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Title: Memoirs of John Abernethy

Author: George Macilwain

Release date: January 19, 2018 [eBook #56400]
                Most recently updated: June 14, 2020

Language: English

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MEMOIRS OF JOHN ABERNETHY.


[Illustration:

  Sir Tho^s. Lawrence P.R.A.      Cook.

  Y^{rs}. most sincerely
  John Abernethy]


MEMOIRS OF JOHN ABERNETHY,

With a View of His Lectures, His Writings, and Character;
with Additional Extracts from Original Documents,
Now First Published;

by

GEORGE MACILWAIN, F.R.C.S.

Author of "Medicine and Surgery One Inductive Science,"
&c. &c. &c.


   "The evil that men do, lives after them:
   The good is oft interred with their bones."

                                 SHAKSPEARE.

Third Edition.






London:
Hatchard and Co. Piccadilly.
1856.

The Author reserves the right of publishing a Translation of this Work
in France.

London:
Printed by J. Mallett, Wardour Street.




                             TO THE MEMORY
                                  OF
                            JOHN ABERNETHY,
                       THIS VOLUME IS INSCRIBED
                                  BY
                          ONE OF HIS NUMEROUS
                                  AND
                           GRATEFUL PUPILS,

                              THE AUTHOR.




PREFACE

TO

THE FIRST EDITION.


In submitting to the Public a Memoir of a great man, it may naturally
be expected that an author should endeavour to convey to them some idea
of the associations, or other circumstances, which have prompted the
undertaking.

My father practised on the borders of a forest; and when he was called
at night to visit a distant patient, it was the greatest treat to me,
then a little boy, to be allowed to saddle my pony and accompany him.
My father knew the forest nearly as well as his own garden; but still,
in passing bogs in impenetrable darkness, the more refined topography
of a forester would be necessary; and it was on one of these occasions
that I first heard two words, "Me-ward" and "Abernethy:" the one from
our forester guide, which I have never heard since, and the other
which I have heard more frequently perhaps than any. The idea I then
had of Abernethy was, that he was a great man who lived in London. The
next distinct impression I have of him was derived from hearing my
father say that a lady, who had gone up to London to have an operation
performed, had been sent by him to Mr. Abernethy, because my father
did not think the operation necessary or proper; that Mr. Abernethy
entirely agreed with him, and that the operation was not performed;
that the lady had returned home, and was getting well. I then found
that my father had studied under him, and his name became a sort of
household word in our family. Circumstances now occurred which occupied
my mind in a different direction, and for some years I thought no more
of Abernethy.

As long as Surgery meant riding across a forest with my father, I
thought it a very agreeable occupation; but when I found that it
included many other things, I soon discovered there was a profession
I liked much better. Some years had rolled away, when, one afternoon
in October, about the year 1816, somewhat to my own surprise, I found
myself, about two o'clock, walking down Holborn Hill, on my way to
Mr. Abernethy's opening lecture at St. Bartholomew's. Disappointed of
being able to follow the profession I had chosen, looking on the one
I was about to adopt with something very much allied to repulsion,
considering everything in this world "flat and unprofitable," and
painfully depressed in spirits, I took my seat at the lecture.

When Mr. Abernethy entered, I was pleased with the expression of his
countenance. I almost fancied that he could have sympathized with the
melancholy with which I felt oppressed. When he commenced, I listened
with some attention; as he went on, I began even to feel some pleasure;
as he proceeded, I found myself entertained; and before he concluded, I
was delighted. What an agreeable, happy man he seems! thought I. What a
fine profession! What would I give now to know as much as he does! In
short, I was converted.

Years again rolled on. I found myself in practice. Now, I had an
opportunity of proving the truth and excellence of the beautiful
principles I had been taught. I found how truthful had been his
representations of them. I was, however, grieved to find that his
opinions and views were very much misunderstood and misrepresented; and
I had very frequent opportunities of seeing how much this restricted
their application, and abridged their utility.

Some few years after his death, I tried to induce some one to endeavour
to correct the erroneous impressions which prevailed in regard to him;
but to do Abernethy full justice, _would require a republication of
his works, with an elaborate commentary_. This was a task involving
too much time, labour, and expense, for any individual to undertake;
whilst anything less, however useful or instructive to the public, must
necessarily subject the author to a criticism which few are disposed to
encounter.

But as it appeared to me that scruples like these stood in the way of
that which was alike just to the memory of Abernethy and useful to the
public, I was resolved at all hazards to undertake at least a Memoir
myself. I shall say little of the difficulties of the task. I feel
them to have been onerous, and I believe them to have been, in some
respects, unexampled.

Apologies for imperfections in works which we are not obliged to write,
are seldom valued: the public very sensibly take a work for what it is
worth, and are ultimately seldom wrong in their decision. I have only
said thus much, not in deprecation of criticism, so much as to show
that I have not shrunk from what I deemed just and useful, on account
of the somewhat oppressive sense I entertain of the risk or difficulty
which it involves.

The scientific reader may, I fear, think that, in endeavouring to
avoid too tedious a gravity, I may sometimes have been forgetful of
the dignity of biographical memoir; but, in the difficulty of having
to treat of subjects which, however important, are not always of the
most popular kind, I have been obliged sometimes to think of the "_quid
vetat ridentem_." In the very delicate task of discussing subjects
relating to some of my contemporaries, I have endeavoured simply to
do Abernethy justice; and, beyond what is necessary for that purpose,
have avoided any quotations or other matter calculated unnecessarily
to revive or rekindle impressions which may as well be dismissed or
forgotten. It may appear to some, that, in my remarks on the present
state of professional affairs, I have been too free. I can only say,
that I have stated exactly what I feel. I am earnestly desirous of
seeing a better state of things; but I have no idea that we can
materially improve that which we are afraid to examine.

I have to express my warmest thanks to several gentlemen for the
readiness with which they have contributed their assistance; my most
grateful acknowledgments to my respected friend, Mr. Fowler of Datchet,
and his son, Mr. Alfred Fowler, Mr. Thacker and Mr. Tummins of
Wolverhampton—three of them being old schoolfellows of Abernethy; to
Mr. White, the distinguished head master of Wolverhampton School, whose
acceptable services have been further enhanced by the ready kindness
with which they were contributed; to Mr. Belfour, the Secretary of the
Royal College of Surgeons, and Mr. Stone, the Librarian, I have to
express my best thanks for their kind assistance; and to the latter
especially, for many very acceptable contributions.

I have also to acknowledge the kind interest taken in the work by Mr.
Wood of Rochdale, Mr. Stowe of Buckingham—old and distinguished pupils
of Abernethy. My best thanks are also due to Dr. Nixon of Antrim, not
only for his own contributions, but still more for the personal trouble
he was so kind as to take in relation to some particulars concerning
the ancestors of Mr. Abernethy; to Mr. Chevasse of Sutton Coldfield,
for very acceptable communications; and to Mr. Preston of Norwich. Nor
must I omit to express my obligation to several gentlemen whom I have
consulted at various times. My thanks are specially due to Professor
Owen. My old friends and fellow-pupils, Mr. Kingdon, Mr. E. A. Lloyd,
Dr. Barnett, Mr. Skey, and Mr. Welbank, have shown as much interest in
the work as their opportunities allowed them, and will please to accept
my best acknowledgments.

  G. M.

  _London, September 20, 1853._




PREFACE

TO

THE SECOND EDITION.


The indulgent reception which the Public and the Profession have been
pleased to accord to these Memoirs having already rendered a second
edition necessary, the volumes have been carefully revised. This has
enabled me to correct some typographical errors, and so to modify
certain passages, that, whilst the narrative remains essentially the
same, it may be in some points presented in an improved dress. I have
also availed myself of the opportunity of making some additions and
corrections, which, though few, are not unimportant.

Although not unacquainted with the fact that Mr. Abernethy had declined
the honour of a Baronetcy, no allusion was made to it in the first
edition; because I was not then in possession of such evidence as
appeared to me necessary in relation to a circumstance that had not
fallen within my own knowledge.

By the kindness of the family, I have been enabled to correct an error
in regard to those who were present in his last moments; which, if in
an historical point of view immaterial, is by no means so with regard
to the feelings of those whom it more immediately concerns.

  G. M.

  _The Court Yard, Albany,
  Nov. 14, 1853._




PREFACE

TO

THE THIRD EDITION.


In publishing a third edition of these Memoirs, I have to express the
grateful sense I entertain of the indulgence with which they continue
to be received.

Since the appearance of the second edition, Miss Abernethy has
kindly placed at my disposal the few papers which Mr. Abernethy had
preserved; and I trust that the additions they have enabled me to
make, may not prove unacceptable. Besides circumstances of minor
interest, interspersed through the volume, there are some of great
importance. The facts relating to the marriage of Mr. Abernethy not
only disprove a number of idle reports, but offer another contribution
to the general kindness and sincerity of his character. In selecting
a few extracts from his thoughts on Religion and Morals, I have been
desirous of placing on record some of Mr. Abernethy's sentiments on
these all-important questions, without forgetting that I am writing
the Memoirs, not of a Divine, but of a _Philosophical Physiologist_
and _Surgeon_. In like manner, in the accompanying observations which
I have submitted on the relations of Science and Religion, I have
restricted myself to little more than a Layman's repudiation of a
vulgar error. Some little anxiety to impress this may be excused, lest
it should be supposed that an argument has been stated in a few pages,
which, even in an abridged form, would require a volume; besides being
inconsistent with the more measured objects of a Biographical Memoir. I
have carefully avoided quoting any papers which, either by opinion or
otherwise, reflected on the conduct of any party; and I have taken some
pains to render this unnecessary. No man could be more sensitive than
Abernethy with regard to any imputation on his honour; but that once
satisfied, I am persuaded that nothing would have been more unwelcome
to him than that his Memoirs should have contained, unnecessarily,
one word that should offend any one; nor anything more acceptable
than its avoidance under circumstances of provocation. I have had to
contend with difficulties which I need not particularize; it is far
more agreeable to express the gratitude I feel for that sympathy and
assistance which have placed papers and documents at my disposal, with
a generous confidence which, though scarcely easy sufficiently to
appreciate, I trust it is impossible knowingly to abuse.

Should it appear that, in my anxiety to avoid disagreeable discussions,
I have left any subject imperfectly handled, as regards the high
character of Mr. Abernethy, I should of course avail myself of the
documents now in my possession. I trust, however, nothing of the
kind may be necessary. Having long thought it would be interesting
to many persons, old pupils and others, to record his manner in his
later days, when delivering his Surgical or Evening Lectures, as well
as the position he was so accustomed to assume when enunciating the
fundamental axiom of that improved Surgery of which he was the author,
I have added the lithograph at page 219. For this artistic sketch I am
indebted scarcely less to the painstaking than to the genius of the
late Mr. Charles Blair Leighton, who, as stated in the text, did not
live to realize those expectations of future excellence to which his
talents had given rise. Mr. Leighton, after a short illness, died in
May, 1855.

  G. M.

  _The Court Yard, Albany,
  November, 1856._




MEMOIRS.




[Illustration:

  My dear Sir

I return you my best Thanks for your Book which you did me the favor
of sending. I have read the new Matter with which I am well pleased. I
feel also obliged to you for your kind Wishes, & asure you that they
are on my part reciprocal I am a cripple with Rheumatism & good for
nothing but still remain

  My dear Sir
  Y^{rs}. most sincerely
  John Abernethy

  Enfield
  26 April

  To George Macilwain Esq^{re}]




  TABLE OF CONTENTS


  CHAPTER I.             1

  CHAPTER II.           10

  CHAPTER III.          17

  CHAPTER IV.           25

  CHAPTER V.            31

  CHAPTER VI.           41

  CHAPTER VII.          55

  CHAPTER VIII.         61

  CHAPTER IX.           78

  CHAPTER X.            86

  CHAPTER XI.           93

  CHAPTER XII.          99

  CHAPTER XIII.        106

  CHAPTER XIV.         118

  CHAPTER XV.          126

  CHAPTER XVI.         143

  CHAPTER XVII.        164

  CHAPTER XVIII.       173

  CHAPTER XIX.         181

  CHAPTER XX.          188

  CHAPTER XXI.         197

  CHAPTER XXII.        217

  CHAPTER XXIII.       234

  CHAPTER XXIV.        240

  CHAPTER XXV.         247

  CHAPTER XXVI.        253

  CHAPTER XXVII.       266

  CHAPTER XXVIII.      284

  CHAPTER XXIX.        296

  CHAPTER XXX.         311

  CHAPTER XXXI.        327

  CHAPTER XXXII.       340

  CHAPTER XXXIII.      355

  CHAPTER XXXIV.       369

  INDEX.               391




MEMOIRS OF ABERNETHY.




CHAPTER I.

    "The Author of Nature appears deliberate throughout His operations,
    accomplishing His natural ends by slow successive steps. And
    there is a plan of things beforehand laid out, which, from the
    nature of it, requires various systems of means, as well as length
    of time, in order to the carrying on its several parts into
    execution."—BUTLER'S ANALOGY.


A retrospect of the history of human knowledge offers to our
contemplation few things of deeper interest than the evidence it so
repeatedly affords of some great law which regulates the gradual
development of truth, and determines the Progress of Discovery.

Although knowledge has, at times, appeared to exhibit something of
uniformity in its advances, yet it cannot have escaped the least
observant that, as a whole, the Progress of Science has been marked by
very variable activity—at one time, marvellously rapid; at another,
indefinitely slow; now merged in darkness or obscurity; and now blazing
forth with meridian splendour.

We observe a series of epochs divided by intervals of great apparent
irregularity—intervals which we can neither calculate nor explain; but
which, nevertheless, exhibit a periodicity, which the very irregularity
serves to render striking and impressive.

We may remark, also, a peculiar fitness in the minds of those to whom
the enunciation of truth has been successively entrusted: a fitness,
not merely for the tasks which have been assigned to each, as the
special mission of the individual, but also in the relations of
different minds to each other. This adaptation to ends which individual
minds have unconsciously combined to accomplish, might be illustrated
by many examples, from the earliest records of antiquity, down to
our own times. This would be incompatible with our present purpose.
We will therefore only refer to one or two illustrations, which, as
being familiar, will serve to show what we mean, and to lead us, not
unnaturally, to our more immediate object.

We cannot contemplate men like Bacon, Galileo, and Kepler, for example,
without feeling how auspicious the precession of such minds must have
been to the development of the genius of Newton[1]. Newton was born
the same year that Galileo died. There is something very interesting
and significant too in the peculiar powers of Kepler. Prolific in
suggestion, great in mathematical ability, elaborate in analysis, and
singularly truthful in spirit, Kepler exemplified two things. These,
though very distinct from each other, were both equally instructive;
both alike suggestive of the link he represented in the chain of
progress. In the laws he discovered, he showed the harvest seldom
withheld from the earnest search for truth; but the enormous labour of
the mode in which he conducted his researches, as well as the limits
prescribed to his discoveries, exemplify the evils which, even in a man
of the greatest power, result from proceeding too much on hypothesis.
Now it is interesting to remember that this was coincident with the
dawning of that glorious light, the Inductive philosophy of Bacon, and
shortly succeeded by the splendid generalization of Newton.

In like manner, if we think of the discoveries of Sir Humphrey
Davy—their nature and relations to physiology as well as
chemistry,—we see how much there might have been that was preparatory,
and, to a mind like Davy's, suggestive, in the investigations of
preceding and contemporaneous philosophers. Priestly had discovered
oxygen gas; Galvani and Volta had shown those remarkable phenomena
which constitute that important branch of knowledge, "Voltaic
electricity;" Berzelius had effected the decomposition of certain salts
by the Voltaic pile; and Lavoisier had even predicted as _probable_
what Davy was destined to demonstrate[3]

In medical science, few things have been more talked of than the
discovery of the circulation of the blood. Now it is curious to observe
that every fact essential to the demonstration of it had been made
out by previous investigators[4] but no one had deduced from them the
discovery of the circulation until Harvey, although it was a conclusion
scarcely more important than obvious.

There is surely something very encouraging in the reflection, that
the advance of knowledge thus results from the accumulated labours of
successive minds. It suggests, that however unequally the honours may
appear to be distributed—however humble, in our eyes, the function of
those who unconsciously prepare the way to great discoveries,—still
it may involve a duty no less important than the more lofty mission
of enunciating them. The importance of a man's mission can never be
estimated by human judgment. We can never know the mission; still less
its relations to the power, or the temptations by which that power has
been assailed. The most humble may here often approach as nearly to his
duty, as the most gifted may have fallen short of it. Our faculties
cannot penetrate the matter. We often see men placed in positions for
which they appear wholly unfitted—men who seem to be bars to that
progress which we should fancy it their duty to promote. Again, we
observe that almost all great discoveries have to encounter opposition,
persecution, obloquy, or derision; and when they are established, a
host of claimants rise up to dispute the property with the rightful
owner. A man who is in earnest cares little for these things. They may
at times discourage and disappoint him; but they only strengthen his
faith, that a day will come when an unerring justice will accord to
every useful improvement its proper place and distinction.

Humanly speaking, we naturally ascribe discoveries to those who have
practically demonstrated them; but when we examine all the clues
which have been furnished by previous observers, we frequently have
misgivings as to the justice of our decisions. In our admiration of
the successful labour of the recent inquirer, we sometimes forget the
patient industry of the early pioneer. With regard to those laws which
govern the human body, we cannot suppose that the development of them
can be destined to progress on any plan less determined than other
branches of human inquiry. But in all laws of nature we know that
there are interferences which, until explained, serve to obscure or
altogether to conceal the law from our view.

In relation to the Physiological laws, these interferences are very
numerous. 1st. Many are furnished by the physical laws; many more
arise from the connection of the physiological with the moral laws,
and especially from the abuse of (a responsible) volition. These
interferences, however, when their nature is clearly developed,
beautifully illustrate the laws they at first obscured; for the common
characters of subjects, in which the law is usually exemplified, are
brought out into higher relief by the very diversities in the midst of
which they occur. The progress of mankind towards a popular familiarity
with this fact, is necessarily slow; but still we think it plainly
perceptible. An individual life, indeed, however distinguished,
represents a mere point in time; it affords little scope for
considering, much less for estimating, as they occur, the true meaning
of various events, which nevertheless ultimately prove to have had
important influence on the progress of knowledge.

These are world-wide things, which we must survey as the geologist does
the facts concerning which he inquires. We must endeavour to combine,
in one view, facts over which long periods of time may have rolled
away, with such as are still passing around us. This will frequently
suggest designs and relations altogether unobservable by the mere
abstract inquirer. In the course of the following pages, a further
opportunity may occur for a few remarks on such views; the elaborate
discussion of the subject would be altogether beyond our present
objects.

It will be our endeavour to point out the position occupied by
Abernethy, in that (as we trust) gradually dawning science, to a
particular phase of which our object and our limits will alike restrict
our attention. We mean that period when Surgery, having approached to
something like a zenith as a mere practical _art_, began to exhibit,
by slow and almost imperceptible degrees, some faint characters of
science—a shadowy commencement of a metamorphose, which we believe
promises to convert (though we fear at a period yet distant) a
monstrous hybrid of mystery and conjecture into the symmetrical beauty
of an Inductive science—a science based on axioms and laws which are
constantly exerting a powerful influence on the social progress and the
health of nations.

In considering Hunter and Abernethy, we shall see not only a remarkable
adaptation for the tasks in which they were respectively engaged,
but also how the peculiar defects of the one were supplied by the
characteristic excellences of the other. We shall see that they
cooperated in laying open clear and definite objects; and that, though
their modes of inquiry were far from fulfilling the requisitions of
an Inductive science, they were eminently calculated to suggest the
convenience, and impress the necessity of it.

We no sooner begin to inquire with clear and definite purpose, than we
are led to the means necessary for the attainment of it.

Abernethy himself, in speaking of the ordinary resources of daily
practice, used to say: "If a man has a clear idea of what he desires to
do, he will seldom fail in selecting the proper means of accomplishing
it."

So, in gathering the materials for building up a science, the first
thing is, to be clear as to those things in which it is deficient. This
once determined, all may lend assistance; and this very division of
labour, when directed with definite purpose, may render even men most
addicted to narrow and partial inquiries, contributors to a great and
common object.

In this way, those blows and discouragements so common in the infancy
of science, which test our motives and try our patience, may prove
tolerable when distributed over the many, instead of proving, as is too
common, depressing or destructive when bearing only on the efforts of
the few.

If we desire to shorten this labour, we need scarcely say there is no
way of doing it but by the adoption of that mode of proceeding to which
every other branch of science owes its present position.

I mean the rigid suspension of all hypotheses, setting to work by
collecting _all_ the facts in relation to the subject, and dealing with
them in strict compliance with the precepts of common sense—or, what
is the same thing, Inductive philosophy.

This will soon show us the just amount of the debt we owe to Hunter
and Abernethy; and, in leading us onwards, instructively point out why
these great men did not farther increase our obligations.

We shall see how the industry and circumspection of the Argus-eyed
Hunter, as Abernethy used to call him, enabled him to unfold a legend
in nature, which he had neither length of days, sufficient opportunity,
nor perhaps aptitude, wholly to decipher; and how far it was developed
into practical usefulness by the penetrative sagacity and happy genius
of Abernethy; which, like light in darkness, guides and sustains
immediate research, and animates and encourages onward inquiry. To
appreciate Abernethy, however, it is necessary that the public should
have correct views at _least_ of the _general_ nature and objects of
Medical Science.

The public have not only a very real interest in acquiring a sound
common-sense view of the objects of medicine and surgery, but a far
deeper interest than it is possible for any one medical man to have,
merely as such, or all medical men put together. This may, for the
moment, appear startling to those who have not been compelled to
consider the subject; but the reader may glean even from this volume,
that so long as life or health, or even money, has value, the remark
is strictly true. From all sides mankind have hitherto imbibed little
but error. They have been taught or induced to believe that the only
objects of medicine and surgery are to prevent or relieve diseases
and accidents by the astute employment of drugs, or by certain adroit
manipulatory or mechanical proceedings, and _par excellence_ by
"operations." Now here is a great mistake—an idea so far from true,
that nothing can more delusively define, or more entirely conceal, the
higher objects of the science.

The direct contrary of the proposition would be nearer the truth. It
would be _more_ correct to say that the object was to relieve diseases
and accidents by removing all interferences with the reparative powers
of nature; and that this was accomplished more perfectly in proportion
as we were enabled to _dispense_ with the employment of drugs, or the
performance of operations.

The making the lame to walk, the blind to see, and the deaf to hear,
were chosen amongst the appropriate symbols of a Divine Mission; and
we need scarcely observe, that, in the restricted sphere of human
capacity, this is a portion of the mission of every conscientious
surgeon.

We may well, therefore, be dissatisfied with the narrow, not to say
degrading, definition of our duties too generally entertained; but, on
the other hand, if we would realize our claims to these higher views
of our calling, and enlarge the sphere of its practical usefulness,
we should recollect there is only one way of attaining that object;
and that is, by the applied interpretation of those symbols, no less
miraculous, no less certain manifestations of Divine Power, the "Laws
of Nature." To name a science from something not essential to it, is
like naming a class of animals from some exceptional peculiarity in an
individual. It is as if we would infer the mission of the ocean wave
from the scum sometimes seen on its surface; or the purposes served by
a feather, from the use we make of it in writing, rather than from its
common character of levity and toughness; as if we treated an exception
as a rule, or any other manifest absurdity.

We have no opportunity of entering more fully into this important
distinction of the more lofty objects of our profession, as contrasted
with those usually assigned to it; we must therefore rest satisfied in
having awakened the reader's attention to the subject, and proceed to
the more ordinary objects of Biographical Memoir.

John Abernethy was born in London, in the parish of St. Stephen's,
Coleman Street, on the 3rd of April, 1764, exactly one year after
John Hunter settled in London. It is also interesting to remark, that
Abernethy's first work, his "Surgical and Physiological Essays"—Part
I—was published the same year that Hunter died, 1793; so that, whilst
his birth occurred nearly at the same time as the commencement of the
more sustained investigations of Hunter, his opening contribution to
science was coincident with the close of the labours of his illustrious
friend and predecessor.

The Abernethy family in their origin were possibly Scotch, and formed
one of those numerous inter-migrations between Scotland and the north
of Ireland, which, after lapse of time, frequently render it difficult
to trace the original stock. There seems little doubt they had resided
for some generations in Ireland. John Abernethy, who was the pastor of
a Coleraine congregation, in 1688, was an eminent Protestant dissenting
minister, and the father of one still more distinguished. The son (also
named John) had been for some time pastor of the old congregation
of Antrim, whence he removed to Dublin about the year 1733, to take
charge of the Wood Street, now Strand Street, Dublin. He is the author
of several volumes of sermons, which are not a little remarkable for
clearness of thought, and the earnestness of purpose, with which
they inculcate practical piety. He had a son who was a merchant, who
subsequently removed to London, and traded under the firm of Abernethy
and Donaldson, in Rood Lane, Fenchurch Street. This gentleman married
a lady whose name was Elizabeth Weir, daughter of Henry and Margaret
Weir, of the town of Antrim, and they had two sons and three daughters.

James[5], the elder brother, was also in business as a merchant, and
died about the year 1823. He was a man of considerable talent, spoke
with an accent suggestive of an Irish origin, and was remarkable for
his admiration and critical familiarity with our immortal Shakspeare.
He was probably born before his father left Ireland. John, the second
son, the subject of our Memoir, was, as we have already said, born in
London. The register of his christening at St. Stephen's is as follows:

            {                          1765.
  Abernethy { John, son of
            { John and Elizabeth,
            {          April, 24.

This register would suggest that he was born a year later than I
have stated. I have, however, preferred 1764, as the year adopted by
his family; for although a man's birth is an occurrence respecting
the date of which he is not the very best authority, he usually gets
his information from those who are. Besides, it was no uncommon
thing at that time to defer the christening of children for a much
longer period. The education of his early childhood was, most likely,
altogether conducted at home; but it is certain that, while yet very
young, he was sent to the Grammar School at Wolverhampton. Here he
received the principal part of his education; and though the records
are somewhat meagre, yet they tend to show that at an early age he
manifested abilities, both general and peculiar, which were indicative
of no ordinary mind; and which, though they do not necessarily
prefigure the future eminence at which he arrived, were sufficiently
suggestive of the probability that, whatever his career might be, he
would occupy a distinguished position.

[Footnote 1:

               Born.        Died.
  Galileo      1564         1642.
  Kepler       1571         1630.
  Bacon        1561         1626.
  Newton       1642[2]      1727.]

[Footnote 2: The same year that Galileo died.]

[Footnote 3:

                          Born.        Died.
  Priestly                1733         1804.
  Galvani                 1737         1798.
  Volta                   1745         1826.
  Lavoisier               1743         1794.
  Crauford                1749         1795.
  Hunter                  1728         1793.
  Davy                    1778         1829.]

[Footnote 4: The valvular contrivances in the veins and heart, which
showed that the blood could move in only one direction, had been either
observed, described, or their effects respectively remarked on, by Paul,
Sylvius, Michael Servetus, Realdus Columbus, Andreas Cesalpinus, and
especially by Fabricius ab Aquapendente, of whom Harvey was a pupil.]

[Footnote 5: In a polite letter which I recently received from a
distinguished pupil of Abernethy's (Dr. Butter, of Plymouth), I find
that James Abernethy died of apoplexy, at Plymouth.]




CHAPTER II.

      "Ah, happy hills! ah, pleasing shade!
      Ah, fields beloved in vain,
      Where once my careless childhood stray'd,
      A stranger yet to pain."

      GRAY.


Mankind naturally feel an interest in the boyhood of men of genius;
but it often happens that very little attention is paid to early
indications; and, when observed, it is certain that they are often
interpreted very falsely.

Nothing more emphatically suggests how much we have to learn on this
subject, than the obscurity which so often hangs over the earlier years
of distinguished men. At school, a number of variable organizations
are subjected to very much the same influences; the necessity for
generalization affords little opportunity for individual analysis. The
main road is broad and familiar; there is no time for indulging in
bye-paths, even should the master have the penetration to perceive,
in individual cases, the expediency of such selection. Hence the
quickening of those impulses, on which the development of character
so much depends, is greatly a matter of uncertainty. The moment boys
leave school, on the contrary, this uniformity of external influences
is replaced by an interminable diversity; at home, scarcely two boys
being subjected to exactly the same. Thus, in many instances, it would
be easier to deduce the character of the boy from the man, than to have
predicted the man from the boy. The evidences of the one are present to
us, those of the other may have been entirely unelicited, unobserved,
or forgotten.

We cannot wonder, then, that expectation should have been so often
disappointed in the boy, or that excellences little dreamt of should
have been developed in the man.

Dryden, who, regarded in the triple capacity of poet, prose-writer,
and critic, is hardly second to any English author, took no honour at
the University. Swift, perhaps our best writer of pure English, whose
talents proved scarcely less versatile and extraordinary than they
had appeared restricted and deficient, was "plucked" for his degree,
in Dublin, and only obtained his recommendation to Oxford "_speciali
gratia_" as it was termed. The phrase, however, being obviously
equivocal, and used only in the bad sense at Dublin, was, fortunately
for Swift, interpreted in a good sense at Oxford—a misapprehension
which Swift, of course, was at no pains to remove.

Sheridan was remarkable for his readiness, his invention, and his
wit; as a writer, he showed considerable powers of sustained thought
also. He had an habitual eloquence, and, on one occasion, delivered
an oration before one of the most distinguished audiences that the
world ever saw[6], with an effect that seems to have rivalled the most
successful efforts of Cicero, or even Demosthenes. Yet he had shown so
little capacity as a boy, that he was presented to a tutor by his own
mother with the complimentary accompaniment that he was an incorrigible
dunce.

Some boys live on encouragement, others seem to work best "up stream."
Niebuhr, the traveller, the father of a son no less illustrious, with
anything but an originally acute mind, seems to have overcome every
disadvantage which the almost constant absence of opportunity could
combine. Those who are curious in such matters might easily multiply
examples of the foregoing description, and add others where—as in
the case of Galileo, Newton, Wren, and many others—the predictions
suggested by early physical organization proved as erroneous as the
intellectual indications to which we have just adverted.

The truth is, we have a great deal to learn on the subject of mind,
although there is no want of materials for instruction. Medicine and
surgery are not the only branches of knowledge which require the aid of
strictly inductive inquiry. In all, the materials (facts) are abundant.

In Abernethy there was a polarity of character, an individuality,
a positiveness of type, which would have made the boy a tolerably
intelligible outline of the future man. The evidence is imperfect; it
is chiefly drawn from the recollections of a living few, who, though
living, have become the men of former days; but still the evidence all
inclines one way.

We can quite imagine a little boy, "careless in his dress, not
slovenly," with his hands in his pockets, some morning about the year
1774, standing under the sunny side of the wall, at Wolverhampton
Grammar School[7]; his pockets containing, perhaps, a few shillings,
some halfpence, and a knife with the point broken, a pencil, together
with a tolerably accurate sketch of "Old Robertson's" wig. This
article, as shown in an accredited portrait[8] now lying before us,
was one of those enormous bygone bushes which represented a sort of
impenetrable fence round the cranium, as if to guard the precious
material within. The said boy just finishing a story to his laughing
companions, though no sign of fun appeared in him, save a little curl
of the lip, and a smile which would creep out of the corner of his
eye in spite of him. I have had the good fortune to find no less than
three schoolfellows of Abernethy, who are still living: John Fowler,
Esq. of Datchet, a gentleman whom I have had the pleasure of knowing
for many years, and who enjoys, in honourable retirement at his country
seat, at the age of eighty-two, the perfect possession of all his
faculties; William Thacker[9], Esq. of Muchall, about two miles from
Wolverhampton, who is in his eighty-fifth year; T. Tummins, Esq. of
King Street, Wolverhampton, who is in his eighty-seventh year. To
these gentlemen, and to J. Wynn, Esq. also of Wolverhampton, I am
principally indebted for the few reminiscences I have been able to
collect of the boyish days of Abernethy.

The information which I gained from Mr. Fowler, he gave me himself; he
also kindly procured me a long letter from Mr. Wynn. The reminiscences
of Mr. Tummins and Mr. Thacker, I have obtained through the very
courteous and kind assistance of the Rev. W. White, the late[10]
distinguished head master of the Wolverhampton School.

To all of these gentlemen I cannot too strongly express my thanks,
for the prompt and kind manner in which they have replied to all the
enquiries which have been addressed to them. The following are the
principal facts which their letters contain, or the conclusions they
justify. Abernethy must have gone to Wolverhampton when very young,
probably; I should say certainly before 1774. He was brought by Dr.
Robertson from London, with another pupil, "his friend Thomas;" and
the "two Londoners" boarded with Dr. Robertson. When Mr. Fowler went
there in 1778, Abernethy was high up in the school, and ultimately got
to the head of the senior form. He must have left Wolverhampton in all
probability not later than 1778, because Dr. Robertson resigned the
head mastership in that year; and we know that in the following (1779),
when he was fifteen, Abernethy was apprenticed to Sir Charles Blicke.

Mr. Thacker says he was very studious, clever, a good scholar,
humorous, but very passionate. Mr. Tummins, Mr. Thacker says, knew
Abernethy well. Abernethy used to go and dine frequently with Mr.
Tummins's father. Mr. Tummins says "Abernethy was a sharp boy, a very
sharp boy, and a very passionate one too. Dr. Robertson," he says, "was
also a very passionate man."

One day, Abernethy had to "do" some Greek Testament; and it appeared
that he set off very glibly, having a "crib" in the shape of a Greek
Testament, with a Latin version on the other side. The old Doctor,
suspecting the case, discovered the crib, and the pupil was instantly
"levelled with the earth." This _fortiter in re_ plan of carrying the
intellect by a _coup-de-main_, has, as the late head master observed,
been replaced by more refined modes of proceeding. The more energetic
plan was (however coarse and objectionable) not always unsuccessful
in implanting a certain quantity of Latin and Greek. Abernethy was a
very fair Latin scholar, and he certainly had not, at one period, a bad
knowledge of Greek also.

There are, however, many other things to be learnt besides Latin and
Greek; and it is probable that the more measured reliance on such
violent appeals, which characterizes modern education, might have
been better suited to Abernethy. To a boy who was naturally shy, and
certainly passionate, such mechanical illustrations of his duty were
likely to augment shyness into distrust, and to exacerbate an excitable
_temper_ into an irritable _disposition_.

Abernethy, in chatting over matters, was accustomed jocularly to
observe that, for his part, he thought his mind had, on some subjects,
what he called a "_punctum saturationis_;" so that "if you put anything
more into his head, you pushed something out." If so, we may readily
conceive that this plan of forcing in the Greek, might have forced out
an equivalent quantity of patience or self-possession. It is difficult
to imagine anything less appropriate to a disposition like Abernethy's
than the discipline in question. It was, in fact, calculated to create
those very infirmities of character which it is the object of education
to correct or remove.

It seems that neither writing nor arithmetic were taught in the
school; and "Tummins and Abernethy" used to go to learn these matters
at the school of a Miss Ready, in King Street, Wolverhampton. This
lady appears to have had, like Dr. Robertson, a high opinion of what
the profession usually term "local applications" in the conduct of
education. Many years afterwards, she called upon Mr. Abernethy. He was
then in full practice in London. He received her with the greatest
kindness, begged her to come and dine with him as often as she could
while she stayed in London; and, introducing her to Mrs. Abernethy,
said: "I beg to introduce to you a lady who has boxed my years many a
time."

Had Miss Ready, however, heard us call in question the necessity
of this association of boxing ears and quill-driving, she would
probably have retorted on us, that few men wrote so good a hand as
John Abernethy. It is certain that, _brusque_ as the discipline might
have been, or ill-suited to the disposition of Abernethy, it did not
interfere with the happiness of his schoolboy life. He always looked
back to his days at Wolverhampton with peculiar pleasure, and seemed to
regard every association with the place with affectionate remembrance.

Mr. Wynn observes, in his letter: "About twenty years ago I accompanied
a patient to Mr. Abernethy. After prescribing, he said, 'let me see
you again in about a week,' 'We cannot, for we are returning into the
country.' 'Why, where do you live?' 'Wolverhampton.' 'Wolverhampton?
Why, I went to school there. Come, sit down, and tell me who's alive
and who's dead.' After running over the names of some of the old
families, their health, circumstances, &c. he wished us good morning,
saying, 'Ah! I cannot forget Wolverhampton!'"

Mr. Thacker's note I subjoin, written in a good firm hand, at
eighty-five.

  "Muchall, near Wolverhampton,
  "May 17, 1852.

  "Sir,

    "As a boy, I remember John Abernethy and William Thomas coming
    from London to board with, and as scholars to, Dr. Robertson, the
    head master of the Wolverhampton School, in which there were two
    masters, both clergymen. We were formed into several classes, in
    which John Abernethy, William Thomas, Walter Acton Mosely, and
    myself, formed one. Abernethy took the head or top of the class;
    but the boys used to change places in the classes according to
    their proficiency; but I do not recollect that Abernethy ever took
    a third place in the class. So also in his sports, he usually made
    a strong side, for he was remarkably quick and active, and soon
    learned a new game. He had but one fault that I knew of—he was
    rather hasty and impetuous in his manner, but it was soon over and
    forgotten.

    "The 'Doctor,' as we used to call him (Robertson), had a daughter
    grown up, and she used to hear the boarders in the house read
    plays before her father, in which, in particular passages, she
    showed where the emphasis should be laid, and how to pronounce the
    same properly; this occasioned the use of the play of 'Cato,' and
    originated the boys' performance of that play in the school-room
    before their fathers and friends. I do not remember the part that
    Abernethy took in that play. I have applied to Mr. Tummins of
    Wolverhampton, but his memory does not supply information. He knew
    Mr. Abernethy well.

    "If I recollect any others of my schoolfellows who knew him, I will
    apply to them for information, and communicate the same to you
    immediately.

  "I am, Sir,
  "Your obedient servant,
  "WILLIAM THACKER.

  "To George Macilwain, Esq."

We learn from another reminiscent, that in the play at Wolverhampton
Abernethy took a "principal part." He certainly had a good deal of
dramatic talent, in the highest sense of the word; and, as will be seen
in the sequel, could light up a story with rich humour, or clothe it
with pathos, as suited the occasion, with equal facility. Scanty as
they are, there is much in these school reminiscences significant of
his future character.

As we have observed, Abernethy left Wolverhampton in 1778. He was
then head of the school, a quick, clever boy, and more that an
average scholar. He returned to London, that world of hopes, fears,
and anxieties; that spacious arena, on which all are desirous of
entering as competitors who are ambitious of professional or commercial
distinction.

[Footnote 6: We allude to his first speech on the trial of Warren
Hastings.]

[Footnote 7: Wolverhampton School, founded by Sir Stephen Jermyn,
Alderman and Knight of the City of London, in the reign of Henry
VIII, for the "Instruction of youth in morals and learning." Many
distinguished men were educated at the School; as Abernethy; Mr. Tork,
fellow of Trinity College, Cambridge; Sir William Congreve; and others.]

[Footnote 8: Kindly sent us by Mr. Fowler, of Datchet.]

[Footnote 9: This gentleman died last year. He had retired to his seat
at Muchall, from Wolverhampton, where he had practised as a solicitor
of great eminence and respectability.]

[Footnote 10: Since the last edition, I have to regret the death of
this gentleman. He was an excellent man, a good mathematician, and an
accomplished scholar. He graduated at Cambridge, and took honors in
1815.]




CHAPTER III.

      "Nunquam ita quisquam bene subductâ ratione ad vitam fuit
      Quin res, ætas, usus, semper aliquid apportet novi
      Aliquid moneat; ut illâ quæ te scire credas, nescias:
      Et quæ tibi putâris primâ, in experiundo repudias."

      TER. AD. A. 5, SC. 4.

      "Never did man lay down so fair a plan,
      So wise a rule of life, but fortune, age,
      Or long experience made some change in it,
      And taught him that those things he thought he knew,
      He did not know, and what he held as best
      In practice, he threw by."

      COLMAN.


Circumstances, in themselves apparently unimportant, often determine
the selection of a profession. Few boys can do exactly what they
please, and the _pros_ and _cons_ are seldom placed before them in
a way to assist them in determining the just value of the reasons
on which their choice may have proceeded. They are not, indeed,
unfrequently dealt with as if, whilst not incompetent to make choice of
a profession, they were held incapable of weighing the circumstances by
which alone such choice could be judiciously directed. The absurdity
of this appears, when we think a moment of what it involves, which is
nothing less than expecting them to do what is impossible; viz. to
form an opinion on a subject when the main facts in relation to it are
withheld from them. Be this as it may, every day shows us that men are
too frequently dissatisfied with the profession which they follow. The
question of our boyhood recollections—

      "Qui fit Mæcenas ut nemo quam sibi sortem,
      Seu ratio dederit seu fors objecerit, illâ,
      Contentus vivat?"[11]

is just as applicable as ever; and although human nature has almost
everything ascribed to its natural infirmities, yet it appears quite as
sensible, and not a whit less humble, to conclude, that paths chosen
without consideration naturally lead to disappointment. The evil, like
most others, carries with it the elements of self correction.

Parents are slow to encourage their children to select paths which they
themselves have trodden with regret. This tends to distribute their
professions to other families. Mutual interchanges of this kind serve
to protect the interests of society, by, in some degree, limiting the
number of cases in which men have failed to select the pursuits best
adapted to them.

In almost all pursuits of life, success is determined, much more than
many are disposed to imagine, by the homely qualities of steadiness and
industry. We are apt—and sometimes not improperly—to ascribe peculiar
_excellence_ to peculiar powers. Yet the more insight we obtain into
the histories of men, the more we perceive how constantly the most
brilliant have been aided by the more homely qualifications to which we
have adverted.

No doubt some minds are so constituted as to be moderately certain
of success or distinction in almost any pursuit to which they might
have been directed; and we are disposed to think that Abernethy's was
a mind of that order; but there is abundant evidence to show that
his talents were at least equalled by his industry. One paper of
his, which contains a beautiful and discriminative adjustment of a
difficult point of practice in Injuries of the Head—which contains no
intrinsic evidence of such industry—was not published until after he
had attended to every serious injury of the head in a large hospital
for almost twenty years; besides examining the bodies of all the
fatal cases. Nor can we estimate this industry properly, without
recollecting that all this time he was only an _assistant surgeon_,
whose duties, for the _most_ part, neither required nor _permitted_ him
to do more than to _observe_ the treatment; and that, therefore, the
whole of this industry was simply in the character of a student of his
profession[12]. All biography is full of this kind of evidence; and
art, as well as science, furnishes its contribution. Who could have
imagined that the peculiar, chaste composition, the easy and graceful
touch of Sir Augustus Callcott, could have owed so much to industry
as it undoubtedly must have done? It is known, for example, that he
made no less than forty different sketches in the composition of one
picture. We allude to his "Rochester." Had Abernethy been allowed to
choose his profession, he, no doubt, would have selected the Bar. It
is impossible to reflect on the various powers he evinced, without
feeling that, had he followed the law, he would have arrived at a very
distinguished position. "Had my father let me be a lawyer," he would
say, "I should have known every Act of Parliament by heart." This,
though no doubt intended as a mere figure of speech, was not so far
from possibility as might be imagined, for it referred to one of his
most striking characteristics; viz. a memory alike marvellously ready,
capacious, and retentive—qualities common enough separately, but rare
in powerful combination.

We may have opportunities by and by, perhaps, of further illustrating
it. We will give one anecdote here. A gentleman, dining with him on a
birthday of Mrs. Abernethy's, had composed a long copy of verses in
honour of the occasion, which he repeated to the family circle after
dinner. "Ah!" said Abernethy, smiling, "that is a good joke, now, your
pretending to have written those verses." His friend simply rejoined,
that, such as they were, they were certainly his own. After a little
good-natured bantering, his friend began to evince something like
annoyance at Abernethy's apparent incredulity; so, thinking it was
time to finish the joke, "Why," said Abernethy, "I know those verses
very well, and could say them by heart[13]." His friend declared it
to be impossible; when Abernethy immediately repeated them throughout
correctly, and with the greatest apparent ease. To return. However
useful this quality might have been at the Bar, Abernethy was destined
to another course of life—a pathway more in need, perhaps, of that
light which his higher qualifications enabled him to throw over it,
and which "his position" "in time" afforded him an opportunity of
doing just when it seemed most required. He probably thus became, both
during life and prospectively, the instrument of greater good to his
fellow-creatures than he would have been in any other station whatever.

I have not been able to discover what the particular circumstances were
which determined his choice of the medical profession. It is probable
that they were not very peculiar. A boy thwarted in his choice of a
profession, is generally somewhat indifferent as to the course which
is next presented to him; besides, as his views would not have been
opposed but for some good reason, a warm and affectionate disposition
would induce him to favour any suggestion from his parents. Sir Charles
Blicke was a surgeon in large practice; he lived at that time in
Mildred's Court, and Abernethy's father was a near neighbour, probably
in Coleman Street.

Abernethy had shown himself a clever boy, a good scholar; and he was
at the top of Wolverhampton School before he was fifteen. Sir Charles
Blicke was quick-sighted, and would easily discover that Abernethy was
a "sharp boy." All that Abernethy probably knew of Sir Charles, was,
that he rode about in his carriage, saw a good many people, and took a
good many fees, all of which, though perhaps presenting no particular
attractions for Abernethy, made a _primâ facie_ case, which was not
repulsive. Accordingly, in the year 1779, being then fifteen years of
age, he became bound an apprentice to Sir Charles, and, probably, for
about five years.

This first step, this apprenticing, has a questionable tendency as
regards the interests of the public and the profession. It exerts,
also, a considerable influence on the character and disposition of
the boy, which we must by and by consider. It is a mode of proceeding
which, we fear, has done not a little to impede the progress of
surgery as a science, and to maintain that handicraft idea of it
suggested by the etymology of the word. Where one man strikes out a
new path, thousands follow the beaten track. A boy, with his mind
ill-prepared, having no _definite_ ideas of the nature and objects of
scientific inquiries, and almost certainly uninstructed as to the rules
to be observed in conducting them—knowing neither any distinction
between an art and a science—a boy thus conditioned is bound for a
certain number of _years_! to a man of whom he knows little, and to
a profession of which he knows nothing. He takes his ideas and his
tone from his master; or, if these be repulsive to him, he _probably
adopts an opposite extreme_. If the master practise his profession
merely as an art, he furnishes his pupil with little more than a string
of conventionalisms; of which, if the pupil has talent enough to do
anything for himself, he is tolerably certain to have a great deal to
unlearn.

We believe the system is in course of improvement; it is high time it
was put an end to altogether. Apprenticeships might not have been an
inauspicious mode of going to work in former times, when there existed
barber-surgeons. This alliance of surgery and shaving, to say nothing
of the numerous other qualifications with which they were sometimes
associated, might conceivably enough have furnished some pretext for
apprenticeships; since Dickey Gossip's definition of

      "Shaving and tooth-drawing,
      Bleeding, cabbaging, and sawing,"

was by no means always sufficiently comprehensive to include the
multifarious accomplishments of "the doctor." I have myself seen,
in a distant part of this island, within twenty-five years, chemist,
druggist, surgeon, apothecary, and the significant &c. followed by the
hatter, hosier, and linen-draper, in one establishment; but as we shall
have to discuss this subject more fully in relation to Abernethy in
another place, we may proceed.

Sir Charles Blicke had a large and lucrative practice. He had the
character of taking care to be well remunerated for his services. He
amassed a considerable fortune; but we incline to think that the ideas
of the profession which Abernethy derived from his experience of his
apprenticeship were not very favourable. The astute, business-like mode
of carrying on the profession, which seems to have characterized Sir
Charles Blicke's practice, could have had few charms for Abernethy.
Mere money-making had never at any time much attraction for him, and,
at that period of his life, probably none at all; whilst the measured
pretensions of surgery to anything like a science could hardly have
been, at times, otherwise than repulsive.

The tone in which he usually spoke of Sir Charles's practice did not
convey a very favourable idea of the impression which it had left on
him. In relating a case, he would say: "Sir Charles was at his house
in the country, where he was always on the look out for patients." On
another occasion, speaking of patients becoming faint under peculiar
circumstances, he observed: "When I was an apprentice, my master used
to say: 'Oh, Sir! you are faint; pray drink some of this water.' And
what do you think was the effect of his putting cold water into a man's
stomach under these circumstances? Why, of course, that it was often
rejected in his face."

Sir Charles's manipulatory and operative proceedings seem, however, to
have represented a tolerably adroit adoption of the prevailing modes of
practice; while his medical surgery consisted chiefly of the empirical
employment of such remedies as he had found most frequently successful,
or, at all events, somehow or other associated with a successful issue;
with the usual absence of any investigation of the cause of either
success or failure. By a mind like Abernethy's, this sort of routine
would be very soon acquired, and, in a short time, estimated at its
real value. Still, while a clear head is all that is necessary to the
reception of what may be positive and truthful, it requires a vivid
perception and a cultivated understanding to detect error. Many things,
however, would creep out in Abernethy's lectures, showing that, young
as he was, even during his apprenticeship, he was not only a real
student, but he had begun to think for himself.

He mentions a case of "Locked-jaw," that occurred as early as 1780 (the
first year of his apprenticeship), which he appears to have noted with
great accuracy. He mentions the medicine that was given to the man, the
unusually large doses, and, lastly, the enormous quantity of it which
was found in the stomach after death. It was opium, and amounted to
many drachms.

We also find him engaged in inquiries involving much more extended
views than were in that day _generally_ associated with the study of
_surgery_. He very early participated in those researches which had for
their object to determine the relation of the digestive functions to
one of the most recondite affections of an extremely important organ
(the kidney).

"When I was a boy," said he, "I half ruined myself in buying oranges
and other things, to ascertain the effects of different kinds of diet
in this disease."

The same researches show how early also he began to perceive the
importance of chemistry in investigating the functions of different
organs, and in _aiding_, generally, physiological researches. We have
heard a contemporary and a lecturer on chemistry attest Abernethy's
proficiency in that science. As his investigations proceeded, he
had the still higher merit of taking _just and sober views_ of the
relations of chemistry to physiological science.

We mean that whilst he fully recognized the importance of it, he
entirely avoided that _exclusive_ reliance on it which is too often
created by some of the more striking demonstrations of chemical
science; that one—idea—tendency, which unconsciously wrests it to the
solution of phenomena which, in the _present state_ of our knowledge,
it is wholly inadequate to explain. We have alluded to the foregoing
facts touching the impressions derived from his apprenticeship, and
his early disposition for philosophical research, because both will be
found to have relations to his subsequent labours and peculiarities.
Diligent as he was, we suspect he found, during his apprenticeship,
little of those attractions which make labour and industry sources of
happiness and pleasure.

As a matter of course, he would have been allowed to attend any
lectures which were given at the hospital to which Sir Charles Blicke
was surgeon (St. Bartholomew's), and this would bring him in contact
with Mr. Pott, who delivered a certain number of surgical lectures
there.

There were no _courses_ of anatomical lectures given at St.
Bartholomew's at that period; but anatomical lectures were delivered
regularly at the London Hospital, by Dr. Maclaurin and Sir William
Blizard, and afterwards by Sir William Blizard alone. As Sir Charles
Blicke lived in Mildred's Court and subsequently in Billiter Square,
Abernethy would be about equidistant from the two hospitals, both of
which he attended. We incline to think that it was in attending these
lectures, and perhaps especially those of Sir William Blizard, that he
first found those awakening impulses which excited in him a real love
for his profession.

It was about this time, we think, that he began to have more enlarged
ideas of the nature and objects of surgical science; a state of mind
calculated to enable him to thoroughly understand and appreciate Mr.
Hunter, and to deduce from the principles which he was shadowing forth,
those relations and consequences which we shall endeavour popularly to
explain; principles which, though originally directed to the treatment
of so-called surgical maladies, were found equally to affect the
practice of medicine.

[Footnote 11: "How happens it, Mæcenas, that no one is content with his
condition, whether reason gave it him, or chance threw it in his way?"]

[Footnote 12: The assistant-surgeons at that period having no
_in_-patients under their care, except in the absence, or by
permission, of their chiefs.]

[Footnote 13: A public journalist was inclined to give this anecdote
to another person. We then stated that we had it on the authority of a
gentleman who was present. Such power of memory, though _rare_, is not
_singular_; other examples have fallen within our own observation.]




CHAPTER IV.

    "There is not a more pleasing exercise of the mind than
    gratitude. Were there no positive command which enjoined it, nor
    any recompense laid up for it hereafter, a generous mind would
    indulge in it, for the natural gratification which accompanies
    it."—ADDISON.


Sir William Blizard was an eminent surgeon and an enthusiastic student
of the profession, as studied in his day. He had a certain bluntness
of manner, which was not unkind neither. He was very straightforward,
which Abernethy liked; and he had nothing of a mercenary disposition,
which Abernethy held in abhorrence. He was a kind of man very likely to
excite in one of Abernethy's tone of mind many agreeable impressions.
He early perceived the talents, and was probably the first to encourage
the industry, of his distinguished pupil. Enthusiastic himself, he had
the power of communicating a similar feeling to many of his pupils; and
he appears to have contributed one of those impulses to Abernethy which
are from time to time necessary to sustain the pursuit of an arduous
profession.

Some men seem to like anatomy for its own sake; examinations of
structure merely, by dissection, or the microscope, have a kind of
intrinsic charm for them. This was not the case with Abernethy. _Mere_
anatomy had few charms for him. He regarded it in its true light, as a
means to an end; as the basis on which he could alone found, not only
the more common or handicraft duties of surgery, but also those higher
views which aim at developing the uses and relations of the various
organs; and in this way to ascertain what the processes of nature are
in the preservation of health and the _conduct of disease_; in short, a
knowledge of what he called physio-pathology.

Sir William, therefore, in exciting Abernethy's enthusiasm at this
time, was probably of great service. He was thus impelled to pursue the
study of anatomy, which perhaps might otherwise have failed to interest
him sufficiently, whilst his attention was by no means diverted from
the real purposes of that study. On the contrary, he always saw
anatomy, as it were, through a physiological medium. This threw a
pleasure into his anatomical pursuits, and was _one_ of the means by
which, in his own lectures, he contrived to impart an interest to the
driest parts of our studies.

Many years afterwards, he was fond of illustrating the true relations
of anatomy and physiology, and at the same time contrasting the
attractions of the one with the comparatively repulsive requisitions of
the other, by saying, with Dr. Barclay, of Edinburgh, that "he never
would have wedded himself to so ugly a witch (anatomy), but for the
dower she brought him (physiology)." The impressions which he derived
from Sir William Blizard were deep and durable. More than thirty years
after, when he himself was at the zenith of his career, we find his
grateful feeling towards Sir William still glowing warm as ever. He
seems to have considered the expression of it as the most appropriate
opening to the first of the beautiful lectures which he delivered at
the College of Surgeons in 1814. It must have been a moment of no small
gratification to Sir William, who was present, now venerable with age,
to have found that the honourable course of his own younger days, and
the purity and excellence of his precepts, had all been garnered up
in the heart of his grateful and most distinguished pupil. Nor could
the evidence of it be well made more striking than when heralded forth
before an audience composed of the most venerable and experienced, as
well as of the most rising members of the profession; and, to crown the
whole, with an eloquence at once modest and emotional, impressive of
the depth and sincerity with which the eulogium was delivered.

