ANNUAL LECTURE. INTRODUCTORY LECTURE TO THE COURSE ON ANATOMY AND PHYSIOLOGY, IN THE VERMONT ACADEMY OF MEDICINE. DELIVERED APRIL 7, 1841. BY JAMES ATCLINTOCK, M. D., PROFESSOR OF ANATOMY AND PHYSIOLOGY, LECTURER ON ANATOMY AND SURGERY IN THE PHILADELPHIA SCHOOL OF ANATOMY. ONE OF THE PHYSICIANS TO THE PHILADLPHIA HOSPITAL, niore especially by pointing out the particulars in which it diliers irom that of animals, whose anatomy had been previously studied as approaching nearest to the organization of man. ^ From the period just stated there appears to have been no an- atomist deserving particular notice, until the time of Galen, one of the most celebrated Physicians of Greece. He was born a- bout the 130th year of the christian era. No expense was spared m his education, after the completion of which, he visited all the most celebrated schools of philosophy which then existed, and afterwards resided chiefiv at Rome in the service of the Empe- rors of that time. Anatomy was his favorite pursuit, but,being debarred the ad- vantage of examin ng liumcn'bodies,—-the dissection of which had then been prohibited, even at -llexandria,—he had recourse to such animals as were supposed to have the greatest resemblance, 1:1 their structure to man. He has written very fully on every part of anatomy: and, indeed, his works may be considered a synopsis of all that was known on the subject "in his time. The great reputation which Galen had acquired, instead of promoting, tended rather to impede the advancement of anatom- ical knowledge during several succeeding centuries, as no hope was entertained of emulating the fame of "one who was regardco as an oracle, all incentive to exertion was destroyed. But" other causes, of a political nature, also contributed to the decline of anatomy, as well as of other branches of learning, from the time of Galen to the downfall of the Roman Empire, and during the ages of intellectual darkness which followed. Learning, how- ever, was still cultivated at Alexandria, until that city was taken "ny the Saracens, in the year 040, at which time the celebrated li- brary was barnt, with the exception of some medical works,, I 6 which the desire of acquiring knowledge to prolong life induced the conquerors to preserve. The Arabians were satisfied with the information to be obtain- ed from the writings of Galen; and as their religious rites prohib- ited all contact with a dead body, improvement in anatomy was of course entirely checked, until the 14th century, when some Italians, who were not satisfied with the anatomical instruction of the times, ventured to investigate for themselves. • Mondini de Luzzi, professor at Bologna, first publicly dissected two subjects in 1315, and soon afterwards published a description of the human body, which, for a long time, was the common sys- tem of Anatomy; but his researches were soon suspended by a decree of Pope Boniface VIII. prohibiting the boiling and pre- paring of human bones. In the 15th century, Montagna, Professor of Padua, couldboast of having dissected fourteen subjects, which were then consider- ed a great number. In the 16th century, anatomy improved more rapidly than here- tofore; for, during this period, Berengarius, Stephans, Fernelius, and Andernack, dissected assiduously; but a veneration for the opinions of Galen, whose dogmas were still considered the best authority, was a great obstacle in the way of improvement, till Vesalius about the year 1520, boldly ventured to question the ac- curacy of his descriptions. So great was the zeal of Vesalius, for dissection, that it is said he used to rob the gibbets and dissect the bodies in his bed-cham- ber. By this means he soon discovered that Galen's knowledge of anatomy, was obtained by the dissection of quadrupeds ; and he then began openly to contradict the assertions of the Grecian Sage. At the age of twenty-fivej he commenced his system of Anatomy, and after overcoming many difficulties, he completed it in the space of three years. Teachers of anatomy who had always lauded Galen as the source of all information, were indignant that his faults should have been exposed by so young a man as Versalius. The contro- versies which ensued, accelerated the progress of anatomical knowledge, as the disputants were obliged to confirm their own opinions, or invalidate those of their opponents, with arguments furnished by the dissection of the human body. Contemporaneous with Vesalius, was Fallopius, who was Pro- fessor of Anatomy at Padua. In 1561 he published his observa- tions in Anatomy, which is considered by some writers one of the best works of the 16th century. About "the same period, also, lived Eustachius, Professor at Rome ; he was the first to describe the renal capsules, and the passage from the throat to the internal ear, called after him,—the Eustachian tube. Fabaicius Hieronymus, who succeeded Fallopius in the Pro- fessorship of Anatomy at Padua, is 'thought to have been the first 7 Anatomist who noticed the valves in the veins, which he demon- strated in 1574. It is probable that this circumstance led to the discovery of the real course of the circulation of the blood by the illustrious William Harvey, who was born in England in 157b. To appreciate the importance of the discovery of Harvey, it will be advantageous to us, to review the history of the circula- tion of the blood, previously to his time. From an examination of the works of Galen and his immedi- ate successors, it has been satisfactorily demonstrated that the ancients knew nothing of the true course of the circulation. They believed that the blood