* * * * *
The want of some guide to the situation of internal parts, has long
been felt. Fixed points have been adopted, but with no regularity.
Measurements guessed by the eye have sometimes been used, but even
they have almost always been absolute, _i. s._ measurements from one
point; rarely proportional, _i. s._ measurements between two points.
The few guessed proportional measurements, however, as for paracentesis
abdominis, paracentesis thoracis, &c. which have been mentioned in
surgical works, have, it must be confessed, been such as, from the
magnitude of the parts with which they were concerned, required little
more than guess. Such, however, as they were, they evidently depended
upon no principle, but seem as if hit upon accidentally, and, at all
events, were never generally applied.
Precise or real proportional measurements between fixed points,
applicable to minute objects, _i. s._ such measurements as I have
proposed and described, never have been, as far as I can discover,
proposed and described before. And these precise or real proportional
measurements, between fixed points, differ exactly as much from guessed
ones, as the accurate cabinet, which was regulated in every part by the
compass and square, would differ from the clumsy and unserviceable one,
where every thing was constructed by guess. Here the parallel is so
close, the difference in the results so striking, that I could not have
adduced a better illustration.
The present proposition, of precise or real proportional measurements
between fixed points, was communicated by me, about five or six years
ago, to James Macartney Esq. lecturer on comparative anatomy, and the
laws of organic existence, at St. Bartholomew’s Hospital, and, in my
opinion, one of the best comparative anatomists in Europe. I had no
sooner announced it, than he assured me that a similar method had struck
himself; and I deem this, so far as authority goes, no mean testimony in
behalf of its value.
Mr Macartney, some time afterward, performed upon the dead subject,
in the dissecting room at St. Bartholomew’s, the difficult operation
I have just described, according to the direction I have given, and
both politely acknowledged me as the proposer, and bestowed on it his
approbation. It is my duty to remark, that there is no person whose
approbation could give me higher satisfaction.
* * * * *
I cannot better illustrate the danger arising from ignorance of this
principle, than by quoting an instance of repeated failure in the very
operation above described, in consequence of such ignorance.
A professor at an hospital in London, generally reckoned one of the
ablest surgeons of the metropolis, when illustrating this operation in
his lectures, first made the usual guessed cut, passing across one half
of the Sterno-cleido-mastoid muscle; and, after some tearing and cutting,
and innumerable complaints against the knives and the unfortunate
assistant, told his pupils, “that they might think he had not yet got the
artery, but he knew he had, and he should know it in the living subject,
even if it did not pulsate.” The subject, however, was carried from the
lecture-room, and the ligature was found to be firmly fixed upon the
nerve.
This mistake was very properly communicated to the ingenious surgeon,
who never forgave the discoverer of it, but very wisely planned how he
might avoid the same mistake, or, what he seemed to dread most, its
consequences to his own reputation, in the subsequent course.
He had thus found, that ligatures left in the dead subject were more
troublesome than in the living; and having tied something, which, to
judge from the vague way in which he described it, might be a muscle as
readily as an artery, he very properly, as his mind was not quite made up
upon the subject, secured, to all appearance, his well earned fame, by
cutting off and withdrawing the ligature that nobody might see what he
had done.
Unfortunately, however, curiosity and the wonder that it was possible for
so great a surgeon to make so deplorable and dangerous an error, prompted
a second examination of the subject. No ligature now remained to direct
the enquirer’s search; but alas! artifice could not obtain impunity even
to reputation—the artery remained bedded in fat and untouched, the nerve
alone was separated from the mass, and bore the mark of the ligature.
May the relation of these disgraceful occurrences, selected from numerous
similar ones, which, to my knowledge, have taken place both in London
and Edinburgh; but which, as, fortunately for their authors, they produce
no injury to reputation, I am therefore unwilling to state—may it, I say,
serve as a proof of the danger arising from ignorance of the principle I
have proposed.
Now, may I ask, what are we to think of the supporters—the promulgators
of such doctrines, and the abettors of their authors? Such men are to be
found in Edinburgh, as well as in London.
Suppose, for a moment, one of these gentlemen, who are the deriders of
precise and accurate methods, proposing to perform on the dead subject,
in the most fascinating and splendid style, the operation for tying the
femoral artery. He delivers a proem which shall verbally assure the pupil
of its ease, but, by the complex flourishes of his knife, he intends to
convince him it is difficult. He expects, however, that he shall speedily
lay it bare, and that his dexterity, in the midst of such complexity,
will produce the most brilliant effect. But alas! his first incision
is made about an inch from the artery—still he cuts deep, in order to
discover it—now he is embarrassed at his situation—next he mines off
laterally, forms excavations under the flesh, and leaves the artery above
the course of his incision—at last he reaches the profound, instead of
the superficial artery, and comes off with the never-failing, and, in
this case, ridiculous excuse, that there was an unusual distribution of
it.... The errors of Surgeons have very curiously discovered a greater
number of varieties in the distribution of arteries than ever were
demonstrated by the labours of anatomists.
