BRIEF MEMORIES OF LOUIS AND SOME OF HIS CONTEMPORARIES IN THE PARISIAN SCHOOL OF MEDICINE OF FORTY YEARS AGO. BY HENRY I. BOWDITCIij. M.D., MEMBER OF THE SOCIETIES FOB MEDICAL OBSERVATION OF PARIS AND OF BOSTON. BOSTON: PRESS OF JOHN WILSON AND SON. 1872. BOSTON, Oct. 10, 1872. HENRY I. BOWDITCH, M. D. DEAR SIR, The undersigned, a Committee of the BOSTON SOCIETY FOR MEDICAL OBSERVATION, have the pleasure to request of you, on behalf of the Society, a copy for publication of your " Memories of Louis and some of his contemporaries," which you read to the Society at a recent meeting. Hoping you will comply with the request and thereby enable the Society to express its respect for the memory of Louis, we remain, very truly, yours, EDWARD H. CLARKE. CALVIN ELLIS. FRANCIS H. BROWN. BOYLSTON STREET, Oct. 10, 1872. DRS. CLARKE, ELLIS, and BROWN, Committee of the BOSTON SOCIETY FOR MEDICAL OBSERVATION. GENTLEMEN, The "Memories of Louis," as I stated at our late meeting, were written con amore, and at the same time calaino currente. It seemed to me proper that some notice should be taken by our Society of the death of Louis. While I wrote I thought of the friend as much as I did of the teacher. It gratifies me, of course, to know that the members of the Society were so far pleased with my endeavor to do honor to the memory of that excellent man, as to request a copy for publication. I can only hope that others who may take the trouble to read it, may be equally kind in their judgment. I herewith give into your hands a copy for the press. Very truly, yours, HENKY I. BOWDITCH. BRIEF MEMORIES OF LOUIS. GENTLEMEN AND MEMBERS OF THE SOCIETY FOR MEDICAL OBSERVA- TION AT BOSTON : To the influence of our celebrated professional associate Louis, of Paris, we owe the birth of this and of kindred Societies elsewhere, and the estab- lishment of the Clinical Conferences of the Medical School of Harvard College. At this meeting, there- fore, when you not only return from your " long vacation " of the summer, refreshed and prepared for renewed labors in the study and practice of our art, but likewise have, through your efficient secre- tary, been led back to the earlier days of this asso- ciation, it seems most appropriate that we should step aside from the usual course pursued at our meetings, in order to pay a passing tribute of respect to the memory of that great master in medicine, who, enriched by well-earned honors, and surrounded by loving friends, has, since we last met, died at the ripened age of eighty-five years. It is with a peculiar, though melancholy pleasure, that I undertake to speak to you at this time, for I had towards that master not only these reverent feelings of respect which Hippocrates tells us we ought to have toward any excellent teacher who has led us into this noble profession, but I have had still warmer emotions whenever during the last forty years I have thought of him as one of the dearest of my personal friends. For this latter reason you will perhaps the more readily pardon any undue enthusiasm you may think I show while speaking of the character and works of this worthy man. LOUIS' LIFE-WORK. In the " Pantheon des Illustrations Frai^aises au Dix-neuvieme Siecle," published at Paris, 1855, I find the following terse and most modest biography, which Louis allowed to be published with his portrait : l " Louis (Pierre Charles Alexandre) , Honorary Physician of the hospitals at Paris ; Member of the Imperial Academy of Medicine ; President for life of the Society for Medical Observation ; Officer of the Legion of Honor, was born at Ai (Marne) in 1787. 1 Panthdon des Illustrations Fran?aises au Dix-neuvieme Siecle, conte- nant un portrait, une biographic, et un autographe de cliacun des homines les plus marquants dans I'adininistration, les arts, Parme'e, le barreau, le clerge", Pindustrie, les lettres, la magistrature, la politique, les sciences, &c. Public sous la direction de Victor Frond, Paris. Lcmcrcier, imprimeur, 57 rue de Seine, 1865. " He was destined by his family to the study of the law, but he soon abandoned that profession in order to study medi- cine. " Having received the rights of doctor of medicine, in 1813, he left France in 1814, and went to Russia, where he practised the profession, after having obtained, at St. Peters- burg, a diploma of doctor of medicine. " On his return to Paris, in 1820, Medical Science, under the influence of the writings and public teachings of Brous- sais, was in great confusion. Much was in doubt, a very painful doubt, and in order to relieve himself from it he resigned practice, and gave himself up wholly to the observa- tion of patients at the Hospital of La Charite". This he did for six consecutive years without other occupation. "The study of the facts there collected enabled him to publish successively : "In 1823, a memoir on perforation of the small intestine, in acute diseases ; a second, on croup in the adult ; a third, on the communications between the right and left cavities of the heart (Archives de medecine). "In 1824, two memoirs on the pathological anatomy of the mucous membrane of the stomach ; another on pericar- ditis. "In 1826, a memoir on abscess of the liver; another on the condition of the spinal marrow in Pott's disease ; a third on sudden and unforeseen deaths ; a fourth upon slow but anti- cipated deaths, but which anatomy will not explain ; a fifth on the treatment of tjenia