It is difficult to imagine a scene more moving to the master, more
gratifying to the pupil, or more honourable to both. As the style
was very characteristic, we select a few passages. He commences the
lecture by saying, of Sir William Blizard, that "he was my earliest
instructor in anatomy and surgery, and I am greatly indebted to him
for much valuable information. My warmest thanks are also due to him
for the _interest he excited in my mind towards these studies_, and
for his excellent advice. 'Let your search after truth,' he would say,
'be eager and constant. Be wary in admitting propositions to be facts,
before you have submitted them to the strictest examination. If, after
this, you believe them to be true, never disregard or forget _any
one_ of them, however unimportant it may at the time appear. Should
you perceive truths to be important, make them motives of action. Let
them serve as springs to your conduct. If we _neglect to draw such
inferences_, or to act in conformity with them, we fail in essential
duties!'" Again, in remarking how Sir William excited his enthusiasm by
the _beau-idéal_ which he drew of the medical character, Mr. Abernethy
observed: "I cannot tell you how splendid and brilliant he made it
appear; and then he cautioned us _never_ to tarnish its lustre by any
disingenuous conduct, or by anything that bore even the _semblance_
of dishonour." Abernethy, then proceeding in a strain, warm, yet
apologetic (Sir William being present), at length concluded his public
thanks to his venerable instructor, by saying, "what I have now stated
is a tribute due from me to him; and I pay it on the present occasion
in the _hope_ that the same precepts and motives may have the same
effects on the junior part of my audience as they were accustomed, in
general, to have on the pupils of Sir William Blizard."[14]

Abernethy then proceeded to advocate similar lofty views of the nature
and duties of our profession in the following manner: "That which
most dignifies man, is the cultivation of those qualities which most
distinguish him from the brute creation. We should indeed seek truth
for its importance, and act as the dictates of reason direct us. By
exercising our minds in the attainment of medical knowledge, we may
improve a science of great public utility. We have need of enthusiasm,
or of some strong incentive, to induce us to spend our nights in study,
and our days in the disgusting and health-destroying duties of the
dissecting-room, or in that careful and distressing observation of
human diseases and infirmities which can alone enable us to alleviate
or remove them; some powerful inducement," he adds, "exclusive of fame
or emolument (for, unfortunately, a man may attain a considerable
share of reputation and _practice, without being a real student of his
profession_). I place before you the most animating incentive I know
of—that is, the enviable power of being extensively useful to your
fellow-creatures. You will be able to confer that which sick kings
would fondly purchase with their diadems, which wealth cannot command,
nor state nor rank bestow:—to alleviate or remove disease, the most
insupportable of human afflictions; and thereby give health, the most
invaluable of human blessings."

When Abernethy entered the London Hospital, he soon gave proofs that
Sir William's lessons were not unfruitful. He was early employed to
prepare the subject for lecture. Anatomy is usually taught by combining
three plans.

In one, the various structures—muscles, vessels, nerves, &c.—are
exposed, by the removal of their covering and connecting-tissues,
and so displayed as to be clear and distinct. This is "dissecting
for lecture;" and it is the duty of the lecturer to describe the
connections and immediate uses of the parts so displayed.

The body is then laid on a clean table, covered with a white cloth,
and everything is ready. There is some difference in these matters in
different hands; but attention to order and cleanliness goes a long way
in facilitating anatomical pursuits. To many there may be much that
is disagreeable in anatomy; but we are persuaded that a coarse and
vulgar inattention to decency has often alone rendered it disgusting or
repulsive.

The other plan is not materially different from the foregoing,
excepting that it is generally done by the anatomical
assistant—technically, the "demonstrator." The parts, having been
somewhat exposed, are left, as much as is consistent with clearness,
in their natural and _relative_ positions; and the vessels, nerves,
muscles, &c. which have been for the most part described _separately_
by the lecturer, are now "demonstrated" (as the phrase is) _together_.
The relative positions of all parts are thus more especially impressed
on the student. In these "demonstrations" there is the same attention
to covering the body with a cloth, &c. as in the lecture.

Lastly, the pupil is required to make out the parts by dissecting them
himself, with such occasional assistance as may be at first necessary,
and which is given by the demonstrator, who attends in the room for
that purpose.

Now these duties (the lecture only excepted) were early performed by
Abernethy. We may safely infer from this, that he was distinguished by
his industry and zeal in the pursuit of knowledge, and that he began
thus early to cultivate that power of communicating what he knew to
others; in the exercise of which he ultimately acquired a success, a
_curiosa felicitas_, in which he excelled all his contemporaries. That
special qualifications were already discernible, we may infer from the
post he occupied being invariably filled by a pupil of the hospital
to which the school belongs; whereas Mr. Abernethy was an apprentice
of a surgeon of St. Bartholomew's. On the testimony of a contemporary
and fellow-student, Mr. W. W. Cox, late of Wolverhampton, we learn
that he began to individualize himself very early. That, at the London
Hospital, "he was for the most part reserved, seldom associating with
any of the other students, but sitting in some place or corner by
himself, diligently intent on the business of the lecture." Sir William
Blizard is known to have felt proud of him, and to have soon indulged
in great expectations from his character and talents.

I have already observed that Abernethy had the advantage of attending
also the Surgical Lectures of Mr. Pott, at St. Bartholomew's. Mr. Pott
was a gentleman, a scholar, and a good writer, and seems to have been
a spirited and attractive lecturer. In an oration delivered by Sir
William Blizard, in 1815, it is said that "it was difficult to give
an idea of the elegance of his language, the animation of his manner,
or the perceptive force or effect of his truths and his doctrines"—a
character which is by no means inconsistent with Mr. Pott's more
sustained compositions.

Such opportunities were not lost on Abernethy. He soon became possessed
of what was known in the ordinary business of anatomy and surgery. His
diligence too had afforded him an opportunity of testing those powers
of communicating what he knew, to which I have just alluded. As an
apprentice of a surgeon of Bartholomew's, his views were directed to
that hospital; and it was not long before the resignation of Mr. Pott,
and the appointment of Sir Charles Blicke, who was assistant surgeon,
to succeed him, opened to Abernethy an arena in which he might further
mature his peculiar aptitude for _teaching_ his profession. This had
been, as we learn from his own testimony, an early object of his
ambition, and one for which he had already begun to educate himself at
the London Hospital.

[Footnote 14: Sir William was a good surgeon and an excellent man. He
was born at Barnes, in Surrey, and practised his profession until his
death, which took place at the advanced age of ninety-three. One of his
eyes was affected with cataract, which was removed by operation when
he was ninety-one. He was enthusiastically fond of his profession, and
was chiefly remarkable for his zealous observance of its honourable
practice, and his indifference to lucre. He died in 1835.]




CHAPTER V.

      "Terra salutiferas herbas eademque nocentes
      Nutrit, et urticæ proxima sæpe rosa est."[15]

      OVID.


A large London Hospital is (if we may be excused the Hibernianism, as
Mr. Abernethy used to call it) a large microcosm. There is little in
human nature, of which an observant eye may not here find types or
realities. Hopes and fears, joys and sorrows, solace and suffering,
are here strangely intermingled. General benevolence, with special
exceptions. There is no human good without its shadow of evil; even
the benevolent must take care. Impatient sensibility is much nearer
a heartless indifference than people generally imagine. The rose,
Charity, must take care of the nettle, Temper. The man who is chary or
chafed, in yielding that sympathy which philosophy and feeling require,
must beware lest he degenerate into a brute.

One of the brightest points in Abernethy's character, was, that,
however he might sometimes forget the courtesy due to his private
patients, he was never unkind to those whom charity had confided to his
care. One morning, leaving home for the hospital, when some one was
desirous of detaining him, he said: "Private patients, if they do not
like me, can go elsewhere; but the poor devils in the hospital I am
bound to take care of."

But to the hospital. Here we find some that have had the best this
world can give—some who have known little but misery: the many no
doubt lie between; but all come upon the same errand. Disease is a
great leveller. There all flock, as to Addison's Mountain of Miseries,
to get rid of their respective burthens, or to effect such exchanges as
benevolence may have to offer, or the grave can alone supply. Our large
hospitals have a most efficient "_matériel_;" the accommodations are
extensive, the revenues princely. St. Bartholomew's, for example, has
a revenue of between twenty and thirty thousand pounds a year, and is
capable of receiving six hundred patients.

As regards what is mechanically or physically necessary to the comfort
of the inmates, the ample appliances of our large hospitals leave
little or nothing to be desired. There is every facility for the
execution of the duties, that convenient space and orderly arrangement
can suggest; in short, everything, in the general sense of the word,
that money can procure. Then there are governors, whose hearts are as
open as their purses, whose names are recorded in gold letters, as the
more recent or current contributors to the funds of the establishment,
and who rejoice in the occasional Saturnalia of venison and turtle; all
duties or customs which may be observed, with the gratifying reflection
that they are taking the thorns out of the feet of the afflicted;
provided only that they do not involve forgetfulness of other duties,
the neglect of which may plant a few in their own. The governors
determine the election of the medical men, to whom the welfare of the
patients and the interests of science are to be entrusted.

We have said that money cannot procure all things, and one of these
is mind—a remark requiring some qualification certainly; but this
we must refer to a subsequent chapter. Minds such as Abernethy's are
not to be found every day; and, notwithstanding the sumptuous bill
of fare we have already glanced at, there are many things in a large
London Hospital yet to be desired—defects which, though it need no
great penetration to discover, may, for aught we know, require public
attention, a _Government altogether better informed_ as to the actual
defects in medical science, and the plastic hand of power, to supply.

Abernethy was elected assistant surgeon of St. Bartholomew's Hospital,
July 15th, 1787. Sir Charles Blicke, an assistant surgeon, had been
appointed to the surgeoncy vacant by the resignation of Mr. Pott,
and Abernethy succeeded to the assistant surgeoncy thus vacated. The
election was contested by two or three other candidates; amongst the
rest, by Mr. Heaviside. This gentleman was an eminent surgeon, and a
gentlemanly, facetious, and agreeable companion. He was originally in
the Guards, and practised in London many years with great credit and
respectability. He was fond of science, and expended considerable sums
in the formation of an interesting museum. In the earlier part of his
life, he gave conversaziones, which were attended by great numbers both
of the scientific and fashionable.

He lived in a day when, if a gentleman felt himself insulted, he had
at least the satisfaction of being relieved from his sensibility by
having his brains blown out in a duel—professionally speaking, by a
kind of "operative surgery;" viz. the demolition of the organ in which
the troublesome faculty resided. Mr. Heaviside, in his professional
capacity, is said to have attended more duels than any other surgeon
of his time. This gentleman, albeit not unused to one kind of contest,
retired from that at the hospital; which then lay between Mr. Jones and
Mr. Abernethy—the former polling twenty-nine, the latter fifty-three
votes.

This was an important epoch in the life of Abernethy. It is difficult
to adjust the influence which it ultimately exerted, for good or
evil, on his future prospects and happiness, or on his relations to
science. The hospital had thus secured a man of extraordinary talent,
it is true, and in spite of a system which indefinitely narrows the
field of choice; but then the same "system" (which we shall by and
by describe) kept Abernethy, as regards the hospital, for no less a
term than twenty-eight years, in a position which, although it did not
exclude him altogether from the field of observation it afforded, did
much to restrict his cultivation of it. His talents for observation,
nevertheless, and the estimation in which he was soon held, no doubt
enabled him, to a certain extent, to bring many of his views to the
test of practice. Still, as an assistant surgeon, except in the absence
of his chief, he had officially nothing to do; whatever cases he
conducted, were only by sufferance of his senior.

To a man of his ability, this was a false and miserably cramped
position; one, in fact, much better calculated for detecting faults,
than for developing the best mode of amending them. As assistant
surgeon, he had no emolument from the hospital: he had, therefore, a
very reasonable inducement to set about doing that for which he felt
himself especially fitted, and to which he had early directed his
attention—namely, to teach his profession. The event showed that
he had by no means miscalculated his powers. These proved well-nigh
unrivalled. The appointment to St. Bartholomew's, besides other
advantages, gave him an opportunity of lecturing with the _prestige_
usually afforded by connection with a large hospital. He did not,
however, at first give his lectures at the hospital, but delivered them
in Bartholomew Close.

There was at this time, in fact, no school, properly so called, at St.
Bartholomew's. Mr. Pott had been accustomed to give about twenty-four
lectures, which, as short practical discourses, were first-rate for
that period; but there were no other lectures, not even on anatomy;
which are essentially the basis of a medical school.

Dr. Marshall, who was a very remarkable man, and no less eminent for
his general ability than for his professional acquirements, was at this
time giving anatomical lectures, at his house, in Bartlett's Buildings,
Holborn. In a biographical notice of him, in the "Gentleman's
Magazine," in which we read that he was giving lectures about the year
1787, it is incidentally remarked, that "in all probability he derived
little support from St. Bartholomew's Hospital; for that recently an
ingenious young gentleman, Mr. Abernethy, had begun to give lectures in
the neighbourhood."

Abernethy, who seems to have been always seeking information, certainly
attended some of Marshall's lectures; because he would occasionally
refer to anecdotes he had heard there. He had thus listened to most
of the best lecturers of his day—Sir William Blizard, Dr. Maclaurin,
Mr. Pott, and Dr. Marshall. To the experience which he had thus
acquired, and with the early intention of applying it, he added a
remarkable natural capacity for communicating his ideas to others. We
thus begin to perceive his _early cultivation_ of that aptitude for
lecturing which no doubt greatly contributed to the excellence which he
ultimately achieved in that mode of instruction.

We desire to impress this feature in his education, because by and by
it will, with other things, assist us in a rather difficult task: that
is, an attempt to analyze the means by which he obtained such a power
over his audience. He thus became a teacher at the age of twenty-three,
at a large hospital where he was about to commence a school, of which
he would be at first the sole support. This necessarily involved a
fearful amount of labour, for an organization, active and energetic,
but by no means of great physical power.

Labour, to be sure, is the stuff that life is made of; but then, in
a fine organization like Abernethy's, it should be directed with
economy of power, and in application to the highest purposes. Such an
organization should, if possible, have been relieved from the drudgery
which lies within the sphere of more ordinary capacity. Ready as we
are, then, to congratulate the young philosopher, about to display his
powers on a field where he was so successful, still misgivings creep in
which restrain, or at least moderate, our enthusiasm. Unusual ability,
no doubt, allows men to anticipate the order which, as the rule, Nature
seems to have assigned to the pursuits of intellect; but we must not
suffer ourselves to be blinded to the rule, by the frequency of the
exception. Youth is the time for _acquiring_ knowledge; and, although
there is no reason why the fruits may not be imparted to others as fast
as they are gathered, still, when the larger space of a man's time at
twenty-three is devoted to _teaching_ merely, it may reasonably be
doubted whether it be such a disposition of it as is best calculated
to economise his power, or develop the maximum of its influence, in
_extending_ the science to which it is devoted.

John Hunter declined undertaking to teach anatomy at forty (1768),
because it would have "_engaged his attention too much_ to admit
of that general attention to his profession; to forming habits and
established modes of thinking, which he thought necessary." In
Abernethy's after life, we think we saw a good deal of the wear and
tear that early and diversified labour had impressed on his physical
organization. In advancing life, the natural desire for ease, if not
carefully guarded, may not be without its perils; but precocious
labour, stinted rest, and the malaria of large cities, crowded
hospitals, and filthy dissecting rooms, too certainly bring on a train
of evils, not less grave because more distant.

We shall have to revert to these points when, in conclusion, we
consider the variety and importance of his contributions to the science
of his profession, and why they were not still more numerous. The
latter, though perhaps the less grateful, is by no means the least
useful portion of biographical analysis.

Commencing his lectures in Bartholomew Close, they soon seem to have
attracted notice. The anatomical courses, which were always on a
similar plan, were very skilfully framed to interest and instruct the
students. The arrangement of the matter was such, that the dry details
of anatomy were lighted up by a description, not only of the purposes
served by the various parts, but by as much as could be conveniently
included of the diseases or accidents to which they were subject;
and thus the juxtaposition of the structure, function, and diseases,
naturally tended to impress the whole.

Diseases of more general site, and which therefore did not fall
conveniently under discussion in describing any one part, were reserved
for a separate course of lectures. It was in this course that he more
fully developed those general principles on which his reputation more
especially rests. Of his inimitable manner we shall speak hereafter.

He was one of the first who insisted on the great importance of
Comparative Anatomy, in studying the uses of the several parts of the
human body. Were it not for the comparison of the relations of various
parts in different animals, we should be continually the victims of
hypotheses, which the juxtaposition or other characters of organs in
any _one_ animal are constantly suggesting. Here necessity compels the
observance of that rule of inductive philosophy, which seeks not for
the true relation of any one thing in _itself_, but from _universals_,
from uses and application which are common to _other_ things. In
one case nature makes that luminously clear, which is only dimly
shadowed forth in another; and in seeing organs under every conceivable
variety of circumstance, we learn to estimate at their full value
characteristics which are common to and inseparable from all—the only
point whence we can securely deduce their real uses in the animal
economy. Of this, Abernethy early saw and inculcated the advantages.

As it was impossible to combine anything like a comprehensive study of
a vast science in the same course with lectures on human Anatomy, he
was accustomed, at the conclusion of the course, to devote a lecture
or two to select illustrations of this important subject. This he
ultimately relinquished, the universal admission of the fact rendering
it no longer necessary.

We shall have occasion, by and by, to record the circumstances
under which one of the most important steps was taken for securing
the interests of Comparative Anatomy in this country—a proceeding
in a great degree owing to the good sense and personal influence
of Abernethy, and exemplifying, in the admirable fitness of the
individual[16], the penetrative perception of character which
distinguished his early Preceptor in Anatomy.

We have little doubt that we have now entered on the most laborious
part of Abernethy's life, and that, during this and some succeeding
years, his exertions were so great and unremitting, as to have laid the
foundation of those ailments which, at a comparatively early period of
life, began to embitter its enjoyment, and to strew the onward path
with the elements of decay and suffering.

He lectured himself on anatomy, physiology, and pathology, besides
surgery—subjects which are now usually divided between three or four
teachers. There is abundant evidence that he was an attentive observer
of what was going on in the hospital. He was assiduous in visiting most
places where any information was to be obtained. We find him attending
Mr. Hunter's lectures, and constantly meditating on what he heard
there; thus seeking opportunities of making himself more and more
familiar with those opinions which, in his view, on most of the points
to _which_ they related, _were_ definite—cautiously deduced—not
always clear, perhaps; but, when understood, truthful.

He endeavoured further to mature an accurate perception of Mr.
Hunter's views, by seeking private conferences with him; and Hunter
kindly afforded him facilities for so doing. We have Abernethy's
own acknowledgment of this, coupled with his regret that he could
not more frequently avail himself of them. Indeed, when we consider
that Abernethy lived at this time in St. Mary Axe, or in Mildred's
Court in the Poultry,—that he was lecturing on the sciences I have
mentioned,—that he was observant of cases at the hospital (a very
timeful occupation),—and consider the distance between these points
and Mr. Hunter's residence in Leicester Square, or his school in
Windmill Street,—we see there could not be much time to spare. It was
not, however, merely during the time at which he was delivering his
lectures that he was thus actively employed. We have, not unfrequently,
evidence that he was often at the hospital late in the day, in the most
leisure season of the year, when perhaps his senior had, during his
absence in the summer, confided the patients to his care.

We used to get, occasionally, such passages as these in the lectures:
"One summer evening, as I was crossing the Square of the hospital,
a student came running to me," &c. Very significant of continued
attention during the summer or leisure season—he not being, be it
remembered, other than an assistant-surgeon, and not, therefore,
necessarily having duties at the hospital.

At this period, it was a common practice with him to rise as early as
four in the morning. He would sometimes go away into the country, that
he might read, more free from interruption. He also instituted various
experiments, some of which we shall have shortly to notice, for the
philosophical spirit in which they were conducted. His visit to France
must have been made about this time, when the celebrated Desault was
at the height of his reputation. His stay could not have been long, in
all probability; but we have evidence showing how quickly he perceived,
amidst the success of Desault, the more important defects of the
hospital—the Hôtel Dieu—to which he was _chirurgien-en-chef_, and the
influence exerted by them on his practice.

As we shall be obliged again to mention Desault in connection with a
material item in the catalogue of our obligations to Abernethy, we
postpone for the present any further remarks on that distinguished
French surgeon.

Abernethy now continued actively engaged in the study and teaching
of his profession. The most remarkable circumstance at this time of
his life, and for several years, was his peculiar diffidence—an
unconquerable shyness, a difficulty in commanding at pleasure that
self-possession which was necessary to open his lecture. Everything
connected with his lectures is of importance to those who may be
engaged in this mode of teaching, or who may desire to excel in it. No
man ever attained to excellence more varied or attractive; yet many
years elapsed before he had overcome the difficulty to which I have
alluded.

An old student, who attended his lectures, not earlier than 1795, told
me that he recollected several occasions on which, before beginning
the lecture, he had left the theatre for a time, to collect himself
sufficiently to begin his discourse. On these occasions, a tumult
of applause seemed only to increase the difficulty. The lecture
once commenced, I have no evidence of his having exhibited further
embarrassment. He seems early to have attained that happy manner
which, though no doubt greatly aided by his peculiar and in some sense
dramatic talent, there is every reason to believe had been carefully
cultivated by study and observation.

His lectures continuing to attract a larger and larger class, the
accommodation became inadequate for the increased number of students.
The governors of St. Bartholomew's, therefore, in 1790, determined on
building a regular theatre within the hospital. It was completed in
1791, and Abernethy gave his October courses of anatomy, physiology,
and surgery of that year in the new theatre. He had thus become the
founder of the School of St. Bartholomew's, which, for the approaches
it made towards giving a more scientific phase to the practice of
Surgery, was certainly superior to any other.

In expressing this opinion, we except, of course, John Hunter's
lectures, for the short time that they were contemporaneous with those
of Mr. Abernethy; John Hunter dying, as we have said, in 1793. As St.
Bartholomew's Hospital was our own Alma Mater, we may, perhaps, speak
with a fallible partiality; but we think not. We are far from being
blind to the faults which Bartholomew's has, in common with other
schools; and, we believe, regret as much as anybody can do, that the
arrangements of our hospitals, excellent as in many respects they are,
should still so defectively supply many of the requisitions which the
interests of science demand. Some of these defects we may endeavour to
point out in their proper place. We shall now leave the subject of Mr.
Abernethy and his lectures, and begin to consider some of his earlier
efforts at authorship, sketch the objects he had in view, and the mode
of investigation.

[Footnote 15: "The same earth nourishes both wholesome and noxious
plants, and the nettle is often next the rose."]

[Footnote 16: Professor Owen.]




CHAPTER VI.

      "All things are but altered, nothing dies,
      And here or there the unbodied spirit flies."

      DRYDEN.


The most universal character impressed on all created things that sense
allows us to recognize, or philosophical inquiry to demonstrate, is
"change."

While nothing is more certain, few things pass less observed; or, when
first announced, more stagger conviction.

An old man sees the yew-tree of his boyish days apparently the same.
Gilpin tells us "eight hundred years is no great age for an oak[17]!"

The cliff which we left "beetling" seems to beetle still; mountains
appear to be everlasting; yet, were seas and rivers to disclose even
a small part of their mission, the Danube or the Volga might tell
of millions of tons of soil carried from higher levels to the Black
Sea and the Caspian. Animals, too, are mighty agents in recording
the mutability of the matter of the universe. Coral Reefs, never
spoken of in smaller terms than miles and fathoms, are the vast ocean
structures of countless millions of animalcules, which serve, as it
were, to link together the two great kingdoms of organic nature—the
animal and vegetable creation. The microscopic geologist informs us of
whole strata, well-nigh entirely composed of the silicified skeletons
of insects. Sir Charles Lyell further impresses on us the reality
of continual change, by referring (and, as it would appear, with
increasing probability) even the stupendous changes demonstrated by
geology to the agency of causes still in operation.

Animals, however, besides the curious structures which they combine to
contribute, are individually undergoing constant change. Man is not
only no exception, but he is a "glaring" example.

The whole human race are in hourly progress of mutation. "In the midst
of life we are in death," is a truth to which physiology yields its
tribute of illustration. Every moment we are having the old particles
of our bodies silently taken away, and new materials as silently laid
down. Surrounding influences, as air, moisture, temperature, &c. which,
during life, are necessary to existence—the moment the breath leaves
us, proceed to resolve the body into the elements of which it was
composed. In all cases, change may be regarded as the combined result
of two forces: the force acting, and the body acted on—that is to say,
of certain external agents and certain forces inherent in the thing
changed.

Animals are no exceptions to this view, and diseases are amongst a
multitude of other exemplifications of it; but, in order to distinguish
these more clearly, it is desirable that we should be familiar with
those more ordinary changes in the body which are constantly going on;
and to some of these were Abernethy's early investigations directed.

In proceeding to give some account of his works, we must be necessarily
more brief than a scientific analysis would require.

To do him full justice, it would be necessary to republish his
writings, with appropriate commentaries. We shall hope, however, to do
enough to relieve his memory from some of the numerous misconceptions
of his principles and opinions; and to endeavour to show his claims to
the respect and gratitude of posterity.

In everything Abernethy did, we find evidence of the acuteness of his
mind, and his general qualifications for philosophical research.

His lectures had gradually attracted an increasing number of students;
and he seems, about 1791, to have been desirous of prefacing his
lectures on Anatomy by discussing the general composition of Animal
Matter.

The rapid advance of chemistry had given a great impetus to this kind
of investigation. Abernethy was not only well up in the chemistry
of the day, but also not unskilled in the manipulatory application
of it; and he felt interested in observing the great diversity of
substances which appeared to be made up of similar elements. Boyle has
recorded a vast number of facts, many of which would even now well
repay a thoughtful revision; and Fordyce was certainly one of our most
philosophical physicians.

Boyle had grown vegetables in water and air only, and found they
produced woody fibre. Fordyce found that gold fish, placed under
similar conditions, not only lived, but _grew_. Abernethy's experiments
had for their object to inquire how far organized bodies (animals and
vegetables) were capable of deriving their various structures from
similar simple elements.

He grew vegetables on flannel, wetted from time to time with distilled
water; and then, analyzing them, compared the results with those of the
analysis of vegetables grown in the ordinary manner.

Other curious experiments consisted in pouring concentrated acids on
vegetable structures, with a view to dissolve any alkali or iron which
they might contain, and then analyzing the vegetables so treated.

He now found, in the burnt vegetable, lime, iron, &c. which, had they
been free to combine, should have been taken up by the acid to which he
had subjected the vegetable before he analyzed it; but he found neither
in the _acid_, whilst both were discovered in the _vegetables_.

He also inquired whether tadpoles and leeches would live when kept only
in distilled water, with the admission of air. For example, he placed
twelve leeches in two gallons of distilled water, They weighed, in
all, twelve scruples. In three months, two had died, but the remaining
ten weighed twelve scruples, showing that they had _grown_. He next
inquired whether vegetables, grown in air and distilled water, would
admit of further conversion into the structure of animals; and, for
this purpose, he fed rabbits on vegetables so reared. His rabbits
appear to have eaten about six plates at a meal of young cabbages thus
reared on flannel wetted with distilled water.

He also experimented on eggs, both before and at the time of incubation.

He wished to ascertain the quantity of lime in the chicken and the egg,
respectively; and whether any of the lime was absorbed from the shell,
which it appeared not to be.

It is curious to observe the time and labour he gave to these
experiments; they evince a very perfect knowledge of the chemistry
necessary; whilst the circumstances calculated to interfere with or
obscure the conclusions from them are judiciously and clearly stated.

Many of his remarks, as well as the ingenious suggestions with which
they are interspersed, exemplify the caution with which he reasoned.
In speaking of his experiments on leeches and tadpoles, many of which
latter had become perfectly developed frogs, he says: "The experiments
which I made on this plan (in vessels of distilled water, covered
with linen) were made in the summer, when to prevent vegetation was
impossible; and, on the other hand, when the vessels were covered over,
even leeches died. In the winter, vegetation might cease; but then the
torpid state of the animals would render the experiments inconclusive."

He reduced an equal number of eggs and chickens (at the time of
incubation) to ashes; sometimes in crucibles, sometimes in retorts. On
the ashes he poured some distilled water, and ascertained the salts
(as lime, &c.) contained in them. In some experiments, the quantity of
these found in the ashes of the chickens greatly exceeded that found in
the ashes of the eggs. In other experiments, the quantities were equal.

In some of his experiments, after using the best chemical tests for
detecting iron, lime, and the salts, and then washing the residue with
distilled water, he burnt it in a crucible, and found more lime and
iron; on which he makes the following remarks, which suggest what we
apprehend, even at this time, is a very necessary caution:

"This circumstance proves to me that the substances found in the
ashes of burnt animal matter do not formally exist in the mass before
its destruction, but are only new distributions of the same ultimate
particles which, under their former mode of arrangement, made the
animal substance; but which, being driven asunder by the repulsive
power of fire, are left at liberty to form other modifications of
matter." Page 97. Just what happens when animal matter is burned, in
the formation of ammonia, by the union of the nitrogen and hydrogen
then set free.

He investigated, also, the question of how far the results of the
decomposition of animal matter would be identical, if the analyses
were conducted by heat, or by putrefactive decomposition. In this
experiment, he selected blood; and he found that blood which had been
allowed to putrify yielded _a much larger quantity_ of iron and lime.

The whole of the experiments are very suggestive, and full of thought;
and not only indicate very forward views of the elementary constitution
of organic and inorganic matter, but also moot questions which have
not lost any of their interest by the most recent investigations. He
concludes by observing that he had undertaken these experiments for the
reasons already assigned, and because he had imbibed the idea that the
_ultimate particles of matter were the same_.

He remarks that the progress of chemistry had not been applied, in
every respect, to the best purpose; that men's views were becoming
_contracted_ by being directed to _individual_ objects; and that they
had ceased to contemplate the beautiful and extensive subject of matter
and its combinations; and he complains that even Fourcroi, Lavoisier,
and Chaptal, either avoid the subject, or do not sufficiently consider
it. We must recollect this was said before Sir H. Davy had made his
splendid discoveries. Abernethy, after observing that he hopes his
experiments will induce others to investigate the subject, concludes
thus:

"I know not any thought that, on contemplation, can so delight the mind
with admiration of the simplicity and power evident in the operations
of the Creator, as the consideration that, by different arrangement and
motion of singular atoms, He has produced that variety of substances
found in the world, and which are so conducive to the wants and
gratification of the creatures who inhabit it."


DISSECTION OF A WHALE.

SECTION I.

                  "Mors sola fatetur
      Quantula sint hominum corpuscula."

      JUV.

Amongst a multitude of examples, which teach us how little we can
infer the importance of anything in nature from its size, or other
impressions which it may convey to mere sense, we might adduce the
wonderful little tubes, certain relations of which were the objects of
this paper. Those constant mutations in animal bodies which are every
moment in progress, are, in great part, due to a very curious order
of vessels, of such extreme minuteness and tenuity, that, being in
the dead animal usually empty and transparent, they are very commonly
invisible, and thus long eluded discovery. There is one situation,
however, in which circumstances combine to expose them to observation.
Transparent though they be, they are here usually rendered visible;
first, by being loaded with a milk-like fluid; and secondly, by being
placed between the folds of a membrane, itself beautifully transparent
(the mesentery). This fluid they have just taken up from the digestive
surfaces on which their mouths open, and they are now carrying it off
to pour it into the blood-vessels, that it may be added to the general
stock of the circulation.

In the situation above mentioned they were at length discovered,
about the commencement of the 17th century. Every thing destined to
support the body with new material, as well as the old, which is to be
taken away, must first be sucked up by the myriads of inconceivably
minute mouths of these vessels, which, from their office, are called
the _absorbents_. These absorbents may therefore be regarded as the
sentinels of the body. They are very sensitive and excitable; but,
besides this, there are placed in the course of their journey, from the
surfaces whence they bring their contents, and the blood-vessels to
which they are carrying them, a number of _douaniers_, or custom-house
officers (the glands, or kernels, as they are popularly called),
whereby, as we have every reason to believe, the fluids they are
importing are subjected to rigid examination; and, if found to be
injurious, to some modification, tending to render them more fit for
admission into the system.

If the contents are very irritating, these vigilant guards—these
kernels—become very painfully affected, and sometimes inflammation is
set up, sufficient even to destroy the part; as if, faithful to their
trust, they perished themselves, rather than give entrance to anything
injurious to the body.

We should never advance, however, in our story, if we were to tell all
the interesting peculiarities of these curious vessels.

When first discovered, and the office assigned to them could no longer
be disputed, the general distribution of them was still doubted. As
it was usual to render them visible by filling them with quicksilver,
so, with a kind of reasoning which has too often characterized mere
anatomical research, when they could not be made visible, it became the
fashion to doubt their existence. Amongst other structures, Bone was
formerly one in regard to which people found a difficulty. How could
such delicate vessels exist in such an apparently dense structure? But
Mr. Abernethy, who, like Bacon, had always opposed mere eye-reasoning,
used to observe, with equal simplicity and good sense, that, for his
part, he could see no more difficulty in an absorbent taking up a
particle of bone, than he could in comprehending how a vessel could
lay it down, which nobody doubted. We now know that bone is not only
supplied with all the vessels which characterize a living structure,
but so liberally, that, in comparison with some other structures of the
body, we regard it as a part of high organization.

Nevertheless, the extreme minuteness and transparency of these
absorbent vessels naturally led persons to regard with considerable
interest any magnified view of them, such as that afforded by
larger animals. In the paper before us, which was published in the
"Philosophical Transactions" for 1793, Mr. Abernethy gives the account
of his examination of the absorbents in a whale; and his object was
to help to determine a question long agitated, whether the glands or
kernels were composed of cells, or whether they were merely multiplied
convolutions of vessels. He selected the absorbents from the situation
to which I have already referred. He threw into the arteries which
carry blood to nourish the gland, a red solution containing wax, which
of course became solid on cooling; and into the veins which return the
blood from all parts, a similar solution, only coloured yellow. He
filled the absorbents with quicksilver.

He found, in filling the absorbents, that wherever the quicksilver
arrived at a gland, there was a hesitation—its course became retarded,
and that this retardation was longest at those glands which were
_nearest the source_ whence the vessels had drawn their contents, viz.
the alimentary canal: as if the surfaces over which the fluid had to
pass were more multiplied where most _necessary_, or, recurring to
our metaphor, as if the more strict _douanier_ had been placed on the
frontier. He says that he found that some of the absorbents went _over_
the glands, whilst others _penetrated_ these bodies. That he found that
the melted wax which he had thrown into the vessels had formed round
nodules of various sizes. He then extended his examination of these
vessels to those of horses and other large animals; and the result of
his investigation was, that it inclined him to the conclusion that the
glands were _not merely_ made up of convolutions of vessels, but were
of _a really cellular structure_.

The paper is very modestly put forth, and he concludes it by observing
that he offers it merely for the facts which it contains, and not as
justifying any _final_ conclusion; but "as all our knowledge of the
absorbents," he continues, "seems to have been acquired by fragments,
I am anxious to add my mite to our general stock of information on the
subject."

It may not be uninteresting to some unprofessional readers to know
that the glands here alluded to are the organs which are so seriously
diseased in those lamentable conditions popularly expressed, I believe,
by the term mesenteric disease, or disease of the mesentery.


SECTION II.

CURIOUS CASES PUBLISHED IN THE "PHILOSOPHICAL

TRANSACTIONS," 1793.

                  "The Universal Cause
      Acts to one end, but acts by various laws."

      POPE.

However paradoxical it may appear, it is not the less true, that
nothing more teachingly impresses the inquirer into nature with the
_actual_ presence of general laws than the _apparent_ exceptions to
them. Finite capacities in dealing with the Infinite must of course
encounter multitudes of facts, the meaning of which they cannot
interpret—portions of the Divine Government, as Butler has said, which
they do not as yet understand.

In philosophical investigations, these are properly regarded as facts
which, in the present state of knowledge, cannot be made to fall under
any of our very limited generalizations.

At one period, departures from the ordinary structure or form in
animals were simply regarded as unintelligible abstractions, and
no more philosophical expression was given to them than "Lusus
Naturæ"—sports of Nature. Progressive science, however, has thrown
considerable light on such phenomena, and invested many of them with a
new interest.

Physiologists have not arrived at the explanation of all such facts;
but much has been done by comparative anatomy to show that many of them
are merely arrests of development, and cases of interference with the
ordinary law.

That, in fact, they show the mutual harmony and connection of the
laws of nature to be such, that the development of any one law implies
the concurrence, so to speak, of some other, just as the successful
incubation of an egg, or any other familiar fact, implies the presence
of certain conditions. We cannot boil a drop of water without the
concurrence of various laws: we say it boils ordinarily at 212° of
Fahrenheit; but how many conditions this involves!

Until understood, how few could have guessed that mechanical pressure
could have so modified the degree of heat necessary, as to exalt it
to more than double, or reduce it to less than half; and again, how
few would have looked for the force which, under common circumstances,
governed the point at which water was thus converted into steam, in
the pressure of the atmosphere; yet so mutually influential are these
conditions—namely, heat and a certain pressure in modifying this
change of form or matter—that some of Faraday's most interesting
results in experimental chemistry (we allude to his reducing several
gaseous bodies to the liquid form) were obtained by _abstracting_ heat
and increasing pressure.

It is of very great consequence to remember these interferences in
relation to disease, because most diseases may be regarded as examples
of them. Considered as "abstract wholes," as entities—diseases are
necessarily unintelligible: but when looked at as natural processes
obscured by interferences (if the inquiry be conducted with strict
observance of those principles which are essential in all philosophical
researches), they either at once become intelligible, or, at least, as
open to investigation as any other facts in natural philosophy.

When we investigate the laws of nature with a view to the development
of the sublime objects of natural theology, the concurrence of the
various conditions, necessary to the most ordinary phenomenon, inclose
the most irresistible proofs, from natural evidence, of the Unity of
the Creator.

Regarded in the light of facts which we as yet may not be able to
generalise, the cases here recorded by Abernethy are very interesting;
although it is to be regretted that both cases were bodies brought in
for dissection, in times when the circumstances baffled, if they did
not forbid, any inquiry into the histories of them. It is lamentable to
think of the state of the law with respect to Anatomy at that time.

Any surgeon who was convicted of _mala praxis_, resulting from
ignorance of Anatomy, was severely fined, perhaps ruined; and yet so
entirely unprovided were the profession with any _legitimate_ means of
studying Anatomy, that they could only be obtained by a connivance at
practices the most demoralizing and revolting.

Bodies were, in fact, chiefly obtained by the nightly maraudings of a
set of men, who, uninfluenced alike by the repulsions of instinct or
the terrors of law, made their living by the plunder of grave-yards.

Many a tale of horror, no doubt, might be told on this subject.

Graves were very commonly watched; and severe nocturnal conflicts
occurred, which were conducted in a deadly spirit, not difficult to
imagine. We believe all this has passed away; there is no necessity now
for such revolting horrors. The public began to _think_ for themselves,
the _real remedy_ for abuses. But to our cases. Both were curious; the
one was the body of a boy, who did not appear to have been imperfectly
nourished, but in whom the alimentary canal was found to be less than
one-fourth of its natural length, and in which also the relative length
of its two grand divisions was reversed. The smaller in diameter,
usually very much the longer, was so unnaturally short, as not to
exceed in length more than one half of the more capacious but normally
shorter division of the canal.

The other case presented a no less curious departure from the ordinary
arrangement of parts than a reversed position of the heart; which,
instead of being placed with its point as usual on the left side, was
found to have that part situated on the right. In the natural condition
of things, there is a difference on the two sides of the body, in the
manner in which the large vessels are given off to supply the head and
upper extremities. These differences existed, but were reversed; the
arrangement of vessels ordinarily found on the right, being here on
the left side, and _vice versâ_.

In all this, there would be nothing to prevent the heart from pumping
the blood to all parts in the natural way. But another very singular
arrangement was found in relation to the liver. To the unprofessional
reader we should observe, that usually, whilst all other things are
made, or secreted as we term it, from the purer or arterial blood; in
the _human body_, the Bile is secreted from a vein which enters the
liver for that purpose.

Now, in the case before us, this great vein never entered the liver at
all; so that here the bile was separated, like other animal fluids, by
the arteries. The arteries going to the liver were found much larger
than usual.

Mr. Abernethy examined the bile by submitting it to various tests; and
comparing the results with those obtained from ordinary bile, he found
them to be the same. His remarks are, as usual, ingenious and to the
point, and very characteristic of the penetrative perception with which
he seized on the proximate and practical relations of facts. "When we
see the unusual circumstance," says he, "of secretion taking place
from a _vein_[18], we are apt to conclude that the properties of such
a secretion require that it should be made from venous blood. But, in
this case, we see that bile could be prepared from _arterial_ blood;
and we are led, therefore, so far to modify our conclusion as to infer,
not that venous blood is _necessary_, but that it can be made to answer
the purpose."

We must not omit that these remarks are supported by comparative
anatomy. As we descend in the scale of creation from the more
complicated organizations to those which are more simple in their
structure or their relations, the arrangement which I have stated as
usual in man no longer obtains, but the bile is secreted from the
arteries as the other fluids of the animal—showing, in fact, that the
inference drawn by Abernethy was the legitimate conclusion.

Since the discovery of this case, one or two others have been observed;
and the opinions of several eminent men, in relation to the bearing
such cases have on the ordinary sources of bile, are described in
Mr. Kiernan's interesting paper on the Anatomy and Physiology of the
Liver, in the "Philosophical Transactions." It is very interesting,
particularly to a professional reader, to peruse that discussion, in
order to estimate Mr. Abernethy's comparatively simple, ready, and, as
it would seem, correct view of the subject.

One other thing we learn from these cases—the extreme importance of
examining bodies whilst their histories and symptoms can be recorded.
It might have been highly useful to science, had the histories of these
cases been known; and the circumstance should be mentioned, as, in some
measure, tending to counterbalance in the public that not unnatural
but (as regards their real interest) not less to be lamented aversion
to the inspection of the dead—a branch only, it is true, but a very
important one of physiological inquiry. It is the only means of which
we can have the comfort of knowing that, however unable we may have
been to arrest disease, we were at least right in the seat we had
assigned to it; but it is infinitely more valuable in disclosing to us
affections of organs which _had given no sign_, and in thus impressing
on us the necessity of taking a wider range in our investigations, and
comprehending in them all _those injurious influences_ which have, _at
various periods_, acted on the body; for we _thus_ obtain an insight
into the nature of disease which _no mere present symptoms_ can ever
afford us.

The repulsions which the public have to overcome are admitted; but let
us not, in common justice, forget those sacrifices of time, labour,
and too often of health also, which are made by the profession. Nor is
it immaterial to mention that it is a service for which they seldom
receive any remuneration, the only incentive being one which, if it
excite no sympathy, is at least entitled to respect—namely, the desire
to improve their knowledge of their profession. There is no doubt of
the deep and common interest which the public and the profession have
in this question; and it is from that conviction that I have ventured
on these few remarks. Abernethy, when he introduced any subject in his
lectures, was accustomed to say at once all that he intended to remark
on it. I beg, in the foregoing observations, to follow his example,
which I trust the reader will accept as an apology for the digression.

[Footnote 17: "Forest Scenery."]

[Footnote 18: The ordinary plan in respect to bile in the _human_
body.]




CHAPTER VII.

    "L'art (de délicatesse) consiste à ne pas tout dire sur certains
    sujets, à glisser dessus plutôt que d'y appuyer; en un mot, à en
    laisser penser aux autres plutôt que l'on n'en dit."—BOUHOURS.


One of the most beautiful poems in the English language, perhaps,
is Armstrong's "Art of Health." Whether it be that the title is
uninviting, or from some other cause, I know not, but it is very
little read; yet scarcely any one who has read it, has done so without
pleasure. Besides containing many admirable and valuable instructions,
it shows how an ordinary, and to many even a repulsive, subject can be
treated with such discretion, taste, and even elegance, as to render it
pleasing and attractive.

Such a writer could have conveyed, even in prose, explanations of
disease so as to interest and instruct his readers. With no such power,
we are almost inclined to regret the impossibility of doing Abernethy
justice, without saying something of nearly all his works. If, however,
in so doing, we make one more step towards familiarizing the public
with matters which affect their best interests, we shall not regret
any labour which this, the most difficult part of our task, may have
required.

We so usually connect pain with disease, that, in our haste, we are
apt to imagine that it is not merely the worst feature, but the only
sign of it. "I am very well, I am in no pain whatever," is a common
expression, and yet a person may be irremediably stricken, without
suffering any pain. Pain is, in fact, often the best possible monitor,
and has saved many thousands of lives by the necessity it has imposed
of observing what is the best of all remedies, in a large class of
cases. Amongst hundreds of examples, we might cite several affections
of joints, wherein pain alone has sometimes exacted the observance of
that which surgeons were a long time before they had learned the full
advantage of; and which, when they had been taught it by Abernethy,
they have often failed, with all their endeavours, to accomplish, but
which, when efficiently secured, is of more consequence than any one
other remedy; we mean "_absolute repose_" There are plenty of diseases
marked by little or no pain, or which, at all events, are not painful;
but they are amongst the most fatal and insidious of human maladies.
Let us commence the record of some of the numerous improvements we owe
to the genius of Abernethy, by mentioning one of them.

We have, too many of us probably, observed something like the
following, on the assembling of a family of a morning: the usual
greetings interchanged, and that cheerful meal, breakfast, fairly
begun, our attention has been directed to some fine, comely, perhaps
beautiful girl, who, to the hilarious spirits of her laughing sisters,
has only contributed a somewhat languid smile. We may, perhaps, have
remarked that she is a little more spoken to by her mother than
any other of the family circle; we may, too, have observed a tone
compounded of confidence and gentleness, somewhat different from that
addressed to her sisters. Still, though less hilarious than the rest,
she has chatted away with considerable cheerfulness; she has, however,
a languor in her manner, which but for the surrounding contrast, might
not have occurred to us. On rising from the breakfast-table, we observe
that her gait is peculiar. She is not exactly lame; but her step has
something between firmness and faltering, that seems to indicate more
effort or less power.

Poor girl! she is about to have, if she have it not already, a stealthy
and hitherto almost painless disease; stealthy, because it is so far
a comparatively painless malady. Deep in the loins there has been the
smouldering fire of disease, which is to result in what is called
"Lumbar abscess." This grievous malady, which in _many instances_
begins not less insidiously than I have mentioned, is found on inquiry
not to have been _wholly_ without some of those premonitory signs
which, in obedience to the beneficent laws of the animal economy,
almost invariably precede even the most insidious malady. Inquiry
generally elicits that, however little complained of, there has been at
times more or less of uneasiness, if not pain, felt in the loins; that
it has not been so much lately; but that it has become less in force or
frequency, since the appearance of some swelling, which may be in the
loins, or some other part, lower or more or less distant.

It is a malady very commonly connected with diseased spine, but
frequently without any such complication; and it is curious that
Mr. Abernethy at first met with as many as, I think, eight cases in
succession, which were not complicated with any disease of the spine.
Under any circumstances, it is a serious malady, and usually, when
the collection bursts, or is opened, severe constitutional symptoms
supervene, which, though not without exceptions, gradually usher in
what Armstrong calls

      "The slow minings of the hectic fire,"

and destroy the patient.

Now, Mr. Abernethy's plan was intended to prevent this last and dreaded
issue. The chief points of excellence in his recommendations are—

First, the emphatic recognition of the constitutional origin and nature
of the malady;

Secondly, the consequent necessity of a greater attention to the
general health of the patient;

And lastly, if it could not be dispersed, to relieve the interior of
its contents, so that its extensive surface should never be exposed.

The mode of proceeding was extremely simple, and there is no doubt that
a great many lives have been saved by the practice thus recommended. I
have heard, however, that some surgeons think the merits of the plan
overrated, which I can only suppose explicable on the ground that it
has been imperfectly followed out; and I am the more disposed to this
view, because nothing can be more _entirely opposed_ to Mr. Abernethy's
principles and intentions, than the treatment of many cases _said to
have been treated_ after Mr. Abernethy's plan.

As a considerable number of families have really a painful interest
in this question, I will, at the risk of being a little professional,
state what has occurred under my own observation, in explanation of
the apparent discrepancy. My own experience obliges me to coincide
with those authorities on this subject, who, approving Mr. Abernethy's
practice, adopted it. Amongst a host of eminent men, I will mention
only two, Sir Astley Cooper, and a scarcely less eminent authority, Mr.
Samuel Cooper, the laborious and distinguished author of the "Surgical
Dictionary," who observes that Mr. Abernethy's plan deserves "infinite
praise." Sir Astley Cooper, too, in speaking of a very dangerous period
of the case to which Mr. Abernethy's plan has an important relation,
says: "We should adopt the plan suggested by Mr. Abernethy, as it is
the best ever invented by any surgeon." The apparent discrepancy in the
results of the experience of different surgeons, is rather a matter of
degree, and admits of easy explanation.

The feature whence the disease derives its name is merely a partial
exposition of an exceedingly deranged state of the whole economy, not
unfrequently complicated with organic disease. Although Mr. Abernethy's
paper shows that even these cases are not necessarily fatal, still, in
general, such will sooner or later terminate unfavourably under any
treatment; but, in many others, the explanation which I first suggested
has been a satisfactory solution of the failure: viz. that the
principle on which Abernethy proceeded has not been seized, and that
therefore the treatment has involved direct violations of it. In some,
the local relief has been by no means conducted with the observance of
those conditions which Mr. Abernethy has enjoined. In others, there has
not been even any reasonable approximation to that careful attention to
the general health which is the necessary basis of the plan.

Another point, which has in some cases impeded the adoption of the
practice, is the increased responsibility it seems to involve. If a
surgeon is to be mistrusted and charged with either, the "laisser
mourir" is much less injurious to him than the "tuer." What we mean is
this: Everything sometimes is going on well, until the opening of the
deposited fluid. If it be left to open by the ordinary processes of
nature, the subsequent symptoms are properly enough ascribed to the
usual course of the disease; but if the surgeon has interfered, and,
from any circumstances whatever, the opening does not heal, or bursts
soon after from some slight accident (which has now and then happened),
the surgeon is blamed. The only remedy for this, is to impress the
necessary caution: repose of the part, and so forth.

There is, however, a third point, of great practical consequence,
on which Mr. Abernethy has been misunderstood. I allude to the
local condition under which the puncture should be made. When,
notwithstanding our persevering observance of all measures calculated
to repress the diseased actions, or to procure the absorption of the
deposited fluid, we perceive it to be increasing or approaching the
surface, _then, before any inflammation_ of the skin has taken place,
it should be discharged.

In many cases, _this_ opening has been delayed until the skin _has
become inflamed_, or much attenuated. Now this risks the accomplishment
of an object which it is a material point with Mr. Abernethy to
secure—namely, the _immediate healing_ of the puncture.

On this point, even so good an authority as Sir Astley Cooper has given
a misdirection. "Let the abscess proceed," says Sir Astley, "until you
observe a blush or redness on the skin, and then adopt Mr. Abernethy's
plan." Now this direction does not absolutely prohibit the opening
of the cyst with the object which Mr. Abernethy had in view; but, as
before stated, it deprives us of _one most desirable condition_. To
settle this point, we quote Mr. Abernethy's own words. In discussing
the point of time at which the opening should be made, he asks: "Are
we to wait until evident _signs of inflammation_ appear? I think not."
Accordingly, in a case where the surface had become red, we find he
took care to _avoid_ opening it _at that part_; because it risked the
security of at once healing the puncture.

The truth is, that the _whole_ of the plan is most valuable; but it
must be carefully followed _in its integrity_; and that this may be
done, the principles on which it is founded must be constantly kept
in mind. These are—the improvement of the general health, with the
view of arresting the action of disease, and producing the absorption
of the morbid secretion. This failing, to puncture the abscess, so as
to secure the discharge of its contents without the admission of air,
and on conditions calculated to _ensure_ the immediate healing of the
wound; then to favour the approximation of the sides of the cavity, by
relieving it of its contents, by puncturing it anew, _before_ it shall
have become so much distended.

Another misapprehension has arisen with regard to Mr. Abernethy's
object in excluding air; and unnecessary pains have been taken to
show that the presence of air is not injurious to living surfaces.
It was not from any apprehension of this kind that he was anxious to
exclude the air; but from the tendency that the _presence of air_ had
to favour the _putrefactive decomposition_ of the new secretion. We
must not omit to mention the origin of this instructive paper, as it is
highly characteristic of Abernethy's acuteness of observation, and his
promptitude in the practical application of it.

A lumbar abscess had been opened by caustic, and when the eschar had
nearly separated, the cyst was partly emptied; the sides of the cavity
collapsing on the imperfectly separated eschar, the opening was closed,
and _none of the usual constitutional disturbance followed_. When,
however, the eschar, finally separating, exposed the cyst,—within
twelve hours, the usual dreaded disturbance of the system supervened.
Abernethy took the hint thus disclosed to him, and produced the
improvement, of the merits of which we have endeavoured to give a brief
representation.




CHAPTER VIII.


HIS ESSAY ON THE SKIN AND LUNGS.

    "It is madness and a contradiction to expect that things which were
    never yet performed should be effected, except by means hitherto
    untried."—BACON, NOV. ORG. APH. 6.

When we consider the object which the distinguished Author had in view,
in the immortal Work whence we have taken the foregoing simple but
instructive aphorism, we cannot but perceive how highly suggestive it
is to those engaged in scientific researches, or how necessary to be
borne in mind by those who are really aware of the present state of
Medicine and Surgery, and desirous of seeing them become a definite
science. Nor does it appear inappropriate to the consideration of
Abernethy's experimental inquiries into the functions of the skin
and lungs. An _extended_ investigation—of which his paper on these
subjects contains an excellent type, and is in part a practical
application—would be a great step towards the creation of a real
science, and would certainly fall within the "means untried" of Lord
Bacon.

Although the latter part of the last century, and the first half of
the present, have been very remarkable for the number of distinguished
men who have flourished during that period, in almost every branch of
knowledge; yet neither the bar nor the senate, neither literature nor
any of the sciences, can boast of greater men, nor lay claim to more
positive improvement, than Chemistry.

If we only consider that interval between the discovery of oxygen by
Priestley, in 1774, and the conclusion of Sir Humphrey Davy's labours,
Chemistry almost seems like a new science; and it continues to advance
with such rapidity, and is daily opening out so many new questions,
that the most accomplished chemist of one year is never sure how much
he may have to learn the next; nor, unless he reasons with great
caution, how much he may have to _un_learn.

To a physiologist, who requires assistance _from all branches of
science_, Chemistry must always be an interesting study. When we lay
aside all speculations as to what is the abstract nature of Life, and
study that which is the proper object of philosophy—that to which it
seems the faculties of man are limited—namely, the _laws_ in obedience
to which the phenomena in nature occur; and apply the knowledge thus
obtained to the occurrences which take place in the human body; we
soon discover that, whatever the abstraction "Life" may be, we live
proximately, in virtue of certain changes in various forms of matter;
as food, air, the various constituents of our bodies, &c.; and that
these consist of multiplied separations and rearrangements of their
respective elements, which it is the special province of Chemistry to
examine.

If we investigate the changes of the living, or the structure of the
dead, with these objects,—we shall be in no danger of perverting
Chemistry to purposes to which it is inapplicable. When, however, we
proceed a step further, and seek to give a _chemical expression_ to
various uses and relations of different parts of the body, the greatest
caution is required.

In the first place, in a machinery which is a practical application of
a great _many_ sciences, it is to the last degree improbable that they
can be expressed by any _one_.

Again, to estimate the true meaning—the physiological interpretation
of many changes which might be in their proximate sense chemical,—a
greater familiarity with the phenomena of _disease_ is necessary than
_usually_ falls within the inquiries of _the most scientific chemist_.

To a person acquainted only with the ordinary phenomena of health,
or who is not even something also of a philosophical pathologist,
Chemistry is for ever suggesting tempting analogies, which are
constantly tending to mislead him to conclusions on insufficient data;
and to examine and rest too much on the _chemical_ facts deducible
from one or other function, without sufficiently attending to the
_physiological_ relations of that function with _all_ others.

In fact, for want of due caution, or it may be of a sufficient range
of information, the assistance which Chemistry has hitherto rendered
to Physiology has been attended with so many assumptions, that it is
extremely difficult to say on which side the balance lies—of advantage
or error. We are aware that at this moment there is a contrary
feeling—a kind of _furore_ for _chemical_ solutions of _physiological_
phenomena. We believe the caution we venture on suggesting was never
more necessary.

