Southwood Smith

“ The basis of all medical and surgical knowledge is anatomy. Not a single step can be made either in medicine or surgery, considered either as an art or a science without it. This should seem self evident, and to need neither proof nor illustration: nevertheless, as it is useful occasionally to contemplate the evidence of important truth, we shall show why it is, that there can be no rational medicine, and no safe surgery, without a thorough knowledge of anatomy. ”

“ The poison generated in both cases is the same; the difference is merely in the degree of its potency. Nature, with her burning sun, her stilled and pent-up wind, her stagnant and teeming marsh, manufactures plague on a large and fearful scale: poverty in her hut, covered with her rags, surrounded with her filth, striving with all her might, to keep out the pure air, and to increase the heat, imitates nature but too successfully ”

“ 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. ”

“ He who believes fever to consist of an affection of the nervous system alone, every other affection that may be combined with it being accidental, will rarely think of using the lancet: he who believes fever to consist of inflammation alone, and overlooks the presence of the nervous affection, will be apt to carry the employment of the lancet too far: he alone who embraces the view of both, brings within his own all the phenomena: he alone adopts a sound theory of the disease, and we now see that he alone is likely to be led to a sound practice. ”

“ To the surgeon, anatomy is eminently what Bacon has so beautifully said that knowledge in general is: it is power—it is power to lessen pain, to save life, and to eradicate diseases, which, without its aid, would be incurable and fatal. ”

“ Prejudices, worthy only of the multitude, have been conjured up and appealed to, in order to call forth popular indignation against those whose business it is to exhibit demonstratively the structure of the human body, and the functions of its different organs. The public journals, from a vicious propensity to pander to the vulgar appetite for excitement, have raked up and industriously circulated stories of exhumation of dead bodies, tending to exasperate and inflame the passions of the mob ”

“ We know the events: we know the order in which they occur: we know therefore what it is that constitutes the disease, and we know consequently what it is by which it is distinguished from every other malady. No other disease exhibits the same train of phenomena in the same order of succession. In inflammation some of the phenomena are the same: but the order in which they concur is not the same; and this affords a clear and universally applicable mark of distinction between fever and inflammation. ”

“ All this time these convulsions are merely a symptom; that symptom depends upon, and denotes, most important disease in the brain: the only chance of saving life, is the prompt and vigorous application of proper remedies to the brain; but the practitioner whose mind is occupied with the symptom, and who prescribes antispasmodics, not only loses the time in which alone any thing can be done to snatch the victim from death, but by his remedies absolutely adds fuel to the flame which is consuming his patient. ”

“ It is not easy for a nurse to resist incessant importunity and even reproach; and there are suspicions to which a physician is subjected, which, when he sees that they are entertained, it requires some moral courage to enable him to bear. Without doubt he deserves the worst that can attach to him if he allow the caprice, or the impatience, or the injustice of his patient, or any earthly consideration to induce him to swerve from the faithful discharge of the duty he has undertaken. ”

“ Every one desires to live as long as he can. Every one values health "above all gold and treasure." Every one knows that as far as his own individual good is concerned, protracted life and a frame of body sound and strong, free from the thousand pains that flesh is heir to, are unspeakably more important than all other objects, because life and health must be secured before any possible result of any possible circumstance can be of consequence to him. ”

“ To assign the reason of what must be so obvious to every one who is acquainted with the elements of physiology, would be entirely out of place here, because it would suppose the reader to be wholly ignorant of the functions of the animal economy. Our knowledge of the pathology of fever can never be complete, until we know the morbid changes that take place in the fluids as perfectly as we are acquainted with the alterations of structure that are produced in the solids, and we ought, therefore, to spare no labour to render our knowledge of the former as exact and certain as it is of the latter. ”

“ Whatever be the number of organs simultaneously affected, the nature of the affection in each is always the same, and is not in the slightest degree changed by the complication. Disease in the brain is the same, whether the brain alone be prominently affected, or the brain and the intestines, or the brain, the intestines and the lungs. Each organ is liable to its own specific disease, and that disease goes on with the utmost regularity, whether it be the sole organ so far diseased as to suffer a change in its structure, or whether many be simultaneously affected in the same manner. ”

“ They are conscious that the operation is one of immense importance: they know that in the hands of an operator ignorant of anatomy, it is one of extreme hazard: they therefore put off the time as long as possible: they have recourse to every expedient: they resort to every thing but the only efficient remedy, and when at last they are compelled by a secret sense of shame to try that, it is too late. All the best practical surgeons express themselves in the strongest language on the importance of performing the operation early, if it be performed at all. ”

“ While the patient experiences the sensation of cold, there is no diminution of the quantity of caloric in the system. The thermometer applied to any part of the body commonly rises as high as in the state of health, and the skin, touched by the hand of another person, communicates not the feeling of cold, but often, on the contrary, that of preternatural heat. There is no positive abstraction of caloric from the body nor any failure in the process, whatever it be, by which animal heat is generated; there is only altered sensation, in consequence of derangement in the function of the skin. ”

“ If has been conceived that the sanctity which attaches to the dead, is reflected back in a profounder feeling of respect for the living; that the solemnity with which death is regarded, elevates, in the general estimation, the value of life; and that he who cannot approach the mortal remains of a fellow creature without an emotion of awe, must regard with horror every thing which places in danger the life of a human being. ”

“ It is remarkable how entirely the most distinguished physicians of all ages who have treated of this subject coincide in the feeling, that with regard to this important class of disease it is impossible in the short life allotted to the most aged to do any thing more than add a little knowledge to the common stock. If there be any foundation for this feeling it can only be by every man faithfully endeavouring to contribute what he may be able, be the amount ever so small, that that stock can speedily become large or ever become complete. ”

