We get off the train in Paris, where we meet
Augusta Dejerine-Klumpke
Augusta Dejerine-Klumpke was an exceptional physician, neurologist and neuroanatomist. She is and will be remembered for the Klumpke palsy, an injury to the lower roots (C8-T1) of the brachial plexus, and for her great contribution to the two-volume book “Anatomie des centres nerveux” (Anatomy of the Central Nervous System). She was the first female intern of a Parisian hospital and the first woman to become president of the Société de Neurologie de Paris. She was a pioneer in rehabilitation therapy of soldiers with spinal cord injuries and the unofficial winner of the famous “aphasia quarrel” in 1908. As a matter of fact, had it not been for her mother, Dejerine-Klumpke would not have become a physician, as she wrote herself:
“To her goes all the merit. She was an admirable mother, with a noble soul, high feelings and total commitment. She was living only for her children. She taught us not to give up when faced with difficulties, to perseverate and to will. Thanks to her, we were privileged among the girl students in Paris, who were usually foreign and isolated. She knew how to create a warm, maternal, hospitable and sunny home, always decorated with flowers, where her smiling and acting goodness radiated. She ran her household with wise economy, and surrounded us with beauty of nature, art and heart. We were her pride and joy, and for us she was everything” (Bogousslavsky, 2005).
Brachial plexus, Klumpke’s palsy
Augusta was fluent in three languages: French, German and English. Thus, she was able to read most of the scientific articles published in the western world (it is worth to remind the reader that during the first decades of the twentieth century, most of the scientists were still writing in their own mother tongue. Only after World War II, English became the prominent and international scientific language).
One of the Erb’s papers describing the clinical signs following injury of the brachial plexus caught Augusta attention, and she was able, based on this paper, to diagnose the Erb’s palsy in one of the patients at the l’Hôpital de Lourcine. In this patient the injury of brachial plexus was complete and there was an oculopupillary involvement. Dejerine-Klumpke made several experiments on dogs to localize the cause of the oculopupillary phenomena, while working in professor Alfred Vulpian‘s laboratory. She made lesions to the brachial plexus at various levels in dogs, finding that the oculopupillary phenomenon was produced only by lesions of the C8 nerve root and of the T1 nerve root, at the level of the intervertebral foramina. Her work was published in 1885 in the Revue de Médecine and, thanks to these results, she won the Godard award of the Academy of Medicine in 1886 and the injuries to the lower part of brachial plexus have being named after her (Klumpke’s palsy).
In 1890 Dejerine-Klumpke received the Lallemand Prize by the French Academy of Science, as well as the silver medal by the Paris Faculty of Medicine for her doctoral thesis (Des Polynévrites en Général et des Paralysies et Atrophies Saturnines en Particulier, On Polyneuritis in General and Paralyses and Lead Atrophies in Particular).
“Von Leyden’s work described five forms of polyneuritis, which Dr. Déjerine- Klumpke honed down to three types, based on clinicopathological review. Her divisions were based on etiology, symptomatology, and her own careful analysis of the pathological anatomy associated with the three types of general polyneuritis…Overall, her work added much physical description and empirical detail to the nascent field of neurology. Her revised model of the generalized forms of polyneuritis also created a more natural construct in which to place the different types of polyneuritis, making it a valuable tool for other researchers” (Ulgen et al, p 365).
Professor and Mrs Dejerine looking at a microscopic sample
Dejerine-Klumpke, together with her husband Joseph Jules Dejerine, wrote the two-volume book “Anatomie des Centres Nerveux “ (Anatomy of the Central Nervous System), a great classic of neurology and a considerable achievement in human neuroanatomy. They described both normal and pathological anatomy of the nervous system. With a microtome they sliced the brain into horizontal, parasagittal, coronal and oblique sections, and they stained them with the Weigert-Pal method. Based on these sections, examined at the microscope, they reconstructed the three-dimensional structures, in a series of anatomical plates with a particular emphasis to the subcortical regions.
Anatomie des centres nerveux
The first seventy pages are dedicated to the methods of serial sections preparation. In fact, Augusta and Jules Dejerine greatly improved the technique used to process and examine the brain, and this allowed them to make a big advancement in the field of neuroanatomy. In these pages they describe every passage from the brain extraction from the skull to the reproduction of stained microscopic sections. Notably, to improve the description of the micro-anatomy, the Dejerines had built a special microscope connected to a projector, so they could magnify the sections by using a projection unit. The technique of whole brain serial sections was entirely developed and performed by Augusta.
