Léon Clément Le Fort
Léon Clément Le Fort (1829-1893) was a French surgeon.
Le Fort discovered and described the direct communications between the bronchial and pulmonary vessels. A strong advocate of the principles of asepsis prior to the development of bacteriology and publishing on the (un)hygienic conditions in the hospitals of France and Great Britain
Surgeon in the Hospice des Enfants-Assistés (1865), Midi (1866), Cochin (1867), Lariboisière (1872), Beaujon (1873), Hôtel-Dieu (1882), Necker (1884) and Pitié (1890)
Eponymously remembered for his description of the Le Fort fracture (1886); Le Fort Operation for uterine prolapse; Le Fort amputation; Le Fort Male Catheter; and Le Fort sound.
Godfather of FOAMed ‘Liberté de l’enseignement‘
Biography
- Born on December 5, 1829 in Lille, France. Uncle and Godfather of René Le Fort (1869-1951)
- Following school, initially worked in his fathers clothing business, then drafted into the military and joined the army sanitary corps for two years during the Franco-Prussian War. Studied medicine at the Military Hospital, Lille until it closed in 1850
- 1850-1856 Studied medicine in Paris under Joseph-François Malgaigne (1806-1865)
- 1858 – Medical doctorate. Thesis ‘Recherches sur l’anatomie du poumon chez l’homme‘ [Research on lung anatomy in humans]
- 1870 – Head of a voluntary field hospital in Metz, French Army in the Franco-Prussian War.
- 1873 – Professor of operative surgery teaching the surgical clinic course at the Hôtel-Dieu
- 1884 – Officier legion d’honneur
- 1892 – First chair at the Hôtel-Dieu
- 1893 – Member and president of the Académie de Médecine
- Died on October 19, 1893 in Ménestreau-en-Villette, France
Medical Eponyms
Le Fort fracture of the ankle (1875, 1886)
Wagstaffe-Le Fort Fracture: vertical avulsion fracture of the medial aspect (anteromedial) of the distal fibula due to avulsion of the anterior tibiofibular ligament attachment (ATFL). See also: Tillaux-Chaput avulsion fracture – posterolateral tibia avulsion
1875 – William Warwick Wagstaffe reviewed 62 ankle fractures sustained between 1866-1868 following direct and indirect violence. He recorded 2 cases in which he could find ‘no parallel instance to the two which are subjoined‘. Wagstaffe original description:
I find in none of the standard works to which I have able to refer any mention of cases in which the fracture was of the character found in the two cases here recorded. The peculiar feature of these cases was the existence of a vertical fracture of the fibula in its lower end, with a displacement of the fractured portion in such a way that it was twisted round on its long axis.’
Wagstaffe 1875
1886 – Le Fort described the same vertical fracture of the anteromedial portion of the fibula (Wagstaffe tubercle) suggesting it was at the site of the anterior inferior tibiofibular ligament (AITFL) insertion. He observed and described 3 clinical cases of isolated fracture of the anterior margin of the lateral malleolus corresponding to the attachment of the ligamentum malleoli lateralis anterius. In his opinion the fracture was produced by forced supination-adduction of the foot.
Le Fort Operation (1877)
Procedure to manage the prolapsed uterus by adhering the anterior wall with the posterior wall of the vagina to oppose the descent of the uterus.
In 1877 Le Fort described a simple and safe surgical correction of uterine prolapse. The procedure of partial colpocleisis continues to find limited application in the elderly and high-risk patient today.
Original
English
Procédés peu dangereux, faciles à mettre en pratique, mais inefficaces; ou bien, procédés efficaces, mais d’une exécution difficile…telles étaient les ressources que m’offrait la médecine opératoire, lorsque, le 10 novembre 1876, entra dans mon service à l’hôpital Beaujon une femme de quarante-huit ans…atteinte d’un prolapsus complet de l’utérus…La malade demande à être débarrassée de son infirmité et préfère une opération, quelle qu’elle puisse être, à la nécessité de porter un bandage quelconque.
L’examen attentif du mécanisme suivant lequel se produisait le prolapsus, me suggéra l’idée du procédé que je mis en usage avec un plein succès…
Evidemment, si on pouvait retenir en rapport ces parois opposées, les empêcher de se porter l’une en avant, l’autre en arrière, on s’opposerait à tout prolapsus. C’est ce que j’ai cherché à faire, et j’ai voulu rendre ce contact non plus médiat, mais intime et permanent, en avivant au même niveau les parois antérieure et postérieure du vagin et en les réunissant par la suture.
