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,”
I dreamed not in that idle glance
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 o
f 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. …