Abstract
In 1826, Georges Duval, the creator of countless vaudeville triumphs, brought another smash hit to the Paris stage: a play entitled Le tailleur des bossus, ou l’orthopédie; contrefaçon en un acte.1 It is difficult to do justice to this title in English. A literal translation might be ‘The Hunchbacks’ Tailor, or Orthopaedia: a Fraud in one act’ — but this fails to convey the droll double-entendre that gave the work its satirical edge and comic appeal. The title is, in fact, a play on words: the orthopaedic ‘tailor’ is really an ‘operator’, a charlatan whose efforts to ‘refashion’ reality are good for nothing but a laugh.
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Notes
On the professionalization (and institutionalization) of medical specialities in France during this period, see George Weisz, ‘The Development of Medical Specialization in Nineteenth-Century Paris’, in Ann La Berge and Mordechai Feingold (eds), French Medical Culture in the Nineteenth Century (Amsterdam/Atlanta: Rodopi, 1994), pp. 149–88 and especially pp. 154–6;
Erwin H. Ackercknecht, Medicine at the Paris Hospital, 1794–1848 (Baltimore: Johns Hopkins University Press, 1967), pp. 163–80; and, with special reference to the development of social medicine and rehabilitative care,
Dora B. Weiner, The Citizen-Patient in Revolutionary and Imperial Paris (Baltimore: Johns Hopkins University Press, 1993), pp. 184–90, 225–46, and passim).
Existing historical scholarship on the development of orthopaedic medicine in France has, by and large, focused on the evolution of therapeutic techniques (especially the rise of surgical orthopaedics), without regard to the changing social and economic context of medical practice in this period. Cf. Leonard Peltier, Orthopedics: a History and Iconography (San Francisco: Norman, 1993), especially pp. 195–209 (on scoliosis);
and David Le Vay, The History of Orthopaedics: an Account of the Study and Practice of Orthopaedics from the Earliest Times to the Modern Era (Park Ridge, NJ: Parthenon, 1990), esp. pp. 238–59.
Anne Martin-Fugier, La vie élégante, ou la formation du Tout-Paris, 1815–1848 (Paris: Fayard, 1990).
On the normalization of aesthetic ideals in middle-class dress of this period, see Philippe Perrot, Fashioning the Bourgeoisie: a History of Clothing in the Nineteenth Century (Princeton: Princeton University Press, 1994).
George Sussman, ‘The Glut of Doctors in Mid-Nineteenth-Century France’, Comparative Studies in Society and History, 19 (1977), 293–303.
It is Dr Canivet, the physician summoned to Yonville following Charles Bovary’s disastrous experiment with tenotomy, who offers this judgement. Flaubert, it should be remembered, was the son of a provincial physician (Achille-Cléophas Flaubert, surgeon at the Hôtel-Dieu in Rouen and a member of the Paris Academy of Medicine), and well-informed about contemporary medical practice. J. Normand and T. Irles, ‘Gustave Flaubert et la médecine’, in Conférences d’histoire de la médecine (Lyon: Fondation Marcel Mérieux, 1992), pp. 21–32 (and esp. pp. 27–30);
René Dumesnil, Flaubert et la médecine (Paris, 1905).
Gustave Flaubert, Dictionnaire des idées reçues, in Oeuvres complètes, II (Paris: Seuil, 1964), p. 304.
Adolphe Milli, the director of a private orthopaedic establishment in Chaillot, is generally credited with having introduced the extension bed to Paris practitioners, around 1822. Milli had been successfully treated for spinal curvature with a device like this at J. G. Heine’s institute in Würzburg, Germany, and began importing the beds to France upon his return. On Milli’s role in the promotion of extension beds, see Joseph-François Malgaigne, Leçons d’Orthopédie professées à la Faculté de Médecine de Paris (Paris: Delahaye, 1862), p. 393;
Guillaume Jalade-Lafond, Exposé succinct des moyens mécaniques oscillatoires imaginés et employés pour rémédier aux déviations de la colonne vertébrale et autres vices de conformation, suivi d’un rapport fait à l’Académie Royale de Médecine, par MM. Breschet, Husson, etc., pour lui faire connaître les avantages … des mécaniques oscillatoires orthopédiques de M. Jalade-Lafond (Paris: Boiste, 1825).
