The history of medicine does not
usually devote much space to Lavoisier.However, his encyclopedic
mind forged many links with medicine: public health, food hygiene,
hospital administration and prison reform all benefitted from his
contributions to the Royal Society of Medicine.
Public
Health.
Throughout his career as an Academician, Lavoisier studied
numerous problems related to public health:the lighting
andventilation of public spaces, the supplyingof drinking water
for Paris by the Yvette Aquaduct, the disposal of liquid wastes,
the study of atmospheric pollution linked with the use of steam
pumps, the efforts to prevent the dumping of cesspools into the
Seine and tomoveslaughterhouses out of the city into
nonresidential areas.He was also concerned by the transmission of
pathogenic agents by the atmosphere and of diseases by
contaminated water.(Lavoisier, Oeuvres, vol. IV, pp.
146-47.)
Food hygiene
Lavoisier wrote reports on colza and turnip oils;the purification
of oils and sugar; the adulteration of cider;the diseases
affecting wheat;parasites in flour; and the use of zinc, tin,
silver and copper as linings for saucepans.He studied ways
ofstoringdrinking water in wooden barrels on sailing ships
andtestedfoods most likely to keep on long sea voyages.At the
request of Turgot, then ministrede la Marine, Lavoisier perfected
the cucurbit, a large metal retort for distilling sea water on
shipboard and producing drinking water, which wouldbe installed on
La Pérouse's ships.
He also used the densimeter to determine the nutritive value of
meat bouillions given to hospitalized patients, explored
techniques for feeding abandoned newborns with cow or ewe's milk,
and drew uphealth and old-age insurance planswhich were presented
in 1787 at the Provincial Assembly of Orléans. Finally,
occupational medicine is endebted to him for studies on mercury
poisoning among workers with felt, and onaccidents caused by
carbon monoxide amongworkers in sewers and cesspools.
Hospitals
WhenJacques Necker (1732-1804) was Prime Minister for the first
time, Lavoisier participated in the important study directed by
Jacques René Tenon (1724-1816)regarding the transfer of the
Hôtel-Dieu and the creation of four largehospitals in
Paris.Tenon's report, a masterpiece of clarity and modernismwas
accompanied by an architectural project drawn up by Bernard Poyet
(1742-1829) whoproposed constructing on the Ile aux Cygnes a new
Hôtel-Dieu,circularin form , with a vast central courtyard,
modeled after the Coliseum in Rome. The proposal, the estimated
cost of which was 12 million livres, underlined the necessity of
creating isolated hospital wings, well ventilated andproperly lit,
and of separating patients in specialized wards.Starting with the
scale of man to determine those of his environment, the authors
calculated the dimensions of hospital wards on the basis of
patients' respiratory needs.For the first time,the
hospital'smission was defined as reserved to treating the ill.
The Commission appointed by the Academy to study the plans was
directed by Lavoisier.However, it was refused admission
totheHôtel Dieuby its administrators, and was forced to meet
the doctors outside andgatherstatistics from birth, baptismal and
death certificates."For more than half a century," the final
report read, "the transfer of the Hôtel Dieu has been
repeatedly recommended by all enlightened persons.The present
location of the hospital in the center of the city, the small
space it occupies, the sight of wards where several patients are
crammed into the same bed, the peculiarity that all the vices of
the regime have established, add to the suffering and anguish of
the poorwho are forced to seek refuge there.In a word, there
exists a terrifying mortality rate that is out of all proportion
with that of most large European hospitals.All these areills on
which it is impossible to look without heartbreak and
indignation."(Lavoisier, Oeuvres, vol. III, p.
603.)
"The Hôtel-Dieu normally cares for from three to four
thousand patients each day in twenty-five wards containing a total
of 1,219 beds.During epidemics, the number can rise tobetween six
and seven thousand.All the ill are thrown together, the contagious
and the insane with all the others.Three, four, indeed sometimes
five or six patients lie in the same bed; hence, they are
overheated and can neither move nor sleep.Such conditions
naturally facilitate the spread of infectious diseases and
parasites.On entering the hospital, apatient is often placed in
the bed and sheets of a scabies infected corpse."(Lavoisier,
Oeuvres, vol. III, p. 636.).
