Abstract
Background: Charles Foix (1882–1927) may be mostly remembered today due to his contributions to vascular neurology and the syndromes that bear his name, such as the Foix-Alajouanine syndrome. However, he also developed a literary career and composed poetry and a vast collection of plays, often dealing with biblical themes or figures from Greek mythology. Summary: His poetry was often inspired by his own experiences during the First World War, in which he was assigned to serve as a medical officer in Greece, becoming enamored with his surroundings and the classical lore. Key Messages: The authors explore Foix’s poetry and drama and their relationship to his overall work as a neurologist, including his wartime experiences.
Introduction
One of the dimensions of the relationship between medicine and literature is that of the physician as a writer [1, 2]. Examples abound in a multitude of literary genres, and in many cases, it is immediately apparent whether the individual thrived most as writer or physician: for prose, William Somerset Maugham (1874–1965) [3] and Arthur Schnitzler (1862–1931) [4] are among the most notable novelists of their ages; Anton Chekhov (1860–1904) [5] became a seminal short story writer, as well as a playwright; Olivers Sacks (1933–2015) [6] wrote nonfiction extensively; poetry was penned by war poet Henry Head (1861–1940) [7] and Brazilian neurologist Antônio Austregésilo (1876–1960) [8]; Santiago Ramón y Cajal (1852–1934) [9] wrote science fiction; Louis-Ferdinand Céline (1894–1961) won the Prix Renaudot in 1932 [10‒12], and Georges Duhamel (1884–1966) won the Prix Goncourt in 1918 [13, 14]. In all cases, though, later assessments have dealt with their medical and literary careers; a glaring omission is that of French neurologist, poet, and playwright Charles Foix (1882–1927) (Fig. 1). Although later evaluations have explored his scientific contributions, especially in the field of vascular neurology, his literary interests are often relegated to the sidenotes [15, 16]. Therefore, the authors aimed to explore this facet of his life and present works that have long been neglected.
Picture of Charles Foix, likely taken in the 1920s. Source: public domain (BIU Santé – Bibliothèques d’Université Paris Cité, at https://archive.wikiwix.com/cache/index2.php?url=https%3A%2F%2Fwww.biusante.parisdescartes.fr%2Fhistoire%2Fmedica%2Fresultats%2Findex.php%3Fdo%3Dpage%26cote%3D100000x1927xartorig%26p%3D432#federation=archive.wikiwix.com&tab=url). Accessed April 16th, 2024.
Picture of Charles Foix, likely taken in the 1920s. Source: public domain (BIU Santé – Bibliothèques d’Université Paris Cité, at https://archive.wikiwix.com/cache/index2.php?url=https%3A%2F%2Fwww.biusante.parisdescartes.fr%2Fhistoire%2Fmedica%2Fresultats%2Findex.php%3Fdo%3Dpage%26cote%3D100000x1927xartorig%26p%3D432#federation=archive.wikiwix.com&tab=url). Accessed April 16th, 2024.
Early Life and Contributions to Neurology
He was born in Salies-de-Béarn, in the French département of Basses-Pyrénées, to Pierre Foix (1841–1891), a provincial physician, and Marie Foix (née Laborde, 1841–?) [17]. Pierre Laurent Charles Foix moved to Paris in order to follow his fathers’ footsteps at the Faculté de Médecine [15, 18]. He became an Interne Provisoire in 1905, at Alexandre-Achille Souques’ (1860–1944) department in Ivry-sur-Seine [19], and an Interne Titulaire in 1906. After studies with Édouard Brissaud (1852–1909) and Jean-Athanase Sicard (1872–1929), he earned the Médaille d’Or [15] and continued his studies with Pierre Marie (1853–1940) at the Hôpital Bicêtre [18]. Foix defended his thesis in 1911 and, in 1912, became Marie’s assistant at the Hôpital de la Salpêtrière, where he first met Théophile Alajouanine (1890–1980), with whom he would later describe the Foix-Alajouanine syndrome [20]. His early work was arguably shaped by the influence of Marie, who decisively impelled him toward neurology. After serving in the French Army during the First World War, Foix returned to Paris in 1919 and was named Médecin des Hôpitaux, with positions at the Hôpital Necker and the Hotel-Dieu. With the support of Henri Claude (1869–1945), he passed his Agrégation in 1923. In the following year, he became Chef de Service at the Hospice des Incurables d’Ivry-sur-Seine [15, 18], now named after Foix, where he would perform the research that ensured his posterity, including seminal studies on cerebral vascular anatomy [21].
