Gilles de la Tourette (1857-1904) was hislast name, Georges Albert Edward Brutus were hisfirst names. The historic honour of being the onlyeponym in the Diagnostic and Statistical Manualof Mental Disorders (DSM III and DSM IV) comesat the price of an unfortunate abbreviation:" Tourette's disorder" [1]. Yet had his name beenDupont or Martin, the pathology he describedwould probably not have had eponymic attributes.His name did not even become famous until near-ly 70 years after his death, when AK. andE . Shapiro published their epidemiological work inthe USA [2]. They quoted the following exclama-tion from a patient in 1978: "What a pretty namefor such a dreadful disease!"

We do not know why Gilles de la To u r e t t ebecame interested in sorting out the different formsof chorea. As early as 1881, the year he became ahouse off i c e r, he had translated, but not annota-ted, the article by Beard on the jumping Frenchmenof Maine [3]. The translation was published in LesArchives de Neurologie; the original article waspublished in 1880 in The Journal of Nervous andMental Diseases. Charcot had to be aware of thiswork. Although the exact circumstances are unk-nown, it is Charcot who encouraged Gilles de laTourette to persist in these studies: "On the advi-ce of our teacher, Professor Charcot, we have our-selves analysed the works of the three earlierauthors (Beard, O'Brien, Hammond), demonstra-ting in July 1884 that Jumping Frenchmen ofMaine, Latah in Malaysia and Myriachit, obser-ved by American officers in Siberia, were one andthe same condition" [4]. In his first description,

which made his beautiful name world famous,G . Gilles de la Tourette reported the observation ofthe baroness of Dampierre, examined by Itard in1825, and re-examined by Charcot on several occa-sions. Gilles de la Tourette added seven other casesand published an article – "L'étude sur une affec-tion nerveuse caractérisé par l'incoordination motri-ce accompagné d'écholalie et de coprolalie" (Studyof a nervous condition characterised by motorincoordination accompanied by echolalia andcoprolalia) – in 1885 in Les Archives deNeurologie. He was still a house officer at the timeand did not defend his doctoral dissertation in medi-cine until 1886 [5]. Except for one article publishedin La Semaine Médicale in 1899, relating a new casein the form of a consultation as was fashionable atthe time, Gilles de la Tourette never again studiedthe "convulsive tic disorder" [6]. It was thus the workof his youth that assured his later celebrity.

This precocity shaped his biography, whi-ch we would like to examine from a new angle, todemonstrate how his personal life was closely rela-ted to his professional life, his work to his wri-tings; in summary, how he lived the life of his wri-tings.

Journalism

Gilles de la Tourette was interested in his-tory from his adolescence. His curiosity led him tostudy the life of Théophraste Renaudot (1586-1653), who was born in the city of Loudun, closeto his own birthplace in Saint-Gervais in Poitou.His renowned compatriot, a physician himself,

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Living his writings: the example of neurologist Georges Gilles de la Tourette

Olivier WalusinskiF28160 Brou

Gregory DuncanCentre hositalier

F62631 Boulogne sur Mer

Movement DisordersSubmitted

september 2009

AbstractGilles de la Tourette is known for the disease which now bears his name. As one of the closest followers of Jean-Martin Charcot, healways remained faithful to his mentor's views and was one of the most vehement defenders of La Salpêtrière. His activities in themanagement of hysterics and in hypnotism, gained him most of his lifetime reputation but are now largely forgotten. Gilles de laTourette had an unusual personality, with hypomanic and histrionic traits. We present some ignored aspects of his life after we havediscovered personnal letters which illuminate the hidden part of this famous neurologist.

accompanied Richelieu to Paris. He imported thefirst pawnshops, or monts de piété, to France, andalso instigated free and charitable consultations aswell as a bureau d'adresse et de rencontre, whichwas a forerunner to employment agencies. Gillesde la Tourette, a positivist and progressive, wasnothing but fascinated by this important figure. On30 May 1631, Renaudot launched his famousGazette. This first French daily paper was a pro-paganda mouthpiece for Richelieu, who granted ita monopoly over the press in 1635, to the detrimentof its Parisian competitors. While still a house off i-c e r, Gilles de la Tourette wrote a biography ofRenaudot that was published in 1884 [7]. It isimpossible not to see his fascination for the writ-ten word, which made him so prolific. Apart fromhis well-known publications on hypnosis and diver-se medical subjects, Gilles de la Tourette used themainstream press to publicise the works of the LaSalpêtrière School.

