Alexis Littré
Alexis Littré (1654-1726) was a French anatomist and surgeon
Educated at Montpellier and Paris, Littré was elected to the Académie Royale des Sciences in 1718 and became known for the precision of his anatomical reports, many of which were published in the Mémoires de l’Académie. His work combined descriptive accuracy with a forward-looking clinical imagination, linking the dissecting room to the operating theatre.
In 1700, Littré described small intestinal diverticula found at autopsy, which when protruding into hernia sacs came to be known as Littré’s hernia. His Description de l’uréthre de l’homme, presented the same year, identified the mucous glands of the urethra now called Littré’s glands, associated with Littritis when inflamed. In 1710, after examining a neonate with imperforate anus, he proposed the creation of an abdominal stoma to relieve obstruction, later termed Littré’s operation by Amussat, the first to successfully perform the operation.
Littré’s observations were accurate and prescient. His diverticular descriptions were clarified embryologically a century later by Meckel, and his colostomy proposal marked the conceptual birth of intestinal stoma surgery. As a mentor to Jean-Louis Petit and Jacques-Bénigne Winslow, he influenced the next generation of French surgeons.
Biographical Timeline
- 1654 – Born July 17, à Cordes en Albigeois. Traditional date (Fontenelle, 1754) recorded as July 21, 1658. Corrected from parish register: born July 17, 1654, baptised July 21, 1654, son of Jean Littré and Alix Maffre.
- c.1670s – Studied medicine in Montpellier, later moving to Paris.
- 1681 – Received M.D. in Paris. Began to publish anatomical observations.
- 1685–1700 – Published numerous contributions to Journal des Sçavans and Mémoires de l’Académie Royale des Sciences.
- 1700 – Described congenital ileal diverticula (later recognised as Meckel’s diverticulum). Later, the presence of these diverticula in a hernia sac became known as Littré’s hernia.
- 1710 – Proposed inguinal colostomy for imperforate anus, based on autopsy findings. This became known as Littré’s operation when clinically performed by Pillore of Rouen (1776) and later modified by Jean-Zuléma Amussat (1796–1856).
- 1710s – Mentor to Jean-Louis Petit (1674–1750) and Jacques-Bénigne Winslow.
- 1718 – Elected member of the Académie Royale des Sciences.
- 1726 – Died February 3 in Paris, aged 71.
Medical Eponyms
Littré’s Hernia (1700)
Littré’s hernia refers to the protrusion of a Meckel’s diverticulum into a hernial sac. Though very rare, it carries clinical importance because of its risk of strangulation, necrosis, and perforation. The condition has been reported in less than 0.1% of all strangulated or incarcerated hernias. Reported sites include inguinal (~50%), femoral (~20%), umbilical (~20%), and rare parastomal cases.
Patients typically present with a painful hernial swelling, and diagnosis is often made intraoperatively. Surgical management consists of excision of the diverticulum and definitive hernia repair, with mesh repair avoided in contaminated fields.
1700 – Littré described his Observations sur une nouvelle espèce de hernie, which were published in the Histoire de l’Académie Royale des Sciences in 1719. He reported post-mortem cases where a small portion of ileum formed a diverticulum and extended into the hernia sac.
Original
English
Une nouvelle espèce de hernie… formée par une petite portion de l’intestin grêle, prolongée en dehors du tube, comme une espèce de vessie, et tombant dans la poche herniaire – Littré, 1700
A new kind of hernia… formed by a small portion of the small intestine, prolonged outward from the tube like a kind of bladder, and falling into the hernial sac. – Littré, 1700
1809 – Johann Friedrich Meckel (the younger) (1781-1833) established the congenital nature of the outpouchings (Meckel’s diverticulum), recognising them as embryological remnants of the vitelline duct.
Littré’s hernia was subsequently described as a very rare type of hernia in which a Meckel’s diverticulum protrudes through a defect in the abdominal wall (hernial orifice).
Littré’s Glands and Littritis
In 1700, Alexis de Littré presented to the Académie Royale des Sciences his detailed anatomical description of the male urethra, later published as Description de l’urèthre de l’homme. In this work he described the mucous glands of the urethra, which were subsequently named Littré’s glands. These small tubular glands open into the urethral lumen and secrete mucus that helps protect the mucosa from injury and infection.
Original
English
La deuxième glande… est une glande qui n’a point de nom, parce qu’elle n’a point encore été décrite… Elle perce la membrane intérieure de l’uréthre dans toute sa circonférence par un grand nombre de conduits excrétoires, qui versent dans ce canal la liqueur que la glande filtre, propre à enduire le canal de l’uréthre. – Littré 1700
The second gland… is a gland which has no name, because it has not yet been described… It pierces the inner membrane of the urethra throughout its circumference by a great number of excretory ducts, which pour into this canal the fluid the gland filters, suited to coat the canal of the urethra – Littré 1700
The clinical significance of these glands became apparent in the early twentieth century, when inflammation of them was recognised as a distinct entity. In 1905, Samuell Alexander introduced the term Littritis, with the variant spelling Littréitis following soon after in 1906.
The condition describes acute or chronic inflammation of Littré’s glands, usually in the setting of urethritis, particularly gonococcal infection, where the glands may act as a reservoir for persistent or recurrent disease. Severe cases can lead to periurethral abscesses and fistula formation.
