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IVIaps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as man/ frames as required. The following diagrams illustrate the method: Les cartes, planches, tableaux, etc., peuvent Atre filmfo d des taux de rdducticn diffArents. Lorsque Ie docu'-»ent est trop grand pour Atre reproduit en un «>^ul cliche, il est film* A partir de I'angle supirleur gauche, de gauche A droite, et dd haut en bas, en prenant Ie nombre d'images nicessaire. Les diagrammes suivants illustrent !a mithode. 1 2 3 1 2 3 4 5 6 i i X mW r - I THE MEDICll INSTITUTIONS Page 5, line 7, for " Donyau" read "' Danyaii." " " 8, for " Charrier" read '* Clierrier." " " 10, for " has considerably" read " is considerably." " " 14, for "191" read "19.1." 4.th line from bottom, for " amazement" read " amusement." Page 8, line 4, for '* hand" road '• liands." '' 12, line 14, for " quartior laticr," read " qnartier latin." " 15, 4th line from bottom, fur " Cliarletan" read " Cliarenton." " 16, 23rd line, for " in a delightful confusion," read '< in delight- fid," kc. " 24, 5th line from bottom, for " recommce" read *• renommee." " 29, 17th line, for •' become'' read " be near." MONTREAL i PRINTED AT THE MEDICAL CHRONICLE OFFICE. THE MEDICAl HSTITCTIONS OF PARIS. BY W. HALES HIN6ST0N, M.D., L.R.C.S.E. MEMBER OF THE GERMAN SOCIETY OF NATURALISTS AND PHYSICIANS; MEMBEn OF THE SOCIETE MEDICALE ALL. DE PARIS, &C. MONTREAL: PRINTED AT THE MEDICAL CHRONICLE OFFICE. 1855. - 86921 MEDICAL INSTITUTIONS BY W. HALES HINGSTON, M.D., L.R.C S.E. Member of the German Society of Naturalists and Physicians ; Member of the Soci6t6 Medicale Alleraande de x^aiis, &;c. There are few cities, if any, of modern times prcscntinir the same ad- vantages of witnessing on a large scale the diseased portion of humani- ty, and the attempts for their alleviation, as does the French capital- Paris has within its walls, not only its own sick, but the sick of the sur- rounding country, and in many cases, of the Provinces. Les meilieun hopitauxy les meilleurs mcdccincs, Ics mcilleurs chirurgicns sont a Pans forms an integral part of every Frenchman's belief from the Pyrenees to Calais; and judging from the number of young physicians from Bri- turn and America who there pass a year or two bclore entering on their professional duties, it would seem that the Frenchman's opinion is shared extensively by those nltra mare. M hether we review the long list of names rendered immortal by their well directed efforts to abridge human suffering j enumerate the large number of hospitals for the reception of the sick, or gaze on the army composed oUeskcros de la science still above the sod or lately laid beneath it, we are eomi.el- led nolens volens to admit the greater part of the claim of that Parisian who styles his city " la villepar excellence des arts, des sccnces, et de Vindus- trie." So great indeed is the « material" for the pen of the medical liisto- nan, that upwards of 50 vols, some of them portly folios, have been writ- ten on this subject-institutions, &c. It must not be expected, therefore, that more than a hurried glance can here be given. I will pursue J course somewhat novel in arrangement; instead of taking each «?tow. dissement, and describing the several hospitals contained therein, I will commence with those in which the infant first draws the breath of life follow it to those institutions prepared for its recei)tion when overtaken by disease and indicated by the nature of that disease, thence to the house of refuge for the aged and the infirm, and finally to its last rest in. r place, and perhaps pay it a visit afler it is there. I shall introduce in the course of my remarks, in connection with a few of the hospitals some observations on the physicians and surgeons whose cliniques I toUowed. It IS now upwards of twelve months since I quitted the scenes I am now about 1o rrvisit in rolrosppct. I mwst claim the reador's indulgence Ihrri'lore il" I stiitc wliiit may clasli with his preconceived notions.— In olhulin^ to the manaital in Paris. L'ilospicE DE LA Maternite.— An abbey in A.D. 1201., which was found- ed by Matthew de Montmorency ; converted into a prison in 1793 ; destin- ed by a decree of the National Convention of the year IV. to receive the nurses and cliildrcn formerly placed at the Vid de Grace; and con- verted into an hospital for pregnant women in 18U. Tatients are ad- mitted after having completed their eighth month, or belore that jieriod if in danger of inuuediatc delivery. It contains 530 beds, of which 223 are set apart for expectant parturients, 133 or thereabouts in form of small cabinets li>r women in labour; U beds for the nurses and 91. for apprentice mill wives, besides 80 cradles. There is a special room for those who leel the first pangs of labour, where they remain un- til it is thought time to remove them to the room they are to occupy during their accouchement. None but femaU-s are allowed to study asmidwives. They arc under the surveillance of under mistresses, assistant mid wives, and the midwife en chef. Women in labour are attended by the female students. The latter are taught the theory as well as the i)ractice of midwifery, vacci- nation, bleeding, and the doses and properties of those plants required during pregnancy and parturition. When a female presents herself to bo admitted as a pupil, she is re- quired to give proof of being able to read and write well ; to produce a certificate of birth and of marriage, if married, or if in widowhood the date and circumstances of the death of her husband ; also a certificate of good morals by the mayor of the district, which certificate requires to mention the condition of father and mother, and of her husband if she have one ; and lastly, a certificate of vaccination or of having had the small pox. During pupilage females are allowed to go out only six times during the year, and then only when accompanied by their father, mo- ther, husband, or some friend particularly mentioned ; and are not al- lowed to commence study when pregnant. They are required to study from the 1st July to that time twelvemonth, when the examina- tion takes place and prizes are distributed. The charge for twelve months amounts to £27 17s. 6(1. sterling, of which £2i is for board, the remainder for washing, books, and instruments. This must be paid quarterly in atlvonce. Those rocommendetl by Iho prefets of their re- pcctivo dopiirtmeuts nro educated gratuitously. The physiciuns attending the institution are Moreau and Girardin^- tho former, author of a work on Midwifery published in 1830, also of the " Accoucheur r.n vosjue," — and the latter of a treatise on cholerttt The accoucheurs are Dubois, accoucheur to the Empress en cas d« iwoen, and son of the accoucheur to Maria Louisa, and Danyan. The nccnueheuse r.n chef ia Madame Charrier, an exceedingly intelligent, ac- tive woman, every way qualified fur the fit discharge of her duties. By strict attention to cleanliness, by placing each patient in a separ- ate bed, the proportion of deaths are considerably diminished. Thus, in the Hotel Dieu, before the establishment of the Maternit6, where four, or more even, were ploced in the same bed, the pregnant with the deli- vered and those in labor, the mortality averaged 1 in 13. Now it is 1 in 191. In 1850, the accouchees numbered 5786, of whom 302 died. Women usually remain in the Maternit6 12 days, at the end of which, they leave, carrying the infant with them. If it be the offspring of an unhallowed passion, it is placed either by its mother, or the institu- tion she has just left, ir; JJ Hospice des ertfants trouvis et orphelins. Hospitals for foindlings are decidedly of ecclesiastical origin, and to a Bibhop of Paris is due the credit (according to some) or discredit (ac- cording to others) of having founded an establishment for the protection of the innocent (according to the former) or for the encouragement of crime (according to the latter). It was long ago the custom to place a large basket or cradle in the cathedral of Paris, in which were laid the children of unknown parents, whose helpless condition was well calculated to appeal to the charity of thfe faithful — hence the name " the poor foundlings of Notre Dame." They were afterwards confided to the care of persons who discharged the duties of mother and nurse, neither, it is to be believed, efliciently, for they were frequently relet to otheriS, and in many cases actually sold to nurses who having had the cure of children had lost them, and thus the cl:,ild of shame bus, there are grounds for believing, been introduced into the halls of the opulent and the proud to share their honor and to bear their name. Many, on the other hand, were sold to mountebanks and others of that caste, who, by mutilating and otherwise disfiguring them, made them serve to the amazement of the crowd. A child usu- ally brought 18s to 20s of this currency. At the time T. am now writing about, when in the vicinity of the parte St. Vid:or, the number of child- ren for admission was do great, and the peCHBiary aid «o unequal wuA in- sufficient, that a certain number were picked out by lottery to be nursed, &c., the remainder were left to their fate. The institution is now on a secure footing, and is situated in Rue de rEnfer. Children are either sent to nurse in the country, or placed under special care in town, and as an inducement to be kind to their charge the nurse or guardian receives 18 francs if she can furnish proof that the infant had been treated with care and attention. In like manner 50 vrancs arc given to those who have reared their infant to the age of 12 without accident. Betoxe it became a rule that all children should be examined &c., the number of deaths was truly enormous, even yet the proportion is by far too great. 