XAVIER BICHAT COMES TO

AMERICA

 

         Revolution erupted in France in 1789, the same year that the newly independent Americans elected George Washington as their first president. The uprising had a great effect on the world of medicine. By 1793 the National Convention, the revolution’s governing body, had abolished all eighteen medical schools and all fifteen surgical colleges as elitest institutions. Enmeshed in civil wars and wars abroad, the nation suffered high casualty rates (medical personnel included) and multiple epidemics. Demands went out for additional doctors and surgeons, but the schools to provide them were closed, forcing the military to begin direct teaching of apprentices in their own hospitals.

Pierre-Joseph Desault (Wikipedia)

         Compelled to modify their egalitarian views, the Convention established three new medical schools, one of them in Paris. In Paris, the city’s exceptional surgeon, Pierre-Joseph Desault at the Hotel Dieu hospital, became the new Professor of Clinical Surgery and Jean-Nicolas Corvisart the new Professor of Clinical Medicine. Hospitals were now the classrooms, and promotions were earned by competitive examinations. “…little reading, much seeing and much doing will be the foundation of the new teaching,” wrote one planner (Fourcroy).

       A young medical student, Xavier Bichat, born in a village near Lyons in 1771, moved to Paris in 1794, where he enrolled as an apprentice on the service of Desault at the Hotel Dieu. Bichat displayed such intelligence and energy that Desault brought him into his home and encouraged his career. 

Xavier Bichat (etching made from a
deathmask, in Additions to the General
Anatomy of Xavier Bichat. Internet
Archive)

Tragically, Desault died one year later, but Bichat worked on, focusing on anatomy. He taught courses and performed thousands of autopsies. His brilliance and originality in formulating a new approach to anatomy impressed both colleagues and students. Bichat, acknowledging antecedent ideas obtained from Philippe Pinel (see blog essay of Nov 2024), identified 21 different tissues in the body, such as serous tissue, lymph tissue, nervous tissue, etc., studying their properties in detail by submitting them to boiling, acids, digestion, chemicals, animal experimentation, and more. His first publication, Traité des Membranes, outlined the new approach.  His major work, Anatomie Générale Appliquée à la Physiologie et à la Médecine, in three volumes, followed in 1801, summarizing his new conception of anatomical study. For example, “carditis” could now be reclassified as pericarditis, myocarditis, or endocarditis. By studying physical properties of the tissues, Bichat also joined anatomy with physiology, form with function. His final work, Anatomie Descriptive, summarized this approach and related clinical symptoms with postmortem findings. Subsequent French contributions to physical diagnosis and the invention of the stethoscope added support to the new clinical-pathologic method.

Hotel Dieu, 1750 (Wikipedia) Despite appearances, inside it was dirty and overcrowded.

 Bichat’s prodigious output was tragically cut short in 1802 by his death from a rapidly progressive, undiagnosed illness. He was 30 years old, yet he had established a new view of anatomy and physiology and proved the value of postmortem findings in documenting disease evolution.

         Back in the new United States, few doctors spoke French and only a small number had studied medicine in Europe. Many, however, were aware of new trends in medicine in France and the need for improved medical education in America. They welcomed English translations of European writings. 

A Boston surgeon, George Hayward, whose name has escaped much notice, began a translation of the Anatomie Général. Hayward, a graduate of Harvard Medical School, had visited surgeons in England and spent the winter of 1812-3 in Paris, before most

George Hayward (Wikipedia)

American physicians made the journey and before Laennec introduced the stethoscope. Hayward was next in seniority to John Collins Warren at the Massachusetts General Hospital. He was present when Warren performed the first operation under ether anesthesia in October 1846 - the removal of a small tumor from the neck. A few days later, Hayward was the first to perform a major operation under ether – the above-knee amputation of a leg of a young woman.

    Hayward’s reputation also rests on another procedure: repair of vesicovaginal fistula. A tear in the bladder wall resulting from a prolonged labor produced this miserable condition that condemned the sufferer to permanent leakage of urine from the vagina. Hayward was the first to report a successful repair (1839). He later reported several other cases with generally good results (1851). Hayward’s case preceded the publications of J. Marion Sims, usually credited with inventing the procedure. Sims perfected his technique on enslaved women from 1845-9.

