. : You are a man of North…

A.D.: I was born in , ninth of a phratry of twelve. My father worked in the textile, and the world of my youth was not at all that of health. I am besides the only one to have followed this channel, all my brothers made studies of engineer.

I passed a conventional and happy childhood in the North put aside the period of the second world war. My education is arts person, I passed a vat of philosophy then I chose to make medicine.

 

. : What is what pushed you to make medicine?

A.D.: I wanted to look after people and to become family practitioner. The general practitioner who followed us, was cordial, it did his work well what pushed me towards this choice. On the other hand, I did not know what was the surgery.

All my medical activity was marked by the influence of a group of medical students of my year that I met at the beginning of my course. We became and remained friendly all our career. Often wire of doctors or owners, they controlled me in the choices which I made. I thus prepared, with them, the then the boarding school.

 

. : Which memories do you have boarding school?

A.D.: If the did not leave me remember imperishable, the preparation of the boarding school was a very strong time; we were a very welded team of students and we all were received.

The conferences of boarding school in which I took part were quite different from those which are described to me now. We formed small cells of work, with like guides, a lecturer of medicine and one of surgery. These lecturers prepared to us during 2 to 4 years at the rate/rhythm of a conference each one per week. The conferences were free, but if one of us had an absence, it supplied the slush fund of the conference.

The program that we needed was very different from the current program as well in its contents as in the organization of the contest. We owed written floor in atters to be acceptable: Medicine, Surgery, Physiology and Anatomy. Once acceptable, an oral test of intake awaited us. I found our lecturer in surgery excellent: hard worker, pedagog, rigorous teacher, he learned how to us to know to clearly cover any subject like the whitlow of the wooden leg. He could also finish the evenings by large a when the moroseness gained us; environment was extraordinary. Its clearness enabled me to appreciate the surgical reasoning and facilitated my first choices of training course in surgery.

We were approximately edical students for 15 places with the contest and 4-5 places in surgery. Very little the exchange rates of FAC were followed, but it is in these conferences that I learned the manner of exposing, and to build a talk.

 

. : How was the hospital life?

A.D.: I made my studies at the time of the hospital concentration in Lille: The meeting of the hospitals dispersed in the city gave rise to “the Hospital City” initially on a hospital then its enlarging until its current size in several contiguous hospitals.

One had just closed various hospitals in the inhabitant of Lille city which were of old design. The activity concentrated gradually on the hospital City. The only training course outside the City that I made is unrolled in Neurology in a hospital old regime. I thus knew the common big room of 24 patients with the central staff waiting room of the nurses. The activity of then was quite different from now: tuberculous meningitises, and the intraspinal injections belong to the memories of external that I kept.

The hospital city was of modern design compared so that I have just described. It made it possible to concentrate all the services and all average the techniques on a site. The effectiveness was much better. This Hospitalière city did not cease growing since.

 

. : Which pathologies marked you during your first years of Medicine?

A.D.: Tuberculosis and traumatology struck me by their frequency.

Tuberculosis held a considerable place in the medical problems of then and all the sectors of pathology. It was very current, and besides, we regularly had in our years students who left in sanatorium. This important place of tuberculosis completely disappeared, whereas we were rocked by the diagnosis tuberculosis like one the first diagnostic assumptions. Tuberculosis was everywhere.

The 2nd strong impression of these studies was the place of the traumatology, which was a heavy traumatology with less regional hospital equipment. All the heavy traumatology of the area converged on the hospital city. This regional concentration remains still important, in spite of the creation and the reinforcement of the of the area.

 

. : You finally chose to become csotcina.comedic surgeon?

A.D.: At the end of the , before beginning my day school, I made a training course of surgery in ; the surgeon who framed to me was typical time, very square, general-purpose, making of all. Even if I liked this clear side and Net of the surgical situations, I did not feel the catch for the surgery at this time.

I arrived at the csotcina.comedic surgery without thinking of it since I believed that I will make general medicine. My first contact with the csotcina.comedic surgery was a training course of external at Pierre in Traumatology. I liked help operational; my second training course of surgery which was in general surgery enabled me to carry out my first intervention: I remember my pride external to have removed a fibroma in the back of a patient under the careful eye of the senior registrar which had judged some me able.

