Charcot and the psychology of hysteria, with special reference to a never published final case history.

Jean-Martin Charcot is perhaps best remembered for his contributions to organic neurology. However, his pursuit of hysteria, the most prevalent diagnosis in his hospital clinic, yielded no anatomical lesion to account for hysteria's plethora of somatic disorders assumed due to a purely functional or dynamic lesion in the cerebral cortex. This led Charcot to turn his attention to the psychology of hysteria. Taking advantage of institutional reforms at the Salpêtrière-notably, the establishment of his professorship in nervous diseases-Charcot from the early 1880s focused his teaching increasingly on case histories of hysteria in male as well as female patients. Already renown for his earlier dramatic public lessons on female hysteria, his lessons of the 1880s, of which two volumes were published at the end of the decade, elaborated the issue of psychology in terms of altered states of patient's suggestibility. By the decade's end, Charcot's worldwide reputation rested on the prospects of this work as acknowledged by numerous students, notably medical psychologists Pierre Janet and Sigmund Freud. Yet Charcot's views remained sketchy. They were discussed at length in his unpublished notes for a lesson intended for May 1893, just a few months before his sudden death. His unpublished notes reveal a detailed case for dreams as illustrating a psychological mechanism underlying hysteria in a 17-year-old Paris artisan. I conclude by considering why this significant climactic case of Charcot's might have been overlooked by his entourage.

Dreams: Charcot's Last Words on Hysteria.

Jean-Martin Charcot (1825-1893), the leading neurologist of his time, is best remembered for his studies on hysteria presented in clinical lectures at the Paris Salpêtrière hospital. Developing the concept of traumatic male hysteria after accidents in which patients suffered slight physical damage led him to advance a psychological explanation for hysteria. Traumatic hysteria is the context for a close reading of Charcot's "last words" based upon a final unpublished lesson in 1893. This case history concerns a seventeen-year-old Parisian artisan whose various signs of hysteria developed following a dream in which he imagined himself the victim of a violent assault. Charcot identifies the dream/nightmare as the "original" feature determining traumatic hysteria. The dream sets in motion an overwhelming consciousness followed by a susceptibility to "autosuggestion" producing somatic signs of hysteria. Charcot's final lesson on dreams thus culminates his study of the psychological basis of traumatic hysteria.

11 January 1887, the day medicine changed: Joseph Grancher's defense of Pasteur's treatment for rabies.

The Pasteur treatment for rabies is generally seen in terms of a triumphant penetration of laboratory science into clinical medicine. Similarly, the debates challenging the Pastorians have been interpreted as retrograde and inevitably vain efforts by a few disgruntled clinicians to resist scientific progress. This article revises the standard account by showing that the defenders of Pasteur perceived a serious threat to their enterprise and acted expeditiously to counter a potential crisis by adopting clinical strategies and tactics to argue for the relative safety of their method and to account for the rare failures resulting in deaths. An extensive unpublished source, the correspondence of Dr. Joseph Grancher with Pasteur, reveals this physician's leading role in successfully orchestrating the defense of Pasteur's antirabies method in January 1887 in the National Academy of Medicine. In responding to Dr. Michel Peter's accusations that the method could be dangerous and had been fatal in certain cases, Grancher invoked notions of risk inherent in all medical therapy, along with individual variability and predisposition to disease. Grancher's unpublished correspondence, supplemented by other manuscript letters, permits a textured understanding of the urgency experienced by Pasteur's team and their interactions as they worked out a strategy to defend their pioneering entry into human medicine. The suppression of autopsy evidence in one fatal case is apparent. More important, the strategy of the Pastorians implied a complementarity between the "clinic" and laboratory science, rather than any opposition.