Baron Guillaume Dupuytren

Rising from grinding poverty and struggles in early life to become France's leading surgeon and millionaire, Baron Guillaume Dupuytren (1777–1835) remains one of the most enigmatic figures in surgical history. Although he was not liked by many of his contemporaries, even his bitter adversaries acknowledged that Dupuytren was the ablest surgeon of his time in France. His name remains eponymous with the Dupuytren contracture, yet the medical contributions of this great surgeon were indeed far-reaching. With a solid foundation in anatomy and pathology, Dupuytren was the outstanding surgical innovator of his day in Europe, the latter part of his working life becoming known as “the age of Dupuytren.”Dupuytren lived during a period of tremendous upheaval in France. At the time of his birth, Louis XVI was still in power, and as a youth, Dupuytren would witness a radical political upheaval in the coming of the French Revolution. Dupuytren was born to an advocate of limited means in Pierre-Buffière, near Limoges in central France. Stimulated by the tumultuous times brought on by the French Revolution, Dupuytren was seriously contemplating a military career. However, there were other surgeons in the family, and Dupuytren bowed to his father's wishes that he too pursue a career in surgery.Dupuytren started his medical training in Limoges and later went to Paris. His early struggles in Paris as a medical student left an indelible mark on his character. Dupuytren's inner strength, determination, and industry carried him through these years of extreme poverty and struggle. It has even been said that he had to use cadaveric fat to make oil for his study lamp.Being a young man of great determination, Dupuytren persisted in his efforts and became prosector of anatomy in charge of autopsies at the Hôtel Dieu in 1795. In 1801, he was appointed chief of anatomic studies. This opportunity furthered his interest in pathology and physiology. Within the first year, his group of prosectors had completed summaries on more than 1000 autopsies, carefully documenting every congenital and acquired lesion and cataloging the abnormalities. So competent was Dupuytren in his teaching that he started his own course in pathological anatomy, with Gaspard Bayle and René Laennec as his assistants. Later, Dupuytren and Laennec, known for inventing the stethoscope, would become bitter professional rivals.In 1802, Dupuytren took the position of surgeon of the second class at the Hôtel Dieu, winning over his rival, Philibert J. Roux. In 1803, he defended his doctoral thesis, entitled in translation “Propositions on several aspects of anatomy, physiology and pathological anatomy.” He quickly rose in his surgical career from assistant to staff surgeon and then, at the age of 38 years, to chief surgeon at the Hôtel Dieu, which was the highest surgical post in France. In addition, he also had a flourishing practice, with about 10,000 patients annually.Dupuytren was an aggressive and overconfident surgeon. His contemporary, Jacques Lisfranc, referred to him as “The Brigand of Hôtel Dieu.” But his jealous enemies and embittered rivals acknowledged his many exceptional contributions and competence. Dupuytren was the first to excise the mandible in a case of jaw tumor and treat torticollis by subcutaneous section of the sternomastoid muscle. He was an innovator in many spheres of surgery, including aneurysms, vascular ligation, lithotomy, creation of an artificial anus, cataracts, and cancer surgery.Dupuytren also was renowned for his contributions to orthopedic and plastic surgery, in particular to congenital dislocation of the hip, fractures, cleft lip, and the Madelung wrist deformity. During the Napoleonic Wars and the Revolution of 1830, he had extensive experience with battle wounds and disfigured war casualties.Dupuytren was the first to describe lines of skin tension. With extensive experience with burn patients, he developed a logical and useful scheme to classify burns into 6 degrees. In 1819, Dupuytren provided original descriptions of fracture of the lower end of the fibula (Dupuytren fracture).An outstanding diagnostician with an amazing power of observation, Dupuytren trained many brilliant pupils throughout Europe and even from across the Atlantic. Among his famous pupils from the United States were such surgeons as J. C. Warren and his son. Dr J. C. Warren, who would later perform the acclaimed first surgical operation under ether anesthesia in Boston, Mass, in 1846, spoke admiringly of the French surgeon. Dupuytren would advise his students to “Read little, see much, do much” (“Peu lire, beacoup voir, beaucoup faire”). His formal medical writings were few; most of Dupuytren's teachings were prepared by assistants for publication. His lectures were translated and reprinted in New York and England.Dupuytren maintained a strict regimen at the Hôtel Dieu, rarely deviating from it for more than 2 decades. His day started around 6 am, with early morning rounds of his surgical patients, followed by a lecture and surgery. After lunch, he would see more patients and return in the evening to inspect his patients who had been newly operated on. Dupuytren's surgical practice was extraordinarily busy. In 1818, he set 178 fractures, drained 300 abscesses, and performed 368 operations. His extensive outpatient practice allowed him to amass a fortune.In December 1831, Dupuytren presented his findings on the contracture of the palmar fascia at the Hôtel Dieu. The lecture was reported verbatim in a Parisian journal by his assistants. The work appeared in the London Medical and Surgical Journal in 1832, detailing the surgical treatment for an affection of the palmar aponeurosis (Dupuytren contracture). Others had previously noted this condition, but Dupuytren devised the first successful surgical operation for the condition. He dissected a cadaver before attempting his first palmar fasciotomy to treat his first patient.Respected by all but not loved, Dupuytren exhibited a vitality and abundance of energy that set him in a league of his own. Surgeon to Louis XVIII and Charles X, he apparently offered the latter 1 million francs in his hour of need. Louis XVIII created a baronetcy for him in 1816.In November 1833, Dupuytren had a stroke. He felt a slight paralysis of his face while lecturing but carried on. He took a leave of absence and later returned to lecture, but his health declined. He died in February 1835.Dupuytren was influential in furthering the evolution of pathological anatomy in France. A monetary endowment from Dupuytren's estate was bequeathed to the University for establishment of a new chair in pathological anatomy, and consistent with his expressed wish, the first contender of this new post was the renowned Jean-Baptise Cruveilhier, who went on to make outstanding contributions to pathology.

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