But how did Paris medics find bodies so easy to get? This was during the period when, notoriously, in London, Edinburgh and Dublin, bodies for dissection and teaching purposes were mainly obtained by raiding graveyards for newly buried corpses. Dublin, in particular, had several conveniently central burial grounds for the poor, which were free and therefore almost unmaintained and unguarded. The raids seem to have been carried out with the more or less open connivance of those in charge of medical education, who apparently took a view that might be classed as enlightened self-interest: on balance, it could be argued, the eventual social benefit of this grave-robbing outweighed the evil. During Arthur Jacob’s period of study in Dublin, before he went on to Edinburgh, it was actually one of the officially recognised duties of those demonstrating anatomy to ‘undertake the direction of the resurrection parties’.5 These were headed by the dissecting room porters, who were paid a standard extra fee for the supply of ‘subjects’. In fact so blatant and busy were the Dublin grave-robbers that by the mid-1820s envious anatomists began to arrive from London in quest of material. A shipment of Irish corpses was discovered being unloaded at Liverpool docks in a crate marked ‘Irish Cheddar’. Arthur himself, by then a Fellow of the Royal College of Surgeons in Ireland and a rising figure in the Dublin medical world, proposed a committee to look into the matter, though it is not clear whether he was more disturbed by the resurrectionist activities in themselves or by the further illicit trade in bodies this engendered and the thought of London gaining from Dublin’s loss. His proposal was defeated. Two years later one of the College porters was killed by an angry mob, led by aggrieved relatives of the freshly dead.
Not till Burke and Hare were found to be actually murdering people in Edinburgh to provide the schools there with ‘subjects’ was the whole traffic properly exposed. The resulting Anatomy Act of 1832 brought the resurrection trade to an end, by officially permitting unclaimed bodies from workhouse infirmaries, free hospitals and the like to be taken by medical schools. In this way Great Britain finally created the same framework for legal dissection that had long been accepted in France.
It becomes apparent that, until then, the liberal French law was a key reason, among others, that ambitious young practitioners such as Arthur Jacob were eager to make their way to Paris to further their clinical studies. In fact there were complaints from French medical students at that period that foreign students were competing for ‘their’ subjects. A Frenchman who qualified in Paris has left us a graphic description of the practical arrangements. A little younger than Arthur and the son of a family who were having to make sacrifices for his education, he had evidently agreed with fellow students to perform a paid service for them:
‘In winter, I used to get up at five in the morning, to go from the Rue du Bac [on the edge of the Faubourg St Germain where the family lived] to the Hôpital de la Pitié [beyond the Latin Quarter to the east, where he was employed as a houseman]. It was imperative for me to get there before the arrival of the covered cart that picked up unreclaimed bodies from all the hospitals in Paris. That way, I could choose for myself my subjects. Then, my scalpel in my hand, I could prepare, for my associates, the teaching material for that day. Our anatomical studies went on all the morning . . .’6
The sheer number of charity hospitals, hospices, orphanages and asylums in Paris drew to the capital the dispossessed and desperate from much of provincial France. After thirty years of social upheaval and War, this meant that very many people breathed their last in a Paris to which they were essentially strangers, with no family on hand to see them decently laid in earth. In any case, in the capital, grave-space had long been so heavily used and so rapidly reused, that all laying to rest was more token than permanent even for respectable members of society. After the hospital cadavers of the poor and unclaimed had been chopped about, all the bits of bodies were supposed to be decently buried, with prayers, in a common grave, but in practice they often arrived there in a state of advanced decomposition. Arthur Jacob’s matter-of-fact view of dead bodies, and what seems to have settled, later in his life, into a private aversion to religious concepts, could only have been strengthened by his Parisian experiences.
