On October 15, 1785, Thomas Jefferson wrote a letter to John Banister (who, I presume, was the Virginia Banister, a member of the Continental Congress.) Banister had, it seems, written to Jefferson to solicit his advice "respecting the best seminary for the education of youth, in Europe." In his response, Jefferson stressed the dangers of exposing young men to the temptations of European life and to the degeneracy of the European aristocracy. He strongly praised the education provided by American institutions like the College of William and Mary. The only exception he made was for a man who intended to study medicine. Jefferson wrote, "For [this], he must come to Europe: the medical class of students, therefore, is the only one which need come to Europe."
Jefferson's time in Paris, 1784-1789, fell at the very beginning of what would become a French revolution in the understanding of illness and the practice of medicine. As early as the 1860s American physicians were journeying to Paris to experience its superior medical education. France had formal medical schools that were allied with hospitals and universities. The American colonies had a system of apprenticeship for aspiring doctors. And the French were doing three things that their American counterparts were not, all of which revealed the French fascination with learning through observation. First, they examined their patients. Second, they took advantage of their easy access to cadavers to study the body and, through observation, to better understand disease. Finally, they expected medical students and doctors to examine women, something that was thought unseemly for doctors in the American colonies and early United States.
One of the earliest American physicians to study medicine in Paris was John Morgan. Between 1760 and 1765 he studied at Edinburgh in Scotland and at the Royal Academy of Surgery in Paris. He returned to the United States in 1765 to found America's first university- and hospital-affiliated medical school at what is today the University of Pennsylvania. After Morgan, the list of American doctors who studied medicine in Paris became long and distinguished.
Benjamin Rush studied in Paris in 1768 and 1769. In later years Jefferson thought Rush to be America's pre-eminent physician. The early 19th Century saw a virtual exodus of American medical students to Paris, among them Oliver Wendell Holmes, Sr.
Jefferson is reported to have been skeptical about the medicine practiced in his time. He subscribed to the theory that the body possessed naturally curative tendencies that needed to be exploited and supported during times of illness. Despite this belief, Jefferson turned to doctors and to medications when confronted with the specific ailments that afflicted him: headaches, rheumatism, and diarrhea. He reported in his letters that his headaches responded better to travel and relaxation than to quinine and other drugs, and that his rheumatism was alleviated by hot springs in western Virginia (although he got skin boils from the experience). Chronic diarrhea is reported to have been his most incapacitating ailment. For a while he found that riding his horse at a trot for 2-3 hours daily was helpful in that it strengthened the muscles surrounding the rectum. In time, however, he resorted to a doctor's prescription of laudanum. He depended on this drug for many years. Laudanum is a tincture of opium comprised of 10% pure opium powder suspended in a 100+ proof alcoholic extract of bark.
Jefferson's thoughts about medicine may be inferred from his expectation that Lewis and Clark take with them on their Expedition, if not a physician, at least the best that American medicine had to offer. He sent Meriwether Lewis to Philadelphia to study with Dr. Benjamin Rush for three months at what is now the University of Pennsylvania School of Medicine. Rush was a firm believer in expunging from the body whatever ill humors had accumulated there, by whatever exit route might be most advantageous – laxatives, emetics, bleedings, and purgatives of all types. Lewis thus left Philadelphia equipped with new skills in phlebotomy and surgery and $90.69 worth of equipment and drugs. The equipment included lancets, forceps, gonorrhea syringes, and scissors. Among the 30 or so drugs were laudanum, opium, calomel, and mercury (for syphilis – the adage at the time being, "One night with Venus, a lifetime with Mercury.") Finally, Rush equipped Lewis with 50 dozen of his patented "Rush Pills." Rush believed his violently potent laxative to be effective in treating numerous ailments. The members of the Expedition used them liberally and called them "Thunder clappers."
When Jefferson arrived in France in 1784, the application of science to the practice of medicine was a novel idea, understood by few and practiced by still fewer. And the science of the time was not the experimental science that we know today. It was based largely on qualitative observation alone – a big step forward, but not the more objective quantitative testing of nature that we take for granted today.
Some French philosophers (as scientists were then called) were, however, dabbling in quantitative experimental science, and Jefferson was interested. Antoine Lavoisier, later known as "The Father of Modern Chemistry," had taken the understanding of elements and compounds from the realm of qualitative observation and into a new world of quantitative predictability. He discovered the role of oxygen in combustion, named oxygen and hydrogen, constructed an early list of elements, and helped develop a metric system that could measure all things. Like so many of his fellow nobles of the time, Corvoisier was guillotined in 1794.
In a letter to the "the Rev. James Madison" from Paris on July 19, 1788, Jefferson wrote,
Speaking one day with Monsieur de Buffon [the great French naturalist who piqued Jefferson by contending that the animal species of the Americas were inferior to, and smaller than, those of Europe], on the present ardor of chemical inquiry, he affected to consider chemistry as cookery, and to place the toils of the laboratory on a footing with those of the kitchen. I think it, on the contrary, among the most useful of sciences, and big with future discoveries for the utility and safety of the human race. It is yet, indeed, a mere embryon. Its principles are contested; experiments seem contradictory; their subjects are so minute as to escape our senses; and their result too fallacious to satisfy the mind. It is probably an age too soon, to propose the establishment of a system. The attempt, therefore, of Lavoisier to reform the chemical nomenclature, is premature.
This being medicine and science at the time of Jefferson's appearance in Paris – two separate and nearly unrelated endeavors – what would the new minister from the United States have seen of French medicine in his time there?
He would have known the Hotel Dieu adjacent to Notre Dame on Ile de la Cite (The House of God), and he would have known the Hopital Salpetriere in the southeastern outskirts of town. Images of "then" and "now" are shown below.
It is no wonder that Jefferson was a skeptic about the medicine and doctors of his time. He was witnessing only the first traces of science in medicine. It is impossible to know if he even recognized them as such. In his time the Hotel Dieu was a place where the poor died in wretched squalor. The Hopital Salpetriere was where undesirables of many sorts were housed in their misery. When Jefferson was in Paris, the great men of French scientific medicine were just beginning to change the way that doctors understood and cared for "patients." For example, Dr. Philippe Pinel, chief physician of Hopital Salpetriere from 1895-1826, had not yet identified what we know today as schizophrenia and epilepsy as medical conditions, and to treat them as such. In the meantime, while Jefferson was in Paris, these unfortunate people were separated from civil society as morally flawed, demonically possessed, dangerous, or simply hard to have around. The greatest French contributions to patient care – and to American medicine - would follow Jefferson's departure from France. How I would love to talk with him about all of this!