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November 19, 2017
19th Century Paul Louis Duroziez

Paul Louis Duroziez (1826-1897)

Du retrecissement mitral pur. Arch. gen. Med., 1877, 6 ser., 30, 32-54, 184-97.

Traite clinique des maladies du coeur. Paris, Steinheil, 1891



Cesalpino Andrea

Paul-Louis Duroziez was a French physician. He studied at the University of Paris and graduated in 1853. During the period1849-1850, he worked under the mentorship of Jean Baptiste Bouillaud at l'Hopital de la Charite. In 1856, he was appointed chef de clinique in the very same institution and worked directly with professor Bouillaud.

Throughout his career, Duroziez made many significant contributions that enhanced our understanding of valvular heart disease. The following brief quotation from the preface of his book is of great value: "Le medecin voit des malades et non des maladies" (The physician sees patients and not diseases).

Duroziez was the first to describe the double intermittent murmur over the femoral arteries in aortic insufficiency. This clinical finding was reported in his article, "Du double souffle intermittent crural, comme signe de l'insuffisance aortique,"  in 1861. This murmur was later became known eponymously as Duroziez's sign.

Duroziez also gave the first account of congenital mitral stenosis or so-called Duroziez's disease in an article entitled, "Du retrecissement mitral pur,"  in 1877. He published his important textbook, "Traite clinique des maladies du coeur," in 1891, in which he described his entire experience on pur mitral stenosis ("retrecissement mitral pur"). In his work, he made a clear etiologic distinction between congenital and rheumatic mitral stenosis. He wrote that he had been following 12 patients at the Children Hospital and that in several cases the disease was evolving for a period extending from one to six years. In none of these cases, he noted a history of rheumatic fever. His entire experience was obviously greater than these 12 patients and included 43 female patients whom he believed were more affected by this disease.

He described a latent period, often long, during which patients were asymptomatic or had minimal symptoms. He commented that the diagnosis of this condition was often missed during enfancy and gave the difficulty to run ("gene pour courir") as an early clinical sign in children. Among later clinical symptoms, he mentioned epistaxis, palpitation, syncope, late and irregular menstruation, abortion, sterility, hemiplegia, aphasia, chorea, hemoptysis, etc.

He described the auscultatory findings including the "eclat extraordinaire du premier claquement" and the "deuxieme claquement dedouble" until the apex. He stressed that the presystolic reinforcement ("bruit presystolique") was not always present. Duroziez described the auscultatory signs of mitral stenosis by the onomatopoeic fout-tata-rou representing presystolic murmur and snapping first sound, second sound, opening snap, and diastolic rumble. He placed a great emphasis on the diagnostic value of cardiac auscultation.

In the second section of this work, he focused on the risk of peripheral embolization associated with pur mitral stenosis particularly in female patients. In his cohort of 43 female patients, he reported 15 cases of neurologic complications with hemiplegia in all 15 patients and aphasia in 11 patients. He did not observe any neurologic complications among male patients.

Duroziez reported that he had performed autopsy examination in very rare occasions. He described the funnel shape of the mitral valve ("valve en entonnoir") in congenital mitral stenosis with smooth leaflets and without any inflammatory lesions. He reported the abnormal aspect of subvalvular apparatus and how it contributes to the funnel shape of the orifice.  He gave a clear description of mitral valve lesions of rheumatic etiology and how they differentiate from congenital mitral stenosis. Furthermore he stressed that in the latter scenario only the mitral valve was affected whereas in the former multiple valves were often involved. Finally, he discussed cases of congenital malformation complicated by rheumatic carditis and recognized that it was difficult to determine the exact etiology in some patients.

The entire section of Duroziez's textbook on "pur mitral stenosis" is displayed here.

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REFERENCES

Duroziez PL. Du double souffle intermittent crural, comme signe de l'insuffisance aortique. Arch gen Med 1861. 5 ser, 17:417-43, 588-605


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