BORDEU AND BICHAT; THE BEGINNING OF EXPERIMENTAL PHYSIOLOGY AND EXPERIMENTAL PATHOLOGY IN FRANCE

ThÉophile Bordeu was born at Iseste, in the region of the Pyrenees, on February 22, 1722. He received his preparatory education at the College of the Jesuits, in Pau. Later, he entered the Medical School at Montpellier, and received his doctor’s degree from that institution in 1744. After graduation he devoted much of his time to giving instruction in anatomy, believing, as he did, in Seneca’s motto—“Doceo ut Discam” (I teach in order that I may learn). Notwithstanding the demands made upon his time by his private practice and by his numerous other engagements (inspection of the mineral springs in the neighboring region, courses of lectures to midwives, etc.) he managed to accomplish considerable research work, and one of the first fruits of these original studies is to be found in a mÉmoire which he wrote on the articulations of the bones of the face. This treatise, which he sent to the AcadÉmie Royale des Sciences, was received with marked favor, as shown by the facts that it was published by that body in their Recueil des Savans Étrangers and that its author was elected a Corresponding Member. In this treatise Bordeu calls attention to the fact that all the bones which form the background of the face are arranged in such a manner as to offer efficient resistance to the repeated upward impulses of the lower jaw, which impulses, acting upon the superior dental arch, have a constant tendency to push upward or to drive apart outwardly the bones into which the teeth of this arch are implanted. To appreciate fully the very creditable character of this essay the reader must remember that Bordeu had not yet reached his thirtieth year and that the ideas which he sets forth in this essay are the strict product of his own thinking and anatomical researches.

In 1752 Bordeu moved to Paris, and soon afterward published one of his best contributions to the science of medicine, viz., a monograph entitled: “Recherches Anatomiques sur la Position des Glandes, et sur leur Action.” The publication of this important and exhaustive mÉmoire occurred so soon after its author reached Paris that one is justified in assuming that all or the greater part of the research work upon which the essay is based was carried on at Montpellier. The object aimed at by Bordeu in this mÉmoire was to prove that

“the secretions which issue from these glandular organs represent a veritable elaboration of the liquid the elements of which are supplied by the blood, and are not merely a simple separation, as the term ‘secretion’ would seem to imply. This function,” says Bordeu, “is the result of the activities belonging properly to the gland as an organ, and does not in any sense—as some would have us believe—represent a mere mechanical relationship between the blood-vessels of the gland and the volume of the globules (blood corpuscles) that are carried into the organ through them. Nor does the function represent in the slightest degree the result of a chemical affinity between the fluid product secreted and the substance of the gland. Furthermore, the excretion (i.e., the expulsion) of this fluid product is due wholly to the vital action of the glandular organ; for it is a well-known fact that the adjacent muscles and organs occupy such positions in relation to the glands themselves that they are quite powerless to compress them and thus to favor expulsion of the fluid which they have secreted. Indeed, their influence is of quite the contrary character; instead of compressing these organs in the manner claimed they do no more than to communicate to them from time to time such trifling shocks and movements as favor their glandular activity.... Modern physiologists have added nothing of importance to what Bordeu has set forth in this mÉmoire, which deserves to be looked upon as one of the finest monuments that has ever been erected in honor of the science of man.” (Richerand.)

Bordeu’s mÉmoire, it seems, created a great sensation among the physicians of Paris, many of whom were still at that period ardent supporters of the mechanical and chemical doctrines taught by Boerhaave; and, as a matter of course, there was also unbounded curiosity among the better-educated physicians of the capital to see and make the acquaintance of the newcomer—this “young athlete,” as Richerand calls him,—who had not feared to enter the lists against such a formidable array of adversaries. The marked popularity that fell to Bordeu’s lot as a private practitioner in Paris after this brilliant beginning was not, however, of long continuance. Professional jealousy rarely fails to develop promptly when a physician manifests his ability to win patients from those of his colleagues who, for a certain number of years, have been established in practice, and this is precisely what happened in Bordeu’s case. The new mÉmoires which he published during the succeeding years—one on the pulse (in 1756), a second on “Metallic Colic” (in 1761–1763), a third on the “Colic of Poitou” (a year or two later), and a fourth on the “History of Medicine” (in 1768)—showed unmistakable evidences of the great talents which he possessed, but they attracted comparatively little attention and did not add to his popularity as a private practitioner. Furthermore, he derived very little if any material advantage from his appointment as one of the attending physicians at La CharitÉ hospital.

