Short abstract
Pioneering haematologist who gave his name to a hereditary bleeding disorder
Professor Jean Bernard was France's leading haematological oncologist and one of the country's intellectual elite. He pioneered the effective treatment of childhood leukaemia and was the first to recognise a hereditary bleeding disorder that bears his name. Bernard was also a member of the Académie française, a former hero of the French resistance, and an acclaimed poet and philosopher of medicine. He diagnosed the shah of Iran's fatal macrogloblinaemia, which triggered a chain of events that led to the 14 month siege of the US embassy in Tehran. A prolific writer and thinker, he was the first president of the French national ethics committee for medicine and life sciences.
Figure 1.
Credit: LIONEL CIRONNEAU/AP PHOTO
In 1950 Bernard described the first chemically induced leukaemia in industrial workers. Then, having observed that tar was a carcinogen when applied repeatedly to human skin, he injected it into the bone marrow of rats, and found that it invariably caused leukaemia. From then on, leukaemia was viewed as a disease of haematopoietic tissue, rather than of blood.
In 1947 he and Dr Marcel Bessis developed exchange blood transfusion as a therapy for childhood leukaemia. In 1948 he and Dr Jean-Pierre Soulier described what is now known as Bernard-Soulier syndrome, a recessive genetic condition in which platelets are oversized and underfunctional. His index patient was a boy of 16 who had prolonged bleeding after tooth extractions, and following an injury bled into his eye and spinal cord; the patient later died from a brain haemorrhage after a fight.
In 1962 Bernard demonstrated that daunorubicin (then called rubidomycin) was an effective treatment for acute lymphoblastic leukaemia, and it was under his care that children with acute lymphoblastic leukaemia achieved remission for the first time.
Jean Albert Bernard was born in Paris in 1907, into a family of engineers. He was 7 at the outbreak of the first world war; his father left for the front, and the children were evacuated to the village of Coueron, in Loire Atlantique, until 1918. When Jean returned to Paris to finish his schooling, he read and wrote extensively. Despite an apparent leaning towards the arts, he had a grand vision of science making constant progress in the struggle against illness, suffering, and death, so he opted for a career in medicine.
After he qualified he was unable to get an immediate internship in the hospital where he trained, so took a vacancy in the hospital nearest his home. That is how he came to be under Dr Paul Chevallier, then France's leading haematologist, at a time when the specialty was in its infancy. He soon learnt the enormous contribution that haematology makes to diagnosis, and in 1931, with Chevallier, he founded the world's first learned society for haematology.
When the second world war broke out he entered the resistance, and was one of the 500 people carrying the resistance card of 1940. He was responsible for parachuting weapons into the Vaucluse and the Bouches-du-Rhône, and was arrested and imprisoned for six months at Fresnes. Released shortly before France was liberated, he carried on fighting until the armistice.
He resumed his medical career by studying bacteriology and immunology, which he regarded as inseparable from haematology, at the Pasteur Institute in Paris. It was here that he did his research on carcinogenesis in rats and made epidemiological observations in industrial workers.
As head of the University of Paris immuno-haematology laboratory, he established and oversaw several teams, including that headed by Professor Jean Dausset, who played a key part in discovering the HLA (human leucocyte antigen) system and who shared the 1980 Nobel prize for medicine or physiology.
Professor Jean-Pierre Allain of Cambridge University told the BMJ: “Bernard was regarded as the pope of haematology. I was in his department for three years from 1965—he was distant, and intellectually dominating. At the same time, he was gentle and he listened to people on a one to one basis.”
Bernard received many honours and appointments. He was professor agrégé at the Pasteur Institute from 1949, professor of oncology there from 1956, clinical professor of haematology and director of the research institute for blood diseases and leukaemia from 1961, and president of the French national committee for research ethics in medicine and life sciences from 1983.
In 1974 a former student asked him to come urgently and secretly to Tehran, Iran. Bernard took another trainee, Dr Georges Flandrin, and discovered that the patient was the longstanding shah, Reza Pahlavi, who was troubled with an enlarged spleen. The two doctors diagnosed chronic lymphocytic leukaemia and Waldenström's macroglobulinaemia. The shah refused further tests as he wanted to keep his condition secret, and failed to take chlorambucil prescribed for him. The shah was deposed in the Iranian revolution three years later, in 1978, and fled to Mexico. A year later, when the shah's cancer worsened, President Carter allowed him into the United States for treatment in New York. A few days later, a group of Iranians retaliated by seizing the US embassy in Tehran, holding 52 American hostages there for over a year.
Bernard published many scientific papers, at least three volumes of poetry, and some 20 books on medical ethics and philosophy. The last five of these were published when he was in his 90s.
Jean Albert Bernard, former haematologist Paris (b Paris 1907; q Paris 1929), d 17 April 2006.