Photo of reenacted first operation under ether 
Present are: John Collins Warren, George Hayward, Solomon Townsend, John Mason Warren, James Johnson, a Mr. Holman, Morton, and 2 others. Faces not paired with names. (Library of Congress)

 That Hayward’s name is less well-known is possibly due to his reticent character in comparison to the self-promoting Sims. As Hayward’s obituary notes, “Disgusted with the too frequent hollowness of posthumous eulogy, he scrupulously destroyed everything that might lead to it… The future biographer may therefore lament the loss of valuable documents…”

Hayward halted the translation Bichat’s work when he learned of a translation underway in England. After six years with no British results, in 1822 he completed the three volumes, reviewed favorably as faithful to the original meaning. In 1823 he translated a subsequent volume, Additions to the General anatomy of Xavier Bichat by P. A. Beclard. 

Hayward was not the first to bring Bichat’s teachings to America. Dr. John Gorham Coffin, a Boston physician and medical educator, in 1813 translated Bichat’s Traité des Membranes. Coffin was a founder the Boston Medical Intelligencer in 1823, an early journal that five years later merged with a precursor to the New England Journal of Medicine. 

Additionally, a prominent Maryland physician, Tobias Watkins, had translated Bichat’s Recherches physiologiques sur la vie et la mort in 1809. Watkins founded The Baltimore Medical and Physical Recorder, Maryland’s first medical journal and the fifth in the U.S. 

Many more American physicians traveled to France, soaking up new medical knowledge, their efforts enhanced by available translations. Medical education at home continued to improve, though sluggishly, aided by the valuable "French connection".

 

SOURCES:

Haigh, E, “The Life of a Young Physician.” 1984; Med Hist Suppl (4): 2-14.

Ackerknecht, E A, Medicine at the Paris Hospital 1794-1848. 1967, Johns Hopkins Hosp. Press.

Vess, D M, Medical Revolution in France 1789-1796. 1975; Univ Presses of Florida.

 

Cofone, L, et al, “Xavier Bichat (1771-1802): Architect of Modern Histology.” 2025; Intl J Morphol43 (5): 1767-70>

Wall, L L, “George Hayward (1791-1863): a Forgotten Pioneer of Reconstructive Surgery.” 2005; Intl Urogynecol J 16: 330-33.

Anon, Review of Hayward’s translation of Bichat. 1822; North American Review 15 (36, July): 132-63.

Perdicoyianni-Paleologou, H, “Xavier Bichat and the Renovation of the

Pathological Anatomy.” 2024; J Med Biog 32 (1): 89-96.

 

Hayward, G, “Remarks on Anesthesia and the Agents Employed to Produce It.” 1859; Boston Med Surg J 61: 319-25.

 

Obituary of George Hayward, 1866; Med Communications Mass Med Soc 10: 342-3.

 

Jones, H W, “A Hospital Inspector's Diary, Being an Account of the Journey of Tobias Watkins…” 1939; Bull Hist Med 7: 210-235.

 

Beecher, H K and Altschule, M D, Medicine at Harvard: The First 300 Years. 1977, Univ Press of New England.

 

Coffin, J G, “A Dissertation on Medical Education and on the Medical Profession”

1822; in Medical dissertations delivered at the annual meetings of the Massachusetts Medical Society, 1829; Massachusetts Medical Society.

A full index of past essays is available at:https://museumofmedicalhistory.org/j-gordon-frierson%2C-md

 

 

 

 

 

 

 

FROM PRISON TO PROMINENCE: A FOUNDER OF

AMERICAN PEDIATRICS

 

         At four o’clock in the morning on July 9, 1853, in Manchester, England, a servant roused a grumbling Friedrich Engels from his bed to greet a shabbily dressed caller. The visitor, Abraham Jacobi, a young German physician of short stature and unkempt hair, produced a letter from Karl Marx asking Engels to accommodate him. Engels, though peeved, found Jacobi lodgings and helped him open a practice in Manchester.

         The disheveled visitor, born in 1830, had received his medical degree at the University of Bonn in 1851. He had been a student radical during the 1848-9 revolution, was part of the communist underground, and knew Karl Marx. His subversive activities had earned him two years in prison, after which he fled to Engels in Manchester.

Abraham Jacobi (from "Festschrift" in honor
of Jacobi, 1900. Internet Archive.)

