Since 1815, the surgical clinic of Hôtel-Dieu has lost none of its ancient reputation. No other clinical course in France can be compared to this, whether for the number of students, the abundance of cases, or, finally, for the genius of the professor. In effect, Monsieur Dupuytren comprehends perfectly in what clinical instruction consists; a thing that ought to be somewhat difficult, seeing how few there are who succeed in it. Lessons of clinical surgery have no resemblance to a course of surgery.... A clinic is altogether a different thing. The professor has need here to speak continually without preparation, because the material of his lesson cannot be regulated by himself, in advance, but is dependent upon chance, which brings him, to-day, a strangulated hernia, to-morrow, a fracture; and, in the same day, four or five different cases....
An excellent practitioner, Monsieur Dupuytren thus really possesses the most essential quality of a clinical professor. But to this first fundamental qualification others ought to be united. The professor ought to have a free command of language and the talent of extemporaneous speaking; he should possess a memory sufficiently good to recall distinctly all the circumstances of diseases, and the peculiarities of the different treatments that he has directed; it is necessary, that, thoroughly understanding the necessity and obligations of his instruction, he should accustom himself to return every day to things which he has a thousand times repeated, unmindful of the fatigue resulting from such repetition; above all, he should remember that he is occupied with inexperienced hearers, to whom it is not sufficient to say things imperfectly; hearers who may easily be dazzled and led astray, but who ought to be instructed, an end that cannot be attained without patience. In respect to all these things, Monsieur Dupuytren is almost irreproachable.... As to myself, instructed by my personal experience, and by the numerous comparisons that I have made, I do not hesitate to believe and to say that the clinic of Monsieur Dupuytren may be offered as a model of this kind of instruction.
In his memoir concerning the medical schools of Paris, John Gross, an English surgeon, says that no lectures at the École de Médecine were so numerously attended as were those delivered by Dupuytren on operative medicine. He adds that at the lecture which he attended on the operation for inguinal hernia, there were present about 1200 students, the greatest number that the theatre is capable of containing. “But I must confess that I have seldom learnt less from any good practical lecture than I did from this. I was too far off to distinguish well what I saw, or comprehend what I heard; and I returned home with a feeling of regret, that what is grand should be so far remote from what is most useful.”
Dupuytren’s health began to break down in 1833, and he was obliged to take a trip to Italy. A certain amount of improvement resulted from this journey, but only for a brief period of time. On February 7, 1835, he died, leaving in his will the sum of 200,000 francs to l’École de Médecine for the establishment of a chair of pathological anatomy. Before his death, however, he assented to the proposition that the École should assume the responsibility of providing funds sufficient for founding the professorship and thus enable the authorities to utilize the legacy in establishing an anatomical museum, the Musée Dupuytren, where all sorts of pathological specimens may be carefully preserved and exposed to view in well-constructed cabinets. (See photograph of this museum in the plate facing page [260].)
CHAPTER XXIII
WORKERS IN SPECIAL DEPARTMENTS OF SURGERY: DEMOURS, DESCEMET, DELPECH, FAUCHARD, JOURDAIN, GARIOT
In modern times such special departments as those devoted to the care of the teeth, mouth and jaws, to the remedying of defective eyesight and other affections of the eyes, to the care of the organ of hearing, and to the cure of the different disorders of the pharynx, larynx and nasal cavities, have assumed the importance of independent fields of surgical activity, and as such they demand and are receiving to-day the attention which they deserve. But during the eighteenth century the practicing physician was expected to possess the knowledge and skill necessary for the relief or cure of all such bodily ills, and he was forced to accept the duties growing out of these problems as a regular part of his day’s work. In the estimation of the general public the holder of the degree of M.D. was credited—up to a comparatively recent date—with the possession of knowledge sufficient for the cure of all bodily ills; and one can now easily imagine how greatly most of these men must have suffered from the feeling that they were playing a false and ignoble part whenever they accepted—as they did in many cases of this nature—a degree of responsibility which they were wholly unable to bear.
In the present chapter I shall discuss very briefly only these three specialties: eye surgery, orthopedic surgery and dental surgery.
In the Middle Ages there seem to have been at least two men who were really skilled in eye surgery and who were widely known in the southern portion of Europe as possessing exceptional knowledge and skill in the treatment of this class of maladies. I refer to Pierre Franco, of Lausanne and Orange, and to Demosthenes of Marseilles. (Brief references to the work of these two will be found in the volume on “The Growth of Medicine.”) Then at Vienna, Austria, as I have stated on a previous page, there were, in the early part of the eighteenth century, Beer, Rosas, and perhaps one or two others, who did excellent work in eye surgery, and whose writings on this subject are still to-day held in high esteem as trustworthy authorities. In France, on the other hand, there were only two men who, in the early part of the eighteenth century, seem to have devoted their time and skill to the relief of affections of the eye—viz., Demours and Descemet.