1794 - 1848

Paris in the first half of the nineteenth century was the medical mecca; students flocked there from all over the world, not least from the United States, to learn the new 11 me'de'cine d'observation", grounded in pathological , practiced in a hospital setting, and employing new modalities of physical examination -- auscultation, percussion, thermometry. From the middle ages to the end of the eighteenth century the symbol of the doctor had been the urine glass; from this point on the symbol would be the stethoscope.

This Paris was still almost a medieval city (Baron Haussmann and the broad: boulevards would come later); "incredible filth lined the dark narrow streets, which were often not paved. There were few sewers and poor water supplies. An enormous amount of poverty, hunger, and misery" was present. Debtors' prisons still existed. Gas lighting arrived in the 182o•s, and railroads in the 183o•s.

The French Revolution had set out to abolish the hospitals, which were simultaneously prisons, asylums, and clinics, with inmates placed 4 and 5 to a bed, the sick and well together. It ended by improving them -- separating out the extraneous functions, enlarging them, founding new ones, setting up specialty clinics. In 1792 the revolutionaries had also closed down the medical school, but a law at the end of 1794 established a new one; one of its most significant features was that it united medicine and in a single faculty. In 1803 increased the course of medical studies to four years, and medical licensure was established. By 18o8 a bachelor's degree was a prerequisite for admission into medical school.

The history of the period is brilliantly recounted in Erwin H. Ackerknecht, Medicine at the Paris Hospital. 1794-1848. WZ 70 Al82m 196?

The involvement of American medical students in Parisian medicine is told in Oliver Wendell Holmes, "Some of rrry early teachers", pp. 420-40 in his Medical Essays 1842-1882. WZ 2?0 H752m 1891 Sir William Osler, "An Alabama student", PP• 1-18, and "The influence of Louis on American medicine", PP• 189-210, in his An Alabama student and other biographical essays. WZ 112 082s 1909 Tp, µ:; • f..-

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1783 American Revolution formally ended 1789 Storming of the Bastille; French Revolution begins 1793 Louis XVI executed; reign of terror begins Cholera epidemic in Philadelphia 1798 Malthus, Essay on Population 1799 Napoleon as First Consul 1803 First Lewis & Clark expedition 1804 Napoleon as Emperor Laennec describes peritonitis 1815 Waterloo; restoration of Louis XVIII 1823 Thomas Wakley founds The Lancet 1829 Daguerre introduces photography Andrew Jackson inaugurated President of the United States 1830 Louis Philippe, the "bourgeois king" of France Berlioz, Symphonie Fantastique 1831 Hugo, Hunchback of Notre Dame 1832 Stendhal, The Red and the Black 1835 Balzac, P~re Goriot 1836 The Alamo National Library of Medicine founded in Washington 1837 Queen Victoria's reign begins 1844 Dumas, Count of Monte Cristo 1845 Wagner, Tannhauser 1846 Years of the Irish famine begin 1848 Revolutions throughout Europe 1851 Napoleon III 1854 Crimean War 1859 City of Denver founded LOUIS 1787 - 1872

Pierre-Charles-Alexandre Louis graduated at Paris in 1813, spent 7 years practicing in Russia, where his despair over the impotence of medicine in a diphtheria epidemic convinced him of the necessity for further study. Returning to Paris, he spent the rest of his on the hospital wards. His principal works are his researches on tuberculosis (1825), based on 358 dissections and 196o clinical cases, and his work on typhoid fever (1829). He used statistical reasoning to show that blood-letting is of no value in pneumonia; he thought that the fallacies of an a priori theory can be thrown into relief by good statistics, and that statistics can sometimes be used as an instrument of precision in cases where other experimental methods are wanting.

Louis was a great clinician and teacher. He was the first, after Sir John Floyer (1707), to use the watch for timing the pulse. He was a great favorite with his American pupils (Holmes, Gerhard, the Jacksons, and others) and through them exercised a powerful influence on the advancement of medicine in the United States.

-- Adapted from Garrison LARREY 1766 - 1842

Jean Dominique Larrey was surgeon-in-chief to Napoleon, grand army, participating in 25 campaigns, 60 battles, and 400 skirmishes. He was wounded three times, he performed 200 amputations in 24 hours at Borodino, and he was the inventor of mobile ambulances for bringing first aid to the wounded on the battlefield.

