Biographies de neurologues
Nouvelle Iconographie de La Salpêtrière
 L'histoire des neurosciences à La Pitié et à La Salpêtrière J Poirier
The history of neurosciences at La Pitié and La Salpêtrière J Poirier
Augustine Gleizes (1861) une hystérique à La Salpêtrière
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mise à jour du 15 mai 2003
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The history of neurosciences at La Pitié and La Salpêtrière
Professeur des Universités-Praticien Hospitalier
Président de la Société Française d'Histoire de la Neurologie


The history of the Pitié and Salpêtrière hospitals began 4 centuries ago, and encompasses the development of psychiatry, neurology, neuropathology, neurosurgery, neuroradiology, and more generally, neuroscience, in France. La Pitié and La Salpêtrière were both created at the beginning of the 17th century. La Pitié was first installed facing the Jardin des Plantes (where the Paris mosque is now located), and used to be a beggars' asylum. The history of La Salpêtrière began in 1634, when the arsenal was transferred from the Bastille area to the confluent of the Bièvre. The arsenal was called La Salpêtrière, because of the saltpeter that was used to make gunpowder. The royal edict of 1656 ordered the «grand renfermement», i.e. the confinement of the poor inside the «Hôpital Général de la Ville de Paris», that comprised 8 institutions, of which La Pitié and La Salpêtrière were among the most important. These hospitals had no obligation to care for the ill, they were only a shelter for the poor, the disabled, the insane, orphans, abandoned children, the destitute elderly and women of «easy virtue». In 1684, in addition to the beggars' asylum, a prison, «La Force», was established in the Salpêtrière, for about 300 common law female prisoners and prostitutes. This prison was used until the French Revolution.
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Trois souvenirs, La Salpêtrière. A. Daudet. 1896
The birth of psychiatry at Salpêtrière : Pinel and the hospital alienists
In 1801, the Hôpital Général became the «Hospices Civils». From 1837 to 1887, La Salpêtrière housed aged women («Hospice de la Vieillesse-Femmes»), and Bicêtre aged men. Prostitutes, convicts, young girls, sick people went elsewhere; only elderly and insane women remained.
It was there that the alienists of Paris hospitals, founded modern medicine for the mentally ill. Between 1785 and 1826, Pinel (and his ward-supervisor Pussin), Esquirol and their successors, greatly contributed to the development of modern psychiatry.
Later on, mental diseases were treated in psychiatric hospitals, but Heuyer, Michaux, Duché, and their successors at La Salpêtrière continued to devote themselves to child and adolescent psychiatry and Widlöcher and his school to the treatment of adults.
The birth of neurology and neuropathology : Charcot, Vulpian and the School of Salpêtrière
In 1862, Jean-Martin Charcot (1845-1893) and his friend Vulpian, became directors of clinics at the Salpêtrière. Vulpian left 5 years later, but Charcot stayed for more than 30 years - a very unusual event- until his death in 1893. At the Salpêtrière, at this period, there were only 2 clinics of medicine, 5 for mental diseases, headed by alienists, and 1 for general surgery. The Hospice Vieillesse-Femmes, as it was still called, counted 4,422 beds, two third of which were reserved for mentally unimpaired indigents and epileptics, and one third for mentally deranged women.
Charcot and Vulpian began a systematic anatomo-clinical study of this truly «living museum of pathology» with hundreds of chronic patients in their two medical departments. Their enormous accomplishements cannot be summarized in a few lines. No type of nervous system disorder was excluded: multiple sclerosis, amyotrophic lateral sclerosis, also called Charcot's disease, Charcot-Marie-Tooth disease, cerebral localization, and, of course, the study of hysteria which contributed to Charcot's world-wide reputation.
In 1882, a specific chair for neurology was created, the «Clinique des Maladies du Système Nerveux» which was the summit of Charcot's career. His successors maintained the anatomo-clinical tradition that he had initiated with Vulpian: Brissaud (ad interim), Raymond, Déjérine, Pierre Marie, Guillain, Alajouanine and Castaigne, the last occupant of Charcot chair, all contributed to the development of this field. Neuropsychology, especially the study of speech and language, was illustrated in particular by the work of Alajouanine and his school, François Lhermitte, Jean-Louis Signoret and their successors. This was, however, not the only neurology department in the Salpêtrière; there were others as well, directed by Souques, Hagueneau, Garcin, Boudin, Buge and their successors, which gave rise to major scientific discoveries.
Neuropathology, initially practiced by the neurologists, gained its independance. It was first concerned with the anatomopathology of the nervous system, still a satellite of clinical neurology, with Ivan Bertrand at the Clinique des Maladies du Système Nerveux at the Salpêtrière, Jean-Emmanuel Grüner then Jean-François Foncin in the Salpêtrière neurosurgery clinic, Henri Berdet then Roger Messimy in neurosurgery at La Pitié. More recently, neuropathology and histology-embryology departments were created, the former by Raymond Escourolle, the latter by Jean Racadot.
The Neurology School of la Pitié and the foundation of neurosurgery : Babinski, Thierry de Martel and Clovis Vincent
At the beginning of the 19th century, under the impetus of Serres, la Pitié became a center for the study of nervous diseases. Its most famous medical doctor was, without any doubt, Joseph Babinski (1857-1932) whose extensor plantar reflex, the Babinski sign, is known world-wide . First trained by Charcot, he became head of a department at La Pitié January 1, 1895.
