described a character with this condition.

Arnold Netter Netter (1855-1936) and infectious pathology of the nervous system

Arnold Netter (1855-1936) was a paediatrician who clinically applied the progress that his Pasteurian contemporaries had made possible through their bacteriological discoveries. From a neurological point of view, he brought looking for Kernig's sign into mainstream use to confirm the clinical diagnosis of meningitis and made diagnostic lumbar puncture systematic. He was one of the first to cure meningococcal and pneumococcal meningitis, long before the era of antibiotics, using subtractive lumbar puncture and intraspinal serotherapy. Netter's attentive vigilance enabled him to recognise, from its onset, the first poliomyelitis epidemic of the 20th century which took place in the summer of 1909. He described the clinical and epidemiological characteristics, identifying the viral rather than microbial origin. Netter detected the first cases of encephalitis lethargica in Paris in 1918. The disease had been described by Constantin von Economo (1876-1931) in Vienna the previous year. Netter spent fifteen years studying this new disease, which caused a pandemic a century ago. He filled in the clinical picture and used his understanding of cerebrospinal fluid and pathological anatomy to enhance knowledge and improve treatment of this neurological pathology.

A history of oculogyric crises during the encephalitis lethargica pandemic

A pandemic of what came to be known as encephalitis lethargica spread starting in the winter of 1916-1917 and continued into the 1930s. Neurological after-effects, namely permanent parkinsonian syndromes and various abnormal movements, permanently disabled the survivors of the one or two million victims, often children or young adults. Among them, a small proportion developed a symptom that was little known up to that point and that is currently exceptional: oculogyric crises; that is, a lateralised, dystonic upward movement of the eyes known as a tonic eye fit. This paper proposes a history of the recognition of this symptom, its inclusion in the neurological nosography, and the pathophysiological hypotheses postulated a century ago.

Louis Duménil (1823-1890), surgeon and pioneer in neurology

Louis-Stanislas Duménil (1823-1890) was a surgeon from Normandy who was a contemporary of Jean-Martin Charcot (1825-1893). Throughout his career, Duménil published annotated observations of neurological pathologies. One year before Guillaume Duchenne de Boulogne (1806-1875), he reported a case of "progressive muscular paralysis of the tongue, soft palate, and lips". He added five other cases of progressive muscular atrophy in 1867, together with histological examinations which showed atrophy in the anterior horns of the spinal cord. Charcot, who described amyotrophic lateral sclerosis, did not fail to pay homage to Duménil for his contribution. In 1862, Duménil added clinical observations of progressive locomotor ataxia, one of the first to do so. This included anatomopathological examinations, thus significantly completing the clinical picture presented by Duchenne in 1858. He confirmed the damage to the roots and posterior tracts of the spinal cord. Finally, by providing multiple observations of the syndrome described by Octave Landry (1826-1865) in 1859, he contributed to the clinical picture of "acute ascending paralysis" which has come down to us as Guillain-Barré syndrome, with no mention of the perspicacious physicians of the previous century who had already perfectly recognised this disease. Finally, Augusta Dejerine-Klumpke (1859-1927) paid a warm tribute to Duménil in her 1889 thesis, calling him one of the pioneers in understanding "the individuality and autonomy of the peripheral nervous system." He was indeed a pioneer, although he has been often overlooked.

Gayet-Wernicke Syndrome: The eye surgeon in a French neurologic eponym

Gayet-Wernicke syndrome is an eponym mainly used in France. In this article, we revisit Charles Gayet's (1833-1904) speciality and his patient example that gave rise to the eponym. Charles Gayet attributed the anatomical lesions to inflammation. However, they were mainly due to hemorrhage, as Wernicke's term "polioencéphalite supérieure aiguë hémorragique" (polio-encephalitis superior haemorrhagica) explicitly indicates. The pathology of Gayet's case did not involve the mamillary bodies, colliculi, or cerebellum. Gayet did not mention abnormal memory functions, which are also cardinal signs of Wernicke-Korsakoff's disease. We argue that the Gayet-Wernicke eponym is not merited and that the more common international term "Wernicke-Korsakoff syndrome" should be used in France as elsewhere in the world.

