The Greater Journey: Americans in Paris (24 page)

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.

Of the celebrated teachers and practitioners of the medical arts who held sway in Paris in the middle of the nineteenth century, none was so esteemed by the American students, or had such influence on them, as Pierre-Charles-Alexandre Louis. For twenty years and more he was to inspire American medical students as did no other French physician.

Louis did nothing for show. He was neither spellbinding nor flamboyant. He could never have filled the amphitheater at the École as did Gabriel Andral. He spoke quietly. Some thought him “dry.” Henry Bowditch would remember him as ill at ease as a teacher and awkward when lecturing. Yet he had a power. What set him off from the others was his clear-headed approach to the treatment of disease, his insistence on the need for analysis based on evidence, on “
facts
.” As Holmes said, he taught “the love of truth.”

Louis was in his forties. After completing his training in Paris, he had gone to Russia, where he practiced medicine for seven years. Since his return, he had given up general practice to devote himself to the study of
disease. That he was married to the sister of Victor Hugo gave him, in the eyes of many of his students, an added importance.

He was known—and at times ridiculed—for his extended questioning of patients, his slow, careful examinations and endless note-taking. Seeing Holmes taking notes one morning during the rounds at La Pitié, Louis exclaimed, “
Vous travaillez, monsieur. C’est bien ça!
” (“You are working, sir. It is well, that!”)

He insisted on “exact observation,” by which he meant listening to what the patient had to say and listening carefully, methodically with the stethoscope, the instrument for the examination of the chest first introduced by the French physician René Laënnec in 1819. As Holmes would write, the stethoscope was “almost a novelty in those days. The microscope was never mentioned by any clinical instructor I listened to while a medical student.”

“The mind of this gentleman is not a brilliant one,” Henry Bowditch wrote of Louis.

It is an observing and calculating spirit, which examines with the utmost exactness the symptoms of disease at the bedside, weighs the different values of them under different circumstances. [Louis] is, in fact, what he wished to be considered, a careful observer of facts, and deduced from these facts laws which regulate disease.

Eagerly embracing the Louis approach, Holmes would spend upward of five hours a day sitting at the bedsides of patients, asking questions and filling his notebook.

Diseases of the chest were Louis’s main interest, and he had made tuberculosis, a leading killer of the time, his forte. At times Louis’s interest in the disease seemed greater than his interest in curing the patient, as even James Jackson conceded.

Tall and soft-spoken, Louis wore small spectacles on a long nose, and when not at the bedside of a patient, he moved swiftly through the wards. Holmes described him as a man of “serene and grave aspect, but with a pleasant smile and kindly voice.” Mason Warren would remember especially
that when, after a long run of perfect health, he took ill for several days, Louis came to see him.

Like the surgeon Velpeau, Louis was partial to American students, and like Velpeau, he saw the promise of this particular group of Americans— Jackson, Warren, Bowditch, and Holmes. Jackson was the master’s favorite, and working with Louis during the cholera epidemic had left Jackson in even greater awe of him. He had come to think of Louis as a second father. And Louis, as he would later tell James Jackson, Sr., thought of James as a son.

Jackson had decided he must stay longer in Paris than originally planned. He wished, as Louis strongly encouraged him, to devote more time to science. He had found his mission in life. “In very truth I look forward with fear and trembling to the day when I must employ my time to earn money, instead of to learning truth,” he wrote in a long thoughtful letter to his father.

I once laughed when I was told the student’s is the happiest life. Persuaded as I am that there is very much in the exercise of our profession, that develops and satisfies the affections— that delights the moral man—yet I must acknowledge that had circumstances favored it, I should have been pleased to pass at least eight or ten years in the study of the sciences of pathology and therapeutics, in the hopes of establishing some important truths. …

We live indeed in darkness, and it costs more time to discover the falsity of pretended truth than it would perhaps to reach something truly valuable. … I believe that we admit many things in America as axioms, which are very far from being proved. We have too long believed that because demonstration on many points was impossible in medicine, it was not worthwhile to study it like an exact science. It is a very false position.

Louis wrote to Jackson’s father urging that James stay on in Paris several more years to concentrate on pathological research. But James

Jackson, Sr., though wholly sympathetic to his son’s desire, wanted him home. James was needed, he would explain in a letter to Louis. “We are a business-doing people. We are new. … Among us, where the hands are few in proportion to the work to be done, every young man engages as soon as he can in the business of life.”

It was settled. On July 13, 1833, James wrote to his father, “In two hours I am to be out of Paris. I will not attempt to describe to you the agony it gives me to quit Louis.”

