ORIGINAL RESEARCH. International Journal of Surgery

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1 International Journal of Surgery 10 (2012) 542e546 Contents lists available at SciVerse ScienceDirect International Journal of Surgery journal homepage: Original research A pioneer in medicine and surgery: Charles Sédillot (1804e1883) Franck Billmann a,b, * a Department of General and Abdominal Surgery, St. Vincentius Kliniken, University of Freiburg i. Br., Germany b Albert Ludwig s University, Freiburg i. Br., Germany article info abstract Article history: Received 20 July 2012 Received in revised form 17 August 2012 Accepted 20 August 2012 Available online 31 August 2012 Keywords: Sédillot History of surgery Gastrostomy Anaesthesiology Infectiology Microbe Professor Charles Sédillot (1804e1883) is one of the pioneers of modern medicine, surgery, anaesthesiology, histopathology and infectiology. Unfortunately, he remains unknown outside of the circles of French military medicine historians. He was the first surgeon in the world to offer techniques such as coxofemoral dislocation and internal urethrotomy, thus becoming a pioneer in endoscopic surgery. By introducing general anaesthesia in France, he revolutionised patient care. In addition, he laid the foundation for the modern, algorithmic treatment of tumours by adopting the principles of clinical histopathology. Long before the description put forth by Semmelweiss (1818e1865), he foresaw and understood the existence and action of microorganisms, which he termed microbes, in the development of postoperative infections. For his work, he was honoured by his peers in France but remained unknown beyond the borders of his homeland. Here, we present a succinct report of the considerable accomplishments of the life and work of this outstanding physician and surgeon. Ó 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved. Charles Sédillot is one of the pioneers of modern medicine and surgery and was described as such in 1883 by Jules Chauvel, professor of operative medicine at Val-de-Grâce in Paris: Endowed by nature with an energetic character, an admirable strength of will, an exquisite good sense and great critical thinking; expert anatomist, brilliant operator, skilled and experienced surgeon, he also had the rare merit, while relying on the tradition of great masters, to never be refractory to modern discoveries Sédillot s life Charles Emmanuel Sédillot was born in Paris on September 18, Sédillot got his spirit of innovation through an exceptional familial environment. His father, Jean Jacques Emmanuel Sédillot (1777e1834), was an assistant in the Bureau des Longitudes (office of longitudes) at the Paris Observatory. In particular, he assisted the great astronomers Jean-Baptiste Delambre (1749e1822) and Pierre Simon de Laplace (1749e1827) in their research. His mother was the daughter of Colonel Fosse of the French military, an author of reference books on the attack and defence of fortresses. His younger brother, Louis Pierre Eugène Amédée Sédillot (1808e 1875), would follow in the footsteps of his father and become * Department of General and Abdominal Surgery, University of Freiburg i. Br., St. Vincentius Kliniken, Südendstraße 32, D Karlsruhe, Germany. Tel.: þ ; fax: þ address: franck.billmann@wanadoo.fr. a professor at the Collège de France. He would publish many reference books on the mathematical sciences among the Greeks and Orientals and on astronomy. During high school, Sédillot made friends with notable contemporaries. First, his friend Hippolyte Larrey (1808e1895), son of the famous Dominique Larrey (1766e 1842), a surgeon who accompanied Napoléon Bonaparte in all of his campaigns, would also become a brilliant surgeon, a surgeon to Napoléon III. In 1821, he enrolled at the school of medicine in Paris at age 17. Charles Sédillot then chose the path of a military surgeon. He completed his medical studies in 1829 and received his doctorate of medicine on December 29, After his doctorate, Sédillot practiced as a young surgeon, a certified assistant-major in the military hospital of Val-de-Grâce in Paris. After the Paris insurrection of the Three Glorious Days (July 27, 28 and 29) that marked the Revolution of July 1830 and ended the Restoration (1814e1830), Warsaw cadet officers revolted against Russia. With Guyon and Malgaigne, Sédillot wished to leave for Poland to lend a hand to their Polish counterparts during the polish upspring (1830e1831). 2 Appointed surgeon to the 6th emergency unit, he immediately went into the combat zones. During this difficult period at the end of May 1831, he succeeded in performing the first coxofemoral dislocation in the world. At that time, cholera was raging within the Polish troops. This was Sédillot s first contact with this disease; he foresaw the contagiousness of cholera and recommended the maintenance of good hygiene and cleanliness and not drinking impure water as a pioneering idea. In December 1836, Sédillot asked to be part of the second expedition to Constantine /$ e see front matter Ó 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

