Charcot’s Anglophilia

Jean-Martin Charcot was one of the most influential physicians of the nineteenth century and is now rightly considered the father of Neurology. The aim of this paper was to review and describe Charcot’s close relationships to Britain and the influence of this particular affinity on his career.


Introduction
Jean-Martin Charcot (1825-1893) was the first occupant at the Parisian Salpêtrière Hospital of the chair in Diseases of the Nervous System (Fig. 1). Using the anatomo-clinical method, he transformed the nosography of nervous disease and through his later studies on hysteria sowed the seeds for what would later become the schism between neurology and psychiatry [1][2][3][4][5][6][7].
His neurological service at the Salpêtrière was regarded as a "Mecca" for those interested in the study of ner-vous disease and his "Leçons du mardi" attracted physicians from all over the world [1][2][3][4][5][6][7]. Throughout his life, he was intrigued by British culture, and he had a good command of the English language. The aim of this paper was to review and describe Charcot's relationship to Britain and Ireland, emphasizing his many visits to England, Wales, and Ireland; the relationship established with his British colleagues; and his fondness for Anglo-Saxon literature, especially Shakespeare.

Charcot's Visits to Britain
The first recorded visit of Charcot to Britain occurred in 1861 when he visited several teaching hospitals in London and the Hunterian Museum of the Royal College of Surgeons [8,9]. He was a frequent delegate at the British Medical Association (BMA) conferences, the first of them being in 1869 when he was accompanied by Brown-Sequard (1817-1894) [8,9]. It was on this occasion that he listened to Russell Reynolds' (1828-1896) lecture on "Paralysis and other disorders of motion and sensation, dependent on idea," which would be an important stimulus for his theories and experiments on hysteria [10] The following year, Paris was besieged by the Germans, and the Salpêtrière hospital had to contend with the treatment of large numbers of patients who had contracted smallpox, cholera, and typhoid. In the infirmary, Charcot attended to French soldiers, some wounded in the fighting, and his valiant work was recognized after the war ended [11]. For safety, he sent his wife (Augustine Victoire Durvis) and 3 children (Jeanne, Jean-Baptiste, and his stepdaughter, Marie) to stay in London with their friends, the Casellas, a British family of Italian origin [7,8]. After the siege ended, Charcot went to London in 1871 and returned with his united family to Paris [8].
In 1872, he visited Dublin, as part of a French delegation of physicians. After fulfilling his formal obligations, as was his custom on overseas trips, he made a grand tour traveling from north to south [8,9]. At the BMA meeting of 1877 in Manchester, he lectured on the relationship between tuberculosis and caseous pneumonia. By popular request, he was asked to repeat his presentation the next morning. This success was narrated in letters to his wife: "[…] It was a true ovation that I had to face alone […] perhaps 1500 persons were present, men and women in full dress. I was showered with the most flattering regards" [8,9].
During the meeting, he presented a representative from the London College of Surgeons with a specimen of a neuropathic shoulder joint that survived the bombing of the college in the Blitz of 1941. At the end of the con-ference, Charcot traveled to explore the Lake District [8,9].
The seventh International Medical Congress took place in London in 1881 and was attended by 3,000 delegates (Fig. 2). Charcot gave a lecture on a case of multiple joint diseases resulting from locomotor ataxia (tabes dorsalis). As a visual aid, he presented a wax model of the joint of a 64-year-old woman, as well as multiple photographs. After the lecture, Sir James Paget (1814-1899) publicly announced that the name of this previously unheard condition would henceforth be referred to in English as Charcot's disease. At the congress dinner, Charcot, together with Pasteur (1822-1895) and Virchow , sat at the top table as distinguished members of the pantheon. Charcot sat two seats away from the Prince of Wales, who was introduced to him later that evening. To top off the celebration, a fireworks display took place, in which portraits of Jean-Martin Charcot, Sir James Paget, and Professor von Langenbeck (1810-1887) were shown in celebration [8][9][10].
Again, Charcot shared these honorific distinctions with his wife: "Yesterday I had a true ovation at the opening of the congress, when I was chosen to be among the most prominent personages going up to the platform […]." Interestingly, a similar report was made by Louis Pasteur to his own wife, even including the contact with the Prince of Wales at the dinner without a mention of Charcot's name [8].  In 1886, Charcot made his final appearance at a BMA meeting when he lectured alongside Hughlings Jackson (1835-1911) and Victor Horsley (1857-1916) on the subject of cerebral localization and the new specialty of neurosurgery. On a visit at the Queen Square Hospital, Charcot watched Horsley's operation on a meningioma [10].
In 1893, he was nominated by a French judge to conduct a medical examination with his colleague Brouardel (1837-1906) on Cornelius Herz (1845-1898) (Fig. 3), a man implicated in the infamous Panama corruption scandal. Herz had taken refuge in Bournemouth, and the French justice system had requested his extradition so that he could stand trial in Paris. However, his English medical advisers stated that he was unfit to travel to France on medical grounds. Charcot and Brouardel concurred that his poor health was indeed an impediment to travel, and he was eventually tried on the English south coast [8,9].
Besides traveling for academic and other medical purposes, Charcot also took leisure trips, often with his children. His wife disliked traveling and did not accompany them. In 1879, he traveled to England with Jean-Baptiste Charcot (1867-1936) his 12-year-old son, where they were welcomed by Mr. Casella and departed the next day to Cork. In 1883, Charcot endured an uncomfortable journey on the bumpy roads of Wales with Jean-Baptiste and his daughter Jeanne, claiming he almost broke his back in the traveling cart. Sketches, drawings, and letters by Charcot thoroughly document these trips [8].

