Project Gutenberg's Use of the Dead to the Living, by Thomas Southwood-Smith
This eBook is for the use of anyone anywhere in the United States and
most other parts of the world at no cost and with almost no restrictions
whatsoever. You may copy it, give it away or re-use it under the terms
of the Project Gutenberg License included with this eBook or online at
www.gutenberg.org. If you are not located in the United States, you'll
have to check the laws of the country where you are located before using
this ebook.
Title: Use of the Dead to the Living
Author: Thomas Southwood-Smith
Release Date: December 12, 2018 [EBook #58460]
Language: English
*** START OF THIS PROJECT GUTENBERG EBOOK USE OF THE DEAD TO THE LIVING ***
Produced by Chris Curnow, Martin Pettit and the Online
Distributed Proofreading Team at http://www.pgdp.net (This
file was produced from images generously made available
by The Internet Archive)
USE OF THE DEAD
TO THE
LIVING.
FROM THE WESTMINSTER REVIEW.
_ALBANY_:
PRINTED BY WEBSTERS AND SKINNERS.
1827.
ADVERTISEMENT.
The following pages contain an article extracted from the Westminster
Review, an English periodical of considerable reputation. On its
appearance in Great Britain, it excited great attention; and, indeed,
has been there reprinted in a cheap form for general distribution. The
author (Dr. SOUTHWOOD SMITH) deserves the thanks of the community for
the talents he has displayed, and the lucid and powerful manner in which
he has investigated the important subject under consideration.
The editors believe that they are discharging a duty to the community in
presenting it to them for perusal and consideration. They will not
conceal their wishes, that it may have a favorable effect on a bill now
pending before the Legislature. Both in a general point of view, as well
as with reference to the particular institution to be benefitted, the
arguments are particularly applicable; nor will an enlightened body of
men be deterred from doing what they may deem their duty by the
unparalleled impudence of those who _now_ cry out against monopoly, when
they have risen into importance by monopoly, and have, always, while it
suited their views, been its most persecuting and vindictive advocates.
It is due to truth to state, that the suggestion of the republication of
this article, originated with a member of the Senate of this state, and
who does not belong to the profession.
_February, 1827._
USE OF THE DEAD TO THE LIVING.
FROM THE WESTMINSTER REVIEW.
_An Appeal to the Public and to the Legislature, on the necessity
of affording Dead Bodies to the Schools of Anatomy, by Legislative
Enactment._ By WILLIAM MACKENZIE. Glasgow. 1824.
Every one desires to live as long as he can. Every one values health
"above all gold and treasure." Every one knows that as far as his own
individual good is concerned, protracted life and a frame of body sound
and strong, free from the thousand pains that flesh is heir to, are
unspeakably more important than all other objects, because life and
health must be secured before any possible result of any possible
circumstance can be of consequence to him. In the improvement of the art
which has for its object the preservation of health and life, every
individual is, therefore, deeply interested. An enlightened physician
and a skilful surgeon, are in the daily habit of administering to their
fellow men more real and unquestionable good, than is communicated, or
communicable by any other class of human beings to another. Ignorant
physicians and surgeons are the most deadly enemies of the community:
the plague itself is not so destructive; its ravages are at distant
intervals, and are accompanied with open and alarming notice of its
purpose and power; theirs are constant, silent, secret; and it is while
they are looked up to as saviours, with the confidence of hope, that
they give speed to the progress of disease and certainty to the stroke
of death.
It is deeply to be lamented that the community, in general, are so
entirely ignorant of all that relates to the art and the science of
medicine. An explanation of the functions of the animal economy; of
their most common and important deviations from the healthy state; of
the remedies best adapted to restore them to a sound condition, and of
the mode in which they operate, as far as that is known, ought to form a
part of every course of liberal education. The profound ignorance of the
people on all these subjects, is attended with many disadvantages to
themselves, and operates unfavorably on the medical character. In
consequence of this want of information, persons neither know what are
the attainments of the man in whose hands they place their life, nor
what they ought to be; they can neither form an opinion of the course of
education which it is incumbent on him to follow, nor judge of the
success with which he has availed himself of the means of knowledge
which have been afforded him. There is one branch of medical education
in particular, the foundation, in fact, on which the whole
superstructure must be raised, the necessity of which is not commonly
understood, but which requires only to be stated to be perceived.
Perhaps it is impossible to name any one subject which it is of more
importance that the community should understand. It is one in which
every man's life is deeply implicated: it is one on which every man's
ignorance or information will have a considerable influence. We shall,
therefore, enter into it with some detail: we shall show the kind of
knowledge which it is indispensable that the physician and surgeon
should possess; we shall illustrate, by a reference to particular cases,
the reason why this kind of knowledge cannot be dispensed with: and we
shall explain, by a statement of facts, the nature and extent of the
obstacles which at present oppose the acquisition of this knowledge. We
repeat, there is no subject in which every reader can be so immediately
and deeply interested, and we trust that he will give us his calm and
unprejudiced attention.
The basis of all medical and surgical knowledge is anatomy. Not a single
step can be made either in medicine or surgery, considered either as an
art or a science without it. This should seem self evident, and to need
neither proof nor illustration: nevertheless, as it is useful
occasionally to contemplate the evidence of important truth, we shall
show why it is, that there can be no rational medicine, and no safe
surgery, without a thorough knowledge of anatomy.
Disease, which it is the object of these arts to prevent and to cure, is
denoted by disordered function: disordered function cannot be understood
without a knowledge of healthy function; healthy function cannot be
understood without a knowledge of structure; structure cannot be
understood unless it be examined.
The organs on which all the important functions of the human body
depend, are concealed from the view. There is no possibility of
ascertaining their situation and connections, much less their nature and
operation, without inspecting the interior of this curious and
complicated machine. The results of the mechanism are visible; the
mechanism itself is concealed, and must be investigated to be perceived.
The important operations of nature are seldom entirely hidden from the
human eye; still less are they obtruded upon it, but over the most
curious and wonderful operations of the animal economy so thick a veil
is drawn, that they never could have been perceived without the most
patient and minute research. The circulation of the blood, for example,
never could have been discovered without dissection. Notwithstanding the
partial knowledge of anatomy which must have been acquired by the
accidents to which the human body is exposed, by attention to wounded
men, by the observance of bodies killed by violence; by the huntsman in
using his prey; by the priest in immolating his victims; by the augur in
pursuing his divinations; by the slaughter of animals; by the dissection
of brutes; and even occasionally by the dissection of the human body,
century after century passed away, without a suspicion having been
excited of the real functions of the two great systems of vessels,
arteries and veins. It was not until the beginning of the 17th century,
when anatomy was ardently cultivated, and had made considerable
progress, that the valves of the veins and of the heart were discovered,
and subsequently that the great Harvey, the pupil of the anatomist who
discovered the latter, by inspecting the structure of these valves; by
contemplating their disposition; by reasoning upon their use, was led to
suspect the course of the blood, and afterwards to demonstrate it.
Several systems of vessels in which the most important functions of
animal life are carried on--the absorbent system, for example, and even
that portion of it which receives the food after it is digested, and
which conveys it into the blood, are invisible to the naked eye, except
under peculiar circumstances: whence it must be evident, not only that
the interior of the human body must be laid open, in order that its
organs may be seen; but that these organs must be minutely and patiently
dissected, in order that their structure may be understood.
The most important diseases have their seat in the organs of the body;
an accurate acquaintance with their situation is, therefore, absolutely
necessary, in order to ascertain the seats of disease; but for the
reasons already assigned, their situation cannot be learnt, without the
study of anatomy. In several regions, organs the most different in
structure and function are placed close to each other. In what is termed
the epigastric region, for example, are situated the stomach, the liver,
the gall bladder, the first portion of the small intestine, (the
duodenum) and a portion of the large intestine (the colon); each of
these organs is essentially different in structure and in use, and is
liable to distinct diseases. Diseases the most diversified, therefore,
requiring the most opposite treatment, may exist in the same region of
the body; the discrimination of which is absolutely impossible, without
that knowledge which the study of anatomy alone can impart.
The seat of pain is often at a great distance from that of the affected
organ. In disease of the liver, the pain is generally felt at the top of
the right shoulder. The right phrenic nerve sends a branch to the liver:
the third cervical nerve, from which the phrenic arises, distributes
numerous branches to the neighborhood of the shoulder: thus is
established a nervous communication between the shoulder and the liver.
This is a fact which nothing but anatomy could teach, and affords the
explanation of a symptom which nothing but anatomy could give. The
knowledge of it would infallibly correct a mistake, into which a person
who is ignorant of it, would be sure to fall: in fact, persons ignorant
of it do constantly commit the error. We have know several instances in
which organic disease of the liver has been considered, and treated as
rheumatism of the shoulder. In each of these cases, disease in a most
important organ might have been allowed to steal on insidiously, until
it became incurable; while a person, acquainted with anatomy, would have
detected it at once, and cured it without difficulty. Many cases have
occurred of persons who have been supposed to labor under disease of the
liver, and who have been treated accordingly: on examination after
death, the liver has been found perfectly healthy, but there has been
discovered extensive disease of the brain. Disease of the liver is often
mistaken for disease of the lungs: on the other hand, the lungs have
been found full of ulcers, when they were supposed to have been
perfectly sound, and when every symptom was referred to disease of the
liver. Persons are constantly attacked with convulsions--children
especially; convulsions are spasms: spasms, of course, are to be treated
by antispasmodics. This is the notion amongst people ignorant of
medicine: it is the notion amongst old medical men: it is the notion
amongst half educated young ones. All this time these convulsions are
merely a symptom; that symptom depends upon, and denotes, most important
disease in the brain: the only chance of saving life, is the prompt and
vigorous application of proper remedies to the brain; but the
practitioner whose mind is occupied with the symptom, and who prescribes
antispasmodics, not only loses the time in which alone any thing can be
done to snatch the victim from death, but by his remedies absolutely
adds fuel to the flame which is consuming his patient. In disease of the
hip-joint pain is felt, not in the hip, but, in the early stage of the
disease, at the knee. This also depends on nervous communication. The
most dreadful consequences daily occur from an ignorance of this single
fact. In all these cases error is inevitable, without a knowledge of
anatomy: it is scarcely possible with it: in all these cases error is
fatal: in all these cases anatomy alone can prevent the error--anatomy
alone can correct it. Experience, so far from leading to its detection,
would only establish it in men's minds, and render its removal
impossible. What is called experience is of no manner of use to an
ignorant and unreflecting practitioner. In nothing does the adage, that
it is the wise only who profit by experience, receive so complete an
illustration as in medicine. A man who is ignorant of certain
principles, and who is incapable of reasoning in a certain manner, may
have daily before him for fifty years cases affording the most complete
evidence of their truth, and of the importance of the deduction to which
they lead, without observing the one, or deducing the other. Hence the
most profoundly ignorant of medicine, are often the oldest members of
the profession, and those who have had the most extensive practice. A
medical education, founded on a knowledge of anatomy, is, therefore, not
only indispensable to prevent the most fatal errors, but to enable a
person to obtain advantage from those sources of improvement which
extensive practice may open to him.
To the surgeon, anatomy is eminently what Bacon has so beautifully said
that knowledge in general is: it is power--it is power to lessen pain,
to save life, and to eradicate diseases, which, without its aid, would
be incurable and fatal. It is impossible to convey to the reader a clear
conception of this truth, without a reference to particular cases; and
the subject is one of such extreme importance, that it may be worth
while to direct the attention for a moment to two or three of the
capital diseases which the surgeon is daily called upon to treat.
Aneurism, for example, is a disease of an artery, and consists of a
preternatural dilatation of its coats. This dilatation arises from the
debility of the vessel, whence, unable to resist the impetus of the
blood, it yields, and is dilated into a sac. When once the disease is
induced, it commonly goes on to increase with a steady and uninterrupted
progress, until at last it suddenly bursts, and the patient expires
instantaneously from loss of blood. When left to itself, it almost
uniformly proves fatal in this manner; yet, before the time of Galen, no
notice was taken of this terrible malady. The ancients, indeed, who
believed that the arteries were air tubes, could not possibly have
conceived the existence of an aneurism. Were the number of individuals
in Europe, who are now annually cured of aneurism, by the interference
of art, to be assumed as the basis of a calculation of the number of
persons who must have perished by this disease, from the beginning of
the world to the time of Galen, it would convey some conception of the
extent to which anatomical knowledge is the means of saving human life.
