Part 6

Every surgical anatomist will (if he examine himself) perceive that, previously to undertaking the performance of an operation upon the living body, he stands reassured and self-reliant in that degree in which he is capable of conjuring up before his mental vision a distinct picture of his subject. Mr. Liston could draw the same anatomical picture mentally which Sir Charles Bell's handicraft could draw in reality of form and figure. Scarpa was his own draughtsman.

If there may be any novelty now-a-days possible to be recognised upon the out-trodden track of human relative anatomy, it can only be in truthful and well-planned illustration. Under this view alone may the anatomist plead an excuse for reiterating a theme which the beautiful works of Cowper, Haller, Hunter, Scarpa, Soemmering, and others, have dealt out so respectably. Except the human anatomist turns now to what he terms the practical ends of his study, and marshals his little knowledge to bear upon those ends, one may proclaim anthropotomy to have worn itself out. Dissection can do no more, except to repeat Cruveilhier. And that which Cruveilhier has done for human anatomy, Muller has completed for the physiological interpretation of human anatomy; Burdach has philosophised, and Magendie has experimented to the full upon this theme, so far as it would permit. All have pushed the subject to its furthest limits, in one aspect of view. The narrow circle is footworn. All the needful facts are long since gathered, sown, and known. We have been seekers after those facts from the days of Aristotle. Are we to put off the day of attempting interpretation for three thousand years more, to allow the human physiologist time to slice the brain into more delicate atoms than he has done hitherto, in order to coin more names, and swell the dictionary? No! The work must now be retrospective, if we would render true knowledge progressive. It is not a list of new and disjointed facts that Science at present thirsts for; but she is impressed with the conviction that her wants can alone be supplied by the creation of a new and truthful theory,--a generalization which the facts already known are sufficient to supply, if they were well ordered according to their natural relationship and mutual dependence. "Le temps viendra peut-etre," says Fontenelle, "que l'on joindra en un corps regulier ces membres epars; et, s'ils sont tels qu'on le souhaite, ils s'assembleront en quelque sorte d'eux-memes. Plusieurs verites separees, des qu'elles sont en assez grand nombre, offrent si vivement a l'esprit leurs rapports et leur mutuelle dependance, qu'il semble qu'apres les avoir detachees par une espece de violence les unes des autres, elles cherchent naturellement a se reunir."--(Preface sur l'utilite des Sciences, &c.)

The comparison of facts already known must henceforward be the scalpel which we are to take in hand. We must return by the same road on which we set out, and reexamine the things and phenomena which, as novices, we passed by too lightly. The travelled experience may now sit down and contemplate.

That which I have said and proved elsewhere in respect to the skeleton system may, with equal truth, be remarked of the nervous system--namely, that the question is not in how far does the limit of diversity extend through the condition of an evidently common analogy, but by what rule or law the uniform ens is rendered the diverse entity? The womb of anatomical science is pregnant of the true interpretation of the law of unity in variety; but the question is of longer duration than was the life of the progenitor. Though Aristotle and Linnaeus, and Buffon and Cuvier, and Geoffroy St. Hilaire and Leibnitz, and Gothe, have lived and spoken, yet the present state of knowledge proclaims the Newton of physiology to be as yet unborn. The iron scalpel has already made acquaintance with not only the greater parts, but even with the infinitesimals of the human body; and reason, confined to this narrow range of a subject, perceives herself to be imprisoned, and quenches her guiding light in despair. Originality has outlived itself; and discovery is a long-forgotten enterprise, except as pursued in the microcosm on the field of the microscope, which, it must be confessed, has drawn forth demonstrations only commensurate in importance with the magnitude of the littleness there seen.