by the Darbon potion (Archives de mdecine). "In 1825, his Anatomical Researches, &c., on Phthisis (1 vol. 8vo) ; reprinted with many additions in 1843. "In 1828, Researches on the Typhoid Affection or Fever (2 vols. 8vo), reprinted with many additions in 1841. "In 1834, Examination of Broussais' examination (in 8vo). "In 1835, Researches on the effects of Venesection in some inflammatory diseases (8vo). "And, finally, 1837, in the first volume of the ' Me'rnoires de la Socie"te Medicale d'Observation,' a Dissertation on the examination of patients and the study of general facts (pp. 63) ; a memoir on vesicular emphysema of the lungs (100 pp.) ; and, in the third volume of the same publication, his Researches on the Yellow-Fever of Gibraltar, where he had been sent, in 1828, with Messrs. Chervin and Trousseau, in order to observe the Yellow-Fever as it prevailed at that place (pp. 300)." Such, gentlemen, is the simple history of Louis' scientific life as given by himself, without com- ment ; viz., fifteen memoirs and four ample octavo volumes, published between 1823 and 1837. These works, though but little read now, formed an epoch in medicine at the time they were published. They were, in fact, the stalwart protest of an earnest, truth-loving man against all the theories then ram- pant under the powerful and winning influence of Broussais, who had regally governed the medical mind of France, England, America, and, in a mea- sure, that of the entire civilized world. Louis' works arc all founded on analyses of cases, recorded without prejudice, but with the greatest accuracy and much detail by the bedsides of the sick. THE NUMERICAL METHOD. They form the brightest exponent of the so-called "^sTumerical Method," of which Louis was the father. This system consisted in counting the various items of several cases, whereby we are enabled to state the exact numbers of cases in which certain symptoms or lesions are observed. It has been the object of ridicule, but nevertheless its very enemies have felt its power, at least in cer- tain directions. 1 It has compelled men at least to appear to investigate thoroughly ; and those of us who believed in it, not as a perfect method, but one which had infinite advantages over the imaginative modes, too often followed previously, have had a secret pleasure in seeing men like Bouillaud, the great disciple of Broussais, at times bowing to its influence. We were also delighted at the cordial 1 One of the squibs of the day was somewhat of this nature : " Louis impressed upon his students the importance of recording the hereditary tendencies in each case. The caricature showed an over-zealous and not very wise pupil, summoned suddenly to set a broken leg, who would do nothing without recording. He has taken out his note-book and has re- corded name, age, and the ancestral troubles of the sufferer, and, according to rule, asks, 'Were your parents or grandparents, uncles or aunts, liable to broken legs or arms ? ' ' 2 10 recognition of its value by Louis' great and eloquent friends, Andral and Chomel. For my own part, I have always believed in that system ; although 1 did not see how it could be exactly applied to many of the minute problems of therapeutics, however easily and properly it could be used in many other medi- cal researches. To that method and to the strict course of investigation which every one ought to pursue in every case, and which was called into use by Louis, I am sure I owe the greater part of what- ever professional success I have had. While then I would urge my junior associates to ponder well this assertion, and to practise upon it with assured suc- cess, I ask all present, if I ought not to be grateful to it, and to the master who taught me this right course of study and of subsequent action. But, whatever may be your opinion, certain it is that its influence, and with that influence the fame of Louis, extended wherever medical science was culti- vated. Louis' works on Phthisis and Typhoid Fever were considered, when first published, and are considered now, as far as they go, a collection of laws of these diseases, derived, as the astronomer derives his laws, from simple observations, and a wide comparison of many such. The "numerical method'' is virtually now carried out under our more improved means of investigation, in which, 11 from the nature of the case, there are fewer observ- ers. We take no one man's assertion of a fact on any question of scientific interest ; but require that numbers of men should confirm or reject it after numbers of observations made by each. As I have acknowledged its great power over me, so I think I see its distinct effect on some of the best writers we have had in England and America during the past thirty years, even when some of them would hardly admit that they were disciples of Louis. But the immediate influence of Louis upon sev- eral English and American students was very great. They carried home his ideas, and these ideas spread rapidly in England and America. SOCIETY FOR MEDICAL OBSERVATION AT PARIS. In 1832, a few students in Paris proposed to form a Society for medical observation, and they asked Louis to be their perpetual president. They also requested Messrs. Andral and Chomel to allow themselves to be considered as honorary presi- dents, as they would thereby show their respect for the objects of the Society. All these gentle- men consented. These objects were : 1. To make all the members of the Society good observers of disease, by requiring each in turn to 12 go through a kind of apprenticeship in the record- ing of observations, and in submitting such obser- vations to the criticisms of every member of the Society. 