Visual Art in the Neurologic Career
of Jean-Martin Charcot
Christopher G. Goetz, MD
\s=b\ Jean-Martin Charcot, the world's first
chaired professor of neurology, incorpo-
rated visual art into his daily practice of
neurology. Art served as scientific docu-
mentation and was a pivotal tool in the de-
velopment and dissemination of Charcot's
clinicoanatomic method. Although Char-
cot drew extensively in clinical and labo-
ratory studies, very few of these visual
documents have ever been published or
are currently available for public study.
Charcot was central to the incorporation
of medical photographs into the study of
neurologic disease and relied heavily on
visual material in his capacity as an inter-
national teacher. Art also misguided Char-
cot's career when he relied heavily on art-
work in his attempt to convince critics that
disorders seen at the Salp\l=e^\tri\l=e`\reHospital,
Paris, France, were independent of his
suggestive influence.
(Arch Neurol. 1991;48:421-425)
Asa physician at the Salpêtrière
**
Hospital, Paris, France, and the
world's first chaired professor of neu¬
rology, Jean-Martin Charcot consid¬
ered art and science to be pivotally
complementary in his effort to de¬
scribe and categorize neurologic dis¬
ease. Science nourished art as Charcot
used his own patients as models in his
neurologic sketches and photographs;
art nourished neurology as Charcot
used art objects from past ages to con¬
vince critics that certain of the disor¬
ders he sometimes described were nei¬
ther new nor of his own creation.
Accepted for publication September 13, 1990.
From the Department of Neurological Sciences,
Rush-Presbyterian-St Luke's Medical Center,
Chicago, Ill.
Reprints not available.
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Charcot's incorporation of art into
neurology guided and misguided his
individual career and established a vi¬
sual tradition in neurologic study that
persists today, although in new tech¬
nologic forms.
ART AS SCIENTIFIC DOCUMENTATION
Charcot's dual devotion to art and
science was reportedly lifelong, and he
had wrestled between medicine and
art as careers.1 Charcot finally chose
medicine and enrolled in the national
medical school in Paris in 1842. There
is almost no documentation of his stu¬
dent years, and his first known medical
drawings date from when Charcot
came to the Salpêtrière as a junior
faculty member. Almost none of Char¬
cot's clinical drawings have ever been
published, and they are not available
for public viewing.
After arriving at the Salpêtrière,
Charcot's first task was to examine and
categorize the thousands of patients
haphazardly housed together through¬
out the walled hospital village of the
Salpêtrière. With his colleague, Vulpi-
an, Charcot gathered a massive clini¬
cal database of neurologic and geriat¬
ric diseases. This material became the
core of Charcot's clinicoanatomic
method, the hallmark of his Salpêt¬
rière school.2
The two-step clinicoanatomic
method involved artistic documenta¬
tion in both phases. The first step
focused on clinical description of neu¬
rologic disease, and Charcot's patient
drawings documented the static defor¬
mities of chronic cases as well as evolv¬
ing signs of acute illnesses. Whereas
the notes accompanying the drawings
were often long-winded, the drawings
rapidly communicated a patient's
changing neurologic state (Fig 1). Us¬
ing art, Charcot documented unusual
cases of dramatic amputees, pock¬
marked victims, and contracted hémi¬
plégies as well as more typical cases of
vascular and neurodegenerative dis¬
eases (Fig 2).
The second step of the clinicoana¬
tomic method, which focused on ana¬
tomic and microscopic analyses, oc¬
curred after the patient died. Here,
too, Charcot used his artistic skills and
later engaged professional artists. He
traced lesions throughout the neuraxis
and documented vascular anomalies in
detail (Fig 3). His early drawings were
among the first to document the mi¬
croscopic changes of multiple sclerosis
and the spinal changes of amyotrophic
lateral sclerosis (Fig 4).
