THE GREATER JOURNEY AMERICANS IN PARIS David McCulloughCHAPTER FouR THE MEDICALS Itis no trife to be a medical student in Paris, OLIVER WENDELL HOLMES mistakably different from fashionable Paris, or political Paris, intel- ctual Paris, financial Paris, or the visitor's Paris, not to say the Paris pPictured in the minds of so many who had never been there, or the Paris Sl the desperately poor,104 + DAVID MecuLrouey hospitals and surgical amphitheaters was, tothe uninitiated, revo among some ofthe celebrated performers such procedures prof ‘valles and ealousies ourished as much as within any opera com Tewasnot a closed world. Visitors were weeome to neatly al ‘fit, tore often than not what they sav, the dedication and kindnesg of th jnutses, the orderliness and scale ofthe care given, seemed everything could be desired, Asa place to learn, it had no equal, and with all its 6 Ponents it was as proud an achievement as any Paris could claim, Largest of the hospitals was the Hotel Dieu, an iminense five pile of a building that stood by Notre-Dame on the Te-de-la-Cité—ani thd Square, or parvis, of Notre-Dame (to the right as one faced the cathedral its back to the Seine, Founded in 1602, and possibly in all Europe. Its only claim to architectural distinction 9 an entrance foyer with Doric columns approached by abroad three side Stone stairway. An annex nearly as large as the main building stood di a rectly behind, on the other sie of the river, the two buildings connected by acovered bridge, ‘his one hospital, with 1,400 beds; served more than 16,000 patent yeas and as in all Paris hospitals, patients were treated ftee of charge ‘ Second in size of the general hospitals and more beautifully situated: ‘was the Hépital dela Pitié, which faced the jardin des Plantes, a short dis jance sway on the other side ofthe Seine, It had Boo beds, and while the) Hotel Dieu was considered preeminent in. surgery, La Pitié was known for. its clinical medicine and particularly forthe treatment of diseases of the chest such as tuberculosis. ‘The Hopital dela Charité also on the Left Bank, was hal 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 dlitectly across the street from one of the most important histori sites in American history, the Hotel d’York, where in 1783, Benjamin Franklin, John Adams, and John Jay had signed the Treaty of Paris that officially ended the Revolutionary Wat, Bat few of the American medical students seemed aware of this, ‘The Hépital des Enfants Malades, on the rue de Sevres, was the frst fal de Bicétre on a hill well jmortheastern part of Paris, laguc. A handsome comp In the single year of 1833, ' Foal of twelve Paris hospital ABoston, by comparison, the {international reputation, held “dents to accompany them as t “Wards. — Auguste-Feangois Chomel side comments during his me large following. Guillaume Di © surgeon at the Hétel Dieu, A lectured at La Charité and th “surgery used by most student | ofa man who by merit and he to the forefront of his profess ofa blacksmith, Philippe Ricord was a no medical professors who spo Ecole on internal pathology most eloquent professor of though neither eloquent not {influence on the American saninitiated, revolting, and 1 procedures, professional ‘hin any opera company. jme to neatly all oft, and stion and kindness of the in seemed everything that all its com- qual, and wit Paris could claim. eu, an immense five-story + the Tle-de-la-Cité—on the as one faced the cathedral), the oldest hospital in Paris cchitectural distinction was ched by a broad three-sided .e main building stood di- two buildings connected he 4 more than 15,000 patients sere treated free of charge. ne! more beautifully situated ssdin des Plantes, a short dis- had Boo beds, and while the vy, La Pitié was known for ases of the - treatment of dise Bank, was halfagain s" 2 par with t the narrow rue J jost important ¢ in 1783, Benjamin Ft treaty of ie American medical st pe ru maller the other two and ans especially popular among jacob, almost storie sitesi rankli 7 ill avis that officially dents ode Sevres, was the fis THE GREATER JOURNEY + 105 children’s hospital in the world. The immense Hépital de la Salpétriére, 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 Hopital de Bicétre on a hill well to the south, The Hépital Saint-Louis, in the northeastern part of Paris, had been built by King Henry 1V to combat the plague, A handsome complex of brick and stone pavilions with the ook of a chateau, it served now as a hospital for diseases of the skin, the first ofits 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 Hotel Dieu, La Pitié, and La Charité, all within walking distance of each other, in combination with the nearby Ecole 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 stu- dents to accompany them as they made their rounds of the patients in the large following. Guillaume Dupuytren held the supreme position of chief surgeon at the Hétel Dieu. Alfred-Armand-Louise-Marie Velpeay, who _lectured at La Charité and the Ecole de Médecine, wrote the treatise on 0 he forefront of his profession. Velpeau, as everyone knew, was the son Of a blacksmith,106 + PAVID MecuLLouan oe pridenee—ficts—as essential to diagnosis and was geaty admired ag the best man in Paris with a stethoscope, Compared to the hospitals, the magnificent Ecole de Médecine onthe © rue de'Bcole de Médecine was brand-new. Its comerstone hd bess laid in 1776 less than sixty years ear was neoclassical in the grand mar net, and enormous. Its central amphitheater for lectures seated neatly a thousand, There were exhibits a library, everything open to all, ‘Atthe Ecole de Médeci A public institution, the Ecole wasa showpiece of French education, In _ > Anatomy, Physiology, Phy the tlme since the Revolution of 789, opportunities fora medical eaves Ee Accouchemonts (birth), 5 tion hed been made available to degree unimaginable cals; the profes, Chemistry, Medical Pathe sion of medicine opened to all qualified young men irrespective of wealth ‘erative Surgery, Clinical $ Diseases of Women and C Enrollment wasas hig number of students then i American students at the of enrollment, numbering For those American s entering such a world wa considerable problem of possible, knowing, as one of which it will be difficul been unlike that of ¢ times watering the “This kind of life cor denly appeared at m later was called for t the surgeon Velpeau’s career testified. In the spirit of opening wide the door, French, not Latin, hed been made the language of instruction. A college education, or equivalent, wae feaulted for admission, as was not the case at American medical schools, but foreign students at the Ecole did not have to mect 