The only way in which it is possible to cure this disease is, to produce
an obliteration of the cavity of the artery. This is the object of the
operation. The diseased artery is exposed, and a ligature is passed
around it, above the dilatation, by means of which the blood is
prevented from flowing into the sac, and inflammation is excited in the
vessel; in consequence of which its sides adhere together, and its
cavity becomes obliterated. The success of the operation depends
entirely on the completeness of the adhesion of the sides of the vessel,
and the consequent obliteration of its cavity. This adhesion will not
take place unless the portion of the artery to which the ligature is
applied be in a sound state. If it be diseased, as it almost always is
near the seat of the aneurism, when the process of nature is completed
by which the ligature is removed, hemorrhage takes place, and the
patient dies just as if the aneurism had been left to itself. For a long
time the ligature was applied as close as possible to the seat of the
aneurism: the aneurismal sac was laid open in its whole extent, and the
blood it contained was scooped out. The consequence was, that a large
deep-seated sore, composed of parts in an unhealthy state, was formed:
it was necessary to the cure that this sore should suppurate, granulate,
and heal: a process which the constitution was frequently unable to
support. Moreover, there was a constant danger that the patient would
perish from hemorrhage, through the want of adhesion of the sides of the
artery. The profound knowledge of healthy and of diseased structure, and
of the laws of the animal economy by which both are regulated, which
John Hunter had acquired from anatomy, suggested to this eminent man a
mode of operating, the effect of which, in preserving human life, has
placed him high in the rank of the benefactors of his race. This
consummate anatomist saw, that the reason why death so often followed
the common operation was, because that process which was essential to
his success was prevented by the diseased condition of the artery. He
perceived that the vessel, at some distance from the aneurism, was in a
sound state; and conceived, that if the ligature were applied to this
distant part, that is, to a sound instead of a diseased portion of the
artery, this necessary process would not be counteracted. To this there
was one capital objection, that it would often be necessary to apply the
ligature around the main trunk of an artery, before it gives off its
branches, in consequence of which the parts below the ligature would be
deprived of their supply of blood, and would therefore mortify. So
frequent and great are the communications between all the arteries of
the body, however, that he thought it probable, that a sufficient
supply would be borne to these parts through the medium of collateral
branches. For an aneurism in the ham, he, therefore, boldly cut down
upon the main trunk of the artery which supplies the lower extremity;
and applied a ligature around it, where it is seated near the middle of
the thigh, in the confident expectation that, though he thus deprived
the limb of the supply of blood which it received through its direct
channel, it would not perish. His knowledge of the processes of the
animal economy, led him to expect that the force of the circulation
being thus taken off from the aneurismal sac, the progress of the
disease would be stopped; that the sac itself, with all its contents,
would be absorbed; that by this means the whole tumor would be removed,
and that an opening into it would be unnecessary. The most complete
success followed this noble experiment, and the sensations which this
philosopher experienced when he witnessed the event, must have been
exquisite, and have constituted an appropriate reward for the
application of profound knowledge to the mitigation of human suffering.
After Hunter followed Abernethy, who, treading in the footsteps of his
master, for an aneurism of the femoral, placed a ligature around the
external iliac artery; lately the internal iliac itself has been taken
up, and surgeons have tied arteries of such importance, that they have
been themselves astonished at the extent and splendor of their success.
Every individual, on whom an operation of this kind has been
successfully performed, is snatched by it from certain and inevitable
death!
The symptom by which an aneurism is distinguished from every other tumor
is, chiefly its pulsating motion. But when an aneurism has become very
large, it ceases to pulsate; and when an abscess is seated near an
artery of great magnitude, it acquires a pulsating motion; because the
pulsations of the artery are perceptible through the abscess. The real
nature of cases of this kind cannot possibly be ascertained, without a
most careful investigation, combined with an exact knowledge of the
structure and relative position of all the parts in the neighborhood of
the tumor. Pelletan, one of the most distinguished surgeons of France,
was one day called to a man who, after a long walk, was seized with a
severe pain in the leg, over the seat of which appeared a tumor, which
was attended with a pulsation so violent that it lifted up the hand of
the examiner. There seemed every reason to suppose that the case was an
aneurismal swelling. This acute observer, however, in comparing the
affected with the sound limb, perceived in the latter a similar
throbbing. On careful examination he discovered that, by a particular
disposition in this individual, one of the main arteries of the leg (the
anterior tibial) deviated from its usual course, and instead of
plunging deep between the muscles, lay immediately under the skin and
fascia. The truth was, that the man in the exertion of walking, had
ruptured some muscular fibres, and the uncommon distribution of the
artery gave to this accident these peculiar symptoms. The real nature of
this case could not possibly have been ascertained but by an anatomist.
The same surgeon has recorded the case of a man who, having fallen twice
from his horse, and experienced for several years considerable
uneasiness in his back, was afflicted with acute pain in the abdomen. At
the same time an oval, irregularly circumscribed tumor made its
appearance in the right flank. It presented a distinct fluctuation, and
had all the appearance of a collection of matter depending on caries of
the vertebræ. The pain was seated chiefly at the lower portion of that
part of the spine which forms the back, which was, moreover, distorted;
and this might have confirmed the opinion that the case was a lumbar
abscess with caries. Pelletan, however, who well knew that an aneurism,
as it enlarges, may destroy any bone in its neighborhood, saw that the
disease was an aneurism, and predicted that the patient must perish. On
opening the body (for the man lived only ten days after Pelletan first
saw him) an aneurismal tumor was discovered, which nearly filled the
cavity of the abdomen. If this case had been mistaken for lumbar
abscess, and the tumor had been opened with a view of affording an exit
to the matter, the man would have died in a few seconds. There is no
surgeon of discernment or experience whose attention has not been
awakened, and whose sagacity has not been put to the test, by the
occurrence of similar cases in his own practice. The consequence of
error is almost always instantaneously fatal. The catalogue of such
disastrous events is long and melancholy. Richerand has recorded, that
Ferrand, head surgeon of the Hotel Dieu, mistook an aneurism in the
armpit for an abscess; plunged his knife into the swelling, and killed
the patient. De Haen speaks of a person who died in consequence of an
opening which was made, contrary to the advice of Boerhaave in a similar
tumor at the knee. Vesalius was consulted about a tumor in the back,
which he pronounced to be an aneurism; but an ignorant practitioner
having made an opening into it, the patient instantly bled to death.
Nothing can be more easy than to confound an aneurism of the artery of
the neck with the swelling of the glands in its neighborhood: with a
swelling of the cellular substance which surrounds the artery; with
abscesses of various kinds; but if a surgeon were to fall into this
error, and to open a carotid aneurism, his patient would certainly be
dead in the space of a few moments. It must be evident, then, that a
thorough knowledge of anatomy is not only indispensable to the proper
treatment of cases of this description, but also to the prevention of
the most fatal mistakes.
There is nothing in surgery of more importance than the proper treatment
of hemorrhage. Of the confusion and terror occasioned by the sight of a
human being from whom the blood is gushing in torrents, and whose
condition none of the spectators is able to relieve, no one can form an
adequate conception, but those who have witnessed it. In all such cases,
there is one thing proper to be done, the prompt performance of which is
generally as certainly successful, as the neglect of it is inevitably
fatal. It is impossible to conceive of a more terrible situation than
that of a medical man who knows not what to do on such an emergency. He
is confused; he hesitates: while he is deciding what measures to adopt,
the patient expires: he can never think of that man's death without
horror, for he is conscious that, but for his ignorance, he might have
averted his patient's fate. The ancient surgeons were constantly placed
in this situation, and the dread inspired by it retarded the progress of
surgery more than all other causes put together. Not only were they
terrified from interfering with the most painful and destructive
diseases, which experience has proved to be capable of safe and easy
removal, but they were afraid to cut even the most trivial tumor. When
they ventured to remove a part, they attempted it only by means of the
ligature, or by the application of burning irons. When they determined
to amputate, they never thought of doing so until the limb had
mortified, and the dead had separated from the living parts; for they
were absolutely afraid to cut into the living flesh. They had no means
of stopping hemorrhage, but by the application of astringents to the
bleeding vessels, remedies which were inert; or of burning irons, or
boiling turpentine, expedients which were not only inert but cruel.
Surgeons now know that the grand means of stopping hemorrhage is
compression of the bleeding vessel. If pressure be made on the trunk of
an artery, though blood be flowing from a thousand branches given off
from it, the bleeding will cease. Should the situation of the artery be
such as to allow of effectual external pressure, nothing further is
requisite: the pressure being applied, the bleeding is stopped at once:
should the situation of the vessel place it beyond the reach of external
pressure, it is necessary to cut down upon it, and to secure it by the
application of a ligature. Parè may be pardoned for supposing that he
was led to the discovery of this invaluable remedy by the inspiration of
the Deity. By means of it the most formidable operations may be
undertaken with the utmost confidence, because the wounded vessels can
be secured the moment they are cut: by the same means the most
frightful hemorrhages may be most effectually stopped: and even when the
bleeding is so violent as to threaten immediate death, it may often be
averted by the simple expedient of placing the finger upon the wounded
vessel, until there is time to tie it. But it is obvious that none of
these expedients can be employed, and that these bleedings can neither
be checked at the moment, nor permanently stopped, without such a
knowledge of the course of the trunks and branches of vessels, as can be
acquired only by the study of anatomy.
The success of amputation is closely connected with the knowledge of the
means of stopping hemorrhage. Not to amputate is often to abandon the
patient to a certain and miserable death. And all that the surgeon
formerly did, was to watch the progress of that death: he had no power
to stop or even to retard it. The fate of Sir Philip Sidney is a
melancholy illustration of this truth. This noble minded man, the light
and glory of his age, was cut off in the bloom of manhood, and the midst
of his usefulness, by the wound of a musket bullet in his left leg, a
little above the knee, "when extraction of the ball, or amputation of
the limb," says his biographer, "would have saved his inestimable life:
but the surgeons and physicians were unwilling to practice the one, and
knew not how to perform the other. He was variously tormented by a
number of surgeons and physicians for three weeks." Amputation indeed
was never attempted, except where mortification had itself half
performed the operation. The just apprehension of an hemorrhage which
there was no adequate means of stopping, checked the hand of the boldest
surgeon, and quailed the courage of the most daring patient--and if ever
the operation was resorted to, it almost always proved fatal: the
patient generally expired, according to the expression of Celsus, "_in
ipso opere_." How could it be otherwise? The surgeon cut through the
flesh of his patient with a red hot knife: this was his only means of
stopping the hemorrhage: by this expedient he sought to convert the
whole surface of the stump into an eschar: but this operation, painful
in its execution, and terrible in its consequences, when it even
appeared to succeed, succeeded only for a few days; for the bleeding
generally returned, and proved fatal as soon as the sloughs or dead
parts became loose. Plunging the stump into boiling oil, into boiling
turpentine, into boiling pitch, for all these means were used, was
attended with no happier result, and after unspeakable suffering, almost
every patient perished. In the manner in which amputation is performed
at present, not more than one person in twenty loses his life in
consequence of the operation, even taking into the account all the cases
in which it is practised in hospitals. In private practice, where many
circumstances favor its success, it is computed that 95 persons out of
100 recover from it, when it is performed at a proper time, and in a
proper manner. It seems impossible to exhibit a more striking
illustration of the great value of anatomical knowledge.
But if there be any disease, which, from the frequency of its
occurrence, from the variety of its forms, from the difficulty of
discriminating between it and other maladies, and from the danger
attendant on almost all its varieties, requires a combination of the
most minute investigation, with the most accurate anatomical knowledge,
it is that of hernia. This disease consists of a protrusion of some of
the viscera of the abdomen, from the cavity in which they are naturally
contained, into a preternatural bag, composed of the portion of the
peritoneum (the membrane which lines the abdomen) which is pushed before
them. It is computed that one sixteenth of the human race are afflicted
with this malady. It is sometimes merely an inconvenient complaint,
attended with no evil consequences whatever; but there is no form of
this disease, which is not liable to be suddenly changed, and by slight
causes, from a perfectly innocent state, into a condition which may
prove fatal in a few hours. The disease itself occurs in numerous
situations; it may be confounded with various diseases; it may exist in
the most diversified states; it may require, without the loss of a
single moment, a most important and delicate operation; and it may
appear to demand this operation, while the performance of it may really
be not only useless, but highly pernicious.