Procedures less dangerous and easily performed but ineffective, or else effective but hard to perform…such were the resources offered to me by operative medicine when, on November 10, 1876, a woman of forty-eight years of age entered my service at Beaujon hospital… suffering from a complete prolapse of the uterus…The patient asked to be relieved of her infirmity and preferred any kind of operation to the need of wearing a bandage.
Careful examination of the mechanism by which prolapse occurred, suggested to me the idea of the procedure which I used with complete success …
Evidently, if one could keep the vaginal walls in contact with each other, thus preventing one of them from going forward and the other backward, he could prevent prolapse completely. This is what I sought to do, striving to make the contact intimate and permanent and to restore the anterior and posterior vaginal walls to the same level in reuniting them by suture.
Other medical eponyms
Le Fort amputation: Modifications of the Pirogoff operation, in which the calcaneus is sectioned horizontally instead of transversely.
Le Fort sound: Curved probe used for dilation of urethral strictures in the male
Le Fort Male Catheter
Key Medical Attributions
1874 – Le Fort was a FOAMed advocate and wrote a series of articles on ‘Liberté de l’enseignement et de la pratique de la médecine‘ [The freedom of practice and the freedom of the teaching of medicine]
Together with the official education of the Paris Faculty of Medicine, there was a revolution in independent education in Medicine which expanded throughout the 19th century. It served a dual purpose:
- independent education included the same subject matter as the official courses, but did so in a more original and novel manner
- at a time of rapid expansion of medical knowledge, it allowed the medical education to be integrated with scientific discoveries and impart them to students.
Whilst the Professors of the Faculty defended and argued for rigid and immutable medical teaching on an encyclopedic scale, the independent education allowed the development of specialisation such as dermatology, cardiology, ophthalmology, paediatrics, venereology as a result of independent educators interacting with a wide range of students. – Pierre Huard 1974
Major Publications
- Le Fort LC. Recherches sur l’anatomie du poumon chez l’homme Thesis. 1859
- Le Fort LC. De la résection de la hanche dans les cas de coxalgie et de plaies par armes à feu. Paris: Baillière. 1862
- Le Fort LC. Note sur quelques points de l’hygiène hospitalière en France et en Angleterre. Paris: Masson. 1862
- Le Fort LC. Discussion sur l’hygiène des hôpitaux: discours prononcé à la Société de chirurgie. 1864
- Le Fort LC. La liberté de la pratique et la liberté de l’enseignement de la médecine. Paris: Masson. 1866
- Le Fort LC. Des Maternités. Paris: Masson. 1866
- Le Fort LC. Des hôpitaux sous tente. Paris: Masson. 1869
- Le Fort LC. Nouvelle méthode de traitement de rétrécissements de l’urèthre: dilatation immédiate progressive. 1876
- Le Fort LC. Note sur une variété non decrite de fracture verticale de la malleole externe par arrachement. [Note on an undescribed variety of vertical fracture of the lateral malleolus by avulsion] Bulletin de thérapeutique médicale et chirurgicale. 1886; 110: 193-199 [Wagstaffe-Le Fort Fracture]
- Le Fort LC. Nouveau procédé pour la guérison du prolapsus utérin. Bulletin de thérapeutique médicale et chirurgicale. 1877; 92: 337-344 [Le Fort Operation]
- Le Fort LC. De la prostitution: dans ses rapports avec la propagation des maladies vénériennes. 1888
References
Biography
- Obituary: Dr. Léon Le Fort. Br Med J 1893; 2 (1713): 976–7
- Fresquet JL. Léon Clément Le Fort (1829-1893). Historia de la Medicina
- Baskett TF. Le Fort, Léon Clément (1829–1893) In: Eponyms and Names in Obstetrics and Gynaecology. 3e. 2019: 236-237
- Bibliography. Le Fort, Léon (Léon Clément) 1829-1893. WorldCat Identities
Eponymous terms
- Huard P. L’enseignement libre de la médecine à Paris au XIXe siècle. Revue d’histoire des sciences. 1974:27-1;45-62
- Fisher A et al. The anatomy of the anterior inferior tibiofibular ligament and its relationship with the Wagstaffe fracture. Foot Ankle Surg. 2021 Apr;27(3):291-295.
- Kikuchi S et al. Characteristic features of the insertions of the distal tibiofibular ligaments on three-dimensional computed tomography- cadaveric study. J Exp Orthop. 2020 Jan 23;7(1):3
- Eponymythology: Eponymous Foot, ankle and talus injuries. LITFL
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