Dissatisfied with Manchester, Jacobi opted for a try in America. He settled in “Kleindeutschland” (Little Germany), an area in the lower east side of Manhattan, and opened a general practice. German immigration to New York at the time was heavy; only Berlin and Vienna hosted larger German populations. Little Germany was notable for poverty, overcrowding and stifling tenements. Thirty percent of its population was under ten years of age. Many would not reach adulthood.

         Jacobi, true to his communist leanings, also cared for the indigent, established contact with trade unions, and was a contact for Marx. The high child mortality rate convinced Jacobi and his colleagues to view disease as a social and political problem, as their contemporary Rudolf Virchow had proclaimed in Germany. Inadequate sewage disposal, contaminated water and milk, Tammany Hall inaction, and other problems generated malnutrition, epidemics and disproportionate deaths. Finding that older physicians paid little attention, Jacobi and six other 1848-refugee physicians founded their own dispensary and medical association. They reviewed current European medical literature, discussed cases, and wrote articles. Jacobi focused on eliminating adulterated and contaminated milk and water, evils that were killing so many infants.

         Jacobi’s activities and writings caught the eye of the sanitary reformer Elisha Harris and of Stephen Smith, an editor at the New York Journal of Medicine. Smith had helped found

Stephen Smith (Wikipedia)

New York’s Metropolitan Health Board, focused on public health measures. He solicited journal contributions from Jacobi, emphasizing European literature.  Smith’s brother, Job Lewis Smith, was another pioneer in child health who published an early text on childhood diseases in 1869. These contacts brought Jacobi and colleagues into academic circles, such as the New York Academy of Medicine and the New York Pathological Society. The latter elected Jacobi its president in 1864. The newly organized New York Medical College offered Jacobi, in 1860, a chair in diseases of children, the first such appointment in the U.S. (J. Lewis Smith became Clinical Professor of Diseases of Children at the Bellevue Hospital Medical College the following year.) Jacobi instituted bedside teaching, home visits, and attracted patients from surrounding areas. He continued to translate European literature; two journals in Germany already dealt with childhood pathology.  

Text by Job Lewis Smith, 8th ed. 
(Internet Archive)

         He railed against institutional orphanages as death houses. At a large orphanage in New York, Jacobi noted an extremely high mortality. After careful study, he concluded that the institution should be closed. Instead, Jacobi himself was ousted. “The younger the child, the larger the institution, the surer is death,” he said later, pleading for home placement of abandoned children, even in the poorest of homes. In general, Jacobi stressed the preventive nature of the care of children: breast feeding, uncontaminated milk and food, and a clean environment.

         His influence widened. The College of Physicians and Surgeons appointed him Clinical Professor of Diseases of Children in 1870. In 1893, the University of Berlin, forgetting Jacobi’s earlier jail time, offered him the chair of pediatrics when Eduard Henoch, known for the description of Henoch–Schönlein purpura, was retiring. Jacobi preferred the U.S., though, and declined. He was elected president of the American Pediatric Society (which he helped found), president of the New York Academy of Medicine, and, at the age of 82, president of the A.M.A. He helped found the German Hospital, later named the Lenox Hill Hospital, and the pediatric section of the Jewish Hospital, later renamed Mount Sinai Hospital. 

The German Hospital, opened 1869. Renamed Lenox Hill Hospital (Wikipedia)

         His writings, the majority by hand, amounted to hundreds of papers and letters, collected later into eight volumes of over 4000 pages. He wrote a popular text, Therapeutics of Infancy and Childhood and contributed to others. His primary interests focused on safe infant feeding and diphtheria (his only son died of it at age 7). He helped Macy’s owner Nathan Straus set up charitable clean milk stations in New York, a major step in curtailing deaths of young children. He was an early proponent of laryngeal intubation to relieve fatal obstruction of the throat in diphtheria, a technique devised to replace the more dangerous tracheotomy. He continued to see adult patients throughout his life, shunning overspecialization.

Mary Putnam (Wikipedia)

In 1893 he married Dr. Mary Putnam, daughter of the publisher George Palmer Putnam. (Two previous wives had died.) Mary was the first woman to graduate from the École de Médecine, Paris, and the sixth woman in the U.S. with an MD degree. The marriage was a happy one, marred only by the death of their son, Ernst.

