CHAPTER FOUR
THE MEDICALS
It is no trifle to be a medical student in Paris.
—OLIVER WENDELL HOLMES
I
Like all great cities, Paris was a composite of many worlds within, each going about its particular, preoccupying ways quite independent, or seemingly independent, of the others. As notable as any of these worlds, and of far-reaching importance, was Paris Médicale, the Paris of numerous hospitals and illustrious physicians, of medical technicians, nurses, interns, and patients numbering in the many thousands; a celebrated medical school, the École de Médecine, and several thousand students from every part of France and much of the world.
This, too, was Paris—their Paris for those caught up in it— unmistakably different from fashionable Paris, or political Paris, intellectual Paris, financial Paris, or the visitor’s Paris, not to say the Paris pictured in the minds of so many who had never been there, or the Paris of the desperately poor.
The population of medical Paris equaled that of a small city, and included every variety of humankind, virtually every known ailment and affliction, much suffering—suffering sometimes relieved, often not—and a constant presence of death. Much about the standard procedures in the hospitals and surgical amphitheaters was, to the uninitiated, revolting, and among some of the celebrated performers of such procedures, professional rivalries and jealousies flourished as much as within any opera company.
It was not a closed world. Visitors were welcome to nearly all of it, and more often than not what they saw, the dedication and kindness of the nurses, the orderliness and scale of the care given, seemed everything that could be desired. As a place to learn, it had no equal, and with all its components it was as proud an achievement as any Paris could claim.
Largest of the hospitals was the Hôtel Dieu, an immense five-story pile of a building that stood by Notre-Dame on the Île-de-la-Cité—on the square, or parvis, of Notre-Dame (to the right as one faced the cathedral), its back to the Seine. Founded in 1602, it was the oldest hospital in Paris and possibly in all Europe. Its only claim to architectural distinction was an entrance foyer with Doric columns approached by a broad three-sided stone stairway. An annex nearly as large as the main building stood directly behind, on the other side of the river, the two buildings connected by a covered bridge.
This one hospital, with 1,400 beds, served more than 15,000 patients a year, and as in all Paris hospitals, patients were treated free of charge.
Second in size of the general hospitals and more beautifully situated was the Hôpital de la Pitié, which faced the Jardin des Plantes, a short distance away on the other side of the Seine. It had 800 beds, and while the Hôtel Dieu was considered preeminent in surgery, La Pitié was known for its clinical medicine and particularly for the treatment of diseases of the chest such as tuberculosis.
The Hôpital de la Charité, also on the Left Bank, was half-again smaller and timeworn in appearance, but much on a par with the other two and distinguished by several acclaimed physicians especially popular among the medical students. La Charité stood on the narrow rue Jacob, almost directly across the street from one of the most important historic sites in American history, the Hôtel d’York, where in 1783, Benjamin Franklin, John Adams, and John Jay had signed the Treaty of Paris that officially ended the Revolutionary War. But few of the American medical students seemed aware of this.
The Hôpital des Enfants Malades, on the rue de Sèvres, was the first children’s hospital in the world. The immense Hôpital de la Salpêtrière, founded originally for beggars in the seventeenth century and built on what had been a site for making saltpeter, was an asylum for indigent and deranged women. For indigent and deranged men, there was the larger Hôpital de Bicêtre on a hill well to the south. The Hôpital Saint-Louis, in the northeastern part of Paris, had been built by King Henry IV to combat the plague. A handsome complex of brick and stone pavilions with the look of a château, it served now as a hospital for diseases of the skin, the first of its kind anywhere.
In the single year of 1833, the year following the cholera epidemic, a total of twelve Paris hospitals provided treatment for 65,935 patients. In Boston, by comparison, the Massachusetts General Hospital and the McLean Hospital together cared for fewer than 800 patients.
The Hôtel Dieu, La Pitié, and La Charité, all within walking distance of each other, in combination with the nearby École de Médecine, formed the heart of medical Paris. Here, at these three hospitals primarily, as well as the medical school, the great luminaries of French medicine, many of international reputation, held forth in the lecture halls and allowed students to accompany them as they made their rounds of the patients in the wards.
Auguste-François Chomel was a leading clinical physician whose bedside comments during his morning rounds at the Hôtel Dieu attracted a large following. Guillaume Dupuytren held the supreme position of chief surgeon at the Hôtel Dieu. Alfred-Armand-Louise-Marie Velpeau, who lectured at La Charité and the École de Médecine, wrote the treatise on surgery used by most students and was considered a surpassing example of a man who by merit and hard work had risen from obscure beginnings to the forefront of his profession. Velpeau, as everyone knew, was the son of a blacksmith.
Philippe Ricord was a noted specialist in syphilis and one of the few medical professors who spoke English. Gabriel Andral lectured at the École on internal pathology and, in the view of many students, was the most eloquent professor of them all. Pierre-Charles-Alexandre Louis, though neither eloquent nor especially popular, was to have the greatest influence on the American students. Louis stood foremost in insisting on evidence—facts—as essential to diagnosis and was greatly admired as the best man in Paris with a stethoscope.
Compared to the hospitals, the magnificent École de Médecine on the rue de l’École de Médecine was brand-new. Its cornerstone had been laid in 1776, less than sixty years earlier. It was neoclassical in the grand manner, and enormous. Its central amphitheater for lectures seated nearly a thousand. There were exhibits, a library, everything open to all.
A public institution, the École was a showpiece of French education. In the time since the Revolution of 1789, opportunities for a medical education had been made available to a degree unimaginable earlier, the profession of medicine opened to all qualified young men irrespective of wealth or background. The social position of one’s family no longer mattered, as the surgeon Velpeau’s career testified.
In the spirit of opening wide the door, French, not Latin, had been made the language of instruction. A college education, or equivalent, was required for admission, as was not the case at American medical schools, but foreign students at the École did not have to meet this requirement. Further, for foreign students, including Americans, there was no tuition. For them, as at the Sorbonne, the lectures were free.
Nothing in the United States remotely compared to the École de Médecine. Medical education in America at the time was barely under way. There were still, in the 1830s, only twenty-one medical schools in the United States, or on average not even one per state, and these were small, with faculties of only five or six professors. Most aspiring physicians in America never attended medical school but learned by apprenticing themselves to “respectable” practitioners, most of whom had been poorly trained. In his novel The Pioneers, Cooper described the medical apprenticeship of a character named Elnathan Todd, said to have been based on a real-life doctor in Cooperstown. Though the setting of the story was earlier in the nineteenth century, and the portrayal a bit exaggerated, the education for “doctoring” had improved little in many parts of the country.
[At about age eighteen] the lad was removed to the house of the village doctor, a gentleman whose early career had not been unlike that of our hero, where he was often seen, sometimes watering the horse, at others watering medicines. … This kind of life continued for a twelvemonth, when he suddenly appeared at meeting in a long coat … and a few months later was called for the first time in his life, Doctor Todd. …
At the École de Médecine, a faculty of twenty-six delivered lectures on Anatomy, Physiology, Physics, Medical Hygiene, Medical Natural History, Accouchements (birth), Surgical Pathology, Pharmacology and Organic Chemistry, Medical Pathology, Therapeutics, Pathological Anatomy, Operative Surgery, Clinical Surgery, Clinical Medicine, Clinical Midwifery, Diseases of Women and Children, and Legal Medicine.
