Theoretical change and therapeutic innovation in the treatment of syphilis in Mid-nineteenth-century France

Journal of the History of Medicine and Allied Sciences

Volumn 59, Issue 4, 2004, Pages 522-554

  Dracobly, Alex ^a  

^a NONE

Author keywords

Fran ois Broussais; Louis Lagneau; Mercury; Michel Cullerier; Nineteenth century France; Philippe Ricord; Physiological Medicine; Potassium Iodide; Therapeutics; Venereal disease

Indexed keywords

MERCURY;

ARTICLE; DECISION MAKING; FRANCE; GONORRHEA; HISTORY; HUMAN; SOCIAL MEDICINE; SYPHILIS; THEORETICAL MODEL;

DECISION MAKING; FRANCE; GONORRHEA; HISTORY, 19TH CENTURY; HUMANS; MERCURY; MODELS, THEORETICAL; SOCIAL MEDICINE; SYPHILIS;

EID: 85047689842     PISSN: 00225045     EISSN: None     Source Type: Journal    
DOI: 10.1093/jhmas/jrh109     Document Type: Article

References (234)

1. For examples see the entry for mercury in Bouchardat, Manuel de matiére médicale de thérapeutique comparée et de pharmacie, 2nd ed. (Paris: Germer Bailliere, 1846), pp. 669-93.
2. Fielding H. Garrison, An Introduction to the History of Medicine, 4th ed. (Philadelphia: W. B. Saunders, 1929), pp. 415-16.
3. This is admittedly a little dated, but the story has scarcely changed since then. For more recent accounts, see Claude Quétel, History of Syphilis, trans. Judith Braddock and Brian Pike (Baltimore, Md.: Johns Hopkins University Press, 1990), pp. 106-30;
4. Daniel Wallach and Gérard Tilles, eds., La Dermatologie en France (Toulouse: Privat, 2002), pp. 197-225;
5. John Thorne Crissey and Lawrence Charles Parish, The Dermatology and Syphilology of the Nineteenth Century (New York: Praeger, 1981), pp. 84-87;
6. or more briefly, Roy Porter, The Greatest Benefit to Mankind (New York: Norton, 1997), P. 452.
7. Although it may not be evident in what follows, it was John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge, Mass.: Harvard University Press, 1986), that first spurred me to think about the history of therapeutics. For programmatic statements,
8. see E. H. Ackerknecht, "A Plea for a 'Behaviorist' Approach in Writing the History of Medicine," J. Hist. Med. All. Sci., 1967, 22, 211-14;
9. Charles E. Rosenberg, "The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America," reprinted in Explaining Epidemics and Other Studies in the History of Medicine (Cambridge: Cambridge University Press, 1992), pp. 9-31;
10. Guenter B. Risse, "The History of Therapeutics," in Essays in the History of Therapeutics, ed. W. F. Bynum and V. Nutton, special issue of Clio Medica, 1991, 22, 3-11.
11. For France, see especially Erwin Ackerknecht, "Die Therapie der Pariser Kliniker zwischen 1795 und 1840," Gesnerus, 1958, 15, 151-63 arid
12. Medicine at the Paris Hospital 1794-1848 (Baltimore, Md.: Johns Hopkins University Press, 1967), pp. 129-38.
13. More recent work includes George Weisz, The Medical Mandarins: The French Academy of Mediane in the Nineteenth and Early Twentieth Centuries (New York: Oxford University Press, 1995), pp. 159-88,
14. several of whose conclusions are repeated here; from the perspective of "professionalization and popular culture," see Matthew Ramsey, Professional and Popular Medicine in France, 1770-1830: The Social World of Medical Practice (Cambridge: Cambridge University Press, 1988).
15. More specifically for syphilis, see Susan P. Conner, "The Pox in Eighteenth-Century France," in The Secret Malady: Venereal Disease in Eighteenth-Century Britain and France, ed. Linda E. Merians (Lexington: University of Kentucky Press, 1996), pp. 15-33;
16. and Owsei Temkin, "Therapeutic Trends and the Treatment of Syphilis before 1900," in Double Face of Janus and Other Essays in the History of Mediane (Baltimore, Md.: Johns Hopkins University Press, 1977), pp. 518-24.
17. See, for example, Porter, The Greatest Benefit to Mankind, p. 452, where he notes that in spite of "substantial advances in knowledge, no therapeutic advances had been made upon the wretched mercury, in use since the sixteenth century."
18. Ibid., p. 319 (for the "therapeutic nihilism of Paris medicine") and p. 307 ("medicine's job was to establish the patterns of pathology").
19. Compare Ackerknecht, Medicine at the Paris Hospital, p. 135, who is careful to distinguish the "therapeutic skepticism" of French medicine as opposed to the "therapeutic nihilism" of Vienna of the 1840s;
20. also W. F. Bynum, Science and the Practice of Medicine in the Nineteenth Century (Cambridge: Cambridge University Press, 1994), pp. 33-46.
21. Jacalyn Duffin, To See with a Better Eye: A Life of R. T. H. Laennec (Princeton, N.J.: Princeton University Press, 1998), who has greatly nuanced the traditional picture of Laennec as an arch-skeptic.
22. For Louis, see Ackerknecht, Medicine at the Paris Hospital, pp. 9-10, 102-4, 134;
23. and John Harley Warner, Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton, N.J.: Princeton University Press, 1998), pp. 127-31, 167-69, who notes that Louis had a greater standing among his American students than within his own profession.
24. See Ackerknecht, Medicine at the Paris Hospital, pp. xiii, for an assertion that French medicine reached a dead-end in the 1840s. This issue is placed within a broader context by Caroline Hannaway and
25. Ann La Berge, "Paris Medicine: Perspectives Past and Present," in Constructing Paris Medicine, ed. Caroline Hannaway and Ann La Berge (Amsterdam and Atlanta, Ga.: Editions Rodopi, 1998), pp. 1-69;
26. also see Joy Harvey, "'Faithful to Its Old Traditions'? Paris Clinical Medicine from the Second Empire to the Third Republic (1848-1872)," in ibid., pp. 313-35, esp. 326-27;
27. and John Harley Warner, "Paradigm Lost or Paradise Declining? American Physicians and the 'Dead End' of the Paris Clinical School," in ibid., pp. 337-83.