Séméiologie des Affections du Système Nerveux
Dejerine-Klumpke made a great contribution also to the “Séméiologie des Affections du Système Nerveux” (Semiology of the Nervous System Diseases), that includes a series of valuable plates.
These plates represent, in a very innovative way, the topography of the neurological injuries. The detailed sensory and motor areas involved in the injury were shown close to the correlated neurological syndrome. Jules Dejerine created the topographic lemma to indicate the operation that leads from the illustration of the lesion to its projection on body surfaces. Dejerine-Klumpke supervised the creation of figures and charts and drew the connection between nervous centres and muscle groups.
The paper examines the contribution of Augusta Dejerine-Klumpke to a discussion on aphasia that took place in the context of a regular meeting of the Société de Neurologie de Paris on July 9, 1908
In July 1908, at the Société de Neurologie in Paris, a 3-day scientific duel took place between Jules Dejerine and Jean-Martin Charcot’s pupil Pierre Marie. The former advocated a classical and systematic view of aphasia, whereas the latter, in a holistic view, claimed that there was only one type of aphasia (Wernicke’s aphasia) and believed that Broca’s aphasia was nothing more than an aphasia Wernicke added to anarthria. Dejerine-Klumpke demonstrated that Marie’s assumptions were wrong:
“using brain preparations, she was able to show that the pars opercularis and triangularis of F3 were very well located within the quadrilateral zone; however, they were superior to the axial section, which was normally used by Pierre Marie to delineate this zone. She concluded that Broca’s aphasia was not caused by a lesion located within the quadrilateral zone; instead, she claimed that it was located precisely in the superior, anterior, and external portion of the zone. In addition, she proposed that lesioned fibers going to and from Broca’s area (pars opercularis and triangularis of F3) must be considered a cause of Broca’s aphasia. According to this, the origin of a neurological deficit in general could not only be situated in the cortex, but also in the subcortical region, affecting fibers that originated and terminated in the respective cortical area” (Krestel et al 2013).
Reunion of neurologists at the Salpêtrière hospital
In 1910 the chair of clinical neurology at the Salpêtrière Hospital, formerly belonging to Charcot, became vacant; Marie and Dejerine were the two possible candidates. Thanks to the Dejerine-Klumpke’ s lessons of anatomy at the aphasia congress, Dejerine obtained the position.
During the World War I, Dejerine-Klumpke served as medical doctor at first at the Salpétriére Hospital and soon after at the “Les Invalides” military hospital in Paris, directed by Professor Jean Camus. Since she was highly knowledgeable in the field of nerve injuries, she was particularly involved in treatments of veterans affected by paraplegia and hemiplegia as a consequence of war-related trauma. Moreover, supported financially by her family and her American friends, Dejerine-Klumpke created a vocational rehabilitation center in a property near Fontainebleau, that her artist sister inherited from the French animal painter, Rosa Bonheur. In some of her patients Dejerine-Klumpke observed a condition, which she called paraosteoarthropathy, that often limited their rehabilitation. Together with Andre Ceillier she wrote an article in 1918, in which they described this condition, now known as heterotopic ossification. Patients with spinal cord injury between the fifth thoracic and second lumbar segment were affected by heterotopic ossification in soft tissues around joints below the level of the neurological injury, showing more difficulty in the rehabilitation process. Even today, the real cause of heterotopic ossification remains unknown, despite numerous studies. The pathological mechanisms that she proposed at that time are still considered insightful and original. In 1921 Dejerine-Klumpke received the second “Légion d’Honneur” ( Legion of Honor) for her work in treating wounded soldiers. Veteran paraplegic patients honored her with the medal to express their gratitude. The first “Légion d’Honneur” was given to her for her scientific studies in 1913.
Portrait of Augusta Dejerine-Klumpke
Biography. Augusta Marie Klumpke was born on October 15, 1859 in San Francisco, United States, by John Gerard Klumpke and Dorothea Mathilda Tolle. Her father was born in Suttrup near Hannover, and was territorial pioneer of California and San Francisco realtors. Her mother was born in Göttingen, Hannover. She moved to San Francisco from New Jersey in 1853, where she met John. They married on October 28, 1855. Augusta was the second of six children: Anna Elizabeth (painter), Dorothea (astronomer), Mathilda (pianist), John William (engineer) and Julia (violin teacher).
