Jean-Martin Charcot (1825-1893): pathologist who shaped modern neurology.

C harcot's pupil, Joseph Babinski, once declared, " To take away from neurology all the discoveries made by Charcot would be to render it unrecognizable. " Before Charcot, textbooks provided only brief and inaccurate descriptions of the central nervous system, and classifi ed as neuroses diseases like epilepsy, chorea and tetanus. Neurology as a discipline was non-existent. Jean-Martin Charcot was a quiet and withdrawn child with artistic talents and an uncanny attention to visual details, qualities that later proved invaluable in his neurological investigations. He was admitted to medical school at the University of Paris, graduating in 1853. In 1857, Charcot was appointed professor of medicine and shortly thereafter became chief of medical services at the Sâlpetrière Hospital, where he remained for the rest of his career. In 1872, Charcot was elected professor of pathological anatomy at the University of Paris, and in 1882, he assumed its newly-created chair of neurology. was originally built by King Louis XIII as an arsenal to store gunpowder (Saltpeter was one of the ingredients of gunpowder, hence the name). Converted into a large public hospital in the 17th century, it housed mostly chronically-ill, indigent women. Paris literally dumped her rejects at Sâlpetrière, including illegitimate children, prostitutes, the insane and incurables. In the 1860's, reorganisation of the French public health system led to reshuffl ing of patients, and Sâlpetrière inherited those with rheumatological and neurological conditions. Little wonder Charcot himself referred to it as the " grand asylum of human misery. " But unlike other physicians, Charcot did not despair over his patient population, declaring, " We are in possession of a sort of living pathology museum of almost inexhaustible resources. " This population allowed Charcot to use his method of anatomoclinical deduction in teasing out differences among neurological conditions, something other physicians were hitherto unable to do. THE ANATOMOCLINICAL METHOD. Charcot was a pathologist by instinct and training, and like most French physicians, relied on the anatomoclinical method, fi rst taught by Italian pathologist, Giovanni Morgagni (1682–1771), and later refi ned by French clinician, René Laennec (1781–1826). This approach, the basis for our modern day clinico-pathological conference, emphasised the correlation between clinical manifestations and post-mortem fi ndings. Charcot fi rst separated patients into clinical types based on their neurological presentation. The majority of patients at Sâlpetrière were wards of the State, and as no one claimed their bodies, Charcot was able to perform autopsies …