Abstract
The cause of death, at the age of 37, of Louis-Victor Marcé (1828–64), one of the most innovative alienists of the nineteenth century, was concealed by his contemporaries and colleagues. Recently it has been discovered that he committed suicide, but the circumstances and reasons for this were unknown. Information has now been found about his family, the events of the last year of his life and an unprecedented correspondence from his father-in-law, the chemist and academician Jules Pelouze, describing Marcé’s condition during the last month of his life. All of these point towards a diagnosis of melancholy, for which none of the appropriate measures were taken, probably as a result of the ailing Marcé’s social situation.
The cause of Louis-Victor Marcé’s death at the age of just 37 (1828–64) was one of the darkest secrets in the history of French psychiatry. The cause would probably have continued to remain a mystery if it had not been for recent acknowledgement of his important work, provoking an interest in the man and in the silence surrounding his death.
Marcé’s name is well known – at least among those working in perinatal psychiatry – since Channi Kumar (Glangeaud-Freudenthal, 2003) instigated the 1980 naming of the ‘Marcé Society’ for the international society created in Britain, referring to the œuvre princeps in the field: the Traité de la folie des femmes enceintes … (Marcé, 1858). However, Marcé’s achievement was not restricted to this pioneering work, for he was equally innovative in many other fields of psychiatry and neurology that were developing at the time.
It is noteworthy that a number of discoveries currently attributed to Marcé were made by English-speaking researchers and historians, mostly British. Since 2010, it has become known that Marcé committed suicide (Lempérière, Luauté and Garrabé, 2010). However, due to the dissimulation of his suicide by his colleagues and contemporaries, discovering the reasons behind his act remained a challenge; there had only been various hypotheses for it.
In the present article, 1 we will summarize the main phases of Marcé’s life and work before covering his publications and the events that took place in the last year of his life, i.e. from September 1863 to August 1864. The causes of the alienist’s suicide were deduced after the discovery of 10 letters that Marcé’s father-in-law, the chemist and academician Jules Pelouze (1807–67), had written from 22 July to 23 August 1864, in which he describes his son-in-law’s state of health.
Marcé’s life
Origin, education
Louis-Victor Marcé (Figure 1) was born in Paris on 3 June 1828 at 170, rue Saint-Denis, home of his maternal grandparents, who were glove-makers. His father, René, had been born in Nantes where the Marcés had belonged to the gentry since the seventeenth century. A judgment of the civil tribunal of the Seine dating from 1913 re-established the aristocratic particle in front of Louis-Victor Marcé’s surname – i.e. he should be called de Marcé – and that of his ancestors. René ‘de Marcé’ seems to have led an unstable life. At the time of his marriage, in 1826 (aged 51), he was supervisor at the hospice in Bicêtre, where he had been recruited by Pariset. Two years earlier Marcé had twice been admitted to Pariset's service for ‘alienation’ (the word signified ‘mental illness’ without the connotation of gravity which it was later to acquire). René de Marcé remained in his post for almost 4 years in Bicêtre before resigning. He died in 1834, at the age of 58, leaving his widow and son in difficult financial circumstances.
L-V Marcé: lithograph by Desmaisons, 1865 (by courtesy of the de Marcé family).
It is very likely that at the age of 12 Louis-Victor Marcé was sent to Nantes for his secondary studies, but somewhat surprisingly his mother remained in Paris. Numerous members of his family lived in Nantes, including his cousin, the doctor Germain-Auguste Marcé (1805–59), who himself had no children and who was something of a father-figure for Louis-Victor. Doctor Marcé was an eminent practitioner in the City and became professor at the school of medicine. Louis-Victor thus found himself in excellent living conditions, and he was a particularly brilliant pupil at the Royal College of Nantes. It is worth noting that he was the classmate and friend of Jules Verne – who was the same age – and that he rubbed shoulders with another pupil later to become famous, the writer and pamphleteer Jules Vallès. Louis-Victor studied hard at the school of medicine and did his first internship in Nantes where he was a pupil of Camille Bouchet, the first incumbent of the post of ‘alienist doctor’ at the newly-built Saint-Jacques hospital.
In 1851 Louis-Victor Marcé passed the internship entrance examination for the Paris Hospitals (third out of 32), where he elected for surgery and worked under Maisoneuve, Chassaignac and Velpeau. Velpeau held Marcé in great esteem, and in 1856 supervised Marcé’s thesis on ‘Spermatic cysts or spermatic encysted hydrocele’. Marcé also spent a year of his internship under Sandras, a neurologist ‘before his time’.
Marriage, alienist doctor
In Paris, Marcé, who led the life of an impoverished student, gave lessons to eke out a living. One of his pupils was the medical student Eugène Pelouze, who introduced Marcé to his father Jules and other members of this influential family. Jules Pelouze (Figure 2) first trained as a pharmacist before completing his studies in chemistry under Louis-Joseph Gay-Lussac (Arnaud, 2009). His scientific work concerned both organic chemistry, of which he was a pioneer in the early 1830s, and inorganic chemistry. A member of the Institut de France at the early age of 30, Pelouze was acknowledged during his life as being one of the greatest chemists of his time. Alfred Nobel was one of his pupils, and he was friendly with some of the greatest chemists of the period, including Liebig. In parallel, he had pursued a professorial career in chemistry and an administrative career at La Monnaie (the Paris Mint) in quai Conti, where he lived in staff lodgings. His living-room, according to chroniclers, was the rendezvous for representatives of the Institute and of the Collège de France. However it was none of these individuals who made the strongest impression on the young doctor, but Anna, the second of Jules Pelouze’s three daughters. There was just one obstacle to the marriage: Marcé’s lack of a position. On hearing that Jules Baillarger and Jacques-Joseph Moreau (Moreau de Tours) were seeking an associate for the board of directors at their clinic in Ivry, he applied and obtained the post.
