One foot in the office and one foot in the lecture theatre
David Chanteranne: How do you get, as you have done, from medicine to Napoleon?
Jean-François Lemaire: Well, it happens if you spend a lot of time with Napoleon in particular and with history in general. At the end of my school years, I hesitated for a long time before making the decision as to whether to take history or medicine. My father, himself a doctor, had however already prepared for my future and made the decision for me … thus I followed the latter path. At that time – which seems so long ago, but yet which also seems very recent – medicine was a practice passed from father to son, but I never stopped thinking about history. In my career I wrote several Que sais-je? (French series of monographic guides) on subjects such as road accidents, smoking addiction and doctors’ responsibility. I was of course wearing my doctor’s hat. But the publishers were amazed to see that of the obligatory 126 pages, almost a quarter were dedicated to the history of the relevant phenomenon. So history for me is not just a retirement hobby. I’ve always done it. In my opinion, the great leap forward in medical knowledge, the birth of modern medicine, occurs somewhere in the period between the beginning of the Revolution and the end of the Empire.
D.C.: What was it that led you to study this period of history?
J.-F.L.: It was Michel Foucault and his Naissance de la clinique, une archéologie du regard médical published in 1963 [translated into English in 1975 as The Birth of the Clinic: An Archaeology of Medical Perception (pdf file)] (it’s a book I keep coming back to). So I made a great effort to become acquainted with the Europe of the second half of the 18th century, a period during which Holland and Austria brought much to the study of medicine. But I came to the conclusion that it was only during the First Empire that modern medicine was born, with the creation of the Napoleonic university and the fact that medical students could then study illnesses with the patients themselves. I then passed quite naturally from Napoleon I to Napoleon III, because all the greats of the Second Empire, such as Claude Bernard and Pasteur, were trained by those who were at the centre of the medical stage during the First Empire. But that doesn’t mean that you can take shortcuts. When they asked me a few years ago to say who I thought was the founder of modern medicine, I said Napoleon. Today, I would qualify that by saying that before him Turgot was however the trigger. This is how you should proceed in history. You should look hard and then clean off a segment so as to set it in the right place alongside the other segments. But it’s a process which presupposes that you’re often going to have to come back to take another look. That’s the school of Jean Tulard.
D.C.: Jean Tulard asked you to teach at the Ecole pratique des Hautes Etudes. How did you manage to get your students (who I suppose were more interested in the First Empire as a whole rather than its context) interested in the history of medicine?
J.-F.L.: I think that you have just put your finger on precisely what this sort of teaching needs to be. You have to highlight a particular element of society which is not at present adequately known. My attachment to the First Empire is fairly logical, because my seminar, on doctors in the 19th century, deals as a matter of course with the debate concerning the great issues of the day. And the result of such debate was that certain existing structures could be redesigned and other more obsolete elements could be abandoned. It was much easier for scientists such as Touret and Cabanis to create the Faculté napoléonienne because the head of state was already in favour of their modernism.
Historical publications
D.C.: In 1992, you published Napoléon et la médecine, for which you were awarded the Académie Française’s Eugène Colas prize. What role did the Emperor play with regard to medicine, both in general terms of the medical administration and in specific terms of the medical corps.
J.-F.L.: It is completely paradoxical, and as such perfectly typical of history. Napoleon laid the foundations of civic medicine without once believing that it would do any good. “This new approach to the sick might be of some benefit later”(Cette nouvelle façon d’approcher les malades donnera peut-être quelque chose plus tard), he is supposed to have said, without noticing that he had created the clinic, that is, modern medicine. After him, illnesses were to be better understood, and as a result of this, so was the as yet tentative role of healing medicine. Napoleon trusted his doctors and they in turn believed in what they were doing. Jean-Nicolas Corvisart, Napoleon’s first doctor, who was convinced that the illnesses he had to treat were imaginary, gave balls of dough to two empresses, telling them it was medicine and thereby inventing the placebo method. Percy was convinced that drugs taken not according to prescription were harmful, and this was at a time when few held such scruples. In their denunciation of those who accepted the multi-drug method, both doctors – and others, notably Hallé and Coste – launched a movement which was to make French medicine the best in the world for more than 60 years. The Académie de Médecine was not however to be founded until the reign of Louis XVIII, although it would have been created earlier had circumstances developed more quickly. What’s more, Laennec’s discovery of the stethoscope could easily have occurred in the same circumstances three years earlier. On the other hand, one medical advance which Napoleon could have achieved was the founding of a functioning health service. It is clear that he needed appropriate procedures to deal with the bloody battles of his reign. He obviously did not feel that it was absolutely necessary – at any rate, not before 1813 – but by which time it was already too late. The letter through which he laid the foundations of what could – and indeed should – have been his health service preceded Louis XVIII’s entrance into Paris by only 6 months.
D.C.: But there were positive developments, particularly by Desgenettes during the Egyptian campaign. What do you think would have been the principal reasons for these developments?