Thillaye himself was a recognized expert in the design and use of trusses, bandages and other medical supports, especially in the treatment of injuries sustained on the battlefield, viz., Jean-Baptiste-Jacques Thillaye, Traité des bandages et appareils, à l’usage des chirurgiens des armées (Paris: Crochard, 1809).
Claude Lachaise, Précis physiologique sur les courbures de la colonne vertébrale; ou, Exposé des moyens de prévenir et de corriger les difformités de la taille, particulièrement chez les jeunes filles, sans le secours des lits mecaniques à extension (Paris: Villeret, 1827), p. xi. Under the pseudonym ‘C. Sachaile de la Barre’, Lachaise published a ‘scientific and moral’ evaluation of his peers in the Paris medical community, Les médecins de Paris jugés par leurs oeuvres; ou, Statistique scientifique et morale des médecine de Paris (Paris, 1845). Of the nearly 1500 practitioners profiled in that work, Lachaise identified only seventeen orthopaedists, including some (like Ferdinand Martin, a truss- and instrument-maker at the famous Invalides military hospice) who were not physicians, but mere officiers de santé.
Claude Lachaise, Topographie médicale de Paris (Paris: Baillière, 1822), esp. pp. 278–301 on the therapeutic benefits of physical exercise.
Guillaume Jalade-Lafond, Recherches pratiques sur les principales difformités du corps humain, et sur les moyens d’y remédier (Paris: Baillière, 1827–9).
Jacques-Mathieu Delpech, De l’Orthomorphie, par rapport à l’espèce humaine: ou Recherches anatomico-pathologiques sur les causes, les moyens de prévenir, ceux de guérir les principales difformités et sur les véritables fondemens de l’art appelé orthpédique (2 vols, atlas) (Paris: Gabon, 1828–9).
Delpech defended the originality of his ‘gymnastic’ methods, which he claimed to have used in treating patients at his clinic as early as 1825. Delpech, De l’Orthomorphie (1828), p. 181. See also Leonard F. Peltier ‘The “Back School” of Delpech in Montpellier’, Clinical Orthopaedics and Related Research, 179 (October, 1983), 4–9.
Though best remembered by historians as the inventor of the hypodermic syringe, Charles-Gabriel Pravaz first distinguished himself in the field of orthopaedic medicine by introducing to France the method of ‘local extension’ promoted by London physician John Shaw. Charles-Gabriel Pravaz, Méthode nouvelle pour le traitement des déviations de la colonne vertébrale, précédée d’un examen critique des divers moyens employés par les orthopédistes modernes (Paris: Gabon, 1827). A report on Pravaz’s method and apparatus was read before the Paris Académie de Médecine in 1828.
See e.g. H.W. Berend, ‘Die orthopädischen Institute zu Paris’, Magazin für die gesamte Heilkunde, 59 (1842), 496;
Valentine Mott, Travels in Europe and the East (New York: Harper, 1842), p. 55.
On the controversy surrounding Hossard’s ceinture à lévier, see J.-F. Malgaigne, Leçons d’Orthopédie, pp. 406–14. See also M. J. Hossard, Traitement des déviations de la taille sans lits mécaniques, système d’inclinaison employé à l’établissement orthopédique d’Angers, Maine et Loire (Angers, 1853).
See also [J.-F. Malgaigne], ‘Les spécialités en police correctionelle — Procès de M. J. Guérin’, Revue médico-chirurgicale, 3 (January 1848), 64. The epithet ‘Crispin’ is an allusion to a character (Crispinus, an ambitious but ignorant critic of the poet Horace) in Ben Jonson’s Poetaster (1601); in French comedy, the term is synonymous with arrogance and self-delusion, typically personified by an insolent valet,
as in A. R. Le Sage’s Crispin, rival de son maistre (Paris, 1737)
or N. Le Breton de Hauteroche’s Crispin médecin (Paris, 1674) — both revived in new stage productions around 1808.