T-J Pelouze: lithograph by Jean-Baptiste Lafosse, 1865 (from a photograph by Pierre Petit).
The Maison d’Ivry was opened in 1828 by Esquirol who managed it until his death in 1840, with the help of his nephew and successor, Mitivié. In 1843 Mitivié appointed Baillarger and Moreau de Tours as associates; they were both former pupils of Esquirol, and were already alienist doctors at Paris hospitals: La Salpêtrière and Bicêtre, respectively. Also in 1843, Baillarger founded the Annales Médico-Psychologiques. He was a member of the Académie de Médecine, and was to become its president several years later. In 1854 he presented to an Académie meeting his mémoire on ‘la folie à double forme’, triggering a priority dispute with his colleague, Jean-Pierre Falret (Pichot, 2006).
As for Moreau de Tours, he had observed the effects of Indian hemp during his travels to the Middle East and became renowned for his work Du hachisch et de l’aliénation mentale, published in 1845. Like Baillarger, he was opposed to all those wanting to ‘spiritualize madness and depict it as an illness of the soul’ (Dowbiggin, 1991: 70).
It was with these two eminent masters, both much older than himself (Baillarger by 19 years and Moreau de Tours by 24), that Marcé was to find teaching and advice, although the subject of mental health was not totally unknown to him. Marcé’s career now took an unexpected turn. A letter from Jules Verne to his parents (Dumas, 1988: 391) about Marcé, who had become his doctor, said: ‘Marcé is getting married; he’s marrying the daughter of Mr Pelouze, member of the Institute and director of la Monnaie in Paris; furthermore he’s been nominated head doctor [sic] of a clinic in Ivry, not that this will prevent him from having his own surgery in Paris; 10,000 fr the first two years and 30,000 fr thereafter – poor thing!’ These sums were considerable, compared with the annual salary of a civil servant which was between 1200 and 3500 francs at that time.
The civil wedding between Louis-Victor Marcé and Anna Pelouze took place on 26 March 1856, with the religious ceremony the following day at the church in Saint-Germain-des-Prés. The civil register gives an idea of the eminently favourable conditions surrounding his career, through the names and status of the four signed witnesses: Pierre-François Rayer, ‘doctor to the Emperor’; the rich industrial magnate Frédéric Kuhlmann, listed as a friend; Alfred-Louis-Marie Velpeau, his former chief; and Jules-Gabriel-François Baillarger, his new associate (and mentor) at Ivry.
Marcé rapidly took up his functions at Ivry and soon afterwards launched into an intense period of scientific activity. He was elected an entitled member of the Medico-Psychological Society in 1859.
University hospital career
Marcé had always liked teaching and since December 1857 he had started giving a ‘public course on neuroses and mental illnesses’ which attracted large audiences. In 1860 he took the challenging and competitive agrégation examination in the medicine and forensic medicine section. The brilliant defence of his thesis on Des altérations de la sensibilité (Marcé, 1860a) put him in first place, ahead of Potain, Vulpian and Charcot, who were all his seniors.
To obtain a hospital position he did not need to take the special competitive examination which had been instituted in 1840 by the council of hospices for recruiting alienists at Bicêtre and la Salpêtrière, but abolished by an 1859 decree. The ministerial authority appointed Marcé in September 1860 to a newly-created post at the Ferme Sainte-Anne, an annexe of Bicêtre, and this seems to confirm that Marcé was in good favour. However, as J-V Laborde (1865: 8) wrote in his eulogy ‘[if] entry by selection examination had just been closed as an option for him… and if he had to endure another mode of nomination, by virtue of the undisputed pre-eminence of his earlier titles, no-one complained more than he did and nobody regretted it more than he.’
In 1861 Marcé benefited from a reshuffle of alienists working for the Assistance Publique: Moreau de Tours was transferred from Bicêtre to la Salpétrière, and Marcé was appointed to the vacant post in Bicêtre. We do not know whether he ever knew that his father had been a supervisor at Bicêtre. Marcé’s colleagues here were Félix Voisin and Delasiauve. Valentin Magnan, one of the fathers of French psychiatry, worked under Marcé for a two-year internship and retained a profound veneration for his master.
For Marcé, and for most of the alienist doctors of his day, the clinical-anatomical method constituted a community of faith. Indeed, Esquirol (1838) had expressed his disappointment in the results of autopsies on ‘the alienated’, and Marcé had made similar negative observations – notably during the autopsy of patients affected with ‘puerperal psychoses’ – but, as a convinced organicist, he put his hope in the future ‘when science would achieve more rigorous means’ (Marcé, 1858: 225).