Relationship with British Colleagues
Charcot was able to correspond in English with many eminent British physicians as well as keep up to date with the Anglo-Saxon medical literature [8,9]. Many of his own works were translated into English, including the first two volumes of his Lectures on diseases of the nervous system. Many of his lessons were later translated by his pupils and published in English journals, such as An account of a demonstration on the phenomena of Hystero-Epilepsy given by Professor Charcot, by Arthur Gamgee Charcot's final work, entitled La Foi qui guérit, was written at the request of the British periodical The New Review of London and was to be published in November 1892. However, a problem in the reception of the paper delayed its publication to January 1893, occurring 1 month after the French version was released in the periodical La Revue Hebdomadaire. This editorial imbroglio led to confusion in the English title, given that it was previously announced as Faith-Healing in 1892 and later as Faith-Cure in the 1893 published version [16].
An example of his wide reading of the English literature was in his commentary on James Parkinson's (1755-1824) studies on the "shaking palsy." Charcot acquired Parkinson's essay in 1887, and as there was no French translation of the work, he encouraged his assistants to translate the monograph. Charcot recognized Parkinson's seminal contribution in his Leçons du mardi despite its incompleteness and coined the name maladie de Parkinson as an alternative to paralysis agitans [17,18].
His knowledge also extended to the works of Thomas Willis (1621-1675), which had been largely forgotten in England [9]. One of his correspondents was John Hughlings Jackson. Charcot praised Jackson's contributions to the field of epilepsy and was the first to refer to "Jacksonian epilepsy." Jackson in turn recognized the impor- tance of Charcot's studies on spinal cord anatomy and physiology. Charcot's esteem for Hughlings Jackson was such that he kept a portrait of Jackson in his office [10]. It is also of note that both men shared similar political and philosophical views [7].
In 1878, he was elected, along with Louis Pasteur, as an honorary member of the British Medical Association [8]. He was also elected an Honorary Fellow of the King and Queen's College and Physicians of Ireland in 1887 as well as an Honorary Fellow of the Royal Society of Medicine in London, in 1891 [10].
His relationship with British neurology, his technical prowess in the English language, and his character traits were also praised in papers published in the British Medical Journal and The Lancet, one referring to him as an epitome of the "English gentleman" [8]. Charcot did however receive some criticisms from British colleagues, in relation to his later work on hysteria and the use of hypnotism. For instance, the British obstetrician Matthew Duncan (1826-1890) aggressively contested Charcot's statements about the ovarian trigger point for some hysterical symptoms during a BMA meeting in Cambridge. Charcot privately dismissed Duncan's criticism as derived from "someone whose knowledge did not extend beyond the pelvis" [19].
After Charcot's death, Anglo-French collaborations received further impetus from the Entente cordiale of 1904, in which a concordat to foster cultural and scientific exchange between the two countries occurred. Charcot's successor, Fulgence Raymond (1844-1910), was appointed the president of the Entente Cordiale Médicale and invited to give a lecture in 1908 in Oxford, in which he praised the many achievements of the early British neurologists and was later granted an honorific degree from the University of Oxford [10].
Although Charcot had a good relationship with his British colleagues, he showed restrictions toward some Anglo-Saxon habits. He abhorred the English blood sport of foxhunting because of his great affection toward animals. At home, he had 2 dogs (Carlo and Sigurd), plus a small female monkey (Rosalie), and during his entire life strongly opposed animal vivisection [20][21][22].
Shakespeare's works seemed to provide him with valuable professional insights, and he would make frequent reference to the Bard in his Leçons du mardi. Shakespeare would also come up frequently in the soirées held in his home in the evening [23][24][25].
Charcot was drawn to the phantasmagorical and appreciated Shakespeare's inclusion of ghosts, witches, and spirits in his tragedies and drew inspiration from his power of observation and philosophical inferences [25,26]. Examples of Shakespearean references at his lectures include somnambulism, in which the patients observed by Charcot [25][26][27].
In his lectures, he discussed the tremulousness of senility described by Shakespeare in Henry IV Part 1 and As You Like it [25][26][27]. In discussing functional abnormal movements, Charcot quoted "There is a method in their madness," from Hamlet [25][26][27].
In his later writings on faith-healing and miraculous cures, Charcot gently teases his colleagues' restricted thinking by quoting again from Hamlet: "There are more things in heaven and earth than are dreamt of in your philosophy" [25][26][27][28]. A quotation from King Lear was inscribed in his study at home: "As flies to wanton boys, are we to the gods/They kill us for their sport" [25][26][27][28]. His personal interest was such that his children and pupils regularly prepared and presented on St Martin's Day (November 11th) a short play based on Shakespeare's works, staged in Charcot's study, which he much enjoyed [25].

Conclusion
Charcot's conversance with the English language, his visits to Britain and Ireland, and his knowledge of the Anglo-Saxon medical literature all contributed to his reputation as one of the greatest clinicians of the nineteenth century. He was well ahead of his time in realizing the need to communicate his ideas on an international stage and the importance of reading the medical literature in English, German, Italian, and Spanish as well as French.