The subject of our study, whichever it happen to be, may appear exhausted of all interest, and the promise of valuable novelty, owing to two reasons:--It may be, like descriptive human anatomy, so cold, poor and sterile in its own nature, and so barren of product, that it will be impossible for even the genius of Promethean fire to warm it; or else, like existing physiology, the very point of view from which the mental eye surveys the theme, will blight the fair prospect of truth, distort induction, and clog up the paces of ratiocination. The physiologist of the present day is too little of a comparative anatomist, and far too closely enveloped in the absurd jargon of the anthropotomist, ever to hope to reveal any great truth for science, and dispel the mists which still hang over the phenomena of the nervous system. He is steeped too deeply in the base nomenclature of the antique school, and too indolent to question the import of Pons, Commissure, Island, Taenia, Nates, Testes, Cornu, Hippocamp, Thalamus, Vermes, Arbor Vitro, Respiratory Tract, Ganglia of Increase, and all such phrase of unmeaning sound, ever to be productive of lucid interpretation of the cerebro-spinal ens. Custom alone sanctions his use of such names; but

"Custom calls him to it! What custom wills; should custom always do it, The dust on antique time would lie unswept, And mountainous error be too highly heaped, For truth to overpeer."

Of the illustrations of this work I may state, in guarantee of their anatomical accuracy, that they have been made by myself from my own dissections, first planned at the London University College, and afterwards realised at the Ecole Pratique, and School of Anatomy adjoining the Hospital La Pitie, Paris, a few years since. As far as the subject of relative anatomy could admit of novel treatment, rigidly confined to facts unalterable, I have endeavoured to give it.

The unbroken surface of the human figure is as a map to the surgeon, explanatory of the anatomy arranged beneath; and I have therefore left appended to the dissected regions as much of the undissected as was necessary. My object was to indicate the interior through the superficies, and thereby illustrate the whole living body which concerns surgery, through its dissected dead counterfeit. We dissect the dead animal body in order to furnish the memory with as clear an account of the structure contained in its living representative, which we are not allowed to analyse, as if this latter were perfectly translucent, and directly demonstrative of its component parts.

J. M

TABLE OF CONTENTS.

PREFACE

INTRODUCTORY TO THE STUDY OF ANATOMY AS A SCIENCE.

COMMENTARY ON PLATES 1 & 2

THE FORM OF THE THORAX, AND THE RELATIVE POSITION OF ITS CONTAINED PARTS--THE LUNGS, HEART, AND LARGER BLOOD VESSELS.

The structure, mechanism, and respiratory motions of the thoracic apparatus. Its varieties in form, according to age and sex. Its deformities. Applications to the study of physical diagnosis.

COMMENTARY ON PLATES 3 & 4

THE SURGICAL FORM OF THE SUPERFICIAL, CERVICAL, AND FACIAL REGIONS, AND THE RELATIVE POSITION OF THE PRINCIPAL BLOOD VESSELS, NERVES, ETC.

The cervical surgical triangles considered in reference to the position of the subclavian and carotid vessels, &c. Venesection in respect to the external jugular vein. Anatomical reasons for avoiding transverse incisions in the neck. The parts endangered in surgical operations on the parotid and submaxillary glands, &c.

COMMENTARY ON PLATES 5 & 6

THE SURGICAL FORM OF THE DEEP CERVICAL AND FACIAL REGIONS, AND THE RELATIVE POSITION OF THE PRINCIPAL BLOOD VESSELS, NERVES, ETC.

The course of the carotid and subclavian vessels in reference to each other, to the surface, and to their respective surgical triangles. Differences in the form of the neck in individuals of different age and sex. Special relations of the vessels. Physiological remarks on the carotid artery. Peculiarities in the relative position of the subclavian artery.

COMMENTARY ON PLATES 7 & 8

THE SURGICAL DISSECTION OF THE SUBCLAVIAN AND CAROTID REGIONS, AND THE RELATIVE ANATOMY OF THEIR CONTENTS.

General observations. Abnormal complications of the carotid and subclavian arteries. Relative position of the vessels liable to change by the motions of the head and shoulder. Necessity for a fixed surgical position in operations affecting these vessels. The operations for tying the carotid or the subclavian at different situations in cases of aneurism, &c. The operation for tying the innominate artery. Reasons of the unfavourable results of this proceeding.

COMMENTARY ON PLATES 9 & 10

THE SURGICAL DISSECTION OF THE EPISTERNAL OR TRACHEAL REGION, AND THE RELATIVE POSITION OF ITS MAIN BLOOD VESSELS, NERVES, ETC.

Varieties of the primary aortic branches explained by the law of metamorphosis. The structures at the median line of the neck. The operations of tracheotomy and laryngotomy in the child and adult, The right and left brachio-cephalic arteries and their varieties considered surgically.

COMMENTARY ON PLATES 11 & 12