Nonetheless, he showed himself to be a determined supporter of anatomical studies on patients with dementia, and at Bicêtre he was able to carry out important clinical-anatomical work. He got Robin and Luys to help him with the histological tests, and he presented his cases to the Société Anatomique de Paris of which he had been a very active member since his internship. He also closely followed the work of those who debated the question of cerebral localization and when Broca, his colleague at Bicêtre, observed ‘the strange predilection of aphemic lesions for the left hemisphere’, Marcé was among the clinicians searching for cases confirming or refuting the radical new data, as Broca himself noted (Broca, 1863).
Life at the Maison de santé, and friendship with Jules Verne
Marcé and his young wife lived in lodgings at the Maison de santé, at 7 rue de Seine in Ivry, and their four children were born there. Marguerite Mathilde was born on 15 November 1856 and died aged 9 months. 2 René-Eugène was born on 29 July 1858, Maurice-Auguste on 6 February 1861, and finally Victor-Louis on 28 January 1864.
The absence of any private correspondence from Louis-Victor Marcé is surprising. We thus have very little information on his personal tastes, friendships and travel, with one very notable exception: his friendship with Jules Verne, his old classmate at the Royal College of Nantes. Verne settled in Paris in the summer of 1848 to study law, then gradually, having passed his exams, he launched his literary career. He led the life of a poor student and, following his arrival in Paris, suffered from continuous digestive troubles, which – according to letters he sent his parents – seem to have been of a hypochondriacal nature. Marcé also had to treat his friend for a genuine facial paralysis associated with great pain, rendering the doctor perplexed and powerless. However, Verne maintained his confidence in Marcé and, probably in reply to his mother, declared to her: ‘I will certainly not see any other doctor than Marcé; I have more confidence in him than in the whole faculty.’ (Dumas, 1988: 371).
Works of Louis-Victor Marcé
We mention here only those of Marcé’s works which have stood the test of time.
Neurological and anatomical works
By the end of his internship, Marcé had made himself known with his ‘Mémoire sur quelques observations de physiologie pathologique tendant à démontrer l’existence d’un principe coordinateur de l’écriture et ses rapports avec le principe coordinateur de la parole’ (Marcé, 1856); in this memoir, he was the first to have at least envisaged the possibility of an isolated agraphia, the term ‘agraphia’ having been introduced by William Ogle in 1867. Following its recognition by Heacen, Angelergues and Douzenis (1963), Marcé’s contribution is now mentioned in the historical section of all works on agraphia.
Among the important clinical-anatomical works he undertook at Bicêtre, his contribution to the isolation of vascular dementia is still relevant today (Marcé, 1863). Dening (1995) commented:
Marcé (1863[a]) in an influential paper contrasted the clinical and pathological features of senile dementia with general paresis. Senile dementia arose from general vascular disease, leading to reduced blood flow and cell loss, as well as an increased risk of vascular rupture and haemorrhage.
Dening even speculates whether Marcé is known only for his work on puerperal disorders.
Marcé’s Traité de la folie des femmes enceintes (1858) is currently his best known work. In the ‘Foreword’, he gives the reasons for his interest in the ‘alienation’ of post-partum mothers, a variety of insanity to which Esquirol (1838) had recently drawn attention. However, it was Baillarger who gave Marcé the idea of writing this Traité and who enabled him to gather observations in Baillarger’s own service at La Salpêtrière, an example followed by Louis Calmeil (1798–1895) with regard to the Charenton registers, then by Jules Mitivié (1796–1871), once again at La Salpêtrière. Compared with the work of Marcé’s predecessors, Traité de la folie des femmes enceintes demonstrates a breadth and depth of knowledge. It was both didactic and practical, and his contemporaries realized this.
In 1859 Marcé entered his Traité for the medicine and surgery prize awarded by the Académie des sciences (the Montyon foundation), receiving an ‘honourable mention of 1500 fr’, and was complimented by Claude Bernard, the jury reporter, ‘for the number and importance of facts that it contains, and for the consequences that the author has deduced through observation. [It] threw new light on a very important subject in mental pathology’. 3 Bernard, a colleague of Jules Pelouze at the Institute, liked Marcé’s essentially descriptive approach, which ‘set aside any theoretical pre-occupation’; also his repeated condemnation of tradition and ‘these inadmissible theories which encumber science’, not to mention ‘physiologist’ (i.e. materialist) pronouncements, such as: ‘the immaterial soul cannot be ill, it is thus the brain which is responsible for intellectual disorders’.
This conception of the body-spirit relationship – and this same formulation – were to be repeated in the introduction to Marcé’s Traité pratique des maladies mentales (1862). La folie des femmes enceintes was later forgotten, except by the best specialists, such as Hamilton (1962: 14) who considered it to be the ‘only comprehensive book on the subject …’. Its importance has recently been rediscovered, and according to Trede et al. (2009):
His work anticipated modern rediscovery of the high risk of depression in pregnancy and of both acute mood disorders and psychoses, postpartum. This comprehensive summary of clinical knowledge of perinatal psychiatric disorders of women is a landmark early contribution to a field that has only recently emerged as a psychiatric subspeciality.
