OUR MEDICAL DEBT TO FRANCE By GUY HINSDALE, M.D. WHITE SULPHUR SPRINGS, WEST VIRGINIA ET US not forget that we owe a of anesthesia by the vapor of hypnotic great debt to France in med- drugs he performed operations for her- ical achievement and the heal- nia and cataract. He cut for stone and —4 ing art. For centuries Paris has classified hemorrhage as arterial and been acknowledged as the artistic andvenous. Lintellectual center of Europe and in the Then came Ambroise Pare (1509- genealogy of American medicine and 1590). He was the most famous surgeon surgery we End that the French line is of his time. Trained at the Hotel Dieu, very strong. he was surgeon to Henry II, Francis II. One of the proudest possessions of Charles IX, and Henry III. He dis- the Academie de Medecine in the rue carded the use of boiling oil, or the red- Bonaparte is the corridor of celebrities hot iron, as cautery after amputation portraying in canvas and marble famous and reintroduced ligation for arterial Frenchmen who have advanced med- bleeding. Henry III thought so much of ical knowledge and surgical art. him, though he was a Protestant, that There have been trends in medicine he saved him in his palace during the as well as in sculpture, painting, and massacre of Saint Bartholomew. Pare science. A thousand years ago it was wrote a treatise on gunshot wounds, Bologna and Padua in Italy and before trepanning, and the ligation of arteries. that it was Salerno that afforded the He also advocated cold-water dress- best teaching. The British schools, nota- ings. This was about four hundred bly those of Edinburgh and London, years ago and in his memory one of were the first to attract students from the hospitals of Paris still bears his the colonies and these in turn estab- name. lished schools of medicine in Philadel- One of Pare’s classic remarks has phia and New York. A trend to the hos- come down the centuries: “Je le pansay pitals of Paris set in at the opening of et Dieu le guarit.”* That is a confes- the nineteenth century and continued sion of faith worthy of a truly great for nearly a hundred years. French man. Pare was the author of “Cinq physicians, teachers and research schol- Livres de Chirurgie,” Paris, 1572, ded- ars have left a deep impress on medi- icated to Charles IX, King of France. cine, and lest we forget the debt we Fhe introduction to this work has been owe, let us review some of their gifts reprinted in the original French and to us in the past. in English translation by Mr. W. B. But before the discovery of Amer- McDaniel, the talented librarian of the ica there was a great French surgeon, College of Physicians of Philadelphia. Gui de Chauliac, who wrote his “Chi- rurgia Magna” in 1363. Using a form * I dress him; God cures him. Very few copies of Pare's works are ex- you need, but they are not as easy to tant.* read as are printed books.” Pierre Joseph Desault (1744-1795) Corvisart’s great work. “Essai stir les was a surgeon to Hotel Dieu and La Charite and a teacher in the Ecole de Saute. His name has come down as hav- ing devised a bandage for fractured clavicle which held good for over a hun- dred years. In the Napoleonic era we find a star of the first magnitude, Jean Nicolas Corvisart (1755-1821). As a youth he visited the medical clinics of Paris and was so fascinated with what he saw that he determined to study medicine. His father disapproved ol this and is said to have thrown him out of the house. However, he got a place as male nurse at Hotel Dieu, the oldest hospital in Paris, where he came under the influence of Professor Desault and Desbois de Rochfort, whom he suc- ceeded at La Charite in 1788. Corvisart was a great teacher. He is said to have given an impetus to the study of pathological anatomy by dem- Maladies du Coeur et des gros vais- onstrating that the chief aim of medi- seaux,” appeared in 1806, and was dedi- cine should be not to elicit by sterile cated to Napoleon who had suggested curiosity what may be found post mor- the subject to the author, who was his tem. but to recognize the presence of personal physician. I he third and last diseases by appropriate signs. Dr. Halls edition of this work appeared in 1818, Dally in his interesting resume of the and really established Corvisart as the life of Corvisart* relates the story of a first cardiologist. By recovering the young pupil who came one day to La work of Auenbrugger on percussion as Charite and Corvisart rather brusquely a means of diagnosis he was able to