         At the age of 88 Jacobi was writing an autobiography in his summer home at Lake George, N.Y. when fire, from which he barely escaped, destroyed the cottage and his remaining papers. He died the following year, 1919.

         At the time of his death virtually all medical schools had established pediatric professorships, children’s hospitals were growing, and research in childhood health and disease was active. From dubious beginnings, Abraham Jacobi had risen to be a celebrated founder of pediatrics in the America he called home.

 

Another example:Thomas Morgan Rotch, first full Professor of
Pediatrics in the U.S. at Harvard Medical School, 1893.
(Wikipedia)

SOURCES:

Leopold, J S, “Abraham Jacobi,” in Veeder, B S, ed., Pediatric Profiles. 1957; C V Mosby.

Nadel, S, Little Germany: Ethnicity, Religion, and Class in New York City, 1845-80. 1990; Univ of Illinois Press.

Halpern, S A, American Pediatrics: The Social Dynamics of Professionalism, 1880-1980. 1988; Univ California Press. Chap. 3.

Cone, T E, History of American Pediatrics. 1979; Little, Brown.

Ligon-Borden, B L, “Abraham Jacobi: Father of American Pediatrics and Advocate for Children’s Health.” Seminars Ped Inf Dis, 2003; 14 (3): 245-9.

Viner, R, “Abraham Jacobi and German Medical Radicalism in Antebellum New York.” Bull Hist Med1998; 72(3): 434-65.

Link, E P, “Abraham and Mary P. Jacobi, Humanitarian Physicians.” J Hist Med All Sci. 1949; 4 (4): 382-92.

Mahnke, E B, “The Growth and Development of a Specialty: The History of Pediatrics.” Clin Pediatrics 2000; 39: 705-14.

Faber, H K, “Job Lewis Smith, Forgotten Pioneer.” J Pediatrics 1963; 63 (4): 794-802.

Truax, R, The Doctors Jacobi. 1952; Little, Brown.

A full index of past essays is available at:https://museumofmedicalhistory.org/j-gordon-frierson%2C-md

 SICKNESS AND MEDICINE AT

VALLEY FORGE

        

         In the late fall of 1777, the outcome of America’s Revolutionary War was uncertain. Washington’s Continental Army had not fared well, and the British had occupied the new nation’s capital, Philadelphia. Washington chose Valley Forge as a place to winter his approximately 12, 500 exhausted troops. The area was situated on an elevated plateau, bordered by rivers and hills for defense.

Diagram of Valley Forge (From Duncan, Medical Men of the 
Revolution, Internet Archive)

 Ample trees provided firewood and small farms dotted the area. And being close to Philadelphia, Washington could keep an eye on the British.

Washington's Army marching to Valley Forge (painting by William Trego. Wikipedia)

         On December 19, the troops marched in over an icy trail in frigid weather. About 2,000 arrived barefoot but the soldiers otherwise in generally good health. Snow blanketed the ground, food supplies were limited, and meat sources sparse. The main fare was “fire cakes,” a mixture of flour and water baked in fire to produce a hard, blackened biscuit. Clothing was threadbare and shoes wearing out. The French patriot, Lafayette, who commanded a division, wrote to his wife that, “The unfortunate soldiers are in want of everything: they have neither coats, hats, shirts, or shoes.” The men shivered in tents until wooden cabins were built, the latter with a fireplace.

Soldier's Hut, reproduction (Wikipedia)

        
         Washington knew the value of health in troops. Early in the war he had insisted that medical officers receive pay comparable to upper-level officers and he restrained army brass from interfering with measures ordered by medical officers. Congress had established the Medical Department of the Army, but chaos ruled in the institution much of the time. The first two medical directors had been dismissed, one on charges of spying for the British. The third, Dr. William Shippen, Jr., a highly educated surgeon and gynecologist,

William Shippen, Surgeon General (Wikipedia)

was medical director during the Valley Forge layover. But disorganization, lack of funds and supplies, constant turnover of personnel, and frequent pilfering continued to hamper the medical-surgical aspect of the war.
        Three available works on military medicine provided information on prevention of “camp diseases,” a major cause of death and disability in armies of the time: Sir John Pringle’s Diseases of the Army, Baron van Swieten’s The Diseases Incident to Armies with the Method of Cure, and John Jones’ manual of military surgery that included a section on preventive measures. Without knowledge of germ theory, all furnished sound advice on preserving troop health.

