The beginning of the eighteenth century in France saw its health system little changed from the Middle Ages. But by the end of the century, war and upheaval had altered French medicine. Revolutionary leaders condemned medical institutions and organizations, as well as doctors, but instead of the expected eradication of these institutions and professions, the movement ultimately resulted in progressive public health policies and new medical schools that produced better-educated doctors.8Lois N. Magner, A History of Medicine, New York: Marcel Dekker, Inc., 1992, p. 230. The medical regulations law of 1803 stipulated a two-tier model for education. Health officers received predominantly practical training, but doctors were required to attend four years at a state medical school and pass examinations in anatomy, physiology, pathology, nosology, material medica, chemistry, pharmacy, hygiene, forensic medicine, and clinical medicine.9Otto L. Bettmann, A Pictorial History of Medicine, Springfield, Illinois: Charles C. Thomas, 1956, p. 234. Hospital reform resulted in a milieu conducive for clinical research, autopsies, and statistical analysis. By 1830 the 30 hospitals in Paris could accommodate 20,000 patients.10Otto L. Bettmann, A Pictorial History of Medicine, Springfield, Illinois: Charles C. Thomas, 1956, p. 236.
In the early nineteenth century, a French physician might see fewer than ten patients daily, sometimes only two or three. This low utilization of professional care was principally due to the high cost of health care compared to earnings. A visit by a health officer, who would have had less formal training than a doctor, might cost an agricultural worker a day's wage, even without a charge for the practitioner's travel. A doctor's house call could be two or three times as high. In Paris, where doctor fees were considerably more than those charged by a rural health officer, an urban artisan could pay a week's wages just for the doctor's visit.11Matthew Ramsey, Professional and Popular Medicine in France, 1770-1830: The Social World of Medical Practice, Cambridge: Cambridge University Press, 1988, p. 118. Remedies cost extra, so it is not surprising that a doctor's clientele consisted mainly of landowners and their servants, merchants, other professionals, and the more successful artisans.12Matthew Ramsey, Professional and Popular Medicine in France, 1770-1830: The Social World of Medical Practice, Cambridge: Cambridge University Press, 1988, p. 119.
Medicine has proved to be a field rich in humor for centuries, and the French doctor's rigorous training did not keep him from being an object of satire. In the middle of the nineteenth century Honoré Daumier created a number of caricatures whose captions, some quoted below, took pointed jabs at the medical profession. Doctors were ridiculed for excessive charges:
…Believe me, drink water, lots of water… rub the bones of your legs… and come to see me often… that won't impoverish you… my consultations are free… Now, you owe me 20 francs for these two bottles…
ineffectual treatments such as bleeding:
…I'm going to apply thirty leeches to your epigastrium and if tomorrow I don't find you improved, I'll apply sixty…
How the devil does it happen that all my patients succumb?… Yet I bleed them, I physic them, I drug them… I simply can't understand!
…you've seen this operation, that everyone said was impossible, performed with complete success…—But, Doctor, the patient's dead…—What of it! She would have died anyway…
and caring more about the chance to treat an interesting illness than the well-being of the patient:
By Jove, I'm delighted! You have yellow fever… it will be the first time I've been lucky enough to treat this disease!13Honoré Daumier, Doctors & Medicine in the Works of Daumier, New York: Tabard Press, [198?], various pages.