{"collection":"philosophy-ethics","full_text_available":true,"graph_url":"https://unchartedknowledge.5gfusion.net/v2/api/page/gutenberg_58460/graph","html_url":"https://unchartedknowledge.5gfusion.net/v2/page/gutenberg_58460","id":"gutenberg_58460","license":"Public Domain (US)","rights_basis":"gutenberg_metadata_copyright_false","source":"gutenberg","source_url":"https://www.gutenberg.org/ebooks/58460","summary":null,"tags":["Category: Health & Medicine","Category: History - Modern (1750+)","Category: Philosophy & Ethics","Category: Science - Biology","Dead bodies (Law)","Human anatomy -- Study and teaching","Mackenzie, William, 1791-1868. An appeal to the public and to the legislature, on the necessity of affording dead bodies to the schools of anatomy by legislative enactment","Medicine -- Study and teaching","Surgery"],"text":"Produced by Chris Curnow, Martin Pettit and the Online\nDistributed Proofreading Team at http://www.pgdp.net (This\nfile was produced from images generously made available\nby The Internet Archive)\n\n\n\n\n\n\nUSE OF THE DEAD\n\nTO THE\n\nLIVING.\n\nFROM THE WESTMINSTER REVIEW.\n\n_ALBANY_:\n\nPRINTED BY WEBSTERS AND SKINNERS.\n\n1827.\n\n\n\n\nADVERTISEMENT.\n\n\nThe following pages contain an article extracted from the Westminster\nReview, an English periodical of considerable reputation. On its\nappearance in Great Britain, it excited great attention; and, indeed,\nhas been there reprinted in a cheap form for general distribution. The\nauthor (Dr. SOUTHWOOD SMITH) deserves the thanks of the community for\nthe talents he has displayed, and the lucid and powerful manner in which\nhe has investigated the important subject under consideration.\n\nThe editors believe that they are discharging a duty to the community in\npresenting it to them for perusal and consideration. They will not\nconceal their wishes, that it may have a favorable effect on a bill now\npending before the Legislature. Both in a general point of view, as well\nas with reference to the particular institution to be benefitted, the\narguments are particularly applicable; nor will an enlightened body of\nmen be deterred from doing what they may deem their duty by the\nunparalleled impudence of those who _now_ cry out against monopoly, when\nthey have risen into importance by monopoly, and have, always, while it\nsuited their views, been its most persecuting and vindictive advocates.\n\nIt is due to truth to state, that the suggestion of the republication of\nthis article, originated with a member of the Senate of this state, and\nwho does not belong to the profession.\n\n_February, 1827._\n\n\n\n\nUSE OF THE DEAD TO THE LIVING.\n\nFROM THE WESTMINSTER REVIEW.\n\n     _An Appeal to the Public and to the Legislature, on the necessity\n     of affording Dead Bodies to the Schools of Anatomy, by Legislative\n     Enactment._ By WILLIAM MACKENZIE. Glasgow. 1824.\n\n\nEvery one desires to live as long as he can. Every one values health\n\"above all gold and treasure.\" Every one knows that as far as his own\nindividual good is concerned, protracted life and a frame of body sound\nand strong, free from the thousand pains that flesh is heir to, are\nunspeakably more important than all other objects, because life and\nhealth must be secured before any possible result of any possible\ncircumstance can be of consequence to him. In the improvement of the art\nwhich has for its object the preservation of health and life, every\nindividual is, therefore, deeply interested. An enlightened physician\nand a skilful surgeon, are in the daily habit of administering to their\nfellow men more real and unquestionable good, than is communicated, or\ncommunicable by any other class of human beings to another. Ignorant\nphysicians and surgeons are the most deadly enemies of the community:\nthe plague itself is not so destructive; its ravages are at distant\nintervals, and are accompanied with open and alarming notice of its\npurpose and power; theirs are constant, silent, secret; and it is while\nthey are looked up to as saviours, with the confidence of hope, that\nthey give speed to the progress of disease and certainty to the stroke\nof death.\n\nIt is deeply to be lamented that the community, in general, are so\nentirely ignorant of all that relates to the art and the science of\nmedicine. An explanation of the functions of the animal economy; of\ntheir most common and important deviations from the healthy state; of\nthe remedies best adapted to restore them to a sound condition, and of\nthe mode in which they operate, as far as that is known, ought to form a\npart of every course of liberal education. The profound ignorance of the\npeople on all these subjects, is attended with many disadvantages to\nthemselves, and operates unfavorably on the medical character. In\nconsequence of this want of information, persons neither know what are\nthe attainments of the man in whose hands they place their life, nor\nwhat they ought to be; they can neither form an opinion of the course of\neducation which it is incumbent on him to follow, nor judge of the\nsuccess with which he has availed himself of the means of knowledge\nwhich have been afforded him. There is one branch of medical education\nin particular, the foundation, in fact, on which the whole\nsuperstructure must be raised, the necessity of which is not commonly\nunderstood, but which requires only to be stated to be perceived.\nPerhaps it is impossible to name any one subject which it is of more\nimportance that the community should understand. It is one in which\nevery man's life is deeply implicated: it is one on which every man's\nignorance or information will have a considerable influence. We shall,\ntherefore, enter into it with some detail: we shall show the kind of\nknowledge which it is indispensable that the physician and surgeon\nshould possess; we shall illustrate, by a reference to particular cases,\nthe reason why this kind of knowledge cannot be dispensed with: and we\nshall explain, by a statement of facts, the nature and extent of the\nobstacles which at present oppose the acquisition of this knowledge. We\nrepeat, there is no subject in which every reader can be so immediately\nand deeply interested, and we trust that he will give us his calm and\nunprejudiced attention.\n\nThe basis of all medical and surgical knowledge is anatomy. Not a single\nstep can be made either in medicine or surgery, considered either as an\nart or a science without it. This should seem self evident, and to need\nneither proof nor illustration: nevertheless, as it is useful\noccasionally to contemplate the evidence of important truth, we shall\nshow why it is, that there can be no rational medicine, and no safe\nsurgery, without a thorough knowledge of anatomy.\n\nDisease, which it is the object of these arts to prevent and to cure, is\ndenoted by disordered function: disordered function cannot be understood\nwithout a knowledge of healthy function; healthy function cannot be\nunderstood without a knowledge of structure; structure cannot be\nunderstood unless it be examined.\n\nThe organs on which all the important functions of the human body\ndepend, are concealed from the view. There is no possibility of\nascertaining their situation and connections, much less their nature and\noperation, without inspecting the interior of this curious and\ncomplicated machine. The results of the mechanism are visible; the\nmechanism itself is concealed, and must be investigated to be perceived.\nThe important operations of nature are seldom entirely hidden from the\nhuman eye; still less are they obtruded upon it, but over the most\ncurious and wonderful operations of the animal economy so thick a veil\nis drawn, that they never could have been perceived without the most\npatient and minute research. The circulation of the blood, for example,\nnever could have been discovered without dissection. Notwithstanding the\npartial knowledge of anatomy which must have been acquired by the\naccidents to which the human body is exposed, by attention to wounded\nmen, by the observance of bodies killed by violence; by the huntsman in\nusing his prey; by the priest in immolating his victims; by the augur in\npursuing his divinations; by the slaughter of animals; by the dissection\nof brutes; and even occasionally by the dissection of the human body,\ncentury after century passed away, without a suspicion having been\nexcited of the real functions of the two great systems of vessels,\narteries and veins. It was not until the beginning of the 17th century,\nwhen anatomy was ardently cultivated, and had made considerable\nprogress, that the valves of the veins and of the heart were discovered,\nand subsequently that the great Harvey, the pupil of the anatomist who\ndiscovered the latter, by inspecting the structure of these valves; by\ncontemplating their disposition; by reasoning upon their use, was led to\nsuspect the course of the blood, and afterwards to demonstrate it.\nSeveral systems of vessels in which the most important functions of\nanimal life are carried on--the absorbent system, for example, and even\nthat portion of it which receives the food after it is digested, and\nwhich conveys it into the blood, are invisible to the naked eye, except\nunder peculiar circumstances: whence it must be evident, not only that\nthe interior of the human body must be laid open, in order that its\norgans may be seen; but that these organs must be minutely and patiently\ndissected, in order that their structure may be understood.\n\nThe most important diseases have their seat in the organs of the body;\nan accurate acquaintance with their situation is, therefore, absolutely\nnecessary, in order to ascertain the seats of disease; but for the\nreasons already assigned, their situation cannot be learnt, without the\nstudy of anatomy. In several regions, organs the most different in\nstructure and function are placed close to each other. In what is termed\nthe epigastric region, for example, are situated the stomach, the liver,\nthe gall bladder, the first portion of the small intestine, (the\nduodenum) and a portion of the large intestine (the colon); each of\nthese organs is essentially different in structure and in use, and is\nliable to distinct diseases. Diseases the most diversified, therefore,\nrequiring the most opposite treatment, may exist in the same region of\nthe body; the discrimination of which is absolutely impossible, without\nthat knowledge which the study of anatomy alone can impart.\n\nThe seat of pain is often at a great distance from that of the affected\norgan. In disease of the liver, the pain is generally felt at the top of\nthe right shoulder. The right phrenic nerve sends a branch to the liver:\nthe third cervical nerve, from which the phrenic arises, distributes\nnumerous branches to the neighborhood of the shoulder: thus is\nestablished a nervous communication between the shoulder and the liver.\nThis is a fact which nothing but anatomy could teach, and affords the\nexplanation of a symptom which nothing but anatomy could give. The\nknowledge of it would infallibly correct a mistake, into which a person\nwho is ignorant of it, would be sure to fall: in fact, persons ignorant\nof it do constantly commit the error. We have know several instances in\nwhich organic disease of the liver has been considered, and treated as\nrheumatism of the shoulder. In each of these cases, disease in a most\nimportant organ might have been allowed to steal on insidiously, until\nit became incurable; while a person, acquainted with anatomy, would have\ndetected it at once, and cured it without difficulty. Many cases have\noccurred of persons who have been supposed to labor under disease of the\nliver, and who have been treated accordingly: on examination after\ndeath, the liver has been found perfectly healthy, but there has been\ndiscovered extensive disease of the brain. Disease of the liver is often\nmistaken for disease of the lungs: on the other hand, the lungs have\nbeen found full of ulcers, when they were supposed to have been\nperfectly sound, and when every symptom was referred to disease of the\nliver. Persons are constantly attacked with convulsions--children\nespecially; convulsions are spasms: spasms, of course, are to be treated\nby antispasmodics. This is the notion amongst people ignorant of\nmedicine: it is the notion amongst old medical men: it is the notion\namongst half educated young ones. All this time these convulsions are\nmerely a symptom; that symptom depends upon, and denotes, most important\ndisease in the brain: the only chance of saving life, is the prompt and\nvigorous application of proper remedies to the brain; but the\npractitioner whose mind is occupied with the symptom, and who prescribes\nantispasmodics, not only loses the time in which alone any thing can be\ndone to snatch the victim from death, but by his remedies absolutely\nadds fuel to the flame which is consuming his patient. In disease of the\nhip-joint pain is felt, not in the hip, but, in the early stage of the\ndisease, at the knee. This also depends on nervous communication. The\nmost dreadful consequences daily occur from an ignorance of this single\nfact. In all these cases error is inevitable, without a knowledge of\nanatomy: it is scarcely possible with it: in all these cases error is\nfatal: in all these cases anatomy alone can prevent the error--anatomy\nalone can correct it. Experience, so far from leading to its detection,\nwould only establish it in men's minds, and render its removal\nimpossible. What is called experience is of no manner of use to an\nignorant and unreflecting practitioner. In nothing does the adage, that\nit is the wise only who profit by experience, receive so complete an\nillustration as in medicine. A man who is ignorant of certain\nprinciples, and who is incapable of reasoning in a certain manner, may\nhave daily before him for fifty years cases affording the most complete\nevidence of their truth, and of the importance of the deduction to which\nthey lead, without observing the one, or deducing the other. Hence the\nmost profoundly ignorant of medicine, are often the oldest members of\nthe profession, and those who have had the most extensive practice. A\nmedical education, founded on a knowledge of anatomy, is, therefore, not\nonly indispensable to prevent the most fatal errors, but to enable a\nperson to obtain advantage from those sources of improvement which\nextensive practice may open to him.