Use of the Dead to the Living

by Southwood Smith

FROM THE WESTMINSTER REVIEW.

An Appeal to the Public and to the Legislature, on the necessity of affording Dead Bodies to the Schools of Anatomy, by Legislative Enactment. By William Mackenzie. Glasgow. 1824.

Every one desires to live as long as he can. Every one values health "above all gold and treasure." Every one knows that as far as his own individual good is concerned, protracted life and a frame of body sound and strong, free from the thousand pains that flesh is heir to, are unspeakably more important than all other objects, because life and health must be secured before any possible result of any possible circumstance can be of consequence to him. In the improvement of the art which has for its object the preservation of health and life, every individual is, therefore, deeply interested. An enlightened physician and a skilful surgeon, are in the daily habit of administering to their fellow men more real and unquestionable good, than is communicated, or communicable by any other class of human beings to another. Ignorant physicians and surgeons are the most deadly enemies of the community: the plague itself is not so destructive; its ravages are at distant intervals, and are accompanied with open and alarming notice of its purpose and power; theirs are constant, silent, secret; and it is while they are looked up to as saviours, with the confidence of hope, that they give speed to the progress of disease and certainty to the stroke of death.

It is deeply to be lamented that the community, in general, are so entirely ignorant of all that relates to the art and the science of medicine. An explanation of the functions of the animal economy; of their most common and important deviations from the healthy state; of the remedies best adapted to restore them to a sound condition, and of the mode in which they operate, as far as that is known, ought to form a part of every course of liberal education. The profound ignorance of the people on all these subjects, is attended with many disadvantages to themselves, and operates unfavorably on the medical character. In consequence of this want of information, persons neither know what are the attainments of the man in whose hands they place their life, nor what they ought to be; they can neither form an opinion of the course of education which it is incumbent on him to follow, nor judge of the success with which he has availed himself of the means of knowledge which have been afforded him. There is one branch of medical education in particular, the foundation, in fact, on which the whole superstructure must be raised, the necessity of which is not commonly understood, but which requires only to be stated to be perceived. Perhaps it is impossible to name any one subject which it is of more importance that the community should understand. It is one in which every man's life is deeply implicated: it is one on which every man's ignorance or information will have a considerable influence. We shall, therefore, enter into it with some detail: we shall show the kind of knowledge which it is indispensable that the physician and surgeon should possess; we shall illustrate, by a reference to particular cases, the reason why this kind of knowledge cannot be dispensed with: and we shall explain, by a statement of facts, the nature and extent of the obstacles which at present oppose the acquisition of this knowledge. We repeat, there is no subject in which every reader can be so immediately and deeply interested, and we trust that he will give us his calm and unprejudiced attention.

The basis of all medical and surgical knowledge is anatomy. Not a single step can be made either in medicine or surgery, considered either as an art or a science without it. This should seem self evident, and to need neither proof nor illustration: nevertheless, as it is useful occasionally to contemplate the evidence of important truth, we shall show why it is, that there can be no rational medicine, and no safe surgery, without a thorough knowledge of anatomy.

Disease, which it is the object of these arts to prevent and to cure, is denoted by disordered function: disordered function cannot be understood without a knowledge of healthy function; healthy function cannot be understood without a knowledge of structure; structure cannot be understood unless it be examined.

