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ANTOINE PORTAL (1742-1832)
Kutia S. A.1, Shaymardanova L. R.2, Abdullaeva V. D.2, Smirnova S. N.1
1Кафедра медицинской биологии, 2кафедра нормальной анатомии, Медицинская академия имени С.И. Георгиевского ФГАОУ ВО «Крымский федеральный университет имени В.И. Вернадского», 295051, бульвар Ленина 5/7, Симферополь, Россия;
Для корреспонденции: Кутя Сергей Анатольевич, доктор медицинских наук, профессор, заместитель Директора по международным связям, заведующий кафедрой медицинской биологии, Медицинская академия имени С.И. Георгиевского ФГАОУ ВО «КФУ им. В.И. Вернадского», е-mail: sergei_kutya@mail.ru.
For correspondence: Kutia Sergey Anatolievich, MD, Professor, Deputy Director for International Relations, Head of Medical Biology Department, Medical Academy named after S.I. Georgievsky of Vernadsky CFU, е-mail: sergei_ kutya@mail.ru
Information about authors:
Kutya S. A. http://orcid.org/0000-0002-1145-4644 Shaymardanova L. R. http://orcid.org/0000-0003-3154-3203 Abdullaeva V. D. http://orcid.org/0000-0002-1767-965X Smirnova S. N. http://orcid.org/0000-000
SUMMARY
The article outlines biography and works of famous French physican Antoine Portal (1742-1832), the founder of the Royal Academy of Medicine, the first doctor of the King Louis XVIII. The information about him is very scarce, despite the huge contribution he made to clinical medicine, pathomorphology, anatomy. He wrote about nature, case reports and treatment of rabies, tuberculosis, rickets, smallpox, hereditary diseases, stroke, asphyxia, liver diseases, epilepsy, etc. He was the first to describe bleeding from esophageal varices, hepatic amyloid. His original approach to the patient included thorough physical examination, percussion and auscultation, which gave more accurate diagnoses. Among his most famous works are the monumental "Histoire de l'anatomie et de la chirurgie" ("History of anatomy and surgery") in seven volumes and a five-volume work - the "Cours d'Anatomiae Médicale ou eléments de anatomie de l'homme" ("Course of medical anatomy, or elements of human anatomy"). His name was immortalized in some anatomical eponyms, such as "Portal's space" - the slit between the lower surface of heart and diaphragm seen on X-ray, "Portal's muscle" - the muscular fibers attaching to the front surface of the elbow joint capsule (musculus capsularis subbrachialis), and "Portal's nodes" - posterior mediastinal lymph nodes. 2017 was marked by the 275-th anniversary of the birth and, at the same time, the 185-th anniversary of the death of Antoine Portal, so with the present work the authors pay the deserved honors to that talented scientist and extraordinary doctor.
Keywords: biography (Portal); clinical medicine; pathology.
АНТУАН ПОРТАЛЬ (1742-1832)
Кутя С. А., Шаймарданова Л. Р., Абдуллаева В. Д., Смирнова С. Н.
РЕЗЮМЕ
В статье описываются биография и работы известного французского врача Антуана Порталя (1742-1832), основателя Королевской медицинской академии, личного доктора короля Людовика XVIII. Информации о нем очень мало, несмотря на огромный вклад, который он внес в клиническую медицину, патоморфологию, анатомию. Он писал о природе, клинических случаях и лечении бешенства, туберкулеза, рахита, оспы, наследственных заболеваний, инсульта, асфиксии, заболеваний печени, эпилепсии и т.д. Также, он первым описал кровотечение из варикозных вен пищевода, амилоидоз печени. Его оригинальный подход к пациенту включал тщательное физическое обследование, перкуссию и аускультацию, что давало более точные диагнозы. Среди его самых известных работ - монументальные "Histoire de l'anatomie et de la chirurgie" («История анатомии и хирургии») в семи томах и пятитомный труд - "Cours d'Anatomiae Médicale ou eléments de anatomie de l'homme" («Курс медицинской анатомии или элементы анатомии человека»). Его имя было увековечено в некоторых анатомических эпонимах, таких как «пространство Порталя» - щель между нижней поверхностью сердца и диафрагмой, видимая на рентгеновском снимке, «мышца Порталя» - пучок мышечных волокон, прикрепляющихся к передней поверхности капсулы локтевого сустава (musculus capsularis subbrachialis) и «узлы Порталя» - задние средостенные лимфатические узлы. 2017 год ознаменовался 275-й годовщиной со дня рождения и 185-й годовщиной со дня смерти Антуана Порталя, в связи с чем в настоящей работе авторы воздают заслуженные почести этому талантливому ученому и неординарному врачу.
