Keywords
Neurology - Neurosciences - Neuroanatomy - History - History of Medicine
Palavras-chave
Neurologia - Neurociências - Neuroanatomia - História - História da Medicina
INTRODUCTION
At the end of the 19th century, Paris became the worldwide center of neurology, with
the Salpêtrière hospital being considered the Mecca of neurology, under the leadership
of Jean-Martin Charcot (1825–1893).[1]
In the same period, a new prolific researcher appeared in Paris, Jules Joseph Dejerine
(1849–1917).[1]
[2]
[3] A disciple of Alfred Vulpian (1826–1887), who was a longtime collaborator and friend
of Charcot's, Dejerine worked at the Bicêtre before his admittance to the Salpêtrière in 1887, after Charcot accepted a request
from Vulpian.[1]
[2]
[3] Dejerine's strong personality led him to behave as an intellectual and scientific
rival for Charcot and his disciples, especially concerning one of his most faithful
pupils: Pierre Marie (1853–1940),[1]
[2]
[3]
[4]
[5]
[6] competing for academic influence within different areas of neurology.[1]
[2]
[3]
[6] This rivalry involved Jules Dejerine's wife, Augusta Dejerine-Klumpke (1859–1927).[1]
[2]
[3]
[6]
[7]
[8]
[9]
[10]
[11]
In this historical report, we discuss the expulsion of Augusta Dejerine-Klumpke of
the Salpêtrière in 1917, after approval by Pierre Marie, as head of the chair Clinics
of Diseases of the Nervous System.
AUGUSTA DEJERINE-KLUMPKE
Augusta Marie Klumpke, born in San Francisco, USA, with parents who emigrated from
Germany, settled in Paris, where she was one of the first women to graduate in medicine
and then intern at Vulpian's neurology service, at the Bicêtre hospital.[7]
[8]
[9]
[10]
[11]
[12]
[13]
[14] There, she met Jules Joseph Dejerine (1849–1917), whom she married in 1888, and
with whom she began an intense scientific production in the areas of neuroanatomy
and neurology. She became known internationally as Augusta Dejerine-Klumpke ([Figure 1]).[7]
[8]
[9]
[10]
[11]
[12]
[13]
[14]
Figure 1 Jules Dejerine (1849–1917) and Augusta Dejerine-Klumpke Déjerine (1859–1924). Source:
The Wellcome Collection. Licensed under CC by 4.0.
Partnering with her husband, she produced works of great relevance such as the book
“Anatomie des Centres Nerveux,” in which she described and illustrated the projection
fibers and fibers of association between the different locations of the central nervous
system. She also contributed to Dejerine's famous publication, entitled “Sémiologie
des affections du système nerveaux.”[6]
[7]
[8]
[10]
[11]
[12]
[13]
[14] The couple also described several diseases of the central and peripheral nervous
systems, such as aphasia, alexia, agraphia, the Klumpke plexopathy (involvement of
the C8–T1 roots of the brachial plexus), cases of meningoradiculitis, and inflammatory
demyelinating polyradiculoneuropathy.[6]
[7]
[8]
[10]
[11]
[12]
[13]
[14]
Despite being recognized by her husband as a great ally in the production of his works,
as a female doctor in the 19th century and a foreigner, many colleagues did not look on her kindly.[9]
[10]
[13]
[14] However, with the influence she had over the years, as one of the pioneers in French
neurology, she paved the way for other women to enter this field and made history
as the first woman to preside over the French Society of Neurology in 1914. She published
56 articles during her career and received several distinctions, such as the Godard
prize from the Academy of Medicine for her study on the Klumpke plexopathy, and the
title of Chevalier de la légion d'honneur, for her work during the war.[6]
[7]
[9]
[10]
[14]
THE INCIDENT EXPLAINED
As Roch-Lecours described in his 1999 article, the rivalry between Pierre Marie ([Figure 2]) and Jules Dejerine was notorious.[15] After Charcot's death in August 1893, the provisional head of the neurology service
at the Salpêtrière hospital was Édouard Brissaud (1852–1909), until the approval by
public tender of Fulgence Raymond (1844–1910), both disciples of Charcot's, though
Raymond was also a disciple of Vulpian). Raymond remained as head of the Department
of Diseases of the Nervous System until 1910, when he died. In the same year, a new
public contest was instituted, and Dejerine was chosen as the new head, defeating
Pierre Marie.[1]
[2]
[3]
[5]
[6]
Figure 2 Pierre Marie (1853–1940). Photograph by Eugene Pirou. Source: The Wellcome Collection.