was formed in the liver, and con- veyed through the veins by an alternate undulatory motion of these vessels in opposite directions ; they also imagined that the finer parts of the blood, by transuding through the septum of the heart, from the right to the left side, mixed with the air received into the lungs, and formed a vital spirit which was moved by a kind of flux and reflux along the arteries. " On the revival of Anatomy in Europe," says Dr. Roget, " some vague notions of the pulmonary circulation appear to have suggested themselves to many eminent men. Vesalius demon- strated that the blood could not possibly pass from the right to the left ventricle, through the septem of the heart. Realdus Co- lumbus, Professor of Anatomy at Padua, who had been a pupil of Vesalius, distinctly traced the passage of the blood through the lungs. The same fact had, moreover, been discovered by Micha- el Seivetus, who was born in Aragon, in 1509. Farther progress was made by Andrew Ccesalpinus,, an Italian Physician, who speaks of a communication existing between the veins and arte- ries at their remote extremities, and notices the effect of the valves of the arteries and of the auricles as calculated to prevent a reflux of the blood; but he is quite at a loss to reconcile this observation with the common notions which he had imbibed, and to which he still adhered, of the functions of these vessels. But, notwithstanding these apparent approximations to the truth, it is probable that many ages would have elapsed before the complete discovery of the circulation, if some bold and penetrating genius, such as that of Harvey, had not arisen. After having studied six years at Cambridge, he, at the age of twenty-one, went to the University of Padua, which was then one of the most celebrated medical schools in the world. He be- came the pupil of Fabricius, who was, at that time, in the habit of demonstrating the valvular structure of the veins. Harvey's attention having been thus directed to the subject, he, on his re- turn to England, began his investigations on the use of the valves. In the course of his inquiries on this point, he performed many experiments on living animals, and, by this means, he ascertain- ed the real course of the blood in its circulation:—thus consum- mating one of the greatest discoveries ever made in any science. 8 Harvey taught this new doctrine, in his lectures, about the year 1616, but did not publ.sh any account of it till 1628. On its promulgation it met with the most violent opposition; and so in- veterate were the prejudices of the public, that the practice of Harvey was considerably diminished in consequence of his dis-. covery. It was remarked that no physician who had passed the age of forty, would admit the truth of a doctrine so much at va- riance with all the systems in which he had been educated. En- vious of his growing reputation, many of his contemporaries had recourse to all kinds of sophistry, with the view of detracting from his merit. They at first vehemently contested the truth of the doctrine; but afterwards, when forced by the decisive evi- dence adduced in its support, to admit its validity, they changed their mode of attack, and alledged that the merit of the discove- ry did not belong to Harvey ; the circulation having been known oven to the ancients. But vain were all the efforts of envy and detraction to lessen that fame, which will command the admira- tion of all future ages. Harvey's discovery was soon followed by another, in many respects, even more extraordinary;—the discovery of a great and important system of vessels, which had seldom been even par- tially seen, and the existence of which was unknown to anato- mists of that era. The food had been traced from the mouth to the stomach, and through the different convolutions of the intestines; but no one Lad ever observed a single passage by which the nutritious part of the aliment might be conveyed into the system. There had been seen, indeed, a number of veins on the intestinal tube: but, as none were observed except the concomitant branches of arte- ries, it was naturally supposed that the veins were the vessels which conveyed the chyle: and, as those which arise from the stomach and intestines terminate in the liver, it was believed that in thatviscus the chyle was changed into blood, from which cir- cumstance it was called the organ of sanguification. This was the generally received opinion until 1VC.-2, when Asc-I- lius, in opening a livinjj dog, observed vessels filled with a whit- ish fluid, passing from the intestines to the pancreas and liver, he at first supposed they were nerves, but more accurate examina- tion proved them to be vessels: from the color of their contents, he called them lacteals. About thirty years after the discovery of tha lacteals, Pecquet, a French Anatomist, while experimenting upon living dogs. found that the lacteals emptied into the receptalum chyli: he al- so discovered the thoracic duct and traced it to its termination in the left subclavian vein. The foregoing discoveries were made upon inferior animals; Veslingius ascertained that the same vessels existed in man: in 1634 he demonstrated the lacteals, and the thoracic duct in 1649. 