Enrollment was as high as 5,000 students, or approximately twice the number of students then in all medical schools in the United States. The American students at the École in the 1830s and ’40s were but a tiny part of enrollment, numbering only 30 to 50 annually.
For those American students newly arrived in Paris, the prospect of entering such a world was exciting and unnerving, quite apart from the considerable problem of language. Some hesitated, putting it off as long as possible, knowing, as one wrote, it would be a “new world from the circle of which it will be difficult to escape when once I am in it.”
But then once “in it,” most of them wanted only to stay longer than they originally intended. During his first days, Ashbel Smith had stressed in letters home that his “attachment” to America could never be diminished, and that he had every intention of returning soon to North Carolina. Within a month, he was confiding to a cousin, “I dislike to fix the time of my departure. I shall protract it as long as possible.”
James Jackson, Jr., who had left Paris for the British Isles after serving in the cholera wards, was, when he returned in the fall of 1832, jubilant to be back. Nothing he had seen in the hospitals of London, Dublin, and Edinburgh had caused him to reconsider his high opinion of medical Paris. The grandeur of the École, he felt, was the grandeur of great minds. A lecture he attended, soon after his return, was the most thrilling he had ever heard. “The glory of the week has been Andral’s introductory lecture on diseases of the brain,” he wrote to his father. “What powers of mind and vastness of comprehension has this man!”
Jackson’s Boston friend Mason Warren, one of the new arrivals, would describe himself later as having been “a perfect ignoramus” in the life of the world into which he was entering, and feeling “quite overwhelmed.” With Jackson and another Bostonian, Henry Bowditch, Warren had found a place to live on the narrow, upward-sloping rue Monsieur-le-Prince. Shortly after, Wendell Holmes moved in on the same street near the top of the rise. Holmes described his room on the uppermost floor of a five-story house as having three windows and a view, a tile floor, and a “very nice” green carpet. The furniture included a bed, a marble-topped bureau, a mahogany table, two mirrors, two armchairs, and an ink stand, all of which cost him 40 francs a month, or about $8, which was average. A “little extra” went to the porter who woke him in the morning, made the bed, washed his clothes, and polished his boots. With the apartment only a few blocks from the École and his route on the rue Monsieur- le-Prince all downhill, Holmes found he could make it to his first lecture in under four minutes door-to-door.
At the request of his physician father back in Boston, Mason Warren described what constituted a typical day, once he was seriously embarked.
I commonly rise a little after six. The servant comes in every morning to wake me and light my candle. From 6 until 8 I attend Chomel at Hôtel Dieu, a man at present very celebrated for his knowledge of diseases of the lungs. At 8 Dupuytren commences his visit which lasts an hour, that is till 9, and he afterwards lectures and has his consultations and operations, which occupies the time until 11. I then breakfast. …
Breakfast over, he attended a lecture on surgery, followed by another on surgical pathology until four o’clock. Dinner was at five, evenings occupied with “reading, etc.,” and lessons in French from a private tutor.
Warren was an openly affable young man whose company everyone welcomed. It was said conversation never languished in his presence. He was always agreeable, remembered Henry Bowditch. “No one ever heard aught against him.” Unlike Bowditch and most of the other Americans, Warren had come to Paris to concentrate on surgery, which, given his family background, was what everyone expected. As Holmes would write, he “never for a moment lost sight of his great objective—to qualify himself for that conspicuous place as a surgeon which was marked for him by the name he bore. …” That Warren had attended Harvard only three months before proceeding with his professional training, first at home under his eminent father, then at the Harvard Medical School, also distinguished him from others of “the medicals,” as they were called.
Students at the École de Médecine chose “lines of study” in either general medicine or surgery, and while they all attended lectures in both as part of their training, and made the rounds of the hospitals with both physicians and surgeons, those training in surgery followed a different curriculum. Thus Warren’s schedule had little resemblance to that of his friends Jackson, Bowditch, and Holmes, none of whom aspired to be surgeons. Indeed, he rarely saw them, other than for an occasional meal, even though they all lived next door to one another.
Warren was a slender, blue-eyed twenty-one-year-old. In a pencil drawing done by a fellow student named Robert Hooper, he is distinguished by a full head of hair, a thin cigar clenched in his teeth at a jaunty angle, and just a suggestion of the fancy attire for which he was known. Dressing to the nines was his nature, something inherited from his father. As a friend of the family would write, “He was, in truth, one who must have everything handsome about him, and … [he] was not slow to avail himself of the opportunities which Paris afforded for the adornment of his person. …” He liked especially bulky coats that made him look less slender, more manly, and whatever the season, his coats and trousers were “irreproachable,” his shirts, “exquisite,” each of his several waistcoats, “a separate triumph of varied color and design.” The considerable running cost of such a wardrobe seems not to have distressed his father in the least.
Poor health, mainly digestive problems, had troubled Warren much of his life—it had been the reason for his leaving Harvard after only three months as an undergraduate—but since arriving in Paris, except for some troubles with his teeth, he had never felt better. Perhaps a regimen that allowed for only two meals a day had something to do with it. (His father had urged him to eat sparingly.) Or possibly, such miseries as he saw daily in the hospitals made any complaints of his own seem scarcely worth mentioning. Or it could have been that the combined excitement of his studies and just being in Paris on his own, far from his father, gave him a therapeutic lift.
As a student, Warren was not on a level with James Jackson—but then no one was—and he was slower than others taking hold of French. He could make himself understood well enough “in regard to the necessities of life,” as he said, but in conversation felt “entirely lost.” Still, he was uncommonly self-disciplined.
As the son and grandson of famous surgeons, Warren had long known how much was expected of him. Like James Jackson, he was obliged to report regularly to his father. It was not just that John Collins Warren cared greatly about the well-being and professional progress of his distant son, but that he insisted on being kept continuously apprised of all that was new and innovative in surgical practice abroad. “Observe operations. Get as near as possible,” insisted his father, who had himself studied in Paris thirty years earlier. “Send me without delay every new book containing anything important. …” These were directions not to be taken lightly.
Like James Jackson, Warren provided his father with a detailed, running chronicle on how he was making use of his time, the procedures he was observing, his professors and what he thought of them, the books and professional journals he was reading. His letters, written in a strong, generally clear hand, customarily ran five to eight pages. In this way, as time passed, he would contribute the fullest, most descriptive of the many accounts by Americans of student life in the medical world of Paris.
II
Inside the ancient Hôtel Dieu, the long wards were each like the great hall of a castle, with rows of beds down both sides numbering nearly a hundred—a striking scene for anyone seeing it for the first time. The waxed oak floors were polished to a high gloss. All was quite orderly. Each of the beds was enclosed with its own white curtains, and high on the walls above each bed, a good-sized window provided ample light and ventilation. Even with as many as 1,200 patients in the hospital, it did not feel crowded.
Scores of Sœurs de la Charité, nuns of the order of Saint-Augustin wearing large white caps, went briskly about their tasks as nurses. Accounts by the Americans frequently express appreciation for “those excellent women,” their skill and kindness. Seeing one he knew while walking with another student, James Jackson exclaimed, “There is a face I dearly love to look upon.” Through the time of the cholera he had been witness to her unfailing devotion to the sick and the dying.