Ключевые слова: биография (Порталь); клиническая медицина; патология.
2018, т. S, № 2
КРЫМСКИЙ ЖУРНАЛ ЭКСПЕРИМЕНТАЛЬНОЙ И КЛИНИЧЕСКОЙ МЕДИЦИНЫ
2017 was marked by the 275-th anniversary of the birth and the 185-th anniversary of the death of Antoine Portal (1742-1832), French physician, anatomist, pathologist and historian of medicine. The information about him is very scarce, despite the huge contribution he made in medicine.
Antoine Portal (fig. 1) was born on January 5, 1742 in Gaillac in the Tarn area, France (1). He was the eldest of 12 children in the family of an apothecary merchant and Second Consul of Gaillac. He attended the Jesuit secondary school, and later studied medicine in Albi, Toulouse, then in 17621765 at University of Montpellier, where on August 2, 1764 he defended his thesis "Generales luxationum complectens notiones". This dissertation contains a precise presentation of the most useful knowledge on the nature and the treatment of dislocations, with the description and the figure of a new machine to reduce them. After successful graduation, he began teaching anatomy at the same university. In 1767 in Paris, owing to the recommendation of Cardinal de Bernis (1715-1794) to the doctor of King Jean-Baptiste Senac (1693-1770) and his assistant Joseph Lieutaud (17031780), he was chosen the anatomy teacher to the young Dauphin, future Louis XVI, and a court physician [1].
In 1769 he succeeded Antoine Ferrein (16931769) in the chair of anatomy at the Royal College of France and officially became the private doctor of the King's brother.
In 1776 Buffon (1707-1788) made him appoint professor of anatomy in the Garden of the King ("Jardin du Roi") where he succeeded Antoine Petit (17221794). After the French revolution it changed the name of "Jardin du Roi" to the "Museum of Natural History".
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His manager's qualities and publishing skills came along with continuous medical practice. One of them was the office on "rue Saint-Andre-des-Arts" where he accepted the patients and often nobility came to witness that.
Under the Empire he became very famous because he treated powerful persons. But the bright persons are usually surrounded by ill-wishers. Portal had the old feud with Jean-Nicolas Corvizart (1755-1821), who was considered "the emperor of Napoleonic medicine", Professor of Medicine at the College de France. Their contradictions reached the point that Corvizart created a coalition with Claude-Louis Berthollet (1748-1822) and Gaspard Monge (17461818) with whom Portal used to quarrel or disagree within the Institute, preventing the latter from being appointed as the personal doctor of Napoleon and becoming that person himself (2). Thus Corvisart acquired an enormous power to close the doors to those who displeased him. He also did everything to make Portal leave his post. Deep envy, rancor and conspiracy against Portal closed his access to the imperial chambers, but the Portal continued to heal the most eminent nobles of France. Despite they both (Portal and Corvizart) had similar approaches to the patient, with thorough physical examination, percussion and auscultation, which gave more accurate diagnoses, the gap of misunderstanding between two great doctors only increased.
Louis XVIII, who came to power, appointed Portal as his personal doctor in 1818. Portal knew about the unsuccessful efforts of Pierre Chirac, the physician of Louis XV, to create a sort of academy for doctors. He organized a campaign of surgeons and physicians elite to assure the King in necessity of it. His ambitious intentions and career plans had the solid background of medical experience and talent, and could not be left unnoticed by his sovereign. In 1820 King Louis XVIII signed an order to create the Royal Academy of Medicine for the development of high professionals in medicine, and Portal became the first President of it at the age of 78 years old. It became the work of his whole life.
Charles X did not break the tradition, and Portal became his private doctor. Charles X granted him the barony in 1824, made the commander of the Legion of Honor and Knight of the Order of Saint-Michel.
Dupont said about Portal: «He lived through all the regimes without too much trouble, swearing allegiance to five kings, to a republic and to an emperor» (3). In reality, Louis XVI, Louis XVIII and Charles X were siblings and grandsons of Louis XV, and Portal's service was nothing more than loyalty to a family.
Probably, that were his medical talent and extraordinary skills that allowed him not only to survive and pass the fire of the insurrection and the Terror (when many progressive people finished their
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lives in Bastille) but to become the recognized and valuable figure, treating the key persons for any regime.
