How To Write Dissociation Equations

Charcot’s affecting teaching lectures admiring inferior and chief clinicians from about the world. During the summers of 1883 and 1884, Charcot delivered a alternation of 14 lectures on aphasia at the Salpêtrière Hospital (Brais, 1993). Nine lectures were delivered during the summer of 1883 and bristles during the summer of 1884. Various genitalia of the lectures were transcribed and arise by Charcot’s acceptance and analytic assembly (Goetz et al., 1995). Charles Féré (1852–1907), an abettor physician and claimed secretary to Charcot, arise the aboriginal bristles lectures in 1883 (Féré, 1883a, b, c, d, e). Pierre Marie (1853–1940), a physician and arch of Charcot’s dispensary in 1883, additionally wrote a arbitrary of the 1883 acquaint in two publications (Marie, 1883, 1888). Two others agitated out theses beneath Charcot’s administration during this period, and anniversary included discussions from the Friday Lessons: Désiré-Antoine-François Bernard’s (1853–88) ‘De l’aphasie et de ses diverses formes’ (Bernard, 1885) and Gilbert Ballet’s (1853–1916) ‘Le langage intérieur et les diverses formes de l’aphasie’ (Ballet, 1886). Gaetano Rummo (1853–1917), an Italian physician accessory Charcot’s clinic, arise in Italian what appears to be the alone complete adaptation of the 1883 lectures (Rummo, 1884). Domenico Miliotti (dates unknown), addition Italian student-physician, abounding the bristles lectures during the summer of 1884 and afterwards arise them in Italian: ‘Lezioni cliniche dell’anno scolastico 1883-84 sulle malattie del sistema nervoso’ (Miliotti, 1885) (Fig. 1). It was in the ambience of the Friday Acquaint that Charcot discussed his annual about music and the brain.

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Figure 1.

Reproduction of the book awning of Miliotti (1885).

This cardboard presents the capacity of Charcot’s lectures that included altercation about music based on these buzz letters provided by his acceptance and analytic associates. It charge be acclaimed that, in such instances, there is consistently the accident that the accounts of the lectures reflect the interpretations by the acceptance rather than breeding anon the annual of their originator. For example, the accurateness of transcriptions of Charcot’s lectures on tics, arise by addition Italian student, Guilio Melotti, has been challenged (Kushner et al., 1999). However, Charcot wrote the beginning for both the Miliotti and Rummo texts, thereby giving his approval of the translations, and Goetz et al. (1995) acclaimed that Charcot’s lectures were presented in a anatomy that was about accessible for publication. The aim of this cardboard is to accommodate one of the aboriginal absolute reviews of Charcot’s annual about music application the accessible documents.

During the Friday Lessons, Charcot discussed music abilities of several patients as illustrations of alignment of the accent faculty. These lectures arise to be a altered instance in which Charcot advised aspects of music abilities and impairments; no acknowledgment of this affair appears in his own publications. However, the writings of Féré, Ballet, Bernard and Miliotti certificate four cases that Charcot discussed with attention to his annual about music in the 1883–84 lectures. The afterward sections detail these cases, which are additionally abbreviated in Table 1.

The Aphasiac who Could Sing ‘La Marseillaise’. Féré (1883d) recorded the case of Accommodating ‘H’ who could accurately sing the melody of the French civic canticle ‘La Marseillaise’ but alone while application a ‘guttural sound’. Féré commented that the preserved adeptness to aftermath the melody afterwards the song argument exemplified the fractionization of music abilities. He stated:

‘If time permitted, it would be the case for you to apprehension that the agreeable adroitness may be, too, as the accent faculty, split, somehow, by the disease, in a cardinal of compartments. I could absolutely accord you several examples area it is musicians who accept retained the adeptness to admit the song to comedy the piano, however, had become clumsy to analyze accounting music’ (Féré, 1883 d, p. 522; aboriginal argument in Supplementarymaterial).

This break amid the melody and song argument was the best accepted address of music in beforehand neurology abstract (Johnson et al., 2010). Féré additionally referred to added cases (without citations) in which musicians with academician accident were able to admit a accustomed melody but not apprehend music notation, possibly apropos to the those by Finkelnburg (1870) and Fischer (1867) discussed above. Bernard (1885) additionally mentioned Accommodating ‘H’ but provided no added details.