\n\nTo the surgeon, anatomy is eminently what Bacon has so beautifully said\nthat knowledge in general is: it is power--it is power to lessen pain,\nto save life, and to eradicate diseases, which, without its aid, would\nbe incurable and fatal. It is impossible to convey to the reader a clear\nconception of this truth, without a reference to particular cases; and\nthe subject is one of such extreme importance, that it may be worth\nwhile to direct the attention for a moment to two or three of the\ncapital diseases which the surgeon is daily called upon to treat.\nAneurism, for example, is a disease of an artery, and consists of a\npreternatural dilatation of its coats. This dilatation arises from the\ndebility of the vessel, whence, unable to resist the impetus of the\nblood, it yields, and is dilated into a sac. When once the disease is\ninduced, it commonly goes on to increase with a steady and uninterrupted\nprogress, until at last it suddenly bursts, and the patient expires\ninstantaneously from loss of blood. When left to itself, it almost\nuniformly proves fatal in this manner; yet, before the time of Galen, no\nnotice was taken of this terrible malady. The ancients, indeed, who\nbelieved that the arteries were air tubes, could not possibly have\nconceived the existence of an aneurism. Were the number of individuals\nin Europe, who are now annually cured of aneurism, by the interference\nof art, to be assumed as the basis of a calculation of the number of\npersons who must have perished by this disease, from the beginning of\nthe world to the time of Galen, it would convey some conception of the\nextent to which anatomical knowledge is the means of saving human life.\n\nThe only way in which it is possible to cure this disease is, to produce\nan obliteration of the cavity of the artery. This is the object of the\noperation. The diseased artery is exposed, and a ligature is passed\naround it, above the dilatation, by means of which the blood is\nprevented from flowing into the sac, and inflammation is excited in the\nvessel; in consequence of which its sides adhere together, and its\ncavity becomes obliterated. The success of the operation depends\nentirely on the completeness of the adhesion of the sides of the vessel,\nand the consequent obliteration of its cavity. This adhesion will not\ntake place unless the portion of the artery to which the ligature is\napplied be in a sound state. If it be diseased, as it almost always is\nnear the seat of the aneurism, when the process of nature is completed\nby which the ligature is removed, hemorrhage takes place, and the\npatient dies just as if the aneurism had been left to itself. For a long\ntime the ligature was applied as close as possible to the seat of the\naneurism: the aneurismal sac was laid open in its whole extent, and the\nblood it contained was scooped out. The consequence was, that a large\ndeep-seated sore, composed of parts in an unhealthy state, was formed:\nit was necessary to the cure that this sore should suppurate, granulate,\nand heal: a process which the constitution was frequently unable to\nsupport. Moreover, there was a constant danger that the patient would\nperish from hemorrhage, through the want of adhesion of the sides of the\nartery. The profound knowledge of healthy and of diseased structure, and\nof the laws of the animal economy by which both are regulated, which\nJohn Hunter had acquired from anatomy, suggested to this eminent man a\nmode of operating, the effect of which, in preserving human life, has\nplaced him high in the rank of the benefactors of his race. This\nconsummate anatomist saw, that the reason why death so often followed\nthe common operation was, because that process which was essential to\nhis success was prevented by the diseased condition of the artery. He\nperceived that the vessel, at some distance from the aneurism, was in a\nsound state; and conceived, that if the ligature were applied to this\ndistant part, that is, to a sound instead of a diseased portion of the\nartery, this necessary process would not be counteracted. To this there\nwas one capital objection, that it would often be necessary to apply the\nligature around the main trunk of an artery, before it gives off its\nbranches, in consequence of which the parts below the ligature would be\ndeprived of their supply of blood, and would therefore mortify. So\nfrequent and great are the communications between all the arteries of\nthe body, however, that he thought it probable, that a sufficient\nsupply would be borne to these parts through the medium of collateral\nbranches. For an aneurism in the ham, he, therefore, boldly cut down\nupon the main trunk of the artery which supplies the lower extremity;\nand applied a ligature around it, where it is seated near the middle of\nthe thigh, in the confident expectation that, though he thus deprived\nthe limb of the supply of blood which it received through its direct\nchannel, it would not perish. His knowledge of the processes of the\nanimal economy, led him to expect that the force of the circulation\nbeing thus taken off from the aneurismal sac, the progress of the\ndisease would be stopped; that the sac itself, with all its contents,\nwould be absorbed; that by this means the whole tumor would be removed,\nand that an opening into it would be unnecessary. The most complete\nsuccess followed this noble experiment, and the sensations which this\nphilosopher experienced when he witnessed the event, must have been\nexquisite, and have constituted an appropriate reward for the\napplication of profound knowledge to the mitigation of human suffering.\nAfter Hunter followed Abernethy, who, treading in the footsteps of his\nmaster, for an aneurism of the femoral, placed a ligature around the\nexternal iliac artery; lately the internal iliac itself has been taken\nup, and surgeons have tied arteries of such importance, that they have\nbeen themselves astonished at the extent and splendor of their success.\nEvery individual, on whom an operation of this kind has been\nsuccessfully performed, is snatched by it from certain and inevitable\ndeath!\n\nThe symptom by which an aneurism is distinguished from every other tumor\nis, chiefly its pulsating motion. But when an aneurism has become very\nlarge, it ceases to pulsate; and when an abscess is seated near an\nartery of great magnitude, it acquires a pulsating motion; because the\npulsations of the artery are perceptible through the abscess. The real\nnature of cases of this kind cannot possibly be ascertained, without a\nmost careful investigation, combined with an exact knowledge of the\nstructure and relative position of all the parts in the neighborhood of\nthe tumor. Pelletan, one of the most distinguished surgeons of France,\nwas one day called to a man who, after a long walk, was seized with a\nsevere pain in the leg, over the seat of which appeared a tumor, which\nwas attended with a pulsation so violent that it lifted up the hand of\nthe examiner. There seemed every reason to suppose that the case was an\naneurismal swelling. This acute observer, however, in comparing the\naffected with the sound limb, perceived in the latter a similar\nthrobbing. On careful examination he discovered that, by a particular\ndisposition in this individual, one of the main arteries of the leg (the\nanterior tibial) deviated from its usual course, and instead of\nplunging deep between the muscles, lay immediately under the skin and\nfascia. The truth was, that the man in the exertion of walking, had\nruptured some muscular fibres, and the uncommon distribution of the\nartery gave to this accident these peculiar symptoms. The real nature of\nthis case could not possibly have been ascertained but by an anatomist.\nThe same surgeon has recorded the case of a man who, having fallen twice\nfrom his horse, and experienced for several years considerable\nuneasiness in his back, was afflicted with acute pain in the abdomen. At\nthe same time an oval, irregularly circumscribed tumor made its\nappearance in the right flank. It presented a distinct fluctuation, and\nhad all the appearance of a collection of matter depending on caries of\nthe vertebr\u00e6. The pain was seated chiefly at the lower portion of that\npart of the spine which forms the back, which was, moreover, distorted;\nand this might have confirmed the opinion that the case was a lumbar\nabscess with caries. Pelletan, however, who well knew that an aneurism,\nas it enlarges, may destroy any bone in its neighborhood, saw that the\ndisease was an aneurism, and predicted that the patient must perish. On\nopening the body (for the man lived only ten days after Pelletan first\nsaw him) an aneurismal tumor was discovered, which nearly filled the\ncavity of the abdomen. If this case had been mistaken for lumbar\nabscess, and the tumor had been opened with a view of affording an exit\nto the matter, the man would have died in a few seconds. There is no\nsurgeon of discernment or experience whose attention has not been\nawakened, and whose sagacity has not been put to the test, by the\noccurrence of similar cases in his own practice. The consequence of\nerror is almost always instantaneously fatal. The catalogue of such\ndisastrous events is long and melancholy. Richerand has recorded, that\nFerrand, head surgeon of the Hotel Dieu, mistook an aneurism in the\narmpit for an abscess; plunged his knife into the swelling, and killed\nthe patient. De Haen speaks of a person who died in consequence of an\nopening which was made, contrary to the advice of Boerhaave in a similar\ntumor at the knee. Vesalius was consulted about a tumor in the back,\nwhich he pronounced to be an aneurism; but an ignorant practitioner\nhaving made an opening into it, the patient instantly bled to death.\nNothing can be more easy than to confound an aneurism of the artery of\nthe neck with the swelling of the glands in its neighborhood: with a\nswelling of the cellular substance which surrounds the artery; with\nabscesses of various kinds; but if a surgeon were to fall into this\nerror, and to open a carotid aneurism, his patient would certainly be\ndead in the space of a few moments. It must be evident, then, that a\nthorough knowledge of anatomy is not only indispensable to the proper\ntreatment of cases of this description, but also to the prevention of\nthe most fatal mistakes.\n\nThere is nothing in surgery of more importance than the proper treatment\nof hemorrhage. Of the confusion and terror occasioned by the sight of a\nhuman being from whom the blood is gushing in torrents, and whose\ncondition none of the spectators is able to relieve, no one can form an\nadequate conception, but those who have witnessed it. In all such cases,\nthere is one thing proper to be done, the prompt performance of which is\ngenerally as certainly successful, as the neglect of it is inevitably\nfatal. It is impossible to conceive of a more terrible situation than\nthat of a medical man who knows not what to do on such an emergency. He\nis confused; he hesitates: while he is deciding what measures to adopt,\nthe patient expires: he can never think of that man's death without\nhorror, for he is conscious that, but for his ignorance, he might have\naverted his patient's fate. The ancient surgeons were constantly placed\nin this situation, and the dread inspired by it retarded the progress of\nsurgery more than all other causes put together. Not only were they\nterrified from interfering with the most painful and destructive\ndiseases, which experience has proved to be capable of safe and easy\nremoval, but they were afraid to cut even the most trivial tumor. When\nthey ventured to remove a part, they attempted it only by means of the\nligature, or by the application of burning irons. When they determined\nto amputate, they never thought of doing so until the limb had\nmortified, and the dead had separated from the living parts; for they\nwere absolutely afraid to cut into the living flesh. They had no means\nof stopping hemorrhage, but by the application of astringents to the\nbleeding vessels, remedies which were inert; or of burning irons, or\nboiling turpentine, expedients which were not only inert but cruel.