9 About the same period Rudbeck, a Swede, discovered the gen- eral absorbents of the body; the lymphatics, and traced them to the throcic duct. Bartholin of Copenhagen, also claimed the dis- covery of these vessels, but most writers award the credit of hav- ing first seen them to Rudbeck. To the use of the microscope, which was introduced about the middle of the 17th century, we are much indebted for a knowl- edge of the minute structure of different parts of the body. Mal- pighi an Italian, was the first to apply this instrument to anatom- ical purposes; he examined with it the minute structure of vari- ous organs, but his attention was chiefly devored to the investi- gation of the glandular system. Microscopic discoveries were also made by Swammerdam, Lewenhock, Bonnet, and others. The manner of injecting the vessels, and preserving parts of the body by drying and varnishing, which had long been, known and practised, was greatly improved by De Graaf, a Dutch an- atomist, who, about the year 1660, invented the syringe now used for injecting. Various fluids had been tried for injecting, none of which an- swered the purpose, until Swammerdam in 1670 introduced the use of melted wax. The art of injecting and making preparations, was much per- fected by Ruysch, the friend and successor of Swammerdam. Interesting and instructive as the inquiry might prove, to detail the labors and discoveries of the anatomists of the 18th century it would occupy more time than we can at present devote to it.— I shall therefore, merely refer to them. In this era lived many men who by their assiduity in the pros- ecution of anatomical inquiries, made such discoveries as tended materially to advance the knowledge of the practice of medicine and surgery. Among'them may be mentioned, Valsalva, Haller, Bcerhave, Vicqd'Azer, Cheselden, Scarpa, Munro, William Hun- ter, and many others ; but the most distinguished anatomist and physiologist of this period was John Hunter the brother of Dr. William Hunter. He was the founder of the most extensive an- atomical collection in Europe, the Museum of the Royal College of Surgeons in London. By his accurate knowledge of anatomy, he was enabled to make so many improvements in the manner of performing vari- ous surgical operations, as to earn the title by which he is still known—the Father of British Surgery. In the present century there have been many men, who by their researches in Anatomy have made for themselves an envi- able reputation. The'most most prominent of these is the cele- brated Bichat, who by the force of his splendid talents and in- dustry did more in his short life, 31 years, for the advancement of anatomical science, than any of his predecessors in double that period. To him we are indebted for the most of ourknowl- 10 edge of the elementary tissues, which constitute the different or- gan* of the body. In our own country, gentlemen, we have had, and still have, many men who by the extent and profundity of their knowledge of Anatomy, have acquired such celebrity, as to reflect honor on the land which acknowledges them as citizens. The first teacher of Anatomy in this country, was Dr. Wm. Shippen of Philadelphia, who began to lecture in the year 1762. to a class of from twelve to fifteen students : in 1765 he was elected Professor of Anatomy, Surgery and Midwifery in the then, recently established medical department of the College of Philadelphia"; his lectures were continued from year to year, ex- cept when interrupted by the revolutionary war, until 1792, when the College of Philadelphia and University of Pennsylvania were united ; and he was appointed Professor of Anatomy in the new institution. In the year 1808, Dr. Casper Wistar was elected to the Chair of Anatomy, it having been vacated by the death of Dr. Ship- pen. As a lecturer, Dr. Wistar is said to have had few equals; as an anatomist, he has left an imperishable monument, for he was the founder of the most splendid and extensive anatomical cabi- net in this country; which is called in honor of him,—the Wis- tar Museum of the University of Pennsylvania. Among the brightest ornaments of our profession in this coun- try, must be mentioned one, who by the exercise of his great talents and indefatigable industry in the study of Anatomy, rais- ed himself in the short period of 35 years, from obscure poverty to the highest pinnacle of fame : such was Dr. John D. Godman. The last to whom I shall call your attention, in this bright gal- axy, is one, who has departed from us within the remembrance of us all. At an early age he went to Europe to complete his medical education, and as a private pupil of John Hunter, he devoted himself so assiduously to anatomical pursuits, that he became perfect master of the subject. When.he returned to his native city, Philadelphia, and began the duties of his profession, he soon, as a physician, made a reputation which extended over the whole country : while in surgery, owing to his numerous improvements and successful operations, he, Dr. Physic, is called the Father of American Surgery. Having now, gentlemen, given a brief history of Anatomy aud Physiology, I will conclude this address with a few remarks in reference to the importance of the study of Anatomy. The student who devotes himself assiduously to the investigation of this subjer.t, may congratulate himself that he is not pursuing a mere phantasy, but that he is acquiring real and substantial knowledge ; for of all the departments of our profession, this is the one most legitimately deserving the name of a science, and it is the foundation upon which the whole superstructure of medi- cal knowledge must be based. n The interesting and. beautiful doctrines of Physiology, if not founded upou correct anatomical information would be mere vague hypotheses and ingenious speculations, but the two sub- jects are so intimately blended as to be instperable, for the anat- omist while examining the minute structure of the