Joseph François Malgaigne

Joseph François Malgaigne (1806 – 1865)

Joseph François Malgaigne (1806 – 1865) was a French Surgeon, medical historian and critical thinker.

An experienced surgeon, Malgaigne was actively engaged in the practice of his profession throughout his life and was one of the first to develop external fixation for fractures. A scholar, he searched out original sources for their meaning without relying upon translators and com­pilers, and was as a historian of medieval surgery. A gifted teacher, he was accustomed to marshalling minutiae into concise and logical patterns.

Malgaigne edited the most comprehensive and accessible edition of Paré’s works [Oeuvres complètes d’Ambroise Paré]. and he was described by Billings, American surgeon and historian, as “the greatest surgical historian and critic the world has ever seen” after his publication of his Histoire de la chirurgie en Occident depuis de VIe jusqu’au XVIe siècle

Malgaigne provided early descriptions of Hill-Sachs defect (1832); and Monteggia fracture (1854). Remembered for his 1847 description of the eponymous Malgaigne Fracture


Biography
  • Born February 14, 1806 in Charmes-sur-Moselle
  • 1821 – Travelled to Nancy, aged 15, to begin his medical education
  • 1825 – Qualified as an officer de saute, or health officer. He tried his hand as a writer with La conspiration des Espagnols contre Venise and Les caprices receiving no acclaim. He then worked as as secretary to M. de Villeneuve, a historian renewing his acquaintance with Latin and Greek and observed the methods and techniques of a historian.
  • 1826 – Travelled to Paris to undergo further medical training, against the wishes of his family who wished him to be satisfied with his position as health officer (as was his father…)
  • 1830 – The Poles revolted from their Russian masters and appealed to the new French government for help. Malgaigne organised a volunteer hospital unit consisting of nine surgeons and other personnel, and led it in action in support of the Polish army. He distinguished himself under fire during several engagements.
  • 1831 – Doctorate of medicine with thesis ‘Paradoxes de médecine théorique et pratique‘ in which he defended the teaching of the history of medicine and surgery
  • 1832 Associate editor for the Gazette médicale de Paris under Jules Guérin (1801-1886), where he developed his claws as an editor and reviewer

« Il y a”, disait Malgaigne, “dans la thèse que M. X vient de soutenir, des choses qui sont nouvelles et des choses qui sont bonnes ; malheureu- sement celles qui sont nouvelles ne sont pas bonnes, et celles qui sont bonnes ne sont pas nouvelles. »

Pilastre, 1905: 28

“There are”, said Malgaigne, “in the thesis which Mr X has just supported, things which are new and things which are good; unfortunately the new ones are not good, and the good ones are not new.”

Pilastre, 1905: 28

  • 1835 – Surgeon of the central bureau of hospitals serving at l’Hôpital Saint-Louis, Bicêtre, and La Charité
  • 1840 – Founded the surgical journal ‘Journal de Chirurgie
  • 1843 – Guerin sued for defamation of character after a barbed public exchange between the former associates. The basic premise being: ‘Can the results of clinical investigations and laboratory experiments which demonstrate the ineffectiveness of methods of treatment, strongly advocated by various indi­viduals, be published with impunity?‘ In the end, Malgaigne had the greatest popular support as an advocate of freedom of inquiry and freedom to publish opinions based on investigations and the lawsuit against him was dismissed.
  • 1846 – Member of the Académie de Médecine
  • 1847 – Chief editor of the ‘Revue médico-chirurgicale de Paris‘. Here, Malgaigne exerted his greatest influence upon his contemporaries. He was a staunch advocate of the statistical approach to the study of medical problems and encouraged animal experimentation. Young men and new ideas always gained a hearing on the pages of his journals.
  • 1847 – The first to use ether anaesthesia in France on January 12, 1847 and presented to a meeting of the Académie de Médecine just three months after Morton’s success in Boston. [Premiers essais sur l’éther pendant 5 opérations chirurgicales]. This was largely responsible for the rapid adoption of ether throughout France.
  • 1850 – 1865 Chair of Professor of Operative Surgery
  • Died October 17, 1865

Significant publications
Manuel de médecine opératoire (1834)

800 page, pocket-sized volume devoid of illustrations with the mantra ‘sécurité, simplicité, et célérité‘. Hence the guiding principles used in selecting the various operative techniques where only the safest, most simple and most rapid means of accomplishing the desired ends are espoused. The text was a compilation of known procedures, and owed its success to its critical evaluation and the clear, concise manner in which the essence of the subject is distilled and was translated into English, German, Spanish, Italian and Arabic.

