Biographies de neurologues
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 L'histoire des neurosciences à La Pitié et à La Salpêtrière J Poirier
The history of neurosciences at La Pitié and La Salpêtrière J Poirier

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Jean Lhermitte
1877 - 1959
François Boller
Le signe de Jean Lhermitte


« Le succès consiste à laisser ceux qui nous écoutent avec le désir de continuer à nous écouter
et non pas avec l'ennui évident de celui qui en a assez »
jean lhermitte
It is always hazardous to state when and where a discipline was "born". However most people agree that the discussions held at the Paris scientific academies in the middle of the nineteenth century and particularly the contribution of Paul Broca (1861) represent a milestone. It may not have been the first, but it certainly marked the beginning of a major surge in interest in language and its physiopathology (Hécaen and Dubois, 1969). We therefore propose to write a series of Editorials dedicated to French neuropsychologists.
We will begin with Jean Lhermitte who, directly or indirectly, had a definite formative influence on most of those who have occupied the field of Neuropsychology in France in more recent years.
Jean Lhermitte was born on January 30, 1877 in Mont Saint Père in the Champagne region. He came from a family of artists, in particular his father Léon was a renowned painter and friend of such artists as Rodin and Van Gogh. Léon Lhermitte's work can be seen in Chateau Thierry and at the Orsay Museum in Paris. His brother was an art photographer.
Mont Saint Père is a town on the Marne river which was to have its hour of fame when in 1918 it was the site of a battle where the French and American troops stopped the last great German offensive of the war (American armies and battlefields in Europe, 1938). The rest of the time it is a most peaceful little town and that is where Lhermitte spent his first years.
After High School in Meaux, Jean Lhermitte attended Medical School in Paris and became "interne des hôpitaux" in 1900. His teachers included Gustave Roussy, Fulgence Raymond and Pierre Marie. His career was interrupted by the Great War. He was a field military doctor for two years and later a medical officer in a Neurology Center in Bourges under the direction of Henri Claude who was later named Chair of Psychiatry at Sainte-Anne Hospital in Paris.
His career was atypical. He was "Professeur agrégé" (corresponding roughly to the title of Associate Professor) of Psychiatry, but he did not have a formal university title in Neurology until his retirement in 1947 when he was named Honorary Professor, a most unusual if not unique distinction. He was not Professor of Neurology because at the time, there was only one Chair in Paris. He did not have a chance of obtaining it since it was occupied in succession by Raymond, Dejerine, Marie and Guillain. He remained for most of his professional life Head of the Neuropathology Laboratory (an appointment he had received from Pierre Marie) which was located in Rue de l'Ecole de Médecine, in Paris. In 1919, he became "Chef de Service" at a relatively peripheral institution, the Paul-Brousse Hospital in Villejuif.
At that time, it was customary for Neurologists to practice more than one discipline (Boller and Duyckaerts, 1999), but few persons were as versatile as Jean Lhermitte. He was actively involved in practice, research and teaching of neuropathology including histology. As early as 1914, he co-authored with Gustave Roussy a classical treatise of neuropathology (Roussy and Lhermitte, 1914). With Pierre Marie, he wrote an early description of the pathology of Huntington's disease. He also worked on Olivo-Ponto-Cerebellar Atrophy, on the pathogenesis of cerebrovascular diseases and on many other pathologies of the Central and Peripheral Nervous System.
He was a prominent neurologist and is known all over the world for having described a characteristic phenomenon, Lhermitte's sign also called Barber Chair phenomenon, whereby flexing of the neck produces electric shock-like sensations that extend down the spine and shoot into the limbs. He described it in a patient with multiple sclerosis (Lhermitte et al., 1924; Lhermitte, 1929), but it is known to be caused also by trauma to the cervical portion of the spinal cord, cervical cord tumors, cervical spondylosis, or even vitamin B12 deficiency.
He called himself a Neuropsychiatrist, but when reading the topics he covered under that label, one sees that he was clearly interested in brain and behavior relationships. In other words his interest was "la discipline qui traite des fonctions mentales supérieures dans leurs rapports avec les structures cérébrales", that is Neuropsychology (Hécaen, 1972). He wrote extensively on many subjects related to neuropsychology. In his later years he also wrote on subjects related to mysticism.
He is perhaps best known to neuropsychologists and behavioral neurologists for his interest in hallucinations. He was one of the first to propose a classification based on insight. On one hand there are patients who have no insight. On the other hand, less commonly, patients have preserved insight and realize that hallucinations are unreal, abnormal phenomena. For these cases, he coined the term hallucinosis. He described the syndrome known as peduncular hallucinosis (Lhermitte, 1922) whereas hallucinations are formed, colored, visual images of people, animals, plants, scenes or geometric patterns. They have been reported in vascular and infective lesions of the thalamus, the pars reticulata of substantia nigra, midbrain, pons and basal diencephalon as well as by compression of the midbrain. He pointed out that these patients can also experience auditory hallucinations and the syndrome of «auditory hallucinosis» as well as its neuropathological basis have been confirmed (Cascino and Adams, 1986). He also described a case of Alzheimer disease in a blind man who had vivid visual hallucinations. Yet the patient had defective imaging, for instance he could not call to mind the visual image of colors (Lhermitte and Nicolas, 1923).
His interest extended to phantom limbs, a phenomenon known at least since the time of Ambroise Paré and which was given its current name by Weir Mitchell (Whitaker, 1979). He studied particularly the painful manifestations of the condition, which he called algo-hallucinoses (Lhermitte, 1954). He thought of these phenomena as hallucinatory because they occur in relation to a part of the body that has been lost, an unreal world. He also described "negative" algohallucinoses as seen in patients who have lost awarenes of a part of their body (usually a limb), and yet experience pain in that limb despite its exclusion from consciousness.
His biographers as well as all those who knew him are unanimous in recognizing his extraordinary gift for teaching. His captivating eloquence as well as his charm inspired many students to later become involved in the field of neurology and neuropsychology as exemplified by the Peruvian Oscar Trelles and of course by his son, François Lhermitte. Both Henry Hécaen and Julian de Ajuriaguerra were among the persons who discovered neuropsychology thanks to him. They wrote some of their early papers with him (Lhermitte and de Ajuriaguerra, 1938; Lhermitte and Hécaen, 1942) and never missed an opportunity to refer to him as their Maître.
In concluding his obituary, Trelles (1977) wrote that because of his almost unlimited knowledge, Jean Lhermitte was the last of the "Seigneurs de la Neurologie". Fortunately, as we shall see in the next Editorials, his memory lives on through his own work and that of his pupils.
AMERICAN ARMIES AND BATTLEFIELDS IN EUROPE. La 3eme Division US dans la Région de Chateau-Thierry, Center of Military History, United States Army, 1938.
BOLLER F and DUYCKAERTS C. 1914 to 1917: The Great War years. Neurology was there. Archives of Neurology, 56: 882-885, 1999.
BROCA P. Perte de la parole, ramollisement chroniqie et destructionpartielle du lobe antérieur gauche du cerveau. Bulletin de la Société d'Anthropologie, 6: 235-237, 1861.
CASCINO GD and ADAMS RD. Brainstem auditory hallucinosis. Neurology, 36: 1042-1047, 1986.
HÉCAEN H. Introduction à la Neuropsychologie. Paris: Larousse, 1972.
HÉCAEN H and DUBOIS J. La Naissance de la Neuropsychologie du Langage. Paris: Flammarion, 1969.
LHERMITTE J. Syndrome de la calotte du pédoncule cérébral. Les troubles psychosensoriels dans les lésions du mésocéphale. Revue Neurologique, 38: 1359-1365, 1922.
LHERMITTE J. Multiple sclerosis. Archives of Neurology and Psychiatry, 22: 5-8, 1929.
LHERMITTE J. Les algo-hallucinoses. Les hallucinations de la douleur. Le Progrès Médical, 82: 248-255, 1954.
LHERMITTE J, BOLLAK J and NICOLAS M. Les douleurs à type de décharge électrique consécutives à la flexion céphalique dans la sclérose en plaques. Un cas de sclérose multiple. Revue Neurologique, 2: 56-57, 1924.
LHERMITTE J and DE AJURIAGUERRA J. Asymbolie tactile et hallucinations du toucher. Etude anatomo-clinique. Revue Neurologique, 492-495, 1938.
LHERMITTE J and HÉCAEN H. Sur les troubles de la psycho-motilité chez le vieillard. Annales Médico-psychologiques, 2: 62-70.1942.
LHERMITTE J and NICOLAS T. Sur la maladie d'Alzheimer, une observation clinique. Annales Médico-psychologiques, 1: 435448, 1923.
ROUSSY G and LHERMITTE J. Techniques Anatomo-Pathologiques du Système Nerveux Anatomie Macroscopique et Histologique. Paris: Masson, 1914.
TRELLES J. Jean Lhermitte (1877-1959). Revue Neurologique. 133: 667-671, 1977.
WHITAKER H. History of the phantom limbs. Neurology, 29: 273, 1979.
signe jean lhermitte
Lhermitte sign during yawning associated with congenital partial aplasia of the posterior arch of the atlas Sagiuchi T, Tachibana S et al.