A historiographical work of British origin (Skrabanek, 1983) attributes to Marcé the first description of mental anorexia in his ‘Note sur une forme de délire hypocondriaque consécutive aux dyspepsies et caractérisée principalement par le refus d’aliments’ presented to the Société Médico Psychologique in 1859 (Marcé, 1860b). Skrabanek (1983) not only attributed the first description to Marcé but he also dismissed Lasègue and Gull, who were engaged in a priority dispute, even going so far as to accuse them of plagiary: ‘But Lasègue and Gull are guilty for not quoting a clear description of anorexia nervosa by Marcé in 1860, which was available both in French and English’. Skrabanek’s finding has been developed by others, and Marcé is currently regarded as the true ‘father’ of this affliction (Blewett and Bottéro, 1995; Silverman, 1989; Van Deth and Vandereycken, 1995).
Traité pratique des maladies mentales (1862)
As Marcé indicates in his preface to this book, it is primarily a teaching work in extension to his course on neuroses and mental illnesses. It received very favourable commentaries upon publication. Ritti (1882) considered it to be Marcé’s masterpiece and, according to Sémelaigne (1932), it was used to teach several generations of students. In his eulogy to Marcé, his friend J-V Laborde (1865) compared it to Griesinger’s (1845) treatise, the French translation of which appeared a year after Marcé’s death. However, Marcé was very familiar with Griesinger’s ideas and he quoted them in the chapter on ‘De la folie à double forme ou folie circulaire’ in his book: ‘the illness consists of a cycle of two forms often alternating very regularly’ (Marcé, 1862: 340). Then Marcé clearly set out J-P Falret’s descriptions (cyclical insanity) and those of his colleague and mentor Baillarger (dual-form insanity). Without entering into controversy, he gives his opinion on the subject:
I don’t hesitate to accept this denomination (that of dual-form insanity) for cases where dual-form attacks are separated by a distinct intermittence; but I think that the term circular insanity applies more exactly to the even more numerous instances where attacks follow on from one another without the slightest intermittence and where the illness revolves indefinitely in the same circle. (Marcé, 1862: 341)
We know that it was the designation of circular (or cyclic) insanity as conceived by Marcé – after Falret – that would later be used by the nosographies, including the DSM-III (Pichot, 2006).
Haustgen and Akiskal (2006) have also mentioned that Marcé was the first to have reported an example of what is designated, after Dunner, Gershon and Goodwin (1976), bipolar II disorder, i.e. cases of major depression alternating with mild manic episodes. Thus he declares having seen ‘a period of excitation characterized solely by intellectual overactivity’ following ‘an attack of melancholy with profound stupor’ (Marcé, 1862: 345).
Marcé’s last year
September to December 1863
Marcé lived with his wife and young children at the Maison de santé. As a daily routine, with his two colleagues he visited the residential patients before going to Bicêtre to attend to his duties there, and finally going to 11 quai Conti (the premises of la Monnaie) where he had opened an outpatient clinic in 1857. He also continued to give his public course on neuroses and mental illnesses at the École pratique ‘every Tuesday and Saturday at eight o’clock in the evening’ (emphasis added).
As a professor – having passed the agrégation – he had to provide a certain number of courses as well as covering for other professors when they were absent. Neither Moreau de Tours nor Baillarger had a professorial grade (and one may speculate as to whether they felt somewhat overshadowed by the brilliant career of their young colleague). Furthermore, Marcé was a very active member of the Société Anatomique de Paris and the Société Médico Psychologique. It is therefore likely that he was overworking, although this reason given, a fortiori, for Marcé’s death by suicide (see below) is of course insufficient.
In September 1863 Marcé enrolled for the first French medical and surgical congress which took place in Rouen from 29 September to 3 October, 1863. It had 250 participants, some of whom came from ‘the furthest points of the Empire’. Of the four communications on mental health care, only Marcé’s lecture, entitled ‘De la valeur des écrits des aliénés au point de vue de la sémiologie et de la médecine légale’, was followed by a discussion (Marcé, 1864a).
During the meeting of the Société Médico Psychologique on 26 October 1863, Delasiauve, the presiding chairman, asked Marcé to present the text of his Rouen communication, and this was followed by a wide discussion in which many members, including several eminent ones, took part. The publication of these discussions in the Annales Médico-Psychologiques allows us to appreciate Marcé’s celebrity, as well as the importance of this in-depth study dealing with a subject concerning the very core of ‘alienism’. The questions posed, and the answers given by Marcé, were probably edited by Delasiauve during Marcé’s illness, or perhaps after his death. Delasiauve, in effect, signed another presentation of the Rouen text followed by an extract of the discussion in Rouen and at the Société Médico Psychologique in two articles in his Journal de médecine mentale (Delasiauve, 1864).
Marcé’s short text also appeared in a fourth publication: a special edition of Annales d’hygiène publique et de médecine légale (Marcé, 1864b). The latter text had been revised, the final discussion deleted, and two pages added with seven samples of writing. If we understand Rigoli (2001) correctly, Marcé was the first to have used this technique.
