Morbid Appearances: The Anatomy of Pathology in the Early Nineteenth Century
Journal: Annals of Internal Medicine (1988)

Russell C. Maulitz set himself a challenging task in undertaking his book Morbidappearances.Not only did he aim to explicate the development ofpathological anatomy in the early part of the nineteenth century-in itself a large and complex enterprise-but he made his primary purpose the investigation of the transmission of medical ideas from one country to another, in this case from France to England.The resulting work is successful in many respects.It provides the historian with much to ponder on a wide range of issues relating to pathological investigation between 1800 and 1830 and opens the way to further innovative scholarship on the reception of ideas and approaches in differing medical cultures.The book is divided into three parts.The first section takes the work of Xavier Bichat as its starting point and discusses the development of histopathology in France up to 1830.The linkage of medical and surgical approaches to disease is depicted as integral to this process.Maulitz eschews what he characterizes as a history of ideas approach to his subject, that is, a concentration on intellectual connections.He argues that the acceptance of new ideas depends upon institutional context and milieu as well as the availability of a medical community willing to learn.Thus, his account of histopathology in France interweaves examination of the educational and medical political consequences of the unification of medicine and surgery in the post-Revolutionary period with his analysis of Bichat's ideas and their extension by Bayle and Laennec.In the next two parts of the book, the scene shifts to England.(Scotland only receives cursory notice.)In the first chapter of Part Two, Maulitz discusses the context of English pathology between 1800 and 1830, showing that certain elements were present that might have led to a similar disciplinary development of histopathology as in France.But the continuation of stratification in the profession worked against such an outcome.At the same time, the educational concerns of the surgeon-apothecary and the proliferation of medical journalism were instrumental in increasing receptivity to new approaches in pathological anatomy from France.This interesting chapter is all too short and would have benefited from further elaboration.In the second chapter of this section, Maulitz describes how British students who travelled to Paris for clinical and pathological experience between 1815 and 1830 became imbued with French ideas.The third part of the book tackles the question of how French pathological anatomy was disseminated in England and investigates to what extent it was accepted.Maulitz sketches how key works were translated and examines the literature review and commentary on the subject in British medical journals.He then uses the initiatives of several individuals as examples to indicate how resistance to and propagation of French ideas worked.The discussion of John Farre and the proposed foundation of the London Academy of Minute Anatomy shows a proponent ofan English national style ofpathological anatomy endeavouring to counter French conceptions.The account of the initiatives of Thomas Hodgkin in attempting to institutionalize pathological anatomy at Guy's Hospital and Robert Carswell in becoming the first professor of pathological anatomy at the University of London in 1829 demonstrates how men with Parisian experience attempted to translate it to their home surroundings.Maulitz's attempt to posit close interaction between intellectual ideas, professional debates, and medical organization undoubtedly has merit.There is some unevenness in the analysis in the book but this is hard to avoid when so many issues are being covered.Giving treatment consonant with each theme's importance is not easy in a limited compass.But it must be noted that the themes might have gained greater clarity if more attention had been paid to arrangement of material and elimination of repetitive sections.Overall, though, Morbid appearances is a significant addition to the literature.