\nSurgeons now know that the grand means of stopping hemorrhage is\ncompression of the bleeding vessel. If pressure be made on the trunk of\nan artery, though blood be flowing from a thousand branches given off\nfrom it, the bleeding will cease. Should the situation of the artery be\nsuch as to allow of effectual external pressure, nothing further is\nrequisite: the pressure being applied, the bleeding is stopped at once:\nshould the situation of the vessel place it beyond the reach of external\npressure, it is necessary to cut down upon it, and to secure it by the\napplication of a ligature. Par\u00e8 may be pardoned for supposing that he\nwas led to the discovery of this invaluable remedy by the inspiration of\nthe Deity. By means of it the most formidable operations may be\nundertaken with the utmost confidence, because the wounded vessels can\nbe secured the moment they are cut: by the same means the most\nfrightful hemorrhages may be most effectually stopped: and even when the\nbleeding is so violent as to threaten immediate death, it may often be\naverted by the simple expedient of placing the finger upon the wounded\nvessel, until there is time to tie it. But it is obvious that none of\nthese expedients can be employed, and that these bleedings can neither\nbe checked at the moment, nor permanently stopped, without such a\nknowledge of the course of the trunks and branches of vessels, as can be\nacquired only by the study of anatomy.\n\nThe success of amputation is closely connected with the knowledge of the\nmeans of stopping hemorrhage. Not to amputate is often to abandon the\npatient to a certain and miserable death. And all that the surgeon\nformerly did, was to watch the progress of that death: he had no power\nto stop or even to retard it. The fate of Sir Philip Sidney is a\nmelancholy illustration of this truth. This noble minded man, the light\nand glory of his age, was cut off in the bloom of manhood, and the midst\nof his usefulness, by the wound of a musket bullet in his left leg, a\nlittle above the knee, \"when extraction of the ball, or amputation of\nthe limb,\" says his biographer, \"would have saved his inestimable life:\nbut the surgeons and physicians were unwilling to practice the one, and\nknew not how to perform the other. He was variously tormented by a\nnumber of surgeons and physicians for three weeks.\" Amputation indeed\nwas never attempted, except where mortification had itself half\nperformed the operation. The just apprehension of an hemorrhage which\nthere was no adequate means of stopping, checked the hand of the boldest\nsurgeon, and quailed the courage of the most daring patient--and if ever\nthe operation was resorted to, it almost always proved fatal: the\npatient generally expired, according to the expression of Celsus, \"_in\nipso opere_.\" How could it be otherwise? The surgeon cut through the\nflesh of his patient with a red hot knife: this was his only means of\nstopping the hemorrhage: by this expedient he sought to convert the\nwhole surface of the stump into an eschar: but this operation, painful\nin its execution, and terrible in its consequences, when it even\nappeared to succeed, succeeded only for a few days; for the bleeding\ngenerally returned, and proved fatal as soon as the sloughs or dead\nparts became loose. Plunging the stump into boiling oil, into boiling\nturpentine, into boiling pitch, for all these means were used, was\nattended with no happier result, and after unspeakable suffering, almost\nevery patient perished. In the manner in which amputation is performed\nat present, not more than one person in twenty loses his life in\nconsequence of the operation, even taking into the account all the cases\nin which it is practised in hospitals. In private practice, where many\ncircumstances favor its success, it is computed that 95 persons out of\n100 recover from it, when it is performed at a proper time, and in a\nproper manner. It seems impossible to exhibit a more striking\nillustration of the great value of anatomical knowledge.\n\nBut if there be any disease, which, from the frequency of its\noccurrence, from the variety of its forms, from the difficulty of\ndiscriminating between it and other maladies, and from the danger\nattendant on almost all its varieties, requires a combination of the\nmost minute investigation, with the most accurate anatomical knowledge,\nit is that of hernia. This disease consists of a protrusion of some of\nthe viscera of the abdomen, from the cavity in which they are naturally\ncontained, into a preternatural bag, composed of the portion of the\nperitoneum (the membrane which lines the abdomen) which is pushed before\nthem. It is computed that one sixteenth of the human race are afflicted\nwith this malady. It is sometimes merely an inconvenient complaint,\nattended with no evil consequences whatever; but there is no form of\nthis disease, which is not liable to be suddenly changed, and by slight\ncauses, from a perfectly innocent state, into a condition which may\nprove fatal in a few hours. The disease itself occurs in numerous\nsituations; it may be confounded with various diseases; it may exist in\nthe most diversified states; it may require, without the loss of a\nsingle moment, a most important and delicate operation; and it may\nappear to demand this operation, while the performance of it may really\nbe not only useless, but highly pernicious.\n\nThe danger of hernia depends on its passing into that state which is\ntechnically termed strangulation. When a protruded intestine suffers\nsuch a degree of pressure, as to occasion a total obstruction to the\npassage of its contents, it is said to be strangulated. The consequence\nof pressure thus producing strangulation is, the excitement of\ninflammation: this inflammation must inevitably prove fatal, unless the\npressure be promptly removed. In most cases, this can be effected only\nby the operation. Two things, then, are indispensable: first, the\nability to ascertain that the symptoms are really produced by pressure,\nthat is, to distinguish the disease from the affections which resemble\nit; and secondly, when this is effected, to perform the operation with\npromptitude and success. The distinction of strangulated hernia from\naffections which resemble it, often requires the most exact knowledge\nand the most minute investigation. The intestine included in a hernial\nsac, may be merely affected with colic, and thus give rise to the\nappearance of strangulation. It may be in a state of irritation,\nproduced, for example, by unusual fatigue; and from this cause, may be\nattacked with the symptoms of inflammation. Inflammation may be excited\nin the intestine, by the common causes of inflammation, which the hernia\nmay have no share in inducing, and of which it may not even participate.\nWere this case mistaken, and the operation performed, it would not only\nbe useless, but pernicious: while the attention of the practitioner\nwould be diverted from the real nature of the malady; the prompt and\nvigorous application of the remedies which alone could save the patient,\nwould be neglected, and he would probably perish. On the other hand, a\nvery small portion of intestine may become strangulated, and urgently\nrequire the operation. But there may be no tumor; all the symptoms may\nbe those, and, on a superficial examination, only those, of inflammation\nof the bowels. Were the real nature of this case mistaken, death would\nbe inevitable. Nothing is more common than fatal errors of this kind. It\nis only a few months ago, that a physician was called in haste to a\nperson who was said to be dying of inflammation of the bowels. Before he\nreached the house the man was dead. He had been ill only three days. On\nlooking at the abdomen, there was a manifest hernia: the first glance\nwas sufficient to ascertain the fact. The practitioner in attendance had\nknown nothing of the matter; he had never suspected the real nature of\nthe disease, and had made no inquiry which could have led to the\ndetection of it. Here was a case which might probably have been saved,\nbut for the criminal ignorance and inattention of the practitioner.\nWhenever there are symptoms of inflammation of the bowels, examination\nof the abdomen is indispensable: and the life of the patient will depend\non the care and accuracy with which the investigation is made.\n\nBut it is possible that inflammation may attack the parts included in\nthe hernial sac, without arising from the hernia itself. The\ninflammation may be produced by the common causes of inflammation; there\nmay be no pressure: there may be no strangulation: the swelling may be\nthe seat, not the cause of the disease. In this case, too, the operation\nwould be both useless and pernicious. Now all these are diversities\nwhich it is of the highest importance to discriminate. In some of them,\nlife depends on the clearness, accuracy, and promptitude, with which the\ndiscrimination is made. Promptitude is of no less consequence than\naccuracy. If the decision be not formed and acted on at once, it will be\nof no avail. The rapidity of the progress of this disease is often\nfrightful. We have mentioned a case in which it was fatal in three days,\nbut it not unfrequently terminates fatally in less than twenty four\nhours. Sir Astley Cooper mentions a case in which the patient was dead\nin eight hours after the commencement of the disease. Larrey has\nrecorded the case of a soldier in whom a hernia took place, which was\nstrangulated immediately. He was brought to the \"ambulance\" instantly,\nand perished in two hours with gangrene of the part, and of the\nabdominal viscera. This was the second instance which had occurred to\nthis surgeon of a rapidity thus appalling. What clearness of judgment,\nwhat accuracy of knowledge, what promptitude of decision, are necessary\nto treat such a disease with any chance of success!\n\nThe moment that a case is ascertained to be strangulated hernia, an\nattempt must be made to liberate the parts from the stricture, and to\nreplace them in their natural situation. This is first attempted by the\nhand, and the operation is technically termed the _taxis_. The patient\nmust be placed in a particular position; pressure must be made in a\nparticular direction; it is impossible to ascertain either, without an\naccurate knowledge of the parts. If pressure be made in a wrong\ndirection, and in a rough and unscientific manner, the organs protruded\ninstead of being urged through a proper opening, are bruised against the\nparts which oppose their return. Many cases are on record, in which\ngangrene and even rupture of the intestine, have been occasioned in this\nmanner. When the parts cannot be returned by the hand, assisted by those\nremedies which experience has proved to be beneficial, the operation\nmust be performed without the delay of a moment. To its proper\nperformance two things are necessary. First, a minute anatomical\nknowledge of the various and complicated parts which are implicated in\nit; and secondly, a steady, firm, and delicate command of the knife. In\nthe first place, the integuments must be divided; the cellular substance\nwhich intervenes between the skin and the hernial sac must be removed\nlayer by layer with the knife and the dissecting forceps; the sac itself\nmust be opened: this part of the operation must be performed with the\nmost extreme caution: the sac being laid open, the protruded organs are\nnow exposed to view. The operator must next ascertain the exact point\nwhere the stricture exists; having discovered its seat, he must make his\nincision with a particular instrument--in a certain direction--to a\ndefinite extent. On account of the nature of the parts implicated in the\noperation, and the proximity of vessels, life depends on an exact\nknowledge and a precise and delicate attention to all these\ncircumstances. How can this knowledge be obtained, how can this\ndexterity be acquired, without a profound acquaintance with anatomy, and\nhow can this be acquired without frequent and laborious dissection? The\neye must become familiar with the appearance of the integuments, with\nthe appearance of the cellular substance beneath it, with the\nappearance of the hernial sac, and of the changes which it undergoes by\ndisease; with the appearance of the various viscera contained in it, and\nof their changes: and the hand must pay that steady and prompt obedience\nto the judgment, which nothing but knowledge, and the consciousness of\nknowledge, can command. Even this is not all. When the operation has\nbeen performed thus far with perfect skill and success, the most\nopposite measures are required according to the actual state of the\norgans contained in the sac. If they are agglutinated together--if\nportions of them are in a state of mortification, to return them into\nthe cavity of the abdomen in that condition, would, in general, be\ncertain death. Preternatural adhesion must be removed; mortified\nportions must be cut away: but how can this possibly be done without an\nacquaintance with healthy and diseased structure, and how can this be\nobtained without dissecting the organs in a state of health and of\ndisease?