In 1913, after the demolition of the ancient Pitié, he installed his department in the new buildings of the newly constructed Pitié, inside the gardens of the Salpêtrière, which was built where it now stands. The accomplishments of Babinski were essentially clinical, aimed at finding objective signs of the organic nature of neurological symptoms, that distinguish them from hysteria. He thus elaborated the semiology of the cerebellar syndrome and described his now classical sign for pyramidal syndromes. His name is also attached to several neurological syndromes: Babinski-Froehlich, Babinski-Nageotte, Anton-Babinski.
During the first years of the 20th century, Babinski initiated neurosurgery in France. Thierry de Martel, then Clovis Vincent, performed the operations. Antoine Chipault (1866-1920), head of a surgery clinic at the Salpêtrière, had previously practiced neurosurgery, but his work remained unknown.
In 1933, a neurosurgery department was created for Clovis Vincent (1879-1947), at La Pitié. In 1938, the first chair of neurosurgery was also created for him there. He was succeeded by Petit-Dutaillis, Marcel David and Bertrand Pertuiset.
Neurology was practiced not only at La Salpêtrière, neurosurgery not only at La Pitié. Guillaume, who succeeded Clovis Vincent, assistant to Thierry de Martel, started as a neurosurgeon at La Salpêtrière, in the surgery departments of Antonin Gosset, then Henri Mondor, before becoming the head of the first neurosurgery department of La Salpêtrière. Lebeau succeeded him in 1960.
New fields of specialization developped : neurophysiology and neuroradiology, more recently neuroimaging. The pioneering work of Hermann Fishgold, closely liked to the neurosurgery department of the Pitié, and of Jean Scherrer in neurophysiology, should be underlined.
Pitié-Salpêtrière in the recent years : a multidisciplinary university hospital with a strong focus on neurosciences
The present era began in the 1960's with :
• the fusion of La Pitié and La Salpêtrière which gave rise toPitié-Salpêtrière hospital center;
• the destruction of the «Infirmerie Générale» which dated from the end of the 18th century, and which was replaced by a new Clinic for the Diseases of the Nervous System, and the Neuropathology Laboratory Charles Foix (1965);
• the disappearance of the remaining elderly (1969);
• the creation of the Pitié-Salpêtrière Medical School (1968) with the Pitié-Salpêtrière as the University Hospital, in association with the Broca Hospital and the Hospice of Ivry.
The Faculty of Medicine, which is part of the University of Paris VI (Pierre and Marie Curie), occupies two buildings, 91 and 105 Boulevard de l'Hôpital.
Thanks to the dean Paul Castaigne, an important university hospital developed where most fields of medicine were represented, but, in keeping with its past history, neurology predominated. There are now many neurology, neurosurgery, adult adolescent and child psychiatry clinics. There are also medico-technical departments : neuroradiology, neurophysiology, neuropathology and histo-embryology.
Some of these were recently grouped together in the modern Babinski building where the Myology Institute is also located. In addition, since the 1970s, a number of neuroscience research groups in neurobiology, neurochemistry, neuropharmacology, neurogenetics, neuroimmunology, neuroepidemiology, functional imaging and neurophysiology of integrated systems have progressively developed, under the auspices of the National Research Institutes. All aspects of neuroscience and cogniscience are represented in the Federated Institute of Neuroscience Research. This research institute is jointl administered by Assistance Publique-Hôpitaux de Paris (AP-HP), Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médical (INSERM),Université Pierre et Marie Curie (UPMC).
The neurological tropism of the Pitié-Salpêtrière is also reinforced by the presence of the Charcot library located above the Charcot lecture hall and next to the «Clinique des Maladies du Système Nerveux Paul Castaigne». It contains not only the medico-scientific heritage of Charcot, but also the Souques library and one of the residents of the Salpêtrière
Hospital, started in the early ages of neurology. It is now a university library, with which the Charcot Institute is associated. It is specialized in neurology, and is growing in the neurosciences.
The French Neurology Society, founded in 1949 as an offshoot of the Paris Neurology Society, holds its monthly
meeting in the Charcot Lecture Hall. The main office of the Society for the History of Neurology, founded in 1991, with Jean-Louis Signoret as first president, is also in the Charcot Library.
Thus, for over four hundred years, from the beginning of the 17th century, to the end of the 20th century, two distinct hospitals, that initially served social functions beggars asylum, prison, hospice for elderly and insane women, developed from the 19th century on, under Pinel, Esquirol, Charcot, Vulpian, Babinski, Clovis Vincent (to name only the major figures), into an establishment for medical care, teaching and research, that is particularly well known for the treatment of mental disorders, diseases of the nervous system, and more recently, research in neuroscience.
The union, in the sixties, of La Pitié and La Salpêtrière Hospitals, with the Pitié-Salpêtrière Medical School, led, under the direction of the dean Paul Castaigne, to the development of a multidisciplinary University and Hospital Center. Its historical neurological vocation has been reinforced with the vitality of the Federated Institute of Neuroscience Research.
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