The organs on which all the important functions of the human body depend, are concealed from the view. There is no possibility of ascertaining their situation and connections, much less their nature and operation, without inspecting the interior of this curious and complicated machine. The results of the mechanism are visible; the mechanism itself is concealed, and must be investigated to be perceived. The important operations of nature are seldom entirely hidden from the human eye; still less are they obtruded upon it, but over the most curious and wonderful operations of the animal economy so thick a veil is drawn, that they never could have been perceived without the most patient and minute research. The circulation of the blood, for example, never could have been discovered without dissection. Notwithstanding the partial knowledge of anatomy which must have been acquired by the accidents to which the human body is exposed, by attention to wounded men, by the observance of bodies killed by violence; by the huntsman in using his prey; by the priest in immolating his victims; by the augur in pursuing his divinations; by the slaughter of animals; by the dissection of brutes; and even occasionally by the dissection of the human body, century after century passed away, without a suspicion having been excited of the real functions of the two great systems of vessels, arteries and veins. It was not until the beginning of the 17th century, when anatomy was ardently cultivated, and had made considerable progress, that the valves of the veins and of the heart were discovered, and subsequently that the great Harvey, the pupil of the anatomist who discovered the latter, by inspecting the structure of these valves; by contemplating their disposition; by reasoning upon their use, was led to suspect the course of the blood, and afterwards to demonstrate it. Several systems of vessels in which the most important functions of animal life are carried on—the absorbent system, for example, and even that portion of it which receives the food after it is digested, and which conveys it into the blood, are invisible to the naked eye, except under peculiar circumstances: whence it must be evident, not only that the interior of the human body must be laid open, in order that its organs may be seen; but that these organs must be minutely and patiently dissected, in order that their structure may be understood.

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

The seat of pain is often at a great distance from that of the affected organ. In disease of the liver, the pain is generally felt at the top of the right shoulder. The right phrenic nerve sends a branch to the liver: the third cervical nerve, from which the phrenic arises, distributes numerous branches to the neighborhood of the shoulder: thus is established a nervous communication between the shoulder and the liver. This is a fact which nothing but anatomy could teach, and affords the explanation of a symptom which nothing but anatomy could give. The knowledge of it would infallibly correct a mistake, into which a person who is ignorant of it, would be sure to fall: in fact, persons ignorant of it do constantly commit the error. We have know several instances in which organic disease of the liver has been considered, and treated as rheumatism of the shoulder. In each of these cases, disease in a most important organ might have been allowed to steal on insidiously, until it became incurable; while a person, acquainted with anatomy, would have detected it at once, and cured it without difficulty. Many cases have occurred of persons who have been supposed to labor under disease of the liver, and who have been treated accordingly: on examination after death, the liver has been found perfectly healthy, but there has been discovered extensive disease of the brain. Disease of the liver is often mistaken for disease of the lungs: on the other hand, the lungs have been found full of ulcers, when they were supposed to have been perfectly sound, and when every symptom was referred to disease of the liver. Persons are constantly attacked with convulsions—children especially; convulsions are spasms: spasms, of course, are to be treated by antispasmodics. This is the notion amongst people ignorant of medicine: it is the notion amongst old medical men: it is the notion amongst half educated young ones. All this time these convulsions are merely a symptom; that symptom depends upon, and denotes, most important disease in the brain: the only chance of saving life, is the prompt and vigorous application of proper remedies to the brain; but the practitioner whose mind is occupied with the symptom, and who prescribes antispasmodics, not only loses the time in which alone any thing can be done to snatch the victim from death, but by his remedies absolutely adds fuel to the flame which is consuming his patient. In disease of the hip-joint pain is felt, not in the hip, but, in the early stage of the disease, at the knee. This also depends on nervous communication. The most dreadful consequences daily occur from an ignorance of this single fact. In all these cases error is inevitable, without a knowledge of anatomy: it is scarcely possible with it: in all these cases error is fatal: in all these cases anatomy alone can prevent the error—anatomy alone can correct it. Experience, so far from leading to its detection, would only establish it in men's minds, and render its removal impossible. What is called experience is of no manner of use to an ignorant and unreflecting practitioner. In nothing does the adage, that it is the wise only who profit by experience, receive so complete an illustration as in medicine. A man who is ignorant of certain principles, and who is incapable of reasoning in a certain manner, may have daily before him for fifty years cases affording the most complete evidence of their truth, and of the importance of the deduction to which they lead, without observing the one, or deducing the other. Hence the most profoundly ignorant of medicine, are often the oldest members of the profession, and those who have had the most extensive practice. A medical education, founded on a knowledge of anatomy, is, therefore, not only indispensable to prevent the most fatal errors, but to enable a person to obtain advantage from those sources of improvement which extensive practice may open to him.