Jules Tinel (1879–1952)
J Neurol
Krzysztof Pietrzak 0 1 2 3
Andrzej Grzybowski 0 1 2 3
Jacek Kaczmarczyk 0 1 2 3
0 Department of Ophthalmology, Poznan ́ City Hospital , Poznan ́ , Poland
1 Department of Orthopaedics and Traumatology, University of Medical Sciences , 28 Czerwca 1956 135/147, 61-545 Poznan ́ , Poland
2 & Andrzej Grzybowski
3 Department of Ophthalmology, University of Warmia and Mazury , Olsztyn , Poland
-
Jules Tinel was born on 13 October 1879 in Rouen in
France to a family with many generations of surgeons and
doctors. He showed both scientific and sports talents from
early childhood. He organised sports teams and showed an
interest in painting and literature, and even contributed to
local literary magazines. His other artistic attempts
involved writing music. Tinel started his education in a
catholic school, and then he started his studies for a degree
in medicine at the University of Rouen. From 1900, he
studied medicine in Paris, where he was awarded the
degree of externe des hˆopitaux, the first degree in medical
education. He completed his studies in 1906. Influenced by
one of his tutors, Joseph Jules Dejerine (1849–1917), he
started to specialise in neurology. In 1910, he received a
doctorate for his work on neurological consequences of
syphilis [
1
]. In 1911, Tinel became head of the
Pitie´-Salpeˆtrie`re Hospital in Paris and 2 years later also the head of
the hospital laboratory. In 1914, Tinel was accepted as a
member of the Socie´te´ de Neurologie and in 1936 he
became the president of the institution.
In 1914, Tinel was appointed head doctor of the
neurology unit in a hospital in Le Mans. After the First World
War broke out, he was mobilised and became an assistant
doctor in an infantry regiment. It was at that time that he
became interested in consequences of damage to peripheral
nerves resulting from ballistic trauma. At that time doctors
had already been aware of sensation disorders and
paresthesias related to nerve damage, yet these were not
considered to be of any clinical or diagnostic significance [
2
].
Tinel’s detailed research resulted in a description of an
effect where tapping of the damaged nerve generated
paresthesis (tingling sensation). He also discovered that
progressing regeneration of the damaged nerve, still
without myelin sheath, gives a more peripheral occurrence of
the sign [
3
]. This sign was named after Tinel. His next
work was based on the observations of 693 patients [
4
]. In
the decades to follow the sign was observed also in nerve
compression syndromes, as for example in carpal tunnel
syndrome [
5
].
The sign attributed to Tinel had been described by
German doctor, Paul Hoffmann (1884–1962) several
months before Tinel did. Hoffmann was a doctor on the
other side of the frontline. His first publication was dated
March 1915, the next one came out several months later [
6,
7
]. Because of the information blockade neither author was
aware of the other’s papers. The news of Hoffman’s
discovery failed to reach a wider audience due to a lower rank
of the periodical and censorship affecting publications
from the Central Powers. His contribution to the discovery
was neglected throughout the first half of the 20th century.
Undoubtedly, contrary to Hoffmann’s work, Tinel’s
descriptions are much more detailed and insightful. He
clearly separated pain from tingling, and found that the
latter had a high prognostic value, and was a sign that the
nerve was regenerating. He also found that if the tingling
no longer progressed, a surgical intervention was required
as it was a signal of a mechanical obstacle to nerve
regeneration. Tinel also linked sensation disorders and
nerve regeneration with the presence of neuroma. He
described not only the regeneration of sensory nerves, but
also accurately predicted that tingling was also a sign that
motor nerves would regenerate [
3, 4
]. The name
predominantly used in pertinent literature nowadays is
TinelHoffmann’s sign, which seems to be the most accurate.
After the War ended and Tinel was demobilised, he
focused his efforts on psychosomatic diseases and
symptoms of encephalitis. In 1922, Tinel and his team were the
first to describe paroxysmal hypertension in
pheochromocytoma [
8
]. From 1922 to 1936 he worked at La
Rochefoucauld, where he managed to set up a research
laboratory despite insufficient facilities. He concentrated
on research into measurements of intracranial pressure and
studies of the autonomic system [
9
], the impact of
histamines on blood vessels and regulation of blood
circulation in the brain [
10
]. From 1936 Tinel worked in Clichy
and in 1940 he returned to Paris.
During the Second World War Tinel was involved in the
French resistance movement. He organised a network for
transporting to Spain wounded pilots whose planes were
shot down over France. His son Jacques Tinel, who was
actively involved in these actions, was arrested and sent to
the concentration camp in Mittlebau-Dora, where he died.
T (...truncated)