For students, the great advantage of study in a hospital of such size was in the number of sick and wounded of all descriptions, and thus in the number of different diseases and ailments to be observed firsthand. They might attend a physician’s examination of half a dozen or more cases of tuberculosis, say, not just one or two, or any of a dozen other maladies as well. Over a period of a few months, a student might take part in the examination of as many as fifty cases of tuberculosis. In the United States, in all but a few medical schools, no experience of any kind in hospitals was required of students.
The first rounds of the wards began at six in the morning, before dawn. They were conducted by candlelight, and when led by one of the more eminent physicians, attended by as many as two-or-three hundred students, which for most made it nearly impossible to get near enough to the beds to see much. To the Americans the French students seemed inordinately eager to get as close as possible, and competition for a vantage point could be fierce. James Jackson described how on more than one occasion he had worked himself up to the bedside, determined to take part in the examination, only to find that when he went to put his ear to the patient’s back, “a French head would slip between mine and that same back.” And this, Jackson hastened to add, would be accomplished always with an ever-ready “Pardon, Monsieur!”
Wendell Holmes would remember students piling up on the back of the chief surgeon, Baron Guillaume Dupuytren, in an effort to see as he bent over a patient, to the point where he would “shake them off from his broad shoulders like so many rats and mice.” (With his remarkable facility with language, Holmes had from the start little or no trouble understanding what was said in the lectures, and within a year was taking notes in French.)
Dupuytren, one of the medical giants of France, let no one doubt he was the reigning presence in the Hôtel Dieu. He was handsome, squarely built, and intimidating. A former battlefield surgeon, he had been made a baron by Napoleon. Clad in his long white apron, he marched heavily through the wards like “a lesser kind of deity,” it seemed to the diminutive Holmes. He had the flushed face of a bon vivant and reputedly spent most nights at one of the better gambling houses at the Palais Royal. The state of his mood at the start of each morning, his students alleged, was the sign of whether he had won or lost the night before. Many mornings his temper was vile.
But to see Dupuytren at work with scalpel in hand was to witness a great performance. He talked the whole time he worked and loved to “make a show.” To the French, it seemed, everything was theater—un spectacle—even surgery.
Mason Warren watched as Dupuytren, working by candlelight, removed cataracts from the eyes of several patients, and from another, a tumor of the tongue the size of a peach. He saw Dupuytren extract gallstones from the bladder of a child, and perform the operation for an artificial anus for which he was also famous. “His operations are always brilliant and his diagnosis sometimes most wonderful,” Warren wrote. “He is always endeavoring to convince us that he is a great man. …”
Warren attended as well the lectures and operations of surgeons Philibert-Joseph Roux at the Hôtel Dieu and Jacques Lisfranc at La Charité, both known for their skill at amputation. He thought Lisfranc’s removal of toes and fingers “very neat and rapid.” He saw Lisfranc remove a cancerous penis “with one stroke of a large amputating knife.” Another day, he observed Roux amputate an arm from one patient, then a leg from another.
Surgeons were known for their steady, quick, dexterous hands. Theirs were the hands of an artist, it was said. To watch them was not simply a matter of seeing how it was done, but beholding an artist at work, and the work, one was told, must be done in the words of the ancient motto, cito, tuto, and jucunde—quickly, surely, and agreeably.
That the eminent Dupuytren and the other surgeons used no anesthetics or bothered ever to wash their hands before proceeding, or sterilized their instruments, was not recorded or remarked upon by Mason Warren and others for the reason that no one as yet knew anything about such precautions.
Nor did Warren write of the screams of the patients.
The attitude of several of the French surgeons toward their patients did, however, trouble Warren and others considerably. The show of professional sangfroid seemed overdone. Lisfranc’s operations were performed in a “kind of off-hand way,” it seemed to Warren, “depending entirely on the state of the disease for the extent to which he carries them. I have seen him work away on a cancer of the eye, chiseling the bones of the head, till I expected every instant to see part of the brain make its appearance.”
Lisfranc was a phlebotomist, a great believer in drawing blood. On one occasion Wendell Holmes saw him order that ten or fifteen patients be bled. (The Hôtel Dieu maintained a ready supply of leeches for the purpose and a full-time keeper-of-leeches was part of the staff.) To Holmes, Lisfranc was little more than “a great drawer of blood and hewer of members.”
Too often it seemed the surgeon’s primary motivation was the desire to operate, with little or no consideration for the patient. Philibert Roux had insisted in carving open an old man for a tumor of the shoulder, and the patient died only an hour later. “Without it he would probably have lived five or six years longer,” Warren wrote. How much of the surgery practiced, he wondered, was intended more “to perform an operation beautifully and quickly” than to save a life?
By Warren’s estimate more than two-thirds of those upon whom amputations were performed died afterward. In fact, most patients who survived surgery of any kind at the hands of the most skilled surgeons later died and nearly always of infection. The work of the French chemist Louis Pasteur on the role of bacteria in the spread of disease and that of the English physician Joseph Lister in antiseptic surgery were still in the future.
Even the best of the surgeons seemed to have no feelings for the patient. They could be rough and ill-tempered. For outright physical brutality to a patient, “the great Guillaume Dupuytren” had no equal.
If his orders are not immediately obeyed, he thinks nothing of striking his patient or abusing him most harshly [Warren wrote]. A very favorite practice of his during his consultation is to make a handle of the noses of his patients. Whenever a man enters with any disease of the head, he is immediately seized by the nose and pulled down onto his knees where he remains half in sorrow and half in anger at the treatment until he is allowed to rise and describe his disease.
The open, often vociferous enmity between some of the surgical prima donnas also came as a surprise to the Americans, and those like Jackson and Warren, who had been raised in the medical profession, found this disgraceful. It was said the tongues of the faculty were more cutting than their scalpels. Lisfranc in particular could hardly deliver a lecture without attacking the reputations of Dupuytren, Roux, or Velpeau.
At six feet, Lisfranc was taller than most men and had a voice like thunder. He wore a rusty black-and-red cap and baggy trousers that flapped in the wind as he rounded the front gate into La Charité. “In his lectures he speaks with that loud style and gesture used by our stump orators,” Warren reported to his father. When angry, he would let fly with “a tremendous volley” of foul language. “When any other man’s ideas come into collision with his own, he gives him no quarter, but lavishes upon his opponent every epithet of abuse that the language affords. …” His most savage invective he saved for Dupuytren, his former teacher and idol, whom he customarily referred to as “le brigand,” the highway robber, or worse.
Crude and unpleasant as all this could be, no student had cause to complain of dull lectures or that any of the faculty were below standards. The great Dupuytren was indisputably the greatest French surgeon of the time. His lectures were spellbinding. It was he who named the contraction of the palmar fascia of the hand, which is still known as “Dupuytren’s contracture.” Alfred Velpeau was to become increasingly popular with the American students, not just because of his celebrated rise from humble beginnings, but because he took an interest in them. In later years, Holmes, recalling Velpeau’s origins and ability, said “a good sound head over a pair of wooden shoes is a good deal better than a wooden head belonging to an owner who cases his feet in calf-skin.”
In addition to the quality of the hospitals, the number of patients, the ability and eminence of the faculty, and the variety of instruction provided, medical training in Paris offered two further important advantages over medical training in the United States. Both had almost entirely to do with the difference in how people saw things in the two countries.