It is difficult to know how Marcé’s interest in the subject arose, but it was probably not from an emerging curiosity in graphology (the term was only coined in 1871 by Abbé Michon); in response to several participants who asked him questions on ‘the possibility of knowing the character of individuals through their writing’, Marcé shared information on his, as yet, fruitless research undertaken ‘amidst a rich collection of famous writers’ autographs’ (Marcé, 1864a). Marcé’s objective was, above all, medical, even forensic. In his text, he develops two points of view on writing: (1) as a mode of expressing delusions, and (2) as a graphic representation, i.e. as the strokes and combination of letters, as a mode of combining words, lines and pages. In the first section, Marcé considers himself in line with those who, before him, had studied the content and presentation of the writing of the ‘alienated’.
In the following section Marcé shows his innovative nature, envisaging the writings of the ‘alienated’ as a graphic representation, then analysing them within each form of insanity. He claims in fact that there are as many impediments in writing as have been observed in speech. Thus, he is able to claim that in the course of cyclic insanity, by examining the lengthy journal written by a patient, it was easy for him ‘upon the sole inspection of the writing, to distinguish with certitude during which period a page had been written’ (Marcé, 1864b: 14).
The diagnostic value of the writing of the ‘alienated’ is to be developed especially in cases of dementia and more particularly of general paralysis. Marcé admits that examining writing might seem to be a point of secondary importance; ‘but when he has to decide upon the mental state of an individual who has become ill, leaving letters, notes or a will, it is through the written elements that the forensic pathologist must enlighten the case, and it is here that he must search for the elements of his conviction’ (Marcé, 1864b: 20).
Deterioration in the writing itself is studied and illustrated (six of the seven reproductions concern the writing of paralytics) according to the stages of the illness. At the outset, the lines are regular, then as the worsening condition reduces the patient’s reactions, writing ‘while resting his hand and with a scrupulous slowness’, in a heavy writing style, sometimes ‘as thick as that of a schoolchild, learning to write’. Thereafter the deterioration is apparent, especially compared with the first lines, with the writing becoming confused and ending up in a scribble. The trembling, which is valuable from a diagnostic point of view, is reflected by ‘little zigzags joined to one another by acute angles that one finds along the course of the slightly longer strokes in the signature, requiring the hand to be launched with a more forceful effort’, etc. Marcé analyses their relationship with the impediments so characteristic of speech. He notes that there is either parallelism – the patient ‘stammers when writing as he stammers in speech’ – or discordance.
In his last chapter, Marcé deals from a forensic point of view with seven examples published by his alienist colleagues, all concerning contested wills. He summarizes each case, quoting the author(s) but with one apparently significant omission. Regarding a long forensic report, ‘Rapport médico-légal sur un cas de démence – demande en nullité de testament’ in Annales Médico-Psychologiques, he fails to mention that the author was Baillarger (1847). This particular omission could signify that relations between the two alienists had deteriorated.
Marcé also cites a study for which he had been commissioned in 1861 regarding a contested will. Having given some indications about the state of the testator, who had presented with several bouts of ‘cerebral congestion’ (stroke) and who ‘died in a state of complete dementia’, Marcé considered this information insufficient and, comparing the will written after the first bout of congestion with several letters dating from a period prior to any morbid state, he was able to find in the changes of the writing itself ‘some irrefutable traces of a disorder of the motor and intellectual faculties’ which he deemed to be due to general paralysis or multiple softening of the brain. He thus concluded that: ‘Written documents have even more value, from a point of view of diagnosing insanity, in that they constitute, even in the absence or after the death of individuals – as in the case of contested wills – a perennial and irrefutable proof’ (Marcé, 1864b: 4).
For the researcher and archive specialist, Philippe Artières (1998: 60), Marcé’s article constitutes ‘the birth certificate of medical studies on the subject’ of which he was, in France ‘the great instigator’. Before it was forgotten, Marcé’s pioneering article had given birth to a whole series of works whose authors, for the most part, recognized Marcé’s precedence.
Marcé regularly attended the sessions of the Société Anatomique de Paris, and in November 1863 he presented his observation of a 55-year-old man suffering from complete dementia, whose autopsy revealed numerous meningitic adherences, large lacunae in the corona radiata and calcareous incrustations (Marcé, 1863b). Afterwards, Campana presented the chemical analysis of the incrustations, whose organic matrix turned out to be amyloid bodies.
January to March 1864
At the begining of the year, there is no hint of the drama to come. On 28 January, Anna Marcé gave birth to their last son Victor-Louis (curiously, his father’s names reversed). At the registration of the birth two days later, the witnesses were: Alfred Collard ‘artillery colonel of the imperial guard’; a neighbour who lived in rue de Seine and, after Louis-Victor’s death, became the surrogate guardian of his three sons; the doctor André Biver (1794–1878), father of Hector Biver, the husband of Marie-Laure-Fanny, Anna Pelouze’s sister. The christening took place at the parish church on 19 March, 1864, with Hector Biver as godfather, and his wife Marie-Laure-Fanny as godmother.
During this first quarter of 1864, Marcé continued to participate in the meetings of the scientific societies of which he was a member. During the session of the Société Médico Psychologique on 25 January – with Moreau de Tours as chairman – it was announced that Marcé would be the first reporter of the commission (with Auguste Voisin and Brierre de Boismont) charged with examining the candidature of Dr Berti from Venice. Curiously, at the meeting on 14 March, the names of Marcé and Voisin had been replaced by those of Loiseau and Legrand du Saulle.