Percivall Pott (1713-1788) on the curvature of the spine and the French contribution

Physicians remember the name of the surgeon Percivall Pott (1713-1788) because of the eponym "Pott's disease", described as "paralysis in the lower limbs, which is often accompanied by curvature of the spine". Pott's writings on surgical subjects are far vaster. For example, he described the fracture-dislocation of the ankle, or Pott's fracture, and determined the cause of scrotum cancer in chimney sweeps. He attributed this disease to contact with tar that contaminated the clothing of workers, often very young children because they were small enough to fit into chimney conduits. His work led to the first law addressing the employment of children. After a brief account of Pott's life, this article presents the description of Pott's paraplegia, for which both Jean-Martin Charcot and Yvonne Sorrel-Dejerine paid him homage. The contribution of some of his predecessors and of French contemporaries is highlighted. Pott was also a pioneer in neurosurgery, describing the non-symptomatic interval between cranial trauma and coma and the indication for trepanation to remove a haematoma.

Louis Tanquerel des Planches (1810-1862) and the history of discovering lead poisoning in the nervous system

Louis Tanquerel des Planches (1810-1862) only left us with one significant medical work, his Traité des maladies de plomb ou saturnines (treatise on lead or saturnine diseases), published in 1839. The work served as a reference for diagnosing and treating lead poisoning throughout the second half of the nineteenth century. The word "encephalopathy" that he coined at that time referred to toxic damage to the central nervous system. Whereas for two millennia and for most physicians, lead poisoning was considered lead colic, i.e. paroxysms of abdominal pain, Tanquerel collected seventy-two observations of damage to the central nervous system in workers exposed to lead in Parisian workshops (which no longer exist). He then inventoried and described forms of paralysis, delirium, coma, and convulsions related to lead poisoning. Having no qualms about stepping away from La Charité Hospital where he had treated patients with lead poisoning, he inspected their workplaces and unambiguously presented the deplorable conditions that caused so many patients to die. His "preservative" advice was an initial attempt at medical-social prophylaxis with the goal of helping the working class exposed in workshops without any respect for human life. With support from chemists and pharmacists, Tanquerel showed the presence of lead in brain tissue and thus demonstrated its neurological toxicity as early as 1839. This article is also an opportunity to note the contributions on this topic of some other physicians: François-de-Paule Combalusier (1713-1762), François Victor Mérat de Vaumartoise (1780-1851), Jean-Louis Brachet (1789-1858), Auguste Mirande (1802-1865), Vincent Nivet (1809-1893), Augustin Grisolle (1811-1869), and Ferdinand de Bernard de Montessus (1817-1899).

The curious synalgia of Henri Gourdan de Fromentel (1858-1914)

In 1883, Henri Gourdan de Fromentel defended his thesis on an original topic that has not really been studied since. He examined the simultaneous perception of pain in two distinct and distant, but homolateral, areas of the body following a single stimulation on himself. In the discussion he compared his synalgia with other types of synaesthesia that did not involve pain and concluded that it was likely to be of central nervous system origin. After a brief account of Fromentel's life, this article discusses his thesis and a book on the subject he published five years later in the light of current understanding of the phenomenon and the proximity of synalgia and allachaesthesia.

The landmark contributions of Paul Blocq, Georges Marinesco, and Édouard Brissaud in Parkinson's disease

Two students of Jean-Martin Charcot, Paul Blocq and Georges Marinesco, presented a case of hemi-parkinsonism to the Société de Biologie on 27 May 1893. A tuberculoma was found at post-mortem in the cerebral peduncle contralateral to the side of the body affected by Parkinson's disease. A year later, in one of his lessons, Édouard Brissaud suggested that damage to the substantia nigra caused by the granuloma might have been responsible for the physical signs. This article provides brief biographical accounts of both Blocq and Marinesco and a detailed review of their seminal paper before going on to discuss how the substantia nigra was eventually established as the most consistent pathological substrate for Parkinson's disease and its role in the dopamine miracle which led to striatal dopamine replacement therapy in 1967.