The danger of hernia depends on its passing into that state which is
technically termed strangulation. When a protruded intestine suffers
such a degree of pressure, as to occasion a total obstruction to the
passage of its contents, it is said to be strangulated. The consequence
of pressure thus producing strangulation is, the excitement of
inflammation: this inflammation must inevitably prove fatal, unless the
pressure be promptly removed. In most cases, this can be effected only
by the operation. Two things, then, are indispensable: first, the
ability to ascertain that the symptoms are really produced by pressure,
that is, to distinguish the disease from the affections which resemble
it; and secondly, when this is effected, to perform the operation with
promptitude and success. The distinction of strangulated hernia from
affections which resemble it, often requires the most exact knowledge
and the most minute investigation. The intestine included in a hernial
sac, may be merely affected with colic, and thus give rise to the
appearance of strangulation. It may be in a state of irritation,
produced, for example, by unusual fatigue; and from this cause, may be
attacked with the symptoms of inflammation. Inflammation may be excited
in the intestine, by the common causes of inflammation, which the hernia
may have no share in inducing, and of which it may not even participate.
Were this case mistaken, and the operation performed, it would not only
be useless, but pernicious: while the attention of the practitioner
would be diverted from the real nature of the malady; the prompt and
vigorous application of the remedies which alone could save the patient,
would be neglected, and he would probably perish. On the other hand, a
very small portion of intestine may become strangulated, and urgently
require the operation. But there may be no tumor; all the symptoms may
be those, and, on a superficial examination, only those, of inflammation
of the bowels. Were the real nature of this case mistaken, death would
be inevitable. Nothing is more common than fatal errors of this kind. It
is only a few months ago, that a physician was called in haste to a
person who was said to be dying of inflammation of the bowels. Before he
reached the house the man was dead. He had been ill only three days. On
looking at the abdomen, there was a manifest hernia: the first glance
was sufficient to ascertain the fact. The practitioner in attendance had
known nothing of the matter; he had never suspected the real nature of
the disease, and had made no inquiry which could have led to the
detection of it. Here was a case which might probably have been saved,
but for the criminal ignorance and inattention of the practitioner.
Whenever there are symptoms of inflammation of the bowels, examination
of the abdomen is indispensable: and the life of the patient will depend
on the care and accuracy with which the investigation is made.
But it is possible that inflammation may attack the parts included in
the hernial sac, without arising from the hernia itself. The
inflammation may be produced by the common causes of inflammation; there
may be no pressure: there may be no strangulation: the swelling may be
the seat, not the cause of the disease. In this case, too, the operation
would be both useless and pernicious. Now all these are diversities
which it is of the highest importance to discriminate. In some of them,
life depends on the clearness, accuracy, and promptitude, with which the
discrimination is made. Promptitude is of no less consequence than
accuracy. If the decision be not formed and acted on at once, it will be
of no avail. The rapidity of the progress of this disease is often
frightful. We have mentioned a case in which it was fatal in three days,
but it not unfrequently terminates fatally in less than twenty four
hours. Sir Astley Cooper mentions a case in which the patient was dead
in eight hours after the commencement of the disease. Larrey has
recorded the case of a soldier in whom a hernia took place, which was
strangulated immediately. He was brought to the "ambulance" instantly,
and perished in two hours with gangrene of the part, and of the
abdominal viscera. This was the second instance which had occurred to
this surgeon of a rapidity thus appalling. What clearness of judgment,
what accuracy of knowledge, what promptitude of decision, are necessary
to treat such a disease with any chance of success!
The moment that a case is ascertained to be strangulated hernia, an
attempt must be made to liberate the parts from the stricture, and to
replace them in their natural situation. This is first attempted by the
hand, and the operation is technically termed the _taxis_. The patient
must be placed in a particular position; pressure must be made in a
particular direction; it is impossible to ascertain either, without an
accurate knowledge of the parts. If pressure be made in a wrong
direction, and in a rough and unscientific manner, the organs protruded
instead of being urged through a proper opening, are bruised against the
parts which oppose their return. Many cases are on record, in which
gangrene and even rupture of the intestine, have been occasioned in this
manner. When the parts cannot be returned by the hand, assisted by those
remedies which experience has proved to be beneficial, the operation
must be performed without the delay of a moment. To its proper
performance two things are necessary. First, a minute anatomical
knowledge of the various and complicated parts which are implicated in
it; and secondly, a steady, firm, and delicate command of the knife. In
the first place, the integuments must be divided; the cellular substance
which intervenes between the skin and the hernial sac must be removed
layer by layer with the knife and the dissecting forceps; the sac itself
must be opened: this part of the operation must be performed with the
most extreme caution: the sac being laid open, the protruded organs are
now exposed to view. The operator must next ascertain the exact point
where the stricture exists; having discovered its seat, he must make his
incision with a particular instrument--in a certain direction--to a
definite extent. On account of the nature of the parts implicated in the
operation, and the proximity of vessels, life depends on an exact
knowledge and a precise and delicate attention to all these
circumstances. How can this knowledge be obtained, how can this
dexterity be acquired, without a profound acquaintance with anatomy, and
how can this be acquired without frequent and laborious dissection? The
eye must become familiar with the appearance of the integuments, with
the appearance of the cellular substance beneath it, with the
appearance of the hernial sac, and of the changes which it undergoes by
disease; with the appearance of the various viscera contained in it, and
of their changes: and the hand must pay that steady and prompt obedience
to the judgment, which nothing but knowledge, and the consciousness of
knowledge, can command. Even this is not all. When the operation has
been performed thus far with perfect skill and success, the most
opposite measures are required according to the actual state of the
organs contained in the sac. If they are agglutinated together--if
portions of them are in a state of mortification, to return them into
the cavity of the abdomen in that condition, would, in general, be
certain death. Preternatural adhesion must be removed; mortified
portions must be cut away: but how can this possibly be done without an
acquaintance with healthy and diseased structure, and how can this be
obtained without dissecting the organs in a state of health and of
disease?
It has been stated that the progress of strangulated hernia to a fatal
termination is often frightfully rapid; in certain cases to delay the
operation, even for a very short period, is, therefore, to lose the only
chance of success. But ignorant and half informed surgeons are afraid to
operate. They are conscious that the operation is one of immense
importance: they know that in the hands of an operator ignorant of
anatomy, it is one of extreme hazard: they therefore put off the time as
long as possible: they have recourse to every expedient: they resort to
every thing but the only efficient remedy, and when at last they are
compelled by a secret sense of shame to try that, it is too late. All
the best practical surgeons express themselves in the strongest language
on the importance of performing the operation early, if it be performed
at all. On this point there is a perfect accordance between the most
celebrated practitioners on the continent, and the great surgeons of our
own country: all represent, in many parts of their writings, the
dangerous and fatal effects of delay. Mr. Hey in his Practical
Observations, states that when he first began to practice, he considered
the operation as the last resource, and only to be employed when the
danger appeared imminent. "By this dilatory mode of practice," says he,
"I lost three patients in five, upon whom the operation was performed.
Having more experience of the urgency of the disease, I made it my
custom, when called to a patient who had laboured two or three days
under the disease, to wait only about two hours, that I might try the
effect of bleeding (if that evacuation was not forbidden by some
peculiar circumstance of the case) and the tobacco clyster. In this mode
of practice, I lost about two patients in nine, upon whom I operated.
This comparison is drawn from cases nearly similar, leaving out of the
account those cases in which gangrene of the intestine had taken place.
I have now, at the time of writing this, performed the operation
thirty-five times; and have often had occasion to lament that I
performed it too late, but never that I had performed it too soon."
These observations are sufficient to show the importance of anatomy in
certain surgical diseases. The state of medical opinion from the
earliest ages to the present time, furnishes a most instructive proof of
its necessity to the detection and cure of disease in general. The
doctrines of the father of physic were in the highest degree vague and
unmeaning. Every thing is resolved by Hippocrates into a general
principle, which he terms nature; and to which he ascribes intelligence;
which he clothes with the attributes of justice; and which he represents
as possessing virtues and powers, which he says are her servants, and by
means of which she performs all her operations in the bodies of animals,
distributes the blood, spirits, and heat, through all the parts of the
body, and imparts to them life and sensation. He states that the manner
in which she acts, is by attracting what is good or agreeable to each
species, and retaining, preparing, and changing it: or, on the other
hand, by rejecting whatever is superfluous or hurtful, after she has
separated it from the good. This is the foundation of the doctrine of
depuration, concoction, and crisis in fevers, so much insisted on by
him, and by other physicians after him; but when he explains what he
means by nature, he resolves it into heat, which he says appears to have
something immortal in it.
The great opponent of Hippocrates was Asclepiades. He asserted that
matter, considered in itself, is of an unchangeable nature: that all
perceptible bodies are composed of a number of small ones, termed
corpuscles, between which there are interspersed an infinity of small
spaces totally devoid of matter: that the soul itself is composed of
these corpuscles: that what is called nature is nothing more than matter
and motion: that Hippocrates knew not what he said when he spoke of
nature as an intelligent being, and ascribed to her various qualities
and virtues: that the corpuscles, of which all bodies are composed, are
of different figures, and consist of different assemblages: that all
bodies contain numerous pores, or interstices, which are of different
sizes: that the human body, like all other bodies, possesses pores
peculiar to itself: that these pores are larger or smaller, according as
the corpuscles which pass through them differ in magnitude: that the
blood consists of the largest, and the spirits and the heat of the
smallest. On these principles, Asclepiades founded his theory of
medicine. He maintains, that as long as the corpuscles are freely
received by the pores, the body remains in its natural state: that, on
the contrary, as soon as any obstacle obstructs their passage, it begins
to recede from that state: that, therefore, health depends on the just
proportion between these pores and corpuscles: that, on the contrary,
disease proceeds from a disproportion between them: that the most usual
obstacle arises from a retention of some of the corpuscles in their
ordinary passages, where they arrive in too large a number, or are of
irregular figures, or move too fast or proceed too slow: that phrensies,
lethargies, pleurises, burning fevers for example, are occasioned by
these corpuscles stopping of their own accord: that pain is produced by
the stagnation of the largest of all these corpuscles, of which the
blood consists: that, on the contrary, deliriums, languors,
extenuations, leanness and dropsies, derive their origin from a bad
state of the pores, which are too much relaxed, or opened: that dropsy,
in particular, proceeds from the flesh being perforated with various
small holes, which convert the nourishment received into them into
water: that hunger is occasioned by an opening of the large pores of the
stomach and belly: that thirst arises from an opening of the small
pores: that intermittent fevers have the same origin: that quotidian
fever is produced by a retention of the largest corpuscles; tertian
fever by a retention of corpuscles somewhat smaller; and quartan fever
by a retention of the smallest corpuscles of all.
Galen maintained that the animal body is composed of three principles,
namely, the solids, the humors, and the spirits. That the solid parts
consist of similar and organic: that the humors are four in number,
namely, the blood, the phlegm, the yellow bile, and the black bile: that
the spirits are of three kinds, namely, the vital, the animal, and the
natural: that the vital spirit is a subtle vapour which arises from the
blood, and which derives its origin from the liver, the organ of
sanguification: that the spirits thus formed, are conveyed to the heart,
where, in conjunction with the air drawn into the lungs by respiration,
they become the matter of the second species, namely, of the vital
spirits: that in their turn, the vital spirits are changed into the
animal in the brain, and so on.
