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J. A. (Joel Asaph) Allen.

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joints, chronic articular rheamatism. This first production of
Charcot showed him to be a careful, painstaking worker and
observer, and as a result he was made chef of the medical clinic from
1853 to 1855. At the end of his term of service he was appointed
physician to the Bureau Central, and four years later passed his
examinations as Agreg^ of the medical faculty of Paris- This
position is similar to the Pri vat Decent of the German universities,
and may be compared to the lecturers on special subjects of our
American medical colleges. His thesis as Agreg^, on chronic
pneumonia, has been often referred to and quoted. In this thesis
he describes that form of pneumonia which is designated chronic
ulcerated pneumonia.

In 1862, Charcot returned to the Salpetriere as chef of the ser-
vice. At this time the Salpetriere was nothing but an out-of-the-
way asylum for old, chronic, broken-down cases, patients who were
thought not to be worth the time and trouble to thoroughly exam-
ine and scrutinize. It was not long, however, before Charcot,
associated with his able friend, Yulpian, discovered that these
chronic castaways were diamonds in the rough, and needed but a
master hand, guided by a master mind, to reveal their significance
and utility to the scientific world. The old stagers were carefully
examined, assorted, their clinical histories thoroughly written out^
abnormalities and disturbances of motion photographed, chemical
and microscopical examinations of the excreta were made from
time to time, and the information thus gained was pigeonholed,
ready for additions and for perusal at the autopsies. These were
made with as much care and precision as are many of our major opera-
tions of today, and the diseased organs were subjected to a most
conscientious microscopical examination. Not only were the
pathological changes noted, but to a greater extent were those
organs which had not undergone pathological change. Thus
armed with the symptoms of disease and the diseased and healthy
organs and tissues under the microscope, it was an easy task for
this man to clear up and efface many of the illusions of medicine
which had existed up to that time.

After an inventory of years, in which time the Salpetriere had
become one of the best known of the Paris hospitals, Charcot
believed that he could better impart the information thus gained
by inaugurating a course of lectures and presenting the patients



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584 KBAUSS: THE LIFE AND WOBK OF CHABCOT.

before the class. These were especially devoted to pneumonia of
the aged, chronic rheumatism, and gout, and were attended by an
appreciative and admiring throng of students. The following
year he delivered his lectures at the !6cole Pratique, on Hemor-
rhage and Softening of the Brain, and made the important discov-
ery that cerebral hemorrhage was due to the bursting of miliary
aneurisms along the cerebral arteries, the result of a periarteritis.
The year 1868 was devoted to the study of paralysis agitans and
sclerose en plaque (multiple sclerosis). Many of the disputed points
of the former disease were cleared away, besides making new addi-
tions to the symptomatology, such as propulsion, retropulsion,
the characteristic tremulous movements of the extremities, absolute
freedom of the head, except when the movement is transmitted
from the body and extremities. Charcot has objected strenuously
to the term paralysis agitans, inasmuch as the tremor may be
absent altogether and the only symptoms present be the stiff-
ness and weakness of the muscles. Multiple sclerosis, or
the presence of scattered islets of sclerosis in the brain and
spinal cord, was illy known and almost unrecognized until
the classical descriptions of the symptomatology and pathology
by Charcot, assisted by Vulpian. Charcot distinguished three
forms of this disease, the cerebral, the spinal and the cerebro-
spinal, according to the situation of the sclerosed patches. Little
has been added to the description as given by Charcot, and, per-
haps, the only symptom that has not been universally accepted in
that description is the severe vertigo which Charcot found in
seventy-five per cent, of his cases.

In his course of lectures delivered in 1869, Charcot treated of
the pathogenesis, the diagnosis and prognosis of cerebral apoplexy.
These lectures were not reported, although they contained many
new points which have since been incorporated in theses by
internes of the Salpetri^re. In this year, Charcot called attention
to the importance of thermometry in the diseases of old age, and
it is principally to his efforts that the clinical thermometer was
vulgarized in France. It was also in this year that Charcot first
described the peculiar joint affections occurring in locomotor
ataxia; the affected bones become brittle, resulting'in spontaneous
fractures, erosion of the cartilages, adhesions between two joint
surfaces, ossification of ligaments, etc., take place. This condition
is known as Charcot's joint disease, a term applied to it by the
English writers. Charcot was a bitter opponent to the Foumier-



