Part 9

Thus I have answered the only objections that it is possible to urge against the principle proposed.

I have already said, that private objections by persons who dare not publicly make one, and who themselves cannot, by one or two incisions, approach within several inches of any artery, I shall uniformly despise, and shall only ask them to perform the operation with my youngest pupil.

I shall now deliver a short history of the method proposed.

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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.

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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.

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.

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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.