At last came Paracelsus, who was believed to have discovered the elixir
of life, and who is the very prince of charlatans. He delivered a course
of lectures on the theory and practice of physic in the University of
Basle, which he commenced by burning the works of Galen and Avicenna in
the presence of his auditory. He assured his hearers, that his
shoe-latchets had more knowledge than both these illustrious authors
put together: that all the academies in the world had not so much
experience as his beard; and that the hair on the back of his neck was
more learned than the whole tribe of authors. It was fitting that a
person of such splendid pretensions should have a magnificent name. He,
therefore, called himself PHILIPPUS AUREOLUS THEOPHRASTUS PARACELSUS
BOMBAST VON HOHENHEIM. He was a great chemist, and like other chemists,
he was a little too apt to carry into other sciences "the smoke and
tarnish of the furnace." He conceived that the elements of the living
system were the same as those of his laboratory, and that sulphur, salt,
and quicksilver, were the constituents of organized bodies. He taught
that these constituents were combined by chemical operations: that their
relations were governed by Archeus, a demon, who performed the part of
alchemist in the stomach, who separated the poisonous from the nutritive
part of the food, and who communicated the tincture by which the food
became capable of assimilation: that this governor of the stomach, this
_spiritus vitæ_, this astral body of man, was the immediate cause of all
diseases, and chief agent in their cure: that each member of the body
had its peculiar stomach, by which the work of secretion was effected:
that diseases were produced by certain influences, of which there were
five in particular, viz. _ens estrale_, _ens veneni_, _ens naturale_,
_ens spirituale_, and _ens deale_: that when Archeus was sick,
putrescence was occasioned, and that either _localiter_ or
_emunctorialiter_, &c. &c. &c.
It would be leading to a detail which is incompatible with our present
purpose to follow these speculations, or to give an account of the
doctrines of the mechanical physicians, who believed that every
operation of the animal economy was explained by comparing it to a
system of ropes, levers, and pulleys, united with a number of rigid
tubes of different lengths and diameters, containing fluids which, from
variations in their impelling causes, moved with different degrees of
velocity: or of the chemical physicians, whose manner of theorizing and
investigating would have qualified them better for the occupation of the
brewer or of the distiller, than for that of the physician. All these
speculations are idle fancies, without any evidence whatever to support
them; and it has been argued that, for this very reason, they must have
been without any practical result, and that, therefore, if they were
productive of no benefit, they were, at least, innoxious. No opinion can
be more false or pernicious. These wretched theories not only pre
occupied the mind, prevented it from observing the real phenomena of
health and of disease, and the actual effect of the remedies which were
employed, and thus put an effectual stop to the progress of the
science: but they were productive of the most direct and serious evils.
It is no less true in medicine than in philosophy and morals, that there
is no such thing as innoxious error; that men's opinions invariably
influence their conduct; and that physicians, like other men, act as
they think. Asclepiades, whose mind was full of corpuscles and
interstices, was intent on finding suitable remedies, which he
discovered in gestation, friction, and the use of wine. By various
exercises, he proposed to render the pores more open, and to make the
juices and corpuscles, the retention of which causes disease, to pass
more freely. Hence he used gestation from the very beginning of the most
burning fevers. He laid it down as a maxim, that one fever was to be
cured by another; that the strength of the patient was to be exhausted
by making him watch and endure thirst to such a degree, that for the
first two days of the disorder he would not allow them to cool their
mouths with a drop of water. Abernethy's regulated diet is luxurious
compared to his plan of abstinence. For the three first days he allowed
his patients no aliment whatever; on the fourth, he so far relented as
to give to some of them a small portion of food; but from others he
absolutely withheld all nourishment till the seventh day. And this is
the gentleman who laid it down as a maxim, that all diseases are to be
cured "_Tuto, celeriter et jucunde_." To be sure he was a believer in
the doctrine of compensation; and in the latter stage of their diseases
endeavored to recompense his patients for the privations he caused them
to endure in the beginning of their illness. Celsus observes, that
though he treated his patients like a butcher during the first days of
the disorder, he afterwards indulged them so far as to give directions
for making their beds in the softest manner. He allowed them abundance
of wine, which he gave freely in all fevers; he did not forbid it even
to those afflicted with phrenzy: nay, he ordered them to drink it till
they were intoxicated; for, said he, it is absolutely necessary that
persons who labor under phrenzy should sleep, and wine has a narcotic
quality. To lethargic patients, he prescribed it with great freedom, but
with the opposite purpose of rousing them from their stupor. His great
remedy in dropsy was friction, which, of course, he employed to open the
pores. With the same view, he enjoined active exercise to the sick; but
what is a little extraordinary, he denied it to those in health.
Eristratus, who was a great speculator, and whose theories had the most
important influence on his practice, banished blood-letting altogether
from medicine, for the following notable reasons: because, he says, we
cannot always see the vein we intend to open; because we are not sure
we may not open an artery instead of a vein; because we cannot
ascertain the true quantity to be taken; because, if we take too little,
the intention is not answered; if too much, we may destroy the patient;
and because the evacuation of the venous blood is succeeded by that of
the spirits, which thus pass from the arteries into the veins;
wherefore, blood-letting ought never to be used as a remedy in disease.
Yet, though he was thus cautious in abstracting blood, it must not be
supposed that he was not a sufficiently bold practitioner. In tumor of
the liver, he hesitated not to cut open the abdomen, and to apply his
medicines immediately to the diseased organ; but though he took such
liberties with the liver, he regarded with the greatest apprehension the
operation of tapping in dropsy of the abdomen: because, said he, the
waters being evacuated, the liver which is inflamed and become hard like
a stone, is more pressed by the adjacent parts, which the waters kept at
a distance from it, whence the patient dies.
One physician conceived that gout originated from an effervescence of
the synovia of the joints with the vitriolated blood: whence he
recommended alcohol for its cure: a remedy for which the court of
aldermen ought to have voted him a medal. A more ancient practitioner,
who believed that the finger of St. Blasius was very efficacious "for
removing a bone which sticks in the throat," maintained that gout was
the "grand drier," and prescribed a remedy for it, which the patient was
to use for a whole year, and to observe the following diet each month.
In September, he must eat and drink milk; in October, he must eat
garlic; in November, he is to abstain from bathing; in December, he must
eat no cabbage; in January, he is to take a glass of pure wine in the
morning; in February, to eat no beef; in March, to mix several things
both in eatables and drinkables; in April, not to eat horse-radish; nor
in May, the fish called Polypus; in June, he is to drink cold water in a
morning; in July, to avoid venery; and lastly, in August, to eat no
mallows.
A third physician deduced all diseases from inspissation of the fluids;
hence he attached the highest importance to diluent drinks, and believed
that tea, especially, is a sovereign remedy in almost every disease to
which the human frame is subject; "tea," says Bentekoe, who is loudest
in his praises of this panacea, and who, as Blumenbach observes,
'deserved to have been pensioned by the East India Company for his
services,' "tea is the best, nay, the only remedy for correcting
viscidity of the blood, the source of all diseases, and for dissipating
the acid of the stomach, as it contains a fine oleaginous volatile salt,
and certain subtle spirits which are analogous in their nature to the
animal spirits. Tea fortifies the memory and all the intellectual
faculties: it will therefore furnish the most effectual means of
improving physical education. Against fever there is no better remedy
than forty or fifty cups of tea, swallowed immediately after one
another, the slime of the pancreas is thus carried off."
Another physician derived all his diseases from a redundancy or
deficiency of fire and water. He maintained that where the water
predominated, the fluids became viscid, and that hence arose
intermittent fevers and arthritic complaints. His remedies are in strict
conformity to his theory. These diseases are to be cured by volatile
salts, which abound with fiery particles; venesection in any case is
highly pernicious; these fiery medicines are the only efficacious
remedies, and are to be employed even in diseases of the most
inflammatory nature. "Life," says Dr. Brown, "is a forced state;" it is
a flame kept alive by excitement; every thing stimulates; some
substances too violently; others not sufficiently; there are thus two
kinds of debility, indirect and direct, and to one or other of these
causes must be referred the origin of all diseases. According to this
doctrine, the mode of cure is simple: we have nothing to do but to
supply, to moderate or to abstract stimuli. Typhus fever, in this
system, is a disease of extreme debility; we must therefore give the
strongest stimulants. Consumption and apoplexy, also, are diseases of
debility; of course, the remedies are active stimulants. Humanity
shudders, and with reason, at the application of such doctrines to
practice. And not less destitute of reason, and not less dangerous in
practice, is the great doctrine of debility promulgated by Cullen. This
celebrated professor taught, that the circumstance which invariably
characterised fever, that which constituted its essence, was debility.
The inference was obvious, that, above all things, the strength must be
supported. The consequence was, that blood-letting was neglected, and
that bark and wine were given in immense quantities, in cases in which
intense inflammation existed. The practice was in the highest degree
mortal; the number of persons who have perished in consequence of this
doctrine is incalculable. So far then is it from being true, that
medical theories are of no practical importance, there is the closest
possible connection between the speculations of the physician in his
closet, and the measures which he adopts at the bed side of his patient.
Truth to him is a benignant power, which stops the progress of disease,
protracts the duration of life, and mitigates the suffering it may be
unable to remove: error is a fearfully active and tremendously potent
principle. There is not a medical prejudice which has not slain its
thousands, nor a false theory which has not immolated its tens of
thousands. The system of medicine and surgery which is established in
any country, has a greater influence over the lives of its inhabitants
than the epidemic diseases produced by its climate, or the decisions of
its government concerning peace and war. The devastations of the yellow
fever will bear no comparison with the ravages committed by the
Brunonian system; and the slaughter of the field of Waterloo counts not
of victims, a tithe of the number of which the Cullenian doctrine of
debility can justly boast. Anatomy alone will not teach a physician to
think, much less to think justly; but it will give him the elements of
thinking; it will furnish him with the means of correcting his errors;
it will certainly save him from some delusions, and will afford to the
public the best shield against his ignorance, which may be fatal, and
against his presumption, which may be devastating.
We have entered into this minute detail at the hazard, we are aware, of
tiring the reader; but in the hope of leaving on his mind a more
distinct impression of the importance of anatomical knowledge, than
could possibly be produced by a mere allusion to the circumstances which
have been explained. In all ages, formidable obstacles have opposed the
prosecution of anatomical investigations. Among these, without doubt,
the most powerful has its source in a feeling which is natural to the
heart of man. The sweetest, the most sacred associations are
indissolubly connected with the person of those we love. It is with the
corporeal frame that our senses have been familiar: it is that on which
we have gazed with rapture; it is that which has so often been the
medium of conveying to our hearts the thrill of exstacy. We cannot
separate the idea of the peculiarities and actions of a friend from the
idea of his person. It is for this reason that "every thing which has
been associated with him acquires a value from that consideration; his
ring, his watch, his books, and his habitation. The value of these as
having been his, is not merely fictitious; they have an empire over my
mind; they can make me happy or unhappy; they can torture and they can
tranquilize; they can purify my sentiments, and make me similar to the
man I love; they possess the virtue which the Indian is said to
attribute to the spoils of him he kills, and inspire me with the power,
the feelings, and the heart of their preceding master." It is nothing,
says the survivor, to tell me, when disease completed its work and death
has seized its prey, that that body, with which are connected so many
delightful sensations, is a senseless mass of matter: that it is no
longer my friend; that the spirit which animated it, and rendered it
lovely to my sight and dear to my affections, is gone. I know that it is
gone, I know that I never more shall see the light of intelligence
brighten that countenance, nor benevolence beam in that eye, nor the
voice of affection sound from those lips: that which I loved, and which
loved me, is not here: but here are still the features of my friend:
this is his form, and the very particles of matter which compose this
dull mass, a few hours ago were a real part of him, and I cannot
separate them, in my imagination, from him. And I approach them with the
profounder reverence; I gaze upon them with the deeper affection,
because they are all that remain to me. I would give all that I possess
to purchase the art of preserving the wholesome character and rosy hue
of this form, that it might be my companion still: but this is
impossible: I cannot detain it from the tomb: but when I have "cast a
heap of mould upon the person of my friend, and taken the cold earth for
its keeper," I visit the spot in which it is deposited with awe: it is
sacred to my imagination: it is dear to my heart. There is a real and
deep foundation for these feelings in human nature: they arise
spontaneously in the bosom of man, and we see their expression and their
power in the customs of all nations, savage as well as civilized, and in
the conduct of all men, the most ignorant and uncultivated no less than
the most intelligent and refined. It has been the policy of society to
foster these sentiments. If has been conceived that the sanctity which
attaches to the dead, is reflected back in a profounder feeling of
respect for the living; that the solemnity with which death is regarded,
elevates, in the general estimation, the value of life; and that he who
cannot approach the mortal remains of a fellow creature without an
emotion of awe, must regard with horror every thing which places in
danger the life of a human being. Religion has contributed indirectly,
but powerfully, to the strength and perpetuity of these impressions; and
superstition has availed herself of them to play her antics, and to
accomplish her base and malignant purposes. It is not the eradication of
these feelings that can be desired, but their control: it is not the
extinction of these natural and useful emotions that is pleaded for, but
they should give way to higher considerations when these exist.
