Philibert Joseph Roux

8/17/2019 Philibert Joseph Roux

1/4

SURGEONS

Philibert Joseph Roux (1780–1854)

Hélène Perdicoyianni-Paléologou

Summary: Philibert Joseph Roux (1780–1854), a French surgeon, was a student and friend of Marie Xavier François Bichat, the father of modern pathology and histology. He was assignedas a surgeon to the Hôpital Beaujon (1806), the Hôpital de la Charité (1810) and to Hôtel-Dieude 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 forhaving been the first surgeon to stitch a ruptured female perineum. His contribution tosurgery has also included the publication of Quarante anné es de pratique chirurgicale. Roux wasawarded 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 3March 1854.

Philibert Joseph Roux was born on 26 April 1780 at

Auxerre, a commune in the Bourgogne region innorth-central France. His father, Jacques Roux,a Surgeon-in-Chief first at the Hôtel-Dieu1 in Paris andlater at École Militaire in Auxerre, treated him withgreat harshness and severity in response to his idlenessand intemperance. He forced him to enrol in the ÉcoleMilitaire, directed by monks of the Order of SaintBenedict,2 with the intention of making him anEngineer of the Bridges and Roads3 but after a shorttime he changed his mind and had him attend classesin surgery at the Hôtel-Dieu.

In 1796 Jacques Roux suggested his son enrol in thearmy. The young Philibert was appointed an Officierde Santé, third class, in the army of Sambre et Meuse4

and was sent off to Andernach.5 Later he was moved tothe Military Hospital at Aix-la-Chapelle where he wasassigned to emergency services. As his pay was only200 francs a month, he had to be inventive in order toobtain adequate rations. In 1790 the Military Surgeonswere accorded rations and hereafter were saved fromthe danger of dying of famine. This hard life endedwith the ratification of the Treaty of Campo Formio.6

After the disbanding of the army he returned to hisfamily.

Medical studies

At the suggestion of his father he continued hismedical studies in Paris. He presented himself at theConcours d’Entrée to the Val-de-Grâce7 but failed com-prehensively. He then decided to study at the École deMédecine. His father allowed him 50 francs per monthfor his medical education. Since this was insufficient topay for daily expenses, pursuit of dissections andadmission to private lectures, he turned to the gamingtable and lost his entire month’s allowance.

In 1798 he attended the private lectures on anatomyoffered by Marie François Xavier Bichat8 who became aclose and devoted friend. Bichat chose him as instruc-tor for the younger students and his assistant in per-forming experiments. Afterwards Roux was appointedProsector.9 In 1799 he enrolled in the Lectures onExternal Pathology and Clinical Medicine offeredrespectively by Alexis Boyer10 and Antoine Dubois.11

In collaboration with Matthieu Bichat, a cousin of François Xavier, he wrote the first lecture of Bichat onGeneral Anatomy and a portion of the DescriptiveAnatomy.

In 1801 he was admitted to the École Pratique byobtaining first prize in recognition of his outstandingachievements and in 1802 delivered a series of lectureson Operative Surgery in which he presented a newclassification of surgical diseases. In the same year he

presented himself at the Concours d’Entrée for theAssistance-Surgery, second class, at the Hôtel-Dieu butwas not selected. The successful candidate was hisrival, Antoine Dupuytren.12

When Bichat died on 22 July 1802, Roux succeededhim and taught courses in anatomy, physiology andoperative medicine, held initially at the Cloister of Saint-Jean de Beauvais and later in an amphitheatre inRue Huchette in the heart of Paris. Although he gavethese assignments his primary attention, he did notgive up writing. In 1803 he defended his DoctoralThesis, Coup d’oeil physiologique sur les secretions, andpublished the fifth volume of the Traité d’anatomiedescriptive that Bichat had not completed. His fervent

interest in surgery was also demonstrated in his

Hélène Perdicoyianni-Paléologou is a specialist in Greek and Latinphilology and linguistics, and holds a PhDs in Classical GreekPhilology and in Latin Linguistics (Sorbonne University). She has also been the recipient of two post-doctoral research positions in ClassicalGreek and Early Byzantine Papyrology (Sorbonne University) andEpigraphy (Besançon University). Since 1996 when she arrived atHellenic College/Holy Cross she has been teaching. She was alsoappointed Visiting Scholar in the Departments of Classics andLinguistics of Harvard, Brown and Stanford Universities, as well as aGuest Visiting Scholar at Harvard Divinity School and ResearchAssociate in the Centre of Studies for Ancient Documents (OxfordUniversity). She studied the History of Greek Medicine withProfessor Jacques Jouanna (Sorbonne University) and Mirko Grmek(École des Hautes Etudes, Section IV). Correspondence: HélènePerdicoyianni-Paléologou, Research Fellow – Adjunct Professor of Classics, HC/HC, Visiting Scholar, Brown University, 44 WashingtonStreet, suite 403, Brookline, MA 02445, USA (email: [email protected])