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 Ecole de ‘Médecine, Medical education in America at the time was barely under way: There were still, inthe 18305, only twenty-one medical schools in the United States, ot on average not even one per state, and those were But then once “in i," mos originally intended. Dutt letters home that his “atta and that he had every ir Within a month, he was « my departure. I shall prot James Jackson, J, why in the cholera wards, was be back, Nothing he had: inburgh had caused him “The grandeur ofthe Ecol ture he attended, soon af small, with faculties of only five or six professors. Most aspiring hysi- cians in America never attended medical schoo! but learned by appren- ficing themselves to “respectable” practitioners, most of whom had been Poorly trained. In his novel The Pioneers, Cooper described the medical SPPrenticeship 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 exag- erated the education for “doctoring” had improved litte in many parts ofthe country, {At about age eighteen] the lad was removed to the house of the village doctor, a gentleman whose early career had notwas greatly admired as the Ecole de Médecine on the 5 cornerstone had been. laid selassical in the grand man- for lectures seated nearly a ything open toall. jiece of French education. In nities for a medical educa- naginable eaufier, the profes- 1: men irespective of wealth amily no longer mattered, os French, not Latin, had been education, or equivalent, was xt American medical schools, ve to meet this requirement. cricans, there was no tuition. ere free, y compared to the Ecole de at the time was barely under .nty-one medical schools in ne per state, and these were essors. Most aspiring physi- .chool but learned by appret ners, most of whom had been Sooper described the medical than Todd, said to have been ‘n, Though the setting of the . and the portrayal a bit exag improved little in many parts removed to the house of sse early career had not THE GREATER JOURNEY + 107 been unlike that of our hero, where he was often seen, some- imes watering the horse, at others watt This kind of life continued for a twelvemonth, when he sud- denly appeared at meeting in along coat ... and afew months later was called for the first time in his life, Doctor Todd. 1g medicines. .. Atthe Ecole de Médecine, faculty of twenty-six delivered lectures on Anatomy, Physiology, Physics, Medical Hygiene, Medical Natural History, Accouchements (bitth), Surgical Pathology, Pharmacology and Organic ‘Chemistry, Medical Pathology, Therapeutics, Pathological Anatomy, Op- erative Surgery, Clinical Surgery, Clinical Medicine, Clinical Midwifery, Diseases of Women and Children, and Legal Medicine, Enrollment was as high as s,000 students, or approximately twice the number of students then in all medical schools in the United States, The American students at the Ecole in the 1830s and ‘sos were but a tiny part ofenrollment, numbering only 30 to so 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 dificult to escape when once fam in it” But then once “in it,” most of them wanted only to stay fonger 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 >e back. Nothing he had seen in the hospitals of London, Dublin, and Ed- _tnburgh had caused him to reconsider his high opinion of medical Paris. Thegrandeur ‘of the Ecole, he felt, was the grandeur of great minds. A lec- {ite he attended, soon after his return, was the most thrilling he had ever108 DAVID MecuLLoveH « THES heard, “Ihe glory ofthe week has been Andtal’s introductory lecture on diseases ofthe brain,” he wrote to his father “What powers of mind and © aught against him” Unlike | vastness of comprehension has this man! q E = Warren had come to Pa Jackson's Boston friend Mason Warten, one of the new artivals, would = {family background, was whe describe himself later as having been “a perfect ‘ignoramus” in the life of ‘he ‘never for amoment lost s the world into which he was entering, and feeling “quite overwhelmed” = for that conspicuous place a: With Jackson and another Bostonian, Henry Bowditch, Warren had’ _ name he bore..." That War found & place to live on the narrow, upward-sloping rue Monsiews. e-Prince. Shortly after, Wendell Holmes moved in on the same street eminent father, then at the near the top of the rise. Holmes described his room on the uppermost = _ him fromothers of ‘the med : Students at the Ecole de ? eral medicine or surgery, an part of their training, and; physicians and surgeons, tt curriculum, Thus Warren's friends Jackson, Bowditch, a ‘geons. Indeed, he rarely saw though they all lived next dc Warren was a slender, drawing done by a fellow ¢ guished by a full head of hai angle, and just a suggestion Dressing to the nines was hi Asa friend of the family w have everything handsome himself of the opportanitic his person. ...” He liked es slendet, more manly, and wl “inteproachable,” his shirts, separate triumph of varied cost of such a wardrobe se floor ofa 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 ‘opped bureau, a mahogany table, vo mirrors, two armchairs, andan ink Stand all of which cost him 40 francs a month, or about $8, which was average “little extra” went tothe porter who woke him inthe morning ‘made the bed, washed his clothes, and polished his boots. With the apart ment only afew blocks from the Ecole and his route on the rue Monsieur. le-Prince all downhill, Holmes found he could make it to his frst lecture in under four minutes door-to-door. At the request of his physician father back in Boston, Mason Watren described what constituted atypical day, once he was seriously embarked { commonly rise a litle after six, The servant comes in every ‘morning to wake me and light my candle. From 6 until 8 Lat- tend Chomel at Hotel Dieu, a man at present very celebrated for his knowledge of diseases of the lungs. At 8 Dupuytren Commences his vist which lasts an hour, that is till 9, and he afterwards lectures and has his consultations and operations, which occupies the time until 13. I then breakfast... Breakfast over he attended a lecture on surgery, followed by another on surgical pathology until four otlock. Dinner was at five, evenings accu- led with “eading, etc,” and lessons in French from a private tutor, Warren was an openly affable young man whose company everyone ‘welcomed. It was sald conversation never languished in his presence, He least. Poor health, mainly dig of his life—it had been the months as an undergraduatTHE GREATER JOURNEY + 109 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 hhim from others of the medicals,” as they were called, ‘Students atthe Ecole de Médecine chose “lines of study" in either gen- eral 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 