Istoria medicinei Chirurgia (2011) 106: 567-572 Nr. 5, Septembrie - Octombrie Copyright© Celsius A neurologist in the origin of European and International neurosurgery: Clovis-Julien-Désiré Vincent (1879-1947) G. Androutsos1, M. Karamanou1, M. Lymberi2, T. Zambelis3, E. Stamboulis3 1History of Medicine Department, Medical school, University of Athens, Greece 2Experimental Physiology Department, Medical school, University of Athens, Greece 3Department of Neurology, Aeginition Hospital, Medical school, University of Athens, Athens, Greece Rezumat interested in pituitary tumors, in cerebral abscesses and in cerebral oedema. Un neurolog la originea neurochirurgiei europene æi internaåionale: Clovis-Julien-Desire Vincent (1879-1947) Key words: Clovis Vincent, Joseph Babinski, neurology, neuro- Vincent Clovis a început cariera sa ca neurolog æi în final a surgery devenit neurochirurg la o vârstã înaintatã. El este considerat formatorul neurochirurgiei franceze æi dupã Harvey Williams Cushing, primul neurochirurg european. El a fost interesat mai ales de tumorile pituitare, abcesele cerebrale æi edemul cerebral. His life and carrier Cuvinte cheie: Clovis Vincent, Joseph Babinski, neurologie, He was born at Ingrès on September 26, 1879. His father, neurochirurgie Laurent-Frederick, was a doctor, as well as his grandfather. Vincent's spirit of independence as a teenager was already manifested, since high school of Orléans, when he gives the impression of protester from his very outset. But when at the end of school his illness kept him at home, he suddenly Abstract imposed, spontaneously, a rule of strict work. Helped only Vincent Clovis began his carrier as a neurologist and finally by a few correspondence courses, the previously mediocre became neurosurgeon at an advanced age. He is considered the student had perfectly prepared for his bachelor's degrees. founder of French neurosurgery, and after Harvey Williams During his medical studies in Paris, he had also a revealing Cushing, the Europe’s first neurosurgeon. He was mainly behavior. Attentive disciple, Vincent quickly discerned the tutors whose teaching would be beneficial; he drew out eagerly from their knowledges the necessary elements for his education, without being submitted to their influence though. His willingness beamed so intensively that imposed on every- Corresponding author: Marianna Karamanou M.D. one in each and every occasion (1). 4 str. Themidos, 14564, Kifissia, Athens, Greece During his years of internship he was student of dermato- Tel: +30 6973606804, Fax: +30 2108235710 logists and neurologists: Auguste-Louis Queyrat (1856-1933), E-mail: [email protected] Achille-Alexandre Souques (1860-1944), Joseph Babinski 568 (1857-1932) Jean Nageotte (1866-1944), Georges Thibierge endless debates that were reigning in this specialty. The (1859-1926), Fulgence Raymond (1842-1910) and Henri- clinical and nosological progress achieved by his predecessors Charles-Jules Claude (1869-1946). But they were too many did not seem to assent to real relief. Instead, Babinski showed masters for him. He had to choose. So, he chose neurology. In him what a profound joy could give the surgical successes Babinski, especially, he found what suited him: observation, achieved in America and England against the so-called silence, patience, slowness or a scruple of expression that incurable lesions. seemed to add to meditation and authenticity (2). His constant desire for development encourages Vincent In 1909, after a competition he took the gold medal for to invent new methods. With his friend Thierry de Martel, internship. He spends the additional year of internship he considered medicine as a sport of the mind and they earned by the the gold medal, with two great professors, wanted to acquire full control of the emerging technologies Marie-Émile-Anatole Chauffard (1855-1932) and Georges- which began in the early 20th century, to enter into all Charles Guillain (1876-1961), while he sacrificed part of his branches of medicine (5). time to complete his outstanding doctoral thesis: Chronic However they were severely criticized by seniors who syphilitic meningitis. The nerve damage of the brain (1910) were seeing in the introduction of these new methods the (3). Like Jean-Nicolas Corvisart (1855-1821) and Théophile- degradation of the work of the rational mind and its replace- René Laennec (1781-1826), he worked with perseverance to ment by an automated system. educate the sense of information, he learned to listen, Vincent stressed also the importance of good physical watch, see, feel, waiting for a sign of a reflex, observe the res- shape maintenance, imperative in a discipline as exhausting as piratory modalities, the stages of a coma, the most tenuous neurosurgery. "Physically, he wrote, the job of a neurosurgeon differences of consciousness. In 1913 he was appointed is painful, the operations are long....Then there is the moni- hospital physician (2). toring of postoperative recoveries, through day and night.... In 1914, at his request, he was assigned to an infantry The neurosurgeon must be