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+*** START OF THE PROJECT GUTENBERG EBOOK 58460 ***
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+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 THE PROJECT GUTENBERG EBOOK 58460 ***