Charcot's self-appointed charge was
to be an objective observer, articulate
and clear, independent of preconceived
prejudice or expectation.3 His personal
artistic preferences focused primarily
on the Dutch masters, whose realism
revealed the world with simplicity and
unadorned clarity.4 His own personal
artistic style reflected his scientific
approach to clinical neurology. His
most distinguishing clinical charac¬
teristic was a keen ability to see the
essential features of diseases, culling
them from among the confusion of de¬
tail. He likewise sketched with an
economy of line that permitted view¬
ers to grasp essential features at a
glance. Whereas his artworks showed
little artistic refinement, they were ef¬
fective documents of immediate visual
impact. He drew patients wherever he

Fig 1.—A drawing from a series of sketches in the hospital record of a patient with a cerebrovas¬
cular accident, stressing here the head and eye deviation with prominence of the stemocleido-
mastoid muscle (original drawing in Bibliothèque Charcot, Salpêtrière Hospital, Paris, France).
Fig 2.—Patient with decerebrate rigidity (original drawing in Bibliothèque Charcot, Salpêtrière
Hospital, Paris, France).
saw them, and even when he was on
vacation or on foreign travel, neuro¬
logic disease did not escape his eyes.
For example, he sketched a North Af¬
rican with Parkinson's disease, cap¬
turing in his hasty strokes the hand
posture, body attitude, joint deformi¬
ties, and masked facies typical of the
disease (Fig 5).
CHARCOT AND PHOTOGRAPHY
Charcot's artistic interests were un¬
doubtedly at the core of his immediate
appreciation of the new art of photog¬
raphy. Under his direction, a photo¬
graphic service at the Salpêtrière was
established 'by Londe,5 and patients
were regularly photographed as part
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of their neurologic evaluation.
Whereas those with static findings
were photographed only once or twice
at differentangles, the photographers
became increasingly adept at docu¬
menting dynamic disorders with se¬
quential and time-lapse photography
methods (Fig 6). Charcot even spoke of
himself in photographic terms: "I only
observe, nothing more," and "I am a
photographer."6
The Salpêtrière photographs were
printed on positive silver plates, and
several thousands of them were gen¬
erated during Charcot's career. Some
of these and many more from the
period after Charcot's death are today
housed in the Countway Medical Li-
brary, Boston, Mass. Such pictorial
documents formed the foundation of
two of Charcot's major neurologic en¬
terprises, the Iconographie Photo¬
graphique and the Nouvelle Iconogra¬
phie de la Salpêtrière. The former was
a limited edition of hand-pasted pho¬
tographs documenting the various dis¬
orders, primarily epilepsy and hyste¬
ria, seen in the Charcot service. The
latter replaced this set with a larger
circulation journal with neurologic ar¬
ticles based specifically on photo¬
graphic or artistic documentation. In
the introduction of the first volume of
the Nouvelle Iconographie de la Sal¬
pêtrière, the editors wrote:
When a patient demonstrates signs of par¬
ticular interest—various atrophies, con¬
tractures, special postures or deformities-
he is immediately drawn or photographed.
With the aid of this immediate record, we
are able to freeze the abnormality, to de¬
compose the various abnormal movements
one by one, and thereby capture the disor¬
der with precision. These vignettes from
the Salpêtrière complement the clinical ex¬
amination to form a collection of great
significance.7
Contemporary journals based on pho¬
tography or videotape (eg, Movement
Disorders) are modern descendants of
this Charcot tradition.
