Albert Pitres (1848–1928) was an internist, neuropsychiatrist, professor of anatomy, pathology, and histology. He never really had a biography in English. However, the development of neurology and neurosciences in Bordeaux owes a lot to him, as to the psychiatrist Emmanuel Régis (1855–1918). The fact that his career was so closely linked with Charcot (1825–1893) should have secured him a more prominent place in neurology and the history of aphasiology. Pitres went on to co-author clinical and experimental research papers with Charcot that are considered some of the most notable ones among Charcot’s publications. Both carried out studies about pathological correlations between cortical lesions and hemiplegia, published series of articles and two major books about neurophysiology of motor control. To convey the atmosphere and the importance of the neurological clinic of Pitres in the heyday, we illustrate this article with unpublished photos of him.

Jean Marie Marcel Albert Pitres was born in Bordeaux on August 26, 1848. He was the son of Jean Adolphe Pitres (1804–1880), landowner, and Madeleine Coraly Rousseille (1820–1892), grocer. He was a college student in Bordeaux, and then began his medical studies at Bordeaux secondary Medical and Pharmaceutical School in 1866. At the end of 1866, Pitres received as an end-of-year excellence prize, the book by Vulpian [1] (1826–1887) published in 1866, “Leçons sur la physiologie générale et comparée du système nerveux, faites au Muséum d’Histoire Naturelle” (Lessons on general and comparative physiology of the nervous system, made at the Natural History Museum), lessons taught in 1864. Reading this book had a decisive influence on his medical orientation.

He performed his residency at Saint-André Hospital in Bordeaux from 1867 to 1869. Pitres was ranked 95th as non-resident student of the hospitals of Paris in 1871, then 8th in the resident contest in 1872. He was then resident with Polaillon in 1873 at Cochin (semester 1), with Demarquay in 1873 at the Maison de Santé (semester 2), Jacques-Joseph Moreau of Tours (1804–1884) in 1874 at the Salpêtrière Hospital, Charles-François Matice at Beaujon in 1875 and Charcot again at the Salpêtrière Hospital in 1876. He was tutor at the École Pratique des Hautes Études from 1877 to 1878.

Charcot and Pitres worked on cerebral localizations from 1876. A that time, scientific study of cerebral locations was recent with Paul Broca (1824–1880) in 1861 and David Ferrier (1843–1928) in 1879 “De la localisation des maladies cérébrales” (On the localization of brain diseases). Earlier, in 1870, Gustav Theodor Fritsch (1838–1927) and Eduard Hitzig (1838–1907), had provided experimental support for John Hughlings Jackson’s (1835–1911) hypothesized motor area in the cortex. Their original experiments would later be replicated by the Englishman David Ferrier (1843–1928). Charcot and Pitres expanded these results and this led to Pitres’ [2] doctoral thesis entitled “Recherches sur les lésions du centre ovale des hémisphères cérébraux, au point de vue des localisations cérébrales” (Research on lesions of the oval centre of the cerebral hemispheres studied from the point of view of cerebral localizations) (Fig. 1). For review, see [3, 4].

Fig. 1.

Cover page of Albert Pitres’ medical doctorate thesis.

Fig. 1.

Cover page of Albert Pitres’ medical doctorate thesis.

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Pitres [2] defended his doctoral thesis in May 1877, under the supervision of Charcot. In his work, he attempted to clarify the role of the ovale centrum. It was on this occasion that he made serial frontal cuts of the brain, “Coupes de Pitres” (Pitres cuts), where centrum ovale lesions can be identified. In parallel, Pitres was introduced to cerebral histology by Louis Antoine Ranvier (1835–1922) at the Collège de France as an assistant and to Physiology by Etienne Jules Marey (1830–1904) in the company of Charles Emile François (1849–1921), deputy director of Marey.

The competition with the German school of neurology following French defeat in 1870, in the race for cerebral localizations, reflects the spiteful spirit that served as a driving force for numerous researches in neurology Pitres, who fought in the war of 1870 as an auxiliary doctor, clearly expresses this spirit of revenge which serves as a driving force for much research. Consequently, regarding the defeat in the War of 1870, Pitres declares: “I felt strongly how the burden of defeat weighs on a defeated nation. I was repeatedly offended by the judgments I heard about the glory of the mightier Germany and the well-deserved lesson it was openly said that France had just received. I understood then that each young Frenchman should use all the means in his power to restore to his country the consideration and the prestige which it had lost and that everyone had the duty to work, not only for their own well-being but for the recovery of their country” [5].

Having been deputy assistant at the Medical School of Paris in 1877 and 1878, Pitres [6] was accepted for the agrégation in the competitive examination in 1878, the year of the founding of Bordeaux Medical School on the topic: “Des hypertrophies et des dilatations cardiaques, indépendantes des lésions valvulaires” (Independent heart enlargement and dilations of valvular lesions) (Fig. 2).

