SURGEONS
Philibert Joseph Roux (1780–1854)
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- Helene Perdicoyianni-Paleologou
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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
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- as a surgeon to the Hopital Beaujon (1806), the Hopital de la Charite (1810) and to Hotel-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
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surgery has also included the publication of Quarante annees 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 Auxerre, a commune in the Bourgogne region in
Medical studies
- north-central France. His father, Jacques Roux,
- At the suggestion of his father he continued his
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ˆa Surgeon-in-Chief first at the Hotel-Dieu in Paris and medical studies in Paris. He presented himself at the
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- later at Ecole Militaire in Auxerre, treated him with
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Concours d’Entree to the Val-de-Grace but failed com-
´great harshness and severity in response to his idleness prehensively. He then decided to study at the Ecole de
´and intemperance. He forced him to enrol in the Ecole
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- Medecine. His father allowed him 50 francs per month
Militaire, directed by monks of the Order of Saint Benedict,2 with the intention of making him an Engineer of the Bridges and Roads3 but after a short time he changed his mind and had him attend classes for his medical education. Since this was insufficient to pay for daily expenses, pursuit of dissections and admission to private lectures, he turned to the gaming table and lost his entire month’s allowance.
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- in surgery at the Hotel-Dieu.
In 1798 he attended the private lectures on anatomy
offered by Marie Franc¸ois Xavier Bichat8 who became a close and devoted friend. Bichat chose him as instructor for the younger students and his assistant in performing experiments. Afterwards Roux was appointed Prosector.9 In 1799 he enrolled in the Lectures on External Pathology and Clinical Medicine offered respectively by Alexis Boyer10 and Antoine Dubois.11 In collaboration with Matthieu Bichat, a cousin of Franc¸ois Xavier, he wrote the first lecture of Bichat on General Anatomy and a portion of the Descriptive Anatomy.
In 1796 Jacques Roux suggested his son enrol in the army. The young Philibert was appointed an Officier
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´de Sante, third class, in the army of Sambre et Meuse and was sent off to Andernach.5 Later he was moved to the Military Hospital at Aix-la-Chapelle where he was assigned to emergency services. As his pay was only 200 francs a month, he had to be inventive in order to obtain adequate rations. In 1790 the Military Surgeons were accorded rations and hereafter were saved from the danger of dying of famine. This hard life ended with the ratification of the Treaty of Campo Formio.6 After the disbanding of the army he returned to his family.
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In 1801 he was admitted to the Ecole Pratique by
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
´presented himself at the Concours d’Entree for the
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Helene Perdicoyianni-Paleologou is a specialist in Greek and Latin philology and linguistics, and holds a PhDs in Classical Greek Philology and in Latin Linguistics (Sorbonne University). She has also been the recipient of two post-doctoral research positions in Classical Greek and Early Byzantine Papyrology (Sorbonne University) and Epigraphy (Besanc¸on University). Since 1996 when she arrived at Hellenic College/Holy Cross she has been teaching. She was also appointed Visiting Scholar in the Departments of Classics and Linguistics of Harvard, Brown and Stanford Universities, as well as a Guest Visiting Scholar at Harvard Divinity School and Research Associate in the Centre of Studies for Ancient Documents (Oxford University). She studied the History of Greek Medicine with Professor Jacques Jouanna (Sorbonne University) and Mirko Grmek
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- Assistance-Surgery, second class, at the Hotel-Dieu but
was not selected. The successful candidate was his rival, Antoine Dupuytren.12
When Bichat died on 22 July 1802, Roux succeeded him and taught courses in anatomy, physiology and operative medicine, held initially at the Cloister of Saint-Jean de Beauvais and later in an amphitheatre in Rue Huchette in the heart of Paris. Although he gave these assignments his primary attention, he did not give up writing. In 1803 he defended his Doctoral
Thesis, Coup d’oeil physiologique sur les secretions, and
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- (Ecole des Hautes Etudes, Section IV). Correspondence: Helene
Perdicoyianni-Paleologou, Research Fellow Classics, HC/HC, Visiting Scholar, Brown University, 44 Washington Street, suite 403, Brookline, MA 02445, USA (email: hperpal@hotmail. com)
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- Adjunct Professor of
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published the fifth volume of the Traite d’anatomie descriptive that Bichat had not completed. His fervent 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-
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graphic fragments in Melanges de Chirurgie. In these he described in detail the three operations he had undertaken at the Beaujon.