The Marquise de Dampierre identified at last, the first described clinical case of Gilles de la Tourette syndrome

Among the observations of patients suffering from abnormal movements, Jean-Gaspard Itard (1775-1838) published the case of Madame D. in 1825. It was republished in 1885 as the first clinical case characteristic of the disease described by Georges Gilles de la Tourette in the seminal article leading to his eponym, still in use today. However, the actual identity of Madame D., known throughout the 19th century as the Marquise de Dampierre, has remained a mystery, until now. The 17 July 1884 edition of the literary periodical Gil Blas provided an important lead by detailing the behavioural disturbances in society of the "Countess Picot de Dampierre". Information from diarists at that time make it possible to confirm that this patient, known for her involuntary verbal outbursts, typical of coprolalia, in salons frequented by the 19th-century Parisian aristocracy was in fact Ernestine Émilie Prondre de Guermantes, her maiden name. She was born on 22 August 1800, and her married name was Countess Picot de Dampierre. She died on 08 July 1884. This article examines the life of this woman, her disease, her identification and the connection with the Duchesse de Guermantes, heroine of LaRecherchedutempsperdu written by Marcel Proust.

Armand Trousseau (1801-1867), a neurologist before neurology

Armand Trousseau is the emblematic figure of the prominent mid-19th century clinician, owing to the quality of his teaching and the influence of French medicine, which during his time brought students from around the world to Paris. A student of Pierre Bretonneau (1778-1862), the famous physician from the western French city of Tours, Trousseau carried forward Bretonneau's clinical description of infectious diseases, developing the notion of their contagion and paving the way toward the discovery of their microbial aetiology by Louis Pasteur (1822-1895) at the end of the century. His teachings, Les Leçons cliniques de l'Hôtel-Dieu, transcribed by his students, played a role in training young physicians for half a century. In this work, Trousseau covered several neurological diseases such as apoplexy, epilepsy, chorea, Parkinson's disease, and amyotrophic lateral sclerosis. The rich, Balzac-like detail of his clinical pictures would be unthinkable today. While he cannot be credited with any seminal descriptions in particular, some of his observations contain significant nuggets, such as a case of Gilles de la Tourette syndrome, twenty years before the seminal publication. After a biographical account, we will present the main lessons given by Trousseau on neurological subjects. One of Trousseau's little-known contributions is to have invited Guillaume Duchenne de Boulogne (1806-1875) to his department at the Hôtel-Dieu hospital, setting Duchenne on the path to becoming a pioneer of Parisian neurology.

A historical approach to hereditary spastic paraplegia

Hereditary spastic paraplegia (HSP) is a group of rare neurological disorders, characterised by their extreme heterogeneity in both their clinical manifestations and genetic origins. Although Charles-Prosper Ollivier d'Angers (1796-1845) sketched out a suggestive description in 1827, it was Heinrich Erb (1840-1921) who described the clinical picture, in 1875, for "spastic spinal paralysis". Jean-Martin Charcot (1825-1893) began teaching the disorder as a clinical entity this same year. Adolf von Strümpell (1853-1925) recognised its hereditary nature in 1880 and Maurice Lorrain (1867-1956) gained posthumous fame for adding his name to that of Strümpell and forming the eponym after his 1898 thesis, the first review covering twenty-nine affected families. He benefited from the knowledge accumulated over a dozen years on this pathology by his teacher, Fulgence Raymond (1844-1910). Here I present a history across two centuries, leading to the clinical, anatomopathological, and genetic description of hereditary spastic paraplegia which today enables a better understanding of the causative cellular dysfunctions and makes it possible to envisage effective treatment.

Marin Cureau de La Chambre (1594-1669), a 17th-century pioneer in neuropsychology

Marin Cureau de La Chambre (1594-1669) was a physician from Le Mans who advised and treated two French Kings, Louis XIII and Louis XIV, as well as his patron, Chancellor Pierre Séguier. As both a physician and a philosopher, he was among the first members of the Académie Française and the Académie des Sciences. His key role in dethroning Latin and using French in its place would have sufficed to ensure his notoriety, as French then became a vehicle for disseminating the sciences throughout Europe. However, it was his interpretation of "the functions of the soul" that made him a true pioneer in the field of neuropsychology, even though he has since been forgotten and overlooked. Indeed, he developed concepts that even today seem contemporary, in particular, concepts dealing with emotions and memory in both animals and human beings.

