Nov 292016
 

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Today is the birthday (1825) of Jean-Martin Charcot, a legendary French neurologist and professor of anatomical pathology now mostly forgotten outside of professional medicine and psychology. He is known in the history of medicine as one of the founders of modern neurology and his name has been associated with at least 15 medical eponyms, including Charcot–Marie–Tooth disease and Charcot disease (better known as amyotrophic lateral sclerosis (ALS), motor neurone disease, or Lou Gehrig disease in the U.S.). He is also credited with being the first to diagnose multiple sclerosis. His work greatly influenced doctors in the developing fields of neurology and psychology, especially his student Sigmund Freud, who initially adopted many of his ideas, but then moved off in new directions. Much of Charcot’s theory and practice in hysteria and hypnosis which was highly regarded in his time has now been debunked, but he blazed the trail on the road to discovery of the subconscious mind in significant ways. Whether we should thank him for this discovery or not is another matter.

Charcot was a native Parisian who worked and taught at the famous Salpêtrière Hospital for 33 years. His reputation as an instructor drew students from all over Europe. In 1882, he established a neurology clinic at Salpêtrière, which was the first of its kind in Europe. Charcot was a part of the French neurological tradition and studied under, and greatly revered, Duchenne de Boulogne whom Charcot credited as the true father of neurology. Medical historians credit Duchenne, not Charcot, with being the first to bring discipline and focus to what beforehand had been a sprawling and incoherent mess of diagnoses and treatments.

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Charcot named and was the first to describe multiple sclerosis. Summarizing previous reports and adding his own clinical and pathological observations, Charcot called the disease sclérose en plaques. The three signs of Multiple sclerosis now known as Charcot’s triad 1 are nystagmus, intention tremor, and telegraphic speech, though these are not unique to MS. Charcot also observed cognition changes, describing his patients as having a “marked enfeeblement of the memory” and “conceptions that formed slowly.” He was also the first to describe a disorder known as Charcot joint or Charcot arthropathy, a degeneration of joint surfaces resulting from loss of proprioception. He also researched the functions of different parts of the brain and the role of arteries in cerebral hemorrhage.

Charcot was one of three physicians to describe ALS. The announcement was made simultaneously with Pierre Marie of France (his resident) and Howard Henry Tooth of England. Therefore it was originally known as Charcot–Marie–Tooth disease (CMT). It can also be called peroneal muscular atrophy, but ALS is the more common term. Most people with ALS die from respiratory failure within 2 to 4 years of diagnosis. Stephen Hawking, who has lived for 50 years with the disease, is a rare case.

Charcot’s studies between 1868 and 1881 were a landmark in the understanding of Parkinson’s disease. Among other advances, he accurately codified distinctions in symptoms, such as, rigidity, weakness and bradykinesia (slow movement), as well as classifying variations.  The disease was formerly named paralysis agitans (shaking palsy), but Charcot had it renamed after James Parkinson.

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Charcot was famous in his day for his studies of hypnosis and hysteria, although his work is now largely discredited. Sometimes going down the wrong path can be fruitful. He initially believed that hysteria was a neurological disorder for which patients were pre-disposed by hereditary features of their nervous system, but near the end of his life concluded that hysteria was a psychological disease. Charcot first began studying hysteria after creating a special ward for women with “hystero-epilepsy.” He classified two distinct forms of hysteria among these women: minor hysteria and major hysteria. His interest in hysteria and hypnotism coincided with a public interest in what were called ‘animal magnetism’ or ‘mesmerism’ – methods of inducing hypnosis in a variety of arenas including spiritualism and spiritual healing that had been kicking around in Europe since the 17th century. Charcot’s use of hypnosis to help patients he diagnosed with hysteria, led to considerable notoriety and mixed reception. For Charcot, the ability to be hypnotized was a clinical feature of hysteria such that at the outset he considered the susceptibility to hypnotism to be synonymous with hysteria. Later he distinguished between grand hypnotisme (in hysterics) and petit hypnotisme (in ordinary people).

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Charcot’s position on hypnosis was sharply criticized by Hippolyte Bernheim, who was also a leading neurologist at the time. Actually Charcot, and his student Georges Gilles de la Tourette (after whom Charcot named Tourette’s syndrome), long had qualms about the use of hypnosis in treatment and about its effect on patients. He also was concerned that the sensationalism hypnosis attracted had robbed it of its scientific interest. It’s fair to say that the jury is still out.

Charcot thought of art as a crucial tool of his clinical methods. He used photos and drawings, many made by himself or his students, in his classes and conferences. He also drew outside the neurology domain, as a personal hobby. Like his mentor Duchenne, he is considered a key figure in the incorporation of photography in the study of neurological cases.

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In October 1885, Freud went to Paris on a fellowship to study with Charcot, and later described the experience of this stay as catalytic in turning him toward the practice of medical psychopathology and away from a less financially promising career in neurological research. It is not recognized enough that Freud always had an eye towards fame and profitability in his career, and that neither he nor Charcot were averse to sensationalism and public acclaim.

Freud began using hypnosis in his clinical work under the influence of Charcot, but then steered away from his approach, using it to encourage patients to release hidden memories rather than as a cure via hypnotic suggestion. Freud’s treatment of one particular patient, Anna O., involved inviting her to talk about her symptoms while under hypnosis. In the course of talking in this way these symptoms became reduced in severity as she retrieved memories of traumatic incidents associated with their onset. She called it the “talking cure” which was subsequently a signature method for Freud — for which he is rarely credited in the popular mind these days, as people, who have never read or studied Freud, habitually dismiss him as a sexist quack. Charcot might suffer the same fate were it not for the fact that he is h

Food that is good for the brain is a hot topic these days, although medical opinion goes through shifts in opinion now and again. In earlier centuries walnuts were considered to be good for the brain following the homeopathic principal that walnuts look like brains so must be good for them. Nowadays nutritional research tends to be more empirical and statistical, although causative principles are still hard to come by. Thus, people who eat diets rich in unsaturated fats, fruits, vegetables, fish, nuts, and whole grains, have fewer neural problems than people who eat diets rich in red meat, dairy products, and sugars. Likewise, simple, natural ingredients are better than processed foods for a healthy brain. Walnut crusted baked salmon combines the theories of two eras, and is delicious.

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Walnut Crusted Baked Salmon

Ingredients

1 ½ cups shelled walnuts
3 tbsp dry breadcrumbs
3 tbsp finely grated lemon rind
1 ½ tbsp extra-virgin olive oil
3 tbsp fresh dill, chopped
salt and pepper
6 3-oz salmon fillets, skin on
Dijon mustard
2 tbsp fresh lemon juice

Instructions

Place the walnuts in a food processor and chop them coarsely. Add the breadcrumbs, lemon rind, olive oil and dill. Pulse a few times to mix until thoroughly combined and sticks together when pressed.  Season with salt and pepper to taste.

Arrange the salmon fillets skin side down on parchment paper lined baking sheets. Brush the tops with mustard.

Divide the walnut-crumb mixture into 6 and spoon a portion over each fillet and gently press it into the surface of the fish. Cover with plastic wrap and refrigerate for up to 2 hours.

Bake at 350°F 15 to 20 minutes, or until salmon flakes with a fork. Just before serving, sprinkle each with  lemon juice.

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