Albert Pitres

Albert Pitres: Charcot's Man in the Provinces

On 28 April 1888 the President of the French Republic, Sadi Carnot, came to Bordeaux to inaugurate a new university campus for the Faculty of Medicine and Pharmacy. The man who had argued it into existence was a thirty-nine-year-old professor of internal medicine who had been dean for less than three years, and who would go on to hold the post, in two long stretches, for two decades. Albert Pitres could have stayed in Paris beside Charcot and become famous. He went home instead, and built something.

A Bordeaux Childhood and a War

He was born on 26 August 1848 at 13 Rue Traversère in Bordeaux — a street that now bears his name — to Jean Adolphe Pitres, a landowner who died when Albert was eight, and Madelaine Corali Rousseille, a grocer. He began medical studies in 1866 at Bordeaux's St Côme School of Medicine and Surgery, and from 1867 served as intern and clinical assistant under Professor Gintrac. The Franco-Prussian War caught him at twenty-two and he served as an auxiliary doctor; the wounds he saw then would come back into his work half a century later, when another war produced the same injuries in larger numbers.

The Salpêtrière

In 1872 he passed the Paris internship examination and entered the hospital system of the capital, which meant, at that moment in history, entering the most productive neurological laboratory in the world. At the Hôpital de la Salpêtrière he worked under Jean-Martin Charcot alongside Joseph Babinski, Georges Gilles de la Tourette and Joseph-Jules Déjerine — four names that between them account for a substantial fraction of the modern neurological examination. He supplemented the clinical work with hard laboratory training: physiological research at the Collège de France under Étienne-Jules Marey, and pathological anatomy under Louis-Antoine Ranvier. He defended his doctoral thesis, on lesions of the centrum ovale, under Charcot's supervision in 1877. He and Charcot became close collaborators and friends.

Mapping the Motor Cortex

The central scientific work of Pitres's life belongs to the great nineteenth-century project of cerebral localisation — the attempt to establish, against considerable resistance, that specific functions live in specific places in the cortex. With Charcot he studied motor cortex areas across 108 patients, correlating what the patient had lost in life with what the pathologist found after death; their joint work appeared in 1883. To do it he devised a systematic technique of serial brain sectioning still referred to as Pitres sections. Two clinical signs carry his name from other parts of his practice: Pitres' sign, the loss of sensitivity in the Achilles tendon in tabes dorsalis, described with Jean Abadie, and the Pitres coin sign, a change in the sound produced by striking coins against the chest when pleural fluid is present — a reminder that he remained a general physician as well as a neurologist.

The Losses of Language

His work on aphasia is the part of his output that English-language neuroscience still cites. He published on pure motor agraphia in 1884 — a case still reexamined in the modern literature — on amnestic aphasia, and in 1895 on aphasia in polyglots, the question of what happens to a multilingual brain when language breaks. And here Pitres showed the quality that separates a good localiser from a dogmatic one. Having spent years demonstrating that functions have addresses, he insisted that memory does not: cortical sensory centres, he wrote, are not isolated from the rest of the brain and do not function autonomously. He had helped build the map and he knew what the map could not do.

Hysteria, Hypnotism, and a Retreat

Between 1884 and 1890 Pitres delivered clinical lectures on hysteria and hypnotism, following Charcot's doctrines and published with a preface by Charcot himself. When Charcot died in 1893, Pitres abandoned the subject. That decision — quiet, unexplained, and correct — tells more about him than the lectures do. He turned instead to obsessions and psychiatric disorders, presenting findings on 250 of his own cases with Emmanuel Régis at the Moscow congress in 1897 and publishing a reference work on the subject in 1902.

Twenty Years as Dean

Pitres was dean of the Bordeaux Faculty of Medicine and Pharmacy from November 1885 to January 1898, and again from January 1904 to January 1915. He got the new campus built at the Place d'Aquitaine. He fought off the closure of the naval medical school, the Santé Navale, in 1890. He created chairs in obstetrics, gynaecology, paediatric surgery, ophthalmology, biochemistry and otorhinolaryngology, and in 1913 he established the first chair of psychiatry in provincial France, for Régis. The Bordeaux school of neuropsychiatry — anatomically grounded, tied to physiology and internal medicine — is his construction.

Medicine for the Poor, and for Soldiers

He opened free outpatient consultations for the destitute at Saint André Hospital. He studied tuberculosis transmission in poor families, identified the link between poverty and infection, backed the human-to-human transmission theory after Koch, and drove the construction in 1903 of the Foyer Dupreux, Bordeaux's first anti-tuberculosis dispensary. In August 1914 he opened psychiatric wards for soldiers and took charge of the military department of neuropsychiatry, returning to the nerve injuries of his youth — phantom sensations in amputees, the mechanisms of nerve regeneration.

Why Albert Is Called a Genius

The quality on display in Pitres is the correlating mind: the ability to hold a bedside sign, a physiological experiment and a slice of dead brain in view simultaneously and see what connects them. He was trained for exactly this — Charcot for clinic, Marey for physiology, Ranvier for tissue — and he used it on 108 patients to help nail down motor localisation, then invented the sectioning method that made the correlation reproducible for everyone else. His finest intellectual moment is a negative one: having proved that some functions are localised, he refused to conclude that all of them are, and said memory could not be pinned to a centre. That is discipline, and it is rarer than discovery.

The counter-case is straightforward and Pitres would probably have accepted it. He was Charcot's collaborator, not Charcot's equal; on hysteria and hypnotism he followed a doctrine that has not survived, and he dropped the subject when his master died rather than testing it. No law, no syndrome of the first rank and no theory bears his name alone — only two clinical signs and a dissection technique. A fair judgement is that his genius was substantially institutional: he was the finest kind of academic builder, a first-rate clinician who converted a provincial faculty into a research school and gave French neuropsychiatry a second capital. Contemporaries described a brilliant intelligence combined with great kindness and humour. That combination built the campus.

Legacy

He was made a corresponding member of the Academy of Medicine in 1888 and a full member in 1889, won the Lallemant Prize of the Academy of Sciences in 1887 and the Montyon Prize in 1898, and rose through the Légion d'honneur from knight in 1888 to commander in 1913. He retired in 1919 and died in Bordeaux on 25 March 1928, at seventy-nine, after a fall down a staircase. His students included Pierre Janet and Jean-René Cruchet. A street in Bordeaux and an amphitheatre at the university's Victoire campus carry his name, and the neuroscience community in the city still dates its own history from him.

Achievements

• Commander of the Legion of Honour
• Held posts at University of Bordeaux