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CHAPTER II.

Climate—Diseases and Medical Institutions of Paris— Comparison between English and French Medical and Surgical Practice—Operations for Squinting and Stammering.

With respect to climate, the principal advantages which Paris has over London consists in the greater purity, clearness, and dryness of the atmosphere, its freedom from smoke and fog, and in the weather being less variable from day to day, as the summers are hotter, and the winters equally cold, if not colder. The average quantity of rain throughout the year, I should conceive to be as great in Paris as in London. It would not, therefore, be advisable to select Paris as a winter residence for persons labouring under pulmonary complaints, (except perhaps some cases of asthma and sympathetic bronchial affection,) or rheumatism. Paris agrees very well with many dyspeptic invalids, to whom the light cookery of the French cuisine is better suited than the more substantial fare usually met with in Britain, which requires greater powers of digestion, always provided the invalid abstains from ragouts, rich sauces, or highly seasoned dishes, and from indigestible vegetables, as truffles or mushrooms. The valetudinarian who labours under depression of spirits, combined with disordered digestion, would likewise frequently find himself better after a few months sojourn in Paris, which offers more resources for mental relaxation and amusement than any other city, not excepting London. Baths are also more general, which is a great advantage to invalids, as well as to persons in health, for I have no doubt that the neglect of this means of keeping the functions of the skin in a proper state is the occasion of many of the disordered states of health met with in England.

Among the most prevalent diseases of Paris may be enumerated inflammations of the respiratory organs, (especially in the winter and spring,) consumption, typhoid fevers, intermittents, rheumatism, chronic inflammation of the stomach and bowels, various forms of dyspepsia, and scrofula. Apoplexy, paralysis, and nervous diseases in general, appear to me to be much less frequent than in England; where also indigestion is more common, especially among the commercial and trading part of the population, and those whose avocations are of a sedentary nature, as clerks and others who have much writing or head-work. The Paris hospitals are larger and more numerous than those of London, several being appropriated to particular classes of diseases, which can thus be studied to greater advantage. They are not, as in England, dependent upon voluntary donations and subscriptions, but are under the superintendence of government, their affairs being directed by an administrative council, and the funds being supplied by contributions from the town, a per centage upon the receipts at the theatres, the profits of the Mont de Piete, and other sources. Patients are admitted on application, if their cases admit of relief, but few being refused for want of room. They are attended upon by the Sceurs de la Charile, who devote their lives, or a certain number of years, to these arduous duties. The physicians and surgeons are elected by concours or public competition, which certainly offers to the sick a better guarantee of the capabilities of their medical attendants than the method pursued in Great Britain, where interest is more generally influential than the degree of talent in deciding these elections; hence the junior members of the profession have not the same inducements for application and exertion as in France, where hospital physicians and surgeons have to make their way by their labour; their merits being known to the public by their works and otherwise, before they are called upon to fill a responsible station. Habits of application and observation thus early acquired are continued in after life; hence the greater richness of the medical press in France from men of experience, and the discoveries for which science is indebted to them. The great influence which such competition must have in the advancement of medicine and surgery is too obvious to require comment. The election of internes and externes, or house physicians, surgeons, and dressers, is decided in the same way. Visits are made at an early hour (six or seven) in the morning; after the visit a clinical lecture is delivered by those physicians or surgeons who are professors of the faculty of medicine ; so that three hours, and frequently more, are devoted to the sick, and to instruction, every morning before breakfast. A fixed salary is allotted to each for the performance of these duties. The expense of medical education is but trifling compared with what it is in England, and many of the students, being the sons of parents in an humble station in life, are exceedingly poor; the profession does not consequently rank so high in public estimation in France as in England, and the compensation for attendance is lower. It should, however, be borne in mind, that all (except the officiers de sante, an inferior class of practitioners in the country) must take out their diplomas as doctors of medicine or surgery, previous to which they have to go through three or four rigid examinations, and that there does not exist a class of practitioners, who, like the surgeon-apothecaries in England, send out medicines for which they are paid instead of their visits. For those who have attained eminence, there is not much disparity (in the compensation expected) between French and English practitioners.

Obstetricy in France is mostly in the hands of females, who are obliged to go through a course of study, attend lectures, and pass an examination, before they are authorized to practise. Several physicians also practise this branch of medicine, but their services are seldom required unless something unusual should occur. Apothecaries are restricted to the vending of drugs and the preparation of prescriptions, being, in fact, on a par with the chemists and druggists in England.

As the treatment of disease presents considerable differences (to some of which I shall only briefly allude here, having entered more fully into their consideration in another work)* in England and on the continent, the English abroad usually prefer being attended by medical advisers from their own country, and at almost all the continental towns to which they are in the habit of resorting, one, two, or more well-informed practitioners reside, who are for the most part members of Scotch or continental universities, or retired army and navy surgeons. There is besides always a certain number of medical desceuvres wandering about the continent from one place to another; and some individuals, who take the name of English physi

* Observations on the Medical Institutions and Practice of France, Italy, and Germany, 1835.