The last two years of his relatively short life were attended with not a little suffering from attacks of gout, which compelled him to give up his private practice and to live exclusively upon the scant income which he derived from the small fortune (80,000 francs—$16,000) that represented his savings from a practice that had apparently been quite successful. His death occurred from cerebral apoplexy on November 23, 1776, when he was not quite fifty-four years old.

Bordeu did not live to see the ultimate triumph of his ideas with regard to the true nature of the secretions supplied by glands. The careful consideration of what this author has written upon the applications of the accessory sciences (chemistry and mechanics) to physiology should put us on our guard, says Richerand, against drawing incorrect conclusions with reference to the nature of vital processes.

Marie FranÇois-Xavier Bichat was born on November 11, 1771, at Thoirette, France, in the Department of the Jura. His father, who was a practicing physician at the neighboring town of Poncin, and who at the same time held the office of mayor, was a man of considerable cultivation. Cherishing, as he did, the hope that his son might eventually adopt medicine as his vocation, he planned the latter’s education with special reference to this possibility; and, as medicine proved to be the very vocation which the son preferred, all this well-planned training counted as so much valuable time gained. FranÇois, who showed himself to be an apt scholar, made most satisfactory progress in all the prescribed studies of early boyhood, and after passing creditably through the regular course of the CollÈge de Nantua, a thriving town among the western foot-hills of the Jura range of mountains, he began the study of medicine at Lyons, in 1791. At first he devoted himself almost exclusively to anatomy and surgery. Marc-Antoine Petit, the celebrated surgeon of the HÔtel-Dieu of Lyons, was his teacher in these branches of medical science, and from the very first took special pains to aid his pupil in his studies in every possible manner. FranÇois manifested an unusual degree of interest in anatomy, a branch of medical science to which at that period only those who had the intention of practicing surgery paid any attention; and in addition he developed, almost at the very start, a strong disposition to learn the precise purpose of each tissue and organ as it was encountered in the course of his dissections. In other words, FranÇois-Xavier Bichat was already, at the early age of twenty, making original investigations in the department of physiology. This fact, says his biographer, should be classed as something very remarkable, for, at the period which we are now considering, practically not one of the students of medicine was giving any thought except to the wonderful surgical work that had been accomplished, a few years earlier, by the famous Parisian surgeon, J. L. Petit (1674–1750), by F. de Lapeyronie of Montpellier (1678–1747), by S. F. Morand of Paris (1697–1793), by the famous lithotomist, FrÈre CÔme (1703–1781), of whose achievements I gave a brief account in “The Growth of Medicine,” and by another celebrated teacher of surgery in Paris, viz., Pierre-Joseph Desault, who, during the period which we are now considering occupied by far the most conspicuous position among the men classed as healers of disease, and who, by the very prominence of his position, compelled almost everybody who took any interest in medicine to keep their eyes riveted on him. These and other circumstances that happened to exist at that period strongly favored among the younger men a leaning toward the career of surgeon. One of these favoring circumstances was the need of army surgeons, for France was in the throes of the French Revolution. It was therefore not strange that at first Bichat devoted the greater part of his time and thought to the fundamental work of a surgeon’s training. A little later he accepted a subordinate position at the HÔtel-Dieu of Lyons, under Marc-Antoine Petit, the head surgeon of that great hospital. Favored in every legitimate way by this eminent and most kindly surgeon, young Bichat made rapid progress. But there arrived a time, shortly after the siege of Lyons, when it was no longer safe for a young man to remain in Lyons, and so Bichat was forced to flee to Paris. There he joined the crowd of students who were regularly following the practical instruction given by Desault.