The discovery of oxygen gas by Priestley, not only gave a great
impetus to chemical inquiries, but affected Physiology in a very
remarkable manner; when it was found that the _more obvious_ phenomena
of all cases of ordinary burning—lamps, candles, and fires of every
kind—consisted mainly of the chemical union of charcoal and oxygen
(carbonic acid); and again, when it was discovered that animals, in
breathing, somehow or other produced a similar change, one may conceive
how ready every one was to cry, "I have found it. The heat of animals
is nothing more than combustion! We inhale oxygen; we breathe out
carbonic acid; the thing is plain. This is _the_ cause of animal heat!"

It has always struck us as a curious thing that _chemists_ should
have attached such a dominant influence, in the production of heat
in animals, to the union of carbon and oxygen; because nobody is
necessarily so familiar as they are with the fact that the evolution
of heat is not at all _peculiar_ to the union of these bodies, but is
a circumstance common to all changes of every kind, in all forms of
matter—there always being either the absorption or the evolution of
heat.

There is no doubt that the analogy is very striking between the changes
which _appear_ to be wrought in respiration, and those which take
place in ordinary combustion. A very little consideration, however,
shows that the idea that respiration is the cause of animal heat, or
that it is due to any other change of oxygen merely, is not only an
assumption, but in the highest degree doubtful. In the first place, the
carbonic acid thrown out when we expire, is certainly _not_ made by
the immediate union of the oxygen inspired with the charcoal expired;
secondly, nothing is so obvious that in respiration there is an immense
quantity of heat _thrown out_ of the body. But as it is very desirable
that the subject of this paper of Abernethy's on the Skin and Lungs
should be understood, we will give the reader a simple view of the
nature of these important organs; and as one (functionally considered)
is as much a breathing organ as the other, we will say a few words
first of the lungs.

In all animals[19], the blood, or other fluid in which the elements of
nutrition are sent to all parts, is exposed to the action of the air;
and this is what we call breathing or respiration; and the exposing
of the blood to air is so arranged that both fluids are in _more or
less_ rapid motion. The staple constituents of the air, so to speak,
are about one-fifth oxygen and four-fifths nitrogen gases, with about
two parts perhaps in a thousand of carbonic acid; and although, as we
too well know, the air is occasionally polluted by many _additions_,
yet, whether we take air from the top of Mont Blanc, or a cellar in
London, the _staple_ principles of oxygen and nitrogen have their
proportions unchanged. The air breathed by animals who live in the
water is somewhat differently constituted; the proportion of _oxygen_
is considerably _greater_, probably about as much as one-third or
thirty-two parts in one hundred; so that fish breathe a more _highly
oxygenated_ air than we do.

Now it is found that, when we inhale the air of the atmosphere (that
is to say, one-fifth oxygen and four-fifths nitrogen), we expire some
oxygen, some carbonic acid, and some nitrogen also; and to ascertain
the _actual changes_ which took place, was the object of Abernethy's
inquiry.

The subject is one of great interest to the public; and, in justice to
Abernethy, we should remark (that which perhaps a few more years may
render it more important to record), that this essay was written more
than half a century ago—1793.

Thousands die every year of affections of the lungs; and many diseases
of these organs, if not in their nature incurable, have too generally
in practice proved to be so. There are not wanting, however, many
persons who ascribe these mournful results, not so much to the abstract
difficulty of the case, as to imperfect and erroneous views of the
functions and relations of these important organs; and who entertain
the opinion that the investigation of the subject has been, either from
preconceived notions, from a too limited view of the phenomena, or from
some other cause, so infelicitously conducted, that the conclusions
arrived at have been either merely assumptions, extremely doubtful, or
absolutely erroneous.

It is sufficiently obvious that if we are ignorant of the use of any
part of a machine, it must be the most unlikely thing in the world that
we should know how to set about repairing it when it is out of order;
and the matter must be still worse, if we should happen to ascribe to
certain parts of it purposes different or contrary to that which they
as really fulfil. So, in an animal, if we are ignorant of the use and
relations of any organ, it is very improbable that we can understand
the nature of its disorders, or treat them in any case successfully,
except by the merest accident, which, though it may waken us up to a
sense of our ignorance, leaves us so blind to the causes of our success
that we have no power of repeating it.

Now this is pretty much the actual state of affairs in respect to
diseases of the lungs. No investigation of any organ is worth anything,
unless it include its relations with other organs in the same machine.

What should we ever learn by looking at the mainspring of a watch,
apart from the general machinery to which it belongs? Though we should
look for ever, and employ a microscope to boot, it is clear we should
never arrive at the perception of its true relations.

Abernethy's inquiry derived great interest from the investigation of
the skin by which it was preceded, and which seems to have formed
his primary object. A few words on this wonderful organ may help the
unprofessional reader to form some estimate of its relations and
importance. As, in all animals, it is the surface in immediate contact
with external influences—the first which attracts our notice—the
first which we instinctively interrogate as to the state of the animal,
so it is of all others the first which presents to us the evidence of
design and adaptation. We tell the climate an animal inhabits, with
moderate certainty, by looking at the skin; and if we occasionally
meet with apparent exceptions, further examination usually shows that
they exemplify the more strikingly the unity of plan. Thus we may
find animals who inhabit _hot_ regions furnished with a somewhat warm
covering of the skin; as the tiger, for example: but when we examine
the eye, and inquire into the habits of the animal, we find that he
preys or feeds at night, when the atmosphere is charged with damp and
cold.

We know that the animals whence we obtain our furs inhabit cold
regions. The changes in the same animal are not less instructive.
Animals placed in certain circumstances, in which they require
greater warmth, have increase of covering, and _vice versâ_. Again,
the tendency to become white, in those inhabiting cold regions, is
a very interesting adaptation, although I am not aware that it has
been satisfactorily explained. Two things, however, are certain: that
they are placed in different circumstances as regards the relation
to heat, and would reflect a great quantity of light, which, in its
intensity in snowy regions, might be prejudicial, as there is no doubt
of the influence of this principle in animals. Again, it is a very
common arrangement that animals should take the colour of the ground
they occupy; and this is sometimes very curiously exemplified. I have
observed in the common hunting-spiders which inhabit some palings in
a garden in the country, that they are of different shades, but they
all more or less resemble that part of the old paling on which they
are found. Those which we see on the ground are generally of some dark
colour. Birds exemplify in a very remarkable manner the adaptation
of their external coverings to the requisitions which their habits
establish. All animals may be said to be surrounded by an atmosphere of
their own, and they are not therefore, strictly speaking, in contact
with the atmosphere; but when they are exposed to air in motion, this
stratum is blown aside, and the atmosphere is brought in contact with
the surface. Its refrigerating influence is now felt; and, just as a
boy cools his broth by blowing on it, a fresh stratum of cold air is
constantly brought to the surface.

The power of resisting or limiting this refrigerating influence is
somewhat differently conferred in different animals: in the healthy
human subject, by increased activity of the vessels of the skin, which
induces greater heat. Birds, in their rapid flight, and especially in
the more elevated regions of the atmosphere, are exposed to intensely
refrigerating influences. These are met by the surface being clothed
first by fine feathers, the worst of all conductors of heat, and these
are overlapped, where they meet the atmosphere, in such a way that the
bad-conducting property of the feathers is increased by the mechanical
arrangement of them. Again, the respiration of birds, which (_as we
contend_) is a refrigerating process, is very restricted; although,
for want of due consideration of all the circumstances, and especially
of certain analogies afforded by insects, very opposite views have
been entertained. Domestic animals (birds inclusive) impressively
suggest the refined adaptation of colour even, of the whole surface,
to the altered position of the individual. Nothing is more striking
than the general uniformity of colour in wild animals—few things
more familiar than their infinitely varied hues when domesticated.
Now it is certain that these differences have a meaning, and that
their relations are important; but when we extend these thoughts from
the coverings of animals to the consideration of surface, whether of
animals or vegetables, what wonderful things occur to us. Every variety
of colouring which we observe in domestic animals, every spot on an
insect's wing, every pencilling on a a flower, places the individual in
a different relation, so far, to light, heat, and other powerful agents
in nature.

Or if we look from another point of view—we cannot walk by a hedge-row
in summer without observing how very small the differences of light and
aspect are, which seem on the same soil to confer on the same species
of flowers such numerous varieties of colour. I have most frequently
observed this in the common cranes-bill, or wild geranium.

In order to estimate correctly the value of these surfaces to the
animal or vegetable, it is obviously of great importance to us to know
what they do; and if they give off any thing, to ascertain its nature.
That either animal or vegetable may be healthy, the processes of
nature, whatever they are, must be carried on; and we may be assured,
that the fragrance of the rose is just as necessary an exhalation
_from_ the plant, as it is an agreeable impression _to_ us.

But all animals may be said to breathe quite as much by their skin as
by their lungs. Leaves, too, are the breathing surfaces of vegetables;
and, therefore, to ascertain the facts in the one, without inquiring
into those observable in the other, would be likely to fog our
reasoning and falsify our conclusions. The first impression we obtain
from all animals is from external form and appearance—from, in fact,
its outward covering. It was the first organ to which Abernethy devoted
his most particular attention; and here again his investigations show
how little those knew of his mind who imagined that his thoughts were
restricted to any one set of organs.

In whatever light we view it, the skin is, in all animals, a most
important organ; and so much so, as—drolly enough—with the exception
of the human subject, to have been long popularly so considered. Yet
so imperfect have been the investigation of its functions, that we are
at this moment chiefly indebted to the early experiments of Abernethy
for what we know that is positive on the subject. The original
experiments of Sanctorius were quantitative and, as general truths, of
sufficient importance to have excited more attention. Cruikshank's were
highly acceptable; but they were less numerous and less varied than
those of Abernethy; whilst the labours of Edwards, though exhibiting
great industry and zeal, were by no means so conclusive as those of
Abernethy. Edwards' experiments served to strengthen and confirm, by
the analogy afforded by other animals, conclusions drawn by Abernethy
from the more secure premises furnished by the _observation_ of
corresponding functions in man.

Mr. Abernethy's inquiry was first directed to ascertain what the skin
actually gave off from the body; and secondly, what changes took
place in the air which we draw into the lungs (inspiration). We will
endeavour to give some idea of these experiments. They were very
simple—they involved no cruelty, like those of Edwards—and they were
many of them such as the public might repeat without difficulty.

Very useful would it be, if persons who have leisure would sometimes
engage in physiological inquiries. They would find them to be extremely
interesting; and a series of facts would be easily collected, from
which the physiologist might obtain the most valuable information,
but which, engaged as most of us are in applying physiology to
the correction of disordered functions, we can seldom collect for
ourselves, except in a few hours stolen from those occupied in an
arduous profession, and perhaps by the sacrifice of paramount duties.

Mr. Abernethy's experiments were very numerous, and commenced in the
summer of 1791; but the winter's cold obliging him to desist, they were
renewed in the spring of 1792. Having referred to the experiments of
Ingenhous and Cruikshank, together with an allusion to a paper (not
then made public) by Lavoisier, he proceeds to describe his own.

Having a trough containing a large quantity of quicksilver, he filled
a glass jar (sufficiently capacious to contain his hand and wrist)
with that metal. He inverted it into the trough in the usual way of
proceeding in collecting gases. He fixed the glass jar in a sloping
position, that he might introduce his hand the more readily beneath
the quicksilver. In this way, whatever was given off from the skin of
the hand, rising through the quicksilver to the top of the glass, and
of course displacing a proportionate quantity of quicksilver, could be
made the subject of analysis.

He describes his first experiment as follows: "I held my hand ten
minutes in the jar beneath the surface of the quicksilver, and
frequently moved it in that situation, in order to detach any
atmospheric air that might accidentally adhere to it, and afterwards
introduced it into the inverted jar. The quicksilver _soon acquired_ a
degree of warmth which rendered it not unpleasant. Minute air-bubbles
ascended to the top of the quicksilver, more speedily in the beginning
of the experiment, more tardily towards the conclusion. After an hour
had elapsed, I withdrew my hand; the bubbles of air, which now appeared
on the top of the quicksilver, were, I suppose, in bulk equal to one
scruple of water.

"In _sixteen hours_, I collected a half-once measure of air, which
makes fifteen grains the average product of an hour. No kind of
moisture appeared on the surface of the quicksilver. Some sucking-paper
was put up, which was withdrawn unmoistened. My hand was always damp
when taken out of the quicksilver. Whatever aqueous perspiration was
produced, adhered to its surface, whilst the aeriform ascended to
the top of the jar. To the air I had thus collected, I threw up some
lime-water[20], when about two thirds of it were rapidly absorbed;
to the remainder, I added a bubble of nitrous gas[21]; but could not
discover any red fumes, nor any diminution of the quantity. I repeated
this experiment six times, with similar though not uniform results. I
believe it will be found that the air perspired consists of carbonic
acid gas, or fixed air, a little more than two thirds; of nitrogenous
gas, a little less than one-third. In one experiment, the nitrogen made
only one-fourth part of the air collected; in another, I thought it
exceeded one-third."

He then made a series of experiments of the same kind, but substituting
water for the quicksilver, sometimes heating himself previously by
exercise. The results of these were not materially different from
those in which he held his hand in quicksilver; but they are less
clear, because the carbonic acid gas given off seemed absorbed by the
water. In the next series of experiments, he held his hand and arm
in atmospheric air. In this case, he found that, in addition to the
giving off of carbonic acid, a portion of the oxygen of the air became
absorbed. This is exactly what happens in the lungs. Now, as the
carbonic acid, when given off, is in both cases coincident with the
disappearance of oxygen, and as carbonic acid is composed of oxygen
and carbon, it _had been_ usually conceived that the oxygen taken in,
contributed to form the carbonic acid given off; and the idea is still
entertained very generally.

The experiments of Abernethy, however, presently to be adverted to, in
regard to the skin; and those of Edwards, long after, in regard to the
lungs; satisfactorily prove, we think, that the carbonic acid is not
_at all derived_ in the manner supposed[22].

To test this matter, Mr. Abernethy confined his hand and arm in various
gases containing _no oxygen_—as hydrogen, and then in nitrogen; but he
found the carbonic acid gas _still given_ off as before. He then placed
his hand in a gas (nitrous oxide) _containing_ oxygen; and lastly, in
oxygen itself, to see if it _increased_, or otherwise affected the
elimination of carbonic acid; but in neither of those experiments was
the carbonic acid thrown off, _increased_, or in any way affected by it.

In a subsequent part of the paper, he remarks on the idea that
physiologists entertained of the carbonic acid given off by the lungs
being made by the oxygen inspired; but he says, very justly, that the
quantity of oxygen is too small for the formation of so much carbonic
acid gas as we find given out by those bodies; and that his experiments
on the skin clearly prove that the exhaling vessels of the skin emit
carbonic acid in a state of _complete formation_; and then adds, what
it is difficult to estimate the merits of, without recollecting that it
was said half a century ago (and before the experiments of Edwards),
"and, doubtless, those of the lungs perform a similar office."

This is one of those bold, and, we believe, successful reasonings
from analogy which were very characteristic of Abernethy. The truth
is, that even the experiments of Edwards, some of which were, a long
time since, repeated by ourselves, with the same results, are not, I
conceive, so conclusive as the analogy of Abernethy. It is true, they
consisted of placing frogs and other animals in gases not containing
oxygen, when it was found, notwithstanding, that there was _no_
diminution in the quantity of the carbonic acid produced, and which
therefore could not have been compounded of any oxygen in the gas. But
even here many possible sources of fallacy suggest themselves. The
previous expulsion _of all_ the oxygen from the animal is obviously a
matter of uncertainty. There are, besides, those sources of fallacy
which are inseparable in some form or other from all experiments on
animals which disturb their natural habits, especially when these
disturbances are so great as to amount to suffering. From all such
experiments Abernethy _instinctively_ shrunk. His repulsion to them
seems not to have rendered it necessary to him to have shown that
they were as _physiologically inconclusive_ as they were morally
questionable. At all events, his present experiments were not obscured
by any such sources of fallacy.

Still the idea of the carbonic acid exhaled by the lungs, being made up
of the union of the carbon exhaled with the oxygen taken in, continued
to be very extensively entertained. We can only say that to us it seems
entirely a child of the imagination; what Horace calls

    "Mentis gratissimus error;"

and shows not only how few people can find leisure to investigate, but
how few venture to observe or think for themselves. Abernethy also
experimented by holding his hand in carbonic acid, when he found that
in about nine hours, three ounces, by measure, of carbonic acid were
absorbed by the skin; and in the remaining gas, a considerable quantity
of other gas which had been given off, which appeared to be nitrogen.

Desirous of ascertaining the quantity of carbonic acid gas given off by
his hand, in different gases in a single hour, he introduced his hand
into various gases. In the experiment with

                                    Drs.
  Nitrous oxide, there came off      6
  Hydrogen                           4
  Atmospheric air                    3

The test for the carbonic acid was, as before, in all cases,
lime-water. He also found that the skin absorbed oxygen much more
readily than most other gases. One remarkable experiment we will
notice, to show how laborious all these investigations were, and for
the interesting nature of the result. He placed his hand alternately in
vessels containing each twenty-four ounces, by measure, of nitrogen and
oxygen gases. After eight hours' exposure in each, two-thirds of the
oxygen had disappeared, whereas only _one twentieth_ of the nitrogen
was absorbed. Indeed, there is no one feature of these experiments
perhaps more interesting than those which suggest the stronger aptitude
of the skin to absorb oxygen in comparison with other gases. For
example, Abernethy found that the skin absorbed, by measure,

                                    Ozs.
  Of oxygen gas, in eight hours      8
  Of nitrous gas, in five hours      3
  Of hydrogen, in five hours         1-1/2
  Of nitrogen, in eight hours        1

Mr. Abernethy then made some experiments on his own lungs, after the
manner that Mr. Cruikshank had done, to find the quantity of _water_
exhaled, by breathing into glass jars filled with and inverted in
quicksilver, and by other methods, and also to ascertain the change
produced in the air by respiration. These are all interesting; but we
can only give general results, referring to the work itself, as full of
material for thought and future observation. He considered that, on the
whole, the change in the air was, that in one hundred parts, consisting
of

                    Parts.
  Nitrogen            80
  Oxygen              18
  Carbonic acid        2

about _three_ parts of the oxygen were absorbed, whilst about _twelve_
parts of carbonic acid were exhaled, the nitrogen being little altered,
or even receiving some small addition. The quantity of _inspired_
oxygen which disappeared varied in different experiments, probably
depending on the depths of the inspiration, and the duration between
it and the following expiration—the time, in fact, during which it
was retained in the lungs. The smallest quantity which disappeared was
one-twelfth; the largest, one-sixth. The moisture (water) exhaled, he
found to be about three drachms in an hour.

These experiments, for the particulars of which we must refer to the
book itself, contain a calculation of the extent of surface of the
body, which he estimates at about two thousand seven hundred square
inches—that is, about thirty-eight times that of the hand and wrist,
on which he experimented. Thus, if we multiply any of the results he
obtained by thirty-eight, we shall obtain some idea of the prodigious
power of this wonderful organ, and of the vast influence which its
various conditions must exert on the whole animal economy. The whole
of the experiments in the paper are just as interesting as ever,
and would, we are well persuaded, be found amply to repay further
investigation.

They exemplify in every line his clearness of thought, and his care in
deducing no other conclusion from the premises than that which they
logically justify. The observations which he has annexed to his paper
also are just, and of great practical value; they discuss the bearing
that the whole has to the relation which exists between the skin and
lungs, and the influence of this on the causes of that fell destroyer,
popularly known under the title of Consumption.

They are a portion of that investigation of relation between various
organs, on which anything like the formation of a definite and
practical science must ultimately depend. We shall endeavour, in the
sequel, to explain the ulterior consequences which necessarily arise
out of such considerations, when they are duly followed out. We shall
endeavour to point out the share they had, in conjunction with other
considerations, in leading to those beautiful and simple principles
which Mr. Abernethy was led more especially to advocate; and show how
far _he_ went, as describing the starting point of those who have
endeavoured at a fuller development of the consequences of his views.

He remarks, justly enough, on the determination to the lungs consequent
on the repression of the surface, and the necessary _additional duty
thrown on those_ important organs engaged in a common function with
the skin, where the duty of the latter is not performed; and on
the elements thus supplied for disease, _especially_ in persons of
restricted chest; relations, _be it remembered_, which exist between
the various other organs of the economy, and which exemplify in a
single case truly, what has been, we trust, since shown in regard
to organs generally; how the organ, which may be the seat of the
_disease_, _may not be_ the seat of the original _cause_, but really
a secondarily affected organ—a hint which, when followed out, is of
_immense practical importance_.

The skin is by no means the only organ which has a community of
function with the lungs, or through which these important parts become
affected; but if this be so, and diseases of the lungs be treated
as an _integral thing_, it requires no great penetration to see how
diseases so handled must be incurable; since the real cause may never
be ministered to.

Again, if a case should be successfully treated, by means which
afford all possible relief to the _lungs_, whilst the _primarily
affected_ organ is also properly treated, it by no means follows that
the treatment should be the same in _every case_; for the primarily
affected organ may be different in different cases. There is, in fact,
no organ of the body which, when subjected to disordering influences,
may not _secondarily_ affect the lungs.

The liver is especially apt to affect them. It is engaged, like the
lungs, in throwing off large quantities of carbon or charcoal from the
system, and has been not very improperly termed the "abdominal lung."
It is constantly also sending through the medium of the heart a large
quantity of blood to the lungs. Now, if this blood have not the proper
quantity of carbon extracted from it by the liver, or if even the blood
be excessive in quantity, why the lungs must have more to do; and many
diseased lungs have been produced in this manner in cases where the
chest has been well formed.

There are, however, many intimate relations between organs which do not
depend on mere community of function. It is very important that the
public should have clear views on this subject; and if they would only
give a little of that attention which they so often bestow on things
infinitely more difficult, there is no doubt many lives would be saved
that are irremediably damaged, as Abernethy says, sometimes even before
any symptoms have suggested that there is anything the matter.

But if there be a shadow of truth in Mr. Abernethy's views, and still
more in those extensions of them to which they have naturally led, we
may learn how necessary is that discrimination which traces disease to
_primarily_ affected organs; and how little success we may expect by
treating the lungs, as the integral seat of disease, by specifics, or
such remedies as tar, naphtha, cod-liver oil, various gases, &c. which
come in and go out of fashion in a manner sufficiently significant of
the claims they can have in a scientific point of view.

Mr. Abernethy also remarks on the comparatively restricted influence
of scrofula in constituting consumption. "At one time," he observes,
"I examined the bodies of many people who died of consumption." After
describing other appearances which he found, he says, "the greater
number were bestudded with larger or smaller tubercles, or _made
uniformly dense_ (consolidated)." He says, this disease (consolidation)
is _very insidious_, that it is often established beyond the
possibility of removal before it is suspected; but, he says, he thinks
it might be known, for the capacity of the lungs is diminished; and
suggests that this should be tested, by allowing a suspected case to
_breathe into a glass vessel over water_, by which the quantity of air
they can receive is rendered perceptible.

His remarks, too, on the treatment are highly interesting and
discriminative, and will not only well repay attentive perusal, but
that study which is necessary to the perception of their full force and
beauty. When we have to sum up the various influences of the views of
Abernethy, we may probably find space for a few facts on that which
they exert on the treatment of the lungs and skin; and this not merely
as affecting the health in general, but also complexion, and other
conditions of these curious and important organs.

We are unwilling to dismiss this paper without directing attention
to the illustration it affords of the erroneous views of those who
imagine that Abernethy's investigations were confined to the digestive
organs, and still less, of course, to one of them (the stomach). It
would, on the contrary, be difficult to find any paper on physiology
so comprehensive in its views, so simple and clear as to its object,
so cautious and logical in its reasonings, so free from any bias,
or with so little reference, either directly or indirectly, to what
are usually understood by the digestive organs. On the other hand,
it is an investigation which (as regards the relation which exists
between two organs having a common function) is an exact type of what
physiological investigation should be. For we have only to extend the
idea of a relation which exists between _two_ organs, to those which
exist between _all_ organs; to regard as their _combined_ functions,
the sustentation of the life and health of the individual, just as we
have been regarding respiration, the common function of the skin and
lungs; and we thus arrive at what must be the basis of any sound or
comprehensive inquiry into the true relations of the various parts of
the economy; by which alone we can interpret the phenomena of health
and disease.

Moreover—however presumptuous the assertion may appear on the one
hand, or however humiliating the view it implies of the present
state of medicine as a science on the other—we must regard this
investigation, in every philosophical sense of the term, as still among
the "means untried" of the illustrious author whose words we have
ventured to place at the head of this chapter.

[Footnote 19: This statement does not hold in regard to Entozoa (animals
living in the bodies of others), or at all events is not proved.]

[Footnote 20: The test for carbonic acid.]

[Footnote 21: A test for the presence of oxygen.]

[Footnote 22: It is in this paper that he uses the significant
expression "ventilating the blood," which looks as if the refrigerating
effect of respiration—and which we have endeavoured to show is the
real, though perhaps not sole, purpose of it—had not wholly escaped
his notice.]




CHAPTER IX.


HIS PAPER ON TIC DOLOREUX.

                "Quis talia fando
      Temperet a lachrymis."

      VIRGIL.

Perhaps, of all known torments, there is none that can be compared,
either in intensity or duration, with that curious disease which has
been called Tic Doloreux. Like the term Neuralgia, it is merely a hard
word to express a violent pain in a nerve. Conventionally, the term
neuralgia, or nerve-pain, is generally used to express a case where
the suffering is of a more or less diffused character. The term "tic"
is more usually applied in cases where the seat of pain is found in
some superficial nerve. Neither term has much claim to the character of
scientific nomenclature; they are merely equivalent to saying that we
know very little of the matter. This obscurity, however, may be soon
lessened, if not entirely cleared, by any one who will go to work in
the way suggested by Mr. Abernethy's principles, and in which, to a
certain point, they will conduct him. He must, however, recollect that
the pain, though a most distressing symptom, is still a _symptom_, and
not the _disease_ which gives rise to it.

This disease teaches us how beneficently framed we are in relation to
all around us; and how small a deviation from a healthy condition of
our sensations converts all usual sources of pleasure into so many
elements of agony. The breeze, of late so grateful and refreshing,
may produce more suffering than would be excited by the most
intensely-heated furnace. In other cases, the cool spring, or the
most delicious fruit, become causes of torture. We should exceed
all reasonable limits if we were to enumerate all the usual sources
of pleasure which, in different cases, are converted into so many
instruments of suffering.

Tic doloreux is indeed a horrible malady; but one which, when properly
considered, becomes very instructive. It admirably illustrates
the views of Abernethy; and how ready he was to concede all that
examination of the views of others which modesty and common sense
require, as well as how superior his own were, both in philosophical
acumen and practical value; first examining the views of others, and
finding them defective, he, with the true philosophical spirit which
first discovers what is wrong—

    "Primus gradus est sapientiæ falso intelligere,"

then proceeds to develop his own.

The nerves are the organs from which we receive all our impressions
from without; and when their ordinary sensibility is thus morbidly
augmented, we may be persuaded that there is _something_ very wrong
within.

The tic doloreux is one of the examples showing how cautious and
circumspect, and how modest withal, Abernethy was in advancing to his
own comprehensive views of disease; and how entirely antithetical the
method he pursued in arriving at them was to that which attempts to cut
the knot of difficulty by gratuitous hypotheses.

When this disease first began to attract attention, it was suggested
that it might be cured by the division of the nerve. The phenomena
of the nervous system afforded abundant grounds for mistrusting the
soundness of this view. The tendency, however, to confound the more
salient symptom of a disease with its intrinsic nature, caused such
phenomena to be overlooked or little considered; and the consequence
was, that where the nerve was divided, the treatment was sometimes
entirely confined to that proceeding.

In the end, the operation disappointed expectation; and that which
careful reasoning might have predicted as probable, was left to be
determined by experiment, In some cases, circumstances concurred to
produce temporary relief; but on the whole the operation was a failure.

In the case he here published, Abernethy removed a little bit of
nerve from a lady's finger. As she had suffered severely, and he was
anxious to give her more permanent relief, he did not rest satisfied
with merely dividing the nerve. For about nine months the lady was in
comparative ease; but then the sensation returned. He remarks on the
interest attached to this return of sensation, and observes on the
analogy it suggests between the supply of blood, and that of nervous
power. For if the vessels conveying the former be tied or obstructed,
the supply is gradually restored through collateral channels. The
return of the nervous functions, after the removal of a portion of the
nerve, seemed to favour that view of the nervous system which regarded
as the proximate cause of the phenomena some subtle principle or other,
like electricity or magnetism, or some analogous power, of which the
nerves might be the conductors.

Perhaps the most interesting fact of this case, however, was the
significant bearing it had on those views which he was beginning
to deduce from a multitude of other sources. The fact being, that
when the lady died, which she did about four years afterwards, _she
died of disordered digestive organs_. Showing, therefore, at least,
the coincidence of the most severe form of nervous disturbance with
disorder of these important functions.

We shall see, by and by, that Mr. Abernethy made this and other cases
the instruments of much future good; but as we shall not be able to
digress from that Summary of our obligations, which we shall then be
employed in taking, we will add a few words here in aid of removing
that difficulty which some people have in understanding how such
dreadful pain can result from any organ in the interior of the body,
where no pain is felt at all. In order to do this, it is only necessary
to have a clear general notion of the nervous system. If you could
take away everything but the nerves, you would have the brain, spinal
marrow, and certain knot-like pieces of nervous substance (ganglions,
as we term them) from which myriads of cords proceeded, varying in size
from the smallest imaginable filaments up to moderate sized cords; the
ends of the delicate filaments terminating in the various organs and
on the surface of the body; millions of messengers of the most extreme
sensibility, by which impressions are telegraphed with the swiftness of
lightning between all parts of the body. There is, however, a habit or
rule which is ordinarily observed, and that is one of the most curious
things in the whole range of physiology—namely, that the immediate
cause of our recognition of sensation is never in the part itself,
but the action is constantly transferred to the extremity of the
nerve. When you strike the ulnar nerve at the elbow (popularly termed,
sometimes, the funny-bone), you feel it in the fingers to which its
branches are distributed.

If you place your finger in cold or warm water, the action that makes
you feel it is in the brain; and we infer this, because if we divide
the communication between the brain and the finger, you no longer
feel the sensation. Now, bearing this in mind, you easily understand
how anything disturbing the nerves of any internal organ may produce
pain in some distant branch; and that this is really so, many cases
of tic doloreux have furnished conclusive and triumphant proofs. Now,
as to _why_ it should be seated in this or that particular site, is
a question of extreme difficulty; as also in what organ the primary
disturbance is seated, supposing it to have been in any of them. The
former, I believe, is a question we have yet been unable to solve; the
_latter_ may usually be accomplished, _if sufficient pains be taken_.

Abernethy, in his lectures on this subject, when observing on the
inefficiency of this division of the nerve—which was ministering to
effects only—was accustomed to remark, with that peculiar archness of
expression which his pupils must so well remember: "I wonder that it
never entered into the head of some wise booby or other to divide the
nerve going to a gouty man's toe." This was a very characteristic mode
of terminating a discussion of any point which he wished to impress on
the memory of the pupil.


SECTION.

OF HIS PAPER ON OCCASIONAL CONSEQUENCES OF BLEEDING.

In these days of improved statistical inquiry, it would be a curious
document which should give us the comparative number of persons who are
now bled, and that of only fifty years ago; and whilst it would present
very instructive data as to the progress of medical science, it would
give also some significant hints as to the relations of fashionable
remedies. First, almost every barber was a bleeder; and within my own
recollection, a lady, who for any serious ailment consulted the most
eminent physician in the neighbourhood in which she lived, would allow
no one to bleed her but the barber.

Formerly, multitudes of people lost a little blood every "spring and
fall." Accidents of all kinds afforded a fine opportunity for bleeding.
The papers announced accidents generally by the usual—"It is with
regret that we learn that Sir Harry —— was thrown from his horse
in the Park. It was feared that the honourable baronet had sustained
serious injury; but, fortunately, Mr. Sharpe was on the spot, so that
the patient was immediately bled. He was conveyed home, and we rejoice
to hear that he is doing well. The accident, which it had been feared
was a fracture, proved to be only a 'dislocation.'"

The questions in regard to bleeding were said to be—who, when, and
how much (_quis, quando, quantum?_); but, to our minds, Aretæus
has a better saying: "When bleeding is required, there is need
of deliberation (_cum sanguinem detrahere oportet, deliberatione
indiget_)." We like this better; because, in addition to the little
words quoted above, it suggests another, more important than
either—namely, _cur?_ why—on many occasions, a favourite inquiry of
Abernethy's.

We recollect a surgeon being called to a gentleman who was taken
ill suddenly, and he found two or three servants and the medical
attendant struggling very vigorously with the patient. Whilst this
was continuing, the first question put to the surgeon by the medical
attendant was:

"Shall I bleed him, Sir?"

"Why should you desire to bleed him?"

"Oh! exactly; you prefer cupping?"

"Why should he be cupped?"

"Then shall I apply some leeches?"

This, too, was declined; in short, it never seemed to have occurred
that neither might be necessary, still less that either might therefore
do mischief.

It is the most curious thing to see the force of a well-grown
conventionalism. As long as it led to moderately bleeding plethoric
baronets in recent accidents, no great harm would have been done;
but the frequency in other cases, in which bleeding was instituted
with "apparent impunity," was too commonly construed into "bleeding
with advantage," until the practice became so indiscriminate as to be
extensively injurious. _Now_, comparatively, few persons are bled; and
some few years ago I had a curious illustration of it.

In a large institution, relieving several thousand patients annually,
and in which, a very few years before, scarcely a day passed without
several persons having been bled; nearly a month elapsed without a
single bleeding having been prescribed by either of the three medical
officers.

No doubt many persons are still bled without any very satisfactory
reason; but we believe that the abuse of bleeding is much diminished,
and that the practice is much more discriminate and judicious. From
this, and perhaps other causes, a very important class of cases which
engaged the attention of Abernethy, as it had that of Hunter before
him, is become comparatively infrequent. When bleeding, however, was
practised, with as little idea of its importance as some other of the
barber-surgeon's ministrations, on all sorts of people, and in all
sorts of disturbed states of health, and probably with no attention at
all to the principles which should alike guide the treatment of the
largest or the smallest wound; this little operation was frequently
followed by inflammation of the vein, nerve, or other contiguous
structures. These cases were, most of them, more or less serious, often
dangerous, and occasionally fatal.

Taking up the subject where it had been left by Mr. Hunter, Abernethy
refers to the cases published in the two volumes of the "Medical
Communications," by Mr. Colly of Torrington, and by Mr. Wilson, and
then proceeds to give some of his own. It is in this paper that he
first moots two questions which have since grown into importance, by an
extension of some of the practices to which they refer. We allude to
the division of fasciæ, and tendinous structures, and also of nerves in
states of disease or disorder.

In many cases we see, in the application of such measures, how much
that clear and quick-sighted discrimination is required which so
eminently distinguished Abernethy. He, however, only _mooted_ these
questions at that time; for he observes that he had not had sufficient
experience to give an opinion. The chief value of the paper _now_ is,
the good sense with which it inculcates a more careful and cleanly
performance of bleeding; a more scientific treatment of the puncture,
by neatly bringing its edges into apposition, and by keeping the _arm
quiet_ until it has healed. Neglect of these cautions in disordered
states of constitution, had no doubt been not infrequently accessory
to the production of some of the serious consequences against which it
is the object of this paper to guard. I need scarcely observe that the
whole subject is important, and should be thoroughly studied by the
young surgeon.

In 1793, Abernethy, by his writings and his lectures, seems to have
created a general impression that he was a man of no ordinary talent.
His papers on Animal Matter, and still more his Essay on the functions
of the Skin and Lungs, had shown that he was no longer to be regarded
merely in the light of a rising surgeon, but as one laying claim to the
additional distinction of a philosophical physiologist. The subject (of
the skin and lungs) had engaged the attention of Böerhaave a long time
before; Cruikshank also, and other very able men, had followed in the
same wake of investigation; therefore there was an opportunity of that
test which comparison alone affords. Abernethy was, in fact, regarded
at this time more in the light of a rising man, than merely a promising
surgeon. He now moved from St. Mary Axe (as I am informed), and took a
house in St. Mildred's Court, in the Poultry.

Sir Charles Blicke had moved to Billiter Square. I find, by the
rate-books, which Mr. B. L. Jones was so good as to inspect for me,
that this was in April, 1793. He could hardly fail at this time to have
had a very acceptable portion of practice, although we apprehend it was
not as yet extensive. His reputation was, however, fast increasing,
which the attention paid to his opinion at the hospital at this time
must have materially accelerated.

Certainly not later than 1795, there were very few cases of doubt
or difficulty, in which (independently of that participation in the
consultation at the hospital common to all the medical officers) there
was not especial value and influence attached to his opinion; and I
have heard a pupil of that day assert, that in cases of real doubt
and difficulty, there was nothing more beautiful in itself, nor more
characteristic of Abernethy, than the masterly way in which he would
analyze a case, bring the practical points before his colleagues, and
at the same time suggest the course he preferred. As, from his other
occupations, it would often happen that some consultation might be
pending whilst he was engaged at the theatre or in the museum, it would
often happen that a consultation would terminate for the time by some one
observing: "Well, we will see what Mr. Abernethy says on the subject."

In 1796, he became a Fellow of the Royal Society, his old preceptor,
Sir William Blizard, being one of those who signed the proposal
for his election. He only contributed one paper after this to the
"Philosophical Transactions." After his death, the Duke of Sussex
pronounced a very well-deserved eulogium, of which a copy will be found
in another part of this volume. He had not been idle, however; but, in
1797, published the third part of the "Physiological Essays," which we
will consider in the next place.




CHAPTER X.


HIS PAPER ON INJURIES OF THE HEAD.

      "Utiliumque sagax rerum."

      HOR.

In estimating the practical penetration and clear judgment of
Abernethy, it was almost necessary to see him placed by the side of
other men.

His mind was so quick at perceiving the difficulties which lay around
any subject, that it appeared to radiate on the most difficult, a
luminosity that made it comparatively easy, by at least putting that
which, to ordinary minds, might have been a confused puzzle, into the
shape of an easy, definite, and intelligible proposition.

It was immaterial whether the difficulties were such as could be
overcome, or whether they were in part insurmountable; both were
clearly placed before you; and whilst the work of the quickest mind was
facilitated, the slowest had the great assistance of seeing clearly
what it had to do.

All this was done by Abernethy in a manner so little suggestive of
effort, that, like his lecturing, it was so apparently easy, that one
wondered how it happened that nobody could ever do it so well.

But when we saw him placed in juxtaposition with other men, these
peculiarities, which, from the easy manner in which they were
exhibited, we had perhaps estimated but lightly, were thrown into high
relief, and by contrast showed the superiority of his powers.

The second series of Essays he had dedicated to his old master, Sir
Charles Blicke. The third, the subject of our present consideration,
he inscribed to his early instructor in anatomy, Sir W. Blizard. The
dedication is straightforward and grateful.

The first paper of the series is interesting in two points of view.
First, it was an important improvement in the management of a difficult
form of a very serious class of accidents—"Injuries of the Head;"
and secondly, it derives a peculiar interest from the parallelism it
suggests between Abernethy and one of the most distinguished surgeons
of France, the celebrated Pierre Joseph Desault—a parallelism
honourable to both, yet remarkably instructive as to the superior
discriminative powers of Abernethy. Desault's pupil, Bichat, himself
one of the most accomplished anatomists of his time, has left an
eloquent eulogium on Desault, which, although somewhat florid, is
by no means above his merits. He says he was the father of Surgical
Anatomy in France; and certainly few men evinced more sagacity, in that
immediate application of a fact to practical purposes which constitutes
art, than Desault.

Bichat, in his glowing analysis of Desault's character, amongst
other things in relation to his study of the profession, observes
of him that "Un esprit profond et réfléchi, ardent à entreprendre,
opiniâtre à continuer, le disposa de bonne heure à surmonter des
dégoûts qui précédent, et les difficultés qui accompagnent son étude.
A cet âge où l'âme encore fermée à la réflexion semble ne s'ouvrir
qu'au plaisir, apprendre fut son premier besoin—savoir sa première
jouissance—devancer les autres sa première passion[23]."

A quick and clear perception, for the most part untrammelled by
preconceived opinions, led Desault to a vivid appreciation of the
immediate results of surgical proceedings; and as these were definite,
successful, doubtful, or abortive, he either persevered with a
characteristic tenacity of purpose, or at once and for ever abandoned
them. He was remarkably happy in his selection and appreciation of the
mechanical parts of surgery; and his quick perception disclosed to him
several useful points in practice which depend on the more important
truths of medical surgery.

Now _almost_ all this, as applied to the active portion of Abernethy's
life, is equally true of both. But Desault was by no means so deep
or so original a thinker as Abernethy. Like Abernethy, he was clear
and penetrative; but he did not see nearly so far, nor were his views
nearly as comprehensive. Desault was quick at detecting an error
in practice, and in sensibly rejecting it. Abernethy would unfold
it, examine it, and, by his talents, convert the very defect into
usefulness. Desault had by no means, in the same degree, that power
of reflection, that suggestive faculty, which, in endeavouring to
interpret the meaning of phenomena, can point out the true question
which it is desired to ask of nature, as well as the mode of inquiry.

All this, and much more, was strikingly developed in Abernethy. The
paper before us involves a subject which had engaged the attention
both of Abernethy and Desault. They had met with the same difficulty;
and the practical solution of it which each obtained, though somewhat
different, was extremely characteristic. We will try to make this
intelligible. In severe injuries in which the cranium is broken, it
frequently happens that a portion of bone is so displaced that it
presses on the brain. The consequence of this, in _many cases_, is a
train of symptoms sufficiently alarming in themselves, but the actual
cause of which many circumstances sometimes concur to complicate or
obscure.

The same forces which produce the accident not unfrequently involve a
violent shock to the whole body. Sometimes fracture or other injury of
other parts. Sometimes the patient is deeply intoxicated. Then, again,
patients are presented to the surgeon, in different cases, at extremely
different intervals after the reception of the injury; so that a case
may wear a very different aspect according to period or the phase at
which it is first brought under his observation.

These and many other circumstances give rise to various modifications
of the symptoms, and, _under some complications_, constitute a class
of cases which yield to none in importance or difficulty. There is
something in the idea of a piece of bone pressing on the brain, which
instinctively suggests the expediency of raising it to the natural
level. This is, in fact, the object of what is called "trepanning;" or,
as we generally term it, "trephining."

The operation is very simple; it consists in carefully perforating the
cranium, and then, by means of an instrument adapted for that purpose,
restoring the piece of bone, which has been depressed, to its natural
level. In many instances, the proceeding was very successful; but in
many others, the cases terminated unfavourably. From what has been
already hinted, it is clear that, in many injuries of the head, this
trephining must have been unnecessary; in others, inapplicable; and in
both (as adding to the injury), mischievous. Still, surgeons went on as
before; so that, in a large class of injuries of the head, there was
(if the bone was depressed) an almost uniform recourse to the trephine.

Again, in cases where it did not immediately appear that the bone was
depressed, too often very unnecessary explorative operations were
undertaken to determine that circumstance. In short, there was too
much of analogy between the matter-of-course adoption of the trephine
in severe injuries of the cranium, and that which we have noticed in
regard to bleeding in more ordinary accidents.

For correcting the abuse of this very serious operation, we are under
great obligations to Abernethy and Desault; and we couple these
illustrious names together on this occasion, because, although the
amount of our obligation to Abernethy is much the greater, we would not
willingly omit the justice due to Desault.

Desault may have been said to have given the first blow, which so often
determines the ultimate fate of a mischievous conventionalism—that blow
which _compels the consideration_ of its claims on our common sense.

Desault had become extremely disgusted with the results of the
operation of the trephine in his hands at the Hôtel Dieu; and, on
consideration, although, as it would seem from Bichat's edition of his
works, he did not in theory absolutely ignore the occasional propriety
of the operation, he practically for ever abandoned it; thus at once
cutting the knot he felt it difficult or impracticable to unravel. As
this was many years before his death, the principal argument on which
he supported the relinquishment of the operation was simply that his
success in the treatment of injuries of the head had been much greater
since he had altogether laid it aside.

This is eminently characteristic of what people call "a practical man;"
but, after all, it is not very sound reasoning. Now, here it was that
the discriminative excellence of Abernethy began to tell.

In the first place, he observed that the raising of the bone could
only be necessary _where it produced symptoms_. He also observed
that experience had recorded certain cases in which, notwithstanding
that the bone had been depressed, the patients had recovered without
any operation. Then again he thought it not improbable that, where
the depression was slight, even though some symptoms might at first
arise, yet, if we were not too precipitate, we might find that they
would again subside, and thus so serious an operation be rendered
unnecessary. These and similar reasonings led him to recommend a more
cautious practice, and to refrain from trephining, even where the bone
_was depressed_, except on conditions which referred to the general
effects of pressure _on the brain_, rather than to the abstract fact of
depression of the bone.

He did not stop here; but having thus placed restrictions on the use of
the trephine, where it had been too indiscriminately employed, he then
describes the practice which is to be pursued where the pressure is
produced from _effusion_ on the brain.

Although, in laying down the rules to be observed in such cases,
there is much of painful uncertainty as to the existence of
effused blood, the site it may occupy, and other circumstances of
embarrassment,—still the rules he proposes in relation to the
avoidance of large vessels, the condition of the bone as indicative
of the actual state of the parts beneath it, &c. are all clearly and
beautifully stated, as deducible from the anatomical and vascular
relations of the parts. The result of all this discrimination is, that
the trephine is seldom employed, whilst the treatment of the various
injuries of the head is much more successfully conducted.

He next proceeds to consider the distinction between those cases in
which the brain has been _shaken_ merely (concussion), and those where
it has been subjected to mechanical pressure. There are two points in
this part of the paper of great interest to the practical surgeon: the
one in which he treats of the distinction of the two cases; the other,
in which he marshals the discordant practices of different surgeons in
cases of concussion, and defines the proper phase of the case in which
we may make them respectively applicable. When, for example, we may by
warmth maintain, or even by cautious stimulation excite, the depressed
powers; or, by judicious abstinence from either, avoid provoking too
violent reaction; and, lastly, how we should combat the latter, if it
unfortunately supervene.

His Remarks on the Assistance to be derived from the consideration
of the Phenomena of Apoplexy, his reference to the cases which had
occurred in the practice of other surgeons, and the observations he
makes on the lamentable _omission of facts in the record of cases_, are
all worthy of profound attention. Equally excellent is the ingenuity
with which he attempts the distinction between the cases of concussion,
and compression, of the brain. His endeavour to discriminate the cases
in which the effusion, or inflammatory action, respectively, affect
one or other membrane, is also extremely sagacious and characteristic.
Whether we consider all or any of these features in the paper before
us; or, lastly, that triumph of science and humanity with which he has
so defined the limits of a dangerous operation, as to have achieved a
comparative abandonment of it; we think most surgeons will be inclined
to regard this essay as one of his happiest contributions to the
improvement of practical science.

In 1804, he added some cases in illustration of the views unfolded
in this paper; and one case which appeared to be exceptional, with
what he considered to be its appropriate explanation. He also gives
an interesting case of a suicide, in whom he had tied the carotid
artery, and in whom the operation was followed by an inflammatory
state of the brain. Here, again, his quick perception suggested to him
the significant idea that _similar_ conditions of brain might result
from _different_ and even _opposite_ states of the circulation—a
conclusion now, I believe, well established; one of great practical
importance; and one for which, so far as I know, we are greatly
indebted to the observations of Dr. Marshall Hall on blood-letting.
In this case, Abernethy eulogizes the plan recommended by Desault, of
feeding a patient by a tube introduced through the left nostril. In
concluding this remarkable paper, which shows how much a great mind may
extract from common subjects—

    "Tantum de medio sumptis accedit honoris"—

we quote one remark, which impresses the importance of a requisition,
the essential basis of all scientific inquiries—namely, a careful
collection of facts.

"In proportion as we advance in knowledge," says Mr. Abernethy, "we
are led to record many circumstances in the progress of the disorder
which had before passed without notice, but which, if known and duly
attended to, would clearly point out to us the nature and remedy of the
complaint. Hence the records of former cases are of much less value, as
the symptoms about which we are _now anxious to inquire_, have in them
_been entirely overlooked_."

[Footnote 23: Bichat, Eloge de Desault. Œuvres.]




CHAPTER XI.


ABERNETHY'S EXPERIMENTS ON THE MUSCLES IN FROGS, ETC.

"There are more things in heaven and earth than are dreamt of in your
philosophy, Horatio," is a sentiment which, in some form or other,
occurs to the most uninformed peasant, and to the most profound
philosopher.

The very small difference between the acquisitions of the two, however
marvellous when viewed abstractedly, sinks into nothing when compared
to the secrets of nature which yet remain unexplored. This comparison
is the true source of that humility which, while it adds dignity to
the acquirements of intellect, is the foundation on which we may most
securely rest the hope of increasing possessions.

The intellectual vision of the wisest man confines him to a very small
area, when compared with the boundless realms of nature. There are,
indeed, a number of objects within the range of his perceptions whose
nature and relations he has the power of examining; but there are also
a multitude of others which, from their dimly sketched outline, he
feels to be beyond the bounds assigned to his limited faculties.

One of the most curious things in animals is the rigidity or stiffness
of their muscles after death. It is, as it were, the last effort of
the living principle. This phenomenon may be indefinitely modified
by particular states, by lightning, by poison, and other peculiar
conditions, induced by the manner and the period at which the death may
have occurred; and in all cases it continues but for a short time. It
is the last exercise of that power which resides in muscles or flesh,
of contracting, and thus moving the various parts to which it is
attached. In a very large sense, this power is under the dominion of
the will, and enables animals to move as their instincts or their wants
suggest.

Now it is a curious thing to think that this power can be excited after
death, by placing the parts between two pieces of metal, or galvanizing
them; so called after the name of the discoverer, Galvani.

It is difficult, at this day, to imagine the astonishment of the wife
of Galvani, or his pupil, when first they observed the leg of a dead
frog thrown into convulsions on being touched by a piece of metal.
Such, however, was the apparently simple origin of a long series
of wonderful discoveries. It has been well observed, however, that
"discoveries, apparently the result of accident, always imply the
exercise of profound thought." And this was no less the case in respect
to galvanism. A fact, which, but for the mention of it to Galvani by
his wife, might have passed unobserved, was, by the scarcely less than
creative power of mind, improved into a most important branch of human
science.

Ignorant as men still remain of the _intrinsic nature_ of the principle
or power which gives rise to the phenomenon, the observation and study
of _its laws_ and _operations_ have led to discoveries which, in their
value, their importance, and their surprising character, yield to no
other yet achieved.

Abernethy, who, at this laborious period of his life, had his
observation directed everywhere, made some experiments on this power
(galvanism), in its relations to the muscles of frogs.

His object seems to have been as follows: Fontana (a celebrated
physiologist, born in the Tyrol about 1734) had showed that a muscle
which could no longer be excited to contract under water, might be
excited anew, if taken out of the water, and exposed for some time
to air. This observation had suggested the idea that air was in some
way or other conducive to this "irritability," as it was termed. Dr.
Girtanner had also endeavoured to prove that the irritability depended
on the oxygen taken into the blood during respiration; and further,
that it was in a direct ratio to the quantity of oxygen respired—"an
opinion which some writers in this country seem disposed to adopt."

Abernethy doubted the soundness of such a view, and he accordingly
instituted some experiments, in the hope that if he could not
absolutely determine the question, he might throw some light on it. His
experiments were very numerous, but he published only a few of them. We
will give one or two. "_Having killed a frog_ (for he properly objected
to experiments on _living_ animals), he experimented on the muscles
of two legs; one was put into a bottle containing oxygen gas procured
from manganese, and which was very pure; the other into a bottle
containing atmospheric air; the quantity in each bottle was about six
ounces by measure; the limbs were supported in the gases, and wholly
surrounded by them. After five hours, the muscles had nearly ceased to
act in both limbs; those, however, of the thigh belonging to that limb
inclosed in the _common air_ acted more vividly than the others, but
in a little time even these could no longer be excited. Upon comparing
the limbs afterwards, the muscles of that limb which had been exposed
to the oxygen gas were evidently the most flabby. Several other trials
were made with a similar result;" whence he observes: "I am disposed
to conclude that oxygenous gas has _no greater power_ of supporting
the irritability of parts _separated_ from the animal than the common
atmosphere."

In some of his experiments the limbs continued to be excitable after
eighteen hours, but with little difference in the two gases.

He next made several experiments, by placing the limbs of frogs
in _nitrogen_ and _hydrogen_: the limbs in nitrogen lost their
irritability in about _two hours and a half_; those in hydrogen, in
about _four_ hours.

Experiments then follow which consisted in placing other limbs in
carbonic acid and nitrous gases respectively; when he found that in
both cases the muscles ceased to act in an hour and a half.

He also placed limbs in carburetted hydrogen, and found that they
ceased to act after the same period. In other experiments, he found the
correctness of Fontana's results; viz. that limbs placed under water,
and which had lost their irritability, had for a time recovered it by
exposure to air and moisture.

Perhaps the most interesting of the whole series are those in which he
compared the results obtained _in vacuo_ and atmospheric air. He says:
"I put one prepared limb of a frog under the exhausted receiver of an
air-pump; it lay on a plate of glass, supported by a cup; zinc was
placed beneath the thigh, and gold under the leg; and, by means of a
probe passing through a collar of leather, I could touch both metals,
so as to excite the muscles to contraction. This I did occasionally,
and found the limb capable of excitement for twenty-two hours. The
corresponding limb, which was left exposed to the atmosphere, also
contracted at the end of that time; so that it was doubtful which of
them retained their powers in the greater degree. The same experiment
was repeated several times, with results so nearly alike, that I am
inclined to believe _irritability_ continues very little longer in
common air than it does in the exhausted receiver of an air-pump.

"I have frequently produced numerous contractions in the limbs of frogs
inclosed in azotic, hydrogenous, and other gases; which likewise tend
to show that the cause of irritability does _not depend on oxygen_ for
its power of action."

He then remarks that, notwithstanding the great importance of oxygen,
he thinks it has been overrated; for, says he, "Different tribes of
animals partake of it in different degrees; and those who have the
least of it are far _from being the least vivacious_."

He here reasons on premises which were then universally admitted, and
which form at present a portion of many very questionable impressions
in relation to respiration.

We mention one: "that fish, frogs, &c., breathe less oxygen than
warm-blooded animals." But whilst, in respect to the frog, there are
many conditions relating to the skin to be considered before we can
admit this proposition, we hold it to be _demonstrable_ that fish
breathe more oxygen than most other animals; due attention not having
been paid to the enormous proportion of oxygen in the air found in
water; being in fact, about, one-third. In his concluding remarks, he
says, that as regards nitrogen, hydrogen, and carbonic acid, it only
shows what we knew before: that they are injurious to life, and that
oxygen is not more beneficial than common air. The experiments "showing
the long continuance of life and action in muscles in an exhausted
receiver, he considers worthy of notice, as tending to show that the
cause of irritability in muscles, when once formed, does not require
the assistance of external matter."

Lastly, he gives an experiment on the blood (which shows how he was
working in every direction), in aid of the opinion that the blood
derives its scarlet colour from the action of oxygen. "I took the
coagulum of venous blood left in a basin after bleeding, and, turning
it bottom upwards, waited till its surface had become of a scarlet
colour. I then took slices of this surface, and similar slices of the
interior part of the coagulum, which had a very dark appearance, and
exposed them repeatedly to azotic and nitrous gases. The scarlet colour
gradually faded upon such exposure; and the azotic gas being afterwards
examined, was found to contain oxygen, while nitrous gas was much
diminished, doubtless by combining with the same principle. The gases
to which the dark-coloured blood was exposed underwent no change in
this experiment. That blood takes oxygen from the air, when it becomes
florid, will not, I suppose, be denied, and the experiment I have
related shows that it will again part with it, though slowly, without
_any alteration in its temperature_."

