Neurology in Paris hospitals, particularly the Salpêtrière before Charcot: Rostan on brain softening
Poirier, J.; Derouesné, C.; Rostan, L.
Revue Neurologique (Paris) 156(6-7): 607-615
2000
ISSN/ISBN: 0035-3787 PMID: 10891794 Document Number: 513830
In the beginning of the xixth century, many studies were devoted to the diseases of the nervous system in France, long before the work of Charcot. The researches of Leon Rostan on the cerebral softening (1819, 1823) were based on the anatomoclinic method developed by the School of Paris whose most famous representatives were Corvisart and Laennec for the study of heart and lung diseases. The researches of Rostan were performed in the Salpetriere hospital which was, at this time, an hospice for old women. Rostan was appointed Inspector of the Health service in the Salpetriere hospital in 1812 then Head of a department in 1818. He was 28 year old when he published his book "Researches on the cerebral softening" in 1819. Rostan was the first to describe the spontaneous cerebral softening as a special anatomoclinic entity distinct from encephalitis and apoplexy. He compared this entity to the senile gangrene and stated that it was related to the ossification of cerebral arteries. He described the pathologic features of the brain softening and also its clinical symptomatology in opposition to that of apoplexy. The concept of brain softening according to Rostan was harshly fought by the followers of the Broussais's physiological medicine (from Lallemand, 1830 to Calmeil, 1859) who claimed that all brain softenings were due to the inflammation process and thus should be described as encephalitis. In opposite, the ideas of Rostan were accepted and developed by others such as Carswell in England (1835), Abercrombie in Scotland (1836) and Andral in France (1827, 1840). These authors agreed that some type of cerebral softening was related to a disease of the arterial system. Nevertheless, the modern concept of brain softening was not definitively accepted before the description of the thromboembolic mechanisms by Virchow in Germany (1856) with the help of the microscope, and the anatomoclinic studies of Proust, Laborde and Prevost and Cottard in France (1866). The book of Rostan was dedicated to the "Conseil General des Hospices" which was created in 1801 to unify the administration of the hospitals in Paris and became the "Administration Generale de l'Assistance Publique a Paris" in 1849. One hundred and fifty years after its publication, the work of Leon Rostan was outstanding by its modernity of the form as well as the substance.