Chapter VII
A WINTER OF HOSPITALS
The Hôpital de la Pitié housed about six hundred patients, many with chronic ailments, all poor, some of them prostitutes or girls who had ‘fallen’. It was behind the large Left Bank botanical garden that stretched down to the river and was traditionally called the Jardin du Roi, the King’s Garden. At the Revolution the name had been changed to the prosaic Jardin des Plantes, and when the place officially went back to being the King’s Garden at the Restoration in practice both names went on being used interchangeably. By that time it had acquired, as well as the plants, a large menagerie of exotic animals and birds, an important natural history collection, an anatomy section used for animal dissection and lectures, and also a collection of human mummies, skeletons and waxworks. No public zoos as yet existed in other capitals, and so this one was an obvious port of call not only for any doctor or scientist visiting Paris but for anyone of an enquiring turn of mind. Nearly all the foreigners who arrived in Paris went there, for this was an era when most Europeans had never before seen a lion or a camel in the flesh, let alone an elephant or a penguin. (The giraffe which was to be a main attraction for many years did not arrive till 1827.) John Scott, the editor of The London Magazine, recorded the day he spent there with his usual vivid attention to detail. There is circumstantial evidence that similar close attention was paid by Arthur Jacob, probably on repeated visits.
Medical men doing the rounds of Paris naturally combined their visit to the Jardin with one to the Pitié, and also to the Salpêtrière nearby.1 The Salpêtrière derived its name from having been installed, in the seventeenth century, in a disused saltpetre works, and by the 1800s it had become the largest refuge for the sick poor in Paris. In the women’s building alone there were six thousand patients many of whom were more or less permanent inmates. John Sims, the young doctor from Manchester who, like Arthur Jacob, finished his training in Edinburgh and then came on to spend a season in Europe, visited the Salpêtrière but was less favourably impressed by it than by most of the Parisian hospitals he saw. He remarked that there were no day-rooms and ‘no amusements of any kind … The accommodation for the lunatics … are of a very inferior description and it would require an entire reformation to render them as comfortable as their unhappy condition is capable of being made.’ He noted that the Superintendant knew this, and had said that Napoleon himself had had plans to improve the place but that these had been aborted by national events.
Like Arthur Jacob, Sims was a dedicated and indefatigable student of his chosen discipline. He must have been richer than Arthur, since he travelled to France, and then across that country and to Switzerland and Italy, by diligence, but he was from a Quaker family with the habit of hard work and plain, decent living. During his time in Paris he set himself just as rigorous a timetable, with just as much walking about from one part of town to another, as Arthur undoubtedly did. (There were no buses in Paris till 1828, only fiacres for private hire.) Like Arthur, who preceded him, Sims had recommendations from tutors in Edinburgh and also from Astley Cooper in London. Unlike Arthur, he kept a detailed diary which has survived,2 and so one can discern in his busy, documented itinerary, the shadow-figure of Arthur, who had already walked in the same paths all over Paris.
For both young men, the outstanding figure of the time was Guillaume Dupuytren who, when Arthur arrived in 1814, had just risen to the position of surgeon-in-chief at the Hotel Dieu. Dupuytren, too, was descended from several generations of country surgeons. He had grown up in the Limousin, part of the mountainous fastness of central France where (as Balzac said) most people couldn’t read or speak the national language properly and believed in witches: a place not unlike rural Ireland. Studying in Paris, Dupuytren was taken under the wing of another from the Limousin, Alexi
s Boyer, who became official surgeon to Napoleon, but Dupuytren’s own abilities carried him up and up. By the end of the Empire he had been decorated by Napoleon, and was to be made a baron under Louis XVIII. He figures in several of Balzac’s novels as The Surgeon, Dr Desplein, and his distinctive name is still affixed to certain conditions today. He is credited with having reorganised the Hôtel Dieu, till then a byword for dirt and overcrowding. He turned it effectively into a teaching hospital, introducing a rigorous methodology and system of note-taking. His time in charge of the place, 1814–35, is generally considered the first era of something approaching modern surgery, though, even with his scrupulous care, the mortality rate following surgery in those days, before antiseptics or asepsis, never fell below twelve per cent.