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KBAUSS: THE LIFB AND WORK OF GHABCOT. 585

Erb doctrine, that tabes is of syphilitic origin, but taught that it
belonged to the great family of nervous diseases, the seeds of
which are transmitted by heredity. It may be remarked here that
the Argyl-Robertson pupil (refusal of the pupil of the eye to
react to light and darkness) was first discovered at the Salpetri^re
by two of Charcot's pupils, Vincent and Congt. Disputed points
in the pathology and advances in treatment were also ably con-
sidered, and especially the re-introduction of the suspension method »
which gives, perhaps, as much satisfaction and relief as any method
of treatment in locomotor ataxia. In 1869, Charcot, associ-
ated with Vulpian lind Brown-S^quard, founded the Archives
de Physiologie, the ablest and most influential medical jour-
nal in France, and with the possible exception of Virchow^s
Archives — the ablest on the continent. During the Franco-Ger-
man war Charcot, besides his regular duties at the Salpetri^re,
assumed charge of a small-pox hospital and hospital barracks. It
may be noted here that he was the court physician of Napoleon
III. for many years, and in sympathy ever afterwards with the
royalists. The service at the Salpetri^re was divided into three
divisions after the war, owing to the vast increase in numbers, and
to Charcot was assigned the hysterical and epileptics. In 1872, he
was appointed professor of pathology in the University of Paris,
a position which he held until 1881. During this time he pub-
lished his observations on diseases of the lungs, liver and kidneys^
albuminuria, diseases of old age, and on cerebral and spinal locali-
zation. His discovery of the asthma crystals, the presence of
octahedral crystals in the blood, spleen, bone marrow, and other
organs of leukemic patients, his contributions to the pathology of
hepatitis, cancer of the lungs, gout, arthritis deformans, etc., show
him to have been as good an observer in general pathology as in
neuropathology. In 1882, the chair of nervous diseases was created
in the faculty of the University of Paris, and Charcot had the
honor of being appointed professor. His attention was directed
now entirely to his chosen work, and as a result we have the crea-
tion of the modem malady hysteria, its symptomatology, different
stages, different forms, its historical importance, modes of treat-
ment ; in short, about all we know positively concerning hys-
teria we owe to Charcot and his pupils. To enumerate all the
advances which he instituted in neuropathology, would require
more time, more paper, and more ability, than are at my
command — in fact, it would mean an almost complete treatise on



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586 KRAUSS: THE LIFE AND WORK OF CHARCOT.

neurology. I will, therefore, review briefly the more important of
his discoveries, which will give you some idea of the grandeur of
his life's work. In 1871, he first described pachymeningitis cervi-
calis hypertrophica, which was at once accepted as a clinical and
pathological entity. In 1874, he described a new disease which
he designated amyotrophic lateral sclerosis, sometimes called Char-
cot's disease, with such clearness as to symptoms, course and
pathology that the German and English writers adopted the name
and disease without even the slightest protest. So thoroughly
were these two last affections delineated that scarcely a word has
been added to the original descriptions. In 1875, Charcot and
Erb described simultaneously an affection — met with particularly
in children — characterized by paresis of the extremities associated
with exaggeration of the tendon reflexes. Charcot designated this
disease tabes dorsalis spasmodique, Erb, spastic spinal paralysis.
Infantile spinal paralysis was first described as a disease by Jac.
von Heine in 1840, but it remained for Charcot, in 1873, to discover
the pathological lesion in the anterior horns, and led him to pro-
mulgate the most important law in spinal pathology — namely, that
destruction of the lateral group of ganglion cells in the anterior
cornua is followed by atrophy of the muscles and loss of tendon
reflexes. In 1870, Charcot found that in those patients suffering
with glosso-labio-laryngeal paralysis (bulbar paralysis) there was a
progressive destruction of the ganglion cells in the medulla and
pons presiding over these parts. Leyden, of Berlin, soon there-
after made the same discovery, independent of Charcot.