The first was that students making the rounds of the wards in the hospitals of Paris had ample opportunity to examine female patients as well as men. This was not the case in America, where most women would have preferred to die than have a physician—a man—examine their bodies. It was a “delicacy” nearly impossible to surmount, and as a consequence a great many American women did die, and young men in medical training in America seldom had any chance to study the female anatomy, other than in books.
In France this was not so. “The French woman, on the contrary, knows nothing at all of this queasy sensibility. She has no hesitation, not only to describe, but to permit her physician to see every complaint,” wrote a Philadelphia surgeon named Augustus Gardner, who came to observe medical practice and training in Paris. “In this respect therefore the Paris educated physician enjoys superior advantages to the homebred man.”
The second great difference was in the supply of cadavers for dissection. In the United States, because of state laws and public attitude, dead bodies for medical study were hard to obtain and consequently expensive. Until 1831, trade in dead bodies in Massachusetts had been illegal, which led numbers of medical students of earlier years, including Mason Warren’s father, to become grave robbers. The new Massachusetts law permitted only the use of corpses buried at public expense, which meant mainly the bodies of those who died in prison. New York, too, had such a law and other states—Connecticut, Maine, New Hampshire, Illinois, Tennessee— would follow. In the South it was the general attitude that, with the consent of the slave owner, the body of any slave could be dissected.
In Paris there was not the least prejudice against dissections. Even mortally ill patients in the hospitals, “aware of their fate,” and knowing that two-thirds of the dead were carried off to the dissecting rooms, did not seem to mind. Beyond the hospitals, due in large part to the ravages of disease and poverty, cadavers were readily available and cheap—about 6 francs for an adult, or $2.50, and still less for a child.
John Sanderson, after taking a room in the Latin Quarter, where he was “living a kind of student’s life” near the hospitals, described seeing carts “arrive and dump a dozen or so of naked men and women, as you do a cord of wood upon the pavement,” these to be distributed to the dissecting rooms.
Delivery time for corpses at the Amphithéâtre d’Anatomie, on the rue d’Orléans near the Hôpital de la Pitié, was at noon. Wendell Holmes wrote of how he and a Swiss student split the cost of their “subject” and by evening had “cut him into inch pieces.” Thus could all parts of the human body—nerves, muscles, organs, blood vessels, and bones—be studied, and this, Holmes stressed, could hardly be done anywhere in the world but in Paris.
The size of the stone-floored amphitheater was such that 600 students could practice operations at the same time. The stench in the thick air was horrific. The visiting Philadelphia surgeon Augustus Gardner left a vivid description of the scene.
Here the assiduous student may be seen with his soiled blouse and his head bedecked with a fantastic cap. In one hand he holds a scalpel, in the other a treatise on anatomy. He carries in his mouth a cigar whose intoxicating fumes, so hurtful on most occasions, render him insensible to the smell of twenty bodies decomposing, putrefying around him. … Here, too, is the learned professor, who thus prepares himself for a difficult operation by refreshing his anatomy; and thus rehearses his part in the tragedy to be acted on the morrow. The blood and pieces of flesh upon the floor he regards as the sculptor does the fragments of marble lying round the unfinished statue.
Disposal of the discarded pieces was managed by feeding them to dogs kept in cages outside. In summer, dissecting was suspended, because in the heat the bodies decomposed too rapidly.
For all that was so morbidly unpleasant about work at the dissecting tables—the stench, the smoke—it was far better, every student came to appreciate, that they practice on the dead than on the living. If the work was laborious, they had chosen a laborious profession. For any of the Americans to have given up and gone home would have been easy enough, but there is no evidence any of them did.
The “medicals” found their Paris quite as inspirational as would the Americans who came to write or paint or study or imbibe in ideas in other fields. In Paris they felt the exhilaration of being at the center of things, as Wendell Holmes tried to convey to his father:
I never was so busy in my life. The hall where we hear our lectures contains nearly a thousand students and it is every day filled to overflowing. … The whole walls around the École de Médecine are covered with notices of lectures. … The lessons are ringing aloud through all the great hospitals. The students from all lands are gathered. …
“Not a day passes,” declared James Jackson, “that I do not gain something new in itself or something old with renewed force.”
Of great importance, in addition to the hospitals and the lectures, was the library at the École with its 30,000 volumes. (By comparison, the library at the College of Physicians and Surgeons of New York City had all of 1,200 volumes. The library at the Harvard Medical School had fewer still.) There were, besides, the world-renowned exhibits and lectures nearby at the Musée d’Histoire Naturelle at the Jardin des Plantes. One enthusiastic medical student, Levin Joyce from Virginia, likened the museum at the Jardin to a great buffet banquet of knowledge. “What a feast is here presented …!”
“By the blessing of God you shall never have reason to repent that you have sent me here,” a grateful Henry Bowditch wrote to his parents. Like Warren, Holmes, and numbers of other medical students, Bowditch was making a point to attend lectures at the Sorbonne as well.
Bowditch had embarked on a medical career far from sure it was right for him. He entered Harvard Medical School with feelings of doubt mixed with repugnance at the thought of some of the elementary work necessary. The change had begun when an instructor in anatomy at Harvard showed him, during a dissection, the arrangement of muscles in a forearm.
Bowditch was another of those with an illustrious father. He was the son of Nathaniel Bowditch, the self-taught astronomer and mathematician who in 1802, after sailing much of the world, had published The New American Practical Navigator, which made his name known everywhere. A well-mannered, intelligent-looking young man with an active sense of humor, he worked hard and caught on quickly. Any squeamishness he may have felt about exercises in dissection had long since disappeared. Finding at the end of a day at the dissecting table that there was more he wished to examine, he put a lung under his hat and walked out, past the guard at the door, all going well as he proceeded through the streets until he felt blood trickling down his face.
James Jackson’s friendship was a godsend to Bowditch. Jackson was the trailblazer, the guiding spirit, the one, they were all certain, destined to make a great mark in time to come. Jackson “devotes himself heart and soul to his profession,” he wrote. “I love him much.”
Jackson made sure Bowditch was headed in the right direction, stressing especially that he attach himself to Pierre Louis. Great as was Jackson’s admiration for the eloquent Gabriel Andral, he had come to idolize Louis as the “Master of the Age” in diagnosis. Jackson saw that Bowditch was introduced to Louis first thing and included in Louis’s rounds at La Pitié, which attracted a much smaller following than the rounds of more popular physicians. Where several hundred made the rounds with Dupuytren at the Hôtel Dieu, those with Louis at La Pitié might number fifteen at most, and Louis sensibly started later in the morning when the light was better.
When Holmes arrived in the spring of 1833, Jackson looked after him as well.
There was rarely a letup in the work, and never a shortage of additional opportunities to be pursued. “The days are so much occupied as to fly past almost like shadows,” wrote Mason Warren, for whom a greatly increased facility with French had made a world of difference. With so many fields of study open, he tried to pursue all he could. He attended lectures on syphilis, observed operations at the Hôpital des Vénériens. He went several times to the Hôpital des Enfants Malades to hear talks on whooping cough, measles, and chicken pox. The diseases of children presented “an entire new field for examination,” Warren wrote with enthusiasm. He sat in on lectures in chemistry at the Sorbonne. For a month he was engaged in “some very interesting experiments” on the intestines of dogs. He took up the study of skin diseases at the Hôpital Saint-Louis and followed with increasing interest the work of a German physician, Jules Sichel, in diseases of the eyes. “I was at a soirée at his house last night, at which there were four languages spoken,” he wrote to his father.
