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  • Writer's pictureDale DeBakcsy

The Woman of a Thousand Brains: Augusta Déjerine-Klumpke, Pioneer Neuroscientist.

The brain is ready. It luxuriated in a solution of potassium bicarbonate for a year, and then in a thick mixture of nitrocellulose for another month and a half, and now it is finally ripe for the slicer. A woman places it in a cylinder, as she has countless times before, and fixes it in place on her microtome, advancing it upwards ever so slightly for each new pass of the blades, which will change this once whole brain, which held a lifetime of memories, triumphs, and frustrations, into some 2000 individual sections to be stained and analyzed for the presence of lesions or abnormalities.


The woman is Augusta Déjerine-Klumpke (1859-1927), the place is an almost comically small back room at Bicêtre Hospital soon to become famous as the birthplace of the century’s most comprehensive examination of neuroanatomy, and the year is 1890, solidly in the center of France’s golden age of neuroscientific research. Though known today primarily as “the wife of eminent neuroscientist Jules Déjerine,” she was at this time, at age 31, already a scientific celebrity, an award-winning researcher and trailblazer with a reputation for procedural rigor and deep familiarity with the international neuroanatomical literature. Born in San Francisco, she was the second oldest of six siblings, the majority of whom went on to international fame in widely different fields of accomplishment.


Her father had come to California in 1849, originally for the prospect of striking it rich in the gold fields, but ultimately, and wisely, deciding to make his money off of the sale of California real estate instead of taking his chances as a prospector. When she was two years old, her older sister Anna (later a famous painter) had a fall that led to osteomyelitis, a bacterial bone infection, which frontier doctors were understandably ill-equipped to treat. So, in 1866, her mother packed her and her three sisters up, and headed for Europe, where better results were hoped for from experts in France and Germany. For nearly two years, they remained in Europe while Anna underwent different treatments, and Augusta began to learn the German language, which would prove invaluable later in life.


Ultimately, Anna’s condition did not appreciably improve in Europe, and she would have trouble walking for the rest of her life, and the family returned to California, where two more siblings were produced, in 1868 and 1870. In spite of the new additions, Augusta’s parents’ marriage was in trouble, and her mother requested a separation, taking her now six children with her to Europe in 1871. Augusta went to a German boarding school, and in 1873 was reunited with the rest of the family, who were living at Clarens, in Switzerland. Here, Augusta continued her studies of French while her mother wondered what to do with her prodigiously gifted daughters.


An obvious solution would be to send them to the University of Zurich, which had a fine medicine school that allowed women to enroll. A significant number of women who took up that opportunity, however, were from Russia, and had a reputation for espousing at-the-time fashionable nihilistic philosophies (a reputation not entirely unfounded - remember from the Mathematics volume of this series that Sofia Kovalevskaya, who left Russia to study mathematics in France around this time, was also the author of the 1890 novel Nihilist Girl). As far as Augusta’s mother was concerned, that disqualified Zurich as a place to send her daughter. Eventually, a friend pointed out the obvious - that if she wanted a place that could offer musical training for Julia, artistic training for Anna, scientific training for Dorothea (who we met in the Astronomy volume of this series), and medical training for Augusta, she could not do better than Paris, where Madeleine Brès had just, in 1875, become the first woman to earn a French medical degree.


Paris it was, then. Here Augusta began her studies in 1877, and for neuroscientific research, she could hardly have been in a better spot. The legendary Jean-Martin Charcot and Alfred Vulpian were both there, and both at the height of their powers. Guillaume Duchenne, the great pioneer in the use of electricity to study neuro-muscular afflictions, had only passed away two years previously. Here the great work was being done, relating maladies of the body to problems of the brain, centered at hospitals that poured out new research at dizzying paces - Bicêtre, the Hôtel-Dieu, the Charité, and most of all, Charcot’s La Salpêtrière. Augusta began by working as assistant to Professor J.A. Fort while studying anatomy, winning the Médaille de Vermeil in 1878 for her work. Fort encouraged her to apply for an externship position, but for several years her requests were turned down on account of her gender.


In 1880, she joined the clinic run by Professor Hardy as a trainee. The previous year, a promising researcher by the name of Jules Déjerine had taken up a post there as chief of the clinic. Jules had been in a disappointing romance before which convinced him that he would never find somebody who would share his serious and deep enthusiasm for science, and that the best course in life would be to remain a bachelor, married to his work. Then he met Augusta, and very soon letters singing her praises were wending their way back to his mother, praising the sharpness of her mind, and the depth of her devotion to research: “The more I see this young woman, the more I like her, and you know, my dear mother, that this is not a galloping love like the last one, it is a rational love which has arrived slowly, and which could not be more serious. It is a love of the minds, as we say between us. And you know, my dear mother, that is true love.”


Besides a blossoming romance, the early 1880s also saw Augusta join forces with the unstoppable Blanche Edwards to give women access to French externships and internships. Edwards wanted nothing so much as to become a surgeon, a virtual impossibility without access to those opportunities. In 1882, Edwards’s lobbying opened the doors of the externship track, allowing Augusta to extern at the Hôtel-Dieu in the mornings and then attend demonstrations and lessons from Charcot, Sée, Fournier, and Besnier during the rest of the day. In 1883, while observing a patient at L’Hôpital de Loursine, she noticed that a patient with an injury to the brachial plexus (a bunching of nerves that branch outwards from the neck) causing an expected arm paralysis also displayed unusual pupil constriction not described in the literature. Using facilities placed at her disposal at the laboratory of Alfred Vulpian (who was the primary mentor of Jules), she studied the effects of different brachial plexus lesions on dogs. Other doctors had assumed that the patient simply had Erb’s palsy, the result of a lesion to the C5-C6 root nerves, but which didn’t explain the pupil constriction. Digging deeper, Augusta found that damage to the C8 and T1 nerve roots produced both phenomena.