Dejerine-Klumpke’s elder sister, Anna, injured her leg twice: at the age of 3 and at the age of 5. The last time the accident led to osteomyelitis with purulent knee arthritis. Dorothea Tolle left for Germany in 1866 with her four daughters to have Anna treated in a clinic. They spent two years in Germany and during this period Augusta went to a German school and hence learned the language. The family came back to San Francisco without any improvement of Anna’s health. Back in the US, Dejerine-Klumpke continued to study German and at the age of 10 she could read German fluently. In 1871, after divorcing John Gerard, Dorothea Tolle embarked to Europe with her six children. They lived together with Dorothea’s cousin in Göttingen and after two years the family went living in Clarens, near Lake Geneva. Dorothea strongly influenced the future of her children. After reading in a fashion magazine that a woman, Mrs Madeleine Brès, had received a doctorate in medicine, she encouraged Augusta to become a physician, and they started discussing what would be the best place for her and for the family to study medicine. During a vacation in 1876, Dorothea met a Parisian lady that told her:
“What, madam, you will be separated from your children, with one daughter in Rome or Munich for artistic studies, the other one perhaps in hell in Zürich, and you with your other children in Lausanne; why don’t you come to Paris, you will find there any possible resource you need: atelier de peinture, courses at the medical faculty and the Sorbonne, excellent schools for your son, teaching for your younger children, and you will not be separated from them” (Bogousslavsky, 2005).
Dejerine-Klumpke was admitted to medical school at the Paris Faculty of Medicine in 1877.
Dejerine-Klumpke immediately appeared to be a competent and brilliant student. Her anatomy professor, Joseph-Auguste Fort, suggested her to apply to the contest of the externship of the Paris hospitals (entrance into the prestigious hospital career of medicine required completion of externship and internship programs, see Becoming a Physician: Medical Education in Great Britain, France, Germany, and the United States, 1750-1945, Thomas Neville Bonner). Her application was rejected because “female medical students were not authorized to join the contest for externship or internship of the Paris hospitals” (Bogousslavsky, 2005). Thanks to the feminist campaign, Dejerine-Klumpke became an extern to l’Hôpital de Lourcine in 1882 with another woman, Blanche Edwards, a member of the French feminist movement. During her extern period, Dejerine-Klumpke came across the paper of Wilhelm Erb on injuries of the upper roots of the brachial plexus. In the Experimental Pathology Laboratory, directed by Vulpian, she studied a patient with a total paralysis of the brachial plexus and oculopupillary involvement. Dejerine-Klumpke made several experiments on dogs to localize the cause of the oculopupillary phenomena. The results of her experiments were published and the paper was awarded the Godard Prize of the Academy of Medicine in 1886. The type of palsy that she described carries her name (Klumpke palsy). Both Augusta and Blanche applied for internships at the Paris hospitals. In 1885 they became backup interns and in 1886 Dejerine-Klumpke became the first female Interne Titulaire des Hôpitaux de Paris.
Portrait of Augusta Dejerine-Klumpke and her grand daughter Jacqueline
After her marriage in 1888 with the neurologist Joseph Jules Dejerine, Augusta interrupted her internship. In 1889 she discussed her doctoral thesis and won the silver medal at the Paris Faculty of Medicine and the Lallemand Prize at the Academy of Sciences. In 1891 Augusta and Joseph Dejerine had a daughter, Yvonne, who also became a well-known neurologist.
After Jules Dejerine’s death, the chair of clinical neurology went to Pierre Marie, the antagonist of Jules Dejerine. Marie dismissed Augusta and told her to clear the laboratory from all the belongings of Dejerine: articles, anatomical specimens, books, patients’ record, etc. Dejerine-Klumpke, together with her daughter, created the “Fondation Dejerine” to collect her husband’s works. The Foundation, that includes a Museum and a laboratory, is currently located in the basement of Jussieu University under the management of the library.
Augusta Dejerine-Klumpke continued to work as a scientist and as a physician. During World War I she worked at the Salpêtrière Hospital and later at Les Invalides, a military hospital treating wounded soldiers with spinal cord injuries.
Augusta Dejerine-Klumpke died on November 5, 1927 and was buried next to her husband in Paris at the Père Lachaise Churchyard.
