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

It was at this period that Desault began his career as a surgeon, and in the course of that career he did at least his full share in the work of supplying the deficiencies that were observed in some of the methods commonly employed at that period, in removing the positive defects that were discovered in others, and in devising entirely new procedures. At the same time Desault did not fail to recognize the importance of making the foundations of his knowledge as solid and firm as possible, and with this idea in mind he spent all the time that he could possibly spare from the clinical lessons which he was then giving, in utilizing the anatomical material available in the dead-house of the hospital. As his rivals stuck closely to the old methods of instruction, and in addition were not endowed with his remarkable gifts of teaching, of drawing all sorts of interesting inferences from the anatomical relations of the part or limb that was under consideration at the moment, Desault rapidly outdistanced all his competitors. He was, so far as I am able to learn from the printed records of this period (1766), the pioneer of this particular type of instruction (anatomical, pathological and clinical) in surgery in the great Paris hospital Hôtel-Dieu. The young men who attended these courses in ever increasing numbers were fascinated by what they heard and saw,—for Desault always taught with the cadaver or the living subject before him,—and it soon became very noticeable that the attendance upon the lectures given by his rivals (i.e., the regular professors) was falling off. Actuated by bitter jealousy these men managed at first to have his permit to teach taken away from him. But Antoine Louis and La Martinière, two of the most influential surgeons of Paris, at that period, interfered and so arranged matters that Desault was able to resume his private courses. In fact, Louis made it clear, by his presence at several of the sessions, that he approved of this teaching and that he proposed to protect Desault against all interference on the part of rivals. Desault’s method of teaching, says Bichat, constituted the first development, in France, of what is now known as surgical anatomy, a very extensive and important department of the art of surgery.

Another striking feature of Desault’s manner of giving instruction is to be found in his invariable practice of demonstrating, whenever it was possible for him to obtain the materials necessary for doing this, the alterations which are produced in a part by disease or by accidental injuries, and also the influence exerted by these lesions upon the neighboring tissues or organs. In these demonstrations he never allowed his mind to wander in the direction of pointing out something akin to a discovery in pathology; he stuck closely to the questions that were under immediate consideration, thus giving preference, over everything else, to what was of chief importance to the students.

By thus conducting his teaching always with an eye single to the best interests of his pupils Desault became, in the course of a very few years, the most celebrated teacher of surgical anatomy in France. His rivals laid stress upon this particular feature of his fame in the hope of thereby belittling, in public estimation, the equally important celebrity, which he was now shortly to attain, of being also a great surgeon. It is in some such words as these which I am using that Bichat, who was his favorite pupil and righthand man during this period of his career, records the efforts made by his jealous rivals to interfere with Desault’s professional success.

In the early stages of his career as a surgeon Desault gave instruction in operative surgery, but in a comparatively short time he advanced beyond this stage and showed that he possessed considerable originality. He invented a very effective method of treating a fractured clavicle by the application, to the shoulder, the elbow and the chest, of a bandage which even to this day is known as “Desault’s bandage.” In planning this bandage its inventor first calculated with great care the forces which play the principal part in causing the displacement of the two segments of the fractured clavicle. This manner of attacking the problem of how best to treat such a fracture was, so Bichat declares, not that which had usually been followed by his predecessors, but it nevertheless proved to be the correct way of finding the right remedy. He believed, for example, that, inasmuch as the external segment or fragment is pulled downward by the weight of the shoulder and forward and inward by the action of the muscles, the right course to pursue must, first, be to furnish proper support to the shoulder, and at the same time to draw the external fragment outward and backward. He realized that by the employment of continuing extension it would be practicable to effect these results. So, placing a cushion over the chest, to serve in some measure as a point or angle of resistance, and resting the arm firmly against it, he was able, by pressing the lower part of the arm closer to the chest, to cause the upper part, together with the fragment attached, to stand out from this part of the trunk. Thus, as it were by a single stroke, he succeeded in obtaining a result which, for a very long period of time, had eluded the best efforts of the surgeon’s art. This was a great triumph for Desault, but its importance was not immediately appreciated. The bandage was successfully used at the Salpétrière, one of the larger hospitals of Paris, but the full recognition of its value came only after the lapse of many years,—indeed, not until after the death of its inventor. To-day it occupies an important place in the history of surgery.

Of the other improvements in surgical procedures that we owe to Desault I will mention here only one—that of ligating the exposed ends of the larger arteries which had been divided in the course of the amputation of a limb. Ambroise Paré, it will be remembered, was the first to introduce this practice in France (early in the seventeenth century), but it failed to meet with general acceptance and was then abandoned for more than a century. At Bicêtre, another of the large hospitals of Paris, the practice of immediately ligating the divided blood-vessels after an amputation was first revived by Desault, and not long afterward Ferrand also introduced the revived method at Hôtel-Dieu. From this time onward it became the standard method of procedure.

In 1788 Desault succeeded Ferrand as Chief Surgeon of Hôtel-Dieu, and from this time forward, for five years, he conducted with great success regular instruction in clinical surgery. Then, toward the end of May, 1793, he was thrown into the prison of the Luxembourg, the charge brought against him being that he had refused to give his professional services to those wounded in the affair of the previous 10th of August. He was retained as a prisoner only three or four days; but from this time to the day of his death (June 1, 1795) he was kept in almost constant fear of being prosecuted, and was consequently prevented in large degree from doing any useful work in surgery.

In his analysis of Desault’s career as a surgeon Bichat calls attention to the fact that the establishment of a clinical school at Hôtel-Dieu was not the only benefit which he conferred upon that hospital. He did much more than this; he improved the arrangement and the ventilation of the different wards, established better methods of distributing the food systematically among the patients, increased their comfort by making rules whereby their wants would be more promptly supplied, etc. All matters of this nature occupied the first place in his thoughts and drove out of his mind, long before he died, all ambition to accumulate a fortune. Despite the stormy conditions which prevailed during the Revolution and which upset completely all the existing arrangements in Paris, he managed to keep up a good part of his clinical courses.

Speaking of Desault’s personal traits of character Bichat says that he was somewhat quick-tempered, but that he promptly got over his bad temper and was then once more gentle and reasonable in his speech.

He had his full share of enemies. In nearly all cases this enmity sprung from jealousy. But what really great man, adds Bichat, ever passed through life without being annoyed by enemies through jealousy? On the other hand, Desault had excellent friends, men who—as he expressed it—were the joy of his life.

Desault was not of a scientific turn of mind; he never wrote articles or took active part in any discussions. Some of the best of the pupils who attended his courses took full notes of his lectures, and these, after Bichat had revised them and edited them, were published under the title of “The Surgical Works of Desault.”