And, importantly, he enrolled in a private course of lectures given by a sage-femme, a noted obstetrician, Madame Marie-Louise La Chapelle, in which students learned to examine with their fingers the wombs of pregnant women and came to understand a great deal more than they ever had about labor pains and the birth of a child. Madame LaChapelle was held in the highest regard by her students. Bowditch was to say he learned more of “midwifery” from Madame La Chapelle in her private course than he had in three years at the Harvard Medical School. To Wendell Holmes she was a shining case in point of why women should not be excluded from a medical education.
Between times, Warren was making himself known among the medical booksellers, surgical-instrument makers, and the preparers of anatomical specimens to be found in and about the crooked side streets of the Latin Quarter. He was shopping mainly for his father. “I send you by ship sailing direct to Boston,” he wrote, “two boxes—a large one containing 50 to 60 specimens of morbid bones, some skulls … also the bones of the head separate.” “Will you tell me to what extent I am to go on in my purchases?” he asked another day. “I have already laid out eighty dollars for bones.”
On Sundays only, it appears, did Warren turn from work to the pleasures of Paris, when he, Jackson, Bowditch, Holmes, and others would cross the Seine to attend the opera or theater, and dine at their favorite Trois Frères Provençaux, where “full of warm blood, of mirth, of gossiping” (in Warren’s words), they delighted in soupe à la Ture or côtelettes à la provençale or any number of other spécialités as well as a favorite Burgundy.
Warren even departed from the usual professional content of his letters home to report that Taglioni’s performance in the ballet La Sylphide was wonderful beyond description. Another night, he attended a grand ball given by the most prominent American banker in Paris, Samuel Welles of Boston, in a mansion on the Place Saint-Georges, as brilliant an event as the young man had ever beheld. The host was the Welles of Welles & Company on the rue Taitbout, where Warren and the other Bostonians posted their mail.
One Sunday, Warren joined a great crowd gathered to watch a statue of Napoleon being placed atop the column in the Place Vendôme. Another day, at midweek, he sat in on a session of the Chambre des Députés, at which Lafayette was present looking very “sad on finding himself so entirely duped by the King.”
There is no doubt that if Lafayette had wished he could have been chosen president and established a republic [Warren informed his father]. Although at present he does everything in his power to show his devotion to the Republican party, he is looked upon by many of them with an evil eye.
Though the world of French politics impinged little on the day-to-day lives of the American medical students, some, like Warren and Holmes, made an effort to keep abreast of what was in the newspapers and the increasing “grumbles” over Louis-Philippe, and in part because they knew how great was the interest in all this at home. “There is a notion that the old gentleman, who is said to be a cunning fellow, has slackened a little in his zeal for the liberal principles,” wrote Holmes of Louis-Philippe. “The papers talk without the slightest ceremony about his defection from the principles of the Revolution of July.
The King is caricatured without mercy. If you have ever seen his portrait, you know that he has a narrow forehead and large fat cheeks. This has been ingeniously imitated by the outline of a pear—so that on half the walls of Paris you will see a figure like this [outline of a pear] done in chalk or charcoal. …
It was very likely, Holmes thought, that in the course of time the French would have a “sober revolution” and a republic.
To ease his mind from work and take a little exercise, Holmes liked to roam about “using my eyes to see everything life had to show.” He loved the broad paths and open sky of the nearby Luxembourg Gardens, and to walk by the Seine, where he felt closest to the essence of Paris. Just to stand on the Pont Neuf and gaze at the river, its passing boats and barges, was, he said, all the occupation one could ask for in an idle hour.
Bowditch preferred the Jardin des Plantes, where in good weather he walked mornings and evenings, often reading Virgil. Bowditch was the only one of the Bostonians known to have had a serious love affair in Paris, but then Bowditch was said to have been of an “impulsive, ardent, and romantic disposition.” His heart had been won by Olivia Yardley from England, who was finishing her education in Paris and lived nearby in the Latin Quarter.
The one hint that Holmes paid the least attention to the numerous young women of the Latin Quarter is a wistful little poem titled “La Grisette.” Whether he wrote it at the time or later is not clear.
Ah, Clemence! When I saw thee last
Trip down the rue de Seine,
And turning, when thy form had past,
I said, “We meet again,”
Thy latest image came
And only left to memory’s trance
A shadow and a name.
Another medical student, Louis Frazee from Kentucky, would later write in a book he published about his time in Paris that it was perfectly acceptable for a student to live on the most intimate terms “with his grisette in many of the hotels, without giving offense to the landlord or landlady.” A grisette could visit a young man’s room whenever she pleased, and stay as long as she pleased.
But of the many surviving firsthand accounts by American medical students, only one diary chronicles in brief but candid detail some off-hours carousing of a kind in which more than a few undoubtedly indulged but never mentioned in what they wrote. In the 1840s young Philip Claiborne Gooch of Richmond, a graduate of the University of Virginia, wrote in his diary in not very good French of countless hours at the billiard tables, of nights playing cards, and getting drunk on champagne and cognac. (In one such session, Gooch duly noted, he and a friend consumed a bottle of cognac each.) He wrote of visiting brothels and of vicious hangovers, but also of working diligently at the hospitals and his studies all the while.
Gooch took up with a grisette named Clementine, while a friend named Theodore favored another, Emeline, both of whom, it seems, were dancers. “I worked all day,” Gooch recorded in one diary entry, the rest of which he devoted to dinner and events following that evening.
I uncork the bottle of champagne. Theodore begins to eat. We drink. I take Emeline, who has the shivers, in my arms and put her on her knees. We kiss. We start to cry. They kiss. We kiss also. She says tu toi. I say tu … The familiar form. We are friends. The three bottles of champagne are empty. We are warm. The cognac flows. Emeline is drunk. We put her to bed. The three of us drink some more. Everyone goes to bed and—and—what follows …
The next morning he wrote, “We got up at 10. An enormous breakfast, and then each goes his way, the girls to the rehearsal at the Opera, me to the dissections, where I stayed until 4.”
Every morning the work resumed. “At 6 A.M. I go to the hospital and from that time to 6 P.M. I am, at least 8 hours, there in the wards … observing, writing … sometimes fifteen pages a day,” wrote James Jackson, who, by the spring of 1833, was spending nearly all his time working with Pierre Louis. But by then they were all under the spell of Louis, including Mason Warren, who said the effect on his friends had been enough in itself for him to make “great sacrifices” to spend six months under Louis’s instructions.
That summer of 1833, Warren’s father wrote to ask if he had “fixed the time” for his return home, but the young man felt he was hardly getting started.
III
Of the celebrated teachers and practitioners of the medical arts who held sway in Paris in the middle of the nineteenth century, none was so esteemed by the American students, or had such influence on them, as Pierre-Charles-Alexandre Louis. For twenty years and more he was to inspire American medical students as did no other French physician.
Louis did nothing for show. He was neither spellbinding nor flamboyant. He could never have filled the amphitheater at the École as did Gabriel Andral. He spoke quietly. Some thought him “dry.” Henry Bowditch would remember him as ill at ease as a teacher and awkward when lecturing. Yet he had a power. What set him off from the others was his clear-headed approach to the treatment of disease, his insistence on the need for analysis based on evidence, on “facts.” As Holmes said, he taught “the love of truth.”
