SURGEONS

Philibert Joseph Roux (1780–1854)

He´le`ne Perdicoyianni-Pale´ologou

Summary: Philibert Joseph Roux (1780–1854), a French surgeon, was a student and friend of Marie Xavier Franc¸ois Bichat, the father of modern pathology and histology. He was assigned as a surgeon to the Hoˆpital Beaujon (1806), the Hoˆpital de la Charite´ (1810) and to Hoˆtel-Dieu de Paris (1835), where he succeeded to Guillaume Dupuyrten, a French anatomist, as a Chief Surgeon. Roux is best known for having performed the surgical repair of a cleft palate and for having been the first surgeon to stitch a ruptured female perineum. His contribution to surgery has also included the publication of Quarante anne´es de pratique chirurgicale. Roux was awarded the grade of Chevalier of the National Order of the legion of Honor and that of Officer. He also served as a President of the Academy of Sciences. He died of a stroke on 3 March 1854.

Philibert Joseph Roux was born on 26 April 1780 at Medical studies Auxerre, a commune in the Bourgogne region in north-central France. His father, Jacques Roux, At the suggestion of his father he continued his a Surgeon-in-Chief first at the Hoˆtel-Dieu1 in Paris and medical studies in Paris. He presented himself at the later at E´ cole Militaire in Auxerre, treated him with Concours d’Entre´e to the Val-de-Graˆce7 but failed com- great harshness and severity in response to his idleness prehensively. He then decided to study at the E´ cole de and intemperance. He forced him to enrol in the E´ cole Me´decine. His father allowed him 50 francs per month Militaire, directed by monks of the Order of Saint for his medical education. Since this was insufficient to Benedict,2 with the intention of making him an pay for daily expenses, pursuit of dissections and Engineer of the Bridges and Roads3 but after a short admission to private lectures, he turned to the gaming time he changed his mind and had him attend classes table and lost his entire month’s allowance. in surgery at the Hoˆtel-Dieu. In 1798 he attended the private lectures on anatomy In 1796 Jacques Roux suggested his son enrol in the offered by Marie Franc¸ois Xavier Bichat8 who became a army. The young Philibert was appointed an Officier close and devoted friend. Bichat chose him as instruc- de Sante´, third class, in the army of Sambre et Meuse4 tor for the younger students and his assistant in per- and was sent off to Andernach.5 Later he was moved to forming experiments. Afterwards Roux was appointed the Military Hospital at Aix-la-Chapelle where he was Prosector.9 In 1799 he enrolled in the Lectures on assigned to emergency services. As his pay was only External Pathology and Clinical Medicine offered 200 francs a month, he had to be inventive in order to respectively by Alexis Boyer10 and Antoine Dubois.11 obtain adequate rations. In 1790 the Military Surgeons In collaboration with Matthieu Bichat, a cousin of were accorded rations and hereafter were saved from Franc¸ois Xavier, he wrote the first lecture of Bichat on the danger of dying of famine. This hard life ended General Anatomy and a portion of the Descriptive with the ratification of the Treaty of Campo Formio.6 Anatomy. After the disbanding of the army he returned to his In 1801 he was admitted to the E´ cole Pratique by family. obtaining first prize in recognition of his outstanding achievements and in 1802 delivered a series of lectures on Operative Surgery in which he presented a new classification of surgical diseases. In the same year he He´le`ne Perdicoyianni-Pale´ologou is a specialist in Greek and Latin presented himself at the Concours d’Entre´e for the philology and linguistics, and holds a PhDs in Classical Greek Assistance-Surgery, second class, at the Hoˆtel-Dieu but Philology and in Latin Linguistics (Sorbonne University). She has also was not selected. The successful candidate was his been the recipient of two post-doctoral research positions in Classical 12 Greek and Early Byzantine Papyrology (Sorbonne University) and rival, Antoine Dupuytren. Epigraphy (Besanc¸on University). Since 1996 when she arrived at When Bichat died on 22 July 1802, Roux succeeded Hellenic College/Holy Cross she has been teaching. She was also him and taught courses in anatomy, physiology and appointed Visiting Scholar in the Departments of Classics and operative medicine, held initially at the Cloister of Linguistics of Harvard, Brown and Stanford Universities, as well as a Saint-Jean de Beauvais and later in an amphitheatre in Guest Visiting Scholar at Harvard Divinity School and Research Associate in the Centre of Studies for Ancient Documents (Oxford Rue Huchette in the heart of Paris. Although he gave University). She studied the History of Greek Medicine with these assignments his primary attention, he did not Professor Jacques Jouanna (Sorbonne University) and Mirko Grmek give up writing. In 1803 he defended his Doctoral (E´ cole des Hautes Etudes, Section IV). Correspondence: He´le`ne Thesis, Coup d’oeil physiologique sur les secretions, and Perdicoyianni-Pale´ologou, Research Fellow – Adjunct Professor of ´ Classics, HC/HC, Visiting Scholar, Brown University, 44 Washington published the fifth volume of the Traite d’anatomie Street, suite 403, Brookline, MA 02445, USA (email: hperpal@hotmail. descriptive that Bichat had not completed. His fervent com) interest in surgery was also demonstrated in his