Till the end of his days, Antoine Portal attended the sessions of the Royal Academy every Tuesday. When he became decrepit, he ceased to meet with the scientific community and barely received people at his home. Antoine Portal died on July 23, 1832, in Paris at the age of 90, from the disease of the stone and was buried in the Calvary cemetery, Saint-Pierre de Montmartre (3). That cemetery is the smallest one in Paris, having only 87 graves, only representatives of aristocracy were buried there. For public it is open only one day a year, on November 1.
Portal made important contributions in many fields of medicine. He wrote about nature, case reports and treatment of rabies, tuberculosis, rickets, smallpox, hereditary diseases, stroke, asphyxia, liver diseases, epilepsy, etc.
Among his notable works we can list: "Precis de chirurgie pratique" (1768), "Observations sur la nature et le traitement de la rage" (1779), "Observations sur les effets des vapeurs méphitiques dans l'homme" (1787), "Observations sur la nature et le traitement de la phthisie pulmonare" (1792), "Observations sur la nature et sur le traitement du rachitisme" (1797), "Observations sur la petite verole" (1799), "Description du nerf intercostal dans l'homme" (1803), "Considerations sur les maladies hereditaires" (1808), "Memoires sur la nature et le traitement de l'apoplexie, et sur les moyens de la prevenir" (1811), " Observations de Portal sur le traitement de l'asphyxie" (1812), "Observations sur la nature et le traitement des maladies du foie" (1813), "Considerations la nature et le traitement des maladies de famille" (1814), "Observations sur la nature et le traitement de l'hydropsiae" (1824), "Observations sur la nature et le traitement de l'epilepsie" (1827), "Memoires sur la nature et le traitement de plusieurs maladies, avec les précis des experiences sur les animaux vivans, et un cours de physiologie pathologique" (1800 - volume I, II, 1808 -volume III, 1819 - volume IV, 1825 - volume V).
Portal made remarkable contributions to pathology. He was the first to describe bleeding from esophageal varices (4). Also, Portal is considered to be the first to describe hepatic amyloid in 1789 (5). He found out a substance similar to lard in the liver of an elderly woman, and later in the liver of an 8-year old boy. Portal also noted kidneys "three times fattier than normal". Because the material from lardaceous liver hardened like albumin when exposed to heat, Portal thought that his patients had some sort of albuminous obstruction. Later, Bohemian physician Carl von Rokitansky (1804-1878) determined it as fatty degeneration of liver associated with kidney pathology.
The first report of a spinal stenosis is attributed to Portal in 1803. He observed at autopsy three specimens with narrowing of the spinal canal. He was also able to relate the pathological findings to the typical clinical symptoms of spinal stenosis (6).
Also, Portal has left his trace in anatomy. In 1770-1773 he published a monumental "Histoire de l'anatomie et de la chirurgie" ("History of anatomy and surgery") in seven volumes (fig. 2), where he described the development of two sciences, gave their periodization, discoveries and their authors. Portal's work was quite different from the previous attempt of Haller to do the same job - to enlighten the past of Anatomy. He was interested in the connection of anatomy with surgery, rather than with physiology. But they both agreed at the same statement, that anatomy and surgery had made a more dramatic upsurge within one century than in the previous two thousand years.
In 1803-1804 he developed five-volume work, the "Cours d'Anatomiae Médicale ou eléments de anatomie de l'homme" ("Course of medical anatomy, or elements of human anatomy") (fig. 3).
In this book, based on Portal's anatomical course and observations, anatomical descriptions are often followed by physiological and especially pathological "remarks", sometimes extended. In the "remarks", there are sometimes remarkable anatomo-clinical observations, some of which are specific, especially when the nervous system is concerned. In the preface of his book, he wrote: "It is not only to know the structure of the human body that we must study anatomy, nor because it leads to the
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2018, т. 8, № 2
КРЫМСКИИ ЖУРНАЛ ЭКСПЕРИМЕНТАЛЬНОМ и клиническои медицины
Fig. 3 Title page of Portal's "Cours d'Anatomiae Médicale ou eléments de anatomie de l'homme"
knowledge of the uses of its various parts, but also because it spreads over nature, the causes and the seat of diseases, lights, without which Medicine would be a blind empiricism" (7). Portal preferred to teach anatomy with clinical application and he was the first to introduce the term "medical anatomy".
