(or maybe better for his reputation), there is nothing left of this piece. Bouchardat finished his pharmacy training in Avallon and, again like Claude Bernard, he went to Paris to study. To fund his studies in pharmacy and medicine, he worked as a teacher and published several books for students to prepare for the baccalaureate. In 1829 he began his medical studies, and in 1832 he finished his doctoral thesis on cholera. He was nominated as Professor of the Medical Faculty as early as 1833, but had to wait 13 years to be appointed as the Chair of Hygiene. From 1834 to 1855 he was Chief Pharmacist at the Hôtel-Dieu hospital, and he wasted no opportunity to criticize the disastrous hygiene conditions of the old hospital, located along the Seine in front of the actual Hôtel-Dieu building. His private address was 8 Rue de Cloître Notre Dame, which faced the north entrance of Notre Dame. In this apartment he received his numerous private patients for decades, some of whom had travelled to Paris from far away. The patients had learned how to test their urine for glucose themselves, and they sent him letters with the results, asking for his advice [1].
Fig. 1. Apollinaire Bouchardat, 1863 (donation to Dr. Jörgens by the Bouchardat family).
Fig. 2. Le diabète sucré – Bouchardat’s opus magnum [3].
At an advanced age, Bouchardat suffered from hearing loss, which was the reason for the faculty to retire him against his will 1885. His successor was Adrian Proust, the father of the writer Marcel Proust. Bouchardat died on April 7, 1886. The funeral mass took place on April 10, 1886 in Notre Dame, a few steps from his apartment. Bouchardat had requested that no speeches be made there and that the guard of honor – he was a knight of the “Légion d’honneur” – should not carry any weapons. He was buried in the Père-Lachaise cemetery.
In 1952, Bouchardat’s portrait was featured in the sixth issue of Diabetes, the official journal of the American Diabetes Association, and an article by Elliott Joslin honored his contributions to diabetes care and research. Joslin stated that Bouchardat was the first clinician to introduce patient education, including self-monitoring of urine glucose [2]. At a time when 300 mL of blood was required for blood glucose estimation, the only method for metabolic self-monitoring available for the patients was urine testing. Bouchardat wrote in his famous book, Le diabète sucré, that “this daily measurement of glucosuria guides patients like the compass that guides the sailor on unknown oceans” [3] (Fig. 2). Bouchardat had observed that weight reduction resulted in substantial improvements in metabolic control, and he was the first to introduce a systematic regimen in obese people with diabetes. In addition to this reduction of food intake, in particular of nutrients containing carbohydrates, Bouchardat also repeatedly emphasized the blood sugar-lowering effect of physical activity – he was the first diabetologist to treat his patients based upon an evidence-based approach including education, self-monitoring, weight reduction, and exercise. He also noticed that this treatment was most effective in older obese patients, whereas slim young patients with ketosis did not show any benefit.
In contrast, his speculations on the pathogenesis of diabetes nowadays seem obscure, since he attributed hyperglycemia to pathologically increased absorption of glucose in the stomach [3]. This hypothesis may seem curious to us, but today’s speculations on the pathogenesis of diabetes may sound just as strange in a hundred years.
Bouchardat was among the first to discuss the pancreas as the source of diabetes. He tried pancreatectomy on dogs, but the dogs all died. He also attempted ligation of the pancreatic duct and observed that the dogs lost weight and developed glucosuria [3]. From today’s perspective, however, his work on physiology and pathogenesis falls far behind his major discovery, which Joslin formulated as “having introduced the personal responsibility of the patient for his own treatment into diabetic therapy” [2]. This was his cardinal contribution.
Bouchardat’s bestseller was his “pocketbook,” Nouveau formulaire magistrale, a succinct compendium of pharmacology which, continued by his son Gustave Bouchardat, was published in 37 editions until 1932. He summarized the treatment of diabetes in the third edition in 1845 as follows: “Decrease the intake of carbohydrates, recommend beef, eggs and fish and vegetables, everything in moderate quantity. One to two liters of wine per day. If no problems with hemorrhoids: opium” [4].
Less known in the diabetes world is his main publication as a Professor of Hygiene: Traité d’hygiène publique et privée, basée sur l’étiologie [5]. Over more than 1,100 pages, this book covers all aspects of disease prevention and is written in an accessible style that made it a tremendous success with the public. The book is expressed with a very human touch and its many amusing stories reveal Bouchardat’s sense of humor and his art de vivre. In the chapter on nutrition, Bouchardat recommends oysters to be included in the diabetic diet, but he does not forget to add that they should be accompanied by bread, butter, and a good glass of Chablis to form a complete meal [5]. He criticizes vehemently the education of children, particularly in catholic schools, where he says sports and exercise are totally neglected. He continues to be even more anticlerical against education provided by the catholic church: “Exaggerated religious exercises lead the ardent or docile natures entrusted to them either to hypocrisy or mystical celibacy.” Also – still partly true today – he mentions that children do not learn anything about a healthy nutrition and hygiene, instead they have to know the useless dates of birth of the Merovingian kings. Bouchardat recommends sexual intercourse every 2nd day for young people and he criticizes celibacy. He urged the French to abolish celibacy; in his opinion, the families of Protestant pastors in Germany with their numerous well-educated children produced excellent German soldiers and he states that this was one of the causes of superiority of Prussia’s army in the war of 1870–1871 [5].
Politically, Bouchardat was a democrat, which was not easy in a time when “Napoleon le petit” was ruling France. In one public lecture entitled “On Poverty,” he demanded more financial support for the working class [6].
Like his contemporary Claude Bernard, Bouchardat always spent his holidays in his native Burgundy in the village of Girolles near Avallon. From his first salary in the Hotel Dieu he had bought a large vineyard next to his mother’s house in Girolles. Like Claude Bernard, he cultivated this vineyard and produced an excellent pinot noir. The vines fell victim to the phylloxera disaster, but the estate is still owned today by the numerous descendants of Bouchardat, who meet regularly in this property, owned by the family for two centuries. On the occasion of Apollinaire’s 200th birthday celebration, the street in which this house is located was renamed Rue Bouchardat [1].
Wise men foresee the future. Apollinaire Bouchardat wrote in 1866: “At a time which may not be as distant as we believe, Europe will form one big republic and the only rivalry among the states will consist of the struggle to develop and