The principal interest, as we think, of this paper on "Irritability,"
is the evidence it affords of his determination to keep his mind
free from preconceived notions on a subject which was at that time
calculated to mislead him; especially as he then participated in the
general impression that the Oxygen was "the great source of animal
heat;" a view which he afterwards, and as we think for excellent
reasons, mistrusted.

This view has been revived, but, as far as we know, in no very
philosophical spirit. Whilst we would respect the opinions of men,
we can only reason on the paramount authority of nature; and we
see increasing ground to believe that he who would leave out of
physiological inquiries so large a portion of the necessary induction
as the phenomena of disease, no matter what be his authority, will
only add to the number of those who have shown that, the moment we
neglect the most comprehensive search for facts of which our knowledge
admits, we fall into error. Mr. Hunter has recorded his opinion of the
impossibility of obtaining a knowledge of functions without considering
the phenomena of disease; and all experience hitherto has tended to
give this observation the validity of an axiom.




CHAPTER XII.


OF EXPERIMENTS ON ANIMALS.

      "Know, Nature's children all divide her care;
      The fur that warms a monarch warmed a bear."

      POPE.

In the foregoing experiments, the reader will have observed the
significant words, "having killed a frog"—Abernethy not approving
of experiments on living animals. When we reflect for a moment on
the thousands of dreadful experiments which have been made on living
animals, and the utter inconclusiveness of them for any useful purpose,
there are, amongst the numerous errors by which so many philosophical
inquiries have been delayed or defeated, few that are more lamentable.

This mode of investigation has not, so far as we can see, produced _any
one useful discovery_; whilst it has tended to obscure, by all that is
disgusting and repulsive, the true mode of cultivating a most alluring
science.

But as we write, however humbly, as physiologists, and may be regarded
as advocating the claims and attractions of that science with something
of the _esprit de métier_, rather than in the cautious spirit which
should characterize a philosophical discussion,—let us for one moment
consider the claims of physiology on the attention of mankind.

Physiology has for its object the investigation of the functions and
relations of the whole organic kingdom (the vegetable and animal
creation), and cannot be successfully cultivated without consulting the
phenomena in both these kingdoms of nature.

The branch of physiology most interesting to the medical philosopher
is that which deals with the functions of animals in general, and of
man in particular. The special interest to the medical philosopher
is therefore obvious: let us just glance at its more general claims.
Linnæus said that the world was one vast museum; and it illustrates the
nature and attributes of the Deity.

But how? In the first place, by the numerous evidences it _everywhere_
presents, even to our finite capacities, of design, wisdom, and
power; and further, of the Unity of that power. But, to our finite
perceptions, it does not _everywhere_ present evidences of love, mercy,
and parental care. Not because they may not exist universally, but
because our faculties do not allow us to connect these ideas with any
but "sentient beings."

This alone renders physiology one of the most elevating of all human
studies—most general in its application—most comprehensive in the
attributes it unfolds to us, and therefore most refining to our moral
nature.

Although, therefore, we would claim the _special_ theological evidences
of physiology, as the distinguishing excellence of this science, it
is not less commanding as regard the evidences which it affords in
_common_ with other parts of the Creation.

In animals, we see not less indications of design, wisdom, power,
and beauty, than elsewhere; but we _also_ see a provision for their
wants and comforts, of such a kind as leaves no room for doubting
that both have been the objects of design. We need not here go into
the multiplied proofs of this proposition. _A priori_, then, it would
seem very unlikely that a mode of investigating the functions of
animals would be productive, which begins by ignoring one of their most
striking relations.

This, too, at once suggests the moral question, Is it right? There
is no necessity, for our present purpose, to moot that question. We
have, over and over again, challenged investigation; but the case is
too clear to admit of discussion. Again, although we humbly submit
that the moral bearing of philosophical questions must always be a
legitimate subject of inquiry, yet it is inexpedient to introduce that
question where it is not required. The questions whether the progress
of physiology has been _accelerated_ by experiments on living animals,
or whether the _treatment of diseases_ has been improved by that mode
of inquiry, or whether it has _tended to mislead people_ into erroneous
and mischievous views, are all things that admit of proof entirely
independent of moral considerations. Now we should be sorry to appear
to undervalue that which we most highly prize, or to represent that to
be irrelevant which is, in all subjects, the great consideration; but
it is wise to take the ground chosen by those who argue in support of a
fallacy; not that which they would ignore, or regard as disputable.

As we have already observed, we think it demonstrable that experiments
on living animals, _involving cruelty_, have been entirely
unproductive, whilst they have tended to mislead more than any other
mode of investigation whatever. Many years since, we corrected some
very extraordinary mis-statements in regard to the experiments of
Orfila, Sir Charles Bell, and others, which could only be accounted
for by a want of attention to the works from which they were selected;
for it is curious to observe that (though different in kind) the
most conclusive evidence of the erroneous value attributed to the
experiments is furnished by the distinguished authors themselves.

Orfila wished to know what would be the effect of various poisons on
the animal economy. He therefore set to work as follows:—He opened
the gullet of a living animal, put in the poison, and then tied the
tube; and this to ascertain how the stomach dealt with substances of
this kind taken into that organ. Now there have been, unfortunately,
too many instances afforded, by accidents and by suicides, of these
very things in the human subject; presenting us with a series of facts,
deplorable enough, it is true, but which, regarded merely as grounds of
philosophical inquiry, are comparatively free from objection; whilst
the experiments made by Orfila on his tortured animals are obviously
loaded with all the elements of fallacy. It is surely not necessary to
urge, as one of these, so serious a preliminary as placing a ligature
on the gullet. We say nothing of the horrible cries that Orfila
describes these animals as uttering; but surely, if the object had
been to interfere with and obscure the processes of nature by every
conceivable ingenuity, one could not have imagined any conditions
better calculated for this purpose.

Sir Charles Bell was a physiologist who distinguished himself by a
really important discovery; and it has been cited as an example of the
successful application of the mode of inquiry in question. This is
entirely an error. Whoever will read his book, will at once perceive
the truth of that which he himself judiciously observes; namely, that
physiology is much more a science of observation than experiment. As
to the influence of experiments on animals, in his own discoveries,
we have the best possible authority for denying it; viz. Sir Charles
Bell himself. He states very clearly the object with which he was
_reluctantly_ induced to make some experiments. They had, in fact,
nothing to do with his _discovery_. They were made in reluctant
concession to the slowly-paced perceptions of others.

This he had the manliness to acknowledge, and the benevolence to
regret. In short, examine what series of such experiments we may, we
always find them either wholly unproductive, or, if they appear to
prove anything of value, it is always something that is much more
_logically_ deducible from sources altogether unobjectionable. But if
this be so, is there no mischief in unproductive modes of inquiry?
Again—putting aside the brutalizing tendency of such practices as
part of the moral question—Is life so long? Is Science so easy? Is
Physiology, and especially the deplorably halt condition of Medical
Science, in such a state that we can afford to waste time in _vicious
modes_ of inquiry? We think not. Is there nothing mischievous in our
endeavour to obtain by the evidence of sense (the eye) that insight
into nature which Lord Bacon has so emphatically warned us is the
office of higher—in fact, of our intellectual—perceptions? If we
are not allowed to indulge in feelings of disgust and abhorrence at
all that is revolting to common sense, and our best and kindliest
sentiments, can we read, without distrust, of experiments which so
disgust by their nature that we know not how to describe them; or which
are so revolting, from their cruelty, that the mind recoils from the
contemplation of them? Is it possible to read many of the experiments
of Spallanzani[24], without feeling the same disgust that Abernethy
used to express in regard to them; or to read of opening animals alive,
dividing them with instruments, breaking their bones, or running
red-hot wires into their cavities, without feeling (if, indeed, any
thing better is to be regarded as merely "mawkish sentimentality") that
at least valuable time has been wasted in pursuits which have been
brutalizing and unproductive?

In a review of a Biography of Sir Astley Cooper, in the "Quarterly,"
an experiment there described was characterized by the writer as
"Hellish." We have no desire whatever to use unnecessarily strong
terms; nor do we think that the one above mentioned was too strong
for the case to which it referred; but we think that this extremely
fallacious mode of investigation will be most quickly abandoned, by
meeting fairly and in a mild and moderate spirit any allegations in its
favour. Dr. Hull, of Norwich, and several other eminent persons, have
expressed their dissent from this mode of inquiry.

Sir Isaac Newton considered cruelty to animals a violation of Christian
charity[25].

For our part, we have several times stated _our willingness to discuss_
any class of experiments which may be selected; for, although we may
not express ourselves so well as a late writer in the "Quarterly,"
yet to our minds heaven and hell do not present an idea of greater
contrast than that afforded by the notion—that laws which govern the
whole animal kingdom, and which present, at every moment, accumulating
evidences of goodness and mercy, should be auspiciously sought, much
less have their nature and relations developed, by torture of those
very objects for whom such benevolent provisions have been designed.
We have paid some attention to this subject; and it is very curious to
remark, that observations or experiments, when they cease to be cruel,
become instructive.

Indeed, if we reflect for a moment, we shall see that it must be so.
If we desire to know the actual nature of any living being, it must be
as if we were ourselves unseen—that is, that the animal may be in a
_perfectly_ undisturbed condition. The moment we _lose_ this, elements
of interference immediately arise and fog our reasoning; and the more
refined the inquiry, the more the avoidance of disturbance becomes
essential: in fact, the utmost success in obtaining the conditions
_philosophically_ necessary, depends on maintaining as nearly as
possible the natural condition—that is, the comfort of the animal; so
that the conditions necessary on philosophical grounds, and those which
we regard as still more important after all, coincide.

In every path of life, there are unpleasant duties; and it might
have happened that the functions of animals could only have been
investigated by the means we would repudiate: but the simple truth is,
that it is demonstrably otherwise.

Abernethy had a decided objection to experiments involving cruelty.
He never made any himself that could fairly be so called; and he
never alludes to the subject without some remark tending to show his
disapproval of them. Nor is it, in our view, any disparagement that
his benevolent feelings were largely influential in governing his
opinions on this subject. He began his researches, with the ability
and inclination to investigate Life under every phase, at a time
when no one had begun, so far as we know, to question this mode of
investigation. But, whilst he left no other untried, he only recognized
experimenting on living animals so far as to show that his benevolence
could be sufficiently discriminative to select experiments where the
existence of suffering was doubtful, and that the doubt alone was
sufficient to induce him to abandon the pursuit.

We are sorry to dismiss a subject of so great importance, both in a
moral and physiological point of view, with what we feel to be so
meagre a discussion. But it would require more than our whole space
to examine the many thousand torturing experiments, and expose the
uselessness and _fallacies_ which they exemplify. We have elsewhere
discussed the subject somewhat more at large[26]: here we have only
the opportunity of just touching on it. The greatest respect we can pay
the memory of a great man, is to apply carefully any principles which
he may have left sufficiently matured for practical purposes; and so to
treat those of which he may have only _given us hints, or elementary
suggestions_[27], as shall most searchingly examine their nature and
claims to further development and cultivation. If every opportunity is
not sufficient to do this in full, we must comfort ourselves with the
hope that, where there is not ability to produce conviction, there may
appear sincerity of purpose sufficient to suggest what is even more
valuable, "patient inquiry."

This is a duty we owe to every subject on which we venture to form any
opinion, either in the study or the practice of our profession; and we
have the utmost confidence that the scientific investigation and the
moral argument will be found to coincide.

      "Heaven's attribute is universal care,
      And man's prerogative to rule, but spare."

[Footnote 24: See the extracts from his Lectures at the College, in
this volume.]

[Footnote 25: See Life by Brewster, 2 vols. 8vo.]

[Footnote 26: Remarks on Vivisection in relation to Physiological
Investigation. T. Hatchard, 1847.]

[Footnote 27: See Extracts from Lectures, _infra_.]




CHAPTER XIII.


HIS REMARKS ON TUMOURS.

    "Cogitatio in vero exquirendo maxime versatur. Appetitus impellit
    ad agendum."—CICERO.

    "The Intellect engages us in the pursuit of Truth. The Passions
    impel us to Action."

In our brief sketches of Abernethy's works, we are quite as desirous of
showing why he did not do more, as we are of setting down faithfully
our many undoubted obligations to him. This, indeed, is the best mode
of giving an onward impulse to those approaches towards a definite
science which (John Hunter excepted) he was the first to secure. If
we would increase the usefulness of those beautiful principles which
he has left us, we can hardly do better than endeavour to point out
any error or deficiency in the investigation of any subjects to which
such principles may be applicable. His work on "Tumours" contains much
that is interesting in regard to the peculiar character of his mind,
and his aptitude for simplification. He does not undertake a thorough
investigation of the subject. His object seems to have been to place in
an intelligible order, to chronicle and mark, that which was _really_
known; to pack together, as it were, that which was clear and positive,
in a form convenient for consideration; to remove that disorder and
obscurity which seem to hang about the threshold of all inquiries, and
substitute so much of arrangement and perspicuity as might invite, and
perhaps facilitate, further investigation.

He states the more important circumstances which he had observed, and
conducts his classification of the so-called "Tumours" on a basis
as scientific as it could be on an imperfect induction of facts. He
did this in a way eminently characteristic of his quick perception,
in seizing those properties on which a nomenclature should be based,
and in marking those distinctions which, in a practical science,
must always be regarded as of the greatest value. He founded his
nomenclature chiefly on certain resemblances, observed in these
diseases, to well-known structures of the body.

The simplicity of this plan, so long as the resemblance is obvious,
is just that which constitutes excellence in nomenclature. To take an
example, amongst others, he says there is a tumour the structure of
which resembles the Pancreas, or Sweetbread as it is popularly called,
and to this tumour he gives the name of Pancreatic. Now every one
knows a sweetbread, and the name implies no opinion whatever as to its
nature; it simply declares a fact. Whatever we may ultimately discover
with regard to tumours, a name of this kind, though it may possibly be
exchanged for one more significant of the nature of the disease, will
still leave us nothing to unlearn; for the tumour in question will
always have that resemblance from which Mr. Abernethy named it; and if
we should find (as indeed we do find), in course of time, that diseases
undergo alterations of type, the rarity of a tumour resembling the
sweetbread would record that circumstance.

Had he examined them by the microscope, and selected the appearances
so elicited as grounds for his classification, it would have been much
less useful. In the first place, comparatively few persons would have
had the opportunity or taken the pains to _observe_; and secondly, we
should have had the inconveniences resulting from that variety which we
generally find in the reports of microscopic researches. There is just
now a great disposition for microscopic inquiry, perhaps somewhat too
much; but no channel should be neglected, if it be not too exclusively
relied on. Abernethy amused himself at one period in examining ultimate
structure by the microscope; but he seems to have had but a very
measured reliance on this mode of investigation.

Judicious nomenclature is of immense importance in the framework of
science, and a want of care in this has probably done as much as
anything to impede the course of rational investigation. There is
nothing, perhaps, in the whole range of science more to be lamented
than many—indeed, I might say all—parts of medical nomenclature.
If our ignorance prevents us from giving a name to a thing which is
descriptive of its nature, we might easily avoid applying such as
are calculated to mislead. We can imagine the confusion which would
result from a druggist labelling a bottle of water, "poison;" and a
vessel containing poison, "water;" yet we doubt whether he would more
imperfectly express the true relations of these fluids, than the terms
"fever" and "inflammation" do the real nature of the conditions which
they are employed to designate.

Abernethy's arrangement of tumours not only illustrates his disposition
to seize on the more salient points of a subject, but also his
inclination to seek for the essential relations of (so-called local)
disease in the general condition of the body. He consistently,
therefore, mentions them in an order founded on such relations. He
places those first which he had found least dangerous in their nature,
least destructive in their effects, and which appeared to him to have
been attended by the least disturbance to the general economy. In like
manner he placed those which had manifested more malignant or dangerous
characters, in the order of their severity; inferring their characters
respectively from the disturbance of the constitution, the resistance
of the disease to treatment, and the variety of structures destroyed in
its progress.

Between these two extremes, he placed, as the step of transition,
that tumour which he had observed to partake most strongly of
intermediate characters. But, besides the desire to throw some light
on the subject of tumours generally, he had another special object
in view. Few diseases exemplify the absence of scientific research
more than tumours. In regard to most of these morbid depositions, it
may be remarked that, even now, whenever a patient with one of these
so-called tumours applies for advice, the practicability of removal
is too often the only thing thought of; and it must be obvious to
common sense that the mere cutting away of a deposition of this kind
(however proper under some peculiar circumstances), can hardly ever
exert any influence on the causes of its production. Indeed the manner
in which these diseases are continually removed, without any previous
inquiry that is really worthy of the name, is amongst the many grounds
on which we found the opinion expressed in the sequel on the present
state of medical surgery, as contrasted with that in which it was
left by Abernethy. Now, while the gravity of the subject rendered
the consideration of all tumours important, there was one which in
an especial manner had eluded all efforts to expose its nature and
dependencies—this was the justly-dreaded cancer. In regard to this,
Mr. Abernethy hoped that further information might be obtained, by
investigating other tumours more closely, and thus bringing, as he
expresses it, collateral knowledge to bear on it, "like light shining
from various places to illustrate the object of our researches."

Here was a suggestion in the true spirit of philosophical inquiry;
whilst, in taking so simple a basis for the names of tumours, and then
associating them in arrangement with their respective constitutional
tendencies, he adopted the best mode of recording in a general sense
their more important relations. But the fault lay in the suppressed
premise that the _relations_ of the so-called tumours were comprehended
by a division which is not founded in nature. Nothing indeed can be
more artificial than that division of diseases to which surgeons
usually restrict the term tumour; a defect which besets all medical
inquiries. The old division, in which all sorts of diseases were
jumbled together under the general name of tumours, defective as it
might be, was much more auspicious, had it ever been made the object
of a really philosophical inquiry; because the very diversity of the
phenomena they presented would, by the ordinary process of common sense
or inductive reasoning, have only served to bring out their common
characters—the most important first step in all investigations of this
nature.

Had Mr. Abernethy extended that collateral view which he justly insists
on, to _all sorts of new depositions_, instead of confining it to the
so-called "tumours," he would have detected how artificial was the
division, and taken it at its just value; he would have found that he
had excluded circumstances which not only led to a much more intimate
knowledge of the relations on which those so-called tumours depend, but
which confer a power of demonstrating easily, and in a more particular
manner, to the most ignorant or prejudiced, those relations to a
disordered state of the body, of which, without such assistance, it
required a mind no less penetrative and suggestive than Abernethy's to
give even a general enunciation. This defect essentially consisted in
the vice we have before alluded to, and is nothing else but a violation
of one of the rules most insisted on by Lord Bacon[28].

It proceeds, perhaps, from the habit of looking at subjects through a
medium too exclusively anatomical, and by which even Mr. Hunter was
sometimes, though exceptionally, hampered. Popularly, it was deducing
conclusions from only a portion of the facts of the subject; but if
Abernethy did not get the whole of the facts, and therefore missed
some portion of the conclusions to be drawn from them, he at least
avoided the error of inferring anything positive which the facts did
not warrant. We hope, however, that the paper has been valuable, in
enabling some of us to arrive at further views, which serve to confirm
the truth and extend the application of those entertained by Abernethy.

Now, to put the whole thing popularly, and to direct the public view to
the common sense of the matter, it is obvious that if we want to know
the real nature of any growth whatever—say a tumour, a plant, or an
animal—we cannot do this by any examination of its structure _alone_.
If we desire to know its nature, we must also examine its habits, food,
climate, and the various influences to which it is subjected. If,
indeed, this were once done, then it is very possible, on again seeing
the structure _merely_, we might recognize its real relations, although
we might still be glad to have any well-known substance to which we
could compare it, if only to _record_ its identity. This is right
enough, thus to _obtain_ the general knowledge before we _assume_
the particular. Again, suppose I had some ground growing all manner
of plants, and twenty different sorts of fungi, what should I get by
_merely_ examining the fibres of one or the other?

But I should easily discover that some plants grew best in one soil,
some in another, some with more moisture, some with less; whilst the
very circumstances of soil, moisture, and so on, which were essential
to some, might be enfeebling or destructive to others. No one will for
a moment doubt that the kind of nutrition was of great importance in
all, and this would necessarily lead me to infer that, "If I desired to
get such a fungus, I must have more moisture, less air, less heat or
light, or another soil," and so on.

In a plant, you must also look to the roots and other parts of the
organism. Now this is exactly what should be done in regard to tumours;
and for no reason more cogent than that the great beauty and beneficent
effects of Mr. Abernethy's views may become practically useful; for
in the same manner that we would desire to influence the plant or
the fungus through the sources whence it derives its nourishment, as
air, water, various ingredients in the earth, and so on; so the only
channels by which _we_ can effect any influence, are those organs by
which these matters are ultimately changed into the structures we
wish to maintain, or we desire to get rid of, as the case may be.
Now, although the number and relations of these organs may render the
investigation more difficult in one case than in another, as they
become more multiplied, or as the animal or vegetable is more or less
simple or complicated in structure; yet, whether we take our example
from man, or any other animal—or, in fact, any organized being of
the countless modifications we find in nature—the instrumentality
through which the vital power acts is neither more nor less than the
assimilating organs.

If we have been too professional in this discussion, we plead, as an
apology, that in no one point in the whole range of surgical practice
would unnecessary suffering be avoided more frequently than on the
subject before us; provided only that what is clear and positive,
as distinguished from what is conventional and erroneous, were once
popularly familiar; for, amongst other evils, most of the operations
in this department of surgery are not only superfluous—to use no
stronger term—but they practically _interfere more than any one thing
whatever_ with the progress of the scientific investigation of the
nature of these maladies.

The removal of them by operation is too commonly undertaken, not
only under circumstances which, as Abernethy said, "add cruelty to
calamity," but for reasons which logically forbid such a proceeding;
and although there are conditions which call for such interference,
yet those under which it is usually instituted help only to obscure
the real relations of the disease, and to throw the shadowy veil of an
irrational empiricism over the operations of nature.

Those who recollect the remarkable results which Abernethy sometimes
obtained in regard to this intractable and often formidable class of
diseases, will, I think, be disposed to agree in thinking that few
maladies are more open to improved investigation, or promise a more
encouraging prospect of enlarging the boundaries of philosophical
medicine.


SECTION.

HIS PAPER ON A CURIOUS CIRCUMSTANCE SOMETIMES

FOLLOWING INJURY TO THE LUNGS.

Fractured ribs are common accidents, and illustrate very beautifully
those conservative principles in animal bodies which give such interest
to the study of their economy.

When first we consider that the ribs form the greater part of that
box in which the lungs and heart are enclosed, and by which they are
protected, we are disposed to regard a fracture of one or more ribs as
a very serious affair.

Nevertheless, these accidents generally do extremely well. In the first
place, the gristles, or cartilages as they are called, by which the
ribs are attached to the sternum in front, give, in conjunction with
the spine behind, considerable elasticity to the whole structure of the
chest. Most injuries have therefore to overcome this elasticity, before
anything gives way; and when the rib has done so, and is fractured, the
resiliency of the cartilage or gristle to which it is attached _tends_
to restore it to its place, or to set it, as we phrase it.

Another very curious thing in accidents is the instantaneity with which
muscles which are _ordinarily_ under the dominion of the will, become
reluctant to obey it, or altogether repudiate its authority. In all
fractures, of course, the most material thing is absolute repose; and
there is very little chance of a man moving his rib when it is broken.
He instinctively begins to expand his chest, for the admission of the
necessary air, by other muscles, usually to the exclusion of those
which are attached to the broken bone.

The Lung, which may be considered as a series of tubes, some conveying
blood, and others air, is often wounded; but the blood immediately
stops the leak, from its tendency to coagulate when out of the
vessels; and no harm ensues. Occasionally, however, a circumstance
occurs, which, until it is understood, appears curious and alarming.
Either from the extent, the scratching of the surface, or some other
peculiarity in the wound of the lung, the air escapes from it, and the
patient is as it were blown up, as to the chest, neck, and face, by
the air impelled from the lung beneath the skin into the connecting
tissue, exactly in the same manner as the butcher does when he is
preparing veal. This blowing-up is called, from the Greek word for it,
_Emphysema_; and it was on this feature in these accidents that Mr.
Abernethy wrote a short paper.

There is not much which is absolutely new in it. It is chiefly
remarkable for the clear manner in which it places before us what is
required, as distinguished from what is officious and unnecessary, and,
in fact, reduces the treatment to that of ordinary cases, with one
clearly defined modification.

He shows his familiarity with Pneumatics, so far as they are touched
by the case, just as he does his knowledge of Chemistry elsewhere. The
exceptional cases, in which the air is confined in the chest, the mode
of procuring it an exit by operation, and the condition regulating this
proceeding, are very simply and clearly laid down.

The paper also contains remarks on the collapse of the lungs when the
chest is opened, and on certain exceptions which have been observed,
which, from their general interest and suggestive character, will well
repay an attentive perusal.

He next offers a few remarks on those mothers' marks, as they are
popularly called, and which are technically styled nævi. They are
generally little more than clusters of enlarged blood-vessels, and are
usually removed by excision or other operative proceedings. As the
essential character of these marks is increased action and size of
vessels, Mr. Abernethy thought that, if well-regulated pressure were
made on them so as to impede the flow of blood into them, and this were
conjoined with Cold (which represses vascular action), many of them
might be got rid of in this manner. He found his idea realized, and
published three cases of its success. The value of these suggestions
consists, first, in the opposition they offer, _pro tanto_, to that
absurd tendency there is to remove everything like a tumour; and the
impediment thence arising to any searching inquiry into the causes on
which they depend.

But there is another inconvenience which occasionally renders the
excision of these nævi very inadvisable. It sometimes happens that
they are so situated that they cannot be removed, without making the
disfigurement greater, or from some other still more serious objection;
as, for example, when small ones occur in the face, or when they
are placed near the eye. Under such circumstances, the contraction
consequent on a wound of any extent is a serious inconvenience; in
some of these cases, the adoption of Mr. Abernethy's plan allows us to
dispense with the operation by excision, as I have myself experienced.
As it illustrates the advantage of the plan in a case where it was
particularly applicable, I will briefly refer to one example. A
young lady had one of these marks at the root of the nose, where,
from the position, as well as from the contiguity of the eyes, any
dragging from the contraction of a scar, would have been particularly
undesirable. She was brought from the country to have it removed; but,
on representing the objections to that course, it was agreed to try Mr.
Abernethy's plan, which was completely successful.

At this period, Mr. Abernethy published sundry other interesting
papers, showing, in his observations of all that was passing around
him, that his views were not less circumspect and comprehensive than
they were clear. His "surgical cases" are all excellent; and if they do
not contain so full an account (the great vice of medical records) of
all the circumstances which preceded them, as are sufficient to furnish
future investigators with the elements of accurate generalization, they
are remarkably valuable for the qualities of clearness and candour.

We may have an opportunity of briefly alluding to some of these papers
in our summary; but they are hardly practicable subjects for popular
analysis, although they form some of the most valuable contributions to
the practical literature of the profession. They show also that he was
as penetrative and efficient in regard to the operative department of
practice, as he was in those higher and more extended views, which, in
enlarging the _science_ of surgery, has tended to diminish, of course,
the number of operations.

About the year 1785, John Hunter had invented his celebrated
improvement in the treatment of a disease of the arteries called
"Aneurism." It was a very simple deduction from observations on the
state of the arteries; and although it was one of those inquiries
which had been made the subject of experiments on living animals, it
was one on which _not the smallest light_ had been thrown by such
investigations.

Mr. Hunter had found that, in addition to many other serious objections
to an operation which had been usually performed for the relief of this
disease—which consists either of a giving way of a _portion_, or a
general enlargement, of a vessel (for it is sometimes one, sometimes
the other)—a great cause of failure had been, that the ligature which
was placed round the artery was too near the disease, and, in fact,
involved a portion of the tube which was unsound. He accordingly
proposed tying the artery a little farther off, and thus substituted,
for an operation which was extremely severe, very hazardous, and too
commonly fatal, a comparatively short and simple proceeding, which,
under _moderately favourable auspices_, is almost uniformly successful.

As with many other discoveries, accident and similarity of views had
suggested similar proceedings to others, so that continental surgeons
were disposed to dispute the merit of the discovery in favour of
Guillemeau, Guattani, Anel, Desault, &c., as their views favoured one
or other; but there can be no doubt that for the first clear exposition
of the _principles_ of the operation, as well as of the objects it was
designed to accomplish, we are indebted to John Hunter.

John Hunter's operation applied to the main artery supplying the lower
extremity, and surgeons have since extended the proceeding to many
other arteries. The first extension of it, however, occurred to Mr.
Abernethy, who, about this time (1797), placed a ligature on what is
called the external iliac artery; and as he seldom touched anything
which he did not improve, he made an important modification in the mode
of proceeding.

Subsequent experience, it is true, has, in some measure, rendered
that improvement no longer necessary; yet, whenever circumstances
arise which lead to any material disturbance of the artery from its
situation, we apprehend the caution of Abernethy in tying it in two
places close to its connection with the surrounding parts, is a
valuable condition.

He also sent, about this time, an ingenious paper to the Royal Society,
on certain small openings into the cavities of the heart. They are
called the "Foramina of Thebesius," from an anatomist who particularly
described them. This is to us one of the prettiest of his physiological
contributions. The facts are stated with great simplicity, their
relations to disease beautifully pointed out, and the inference from
the whole very striking, as being in harmony with the facts whence it
is deduced. Abernethy's idea being, that the holes were for the purpose
of obviating excessive repletion of the nutrient vessels of the heart,
by allowing them to relieve themselves by pouring a portion of their
blood through these holes into the general mass of the circulation.
It could hardly, however, be made interesting to the general reader
without going into the subject more than is suited to our present
object.

In 1799, Abernethy's reputation had gone on rapidly increasing. His
numerous pupils, too, had become the media for frequent consultations,
in addition to those which arose from his own connection, and his
reputation with the public.

He now moved from St. Mildred's Court, and took the house in Bedford
Row. This was some time previous to October, 1799, the September of
that year being the last time his name appears on the rate-book of St.
Mildred's Court. He never again changed his professional residence. The
move was an important step, but it was only the precursor to one still
more interesting.

In the January of the following year, an event occurred which seldom
fails to exert a greater influence on a man's future prospects and
happiness than any other. This was no less than his marriage—of which
we must say a few words in a separate chapter.

[Footnote 28: That the nature of a thing is not to be sought only out
of itself, but from things more in common.]




CHAPTER XIV.


HIS MARRIAGE.

      "Ye solvers of enigmas—ye
        Who deal in mystery—say,
      What's cried about in London streets
          And purchased every day?

      "'Tis that which all, both great and small,
        Are striving to obtain;
      And yet, though common and quite cheap,
        Is daily sought in vain."

      OLD RIDDLE.

There are few subjects on which people are more agreed than the
value of "good matches;" neither do they seem to differ very widely
as to what that phrase is intended to convey. Not that everybody's
_beau-idéal_ implies identity of composition, but they are pretty well
agreed as to the more essential elements.

But if we observe the different ways by which people seek to obtain a
common object, we are puzzled to know how folks that set out in such
various directions should ever arrive at the same point. The travellers
are said, too, to provide themselves not unfrequently with various
disguises; not only in dress and externals, but even in manners and
sentiments, which they do not usually entertain. Thus we have heard of
one who professed a great love of music, who scarcely had an idea of
melody; of another who expressed an admiration of poets whom he had
never read, or voted unmitigated bores. Others have been known to avow
a perfect indifference to wealth, who have had scarcely an idea unmixed
with an instinctive admiration of the _æs in presenti_.

We once heard a curious fellow say that he could marry any lady he
liked, if he could only "bring himself to take the trouble;" and we
thought how happy he would be if he could live on as good terms with
his wife as he appeared to be on with himself. Some start with an
apothegm which they carry about like an amulet or charm; such as, "No
greater rogue than he who marries only for money, and no greater fool
than he who marries only for love." Apothegms, however, like many
things in this world—Macintoshes and umbrellas inclusive—are very apt
to be left at home when most wanted.

We are not informed whether table-turning or mesmerism have yet
discovered any prophylactics against the undoubted perils of an
expedition in search of a partner.

We are unfortunately not sufficiently versed in these mysteries to know
the "latest accounts;" but from the reputed effects of platinum and
other metals, we should not be surprised to hear that a person well
mesmerised would be found very clairvoyant of gold. We are not aware
of the achievements necessary to arrive at the exalted position of "a
Professor;" but it is said that "Professors" find gold without the
necessity of going to the "diggings."

Table-turning, we hear, has not as yet been found successful. By
shooting too much ahead of the slowly moving current of human affairs,
it skipped over one generation, and thus recently entrapped an Irish
gentleman of the "highest respectability" by giving a fortune to a lady
too soon; it happening to be found still in possession of its "right
owner"—or, as the technical phrase is, "in expectation."

Many aspirants for wedlock have sundry misgivings about certain
traditionary repulsions which are said to exist between love and
poverty, and, uninfluenced by the charms of matrimony, think only of
the possible consequences. Not a few, however, regard marriage as
too serious an affair for sport or speculation. They think it very
difficult for mortals who know so little of themselves to know much
about other people, and that though matches in rank and money are daily
seen to be very practicable, yet that matches in mind are still as
difficult as Dryden represented them—

      "Minds are so hardly match'd, that e'en the first,
      Though pair'd in Heaven, in Paradise were curs'd."

People of this sort contemplate marriage in a very unpoetical manner.
They have great faith that correct intention and common sense are the
best guides; and, although they may not feel less transported with
their prospects than other people, they are apt to remember that it is
"transportation for life."

A great deal has been said of the marriage of Abernethy, and very
much of it in proof of his eccentricity of character; but if a steady
reliance on earnestness, sincerity, and common sense, on an occasion on
which one or other of these qualities are sometimes laid aside, and the
employment of the highest qualities of the mind for the most important
purposes be wise, we must, if we admit the eccentricity of Abernethy,
concede to him the less-equivocal merit of practical wisdom. Himself a
sensible and clever man, and a great admirer of these qualifications in
others, he was not very likely to ally himself to any lady who appeared
deficient in such characteristics.

Abernethy had a very quick perception of character, and his profession
afforded him ample opportunities for the exercise and the cultivation
of this faculty. He would not have been very likely to lay it aside
on an occasion when a judicious and successful exercise of it, as
distinguished from mere impulse or first impression, is of more
consequence than on almost any other.

Miss Anne Threlfall was the daughter of a gentleman who had retired
from business, and who it appears had been residing in the town of
the far-famed Edmonton. This lady was intimate with the family of Mr.
Hodgson, where Abernethy was also a frequent visitor.

It was at Mr. Hodgson's that Mr. Abernethy first made the acquaintance
of her who was destined to exert so considerable an influence on his
future happiness.

In the unrestrained intercourse of the society of intimate mutual
friends, a man of Abernethy's penetration would not be long in
discovering the amiable or the estimable qualities of an agreeable
woman.

Mrs. Abernethy added to personal attractions of no common order, great
good sense, and a very lively, ladylike manner. These had not been
without their influence, on their first meeting; and a few additional
interviews, which the usual precursor of an undefinable pleasure in her
society served to accelerate, not only confirmed his first impressions,
but seem to have deepened them into sentiments of warm respect and
affection. Now, supposing his opinion formed, his resolution taken,
there was still a difficulty—Abernethy was remarkably shy, and
extremely sensitive.

His whole time was absorbed in teaching, studying, and practising his
profession; his rising ambition just getting success within its grasp.
How was resolution or opportunity to be found for the tardigrade,
time-consuming process of a regular siege? Still, after all, the
shyness was the real Rubicon which he felt a difficulty in passing.
Common Sense said to a sensitive Conscience, "You are about to ask a
lady to entrust to you her happiness for life." "Ah!" said Conscience,
"that is indeed a great deal to ask of any one." And Shyness said it
was equally difficult to know what to say, how to make the request, or
brook a refusal. The difficulty with Abernethy was so great, that there
is some reason to doubt whether he could have got over it, had he been
left entirely to his own resources.

Mr. Hodgson, it seems, did not sympathize with Abernethy's scruples
and difficulties, but simply encouraged him to overcome them. It is
wonderful how even the greatest minds are influenced sometimes by a
timely "pat on the back." We recollect a distinguished public man, and
a peculiarly single-minded one too, once observing, that few people
had any idea of the comfort which public men sometimes derived from
any one, whom they imagined sincere, simply saying, "You were quite
right, I think." Whatever Abernethy might, or might not, have owed to
some little help of this kind, it is quite certain that he at last
opened his heart to Miss Threlfall, or at least essayed so to do; but,
apparently not very well assured that he had said what he intended _to
say_, he supported it by a letter, which proved successful.

This letter is still extant, and an interesting document it is. It
forms a curious commentary on the numerous and dissimilar versions
which have been given of it by gossip; all the versions we ever heard
having had the common character of being in every respect entirely
unlike the original. Here it is:

  "Tuesday.

    "I have felt extremely anxious, dearest Lady, since I had
    the pleasure to be with you, lest, from my embarrassment in
    delivering my sentiments, I might have said any thing liable to
    misapprehension. This anxiety induces me to trouble you with the
    present letter. I had designed, in our last conversation, to have
    said, that I had ever regarded the marriage state as that of the
    greatest happiness. It always appeared to me that two persons
    of different sexes living together in reciprocal benevolence
    were placed at the summit of human felicity. Hard necessity has,
    however, precluded me from the enjoyment of such bliss; and when
    I had at length relinquished even the idea of it, by accident I
    met with a lady in whom were concentred all the qualities which
    I could have wished for in the moments of fondest expectation,
    and from whom I was led to believe I might derive what I had ever
    regarded as the greatest happiness. This was to me one of those
    circumstances of the reality of which the mind seems doubtful, from
    the excess of delight that it occasions. I had wished, dearest
    Lady, at our last interview, to have convinced you that I was
    capable of discerning and loving you, as well for the perfections
    of your mind, as for the charms of your person. I have ever been an
    enthusiastic admirer of intellectual excellence; and in the minds
    of some ladies whom I have known, I have distinguished a purity of
    thought and benevolence of design which I have never found, nor
    can I expect to find, amongst men. In addition to these simple and
    fascinating qualities, I have witnessed a clearness of perception
    and judgment, an undeviating rectitude of principle, and, as the
    result of these and other qualities, such a dignity of character,
    that I have looked up to the possessor of them as to something
    divine. I had wished to have made you acquainted, in some degree,
    with my own character, as far as I might have been supposed to have
    acquired that most difficultly attained information, a knowledge
    of myself. I perceive, however, an impropriety in saying much upon
    this subject; but I wish you to be assured, that I am incapable of
    uttering any thing false or deceitful, and that consequently you
    may rely upon my word. I have pursued every object in life with an
    avidity which has appeared to many disproportionate to its value;
    but surely, if an object be worth attaining, neither diligence
    should be spared nor time lost in its attainment. How anxious
    and earnestly interested must a person of this disposition, with
    respect to subjects of little importance, feel when engaged in what
    he considers as the most important concern of his life. I shall
    suffer the greatest inquietude until I am assured of your good
    opinion. This letter has been written by snatches, in the midst of
    the avocations of this day, which now so call upon me, that I can
    only add (what I hope may be an unnecessary assurance) that I shall
    ever be, with the truest affection, and most faithfully yours.

  "JOHN ABERNETHY."

This beautiful letter is very characteristic. The simplicity and
straightforwardness,—the respect and tenderness, "Dearest Lady,"—the
brief, modest, but truthful tone in which he alludes to his own
pretensions,—the plea for his earnestness deducible from his known
character in ordinary pursuits,—his frank confession of anxiety
and inquietude until he is assured of her "good opinion,"—and his
naïveté in saying that his occupations oblige him to conclude,—all
respectively sketch the natural warmth, tenderness, sincerity, and
earnestness of his real disposition.

The marriage took place accordingly in the parish church of All Saints,
Edmonton, on the 9th of January, 1800, and is thus entered in the
Register:

    "John Abernethy, Bachelor, of the Parish of St. Andrew's, Holborn,
    to Anne Threlfall, of this Parish, Spinster, were married in this
    Church by licence, the 9th day of January, 1800, by me,

  "D. WARREN, _Vicar_.

  "This marriage was solemnized between us:

  "JOHN ABERNETHY.
  "ANNE THRELFALL.

  "In the presence of

  "JONATHAN PATTEN.
  "WILLIAM HODGSON.
  "J. HODGSON.
  "MARY THRELFALL.
  "CHARLOTTE HODGSON."

By marriage Abernethy obtained a partner for life who to personal
attractions added those social and moral excellences which combine
to form a superior woman—one to whom such a man as Abernethy could,
and always did, to his last moment, look up with equal respect and
affection, as the wife, mother, and the friend. As a husband, there can
be no doubt that, during the thirty years he lived after his marriage,
his conduct was a practical commentary on, and fulfilment of, the
preceding letter; and he endeavoured at all times to convey to the
children the warm sentiments of respect for, and reliance on, their
mother that he had seen so much reason himself to entertain. On the
other hand, it is impossible to overrate the grateful warmth with which
Mrs. Abernethy returned his affection, or the veneration and respect
with which she honored his memory.

Few persons, if any, have experienced a longer period of uninterrupted
happiness than that which followed the marriage of Abernethy. Mrs.
Abernethy survived him twenty-four years, having died in July, 1854.
She had for many years been afflicted with paralysis, which at times
was attended with considerable suffering. It was consolatory, however,
to feel that her faculties remained without being materially impaired
to the last.

Mr. Abernethy had, in his last illness, repeatedly expressed his
anxiety that every kindness and care should be shown towards her to
whom he felt so much indebted; and he had prophetically suggested, as
probable, what really happened. He said, "Take every care of your dear
mother. She may have many and perhaps serious illnesses; but she will
still be, most likely, a long-lived woman." This legacy, we have reason
to know, was most fully and kindly administered.

One circumstance, on the occasion of his marriage, is very
characteristic of him: namely, his not allowing it to interrupt,
even for a day, a duty with which he rarely suffered anything to
interfere—we mean the lecture at the hospital.

Many years after this, I met him coming into the hospital one day, a
little before two (the hour of lecture), and seeing him rather smartly
dressed, with a white waistcoat, I said:

"You are very gay to-day, Sir."

"Ay," said he; "one of the girls was married this morning."

"Indeed, Sir!" I said. "You should have given yourself a holiday on
such an occasion, and not come down to lecture."

"Nay," returned he. "Egad! I came down to lecture the day I was married
myself!"

On another occasion, I recollect his being sent for to a case just
before lecture. The case was close in the neighbourhood, and it being
a question of time, he hesitated a little; but being pressed to go, he
started off. He had, however, hardly passed the gates of the hospital
before the clock struck two, when, all at once, he said, "No, I'll be
—— if I do!" and returned to the lecture-room.




CHAPTER XV.


OF ABERNETHY'S BOOK ON "THE CONSTITUTIONAL ORIGIN OF

LOCAL DISEASES," OTHERWISE "MY BOOK."

      "From the barr'd Vizor of Antiquity
      Reflected shines the Eternal light of Truth,
      As from a mirror; all the means of action,
      The shapeless masses, the materials,
      Are everywhere around us. What we need
      Is the celestial fire, to change the flint
      Into transparent crystal, bright as fair."

      LONGFELLOW'S "SPANISH STUDENT."

In all that Abernethy had hitherto published, it was easy to perceive
that, although he was carefully examining the prevailing opinions and
practice of the day, he was emphatically one of those independent
thinkers who had power to overlay the most established conventionalisms
with opinions of his own. Although hitherto his publications had
related to particular diseases or accidents which were held as
within the ordinary province of the surgeon, he was shadowing forth
_principles_—views which, if they were true, must necessarily have a
much wider range of application than to the particular cases which it
had been his object to consider. In 1804, he had sufficiently matured
his general views to think it right to publish them; and this he did in
his book on the "Constitutional Origin of Local Diseases," popularly
known as the "My Book," to which he not unfrequently referred his
patients for a more detailed account of his views, than he could find
time to give in the consulting room. When we reflect that diseases
consist entirely of altered conditions in the structure or function of
some part of the body, a formal announcement that they must be greatly
influenced by the organs on which _the whole body depends_ for its
nutrition, seems to have so much the aspect of an obvious truism, that
we scarcely know whether most to wonder at so formal an announcement of
it having been necessary, or the astonishing number and variety of the
reservations with which it has been admitted.

But, strange as this may appear, and although all the facts have been
before the eyes of man for ages—nay, though their relations have been
_more or less felt_ and acknowledged in cases usually submitted to the
physician,—we venture to say that nothing like an attention at all
adequate to their importance was obtained for them in the practice
of physic, and scarcely any at all in surgery, _until the time of
Abernethy_.

At the present time, a great deal has been done to establish, by the
most clear and indisputable demonstration, the practical usefulness
and necessity of the principles to which Abernethy conducted us,
in the cure of diseases, whether medical or surgical. Still, these
principles are much neglected, much misunderstood, or so _imperfectly
carried out_, as to excite, even in many of the public, expressions
of astonishment. It is, indeed, not too much to assert, that, even
in those cases in which their successful application has been most
incontestibly exemplified, his principles are _fully carried out on
comparatively few occasions_.

The causes of all this are, we fear, too easily detected; the removal
of them is indeed sufficiently difficult. We may possibly discuss both
points in the sequel.

Instead of the exquisite simplicity and clearness of Abernethy's
views, so far as he had gone, being carefully studied, and with a
view to the _extension_ of them beyond those limits which his time,
his opportunities, and his caution had assigned to them; instead of
examining into, and testing, the practical value of the deducible, and,
in fact, necessary sequences, on views of which he had demonstrated the
truth and value; practice appears to have taken a retrograde movement.

He who would advance even as far as Abernethy, is in danger of being
regarded as crotchety or peculiar; whilst any who should strive by
a more careful examination of his views to render their practical
application more definite and analytical, must be prepared to be looked
on simply as an enthusiast.

This has, indeed, been the case more or less in all sciences from the
earliest times. The _facts_ which conduct us to a true interpretation
of the _laws_ in obedience to which they occur, have been always before
us; the very same facts on which, as Professor Whewell[29] observes,
we have raised the stately structure of modern science. Butler[30]
had before made a similar remark. Poets too, as even the motto to
our chapter shows, have held the same sentiment; what everybody
_knows_, how few _consider_! Neither Copernicus nor Galileo altered or
invented _facts_. Those they _observed_! what they _discovered_, were
conclusions interpreting the true relations of them. Bodies fell to
the earth, and the crystal rain-drop had shown the composite nature
of light in the beautiful colours and wonderful illustrations of the
rainbow, ages before Newton discovered the true explanation of the one,
and the great law exemplified in the other.

The object of "the Book" is to set forth the great fact of the
reciprocal influence existing between the nervous system and the
digestive organs, and the power they mutually exert in the causation
and cure of diseases; and this, whether the diseases originate in
disturbance _primarily_ directed to the brain or any other portion of
the nervous system, or to the _digestive organs_; whether the result
of accident, such as mechanical injury, or other local manifestations
more commonly termed disease. In the book before us we shall find
an ample refutation of many misconstructions and misapprehensions
of Abernethy's views; misconstructions which have tended to obscure
principles, remarkable for their simplicity and truthfulness; to
impede the beneficial application of them in a manner which has been
equally injurious to the public and the profession, and which, have
impressed on mankind a very inadequate idea of the obligations due to
the distinguished author. His views were said to be theoretical and
exaggerated, whilst they were conclusions logically deduced from facts;
and so far from the pervading power of the influences to which he
proximately attributed the causation and cure of disease having been
exaggerated, the onward study of his principles only serves, by the
discovery of more multiplied and refined applications of them, to fill
in with additional illustrations the accurate outline which he has so
truthfully drawn. He never wrests a fact to a conclusion to which it
does not legitimately lead. In virtue of that suggestive quality of his
mind (so important an aid in philosophical inquiries), he occasionally,
in all his writings, puts forth suppositions, but these only as
_questions_, the next in the order of inquiry, and these he asks of
nature alone.

Mr. Hunter had been the first in this country to make the true use of
anatomy; I mean in the sense that whilst it was no doubt the basis
of our investigation into the functions or uses of parts, still it
was only _one_ of an extensive series of inquiries. He had _examined_
the _dead_ with no purpose more earnestly, than to assist him in his
endeavours to _observe the living_; examined _parts_, that he might
better understand the whole. He had made himself familiar with the
economy of animals, and generally with the habits of organized beings,
whether animal or vegetable, that he might know their relations to each
other, and that of the _whole_ to the phenomena, habits, and laws,
of the _Human_ economy. As he neglected no source whence it had been
customary to seek for information, so, notwithstanding his fondness for
animals, he made various experiments on living creatures. But whilst
these experiments afford additional proofs of the poverty, so to speak,
of this plan of investigation, they impress on us the truth of Sir
Charles Bell's assertion, that physiology is essentially a science of
_observation_. We have only to place Mr. Hunter's _observations_ and
_experiments_ here referred to, in juxtaposition, in order to bring
out in high relief the great meaning and value of the one, and the
unnecessary, or inconclusive, character of the other. He also examined
the various facts presented to him in the _living_ body with unequalled
patience and circumspection.

Amongst others, he had paid particular attention to those which
exemplify that vivid, that watchful connection which exists between
various parts and organs, and by which impressions or sensations
excited in any one part are telegraphed, as it were, with the
swiftness of lightning to any or all of the organs of the body; facts
which may be observed by _anybody_, by no one better, and by few so
well, _as patients_ themselves. To take a common example: everybody
is familiar with the fact that certain disturbances of the stomach
produce pain or other annoyance in the head. Every one also knows that
in such cases there is very often no pain, and sometimes no sensation
of annoyance in the stomach; so that were it not from an innumerable
succession of such conditions, in connection with particular influences
on the stomach, we should, from the feeling of the _stomach only_,
never dream of the cause being in that organ. Now on these simple facts
hang not only the most practical of all John Hunter's observations,
not only the most valuable of Mr. Abernethy's, but (as far as we
can see) those relations through a philosophical examination of
which we shall still most auspiciously seek to extend our practical
knowledge of disease. We see here just that which Mr. Hunter had
asserted—namely, "that the organ _secondarily_ affected (in this case,
the head) sometimes appeared to suffer more than the organ to which the
disturbance _had first_ been directed."

He observed also that the connection thus manifested, existed equally
between _all other parts_ and organs; that although it might be
exemplified in different forms, still the association it implied was
indisputable. He adopted the usual terms by which these phenomena had
been designated. Parts were said to _sympathize_ with each other, and
no term could be better, as it simply expressed the fact of associated
disturbance or suffering. It is true the _facts_ were not at all new;
they had always existed; nay, they had been observed and commented on
by many persons ever since the time of Hippocrates; and if I were to
mention the whole of such facts, there is scarcely one which would not
be to some one or other as familiar as a headache from disturbance of
the stomach. Mr. Hunter, however, had a kind of instinctive idea of
the yet unseen value of the clue thus afforded to the investigation of
disease; and he observed these facts with a greater attention to all
their details than any one, or all, who had preceded him.

Hunter's observations on the subject in his lectures were extremely
numerous, and elaborate even to tediousness; Abernethy, who used to
give us a very humorous description of some of the audiences of John
Hunter on these occasions, was accustomed to say, "That the more
humorous and lively part of the audience would be tittering, the more
sober and unexcitable quietly dosing into a nap; whilst the studious
and penetrative few appeared to be seriously impressed with the value
of Mr. Hunter's observations and inquiries." Mr. Cline, an honoured
name in our profession, and one who, had he lived in later times, would
probably have been as distinguished in advancing science as he was for
his practical excellence, significantly expressed his impressions of
the future importance of the inquiries in which Hunter was engaged.
Addressing Mr. Clift, after one of the lectures, he said:

"Ah! Mr. Clift, we must all go to school again."

Mr. Abernethy carefully treasured up and pondered on what he heard. He
placed himself as much as he could near Mr. Hunter; took every pains,
which his time and occupations allowed, thoroughly to understand him;
and, with his characteristic tendency to simplification, said: "Well,
what Mr. Hunter tells us, resolves itself into this: _that the whole
body sympathizes with all its parts_."

His perceptivity, naturally rapid, was evidently employed in observing
the bearing of this axiom on the facts of disease. The digestive
organs, which, if we extend the meaning to all those engaged in
assimilating our food, compose nearly the whole viscera of the body,
could not escape his attention, nor indeed fail to be regarded in all
experimental investigations of any _one organ_. Accordingly, in his
paper on the skin and lungs, we have seen a very important application
of the relations between organs engaged in concurrent functions; we
have placed before us the physiological evidences of their being
engaged in a common function, and the sympathetic association it
rendered necessary; whence he had observed relations of great moment,
and pointed out the practical bearing they _must_ have on Consumption.
He had, however, been paying attention for some time to the digestive
functions, when his intimate friend, Mr. Boodle, of Ongar in Essex,
gave a fresh stimulus to his exertions. This gentleman requested him
to investigate the functions and conditions of the liver in various
nervous diseases, as also in certain affections of the lungs, which
had appeared to him, Mr. Boodle, to originate in the former organ.
Mr. Abernethy says: "I soon perceived that the subject was of the
highest consequence in the practice _of surgery_; for local diseases
disturb the functions of the digestive organs, and, conversely, a
deranged state of those organs, either occurring in consequence of such
sympathy, or _existing previously_, materially affects the progress of
_local complaints_."

At the very commencement, he hits on a great cause of evil, and
boldly assails one of the most mischievous of all conventionalisms.
"The division of medicine and surgery," he observes, "is mischievous,
as directing the attention of the two orders of practitioners too
exclusively to the diseases usually allotted to them." There is indeed
no exaggerating the evils of that partial mode of investigation to
which such a custom almost necessarily leads. We fall into error, not
because of the difficulty of the subject, but because we never can, by
looking _at one set of diseased processes only_, learn the whole of
the facts belonging to the subject. It was just this that prevented
Fordyce from arriving at correct views of fever. Nothing could be
more excellent than the way he _began_ to consider it; but he hardly
begins, before he tells us that he intends to exclude those febrile
affections which fall under the care of surgeons. In doing this, he
at once abandoned a series of facts which are absolutely essential
to the investigation. It must be obvious, on a moment's reflection,
that, if a particular condition of a part have a relation to the whole
body, the study of one without the other, or even if both be taken
up by different persons, nothing but the most imperfect views can
result. A jury, still more a judge, might in some cases guess from
partial evidence the issue of a legal investigation; but who ever
heard of either determining beforehand to examine a portion only of
that evidence? Yet it is not too much to say, that hardly any legal
question can be so recondite as many inquiries in physiology. The
nature of the case is always more or less obscured by a number and
variety of interfering circumstances. Diseases may be regarded, in
fact, as nothing more than natural laws, developed under _more or less
complicated circumstances of interference_.

Lord Bacon had warned all investigators of Nature of the danger of
attending only to a portion of the facts; it had been one of the great
bars to progress of knowledge in general. I regret to say that it still
continues the bane of _almost all medical inquiries_.

Abernethy's inference in relation to this mutilated sort of
investigation is too true, when he observes that "the connection of all
local diseases with the state of the constitution has obtained little
notice;" whereas the truth is, that "no part of an animal body can be
considerably disordered without affecting the whole system." Now here
Mr. Abernethy claims—what? Simply this: he claims for _function_—that
is, _the various offices fulfilled_ by the several parts and organs of
the body—that which Cuvier has so beautifully insisted on, and which
our own Owen has so instructively exemplified in regard to _structure
or formation_; namely, a _necessary relation_ between the whole and all
its parts.

In speaking of affections of the nervous system, Abernethy observes
that the brain may be affected by the part injured, and that _then_
it may affect the various organs by a "reflected" operation; but that
whatever _may be the mode_ (thus carefully separating the opinion from
the fact), "the fact is indisputable." He adds that it may affect
some organs more than others, and thus give a character or name to a
disease. For example, it might affect the liver, we will say, when the
name which would be given would probably be expressive of what was a
secondary circumstance—namely, a disturbance of the liver. This does
not so frequently happen, perhaps, nor so mischievously in relation to
local injuries; but in other cases it is the cause of a great deal of
erroneous and misleading nomenclature.