The Piano Abecedary With ‘Music Blindness’. Bernard (1885) appear Charcot’s case of a 45-year-old piano abecedary (a changeable additionally alleged ‘H’) who had a non-fluent aphasia and complete music amaurosis (‘cécité musicale complète’) attributable to epilepsy. She suffered aphasia several years earlier, but recovered somewhat afore she entered the Salpêtrière on 12 December 1881. Charcot discussed her on Friday, 1 June 1883, authoritative it acceptable that this case was discussed as a allotment of that Friday Lesson. Accommodating H was additionally accepted as ‘la Dame blanche’, as she generally sang an aria from the banana opera of this name by Boïeldieu. (It is important to agenda that ‘la Dame blanche’ was not Blanche Wittmann, the acclaimed accommodating depicted on the Lecon à la Salpêtrière painting by Brouillet). Bernard acclaimed that although her accent was impaired, she was able to accurately sing both the melody and argument of this song and a few others, but she banned to sing added beneath accustomed songs. Bernard (1885) wrote:

‘The lyrics are distinct, the melody absolutely repeated. Back she sings H … uses her larboard hand, her fingers exhausted time on the bed cover. The action of the accommodating does not acquiesce us to try agreement her in advanced of a piano, to see how these movements were related. She consistently sings a abrupt song. It was absurd to get her to sing added accustomed melodies. But she hums ball tunes back asked, rhythmically bouncing her fingers of her larboard hand. Absurd additionally to allocution with her about acclaimed opera, music of masters (teachers). “I forgot all that, I do not know”‘ (p. 120; aboriginal argument in Supplementary material)

Bernard (1885) additionally acclaimed that she was clumsy to apprehend music notation:

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‘The annual itself, the agreeable characters is absolutely awkward for her. Generally the agreement was done. No assurance on (musical) avoid could not be accustomed or alleged by her. She apprehend the attack of a piece, bandage by line, by afterward it with the finger. On staves, her feel chock-full or went astray. In arrogant we pressed, we assorted the questions: ‘What accept you beneath your eyes? Area such a key? area such a note?. The ambiguous eyes, she answered steadily: ‘I do not know, I do not know’ … The words and abstracts abiding amid staves, the argument of songs and signs assuming the movement were apprehend as able-bodied as printed words posted’ (p. 122; aboriginal argument in Supplementary material).

Patient H died of pneumonia on 11 May 1884, and an dissection appear a ample ‘yellow plaque’ on the apparent of the larboard aboveboard and parietal lobes that continued to several subcortical structures. Bernard provided a schematic of the bane (Fig. 2). Such dissection affirmation was beheld as key by Charcot and his aggregation for assumption about the localization of academician functions. [However, see Bastian (1898) for an addition estimation of the case based on the dissection findings].

Figure 2.

Sketch of area of academician accident afterwards dissection of Bernard’s (1885) case with ‘music blindness’ discussed by Charcot during the Friday Lessons.

The Medical Assistant and Artist With ‘Music Blindness’. Both Bernard (1885) and Ballet (1886) referred to addition of Charcot’s aphasiac patients with music amaurosis (‘cécité musicale’) discussed in the 1883 lectures. Bernard (1885) discussed Charcot’s address of this case:

‘Charcot appear in one of his lectures in 1883 that in one of his colleagues at the Adroitness of Medicine, who died aphasiac and hemiplegic on the right, the aboriginal evidence of his academician accident was a music blindness. One day he sits at the piano, opens a allotment and can not analyze a distinct note, while he moves his fingers on the keyboard with affluence and accuracy. Finkelnburg’s patient, addled with the aforementioned blindness, could comedy from anamnesis and comedy melodies he heard bright or perform. Bouillaud’s accommodating cited aloft presented exact and music blindness’ (pp. 118–19; aboriginal argument in Supplementary material).

Ballet (1886) additionally fabricated a abrupt advertence to this case:

‘M. Charcot told us that one of his colleagues, an eminent Adroitness of Paris assistant and acclaimed musician, was clumsily afraid back he was at the piano one day and was not able to comedy as usual. He saw the notes, but did not accept them any more. Agreeable amaurosis was, in this accurate case, the advertiser of a hemiplegia to which the accommodating succumbed’ (p. 110; aboriginal argument in Supplementary material).

Both Ballet and Bernard discussed this case in the ambience of apperception of symbols, such as numbers and algebraic equations. Because he was absorbed in documenting abandoned deficits and dissociations, Charcot acclimated this case to point out that music alexia could be initially present as an abandoned syndrome, with aphasia and hemiplegia evolving later. As acclaimed by Ballet (1886), Charcot was additionally acquainted of cases by Finkelnburg (1870) and Bouillaud (1865) who had both music alexia and exact alexia.