In 1810 he married the daughter of Alexis Boyer who
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- soon introduced him to La Charite Hospital
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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 Raphael Bienvenu Sabatier.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
soft palate in order to remove a nasopharyngeal polyp. He had left the palate open but realized that suture should be possible later. The patient declined the second operation. In 1783 Eustathe submitted a detailed description of a proposed method for repairing the soft palate to the Academy of Surgery in Paris. However, on 12 August 1784 Dubois declared the operation to be unfeasible and rejected the proposal. It was not until 1816 that Karl Ferdinand Von Graefe reported to the Medico-Chirurgical Society of Berlin that he had at last achieved success in closing fissures of the soft palate, freshening the edges with muriatic acid and a solution of cantharides and then joining them with sutures. In 1819 Roux modified Graefe’s operation by closing the cleft palate with three sutures across the cleft, paring the edges, attaching the sutures and drawing the raw surfaces together25 and in 1825 he published the details.26
In 1820 he succeeded Percy in the Chair in Surgical
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 the Chair in Clinical Surgery. In 1832 he became the first surgeon to stitch a ruptured female perineum. In 1834 he succeeded Alexis Boyer at the Academy of Sciences.
London, 1814
In 1814 Roux spent a month in London. He was one of the few eminent French physicians during that period who travelled to London and witnessed their British colleagues at work. In the book Relation d’un voyage fait
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`a Londres en 1814
he compared the French and
English surgical schools and admitted there was equal development of surgical procedures in the two countries. However, he asserted ‘the rational organization of the Paris Faculty of Medicine presented more guarantees of adequate training than the London schools’.22
In 1815 Roux (Figure 1) was awarded the grade of
Chevalier of the National Order of the Legion of Honor23 and in 1831 that of Officier. In 1817 he delivered a lecture at the Academy of Sciences24 during which he made out that he had operated on more than 700 patients suffering from cataracts, with an estimated success rate of 10%.
Cleft palate surgery
In 1819 he operated successfully on an English student suffering from cleft palate. The first cleft closure had been made in 1764 by the French dentist Le Monnier, who succeeded in closing a fissure in the palate by paring the edges and stitching them together. In 1779 after studying the problems of feeding and speaking caused by a cleft palate, Eustathe, a physician of the town Beziers in Languedoc, had occasion to divide the
When Dupuytren died in 1835 Roux succeeded him
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- as Chief Surgeon at Hotel-Dieu and here he had to face
devoted followers of Dupuytren and defamatory statements impugning his professional honour although his surgical skills and expertise soon made his adversaries change their minds and, indeed, come to feel a deep
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H Perdicoyianni-Paleologou Philibert Joseph Roux (1780–1854) 159
ˆadmiration for him. He stayed at the Hotel-Dieu for nearly 20 years.
Broca (1824–80), immediately contacted the editor, Victor Masson. In keeping with the committee’s decision, they undertook the task of revising the proofs and of arranging and checking the manuscripts.
Final illness
His contribution to surgery was praised by Paul
Busquet,30 Frederic Dubois (1799–1873),31 Rene
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On 2 January 1854, on his way to a session of the Academy of Sciences of which he had been elected President, he suffered a stroke and died on 3 March
Marjolin (1812–95)32 and Dionis des Carrieres.
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1854. He had finished writing the four volumes of his
References and notes
28
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- book Quarante Annees de Pratique Chirurgicale (Figure 2),
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- Hotel-Dieu de Paris, the most ancient hospital in Paris, was
which he considered to be a set of briefs based on clini-
founded by Saint Landry in 651, Bishop of Paris, a symbol of charity and hospitality
cal facts,29 and he had nearly completed preparing for
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- The Order of Saint Benedict or Order of the Benedictines was
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publication the first two volumes, Chirurgie Reparatrice
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- established in 529 by Benoıt de Nursie. This Roman Catholic
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- and Maladies des Arteres.
