II. MEDICINE

The doctors might have said the same, with Napoleon’s hearty consent. He never gave up hope of convincing his physicians that their drugs had done more harm than good, and that they would have more deaths to answer for, at the Last Judgment, than the generals. Dr. Corvisart, who loved him, heard his banter patiently; Dr. Antommarchi avenged and deserved Napoleon’s taunts by giving him—then approaching death—one enema after another. That Napoleon appreciated the work of devoted and competent physicians is evident from his bequest of 100,000 francs to Dominique Larrey (1766–1842), the “virtuous” surgeon who accompanied the French army in Egypt, Russia, and at Waterloo, introduced the “flying ambulance” to give quick aid to the wounded, performed two hundred amputations in one day at Borodino, and left four volumes of Mémoires de chirurgie militaire et campagnes (1812–17).5a

The Emperor was not mistaken when he chose Jean-Nicolas Corvisart as his personal physician. The professor of practical medicine at the Collège de France was as careful in his diagnoses as he was skeptical of his treatments. He was the first French doctor to adopt percussion—chest tapping—as a diagnostic aid in ailments of the heart or lungs. He had found this method proposed in Inventum novum ex Percussione (1760) of Leopold Auenbrugger of Vienna; he translated the 95-page monograph, added to it from his own experience, and expanded it into a textbook of 440 pages.6 His Essai sur les maladies et les lésions organiques du coeur et des gros vaisseaux (1806) established him as one of the founders of pathological anatomy. A year later he joined the imperial household as its resident physician. His difficult employer used to say that he had no faith in medicine, but full faith in Corvisart.7 When Napoleon went to St. Helena Corvisart withdrew into rural obscurity, and he died faithfully in the year of his master’s death (1821).

His pupil René-Théophile Laënnec carried further the experiments in auscultation (literally, listening), which, in his first attempt, consisted of two cylinders, each placed one end on the patient’s body, the other end at the ear of the doctor, who was thereby “seeing the chest” (stethos) with his ears; so the sounds made by the internal organs—as in breathing, coughing, and digestion—could be heard unconfused by irrelevant noise. Helped by this instrument, Laënnec proceeded with investigations whose results he summarized in a Traité de F auscultation médiate (1819); its second edition (1826) has been described as “the most important treatise on the thoracic organs ever written.”8 Its description of pneumonia remained an authoritative classic till the twentieth century.9

The outstanding achievement of French medicine in this period was in humanizing the treatment of the insane. When, in 1792, Philippe Pinel was appointed medical director of the famous asylum that Richelieu had founded at suburban Bicêtre, he was shocked to find that the rights of man so confidently declared by the Revolution had not been extended to the mentally deranged who were confined there or at a similar institution, the Salpêtrière. Many of the inmates were kept in chains lest they injure others or themselves; many more were quieted by frequent bloodletting or by stupefying drugs; any new arrival—not necessarily demented, but perhaps a nuisance to relatives or the government—was flung into the bedlam and left to deteriorate, by contagion, in body and mind. The result was a mess of maniacs whose antics, dull stares, or desperate appeals were occasionally exhibited to the public for a modest admission fee. Pinel went in person to the Convention to ask authority for trying a gentler regimen. He removed the chains, reduced to a minimum the bloodletting and the drugs, released the patients into the invigorating air, and ordered the guards to treat the insane not as secret criminals cursed by God but as invalids often amenable to improvement by patient care. He formulated his views and regimen in an enduring Traité médico-philosophique sur l’aliénation mentale (1801). The title was one more sign that Pinel had achieved, or aimed for, the Hippocratic ideal of the physician as combining the learning of the scientist with the sympathetic understanding of the philosopher. “A physician who is a lover of wisdom,” Hippocrates had said, “is the equal of God.”10

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