She published the results of her research in 1885, won the Godard Prize for the discovery in 1886, and today the condition is known as Klumpke’s Palsy or Déjerine-Klumpke’s Palsy. 1885 was also the year that she and Edwards broke through the internship barrier, thanks again to Edwards’s gift for lobbying. At the time, internships were granted by participation in a contest which generally required preparation via a series of courses. Though they were given permission to compete for the internships, the medical establishment conspired to close the doors of any preparation courses to them, and so they had to make do as best they could between private teachers and their own studies. In 1885, Augusta won a temporary intern position, and in 1886, a full internship.


For the next three years, she interned at some of France’s most important hospitals, working with some of medicine’s leading lights. In 1888, however, she and Jules finally married, and Augusta cut short her internship program to work with Jules at Bicêtre, where the pair would remain until 1895, with Augusta earning her PhD in 1889 for a dissertation which improved upon the existing classifications system for polyneuritis. Here at Bicêtre, Augusta worked at preserving, sectioning, staining, sketching, and analyzing the brains of patients possessing different maladies to determine what lesions and abnormalities might underlie those conditions, compiling the data that the pair would eventually publish in the 1200 page Sémiologie du Système Nerveux (1900) and the two volume Anatomie des Centres Nerveux (1895, 1901), which presented not only Augusta’s sectioning and staining methods, but also the couple’s novel projection method for obtaining more detail out of microscopic observations. These were definitive texts, creating mappings of neurological conditions to the underlying brain areas involved with heretofore unknown levels of clarity, thanks to the illustrations drawn by Augusta and the careful analytic work she and Jules performed to make minute distinctions in the subcortical structures involved in different diseases.


Nowhere was Augusta’s analytic skill more on display than in the great Aphasia Duel of 1908, with in one corner the great student of Charcot, Pierre Marie, and in the other, that of Vulpian, Jules Déjerine. The debate between the greatest students of France’s most legendary neurological researchers was the Wrestlemania main event of its time, though today the topic of that debate, a disagreement over how many types of unique aphasia (language processing problems caused by brain damage) there are, couldn’t seem less likely to be the stuff of high drama. But high drama it was, and Augusta’s analysis of the anatomical differences in the lesioning behind two different types of aphasia dealt Marie the knockout blow, a defeat Marie would not be quick to forget, or forgive.


From 1895 to World War I, the Déjerines, after a round of succession drama occasioned by the death of Charcot in 1893, worked at the Salpêtrière that Charcot had ruled for over three decades, continuing their research not only into distinct new neurological syndromes, but into new approaches for the treatment of patients who had been diagnosed with incurable neural diseases by over-eager neurologists, when in fact all they needed was a sympathetic doctor and rest to find their balance again. With the coming of World War I, Jules volunteered his medical and administrative services while Augusta set up hospital care for the war’s paraplegics and hemiplegics, developing new procedures to help them re-train their bodies, researching the impact of different war injuries (and discovering heterotopic ossification, or the growth of bones fragments within soft tissues, in the process), and creating work training programs so that even those most severely injured could find self-respect and occupation after the war. For these services, which she was actively involved in until 1920, she was made an officer of the Legion of Honor in 1921.


In 1917, Jules’s health, which had been on the decline for some time, finally snapped, and with his passing, his old adversaries saw a chance to strike at his legacy through his wife. Pierre Marie, elevated to the Salpêtrière chair, and Jules’s great rival, gave Augusta fifteen days to clear out their working space and leave. She did, taking the treasure trove of specimens and data they had collected over the last nearly three decades with her, and donating 10,000 francs to the establishment of a Foundation to oversee their care. Meanwhile, the French scientific establishment that had done so much to hinder her rise made up for its previous behavior in some part by honoring her in her final years, electing her a member of the Société de Biologie in 1924, while the Académie was planning to elect her to the first available vacancy, but did not get the chance to do so before her death in 1927. She left behind a daughter, Yvonne, who would go on to be a neuroscientist herself, as well as a determined guardian of her parents’ legacy, a host of wounded veterans who would honor her memory for the rest of their lives for her personal and innovative care, a treasure trove of neurological specimens and records denoting in exquisite detail the structure and symptoms of damaged brains, some fifty-six scientific articles, three absolutely foundational works in the history of neuroanatomy, and a nation that remembered her as a beloved adopted daughter who took the baton of Charcot and Vulpian and carried it securely into a new century.


FURTHER READING:


There is actually quite a bit about Augusta Déjerine-Klumpke out there, particularly if you can read French. She wrote an autobiographical fragment which covers the years up to her marriage, and which is a useful source to resolve many of the contradictory dates you see concerning these early years in different online accounts. Passion Neurologie: Jules et Augusta Déjerine (2017) by Michel Fardeau is an interesting source which gives some nice context about the French neurological scene at the time of the Déjerines arrival, though the book concentrates more on Jules than Augusta. Harder to find is Gauckler’s 1922 biography of Jules Déjerine, Le Professeur J. Déjerine, which benefits from knowing personally all the main players but which correspondingly also needs to be taken with a pinch of salt. The Déjerines main neuroanatomical volumes, meanwhile, are readily available in reprint editions, and are worth it for the hundreds of illustrations alone.


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