The Lallemand award
Prizes and awards
- 1874 President of the schoolgirl association “La Perseveranza” at the age of 15
- 1878-1879 “Anatomy Prize” of the free teaching (Médaille de Vermeil)
- 1886 Godard award of the Academy of Medicine for a paper on brachial plexus palsies
- 1890 Silver medal at the Paris Faculty of Medicine and the Lallemand award of the prestigious Académie des Sciences for the doctoral thesis
- 1913 “Legion of Honor” for her scientific studies
- 1914 First woman to became President of the French Society of Neurology
- 1921 “Legion of Honor” with the rank of Officer, for her extensive work in treating wounded soldiers during the war
Trivia: a laurel crown and a memorial bronze plaque
The Dejerines used to spend their summer holidays in Thalgut at the river Aar, near Wichtrach in Canton Berne.
“The Thalgut had been a hunting meeting place in the seventeenth century, with a farm, a hotel and a chalet, the latter being initially let to the Déjerine’s by the owner Mr Grossglauser, before acquiring it and naming it “Le Neurone” (the Neuron). In Gauckler’s biography of Jules Déjerine, an episode is related when a young girl nearly drowned in the Aar. In his attempt to rescue her, Jules Déjerine also nearly drowned, before his wife could intervene and save them both, allegedly gripping the girl by her hair. The girl was in fact Mr Grossglauser’s daughter, who was slightly younger than the Déjerines’ daughter, and the Déjerines subsequently received a laurel crown and a memorial bronze plaque from the Rescue Society in the nearby hotel a few weeks later” (Bogousslavsky, 2011)
Acknowledgements
We are grateful to Julien Bogousslavsky for providing material.
Credit
To cite this profile, please use the following format:
Mele, S., Metitieri, T. and Favero, M. (2017). Profile of Augusta Dejerine-Klumpke. In WiNEu, European Women in Neuroscience, Untold stories: the Women Pioneers of Neuroscience in Europe. Retrieved from https://wineurope.eu/dejerine-klumpke/
Selected work
Augusta Dejerine-Klumpke published a total of 56 scientific articles between 1885 and 1926. Here we report the most important.
- Klumpke A. (1885): Contribution à l’étude des paralysies radiculaires du plexus brachial. Paralysies radiculaires totales. Paralysies radiculaires inférieures. De la participation des filéts sympathiques oculopupillaires dans ces paralysies. Revue Médicale 5: 591-616, 739–90.
- Dejerine J., Dejerine-Klumpke A. (1885 & 1901): Anatomie des Centres Nerveux. Vol 1 & 2. Paris: Rueff et Cie. click here
- Dejerine-Klumpke A. (1889): Des polynévrites en général et des paralysies et atrophies saturnines en particulier: étude clinique et anatomopathologique. Thèse de médecine: Paris.
- Dejerine-Klumpke A. (1908): Paralysie radiculaire totale ou plexus brachial avec phénomènes oculo-pupillaire. Paris: Masson.
- Dejerine-Klumpke A., Jumentié J. (1910): Contribution à l’étude des fibres aberrantes de la voie pédonculaire dans son trajet pontin. Les faisceaux aberrants bulbo-protubérantiels internes et externes. Fascicules aberrants médio-pontins. Pes lemniscus interne. Revue Neurologique (Paris) 20: 385–98.
- Dejerine J., Dejerine-Klumpke A. (1914): Sémiologie des affections du système nerveux. Paris: Masson. click here
- Dejerine J., Dejerine-Klumpke A., Jumentié M.J. (1914): Sur l’Etat de la Moelle Epinière dans Les Cas de Paraplégie avec Troubles Dissociés. Contribution à l’Etude du Trajet de Certains Faisceaux Médullaires et Syndrome des Fibres Radiculaires Longues des Cornes Postérieures. Revue Neurologique 15: 54-61.
- Dejerine J., Dejerine-Klumpke A., Mouzon J. (1914): Sur l’Etat des Réflexes dans les Sections Complètes de la Moelle Epinière. Revue Neurologique 15: 155 -163.
- Dejerine-Klumpke A. (1917): Rééducation Fonctionnelle des Grands Invalides Nerveux: In: Major Jean Camus Report. Les Grand Infirmes par Troubles des Centres Nerveux. Conférence Interalliée, 9 May: 519-522.