The discovery of the lesion in the Duchenne-Aran type of pro-
gressive muscular atrophy in the anterior cornua was due to Char-
cot. Stubbornly opposed for a time was the German school, headed
by Friedreich, who believed that the atrophy was due to a
myositis, and the nerve and spinal cord changes were considered
as sequelae. Charcot's theory is now universally accepted. In
i886, he, associated with Marie, described the peroneal or leg-type
of progressive muscular atrophy, at about the same time Tooth,
of London, made the same discovery. Much that we know of
the pathology of myelitis, and compression myelitis, syringo-
myelia, Morvan's disease — in short, there is not an organic lesion
of the spinal cord which has not the name Charcot stamped
upon it.

In cerebro-pathology we owe to him, besides the discovery of
the miliary aneurisms in cerebral apoplexy, the location of the



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KRAUSS: THE LIFE AND WORK OF CHARCOT. 687

agraphic center, the location of the lesion in atbelosis, the path of
fibers in the internal capsule and the discovery of the carrefour
sensitiv. He has given valaable hints in regard to epilepsy, chorea,
and post-hemiplegic chorea, astasia-abasia, the urinary paraplegias,
the traumatic neuroses, male hysteria and sciatica.

It has been said that Charcot did not pay as much attention to
therapeutics as could have been expected of one with such bound-
less opportunities. This criticism I believe unjust. In 1876, he
revised the work of Burq on metalloscopie and metallotherapie,
introducing the magnet as a therapeutic agent, and other discover-
ies in the treatment of the hysterical, notably the value of ovarian
pressure in aborting attacks, and all that is scientific and uncharla-
tan in the use of hypnotism as a therapeutic agent. His views on
the latter are so firm and so clear regarding the proper use of
hypnotism, its nature and powers, that they have received the
appellation — Charcot's doctrine. He first advised the quinine treat-
ment in Meniere's disease, the use of the cautery in paraplegia, the
syphilitic treatment of Jacksonian epilepsy, which, by the way,
was first discovered at the Salpetriere.

Charcot was elected a member of the Academy of Medicine of
Paris in 1872, a member of the Institute of France in 1883, com-
mander of the Legion of Honor in 1892, besides receiving orders
and decorations from many of the crowned heads of Europe.
Besides founding the Archives of Phyaiologie^ he aided Bourneville
in founding the L^ Progrh Medical in 1876, and in 1880 founded
the Archives of JSTeurologie. He also created the Mevue Mensuelle
de Medicine et de Chirurgie in 1873, and was instrumental in calling
to life the Iconographie Nbuvelle de la Salpetriere.

The published works of Charcot consist of five volumes on
nervous diseases, five volumes on diseases of the liver, lungs,
kidneys, diseases of old age and infectious diseases, two volumes
of the Le9onB de Mardi, and two volumes of Charcot's clinic,
besides innumerable essays — partly alone, partly in collaboration
with his internes — on special subjects in general and neuropathol-
ogy. Among those who comprise the school of the Salpetriere
(his former internes and followers) we find such names as Jeffrey,
F^r^, Bourneville, Cornil, Gombault, Marie, Babinski, Guinon,
Pierret, Bloch, Brissaud, Huet, Gilles de la Tourette, Colin, Richer,
Pitres, names of men all of whom are well known in medicine.
Charcot was not only a physician but an artist of some celebrity,
a thorough musician, and a lover of things beautiful.



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588 CLINICAL REPORT.

As a man in the broad sense of the word he was peerless —
kind, obliging, considerate and generous to the lowest as well aa
the highest in society's scale, one who shunned the glare of fraud
and hypocrisy in his profession, he bequeathed to his science more
than any man in France, if not in Europe, and leaves a monument
to his memory in the heart and mind of everyone who ever had the
pleasure of meeting with him in the Salle des Cours of the Sal-
petriere.

382 Virginia Street.



(^flnieaf f^ejiorf.



CLINICAL MEMORANDA FROM THE SURGICAL CLINIC
AT THE SISTERS OF CHARITY HOSPITAL.

Bt HERMAN MYNTER, M. D..

Professor of Surgery, Niagara University, and Surgeon to the Sisters' Hospital.

TUBERCULOUS EPIDIDYMITIS.

