Body-snatching

by Anonymous

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 operations of nature are seldom entirely hidden from the human eye; still less are they obtruded upon it, but over the most curious and wonderful operations of the animal economy so thick a veil is drawn, that they never could have been perceived without the most patient and minute research. The circulation of the blood, for example, never could have been discovered without dissection. Notwithstanding the partial knowledge of anatomy which must have been acquired by the accidents to which the human body is exposed, by attention to wounded men, by the observance of bodies killed by violence; by the huntsman in using his prey; by the priest in immolating his victims; by the augur in pursuing his divinations; by the slaughter of animals; by the dissection of brutes; and even occasionally by the dissection of the human body, century after century passed away, without a suspicion having been excited of the real functions of the two great systems of vessels, arteries and veins. It was not until the beginning of the 17th century, when anatomy was ardently cultivated, and had made considerable progress, that the valves of the veins and of the heart were discovered, and subsequently that the great Harvey, the pupil of the anatomist who discovered the latter, by inspecting the structure of these valves; by contemplating their disposition; by reasoning upon their use, was led to suspect the course of the blood, and afterwards to demonstrate it. Several systems of vessels in which the most important functions of animal life are carried on—the absorbent system, for example, and even that portion of it which receives the food after it is digested, and which conveys it into the blood, are invisible to the naked eye, except under peculiar circumstances: whence it must be evident, not only that the interior of the human body must be laid open, in order that its organs may be seen; but that these organs must be minutely and patiently dissected, in order that their structure may be understood.

The most important diseases have their seat in the organs of the body; an accurate acquaintance with their situation is, therefore, absolutely necessary, in order to ascertain the seats of disease; but for the reasons already assigned, their situation cannot be learnt, without the study of anatomy. In several regions, organs the most different in structure and function are placed close to each other. In what is termed the epigastric region, for example, are situated the stomach, the liver, the gall bladder, the first portion of the small intestine (the duodenum) and a portion of the large intestine (the colon); each of these organs is essentially different in structure and in use, and is liable to distinct diseases. Diseases the most diversified, therefore requiring the most opposite treatment, may exist in the same region of the body; the discrimination of which is absolutely impossible, without that knowledge which the study of anatomy alone can impart.

The seat of pain is often at a great distance from that of the affected organ. In disease of the liver, 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 neighbourhood 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 known 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 labour 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 the truth of those principles, 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 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 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 either instantaneously from loss of blood, or by degrees from repeated losses. When left to itself, it almost uniformly proves fatal in one or other of these modes; 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 have had no conception of 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 its 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 tumour 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 tumour 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 neighbourhood of the tumour. 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 tumour, which was attended with a pulsation so violent that it lifted up the hand of the examiner. There seemed every reason to suppose that the case was an aneurismal swelling. This acute observer, however, in comparing the affected with the sound limb, perceived in the latter a similar throbbing. On careful examination he discovered that, by a particular disposition in this individual, one of the main arteries of the leg (the anterior tibial) deviated from its usual course, and instead of plunging deep between the muscles, lay immediately under the skin and fascia. The truth was, that the man in the exertion of walking had ruptured some muscular fibres, and the uncommon distribution of the artery gave to this accident these peculiar symptoms. The real nature of this case could not possibly have been ascertained, but by an anatomist. The same surgeon has recorded the case of a man who, having fallen twice from his horse, and experienced for several years considerable uneasiness in his back, was at length afflicted with acute pain in the abdomen. At the same time an oval, irregularly circumscribed tumour made its appearance in the right flank. It presented a distinct fluctuation, and had all the appearance of a collection of matter depending on caries of the vertebræ. The pain was seated chiefly at the lower portion of that part of the spine which forms the back, which was, moreover, distorted; and this might have confirmed the opinion that the case was a lumbar abscess with caries. Pelletan, however, who well knew that an aneurism, as it enlarges, may destroy any bone in its neighbourhood, saw that the disease was an aneurism, and predicted that the patient must perish. On opening the body (for the man lived only ten days after Pelletan first saw him) an aneurismal tumour was discovered, which nearly filled the cavity of the abdomen. If this case had been mistaken for lumbar abscess, and the tumour 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 and 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 tumour at the knee. Vesalius was consulted about a tumour 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 a swelling of the glands in its neighbourhood: with a swelling of the cellular substance which surrounds the artery; with abscesses of various kinds; but if a surgeon were to fall into this error, and to open a carotid aneurism, his patient would certainly be dead in the space of a few moments. It must be evident, then, that a thorough knowledge of anatomy is not only indispensable to the proper treatment of cases of this description, but also to the prevention of the most fatal mistakes.

