Cruveilhier, Jean

(b. Limoges, France, 9 February 1791; d. Sussac, Haute-Vienne, France, 10 March 1874)

anatomy, pathology.

Agrégée in surgery at the Faculty of Medicine of Montpellier (1823), Cruveilhier became professor of anatomy at Paris in 1825 and médecin des hôpitaux in 1826. In the same year he reorganized the Société Anatomique and was its founding president until 1866. Elected to the Académie de Médecine in 1836, he was its president in 1839. 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 “system pass and only the facts remain,” he was essentially a researcher who owed his reputation more to his books than to his teaching.

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 Stéphane Tarnier, 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 labor, in which each woman would have a private room.”

Cruveilhier was at the same time an experimenter, an anatomist, and a pathologist. In 1836 he became the first holder of the chair of pathological anatomy founded by a bequest of his teacher, Guillaume Dupuytren. At that time he relinquished his chair of normal anatomy to Gilbert Breschet.

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 secondary, Cruveilhier thought that alteration of the venous wall generated the thrombosis. Later investigations have confirmed his thesis.

Cruveihier described a valvula at the distal extremity of the lacrimonasal canal that was also known to G. B. Bianchi and Joseph Hasner. He also gave his name to the vertebral nerve in the posterior cervical plexus that issues from the first three cervical Paris. He showed that the styloglossal and palatoglossal nerves can originate in the lingual branch of the facial nerve (Hirschfeld’s nerve) which anastamoses with the glossopharyngeal (Haller’s ansa).

Cruveilhier’s Cours d’études anatomiques (1830), which was expanded into Anatomie descriptive (1834–1836), played a major role in the progress of anatomical studies at the École de Médecine at Paris. E. P. Chassaignac was one of the collaborators on this work. Cruveilhier’s son, Edouard, brought out a new edition (1862–1867) with the assistance of Marc Sée.

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 them he describes cysts; gastric ulcus rodens, which he isolated from chronic gastric ulcus rodens, colic diverticulosis;progressive muscular paralysis (at the same time as E. Aran and Guillaume Duchenne); “the fibrous bodies of the breast” that, with Velpeau and Sir Astley Cooper, he differentiated from breast cancer; diffuse cerebral sclerosis; the “gelatinous disease” of the peritoneum; and the dilation of the veins abdominal wall giving the appearance of a Medusa’s head, later described by Clemens von Baumgarten. In 1829 he 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. In the diagnosis of tumors Cruveilhier described “cancerous juice” as the criterion of malignancy; it was later replaced by the histological criterion.

Cruveilhier knew little of histology, to which one finds only a few allusions in the fifth volume of the Traité, which was edited by his students. Nevertheless, his 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.

BIBLIOGRAPHY

I Original Works. Cruveilhier’s writings are Essai sur l’anatomie pathologique en général (Paris, 1816), his doctoral thesis; Essai sur l’anatomie pathologique en général et sur les transformations et productions organiques en particulier, 2 vols. (Paris, 1816); Médecine pratique éclairée par l’anatomie et la physiologie pathologiques (Paris, 1821); An omnis pulmonum exulceratio vel etiam excavatio insanabilis? (Montpellier, 1824) his agrégation thesis; Discours sur l’histoire de l’anatomie (Paris, 1825), the opening lecture of his anatomy course; Anatomie pathologique du corps humain; ou description, avec figures lithographiées et coloriées, des diverses alterations morbides dont le corps humain est susceptible, 2 vols. (Paris, 1828–1842), illustrated with more than two hundred colored plates; Cours ‘études anatomiques (Paris, 1830); Anatomie descriptive, 4 vols. (Paris, 1834–1836); Des devoirs et de la moralité du médecin, Discours prononcé dans la séance publique de la Faculté de Médecine, le 3 novembre 1836 (Paris, 1837); Vie de Dupuytren (Paris, 1840); “Histoire de l’anatomie pathologique,” in Annales de l’anatomie et de la physiologie pathologiques (1846), 9–18, 37–46, 75–88; Traite d’ anatomie pathologique generale, 5 vols. (Paris, 1849–1864); in the Dictionnaire de medecine et de chirurgie pratique, 15 vols. (Paris, 1829), the following articles: “Abdomen,” Acéphalocystes,” “Adhérences,” “Adhésions,” “Anatomiee chirergicale médicale,” “Anatomie pathologique,” “Artéres Entozoaires, (maladies des),” “Articulations (maladies),” “Entozoares,” “Estomac,” “Muscles,” and “Phlébites;” Académie royale de medecine—Rapport fait à cepte academie dans la séance du 22 octobre 1839 sur les pièces pathologiques modelées en relief et publiees par le docteur Felix Thibert… (Paris, 1839); “Sur la paralysie progressive atrophique,” in Bulletin de l’Academie de medecine, 18 (8 Mar. 1853), 490–502 (29 Mar. 1853), 546–584; and Trios rapports sur un mémoire de M. Jules Guérin relatif aux déviations simulées de la colonne vertébrale, faits à l’Academie royale de médecine (Paris, 1856).