\n\nIt has been stated that the progress of strangulated hernia to a fatal\ntermination is often frightfully rapid; in certain cases to delay the\noperation, even for a very short period, is, therefore, to lose the only\nchance of success. But ignorant and half informed surgeons are afraid to\noperate. They are conscious that the operation is one of immense\nimportance: they know that in the hands of an operator ignorant of\nanatomy, it is one of extreme hazard: they therefore put off the time as\nlong as possible: they have recourse to every expedient: they resort to\nevery thing but the only efficient remedy, and when at last they are\ncompelled by a secret sense of shame to try that, it is too late. All\nthe best practical surgeons express themselves in the strongest language\non the importance of performing the operation early, if it be performed\nat all. On this point there is a perfect accordance between the most\ncelebrated practitioners on the continent, and the great surgeons of our\nown country: all represent, in many parts of their writings, the\ndangerous and fatal effects of delay. Mr. Hey in his Practical\nObservations, states that when he first began to practice, he considered\nthe operation as the last resource, and only to be employed when the\ndanger appeared imminent. \"By this dilatory mode of practice,\" says he,\n\"I lost three patients in five, upon whom the operation was performed.\nHaving more experience of the urgency of the disease, I made it my\ncustom, when called to a patient who had laboured two or three days\nunder the disease, to wait only about two hours, that I might try the\neffect of bleeding (if that evacuation was not forbidden by some\npeculiar circumstance of the case) and the tobacco clyster. In this mode\nof practice, I lost about two patients in nine, upon whom I operated.\nThis comparison is drawn from cases nearly similar, leaving out of the\naccount those cases in which gangrene of the intestine had taken place.\nI have now, at the time of writing this, performed the operation\nthirty-five times; and have often had occasion to lament that I\nperformed it too late, but never that I had performed it too soon.\"\n\nThese observations are sufficient to show the importance of anatomy in\ncertain surgical diseases. The state of medical opinion from the\nearliest ages to the present time, furnishes a most instructive proof of\nits necessity to the detection and cure of disease in general. The\ndoctrines of the father of physic were in the highest degree vague and\nunmeaning. Every thing is resolved by Hippocrates into a general\nprinciple, which he terms nature; and to which he ascribes intelligence;\nwhich he clothes with the attributes of justice; and which he represents\nas possessing virtues and powers, which he says are her servants, and by\nmeans of which she performs all her operations in the bodies of animals,\ndistributes the blood, spirits, and heat, through all the parts of the\nbody, and imparts to them life and sensation. He states that the manner\nin which she acts, is by attracting what is good or agreeable to each\nspecies, and retaining, preparing, and changing it: or, on the other\nhand, by rejecting whatever is superfluous or hurtful, after she has\nseparated it from the good. This is the foundation of the doctrine of\ndepuration, concoction, and crisis in fevers, so much insisted on by\nhim, and by other physicians after him; but when he explains what he\nmeans by nature, he resolves it into heat, which he says appears to have\nsomething immortal in it.\n\nThe great opponent of Hippocrates was Asclepiades. He asserted that\nmatter, considered in itself, is of an unchangeable nature: that all\nperceptible bodies are composed of a number of small ones, termed\ncorpuscles, between which there are interspersed an infinity of small\nspaces totally devoid of matter: that the soul itself is composed of\nthese corpuscles: that what is called nature is nothing more than matter\nand motion: that Hippocrates knew not what he said when he spoke of\nnature as an intelligent being, and ascribed to her various qualities\nand virtues: that the corpuscles, of which all bodies are composed, are\nof different figures, and consist of different assemblages: that all\nbodies contain numerous pores, or interstices, which are of different\nsizes: that the human body, like all other bodies, possesses pores\npeculiar to itself: that these pores are larger or smaller, according as\nthe corpuscles which pass through them differ in magnitude: that the\nblood consists of the largest, and the spirits and the heat of the\nsmallest. On these principles, Asclepiades founded his theory of\nmedicine. He maintains, that as long as the corpuscles are freely\nreceived by the pores, the body remains in its natural state: that, on\nthe contrary, as soon as any obstacle obstructs their passage, it begins\nto recede from that state: that, therefore, health depends on the just\nproportion between these pores and corpuscles: that, on the contrary,\ndisease proceeds from a disproportion between them: that the most usual\nobstacle arises from a retention of some of the corpuscles in their\nordinary passages, where they arrive in too large a number, or are of\nirregular figures, or move too fast or proceed too slow: that phrensies,\nlethargies, pleurises, burning fevers for example, are occasioned by\nthese corpuscles stopping of their own accord: that pain is produced by\nthe stagnation of the largest of all these corpuscles, of which the\nblood consists: that, on the contrary, deliriums, languors,\nextenuations, leanness and dropsies, derive their origin from a bad\nstate of the pores, which are too much relaxed, or opened: that dropsy,\nin particular, proceeds from the flesh being perforated with various\nsmall holes, which convert the nourishment received into them into\nwater: that hunger is occasioned by an opening of the large pores of the\nstomach and belly: that thirst arises from an opening of the small\npores: that intermittent fevers have the same origin: that quotidian\nfever is produced by a retention of the largest corpuscles; tertian\nfever by a retention of corpuscles somewhat smaller; and quartan fever\nby a retention of the smallest corpuscles of all.\n\nGalen maintained that the animal body is composed of three principles,\nnamely, the solids, the humors, and the spirits. That the solid parts\nconsist of similar and organic: that the humors are four in number,\nnamely, the blood, the phlegm, the yellow bile, and the black bile: that\nthe spirits are of three kinds, namely, the vital, the animal, and the\nnatural: that the vital spirit is a subtle vapour which arises from the\nblood, and which derives its origin from the liver, the organ of\nsanguification: that the spirits thus formed, are conveyed to the heart,\nwhere, in conjunction with the air drawn into the lungs by respiration,\nthey become the matter of the second species, namely, of the vital\nspirits: that in their turn, the vital spirits are changed into the\nanimal in the brain, and so on.\n\nAt last came Paracelsus, who was believed to have discovered the elixir\nof life, and who is the very prince of charlatans. He delivered a course\nof lectures on the theory and practice of physic in the University of\nBasle, which he commenced by burning the works of Galen and Avicenna in\nthe presence of his auditory. He assured his hearers, that his\nshoe-latchets had more knowledge than both these illustrious authors\nput together: that all the academies in the world had not so much\nexperience as his beard; and that the hair on the back of his neck was\nmore learned than the whole tribe of authors. It was fitting that a\nperson of such splendid pretensions should have a magnificent name. He,\ntherefore, called himself PHILIPPUS AUREOLUS THEOPHRASTUS PARACELSUS\nBOMBAST VON HOHENHEIM. He was a great chemist, and like other chemists,\nhe was a little too apt to carry into other sciences \"the smoke and\ntarnish of the furnace.\" He conceived that the elements of the living\nsystem were the same as those of his laboratory, and that sulphur, salt,\nand quicksilver, were the constituents of organized bodies. He taught\nthat these constituents were combined by chemical operations: that their\nrelations were governed by Archeus, a demon, who performed the part of\nalchemist in the stomach, who separated the poisonous from the nutritive\npart of the food, and who communicated the tincture by which the food\nbecame capable of assimilation: that this governor of the stomach, this\n_spiritus vit\u00e6_, this astral body of man, was the immediate cause of all\ndiseases, and chief agent in their cure: that each member of the body\nhad its peculiar stomach, by which the work of secretion was effected:\nthat diseases were produced by certain influences, of which there were\nfive in particular, viz. _ens estrale_, _ens veneni_, _ens naturale_,\n_ens spirituale_, and _ens deale_: that when Archeus was sick,\nputrescence was occasioned, and that either _localiter_ or\n_emunctorialiter_, &c. &c. &c.\n\nIt would be leading to a detail which is incompatible with our present\npurpose to follow these speculations, or to give an account of the\ndoctrines of the mechanical physicians, who believed that every\noperation of the animal economy was explained by comparing it to a\nsystem of ropes, levers, and pulleys, united with a number of rigid\ntubes of different lengths and diameters, containing fluids which, from\nvariations in their impelling causes, moved with different degrees of\nvelocity: or of the chemical physicians, whose manner of theorizing and\ninvestigating would have qualified them better for the occupation of the\nbrewer or of the distiller, than for that of the physician. All these\nspeculations are idle fancies, without any evidence whatever to support\nthem; and it has been argued that, for this very reason, they must have\nbeen without any practical result, and that, therefore, if they were\nproductive of no benefit, they were, at least, innoxious. No opinion can\nbe more false or pernicious. These wretched theories not only pre\noccupied the mind, prevented it from observing the real phenomena of\nhealth and of disease, and the actual effect of the remedies which were\nemployed, and thus put an effectual stop to the progress of the\nscience: but they were productive of the most direct and serious evils.\nIt is no less true in medicine than in philosophy and morals, that there\nis no such thing as innoxious error; that men's opinions invariably\ninfluence their conduct; and that physicians, like other men, act as\nthey think. Asclepiades, whose mind was full of corpuscles and\ninterstices, was intent on finding suitable remedies, which he\ndiscovered in gestation, friction, and the use of wine. By various\nexercises, he proposed to render the pores more open, and to make the\njuices and corpuscles, the retention of which causes disease, to pass\nmore freely. Hence he used gestation from the very beginning of the most\nburning fevers. He laid it down as a maxim, that one fever was to be\ncured by another; that the strength of the patient was to be exhausted\nby making him watch and endure thirst to such a degree, that for the\nfirst two days of the disorder he would not allow them to cool their\nmouths with a drop of water. Abernethy's regulated diet is luxurious\ncompared to his plan of abstinence. For the three first days he allowed\nhis patients no aliment whatever; on the fourth, he so far relented as\nto give to some of them a small portion of food; but from others he\nabsolutely withheld all nourishment till the seventh day. And this is\nthe gentleman who laid it down as a maxim, that all diseases are to be\ncured \"_Tuto, celeriter et jucunde_.\" To be sure he was a believer in\nthe doctrine of compensation; and in the latter stage of their diseases\nendeavored to recompense his patients for the privations he caused them\nto endure in the beginning of their illness. Celsus observes, that\nthough he treated his patients like a butcher during the first days of\nthe disorder, he afterwards indulged them so far as to give directions\nfor making their beds in the softest manner. He allowed them abundance\nof wine, which he gave freely in all fevers; he did not forbid it even\nto those afflicted with phrenzy: nay, he ordered them to drink it till\nthey were intoxicated; for, said he, it is absolutely necessary that\npersons who labor under phrenzy should sleep, and wine has a narcotic\nquality. To lethargic patients, he prescribed it with great freedom, but\nwith the opposite purpose of rousing them from their stupor. His great\nremedy in dropsy was friction, which, of course, he employed to open the\npores. With the same view, he enjoined active exercise to the sick; but\nwhat is a little extraordinary, he denied it to those in health.\n\nEristratus, who was a great speculator, and whose theories had the most\nimportant influence on his practice, banished blood-letting altogether\nfrom medicine, for the following notable reasons: because, he says, we\ncannot always see the vein we intend to open; because we are not sure\nwe may not open an artery instead of a vein; because we cannot\nascertain the true quantity to be taken; because, if we take too little,\nthe intention is not answered; if too much, we may destroy the patient;\nand because the evacuation of the venous blood is succeeded by that of\nthe spirits, which thus pass from the arteries into the veins;\nwherefore, blood-letting ought never to be used as a remedy in disease.