The Salpetriere

In 1656 Louis XIV became concerned about the breakdown of social order in Paris evidenced by the number of marginalised persons at large in the streets of the French capital. He decided that such citizens, many incapable of independent support and inimical to the public order, should be institutionalised and ordered that a hospice be built for their containment. The site chosen was that of a former gun factory and arsenal storing saltpetre, a constituent of gunpowder. Owing to this former function the institution became the Hospice de la Salpetriere. In time it evolved to serve a multitudinous clientele caring for foundlings, the homeless and indigent, prostitutes and the mentally disordered with some similarity of function to the workhouses of 19th-century Ireland, although on a far greater scale. At its acme, Salpetriere housed 7000 residents in a variety of pavilions set out in pleasant gardens and miniature parks. As the years went by it became ever more medicalised and in 1964 amalgamated with the nearby Hopital de la Pitie, founded in 1612, to become the Groupe Hospitalier Pitie-Salpetriere.

Jean-Martin Charcot

Jean-Martin Charcot had been born in Paris in 1823, son of a coachbuilder of modest means. From early on, however, showing considerable talent and commitment to his studies and an interest in painting and drawing, his father decided to support his further education to the hilt at the expense of his less-promising siblings. Thus, it was that Jean-Martin qualified as a physician at the age of 23 and entered the Salpetriere as an intern and there he was destined to spend the rest of his professional career. Mentored by the physician Duchenne de Boulogne, his work commitment and his clinical insights saw him progress at the hospital and become chef de clinique in 1862.

Charcot at the Salpetriere

At the Salpetriere, Charcot’s interest in neurological conditions grew and in 1872 his department became the first centre of neurology to be established in Europe attracting doctors and students from far and wide.

By now Charcot was identified as the Napoleon of neurology, renowned for his descriptions of multiple sclerosis, motor neurone disease, Parkinsonism and much else besides with no less than 15 eponymous conditions and structures. He gave his Salpetriere lectures to audiences that included many distinguished colleagues such as Babinsky, Marie, Janet, Lombroso, Freud, Axel Munthe, Breuer of Nancy, Duchenne – a veritable galaxy of medical scientists, all present at one time or another. Among them, too, was Gilles de la Tourette, a favourite son of Charcot whose tragic end, suffering from progressive psychosis in the cantonal psychiatric hospital at Cery, Lausanne, where Luc Ciompi was later to carry out his celebrated long-term follow-up of schizophrenia, is deeply moving. Present too were many non-medical personages including writers such as Guy de Maupassant and the sociologist Emile Durkheim, in fact tout le monde of smart fin de siècle Paris attracted by Charcot’s demonstrations of hysteria and hypnosis.

In my book by Sigerson, one-third of Charcot’s lectures are on descriptions and clinical demonstrations of ‘hystero-epilepsy’. These ‘lecons du mardi’ subsequently tarnished Charcot’s reputation as many believed that much of this theatrical display was fraudulent, not necessarily consciously so as Charcot sought an organic basis for his ‘hysterics’ but not finding one, still did not subscribe to the possible socio-psychological nature of what he was presenting. It has been claimed that the La Grandie Hysterie of the Salpetriere, in all its manifestations, came about when epileptics, hospitalised there, were transferred to the care of Charcot whose more suggestible patients adopted the epileptic symptoms of their organic peers. The biographies of his prime hysterical exhibits, three women, have been presented in a recent publication (Husttvedt Reference Hustvedt2011). Charcot did not interest himself in mental illness as such and never visited the psychiatric ward of the Salpetriere.

I had in 1978 the good fortune of being able to visit the Salpetriere, passing the statue of Pinel at the entrance, to view an exhibition there entitled ‘Charcot et l’hysterie au XIX siècle’, where a great deal of Charcot memorabilia were on display, including the celebrated painting by Andre Brouillet ‘A clinical lecture at the Saltpetriere’ with Charcot in full flight presenting the redoubtable and famous ‘Blanche’, otherwise Marie Witmann, one of the three above referred to, swooning in hypnotic trance and supported by Babinsky. My catalogue contains many photographs by the physician, photographer and illustrator, Paul Richter, showing patients in the phases of catalepsy, hypnotism, automatism and with examples of dermatographism. In November 2013, the international Photo Paris exhibition included a rather terrifying photo of a patient’s expression during electrical stimulation by the neurologist and photographer, Dr Duchenne de Boulogne at the Salpetriere of Charcot’s time.