3rd year of the Republic admitted 3,933, died 3,150.. Now the mortality averages 1 ia 7.7 ; whereas in private 1 i.i 14. is the average. Childi-en are admitted into the foundling hospital from birth till the age of 10 years. When received th6 hour of its arrival is correctly noted by a sister of charity, and a number is attached to its right arm ; it is then .carried to a large rocm v/here it is fed with milk along with the rest of tne children. A wet nurse is immediately provided, and the child is sent with h^r to the country, where it remains, ^nitil the age of 12 years— its whereabouts, however, being kept secret ; it is then sent to the Orphelius. If, at any time, the mother should appear, to reclaim her child, she requires to deposit 30 francs, of which 10 are retained for search in case of the child\s death, and 20 for defraying expenses of edu- cation if living. If reclaimed it remains under the care of the adminis- iration until it has attained its majority. The number of children re- ceived is upwards of 5,000 per annum. The following are the statistics for 1850 ;— Foundlings. Orphans. JBoys, 1,822 219 «irls,... 1,769 142 En Depot. 667 591 3,491 There were in the <;ountry belonging to the hospital in question on the 1st January, 1850, • Entered during the year. Left do do Deaths do do Remaining on 31st December, /-il-^IJ — — ~y.^1r>ivt->A/4 Atjrirnr 1 Qf>rt ------ 361 1,258 patien with t Boys. Girls. same 6,474 6,580 turn il 8,437 8,475 missio 881 923 one), 792 757 of nin 6,;764 6,795 nue a 13 5 rcndis ry to be Litution is Children 1 care in 5 nurse or nfaut had rancs arc I without ined &c., )roport.ion ed3,150.. !4) is tlie li till the correctly ght arm ; jng with , and the ne age of hen sent D reclaim ained for 3S of edu- ad minis- Id ren re- in Depot. 667 591 1,258 Girls. 6,580 8,475 923 757 6,795 5 In accordance with a law passed in 1850, children are educated after having reached their sixth year. A branch- of their education might with propriety be neglected, namely, the looking for gratuities from visitors. Inspectors are a{)pointed who see that the children placed in the hand of nurses in the country and in the city perform their duties with lionesty. The physician in sittendance is M. Ragef, an observant writer, whose works on the diseases of children and on auscultation and percussion are extensively perused. M. Morel Lavallee is the surgeon. HopiTAL DES Enfants Malades, situatcd near the Neckar Hospital in Rue de Sevre, for sick children between the ages-of 2 and 15 years, con- tains 600 beds. Although -as clean as any other Parisian hospital, and attended with equal assiduity by the medical staff as well as by the nurses, phthisis here makes dreadful ravages — much, no doubt, depends on the sombre, cheerless appearance of the hospitui. Mortality was never under 1 in 6 — but 1 in 4.8 is the general average. Trousseau was connected with this institution previous to his recent translation to the Hotel Die u. The most popular of the staff is Guersant, a. somewhfxt prosy lecturer, but good surgeon, eminently practical and a favorite with the profession, who have elected him President of the " Soci^te de Chi- rurgie." HoTEL-DiEU. — The oldest hospital of the French capital, whose foundation dates as far back as the year 600 ; was at first a sort of lodging house for the poor and indigent. The number of inmates increasing much more rapidly than the accommodtition for them, it degenerated into a " pest house " and serious intentions were entertained of the propriety of destroying it altogether. At one period of its existence mortality was two to nine and this as late as the 18th century, when it might be sup- posed, the broad principles of hygiene should have been more clearly understood Four, five and six occupied the same bed — small pox, venereal, fever patients, &c., were huddled together ; the pregnant, and those in labour with the prostitute and the accouchee. — Operations were performed in the same ward in which were those already operated u|ion,and those whose turn it was next, to suffer. Indeed when we read the report of the com- missioners appointed to visit the Ilotcl-Dicu, (of which Lavoisier was one), we wonder that the mortality (^2 in 9) was not greater ; or that out of nine there could escape two. But this state of things did not conti- nue after the revolution ; hospitals were constructed in the dilierent ar- rcndissements '. for the small rox. the venereal, the affected with calculus! 9 the pregnant, &c., special hospitals w^ere provided, and the Hotel Bieit disgorged herself of her superabundance. Every patient has now a separate bed, of which there are 1260* About 13,000 receive medical and surgical aid during the year, of which upwards of 1400 die. Mortality is 1 in 7.39 in the service of medicine, and 1 in 22.50 in that of surgery ; and 1 in 9.06 when conjoined. The hospital occupies both banks of the Seine, connected together by a covered bridge ; it is built entirely of stone — stone walls, stone ceilings, stone floors. To some of the wards we descend as ii into the ground, and into which the light penetrates but feebly. Many of them resemble dungeons — nor are iron bars wanting to improve the comparison. They are all, however, kept scrupulously clean. The bedsteads are of iron, with curtains of blue cotton. Louis, Martin Solon, Guerard, ChomeJ, Piedagnel, Horteloup, R6quin, and Trousseau are the physicians. Louis never took much trouble with those visiting the hospital. He prefers holding communion with the medical world through the medium of the pen, rather than viva voce. Of the remainder. Trousseau's i* the most numerously attended medical clinique in Paris. He is very popular as a lecturer, and dwells at great length on the doses and pro- perties of medicines. He lectures with wonderful facility, and is pos- sessed of the rare faculty of making listeners believe that what he is talking about is unquestionably the most important matter he has ever submitted to their consideration. Thus, one morning's lecture was oc- cupied with veratria, and its employment in acute rheumatism. It was (so he told us) to supersede all other remedies. Borax and honey in croup and hooping cough formed the subject of another morning's lec- ture, and if his listeners did not feel disposed to place as much reliance in those remedies as he did, (which'they certainly could not but do after his frequent reiterations of^e Vasserteje Vaffirme, c'est mm qui ledit, Sfe,) they were unanimous in their admiration of his eloquence, and of the ingbuuity with which he manufactured mountains out of molehills. Yet to be candid, I know of no medical clinic where students can receive more instruction. He prescribes no medicine without explaining its action on the economy, and the results he wishes to obtain. He is very popular with the students, and deservedly so, for they are always treated by him with gentleness and kindness. The surgeons are (1853), Roux, Boyer, and Jobert de Lamballe. Roux is now so old that, when operating, he makes a series of cuts where one was necessary. The tying of arteries is quickly managed by his assist- ants, who sunply, in a great measure his imperfect vision. His memory »tel Dictf ire 1260, of which nedicine, 3d. The ler by a ceilings, ground, resemble n. They } of iron, Chomel, s. ital. He } medium sseau's i» e is very and pro- d is pos- hat he is has ever e was oc- i. It was honey in ling's lec- 1 reliance ut do after le dit, SfC,) nd of the hills. Yet n receive explaining tain. He re always lie. Roiix kvhere one his assist- 18 memory js fast failing, and this is painfully apparent in his constant repetition \)f the same matter, clothed frequently in the same words.* •Tobert de Lamballe has gained considerable reputation by his cJdrur- sic plastiquc, and his treatment of vcsico vaginal fistules ; yet the rude- ness of his manner renders him unpopular, and his clinic very thinly a- tended. A number, however, collect once a week in the aisle adjoining one of the female wards to see him operating on diseased wombs. It was on one of those occasions that I first saw him, enveloped completely •in smoke, which, with the stench arising from the application of the actual cautery to diseased mouths and necks, was almost intolerable. Seven or eight womeji are generally operated upon in a morning. A three bladed speculum is introduced up to the os, and through it the red hot iron is applied to the diseased structure. No pain whatever is expe- rienced. Those manipulations necessai-ily indelicate, are rendered still more repugnant to their feelings, by the rude and disgusting manner in which they are performed. Their persons are uncovered even to their waists, and exposed to the gaze of the assembled : while " Jc siiis una femme modeste, Momieiir,^' from them, is met by a severe retort from Jobert. One word of comfort or encouragement I have never heard to escape his lips. He still adheres to the old practice of enveloping re- cently cut stumps with lint, linen, plu masseau, i]-c. Is a very indifTerent lecturer, but manages to fdl up the hour, with administering, entre autre x:hoscs, rebukes to his assistants. HopiTAL Ste. Marguerite, now a permanent establishment, although founded in 1840 for the purpose of receiving the sick and wounded, for whom there were no vacancies in the Hotel Dieu. It is a very pretty hospital, in a cheerful part of the city (Rue du Faubourg St. Antoine), surrounded by pretty walks. Upwards of 5000 are here attended during the year, in which the mortality is as 1 in 12.27 in medicine, and 1 in 4-5,25 in surgery. One of the pliysicians to this hospital (M. Tessier), is a homo^opathist. Hoi'iTAL DE LA TiTiE, founded iu 1612. This hospital, formerly re- ceived poor children and foundlings, but since the establishment of spe- cial houses for that purpose, has become a general hospital. It is a well constructed building, is divided into a number of houses, separated from each other by courts and avenues. Many of the wards look into the Jaidin des Plantes, near which it is situated. Gendrin, Nonat, Serres, Clement and A'alleix are the physicians in at- tendance. The cliniques of Gendrin and Valleix are well attended. * Roux has since vacated the chair as r/oi/cn, and laid aside the knife for ever. He ev- liiica on .Jrd ..larch, isjJ. He was disiingtushed ironi the commencement ot his prole«- Eional caieei , and died belcvcd even by his conrieres. 