Perhaps one of Foix’s most notable contributions to vascular neurology was the first recognition on the posterior cerebral artery as supplier of blood to the visual cortex, the splenium of the corpus callosum, the thalamus, and the inferior portion of the temporal lobe [15, 22]. Though Foix is mostly remembered for his studies on the posterior circulation, which also comprehended publications on vascular supply of the pons [23, 24] and thalamus [25] and the lateral medullary syndrome [26], he explored the anterior circulation as well, with seminal publications on the middle cerebral artery [27], the anterior cerebral artery [28], and the anterior choroidal artery [29]. Other particularly interesting line of research, as highlighted by Caplan [15], was a late study on the correlation of the degree of arterial occlusion and cerebral ramollissement, in which Foix and his coauthors identified several cases with little to no stenosis on the pertinent artery. This led them to question whether the occlusion followed the softening, the embolism happened after death, the artery suffered vasospasm (spasme artériel), or the circulatory failure was more proximally situated (insuffisance cardio artérielle) [15, 30].
Wartime Experiences
It was war, though, that would perhaps be the defining trigger event of his mature literary ambitions. Foix had earned, due to him being a medical student, a reduced time of mandatory military service. He completed his service in 1902, serving in the infantry, with the matricule number 1130 [31, 32]. As physician of the réserve militaire, he became médecin aide-major de 2e classe de réserve in 1912, a rank roughly equivalent to that of a sublieutenant nowadays [33]. However, the Great War started in 1914, soon after Foix had been approved in second place at the competition for admission at the Médicat des Hôpitaux de Paris [18]. As with every physician aged 20–40 years old, Foix was mobilized. On August 1914, he was designated for the ambulance unit 2/61, or second ambulance unit of the 61eDivision d’Infanterie, then commanded by Général Robert Nivelle (1856–1924) [18, 31, 32]; however, typhoid fever soon meant he was evacuated to the Gouvernement militaire in Paris. His work early in the war dealt mostly with war injuries, such as aphasias, and epidemies, such as of cholera [31, 32], which led, in 1916, to him being awarded the argent class of the Médaille d’honneur des épidémies [32]. The year 1916 also saw Foix assigned to the Armée d’Orient and promoted to médecin aide-major de 1ère classe [32], or lieutenant [33]. Foix was sent to the Zeitenlik Hospital No. 3 in Salonika (now called Thessaloniki), in Greece, focusing on infectious diseases. He returned to the ambulance corps and was assigned to Veria, known as Berea in ancient times and located in Macedonia, with unit 10/10 [31, 32]. Further promotions followed in 1918, as Foix became médecin major de 2e classe, or captain [32, 33], and was reassigned again to Salonika, at the neurology center of Zeitenlik Hospital No. 2 [31, 32]. His voyage to Macedonia, albeit brief, would serve as a major influence on his poetic writings, influenced by mythological themes; Foix had enough leisure time by then to refine his literary works in 1919, while stationed in Salonika [18]. Another major event was the passing, “on his own arms” [18], of fellow physician Henry Salin (1884–1917) [11, 31]. Alajouanine described Foix’s devotion to Salin in life and his despair as the latter was buried in Salonika [34]. As noted by Paul Hillemand (1895–1979) [18] Foix was also “filled of pity” by the plight of fellow soldiers, as they died far from family, and felt utmost compassion for their sufferings.
Poet and Playwright
As noted by the poet Fernand Divoire (1883–1951), relaying a conversation with neuropsychiatrist Jean Vinchon (1884–1964) after Foix’s death, “the earth is saturated with antiquity. The Vardar (or Axios) river flows by warm mists. (Mount) Olympus is there. These, with the ancient trees and the waterfalls of Veria, Macedonian oasis, would nourish the decoration of his (Foix’s) thoughts” (translation by the authors) [35]. Hillemand, fellow neurologist and pupil of Foix’s, recalls him saying that “it was there, by the woods of the Thracian mountains, that God leaned to my ear and taught me the Divine Song that now I attempt to reproduce; flee! awkwardness of my fingers!” (translation by the authors) [18].
His first verses were penned at the tender age of 12 years old; another defining event came 4 years later, when he discovered the poetry of Paul Verlaine (1844–1896), forever his favorite poet; he also admired fellow Pyrenean Paul-Jean Toulet (1867–1920) [34]. The works that remain to this day were the ones who survived his fireplace, as he was his own harshest critic. A member of the Académie du Béarn, he lectured on poetry in general and Stéphane Mallarmé (1842–1898); Foix made acquaintances with Paul Valéry (1871–1945) and Jacques Rivière (1886–1925), among others [18].
