William Osler: on Chorea: on Charcot

As the first Professor of Diseases of the Nervous System at the Faculté de Paris, Jean-Martin Charcot was an immensely powerful figure at the end of the 19th century who engendered both wide admiration and resentment. William Osler offers a particularly valuable resource to view Charcot's place in neurology in a relatively unbiased and balanced perspective. Although Osler made numerous seminal neurological contributions, he never considered himself a neurologist, had no formal training with Charcot, and, as a North American, was not tied to the European academic hierarchy of university medicine. One year after Charcot's death, Osler published On Chorea and Choreiform Affectations (1894), and in this pithy monograph, Osler offered a particularly useful evaluation of Charcot's neurological contributions. Whereas in most instances, Osler and Charcot agreed, Osler used data from the new fields of genetics and bacteriology to draw a dear distinction between two entities that Charcot had failed to separate, Sydenham's chorea and Huntington's disease. Osler's On Chorea uniquely captures the transition period between the 19th and 20th centuries. With clarity and insight, Osler documents Charcot's important contributions on disease description, differential diagnosis, and treatment. But with equal sobriety, he delineates Charcot's and his generation's limitation, as the 20th century opens toward the search for neurological causes and embraces new laboratory and experimental methodologies.