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February 27, 2017
19th Century Pierre Charles Edouard Potain

Pierre Charles Edouard Potain (1825-1901)

Clinique medicale de la Charite- Lecons et memoires. Paris. Masson, 1894



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Pierre Carl Edouard Potain was one of the leading French physicians of the second half of the 19th century. He studied at the University of Paris and obtained his medical degree in 1853. He became Bouillaud's assistant in 1856 and was appointed Chef de Clinique at l'Hopital de la Charite . Later in 1876, he was appointed professor of medicine. Among his pupils were outstanding physicians such as Louis-Henri Vaquez, Henri Huchard, and Scipione Riva-Rocci.

Potain made important contributions to the field of cardiology. He was greatly interested in the graphic recordings of physiological events including the arterial and venous pulse waves, and the apical heart beat. In 1867, he published an important study in which he gave an accurate account of the movements and sounds in the jugular veins. He distinguished two kinds of murmurs audible in the neck, namely arterial and venous. According to Potain, arterial murmurs were intermittant and venous murmurs may be continuous, intermittant or continuous with accentuation. He showed that the amplification was related to the acceleration of the blood velocity in the jugular veins. He also noted the venous murmurs were more likely to be present in anemic patients.

In 1876, Potain described the gallop rhythm, a medical term which was first used by Bouillaud. He also distinguished between a split first sound and a presystolic gallop (S4).

He also contributed in the further development of the sphygmomanometer and devised a simple portable air sphygmomanometer for blood pressure estimation. He was the first to postulate that hypertension was the cause of ventricular hypertrophy in Bright's disease. Other Potain's major contributions were the development of a device to count eryhtrocytes and the design of an aspirator for thoracocentesis.

Potain published an important textbook, "Clinique medicale de la Charite- Lecons et memoires," in 1894. He placed a great emphasis in this work on physical diagnosis and cardiac auscultation. He described an atypical cardiac sound that he described as  "small, sharp clicking sounds" . He believed that pericardial adhesions were at the origin of this clicking sound. Throughout the first half of the 20th century, it was believed that clicking sounds were of extracardiac origin. It is possible that Potain and others were referring to the mid systolic click secondary to mitral valve prolapse which would be described after the pioneering work of Reid and Barlow In 1960's.

Potain devoted a chapter to "Acute rheumatic endocarditis" in this work. He reviewed the clinical symptoms of this disease in detail and stressed the fact that in acute rheumatic endocarditis "although general condition improves over time and articular pain resolves , the patient needs close follow up as the cardiac lesions may evolve and worsen in a relatively short period of time." He agreed with his contemporaries (Peter, Constantin paul and Bucquoy) that cardiac murmurs in the setting of acute articular rheumatism were in favor of endocardial complications, but he also added that the alteration of normal cardiac sounds, particularly their "assourdissement", should evoke this diagnosis. He reviewed in detail the modifications of the tone and sonority of cardiac sounds and murmurs in the setting of acute rheumatic endocarditis. He postulated that, from anatomopathologic point of view, the inflammation of the valvular tissue and their oedematous transformation and thickening were the explanation for the modification of normal cardiac sounds. He also commented that auscultation was critical in the follow up of these patients as the tonality and sonority of cardiac sounds and murmurs would change according to the evolutive stage of the disease.

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Another chapter of this book is entitled, "Du rythme mitral (Of mitral rhythm)." Potain described in detail the different features of cardiac sounds and murmur in mitral stenosis. He distinguished three degrees of mitral stenosis with increasing severity and determined the characteristics of murmur and cardiac sounds for each degree. He discussed the view of different authors regarding the presystolic reinforcement. Finally , Potain commented on the murmur of mitral stenosis in the setting of aortic regurgitation which was first described by Austin Flint.

The content of this chapter is very instructive although there are no original contributions.

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REFERENCES

Potain PC. Des mouvements et des bruits qui se passent dans les veines jugulaires. Bull. Sco. Med. Hop. Paris (Memories) 1867 ; 2 ser, 4:3-27

Potain PC. Du rhythme cardiaque appele bruit de gallop, de son mecanisme et de sa valeur semeiologique. Bull. Soc. Med. Hop. Paris, (1875), 1876, 12, (Mem.) :137-66

Potain PC. Du sphygmomanometere et de la mesure de la pression arterielle chez l'homme a l'etat normal et pathologique. Arch. Physiol. Norm. Path. 1889; 5 ser, 1:556-69

Cantwell JD. Profiles in cardiology: Pierre-Carl Potain. Clin Cardiol 1994;17:569-571

Willius FA, Dry TJ. A history of the heart and the circulation. Philadelphia, WB Saunders Co., 1948


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