Jean Lhermitte
1877 - 1959
Les douleurs à type de décharge électrique consécutives à la flexion céphalique dans la sclérose en plaques
Un cas de sclérose multiple
Lhermitte J, Bollak J, Nicolas M. Revue Neurologique 1924; 31; 56-62
Le signe de Lhermitte
J. Cambier La Presse Médicale 1993; 22; 32; 1611-1614
Modern neuropsychology in France: Jean Lhermitte
F. Boller Cortex 2005; 41, 740-741
La douleur à type de décharge électrique, provoquee par la flexion de la tête et parcourant le corps de haut en bas
Alajouanine T, Thurel R, Papaïoanou Revue Neurologique 1949; 81; 2; 89-97
Lhermitte's sign From observation to eponym
Gutrecht JA. Arch Neurol 1989; 46; 5; 557-558
Lhermitte's sign: Flexing of the neck produces electric shock-like sensations that extend down the spine and shoot into the limbs.
Lhermitte's syndrom: A rare syndrome of ocular palsy with nystagmus and paralysis of adduction during attempted lateral deviation of the eyes.
Lhermitte-Cornil-Quesnel syndrome: A slowly progressive pyramidopallidal degeneration.
Lhermitte-Duclos syndrome: A rare pathologic entity with progrediating, diffuse hypertrophy chiefly of the stratum granulosum of the cerebellum.
Lhermitte-Lévy syndrome: A syndrome of slowly progressing paralysis after a stroke.
Lhermitte-McAlpine syndrome: A combined pyramidal and extrapyramidal tract syndrome in middle-aged and elderly persons.
Lhermitte-Trelles syndrome: A syndrome characterised by lymphoblastic infiltrations of the peripheral nervous system, associated with paresis and amyoptrophia.