Alexis Boyer (1757-1833), Napoleon I’s surgeon


byXavier Riaud*, FINS, Medal of Honour of the companions of the INS, INS Legion of Merit Medal.


Alexis Boyer (Corlieu, 1896, © BIUM).

 

Alexis Boyer was born in Uzerche, on March 1st 1757. Born to a modest family, he attended a small school where he was only taught reading and writing. Later on, he worked as a clerk in the local notary’s office, M. Mondat. Next to the office lived a barber surgeon who fascinated the young Alexis. The latter tried to visit him as soon as he could. He obtained his first medical knowledge in his shop. Among the regular customers of the shop was a surgeon whose name was Cruvelhier. As he was amazed at his incredible dexterity, the practitioner invited the young man to accompany him on his visits. During one of them, he let him carry out minor surgery on his patients. As he was convinced to go to Paris to start medical studies, he saved money for a full year (Dubois, 1853). He turned 17 years old in 1774 and went to the French capital city. There, he met a medical student who introduced him to a barber. He immediately started to work for him as “first boy”. Big-hearted and endowed with indisputable principles, he tackled the task.

An intelligent, honest, decent, wise, patient, orderly, methodical and tenacious man with a fabulous memory, he knew that it was going to take a lot of work and a long time before reaching his objectives. During his spare time, he attended dissections in anatomical amphitheatres which were close to the barber’s shop (Goudeaux, 1904). At the beginning, he assiduously audited and listened to all the lectures, observed and learnt without saying a word. He had noticed that many students were reprimanded for they often left their dirty instruments after each demonstration. Therefore, one day, after their departure, he washed and sharpened them. The students, who were extremely grateful, quickly included him and got him involved in their dissection works. But soon, he excelled by his skills and quickly became a demonstrator. He gave lectures of anatomy against payment. It was hard for him to survive at first, but still, he managed to survive. After 5 years of studies and various fieldwork under precarious conditions, he was awarded with the Gold Medal from the Practical School of the Surgery College in 1781. In 1782, he studied in the “hôpital de la Charité”. There, he attended lectures and made dressings. On July 9th 1787, he won a position of surgeon which he had applied for as it had been available since June 25th. He was entrusted with a service. He was 30 years old (Dubois, 1853; Dupont, 1999). Androutsos ((a), 2003) wrote that Raphaël-Bienvenu Sabatier supervised him whereas Dubois (1853) maintained that Sabatier had been his great rival for this position.

In 1789, as a staunch patriot, he participated in the storming of the Bastille alongside the students of the Medical College. In 1792, after the deliberation of the Assembly, Boyer became second surgeon of the “hôpital de la Charité”. He had worked there for 32 years until his head’s death, Mr. Deschamps. Upon his request and with the approval of the Administrative Commission of Hospices, he gave lectures of surgical clinic at the “Charité”. In 1795, Boyer became professor of operative medicine at “Ecole de santé de Paris” (the School of Health in Paris). He was immediately entrusted with the chair of the outpatient clinic. After teaching anatomy, he gave lectures on surgery. Moreover, during that year, he joined the faculty of Desault’s school of anatomy at the “Hôtel-Dieu”, as doctor and then, as assistant professor (Dubois, 1853; Androutsos (a), 2003).

Working with Desault made Boyer realise the necessity of ensuring that anatomy would be carried out with rigour and methodology. In 1797, he published the first of the four volumes of his Traité complet d’anatomie, description de toutes les parties du corps humain (Complete treatise on anatomy, description of all parts of the human body), whose publication was from 1797 to 1805. This piece of work was republished four times (http://fr.wikipedia.org, 2010).
After Antoine Dubois’s departure to Egypt in 1798, he became a key player in his field as all his great masters had prematurely passed away. Thus, he taught four subjects every day (anatomy, operative medicine, external pathology and surgical clinic). His lecture on external pathology lasted 15 years and was the most followed. Soon a formality was required. He had to defend his doctoral thesis and he taught his jury a real lesson (Dubois, 1853).

In 1804, he was appointed member of the surgical service of the “Hôtel-Dieu”, then professor of surgery at “l’Ecole de santé”. He succeeded Desault as the head of the surgical clinic chair.

In 1805, Corvisart recommended him to the new Emperor for the position of Napoleon’s first surgeon. Indeed, as he was convinced that he would never get the upper hand over Dubois his rival and friend, Corvisart admitted that Dubois would have never been chosen because “the Emperor’s favourite doctor” wanted to keep his power and he did not want to take the risk of losing it (Ganière, 1988 & Riaud, 2010). Therefore, he prefered to promote Boyer for this position as he found him easier to control.

Upright and hard-working, Napoleon immediately appreciated him and covered him with praise. In 1806 and 1807, he accompanied the Emperor during the Prussian campaign. Shortly after this, the Corsican assigned him to operate Marshall Suchet in Spain. Upon his return, Napoleon authorised him to go back to the “Charité” to teach (Dubois, 1853).

Every day, he would wake up at 5 o’clock in summer and 6 in winter. An hour later, he would be in the hospital to visit his patients, then he would give his lectures of external clinic at patients’ bedsides. From 9 to 10, he would go back home, get his hair done, get dressed and provide his consultations until 12. After a large meal, he would go to the “Ecole de santé” at 1 o’clock in the afternoon. Otherwise, he would consult in town. Around 6, he would eat and at 7, he would start thinking of his book that he wrote and dictated. He would go to bed at half past ten every night. A pipe smoker, he would enliven his thoughts with a few glasses of beer.

