Louis Dominique le Roy and the first documented and successful crural fracture osteosynthesis, performed in Antwerp in 1796

Abstract

Methods

In 1796 the Antwerp surgeon Louis Dominique Le Roy (1755–1826) performed an osteosynthesis for an open crural fracture, using cerclage of the tibia with a golden thread. The written report, the first ever of such osteosynthesis, is documented by the publication in Dutch, and translated here in English language.

Results

The osteosynthesis proved successful. The patient completely healed.

Conclusion

This is the first successful osteosynthesis and thereby antedates by far the late nineteenth century cerclage operations of long bones.

Keywords:

• Osteosynthesis
• fracture
• tibia
• louis dominique le roy
• flemish language

Notes

1 For instance in Amsterdam in 1790 and in Brussels in 1795. See respectively van der Sluis [3], 179, footnote 140, and Kesteloot [2], 19–20.

2 ‘The one who doesn’t help (his fellow man), is a murderer’.

3 Le Roy himself signed his name in two words. Later both spelling forms were used.

4 Montfort, surgeon in Borgerhout, now a district of Antwerp.

5 Pierre-Joseph Desault (1738–1795) was a French surgeon, who improved substantially surgical education and practice. After having created a school of anatomy in Paris in 1766, he became a leading surgeon successively in 1782 in the Charité hospital, and in 1784 in the Hôtel-Dieu hospital, where he instituted a clinical school of surgery. Together with François Chopart 1743–1795) he published in 1779 a ‘Traité des maladies chirurgicales’, in which he proposed already splints for immobilising bone fractures. See this treatise 1779, vol.1, p. 29. In the ‘Oeuvres chirurgicales’ of Desault, published by his pupil Xavier Bichat (1771–1802) in 1798, he describes at large his treatment of fractures of the tibia, including the two splints he used for immobilisation. See Desault, 1798, vol.1, pp. 355–366.

6 Possibly David Macbride (1726–1778), an Irish naval surgeon, who was one of the founding surgeons of the Meath Hospital in Dublin. He wrote on scurvy but also produced a medico-philosophical treatise.

7 Joseph-Guichard Duverney or Du Verney (1648–1730) was a French surgeon and anatomist. He is one of the first otologists, but was also interested in bone disease. His treatise on ‘Maladies des Os’ was published posthumously in 1751 and contained the description of the eponymous ‘Duverney fracture’ of the iliac wing of the pelvic bone.

8 Le Roy cites here in footnote 1 the reference: ‘Traité sur les maladies des os’. Tôme 1, Chapître IV. Equally the Dutch translation by Houttuyn, Part I. Chapter IV, concerning ‘De Splijting der Beenderen’. See Du Verney 1751, 159.

9 Jean-Louis Petit (1674–1750) was a French surgeon, who became director of the Académie Royale de Chirurgie in Paris in 1731. He wrote ‘L’Art de guérir les maladies des os, ou l’on traite des luxations et des fractures avec une machine de nouvelle invention pour les réduire’, published in 1705.

10 The author cites in footnote 2 the reference: ‘Traité des Maladies des Os’, nouvelle Edition, augmentée par M. Louis. Tome II, Chapitre I, p. 6. See Petit [17], II, 6.

11 Probably a quarter of a foot.

12 This was Joannes F. Van Camp who got his certificate of surgeon in the Antwerp guild at the end of March 1792, He was the son of surgeon Jacobus Van Camp, who got his certificate of surgeon in the guild on June 25^th, 1754. See de Mets [18], 21 & 20.

13 This proved a disinfecting solution!.

14 This Diacodium syrup is a weak German variant of the Papaver Syrup; It indeed contains less tincture of the poppy than the classical British Syrupus Papaveris. It is nevertheless narcotic.

See https://www.henriettes-herb.com/eclectic/kings/papaver_syru.html

15 Kinkina is an extract of the bark of the kina tree or Cinchona pubescens. It contains kinin and has fever and pain reducing actions.

16 It is clear that the author still adheres to the principle of ‘pus bonum et laudabile’ of Guy de Chauliac. This principle was followed till late in the 19^th century!.

17 Le Roy gives in his 3rd footnote (number 1 of this page) the following remark. ‘Unless that one would have removed the too sharp bone ends of the oblique fracture by means of a saw or bone forcepses; or would have proceeded to the excision of the upper and lower fragments of the broken bone pipes, [as accepted] under the authority of the learned David, who showed that this loss of autonomy can be restored by nature.

And what the great Sabatier, member of this Society has already presented at the Académie de Chirurgie in Paris. However the starting gangrene (Gangrena) in the vicinity of the wound [in this case] eased the possibility to conduct and position the thread under the broken and reduced bone ends, so that it was unnecessary to use a heavy apparatus. Observation sur une Maladie d’Os comme sous le nom Nécrose. Paris, 1782. Séances publiques de l’Académie Royale de Chirurgie de Paris, page 83, 1779’. See respectively David [19] & Sabatier [20].

18 She was born in Antwerp in 1716, and died in the same city on August 14^th 1796, or 21 thermidor, An 4.

19 She died in Waasmunster on May 28^th 1806.

20 Born in Antwerp at home on 10 pluviose an 7 (=1799), she died 9 months later at home, on November 11^th, 1799.

21 Louis Dominique jr. was born in Antwerp on July 1^st 1802, and married in Tournai on November 8^th 1842 with Marie Clara Joseph Delamotte Baraffe, daughter of Emmanuel Auguste Marie Joseph, baron of de Lamotte Baraffe, knight of the Order of the Belgian Lion. Louis Dominique jr. was lieutenant of the 1^st Regiment of Hunters, in garrison at Tournai.