\nYet, though he was thus cautious in abstracting blood, it must not be\nsupposed that he was not a sufficiently bold practitioner. In tumor of\nthe liver, he hesitated not to cut open the abdomen, and to apply his\nmedicines immediately to the diseased organ; but though he took such\nliberties with the liver, he regarded with the greatest apprehension the\noperation of tapping in dropsy of the abdomen: because, said he, the\nwaters being evacuated, the liver which is inflamed and become hard like\na stone, is more pressed by the adjacent parts, which the waters kept at\na distance from it, whence the patient dies.\n\nOne physician conceived that gout originated from an effervescence of\nthe synovia of the joints with the vitriolated blood: whence he\nrecommended alcohol for its cure: a remedy for which the court of\naldermen ought to have voted him a medal. A more ancient practitioner,\nwho believed that the finger of St. Blasius was very efficacious \"for\nremoving a bone which sticks in the throat,\" maintained that gout was\nthe \"grand drier,\" and prescribed a remedy for it, which the patient was\nto use for a whole year, and to observe the following diet each month.\nIn September, he must eat and drink milk; in October, he must eat\ngarlic; in November, he is to abstain from bathing; in December, he must\neat no cabbage; in January, he is to take a glass of pure wine in the\nmorning; in February, to eat no beef; in March, to mix several things\nboth in eatables and drinkables; in April, not to eat horse-radish; nor\nin May, the fish called Polypus; in June, he is to drink cold water in a\nmorning; in July, to avoid venery; and lastly, in August, to eat no\nmallows.\n\nA third physician deduced all diseases from inspissation of the fluids;\nhence he attached the highest importance to diluent drinks, and believed\nthat tea, especially, is a sovereign remedy in almost every disease to\nwhich the human frame is subject; \"tea,\" says Bentekoe, who is loudest\nin his praises of this panacea, and who, as Blumenbach observes,\n'deserved to have been pensioned by the East India Company for his\nservices,' \"tea is the best, nay, the only remedy for correcting\nviscidity of the blood, the source of all diseases, and for dissipating\nthe acid of the stomach, as it contains a fine oleaginous volatile salt,\nand certain subtle spirits which are analogous in their nature to the\nanimal spirits. Tea fortifies the memory and all the intellectual\nfaculties: it will therefore furnish the most effectual means of\nimproving physical education. Against fever there is no better remedy\nthan forty or fifty cups of tea, swallowed immediately after one\nanother, the slime of the pancreas is thus carried off.\"\n\nAnother physician derived all his diseases from a redundancy or\ndeficiency of fire and water. He maintained that where the water\npredominated, the fluids became viscid, and that hence arose\nintermittent fevers and arthritic complaints. His remedies are in strict\nconformity to his theory. These diseases are to be cured by volatile\nsalts, which abound with fiery particles; venesection in any case is\nhighly pernicious; these fiery medicines are the only efficacious\nremedies, and are to be employed even in diseases of the most\ninflammatory nature. \"Life,\" says Dr. Brown, \"is a forced state;\" it is\na flame kept alive by excitement; every thing stimulates; some\nsubstances too violently; others not sufficiently; there are thus two\nkinds of debility, indirect and direct, and to one or other of these\ncauses must be referred the origin of all diseases. According to this\ndoctrine, the mode of cure is simple: we have nothing to do but to\nsupply, to moderate or to abstract stimuli. Typhus fever, in this\nsystem, is a disease of extreme debility; we must therefore give the\nstrongest stimulants. Consumption and apoplexy, also, are diseases of\ndebility; of course, the remedies are active stimulants. Humanity\nshudders, and with reason, at the application of such doctrines to\npractice. And not less destitute of reason, and not less dangerous in\npractice, is the great doctrine of debility promulgated by Cullen. This\ncelebrated professor taught, that the circumstance which invariably\ncharacterised fever, that which constituted its essence, was debility.\nThe inference was obvious, that, above all things, the strength must be\nsupported. The consequence was, that blood-letting was neglected, and\nthat bark and wine were given in immense quantities, in cases in which\nintense inflammation existed. The practice was in the highest degree\nmortal; the number of persons who have perished in consequence of this\ndoctrine is incalculable. So far then is it from being true, that\nmedical theories are of no practical importance, there is the closest\npossible connection between the speculations of the physician in his\ncloset, and the measures which he adopts at the bed side of his patient.\nTruth to him is a benignant power, which stops the progress of disease,\nprotracts the duration of life, and mitigates the suffering it may be\nunable to remove: error is a fearfully active and tremendously potent\nprinciple. There is not a medical prejudice which has not slain its\nthousands, nor a false theory which has not immolated its tens of\nthousands. The system of medicine and surgery which is established in\nany country, has a greater influence over the lives of its inhabitants\nthan the epidemic diseases produced by its climate, or the decisions of\nits government concerning peace and war. The devastations of the yellow\nfever will bear no comparison with the ravages committed by the\nBrunonian system; and the slaughter of the field of Waterloo counts not\nof victims, a tithe of the number of which the Cullenian doctrine of\ndebility can justly boast. Anatomy alone will not teach a physician to\nthink, much less to think justly; but it will give him the elements of\nthinking; it will furnish him with the means of correcting his errors;\nit will certainly save him from some delusions, and will afford to the\npublic the best shield against his ignorance, which may be fatal, and\nagainst his presumption, which may be devastating.\n\nWe have entered into this minute detail at the hazard, we are aware, of\ntiring the reader; but in the hope of leaving on his mind a more\ndistinct impression of the importance of anatomical knowledge, than\ncould possibly be produced by a mere allusion to the circumstances which\nhave been explained. In all ages, formidable obstacles have opposed the\nprosecution of anatomical investigations. Among these, without doubt,\nthe most powerful has its source in a feeling which is natural to the\nheart of man. The sweetest, the most sacred associations are\nindissolubly connected with the person of those we love. It is with the\ncorporeal frame that our senses have been familiar: it is that on which\nwe have gazed with rapture; it is that which has so often been the\nmedium of conveying to our hearts the thrill of exstacy. We cannot\nseparate the idea of the peculiarities and actions of a friend from the\nidea of his person. It is for this reason that \"every thing which has\nbeen associated with him acquires a value from that consideration; his\nring, his watch, his books, and his habitation. The value of these as\nhaving been his, is not merely fictitious; they have an empire over my\nmind; they can make me happy or unhappy; they can torture and they can\ntranquilize; they can purify my sentiments, and make me similar to the\nman I love; they possess the virtue which the Indian is said to\nattribute to the spoils of him he kills, and inspire me with the power,\nthe feelings, and the heart of their preceding master.\" It is nothing,\nsays the survivor, to tell me, when disease completed its work and death\nhas seized its prey, that that body, with which are connected so many\ndelightful sensations, is a senseless mass of matter: that it is no\nlonger my friend; that the spirit which animated it, and rendered it\nlovely to my sight and dear to my affections, is gone. I know that it is\ngone, I know that I never more shall see the light of intelligence\nbrighten that countenance, nor benevolence beam in that eye, nor the\nvoice of affection sound from those lips: that which I loved, and which\nloved me, is not here: but here are still the features of my friend:\nthis is his form, and the very particles of matter which compose this\ndull mass, a few hours ago were a real part of him, and I cannot\nseparate them, in my imagination, from him. And I approach them with the\nprofounder reverence; I gaze upon them with the deeper affection,\nbecause they are all that remain to me. I would give all that I possess\nto purchase the art of preserving the wholesome character and rosy hue\nof this form, that it might be my companion still: but this is\nimpossible: I cannot detain it from the tomb: but when I have \"cast a\nheap of mould upon the person of my friend, and taken the cold earth for\nits keeper,\" I visit the spot in which it is deposited with awe: it is\nsacred to my imagination: it is dear to my heart. There is a real and\ndeep foundation for these feelings in human nature: they arise\nspontaneously in the bosom of man, and we see their expression and their\npower in the customs of all nations, savage as well as civilized, and in\nthe conduct of all men, the most ignorant and uncultivated no less than\nthe most intelligent and refined. It has been the policy of society to\nfoster these sentiments. If has been conceived that the sanctity which\nattaches to the dead, is reflected back in a profounder feeling of\nrespect for the living; that the solemnity with which death is regarded,\nelevates, in the general estimation, the value of life; and that he who\ncannot approach the mortal remains of a fellow creature without an\nemotion of awe, must regard with horror every thing which places in\ndanger the life of a human being. Religion has contributed indirectly,\nbut powerfully, to the strength and perpetuity of these impressions; and\nsuperstition has availed herself of them to play her antics, and to\naccomplish her base and malignant purposes. It is not the eradication of\nthese feelings that can be desired, but their control: it is not the\nextinction of these natural and useful emotions that is pleaded for, but\nthey should give way to higher considerations when these exist.\nVeneration for the dead is connected with the noblest and sweetest\nsympathies of our nature: but the promotion of the happiness of the\nliving is a duty from which we can never be exonerated.\n\nIn antient times the voice of reason could not be heard. Superstition,\nand customs founded on superstition, excited an influence which was\nneither to be resisted nor evaded. Dissection was then regarded with\nhorror. In the warm countries of the east, the pursuit must have been\nhighly offensive and even dangerous, and it was absolutely incompatible\nwith the notions and ceremonies universally prevalent in those days.\nThe Jewish tenet of pollution must have formed an insuperable obstacle\nto the cultivation of anatomy amongst that people. By the Egyptians,\nevery one who cut open a dead body was regarded with inexpressible\nhorror. The Grecian philosophers so far overcame the prejudice, as\noccasionally to engage in the pursuit, and the first dissection on\nrecord was one made by Democritus of Abdera, the friend of Hippocrates,\nin order to discover the course of the bile. The Romans contributed\nnothing to the progress of the art: they were content with propitiating\nthe Deities who presided over health and disease. They erected on the\nPalatine Mount a temple to the goddess Febris, whom they worshipped from\na dread of her power. They also sacrificed to the goddess Ossipaga, who,\nit seems, presided over the growth of the bones, and to another styled\nCarna, who took care of the viscera, and to whom they offered bean broth\nand bacon, because these were the most nutritious articles of diet. The\nArabians adopted the Jewish notion of pollution, and were thus\nprohibited by the tenets of their religion from practising dissection.\nAbdollaliph, who flourished about the year 1200, a man of learning and a\nteacher of anatomy, never saw and never thought of a human dissection.\nIn order to examine and demonstrate the bones, he took his students to\nburying grounds, and earnestly recommended them, instead of reading\nbooks, to adopt that method of study: yet he seemed to have no\nconception that the dissection of a recent subject might be a still\nbetter method of learning. Christians were equally hostile to\ndissection. Pope Boniface the 8th issued a bull prohibiting even the\nmaceration and preparation of skeletons. The priests were the only\nphysicians, and so greatly did they abuse the office they assumed, that\nthe evil at length became too intolerable to be borne. The church itself\nwas obliged to prohibit the priesthood from interfering with the\npractice of medicine. All monks and canons who applied themselves to\nphysic, were threatened with severe penalties, and all bishops, abbots,\nand priors who connived at their misconduct, were ordered to be\nsuspended from their ecclesiastical functions. But it was not till three\nhundred years after this interdiction, that by a special bull which\npermitted physicians to marry, their complete separation from the clergy\nwas effected.