In February Marcé gave a long speech to the Société Anatomique de Paris during the presentation made by Liouville of the brain of a 73-year-old woman who had succumbed to the outcome of a ‘red softening’. Marcé deemed that the type of deterioration discovered was frequent among the elderly and ‘that from sixty years on, all cases of softening are due to an arterial lesion and that all the phenomena are very well explained by a more or less pronounced deterioration of the vessel. If obliteration is complete, the softening undergoes a rapid progression and this is the apoplectic form’ (Liouville and Marcé, 1864).
April to May 1864
On 4 April, Marcé attended the session of the Société Médico Psychologique and was invited to give news of Moreau de Tours ‘whose health is the cause of great concern for his family and friends’. This illness, which Moreau de Tours’ biographers do not mention, was sudden (he had chaired the session of 14 March) and sufficiently serious for the annual banquet of the Society on 25 April to be cancelled. Brierre de Boismont and Legrand du Saulle were invited to visit the sick man and express the sympathy of the Society.
Marcé’s schedule on that day was particularly busy. Bourneville (1864) mentioned that he had started his course on mental illnesses again, ‘at three o’clock at the Ecole pratique’ (emphasis added) and that he would continue it on Mondays and Fridays. Does this change of days – and especially the time, from 8 to 3p.m. – mean that he was feeling tired?
Also on 4 April, Bernard read to the Académie des sciences Marcé’s last major work entitled ‘Sur l’action toxique de l’essence d’absinthe’ (Marcé, 1864c); 4 see Figure 3. Many unknown factors remain concerning this work, which he signed alone although it was a summary of Magnan’s experimental work (this is surprising, as Marcé and Luys had always both signed the work they did together). Nor do we know the exact reasons for Marcé’s interest in this subject, but it was probably because of a singular observation made by Magnan, Marcé’s intern, of a chronic alcoholic who had epileptic fits only when he drank absinthe. Magnan reported this in an article published in August 1864, of which he was the sole author; he described the experiments he carried out ‘under the supervision and for the private research of my excellent master, Mr Marcé’, and his principal conclusion was the existence of a specific absinthic epilepsy.
Marcé’s last work, 1864c (by courtesy of the Academie des Sciences).
Marcé, as all his contemporaries have witnessed, was a positivist and, as Linas (1865) wrote in his eulogy: ‘His severe sense of reason rejected conceptions born of the arbitrary or fantasy and only admitted positive facts and experimental truths’. His last work bears witness to this. Marcé was the first to demonstrate the convulsive-inducing power of the essence (or essential oil) of absinthe and to have supposed that absinthe liqueur (the drink commonly called absinthe) was toxic due to the presence of alcohol as well as the essence of the plant. 5
Respite in Chenonceau
It was only 18 years after Marcé’s death that Auguste Ritti (1882) provided a little further information about the last months in the life of Louis-Victor Marcé. Ritti described the ceaseless labours of this ‘untiring worker, rising at dawn and [who] from morning to night, focused entirely on his scientific work … he ended up realizing that he needed better mental hygiene and he went to spend some time at the château of Chenonceau’. His rich sister-in-law, Marguerite Wilson-Pelouze, wife of Eugène Pelouze, 6 had just acquired it.
If we read Ritti correctly, Marcé’s stay at Chenonceau was probably devoted to rest as much as to relaxation. Ritti (1882) says: ‘Marcé came to spend a little time in this enchanting retreat and he discovered along with physical rest, the tranquility of mind that he so badly needed’ (emphasis added). This is a valuable indication about Marcé’s state of mind, as it was provided by an alienist who still, despite the date of his eulogy, had access to direct accounts of certain events in which Marcé was involved. The exact dates of Marcé’s stay in Chenonceau remain unknown, but it was certainly a short visit as he attended the Société Médico Psychologique meeting on 30 May where he was the reporter for the candidature of Numa Lafitte as a correspondent member.
June to August 1864
The registers of the hospice in Bicêtre, in which all the certificates required by the 1838 Law were copied and signed, show that Marcé was still active on 2 July. There was no further information about him between this date and his death ‘on 24th August at 3 o’clock in the evening’ at 10 rue Boileau, the address of the Maison de santé in Auteuil (information featuring on his death certificate). 7
This certificate provided Lempérière et al. (2010) with the first clue in support of the hypo-thesis of suicide, as the two witnesses were the establishment’s gardener and a coachman; either they had discovered Marcé’s body, or they had been delegated by distraught relatives to accomplish this sad responsibility. Subsequently, further arguments in support of suicide have been gathered:
The silence about the cause of death (only a verdict of overwork) in all articles and notices which appeared after Marcé’s death, whereas these reasons were usually given.
The lack of burial at Ivry (where he lived) or in any of the Parisian cemeteries; it required a family witness to find out that he had been buried at Saint-Gobain (Aisne) in the ‘Biver burial plot’ of the cemetery where he rests alongside his daughter, Marguerite.