Journal of Medical Biography 2011; 19: 157–160. DOI: 10.1258/jmb.2010.010057 158 Journal of Medical Biography Volume 19 November 2011 publishing between 1802 and 1808 classifications and tabular views on surgical topics.

The Beaujon Hospital in 1807

In 1807 he was appointed Surgeon, second class, to the Beaujon Hospital.13 In 1809 he reprinted his noso- graphic fragments in Me´langes de Chirurgie. In these he described in detail the three operations he had under- taken at the Beaujon. In 1810 he married the daughter of Alexis Boyer who soon introduced him to La Charite´ Hospital14 as Assistant-Surgeon. He then abandoned his thoughts on physiology and surgical nosography and understood that clinical observations are the basis of pathology. In this context he undertook his Treatise on Operative Medicine15 that would be published in 1813 although he was not able to finish the two planned succeeding volumes. In 1811 Roux presented himself at the concours for the Chair of Raphae¨lBienvenuSabatier.16 Among his competitors were AE Tartra, Guillaume Dupuytren and Jean-Nicolas Marjolin.17 The jury was composed of Philippe-Jean Pelletan,18 Antoine Dubois, Pierre-Franc¸ois Percy19 and Anthelme Richerand.20 On 10 February 1812 Dupuytren was unanimously elected Professor of Operative Medicine: once again, he had triumphed over his old rival. Figure 1 Philibert Joseph Roux