2 F. Billmann / International Journal of Surgery 10 (2012) 542e during the on-going conquest of Algeria. Sédillot was assigned under the command of Guyon to direct the emergency unit to the forefront of the expeditionary column. The assault on Constantine, undertaken on October 10, 1837, proved murderous. On this occasion, Sédillot collected many original observations that he published upon his return in a valuable work titled Constantine Campaign of 1837, with explanatory plates, 3 published in Paris in 1838 (308 p.). This participation in the campaign of Constantine had an essential influence on the orientation of Sédillot s future research in infectious disease. Indeed, during this brief campaign, at the Medjez-Amar camp, he noticed that the real danger was not the enemy s bullets but was instead diseases, particularly cholera and malaria, that decimated the European contingents. His exemplary conduct earned him the title Chevalier of the Legion of Honour on December 9, He would then be promoted to Officer in 1850 and Commander in 1863 (Fig. 1). Sédillot s unrelenting work and efforts were rewarded with an appointment as professor of surgical pathology and operative medicine at the Hôpital de Perfectionnement (teaching hospital) of Val-de-Grâce in In 1841, at age 37, Sédillot applied to the open competition for the chair of surgery at the University of Strasbourg. Sédillot was given the chair of external pathology and clinical surgery. During holidays, he travelled to London to see his friend John Avery, a surgeon at the Charing-Cross hospital, who had been his companion in Poland. He aimed to visit a different country every year and actually made several trips to Germany and Italy. In his Medical letter on London, 4 published in 1847, Sédillot emphasised the benefits of such trips and meetings with contemporary scientists: To better judge oneself and others, we must occasionally leave our everyday surroundings, compare places and people, look where reputations stop and ponder the human vanities. In 1856 the city of Strasbourg was designated for the site of the military school of health. The school management fell under the chief medical officer of the military hospital, which was Sédillot at that time. The relationships between the military school, the military hospital and the school of medicine were not easy to manage. At first, these new duties did not appear to have contended Charles Sédillot; however, all the students described Sédillot as a clear and leading teacher. As a thoughtful surgeon, he transmitted his medical philosophy to his colleagues; the Treatise on operative surgery contains many of his philosophical considerations on the practice of surgery. In 1870, at age 65, Charles Sédillot was still professor at the school of medicine in Strasbourg but had been retired from his military duties for over a year. The war of 1870 would give him the sad occasion to delve back into war surgery. Sédillot said: Everywhere we see hospitals, emergency units, villages and cities congested. From the eighth to the twelfth day, we recognise the places where the wounded stay from the smell of suppuration and gangrene that emerges. A few days later, the infection is widespread and causes huge mortalities. The medical and hospital staff does not escape this Fig. 1. Charles Sédillot (1804e1883) in uniform as a medical inspector (¼General) bearing the cross of Commander of the Legion of Honour and Commander of the Pontifical Order of St. Gregory-the-Great. Fig. 2. Woodcut illustration of the publication by C. Sédillot, Contributions to surgery (1862). Skin and stomach incisions (472, 473), gastrostomy cannulae (478e482), and endoscopy trocar cannula (575).

3 544 F. Billmann / International Journal of Surgery 10 (2012) 542e546 deleterious effect, marked from the beginning with gastrointestinal disorders of varying severity. How can the unfortunate wounded survive this! 5 The observations made by Sédillot on the treatment of injuries caused by firearms were valuable and got him to engage more fully in favour of a more conservative treatment approach by occlusion and immobilisation at a time when amputation was the rule of principle. 5,6 He retired on November 25, 1868, after 44 years of military service, and returned to Paris. He continued to lead a full and varied intellectual life. On June 24, 1872, Charles Sédillot was elected to the academy of sciences with a great majority. In June 1879, Charles Sédillot suffered a hemiplegia and subsequently had to face the gradual deterioration of his health. On January 29, 1883, Charles Sédillot died at the age of 78 at his son s house. 2. Sédillot s oeuvre and works Sédillot s oeuvre and works are considerable. He is supposed to have had a major influence on physicians and surgeons around the world The surgery pioneer In 1831, Sédillot successfully completed the first coxofemoral dislocation in the world, 7 an intervention corresponding to the amputation of the entire lower limb through the hip joint with soft tissue coverage. Bone and joint surgery and limb surgery would remain Sédillot s favourite subjects throughout his career. He proposed and improved limb amputation techniques. 7e10 Several surgical methods of Sédillot are presented and illustrated in the seventh volume of the monumental reference volume of JM Bourgery, Treatise on humans including operative medicine, 11 published in 1839e1840. In 1846, Sédillot was the first in the world to practice gastrostomy, a surgery that establishes a permanent opening between the stomach and the abdominal wall to enable the absorption of food by means of a probe when the upper digestive tract is obstructed. 12,13 He introduced a curved and cylindrical silver cannula topped with a square cork plate affixed using two ribbons encircling the body (Fig. 2). First performed in 1846, this daring surgery has since become common practice by the implementation of Fig. 3. Restorative maxillofacial plastic surgery techniques proposed by C. Sédillot.