10 The former on diseases of tlic heart, the latter on those of the uterus and' nervous diseases. Michon has a siirj!,ical cliniquo, and few Tarisian sur- geons arc morfc cjminently practical. Laugier occupies the oflicial chair in surgery. The hospital contains G24. beds. Nearly 12,000 receive profes- sional assistance during the year ; the mortality among which for medi- cine is 1 in 14.78 and 1 in 27.97 for surgery. IIopiTAL Cochin, founded in 1779, by Jean Denis Cochin, a cure of the Parish (Ste. Jacques) in which it now stands, and for this purpose he alienated his fortune, although it did not bear his name until after his death. About 5,000 patients are admitted during the year, and the mortality is 1 in 15.4 in the medical wards, and 1 in 14.2 in the surgery. Beau and Maisonneuve are the physician and surgeon. The latter prac- tices the coiqy sur coirp dilatation of the urethra for stricture, and judging from the shrieks of those operated upon, amputation of the penis would, I am certain, be a luxury i)i comparison. Maisonneuve operates well, but is too meddlesome in his treatment, trusting more, seemingly, to the resources of art than to those of nature. IIopiTAL Beaujon. — This hospital, situated in the Favhourg St. Honore,. is unassuming, and, at the same time, one of the most comfortable hos- pitals in Paris. It contains 438 beds. On entering this establishment, our nasal organs do not receive that disagreeable evidence of the vicinity of sick wards, that they are accustomed to receive in such localities. The air is as pure within, as it is without, the hospital. A process of removing tainted, and introducing fresh air, is constantly going on. By a like contrivance, in summer, cool air is forced in, and warm removed — the reverse in winter. By this means the temperature of the wards is the same, winter and summer, and throughout the whole establishment there is rarely a difference of one degree. Upwards of 6000 are attend- ed during the year ; a mere fraction of those who present themselves. Mortality (medical ward) 1 in 7.7; (surgical) 1 in 15.8. Legroux, Sandras, Earth, and Grisolle, are the physicians ; Robert and Hugier, surgeons. Of the former, Earth is most generally followed, who offers very practical remarks on the use of the stethoscope and auscultation. This hospital, however, is not numerously attended by students. HopiTAL St. Antoine, in the suburb of the same name ; unquestionably the model hospital of Paris. At first a home of refuge for reformed pro- stitutes, now a general hospital. Contains 290 beds, and acministei^s re- lief to upwards of 5000 annually ; the mortality among which is about 1 in 9.6. Chassaignac, known for his translation of Cooper, is the sur- geon. HopiTAL Necker, founded by a lady of the same name, mother of the celebrated Madame de Stael, in 1779. This hospital is rendered ia- II uterus and' arisiun siir- 3ial chair ill five proH.^s- 1 for meili- , a cure of purpose he til after his r, and the he surgery, latter prac- md judging en is would, e rates well, Qgly, to the St. Honore,. irtable hos- Eiblishment, the vicinity 1 localities, process of ng on. By removed — le wards is tablishment I are attend- theraselves. Legroux, md Hugier, who offers uscultation. nts. questionably formed pro- Qiinisters re- ih is about 1 is the sur- lother of the •endered ia- mous by Mio presence of one jnan — Civiale, tiie lithotrotist, a man (|nali- fied io add renown to a city. He lectures easily, but not sutliciently loud to be distinctly heard. He seis^es the stone witji the greatest ease find dexterity, breaks it into isoveral pieces, and crushes those again. Unlike those who make one operation a Iiobby, he frequently rejects persons who come to him, when the stone is too large or too hard. Li- thotrity, he says, should only be performed when the stone is friable, and under a certain size. He is very mild and affable in his manner, with a total absence of that boasting there is so much reason to censure in les etoiles dc la science. HoPiTAL DE LA Charite, Originally the head quarters of a religious corporation (Saint Jean de Dieu]) for nourishing the sick, whose ramifi- cations extended throughout the greater part of France. To-day a hos- pital of the first-class, containing about 500 beds ; nearly 8000 patients receive professional assistance annually. It is composed of a series of buildings, forming a hollow square. Some of the wards are very large, containing about 90 beds, labelled off into different salles. A most effi- cient medical and surgical staff attend this hospital, and it is but neces- sary to mention the names olRayer, Cruveilhier^ Andral, Bouillaud, Pi- orry, and Briquet, physicians ; Velpeau and Gerdy, surgeons, as a proof. Cruveilhier and Andral, probably the most generally known throughout the world, are not so much sought afler in hospital as are those of more circumscribed reputation. A. rarely dilates on the cases under treat- ment, while walking through the wards ; his views, therefore, are not easily learned from himself; while Cruveilhier is frequently absent, from indisposition and the press of private engagements. Bouillaud thinks, thai notwithstanding his strenuous labors in the cause of science, the world is unm-mdful of them, ar ' also of him. And often does he com- plain of the decision of that portion of the medical public who view with a more favorable eye, the labors of his more fortunate, though less de- serving confreres. B. was the first to point out the frequency with which articular rheumatism is accompanied by endocarditis. In the lat- ter affection, as well as in pericarditis, he still adheres to his old severe anti- phlogistic plan. I have rarely seen a physician more correcfin diagno- sis. A contrast to Bouillaud in most respects, is met with in his colleague Piorry. The latter seems to possess internal evidence of the bruit he has mode in the world ; and while he inwardly congratulates himself on the distinguished position he has attained, he highly approves of the public choice, in conferring honors and distinctions upon one so deserv- ing of them. An extract from a conveisazione will show the estimation in which he holds himself: — ^"Messieurs, — Si vous suiverez mes lee- i! t 12 tures regnlicrement, je voiis ilonnerai un ccrtificat.; et im ccrliitcut be MOi vaut plus qii^iii diplorae." Not only in chest alVcctions, but also in those of the abdomen and /enal regions, the plcximcter is invariably had lecoursc to, to resolve all difliculties. His tactits cntditus is really extra- ordinary, and although many are disposed to smile at the extreme length to which he carries those matters, ^;asi WMrtcm appearances generally confirm liis diagnosis. Velpeau — a quiet, little, grey-haired old man, still attends as regularly to his duties as if he had his reputation yet to earn. He seems to be a favorite, and is always encircled by a number of students, who listen with respect and attention to the remarks offered in an easy familiar manner. The students who attend his instructions are quiet and attentive — rarfx, aves in the warde of a Parisian hospital. HoPiTAi, DE LA Faculte, in the vicinity of, and directly opposite to, the Ecolc clc Medicine, in the qiiarticr laticr. la this hospital there are a ■surgical and obstetrical clinic ; about 850 receive assistance in the for- mer during the year, and upwards of 2000 births take place in the latter ; mortality among which is 1 in 23.0, and 1 in 16. S in surgery. Dubois and Nelaton are the professors in their respective departments. Nekton's surgical clinic is Uie most numerously attended inPa-ris, and he one of the most popular teachers. He is mild and agreeable in his manners — of an even gentle temper. Although he lectures Avith great facility, he seems to attach little importance to oratorical display. He is possessed of wonderful acuteness of perception, and faculty for observa- tion — is bold and energetic, at the same time cautious. In fine no truer or nohigher tribute can be paid him as a surgeon than by styling him the Syme of Paris. HopiTAL BoNSECouRS, Containing 318 beds, and administering reliefto upwards of 5000 in-door patients annually. Mortality in the medical wards averages 1 in 11-8 ; in the surgical 1 in 28.1. Maison Nationale de Sante, for those who are able to ,pay the ex- penses of their keeping. Not more than 5, or less than 2 francs are charged;:>e?-^Zie?