Fig. 2.

Cover page of the aggregation in the competitive examination of 1878.

Fig. 2.

Cover page of the aggregation in the competitive examination of 1878.

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In 1878, Henri Gintrac (1820–1878), dean of the Medical School, asked the young associate professor, who had been his pupil and resident at the Saint-André Hospital in 1869, to return to Bordeaux. But Pitres was very reluctant to leave Paris and to return to the banks of the Gironde. Indeed, his father had died young, and his mother had limited resources. The young Pitres had to support his brothers’ education through a “very enviable” career in Bordeaux. He therefore left for Bordeaux.

In 1879, Pitres (Fig. 3) was nominated to the chair of pathological anatomy and histology at Bordeaux Medical School. He was in charge of the course of general Anatomy and Histology. He was a doctor at Bordeaux hospitals in the 1878 competition, then professor of medical clinic in Bordeaux, succeeding Professor Jules Mabit (1809–1881), on March 10, 1881, where he remained until 1919.

Fig. 3.

Portrait of Prof. Albert Pitres.

Fig. 3.

Portrait of Prof. Albert Pitres.

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In 1885, at the age of 37, Rector François Ouvre (1824–1890) called on Pitres to take charge of the deanery of Bordeaux Medical School. He was elected dean, “almost in spite of himself,” replacing Paul Denucé (who had retired from active life for health reasons) and would remain so for a little over 20 years. As dean, Pitres saw high and far. He was keen to create teaching of medical specialities, in the form of complementary courses.

At the time of Pitres and Charcot, two important questions regarding central nervous system physiology and pathology preoccupied the scientific world. Firstly, the use of cerebral localization doctrine in clinical routine was urgently needed [7, 8]. Then, neurologists were interested in the precise detailed, scientific description of hysteria and hypnotism. His publications on hysteria and hypnotism marked a moment in the history of neurology.

As early as 1877, in collaboration with Charcot, Charcot and Pitres [9] published a new study on “Contribution à l’étude des localisations dans l’écorce des hémisphères du cerveau” (Contribution to the study of localizations in the crust of the hemispheres of the brain) in the monthly Journal of Medicine and Surgery. The file of cerebral localizations increased with new studies in 1878 and 1879 with the “Nouvelles contributions à l’étude des localisations motrices dans l’écorce des hémisphères du cerveau” (New contributions to the study of motor localizations in the crust of the hemispheres of the brain) performed with Charcot and Pitres [10].

In 1883, based on 200 cortical lesions in humans collected from 1879 to 1882, Pitres and Charcot [11] published a 120 pages thesis entitled “Critical and clinical study of the doctrine of motor localizations in the cerebral hemispheres of man” to convince the last “hesitators.” Pitres and Charcot emphasized the function of the grey and white matter, the geographical distribution of the areas of the cerebral mantle that serve to control the muscles of the life of relationship. They were the first to conclusively show that damage to the human motor cortex causes degeneration of the pyramidal tracts and lateral columns of the spinal cord.

Pitres’ [12] “ Leçons sur l’hystérie et l’hypnotisme faites à l’hôpital Saint-André de Bordeaux” (Clinical lessons on hysteria and hypnotism given at Saint-André Hospital in Bordeaux), published in 1891, were given from 1884 to 1890 and had legitimate impact in France and abroad. These lessons were prefaced by Charcot, who found there an opportunity to justify his quarrel with the Nancy School of Hippolyte Bernheim (1840–1919). Moreover, Charcot was pleased that “the hysteria observed in Paris was of the same nature as in the provinces.” In fact, Bern-heim set up the School of Nancy, or School of Suggestion, as opposed to the Charcot’ School of Salpêtrière. Bernheim defined hypnosis as simple sleep produced by suggestion and susceptible to therapeutic applications. In this, he disagreed with Charcot who considered hypnosis as a pathological state specific to hysterics.

Neurological patients were sent from all over the world to Pitres’ department at the Saint-André Hospital in Bordeaux. On each occasion, he led his students to publications of which he left the honour but of which he was the inspiration. Pitres carried out his scientific research, his clinical work, and his administrative work at the deanship at the same time. At that time, Bordeaux Medical School (Fig. 4) was the second largest in the province in terms of number of students. Pitres also created outpatient clinics, research laboratories in the hospital, and new chairs of medical clinics.

Fig. 4.

Facade of the Holy André hospital in Bordeaux at the time of Pitres.

Fig. 4.

Facade of the Holy André hospital in Bordeaux at the time of Pitres.