Louis was in his forties. After completing his training in Paris, he had gone to Russia, where he practiced medicine for seven years. Since his return, he had given up general practice to devote himself to the study of disease. That he was married to the sister of Victor Hugo gave him, in the eyes of many of his students, an added importance.
He was known—and at times ridiculed—for his extended questioning of patients, his slow, careful examinations and endless note-taking. Seeing Holmes taking notes one morning during the rounds at La Pitié, Louis exclaimed, “Vous travaillez, monsieur. C’est bien ça!” (“You are working, sir. It is well, that!”)
He insisted on “exact observation,” by which he meant listening to what the patient had to say and listening carefully, methodically with the stethoscope, the instrument for the examination of the chest first introduced by the French physician René Laënnec in 1819. As Holmes would write, the stethoscope was “almost a novelty in those days. The microscope was never mentioned by any clinical instructor I listened to while a medical student.”
“The mind of this gentleman is not a brilliant one,” Henry Bowditch wrote of Louis.
It is an observing and calculating spirit, which examines with the utmost exactness the symptoms of disease at the bedside, weighs the different values of them under different circumstances. [Louis] is, in fact, what he wished to be considered, a careful observer of facts, and deduced from these facts laws which regulate disease.
Eagerly embracing the Louis approach, Holmes would spend upward of five hours a day sitting at the bedsides of patients, asking questions and filling his notebook.
Diseases of the chest were Louis’s main interest, and he had made tuberculosis, a leading killer of the time, his forte. At times Louis’s interest in the disease seemed greater than his interest in curing the patient, as even James Jackson conceded.
Tall and soft-spoken, Louis wore small spectacles on a long nose, and when not at the bedside of a patient, he moved swiftly through the wards. Holmes described him as a man of “serene and grave aspect, but with a pleasant smile and kindly voice.” Mason Warren would remember especially that when, after a long run of perfect health, he took ill for several days, Louis came to see him.
Like the surgeon Velpeau, Louis was partial to American students, and like Velpeau, he saw the promise of this particular group of Americans— Jackson, Warren, Bowditch, and Holmes. Jackson was the master’s favorite, and working with Louis during the cholera epidemic had left Jackson in even greater awe of him. He had come to think of Louis as a second father. And Louis, as he would later tell James Jackson, Sr., thought of James as a son.
Jackson had decided he must stay longer in Paris than originally planned. He wished, as Louis strongly encouraged him, to devote more time to science. He had found his mission in life. “In very truth I look forward with fear and trembling to the day when I must employ my time to earn money, instead of to learning truth,” he wrote in a long thoughtful letter to his father.
I once laughed when I was told the student’s is the happiest life. Persuaded as I am that there is very much in the exercise of our profession, that develops and satisfies the affections— that delights the moral man—yet I must acknowledge that had circumstances favored it, I should have been pleased to pass at least eight or ten years in the study of the sciences of pathology and therapeutics, in the hopes of establishing some important truths. …
We live indeed in darkness, and it costs more time to discover the falsity of pretended truth than it would perhaps to reach something truly valuable. … I believe that we admit many things in America as axioms, which are very far from being proved. We have too long believed that because demonstration on many points was impossible in medicine, it was not worthwhile to study it like an exact science. It is a very false position.
Louis wrote to Jackson’s father urging that James stay on in Paris several more years to concentrate on pathological research. But James
Jackson, Sr., though wholly sympathetic to his son’s desire, wanted him home. James was needed, he would explain in a letter to Louis. “We are a business-doing people. We are new. … Among us, where the hands are few in proportion to the work to be done, every young man engages as soon as he can in the business of life.”
It was settled. On July 13, 1833, James wrote to his father, “In two hours I am to be out of Paris. I will not attempt to describe to you the agony it gives me to quit Louis.”
Inspired by Louis and his approach, Bowditch decided to concentrate on diseases of the chest. “Thrice happy am I that I have trod French soil, and breathed a French atmosphere; have known Louis,” he wrote.
Enthralled with Louis’s scientific approach, Holmes felt as intellectually exhilarated as he had ever been and even more adamant about the value of all he had come to understand that he never would have had he remained at home. Here was the future of medicine. Were he asked why he would prefer the intelligent young man who had been studying in Paris to a venerable practitioner of the old school, Holmes’s answer would be this:
… because the young man has experience. He has seen more cases perhaps of any given disease. He has seen them grouped so as to throw light upon each other. He has been taught to bestow upon them far more painful investigation. He has been instructed daily by men whom the world allows to be its most competent teachers—by men who know no masters and teach no doctrine but nature and her laws, pointed out at bedside for those to own who see them, and for the meanest student to doubt, to dispute if they cannot be seen. He has examined the dead body oftener and more thoroughly in the course of a year than the vast majority of our practitioners have in any ten years … merely to have breathed a concentrated scientific atmosphere like that of Paris must have an effect on anyone who has lived where stupidity is tolerated, where mediocrity is applauded. …
In another letter, Holmes wrote, “I am more and more attached every day to the study of my profession and more and more determined to do what I can to give [to] my country.” To mark the end of his first year in Paris, he wrote still again in an effort to define what he felt he had accomplished thus far:
My aim has been to qualify myself so far as my faculties would allow me, not for a new scholar, [or] for a follower of other men’s opinions, [or] for a dependent on their authority, but for the character of a man who has seen and therefore knows, who has thought and therefore arrived at his own conclusions. I have lived among a great and glorious people. I have thrown my thoughts into a new language. I have received the shock of new minds and new habit. I have drawn closer the ties of social relations with the best formed minds I have been able to find from my own country. … I hope you do not think your money wasted.
His expenses, he told them, were $1,200 a year, for books, instruments, private instructions, everything. “I tell you that it is not throwing away money, because nine tenths of it goes straight into my head in the shape of knowledge.”
In the second week of April 1834, violence broke out in Paris in protest of the government. Barricades went up in the streets of the poorest quarters of the city, and in the “pacification” that ensued, scores of citizens were killed and wounded. In response to gunfire from a building on rue Transnonain, government troops broke down the door and massacred all within—12 men, women, and children—a scene of horror later depicted in a powerful lithograph by the caricaturist Honoré Daumier.
For days wheelbarrow loads of the wounded kept arriving at the hospitals, and the students had their first sight of gunshot and bayonet wounds. Mason Warren wrote of “one poor fellow” who had been hit by ten musket balls and a woman who had had part of her leg shot away. “Many of the dead were disposed in the morgue, some of them horribly slashed up.”
Then, only weeks later in May, came heartbreaking news that hit Holmes, Warren, and Bowditch as nothing had. For all they and others had been dealing with daily at the hospitals, all the diseases they had been exposed to, not one of them had been seriously ill during his time in Paris. Now came word that James Jackson, Jr., had died in Boston of typhoid fever.
Earlier that winter the news that Jackson was ill had caused much concern among his friends in Paris. “No one could excite a greater interest in our minds on all accounts,” Holmes had written to his parents. But the warning had in no way lessened the blow, nor was it felt by the Bostonians only. “I have seldom seen such a general feeling expressed on all sides,” wrote Mason Warren. Pierre Louis was “altogether overcome, quite unable to contain himself.”