Yawning: a cue and a signal

Yawning behaviour has been associated with a variety of physiological and social events and a number of corresponding functions have been attributed to it. Non-directed (self-directed behaviour) and directed yawning (display behaviour) might nonetheless encompass all expressions of yawning, although it is difficult to differentiate one type from the other in a social context. Here we analysed more fully the data from a study in which four combinations of sensory cues were presented to pairs of either cage mate or stranger rats. The aim of the re-analysis was to demonstrate that non-directed and directed yawning might be identified by their distinctive functions. All pairs of rats used olfactory cues to recognise each other as stranger or cage mate companions, but only stranger rats used auditory cues to detect and respond to each other’s yawning. Increasing defecation rates (i.e. an index of emotional reactivity) inhibited yawning in cage mate rats such that yawning frequency reflected each rat’s physiological state. These results suggest that non-directed yawning functions as a cue in cage mate rats and directed yawning as a signal in stranger rats. We hypothesize that cue yawning might be a regulatory act that animals perform to adjust muscle tone for a coordinated change of state. Signal yawning might indicate the physiological capacity of rats in male-male conflicts.

Joseph Jumentié (1879-1928), a forgotten neurologist

Joseph Jumentié (1879-1928), through his clinical skill and expertise in anatomical pathology, enhanced the prestige of the master neurologists he studied under- Jules Dejerine, Augusta Dejerine-Klumpke and Joseph Babiński -and their fame overshadowed the crucial support that Jumentié provided them. Following a remarkable doctoral thesis in 1911, which defined the semiology of tumors in the cerebellopontine angle, Jumentié conducted research into various areas of neurology and authored numerous publications. The present report discusses, as examples of his work, his research on the cerebellum and brain tumors, as well as his contribution to Dejerine-Klumpke's use of serial sectioning to identify the 'fasciculi' of corticospinal tracts. This discussion is introduced by a brief biography illustrated by photographs, most of which have never before been published.

Louis Delasiauve (1804-1893), an alienist at the dawn of epileptology and pediatric psychiatry

This paper aims to honor the memory of the alienist Louis Delasiauve (1804-1893). His classification of the different types of epilepsy based on clinical symptoms is still relevant today and made him a precursor of contemporary epileptology. In 1851, Delasiauve clinically and etiologically isolated 'acute mental confusion' (acute confusional state) from all other forms of dementia. Never deviating from his republican and progressive ideals, he devoted himself throughout the 19th century to treating those insane asylum patients who received the poorest care: epileptics and children with intellectual disabilities. Studying functional cognitive disability as well as mental disability secondary to congenital malformations, Delasiauve developed a novel specific form of pedagogy to deal with delays in cognitive development. This made him one of the initiators of institutional pediatric psychiatry. His ideas would be carried forward by his favorite student, Désiré-Magloire Bourneville (1840-1909). Committed to social welfare, Delasiauve worked relentlessly to improve access to healthcare for the least fortunate throughout France. As a passionate supporter of universal, free and secular education, he participated in a major movement away from religious establishments that involved opening a public school in every French canton.

Jean-André Rochoux (1787-1852), a physician philosopher at the dawn of vascular neurology

Jean-André Rochoux (1787-1852) can be considered the author, in 1812, of the first clinical and neuropathological description of cerebral hemorrhage and ischemia, based on concepts that underlie current vascular neurology. His biography reveals how his thinking was shaped by materialist philosophy, which was also the basis of his rigorous scientific reasoning. Due to his intransigent defence of his philosophical ideas and his outspoken anticlericalism, he was often contradicted and had many opponents who were not inclined to perpetuate his memory after his death, despite the high quality of his medical research. Our biography traces the career of this iconoclastic thinker and physician ahead of his time.

Jean-Louis Brachet (1789-1858). A forgotten contributor to early 19th century neurology

Specialists of the history of hysteria know the name of Jean-Louis Brachet (1789-1858), but few realise the influence of this physician and surgeon from Lyon, a city in the southeastern part of France. Not only a clinician, he was also a neurophysiology researcher in the early 19th century. Along with his descriptions of meningoencephalitis, including hydrocephalus and meningoencephalitis, he elucidated the functioning of the vegetative nervous system and described its activity during emotional states. He also helped describe the different forms of epilepsy and sought to understand their aetiologies, working at the same time as the better-known Louis-Florentin Calmeil (1798-1895). We present a biography of this forgotten physician, a prolific writer, keen clinical observer and staunch devotee of a rigorous scientific approach.