Starting in 1892 and using the pseudo-nym Paracelse, he wrote as a scientific columniston madness and its depiction in the theatre, andalso on crimes of passion: l'Etat mental de Froufrou[8], La Folie de la Reine Junana [9], A propos duprocès Cauvin: l'état mental de Marie Michel [10],L'état mental de feu Ravachol [11], L'épilogue del'affaire Eyraud-Bompard [12].

In 1882 Gilles de la Tourette developed aprofound and lasting friendship with the journa-list Georges Montorgueil, who like him was bornin 1857 and wrote the news column for the jour-nal L'Eclair [13]. Drawing his inspiration fromRenaudot, Gilles de la Tourette had his friend publi-sh not only medical news from the works of the LaSalpêtrière School, thereby assuring its notoriety,but also day-to-day correspondence ("22 June 1894:I am writing first and foremost to ask you not toforget our complaint concerning a shelter for ourchildren at the Tuileries; in case of rain there isnothing, whereas everywhere on the ChampsElysées and in the Luxembourg gardens, there areshelters... Thank you in advance for the children.Affectionately yours. GdT").

Another example dates from 1894. Gillesde la Tourette took a passionate interest in thedefence of Dr. Lafitte, accused of helping with anabortion. On one hand, he informed the medical pro-fession by publishing an article in the ProgrèsMédical, run by his friend Bourneville; on the other,he provided the arguments that Montorgueil woulduse to orchestrate a press campaign [14]. This ledto a three-column cover story in L'Eclair on

28 August 1894. In a long letter addressed to theeditor of the newspaper Le Temps, he took Dr.Lafitte's defence: "Dear Mr. Editor-in-chief, A l l o wme as a delegate of the medical press associationto protest against the manner in which youremployee has misrepresented the sentiment gui-ding us in our defence of Dr. Lafitte... If the edi-tor of Le Temps is not convinced as we are that thisill-fated man is innocent, he could, instead of dis-cussing self-interest, at least accord a few huma-nitarian feelings to those taking care of this unfor-tunate family. I dare to hope, Mr. Editor-in-Chief,that you will out of fairness agree to publish thisl e t t e r." The complicity between Gilles de laTourette and Montorgueil is also evident in themany letters they exchanged, such as this one: "15October 1894, My dear friend, Thank you for theLafitte aff a i r. Here is the latest news. My wife hasbeen very kindly received by Mrs. Casimir Perier,the wife of the President of the Republic. She gaveher a petition by Dr. Lafitte's two small twins. T h i sis of course between us, nothing for the newspa-p e r. I appear often enough in the papers ofRenaudot. What a nice article I will give you ifmercy does not win... The behaviour of the Seine-and-Oise public prosecutor is disgusting. PS: Donot tell any of your colleagues about my wifeseeing Mrs. Casimir Perrier. They may not be asdiscreet as you are."

These examples, among others, explainthe words of his friend and hagiographer PaulLegendre. At the beginning of his biography onGilles de la Tourette, he wrote: "With his likingfor history and literature he could have been temp-ted to desert his medical school classes and thehospital theatres for classes at the Sorbonne and theCollège de France; he perhaps would have slippedinto literary and political journals and exclusivelyworked as a publicist, instead of finding in journalisma mere reprieve from his medical career" [15].

Hysteria

Gilles de la Tourette enrolled in medicalschool in 1876, becoming a non-resident studentafter his second attempt in 1878 and a house offi-cer in 1881 when he was 24 years old. He completedhis house officership at La Salpêtrière Hospital in1884. In 1887 he became a specialist registrar underJM. Charcot, who was then at the height of hisg l o r y, having been appointed to the Chair ofDisorders of the Nervous System in 1882. By thattime, JM. Charcot had already made his majorcontributions to neurology. He had describedParkinson's disease, amyotrophic lateral sclerosis,

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multiple sclerosis and his theories on cerebral loca-lisation. Having been interested for the past tenyears in hysteria, he found in Gilles de la Tourettehis most zealous disciple for spreading his ideas.JM. Charcot would never publish a book in hisown name and in French again. He tasked his stu-dents with publishing the works that would assu-re his celebrity among his contemporaries, but pro-voke the most controversy later on. These studentsincluded Gilles de la Tourette, Richer, Guinon,Blocq and Bourneville [16]. He only gave his viewsin the prefaces he accorded to each of them. OnlyGilles de la Tourette would get three prefaces, eachof them on hysteria, which is a good indication ofthe particular esteem JM. Charcot had for him [17].It should be noted that JM. Charcot also publishedtwo articles, now forgotten, in English under his ownname in the mainstream American journal Forumof New York: "Magnetism and Hypnotism" in 1889and "Hypnotism and Crime" in 1890 [18,19].