I have seen one of these surgeons commence such a disgraceful operation
with more flourishes of the knife, than ever a dragoon used when
performing the Saxon exercise with the sabre. Contrast this with the
plain and manly operator, every movement of whose knife has a meaning,
because every movement of it is strictly adapted to effect the most
useful of purposes.[1]
[1] It may be surprising, but it is not inconsistent with human
nature, that such men should be the persecutors of others; and
it may perhaps be worth while to quote a few sentences from the
production of such men directed against myself.
“While an intimate acquaintance with the Anatomy of the human
body, is absolutely necessary to him who wishes to practise
Surgery, with credit and success, it must be acknowledged, that
_those who are much occupied with dissection, are but too apt
to overrate the practical importance of a minute knowledge of
healthy structure_. That surgeon would indeed justly hazard the
imputation of rashness and presumption, who would (_should_
is here meant) imprudently venture to apply a ligature to
the carotid or subclavian arteries, or attempt to remove the
stricture in a strangulated crural hernia, without an accurate
knowledge of the assemblage of important vessels which are
included in the regions of the neck and groin: yet _we do
not allow ourselves to be much influenced by the opinions of
the anatomist who affirms, that there are certain fixed and
invariable rules, according to which, in every case, those
operations are to be performed_. We have learnt to infer, that
the different regions of the body include almost constantly
similar organs in every individual; and we know, that these
organs have usually a general relation to each other, in form,
magnitude, and position. Yet very little further observation is
sufficient to convince us, that these relations do not admit
of being determined with mathematical precision. The form
and position of parts, ascertained with the most scrupulous
accuracy in one individual, are not to be adopted as the
basis of a system of rules, by which the operative surgeon
is invariably to be directed in the practice of his art. To
inculcate on the minds of the inexperienced, that surgical
operation consists merely in the study of the external form,
and that it is solely regulated by the mathematical bearings of
certain prominences and depressions on the surface of the body,
is to encourage the rash and the ignorant to sport with the
lives of their fellow creatures, and entail disgrace and misery
on themselves.”
What must the liberal and candid think of this, when they are
informed that the misrepresentations which I now quote, are the
production of a party, of whom more than one intends to give
a course of lectures on subjects similar to the man against
whom they privately direct these attacks!... What they want
in intellect and genius, they compensate for in numbers and
in stratagem. I am aware that these gentlemen may influence
some of better minds than their own; but I shall entrust their
confutation and their shame to demonstration and the evidence
of facts.
When _I_ have mistaken the femoral artery for the profunda;
when _I_ have taken up arteries in amputation before sawing
off the bone; and when, in attempting to perform the operation
of Lithotomy, _I_ have been forced to abandon it, publicly
to attempt an explanation in apology for the blunder, and
then obliged to leave it, to see whether THE STONE WOULD COME
AWAY OF ITSELF! or be, as is perpetually the case on similar
occasions, privately extracted by another—when I have done
all this, and made myself an object of laughter even to the
youngest pupil—then, then I shall cease even to speak of
Surgery or Medicine.
I have now only to add a few words concerning the necessity of such
precise methods of operation in the present military state of Europe.
* * * * *
While such important operations remain in so vague a state, what ease
would not such measurements confer, when, in the cockpit of the man of
war or on the field of battle, the perplexed and bewildered surgeon knows
not where to turn him, but must leave an hundred operations in an hour to
an unexperienced assistant.
At a time, when a successful conspiracy of adventurous ruffians are, at
the point of the bayonet, establishing, from the Don to the Douro, from
the Scheldt to the Cattarro, over all the fairest provinces of Europe,
the most dreadful of military despotisms;—at a time, when, to the shout
“Avance, Avance,” louder and more tremendous than the noise of their
guns, the myriad legions of France are carrying death and destruction
before them, and sweeping together man and civilization from the face of
the Continent;—at a time, when he who has “sceptres tipt with coronets
for his pallisadoes, kingdoms for his martello towers and kings for his
centinels,” threats at once the liberties and the existence of Britain,
and stains every step of his career with perfidy and blood;—at a time,
when it is the duty—it is the wish of every man of honour successfully
to defend, or, covered with wounds, nobly to die for the liberties of
Britain and the emancipation of Europe—when all this is the case, what
are not his duties whose sole profession it is, aided by science, to
rescue from death or agony those whom tyranny has attempted to destroy,
the genius of whose god-like art it is to save both friends and foes;
and, upon whose knowledge, the existence and the fate of armies may, in
no small degree, be said to depend.
Never were the duties of the military surgeon more complex or more
formidable. Never did he stand in need of greater precision. And, in his
art at least, he ought to recollect that no commissions are sold—the
precisest knowledge alone entitles to—infallibly secures, pre-eminence
and fortune.