When I became internal, I hesitated, because I was also very interested by the medical imagery (perhaps because I liked much the photograph). To consolidate me in this choice, I thus chose a training course of surgery at… Pierre . There my vocation was definitively confirmed.

Why the articular surgery ? Probably because of the effectiveness of the surgery in traumatology which was already repairing. I found filling with enthusiasm to be able to repair our patients and to see the result of it quickly.

 

. : Did Pierre influence this choice, why?

A.D.: Environment in its service was pleasant. For him, speed and the operational brilliance were not something of determinant, it operated calmly and appreciated the gestures well done.

Young person, I was fascinated by the artisanal side of certain interventions, as well as the importance of the completion. A well adjusted intervention is a pleasure.

I thus remember a Clerc's Office for the processing of a pseudarthrosis of leg. The nonunions of leg were current and one discussed them by Clerc's Offices “in ”, i.e. in marquetry, one made a trench in the bone pseudarthrosis and one embedded a taken tibial graft on other side; if embedding were perfect one did not fix it or slightly by 2 screws. I remember to have told to the operator, “they are absolutely marvellous, one would say a work of fine joinery or of cabinet work”, it very badly took it, whereas it was for me a compliment.

 

. : Speak to us a little Pierre ?

A.D.: Pierre was as it was seen: a man calm, solid, it had the slow step somebody of quiet. He emanated from him a natural authority, and he did not need to show authoritarianism contrary to some. There had remained simple, he was no courtier in his service; each one had its place and one understood oneself well. He hated the hustle, privileged the good sense, finally it was a remarkable pedagog. He had inherited this talent his teaching parents (his/her father was instructor): art to say the things simply. The mother of his wife had attended her professorial lesson, it was not doctor, it was come out from it charmed while stating to him: “It is well I very understood”.

It was also somebody who had a modern vision of the things. Under its crook, the department of traumatology opened into 53 and it is one of the very first services of France where the surgery separated general surgery. At the time, the surgery, most of the time, was made in the general surgery services. There were simply the services of Strasbourg and that of which had also succeeded in separating.

This service was as they at the time were done: considerable for our time with its creation, 120 beds “acute” and 40 beds of “chronicles” (not from bed of septic, this sector had not been isolated yet). This chronic sector related to patients in continuous extension. This type of drug was easily used in the diaphyseal comminuted fractures. We did not have a locked nail and the external fixers did not have the user friendliness of today. There were thus no badly patients who remained 120 days in traction at the hospital! There was also a center of the flarings which it had made create, and for which he had the responsibility. Pierre worked with ECSC (Committee European of the Carbon and Steel), and Lille received the victims of these typical industries of the North of the time.

One was also rather close to where one went regularly. As there was no center of rehabilitation on Lille, our patients went in center of rehabilitation in . Pierre went once a month in like or .

 

. : How was the life in the service?

A.D.: Pierre wished that each one be able to find its expression or its channel. He took care to control the things but sufficient freedom left us to impel the new techniques in the service and finally the activities of each one were distributed between us by mutual agreement. I re-examined it well when I read again my proof of bonds, the first 10 years I made of all, even if traumatology were dominant. I even made of the upper limb. csotcina.comedy was still stammering, my thesis was a thesis of csotcina.comedy since it was devoted to the surgery of the paralytic equine foot of the adult in particular after paralysis of the SPE, it was the operation of associated with the transfer with leg posterior.

The prevalent activity of the service was thus traumatology. In my memories, it was about a heavy traumatology: with the urgency, one discussed only the open fractures, the closed fractures went up in the stages and during the first years, the great diaphyseal crashes were readily discussed by continuous traction. The environment of the service, as Jean told, was that of a “small Breton port” with engine pylons and strings in all the corners. There were many patients tractor drawn a long time. Environment was quite different from the current departments of csotcina.comedic surgery. One did not have into 60-65 of average therapeutic sophisticated or very not varied separately long plates with less good results.

. : Your “very favorite” as intern?

A.D.: My larger shock as intern was the first exchange rate of the osteosynthesis of the in Davos. I discovered a whole philosophy of the osteosynthesis which was accompanied by a coherent technology. What we did resembled do-it-yourself compared to the system of (plates with compression, sizes different, tarots, precise ) and that was a fantastic shock, I had the impression to have discovered another planet. I returned while telling me “it is necessary to acquire this hardware and these techniques, we can balance our live of obsolete and them ”. At the beginning, this meeting did not have the magnitude that took afterwards, one did that in a small room of cinema.