Journal of Medical Biography 2011; 19: 157 –160. DOI: 10.1258/ jmb.2010.010057


2/4

publishing between 1802 and 1808 classifications andtabular 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-graphic fragments in Mé langes de Chirurgie. In these hedescribed in detail the three operations he had under-taken at the Beaujon.

In 1810 he married the daughter of Alexis Boyer whosoon introduced him to La Charité Hospital14 asAssistant-Surgeon. He then abandoned his thoughts onphysiology and surgical nosography and understoodthat clinical observations are the basis of pathology.In this context he undertook his Treatise on Operative Medicine15 that would be published in 1813 althoughhe was not able to finish the two planned succeedingvolumes.

In 1811 Roux presented himself at the concours for the

Chair of Raphaël Bienvenu Sabatier.16

Amonghis competitors were AE Tartra, Guillaume Dupuytrenand Jean-Nicolas Marjolin.17 The jury was composed of Philippe-Jean Pelletan,18 Antoine Dubois, Pierre-FrançoisPercy19 and Anthelme Richerand.20 On 10 February 1812Dupuytren was unanimously elected Professor of Operative Medicine: once again, he had triumphed overhis old rival.

London, 1814

In 1814 Roux spent a month in London. He was one of the few eminent French physicians during that periodwho travelled to London and witnessed their Britishcolleagues at work. In the book Relation d’un voyage faità Londres en 181421 he compared the French andEnglish surgical schools and admitted there was equaldevelopment of surgical procedures in the twocountries. However, he asserted ‘the rational organiza-tion of the Paris Faculty of Medicine presented moreguarantees of adequate training than the Londonschools’.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 deliv-ered a lecture at the Academy of Sciences24 during

which he made out that he had operated on more than700 patients suffering from cataracts, with an estimatedsuccess rate of 10%.

Cleft palate surgery

In 1819 he operated successfully on an English studentsuffering 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 byparing the edges and stitching them together. In 1779after studying the problems of feeding and speakingcaused by a cleft palate, Eustathe, a physician of the

town Beziers in Languedoc, had occasion to divide the

soft palate in order to remove a nasopharyngeal polyp.He had left the palate open but realized that sutureshould be possible later. The patient declined thesecond operation. In 1783 Eustathe submitted a detailed

description of a proposed method for repairing the softpalate to the Academy of Surgery in Paris. However, on12 August 1784 Dubois declared the operation to beunfeasible and rejected the proposal. It was not until1816 that Karl Ferdinand Von Graefe reported to theMedico-Chirurgical Society of Berlin that he had at lastachieved success in closing fissures of the soft palate,freshening the edges with muriatic acid and a solutionof cantharides and then joining them with sutures. In1819 Roux modified Graefe’s operation by closing thecleft palate with three sutures across the cleft, paringthe edges, attaching the sutures and drawing the rawsurfaces together25 and in 1825 he published the

details.26

In 1820 he succeeded Percy in the Chair in SurgicalPathology and was elected a member of the Division of Surgery at the National Academy of Medicine27 and in1828 he became President. In 1830 he was promoted tothe Chair in Clinical Surgery. In 1832 he became thefirst surgeon to stitch a ruptured female perineum. In1834 he succeeded Alexis Boyer at the Academy of Sciences.

When Dupuytren died in 1835 Roux succeeded himas Chief Surgeon at Hôtel-Dieu and here he had to facedevoted followers of Dupuytren and defamatory state-ments impugning his professional honour although hissurgical skills and expertise soon made his adversaries

change their minds and, indeed, come to feel a deep

Figure 1 Philibert Joseph Roux

158 Journal of Medical Biography Volume 19 November 2011


3/4

admiration for him. He stayed at the Hôtel-Dieu fornearly 20 years.