Jules Guérin, Mémoire sur les déviations simulées de la colonne vertébrale et les moyens de les distinguer des déviations pathologiques, présenté a l’Académie Royale de Médecine le 31 Mai 1836 (Paris: Gazette Médicale, 1838). See also the reports published in the Gazette médicale de Paris, 3 (1835): 606–7, 622–3. The standard of proof applied in determining the success (or failure) of a specific therapeutic technique varied, where orthopaedic treatment was concerned. In Hossard’s case, plaster casts of the original deformities (spinal deviations) were compared to the spinal columns of the same patients, following a course of treatment with the ceinture à levier (l’appareil Hossard). Delpech used the same technique (in De l’Orthomorphie) to document his success in treating scoliosis, but the results of his treatment were evidently not presented to any official tribunal (like the Academy of Medicine) for assessment.
Jules Guérin, Mémoire sur l’éclectisme en médecine, précédé d’un rapport fait à l’Académie royale de médecine de Paris (Paris: Gazette médicale, 1831);
Guérin, Examen de la doctrine physiologique, appliquée à l’étude et au traitement du choléra-morbus, suivie de l’histoire de la maladie de M. Casimir Périer (Paris, 1832). See also Ackercknecht, Medicine at the Paris Hospital, pp. 101–13.
Valentin, Geschichte der Orthopädie, p. 201. Pravaz’s name is not mentioned in the 1837 prospectus for the Institut Orthopédique de Paris, but appears in a number of publications in Lyon, e.g.: Charles-Gabriel Pravaz, Mémoire sur l’application de la gymnastique au traitement des affections lymphatiques et nerveuses, et au redressement des difformités: présenté à la Société de médecine de Lyon (Lyon: Ch. Savy jeune, 1837).
Both Duval and Delpech had used tenotomy successfully in the treatment of club-foot before Guérin began to generalize the procedure’s use. Guérin first applied the technique (sectioning muscles, rather than tendons) to the correction of spinal deviations in 1839, and to the correction of strabismus — which he referred to as ‘club-foot of the eye’ — in 1841. J. Guérin, Mémoire sur l’étiologie générale du strabisme lu à l’Académie Royale des Sciences, le 25 janvier 1841 (Paris: Gazette médicale, 1843)
and Guérin , Première mémoire sur le traitement des déviations de l’epine par la section des muscles du dos, 2nd ed. (Paris: Gazette médicale, 1843).
See also J. Guérin, Mémoire sur l’étiologie générale des pieds-bots congénitaux, lu à l’Académie de Médecine, le 11 Decembre 1838 (Paris, Gazette médicale, 1838)
and Guérin, Mémoire sur l’étiologie générale des déviations latérales de l’épine, par rétraction musculaire active, lu à l’Académie royale des Sciences, le 23 septembre 1839 (Paris: Gazette médicale, 1840).
Bouvier was among those who critiqued Guérin’s over-use of this procedure in the 1840s. See e.g. his comments at a meeting of the Paris Academy of Medicine (16 October 1848), reprinted in the Revue médico-chirurgicale de Paris, 4 (November 1848), 319–20. See also Bouvier’s remarks on Guérin’s use of myotomy in the treatment of spinal deviations, published in the Gazette médicale, 11 (15 July 1843), 454–6, and J.-F. Malgaigne, Sur l’abus et le danger des sections tendineuses et musculaires dans le traitement de certaines difformités, mémoire adressé à l’Académie Royale des Sciences, le 5 fevrier 1844 and Malgaigne , Mémoire sur la valeur réelle de l’orthopedie et spécialement de la myotomie rachidienne dans le traitement des déviations latérales de l’epine (Paris: Baillière, 1845).