 

. : Speak us about the operational programs about then?

A.D.: The program was done on 4 rooms at a rate of 15-20 blocks per day, with often of the large patients. The rotation of the patients was faster than now, the programs were done from 8 to 4 p.m. At 5 p.m., a check inspection carried out with the pitch of race enabled us to see all the patients of the service (120 beds). And the practice was to turn together.

The operational tasks and vacations were distributed cordially in front of the weekly program, because there were no specialization of the ones and others.

 

. : The relationship between the Parisian Schools and the School Inhabitant of Lille?

A.D.: Pierre had very good relations with Merle of , as the exchanges between the 2 services was accepted and supported, with such sign as aggregative of the service was to go at Mondays afternoon of . One was thus going to attend with Jean with the public consultation of Blackbird of which was a great consultation, like the theoretical talks of . We had less contact with the provincial towns, but I do not know why. The few provincial contacts that we had made mainly with the team of Strasbourg.

Certain operative procedures were put oddly on the way more quickly in province than in Paris, I think of the central-medullary which appeared badly seen by the school and little encouraged by the Merle school of whereas it quickly was very much used by Strasbourg, Lille and Bordeaux. The external fixer was also used very early in province.

 

. : Your career after the departure of Pierre …

A.D.: I initially sought to develop a team rather than scientific axes; I wanted to have collaborators with whom I understood themselves well and which would take complementary guidelines.

The 2nd objective was to improve the assumption of responsibility of the patients in the hospital, because the hospital operation of then appeared to me of a hardness enough terrifying.

The 3rd thing which appeared fundamental to me was that we must control our activities by regular overhauls of our operated patients and series: I was very attached to the scientific work of overhaul and publications.

There remains a characteristic of the Lilloise area which helped me well: the mining area of population was such as if a technique or a new guideline were proposed, the patients arrived. I thus could develop all the types of surgery which I liked: if I were interested in it, I could quickly install this new activity. I have, for example, makes for a long time knee surgery or until the advent of the at which I did not put myself. The fact was crippling and very quickly François , who was interested there, developed these techniques. As I did not wish to continue with to do everything at all costs…

 

. : You acquired an expertise in laxities of ankle…

A.D.: That was done in several times; I initially was interested in fresh traumatology of ankle. I made a series on the fresh lesions of, of LI, but it is a roundtable of the on the serious distorsions of tibio-tarsal which made known to me on the pathology of ankle. Moreover, it encouraged me with set up a system of overhaul.

The clarification of the is the transfer of a technique carried out to another hinge. I made at the time much of , it was that in a chronic injury of I ankle fell on a crucible and I told to my aid, “looks at, one would say a crucible of . Why not discuss it as in a shoulder by erasing the crucible”. I called besides this intervention the “ of ankle”. This repair of the lesion lent itself well when there was a crucible, which is not always the case. I transposed to ankle what I liked to do with the shoulder. That enabled me to repair rather than to bring a tendon taken elsewhere, because the latest thing of then was the of .

By chance, I fell at the beginning on small crucibles which I did not always find afterwards. But it is as that which I began. The follow-up of the patients showed me that this technique was effective and sure. I did not have to take again these patients by except some cases of iterative tear per traumatic repetition.

 

. : You gradually showed an private interest for the hip dysplasia?

A.D.: On the dysplasia of the hip, the school inhabitant of Lille somewhat disunited Parisian school in particular of because and its pupils made stops. In , one was primarily , i.e. osteotomy of and seldom obstinate isolated. That grained to me to leave this femoral head discovered even with an important and I started to rather early make stops into 63 or 64. I have from the start used the armed stop described by . That gave me satisfactions, but despite everything, I was not satisfied because I had the impression that one did not cover completely the head, in particular behind. I was thus interested in . I never was to see (it is a wrong and a regret), but I read his publications.

After some interventions of , I was struck by the technical difficulty of this intervention which had been thought to be realized in the child. At the beginning, was not fixed: the patient was immobilized in a plaster cruro-pedal Bi, hip in abduction for one month in one month and half. This heavy immobilization was supported with difficulty by the patients; moreover, one did not control well the , I had besides some increases of this in the plaster. I tried on the one hand to develop a reproducible and transmissible technique, on the other hand to specify the indications of this intervention more difficult to realize than a stop.

