The Greater Journey: Americans in Paris (21 page)

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.

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.