22 For a biography of Matthey, see Broeckx [32].

23 Together with Jean Henri Matthey. See Sondervorst [21], 148.

24 This regulation adapted the old rules for the medical professions to the necessities of the new contemporary era: in 6 chapters the practices of medical doctors (2 chapters), pharmacists (2 chapters) and surgeons were determined. See Broeckx [22], 272–291.

25 Including for instance dermatological and venereal diseases.

26 Patients were mostly with two or more in the available 94 beds at that time. As there was no heating in winter, all rooms were cold and wet.

27 Where an analogous Society was founded in 1795.

28 ‘Sur la jurisprudence médicale et la nécessité d’établir dans chaque ville une administration de jury de médecine légale’ (1801). See Le Roy [13].

29 French army surgeon, surgeon in chief of the Antwerp military hospital.

30 He was surrounded by pharmacist van Merstraeten, and by the doctors van den Sande, van Haesendonck, Lemercier, and Martin Joseph Béguinet. See de Mets [18], 17; Vermeiren [28], 160.

31 His name had become Leroy.

32 de Haan was a pupil of Herman Boerhaave (1668–1738) and later worked in Vienna, where he became the protagonist of daily use of a thermometer in hospital patient care. He published the ‘Ratio medendi’, an enormous work in 15 volumes.

33 Petrus Stephanus Kok (1750–1840), born in Rotterdam, was a medical doctor who first practiced in Antwerp, where he gave such excellent anatomic demonstrations, that he was asked to become professor anatomy in Louvain. After the transfer of this university to Brussels, he continued to be professor in the capital.

He was one of the founders of the Brussels Society of medicine, surgery and pharmacy in 1795. He wrote several articles in the journal of that Society (Actes de la Société de Médecine, Chirurgie et Pharmacie de Bruxelles, 1^re partie, pp. 35–36, & 2^e partie, pp. 10–13, an VI.[1798]). He was a famous surgeon and obstetrician.

34 Jean Henri Matthey (1742–1796), born in Maaseik, first became a surgeon in Antwerp in 1766, then entered the Austrian Army. He became member of the guild of surgeons in Antwerp in 1770. Then he studied medicine at the University of Louvain, where he got his license in 1776I. In 1783 he became town doctor and official in Antwerp. He had some troubles with the city council and got very pleased when France invaded Belgium, and the new municipality in 1794 offered him a seat as alderman, to finally promote him to maire of Antwerp in 1795. After a year of absolute submission to the French government, he suddenly died from a stroke in 1796. See Sondervorst 1981, 139–140 and de Mets 1929, 16.

35 See Leroy’s reprint 1936.

36 Paré indeed quotes Franco as the inventor of the technique!.

37 This tread leader is a prototype of the later Reverdin needle.

38 Paré [34], Livre VIII, Chap. XVI, 191–192. See also Rogge [35], 127–129.

39 Nor was it performed for any -other indication.

40 Fabricius ab Aquapendente. 1592, 516–517. Le Roy may have possessed the French translation of Fabricius’s works, where the same chapter X of Book IV is reproduced. See Fabrice d’Aquapendente 1674, 451–452.

41 French city in the ‘Département du Tarn’.

42 Moreover Pujol accused Icart of having performed in 1761 an analogous cerclage in one of his patients, suffering from an open humerus fracture and resulting in the death of this patient. The patient however was treated conservatively by Icart with bandages, but ultimately died after 12 days from an intrathoracic haemorrhage, resulting from the original trauma. See for the extensive correspondence between the two antagonists: Pujol [39], 43: 170–171, the response by Icart in 1775, 44: 164–181, and finally the reply of Pujol, attacking Icart, [40], 45: 167–185. See for this remarkable quarrel also the citations by Burny & Burny-Magerat [41], 565–566, and by Christopher Colton [42], 24, I, 12.

43 Or vice versa.

44 There are reports by Kearny Rodgers (1793–1851) in 1825, Valentine Mott (1785–1865) in 1831, John Cheesemann in 1838, Achille-Cléophas Flaubert (1784–1845) in 1835 and 1838, and Joseph-François Malgaigne in 1847. See Povacz [45], 136–137.

45 ‘Traité de l’immobilisation directe des fragments osseux dans les fractures’. See Bérenger-Féraud [46], 1–744. The issues of this book were first presented by the author during a lecture at the Académie de Médecine on November 8^th, 1864.

46 Bérenger-Féraud 1970, p. IX.

47 ‘Je n’en trouvai pas la moindre mention’. See Bérenger-Féraud 1870, p. X.

48 This is an extensive description of the delivery of Siamese conjoined twins. The twins died but the mother survived after delivery [6]. Le Roy had received the corpse of the twins at the Surgical Schol in 1795, and dedicated an article to this particular case the following year [7]. This is another article, written by Leroy, depicting six cases, he treated with cold drinks and clysma’s, as well as cold compresses on the skull [8]. This is Le Roy’s speech as President of the Society [25]. Broezckx 1858, 297–314. Asking for better education of doctors and surgeons in the St. Elisabeth Hospital [26]. Asking to organize a subscription in view of collecting funds for a better education of surgeons in the hospital [26]. Asking to provide on the one hand more cadavers for anatomical dissection in the lessons for doctors and surgeons, and on the other hand to nominate two surgeons to give the demonstrations [30]. Asking to restore the old Collegium Medicum Antverpiense and let resume its functions [43].