Boyer was a cold-blooded, rational, skilful, cautious man, complying with the rules and the principles indispensable for his discipline. He never innovated. He had not invented a new method, however, he had modified essential ones such as the incision of the anal fistula, the use of injections for hydroceles and of the continuous extension in the event of fractures. His diagnosis was always right, in particular when he had to ascertain whether or not an operation was needed. The patient and his recovery were his priority. He never took any unnecessary risks. He always used over-simplified methods and equipment. Between visiting his patients and teaching, he also enjoyed sitting around an oak table, surrounded by some students and surrendering to the sheer pleasure of discussing with an unexpected talent of speaker and inexhaustable vigour (Dubois, 1853).

Napoleon conferred on him the Legion of Honor, with the title of baron of the empire in 1810 (Boyer, 1810). 

In 1811, he started writing his Traité des maladies chirurgicales et des opérations qui leur conviennent. In 1814, five volumes were published. The edition of six others continued until 1826. This fundamental work was the best surgery had at that time. Boyer gathered all his experience and his knowledge acquired during his numerous years of practice and work (Dubois, 1853).

Boyer enjoyed receiving honours but did not seek them. Without refusing them, he never gave them importance and never associated his name with the title of baron. He never frequented the upper middle class and barely watched performances. After the Emperor’s abdication, he exclaimed: “Today, I lose my allowance, 25 000 francs and at the same time, my position as the Emperor’s first surgeon. I have five horses. I will sell three and I will keep my car which costs me nothing. Tonight, I will read a chapter of Seneca and I will not think about it.” However, after the end of the Empire, he became a consulting surgeon to Louis XVIII, Charles X, and then, Louis Philippe (Androutsos (b), 2003).

In 1832, his wife’s death caused him unalterable sadness. He passed away on November 25th 1833. He was 76 years old.

He used to sell his books at home as he never wanted someone else to do it. To ensure fairness, he always set a price that he considered appropriate and never respected the price publishers used to set for his books. Generous and altruistic, he also gave money to his poorest patients to help them to restart their lives (Dubois, 1853). Covered with praise, he was chosen a member of the Academy of Sciences and surgeon-in-chief at the “Hôpital de la Charité” in the same year.

His works made him a precursor of urology 50 years before this discipline was recognised as an independent medical speciality, the first urology chair being established in 1870, at the “Hôpital Necker”, by Félix Guyon (Androutsos (a), 2003).

 

Bibliography:
Androutsos Georges (a), « Alexis Boyer (1757-1833), éminent chirurgien et anatomiste, et l’étude des troubles mictionnels » [“Alexis Boyer (1757-1833), a distinguished surgeon and anatomist, and the study of urinary problems”], in Prog. Uro., 2003; 13: 527-532.
Androutsos Georges (b), « Alexis Boyer (1757-1833), éminent chirurgien et anatomiste. La place de l’andrologie dans son œuvre. Varicocèle et hypospadias comme facteurs d’infécondité » [“Alexis Boyer (1757-1833), a distinguished surgeon and anatomist. The place of andrology in his work. Varicocele and hypospadias as risk factors of infertility”], in Andrologie, 2003; 13 (2): 180-186.
Bibliothèque Interuniversitaire (BIUM) [Inter-university Health Library], personal communication, Paris, 2010.
Boyer Alexis, Traité complet d’anatomie, description de toutes les parties du corps humain [Complete treatise on anatomy, description of all parts of the human body], Migneret (ed.), Paris, volume I, 1810, 3rd edition.
Corlieu Auguste, Centenaire de la Faculté de Médecine de Paris (1794-1894) [Centenary of the Faculty of Medicine in Paris], Alcan – Baillère – Doin – Masson (ed.), Paris, 1896.
Dubois F., « Eloge de M. Boyer lu à l’Académie de médecine le 14 décembre 1852 » [“M. Boyer’s praise read in front of the Academy of Medicine on December 14th 1852”], in Mémoires de l’Académie impériale de médecine [Memoirs on the Imperial Academy of Medicine], J.-B. Baillère (ed.), volume VII, Paris, 1853.
Dupont Michel, Dictionnaire historique des Médecins dans et hors de la Médecine [Historical Dictionary of Physicians both inside and outside Medicine], Larousse (ed.), Paris, 1999.
Ganière Paul, « Dubois Antoine (1756-1837), médecin » [“Dubois Antoine (1756-1837), doctor”], in Revue du Souvenir napoléonien [Review of Napoleonic memories], December 1988; 362: 51-52.
Goudeaux Edmond, Alexis Boyer (1757-1833), sa vie, son œuvre [Alexis Boyer (1757-1833), his life, his work], Jules Rousset (ed.), 1904.
http://fr.wikipedia.org, Alexis Boyer, 2010, pp. 1-2.
Riaud Xavier, « Antoine Dubois (1756-1837), médecin accoucheur de Marie-Louise et baron de l’Empire » [“Antoine Dubois (1756-1837), Marie-Louise’s birthing physician and baron of the Empire”], in The International Napoleonic Society, Montreal, 2010, http://www.napoleonicsociety.com, pp. 1-2.

 

(*) DDS, PhD in Epistemology, History of Sciences and Techniques, Laureate and associate member of the National Academy of Dental Surgery, Free member of the National Academy of Surgery.