\n\nIn the 14th century, Mundinus, professor at Bologna, astonished the\nworld by the public dissection of two human bodies. In the 15th century,\nLeonardo da Vinci contributed essentially to the progress of the art, by\nthe introduction of anatomical plates, which were admirably executed. In\nthe 16th century, the Emperor, Charles the 5th, ordered a consultation\nto be held by the divines of Salamanca, to determine whether it was\nlawful, in point of conscience, to dissect a dead body in order to learn\nits structure. In the 17th century, Cortesius, professor of anatomy at\nBologna, and afterwards professor of medicine at Messina, had long begun\na treatise on practical anatomy, which he had an earnest desire to\nfinish, but so great was the difficulty of prosecuting the study even in\nItaly, that in 24 years he could only twice procure an opportunity of\ndissecting a human body, and even then with difficulty and in hurry;\nwhereas, he had expected to have done so, he says, once every year,\naccording to the custom of the famous academies of Italy. In Muscovy,\nuntil very lately, both anatomy and the use of skeletons were positively\nforbidden; the first as inhuman, and the latter as subservient to\nwitchcraft. Even the illustrious Luther was so biassed by the prejudices\nof his age, that he ascribed the majority of the diseases to the arts of\nthe devil, and found great fault with physicians when they attempted to\naccount for them by natural causes. England acquired the bad fame of\nbeing the country of witches, and opposed almost insuperable obstacles\nto the cultivation of anatomy. Even at present the prejudices of the\npeople on this subject are violent and deeply rooted. The measure of\nthat violence may be estimated by the degree of abhorrence with which\nthey regard those persons who are employed to procure the subjects\nnecessary for dissection. In this country, there is no other method of\nobtaining subjects but that of exhumation: aversion to this employment\nmay be pardoned: dislike to the persons who engage in it is natural, but\nto regard them with detestation, to exult in their punishment, to\ndetermine for themselves its nature and measure, and to endeavor to\nassume the power of inflicting it with their own hands, is absurd.\nMagistrates have too often fostered the prejudices of the people, and\nafforded them the means of executing their vengeance on the objects of\ntheir aversion. The press has uniformly allied itself with the ignorance\nand violence of the vulgar, and has done every thing in its power to\ninflame the passions, which it was its duty to endeavor to soothe. It is\nnotorious that the winter before last there was scarcely a week in which\nthe papers did not contain the most exaggerated and disgusting\nstatements: the appetite which could be gratified with such\nrepresentations, was sufficiently degraded: but still more base was the\nservility which could pander to it. Half a century ago there was in\nScotland no difficulty in obtaining the subjects which were necessary to\nsupply the schools of anatomy. The consequence was, that medicine and\nsurgery assumed new life--started from the torpor in which they had been\nspell-bound--and made an immediate, and rapid, and brilliant progress.\nThe new seminaries constantly sent into the world men of the most\nsplendid abilities, at once demonstrating the excellence of the schools\nin which they were educated, and rendering them illustrious. Pupils\nflocked to them from all quarters of the globe, and they essentially\ncontributed to that advancement of science which the present age has\nwitnessed. In the 19th century, the good people of Scotland, that\nintelligent, that cool and calculating, that most reasonable and\nthinking people, have thought proper to return to the worst feeling and\nthe worst conduct of the darkest periods of antiquity. There is at\npresent no offence whatever, which seems to have such power to heat and\nexalt into a kind of torrent, the blood which usually flows so calmly\nand sluggishly in the veins of a Scotchman. The people of 1823 (to\ncompare great things with small) emulate the spirit of those of their\nforefathers who \"_were out in the forty-five_;\" the object, to be sure,\nis somewhat different, but it is amusing to see the intensity and\nseriousness of the excitement. About twelve months ago an honest farmer\nof the name of Scott, who resides at Linlithgow, apprehended a poor\nwight who was pursuing his vocation, we presume, in the churchyard of\nthat place; and this service appeared so meritorious to the people in\nhis neighborhood, that they absolutely presented him with a piece of\nplate. In the winter sessions of 1822-3, a body was discovered on its\nway to the lecture-room of an anatomist in Glasgow, and in spite of the\nexertions of the police, aided by those of the military, this\ngentleman's premises and their contents, which were valuable, were\nentirely destroyed by the mob. For some time after this achievement, it\nwas necessary to station a military guard at the houses of all the\nmedical professors in that city. In the spring circuit of the justiciary\ncourt last year at Stirling, while the judges were proceeding to the\ncourt, the procession was assaulted with missiles; several persons were\ninjured, and it was necessary to call in the protection of a military\nforce. The object of the mob was to inflict summary punishment on a man\nwho was about to be tried for the exhumation of a body. We happen to\nknow that the most disgraceful proceedings were some time ago instituted\nin that town against a young gentleman of respectable family and\nconnections, who was in fact expatriated, and whose prospects in life\nwere entirely changed, if not ruined, because he had too much honor to\nimplicate his instructors in a transaction which would have put them to\nan inconvenience, and in which they had engaged from a desire faithfully\nto discharge their duty to their pupils. Within the last five years\nthree men were lodged in the county jail at Haddington, charged with a\ntrespass in the churchyard of that town. So enraged was the mob against\nthem, that an attempt was made to force the jail in order to get at\nthem. On their way to the court, the men were again attacked, forced\nfrom the carriage, and severely maimed. After examination they were\nadmitted to bail; but, when set at liberty, they were assailed with more\nviolence than ever, and were nearly killed. On the 29th of June, 1823,\nbeing Sunday, a most extraordinary outrage was perpetrated in the\nstreets of Edinburgh. A coach containing an empty coffin and two men,\nwas observed proceeding along the south bridge. The people suspecting\nthat it was intended to convey a body taken from some churchyard, seized\nthe coach. It was with difficulty that the police protected the men from\nthe assaults of the populace: the coach they had no power to preserve.\nThe horses were taken from it, and together with the coffin, after\nhaving been trundled a mile and a half through the streets of the city,\nit was deliberately projected over the steep side of the mound, and\nsmashed into a thousand pieces. The people following it to the bottom,\nkindled a fire with its fragments, and surrounded it like the savages in\nRobinson Crusoe, till it was entirely consumed. In this case there was\nno foundation for their suspicions. The coffin was intended to have\nconveyed to his house in Edinburgh the body of a physician who that\nmorning had died in a cottage near the neighborhood. A similar assault\nwas some time ago made on two American gentlemen, who went to visit the\nabbey of Linlithgow after nightfall. The churchyards of the \"gude Scots\"\nare now strictly guarded by men and dogs; watch-towers are erected\nwithin the grounds, and _mort-safes_, as they are called, that is to\nsay, strong iron frames are deposited in the ground over the graves.\nThese people sometimes declare that they will put an end to anatomy, and\ncertainly they are succeeding in the accomplishment of this menace as\nrapidly as they can well desire. The average number of medical students\nin Edinburgh is 700 each session. For several years past the difficulty\nof procuring subjects in that place has been so great, that out of all\nthat number, not more than 150 or 200 have ever attempted to dissect;\nand even these have latterly been so opposed in their endeavours to\nprosecute their studies, that many of them have left the place in\ndisgust. We have been informed by a friend, that he alone was personally\nacquainted with twenty individuals who retired from it at the beginning\nof last session, and who went to pursue their studies at Dublin, and we\nknow that vast numbers followed their example at the end of the winter\ncourse. The medical school at Edinburgh, in fact, is now subsisting\nentirely on its past reputation; in the course of a few years it will be\nentirely at an end, unless the system be changed. Let those who have the\nprosperity of the university at heart, and who have the power to\nprotect it, consider this before it be too late: they may be assured it\nis no idle prediction; for we give them notice, that it is at this\nmoment the universal opinion and the current language of every\nwell-informed medical man in England.\n\nAn excellent system of anatomical plates, which has been well received\nby the profession, has lately been published by Mr. Lizars, a lecturer\non anatomy and physiology, in Edinburgh. This gentleman states that he\nhas been induced to undertake this work, in order to obviate the most\nfatal consequences to the public; as far, at least, as a reference to\nart, instead of nature, is capable of obviating those consequences. He\naffirms, that the difficulty of obtaining instruction from nature has\nrisen to such a pitch, owing to the extraordinary severity exercised by\nthe legal authorities of the kingdom against persons employed in\nprocuring subjects for dissection, as to threaten the ultimate\ndestruction of medical and anatomical science. In his preface to the\nsecond part of his work, he apologizes to his readers for dividing one\nportion of it from another, with which it ought to have been connected;\nbut states that he has been compelled to do so from the prejudices of\nthe place, which prevented him for upwards of five months, from\nprocuring a subject from which he might make his drawings. \"In place of\nliving,\" he says, \"in a civilized and enlightened period, we appear as\nif we had been thrown back some centuries into the dark ages of\nignorance, bigotry and superstition. Prejudices, worthy only of the\nmultitude, have been conjured up and appealed to, in order to call forth\npopular indignation against those whose business it is to exhibit\ndemonstratively the structure of the human body, and the functions of\nits different organs. The public journals, from a vicious propensity to\npander to the vulgar appetite for excitement, have raked up and\nindustriously circulated stories of exhumation of dead bodies, tending\nto exasperate and inflame the passions of the mob; and persons who, by\ntheir own showing, are friendly to the interests of science, have, in\nthe excess of their zeal that bodies should remain undisturbed in their\nprogress to decomposition, laboured to destroy in this country, that\nart, whose province it is to free living bodies from the consequences\ninseparable from accident and disease. And, which is worst of all, the\nprejudices of the multitude have been confirmed and rendered inveterate\nby the proceedings in our courts of justice, which have visited with the\npunishment due only to felons, the unhappy persons necessarily employed\nin the present state of the law, in procuring subjects for the\ndissecting-room.\"\n\nHe then goes on to state, that until anatomy be publicly sanctioned in\nEdinburgh, the school of medicine there can never flourish; that upon\nthe present system, young men obtain a degree or a diploma after a year\nor two of grinding, that is, of learning by rote the answers to the\nquestions which the examiners are in the habit of putting to the\ncandidates; that ignorant of the very elements of their profession,\nnumbers of persons thus educated annually, go to the East and West\nIndies, and to the army and navy, where they have the charge of hundreds\nof their suffering fellow creatures, to whom they are in fact the\ninstruments of cruelty and murder. In the preface to the 4th Part, he\nadds, that when Part II. was published, in the early part of the\nsession, he took occasion to express his sorrow for the degraded state\nof his profession, and the threatened ruin of the Medical School of his\nnative place, owing to the scarcity of subjects: That, for doing this,\nhe has incurred considerable censure: that he regrets that he has yet\nfound no reason to alter his opinion, for the winter session is now near\nits conclusion, and, he candidly declares, that such has been the\nscarcity of material, that _no teacher of anatomy or surgery has been\nable either to follow the regular plan of his course, or to do his duty\nto his pupils_; the consequence of which has been, that many of the\nstudents have left the school in disgust, and gone either to Dublin or\nParis; while a still greater number, deprived of the means of\ndissecting, have contented themselves with lectures or theories, and\nwith grinding; and entered on the practice of their profession ignorant\nof its fundamental principles.