1903 manuscript revived: Cerebral disturbances in multiple sclerosis (Des troubles cérébraux dans la sclérose en plaques) by Raymond Cestan (1872-1933) and Claudien Philippe (1866-1903)

Philanthropy aimed at helping medical research has been around for a long time. In the 19th century, cash awards were distributed by the French Academy of Medicine according to criteria determined by each generous donor. It was thus that Mrs. Bernard de Civrieux endowed the Academy each year with the task of supporting one or more laureates whose work furthered understanding of "nervous diseases". In 1903, Raymond Cestan (1872-1933) and Claudien Philippe (1866-1903) were selected for their dissertation on "cerebral disturbances" during multiple sclerosis with clinical as well as anatomical-pathological effects. Never published, this innovative manuscript, taken from the library of Fulgence Raymond (1844-1910), will be analysed here after a brief biography of each author.

Hand up! Yawn and raise your arm

BACKGROUND

In some cases of hemiplegia, the initiation of yawning is associated with involuntary raising of the paralysed arm. Reports are scarce in the literature, probably because the phenomenon has largely been overlooked.

METHODS

We studied six patients from two neurologic units, and compared them with published cases from the last 200 years. Brain imaging typically shows a small vascular lesion most often located in the internal capsule.

RESULTS

After comparison with experimental models in cats, we suggest that damage to the cortico-neocerebellar tract of the extrapyramidal system disinhibits the spino-archeocerebellar tract, enabling a motor stimulation of the arm by the lateral reticular nucleus, which harmonises both central respiratory and locomotor rhythms.

CONCLUSIONS

When phylogenetically primitive structures are disinhibited, they regain autonomy in the homeostatic process associating the massive inspiration of yawning--a form of behaviour that stimulates vigilance--with a motor control mechanism that is active during locomotion. For this phenomenon, we coined the term 'parakinesia brachialis oscitans'.

[The phylogeny, ethology and nosology of yawning]

Charles Darwin would have said that yawning was a useless piece of physiology. If so, then how should the survival of this very stereotyped behavior among the poikilothermal and homoeothermic vertebrates, from the basic brained reptiles to human primates, whether in the air, on the land or in the sea be understand? This issue of the ethnological, neurophysiologic and neuropsychological literature depicts yawning as being associated with an alternation of "awake-sleep" rhythms, sexuality, and nutrition, where it appears as a reference behavior of the mechanisms stimulating the state of vigilance. In pharmacology, yawning is used as an indicator of dopamine-ocytocinergic pathway activity, but in the Parkinson patient the neurologist sees it as an expression of therapeutic dopaminergic activity. J.M. Charcot and his school considered yawning as a clinical sign, long since forgotten. However, many patients complain about excessive yawning. Iatrogenic causes are the most frequent and can be found among many neurological diseases: vasovagal syncope, migraine, epilepsy, hypophyseal tumor, or stroke. Our ability to achieve motor and emotional behavior in resonance with others is deeply rooted in hominid evolution, and probably explains the strange phenomenon of contagious yawning.

La parakinésie brachiale oscitante

INTRODUCTION

In some cases of hemiplegia the onset of yawning is associated with an involuntary raising of the paralyzed arm.

PATIENTS AND METHOD

Four observations of this movement, which is seldom described probably because it is mostly neglected, were made in the neurology unit of the University Hospital of Poitiers. The descriptions were compared with other cases that have been published in the medical literature of the last 150 years. Cerebral imagery shows a lesion that is most often localized on the internal capsule. After comparison with experimental models in cats, it is proposed that the section of the cortico-neocerebellum tract of the extra-pyramidal system disinhibits the spino-archeocerebellum tract, enabling a motor stimulation of the arm by the lateral reticular nucleus, which harmonises central respiratory and locomotor rhythms.

RESULTS AND CONCLUSION

Some subcortical structures, that are phylogenetically more ancient, thus disinhibit regained autonomy in the homeostasis process associating the massive inspiration of yawning--a form of reflex behavior that stimulates vigilance--with a motor control that is active during locomotion. For this phenomenon we coined the term "parakinesia brachialis oscitans".