TIME TO REMEMBER CELEBRITIES: the SWISS Surgeon Ludwig Courvoisier (10th Nov 1843 – 8th Apr 1918)
Ludwig Courvoisier was born in 1843 in Basel, Switzerland and died there in 1918. Courvoisier passed his A-level in 1862 and started afterwards his medical course in Basel, Switzerland. Due to Typhus with complications and therefore had to interrupt his education. It is reported that he caught up easily with the learning stuff as he always was a hard working man. The Anatomist and Physiologist Wilhelm His as well as the Zoologist Ludwig Rütimeyer and the Chemist Friedrich Schoenbein strongly influenced Courvoisier. This enlarged (next to later the biliary tract) his strong interest in entomology and botanic and very interested in butterflies (esp. species Lycaennidae).
During his practical medical course education he was under the supervision of his mentor, August Socin, he was also the support for him getting a surgeon. After graduation he completed his thesis 19th Mar 1868 and visited his grandfather in England and learned from Spencer, Wells and Ferguson in London. With his friend Lötz, Courvoisier visited Vienna and by this was influenced by Czerny and Billroth. Afterwards he was 2 years assistant of Socin and followed him in 1870 to the Barackenlazarett, Karlsruhe. In March 1871 Courvoisier was appointed at the Diakonissenspital Riehen, Switzerland.
In 1882 Courvoisier finished his habilitation (in accordance to Ph.D.) at the Faculty of the University of Basel and was appointed in 1888 Professor of Surgery becoming later one of the leading figures in surgery. In 1912 he officially retired or being the chairman but continued operating and treating patients. From this he finally retired New Year 1918 and died due to pneumonia some months later in Apr 1918.
COURVOISIER LAW
This eponymous law (sign) describes the physical examination of the right upper abdominal quadrant implicating malignancy of the gall bladder or pancreas unlikely due to gall stones out of the following trias (1) plump-elastic palpable gall bladder, (2) without pain and (3) visible jaundice.
Clinically this sign was, is and will be of relevance and is helpful – no doubt. However, Courvoisier himself did not construct this law (sign). Courvoisier described n=187 cases of common bile ducts obstruction and made the observation of a rare dilatation of the gall bladder, with stone obstruction of the bile duct. At least to my knowledge it is not known, when this became a kind of sign / law, the so-called “Courvoisier-sign (or law)”, an eponymous law for medical students and trainees. It should be mentioned, that Courvoisier himself never stated in his original publication the association with malignancy as he wrote “in my surgical patients I found 35 cases with obstruction to the choledochus; 17 had stones, 18 had strictures or compression by tumors. Of the 17 with stones, only 4 had ectasia of the gall bladder, compared with 16 of the 18 with other causes. Of the 20 ectasias only 4 had stone obstruction; 16 were due to other causes” [Courvoisier 1890].
Reference:
Courvoisier LG: Casuistisch-Statistische Beiträge zur Pathologie und Chirurgie der Gallenwege. Leipzig: C.F.W. Vogel 1890.
For further reading, please read an excellent article by Fitzgerald, White and Lobo from Nottingham at World J Surg 2009;33:886-891:
http://www.academia.edu/7749370/Courvoisiers_gallbladder_law_or_sign
http://www.academia.edu/7749370/Courvoisiers_gallbladder_law_or_sign
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