ng in surgery followed a different troductory lecture on it powers of mind and he new arrivals, would voramus” in the life of quite overwhelmed.” cowditch, Warren had loping rue Monsieur- in on the same street ‘om on the uppermost sand a view, a tle floor, juded a bed, a marble- sarmehairs, and an ink or about $8, which was ‘ke him in the morning, sboots. With the apart- teon the rue Monsieur- ake it to his first lecture physicians and surgeons, those t curriculum, Thus Warren's schedule had little resemblance to that of his friends Jackson, Bowditch, and Holmes, none of whom aspired to be sur- geons, Indeed, he rarely saw them, other than foran oceasional 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 distin- guished by a full head of hai, 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. ‘Asa 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 “inreproachable,” 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 Boston, Mason Warren was seriously embarked. nt comes in every ‘om 6 until 8 Lat- nt very celebrated At 8 Dupuytren rat is till 9, and he nsand operations, akfast...- coma private tutor, * -~ithad been the reason for his leaving Harvard after only three hose company everyone shed in his presence. He | | Months as an undergraduate but since atriving in Parl, except for someno PAVin MecULLOUGH « troubles with his teeth, he had never felt better, Pe allowed for only two meals a day had something to had urged him to eat sparingly) Or possibly, such misetes ac he saw dail in the hospitals made any complaints of his own ‘mentioning, Or it could have studies and just being in Paris on his own, therapeutic lift, thaps a regimen th; Asastudent, no one was-—and he was slower than others taking hold of French, He could make himself understood well enough "in regatd to the necessities oF lf" as he said, but in conversation fel “entiely lost” Stil, he wae un. commonly self-disciplined. As thesonand grandson of famous surgeons, Warren had long known hhow much was expected of him. Like James Jackson, he was obliged to re- Port regulary to his father. It was not just that John Collins Warren cared sreatly about the well-being and professional progress of his distant son, but that he insisted on being kept continuously apprised ofall that wen new and innovative in surgical practice abroad, “Observe operations, Get &s near as possible,” insisted his father, who had himself studied in Patig thisty years carlier. “Send me without delay every new book containing anything important...” These were directions not to be taken lightly. ike James Jackson, Warren provided his father with a detailed, run- ning 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 ‘ime passed, he would contribute the fullest, accounts by Americans of student life in the most descriptive of the many ‘medical world of Paris, U0 ise the ancient Hétel 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 do with it. His father 2 seem scarcely worth been that the combined excitement of hig _ far from his father, ave him a ‘Warren was not on a level with James Jackson—but then ‘waxed oak floors were polishe ‘of the beds was enclosed wit walls above each bed, a good iation. Even with as many at ‘crowded. Scores of Sceurs de la Ct wearing large white caps, wi couints by the Americans fre ent women,” their skill and 1 with another student, James love to look upon.” Through toher unfailing devotion tot For students, the great a was in the number of sick @ the number of different dise ‘They might attend a physi of tuberculosis, say, not just as well. Over a period of a fi ‘examination of as many as fi inall but afew medical schoc required of students. ‘The first rounds of the we “They were conducted by can inent physicians, attended b which for most made it nea to see much, To the Americ eager to get as close as possi be fierce. James Jackson des worked himself up to the br nation, only to find that wh “a French head would slip t Jackson hastened to add, + ready “Pardon, Monsieur!” Wendell Holmes would the chief surgeon, Baron Gone THE GREATER JouRNEY « a 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 ven- tilation. Even with as many as 4,200 patients in the hospital, it did not feel crowded, Scores of Sceurs de la Charité, nuns of the order of Saint-Augus ‘wearing large white caps, went briskly about their tasks as nurses, Ac- counts by the Americans frequently express appreciation for “those excel- lent women,” their skill and kindness, Seeing one he knew while walking with another student, James Jackson exclaimed, “There is face I dearly love to look upon.” ‘Through the time of the cholera he had been witness toher 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, {inall but 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 em- {nent physicians, attended by as many as two-or-three hundred students, Which for most made it neatly impossible to get near enough to the beds eight pages. In this way, a5 tosee much, To the Americans the French students seemed inordinately nost descriptive of the many ‘eager to get as close as possible, and competition fora vantage point could nedical world of Patis. © befierce. James Jackson described how on more than one occasion he had _ Worked himself up to the bedside, determined to take part in the exami ‘ation, only to find that when he went to put his ear to the patient's back, French head would slip between mine and that same back” And this, _}ickson hastened to add, would be accomplished always with an ever- teady Pardon, Monsieua!” Wendell Holmes would remember students piling up on the back of ihe chief surgeon, Baron Guillaume Dupuytren, in an effort to see as he cet. Perhaps a regimen that rg to do with it. (His father sch miseries as he saw daily ‘own seem scarcely worth ‘ombined excitement of his from his father, gave him a n th James Jackson—but then caking hold of French, He in regard to the necessities tirely lost.” Still, he was un- ', Warren had long known ickson, he was obliged to re- {John Collins Warren cared progress of his distant son, isly apprised of all that was d. “Observe operations. Get rad himself studied in Paris every new book containing not to be taken lightly, father with a detailed, run- his time, the procedures he hought of them, the books letters, written in a strong, ds were each like the great h sides numbering neatly #7aa DAVID MecULLOUGH - bent over a patient, to the point where he would ‘shake them off from broad shoulders like so. ‘many rats and mice,” (With his remarkable faci with language, Holines had from the start litte or no trouble understand: ing what was said in the lectures, and within a year was taking notes ing French) . Dupuytren, one of