_POSTSCRIPT._
Since the publication of my Prospectus, and of the observations delivered
in the previous note, the persons to whom that note alludes, have become
ashamed of their conduct, and have, both in their lectures and through
the press, asserted that I was not the object of their public attack;
but that, _although it was quite unconnected with the object of the
pamphlet in which it appeared_, yet they had taken the trouble to direct
the attack against a gentleman at almost a thousand miles distance from
them, and only two copies of whose book had ever reached the country;
because, I suppose, they were alarmed lest, at that _short distance_,
that gentleman should influence attendance upon their lectures, and lest
a work so _widely diffused_ over the country should “encourage the rash
and the ignorant to sport, _by means of accurate measurements_, with
the lives of their fellow creatures, and entail disgrace and misery
on themselves....” _Humanity_ is certainly deeply indebted to their
generous, disinterested and philanthropic exertions! How much to be
regretted that it has not ever had such guardians! Monuments doubtless,
rivalling that of the hero of Trafalgar, will be erected to their
memory—monuments of a nobler kind, because destined to record, not the
triumphs of war, but the triumphs of lectureship in anatomy, physiology
and surgery, which certainly involve, not the destruction, but the
preservation of lives.
What! M. Richerand, only at a thousand miles distance, influencing the
_newly organized_ courses of lectures in Edinburgh, and _two copies_ of
his dangerous book, proposing precise measurements in surgery, _actually_
in the British empire.—Some gentlemen, perhaps, may be sufficiently
ill-informed to imagine that the attack was really directed against so
weak a creature as myself. How improbable! It is self-evident that I, _in
Edinburgh_, could not have a thousandth part of the influence upon their
lectures, that M. Richerand could _at the distance of a thousand miles_,
and that my lectures, inculcating the principle _every day_, could not
have a millionth part of the tendency to “encourage the rash and ignorant
to sport, _by means of accurate measurements_, with the lives of their
fellow creatures and entail disgrace and misery on themselves,” that _two
copies_ of M. Richerand’s book, actually in the country, must infallibly
have.... He would be almost mad who could suppose the allusion was to me,
because I was at hand and _therefore_ could have no influence upon their
lectures; I was delivering these opinions every day, and they _therefore_
could not be disseminated: hence these gentlemen had no earthly interest
in alluding to me. He, on the contrary, is wise who supposes that the
allusion is to M. Richerand, because he is in Paris and _therefore_ must
have great influence upon their lectures; of his book even two copies
are in the British empire and its sentiments _consequently_ must be most
widely disseminated; and it was _well contrived_ and _inexpressibly
humane_ to introduce and firmly to oppose such a _desperate_ character,
even in a work upon a _different subject_. In short, these gentlemen
had the nearest interest in opposing him.... Well, it must certainly
be highly satisfactory to have thus opposed the progress of error
and rescued the human race from _disgrace_ and _misery_. Generous,
disinterested, philanthropic defenders of _humanity_, you have your
reward _in your own breasts_.
But their apology will not bear the test of ridicule. Let us therefore
examine, in another way, the foundation upon which it rests.
After denying the truth of the principle they ascribe it to another.
And who is ignorant that this has been the fate of every original
proposition? M. Richerand, they say, discovered it in 1805. Now granting,
for a moment, the truth of this, I preceded him by a year or two at
least, and James Macartney, Esq. lecturer on comparative anatomy, even
constructed, twelve months before the time they mention, a work upon the
principle, for which he was favoured with drawings by Charles Bell, Esq.
at the time the discovery is ascribed to M. Richerand. I mention these
facts because, even granting the truth of what these gentlemen state, it
refutes the assertions they found upon it.—I shall make a point of laying
the further details on this subject (to me very important) before the
medical world, which will show that, _even since I first enunciated the
principle_, neither M. Richerand, nor any other person, has even repeated
the proposition, and I defy these gentlemen to produce an instance of it.
This, however, I must remark, even these gentlemen most inconsistently
grant; for they say that the proposal, which they assert was made by
M. Richerand, has been tried and has _failed_; whereas the proposition
enunciated by me has been tried, has _uniformly succeeded_, and, such is
its correctness, that it constitutes the basis of that part of my course
which involves the operations of surgery. Therefore, even according to
themselves, _the propositions cannot be the same_.
I may now conclude by observing, that, notwithstanding the conduct of
these gentlemen, I am far from bearing them any personal dislike,—but
shall, on the contrary, be happy to labour with them in the same
vineyard, and wish them the utmost success.
* * * * *
Mr WALKER’S Course of ANATOMY and PHYSIOLOGY recommences on _Tuesday the
8th of November, at_ ELEVEN O’CLOCK, a. m. and his Course of PATHOLOGY
and the PRACTICE OF MEDICINE, at TWO O’CLOCK, p. m. and will be continued
daily at these hours, at No. 63, SOUTH BRIDGE-STREET.