French neurosurgeon, born July 7, 1849, Condé-sur-Noireau, Normandy; died April 7, 1921.
Biography of Henri DuretHenri Duret was the son of a cotton yarn merchant. He began his studies at the medical school in Caen in 1867, continuing at the medical school in Paris in 1869. Ranking 23rd on the competitive exam for non-residents the same year, he decided to study surgery with Simon Duplay (1836-1924), but the Franco-Prussian War erupted shortly thereafter. With his brief year of training, he nonetheless passed the exam to become a junior military physician at the Val-de-Grâce military hospital, becoming a junior surgeon two months later.
He fought throughout the War of 1870 in the army of General Alfred Chanzy (1823-1833), from the siege of Sedan until the Tertre de Changé battle, close to Le Mans, which the French lost to the Prussians (12 January 1871). He then took care of the wounded round the clock for several weeks. Chanzy nominated him for the Legion of Honour when he was only 21, but he wasn’t decorated until 50 years later! Back from his army experience, Duret ranked 49th in the 1871 competitive exam for residents in the Paris hospitals.
His classmates included Fulgence Raymond (1844-1910), Louis Landouzy (1845-1917) and Jules Voisin (1844-1920). In 1872 he began working with Ulysse Trélat (1795-1879), who was head of a department for insane patients at La Salpêtrière Hospital. His location allowed him to work in the laboratory connected to the department of Jean-Martin Charcot (1825-1893). When he published his first works, he indicated that he was a "student in Professor Charcot’s department, where we often witness the insufficiency of current knowledge on brain circulation in relation to the form, location and disposition of certain brain lesions, particularly haemorrhaging and softening".
He became an assistant for anatomy lectures on 30 April 1873 and continued his surgery training with Paul-Jules Tillaux (1834-1904) and Simon Duplay, and also with Aristide Verneuil (1823-1895), for whom he became chef de clinique (specialist registrar). He defended his thesis on February 22, 1878, before a committee including Alfred Vulpian (1826-1887), Jacques Grancher (1843-1907) and Samuel Pozzi (1846-1918) and presided by Verneuil. In his acknowledgements, he paid homage to Charcot, Verneuil and Vulpian, professors at the medical school "who have inspired and guided us on the elevated path of science". His thesis, focused on experimental studies of brain trauma, earned him the experimental physiology prize awarded by the Institut de France.
Researcher and professor of surgery in Lille
Though Duret ranked 1st on the competitive surgery exam for the Paris hospitals in 1882, twice he failed the agrégation exam to become a professor. The 1880 jury composed of Jules Levrat (1850-1895) and Georges Bouilly (1893-1903) accorded available positions to Pierre Budin (1846-1907) and Paul Reclus (1847-1914) rather than to Duret. On his second attempt at the agrégation (30 June 1883), the jury chose Edouard Kirmisson (1848-1924), Victor Campenon (1846-1916) and Paul Segond (1851-1912),
Realising that a university career would be impossible for him in Paris, he relied on help from his brother, the abbey Joseph Duret, and joined the Catholic Medical School of Lille, founded in 1875, though he did face some opposition from the Catholic hierarchy of northern France due to his work with the Salpêtrière school.
He was initially named to the Chair of General Pathology, and then to the Chair of Clinical Surgery, which grew in prestige from 1885 to 1911 due to the quality of Duret's teaching. An extraordinary capacity for work, a will of steel, perfect mastery in his operations and a remarkable feel for teaching earned him the admiration of his entourage, particularly his students: "[Duret's] powerful activity drew in the youth around him like an irresistible cyclone […]. Everyone knew of his daring in the operating theatre; his sang-froid—not always calm—was proverbial and some of his operations will remain legendary"
Appointed Dean of the Catholic Medical School of Lille three times (1890, 1899 and 1905), he created the Anatomical-Clinical Society of Lille for the students (modelled after the corresponding society in Paris) which he presided over himself from 1886 to1905. He nonetheless did not neglect his duties at the Society of Medical Sciences of Lille, which he also presided over several times. To improve the care given by the Aid Society for the Military Wounded, Duret founded the Dispensary/School of the Red Cross of Lille in 1905.
In collaboration with a professor of paleobotany at the Faculty of Sciences who was also a priest, Jean Boulay (1838-1905), Duret founded the School of Anthropology, whose underlying goal was to defend Christianity. Duret was elected a correspondent member of the French Academy of Medicine in 1900, then associate member in 1907. An active member of the Neurological Society of Paris, founded in 1899, he was also involved with the Biological Society throughout his long career, presenting his first work to members in 1873. He was a correspondent of the Royal Academy of
Belgium, doctor honoris causa at the Université de Louvain and Commander of the Order of Saint Grégoire le Grand.
Duret retired in 1911 and could not be called up for service during World War I (1914-1918). He nonetheless directed the auxiliary military hospitals 4 and 10, on the premises of the Catholic Medical School of Lille and in a nearby middle school. He was made a Knight of the Legion of Honour on 23 February 1921 for his military achievements. He died on 7 April 1921 after a slow, painful bout with cancer.
In the eulogy Henri Claude (1869-1945) delivered to the Neurological Society on 5 May 1921, he recalled the "formidable study undertaken during the war by this relentless worker, entitled: Traumatismes cranio-cérébraux.’Formidable' is not excessive in qualifying such a work. Three enormous volumes of 1500 pages have already been published." The fourth was completed in 1922 by his colleagues in Lille: Jules-Alfred Voituriez (1858-1938) and Joseph Delépine (1877-1923).
