Christopher Gardner-Thorpe

Jules Cotard (1840–1889) His life and the unique syndrome which bears his name

Dr. Jules Cotard (1840-1889) was a Parisian neurologist who first described the délire des négations. Cotards syndrome or Cotards delusion comprises any one of a series of delusions ranging from the fixed and unshakable belief that one has lost organs, blood, or body parts to believing that one has lost ones soul or is dead. In its most profound form, the delusion takes the form of a professed belief that one does not exist. Encountered primarily in psychoses such as schizophrenia and bipolar disorder, Cotards syndrome has also been described in organic lesions of the nondominant temporoparietal cortex as well as in migraine. Cotards delusion is the only self-certifiable syndrome of delusional psychosis. Jules Cotard, a Parisian neurologist and psychiatrist and former military surgeon, was one of the first to induce cerebral atrophy by the experimental embolization of cerebral arteries in animals and a pioneer in studies of the clinicopathologic correlates of cerebral atrophy secondary to perinatal and postnatal pathologic changes. He was the first to record that unilateral cerebral atrophy in infancy does not necessarily lead to aphasia and was also the pioneer of studies of altered conscious states in diabetic hyperglycemia.

Muscle weakness due to sarcoid myopathy: Six case reports and an evaluation of steroid therapy

Fatigue and weakness are common complaints in a wide variety of functional and organic disorders, including sarcoidosis. -3 Skeletal muscle weakness associated with granulomatous infil tration in sarcoid disease is well recognized and may be t h e first symptom of the disorder. Two aspects of sarcoid myopa thy are controversial: 1 1 Claims have been made that sarcoid disease may be confined to the skeletal mus~ u l a t u r e . ~ There is no clear reason why this should b e so; it is more likely tha t the incidence of other system involvement is related t o the durat ion of the pathological process and the thoroughness of investigation. 21 Steroid therapy is o f t en prescribed f o r sarcoid myopa thy b u t n o critical assessment of t he value of such therapy has been found in the literature. Forty-five case reports5 -3 have been reviewed and 6 hitherto unrecorded case reports are presented. Cases 47, 49, and 50 have been seen personally; details of Cases 46, 48, and 51 were obtained f rom the physicians w h o cared fo r them. The value of steroid therapy in other types of sarcoid disease is not considered here.

The Cotard syndrome. Report of two patients: with a review of the extended spectrum of ‘délire des négations’

The Cotard syndrome is characterized by the delusion where an individual insists that he has died or part of his body has decayed. Although described classically in schizophrenia and bipolar disorder, physical disorders including migraine, tumour and trauma have also been associated with the syndrome. Two new cases are described here, the one associated with arteriovenous malformations and the other with probable multiple sclerosis. The delusion has been embarrassing to each patient. Study of such cases may have wider implications for the understanding of the psychotic interpretation of body image, for example that occurring in anorexia nervosa.

A Biographical Note on Marcel Proust's Professor Cottard

A medical practitioner, Professor Cottard, features in Marcel Prousts À la recherche du temps perdu, which has been described as one of the supreme achievements of world literature. Proust modelled the character of Cottard on the real-life Parisian neurologist and psychiatrist Dr Jules Cotard (1840–1889). Marcel Prousts father, Dr Adrien Proust, was an eminent Parisian surgeon and a contemporary of Cotard. A review of the biographical literature (in French) relating to Dr Jules Cotard and an analysis of his published work (in English and French) have revealed a striking parallelism between the lives of the fictional Cottard and Jules Cotard.

James Parkinson (1755–1824): A pioneer of child care

Abstract: James Parkinson (1755–1824) of Parkinson’s disease, is well recognized as a pioneer of clinical neurology; and is even more famous as a founder of modern palaeontology. We have reviewed from primary sources his extensive contributions to clinical child care and his pioneering advocacy for child welfare, protection and safety. His writings, outreach and advocacy for children’s health characterizes him as one whose influence was an important springboard from which evolved the modern specialty of paediatrics. Parkinson was one of the first to write on child‐rearing practices and in this context antedated Benjamin Spock by 150 years. Parkinson was a pioneer of child safety and the prevention of childhood trauma. He wrote of the resuscitation of near‐drowned children and of first aid for injured children. This critical analysis reviews his pioneering description of child abuse and the development of post‐abuse hydrocephalus. He wrote the datum description (in English) of the pathophysiology and pathology of appendicitis in children, of fatal rabies in children and highlighted the risk of death even when the biting dog was not clinically rabid. His advocacy for social reform for children’s welfare was courageous and pioneering. James Parkinson, hitherto unacknowledged, was a significant founder of the evolving discipline of paediatrics and child health.