2. They hoped to be able to influence the medi- cal mind generally, and bring it to the comprehen- sion of the great value of accurate observation and recording of the phenomena of disease. 3. They also hoped, either as a Society or as indi- viduals, to publish memoirs which, being in them- selves strict deductions from facts, would be real additions to medical science, while at the same time they would present fair examples of the numerical method as used by Louis in medicine. These three objects I believe were attained. Societies for medical observation were also estab- lished in London and Boston. It must be ad- mitted that the plan pursued by the parent Society was not likely to persuade the majority of students to join it, even though they might admit the value of accurate observation, and the importance of be- coming skilled observers. That plan was to have weekly meetings, at which each member in turn was required to read an observation which had been recorded at the bedside. The members were ar- ranged around a table which occupied three sides of the room, and each person had paper and pen or 13 pencil before him. He was prepared to listen care- fully to the reader, and equally prepared to note the most trivial omission or a too inconsiderate deduc- tion made by him. In turn each subsequently criticised the papers from these notes. This was done in the keenest manner. Louis, as president, summed up the result of the meeting by not only criticising the reader, but also his critics' remarks, so far as he deemed them proper, or worthy of further remark. In order to give you a more perfect idea of the methods pursued by the Society, allow me in this connection to tiy to bring up to my own memory and possibly in some degree before you, the facts as they occurred at my reception into it. How vividly do I remember the general effect of that evening when I presented my first " observa- tion," and stood prepared to meet such criticism as I have spoken of! Though so long ago it seems but as yesterday, that, having at last, after much labor and trial, succeeded, with the aid of my friend Bizot, in having my case rendered into good French, I took my place at the three-sided table above alluded to. I had in my anxiety been awake and oftentimes engaged in writing during much of the previous night. Of course this foolish proceeding did not tend to make me calmer as I approached 14 the ordeal. I got through with the reading well enough for an American who was not quite skilled in the tripping, light language of France, and doubtless with many a slip in proper intonation, often, I knew, provocative of an internal smile, but which those around me were too polite to express upon their faces. But the reading was a small matter compared with the subsequent judgment of that Khadamanthine court, as it almost seemed to me when fairly brought before it. I had ceased reading, and Louis proceeded to ask each member in turn to state the errors he had noticed in the paper. With this commenced a running fire of the severest kind of criticism. All of it was made in the most gentlemanly manner and evidently in no captious spirit, but simply with the determination to make as much out of the occasion as could be made towards the clearest elucidation of the subject. Of course I had neglected many common questions which adepts felt necessary. These I admitted frankly. But when one book-worm seized upon me and held me up as neglectful of duty because I had not made my " observation," by a more proper and more careful questioning of my patient, elucidate some distant relations which the disease in question bore to another; or when a second member quietly remarked that such a writer, naming him, of whom 15 perhaps not one other member of the Society had thought, had suggested so and so, and that I had absolutely neglected to offer any answer to that important matter, after such remarks I, of course, was dumb. All the members having thus given their views, our president, Louis, took up the subject, and, after rapidly reviewing what had been said by others so far as he thought necessary, finally came down upon me like a discharge of one of the far-famed mitrail- leuses upon the body of an enemy. If my compeers had hit hard with their random shots, he would, it seemed, annihilate me, as in fact he finally did on one of my points ; viz., that because I had not pare- fully examined one side of it, I "might as well have omitted all reference to the subject " ! And with this our meeting ended. Believe me or not as you may when I declare that I bore the whole not only with complacency, but with a certain grim delight. It was evident that there was to be no nonsense, and that in that society I should have what Burns so graphically describes when he sings: " O wad some power the giftie gie us To see oursels as others see us." And I was heartily contented with the result. I looked forward with pleasure to another trial, fully 16 satisfied that much good would result therefrom. My subsequent experience in the Society proved that this kind of treatment was readily borne by all the original members, composed as they were of