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Lhermitte, Professor Jean

Category: Scientist

 

Jacques Jean Lhermitte  (20 January 1877 – 24 January 1959) was a French neurologist, writer, professor of medicine and neuropsychiatrist.  Directly or indirectly, he is recognised as having had a definite formative influence on most of those who have occupied the field of Neuropsychology.  Lhermitte is one of the founders of neuropsychology, arguing that these two disciplines - neurology and psychiatry - cannot and should not be separated. 

An honorary professor and staff physician from 1919, he wrote many books on medical subjects and parapsychology.  His works include "Dreams," 1942, "The Brain and Thought, "1951 and "Mystics and False Mystics," 1952.  He is also well known for a book still in use by priests - True or False Possession: How to Distinguish the Demonic from the Demented.  Altogether, he wrote sixteen books and more than eight hundred articles.

Lhermitte was famous for his prodigious memory, a memory that covered a vast range of topics.  His anatomical work covered such areas as neuroglia, olivary hypertrophy, zoster myelitis, peripheral neurolymphomatosis, tumors, demyelinating diseases, softening and cerebral haemorrhage, venous disease, early dementia, senile dementia, and thalamic and striated syndromes.    

Leon Lhermitte [father of Jean] -death-and-the-woodcutter
 
 

His work in neuropsychology covered areas such as phantom limbs, hallucinations, spatial thinking, constructive apraxia, disorders of the consciousness, etc.

He is best known for the sign that bears his name: the sign of Jean Lhermitte

In Lhermitte's sign: Flexion of the neck in patients with multiple sclerosis, produces electric shock-like sensations that extend down the spine and may shoot into the limbs.

A number of other medically relevant terms bear his name:

  • Lhermitte's peduncular hallucinosis: Purely visual hallucinations recognized as unreal, abnormal phenomena (preserved insight).
  • Lhermitte's syndrome: A rare syndrome of ocular palsy with nystagmus and paralysis of adduction during attempted lateral deviation of the eyes.
  • Lhermitte-Cornil-Quesnel syndrome: A slowly progressive pyramidopallidal degeneration.
  • Lhermitte-Duclos syndrome: A rare pathologic entity with hypertrophy chiefly of the stratum granulosum of the cerebellum.
  • Lhermitte-Lévy syndrome: A syndrome of slowly progressing paralysis after a stroke.
  • Lhermitte-McAlpine syndrome: A combined pyramidal and extrapyramidal tract syndrome in middle-aged and elderly persons.
  • Lhermitte-Trelles syndrome: A syndrome characterized by lymphoblastic infiltration of the peripheral nervous system, associated with paralysis and amyotrophy.
Leon Lhermitte

Many of his pupils remember Lhermitte as being a very gifted teacher. His ‘captivating eloquence’ as well as his charm inspired many students to later become involved in the field of neurology and neuropsychology, for example, the Peruvian Oscar Trelles, Henry Hécaen, Julian de Ajuriaguerra and of course his son, François Lhermitte.

His students also wrote some of their early papers with him (Lhermitte and de Ajuriaguerra, 1938; Lhermitte and Hécaen, 1942) and he was generally known by the title the Maître

As a consequence of this gift for teaching, his memory lives on through his own work and that of his pupils.

Life

Jean Lhermitte – by François Boller

Jean Lhermitte was born on January 30, 1877 in Mont Saint Père in the Champagne region. He came from a family of artists, in particular his father Léon was a renowned painter and friend of such artists as Rodin and Van Gogh. Léon Lhermitte's work can be seen in Chateau Thierry and at the Orsay Museum in Paris. His brother was an art photographer. 

Leon Lhermitte

Mont Saint Père is a town on the Marne river which was to have its hour of fame when in 1918 it was the site of a battle where the French and American troops stopped the last great German offensive of the war (American armies and battlefields in Europe, 1938). The rest of the time it is a most peaceful little town and that is where Lhermitte spent his first years. 

After High School in Meaux, Jean Lhermitte attended Medical School in Paris and became "interne des hôpitaux" in 1900. His teachers included Gustave Roussy, Fulgence Raymond and Pierre Marie. His career was interrupted by the Great War. He was a field military doctor for two years and later a medical officer in a Neurology Center in Bourges under the direction of Henri Claude who was later named Chair of Psychiatry at Sainte-Anne Hospital in Paris.