In early 1921, a few of his colleagues at the Catholic Medical School of Lille proposed Duret as a candidate for the Nobel Prize in Medicine or Physiology. His death put an end to their efforts. Whether coincidentally or consequently, the prize was not attributed that year
On the supply arteries of the brain The thesis of Etienne Lancereaux (1829-1910), defended in 1862, is one of the first complete French-language reports of the pathophysiology of cardiovascular accidents; its title translates as "Cerebral Thrombosis and Embolism Considered Principally with Regard to Brain Softening".
It was Duret who, on December 7, 1872, presented the first study on "the distribution of the arteries
supplying the medulla oblongata" to the Biological Society. He wrote: "The progress recently made in understanding medullary pathology calls for a more complete study of medullary circulation than what can be found in the treatises of descriptive anatomy. We have embarked on this study, under Charcot’s direction, to fill this gap". As Duret indicated, "the supply arteries of the medulla, which we will call median arteries or arteries of the nuclei, have not been described [...]. The distribution of arterial blood in an organ as important as the medulla has not been left to chance; it is governed
Duret went on to distinguish and describe with extreme precision the radicular arteries supplying the roots of nerves emerging from the medulla, arteries supplying brainstem nuclei, and other arteries supplying "other parts of the medulla", thereby showing in a novel way "the terminal disposition of the median arteries of the nuclei […]. This study of the distribution of medullary supply arteries provides a very satisfactory explanation for certain phenomena in medullary disease";
Duret proposed a precise and detailed study of the territorial distribution of each artery, using coloured injections. Once again in novel fashion, he distinguished "the arteries of the cerebral nuclei and the arteries of the gyri". For the first time, he described "the branches supplying the striatum and the thalamus". In particular, he distinguished between a branch "that follows, along a certain length, the base of the lenticular nucleus at the limit of the external capsule, passing in front and inside toward the extraventricular basal ganglia where it divides into four or five terminal branches. … This group of external arteries can be designated as the lenticulostriate arteries; the others—art è res lenticulo-opiques [thalamogeniculate arteries]— pass behind, at the posterior extremity of the lenticular nucleus and terminate in the thalamus above it; they are only separated from the thalamus by the ‘couronne de Reil’ [corona radiata]".
Duret’s work gave rise to the theory of cerebrovascular accidents whereby each cerebral infarct results from thrombosis in a single artery. This theory led to a multitude of studies, published at the beginning of the 20th century.
When Duret was still a young resident, from 1874, he brought the innovative brain physiology research published in England by David Ferrier (1843-1928) to French readers by means of the translations he undertook for Progrès Médical . The slender volume he produced was to serve as an introduction to a much more ambitious work to be published the following year. Together with Camille-Henri Carville (1828-1885), a student of Vulpian and assistant for his experimental pathology course, Duret presented, in 1875, "a critical history of experimental research on the functions of the cerebral hemispheres".
After describing localised ablation experiments on the cortex of rabbits and pigeons conducted by Pierre Flourens (1794-1867), Vulpian, and Ernest Onimus (1840-1915), then those involving localised "interstitial" injections conducted by Henry Beaunis (1830-1921) and Hermann Nothnagel (1841-1905), Duret and Carville described all the recent advances made by using cortical stimulation involving non-destructive galvanic currents as developed by Gustav Fritsch (1838-1927) and Edouard Hitzig (1838-1907) in Germany, and faradic currents as developed by Ferrier in England..
Following up on research conducted in Germany by Arnold Friedrich Pagenstecher (1837-1913) on localised cerebral compressions, and in order to experimentally confirm his theory, Duret tested the effects of injecting water and wax inside the cranium of dogs and horses, in order to replicate the symptoms observed in humans after traumatic brain injury . Then he experimented with hemispheric compression involving bone splinters or pieces of cork, thereby simulating the compressive effect of localised internal bleeding, especially in the meninges, in various localisations: vertex, at the base of the skull, and under the cerebellar tentorium.
At the beginning of the 20th century, the only book in French dedicated exclusively to brain tumours was that of Maurice Auvray (1868-1945), which was published in 1896. Victor Horsley (1857-1916) was the first to operate on epileptics. In 1887, he published a series of ten tumour exereses, describing in great detail his techniques. After focusing on cerebral localisations and intracranial hypertension, Duret logically turned his attention toward brain tumours. His book ‘Les tumeurs de l’encéphale, manifestations et chirurgie’ was published in 1905, building on the report he had presented in 1903 at the French Surgery Conference. This literature review, international in scope, enabled him to report on 400 observations of intracranial tumours. The resulting work, a monumental 835 pages and 297 figures, is divided into four parts: general manifestations, localised manifestations, diagnosis and surgery (fig. 6). Duret attempted to respond to the concerns of surgeons: "The problem to resolve, for surgeons, is threefold. Is there a tumour? Where is it located? What type of tumour is it? These are the three preliminary questions that the surgeon must answer".
Duret recommended lumbar puncture and only illustrated his book with two skull radiographs, both blurry and not very helpful. Finally, Duret argued in favour of brain surgery: "Tumour surgery is complex and difficult but will soon reach a stage where the success rate is high". This stood in opposition to colleagues such as Ferrier, who declared that surgery on brain tumours was a disappointing affair.
Duret also saluted Just Lucas-Championnière (1843-1913), who invented the trephine and gave special mention to Chipault and Horsley for their surgical daring and the instruments they invented to perform craniectomies. Duret's book described instruments invented throughout the world, covering both design and usage techniques. He concluded with statistics from the 400 operations studied. It is surprising that this monumental work is not better known, that it was never cited by Cushing, for example, despite the wealth of collected data, and the quality and quantity of figures.
We thank Olivier Walusinski for submitting this article, which is the basis for this entry:
Olivier Walusinski and Philippe Courivaud:
• Henry Duret, 1849-1921. A Surgeon and forgotten Neurologist.
European Neurology, Basel, 2014.