GOMES, Marleide da Mota; CAVALCANTI, Jose Luiz de Sa and ENGELHARDT, Eliasz. French school of neurology in the 19 th and first half of the 20th century, and its influence in Brazil. Arq. Neuro-Psiquiatr. [online]. 2013, vol.71, n.10 [cited 2016-12-30], pp.818-821.
French medicine was of the utmost importance for the birth of modern medicine and neurology in the 19th century. Innovative approaches, such as examination at the bedside, the use of the stethoscope, techniques of auscultation, palpation, and close patient examination, besides emphasis on anatomical-clinical correlation and observation of the outcome of the disease, were put into practice. French medicine offered professional training and incentives for the beginnings of Brazilian neurology and psychiatry. Returning from France, many Brazilian physicians implemented what they had learned, mainly in Paris. The most important pupils of the French neurology schools in Brazil during the 19th century and first half of the 20th century include names like Antonio Austregesilo, Aloysio de Castro, Enjolras Vampré, and Deolindo Couto, founders of the leading Brazilian neurological schools, directly influenced by Dejerine, Pierre Marie, Guillain and Babinski
Brazilian medicine, in the 19 th century and the first half of 20 th century was mainly influenced by French medicine, and reinforced later by a German contribution. This also includes the influence exerted by Jean-Martin Charcot (1825–1893) and his followers on the leaders of the first Brazilian schools of neurology (in Rio de Janeiro, the majority, and also in São Paulo).
FRENCH MEDICINE: 19 TH CENTURY AND BEGINNING OF THE 20 TH CENTURY
France after the Napoleonic revolution emphasized the hospital ward as the most important place for medical activity, and public health measures were seen as a duty of the State, with medical practice open to all classes.
The main characteristic of 19 th century medicine was the correlation of observations obtained at the bedside with laboratory discoveries through autopsy. Among many famous names it is necessary to highlight those that follow. Philippe Pinel (1745–1826) was concerned with classification of diseases, and later favored specialization in mental diseases. Rene-Theophile-Hyacinthe Laennec (1781–1826), inventor of the stethoscope and apologist of the anatomical–clinical method, was one of the finest clinicians of the time, but was not as renowned as François-Joseph-Victor Broussais (1772–1838), who considered that proper treatment should focus on changes in tissue pathology. Finally, the main founders of clinical neurology in France were Guillaume B. A. Duchenne (1806–1875) and the remarkable Charcot. Charcot adopted the anatomical–clinical method and became world-famous through his clinical lectures at L’Hôpital de la Salpêtrière in Paris. Many of his pupils and/or successors were influential members of French neurology community.
FRENCH MEDICINE AND THE PRECURSORS OF BRAZILIAN NEUROLOGY
French medicine exerted a strong influence on Brazilian physicians who held pioneering roles in their professional field. Three of them who were the “first” in their field of knowledge must be stressed.
José Martins da Cruz Jobim (1802–1878), graduated in Medicine at the Faculté de Médecine de Paris (1828), was strongly influenced by the doctrine of François Broussais (1772–1838). As the author of the first Brazilian neuropsychiatric text, Insania loquaz (1831), he may be regarded as the first Brazilian neuro- psychiatrist.
João Vicente Torres Homem (1837–1887), the author of the first Brazilian medical book fully committed to neurology, Lições sobre as moléstias do systema nervoso… (1886), was the Internal Medicine Chair in Rio de Janeiro. According to Nava (apud Fiocruz) : “Torres Homem is the representative type, the index, the sum of whom was the result of the influence of French Medicine on the evolution of indigenous clinics. To the cycle of French influence we are indebted – and in the human personality and as medical teacher, Torres is the symbol of it”.
João Carlos Teixeira Brandão (1854–1921), the first Brazilian professor of the chair of “Mental and Nervous Diseases”, the “father” of the Brazilian psychiatry, was inspired by the conceptions of the French alienists, such as Morel’s “degenerescence” (Bénédict-Augustin Morel, 1809–1873). He spent time in France, Germany, and Italy to study European Psychiatry.
FRENCH NEUROLOGISTS AND THEIR INFLUENCE ON BRAZILIAN NEUROLOGY
Besides the previously cited precursors (Jobim, Torres Homem, Brandão), Brazilian neurology was strongly influenced by the modern French neurological school, which had Charcot as its powerful “patron”. Charcot provided clinical and pathological descriptions of multiple sclerosis, amyotrophic lateral sclerosis, hereditary motor and sensory neuropathy, and motor ataxia. He labeled “shaking palsy” with Parkinson’s name, and the “ maladies des tics ” with that of Gilles de la Tourette. Aphasia and agnosia passed through his sieve, and some signs and diseases were named after him. Despite Charcot’s dominance of French neurology, other significant names in this field developed careers in an independent way, such as Charles-Édouard Brown-Séquard (1817–1894) and Joseph-Jules Dejerine (1849–1917). Dejerine was Vulpian’s (Alfred Vulpian, 1826–1887) pupil at the Hôpital Bicêtre, and Charcot’s collaborator. Fulgence Raymond (1844–1910), Charcot’s senior chef de clinique , succeeded Édouard Brissaud (1852–1909) at the Salpetrière and Dejerine followed after Raymond’s death (1910). It is necessary to mention that Brissaud, Charcot’s temporary successor, was also a pupil of Pierre Paul Broca (1824–1880), one of the pillars of modern neurology. Pierre Marie (1853–1940), one of Charcot’s favorite pupils, teacher at the Faculty of Paris (1889), created a neurological service at Bicêtre. In 1907, he succeeded Charcot as Chair of Pathological Anatomy, and, in 1918, he became Professor of Clinical Neurology at the Salpêtrière after Dejerine. Later, Georges Guillain (1876–1961), who obtained his medical doctorate at Paris in 1898, became Professor of Neurology at the Salpêtrière in 1923. Joseph Jules François Félix Babinski (1857–1932) at La Pitié, one of the stars of the ‘‘master’s’’ circle, became an important leader of the new neurology.
The illustrious French personalities, Dejerine, Marie, Babinski, and Guillain, members of the “Parisian neurologists”, who trained students and doctors from around the world, were the main French mentors of some pioneers of Brazilian neurology, as mentioned below.
Antônio Austregesilo Rodrigues de Lima (1876–1960), who may be seen as the father of Brazilian neurology, was trained in Paris by Dejerine, Marie, and Babinski. He wrote an extensive bibliography on mental diseases, and in 1912 became Head of Neurology at the School of Medicine in Rio de Janeiro. There, he introduced the new specialty, created the first neurological school in Rio de Janeiro, and was one of the founders of Arquivos Brasileiros de Neurologia e de Psiquiatria.
Aloysio de Castro (1881–1959), a co-founder of Brazilian neurology, traveled to Europe, where he expanded his knowledge on nervous semiology at the Hôpital Bicêtre under the supervision of Pierre Marie.
Enjolras Vampré (1895–1938) is seen as the father of Neurology in São Paulo, at the time the second most important neurological school in Brazil. In Paris, he attended lessons given by Babinski, Dejerine, Foix, and Bertrand (1908, 1925), and qualified at the Salpêtrière hospital under the supervision of George Guillain.
Deolindo Augusto de Nunes Couto (1902–1992), the most influential neurologist in Brazil from 1945 to 1972, was Guillain’s disciple at Salpêtrière hospital (1935 and 1936), and along with his colleagues introduced French medical knowledge, the methodology and way of thinking to Brazil, which have become mainstays of Brazilian neurology.
These distinguished followers of the French school, the founders and developers of Brazilian neurology, left a legacy for future Brazilian generations, and owe a debt to the Gallic neurology.