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The historical background of Jules and Augusta Dejerines’ work - 28/01/17

Doi : 10.1016/j.neurol.2016.12.028 
Laura Bossi
 Laboratoire SPHERE, université Paris VII, 1, rue du Mail, 75002 Paris, France 

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Jules Dejerine (1849–1917) is quoted by Haymaker among the 133 “Founders of neurology” of 18 nationalities (26 French, 29 Germans, 17 British, 14 North Americans, 9 Italians). Augusta Klumpke-Dejerine (1859–1927) in mentioned in her husband's biography as one of the rare examples of ‘collaboration of two intellectual giants’, comparable only to the couples formed by Pierre and Marie Curie or, in the domain of neurology, by Oskar and Cécile Vogt in Berlin (Figure 1).

“The Dejerines” are active at a time when neurology is taking shape as an individual discipline, organizes itself in hospital and university institutions independent from internal medicine or psychiatry, and begins to constitute sub-specialties such as neuroanatomy, neurophysiology, neuropathology and neurosurgery.

In France, the anatomo-clinical school started at the Salpêtrière in 1862 by Jean-Martin Charcot (1825–1893) and his friend Alfred Vulpian (1826–1887) has made Paris the centre of French neurology, and one of the world's leading ones. Vulpian will leave the Salpêtrière five years later for a brilliant career in the University that will ultimately lead him to the responsibility of Dean (1875); Charcot will remain there until his death. He creates the first Clinical Chair for Nervous system diseases (1882) and trains a number of gifted pupils and coworkers who will subsequently direct most neurology departments in Paris: la Pitié (Joseph Babinski), Bicêtre (Pierre Marie, Achille Soucques, Désiré Bourneville for psychiatry), Ivry (Achille Gombault, Soucques). After his death, his first successors at the Neurology chair will be his pupils Édouard Brissaud and Fulgence Raymond.

As pupils of Vulpian, Jules et Augusta Dejerine occupy a singular and eminent place in the neurological scene dominated by Charcot's school. During the years spent at Bicêtre (1887-1894) they undertake an anatomical study of the brain based on serial sections (Anatomie du système nerveux, 1895), allowing a precise reconstruction of tridimensional structures, particularly of subcortical regions, as well as a detailed cartography of the bundles connecting the various regions of the brain. They will complete this work at the Salpêtrière, where Dejerine will direct the Jacquart department between 1895 and 1910, before his election at Charcot's chair, and produce a “topography” correlating the sites of the lesions of sensory and motor centres and pathways with the affected skin areas and muscle groups. Their “Sémiologie des affections du système nerveux” (1914) represents the accomplishment of the anatomo-clinical method of the XIX century.

In Great Britain, London's role will be comparable to that of Paris, with the foundation of the National hospital for the paralysed and epileptics in Queen Square in 1860. John Hughlings Jackson (1835–1911), the “father of British neurology”, worked there during 45 years. He was the editor of the journal Brain since its foundation in 1878, and the first president of the Neurological society of London in 1886. His studies of epilepsy remain exemplary. His evolutionary model of the brain postulating the existence of three hierarchical levels and his distinction between “positive” and “negative” symptoms will influence Sigmund Freud as well as French (Henry Ey) and North American psychiatrists (DSM). Queen Square hosted other eminent characters such as David Ferrier (1843–1928), who established a cartography of the localisation of motor functions in animals; the pioneering neurosurgeon Victor Horsley (1857–1916); William Gowers (1845–1915), author of the “bible” of British neurology, the Manual of Diseases of the Nervous System (1886, 1888); or Gordon Holmes (1876–1965), who authored classical studies on the cerebellum and on visual troubles.

However, the National Hospital will not be associated to the University until late: an Institute for the Teaching and Study of Neurology is instituted at Queen Square in 1938, and is incorporated into the London University in 1950, two years after the foundation of the National Health Service. In 1958 there were still only 73 neurologists in Great Britain, and three Chairs for Neurology: London, Oxford and Edinburgh.