28. Although associated with Cullerier, this theory found its classic expression in L. V. Lagneau, Exposé des diverses méthodes de traiter la maladie vénérienne, et leurs différentes modifications, selon l'áge, le tempéament du sujet, et les maladies concomitantes (Paris: Méquignon, 1805) (although the title varied in subsequent editions, the content remained essentially the same through its sixth and final edition in 1828).
29. Also Petit-Radel, Cours de maladies syphilitiques, fait aux Écoles de médecine de Paris en 1809 et années suivantes, 2 vols. (Paris: Chanson arid Fournier, 1812);
30. [Jacques Mathieu] Delpech, Chirurgie clinique de Montpellier, ou observations et réflexions tirées de travaux de chirurgie clinique de cette école, 2 vols. (Paris and Montpellier: Gabon, 1823 and 1828), I, 263-471.
31. L. V. Lagneau, Traité pratique des maladies syphilitiques, 6th ed., 2 vols. (Paris: Gabon, 1828), I, 461-64. Theories of the effectiveness of mercury - that salivation expelled the virus, that the virus was destroyed in the bloodstream by the chemical action of mercury, and so on - were common until the beginning of the nineteenth century. Although some doctors continued to appeal to such notions (the salivation theory in particular died hard), the trend was toward greater agnosticism with respect to the exact mechanism that explained mercury's effectiveness. Where most doctors (with the notable exception of the physiologists) agreed was that mercury not only treated the symptoms of the disease but also exerted an action on its cause, the syphilitic virus.
32. Ibid., II, 99-135;
33. Delpech, Chirurgie clinique de Montpellier, I, 394-400.
34. For general discussions, Cullerier and Bard, "Syphilis," in Dictionnaire des sciences médicales, 60 vols. (Paris: Panckoucke, 1812-1822), vol. 54 (1821), 127-62, esp. p. 143;
35. Lagneau, Traité pratique des maladies syphilitiques (1828), II, 136-213;
36. arid Joseph Humbert, Manuel pratique des maladies de la peau appelées syphilides, d'après les lecons cliniques de M. Biett (Paris: Germer Baillière, 1833), pp. 72-105, 202-7.
37. Lagneau, Traité pratique des maladies syphilitiques (1828), I, 271. All translations from French to English are my own unless otherwise noted.
38. This was the dominant meaning of the term through 18405, when the unicists were engaged in their debate with Ricord's new doctrine. This unicist theory, however, should not be confused with another theoretical dispute from the 1850s over the unity of the syphilitic chancre, a debate in which Ricord also figured prominently (in this debate the unicists maintained that there was but a single chancre, syphilitic in nature and whose appearance varied; the dualists that the syphilitic chancre and the "soft" chancre were symptoms of two distinct diseases, syphilis and what became known as "chancroid").
39. Lagneau, Traité pratique des maladies syphilitiques (1828), I, 18-162 (for "blennorrhagie"). "Recent or Light Syphilis" was the title of chapter 1,
40. ibid., I, 18-246.
41. L. V. Lagneau, Exposé des symptômes de la maladie vénérienne, 3rd ed. (Paris: Gabon, 1812), p. 39.
42. Lagneau, Traité pratique des maladies syphilitiques (1828), I, 54.
43. C. M. Gibert, Manuel pratique des maladies vénériennes (Paris: Germer Baillière, 1837), pp. 215, 250.
44. Ibid., p. 215.
45. For instance, a case in which someone presenting gonorrheal symptoms transmitted this disease to his or her partner and subsequently developed syphilis. A unicist would have diagnosed this case as a virulent gonorrhoea - that is, syphilitic in nature - and would have treated both persons with mercury.
46. For Broussais and his theories, Ackerknecht, Mediane at the Paris Hospital, pp. 61-80;
47. Jean-François Braunstein, Broussais et le matérialisme: médecine et philosophie au XIXe siècle (Paris: Meridiens Klincksieck, 1986).
48. F.-J.-V. Broussais, Examen des doctrines médicales et des systèmes de nosologie, 2nd ed., 2 vols. (Paris: Méquignon-Marvis, 1821), II, propositions CDV-CDXIII.
49. The main works were A.-J.-L. Jourdan, Traité complet des maladies vénériennes, 2 vols. (Paris: Méquignon-Marvis, 1826);
50. M. N. Devergie, Clinique de la maladie syphilitique, 2 vols. (Paris: F. M. Maurice, 1826-1833);
51. H.-M.-J. Desruelles, Traité pratique des maladies vénériennes, 2 vols. (Bruxelles: Société Belge de Librairie, 1837);
52. and L.-F.-R.-A. Richond des Brus, De la non-existence du virus vénérien . . . rédigé d'après les principes de la nouvelle doctrine médicale, 2 vols. (Paris: Delaunay, 1826).
53. Devergie, Clinique de la maladie syphilitique, I, 107 for quote and 100-11 for explanation of sympathy. This volume is usually listed as being published in 1826, but it is clear from internal evidence that it was published in parts (fascicules) between 1826 and 1833.
54. Broussais, Examen des doctrines médicales, II, proposition CDVII.
55. See Elizabeth A. Williams, A Cultural History of Medical Vitalism in Enlightenment Montpellier (Aldershot, England, and Burlington, Vt.: Ashgate, 2003);
56. Roselyne Rey, Naissance et développement du vitalisme en France de la deuxième moitié du 18e siècle à la fin du Premier Empire (Oxford: Voltaire Foundation, 2000);
57. William B. Coleman, "Health and Hygiene in the Encyclopédie; A Medical Doctrine for the Bourgeoisie," J. Hist, Med. All. Sci., 1974, 29, 399-421;
58. and L. J. Rather, "The 'Six Things Non-Natural': A Note on the Origins and Fate of a Doctrine and a Phrase," Clio Medica, 1968, 3, 337-47.
