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.
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.)
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.
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.
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.)
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.
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.)