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Baron Guillaume Dupuytren (1777-1835): One of the Most Outstanding Surgeons of 19Th Century

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Baron Guillaume Dupuytren (1777-1835): One of the Most Outstanding Surgeons of 19Th Century 239 19 Hellenic Journal of Surgery 2011; 83: 5 Baron Guillaume Dupuytren (1777-1835): One of the Most Outstanding Surgeons of 19th Century Editorial G. Androutsos, M. Karamanou, A. Kostakis Received 17/06/2011 Accepted 21/07/2011 Abstract 200,000 francs and also collections so that a museum Baron Guillaume Dupuytren is considered to be a of pathological anatomy could be established at the leading figure of surgery. Domineering and unfor- Faculty of medicine, the museum which today bears giving to those who were an obstacle in his career, his name. He also made an important bequest that he was unrivalled as a teacher and respected as an the faculty create a chair of pathological anatomy excellent surgeon. Regarded as the greatest surgeon for his friend and disciple Cruveilhier. of the 19th century, he introduced the anatomo-clin- ical method in surgery. Key words: Dupuytren, Eminent surgeon, Dupuytren’s disease, Anatomo- clinic method Life-studies Guillaume Dupuytren was born in the village of Pierre-Bouffière, the son of a constantly struggling lawyer (Fig.1). His eventful life began at the age of three when he was kidnapped by a lady who thought him charming and whisked him off in her carriage. At seven, he ran away from home, but was soon brought back and punished. Shortly afterward, a troop of hussars came along, fell under his spell and, surprisingly, got permission to take him with them to Paris. He studied Humanities at the Magnac-La- val College, then at the Marche in Paris (1789). At Fig. 1 The eminent surgeon Guillaume Dupuytren (1778-1835) the end of his studies (1793), he wanted to become a soldier. However, his father objected and forced He was appointed hereditary baron by Louis him to enroll at the Medical-Surgical School of the XVIII (1820). A member of the Safety Council, he St. Alexis Hospital in Limoges with the authoritar- was elected member of the Academy of Medicine ian injunction that he would become a surgeon. Du- on the section of surgery in 1820, and was chairman puytren accepted his father’s wishes but decided to by 1824. He also became a member of the Academy pursue his education in Paris. of Sciences’ in 1825, replacing Percy and Officer of One of the founders of the medical society of em- the Legion of Honour. ulation in 1796, in 1803 he founded the Anatomical On March 21, 1810, he married Geneviève Lam- Society. Upon his death, he left an endowment of bert de Saint-Olive in Paris, from whom he sepa- rated in 1826. They had a daughter Adeline Gen- eviève. He died on February 8, 1835. The autopsy con- firmed the expected lesions of cerebral infarction, bilateral tuberculous pleurisy which were incurable G. Androutsos, M. Karamanou (Corresponding author) - History of Medicine department, Medical school, University of at the time, as well as kidney stones [1]. Athens, Greece A. Kostakis, President of Hellenic Surgical Society - Biomedical Research Foundation, Academy of Athens, Greece Career e-mail: [email protected] In Paris, he followed the courses of Jean-Nicolas 20 240 Baron Guillaume Dupuytren (1777-1835): One of the Most Outstanding Surgeons of 19th Century Hellenic Journal of Surgery 2011; 83: 5 Corvisart (1755-1821), Alexis Boyer (1760-1833), rently do. His concern with burns also led to new Philippe Pinel (1745-1826) and Georges Cuvier plastic surgery for repairing skin defects and scars. (1769-1832). In 1795, he was named prosector at 6) Dupuytren’s contracture (Dupuytren’s disease) the the school of medicine in Paris and also gave pri- term given to a fibrous condition of the palms, often vate lessons of anatomy and physiology to increase found in older men, for which he devised an operation. his financial resources. Thereafter, he was to un- 7) Dupuytren’s fibrous body amputation (Syn. fibrous dertake several other positions - 1801: Chief of the ameloblastoma): Simple solid ameloblastoma, with anatomy department; 1803: Second surgeon at the fibrous appearance. Hôtel-Dieu hospital; 1808: Chief surgeon assistant 8) Dupuytren’s enterotome: consisted of two blades of Hôtel-Dieu hospital; 1809: General inspector which could be disarticulated for insertion into the for higher education in medicine; 1812: Profes- bowel and used for the treatment of artificial anus. sor of Surgery at Hôtel-Dieu hospital, replacing 9) Dupuytren’s spur (Syn. promontorium of Scarpa): Raphaël-Bienvenu Sabatier (1732-1811). From the partition separating the two intestinal orifices in an moment he is appointed professor, he is on equal artificial anus, formed by the projection of the deep footing with Philippe Pelletan (1745-1829) and as wall of the intestinal loop bent at an acute angle to such, he does