The Greater Journey: Americans in Paris.
Article Type: Book review
Subject: Books (Book reviews)
Author: Willard, Fran Roberts
Pub Date: 04/01/2012
Publication: Name: Baylor University Medical Center Proceedings Publisher: The Baylor University Medical Center Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 The Baylor University Medical Center ISSN: 0899-8280
Issue: Date: April, 2012 Source Volume: 25 Source Issue: 2
Topic: NamedWork: The Greater Journey (Nonfiction work)
Persons: Reviewee: McCullough, David
Accession Number: 306359150
Full Text: The Greater Journey: Americans in Paris by David McCullough

New York: Simon & Schuster, 2011.

Hardcover, 558 pp., $37.50.

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To read David McCullough's absorbing account of a 70-year period in French history is to be swept away in the vivid and inspiring stories of some of the hundreds of Americans who made the migration east to partake in the intellectual and cultural riches of the City of Light. What many of them achieved individually in literature, the arts, and sciences would profoundly influence our own American history.

In the 1830s, the first wave of talented and ambitious Americans set sail for Paris with the firm notion that only there would they be able to realize their dreams. Most were well educated and reasonably well off, or at least they had parents able and willing to finance them. Most, though not all, were single men in their 20s, with at least one exception being Elizabeth Blackwell, America's first female physician. One such young man was Oliver Wendell Holmes, a shy, affable Bostonian, who at 25 years of age had already gained some acclaim for his poem "Old Ironsides," a tribute to the USS Constitution, which had helped save the Navy from scrapping the historic ship. His compatriots included James Jackson Jr. and Mason Warren, the sons of Boston's most prominent physicians, James Jackson and John Collins Warren, who had founded the Massachusetts General Hospital. Unlike these two young men, Holmes had not had an easy time convincing his father to fund his most expensive dream to receive medical training in Paris, for not only would it require great sacrifice at home but his preacher father was concerned for his son's morals. "If he was to be anything better than a rural dispenser of pills and powders," he had argued, he would need at least 2 years in Paris, the world's leading center of medicine and medical training at that time.

A perilous sea voyage of 3000 miles lay ahead, but Holmes braved the Atlantic in the spring of 1833. Nothing could have prepared him for Paris, a city of 800,000 (four times the size of New York City) and the cultural center of Europe. How old things looked made a deep impression, as did the appalling poverty. And, yet, there were the riches of Paris to be discovered in long, rambling walks. It was impossible not to be impressed with the famous bridges on the Seine and the unique beauty of the numerous gardens and palaces. There was theater and opera and cafes to be enjoyed and, of course, the Louvre, the world's greatest museum of art.

Holmes immediately took to Paris, to the French people and to the language. He chose to live on the Left Bank in the Latin Quarter, settling into a top-floor room in a fifth-floor high-rise. For 40 francs a month ($8), he got not only some basic furnishings but also a porter, who would wake him in the mornings, make his bed, wash his clothes, and polish his boots. Better yet, his room was only a few blocks from the Ecole de Medecine; to his delight, he found he could make it to his first lecture each morning in 4 minutes flat.

This was the sixth arrondissement and home to the College of the Sorbonne and the School of Law, but, most of all, it was the world of Paris Medicale, whose population rivaled that of a small city. The celebrated medical school drew several thousand students from all over France and much of the world. Here, too, were the shops and homes of the medical booksellers, instrument makers, and medical artists. As a place to learn it was beyond compare, for it was here that the illustrious professors and physicians were advancing the art and science of medicine as nowhere else in the world.

There were a number of hospitals serving Paris Medicale. The largest and oldest of the hospitals was Hotel-Dieu, considered preeminent in surgery and serving more than 15,000 patients a year; as in all Paris hospitals, patients were treated for free. The 800-bed Hopital de la Pitie was known for its clinical medicine, particularly for the treatment of diseases of the chest, such as tuberculosis. The Hopital des Enfants-Malades was the first children's hospital in the world. In 1833, a total of 12 hospitals provided treatment for 65,935 patients; in comparison, the combined number of patients that same year for the Massachusetts Hospital and the McLean Hospital was less than 800. The sheer number of patients and the range of their diseases gave medical students a first-hand experience they would not be able to obtain elsewhere.

Although the hospitals were mostly old, the medical school had been founded only about 70 years earlier, and since the Revolution of 1789, all qualified young men, regardless of wealth or family background, were allowed to attend. For this reason, the language of instruction had been changed from Latin to French. Unlike at American medical schools, a college education was required; however, this requirement was waived for American students, as was the tuition.