It was at that time an established custom in the medical school for certain pupils, who had been previously selected for this work, to read (in turn) to the assembled group of students, just before the arrival of the attending surgeon, a rÉsumÉ of the previous day’s lecture. In this way the man whose turn it was to read the rÉsumÉ which he had prepared, secured a most valuable bit of training, and those who simply listened were afforded an excellent opportunity for refreshing their memories with regard to the lecture of the previous day. On these occasions the First Assistant was always present and was therefore in a position to report to his Chief just how successfully each reader of such a review had performed the duty assigned to him. At one of his lectures Desault entered more elaborately than usual into a description of his manner of treating fracture of the clavicle, demonstrating among other things the proper manner of applying what has since become known as “Desault’s bandage.” The student who had been assigned to the duty of preparing a rÉsumÉ of that day’s lecture happened to be absent on that particular occasion, and so the First Assistant asked the members of the class whether perhaps one of their number would be willing to act as a substitute. Bichat volunteered his services, and he thereupon prepared a rÉsumÉ which, when read on the following day, proved to be so clearly expressed and covered the ground so thoroughly that the class, after listening to it in profound silence, expressed its approval by the most pronounced applause. When Desault was told by his First Assistant, Manouty, of what had happened he was very impatient to make Bichat’s acquaintance; and, after he had talked with the latter for a short time, he became so impressed with the extent of the knowledge which he had already acquired, with his earnestness of purpose, and with his amiability of character, that he did not hesitate to invite him to become one of his household. Indeed, the favorable impression which Bichat made upon him led him promptly to decide that, if nothing happened later to change the impression which he had first received, he would do all in his power to make this young man his successor.

This kindly reception on the part of his honored preceptor made a deep and most cheering impression on Bichat and stimulated him to put forth his best powers to justify the confidence shown by Desault. At the latter’s request he took charge of part of Desault’s private practice, and he also accepted the position of Hospital Attending Physician to the Outside Poor. Furthermore, he acted as Desault’s corresponding secretary, answering for him all the requests for advice that came to him from every district of France. Then, in addition, he assisted him in all his operations in private practice. Finally, as if he were not already burdened to the limit of his strength with all this mass of work, he not infrequently spent a portion of the night in aiding Desault to solve various problems in experimental surgery, problems relating chiefly to diseases of the bones. Whenever a lull occurred in this series of engrossing labors he devoted all the available time to the performance of operations upon the cadaver and to experiments in relation to physiological problems that suggested themselves to his own mind.

Already as early as in 1797—that is, when he was twenty-six years of age—Bichat gave his first course in anatomy. The room in which the instruction was given was quite small, for he was confident that only a few pupils would feel disposed to subscribe for such a course, and in addition no provision for laboratory work had been made. At first, the teaching was limited to simple demonstrations, but very soon discussions with regard to physiological questions began to occupy some of the time of the sessions. Finally, Bichat found it desirable now and then to carry out experiments on living animals, in order to verify certain seemingly well-known facts and also to determine the exact points at which new investigations should be instituted. When this first course in anatomy came to an end he surprised his friends by beginning a course on operative surgery. “I wish,” he remarked to one of his intimates, “to demonstrate that even a young man may be quite as capable as one of mature age, to operate with the requisite degree of precision.” The course proved a great success, and demonstrated perfectly the truth of his statement.

Under all this strain upon his vital energy, it soon began to be apparent that Bichat’s health was giving way, and it was not long before a pulmonary or bronchial hemorrhage forced him to desist from his work. At one time, indeed, his physical condition was such as to make his friends fear for his life. In the course of a few months, however, he seemed to regain his health; and then he forthwith made arrangements for a much more complete course in anatomy than that which he had carried through so successfully the year before. A laboratory provided with accommodations for eighty dissectors was constructed, and, before the course began, every one of these eighty seats was engaged. (This was in 1798.)