Inspired by Louis and his approach, Bowditch decided to concentrate on diseases of the chest. “Thrice happy am I that I have trod French soil, and breathed a French atmosphere; have known Louis,” he wrote.

Enthralled with Louis’s scientific approach, Holmes felt as intellectually exhilarated as he had ever been and even more adamant about the value of all he had come to understand that he never would have had he remained at home. Here was the future of medicine. Were he asked why he would prefer the intelligent young man who had been studying in Paris to a venerable practitioner of the old school, Holmes’s answer would be this:

… because the young man has experience. He has seen more cases perhaps of any given disease. He has seen them grouped so as to throw light upon each other. He has been taught to bestow upon them far more painful investigation. He has been instructed daily by men whom the world allows to be its most competent teachers—by men who know no masters and teach no doctrine but nature and her laws, pointed out at bedside for those to own who see them, and for the meanest student to doubt, to dispute if they cannot be seen. He has examined the dead body oftener and more thoroughly in the course of a year than the vast majority of our practitioners have in any ten years … merely to have breathed a concentrated scientific atmosphere like that of Paris must have an effect on anyone who has lived where stupidity is tolerated, where mediocrity is applauded. …

In another letter, Holmes wrote, “I am more and more attached every day to the study of my profession and more and more determined to do what I can to give [to] my country.” To mark the end of his first year in Paris, he wrote still again in an effort to define what he felt he had accomplished thus far:

My aim has been to qualify myself so far as my faculties would allow me, not for a new scholar, [or] for a follower of other men’s opinions, [or] for a dependent on their authority, but for the character of a man who has seen and therefore knows, who has thought and therefore arrived at his own conclusions. I have lived among a great and glorious people. I have thrown my thoughts into a new language. I have received the shock of new minds and new habit. I have drawn closer the ties of social relations with the best formed minds I have been able to find from my own country. … I hope you do not think your money wasted.

His expenses, he told them, were $1,200 a year, for books, instruments, private instructions, everything. “I tell you that it is not throwing away money, because nine tenths of it goes straight into my head in the shape of knowledge.”

In the second week of April 1834, violence broke out in Paris in protest of the government. Barricades went up in the streets of the poorest quarters of the city, and in the “pacification” that ensued, scores of citizens were killed and wounded. In response to gunfire from a building on rue Transnonain, government troops broke down the door and massacred all within—12 men, women, and children—a scene of horror later depicted in a powerful lithograph by the caricaturist Honoré Daumier.

For days wheelbarrow loads of the wounded kept arriving at the hospitals, and the students had their first sight of gunshot and bayonet wounds. Mason Warren wrote of “one poor fellow” who had been hit by ten musket balls and a woman who had had part of her leg shot away.
“Many of the dead were disposed in the morgue, some of them horribly slashed up.”

Then, only weeks later in May, came heartbreaking news that hit Holmes, Warren, and Bowditch as nothing had. For all they and others had been dealing with daily at the hospitals, all the diseases they had been exposed to, not one of them had been seriously ill during his time in Paris. Now came word that James Jackson, Jr., had died in Boston of typhoid fever.

Earlier that winter the news that Jackson was ill had caused much concern among his friends in Paris. “No one could excite a greater interest in our minds on all accounts,” Holmes had written to his parents. But the warning had in no way lessened the blow, nor was it felt by the Bostonians only. “I have seldom seen such a general feeling expressed on all sides,” wrote Mason Warren. Pierre Louis was “altogether overcome, quite unable to contain himself.”

As James Jackson, Sr., was to explain, his son had become actively involved with work at the Massachusetts General Hospital from the time he arrived home.

Our autumnal fever was prevalent much more than usual, and with uncommon severity. The opportunity to study this and to compare it with the fever of Paris, on which Louis had written so admirably, was one which he could not forego. And when he found that this disease exhibited in the living and in the dead the same characteristics, which his master had so accurately delineated, his ardor was increased more and more and he put all his powers to their greatest trial. It is not surprising, in the retrospect, that he became affected with the prevailing disease.

After weeks of severe illness and a slow convalescence, James appeared to recover, when suddenly he took a turn for the worse, his mind “gave way,” and he died.

“What shall I say of his ambition?” his father asked.

I think his young friends and associates will agree that he was not anxious for honorary distinctions. He had not such a spirit of emulation as leads one to study hard so that he may get the highest rank among his fellows. … But he had the strongest ambition to be worthy of the esteem and love of the wise and good. He rejoiced openly when he made an acquisition in knowledge.