Jean Cruveilhier

Born 1791-03-09
Died 1874-03-10

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French pathologist, born February 9, 1791, Limoges; died March 10, 1874, Sussac, Haute-Vienne.

Biography of Jean Cruveilhier

Jean Cruveilhier's father was a military surgeon who was obliged to follow the army and thus often had to leave his family alone. Cruveilhier was thus to a large degree brought up by his mother, from whom he inherited a serious mind. Thus, while still a student at the College of Limoges, he decided to enter the priesthood, but was denied this career course by his energetic father, who wanted for him to become his worthy successor. Jean Cruveilhier was therefore forced to study medicine. In 1810 he moved from Limoges to Paris armed with letters to the famous Guillaume Dupuytren (1777-1835), under whom he commenced his medical studies.

After his first four autopsies, however, he was so disgusted with medicine that he joined a secret order and began the study of religion at the seminary of the holy Sulpicius. As news of this reached his father, he went to Paris and got his son back to medical school, where Dupuytren, a friend of his father, made him his protégé and aroused his interest in pathology.

Cruveilhier was conferred doctor of medicine in Paris in 1816 with a dissertation on a new classification of organs according to their pathological changes. The general idea on which this was based was taken from the lectures of Dupuytren. He returned to Limoges, married and settled down to the prosaic life of a small town doctor. Stung by failure to secure an appointment as surgeon to the city hospital, and stimulated by his father’s overwhelming ambition for him, in 1823 he returned to Paris, where he participated in a concours for a position as extraordinary professor. He won and supported by Dupuytren he was appointed agrégé of surgery at the Faculty of Medicine of Montpellier.

He was about to give up this post and return to Limoges to continue his practice, as the minister of education, bishop Frayssinon, with whom he had become acquainted at the St. Sulpice, encouraged him to compete for the chair of descriptive anatomy, which had been vacated through the unexpected death of Pierre Béclard (1785-1825). He held his inaugural speech as professor of descriptive anatomy in Paris in 1825. In 1826 he became médecin des hôpitaux. In the same year he reorganized the Société anatomique, which had been organized in 1803 by Dupuytren and discontinued in 1808 while under the leadership of René-Théophile-Hyacinthe Laënnec (1781-1826). Cruveilhier was to remain its president for over 40 years. Elected to the Académie de Médecine in 1836, he was its president in 1839.

In 1836 he became the first to hold the chair of pathological anatomy, which had been established with means from his teacher, Dupuytren. At that time he had relinquished his chair of normal anatomy to Gilbert Breschet (1784-1845). He remained in this position for more than thirty years. Already in 1830 he had become physician-in-chief and director of the Hospice de la maternité, later at the Salpêtrière and the Charité.

The vast amount of material from the deadhouse of the Salpêtrière, the establishment of the Musée Dupuytren, and the lectureship in morbid anatomy furnished both necessary material and incentive, and Cruveilhier continued to publish his folios of coloured lithographs of his Anatomie pathologique du corps humain (Paris, Billière, 1829-1842), which was dedicated to Dupuytren.

Cruveilhier devoted himself to his enormous practice, following the rules of a very strict ethic that he condensed in his Des devoirs et de la moralité du médecin (1837). A modest and honest physician, he was not gifted with eloquence. He was neither a great clinician nor a great teacher, neither a credulous disciple nor an innovator. Fond of saying that «systems pass and only the facts remain,» he was essentially a researcher who owed his reputation more to his books than to his teaching.

Among those who consulted him was Charles-Maurice de Talleyrand-Périgord (1754-1838), to whom he was house physician from 1835. At this time the gates to the academy were opened to him. He was a prolific writer, although the value of each single work may be questioned. The major shortage is in his lack of knowledge of important works published in other languages, as well as his insufficient knowledge of chemistry and histology. He died on his country estate in Sussac near Limoges, aged 83, from an inflammation of the lungs and peritoneum.

In 1840 he published a memorial work on his great teacher, Guillaume Dupuytren, titled Life of Dupuytren. From 1826 he was an enthusiastic contributor to the Bulletin de la Société anatomique, of which he was president. Cruveilhier is frequently compared with Morgagni.

Cruveilhier’s liking for observation revealed to him, during his service at La Maternité, the importance of the concepts of contagion and isolation. As early as 1821, anticipating Étienne Stéphane Tarnier (1828-1897), he called for «the elimination of large maternity hospitals and their replacement by home care, to which might be added a certain number of small hospitals situated outside of Paris, capable of accommodating twelve to twenty women in labour, in which each woman would have a private room.

His experiments on the formation of callus after bone fractures in pigeons showed Cruveilhier the importance of extraosseous tissues (periosteum, muscles) in the reconstitution of bones of leverage. His injections of mercury into the blood vessels and the bronchial system bore out the theory of phlebitis, which he said, «dominates the whole of pathology.» It made possible the conceptions of embolism and infarction, which were developed by Virchow beginning in 1846. But while Virchow considered the vascular thrombosis to be the primary lesion and the lesion in the venous wall to be the secondary, Cruveilhier thought that alteration of the venous wall generated the thrombosis. Later investigations have confirmed his thesis.

Cruveilhier described a valvula at the distal extremity of the lacrimonasal canal that was also known to Giovanni Battista Bianchi (1681-1761) and Joseph Hasner (1819-1892). He also gave his name to the vertebral nerve in the posterior cervical plexus that issues from the first three cervical pairs. He showed that the styloglossal and palatoglossal nerves could originate in the lingual branch of the facial nerve (Hirschfeld’s nerve), which anastomoses with the glossopharyngeal (Haller’s ansa).

Cruveilhier’s Cours d’études anatomiques (1830), which was expanded into Anatomie descriptive (1834-1836), plays a major role in the progress of anatomical studies at the École de Médecine at Paris. Édouard Pierre Marie Chassaignac (1804-1879) was one of the collaborators on this work. Cruveilhier’s son, Édouard, brought out a new edition (1862-1867) with the assistance of Marc Sée (1827-). The six-volume Anatomie pathologique du corps humain (1828-1842) and the Traité d’anatomie pathologique générale (1849-1864) are Cruveilhier’s true claims to fame for their illustrations, remarkable even today, and for their conception

In 1820 Cruveilhier diagnosed a cerebral tumor with localization of the lesion, which had invaded the acoustic nerve. The observation was so precise that nearly a century later (1927) Harvey Cushing found nothing to add to it. Despite his scant knowledge of histology, Cruveilhier’s work has become less dated than some more recent ones that make the most use of the microscope. That is why Virchow called himself Cruveilhier’s disciple and why many of his findings remain valid. His system of pathology, which erroneously taught that "phlebitis dominates all pathology", was permanently discredited by Virchow's later work.

Cruveilhier was a prolific writer. His best-known work is Anatomie pathologique du corps humain, in which he renders a superb description of ulcer as well as the first pathological account of disseminated sclerosis. He reported a French soldier who, in 1813, was taken prisoner by Hungarian troops, beaten up and left to die, after having received an extremely heavy blow with a rifle butt. After six months in hospital he was restituted and returned to civilian life. Some years later, however, abdominal swelling troubled him and a loud murmur could be heard over his umbilicus. He died in 1874, and at autopsy his liver was found to be somewhat small in size, smaller than his spleen, but no cirrhosis was commented upon. There were large veins coursing from his umbilicus, connecting the systemic with his portal system. Cruveilhier speculated whether this could be congenital or acquired following the trauma.

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