The operating rooms were exposed to the dust of the street and the
din of traffic.Furthermore, they were poorly ventilated.Lavoisier
estimated that patients would have difficulty finding the
necessary minimum of vital air.And yet, "a man cannot live more
than twenty-four hours unless he has at least three cubic meters
of air that is being constantly replaced."(Lavoisier,
Oeuvres, vol. III, p. 647.).
The result of such conditions was that illnesses lasted twice as
long at the Hôtel-Dieu asatanother Paris hospital, La
Charité, and the death rate was twice as high.To make
matters worse, the buildings had been constructed on stores of
combustible materials which exposed them to the risk ofthekind of
fire that had occurred in1772."We can conclude," the Commissioners
wrote, "that this hospitalneeds to be reformed, established on
better principles, in a much larger space; that the
Hôtel-Dieu as it now exists is inadequate, inconvenient,
eminently insalubrious and that the necessity of its transfer to a
more suitable site has been invincibly demonstrated."(Lavoisier,
Oeuvres, vol. III, p. 668.)They recommended that it be closed and
replaced by four hospitals: Saint-Louis in the North, Sainte-Anne
in the South, la Roquette in the East and, in the West, by
theabbaye of Sainte-Périne de Chaillot or a building to be
constructed on land belonging to the Ecole Militaire.Theyhad
chosen these four locationsat some distance from the Seine to
avoid the fog and humidity common to the vicinity.It was this
reasoning, moreover, which led them to reject the proposed
installation on the Ile aux Cygnes.However, their project was
criticized because, it was argued, the ill risked being carried
all over Paris beforefinding a place in one of the hospitals. It
was a simple matter of organization, Lavoisier responded."To be
admitted to one of the hospitals, a personwill do exactly what he
does to be admitted to la Charité: send somebody to find
out if there is a vacant bed.But also there would be a
clearinghouse in the center of Paris.Every evening each hospital
would submit a report on its situation to this office and, by
consulting the register, one could find out where the patient
should be sent." (Lavoisier, Oeuvres, vol. III, p.
701.)
The Academicians' conclusions were adopted by Louis XVI on June
22, 1787.A competition was organized for the construction of the
four hospitals.Breteuillaunched a fund-raising campaign, but he
immediatelyclashed with established interests, in particular the
Church, and left the government.The Hospital Commission was
disbanded and everything was left in abeyance.
Medicine
Lavoisier was also involved in the theoretical aspects of
medicine.He was a friend of Félix Vicq d'Azyr (1748-1794)
and had, like him, belonged to the Royal Society of Medicine since
1782.Along with the thirty regularmembers, all physicians, the
Society had twelve associates who had distinguished themselves in
other disciplines.Lavoisier presented two papers to the Society
and participated in the writing of nine reports.The first paper
dealt with the medical effects of ether, in particular its
analgesic effect on migraine.The second explored the changes in
air brought about by the respiration of large numbers of people in
confined spaces, such as theaters and hospitals.Lavoisier
hadannounced that hewould write a third paper dealing with the
effects on air of the combustion of oil lamps, candles, charcoal
and oil paint,to be followed by another on the role of airin
transmitting infectious diseases.However, these reports were never
written.
Several other reports to which he contributed dealt with food
hygiene: the detection of impurities in cider, the diet of sailors
on warships and in military hospitals, the use of the densimeter
to measure the protein content of meat broths and ofmetals to line
saucepans.
Two reports on cutaneous respiration and the waterproofing of
fabrics led to medical considerations: an inventor by the name of
Le Roux had perfected a waxed taffeta which he claimedwas both
waterproof and airtight.It would thus, he asserted,provide
protection against bad weather, permit one to cross a river
without getting wet or savea drowning person without knowing how
to swim.Le Roux also claimed that his invention would "protectfrom
exposure to air, whichwould have great advantages in certain
illnesses, sincethe natural heat of the part of the body covered
with it, would spreadless easily in thesurrounding air and would
be concentrated, encouraging abundant perspiration, which could be
useful in treating oedema, abcessesand the engorgements of varous
organs, as well as chronic rheumatism;itcan alsoaid the action of
remedies appropriate to these illnesses."(Lavoisier, Tillet,
Varnier, quoted by W.A. Smeaton, "Lavoisier's Membership in the
Société Royale de Médecine," in
Annals of Science 12 , 1956, pp. 228-44.)