Stories of rudeness and domestic brutality hover round Dupuytren’s name, but all the evidence from those who saw him in the hospital is that he was kind and calm, with ‘a soft, smooth voice’ assuring patients he would cure them, and particularly good with children. Possibly he was more at ease with patients, students and hospital colleagues than he was with his professional equals and rivals. There was an especial animosity between him and Antoine Dubois who, as physician to Napoleon’s second Empress, was made a baron before Dupuytren. Today the names of the two lifelong enemies have been given to two short streets that run next to one another out of the Rue de l’Ecole de Médecine up to the old wall-line.
John Sims made numerous visits to the Hôtel Dieu to watch the great man operating. Sometimes his travelling companion, an American Quaker called John Griscom, came along too, for though he was not a doctor himself he was interested in everything and the two young men had been sharing digs and expenses since they had first met in Geneva. Dupuytren operating on a man with cancer of the penis made a particular impression, and Sims describes it twice, once in his journal and once in what appears to be a letter:
‘He cut off the part with a single stroke of the knife, then began to tie the numerous arteries … He performed this operation with such dexterity as to give the man as little pain as possible. I observed the furnace with red hot irons was ready in case the bleeding should be unmanageable.’ Either the furnace or the very nature of the operation was too much for Griscom. He began breathing hard, and ‘his countenance indicated that if he did not speedily leave the theatre he would soon be upon the floor.’ So they went out. Griscom, on Sims’s advice, stretched out flat on a bench outside Notre Dame. Sims went back into the theatre and watched the ‘very interesting case’ of a woman who had just died on the operating table. Then came a ruptured uterus, where Dupuytren succeeded in dismembering the dead baby – ‘If it had been living, he would have tried a Caesarian.’ Presumably he used a simple trumpet-shaped device to help him to decide that the baby’s heart had stopped, for Laennec’s stethoscope was then only just in the process of invention. At the end of this early-morning session Sims rejoined his friend, finding him much restored by the fresh winter air, and the pair went to eat a hearty breakfast at one of the cafés that were beginning to be a feature of Paris.
This, to modern sensibility, appears to come from the Chamber of Horrors of old-style, pre-anaesthesia surgery. However, Dupuytren and several of his colleagues were extremely skilled and, for their time, knowledgeable, pioneering intricate procedures that had hardly been attempted before. All were to some extent general surgeons, for specialisation itself was in its infancy. Even Dubois, who reigned over ‘La Bourbe’ – the big, well-appointed lying-in hospital in the suburbs south of the Latin Quarter – and gave lectures to the student-midwives (something that did not exist in London), turned his hand to many other medical procedures. This is why newly qualified medics such as John Sims and Arthur Jacob attended a whole range of operations, demonstrations and lectures, and saw over hospitals and asylums of every kind. They were trying to orientate themselves in a world of knowledge that now seemed almost overwhelmingly full of possibilities.
So they went to La Charité by St Germain des Prés; and to the Foundling Hospital in the Rue d’Enfer with ‘pretty, curtained cribs’, where some five and a half thousand babies were left each year, no questions asked. They went to the Hospital for Incurable Women on the Left Bank and to the huge Hôpital St Louis on the far side of Paris, originally a plague hospital, where those with skin diseases were treated by such modern methods as steam baths and statistical evaluation. They saw round the Sick Children’s Hospital (another idea as yet untried across the Channel) and the new dissecting rooms in the old convent garden of the Hospice du Perfectionnement – Sims found these well lighted, with a black marble table in each, but ‘dirty’, though he acknowledged that the young anatomist giving lectures was excellent. They saw other dissections in the military hospital at the Val de Grâce (another ex-convent); they visited orphanages and asylums for the insane of all kinds, and for ‘girls of incorrect life’. They saw a place in eastern Paris where deaf and dumb boys were being educated in language by being taught to read, and another where blind ones were being taught with very large letters embossed onto the wall for them to feel. They went to the Hôpital des Quinze Vents where incapacitated men lived, often with their whole families – the place had been founded six centuries before by St Louis for crusaders returning blinded from the wars. Paris was indeed well provided with ‘receptacles’ for life’s casualties.