The perineal infection from a Cowperitis, a Littreitis or a prostatitis may arise either by lymphatic infection along the membranous urethra or after rupture of the abscess into the urethra.
Alexander, 1905
Although rarely used in current practice, Littré’s original observations remain a reminder of how careful anatomical study laid the groundwork for later clinical recognition.
Littré’s Operation (1710)
In 1710, Littré presented to the Académie Royale des Sciences a striking autopsy observation in a newborn with congenital malformation of the rectum. Reflecting on the fatal obstruction, he proposed a daring but purely theoretical remedy:
Original
English
…Il faudrait faire une incision au ventre, et recoudre ensemble les deux parties d’intestin après les avoir rouvertes, ou du moins faire venir la partie supérieure de l’intestin à la plaie du ventre, que l’on ne refermerait jamais, et qui ferait la fonction d’anus – Littré, 1710
…One should make an incision in the abdomen, and stitch together the two parts of intestine after reopening them, or at least bring the upper intestine to the abdominal wound, which would never be closed, and which would perform the function of an anus – Littré, 1710
This proposal, never attempted by Littré himself, became the conceptual foundation of colostomy.
The first recorded attempt was made by Pillore of Rouen in 1776, on a wine merchant with carcinoma of the rectum. Pillore created an artificial anus by exteriorising the caecum through the right iliac region. The patient initially improved but died 28 days later, with autopsy revealing obstructing cancer and retained mercury he had swallowed in a misguided earlier treatment.
On June 2, 1839 Jean-Zuléma Amussat (1796–1856) performed the first successful extraperitoneal lumbar colostomy for a patient with intestinal obstruction caused by a rectal growth. The eponymous attribution remains as Littré’s operation as the first to envision colostomy, and Ammusat’s operation as the first to successfully perform the operation.
Controversies
Date of Birth Controversy
Most early biographers, following Bernard de Fontenelle’s Éloge de M. Littré (1754), gave July 21, 1658 as the date of birth for Alexis Littré. This error was repeated for over two centuries.
However, archival research corrected the record. Parish register of Cordes (GG.175) documents that Alexis Littré was baptised on July 21, 1654, and that he was born on July 17, 1654, son of Jean Littré and Alix Maffre.
Ce 21 juillet 1654, je, soubsigné, ay baptisé un fils né le 17e du dit mois, de Me Jean Littre et de demoiselle Alix Mapfre (Maffre), mariés et résidens en ceste ville de Cordes, auquel a esté imposé le nom d’Alexis ; le parrain a esté Maistre Jean de Salvy, la marraine Marguerite d’Austry.
Lebrun, prebstre et vicaire de Cordes
Historian Charles Portal (Histoire de la ville de Cordes, 1902) and the Correspondance historique et archéologique (1898) published that 1654, not 1658, is the correct year suggesting a misreading of the final digit from handwritten manuscripts. Furthermore the day of birth (July 17) was most likely confused with the baptismal date (July 21).
Major Publications
- Littre A. Observations sur une nouvelle espèce de hernie. Histoire de l’Académie royale des sciences avec les Mémoires de mathematique et de physique. 1700: 300-310. [Littre’s hernia]
- Littre A. Description de l’urèthre de l’homme, démontrée à l’Académie le troisième juillet 1700. Histoire de l’Académie royale des sciences avec les Mémoires de mathematique et de physique. Paris, 1700: 311-316. [Littre’s glands]
- Littre A. Diverses observations anatomiques. Histoire de l’Académie royale des sciences, Paris, (1710), 1732: 36-37. [Littre’s operation]
References
Biography
- Fontenelle B. Éloge de M. Littré. Oeuvres de Monsieur de Fontenelle 1754; 6: 129-138
- Portal C. La date de naissance d’Alexis Littre. La Correspondance historique et archéologique 1898; 5(56): 240-242
- Portal C. Le tiers état In: Histoire de la ville de Cordes, Tarn (1222-1799). 1902: 471
Eponymous terms
- Amussat J-Z. Opération d’anus artificiel, par la méthode de Littré, sur un homme adulte qui a survécu vingt-huit jours. In: Mémoire sur la possibilité d’établir un anus artificiel dans la région lombaire sans pénétrer dans le péritoine. Lu à l’Académie Royale de Médecine, le 1er octobre 1839: 85-88 and 109-117
- Alexander S. Observations Upon the Cause and Treatment of Perineal Abscess, and of Periurethral Suppurations Above the Triangular Ligaments. Medical Record, 1905; 68(18): 685-690 [Littritis]
- Schärli WF. The history of colostomy in childhood. Prog Pediatr Surg. 1986;20:188-98.
- Cotlar AM. Historical landmarks in operations on the colon–surgeons courageous. Curr Surg. 2002 Jan-Feb;59(1):91-5
- Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P. Littre hernia: surgical anatomy, embryology, and technique of repair. Am Surg. 2006 Mar;72(3):238-43.
- Schizas D, Katsaros I, Tsapralis D, Moris D, Michalinos A, Tsilimigras DI, Frountzas M, Machairas N, Troupis T. Littre’s hernia: a systematic review of the literature. Hernia. 2019 Feb;23(1):125-130.
- Sarofim M, Ashrafizadeh A, Kabir S. A new hernia: Meckel’s diverticulum within a parastomal hernia. J Surg Case Rep. 2022 Oct 27;2022(10):rjac398.
Eponym
the person behind the name
BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | On Call: Principles and Protocol 4e| Eponyms | Books |