Part 5

It is an odious thing that the teachers of anatomy should be brought into contact with such men: that they should be obliged to employ them, and that they should even be in their power; which they are to such a degree, that they are obliged to bear with the wantonness of their tyranny and insult. All the clamour against these men, all the punishment inflicted on them, only operate to raise the premium on the repetition of their offence. This premium the teachers of anatomy are obliged to pay, which these men perfectly understand, who do not at all dislike the opposition which is made to their vocation. It gives them no unreasonable pretext for exorbitancy in their demands. In general they are men of infamous character; some of them are thieves, others are the companions and abettors of thieves. Almost all of them are extremely destitute. When apprehended for the offence in question, the teachers of anatomy are obliged to pay the expenses of the trial, and to support their families while they are in prison; whence the idea of immunity is associated, in these men’s minds, with the violation of the law, and when they do happen to incur its penalties, they practically find that they and their families are provided for, and this provision comes to them in the shape of a reward for the commission of their offence. The operation of such a system on the minds of the individuals themselves is exceedingly pernicious, and is not a little dangerous to the community.

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 mis-spend 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 tumour, 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.[A] 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.

The plan we would propose to substitute is the following:--

1. That the bodies of those persons who die in all infirmaries and hospitals throughout the kingdom, _unclaimed by immediate relatives_, be appropriated to the purpose of anatomy.

2. That the bodies of those persons who die in all work-houses and poor-houses be appropriated to the same purpose.

3. That the bodies of those persons who die in all houses of correction, in all prisons, and in the hulks, be thus appropriated.

An objection may be anticipated to such an appropriation of the bodies of those who die in infirmaries and hospitals. And it is admitted, that in the present state of public feeling it would not be right thus to appropriate the bodies of _all_ who die in those public charities. But this is not proposed: what is proposed is to appropriate to this use the bodies of those ONLY _who die unclaimed by immediate relatives_. No reasonable objection can be urged to this measure thus guarded. No one who has not inquired into the subject can have any conception of the number of persons who die in the public hospitals in London, unvisited by friends during life, unclaimed by them after death. Surely to devote to this use the bodies of those who die under such circumstances can inflict no wound on any private individual--can violate no public right. Still there is one objection to the measure which is specious but not solid. It is urged that it might be the means of deterring this class of persons from entering the hospitals. The answer to this objection is complete, because it is an answer derived from experience. The measure has been actually adopted, and found in practice 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.

It has been stated that this plan has been tried in Edinburgh, and that experience has proved its efficacy. It was, in fact, adopted in that city with perfect success 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. The following account of the mode in which those of Paris in particular are supplied, has been obtained from the gentleman who is at the head of the anatomical department in that city. It is stated; 1. That the faculty of medicine at Paris is authorized to take from the civil hospitals, from the prisons, and from dépôts 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 2,000 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 1,000 or 1,200. 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 to 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 investigations. 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 regarded as the most ignorant of men.

To the other parts of the plan proposed above for supplying the anatomical schools in Great Britain, there appears to be no objections whatever. No one can object to such a disposal of the bodies of those who die in prisons; no one can reasonably object to such a disposal of the bodies of those who die in poor-houses. These persons are pensioners upon the public bounty: they owe the public a debt: they have been supported by the public during life; if, therefore, after death they can be made useful to the public, it is a prejudice, not a reason--it is an act of injustice, not the observance of a duty, which would prevent them from becoming so. It is true that many of these persons are honest and respectable; and have been reduced to indigence by misfortune: were they all so it would not alter the state of the argument. Some concession and co-operation on the part of the public, for this great public object, is indispensable, without which nothing can be done: but if any concession be made, it can be made with respect to this class of persons better than any other, because it can be made with less violation of public feeling. Nor is any indignity either intended or offered to these persons. They are appropriated to this service not because they are poor, but because they are friendless: because, that is, no persons survive them who take such an interest in their fate as to be rendered unhappy by this disposal of their remains. That they are without friends is no good reason why their memory should be treated with indignity; but it is a good reason, it is the best possible reason why they should be selected for this public service. Poverty, it is true, is a misfortune: poverty, it is true, has terror and pain enough in itself: no legislature ought by any act to increase its wretchedness; but the measure here proposed is pregnant with good to the poor, and would tend more than can be estimated to lessen the misery of their condition. For it would give knowledge to the lowest practitioners of the medical art; that is, to the persons who are at present lamentably deficient, and into whose hands the great bulk of the poor fall. And, after all, the true 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 must be--and will be. The rich will always have it in their power to select, for the performance of an operation, the surgeon who has 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 has attained deserved 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. What would be the immediate and constant effect of an abolition of the practice of dissecting the dead? It would be to convert poor-houses and public hospitals into so many schools where the surgeons, by practising on the living bodies of the poor, would learn to operate on those of the rich with safety and dexterity. Thus the poor would be tortured, and many of them would be put to death in order that the rich might be saved from pain and danger. This would be the certain and inevitable result--this would indeed be to treat this class of the people with real indignity and horrible injustice, and proves how possible it is to show an apparent consideration for the poor, and yet practically to abuse them in the most cruel manner.

The plan now proposed for remedying the evils which have been stated would accomplish the object easily and completely: it would inflict no injury on any private individual: it would do no violence to the public feeling: it would render the dread of anatomy, as far as that dread were really operative, directly beneficial to the community: it would terminate at once the evils of the present system: it would put an end to the education of daring and desperate violators of the law: it would tranquillize the public mind: the 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 submit these observations to the calm and serious consideration of our countrymen. We address them especially to the members of our legislature. Upon the attention of the latter we would particularly urge this further consideration, the importance of which they well know how to estimate. In consequence of the difficulty of procuring subjects in England, every medical student in Great Britain who can possibly afford the time now goes to Paris to perfect himself in anatomy. Accordingly the number of English students in Paris is already immense: that number increases rapidly every year: it increases by the desertion of the schools in Edinburgh and London. The consequence is obvious, and will be surely and deeply felt in a few years. Anatomy will be neglected in England, and for this indispensable branch of knowledge England will become entirely dependent on France. There cannot be a doubt that there is good sense enough among the people of England to submit to whatever regulations may be necessary to prevent evils so serious and so fatal, provided such regulations are framed in a proper spirit, and observed with a due regard to decorum, and it is certain that those persons who co-operate to establish these regulations will ultimately receive, as they will deserve, the gratitude of their country.

FINIS.

T. C. Hansard, Pater-noster-row Press.

FOOTNOTE:

[A] A winter never passes without proving fatal to several students who die from injuries received in dissection.