As James Jackson, Sr., was to explain, his son had become actively involved with work at the Massachusetts General Hospital from the time he arrived home.
Our autumnal fever was prevalent much more than usual, and with uncommon severity. The opportunity to study this and to compare it with the fever of Paris, on which Louis had written so admirably, was one which he could not forego. And when he found that this disease exhibited in the living and in the dead the same characteristics, which his master had so accurately delineated, his ardor was increased more and more and he put all his powers to their greatest trial. It is not surprising, in the retrospect, that he became affected with the prevailing disease.
After weeks of severe illness and a slow convalescence, James appeared to recover, when suddenly he took a turn for the worse, his mind “gave way,” and he died.
“What shall I say of his ambition?” his father asked.
I think his young friends and associates will agree that he was not anxious for honorary distinctions. He had not such a spirit of emulation as leads one to study hard so that he may get the highest rank among his fellows. … But he had the strongest ambition to be worthy of the esteem and love of the wise and good. He rejoiced openly when he made an acquisition in knowledge.
That same month of May 1834 marked the death of Marie-Joseph-Paul-Yves-Roch-Gilbert du Motier, the Marquis de Lafayette. The legendary hero breathed his last on May 20, at age seventy-six, at his house on the rue d’Anjou, in the Faubourg Saint-Honoré. The day of the funeral, crowds of 200,000 or more lined the route of a long military procession to the Picpus Cemetery, where the interment in the family vault was private, as he had requested. In Washington, President Andrew Jackson declared a time of national mourning, and former president John Quincy Adams, now a member of the House of Representatives, read a lengthy tribute to the heroic friend of liberty.
For those Americans in Paris for whom Lafayette had been such a looming symbolic presence, it was an especially heavy loss. To many like Nathaniel Willis, who happened to be back in Paris briefly, the military funeral was a sham and a disgrace. “They buried the old patriot like a criminal. Fixed bayonets before and behind his hearse, his own National Guard disarmed, and troops enough to beleaguer a city, were the honors paid by the ‘citizen king’ to the man who made him!”
“They have buried liberty and Lafayette together,” another American told Willis gloomily. “Our last hope in Europe is quite dead with him!”
In the fall of 1834, Mason Warren noted the rising number of “fine young men” from New York, Philadelphia, and other parts of the United States who had lately arrived in Paris to take up their studies in medicine, adding proudly that among all the students, “the Americans stand as high as those of any nation who come here, and they are surpassed by none. …”
Early in 1835, Warren was pleased to report that Dr. Louis was delivering his lectures with increased facility and now had a “great crowd” of students following him. Louis had been discovered, and in large part because of the American students, and recognition of his “value” was to last for years to come. Acolytes like Warren, Bowditch, and Holmes would carry the word home to Boston and beyond—Bowditch was already translating into English one of Louis’s principal works on typhoid fever.
Bowditch departed for Boston in 1834, sooner than intended. He had sent a letter to his family announcing that he and his English love, Olivia Yardley, were engaged to be married. His father responded by telling him he must return home with no delay and alone.
Mason Warren departed in 1835. By then, except for a few side trips elsewhere in Europe, Warren had been in Paris nearly three years.
Holmes, who had been in Paris for more than two years, kept urging his parents to let him stay longer. The issue was money. He knew it would mean “hard squeezing” at home, but his cause was noble, he insisted. His pleading was to no avail. Reluctantly he sailed in the fall of 1835.
Meanwhile, more American students kept arriving, including another Bostonian destined for a distinguished medical career. George Shattuck began his studies under Louis (who thought so highly of Shattuck that he entrusted him with the translation of his text on yellow fever), and it was Shattuck in 1838 who encouraged Charles Sumner to join the “medicals” in their morning rounds at the hospitals as a part of Sumner’s self-directed, eclectic education.
Sumner, whose line of study at the Sorbonne included everything from the history of Greece to civil law to geology, welcomed the chance. At six feet two he loomed over everyone making the rounds and had no trouble observing.
Following Alfred Velpeau at the Hôpital de la Charité, Sumner saw “every kind of hurt, swelling, and loathsome complaint,” all observed with “an undisturbed countenance” by students and teachers. “Blessed be science,” he wrote, “which has armed man with knowledge and resolution to meet these forms of human distress!” What struck Sumner especially about Pierre Louis was the spirit with which he expressed his love of science.
The strong impression made by the hospitals and the French approach to medicine was to figure importantly in Sumner’s life to come. But of far greater future consequence was the impression made by something he observed at the Sorbonne.
On Saturday, January 20, 1838, as he recorded in his journal, Sumner attended a lecture at the Sorbonne on the philosophical theory of Heraclites delivered by Adolphe-Marie du Caurroy, a distinguished grey-haired scholar who spoke extremely slowly. Sumner began looking about the hall.
“He had quite a large audience,” Sumner wrote, “among whom I noticed two or three blacks, or rather mulattos—two-thirds black perhaps— dressed quite à la mode and having the easy, jaunty air of young men of fashion. …” He watched closely. The black students were “well received” by the other students, he noted.
They were standing in the midst of a knot of young men, and their color seemed to be no objection to them. I was glad to see this, though with American impressions, it seemed very strange. It must be then that the distance between free blacks and whites among us is derived from education, and does not exist in the nature of things.
It was for Sumner a stunning revelation. Until this point he is not known to have shown any particular interest in the lives of black people, neither free blacks nor slaves. On his trip to Washington a few years earlier, traveling by rail through Maryland, he had seen slaves for the first time. They were working in the fields, and as he made clear in his journal, he felt only disdain for them. “They appear to be nothing more than moving masses of flesh, unendowed with anything of intelligence above the brutes.” He was to think that way no longer.
It would be a while before Sumner’s revelation—that attitudes about race in America were taught, not part of “the nature of things”—would take effect in his career, but when it did, the consequences would be profound. Indeed, of all that Americans were to “bring home” from their time in Paris in the form of newly acquired professional skills, new ideas, and new ways of seeing things, this insight was to be as important as any.
Like so many, Sumner, too, wished he could stay longer in Paris. In the spring of 1838, with only a few days remaining, he wrote of his regret over “a thousand things undone, unlearned, and unstudied which I wished to do, to learn and to study.” But in another letter he added, “I have never felt myself so much an American, have never loved my country so ardently. …”
The flow of Americans to the “medical mecca” of Paris continued through the 1840s, and the same illustrious French physicians—Lisfranc, Velpeau, Roux, Louis—continued to make their rounds and deliver their lectures. The only one missing from the professional galaxy was Guillaume Dupuytren. On the day of his funeral, on the way to Père Lachaise Cemetery, students had unharnessed the horses from the hearse and dragged it themselves to the tomb.
Between 1830 and 1860 nearly seven hundred Americans came to Paris to study medicine, and nearly all returned home to practice their profession greatly benefited by what they had learned. And much of this they would pass on to others.
Considerable attention and respect were given to nearly every young Paris-trained physician on his return. What was said of Mason Warren could have been said for most of them. “Apart from all other considerations, the mere fact of his long absence in Europe caused a degree of importance to be attached to him, as in those days few of our countrymen traveled abroad. …” Inevitably some returned from Paris a bit too pleased with themselves, while others in the profession who had never left home belittled the whole idea of study abroad or were openly critical of French medicine.