59. For the relation between vitalism, neohippocratism, and Paris medicine, see Elizabeth Williams, "Hippocrates and the Montpellier Vitalists in the French Medical Enlightenment,"
60. and Ann F. La Berge, "The Rhetoric of Hippocrates at the Paris School," both in Reinventing Hippocrates, ed. David Cantor (Ashgate: Aldershot, 2002), pp. 157-77 and 178-99, respectively.
61. Devergie, Recherches historiques et médicales sur l'Origine, la nature et le traitement de la syphilis (Paris: Baillière, n.d. [1834]), p. 21.
62. Devergie, Clinique de la maladie syphilitique, I, 44, 105.
63. The physiologists considered mercury a "revulsive" treatment, that is, a treatment that stimulated one region of the body to reduce stimulation in another region: see Jourdan, Traité complet des maladies vénériennes, II, 655-59;
64. and Richond des Brus, De la non-existence du virus véné rien, I, 438 (the entire second volume of which is devoted to a demonstration of the superiority of nonmercurial cures). Devergie was probably the physiologist most willing to envisage the use of mercury.
65. See, for example, Examen des critiques publiées depuis 1827 sur la nouvelle doctrine de la syphilis et le traitement antiphlogistique (n.p., n.d. [1829?]), pp. 55-56;
66. but this is not saying much; compare Recherches historiques et médicales sur l'origine, la nature et le traitement de la syphilis (Paris: Baillière, [1834]), pp. 30-51. In later years, Desruelles, the only one of the physiologists still actively defending the theory, greatly softened his opposition to mercury;
67. Lettres écrites du Val-de-Grâce sur les maladies vénériennes et sur le traitement qui leur convient, d'après l'observation et l'expérimentation pratique, 3rd ed. (Paris: J.-B. Baillière, 1847), pp. 47-52.
68. See, for example, J. Krueger, "Exposition de la méthode suivie chez les Anglais pour le traitement des maladies véné riennes sans mercure," J. compl. dict, sci. méd., 1822, 14, 107-42, 208-20;
69. Jean [sic] Thomson, "Remarques sur le traitement de la syphilis sans mercure," J. compl. dict. sci. méd., 1825, 22, 16-22;
70. G.-J. Guthrie, "Remarques sur le traitement de la maladie vénérienne sans mercure,"J. compl. diet. sci. méd., 1825, 22, 116-32.
71. A good review of this literature can be found in L.-P.-A. Gauthier, Examen historique et critique des nouvelles doctrines médicales sur le traitement de la syphilis (Paris: J.-B. Baillière; Lyon: Savy, 1843), pp. 5-25.
72. The most important of these trials was described in H.-M.-J. Desruelles, "Mémoire sur les résultats comparatifs obtenus par les divers modes de traitement mercuriel et sans mercure, employés à l'hôpital militaire d'instruction du Val-de-Grace, depuis le 16 avril 1825 jusqu'au 31 juillet 1827 contre les maladies vénériennes," Rec. mém. méd., chir. pharm. mil., 1828, 25, xii-xlviii, 1-402
73. and "Second mémoire sur les résultats comparatifs obtenus par les divers modes de traitement mercuriel et sans mercure, employés à l'hôpital militaire d'instruction du Val-de-Grâce, depuis le 16 avril 1825 jusqu'au 31 juillet 1827 contre les maladies vénériennes," Rec. mém. méd., chir. pharm. mil., 1829, 27, 1-386.
74. Richond des Brus, De la non-existence du virus vénérien, I, part 1, 8, chimed to have cured 1004 patients without mercury; see ibid., I, part 1, 15-18 for synoptic tables of the results. Desruelles's trials at Val-de-Grâce,
75. reported in "Mémoire sur les résultats comparatifs" and "Second mémoire sur les résultats comparatifs," involved well in excess of a thousand patients. Further experimental results were reported in Devergie, Clinique de la maladie syphilitique, 1:240-67.
76. In a good example of the rhetoric that so irritated their adversaries, Desruelles would claim in 1840 "more than 300,000 published facts" in support of the nonmercurial cure, Lettres écrites du Val-de-Grâce sur les maladies vénériennes et sur le traitement qui leur convient, d'après l'observation et l'expérimentation pratique, 2nd ed. (Paris: n.p., 1840-1841), p. 7.
77. Desruelles, "Mémoire sur les résultats comparatifs," xxv. Although Desruelles's experiments had begun in 1825, he only ceased using mercury altogether in January 1827, just six months before the experiment ended; see
78. ibid., 156.
79. Also Anonymous, "Bibliographie française: Recherches pratiques sur la thérapeutique de la syphilis, par Lucas Champonnière," Arch, méd. Strasbourg, 1836, 3, 344-55 and 429-41, esp. pp. 354-55. For criticisms of the physiologists' experiments,
80. see Bernet, "De l'existence du virus vénérien et des moyens employés pour le combattre," J. méd.-prat. rec. trav. Soc. roy. méd. Bordeaux, 2nd ser., 1836, 4, 80-91;
81. Gauthier, Examen historique et critique des nouvelles doctrines, pp. 57-61;
82. and the comments of Leborgne in Procès-verbaux des séances tenues par les médecins de Nantes, pour discuter la valeur des doctrines relativement à la nature et au traitement de la syphilis (Nantes: Mellinet, 1835), p. 14,
83. which led to the exchange between Desruelles and Lepelletier in J. conn, méd., 1835-1836, 3, 243, 284;
84. and between [Lucas-Champonnière], "Variétés: Congrès médical," J. méd. chir. prat., 1835, 6, 430-32,
85. and the Nantais, "Variétés: réclamations," J. méd. chir. prat., 1835, 6, 475-80.
