The Greater Journey

by David McCullough

  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.

  That same month of May 1834 marked the death of Marie-Joseph-Paul-Yves-Roch-Gilbert du Motier, the Marquis de Lafayette. The legendary hero breathed his last on May 20, at age seventy-six, at his house on the rue d’Anjou, in the Faubourg Saint-Honoré. The day of the funeral, crowds of 200,000 or more lined the route of a long military procession to the Picpus Cemetery, where the interment in the family vault was private, as he had requested. In Washington, President Andrew Jackson declared a time of national mourning, and former president John Quincy Adams, now a member of the House of Representatives, read a lengthy tribute to the heroic friend of liberty.

  For those Americans in Paris for whom Lafayette had been such a looming symbolic presence, it was an especially heavy loss. To many like Nathaniel Willis, who happened to be back in Paris briefly, the military funeral was a sham and a disgrace. “They buried the old patriot like a criminal. Fixed bayonets before and behind his hearse, his own National Guard disarmed, and troops enough to beleaguer a city, were the honors paid by the ‘citizen king’ to the man who made him!”

  “They have buried liberty and Lafayette together,” another American told Willis gloomily. “Our last hope in Europe is quite dead with him!”

  In the fall of 1834, Mason Warren noted the rising number of “fine young men” from New York, Philadelphia, and other parts of the United States who had lately arrived in Paris to take up their studies in medicine, adding proudly that among all the students, “the Americans stand as high as those of any nation who come here, and they are surpassed by none. …”

  Early in 1835, Warren was pleased to report that Dr. Louis was delivering his lectures
with increased facility and now had a “great crowd” of students following him. Louis had been discovered, and in large part because of the American students, and recognition of his “value” was to last for years to come. Acolytes like Warren, Bowditch, and Holmes would carry the word home to Boston and beyond—Bowditch was already translating into English one of Louis’s principal works on typhoid fever.

  Bowditch departed for Boston in 1834, sooner than intended. He had sent a letter to his family announcing that he and his English love, Olivia Yardley, were engaged to be married. His father responded by telling him he must return home with no delay and alone.

  Mason Warren departed in 1835. By then, except for a few side trips elsewhere in Europe, Warren had been in Paris nearly three years.

  Holmes, who had been in Paris for more than two years, kept urging his parents to let him stay longer. The issue was money. He knew it would mean “hard squeezing” at home, but his cause was noble, he insisted. His pleading was to no avail. Reluctantly he sailed in the fall of 1835.

  Meanwhile, more American students kept arriving, including another Bostonian destined for a distinguished medical career. George Shattuck began his studies under Louis (who thought so highly of Shattuck that he entrusted him with the translation of his text on yellow fever), and it was Shattuck in 1838 who encouraged Charles Sumner to join the “medicals” in their morning rounds at the hospitals as a part of Sumner’s self-directed, eclectic education.

  Sumner, whose line of study at the Sorbonne included everything from the history of Greece to civil law to geology, welcomed the chance. At six feet two he loomed over everyone making the rounds and had no trouble observing.

  Following Alfred Velpeau at the Hôpital de la Charité, Sumner saw “every kind of hurt, swelling, and loathsome complaint,” all observed with “an undisturbed countenance” by students and teachers. “Blessed be science,” he wrote, “which has armed man with knowledge and resolution to meet these forms of human distress!” What struck Sumner especially about Pierre Louis was the spirit with which he expressed his love of science.

  The strong impression made by the hospitals and the French approach to medicine was to figure importantly in Sumner’s life to come. But of far greater future consequence was the impression made by something he observed at the Sorbonne.

  On Saturday, January 20, 1838, as he recorded in his journal, Sumner attended a lecture at the Sorbonne on the philosophical theory of Heraclites delivered by Adolphe-Marie du Caurroy, a distinguished grey-haired scholar who spoke extremely slowly. Sumner began looking about the hall.

  “He had quite a large audience,” Sumner wrote, “among whom I noticed two or three blacks, or rather mulattos—two-thirds black perhaps— dressed quite à la mode and having the easy, jaunty air of young men of fashion. …” He watched closely. The black students were “well received” by the other students, he noted.

  They were standing in the midst of a knot of young men, and their color seemed to be no objection to them. I was glad to see this, though with American impressions, it seemed very strange. It must be then that the distance between free blacks and whites among us is derived from education, and does not exist in the nature of things.

  It was for Sumner a stunning revelation. Until this point he is not known to have shown any particular interest in the lives of black people, neither free blacks nor slaves. On his trip to Washington a few years earlier, traveling by rail through Maryland, he had seen slaves for the first time. They were working in the fields, and as he made clear in his journal, he felt only disdain for them. “They appear to be nothing more than moving masses of flesh, unendowed with anything of intelligence above the brutes.” He was to think that way no longer.

  It would be a while before Sumner’s revelation—that attitudes about race in America were taught, not part of “the nature of things”—would take effect in his career, but when it did, the consequences would be profound. Indeed, of all that Americans were to “bring home” from their time in Paris in the form of newly acquired professional skills, new ideas, and new ways of seeing things, this insight was to be as important as any.