Erasmus Darwin (1731–1802): Neurologist

Erasmus Darwin was the founder of evolutionary biology, a renown poet, an inventor, and a general medical practitioner. Erasmus Darwin wrote specifically about the evolutionary and phylogenetic development of the nervous system, neuroembryology, psychiatric illness (including delusions and depression), and electrical therapy for childhood hemiplegia. He conducted experiments in neuro-ophthalmology and wrote about color vision, afterimages, the blind spot, and visual memory.

The Olympic Games and the limits of human endeavour

Medicine is concerned with the promotion of health through good public health measures and positive personal endeavour. This holistic approach includes the promotion of fitness, a measure difficult to define but possible to achieve using a well-functioning body and mind. Exercise is fun though more taxing when pushing the boundaries of what is humanly possible. n nSport helps channel energy away from violence that may otherwise be used to cause harm. It helps promote happiness and contentment within communities. Team activities encourage interaction in other areas of life and help players come to terms with failure. Good health has economic advantages for the whole community too, not least in lessening the effects of the current epidemic of obesity. n nThe boundaries of human endeavour were tested in the games held in 776BC and every four years thereafter in the Sanctuary of the Father of the Gods, Zeus, and in the temples and stadium at Olympia in Greece. Dorians, Ionians, Spartans and Athenians competed (before the Peloponnesian Wars of 460–445BC and 431–404BC); lifelong honour was bestowed upon winners whose images were exhibited in the form of statues, some surviving to this day. Discus, javelin, chariot and hand-to-hand fighting showed who was fittest. n nToday, human endeavour is tested in much the same way as at the Olympic Games but ability is demonstrated not only in this formal, public manner. Many people have pushed the boundaries of work and sport, showing bravery and persistence. A few have travelled to the Moon, rowed the Atlantic and swum long distances. Others have traversed the planet with minimum equipment. Television documentaries portray the fortitude of those who fought in the First World War, for example, for the sake of liberty: ‘The work of these people under the greatest of difficulties is beyond all praise.’1 n nWhen we fail the test we should try again. Sometimes we are lucky enough to rub shoulders with those who have pushed the boundaries of human endeavour2 from near and far3 and in exposure to extremes of temperature. Arctic and Antarctic exploration,4 mountaineering and seafaring all tax the human body and its resources. Although increasing numbers are scaling Mount Everest, just possible without oxygen, some climbers still die. n nWe read of heroism here and might conclude that there is little between these self-imposed challenges and a psychopathic mind. It all depends upon the motive. What, then, of those people who have almost reached the summit and turned back to help other climbers who would have perished without their help? There are several reports of this brave and extreme self-denial.5 These are among the exploits of doctors, nurses and other health professionals, including those participating in the Olympics Games. n nPerhaps the starting point of revival of the Olympic Games was when the lawyer Robert Dover organized competitive games in the Cotswold Hills. His Olimpick Games were described in 1636.6 The Wenlock Olympian Games in 1850 at Much Wenlock were the brainchild of general practitioner William Penny Brookes.7,8 The Athens Games of 1896 were the beginning of the revival of the Olympic Games in Greece. The Parisian Pierre de Coubertin, whose ‘pedagogie sportive’, moral and social education based on games at school, led him to develop the International Olympic Movement.9 Sir Ludwig Guttmann started the Stoke Mandeville Games for those who were undergoing rehabilitative medicine at the centre he founded, and it was probably from these that the Paralympic Games emerged.10 n nThe August and November issues of the Journal of Medical Biography, also published by the Royal Society of Medicine Press, will tell us in more detail of the extraordinarily taxing and brave exploits of those who have pushed, and still do push further the limits of human endeavour. More than three hundred place names in Antarctica commemorate the contribution of doctors in different ways to the exploration of this huge landmass.11 This is just the tip of the iceberg of human endeavour.

Sunday Stone: an enduring metaphor of mining diseases and underground mining conditions

Abstract The occupational hazards of miners include acute trauma and death from rock falls, water inundation, explosions and the long-term effects of progressive pulmonary disease. One of the most evocative of records of the dust-laden atmosphere in which coalminers work is Sunday Stone. Specimens of Sunday Stone are preserved in the Great North Museum, the ‘Hancock’, managed by Tyne and Wear Archives and Museums in Newcastle-upon-Tyne. Sunday Stone is the name given to calcareous deposits that formed inside wooden pipes carrying wastewater from the collieries of Durham and Northumberland. Sunday Stone is composed of alternating light and dark bands, each double-band representing one 24-hour period. Water seeping into the working mines became laden with coal dust and dissolved mineral salts. The daily dark band corresponded to the working day (the ‘fore’ and ‘back’ shifts) with its heavy dust-laden atmosphere. The broader light-coloured band was laid down on Sundays during coalface downtime. Sunday Stone today comprises an enduring metaphor of the mining industry, and specimens remain as a silent but permanent witness to the conditions in which millions of underground coalminers have worked and often work today. In these banded patterns one sees the progressive struggle to improve mine safety and ventilation and the evolution of industrial preventive medicine.