JM. Charcot always encouraged his stu-dents to find the illustration of his ideas on hyste-ria in art. It is once again in Loudun where Gillesde la Tourette found the best example. In 1886 hewrote Soeur Jeanne des Anges supérieure des ursu-lines de Loudun XVIIè s, autobiographie d'unehystérique possédée (Sister Jeanne des A n g e s ,mother superior of the Ursulines in Loudun duringthe17th century, an autobiographical case of hys-terical possession), with a preface for the first timeby JM. Charcot [20]).

But it should be noted that Gilles de laTourette was a house officer under P. Brouardeland became a qualified forensic physician in 1891.It is thus interesting to see the changes in his foren-sic view on hysteria and hypnotism, particularlyin light of the controversy with the Nancy Schooland Bernheim. In 1887 in his book L'hypnotismeet les états analogues du point de vue médico-légal(Hypnotism and similar states from the forensicpoint of view), Gilles de la Tourette described twoexamples of hysteria (the famous Blanche Wi t t m a nand Ms. H.E.), who were induced to commit a cri-me while under hypnosis and who declared they actual-ly committed the act before waking up [21]. Yet Gillesde la Tourette would fiercely defend the oppositepoint of view on two occasions.

The first was a criminal affair that fasci-nated the public in 1889-1890, the Gouffé affair,named after a bailiff. Gouffé was hanged by MichelEyraud. The latter had been hiding behind a cur-tain while Gouffé was invited to lie down on a sofaby Gabrielle Bompard, the flirtatious accomplice

who had drawn him into this trap and delicately slip-ped a rope around his neck during supposed fore-p l a y. The murderers did not find the expectedsavings and left the body in a trunk. G. Bompardvoluntarily turned herself in a few months later.Her lawyers built her defence on the premise thatshe had acted under hypnosis, having been placedin this state by M. Eyraud. Liégeois, representingBernheim and the Nancy School, came to court todemonstrate his own experiments, which were sup-posed to prove that a crime could be committedby suggestion. But the appointed experts,P. Brouardel and G. Ballet, ridiculed his deposition.Eyraud was convicted to death and Bompard to 20years imprisonment [22]. On this occasion Gillesde la Tourette wrote the memorable Épilogue d'unprocès célèbre (Epilogue of a famous trial), proclaimingvictory for the theories of the La Salpêtrière School,which denied all possibility of a violent act underhypnosis and by suggestion [23].

The second occasion was a letter to his friendMontorgueil: "14 January 1893. My dear Sir, I donot know what you do to make your articles solively and so precise with so little information. I willgive you an idea for another one. I wanted to wri-te it for my scientific chronicle in the Revue heb-domadaire, but I do not have time at the momentand I am afraid that the news will fade. Is it pos-sible to put someone to sleep against his wishes?Answer: no. Everything they say is foolishness.Can we convince you? Please do me the favour ofhaving an (informal) supper with us Friday 20January at 7:30 pm. You will meet my friendsCravard and Lembert who just completed theirwork on a treatise of surgical and obstetrical anaes-

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Letter from Gilles de la Tourette to Montorgueil

thesia. I will end the matter by telling you "oral-ly" the conditions under which someone can beput to sleep against his will (or against my ownwill; I am on bad terms with the Academy). Andwe will drink to the health of T h é o p h r a s t eRenaudot, who is hugely indebted to you. I trustyou will come. Sincerely, Gilles de la Tourette."