a company who united for that very purpose, and knew what they were to undergo. None among them ever allowed any sentimental delicacy towards a reader to prevent him from noticing any thing deemed erroneous or wanting in any paper ; at the same time there was 110 petty quibbling, no personal attacks; and all bore good-humoredly any remarks, however severe. I am not aware that any member ever left the parent Society in consequence of that severity. As much cannot be said of this, our Boston Society, although certainly of late years we have not made even the most trifling approach to the standard raised at Paris. And I fear we never shall come up to that standard. Certainly we never shall do so unless we wholly change our present modes of conducting our meetings. Com- pare the two, gentlemen ! What lack-lustre gatherings we have here now compared with those in the palmy days of the parent Society or even of this Society! It is true that in the earlier days of this Society we made an approach to that model ; and I know that some of those whose names now 17 appear on our retired list, in the newly printed catalogue of members, left our company because of the severe species of criticism then prevalent. It is true also, sometimes the manner in which those criticisms were made had not that fine polish which I always noticed in Paris, and which cannot be found perhaps anywhere save in that gay capital. Nevertheless, would that we could go back to old habits, and gather again around the table, each with his paper and pencil before him prepared for real work, all of us! whereas now, usually, we listlessly let a reader give us some most important or it may be very imperfect papers, and then, while admitting this in private, we fail to express an opinion or to criticise him openly. To speak the plain truth, gentlemen, the Boston Society for Medical Observation seems fairly emasculated in respect to that truthful criticism which it behooves all honest scholars to be willing to give or to receive. It would seem at present as if the elders of the Society could not, and the juniors would not, engage at all in this noblest of exercises, that is if it be governed solely by a pure love of and a desire to arrive at truth. 18 MEMOIRS OF THE SOCIETY FOR MEDICAL OBSER- VATION AT PARIS. Since its commencement in 1832, the Society in Paris has published three volumes octavo. Al- though some of the subjects investigated may not happen to be those most interesting to young medi- cal minds of the present day ; and although the investigations are less perfect than we have now the means of making, in these microscopic, spec- troscopic, thermometric and chemical times, nevertheless the treatises, as far as they reach, will always remain true expressions of the teachings of nature, as far as any of the necessarily imperfect labors of man can be. POSITION OF LOUIS IN MEDICAL HISTORY. Where now in the history of medicine shall we place Louis? It has always seemed to me that we should place him, in his influence on his own and on subsequent generations, by the side of John Hunter, Morgagni, and men of that stamp. Not that we could class his intellect with that of John Hunter ; although with Morgagni he would be nearly if not quite on a par. But John Hunter, in his far-seeing genius, so much transcended any 19 other man we have had in medicine for centuries, that it would be impossible to rank Louis with him. Nevertheless the three were not only animated, but were fairly " possessed," as it were, by the spirit of inquiry into the secrets of nature in medical science. It is the same impulse which urged Faraday, and which has urged all really great scientific investigators, and which will continue to do so till the end of time. These three great men of our profession were "possessed" by this spirit in an eminent degree. Louis finely describes it in the autograph which he gave to the editor of the "Pantheon" already alluded to. At his last interview with me, Louis, when giving me his portrait and autograph (which I now place in your care), slowly read over the words, as if they were his parting gift to me, his pupil. It runs thus : " There is something rarer than the spirit of dis- cernment : it is the need of truth ; that state of the soul which does not allow us to stop in any scien- tific labors at what is only probable, but compels us to continue our researches until we have arrived & evidence." 1 1 H 7 a quelque chose de plus rare que 1'esprit de discernement, (feat le besoin de la verite ; cet etat de 1'tiine qui ne nous permet pas de nous arretor, dans les travaux scientifiques, a ce qui n'est que vraisemblable, et nous oblige a continuer nos recherches jusqu'k ce que nous soyons arrived & 1'e'vidence. 