[J.-F. Malgaigne], ‘Discussion sur la ténotomie’, Journal de Chirurgie, 1 (January 1843), 19–25, 55–6.
J. Guérin, ‘Relevé général du service orthopédique de l’Hôpital des Enfants’, Gazette médicale, 11 (11 July 1843), 424. Of a total of 1394 cases admitted to the hospital, Guérin claimed to have ‘completely cured’ some 377, and ‘improved’ the situation of an additional 296. Twenty-five patients were reported to have died during the course of treatment (though not from any direct result of their treatment). An additional 619 patients were effectively excluded from Guérin’s assessment on the grounds that their treatment had not been completed, or was never undertaken. For Malgaigne’s critique, see ‘Relevé général du service orthopédique de l’Hôpital des Enfants’, Journal de Chirurgie, 1 (July 1843), 246, and ‘De quelques illusions orthopédiques, à l’occasion du Relevé général du service orthopédique de M. J. Guérin’, Journal de Chirurgie, 1 (August 1843), 257–65. Guérin’s reported results were also challenged by Dr Charles Maisonabe, who addressed several critical letters on the subject to the editor of the Gazette des hôpitaux (François Fabre, also publisher of the satirical Némésis médicale). See correspondence published in the Gazette des hôpitaux, 5 (6 July 1843), 315–16, and 5 (15 July 1843), 318.
Guérin targeted the editors of two popular medical journals in which ‘libelous’ critiques of his work had been published (J.-F. Malgaigne of the Revue médico-chirurgicale de Paris, and Auguste Vidal de Cassis of the Annales de la Chirurgie Française et Etrangère), and a journalist, M. Henroz. Guérin sought (but did not win) a financial reparation of 20,000 francs, which was to be awarded to the Hôpital des Enfants Malades to support the services of the orthopaedic ward. See: ‘Nouvelle simplification des discussions orthopédiques. — Procès intenté au Journal de Chirurgie’, Journal de Chirurgie, 1 (1843), 321–2. [Jules Guérin], Mémoire à consulter pour M. Jules Guérin, contre MM. Malgaigne, Vidal (de Cassis) et Henroz (Paris: Malteste, 1844).
See also Leonard Peltier, ‘Guérin Versus Malgaigne: a Precedent for the Free Criticism of Scientific Papers’, Journal of Orthopaedic Research, 1 (1983), 115–18.
Malgaigne went so far as to imply that the text of the rapport, which offered fulsome praise for Guérin’s methods and technique, had been written by Guérin himself, and then signed (but not read or critiqued) by the Academy’s commissioners — all of whom, Malgaigne cynically observed, were friends and associates of Dr Guérin. [J.-F.] Malgaigne, ‘Lettre à un chirurgien de province sur le Rapport addressé à M. le Délégué du gouvernement provisoire sur les traitements orthopédiques de M. le docteur Jules Guérin, etc.; par une commission composée de MM. Blandin, P. Dubois, Jobert, Louis, Rayer et Serres; président, M. Orfila’, Revue médico-chirurgicale, 4 (October 1848), 249–58. See also Malgaigne’s sarcastic send-up of an article by the astronomer and cleric l’Abbé Moigno, defending Guérin’s claims to scientific integrity and originality. [J.-F. Malgaigne], ‘A quoi servent certains grands prix de l’Institut’, Revue médico-chirurgicale, 4 (November 1848), 322.
The surgical manual used by Bovary is identified by Flaubert as [Vincent] Duval’s Traité pratique du pied-bot (Paris: Baillière, 1839). Vincent Duval had studied with Flaubert’s father at the Paris Faculty of Medicine in the 1820s.
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Malpas, C. (2004). Jules Guérin Makes his Market: the Social Economy of Orthopaedic Medicine in Paris, c. 1825–1845. In: de Blécourt, W., Usborne, C. (eds) Cultural Approaches to the History of Medicine. Palgrave Macmillan, London. https://doi.org/10.1057/9780230287594_9
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