Veneration for the dead is connected with the noblest and sweetest
sympathies of our nature: but the promotion of the happiness of the
living is a duty from which we can never be exonerated.
In antient times the voice of reason could not be heard. Superstition,
and customs founded on superstition, excited an influence which was
neither to be resisted nor evaded. Dissection was then regarded with
horror. In the warm countries of the east, the pursuit must have been
highly offensive and even dangerous, and it was absolutely incompatible
with the notions and ceremonies universally prevalent in those days.
The Jewish tenet of pollution must have formed an insuperable obstacle
to the cultivation of anatomy amongst that people. By the Egyptians,
every one who cut open a dead body was regarded with inexpressible
horror. The Grecian philosophers so far overcame the prejudice, as
occasionally to engage in the pursuit, and the first dissection on
record was one made by Democritus of Abdera, the friend of Hippocrates,
in order to discover the course of the bile. The Romans contributed
nothing to the progress of the art: they were content with propitiating
the Deities who presided over health and disease. They erected on the
Palatine Mount a temple to the goddess Febris, whom they worshipped from
a dread of her power. They also sacrificed to the goddess Ossipaga, who,
it seems, presided over the growth of the bones, and to another styled
Carna, who took care of the viscera, and to whom they offered bean broth
and bacon, because these were the most nutritious articles of diet. The
Arabians adopted the Jewish notion of pollution, and were thus
prohibited by the tenets of their religion from practising dissection.
Abdollaliph, who flourished about the year 1200, a man of learning and a
teacher of anatomy, never saw and never thought of a human dissection.
In order to examine and demonstrate the bones, he took his students to
burying grounds, and earnestly recommended them, instead of reading
books, to adopt that method of study: yet he seemed to have no
conception that the dissection of a recent subject might be a still
better method of learning. Christians were equally hostile to
dissection. Pope Boniface the 8th issued a bull prohibiting even the
maceration and preparation of skeletons. The priests were the only
physicians, and so greatly did they abuse the office they assumed, that
the evil at length became too intolerable to be borne. The church itself
was obliged to prohibit the priesthood from interfering with the
practice of medicine. All monks and canons who applied themselves to
physic, were threatened with severe penalties, and all bishops, abbots,
and priors who connived at their misconduct, were ordered to be
suspended from their ecclesiastical functions. But it was not till three
hundred years after this interdiction, that by a special bull which
permitted physicians to marry, their complete separation from the clergy
was effected.
In the 14th century, Mundinus, professor at Bologna, astonished the
world by the public dissection of two human bodies. In the 15th century,
Leonardo da Vinci contributed essentially to the progress of the art, by
the introduction of anatomical plates, which were admirably executed. In
the 16th century, the Emperor, Charles the 5th, ordered a consultation
to be held by the divines of Salamanca, to determine whether it was
lawful, in point of conscience, to dissect a dead body in order to learn
its structure. In the 17th century, Cortesius, professor of anatomy at
Bologna, and afterwards professor of medicine at Messina, had long begun
a treatise on practical anatomy, which he had an earnest desire to
finish, but so great was the difficulty of prosecuting the study even in
Italy, that in 24 years he could only twice procure an opportunity of
dissecting a human body, and even then with difficulty and in hurry;
whereas, he had expected to have done so, he says, once every year,
according to the custom of the famous academies of Italy. In Muscovy,
until very lately, both anatomy and the use of skeletons were positively
forbidden; the first as inhuman, and the latter as subservient to
witchcraft. Even the illustrious Luther was so biassed by the prejudices
of his age, that he ascribed the majority of the diseases to the arts of
the devil, and found great fault with physicians when they attempted to
account for them by natural causes. England acquired the bad fame of
being the country of witches, and opposed almost insuperable obstacles
to the cultivation of anatomy. Even at present the prejudices of the
people on this subject are violent and deeply rooted. The measure of
that violence may be estimated by the degree of abhorrence with which
they regard those persons who are employed to procure the subjects
necessary for dissection. In this country, there is no other method of
obtaining subjects but that of exhumation: aversion to this employment
may be pardoned: dislike to the persons who engage in it is natural, but
to regard them with detestation, to exult in their punishment, to
determine for themselves its nature and measure, and to endeavor to
assume the power of inflicting it with their own hands, is absurd.
Magistrates have too often fostered the prejudices of the people, and
afforded them the means of executing their vengeance on the objects of
their aversion. The press has uniformly allied itself with the ignorance
and violence of the vulgar, and has done every thing in its power to
inflame the passions, which it was its duty to endeavor to soothe. It is
notorious that the winter before last there was scarcely a week in which
the papers did not contain the most exaggerated and disgusting
statements: the appetite which could be gratified with such
representations, was sufficiently degraded: but still more base was the
servility which could pander to it. Half a century ago there was in
Scotland no difficulty in obtaining the subjects which were necessary to
supply the schools of anatomy. The consequence was, that medicine and
surgery assumed new life--started from the torpor in which they had been
spell-bound--and made an immediate, and rapid, and brilliant progress.
The new seminaries constantly sent into the world men of the most
splendid abilities, at once demonstrating the excellence of the schools
in which they were educated, and rendering them illustrious. Pupils
flocked to them from all quarters of the globe, and they essentially
contributed to that advancement of science which the present age has
witnessed. In the 19th century, the good people of Scotland, that
intelligent, that cool and calculating, that most reasonable and
thinking people, have thought proper to return to the worst feeling and
the worst conduct of the darkest periods of antiquity. There is at
present no offence whatever, which seems to have such power to heat and
exalt into a kind of torrent, the blood which usually flows so calmly
and sluggishly in the veins of a Scotchman. The people of 1823 (to
compare great things with small) emulate the spirit of those of their
forefathers who "_were out in the forty-five_;" the object, to be sure,
is somewhat different, but it is amusing to see the intensity and
seriousness of the excitement. About twelve months ago an honest farmer
of the name of Scott, who resides at Linlithgow, apprehended a poor
wight who was pursuing his vocation, we presume, in the churchyard of
that place; and this service appeared so meritorious to the people in
his neighborhood, that they absolutely presented him with a piece of
plate. In the winter sessions of 1822-3, a body was discovered on its
way to the lecture-room of an anatomist in Glasgow, and in spite of the
exertions of the police, aided by those of the military, this
gentleman's premises and their contents, which were valuable, were
entirely destroyed by the mob. For some time after this achievement, it
was necessary to station a military guard at the houses of all the
medical professors in that city. In the spring circuit of the justiciary
court last year at Stirling, while the judges were proceeding to the
court, the procession was assaulted with missiles; several persons were
injured, and it was necessary to call in the protection of a military
force. The object of the mob was to inflict summary punishment on a man
who was about to be tried for the exhumation of a body. We happen to
know that the most disgraceful proceedings were some time ago instituted
in that town against a young gentleman of respectable family and
connections, who was in fact expatriated, and whose prospects in life
were entirely changed, if not ruined, because he had too much honor to
implicate his instructors in a transaction which would have put them to
an inconvenience, and in which they had engaged from a desire faithfully
to discharge their duty to their pupils. Within the last five years
three men were lodged in the county jail at Haddington, charged with a
trespass in the churchyard of that town. So enraged was the mob against
them, that an attempt was made to force the jail in order to get at
them. On their way to the court, the men were again attacked, forced
from the carriage, and severely maimed. After examination they were
admitted to bail; but, when set at liberty, they were assailed with more
violence than ever, and were nearly killed. On the 29th of June, 1823,
being Sunday, a most extraordinary outrage was perpetrated in the
streets of Edinburgh. A coach containing an empty coffin and two men,
was observed proceeding along the south bridge. The people suspecting
that it was intended to convey a body taken from some churchyard, seized
the coach. It was with difficulty that the police protected the men from
the assaults of the populace: the coach they had no power to preserve.
The horses were taken from it, and together with the coffin, after
having been trundled a mile and a half through the streets of the city,
it was deliberately projected over the steep side of the mound, and
smashed into a thousand pieces. The people following it to the bottom,
kindled a fire with its fragments, and surrounded it like the savages in
Robinson Crusoe, till it was entirely consumed. In this case there was
no foundation for their suspicions. The coffin was intended to have
conveyed to his house in Edinburgh the body of a physician who that
morning had died in a cottage near the neighborhood. A similar assault
was some time ago made on two American gentlemen, who went to visit the
abbey of Linlithgow after nightfall. The churchyards of the "gude Scots"
are now strictly guarded by men and dogs; watch-towers are erected
within the grounds, and _mort-safes_, as they are called, that is to
say, strong iron frames are deposited in the ground over the graves.
These people sometimes declare that they will put an end to anatomy, and
certainly they are succeeding in the accomplishment of this menace as
rapidly as they can well desire. The average number of medical students
in Edinburgh is 700 each session. For several years past the difficulty
of procuring subjects in that place has been so great, that out of all
that number, not more than 150 or 200 have ever attempted to dissect;
and even these have latterly been so opposed in their endeavours to
prosecute their studies, that many of them have left the place in
disgust. We have been informed by a friend, that he alone was personally
acquainted with twenty individuals who retired from it at the beginning
of last session, and who went to pursue their studies at Dublin, and we
know that vast numbers followed their example at the end of the winter
course. The medical school at Edinburgh, in fact, is now subsisting
entirely on its past reputation; in the course of a few years it will be
entirely at an end, unless the system be changed. Let those who have the
prosperity of the university at heart, and who have the power to
protect it, consider this before it be too late: they may be assured it
is no idle prediction; for we give them notice, that it is at this
moment the universal opinion and the current language of every
well-informed medical man in England.
An excellent system of anatomical plates, which has been well received
by the profession, has lately been published by Mr. Lizars, a lecturer
on anatomy and physiology, in Edinburgh. This gentleman states that he
has been induced to undertake this work, in order to obviate the most
fatal consequences to the public; as far, at least, as a reference to
art, instead of nature, is capable of obviating those consequences. He
affirms, that the difficulty of obtaining instruction from nature has
risen to such a pitch, owing to the extraordinary severity exercised by
the legal authorities of the kingdom against persons employed in
procuring subjects for dissection, as to threaten the ultimate
destruction of medical and anatomical science. In his preface to the
second part of his work, he apologizes to his readers for dividing one
portion of it from another, with which it ought to have been connected;
but states that he has been compelled to do so from the prejudices of
the place, which prevented him for upwards of five months, from
procuring a subject from which he might make his drawings. "In place of
living," he says, "in a civilized and enlightened period, we appear as
if we had been thrown back some centuries into the dark ages of
ignorance, bigotry and superstition. Prejudices, worthy only of the
multitude, have been conjured up and appealed to, in order to call forth
popular indignation against those whose business it is to exhibit
demonstratively the structure of the human body, and the functions of
its different organs. The public journals, from a vicious propensity to
pander to the vulgar appetite for excitement, have raked up and
industriously circulated stories of exhumation of dead bodies, tending
to exasperate and inflame the passions of the mob; and persons who, by
their own showing, are friendly to the interests of science, have, in
the excess of their zeal that bodies should remain undisturbed in their
progress to decomposition, laboured to destroy in this country, that
art, whose province it is to free living bodies from the consequences
inseparable from accident and disease. And, which is worst of all, the
prejudices of the multitude have been confirmed and rendered inveterate
by the proceedings in our courts of justice, which have visited with the
punishment due only to felons, the unhappy persons necessarily employed
in the present state of the law, in procuring subjects for the
dissecting-room."