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Many of his lessons in amphitheatre have been gathered into books. Although Pitres’s activities in the field of Neurology were far-flung, his favourite subject was aphasia [13]. In 1884, he published the first detailed clinical case study of pure agraphia [14]. He is mentioned in the aphasia literature primarily with regard to his 1895 paper on polyglot aphasia “Étude sur l’aphasie chez les polyglottes” [15]. Ten years after he published his paper on pure agraphia, he gave a talk at the Congrès Français de Médecine Interne in Lyon [16]. At this meeting, he took the opportunity to launch a detailed attack toward the Holists such as Marie and toward Bernheim who questioned the existence of focal disorders. His description of agraphia has become famous.

Pitres’ observations on amnesic aphasia were also famous. He hypothesized that amnesic aphasia depends on the breakdown of pathways between memory and verbal image putative centres. Thus, according to Pitres [17], amnesic aphasia can exist without lesion in Broca’s area: it is caused by the loss of evocation of words and could be less serious than motor aphasia.

Coming from Paris, Emmanuel Régis (1855–1918) gave lectures on mental diseases in Bordeaux. He can be considered as the founder of the Bordeaux neuropsychiatric school. He began his studies in Toulouse, then in Paris, where he was an intern and Clinical head at Saint Anne Hospital with Benjamin Ball (1833–1893). In 1894, he proposed the term “dreamlike” to account for acute hallucinatory states, including mental confusion. Pitres and Régis [18] published “Obsessions et impulsions” in 1902. They defined obsessions as “a morbid syndrome characterized by the anxious experience of parasitical thoughts and feelings, and leading to some psychical dissociation whose final stage is a splitting of the conscious personality” (p. 16). They defended this emotivist view at the 12th International Congress of Medicine in Moscow in 1897. At the request of Pitres, Régis was appointed holder of the Bordeaux chair in mental pathology from 1913 to 1918 at the Saint-André hospital. Régis was increasingly close associate of Pitres. Régis published the “Practical manual of mental medicine” in 1885, considered a reference manual in France.

Pitres had already taken part in the France-Prussia 1870 war. He was particularly interested in the stumps of amputees [19], having already tried to assess pathophysiology of soldier phantom limbs. Pitres [20] chose a peripheral explanation linked to the abnormal excitability of the nerve endings of the stump (1897), very close to the actual mechanisms. Another later explanation referred to the spontaneous stimulation of cortical areas representative of the lost limb. Lhermitte [21] (1877–1959) emphasized the role of body image in explaining this phenomenon. During the First World War, despite his age, Pitres was given the task of directing South West neurological centre (XVIIIth military area). Together with the anatomist Léo Testut and Pitres [22] (1849–1925), he wrote a masterly work on “Les nerfs en schémas, Anatomie et physiopathologie” (The nerves layout. Anatomy and pathophysiology) and “Peripheral neuritis” in collaboration with Louis Vaillard (1850–1935) in 1885 (Félix Alcan). In 1895, Charcot and Pitres [23] work on “Centres moteurs corticaux chez l’Homme” (Cortical motor centres in man) was published.

Pitres Got Also Interested in Epilepsy

At Bordeaux Medical Congress in 1895, he took up Charcot’ definition, describing it as “a morbid episode, occurring by fits, in which the patient, obeying sudden and irresistible impulse, abruptly leaves the home and wanders around for a longer or shorter time. After the end of the impulse, he returns home and lives there peacefully until another attack causes a runaway, as unpredictable and as irrational as the previous one.”

Charcot made “automatism” a mechanism common to many situations, including pre-existing phenomena, traumatic amnesia, non-convulsive epilepsies, and sleepwalking. For Charcot, epileptic patients may have automatic behaviours after seizures and, “under the influence of terrible dreams, become violent, break things, destroy everything …” Pitres [24, 25] described the case of a patient presenting with Jacksonian epilepsy with paroxysmal tachycardia of epileptoid nature (1894), ambulatory automatism in relation to epilepsy (1896) and on the semiological value of Jacksonian epilepsy in the topographical diagnosis of brain lesions (1901). Here, Pitres was back to motor cortex localization research.

In 1889, Charcot entrusted the management of the psychology laboratory at La Salpêtrière to Pierre Janet (1859–1947), one of his students Janet [26] wanted to combine medical studies with philosophical studies to try to clinically analyse the mental state of the hysterical patient. In her studies on “The Mental State of the Hysterics,” Janet was largely influenced by the work of Pitres on this subject.

Pitres reviewed the notion of psychasthenia first described by Pierre Janet. The latter specified that it is an abulic behaviour (difficulty in acting) associated with obsessive ideas and inhibitions. Janet also mentioned “feelings of incompleteness,” manias or phobias. Pitres [27] specifies that it can indeed be a question of a loss of the function of the real but also of disturbances related to. In 1883, Charcot came to visit Pitres in Bordeaux. Pitres having only modest premises to show his professor, Charcot replied: “It doesn’t matter about the premises, what matters is to make pupils.”

