Beyond ‘A Clinical Lesson at La Salpêtrière’: a brief assessment of André Brouillet’s other paintings on medical subjects, life, and times

ABSTRACT André Brouillet’s (1857-1914) famous group tableau ‘A Clinical Lesson at La Salpêtrière ’ (French: Une leçon clinique à la Salpêtrière ) is possibly the most celebrated painting in the history of neurology. His depiction of one of Jean-Martin Charcot’s legendary “ Tuesday Lessons ” includes portraits of not only one of the master’s most famous patients, but also of his pupils, the heirs to the founder of modern neurology. However, the painter himself has long been neglected, and even his other paintings on medical subjects are little acknowledged. The authors aim to bring attention to Brouillet’s life and times, as well as the remainder of his notable works; and in giving a proper context to the famous painting, neurologists today may be able to appreciate better the early history of our field and its cultural impact.


INTRODUCTION
A lively portrait of one of Jean-Martin Charcot' s famed lessons, André Brouillet' s (1857-1914) ' A Clinical Lesson at La Salpêtrière' (French: Une leçon clinique à la Salpêtrière, Figure 1A) is likely the most famous painting in the history of neurology1.However, the artist who immortalized modern neurology' s inaugurator is little remembered today, with few of his other works holding a place in our imagination, and even biographical data about him is relatively scarce.Thus, the authors aim to shed some light on his life and his other works, on medical subjects, contextualizing them in relation to the golden age of French neurology.
He travelled in 1883 to Algeria with his wife, where they would eventually raise Yvonne, the daughter of Emma's other brother Ferdinand Isaac (1860-1915, born there in 1899 out of wedlock.Yvonne was taken to France by the couple after her mother's demise.Yvonne eventually appeared in 15 of Brouillet's paintings and became an opera singer 3 .In 1894, Brouillet became a Chevalier of the Légion d'Honneur 4 .In 1907, he visited New York for three months and painted multiple portraits, especially of fellow artists. Brouillet continued his travels with a visit to Greece in 1903 to paint a portrait of Queen Olga (1851-1926) 2 .In 1906, he became Officer of the Légion d'honneur 4 .In his later years, thanks to his academicist style, he became involved in a series of paintings for the Sorbonne, such as 'Jules Ferry approuvant les plans de la Nouvelle Sorbonne' and 'Les étudiants acclament Edgar Quinet et Edmond Michelet le 6 mars 1848 lorsqu'ils reprennent possession de leur chaire', which earned him a 1st class medal at the 1906 Salon, as well as commissions from the Academie Française ('Le Tsar, la tsarine, et le Président de la République assistant à une séance de l' Académie française le 7 octobre 1896' -Figure 2A) 2 .
Brouillet passed away at the age of 57 during the First World War of a sudden, after helping a convoy of Belgian refugees near his home in Couhé 2 .His subjects and themes were plentiful, ranging from portraits of Yvonne, such as 'The Little Girl in Red' (La petite fille en rouge, Figure 2B) 3 , historical scenes, depictions of ordinary life in the metropolis and in the countryside, commissioned portraits, and Gérôme-like oriental scenes.He was most notably celebrated by a comprehensive retrospective in Poitiers in 2000 5 .

THE TIMES
The Hôpital de la Salpêtrière was already one of Paris' most celebrated medical centers before Charcot, as it had been scenery of Phillipe Pinel's 'Liberation of the Insane' and Jean-Étienne Dominique Esquirol's (1772-1840) lectures on alienism 6 .Guillaume Duchenne de Boulogne (1806-1875), though never a formal staff physician, also contributed to Salpêtrière's status 6 .However, under Charcot, the hospital would flourish even further.
Jean-Martin Charcot (1825-1893), the founder of modern neurology 6 , succeeded Alfred Vulpian (1826-1887) as professor of anatomical pathology at the Faculty of Medicine in 1872.An avid defender of the anatomical-clinical method 7 , he studied dissociative phenomena, then known as hysteria, Parkinson' s disease (he renamed the "shaking palsy" after the British neurologist who first described it), multiple sclerosis (sclérose en plaques), amyotrophic lateral sclerosis (or Charcot' s disease), and Charcot-Marie-Tooth' s disease, among others 8  Charcot' s fame grew to the point where it is hard to separate man from myth.Still, his Tuesday Lessons (Leçons du Mardi), public and less technical sessions, became a sensation 6 .
A Clinical Lesson at La Salpêtrière (Une leçon clinique à la Salpêtrière) is a 300×425 cm oil on canvas from 1887, commissioned by Jean-Martin himself, displayed at the Musée d'Histoire de la Médecine; it was not uncommon for illustrious physicians at the time to request paintings to commemorate their feats: one needs only to remember Thomas Eakins' portraits of Samuel Gross and David Agnew 11 , or of Adalbert Seligmann's depiction of Theodor Billroth 12 .In this collective portrait of one of Charcot's Tuesday Lessons, which took two years to be completed, Brouillet draws the viewer to the master's index finger 10 -on the right side, Marie 'Blanche' Wittman (1859-1912), 'la reine des hystériques', is held by Babiński.As nurse Marguerite Bottard (1822-1906) assists her, Charcot's students observe attentively 13 : Georges Gilles de la Tourette, Henri Parinaud (1844-1905), Pierre Marie, Charles Féré (1852-1907) -it is worth noting that Féré and Gilles de la Tourette had been previously mislabeled 1 , while Paul Richer (1849-1933), pencil in hand, draws the scene.To the left, a charcoal depiction of hysterical opisthotonos (l'arc hystérique), by Richer, graces one of the walls of the room 14 .The painting caused a commotion at the 1887 Salon des Indépendants and soon became the painter's most noted work 2 .
' A Clinical Lesson at La Salpêtrière' (Une leçon clinique à la Salpêtrière) would not be Brouillet's last picture on a medical subject.In 1891, he received another commission: during the siege of Paris, in 1870, the building of the Comédie-Française became an infirmary.'The Infirmary Organized in the Comédie Française during the siege of Paris in 1870' (L' Ambulance de la Comédie-Française, Figure 2C) depicts Professor Alfred Richet (1816-1891) caring for a wounded soldier.His son, Nobel Prize laureate Charles Richet (1850-1935), commissioned the painting 15 .
By studying Brouillet' s life, his most famous painting, and his oeuvre and its rich historical and social context, modern neurologists may better understand and appreciate the lives and works of not only the painter, but those of Charcot and his pupils, as well as rediscover their influence 16 , and be inspired by the same awe that they felt back in the nineteenth century.