London, 1814 soft palate in order to remove a nasopharyngeal polyp. He had left the palate open but realized that suture In 1814 Roux spent a month in London. He was one of should be possible later. The patient declined the the few eminent French physicians during that period second operation. In 1783 Eustathe submitted a detailed who travelled to London and witnessed their British description of a proposed method for repairing the soft colleagues at work. In the book Relation d’un voyage fait palate to the Academy of Surgery in Paris. However, on a` Londres en 181421 he compared the French and 12 August 1784 Dubois declared the operation to be English surgical schools and admitted there was equal unfeasible and rejected the proposal. It was not until development of surgical procedures in the two 1816 that Karl Ferdinand Von Graefe reported to the countries. However, he asserted ‘the rational organiza- Medico-Chirurgical Society of Berlin that he had at last tion of the Paris Faculty of Medicine presented more achieved success in closing fissures of the soft palate, guarantees of adequate training than the London freshening the edges with muriatic acid and a solution schools’.22 of cantharides and then joining them with sutures. In In 1815 Roux (Figure 1) was awarded the grade of 1819 Roux modified Graefe’s operation by closing the Chevalier of the National Order of the Legion of cleft palate with three sutures across the cleft, paring Honor23 and in 1831 that of Officier. In 1817 he deliv- the edges, attaching the sutures and drawing the raw 25 ered a lecture at the Academy of Sciences24 during surfaces together and in 1825 he published the 26 which he made out that he had operated on more than details. 700 patients suffering from cataracts, with an estimated In 1820 he succeeded Percy in the Chair in Surgical success rate of 10%. Pathology and was elected a member of the Division of Surgery at the National Academy of Medicine27 and in 1828 he became President. In 1830 he was promoted to Cleft palate surgery the Chair in Clinical Surgery. In 1832 he became the first surgeon to stitch a ruptured female perineum. In In 1819 he operated successfully on an English student 1834 he succeeded Alexis Boyer at the Academy of suffering from cleft palate. The first cleft closure had Sciences. been made in 1764 by the French dentist Le Monnier, When Dupuytren died in 1835 Roux succeeded him who succeeded in closing a fissure in the palate by as Chief Surgeon at Hoˆtel-Dieu and here he had to face paring the edges and stitching them together. In 1779 devoted followers of Dupuytren and defamatory state- after studying the problems of feeding and speaking ments impugning his professional honour although his caused by a cleft palate, Eustathe, a physician of the surgical skills and expertise soon made his adversaries town Beziers in Languedoc, had occasion to divide the change their minds and, indeed, come to feel a deep H Perdicoyianni-Pale´ologou Philibert Joseph Roux (1780–1854) 159 admiration for him. He stayed at the Hoˆtel-Dieu for Broca (1824–80), immediately contacted the editor, Victor nearly 20 years. Masson. In keeping with the committee’s decision, they undertook the task of revising the proofs and of arran- ging and checking the manuscripts. Final illness His contribution to surgery was praised by Paul Busquet,30 Fre´de´ric Dubois (1799–1873),31 Re´ne´ On 2 January 1854, on his way to a session of the Marjolin (1812–95)32 and Dionis des Carrie`res.33 Academy of Sciences of which he had been elected President, he suffered a stroke and died on 3 March 1854. He had finished writing the four volumes of his References and notes book Quarante Anne´es de Pratique Chirurgicale28 (Figure 2), 1Hoˆtel-Dieu de Paris, the most ancient hospital in Paris, was which he considered to be a set of briefs based on clini- 29 founded by Saint Landry in 651, Bishop of Paris, a symbol of cal facts, and he had nearly completed preparing for charity and hospitality publication the first two volumes, Chirurgie Re´paratrice 2 The Order of Saint Benedict or Order of the Benedictines was and Maladies des Arte`res. established in 529 by Benoı¨t de Nursie. This Roman Catholic religious order is constituted of members that observe the Rule As a tribute to the memory of this surgeon and to of Saint Benedict and belong to the Benedictine Confederation save the valuable results of his extensive experience 3 The Corps of Bridges and Roads (Inge´nieurs des Ponts and des from oblivion, on 27 April 1854 and at the suggestion Chausse´es) is composed of State Engineers of Bridges and Roads. of Felix-Hyppolyte Larrey (1808–95), the Society of It was created in 1717 in order to assure the establishment of an Surgery of Paris decided that a five-member committee effective transport truck network in France 4 The Army of Sambre-et-Meuse is the best known of the armies of should seek permission from his family to complete the the French Revolution. It was constituted of the Army of the publication of the first two volumes. This proposition Ardennes, the left wing of the Army of Moselle and the right was approved and the committee, composed of Antoine wing of the Army of the North. On 29 September 1797 the Army Danyau, Felix-Hippolyte Larrey, Adolphe Lenoir (1808– of Sambre-et-Meuse joined the Army of Rhin-et-Moselle under the title ‘Army of German’ 66), Le´on-Athanase Gosselin (1815–87) and Pierre-Paul 5 Andernach is a town in the district of Mayen-Koblenz in Germany 6 The Treaty of Campo Formio was signed on 17 October 1797 by Napoleon Bonaparte, General of the French Army, and Count Ludwig von Coblenzl, a representative of Austria. This treaty marked the end of the first phase of the Napoleonic Wars 7 The Val-de-Graˆce (Hoˆpital d’instruction des arme´es du Val-de-Graˆce, or HIA Val-de-Graˆce) is a military hospital. On 9 August 1850 the E´ cole d’application de Me´decine Militaire was founded. In 1993 the E´cole became E´cole d’application du Service de Sante´ des Arme´es and represents the first French academic military hospital centre 8 Marie Franc¸ois Xavier Bichat (14 November 1771 – 22 July 1802), anatomist, biologist and physiologist. He is best known as the anatomist who looked beyond the recognizable organ systems without a microscope and introduced the notion of tissue (‘tissues’) as distinct entities. He also maintained that diseases acted upon the tissue rather than upon whole organs. For these insights Bichat is considered the ‘Father of modern histology and pathology’ 9 A prosector dissects corpses for anatomical demonstration 10 Alexis Boyer (1 March 1757 – 25 November 1833) was a famous anatomist and one of the most respected surgeons in Parisian medical circles who thought and wrote with great clearness and accuracy. He specialized in urological pathology, especially disorders of micturition. As a physician, he was distrustful of innovations in treatment and attentive in making his judgment about individual cases 11 Antoine Dubois (19 June 1756 – 30 March 1837) was a surgeon who developed a new generation of surgical instruments, especially forceps 12 Guillaume Dupuytren (5 October 1777 – 8 February 1835), an anatomist and military surgeon was known for treating Napoleon Bonaparte’s haemorrhoids and for developing a surgical technique to fix the tissue defect known as ‘Dupuytren’s contracture’ which he described in 1831 13 The Beaujon Hospital (Hoˆpital Beaujon) later served, during the World War I, as a military hospital. It took its name from Nicolas Beaujon who gave a large amount of money for its construction 14 La Charite´ Hospital (Hoˆpital de la Charite´), a hospital founded in Paris in 1613 under the auspices of Marie de Medici and closed in 1935 15 Nouveaux e´le´ments de me´decine ope´ratoire, 2 vol. Paris: Me´quignon- Marvis 16 Raphae¨l Bienvenu Sabatier (11 October 1732 – 19 July 1811), anatomist and surgeon, was a consultant-surgeon to Napoleon Figure 2 Title page of Quarante Anne´es de Pratique Chirurgicale Bonaparte and a pre-eminent authority on the development of 160 Journal of Medical Biography Volume 19 November 2011