J.-F.L.: Yes, Desgenettes, and we mustn’t forget Larrey, Dubois and a little later Berthollet. But, that being said, Desgenettes was quite exceptional, both generally and medically speaking. He was also quite rough. Even though he went along with Napoleon from Fréjus, he was never a lackey. His integrity, independence and competence were all at a remarkably high level.
D.C.: You published a book on Jean-François Coste, a famous doctor in his time, but almost completely unknown before you brought him back into the public eye. He was also Mayor of Versailles. Your book shows the social role played by doctors in the 19th century. Do you agree that the First Empire was the origin of this change of mind?
J.-F.L.: No doubt about it. But Coste wasn’t the only one or indeed the first. I just mentioned Turgot. Vicq d’Azyr and Quesnay were Turgot’s protégés, but they also represented the new society of men wrestling with grand ideas and vast projects. Fourcroy was Vicq d’Azyr’s secretary during the Ancien Régime, and he remained such until his death in 1794 (he was not a victim of the guillotine – which certainly might have happened to him – but of a cold caught on his return from the Fête de l’Être suprême). So you see, things are very different.
D.C.: Your book Marat homme de science? [Was Marat a man of science?] is an original work. It is rare to read about the scientific qualities of a man who is only known for his death.
J.-F.L.: I spent some time with Prof. Jean Bernard, in the course of the organisation of the bicentenary ceremonies of the French Revolution, considering Marat and his role. A Franco-American conference was organised and we managed to show that Marat was a remarkable consultant in Paris, clearly an able clinician, even possessing a diploma from St Andrews near Edinburgh. His medical training was very detailed and rigourous. He was trilingual and worked subsequently in London. He held the greats of the world in high respect, notably through his role as doctor to the garde du corps of the Comte d’Artois. But his mental health deteriorated rapidly and he quickly went mad. But that fact should not lead us to alter our opinion of him before his descent ‘into the pit’.
D.C.: Your latest book, Les blessés de la Grande Armée, has recently been awarded a prize by the Fondation Napoléon. It’s a reworking of your doctoral thesis presented in July 1998. How did you chose the topic and what were your main conclusions?
J.-F.L.: I took a look at the officers’ dossiers at the S.H.A.T. (Service Historique de l’Armée de Terre, Vincennes), and I realised that no modern medical specialist could be satisfied with the way in which, after a battle, the wounds received were recorded. I read the administrative notes, the reports of the war commissioners and found them very useful because they made it possible to see how much a certain wound affected the future career of a soldier. Men who were very seriously wounded at Ulm reappear at Austerlitz (only to be wounded again) and again at other famous battlefields of the Napoleonic period. Expressions such as “bullet full in the chest”, “bullet in the head”, “broken leg” are in effect meaningless in isolation. A few days later the same soldier could be dead or he could be wounded on another battlefield. Only with the inclusion of the other elements in the dossier is it possible to get the complete picture.
D.C.: Are there still unknown medical figures to be rediscovered in the history of the First and Second Empires?
J.-F.L.: Cabanis deserves a thorough treatment. No one has yet written a biography of him. His ideas still seem up-to-date, as do his theories on medical research, patient isolation in hospitals and doctor training. Thouret, the first ‘Doyen’ of the Imperial University, is also very little known. All the minutes of the professorial committees concerning medicine in the Revolutionary and First Empire periods are languishing – at least as regards the Paris faculty – in the Paris Archives Nationales and they have never been really effectively consulted. I’m sure that we’re in for some very significant surprises. It would be good for someone to consider the issue. Leroux de Tillets is another great unknown of the period. He was docteur-regent during the Ancien Régime, he was with the Paris municipality when they received Louis XVI on 17 July 1789, and he subsequently followed a chaotic career, becoming Corvisart’s second in command before taking over from Thouret. Hallé, a clinician who was perhaps even more gifted than Corvisart, is equally a surprisingly shady figure.
D.C.: Did you find that after your many articles in Jean Tulard’s Dictionnaire Napoléon and Dictionnaire du Second Empire, raised interest in doctors and medicine in general?
J.-F.L.: Yes. I received many letters via the publisher. Some from the world of medicine were perhaps even called to become historians. I had as many questions about the characters as about their ideas. I realised that doctors in general want from history what Stendhal called “le petit fait vrai”. I suppose, for doctors this is a reflex, almost an occupational hazard.
The Bonapartes and their illnesses
D.C.: I don’t think any other French ruler was as interested in medicine as Napoleon III, what with his taking of the waters and medical consultations, etc. Do you think that this coloured his vision of the medical domain?
J.-F.L.: He had remarkable vision concerning medicine in general, most notably in social and humanitarian terms, particularly for a French sovereign, and he should be given credit for it. As for his own health, given its serious deterioration, he showed himself incapable of taking a firm decision on whether to undertake an operation which was risky but which could have cured him. He preferred to take the waters. We know that thermal cures ease the pain but they do not really get to bottom of the problem. It is clear that he should have acted before 1865, and that he did not. For their part, the doctors and surgeons did not want to act because they knew that they would be blamed for the Emperor’s death if he died during or after the operation. Eugenie’s role is also worth questioning. She perhaps ought to have put more pressure on. But which would have been better for France: for Eugenie to be regent to the young prince or to be regent for the sick emperor. There is no answer to the question.