To refine the indications and to know until where I could go, I re-examined these patients regularly. Too much often, one privileges the surgical act whereas the discussion of the indications is more profitable, even if with the joint replacements the problem is not more completely the same one.

The nonprosthetic surgery has a result completely depend on the relevance of the indication. To tighten the indications, to analyze the results with my collaborators well were enthralling moments. I thus remember all my files of which I re-examined for the thesis of Henri (a little as if they were my grandchildren). One ends up having an idea with a reasoning of the type “here I can, there I cannot”. It is not any more one question of surgical skill, but an amendment of the surgical act to the situation.

 

. : Whereas the majority of the teams published their good performances of prostheses, you defended the nonprosthetic processing of hip osteoarthritis…

A.D.: It is perhaps a rearguard action, but I always preferred to repair that to replace: the standard replacement, poses removal, I quickly knew like others, that it went, at least in the medium term.

But to relieve a patient, to restore a function, to see reappearing a joint space thanks to a preserving surgery, brought to me intellectual satisfactions much larger; this is why during 30 years I sought to specify the indications and the limits of the preserving surgery of the hip.

But before speaking about the total arthroplasty of hip, I would like in a few words to say what in 1960 the surgery of the primitive hip osteoarthritis of the old subject was.

When one decided to operate it, the conventional program was the combination of an arthrodesis on a side and a resection head and neck of the other, to have on a side a stable hip, and other a mobile, but unfortunately unstable hip. As you imagine it, the program was very heavy, long and painful convalescence and the poor functional results.

Before passing to the total prosthesis, we largely used, like others, the joint replacement with cup: initially that of , then the cup of . The result could be excellent, but there remained very random, indolence not being always obtained.

 

. : How did you choose your first prostheses?

A.D.: It is towards 1965 that the total prostheses of hip appeared, but the choice of the model was difficult because of the restricted number of the publications and the weak retreats.

With Jean , we were at Mac three days, we returned enthusiastic from this meeting and we started to pose his prosthesis. Why that of Mac rather than that of , I do not find precise reason today.

This voyage to Mac , I remember our admiring astonishment, when the gardener of the hospital where Mac operated, made in front of us a demonstration of what it could make with his two prostheses. The result was so perfect for the time, that a friend surgeon who accompanied us did not believe his eyes of them and asked to see the cicatrices of operated. It is thus probably this amazement which us led one year or two to use the prosthesis of Mac to couple metal-metal, then we passed to the couple metal-polyethylene with the prostheses of .

 

. : Why not the prosthesis of ?

A.D.: The reason was probably that did not accept that one poses his prosthesis which if one had come to make a training course at his place, reason which, between brackets, shows the serious one and the rigor of . In addition, there was quickly an important friendship between the school inhabitant of Lille in general, Jean in particular and Maurice . The exchange rates of the were very appreciated by our young collaborators, one thus quite naturally passed to the prosthesis of .

 

. : Vis-a-vis the opposition cement/without cement of a few years ago, you were rather pragmatic in your choices…

A.D.: Indeed I had some difficulties in use it without cement, but this probably reflects my rather preserving tendency; in front of a technique whose results are confirmed, I find that it is extremely difficult to change.

Cemented the prosthesis known as was well, I did not see why I would leave towards a choice without cement, whereas the cemented prosthesis gave satisfaction. In addition when I currently see the results of with 20 and maintaining 30 years, I remain a little impressed!!! On the other hand, quickly the cemented appeared much more fragile to me.

 

. : In spite of did this displayed prudence, you test new techniques?

A.D.: It was a little against my liking, even if I guaranteed it, but I am convinced that on this point, the motive fluids in my service were my assistants. As I already said, it appears difficult to me to change a technique which gives satisfaction. In particular, I hate the reflections of the style “one will make of it a pair and one will see well what that gives”, because the results to have a direction, ask for many years of retreat. One can make fun of certain schools which appear , but it is necessary to then recognize to them a intellectual coherence in this step which consists in telling “Prove us that what you made is better, one will change”.

However, it was impossible as soon as one enlarged our indications on younger subjects to deny than cement was (with polyethylene) a weak link of the prosthetic whole on the level of . I was thus obliged to interest me in without cement and I had much evil to choose: many elements intervened and were to be discussed.

