Morgantown, West Virginia, United States
“Professor Charcot, allow me to introduce Mr. Thomas who has travelled to Paris from America in hope that you might assist him with a most troubling malady.”
Charcot’s dutiful assistant stepped back and gave a transmitting nod. Charcot returned the gesture with an acknowledging nod.
“Of course. Mr. Thomas, you honor me by travelling such a great distance to seek my humble opinion. What manner of symptoms are plaguing you?”
“Dr. Charcot, I am a businessman from Philadelphia. My work is exhausting and demands my constant attention. For the past several months, I have experienced extreme fatigue and exhaustion after even the slightest effort. My other symptoms include inability to experience restful sleep, irritability, anxiety, and poor concentration. Without help, I fear my business will fail. I need help.”
Charcot spent the better part of the next hour carefully reviewing Mr. Thomas’ symptoms and performing a detailed physical examination.
“Mr. Thomas, your case is quite complex and will require a prolonged treatment regimen, one that you could not realistically expect to complete during an abbreviated visit to the European continent. However, it is most fortunate that you have in Philadelphia a physician who knows more about nervous energy exhaustion than anyone else does in the world. My recommendation is that you expeditiously consult with Dr. S. Weir Mitchell upon your return to the United States.”
Upon giving and hearing the recommendation, Dr. Charcot and “Mr. Thomas” exchanged self-assuring smiles of satisfaction and accomplishment. Dr. Charcot and his assistant exchanged knowing nods.
This meeting between a Father of Neurology (Jean-Martin Charcot) and a Father of American Neurology (Silas Weir Mitchell) occurred in 1873. While this creative conversation vignette is fiction, its basis is not. Dr. Mitchell was an influential neurologist, remembered for his proposed cures of “neurasthenia” by prolonged rest, as in The Yellow Wallpaper. Dr. Charcot was even more famous. Mitchell felt he had outwitted the great Charcot. However, the latter gained a disciple for life by cleverly playing to the former’s ego.
“[Mitchell] was fond of telling anecdotes … his favorite was … of his visit to the great neurologist, Charcot. Mitchell … presented himself as a patient, and gave an account of various symptoms of the neurasthenic syndrome. Charcot, learning that the supposed patient was soon to return to the United States, recommended that he see Dr. Weir Mitchell, who ‘knew more about those troubles than anyone else.’”1
“… [Mitchell] was in Paris and had been overworked … so he decided to consult the great nerve specialist, Dr. Charcot. Wishing an independent opinion, he did not give his name. Dr. Charcot examined him and gave a few simple directions … asked him where he was from. Dr. Mitchell told him he was from Philadelphia. Then Dr. Charcot said: ‘you have a man in Philadelphia who knows more about run-down nervous conditions than anyone else I know of … Dr. S. Weir Mitchell … you must consult.’”2
“Every morning he [Charcot] made rounds on his hospital service with exemplary regularity and a sense of duty, but like all physicians of his generation, he did not return to his service in the afternoon. Accordingly his chiefs of clinics, his interns, and other assistants prepared the patients, hypnotized them, and organized the experiments. Charcot personally never hypnotized a single patient, never checked the experiments and, as a result, was not aware of their inadequacies … Many of the women, who were excellent comedians, when they were offered a slight pecuniary remuneration imitated perfectly the major hysteric crises of former times.”3
“Although Charcot rarely wrote about the theatrical practices of his day, his work is redolent with theatrical concepts … Charcot’s recourse to models of theatrical spectatorship … was inspired. Charcot was, however, then faced with the problem of differentiating between illness and the mere performance of illness …”4
- Earnest E. S. Weir Mitchell, Novelist and Physician. Philadelphia: University of Pennsylvania Press; 1950: 241-2.
- Tucker BR. S. Weir Mitchell, A Brief Sketch of His Life with Personal Recollections. Boston: Richard G. Badger; 1914: 54.
- Guillain G (edited and translated by P Bailey). J.-M. Charcot 1825 – 1893 His Life – His Work. New York: Paul B. Hoeber; 1959: 174.
- Marshall JW. Performing Neurology, The Dramaturgy of Dr. Jean-Martin Charcot. New York: Palgrave Macmillan; 2016: 2.
JACK E. RIGGS, M.D. is a Professor of Neurology at West Virginia University