Bretonneau, Pierre

(b. St.–Georges–sur–Cher, France, 3 April 1778; d. Passy, France, 18 February 1862)

medicine.

Bretonneau’s father, Pierre, a master surgeon, and his mother, Elisabeth Lecomte, came from the old bourgeois class. Almost completely uneducated during his childhood (at nine he was not yet able to read), he was sent to the Ècole de Santé in Paris in 1795. There he attended the clinical lectures of Corvisart. He abandoned his studies, however, after being unjustifiably failed on an examination (1801) and became a public health officer in Chenonceaux. His skill gained Bretonneau reputation, and he was made chief physician at the Tours hospital; to qualify for this position he took his final examinations and completed his doctoral thesis in 1815. In 1838 he left this post and the directorship of the Ècole de Santé in Tours, to dedicate himself to practicing medicine among the poor. After a first marriage to a woman twenty–five years his senior he married at the age of seventy–eight a girl of eighteen.

A man of many interests, Bretonneau constructed hydraulic hammers, barometers, and thermometers; sculpted and drew; and studied the habits of bees and ants. He was a first–rate botanist and horticulturist, and wrote a treatise on plant grafting; his garden in Palluau was famous throughout Europe. Independent, proud yet modest, and disdainful of honors, Bretonneau was a dedicated physician and an able therapist. His lectures, which were in the Hippocratic tradition, made a profound impression upon his students.

Bretonneau’s outlook made him a member of the school of Paris, which considered the lesion to be the trace that makes possible the definition, classification, and comprehension of an illness. Physical signs, as direct mediators of the lesion, were preferred to epiphenomenal symptoms. G.L. Bayle introduced the concept of a definite development of a lesion that defines its specificity instead of altering it. Laennec illustrated this idea by showing that the various lesions of “phthisis” were in fact the gross signs of a specific disease, tuberculosis. In 1801 Bayle defended the unicity of smallpox (either discrete or confluent) in his M.D. thesis, arguing for the existence of cross–contagiousness. This thesis, which described two kinds of smallpox, had many repercussions.

The concepts of specificity and contagiousness, as well as the previous work on smallpox, later gave Bretonneau a model for introducing those concepts into his work on two diseases of the mucous membranes of the digestive and respiratory tracts. He demonstrated that, just as the skin could show a great many reactions, the mucous membranes did not have only one response to all pathogens. Against an excessively narrow concept of tissue pathology, inherited from Bichat, he proposed the concept of specific inflammation.

As early as 1819 Bretonneau individualized typhoid fever (called dothinentérie). He demonstrated the localization of the lesion on Peyer’s patches in the ileum, the cyclic development of the lesion (each phase had formerly been described as a separate disease), and the uniqueness of the various fevers, and defended the concept of a specific transmissible agent. In his memoir of 1829, Bretonneau described the course of a typhoid epidemic at Chenonceaux and showed the role of contact in its propagation. He observed that the disease was endemic to Paris because the chains of transmission were frequently broken by the immunity of those who had already had the disease. He suspected that besides typhoid there was a petechial pyrexia with a more rapid course (exanthematic typhus) that was often mistaken for typhoid.

From 1818 to 1820 a diphtheria epidemic raged in Tours. In 1821 Bretonneau published his observations. He individualized the disease through analysis of the characteristics of the false membrane, showing its primary tonsillar localization and its possible nasopharyngeal, auricular, and laryngeal (“croup”) extensions, which lead to asphyxia. He showed that certain (toxic) symptoms exist regardless of localization, and deduced that the specificity of the inflammation—much more than the type of tissue in which it occurs—is responsible for the disturbance of functions that every inflammatory lesion produces: duration, severity, and danger of most fevers depend on the specificity of the inflammation.

Concerned with preventing fatal asphyxia, Bretonneau, after two experiments that failed in man but succeeded in a dog, performed a successful tracheotomy on a four–year–old girl in July 1825. The operation, the first to be performed on a croup patient, was made possible by his manual dexterity and his ingenuity (he invented the double cannula). He was convinced that diphtheria was contagious and that it was transmitted by drinking glasses. He tried, in vain, to infect animals with the disease. He defended the idea of specific therapy, but his experimental work in that area proved fruitless.

BIBLIOGRAPHY

I. Original Works. Bretonneau published his works sparingly, some time after they had been written, and at the insistence of his students: De l’utilité de la compression et, en particulier, de l’efficacité du bandage de Theden dansles inflammations idiopathiques de la peau (Paris, 1815), his M. D. thesis; Des inflammations spéciales du tissu muqueux et en particulier de la diphthérite ou inflammation pelliculaire (Paris, 1826), which consists of two papers read to the Académie Royale de Médecine on 26 June and 6 August 1821; “Notice sur la contagion de la dothinentérie, lue à l’Académie royale de médecine le 7 juillet 1829,” in Archives générales de médecine, 21 (1829), 57–78; and Traités de la dothinentérie et de la spécificité, L. Dubreuil–Chambardel, ed. (Paris, 1922), which contains a biography and an analysis of the work.

II. Secondary Literature. Works on Bretonneau are E. Apert, “Bretonneau,” in Biographies médicales, no. 6 (1938); J. D. Rolleston, “Bretonneau: His Life and Work,” in Proceedings of the Royal Society of Medicine, Section of the History of Medicine, 18 (1924); and P. Triaire, Bretonneau et ses correspondants (Paris, 1892). Useful explanations of Bretonneau’s ideas may be found in Trousseau’s complete works.

Alain Rousseau