the medical giants of France, let no one doubt he as the reigning presence in the Hétel Dieu. He was handsome, squarely built, and intimidating. A former battlefield surgeon, he had been made. 2 baron by Napoleon, Clad in his long white apron, he marched heavily through the wards like “a lessér kind of deity,” it seemed to the diminu- tive 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 sigh of whether he had won or ost 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—u spectacle—even surgery, Mason Warren watched as Dupuytren, working by candlelight, re- moved cataracts from the eyes of several patients, and from another a tumor of the tongue the size of a peach. He saw Dupuytren extract gall- stones from the bladder of a child, and perform the operation for an at- tificial 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 groat man..." Warren attended as well the lectures and operations of surgeons Philibert-Joseph Roux at the H6tel 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 # 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 i atter of seeing how it was don ni work, one was told, must be do > tuto, and jucunde—quickly, sur “that the eminent Dupuytr “thetics or bothered ever to was ped their instruments, was "Warren and others for the reas i such precautions. Nor did Warren write of th ‘The attitude of several of did, however, trouble Warren ¢ jonal sangfrold seemed over ina “kind of off-hand way," it the state of the disease for the fhim work away on a cancer of Lexpected every instant to se Lisfrane was a phleboton cone occasion Wendell Holn tients be bled, (The Hotel Di the purpose and a full-time Holmes, Lisfranc was little of members.” Too often it seemed the ¢ to operate, with little or no had insisted in carving open the patient died only an hot lived five or six years longe: practiced, he wondered, wi beautifully and quickly” tha By Warren's estimate me putations were performed d vived surgery of any kind a died and nearly always ofin Pasteur on the role of bacte glish physician Joseph Liste“shake them off from his ‘ith his remarkable facility or no trouble understand- a year was taking notes in rance, let no one doubt he Ie was handsome, squarely turgeon, he had been made apron, he marched heavily it seemed to the diminu- vivant and reputedly spent ses at the Palais Royal. the 5. his students alleged, was «ht before. Many mornings 1 in hand was to witness a e he worked and loved to exything was theater—un vovking by candlelight, re- ients, and from another, a sw Dupuytren extract gall- rm the operation for an at- His operations are always vonderful,” Warren wrote, he isa great man...” id operations of surgeons vd Jacques Lisftane at La tion, He thought Lisfrane’s d." He saw Lisfranc remove putating knife,” Anothe one patient, then a leg from “led and nearly always of infection, The work of the French chemist Loui: Pasteur on the role of bacteria in the spread of disease and that of the En- + THE GREATER JOURNEY + ng 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, surcly, and agreeably. ‘That the eminent Dupuytren and the other surgeons used no anes- thetics or bothered ever to wash their hands before proceeding, or steril- ized their instruments, was not recorded or rematked 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 theie patients did, however, trouble Warten and others considerably. The show of profes- sional sangfroid seemed overdone. Lisfranc’s operations were performed ina “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. Ihave seen im work away on a cancer of the eye, chiseling the bones of the head, tll Lexpected 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 pa- tients be bled. (The Hétel Diew 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 Wareen’s estimate more than two-thirds of those upon whom am- Putations were performed died afterward. In fact, most patients who sur- yived surgery of any kind at the hands of the most skilled surgeons later lish physician Joseph Lister in antiseptic surgery were stil in the future,ng * PAVID MecuLLouen « Even the best of the surg tient, They could be rough a ity toa patient, “the great Gi ‘geons seemed to have no ind ill-tempered, For outr ‘uillaume Dupuytren” had feelings for the ight physical brutal. © no equal, Ifhis orders are not immedi of striking his patient or abu wrote). A very favorite practic is to make a handle of the n ‘man enters with any © Holmes, recalling Velpe: ately obeyed, he thinks nothing B © ver apair of wooden shi sing him most harshly [Warren ce of his during his consultation ‘ses of his patients. Whenever a disease of the head, he is immediately In.adltion tothe quality selzed by the nose and pulled down onto hig knees where é ity and eminence of the he remains half in sovrow and hal anger at the treatment medical training in Paris, ‘nlite isallowed to rise and describe is disease medical training in the U. the difference in how peo “The first was that stud pitals of Paris had ample ‘asmen. This was not the c prefetred to die than have was a “delicacy” neacly in The open, often vociferous enmity between donnas also came asa surprise to the Americans, and those like Jackson nd Watren, who had been raised in the medieet Profession, found this disgraceful. twas said the tongues ofthe fa ‘culty were more cutting than thelr scalpels. Listranc in particular could hardly delivera lecture without ux, oF Velpeau, some of the surgical prima seat many American wor in America seldom had a than in books, In France this was not: nothing at all of this que: to describe, but to permit 4 Philadelphia surgeon na medical practice and train ‘educated physician enjoys ‘The setond great differ tion, In the United States, bodies for medical study we Until 1831, trade in dead be Jed numbers of medical st. tents father, to become grav ted only the use of corpses the bodies of those who most savage invective he sa whom he customarily refer worse, ler teacher and idol, “the highway robber, or rred to as "Le brigand,” lieTHe GREATER JounNEY + ns nave no feelings for the pa- ior outright physical bratal- en’ had no equal. contracture,” Alfred Velpeau was to become increasingly popular with the American students, not just because of his celebrated rise from hum- ble 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 be- longing to an owner who cases his feet in calf-skin.” sd, he thinks nothing nost harshly (Warten uring his consultation patients. Whenever a 1d, he is immediately snto his knees where ger at the treatment tis disease, Inaddition to the quality ofthe hospitals, the number of patients, the abil- ity 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 sav things in the two countries, ‘The first