The neurology of Jean Cruveilhier.

TODAY Jean Cruveilhier is best remembered as an early professor of pathology, as the author of the two-volume atlas L'Anatomie pathologique du Corps Humain, and for his theoretical views on the role of phlebitis and inflammation in general disease processes.13 Works dealing with the history of pathology emphasize his views on inflammation and mention several conditions of which he gave the first or an early description-peptic ulcer, multiple sclerosis, and progressive muscular atrophy.' 923'26 To those interested in the nervous system, Cruveilhier's Anatomie pathologique is a storehouse of fascinating cases equalled only by Morgagni's De Sedibus. The magnificent illustrations make the work unique in all the literature of pathology for clarity and accuracy of presentation as well as aesthetic appeal. His theories of disease processes epitomized by 'phlebitis dominates all pathology' have not survived the development of medicine in the century since his death,1"'9 but his descriptions of certain neurological conditions both clinically and pathologically are as accurate and interesting as any case report today. His illustrations surpass many subsequent ones in detail and beauty. In addition to the superb illustrations of many of these conditions, Cruveilhier has added extensive clinical material for most of the cases and summarizes these with his own comments on the patients' histories, physical findings, and autopsies. He organizes this material in such a way that certain patterns useful in arriving at diagnoses can be made. Again and again he stresses the importance and absolute necessity of correlating autopsy findings with events in the history and clinical examination. This extensive commentary, not present in the other early nineteenth-century illustrated works of neuropathology, sets his atlas apart from the others. Contemporary books by Hooper, Bright, and Carswell contain superb illustrations of important central nervous system lesions, but none of these writers displays the clinical acumen and insight that Cruveilhier does in arriving at accurate clinical-pathological correlations.7""22 These clinical observations by Cruveilhier have not received the attention they deserve in several works dealing with the history of neurology and neurosurgery.21t29935 Certain problems arise in evaluating a work of this type. For one thing it was published over a thirteen-year period from 1829 to 1842 and reflects certain changes in the author's opinions that are difficult to summarize. Also, the work is devoid of any literary organization. Diseases of different types and different organs are included in the same divisions of Livraisons. In sections on spinal cord disease, Cruveilhier makes digressions to discuss hemiplegia and speech disorders.