II. Secondary Literature On Cruveilhier or his work, see P. Astruc, “Les belles pages médicals—Jean Cruveilhier (1791–1874),” in Informateur médical (31 Jan. 1932), 2–4: and “Le centenaire de la médecine d’observation,” in Progrès médical, ill. supp. nos. 10 and 11 (1932), p.81: de Bardinete, Souvenirs, 8 vols. (Paris, 1901), vol. 7, p311: Bardinet, “Discours prononcé aux funerailles de Cruveilhier,” in L’union médicale, 17 (1874), 436–438; J. Béclard,“M. Cruveilhier—Notice lue dans la séance publique annuelle de l’Academie de médecine-4 mai 1875,” in Memoires de l’Academic de médecine, 31 (1875), 21–24 and in Notices et portraits (Paris, 1878), pp. 259–289; A. Chéreau, “Cruveilhier,” in Dictionnaire encyclopédiquedes science médicales, Ist ser,. 24 , 10–13: A. Corlieu, in Centenaire de la Faculté de médecine de Paris (1794–1894) (Paris, 1896), pp. 249–325; P. Delaunay, “Les médecines La Restauration et la Révolution de 1830,” in Médecine interne illustrée (1931–1932), P. 54 L. Delhoume, and P. Huard, “Le livre de comptes de Cruveilhier pour les années 1840–43,” in Histoire de la médecine (1962), 47–52; L. Delhoume, “Une observation de Jean Cruveilhier,” in Concours médical (1960), 2061–2066; P. Grousset, “Le Docteur Cruveilhier père,”in Le Figaro, repr. in Labarthe, Nos meédecins contemporains (Paris, 1868). pp.131–138: Kelly, Emerson, and Crosly, Encyclopedia of Medical Sources (Baltimore, 1948; G. Lacour-Gayet. Talleyrand, 1754–1838, III, 366, 374, 384, 386, 389, 392, 397, 408; C. Lasègue. “Cruveilhier—Sa vie scientifique, Ses oeuvres,” in Archives générales de médecine, 1 (1874), 594–599: Jacques Ménétrier, “Cruveilhier (1791–1874),” in Progres médecal (5 Mar. 1927), 357–364; in Gazette médecale limousine (July 1927); and in Aesculape (July 1927), 182–187 (Aug. 1927), 212–216; Morton T. Leslie, in Garrison and Mottoris, Medical Bibliography (London, 1954); J. Rochard, Histoire de la chirurgie française au XIX° siècle (Paris, 1874); C. Sachaile, Les médecins de paris jugés par leurs oeuvres (Paris, 1845), pp. 214–217; “La plaque commémorative de Cruveilhier à Limoges,” in Gazette médicale limousine (July, 1927); “Un appel d’Alfred de Vigny à Cruveilhier,” in Aesculape (Aug. 1927), 198–199; “Une lettre inédite de Cruveilhier,” in Chronique médicale(1904), 184; and Monpart, “Cruveilhier,” in Journal de la Santé, 19 (1902), 2321.

A portrait of Cruveilhier by Apnée is property of Dr. Louis Cruveilhier; one by A. Delbecke is in the Muse Dupuytren, Paris. An unsigned marble bust, at the Faculté de Médecine, Paris, was reproduced as a marble medallion by the sculptor Marcellin Bourgeois for the Faculté de Médecine, Bordeaux, in 1887. Other likenesses are a lithograph by Travies in Charivari(19 Oct, 1838); and a lithograph by Maurin (1828), a drawing by Lasnier (1865), and a photograph by Trinquart in Biographies mé;dicales (1934), pp. 296, 297, 305. A portrait appears in A. Corlieu, Centenaire de la Faculté de Médecine (1794–1894) (Paris, 1896), p.324.

Pierre Huard

Cruveilhier, Jean

2/9/1791–3/10/1874
FRENCH
ANATOMIST

Jean Cruveilhier was the first professor of pathology at the University of Paris. He introduced the descriptive method to the field of pathology, and this method was defined by the lithographs in his massive two-volume atlas, Anatomie pathologique du corps humain (Pathological Anatomy of the Human Body).