His work as a doctor during the First World War, where he treated the wounded at the Neuro-Psychiatric Center of the VIIIth region in Bourges led to papers co-written with Gustave Roussy (1874-1948) where he described both his experience of the care of the mentally wounded, in 1917, and those physically wounded in the spinal cord, in 1918.

 Jean Lhermitte – by François Boller

Leon Lhermitte

His career was atypical. He was "Professeur agrégé" (corresponding roughly to the title of Associate Professor) of Psychiatry, but he did not have a formal university title in Neurology until his retirement in 1947, when he was named Honorary Professor, a most unusual if not unique distinction. He was not Professor of Neurology because at the time, there was only one Chair in Paris. He did not have a chance of obtaining it, since it was occupied in succession by Raymond, Dejerine, Marie and Guillain. He remained for most of his professional life Head of the Neuropathology Laboratory (an appointment he had received from Pierre Marie) which was located in Rue de l'Ecole de Médecine, in Paris. In 1919, he became "Chef de Service" at a relatively peripheral institution, the Paul-Brousse Hospital in Villejuif.

 At that time, it was customary for Neurologists to practice more than one discipline (Boller and Duyckaerts, 1999), but few persons were as versatile as Jean Lhermitte. He was actively involved in practice, research and teaching of neuropathology including histology. As early as 1914, he co-authored with Gustave Roussy a classical treatise of neuropathology (Roussy and Lhermitte, 1914). With Pierre Marie, he wrote an early description of the pathology of Huntington's disease. He also worked on Olivo-Ponto-Cerebellar Atrophy, on the pathogenesis of cerebrovascular diseases and on many other pathologies of the Central and Peripheral Nervous System.

Leon Lhermitte

He was a prominent neurologist and is known all over the world for having described a characteristic phenomenon, Lhermitte's sign also called Barber Chair phenomenon, whereby flexing of the neck produces electric shock-like sensations that extend down the spine and shoot into the limbs. He described it in a patient with multiple sclerosis (Lhermitte et al., 1924; Lhermitte, 1929), but it is known to be caused also by trauma to the cervical portion of the spinal cord, cervical cord tumours, cervical spondylosis, or even vitamin B12 deficiency.

 He called himself a Neuropsychiatrist, but when reading the topics he covered under that label, one sees that he was clearly interested in brain and behaviour relationships. In other words his interest was "la discipline qui traite des fonctions mentales supérieures dans leurs rapports avec les structures cérébrales", that is Neuropsychology (Hécaen, 1972).

Lhermitte’s career was as Chef-de-clinique (resident) for nervous diseases in 1908, Chef de laboratoire in 1910, and professeur agrégé for psychiatry 1922. He later became Médecin des Hôpitaux at the "Hospice Paul Brousse", head of the foundation "Dejerine", and clinical director at the Salpêtrière Hospital.

Leon Lhermitte - ouvroir du beguinage a Gand

Work on spiritual and mystic subjects

Léon Lhermitte - The Confirmation

Lhermitte wrote extensively on many subjects related to neuropsychology, but in his later years he developed a particular interest in such subjects as possession, hallucinations and subjects related to mysticism. 

A deeply religious man, he explored the common territory between theology and medicine, and this led to interesting studies on demoniacal possession and stigmatisation

Hallucinosis - Lhermitte is perhaps best known to neuropsychologists and behavioural neurologists for his interest in hallucinations. He was one of the first to propose a classification based on ‘insight’. The term insight is used in relation to a patient’s realisation that an image is not ‘real’ – has no physical existence.  Some patients preserve ‘insight’ and realize that an hallucination is unreal, and for these cases, he coined the term hallucinosis.

Peduncular hallucinosis - Lhermitte also described the syndrome now known as peduncular hallucinosis

Leon Lhermitte - Paying the harvesters

G.B. Young, in Encyclopedia of the Neurological Sciences (Second Edition), 2014.

Peduncular hallucinosis (LHERmitte's syndrome) consists of vivid hallucinations that are usually visual but can be auditory, tactile, or mixed. They are similar to hypnagogic hallucinations and consist of variable sequential scenes, often coming on in the evening with eye closure. Usually patients realize that the images do not represent real, ongoing scenes. They also differ from hallucinations of psychoses, for example, in schizophrenia, in that patients do not incorporate the hallucinations into delusional thinking.
Lesions associated with peduncular hallucinosis are usually in the rostral brainstem, involving the reticular formation. The thalamus, especially the pulvinar and medial thalamic nuclei, has also been also involved in some cases. In one case the pars reticulate of the substantia nigra was selectively affected.