86. Jourdan, Traité complet des maladies vénériennes, I, 247, and II, 656;
87. Devergie Clinique de la maladie syphilitique, I, 172-173;
88. and [Lucas-Champonnière], "Hôpital des vénériens," J. méd. chir. prat., 1834, 5, 309-21, p. 312 note 1;
89. idem, "Hôpital des vénériens,"J. méd. chir. prat., 1835, 6, 171-78, pp. 173, 177. Lucas- Champonnière was François-August Cullerier's (nephew of Michel) mouthpiece.
90. Although I have been unable to locate an actual copy of this order, it is described in L. J. B. [Bégin?], "Note préliminaire du rédacteur," Rec. mém, méd. chir. pharm. milit., 1828, 25, i-xii.
91. Frémanger, "Observation de maladies véné riennes, et conséquences que l'on peut en déduire, concernant le traitement qu'il convient de leur opposer," Rec. mém. méd., chir. pharm. mil., 1833, 35, 224-40, pp. 224-25.
92. Léonard, fils, "Considérations générales et pratiques sur les affections syphilitiques observées et traitées à l'hôpital militaire de Lille," Rec. mém. méd., chir. pharm. mil., 1833, 35, 241-57, p. 242.
93. J. sec. méd. Soc. acad. dép. Loire-Inférieure, 1835, 11, 21-22.
94. These were published in J. sec, méd. Soc. acad. dép, Loire-Inférieure, 1835, 11, 204-28;
95. for the Nantais's own deliberations, Procès-verbaux des séances tenues par les médecins de Nantes;
96. a reaction sympathetic to the physiologists can be found in J. méd. chir. prat., 1835, 6, 430-32
97. (but compare ibid., 1835, 6, 475-80).
98. Other responses to the Nantais's request can be found in Gaz. méd. Paris, 1835, 6, 639-40;
99. J. méd. chir. prat., 1836, 7, 87-88;
100. J. conn. méd., 1835-1836, 3, 86, 243, 284, 347-50;
101. and for the Medical Society of Lyon, Bottex, De la nature et du traitement de la syphilis (Lyon: Louis Perrin, 1836).
102. In the Medical Society of Tours, the vote was eleven to one; the Medical Society of the Sarthe unanimously endorsed the use of mercury; in Rennes (where the physiologist Desruelles's brother practiced) the vote was twenty to two; only the Medical Society of Angers dissented, arguing that more comparative experiments were necessary: J. sec, méd. Soc. acad. dép. Loire-Inférieure, 1835, 11, 204-28.
103. Cullerier and Ratier, "Syphilis," in Dictionnaire de médecine et de chirurgie pratiques, 15 vols. (Paris: Méquignon- Marvis, J.-B. Baillière, 1829-1836), XV (1836), 176-234;
104. for the citation, see Cullerier in the preface to Lucas- Champonnière, Recherches pratiques sur la thérapeutique de la syphilis (Paris: Au Bureau du Journal de Médecine, 1836), p. vi. It should be noted that Cullerier later rallied to Ricord's theory.
105. Gauthier, Examen historique et critique des nouvelles doctrines, pp. 72-76.
106. The use of mercury appears to have rebounded in later decades, first in response to fears regarding hereditary syphilis and later to the broader fears inspired by the péril vénérien. For a case study, see Jill Harsin, "Syphilis, Wives, and Physicians: Medical Ethics and the Family in Late-Nineteenth-Century France," French Hist. Stud., 1989, 16, 72-95.
107. Philippe Ricord, Lettres sur la syphilis (Paris: Au Bureau de l'Union médicale, 1851), pp. 5, 4.
108. For Ricord's celebrity and wealth in this period, see F. de Lansac, Encyclopédie biographique du XIXme siècle. Médecins célèbres (Paris: Au Bureau de l'Encyclopédie biographique du XlXme siècle, 1843), pp. 63-83;
109. and C. Sächeile [Claude Lachaise], Les médecins de Paris jugés par leurs oevres, ou statistique scientifique et morale des médecins de Paris (Paris: Chez l'auteur, 1845), pp. 554-56.
110. For one such controversy concerning the contagiousness of the symptoms of the secondary stage of syphilis, see Alex Dracobly, "Ethics and Experimentation on Human Subjects in Mid-Nineteenth-Century France: The Story of the 1859 Syphilis Experiments," Bull. Hist. Med., 2003, 77, 332-66.
111. Philippe Ricord, Traité pratique des maladies véné riennes (Paris: Just Rouvier et E. Le Bouvier, 1838). Ricord's key finding that gonorrhea and syphilis were distinct diseases remained intact. In the 18505, however, he was forced first to recognize the existence of chancroid as a distinct disease (in
112. Philippe Ricord, Leçons sur le chancre, ed. Alfred Fournier [Paris: Adrien Delahaye; Aux Bureaux du Journal l'Union médicale, 1858]), and subsequently to admit the contagiousness of the symptoms of the secondary stage of syphilis. Both findings had important implications for Ricord's new doctrine, because they undermined the entire interpretive framework of his experimental model. The theory had been based on the assumption that the pus of the soft chancre (understood as a stage of the syphilitic chancre) alone was capable of transmitting the disease. Now it turned out that not only was the soft chancre not syphilitic but that the symptoms of the secondary stage of syphilis were capable of transmitting the disease as well. See later, notes 51, 53, and 79, for further discussion of Ricord's experimental model.
113. Ricord, Lettres sur la syphilis, pp. 5-6.
114. Ricord, Traité pratique, pp. 1-198, outlines the theory and explains his research methodology; for a more succinct description of his experimental model,
115. see Ricord, Lettres sur la syphilis, pp. 5-9.
