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USE OF THE DEAD

TO THE

LIVING.

FROM THE WESTMINSTER REVIEW.

PRINTED BY WEBSTERS AND SKINNERS.

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 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.

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.

USE OF THE DEAD TO THE LIVING.

FROM THE WESTMINSTER REVIEW.

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, and a portion of the large intestine ; 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 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 vertebrae. 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 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.

When the end of the year came, Mr. Goodnow did not wait for John to speak. On New-Year's Eve, just before bed-time, he laid down his paper, crossed the room, put his hand on John's shoulder, and, as if only an hour instead of seven months had passed since he had last spoken of what he wished John to be, he said, "Well, my boy, speak out: will ye be farmer or lawyer?"

John rose quickly, and looked at his father. "I will be a lawyer, if I can," said he. "But, father, I do wish you could like it;" and his voice trembled a little.

"I do like it--I like it very much," said Mr. Goodnow, quickly; "for if ye can do so well as ye have done at a work ye don't take to, I'm sure ye'll prove a master-hand at what yer heart's so sot on. Ye've helped me in my way, and I'll help ye in yourn. Ye shall have the best schoolin' in law that money can buy, and ye've shown ye'll do the rest yourself. Happy New-Year, my boy!" Mr. Goodnow held out his hand, and John took it with a grip that made his father wince and smile at the same time.

Then John went to his mother, who, of course, knew all about it, and was as happy, yes, happier, than her boy over the happiness which he had earned so well. When he went to his own room, he was so busy thinking, that it was some time before he looked up; but when he did he started, and shouted "Jerusalem!" as if the word had been a bullet and he the gun. On the wall over the table were three pictures which had not been there before. One was of Charles Sumner, one of Rufus Choate, and one of Abraham Lincoln. On the table beneath was this note in his mother's hand:

"I want you, my own good boy, to learn what you attempt to know as thoroughly, and do what you believe to be right as fearlessly, as Charles Sumner did. Rufus Choate had the great power to so move men's minds that they were like something melted which he could shape as he chose. If you can be as brave, tender, and good as Abraham Lincoln was, I shall wish with all my heart that you may have power like Rufus Choate's and opportunity like Charles Sumner's. You mustn't fret about father. He's as pleased and satisfied as we are. You won him just as I told you you would, by yielding. It is more than a month since he brought home the books you will find on your table. They are for your first term in the law-school. Now good-night, and a happy New-Year from your loving

"MOTHER."

Under the books on the table lay a flat package which his mother did not know about, as Mr. Goodnow had slyly placed it there the last thing before John went up to bed. John untied it, and found a fine picture of Horace Greeley, and this note from his father:

"You needn't be afraid of putting Horace Greeley along of them chaps your mother has given you. He can stand it if they can; and they'll make a good beginning of your picter-gallery. I've heard tell of lawyers getting to be editors, too, afore now. If you should ever run a paper, what you know about farming won't hurt it none."

CAMPING OUT.

BY WILLIAM O. STODDARD.

"What am I a-stoppin' for? Why, this 'ere's the eend of the road. It's as fur as I can git, even with one hoss and a buckboard."

It looked like it, for the wood road had been getting dreadfully scrubby for a mile or so.

"Wade, was it like this when you and your father and the rest were here before?"

"A good deal like it. How far are we from Pot Lake now, Mr. Jones?"

The queer-looking old teamster was busily unfastening several small packages from the broad "buckboard" of his rude wagon, but he looked gruffly up to say, "'Baout a mile 'n' a half."

"It's all of that, Sid, but it's of no use to grumble. We've got to foot it the rest of the way. It's a plain enough path."

"Foot it! And lug all that?"

"Guess you'll be glad there ain't any more of it afore ye git thar."

Mr. Jones was right, for they were both of them glad already, considering how warm a day it was.

Neither of the boys was much over sixteen, but Wade Norton looked the older of the two, although his companion was fully as tall and strong. Standing together, they made a good "specimen pair" of vigorous, bright-eyed, self-reliant youngsters.

In three minutes more Mr. Jones and his pony and his buckboard were out of sight among the trees, and Sid and Wade were left to their own resources.

It was seven miles due south, and a good deal longer by the road, to the nearest clearing, and all to the north of them was wilderness--woods, lakes, and mountains.

"Now, Wade, how'll we divide the load? There's a heap of it."

"Guess we won't divide it. I'll show you--here's the hatchet."

"Go ahead. I'm a greenhorn yet. What are you going to do?"

Wade was too busy to answer, but he quickly had a pair of very slender ash saplings hacked down, trimmed clean, and laid side by side about two feet apart. To these he tied a couple of cross-sticks, six feet from each other. Then he spread his blanket on the ground, laid the frame in the middle, folded the blanket across, and pinned it firmly.

"Looks like a litter," said Sid.

"That's what it is. Put the tin box of hard-tack in the middle. It's the heaviest thing we've got; weighs ten pounds. Now the bacon; that only weighs five. Now the other things. The guns ain't loaded; lay 'em along the sides. And the fishing-rods. Now we're ready."

One boy in front between the poles, and one behind, and it was a pleasant surprise to Sid to find how easy it worked. Still, it was a dreadfully long and warm mile and a half over that rough forest path before they came out on the slope that led down to the blue waters of Pot Lake.

"It's just beautiful," said Sid, as they set down their load for a rest and a look.

"Hist! Let me get my gun."

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