«, according to the room occupied,— baths, food, linen, &c., are included. The patients are attended by six medical students, and, when necosvsary, Nelaton and Denonvilliers are called ia consulta- tion. HoPiTAL Saint Louis. — This hospital, for the treatment of skin dis- eases, is situated in the Rue Bichat, Faubourg du Temple ; contains 825 beds, generally all filled ; but the number of in-door patients is trifling, compared to that of the out-door. The surgical cases, of which there are a great number, are attended to by Malgaigne and Denonvilliers. Malgaigne's proper theatre is the Ecole de Medicine, where students, in addition to being taught surgery, are listeners to the most cioqucul i LittCUt BE it also in ■iablyliacl lly exlru- ne length generally old man, on yet to I numbe-r ks offered structions )5.pital. iposite to, iiere are a 1 the for- ,he latter ; . Dubois Pa'fis, and l)le in his v^-iih great iplay. He r observa- e no truer g him the ig reliefto B medical /■ the ex- Tancs are od, linen, students, consulta- f skin dis- ntains 825 is trifling, hich there villiers. 3 students, it eloquent 13 1 diss, rtatiuijs that ure to be heard within the walls of a college. 'I'hey stylo liiin '< La Rachel de la Faculty, Le Cecero dos 11. )8pilnnx, ifco I htive often listened to hirr. with unbounded pleasur*' and .'Klmir.ition. His clear voice is distinctly heard in every corner of tlie inimonsi-, dark, sombre lectiire rotmi. In the St. Louis, his clinic is w.dl att.-ndt>d, rs- piciiilly by siniugt-rs, I'lany of whom are forced to come to the co.ichi- sioa tliat the medical world cune to, long iigo, . AVhile they ;;d- iJiire the fertility of his genius, they regrc;t that the patient's f.-eiingsund comibrt furm such an unimportant item in his calculations. HopiTAL DU Midi,— founded by Godfrey de la Tonr, in K)13. ^t tbe time of its foundation, one bed .served for eight patients, four of whom oc- cupied it fron 8 p.m. to 1 a.m. ; and the other four from 1 to 7 a.m. They receive;!, Avilh their ticket of admisJon, a severe flogging— were thrust into a chn-k, cltsecellnr,;tnjoiig other unfortunates— forced to wait months, and sometimes a yc ar, hcllrr. being placed under treatment— -to lie as already mentioned, and fiuiiliy to rect ive another severe castiga- tion befcre leaving. Ai that lime tiie mjirried and .he single of both sexes occui.ied the snijie ill-liglilod, lil-ventilated dungeons. But now matters are changed, a',;d if the AJidi is not ho elegiMit as other hospitals, every inmate of it, has, at least, a separate bed— of which there arc 32 L L])wurds of 3000 are admitted during the year, the mortality among whom does not generally exceed 11. llieordand VidaJ attend. VVe rarely meet with ])hysiciansto the same hospiUiJ, holding views so widely dille'- rent, as are those of xVl. Ilicord from his colieaguo V-aI-A. \Vij)le,'on i lie one hand, ivicord, almostalone ajid uuji^si.siecl, a.-^.M rts the non-trnnsmis- sihility of matter other than the piisof ehajicro, aad its entrance into the system only by a elianci-..> — Vidal, v. ith A'olj.-eau, ilir.lgaigiie, aial a host of lesser stars, have tried liaid lo coniuLe him, and vrhel.lier success- ful or not the curio-is m liiot-e luiuters i rust dLCidc f.r tlMTiiselvs. .Ili- cord, notwithslardiiig tlus poveerf!;! ojij.jsitiou, still iiolds forth to a, (dass if anything more numerous than bellre. He is |/os.-.essed of great volu- bility ol spi'och, is remark!, My wit;y, coKstaMtly iudulgos in r59 ; was subsequently, however, n house orjcliiuv, hut finally returned to its (^rijrhial ol)joct. It is one of the most comlbrtnblo and conveai':nt in Paris; one in which theru is every laeiiity for Initii- ing, washing, &c. U[.wards of 2000 arc treated annually ; the mortality among which is 1 in 50. This hospital is not so wi'll attondnl ns it should ho; students are fonder of following the surgical cliniciucs, uJid those on diseases of the chest. In no other hospital wilh which I am acquainted, with the exception of the venereal wards of the Chnritc, in Berlin under Simon, is there the same facilities for investigating for one's self, this brancli of medicine,and for examining diseased structures ; the opportunity, therefore, should not be neglected, of attending while in Paris the Lourcine, and of receiving the instructions of Cullerier and Gossclin. HopiTAL DE l'IIotel des Invalides.— This hospital, I need hardly mention, is for the reception of old soldiers who had been wounded n the field of buttle or otherwise in their country's cause. It was opened for that purpose in 1074. It was nol, however, then completed, for the cl)ai)el, in which now rests the remains of Napoleon, was not finished until thirty years afterwards. The Hotel des Invalides ranks with the nifst mngnificeint edifices in Paris, and is pointed at with pleasure and with pride by those of their countrymen who envy not the comfortable and elegant homo of the aged and maimed soldier. It contains nearly 3500 men, of whom nearly 150 are officers. They are divided into 14 divisions, each commanded by a cliief, adjutant, and sub-adjutant of di- vision. The first division is formed of ofiicers, among whom is a female, bearing the title of sul)-lieutonant, and M-earing ei)aulette and sword. In the hospital of the Hotel the deaths nearly average 1 per diem ; more than half of whom die between the ages of 70 and 80. Two physicians and three surgeons are in attendance. HoPiTAL DU Val-de-Grace.— On tlie 1st April lfi45. Louis XIV. laid the first stone, in accordance with a vow made by his mother, Ann of Austria ; it having pleased the Almighty to put an end to her sterility. It was for nearly two centuries and a half the residence of a religions corporation, when in 1793 it was converted into a military hospital. The first object that meets our eye, after our entrance, and one that must be grateful to the sight of every lover of humanity, is a bronze statue, by p.^vid— of him of wliom Napoleon said- cest Phomrii^; le jilus homtete que fai coHHU—o^ Baron Larrey. This hospital is composed of three squares, and is surrounded by extensive and beautiful gardens, one part of which is a promenade for soldiers, and the other for officers. Iliere is also a botanic garden, for those whose inclination leads them in that quarter. There is a hue collection of anatomical preparations, both wax and soft. Also a museum for compar;;tivc anatomy, and a cabinet of natural history c- 15 cfiiav, Ijiit »nilbrt:iblo ^ lor Initli- I mortality ndrd ns it iqucs, tuid hicli I tira Dharitc, in ig for one's ■tiires ; the g while in Uerier and sed hardly 'ounded n vus opened, ed, for the ot finished s with the easure iind. comfortable :\ins nearly led into 14 itant of di- is a female, d sword . In Hem ; more ) physicians s XIV. laid ler, Ann of er sterility. ■ a religious ospital. The lat must be ;e statue, by s honnete que irce squares, t of which is Iso a botanic ter. There i soft. Also I history e" . riosities. There are euriositios, however, to whic-h the medical portion of the public attach greater interest, namely, tht- instruments, cVc, tliat Larry used ill Hie campaign. The trophies that ho brought back with him bear evidence of the scenes he witnessed, while there exists abun- dant proof of the unbounded fertility of his g^-nius, in the rude contri- vances to which he was often compelled to resort on the field of buttle. The hospital can be made to accommodate 4000 soldiers. Previous to ISfiO, studeiits were educated in the Val-do-Cira<'e for the army, but^ince that period, none but physicians are allowed to attend, who are com- pelled to i)ass a year there en service before entering the army. The mortality in thc! Val-de-Grace averages about 1 in '3i, and about 220 deaths occur during the week. The chirurgien en chef is M. Larrey, son of the late Baron. In Lar- rey we meet with a true representative of a class of persons, now im- conmionly rare — un vmi Fmiicaia du hon vicux temps — quiet, graceful, exceedingly and really polite — paying due attention to, and courting the opinions of others, and advancing his own wdthout ostentaiion. lie is tar from being a dexterous operator, and o?i (lit that he inherits the pow- ers of application, though not the talent, of his lather. Admission is granted to this hospital but once a week ; M. Larry, however, can, at his discretion, furnish a carte d' entree at any time, and it seemingly af- fords him great pleasure to do so. HopiTAL MiLir.viRE DU llouLB. — Tlic sltc of this hospital, (Paie du Faubourg St. Ilonore,) is that on w^hich formerly stood the stables cf the family d'Artois ; but whether for a stable or an hospital, the situation is unexceptionable. It is composed of a series of buildings, forming a hol- low square, a portion of which is a garden, contains 700 beds and mor- tality is 1 in 19. Seven physicians are attached to the hospital, besides about 20 assistants. HopiTAL DU Gros-Caillou. — Near the Champ de ^ars, in a very fa- vorable position, is situated the Gros-Caillou— a number of buildings en- closing a garden. The whole interior of this establishment is kept scru- pulously clean. It recei/es about 6000 annually; mortality among which is 1 in 29. Nine physicians and their assistants compose the stall" of this hospital. Mai«jon Nationale de Charletan.*— It issnrprisingwhatnulookcd for results do frequently follow the exertions of humble individuals. When, in 1641, Sebustien Leblanc, in the goodness of his hone.vt and * The distance of this establishment from Paris (nearly six miles) might almost exclude it from Ihis paper, but il has hitherto been associated with similar iuitilulions within the city, and 1 am not desirous of departing from the usual custom. ir. f^piicroiis lipjut, foniulefl the above institution, and looked with pleasure and with pridt' on i\ni four jioor sick men, tlnit iiis bounty fed, and his kiiidiit's^ nursed, litt.ic dill liedicani lliat nuiirlv hiiltuhiiiidnid diniu-iitt-d bciii'j^s woidd oin' day bo congregated togetlicr on tht; suae spot, and within an cdilice uiisiirpt^sed in comfort or architectural beauty. It is sitnatcil in a luosLdeiii^iUtld part of tlie country. On one side the forest of Vinccnucs, and on I lie otlier the Marne and iScino. There are nume- rous gardens, prunu nades, pretty groves, &cc.. The males occu[)y one end o{ the building, tlie females the other: mortality is about 1 in S.f), The nninln'r of r('coveri{^s (of iutelleet,) not unfrei|U'nitly miounts to one in 3 and it is thought that many more would recover were it not for short- coming funds compelling their removal. IfospirK PE r,.