As we have seen, it often occurs that when the organs of the body
are disordered, the more salient "symptoms," perhaps the _whole_ of
those _observed_, are referred to a secondarily affected organ, and
the disease is named from that circumstance. The too frequent result
is, that attention is exclusively directed to that organ, whilst the
_cause_, being elsewhere, and where there _are no symptoms_, wholly
escapes observation.

This is a very important branch of inquiry; and as it closely connects
what Abernethy left us with what appears to us to be one of the next
things to be clearly made out, we will endeavour to illustrate it.

Suppose a person meet with a severe injury, a cut, bruise, fracture,
or any thing that we have seen a hundred times before, and, instead
of being succeeded by the _usual_ processes of repair, it be followed
by some others: the simple expression of the fact is, that something
has interfered with the _usual_ mode and progress of repair; and as
former experience has shown us that there was nothing in the nature of
the injury to account for this, we are naturally led to look for the
explanation of it in the state of the individual. But if the unusual
appearance be one which we have agreed to call "Erysipelas," and we
are accustomed to see long papers written upon this appearance as a
_distinct disease_, we acquire a tendency, as every day's experience
shows, to regard it as a kind of abstraction, or as an entity;
something composed of precise and definite relations, contained in
that particular description of case. Yet these relations may not be
in any two successive cases exactly alike. Again, all of them may be
subordinate to some more general character, probably a relation without
which we cannot readily explain the phenomena; but at which we cannot
arrive, because we have not comprehended a sufficient number of facts
in our inquiry to include it.

"Erysipelas" is nothing more than a natural law obscured; because,
as we have just hinted, it is developed under circumstances of
interference (from disordered conditions of the economy) which distort
the natural features of the law, modify its effects, or which may
prevent altogether its full development. But now, if we study the
means afforded by the various links _which other varieties of disease_
furnish, the ascertainment of the real relations becomes comparatively
_easy_; and we find that, whilst there are certain general relations
which belong to all cases, there are certain others which may in a
given number in succession be identical; or in no two exactly the same.

Partial investigations, leading, of course, to erroneous views, are
sure to entail on us a defective nomenclature; and then the two do very
materially contribute to continue the fallacies of each other. We may
have an affection of a lung, perhaps; the cause may not be in the chest
at all, although the lung may be inflamed or otherwise affected; but
we call it Pneumonia, or Pleuritis, or some other name which _simply
refers to what is happening to the part_; but all such names have
reference only to effects; they are extremely defective therefore, as
comprehending only a portion of the _nature_, and having no reference
whatever to the _seat_, of the _cause_ of the malady. The consequences
of all this may not be _necessarily_ mischievous; but they are so
lamentably common, as to continue to form a very large share of the
routine practice. The cause is elsewhere; but the remedies are directed
to the chest—that is, they are, in such cases, applied to effects,
not causes. If we must retain names so defective, it would be very
practicable to combine them with something which should indicate that
we had, at least, _looked_ for the cause. This would, at all events,
encourage a habit of looking beyond mere symptoms, and carry us at
least one link higher up the chain of causation.

Abernethy, in demonstrating the connection between local disease, or
injury, and general disturbance, judiciously takes cases where the
relation was most unequivocal; that is, where the local disturbance
consisted of a mechanical injury; such as in a gentleman who had
undergone an operation—in another who had met with a bad fracture
of his leg. In order to amplify his illustrations of the connection
between the brain and all parts with the digestive organs, he draws
them from all sorts of sources—from diseases the most severe and
dangerous, as well as from affections which are regarded as most common
or trivial—from the last stages of cancer and serious diseases of the
loins, to the common disturbances of teething in children—sources
which, from their apparent _dissimilarity_, confer, of course, the
strongest force on testimony in _which they combine_.

His delineation of the features by which disorders of the digestive
organs may be generally detected, is remarkably simple, clear, and
truthful.

Every word has the inestimable value also of being alike intelligible
to the public and the profession. His statement is interspersed
with remarks of great value, which, we trust, have not passed away
altogether unimproved: such as, that he had observed disorder of the
digestive organs produce states of health "similar to those" said to
be characteristic of the absorption of particular poisons—a most
recondite subject; but one, the obscurity of which has entirely, as
we think, resulted from the determination to regard the diseases to
which it refers as _abstractions_, and to investigate them under the
impenetrable shadow of _preconceived_ opinions.

Almost all his remarks have received more or less confirmation from
the experience of the whole civilized world. There are few things
in his observations more interesting than the emphatic way in which
they ignore the vulgar impression that he referred all diseases to
the stomach. In the whole round of scientific literature, it would be
difficult to find, in the same space, so complete or comprehensive a
view of _all_ those which we usually term the digestive organs.

Abernethy was very far from any such narrow views; whilst, in regard
to other organs, to which some of our most distinguished men had
paid particular attention, it is not too much to say, that, more
clear and precise than Curry, and equally careful with Hunter, not
less painstaking than our excellent Prout, he is more _practically_
penetrating and comprehensive on this subject than any of them. But as
to the charge of exclusive reference to the stomach, we shall easily
see there was no foundation for it.

In speaking of the reciprocal affections of the brain and the digestive
organs, he says: "The stomach is said to be chiefly concerned in
producing these effects; but the cause of the sympathetic affection is
probably more general." Page 48. He then goes on to exemplify causes
acting on the _Liver_, and so forth. Page 49.

He distinctly contends that _other_ of the chylopoetic organs may
disturb the brain as well as the stomach. Again, at page 52, he
repeats a similar opinion, and especially adds, that when the
alimentary canal _is_ affected, we can never be sure that it is
_primarily so_.

He also says, at page 53, that, in some cases, the disorder of the
digestive organs is dependent on disease of the brain.

I have alluded to these passages, because nothing is more unjust
to Abernethy than to suppose that he attributed everything to the
stomach, or restricted his attention to that or any other organ. Such
a misapprehension also tends indefinitely to impede the practical
application of his principles, and to deprive us of the advantages
which are so constantly derivable from them.

This is so important, that it may be useful to consider a little the
circumstances which may have thus misled the public, and we fear, not
unfrequently, the profession also, in the interpretation of Abernethy's
views.

In conducting the treatment of diseases of the digestive organs,
whatever organ we may desire to influence, either by inducing
tranquillity of the nervous system, or by the selection of food
appropriate to the actual condition of the organ specially affected,
the stomach is necessarily a primary consideration.

The reasons for this are sufficiently obvious, but have not perhaps
been always adequately regarded. Digestion is, on the whole, a
manufacture, so to speak, of a raw material (food) into a fluid
(blood), which is to be absolutely adapted to purposes for which it is
designed. This is effected not by one, but by several organs, which
each produce their respective changes in the materials submitted to
them. If we desire, therefore, to adapt the work to any organ which is
engaged in this process, however remote it may be from the stomach,
which, with the teeth and other auxiliaries, execute the _first_
process in the manufacture, it is quite clear that we must begin with
the _first process_ to which we subject the said raw material or
food. Say that in a machine for the manufacture of cloth the spinning
apparatus were out of order, we must begin by giving out a less
quantity of wool to the carding machine, or whatever represented the
first process; because, having once delivered the wrong quantity or
quality, we have no means of recalling it, and we should only still
further derange the defective machinery.

So in the body; the liver, kidney, and other organs, not excepting the
lungs and skin; their work must all bear relation to the quantity or
quality of raw material, whether their function be the manufacture of
the new product, or the rejection of that which is useless. So that
supposing there were no other reason, no other than this mechanical
relation (which is very far from the real state of the case), still we
must _de facto_ begin with the stomach, even where we entertain _no
idea of any_ special derangement of that organ. The stomach, however,
is very important in another sense, and has a power of indicating the
necessity of attention to those points which I have endeavoured to
illustrate by the homely similitude of a manufacture.

Wherever impressions _first_ act on the body, nature has placed a most
vigilant guard. This is variously managed in different cases; the
result is the same, and, as it would appear, the final cause also. In
the eye, there is the most beautiful contrivance for moderating the
ingress of light, as also any abrupt increase of intensity. Fringed
curtains are provided which can close with electrical celerity. Again,
the aperture by which light is finally admitted into the eye is vividly
contractile or expansive, as the occasion may require; then again
there are various media of different densities, through the influence
of which even the velocity of light undergoes practical retardation
by repeated refractions; and lastly, there are powers of sensual
adaptation in the nerve with which the light is ultimately brought in
contact, more wonderful than all.

The ear, being likewise a portal for external impressions, is guarded
with equal care. Not a single vibration of air can ever reach the nerve
of the ear with the crude intensity (if I may use the expression) with
which it is generated. Passing over preliminary apparatus, by which
the vibrations of air are first collected, the impressions of sound
are first received on the parchment of a little drum, which parchment
can be relaxed or tightened with the quickness of thought, so as to
modify the force of the impression. This impression is then, by means
of a little chain of bones, conveyed across the drum, which is filled
with air. It then reaches a portion of the ear in which are found very
curious cavities and canals, of various forms, and taking different
directions, and which, from the curious and complex arrangement of
the whole, is not inappropriately called the labyrinth. This is the
mysterious seat of those nerves which convey impressions to the brain.
There is, however, here, an arrangement more exquisite than any we have
yet mentioned.

In these cavities and canals, which are themselves so small as to be
not unfit objects for magnifying glasses, there are corresponding
delicate sacs and tubes, and these are filled with a limpid fluid.
On this delicate apparatus, so exquisitely calculated to modify any
undue force of impression, the sensitive extremities of the auditory
nerves are spread out, which convey impressions to the brain. We
see, therefore, how carefully these portals of the body are guarded;
arrangements equally conservative prevail throughout. We might show a
similarly exquisite arrangement in the laws governing the mind; but
that is not our present object. We have seen hitherto that, beautiful
as the arrangement is for securing us against painful impressions, it
has been in a great degree mechanical.

The stomach, however, is the portal to a vast series of important
organs, and is protected by a phalanx of sentinels, endowed with powers
proportioned to the importance of the organ which they guard. There
is little that falls within any idea which we can express by the term
mechanical; everything is subjected to an examination essentially
sentient; to powers residing in the nerves; the _laws_ and _operations_
of which, we can with proper attention trace out, but which exhibit
powers demonstrative of an intensity and refinement of which our
limited perceptions scarcely enable us to form a definite idea.

First, there is the olfactory nerve, between which and the stomach
there is the most vivid sympathy.

Until our tastes become vitiated, the stomach seldom admits anything
of which the nose reports unfavourably. The sense of smell, even in
the somewhat measured power possessed by man, is capable of detecting
forms of matter so subtle as to be beyond our powers of imagination.
Nothing which so plainly deals with "matter" impresses more strongly
the immense range which must exist between the chemistry of life and
that of the laboratory. We all know the extraordinary powers of musk.
I have myself a small mass of odorous matter (a Goa ball) which, from
the circumstances under which it came into my possession, must have
been emitting the odour for little less than a century. It has been
exposed to air, is covered by a film of gold (I believe), is in no
respect visibly changed, and for the last thirty years not detectably
in weight; yet at this moment it emits as strong an odour of musk as
ever. How exquisitely subtle must be the matter thus emitted; or how
still more wonderful if it merely so modifies the atoms of air in its
neighbourhood as to produce odour. We have no intellectual powers which
enable us to realize a conception of such infinite tenuity of matter;
yet the sense of smell instantly detects its presence.

Next come the nerves of the tongue; and here again, in natural
conditions, there is a constant harmony between them and the
stomach—that to which the taste readily gives admission being, in
_undisturbed_ conditions of the economy, some guarantee that it is
innoxious; but what these _functions are to the stomach_, the stomach
is _to the other organs_. In the first place, in natural conditions
it usually at once rejects any noxious material which, from being
disguised, or from any other circumstances, may have eluded the
vigilance of the sentinels I have mentioned; but it has a vivid
sympathy with every organ in the body. If anything deleterious be once
admitted, it has to go through various processes, which may render it
a source of indefinite disturbance; therefore, if any organ in the
series of the blood-manufacture be materially disturbed—that is, so as
to be disabled—the stomach usually refuses food; because there is no
other way of stopping the mischief. Illustrations of this occur in many
disorders of the kidney, in many affections of the alimentary canal, as
also of the liver, and other parts.

No doubt the stomach is therefore a most important organ; but to
suppose that it is therefore always the seat of disorder, is not only
a most mischievous error, but a complete blind to its most beautiful
and instructive relations; and as opposite to Mr. Abernethy's views as
the most narrow can be to the most comprehensive. Proceeding with his
illustrations, Mr. Abernethy cites a number of most instructive cases,
such as palsy and other affections of most serious character, which
too often result either from organic disease of some organ, or from
mechanical pressure on the brain or spinal marrow, but which in the
cases cited depend on disorder of the digestive organs.

It is impossible to exaggerate the interest or importance of these
cases; not only from the fact that they almost certainly would have
led to organic disease, but also for the value of that practical
discrimination which they exemplify. Again, the very treatment which
would have been proper, which had sometimes been begun, and which
was not inappropriate to cases of _organic_ disease, with which the
symptoms were in part identical, would have inevitably, in the cases
in question, only served to exasperate the very conditions they were
designed to relieve, and to hasten those processes against which they
were intended to guard.

No one can understand the force of these cases, without recollecting
the intense difficulty of ascertaining that point at which disorder
ceases to be merely functional, and at which organic disease begins.
This is of all things the most difficult to determine in the whole
circle of physiological or pathological inquiry.

The _symptoms alone_ are absolutely useless in any case of real
difficulty. Of that Abernethy was well aware, and he did much to guard
us against the error into which a reliance on them was calculated to
lead. He knew that organs which were diseased would sometimes afford
indications not distinguishable from those of health; and that,
conversely, organs essentially sound would sometimes only afford those
signs which were indicative of disorder. We have, we trust, made some
little progress in this very difficult branch of inquiry; and although
it is true that organic disease not unfrequently escapes detection
during life, yet, so far as we have observed, it is only in those cases
in which there is, notwithstanding the daily lessons of experience,
an _improper reliance_ on what are called the symptoms. We assert,
without the least hesitation, that organic diseases should seldom
elude detection where the investigation is sufficiently comprehensive;
but it must include _all the facts_ of the case, the early history,
and such circumstances which, however remote, have been over and over
again proved to be capable of exerting an influence on the body; an
investigation which, however vainly pleaded for in medical science,
however regarded as too exacting, involves nothing more in principle
than is required as a matter of course _in all other_ scientific
investigations.

When these conditions are observed, it is very rarely that we cannot
detect organic affections in organs in which there may be no _present_
symptoms. In relation to the _extent_ to which they may be affected,
it is true we have yet much to learn; still, if cases be judged of not
by the history _merely_, nor by the symptoms _merely_, but by both
in conjunction, and if to these be added a careful observation of
the _amount_ of work that the organs are separately or collectively
doing, as _compared with their natural proportions_; together with
a careful estimate of that which the actions of any visible disease
may be eliminating from the body; then, indeed, we have good ground
for hope that means will be opened to us of distinguishing more
accurately various states of the system; and additional principles and
powers disclosed of readjusting the disturbed balance of the various
functions, which is the essential element of disease.

[Footnote 29: "History of the Inductive Sciences."]

[Footnote 30: Butler's "Analogy."]




CHAPTER XVI.


"MY BOOK" CONTINUED.

    "La première chose qui s'offre à l'Homme quand il se regarde, c'est
    son corps. Mais pour comprendre ce qu'elle est, il faut qu'il la
    compare avec tout ce qui est au-dessus de lui, et tout ce qui
    est au-dessous, afin de reconnoître ses justes bornes."—PASCAL,
    PENSÉES, NATURE DES HOMMES, vol. ii, p. 57.

Abernethy, in impressing any anatomical fact, would sometimes say
that we carried about with us in our own bodies excellent means of
refreshing our impressions on many points of anatomy; but we may say
this in a much more extensive sense with regard to the interpretation
of that for which anatomy is alone useful—namely, the _uses_ or
_functions_ of the body. It would be very possible for any observant
person, who was moderately versed in the ordinary principles of
correct reasoning, to detect many defects in medical investigations
and practice; in the correction of which many of Abernethy's practical
contributions consisted; but the mind, restlessly impatient to arrive
at conclusions, often overlooks the most important facts, and deduces
inferences _directly_ from the evidence of the eye or other senses,
without submitting it to such test as the intellectual faculty can
alone supply. Nothing can exceed the mischief of this in serious
matters, nor the absurdity of it, when we _think awhile_.

We should hardly refrain from laughter if we saw a man try to see with
the point of his nose, or endeavour to examine the odour of a rose by
his ear, or to listen with his eye; yet this is not a whit more absurd
than to try to deduce conclusions from the impressions furnished by
the eye, which can alone be afforded by the rational faculty. Nothing
is more common than this sort of fallacy, nothing more easy than its
correction; but then people must bestow at least a little of that time
on their highest faculties which they so lavishly expend on inferior
powers. How much time we consume, for example, in the study of various
languages—those instruments for the communication of ideas—as
compared with that bestowed on the collecting and marshalling of
ideas themselves; which is little better than grasping at the shadow,
and losing the substance; or, to use a humorous illustration, like a
friend of our own, who, having a new dog, sent his servant forthwith
to purchase sundry articles for him, in the shape of kennel, chains,
engraved collars and food; all of which, at some expense, he safely
accomplished to his master's satisfaction, expressing his sorrow at the
same time for having accidentally lost the dog!

It is curious, however, to observe how the real business of the human
mind is shadowed forth in the very abuses of its powers; nothing so bad
but it is charged with a certain quantity of good; no error so great
but carries with it the element of its own correction. The mind in its
greatest aberrations is followed by the shadow of its real duty, which
as it were waits on the time when clearer views shall burst on it.
Nothing shows the real tendencies of mind more than its restless desire
to arrive at _some_ conclusion, _some_ tangible evidence of its highest
functions. It is the impulse of this instinct—the ungoverned abuse of
a high faculty, impatient for illegitimate fruition—which lies at the
bottom of much false reasoning, and which blinds men, even of great
power, to obstacles which are luminously evident to the most ordinary
capacity. Important as the next series of illustrations cited by
Abernethy are, the conclusions he deduced from them were the necessary
sequences of clear and correct reasoning on familiar and established
facts.

The illustrations in question were those afforded by various cases
of injuries of the head, in which certain consequences, however
exceptional they may be, are too commonly referred to the abstract
nature of the injury. We _see_ that a man has a blow, we _see_ that he
does not recover in the usual way in which we have known many others to
recover; but we do not, perhaps, _consider_ that if a similar—nay,
perhaps an identical force produces very different effects in different
cases, the cause will probably not be in the nature or direction of
the force so much as the condition of the body. Now the value of these
cases of Abernethy's consists, first, in impressing the influence
of this condition as modifying—in other words, _sustaining_—the
disturbance consequent on injuries (in their origin) purely mechanical;
and secondly, in showing that, in the cases in question, _that
condition_ depended on a disordered state of the digestive organs.
We hardly know any cases more valuable than those in question. When
a patient receives a blow, and, the _immediate_ consequences having
subsided, there still remains an impairment of sense or motion, the
most usual thing, and no doubt very often the true view, is to refer
it all to lesion of nervous structure. It is therefore of the highest
consequence to know the facts of these cases. They not only prevent
the hasty institution of treatment which would be injurious; not only
secure the patient from being abandoned in despair; but supply at
the same time the clues to a rational treatment, and the hope of a
favourable issue.

There can now be few observant surgeons who have not met with cases in
illustration of these circumstances; and yet I know not to whom the
perusal of Mr. Abernethy's cases might not be useful. It is not without
regret that I forego transcribing at least one of them; forgetful how
impossible it is to do Abernethy full justice in a work intended for
all readers. In his "Book," the cases in question begin at page 97, and
occupy but a few pages.

The next class of cases, from which Abernethy illustrates the
prevailing influence of the digestive organs, receives additional
importance from the _imperfect_ manner in which the phenomena have been
interpreted in a vast variety of diseases; like small-pox and others,
ascribed to the action of particular poisons. We may possibly have an
opportunity of saying something more on this subject; but we may remark
that when any disease has been presented to the physician or surgeon,
supposed to be the result of specific poisons, it is just the last
case in which any special attention is paid to the digestive organs.
Now Abernethy observed that disorders of the digestive organs would
sometimes _produce_ diseases resembling maladies said to result from
specific poisons. This is about the first indication or hint of that
which, duly carried out by an advancing science, will, we trust, ere
long, demonstrate what to _us_ has long appeared only part of a general
law. Of this we may by and by say a little more, when we endeavour to
show the small quantity of truth which there is mixed with some of
the prevailing errors; and how their occasional success results from
blundering, as it were, on small portions of the principles enunciated
by Abernethy.

In the meantime, we may refer to the illustration afforded by
small-pox of the remarkable influence of the digestive organs in
diseases called specific. We adduce this, because it is one which is
popularly familiar, and a disease that, had it been studied under any
but one particular phase, would have proved, of all others, the most
instructive. There is no malady, under certain circumstances, more
extensively fatal.

In the Spanish conquest in America—a history scarcely less interesting
in a medical than in a moral point of view—it seems that not all the
cruelties of the Spaniards were more destructive than the small-pox. In
less than a century after the arrival of Columbus, it was computed that
it had destroyed more than half the population; and in one year (1590),
it so spread along the coast of Peru, that it swept away nearly the
whole of the Indians, the Mulattoes, and the Mestichos, in the cities
of Potosi and De la Hay[31].

As is well known, before the discovery of vaccination, persons were
_inoculated_ with the small-pox, because it was found that the disease
could _be thus rendered_ comparatively harmless; whilst, if it was
taken naturally, as it was termed, it was always serious, and too
frequently extremely fatal. The preparation for inoculation consisted
of _measures addressed to the digestive organs_. Now the effect may be
judged of by this fact: Inoculation was at first violently opposed;
and, in reply to the alleged safety of it, an opponent wrote to prove
that _one_ in _one_ hundred and eighty-two had died of it. I wish we
could say so of many other diseases.

That such persons had, nevertheless, the genuine malady, was proved
by the fact they were capable of infecting others (unprepared) with
the disease in its most malignant form. But our notions of the mode in
which the laws of the animal economy deal with injurious influences
of this kind, are mischievously conventional. What quantities, for
example, of mercury, in its different forms, have been administered in
almost all diseases; and yet unquestionably there is a great deal of
false reasoning in regard to this poison. Effects are attributed to it
_as mercury_, which only belong to it in _its general character of an
injurious agent_. All the (so-called) specific effects of it, most of
which are become popularly familiar, may occur without any mercury at
all. We have seen them induced by aloes, by scammony; and in a case
where no medicine had been given, and where the only detectable poison
was one which was to be sure bad enough, an enormously loaded liver.

We are obliged to say but little here in connection with this subject.
Abernethy's cases were very important in relation to the influence of
the digestive organs, although he did not see the generalization to
which, as it appears to us, they help to conduct the pathologist. The
subject is too extensive for discussion here. We will attempt something
of a popular view of it, when we endeavour to explain the fallacy to
which we have already referred.

Abernethy next adduces various illustrations from cases of other
diseases; as indurations, tumours, carbuncles, scrofulous affections,
and others; in proof of the dependence of a "numerous and dissimilar
progeny" of so-called local diseases, on that "fruitful parent,"
disorder of the digestive organs. Of one of the most interesting
and remarkable cases of tumour, Mr. Abernethy did not live to see
the termination. It was of a lady who consulted him previous to the
proposed infliction of an operation. She had been recommended by my
father, in the country, to consult Abernethy before submitting to
it; because he disapproved of it, as did Abernethy—not because they
doubted of the nature of the disease, but because it was not confined
to the part on which it was proposed to operate.

The lady used to call on Abernethy when she came to town; and after his
death she came to me—as she said, just to report her condition. She
had at times various disturbances of her digestive organs; but always
from some imprudence; for, although habitually very simple in her
habits, she would be sometimes careless or forgetful.

She died at a very advanced age—between seventy and eighty—but
there had been no return of the disease for which she had originally
consulted Abernethy, nor had she undergone any operation. It is a
significant circumstance, too, that she had a sister who died of cancer.

The whole of the cases are, however, scarcely less valuable. In the
fifth section, he treats of disorders of parts having continuity of
surface with the alimentary canal, certain affections of the nose, of
the eye, and of the gullet or œsophagus. His observations on the latter
are especially valuable. They strike at that meddling practice which
is too common in the treatment of diseases of these parts. Many of us
have recommended a practice which, without neglecting either, relies
_less_ on manipulatory proceedings, and more on measures directed to
the general health, in such cases; as producing effects which are not
to be obtained by other means; but, if we are to judge from the medical
periodicals, without much success; so inveterate is the habit of
imagining that, whatever the causes of disease may be, if the _results_
be but _mechanical_, mechanical means can alone be applicable. Public
attention, and the perusal of such cases as those of Abernethy, can
alone correct these errors.

Lastly, he describes the results of his dissections as bearing on the
whole subject. Here he shows, that whilst disordered function may
take place coincidentally with, or as a consequence of, change of
structure, yet that such change, so _as to afford visible or detectable
departures_ from natural appearances, is by no means necessary, in
_organs which, during life_, had afforded the most incontrovertible
evidence of impaired function. He also shows that disease has
_terminated_ in _disorder_ which had its original seat in the
digestive organs. And again—that, in cases where the cause of death
had been in the abrogated _function_ of the brain, he found no actual
_disease_ in that organ, but in the _abdominal viscera_. He very justly
observes that the conclusions he has drawn can be _neither_ ascertained
nor disproved by anatomical evidence _alone_. He mentions especially,
and illustrates by a remarkably successful case, how _diseases of the
lungs_ may be engendered by disorders of the digestive organs, and
_entirely_ subdued by correction of that disorder.

He speaks also suggestively of the possibility of that which is
certainly now an established fact. He says: "In cases of diseased
lungs, where no disease of the digestive organs is discovered, yet
considerable _disorder_ does exist, and may continue for many years
without any _organic_ disease being _apparent_; it is possible that
such disorder may excite disease of the lungs, and thus produce a
_severer_ disease of the latter organs than what existed in the
former. Accurate attention to the _digestive organs may determine
this important subject, and lead to the prevention and cure of the
sympathetic diseases which I have mentioned_." "This attention must
not be merely of that general kind which adverts only to the quality
of the ingesta, &c., but one which more strictly observes whether the
viscera" (that is, reader, not merely the stomach, not merely the
digestive organs, but the whole viscera of the body) "and whether these
secretions are healthy or otherwise." After speaking of the heart also,
as affected by the digestive organs; and of the infinity of diseases
which arise from the reciprocal disturbance excited between them and
the brain;—he says: "But even these are not the worst consequences.
The disorder of the sensorium, excited and aggravated (by the means
which he has described), affects the mind. The operations of the
intellect become enfeebled, perplexed, and perverted; the temper
and disposition, irritable, unbenevolent, and desponding. The moral
character and conduct appears even to be liable to be affected by these
circumstances. The individual in this case is not the only sufferer,
but the evil extends to his connections and to society. The subject,
therefore, appears to me to be of such importance, that no apology
need be offered for this imperfect attempt to place it under general
contemplation." Here is that suggestion which, when carried out, leads
to the detection of cases of insanity which depend on disturbances of
the digestive organs.

Lastly, as if, notwithstanding his own previous attention to the
important question of the influence of the digestive organs in
disease, he felt that the inquiry had grown upon him in consequence of
Mr. Boodle's endeavour to concentrate his attention to the subject,
he concludes by expressing his past obligations to Mr. Boodle; for
he says, with admirable modesty and candour, "for Mr. Boodle first
instructed me how to detect disorders of the digestive organs, _when
their local symptoms were so trivial as to be unnoticed_ by the
patient." He urges Mr. Boodle to publish also his own observations on
the subject, because any remarks from one who observes the progress of
disease "with such sagacity and accuracy, cannot but be interesting."
We are quite aware how feeble our attempt has been to do justice to
this admirable book. But nothing can do that but a careful study of the
various principles which it either suggests, dimly shadows forth, or
deeply and beautifully unfolds.

Through not a very short life, we have had ample opportunity of testing
these principles by the bedside, and of endeavouring to connect some
of them with the laws in obedience to which they occur; and we are
free to declare our impression that when the book is studied with the
requisite previous knowledge, and freedom from preconceived opinion;
and when tested and carried out in _principle_, as distinguished from
any adhesion to mere matters of _detail_; we think it infinitely more
valuable than all other professional works whatever. In examining
the truths it unfolds, or in our humble endeavours elsewhere at a
more analytical or extended application of them, like Abernethy, we
have rested our reasoning wholly on facts and observations which are
acknowledged and indisputable.

Whilst other views have only led to a practice in the highest degree
empirical, or, what is worse, conjectural, those of Abernethy's lead
often directly, but always _when duly studied_, to a practice at once
clear, definite, and in the sense in which we shall qualify the word
"positive,"—that is, one which gives us the power (when we really have
the management of the case) of predicting the success or failure; which
is at least a ripple indicative of a coming science.

In order, however, to carry out this clearly, we shall at once add what
we think necessary to the profession and the public on the subject.
The _general relation_ of Abernethy's labours to a real and definite
science will be better developed in our concluding Summary; when we may
have an opportunity of stating what further appears to have been done,
and what is yet required. It will have been perhaps already observed
that Abernethy's views involve a few very simple propositions: first,
that disturbance of a _part_ is competent to disturb the whole system;
and conversely, that disturbance of the _whole system_ is competent to
disturb any _part_. That the disturbance may _commence_ in the brain or
nervous system, may then disturb the various organs, and that these may
again by reflected action disturb the brain, and so reciprocally; and
that in all these cases tranquillity of the digestive organs is of the
very first consequence; not merely from its abstract importance, but
from the influence it exerts on the state of the nervous system.

With respect to any influences immediately directed to the nervous
system, these we apprehend to be few and simple; some kinds of
medicine, are, no doubt, in particular cases useful, none are
susceptible of _general_ application. None of them are _certain_;
and sedatives of all kinds, which appear to have the most direct
influence on the nervous system, either require to be employed with
the utmost caution, or are in the highest degree objectionable. But
there are other _direct_ influences, certainly; and very important
they are. Quiet, avoidance of disturbing external impressions, whether
of light, sound, temperature, &c. whether in fact of mind or body;
but, in the majority of mankind, how few of them we can, in a strictly
philosophical sense, command. We are therefore driven to other sources
of disturbance; and in the digestive organs we find those on which we
can exert great influence, and in which tranquillity, however procured
or under whatever circumstances, is _certain_, _pro tanto_, to relieve
the whole system. This Abernethy attempted, and with a success which
was remarkable in no cases more than those which had resisted all more
ordinary modes of proceeding; by general measures, by simplicity of
diet, by occasional solicitation of this or that organ, by air and
exercise, and measures which were directed to the general health. No
doubt in some cases he failed, and so we shall in many; but let us look
boldly at the cause, and see whether we do not fail a great deal more
from our own ignorance than from any natural impossibility.

To examine the question, we must for the moment forget our admiration
of Abernethy; be no longer dazzled by his genius, but look only to our
duty; endeavour to discover his defects, or rather those of the state
of the question when he left us, and see what further investigation has
afforded in aid of supplying them.

In the first place, we must examine a little further that proposition
which we have seen both in Hunter and Abernethy under different forms.
Hunter says the disturbance of the organ sympathizing is sometimes more
prominent than that of the organ with which it sympathizes. Abernethy
says that the organ primarily affected is sometimes very little
apparently disturbed, or not even perceptibly so.

Now, from both these statements, we find that there may be no signs
in the primarily affected organ; which, practically rendered, is
nothing more or less than saying that in many cases we must not seek
for the primarily affected organ where _the symptoms are_; and this
is a great fact: because, although it does not necessarily teach us
what we must do, it exposes the broken reed on which so many rely. Now
the further point, which, as we would contend, time and labour have
supplied, is first this—that what Hunter had mentioned as one feature
in the history of the sympathies of different organs, and Abernethy as
an occasional or not unfrequent occurrence, is, in disorders of any
standing, and with the exception of mechanical injury, _in fact the
rule_—the _symptoms_ of disorder being almost _never_ in the primary
organ; nay, even organic change (disease) is for the _most part_ first
seen in a _secondarily_ affected organ. In regard to primarily affected
parts, the skin only excepted, they will be found, in the vast majority
of cases, to be one or other of the digestive organs.

I will endeavour to render the cause of this intelligible. A minute
examination of what happens in a living person, especially if it
be extended to some thousands of cases, will soon disclose to the
most unlettered person a few instructive facts, showing that Nature
has a regular plan of dealing with _all_ injurious influences,
which, however _various_ many of the _details_ may be, is in general
character exquisitely simple, surprisingly beautiful, and intelligibly
conservative; and that the various modes on which she exercises this
plan, from the cradle to the grave, are, in _frequency, directly in
the order of their conservative tendency_. Let us explain. There is no
dearth of illustration; the _facts_ are bewilderingly abundant; the
difficulty is which to choose, and how to give them an intelligible
_general expression_. Let us take a single case. We know that if a mote
gets into the eye, there is irritation, immediately there is flow of
blood to the part, a gland pours forth an abundant supply of tears,
and the substance is probably washed out. Very well; we say that is
intelligible. But suppose you have the vapour of turpentine, or any
other irritant, the same thing happens; but still you cannot give quite
the same _mechanical_ explanation.

Again—substances which affect the mouth, nose, and stomach, will
irritate the eye without any contact, and cause a flow of tears.

Lastly, you know that affections of the mind will do this, and where
even we have no _mechanical_ irritant at all.

In _all_ these cases there has been activity of the vessels of the eye,
and in all it has been relieved by secretion. Now this is the universal
mode throughout the body; all irritation of the organs is attended by
secretion; and where this is done, there is no disorder; or rather,
the disorder is relieved: but if organs are irritated _continuously_,
another thing happens, and that is, that an organ becomes unable to
secrete constantly more than is natural, and then _some other_ organ,
less irritated in the commencement, takes on an additional duty—that
is, the duty of the animal economy is _still done_, but _not equally_
distributed.

This is the state in which most people are in crowded cities, and
who live in the ordinary luxury or the ordinary habits of civilized
society, according to the section to which they may belong. It is easy,
in such cases, to detect those differences which distinguish this state
from what is called condition or perfect health, as we have elsewhere
shown[32].

But of course there is _a limit to this power_ in organs of taking on
additional or compensating actions; and when this limit is exceeded,
then those actions are instituted which we call Disease. The site is
_seldom found_ to be that of the original disturbance; and usually
for a very plain reason—because there it would be more dangerous, or
fatal. It would be scarcely less serious in many cases, even though
placed on organs _secondarily_ affected; and therefore it is more
usually determined _to the surface_ of the body; where, taking them
simply in the order of their greatest number, or frequency, we find the
first class of diseased appearances, and which strikingly impress the
real nature of _the law_. They are the most numerous, most obviously
dependent on general disturbance, and most conservative, as being least
fatal. Diseases of the skin are those to which we allude, and which, in
the characters I have mentioned, exceed all other diseases.

Again—the next surface is that involution of the skin which covers the
eye, and which lines the mouth, throat, and the whole of the interior
surface of the respiratory tubes and the digestive organs. Here again
we find the _next_ seat of greatest frequency, and the conservative
tendency, to coincide. We need only refer to the comparative frequency
of what are called colds, ordinary sore throat, and so forth; as
contrasted with those more serious diseases which occur in the
corresponding surfaces of the respiratory organs and alimentary canal.
In tracing diseases onwards in the order of their number, we never lose
sight of this conservative tendency. When _organs_ become involved
in disease, we find that, for once that the _substance_ of the organ
is so _affected_, the _membrane covering_ it is affected a hundred,
perhaps a thousand times. This is equally observable with respect to
the brain, heart, lungs, digestive organs, and some other parts; and it
is of great importance practically to know how readily affections are
transferred from the _lining_ of the alimentary canal and other parts
to the membrane _covering_ it, rather than to the intermediate texture
of the organ; again impressing, though now in a dangerous type truly,
the conservative _tendency_ of the law.

Finally, then, we arrive at diseases of Organs; and here we see this
conservative tendency still typed in the site first chosen, which is
almost always (where we can distinguish the two structures) not so
much in the _actual tissue_ of the organ as in that which connects it
together—what we term the _cellular tissue_.

This is remarkable in the lungs; where tubercular deposits are first
seated; not in the essential structures of the organs, but in those
by which they are joined together. All those various depositions also
which are called tumours, generally begin in, and are frequently
confined to, the _cellular tissue_; and even though there is, in
certain malignant forms of tumour, a disposition to locate themselves
in organs, there is a very curious tendency towards such, as may have
_already fulfilled_ their purposes in the animal economy.

We might multiply these illustrations to a tedious extent. We might
show, for example, in the eye, how curiously the greatest number of
diseases in that organ are placed in structures least dangerous to
the organ; and even when the organ is spoiled, so to speak, how much
more frequently this is in relation to its function as _an optical
instrument_, than to the structure which forms the link with the brain,
as _an organ of sensation_. I must, however, refer those who wish to
see more of the subject, to the work[33] in which it is more fully
discussed, under the term, "The Law of Inflammation," which is a bad
phrase, as imperfectly expressing the law; but as the greatest evils it
exposes occur in cases of Inflammation, and as it shows the essential
nature of that process to be entirely distinct from the characters
which had been usually ascribed to it, every one of which may be absent
so that expression was somewhat hastily given to the generalization
which seemed best to express a great practical fact.

To return to the bearing of all this on Abernethy's views, and in
relation to organs primarily or secondarily affected. In obedience to
the conservative law to which I have above alluded, defective function
in one organ is usually accompanied by increased action in some other;
and thus it happens that the symptoms are _almost always_ in one organ,
whilst the cause, or originally injurious influence, has acted on
another. The general reader will, of course, understand that we are not
speaking of direct mechanical injury to an organ. _Now_ all the most
recondite diseases of the kidney are already acknowledged by many to
be seated in a secondarily affected organ. Still the practice is, in
too many instances, a _strange mixture_ of that which is in accordance
with the true view, more or less marred by much _that is in opposition
to it_; because it often includes that which is certain more or less to
_disturb_ the organ which it should be the object to tranquillize or
relieve.

In the same manner, the lungs and heart are continually disordered,
and ultimately diseased, from causes which primarily act on the liver;
and I have seen such a case treated with cod-liver oil and bitter
ales, with a result which could not but be disastrous. The liver sends
an enormous quantity of blood to the heart and lungs, from which
it ought previously to have extracted a certain quantity of carbon
(bile). If this be not done, the heart and lungs are oppressed both
by the quantity and the quality of the blood sent to them. If nothing
happen in either of the various sites I have mentioned, the blood must
be got rid of; and it is so. In many cases, a vessel gives way; or
blood is poured out from a vessel; or blood is employed in building
up the structures of disease; but then the _symptoms_ are frequently
altogether in the chest, and not a sign of anything wrong in the liver.

I cannot go on with the multitudinous illustrations of these
principles. The law is to determine injurious influences to the
surface. Deposition in the cellular tissue of the lung is bad enough;
but it is better—that is, less certainly fatal—there, than in the
respiratory tubes: and that is the explanation.

But now comes the practical point. How is the primary organ to be
got at? because that is the way to carry out the removal of the
impediments to the sanative processes of nature, which, in many cases,
no _mere general_ treatment can accomplish. This is to be found by an
examination into the _whole_ (that is, the former _as well as_ the more
recent) history of the case, and adding the further test of a real and
careful observation of all the secretions.

By going back to the former life of the patient, we shall seldom fail
to discover the various influences to which he has been subjected, and
the organs to which they have been originally addressed. Having made up
our minds, from our previous knowledge of injurious influences, on what
organ they will most probably have acted, we now test this, not merely
by inquiry after symptoms—and it may be not by symptoms at all—but
by careful observation of the _actual work_ of the suspected organ.
In this way we almost certainly discover the real offender; in other
words, the organ primarily affected. This is of immense importance;
for we confidently affirm that _one single beneficial impression made
on it_ will do more in a short time—nay, in some rare instances,
_in a single day_—than years of routine treatment, that has been,
nevertheless, of good _general_ tendency.

In treating it—_i. e._ the primary organ—however, great
discrimination is necessary. If it be already organically affected,
that treatment which would be, under _other circumstances_, necessary,
becomes either objectionable, or requiring the utmost caution.
For although an organ _diseased in structure_ will, under some
circumstances, as Abernethy long ago observed, yield its characteristic
secretion, yet, unless we know the _extent_ of the disease, which is
just the thing we can almost never be certain about, excitement of
it is _never without danger_. We should therefore excite the primary
organ with more or less energy, with more or less caution, or _not at
all_, according to circumstances. If we determine on not exciting it,
we should then act on organs _with_ which it has ordinarily closest
_community_ of function, or on whose integrity we can most depend.
For choice, we prefer organs which, in a natural state, have nearest
identity of function, as having the readiest sympathy, it may be, with
each other. Yet so universal is the sympathy between all the organs,
that there is no one that will not, under certain circumstances, or
which may not be induced, perhaps, by judicious management, to take on
_compensating_ actions.

We must not here pursue this subject further. We have endeavoured to
sketch certain extensions of the views of Mr. Abernethy, and can only
refer the profession and the public, for the facts and arguments which
demonstrate and illustrate them, to those works in which they have
been enunciated[34]. They have now been subjected to severer trials,
and abundant criticisms. So far as we know, they have not been shaken;
but if there be any merit in them, if they shall have made any nearer
approach to a definite science, or sketched the proofs that Induction
alone can place us in a position to talk of science at all, _they are
still sequences which have been arrived at by a steady analysis of
Abernethy's views_. It was he who taught us, in our pupil days, first
to think on such subjects; to him we owe the first glimpse we ever
had of the imperfect state of medical and surgical science; and if we
do not wholly owe to him the means by which we conceive it can alone
be rendered more perfect and satisfactory, he has at least in part
exemplified the application of them. If we have made some advances on
what he left us, and added to his beautiful and simple general views,
something more definite on some points, something more _analytical_ on
others,—still, inasmuch as they are clear deductions from the views he
has left us, and from such views alone, such advances remind us that
the study of his principles serves but to demonstrate their increasing
usefulness, and to augment the sum of our obligations.


SECTION.

Mr. Abernethy's book "On the Constitutional Origin of Local Diseases"
had an extensive circulation, and excited a great deal of attention
from the public as well as the profession.

As a work which may be read as it were in two days, so as a person
read it with one or other subject, it produced a great variety of
impressions. It may be read simply as a narrative of a number of facts,
with the inferences immediately deducible from them. All this is plain
and intelligible at once to anybody, and of great practical value; but
the work contains numerous observations of a suggestive kind, which
require careful thought, and some previous knowledge, to enable a
person to estimate their value, or to trace their onward relations.
The impression made by the work on different minds varied, of course,
with the reader, his information, and, in some sort, with the spirit in
which it was studied. Some, who had, in their solitary rides, and in
the equally solitary responsibilities of country practice, been obliged
to think for themselves, recognized, in the orderly statement of
clearly enunciated views, facts and principles which they had already
seen exemplified in their own experience, and hailed with admiration
and pleasure a book which realized their own ideas, and supplied a
rational explanation of their truth and value.

Some, who had never thought much on the subject, and were very
ill-disposed to begin, regarded his ideas as exaggerated, and hastily
dismissed the subjects, with the conclusion that he was a clever man,
but too full of theory, and too much disposed to look to the stomach or
the digestive organs. Others, making very little distinction between
what they heard of the man, the book, or his practice, and probably
not having seen either, but deriving only a kind of dreamy notion of a
clever man with many peculiarities, would say that he was mad, or an
enthusiast. Still, a great many of the thinking portion of the public
and the profession held a different tone. The book was recognized as
an intelligible enunciation of definite views—rather a new thing in
medical science. The application of them became more and more general;
his pupils were everywhere disseminating them, more or less, in the
navy, in the army, in the provinces, and in America.

Still, it must not be imagined that his principles became diffused
with that rapidity which might have been inferred from his
numerous and attentive class. Constituted as medical education is,
but more especially as it was at that time—for it is _slowly_
improving—pupils were almost entirely absorbed in the conventional
requisitions for examination. There, they were not questioned as to
the laws of the animal economy, nor any _laws_ at all, nor even on any
real axioms in approximation to them; but simply as to plain anatomy,
the relative situation of parts, and such of the ordinary surgery of
the day as had received the approbation of the Examiners, who were,
for the time, the authorities in the profession. Therefore, out of a
large number, there were comparatively few whose attentions were not
too much absorbed by the prescribed curriculum of hospital routine to
study principles: a curriculum constructed as if the object were to see
how much could be learnt in a short time, without detriment to the very
moderate requisitions of the examination at the College of Surgeons.
But if comparatively few had time to study Abernethy's lectures at the
time, a great many had treasured up his remarks. As the impressions we
receive in our childhood, before we are capable of thinking of their
value, are vividly rekindled by the experience of real life, so many
of the more suggestive lessons of Abernethy's lectures, which passed
comparatively unheeded at the time, or were swamped in the "getting
up" of the requisitions for an examination at the College, recurred in
after days in all their force and truthfulness. Many, however, with
more time, and perhaps more zeal, endeavoured to thoroughly master his
views; and now and then he was gratified by evidence, that time had
only served to mature the conviction of the pupils—in dedications and
other complimentary recognitions, in the works of such of them as had
been induced to publish any portion of their own experience.

However various, too, the impressions made by his book, there are two
things certain; viz. that he was much talked of, and the book had an
extensive sale, went through several editions, and served to give the
_public_ some notion of those principles which he was so beautifully
unfolding to the younger portions of the profession in his lectures.
Besides, although there were not wanting those who spoke disparagingly
of him, still, as an old and very far-seeing colleague of our own
used to say, with perhaps too much truth, when canvassing the various
difficulties of a medical man's progress in the metropolis, "A man
had better be spoken ill of, than not spoken of at all." He was now
beginning to be very largely consulted. The Public had "got hold of
him," as we once heard a fashionable physician phrase it, and he soon
obtained a large practice. A great many consulted him for very good
reasons, and probably many for little better reason than that he was
the fashion.

Abernethy had now an amount of practice to which neither he nor any
other man could do full justice. Finding it impossible to make people
understand his views in the time usually allotted for consultation, he
now referred his patients to his book, and especially page 72. This has
been made the subject of a great deal of quizzing, and of something
besides, not altogether quite so good-natured. For our parts, we
think it the most natural thing in the world to refer a patient to a
book, which may contain more in full the principles we desire them to
understand, than we can hope to find opportunity to explain at the time
of consultation. We think that if asking a few questions, and writing
a prescription (and we are here only thinking of a reasonably fair
average time visit), be worth a guinea, the explaining a principle,
or so placing a plan before a patient that his following it may be
assisted and secured, is worth fifty times as much; and it came
particularly well from Abernethy, one of whose lessons, and a most
excellent lesson too, was the remark, "That if a medical man thought
he had done his duty when he had written a prescription, and a patient
regarded his as fulfilled when he had swallowed it, they were both
deceived."

As we are convinced that, _cæteris paribus_, success in medical
treatment is indefinitely promoted by both patient and surgeon _clearly
understanding_ each other as to _principles_, we think it would be of
great use if every medical man, who has any definite principles of
practice, were to explain them in short printed digests. Nay, we have
sometimes thought it would be useful to both parties, if, in addition
to the inquiries and advice given at consultation, a medical man should
have brief printed digests of the _general_ nature and relations of
most of the well-defined diseases. A careful perusal of one of these
would help the patients to comprehend the nature and objects of the
advice given, tend to the diffusion of useful knowledge, and in time
help them to understand whether their treatment were conducted on
scientific views, or merely a respectable sort of empiricism. What is
here intended might be printed on a sheet of note paper; and, whilst it
would be of great service to the patient, would form _no bad test of
the clearness and definite principles of the medical attendant_. There
is no doubt that Abernethy did good service by referring patients to
his book. It led some to think for themselves, and it also assisted,
_pro tanto_, in doing away with that absurd idea which supposes
something in medical practice inappreciable by the public.

At this time, whilst, with a considerable indifference to money, he
was making a large income, still he was obliged to work hard for it.
He had as yet no emolument from the Hospital; he was still only an
assistant surgeon. The tenacity of office, of which assistant surgeons
so commonly complain, they have themselves seldom failed to exercise
when they have become surgeons (Mr. Abernethy, however, excepted). The
long tenure of office by his senior (Sir James Earle) wearied him, and
was at times a source of not very agreeable discussions.

On one occasion, Sir James was reported to have given Abernethy to
understand that, on the occurrence of a certain event, on which he
would obtain an accession of property, he, Sir James, would certainly
resign the surgeoncy of the hospital. About the time that the event
occurred, he happened one day to call on Abernethy, and was reminded
of what he had been understood to have promised. Sir James, however,
having, we suppose, a different impression of the facts, denied ever
having given such a pledge. The affirmative and negative were more than
once exchanged, and not in the most courteous manner. When Sir James
was going to take his leave, Abernethy opened the door for him, and,
as he had always something quaint or humorous to close a conversation
with, he said, at parting, "Well, Sir James, it comes to this: you say
that you did not promise to resign the surgeoncy of the hospital; I, on
the contrary, affirm that you did: now all I have to add is, —— the
liar!"

In 1813, Abernethy accepted the surgeoncy of Christ's Hospital, which
he held until 1828, a short time before he retired from practice.

In 1814, he was appointed Professor of Anatomy and Surgery to the
College of Surgeons—an appointment which could be, at this period, of
little service to him, whatever lustre it might reflect on the College,
where he gave lectures with a result which has not always followed
on that appointment: namely, of still adding to his reputation. He
was one of the few who addressed the elders of the profession without
impressing the conviction that he had been too much employed in
addressing pupils. He had given lectures two years in succession, when,
in 1816, circumstances occurred which will occupy us for some little
time. A new scene will be opening upon us; and this suggests the period
(1815-16) as convenient for taking a retrospect, and a sort of general
view of Abernethy's position.

[Footnote 31: Clench's History. Letter from Ch. Uslano, to Gonsalvo de
Solano, July, 1590.]

[Footnote 32: "Health and Disease." See Treatise on Tumours.]

[Footnote 33: "Medicine and Surgery One Inductive Science." London,
1838. Highley.]

[Footnote 34: "Medicine and Surgery One Inductive Science;" and "On
Tumours," Art. "Treatment of Organs."]




CHAPTER XVII.

      "Sperat infestis, metuit secundis,
      Alteram sortem bene preparatum Pectus."

      HOR.

      "Whoe'er enjoys th' untroubled breast,
      With Virtue's tranquil wisdom blest,
      With hope the gloomy hour can cheer,
      And temper happiness with fear."


When we look abroad amongst mankind—nay, even in the contracted
sphere of our own experience—it is interesting to observe the varied
current of human life in different cases. In some, from the cradle
to the grave, life has been beset with difficulties; it has been a
continued struggle; the breath seems to have been first drawn, and
finally yielded up, amidst the multifarious oppositions and agitations
of adversity. In other instances, life seems like an easy, smoothly
gliding stream, gently bearing Man on to what had appeared to be the
haven of his wishes; and the little voyage has been begun and completed
without the appearance of a ripple. All varieties are, no doubt, the
result of constantly operating laws. Of these, many are probably
inscrutable by us; many more, no doubt, escape our observation. The
unforeseen nature of many events confers the character of mystery on
any attempt at foresight; yet, when we take a careful retrospect of
a life, it is curious to observe how naturally the secondary causes
appear to have produced the results by which they were followed; but
which, beforehand, no one had thought of predicting.

Varied, however, as is the course of human life, few men have
arrived at eminence without difficulty. We do not mean that ephemeral
prominence of "position" which makes them marked in their day;
but that which leaves the impression of their minds on the age in
which they lived, or on the science or other pursuit which they had
chosen—original minds, who have enlarged the boundaries of our
knowledge. Such men usually have the ample gifts of nature with
which they are endowed, somewhat counterbalanced by the difficulty
experienced in the successful application of them.

Abernethy had not been altogether exempt from such difficulties. With
a sensitive organization, he had had to make his own way; he had
experienced the difficulties which attend the advocacy of opinions
and principles which were opposed to, or at all events different
from, those generally entertained. He had had to encounter that
misconstruction, misrepresentation, ridicule, even malice—save the
mark!—which are too frequently provoked by any attempts to tell people
that there is something more correct than the notions which they have
been accustomed to value. Still, when we compare Abernethy's course
with that of _many_—we had almost said _most_—benefactors to science,
he might be said to have been a fortunate man. If a man has power, and
a "place to stand on"—and Abernethy had both—truth will tell at last.

A retired spot, a room in an obscure street, near St. Bartholomew's,
had been by his unaided talents expanded into a theatre within the
walls of the hospital. This was becoming again crowded; and, although
it formed a satisfactory arena for the development and illustration of
his principles, the increasing audiences were significant of the coming
necessity of a still larger building; which was, in fact, a few years
afterwards, constructed. He had indeed arrived, as we imagine, at a
point which was comparatively smooth water, and which we are inclined
to regard as the zenith of his career.

In the opening of his beautiful lectures at the College, Abernethy,
in one of his warm and earnest endeavours to animate his audience to
regard benevolence, and the love of truth, as the impulses which could
alone urge on, and sustain, industry in cultivating the "Science" of
our profession, had observed that, "unfortunately, a man might attain
to a considerable share of public reputation without being a real
student of his profession." There have been indeed too many examples
of that, as also of those who, after years of labour, have failed to
obtain a scanty living.

Abernethy had been a real and laborious student in science, and he
was now reaping an abundant and well-deserved fruition. Few surgeons
have arrived at a position so calculated to satisfy the most exacting
ambition. Although the full extent and bearing of his principles were
by no means universally understood, yet the general importance of them
was so, and in some measure appreciated. In a greater or less degree,
they were answering the tests afforded by the bedside in all parts of
the world.

Ample, therefore, as might be the harvest he was reaping in a large
practice, he was enjoying a still higher fruition in the kind of
estimation in which he was held. He had a high reputation with
the public; one still higher amongst men of science. His crowded
waiting-room was a satisfactory evidence of the one, and the manner in
which his name was received here, on the Continent, and in America, a
gratifying testimony of the other. He was regarded much more in the
light of a man of enlarged mind—a medical philosopher—than merely as
a distinguished surgeon.

From the very small beginnings left by Mr. Pott, he had raised the
school of St. Bartholomew's to an eminence never before attained by
any school in this country. I think I may say that, in its _peculiar
character_, it was at that time (1816) unrivalled.

Sir Astley Cooper was in great force and in high repute at this time;
and, combining as he did the schools of _two_ large hospitals, had, I
believe, even a larger class. Both schools, no doubt, endeavoured to
combine what is not, perhaps, very intelligibly conveyed by the terms
practical and scientific; but the universal impression, assigned the
latter as the distinguishing excellence of Mr. Abernethy, whilst the
former was held to express more happily the characteristic of his
eminent contemporary.

Whatever school, however, a London student might have selected as
his Alma Mater, it was very common for those whose purse, time, or
plans permitted it, to attend one or more courses of Abernethy's
lectures; and it was pleasing to recognize the graceful concession to
Mr. Abernethy's peculiar excellence afforded by the attendance of some
of Sir Astley's pupils, and his since distinguished relatives, at the
lectures of Abernethy.

As I have said, his practice was extensive, and of the most lucrative
kind; that is, it consisted largely of consultations at home. Still, he
had patients to visit, and, as he was very remarkable for punctuality
in all his appointments, was therefore not unfrequently obliged to
leave home before he had seen the whole of those who had applied to
him. The extent of his practice was the more remarkable, as there was
a very general impression, however exaggerated it might be, that his
manners were unkind and repulsive. His pupils were enthusiastically
fond of him; and it was difficult to know which was the dominant
feeling—their admiration of his talents, or their personal regard.

