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and accuracy of observation are predominant, there also, cæteris paribus, will be the greatest number of eminent physicians.
But Surgery also has its conjectural as well as its operative part. The former is something like medicine, and requires its portion of sagacity. The other certainly cannot proceed without some intellect; but the picture of an operative surgeon is thus drawn by Celsus." He must not be too old, his hand must • not shake, he must be ambidexter, his sight must be clear and
penetrating, his mind pitiless (immiscricors), and he must be • heedless of the screams of his patient.' The only mention made of mind in all this, is that it should be pitiless. Now it would be a strong argument in favour of what we advance upon the state of intellect in England and France, if the history of these branches of knowledge should demonstrate that the only one in which the French can claim a superiority, is that in which ambidexterity and the pitiless mind are the chief ingredients.
In 1271 Pitard established the college of surgeons in France; but the father of improved French surgery is Ambroise Paré, a man of extraordinary genius, and, on that account, saved by the King himself, Charles IX., from the massacre of St Bartholomew. His mere presence in a besieged town made the inhabitants as intrepid as if they were invulnerable. His discoveries and observations on the modes of operating are innumerable and invaluable. To him succeeded Rousset, Guillemeau, Covillard, Cabrol, Habicat: and about the same time Wiseman and Harvey flourished in England. In the 17th century surgery declined in France, and under Louis XIV. it was in a degraded state. In the last century, Petit
gave new life to this study; and his principal cooperator was Dessault. In the Memoirs of the Royal Academy of Surgery, may be found a list of celebrated names, amounting to near twenty, among which are Bordenave, Le Cat, Le Dran, Fabre, Faye, Foubert, Lassus, Livret, Louis, Peyrihle, Sabatier, Verdier, &c.; Now though it is difficult to decide upon the manual merit of an operation, which is transient, we will give up this to the French. But we will maintain, that the writings of the English surgeons, taken in toto, contain much more comprehensive, just, and philosophical views of their subjects, and form a more complete body of science, than those of the French authors; and the world would sustain a greater loss by the destruction of the former, than of the latter. Within the last 30 years the operative part of surgery, in which we had been the most deficient, has made prodigious advances in England; and we should not hesitate to say that, at this moment, France docs not possess one single operating surgeon, equal in
merit to many whom we could name in Britain; and, if we were to enumerate the consulting surgeons in this country, whose opinions are of higher value than any in France, we should swell our list to an unconscionable length. The fact is, the reputation of French surgery always stood too high with regard to the ratiocinative part; and, at this moment, the manual part is too much indebted for its fame to the
of Ambroise Paré, and to the operative skill of Frere, Corme and Dessault. In both we are now superior; but still more in consultation than in manipulation. We spare our readers the catalogue of names which might be enumerated on either side. One of the modern inventions of French surgery, is what Mr Larrey has introduced into military medicine under the name of ambiilance, but which unfortunately for his pretensions to originality was thus described, some eighty years ago by Ranby sergeant surgeon to our George the Second, whom he accompanied in his German wars. • When the army is forming for an engage• ment, let the surgeons with their respective mates, of the
three or four regiments that are posted near each other, collect themselves into a body, (the same method being observed throughout the line), and take their station in the rear accord
ding to the command of the general. Here let the wounded • be put under immediate care and management. By this means
they will be enabled mutually to assist each other, and to per • form with more exactness and despatch :'—and he concludes by painting the sufferings of the wounded, who with large lacerated wounds and bleeding arteries and fractured limbs, were carried to a distance, as in the usual method. (Ranby on Gun-shot Wounds, p. 33.)
In the other branch of Therapeutics, and which we deem to be the highest, the English have at all times been superior. The ignorance of French physicians always has been excessive; and even those who have read and written upon the subject, are little skilful in the practice. The origin of this superiority we conceive to be the same which has acted upon our whole mind; and given it a greater reach of thought, and a wider power of combination. What has particularly turned that mind in the channel of medical inquiries, is the uncertainty of our climate, which exposes us to a greater variety of diseases, and lowers the general average of health in this country; while the disorders which fall under the cognizance of surgery are, in part, produced by accidents independent of climate. From these too has resulted another cause, which has not a little contributed to advance the study of medicine. Its practitioners, as being more necessary here, are upon a more dignified footing than in any
other part of Europe: in rank they have. precedency of an esquire : in estimation they are considered as gentlemen : and, as men of learning and talent, they are respected. The person to whom we fly for aid in the dread alternative of life and death, honoured, as he should be, by our esteem, while he holds in his hands the web of our fate, is not, the moment afterwards, discarded, and thrown into the worthless lumber of society, as in France. Under these circumstances, it is clear, a priori, that the medical sciences and profession cannot any where stand upon so fair a footing as in England.