was that students making the rounds of the wards in the hos- pitals of Paris had ample opportunity to examine female patients as well ‘as men. This was not the casein 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 asa 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, oh the contrary, knows nothing at all of this queasy sensibility. She has no hesitation, not only ry, he would let fly with ‘a to describe, but to permit her physician to see every complaint,” wrote any other man’ ideas come a Philadelphia surgeon named Augustus Gardner, who came to observe quarter, but lavishes upon |). medical practice and training in Paris. "In this respect therefore the Paris "language affords. ..." His _¢ducated physician enjoys superior advantages to the homebred man?” his former teacher and idol, 5 ‘The second great difference was in the supply of cadavers for dissec- nd,” the highway robber, of | tion. In the United States, because of state laws and public attitude, dead Dodies for medical study were hard to obtain and consequently expensive. e, no student had cause f0. til 1831, trade in dead bodies in Massachusetts had been illegal, which Ity were below standards: led numbers of medical students of earlier years, including Mason War- atest French surgeon of the | _ ets father, to become grave robbers. The new Massachusetts law pecmit- e who named the contrac? ted only the use of corpses buried at public expense, which meant mainly ill known as “Dupuyteen’s 4 odies of those who died in prison. New York, too, had such a aw and 1 some of the surgical prima -ans, and those like Jackson ‘ical profession, found this sIty were more cutting than dly deliver a lecture without or Velpeau. t men and had a voiee like p and baggy trousers that rate into La Charité. “In his ture used by our stump or6 PAVID MecuLtoven « other: ‘states—Connecticut, Maine, New F Hampshire, ois, ‘would follow. In the South it ‘was the general attitude that, with the coy Sent ofthe slave owner, the body of any slave could be dissected. in Batis there was not the least prejudice against dissectong Bren ‘mortally ill patients in the hospitals, ‘aware of thei fate? and knowing. that two-thirds of the dead were cattied off tothe dissect ig fooms, did due in large part to the ravages cadavers were eadily avilable and cheap—aboug not seem to mind. Beyond the hospitals, of disease and poverty, 6 feanes for an adult, or $2.50, and still ess fora child John Sanderson, after taking a room in the Latin Quan ter, where he ‘was “living a kind of student Ife” near the hospitals, described seeing carts “urive and dump a dozen or so of naked men and women, ¢s youdo a cord of wood upon the Pavement,” these to be distr: ‘buted to the dissect- ing rooms. Delivery time for corpses at the Amphithéatre Anatomie, on the ruc d'Orléans near the | 1épital de la Pitié, was at noon. Wendell Holmes wrote of how he anda 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—netves, muscles, organs, blood vessels, and bones. be, studied, and this, Holmes: ‘stressed, could hardly be done anywhere in the world but in Paris. 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 scelpe, in the othera treatise on anatomy. He eatiee in is mouth a cigar whose intoxicating fumes, so hurtful on fnost occasions, render him insensible to the smell of twenty bodies decomposing, putrefyingaround him... Here, too fe the learned professor, who thus prepares imselfforadificatt, operation by refreshing his anatomy; and thus rehearses his Partin the tragedy tobe acted on the morrow. The blood and = ept in cages outside. In s © the heat the bodies decom ing tables—the stench, th: pieces of flesh upon the fragments of ms card Disposal of the: For all that was so m« to appreciate, that they p work was laborious, they the Americans to have gl ‘enough, but there is no evi The “medicals” found ‘Americans who came tow fields, In Paris they felt the Wendell Holmes tried to« Inever was so busy tures contains near) filled to overflowing ‘Médecine are cover sons are ringing alt students from all ler “Not a day passes,” dec thing new in itself or some Of great importance, was the library at the Bo the library at the College had all of 1,200 volumes. fewer still) There were, be: nearby at the Musée d’Hi enthusiastic medical studi seum at the Jardin toa ge ishere presented,shite, Illinois, Tennessee— ictitude that, with the con- ould be dissected. against dissections. Even of their fate,” and knowing > the dissecting rooms, did in large part to the ravages available and cheap—about achild, ve Latin Quarter, where he hospitals, described seeing men and women, as you do ve distributed to the dissect- théatre d’Anatomie, on the as at noon, Wendell Holmes cost of their “subject” and by could all parts of the human and bones—bestudied, and inywhere in the world but in 1 was such that 6oo students he stench in the thick air was ‘ugustus Gardner left a vivid 1 with his soiled blouse ic cap. In one hand he on anatomy. He carries g fumes, so hurtful on othe smell of twenty id him, .. . Here, too, is es himself for a difficult and thus rehearses his morrow. The blood and Tue GREATER JOURNEY + 7 pieces of flesh upon the floor he regards as the sculptor does the fragments of marble lying round the unfinished statue, Disposal ofthe 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 dissect- ing 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 Pacis they felt the exhilaration of being at the center of things, as ‘Wendell Holmes tried to convey to his father: {never was s0 busy in my life, The hall where we hear our lec- tures contains nearly a thousand students and itis every day filled to overflowing. .. . The whole walls around the Ecole de Médecine are covered with notices of lectures. ... The les- sons are ringing aloud through all the great hospitals, The students from all lands are gatheres "Not a day passes," declared James Jackson, “that I do not gain some- thing 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 Ecole with its 30,000 volumes. (By comparison, the libraty 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 __ fewerstill) There were, besides, the world-renowned exhibits and lectures Aearby at the Musée d'Histoire Naturelle at the Jardin des Plantes. One nthusiastic medical student, Levin Joyce from Virginia, likened the mu- im at the Jardin to a great buffet banquet of knowledge, “What a feast here presented...”ns DAVID MecuLLoUGH « “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 wag ‘making a point (o attend lectures at the Sorbonne as well, Bowditch had embarked on a medical carer far from sure it was ight forhim. He entered Harvard Medical School with feelings of doubt mixed with epugnance a