Last but not least, the means of suicide used by Marcé has been found in Legrand du Saulle’s Le délire des persécutions published in 1871. He reproduces the letter, dated 28 September 1865, addressed to Monsieur le duc de Persigny by Abbé Paganel, a priest who was defrocked because of his mental problems and who was admitted to Bicêtre on 15 May, 1860, on Félix Voisin’s ward. In his post-scriptum Paganel writes: ‘Before finishing, I should tell you a thing or two about the Bicêtre assassin. You know the principal guilty parties were sires Brault, the director, Hubert, supervisor, Marcé, F. Voisin, Delasiauve, doctors, and what proves that it is true is that since I have had the honour to write to you, two of them have committed suicide to escape from police pursuits: they are sires Brault, that the Prefect of the Seine had nominated Mayor of Gentilly – who poisoned himself – and Marcé, who cut his throat with a razor.’
Paganel must have been repeating rumours that he heard in Bicêtre and, as Legrand du Saulle reproduces without commentary what Paganel says about Marcé’s suicide, it is because it was already public knowledge.
Since then it has been discovered that Jules Vallès, Marcé’s former classmate at the Royal College in Nantes, had also spoken (anonymously) of Marcé’s suicide and mentioned the means used, but probably with an intentional transposition of place (Luauté and Lempérière, 2012). In 1882, Vallès wrote about a visit to the Sainte Anne Asylum:
We quote the case of doctor M… happy, full of health and hope for the future, already made famous through his studies on the alienated and who (barely twenty years ago) went up to a bedroom in Charenton where he was a doctor, took his razor, and cut his throat. They say he had written on a piece of paper: ‘I’m killing myself because I feel I’m going mad.’ (Vallès, 1969–70)
There is nothing that allows us to confirm or refute the reality of this written message.
The letters of Jules Pelouze
The reasons given for Marcé’s stay in Auteuil and for his suicide were conjectural until letters written by Jules Pelouze provided more evidence about the state of health of his son-in-law, Marcé (Arnaud, 2009; Luauté and Lempérière, 2012). The letters, which had been in a cardboard box in a Paris bookshop for decades, included 10 letters dated between 22 July and 23 August 1864. 8
It appears that Marcé was at his father-in-law’s in quai Conti with his family in late July and was deeply concerned about his future and his financial situation. He expressed these fears ‘vehemently’ and was unable to sleep. On 22 July it was decided that he would return home to Ivry alone. On the eve of his departure he had been seen by Grisolle (see below) who had confirmed the plan to be followed, i.e. Marcé was to return to Ivry, and then abandon his work in Ivry and even his alienist profession, ‘in which he had been so cruelly hit’, as Pelouze wrote, in favour of a career as a medical generalist. Marcé was encouraged to submit to this decision by his doctors, and especially by his powerful father-in-law, Jules Pelouze. ‘The poor excellent Marcé’, as Pelouze called him, had seemingly not sought, nor had he been able to contest, this most critical decision. Pelouze gives no reason for this advice, which appeared to be more of an injunction and which could be understood through Marcé’s prior state and by the popular belief that contact with the ‘alienated’ had made him lose his senses. Pelouze also evokes overwork, first and foremost, as the cause of the illness. It would appear from the letters that Marcé’s worries and dark ideas stemmed from losing his job at Ivry and the consequent fears that he may have had for his family’s future. These concerns were apparently justified since Pelouze, and his son-in-law Biver, envisaged tight negotiations with Marcé’s associates. However, Pelouze – in a letter of 2 August to Marguerite Wilson – estimated that if Marcé paid a replacement, he would have still have 20,000–25,000 francs per year, which was a very comfortable income.
Pelouze’s letters are also notable for their revelation of a recent dissension between Marcé and Baillarger which was in the process of being settled. Overall, Pelouze’s letters leave no doubt about the reality and gravity of Marcé’s mental disorders.
Grisolle, a member of the Académie de Médecine, who appears to have been in charge of Marcé’s care, was a pneumologist and an ‘internist’. It was he who wished for ‘a more thorough direction’ (Pelouze’s letter of 25 July), and it was with his agreement that Marcé’s stay in Auteuil was decided.
In 1864 the medical director of the Maison d’Auteuil was Jean-Baptiste Octave Landry. It was a rest centre for high society, but it also received genuinely ill patients and, a few years later under Dr Beni-Barde, it became the foremost place for hydrotherapy treatment of general paralysis. Landry (1836–65) was an eminent ‘neurologist’ (Walusinski, 2013) and he had become head of the Maison d’Auteuil after a university career which had enabled him, among several works in the field of neurology, to describe the syndrome of ascending myelitis which still bears his name. Pelouze speaks of Landry as a friend of Marcé.
Marcé was admitted on 27 July after a meeting between Pelouze, Landry and Grisolle. Pelouze had rented for Marcé a furnished house close to the establishment where he went for hydrotherapy sessions. Anna was with her husband, the children having stayed behind at quai de Conti. On 22 August, after a visit from Moreau de Tours during which they had spoken about the Maison d’Ivry (Pelouze’s letter of 23 August), Marcé’s state became critical. Pelouze did not want to leave his daughter alone with Marcé, so he spent the night with them. In the early hours of the morning, Anna went to warn Landry, and we assume that Marcé was then kept in the Maison d’Auteuil. He committed suicide there the following day.