The progress which physic had made in other countries, while no attempt had yet been made in France to promote its study, is quite astonishing. In the 12th century, the schools of Salerno, Padua, Pavia, Placenza, Milan, Ferrara, Bologna, were flourishing; while only two in France, those of Paris and Montpellier, were known. In the 13th century, the French had Pitard, a man, as Quesnay says, born for surgery; while Gilbert, John of St Giles, Richard of Windermere, Nicolas Farneham, John of Goddesdem, flourished in England. When the absurdities of the Arabian doctrines began to be exposed, and the merits of the Greeks to be made known, by Leonicenus and Manardus in Italy, by Fueks, Koch, Umter, Hagenbut in Germany, by Linacre and Caius (Anglicè John Kaye) in England, -Gorris, Duret, Houlier, and Foesius in France were illustrating the precepts of Hippocrates : But Brissot of Poitou was the first Frenchman who proposed any practical improvement. A very long period of stagnation elapsed after this, during which the French did hardly any thing; though many discoveries were making elsewhere, and the mind of Lord Bacon was towering over the medical, as over all other sciences. Then came their fanciful theories concerning the fermentation of the fluids and the animal spirits from the brain; and various ridiculous refinements upon the chemico-mechanico-physiological vortices of Descartes, together with other systems,—the absurdity of which Boyle first attacked, and Sydenham quite overthrew. Dionis, professor of surgery at the King's Garden in Paris, who maintained that the circulating system of the human body was the same as the machine at Marly, (a miserable hydraulic machine for raising water from the Seine, yet one of the wonders of the environs of Paris), was posterior to Sydenham. To this very eminent English physician succeeded Pitcairne, Keil, Wintringham, Mead, Lower, Molyneux, Mayan, Glisson, Wharton, Musgrave, Willis, Porterfield,
Whytt, Cullen, Brown, Gregory, Darwin, Baillie; and, in France, Hocquet, Astruc, Pecquet, Drelincourt, Sauvages, Senac, and perVOL. XXXIV. NO. 68.
haps superior to all French physicians, even at the early age at which he died, Bichat. Medicine, says Stahl, is little more than rational empyricism. So, it may be said, is every science not founded on demonstration, and reduced to practice. But the perfection of all these is, when such consistency is given to the rationale, that it may supersede the mere empyrical. This is the work of genius and sagacity; and this is what the English have most particularly effected. In practice, indeed, we seem to have made a singular partition with the French, and to have left them the empirical and the anile, while we have kept the rationale to ourselves. They are indeed in the most deplorable state in which men who wish for knowledge can be; for they have theories without philosophy- and the place where they are most inefficient is the bed side of the patient.
It is not so much in the diagnosis of disease, as in the exhibition of medicines, that the French practitioners are deficient. The difference between the English and French modes of practice, has been thus jocosely characterized. The English physician kills his patient: The French physician lets him die. This saying may be put in the same rank with the various antigalenical aphorisms of persons who grumble, because physicians have not yet subverted the laws of nature, and restored antediluvian longevity. But let a proportion be established between the quantity of health and sickness in the world; let it be considered how many disorders have a fatal tendency; how many of these are, by the laws of nature, and the duration which Providence has assigned to human existence, beyond the reach of any but supernatural aid and how many may be removed by enlightened medical assistance ;-and, from these data, let the mean term which the science of medicine may rationally be expected to add to the established term of life be deduced, and we are convinced it would be infinitely little. The period of life at which man has the probability of the greatest number of years to come, is the age of 33. Now we are rationally convinced that all the medical skill which men have ever possessed, nay, which the Creator ever will allow them to possess, could not add 1-400th part to that period, and make it, instead of 33 years,
33 years and one month; that is to say, the labours of medicine have not made, and cannot make, a perceptible addition to the mean term of human life. How much of that month has been added in England, and how much in France, we cannot pretend to determine; but we may confidently advance the former, whatever it is, to be double of the latter; and the proportion of individual sufferings relieved (for such is the real advantage of medicine) to be infinitely greater.
The Materia Medica of the French is very limited; but, such as it is, it is held to contain more mortal words than the whole nosologies of Sauvages and of Cullen taken together. We say words; for, according to their practice, one would suppose the very name of some substances were deadly. They seem to know but little, too, of the opposite qualities of one entire class of remedies, which, in one proportion, excite, and, in another, depress; and of the tendency which particular medicines have to particular organs of our frame. The language of this science is altogether metaphorical. Tea whips the blood; diluting beverages wash it; corroborants put fire into the body; baths of whey give unctuosity to crisped nerves; and this is the more extraordinary, as French poetry admits such sparing use of tropes and metaphors. We were present when the Nestor of Parisian medicine and anatomy ordered a patient, who had laboured under au ague for seven months, du thé de tilleul, de l'eau de fleurs d'orange, et les pieds dans l'eau.' The result of a consultation of some eminent Parisian practitioners, in 1818, was to order their patient to suck the dried skin of an Egyptian ass. A physician told a rheumatic lady, that her illness proceeded from her not having been purgée at her last lying-in-her youngest child being then aged 32. We have known a conseil de famille, presided by the family Esculapius, to sit in deliberation whether a dose of hippecacuanha might not be administered, in a few days, to one of its members afflicted with catarrh. Every person has, for every disorder, his little pacotille of heroic medicines, such as those just mentioned; to which may be added, in cases of indigestion, a verre d'eau sucrée; and no details of their effects are ever spared in conversation. The sovereigns of Asia trumpet to the world when they have dined; the subjects of France seem to have a public privilege of an opposite kind. Their physicians could not, at similar epochas, adduce any examples in their practice or theory to be compared to Willis on the brain and nerves, the speculations of Cullen, the Brunonian theory, Darwin's theory of fever, his catenation of animal motions and diseases, association, inoculation, vaccination, the use of mercury in cachexia, the improved modes of treating fever, particularly by cold affusion, &c.
The last science which we mean to compare in the two countries, is Chemistry. It is that in which the French have claimed, in modern times, the greatest superiority; and have directed the entire activity of their ambition to affix, to the last half century, the title of the French Age of Chemistry. We will not