20 This principle, underlying as it does the works of Hunter, Morgagni, and Louis, and others of that class of mind, allies them to one another, and has ever made their influence great with their associates, and still greater in a wider field with posterity. Not that the persons who may be so influenced will always recognize the benign power that sways them ; but they will be swayed notwith- standing. That this is true is evident in the present power of John Hunter, but who, of the many who allude to him, now read his many works? His powerful mind has indelibly impressed itself on the ages, because it was in its operations con- sonant with those of nature, which are ever en- during, ever widening. Morgagni, Hunter, and Louis were all a protest each in his own day, and within his own intellectual limits against any pretence to unravel the secrets of nature by specu- lation merely. They all deemed that hard labor on the facts of nature alone brought out the truth. CLINICAL CONFERENCES AT HARVARD. Here let me allude to one influence now exerted by Louis, and which I trust will be for ever exerted by him in Massachusetts. The origin of this in- fluence is suspected only by a few, and is wholly 21 unknown to most of those who have felt it hitherto. I allude to the Clinical Conferences, so called, of the Harvard Medical School. These exercises were commenced in 1859, when I first became connected with the chair of clinical medicine in the University. Since their commencement, I think I may say with truth, they have been of service to all who have practically engaged in them, although of little or no use to those who range themselves as mere spectators in the upper seats of the theatre in which these sessions are held. I here confidently appeal to those who have availed themselves of these opportunities for instruction to say whether there is any other work in that school which is more stimulating to vigorous mental action than these " Conferences." And they owe their origin wholly to Louis. They are, in fact, simply an ap- plication to the teaching of clinical medicine in Massachusetts of the principles and modes of action pursued by Louis and the Society for Medical Ob- servation in Paris. Let me add that the very word " conferences," which has been sneered at by some as savoring rather of religious dogma than of science, is adopted from Louis' own expression, who in his modesty would not call his clinical lectures at La Pitie by that name, but simply " conferences," though in 22 public he did all the talking. But after his lecture was over, he, like Socrates, delighted to converse with a bevy of young disciples ; and certainly these subsequent conferences were most profitable to us all. A1STDRAL, CHOMEL, AKD LOUIS ! THE TRIUMVI- RATE OF THE MEDICAL SCHOOL OF PARIS OF FORTY TEARS AGO. How friendly were these three men ! how similar in their undercurrents of thought! how dissimilar in their modes of expressing these thoughts ! Allow me in passing to try, hastily and all im- perfectly I know, to bring up before you each one of these great men of our profession. Andral, as professor at the Ecole de Medecine, was lecturing on general pathology. Chomel gave clinical lectures at La Charite ; Louis held his " conferences " at La Pitie. Andral was the rising sun. Broussais, then faltering with age, still clung with iron tenacity to all the theories he had pro- mulgated, and fought for them in his old arena, the amphitheatre of the school, with a fury that at times was most unamiable to see. Quite grotesque and what would have been very laughable incidents occurred at times at his lectures, if one could ever look with levity on the follies of an old % man who, having been once famous, had survived his own fame, not only with the wild students at Paris, but likewise with many medical men. By a most un- fortunate arrangement for Broussais, he was com- pelled to lecture during the hour immediately preceding that which his junior and great rival Andral occupied. The consequence was, that those wishing to procure good seats and to hear Andral with ease in that immense amphitheatre, were forced to listen, the half-hour previous to Andral's lecture, to the violent denunciations which the weak old man squeaked out against all who did not accept the doctrines of the "Phlegmaties Chroniques." At these times he would often become almost fran- tic, as he saw the seats which had been nearly empty at the beginning of his own lecture, gradu- ally filling to their utmost capacity towards the termination of it, with students who had come to hear his younger and great opponent. His face at such a time seemed to light up apparently in unut- terable wrath, and he rapidly poured out his vol- umes of theory upon those who, he well knew, were adherents of Andral. One day, in order to occupy the vacant half-hour, one of my friends, with whom I usually attended upon Andral's course, made a pen- cil sketch of the angry professor; and the artist has 24 caught, as we all thought at the time, I had nearly said the almost demoniac expression which Brous- sais had at the moment of his anger. That sketch is now in the Cabinet of the Harvard Medical School, and I never looked at it without having most vividly brought back to my memory the fol- lowing scene. The amphitheatre was nearly full. The professor was dressed in his usual scarlet- trimmed cap and flowing black gown. As he went on in his discourse he became more and more earnest. His face glowed savagely. His arms were thrown about furiously and rather irregu- larly. He used two pairs of spectacles ; one rested on his nose, while the handle of the other was grasped in his right hand. We never could tell whether it was this second pair or some fold of his gown which floated up ; but certain it is that one or the other struck the profes- sor's cap, and it rolled from his head upon the floor before him. The confusion of the unfortunate man at the accident may be imagined. It was most painful to many of us who now began to sympathize with him. The incident, however, met with no sym- pathy from the majority of the students