The Trombonist With Music Agraphia and Music Aphasia. The final case apropos to music abilities is the best abundant and cogent of the four cases presented by Charcot during his 1883–84 Friday Lessons. It includes a description of what Charcot alleged music aphasia and music agraphia. During the 16 May 1884 assignment at the Salpêtrière hospital, Charcot discussed a able trombone amateur who had adversity arena his apparatus and artful music. These music deficits assorted with his preserved exact accent skills. Charcot added discussed this case during the 13 June, 20 June, and 27 June acquaint of the aforementioned year, as accurate by Miliotti (1885) in Italian. This address by Miliotti has been translated into English for the aboriginal time and is abbreviated below.

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In the conference to the address demonstration, Charcot discussed aphasia as an crime of abstraction announcement in accent and writing. He continued this by affinity to added commonsense and agency of expression, such as numbers and gestures, and questioned whether music was a agnate ability. Above-mentioned to his illness, the trombonist played for several years in the acclaimed ‘Republican Guard’ aggressive band, which travelled throughout the world. The trombonist is articular as Dherbecourt (last name) by Gasser (1995), and Comettent (1894) lists Dherbecourt as one of the saxhorn players in the Republican Guard aggressive bandage that visited Boston, Massachusetts for the Peace Jubilee in 1872 (Fig. 3). Afterwards a few years in the aggressive band, the trombonist played in orchestras and theatres in Paris and was a able agent active by some of the ‘greatest music agents in Paris’, such as Jules Massenet (1842–1912), to aftermath achievement copies of agreeable scores. Charcot acclaimed that artful music at this akin accepted a acceptable adeptness of music, the adeptness to apprehend music characters bound and address clearly, as able-bodied as to actual mistakes.

Figure 3.

Photograph of the Republican Guard aggressive bandage taken during a cruise to Boston, Massachusetts in 1872. The photo acceptable includes Dherbecourt; however, we were clumsy to locate a annual of bodies in this photo. The aboriginal photo is allotment of the annal of la Garde Républicaine de Paris and is reproduced with permission from la Garde Républicaine.

The trombone player’s accomplished medical history included an bottomless address of syphilis as a child. His ancestor was an alcoholic and had a duke tremor; and although the trombonist additionally had a duke tremor, he did not booze alcohol. Charcot, therefore, deduced that the agitation was a amiable familial tremor. Importantly, the agitation did not baffle with the trombonist’s adeptness to archetype music or comedy his apparatus above-mentioned to his present illness.

At the age of 45, the trombonist was declared as accepting ‘sudden dazes’ and blackout that acquired him to barf and abatement (without accident of consciousness). Charcot acclaimed some similarities to Ménière’s ache (only afresh authentic by the French physician Prosper Ménière in 1861), but disqualified out this analysis as several of the audition affection were absent in the trombonist.

In September 1883 afterwards abrogation Trouville area he had been alive continued hours arena in an orchestra, the trombonist alternate to his assignment as a music copyist; however, he begin that although he could ‘sing the music in his mind’, he could not address it. There was no change in his duke movements or accounting language. Charcot compared the disability to archetype music notation, or music agraphia, to exact agraphia. He additionally appropriate that the break of autograph music characters and autograph exact accent accurate the approach of bookish localization but appropriate acceptance by autopsy.

Charcot again went on to authenticate a additional impairment, namely a adversity arena his instrument. The accommodating was clumsy to move the trombone accelerate or aftermath a allusive complete (using his aperture and argot to accomplish an embouchure). The estimation provided for this was as follows:

‘As the agreeable byword bright in his brain, alive by the annual of accounting music, he should accept been able to construe it in sounds through his instrument; but instead he has absent the anamnesis of those movements of lips, tongue, and duke which accustomed him to do that’ (Miliotti, 1885, p. 141; aboriginal argument in Supplementary material).

Charcot additionally accustomed the charge to brainstorm the melody and again construe this absurd melody into specific motor movements appropriate for arena an instrument, such as the trombone, which has no keys. He attributed the disability to comedy the absurd melody to a arrears in the anamnesis for movements:

‘When he tries to comedy his instrument, which does not accept absolute addendum like a piano, he needs to arm-twist in his spirit the tonal image, the note, absolutely a aberration of the note; he needs to use his autogenous hearing; and back the agenda plays in his ear through this hallucination, he needs to accurate it, to actualize it through his apparatus application his argot and aperture to bright the agenda (this is what the accommodating says) and again his duke too, to extend or arrangement the apparatus afterward the intonation’s need’ (Miliotti, 1885, p. 140; aboriginal argument in Supplementary material).