Causes of the suicide
The psychological significance of Marcé’s act seems to correspond with a defensive process that occurs ‘when suicide appears directly related to a situation seen as unbearable’ (Deshaies, 1947). However, an agressive aspect may also legitimately be inferred from the method that Marcé chose, and this could have been fuelled by the resentment that he may have felt towards his colleagues, and indeed towards all those who obliged him to abandon his profession as an alienist. Pelouze’s letters do not mention how difficult it must have been for Marcé to abandon a career in which he had invested so much. One may even wonder whether the visit by Moreau de Tours on 22 August – so badly received by Marcé – had been the final blow which removed all hope of him returning to Ivry.
According to Pelouze, Marcé’s state was linked to his profession ‘where he had been so cruelly hit’. But Pelouze makes no mention of any serious situation involving Marcé at Ivry which could explain Baillarger’s initial ill-humour towards him. Was Marcé too ill to be able to practise? Had he committed a professional error? These are questions which it is impossible to answer as we have no information about what happened at Ivry, and the archives of the Maison de santé and even the ‘Legal registers’ (1838) have disappeared. Only one witness report gives an idea of the rivalries which existed between alienists at the time; this was from a witness who, though non-medical, was perfectly well informed. Alfred Maury, an active member of the Société Médico Psychologique, included in his memoirs several strong criticisms of the professional rivalries between alienists: ‘The doctors fuel their scientific or personal quarrels with an acrimony sometimes verging on brutality. Their idealogical differences are almost always complicated by clashes of interests’ (Maury, 1892, Vol. 4: 20).
Pelouze’s letters provide a decisive element for the suicide by clearly describing a major depressive state with a heavy burden of anxiety. Furthermore, his repeated mention of fears harboured by Marcé about the future brings a tone of delusional melancholy to the picture. The suicidal act and the very choice of the means used both fit in with this, and the delusional aspect is argued a contrario by what we know of Marcé’s relative fortune at the time.
The act of inheritance (Luauté and Lempérière, 2012) recorded on 22 February 1865 provides valuable information on the assets that Louis-Victor Marcé had acquired since his marriage. The total value of the inheritance was 296,839.05 francs, a considerable sum at the time. It is note-worthy that ‘the value of a work written by M Marcé’ (Traité de la folie des femmes enceintes) and ‘the sales of the said work up until the death of M Marcé’ amount to 500 and 75 francs, respectively. It is thus not his scientific works that made him wealthy, nor certainly his salary as a hospice doctor at Bicêtre and professor ‘agrégé’, but that of his work as medical director of a clinic. Thus, Marcé’s fears about his finances seem to have had no objective foundation.
In which framework should his supposedly initial melancholia be classed? Was it a bipolar disorder? The notion of a hereditary pathology (professional instability of his father followed by confinement as an ‘aliéné’) renders this hypothesis theoretically plausible. However, nothing in Marcé’s biography indicates significant mood swings in this man, described as living a very ordered life and whose works show extreme mastery. Certainly, Marcé was the first (Dunner et al., 1976; Haustgen and Akiskal, 2006) to have reported an example of bipolar II disorder, but nothing in his works suggests that he might have had a personal insight into the problem.
Nor is there any indication in the various testimonies we have examined of the existence of a proven personality disorder. These accounts give an image of Marcé as an austere, rigorous, possibly rigid person. His modest origins should not be forgotten; they could explain a profound feeling of insufficiency and humiliation at the idea that his (relative) loss in revenue would not allow him to provide his wife and children with a material situation equivalent to that of his in-laws. However, the main source of his suffering seems to have been the heartbreak of being forced to abandon his profession of alienist. The circumstances, together with Marcé’s strong bouts of despair (up to the last one on 23 August), should have set alarm bells ringing about the risk of suicide and the need to set up appropriate means of preventing him from harming himself. The choice of the hydrotherapy establishment in Auteuil unfortunately illustrates the lack of psychological analysis and foresight on the part of his family and medical carers. It confirms a contrario the measures that Marcé himself recommended in cases of melancholy in his Traité pratique des maladies mentales. In the tradition of Esquirol, he not only defended the necessity for isolation ‘in a special clinic, far from the family’, but he also perfectly described the opposition that this measure encountered in ‘well-placed families in fear of scandal’ (Marcé, 1862: 180). His intransigent position seems to apply to his own situation:
The doctor must fight every step of the way against all these objections, and in urgent cases, should impose a decision which far too often is taken too late, after long discussions and fruitless attempts at treatment, during which the mental illness becomes more tenacious, more serious and loses part of its chances of improving. (p. 180)
Marcé had earlier described all the forms of suicide (including that by irresistible impulse) and described in detail all the precautions to be taken to prevent it.
During the session of the Société Médico Psychologique on 31 October 1864, Moreau de Tours, President-in-office, curtly announced the ‘unfortunate death of Mr Marcé’, before handing over to Linas for the eulogy (Linas, 1865). The medical journals of the time also announced the death, but thereafter – apart from Ritti’s eulogy in 1882 − Marcé and his work were shrouded in silence. The secret surrounding Marcé’s suicide avoided the type of ranting and raving that followed the suicide of another doctor in 1934, 9 and credit should be given for this.
Footnotes
Acknowledgements
The authors are grateful to Ian Bailey for translating the original manuscript into English and to Karel de Pauw for kindly checking it.