My catalogue of the Salpetriere exhibition details that Jeanne Beaudon, who later became as, nom de theatre, Jane Avril and was to be depicted by Toulouse Lautrec on stage in the Moulin Rouge, was also a patient in Charcot’s ward, although only aged 14.

Axel Munthe’s book The Story of San Michele (Munthe Reference Munthe1929), not as well known in medical circles as it should be, describes how Munthe was evicted from Salpetriere by the master as he was believed to have befriended a patient often presented by Charcot at his séances. Munthe is unflattering to Charcot, perhaps because of being barred. No such fate awaited Sigmund Freud who was very impressed with Charcot’s eminence as a neurologist and worked with him on post mortems of some patients. Indeed, Freud hung a copy of Brouillet’s picture on his consulting room wall in London.

Sigerson at the Salpetriere

This then was the setting to which George Sigerson, an Irish visiting physician, educated in France and proficient in that language, went to further his medical education and skills. Lyons (Reference Lyons1997) recounts a deputation of Irish nationalists, including Sigerson going to Chalons in 1860, and presenting a sword of honour to Marechal MacMahon, a prominent officer in the French Army campaigns at Sebastopol and elsewhere. Lyons does not tell us the background to this presentation nor that, at least in socialist circles, McMahon’s reputation was somewhat sullied by his participation in putting down, with much bloodshed, the Paris Communards of 1871, despite later becoming President of France of the Third Republic.

Lyons speculates that during this visit Sigerson may have taken the opportunity of visiting Paris hospitals and that when he first met Charcot is unclear, but since Charcot had stayed with Sigerson and his family in 3, Clare Street in Dublin in 1872 and had attended a course in pathology run by Charcot in 1873 it is likely that they had first encountered one another in the late 1860s.

Throughout the 1870s Sigerson regularly visited Salpetriere to study under Charcot meeting there the crème de la crème of European medical men including Freud and Claude Bernard. Charcot was impressed by this Irish student and thus began a lifelong friendship. Their intimacy culminated in the translation into English of Charcot’s Tuesday’s and Friday’s clinical demonstrations and lectures at the Salpetriere by Sigerson. When Charcot visited Cork in 1879, while attending a meeting of the British Medical Association there, he travelled on to Dublin to stay with Sigerson at Clare Street. The Irishman later became a dinner guest of Charcot at his home in the Boulevard Saint Germain where Charcot, having married a wealthy widow, had purchased a hotel particulier, the Hotel de Varengeville with its celebrated architecture and boiseries, a room of which is now in the Metropolitan Museum of Art, New York. Sigerson became friendly with Charcot’s son, whose father had wanted him to become a neurologist following medical qualification, but who had instead insisted on becoming an Arctic explorer and frequently visited Sigerson in Dublin.

Retirement and death

Charcot did not survive to enjoy retirement. Though still clinically active he suffered from angina from 1890 onwards and died, aged 68, in 1893 while on holiday in the Morvan near the celebrated monastic settlement and church of Vezelay. Through Sigerson’s influence an honorary fellowship of the King’s and Queen’s College of Ireland was conferred on Charcot in 1887. Sigerson himself was similarly honoured, belatedly, in 1918, aged 82, and in 1923 he represented the National University of Ireland at Charcot’s centenary celebrations at the Sorbonne, Paris in 1923.

A source not quoted by Lyons is Curran (Reference Curran1970) which relates memories of Sigerson, his literary and other endeavours. Curran, being a close friend, on visits to Paris often dined with Sigerson at Restaurant Vefour, the oldest restaurant in Paris, being founded in 1784. It had been the rendezvous of revolutionaries and intellectuals and its clientele has included Lamartine, Victor Hugo, Napoleon and Josephine and more recently Jean Paul Sartre.

In retirement in Clare Street, Curran tells us, Sigerson hosted soirees and dinner parties amid a décor overwhelmingly French, resplendent with tapestry, paintings, pastels and period furniture of Louis XIV and Louis XV. He preferred candlelight to electricity, glowing in the splendours of his collection that included a Rafaello drawing subsequently donated to our National Gallery. These dinners have been described by guest Mary Colum, wife of Patrick Colum, ‘as having the atmosphere of a Paris salon about them’.

Curran describes evenings spent with Sigerson in his twilight days, cataloguing his art collection in ‘a lonely house’, he now being a widower and retired from practice. He died in February 1925 aged 89. Number 3, Clare Street has been demolished and the space now houses the Millennium extension of the National Gallery of Ireland.

The Royal College of Physicians of Ireland has an early 20th-century oil portrait of Sigerson by an unknown artist, reproduced here with kind permission of the College, as well as a death mask by Estella Solomons.