  Like so many, Sumner, too, wished he could stay longer in Paris. In the spring of 1838, with only a few days remaining, he wrote of his regret over “a thousand things undone, unlearned, and unstudied which I wished to do, to learn and to study.” But in another letter he added, “I have never felt myself so much an American, have never loved my country so ardently. …”

  The flow of Americans to the “medical mecca” of Paris continued through the 1840s, and the same illustrious French physicians—Lisfranc, Velpeau, Roux, Louis—continued to make their rounds and deliver their lectures. The only one missing from the professional galaxy was Guillaume Dupuytren. On the day of his funeral, on the way to Père Lachaise Cemetery, students had unharnessed the horses from the hearse and dragged it themselves to the tomb.

  Between 1830 and 1860 nearly seven hundred Americans came to Paris to study medicine, and nearly all returned home to practice their profession greatly benefited by what they had learned. And much of this they would pass on to others.

  Considerable attention and respect were given to nearly every young Paris-trained physician on his return. What was said of Mason Warren could have been said for most of them. “Apart from all other considerations, the mere fact of his long absence in Europe caused a degree of importance to be attached to him, as in those days few of our countrymen traveled abroad. …” Inevitably some returned from Paris a bit too pleased with themselves, while others in the profession who had never left home belittled the whole idea of study abroad or were openly critical of French medicine.

  Decades later, in the 1890s, William Osler, one of the founders of the Johns Hopkins Medical School and as respected a figure as any in American medicine, would write that “modern scientific medicine” had had “its rise in France in the early days of this century.” More than any others, it was the pupils of Pierre Louis who gave “impetus” to the scientific study of medicine in the United States.

  Approximately seventy of those who had trained in Paris in the 1830s, or one out of three, later taught in American medical schools, and several ranked among the leading physicians in the nation. The Philadelphian William Gibson became chief of surgery at the University of Pennsylvania. A student from Salem, Massachusetts, Henry Williams, having discovered an interest in diseases of the eyes during his time in Paris, was made the first professor of ophthalmology at Harvard. George Shattuck became dean of Harvard Medical School. Furthermore, all contributed in other ways as well. Williams, as an example, wrote three books on diseases of the eyes that were considered the best of their time.

  Henry Bowditch became a professor of clinical medicine at Harvard, where diseases of the chest remained his first interest, tuberculosis his specialty. In 1846, Bowditch published The Young Stethoscopist, a work used by medical students for half a century. His “greatest service,” however, was in the field of public health, in which he was to have more influence nationally than anyone of his day.

  Mason Warren “gave himself at once” to a large and popular practice as a surgeon in Boston. On October 16, 1846, in the operating theater at the Massachusetts General Hospital, he was present for the historic moment when his father, John Collins Warren, at age seventy, performed the first operation ever in which ether, administered by a Boston dentist named W. T. G. Morton, was used as an anesthetic. Morton had been experimenting successfully with the use of sulfuric ether fumes as a way to make tooth extractions painless. When word of this novelty reached John Collins Warren, he decided to proceed with a public surgical demonstration. The removal of a tumor from the neck of a young man took five minutes. The patient felt no pain.

  A month later, on November 12, 1846, Mason Warren himself performed the first successful operation under ether done in private practice, and the month following he employed ether for the first time during surgery on a child.

  Wendell Holmes was the
illustrious, beloved professor of anatomy at the Harvard Medical School for thirty-six years, and for part of that time, he served as dean of the school. His lectures on anatomy began promptly at one in the afternoon five days a week. “He was never tired, always fresh, always eager in learning and teaching it,” remembered one of his students.

  Holmes’s writings on medical subjects drew professional attention nationally, but it was in his spare hours that he continued his literary pursuits, publishing poetry and essays, for which he was even more widely known. In 1857 he began a series of witty essays in the new magazine he had helped found, the Atlantic Monthly. The first of these, “The Autocrat of the Breakfast Table,” and a number that followed, published as a book, were to become an American classic, in which, among other things, Holmes defined Boston as “the hub” of the solar system and was the first to call Boston aristocrats Brahmins—a category he himself qualified for in every way except wealth.

  Each of the three eminent Bostonians married and had children. Bowditch, after waiting patiently for several years, at last married his Paris true love, Olivia Yardley. Warren married Anna Crowninshield of Boston, and Holmes wed Amelia Jackson, a first cousin of James Jackson, Jr. The oldest of the three Holmes children, the eminent Oliver Wendell Holmes, Jr., was born on March 8, 1841.

  Except for his two years in Paris as a student, Holmes lived all his life in or near Boston, but the immense importance of his Paris years may be judged by the fact that half a century later, in 1886, on the eve of his retirement from Harvard Medical School, having reviewed in his mind so much that he had seen and learned in his long career, he chose to talk about the remarkable French physicians under whom he had once studied in Paris. And Pierre Louis figured foremost.