The Dawn of Modern Medicine / An Account of the Revival of the Science and Art of Medicine Which Took Place in Western Europe During the Latter Half of the Eighteenth Century and the First Part of the Nineteenth

by Albert H. Buck

CHAPTER XXVII.

ARMAND TROUSSEAU, ONE OF THE LAST OF FRANCE’S GREAT CLINICAL TEACHERS

In the preface to his “Bibliothèque de Thérapeutique,” which was published first in 1828, A. L. J. Bayle says that the art of treating diseases has been greatly neglected, in comparison with the enthusiastic efforts made to promote some of the other branches of the science of medicine, especially that of pathological anatomy; and, as a result, this art has in reality actually retrograded. Indeed, he goes on to say, quite a large number of agents which, up to a recent date, had been considered efficient remedies, have been entirely forgotten or even, in some instances, proscribed. This unfortunate tendency, he adds, may be attributed to many different causes. One of the most important of these, he believes, is to be found in the fact that certain physicians have allowed the idea to take root in their minds that the lesions which have been discovered in the different organs of the body at post-mortem examinations were the cause of the symptoms that, taken in the aggregate, constitute the particular disease under consideration; and, acting under the influence of this idea, they have assumed that their therapeutic efforts should be directed solely to these lesions. “Experience has not confirmed the correctness of this theory; on the contrary, it has shown that, if pathological anatomy is useful to the practitioner, it is chiefly so because it throws light upon the course and prognosis of certain diseases, and not because it has furnished a basis upon which the treatment may be built up.”

There is still another equally strong reason, says Bayle, why the art of therapeutics has been prevented from making a satisfactory advance, viz., the propagation of the physiological doctrine (Broussaism), a doctrine which admits the existence of practically only one disease—irritation, in its varying degrees of intensity, together with a single class of remedies—anti-irritants. Modern therapeutists reject most of these ideas, and experience also shows that, in the matter of therapeutics, these anti-irritants often produce harmful results. “A treatise on therapeutics,” he goes on to say, “should contain the substance of all the good memoirs that have been published on the treatment of the different diseases and on the remedies employed; it should also mention all the circumstances which indicate or contra-indicate the employment of remedial agents, the best forms in which the latter may be administered, all the cases in which they have succeeded in affording relief as well as all those in which they have failed to accomplish this result; all the authors who have written on the subject under consideration; and, finally whatever additional facts may give the practitioner confidence in the reality of the results proclaimed.”

There came under public notice, at about this period of time, a French physician who evidently held very much the same beliefs as were put forward by A. L. J. Bayle and which I have very briefly stated in the preceding paragraph. I refer to Armand Trousseau, who was born (1801) in Western France, and who received his early medical training under that prince of physicians, Bretonneau, of Tours. In association with his friend, Hermann Pidoux, he published (in two volumes, Paris, 1836–1839) an excellent treatise on materia medica and therapeutics. The spirit which guided him in the preparation of this treatise is well expressed in his own words as follows:—

Medicine is both a science and an art.... It is an art when it becomes necessary to apply it to a human being who is ill, and this is especially true when the manner of treatment is under consideration. It is in this art that the physician reveals how much talent he possesses; he reveals himself as a true artist by the particular form of remedial preparation which he decides to administer to his patient, by the felicitous choice which he makes between remedies, and by the favorable manner in which he combines them.

TROUSSEAU

Dujardin-Beaumetz then adds the important statement that in his belief Trousseau was—at the time when he gave utterance to these words—the living personification of the truth of what he said, for nobody had carried the therapeutic art to a higher state of perfection than he had. To this statement may be added, with perfect truth, the opinion held by many of his contemporaries to the effect that the publication of the Trousseau-Pidoux treatise promoted effectively the growth of a sound and trustworthy therapeutic code. The mere fact that in 1875 this treatise had already reached its ninth edition furnishes strongly corroborative proof of the correctness of this opinion.

The scantiness of the space which I consider it proper to devote to this single memoir appears to me to justify the omission, from this point onward, of everything that does not add to the description of Trousseau’s career as one of the greatest clinical teachers in the domain of internal medicine in France. I am the more strongly impelled to adopt this course because so many of my personal friends among the physicians who returned to New York, during the years 1860–1864, spoke in such terms of praise of the success attained by Trousseau in this particular branch of medical education.