collected there, and the room rang with derisive laughter, and the lecture was suddenly and ignobly finished. Immediately after Broussais had finished his lee- 25 tare, Andral entered and took possession of the professor's vacant rostrum. He was quiet and calm, and bowed gracefully to rounds of hearty applause from the students. Andral was rather below the medium size. He had a young and a fine intelligent face. His head was covered with an ample supply of dark hair. The moment he commenced speaking there fell over the vast hall of the Ecole de Medecine an entire silence, which was preserved with the great- est decorum and attention to the very end of the lecture. Andral always viewed in its fullest extent, and really ennobled in our eyes, every subject, what- ever its character, on which he undertook to speak. His learning seemed illimitable, and he would gather all of it before us to illustrate his theme. He was, nevertheless, a great dealer in facts, which with his broad generalizing power he was wont to classify, when inferior men were unable to see their relations. His tendencies were, if I may so speak, centrifugal, as Louis' were centripetal. That is, Andral, while obeying a certain impulse to rest on facts, would with his learning and imagination bring data from the opposite extremes of medical experience, and bind them into one vast whole. All this was done in the most polished language, with an easy, frank delivery and perfect self-possession. His sonorous 26 voice rang through the amphitheatre, and he kept the attention even of the most frivolous of the students riveted to the subject. He felt entirely at home among them, and he governed them with his words and a nod. He was the demigod of the hour and place. Next to Andral appeared, in the eyes of most stu- dents, the well-beloved and respected Chomel. He reminded me in his manners to his patients and to his pupils, in his clear method of lecturing on cases and his skill in diagnosis, more of the late Dr. James Jackson than of any other man, I ever saw, French, American, or English. He was always the genial, easy-speaking, well-informed, truth- loving teacher and gentleman. His intelligent smile was like a sunbeam to us. Words fell from his lips like the natural and melodious notes of a bird. His eloquent and truthful lectures won all hearts as much by the grace and kindly manner with which they were delivered as by the medical learning they showed. His allusions to the laws laid down by his great friend Louis won praise from all. And last but not least of these three comes Louis. I have already alluded to his style of lectur- ing. He was of tall, compact form, and with fea- tures rather severe ; grave in manner to those who 27 knew him not, but full of loving tenderness to those to whom he gave his heart. "With his patients he had a brusque manner, and a quick, jerking kind of utterance; and often, I doubt not, appeared rough when propounding his searching questions. His voice lacked the clear tones of Andral, the gentle, win- ning softness which marked Chomel in his general intercourse with the students. In fact it seemed to me that until age and grief had mellowed Louis' whole nature, he lacked towards the multitude that fine delicacy of voice and manner his two friends pos- sessed in a high degree. But that he had it, those well knew who were admitted to his friendship. What shall I say of Louis as a lecturer ? He was not an easy speaker. He lacked power and grace of delivery. In fact, in order to be able com- fortably to follow him, one needed to feel the value of the method he had pursued in his studies, and to have a faith in his love of truth coupled with a belief that from these two facts the professor would be better able than any mere theorist to re- veal to us the laws of disease, so far as they were known. But he was ill at ease in the teacher's chair. He would talk fluently by the bedside of a patient, and give out the brilliant results of his years of patient labor while in Chomel's wards; but he trembled and was awkward with his notes when 28 lecturing at his so-called " conferences." His hand at times shook so much that one felt a sincere pity for him, as in his " numerical " way, he laid down his propositions. The consequence of all this was that Louis always had few followers. "He was dry," the students said. He had none of the glowing and delightful manners of Chomel or of the eloquence and comprehensive views of Andral, whose simple presence in the vast amphitheatre of the Ecole de Medecine was always the signal for wild enthusiasm of the two or three thousand stu- dents who filled it. LOUIS AS MAN AND FRIEND. "When a few weeks since I read in the " Medical Times and Gazette " the fact that Louis was dead ; ' and that Barth, my old fellow-student and asso- ciate in the Society for Medical Observation, now president of the National Academy of Medicine, had said words of touching eulogy over his grave, a pang went through me as at the loss of one of my dearest friends. And, gentlemen, I had just reason for such a feeling, as you will readily acknowledge when I tell you the following fact. When I, a young American stranger, fell ill in 1 After a brief illness, Aug. 22, 1872. 