(b. Aix-en-Provence, France, 21 June 1703; d. Versailles, France, 6 December 1780)
Lieutaud was raised by his uncle, the physician and botanist Pierre-Joseph Garidel. He received a degree in medicine at Aix and a later, honorary one from Paris in 1752. Lieutaud moved to Paris and, with the help of Senac, chief physician to Louis XV, began a career as a royal physician. He held successive appointments as physician to the royal children (in 1755), chief physician to Monsieur and to the Comte d’Artois, and finally chief physician to Louis XV. An essentially modest man, Lieutaud then asked J. M. F. de Lassone to assume his duties at court so that he might devote Ms time to his own research. By so doing he further stimulated the professional activity of the other court physicians, as well as that of the doctors of the Versailles infirmary, of which he was more or less the director.
Lieutaud’s lifework was strongly oriented toward practical medicine, a notion that was then being defined. Practical medicine as such rejected all theoretical systems and speculative etiologies; in the schools it sought to replace Latin with the vernacular to benefit physicians who should “read little, see a great deal, and do a great deal,” as Fourcroy later put it. Such medicine was to be concerned with facts, not opinions, and to be learned at the bedside and in the autopsy room. While it might be illuminated by the “preliminary sciences”—that is, by “most of mathematics, experimental physics, chemistry, anatomy, natural history, etc.”—erudition alone was insufficient to the discipline. Lieutaud, as one of the leaders of the new school, “reproached those whom he saw occupied solely with accumulating books” (although he himself possessed a splendid library, in part inherited from his uncle).
For these reasons Lieutaud devoted a great deal of attention to postmortem observations. From 1750 on, he examined more than 1.200 cadavers at the Versailles infirmary, as well as attending the autopsies of the son of the dauphin (1761), the dauphin (1765), and the dauphine (1765). He used postmortem materials to study both normal anatomy and pathology; he further undertook to determine the correlation between the symptoms recorded during the life of a patient and the physical lesions found after his death. Lieutaud thus established a method based upon complete and Précise observation of the patient which was carried on by his students, including Pierre Edouard Brunyer, his successor at the infirmary. He may thus be considered one of the French pioneers in the pathological anatomy and anatomico-clinical concept of disease that gradually replaced the various medical systems of the eighteenth century.
Lieutaud’s clinical practice included the inoculation of his patients against smallpox, using Sutton’s method. Lassone reported to the Academic des Sciences the successful results of a series of inoculations that Lieutaud performed on 18 June 1774 at the Chateau of Marly; this communication contributed greatly toward modifying the generally conservative French attitude toward inoculation. Lieutaud himself reported to the Academy on a number of subjects, including the pathology of the gall bladder; empyema of the frontal sinus; hydrocephalus; osteoma of the cerebellum; pathological anatomy of the spleen, heart, and stomach; hydatids of the thyroid; laryngeal polyps; and the correlation between stomach contraction and splenic hypertrophy (or, conversely, between stomach distension and splenic hypotrophy). This last finding was accepted by Haller and Soemmerring, but criticized severely by Bichat.
Like his clinical work, Lieutaud’s writings were directed toward practical medicine. His Essais anatomiques of 1742 was widely read for thirty years, and was given a scholarly second edition, as Anatomie historique et pratique, by A. Portal in 1776-1777. Although Lieutaud’s intent was to place basic practical knowledge of both normal and pathological anatomy (which he considered to be two branches of the same field) at the disposal of the practitioner, his book and the techniques presented in it surpassed this aim. The first part of the book is devoted to descriptive anatomy, while the second gives Précise instructions for dissecting both mature and fetal human bodies, ending with a “recapitulation” that is actually an essay on topographical anatomy in which Lieutaud demonstrates the disposition of the organs in one system after another. (It is typical of Lieutaud’s thoroughness that in the second section he devoted a full seven pages to the technique for dissecting the middle and inner ear.)
In Précis de la medecine pratiqueof 1759, Lieutaud offered a classification of diseases as being those of the general population or those affecting men, women, or children, respectively. He set out the symptomatology of each disease and discussed the therapy for it; although he treated surgical therapy only in broad outline, his prescriptions of medical treatments are fully detailed. The book includes a number of case histories drawn from Lieutaud’s own observations and from the literature.
Précis de la matiere mdedicale (1766) is a catalog, with an index in both French and Latin, in which Lieutaud classified drugs by their pharmaceutical complexity and gave directions for their compounding and their therapeutic indications. In it he recommended the use of simple, “domestic” (or“Galenic”) medicines, of which the effects are well known, and denounced the polypharmacy of the Arabs and the pyrotechnical remedies that had been fashionable in the preceding century. Lieutaud’s standards for inclusion in his materia medica were, indeed, so strict that he here presented “only a twentieth part” of the contents of other contemporary manuals.
Lieutaud’s work earned him admission to the Academie des Science as a corresponding member in 1731; in 1751 he became adjunct anatomist and, in 1759, associate anatomist. He was also a member of the Royal Society. He remained a grateful friend of the Paris Faculty of Medicine, and did not hesitate to support it against its opponents—as when on 22 December 1777 he arranged to present at court Sigault, who had, against the unanimous advice of the Academie Royal de Chirurgie, just performed a symphysiotomy on a woman named Souchot. Although he activity opposed the founding of the Societe Royal de Médicine, which was nonetheless accomplished by Lassone and Vicq d’Azyr in 1778, he later accepted its presidency.