Licensed under a public domain mark.
This fact escalated the rivalry between Marie and Dejerine, which was already quite
evident with the famous duels between them, including the so-called debate of aphasias
in Paris, which occurred in the year 1908.[1]
[6]
[15]
[16]
[17]
[18]
In the year 1917, Dejerine died, and a new competition was opened to choose the new
head of Chair of Diseases of the Nervous System at the Salpêtrière hospital, with
the selection of Pierre Marie. The doctor remained as head of Clinics of Diseases
of Nervous System, of the Salpêtrière from 1917 to 1925, when he retired.[1]
[2]
[3]
[5]
[6]
[18]
THE EXPULSION OF AUGUSTA DEJERINE-KLUMPKE FROM THE SALPÊTRIÈRE HOSPITAL
THE EXPULSION OF AUGUSTA DEJERINE-KLUMPKE FROM THE SALPÊTRIÈRE HOSPITAL
In 1917, at last, Pierre Marie returned to the Salpêtrière as head of the neurology
service; 24 years after Charcot's death, the school he had created returned to power.[1]
[5]
[6]
[18] Due to Pierre Marie's difficult and sometimes irascible temperament, shortly after
his return to the Salpêtrière and the beginning of his activities as head of the neurology
service, he immediately determined that Dejerine's widow, Augusta Dejerine-Klumpke,
should be expelled from the hospital, giving a period of 2 weeks for this action to
be accomplished.[5]
[11]
[17]
Although little is known about the expulsion itself, it is established that the trigger
for the expulsion was, allegedly, economical: as France was devastated at the end
of World War I, the Salpêtrière could no longer afford the costly facilities of Madame
Dejerine.[6] Marie disfavored the Dejerine couple, as both were Vulpian's students, had no neurological
training at the Salpêtrière, and Marie opposed the ideas on aphasia localization that
the Dejerines defended.[1]
[2]
[3]
[5]
[6]
[10]
[14]
[16]
[17]
[18]
In addition to professional rivalries, there is unproven evidence that antagonism
of social classes played a role in this schism, since Pierre Marie was from the French
bourgeoisie, upper middle class, married to a woman from a wealthy family, while Dejerine was
related to modest peasants from Switzerland.[3]
[5]
[6]
[11]
[14]
[15]
After her expulsion, Madame Dejerine-Klumpke was aided by her friend Maurice Letulle
(1853–1929), Pierre Marie's successor to the chair of pathological anatomy, who stored
her collection in his department. Later, Madame Dejerine and her daughter, Yvonne
Sorrel-Dejerine (1891–1986), created a fund to maintain the collection and established
The Dejerine Foundation in 1920, dedicated to the preservation of the Dejerine legacy,
and fostering neurological research and education.[19]
Augusta Dejerine-Klumpke was ahead of her time, providing outstanding contributions
in the field of neurology and achieving international recognition.[7]
[8]
[9]
[10]
[11]
[12] Despite an accoladed career, she was expelled from the Salpêtrière in 1917 due to
the rivalry and hatred between Pierre Marie and Jules Dejerine, her husband and collaborator.[7]
[8]
[9]
[10]
[11]
[12]
[17] For Pierre Marie, with his hostile temper, the Neurology Service at the Salpêtrière
had finally returned to its Charcotian hosts.