116. See John Hunter, A Treatise on the Venereal Disease (London: n.p., 1786), pp. 324-27, for the famous experiment in which he infected himself with the "venereal poison" (and from which Hunter erroneously concluded that "matter from a gonorrhoea will produce chancres," p. 327). In France the most important inoculation experiments prior to Ricord were described in
117. J. F. Hemandez, Essai analytique sur la non-identité des virus gonorrhoïque et syphilitique (Paris: Author and J.J. Paschoud, 1812).
118. A description of these experiments made up the bulk of Ricord, Traité pratique, pp. 199-524. He later restricted the use of inoculation to "des cas particuliers ou le diagnostic hesitant a besoin d'un guide," Ricord as reported in
119. Ed Courtin, "Des maladies vénériennes. Extrait des leçons cliniques de M. le docteur Ricord à l'hôpital du Midi," J. conn. méd.-chir., 1846, ist semester, 14, 13-17, 16. See later discussion for diagnostic uses of the technique.
120. First stated in Philippe Ricord, "Considérations pratiques sur le chancre, pour servir à la thérapeutique des affections syphilitiques," Bull. gén. thér. méd. chir., 1836, 11, 49-59, 92-9, 119-24, 187-94, 281-88. As it turns out, Ricord's experimental model was flawed. Ricord did initially not recognize the distinction between the hard and soft chancre as one of nature. Rather, he maintained that these two symptoms represented different stages of the syphilitic chancre: soft and contagious in its early stage, hard and noncontagious in its later stage. It is unclear exactly when he became convinced of the specificity of chancroid (Ricord's soft chancre). His student, P. I. A. Léon Bassereau,
121. Traité des affections de la peau syniptomatiques de la syphilis (Paris: J. B. Baillière, 1852),
122. is usually credited with the discovery, bvit Ricord's change of mind only became official with the publication of Ricord, Leçons sur le chancre (1858). This admission implied that Ricord's entire theory was in error, because his positive inoculations were now understood to have been chancroid, not syphilis.
123. Ricord, Traité pratique, pp. 53-54.
124. K. Codell Carter, The Rise of Causal Concepts of Disease: Case Histories (Aldershot, England, and Burlington, Vt.: Ashgate, 2003), p. 25. Ricord's theory essentially meets the requirements of what Carter describes as the etiological standpoint. For Ricord the cause of syphilis was natural, universal, and necessary
125. (see ibid., p. 1), but he also wedded these principles to a mechanical understanding of causation, so that given the proper circumstances, contact with the virus would necessarily result in an infection. It was by this means that he tried to address the problem of false negatives, see note 79 later.
126. Ricord, Traité pratique, pp. 117-34.
127. For a detailed discussion of specific symptoms, see Philippe Ricord, Traité complet des maladies vénériennes. Clinique iconographique de l'Hôpital des vénériens (Paris: Just Rouvier, 1851). It is important to recognize, however, that Ricord defined secondary symptoms more as a function of the stage of the disease than as a function of what form the symptom took.
128. Ricord, Traité pratique, p. 160.
129. Ibid., pp. 159-67. This method naturally assumed that a positive diagnosis of syphilis had already been established. Ricord advocated the use of diagnostic inoculation for two different purposes: to establish a differential diagnosis of gonorrhea and syphilis (especially in situations where a chancre could not be located) and to establish a differential diagnosis of the primary and secondary stage of syphilis.
130. Ibid., p. 160.
131. I b i d.
132. Ibid., p. 645.
133. Ibid., pp. 645-46.
134. See Ricord's notes to John Hunter, Traité de la syphilis, in Oeuvres complètas de John Hunter, 4 vols., trans. G. Richelot (Paris: Labé and Firmin Didot, 1839), IV, 238, 260-66, 274.
135. Philippe Ricord, "Mémoire sur quelques faits observés à l'hôpital des vénériens," Mém. Acad. roy. méd., 1833, 2, 158-77,
136. for an early warning against the use of mercury; also Ricord, "Du traitement de la blennorrhagie chez l'homme," Bull. gén. thér. méd chir., 1840, 20, 24-32;
137. Ricord, "Quelques considérations sur la blennorrhagie en général et sur le traitement particulier de k balano-posthite et de l'urétrite blennorrhagique," Bull. gén. thér. méd chir., 1843, 25, 109-19.
138. Ricord, "Considérations pratiques sur le chancre," 49-59, 92-99, 119-24, and esp. 187-94, 281-88.
139. His language was not always so clear. In 1839, for instance, Ricord wrote that "if [mercury] was not a specific," it was still the most powerful "means" of treating syphilis, "Quelques considérations thérapeutiques sur les accidents primitifs et généraux des maladies vénériennes, et sur l'emploi de l'iodure de potassium dans le traitement des accidents tertiaires," Bull. gén. thér. méd chir., 1839, 17, 21-29, 22. The following year, however, he stated that one must "consider" mercury as a specific against syphilis, "Considérations pratiques sur les accidents tertiaires de la syphilis constitutionnelle, et en particulier sur les ulcérations de la gorge, et sur leur traitement par l'iodure de potassium,"
140. Bull. gén. thér. méd chir., 1840, 19, 15-22, 16.
141. See, for example, Société de médecine de Bordeaux, "Discussion sur la cauteŕisation du chancre," J. méd.-prat. rec. trav. Soc. roy. méd. Bordeaux, 1841, 13, 151-63, esp. 162, where one Dr. Degranges notes Record's "hostility" to mercury; and
142. Amable Cade "De l'iodure de potassium dans le traitement de la syphilis," J. soc. méd. prat. Montpellier, 1844, 10, 303-12, 303.
143. On eclecticism, Ackerknecht, Medicine at the Paris Hospital, pp. 101-13.
144. The term anatomism comes from a hostile article published in the Rev. méd., cited in ibid., p. 111.
145. For "rational empiricism," see Miquel, "Considé rations sur l'état présent de la thérapeutique," Bull. gén. thér. méd chir., 1837, 13, 5-9, 7.