\ ViRLT.EssE (Malk). — This hospital is usually known under the name of Bicutre and is situated at the distance of'u mile and u half from Paris. Almost every public building in Paris has, at one lime or another, experienced those vicissitudes of iorlune. '!>ose convul- sive movements, wliieh, unfortunately for the French nation, too fre- (juently occur. Tlu5 Bicetrc forms no exception, and is intimately incor- porated with its country's history. It was u chateau in 12^10, then the hnt bed of political intrigue — afterwards the seat of diplomatic negocia- tions — tlien a retreat fbi- dchauchiis courtiers — suhsequently a military lKS[)ital— ailerwards a general hospital, where diseases of all kinds were huddled togetlieriii a delightful confusion. Idiots, knaves, and ])i'ostituU-s, wiih the really and ieignedly siek, without distiiietion of age or t^cx, were cuoji 'd u]) within its walls, and it was not until 1820 that the iii- (:iH.re bocaiue, i..s it is ao^v. a house of refuge lor indigent old age. The situation of tli" iJic-'lr.' i^ v'r: favorable — an elevated piece of land, in the middle of an exton^ivc op mi field. Those who have iittained the age of 70 areadinissi!) e oil i-(c)inineiidation, while those who have at- tained 7!\ by right. In euuaeetion with it there is a d'-partinent for lu- natics. The indigent and tlie insane work a certain number of hours a day (um!cs3 countermandi'd by the physicians attending), and to the in- digent is rel.nr.i.-d on f-tiiitvl •><' the proooeds of their labor. The estab- lisiimeut c.'ntiiiis .']I:1U beds. 100 of which are for the insane. The mtr- tality among I'u.; lati.'V is I m (i. IS, precisely the same as that which holds good among the au' d i In coniiection A\'ith the i;ice!re, there is, for the female insane, a work- house ; and an immen^^e farm f.-r the males ; the latter work on an average 8 anil 10 hours a day. Male anil female teachers are attached, who go fur towards bringing baek detlironed reason. SAt.ri;ii\u:aE. — An institution similar to the preceding, for females exclusi\;ely, above 70, and the insane and cancerous. For the indigent 17 li pleasure (I, uiul liis tllMIU'llh'li s[)ot, imd uty. It is 3 the forest nro niime- py out' 011(1 S.f), I'ho ,o one in 3 for short- lly known a mili; and las, at one se conviil- 111, too fre- itely incor- ', then the c negocia- a military kinds were l)i'o.stitutes, I tie or j<('X, hat the lii- age. Tlie of kind, in Ltaiued tlie h:t.vp at- lent for lii- of lioiirs a . to the in- Tlie estab- The tncr- that which le, a work- an average ed, who go for females he indigent 3141 beds arc set apart. Nearly 3000 occupy the Suli^triere at the snnia time, and the mortality averages 1 in 7.28. The number of reco- veries among those of abtrred intellect is about a third ; no coercion, but on the contrary, the greatest gentleness is used towards these unfortu- nates. The mortality among them averages about 1 in 9.35— a much more favoriibk' per centage than that among the males. As this is the last institution of the kind that I shall have occasion to mention, I may be pardoned for recording my humble, yet sincere testi- mony in favor of the moral management of the insane, which I iiad so much pleasure in observing at the above institution. In no instance did I observe the least fear in the countenances of the demented on the approach of their keepers; on the contrary, their appearance was mva* riably hailed with pleasure; thoHc who could smile i extenso, for, with the exception of Pnisaia, and perhaps Bavaria, tliere is probably no country in which medical sta tistics are kept with so much precision. Among the list of " Phy sical Causes," the reader will o])serve that out of nearly nineteen thousand cases of insanity, only 4-50 are traceable to Onanism. On corn- jtaring this, to the statement made a few years ago, in the " American Journal of Insanity," to the effect that upwards of half the cases in the U.S. were traceable to an excessive indulgence in this solitary vice, we are surprised at the discrepancy, and wonder why it is so much less fre- fiuent, in n country, in which the standard of morality, is unquestionably lower. " Many ti truth is told in a joke," and the remarks of a Frencli gentlem ■ v. ■\ h-Mii I mentioned the circumstance, may not be an excep- tion to the adage : « On n'est pas neccssite ici en France, aavoirrecours a ces raoyens artificielles. — Virgines Faciles ne sont pas si raros que dans TAmerique, et on est liceiicie tunt par les manirs qu'on est prot^g^ j)ar la loi." There exist, for the removal of deformity, three orthopcEdic establish- ments. llydrojmLhy also has a few, where worshippers at the shrine of Humbug, may, ibr a small consideration of £.50 or £60, be fed, lodged, and rolled in wet sjioets 365 times a-year ! In the Kue des RecoUets iit in ion, or pro- ol' iiitrroNt. hIioiI ill thu 801 1801) 818 478 34(* 632 mI, &c., '» 13,12.) 5,849 18.972 771 8U8 298 41 471 1427 25C4 1256 1164 3014 3898 : of Prussia, icdical sta of " Phy Y nineteen On corn- ' American ise.s in the y vice, we ;h less fre- leslionably a French e an excej)* •oirrecours raros que ^st prot^g^ ! establish- e shrine of fed, lodged, lecoUets in the Fauhoiirj? Jit. Murliii is situated the Hoshici: dks iNcinABLKs (male), u house of retreat for old men above the age of 70. Some are admitted under that age when infirm and helpless. ]t contains 512 beds; sorao i the property of donors who fill them with the aged of their choicu. I I\lortality 1 in S.3. I An establishment of the same name as the precfding for females over I 70 years contain*- 695 beds. Mortality 1 in 10.6. ? The Hospices Le Prince and St. Merry are for the same purpos-j ; the former admitting 'iO above the ago of 70— the latter It of both sexes. There are three honse.t of retreat, ill addition to those already men- tioned, containing in all 1212 beds, which demand .-special notice. One (Hospice des Manages) is intended for aged house-keepers, or the wi- dowed, who receive tlireepence a-day, a certain quantity of bread, meat, wood and coal. The inmates nui^t have been house-keepers for at least , 10 years. Anotlier (II. do la ilochefoiicauld) receives llie old servants 1 of similar establishments, 12 aged or infirm ecchsiastics, and persons above 60, or deprived of their limlw. The third (II. do Ste. Purine) re- ceives those, who, up to the period of their ulmissiou, had i>aid regularly a small instalment. Institution Impkriai.e des Sourds Muets. — Notwithfstanding the advancement made in science and learning, after the revival of letters, the attention of philanthropists and physicians was not directed to the condition of the deaf and dumb, with un eye totheir alleviation until late in the eighteenth century, when France and England, ever foremost in those works which have for their foundation, .science, and ibr their end, the good of mankind, showed us in the labors of a Wallis a Pereira, and others, that mind is given to every infant with the breath of life ; that for the manijestation, speech or .signs are necessary ; but that mind, or idea, or thought, is associated witli the human form whether there exist melius for manifesting the same or not. Previous to the seventeenth century, sages and theologians taught, that deaf mutes were animals of an inferior class or order in the scale of being, and as inferior animals were they treated. Those alr(>ady mentioned were among the first to regard speech merely as the echo of thouglit, and to suggest means for the pro- duction of that echo when impediments to it existed. Had they lived a century later, physiology, which teaches us that there is no such thing as dumbness, but that it arises from, and is a consequence of, un impos- sibility of hearing or appreciating sound, would have greatly aided them in their labors. The principles which they laid down were these which guided I'Abbe de I'Epee in his teachings, when he first formed the class of deaf mutes. 