        Washington ordered hospitals, called “regimental hospitals,” to be built. They housed men with short-lived medical problems, while more serious cases went to a middle stage, the “flying hospital” and the most serious to “general hospitals” outside Valley Forge*. Medical supplies were scarce. As the cold weather ground on, many doctors disappeared on unauthorized leaves, cattle and grain had to be “requisitioned” from local farmers, and soldiers caught fish in the nearby rivers.

Hospital, Valley Forge (from Gillette, The Army Medical 
Department)

         Washington enacted several measures to prevent “camp diseases.” He ordered latrines and holes for fecal matter to be dug at least 200 feet away from living quarters and any man found defecating elsewhere was subject to five lashes. The frosted ground made this difficult and time-consuming, and camps needed to be moved occasionally due to offensive smell. The troops were to wash and shave regularly and launder their scanty clothing. In the hospital, straw from discharged patients was burned and their bedding washed.

Washington (left) and Lafayette at Valley Forge (by John Ward Dunsmore. Wikipedia)

       One of the surgeons, Albigence Waldo, serving since mid-1775, left a diary of his experiences at Valley Forge. The entries in December and January focus on the biting cold weather and scarcity of food. On Christmas day, he writes, “We are still in Tents – when we ought to be in huts – the poor Sick suffer much in Tents this cold Winter. We give them Mutton and Grogg and a Capital Medicine once in a While…. but very few of the sick men die.”
         By mid-January most of the men had left the tents for smoke-filled huts and the hospitals were functioning. Frostbite was common, requiring amputations for many. Respiratory illness, including pneumonia, predominated during cold weather. Simple lack of clothing occasioned three to four thousand men to be reported as unfit for duty. With warmer spring weather, dysentery and “putrid fever,” probably a mixture of typhoid and typhus, appeared. A major problem affecting most of the troops was “the itch,” or scabies. Caused by a small mite, it is highly contagious in close quarters. Constant scratching leads to open sores, secondary abscesses and other infections. Sulfur applications, in lard, along with bathing and laundering of clothing generally resolved it. Venereal disease, as usual, was another problem, though the records do not suggest it as a major one. Scurvy was not recorded, possibly related to large amounts of lime juice ordered.

Schoolhouse converted to a hospital (from Gillette, The
Army Medical Department)

         Washington had seen the devastating effects of smallpox on fighting ability earlier in the war and determined to prevent future cases. All soldiers who had not had smallpox underwent compulsory inoculation with a small amount of material from an active lesion. Many of the roughly 4,000 inoculated soldiers sickened with the disease, creating a great strain on the hospitals, but only 10 died.
         During the stay at Valley Forge, France entered the war as an ally. By April and May 1778, shoes, clothing, and supplies began arriving from French ships. Finally, on June 18 the rehabilitated army left Valley Forge for new maneuvers, in generally good condition, though many were still recovering from inoculated smallpox. The overall mortality for the winter stay is quoted as 3,000 men (out of 12,500), but an accurate figure is not available.
         Life was harsh and uncertain at Valley Forge that winter, but the hygienic measures and smallpox inoculations ordered by George Washington saved many lives.

*The hospital terminology is from Pringle. A quote from the 1775 edition, “Among the chief causes of sickness and mortality in an army, the reader will little expect that I should rank the hospitals themselves…”

 

SOURCES:

Reiss, O, Medicine and the American Revolution. McFarland & Co. 1998.

Gillett, M C, The Army Medical Department 1775-1818. Center of Military History, United States Army. 1981.

Trussell, J B B Jr, Birthplace of an Army: A Study of the Valley Forge Encampment. Pennsylvania Historical and Museum Commission. 1976.

Duncan, L C, Medical Men of the American Revolution, 1775-1783. The Medical Field Service School, Pennsylvania. 1931.

Middleton, W S, “Medicine at Valley Forge.” Ann Med Hist 1941; 3, 3^rd ser (6): 461-486.

Waldo, A, “Valley Forge: 1777-1778, Diary of Surgeon Albigence Waldo, of the Connecticut Line.” Pennsylvania Magazine of History and Biography, 1897; 21 (3): 299-323.