Some of the most distinguished men had been of their number; and it
would be gratifying to us to enumerate the very complimentary catalogue
of able men who have been indebted for much of their eminence and
success to the lessons of Abernethy; but as, in doing so, we might
possibly, in our ignorance, omit some names which ought to be recorded,
we forego this pleasure, lest we should unintentionally appear to
neglect any professional brother whom we ought to have remembered.

In 1812-13, the pupils had presented Mr. Abernethy with a piece of
plate, "as a testimony of their respect and gratitude." The arrangement
of the matter was confided chiefly to the present Sir James Eyre, Mr.
Stowe of Buckingham, and Mr. George Bullen. In a very interesting
letter, with which I have been favoured by Mr. Stowe, amongst other
matters hereafter to be mentioned, it is stated that the plate was
delivered at Abernethy's house on the 1st of April; and as he had no
more entirely escaped such things than other medical men, he at first
regarded it as a hoax. But when the contents were exposed, and he
discovered the truth, he became much affected.

The regard of the pupils was always the thing nearest his heart. On
meeting the class at the hospital, he essayed to express his feelings;
but finding that he should only break down, he adopted the same course
as he had employed on another memorable occasion, and _wrote_ his
acknowledgments, a copy of which was suspended against the wall of the
theatre.

It is due to our worthy and kind-hearted contemporary, Sir James Eyre,
to add that Mr. Stowe observes in his letter, that, of all others, Sir
James was the most zealous promoter of a movement so creditable to all
parties. Some years after this, another subscription was commenced by
the pupils for a portrait of Abernethy, which was painted by Sir Thomas
Lawrence, and engraved by Bromley. It was after this engraving that
Mr. Cook executed the portrait which forms the frontispiece of the
present volume. Sir Thomas, and the engraver after him, have been most
successful. He has caught one of Mr. Abernethy's most characteristic
expressions. We see him as he often stood when addressing the
_anatomical_ class. We think it impossible to combine more of of him
in one view. We fancy we see his acute penetration, his thoughtful
expression, his archness and humour, and his benevolence, all most
happily delineated, whilst the general position and manner is eminently
faithful. In his surgical lectures, he was generally seated; and in
the lithograph, he is represented in the position which he almost
invariably assumed when he was enunciating the proposition which is
placed beneath the engraving. It is the work of a young artist who was
considered to evince great promise of future excellence; but who, we
regret to say, died last year—Mr. Leighton.

In 1815, he had been appointed surgeon to the hospital, after
twenty-eight years' tenure of the assistant surgeoncy; a subject that
we merely mention now, as we shall be obliged to revert to it when we
consider the subject of the "Hospital System."

At the time to which we allude, lecturing had become so easy as to
appear little more than amusement to him; yet there were (we speak of
about 1816) no signs of neglect or forgetfulness. His own interest in
the subject was sustained throughout; but as his unrivalled lecturing
will be more fully described, we must not anticipate. Few old pupils
visited London without contriving to get to the hospital at lecture
time. The drudgery of the early morning anatomical demonstration was
taken off his hands by a gentleman who performed his task with credit
to himself and with justice to his pupils.

Abernethy, at this time, in addition to a successful school, a large
and attached class, a solid and world-wide reputation, was receiving
numerous proofs that his principles were recognized; that, however
imperfectly adopted, they were gaining ground; and that if all his
suggestions were not universally admitted, they were becoming axiomatic
with some of the first surgeons, both in this and other countries.

We think it not improbable that it was somewhere about this period
that it was proposed to confer on him the honour of a Baronetcy. We
had long been familiar with the fact; but not regarding it as very
important, and having nothing in proof of it but the generally received
impression, we omitted any reference to it in the first edition
of these Memoirs. Finding, however, more interest attached to the
circumstance than we expected, we have communicated with the family on
the subject, and have ascertained that all the circumstances are fresh
in their recollection, although they cannot recall the exact period at
which they occurred.

His first announcement of the fact to his family was at table, by his
jocosely saying: "Lady Abernethy, will you allow me to assist you
to—?" &c. Having had his joke, he then formally announced to them
the fact, together with the reasons which had induced him to decline
the proffered honour—namely, that he did not consider his fortune
sufficient, after having made what he regarded as only a necessary
provision for his family.

It is probable that his motives were of a mixed character. We do not
believe that he attached much value to this kind of distinction, and
that, had he availed himself of the offer, it would have been rather
from a kind of deference to the recognition it afforded of the claims,
and thus indirectly promoting the cultivation of Science, than for
any other reason. It was not but that he held rank and station in the
respect which is justly due to them; but that he regarded titles as
no very certain tests of scientific distinction. Enthusiastic in his
admiration of intellectual, still more of moral excellence, he had
something scarcely less than coldness in regard to the value of mere
titles; whilst he beheld, with something like repulsion, the flattery
to which their possessors were so often exposed.

There are men who have so individualized themselves that they seem
to obscure their identity by any new title. John Hunter was scarcely
known by any less simple appellation. We hardly now say "_Mr._" Hunter
without feeling that we may be misunderstood. It begins to have a sound
like "Mr." Milton or "Mr." Shakspeare; Abernethy and John Abernethy are
fast becoming the only recognized designations of our philosophical
surgeon, for even the modest prefix of _Mr._ is fast going into disuse.
Be this as it may, it is certain he declined the honour; and to us it
is equally so that he felt at least indifferent to it; for although
the good sense and good feeling implied in the reasons alleged were
characteristic, yet, had they constituted the only motive, he might,
with his abundant opportunities, have removed that objection in a very
reasonable time, without difficulty.

It is perhaps significant of the measured interest with which
Mr. Abernethy regarded the acquisition of a Baronetcy, that the
family could not recollect the period at which it was offered. This
information, however, I obtained from Sir Benjamin Brodie, who has
kindly allowed me to record the fact in the following reply to my
inquiry on the subject.

  "14, Saville Row,
  "November 16, 1854.

  "MY DEAR SIR,

    "My answer to your inquiry may be given in a very few words. I
    perfectly well remember the having been informed by the late Sir
    John Becket that he had been commissioned by Lord Liverpool to
    offer Mr. Abernethy, on the part of the Crown, the honor of being
    created a Baronet, which, however, Mr. Abernethy declined.

  "I am, dear SIR,
  "Yours faithfully,
  "B. C. BRODIE.

  "G. MACILWAIN, Esq."

He told me once of an interview he had with Lord Castlereagh, which
may, perhaps, be not out of place here. When Sir T. Lawrence was
painting the portrait, and Abernethy went to give him a sitting,
Abernethy was shown into a room where another visitor, a stranger to
him, was also waiting. The stranger, looking at a portrait of the Duke
of York, observed, "Very well painted, and very like." "Very well
painted," Abernethy replied. The other rejoined: "A good picture, and
an excellent likeness." "A very good picture," said Abernethy. "And
an excellent likeness," again rejoined his companion. "Why, the fact
is," said Abernethy, "Sir Thomas has lived so much amongst the great,
that he has learnt to flatter them most abominably." On being shown in
to Sir Thomas, Sir Thomas said: "I find you have been talking to Lord
Castlereagh."

He had not, we think, as yet sustained the loss of any member of his
family, nor hardly experienced any of those ordinary crosses from
which few men's lives are free, and which, sooner or later, seldom
fail to strew our paths with enough to convince us that perfect peace
cannot be auspiciously sought in the conduct of human affairs. He
was soon, however, to receive an impression of a painful nature,
and from a quarter whence, whatever might have been his experience,
he certainly little expected it. Long accustomed to be listened to
by admiring and assenting audiences, whether in the theatre of the
hospital, or in those clusters of pupils which never failed to crowd
around him whenever he had anything to say; he was now to have some of
his opinions disputed, his mode of advocating them impugned, his views
of "Life," made the subject of ridicule, and even his fair dealing
in argument called in question. All this, too, by no stranger; no
person known only to him as one of the public, but by one who had been
his pupil, whose talents he had helped to mature and develop, whose
progress and prospects in life he had fostered and improved, and to
whom, as was affirmed by the one, and attested by the other, he had
been a constant friend.

That this controversy was the source of much suffering to Abernethy, we
are compelled to believe; and it is altogether to us so disagreeable,
and difficult a subject, that we should have preferred confining
ourselves to a bare mention of it, and a reference to the works
wherein the details might be found; it is, however, too important an
episode in the life of Abernethy to be so passed over; it suggests
many interesting reflections; it exhibits Abernethy in a new phase,
illustrates, under very trying circumstances, the

                  "Virtus repulsæ nescia
      Intaminatis fulget honoribus,"

and brings out in stronger relief than any other transaction of his
life the best and most distinctive traits of his character (benevolence
and Christian feeling), under temptations which have too frequently
disturbed the one, and destroyed the other.




CHAPTER XVIII.

    "Opinionum commenta delet dies, naturæ judicia confirmat."—CICERO.

    "Time, which obliterates the fictions of opinion, confirms the
    decisions of nature."


Whoever has wandered to the south side of Lincoln's Inn Fields,
will have found himself in one of the "solitudes of London"—one
of those places which, interspersed here and there amidst the busy
current that rushes along every street and ally, seem quite out
of the human life-tide, and furnish serene spots, a dead calm, in
the midst of tumult and agitation. Here a lawyer may con over a
"glorious uncertainty," a surgeon a difficult case, a mathematician
the general doctrine of probability, or the Chevalier d'Industrie
the particular case of the _habitat_ of his next dinner; but, unless
you have some such need of abstraction from the world, these places
are heart-sinkingly dull. You see few people; perhaps there may be a
sallow-looking gentleman, in a black coat, with a handful of papers,
rushing into "chambers;" or a somewhat more rubicund one in blue,
walking seriously out: the very stones are remarkably round and
salient, as if from want, rather than from excess, of friction. The
atmosphere from the distance comes charged with the half-spent, booming
hum of population.

Immediately around you, all is comparatively silent.

If you are in a carriage, it seems every moment to come in contact with
fresh surfaces, and "beats a roll" of continued vibrations; or, if a
carriage happen to pass you, it seems to make more noise than half
a dozen vehicles anywhere else. You may observe a long façade, of
irregular elevations—upright parallelograms, called habitable houses;
but, for aught you see, half of them may have been deserted: the dull
sameness of the façade is broken only by half a dozen Ionic columns,
which, notwithstanding their number, seem very serious and very
solitary. You may, perhaps, imagine that they bear a somewhat equivocal
relation to the large house before which they stand. You may fancy them
to be architectural relics, inconveniently large for admission to some
depository within, or that they are intended as a sort of respectable
garniture to the very plain house which they partly serve to conceal
or embellish; or quiz them as you please, for architects cannot do
everything, nor at once convert a very ugly house into a very beautiful
temple.

But, stop there!—for temple it is—ay, perhaps, as human temples
always are, not altogether unprofaned; but not so desecrated, we trust,
but that it may yet contain the elements of its own purification. It
enshrines, reader, a gem of great value, which nothing extrinsic can
improve, which no mere art can embellish—a treasure gathered from the
ample fields of nature, and which can be enriched or adorned only from
the same exhaustless store. Though humble, indeed, the tenement, yet,
were it humbler still, though it were composed of reeds, and covered in
with straw, it would remain hallowed to science.

It holds the monument of the untiring labour of a great master—the
rich garnerings of a single mind—the record, alas! but of _some_ of
the obligations mankind owe to the faithful pioneer of a Science which,
however now partially merged in clouds and darkness, and obscured by
error, still exhibits through the gloom, enough to assert its lofty
original, and to foster hopes of better times.

The museum of John Hunter (for it is of that we write) is one of the
greatest labours ever achieved by a single individual. To estimate that
labour aright, to arrive at a correct notion of the man, the spectator
should disregard the number of preparations—the mass of mechanical
and manipulatory labour which is involved—the toil, in fact, of mere
collection; and, looking through that, contemplate the _thought_ which
it records; the general nature of the plan; the manner in which the
Argus-eyed Author has assembled together various processes in the
vegetable creation; how he has associated them with their nearest
relations in the animal kingdom; and how he has traced the chain from
link to link, from the more simple to the more compounded forms, so
as to throw light on the laws dispensed to Man. The spectator should
then think of the Hunterian portion of the museum as the exhausting
harvest of half a life, blessed with no greatly lengthened days; a
museum gathered not in peaceful seasons of leisure, nor amid the ease
of undiverted thought, but amidst the interrupting agitations of a
populous city—the persistent embarrassments of measured means—the
multiform distractions of an arduous profession—the still more serious
interruptions of occasional indisposition—and, finally, amidst
annoyances from quarters whence he had every right to expect support
and sympathy—annoyances which served no other purpose but to embitter
the tenure of life, and to hasten its termination.

Our space will not allow us to dwell more on this subject or the Museum
just now. But where is our excellent conservator—where is Mr. Clift,
the assistant, the friend, and young companion of John Hunter? He,
too, is gathered to his rest. He, on whose countenance benevolence
had impressed a life-long smile—he who used to tell us, as boys, so
much of all he knew, and to remind us, as men, how much we were in
danger of forgetting—is now no more. How kind and communicative he
was; how modest, and yet how full of information; how acceptably the
cheerfulness of social feelings mantled over the staid gravity of
science. How fond of any little pleasant story to vary the round of
conservative exposition; and then, if half a dozen of us were going
round with him the "_con_ticuere omnes," when, with his characteristic
prefatory shrug, he was about to speak of Hunter. Then such a memory!
Why once, in a long delightful chat, we were talking over the Lectures
at the College, and he ran over the general objects of various courses,
during a succession of years, with an accuracy which, if judged of
by those which had fallen within our own recollection, might have
suggested that he had carried a syllabus of each in his pocket.

We had much to say of Mr. Clift; but, in these times of speed, there is
hardly time for anything; yet we think that many an old student, when
he has lingered over the stately pile reared by John Hunter, may have
paused and felt his eyes moistened by the memory of William Clift.

When Mr. Abernethy lectured at the College, there was no permanent
professor, as is now the case; no Professor Owen, of whom we shall have
to speak more in the sequel. Both the professorship of anatomy and
surgery, and also that of comparative anatomy, were only held for a
comparatively short time.

It is not very easy to state the principle on which the professors were
selected. The privilege of addressing the seniors of the profession has
never, any more than any other appointment in the profession, been the
subject of public competition; nor, unless the Council have had less
penetration than we are disposed to give them credit for, has "special
fitness" been a very dominant principle. Considering the respectability
and position of the gentlemen who have been selected, the Lectures at
the College of Surgeons, under the arrangements we are recording, were
certainly much less productive, as regards any improvement in science,
than might have been reasonably expected.

The vice of "system" could not be always, however, corrected by the
merits of the individual. One result, which too commonly arose out of
it, was, that gentlemen were called on to address their seniors and
contemporaries for the first time, who had never before addressed any
but pupils. It would not, therefore, have been very wonderful, if,
amongst the other difficulties of lecturing, that most inconvenient one
of all should have sometimes occurred, of having nothing to say.

Mr. Abernethy was appointed in 1814, and had the rare success of
conferring a lustre on the appointment, and the perhaps still more
difficult task of sustaining, before his seniors and contemporaries,
that unrivalled reputation as a lecturer which he had previously
acquired. As Mr. Abernethy had been all his life teaching a more
scientific surgery, which he believed to be founded on principles
legitimately deducible from facts developed by Hunter; so every
circumstance of time, place, and inclination, disposed him to bring
Mr. Hunter's views and opinions under the review of the audience at the
College, composed of his seniors, his contemporaries, and of pupils
from the different schools. He was, we believe, equally desirous of
disseminating them amongst the one class, and of having them considered
by the others. At this time, no lectures of Mr. Hunter had been
published; and Mr. Abernethy thought that, _to understand_ Hunter's
opinions of the _actions_ of living bodies, it was expedient that
people should have some notion of what Mr. Hunter considered to be the
general nature of—"Life."

We hold this point to be very important; for all experience shows that
speculation on the abstract nature of things is to the last degree
unprofitable. Nothing is so clear in all sciences as that the proper
study of mankind is the Laws by which they are governed. Yet we cannot,
in any science, proceed without something to give an intelligible
expression to our ideas; which _something_ is essentially hypothetical.

If, for example, we speak of light, we can hardly express our ideas
without first supposing of light that it is some subtle substance sent
off from luminous bodies, or that it consists in undulations; as we
adopt the corpuscular or undulatory theory. It would be easy to form a
third, somewhat different from either, and which would yet pretend to
no more than to give a still more intelligible expression to phenomena.

Now this is, as it appears to us, just what Mr. Abernethy did. He did
not speculate on the nature of life for any other reason than to give
a more intelligible expression to Mr. Hunter's other views. At that
time there was nothing _published_, showing that Mr. Hunter's ideas
of life were what Mr. Abernethy represented them to be; they might
have been remembered by men of his own age, but this was not very
good for controversy; and as that was made a point of attack[35], it
is well that the since collected "Life and Lectures of John Hunter,"
by Mr. Palmer, have given us a written authority for the accuracy of
Abernethy's representations.

In theorizing on the cause of the phenomena of living bodies, men have,
at different times, arrived at various opinions; but although not so
understood, it seems to us that they all merge into two—the one which
supposes Life to be the result of organization, or the arrangement
of matter; the other, that the organization given, Life is something
superadded to it; just as electricity or magnetism to the bodies with
which these forces may be connected. The latter was the opinion which
Mr. Abernethy advocated as that held by Mr. Hunter, and which he
honestly entertained as most intelligibly and rationally, in his view,
explaining the phenomena.

That such were really the views held by Mr. Hunter, a few passages
from the work, as published by Mr. Palmer, will show. "Animal and
vegetable substances," says Mr. Hunter, "differ from common matter
in having a power superadded totally different from any other known
property of matter; out of which various new properties arise[36]."
So much for a general view. Next, a reference to particular powers:
"Actions in animal bodies have been so much considered under a chemical
and mechanical philosophy, that physiologists have entirely lost
sight of Life;" again showing how correctly Abernethy had interpreted
Hunter's notion of the necessary "Key," as Abernethy phrased it, to
his views; Hunter says: "For unless we consider Life as the immediate
cause of attraction occurring in animals and vegetables, we can _have
no just conception_ of animal and vegetable matter[37]." Mr. Hunter,
in relation to the idea of life being the result of organization,
shows how faithful an exposition Abernethy had given of his views. "It
appears," says he, "that the Living Principle cannot arise from the
peculiar modification of matter, because the same modification exists
where this principle is no more."—Vol. i, p. 221. And in the same
page: "Life, then, appears to be something superadded to this peculiar
modification of matter."

Then as to one of the illustrations employed by Abernethy, Hunter,
after saying that he is aware that it is difficult to conceive
this superaddition, adds: "But to show that matter may take on new
properties without being altered itself as to the species of matter,
it may not be improper to illustrate this. Perhaps magnetism affords
the best illustration. A bar of iron, without magnetism, may be
considered as animal matter without life. With magnetism, it acquires
new properties of attraction and repulsion," &c.

Mr. Abernethy, as we have said, advocated similar views; and, we
repeat, founded his reason for so doing on what he conceived to be
the necessity of explaining Mr. Hunter's ideas of life, _before he
could render_ his (Hunter's) _explanation_ of the various phenomena
intelligible. In all of this, he certainly was expressing Mr. Hunter's
own views, with that talent for ornamenting and illustrating everything
he discussed, for which he was so remarkable.

Abernethy multiplied the illustrations by showing the various analogies
which seemed to him to be presented in the velocity, the chemical, and
other powers of Life and Electricity; and, with especial reference
to the extraordinary discoveries of Sir Humphrey Davy, added such
illustrations, as more recent achievements in chemical science had
placed within his grasp; and thence concluding it as evident that some
subtile, mobile, invisible substance seemed to pervade all nature,
so it was not unreasonable to suppose that some similar substance or
power pervaded animal bodies. He guarded himself, however, both in his
first and again in his second Course of Lectures, from being supposed
to identify Life with electricity, in a long paragraph especially
devoted to that object. In his second Course, in 1815, he proceeded to
enumerate John Hunter's various labours and contributions to science,
as shown by the Museum; imparting great interest to every subject, and
in so popular a form, that we wonder now, when (as we rejoice to see)
there are some small beginnings of a popularization of physiology, that
there is not a cheap reprint of these Lectures.

Keeping, then, his object in view, we cannot see how, as a faithful
interpreter of John Hunter, Abernethy could have done less; and if
any theory of life at all is to be adopted, as _necessary to give an
intelligible impression_ to phenomena, one can hardly quarrel with
that which takes the phenomena of life on one hand, and those of death
on the other, as the means of expressing our ideas. When we see a man
dead, whom we had contemplated alive, it certainly seems that something
has left him; and whether we say "something superadded,"—the "breath"
or "Life," or by whatever term we call it,—we appear really to express
in as simple a form as possible the facts before us. It seems to us
that, after all, John Hunter did little more; for the illustration
or similitude by which we endeavour to render an idea clear, has in
strictness nothing _necessarily_ to do with the idea itself; any more
than an analogy, however real the likeness, or a parallelism, however
close, represents identity.

We should have thought it, therefore, of all things in the world the
least likely that a representation of any theory of Hunter's should
have disturbed the harmony which ought to exist between men engaged
in scientific inquiries. It shows, however, the value of confining
ourselves as strictly as possible to phenomena, and the conclusions
deducible from them. Nothing could possibly be more philosophical than
the terms in which Mr. Abernethy undertook to advocate Mr. Hunter's
views of life. His definitions of hypothesis, the conditions on which
he founded its legitimate character, the modesty with which he applies
it, and the clearness with which he states how easily our best-grounded
suppositions may be subverted by new facts, are very lucid and
beautiful, and give a tone to the lectures (as we should have thought)
the very last calculated to have led to the consequences which followed.

[Footnote 35: "For this Hunterian Theory of Life, which its _real_
author so stoutly maintains, &c. is nowhere to be found in the
published writings of Mr. Hunter."—_See Lawrence's Two Lectures
(Notes)._]

[Footnote 36: Vol. i, p. 214. Note.]

[Footnote 37: Vol. i, p. 217.]




CHAPTER XIX.

      "Oft expectation fails, and most oft there
      Where most it promises."

      ALL'S WELL THAT ENDS WELL.


No man, perhaps, ever made a happier application of a Divine precept to
the conduct of human pursuits than Lord Bacon, when he said that the
kingdom of man founded in the sciences must be entered like the kingdom
of God—that is, as a little child.

Independently of the sublimity of the comparison, it is no less
remarkable for its practical excellence.

How many broken friendships, enmities, and heart-burnings might have
been prevented, had even a very moderate degree of the temper of
mind here so beautifully typified been allowed to preside over human
labour! How charitably should we have been led to judge of the works
of others! how measured the approbation of the most successful of our
own! No doubt, in the pursuit of truth, there is great difficulty in
commanding that combination of fearlessness towards the world, and
that reverential humility towards the subject, both of which are alike
necessary; although the one may be more essential to the _discovery_ of
truth, the other the _enunciation_ of it.

To pursue truth regardless of the multiform errors and
conventionalisms, amidst which experience has generally shown almost
all subjects to have been involved; unmindful of the rebukes and
obloquy by which too often the best-conducted investigations are
opposed and assailed; and yet to let no angry passion stir, no
conviction that we are right engender an improper idea of our own
superiority, or a disregard for the claims of others; this overcoming
of the world (we had almost said) is intensely difficult, for it is
in fact overcoming ourselves. Yet we dare not say it is that of which
human nature is incapable, for there is nothing that the heart suggests
as morally right which is really impossible to us; and instances have
not been wanting of the combination of the deepest knowledge with the
most profound humility.

On the other hand, it must be admitted that if there were anything
especially calculated to bring down the cultivators of science and
literature to the level of those who are regardless of the claims, or
insensible to the attractions of either; we could hardly find a series
of facts more fatally influential than are furnished by the disputes
of men who have been employed in the cultivation of these elevating
studies. Powerful intellects in teaching the comparative nothingness
of man's knowledge seem to give great assistance in the acquisition
of humility; but how few are the intellects of such power? The
contemplation of nature, however, may, we conceive, infuse _feelings_
of humility, which can rarely be attained by the efforts of intellect
alone.

We have seen, in Lord Bacon, that the highest powers of intellect
afforded for a while no security against the subtle, but one would have
thought feeble, suggestions of a degrading cupidity. We all know, in
literature, how much the fruits of intellect depend on the dominant
feeling under which they are reared and nourished. Even men like Pope
and Addison, who had little in common but that which should elevate and
adorn human nature, were so dragged down by the demon of controversy,
that, commencing with little more than the irritability of poets, they
ceased only when they had forgotten even the language of gentlemen.
In the controversy in question, Mr. Abernethy's position was a very
difficult one, and one which shows how easily a man with the best
intentions may find himself engaged in a discussion which he never
contemplated; be wounded on points on which he was most sensitive, and
yet defend himself with dignity, and without compromise of any of those
principles which should guide a gentleman and a Christian.

Mr. Lawrence was appointed Professor of Comparative Anatomy in 1816;
and we know that Mr. Abernethy hailed his appointment with considerable
interest. He was regarded as a gentleman of some promise, and had
already distinguished himself by a singularly nice, level style of
composition, as well as by careful compilation.

Nothing could seem more auspicious than such a prospect. Mr. Abernethy
was a man remarkable for the original view he took of most subjects;
a vast experience, gathered from various sources by a mind combining
vividly perceptive powers with great capacity for reflection, a
conformation well adapted for opening out _new paths, and extending
the boundaries of science_. Abernethy was now to be associated with
a colleague who had already manifested no ordinary talent for the
graceful and judicious exposition of what _was already known_.

Nothing could have seemed more promising; nor was there anything in
the opening of Mr. Lawrence's first lecture which seemed calculated
to baulk these expectations. His exordium contained an appropriate
recognition of Mr. Abernethy, which, as we should only mar it by
extract, we give entire. Having referred to the circumstances which
immediately preceded his appointment, Mr. Lawrence thus proceeds:

"To your feelings I must trust for an excuse, if any be thought
necessary, for taking the earliest opportunity of giving utterance to
the sentiments of respect and gratitude I entertain for the latter
gentleman (Mr. Abernethy). You and the public know, and have long
known, his acute mind, his peculiar talent for observation, his
zeal for the advancement of surgery, and his successful exertions
in improving the scientific knowledge and treatment of disease; his
singular happiness in developing and teaching to others the original
and philosophic views which he naturally takes of all subjects that
come under his examination, and the success with which he communicates
that enthusiasm in the cause of science and humanity which is so warmly
felt by himself; the admirable skill with which he enlivens the dry
details of elementary instruction are most gratefully acknowledged by
his numerous pupils.

"All these sources of excellence have been repeatedly felt in this
theatre. Having had the good fortune to be initiated in the profession
by Mr. Abernethy, and to have lived for many years under his roof,
I can assure you, with the greatest sincerity, that however highly
the public may estimate the surgeon and philosopher, I have reason to
speak still more highly of the man and of the friend, of the invariable
kindness which directed my early studies and pursuits, and the
disinterested friendship which has assisted every step of my progress
in life, the independent spirit and the liberal conduct which, while
they dignify the profession, win our love, command our respect for
genius and knowledge, converting these precious gifts into instruments
of the most extensive public good[38]."

This graceful exordium, so appropriate to the mutual relations of Mr.
Abernethy and Mr. Lawrence, deriving, too, a peculiar interest from the
circumstances under which it was delivered, had also the rare merit
of an eulogium marked by a comprehensive fidelity. There is nothing
fulsome or overstrained. Mr. Abernethy's well-known excellences were
touchingly adverted to as matters with which all were _in common_
familiar, whilst the necessarily more special facts of his social
virtues were judiciously brought out in just relief, and as an
appropriate climax, by one who appeared animated by a grateful and
personal experience of them. It is distressing to think that anything
should have followed otherwise than in harmony with that kindness and
benevolence which, whilst it forms the most auspicious tone for the
calm pursuits of philosophy, confers on them the purifying spirit of
practical Christianity.

Mr. Lawrence's first lecture consisted mainly of an able and
interesting _exposé_ of the objects and advantages of Comparative
Anatomy to the physiologist, pathologist, medical man, and the
theologian; together with numerous references to those authors to
whom the science was most indebted. The second lecture was devoted
to the consideration and the discussion of various views which had
been entertained of the living principle, or by whatever name we may
designate that force which is the immediate cause of the phenomena of
Living Bodies.

Amongst others, those entertained by Mr. Hunter and advocated by Mr.
Abernethy were referred to; but in a tone which was not, perhaps, best
suited to promote calm discussion, and which we may be allowed to
say was unfortunate—a tone of ridicule and banter, which was hardly
suited either to the subject, the place, or the distinguished men to
whom it related; to say the least of it, it was unnecessary. We do not
quote these passages, because they are, we think, not necessary to the
narrative, and could, we think, now give no pleasure to any party[39].

In Mr. Abernethy's next lecture at the College, he still advocated
the rational nature of Mr. Hunter's views of Life; and, in a most
interesting exposition of the Gallery of the Museum, opposed at every
opportunity the views of certain French physiologists which Mr.
Lawrence had adopted.

He did this, however, without naming Mr. Lawrence; and applied his
remarks to the whole of those who had advocated the opinions that Life
was the result of organization, as a "Band of modern sceptics."

Mr. Abernethy had, as he says, argued against a party, and studiously
kept Mr. Lawrence, as an individual, out of view. He, however, argued
roundly against the views advocated by him, and endeavoured to show
that those of Mr. Hunter, besides being at least a philosophical
explanation of the phenomena, had a good moral tendency; although he
admitted that the belief that man was a mere machine did not alter
established notions, and that there were many good sceptics, still he
thought that the "belief of the distinct and independent nature of mind
incited people to act rightly," &c.

In regard to the general influence of the state of France, he says,
"Most people think and act with a party;" and that "in France, where
the writings of the philosophers and wits had greatly tended to
demoralize the people, he was not surprised that their anatomists and
physiologists should represent the subject of their studies in a manner
conformable to what is esteemed most philosophical and clever; but
that in this country the mere opinions of some French anatomists with
respect to the nature of life should be extracted from their general
writings, translated, and extolled, cannot but excite surprise and
indignation in any one apprized of their pernicious tendency."

There is no doubt that there was at the time, in this country, a
disposition in many people to disseminate very many opinions on various
subjects different from those usually entertained; and we believe that
this disposition was very greatly increased by the well-intentioned, no
doubt, but in our view injudicious, means employed for the suppression
of them.

We think it important to remember this; because, in estimating fairly
any books or lectures, we must regard the spirit of the time in which
they were delivered—what would be judicious or necessary at one
period, being, of course, unnecessary or injudicious at another.

In relation to the opinions of the nature of life; that which Mr.
Abernethy alleged that he intended to apply to a party, Mr. Lawrence
alleged that he held as personally applying to himself. Accordingly,
the following course of Mr. Lawrence's lectures commenced with "A
Reply to the 'Charges' of Mr. Abernethy." This lecture, which it is
impossible for any man, mindful of all the circumstances, to peruse
without pain (especially if we include the notes), is couched in
language of the most vituperative and contemptuous character: sarcasm,
ridicule, imputation of corrupt motives, by turn, are the weapons
wielded with the appearance of the most unrelenting virulence.

Those of the audience who had heard the graceful exordium, which
we have quoted, to the first course of lectures, and which so
appropriately represented a just tribute to a great master and kind
friend, from a distinguished and favoured pupil, were now to listen to
a discourse which was so charged with various shades and descriptions
of ridicule and invective, as scarcely to be paralleled in the whole
history of literary or scientific controversy. We have recently again
perused the respective Lectures, and we are utterly at a loss to
understand how the most sensitive mind could have found anything in
Mr. Abernethy's Lectures to call for such a "Reply." As it appears
to us, its very virulence was calculated to weaken its force, and
to enlist the sympathies of people on the opposite side. We again
forbear quotation. All we have to do is to show that circumstances of
very unusual provocation, such as no man living could help feeling
most deeply, and which bore on one who was acutely sensitive, never
materially disturbed the native benevolence of Abernethy's disposition.

The dispute, however, soon merged into matters which the public
regarded as more important. Mr. Lawrence, in the lectures which
followed, took occasion to make some remarks on the Scriptures, which
gave great offence, and led other writers to engage in a controversy
which now assumed more of a theological than a physiological character.
This, however, rather belongs to the writings and opinions of Mr.
Lawrence, than to the life of Abernethy. We will therefore at once
offer the very few observations which we alone think it necessary to
make, either in justice to Mr. Abernethy or the profession.

[Footnote 38: March, 1816. Introductory Lecture to Comparative Anatomy.
Published, July.]

[Footnote 39: Introduction to Comp. Anat. by W. Lawrence, F.R.S.
London, 1816.]




CHAPTER XX.

                    "Love all, trust a few,
      Do wrong to none: be able for thine enemy
      Rather in power than use; and keep thy friend
      Under thine own Life's key: be check'd for silence,
      But never tax'd for speech. What Heaven more will,
      That thee may furnish, and my prayers pluck down,
      Fall on thy head!"

      ALL'S WELL THAT ENDS WELL.


In reviewing the facts of the foregoing controversy, we are anxious to
restrict our remarks to such points as fall within the proper scope of
our present object. These appear to us to relate to the mode in which
Mr. Abernethy conducted his argument, as being legitimate or otherwise;
secondly, the influence the whole affair had in developing one of the
most important features in his character; and, lastly, the impression
it produced, for good or evil, on the public mind, in relation to our
profession.

We would observe, in the first place, that the difficulty of Mr.
Abernethy's position was very painful and peculiar. We are not learned
in controversy; but we should imagine that position to have been almost
without parallel. Mr. Lawrence had been his pupil. As we have seen,
Mr. Abernethy had been his patron and his friend; and, moreover, he
had been not a little instrumental in placing Mr. Lawrence in the
Professor's chair. This instrumentality could not have been merely
passive. Mr. Abernethy himself was not a senior of the Council at that
time. At all events, he was associated at the College with men much
older than himself, and must have owed any influence in the appointment
to an active expression of his wishes, supported by that attention
to them which, though not necessarily connected with his standing at
the College, was readily enough, no doubt, conceded to his talents
and his reputation. His singleness of mind in this business was the
more amiable, because, had he been disposed to be inactive, there were
not wanting circumstances which might not unnaturally have induced
some hesitation on the subject. In the postscript at the end of Mr.
Abernethy's published Lectures, delivered at the College, we learn
that, "From an early period of his studies, Mr. Lawrence had been
accustomed to decry and scoff at what I taught as Mr. Hunter's opinions
respecting life and its functions; yet," he adds, "as I never could
find that he had any good reason for his conduct, I continued to teach
them in the midst of the controversy, and derision of such students as
had become his proselytes," &c.

This could hardly have been very agreeable. The pupils were wont to
discuss most subjects in their gossips in the Square of the hospital,
or elsewhere; and many a careless hour has not been unprofitably so
employed. On such occasions, those who were so inclined would no
doubt use ridicule, or any other weapon that suited their purpose;
and so long as any reasonable limits were observed, Mr. Abernethy was
the last person likely to take notice of anything which might have
reached him on the subject. On the contrary, it was his excellence,
and his often-expressed wish that we should canvass every subject for
ourselves; and he would enforce the sincerity of his recommendation by
advising us with an often-repeated quotation:

    "Nullius addictus jurare in verba magistri."

Still, we cannot conceive that the desultory discussions at the
hospital, of which he might from time to time have accidentally heard,
could have prepared him to expect that a similar tone was to form any
portion of the sustained compositions of Lectures to be delivered in
Lincoln's Inn Fields. When, however, he found his opinions ridiculed
there, by his friend and pupil, what was to be done? Was he to enter
into a direct personal sort of controversy with his colleague in office
at the College of Surgeons?

There was everything in that course that was inexpedient and
repulsive. Was he to be silent on opinions which he _knew_ to have been
Mr. Hunter's, and of the moral and scientific advantages of which he
had a most matured conviction? That would have been a compromise of his
duty. It was a difficult dilemma—a real case of the

    "Incidit in Scyllam qui vult vitare Charybdim."

If he avoided one difficulty, he fell into another. He tried to take a
middle course—he argued in support of the opinions he had enunciated,
and aided these by additional illustrations; and, in contrasting them
with those opinions which were opposed to him, he endeavoured to
avoid a personal allusion to individuals, by arguing against a class,
which he termed the "band of modern sceptics." Even this was a little
Charybdis, perhaps; because it had a sort of name-calling effect,
whilst it was not at all essential thus to embody in any one phrase the
persons who held opposite opinions.

His position was intensely difficult. It should be recollected that
Abernethy had always been a teacher of young men; that he had _always_
taught principles of surgery which he conceived to be deducible from
those delivered by Hunter; that he further believed that, to understand
Hunter clearly, it was necessary to have a correct notion of the idea
Mr. Hunter entertained of "Life;" and lastly, that, in _all_ his
Lectures, Abernethy had a constant tendency to consider, and a habit
of frequent appeal to, what, under different forms, might be regarded
as the moral bearings of any subject which might be under discussion.
We readily admit that, usually, in conducting scientific _arguments_,
the alleged moral tendencies of this or that view are more acceptable
when reserved to grace a conclusion, than when employed to enforce an
argument; yet we think that, now, comparatively few persons would think
the discussion of any subject bearing on the physical nature of Man,
complete, which omitted the very intimate and demonstrable relations
which exist between the moral and the physiological laws.

The point, however, which we wish to impress, is, that Mr. Abernethy,
in pleading the moral bearings of Hunter's views by deductions of
his own, was simply following that course which he _had been in
the habit_ of doing on most other questions; it was merely part of
that plan on which, without the smallest approach at any attempt to
intrude religious considerations inappropriately into the discussion
of matters ordinarily regarded as secular, he had always inculcated
a straightforward, free-from-cant, do-as-you-would-be-done-by tone
in his own Lectures. This, while it formed one of their brightest
ornaments, was just that without which all lectures must be held as
defective, which are addressed to young men about to enter an arduous
and responsible profession.

Abernethy stated nothing as facts but which were demonstrably such; and
with regard to any hypotheses which he employed in aid of explaining
them, he observed those conditions which philosophers agree on as
necessary, whether the hypotheses be adopted or otherwise. He did not
do even this, but for the very legitimate object of explaining the
views of the man on whose labours he was discoursing.

When those views of Mr. Hunter, which had been thus set forth and
illustrated, were attacked, he defended them with his characteristic
ability; and although we will not undertake to say that the defence
contains no single passage that might not as well have been omitted, we
are not aware that, from the beginning to the end, it is charged with a
single paragraph that does not fall fairly within the limits that the
most stringent would prescribe to scientific controversy.

The discussion of abstract principles is generally unprofitable. We
think few things more clear than that we know not the intrinsic nature
of _any_ abstract principle; and although it would be presumptuous
to say we never shall, yet we think it impossible for any reflecting
student in any science to avoid perceiving that there are peculiar
relations between the _laws_ of nature and the human capacity, which
most emphatically suggest that the study of the one is the _proper
business_, and the _prescribed limit_ to the power, of the other.

Still, the poverty of language is such, as regards the expression
of natural phenomena, that necessity has obliged us to clothe the
forces in nature with some attribute sufficiently in conformity with
our ideas to enable us to give them an intelligible expression; and,
whether we talk of luminous particles, ethereal undulations, electric
or magnetic fluids, matter of heat, &c. we apprehend that no one now
means more than to convey an intellectually tangible expression, of
certain _forces_ in nature, of which he desires to discourse; in order
to describe the _habitudes_ they observe, or the laws which they obey.
This is all we think it necessary to say on the scientific conduct of
the argument by Abernethy.

The public have long since expressed their opinion on Mr. Lawrence's
Reply and Lectures; and whatever may be regarded as their decision,
we have no disposition to canvass or disturb it. There was nothing
wonderful, however unusual, in a young man so placed, in a profession
like ours, getting into a controversy with a man of such eminence as
Abernethy, particularly on speculative subjects. There were in the
present case, to be sure, very many objections to such a position; but
these it was Mr. Lawrence's province to consider. On this, and many
other points, we have as little inclination as we have right, perhaps,
to state our opinion. Nevertheless, we must not omit a few words in
recognition of Mr. Abernethy's efforts, and a few observations on the
conduct of the governing body of the College at that time. In the
first place, we feel obliged to Mr. Abernethy for the defence he made
on that occasion: not from the importance of any abstract theory, but
from the tendency that his whole tone had to inculcate just views of
the nature and character of the profession. But we can by no means
acquit the Council of the College, at the time of the said controversy,
of what we must conceive to have been a great neglect of duty. There
is, amongst a certain class of persons, an idea that the medical
profession are sceptical on religious subjects; and many of these
persons are people of whom it is impossible not to value the respect
and good opinion. We never could trace any _legitimate_ grounds for the
conclusion. On inquiry, it has always appeared to be nothing more than
a "vulgar error," resting, as "vulgar errors" generally do, on general
conclusions drawn by people who have deduced them from insufficient
particulars.

Sometimes, the persons indulging in this idea have known a medical man
whom _they consider_ to be unstable in his religious views; another
knows that Mr. A. or B. never goes to church; sometimes, even political
differences have been held sufficient excuse for impugning the
soundness of a man's ideas on the all-important subject of religion. We
have never been able to discover any grounds on which they could, with
any show of justice, support so serious an imputation. For our parts,
we know not how the necessary data are to be obtained, and therefore
should shrink from anything so presumptuous as an attempt to describe
the religious character of any profession.

We have no means of obtaining the evidence necessary even to examine,
much less to support, so serious and difficult a generalization.
The great bulk of our profession are general practitioners; and in
forming opinions in regard to any class of men, we naturally look to
the greatest number. So far as our own experience has gone, we cannot
find the slightest ground for the degrading imputation. Like all other
medical men, their labours are incessant, their hours of recreation
few, and far between. In their requisitions on their time, the public
regard neither night nor day, nor the Sabbath, when they require
attention. Then, if we look to conduct as no unreasonable test of
religion, we may, like all other professions, have blots. We have, in
all grades, it may be, our fee-hunters and long-billed practitioners;
but whether we regard the physician, surgeon, or general practitioner,
we verily believe that there are no men in the kingdom who, as a body,
conduct themselves more honourably, none who are less mercenary, none
who, in relation to their position, are less affluent—no bad test—nor
who do one-tenth of the work which they do, without any remuneration
whatever.

With regard to the alleged absence from public worship, there may be
(however explicable) some ground for the remark, and especially as no
profession shows, in the general respectability of their conduct, a
more ready and respectful acquiescence in the established usages of
mankind.

But let the question be fairly stated. How many medical men can go to
church every Sunday, and to the same church, without a compromise of
a paramount duty? We are ready to concede, that the necessities which
professional calls impose on so many occasions, may have a tendency to
form habits, when impediments are less pressing; but is it not rather
the exactions of the public, than the choice of the profession, which
imposes the necessity? How many of the public would be satisfied, if
they wished to see a professional man on any pressing occasion, and
were told that he could not be seen for a couple of hours, as he was
going to church?

Highly as we venerate the benign and beautiful ordinance of the
Sabbath, important as we think it, that, on all accounts, it should be
observed with reverence and gratitude,—still we should hesitate before
we regarded the single act of attendance or absence on public worship
as a safe or charitable exposition of any man's religious stability.
We, therefore, as far as in us lies, repudiate the charge; we regard it
as groundless; and think that, as no profession affords more frequent
opportunities for a constant awakening and keeping alive the best
sympathies of our nature, so no profession can be more calculated to
impress the fragile nature of the body, as contrasted with the immortal
spirit which inhabits it, or the constant presence of that Power by
whose laws they are both governed. But groundless as we think the
charge, we must contend that the apathy of the Council of the College,
at the time Mr. Lawrence delivered the lectures in question, was a
serious neglect of duty. In those Lectures, Mr. Lawrence spoke of the
Old Testament in a tone which must, we think, be regarded as irrelevant
to, or at least unnecessary in, a course of Lectures on Comparative
Anatomy.

We hold no sympathy with that sort of persecution with which several
well-intentioned people visited the book; but we must always regard
the Council of the time as having been neglectful of their duty.
Lectures on Comparative Anatomy do not render it necessary to impugn
the historical correctness, or the inspired character, of the Old
Testament. What answer could private individuals make, or with what
influence could they oppose the prejudices of the public in relation
to the religious securities afforded by men in whom they confide, when
they saw a young professor allowed to introduce into lectures—given
to an audience composed of the most aged and eminent of the profession,
as well as of many of those who were just commencing their studies,
delivered, too, at the chartered College of the profession—matter
which was not only not at all necessary to the most ample exposition
of the subject, but which, as we have said, only alluded to the
Old Testament in a manner calculated to weaken its authority as an
historical document, and to impugn its inspired character?

Surely there was no more certain mode of giving an _ex cathedrâ_
sanction to the unfavourable impressions of the public; impressions
which tend to tarnish the lustre of a profession which founds its claim
to respect on its high office in kindly ministrations and unquestioned
utility; and to arm a vulgar and unfounded prejudice with all the
influence of Collegiate recognition. If, indeed, the College had
desired to support the alleged favourable tendency of Mr. Abernethy's
views, or the alleged opposite bearings of those to which he was
opposed, they could hardly have done better than to have allowed of
the irrelevant matter in question. But we have done. It is no part of
our business to quote passages, or further to renew discussions long
since passed away, than is necessary for our proper objects. But when
we consider on how many points Abernethy must have been hurt, the very
difficult and perplexing position in which he was placed, we cannot
too much admire the very measured tone he adopted throughout; or the
evidently wounded feeling, but still dignified yet simple statement in
the published Postscript in his Lectures; and though there had been no
subsequent exemplification of his forgiving temper—which was not the
case—we should still have felt obliged to regard the whole affair as
indicative of great goodness of heart; and, when all the circumstances
of disappointment and vexation are duly weighed, of almost unexampled
moderation.

It is just to Mr. Lawrence to observe, that, some few years after
this, the Governors of Bethlem Hospital, on the annual (and usually
formal) election of the surgeon, an office held by Mr. Lawrence, threw
the appointment open to competition; on which occasion Mr. Lawrence
published a letter expressing regret, in general terms, as to certain
passages in the Lectures in question, and his determination not to
publish any more on similar subjects. The coincidence of this letter
with the threatened tenure of office, of course gave rise to the usual
remarks; but, if a man say he is sorry for a thing, perhaps it is
better not to scan motives too closely. Mankind stand too much in need
of what Burns suggests, and with which we close this not very agreeable
subject:

      "Then gently scan your brother man,
      Still gentler sister woman;
      Though they may gang a kennin wrang,
      To step aside is human."




CHAPTER XXI.

      "And though they prove not, they confirm the cause,
      When what is taught agrees with Nature's laws."

      DRYDEN'S RELIG. LAICI.


PREFATORY REMARKS.

In endeavouring to give some idea of Abernethy's manner in more
sustained compositions, we have made some selections from the Lectures
he delivered at the College of Surgeons. Without any pretensions to a
critically faultless style, there always seemed to us to be a peculiar
simplicity, combined with a broad and comprehensive range of thought.
Sometimes, too, he has almost a "curiosa felicitas" in the tone of
his expressions; though this was more remarkable, we think, when he
felt more free; that is, in his unrivalled teaching at the Hospital,
of which we shall endeavour to give a more particular account. As we
have before remarked, it is impossible to do full justice to Abernethy,
unless we were to publish his works, with a running commentary; and we
fear that in the selections we offer we have incurred a responsibility
which we shall not properly fulfil. To convey the full, the suggestive
merit of even some of the following passages, it would be necessary to
state carefully the relation they bear to the state of science, both
chemical and physiological, at the time they were written, and the
present.

The interest of the Lectures is so evenly distributed through the
whole, that selection is very difficult; and being obliged to consider
our limits, we have, in the absence of a better guide, selected the
passages at random, as suggested by our own impressions of them. We
therefore can only earnestly recommend the perusal of the Lectures
themselves, as equally entertaining and instructive to the general as
well as the professional reader. The varied expression and manner,
and his fine intellectual countenance, by which he imparted so
much interest to his delivery on every subject he touched, will be
considered in connection with his success in the art of lecturing, to
which these somewhat formal specimens may serve as an introduction.


THE APPARENT UNIVERSAL DISTRIBUTION OF SOME POWERFUL

FORCE LIKE ELECTRICITY, MAGNETISM, ETC.

"When, therefore, we perceive in the universe at large a cause of rapid
and powerful motions of masses of inert matter, may we not naturally
conclude that the inert molecules of vegetable and animal matter may be
made to move in a similar manner by a similar cause?"


REPUDIATION OF AN OFTEN-ALLEGED OPINION.

"It is not meant that electricity is life. There are strong analogies
between electricity and magnetism; and yet I do not know that any
one has been hardy enough to assert their absolute identity[40]. I
only mean to prove that Mr. Hunter's theory is verifiable, by showing
that a subtile substance of a quickly, powerfully mobile nature seems
to pervade everything, and appears to be the life of the world; and
therefore it is probable that a similar substance pervades organized
bodies, and produces similar effects in them.

"The opinions which, in former times, were a justifiable hypothesis,
seem to me now to be converted into a rational theory[41]."


IN RELATION TO MICROSCOPIC OBSERVATION.

"This general and imperfect sketch of the anatomy of the nervous system
relates only to what may be discovered by our unassisted sight. If by
means of the microscope we endeavour to observe the ultimate nervous
fibres, persons in general are as much at a loss as when, by the same
means, they attempt to trace the ultimate muscular fibres[42]."


ILLUSTRATION, OF MOTION NOT NECESSARILY IMPLYING SENSATION.

"Assuredly, motion does not necessarily imply sensation; it takes place
where no one ever yet imagined there could be sensation. If I put on
the table a basin containing a saturated solution of salt, and threw
into it a single crystal, the act of crystallization would begin from
the point touched, and rapidly and regularly pervade the liquor till
it assumed a solid form. Yet I know I should incur your ridicule if I
suggested the idea that the stimulus of salt had primarily excited the
action, or that its extension was the effect of continuous sympathy.
If, also, I threw a spark amongst gunpowder; what would you think, were
I to represent the explosion as a struggle resentful of injury, or the
noise as the clamorous expression of pain[43]?"


DIFFERENT NERVOUS SYSTEMS VARIOUSLY AFFECTED BY SIMILAR

IMPRESSIONS.

"Thus the odour of a cat, or the effluvia of mutton, the one
imperceptible, the other grateful to the generality of persons, has
caused individuals to fall on the ground as though bereaved of life,
or to have their whole frame agitated by convulsions. Substances which
induce disease in one person or animal, do not induce disease in
others[44]."


IMPORTANCE OF OPINIONS.

"Thinking being inevitable, we ought, as I said, to be solicitous to
think correctly. Opinions are equally the natural result of thought,
and the cause of conduct. If errors of thought terminated in opinions,
they would be of less consequence; but a slight deviation from the
line of rectitude in thought may lead to a most distant and disastrous
aberration from that line in action. I own I cannot readily believe
any one who tells me he has formed no opinion on subjects which must
have engaged and interested his attention. Persons both of sceptical
and credulous characters form opinions, and we have in general some
principal opinion, to which we connect the rest, and to which we make
them subservient; and this has a great influence on all our conduct.
Doubt and uncertainty are so fatiguing to the human mind, by keeping it
in continual action, that it will and must rest somewhere; and if so,
our inquiry ought to be where it may rest most securely and comfortably
to itself, and with most advantage to others.

"In the uncertainty of opinions, wisdom would counsel us to adopt those
which have a tendency to produce beneficial actions."


INDEPENDENCE OF MIND ON LIFE AS ARISING OUT OF THE IDEA

THAT LIFE WAS SUPERADDED TO ORGANIZATION—HIS DISPOSITION

TO ALLEGORY.

"If I may be allowed to express myself allegorically with regard to
our intellectual operations, I would say that the mind chooses for
itself some little spot or district, where it erects a dwelling, which
it furnishes and decorates with the various materials it collects.
Of many apartments contained in it, there is one to which it is most
partial, where it chiefly reposes, and where it sometimes indulges its
visionary fancies. At the same time, it employs itself in cultivating
the surrounding grounds, raising little articles for intellectual
traffic with its neighbours, or perhaps some produce worthy to be
deposited amongst the general stores of human knowledge. Thus my
mind rests at peace in thinking on the subject of life, as it has
been taught by Mr. Hunter; and I am visionary enough to imagine that
if these opinions should become so established as to be generally
admitted by philosophers, that if they once saw reason to believe that
life was something of an invisible and active nature _superadded_ to
organization, they would then see equal reason to believe that mind
might be superadded to life, as life is to structure. They would then,
indeed, still further perceive how mind and matter might reciprocally
operate on each other by means of an intervening substance. Thus,
even, would physiological researches enforce the belief which I say is
natural to man: that, in addition to his bodily frame, he possesses
a sensitive, intelligent, and _independent_ mind—an opinion which
tends in an eminent degree to produce virtuous, honourable, and useful
actions[45]."


ATTRACTIONS OF PhYSIOLOGY—THE NECESSITY OF EXAMINING

BOTH HEALTH AND DISEASE A VERY IMPORTANT POINT JUST

NOW, AS TESTING THE VALIDITY OF CERTAIN VIEWS OF LIEBIG

AND OTHERS.

"No study can surely be so interesting as Physiology. Whilst other
sciences carry us abroad in search of objects, in this we are engaged
at home, and on concerns highly important to us, in inquiring into
the means by which 'we live, and move, and have our being.' To those,
however, engaged in the practice of Medicine, the study of Physiology
is indispensable; for it is evident that the nature of the disordered
actions of parts or organs can never be understood or judiciously
counteracted, unless the nature of their healthy actions be previously
known.

"The study of Physiology, however, not only requires that we should
investigate the nature of the various vital processes carried on in
our own bodies, but also that we should compare them with similar
processes in all the varieties of living beings; not only that we
should consider them in a state of natural and healthy action, but also
under all the varying circumstances of disorder and disease. Few indeed
have studied Physiology thus extensively, and none in an equal degree
with Mr. Hunter. Whoever attentively peruses his writings, must, I
think, perceive that he draws his crowds of facts from such different
and remote sources, as to make it extremely difficult to assemble and
arrange them[46]."


OF DISORDER AND DISEASE.

"Disorder, which is the effect of faulty actions of _nerves_,
induces disease, which is the consequence of faulty actions of the
_vessels_. There are some who find it difficult to understand how
similar swellings or ulcers may form in various parts of the body
in consequence of general nervous disorder, and are all curable by
appeasing and removing such general disorder. The fact is indisputable.
Such persons are not so much surprised that general nervous disorder
should produce local effects in the nervous and muscular systems;
yet they cannot so well understand how it should locally affect the
vascular system. To me there appears nothing wonderful in such events;
for the local affection is primarily nervous, and the vascular actions
are consequent. Yet it must indeed be granted that there may be other
circumstances leading to the peculiarities of local diseases, with
which, at present, we are unacquainted. Disorder excites to disease,
and when _important organs_ become in a degree diseased, they
will still perform their functions moderately well, _if disorder_
be relieved, which _ought to be the Alpha and Omega of medical
attention_[47]."


As we have seen, in the early part of our narrative, he was one of
the first to insist on the importance of Comparative Anatomy and
Physiology, and, as we shall have to relate, most active in securing
what has proved so greatly influential to its progress in this country
(the appointment of Professor Owen). Yet he modestly ignores any
positive pretensions which might be imputed to him from his endeavour
to illustrate a Museum dealing so largely with Comparative Anatomy.


"Gratitude to the former of the Museum, and also to the donors to
it, equally demand that its value and excellency should be publicly
acknowledged and displayed, which consideration has goaded me on to
undertake and imperfectly execute a task for which I feel myself not
properly qualified."


Here follows what is very candid in Abernethy, and honourable to Mr.
Clift, who had very many debtors who were less communicative.


"I cordially acknowledge that I have little acquaintance with the
subject, except what I derived from looking over the preparations
in the Museum, from reading Professor Cuvier's Lectures, and from
the frank and friendly communications of our highly praiseworthy
conservator, Mr. Clift. Permit me to say, gentlemen, though many know
it already, that Mr. Clift resided with Mr. Hunter, and was taught
by him to exhibit anatomical facts in preparations,—that he does
credit to his excellent instructor,—that he feels the same interest
and zeal that his patron did for the improvement of this department
of science,—and that he possesses the same candour and simplicity of
character[48]."