Decades later, in the 1890s, William Osler, one of the founders of the Johns Hopkins Medical School and as respected a figure as any in American medicine, would write that “modern scientific medicine” had had “its rise in France in the early days of this century.” More than any others, it was the pupils of Pierre Louis who gave “impetus” to the scientific study of medicine in the United States.
Approximately seventy of those who had trained in Paris in the 1830s, or one out of three, later taught in American medical schools, and several ranked among the leading physicians in the nation. The Philadelphian William Gibson became chief of surgery at the University of Pennsylvania. A student from Salem, Massachusetts, Henry Williams, having discovered an interest in diseases of the eyes during his time in Paris, was made the first professor of ophthalmology at Harvard. George Shattuck became dean of Harvard Medical School. Furthermore, all contributed in other ways as well. Williams, as an example, wrote three books on diseases of the eyes that were considered the best of their time.
Henry Bowditch became a professor of clinical medicine at Harvard, where diseases of the chest remained his first interest, tuberculosis his specialty. In 1846, Bowditch published The Young Stethoscopist, a work used by medical students for half a century. His “greatest service,” however, was in the field of public health, in which he was to have more influence nationally than anyone of his day.
Mason Warren “gave himself at once” to a large and popular practice as a surgeon in Boston. On October 16, 1846, in the operating theater at the Massachusetts General Hospital, he was present for the historic moment when his father, John Collins Warren, at age seventy, performed the first operation ever in which ether, administered by a Boston dentist named W. T. G. Morton, was used as an anesthetic. Morton had been experimenting successfully with the use of sulfuric ether fumes as a way to make tooth extractions painless. When word of this novelty reached John Collins Warren, he decided to proceed with a public surgical demonstration. The removal of a tumor from the neck of a young man took five minutes. The patient felt no pain.
A month later, on November 12, 1846, Mason Warren himself performed the first successful operation under ether done in private practice, and the month following he employed ether for the first time during surgery on a child.
Wendell Holmes was the illustrious, beloved professor of anatomy at the Harvard Medical School for thirty-six years, and for part of that time, he served as dean of the school. His lectures on anatomy began promptly at one in the afternoon five days a week. “He was never tired, always fresh, always eager in learning and teaching it,” remembered one of his students.
Holmes’s writings on medical subjects drew professional attention nationally, but it was in his spare hours that he continued his literary pursuits, publishing poetry and essays, for which he was even more widely known. In 1857 he began a series of witty essays in the new magazine he had helped found, the Atlantic Monthly. The first of these, “The Autocrat of the Breakfast Table,” and a number that followed, published as a book, were to become an American classic, in which, among other things, Holmes defined Boston as “the hub” of the solar system and was the first to call Boston aristocrats Brahmins—a category he himself qualified for in every way except wealth.
Each of the three eminent Bostonians married and had children. Bowditch, after waiting patiently for several years, at last married his Paris true love, Olivia Yardley. Warren married Anna Crowninshield of Boston, and Holmes wed Amelia Jackson, a first cousin of James Jackson, Jr. The oldest of the three Holmes children, the eminent Oliver Wendell Holmes, Jr., was born on March 8, 1841.
Except for his two years in Paris as a student, Holmes lived all his life in or near Boston, but the immense importance of his Paris years may be judged by the fact that half a century later, in 1886, on the eve of his retirement from Harvard Medical School, having reviewed in his mind so much that he had seen and learned in his long career, he chose to talk about the remarkable French physicians under whom he had once studied in Paris. And Pierre Louis figured foremost.
“He had that quality which is the special gift of the man born for a teacher—the power in exciting an interest in that which he taught.”
You young men [Holmes continued] … hardly know how much you are indebted to Louis … I say, as I look back on the long hours of the many days I spent in the wards and in the autopsy room of La Pitié. …
Once, when Emerson referred to Pierre Louis in public as an example of French theatricality, Holmes wrote to him to say that while Louis had “assimilated to himself” many of the best and most industrious American students, there had been “nothing to keep them around him except his truthfulness, diligence and modesty in the presence of nature.” The “master key” to all Louis’s success, Holmes said, was “honesty.”
Yet, with the passage of years, Holmes wondered whether he and the other American students had “addicted” themselves too closely to the teachings of the master. He felt, Holmes said, “that I gave myself up too exclusively to his methods of thought and study.” As essential, as invaluable as was the study of specific diseases through close, scientific investigation, there had to be more to the physician’s comprehension and approach. There had to be concern for and some understanding of the patient. Medicine was a science to be sure, but also an art, “the noblest of arts.”
He had been thinking about this duality for a long time. In an introductory lecture at the medical school some years earlier, recalling the strengths of his first great teacher, James Jackson, Sr., Holmes had talked of Jackson’s kindness as one of his greatest professional strengths. He had always applied “the best of all that he knew for the good of his patient. … I never saw the man so altogether admirable at the bedside of the sick as Dr. James Jackson.”
Much that Holmes had come to value about his time in Paris had to do with what he had learned beyond Paris Médicale, by just being in Paris, living in Paris—so much of art, music, poetry, and of good conversation.
The same could have been said of Warren and Bowditch. For as long as they lived, they would remember the feeling of walking into the Louvre and of beholding its treasures for the first time, the thrill of the Paris Opera, of seeing Molière performed onstage, seeing Taglioni. This, too, they knew, had made them better prepared to understand the human condition and thereby better able to serve in their profession.
Bowditch’s son, Vincent, would write of his father, “He never allowed his interests in his patient’s case to hide the fact that he was dealing with a fellow human being.” When Vincent was himself about to leave for medical training abroad, Henry Bowditch told him:
While medicine is your chief aim, remember that I want you to see all you can of art and music. I often think I have done more good to some poor, weary patients by sitting down and telling them of a delightful European experience than by all the drugs I have ever poured down their throats.
Bowditch, Warren, and Holmes remained friends as well as colleagues for the rest of their lives, none ever forgetting they had Paris in common. After attending an address by Warren before the Massachusetts Medical Society, Holmes told him in a note that regrettably he had not been able to hear very well. “I suspect that my ear-drums may not be quite as tightly corded up as in the days when we saw our young faces in the Burgundy of the Trois Frères.”
Each of them would return to Paris as time passed, and in some cases more than once. Sometimes it was for their health—in the hope that just being there would provide the needed lift of outlook—and sometimes that worked. Mason Warren, who struggled with poor health all of his life, with the exception of his student years in Paris, returned three times. Suffering from depression, he made his first trip in 1844 and came home sufficiently “refreshed” to work steadily another ten years. He had revisited all the old haunts, as would both Bowditch and Holmes.
During his return in 1867, Bowditch discovered the same porter still on the job at his old lodgings in the Latin Quarter. “Found my old garçon, John, who remembered me well,” he wrote in amazement. He revisited the spot where he had first met Olivia Yardley and, as a highlight, dined with Pierre Louis, who was then eighty years old. Louis, Bowditch wrote, was “as beautiful in his old age as you can imagine a man to be.” Louis died five years later.
Holmes returned just once, in 1886, for what he called a Rip Van Winkle experiment. Like the others, he walked the rue Monsieur-le-Prince, his head filled with memories.
For all of them, to judge by so much that they wrote in later years, the life they had known as “medicals” in Paris had been what James Jackson, Jr., had said then—the happiest life.