FORTUNE FAVOURS THE PREPARED MIND

Hi friends,

I was thinking what to write for this week’s blog post. Initially, I thought of writing about a landmark discovery in one of the hematological malignancies but when I was reading in detail about that, I came across other interesting things, which am sharing in this post.

Lets start with the origin of the word “cancer”.

Cancer is derived from the greek word “karkinos”, meaning crab. The Greek physician Hippocrates is credited for coining the term cancer.

And guess why he called it as cancer?  

Hippocrates noticed that the blood vessels around a malignant tumour resembled the claws of crab and hence the word cancer.

Now moving on to “leukemias”

There is not much literature stating when leukemias were first discovered.   It dates back to 4 or 5 century BC and recognized by the ancient Greeks.  Most of the literature are from the 19^th century and initially started as description of cases with uncommon alterations of blood.

FIRST DESCRIPTION OF LEUKEMIAS:

There is no one credited with the first description of leukemia unlike Burkitt lymphoma or Hodgkins lymphoma or Castleman disease etc. It it was one or two persons, then the disease might have had a eponymous name.

The earliest report of such hematological malignancy was first considered to be given by Velpeau in 1827. He reported a case of a 63 year old woman who presented with fatigue, fever and abdominal swelling. At autopsy, she was found to have massive splenomegaly,and whose blood was “thick like gruel such that one might have asked if it were not rather laudable pus, than blood”.

Who is this Velpeau?

I am sure, orthopedicians must be aware of Velpeau more than the physicians or pathologists dealing with acute leukemias.

And for people who are confused how someone can describe acute leukemias and be famous in orthropedics also. In those days, there was no subspecialty and a doctor could be a surgeon, pediatrician, orthopedician and so on.

This is the first time I read about Velpeau . I found it interesting and I hope it will be interesting for you as well.

Alfred Velpeau, Picture taken from google images, Wikipedia.

Ifred Armand Louis Marie Velpeau was born on 18 May, 1795 in Touraine Village of Breches, France. His father was a farrier. Farrier is someone who makes and fits metal plates for horses feet. I did not know what farrier was and I googled it. Alfred was taught by the village priest to write in French and to serve in Latin mass. He was expected to follow his father footsteps of becoming a farrier. But, he was interested in medicine. He bought two medical textbooks from the money he got by selling chestnuts which he collected while looking after his father’s cattle.

A stroke of luck changed his life. He poisoned a depressed young girl with hellebore (a poisonous winter flowering plant), trying to dissipate her sadness. The local physician Dr.Bodin was called and while treating her, he became so impressed with Velpeau’s knowledge and intelligence. He introduced Alfred to a neighbouring member of the aristocracy, M. Ducan, who permitted Alfred to join lessons of his children’s tutor.

He progressed so well within a year that Dr.Bodin and M. Ducan introduced him to Vincent Gourand, surgeon at the Hospital at Tours, who then introduced him to Pierre Fidele Bretonneau, the newly appointed head doctor of the hospital in 1816 when Velpeau was 21 years old. Bretonneau was one of the outstanding physicians in France and had been contributing to important advances in the understanding and treatment of diphtheria, typhoid and rickets.

He also recognized the exceptional talent of Velpeau and treated him like a son for next four years. He trained him in clinical medicine and pathology. Sometimes, they involved body snatching from cementeries to do research. Years later, Velpeau wrote, “Here, we are every night at 2.00 am with ladders, climbing walls as criminals. This way, we obtained 36 necropsies, in a few months. People guessed about our profanities and twice I was fired on by inhabitants. I still have some lead in certain places.”

By 1819, Velpeau became “officier de santé”. But Bretonneau was keen that Velpeau goes to medical school. At the age of 25, in 1820, Velpeau got admission in Saint Louis Hospital, Paris with the help of Jules Cloquet, a friend of Bretonneau.

Velpeau was a very intelligent and hard working student. He got prizes in anatomy and physiology. He was financially supporting himself by earning a small income teaching junior medical students. He was also learning Latin and French literature. He could not afford the board hence he lived in a garret in Hotel de l’Abeille.

In 1823, he qualified medicine and was appointed as “agrege de medicine” with honours. He wrote his thesis on intermittent and chronic fevers in Latin under the guidance of Laennec. Velpeau was referred to as “the Saint John of my disciples” by Bretonneau as he and later Armand Trousseau brought much of unpublished work of Bretonneau to light.  

At the age of 29, Velpeau was appointed as a junior surgeon in many hospitals: Saint Antoine, La Pitie, and La Charite.  In 1829, at the age of 33, he passed the “Chiurgical”, which is a higher degree in surgery. He was then appointed as surgeon in La Pitie.  At 38 years, he succeeded Boyer in the university chair of clinical surgery and he continued in this post for next 33 years. He took charge of the clinical ward of La Charite. Velpeau never forgot his teachers. He wrote to his old chief: “ I am nominated, dear master; my joy cannot be described, my heart has never experienced such feelings before.  All my ideas are confounded and everything disrupted in my soul..tomorrow the clam will allow me to write with more detail. Adieu. I send a thousand kisses.

Its not only the velpeau bandage or description of a leukemia case, but he had published in some 340 titles. He had written texts on surgical anatomy, obstetrics, operative medicine, embryology, diseases of the uterus and breasts. There are many medical terms associated with his name and some names are now of historical purposes only.  Velpeau bandage, ‘Velpeau hernia’ for femoral hernia, ‘Velpeau disease’ for hidradenitis suppurativa, ‘Velpeau canal’ for inguinal canal and ‘Velpeau fossa’ as ischiorectal fossa.

Velpeau, born in a small village of Breches, son of a farrier, who was serving mass in church but a chance event changed his life and he reached to the top position in clinical surgery. Is this only luck?  Remember, Velpeau read medicine books even at a younger age because of his interest in medicine. He got those books by selling chestnuts.

We have seen chance events in many discoveries.

If Burkitt had not examined the child showed by Hugh Trowell, if he had not been curious when he saw another child with similar swelling, if he did not follow the answer in search of his curiosity, then this lymphoma might not have been named after him.

If Epstein had not waited for the sample to reach lab, if he had gone home early for weekend, if he had ignored the sample as bacterial contamination and discarded instead of seeing it under microscope, then he could not have cultured the lymphoma cells and  would have missed a landmark discovery.

If Auer would have ignored the needle shaped rods and had not published it, then his name might not have been associated with these structures.

If Dr.Ernest Irons had ignored the sickle shaped cells in blood smear and had not taken pains to publish it, then we will not be reading about him now.

Many chance events are described in the history of many discoveries.

I believe, these chance events happen in all our lives. But its upto us, how we take it forward.

All this great people have really worked hard, struggled for their success and for what they have been in their life.

I end this post by quoting one of my favourite quotes by Louis Pasteur, “Fortune favours the prepared mind”.

References:

1.     P M Dunn. Dr Alfred Velpeau (1795–1867) of Tours: the umbilical cord and birth asphyxia. Arch Dis Child Fetal Neonatal Ed 2005;90:F184–F186.

2.    Xavier Thomas. First contributors in the history of leukemia. World J Hematol.Aug 6, 2013;62-70.

                                                                                      Written by Dr.Priyavadhana B