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UP CLOSE & PERSONAL WITH CHRISTOPHER G. GOETZ, MD: NEUROLOGIST AND HISTORIAN

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‘If contemporary neurologists want to understand the way a disease unfolds in its natural state, they can't do better than to go back to the original documents.’

The Neurology: Careers Plus column regularly features neurologists who do interesting things outside of or related to the field of neurology. We welcome your suggestions for neurologists to feature in Neurology Today. Send your ideas to NeuroToday@LWW.com.

Christopher G. Goetz, MD, Professor and Associate Chairman of the Department of Neurological Sciences at Rush University, does not consider himself an historian. First and foremost, he is a practicing neurologist, researcher, and lecturer on Parkinson disease and Tourette syndrome. But years ago, as a Fulbright scholar studying biochemistry at the Collège De France in Paris in 1981, he had the opportunity to gain access to the medical records of 19th century neurologist, Dr. Jean-Martin Charcot. That “eye opening” experience, he said, inspired him to look deeper into other events and personalities that have shaped the field of neurology.

Dr. Goetz, who received the AAN McHenry Award for Medical History in 1984, has written books and articles about Dr. Charcot, including a biography, Charcot: The Clinician (Raven Press). In addition, he developed a centenary tribute to Dr. Charcot in 1993, contributed to the AAN's 50th anniversary exhibit in 1998, and in 2001, completed a two part exhibit for the American Neurological Association (ANA) – covering the ANA's role in the field through the 20th century.

In a phone interview, Dr. Goetz discussed his interest in history and how that has shaped his perspectives on contemporary neurology issues.

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WHAT INFLUENCED YOUR INTERESTS INNEUROLOGY AND ITS HISTORY?

My primary intellectual interests are behavior and chemistry, and so I was attracted to the fields of neurology and psychiatry. The biological basis and precision of neurological discipline quickly steered me in the direction of neurology.

In medical school, the late Dr. Harold Klawans, a movement disorders specialist and pharmacologist, greatly influenced me. He was interested in literature and history. I studied under him, worked in his animal laboratory, and saw patients under his direct guidance. He encouraged me to study abroad and supported my Fulbright senior award application. He started out as my mentor, but over time, we became more like colleagues. We shared in each other's success with pride and without competition. I think this is a very rare evolution.

I also had the very fortunate experience to be a Fulbright scholar and to go to France for two years. During that period, I visited many interesting libraries in Paris, including the Charcot Library at the Salpêtrière Hospital, and read through the original patient notes that Dr. Charcot used when he examined patients. Since then, I have been interested in looking at source documents in neurological history.

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DID YOU INTEND TO STUDY HISTORY IN PARIS?

I developed my focus on history in France. My work at the Collège De France was in biochemistry, but through the Fulbright organization and my contacts in France, I was able to get into their libraries. You need a personal entrée to get into a library in Europe to look at documents, because, unlike the US, the real charge of the librarian there is to protect and store documents.

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WHY WERE YOU DRAWN TO DR. CHARCOT?

During my medical education, Dr. Charcot was frequently cited, and with my background in French language and literature, I found reading his works a perfect way to merge my interests in neurology and language.

Dr. Charcot's primary contribution to neurology was the development of the standard research method of clinico-anatomical correlation. He examined numerous patients with the same or similar signs and then examined their brains and spinal cords after death. In this way, he classified patients and made important correlations between clinical signs and anatomical lesions. The prioritization of clinical skills and the precision of Dr. Charcot's anatomical studies naturally drew me to study his extensive contributions.

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WHY WERE DR. CHARCOT'S PATIENT NOTES SOINTERESTING TO YOU?

Dr. Charcot developed a teaching method of “show and tell” where patients were presented to him in an impromptu format before his student audience. The dialogues between Dr. Charcot and his patients, which his students transcribed word-for-word, were structured to teach physicians how to think neurologically and to gather information and elicit signs that would lead to a clinical diagnosis. These documents offer a first-hand look at the types of disorders seen and the personal scientific method that Dr. Charcot applied as a clinical neurologist. More than that, they provide glimpses of Dr. Charcot's honesty and wit, as well as his authority and humility. They are also highly educational documents on neurological illness as seen from the patient's perspective. In my opinion, no other documents are as vivid as these in teaching modern readers about the ambience and methods of neurological study during the 19th century.

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WHAT CAN NEUROLOGISTS LEARN FROM 19th CENTURY NEUROLOGY?

The 19th century neurologists followed the natural history of diseases, and they described what they observed in highly descriptive, elegant language. These documents, not the modern textbooks, remain the pillars of clinical neurology in terms of clinical phenomenology.

Today, we face this terrible crunch on space and time; we have to do everything in a reduced form. If contemporary neurologists want to understand the way a disease unfolds in its natural state, they can't do better than to go back to the original documents.

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HOW DOES YOUR BACKGROUND IN HISTORY AFFECT YOUR WORK?

Figure. Dr. Christop...
Figure. Dr. Christop...
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Of great interest to me is how much the 19th century neurologists leaned on hereditary issues as causes for most neurologic illnesses. During the early 20th century, the tables turned, and we looked at issues of environment, inflammation, and infection, but today we have come back to looking for genetic causes for most of the primary neurodegenerative illnesses. To see this total circle from the 19th century, where these illnesses were felt to be hereditary in some way, and now to see the modern theories is a real lesson in terms of the kind of neurological discipline that we use.

It is also very interesting that, originally, neurologists felt that a disease could have many different manifestations and could reflect the same genetic or hereditary problem. We now think of many neurologic illnesses in exactly the same light, as having one genetic defect that we can actually characterize with many different phenotypes. I think the modern neurologist is wise to go back to these early discussions and look at the reasoning and observations behind the 19th century theories.

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WHAT OTHER HISTORY PROJECTS ARE YOU WORKING NOW?

I just completed the first in a series of exhibits for the ANA's annual meetings that will trace the history of neurology in the city or region where the meeting is being held that year. In 2000, we presented an exhibit on the history of Chicago neurology, including an overview of its development in the 19th and early 20th century; illustrious figures from the Chicago history; and textbooks, societies, and journals related to Chicago neurology. Next year's meeting will be in New York, and I am in the process of designing that exhibit with my colleague Dr. Elan Louis.

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WHY ARE YOU SO PASSIONATE ABOUT HISTORY?

History is an important element of my neurological career and I have tried to study a short period in detail, concentrating primarily on French neurology and its influences on American neurology. As such, every day of my patient care and research brings history into my mind, because the diagnoses and hypotheses we generate today have such direct parallels with the late 19th century. For me, my historical interests and modern neurology are implicitly linked; to the extent that passionate is appropriate vocabulary, it applies to my feelings of history and neurology equally.

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RECOMMENDED READING

Dr. Goetz recommends these books for neurologists interested in their history:

Advice for a Young Investigator by neuroscientist, Santiago Ramón y Cajal, is a book Dr. Goetz often gives as a gift. “The book is a personal reflection on a career in neuroscience and a good book to read and reread,” he says. (MIT Press)

Mind Behind the Brain: A History of the Pioneers and Their Discoveries by historian, Stanley Finger features well-known neuroscientists and examines their careers in the context of their time. (Oxford University Press)

Neurological Eponyms by Peter Koehler, a recommended read for practicing neurologists, discusses the person and the history behind many different neurological signs and diseases. (Oxford University Press)

Brown-Sequard: A Visionary of Science – a very readable, concise book by neurologist Michael Aminoff – offers a good look at 19th century science. (Raven Press)

©2002 American Academy of Neurology

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