“ It seems impossible to exhibit a more striking illustration of the great value of anatomical knowledge.
But if there be any disease, which, from the frequency of its occurrence, from the variety of its forms, from the difficulty of discriminating between it and other maladies, and from the danger attendant on almost all its varieties, requires a combination of the most minute investigation, with the most accurate anatomical knowledge, it is that of hernia. ”

“ Whatever may be thought of the superior power of the theory of Brown, the pupil and rival of Cullen, to explain the general phenomena of the living body, whether in a state of health or of disease, the doctrine of the pupil relative to fever, differs in no essential respect from that of the master. Like his predecessor, Brown attributes all fevers to debility; and affirms that the distinctions which physicians have made about the differences of fever are without foundation; that they are all the same, differing only in degree; that the debility during the cold stage is the greatest ”

“ Several systems of vessels in which the most important functions of animal life are carried on—the absorbent system, for example, and even that portion of it which receives the food after it is digested, and which conveys it into the blood, are invisible to the naked eye, except under peculiar circumstances: whence it must be evident, not only that the interior of the human body must be laid open, in order that its organs may be seen; but that these organs must be minutely and patiently dissected, in order that their structure may be understood. ”

“ A knowledge of the condition of the internal organs, in fever, can alone guide us to a rational and successful treatment of this most dangerous disease. It is only by examining the body after death that we can acquire this information: it is only by observing the symptoms during life and comparing them with the morbid appearances after death, that we can discover the signs which indicate the existence of these states. ”

“ The system of medicine and surgery which is established in any country, has a greater influence over the lives of its inhabitants than the epidemic diseases produced by its climate, or the decisions of its government concerning peace and war. The devastations of the yellow fever will bear no comparison with the ravages committed by the Brunonian system; and the slaughter of the field of Waterloo counts not of victims, a tithe of the number of which the Cullenian doctrine of debility can justly boast. Anatomy alone will not teach a physician to think, much less to think justly ”

“ The eye cannot well bear the light: there are few cases in which the full glare of day does not excite uneasiness, while in many the ordinary light of a room cannot be borne: in these cases the opening between the eye-lids is frequently observed to be contracted, as if from an involuntary effort to exclude a portion of that stimulus which in health excites no inconvenience, and this state of the eye-lids assists in giving to the eye its dull and heavy expression, so characteristic of fever. The increase of sensibility in the organ of hearing is equally striking. ”

“ Pupils flocked to them from all quarters of the globe, and they essentially contributed to that advancement of science which the present age has witnessed. In the 19th century, the good people of Scotland, that intelligent, that cool and calculating, that most reasonable and thinking people, have thought proper to return to the worst feeling and the worst conduct of the darkest periods of antiquity. There is at present no offence whatever, which seems to have such power to heat and exalt into a kind of torrent, the blood which usually flows so calmly and sluggishly in the veins of a Scotchman. ”

“ How great then must necessarily be the diversity of symptoms presented by the different forms of fever! How incalculable are the varieties that result from difference of intensity alone. One degree of affection of the brain, for example, will occasion violent headache, constant watchfulness, great restlessness, a peculiar expression of the eye, and intolerance of light; in another there will be no headache, or none of which the patient will complain; there will be sleep though it be disturbed and unrefreshing; there will be no peculiar expression of the eye, and no intolerance of light. ”

“ Disease, which it is the object of these arts to prevent and to cure, is denoted by disordered function: disordered function cannot be understood without a knowledge of healthy function; healthy function cannot be understood without a knowledge of structure; structure cannot be understood unless it be examined.
The organs on which all the important functions of the human body depend, are concealed from the view. There is no possibility of ascertaining their situation and connections, much less their nature and operation, without inspecting the interior of this curious and complicated machine. ”

“ So far then is it from being true, that medical theories are of no practical importance, there is the closest possible connection between the speculations of the physician in his closet, and the measures which he adopts at the bed side of his patient. Truth to him is a benignant power, which stops the progress of disease, protracts the duration of life, and mitigates the suffering it may be unable to remove: error is a fearfully active and tremendously potent principle. ”

“ We may not be able to see a single spark, but if we see the smoke and feel the heat, we know that there is fire somewhere, and that however concealed at present it will soon make itself visible enough, and that it will consume not only the structure in which it originates, but others with which it may come in contact if it be not put out. With equal certainty we know that fever, though apparently mild in the commencement, will excite inflammation in vital organs, and that that inflammation, if it be allowed to establish itself, will place the fabric of the body in the most imminent danger. ”

“ This is a fact which nothing but anatomy could teach, and affords the explanation of a symptom which nothing but anatomy could give. The knowledge of it would infallibly correct a mistake, into which a person who is ignorant of it, would be sure to fall: in fact, persons ignorant of it do constantly commit the error. We have know several instances in which organic disease of the liver has been considered, and treated as rheumatism of the shoulder. In each of these cases, disease in a most important organ might have been allowed to steal on insidiously, until it became incurable ”

“ Slowness of the pulse, with severe and obstinate pain in the head, attended with confusion of mind, is always a highly dangerous-symptom: it invariably denotes intense cerebral disease. Whenever there is such a struggle, as this case exhibits, between the physician and the disease, the disease is sure to conquer. For if the physician, terrified at the name or the duration of the malady, while he resolve to use the lancet, hesitate to employ it to the extent of subduing the disease by the first bleedings, the patient is lost. ”

“ In this country, there is no other method of obtaining subjects but that of exhumation: aversion to this employment may be pardoned: dislike to the persons who engage in it is natural, but to regard them with detestation, to exult in their punishment, to determine for themselves its nature and measure, and to endeavor to assume the power of inflicting it with their own hands, is absurd. Magistrates have too often fostered the prejudices of the people, and afforded them the means of executing their vengeance on the objects of their aversion. ”