Traité des fractures et des luxations (1847)

Malgaigne’s published a 1300 page, two volume treatise with atlas of plates on fractures and dislocations (18471848 translated to English in 1859). This work was arguably the most comprehensive overview of orthopaedics of the 19th century (although Astley Paston Cooper may disagree…)

I have aimed at presenting a resume of all the doctrines and ideas maintained from the earliest times to our own day, having recourse as much as possible to the original works. As to my teachings, I have asserted nothing unsupported by facts, drawn either from my own experience or from that of others. Where clinical observation was insufficient., I have sought a substitute for it in experiments upon dead bodies, or upon the lower animals; but above all, I have tried to clear up a great many mooted points by throwing upon them the light of pathological anatomy; and this is the object of my atlas

Malgaigne 1847

The opening statical analysis of 2,328 patients with fractures seen at the Hotel Dieu over an 11-year period is unique for this period. The patients are classified according to age and sex, the time of year the fracture occurred, and the bone fractured.

Malgaigne’s principles on the treatment of fractures and disloca­tions were based on the great tradition of French surgery, handed down through Paré, Petit, Desault, and Dupuytren. Malgaigne, however, was not afraid to break with this tradition when his own observations and ex­periences showed the old masters to be in error. Like Dupuytren and Pott he advocated the use of the semi-flexed position in reducing fractures of the lower extremities. He proved his point by a series of ingenious experiments upon animals and cadavers, in which he showed that when the quadriceps and hamstring tendons are cut simultaneously with the knee partially flexed, the tendons retract equal distances, demonstrating that in this position the opposing muscles are equally balanced. Such is not the case when the tendons are sectioned with the knee fully extended

Malgaigne was the greatest surgical historian and critic the world has yet seen, a brilliant speaker and writer, whose native genius, joined to incessant labor, brought about a new mode of judging of the merits of surgical procedures…and the mode of statistical comparison joined to experiment. He was not a great operator, and although he made some improvement in the art, such as his hooks for the treatment of fractures of the patella, his sugges­tion of suprathyroid laryngotomy, and so forth; these are of small importance as compared with his work of exploding errors, exposing fallacies in reasoning, and bringing to bear upon the work of the present day the light of the experience of the past, of which his treatise on fractures and dislocations affords many excellent examples

Billings, The history and literature of surgery. 1895; 1: 113

Medical Eponyms
Malgaigne Fracture (1847)

Malgaigne fracture is an unstable fracture of the pelvis. The Malgaigne fracture usually results from a vertical shear force causing two ipsilateral pelvic ring fractures. Fractures are ipsilateral and vertically orientated (one anterior and one posterior to the acetabulum)

The most common disruption involves the superior/inferior pubic rami AND sacroiliac joint/sacral wing rather than the sacroiliac joint with a lateral fragment containing the acetabulum.

Malgaine-fracture-1847 full
Malgaigne fracture

1847 – JF Malgaigne provided the first description of the unstable, vertical shear pelvic fracture, involving one hemipelvis – ‘De la double fracture verticale du bassin‘ in his Traité des fractures et des luxations.

De la double fracture verticale du bassin

“Je décrirai sous cette dénomination une fracture multiple du bassin qui… mérite d’ailleurs une attention spéciale… C’est une combinaison de deux fractures verticales, découpant sur l’un des côtes du bassin un fragment moyen qui comprend l’articulation coxo-fémorale… De ces deux fractures, l’antérieure occupe presque constamment la branche horizontale et la branche descendante du pubis, séparant cet os de l’ilium et de l’ischion; la postérieure est toujours en arrière de la cavité cotyloïde.

Les causes sont le plus souvent directes; telles sont une chute de haut sur la hanche, une pression du bassin entre deux voitures, le passage d’une roue de voiture sur la hanche, un coup de pied de cheval, etc.”

Malgaigne JF. 1847: 651

Double Vertical Fracture of the Pelvis

“Under this name I shall describe under this denomination, a multiple fracture of the pelvis which… merits a special attention… It is a combination of two vertical fractures, cutting out on the one side of the pelvis a median fragment containing the coxo-femoral articulation… Of these two fractures, the anterior occupies nearly always the horizontal and descending branches of the pubis, separating this bone from the ilium and the ischium; the posterior one is always behind the acetabulum.

The causes are most often direct; such as a fall from height onto the hip, press ion of the pelvis between two cars, the passing of a wheel of a car over the hip, a kick from a horse etc.”

Malgaigne JF. 1847: 651

In the 1855 atlas volume accompanying his work on fractures and dislocations, Malgaigne shows a specimen taken from the Musée Dupuytren which shows a bilateral anterior subluxation of the sacrum with a fracture-of the pelvic ring anteriorly. The specimen was taken from a 48 year old man who died 5 days after being run over by a carriage and fully reported by Foucher in 1851

The more frequent type of Malgaigne fracture consists of the fractures of the hemipelvis, through the pubic rami in front and the ilium behind, with displacement of the lateral fragment upwards.