146. According to the statement of purpose published in its first issue in 1830 ("Des agens thérapeutique en général," Bull. gén. thér. méd chir., 1830, I, 8-10, cited here p. 10),
147. the aim of the journal was to "restore therapeutics in all its importance, but also in all its simplicity; to proceed with experimentation with a conscientious and deepened knowledge of the elementary facts, and to profit from discoveries, both ancient and recent, but only in so far as they are well established." For further examples, see F. R., "Considérations sur l'importance et l'état actuel de la thérapeutique," Bull. gén. thér. méd chir., 1830, 1, 5-8;
148. anonymous, "De la vanité des systèmes en thérapeutique," Bull. gén. thér. méd chir., 1835, 5, 5-9;
149. [Miquel], "Considérations sur l'état présent de la thérapeutique," Bull. gén. thér. méd chir., 1835, 9, 7-11;
150. and Max Simon, "La thérapeutique doit, dans l'état actuel de la science se placer en dehors des idées exclusives de l'anatomisme et du physiologisme," Bull. gén. thér. méd chir., 1837, 13, 293-99.
151. The most important exception (also a work on therapeutics) was Philippe Ricord, "Uréthroplastie par un procédé nouveau," Ann. chir. franç. étrang., 1841, 2, 62-70, which won Ricord the third and last of his Montyon Prizes from the Academy of Sciences. For the prize, see Archives de l'Académie des sciences, "Concours aux prix de Médecine et de chirurgie de la fondation Montyon pour 1841," folios 15-16.
152. "Nouveau traitement de la blennorrhagie chez la femme," Bull. gén. thér. méd chir., 1835, 8, 337-41.
153. "Considérations pratiques sur le chancre."
154. "Du traitement de la blennorrhagie chez l'homme," Bull. gén. thér. méd chir., 1840, 20, 24-32.
155. "Quelques considérations sur la blennorrhagie en général et sur le traitement particulier de la balano-posthite et de l'urétrite blennorrhagique," Bull. gén. thér. méd chir., 1843, 25, 109-19.
156. "De la chlorose syphilitique, et de son traitement," Bull. gén. thér. méd chir., 1844, 27, 111-14.
157. Ironically, Ricord's most widely read book today, Lettres sur la syphilis, was the most polemical and least practical of all his medical works. This work must be seen, however, in light of the various polemics in which Ricord found himself immersed at that time. For the circumstances, see
158. Dracobly, "Ethics and Experimentation," 340-45.
159. G. V. Lafargue, "Excellents effets de l'iodure de potassium adminstré d'après la méthode de M. Ricord contre les accidens tertiaires syphilitiques réputés incurables," Bull. gén. thér. méd chir., 1840, 19, 340-46.
160. Ricord, Traité pratique, pp. 169-82, a section titled, "L'inoculation peut servir à la thérapeutique."
161. A common complaint was that it was unusable in private practice because a paying patient would never submit to so invasive and painful a procedure. See Société de médecine de Bordeaux, "Discussion sur la cautérisation du chancre," pp. 160-61;
162. and Devergie, Deuxième lettre sur la syphilis (Paris: Béthune et Plon, 1841), pp. 25-27.
163. But for a case illustrating the use of diagnostic inoculation, A. Foucart, "Hôpital de Lourcine. - M. Cullerier. Chancres à la vulve. Ulcérations à la main, d'origine et de nature douteuses. Inoculation," Gaz, hôp. civ. milit., 1843, 16, 598-99.
164. A positive result, according to Ricord's theory, could mean only one thing: the presence of a syphilitic chancre. As a number of his critics noted, however, the theory was not only bedeviled by the problem of false negatives but even a reliable negative result could have one of several possible meanings. It could mean the absence of syphilis, but it could also mean a syphilis that was no longer contagious. For a critique of Ricord's method of inoculation as a diagnostic tool, see Gibert, Manuel pratique des maladies véné riennes, pp. 296-97;
165. and more generally Henri de Castelnau, Recherches sur l'inoculation appliquée à 1'étude de la syphilis (Paris: Méquignon-Marvis, 1841);
166. and P. L. Alphée Cazenave Traité des syphilides on maladies vénériennes de la peau (Paris: Labé, 1843), pp. 78-89.
167. For a defense of the procedure, see Reyriaud, Traité pratique des maladies vénériennes (Toulon: Monge; Paris: Labé, 1845), pp. 19-26, 156;
168. J.-G. Maisonneuve and H. Montanier, Traité pratique des maladies vénériennes (Paris: Labé, 1853), pp. 16-24, 145.
169. [Auguste] Cullerier jeune, "Chancre," Dictionnaire des études médicales pratiques, 4 vols. (Paris: Administration du dictionnaire, 1838-1839), III (1839), 382. The author was the son of François-Auguste Cullerier (thus, son of the nephew of Michel Cullerier).
170. Ricord's most famous statement to this effect was "Différence entre la blennorrhagie et le chancre, le chancre uréthral constituant seul la blennorrhagie virulente, par M. Ricord. - Rapport de M. Lagneau," Bull. Acad. roy. méd., 1841-1842, 7, 459-78.
171. An illustration of this case can be found in Philippe Ricord, Traité complet . . . Clinique iconographique, planche VIII.
172. Also see planche XlIIbis for examples of "Ulcères primitifs indurés (chancres) de l'anus."
173. For Ricord's advocacy of the speculum, see Philippe Ricord, "Mémoire sur quelques faits observés à l'hôpital des vénériens";
174. for his role in popularizing the speculum, see Gauthier, Examen historique et critique des nouvelles doctrines, p. 38;
175. and Luc Ducros, Guide pratique pour l'étude et le traitement des maladies syphilitiques (Paris: Béchet jeune et Labé, 1841), pp. 24-26.