Final illness

On 2 January 1854, on his way to a session of theAcademy of Sciences of which he had been electedPresident, he suffered a stroke and died on 3 March1854. He had finished writing the four volumes of his book Quarante Anné es de Pratique Chirurgicale28 (Figure 2),which he considered to be a set of briefs based on clini-cal facts,29 and he had nearly completed preparing forpublication the first two volumes, Chirurgie Ré paratriceand Maladies des Artères.

As a tribute to the memory of this surgeon and tosave the valuable results of his extensive experiencefrom oblivion, on 27 April 1854 and at the suggestionof Felix-Hyppolyte Larrey (1808– 95), the Society of Surgery of Paris decided that a five-member committeeshould seek permission from his family to complete the

publication of the first two volumes. This propositionwas approved and the committee, composed of AntoineDanyau, Felix-Hippolyte Larrey, Adolphe Lenoir (1808–66), Léon-Athanase Gosselin (1815– 87) and Pierre-Paul

Broca (1824–80), immediately contacted the editor, VictorMasson. In keeping with the committee’s decision, theyundertook the task of revising the proofs and of arran-ging and checking the manuscripts.

His contribution to surgery was praised by PaulBusquet,30 Frédéric Dubois (1799–1873),31 RénéMarjolin (1812–95)32 and Dionis des Carrières.33

References and notes

1 Hôtel-Dieu de Paris, the most ancient hospital in Paris, wasfounded by Saint Landry in 651, Bishop of Paris, a symbol of charity and hospitality

2 The Order of Saint Benedict or Order of the Benedictines wasestablished in 529 by Benoı̈t de Nursie. This Roman Catholicreligious order is constituted of members that observe the Ruleof Saint Benedict and belong to the Benedictine Confederation

3 The Corps of Bridges and Roads (Ingé nieurs des Ponts and desChaussé es) is composed of State Engineers of Bridges and Roads.It was created in 1717 in order to assure the establishment of aneffective transport truck network in France

4 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 rightwing of the Army of the North. On 29 September 1797 the Armyof Sambre-et-Meuse joined the Army of Rhin-et-Moselle underthe title ‘Army of German’

5 Andernach is a town in the district of Mayen-Koblenz inGermany

6 The Treaty of Campo Formio was signed on 17 October 1797 byNapoleon Bonaparte, General of the French Army, and CountLudwig von Coblenzl, a representative of Austria. This treatymarked the end of the first phase of the Napoleonic Wars

7 The Val-de-Grâce ( Hô pital d’instruction des armé es du Val-de-Grâ ce,or HIA Val-de-Grâ ce) is a military hospital. On 9 August 1850 theÉcole d’application de Médecine Militaire was founded. In 1993the École became École d’application du Service de Santé desArmées and represents the first French academic militaryhospital centre

8 Marie François Xavier Bichat (14 November 1771 – 22 July 1802),anatomist, biologist and physiologist. He is best known as theanatomist who looked beyond the recognizable organ systemswithout a microscope and introduced the notion of tissue(‘tissues’) as distinct entities. He also maintained that diseasesacted upon the tissue rather than upon whole organs. For theseinsights Bichat is considered the ‘Father of modern histology andpathology’

9 A prosector dissects corpses for anatomical demonstration10 Alexis Boyer (1 March 1757 – 25 November 1833) was a famous

anatomist and one of the most respected surgeons in Parisianmedical circles who thought and wrote with great clearness andaccuracy. He specialized in urological pathology, especiallydisorders of micturition. As a physician, he was distrustful of innovations in treatment and attentive in making his judgmentabout individual cases

11 Antoine Dubois (19 June 1756 – 30 March 1837) was a surgeon

who developed a new generation of surgical instruments,especially forceps

12 Guillaume Dupuytren (5 October 1777 – 8 February 1835),an anatomist and military surgeon was known for treatingNapoleon Bonaparte’s haemorrhoids and for developing asurgical technique to fix the tissue defect known as ‘Dupuytren’scontracture’ which he described in 1831

13 The Beaujon Hospital ( Hô pital Beaujon) later served, during theWorld War I, as a military hospital. It took its name from NicolasBeaujon who gave a large amount of money for its construction

14 La Charité Hospital ( Hô pital de la Charité ), a hospital founded inParis in 1613 under the auspices of Marie de Medici and closedin 1935

