Original Paper
Pediatr Neurosurg 2003;39:10–13
DOI: 10.1159/000070872
Received: November 16, 2002
Accepted: January 24, 2003
The First Description of a Device for Repeated
External Ventricular Drainage in the
Treatment of Congenital Hydrocephalus,
Invented in 1744 by Claude-Nicolas Le Cat
E.J.O. Kompanje E.J. Delwel
Department of Neurosurgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Key Words
Hydrocephalus W Ventricular drainage W Historical
review W Claude-Nicolas Le Cat
Abstract
An 18th century report of a device for repeated extracranial drainage of cerebrospinal fluid in the treatment of
congenital hydrocephalus is reviewed. On 15th October
1744, the French surgeon Claude-Nicolas Le Cat (1700–
1768) introduced a specially invented canula into the lateral ventricle of a newborn boy with hydrocephalus. The
canula was used as a tap and was left in place for 5 days,
until the death of the child. This procedure should be
seen as the first documented description of a device
for repeated ventricular taps in the treatment of hydrocephalus.
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Introduction
The first known documented description of hydrocephalus is attributed to Hippocrates (466–377 BC). After
that, many authors described the features and symptoms
of the condition in newborns, children and adults. One of
the first scientific monographs on acute hydrocephalus
appeared at the turn of the 19th century from the hand of
John Cheyne [1]. Besides conservative treatment such as
diet, diuretics and head bandaging, single and repeated
ventricular punctures were performed as ‘treatment’ of
childhood hydrocephalus in the 18th and 19th century,
usually with a fatal ending for the child. The first reports
of continuous external ventricular drainages in the treatment of congenital hydrocephalus appeared in the medical literature at the end of the 19th century [2, 3]. The
famous German neurologist Hermann Oppenheim [4]
considered ventricular puncture with subsequent external
drainage as a dangerous and often deadly procedure.
However, already in the 18th century, a device for
repeated external drainage of ventricular cerebrospinal
fluid was described. This device, invented by the French
anatomist/surgeon Claude-Nicolas Le Cat (1700–1768),
has not previously been recognised in the literature, and
E.J.O. Kompanje, PhD
Department of Neurosurgery
Erasmus Medical Center Rotterdam
dr Molewaterplein 40, NL–3015 GD Rotterdam (The Netherlands)
E-Mail [email protected] or [email protected]
only few authors have cited this case report from 1744 as
the first documentation of ventricular puncture/drainage
in the history of treatment of congenital hydrocephalus [5,
6], others only refer to the citations [7–9]. Most modern
reviewers of the history of the (surgical) treatment of
hydrocephalus do not mention the published procedure at
all [10–15]. However, in our opinion, Le Cat deserves full
credit for the first description of a device for external ventricular tap in a desperate case of congenital hydrocephalus, during which he left a fixed drainage canula in place
for 5 days. This article gives a short biography of Le Cat
and reviews the original case report by Le Cat.
Claude-Nicolas Le Cat
Claude-Nicolas Le Cat (fig. 1) was born on 6th September 1700 at Blérancourt, Oise, France, into a family of
physicians. He studied medicine and surgery in Paris,
obtained his doctor’s degree in 1732 at Reims and settled
in Rouen in 1733. He became first surgeon in the HôtelDieu in Rouen and professor in anatomy and surgery. In
1736, he received the Royal title of professor and demonstrator. He was founder of the ‘Académie royale des
sciences, belles-lettres et arts’ in Rouen in 1744. Le Cat
was famous in his time for his urological surgical skills,
and invented several urological instruments, the most
noted being a combined gorget and cystotome [16]. He
removed a bladder tumour for the first time by means of a
forceps introduced along the urethra, described in his
‘Pièces concernant l’opération de la taille’ in 1749. In
1742, he invented ‘a machine for dressing and curing
patients, who are very unwieldy and are under the surgeons hands for some ailment on the back, the os sacrum,
etc. or are apprehensive of it’ [17]. Besides medicine and
surgery, Le Cat published, as a true homo universalis, articles on anatomy and physiology, teratology, mathematics,
architecture and philosophy. Many articles from his hand,
as the one discussed here, were translated from French
into English and published in the Philosophical Transactions of the Royal Society of London. He died on 20
August, 1768 [18].
Case Report
Claude-Nicolas Le Cat was consulted on 15 October 1744 by the
parents of a 5-week-old boy with an enormous congenital hydrocephalus. Seeing the enormous size of the head (fig. 2) and the rapid evolution of the condition, Le Cat judged the case as incurable, and he
‘exhorted the parents to patience’. However, the parents came again to
Historical Report on External Ventricular
Drainage
Fig. 1. Claude-Nicolas Le Cat (1700–1768).