176. The term antiphysical appears in Ricord's notes to Hunter, Traité de la syphilis, II, 168.
177. For Ricord as the Marivaux of medicine, see de Lansac, Encyclopédie biographique du XIXme siècle, 82. Pierre Carlet de Chamblain de Marivaux (1688-1763) was an eighteenth-century playwright known for his complicated and unlikely tales of love. Examples of Ricord's own more scabrous tales can be found in Courtin,
178. "Des maladies vénériennes. Extrait des leçons cliniques de M. le docteur Ricord," 13-15;
179. Philippe Ricord, "Lectures on Venereal and Other Diseases Arising from Sexual Intercourse," Lancet, 1848, 1, 34;
180. and Lettres sur la syphilis, pp. 42-43, 91-92, 95-96, 104-6.
181. J.-J.-L. Rattier, "Considérations sur le traitement des accidens tertiaires de la syphilis parle proto-iodure de potassium," Gaz. hôp. civ. milit., 1839, 12, 133-34, 133.
182. This is a point that has not been widely recognized, in part because Ricord spent most of the introduction to the Traité pratique blasting the physiologists. But the physiologists were quick to recognize Ricord's indebtedness to their theory. See, for example, Devergie, Première lettre sur la syphilis (Paris: Gros, 1840), p. 3;
183. F ... R, "Première lettre sur la syphilis, ou Examen critique des doctrines de M. Ricord," Gaz. hôp. civ. milit., 1840, 13, 147-48.
184. For a defense of the procedure, see Courtin, "Des maladies vénériennes. Extrait des leçons cliniques de M. le docteur Ricord," 15-16; to prove his good faith, Ricord used the procedure on himself in 1843 and described the results to the Academy of Medicine.
185. See "Communication verbale: Ricord, inoculation syphilitique fortuite," Bull. Acad. ray. méd., 1843-1844, 9, 142-43.
186. This was certainly the case in hospitals: see [Lucas-Champonnière] , "Hôpital des vénériens," J. méd. chir. prat., 1834, 5, 26-39, 28-29;
187. Auzias-Turenne, "Correspondance syphilitique" (1860),
188. in La syphilisation (Paris: Baillière, 1878), pp. 500-501;
189. also Gauthier, Examen historique et critique des nouvelles doctrines, p. 38;
190. Durand-Fardel, "Mémoire sur la blennorrhagie chez la femme, et ses diverses complications," J. conn. méd. 1840-1841, 8, 3-12, 59-64, 102-7, esp. 3.
191. It is indicative that in a search for vérole in the ARTFL database of French literary texts, nearly half of the hits for the entire nineteenth century came either from Flaubert's letters or the Goncourts' Journal. Indeed, in spite of the presence of syphilis in the literature of the day, the words vérole and syphilis are almost entirely absent from literary works published in the nineteenth century. For further discussion, see Patrick Wald Lasowski, Syphilis: essai sur la littérature française du XIXe siécle (Paris: Gallimard, 1982).
192. Most notably, Delpech, Chirurgie clinique de Montpellier, I, 354-77;
193. also D.-J. Larrey, Clinique chirurgicale, exercée particulièrement dans les camps et les hôpitaux militaires, depuis 1792 jusqu'en 1832, 5 vols. (Paris: J.-B. Baillière, 1829-1832), IV (1832), 170.
194. For the use of potassium iodide in the treatment of syphilis prior to Ricord, see A. Trousseau and H. Pidoux, Traité de thérapeutique et de matière médicale, 2 vols, in 3 (Paris: Béchet jeune, 1836-1839), II, part 1, 123-42;
195. also see Cullerier, "Rapport [à l'Académie royale de médecine] sur un mémoire de M. Devergie. Discussion sur la nature et le traitement des affections syphilitiques," Gaz. méd. Paris, 1835, 6, 13-14, 13, where Gérardin explains that military physicians in Strasbourg have been using potassium iodide instead of mercury.
196. Ricord, Traité pratique, pp. 159-61, 646.
197. Philippe Ricord, "Quelques considérations thérapeutiques," 21-29;
198. Ricord, "Considérations pratiques sur les accidents tertiaires," 15-22 (see note 65 here).
199. Several of these appeared in Ricord's home journal, for example, G. V. Lafargue, "Excellents effets de l'iodure de potassium administré d'après la méthode de M. Ricord contre les accidens tertiaires syphilitiques réputés incurables," Bull. gén. thér. méd chir., 1840, 19, 340-46;
200. but also see "Revue analytique et critique des journaux de médecine français: Ricord, Etudes sur l'action pathogénique de l'iodure de potassium, pour servir à régler l'administration de ce remède," Rev. méd. franç. étrang., 1842, 4, 114-15;
201. Chomel, "Résumé de la clinique de l'année, " Gaz. hôp. civ. milit., 1843, 2nd ser., 16, 253-55;
202. Taddei, "Quelques observations sur l'efficacité de l'hydriodate de potasse ioduré contre les affections syphilitiques," Gaz. hôp. civ. milit., 1843, 2nd ser., 16, 388.
203. Important substantive articles included the favorable report by Camille Gibert, a proponent of the unicist theory, to the Academy of Medicine, "De l'iodure de potassium dans le traitement des affections syphilitiques," Rev. méd. franç., Étrang., 1845, 3, 20-35;
204. L.-P.-A. Gauthier, "Observations pratiques sur le traitement des maladies syphilitiques par l'iodure de potassium," J. méd. Lyon, 1844, 7, 447-96
205. and L.-P.-A. Gauthier, "Observations pratiques sur le traitement des maladies syphilitiques par l'iodure de potassium," J. méd. Lyon, 1845, 8, 4-49;
206. and Payan, "De l'emploi de l'iodure de potassium dans les maladies syphilitiques," Rev. méd. franç., étrang., 1845, 3, 161-84, 353-81, 497-525;
207. Payan, "De l'emploi de l'iodure de potassium dans les maladies syphilitiques," Rev. méd. franç., étrang, ibid., 1846, 1, 218-40, 533-55;
208. Payan, "De l'emploi de l'iodure de potassium dans les maladies syphilitiques," Rev. méd. franç., étrang, ibid., 1846, 2, 68-89, 215-37, 357-77, 524-47;
209. and ibid., Payan, "De l'emploi de l'iodure de potassium dans les maladies syphilitiques," Rev. méd. franç., étrang, 1846, 3, 233-54, 353-67.