Atkinson, R, The Fate of the Day: The War for America, Fort Ticonderoga to Charleston, 1777-1780.

Pringle, Sir John, Diseases of the Army. 1775; London.

A full index of past essays is available at: https://museumofmedicalhistory.org/j-gordon-frierson%2C-md

 

DID A NOVEL HELP CREATE THE NATIONAL HEALTH SERVICE? 

         A.J. Cronin’s medically oriented novel of 1937, The Citadel, was one of the world’s greatest publishing successes of all time. The author, a physician himself, wove a tale of an idealistic and hard-working young physician at odds with a crusty, decaying British medical establishment. Over time, the novel sold millions of copies and was even popular (and allowed) in the Soviet Union and its satellites, probably because of its criticisms of British health services. Many cite the work as influential in the formation of the British National Health Service. 

First edition of Cronin's novel (Wikipedia)

        The hero of the novel, Andrew Manson, a young Scottish doctor with a Bachelor of Medicine (BM) degree, fresh out of school with no internship, takes work in a Welsh mining town. After an unhappy time there, Manson moves to another mining town, Aberalaw. In Aberalaw medical care of the miners is paid through funds in part deducted from the miners’ pay and in part contributed to by the mine owners. 

        While working in Aberalaw, Manson crams at night, earns an MD degree and acquires a membership in the Royal College of Physicians. He notices several miners coughing and laboring to breathe and begins a research project, including research on mice, to determine the role of inhaled particles. After being criticized for experimenting on animals, he leaves in anger and accepts a position on a government board that oversees safety in mines. But he is disillusioned by the laziness, neglect, and lack of progress shown by the board. Andrew then buys a private practice in London. Soon he is mesmerized by his high income and the swanky social circles he inhabits but in time is troubled by pandering to hypochondriacs for large fees, fee splitting, and the coverup of a botched surgery. There are more twists to the plot but eventually Manson and two others, one a skilled surgeon and one an American tuberculosis specialist, who is not an MD, depart London to set up a multispecialty group practice in a small middle-class town. Some former colleagues, angry and slighted, charge him with practicing with a non-physician and abducting a patient from a decaying TB hospital to receive a new and unproven treatment. In the finale, an impassioned speech, announcing his good intentions, saves Manson from losing his license. 

Scene from movie version starring Robert Donat (Wikipedia)

        Throughout the drama, the novel is quite critical of several aspects of British medicine of the time and is said to have been a driving factor in the introduction of the British National Health program. Was this so, and did Cronin advocate a National Health Service? 

        The novel is highly autobiographic. Cronin was born in 

A J Cronin (Wikipedia)

Scotland in 1896. Like Andrew Manson, Cronin received his medical education in Glasgow and began practice in a Welsh mining town as assistant to a general practitioner. Cronin next moved to Tredegar, a nearby mining town, given the name Aberalaw in the novel. As in the fictional Aberalaw, Tredegar’s distinction was a well-functioning medical system, financed by modest deductions from the workers’ pay and by contributions from the Tredegar Iron and Coal Company and other employers. It provided medical, including hospital, care for some 20-25,000 inhabitants. Cronin portrayed this type of practice, private and communal at the same time, as an optimal approach, as did his fictional hero, Andrew Mason. And, like Mason, Cronin studied in late hours to earn his MD and FRCP honors. 

Tregedar Cottage Hospital, taken 2017 (Wikipedia)

        Aneurin Bevan, the principle driving force behind the formation of the National Health Service, was born in Tredegar in 1897, one year after Cronin. His father, a miner who had embraced socialism, died of pneumonoconiosis. Aneurin worked in the mines, became active in labor politics, and attended college on a scholarship. He spent two years on the management committee of the Tredegar Cottage Hospital, where he had a close look at the medical system. He joined the Labor Party, remaining on its left wing. During WWII he criticized Churchill and Army leadership and felt that England should cultivate closer ties with Russia. 

     

Aneurin Bevan (Wikipedia)

   Bevan promoted the idea of national health care, funded on a tax-based model rather than private organizations. Bevin struggled with fierce resistance from the medical profession and the British Medical Association and eventually made concessions, such as higher pay for consultants and allowance of private practice alongside work in the NHS. As Minister of Health in the post-war Atlee government, he shepherded The National Health Care Act into law in 1946. 