29 Paris, Louis immediately sought out my residence and attended me like a father during a severe rheu- matic fever which lasted for weeks. How many of our American professors would do the same favor to a young Frenchman who should happen to be attending their lectures ? It is true that I had been favorably introduced to him by my classmate James Jackson, Jr., and Louis and Jackson were devoted friends ; and, through their friendship, I was able to see how cordial and true Louis was in those inti- mate relations. How like pleasant dreams come up before me the daily morning visits of that excellent man during those weeks of lonely and severe suffer- ing ! How genial and even merry his voice at those times! He always had some badinage to cheer me, and often words of wisdom. :r Well, my dear," said he one morning, "are you taking notes of your case ? You cannot do any thing better, for you may be sure you will never have a better opportunity of studying it than you have now I " The suggestion seems at first sight a joke, and yet I do not think he really meant it wholly as such. At any rate, it led me for some days to the notice of special parts of my body which became successively affected, and my time was thus to a certain extent pleasurably passed in watching the different muscles or joints as they became painful or difficult of motion. A 30 few days afterwards on my mentioning the fact that I had noted' down various items, but that I could do so no longer, as both hands were then lame, "Oh ! " he replied with sparkling, merry eye, "now you must dictate." But this was more than my human nature could endure, especially as the pains became terribly acute soon afterwards. / INFLUENCE OF LOUIS ON SCEPTICISM IN MEDICINE. I spent the greater part of two years and a half in his wards. In the spring of 1835 I left him with regret. I had had special courses with various individuals ; but my chief, I may almost say my only, Parisian medical education had been with him. He had moulded my medical mind into such a rigid belief in the necessity of strict deductions from facts actually studied out with the utmost care at the bedside that, for a time, I flippantly talked of all that had preceded us as if their influence was to be deemed of no im- portance in the presence of the exceeding light that strict observation was to throw on medicine. I also gathered from him a scepticism in regard to all treatment, and was apt to think it extreme wisdom to decry all remedies, even those which centuries had handed down to us. I have had gradually to 31 unlearn this grave error, as I deem it, under the influence of my own experience in practice. But it is astonishing how little of the details of medical diagnosis and prognosis which I learned of him I have found erroneous. But, after all, are not these among the chief objects that should interest every physician ? How in fact can we treat any patient without them ? The late Dr. James Jackson, our master in medicine for New England, once said : " Gentlemen, study always to make an accurate and minute diagnosis and prognosis in each case. Hav- ing got these accurately, the treatment is compara- tively plain." To the first part of the proposition I suppose we all heartily agree, but to the latter, viz., as to treatment, we should none of us now give our consent ; for, in the utter chaos of opinion now ex- isting as to treatment, all are pervaded with a trem- bling hesitation, very different from that state of comparatively placid routine which held sway when Dr. Jackson uttered the remark. Over this chaos I think I see a light breaking, and already some of the great points of therapeutics, some of which have been often seen since the time of Hippoc- rates, are reappearing amid the mists that surround us. But the amount of the positive which I got from Louis as a physician, so far transcends all the merely negative, and the love I bore him as a man, 32 have been so precious to me, and so perpetually recurring during" all my professional life, that now my regret at his death is more than can be told to any. HIS LATER LITE. I have seen him twice during the past forty years. In 1859 I found him keenly and kindly critical as of old. I laid out before him on the floor of his study at Rue de Menars my map of Massachusetts in reference to the influence of moisture in causing consumption. It was evidently a new thought to him. He did not reject it, but suggested that I should make still further investigation, and widen my horizon of observation. He was then sixty-two years old. He had retired from La Pitie, the scene of his chief labors as a teacher, and was having an ample consultation practice. His early hard study and self-denial were having a full pecuniary re- ward. He had married the sister of the eminent republican refugee, Victor Hugo. She was a most estimable and intelligent lady, who gave that grace- fulness to his home which, if he had remained a bachelor, it would perhaps have wanted. They had one son. He was the idol of his parents, and fully worthy of them as I have learned from others. The few hours I spent with my old master 33 proved that, though resting from his labors and enjoying an enviable fame with an ample profes- sional practice, he still retained that noble spirit of faithful, kindly criticism he had early inculcated on all of us. The moments thus passed in his study are most pleasant memories. It was my good fortune to meet him once more in this life, viz., in 1867, when Louis was eighty years old, and I no longer a student, but a graybeard of fifty-nine. We had both experienced some of the highest