210. Jaegerschmits, "Correspondance médicale: Bons effets du sirop de deuto-iodure de mercure ioduré et de l'iodure de potassium dans les accidents syphilitiques constitutionnels," Bull. gén. thér. méd chir., 1849, 36, 75-78, 76.
211. Also, "De l'action specifique de quelques préparations niercurielles dans les maladies de la peau et de la syphilis, par M. Gibert, . . .- Commissaires: MM. Lagneau, Soubeiran, et Pâtissier, rapporteur," Bull. Acad. roy. méd., 1846-1847, 12, 382-91, 386 (though compare p. 391, where Gimelle contests its utility).
212. Edmond and Jules de Goncourt, Journal: Mémoires de la vie littéraire, 4 vols. (Paris: Fasquelle and Flammarion, 1956), II, 257 (entry for 11 April 1866).
213. Even correcting for the Goncourts' cynicism, this is all the more significant in so far as potassium iodide had many uses in medicine. P. S. Payan, Essai thérapeutique sur l'iode, ou applications de la médication iodée ou iodurée au traitement des malades (Bruselles: J. B. Tircher, 1850) lists thirty-two other diseases for which potassium iodide was used, though typical of most works on the subject from this period, it focuses primarily on syphilis. I am indebted to an audience member at the 2000 meeting of the AAHM for this point.
214. Payan, "De l'emploi de l'iodure de potassium dans les maladies syphilitiques," 182.
215. "Revue des journaux de médecine. Journaux italiens. Bulletino delle scienze mediche. Symptômes, caractères anatomiques, diagnostic différentiel et traitement de la syphilis tertiaire; par M. Gamberini," Gaz. méd. Paris, 1848, 19, 89-90, 89.
216. A. Michel, "Correspondance médicale. De l'emploi de l'iodure de potassium combiné et de l'eau de goudron contre la syphilis," Bull. gén. thér. méd chir., 1847, 33, 50-54, 50,
217. where he also gives Ricord credit. Also see Bouchardat, Manuel de matière médicale de thérapeutique, p. 738.
218. See, for example, F. Bouisson, "Mémoire sur les tumeurs syphilitiques des muscles et de leurs annexes," Gaz. méd. Paris, 1846, 17, 542-44, 563-66, 583-85, 594-96, esp. 596, where the author speaks of "a kind of fad [that] has exaggerated [potassium iodide's] therapeutic virtues";
219. and "Bibliographie. Sur l'emploi de l'iodure de potassium dans le traitement des maladies syphilitiques . . . par M. Payan," Gaz. méd. Paris, 1848, 19, 642.
220. With the one exception of a few reports from Montpellier, where gold was still employed by Serres and Lallemand (see Edwin Lee, Observations on the Principal Medical Institutions and Practice of France, Italy, and Germany, 2nd ed. [London:]. Churchill, 1843], p. 86), one hears little about substitutes for mercury after the early 18405.
221. Charles Baudelaire, Correspondance générale, ed. Jacques Crépet, 6 vols. (Paris: Éditions Louis Conard, 1947-1953), III (1948), 22,
222. cited in Peter Gay, Schnitzler's Europe: The Making of Middle-Class Culture 1813-1914 (New York: Norton, 2002), p. 131.
223. Also see Roger L. Williams, The Horror of Life (Chicago: University of Chicago Press, 1980), pp. 47-51.
224. The entire question of cure is complicated, first by the fact that it is difficult to say exactly what effect mercury had on syphilis and second by the issue of the period of latency and how this was interpreted. Ricord's understanding of constitutional syphilis probably corresponded to what we would today consider latent syphilis. The important point is to recognize that Ricord and most of his colleagues could think of a cured person as still being syphilitic in that that person's constitution had undergone some fundamental alteration. This was how Ricord explained the fact that one could only be constitutionally infected with syphilis a single time (the "no double dose" theory), a concept that we might today regard as an early form of immunity theory. For untreated and latent syphilis, see William J. Brown et al., Syphilis and Other Venereal Diseases (Cambridge, Mass.: Harvard University Press, 1970), pp. 12, 17-26, 103-29;
225. and for the effect of mercury and iodides, John H. Stokes, Modern Clinical Syphilology: Diagnosis - Treatment - Case Studies, 2nd ed. (Philadelphia: W. B. Saunders, 1934), pp. 265-67, 277-82.
226. This is a partial list of characteristics. For a detailed discussion of this myth and its origins in the nineteenth century, see Hannaway and La Berge, "Paris Medicine: Perspectives Past and Present," pp. 1-69.
227. See, for example, the bibliography in Constructing Paris Medicine, ed. Hannaway and La Berge, pp. 385-96.
228. A point similarly made in Weisz, The Medical Mandarins, pp. 159-88.
229. Robert A. Nye, Crime, Madness, and Politics in Modem France: The Medical Concept of National Decline (Princeton, N.J.: Princeton University Press, 1984), pp. 160-63;
230. Alain Corbin, Les filles de noces: misère sexuelle et prostitution (19e siècle) (Paris: Flammarion, 1978), pp. 386-90.
231. Nye, Crime, Madness, and Politics in Modern France, xii.
232. Owsei Temkin, "On the History of Morality and Syphilis,' " in The Double Face of Janus, ed. Temkin, pp. 472-84.
233. P. S. Payari, Essai thérapeutique sur l'iode, ou applications de la médication iodée ou iodurée au traitement des malades (Bruselles: J. B. Tircher, 1850), pp. 194-95.
234. This was a longer version of an essay that won a prize in 1847 from the Société de médicine de Lyon, P. S. Payari, Essai thérapeutique sur l'iode, ou applications de la médication iodée ou iodurée au traitement des malades see ibid., pp. i-ii.