WORKERS IN SPECIAL DEPARTMENTS OF SURGERY: DEMOURS, DESCEMET, DELPECH, FAUCHARD, JOURDAIN, GARIOT

In modern times such special departments as those devoted to the care of the teeth, mouth and jaws, to the remedying of defective eyesight and other affections of the eyes, to the care of the organ of hearing, and to the cure of the different disorders of the pharynx, larynx and nasal cavities, have assumed the importance of independent fields of surgical activity, and as such they demand and are receiving to-day the attention which they deserve. But during the eighteenth century the practicing physician was expected to possess the knowledge and skill necessary for the relief or cure of all such bodily ills, and he was forced to accept the duties growing out of these problems as a regular part of his day’s work. In the estimation of the general public the holder of the degree of M.D. was credited—up to a comparatively recent date—with the possession of knowledge sufficient for the cure of all bodily ills; and one can now easily imagine how greatly most of these men must have suffered from the feeling that they were playing a false and ignoble part whenever they accepted—as they did in many cases of this nature—a degree of responsibility which they were wholly unable to bear.

In the present chapter I shall discuss very briefly only these three specialties: eye surgery, orthopedic surgery and dental surgery.

In the Middle Ages there seem to have been at least two men who were really skilled in eye surgery and who were widely known in the southern portion of Europe as possessing exceptional knowledge and skill in the treatment of this class of maladies. I refer to Pierre Franco, of Lausanne and Orange, and to Demosthenes of Marseilles. (Brief references to the work of these two will be found in the volume on “The Growth of Medicine.”) Then at Vienna, Austria, as I have stated on a previous page, there were, in the early part of the eighteenth century, Beer, Rosas, and perhaps one or two others, who did excellent work in eye surgery, and whose writings on this subject are still to-day held in high esteem as trustworthy authorities. In France, on the other hand, there were only two men who, in the early part of the eighteenth century, seem to have devoted their time and skill to the relief of affections of the eye—viz., Demours and Descemet.

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Pierre Demours was born at Marseilles in the early part of the eighteenth century, began the study of medicine at Avignon, and then went to Paris for the completion of his professional training. He received his doctor’s degree, however, at Avignon in 1728, probably because the graduation fees in the latter city were not so large as those required in Paris. At a still later date he returned to the capital for the further prosecution of his professional studies, and while there he was given the appointment of Assistant to Duverney, the celebrated anatomist, who at that period, despite his advanced age (eighty years), was still actively engaged in research work. Two years later, upon Duverney’s death, Demours was invited to accept the associated positions of Demonstrator and Custodian of the Cabinet of Natural History at the Jardin du Roi. He had occupied these positions only a short time when Jean-Louis Petit, the celebrated French surgeon, who had observed the excellent character of the work performed by Demours, advised him to direct his studies more particularly to the anatomy and maladies of the eyes. Demours was quite ready to accept this advice, and thus it came about that in a few years he acquired considerable reputation as a successful practitioner in affections of the eye, a reputation which he continued to hold up to the time of his death on June 26, 1795.

Among the contributions which Demours made to the literature of ophthalmology the following deserve to receive special mention:—

Letter to Petit giving the report of an eye complication that developed as the result of an inoculation with the virus of small-pox; together with an account of some new observations relating to the anatomy of the eye and a few general comments on diseases of that organ; Paris, 1767.

A new series of remarks upon certain features in the anatomy of the cornea; Paris, 1770.

Observations on the structure of the corpus vitreum; Paris, 1741.

Observations on the cornea; Paris, 1741.

Dissertation on the mechanism of the movements of the pupil and on certain characteristics of the fibrae rectae of the uvea, in “MÉmoires des Savans Étrangers,” tome II.; and the following articles in the “Journal de MÉdecine” edited by Vandermonde: “On an affection of the eyes which sometimes develops after a perfectly faultless cataract operation (extraction),” in tome XVI.; “Reply to Monsieur Descemet’s article on the cartilaginous layer of the cornea,” in tomes XXXI. and XXXIII.

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Jean Descemet, born at Paris on April 20, 1732, was the pupil and friend of Duhamel-Dumonceau, one of the greatest teachers of that period and an enthusiastic scientist, but not a physician. Vicq-d’Azyr says that the list of the papers which he published during his lifetime (he was eighty-two years old at the time of his death) is very long and reveals the fact that he was interested in a great variety of topics, the majority of them relating to commerce, the arts, vegetable physiology, agriculture, and marine questions. To Descemet the influence of such a powerful mind, so enthusiastic and yet so precise in all its operations, could not fail to have been very great, and one of its earliest effects was to lead him to take a strong interest in botany and in anatomical research work. His graduation thesis, which—in accordance with the prevailing custom—he publicly defended early in 1758, dealt with the subject of the minute anatomy of the cornea and the lens. As the investigations which he made in regard to these important structures were strictly original, the scientific authorities accorded to him the honor of having his name attached to the membrane which lines the internal face of the transparent cornea, and which at the same time envelopes the aqueous humor. The reason why this membrane was selected by preference was this: Descemet was believed to have been the first person to describe in great detail this previously unknown structure. Demours, in 1767, published an article in which he claimed that the honor of this discovery belonged to him and not to Descemet. I cannot pretend to decide upon the justice of this claim; but, so far as I am able to learn, nobody has in modern times seriously disputed the propriety of retaining the name “Descemet’s membrane.”^[25]

Descemet was held in high esteem by all his associates in the Paris Faculty of Medicine. He was generally recognized by the medical men of France to be a skilled anatomist and a careful and trustworthy observer. The various offices which he held at one time or another in the course of his active life give further proof of the correctness of the estimate which I have furnished of this admirable French physician. His death occurred at Paris in 1810.

