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Augusta Klumpke: pioneer neurologist.

The second half of the 19th century was the period in which women at last succeeded in gaining their medical training--in the U.K., continental Europe and the USA. Moreover, many of these pioneers showed themselves to be exceptionally capable in their chosen fields. A good example of this was Augusta Klumpke, an outstanding neurologist.

Augusta was born in 1859 in San Francisco. Her father, an Englishman, had emigrated to the USA and had become a wealthy estate agent. Her American mother brought her and her elder sister to Europe to seek treatment for the sister's chronic osteomyelitis of the femur. Sadly, this proved the end of the marriage and her mother, alone, brought up the two girls in Germany and then in Switzerland.

Young Miss Klumpke became a science student in Lausanne, intending to become a school teacher. However, her mother read that a Mdm. Madeleine Bres had become medically qualified in Paris and she encouraged Augusta to apply for a place, and to be accepted, as a medical student in Paris in 1877. She proved to be a brilliant student and gained a prize for anatomical research the following year. In 1882, Augusta became a medical externe at what is now the Broca Hospital in Paris, and five years later became the first woman in France to be appointed Interne des Hopitaux. Interestingly, her appointment as externe was made together with an Englishwoman, Blanche Edwards, who became prominent in the French feminist movement.

It was while working as an externe at the Broca that Klumpke began to make contributions to neurology and neuroanatomy. She became interested in an important paper by Professor Wilhelm Erb, of Heidelberg, Germany, on injuries to the upper part of the brachial plexus, the 5th and 6th cervical roots, (to this day known as 'Erb's palsy'). Characteristically in this condition the arm hangs down by the side with the forearm pronated and the palm facing backwards, in the 'waiter hinting for a tip' position and there is associated sensory loss along the lateral side of the arm. This paper encouraged Klumpke to carry out clinical and experimental studies on injuries to the brachial plexus under the supervision of Professor Vulpian, of the Hotel Dieu hospital in Paris.

Augusta's thesis on this topic was published in 1885. In this she describes a patient with avulsion of the lowest root of the brachial plexus, (the first thoracic), with Horner's syndrome as a result of concomitant injury to the adjacent sympathetic chain, (lid lag and a constricted pupil on the affected side), together with paralysis of the small muscles of the hand and sensory loss along the ulnar side of the arm. To this day this deformity of the hand is termed 'Klumpke's palsy'.

Interestingly, these brachial plexus injuries were not uncommon in children when I was a medical student 60 years ago. Erb's palsy might follow a difficult forceps delivery, (the Emperor Wilhelm 1st of Germany at the time of the First World War had this deformity, which he hid under a long cloak), while Klumke's palsy might result from a difficult breech delivery with an after-coming arm. These deformities are rarely seen nowadays in this country with early resort to Caesarian section in problem cases. Today, upper plexus injuries may be seen following a violent distraction between the shoulder and neck - the motor cyclist who lands on his shoulder and side of head. Klumpke's lesion may follow violent abduction of the shoulder and may also result from malignant infitration of the lower roots of the plexus from involved cervical nodes or from a carcinoma at the apex of the lung (Pancoast tumour).

Klumpke's thesis was approved in 1889 and the following year was awarded the silver medal of the Paris Faculty of Medicine.

Meanwhile, in 1888, Augusta had married the distinguished French neurologist Joseph Jules Dejerine (of the Charite Hospital, Paris) and became Augusta Dejerine-Klumpke.

The Dejerines, husband and wife, made a powerful combination of talents. Among other contributions, they published a major two volume treatise on the anatomy of the central nervous system, many of the beautiful illustrations being drawn by Augusta. Their daughter, Jeanne, was born in 1891. She, in turn, qualified as a doctor her mother was one of her teaching faculty.

In 1914, Augusta was elected the first female president of the French Neurological Society. Dejerine died in 1917, but Augusta continued their neurological work. She became a pioneer, during World War 1, in the rehabilitation of wounded soldiers with injuries to the central nervous system, and in particular with the management of paraplegia resulting from spinal injuries.

Augusta Klumpke died in 1927. She was buried beside her husband in the great cemetery of Pierre Lachaise in Paris.

KEYWORDS Augusta Klumpke / Brachial plexus injuries / Spinal injuries / Neurology / Klumke's palsy

Correspondence address: Department of Anatomy, Guy's Campus, London, SE1 1UL

Professor Harold Ellis

CBE, FRCS

Emeritus Professor of Surgery, University of London; Department of Anatomy, Guy's Hospital, London
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Title Annotation:NOTABLE WOMEN IN HEALTHCARE
Author:Ellis, Harold
Publication:Journal of Perioperative Practice
Date:Dec 1, 2008
Words:826
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