religious order is constituted of members that observe the Rule of Saint Benedict and belong to the Benedictine Confederation
As a tribute to the memory of this surgeon and to save the valuable results of his extensive experience from oblivion, on 27 April 1854 and at the suggestion of Felix-Hyppolyte Larrey (1808–95), the Society of Surgery of Paris decided that a five-member committee should seek permission from his family to complete the publication of the first two volumes. This proposition was approved and the committee, composed of Antoine Danyau, Felix-Hippolyte Larrey, Adolphe Lenoir (1808–
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The Corps of Bridges and Roads (Ingenieurs des Ponts and des
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Chaussees) is composed of State Engineers of Bridges and Roads. It was created in 1717 in order to assure the establishment of an effective transport truck network in France The Army of Sambre-et-Meuse is the best known of the armies of the French Revolution. It was constituted of the Army of the Ardennes, the left wing of the Army of Moselle and the right wing of the Army of the North. On 29 September 1797 the Army of Sambre-et-Meuse joined the Army of Rhin-et-Moselle under the title ‘Army of German’
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66), Leon-Athanase Gosselin (1815–87) and Pierre-Paul
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Andernach is Germany
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- town in the district of Mayen-Koblenz in
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
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The Val-de-Grace (Hopital d’instruction des armees du Val-de-Grace,
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or HIA Val-de-Grace) is a military hospital. On 9 August 1850 the Ecole d’application de Medecine Militaire was founded. In 1993 the Ecole became Ecole d’application du Service de Sante des Armees and represents the first French academic military ´
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´hospital centre 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
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- 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’
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- 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 especially forceps
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- new generation of surgical instruments,
12 Guillaume Dupuytren (5 October 1777 an anatomist and military surgeon was known for treating Napoleon Bonaparte’s haemorrhoids and for developing
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- 8 February 1835),
asurgical technique to fix the tissue defect known as ‘Dupuytren’s contracture’ which he described in 1831
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13 The Beaujon Hospital (Hopital 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
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14 La Charite Hospital (Hopital de la Charite), a hospital founded in
Paris in 1613 under the auspices of Marie de Medici and closed in 1935
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15 Nouveaux elements de medecine operatoire, 2 vol. Paris: Mequignon-
Marvis
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- 16 Raphael Bienvenu Sabatier (11 October 1732 – 19 July 1811),
anatomist and surgeon, was a consultant-surgeon to Napoleon
- Bonaparte and a pre-eminent authority on the development of
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- Figure 2 Title page of Quarante Annees de Pratique Chirurgicale
160 Journal of Medical Biography Volume 19 November 2011
´urology and on its recognition as an autonomous medical discipline
23 The National Order of the Legion of Honor (Legion d’honneur,
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- or Ordre National de la Legion d’honneur) was established by
- 17 Jean-Nicolas Marjolin (6 December 1780
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- March 1850),
- Napoleon Bonaparte on 19 May 1802. The Order is the highest
decoration in France and is divided into five degrees: Knight (Chevalier), Officer (Officier), Commander (Commandeur), Grand Officer (Grand Officier) and Grand Cross (Grand Croix) a surgeon and member of the National Academy of Medicine
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(Academie de Medecine). In 1815 he published a manual on
- anatomy (Manuel d’anatomie) for his students, giving
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´comprehensive view of the dissection of the corpse. Moreover, he is remembered for first describing in 1828 the occurrence of ulcerating lesions within scar tissue. Marjolin’s ulcer is defined as a ‘squamous carcinoma developing in a chronic benign ulcer, e. g. a varicose ulcer, an old unhealed burn, or a wound scar’. Sir AS MacNalty, ed. British Medical Dictionary. London 1961, 876
24 The French Academy of Sciences (Academie des Sciences) was one of the earliest academic societies of sciences in Europe, established in 1666 by Louis XIV at the suggestion of JeanBaptiste Colbert to encourage and protect French scientific research
25 On Roux’s method see: Jones G. A short history of anaesthesia for hare-lip, cleft palate repair. British Journal of Anaesthesia 1971;43:796. See also: Sherman HM. Points in the management of cleft palate cases, before, during, after operation. California State
Journal of Medicine 1902;1–2:44–7
- 18 Philippe-Jean Pelletan (4 May 1747
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- 26 September 1829),
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- a surgeon at the Hotel-Dieu de Paris taught at the Ecole de
´Medecine where he excelled by his eloquence, being given the appellation of ‘the Chrysostom of Surgeons’ (‘le Chrysostome des chirurgiens’) or ‘Golden mouth’ (‘Bouche d’or’)
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26 Memoire sur la staphylorraphie, ou suture du voile du palais.
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- 19 Pierre-Franc¸ois Percy (28 October 1754
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- 10 February 1825),
Archives Generales de Medecine, Paris 1825;7:536–8
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- doctor and Surgeon-in-Chief of the Army during the
- 27 The National Academy of Medicine (Academie Nationale de
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- Revolution and the Empire. Percy invented the ‘chirurgie mobile’
where surgeons and their instruments were brought close to the front from where they would jump off their ‘wurst’, eg a large and long four-wheel carriage, to take care promptly of the wounded. He also made the first resection of the humeral head
Medecine) was founded in 1820 by Louis XVIII at the urging of Baron Antoine Portal. Initially known as the Royal Academy
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- of Medicine (Academie Royale de Medecine), it was comprised
´of two institutions: the Royal Academy of Surgery (Academie Royale de Chirurgie) established in 1731 and the Royal Society of
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- 20 Anthelme Richerand (4 February 1779
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- 23 January 1840),
- Medicine (Companie Royale de Medecine) established in 1776
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surgeon and physiologist and as surgeon to the Hospital Saint Louis. In 1807 he was appointed Professor of Surgical Pathology
28 Quarante annees de pratique chirurgicale, par Roux Ph-J. Notice sur
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