Friday, 10 April 2009

Charcot Marie Tooth

I was waiting for the train to take me into the centre of Paris. An elderly lady was walking past. What was distinct about her gait was that it was the classic Foot Drop!

A professor at London once advised us all medical students, “the greatest pathological museum is the London Underground”, and requested that we keep our eyes open, while being discreet. Sure enough, we learned to spot Parkinson’s Disease, an odd graves Diseases, various forms tics and palsies and several types of growths…

What is a Foot Drop? It is a (high)steppage gait, “Foot Drop” presenting with two unique features.

High Steppage: this consists of knees raised unusually high to allow the drooping foot to clear the ground. And yet, since the toes of the lifted foot remain pointed downward, they still scrape the floor.

Second part is the Foot Slap, creating a double loud sound of contact (first the heel and then the forefront)..

No, perhaps this is not the classic foot drop I said to myself while feeling very sad at the plight of this unkempt lady, trying to avoid the gaze of others..

Could this be Charcot-Marie-Tooth gait? Charcot’s name came to my mind because here I was in his town, Paris…

Before I tell you about Charcot and then Marie, let me say the causes of Foot Drop are LMN disease, Peripheral Neuropathy, peroneal injury and muscular dystrophies

Jean M Charcot 1825-1893 was a legend in French Medicine and if any one deserves the name Father of Neurology,it should go to Charcot. He has 15 medical eponyms to his credit, he was also the first one to describe ALS (amyotrophic Lateral sclerosis). He was an animal lover and a talented artist. He was a Beethoven fanatic. He was well remembered as a Charismatic Teacher, who influenced the likes of Pierre marie, Joseph Babinski, Vladimir Bekhterev, Desiree Bourneville, Gilles de la Tourette, and a 29 year old Sigmund Freud. For aspiring clinical diagnosticians, it is well worth remembering his words: We tend to see only what we are ready to see, what we have been taught to see. We eliminate and ignore everything that is not part of our prejudices. Hence, if the clinician wishes to see things as they areally are, he must make a tabula rasa of his mind and proceed without any preconceived notion..

(a fine medical anthropological study of encounters between patients and their family doctors, has alluded to the fact that the Family Physician tend to make the diagnosis even before he has seen the patient,so strong is his prejudice against certain patients).

Pierre Marie was a student of Charcot, started as a Law student, saw the futility of that discipline and switched to Medicine, much to our benefit.

Henry Tooth was British Surgeon during the Boer War and World War I. He was also an excellent carpenter and musician..