Jean-Martin Charcot and the opening of the French medical hierarchy to women

Although the careers of Jean-Martin Charcot and the Dejerines scarcely intersected, Charcot played an important role in the effort to open the Faculte de Medecine to women, thereby serving indirectly to facilitate the ascension and fame of Augusta Klumpke-Dejerine. He welcomed one of the first women externs to the Salpetriere, he supported the petition to allow women to compete for internship, and he demonstrated that neurological disorders, specifically hysteria, affected men as well as women. Through these efforts and his example, the Faculte de Medecine, the Salpetriere, and the scientific world of the next generation were prepared to witness the celebrated and shared careers of the Dejerines. Charcot spent his entire career at the Salpetriere from 1850 to his death in 1893. With demanding discipline and a carefully planned strategy, he constructed a multidisciplinary enterprise dedicated to neurological disorders, founded on the principle of correlating neurological signs with pathological lesions. Because of his studies, he showed that neurological diseases could be diagnosed during life with clear predictions of the neuroanatomical substrates underlying the salient clinical signs. Editor and author of major texts, known throughout the world, Charcot became a major figure of scientific power, and the Chair for Diseases of the Nervous System was created for him in 1882. In this context of power, influence, and a male-dominated hierarchy, the feminist movement emerged in the closing decades of the nineteenth century. Until 1881, women were allowed to become medical students, but they were excluded from the externship competition that was the first step on the ladder to enter the academic hierarchy of the medical system. Facing widespread protests, Miss Blanche Edwards, daughter of a French woman and a British physician, enrolled in the examination and succeeded in 1882 along with her American friend and colleague, the young Augusta Klumpke. As tradition dictated, externs selected their own rotations, and between 1884 and 1885, Edwards chose to work at the Salpetriere, specifically in the Charcot service (Figure 1). Charcot became Edward's mentor and served as jury president for her thesis, titled “On hemiplegia in certain neurological disorders”. At the thesis defense, he said to Edwards: “You are among the best physicians; you have performed with particular brilliance in your examinations… I will be happy to see you enter our hospitals: this will provide us with a variety of physicians, which surely will be quite interesting”. Charcot continued his summary, publicly supporting the complete integration of women into the medical hierarchy, but he was not naive in recognizing the reality of the time. The intern competition remained closed to Edwards, to Klumpke, and all other successfully women externs. Opening internship to women was a battle of greater dimensions. In 1884, a petition supporting the cause received only eleven signatures among the faculty professors. Charcot's name appeared second on the list, followed by those of his close colleagues and former interns, Joffroy, Raymond, and Brissaud. After a long period of debate and hesitation, the competition was finally opened to women externs in 1885 with the result that Augusta Klumpke was named full intern on her second round of completion in 1886 and Blanche Edwards was named as a substitute, interne provisoire. In his scientific studies, Charcot also contributed to the cause of eliminating sexism. Among his most important clinical observations, he demonstrated that hysteria was not a disorder restricted to women. As a consultant to the railroad services, he treated hundreds of workers, all males and physically robust, who developed typical symptoms of hysteria after work-related collisions or other accidents. In presenting such cases to his stunned colleagues, he stated: “Male hysteria is therefore far from a rarity. One will concede that a young, effeminate man can present with hysteria-like signs, but that a vigorous worker, solid, integrated into society – a train engineer for instance – could develop hysteria – just as a woman might – this seems to be beyond imagination. Yet, nothing is clearer, and it is a concept to which we must adjust. Such was the case with so many other ideas that today are universally accepted, because they are based on demonstrable evidence, but for so long only met skepticism and often sarcasm. One can extend the ideas behind this reference to the larger context of the opening of the international medical hierarchy to women. In spite of the long history of “skepticism and often sarcasm”, young and ambitious women in medicine entered the ranks of externs and interns in the generation after Charcot's death in 1893. The Dejerine's career is a strong example of the success of this liberalization by which these two physicians developed a celebrated career, shared by man and woman as scientific equals.