ART AND TEACHING
The incorporation of an artistic ef¬
fort in the Charcot service had impor¬
tant consequences not directly linked
to scientific documentation. Visual
material, by nature, extends beyond
language barriers and bypasses tech¬
nical medical terminology. It can at¬
tract attention and provoke inquiry
that might be passed over in a dry ac¬
count of written neurologic descrip¬
tion. When Charcot started his faculty
career, he was acutely aware that the
Salpêtrière was considered far from
central Paris and that it carried the
stigma of an academic wasteland, "an
exile in a lost land where the patholo-
gists and clinician had very little to
see."8 To attract students, Charcot
compiled a series of rehearsed-to-per-
fection lessons on selected medical top¬
ics. He incorporated all his resources
in these efforts, and each year their
appeal grew wider. His drawings,
charts, and theoretical constructs
were presented in multicolored spec¬
tacle. Fifteen years before the better
known aphasia diagrams of Lichteim
were created, Charcot presented his
audience with an elaborate series of
drawings involving a bell as the cen¬
tral theme (Fig 7). Charcot was among
the first teachers to use slide projec-
 Fig 4. Denuded axons and maintained neu¬
rons multiple sclerosis. Drawn by Charcot
in —

and published in his Oeuvres Complètes.

Fig 3.—Charcot's autopsy diagram of an aneurysm, drawn in red and black, and accompanying
clinical notes and medical drawings of the patient (original drawing in Bibliothèque Charcot, Sal¬
pêtrière Hospital, Paris, France).

Fig 5.—A drawing by Charcot of a Moroccan

with Parkinson's disease (1889). "I have seen
such patients everywhere, in Rome, Amster¬
dam, Spain, always the same picture."3

cine was weak, the visual material was

Fig 6.—Londe5 photographing a patient in her room at the Salpêtrière Hospital, Paris, France. The
photographic service was a regular part of the neurologic evaluation and research effort under undoubtedly pivotal to effective com¬
Charcot's direction (from La Nature, No. 536; Paris, France: Bureaux du Progrès Médical; 1892. munication. As the American Alan
Starr recalled when he first saw Char¬
cot in a classroom:
But grant that it was theatrical; it left on
tors in his classroom. He brought stat¬ Paris medical system to the foreign the mind of the student a series of mental
ues, photographs, and patients them¬ medical world and to nonmedicai Paris pictures of patients and of lessons which no
selves asvisual documents. He also society. Especially in the 1880s and in amount of private study could possibly pro¬
was an excellent mime and recreated his last years, Charcot's classroom was duce. It taught man so that they could not
clinical syndromes for his audience, a mélange of doctors from eastern and fail to remember; and what higher result
can a teacher wish?9
including gait abnormalities, parkin¬ western Europe and the Americas, as
sonism, tic disorders, and various well as Parisian artists, journalists, Clearly Charcot was not the first or
types of weakness.2 politicians, and social commentators. the only investigator to use medical il¬
Charcot's reputation of magnetic For many of these people, whose fa¬ lustration and visual arts as a means
presentations extended beyond the miliarity with French or with medi- of medical documentation. His con-

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Fig 7.—Diagram of a bell used by Charcot in
his presentations on aphasia. IC indicates
center for ideas; CAC, auditory center; CVC,
visual center; CAM, auditory center for words;
CVM, visual center for words; CPM, phonetic
center for words; and CGM, graphic center for
words."
Fig 9.—A clinical lesson at the Salpêtrière Hospital, Paris, France, by Brouillet, prepared for the
1887 Paris Salon and showing Charcot, Babinski, Marie, Tourette, and other physicians, as well
as artists, social commentators, and government officials in attendance.
temporaries Gowers and Hughlings
Jackson included their own medical
drawings in their text. Charcot, how¬
ever, used visual arts in every aspect of
his daily work effort. Art at the Sal¬
pêtrière was inseparable from the sci¬
entific effort and was as much the em¬
bodiment of the clinicoanatomic
method as any other neurologic activ¬
ity under Charcot's direction.
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Fig 8.—Cover from Charcot's and Richer's
Demonios in Art, showing one of the drawings
used by the authors to support their thesis that
hysterical epileptic fits were not a new disorder
nor were they behaviors found only, or pre¬
dominantly, at the Salpêtrière Hospital, Paris,
France.
ART AS SCIENTIFIC JUSTIFICATION
In the sphere of organic neurology,
Charcot's clinicoanatomic method met
with repeated successes and estab¬
lished him and his school as the inter¬
national pillars of clinical neurology.
