: Use of the Dead to the Living by Smith Southwood - Surgery; Mackenzie William 1791-1868. An appeal to the public and to the legislature on the necessity of affording dead bodies to the schools of anatomy by legislative enactment; Dead bodies (Law); Human a

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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.

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