Indeed, Pitres succeeded in doing so with great success, constituting a kind of chief-of-staff full of dedication (Fig. 5, 6). Pitres regularly asked his students to make clinical observations and read them at the patient’s bed.

Fig. 5.

The neurological team of Prof. Albert Pitres at the Bordeaux hospital.

Fig. 5.

The neurological team of Prof. Albert Pitres at the Bordeaux hospital.

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Fig. 6.

The neurological team of Prof. Albert Pitres at the Bordeaux hospital.

Fig. 6.

The neurological team of Prof. Albert Pitres at the Bordeaux hospital.

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Pitres was charged with all kinds of honours. He was corresponding member (from 1888) and national associate member (from 1898) of the French Academy of Medicine. In addition, he was secretary of the Anatomical Society, correspondent of the Biology Society of Paris in 1878, honorary member of the Anatomical Society of Paris in 1878, corresponding member of the Medico-Psychological Society, correspondent of the Academy of Moral Sciences for the section of Philosophy. He was elected and introduced as a resident member of the Academy of Sciences, Belles Lettres and Arts1 of Bordeaux during the session of March 20, 1890, by Mr Berchon (Vice President). He succeeded to this title to Henri Gintrac and Paul Denucé.

The latter recalled that the young Professor Pitres had conquered a high scientific position in the Medical School within the University of Bordeaux. Pitres was one of the Presidents of the Academy of Bordeaux. He was successively elevated to the rank of Knight (April 25, 1888, Ministry of Public Instruction), Officer (January 2, 1904, Ministry of Public Instruction), and finally Commander of the Legion of Honour (Pasteur promotion, August 9, 1913, Ministry of the Interior). He was made Officer of Public Instruction on January 10, 1892, laureate of the Institute in 1887 (Lallemand Prize) [28]. Pitres loved his students. He regularly invited them to his home in the presence of his wife. They lived in a beautiful building, acquired in 1888, located at 119 Cours d’Alsace-Lorraine in Bordeaux. All his students showed him a grateful affection in all circumstances. From 1881, Pitres had 14 assistants. He was 39 times the President and 25 times member of MD thesis jury between 1890 and 1897. He would be the President of the Jury for René Cruchet (1875–1959) MD thesis in 1902, which introduced the initial form of cognitive behavioural treatments of tics and Tourette’s Syndrome. Cruchet considered tics as a functional disorder between cortex and basal ganglia with precognition [29]. His therapeutical approach involved conscious mental control upon ventilation in order to inhibit tics with breathing gymnastics. After Albert Pitres, the chair of nervous and mental diseases was transmitted to Jean Abadie (1873–1946), then to Paul Delmas-Marselet (1898–1977).

Finally, the sign of Pitres is related to sock hypoesthesia observed in tabes dorsalis. This sign was jointly described by Pitres and Abadie in the “Ostéopathies du tabès.” Jean Abadie (1873–1946), well known in the field of epileptology, became the holder of the clinical chair of mental illnesses after Pitres in 1919. He was, according to Jean Lhermitte who delivered his praise to the Academy of Medicine, one of the most brilliant and illustrious representatives of French neurology. Later, the chair was transmitted to Paul Delmas-Marselet (1898–1977). In a quite different field, the sign of Pitres penny made possible the diagnosis of pleural effusion, by striking two bronze pennies on the thorax and by placing the ear on the opposite side.

Pitres died in Bordeaux, his native city, at the age of 80 (Fig. 7), after falling down a flight of stairs. He remained revered in Bordeaux as a clinical professor but also as Dean, the second founder of the Medical School. He had an exceptional capacity for work, no less exceptional teaching qualities, and the art of revealing intelligence. The medal pressed at the request of his students in 1919, upon his retirement, was designed by Paul Richer (1849–1933), another student of Charcot at La Salpêtrière.

Fig. 7.

Portrait of Prof. Albert Pitres during his retirement.

Fig. 7.

Portrait of Prof. Albert Pitres during his retirement.

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We would like to thank for their help: Mr. Yann Bubien, General Director of the Bordeaux University Hospital, Mr. Damien Blanchard at the National Academy of Medicine and Mr. Frédéric Laux, Director of the Bordeaux Archives. Special thanks to Pr Jacques Poirier for his help. All figures in this article are from the own collection of Dr. Emmanuel Drouin.

This work required no approval from an institutional review board and was prepared in accordance with ethical guidelines of the journal.

The author has no conflicts of interest to declare.

No funding was obtained for this work.

Emmanuel Drouin, Yann Pereon: design. Marta Pasquini: proofreading and design. Patrick Hautecoeur: supervision.

All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.

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Footnotes

1

This Academy has always greatly appreciated medical studies.

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