In the 1870s and thereafter, however,
he increasingly devoted his attention
to hysteria, a topic that had haunted
Fig 10.—Charcot and his patients. This picture
was on the cover of the Paris tabloid Revue Il¬
lustrée and shows the extent to which Charcot
became a popularized figure in nonmedicai so¬
ciety (from Countway Medical Library, Harvard
University, Boston, Mass).
and befuddled physicians before
him.10·" In working with hysteria and
attempting to apply the clinicoana¬
tomic method to a condition with an
elusive lesion, Charcot drifted in the
eyes of his contemporaries. Visiting
physicians did not recognize the spells
he demonstrated in the amphitheater
of the Salpêtrière, and, because the
spells were too dramatic to be missed
if they actually existed elsewhere, crit¬
ics contended that they must be
feigned or created by Charcot's own
powerful suggestion. Charcot was
keenly aware that hysteroepilepsy be¬
came derisively known as the Salpêt¬
rière illness.6
To address this criticism and rescue
his compromised scientific reputation,
Charcot called on art in a way he had
never previously used it. While lectur¬
ing to his students that hysteria "must
henceforth become a household
word,"12 he looked to art to demon¬
strate that the behaviors he saw were
independent of him. He went outside
the Salpêtrière, beyond medicine, and
indeed out of the time constraints of
his own era to j ustify his stand that the
signs of hysteria were implicit to the
disease and not to the observer. At a
time when he relegated much of his
publication material to students, he
embarked on two major works on neu¬
rologic disease in art, The Disease and
Deformed in Art and The Demonios in
Art, both largely focusing on hysteria
(Fig 8). These works were pointedly
 aimed at repudiating suspicions of ma¬
nipulation of falsification of clinical
medicine.
In them, Charcot demonstrated that
behaviors similar to those seen at the
Salpêtrière could be found in medieval
and mannerist paintings and other
artworks depicting demonic posses¬
sion or spiritual ecstacy. Charcot, how¬
ever, did not succeed in accomplishing
his goal, and he did not convince scien¬
tific skeptics that his personality was
not intimately connected to the behav¬
iors seen at the Salpêtrière.13 In fact,
Charcot's mere reliance on religious
art that was doubtfully conceived or
executed with objectivity as its guiding
force and the glaring lack of historical
or genre painting to support his thesis
suggest a certain intellectual despera¬
tion in a man otherwise so perceptu¬
ally acute. In the end, Charcot appar¬
ently recognized that his efforts had
failed. The last night he worked on
scientific material before he died, he
reportedly told Guiñón14: "Our concep¬
tion of hysteria has become obsolete. A
total revamping of this area of neuro¬
logic disease is required."
ART AS SOCIAL VEHICLE
In spite of his failure to justify sci¬
entific credibility through art, Char¬
cot's artistic projects were of signifi¬
cant personal and social benefit. With
them, he effectively presented himself
as a multitalented and culturally so¬
phisticated man. The importance of
1. Guillain C; Bailey P, trans. J. M. Charcot: His
Life\p=m-\His
Work. New York, NY: Hoeber; 1959.
2. Goetz CG. Charcot: The Clinician\p=m-\The
Tuesday Lessons. New York, NY: Raven Press;
1987.
3. Charcot JM. Le\l=c;\onsdu Mardi, 1887-88. Paris,
France: Bureaux du Progr\l=e`\sM\l=e'\dical;January 31,
1888.
4. Meige H. Charcot\p=m-\artiste.Nouv Iconogr
Salpetriere. 1898;2:489-516.
5. Londe A. Le service photographique de la
Salp\l=e^\tri\l=e`\re.Paris,
France: Doin; 1892.