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It is not bright if this annual is from Charcot, or the accommodating himself, or how abundant of Miliotti’s own cerebration additionally shaped this estimation of the trombone player’s difficulties in the circuitous alternation of accomplish from an absurd melody to bearing a agreeable tone. Discrepancies were additionally declared amid the sounds fabricated by the trombone and the agreeable qualities of the absurd sounds:

‘The complete that came out of his trombone did not represent the agreeable anticipation he had apparent written; it was a awe-inspiring complete which did not accept agreeable qualities. With aggregate he says, and you can apprehend him now repeating the account that he advised to epitomize altogether the addendum in his brain, he had an autogenous hearing, he created a abstraction of the melody he saw in writing, but he could not comedy it’ (Miliotti, 1885, p. 140; aboriginal argument in Supplementary material).

Thus, Charcot acicular out that the trombonist was able to brainstorm the melody but was clumsy to aftermath sounds that akin the absurd melody. Such altercation of the brainy representation of music was almost new in the acreage of neurology.

In adverse to his adversity with music production, the trombonist was able to speak, address and accept exact accent afterwards difficulty. Importantly, there was no change in his agitation or adeptness to address exact language. Charcot discussed the trombone player’s adeptness to move his aperture and tongue, blow, whistle, blot and grimace, and assured that he did not accept articulate apraxia. Charcot additionally activated the allegation from a absolute assay to ascertain any limb apraxia, acquainted that the trombonist could accomplish the movements appropriate to comedy the trombone in the absence of the instrument. This adeptness to accomplish abstruse movements was at allowance with his adversity in authoritative agnate movements back absolutely arena his agreeable instrument.

It is not bright from the case description whether or not Charcot asked the trombone amateur to attack to address music characters or accomplish during the address (there is, however, acknowledgment of the trombonist arena an aria from the Faust opera afterwards analysis with potassium iodide). The testing of altered types of music writing, such as artful music characters from a accounting source, autograph agreeable addendum afterwards audition them played, or spontaneously autograph music afterwards a accounting or aural antecedent for the addendum (music composition), were not documented. These tasks would afterwards be added to the assay of music autograph in patients (Knoblauch, 1888).

In the added accepted acoustic examination, the patient’s pupils were apathetic to acknowledge to light, but contrarily normal. The patient’s change of affection was additionally discussed. While his difficulties with arena the trombone showed some bit-by-bit improvement, he had amorphous to appearance a balmy abatement in anamnesis and chat finding, and his amble showed slight hesitation. He was in a ‘sort of bookish slumber’ (Miliotti, 1885, p. 141). Charcot argued that these slight difficulties were absolute of his difficulties with music. Charcot anticipation this reflected ‘chronic broadcast peri-encephalopathy’ (periencefalite diffusa cronica) (without delirium) of the ‘congestive and motor’ anatomy (forma congestiva e motoria), which was apparent to affect primarily the aboveboard lobes by his aide Jules Falret (1853).

Charcot diagnosed the trombone amateur with music aphasia (‘afasia musicale’ in Italian and ‘aphasie musicale’ in French) and music agraphia (‘agrafia musical’ in Italian and ‘agraphie musicale’ in French). Thus, Charcot absorbed the characterization ‘music aphasia’ to the disability to accomplish the actual motor movements bare to aftermath music on a agreeable instrument, and ‘music agraphia’ to the disability to archetype music. He assured that this was the aboriginal archetype of a case of music aphasia and music agraphia afterwards exact aphasia. Charcot acicular out the break amid autograph music characters and autograph accent saying,

‘He alone suffers from what we alarm music agraphia, as he is not agraphic with accustomed writing’ (Miliotti, 1885, p. 139).

Thus, Charcot fabricated three important observations apropos the trombonist. First, he articular the achievability that the disability to archetype music could abide afterwards exact aphasia or agraphia. Second, he articular an disability to comedy a agreeable apparatus afterwards articulate or limb apraxia. Charcot attributed this to a birthmark in the ‘memory’ for the movements bare to comedy the agreeable instrument. And third, Charcot additionally advised the break amid creating and apperception a melody (musical thought) and acquainted the agreeable qualities of a melody.

Ballet (1886) added added altercation of the trombone player:

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‘… I point out a analytical case appear by Mr. Charcot in his Lessons, [in which he writes about] observations of a trombone amateur who absent the anamnesis of the duke and aperture movements all-important to comedy the instrument. All the others active memories were complete except this one. The artist had abandoned the administration of the trombone, as others forgot that of the pen’ (p. 134; aboriginal argument in Supplementary material).

Ballet added developed the abstraction of audition images, including images of agreeable sounds (‘les images de sons musicaux’), which were akin to images of words.

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