the thought of some of the elementary worknecessary, ‘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 mathemati. clan 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, intelligentooking 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 Buard 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 al certain, destined tomake 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, stress- {ng especially that he attach himself to Pierre Louis, Great as was Jack- son'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 smalter following than the rounds of more Popular physicians. Where several hundred made the rounds with Du- Puytren at the Hotel 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, there was rarely a letup in ¢ ‘opportunities to be pursued, almost like shadows; facility with French had mac of study open, he tried to p syphilis, observed operation eral times to the Hopital det cough, measles, and chicker ‘entire new field for examine in on lectures in chemistry’ in “some very interesting ex up the study of skin diseases increasing interest the wor ‘eases of the eyes. "I was at ¢ ‘were four languages spoken ‘And, importantly, he en sage-femme, a noted obstet which students learned to ¢ nant women and came to hrad about labor pains and held in the highest regard b more of “midwifery” from he had in three years at the she was a shining case in from a medical education, Between times, Warter cal booksellers, surgical-int cal specimens to be found Quarter. He was shopping ing direct to Boston,” he we reason to repent that you 1 wrote to his parents, Like -al students, Bowditch was nneas well. er far from sureit was right ith feelings of doubt mixed elementary work necessary. inatomy at Harvard showed muscles ina forearm. tustrious father. He was the stronomer and mathemati- sed, had published The New isname known everywhere. man with an active sense of ily, Any squeamishness he nad long since disappeared. able that there was more he rat and walked out, past the fed through the streets until d to Bowditch. Jackson was ey were all certain, destined 1 “devotes himselfheartand such." re Louis, Great as was Jack: clral, he had come to id . Jackson saw that Bowditch s at La Pitié might nut ter in the morning when HE inthe right direction, stress: ded in Louis's rounds at 14 ing than the rounds of more | made the rounds with Di bet: THE GREATER JOURNEY « ug When Holmes arrived in the spring of 1833, Jackson looked after him as well There vas 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 Erench 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 Hépital des Vénériens, He went sev- ‘eal times to the Hopital des Enfants Malades to hear talks on whooping cough, measles, and chicken pox, The diseases of children presented “an entire new field for examination,” Warten wrote with enthusiasm, He sat in on lectures in chemistry at the Sorbonne, For a month he was engaged some very interesting experiments” on the intestines of dogs. He took up the study of skin diseases at the Hépital Saint-Louis and followed with increasing interest the work ofa German physician, Jules Sichel, in dis- eases 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 bya sage-fenime, a noted obstetrician, Madame Marie-Louise La Chapelle, in which students learned to examine with thelr Fingers the wombs of preg- rant women and came to understand a great deal more than they ever had about labor pains and the birth ofa child, Madame LaChapelle was the highest regard by her students. Bowditch was to say he learned ‘more of midwifery” from Madame La Chapelle in her private course than head in three years at the Harvard Medical School. To Wendell Holmes he was a shining case in point of why women should not be excluded Betiveen times, Warren was making himself known among the medi- booksellers, surgical-instrument makers, and the prepacers of anatomi- | speclmens 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 sail "he wrote, “two boxes—a large one containing 50 to120 DAVID MecULLoUGN « 60 specimens of morbid bones, some skulls Separate.” “Will you tell me to what extent I am he asked another day. “Ihave: already laid out eighty dollars for bones,” also the bones of the hi On Sundays only, t appears, did Warren turn from work to the pleasures of Pati when ke, Jackson, Bowditch, Holmes, and others would cr0ss the Seine toattend the opera or theater, anc dine at thet favorite ‘Trois Fréves Provengaux, where “full of warm blood, of mitth, of goss ing” (In War ren’s words), they delighted in souped la ‘or any number of other spécialités as well as a favorite Bur rgundy. ‘Warten even departed from the usual professional content cf hy let. ‘ers home to report that Taglion's performance in the ballet La Svlphide Nas wonderful beyond description, Another night, he attended a grand ball given by the most prominent Amevican banker in Paris, Samuel Welles of Boston, in a mansion on the Place Saint-Georges, as brilliant Vranas the young man had ever beheld. The host was the Welles of Welles & Company on the rue Taitbout, where Warren and the other Bos- tonians posted their mail, One Sunday, Waren joined a great crowd gathered to watch a statue of Napoleon being paced atop the column in the Place Venddme Another day a midweek, he sat in on a session of the Chambre des Députés, at Which Lafayette was present looking very “sad on finding himself so en- tirely duped by the King” ‘There is no doubt that if Lafayette had wished he could have been chosen president and established a republic [Warren i formed his father}. Although at present he does, everything in his power to show his devotion to the Republican arty, he ‘slooked upon by many of them with an evil eye, ‘Though the world of French politics impinged little on the day-to-day lies of the American medical students, some, like Warren and 1 folmes, ‘made an effort to keep abreast of what was in the newspapers andthe ine creasing “rumbles” over Louis-Philippe, and in part because they knew. (080 on in my purchasesie Ture or cételettes dla provengate great was the interest id gentleman, who is said “fis zeal for the liberal prit apers talk without the st siples of the Revolutio “The King is caricatt his portrait, you knc fat checks. ‘This has of a pear—so that 0 this foutlin« ure! It was very likely, Holmes ould have a “sober revolt To ease his mind from roam about “using my eyt the broad paths and oper to walk by the Seine, whe stand on the Pont Neufar was, he said, all the oceup Bowditch preferred tl he walked mornings and the only one of the Bostot aris, but then Bowditch and romantic disposition, England, who was finishit Latin Quarter. ‘The one hint that Ho young women of the Lati settes" Whether