1855 Planche XVIII, Fig 5. Luxation du sacrum en avant, avec fracture de l’os iliaque gauche (Musée Dupuytren, no 765). Cette pièce m’avait été communiquée par M. Foucher, qui en a consigné l’observation dans la Revue médico-chirurgicale 1851. J’en ai donné l’analyse tome II: 783.


Key Medical Contributions
Malgaigne Hook and External fixation techniques

Malgaigne was the first to devise and to apply a practical method of external skeletal fixation.

1840 – Malgaigne described a ‘pointe métallique‘ which was a spike introduced into bone and fixed to a splint, with the aid of a strap, to prevent displacement of fractures of the tibia.

Malgaigne pointe for external fixation 1840
Malgaigne pointe for external fixation 1840

1843 – Malgaigne devised a ‘griffe métallique‘ ‘ which approximated four transcutaneous metal prongs for the reduction and maintenance of displaced transverse fractures of the patella. The two double hooks were inserted through the skin into the upper and lower borders of the patella. The hooks were then connected by a screw which drew the fragments into apposition and maintained.

Malgaigne clamp transverse patella fracture 1843
Malgaigne hooks. 1843 [Stimson 1905: 369]

Malgaigne treated four patients using his clamp with varying degrees of success. He described two problems inherent with external fixation: “First, to let the patient have access to the screw; second, to require a substantial force to tighten and loosen the screw, a force which caused the whole appliance to move and was very painful for the patient


Key Medical Attributions

Statistics and statistical analysis

Statistical evaluations included mortality rates form surgical procedures especially his treatise on the statistics of fractures and luxations (1839) and amputations (1841).

In 1840 he published a geographical analysis or ‘medicostatistical map‘ correlating inguinal hernia’s with mountainous country and the ‘culture of the olive’ in France


1832 – Malgaigne provided the first description of Hill-Sachs defect. He noted that following anterior shoulder dislocation a bony defect in the humeral head could be present

“Amenée donc à l’Hôtel-Dieu près d’un mois après l’accident, ce qui frappa d’abord, ce furent les symptômes suivans: saillie de l’acromion, aplatissement du deltoïde, le coude écarté du tronc et n’en pouvant être rapproché, le bras ne pouvant s’élever vers la tête; enfin dans l’aisselle, une saillie évidemment osseuse. C’étaient bien là les signes de la luxation; mais ces mêmes signes accompagnent aussi la fracture”

Malgaigne, Gazette médicale de Paris. 1832

“Admitted to the Hotel-Dieu nearly a month after the accident, what was most evident, were the following symptoms: protrusion of the acromion, flattening of the deltoid, the elbow separated from the trunk, unable to be approximated, the arm unable to be lifted to the head; finally, in the axilla, an evidently bony protrusion. These were indeed the signs of the luxation; but these same signs accompany also the fracture”

Malgaigne, Gazette médicale de Paris. 1832

1844 – Malgaigne published his revolutionary two-flap method for repair of cleft lip.

1854 – Malgaigne reported on 5 cases of Monteggia fracture; fracture of the shaft of the ulna with dislocation of the head of the radius, and provided sound advice to young surgeons 

Non que le diagnostic soit difficile une fois l’attention éveillée sur les deux lésions, mais parce que la présence d’une lésion fait trop souvent oublier l’autre . Voici donc l’avis que je donne aux jeunes chirurgiens:

Dans toute fracture du cubitus, méfiez-vous de la luxation de la tête radiale;

Et d’une façon plus générale encore:

Dans toute fracture des os de l’avant -bras où le gonflement se prolonge au delà du coude, souvenez-vous que la fracture simple s’accompagne rarement d’un gonflement si considérable, et explorez scrupuleusement l’articulation.

Malgaigne, Revue médico-chirurgicale de Paris. 1854; 15: 215-220

Not that the diagnosis is difficult once the attention is awakened to the two lesions, but because the presence of one lesion too often makes us forget the other. Here is the advice I give to young surgeons:

In any fracture of the ulna, beware of dislocation of the radial head;

And more generally still:

In any fracture of the bones of the forearm where the swelling extends beyond the elbow, remember that the simple fracture is seldom accompanied by such considerable swelling, and carefully explore the joint.

Malgaigne, Revue médico-chirurgicale de Paris. 1854; 15: 215-220


Interesting fact

Malgaigne had two daughters with his wife Aglaé Françoise Pommier (1818-1893). One of them married the professor of surgery Léon Clement Le Fort.


Major Publications

References

Biography

Eponymous terms


eponymictionary CTA

eponym

the person behind the name

Resident medical officer in emergency medicine MB ChB (Uni. Dundee)  MRCS Ed. Avid traveller, yoga teacher, polylinguist with a passion for discovering cultures.

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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