Use of the Dead to the Living

by Southwood Smith

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 (and most of these young men go to the country) 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.[2] 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!

We shall have entered into the discussion of this subject to little purpose, if we have not produced in the minds of our readers a deep conviction, that anatomy ought to form an essential part of medical education, that anatomy cannot be studied without the practice of dissection; that dissection cannot be practised without a supply of subjects, and that the manner in which that supply is obtained in England is detestable, and ought immediately to be changed. It might be changed easily. We agree with Mr. Mackenzie, that legislative interference is necessary; we are satisfied that nothing will be done in England without it. The plan which Mr. Mackenzie suggests is as follows: 1. That the clause of our criminal code, by which the dissection of the dead body is made part of the punishment for murder, be repealed. 2. That the exhumation of dead bodies be punishable as felony. 3. That no diploma in medicine or surgery, be granted by any faculty, college, or university, except to those persons who shall produce undoubted evidence of their having carefully dissected at least five human bodies. 4. That in each of the hospitals, infirmaries, work-houses, poor-houses, foundling-houses, houses of correction, and prisons of London, Edinburgh, Glasgow, and Dublin, and if need be, of all other towns in Great Britain and Ireland, an apartment be appointed for the reception of the bodies of all persons dying in the said hospitals, infirmaries, work houses, poor-houses, foundling-houses, houses of correction, and prisons, unclaimed by immediate relatives, or whose relatives decline to defray the expenses of interment. 5. That the bodies of all persons dying in these towns, and, if need be, in all other towns, and also in country parishes, unclaimable by immediate relatives, or whose relatives decline to defray the expenses of interment, shall be conveyed to a mort-house appointed in the said towns for their reception. 6. That no dead bodies shall be delivered from any hospital, infirmary, work house, poor-house, foundling-house, house of correction, prison, or mort-house for anatomical purposes, except upon the requisition of a member of the Royal College of Physicians or of Surgeons, of London, Edinburgh, or Dublin, or of the Faculty of Physicians and Surgeons of Glasgow, and upon the payment of twenty shillings into the hands of the treasurer, of the hospital, infirmary, work-house, poor-house, foundling-house, house of correction, prison, or other officer appointed to receive the same. [This is too large a sum.] 7. That no dead body shall be conveyed from a hospital, infirmary, work-house, poor-house, foundling-house, house of correction, prison, or mort-house, to a school of anatomy, except in a covered bier, and between the hours of four and six in the morning. 8. That after the expiration of twenty-eight days, an officer appointed for this purpose, in each of the four towns above-mentioned, shall cause the remains of the dead to be placed in a coffin, removed from the school of anatomy, where the dead body has been examined, to the mort-house of the town and decently buried. 9. That the expenses attending the execution of these regulations, be defrayed out of fees paid by teachers and students of anatomy, on receiving dead bodies from the hospitals, infirmaries, work-houses, poor houses, foundling-houses, houses of correction, prisons, and mort-houses.

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 depôts 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'Hôpital de la Pitié, 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'Hôpital de la Pitié, 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:

[1] Since the above was written, we have learned that this man has been recently liberated, and his fine remitted.