he wrote Al, Cle Diy And tw Isa.also the bones of the head to go on in my purchases?” ghty dollars for bones” from work to the pleasures and others would cross the rt their favorite Trois Fréres irth, of gossiping” (in War- or eételettes @ la provencale favorite Burgundy. fessional content of his let- cen the ballet La Syiphide night, he attended a grand n banker in Paris, Samuel Saint-Georges, as brilliant The host was the Welles of Warten and the other Bos- gathered to watch a statue ne Place Vendéme, Another - Chambre des Députés, at { on finding himself so en vished he could have republic [Warren in- we does everything in Republican party, he evilleye. THE GREATER ouRNaY - sas how great was the interest in all this at home. “There is a notion that the old gentleman, who is said to bea 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. Ifyou have ever seen his porteait, you kntow that he has a narrow forehead and large fat cheeks. This has been ingeniously imitated by the outline ‘of pear—so that on half the walls of Paris you will see a fig- ure like this outline of a pear} done in chalk or charcoal... Tt was very likely, Holmes thought, that in the course of time the French would have a “sober revolution” and a republic. ‘To case his mind from work and take alittle 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 Patis, Just to stand on the Pont Noufand gaze at the rive, its passing boats and barges, ‘was, he sai, 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 affaic in Paris, but then Bowditch was sald 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 Patis and lived nearby in the tin Quarter, ‘The one hint that Holmes paid the least attention to the numerous tung women of the Latin Quarter is a wistful little poem titled “La Gri tte.” Whether he wrote it at the time or later is not clear Abs, Clemence! When I saw thee last ‘Trip down the rue de Seine, And turning, when thy form had past, Isaid, "We meet again,”12 PAVID MecuLLoUGH » Jdreamed notin that idle glance Fe smommnghen ‘ab iftonen i nd then each goes his wa ere the dissections, where I st: A shadow and a name, ae “from that time to 6 Pat. = observing, writing... sc “Jackson, who, by the spr working with Pierre Loui Louis, including Mason \ been enough in itself for months under Louis's inst “That summer of 1833, time” for his return home started, would later nis that it was perfectly ac_ e terms “with his grisetre the landlord or landlady.” shenever she Pleased, and stay Another medical student, Louis Frazee from Kentucky, ‘write in a book he published about his time in Pai Ceptable for a student to live on the most intima in many of the hotels, without giving offense to A grisette could visit a young man’s room wl slong as she pleased, But of the many survivin, students, only one diary firsthand accounts by Am: chronicles in brief but candid detail hours carousing ofa kind in which more than a few undoubted but never mentioned in what they wrot bore Gooch of Richmond, a graduate inhisdiary in not very good French of. ‘of nights playing cards, and getting drunk on champagne and cognac. (In one such session, Gooch cluly noted, he and a friend consumed a bottle of la Charité, Sumner saw plaint,” all observed with from132 DAVID MecuLLoven » ideas, and new ways of seeing things, asany, this insight was to be as impor We ‘ike so many, Sumner, too, wished he could stay longer in Paris, the spring of 1838, with only a few days remaining, he wrote of his re. Bret over “a thousand things undone, unlearned, and unstudied which 1 wished to do, to learn and to study” But never felt myself so much an American, ardently. hhave never loved my country so. ‘The flow of Americans tothe “medical mecca'of Paris continued through the 18405, and the same illustrious French physicians-—Listrane, vel Peau, Rou, Louis—continued to make their rounds and deliver ther leo. e ng from the professional galaxy wes Guillaume Dupuytren, On the day of his funeral, on the way to Péze Lachaise Com. Ritd Students had unharnessed the horses from the hearse and dragged it themselves to the tomb, Between 1830 and 2860 nearly seven hundred Americans came to Paris to study medicine, and neatly all returned home to practice their Profession greatly benefited by what they had learned. And much ofthis 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 consider, ations, the mete fect 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 Pats abit oo pleased with themselves, while others in the profession who had never left home belitied the whole idea of study abroad or were openly critical of French medicine, Decades later, in the 1890s, William Osler, Johns Hopkins Medical School and as respecte can medicine, one of the founders of the sda figure as any in Ameri- would write that “modern scientific medicine” had had “its ‘ise in France inthe early days of this century.” More than any others, it tin another etter he added, I have anked among the leadin 4 on became ¢ covered an interest in ‘made the first professor ¢ became dean of Harvard in other ways as well. W diseases of the eyes that w Henry Bowditch bect vard, where diseases of tl sis his specialty. In 1846, ‘work used by medical stu however, was in the field {influence nationally than. ‘Mason Warren “gave tice as « surgeon in Bostor at the Massachusetts Ger moment when his father, the first operation ever in hamed W. T. G. Morton, experimenting successful to make tooth extraction John Collins Warren, he ‘onstration. The removal « five minutes. The patient ‘A month later, on No formed the first suecessfx and the month following gery ona child. Wendell Holmes was«ht was to be as important ald stay longer in Paris. In sining, he wrote of his re- ed, and unstudied which I ther letter headded, “Lhave never loved my country so ‘of Paris continued through physicians—Lisfranc, Vel- counds and deliver their lee- ional galaxy was Guillaume scay to Pere Lachaise Cem- ‘om the hearse and dragged ndred Americans came to ed home to practice thelr {Tearned. And much of this given to nearly every young ‘was said.of Mason Warren art from all other consider- Europe caused a degree of days few of our countrymen -a bit too pleased on who had never left home openly critical of French { from Pat «one of the founders of the ced a figure as am THE GREATER JOURNEY + 133 was the pupils of Piette Louis who gave “impetus” to the scientific study of medicine in the United States. Approximately seventy of those who had trained in Patis in the 1830s, oF one out of three, ater 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 Pennsylva- nla. A student from Salem, Massachusetts, Henry Williams, having dis- covered 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 