At the Salpetriere

A Lecture at the Salpetriere, Andre Brouillet, 1887

In 1656, Louis XIV built a hospital on the site of an old gunpowder factory. It unfortunately retained the name, so it became the “Hospital of the Gunpowder Factory”, l’Hospice de la Salpetriere.

The implication that the place might have been a powder keg was fascinatingly prescient.

It was not just a women’s hospital. It was where all the madwomen were sent. It also served as a notorious women’s prison. Prostitutes were housed here before being expelled to New France (and you wonder why New Orleans is the way it is?). The infamous Jeanne de la Motte was imprisoned in the Salpetriere after the Affair of the Diamond Necklace. She escaped in 1787, dressed as a boy.

After the Revolution, the hospital returned to semi-normalcy under the tutelage of the great Phillipe Pinel. It was inherited, in the mid-19th century, by Jean-Martin Charcot, the Father of Neurology.

To state that he was the Father of Neurology is not an exaggeration. He developed the modern understanding of the neurological system. He mapped, tracked and studied neurological disease in what is, in retrospect, a very modern way, considering that at the time frame in which he was operating, they were still treating just about everything with blood-letting. He is credited with defining multiple sclerosis, amyotropic lateral sclerosis, Parkinson’s, Charcot-Marie-Tooth disease, Charcot joint… His students read like a who’s who list of famous names in neurology: Babinski, Tourette, Janet, and the rogue son, Sigmund Freud.

But even a brilliant man has bad days. Charcot’s Waterloo was that he worked in a women’s psychiatric hospital in the heyday of hysteria. He really had no choice but to take it on.

And take it on he did. But Charcot was a SCIENTIST, damn it. He approached hysteria not from the black hole of ancient history but from the perspective of an acute observer of signs and symptoms. The problem was, hysteria wasn’t so easy to pin down, being that it really didn’t have an organic lesion and all. His patients were carefully examined, followed, tracked, mapped, studied and observed. Constantly. Their periods, and even their vaginal secretions, were examined. They were studied with electrical probes, magnetic fields, amyl nitrate, and, eventually, hypnosis.

If they weren’t hysterical before all this started, they probably were when he was done.

Charcot employed hypnosis (a direct consequence of mesmerism and its daughters) to demonstrate that his hysterics were quite impressionable. In fact, he seems to have considered hypnotizability as a defining factor of hysteria. Unfortunately, he failed to grasp that, by hypnotizing his subjects, he was MAKING them impressionable.

The Salpetriere held Tuesday afternoon public demonstrations of Charcot’s hypnotic technique on hysteria patients. These have been immortalized in the famous painting by Brouillet.

What the picture doesn’t show is that, on the opposite wall, the one the patient could see? Was a representation, carefully charted, of the stages of a hysterical fit. In other words, a roadmap of exactly what she should do. And do it she must, because the only way to make all the studies stop was to play along. It was a stage show, with the women as the entertainment, and the one person who doesn’t seem to have figured that out was Dr. Charcot.

Take the case of Augustine. Augustine’s image is famous, although no one knows her name. THIS is Augustine:

(It has been pointed out that the exposure time for a photographic plate at the time was around 10 minutes. These photos weren’t captured in the throes of a fit. They were staged. Patient compliance was critical.)

Augustine came to the Saltpetriere at 15, after being raped by her mother’s lover brandishing a knife. She complained of pains in the stomach and vivid nightmares about the rape, which precipitated convulsions and occasionally left her paralyzed. She was placed on the hysteria ward. She stayed there for five years. She made many escape attempts, often injuring herself in the process, which only further convinced her doctors that she was ill.

Augustine finally escaped in 1880, dressed as a boy. Perhaps Jeanne de la Motte’s ghost was watching over her.

To his credit, Charcot denounced the uterine model of hysteria. In fact, he eventually opened up a clinic to treat MALE hysterics, and wrote extensively on the topic. He stressed that hysteria was not just a disease of women. But even this enlightened viewpoint showed the products of his age: male hysterics were affected by trauma (often from train wrecks, the nastiest thing anyone had seen to date), female hysterics were sick because of a vulnerable nervous system and an inability to control themselves.

He never seems to have realized that he had been hoodwinked by his own genius. When he left the Salpetriere, Babinski quietly cleared out the ward. By that time, Freud and Breuer had begun to put together what Charcot had missed–Salpetrian hysteria wasn’t a disease of the nervous system. It was a disease of the psyche.

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