Among his published writings the following deserve to receive special mention:—

“An sola lens crystallina cataractae sedes?”—Paris, 1758.

“Catalogues of the garden plants cultivated by the apothecaries of Paris,” Paris, 1759.

“MÉmoire et observations sur la choroÏde, etc.,” in “MÉmoires des Savans Étrangers de l’Academie Royale des Sciences,” tome V., 1768.

In the last-named article valuable information is furnished with regard to the membrane which bears his name. Here, for instance, is revealed the fact that with advancing age the attachment of the membrane to the cornea gradually becomes less firm until finally, at the age of about sixty, it becomes completely detached.

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Jacques Delpech was born at Toulouse, in the south-western part of France, in 1772. After he had completed his preliminary studies at Toulouse he went to Montpellier, took the regular course in medicine at the university, and was given the degree of Doctor in Surgery in 1801. While residing in that city he acted as an Officier de SantÉ in one of the military hospitals. The following year he was given the position of Instructor in Anatomy at the Toulouse Medical School, which at that period bore the title of “SociÉtÉ de MÉdecine et de Pharmacie.” It was here that he first manifested his great gifts as a teacher, his success in this respect being truly remarkable. In 1812 he offered himself, along with several other competitors, as a candidate for the chair of clinical surgery in the Faculty of the Montpellier Medical School, and was given this coveted position. It should be stated, however, that previous to this event, for a period of several years following his brief service as an instructor in anatomy at Toulouse, he had devoted himself with great zeal and thoroughness to the study of surgery in Paris, and was therefore specially well prepared for this competitive test. In the new field in which, from this time forward to the end of his career, he worked with unflagging enthusiasm, Delpech had ample opportunity to show to the world his great talents as a teacher of surgery.

There was one branch of surgical work in which he took a greater interest than in all the others, made many ingenious discoveries, and thus gained great distinction; I refer to the pathology and treatment of deformities, the science of orthopedics. He not only built up a large practice in cases of this nature, but he also wrote a valuable treatise on the subject. This work, which was published in Paris in 1828–1829, bears the title: “De l’Orthomorphie, par Rapport À l’EspÈce Humaine, ou Recherches Anatomico-Pathologiques sur les Causes, les Moyens de PrÉvenir, Ceux de GuÉrir les Principales DifformitÉs, et sur les VÉritables Fondemens de l’Art AppelÉ OrthopÉdique.” It is, briefly stated, a complete treatise on the pathology and treatment of deformities of the human frame, one of the first (possibly the very first) of its kind published in a modern language. From statements which he makes in the course of his text it appears that Delpech recognized at an early date that it is upon the muscles surrounding a joint that its solidity is chiefly dependent, and consequently that all lesions involving the muscular apparatus in the neighborhood of a joint are very potent factors in the causation of deformities. In addition, he states that the absence of exact fitting of two opposite articular surfaces, one upon the other, during the period of development of the skeleton, constitutes another and very important cause of deformities both in the limbs and in the trunk. To these general causes, he says, there may be added the following: muscular debility, the effects produced by certain attitudes of the body, by the paralysis and also by the contractures of certain muscles, by the effects of rheumatism, by softening of the bones, etc.

In other sections of the treatise he discusses in a most practical and interesting manner the subjects of diagnosis and treatment of deformities. In the remarkable orthopedic hospital which he established in Montpellier he treated, with enthusiasm and untiring faithfulness, large numbers of patients suffering from deformities of all sorts, thus gaining a wide experience in this particular class of cases, and constantly increasing his skill in treating them successfully.

In the earlier years of his practice Delpech also published an important paper on the subject of hospital gangrene, under the title: “MÉmoire sur la Complication des Plaies et des UlcÈres, Connue sous le Nom de ‘Pourriture d’HÔpital’”; Paris, 1815. This memoir is esteemed by his biographer to be the best treatise that had been written on hospital gangrene up to the year 1834.

Delpech, says his biographer, will always be classed as one of the most distinguished professors of the Medical School of Montpellier during the early part of the nineteenth century.

On the 28th of October, 1832, he was assassinated by a merchant of Bordeaux upon whom he had operated for varicocele during the preceding year, and who, immediately after killing his victim, destroyed his own life.