OF DEEP AND SUPERFICIAL THINKING.

"I now beg leave to add that there are many who think clearly,
who do not think deeply; and they have greatly the advantage in
expressing themselves, for their thoughts are generally simple and
easy of apprehension. Opinions immediately deduced from any series or
assemblage of facts may be called primary opinions, and they become
types and representatives of the facts from which they are formed,
and, like the facts themselves, admit of assortment, comparison, and
inference; so that from them we deduce ulterior opinions, till at
length, by a kind of intellectual calculation, we obtain some general
total, which in like manner becomes the representative and co-efficient
of all our knowledge, with relation to the subject examined and
considered.

"In proportion to the pains we have taken in this algebraical process
of the mind, and our assurance of its correctness, so do we contemplate
the conclusion or consummation of our labours with satisfaction[49]."


CHARACTERISTIC OF HIS INCLINATION TO THE LAW.

"Gentlemen (of the jury), I trust I can prove to your perfect
conviction, by ample and incontrovertible evidence, that my client
(John Hunter) died seized and possessed of very considerable literary
property, the hard-earned gainings of great talent and unparalleled
industry. It is not, however, for the property that I plead; because
already that is secured; it is fenced in; land-marks are set up; it
is registered in public documents. I plead only for the restitution
of a great and accumulated income of reputation derivable from that
property, which, I trust, you will perceive to be justly due, and will
consequently award to my client, and his country[50]."


OF MR. HUNTER—PROGRESS OF HIS MIND, ETC.

"Believing that no man will labour in the strenuous and unremitting
manner that Mr. Hunter did, and to the detriment of his own private
interest, without some strong incentive; I have supposed that at an
early period he conceived those notions of life which were confirmed
by his future inquiries and experiments. He began his observations on
the incubated egg, in the year 1755, which must either have suggested
or corroborated all his opinions with regard to the cause of the vital
phenomena. He perceived that, however different in form and faculty,
every creature was nevertheless allied to himself, because it was a
living being; and therefore he became solicitous to inquire how the
vital processes were carried on in all the varieties of animal and even
vegetable existence."


OF GENIUS AND JUDGMENT.

"In the progress of science, genius with light and airy steps often far
precedes judgment, which proceeds slowly, and either finds or forms
a road along which all may proceed with facility and security; but
the _direction_ of the course of judgment is often suggested, and its
actions are excited and accelerated, by the invocations of preceding
genius[51]."


REITERATION OF THE DENIAL THAT HE IDENTIFIED LIFE WITH

ELECTRICITY.

"As Sir H. Davy's experiments fully prove that electricity may be
superadded to, and that it enters into, the composition of all those
substances we call matter, I felt satisfied with the establishment
of the philosophy of Mr. Hunter's views, nor thought it necessary to
proceed further, but merely added: 'It is not meant to be affirmed that
electricity is life.' I only mean to argue in favour of Mr. Hunter's
theory, by showing that a subtile substance of a quickly and powerfully
mobile nature seems to pervade everything, and appears to be the life
of the world; and that therefore it is probable a similar substance
pervades organized bodies, and is the life of these bodies. I am
concerned, yet obliged, to detain you by this recapitulation, because
my meaning has been either misunderstood or misrepresented[52]."


CHEMISTRY OF LIFE.

"He (Mr. Hunter) told us that life was a great chemist, and, even in a
seemingly quiescent state, had the power of resisting the operations of
external chemical agency, and thereby preventing the decomposition of
those bodies in which it resided. Thus seeds may lie buried far beneath
the surface of the earth for a great length of time without decaying,
but being thrown up, they vegetate. Mr. Hunter showed us that this
chemist, 'Life,' had the power of regulating the temperature of the
substances in which it resides[53]."


INTERESTING; ALSO SIGNIFICANT IN REGARD TO WHAT ARE PROBABLY

THE REAL SOURCES OF ANIMAL HEAT, AND IN RELATION

TO THE LUNGS, WHICH WE HAVE CONTENDED ARE REFRIGERATING

AND NOT HEATING ORGANS.

"The progress of science since Mr. Hunter's time has wonderfully
manifested that the beam, when dissected by a prism, is not only
separable into seven calorific rays of different refrangibility,
producing the iridescent spectrum, but also into calorific rays
refracted in the greatest degree or intensity beyond the red colour,
and into rays not calorific, refracted in like manner, to the opposite
side of the spectrum beyond the violet colour; and that the calorific
and uncalorific rays produce effects similar to those occasioned by
the two kinds of electricity; and thus afforded additional reasons for
believing that subtile, mobile substances do enter into the composition
of all those bodies which the sun illumines, or its beams can penetrate.

"Late observations induce the belief that even light may be
incorporated in a latent state with animal substances and afterwards
elicited by a kind of spontaneous separation by vital actions, or
by causes that seem to act mechanically on the substance in which
it inheres. All the late discoveries in science seem to realize the
speculations of ancient philosophers, and show that all the changes and
motions which occur in surrounding bodies, as well as those in which we
live, are the effect of subtile and invisible principles existing in
them, or acting on them. Mr. Ellis, who, with such great industry and
intelligence, has collated all the scattered evidences relative to the
production of heat in living bodies, and added so much to the collected
knowledge, seems to think that all the variations of temperature in
them may be accounted for by known chemical processes.

"Here, however, I must observe, that Mr. Hunter's opinion of life
having the power of regulating temperature was deduced, not only from
his own experiments, related in the 'Philosophical Transactions,' but
also from observing, that, in certain _affections of the stomach, the
heat of the body is subject to great vicissitudes, whilst respiration
and circulation remain unaltered_; and also that parts of the body are
subject to similar variations, which appear inexplicable upon any other
supposition than that of _local nervous excitement_, or torpor, or some
similar affections of the vital powers of the part which undergoes such
transitions[54]."


ALLEGED TENDENCIES OF A BELIEF IN THE INDEPENDENT

NATURE OF MIND.

"It is equally apparent that the belief of the distinct and independent
nature of mind incites us to act rightly from principle; to relieve
distress, to repel aggression, and defend those who are incapable of
protecting themselves; to practise and extol whatever is virtuous,
excellent, and honourable; to shun and condemn whatever is vicious and
base, regardless also of our own personal feelings and interests when
put in competition with our duty[55]."


OF PHRENOLOGY.

"There is nothing in the assertions of Drs. Gall and Spurzheim
contradictory to the results of general observation and experience. It
is admitted that the superior intellectual faculties can and ought
to control the inferior propensities. It is admitted that we possess
organs, which, nevertheless, may be inactive from general torpor or
want of education. General observation and experience proclaim that
susceptibility is the chief incentive to action, that it is the source
of genius; and that the character of the man greatly depends on his
education and habits. We educate our faculties; what is at first
accomplished with difficulty, by repetition is easily performed, and
becomes more perfect and established by habit. Trains of perceptions
and thoughts also become firmly concentrated, and occur in succession.
Even our feelings undergo the same kind of education and establishment.
Casual feelings of goodwill by repetition strengthen and produce
lasting friendships; whilst trivial sensations of disgust, in like
manner, may occasion inveterate hatred."


ON THE SAME.

"Should the result of our general inquiries, or attention to the
subjects proposed to us by Drs. Gall and Spurzheim, induce us to
believe that the peculiarities of our feelings and faculties were the
effects of variety of excitement, transmitted through a diversity
of organization, they would tend to produce mutual forbearance and
toleration. We should perceive how nearly impossible it must be that
any persons should think and feel exactly alike upon any subject. We
should not arrogantly pride ourselves on our own virtue and knowledge,
nor condemn the errors and weakness of others, since they may depend
upon causes which we can neither produce nor readily counteract. The
path of virtue is plain and direct, and its object distinctly before
us; so that no one can miss either, who has resolution enough never
to lose sight of them, by adverting to advantages and allurements
with which he may be presented on the one hand, or the menacings
with which he may be assailed on the other. Yet no one, judging from
his own feelings and powers, can be aware of the kind and degree of
temptation or terror, or the seeming incapacity to resist them, which
may have induced others to deviate. Now, though from the foregoing
considerations I am pleased with the speculations of Drs. Gall and
Spurzheim, I am quite incompetent to give any opinion as to the
probability of what they have suggested; because I see no mode by which
we can with propriety admit or reject their assertions, except by
pursuing the same course of investigations which they themselves have
followed; a task of great labour and difficulty, and one which, for
various reasons, I should feel great repugnance to undertake[56]."


Abernethy used to like very well to talk with Spurzheim, who resided
for some time in this country. One day, Abernethy, half-seriously,
half-humorously said to Spurzheim: "Well, Doctor, where do you place
the organ of common sense?" Spurzheim's reply certainly sustained the
coincidence of phrenological deductions with those of experience.
"There is no organ," said he, "for common sense, but it depends on the
equilibrium of the other organs."


THEOLOGICAL APPLICATION OF ANATOMICAL FACTS.

"Therefore, from this least interesting part of anatomy, we derive
the strongest conviction of there being design and contrivance in the
construction of animals. Equal evidences of design and contrivance and
of adaptation of means to ends may be observed in the construction of
the framework, as I may call it, of other animals, as in that of man,
which subject seems to me very happily displayed in Professor Cuvier's
Lectures[57].

"It was, however, the comparing the mechanism of the hand and foot
that led Galen, who they say was a sceptic in his youth, to the public
declaration of his opinion that intelligence must have operated in
ordaining the laws by which living beings are constructed. That Galen
was a man of a very superior intellect could readily be proved, were it
necessary. I have often known the passage I allude to made a subject
of reference, but not of quotation, and therefore I recite it on the
present occasion, and particularly because it shows that Galen was
not in the least degree tinctured with superstition. 'In explaining
these things,' he says, 'I esteem myself as composing a solemn hymn
to the great Architect of our bodily frame, in which I think there is
more true piety than in sacrificing whole hecatombs of oxen, or in
burning the most costly perfumes; for, first, I endeavour from His
works to know Him myself, and afterwards by the same means to show
Him to others, to inform them how great is His wisdom, goodness, and
power[58].'"


DISTINCTIVE CHARACTER OF LIVING BODIES.

"Those bodies which we call living are chiefly characterized by their
powers of converting surrounding substances into their own nature,
of building up the structure of their own bodies, and repairing the
injuries they may accidentally sustain[59]."


IN REPUDIATION OF CRUELTY AND EXPERIMENTS ON ANIMALS.

Very important in our view. The objection was very new at that time,
and has made very little way yet. We have already referred to this
subject. Considering the period of these Lectures (nearly forty years
ago), Abernethy's objections, though cautious, are very sound, and,
for him, very positive. We know that he felt still more strongly.

"Mr. Hunter, whom I should not have believed to be very scrupulous
about inflicting sufferings upon animals, nevertheless censures
Spalanzani for the unmeaning repetition of similar experiments. Having
resolved publicly to express my own opinion with respect to this
subject, I choose the present opportunity to do it, because I believe
Spalanzani to have been one of those who have tortured and destroyed
animals in vain. I do not perceive that in the two principal subjects
which he sought to elucidate, he has added any important fact to our
stock of knowledge; besides, some of his experiments are of a nature
that a good man would have blushed to think of, and a wise man ashamed
to publish, for they prove no fact requiring to be proved, and only
show that the aforesaid Abbé was a filthy-minded fellow."


ON THE SAME.

"The design of experiments is to interrogate nature; and surely
the inquirer ought to make himself acquainted with the language of
nature, and take care to propose pertinent questions. He ought further
to consider the probable kind of replies that may be made to his
inquiries, and the inferences that may be warranted in drawing from
different responses, so as to be able to determine whether, by the
commission of cruelty, he is likely to obtain adequate instruction.
Indeed, before we make experiments on sensitive beings, we ought
further to consider whether the information we seek may not be
attainable by other means. I am aware of the advantages which have been
derived from such experiments when made by persons of talent, and who
have properly prepared themselves; but I know that these experiments
tend to harden the feelings which often lead to the inconsiderate
performance of them.

"Surely we should endeavour to foster, and not stifle, benevolence,
the best sentiment of our nature, that which is productive of
the greatest gratification both to its possessor and to others.
_Considering the professors in this place as the organs of the Court
of the College_, addressing its members, I feel that I act as becomes
a senior of this institution, whilst admitting the propriety of the
practice under the foregoing restrictions, I, at the same time,
express an earnest hope that the character of an English surgeon may
never be tarnished by the commission of inconsiderate or unnecessary
cruelty[60]."


A VERY EARLY EXCELLENCE OF ABERNETHY: EXCEEDINGLY NECESSARY

AT ONE TIME IN RELATION TO THE ERRONEOUS

NOTIONS ON WHICH ANATOMICAL INVESTIGATIONS WERE CONDUCTED;

ADVANCING SCIENCE HAS FULLY CONFIRMED THE

JUSTICE AND GOOD SENSE OF HIS REMARKS.

"To me, however, who confide more in the eye of reason than in that
of sense, and would rather form opinions from analogy than from the
imperfect evidence of sight, it seems too hasty an inference to
conclude that, in the minute animals, there are no vessels nor other
organization because we cannot see them, or that polypes are actually
devoid of vessels, and merely of the structure described, because we
can discern no other. Were it, however, really so, such facts would
then only show with how little and with what various organization life
could accomplish its principal functions of assimilation, formation,
and multiplication. Who has seen the multitudinous distribution of
absorbing vessels, and all the other organization, which doubtless
exists in the vitreous humour of the eye, than which no glass ever
appeared more transparent or more seemingly inorganic[61]? How strange
is it that anatomists, above all other members of the community of
science, should hesitate to admit the existence of what they cannot
discern, since they, more than all the rest, have such constant
assurance of the imperfection and fallibility of sight[62]?"


REITERATION OF AN IMPORTANT AXIOM, QUITE NECESSARY AT THIS TIME TO THE
CHEMICAL PHYSIOLOGISTS.

"Our physiological theories should be adequate to account for all the
vital phenomena both in health _and disorder_, or they can never be
maintained as good theories[63]."


OF RESPIRATION. CAUTIOUS REASONING. HAD ALL REASONED

THUS, WE MIGHT HAVE ESCAPED MUCH UNSOUND THEORIZING

ON THIS IMPORTANT PROCESS.

"Chemists have considered the change as contributory to the production
of animal heat, which opinion may, indeed, be true, though the manner
in which it produces such an effect has not, as yet, been explained.
Mr. Hunter, who believed that life had the power of regulating
temperature, _independently of_ respiration, says nothing of that
process as directly contributing to such an effect. He says: 'Breathing
seems to render life to the blood, and the blood conveys it to every
part of the body,' yet he believes the blood derives its vitality
also from the food. I am at a loss to know what chemists now think
respecting heat, whether they consider it to be a distinct species of
matter, or mere motion and vibration. Among the curious revolutions
which this age has produced, those of chemical opinions have a fair
claim to distinction. To show which, I may add, that a lady[64], on
her first marriage, was wedded to that scientific champion who first
overthrew phlogiston, and established, in its stead, the empire of
caloric; and after his decease, on her second nuptials, was united to
the man who vainly supposed he had subverted the rule of caloric and
restored the ancient but long-banished dynasty of motion and vibration.
In this state of perplexity, I cannot, with prudence or probable
security, advance one step further than Mr. Hunter has led me. I must
believe respiration to be essential to life, and that life has the
power, by its actions, of maintaining and regulating temperature[65]."


CHARACTERISTIC, BOTH AS TO ILLUSTRATION AND MORAL

BEARING.

"Those of the medical profession must readily accord with the remark
of Shakspeare, that such affections (disturbed states of the nervous
system) which may well indeed be called 'master passions,' sway us
to their mood in what we like or loathe. For we well know that our
patients and ourselves, from disturbance of the nervous functions of
the digestive organs, producing such affections of the brain, may
become irritable, petulant, and violent about trifles, or oppressed,
morose, and desponding. Permit me, however, to add that those of the
medical profession must be equally apprized that when the functions
of the mind are not disturbed by such affections, it displays great
energy of thought, and evidence of established character, even in
death. Have we not lately heard that the last words of Nelson were:
'Tell Collingwood to bring the fleet to an anchor?' Shakspeare has
also represented Mercutio continuing to jest, though he was mortally
wounded; the expiring Hotspur thinking of nothing but honour, and the
dying Falstaff cracking his jokes on Bardolph's nose. I request you
to excuse this digression, which I have been induced to make, from
perceiving that, if such facts were duly attended to, they would
prompt us to a more liberal allowance for each other's conduct, under
certain circumstances, than we are accustomed to do; and also incite us
to the more active and constant performance of the great business of
human life—the education of the mind; for, according to its knowledge
and dispositions, do we possess the ability of contributing to our own
welfare and comfort, and that of others[66]."

[Illustration: "_The proposition is this:—I say that Local disease,
injury, or irritation, may disturb the whole system, and conversely,
disturbance of the whole system, may affect any part._" (_Surgical
Lectures_.)]

[Footnote 40: Oersted's experiments, which by some are regarded as
identifying these powers, occurred in 1820, four or five years after
the delivery of this Lecture.]

[Footnote 41: Anatom. Lect. I, p. 51.]

[Footnote 42: Anat. Lect. II, p. 62.]

[Footnote 43: Ibid. p. 84.]

[Footnote 44: Ibid. p. 85.]

[Footnote 45: Anat. Lect. II, p. 92.]

[Footnote 46: Physiol. Lect. I, p. 3. 1817.]

[Footnote 47: Introd. Lect. p. 117. 1815.]

[Footnote 48: Physiol. Lect. I, p. 14.]

[Footnote 49: Ibid. p. 22.]

[Footnote 50: Physiol. Lect. I, p. 16.]

[Footnote 51: Physiol. Lect. I, p. 19.]

[Footnote 52: Ibid. p. 26.]

[Footnote 53: Physiol. Lect. I, p. 27.]

[Footnote 54: Physiol. Lect. I, p. 37.]

[Footnote 55: Physiol. Lect. I, p. 51.]

[Footnote 56: Physiol. Lect. III, p. 99.]

[Footnote 57: Physiol. Lect. III, p. 151.]

[Footnote 58: Physiol. Lect. III, p. 152.]

[Footnote 59: Physiol. Lect. IV, p. 155.]

[Footnote 60: Physiol. Lect. IV, p. 164.]

[Footnote 61: Physiol. Lect. V, p. 203.]

[Footnote 62: Physiol. Lect. V, p. 209.]

[Footnote 63: Ibid. p. 229.]

[Footnote 64: Madame Lavoisier, whose celebrated husband was
guillotined, afterwards married Count Rumford.]

[Footnote 65: Physiol. Lect. V, p. 237.]

[Footnote 66: Lect. VI, p. 257.]




CHAPTER XXII.


ABERNETHY AS A TEACHER.

      "Trace Science, then, with Modesty thy guide;
      First, strip off all her equipage of pride;
      Deduct what is but vanity of dress,
      Or learning's luxury, or idleness,
      Or tricks to show the stretch of human brain,
      Mere curious pleasure, or ingenious pain."

Lecturing after a fashion is easy enough; _teaching_ is a very
different affair. The one requires little more than good information,
some confidence, and a _copia verborum_; the other establishes
several additional requisitions. These requisitions, when rendered
comparatively easy by nature, are seldom perfectly matured without art
and careful study. The transmission of ideas from one mind to another,
in a simple, unequivocal form, is not always easy; but, in teaching,
the object is not merely to convey the idea, but to give a lively
and lasting impression—something that should not merely cause the
retention of the image, but in such connection as to excite another
process, "thought."

There was no peculiarity in Abernethy more striking than the power he
possessed of communicating his ideas, and of sustaining the interest
of the subject on which he spoke. For this there is no doubt he was
greatly indebted to natural talent; but it is equally clear that he had
cultivated it with much care. His ability as a lecturer was, we think,
unique. We never saw his like before: we hardly dare hope we shall
again.

There is no doubt that a great part of his success depended on a
facility of giving that variety of expression, and that versatility
of manner, which falls within the province of what we must call
dramatic; but then it was of the very highest description, in that it
was perfectly natural. It was of that kind which we sometimes find in
an actor, and which conveys the impression that he is speaking his
own sentiments, rather than those of the author. It is a species of
talent which dies with its possessor, and cannot, we think, be conveyed
by description. Still there were many things in Abernethy that were
observable, and such as could hardly have been acquired without study.

If we examine any lecturer's style, and ask ourselves what is his
fault, we shall find very few in whom we cannot detect one or more.
When we do this, and then reflect on Abernethy, we are astonished
to find how many he avoided. We shall endeavour to make this as
intelligible as we can, by citing some of the points which our
attention to different lecturers have suggested.

"Simplicity" has struck us as a feature which, in some sense or
other, is very commonly defective. Simplicity appears so important,
that perhaps, by not a very illegitimate extension of its meaning, it
might be made to include almost all the requisitions of this mode of
teaching. Let us think of it in relation to language and illustration.
In all sciences, the _facts_ are simple; the laws are yet _more
so_; increasing knowledge tends to impress on us an ever-increasing
and comprehensive simplicity. In explaining simple things, no doubt
language should be simple too. If we employ language unnecessarily
technical, we use symbols to which the learner is unaccustomed.
He has not to learn the facts _only_; but he has the _additional
labour_ of something allied to learning it in a foreign language. The
_unnecessary_ use of technicalities should then surely be avoided.
Abernethy was obliged to use them, because there were often no other
terms; but he always avoided any needless multiplication of them. When
they were difficult or objectionable, he tried some manœuvre to lighten
the repulsiveness of them.

There are many muscles in the neck with long names, and which are
generally given with important parts of surgical anatomy. Here he used
to chat a little; he called them the _little_ muscles with the _long_
names; but he would add, that, after all, they were the best-named
muscles in the body, because their names expressed their attachments.
This gave him an excuse for referring to what he had just described,
in the form of a narrative, rather than a dry repetition. Then, with
regard to one muscle, that he wished particularly to impress, the name
of which was longer than any of the others, he used to point it out as
a striking feature in all statues; and then, repeating its attachments,
and pointing to the sites which they occupied, say it was impossible to
do so without having the image of the muscle before us.

In other parts of the Lectures, he would accompany the technical name
by the popular one. Thus he would speak of the pancreas, or sweetbread;
cartilage, or gristle. Few people are aware how many difficulties are
smoothed by such simple manœuvres. Nothing interests people so much as
giving anything _positive_. We think it not improbable that many a man
has heard a lecture, in which animals have been described with whose
habits he had been perfectly familiar, without having recognized his
familiar acquaintances in the disguise afforded by a voluminous Greek
compound. Abernethy seemed always to lecture, not so much as if he was
telling us what he _knew_, as that which _we_ did _not_ know. There was
an absence of all display of any kind whatever.

To hear some lecturers, one would almost think that they adopted the
definition of language which is reported of Talleyrand—that it was
intended to conceal our ideas. Some make simple things very much
otherwise by the mode of explaining them. This reminds us of a very
worthy country clergyman, in the west of England, who, happening to
illustrate something in his sermon by reference to the qualities of
pitch, thought he should help his rustic congregation by enlarging a
little on the qualities of that mineral. He accordingly commenced by
saying, "Now, dear brethren, pitch is a bituminous substance:" rather a
difficult beginning, we should think, to have brought to a successful
conclusion.

Sometimes we have heard a very unnecessary catalogue of technicalities
joined with several propositions in one sentence. It is hardly to
be imagined how this increases the difficulty to a beginner; whilst
it impresses the excellence of that simplicity and clearness which
were so charming in Abernethy. We give an example of this defect. The
lecturer is describing the continuation of the cuticle over the eyes
of the crustacea, as lobsters, &c.: "The epidermis (the cuticle) in
the compound eyes of the crustacea passes transparent and homogeneous
over the external surface of the thick layer of the prismatic corneæ,
which are here, as in insects, generally hexagonal, but sometimes
quadrangular; and to the internal ends of the prismatic corneæ are
applied the broad bases of the hard, tapering, transparent lenses,
which have their internal truncated apices directed to the retinal
expansions of the numerous optic nerves."

The high respect we entertain for the lecturer here alluded to,
withholds us from attempting to supply a more homely version of the
foregoing passage. But what an idea this must give to a student who
reads it in "the outlines" of a science of which he is about to
commence the study. There is nothing whatever difficult in the ideas
themselves; but what a bristling _chevaux-de-frise_ of hard words,
what a phalanx of propositions! We fear we should never arrive at the
knowledge of many of those beautiful adaptations which all animals
exemplify, if we had to approach them by such a forbidding pathway.

As contrasted with simple facts thus obscured by an unnecessary
complexity of expression, we may see in Abernethy how a very
comprehensive proposition may be very simply expressed. Take almost the
first sentence in his Surgical Lectures, the germ, as it were, of a
new science: "Now I say that local disease, injury, or irritation, may
affect the whole system; and conversely, that disturbance of the whole
system may affect any part."

We have sometimes thought that lecturers who have had several desirable
qualifications have materially diminished the attraction of them by
faults which we hardly know how to designate by a better term than
vulgarity, ill-breeding, or _gaucherie_. Now Abernethy had, in the
first place, that most difficult thing to acquire, the appearance of
_perfect ease, without_ the slightest _presumption_. Some lecturers
appear painfully "in company;" others have a self-complacent
assurance, that conveys an unfavourable impression to most well-bred
people. Abernethy had a calm, quiet sort of ease, with that expression
of thought which betokened respect for his task and his audience, with
just enough of effort only, to show that his mind was in his business.

He had no offensive tricks. We have known lecturers who never began
without making faces; others who intersperse the lecture with unseemly
gesticulations. Some, on the most trivial occasion, as referring to
a diagram, are constantly turning their backs _completely_ to the
audience. This is, we know, disagreeable to many people, and, unless a
lecturer is very clear and articulate, occasionally renders his words
not distinctly audible. Even in explaining diagrams, it is seldom
necessary to turn quite round; the smallest inclination towards the
audience satisfies the requisitions of good breeding, reminds them
agreeably of a respect with which they never fail to be pleased, and of
the lecturer's self-possession.

There are, indeed, occasions when the lecturer had better turn a
little aside. Not long ago, we heard a very sensible lecturer, and a
very estimable man, produce an effect which was rather ludicrous—a
very inconvenient impression when not intended. He had been stating,
very clearly, some important facts, and he then observed: "The great
importance of these facts I will now proceed to explain to you;" when
he immediately began to apply the pocket-handkerchief he had in his
hand most elaborately to his nose, still fronting the audience. It had
the most ridiculous effect, and followed so closely on the preceding
remark, as to suggest to the humorously inclined that it was part of
the proposed explanation.

Some think it excusable to cast their eyes upwards, with an expression
of intense thought, or even to carry their hands to their heads or
forehead for the same purpose. But this conveys a painful feeling to
the audience, whose attention is apt to be diverted from the subject by
sympathy with the apparent embarrassment of the lecturer. Sometimes it
conveys the impression of affectation, which of course is one form of
vulgarity.

Abernethy was remarkably free from anything of the kind. The
expression of his countenance was, in the highest degree, clear,
penetrative, and intellectual; and his long, but not neglected,
powdered hair, which covered both ears, gave altogether a philosophic
calmness to his whole expression that was peculiarly pleasing. Then
came a sort of little smile, which mantled over the whole face, and
lighted it up with something which we cannot define, but which seemed a
compound of mirth, archness, and benevolence.

The adjustment of the quantity of matter to the time employed in
discussing it, is an important point in teaching. A lecture too _full_,
is as objectionable as a lecture _too long_. If the matter is spread
too thinly, the lecture is bald and uninteresting, and apt to fall
short of representing any integral division of a subject; if it be too
thick, it is worse, for then all is confused and difficult. A man's
brain is like a box packed in a hurry; when all is done, you neither
know what you have got, nor what you have forgotten.

Here again Abernethy was in general very happy. Various circumstances
would sometimes, indeed, in the Anatomical Course, oblige him to put
more into one lecture than was usual; but he had always, in such a
case, some little manœuvre to sustain the attention of his audience.
No man was ever a more perfect master of the _ars est celare artem_.
Everything he did had its object, every joke or anecdote its particular
errand, which was in general most effectively fulfilled.

The various ways in which Abernethy managed to lighten up the general
lecture, or to illustrate single points, can hardly be conveyed by
selection of particular examples. There was a sort of running metaphor
in his language, which, aided by a certain quaintness of manner, made
common things go very amusingly. Muscles which pursued the same course
to a certain point, were said to travel sociably together, and then to
"part company." Blood-vessels and nerves had certain habits in their
mode of distribution contrasted in this way; arteries were said to
_creep_ along the sides or between muscles. Nerves, on the contrary,
were represented as penetrating their substance "_without ceremony_."
Then he had always a ready sympathy with his audience. If a thing was
difficult, he would, as we have said, anticipate the feelings of the
student. This is always encouraging; because, when a student finds a
point difficult, if he is merely diffident, he is depressed; if he is
disposed to be lazy, he finds too good an excuse for it.

Abernethy's illustrations were usually drawn from some source already
familiar; and if they were calculated to impress the fact, he was not
very scrupulous whence he drew them. This would sometimes lead him
into little trippings against refinement; but these were never wanton.
Everything had its object, from the most pathetic tale down to the
smallest joke. When the thing to be impressed was not so much single
facts or propositions, as a more continued series, he had an admirable
mode of pretending to con over the lecture in a manner which he would
first recommend students to do—something after this fashion: "Let me
see—what did he say?" "Well, first he told us that he should speak of
Matter in general; then he said something about the Laws of Matter,
of Inertia, &c. Well, I did not understand much of that; and I don't
think he knew much about it himself;" and so on. There would now be a
general smile; the attention of the class would be thoroughly alive;
and then he would, in this "conning over," bring forward the points
he most wished to impress of the whole lecture. A very striking proof
of how much power he had in this way, came out in a conversation I
had with Dr. Thomas Rees. This gentleman knew Abernethy well, and, in
kindly answering some inquiries I made of him, he spoke of his power
in lecturing. Amongst other things, he said: "The first lecture I ever
heard him give, impressed me very much; I thought it admirable. His
skill appeared so extraordinary! At the conclusion of the lecture,"
said Dr. Rees, "he proposed to the students to con over the lecture,
which he proceeded to do for them." Dr. Rees then continued repeating
the heads of the lecture, and this after at least thirty, perhaps forty
years.

Lecturers will sometimes endeavour to illustrate a point which is
difficult or obscure by something more difficult still, or something
borrowed from another branch of science. Sometimes the illustrations
are so lengthy, or intrinsically important, that a pupil forgets _what
principle_ it was that was _to be illustrated_. When we are desirous
of learning something about water or air, it is painful for a pupil
to be "reminded" of the "properties of angles," which it is an even
chance he never knew. It is equally uncomfortable to many an audience,
in lectures on _other subjects_, to have the course of a cannon-ball,
which three pieces of string would sufficiently explain, for mere
purposes of illustration, charged with the "laws of projectiles," the
"composition of forces," &c. We are of course not thinking of learn_ed_
but learn_ing_ audiences. To the former, lectures are of no use; but
we allude to learners of mixed information and capacity; like young
men who have been residing with medical men in the country; who come
to a lecture for information, and who require to be interested, in
order that they may be instructed. Abernethy's illustrations were
always in simple language. Rough ridden sometimes by a succession of
many-footed Greek compounds, the mind of a student loves to repose on
the refreshing simplicity of household phrases.

Abernethy had stories innumerable. Every case almost was given with the
interest of a tale; and every tale impressed some lesson, or taught
some relation in the structure, functions, or diseases of the body. We
will give one or two; but their effect lay in the admirable manner in
which they were related.

If he was telling anything at all humorous, it would be lighted up by
his half-shut, half-smiling, and habitually benevolent eye. Yet his eye
would easily assume the fire of indignation when he spoke of cruelty or
neglect, showing how really repulsive these things were to him. Then
his quiet, almost stealthy, but highly dramatic imitation of the manner
of some singular patient. His equally finished mode of expressing pain,
in the subdued tone of his voice; and then when something soothing or
comfortable had been successfully administered to a patient, his "Thank
you, sir, thank you, that is very comfortable," was just enough always
to interest, and never to offend. Now and then he would sketch some
patient who had been as hasty as he himself was sometimes reported to
be. "Mr. Abernethy, I am come, sir, to consult you about a complaint
that has given me a great deal of trouble." "Show me your tongue,
sir. Ah, I see your digestive organs are very wrong." "I beg your
pardon, sir; there you are wrong yourself; I never was better in all my
life," &c. All this, which is nothing in telling, was delivered in a
half-serious, half-Munden-like, humorous manner, and yet so subdued as
never to border on vulgarity or farce.

His mode of relating cases which involved some important principle,
showed how really interested he had been in them. A gentleman having
recovered from a very serious illness, after having failed a long time
in getting relief, was threatened, by the influence of the same causes,
with a return of his malady. "He thought," said Abernethy, "that if he
did not drink deeply, he might eat like a glutton." He lived in the
country, and Mr. Abernethy one day went and dined with him. "Well,"
said Mr. Abernethy, "I saw he was at his old tricks again; so, being
a merchant, I asked him what he would think of a man who, having been
thriving in business, had amassed a comfortable fortune, and then went
and risked it all in some imprudent speculation?" "Why," said the
merchant, "I should think him a great ass." "Nay, then, sir," said
Abernethy, "thou art the man."

On another occasion, a boy having suffered severely from disease of the
hip, Abernethy had enjoined his father to remove him from a situation
which he was unfitted to fill, and which, from the exertion it
required, would expose him to a dangerous recurrence of his complaint.
The father, however, put the boy back to his situation. One day,
Abernethy met both father and son in Chancery Lane, and he saw the
boy, who had a second time recovered, again limping in his walk. After
making the necessary inquiry—"Sir," said he to the father, "did I not
warn you not to place your son in that situation again?" The father
admitted the fact. "Then, sir," said Abernethy, "if that boy dies, I
shall be ready to say you are his murderer." Sure enough, the boy had
another attack, and did die in a horrible condition.

This story, and others of a similar kind, were intended to impress
the paramount importance of keeping diseased parts, _and joints
especially_, in a state of _perfect repose_; and to prevent a
recurrence of mischief, by avoiding modes of life inappropriate to
constitutions which had exhibited a tendency to this serious class of
diseases.

He was remarkably good on the mode of examining and detecting the
nature of accidents; as fractures and dislocations. In regard to the
latter, he had many very good stories, of which we will presently cite
a ludicrous example. He could, however, throw in pathos with admirable
skill when he desired it. The following lamentable case he used to tell
to an audience singularly silent. He is speaking of the course of a
large artery.

"Ah," said he, "there is no saying too much on the importance of
recollecting the course of large arteries: but I will tell you a
case. There was an officer in the navy, and as brave a fellow as ever
stepped, who in a sea-fight received a severe wound in the shoulder,
which opened his axillary artery. He lost a large quantity of blood;
but the wound was staunched for the moment, and he was taken below. As
he was an officer, the surgeon, who saw he was wounded severely, was
about to attend him, before a seaman who had just been brought down.
But the officer, though evidently in great pain, said: 'Attend to that
man, sir, if you please; I can wait.' Well, his turn came; the surgeon
made up his mind that a large artery had been wounded; but, as there
was no bleeding, dressed the wound, and went on with his business. The
officer lay very faint and exhausted for some time, and at length began
to rally again, when the bleeding returned. The surgeon was immediately
called, and, not knowing where to find the artery, or what else to do,
told the officer he must amputate his arm at the shoulder joint. The
officer at once calmly submitted to this additional, but unnecessary
suffering; and, as the operator proceeded, asked if it would be long.
The surgeon replied that it would soon be over. The officer rejoined:
'Sir, I thank God for it!' But he never spake more."

Amidst the death-like silence of the class, Abernethy calmly concluded:
"I hope you will never forget the course of the axillary artery."

His position was always easy and natural—sometimes homely, perhaps.
In the Anatomical Lecture, he always stood, and either leant against
the wall, with his hands folded before him, or resting one hand on the
table, with the other perhaps in his pocket. In his Surgical Lecture,
he usually sat, and very generally with one leg resting on the other.

He was particularly happy in a kind of coziness, or friendliness of
manner, which seemed to identify him with his audience; as if we were
all about to investigate something interesting _together_, and not as
if we were going to be "Lectured at" at all. He spoke as if addressing
each individual, and his discourse, like a happy portrait, always
seemed to be looking you in the face. On very many accounts, the tone
and pitch of the voice, in lecturing, are important. First: That it may
not be inaudible; nor, on the contrary, too loud. The one of course
renders the whole useless; the other is apt to give an impression of
vulgarity. We recollect a gentleman who was about to deliver a lecture
in a theatre to which he was unaccustomed. He was advised to ascertain
the loudness required, and to place a friend in the most distant part,
to judge of its fitness; but he declined it as unnecessary. When he had
given the lecture, which was a very good one, on a very interesting
subject, he was much mortified in finding that he had been inaudible to
at least one half of the audience.

Abernethy was very successful in this respect. His voice seldom rose
above what we may term the conversational, either in pitch or tone;
it was, in general, pleasing in quality, and enlivened by a sort of
archness of expression. His loudest tone was never oppressive to those
nearest to him; his most subdued, audible everywhere. The _range_
of pitch was very limited; the expression of the eye, and a _slight
modulation_ of the voice being the means by which he infused through
the lecture an agreeable variety, or gave to particular sentiments
the requisite expression. There was nothing like declamation; even
quotations were seldom louder than would have been admissible in a
drawing-room. We have heard lecturers whose habitually declamatory tone
has been very disagreeable; and this seldom fails to be mischievous. A
declamatory tone tends to divert the attention, or to weary it when
properly directed. On almost every subject, it is sure to be the source
of occasional bathos, which now and then borders on the ridiculous.
Conceive a man, describing a curious animal in a diagram, saying,
"This part, to which I now direct my rod, is the point of the tail,"
in a sepulchral tone, and heavy cadence, as if he had said, "This
is the end of all things." Another inconvenience often attending a
declamatory tone, as distinguished from the narrative or descriptive,
is the tendency it has to make a particular cadence. Sometimes we have
heard lecturers give to every other sentence a peculiar fall; and this
succession of rhythmical samenesses, if the lecturer be not otherwise
extremely able, sends people napping.

Another fault we observe in some lecturers is, a reiteration of
particular phrases. In description, it is not easy always to avoid
this; but it seldom occurred in any disagreeable degree in Abernethy.
We have heard some lecturers, in describing things, continually
reiterating such phrases as "We find," "It is to be observed," in such
quick and frequent succession, that people's sides began to jog in
spite of them.

Provincial or national idiom, or other peculiarity, is by no means
uncommon, and generally more or less disagreeable, Abernethy was
particularly free from either. He could, in telling stories, slightly
imitate the tone and manner of the persons concerned; but it was always
touched in the lightest possible manner, and with the subdued colouring
and finish of a first-rate artist. His power of impressing facts, and
of rendering them simple and interesting by abundance and variety of
illustration, was very remarkable, and had the effect of imparting an
interest to the driest subject. In the first place, he had an agreeable
mode of sympathizing with the difficulty of the student. If he were
about to describe a bone or anything which he knew to be difficult,
he would adopt a tone more like that in which a man would teach it to
himself than describe it to others. For example, he would say, perhaps:
"Ah! this is a queer-looking bone; it has a very odd shape; but I
plainly perceive that one may divide it into two parts." Then pointing
with a probe to the division he proposed, he would begin, not so much
to _describe_ as to _find_, as if for the first time, the various
parts of which he wished to teach the names and uses; the description
being a kind of running accompaniment to his tracing of the bone, and
in a tone as if half-talking to himself and half to the audience.

Every one feels the value of order, and clearness of arrangement.
Of Abernethy's, we have already spoken generally: simplicity, and
impressing the more essential facts, were his main objects. He showed
very frequently his perception of the importance of order, and would
often methodize for the students. He knew very well that A B C was much
more easily remembered than Z K J; and he would sometimes humorously
contrast the difference between a man whose knowledge was well packed,
and one whose information was scattered and without arrangement. This
he usually did by supposing two students under examination. The scene
would not _tell_ upon paper; but it never failed to create a good deal
of mirth in the theatre, during which he would contrive to repeat the
facts he meant to impress, without the tedium of mere reiteration.

Various people have been more or less deeply impressed with different
parts of his lectures, most persons having their favourite passages. In
his anatomical course we were never more pleased than by his _general_
view of the structure of the body. He adopted on that occasion the
synthetical plan, and in imagination put the various parts together
which were to be afterwards taught analytically. In his surgical
course, the manner in which he illustrated the practical points, and
his own views in the "Eventful History of a Compound Fracture," was, we
think, the most successful triumph, both as to matter and manner, which
we have ever witnessed.

An abundance of resource and manœuvres of the kind we have mentioned,
gave a great "liveliness" to his lecture, which _in its quiet form so
as not to divert or disturb_, is a great difficulty in lecturing.

We have heard an excellent lecturer whose only fault, we think, was
want of liveliness and variety. Few men could in other respects lecture
comparably to him. Nothing could surpass the quiet, polished manner
of this accomplished teacher. His voice, though not good, was by no
means unpleasing. His articulation elaborately distinct, and free from
all provincialism. His language invariably correct and appropriate;
the structure of his sentences strikingly grammatical; and they fell
in such an easy, though somewhat too rhythmical succession, as to be
at once graceful and melodious. His arrangement, always simple and
clear. Nothing was more striking than the deferential manner in which
he approached a philosophical subject. "I like ——," said one who
had often heard him, "because he is always so gentlemanly. There is
nothing off-hand, as if he thought himself very clever, but a kind of
unaffected respect for himself and his audience, which obliges one to
pay attention to him, if it were only because you feel that a man of
education is speaking to you."

What, it may be said, can such a man want? Why he wanted liveliness
and flexibility. His voice measured forth its gentlemanly way with
all the regularity of a surveying rod. Various and interesting as his
subjects were, and handled with consummate ability, he must certainly
have _taught_; yet we think he sent away many of his audience passive
recipients, as distinguished from persons _set on thinking_ what they
had heard "into their own."

He performed his task like a good man and a scholar; but still it was
like a task after all. It was something like a scholar reading a book,
always excepting the beautifully clear illustrations for which his
subject gave him abundant opportunity. He wanted that animation and
interest in his subject by which a lecturer inoculates you with his own
enthusiasm. He was the most striking example in our experience of the
importance of liveliness and variety, and of making a lecture, however
well delivered, just that thing which we _cannot_ find in a book. The
life-like, the dramatic effect was wanting; and it was to this alone
that we can ascribe what we have not unfrequently observed in the midst
of a generally attentive audience, a few who were "nodding" their
assent to his propositions.

Now Abernethy's manner was perfect in these respects. He had just got
the "cheerfully, not too fast" expression, that we sometimes see at
the head of a musical composition. His manner was so good, that it
is difficult to convey any idea of it. It was easy, without being
negligent; cheerful, without being excited; humorous, often witty,
without being vulgar; expeditious, without being in a bustle; and he
usually took care that you should learn _the thing_, before he gave the
_name of it_; and understand it, before he expatiated on the beauty or
perfection of its adaptation to the ends it seemed designed to serve.

He was particularly chaste in the manner in which he spoke of design,
or other of the Attributes so frequently observable in natural
arrangements. It is a great mistake, we think, and not without
something akin to vulgarity, to usher in any description of the
beauties of nature by a flourish of such trumpets as human epithets
form—mere notes of admiration. Nature speaks best for herself. The
mind is kept in a state of excitement by too frequent _feux de joies_
of this kind; the frequent recurrence of such terms as "curious!
strange! wonderful!" on subjects where all is wonderful, have a sort of
bathos in the ears of the judicious, while to the less critical they
produce a kind of disturbed atmosphere, which is unfavourable to the
calm operations of the intellect.

Abernethy was generally very careful in these matters. I give one
example. He is speaking of cartilage, or gristle, which covers the
ends of the bones where they form joints, and has explained its great
elasticity, the use of it in preventing jarring; and contrasted the
_springiness_ of youth with the easily jarred frame of age. "Well,"
he adds, "this cartilage is fibrous, and they say that the fibres are
arranged vertically; so that the body may be said to be supported on
'_myriads of elastic columns_.'" That was the beauty by which he wished
to impress that which he had previously _taught_.

When marvellousness is too much excited, many say, "Ah, how clever
that gentleman is! what an interesting lecture! what a curious thing
that was he showed us!" But when you inquire what _principle_ or _law_
was intended to be illustrated, you find that the sensual or the
imaginative faculty has alone been excited, and has galloped off with
that which was intended for the intellect. If persons are examined as
to a particular point of the lecture, they are apt to say: "Well, that
is just what I wanted to know; would you explain it?"

It would seem that it is a great mistake to excite marvellousness
or our external senses very vividly, when we desire to concentrate
the intellectual faculties. That breathless silence, with eyes and
mouth open, that "_intenti que ora tenebant_" condition, excited by
marvellousness, is very well for the story of Æneas, or Robinson
Crusoe; but it is out of place, when we are endeavouring to augment our
intellectual possessions.

We require, in fact, a calmer atmosphere. The desire to interest and
hold the attention of our audience is so natural, that it is very apt
to escape one that this may be done _on terms not consistent_ with our
real object—the interesting the intellect; and this fault is perhaps,
of all, the worst; because it is never a greater failure than when it
appears to be successful. All other faults in lecturing, if serious, in
one respect tell their own tale in the thinning audience.

The learned author of the "Philosophy of Rhetoric" has observed that "A
discourse directed to the understanding will not admit of an address to
the passions, which, as it never fails to disturb the operation of the
intellectual faculty, must be regarded by every intelligent hearer as
foreign indeed, if not insidious." He had before said, "that in such a
discourse you may borrow metaphor or comparison to illustrate it, but
not the bolder figures, prosopopœia and the like, which are intended
not to elucidate the subject, but to _create admiration_."

"It is obvious," he continues, "that either of the foregoing, far from
being subservient to the main design (to address the intellect), serves
only to distract the attention from it[67]."

This judicious writer, however, in the first sentence makes a
distinction, which requires, perhaps, to be received with some caution.

There is no discourse that is solely intellectual; the driest
mathematical proposition interests our _feelings_. The pleasure of
truth, what is that? Not merely intellectual, certainly. It is a
pleasure derived _from_ the intellect, no doubt; but it is a _feeling_
entirely distinct. So, in addresses to the passions, if they are
successful, the presiding influence of the intellect is very obvious;
this away, a discourse soon merges into bombast or fustian, a something
which neither impresses the feelings nor the passions as desired.

The true desideratum, as it appears to us, is accuracy of adjustment,
not separation. In intellectual operations, the feelings are to be
subservient to the accomplishment of the objects of the intellect. In
discourses, where the passions or feelings are most appealed to, or
most prominent, the intellect must still really guide, though it may
appear to follow.

Notwithstanding that so much of Abernethy's lecturing was on anatomy,
and therefore necessarily addressed to the eye, yet he seldom offered
any _illustration_ to the external senses. He was always endeavouring
to impress the mechanical arrangement of parts, by reference to their
uses and surgical relations. Even in speaking of light, he would be
suggestive beyond the mere perception of sense. He used to say, of
refraction of light, when the refracting medium was, as it commonly
is, the denser body, "that the ray seems as if attracted"—a very
suggestive phrase to any one who has thought much on the subject of
light. It is a curious thing to observe how confused the ideas of many
people are on phenomena of light; and we are afraid that the cause is,
that the illustrations to the eye are given _too soon_. If people were
made to _understand_ by a simple illustration what they are about to
_see_, it is probable they would have much clearer ideas. The intellect
having gone before, the eye no longer diverts it from its office; and
the eye would then be merely _impressing_, by means of a physical
representation, an established idea.

[Footnote 67: Vol. i, p. 23.]




CHAPTER XXIII.

    "Suavis autem est et vehementer sæpe utilis jocus et facetiæ."—CIC.
    DE ORAT.


Abernethy's humour was very peculiar; and though there was of course
something in the matter, there was a good deal more, as it appeared
to us, in the manner. The secret of humour, we apprehend, lies in the
juxtaposition, either expressed or implied, of incongruities, and it is
not easy to conceive anything humourous which does not involve these
conditions. We have sometimes thought there was just this difference in
the humour of Abernethy, as contrasted with that of Sidney Smith. In
Smith's, there was something that, told by whom it might be, was always
ludicrous. Abernethy's generally lay in the telling.

      "The jest's propriety lies in the ear
      Of him who hears it, never in the tongue
      Of him that makes it,"

although true, was still to be taken in rather a different sense from
that in which it is usually received. The former (a far higher species
of humour) may be recorded; the dramatic necessities of the other
occasion it to die with the author. The expression Abernethy threw into
his humour (though of course without that broadness which is excusable
in the drama, but which would have been out of place in a philosophical
discourse) was a quiet, much-subdued colouring, between the good-nature
of Dowton, and (a little closer perhaps to the latter) the more quiet
and gentlemanly portions of Munden.

Few old pupils will forget the story of the Major who had dislocated
his jaw.

This accident is a very simple one, and easily put right; but, having
once happened, it is apt to recur on any unusual extension of the lower
jaw. Abernethy used to represent this as a frequent occurrence with
an hilarious Major; but as it generally happened at mess, the surgeon
went round to him and immediately put it in again. One day, however,
the Major was dining about fourteen miles from the regiment, and, in a
hearty laugh, "out went his jaw." They sent for the medical man, whom,
said Abernethy, we must call the apothecary. Well, at first, he thought
that the jaw was dislocated; but he began to pull and to show that he
knew nothing about the proper mode of putting it right again. On this,
the Major appeared to be very excited, and vociferated inarticulately
in a strange manner; when, all at once, the doctor, as if he had just
hit on the nature of the case, suggested that the Major's complaint was
in his brain, and that he could not be in his right mind. On hearing
this, the Major became furious, which was regarded as confirmatory of
the doctor's opinion; they accordingly seized him, confined him in
a strait-waistcoat and put him to bed, and the doctor ordered that
the barber should be sent for to shave the head, and a blister to be
applied "to the part affected."

The Major, fairly beaten, ceased making resistance, but made the
best signs his situation and his imperfect articulation allowed, for
pen and paper. This request, being hailed as indicative of returning
rationality, was complied with; and, as soon as he was sufficiently
freed from his bonds, he wrote—"For God's sake send for the surgeon of
the regiment." This was accordingly done, and the jaw readily reduced,
as it had been often before. "I hope," added Abernethy, "you will never
forget how to reduce a dislocated jaw."

We think that what we have said of the style of his humour cannot be
very incorrect, from knowing that the impressions of one of his oldest
pupils and greatest admirers were almost identical with the foregoing.
I recollect it being said of John Bannister, that the reason his acting
pleased everybody was that he was always a gentleman; an extremely
difficult thing, we should imagine, in handling some of the freer parts
of our comic dialogues. Abernethy's humour (exceptionally indeed, but
occasionally a little broad) never suggested the idea of vulgarity;
and, as we have said, every joke had its mission. Then, at times,
though there was not much humour, yet a promptness of repartee gave it
that character.

"Mr. Abernethy," said a patient, "I have something the matter, sir,
with this arm. There, oh! (making a particular motion with the limb)
that, sir, gives me great pain." "Well, what a fool you must be to do
it, then," said Abernethy.

One of the most interesting facts in relation to Abernethy's lecturing,
was, that however great his natural capacity, he certainly owed very
much to careful study and practice; and we cannot but think that it
is highly encouraging to a more careful education for this mode of
teaching, to know the difficulty that even such a man as Abernethy had
for some few years in commanding his self-possession. To those who only
knew him in his zenith or his decline, this will appear extraordinary;
yet, to a careful observer, there were many occasions when it was
easy to see that he did not appear so entirely at ease _without some
effort_. He was very impatient of interruption; an accidental knock
at the door of the theatre, which, by mistake of some stranger, would
occasionally happen, would disconcert him considerably; and once,
when he saw some pupil joking or inattentive, he stopped, and with a
severity of manner I hardly ever saw before or afterwards, said: "If the
lecture, sir, is not interesting to you, I must beg you to walk out."

There were, as we shall hereafter observe, perhaps physical reasons
for this irritability. He never hesitated, as we occasionally hear
lecturers do, nor ever used any notes. When he came to any part that
he perhaps wished to impress, he would pause and think for a second
or two, with his class singularly silent. It was a fine moment. We
recollect being once at his lecture with the late Professor Macartney,
who had been a student of Abernethy's[68]. Macartney said, "what can
it be that enables him to give so much interest to what we have so
often heard before?" We believe it to have been nothing but a steady
observance of rules, combined with an admirable power _matured by
study_.

That which, above everything, we valued in the whole of Abernethy's
lectures, was what can hardly be expressed otherwise than by the
term, tone. With an absence of all affectation, with the infusion
of all sorts of different qualities: with humour, hilarity, lively
manner, sometimes rather broad illustrations, at other times, calm
and philosophical, with all the character of deep thought and acute
penetration; indignation at what was wrong or unfeeling, and pathos in
relation to irremediable calamity; still the thing which surpassed all,
was the feeling, with which he inoculated the pupils, of a high and
conscientious calling. He had a way which excited enthusiasm without
the pupil knowing why. We are often told by lecturers of the value of
knowledge for various purposes—for increasing the power and wealth of
the country—for multiplying the comforts and pleasures of society—for
amassing fortunes, and for obtaining what the world usually means by
the term distinction. But Abernethy created a feeling distinct from and
superior to all mere utilitarian purposes. He made one feel the mission
of a conscientious surgeon to be a high calling, and spurned, in manner
as well as matter, the more trite and hackneyed modes of inculcating
these things. You had no set essay, no long speeches. The _moral_
was like a golden thread artfully interwoven in a tissue to which it
gives a diffusive lustre; which, pervading it everywhere, is obtrusive
nowhere.

For example, the condition attached to the performance of our lowest
duties (operations), were, the well-ascertained inefficacy of our
best powers directed to judicious treatment; the _crowning_ test—the
conviction that, placed in the same circumstances, _we would have the
same operation performed on ourselves_. Much of the suggestive lies
in these directions. Our sympathies toward the victims of mistake or
ignorance, excited by the relation of their sufferings, were heightened
by the additional mention of any good quality the patient might have
possessed, or advantage of which he might have been deprived; and thus
that interest secured which a bare narration of the case might have
failed to awaken.

A father, who, in subservience to the worldly prospects of his son,
placed him in a situation to which he was unequal, and thus forgot his
first duty, the health of his offspring, was the "murderer" of his
child. Another victim, we have seen, was as "brave a fellow as ever
stepped," &c.

Humanity and Science went hand in hand. His method of _discovering_
the nature of dislocations and fractures, by attention to the relative
position of parts, was admirable; and few of his pupils, who have
had much experience, have failed to prove the practical excellence
of them. He repudiated nothing more than the too commonly regarded
test, in fractures, of "grating, or crepitus." Nothing distinguished
his examination of a case more than his gentleness, unless it was the
clearness with which he delivered his opinion.

To show how important gentleness is—a surgeon had a puzzling case
of injury to the elbow. He believed that he knew the nature of the
accident, and that he had put the parts right; but still the joint
remained in a half-straight position; and the surgeon, who knew his
business, became alarmed, lest something had escaped him, and that
the joint would be stiff. He proposed a consultation. The joint was
examined with great gentleness, and after Abernethy's plan. The boy
experienced no pain. Everything appeared in its natural position. The
surgeon said: "Now, my boy, bend your arm a little, but no farther
than just to reach my finger; and not as much as that, if it gives you
any pain." This the boy did very gently. After waiting a few minutes,
the surgeon again told him to bend it a little more, and upon the same
conditions; and so on, until, in a very short space of time—perhaps
eight or ten minutes—the arm had been completely bent. The boy had
been alarmed, and the muscles had become so sensitive that they held
the parts with the most painful tenacity; but, beyond this, there was
nothing the matter.