There is nothing in surgery of more importance than the proper treatment of hemorrhage. Of the confusion and terror occasioned by the sight of a human being from whom the blood is gushing in torrents, and whose condition none of the spectators is able to relieve, no one can form an adequate conception, but those who have witnessed it. In all such cases there is one thing proper to be done, the prompt performance of which is generally as certainly successful, as the neglect of it is inevitably fatal. It is impossible to conceive of a more terrible situation than that of a medical man who knows not what to do on such an emergency. He is confused; he hesitates: while he is deciding what measures to adopt the patient expires: he can never think of that man’s death without horror, for he is conscious that, but for his ignorance he might have averted his patient’s fate. The ancient surgeons were constantly placed in this situation, and the dread inspired by it retarded the progress of surgery more than all other causes put together. Not only were they terrified from interfering with the most painful and destructive diseases, which experience has proved to be capable of safe and easy removal, but they were afraid to cut even the most trivial tumour. When they ventured to remove a part, they attempted it only by means of the ligature, or by the application of burning irons. When they determined to amputate, they never thought of doing so, until the limb had mortified, and the dead had separated from the living parts; for they were absolutely afraid to cut into the living flesh. They had no means of stopping hemorrhage, but by the application of astringents to the bleeding vessels, remedies which were inert; or of burning irons, or boiling turpentine, expedients which were not only inert but cruel. Surgeons now know that the grand means of stopping hemorrhage is compression of the bleeding vessel. If pressure be made on the trunk of an artery, though blood be flowing from a thousand branches given off from it, the bleeding will cease. Should the situation of the artery be such as to allow of effectual external pressure, nothing further is requisite: the pressure being applied, the bleeding is stopped at once: should the situation of the vessel place it beyond the reach of external pressure, it is necessary to cut down upon it, and to secure it by the application of a ligature. Parè may be pardoned for supposing that he was led to the discovery of this invaluable remedy by inspiration of the Deity. By means of it the most formidable operations may be undertaken with the utmost confidence, because the wounded vessels can be secured the moment they are cut: by the same means the most frightful hemorrhages may be effectually stopped: and even when the bleeding is so violent as to threaten immediate death, it may often be averted by the simple expedient of placing the finger upon the wounded vessel, until there is time to tie it. But it is obvious that none of these expedients can be employed, and that these bleedings can neither be checked at the moment, nor permanently stopped, without such a knowledge of the course of the trunks and branches of vessels, as can be acquired only by the study of anatomy.

The success of amputation is closely connected with the knowledge of the means of stopping hemorrhage. Not to amputate, is often to abandon the patient to a certain and miserable death. And all that the surgeon formerly did, was to watch the progress of that death: he had no power to stop or even to retard it. The fate of sir Philip Sidney is a melancholy illustration of this truth. This noble-minded man, the light and glory of his age, was cut off in the bloom of manhood, and the midst of his usefulness, by the wound of a musket bullet in his left leg, a little above the knee, “when extraction of the ball, or amputation of the limb,â€� says his biographer, “would have saved his inestimable life: but the surgeons and physicians were unwilling to practice the one, and knew not how to perform the other. He was variously tormented by a number of surgeons and physicians for three weeks.â€� Amputation indeed was never attempted except where mortification had itself half performed the operation. The just apprehension of an hemorrhage which there was no adequate means of stopping, checked the hand of the boldest surgeon, and quailed the courage of the most daring patient—and if ever the operation was resorted to, it almost always proved fatal: the patient generally expired, according to the expression of Celsus, “in ipso opere.â€� How could it be otherwise? The surgeon cut through the flesh of his patient with a red hot knife: this was his only means of stopping the hemorrhage: by this expedient he sought to convert the whole surface of the stump into an eschar: but this operation, painful in its execution, and terrible in its consequences, when it even appeared to succeed, succeeded only for a few days; for the bleeding generally returned and proved fatal as soon as the sloughs or dead parts became loose. Plunging the stump into boiling oil, into boiling turpentine, into boiling pitch, for all these means were used, was attended with no happier result, and after unspeakable suffering, almost every patient perished. In the manner in which amputation is performed at present, not more than one person in twenty loses his life in consequence of the operation, even taking into the account all the cases in which it is practised in hospitals. In private practice, where many circumstances favour 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.