Perhaps his most famous lyric work is 1923 Une Trilogie (Fig. 2a, c) [36], encompassing three plays based on ancient Greek mythology: Adonis (in five scenes, finished in Paris in 1920), Silène (in a single scene, finished in Paris in 1919), and La Tragédie de Dionysos (in three scenes, finished in Salonika in 1919). As with other works by Foix, Une Trilogie was published by Éditions Jonquières, illustrated with wood engravings by frequent collaborator André-Jean Powilewicz (1886–1969). In Prométhée (Fig. 2b, d) [37], he goes beyond the Greek narrative and establishes the transition from pagan roots to Christianity in the Western world, freely incorporating biblical themes during the course of the play’s five acts. In Les Bassarides (Fig. 3a) [38], in three scenes, Foix narrates the actions of the titular menads, followers of Dionysus, as they attempt to coerce a mourning Orpheus into entertaining them. Other works include Poèmes en Prose, Danses et Visages, Résurrection de Lazare, and Safo [35]; David, in five acts, had its inception in Salonika in 1919 but was published only posthumously, in 1928, after editing by the Académie du Béarn (Fig. 3b) [39], focusing on the king’s rape of Bathsheba and his tortured downfall that followed, foretold by the prophet Nathan. It is not known whether these plays were performed after publication during his lifetime.
a, cUne Trilogie, comprising Adonis, Silène, and La Tragédie de Dionysios, from 1923, with engravings by André-Jean Powilewicz. a Cover. c Dedication by Charles Foix. Source: private collection MKFP. b, dProméthée, from 1924, also with engravings by André-Jean Powilewicz. b Cover. d Dedication by Powilewicz. Source: private collection MKFP.
a, cUne Trilogie, comprising Adonis, Silène, and La Tragédie de Dionysios, from 1923, with engravings by André-Jean Powilewicz. a Cover. c Dedication by Charles Foix. Source: private collection MKFP. b, dProméthée, from 1924, also with engravings by André-Jean Powilewicz. b Cover. d Dedication by Powilewicz. Source: private collection MKFP.
aLes Bassarides, from 1926, also with engravings by André-Jean Powilewicz. Source: private collection MKFP. bDavid, published posthumously in 1928. Source: private collection MKFP.
aLes Bassarides, from 1926, also with engravings by André-Jean Powilewicz. Source: private collection MKFP. bDavid, published posthumously in 1928. Source: private collection MKFP.
The critical assessment of Foix’s works seems to have been positive [40]; Divoire [35] considered his oeuvre “important,” in the same vein as the tragedies of Joséphin Péladan (1858–1918), and compared it to “menads inebriated with truth” (translation by the authors). Though Greek myths and gods played an important role in his work, Christianity also featured prominently, especially in his later writings, in theater as well as in poetry [41]. Even as Foix wrote during the heydays of modernism, his work was still thematically and stylistically conservative [34], though imbued with “the same intellectual qualities, the same expressive perfection, the same moral elevation” as his medical work (translation by the authors) [34]. Still, even established poets, like Valéry, gave positive assessments of Foix’s works and praised their musicality [18]. In addition, he played the lyre [15], a possible nod to his passion for the Greek arts. His life came to an early end in 1927, likely from appendicitis; he was eulogized by Alajouanine and Gustave Roussy (1874–1948) in the La Presse Médicale [34] and in the Revue Neurologique [42], respectively.
Conclusion
As one can easily note, Foix fulfilled many roles during his life. He was not the only French neurologist who served during the First World War, as he was accompanied by Alajouanine, Roussy, Jean Lhermitte (1877–1959), Georges Guillain (1876–1961), and neurologist and later neurosurgeon Clovis Vincent (1879–1947) (whom Foix actually succeeded at Ivry) [15, 18, 21, 31]. Nor was Foix the only writer and poet who experienced the horrors of war firsthand, as we can count Ernest Hemingway (1899–1961), John dos Passos (1896–1960), Gertrude Stein (1874–1946), Somerset Maugham, Edward Estlin Cummings (1894–1962), more commonly styled as e. e. Cummings [7], and fellow Frenchmen Céline, Blaise Cendrars (1887–1961), and Maurice Genevoix (1890–1980), all also neurological patients, and Jean Giono (1895–1970) [11]. As previously noted, Foix was also not the only physician who ever doubled as a poet and writer. Foix, however, achieved the remarkable feat of intertwining all these different facets and allowing each to interact and influence the others, while at the same time producing a body of scientific production matched by few and effectively inaugurating a field of neurology as we understand it today. Perhaps it is now time his verse finds a new audience: as he wrote in the conclusion of David, one can hope “le chant va déferlant sur la terre et l’inonde, traverse l’infini, s’épanche sur le monde, jusqu’à la tente du soleil” (the song sweeps over the earth and floods it, crosses infinity, spreads over the world, until the tent of the sun) (translation by the authors) [39].
Acknowledgments
The authors thank Júlia Campos Kahakura, MD, and Isabelle Batista for their support with the procurement of the primary sources.
Statement of Ethics
Ethical approval was not required for this study in accordance with local/national guidelines.
Conflict of Interest Statement
The authors have no conflict of interest in this paper due to its historical nature.
Funding Sources
This work had no funding due to its historical nature.
Author Contributions
C.L.T. and J.G.C.D.: manuscript research and composition; M.K.F.P.: manuscript research, composition, and revision.
Data Availability Statement
All the data generated for this article is contained above. Further inquiries can be directed to the corresponding author.