Tourette syndrome, which among other symptoms can produce simple and complex tics, verbal repetitions of what others say (echolalia), and uncontrollable outbursts of obscene language (coprolalia), affects roughly 400,000 American children and adults. Though the French neurologist Gilles de la Tourette (1857-1904) is remembered today for his description of the syndrome in 1885, he would have been quite surprised, as he considered himself a lifelong researcher in hysteria. In this post, we will explore his colorful life and see how this came about.
Gilles de la Tourette, who had been born on Oct. 30, 1857, near Loudun, in the Poitou region in west-central France, went to medical school in Poitiers, and came to Paris to continue his studies in 1877. By 1881 he had become an intern, and in 1884 came to study with Jean-Martin Charcot (1825-1893), who is often described as the father of modern neurology. Charcot is credited with discovering diseases such as multiple sclerosis and amyotrophic lateral sclerosis, and suggesting that the "shaking palsy" be named after the English surgeon James Parkinson.
How Tourette Syndrome Was Identified and Named
Although Charcot’s attention was turning in those years to hysteria, he asked his trainee to clarify a particular group of patients, in his words, to "bring some order to the chaos of choreas," a term which as used then referred to a wide range of involuntary movements. Gilles de la Tourette was aware of what were known as ‘startle syndromes,’ in conditions including ‘latah’ in Malaysia, ‘myriachit’ in Siberia, as well as the 'jumping Frenchmen of Maine.' He was particularly interested in the latter, which had a familial aspect, with symptoms first appearing in childhood. In 1885 he wrote a paper describing some nine patients with similar conditions. One of the most colorful of these, the Marquise de Dampierre (1799-1884), had in fact been described in 1825 by Dr. Jean Itard in Paris. She had a certain notoriety, and was well known in high society for her frequent utterances of obscenities. At a clinical conference later in the year, Charcot announced that this maladie des tics should be named after Gilles de la Tourette. As an aside: It is said that Charcot chose his surname in part because of its melodious quality; it actually is comprised of two poetry meters going back to ancient Greece, an iambus following a dactyl (1). It seems likely, however, that neither Charcot nor his precocious trainee recognized the full significance of what they had described.
The Initial Reception of Gilles de la Tourette’s Work
The paper received little recognition at the time, and Gilles de la Tourette never wrote about it again aside from one article in 1899. Instead, he turned his attention to what had become Charcot’s main interest. In 1870, a ward which specialized in treating ‘hystero-epilepsy’ was closed due to deterioration of the building which housed it, and approximately 150 such patients had been transferred to his service. Charcot found himself responsible for a large number of patients with what was then known as hysteria, and he became very interested in their condition. It was an illness in which patients—women and also men, he was quick to point out, establishing a ward to study male hysterics—manifested a variety of striking symptoms, for which no medical cause could be found. Among these were convulsions, trance-like states, tetany, spasms, and periods of amnesia. Charcot was a charismatic figure, whose demonstrations of the dramatic behavior of patients with hysteria, whom he believed could be treated with hypnosis, drew the attention of not only the medical community, including Sigmund Freud, but also journalists as well as dancers and actresses such as Sarah Bernhardt. This was a heady atmosphere for a young neurologist finishing up his training, and Gilles de la Tourette spent most of his professional life studying it.
As the years went on, Gilles de la Tourette did study after study, reporting, for instance, that he believed one could write with a finger upon the skin of such patients (dermatographia) or that when cut, they bleed less than others. Ultimately he published a three-volume summation of his understanding of hysteria in 1881 through 1885. Though he studied many other conditions such as epilepsy and the legal aspects of hypnosis, he also engaged in public debates on social issues, and was the chief physician of the Paris World’s Fair in 1900. He undoubtedly would have considered his tomes on hysteria the epitome of his work. Today, many of his findings seem quaint, and the diagnosis of hysteria per se was appropriately removed from the major psychiatric nomenclature (the DSM) in 1980, its various components dispersed among other conditions including conversion disorder, and now more currently in "functional neurological symptom disorder" and other diagnoses (2). It’s a good reminder that the work that reflects one’s passion can easily be mistaken for the work which was most lasting across time.
Why Gilles de la Tourette Left His Eponymous Syndrome to Others
Another intriguing aspect of Gilles de la Tourette’s description of his syndrome is the way in which he moved on to other things, leaving it for others to work out the implications of what he had found. It turns out that this has happened a number of times in the history of medicine. As but one example, after discovering Penicillium mold in a culture dish of staphylococcus bacteria on Sept. 3, 1928, Alexander Fleming published his discovery in 1929, only briefly describing its possible utility as a medicine. After 1931, his interests turned elsewhere. It was only in 1938 that Howard Florey, at Oxford, saw Fleming’s article and realized its significance. He and chemist Ernst Chain developed it as a medicine, first given to a human in 1941, and within a few years it was widely used for treatment of infected wounds in World War II. A similar phenomenon occurred after the re-discovery of lithium as a treatment for bipolar disorder by John Cade in 1949 (3).
Over the decades, the understanding of Tourette syndrome has evolved, including modern treatments which began with haloperidol in the 1960s, and the view that it involves autoimmune and genetic influences, as well as the interaction of genetic predisposition with environmental factors. But it all began when a trainee was asked by his mentor to clarify a particular group of movement disorders, had a syndrome named after him in part because of his poetic name, left it to others to realize the importance of his finding, and went on to devote his career to an illness that in a sense no longer exists. Science moves forward in complex ways.