1 15 boys and 15 girls are now being echicated where the Abbe once gave his solitary inslriiclion. Children ol" Iroin A to 15 years "10 of age are roceived and educated. They are permitted to remain 6 years- This institution is situated in tlie Rue St. Jacques. Institutiun des Jkunes Aveugles, — This very excellent and very admirably conducted institution, is situated in the J3oulevard des Inva- lides. It is now about 70 years since it was founded. EtHween 150 and 200 now receive instruction in the various branches of education. A full course is distrilmtod over a period of ei::lit years, and comprises* with the usual branches, a knowledge of different trades. HopiTAL Impeuia.m)es QuiNZE-VtNGTS. — Fouudcd by St. Louis in 122J' — this liospital afterwards contained so many, that b'adges liad to be worn to distinguish them from the other blind. It is aj^ain confined to its ori- ginal object, namely, the accommodation of, as its name implies, twenty fifteens. The old men of the JOth Arrondissement have a maison de rctraite of their own ; the origin of wiiich is peculiar. About l-i years ago, two young girls, one less tlian, and tl^e other 18 years of age, collected toge- ther a lew infirm old persons, and ])y begging the crumbs and waste vic- tuals from the rich man^s table, managed to support them. The National Guard, observing the good resulting from the labours of two individuals, and thinking that by more extended encouragement, they might obtain far themselves, a comlbrtable retreat when overtaken by old age, secured llie services of these two maidens. The inmates now amount to up- wards of 100. About jC-i sterling is charged annually to mal^s j £2 15s to females. Cheap boarding this 5 but " No solid (lish their week-day meal afTords, No nddtil )iuddi:igs solemnize the Lord's." A cup of coffee for breakfist; soup, a plate of meat, and a glass of wine for dinner; a plute of vegetables and a glass of wine for supper. The inmates work about six hours aday. and leceive half the proceeds of their labour. In the E-ue de Colombes, Protestants have a very agreeable retreat-— the Asile Lambrechts for the aged and the blind — amounting to 100. The situation is agreeable, the grounds and garden well laid out ; the whole establishment most comfortable. The Jews have, since 1S52, a house of refuge for those of their per- suMsiou, for which they are indebted to Baron .lames Kothschild. The Jlospice Israelite is second to no institution of the kind in external ap- pearance, and contains 100 beds. The Asile DE la Providence receives GO old persons; the Maison nE tSECOUBS Du Guano Orient, 24' ; relieves with bread, meat, fuel, elothing, or medicpments, the masons en voyage to or from any nrt of llie world, am! iuniishct tlicm with a home, or money, i( necessary. •Jl lain 6 years- it and very :l des InvH- een 150 and ncation. A coraprise.s> oil is ill ]22J< J to be worn 3d to its ori- lies, twenly 5 rctraite of rs ago, two lected togc- 1 waste vie-' ,16 National individuals, ight obtain gc, secured unt to uji- ?s ; £2 1bii Eiss of wine pper. Tlie edsof their e retreat— ng to 100. d out ; the { their per- hild. The itcrnal up- lie Maison meat, fuel, any nrt of necessary. The Maison IIospitaliere d'EngHIen lodges GO men and 40 woaien. The Lnfiumerie de ATarig Therese, 32. This brings the enumeration of the Hopitaux et Hospices Pari- siennes to a close, and, in talcing leave of them, I must express to my very excellent friend, Dr. Meding, Tresident of the Soci6te Med. AH., my warnest acknowledgement for his advice and assistance — assistance of the greatest moment, inasmuch as he himself, had previously been engaiied in the same labour. I have consulted his work, and when tiraedid not allow me to obtain correct statistics, I have incorporated his, well assured, that few errors were likely to occur in a work by a gentleman of his talent and application. A few general remarks on the management of (he Parisian Hospitals, legitimately belong to a description of each one of them. And as the int^ernal arrangement as well as the general management of them, differ in many respects from thoseof similar institutions in Britain and America —those remarks may possess some interest. While in Britain, Canada, and elsewhere, Private Charity erects, and private charity supports those institutions which have for their ob- ject the alleviation of diseased humanity— L'as&istanee publique forms a huge and important item in rrench Government. There are numerous exceptions, however, and costly edifices are her and there seen to rear their heads, beneatli which are collected numerois living monuments to individual philantliropy. These institutions flourish with the founders ; and, as a general rule, ihe latter, dying, " bequeath them as a rich lega- cy" unto their country. All French Hospitals, as well at Paris as in the Provinces, are under the direction of, are guided by, and receive assist- ance from, the adminulration gcneralc. This is one of the wealthiest and most perfectly organized corporations in Frnnce. With an annual income of upwards of half a million, it is placed lims tie besoin, and pre- ])nred for any emergency. This immense income enables it to support not only general hospitals, but also special ones for almost every disease and age. Thus it has been seen that the infant may draw the first breath of liflAn a hospital— reach extreme old age, and terminate his existence there ; and during the whole course of his chequered and diseased life, }>ublic solicitude watches over him, and ministers to his every comfort. The admi?iist ration generale is composed of a Director General, (a go- vernment ai>pointuient) a council of inspection, composed of 20 members, of which only 4 are physicians, a general secretary, two inspectors, and a treasurer. Each one of the above is charged, in addition to his common duties, with the inspection of certain institutions. The ostensible head of a hospital, in virtue of hisappintment is a non-professioual, or at least H non-medical ; the «dwa/ diiccler, in virtue of his duties, is u proles- r)'l «ionaI. Whfi'e a perfect lanlerstanding iuid friendly relations exist be- tween the legal and shoi.id be director, I mean, when the physician as- sumes all responsibility, and acts independently of, thoiigh apparently in concert with, the director, the latter, all the time unconscious but that Vie is the moving power, every thing goes on smoothly ; but when a director is too keenly alive to the importance of his oflice, is jealous of his prero- gative, und seeks for opportunities of exercising it, such as refusing wine or extras to pi'tients when ordereil, or denying admission to those Avho require immedicite ciiri,-, it is tlitn the greatest confusion arises, and the injurious elleets of misplaced poAv^er are. most ap])arent. This has been ci>nnnented upon at great length by th(^ Presse of Taris, and there is no doubt but the evil will soon be remedied. It is not left to the discretion of :in individual to seek admission into any hcs])ital he ju;iy choose, unless suddenly taken ill, or in danger of death from accident ; otherwise, he is compelled to go the Bureau Cen- trnl, in tlie Place du ranis, and there recei\ e a ticket for that hospital —to which the nature of the disease i)eculiarly entitles him. Thi.s Bureau, in addition to the above, serves the purpose of a large dispen- sary. The poor there receive bandages, trussc^s, bougies, catheters, belts, Avooden legs, «fce., (fcc, <5cc. On certam days, attention is given to spe- cial diseases, as of the eye, urethra, &c. The Bureau Central is com- posed of twelve physicians and six surgeons. But to return to the hos- pitals. The number now m Paris under the supervision of the achmnis' tration generale amounts to 27* In these 27 there are about 18,000 pa- tients. The number consigned to the care of one medical attendant is, by far too great. Most of the hospital stali are men of extensive prac- tice, and it cannot be expected that in an hour or less, physicians can prescribe (or 80 patients— more frequently still for '90, and often for 100. The huiried manner in which they pass through the wards,is as unproduc- tive to [)atients as to those who take the trouble to follow them— scarce- ly sulRcient time being allowed to enable the intei ne to write the oft repeated order, bouillon, bouillon, bouillon. Indeed, to hear a cli- nical teacher's observations on cases in the ward, a person must station himself in advance at some bed where the ticket has been taken down —for at such only does he stop. The hurried manner in which Physi- cians pass througl:. the wards, is, to a considerable extent, compensated lor, by the care and attention of the zealous and highly efficient hospital apothecaries and othm- officers. Patients are much more at the mercy of these, than of the attending Physicians, and much more still at the mercy of the Sisters of Charity who act as nurses. The latter are in ♦ I ilo not, ofcouise, incliuie the lur.iuuous private iiislilutioiis, some of which I have al- jcudv inenliosied in the text. •2:i i I'xist be- ysician as- larently in s but that I a director ■ his prero- ising wine those who irises, and This has and there lission into danger of ucau Cen- at hospital lim. This rge dispen- eters, belts, ven to spe- •al is com- to the hos- le adrmnis' 18,000 pa- ttt!r.dant is, nsive prac- sic'ians can ten for 100. s iinproduc- ni — scarce- i write the hear a di- nust station ;aken down liich Physi- Dmpensated L'nt hospital lie mercy of still at the ,ttcr are in lich I have a I* the constant habit of altering prescrij.tions, diet, Sec, ad Hhilmn. The ra;«emcs are advanced students— eloctcd annnally— and having served for one year are eligible for internes. These are elected for four years. The diet of the hospitals is divided into four kinds— the lowest or 1st consisting uf nothing— the 4.th or most generous of bread, soup, bodi'd meat, dry or fresh vegetables, in snlRcient quantity, with wine. The bread used is very good and is made at the Eoulangcrie Gen6rale in the Hue Soi])ion. The meat is killed at the Eoucherie Gencrale in the Boulevard de ITIopital. These establishments arc under the exclu- sive management of the administration gencrale. When patients leave the hospital they are allowed 3 portions of bread, 3 of wine and 5 of boiled meat with soup. The poor receive, in a.ldition, some money and clothes. The mortality nt the different hospitals averages 1 in 12.07- the greatest (1 in 9.0G) being at the Hotel-Dieu— the least (1 in 15.09) at the hopital Cochin. In closing, I cannot refrain from again alluding to, and censuring, that direct infringement of alUIygienic Iuav, by which 80, 90, or 100 sick per- sons are confined in a not over-cheerful or too well ventilated room. i The wholesale manner in which pntients are prescribed