\n\nMuch of this opposition on the part of the people, arises from the\npresent mode of procuring subjects. Fortunately, there is in Great\nBritain no custom, no superstition, no law, and we may add, no\nprejudice, against anatomy itself. There is even a general conviction of\nits necessity; there may be a feeling that it is a repulsive employment,\nbut it is commonly acknowledged that it must not be neglected. The\nopposition which is made, is made not against anatomy, but against the\npractice of exhumation: and this is a practice which ought to be\nopposed. It is in the highest degree revolting; it would be disgraceful\nto a horde of savages; every feeling of the human heart rises up against\nit: so long as no other means of procuring bodies for dissection are\nprovided, it must be tolerated; but, in itself, it is alike odious to\nthe ignorant and the enlightened, to the most uncultivated and the most\nrefined.\n\nBut the capital objection to this practice is, that it necessarily\ncreates a crime, and educates a race of criminals.--Exhumation is\nforbidden by the law. It is, indeed, prohibited by no statute, either in\nEngland or Scotland: in both, it is an offence punishable at common law.\nThere is a statute of James the first, which makes it felony to steal a\ndead body for the purpose of witchcraft; there is none against taking a\nbody for the purpose of dissection. In the case of the King against Lynn\n(1788), the court decided that the body being taken for the latter\npurpose, did not make it less an indictable offence; and that it is\nwithout doubt cognizable in a criminal court, because it is an act\n\"highly indecent, at the bare idea of which nature revolts.\" It is\npunishable, therefore, by fine or imprisonment, or both: In Scotland, it\nis also punishable by whipping, and even by transportation.\n\nWe expected better things of America. We cannot express our astonishment\nand indignation, when we found that the state of New York has actually\nmade it felony to remove a dead body from the place of sepulture for the\npurpose of dissection, without providing in any other mode for the\nschools of anatomy. This is worse than any thing that exists in any\nother part of the world. If these pages should meet the eye of any of\nour American brethren, we intreat them to read with attention, the facts\nwhich have been stated in the former part of this article, and to\nconsider with seriousness the mischief they are doing. It will not be\nbelieved in England, that such scenes could have been witnessed in\nAmerica, as were actually exhibited there scarcely a month ago. To\nsatisfy our readers, however, that we do not misrepresent the state of\nthings in that country, we transcribe the following accounts from _The\nNew York Evening Post_, of _May 20th_. \"At the late Court of Sessions,\nSolomon Parmeli was indicted for a misdemeanor, in entering Potter's\nField, and removing the covers of two coffins deposited in a pit, and\ncovered partly with earth. _The statute of this state making it a\nfelony, to dig up or remove a dead human body with intent to dissect\nit_, did not embrace this case; because the prisoner had not dug up or\nremoved the body. Mr. Schureman, the present keeper of Potter's Field,\nsuspected that some person had entered it for the purpose of removing\nthe dead; and, after sending for two watchmen, and calling his faithful\ndog, he went to ascertain the fact. On arriving at the grave, he found\nhis suspicion confirmed; and requested the person concealed in the pit,\nto come out and show himself: no answer being given, Mr. Schureman sent\nhis dog into the pit, and in the twinkling of an eye a tall stout fellow\nmade his appearance, and took to his heels across the field. The night\nbeing dark, he might have effected his escape, had it not been for the\nsagacity and courage of the dog, who pursued him for some distance, but\nat last came up with him, seized and held him fast, until the arrival of\nMr. Schureman and the watchmen, who secured him. The jury convicted the\nprisoner, and the court sentenced him to six months' imprisonment in\nthe Penitentiary. _The young gentlemen attending the Medical School of\nthis city, will take warning by this man's fate. They may rest assured,\nthat the keeper of Potter's Field will do his duty, and public justice\nwill be executed on any man, whatever may be his condition in life, who\nis found violating the law, and the decency of Christian burial!_\" The\nsame paper gives the following account of a transaction, which took\nplace at Hartford, in Connecticut, May 17. \"Yesterday morning, two\nladies were taking a walk in the South burying ground, when they\ndiscovered a tape-string, and a piece of cloth, which upon examination\nwas found to be the piece that was laced upon Miss Jane Benton's face,\nwho came to her death by drowning, and was buried a few days since. The\nladies then went to the grave, and found that it had been\ndisturbed--that she was taken out of her coffin, and a rope around her\nneck. The circumstance has produced great excitement in the public mind;\nand every one is on the alert to discover the perpetrators of this\nunfeeling, brutal act. _The citizens turned out in a body yesterday, and\ninterred the corpse again!_\"\n\nThese scenes are highly disgraceful, and disgraceful to all, though not\n_alike_ to all parties. We do not blame the Americans for abolishing the\npractice of exhumation; but we blame them for stopping there. We\nmaintain, that it is both absurd and criminal, to make this practice\nfelony, without providing in some other method for the cultivation of\nanatomy.\n\nIn Great Britain, the law against the practice of exhumation is not\nallowed to slumber. There may be other cases which have not come to our\nknowledge; but we have ascertained that there have been 14 convictions\nfor England alone, during the last year. The punishments inflicted have\nbeen imprisonment for various periods, with fines of different sums. The\nfines in general are heavy, considering the poverty of the offenders.\nSeveral persons are, at this moment, suffering these penalties; among\nothers, there is now in the gaol of St. Alban's, a man who was sentenced\nfor this offence to two years' imprisonment, and a fine of twenty\npounds. The period of his confinement has expired some time; but he\nstill remains in prison, on account of his inability to pay the fine.[1]\nSince the passing of the new Vagrant act, it has been the common\npractice to commit these offenders to hard labour for various periods.\nVery lately, two men, convicted of this offence, were sent to the Tread\nMill, in Cold Bath Fields; one of whom died in one month after his\ncommitment. It is an error to suppose that these punishments operate to\nprevent exhumation; their only effect is to raise the price of subjects:\na little reflection will show that they can have no other operation. At\npresent, exhumation is the only method by which subjects for dissection\ncan be procured; but subjects for this purpose must be procured: and be\nthe difficulties what they may, will be procured: diseases will occur,\noperations must be performed, medical men must be educated, anatomy must\nbe studied, dissections must go on. Unless some other means for\naffording a supply be adopted; whatever be the law or the popular\nfeeling, neither magistrates, nor judges, nor juries, will, or can, put\nan entire stop to the practice. It is one, which, from the absolute\nnecessity of the case, must be allowed. What is the consequence? So long\nas the practice of exhumation continues, a race of men must be trained\nup to violate the law. These men must go out in company for the purpose\nof nightly plunder, and plunder of the most odious kind, tending in a\npeculiar and most alarming measure to brutify the mind, and to eradicate\nevery feeling and sentiment worthy of a man. This employment becomes a\nschool in which men are trained for the commission of the most daring\nand inhuman crimes. Its operation is similar, but much worse than the\nnightly banding to violate the game laws, because there is something in\nthe violation of the grave, which tends still more to degrade the\ncharacter and to harden the heart. This offence is connived at; nay, it\nis rewarded; these men are absolutely paid to violate the law; and paid\nby men of reputation and influence in society. The transition is but too\neasy to the commission of other offences in the hope of similar\nconnivance, if not of similar reward.\n\nIt is an odious thing that the teachers of anatomy should be brought\ninto contact with such men: that they should be obliged to employ them,\nand that they should even be in their power; which they are to such a\ndegree, that they are obliged to bear with the wantonness of their\ntyranny and insult. All the clamour against these men, all the\npunishment inflicted on them, only operate to raise the premium on the\nrepetition of their offence. This premium the teachers of anatomy are\nobliged to pay, which these men perfectly understand, who do not at all\ndislike the opposition which is made to their vocation. It gives them no\nunreasonable pretext for exorbitancy in their demands. In general, they\nare men of infamous character; some of them are thieves, others are the\ncompanions and abettors of thieves. Almost all of them are extremely\ndestitute. When apprehended for the offence in question, the teachers of\nanatomy are obliged to pay the expenses of the trial, and to support\ntheir families while they are in prison: whence the idea of immunity is\nassociated, in these men's minds, with the violation of the law, and\nwhen they do happen to incur its penalties, they practically find that\nthey and their families are provided for, and this provision comes to\nthem in the shape of a reward for the commission of their offence. The\noperation of such a system on the minds of the individuals themselves is\nexceedingly pernicious, and is not a little dangerous to the community.\n\nMoreover, by the method of exhumation, the supply after all is scanty;\nit is never adequate to the wants of the schools; it is of necessity\nprecarious, and it sometimes fails altogether for several months. But it\nis of the utmost importance that it should be abundant, regular, and\ncheap.--The number of young men who come annually to London for the\npurpose of studying medicine and surgery, may be about a thousand. Their\nexpenses are necessarily very considerable while in town; they have\nalready paid a large sum for their apprenticeship in the country; the\ncircumstances of country practitioners, in general, can but ill afford\nprotracted expenses for their sons in London; few of them stay a month\nlonger than the time prescribed by the College of Surgeons. But the\nshort period they spend in London, is the only time they have for\nacquiring the knowledge of their profession. If they mispend these\nprecious hours, or if the means of employing them properly be denied\nthem, they must necessarily remain ignorant for life. After they leave\nLondon they have no means of dissecting. We have seen that it is by\ndissecting alone, that they can make themselves acquainted even with the\nprinciples of their art; that without it they cannot so much as avail\nthemselves of the opportunities of improvement, which experience itself\nmay offer, nor, without the highest temerity, perform a single\noperation. We have seen that occasions suddenly occur, which require the\nprompt performance of important and difficult operations; we have seen\nthat unless such operations are performed immediately, and with the\nutmost skill, life is inevitably lost. In many such cases, there is no\ntime to send for other assistance. If a country practitioner (and most\nof these young men go to the country) be not himself capable of doing\nwhat is proper to be done, the death of the patient is certain. We put\nit to the reader to imagine what the feelings of an ingenuous young man\nmust be, who is aware of what he ought to do, but who is conscious that\nhis knowledge is not sufficient to authorise him to attempt to perform\nit, and who sees his patient die before him, when he knows that he might\nbe saved, and that it would have been in his own power to save him, had\nhe been properly educated. We put it to the reader to conceive what his\nown sensations would be, were an ignorant surgeon, with a rashness more\nfatal than the criminal modesty of the former, to undertake an important\noperation--Suppose it were a tumor, which turned out to be an aneurism;\nsuppose it were a hernia, in operating on which the epigastric artery\nwere divided, or the intestine itself wounded: suppose it were his\nmother, his wife, his sister, his child, whom he thus saw perish before\nhis eyes, what would the reader then think of the prejudice which\nwithholds from the surgeon that information, without which the practice\nof his profession is murder?\n\nThe study of anatomy is a severe and laborious study; the practice of\ndissection is on many accounts highly repulsive: it is even not without\ndanger to life itself.