ofthe eyes that were considered the best of their time, Henry Bowditch became a professor of clinical medicine at Har- vard, where diseases of the chest remained his first interest, tuberculo- sis 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 prac- tice 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 famed W. T. G. Morton, was used as an anesthetic. Morton had been _ S*perimenting successfully with the use of sulfuric ether fumes as a way painless. When word of this novelty reached he decided to proceed with a public surgical dem- = pistration. The removal of a tumor from the neck of a young man took Ave minutes, The patient felt no pain. A month later, on November 12, 1846, Mason Warren himself per- zed the first successful operation under ether done in private practice, 97 the month following he employed ether for the fist time during su ona child. Srdell Holmes was the illustcious, beloved professor of anatomy ata4 + DAVID Meevtiouen « THE the Harvard Medical Schoo! fr thitty-six years, and for par ofthat ting = ‘Once, when Emerson ret he served as dean ofthe school. His eetures on anatomy began prompt At one inthe afternoon five days @ week. “He was never tied ayy fresh, always eager in learning and teaching it” remembered one of hg students : Holmes’ writings on medical subjects drew professional attention na. ter key” to all Louis's succes tonal, but twas in his spare hours that he continued his literary pus, Yet, with the passage of suit, publishing poetry and essays, for which he was even more widely other American students I knowin, In 1857 he began a series of witty essays in the new magazine he = fe8 = teachings of the master, He had helped found, the Atfantic Monthly. The first of these, “The Auto: | exclusively to his methods « crat of the Breakfast Table,” and a number that followed, published as a able as was the study of 5} book, were to become an American classic, in which, among other things, vestigation, there had to be Holmes defined Boston as "the hub” of the solar system and was the frst approach. There had to be {0 call Boston aristocrats Brahmins—a category he himself qualified for patient. Medicine was a scic in every way except wealth. Each of the three eminent Bostonians matried and had children, Bowditch, after waiting patiently for several years, at last marsied his Paris true love, Olivia Yardley. Warren married Anna Crowninshield of Boston, and Holmes wed Amelia Jackson, a first cousin of James Jack- son, Jt. The oldest ofthe three Holmes children, the eminent Oliver Wen. dell Holmes, Jc, was born on March 8, 3841, Except for his two years in Paris asa student, Holmes lived all his life {n or near Boston, but the immense importance of his Paris years may be judged by the fact that half @ 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.” arts.” He had been thinking a ductory lecture at the mec strengths of his first great t of Jackson's kindness as one always applied “the best of Inever saw the man so alte Dr, James Jackson.” ‘Much that Holmes had « with what he had learned | Jiving in Paris—so much of ‘The same could have be as they lived, they would re: and of beholding its treas Opera, of seeing Moligre ¢ they knew, had made ther condition and thereby bett: Bowditch’s son, Vincen his interests in his patient's fellow human being” Whe: cal training abroad, Henty You young men {Holmes continued] ... hardly know how much you are indebted to Louis... . say, as Ilook back on the Jong hours of the many days I spent in the wards and in the autopsy room of La Pitié,for part of that time, atomy began promptly as never tired, always smembered one of his sfessional attention na- inued his literary pur- was even more widely 1 the new magazine he tof these, “The Auto- silowed, published as a among other things, tem and was the first himself qualified for ‘ed and had children. .rs, at last married his nna Crowninshield of - cousin of James Jack- .e eminent Oliver Wen- Holmes lived all his life of his Paris years may 1886, on the eve of his a reviewed in his mind career, he chose to talk om he had once studied -of the man born for a which he taught” ardly know how {look back on the wards and in the + THe GReareR yourwey + 135 (Once, when Emerson referred to Pierte 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 “mas- ter 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 invalu- able as was the study of specific diseases through close, scien vestigation, there had to be more to the physician's comprehension and approach, Thete 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 intro- ductory lecture at the medical school some years earlier, recalling the strengths of his frst 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 ofall that he knew for the good of his patient... 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 todo with what he had learned beyond Paris Médicale, by just being in Paris, living in Patis—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 Molitre performed onstage, seeing ‘Taglioni. This, too, they knew, had made them better prepared to understand the human _Sondition and thereby better able to serve in their profession. Bowditch’s son, Vincent, would write of his father, “He never allowed __hisintecests in his patient's case to hide the fact that he was dealing with a low human being.” When Vincent was himself about to leave for medi-136 + DAVID MecULLoUGH + ‘While medicine is your chief aim, remember that I want you to see all you can of art and music. | often think Ihave done ‘more good to some poor, weary patients by sitting down and telling them of delightful European experience than by al the drugs I have ever poured down their throats. Bowditch, Warren, and Holmes remained friends as well as colleagues for the rest oftheir 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 tohent very vell."Tsuspect that my ear-drums may not be quiteas tightly corded up as in the days when we saw our young faces in the Burgundy of the Trois Fréves.” Each of them would return to Paris as time passed, andl in some cases more than once. Sometimes it was for their health—in the hope that just being there would provide the needed lift ofoutlook—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 theee times, Suf, fering from depression, he made his first trip in 844 and came home suf. ficiently “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 con the job at his old lodgings in the Latin Quarter. "Found my old gargon, 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 Pletre 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 Win- ‘le 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 Jack. son, Jr, had said then—the happiest life,