The Surgeon at the Hôtel-Dieu : Part 2

Flaubert: A Biography
by Frederick Brown

(Page 2 of 6)

What one knows for certain is that the young man began his career at a seminal moment in the history of French medicine. Amid the rubble left by revolutionaries bent on smashing institutional structures that safeguarded privilege and consecrated traditional authority, adventurous minds found room to maneuver. The empirical method flourished, students sought instruction at Paris's Hôtel-Dieu on the île de la Cité, and in this movement toward hospital medicine, surgeons held the torch for physicians. They who once trailed behind academic luminaries contemptuous of their intimacy with the human body now constituted a brilliant, scientific vanguard.

The reversal had occurred slowly. Although France had produced the great surgeon Ambroise Paré in Rabelais's time, it took most of the eighteenth century and a battalion of philosophes challenging well-entrenched pieties to clear the ground for clinical medicine. Set against it were not only the church but a high culture whose apologists felt impelled to frame the physical or sensual world in rationalist hypotheses. Behind its ogives on the rue de la Bûcherie, the Medical Faculty, where lectures were given in Latin and readily understood by youths, mostly wellborn, who had earned a master of arts degree, restricted its teaching to humane letters, to natural philosophy, and to medical theory derived from classical texts. Never dissecting a dead person or laying hands on a sick one, future physicians became thoroughly conversant with Hippocrates and Galen but remained largely ignorant of humanity in the flesh.

Proud to be called antiquarum tenax, this establishment, which scoffed, for example, at William Harvey's discovery that blood circulates, regarded surgery as a subordinate discipline, a manual or "mechanical" trade, fit for the dexterous and inarticulate. Here, as in the culture at large, much was predicated upon the superiority of head over hand. When Louis XIV's premier physician, Guy-Crescent Fagon, survived a lithotomy in 1701, receiving advice on a postoperative regimen from the surgeon, whom he dismissed with "I needed your hand, but I do not need your head," proved more painful than having stones removed from his bladder. In this curt rejoinder, he formulated the prejudice of almost all of his colleagues. Threatened as they increasingly were, they sought shelter from modern times in the distinction conferred upon humanists by their knowledge of the language that gave one access to medical scripture. However skillful the artisan, without Latin he spoke without intellectual authority.

So it was that the faculty, unable in 1724 to veto royal patents endowing public courses for five eminent surgeons at the amphitheater of Saint-Côme, persuaded the crown to have those five appointed as "demonstrators" rather than "professors." It thus maintained the settled order of things by ensuring, titularly, that ignoramuses whose text was the body should not profess but, like children or nominal mutes, "demonstrate," show, point. An event even more portentous occurred twenty years later, when Louis XV's chancellor, concurring with petitioners from Saint-Côme who argued that "knowledge of the Latin tongue and the study of Philosophy" would greatly improve them - that a thorough command of logic, rhetoric, and grammar would broaden their professional horizon - declared the master of arts degree to be a requirement for the surgical mastership. With its very identity at stake, the faculty proclaimed from its bully pulpit the existence of an inherent difference between physician and surgeon.

Did surgeon not derive from the Greek word meaning "manual operation"? asked a professor at the medical school. Literary culture, which had previously been seen as the surgeon's deficiency, was henceforth pictured as an encumbrance certain to dull the cunning of his hand. The hand that cut would now scribble, the mouth that demonstrated would now orate. "The [surgeon] demonstrators will have the title of professors," an alarmed opponent of reform exclaimed in 1743. "No longer will they demonstrate anatomy and operations by word of mouth, they will read from books; they will give lessons and not examples; they will play the part of orators to be listened to, instead of offering a model to be imitated."

When one eminent physician argued that the hospital should serve as the surgeon's library and cadavers as his books, he wasn't voicing enthusiasm for dissection or the clinical method. He was simply putting a subordinate in his place. And, inversely, when the Revolutionary government proposed that the patent laws of 1791 (levying a tax on businesses) should include medicine, the umbrageous faculty declared itself, in what would prove to be its dying breath, a priestly caste, a transcendent corporation whose stock-in-trade was its aptitude for hermeneutics. "Nothing can legally verify the practice of a profession which is purely intellectual, and which is performed exclusively by verbal means, without the intermediary of any material object."

How far the values informing the conflict between surgeon and physician reached into cultural life beyond medicine may best be seen in the realm of theater. Here a battle raged throughout the eighteenth century between the King's Players and actors who earned their livelihood on the popular or fairground stage. Chartered in 1680 by Louis XIV, the Comédie-Française had been given, as its birthright, hegemony over Parisian theater. To "render more perfect the performance of plays," in language closely monitored for barbarisms, was its mission. It alone could utter French; the spoken word was banned from every other stage, and transgressions by the profanum vulgus would not go unpunished. At the Saint-Germain fair, police regularly dismantled jerry-built playhouses in which ingenious devices were used to circumvent the taboo against speech.

A theater full of antic mischief, with personae descended straight from commedia dell'arte, marshaled its zanies against the classical company (whose members, nicknamed "Romans" in fairground parlance, dared never run onstage, much less tumble). In language necessarily gestural, Harlequin's slapstick matched the surgeon's scalpel, emblemizing a primitive world, at once older and childish, outside the precincts of culture. While officialdom beat a retreat under Louis XV, it did so in the same tactical spirit as the Medical Faculty declaring that erudition would cramp a surgeon's style. In time the censor came to allow speech on fairground stages, provided only that it be distasteful; judgments delivered thereafter show greater tolerance of smut than of literate badinage. Perverse as this may seem, it was consonant with a desire to keep high essentially distinct from low, to safeguard the one by preserving the other. Let Shakespeare marry eloquence and scatology, intellectual delight and visual excitement. In France, order hinged on their separation. "The crude multitude can derive no pleasure from a serious, solemn, truly tragic discourse and . . . this many-headed monster can know at most only the ornaments of theater," affirmed a noted esthetician.

Copyright © 2006 by Frederick Brown

About the Author

Frederick Brown is the author of An Impersonation of Angels: A Biography of Jean Cocteau; Père-Lachaise, Theater and Revolution; and Zola: A Life. Twice the recipient of both Guggenheim and National Endowment for the Humanities fellowships, he lives in New York City.