Blindsight - Lhermitte was one of the first to scientifically recognise the existence of ‘blindsight’.  In 1923, in a paper by himself and Nicolas, he described a case of Alzheimer’s disease in a blind man who had vivid visual hallucinations.

Phantom limbs – Lhermitte’s interest was particularly in the painful manifestations of the condition, which he called algo-hallucinoses (Lhermitte, 1954). He thought of these phenomena as hallucinatory because they occur in relation to a part of the body that has been lost. He also described "negative" algohallucinoses as seen in patients who have lost awareness of a part of their body (usually a limb), and yet experience pain in that limb despite its exclusion from consciousness.

 Possession - For his book on demonic possession, Lhermitte gathered notable case reviews as well as individual case histories. He also wrote on stigmatisation

Visual hallucinations of the self – on which he wrote a paper for the British medical journal that we have used for the observations.

Death

 

Lhermitte had married in 1907, but was widowed in 1916 and remarried in 1918.  

He died on 2th January peacefully in his sleep in his 81st year.  His obituary in the British Medical Journal of March 7th 1959 described him as an outstanding figure of medicine, with a ‘boyish and captivating enthusiasm’. 

British Medical Journal of March 7th 1959
Lhermitte was one of the greatest clinical neurologists of all time.  His truly brilliant gifts were erected upon a very firm foundation in normal and morbid anatomy of the nervous system.  Later there came a keen and searching evaluation of disorders of the mind.  He was the beau-ideal of a neuro-psychiatrist, as shown by his numerous contributions to the literature…
he was a devout churchman and was intrigued by the common territory between theology and medicine.  …He was also a leading contributor to the Etudes Carmelitiennes as shown by the monograph upon Satan and Le Coeur.  The last named subject was treated from the historical angle of the traditional correlation of the heart with the seat of the emotions.
Lhermitte had an abounding vivacity and until his latter years a vigorous and robust constitution.  He seemed never to rest, and he combined a huge practise with continued interest in professional writing.  He was a fluent and eloquent speaker….. Neurologists in this country will long remember him as the most sincere and generous of friends, warm hearted and tolerant, stimulating and encouraging.  He gloried in the company of his younger colleagues to whom he was a mentor and an inspiration.

 Lhermitte senior - Supper at Emmaus

References

  • Techniques anatomo-pathologiques du système nerveux. / Anatomo-pathological techniques of the nervous system. Paris, 1914
  • Psycho-névroses de guerre/ Psycho-neuroses of war. Paris, 1916
  • Les blessures de la moelle épinière/ Injuries of the spinal cord. Paris, 1917
  • La section totale de la moelle épinière/ The total section of the spinal cord. Paris, 1918
  • Les fondements biologiques de la psychologie/ The biological foundations of psychology Paris, 1925
  • Les hallucinations: clinique et physiopathologie. Paris, 1951

Also

  • LHERMITTE J. Syndrome de la calotte du pédoncule cérébral. Les troubles psychosensoriels dans les lésions du mésocéphale. Revue Neurologique, 38: 1359-1365, 1922.
  • LHERMITTE J. Multiple sclerosis. Archives of Neurology and Psychiatry, 22: 5-8, 1929.
  • LHERMITTE J. Les algo-hallucinoses. Les hallucinations de la douleur. Le Progrès Médical, 82: 248-255, 1954.
  • LHERMITTE J, BOLLAK J and NICOLAS M. Les douleurs à type de décharge électrique consécutives à la flexion céphalique dans la sclérose en plaques. Un cas de sclérose multiple. Revue Neurologique, 2: 56-57, 1924.
  • LHERMITTE J and DE AJURIAGUERRA J. Asymbolie tactile et hallucinations du toucher. Etude anatomo-clinique. Revue Neurologique, 492-495, 1938.
  • LHERMITTE J and HÉCAEN H. Sur les troubles de la psycho-motilité chez le vieillard. Annales Médico-psychologiques, 2: 62-70.1942.
  • LHERMITTE J and NICOLAS T. Sur la maladie d'Alzheimer, une observation clinique. Annales Médico-psychologiques, 1: 435448, 1923.
  • ROUSSY G and LHERMITTE J. Techniques Anatomo-Pathologiques du Système Nerveux Anatomie Macroscopique et Histologique. Paris: Masson, 1914.

Observations

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