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Pierre Fauchard, A. Jourdain and J. B. Gariot.—Although it is the general belief that dentistry did not become a separate and independent branch of surgical practice until a comparatively recent date, there is nevertheless some evidence that efforts were made by certain surgeons, many years ago, to engage in this special field of work. The earliest record of this fact, so far as I have been able to discover, is furnished by Francis Gribble in his book entitled: “Lake Geneva and its Literary Landmarks.” According to his statement a dentist, toward the end of the sixteenth century, applied to the Governing Body of Geneva, Switzerland, for permission to settle in that city and practice his profession. As the civic authorities, however, did not appear to comprehend just how much risk, either to the bodies or to the souls of the Genevese, was involved in granting the desired permission, they referred the question to ThÉodore de BÈze, the great theologist, who, in the temporary absence of John Calvin, was acting as the Syndic or Mayor of the city. We are not told by Gribble how the matter was at last decided, but there can be scarcely any doubt that the dentist was finally permitted to hang out his shingle and go to work.

The explorations made among the ruins of ancient Egypt show that even at that remote period, three or four hundred years before the Christian Era, there were men who knew how to fill carious cavities in human teeth and to perform other surgical acts which call for the skill and knowledge of the practical dentist. But the discovery of such isolated facts does not demonstrate clearly that dentistry was practiced at that early period as a special department of the surgical art; and, furthermore, many centuries after that date elapsed before there was discovered any further evidence that dentistry had survived during the long intervening period. In fact, the records do not throw much light on this subject until we reach the seventeenth century. Then it appears that a certain Alexandre Poteler, during the latter part of that century, attained considerable celebrity, in France, as a skilful and experienced dental surgeon. Further details concerning this man are lacking.

Sprengel, in his history of medicine, mentions the names of several men—Germans, French and English—who during the early part of the eighteenth century occasionally performed operations in the field of dentistry, but among this number I find only three who appear to have attained eminence in their special line of work—viz., Pierre Fauchard, A. Jourdain, and J. B. Gariot. I will furnish here the few details which I have been able to obtain concerning the career of these men.

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Pierre Fauchard was born in France toward the end of the seventeenth century. After receiving the regular training of a physician he entered the service of the Royal Navy, ultimately attaining the rank of Surgeon-Major. Subsequently, having first taken a special course of instruction under Alexandre Poteler, he settled at Paris and practiced dentistry in that city for a period of more than fifty years. During the course of his career he published a treatise on the surgery of the mouth, and in the preparation of this work he received efficient aid from Jean Devaux (1649–1729), one of the most learned surgeons of his time in France. This treatise, according to the testimony of his biographer, contains many reports of cases which were observed by Fauchard in actual practice; and, he adds, the book still possesses considerable value as a work of reference. Among the unusual pathological conditions described and occasionally pictured the following deserve to receive special mention:—“Abscess or Softening of the Dental Pulp without Recognizable Alteration of the Cortical Substance” (relief was obtained by trephining the tooth); “Defective Teeth of Many Different Kinds,” and the proper manner of remedying such defects, both in cases where only a part of the tooth is defective, and also in those where it is found necessary to supply an entire tooth or even several teeth; “On the Art of Remedying Defects in the Palate”; “On the More Extensive Employment of Lead Fillings, etc.” The treatise here referred to bears the following title: “Le Chirurgien Dentiste, ou TraitÉ des Dents, etc.,” with 40 engraved plates; 2 vols., Paris, 1728; a second edition, which was published in 1746, contains many important additions.

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Anselme-Louis-Bernard-Brechillet Jourdain, who was born in Paris, November 28, 1734, was one of the most distinguished French physicians of the eighteenth century who devoted himself largely to the study and practice of dentistry. He was also interested in medical science generally, having acted for several years as an associate editor of the Journal de MÉdecine. Among the treatises which he wrote on topics relating to dentistry the following deserve to receive special mention:—“Nouveaux ÉlÉmens d’Odontalgie,” Paris, 1756; “TraitÉ des DÉpÔts dans le Sinus Maxillaire, des Fractures et des Caries de l’Une et de l’Autre MÂchoire; Suivi de RÉflexions et d’Observations sur Toutes les OpÉrations de l’Art du Dentiste,” Paris, 1760; “Essai sur la Formation des Dents, ComparÉe avec Celle des Os, Suivi de Plusieurs ExpÉriences, tant sur les Os que sur les Parties qui Entrent dans leur Constitution,” Paris, 1766; and “TraitÉ des Maladies et des OpÉrations RÉellement Chirurgicales de la Bouche et des Parties qui y Correspondent, Suivi de Notes, d’Observations Interessantes, tant Anciennes que Modernes,” Paris, 1772, 2 vols.

Jourdain’s death occurred on January 7, 1816.

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Jean-Baptiste Gariot was born in France during the latter half of the eighteenth century. The French records furnish very scanty information concerning his professional career. For example, among other matters of minor importance, it is stated that he was a member of the Royal College at Madrid, that he was the dentist of the King of Spain, and that he published a treatise which bears the following title: “TraitÉ des Maladies de la Bouche,” together with an account of the structure and functions of the parts that enter into the formation of the mouth, the diseases to which these parts are liable, the means that may be employed for maintaining them in health and beauty, and the different operations which belong specially to the domain of the dentist; with 15 plates, Paris, 1805.