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COMMENTARY |
Centre de Geriatrie Toulouse, Grenoble and Paris, Toulouse, France.
Address correspondence to Pr. Bruno Vellas, Centre de Geriatrie, 170 Ave. de Casselardit, 31300 Toulouse, France. E-mail: vellas.b{at}chu-toulouse.fr
Physicians find the history of medicine a fascinating subject. It encourages us to be modest by revealing the genius and courage of our predecessors, sometimes in very distant times. It reassures us, as we can now avoid the mistakes they could not help but make. It gives further meaning to the art of medicine. But how difficult this art is to practice, in particular geriatric medicine, which has so many different facets! Although geriatric medicine has always existed, as a discipline it is very recent; it is highly medical although its basic approach is a social one, it is very precise and technical even though it must take into account all aspects of the human being involved, highly individual even if the response required may be collective, and it is particularly concerned with ethics because the decisions to be made lie at the heart of a number of existential conflicts. How difficult it is to give geriatrics the place it deserves in a retrospective study of the history of medicine!
John Morley must therefore be congratulated on his courage in undertaking this brief universal history of geriatric medicine (1). To read it is to be transported in time and space, to travel through different ages and continents.
With regard to France, the history is incomplete, even if the spotlight falls on the best among us. In the 19th century, the famous Charcot, the great neurologist at the hospital of La Pitié-Salpêtrière in Paris, was already concerned by the fate of the oldest patients. A certain number of French geriatricians consider him as a founding father. Modern geriatric medicine was born in France with Huet, during the years 1947–1952 (2), after World War II, and found expression in working groups that became scientific societies and led to the present Société Française de Gériatrie et Gérontologie. During that period, Dr. Toussaint Gallet founded the Revue Française de Gérontologie, now the Revue de Gériatrie. Members of a variety of disciplines were already taking part, including well-known medical personalities such as the physiologist Bourlière, Destrem and Vignalou who practiced in the homes for incurables, Pequignot and Choussat, professors of internal medicine, and Hugonot, a university specialist in internal medicine and resuscitation who, after a medical career in the army, became particularly interested in community health. Paul Berthaux in Paris and Gérard Cuny in Nancy, also professors of internal medicine, founded the first schools of geriatric medicine in the 1960s. During the same period, a link was forged between geriatricians and university professors of the humanities for whom gerontology was a discovery, such as Michel Philibert, a philosopher at the university of Grenoble, and Pierre Vellas, a jurist at the University of Toulouse.
These pioneers, who have an incontestable place in the history of geriatric medicine in France, do not appear in John Morley's article. On the planetary scale, this is not important, but on a scientific level, this observation raises an interesting question: that of the cultural, linguistic, scientific, or even methodological barriers separating the Anglo-Saxon medical world from the Latin, Northern culture from Southern, factual medicine from the qualitative approach, and of the uncontested preeminence of the English language in the medical sciences and of factual history in the historical sciences. Over recent years, these differences have become less marked. But their recognition and acceptance cannot but make a useful contribution to the necessary expansion of geriatrics on a world-wide scale.
Recently, geriatric medicine has developed considerably in France. Recognized as a specialty by the French authorities, it is now taught in all medical faculties and to all students. Close links have been established at a European level. In 2009, the world congress of the International Association of Gerontology will be held in Paris. Geriatric medicine must also develop and stimulate research. Geriatricians are deeply involved in organizing care and assistance within the hospital and the community, in a system that in France is now undergoing profound change and is based on the principle that geriatric and gerontological care must be available for patients in all regions of the country. This involvement of geriatricians in the political and economic debate (3) is not devoid of professional consequences, and it highlights the real need for an ethic of responsibility, which would ally the interest of the community as a whole and its consequences for public health, and the interest of the individual patient in accordance with the teaching of Hippocrates.
References
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