Lieutaud died five days after contracting pneumonia; faithful to his principles, he refused all remedies. He was by royal favor buried in the Ancienne Eglise near Notre-Dame de Versailles. He had previously sold his library to the Comte de Provence, who had allowed him to continue to use it; at the death had Comte de Provence Lieutaud’s books were taken to Versailles, where they now contitute the bulk of the medical collection of the municipal library. His name is perpetuated in the medical literature in Lieutaud’s sinus, Lieutaud’s uvula, and, especially. Lieutaud’s body—the triangular area, limited by the interureteric fold and by the uvula of the bladder, that he isolated and described.
I. Original Works. Lieutaud’s communications to the Academie des Science, all published in Histoire de l’Academie royale des science, include “Observations sur la vésicule du fiel, sur une quantité très considérable de pus dans les sinus frontaux, sur deux livres au moins de sérosité très claire, trouvées dans les ventricules du cerveau,” in Histoire…année 1735, (1738), 16-22, “Observations sur un corps osseux…trouve dans le cervelet d’un jeune homme de 18 ans…,” in Histoire…annee 1737 (1740), 51; “Observation sur la grosseur naturelle de la rate,” in Histoire…annee 1738 (1740), 39; “Sur une maladie rare de l’estomac, sur le vomissement et sur l’usage de la rate, sur un écu de six livérs avale, sur une maladie singuliere…,” in Histoire…année 1752 (1756), 45-49, 71-75; “Rlation d’une maladie rare de l’estomac avec quelques observations concernant le méchanisme du vomissement et l’usage de la rate,” ibid., 223-232; “Observations anatomiques sur le coeur,” ibid., 244-265, 308-322; “Observations anatomiques sur la structure de la vessie,” in Histoire…année 1753 (1757), 1-26; “Observations anatomiques sur le coeur. Troisieme memoire contenant la descriptions particulière des oreillettes du trou oval et du canal arteriel,” in Histoire…annee 1754 (1759), 369-381; and “Observations sur les suites d’une suppression et sur les hydatides formées dans la glande thyroide, sur unpolype en forme de grappe, situé immédiatement au dessous du larynx,” ibid., 70-74.
Lieutaud’s books, most of which were published in several editions, are Essais anatomiques contenant l’histoire exacte de toutes les parties qui composent le corps de l’homme avec la maniere de disséquer (Paris, 1742); 2nd ed. by A. Portal, as Anatomie historique et pratique. Nouvelle edit. augmentee de diverses remarques historiques et critiques et de nouvelles planches, 2 vols. (Paris, 1776-1777); Elementa physiologiae, juxta solertiora, novissimaque physicorum experimenta et accuratiores anatomicorum observationes concinnata (Amsterdam, 1749); Précis de la médicine pratique, contenant l’histoire des maladies et de la maniere de les traiter avec des observations et remarques critiques sur les points les plus interessants (Paris, 1759); Synopsis universae praxeos medicae in binas partes divisa (Amsterdam, 1765); English trans. by E. A. Atlee as Synopsis of the Universal Practice of Médicine. Exhibiting a Concise View of all Diseases, Both Internal and External Illustrated with Complete Commentaries (Philadelphia, 1816); Précis de la matiere medicale, contenant les connaissances les plus utiles sur l’histoire, la nature, les vertus et les doses des medicaments, tant simples qu’officinaux, usites dans la pratique actuelle de la medicine avec un grand nombre de formules eprouvees (Paris, 1766); and A. Portal, ed., Historia anatomica medica, sistens numerosissima cadaverum humanorum extispicia, quibus in apricum venit generia morborum sedes, horumque reserantur causae, vel patent effectus. Recensuit suas observationes numero plures adjecit (Paris, 1767).
II. Secondary Literature. On Lieutaud and his work see the article under his name in Biographie universelle ancienne et moderne, XXIV (Paris, 1819), 470-471; that by A.-L. Bayle and A.-J. Thillaye, in their Biographie médicale, II )Paris, 18550, 321-322; and A. Chéreau, in Dictionnaire encyclopédique des science médicals Dechambre, 2nd ser., II (Paris, 1876), 555-556.
See also M. Bariéty, “Lieutaud et la méthode anatomoclinique,” in Mémoires de la Société francaise d’histoire de la médecine, 3 (1947), 13-16; P. Brassart, “Contribution a l’etude du monde medical versaillais sous le regne de Louis XIV et pendant la Révolution,” medical thesis, University of Rennes (1965); P. Delaunay, “Le monde Médical parisien au XVIIIéme siécle,” medical thesis, University of Paris (1906), 443-453; and C. Fiessinger, “La thérapeutique de Joseph Lieutaud,” in his Thérapeutique des vieux maitres (Paris, 1897), 250-256.
Éloges are that published anonymously in Histoire de la Société r royale de médecine … année 1779 (1782), 94-117; and A, de Condorcet, in Mémoires de l’ Academie royale des sciences.., amiée 1780 (1784), 46-59.
Marie JosÉ Imbault-Huart