Like Pari, he was adored by his comrades in arms for his good nature, courage, and humanity. In his will, Napoleon left 100,000 francs to "Larrey, the most virtuous man I have ever known." (This is in considerable contrast to his contemporary DUPUYTREN, the dictator of French surgery from 1815 to 1835, but "beyond any doubt the greatest French surgeon of his time" (Ackerknecht)).

Larrey was later a professor at the Ecole de H~decine Hilitaire at Val-de-Grace. One of his most interestinS works is his 4-volume Memoires (1812-7) which contains among other things the first account of trench foot. LAENNEC 1781 - 1826

The genius who really broke new ground was Renl~Thlophile-Hyacinthe La.ennec, whose Traite de l'auscultation mediate (1819) belongs among the great works which mark epochs in medicine.

"From the time of the book's appearance, the saw his task at the bedside change. The physician now began not only to observe, but to examine the patient••• Before La.ennec's time a physician's examination of his patient consisted entirely in observing his appearance, feeling his pulse, looking at his tongue, examining the urine•••Laennec made the greatest advance when, in 1816, he conceived the idea of indirect auscultation, which resulted in his invention of the stethoscope.

"By comparing the conditions present in the patient with the course of the disease and the lesions found at post-mortem examinations, Laennec created a series of entirely new and classical pictures of disease. lie was the first to describe emphysema•••pulmonary edema •••bronchiectasis. He described pneumothorax, and distinguished pneumonia from various kinds of bronchitis and pleuritis••• Before his time had merged them all under the term peri-pneu.monia, inherited from the ancients•••

"Laennec's greatest accomplishment was his description of tuberculosis•••He was the first to recognize that all varieties were but stages in one disease•••Clinically he demonstrated that the process usually begins in the apex of the lung, and that the various anatomical changes may be demonstrated b) means of stethoscopy•••He also recognized that tuberculosis in other organs ( and also scrofula) were varieties of the same general disease."

A second (and better arranged)edition of Laennec's treatise was published in 1826. He died in the same year, at 45, of tuberculosis.

-- Knud Faber, Nosography. WZ 59 F115n 1923 PINEL 1745 - 1826

Philippe Pinel came to Paris in 1778, after studying at Toulouse and . He became increasingly interested in mental diseases, and in 1793 was made physician at the Bicetre, where he unchained the insane. His Traite•••sur l'alienation mentale appeared in 1801.

His was the leading name in the Paris school during the early part of this period, and he was the teacher of many who followed him. He was an astute clinician; he differentiated the rheumatisms, he observed that scarlet fever was often transmitted by people suffering from sore throat, he realized the importance of psychological factors in the causation and cure of diseases, and he took a great interest in geriatric medicine. C0RVISART 1755 - 1821

Jean Nicolas Corvisart began his career as a surgeon and anatomist, but / , ~ when the new Ecole de Sante (later the Ecole de Medecine) opened in 1794 he was appointed Professor of Clinical Medicine.

His Maladies du coeur appeared in 1806. In it he described pericarditis, dilatation and hypertJq>hy, and diseases of the myocardium, valves, and aorta. He emphasized heredity as one of the prime causes of disease. In 1808 he published his translation and commentary on Leopold AUENBRUGGER's work of 1761 on percussion, and his propagation of this technique was his greatest accomplishment. Every case dying on his wards was autopsied.

Corvisart was of critical and skeptical mien, and especially as regards therapeutics. In 1804 he became personal physician to Napoleon; after 1815, he never again practiced. BICHAT 1771 - 1802

Marie-Francois-Xavier, Bichat began his medical studies at in 1791, and continued them under the surgeon and anatomist Pierre Joseph DESAULT at Paris in 1793. By 1798 Bichat was giving very successful private courses in anatomy and surgery, and during the next year, as physician at the Hotel Dieu, while continuously teaching, doing research, and taking care of patients, he produced his first great books. During one winter he performed 6oo autopsies. He died in 1802, at the age of 31, after a few days of acute illness.

His Traite" des membranes appeared in 1800 (by 'membranes' we are to understand 'tissues•). He saw the tissues as independent elements of organs, and as systems with common traits. He was an experimenter rather than an armchair physiologist, but he never used the . He was a great physiologist, but he believed that the laws of physics and chemistry were not applicable to the subject.

"Analyze with precision the properlies of living tissues; show that each physiological phenomenon ultimately derives from these properties; that each pathological phenomenon depends on their augmentation, diminution, or alteration; that each therapeutic phenomenon should effect their return to their natural state, from which they have deviated."

Bichat, Anatomie generale, 1801. . , "-,;,, ...

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