His name was immortalized in some anatomical eponyms, such as "Portal's space" - the slit between the lower surface of heart and diaphragm seen on X-ray, "Portal's muscle" - the muscular fibers attaching to the front surface of the elbow joint capsule (musculus capsularis subbrachialis), and "Portal's nodes" - posterior mediastinal lymph nodes (8).
Portal's contributions to scientific research have been internationally recognized: he was a member of the National Institute of Bologna, of the Academy of Sciences of Turin, of the Society of Sciences of Harlem, of the Societies of Medicine of Edinburgh, Padua, Genoa, Brussels, Antwerp, Paris, Montpellier, Toulouse, Bordeaux, Tours and Neufchátel (9-11).
The authors have no conflict of interests.
Авторы заявляют об отсутствии конфликта интересов.
ЛИТЕРАТУРА
1. Riaud X. Antoine Portal (1742-1832), doctor Knight of the empire and founder of the Royal Academy of Medicine. Available at: http://www.napoleonicsociety.com/ english/riaudportala.html. Accessed December 1, 2017.
2. Anonymous. Antoine Portal. Available at: http://www. napoleon-empire.net/personnages/portal.php. Accessed November 27, 2017.
3. Dupont M. Dictionnaire historique des Médecins dans et hors de la Médecine. Paris, France; 1999.
4. Moodley J., Singh B, Lalloo S., Pershad S., Robbs J.V. Non-operative management of haemobilia. Br J
Surg 2001;88(8):1073-76. https://doi.org/10.1046/j.0007-1323.2001.01825.x.
5. Kyle R.A. Amyloidosis: a convoluted story. Br J Haematol. 2001;114(3): 529-538. https://doi.org/10.1046/ j.1365-2141.2001.02999.x.
6. Gruber Ph., Boeni Th. History of spinal disorders. In: Boos N, Aebi M, editors. Spinal disorders. Fundamentals of diagnosis and treatment. Berlin Heidelberg: SpringerVerlag; 2008:1-37.
7. Portal A. Cours d'Anatomiae Médicale ou eléments de anatomie de l'homme. T.1. Paris; 1804.
8. Гончаров Н.И. Иллюстрированный словарь эпонимов в морфологии. Волгоград: Издатель, 2009.
9. Ganière, P. Baron Antoine Portal, perpetual President of the Académie Royale de Médecine. Bull Acad Natl Med. 150(26): 539-45. PMID 4864573.
10. Antoine Portal (1742-1832): Médecin, anatomiste français et historien de la médecine. (in French). Portraits de medicines. Archived from the original on 2007-07-14. Retrieved 2007-07-16.
11. Antoine Portal (1742-1832). http://themitralvalve. org/mitralvalve/antoine-portal
REFERENCES
1. Riaud X. Antoine Portal (1742-1832), doctor Knight of the empire and founder of the Royal Academy of Medicine. Available at: http://www.napoleonicsociety.com/ english/riaudportala.html. Accessed December 1, 2017.
2. Anonymous. Antoine Portal. Available at: http://www. napoleon-empire.net/personnages/portal.php. Accessed November 27, 2017.
3. Dupont M. Dictionnaire historique des Médecins dans et hors de la Médecine. Paris, France;1999.
4. Moodley J., Singh B, Lalloo S., Pershad S., Robbs J.V. Non-operative management of haemobilia. Br J Surg 2001;88(8):1073-76. https://doi.org/10.1046/j.0007-1323.2001.01825.x.
5. Kyle R.A. Amyloidosis: a convoluted story. Br J Haematol. 2001;114(3): 529-538. https://doi.org/10.1046/ j.1365-2141.2001.02999.x.
6. Gruber Ph., Boeni Th. History of spinal disorders. In: Boos N, Aebi M, editors. Spinal disorders. Fundamentals of diagnosis and treatment. Berlin Heidelberg: SpringerVerlag; 2008:1-37.
7. Portal A. Cours d'Anatomiae Médicale ou eléments de anatomie de l'homme. T.1. Paris; 1804.
8. Goncharov N.I. Illustrated dictionary of eponyms in morphology. Volgograd, Russia: Izdatel, 2009; 504 p. Russian.
9. Ganière, P. Baron Antoine Portal, perpetual President of the Académie Royale de Médecine. Bull Acad Natl Med. 150(26):539-45. PMID 4864573.
10. Antoine Portal (1742-1832): Médecin, anatomiste français et historien de la médecine. (in French). Portraits de medicines. Archived from the original on 2007-07-14. Retrieved 2007-07-16.
11. Antoine Portal (1742-1832). http://themitralvalve. org/mitralvalve/antoine-portal