for, might also, " with ad<-antage to them, be changed. Nor would the immense number f of students who frequent the hospitals be iujured thereby, for it must be {apparent to all who have given the least attention to the subject, that more real good is to be derived from the careful study of a few select cases brought together in a clinical ward, (as is the case in the German I hospitals, and those British ones into which the late Dr. Graves intro- duced the German system) than in hurrying past a hundred diseased creatures, in about as much time as might suffice for the proper exami- nation of half a dozen. I There yet remain a number of houses of refuge, iVc, which should I with equal justice be introduced, but the limits originally prescribed have ! already been overstepped, and time and circumstances permit of but very little addition. I will conclude with a brief review of the most impor- tant medical societies^ &;c., commencing with that which seems to exer- cise the greatest influence on the character of the French Physician — the Facl'lte dk Medecine. — The foundation of this institution — pregnant with historic interest, is, by many writers, carried back to the time when Charlemagne held imperial sway. It was not till the middle of the 12th century, that the nature and objects of tlfe Faculte were defined — when it assumed to itself the prerogative and authority of a University. Up to that time, the members of it amounted to 31, the number (exclusive •il of Sar-Gonsaudllconlu.le.) iructisi.ig in Paris. Al its or.-.a il was poor for then, us uo\v,'Pl.vsici:uis, as a Inuly, were as much distinguish- ed for their poverty, us they ever have been for their scicntilic acquire- ments. In the beoinning of the 16th century, schools were built, and thence we may date the commencement of a sysUnu of instruction, which, modified and improved, has, in our day, arrived at a degree of exceUeuct? and perfection, which we meet not with elsewhere. At an early period of its history, there were two profes.^.ors of medicine ; one taught concerning " ildngs natural and unnalurair (anatomy, physio- logy, hygiene,! the other, concerning joreternaUmd things. Each cue corni>leted the course he had begun, by taking the place of the other. Surgery was then introduced, and physicians fearing they might over- step their legitimate boundary thus dcfino the province of surgery: Chirurgic^^ professor fihimrgica tantum doceat ulest qucBoperatio^icm manum mrtincnt. At that time the qualifications necessary to become a mem- ber were very high, and stran-e to say, of a medical society, members when admitted, were required to declare on oath that they were not married, nor were they allowed to marry, when members, under pain ot expulsion. Early in the 18th century, surgery, under the special favour of the King, eclipsed iu brilliancy, the proudest days of medicine, and the indignities which the latter had heaped upon surgery, were now aided by the strong arm of royalty, returned. The Faculte was, after a time, again victorious, and again and again was on the brink of disso- iution. It continued,however, to drag its sluggish length along until 18^.1, when the Academic lloyale came into existence. This Academic after- wards called Nationale, now Imperiale, succeeded in obtaining the sup- pression of the Eaculty-but only for a time-for students, attached to their teachers, and possessing unusual advantages in an excellent Mu- seum, Library, &c., would not attend those, whose greatest claim to be listened to, was royal favour. The Facult6 still exists, changed indeed, by making new and repealing old statutes, but still possessing the germs implanted by its founders, which has enabled it to exist during a period of 500 years of no common vicissitude, and at times to flourish. Con- nected with it, are an Anatomical Amphitheatre, Botanic Garden, Mu- seum (the flir-famed Dupuytren's) Chemical Laboratory, Library, Hos- pital, where there are conveniences for dissecting 450 bodies. All the chairs in the Faculte de Medecine are filled by men of world wide rcrnmime, and it is necessary to mention among others, the names of Cruveilhier. Malgaigne, Orfila,* Andral, Piorry, Bouillaud, Trousseau, Iloux,Nelaton, Velpeau, Dubois, &c., &c. in confirmation. The faces of the students wore an unusual air of solemnity, when on repairing on the I2lh mS 1853 to theE^olc de Medecine in the (^uarlm iMiin, ther found the gale, closed, td , it was ngiiish- uquirt.'- ilt, and fraction, ?gree of At au nc ; one pliysio- Licli one e other. ;lit ovcr- siirgery : I mamcm a mem- nieml)ers tvere not !r pain of al favour sine, and veve now vas, after of disso- ntil 1821, me after- f the sup- tached to silent Mu- lim to be ndced, by he germs r a period sh. Cou- rden, Mu- rary, Hos- 1 of world he names rrousseau, airing on the J gates closed, Institut de Fbancf. — At ilie latter part of last century, the various academies in Paris, of which there were then a great number, were united into one, under the name of Institut de France. It is unneces- sary to dwell at any length upon it, for few, I am convinced, who are at all conversant with French literature,can be ignorant of the advantages which have resulted to the whole scientific world from the labours of this non-pareille institution. The scientific world is also indebted to the Institut for being the first to permit to their distant colabourers in science— competition for prizes. Even at a time when the most deadly haired existed between the French and English nations, when all foreigners, especially Frenchmen, were excluded from taking part in, or competing for honours in the learned societies of England, the Institut under Napoleon, threw open « the lists," to persons of all parties, and of all nations— which were freely entered — and more than one Briton has borne off laurels from the Capital of France. The Institut is divid- ed into eleven sections. The first five pertain to mathematical science scilicet: geometry, mechanics, astronomy, geography and navigation, physics; the latter six belong to the physical sciences, they are : chemis- try, mineralogy, botany, rural economy, anatomy and zoology, and lastly medicine and surgery. Each section is represented by six members. Frangois Arago, whose loss, science has since had to deplore, was pre- sent in his place of perpetual Secretary, when I last saw him, in April 1853. Several prizes are given annually. Those relating to medicine are the following: 1. Pour recompenser les perfectionnements de la ro*- decine et de la chirurgie, et Jes d^couvertes ayant pour objet le traite- ment d'une maladie interne, et celui d'une maladie externe. 2. Pour r6corapenser ceux qui auront trouv6 le moyen de rendre un art ou me- tier moins insalubres, et a d6cerner aux ouvrages ou d^couvertes qui auront paru dans Tannic sur des objets utiles. 3. Prix de statistique. 4. Prix de physiologie experimentale, AcADBMiE DE Medecine.— Foundcd in 1820, for the purpose of furnish- and their eyes rested on a small piece of paper attached to the court-railing on which waa written: " caus^ par ia mort de M. Orfila." The unwelcome nature of the intelligence was visible in their countenances, for Orfila was their favorite and friend, and had fitted up a Museum of great value, which he dedicated " aux Etudiantsen Medecine," and had insU- tuted prizes in those branches to which he had devoted his lilie-time. The following Mon- day, the corse was borne from his late residence to the Eglise St. Sulpice, where a ser- vice for the dead was performed. All the professors and academicians in their robes as- sisted. The road leading from the Church to Pere la Chaise was lined by military, who, " close up" as the cortige passes. The coffin is laid in the earth— a funeral oration i« pronounced, and Orfila is left alone. Thus terminated the existence of one, whose sun rose m obscurily, but wentdown in fiplendour. Tbeyouth, who,upward8of half a century aga, finds his way to Paris, unknown, uncnred for, becomes the honoured associate of poten- tates and princes in science, whose authority has brought, is bringing, and will bring death or freedom to thousands who never heajd Ik name, for Orfila as a toxicologiiit and an tu- ►horifr in !.-g>i! fMc^licir?-, ito,---^ ?!or!€. 26 ing to government information concerning the public health. This is toDsidered the highest medical society in Paris— and to be member of it, is a distinction much coveted, and bestowed with care and discrimina- tion. The President is M. Berard, and the foreign British associates are Brodie, Lawrence, Marshall Hall and Travers,all of London. • SociETE DE Chirurgie.— This society, founded in 184-3, for the pur- pbse of advancing the interests of surgery, is composed of 36 members. Candidates for membership must present an original memoire, addressed to the society, accompanied with a written application. The character of the Essay, and the professional reputation of the writer, decide the voting. The President is M. Guersant and 15 distinguished foreigners are members, among whom are Brodie, Guthrie, Lawrence, and Travers of London, Ballingali and Simpson, of Edinburgh, Sir Phillip Crampton, of Dublin, and Mott, of New York. * A Society under the name Societe de Medecine pratique, under the presidency of Paul Dubois, holds its monthly sittings for the purpose of , directing special attention to Therapeutics. Another bearing the title Societe Medico-pratiqiie discusses at its fortnightly meetings, questions relating to practical medicine and surgery. The Societe Medicale d'E- mulation hold its sittings once a month. The above three give prizes annually, on the best essays presented to them during the year. Societe Medicale des Hopitaux.