The Day the Universe Changed - James Burke [101]
The initial three-year course for students included training on tasks once thought fit only for surgeons. These included dressing wounds, making minor incisions, maintaining daily records, collecting anatomical specimens and carrying out post-mortems. The motto of the school was, ‘Read little, see much, do much’. The success of the new approach was immediately evident. The survival rate of fever victims being treated by physicians was much lower than those in the hands of the surgeons.
The new circumstances also offered a unique opportunity for the implementation of the earlier philosophical inclinations towards sensationalism and detailed analysis. Surgeons were, after all, sensationalists by profession. Their job had always been to look, to feel and to deal with the immediate, local cause of pain, the lesion itself.
One of the first surgically trained chiefs at the Paris school, Philippe Pinel, was close to the circle of ideologue philosophers under the influence of Condillac. In 1798 Pinel wrote a book called Philosophical Nosology, or the application of analysis to medicine. Six editions were printed during the next twenty years, influencing doctors all over Europe. Pinel claimed that concepts of sickness based on phenomena alone were inadequate. For a proper understanding of disease the data had to be observed clinically and traced back to their sources in the organs of the body.
This analysis was not thorough enough for one of Pinel’s pupils, Xavier Bichat, who was also a surgeon. Bichat applied Pinel’s elementary analysis to the static texture of the body, less complex to study than the living organism. Bichat believed that the tissue in the organs would represent the irreducibly simple element of which Condillac had written.
He set out to discover all he could about human tissue. First he dissected it to the fibrous state. Then he tested its reaction to putrefaction, soaking, boiling, baking, acid, alkalis, and so on. Bichat was less interested in the chemical composition of tissue than in its ‘organisation’and ‘character’. He regarded the tissue as a source of simple, sensory information, and finally identified twenty-one tissue types, among them: cellular, nervous, arterial, venous, exhalant, dermoid, epidermoid, absorbent, osseous, medullary, cartilaginous, fibrous, pilous, fibro-cartilaginous, muscular, mucous, serous, synovial and glandular.
The doctor’s reputation grows. An early nineteenth-century surgeon presents the successful result of a cataract operation to a formal gathering of public authorities.
In his Treatise on Membranes, published in 1800, Bichat presented the first systematic view of disease as a localised phenomenon. No longer was sickness to be regarded as a single entity, which manifested itself in different forms all over the body. Disease was specific to the lesion and was active in the tissues. Postmortems carried out to test Bichat’s theory showed that diseases spread from tissue to tissue through the body. Bichat had invented pathological anatomy.
This new view of disease removed the patient from direct involvement with the doctor. In the hospitals, conditions favoured his isolation. Hospital doctors were now more dominant, the elite of the profession. The patients themselves were a new breed. They were, for the most part, poor and destitute, or inarticulate soldiers accustomed to taking orders, lying in the hospitals in their obedient and passive thousands, poked and prodded by students who would come to their bedside at will. It was often the practice to hang a lantern outside a hospital to indicate that there were viewable cases or pregnancies within. All hospitals except the exclusive Maison Royale were open to students.
If a patient objected to his treatment he would in general be discharged immediately. Most