In a paper on Tuberculous Epididymitis, published in Annals of
Surgery y in April, 1893, 1 advocated the early and complete extir-
pation of the tuberculous epididymis, from the following reasons :
A patient with double tuberculous epididymitis is sterile and his
semen does not contain spermatozoa. The testes must atrophy
unless the worse thing happen that they become secondarily
tuberculous. The danger of extension of the tuberculous process
to the prostate, bladder and kidney is great, and the disease is
then fatal. By extirpating the diseased epididymis we do not
make the patient any more sterile than he was before, and by
retaining the testes sufficient nervous stimulus is preserved to pro-
duce erection and make sexual intercourse possible ; yes, even an
ejaculation, probably from vesiculs seminales, may occur. Thia
little operation is devoid of danger, and a sure and radical cure
may be obtained in a couple of weeks. The cases I reported in
1893 are still in excellent health, and I wish here to report two
other cases in support of this operation and earnestly to advocate
its use:

Case XV. — Mr. W. C. F., twenty-three years of ag^e, entered the
Sisters' hospital, on April 17, 1898, with the following history : He^
was kicked on the left testis five years previously. The testis swelled.



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CLINICAL BEPOBT. 689

but after the swelllDg was reduced a lump was left around the left
testis, which has since been the source of a great deal of pain and dis-
comfort. He has never had gonorrhea or syphilis ; no tuberculosis in
the family. On examination, the left epididymis was found nodulated,
as large as a dove^s egg ; the testis felt normal, with normal testicular
sense, the vas deferens thickened and painful for several inches ;
the vesiculse seminales normal. Under cocaine anesthesia the left
epididymis and four inches of the diseased vas deferens were removed.
The wound healed by first intention and he left the hospital, recovered,
on April 23d, and has been well since. The microscopical examination
of the specimen showed tuberculous bacilli.

Case XVI. — Mr. D. M., aged thirty, entered the hospital on March
8, 1894. In August, 1893, he noticed that the right testicle was tender
and painful, and a small hard lump appeared at its lower end. This
lump increased in size for about seven weeks, when it broke, leaving a
sinus, through which yellowish matter was discharged. The lump
became thereafter smaller and harder. About the same time, a small,
hard, painful swelling appeared at the lower end of the left testicle.
This swelling remained stationary until about January 10, 1894, when
it increased greatly in size and became intensely painful. At last it
broke, leaving a sinus behind, through which a cheesy material m^
be pressed out. His general health is good ; no swelling of the
vesioulae seminales. Several members of the family had died of tuber-
culosis. As he himself had been unable to work since August last, he
readily submitted to operation when its nature had been explained to
him.

At the examination, both epididymes were found hard, painful and
enlarged to about twice the size of the testes. Either testis was easily
outlined and apparently healthy. Under narcosis, both epididymes,
with several inches of the vas deferens, were removed. The epididy-
mes were both found in a state of tuberculous degeneration Ti^ith
cheesy deposits and circumscribed abscesses, extending on the left side
slightly into the hilus of the testes. This was carefully removed by sharp
spoon, the wounds sutured and antiseptic bandages applied. He left the
hospital on March 20th with the wounds healed by first intention. He
called at my office on April 6th, stated that he felt well, had no pain
whatever, could have strong erections, and had gone to work as brake-
man on the railroad again. The testes felt normal, with testicular
sense; over the left hilus still a little hardness.



The Pennsylvania Railroad Company has sent out a special train with
two physicians, who are to go over the whole line to Chicago, and vac-
cinate at each station all the switchmen, sectionmen, gatekeepers and
other employes. — Chicago Medical Record,



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590 SOCIETY PBOCBEDING8.



3ociefy proceec^lngA,



BUFFALO ACADEMY OF MEDICINE.^

Section on Gbnebal Medicine,
bepobt of the committee on tubebculosis.
To the Medical Section of the JBuffcUo Academy of Medicine :

Tour committee, appointed to consider tuberculosis as an in-
fectious disease and the best methods which may be adopted to
prevent its dissemination, respectfully submit the following report :

The question of the communicability having been settled by
the work of Koch and his followers, and the active causative agent
having been proved to be the bacillus tuberculosis, it remains, first, for
us to consider the statistics of the mortality of this disease as com-
pared with the mortality of other diseases, and what bearing these
statistics may have upon the communicability of the disease and
the prevention of its dissemination ; second, to consider the mode
or modes of infection, that is, the material in which the bacillus
exists inside and outside of the diseased individual, and the ave-
nues by which it may gain entrance to the economy of the previ-
ously healthy individual, and whether there are predisposing causes
which render one individual more susceptible to the disease than
another ; and third, what means may be adopted to prevent the in-
troduction of the germ into a healthy individual and so prevent
the spread of the disease.

