Functional Units & Acute Pains

Functional Units & Acute Pains

“In seeking absolute truth we aim at the unattainable, and must be content with finding broken portions.”
Sir William Osler

Functional units can also be productively applied to the common problem of acute pain. There are really only three possible sources for acute pain: local structures, pain referred from other sites, and pain ‘projected’ to a site, for example from nerve roots. Here is an example from the shoulder – and again if we were to sieve each individual component, we could easily build up a comprehensive list of differential diagnoses for shoulder pain.
Charcot described many neurological diseases and signs for the first time including Charcot’s joints, Charcot-Marie-Tooth disease, ankle clonus and amyotrophic lateral sclerosis. His work capacity was enormous. He worked long hours each day and then often late into the next morning under lamplight in his office. Thursday evenings, however, were devoted to his other great passion – music, and no one was allowed to utter a word of medicine on such occasions. He was a brilliant observer, and once employed a housemaid who suffered from disseminated sclerosis in order to scrutinise the condition more closely – until she had to be admitted to the Saltpetriere and died, when he conducted her autopsy and proved his theories.
Much of Charcot’s brilliance lay in his inspirational teaching. He had a floodlit stage at the Saltpetriere where he held numerous live performances and lectures, demonstrating patients and their disorders to a large crowd. A short broad man with a low forehead, cold piercing eyes and sensitive lips, he was said to be an articulate speaker who would often pause for minutes at a time to demonstrate an observation in the patient. His demonstrations became famous and attracted the fashionable and aristocratic people of the day. He held controversial theories on hypnosis and hysteria attracting critics as well as students including Sigmund Freud.
Charcot was a great lover of animals and refused to experiment with them, declaring “you find no dog clinic with me”. He died of heart disease aged 68, leaving in his wake a revolutionised discipline of neurology. He said: “To learn how to treat a disease, one must learn how to recognize it. The diagnosis is the best trump in the scheme of treatment.”
Jean-Martin Charcot (1825-1893). Born to a family of coach-makers, Charcot rose to become the founder of modern neurology. He entered medicine early but did not really make his name until appointed director of the Saltpetriere (a famous hospital named for its role as an armoury and gunpowder store to Louis XIII). The Saltpetriere was filled with thousands of destitute patients from the streets of Paris, and Charcot spent his life studying and describing their many illnesses, building the discipline of neurology along the way.