Etienne Lancereaux (1829-1910)
Etienne Lancereaux was one of the great personalities of 19th century medicine, and was deeply influenced by Claude Bernard’s scientific spirit. He was injured by a cart at the age of 19, and the subsequent care he received from a country physician inspired him to seek a career in medicine.
Etienne LancereauxHe was to prove an outstanding clinician, endowed with a keen sense of observation, and his powerful physique and tireless energy earned him the nickname ‘sanglier d’Ardennes’ (the boar of the Ardennes). His celebrated three-volume Traité de Pathologie, published in 1875, was based on thousands of painstaking clinico-pathological correlations, and was designed to promote knowledge of diseases according to their causes, thus prefiguring the aetiological classification of disease. He extended this concept to diabetes, which he studied methodically. He argued consistently for a pancreatic origin of diabetes, and introduced the term ‘pancreatic diabetes’ as early as 1877, in a paper in which he described some young patients with diabetes and fibrocalculous disease of the pancreas .
Appreciating the importance of experimental confirmation of his anatomical and clinical data, he asked Claude Bernard for help. Bernard had previously doubted a pancreatic origin of the disease, based on an experiment in which he had induced pancreatic atrophy, but not diabetes, by injection of gelatine into the pancreatic duct. Although he agreed to test the effect of injection of a pancreatic extract, Bernard died the following year, before this could be tested. Lancereaux accumulated further proof of the pancreatic origin of diabetes in the years that followed, and published the evidence in three further papers, the last of which appeared whilst he was working at the Hôtel Dieu in 1888 . A year later, Oskar Minkowski and Josef von Mering confirmed his hypothesis. Although their main achievement was to provide experimental confirmation of Lancereaux’s clinical observations, the term ‘pancreatic diabetes’ was later attributed to Minkowski and von Mering, despite appearing in all of Lancereaux’s publications—one of many apparently innocent mistakes that have been perpetuated to this day. We may now say that it was Lancereaux who transformed diabetes from Morgagni’s 1761 morbus in sede incerta locus into a morbus in sede certa locus .
This key achievement apart, Lancereaux made two other great contributions to the field. The first was to characterize diabetes as a syndrome rather than a disease. ‘A disease’, as he pointed out, ‘corresponds to a special cause, to a particular course, to constant anatomical lesions. But nothing like this exists for diabetes mellitus: its cause is unknown, its course so variable, that some patients could live 40 years and more, while others die after only 2 or 3 years.’ His second contribution was to create the basis of our modern classification of diabetes, with its two fundamental forms, which he referred to as ‘thin’ and ‘fat’ diabetes:
‘In summary’, he said, ‘diabetes mellitus, as it is known today, is not one disease, but a collection of different pathological entities. One of these is characterized by its sudden onset, striking clinical manifestations and, above all, by weight loss and the accompanying pancreatic lesions: this type we call thin diabetes or pancreatic diabetes. We have also described another very characteristic form. This is more common than the first, is often inherited, is accompanied at onset by obesity and does not show pancreatic lesions. Its symptoms are few; its progression is slow and chronic; it is a syndrome often associated with other morbid circumstances. We call this type fat diabetes or constitutional diabetes..
Lancereaux’s indefatigable energy never failed him until he died from septicaemia at the age of 81, acquired when he injured his knee while climbing some stairs to examine a patient. His great prestige, illustrated by the fact that he was President of the French Academy of Medicine for the latter part of his life, explains why it was sometimes claimed that he was to medicine what Claude Bernard was to physiology and Louis Pasteur to microbiology.
^ Lancereaux E (1877) Note et réflexions sur deux cas de diabète sucré avec alteration du pancrèas. Bull Acad Méd 2e serie, tom VI, pp 1215.
^ Lancereaux E (1888) Nouveaux faits de diabète sucré avec alterations du pancrèas. Bull Acad Méd Communication from a meeting held on 8 May 1888
^ Ionescu-Tîrgovişte C (1996) The re-discovery of insulin. Ed Geneze, Bucharest.