4 F. Billmann / International Journal of Surgery 10 (2012) 542e gastrocutaneous fistulas (mainly for the nutrition of patients with tumours of the upper digestive tract). From 1844, Sédillot also championed the advancement of restorative plastic surgery by proposing new methods of rhinoplasty, cheiloplasty, uranoplasty, staphylorrhaphy and the treatment of cleft lip and palate (Fig. 3). 14e16 In 1849, Sédillot developed a novel procedure for internal urethrotomy, 17,18 corresponding to an incision in the inner lining of the urethra to restore the flow of urine. He ushered in the field of endoscopic surgery and was the first to highlight its importance. In 1839, at age 35, Sédillot published his Treatise on operative surgery, bandages and equipment in two volumes. 19 This book met with great success and would have three revised editions. The last edition included nearly 700 interspersed figures in the text (Fig. 4). The Treatise on operative surgery by Sédillot also contained many general considerations on the practice of surgery and the fruits of his extensive experience, many of which are still valuable today. For example, Sédillot wrote: The success of operations depends on the skill of the surgeon. Setbacks acknowledge our ignorance or mistakes, and perfection is the goal of the art. A belief in the sovereign efficacy of the art and the sense of personal responsibilities never lack in a true surgeon, whose first rule of conduct is faith in the success of the operation he advises and undertakes. Committed by his judgments, he pronounces them with reflection, maturity and prudence The inventor of the word microbe in 1878 Charles Sédillot was the inventor of the word microbe (from the Greek: mikros, small, and bios, life ), which he proposed in 1878 in his communications to the academy of sciences, titled On the influence of the work of Mr. Pasteur on the progress of surgery. 25 Sédillot, who met Pasteur while he had his appointment as Professor of Chemistry at Strasbourg from 1848 until 1854, wrote presciently: These organisms form a world composed of species, 2.2. A pioneer in anaesthesiology Sédillot was also a pioneer of surgical anaesthesia in France. On January 19 and 29, 1847, Sédillot introduced general anaesthesia with ether (or etherisation) in Strasbourg. Sédillot had been impressed after attending an amputation at the thigh level performed under ether anaesthesia in London by his friend John Avery. In the same year, in 1847, Sédillot presented a remarkable series of 50 patients from his service operated upon under ether anaesthesia in front of the academy of sciences. 20, A pioneer in microscopy and histopathology Beginning in 1844, under the impetus of professor Emile Kuss (1815e1871), head of anatomical studies from 1843 to 1847, appointed head professor of the physiology chair in the school of medicine in Strasbourg in 1846, the clinical use of microscopes, then contested, was developed. Strasbourg professors C Sédillot, JA Stoltz, E Koeberlé, E Michel and C Schuetzenberger henceforth routinely used microscopy to specify the natures of the pathological specimens they observed, marking the start of histopathology A pioneer in hygiene and the field of infectious disease In 1849, Sédillot published a voluminous 520-page book titled Of purulent infection or pyaemia. 23 Following his numerous groundwork observations during the campaigns in Poland and Constantine, he predicted the presence of causative agents of infections and established a direct link between these agents and postoperative infections observed in surgery units. In 1851 and 1853, Sédillot linked the postoperative infectious complications observed under his clinical service and the proximity to anatomy services and the dissection room. In this context, the new doctrine of surgical sepsis, developed by Ignace Philippe Semmelweis (1818e1865) and published in 1861, provided both confirmation and explanation of the facts that Sédillot foresaw a decade earlier. Sédillot proposed specific hygienic and aseptic measures. Cornerstones of his surgical success included operating with clean hands, using instruments that had been washed and banning the use of dirty dressings. 23,24 Fig. 4. Preparatory drawing in India ink by Emile Schweitzer (1837e1903) and woodcut illustration of the publication by C. Sédillot, Treatise of operative medicine, bandages and equipment (4th edition, 1870). A perineal lithotomy for bladder stones, where the operating surgeon represented is Sédillot. Out of the 92 figures signed in this work, 54 were drawn by the Strasbourg artist Emile Schweitzer (1837e1903).

