Walking the Paris Hospitals: Diary of an Edinburgh Medical Student, 1834-1835 (review)

Diaries can provide an immediate eyewitness view of medicine, its institutions, and its culture, but their value is sometimes offset by obscure references to people, places, and things that require a whole reference collection to track down. Happily, Diana Manuel has done all the hard work for us by providing a scrupulously researched, copiously annotated edition of the diary of an Edinburgh medical student resident in Paris during the academic year 1834–1835. The diary is anonymous, but Manuel makes a convincing case for attributing it to James Surrage, a Gloucestershire student who graduated with his M.D. from Edinburgh University in 1835. However, she does not take the attribution as proven and, instead, refers to "the diarist" throughout her introductory essay and notes.

Manuel begins by describing medical life in Paris and the opportunities available for students there. By the 1830s, Paris was attracting hundreds of students from the English-speaking world to its extensive hospital facilities. Many of them, like the diarist, were struck by the matter-of-fact approach to hands-on clinical examination, contrasting it with the moral outrage that would attend such a practice at home. They were struck too with the opportunities for dissection of cadavers, still limited in Britain despite the Anatomy Act of 1832. Manuel next goes on to describe the most important aspects of medicine addressed in the diary. These include maladies such as fevers and typhus, skin diseases, and eye diseases. Also included are the medical branches of surgery, midwifery, and dentistry, still regarded by many practitioners as distinct from "medicine," though the boundaries were increasingly blurred. Manuel also discusses the new practice of auscultation and the stethoscope, which impressed the diarist, as it did his contemporaries, as an important new diagnostic tool. Use of the stethoscope required daily practice and the development of a whole new vocabulary to describe the different sounds, which are recounted in this diary.

The diary itself opens on 1 November 1835, by which time the diarist had evidently settled into Paris and acquainted himself with the hospitals there: La Charité, La Pitié, and the Hôtel Dieu. It runs through 20 June 1836. His daily comments throughout remain nearly entirely focused on medicine, as he describes clinical cases, prominent professors, and new publications. This is an advantage to the reader, for the diarist is much more interesting when speaking about medicine than about anything else. His comments on French religion and society sound like the typical homesick student abroad, insular and dismissive. But when presented with any new medical fact, the diarist is instantly attentive, and he has an excellent memory for his lectures and reading. The result, for us, is a view of the medical world of Paris from a man neatly poised between the student and the practitioner. Like other students, the diarist had the freedom to pursue his intellectual interests without the daily pressure to earn his living. Like a practitioner, the diarist had a professional approach to medical opportunities, keeping up with the latest literature, comparing methods of treatment, and passing judgment on therapeutic results. This professional approach was by no means universal among medical students in this period, and it is noteworthy that the diarist already possessed it upon his arrival in Paris. Whether the credit for his professionalization should go to the diarist himself, his family, or his Edinburgh education is a subject for further study.

Manuel provides detailed notes for every personal name, medical term, and obscure phrase, sometimes as many as ten per page. She also provides a useful bibliography. The illustrations complement the text, and the map of Paris, showing the locations of places mentioned in the diary, is especially useful. The only regret readers will have after studying this book is that the diarist was in such a hurry to leave the medical world he depicted...