The city of Paris and the rise of clinical medicine.

This article argues that the city of Paris played a unique role in shaping clinical medicine at the Paris hospital at the turn of the nineteenth century. Under outstanding clinicians such as Corvisart, Pinel, Bichat, Desault, Alibert, Bayle, and Laennec, who headed the "Paris School," teaching and research became hospital-based. New methods such as percussion, mediate auscultation, and psychological evaluation were introduced, and autopsies became routine. Chaptal, a physcian and minister of internal affairs under the Consulate, played a key role by creating the Paris Hospital and Health Councils, the Central Pharmacy, and central triage for hospital admissions. These municipal councils supervised the practice and teaching of anatomo-clinical medicine and the concomitant social changes involved in the delivery of health care to a city of six hundred thousand inhabitants. These changes included the orderly provision of bodies for dissection, the subordination of nurses to physicians, the teaching of preclinical courses, and the adaptation of the confiscated religious buildings to house patients grouped according to their diseases. The new arrangements fostered the rise of medical specialties, including public health, practiced by hygienists who turned Paris itself into a patient.