Pierre-Antoine Prost a-t-il découvert l’origine intestinale de la folie ?

Abstract

Pierre-Antoine Prost in his seminal work of 1804 Médecine éclairée par l’observation et l’ouverture des corps (“Medicine enlightened by the observation and examination of bodies”) tells how he undertook the complete autopsy of each deceased patient without taking into account the organs that were presumed to be the site of the disease. Then, opening the intestines of patients who had died from conditions presumed to be in the brain (“fevers”, madness, neuroses), he consistently discovered inflammatory lesions of the intestinal mucosa in its proximal part, while the brain was unharmed. He had probably been oriented towards the abdomen through the teaching of Philippe Pinel, who believed that passions had their seat in the epigastrium. However, since Pinel never quoted Prost, we cannot know what he might have thought about the connection made by Prost between the epigastrium, seat of passions, the intestines and the seat of insanity. It is likely — as claimed in 1826 by Bretonneau's pupil, Trousseau — that the lesions discovered by Prost in relatively young patients, who had disorders of consciousness and died as a result of a single course of their disease, had been affected by encephalitic forms of typhoid fever, a disease first described by Bretonneau as Dothinenteria. For the other patients, these were probably post-mortem lesions. Prost's discovery was exploited by the renowned Broussais who made gastroenteritis the basic lesion of his “physiological medicine”. The results of Prost and Broussais deserve to be updated in the light of recent work on the microbiota and the role of inflammation in mental illness.