5 546 F. Billmann / International Journal of Surgery 10 (2012) 542e546 families and varieties whose history, barely begun, is already rich in foresight and results of the utmost importance. Louis Pasteur (1822e 1895), then age 56, approved the word microbe and was deeply touched by the marks of attachment that Sédillot bestowed upon him, especially because criticism had not subsided. On March 19, 1881, Pasteur wrote in a letter to Sédillot regarding this topic: Dear and illustrious master, will you allow me to publish (and to say that it is done with your permission) the letter in which Mr Littré approved the word microbe, proposed by you, to silence the scruples of some more or less self-interested people. Please accept, with the hope that I, and all your colleagues as well, help the restoration of your health, a tribute of my most deepest and affectionate respect. In conclusion, Sédillot had a major role and impact in the development of modern medicine and surgery. The evocation of its exceptional, rich, and eclectic life should lead us to address the recurrent question of the adequacy of hyperspecialization in medicine and sciences. In our mind, Sédillot s life and work is questioning, in an adequate way, established medical paradigms. Ethical approval None. Funding No financial ties. Author contribution Billmann contributed to all parts of the present article. Conflicts of interest No conflicts of interest. Acknowledgements We wish to thank Professor Louis-François Hollender (1922e 2011), former president of the french Academy of Medicine and the french Academy of Surgery, Professor of General and Abdominal Surgery at the University and School of Medicine in Strabourg (France), and Dr Jean-Marie Le Minor, senior lecturer, member of the National Council of Universities in Anatomy and hospital physician in radiology at the School of Medicine in Strasbourg (France), for his preparatory work. We thank also Dr Therezia Bokor-Billmann for her support in the writing and revision process. References 1. Chauvel J. Sédillot et son oeuvre chirurgicale. Rev Chir 1883;111:241e Bonnot D. Charles-Emmanuel Sédillot (1804e1883). Paris: La Pensée Universelle; Sédillot C. Campagne de Constantine de 1837, avec planche explicative. Paris: Crochard et Cie; Sédillot C. Lettre médicale sur London. Gaz Med Paris 1847;17:857e Sédillot C. Suite des indications relatives aux amputations faites à la suite de blesssures par les armes de guerre. Suites funestes de l encombrement et de tout ce qui s oppose à une parfaite aération des lieux où sont reçus les blessés. Conditions qui devront augmenter les chances de guérison; mesures proposées à cet effet. CRAcadSci1870;71:435e9. 6. Sédillot C. Observations relatives aux indications chirurgicales et aux conséquences des amputations, à la suite des blessures par les armes de guerre. C R Acad Sci 1870;71:421e5. 7. Sédillot C. De la résection coxo-fémorale. C R Acad Sci 1866;63:629e Sédillot C. Des moyens d assurer la réussite des amputations des membres. CR Acad Sci 1848;27:250e6. 9. Sédillot C. Mémoire sur les amputations des membres. C R Acad Sci 1849;29: 430e Sédillot C. Des moyens d assurer la réussite des amputations des membres. Résultats statistiques des amputations pratiquées par moi pendant la dernière année scolaire 1850e1851. Observations des malades opérés. C R Acad Sci 1852;34:302e Bourgery JM, Jacob NH. Traité complet de l anatomie de l Homme comprenant la médecine opératoire. Paris: Delaunay Ed; Sédillot C. De la gastrostomie fistuleuse. C R Acad Sci 1846;23:222e Sédillot C. Des cas auxquels l opération de la gastrostomie est applicable. C R Acad Sci 1846;23:907e Sédillot C. Sur un nouveau procédé de rhinoplastie, avec un succès complet. C R Acad Sci 1844;19:747e Sédillot C. Nouveau procédé de cheiloplastie, procédé à double lambeau de la méthode indienne. 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