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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 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!
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.
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.
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."
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 , 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.
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. 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.
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 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. 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!
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 dep?ts 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'H?pital de la Piti?, 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'H?pital de la Piti?, 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:
Since the above was written, we have learned that this man has been recently liberated, and his fine remitted.
A winter never passes without proving fatal to several students who die from injuries received in dissection.
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