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Cholera Epidemics in the 19th Century

The Great Plague of London, 1665

The Boston Smallpox Epidemic, 1721

“Pestilence” and the Printed Books of the Late 15th Century

Spanish Influenza in North America, 1918–1919

Syphilis, 1494–1923

Tropical Diseases and the Construction of the Panama Canal, 1904–1914

Tuberculosis in Europe and North America, 1800–1922

The Yellow Fever Epidemic in Philadelphia, 1793

General Materials

Notable People

Related Links

 


P. C. A. Louis, 1787–1872

Pierre Charles Alexandre Louis was one of an influential group of early 19th–century physician–researchers known as the Paris Clinical School. Louis was a strong proponent of numerical methods in medicine, and his work comparing different treatment protocols for different groups of patients laid the foundations for the modern clinical trial. He found, for instance, that bloodletting in pneumonia had no effect on outcome. His work is often associated today with the concept of “evidence–based medicine,” which uses the scientific method to evaluate evidence to measure the effectiveness of treatment.

The Paris Clinical School

The Paris Clinical School is sometimes referred to as the first scientific medicine in the 19th century, one that helped pave the way to the idea of specific diseases associated with the germ theory. It is also known as the beginning of impersonal, “objective,” and institutionalized modern medicine, in which patients are evaluated in terms of their deviation from statistical norms rather than from what is normal for each patient as an individual.

Associated with the social and ideological reforms of the French Revolution (1789), the Paris Clinical School rejected the authority of humoral theory, scholastic training based on the study of texts rather than human bodies, and elite private practice. Instead, the Paris School focused on hands–on experience with large numbers of clinical cases, typically found at the large charitable hospitals, such the Hotel–Dieu in Paris.

The Paris Clinical School is also significant for its attention to autopsy as a means for corroborating internal lesions with bedside diagnoses, and for its use of statistics, or, to use the term most associated with Louis, “the numerical method,” to understand the typical course of a disease. The Paris School emphasized accuracy of observation, diagnosis, and detailed understanding of the typical course of common diseases such as tuberculosis.

Notably, the Paris School was not known for its cures and is often associated with a widespread, 19th–century concept known as “therapeutic nihilism.” This concept, held by the public and physicians alike, held that medicine as then practiced made little or no difference in a patient’s outcome.

Americans in Paris

In the first decades of the 19th century, Americans who wanted a truly elite medical education went to Europe, particularly to Paris, to study. In this way, P. C. A. Louis exerted a significant influence on American medicine.

Among these Americans was James Jackson. Jr., whose account of the 1832 Paris cholera epidemic can be found in letters exchanged with his father, the influential American physician James Jackson, Sr. By the 1830s and 1840s, medical innovation was becoming associated with German medical schools and laboratories rather than large public Paris clinics, and Jackson also expresses his desire to spend the next phase of his training there.

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Selected Contagion Resources

This is a partial list of digitized materials available in Contagion: Historical Views of Diseases and Epidemics. Additional materials may be found by browsing the topic “P. C. A. Louis, 1787–1872” and by searching the collection’s Catalog and Full Text databases.

Web Pages

Cholera Epidemics in the 19th Century
Domestic Medicine
Germ Theory
James Jackson Papers
Tuberculosis in Europe and the US, 1800–1922

Publications

Bayle, G. L. Recherches Sur la Phthisie Pulmonaire: Ouvrage lu à la Société de la Faculté de Médecine de Paris, Dans Diverses Séances, en 1809 et 1810 Paris: Gabon, 1810.
Louis, P. C. A. Recherches Anatomico–Pathologiques sur la Phthisie. Paris: Chez Gabon et cie, 1825.
Louis, P. C. A. Pathological Researches on Phthisis. Translated from the French, with introduction, notes, additions, and an essay on treatment by Charles Cowan; revised and altered by Henry I. Bowditch. Boston: Hilliard, Gray, 1836.
Louis, P. C. A. Recherches sur les Effets de la Saignée dans Quelques Maladies Inflammatoires, et sur l’Action de l’émétique et des Vésicatoires dans la Pneumonie. . Paris: J.B. Baillière, Libraire de l’Académie royale de médecine, 1835 ([Paris]: imprimé chez Paul Renouard).
Osler, William, Sir. Influence of Louis on American Medicine. Baltimore?: s.n., 1897.
Paillard, H. Histoire Statistique du Choléra–Morbus qui a Régné en France en 1832: Suivie de Réflexions sur les Causes et la Propagation de Cette Épidémie, de 40 Tableaux Contenant les Résultats Obtenus par Chacun des Médecins de l’Hôtel–Dieu, et le Chiffre des Malades et des Morts en France, Classés par Jour et par Arrondissement. Paris: Chez l’auteur: Chez J.–B. Baillière, 1832.

References

The following sources were used in writing this page.

Ackerknecht, Erwin Medicine at the Paris Hospital, 1794–1848. Baltimore: Johns Hopkins University Press, 1967.
Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. Trans. A. M. Sheridan Smith. New York: Pantheon Books, 1973.
Matthews, J. Rosser. Quantification and the Quest for Medical Certainty. Princeton: Princeton University Press, 1995.
Weiner, Dora B. and Sauter, Michael J. “The City of Paris and the Rise of Clinical Medicine.” Osiris, Vol. 18, Science and the City (2003), pp. 23–42.
Weisz, George. “Reconstructing Paris Medicine.” Bulletin of the History of Medicine, 2001, 75, pp. 105–119.

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