— Composed entirely of the physi- cians to the Civil Hospitals in Paris, this society, which publishes the business of its fortnightly meetings in the form of Actes de la Soci6t6 Medicale des Hopitaux, may be regarded as the exponent of French doctrine and French practice. It apparently possesses more vitality than the others I have mentioned, and occasional Assaut d'Armes, add to their discussions an enlivening character. Societe Medicale d'Observation.— Of which M. Louis is the perma- nent President--perpendend(E et numemndjE observationes— meets every Friday evening, at the Hotel-Dieu. The proceedings of the Societ6 M6dico-Chirurgicale may be gleaned from the Gazette des Hopitaux. The Soci6t6 Anatomique was reorganized in 1826 around a nucleus composed of Cruveilhier and a few students ; Cruveilhier has since con- tinued president. The Soci6t6 de Pharmacie, founded for the purpose Of binding together the pharmaceutists of France and elsewhere, dis- • Tf mnst hf. a source of gratification to Americans visiting Europe, to perceive the yerjj high .dmat'on in which tlfelr illustrious countryman is held-show.n, that there are ho e 31-""!!: who zr. nnf quite " Barbarians in Science." The nameof yalentmc Mot is as ramiiiJ; in' their mouthsls Household word,.'' Hi. •Action to the ^oc.cto de Luin.,,,. ■w*» th« only un»ninao«« o»«. 27 This is ber of it, jrimina- ates are the pur- lembers. ddressed haracter 5cide the )reigners Travers iipton, of nder the urpose of , the title questions cale d'E- ive prizes he physi- ishes the [a Soci6t6 of French ality than d to their rie perma- jets every e Societ6 Hopitaux. a nucleus since con- le purpose '^here, dis- eive the very lere are those e Mot tis " as tribute^ annually a number of prizes, many of them oi value, Boii: chardat presides and Souberain is Secretary. Biology has lately become a science in Paris, and the Societfe de Bio- Ipgie for its propagation, counts among its members, Velpeau, Mageur die, Andral, Bouillaud, Bartli, &c., the latter being president. The British, German and American Physician, congregated in Paris, have each a society (Parisian Medical Society, Verein Deutscher Aerzte, American Medical Society), in which are discussed what of interest has occurred in the hospitiiis during the preceding week. Mei- sieurs les Medecins des Hopitaux little dream of the over-hauling they sometimes get at the hands of these worthies. I will hazard a short sketch of the French Physicians for (although I much doubt my ability to give a correct one) the nature of this paper im- peratively demands some such attempt. But far from wishing to thiust any observations of mine upon the reader,to be received as articles of faith I would beg to mention them merely as impressions. If we follow a physician through the wards of an hospital, or attend him in the walks of private professional life, we soon learn to form an estimate of his cha- racter, and to estimate, at something approaching to an equivalent, hi^ professional worth. Of individuals, however, it is easy to speak, but, to reduce a class composed of such heterologous material to a general standard, is, to say the least of it, a matter of no small difficulty. Regard in what aspect we may, the Parisian Physician and Surgeon (for sucl) I take as the type) the conclusion at which we cannot but arrive, is, that they are, generally speaking, men of high scientific at- tainment§, and, in the principles of their noble profession well versed. Few there are who deny this, and were we content to admit all that is told us concerning " The way toe heale diseases rare As if by plummet rule and square." the high opinion preconceived of them would be greatly strengthened. Indeed, on first visiting Paris, I was half inclined to think that I had spent too much time in cruising about among the hospitals of Britaia and Germany picking up the little crumbs of knowledge. How much more might I have learned, thought I, had I sooner directed my steps hither where they seem to have the happy nack of curing diseases in /to//" the time. But the charm with which novelty invests ail things, soon wore off, " and then came a change o'er the spirit of my dream." The Chefs de (Jlinique, especially those of renommee seem placed in a false position, as it were. Great things, in the form of novelties, are exr pected of them, and their utmost endeavour is exerted in catering to this .morbid iaste« But taking matters by the fore-lock i» frequently the ^ 28 least expeditious, and the remedies Innded, and the theories built-up to- day, require discarding and pulling down to-morrow. The lectures of many of them are occupied, and the medical press teems, with " won- derful discoveries" for curtailing misery and lengthening the human span No doubt, a stray shot does occasional ly hit the mark, hut the vast majo'rity fall far wide of it. If we wish to derive much real.and less ap- parent good, we require to leave the much frequented haunts ot students and visit those hospitals where time permits the attendant, quietly to con- sider the cases under treatment, and it is there we see Freuch practice, and hear opinions which have been matured by experience and reflection. The French are proverbially no philologists, and it may be for this reason that we rarely hear the name of a British physician or surgeon men- tioned within the walls of a College or Hospital, unless by Britons them- selves, who do not like to see their countrymen passed over in silence. At fint I thought this proceeded from jealousy, and no doubt it ofter does, but when we hear a lecturer, for instance, enumerate the differed amputations at the foot without mentioning Harvey or Syrae ; speak o diseases of the chest and liver, without allusion to Stokes, Budd, &c but cite in ail cases, French authority and the results of French practice we cannot but conclude that they are really ignorant of the existence c such men, and of the boon they, et hoc genus omne, have conferred c mankind. Indeed they seem constantly to impress on the minds of th students, that, without the gates of Paris there is little to be learned, im pressions generally acted upon, for French students are rarely met wit) out of France. The political alliance now happily subsisting betweei the two great powers will j^reatly tend to a change in these matters The French Physician possesses in an emir.ent degree that « mani^r « faire" so peculiar to his countryms- '' might also add '« la manidr a parler," but verbiage is oft times suua i argument. An hou is with ease occupied in discussing quest! *riviul importance. Fo the time an auditor may be well satisfied, t .eirospective glance to often shows him that there has been (to use a Shakspearian phrase « much ado about nothing." I do not intend such sweeping remarks to apply to the whole profession, for there are men such as Civiale, Nelaton, Audral, Velpeau, Guersaut, and a hundred others, who despise anything approaching to thailatanerie, but I am convinced that they are appli- cable to the class. Of the talents, genius, faculty for observation an. powers of perception of the French, it would ill-become me to speak, they are discernible in almost every page of medical history, and the names of many will last as long as the science they have so much en- riched. The medical student in Paris is not so distinctive a character as he is 29 \t-up lo stures of " won- I human the vast I less ap- studentij y to con- practice, jflection. is reason 3n men- ns them- silence. )t it ofter different speak o udd, &c practice istence c ferred c ids of til Lrned,iir met wit) ; betweei matters ' mani^r I mani^r An hou ince. Fo fiance tO' m phrase jmarks to 5, Nelaton, ! anything are appli- ration an* to speak, r, and the > much en- in Germany. While the latter has been pictured with his scars acrow his intelligent and eontented looking face, his mug of Bayerische bier and his pipe, the latter might be sketched with his wan, sallow countenance, his demi-boutnll". de bon vin before him, pud his grisette by his side. The latter is with him an indispensable article of furniture to grace his lodg- ing, prepare his meals, &c. Eacli grisette occasionally gives her little tea-party, at which assist the intimate friends of her aimant and their »»risettes. Once aweek they adjourn to the Prndo, or some other dancing locale, and there " trip the light fantastic toe." The gri- settes, when students are received, are transferred to some one elsei provided they do not get married, which not nnfrequently happens. It is sometimes a difficult matter to keep students in order during a lecture or operation. If too long, they put an end to it by their shuffling. If some unlucky assistant places himself between the operat«r and the stu- dents, the confusion that arises is really amuaing ; he is saluted with such epithets as cannot but be painful to his vanity ; and if that does not suc- ceed, with such missiles as may chance to become. If a lecturer is too long in making his appearance, one might fancy that all the animals of a menagerie had found their way into the lecture room, nor is quietness alvrays restored on his entrance. The curriculum of study requires four years in Paris. It is not so ex- pensive as in Britain, for hospital tickets, wiiich, in the latter, form such a huge item of expense, are free. The order of study is prescribed by the College. [ have thus hastily reviewed much of what I considered interesting — but while there yet remains matter for a hundred such papers, I have contented myself with merely lifting a corner of the veil which conceal* the whole. Montreal, January 22, 1855, ;r as he is