everything in his power to make Pel- the skin and anastomosed. It is created to ensure letan’s life difficult and take his place as chief sur- a complete derivation of the faeces, but can some- geon of the Hôtel-Dieu hospital. He publicly dem- times be complicated by the gradual constitution of onstrates the inadequacy of his former master and a cavity. discredits him to his students, obliging Pelletan to 10) Dupuytren’s fascia (Palmar aponeurosis). concede his place in 1815. However, he has such 11) Dupuytren’s fracture (Syn. Pott’s fracture- Anglo- a need to dominate that he cannot even suffer the saxon term): Fracture of the instep by abduction, presence of other surgeons with him and forces his breaking both ankles (possibly including a third two assistants, Jean-Nicolas Marjolin (1780-1850) fracture of the posterior tibial margin), causing an and Thevenot of St. Blaise, to withdraw and leave outward and backward swerve of the foot compared him a free rein. In 1823, he is appointed a baron by to the axis of the leg. A better way of handling frac- Louis XVIII after becoming his personal surgeon; tures enabled him to achieve amazing results: he He retains this function during the reign of Charles once reported that after receiving his extension X (1757-1836). In 1835, it is Philibert-Joseph Roux treatment, 200 of 207 cases with “Pott’s fracture” (1780-1854) who succeeded him in the Hôtel-Dieu made a complete recovery. hospital [2]. 12) Dupuytren’s Hydrocele: Bilocular hydrocele of the tunicae vaginalis (perididymis). A bilocular hy- His contributions to surgery and medicine drocele in which the sac fills the scrotum and also extends Dupuytren is eponymously associated with: into the abdominal cavity beneath the peritoneum. 1) Dupuytren’s abscess (Syn. iliac phlegmon): Phleg- 13) Dupuytren’s disease (Syn. Dupuytren’s contrac- monous collection of small basin located in the vir- ture): Disease of unknown aetiology, characterized tual space between the muscle sheaths and the peri- by a retractile sclerosis of the palmar fascia, start- toneal serous of the iliac fossa. ing with palmar nodules and usually affecting both 2) Dupuytren’s amputation (Syn. Lisfranc’s amputa- hands. Very common and difficult to treat, this dis- tion): Amputation of the arm at the shoulder joint. ease may be associated with cervical arthritis (cervi- 3) Dupuytren’s splint: a) Splint for immobilization of cal spondylosis). Dupuytren’s fracture of fibula. b) splint for immobi- 14) Dupuytren’s Operation: a) Surgical technique for lization of a fractured wrist. the correction of congenital absence of the vagina, 4) Dupuytren’s cannula: Metal cannula covered with with a broad and deep, rectovesical cleavage to the gauze, attached to a circular groove in one extrem- Douglas pouch and the introduction of a cylindrical ity; it is used for drainage of urine in cystostomy or mandrin which is left there permanently. b) Subcu- haemostasis. taneous tenotomy of the sternal head of the sterno- 5) Dupuytren’s classification: Classification of burns cleidomastoid muscle. into six degrees of increasing severity: skin redness, 15) Dupuytren’s Paste: Paste made of arsenic triox- blisters, partial destruction of the skin, total destruc- ide, gum and mercurous chloride once used as a tion of the skin, charring of muscles; charring of the caustic agent. bone. He was the first to classify burns systemati- 16) Dupuytren’s Phlegmon: Diffuse neck abscess, de- cally, using six degrees rather than three as we cur- scribed by Dupuytren, in 1833 (obsolete term). 17) Dupuytren’s Pills: Pill containing 1 cg of mercu- 241 21 Hellenic Journal of Surgery 2011; 83: 5 Baron Guillaume Dupuytren (1777-1835): One of the Most Outstanding Surgeons of 19th Century rous chloride and 2 cg of opium extract, once used A giant of surgery with a special character in the treatment of syphilis. On September 9, 1815, when Dupuytren was ap- 18) Dupuytren Sign: a) movement of the head of the pointed chief surgeon of the Hôtel-Dieu hospital, he femur upon pulling on the leg, with shortening of the asked “that the processing be kept by Pelletan, his leg during its repression from the bottom up, caused old master”, to be continued until his death, in 1829. to the infant lying on its back, and return to a normal Etienne Pariset said in his eulogy: “However, when length with the traction of the member. This sign he appeared alone on the ruins of Pelletan, on the indicates an abnormal laxity of the articular capsule ashes of Bichat and Desault, a feeling of surprise, in congenital dislocation of the hip. b) Creaking per- mixed with anxiety and suspicion seized all minds” ceived from the pressure on a sarcomatous bone. [10]. According to J. Lisfranc and a story recalled (A clinical sign in which there is free up-and-down by J.F. Malgaigne, Dupuytren said then: “Con- movement of the head of the femur when traction is gratulate me.
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