He then goes on to state, that until anatomy be publicly sanctioned in
Edinburgh, the school of medicine there can never flourish; that upon
the present system, young men obtain a degree or a diploma after a year
or two of grinding, that is, of learning by rote the answers to the
questions which the examiners are in the habit of putting to the
candidates; that ignorant of the very elements of their profession,
numbers of persons thus educated annually, go to the East and West
Indies, and to the army and navy, where they have the charge of hundreds
of their suffering fellow creatures, to whom they are in fact the
instruments of cruelty and murder. In the preface to the 4th Part, he
adds, that when Part II. was published, in the early part of the
session, he took occasion to express his sorrow for the degraded state
of his profession, and the threatened ruin of the Medical School of his
native place, owing to the scarcity of subjects: That, for doing this,
he has incurred considerable censure: that he regrets that he has yet
found no reason to alter his opinion, for the winter session is now near
its conclusion, and, he candidly declares, that such has been the
scarcity of material, that _no teacher of anatomy or surgery has been
able either to follow the regular plan of his course, or to do his duty
to his pupils_; the consequence of which has been, that many of the
students have left the school in disgust, and gone either to Dublin or
Paris; while a still greater number, deprived of the means of
dissecting, have contented themselves with lectures or theories, and
with grinding; and entered on the practice of their profession ignorant
of its fundamental principles.
Much of this opposition on the part of the people, arises from the
present mode of procuring subjects. Fortunately, there is in Great
Britain no custom, no superstition, no law, and we may add, no
prejudice, against anatomy itself. There is even a general conviction of
its necessity; there may be a feeling that it is a repulsive employment,
but it is commonly acknowledged that it must not be neglected. The
opposition which is made, is made not against anatomy, but against the
practice of exhumation: and this is a practice which ought to be
opposed. It is in the highest degree revolting; it would be disgraceful
to a horde of savages; every feeling of the human heart rises up against
it: so long as no other means of procuring bodies for dissection are
provided, it must be tolerated; but, in itself, it is alike odious to
the ignorant and the enlightened, to the most uncultivated and the most
refined.
But the capital objection to this practice is, that it necessarily
creates a crime, and educates a race of criminals.--Exhumation is
forbidden by the law. It is, indeed, prohibited by no statute, either in
England or Scotland: in both, it is an offence punishable at common law.
There is a statute of James the first, which makes it felony to steal a
dead body for the purpose of witchcraft; there is none against taking a
body for the purpose of dissection. In the case of the King against Lynn
(1788), the court decided that the body being taken for the latter
purpose, did not make it less an indictable offence; and that it is
without doubt cognizable in a criminal court, because it is an act
"highly indecent, at the bare idea of which nature revolts." It is
punishable, therefore, by fine or imprisonment, or both: In Scotland, it
is also punishable by whipping, and even by transportation.
We expected better things of America. We cannot express our astonishment
and indignation, when we found that the state of New York has actually
made it felony to remove a dead body from the place of sepulture for the
purpose of dissection, without providing in any other mode for the
schools of anatomy. This is worse than any thing that exists in any
other part of the world. If these pages should meet the eye of any of
our American brethren, we intreat them to read with attention, the facts
which have been stated in the former part of this article, and to
consider with seriousness the mischief they are doing. It will not be
believed in England, that such scenes could have been witnessed in
America, as were actually exhibited there scarcely a month ago. To
satisfy our readers, however, that we do not misrepresent the state of
things in that country, we transcribe the following accounts from _The
New York Evening Post_, of _May 20th_. "At the late Court of Sessions,
Solomon Parmeli was indicted for a misdemeanor, in entering Potter's
Field, and removing the covers of two coffins deposited in a pit, and
covered partly with earth. _The statute of this state making it a
felony, to dig up or remove a dead human body with intent to dissect
it_, did not embrace this case; because the prisoner had not dug up or
removed the body. Mr. Schureman, the present keeper of Potter's Field,
suspected that some person had entered it for the purpose of removing
the dead; and, after sending for two watchmen, and calling his faithful
dog, he went to ascertain the fact. On arriving at the grave, he found
his suspicion confirmed; and requested the person concealed in the pit,
to come out and show himself: no answer being given, Mr. Schureman sent
his dog into the pit, and in the twinkling of an eye a tall stout fellow
made his appearance, and took to his heels across the field. The night
being dark, he might have effected his escape, had it not been for the
sagacity and courage of the dog, who pursued him for some distance, but
at last came up with him, seized and held him fast, until the arrival of
Mr. Schureman and the watchmen, who secured him. The jury convicted the
prisoner, and the court sentenced him to six months' imprisonment in
the Penitentiary. _The young gentlemen attending the Medical School of
this city, will take warning by this man's fate. They may rest assured,
that the keeper of Potter's Field will do his duty, and public justice
will be executed on any man, whatever may be his condition in life, who
is found violating the law, and the decency of Christian burial!_" The
same paper gives the following account of a transaction, which took
place at Hartford, in Connecticut, May 17. "Yesterday morning, two
ladies were taking a walk in the South burying ground, when they
discovered a tape-string, and a piece of cloth, which upon examination
was found to be the piece that was laced upon Miss Jane Benton's face,
who came to her death by drowning, and was buried a few days since. The
ladies then went to the grave, and found that it had been
disturbed--that she was taken out of her coffin, and a rope around her
neck. The circumstance has produced great excitement in the public mind;
and every one is on the alert to discover the perpetrators of this
unfeeling, brutal act. _The citizens turned out in a body yesterday, and
interred the corpse again!_"
These scenes are highly disgraceful, and disgraceful to all, though not
_alike_ to all parties. We do not blame the Americans for abolishing the
practice of exhumation; but we blame them for stopping there. We
maintain, that it is both absurd and criminal, to make this practice
felony, without providing in some other method for the cultivation of
anatomy.
In Great Britain, the law against the practice of exhumation is not
allowed to slumber. There may be other cases which have not come to our
knowledge; but we have ascertained that there have been 14 convictions
for England alone, during the last year. The punishments inflicted have
been imprisonment for various periods, with fines of different sums. The
fines in general are heavy, considering the poverty of the offenders.
Several persons are, at this moment, suffering these penalties; among
others, there is now in the gaol of St. Alban's, a man who was sentenced
for this offence to two years' imprisonment, and a fine of twenty
pounds. The period of his confinement has expired some time; but he
still remains in prison, on account of his inability to pay the fine.[1]
Since the passing of the new Vagrant act, it has been the common
practice to commit these offenders to hard labour for various periods.
Very lately, two men, convicted of this offence, were sent to the Tread
Mill, in Cold Bath Fields; one of whom died in one month after his
commitment. It is an error to suppose that these punishments operate to
prevent exhumation; their only effect is to raise the price of subjects:
a little reflection will show that they can have no other operation. At
present, exhumation is the only method by which subjects for dissection
can be procured; but subjects for this purpose must be procured: and be
the difficulties what they may, will be procured: diseases will occur,
operations must be performed, medical men must be educated, anatomy must
be studied, dissections must go on. Unless some other means for
affording a supply be adopted; whatever be the law or the popular
feeling, neither magistrates, nor judges, nor juries, will, or can, put
an entire stop to the practice. It is one, which, from the absolute
necessity of the case, must be allowed. What is the consequence? So long
as the practice of exhumation continues, a race of men must be trained
up to violate the law. These men must go out in company for the purpose
of nightly plunder, and plunder of the most odious kind, tending in a
peculiar and most alarming measure to brutify the mind, and to eradicate
every feeling and sentiment worthy of a man. This employment becomes a
school in which men are trained for the commission of the most daring
and inhuman crimes. Its operation is similar, but much worse than the
nightly banding to violate the game laws, because there is something in
the violation of the grave, which tends still more to degrade the
character and to harden the heart. This offence is connived at; nay, it
is rewarded; these men are absolutely paid to violate the law; and paid
by men of reputation and influence in society. The transition is but too
easy to the commission of other offences in the hope of similar
connivance, if not of similar reward.
It is an odious thing that the teachers of anatomy should be brought
into contact with such men: that they should be obliged to employ them,
and that they should even be in their power; which they are to such a
degree, that they are obliged to bear with the wantonness of their
tyranny and insult. All the clamour against these men, all the
punishment inflicted on them, only operate to raise the premium on the
repetition of their offence. This premium the teachers of anatomy are
obliged to pay, which these men perfectly understand, who do not at all
dislike the opposition which is made to their vocation. It gives them no
unreasonable pretext for exorbitancy in their demands. In general, they
are men of infamous character; some of them are thieves, others are the
companions and abettors of thieves. Almost all of them are extremely
destitute. When apprehended for the offence in question, the teachers of
anatomy are obliged to pay the expenses of the trial, and to support
their families while they are in prison: whence the idea of immunity is
associated, in these men's minds, with the violation of the law, and
when they do happen to incur its penalties, they practically find that
they and their families are provided for, and this provision comes to
them in the shape of a reward for the commission of their offence. The
operation of such a system on the minds of the individuals themselves is
exceedingly pernicious, and is not a little dangerous to the community.
Moreover, by the method of exhumation, the supply after all is scanty;
it is never adequate to the wants of the schools; it is of necessity
precarious, and it sometimes fails altogether for several months. But it
is of the utmost importance that it should be abundant, regular, and
cheap.--The number of young men who come annually to London for the
purpose of studying medicine and surgery, may be about a thousand. Their
expenses are necessarily very considerable while in town; they have
already paid a large sum for their apprenticeship in the country; the
circumstances of country practitioners, in general, can but ill afford
protracted expenses for their sons in London; few of them stay a month
longer than the time prescribed by the College of Surgeons. But the
short period they spend in London, is the only time they have for
acquiring the knowledge of their profession. If they mispend these
precious hours, or if the means of employing them properly be denied
them, they must necessarily remain ignorant for life. After they leave
London they have no means of dissecting. We have seen that it is by
dissecting alone, that they can make themselves acquainted even with the
principles of their art; that without it they cannot so much as avail
themselves of the opportunities of improvement, which experience itself
may offer, nor, without the highest temerity, perform a single
operation. We have seen that occasions suddenly occur, which require the
prompt performance of important and difficult operations; we have seen
that unless such operations are performed immediately, and with the
utmost skill, life is inevitably lost. In many such cases, there is no
time to send for other assistance. If a country practitioner (and most
of these young men go to the country) be not himself capable of doing
what is proper to be done, the death of the patient is certain. We put
it to the reader to imagine what the feelings of an ingenuous young man
must be, who is aware of what he ought to do, but who is conscious that
his knowledge is not sufficient to authorise him to attempt to perform
it, and who sees his patient die before him, when he knows that he might
be saved, and that it would have been in his own power to save him, had
he been properly educated. We put it to the reader to conceive what his
own sensations would be, were an ignorant surgeon, with a rashness more
fatal than the criminal modesty of the former, to undertake an important
operation--Suppose it were a tumor, which turned out to be an aneurism;
suppose it were a hernia, in operating on which the epigastric artery
were divided, or the intestine itself wounded: suppose it were his
mother, his wife, his sister, his child, whom he thus saw perish before
his eyes, what would the reader then think of the prejudice which
withholds from the surgeon that information, without which the practice
of his profession is murder?
The study of anatomy is a severe and laborious study; the practice of
dissection is on many accounts highly repulsive: it is even not without
danger to life itself.[2] To men of clear understandings, to those
especially of a philosophical turn of mind, the pursuit is its own
reward; they are so fully satisfied, that the more it is cultivated the
more satisfaction it will afford, that they need no stimulus to induce
them to undergo the drudgery. But this is by no means the case with
ordinary minds. The fatigue and disgust of the dissecting-room, are
appalling to them, and they need the stimulus of necessity to urge them
to the task. The court of examiners of the College of Surgeons, requires
from the candidates for surgical diplomas certificates that they have
gone through at least two courses of dissections; the examiners at
Apothecaries'-hall do not require such certificates. The consequence is,
that many young men content themselves with attending lectures, and with
passing their examinations at Apothecaries'-hall, and do not apply for a
diploma at the College of Surgeons. This single fact is sufficient to
demonstrate to the public, that instead of throwing obstacles in the way
of dissection, it is a duty which they owe to themselves to afford every
possible facility to its practice, and to hold out to every member of
the profession, the most powerful inducements to engage in it, by
rewarding with confidence those who cultivate anatomy, by making
excellence in anatomy indispensable to all offices in dispensaries and
hospitals, and by thus rendering it impossible for any one who is
ignorant of anatomy, to obtain rank in his profession. When a candidate
presents himself for a diploma in Denmark, in his first trial he is put
into a room with a subject, a case of instruments, and a memorandum, and
informed that he is to display the anatomy of the face and neck, or that
of the upper extremity or that of the lower extremity: that by the
anatomy is to be understood, the blood-vessels, nerves, and muscles; and
that as soon as he has accomplished his task, the professors will
attend his summons to judge of his attainments. These professors are the
true examiners!