         Although Bevan created a socialist framework for national health services, he may well have been influenced by his association with the similar, but private, scheme in Tredegar. Cronin’s direct influence on Bevan is probably slight, as no meeting is recorded. Cronin’s Andrew Mason praised the Tredegar system, but Cronin himself was silent on the program promulgated by Bevin and did not take part in the politics of health care. 

         In The Citadel and in other fiction, Cronin criticized the custom of beginning practice without hospital experience (such as an internship), urged more complete postgraduate medical education, and frowned on various practices such as fee-splitting as dishonest and unbecoming. And he portrayed public health officials as lazy and incompetent. This suggests a suspicion of governmental management in health matters and Cronin, through his fiction or elsewhere, never advocated a government-run health service. In The Citadel, Manson’s dream follows the lines of the Tredegar plan. While there is a connection between Aneurin Bevan, the miner’s life, and the hospital at Tredegar, Bevan’s ideological ties to socialist thought in his crusade for equal health care for all probably were the dominant factors in designing the NHS. 

         Apologies for missing June. I was traveling again. 

 SOURCES: 

 Dunn, Francis Gerard, A. J. Cronin’s Career and Fiction with Specific Reference to The Citadel and the Context of the Foundation of the National Health Service. MPhil(R) thesis, University of Glasgow, 2022. 

 McKibbin, Ross, “Politics and the Medical hero: A.J. Cronin’s The Citadel.” English Historical Review 2008; 123: 651-78. 

 Davies, Alan, A. J. Cronin, The Man Who Created Dr. Finlay. Alma Books, London, 2011. 

 Cronin, A J, The Citadel. Victor Gollancz Ltd., London. 1937. 

 Cronin, A J, “Dust Inhalation by Hematite Miners.” J Indust Hygiene 1926; 8 (7): 291-4. 

 Richardson, Ruth, “The Art of Medicine: A J Cronin’s Citadel.” Lancet 2016; 387 (June 4): 2284-5. 

 A full index of past essays is available at: https://museumofmedicalhistory.org/j-gordon-frierson%2C-md

           PROSPER MENIÈRE AND HIS DISEASE

 

         On a bitter, cold night, sometime before 1848, a young menstruating woman riding in an open carriage suffered an attack of severe vertigo, vomiting, and hearing loss. She was admitted to the service of Auguste François Chomel at the Charité hospital in Paris where she died five days later. Details of the illness are sparse but, because of the deafness, Dr. Prosper Menière, chief of the National

Prosper Menière (Wikipedia)

Institute for the Deaf and Dumb in Paris, was consulted. He opened the temporal bone and described the semicircular canals as “filled with a red, plastic matter, a sort of bloody exudate, a few traces of which were discovered with difficulty in the vestibule and which did not exist at all in the cochlea.” Dr. Menière gave two accounts of this event, thirteen years apart. The first, an annotation in an 1848 translation he made of a German textbook, did not mention vertigo. 

The second account, quoted above, he read at the Imperial Academy of Medicine on a rainy day in 1861 before a limited audience. The following week, Armand Trousseau,

Armand Trousseau (Wikipedia)

 physician-in-chief at the Hôtel Dieu, read a paper on “apoplectiform cerebral congestion.” That term applied to any condition involving change in level of consciousness, fits (except established epilepsy), or paralysis, and was considered a sign of impending or actual cerebral hemorrhage. Trousseau argued that this wordy diagnosis was a grab bag of conditions that should be classified individually and he cited Menière’s case as an example. Comprehension of brain and nervous system disorders at the time was primitive and Jean-Martin Charcot, who virtually created the field of neurology, began his studies at the Salpêtrière only the following year. Menière eventually published four papers on the syndrome that bears his name: noise in the ear, vertigo, and deafness.

Prosper Menière was born in Angers, France, in 1799, as Napoleon was coming to power. A bright student, he finished secondary school and primary medical education near home and at age 20 secured a position as externe at the Hôtel Dieux in Paris. Three year later, he secured an internship and over time served as assistant, and chief of service, under three famous staff physicians: Paul Dubois, an obstetrician, Auguste Chomel, the internist 

Guillaume Dupuytren (Wikipedia)

mentioned above, and the famous surgeon, Guillaume Dupuytren. Menière received his doctorate in 1828. Two years later, serving as assistant to Dupuytren, the “July revolution,” a rebellion against the repressive regime of Charles X, exploded in the streets. Menière, Dupuytren and others in the Hôtel Dieux worked non-stop caring for about 800 casualties received over a few days. Ironically, Dupuytren was chief surgeon to the deposed king, but did not follow him into exile.  