As to the statistics of the disease, the excellent presentation of
the subject by Dr. Gram, as regards the local death-rate, shows
that tuberculosis kills 3,375 out of a total number of deaths from
all causes of 34,629.

His figures do not differ materially from those of other
observers. Osier says : " The death-rate from phthisis is esti-
mated at 15 per cent, of the total mortality." Flick has studied
the distribution of the deaths from tuberculosis in a single city
ward in Philadelphia for twenty-five years. His researches go
far to show how the infectious agent persists in certain houses :
<< About 33 per cent, of infected houses have had more than one
case. Less than one-third of the houses of the ward became in-
fected with tuberculosis during the twenty-five years previous to

1. Read and adopted at the regular meeting January 9, 1894.



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BUFFALO ACADEMY OF MEDICINE. 591

1888. Yet more than half the deaths from this disease in 1888
occurred in those infected houses." " The investigations of Cornet
upon the death-rate from consumption among certain religious
orders devoted to nursing, give some striking facts in illustration
of this. In a review of thirty-eight cloisters, embracing the aver-
age number of 4,028 residents, among 2,000 deaths in the course
of twenty-five years, 1,320 (62.88 per cent.) were from tuberculosis.
In some of the cloisters more than three-fourths of the deaths are
from this disease."

A most excellent illustration of the wide distribution of the
infective agent is given in the report by H. P. Loomis, that of
thirty cases presenting no microscopical evidence of old or recent
tubercular disease, the bronchial glands of eight were infective to
rabbits.

The statistics thus presented show that tuberculosis is (with
the possible exception of syphilis) the most widespread of diseases
and is the most fatal. The reason for the widespread existence of the
disease is that until 1881 its infectious nature had not been proved,
although frequently suspected, and that ever since that time no
active measures have been adopted by the profession at large to
inform the laity of the infectious nature of the disease, or to pre-
vent its spread in the community, although a few individual physi-
cians have now and then, here and there given such information
each to his own clientele.

The consideration of the subject from this point of view brings
us to the second division of our subject — namely, the mode, or
modes, of infection. This is brought about only by direct contact
of the material containing the bacillus with either an open wound
or scratch, or an absorbing mucous surface.

How is this contact brought about ? Inoculation through an
abrasion of the skin, or other open wound, is rare among human
beings, but may occur in those '< whose occupation brings them in
contact with dead bodies, or animal products. Demonstrators of
morbid anatomy, butchers and handlers of hides are subject to a
local tubercle of the skin," from which source, occasionally, gen-
eral infection takes place. The performance of the rite of circum-
cision by a tubercular operator has occasionally been a source of
infection through a wound. *< Other means of inoculation have
been described, as the wearing of earrings, wearing the clothes of
tuberculous patients, the bite of a tuberculous subject, or inocula-
tion from a cut by a broken spit-glass of a consumptive, and



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592 SOCIBTT PB0CEBDIN6S.

Czerny has reported two cases of infection by transplantation of
skin."

As regards infection through eating meat, Osier says : ^* The
meat of tuberculous animals is not necessarily infective. The
results of experiments with the flesh of cows are not in accord.
This mode of infection, probably, plays a minor r61e in the etiology
of human tuberculosis, as usually the flesh is thoroughly cooked
before eating. The possibility, however, must be borne in mind,
and it would certainly be safer in the interests of a community to
confiscate the carcasses of all tuberculous animals."

As regards infection by milk, the same author says : <^ The
milk of an animal suffering from tuberculosis may contain the
virus, and is capable of communicating the disease." ^< It was for-
merly thought that the cow must present tuberculous disease of the
udder, but Ernst has shown that the bacilli may be present, and
the milk be infective in a large proportion of cases in which there
is no tuberculous mammitis." ^<This author states the interesting
fact that an owner of a herd, known to be tuberculous, withdrew
the milk from market and used it, without boiling, to' fatten his
pigs, which, almost without exception, became tuberculous, so that
the whole stock had to be slaughtered. There is no reason to be-
lieve that young children, or even adults, are less susceptible to
the virus than the calveB or pigs, so that the danger of the disease
from this source is real and serious. The great frequency of in-



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 59 of 78)