We shall have entered into the discussion of this subject to little
purpose, if we have not produced in the minds of our readers a deep
conviction, that anatomy ought to form an essential part of medical
education, that anatomy cannot be studied without the practice of
dissection; that dissection cannot be practised without a supply of
subjects, and that the manner in which that supply is obtained in
England is detestable, and ought immediately to be changed. It might be
changed easily. We agree with Mr. Mackenzie, that legislative
interference is necessary; we are satisfied that nothing will be done in
England without it. The plan which Mr. Mackenzie suggests is as follows:
1. That the clause of our criminal code, by which the dissection of the
dead body is made part of the punishment for murder, be repealed. 2.
That the exhumation of dead bodies be punishable as felony. 3. That no
diploma in medicine or surgery, be granted by any faculty, college, or
university, except to those persons who shall produce undoubted evidence
of their having carefully dissected at least five human bodies. 4. That
in each of the hospitals, infirmaries, work-houses, poor-houses,
foundling-houses, houses of correction, and prisons of London,
Edinburgh, Glasgow, and Dublin, and if need be, of all other towns in
Great Britain and Ireland, an apartment be appointed for the reception
of the bodies of all persons dying in the said hospitals, infirmaries,
work houses, poor-houses, foundling-houses, houses of correction, and
prisons, _unclaimed by immediate relatives, or whose relatives decline
to defray the expenses of interment_. 5. That the bodies of all persons
dying in these towns, and, if need be, in all other towns, and also in
country parishes, _unclaimable by immediate relatives, or whose
relatives decline to defray the expenses of interment_, shall be
conveyed to a mort-house appointed in the said towns for their
reception. 6. That no dead bodies shall be delivered from any hospital,
infirmary, work house, poor-house, foundling-house, house of correction,
prison, or mort-house for anatomical purposes, except upon the
requisition of a member of the Royal College of Physicians or of
Surgeons, of London, Edinburgh, or Dublin, or of the Faculty of
Physicians and Surgeons of Glasgow, and upon the payment of twenty
shillings into the hands of the treasurer, of the hospital, infirmary,
work-house, poor-house, foundling-house, house of correction, prison, or
other officer appointed to receive the same. [This is too large a sum.]
7. That no dead body shall be conveyed from a hospital, infirmary,
work-house, poor-house, foundling-house, house of correction, prison,
or mort-house, to a school of anatomy, except in a covered bier, and
between the hours of four and six in the morning. 8. That after the
expiration of twenty-eight days, an officer appointed for this purpose,
in each of the four towns above-mentioned, shall cause the remains of
the dead to be placed in a coffin, removed from the school of anatomy,
where the dead body has been examined, to the mort-house of the town and
decently buried. 9. That the expenses attending the execution of these
regulations, be defrayed out of fees paid by teachers and students of
anatomy, on receiving dead bodies from the hospitals, infirmaries,
work-houses, poor houses, foundling-houses, houses of correction,
prisons, and mort-houses.
To this plan there is but one objection, viz. that it is making the
bodies of the poor public property. The answer is, that the limitation
in the proposed law, which the objection does not notice, entirely
removes the weight of that objection. Though no maxim can be more
indisputable than that those who are supported by the public die in its
debt, and that their remains at least, might, without injustice, be
converted to the public use, yet it is not proposed to dispose in this
manner of the bodies of all the poor: but only of that portion of the
poor who die unclaimed and without friends, and whose appropriation to
this public service could, therefore, afford pain to no one. If any
concession and co-operation on the part of the public, for this great
public object is to be expected, and without concession and co-operation
nothing can be done, it is not easy to conceive of any plan which
requires less public concession or implies less violation of public
feeling. In point of fact it would put no indignity, it would inflict no
injury on the poor; it is the rejection of it that would really and
practically be unjust and cruel. The question is, whether the surgeon
shall be allowed to gain knowledge by operating on the bodies of the
dead, or driven to obtain it by practising on the bodies of the living.
If the dead bodies of the poor are not appropriated to this use, their
living bodies will and must be. The rich will always have it in their
power to select, for the performance of an operation, the surgeon who
has already signalized himself by success: but that surgeon, if he have
not obtained the dexterity which ensures success, by dissecting and
operating on the dead, must have acquired it by making experiments on
the living bodies of the poor. There is no other means by which he can
possibly have gained the necessary information. Every such surgeon who
rises to eminence, must have risen to it through the suffering which he
has inflicted, and the death which he has brought upon hundreds of the
poor. The effect of the entire abolition of the practice of dissecting
the dead, would be, to convert poor-houses and public hospitals into so
many schools where the surgeon, by practising on the poor, would learn
to operate on the rich with safety and dexterity. This would be the
certain and inevitable result: and this, indeed, would be to treat them
with real indignity, and horrible injustice; and proves, how possible it
is to show an apparent consideration for the poor, and yet practically
to treat them in the most injurious and cruel manner.
Nor would the proposed plan be the means of deterring this class of
people from entering the hospitals. There is something reasonable in the
apprehension on which this objection is founded: but the answer to it is
complete, because it is an answer, derived from experience, to an
objection, which is merely a deduction from what is probable. The plan
has been acted on, and found to be unattended with this result: it was
tried in Edinburgh, and the hospital was as full as it is at present: it
is universally acted on in France, and the hospitals are always crowded.
The great advantages of the plan are, that it would accomplish the
proposed object, easily and completely, whereas the plan in operation
effects it imperfectly and with difficulty; and it would put an
immediate and entire stop to all the evils of the present system. At
once it would put an end to the needless education of daring and
desperate violators of the law. It would tranquillize the public mind.
Their dead would rest undisturbed: the sepulchre would be sacred: and
all the horrors which the imagination connects with its violation would
cease for ever.
We have stated, that the plan has been tried. Experience has proved its
efficacy. It was adopted with perfect success in Edinburgh more than a
century ago. In the Council Register for 1694, it is recorded that all
unclaimed dead bodies in the charitable institutions or in the streets,
were given for dissection to the College of Surgeons, to one or two of
its individual members, and to the professor of anatomy. This
regulation, at that period, excited no opposition on the part of the
people, but effectually answered the desired object. All the medical
schools on the continent are supplied with subjects, by public
authority, in a similar manner. We have obtained from a friend in Paris,
a gentleman who is at the head of the anatomical department in that
city, the following account of the manner in which the schools of
anatomy are supplied. It is stated; 1. That the faculty of medicine at
Paris is authorized to take from the civil hospitals, from the prisons,
and from the depôts of mendicity, the bodies which are necessary for
teaching anatomy. 2. That a gratuity of eight pence is given to the
attendants in the hospitals for each body. 3. That upon the foundation
by the National Convention, of schools of health, the statutes of their
foundation declare, that the subjects necessary for the schools of
anatomy shall be taken from the hospitals, and that since this period,
the council of hospitals and the prefect of police, have always
permitted the practice. 4. That M. Breschet, chief of the anatomical
department of the faculty of Paris, sends a carriage daily to the
different hospitals, which brings back the necessary number of bodies:
that this number has sometimes amounted to 2000 per annum for the
faculty only, without reckoning those used in L'Hôpital de la Pitié, but
that since the general attention which has recently been bestowed upon
pathologic anatomy, numbers of bodies are opened in the civil and
military hospitals, and that the faculty seldom obtain more than 1000 or
1200. 5. That, besides the dissections by the faculty of medicine, and
those pursued in L'Hôpital de la Pitié, theatres of anatomy are opened
in all the great hospitals, for the pupils of those establishments: that
in these institutions anatomy is carefully taught, and that pupils have
all the facilities for dissection that can be desired. 6. That the price
of a body varies from four shillings to eight shillings and sixpence. 7.
That after dissection, the bodies are wrapt in cloths, and carried to
the neighbouring cemetery, where they are received for ten-pence. 8.
That the practice of exhumation is abolished: that there are
insurmountable obstacles to the return of that system, and that bodies
are never taken from burial grounds, without an order for exhumation,
which is given only when the tribunals require it for the purpose of
medico-legal investigation. 9. That though the people have an aversion
to the operations of dissection, yet they never make any opposition to
them, provided respect be paid to the laws of decency and salubrity, on
account of the deep conviction that prevails of their utility, 10. That
the relatives of the deceased seldom or never oppose the opening of any
body, if the physicians desire it. That all the medical students in
France, with scarcely any exception, dissect, and that that physician or
surgeon who is not acquainted with anatomy, is universally regarged as
the most ignorant of men.
It is time that the physicians and surgeons of England, should exert
themselves to change a system which has so long retarded the progress of
their science, and been productive of so much evil to the community. We
are persuaded, that there is good sense enough, both in the people and
in the legislature, to listen to their representations. We would advise
them to avail themselves of the means they possess to communicate
information to the people, and to make individual members of parliament
acquainted with the subject. With this view we would recommend the
whole body to act in concert, to appoint a committee for conducting the
matter, and to petition parliament, as soon as they shall have made the
nature of their claims, and the grounds on which they rest, more
generally known. If they act in co-operation with each other, and pursue
their object temperately, and steadily, we cannot but believe, that
their efforts at no distant period, will be crowned with success.
FOOTNOTES:
[1] Since the above was written, we have learned that this man has been
recently liberated, and his fine remitted.
[2] A winter never passes without proving fatal to several students who
die from injuries received in dissection.
End of the Project Gutenberg EBook of Use of the Dead to the Living, by
Thomas Southwood-Smith
*** END OF THIS PROJECT GUTENBERG EBOOK USE OF THE DEAD TO THE LIVING ***
***** This file should be named 58460-8.txt or 58460-8.zip *****
This and all associated files of various formats will be found in:
http://www.gutenberg.org/5/8/4/6/58460/
Produced by Chris Curnow, Martin Pettit and the Online
Distributed Proofreading Team at http://www.pgdp.net (This
file was produced from images generously made available
by The Internet Archive)
Updated editions will replace the previous one--the old editions will
be renamed.
Creating the works from print editions not protected by U.S. copyright
law means that no one owns a United States copyright in these works,
so the Foundation (and you!) can copy and distribute it in the United
States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part
of this license, apply to copying and distributing Project
Gutenberg-tm electronic works to protect the PROJECT GUTENBERG-tm
concept and trademark. Project Gutenberg is a registered trademark,
and may not be used if you charge for the eBooks, unless you receive
specific permission. If you do not charge anything for copies of this
eBook, complying with the rules is very easy. You may use this eBook
for nearly any purpose such as creation of derivative works, reports,
performances and research. They may be modified and printed and given
away--you may do practically ANYTHING in the United States with eBooks
not protected by U.S. copyright law. Redistribution is subject to the
trademark license, especially commercial redistribution.
START: FULL LICENSE
THE FULL PROJECT GUTENBERG LICENSE
PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK
To protect the Project Gutenberg-tm mission of promoting the free
distribution of electronic works, by using or distributing this work
(or any other work associated in any way with the phrase "Project
Gutenberg"), you agree to comply with all the terms of the Full
Project Gutenberg-tm License available with this file or online at
www.gutenberg.org/license.
Section 1. General Terms of Use and Redistributing Project
Gutenberg-tm electronic works
1.A. By reading or using any part of this Project Gutenberg-tm
electronic work, you indicate that you have read, understand, agree to
and accept all the terms of this license and intellectual property
(trademark/copyright) agreement. If you do not agree to abide by all
the terms of this agreement, you must cease using and return or
destroy all copies of Project Gutenberg-tm electronic works in your
possession. If you paid a fee for obtaining a copy of or access to a
Project Gutenberg-tm electronic work and you do not agree to be bound
by the terms of this agreement, you may obtain a refund from the
person or entity to whom you paid the fee as set forth in paragraph
1.E.8.