physically trained as an Olympic battalion. At the end of 1916, he deliberately left the champion”. In 1945, he added: “If neurosurgery gives joy like Neurological Center in Tours to return to the front, and no other ... it makes the surgeons real slaves.... The last fifteen received the Legion of Honor as physician to the 46th infantry years, almost day and night, my life has been confused with regiment. The war had to offer to Vincent several opportuni- that of neurosurgery” (6). ties to show some originality in both behavioral and admirable It was in 1930 that finally Vincent separated from Thierry virtues. In the post of neurologist, he would be as original and de Martel, for whom he was sharing fraternal affection. brave as he was at the front, and particularly rough against Charles Jacques Bouchard (1837-1915) who dominated in cheaters. Trained before the war to detect hystericals, disease medicine for years with dictatorial ways denied the title of simulators, he thought he discovered a large number of rogues Associate professor to Babinski. This autocracy had marked who imitated the symptoms, stood resolutely away from the Babinski, who passed that bad memory to Vincent (7). fighting, filling the hospitals of the rear. Vincent could not Babinski brought in some way, the neurosurgery in tolerate this hideous spectacle. He invented a method of France from Sir Victor Horsley (1857-1916), by operating in electric shock with which he hoped to distinguish the real Paris, the first tumor of the spinal cord and from Paul Lécène from the fake sick. This initiative, inspired by patriotism and (1878-1929), who was the first French surgeon involved in a exemplary loyalty, but perhaps with little concern for chari- similar case. ness, raised strong protests. Much criticism raised against the Vincent himself had requested, before the war, his friend person who was seeking to protect the good soldiers against Thierry de Martel (1876-1940), to do to some brain tumors, the guile of the bad ones, and who refused to permit the what Babinski had teached him in foreign trials. Gradually, deceiving of the honest people by the crooks, when the thanks to Vincent and other Babinski's students, Jean- gathering of all the forces of the country seemed necessary. Alexandre Barré (1880-1967) and Auguste Tournay (1876- Vincent, with his little harsh but harmless method, came 1969) in particular, Martel became the Babinski's neuro- gradually to make valid many soldiers in the battle formations, surgeon, who did not give easily confidence. As for Lécène, considered until that moment as unfit, by ignorance or he realized that it was impossible to perform both general complicity. He didn't seek to reach to the sources of hysteria, surgery and neurosurgery. because, in those times of emergency, if he had to submit them Martel did everything he could to be aware of neuro- to the slow complacent dialogue form of psychological analy- surgery of that time. He visited, in fact, the masters of the sis, the therapeutic success would be scarce and delayed (4). specialty, Horsley, Harvey Cushing (1869-1939), and soon he had many patients to treat. He operated the second spinal From neurologist to neurosurgeon tumor that was cured in France, he introduced the retro- gasserian neurotomy (Frazier's operation) and he endowed Vincent's return to Paris as a war hero brought him back to his the instrumentation with a very ingenious trepan, which master Babinski. Next to him, he began a new cycle of works. attained big success everywhere. His great knowledge and talent on classical neurology was Although Babinski and Vincent were disappointed by astonishing; even so, he couldn't accept the therapeutic the severe postoperative complications of their patients, in scepticism or the theorist and academic bearing because of the the same period Horsley and Cushing had excellent post- 569 operative results. A century ago any man suffering from admirable knowledge of brain and lesions. Cushing operated his brain tumor succumbed after suffering overwhelming patients having around him all of his assistants, gathered in a headaches, and sometimes, after having become blind for large cohesive team and being happy to obey such a leader. many months. Any patient suffering from paralysis due to Having learned during this first trip, the value of a compression of the spine by tumors, even benign, could not diagnosis more accurate than those which he already knew to leave his bed where he had to pass very miserable years, do, and the number of specialized collaborators that a neuro- before being defeated by painful complications. Many surgeon must at all costs obtain for help, if his ambition is the patients with facial neuralgia felt their pain exasperate so perfect clinical and proper preparation of the patient before mercilessly that suicide was the only thing they could think the surgical procedure: having seen how the cerebral hemi- of. For the majority of such patients, the situation in spheres should be treated, differently than ordinary tissues, if several countries began to be reversed (8).