Sunday, 12 January 2020

History of Medicine - Duchenne de Boulogne

The history of science fascinates me for many reasons. The most signficant being that it is a brazen example of the cumulative efforts of men and women separated by time & space but united through their ideas. Perhaps it is best described by the saying Isaac Newton popularised; "to be standing on the shoulders of giants". Today, I would like to briefly look at the history of neurology and see how (and why) many eponymous diseases and signs have obtained their names.
Duchenne de Boulogne

We start with Duchenne de Boulogne, a French neurologist in the 1800s, whose understanding of electrophysiology, neural pathways, diagnostic techniques have arguably made him a father of the speciality and one of the 19th century's original clinicians.

Born in Calais in 1805, he studied medicine in Paris and became a physician in 1831. At Paris, he was taught by the likes of Cruveilhier, Dupuytren, Velpeau, and Laennec (inventor of the stethoscope). He remained in Calais as a practitioner of general medicine until his wife died of puerperal fever in 1844. He returned to Paris to initiate his pioneering studies on electrical stimulation of muscles.

He pioneered the use of deep tissue biopsy using a trochar he constructed, and described an array of myopathies that bear his name today. This includes Duchenne's muscular dystrophy, Erb-Duchenne palsy amongst others.

Interestingly, he published a monographic album of the muscles involved in human expressions (see adjacent photo). This album would later serve as a resource for a young Charles Darwin in his own study on the genetics of behaviour.

Duchenne (right) and his patient, an "old toothless man, with a thin face, whose features, without being absolutely ugly, approached ordinary triviality".
Over the course of his career, he worked with Armand Trousseau, Pierre Rayer, and Jean-Martin Charcot - all of whom he described as his closest friends. Duchenne was a shy yet hard-working physician. Despite his contributions, he was never given any hospital appointments or academic chair, likely due to his modesty and speech difficulties when presenting at conferences. Most of his work would not have been published without the help of his friends, Trousseau and Charcot.

Duchenne died in Paris in 1875.

Duchenne had many students throughout his career passing down his methodology and theoretical knowledge, as was common for physicians in training the next generation. Perhaps his most famous student was Jean-Martin Charcot, the "founder of modern neurology" who has at least 15 eponymous medical diseases and signs named after him, and perhaps the bane of medical students worldwide. He will be covered in detail next time.

References:
1. Parent A. Duchenne De Boulogne: a pioneer in neurology and medical photography. Canadian journal of neurological sciences. 2005 Aug;32(3):369-77.
2. Broussolle E, Poirier J, Clarac F, Barbara JG. Figures and institutions of the neurological sciences in Paris from 1800 to 1950. Part III: neurology. Revue neurologique. 2012 Apr 1;168(4):301-20.

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