In time to come, Arthur was to focus particular interest on the diseases of the skin and on the eye. He founded Dublin’s first opthalmic hospital, was the first person to identify a light-sensitive inner coating to the eye (membrane Jacobi) and became known as one of Dublin’s first eye specialists: by the later part of his career he was concentrating entirely on eyes.
The only other eye specialist in Dublin was the father of Oscar Wilde, Sir William Wilde. The two ophthalmologists collaborated in visiting workhouse infirmaries when a contagious eye disease struck Ireland in the late 1840s, in the wake of the potato famine. I had nurtured the idea that the Jacob and the Wilde families, as near neighbours in Dublin, both in the same professional field and both with cultured tastes, might also have enjoyed socialising together. However, it turns out that, as the years went by, the Jacob interest came to disapprove of Wilde, professionally and personally. He was ‘showy’. He had manoeuvred to get his knighthood. His wife, who wrote newspaper articles and rather bad poetry under the name Speranza, was worse. And when the scandal broke about Dr Wilde having had an improper relationship with a young female patient, and claims and counter-claims of libel followed, the Jacob family said that they had suspected him all along: look at those illegitimate children of his that he passed off as ‘wards’. And why did he dishonestly avoid giving evidence in court himself when Speranza was accused of libel? Arthur wrote in The Dublin Medical Press, a paper he had founded with another doctor, that Wilde ‘owed it to his profession, which must now endure the onus of the disgrace – he owed it to the public, who have confided and are still expected to confide themselves to his honour – and he owed it to Her Majesty’s representative who had conferred an unusual mark of distinction on him, to purge himself of the suspicion which at this moment lies heavily on his name’.
Such was life among the elegant Georgian terraces in the heart of Dublin’s Protestant Ascendancy, where Arthur forged a reputation for scrupulous expertise and for forthright speaking.
Brief, official accounts of Arthur’s career suggest that a formative influence on his choice of speciality was William Lawrence, at whose Dispensary for Curing Diseases of the Eye and Ear he worked for a while when he came back from Paris to London. Lawrence, who was only seven years older than Arthur, had himself been much influenced by the French school of medicine, which viewed human physiology as part of the spectrum of natural history that covered all animals, rather than as a separate study. A public lecture he gave had even been denounced by the Lord Chamberlain as ‘anti-scripture’. All this would seem to have accorded with Arthur’s own evolving view.
But something in France mu
st have set him on the path towards ophthalmology. In the early nineteenth century, eyes were being looked at medically almost for the first time. There had long been a French tradition of dislodging cataracts by prodding them downwards, but it had only recently been recognised that a cataract is distinct from the lens itself and is therefore removable. Dupuytren took an interest in cataracts and on occasions removed them successfully, but he was wary of doing so in any season or circumstances when infection might strike. It was recognised that inflammation in one eye could all too easily pass to the other, and then the luckless patient, from being poorly sighted before the operation, could end up blind.
Two years after Arthur returned to England, a series of lectures on eye surgery was given for the first time in London by George James Guthrie. For case histories of cataracts Guthrie relied a good deal on F.J. Gondret, who had worked in Paris and published a treatise on the subject. Did Arthur Jacob encounter Gondret? Did Gondret perhaps work at an eye clinic that was established at no. 6 Rue de l’Observance (today Rue Dubois) which led out of the Rue de l’Ecole de Médecine? Certainly the technique Gondret described to tease a cataract from behind the pupil of the eye, using a fine sewing needle that he bent just-so towards the point, was the same method that Arthur Jacob famously used in Dublin many years afterwards.
Footprints in Paris Page 8