dif- had asked him what he came there for. ferentiate between cardiac and pul- “To study,” replied the young man. monary disease and between functional “To study!” exclaimed Corvisart. and organic heart disease. He likewise “That is good, my young friend. Here distinguished hypertrophy from dilata- (pointing to the patients) are the books tion. Napoleon was so pleased with the renown of his chief physician that he * Transactions and Studies of the College made him a Baron of the Empire, an of Physicians of Philadelphia, April, 1940. officer of the Legion of Honor and a See also Doe, Janet: A Bibliography of the Works of Ambroise Pare. Univ, of Chicago Commander of the Order of the Re- Press, 1937. union. One of Baron Corvisart’s duties * Proceedings of the Royal Society of was to attend the Imperial Court and Medicine, London, March, 1941. on Wednesdays and Saturdays he was expected to attend the Emperor when became chief physician at Necker Hos- he rose and retired. He was always ad- pital where he made the discovery that mitted to his Imperial Majesty’s pres- immortalized him. It was a simple observation at the outset, but it had a marvelous and revolutionary effect on the diagnosis of diseases of the heart and lungs. From a simple cylinder of wood, which trans- mits sounds from the patient’s chest to the observer’s ear, it has been de- veloped into the binaural instrument without which we would now feel lost. Laennec’s description of the discov- ery of a new method of auscultation was published in 1819. He first used a ten inch solid cylinder of wood one and a half inches in diameter but im- proved it by boring it out lengthwise so as to transmit the sounds from the heart and lungs more perfectly than could be heard by the unaided ear. The original model allowed separation into two halves by means of a screw for convenience of carriage. It is very remarkable that such a ence even if he was in his bath. The great discovery as that of the stetho- two fell ont over advice given to the scope should have been suggested by Empress Josephine concerning some children at play listening at one end of family matters. Corvisart never gos- a log to the sounds conveyed from end siped and that was greatly to his credit, to end when scratching sounds are especially in such a court and in such made. terrific campaigns. Laennec wrote several monographs Corvisart had some wonderfid pu- and his name is associated with an pils, one of whom—-strange as it may atrophic form of cirrhosis of the liver, seem—was destined to transcend his due in many cases to alcoholism, ma- chief, brilliant though he was, and put laria or syphilis and associated with the entire medical world under obli- ascites. A statue of this famous physi- gation. cian and teacher stands in the cathe- Rene Theophile Hyacinthe Laennec dral square in Quimper, Brittany. (1781-1826) came from Quimper in Three medical societies named in Brittany, went to Nantes for study and Laennec’s honor have been founded on from there to Paris, where he Avon his this side of the Atlantic. One was es- doctor’s degree in 1804 at the age of tablished in Baltimore by Dr. Osler in twenty-four. He served under Corvi- 1899, but came to an end ten years ago. sart for three years. At La Charite he The second was organized in Toronto drew up a minute history of nearly four about ten years ago and has an active hundred cases of disease. He finally membership of 125. It includes the field of tuberculosis and sanatorium Then there was Jean Civiale (1792- treatment. 1867), who improved the operation of The Laennec Society of Philadelphia lithotrity. lie made urology his spe- was organized October 26, 1932, and cialty and his fame won him member- has continued with undiminished ac- ship in the Institut. tivity, worthy of the name it bears. About this time also came Alfred Three Americans are known to have Armand Louis Velpeau (1795-1867), been pupils of Laennec, Samuel George who was professor of clinical surgery Morton and John Bell, of Philadelphia, and anatomy and chief surgeon at La and John D. Fisher, of Boston. They Charite. He succeeded Baron Larrey all took an active part in spreading his in 1842. and his bandage for fractured teaching in this country. clavicle became classic. In the Warren Anatomical Museum One of their contemporaries was of Harvard Medical School there is an Joseph Francois Malgaigne (1806- original Laennec stethoscope, there de- 1865), who contributed a two volume posited by the will of the late Dr.