I chose at the beginning for without cement of Harris and the stem without cement of , because I never liked the femoral stem of Harris-Gallant whereas it “near-made” of Harris, and its complementary fixing by screws appeared reliable to me. The primary anchoring of has me from the start appeared reassuring and with time this choice me forever disappointed. Thereafter, I tested other more anatomical models, but to date, it is difficult for me to affirm that they are higher than this first stem without cement.

Vis-a-vis the diversity of the prosthetic models at the disposal of the surgeons, I would like to make a more general remark. I think that we are not rigorous enough vis-a-vis the evaluation of the novel methods or technologies. It does not seem normal to me that each one can constantly, to put any model of its choice.

I wonder whether we do not have lessons to take on behalf of our colleagues doctors: I have the impression that AM are much more rigorous than the conditions of marketing of a prosthesis. A surgeon with the aid of a manufacturer invents a new model of prosthesis, and as soon as the prosthesis is marketed, each one can use it without restriction, unconstrained and without control. Is this quite reasonable?

I wonder whether the possible users would not have, when a new model leaves, to be obliged, to follow a certain number of protocols of installation on the one hand, and regular overhaul on the other hand with regular data-processing follow-up and publication of the results. This step is already implemented by certain manufacturers, but it remains about voluntariate; would not have one to go a little further in the rigor and a certain state intervention. This would prevent us certain unhappy experiments that each one knows.

In the same way,
I would like to speak about the notes
of that I often have
claimed.

Any author of item should be held with a note of 5 years after the publication of the item, notes which could be very short. He is completely abnormal to learn by the “word of mount” that such which defended a technique or a prosthesis in publications completely gave up it without this not being the subject of a written publication or that one knows the reason of it.

 

. : You always pushed your collaborators to go to see elsewhere…

A.D.: I, indeed, am convinced that our experiment is worked by the meetings of surgeons whom one will see working. It is necessary to see the colleague operating and consulting. These personal meetings quickly give an idea of the credibility of its work and its results. In addition, one also quickly has an idea in the way in which the medical records are managed and this makes it possible to evaluate the credibility of the publications. I was very content that my collaborators travel and will see elsewhere. In this respect, I consider it regrettable that from the level of the Society of csotcina.comedy the purses are not more requested for this kind of opening. This seems to me a deficiency.

 

. : In another register, you defended the csotcina.comedic processing of the fractures of …

A.D.: It does not appear right to me to say that I defend the csotcina.comedic processing of these fractures. But the symposium of the processing of these fractures which I had made with Jacques learned to me enormously from things. Indeed, the rigorous overhaul of the 500 files of fractures of discussed either , or surgically, enabled us to tell “there is certainly a place in these fractures for the csotcina.comedic processing but it is necessary to specify the possibilities and the limits of them. As in addition the surgery of the fracture of is a surgery difficult, high-risk, which requires a perfection not always reached even in the best hands, we tried to specify the anatomical forms and displacements compatible with an csotcina.comedic processing as well as the fractures concerned with the surgery. To privilege the surgical act systematically did not appear desirable to me.

I do not criticize the step of Emile who was lucid, since he says it very well in his book: at the beginning he wanted all to operate them to know them on the plan anatomo-private clinic, he was necessary that it recognizes all the anatomical varieties.

He had made a surgical choice of which the primary goal was a better anatomo-pathological knowledge of the lesions. He made some us profited obviously because he had acquired of it a single knowledge but which enabled us to tell: There are cases where the csotcina.comedic processing keeps its place.

 

. : You animated the College of csotcina.comedy…

A.D.: I animated it in Lille while succeeding Pierre , of which it was one of the children. It was one of the motive fluids in the creation of the College of csotcina.comedy. It was very faithful there until the end of its life. One of my great happinesses also was to train my pupils. It is very well to operate the patients, it is the reason first of our work. But gradually while advancing, I discovered that to train its pupils, to learn how to them to reason healthily, to have a good diagnostic and therapeutic step with respect to their patients was a happiness which passed even less than the surgical pleasure. The meeting of all my last collaborators and present before my departure was for me, a dedication: their attachment showed me that I had worked only for me. I had the feeling to leave a team of people who understand themselves and who keep a certain thought identity that I share. Finally one with the impression to be rewarded beyond the furnished effort to train his/her collaborators.

