Historical perspective on pressure ulcers: the decubitus ominosus of Jean-Martin Charcot.

Jean-Martin Charcot was a towering figure in the French medical community in the 19th century. Among the diseases he studied was the decubitus, or pressure ulcer, as it is commonly called today. He did not believe that pressure or local irritation were causative factors for the decubitus but rather subscribed to the "neurotrophic theory," which held that damage to the central nervous system led directly to its occurrence. Charcot observed that many patients who developed eschar of the sacrum and buttocks died soon afterwards, and referred to this lesion as the decubitus ominosus, implying that its occurrence heralded impending death. His description of the evolving decubitus is extraordinarily detailed and accurate and includes complications that are seldom seen today, such as gangrenous metastases to the lung and invasion of the spinal cord. Charcot's therapeutic nihilism is largely a product of the limited medical technology of his day. The importance of risk factor assessment and timely intervention for persons at risk is now understood. In addition, it is recognized that not all pressure ulcers are unavoidable and that many ulcers, particularly those in early stages, can be reversed. Comparing Charcot's view of the decubitus with our own, insight is provided into the way medicine is practiced today.