During this same year, on 6 December1893, a few months after Gilles de la Tourette hadlost a son to meningitis and his teacher Charcothad passed away, a young woman by the name ofRose Kamper fired on him in his consultation off i-ce after he refused to give her the money shedemanded. The wounds were only superficial.Shortly after the incident, the following was repor-ted: "When asked why she had attempted to kill thed o c t o r, this woman repeated that she lived in pover-ty and had long ago, either voluntarily, or withouther knowledge [sic], agreed to be a subject for hyp-notism experiments at La Salpêtrière. By doing soshe had lost her will to such an extent that shefound it impossible to continue working, and conse-q u e n t l y, asking for money from those who hadtaken away her livelihood appeared logical to her. "That same night Gilles de la Tourette wrote toMontorgueil with an unsteady hand: "I would behappy to see you today. The bullet has been takenout. I am better, better. Sincerely. Gilles de laTourette. What a strange story." And on8 D e c e m b e r, Montorgueil published a completearticle in the L'Eclair ! This trivial event sparkedconsiderable media coverage, occurring a fewmonths after the public dispute in a courtroom bet-ween the Nancy School and the La SalpêtrièreSchool. Certain newspapers went as far as to insi-nuate a publicity stunt orchestrated by Gilles de laTourette. In 1895, Gilles de la Tourette publishedthe third volume of his Traité de l'hystérie (Tr e a t i s eon hysteria), which JM. Charcot revised a few daysbefore his death. After that he wrote only one morearticle about hysteria in 1900 [23, 24, 25]. In sum,we can say that Gilles de la Tourette developedtheories of criminal suggestion, served as a legalexpert arguing against the precedent, and was anindirect victim of these theories ! [26]

Personality

Gilles de la Tourette was born in Poitouon 30 October 1857 into a family of physicians. Hischildhood and adolescence were marked in partby his brilliant academic performance which led himto obtain his baccalauréat at age 16. But he also hadtrouble fitting in socially during this time, particularlyas a boarder at the upper secondary school in

Chatellerault, where he was constantly breakingthe rules and being reprimanded. His mother consi-dered him immature and forced him to start hismedical studies in Poitiers, fearing that he mightget into trouble in Paris. He would stay in Poitiersfor three years.

His friend Paul Legendre, who met himin 1881 at the beginning of his house officership,described him this way: "He was a jovial and exu-berant boy, with the gift of the gab and a pre-sumptuous tone. Very passionate, but impatient,he was not a man to let his opponents slowly runout of arguments… he flew off the handle at thefirst contradiction…" Freud met Gilles de laTourette on a trip to Paris, during a Tuesday eve-ning with JM. Charcot, and mentioned him in aletter to his wife, commenting on his hot-headedand fiery character: "He's an authentic southernFrenchman". Gilles de la Tourette did not displaypolitical opinions any more than JM. Charcot, buthe shared the strong and anticlerical republicanideas of his teacher. He was a friend of Bournevilleand supported him in his fight to secularise thehospitals. A song from the staff room bears witnessto this [15, 27, 28, 29]:

"M'sieu Gilles de la TouretteN'est pas d'humeur facileQuand avec des pincettesOn touche à Bourneville".

("Mr. Gilles de la TouretteHas no easy temperWhen we poke funAt Bourneville")

Léon Daudet painted a harsh portrait in Devantla douleur: "Gilles de la Tourette was ugly, like aPapuan idol covered with patches of hair… He hada raspy and scorched voice, abrupt gestures and agrotesque demeanour. He was seen as unusual. Hewould broach an interesting subject, then let it dropin favour of another. He disconcerted his teacherswith his quirks that became increasingly frequentand less and less funny. He pranced about, jumpingand dancing when people drew his attention to cer-tain coincidences. He would repeat, "That is my verystrong conviction".

Gilles de la Tourette thus had an unusualpersonality, with hypomanic and histrionic traits.He was intelligent but unstable, hyperactive andcombative. The disease that would claim his life aggra-vated all of these traits.

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Syphilis

Gilles de la Tourette was a house officerunder Fournier. While he accepted that tabes dor-salis was due to syphilis, he never agreed with hisformer teacher on the syphilitic origin of demen-tia in general paralysis [30]. In Paris vécu, Léon Daudetgives his version of how Gilles de la To u r e t t e ' sdisease revealed itself publicly. "Pierre Marie, whomuch later attracted considerable attention withhis localisation of articulated speech, was very dis-ciplined and modest, keeping very much to thebackground: "Yes Sir, no Sir, perfectly Sir". Hewas attractive, very kind, resembling a shy lawyermore than a physician. He stood in contrast toGilles de la Tourette, who was hirsute, categoricallytalkative and absurd and would die insane. Gillesde la Tourette's delirium, resulting from a neglec-ted treponemal infection, became publicly appa-rent in the most comical way. While conductingan exam he asked the candidate: "Who are, Sir,the three greatest French physicians of the 19thcentury?" The student thought about it and ans-wered: "Laennec, Duchenne de Boulogne andCharcot", because he knew that Gilles de laTourette had been Charcot's student. "No, Sir, thatis incorrect: it was my grand-father, my father andme, mate. That is why in this room the examinerput his own toque d'agrégé on the head of thespeechless young man, that is why a potassiumbromide statue will be erected for me!" The publicassistance archives showed that Gilles de laTourette was on leave for health reasons starting1 November 1901 [31]. After the resignation ofBrissaud as the chair of Medical History in 1900,Gilles de la Tourette considered applying for the posi-tion. The 38-page manuscript he wrote for this pur-pose but never submitted contains pathetic pas-sages indicating a flight of ideas, megalomania andthe loss of his critical faculties: "We think it amagnificent service we have rendered to the his-tory of medicine by bringing attention to these oldtreasures in our museums and also by making themappealing. These documents are so specific and soaccurate in their representation… and were almostcompletely ignored until now and unknown to mostof the public and also to those physicians mostspecialised in the posthumous objects of medici-ne. We have also published, as an appendix, ori-ginal texts describing the most beautiful discove-ries in ancient and modern art, with a minimum of300 to 400 drawings, which could also constitutea superb volume to the glory of French medicine.We should always consult it to constantly keep inmind this parallel and admirable evolution of thehistory of medicine and the art of sculpture, pain-