6. Charcot JM. Le\l=c;\ons du Mardi,1887-88. Paris,
France: Bureaux du Progr\l=e`\sM\l=e'\dical;February 7,
Downloaded from www.archneurol.com at Kings College London, on January 24, 2011
this dimension to his career should not
be underestimated, for Charcot came
from very humble origins. If a certain
underlying cultural insecurity existed,
his extensive literary references to po¬
etry and Shakespeare and his artistic
allusions that spanned the centuries of
western culture obviously helped
Charcot to present himself as a man of
Renaissance dimension.215 He also
posed as the focal point for an im¬
mense group portrait by Brouillet, "A
Clinical Lesson at the Salpêtrière"
(Fig 9), a painting that became part of
the celebrated 1887 Paris Salon, the
focal point of artistic Paris at the
time.16 His name was known to the
public, and he was even pictured on the
cover of a popular street tabloid sur¬
rounded by his patients (Fig 10). These
documents demonstrate that by the
close of his career, Charcot, the Sal¬
pêtrière, and neurology had entered
into the current social consciousness of
the time. In these ways, art served
Charcot directly to broaden his image
and to solidify him as a cultural as well
as a scientific figure of French society
in the glittering close of the 19th cen¬
tury. Without this dimension and the
close political ties that Charcot culti¬
vated with Gambetta and other gov¬
ernmental figures of the third French
Republic, one could question whether
the original chair of neurologic dis¬
eases would ever have been established
as early as 1882, and specifically in
Paris at the Salpêtrière.
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8. Raymond F. Le\l=c;\ond'ouverture. Prog Med.
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9. Starr A. Charcot. In: The Physician
Throughout the Ages. New York, NY: Capehart\x=req-\
Brown; 1928:559-562.
10. Trillat E. Histoire de l'hyst\l=e'\rie.Paris,
France: Seghers; 1986.
11. Laseque C. Etudes m\l=e'\dicales.Paris, France:
Asselin; 1884.
12. Charcot JM. Le\l=c;\onsdu Mardi, 1887-88.
Paris, France: Bureaux du Progr\l=e`\sM\l=e'\dical;Octo-
CHARCOT'S NEUROLOGIC ARTISTIC
LEGACY
In 1893, when Charcot died, the Sal¬
pêtrière service included artists, sculp¬
tors, photographers, and a team of
young neurologists well versed in vi¬
sual documentation. Thereafter, the
photographic wing actively continued
for several generations, and the Nou¬
velle Iconographie de la Salpêtrière
was published until 1929. In the 1950s,
however, the Charcot Museum, with
its extensive documentation of the Sal¬
pêtrière visual effort, was dissolved
and the collection was lost or
dispersed.2 A pivotal investment in vi¬
sual medical documentation is no
longer specifically linked to the Salpêt¬
rière, nor has it been for the past 70
years, and more recent international
generations have developed innovative
applications of scanning devices, vid¬
eotaping, and other technologies that
continue Charcot's tradition of visual
neurologic documentation. These tech¬
niques are pivotal to the continued ap¬
plication of the clinicoanatomic neu¬
rologic method and to the refinement
of modern neurologic nosology. As the
centenary of Charcot's death ap¬
proaches and the neurologic world in¬
vests increasingly in reexamining his
written legacy, the "visual Charcot"
deserves emphasis because it coalesces
neurologist, teacher, social figure, and
private citizen without needed gram¬
matical translation or language study.
ber 30, 1888.
13. Gowers WR. Epilepsy and Other Chronic
Convulsive Disorders. London, England:
Churchill; 1881.
14. Guinon G. Charcot intime. Paris Med.
1925;26:511-526.
15. Goetz CG. Shakespeare in Charcot's neuro-
logic teaching. Arch Neurol. 1988;45:920-921.
16. Signoret JL. Une le\l=c;\onclinique \l=a`\la Salp\l=e^\t-
ri\l=e`\re(1887) par Andr\l=e'\Brouillet. Rev Neurol
(Paris). 1983;139:687-701.
17. Charcot JM. Differenti forme d'afasia. Mi-
lan, Italy: Casa Editrice Dottore F. Vallardi; 1884.