At the Ecole, students would have to select "lines of study" in either surgery or general medicine, which is what Holmes chose. All students, though, would attend lectures in both as part of their training and would make the rounds of the hospitals with both physicians and surgeons, but surgery students would have a different curriculum.

One of the medical giants in France was Guillaume Dupuytren, once a battlefield surgeon who had been made a baron by Napoleon. The contraction of the palmari fascia of the hand, known as "Dupuytren's contracture," was named after him. Watching Dupuytren march through the wards in his white apron, the diminutive Holmes thought him a "lesser kind of deity." Dupuytren reportedly spent most nights at one of the better gambling houses at the Palais Royal, and the students assumed his mood each morning revealed whether he had won or lost. On most mornings, his mood was foul. Still, his lectures were not to be missed, and to see him with scalpel in hand was to see un spectacle. He spoke the whole time and loved to "make a show." There was no anesthesia, and Dupuytren, like other surgeons of the time, did not wash his hands or sterilize his instruments before surgery, as such precautions were not yet known. Unfortunately, most patients who survived surgery would later die of infection.

The teacher and practitioner who seemed to influence the American medical students most profoundly was Pierre-Charles-Alexandre Louis. Diseases of the chest, particularly tuberculosis, a leading killer of the day, were his forte. That he was married to the sister of Victor Hugo only added to his reputation. His insistence on the need for facts and for "exact observation" in the treatment of disease made him require his students to make slow and careful examinations of patients, to question them at length, to make good use of the stethoscope, which was first introduced in 1819, and to take detailed notes. Holmes embraced the Louis scientific approach and recorded how he would spend 5 hours a day sitting at the bedsides of patients, asking questions and filling his notebook with notes.

Another advantage for American medical students studying in Paris was the easy availability of cadavers for dissection, which was not the case in the United States because of both state laws and public attitude. Holmes wrote of sharing the cost of a cadaver with a Swiss student and how by evening they had "cut him into pieces." These students not only had the opportunity through dissection to study all parts of the body--nerves, muscles, organs, blood vessels, and bones--they also had the chance to examine women patients, who did not share the same attitude as American women, some of whom would rather have died than be examined by a male physician.

To mark the end of his first year, Holmes wrote his father:

But it was not enough to persuade his father to let him stay much longer. At the end of his second year, Holmes reluctantly returned to Boston, where he would become the professor of anatomy at Harvard Medical School for 36 years, also serving for part of that time as dean. Meanwhile, more American medical school students kept arriving, totaling nearly 700 by the year 1900. They would also return home to practice medicine and to pass on their knowledge to others.

While a whole chapter is devoted to "The Medicals," McCullough fully explores the varied and rich stories of numerous Americans inspired by their time in Paris, such as James Fenimore Cooper, whose The Last of the Mohicans was the first American novel to garner international readership, and Samuel Morse, who worked diligently on his ambitious project, "The Gallery of the Louvre." Thinking he had failed as an artist, Morse returned to America and would later become an inventor, revolutionizing the field of communications. He would never have believed that his masterpiece would sell nearly 150 years later for $3 million, the largest sum ever paid--until that time--for an American work of art. These stories of aspiring Americans, including Mary Cassatt, Harriet Beecher Stowe, and Augustus Saint-Gaudens, the sculptor of such memorials as the Farragut, Sherman, and Robert Gould Shaw memorials, serve as an important reminder of how much dedicated work and perseverance are required to realize great talent.

McCullough also examines the panoramic changes Paris itself went through during this time, including the Cholera epidemic of 1832, which killed 18,000 people, and the Franco-Prussian War. McCullough's story of Elihu Washburne, America's minister to France between 1869 and 1877, serves as a beautiful portrait of a true statesman.

Like the other talented Americans, Holmes had made the most of his time in the City of Light. He'd not only received the best medical training to be had in the world, but also now shared the French conviction that art, music, poetry, and good conversation were essential to the enjoyment and meaning of life. So, it is no surprise that he frequently liked to say: "Good Americans, when they die, go to Paris."

The reviewer, Fran Roberts Willard, is a freelance writer in Leesburg, Virginia.
My aim has been to qualify myself so far as my faculties would
   allow me, not for a new scholar, (or) for a follower of other
   men's opinions, (or) for a dependent on their authority, but
   for the character of a man who has seen and therefore knows,
   who has thought and therefore arrived at his own conclusions.
   I have lived among a great and glorious people. I have thrown
   my thoughts into a new language. I have received the shock
   of new minds and new habit. I have drawn closer the ties of
   social relations with the best formed minds I have been able to
   find from my own country.... I hope you do not think your
   money has been wasted.
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