D.C.: One particular illness which has been very much in the glare of publicity is that of Napoleon I. You state, in the documentary by Dorothée Poivre d’Arvor entitled Sainte-Hélène 1821 (broadcast on France 3, Friday 7 May, 1999), that the much-quoted cancer is not quite the dead certainty previously thought.
J.-F.L.: I wrote in 1992 (in Napoléon et la médecine) – and I stand by my conclusions – that it couldn’t have been a full-blown cancer but rather an ulcer. The dethroned emperor was under a great deal of stress, and life at Longwood had not improved matters. He began to suffer from hepatitis during his stay. Most of all, he must have given up all hope of returning to France, a fact which must have demoralised him completely. Just consider for a moment the place where he chose to live and die. St Helena has two very different environments, green and sunny lowlands (Jamestown, The Briars, Plantation House) and lugubrious empty upland plains, prey to the wind and rain (Longwood). Nevertheless, Napoleon wanted to live in Longwood. It would seem that he was trying to heighten the sense of martyrdom.
D.C.: What is your opinion of the poisoning theory?
J.-F.L.: Nonsense. I am quite willing to accept that the arguments put forward by these people are very seductive, emotionally compelling and surprising, but they are in no way convincing. It is one thing to pile up suspicions so that the combined weight brings about a ‘deep personal conviction’ and another to bring together hard facts which form a scientific demonstration. In legal medicine, only the latter can be taken into account, but in the case you mention here, such facts have not been brought to bear.
On 4 May, during a lunch at the restaurant of the French Upper House, or Sénat, (Paris) to which had been invited 6 scientific specialists, some prominent figures in the Napoleonic world and a number of journalists, Ben Weider, the founder of the International Napoleonic Society, repeated (without adding any new material) his conclusion developed in various books (amongst which Napoléon assassiné (Watelet-Pygmalion, 1999)) that the Emperor was poisoned with arsenic.
After his words, the scientists gave their opinions. All, with the exception of Professor Maurice Guéniot, expressed – each from his own point of view – a great deal of scepticism regarding this hypothesis and refused to support it. For Professor Guéniot, best known as a specialist in Hospital Administration, the state of conservation of Napoleon’s body when it was exhumed would imply “severe intoxication by arsenic”. This was immediately challenged by Professor Molinaro, toxicological specialist from the Gendarmerie criminal investigation department. “For arsenic to preserve a body” he noted, “it has not to be swallowed but rather used externally (applied to the skin). What is more, large quantities are required. Neither of these two conditions was fulfilled in any way.”.
Hence the great surprise to hear later that evening the French cable news channel LCI state “The scientists have reached their decision; Napoleon was poisoned”, the conclusion repeated by the printed press the following morning. In fact, the impression of those who participated in the event was precisely the opposite.
On 9 May, having been invited, along with Jean Tulard, by Jean-François Rabilloud to speak on the LCI programme “On en parle”, and subsequently on 18 May in the “Journal de l’Histoire” (HISTOIRE) at the invitation of Guillaume Durand, I was able to come back to these various details.
Select Bibliography
Books:
Les blessés dans les armées napoléoniennes
Paris: Lettrage Distribution, 1999 (Fondation Napoléon History Prize 1999)
Jean-François Coste, Premier médecin des armées de Napoléon
Paris: Stock, 1997 (Prix Mauguin de l’Académie des sciences morales et politiques and Prix d’histoire de la médecine aux armées, Val de Grâce)
Napoléon et la médecine
Paris: François Bourin, 1992 (The Académie Française Eugène Colas prize)
Maygrier et son annuaire médical
Paris: École Pratique des Hautes Études, 1991
Article:
L’émulatrice faculté de médecine de Paris sous l’Empire, Revue du Souvenir Napoléon, n° 394, March-April 1994, p. 14-35
Works of joint authorship:
Les grandes batailles de Napoléon (1796-1815), with Jean Tranié
Paris : Ed. Tallandier, 1998
All the notes on medical subjects in the Dictionnaire du Second Empire
Paris: Ed. Fayard, 1995
De Gaulle et la médecine, with Alain Larcan
Paris: Ed. Les empêcheurs de penser en rond / Fondation Charles-de-Gaulle, 1995
L’acte de naissance de la médecine moderne, with Jean Bernard et Jean-Pierre Poirier
Paris: Ed. Les empêcheurs de penser en rond, 1995
Marat, homme de science?, with Jean Bernard et Alain Larcan
Paris: Ed. Les empêcheurs de penser en rond, 1993
Most of the notes on medical subjects in the Dictionnaire Napoléon, with Jean Tulard
Paris: Ed. Fayard, 1987 (rééd. 1999, 2 vol.)
Benjamin Franklin à Paris, with Jean Bernard
Paris: Institut de France, les Amis français de la Smithsonian Institution, 1992