The Sun King’s anal fistula

The development of French surgery

Using his power and influence, the Sun King restored the independence of surgical medicine. For example, in 1671 he ensured that a teaching position in surgery was established at Le Jardin du Roi (the King’s Garden), now the Jardin des Plantes, to improve the training of surgeons. He often had to intervene in quarrels between the powerful faculty of medicine in Paris and his own doctors.

Being the chief royal surgeon meant holding the supreme surgical position in the country (12). The Paris medical faculty had always remained critical of the king’s doctors, and disapproved of the reputation that the surgeons gradually gained at the court (2, 9). Headed by the dean, they even physically attacked them (9). The medical faculty in Paris had a reputation for being reactionary and opposed the new ideas of the Enlightenment (2).

After the death of Louis XIV, the three subsequent chief royal surgeons – Mareschal, François Gigot de la Peyronie (1678 – 1747) and Germain Pichault de la Martinière (1697 – 1783) – introduced a series of reforms. The first included a reorganisation of surgical training. The training provided under the auspices of the medical faculty had little worth. Those who wanted to become skilled surgeons did not attend this training; they preferred to apprentice with experienced surgeons.

The first official training for surgeons was established in 1724 at the Saint-Côme seat of learning (13). The medical faculty made repeated attempts to usurp control of it, but unsuccessfully. La Peyronie and La Martinière later established further educational institutions (14). Their major innovation was the establishment of the Royal Academy of Surgery (l’Academie Royale de Chirurgie) in 1731 (13), with the support of Louis XV and his chief physician Pierre Chirac (1650 – 1732). It is part of the story that a similar royal academy of medicine, promoted by the same Chirac, failed to materialise because Chirac died too soon to overcome the dogged resistance put up by the medical faculty.

The establishment of the academy of surgery was an immediate success, and it enjoyed high prestige. It existed for 62 years and nurtured a number of famous surgeons. In the words of Voltaire: «Progress in surgery came so fast and was so astounding that people came to Paris from all corners of the world to be operated on and cured. Not only was France the only country to have outstanding surgeons, it was only in this country that the necessary instruments were made» (13).

With the great revolution in 1789 all the academies were closed down. The following turbulent period of French history, with the empire, restoration of the monarchy and the republics, was devoid of any academic development in surgery and lasted until the establishment of the new association for surgery in Paris in 1843. Surgical medicine persisted, however (13). Medical training institutions were established in Paris, Montpellier and Strasbourg to replace the dedicated schools of surgery. This testified to a readiness to favour a shared basis for medical teaching, a combination of internal medicine and surgery, under the clear influence of the Enlightenment author and philosopher, Diderot (1, 13).

Napoleon prevented a new split between internal medicine and surgery by outlawing an independent organisation of surgeons (13). In 1808, during the reorganisation of the entire university, the medical faculty was re-established, with instruction in internal medicine as well as surgery (13). These two great disciplines had finally been placed on an equal footing within an academic framework.