pleasures, and suffered one of the sever- est losses that can fall upon any man. Louis' son had grown up to be a youth of great promise, when the seeds of consumption began to manifest them- selves. In vain did the father try to ward off the blow by travel and change of climate. Death early came, and that blow for a time prostrated Louis. But I was most happy to find that it had left no sting of petty complaint behind it. Believing as he did in the governance of this world by almighty goodness as well as power, Louis arose chastened and subdued in regard to many things, but with a heart warmer than ever to all the advanced learning of his juniors in the profession, and to all the amen- ities of friendly life. I called at the old place, Rue de Menars, \o. 8. Mons. Louis was at his country seat, which he hired, nearly opposite the lovely Jar- 6 34 din d'Acclimitation in the Bois de Boulogne. He immediately returned the call, and invited me to dine with him. Not satisfied with that, and fearing I might not easily find the spot, he drove over in his own carriage and took me to it. Here I met his family and a few others in the most friendly and unconventional way. Fauvel, recently returned from his Eastern expedition where he had under- taken to study cholera, and Woillez, were there. Louis had the same tall form and commanding head as in previous days ; the same quick mode of utter- ance, and merry twinkle of the eye. It was pleas- ant to see the affectionate manner with which he greeted his friends and kissed the cheek of his fair niece, who with her husband was of the party. Louis was the centre of all, and easily presided over all. In. fact he gently checked the inconsid- erate language of one young Imperialist, who felt called upon, during the conversation at dinner, repeatedly to utter words of dislike, not to say con- tempt, for all republics, and so pointed was he on one occasion in an allusion to America, that I felt compelled to reply. Louis came to my assistance with all the seeming vigor of youth, and gently threw oil on the troubled waters. Forty years seemed not to have added a feather's weight to him. His hair was silvered and longer than for- 35 merly, but, as he talked of modern work in medicine, and regretted the going out of the great lights of the medical school of forty years ago, of Chomel, who is I believe dead, and of Andral, who is wholly absorbed in other things than the teaching of medicine, he seemed filled with his old fire; but superadded to it, and giving a grace and dignity to him which I had never seen before, were the com- bined influences of age genially borne, and the blessed memory of a great sorrow. CONCLUSION. I have thus, gentlemen, in a most rapid, desul- tory, and, perhaps you may say, too egotistical a manner, given you a few reminiscences of my great master and dear friend, and his compeers. I cannot bear the thought that I may never more see that sunny smile, or touch the friendly hand, or listen to the voice that spoke so sweetly to me when ill and suffering in the days of my youth, and greeted me so cordially at our last interview. Allow me to conclude with allusions to two answers given by Louis to a question propounded by me at two periods of his life; viz., at the time I first left Paris, when he was forty-seven years old, and again when I last saw him, when he was 36 eighty. I must premise that at the time of my first residence in Paris, Jouffroy, the great lecturer on philosophy at the Sorbonne, attracted me and many of my friends to listen to his lectures, on the great themes of life and death, and of the future. These themes he handled with perfect frankness, and in a manner most attractive, even to some of the most volatile of the French students. I well remember the first subject I heard treated by him, and the announcement of his lecture was some- what as follows : "Gentlemen, I shall speak to you to-day of the future life, of what it must be according to the constitution of the human mind." A bold thesis truly, but most nobly handled ! Of course I talked with many persons about it. Among others, I asked Louis what he thought. "My dear, I thought on these subjects for thirty years, and now I think of them no more." Such was the sum total of his reply at forty-seven. At my last meeting, when he was eighty-two, on my suggesting questions of similar import, he re- plied to the purport that he had faith that whatever the good God (" le bon Dieu ") did for us would be right, and for our best good. It was pleasant to find that all the events of his life had brought 37 him to this simple serene faith, and placid confi- dence and trust; and with this thought I will leave the memory of my beloved master and friend in your keeping. Hold it there most reverently. The sole regret I feel has been my inability to tell you more perfectly of his many most excellent qualities. Rest assured, gentlemen, that you can scarcely over-estimate his manly traits of character. Such a person does not arise more than once in a century. Thrice happy are they whose good fortune has led them to know, to love, and to listen to him. 1281 University of California SOUTHERN REGIONAL LIBRARY FACILITY 405 Hilgard Avenue, Los Angeles, CA 90024-1388 Return this material to the library from which it was borrowed. LOAIB JUL 7 1994 NOV 032000 OCT. UQ02 REC'DYRL -.409200* 1970 '00692 7559 1C, SOUTHERN REGIONAL LIBRARY FACILITY A 001 226 566 6