 

. : You supported the hyper-specialization of your collaborators and yet you always defended a department of csotcina.comaedics general.

A.D.: Their specialization pleased to me, because I did not want any more courage and to do everything. I reported myself that in this system enough inhabitant of Lille of an ostéo-articular surgery with services remaining rather general-purpose, one could not all make well any more. I used one of the main advantages of the : to be able to surround me by a sufficient number of collaborators to cover all pathology with a certain homogeneity of indications.

The specialization of the surgical act appeared a need to me in front of the explosion of the subspecialties of our discipline and the growing number of capture in specific charge.

The role of the department head that I was became mainly to inculcate a manner of approaching this discipline, in the discussion of the indications, the importance of the review and the follow-up of the patients.

 

. : You always were being wary compared to the therapeutic modes!

A.D.: Yes, I always hated the modes.

I was often defined as a craftsman, it is what characterizes our trade, we refine to the maximum our knowledge of the indications, but the surgical gesture remains the personal realization with all its risks.

My fears and my reserves vis-a-vis the innovation are an expression on my preserving side. I am wary of the “new whole, very beautiful”. I do not have a reserve with respect to the innovation, but it is a duty of requirement to validate an innovation before adopting it. Perhaps that such couple of friction is the future, but it should be proven.

One of our difficulties remains our dependence with respect to the manufacturers. A certain number of progress suggested by our manufacturers gave us some bad surprise: the titanium which was to be the panacea; couples of friction for which it is still difficult to slice, etc

Time is completed where each one in its corner arranged a technique or an implant to see or “I told myself will put a pair of it to have an idea”. That does not have any more any direction because a prosthesis will not have an poor outcome before several years except if it is really bad. Moreover one small series no conclusion will allow: the cases will be thus not exploitable. One of the interesting solutions was to group in association that one is deprived or public in clubs to make series. This allowed the validation of several interesting concepts.

But without cultivating the , it is important to publish the poor performances.

 

. : How do you imagine the surgery in 5 or 10 years?

A.D.: I must say that I am impressed by the surgery with data-processing assistance. I often compared myself with a craftsman, but I think that one will attend in our trade a significant development of the assisted surgery.

The imagery becomes increasingly precise, I do not know how that will be concretized, but I think that the combination of the operational act and the imagery will be increasingly narrow in the future.

One will not be able to be satisfied experiment more and glance of the surgeon, measurements per-operational by more precise machine as in industry or aviation will be inevitable. That will not abolish the surgeon, but will oblige us to equip us consequently.

Another slope of the future is certainly the development of the biomaterials. To find a substitute with polyethylene will allow a fresh progress of the results of our prostheses.

The biomaterials of filling, the ostéo-inductors are also runways full with
promises.

Some think that progress of medicine will be such as ageing will be controlled and that the csotcina.comedy of degenerative pathology will disappear. Personally, I do not believe it; ageing is registered in the airframe. Even if I expect considerable progresses vis-a-vis the various phenomena concerning ageing, I do not think only one intra-articular injection of some product that it is, can stop it.

All in all, neither traumatology, nor csotcina.comedy are threatened in the medium term of decline.

 

. : Were you a happy surgeon?

A.D.: Yes, the trade of surgeon brought all possible satisfactions to me and I do not see which other trade I will have been able to make a posteriori. This trade brought to me beyond until I waited, in particular in two human managements which were expensive to me:

- The assumption of responsibility of the patients: now that I, I stopped working misses the consultation more than the surgical act. A consultation in csotcina.comedy is one moment privileged with patients opposite oneself of which it is necessary to seek to know the desires, the sufferings, the fears to bring the suitable remedy there.

- The surgical team: to have the chance to have a team that one formed and who works was a great pleasure.

It is, in addition, an advantage which enabled me to keep my surgical extra passions.

 

. : Did the music, the photograph and the mountain really accompany the surgery?

A.D.: Yes, I am impassioned of mountain, music and photograph. I am astonished by the success that I had in surgery because I never agreed to give up these passions. I required to have another thing in my life that the surgery. If I had invested myself at 100% in the surgery, I, perhaps, would have been more autocratic? The fact of having had these passions beside this work easily devouring, probably left a larger place to the others in the life of the team than we form.