15 Nouveaux é lé ments de mé decine opé ratoire, 2 vol. Paris: Méquignon-Marvis

16 Raphaël Bienvenu Sabatier (11 October 1732 – 19 July 1811),anatomist and surgeon, was a consultant-surgeon to NapoleonBonaparte and a pre-eminent authority on the development of Figure 2 Title page of Quarante Années de Pratique Chirurgicale

H Perdicoyianni-Paléologou Philibert Joseph Roux (1780–1854) 159


4/4

urology and on its recognition as an autonomous medicaldiscipline

17 Jean-Nicolas Marjolin (6 December 1780 – 4 March 1850),a surgeon and member of the National Academy of Medicine( Acadé mie de Mé decine). In 1815 he published a manual onanatomy ( Manuel d’anatomie) for his students, giving acomprehensive 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 asa ‘squamous carcinoma developing in a chronic benign ulcer, e. g.a varicose ulcer, an old unhealed burn, or a wound scar’. Sir ASMacNalty, ed. British Medical Dictionary. London 1961, 876

18 Philippe-Jean Pelletan (4 May 1747 – 26 September 1829),a surgeon at the Hôtel-Dieu de Paris taught at the École deMédecine where he excelled by his eloquence, being given theappellation of ‘the Chrysostom of Surgeons’ (‘le Chrysostome deschirurgiens’) or ‘Golden mouth’ (‘Bouche d’or’)

19 Pierre-François Percy (28 October 1754 – 10 February 1825),a doctor and Surgeon-in-Chief of the Army during theRevolution and the Empire. Percy invented the ‘chirurgie mobile’where surgeons and their instruments were brought close to thefront from where they would jump off their ‘wurst’, eg a largeand long four-wheel carriage, to take care promptly of thewounded. He also made the first resection of the humeral head

20 Anthelme Richerand (4 February 1779 – 23 January 1840),surgeon and physiologist and as surgeon to the Hospital Saint

Louis. In 1807 he was appointed Professor of Surgical Pathologyin the Faculté de Médecine in Paris

21 Relation d’un voyage fait à Londres en 1814, or Parallèle de lachirurgie anglaise avec la chirurgie française, pré cé dé de considé rationssur les hô pitaux de Londres, faits et remarques pour servir à l’histoirede l’ané vrysme arté rio-veineux, par Roux Ph-J, Paris 1851

22 Palluault F. Medical students in England and France 1815– 1858. A comparative study. PhD thesis University of Oxford, Faculty of Modern History – History of Science 2003:9

23 The National Order of the Legion of Honor (Légion d’honneur,or Ordre National de la Légion d’honneur) was established byNapoleon Bonaparte on 19 May 1802. The Order is the highestdecoration in France and is divided into five degrees: Knight(Chevalier), Officer (Officier), Commander (Commandeur),Grand Officer (Grand Officier) and Grand Cross (Grand Croix)

24 The French Academy of Sciences (Académie des Sciences) wasone of the earliest academic societies of sciences in Europe,established in 1666 by Louis XIV at the suggestion of Jean-Baptiste Colbert to encourage and protect French scientificresearch

25 On Roux’s method see: Jones G. A short history of anaesthesiafor hare-lip, cleft palate repair. British Journal of Anaesthesia1971;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

26 Mémoire sur la staphylorraphie, ou suture du voile du palais. Archives Gé né rales de Mé decine, Paris 1825;7:536–8

27 The National Academy of Medicine (Académie Nationale deMédecine) was founded in 1820 by Louis XVIII at the urging of Baron Antoine Portal. Initially known as the Royal Academyof Medicine (Académie Royale de Médecine), it was comprisedof two institutions: the Royal Academy of Surgery (AcadémieRoyale de Chirurgie) established in 1731 and the Royal Society of Medicine (Companie Royale de Médecine) established in 1776

28 Quarante anné es de pratique chirurgicale, par Roux Ph-J. Notice sur

la vie et les travaux de Roux Ph-J , par Réné Marjolin, Paris 185429 Roux Ph-J, 1854:vii30 Busquet P. Roux (Philibert-Joseph). Paris: Les Biographies

Médicales, 193031 Fr Dubois. É loge de Roux. Paris: Mémoires de l’Académie de

Médecine, 185732 Marjolin R. Notice sur la vie et les travaux de Ph-J Roux . Paris, 185533 des Carrières D. Roux, sa vie, son œuvre. Bulletin de la Socié té des

Sciences de l’Yonne, 1870

160 Journal of Medical Biography Volume 19 November 2011