History of Medicine

  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