Menière grew in reputation, publishing several papers on assorted topics. In 1833, at the recommendation of Mathieu Orfila, dean of the Faculty of Medicine, the new king, Louis Philippe, dispatched Menière on a unique mission.

Duchess de Berry (Wikipedia)

The widow of the deceased son of the deposed king Charles, the Duchess de Berry, who was the mother of the king’s grandson, had stealthily reentered France to promote the child as a future heir to the throne. But rumors abounded that she was pregnant again. Menière’s task was to sniff out her true intentions. Surprisingly, the two enjoyed each other’s company. Menière saw that she was indeed pregnant, and delivered the child, a girl. The duchess had been secretly married to an Italian count and discretely returned to Italy, abandoning royal aspirations.

In 1835 Menière led a commission to combat an outbreak of cholera in southern France for which he received the Legion of Honor.

He was passed over for two prestigious posts, despite having better qualifications than his competitors, probably because of academic politics. In 1838 the head of the National Institute for the Deaf and Dumb died. Menière’s friends helped him secure the vacant post over the protests of respected experts in ear diseases. 

The National Institute of Deaf Youth of Paris, the same building where Menière worked.
The statue depicts the Abbé de l'Épée, the Institute's founder. (Wikipedia)

 The year of his appointment, 1838, he married Anne Pauline Becquerel of the Becquerel family of physicists (Henri Becquerel shared the Nobel Prize in physics in 1903 with Marie and Pierre Curie). The union produced one son, who became a specialist in ear diseases and eventually published Prosper’s diaries.

In later years, Menière devoted more time to literary pursuits. He wrote a 500-page book on medical studies of Latin poets, corresponded and mingled with literary and artistic lights of the day, including Balzac, Victor Hugo, and Franz Liszt, and kept a voluminous diary. He frequented the opera and theater and was welcome in Parisian salons. He never became a member of the Faculty of Medicine and never achieved a full professorship, in spite of apparent qualifications. Menière was 61years old when he saw the young woman with the syndrome bearing his name. 

In 1862, only a year after his innovative publications on vertigo, Menière met a sudden end, felled rapidly by an aggressive “influenza pneumonia.” 

It was left to the British otologist, Charles Hallpike, aided by neurosurgeon Hugh Cairns, to elucidate more details of the pathology of the swelling within the semicircular canals in Menière’s disease. They decalcified,

Charles Hallpike (Wikipedia)

 fixed, and sectioned the temporal bone of two patients deceased after surgery on the acoustic nerve. Almost simultaneously a Japanese investigator, Kyoshiro Yamakawa, published similar findings. Both had studied with the German ENT professor, Karl Wittmaack, in Hamburg, applying his innovative techniques for processing the temporal bone.

The name “Menière’s disease” persists to this day, though it is considered by many to be a syndrome rather than a disease.

 

 

SOURCES:

 

Atkinson M, Acta Laryngologica 1961; 53: Suppl 162, pp 7-78. (Contains several articles on Menière, including translations of four original papers)

 

M’Kenzie D, “Menière’s Original Case.” J Laryngol Otol 1924; 39(8): 446-9.

 

Maranhao P, Prosper Menière: the Man WHO Located Vertigo in the Inner Ear.” 2021; Arquivos Neuro-Psiquiatr 79 (3): 254-6.

 

Hawkins J E, “Sketches of Otohistory Part 5: Prosper Menière: Physician, Botanist, Classicist, Diarist and Historian.” 2005; Audiol Neurootol 10: 1-5.

 

Beasley N J P, Jones N S, “Menière’s Disease: Evolution of a Definition.” 1996; J Laryngol Otol 110: 1107-13.

 

Barsky H K, Guillaume Dupuytren: A Surgeon in His Place and Time 1984; Vantage Press.

 

Baloh R W, “Charles Skinner Hallpike and the Beginnings of Neurotology.” 2000; Neurology 54: 2138-46.

 

A full index of past essays is available at: https://museumofmedicalhistory.org/j-gordon-frierson%2C-md