Cruveilhier was born on February 9, 1791, in Limoges, France, as Léon Jean Baptiste Cruveilhier, the son of a career military surgeon. He was raised almost exclusively by his mother, as his father was usually away with the army during the French Revolutionary and Napoleonic Wars. Cruveilhier felt a calling to the Roman Catholic priesthood, but his father refused to allow it, insisting that he study medicine instead. He completed his secondary education at the College of Limoges in 1810, then moved to Paris, where his father had arranged for him to become the student of Guillaume Dupuytren, the most prominent French surgeon of the era.

Dupuytren struggled to turn his friend's son away from religion toward medicine and finally succeeded in awakening his interest in pathology. After taking his M.D. degree in 1816, Cruveilhier sought only the simple life of an ordinary physician in his native town, but, goaded by his father's ambitious plans for him and failing, perhaps because of his father's machinations, to gain a staff position as hospital surgeon in Limoges, he returned to Paris in 1823. Dupuytren secured him a professorship in surgery at the University of Montpellier. Cruveilhier soon resigned, intending to go back to Limoges, but in 1825 he became professor of descriptive anatomy in Paris, where he spent the rest of his career.

By 1826, Cruveilhier was on the staff of most hospitals in Paris and had established a small but prestigious and successful medical practice. Charles-Maurice de Talleyrand-Périgord was among his patients. Cruveilhier took advantage of the death of René-Théophile-Hyacinthe Laënnec in 1826 to revive the Anatomical Society of Paris, which Dupuytren had founded in 1803 but which Laënnec, as president, had allowed to become dormant after 1808. Serving as its president until 1866, Cruveilhier broadened and solidified its publishing program.

Dupuytren died in Paris on February 8, 1835. His will stipulated that a chair of pathological anatomy at the University of Paris and a museum of pathological anatomy should both be established with funds from his estate and that Cruveilhier should occupy this chair. These bequests were honored. The toxicologist Mathieu Orfila founded the Musée Dupuytren in 1835; Cruveilhier assumed the professorship in 1836 and held it for the rest of his life. He published a short biography of Dupuytren in 1841.

The National Academy of Medicine elected Cruveilhier a member in 1836 and its president in 1839. Always concerned with medical ethics, he gave an important speech on November 2, 1836, at the public meeting of the Paris medical faculty, "On the Duties and the Morality of the Physician," which was published the following year.

Cruveilhier's first major publication was his doctoral thesis, Essai sur l'anatomie pathologique en général (Essay on Pathological Anatomy in General), which appeared in 1816. He continued on this subject in his 1821 book, Médecine pratiqueé éclairée par l'anatomie et la physiologie pathologiques (Practical Medicine Clarified by Pathological Anatomy and Physiology). In 1830 his textbook, Cours d'études anatomiques (Course of Anatomical Studies) appeared. His Traité d'anatomie descriptive (Treatise of Descriptive Anatomy) was published in four volumes from 1833 to 1836 and his Traité d'anatomie pathologique générale (Treatise of GeneralPathological Anatomy) was published in five volumes from 1849 to 1864.

The subtitle of Cruveilhier's greatest work, the Pathological Anatomy, which he issued gradually in forty parts from 1829 to 1842, indicates that it contains "descriptions of the various morbid changes to which the human body is susceptible." Its text was quickly translated into English, German, Italian, Arabic, and Spanish and its plates were cheaply and sometimes poorly reproduced by either redrawing or transfer lithography. Cruveilhier's dissection of 54-year-old Louise Bonin, who died of uterine cancer in 1838, resulted in a section of the Pathological Anatomy that was long believed to be the first description of multiple sclerosis, but recent scholarship has established that Scottish pathologist Robert Carswell studied this disease before Cruveilhier.

Cruveilhier's contributions to forensic science predominantly involved developing precise methods of autopsy for determining the specific cause of death . His research into phlebitis, embolism, infarction, and other vascular disorders formed the basis of Rudolf Virchow's more significant work on these topics.

Cruveilhier lacked knowledge of chemistry, biology, histology, and several other disciplines that a medical scientist would normally be expected to have mastered. Yet, his observations of gross anatomy and lesions were so meticulous and his descriptions so clear and accurate that even the discerning neurosurgeon Harvey Cushing, a hundred years later, could not find fault with them. Cruveilhier died on March 18, 1876, at his country home near Limoges in Sussac, Haute-Vienne.

see also Autopsy; Death, cause of; Pathology.