- Dejerne A., Ceillier A. (1918): Paraosteoarthropathies des Parapleégiques par Lésion Médullaire; Etude Clinique et Radiographique. Annales de Médecine 5: 497.
- Dejerine-Klumpke A., Ceillier M.A. (1918): Trois cas d’Ostéomes-Ossifications Périostées Juxta-Musculaires, chez des Paraplégiques. Société de Neurologie, Séance du 7 mars 1918. Revue Neurologique, 159-172.
- Dejerine-Klumpke A., Ceillier A. (1918): Para-arthropathies du Genou chez les Paraplégiques. Revue Neurologique, 348-356.
- Dejerine-Klumpke A. (1927). Discours au nom des anciens élèves de Vulpain. Revue Neurologique (Paris) 6: 1112-1122.
- Dejerine A., Ceillier A. (1991): The Classic Paraostoarthropathies of Paraplegic Patients by Spinal Cord Lesion: A Clinical and Roentgenographic Study, Translated by Peltier L.F. Clinical Orthopaedics & Related Research 263: 3-12.
References
- Berhoune N.N., Thobois S., Gobert F., Campean L., Broussolle E. (2014): Augusta Dejerine-Klumpke (1859-1927): an extraordinary neurologist and an inspiration for all women in medical careers. Pediatric Neurology 50(6): 547-8.
- Bogousslavsky J. (2005): The Klumpke family – Memories by Doctor Déjerine, born Augusta Klumpke. European Journal of Neurology 53: 113–120. pdf
- Bogousslavsky J. (2011): The Swiss connection of Augusta Déjerine-Klumpke. Schweizer Archiv für Neurologie und Psychiatrie 162: 37–41.
- Broussolle E., Poirier J., Clarac F., Barbara J. G. (2012): Figures and institutions of the neurological sciences. Part III: Neurology. Revue Neurologique (Paris) 168: 301–320.
- Dibattista L. (2006): Un’americana alla Salpetrière: Augusta Dejerine-Klumpke (1859-1927) e la cartografia del cervello. Revista Internacional de Culturas Y Literaturas 3: 1885-3625.
- Ellis H. (2010). Augusta Klumpke (1859–1927). Journal of Neurology 257: 1765–1766.
- Krestel H., Bassetti C., Jagella C. (2013): Augusta Dejerine Klumpke (1859-1927): contributions to aphasiology by scientific mobility in the late 19th century. Journal of Neurolinguistics 26: 581-589.
- Krestel H., Annoni J.M., Jagella C. (2013): White matter in aphasia: a historical review of the Dejerines’ studies. Brain and Language 127(3): 526-32.
- Lecours A.R., Caplan D. (1984): Augusta Dejerine-Klumpke or the lesson of anatomy. Brain and Cognition 3: 166–197.
- Lecours A.R., Chain F., Poncet M., Nespoulous J.L., Joanette Y. (1992): Paris 1908: The hot summer of aphasiology or a season in the life of a chair. Brain and Language 42: 105–152.
- Mikol J. (2017). The eviction of Augusta and the Dejerine Foundation. Revue Neurologique 173(1): S4–S5.
- Sartran R. (1974). Augusta Dejerine-Klumpke. First woman Intern in Paris Hospitals. Annals of Internal Medicine 80: 260–264.
- Shoja M.M., Tubbs R.S. (2007). Augusta Déjerine-Klumpke: The first female neuroanatomist. Clinical Anatatomy 20: 585–587.
- Sorrel-Dejerine Y. (1959). Madame Dejerine-Klumpke (1859–1927). La Presse Médicale 14: 1997–1998.
- Schurch B., Dollfus P. (1998): The “Déjerines”: An historical review and homage to two pioneers in the field neurology and their contribution to the understanding of spinal cord pathology. Spinal Cord 36: 78–86.
- Ulgen B.O., Brumblay H., Yang L.J., Doyle S.M., Chung K.C. (2008): Augusta Déjerine-Klumpke, M.D. (1859–1927): a historical perspective on Klumpke’s palsy. Neurosurgery 63: 359–366 (discussion 366–367).
- Yildirim F.B., Sarikcioglu L. (2008): Augusta Dejerine-Klumpke (1859–1927) and her eponym. Journal of Neurology Neurosurgery and Psychiatry 79(1): 102.