body, almost invariably acquires some knowledge of the functions, for although it be true that an acquaintance with the parts of the organiza- tion, does not demonstrate the uses of such parts, it is equally certain, that the one cannot be understood without an intimacy with the other. The next department of our profession most intimately con- nected with this science, is Surgesy. Many men are first rate anatomists who, owing to constitutional peculiarites, can never become good surgeons; but in the whole history of medicine from the most remote antiquity down to the present time, there cannot be found an instance of one man who became celebrated as a surgeon without being well versed in Anatomy ; the individ- ual who attempts the practice of the oue without possessing the necessary acquaintance with the other, is like the mariner who tries to navigate the ocean ignorant of the locality of his port of destination, or the use of chart and compass by which he is to steer for that haven, he either drives his vessel ashore or rushes on the rocks upou which his ship is destroyed, and meets an ig- noble but deserved fate—a watery grave, or else he runs into the quicksands and there meets an eqally certain doom. So with the pretended surgeon, he knows not the situation of the part to be operated upon^and is entirely ignorant of the tissues in his passage to it. For a thrilling picture of the horrors of a person in such a situation, I refer you to the description of the justly celebrated John Bell, in the first volume of his principles tf ■Surger/. Pathology is equally dependent upon Anatomy and Physiology for its existence ; you can readily appreciate the impossibility of understanding the diseased actions of the body, without being fully aware of its structure and functions in a healthy state. The practitioner of medicine, ignorant of Anatomy and Phys- iology, is but an experimenting quack, for how can he know the symptoms evolved by diseased parts, while he is not at all aware of the location and functions of such organs in a normal state ? The study of Materia Medica and Chemistry, instructive and necessary as I know them to be, would be but an idle waste of time without a previous or concomitant knowledge of our sci- ence, for vague and uncertain would be the prescribing of any one, no difference how well he understood the history, medicinal effects and incompatibilities of remedies, without being well grounded in Anatomy. In Midwifery, that most delicate branch of our profession, tbo advantages of anatomical knowledge are strikingly manifest; 12 the practitioner who is not properly acquainted with the structure and functions of the parts, becomes, when the slightest mal-pre- sentation occurs, agitated and alarmed, and in consequence of his most culpable ignorance, the mother for want of aid in this, the most momentous period of her life, is permitted to die unde- livered, or, if the case do not terminate by her martyrdom, in all probability the innocent babe is sacrificed by his stupidity. Far different under such circumstances is the conduct of one familiar with our science; he having carefully studied the axes, diameters and straits of the mother's organs, and being familiar with the correspondent part of the child, is enabled in almost all cases, to yield at once such assistance as to consumate the labor in perfect safety to both the mother and her tender infant. In no part of our professional sphere, is the paramount value of anatomical knowledge more conspicuously shown than in medico-legal examinations. Unfortunately .for the reputation of our calling, it often happens that men ignorrnt of this subject are called into courts of justice as witnesses, and so manifest is their deficiency that their testimony is set aside, and they get what they so justly merit—the contempt of the by-stande'rs; were this all, they would receive their deserts, but the consequences do not stop here; for by their misconduct the honor of the noble profession they pretend to understand is degraded. Within my own knowledge, a case occurred in which one of these drones received the castigation he so richly deserved; in a trial for mur- der, a medical witness was asked where the phrenic nerve was situated ? he believed it was in the neck, but with its locality he was unacquainted; the attorney of the opposite side availed him- self promptly of this weak point in the case, for the medical ex- amination was all important, had it been given by one acquaint- ed with our subject, and he saved his client, but in the mean- time so ridiculed medical testimony, and the ignorant doctor in particular, that well informed physicians have since been exceed- ingly annoyed in giving evidence before that bench. Before 1 conclude my remarks, permit me to express the hope that the consideration of the subjects adverted to in this discourse may so stimulate the laudable ambition, which I have no doubt you possess, that you will increase your exertions to emulate the attainments of the honored men whose history I have attempted briefly to pourtray. Do not be discouraged if in the commence- ment of your researches you encounter difficulties, they can all be surmounted by patience and perseverance. Let not the idea that you are not blessed with the highest qualities of mind, de- press you, for it often happens that those most richly favored with intellectual abilities, faint by the way; while those possess- ing less talentj but endowed with determination and industy, struggle on until they attain what will be the sure reward of all such—ithe highest honors of our profession.