It was said thatwhen the wife of the porter at the Hôtel
Lubert, who had fallen while coming down the narrow stairs of the
entresol where she lived, had developed a large painful bruise on
her left thigh,she hadworn a stocking made from Le Roux'swaxed
fabric. Perspiration had been abundant and healingrapid. People
suffering from rheumaticpains hadalso been relieved,it was
reported.But Lavosier, who at the time was carrying out
experiments on perspiration with the help of Armand Seguin
(1767-1835) formulated three objections: "1) the waxed taffeta
(...) protects the part of the body covered by itfrom exposure to
exterior air, but it does not prevent the body heat from
dispersing, given that it passes through the fabric and, in
general, through all known materials.Thus, all that can be said is
thatthe application of the fabric simply slows down the dispersal
of body heat.2)Furs preserve body heat not because they block off
the contact and renewal of air, but rather because they are poor
conductors of heat.3)Can we be surethat the applicaton of waxed
taffeta increased perspiration, and would it not be more natural
to believe that it only prevented evaporation, the dispersal of
this secretion?"(Lavoisier, quoted by W.A. Smeaton, "Lavoisier's
Membership in the Société Royale de
Médecine," Annals of
Science, 12, 1956, 42-43.)
Prisons
Lavoisier's final report, dated August 30, 1791, dealt with
sanitary conditions in prisons. Having beena member of a
commission appointed bythe Academy of Sciences in 1780to study
prison reform,he was asked, alongwith eight of his colleagues in
the Society-including Fourcroy, Thouret and Vicq d'Azur -, to
inspect the prisons of Châtelet, the Abbaye, Hôtel de
la Force, Bicêtre, Salpêtrière and the
Conciergerie.
He recalled his conclusions from ten years earlier: four points
were essential for improving detention conditions:a cleaner
environment, an adequate supply of water, proper ventilation
andminimum standards of hygiene for the prisoners.
Windows should be large and numerous, providing a permanent
draught, from bottom to top.More water could be obtained by
building a canal - in the interim, rain and well water should be
used.Latrines and cesspools should be located at a good distance
fromthe cells and drained by underground sewersemptying into the
Seine.
To prevent contagious illnesses, there had to be proper
ventilation, a regular and thorough washing of floors,
frequentchanges of clothing for the prisoners and the premises
should be disinfected at least once a year with chlorine, using
Guyton de Morveau's method.
Covered galleries were to be built so that prisoners could
exercise even when it rained and the number of benches was to be
increased so thatallcould be assured of a place to sit. Inmates
were to be fed by the state and no longer abandoned to the charity
of citizens.Military offenders were to be separated from civil
ones andthose imprisoned for debtsfrom criminals. Every prison was
to house an infirmery.
Finally, he wrote that "it is only fair that prisoners work to pay
for at least a part of their food.A regular and reasonable
occupation is necessary for their health as well as for
maintaining peace and order and for banishing idleness, more
dangerous in these sanctuaries of crime and debauchery than
elsewhere."(Lavoisier, Oeuvres, vol. III, p. 497.) Lavoisier would
faithfully attend all the meetings of the Royal Society of
Medicine until its last one on August 8, 1793.
Behavioral
Psychology
It is even possible to recognize in Lavoisier the talents of a
sociologist and see him as the precursor of Gustave Lebon.In the
Mémoire sur la respiration des animaux, alludingto the
disorders accompanying the first year of the Revolution, he wrote:
"Let us hope especially that the enthusiasm and exaggeration which
so easily seize men congregated in large groups - affecting human
passions and leading the crowd against its own interest,sweeping
up in their whirlwind the sage and philosopher as well as ordinary
men - will not destroy a work undertaken with such noble
intentions and, with it, the hope of the country."(Lavoisier,
Oeuvres, vol. II, p. 699.)