Le Cat, begging him for treatment of their unfortunate boy. Le Cat
suspected that: ‘... the cause of the deaths of those, who had been
punctured for the hydrocephalus, might probably be, that all the
water had been drawn off at once; and that the brain had been left, as
it were, uncovered and exposed to the impressions of the air, which
must necessarily fill the wide space, that had been occupied by the
water; since, in this case, the integuments could not be pressed close
on the contained parts, as it happens to the integuments of the abdomen after the puncture in ascites.’ Le Cat decided to drain the cerebrospinal fluid not all at once, but to: ‘... draw the water by little and
little, at different times distant from each other; and in the intervals
of these evacuations to compress the integuments with a proper bandage, to make them come near the brain.’ Le Cat considered the
hydrocephalus to be external to the brain, a common thought in those
days. The common trocars, as used for the treatment of ascites, did
not satisfy Le Cat for his proposed treatment. He held the opinion
that: ‘...punctures often repeated in these nervous parts were dangerous: besides, as the integuments of the head were thin, and upon
stretch, the opening being once made would never close sufficiently
to stop the evacuation, when the canula was removed; and if I left the
Pediatr Neurosurg 2003;39:10–13
11
Fig. 2. The original plate from Le Cat
(1751). Legend of the plate: Fig. 1. The
hydrocephalic boy as presented to Le Cat on
15 October, 1744. Fig. 2. The newly developed canula and trocar. Fig. 3. The canula
without trocar. a: Internal canula; b: external
canula; c: silver stopple. Fig. 4. The internal
and external canula unscrewed. Fig. 5. The
complete canula with trocar and the piece of
plaster between the two parts of the canula.
!: The piece of plaster.
canula in the orifice, and stopped in with a stopple, this same disposition of the integuments would suffer the water to ouze out between
them and the sides of the canula: thus would the evacuation become
total, in spite of me, whatever method I used with the trocars already
known’. These thoughts made Le Cat contrive a new trocar for the
treatment of the dying child. To give full credit to Le Cat, we cite the
description of the treatment from the original article [19]: ‘It is a new
trocar, represented by Fig. 2 and which has this peculiarity, that the
canula is much shorter than ordinary. This canula is represented in
Fig. 3: but there ought to be several of different lengths for different
cases. On the upper part of this canula there are two circles, each one
of which is fasten’d to a different piece. These pieces are exhibited
separately in Fig. 4 and they are made so as to be screw’d one on the
other. These circles are somewhat concave in their surfaces, which
correspond reciprocally; so that their circumferences touch, while
there is a tolerable vacuity towards their centre. By means of this
simple mechanism, I apply the plaster x, with a hole in it, on the
lower circle A, whose screw passes into the hole of the plaister: this
done, I screw the upper piece B on the lower A, and I squeeze the
plaister tight between these two circles. The instrument becomes then
as in Fig. 5. The plaister, which I have chosen, is that of Andreas a
Cruce; but one may use Burgundy-pitch, or any other powerful
emplastic, at pleasure. My plaister was three inches broad. To the
upper end of the canula I adapted a very exact silver stopple c, Fig. 3.
The part, where I intended to make the puncture, was shaved, wider
than the plaister. Thus having prepared every thing, and the canula
being armed with its trocar, and fortified with the plaister, as it
appears Fig. 5. I performed the puncture on Friday the 23 of October
1744, by thrusting in the trocar and canula up to the circles and plaister, which I applied and made to stick in all its parts on the head, by
pressing it with my hand and fingers made very warm, and also
12
Pediatr Neurosurg 2003;39:10–13
with hot linencloths. When the plaister was throughly well fasten’d
on, I pull’d out the trocar, and drew four or five ounces of serosity, of
a brownish white, or the colour of white-wine, and somewhat foul:
after which I closed the canula with the stopple c. ... ... Saturday,
Oct. 24, I unstopped the canula, and drew the same quantity of
water. The infant was ill on the Sunday: wherefore I did not disturb
him that day. Monday the 26 he was better. I drew five more ounces
of water. Tuesday I suffer’d him to take rest. Every time that I made
this evacuation, I bound the head with a strong capeline (A bandage
peculiar to the head). Notwithstanding these precautions, the infant
died in the night between Tuesday and Wednesday; and it will
presently appear, that this hydrocephalus was of an incureable sort.’
During the examination of the skull and brain of the deceased child,
Le Cat concluded that the hydrocephalus was not external, but
restricted to the lateral ventricles, and that drainage at a stage as it
appeared to him was doomed to failure, as the brain: ‘... could not
possibly resume its natural form, how slowly soever I had evacuated
the waters.’
Discussion
In the days of Le Cat, congenital hydrocephalus was
considered a fatal condition. Isolated ventricular punctures with drainage of large amounts of cerebrospinal
fluid leads in most cases to collapse of the skull bones and
the brain and subsequently to death. Other ‘treated’
infants died of secondary infection. The idea of ClaudeNicolas Le Cat to drain small amounts of cerebrospinal
Kompanje/Delwel
fluid at different times, after leaving a specially developed
canula with a stopple in the lateral ventricle and fixed
with a plaster to the head of the hydrocephalic infant,
should be seen as the first documented serious attempt in
the controlled treatment of an infant with this congenital
anomaly. Le Cat should be given full credit for developing
the first documented device for external ventricular
drainage in the treatment of congenital hydrocephalus. At
the very least, he should be considered as the first surgeon
who drained the lateral ventricle to the surface for a certain period of time.
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