Pierre Dionis

‘Paris shone in furnishing better means of instruction [in surgery] than in any other city of Europe : public demonstrations were made there in three different localities, in the Royal Garden, at the École de Médicine, and at St. Côme, all three of which were give by sworn masters of surgery’.

Pierre Dionis, cited by Zimmerman and Veith, Great Ideas in the History of Surgery (Baltimore, 1961), p. 359.

Portrait of Pierre Dionis, Cours d’operations de chirurgie,
demonstre’es au Jardin Royal … (Paris, 1714)

Pierre Dionis (1643-1718) was a renowned French surgeon. He taught anatomy and surgery at the Jardin du Roi and was later appointed as physician to Queen Maria Theresa (1638-83) and the dauphines Maria Anna Victoria of Bavaria (1660-90) and Marie-Adélaïde of Savoy (1685-1712). This textbook of his surgery course at the Jardin du Roi was first published in 1707 and bought by Worth in a Parisian 1714 edition. Like the Armamentarium Chirurgicam of Johannes Scultetus in the seventeenth century, the Cours d’operations de chirurgie became an eighteenth-century bestseller and was still popular in the late eighteenth century.[1]

As Ellis notes, the 1673 appointment of Dionis by Louis XIV (1638-1715) to undertake anatomical dissections and surgical operations at the Jardin du Roi established the ‘French School of Surgery’.[2] Vons argues that Dionis’s previous experiences at the prestigious Company of Saint-Côme greatly influenced his sojourn at the Jardin du Roi.[3] Though he only stayed at the Jardin du Roi until 1680, his lectures and the subsequent textbook of his course played a vital role in developing the reputation of the school of surgery there.

His A-Z of Instruments shows his skill lay in communicating his findings in a clear manner. The following extracts demonstrate that his commentary on surgical operations were preceded by an illustration of the necessary instruments for each particular surgical operation. As Simpson says, ‘Dionis is a good guide to the state of European surgery at the beginning of the eighteenth century’.[4]

Pierre Dionis, Cours d’operations de chirurgie,
demonstre’es au Jardin Royal … (Paris, 1714), p. 94.

Of the EXOMPHALOS.

‘The Exomphalos comprehends all the Tumours incident to the Navel ; the Word is compounded of Ex or Extra, of which signifies without, and Omphalos, which is the Navel, the Disease being a Protuberance of the Navel, which extends outwards beyond tis due Bounds…’[5]

This images shows the various instruments used by Dionis to combat what he called ‘tumours of the Navel’ (known today as omphalocele, a rare defect in the abdominal wall whereby organs are outside the body). Dionis divided his various ‘exomphalos’ by size and touch into ‘Enteromphale’ (‘a Tense very hard Tumour’) ; ‘Epiplomphale’ (‘softer and larger on one side than the other’) ; ‘Enteroepiplomphale (‘bigger, more painful, and more uneven’) ; ‘Hydromphale’ (‘soft, and yet very little obedient to the Touch’) ; ‘Pneumatomphale’ (‘a soft Tumour, easily yielding to the Fingers’) ; ‘Sarcomphale’ (‘a hard Tumour, which does not yeild to the Fingers when touched’) ; and ‘Varicomphale’ (‘an uneven and various Tumour, whose Colour is brown and livid’).[6]

He advocated initial treatment by various medicaments, but, if these failed, the surgeon was advised to reach for his knife (and other instruments). The ‘Hydromphale’ could be punctured using ‘an Instrument F of three Fingers length, and not larger than a small Quill, with a handle at one end, and a triangular Point at the other ; in order to pierce the Skin, ‘tis run thro’ a very small Silver Pipe, or Tube G, whose Cavity is proportioned to this Instrument, which is thrust into the midst of the Tumour, after which the Pipe is somewhat hardly pressed on, in order to force it into the Aperture, and withdrawing the Instrument which fill’d the Pipe, ‘tis followed by the Water which the Chirurgeon suffers to run out to as large a quantity as the Patient’s Disease or Strength will allow …’[7] The ‘Pneumatomphale’ was to be pricked in several places by ‘a great Needle, H’, while the Sarcomphale’ deemed by Dionis ‘very difficult to cure’ would be laid open by the Incision Knife I. The preferred instruments for treatment of a Varicomphale were ‘The Lancet K’ and ‘the Vitriol Balls’ L’.[8]

Pierre Dionis, Cours d’operations de chirurgie,
demonstre’es au Jardin Royal … (Paris, 1714), p. 110.

Of the Paracentesis.

‘Some Authors give the Name of Paracentesis to all Operations which are performed either by the Lancet or N else in what part of the Body soever, not exempting that executed on the Eye to couch a Cataract, founding themselves on the Etymology of the Word which comes from Para, which figures beyond, and Kontein to pierce or prick : Many other Writers don’t allow it so large an extent, expressing no more by Paracentesis than the Apertures of the Head, Breast, Belly and Scrotum, in order to draw out the Waters therein contained; and lastly, most confine the Signification of the Word Paracentesis solely to the practical Operation apply’d to the Bellies of dropsical Patients … We call that Paracentesis only, which the Dropsy of the Belly requires, and ‘tis that which I am going to demonstrate to you’.[9]

Paracentesis, a form of body fluid sampling whereby a needle punctures the peritoneal cavity to capture peritoneal fluid, is used for diagnostic purposes. During the early modern period it was used to treat fluid accumulation.

Sources

De Moulin, Daniel, A History of Surgery (Dordrecht, 1988),

Dionis, Pierre, A Course of Chirurgical Operations, Demonstrated in the Royal Garden at Paris (London, 1733). This is an English translation of Dionis’ Cours d’operations de chirurgie, demonstre’es au Jardin Royal … (Paris, 1707). Worth had the 1714 Parisian edition.

Ellis, Harold, The Cambridge Illustrated History of Surgery (Cambridge, 2009).

‘Pierre Dionis’ in Nouvelle Biographie Générale … edited by Hoefer (Copenhagen, 1965), xiii-xiv, p. 294.

Simpson, Donald, ‘Pierre Dionis and the Franco-British Dialogue in Surgery’, Australian and New Zealand Journal of Surgery, vol. 70 (2003), 336-40.

Tubbs, R. Shane, ‘Pierre Dionis (1643-1718) : Surgeon and Anatomist’, Singapore Medical Journal, vol. 50, no. 4 (2009), 447-9.

Vons, Jacqueline, ‘Pierre Dionis, chirurgien aulique et Maître chirurgien juré (1643-1718)’.

Zimmerman, Leo M. and Ilza Veith, Great Ideas in the History of Surgery (Baltimore, 1961).

Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, Dublin.

[1] De Moulin, Daniel, A History of Surgery (Dordrecht, 1988), p. 107.

[2] Ellis, Harold, The Cambridge Illustrated History of Surgery (Cambridge, 2009), p. 43.

[3] Vons, Jacqueline, ‘Pierre Dionis, chirurgien aulique et Maître chirurgien juré (1643-1718)’.

[4] Simpson, Donald, ‘Pierre Dionis and the Franco-British Dialogue in Surgery’, Australian and New Zealand Journal of Surgery, vol. 73 (2003), 337.

[5] Dionis, Pierre, A Course of Chirurgical Operations, Demonstrated in the Royal Garden at Paris (London, 1733), p. 59.

[6] Ibid., pp 61-65.

[7] Ibid., p. 64.

[8] Ibid., p. 65.

[9] Ibid., pp 69-70.