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Paris Medicine for inclusion in the History of Hospitals page

At the turn of the 19th century, Paris medicine played a significant role in shaping clinical medicine. New emphasis on physically examining the body led to methods such as percussion, inspection, palpation, auscultation, and autopsy. The situation in Paris was particularly unique due to the fact that there was a very large concentration of medical professionals in a very small setting allowing for a large flow of ideas and the spread of innovation. One of the innovations to come out of the Paris hospital setting was Laennec's stethoscope. Weiner states that the widespread acceptance of the stethoscope would likely not have happened in any other setting, and the setting allowed for Laennec to pass on this technology to the eager medical community that had gathered there. This invention also brought even more attention to the Paris scene.

Before the start of the 19th century, there were many problems existing within the French medical system. These problems were outlined by many seeking to reform hospitals including a contemporary surgeon Jacques Tenon in his book Memoirs on Paris Hospitals. Some of the problems Tenon drew attention to were the lack of space, the inability to separate patients based on the type of illness (including those that were contagious), and general sanitation problems. Additionally, the secular revolution led to the nationalization of hospitals previously owned by the Catholic Church and led to a call for a hospital reform which actually pushed for the deinstitutionalization of medicine. This contributed to the state of disarray Paris hospitals soon fell into which ultimately called for the establishment of a new hospital system outlined in the law of 1794. The law of 1794 played a significant part in revolutionizing Paris Medicine because it aimed to address some of the problems facing Paris Hospitals of the time.

First, the law of 1794 created three new schools in Paris, Montpellier, and Strasbour due to the lack of medical professionals available to treat a growing French army. It also gave physicians and surgeons equal status in the hospital environment, whereas previously physicians were regarded as intellectually superior. This led to the integration of surgery into traditional medical education contributing to a new breed of doctors that focused on pathology, anatomy and diagnosis. The new focus on anatomy was further facilitated by this law because it ensured that medical students had enough bodies to dissect. Additionally, pathological education was furthered by the increased use of autopsies to determine a patient's cause of death. Lastly, the law of 1794 allocated funds for full time salaried teachers in hospitals, as well as creating scholarships for medical students. Overall, the law of 1794 contributed to the shift of medical teaching away from theory and towards practice and experience, all within a hospital setting. Hospitals became a center for learning and development of medical techniques, which was a departure from the previous notion of a hospital as an area that accepted people who needed help of any kind, ill or not. This shift was consistent with much of the philosophy of the time, particularly the ideas of John Locke who preached that observation using ones senses was the best way to analyze and understand a phenomena. Foucalt, however, critized this shift in his book The Birth of the Clinic, stating that this shift took attention away from the patient and objectified patients, ultimately resulting in a loss of the patient's narrative. He argued that from this point forward, in the eyes of doctors, patients lost their humanity and became more like objects for inspection and examination.

The next advancement in Paris medicine came with the creation of an examination system, that after 1803, was required for the licensing of all medical professions creating a uniform and centralized system of licensing. This law also created another class of health professionals, mostly for those living outside of cities, who did not have to go through the licensing pricess but instead went through a simpler and shorter training process.

Another area influenced by Paris hospitals was the development of specialties. The structure of a Paris hospital allowed physicians more freedom to pursue interests as well as providing the necessary resources. An example of a physician who used this flexibility to conduct research is Phillipe Pinel who conducted a four year study on the hospitalization and treatment of mentally-ill women within the the Salpêtriére hospital. This was the first study ever done of this magnitude by a physician, and the Pinel was the first to realize that patients dealing with similar illnesses could be group together, compared, and classified. For inclusion in the Francis Galton page

Anthropometric Laboratory at the 1884 English Health Exhibition

In 1884, London hosted the International Health Exhibition. This exhibition placed a lot of emphasis on highlighting Victorian developments in sanitation and public health, and allowed for the nation to display its advanced public health outreach, compared to other countries at the time. Francis Galton took advantage of this opportunity to set up his anthropometric laboratory. He stated that the purpose of this laboratory was to “show the public the simplicity of the instruments and methods by which the chief physical characteristics of man may be measured and recorded.” The laboratory was an interactive walk-through in which subjects would measure various physical characteristics such as height, weight, eyesight, etc. after paying an admissions fee. Upon entering the laboratory, a person would visit the following stations in this order. First, they would fill out a form with personal and family history (age, birthplace, marital status, residence, and occupation), then visit stations that recorded hair and eye color, followed by the keenness, color-sense, and depth perception of sight. Next, they would examine the keenness, or relative acuteness, of hearing and highest audible note of their hearing followed by an examination of their sense of touch. However, because the surrounding area was noisy, the apparatus intended to measure hearing was rendered ineffective due to the loudness and echoes of the building. Their breathing capacity would also be measured, as well as their ability to throw a punch. The next stations would examine strength of both pulling and squeezing with both hands. Lastly, they would measure their heights in various positions (sitting, standing, etc.) as well as wingspan and weight. One excluded characteristic of interest is the size of the head. Galton notes in his analysis that this omission was mostly for practical reasons. For instance, it would not be very accurate and additionally it would require a lot of time for women to disassemble and reassemble their hair and bonnets. The patrons would then get to keep a souvenir containing all their biological data, while Galton would also keep a copy for future statistical research.

Though the laboratory did not employ any revolution measurement techniques, it was unique because of the simple logistics of constructing such a demonstration within a limited space and have it quickly and efficiently be able to gather all the necessary data. The laboratory itself was a see through (lattice-walled) fenced off gallery measuring 36 feet long by 6 feet long. In order to efficiently collect data, Galton had to make the process as simple as possible for people to understand. As a result, people were taken through the laboratory in pairs so that explanations could be given to two-people at a time also so that, ideally, one of the two would confidently take initiative to go through all the tests first in order to encourage others, who may be more hesitant. This design made it so that the total time spent in the exhibit was fourteen minutes for each pair.

Galton states that the measurements of human characteristics are useful for two reasons. First, he states that measuring physical characteristics is useful in order to ensure, on a more domestic level, that children are developing properly. A useful example he gives for the practicality of these domestic measurements are regularly checking your child’s eye sight, in order to correct any deficiencies early on. The second use for the data from his anthropometric laboratory is for statistical studies. He comments on the usefulness of the collected data to compare attributes across occupations, residences, races, etc. The exhibit at the health exhibition allowed Galton to collect an incredible amount of raw data from which to conduct further comparative studies. He had 9,337 respondents and each respondent was measured in 17 categories, creating a rather comprehensive statistical database.

After the conclusion of the International Health Exhibition, Galton used this data in order to confirm his theory of linear regression, that he had posed after studied sweet peas, in relation to humans. The accumulation of this human data allowed him to observe the correlation between forearm length and height, head width and head breadth, and head length and height. With these observations he was able to write “Co-relations and their Measurements, chiefly from Anthropometric Data". In this publication, Galton defined what co-relation as a phenomemon that occurs when "the variation of the one [variable] is accompanied on the average by more or less variation of the other, and in the same direction."