ting and costumes in France and abroad, with illus-trated documents that are unrivalled in the world.They appear only rarely in common books, asideperhaps from the important work of the honestAmbroise Paré, who must have been an excellentartist as his book is adorned with marvels." Hewas hospitalised involuntarily at the medical faci-lity in Bois de Céry, close to Lausanne, accompa-nied by JB Charcot, his teacher's son and fellow stu-dent, who explained that they were going to givea medical opinion on a famous patient at the faci-l i t y. Gilles de la Tourette became psychotic ands u ffered from dementia. He was the victim ofrepeated convulsions and died on 22 May 1904.

What a unique journey for a unique personali-ty!

As the biographer of T h é o p h r a s t eRenaudot, the inventor of journalism, Gilles de laTourette seemed to take profound inspiration inhis subject's work, becoming a prolific author anddebater on medical as well as artistic subjects, andon the events of his time, in multiple periodicalsand several books. He knew how to use his closefriendship with an influential journalist to publicisehis results and those of his revered teacherJM. Charcot, but he also used this relationship toobtain unofficial information, as Renaudot did withRichelieu.

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Gilles de la Tourette

As an intransigent spokesman of the dog-mas on hysteria from the La Salpêtrière School,he argued against the possibility of crimes committedunder the influence of a hypnotic state and by sug-gestion and ultimately became a direct victim of the-se ideas when a woman attempted to kill him.

Steadfastly opposing Fournier with hisperemptory view that general paralysis was not ofsyphilitic origin, he ended up dying from this disea-se in a state of dementia and neurological deterio-ration.

At the very beginning of his career as aneurologist, Gilles de la Tourette spent less than threeyears extracting a new pathological entity from thedescriptive chaos of chorea. Bearing his name,Gilles de la Tourette disorder is definitively asso-ciated with him. Witness accounts by his contem-poraries about his behaviour suggest that he exhi-bited psychopathological traits that are now part ofthis disorder's description.

Thus Gilles de la Tourette truly had the lifeof his writings.

References

1°) Diagnostic and Statistical Manual of MentalDisorders. American Psychiatric Association. 1994.792p.

2°) Shapiro AK, Shapiro E, Bruun RD, Sweet RD.Gilles de la Tourette Syndrome. New York. RavenPress. 1978.

3°) Beard G. Experiments with the "jumpers" or "jum-ping Frenchmen" of Maine. Journal of Nervous andMental Disease. 1880;7:487-490.

3 bis°) Gilles de la Tourette G. Les "Sauteurs" duMaine (États-Unis), traduit de G. Beard. A r c hNeurol (Paris). 1881;2:146-160.

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20°) Gilles de la Tourette G. Soeur Jeanne desAnges supérieure des ursulines de Loudun auXVIIè s, autobiographie d’une hystérique possédée,d’après le manuscrit inédit de la bibliothèque de To u r s .Le Progrès Médical. Paris; 1886. 321p.

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21°) Gilles de la Tourette G. L’hypnotisme et lesétats analogues du point de vue médico-légal.Libraire Plon-Nourrit. Paris 1887. 534p.

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30°) Gilles de la Tourette G. Formes cliniques ettraitement des myélites syphilitiques. JB Baillièreet fils. Paris 1899. 90p.

31°) Archives de l’Assistance Publique. Etat dupersonnel médical des hôpitaux et hospices, janvier1903, D617.

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