target="_blank" rel="nofollow" href="#ulink_19bdab28-bcf5-50e8-9ea8-13894fd923cb">7Langerhans P: Handbuch für Madeira. Berlin, Hirschwald, 1885.
8Hausen BM: As “ilhas” de Paul Langerhans, una biograpfia em fotos e documentos. Lisbon, Edicoes Colibri, 2015.
9Hausen BM: Die Inseln des Paul Langerhans, eine Biographie in Bildern und Dokumenten. Vienna, Überreuter Wissenschaft, 1988.
10Langerhans P: Beiträge zur mikroskopischen Anatomie der Bauchspeicheldrüse; med. dissertation, Berlin, 1869. Printed by G. Lange, 1869.
Dr. Viktor Jörgens
Fuhlrottweg 15
DE–40591 Düsseldorf (Germany)
Jörgens V, Porta M (eds): Unveiling Diabetes - Historical Milestones in Diabetology. Front Diabetes. Basel, Karger, 2020, vol 29, pp 36–39 (DOI: 10.1159/000506557)
______________________
Apollinaire Bouchardat Invented Patient Education
Viktor Jörgens
Executive Director EASD/EFSD 1987–2015, Düsseldorf, Germany
______________________
Abstract
Apollinaire Bouchardat was the leading clinical diabetologist of the 19th century. He invented patient education for people with type 2 diabetes. He told patients to lose weight until the urine tests for glucose they performed at home became negative. Today’s treatment of obese people with type 2 diabetes does not differ very much from Bouchardat’s approach. He summarized his observations in the monography De la glucosurie ou diabète sucré. Bouchardat also wrote a very popular textbook on hygiene, over 1,000 pages long, in which he summarized all his views on a healthy life, from nutrition to the frequency of sexual intercourse, garnished with many amusing remarks based on his political, very socially oriented, and anticlerical opinions.
© 2020 S. Karger AG, Basel
Apollinaire Bouchardat (1806–1886; Fig. 1) was one of the outstanding clinical diabetologists of the 19th century. His father was away with Napoleon’s army when he was born in L’Isle-sur-Serein near Avallon in Burgundy on July 23, 1806. Today, two commemorative plates decorate his very modest birthplace in the Rue Bouchardat in front of the mayor’s house of L’Isle-sur-Serein. A few steps from this birthplace, the diabetologist travelling in Burgundy should enjoy the excellent local cuisine of the restaurant “Le pot d’étain” as Bouchardat enjoyed the culinary and enological treasures of Burgundy during his whole life.
Bouchardat’s father abandoned his wife and she had to ask his uncle in Avallon to take care of the boy. He worked in his uncle’s pharmacy before leaving for Paris at the age of 19 years. Like Claude Bernard he dreamt of a career as a writer. He wrote a drama which was performed in the theater of Avallon, which is nowadays the cinema of the city. Sadly (or maybe better for his reputation), there is nothing left of this piece. Bouchardat finished his pharmacy training in Avallon and, again like Claude Bernard, he went to Paris to study. To fund his studies in pharmacy and medicine, he worked as a teacher and published several books for students to prepare for the baccalaureate. In 1829 he began his medical studies, and in 1832 he finished his doctoral thesis on cholera. He was nominated as Professor of the Medical Faculty as early as 1833, but had to wait 13 years to be appointed as the Chair of Hygiene. From 1834 to 1855 he was Chief Pharmacist at the Hôtel-Dieu hospital, and he wasted no opportunity to criticize the disastrous hygiene conditions of the old hospital, located along the Seine in front of the actual Hôtel-Dieu building. His private address was 8 Rue de Cloître Notre Dame, which faced the north entrance of Notre Dame. In this apartment he received his numerous private patients for decades, some of whom had travelled to Paris from far away. The patients had learned how to test their urine for glucose themselves, and they sent him letters with the results, asking for his advice [1].
Fig. 1. Apollinaire Bouchardat, 1863 (donation to Dr. Jörgens by the Bouchardat family).
Fig. 2. Le diabète sucré – Bouchardat’s opus magnum [3].
At an advanced age, Bouchardat suffered from hearing loss, which was the reason for the faculty to retire him against his will 1885. His successor was Adrian Proust, the father of the writer Marcel Proust. Bouchardat died on April 7, 1886. The funeral mass took place on April 10, 1886 in Notre Dame, a few steps from his apartment. Bouchardat had requested that no speeches be made there and that the guard of honor – he was a knight of the “Légion d’honneur” – should not carry any weapons. He was buried in the Père-Lachaise cemetery.
In 1952, Bouchardat’s portrait was featured in the sixth issue of Diabetes, the official journal of the American Diabetes Association, and an article by Elliott Joslin honored his contributions to diabetes care and research. Joslin stated that Bouchardat was the first clinician to introduce patient education, including self-monitoring of urine glucose [2]. At a time when 300 mL of blood was required for blood glucose estimation, the only method for metabolic self-monitoring available for the patients was urine testing. Bouchardat wrote in his famous book, Le diabète sucré, that “this daily measurement of glucosuria guides patients like the compass that guides the sailor on unknown oceans” [3] (Fig. 2). Bouchardat had observed that weight reduction resulted in substantial improvements in metabolic control, and he was the first to introduce a systematic regimen in obese people with diabetes. In addition to this reduction of food intake, in particular of nutrients containing carbohydrates, Bouchardat also repeatedly emphasized the blood sugar-lowering effect of physical activity – he was the first diabetologist to treat his patients based upon an evidence-based approach including education, self-monitoring, weight reduction, and exercise. He also noticed that this treatment was most effective in older obese patients, whereas slim young patients with ketosis did not show any benefit.
In contrast, his speculations on the pathogenesis of diabetes nowadays seem obscure, since he attributed hyperglycemia to pathologically increased absorption of glucose in the stomach [3]. This hypothesis may seem curious to us, but today’s speculations on the pathogenesis of diabetes may sound just as strange in a hundred years.
Bouchardat was among the first to discuss the pancreas as the source of diabetes. He tried pancreatectomy on dogs, but the dogs all died. He also attempted ligation of the pancreatic duct and observed that the dogs lost weight and developed glucosuria [3]. From today’s perspective, however, his work on physiology and pathogenesis falls far behind his major discovery, which Joslin formulated as “having introduced the personal responsibility of the patient for his own treatment