It was a great source of amazement to his friends—and it continues to be a great source of amazement to the physicians of the present day—how Bichat managed to accomplish successfully such a number of things as he, at this early period of his life and with a decidedly precarious state of health, had taken in hand.

One thing was now very noticeable, namely, that he was devoting a much larger part of his time and attention to experimental physiology—that is, to the phenomena and the laws of life—than he had hitherto done to anatomy. After he had finished the work which belonged properly to the daylight hours he devoted no small portion of the nighttime to the work of revising the writings of his beloved teacher and friend, Desault.

Among the anatomical structures about which almost nothing was known toward the end of the eighteenth century, but of which the structure and functions were fully exposed to light by Bichat’s labors, the synovial membranes deserve to receive the very first mention. His researches concerning these membranes were first made known in the public lectures which he was giving at that time to the medical students, but they did not appear in print until a later date, viz., in the second volume of the “Recueil de la SociÉtÉ MÉdicale d’Émulation.”

At a somewhat later period Bichat abandoned all further attempts to cultivate either the knowledge or the practice of surgery, and concentrated all his efforts upon the extension of our knowledge of the principles of physiology. He made very careful researches into the nature and functions of serous membranes, and published the results of his labors in a volume which met with great favor at the hands of a large part of the medical profession, and yet at the same time brought out strong manifestations of envy on the part of other physicians. As Buisson justly remarks, these manifestations of envy furnished the very best sort of proof that Bichat, who paid no attention whatever to these criticisms, had done his work remarkably well.^[18]

In the same year (1800) Bichat published a third treatise, under the title “Recherches Physiologiques sur la Vie et la Mort.” (A later edition appeared in 1805.)

One day, as Bichat was descending the main staircase of HÔtel-Dieu, his foot slipped and he fell in such a manner as to strike his head with considerable force against one of the steps. When somebody came to his assistance it was found that he was unconscious. In a short time, however, consciousness returned, and Bichat was able, though with some difficulty, to regain his home. On the following day he suffered from a severe headache, but insisted, nevertheless, on making a few professional calls. The exhaustion which he felt after making these visits compelled him to take to his bed as soon as he reached his residence. Death took place on the fourteenth day after the occurrence of the accident; that is, on July 22, 1802.

Bonaparte, who was at that time First Consul of the French Republic, gave orders, upon hearing the news of Bichat’s death, that a monument should be erected in the vestibule of HÔtel-Dieu to commemorate the distinguished services rendered to humanity in that institution by Desault and Bichat. The following is the inscription which it bears:—

Ce marbre dÉdiÉ a la MÉmoire des Citoyens Desault et Bichat a ÉtÉ posÉ pour attester la reconnaissance de leur contemporains, pour les services qu’ils ont rendus, le premier À la Chirurgie FranÇaise dont il est le restaurateur, le second À la MÉdecine qu’il a enrichÉe de plusieurs ouvrages utiles, et dont il eÛt aggrandi le domaine si l’impitoyable mort ne l’eÛt frappÉ dans sa 31me annÉe.^[19]

Aside from his scientific attainments and from his untiring zeal in prosecuting his researches in anatomy and physiology, Bichat possessed certain traits of character which caused him to be greatly beloved by his pupils. He was of a very kindly disposition, and it was not an easy matter to excite him to anger or even to cause him to show impatience.

The first feeble beginnings of experimental physiology are to be credited to the Swiss physician, Albrecht von Haller, whose death occurred in 1777. Then followed, a few years later, the more serious efforts that were made in the same field of scientific inquiry by John Hunter, of England. The real birth of this new science, however, took place in France, under the fostering care of Lavoisier, Bichat, Magendie and others. The establishment in Paris, by Bichat, of a large laboratory where such research work could be carried on advantageously, constituted the first act in the creation of an organized experimental physiology. Several years later (1867), Claude Bernard induced Monsieur Duruy, who was at that time Minister of Public Instruction in France, to establish at the Jardin des Plantes a laboratory where general physiology might be studied experimentally.