urology and on its recognition as an autonomous medical 23 The National Order of the Legion of Honor (Le´gion d’honneur, discipline or Ordre National de la Le´gion d’honneur) was established by 17 Jean-Nicolas Marjolin (6 December 1780 – 4 March 1850), Napoleon Bonaparte on 19 May 1802. The Order is the highest a surgeon and member of the National Academy of Medicine decoration in France and is divided into five degrees: Knight (Acade´mie de Me´decine). In 1815 he published a manual on (Chevalier), Officer (Officier), Commander (Commandeur), anatomy (Manuel d’anatomie) for his students, giving a Grand Officer (Grand Officier) and Grand Cross (Grand Croix) comprehensive view of the dissection of the corpse. Moreover, 24 The French Academy of Sciences (Acade´mie des Sciences) was he is remembered for first describing in 1828 the occurrence of one of the earliest academic societies of sciences in Europe, ulcerating lesions within scar tissue. Marjolin’s ulcer is defined as established in 1666 by Louis XIV at the suggestion of Jean- a ‘squamous carcinoma developing in a chronic benign ulcer, e. g. Baptiste Colbert to encourage and protect French scientific a varicose ulcer, an old unhealed burn, or a wound scar’. Sir AS research MacNalty, ed. British Medical Dictionary. London 1961, 876 25 On Roux’s method see: Jones G. A short history of anaesthesia 18 Philippe-Jean Pelletan (4 May 1747 – 26 September 1829), for hare-lip, cleft palate repair. British Journal of Anaesthesia a surgeon at the Hoˆtel-Dieu de Paris taught at the E´ cole de 1971;43:796. See also: Sherman HM. Points in the management of Me´decine where he excelled by his eloquence, being given the cleft palate cases, before, during, after operation. California State appellation of ‘the Chrysostom of Surgeons’ (‘le Chrysostome des Journal of Medicine 1902;1–2:44–7 chirurgiens’) or ‘Golden mouth’ (‘Bouche d’or’) 26 Me´moire sur la staphylorraphie, ou suture du voile du palais. 19 Pierre-Franc¸ois Percy (28 October 1754 – 10 February 1825), Archives Ge´ne´rales de Me´decine, Paris 1825;7:536–8 a doctor and Surgeon-in-Chief of the Army during the 27 The National Academy of Medicine (Acade´mie Nationale de Revolution and the Empire. Percy invented the ‘chirurgie mobile’ Me´decine) was founded in 1820 by Louis XVIII at the urging of where surgeons and their instruments were brought close to the Baron Antoine Portal. Initially known as the Royal Academy front from where they would jump off their ‘wurst’, eg a large of Medicine (Acade´mie Royale de Me´decine), it was comprised and long four-wheel carriage, to take care promptly of the of two institutions: the Royal Academy of Surgery (Acade´mie wounded. He also made the first resection of the humeral head Royale de Chirurgie) established in 1731 and the Royal Society of 20 Anthelme Richerand (4 February 1779 – 23 January 1840), Medicine (Companie Royale de Me´decine) established in 1776 surgeon and physiologist and as surgeon to the Hospital Saint 28 Quarante anne´es de pratique chirurgicale, par Roux Ph-J. Notice sur Louis. In 1807 he was appointed Professor of Surgical Pathology la vie et les travaux de Roux Ph-J, par Re´ne´ Marjolin, Paris 1854 in the Faculte´ de Me´decine in Paris 29 Roux Ph-J, 1854:vii 21 Relation d’un voyage fait a` Londres en 1814, or Paralle`le de la 30 Busquet P. Roux (Philibert-Joseph). Paris: Les Biographies chirurgie anglaise avec la chirurgie franc¸aise, pre´ce´de´ de conside´rations Me´dicales, 1930 sur les hoˆpitaux de Londres, faits et remarques pour servir a` l’histoire 31 Fr Dubois. E´ loge de Roux. Paris: Me´moires de l’Acade´mie de de l’ane´vrysme arte´rio-veineux, par Roux Ph-J, Paris 1851 Me´decine, 1857 22 Palluault F. Medical students in England and France 1815–1858. 32 Marjolin R. Notice sur la vie et les travaux de Ph-J Roux. Paris, 1855 A comparative study. PhD thesis University of Oxford, Faculty of 33 des Carrie`res D. Roux, sa vie, son œuvre. Bulletin de la Socie´te´ des Modern History – History of Science 2003:9 Sciences de l’Yonne, 1870