Henry Head (1861–1940) in Cambridge and Charles Scott Sherrington (1857–1952) in Cambridge and in Oxford gave a strong neurophysiological orientation to British neurology. In 1932 Sherrington was awarded the Nobel Prize jointly to Edgar Adrian (1889–1977), for their discoveries on neuronal functions. This was to be the second Nobel Prize awarded in the field of the neurosciences, after the one shared in 1906 by the great Spanish anatomist Santiago Ramon y Cajal (1852–1934), the “discoverer” of the neuron, and the Italian Camillo Golgi (1843–1926), the inventor of the silver staining technique.

In German-speaking countries the development of neurology followed a different path, without the centralisation in the capital that characterized France and Great Britain. When Johannes Müller (1801–1858), the founder of German physiology, brought together a group of exceptionally gifted pupils in the University of Berlin established in 1809 par Wilhelm von Humboldt (1767–1835), a rapid and remarkable development of natural and medical sciences took place (Henle, Schwann, Koelliker for anatomy; Rudolf Virchow for cellular pathology; du Bois Reymond, Brücke and Helmholtz for physiology). At the same time, Moritz Heinrich Romberg (1795–1873), appointed in 1840 as director of the Königliches Poliklinisches Institut in Berlin, was one of the founders of clinical neurology; his Lehrbuch der Nervenkrankheiten (1853) will be influential. However, Berlin never succeeded in constituting a stable pole of excellence. Romberg's successor in 1865 was Wilhelm Griesinger (1817–1868), a psychiatrist mainly focusing on the reform of the asylums. Later, the outstanding clinician Hermann Oppenheim (1858–1919) was not appointed because of his Jewish origins. A second opportunity was missed in 1912, when Emil Kraepelin (1856–1926), the founder of modern psychiatric nosology, was offered a chair in Berlin. He was ready to accept the call, but asked for a separation of psychiatry and neurology, which was refused by the Ministry.

Important contributions to clinical neurology came nevertheless from clinicians trained in internal medicine, such as Wilhelm Heinrich Erb (1840–1921) in Heidelberg, who introduced the teaching of neurology in the medical curriculum and who founded the Deutsche Zeitschrift für Nervenheilkunde in 1891.

In the younger generation, Oskar Vogt (1870–1959) had a pioneering role, together with his wife, the French Neurologist Cécile Mugnier, whom he met in Paris in 1898 during a training period in Dejerine's lab. He created the Kaiser-Wilhelm Institut für Hirnforschung in Berlin-Buch, a true breeding ground for gifted scientist such as Korbinian Brodman, who performed his studies of the cortical cytoarchitectonics in Vogt's lab. In Breslau, Ottfried Förster (1873–1941) a pupil of Dejerine, will become one of the most active neurologists of the first half of the XXth century.

However it was in the field of pathological anatomy where Germany had a leading role. To quote only some of the best known: Rudolf Virchow (1821–1894) in Berlin, founder of cell pathology and author of important observations on glial cells; Albert Koelliker (1817–1905) in Würzburg, whose Handbuch der Gewebelehre (1850) remains a classic, comparable to Cajal's works; Theodor Meynert (1833–1892) in Vienna, who contributed to the scientific stature of the faculty, that strived to compete with the Salpêtrière and Queen Square; Carl Wernicke (1848–1905), anatomist and psychiatrist in Berlin, Breslau, Halle, author of a Lehrbuch der Gehirnkrankheiten (1881–1883) summarizing the knowledge of the time on cerebral localisations; and the team around Kraepelin in Munich: Franz Nissl (1860–1919), known mainly for his staining methods, and Aloys Alzheimer (1864–1915), famous for his first description of the anatomopathological characteristics of the illness that was named after him.

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 Meeting abstract Jules Dejerine: bilingual publication (English version).

© 2016  Publié par Elsevier Masson SAS.
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Vol 173 - N° S1

P. S29-S31 - février 2017 Retour au numéro
Article précédent Article précédent
  • L’œuvre de Jules et Augusta Dejerine dans son contexte historique
  • Laura Bossi

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