1.B. "Project Gutenberg" is a registered trademark. It may only be
used on or associated in any way with an electronic work by people who
agree to be bound by the terms of this agreement. There are a few
things that you can do with most Project Gutenberg-tm electronic works
even without complying with the full terms of this agreement. See
paragraph 1.C below. There are a lot of things you can do with Project
Gutenberg-tm electronic works if you follow the terms of this
agreement and help preserve free future access to Project Gutenberg-tm
electronic works. See paragraph 1.E below.
1.C. The Project Gutenberg Literary Archive Foundation ("the
Foundation" or PGLAF), owns a compilation copyright in the collection
of Project Gutenberg-tm electronic works. Nearly all the individual
works in the collection are in the public domain in the United
States. If an individual work is unprotected by copyright law in the
United States and you are located in the United States, we do not
claim a right to prevent you from copying, distributing, performing,
displaying or creating derivative works based on the work as long as
all references to Project Gutenberg are removed. Of course, we hope
that you will support the Project Gutenberg-tm mission of promoting
free access to electronic works by freely sharing Project Gutenberg-tm
works in compliance with the terms of this agreement for keeping the
Project Gutenberg-tm name associated with the work. You can easily
comply with the terms of this agreement by keeping this work in the
same format with its attached full Project Gutenberg-tm License when
you share it without charge with others.
1.D. The copyright laws of the place where you are located also govern
what you can do with this work. Copyright laws in most countries are
in a constant state of change. If you are outside the United States,
check the laws of your country in addition to the terms of this
agreement before downloading, copying, displaying, performing,
distributing or creating derivative works based on this work or any
other Project Gutenberg-tm work. The Foundation makes no
representations concerning the copyright status of any work in any
country outside the United States.
1.E. Unless you have removed all references to Project Gutenberg:
1.E.1. The following sentence, with active links to, or other
immediate access to, the full Project Gutenberg-tm License must appear
prominently whenever any copy of a Project Gutenberg-tm work (any work
on which the phrase "Project Gutenberg" appears, or with which the
phrase "Project Gutenberg" is associated) is accessed, displayed,
performed, viewed, copied or distributed:
This eBook is for the use of anyone anywhere in the United States and
most other parts of the world at no cost and with almost no
restrictions whatsoever. You may copy it, give it away or re-use it
under the terms of the Project Gutenberg License included with this
eBook or online at www.gutenberg.org. If you are not located in the
United States, you'll have to check the laws of the country where you
are located before using this ebook.
1.E.2. If an individual Project Gutenberg-tm electronic work is
derived from texts not protected by U.S. copyright law (does not
contain a notice indicating that it is posted with permission of the
copyright holder), the work can be copied and distributed to anyone in
the United States without paying any fees or charges. If you are
redistributing or providing access to a work with the phrase "Project
Gutenberg" associated with or appearing on the work, you must comply
either with the requirements of paragraphs 1.E.1 through 1.E.7 or
obtain permission for the use of the work and the Project Gutenberg-tm
trademark as set forth in paragraphs 1.E.8 or 1.E.9.
1.E.3. If an individual Project Gutenberg-tm electronic work is posted
with the permission of the copyright holder, your use and distribution
must comply with both paragraphs 1.E.1 through 1.E.7 and any
additional terms imposed by the copyright holder. Additional terms
will be linked to the Project Gutenberg-tm License for all works
posted with the permission of the copyright holder found at the
beginning of this work.
1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm
License terms from this work, or any files containing a part of this
work or any other work associated with Project Gutenberg-tm.
1.E.5. Do not copy, display, perform, distribute or redistribute this
electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1 with
active links or immediate access to the full terms of the Project
Gutenberg-tm License.
1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form, including
any word processing or hypertext form. However, if you provide access
to or distribute copies of a Project Gutenberg-tm work in a format
other than "Plain Vanilla ASCII" or other format used in the official
version posted on the official Project Gutenberg-tm web site
(www.gutenberg.org), you must, at no additional cost, fee or expense
to the user, provide a copy, a means of exporting a copy, or a means
of obtaining a copy upon request, of the work in its original "Plain
Vanilla ASCII" or other form. Any alternate format must include the
full Project Gutenberg-tm License as specified in paragraph 1.E.1.
1.E.7. Do not charge a fee for access to, viewing, displaying,
performing, copying or distributing any Project Gutenberg-tm works
unless you comply with paragraph 1.E.8 or 1.E.9.
1.E.8. You may charge a reasonable fee for copies of or providing
access to or distributing Project Gutenberg-tm electronic works
provided that
* You pay a royalty fee of 20% of the gross profits you derive from
the use of Project Gutenberg-tm works calculated using the method
you already use to calculate your applicable taxes. The fee is owed
to the owner of the Project Gutenberg-tm trademark, but he has
agreed to donate royalties under this paragraph to the Project
Gutenberg Literary Archive Foundation. Royalty payments must be paid
within 60 days following each date on which you prepare (or are
legally required to prepare) your periodic tax returns. Royalty
payments should be clearly marked as such and sent to the Project
Gutenberg Literary Archive Foundation at the address specified in
Section 4, "Information about donations to the Project Gutenberg
Literary Archive Foundation."
* You provide a full refund of any money paid by a user who notifies
you in writing (or by e-mail) within 30 days of receipt that s/he
does not agree to the terms of the full Project Gutenberg-tm
License. You must require such a user to return or destroy all
copies of the works possessed in a physical medium and discontinue
all use of and all access to other copies of Project Gutenberg-tm
works.
* You provide, in accordance with paragraph 1.F.3, a full refund of
any money paid for a work or a replacement copy, if a defect in the
electronic work is discovered and reported to you within 90 days of
receipt of the work.
* You comply with all other terms of this agreement for free
distribution of Project Gutenberg-tm works.
1.E.9. If you wish to charge a fee or distribute a Project
Gutenberg-tm electronic work or group of works on different terms than
are set forth in this agreement, you must obtain permission in writing
from both the Project Gutenberg Literary Archive Foundation and The
Project Gutenberg Trademark LLC, the owner of the Project Gutenberg-tm
trademark. Contact the Foundation as set forth in Section 3 below.
1.F.
1.F.1. Project Gutenberg volunteers and employees expend considerable
effort to identify, do copyright research on, transcribe and proofread
works not protected by U.S. copyright law in creating the Project
Gutenberg-tm collection. Despite these efforts, Project Gutenberg-tm
electronic works, and the medium on which they may be stored, may
contain "Defects," such as, but not limited to, incomplete, inaccurate
or corrupt data, transcription errors, a copyright or other
intellectual property infringement, a defective or damaged disk or
other medium, a computer virus, or computer codes that damage or
cannot be read by your equipment.
1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right
of Replacement or Refund" described in paragraph 1.F.3, the Project
Gutenberg Literary Archive Foundation, the owner of the Project
Gutenberg-tm trademark, and any other party distributing a Project
Gutenberg-tm electronic work under this agreement, disclaim all
liability to you for damages, costs and expenses, including legal
fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT
LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE
PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE
TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE
LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR
INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH
DAMAGE.
1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a
defect in this electronic work within 90 days of receiving it, you can
receive a refund of the money (if any) you paid for it by sending a
written explanation to the person you received the work from. If you
received the work on a physical medium, you must return the medium
with your written explanation. The person or entity that provided you
with the defective work may elect to provide a replacement copy in
lieu of a refund. If you received the work electronically, the person
or entity providing it to you may choose to give you a second
opportunity to receive the work electronically in lieu of a refund. If
the second copy is also defective, you may demand a refund in writing
without further opportunities to fix the problem.
1.F.4. Except for the limited right of replacement or refund set forth
in paragraph 1.F.3, this work is provided to you 'AS-IS', WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT
LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.
1.F.5. Some states do not allow disclaimers of certain implied
warranties or the exclusion or limitation of certain types of
damages. If any disclaimer or limitation set forth in this agreement
violates the law of the state applicable to this agreement, the
agreement shall be interpreted to make the maximum disclaimer or
limitation permitted by the applicable state law. The invalidity or
unenforceability of any provision of this agreement shall not void the
remaining provisions.
1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the
trademark owner, any agent or employee of the Foundation, anyone
providing copies of Project Gutenberg-tm electronic works in
accordance with this agreement, and any volunteers associated with the
production, promotion and distribution of Project Gutenberg-tm
electronic works, harmless from all liability, costs and expenses,
including legal fees, that arise directly or indirectly from any of
the following which you do or cause to occur: (a) distribution of this
or any Project Gutenberg-tm work, (b) alteration, modification, or
additions or deletions to any Project Gutenberg-tm work, and (c) any
Defect you cause.
Section 2. Information about the Mission of Project Gutenberg-tm
Project Gutenberg-tm is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new computers. It
exists because of the efforts of hundreds of volunteers and donations
from people in all walks of life.
Volunteers and financial support to provide volunteers with the
assistance they need are critical to reaching Project Gutenberg-tm's
goals and ensuring that the Project Gutenberg-tm collection will
remain freely available for generations to come. In 2001, the Project
Gutenberg Literary Archive Foundation was created to provide a secure
and permanent future for Project Gutenberg-tm and future
generations. To learn more about the Project Gutenberg Literary
Archive Foundation and how your efforts and donations can help, see
Sections 3 and 4 and the Foundation information page at
www.gutenberg.org Section 3. Information about the Project Gutenberg
Literary Archive Foundation
The Project Gutenberg Literary Archive Foundation is a non profit
501(c)(3) educational corporation organized under the laws of the
state of Mississippi and granted tax exempt status by the Internal
Revenue Service. The Foundation's EIN or federal tax identification
number is 64-6221541. Contributions to the Project Gutenberg Literary
Archive Foundation are tax deductible to the full extent permitted by
U.S. federal laws and your state's laws.
The Foundation's principal office is in Fairbanks, Alaska, with the
mailing address: PO Box 750175, Fairbanks, AK 99775, but its
volunteers and employees are scattered throughout numerous
locations. Its business office is located at 809 North 1500 West, Salt
Lake City, UT 84116, (801) 596-1887. Email contact links and up to
date contact information can be found at the Foundation's web site and
official page at www.gutenberg.org/contact
For additional contact information:
Dr. Gregory B. Newby
Chief Executive and Director
[email protected]
Section 4. Information about Donations to the Project Gutenberg
Literary Archive Foundation
Project Gutenberg-tm depends upon and cannot survive without wide
spread public support and donations to carry out its mission of
increasing the number of public domain and licensed works that can be
freely distributed in machine readable form accessible by the widest
array of equipment including outdated equipment. Many small donations
($1 to $5,000) are particularly important to maintaining tax exempt
status with the IRS.
The Foundation is committed to complying with the laws regulating
charities and charitable donations in all 50 states of the United
States. Compliance requirements are not uniform and it takes a
considerable effort, much paperwork and many fees to meet and keep up
with these requirements. We do not solicit donations in locations
where we have not received written confirmation of compliance. To SEND
DONATIONS or determine the status of compliance for any particular
state visit www.gutenberg.org/donate
While we cannot and do not solicit contributions from states where we
have not met the solicitation requirements, we know of no prohibition
against accepting unsolicited donations from donors in such states who
approach us with offers to donate.
International donations are gratefully accepted, but we cannot make
any statements concerning tax treatment of donations received from
outside the United States. U.S. laws alone swamp our small staff.
Please check the Project Gutenberg Web pages for current donation
methods and addresses. Donations are accepted in a number of other
ways including checks, online payments and credit card donations. To
donate, please visit: www.gutenberg.org/donate
Section 5. General Information About Project Gutenberg-tm electronic works.
Professor Michael S. Hart was the originator of the Project
Gutenberg-tm concept of a library of electronic works that could be
freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg-tm eBooks with only a loose network of
volunteer support.
Project Gutenberg-tm eBooks are often created from several printed
editions, all of which are confirmed as not protected by copyright in
the U.S. unless a copyright notice is included. Thus, we do not
necessarily keep eBooks in compliance with any particular paper
edition.
Most people start at our Web site which has the main PG search
facility: www.gutenberg.org
This Web site includes information about Project Gutenberg-tm,
including how to make donations to the Project Gutenberg Literary
Archive Foundation, how to help produce our new eBooks, and how to
subscribe to our email newsletter to hear about new eBooks.