[2] To men of clear understandings, to those\nespecially of a philosophical turn of mind, the pursuit is its own\nreward; they are so fully satisfied, that the more it is cultivated the\nmore satisfaction it will afford, that they need no stimulus to induce\nthem to undergo the drudgery. But this is by no means the case with\nordinary minds. The fatigue and disgust of the dissecting-room, are\nappalling to them, and they need the stimulus of necessity to urge them\nto the task. The court of examiners of the College of Surgeons, requires\nfrom the candidates for surgical diplomas certificates that they have\ngone through at least two courses of dissections; the examiners at\nApothecaries'-hall do not require such certificates. The consequence is,\nthat many young men content themselves with attending lectures, and with\npassing their examinations at Apothecaries'-hall, and do not apply for a\ndiploma at the College of Surgeons. This single fact is sufficient to\ndemonstrate to the public, that instead of throwing obstacles in the way\nof dissection, it is a duty which they owe to themselves to afford every\npossible facility to its practice, and to hold out to every member of\nthe profession, the most powerful inducements to engage in it, by\nrewarding with confidence those who cultivate anatomy, by making\nexcellence in anatomy indispensable to all offices in dispensaries and\nhospitals, and by thus rendering it impossible for any one who is\nignorant of anatomy, to obtain rank in his profession. When a candidate\npresents himself for a diploma in Denmark, in his first trial he is put\ninto a room with a subject, a case of instruments, and a memorandum, and\ninformed that he is to display the anatomy of the face and neck, or that\nof the upper extremity or that of the lower extremity: that by the\nanatomy is to be understood, the blood-vessels, nerves, and muscles; and\nthat as soon as he has accomplished his task, the professors will\nattend his summons to judge of his attainments. These professors are the\ntrue examiners!\n\nWe shall have entered into the discussion of this subject to little\npurpose, if we have not produced in the minds of our readers a deep\nconviction, that anatomy ought to form an essential part of medical\neducation, that anatomy cannot be studied without the practice of\ndissection; that dissection cannot be practised without a supply of\nsubjects, and that the manner in which that supply is obtained in\nEngland is detestable, and ought immediately to be changed. It might be\nchanged easily. We agree with Mr. Mackenzie, that legislative\ninterference is necessary; we are satisfied that nothing will be done in\nEngland without it. The plan which Mr. Mackenzie suggests is as follows:\n1. That the clause of our criminal code, by which the dissection of the\ndead body is made part of the punishment for murder, be repealed. 2.\nThat the exhumation of dead bodies be punishable as felony. 3. That no\ndiploma in medicine or surgery, be granted by any faculty, college, or\nuniversity, except to those persons who shall produce undoubted evidence\nof their having carefully dissected at least five human bodies. 4. That\nin each of the hospitals, infirmaries, work-houses, poor-houses,\nfoundling-houses, houses of correction, and prisons of London,\nEdinburgh, Glasgow, and Dublin, and if need be, of all other towns in\nGreat Britain and Ireland, an apartment be appointed for the reception\nof the bodies of all persons dying in the said hospitals, infirmaries,\nwork houses, poor-houses, foundling-houses, houses of correction, and\nprisons, _unclaimed by immediate relatives, or whose relatives decline\nto defray the expenses of interment_. 5. That the bodies of all persons\ndying in these towns, and, if need be, in all other towns, and also in\ncountry parishes, _unclaimable by immediate relatives, or whose\nrelatives decline to defray the expenses of interment_, shall be\nconveyed to a mort-house appointed in the said towns for their\nreception. 6. That no dead bodies shall be delivered from any hospital,\ninfirmary, work house, poor-house, foundling-house, house of correction,\nprison, or mort-house for anatomical purposes, except upon the\nrequisition of a member of the Royal College of Physicians or of\nSurgeons, of London, Edinburgh, or Dublin, or of the Faculty of\nPhysicians and Surgeons of Glasgow, and upon the payment of twenty\nshillings into the hands of the treasurer, of the hospital, infirmary,\nwork-house, poor-house, foundling-house, house of correction, prison, or\nother officer appointed to receive the same. [This is too large a sum.]\n7. That no dead body shall be conveyed from a hospital, infirmary,\nwork-house, poor-house, foundling-house, house of correction, prison,\nor mort-house, to a school of anatomy, except in a covered bier, and\nbetween the hours of four and six in the morning. 8. That after the\nexpiration of twenty-eight days, an officer appointed for this purpose,\nin each of the four towns above-mentioned, shall cause the remains of\nthe dead to be placed in a coffin, removed from the school of anatomy,\nwhere the dead body has been examined, to the mort-house of the town and\ndecently buried. 9. That the expenses attending the execution of these\nregulations, be defrayed out of fees paid by teachers and students of\nanatomy, on receiving dead bodies from the hospitals, infirmaries,\nwork-houses, poor houses, foundling-houses, houses of correction,\nprisons, and mort-houses.\n\nTo this plan there is but one objection, viz. that it is making the\nbodies of the poor public property. The answer is, that the limitation\nin the proposed law, which the objection does not notice, entirely\nremoves the weight of that objection. Though no maxim can be more\nindisputable than that those who are supported by the public die in its\ndebt, and that their remains at least, might, without injustice, be\nconverted to the public use, yet it is not proposed to dispose in this\nmanner of the bodies of all the poor: but only of that portion of the\npoor who die unclaimed and without friends, and whose appropriation to\nthis public service could, therefore, afford pain to no one. If any\nconcession and co-operation on the part of the public, for this great\npublic object is to be expected, and without concession and co-operation\nnothing can be done, it is not easy to conceive of any plan which\nrequires less public concession or implies less violation of public\nfeeling. In point of fact it would put no indignity, it would inflict no\ninjury on the poor; it is the rejection of it that would really and\npractically be unjust and cruel. The question is, whether the surgeon\nshall be allowed to gain knowledge by operating on the bodies of the\ndead, or driven to obtain it by practising on the bodies of the living.\nIf the dead bodies of the poor are not appropriated to this use, their\nliving bodies will and must be. The rich will always have it in their\npower to select, for the performance of an operation, the surgeon who\nhas already signalized himself by success: but that surgeon, if he have\nnot obtained the dexterity which ensures success, by dissecting and\noperating on the dead, must have acquired it by making experiments on\nthe living bodies of the poor. There is no other means by which he can\npossibly have gained the necessary information. Every such surgeon who\nrises to eminence, must have risen to it through the suffering which he\nhas inflicted, and the death which he has brought upon hundreds of the\npoor. The effect of the entire abolition of the practice of dissecting\nthe dead, would be, to convert poor-houses and public hospitals into so\nmany schools where the surgeon, by practising on the poor, would learn\nto operate on the rich with safety and dexterity. This would be the\ncertain and inevitable result: and this, indeed, would be to treat them\nwith real indignity, and horrible injustice; and proves, how possible it\nis to show an apparent consideration for the poor, and yet practically\nto treat them in the most injurious and cruel manner.\n\nNor would the proposed plan be the means of deterring this class of\npeople from entering the hospitals. There is something reasonable in the\napprehension on which this objection is founded: but the answer to it is\ncomplete, because it is an answer, derived from experience, to an\nobjection, which is merely a deduction from what is probable. The plan\nhas been acted on, and found to be unattended with this result: it was\ntried in Edinburgh, and the hospital was as full as it is at present: it\nis universally acted on in France, and the hospitals are always crowded.\n\nThe great advantages of the plan are, that it would accomplish the\nproposed object, easily and completely, whereas the plan in operation\neffects it imperfectly and with difficulty; and it would put an\nimmediate and entire stop to all the evils of the present system. At\nonce it would put an end to the needless education of daring and\ndesperate violators of the law. It would tranquillize the public mind.\nTheir dead would rest undisturbed: the sepulchre would be sacred: and\nall the horrors which the imagination connects with its violation would\ncease for ever.\n\nWe have stated, that the plan has been tried. Experience has proved its\nefficacy. It was adopted with perfect success in Edinburgh more than a\ncentury ago. In the Council Register for 1694, it is recorded that all\nunclaimed dead bodies in the charitable institutions or in the streets,\nwere given for dissection to the College of Surgeons, to one or two of\nits individual members, and to the professor of anatomy. This\nregulation, at that period, excited no opposition on the part of the\npeople, but effectually answered the desired object. All the medical\nschools on the continent are supplied with subjects, by public\nauthority, in a similar manner. We have obtained from a friend in Paris,\na gentleman who is at the head of the anatomical department in that\ncity, the following account of the manner in which the schools of\nanatomy are supplied. It is stated; 1. That the faculty of medicine at\nParis is authorized to take from the civil hospitals, from the prisons,\nand from the dep\u00f4ts of mendicity, the bodies which are necessary for\nteaching anatomy. 2. That a gratuity of eight pence is given to the\nattendants in the hospitals for each body. 3. That upon the foundation\nby the National Convention, of schools of health, the statutes of their\nfoundation declare, that the subjects necessary for the schools of\nanatomy shall be taken from the hospitals, and that since this period,\nthe council of hospitals and the prefect of police, have always\npermitted the practice. 4. That M. Breschet, chief of the anatomical\ndepartment of the faculty of Paris, sends a carriage daily to the\ndifferent hospitals, which brings back the necessary number of bodies:\nthat this number has sometimes amounted to 2000 per annum for the\nfaculty only, without reckoning those used in L'H\u00f4pital de la Piti\u00e9, but\nthat since the general attention which has recently been bestowed upon\npathologic anatomy, numbers of bodies are opened in the civil and\nmilitary hospitals, and that the faculty seldom obtain more than 1000 or\n1200. 5. That, besides the dissections by the faculty of medicine, and\nthose pursued in L'H\u00f4pital de la Piti\u00e9, theatres of anatomy are opened\nin all the great hospitals, for the pupils of those establishments: that\nin these institutions anatomy is carefully taught, and that pupils have\nall the facilities for dissection that can be desired. 6. That the price\nof a body varies from four shillings to eight shillings and sixpence. 7.\nThat after dissection, the bodies are wrapt in cloths, and carried to\nthe neighbouring cemetery, where they are received for ten-pence. 8.\nThat the practice of exhumation is abolished: that there are\ninsurmountable obstacles to the return of that system, and that bodies\nare never taken from burial grounds, without an order for exhumation,\nwhich is given only when the tribunals require it for the purpose of\nmedico-legal investigation. 9. That though the people have an aversion\nto the operations of dissection, yet they never make any opposition to\nthem, provided respect be paid to the laws of decency and salubrity, on\naccount of the deep conviction that prevails of their utility, 10. That\nthe relatives of the deceased seldom or never oppose the opening of any\nbody, if the physicians desire it. That all the medical students in\nFrance, with scarcely any exception, dissect, and that that physician or\nsurgeon who is not acquainted with anatomy, is universally regarged as\nthe most ignorant of men.\n\nIt is time that the physicians and surgeons of England, should exert\nthemselves to change a system which has so long retarded the progress of\ntheir science, and been productive of so much evil to the community. We\nare persuaded, that there is good sense enough, both in the people and\nin the legislature, to listen to their representations. We would advise\nthem to avail themselves of the means they possess to communicate\ninformation to the people, and to make individual members of parliament\nacquainted with the subject. With this view we would recommend the\nwhole body to act in concert, to appoint a committee for conducting the\nmatter, and to petition parliament, as soon as they shall have made the\nnature of their claims, and the grounds on which they rest, more\ngenerally known. If they act in co-operation with each other, and pursue\ntheir object temperately, and steadily, we cannot but believe, that\ntheir efforts at no distant period, will be crowned with success.\n\nFOOTNOTES:\n\n[1] Since the above was written, we have learned that this man has been\nrecently liberated, and his fine remitted.\n\n[2] A winter never passes without proving fatal to several students who\ndie from injuries received in dissection.","title":"Use of the Dead to the Living","tradition":"philosophy-ethics","translated_text":null,"word_count":17991}