We cannot help thinking that Abernethy's benevolence had a great
influence in directing some of his happiest contributions to practice.
We consider that every sufferer with that serious accident, fracture
of the neck of the thigh bone within the joint, owes a great portion
of any recovery he may have, to Abernethy. It was he who was the real
means of overthrowing a dangerous dogma, that such cases could not
unite by bone, and who opposed the practice consequent on it, by which
reparation by bone became impossible. There was hardly any subject
which he touched, of which he did not take some view more or less
original; and his reasoning was always particularly simple and to the
point. No man, we believe, ever exceeded him in the skill he possessed
in conveying ideas from one mind into another; but he did a great deal
more: those who really studied him were sent away thinking, and led to
work with a kind of pleasure, which was in some sense distinct from any
merely practical or professional interest.

He contrived to imbue you with the love of philosophical research
in the abstract—with an interest in truth for its own sake;
you found yourself remembering the bare facts, not so much from
conscious _efforts_ of memory, as from the suggestive interest of the
observations with which they were so frequently associated. In going
over one of his Lectures alone, they seem to grow and expand under your
own reflections. We know not how to express the effect they produced:
they seemed to give new pleasure on repetition, to purify your thoughts
scarcely less than they animated your onward studies.

In studying their more suggestive passages, you would now and then feel
surprise at the number and variety of important practical relations
arising out of a single proposition. We are here merely stating our
own early impressions of his power. What we always really felt was,
that, great as was the excellence of these Lectures in a scientific
or professional sense, there was something more excellent still in
the element they contained of intellectual expansion and of moral
improvement.

We cannot indeed say that they had no faults; but we should be hard
driven to point them out: and although we feel how short our attempt
to give some idea of his mode of proceeding must fall of doing him
justice, still, if there be any truth at all in our representation, it
is quite clear that his negative excellences alone must have implied
no ordinary powers. But we must conclude: "Quid multa? istum audiens
equidem sic judicare soleo; quidquid aut addideris aut mutaveris aut
detraxeris, vitiosius et deterius futurum."

[Footnote 68: Professor Macartney had also formerly given the
Anatomical Demonstrations.]




CHAPTER XXIV.

      HOR.    Is it a custom?

      HAMLET. Ay, marry, is't:
              But, to my mind, though I am native here
              And to the manner born, it is a custom
              More honoured in the breach than the observance.

      HAMLET, Act I, Sc. IV.


If a moralist were to divide his catalogue of immoralities into such
as were of general commission, and such as occurred in the conduct of
the various trades and professions, we fear the latter division would
suggest no flattering position to humanity. An elevation somewhat above
gifted creatures it might be; but still we fear it would be at so low a
level as to afford Man but a humiliating indication of the height from
which he had fallen. He would, in too many instances, perhaps, find his
real _claims_ to his high destiny about equal to the shadowy difference
between a creature who fulfils _some_ only of his responsibilities,
and one who has no responsibilities to fulfil. We should like to hear
some grave philosopher discourse on Fashion: it is surely a curious
thing, for there is a fashion in everything. It is very like habit; but
it is not habit neither. Habit is a garment, which takes some time to
fit easily, and is then not abandoned without difficulty. Fashion is a
good fit _instanter_, but is thrown aside at once without the smallest
trouble. The most grotesque or absurd custom which slowly-paced
habit bores us with examining, is at once adopted by fashion with a
characteristic assentation.

Morals are by no means free from this kind of conventionalism: so
much the contrary, that few things evince more strongly the power of
fashion. It might be imagined that the multiplication of examples would
tend to teach the true nature of the thing exemplified; but it would
not seem so with error; "_tout au contraire_." Arts or acts, which are
tabooed as vicious in the singular number, become, in the plasticity of
our moral grammars, very tolerable in the plural. Things that the most
hardy shrink from perpetrating _single-handed_, are regarded as easy
"compliances with custom" when "joint-stock" vices; practices which,
when partial, men are penetrating enough to discover to be unchristian,
or sufficiently sensitive to regard as ungentlemanly, pass muster with
marvellous lubricity when they become universal. We can anathemize,
with self-complacent indignation, vices in which we have no share; but
we are abundantly charitable when we discuss those in which we have a
common property; and, finally, moral accounts are settled very much to
our own satisfaction, as Butler says, by compounding

              "For sins we are inclined to,
      By damning those we have no mind to."

After all, society keeps a pretty good "look-out" after offences
distributed in common. The law is tolerably comprehensive of things
which are of general commission; and mankind, sooner or later, contrive
to catch, or successfully oppose, the numerous little enormities which
slip through the finest of our legal meshes.

      "Raro antecedentem scelestum,
      Deseruit pede pœna claudo."

From all this it results that moral obliquities, which fall within the
observation of society, make but an up-hill game; that which is _felt_
to be prejudicial to the interests of all men, is easily determined
to be vicious. But here again there is much in fashion. Society has
often determined that the immorality of a thing is not to be measured
by the nature of the act, nor the motive even on which it has been
founded, so much as by the more refined test afforded by the _position_
of the _actor_. One man may, like a sort of commercial megatherium,
gorge, with railway velocity, provisions which a once-breathing, fond
affection and a cold world had alike determined to be the life-blood of
widows and orphans, and yet have noblemen and others for his associate!
he may perhaps be a legislator in a great nation; whilst the poor
starveling, who steals for the vulgar purpose of satisfying hunger, may
be sent to the treadmill, where he may solve at leisure the problem
thus set him, by "the most enlightened nation on earth."

Again, vices which have a known influence in disturbing the relations
of society are in various ways opposed by the more _public_ influence
of religion. So that in the end a man finds—although he may arrive at
the conclusion, only by exhausting all other views before he hits on
those which lead to it—that honesty is as good a way of getting on as
any other; or he may advance perhaps even on this utilitarian creed so
far as to agree with Tillotson: that people take more trouble to get to
Hell, than would suffice to carry them to Heaven. The immoralities of
trades and professions lie in a very different position, and involve
peculiarities which favour their growth and perpetuity.

They are committed in secret;—people are proverbially cautious of
attacking the weak positions of others, who feel that their own are
ill-defended. This, and the established manœuvres of each calling,
enable an individual to do a good deal "off his own bat," without, as
one of our bishops happily expressed it, "being caught out." In trade
we are sometimes informed that a thing cannot be sold cheaper; that the
price asked is already less than the cost; and people are appropriately
addressed as idiots, who every day appear to believe that which common
sense shows to be impossible.

Your purveyors will sometimes tell you that they are not living by the
prices they charge; although you have just ascertained that the same
article may be bought at infinitely less cost in the next market. The
other day, a watchmaker told us that our watch wanted a good deal of
looking to, and, amongst other things, "no doubt cleaning;" but this he
discovered, we suppose, by some recondite mesmeric process in a book,
which recorded when it had been cleaned last, without looking at the
watch at all.

As regards professions, lawyers are said to defend right and wrong with
indiscriminate avidity, with the encouraging prospect of obtaining more
fruit in maintaining one wrong cause, than establishing twenty right.

Then the _real nature_ of these things is, like too many in other
sciences, obscured by a cloudy nomenclature. We hear of "customs of
the trade," "secrets of the trade," or "profession," applied to things
which the moralist only recognizes under very different designations.
Sophisms thus secured, and which appear to minister to a man's
interests, have their true colours developed with difficulty; to say
nothing of it not being easy to discover that which there is no desire
to examine.

If any man should be so "peculiar," or "crotchety," as to consider that
names are of little import, and that "Vice is vice, for a' that," and
venture to anathematize any custom, or even refuse to be an accessory,
in declining to wink at it, he may encounter charges of violating
professional confidence, of being deficient in a proper _esprit de
corps_, and be outvoted, for no better reason than that he cannot
concur in the dogma, that a _vicious sophism is more valuable than a
simple truth_; nor agree with the currier, "that leather is the best
material for fortification." He may possibly be let off by conceding
his connivance; which is little better than declining to be thief, as
too shocking; but having no objection to the more lubricated position
of the receiver.

But does any one for one moment believe that all this can be hung
on any trade, or profession, with no effect? Or that it will not
have a baneful influence on every calling, and that in proportion
as its _real_ and _proper_ duties are beneficent and exalted? Now,
whilst we claim for the medical profession a character which, in its
single-mindedness and benevolence, yields to no other whatever, we fear
it is not entirely free from these technical besettings.

In the medical profession, we trust, that which we, for want of a
better term, designate as technical immoralities are exceptions.
Exceptional they may be, and we sincerely hope they are; but, in
a crowded island, exceptions, even if _relatively_ few, may be
_absolutely_ numerous; and whenever they occur, especially if men hold
any position, one case of compromise of duty does more harm than a
hundred of the most inflexible adhesions to it can remedy. Suppose a
patient apply to a surgeon with a complaint requiring one operation,
and his fears incline him to another; he is informed it is improper for
his case: that so far from relieving him, it will indefinitely increase
his sufferings. The patient reiterates his wishes; the surgeon declines
doing that which he would not have done in his own person. On lamenting
what he believes to be the consequences of the patient's determination,
to a brother surgeon, he is met by: "What a fool you must be to throw
away —— guineas; if you don't do it, somebody else will."

He is too right in his prediction, and so is the surgeon who refused
to operate, and he has lost a large fee; he receives the verification
of his prediction subsequently from the patient, who exclaims, "Sir,
I never have a moment's ease!" and when, after weeks of suffering,
the patient dies, the surgeon consoles himself with the melancholy
satisfaction of not having contributed to sufferings which he was
called in too late to remedy.

The more plastic practitioner has, it is true, taken fifty or a hundred
guineas, it may be, out of the one pocket, and put it into his own; but
in what way are mankind benefited? or does any one really think that
the apparent gainer can ultimately be so? The fault in this, as in many
other cases, is the ignorance of the public. There is nothing in the
foregoing sketch that was not as easily intelligible to the commonest
understanding, as that two and two are equal to four! And is it no evil
that one man should pay so large a sum for so plain a piece of honesty?
or that another should be rewarded, as the case may be, for ignorance,
or a compromise of his duty?

Let us take another case. A gentleman was called on to give a
certificate; he examined the case, and found that the wording of the
certificate called on him to certify to that which was diametrically
opposite to the fact. He naturally declined, and, as the point was of
some importance, went to the parties to explain. He was then informed
that two professional men had, the previous day, given the certificate
without hesitation. He is complimented on his conscientiousness,
but never employed again by that family; and he has the further
satisfaction of hearing that his place is supplied by one of his
more accommodating brethren! We fear that in such a case there is a
balance to be adjusted between the several persons, and an appropriate
appellation to be discovered besides. We respectfully leave it to the
reader's judgment to adjust the one, and to draw on his aptitude for
nomenclature to supply the other.

Again, a man is called in to a consultation; he disapproves of the
treatment, but declares to the friends of the patient that every thing
has been very properly done. In another case of consultation, finding
that every thing has been really conducted properly, he commences an
_apparently_ different treatment, but essentially the same, without
giving his confiding brother the benefit which his acquiescence in his
views would necessarily imply.

In an operation, where the course is doubtful and the opinion various,
the choice is left to the patient—that is, the decision of how the
surgeon is to act is to be determined by him who is confessedly really
least capable of judging. Can it be right to perform a _doubtful_
operation under such circumstances? Should not the patient reflect
that the _temptations_ are all on one side? The attempt to dispense
with the operation is laborious, time-consuming, anxious, encouraged
perhaps only by small, minute accessions of improvement, interspersed
with complaints of tedium and delay, and the result admitted to be
doubtful; the operation, on the other hand, is a work of a few minutes,
the remuneration munificent, the _éclat_ productive, and the labour
nothing. All this and much more no man can entirely prevent; the real
cause is the ignorance of the public, which a very little of the labour
they bestow on many far less important subjects would easily and
quickly dispel.

If these and multitudes of similar things are evils; if they contribute
to debase a profession and to charge the conscientious with unthankful
office and unrequited labour, and to confer fame and profit on a
triumphant chicanery; we surely must feel indebted—not only as
professional men, not merely as patients, but in a far higher and
wider sense—to a man who, availing himself of a commanding position
for the highest purposes, endeavoured, by precept and example, to
oppose all such proceedings, and to cultivate a high _morale_ in the
conduct of the profession. Now no one more sedulously aimed at this
than John Abernethy. Although we shall not, we trust, be accused of
underrating the obligations we owe him in a professional or scientific
sense, we think that, great as they are, they are at least equalled
by those arising out of that duty-to-your-neighbour spirit which was
so universally diffused through every thing he taught, and which, in
his intercourse with his pupils, he never on any occasion failed to
inculcate. We will endeavour to render what we mean intelligible, and
perhaps we cannot do this better than by selecting a few illustrations
from observation of "Abernethy in Consultation."




CHAPTER XXV.

    "Hoc autem de quo nunc agimus id ipsum est quod utile
    appellatur."—CICERO.


Consultation. We are to have a consultation! What a sound is that! How
many a heart has been set thumping by this one word. We doubt whether
there be any in the English language that has more frequently disturbed
the current it was intended to calm. But consultations must be. Already
the carriage of a physician has arrived, a tremendous rap has been
given at the door, the interesting visitor is already in the library.

Another rap, louder somewhat than the former, announces another
physician, or a consulting surgeon. The general practitioner,
taking advantage of his intimacy with the family, may have perhaps
very sensibly walked in without knocking at all. They are now all
assembled in the library, and, having remarked on a "Storm Scene" by
Gaspar Poussin, which hangs over the fire-place, we leave them to the
preliminaries of a consultation.

Presently they are introduced to the patient, on whom the knocking has
already had some effect. A short pause, and they are again assembled
in the library. In a few minutes the bell rings, and the father of a
fine young woman is summoned to hear their decision. As he proceeds,
he stealthily removes a straggling tear that, with all care, would
get out of bounds, enters the library, and hears the result of the
consultation. Neatly enveloped _honoraria_ are presented to the
consultants, the bell has rung, Thomas has shown the gentlemen to their
respective vehicles, and and so ends the consultation.

The father, a widower, returns to the drawing-room, and his second
daughter says: "Well, papa, what do the doctors say of Emily?" "Well,
my dear, they say that Emily is very ill; that she requires great
care; that they cannot say positively, but hope she may ultimately do
well. They entirely coincide with our friend Mr. Smith Jones as to the
nature of the disease, and think his treatment of the case has been
highly judicious. They say there are some points on which the case may
turn, but of which they cannot speak positively to-day; but they hope
to be able to do so when they meet again, which they are to do the day
'after to-morrow.' They all seem to consider the nervous system very
much affected. They say we must keep Emily very quiet. She is to have
any light diet she desires, and to have some new medicine to-morrow.
The cod-liver oil, they say, has done her all the good now that it is
calculated to do, and she is this evening to take a composing draught."
The family are silent, and so ends the consultation.

What! and are all consultations like that? No, reader, we hope not.
Many a valuable life has, we believe, been saved or prolonged by
consultation; and perhaps many more would be, if people would only
_think a little more before_ they act in such important matters.

But how is this to be, when men and women who _do_ think will dive into
all other branches of knowledge, more or less, and neglect all inquiry
into laws, a _general_ knowledge of which may easily be acquired, and
of which ignorance is so frequently visited by no less punishment
than the premature separation of our dearest ties, and the loss or
impairment of that which is acknowledged to be the first of temporal
blessings. There are many things in consultations, which require
putting right, which do not depend on any one man, or on any one class.
What are we to say to a man who admits the ability, and approves of
the investigative power and practice of another, but who cannot call
him in because he _orders so little medicine_? Or of the mode in which
the public treat another, who, wishing to practise as a gentleman, and
to be paid for his brains rather than his bottles, makes no charge for
the latter; and yet who informed us that, having tried this for three
years, he lost so many families by it, that if he had not relinquished
the plan, he should have wanted bread for his own? Or who shall we
blame, when one man, calling in another to a patient, finds that the
other feels no scruple in repaying the _prestige_ which he thus owes
to his confiding brother by taking the patient from him the first
opportunity; albeit that he occupies what should be, and, we trust, as
the rule is, a higher walk in the profession.

We have seen so much feeling arising from this practice, and we hold it
as so serious an error, that we regard it as _tending more than any one
thing whatever_ to injure the position and character of the consulting
branches of the profession.

Again, how inconsiderate must be the adoption of that custom which
first of all institutes an inquiry to ascertain whether there is
any difference of opinion, and yet accompanies it with trammels,
the tendency of which is to oblige men to _appear_ to agree. When
coincidence of opinion is _alone safe_, who can be expected to differ?
The public have allowed lawyers to differ without that difference
involving any reproach. They have also proverbially determined that
"doctors do." Yet that which they consider as an almost necessary
rule in the one case, in the other they are very prone to visit, in
regard to some one of the dissentients, as a proof of professional
inferiority. A great deal of mischief results from this state of
things; it indefinitely increases the difficulty of obtaining a _really
honest_ and unreserved opinion, and leads to other consequences which
tend to impair that mutual confidence between man and man, which should
be the very life-blood of a fine profession.

We recollect a case, on the nature of which two surgeons were
consulted; and when the patient—a young lady—had been withdrawn, the
_father_ requested to know if there were any objection to his being
present at the conference. The surgeon to whom he seemed to address
himself said, "None on my part;" to which the other _seemed_ also
to assent. When the consultation was over, the surgeon who had thus
_seemed_ to consent addressed the other, saying: "If ever we meet
again, sir, our consultation must not be in the presence of the friends
of the patient." This was said in a tone to which the other had not
been accustomed; but, as a lady had just then entered the room, no
reply was made. The next morning, however, the gentleman was called
on to re-consider the tone in which he had thus addressed his brother
consultant, when a satisfactory explanation settled the matter.

Such things, however, are extremely disagreeable, and illustrate how
much more easy it is to go straightforward than by any zigzag route.
What! could not a father hear the honest opinion of two men concerning
his child, until results of the consultation had been shorn down,
certain parts thrown out, and the rest dovetailed together so as to be
made a symmetrical nondescript, adapted to the requisitions of a vulgar
conventionalism?

In another case, in a consultation on a disease as plainly scrofulous
as it was possible to be, the family attendant had pronounced that it
was _constitutional_, but _not_ scrofula. This was, it appeared, a
miserable assentation to the prejudices of the family, for the result
proved that he knew better. Nevertheless, a consultation had taken
place already with a very eminent surgeon, without the family being
any the wiser in regard to the nature of the disease. The case not
progressing, another surgeon was consulted, who, being asked what
he considered the disease to be, replied that it was scrofula. Upon
this, considerable surprise and uneasiness were manifested on the part
of the family; and the surgeon, wondering what, in so plain a case,
could be the doubt, took occasion to see the former medical attendant,
and to ask him what he thought of the case; when he said that it was
clearly scrofula, and that he had _never known the children_ of certain
temperaments to which he considered the parents to belong, wholly
without a tendency to that disease; so that he had all along been
blinding the parents, so far as his opinion and that of another eminent
man went, to the real nature of the malady.

An occurrence, singular, as we hope, took place one day in
consultation, showing how comfortably the most questionable things
may appear to sit on a man's conscience, if only supported by some
_supposed_ sanction from custom. Two surgeons met to consider a case.
They differed as to its nature and treatment; as thus—the one thought
a certain remedy necessary, and that any prospective consequences on
its employment merged into the necessity of the moment; the other
thought that remedy wholly unnecessary, and therefore held even the
_possibility_ of any prospective mischief, an insuperable objection to
its use; conceding, however, that it _might_ possibly, if the treatment
were conducted cautiously, be so managed as to secure the patient
from the consequences in question; and that, if the patient preferred
that course, after the matter had been fairly stated to him, he would
superintend the plan.

Having retired into another room to consult, they were now again
introduced to the patient, when the junior was somewhat startled to
hear his senior begin thus: "Well, sir, we have considered your case,
and we perfectly agree as to the nature of it." Thinking that this
unexpected exordium might possibly be preliminary to some explanation
of the points on which they differed, the surgeon waited a minute to
hear what followed; but finding that his brother was irremediably
misrepresenting the matter, he said: "Stop, let us understand each
other!" and then stated what had really happened, and the exact nature
of their respective opinions; on which the other, in the coolest manner
possible, said: "Yes—exactly, you are quite right!" and so ended the
consultation.

There is, no doubt, some fault on all sides. The public are too
uninformed on these important subjects, and therefore do much that
is equally against their own interests and the preservation of that
dignity and respect which should ever attach to a high-missioned
profession. But is the profession itself free from blame? Do they
never themselves minister to this wretched system of double dealing?
We fear there is but one answer to this question. We are not careful,
for obvious reasons, to multiply examples of such things; but we are
convinced that there must be a change; and since the profession cannot,
as too many of the public may, plead ignorance—for this and a thousand
other reasons, they should lead the way. We only claim for ourselves
what we readily concede to others—the expression of our opinion—when
we say that consultations should be _bonâ fide_ examinations of the
case, and should be followed by _bonâ fide intelligible_ explanations
of it to the _patient_ or his _friends_, according to the obvious
suggestions of prudence or humanity in the individual case. When the
treatment is correct, the most honest proof should be afforded of it;
namely, the continuance of the plan of the attendant in ordinary,
unobscured by the farce or form of a prescription; or, if _additional_
appliance only is adopted, in such a case its subordinate character
should be honestly explained.

Where there is difference of view, if it be material, that also should
be candidly stated; and if this be done with _real fairness_, our
experience has convinced us that it may be effected without damage
to either party. In other differences of opinion, the public never
think it necessary to impute ignorance or incapacity: let them, _for
their own sakes_, repudiate this construction in regard to the medical
profession. Lastly, let them for ever abandon the practice of paying
any man for his bottles, the number of which will often be an inverse
ratio with his skill and judgment.

To return to Abernethy. No doubt his manner varied in consultation; but
of "Manner" we shall speak in a separate chapter. We will here record
our impressions as to "Abernethy in consultation;" the conditions
which seemed to secure a considerate opinion from him; the good sense
and reasonableness of those conditions; the practical result of the
observance of them, and the effect they were calculated to produce on
the public, in giving to consultations that efficiency by which they
should be characterized—an efficiency which _every one_ begins to
perceive to be necessary, and which must be equally to the advantage of
the public and the elevation of the profession.




CHAPTER XXVI.

    "Quidquid enim justum sit id etiam utile esse censent; itemque quod
    honestum idem justum, ex quo efficitur, ut quidquid honestum sit
    idem sit utile."—CICERO.


The first thing, in consulting Abernethy, if you were a medical man,
was to be clear, and "well up" in the nature of the case; and the next
thing, not to state any opinion, unless you were prepared to give a
good reason for it. These conditions premised, we never saw any one
more unaffectedly deferential to the opinion of another.

A surgeon took a serious case to him, in which the question was as to
the removal of a large tumour in the neck, which seemed to be acquiring
connections of such depth and importance as to threaten (should that
step be desirable) to render the removal of it impossible. The patient
was advised to allow his surgeon in ordinary to state his case, and to
interrupt him only if he omitted anything in regard to it within the
patient's knowledge. This was done; the general habits of the patient
described, with the difference which had existed antecedent to the age
of thirty, and subsequently thereto. Mr. Abernethy examined the tumour.

To the SURGEON. It is parotid, is it not?

SURGEON. I think not, sir.

ABERNETHY (_hastily_). Why not?

SURGEON. Because, sir, reflecting on the depth and situation of the
parotid gland, I should hardly expect the tumour to be so moveable.

ABERNETHY. Ah, I see! Very well. (Then to the patient). Well, sir,
I should advise you to attend to your general health, and continue
to follow Mr. ——'s advice on that subject. What I say is—— (Then
followed a short lecture on the digestive organs.)

PATIENT. Do you think, sir, I shall get rid of it?

ABERNETHY. Nay, I cannot tell that. But now suppose you pursue a plan
steadily, say for a month, and the tumour does not increase, will it
not be encouraging to you?

PATIENT. Certainly, sir.

ABERNETHY. Well, then, try it; for if its removal should become
necessary, you will at least be in better condition for the operation.
If it does not get larger, or otherwise inconvenience you, let it alone.

The patient had heard so much of Abernethy's roughness, that he came
away equally pleased and astonished.

A surgeon took a Colonel in the army to him, with a case which was
progressing fairly, but, as he conceived, in consequence of the patient
not paying so much attention to his health as he was recommended to do,
not so satisfactorily as he desired. The Colonel briefly stated his
case.

ABERNETHY. Show me your tongue. Ah! that is bad enough.

COLONEL. You are quite right there.

ABERNETHY. Well, man, I don't require to be told that.

Here the surgeon stated the treatment, which had, in addition to
attention to the general health, involved some local administrations,
of which, in general, Abernethy approved, but, as it would seem, not in
this case. His difference of opinion he thus stated, in the presence of
the patient:

"Well, I say that there is a sufficient disorder of your digestive
organs to maintain the annoyances of which you complain; and I should
confine my attention to endeavour to put that disorder right. Mr. ——
seems to think that, in adding to this treatment the plan he proposes,
he will shorten the case. Well, that may be so; he has paid, I know,
a good deal of attention to this subject; and if I had one of my own
family ill with this complaint, I should feel perfectly satisfied, if
they were under his care. At the same time, I say what I think; and if
you do not find the general plan successful, then the means he proposes
might with propriety be added."

No harm resulted from this difference of opinion; but much benefit. The
patient was not pleased with Abernethy; but he thought him very skilful
and very honest.

One day, a surgeon went to him under the following circumstances. A
patient who had recently recovered from a lameness, which, as alleged,
had its cause in the foot, on a relapse went to another surgeon. This
gentleman had, as it ultimately appeared, hastily decided that the lady
had a complaint in the hip; she was therefore consigned to bed, and
treated for disease of that part. After about three months, feeling
no better, she desired to see the surgeon under whose care she had
formerly been.

The surgeon was now very much annoyed; for he found that he had been
by many persons charged with having mistaken the case, which he had
never even seen on the second attack, and which now presented a phase
in which disease of the hip, to a hasty examiner, might easily be
suggested. He was not much better satisfied, when, after a careful
examination of the case, he felt convinced that there was no disease in
the hip, although the symptoms were more severe than ever. He declined
undertaking the case without a previous consultation with the surgeon
who had decided it to be a disease of the hip; but the patient being
immoveable in her opposition to this request, and offering any other
surgeon, or more, if required, her wishes were acceded to, and Mr.
Abernethy requested to visit the case. On going to the patient, the
surgeon explained to Mr. Abernethy the points at issue, but without
telling him to which view his own opinion inclined, or the positive
_dictum_ of his senior brother, a very eminent surgeon. "I shall,
therefore," said he to Abernethy, "feel particularly obliged to you,
sir, if you will examine the case for yourself."

When they were introduced to the lady, Abernethy said: "Well, now, I
should be very well satisfied with Mr. ——'s report of your case; but
he says I must examine the limb for myself: so here goes."—A somewhat
repulsive beginning to a delicate lady, perhaps; but nothing could
be more cautiously gentle than his examination. In conducting it,
he had avoided one test which usually _does_ give a little pain. The
other surgeon, deeming the decision to be very important, reminded him
of this test (raising the limb and striking the heel gently), which
he then proceeded to do with equal gentleness. "That will do," said
he. "Now, sir, shall we go into another room?" "No, sir," replied the
surgeon. "If you please, Mr. Abernethy, I should prefer your at once
telling the patient what is your opinion on the case."

He then declared his opinion; but, fearing he might injure one or other
party, with the following exordium: "Now, madam, we are all liable
to mistakes: there is no man living who does not make more or less;
and I am sure I make mistakes; therefore I may do so in my opinion
of your case. But for the life of me I cannot perceive that you have
any disease in your hip." He then gave a short, but most lucid view
of what he conceived to be the cause of her pain, and illustrated it
by referring to something which happened to himself in one of his own
severe rheumatic attacks. The result proved that he was quite right as
to his view of the case; the lady, by exercise and other means (which,
had the hip been diseased, would have only exasperated her complaint),
had a good recovery.

One very great charm in Abernethy in consultation was, that there was
no difficulty in getting him to speak out. Some men are so afraid of
being wrong, that they never give you the whole of their opinion in a
case involving any difficulty. It is so obscure, and followed up by so
guarded a prognosis, that it sometimes amounts to no opinion at all.

Even with surgeons who were very unobjectionable, Abernethy in his
best manner contrasted very favourably. We recollect being very much
struck with this when, very young, we had to meet Mr. Cline and Mr.
Abernethy, within a few days of each other, in the same case. Mr. Cline
was very kind to the patient, elaborately civil; nor was there anything
which could be fairly regarded as objectionable; but his manner was
too artificial; the contrast in Abernethy was very agreeable. The case
was serious, and (as we thought) hopeless. Abernethy, the moment he
saw it, had his sympathies painfully awakened. Having asked a few
questions, he, in the very kindest manner, said, "Well, I will tell you
what I would do, were I in your situation." He then proceeded to direct
how she should regulate her living, how avoid mischievous experiments,
and went into a rather lengthy series of directions, in the most
unaffected manner, without leaving the room, or having any private
consultation whatever. The lady, who was a distinguished person, and a
very accomplished woman, was exceedingly pleased with him.

His manner, as we shall by and by admit, was occasionally rough,
and sometimes rather prematurely truthful. One day, he was called,
in consultation, by a physician, to give an opinion on a case of a
pulsating tumour, which was pretty clearly an aneurism. On proceeding
to examine the tumour, he found a plaister on it. "What is this?" said
Abernethy. "Oh! that is a plaister?" "Pooh!" said Abernethy, taking
it off and throwing it aside. "That was all very well," said the
physician; "but that 'pooh' took several guineas out of my pocket."

On the other hand, he never failed to give the warmest and most
efficient sanction he could to what he conceived to be judicious
treatment on the part of a practitioner with whom he was in
consultation. Mr. Stowe has kindly sent me a very good example of this;
and it illustrates also another very valuable feature in a consultant:
the forbearance from _doing anything_ where nothing is necessary. A
gentleman had met with a severe accident, a compound dislocation of
the ankle, an accident that Abernethy was the chief means of redeeming
from habitual amputation. The accident happened near Winterslow Hut,
on the road between Andover and Salisbury, and Mr. Davis of Andover
was called in. Mr. Davis placed the parts right, and then said to the
patient, "Now, when you get well, and have, as you most likely will,
a stiff joint, your friends will tell you— 'Ah! you had a country
doctor.' So, sir, I would advise you to send for a London surgeon to
confirm or correct what I have done." The patient consented, and sent
to London for Abernethy, who reached the spot by the mail about two in
the morning. He looked carefully at the limb, and saw that it was in
a good position, and was told what had been done. He then said, "I
am come a long way, sir, to do nothing. I might indeed pretend to do
something; but as any avoidable motion of the limb must necessarily be
mischievous, I should only do harm. You are in very good hands, and
I dare say will do very well. You may indeed come home with a stiff
joint; but that is better than a wooden leg." He took a cheque for his
fee (sixty guineas), and made his way back to London.

Soon after this, an old clergyman, in the same neighbourhood, had a
violent attack of erysipelas in the head and arm. His family, becoming
alarmed, wrote up to his brother, who resided near Bedford Row, to
request Mr. Abernethy to go down and visit the patient. Abernethy said,
"Who attends your brother?" "Mr. Davis[69], of Andover." "Well, I told
him all I knew about surgery, and I _know_ he has not forgotten it.
You may be perfectly satisfied. I shall not go." Here, as Mr. Stowe
observes, he might have had another sixty guineas.

He always felt a great deal of interest about compound dislocations of
the ankle-joint; because of his conviction that amputation, then so
commonly resorted to, was unnecessary. He used to tell several cases in
his lectures. One of them we will briefly relate here. It was that of a
labouring man, who fell off a scaffold in his own neighbourhood; and,
amongst other surgeons, they had sent for Abernethy. When he got to
the house, he found, he says, "a poor wee man, lying on his mattress,
with a very complete compound dislocation of the ankle-joint. The joint
was completely exposed, and the torn skin was overlapping the edge of
the bone." He placed the parts in their natural position, and drew the
skin out of the rent; and when he had thus adjusted it, as he said, a
horrible accident looked as if there had been very little the matter.
"Do you think, sir," said the poor little man, "that this can ever get
well?" "Yes, verily," said Abernethy. "Do not be out of heart about
it; I have known many such cases do well." "Why, sir," said the man,
"they have gone for the instruments." "I now found," said Abernethy,
"that two other surgeons had seen him, and had determined that it was
necessary to amputate. I felt that I had got into an embarrassing
predicament, and was obliged to wait until these heroes returned. When
they arrived, and saw the man lying so comfortably, they seemed a
little staggered: but one of them said, 'Mr. Abernethy, you know the
serious nature of these accidents, and can you give us an assurance
that this will do well?' I said, 'no, certainly not; but if it does
not do well, you can have recourse to amputation afterwards, and my
surgical character is pledged no further than this. I give you the
assurance that no immediate mischief will come on to endanger the man's
life. You may wait and see whether his constitution will allow him to
do well.' I added: 'I feel that I am got rather into a scrape; so you
must allow me to manage it in my own way.' So I got splints, put up
the limb, varnished the plaister, and then told them about sponging
it continually, so as never to allow any increase of temperature. Now
there are two holds you have on a patient's mind—hope and fear; and
I make use of both. So I said, 'If you lie perfectly still, you will
do well; and if you move one jot, you will do ill—that's all.'" The
remainder of the case need not be given. The man recovered, and saved
his limb.

We have referred to that case because, though relating to a
professional matter, there is a moral in it. He might easily have saved
himself all the trouble he took, and on the plea of etiquette; but
the poverty of the man pleaded for his limb, and the impossibility in
such a case, of the imputation of any wrong motive, left free exercise
for the prevailing feature of Abernethy's character—benevolence. The
mention of the instruments secured to the poor man that _personal_
attention to details by Abernethy himself which a more wealthy patient
might not have so certainly obtained.

We have remarked before on his kindness to hospital patients; and
sometimes the expression of their gratitude would be very touching.
It is difficult or impossible to carry out Mr. Abernethy's principles
of practice with _perfect_ efficiency in the atmosphere of a large
hospital in a crowded city, yet the truth of his views would sometimes
be impressed by very extraordinary and unexpected results. We select
the following as an example, for reasons which will be suggested by
the narrative. We are indebted to Mr. Wood[70], of Rochdale, for the
illustration; and, as we should only mar the scene by any abbreviation,
we must allow him to tell it in his own manner:

"It was on his first going through the wards after a visit to Bath,
that, passing up between the rows of beds, with an immense crowd of
pupils after him—myself among the rest—that the apparition of a poor
Irishman, with the scantiest shirt I ever saw, jumping out of bed, and
literally throwing himself on his knees at Abernethy's feet, presented
itself. For some moments, everybody was bewildered; but the poor
fellow, with all his country's eloquence, poured out such a torrent
of thanks, prayers, and blessings, and made such pantomimic displays
of his leg, that we were not long left in doubt. 'That's the leg, yer
honnor! Glory be to God! Yer honnor's the boy to do it! May the heavens
be your bed! Long life to your honnor! To the divole with the spalpeens
that said your honnor would cut it off!' &c. The man had come into
the hospital about three months before, with a diseased ankle, and it
had been at once condemned to amputation. Something, however, induced
Abernethy to try what _rest_ and constitutional treatment would do for
it, and with the happiest result.

"With some difficulty the patient was got into bed, and Abernethy
took the opportunity of giving us a clinical lecture about diseases
and their constitutional treatment. And now commenced the fun. Every
sentence Abernethy uttered, Pat confirmed. 'Thrue, yer honnor, divole
a lie in it. His honnor's 'the grate dochter entirely!' While, at the
slightest allusion to his case, off went the bed clothes, and up went
his leg, as if he were taking aim at the ceiling with it. 'That's it,
by gorra! and a bitther leg than the villin's that wanted to cut it
off.' This was soon after I went to London, and I was much struck with
Abernethy's manner; in the midst of the laughter, stooping down to the
patient, he said with much earnestness: 'I am glad your leg is doing
well; but never kneel, except to your Maker.'"

The following letter, though containing nothing extraordinary, still
shows his usual manner of addressing a patient by letter:

  "Sir,

    "In reply to your letter, I can only say what I must have said to
    you in part, when you did me the honour of consulting me.

    "Firstly. That the restoration of the digestive organs to a
    tranquil and healthy state, greatly depends on the strict
    observance of rational rules of diet. My opinions on this subject,
    which are too long to be transcribed, are to be met with at page
    72, of the first part of 'Abernethy's Surgical Observations,'
    published by Longman and Co., of Paternoster Row.

    "Secondly. Upon keeping the bowels clear, yet without irritating
    them by over-doses of aperient medicine.

    "Thirdly. I consider the blue pill as a probilious medicine, and
    only urge that the dose be such as to do no harm, if it fail to do
    good, and then to be taken perseveringly for some time, in order to
    determine whether it will not slowly effect the object for which it
    was given. In gouty habits, carbonate of soda, &c., may be given,
    to neutralize acidity in the stomach, with light bitters; but
    the _prescription of medicines of this kind_, as also any advice
    relative to the cold bath, must rest with your medical attendant."

    Dated the 17th of September; as usual, with him, without the year,
    which was about 1824.

It is obvious that very few professional letters are adapted for
introduction. This was one kindly sent us by Mr. Preston, of Norwich,
and was written to a gentleman in Yorkshire.

Few things were more pleasing or valuable in Abernethy, than his
modesty and his sense of justice. He knew his superiority well enough,
but he measured it—as Science shows us all should do—with reference
to what was still beyond him, and not by the standard afforded by the
knowledge of others. His sense of justice was, we think, never appealed
to in vain. The following letter has appeared to us significant in
relation to these points. Amid the peaceful glories of a useful
profession, there is nothing that sinks deeper or interests our regard
more, than a man, in the hour of success, remembering what is due to
others. We think this remark particularly applicable to the late Mr.
Tait, in the following case. The letter from Abernethy was obligingly
sent us by Mr. Tait's son and successor. The remarks with which Mr.
Tait concludes his case, are as creditable to the writer as to him whom
they were intended to honour.

We have stated that Mr. Abernethy had been the first to extend the
application of John Hunter's celebrated operation for the cure of
aneurism, to a vessel nearer the heart (the external iliac artery), on
which Mr. Abernethy placed a ligature in 1797. Mr. Tait, of Paisley,
had an extraordinary case of aneurism in both lower extremities, so
high up as to oblige him to place a ligature on the external iliac
artery on both sides of the body. The case occurred in an old dragoon,
and the two operations were performed at separate times, with great
judgment and with complete success. The case of course made some
noise, and was highly creditable[71]. In closing his account of the
patient, Mr. Tait observes: "The complete success which has attended
these operations, while, certainly, it affords me one of the highest
gratifications the practice of my profession can procure me, chiefly
affects Mr. Abernethy.

"Accident has placed under my care a case which, so far as I know, is
unparalleled in the history of surgery, and it has been cured; but I
have only put in practice what every surgeon of the day ought to have
done. When, thirty years ago, Mr. Abernethy formed the firm resolve
of cutting open the walls of the abdomen and seizing the external
iliac artery, he made a mighty step in advance, he formed an epoch in
the history of his profession. John Hunter, upon reflecting on the
hæmorrhage proceeding from the vessel below the sac, after an operation
in 1779, when Mr. Broomfield, 'for security,' had tied the artery three
or four inches above the aneurism, had probably the first glimpse at
his great improvement of tying the artery, in cases of aneurism, nearer
the heart. His eminent successor has extended the principles of the
illustrious Hunter.

"So firmly impressed was Mr. Abernethy with the certainty of ultimate
success, that, nothing daunted by the unfortunate issue of his two
first cases, he persevered, and at length successfully secured the
external iliac artery. His steps have been followed by a host, till at
length it needed but such a case as mine to add the finishing touch to
his well-earned fame. In doing justice to the merits of such men, we act
but the part of prudence; since, if we do not, indignant posterity will.

"Paisley, January, 1826."


The following is Abernethy's reply to a communication from Mr. Tait on
the subject, and couched in a tone, just in relation to Mr. Hunter,
modest and characteristic as regards himself.

  "TO DAVID TAIT, ESQ.
  "SURGEON, PAISLEY.

  "Dear Sir,

    "I have read your interesting case in the 'Edinburgh Journal,' but
    have no comments to offer. I have therefore only to thank you for
    the honourable mention you have made of me. The progress of science
    has given us reason to confide in the anastomosing[72] channels
    for carrying on the circulation. The only question necessary to
    be decided was—would _large_ arteries heal when tied? Every case
    confirmed that point, and therefore there was little merit in
    perseverance. Nevertheless, I feel grateful for your good opinion,
    and with congratulation and best wishes,

  "I am, dear sir,
  "Yours very sincerely,
  "JOHN ABERNETHY."

  "Bedford Row, July 14."
  (Post mark 1826.)

The following portion of a note, necessarily mutilated by the
suppression of professional matter, we copy as a written evidence of
his not _in any way_ appearing to alter or add to a treatment which he
approved. It is written to a highly esteemed member of our profession,
Mr. Beaman, of King Street, Covent Garden. Mr. Beaman had sent a
patient alone to Mr. Abernethy, who, having seen him, gave him the
following note:

  "My dear Sir,

    "The patient says"—here the symptoms referring to the point to be
    investigated are stated—"and if this be true, I have no wish * *
    * * nor can I suggest better treatment than that which you have
    adopted.

  "Yours very sincerely,
  "JOHN ABERNETHY."

  (No date, post mark 1825.)

The following letter to Mr. Wood, of Rochdale, reiterates his opinion
on a very important disease, contraction of the gullet or œsophagus,
and conveys a practical truth, which, if we may judge from the cases
published in the periodicals, is just as necessary as ever. We allude
to the too officious use of instruments in this affection, a lesson
of Abernethy's, of the practical excellence of which Mr. Wood had
convinced himself by his own experience, as we ourselves have on many
occasions.

  "My dear Sir,

    "I think as you do with regard to the difficulty of swallowing. It
    seems likely to be the effect of irritability of the stomach; and
    if so, the _passing of instruments, however soft and well-directed
    they may be_, is not likely to be beneficial.

    "Indeed, I have seen so little good from such measures, that I
    should feel reluctant to employ them until impelled by stronger
    necessity than exists in the present case. Spasmodic affection
    in the part is, as you know, exceedingly common, and _continues_
    for a great many years without producing permanent contraction.
    With respect to the main object of the treatment of this case, I
    cannot say more than you are already acquainted with, and which is
    suggested at page 72.

    "I have of late been personally convinced of the benefit of the
    strictest attention to diet. Last summer, my stomach was so
    disordered that it would not digest any thing, and I was constantly
    tormented by the chemical changes which the food underwent in that
    organ. I had scarcely any flesh on my bones, and sometimes every
    ten minutes was seized with rheumatic spasms, which were as general
    and severe as those of tetanus[73]. I went into the country, where
    I could get good milk and eggs, and lived upon three ounces of
    baked custard taken three times a day, drinking, four hours after
    each meal, some boiled water that had been poured upon a small
    quantity of ginger. Upon this quantity of food I regained my
    flesh, and uniformly got better as long as I continued this plan
    of diet, which was but for one month, for then I returned to town.
    From the very first day, I had no more of these spasms. As for
    medical treatment, I repeat that I cannot say more than you already
    know. It gives me pleasure to find that you are settled to your
    satisfaction.

  "I remain,
  "My dear Sir,
  "Very sincerely yours,
  "JOHN ABERNETHY.

  "Bedford Row, January 9."

[Footnote 69: A very early pupil of Abernethy's. Mr. Davis was many
years in the army, and afterwards practised with great credit and
success at Andover. Late in life, he retired to Hampstead, where he
died at an advanced age, about four years since.]

[Footnote 70: The interesting letters of Mr. Wood and Mr. Stowe
were placed beside each other, and, in selecting extracts, in the
first edition, Mr. Stowe's name occurred in this place instead of
Mr. Wood's—a mistake for which we beg these gentlemen to accept the
assurance of our regret.]

[Footnote 71: Edinburgh Medical and Surgical Journal, vol. xxvi.]

[Footnote 72: The name applied to the collateral branches which carry
on the circulation when the main artery of limb is tied or obstructed.]

[Footnote 73: Locked-jaw.]




CHAPTER XXVII.


OF MANNER.

                      "Non ego paucis,
      Offendar maculis, quas aut incuria fudit,
      Aut humana parum cavit natura."

      HORACE.

    "I will not be offended by a few blemishes, the result of
    inattention, or against which human frailty has not sufficiently
    guarded."

Mankind have long established, by universal consent, the great
importance of "Manner." It has been so ably and so variously discussed
by different writers, that it is next to impossible to say any thing
new on the subject, or what has not been even better said on the
subject already. Still it is equally true that it is a thing very much
less cultivated than its influence demands; so that really easy, good
manners continue to be a very rare and enviable possession. But if
manner be thus influential in the ordinary intercourse of life, it is
still more important in ministering to disease. People, when they are
ill, have, for the wisest purposes, their susceptibilities more vivid;
and it is happy for them when those in health have their sympathies—as
is natural, we think, that they should be—quickened in proportion.
No doubt it is a great subtraction from whatever benefit the most
skilful can confer, if it be administered in a dry, cold, unfeeling, or
otherwise repulsive manner. There is too a very sound _physiological_
as well as _moral_ reason for kindness. It is difficult to overrate
the value of that calm which is sometimes diffused over the whole
system by the impression that there is an unaffected sympathy in our
sufferings. We have of course, in our time, observed abundant varieties
of manner in our professional brethren; and we have often listened with
interest to conversations in society, in which the manners of various
medical men have been the subject of discussion, from which good
listeners might, we think, have often taken valuable lessons.

We are convinced that the disguise, worn by some, of an artificial
manner, leaves, on many occasions, no one more deceived than the
wearer. Many patients have their perceptions remarkably quickened
by indisposition, and will penetrate the thin veil of any form of
affectation much more readily than people imagine. In common language,
good feeling and kind manner are said to spring from the heart. If a
man feels kindly, he will rarely express himself otherwise, except
under some momentary impulse of impatience or indisposition.

There is no doubt that the secret of a kind and conciliatory manner
consists in the regulation of the feelings, and in carrying into the
most ordinary affairs of life that principle which we acknowledge as
indispensable in serious matters—of doing to others as we would they
should do to us.

We are not speaking of a _polished_ manner; that is another affair.
A man's manner to a patient may be unpolished, or as homely as you
please; but if he really feels a sympathy for his patient, it will,
with the exception to be stated, never be coarse or unkind.

Some men are absurdly pompous; others, hard and cold; some put on a
drawling, maudlin tone, which the most superficial observer detects
as being affected. An honest sympathy is more acceptable than even a
polished manner; though doubtless that is a very desirable grace to a
learned profession.

In general, our own experience—and we know something of indisposition
in our own person—has induced us to judge favourably of the manner of
medical men.

There are, no doubt, exceptions, and sometimes in men in whom you would
least expect it. We have known men "eye" a patient, as if looking at
some minute object; some, jocosely familiar. One man has an absurd
gravity; another thinks he must be all smiles. We have known, too, the
adoption of a tone characterized by a sort of religious solemnity.
These, when assumed, are generally detected, and of course always
vulgar. Some even say really rude and unfeeling things, before any
thing has happened to provoke them. We attended a gentleman who had a
great deal of dry humour, and who was very amusing on such matters. One
morning, he said, "I saw Dr. —— on one occasion, and the first thing
he said to me I thought he might as well have omitted. 'I see, sir,'
said he, 'that you have taken the shine out of your constitution.'"

Abernethy's manner was at times—always, in serious cases, and, so far
as we ever observed, to hospital patients—invariably, as unaffectedly,
kind as could be desired. It is too true that, on many occasions of
minor import, that impulsiveness of character which we have seen in
the boy, was still uncontrolled in the man, and led him to say things
which, however we may palliate, we shall not attempt to excuse.

It is true his roughness was very superficial; it was the easiest thing
in the world to develop the real kindness of heart which constantly lay
beneath it; and it is very instructive to observe how a _very little
yielding_ to an infirmity may occasionally obscure one of the most
benevolent hearts that ever beat in a human breast, with the repulsive
exterior of ungentle manners. Still, patients could not be expected
to know this; and therefore too many went away dissatisfied, if not
disgusted.

The slightest reaction was, in general, sufficient to bring him to
his self-possession. A lady, whom he had seen on former occasions,
was one day exceedingly hurt by his manner, and burst into tears. He
immediately became as kind and patient as possible, and the lady came
away just as pleased as she had been at first offended.

Reaction of a different kind would answer equally well. One day, a
gentleman consulted him on a painful affection of his shoulder, which
had been of a very excruciating character. Before he had time to enter
on his case, Abernethy said, "Well, I know nothing about it." The
gentleman sharply retorted: "I do not know how you should; but if you
will have patience till I tell you, perhaps you then may." Abernethy at
once said, "Sit down;" and heard him out, with the greatest kindness
and patience.

I am indebted to Thomas Chevasse, Esq. of Sutton Coldfield, Warwick,
for the following letter to a patient in Surrey, who had complained
that he did not receive any sympathy from him.

  "Dear Sir,

    "I am sorry to have said any thing that has offended you. I may
    have felt annoyed that I could not suggest any plan of treatment
    more directly curative of your malady, and expressed myself
    pettishly when you did not seem to understand my meaning; for I
    am a fellow-sufferer, and had tried what are considered to be
    appropriate remedies, unavailingly. I assure you that I did not
    mean to hurt your feelings, and that I earnestly hope the state of
    your health will gradually improve, and that your local maladies
    will decline in proportion.

  "I am, dear Sir,
  "Your obedient servant,
  "JOHN ABERNETHY.

  "Bedford Row, October 25."

A surgeon was requested to visit a patient in one of the suburbs of
the metropolis. When he arrived there, he had to mount two or three
dilapidated steps, and to read a number which had been so nearly worn
away, that he was enabled to determine whether it was the number he
sought only by the more legible condition of its two neighbours. Having
applied a very loose, dilapidated knocker, an old woman came to the
door.

"Does Captain —— live here?"

"Yes, sir."

"Is he at home?"

"Yes, sir. Please, sir, may I be so bold—are you the doctor, sir?"

"Yes."

"Oh! then, sir, please to walk up."

The surgeon went up a small, narrow staircase, into a moderate-size,
dirty, ill-furnished room, the walls of which were coloured something
between yellow and red, with a black border. An old man, in a very
shabby and variegated _deshabille_, rose from his chair, and, with
a grace worthy of a court, welcomed the stranger. His manner was
extremely gentlemanly, his language well chosen, the statement of his
complaint particularly simple and clear. The surgeon, who, like most
of us, sees strange things, was puzzled to make out his new patient;
but concluded he was one of the many who, having been born to better
things, had been reduced by some misfortune to narrow circumstances.
Everything seemed to suggest that construction, and to warrant no
other. Accordingly, having prescribed, the surgeon was about to take
his leave, when the old gentleman said:

"Sir, I thank you very much for your attention;" at the same time
offering his hand with a fee.

This the surgeon declined, simply saying:

"No, I thank you, sir. I hope you will soon be better. Good morning."

"Stay, sir," said the old gentleman; "I shall insist on this, if you
please;" in a tone which at once made the surgeon feel that it would
be painful and improper to refuse. He accordingly took it. The old
gentleman then said, "I am very much obliged to you, sir; for had
you not taken your fee, I could not again have the advantage of your
advice. I sent for you because I had understood that you were a pupil
of Mr. Abernethy's, for whom I could not send again, because he would
not take his fee; and I was so hurt, that I am afraid I was almost rude
to him. I suppose, judging from the appearance of things here that I
could not afford it, he refused his fee; on which I begged him not to
be deceived by appearances, but to take it. However, he kept retreating
and declining it, until, forgetting myself a little, and feeling
somewhat vexed, I said, 'By G—, sir, I insist on your taking it!' when
he replied, 'By G—, sir, I will not!' and, hastily leaving the room,
closed the door after him."

This gentleman has been dead some years. He lived to a very advanced
age—nearly, if not quite, ninety—and had many instructive points of
character. He was really in very good circumstances; but he lived in
a very humble manner, to enable him to assist very efficiently some
poor relations. To do this, he saved all that he could; and although
he insisted on the surgeon taking a fee when he visited him, he said
that he should not hesitate to accept his kindness when he called on
the surgeon. The intercourse continued many years; but with rather a
curious result.

After a time, growing infirmities converted what had been a
visit—perhaps once or twice a year—into occasional attendances,
when the rule he had prescribed to himself, of paying visits at home,
became characterized by very numerous exceptions; and, at last, by so
many, that the rule and the exception changed places. The surgeon,
however, went on, thinking that the patient could not do other without
disturbing existing arrangements. When, however, the old gentleman
died, about four hundred guineas were found in his boxes, wrapped up,
and in various sums, strongly suggestive of their having been (under
the influence of a propensity too common in advancing life) savings,
from the somewhat unnecessary forbearance of his medical attendant. We
know one other very similar occurrence.

Sometimes Mr. Abernethy would meet with a patient who would afford
a useful lesson. A lady, the wife of a very distinguished musician,
consulted him, and, finding him uncourteous, said, "I had heard of your
rudeness before I came, sir; but I did not expect this." When Abernethy
gave her the prescription, she said, "What am I to do with this?"

"Anything you like. Put it in the fire, if you please."

The lady took him at his word—laid his fee on the table, and threw
the prescription into the fire, and hastily left the room. Abernethy
followed her into the hall, pressing her to take back her fee, or to
let him give her another prescription; but the lady was inexorable, and
left the house.

The foregoing is well-authenticated. Mr. Stowe knows the lady well, who
is still living. But many of these stories, to our own knowledge, were
greatly exaggerated. Abernethy would sometimes offend, not so much by
the manner as by the matter; by saying what were very salutary, but
very unpleasant truths, and of which the patient perhaps felt only the
sting. We know a gentleman, an old fox-hunter, who abused Abernethy
roundly; but all he could say against him was: "Why, sir, almost the
moment I entered the room, he said: 'I perceive you drink a good
deal,'" which was very true. "Now," added the patient, very _naïvely_,
"suppose I did, what the devil was that to him!"

Another gentleman, of considerable literary reputation, but who,
as regarded drinking, was not intemperate, had a most unfortunate
appearance on his nose, exactly like that which frequently accompanies
dram-drinking. This gentleman used to be exceedingly irate against
Abernethy, although all I could gather from him amounted to nothing
more than this, that when he said his stomach was out of order,
Abernethy observed, "Ay, I see that by your nose," or some equivalent
expression.

However rough Abernethy could occasionally be, there was, on grave
occasions, no feature of his character more striking than his humanity.
Dr. Barnett[74] had a case where Abernethy was about to perform a
severe operation. The Doctor, at that time a young man, was anxious
to have every thing duly prepared, and had been very careful. When
Abernethy arrived, he went into the room into which the patient was to
be brought, and, looking on the instruments, &c. on the table, said:
"Ay, yes, that is all right;" then, pausing for a moment, he said: "No,
there is one thing you have forgotten;" and then, throwing a napkin
over the instruments, added: "It is bad enough for the poor patient
to have to undergo an operation, without being obliged to see those
terrible instruments."

Few people get off so badly in the world as poor gentlemen. There are
multifarious provisions in this kingdom for all sorts of claimants; but
a poor gentleman slips down between those which are not applicable
to his case, and those which are too repulsive to be practicable. His
sensibilities remain—nay, perhaps are sharpened—and thus, whilst
they tend to exasperate his wants, they increase the difficulty of
supplying them. There is here afforded a grateful opportunity for the
indulgence of what we believe, amidst some exceptions, to be the ruling
spirit of medical men: a sensitive philanthropy, which no men in the
world are more liberal in disbursing. Abernethy had his full share of
this excellence. There are multitudes of instances exemplifying it.
We are indebted for the following to Mr. Brown, of the respected firm
of Longman and Co. Abernethy was just stepping into his carriage to
go and see the Duke of ——, to whom he had been sent for in a hurry,
when a gentleman stopped him to say that he should be very glad if
he could, at his leisure, pay Mr. —— another visit at Somers Town.
Abernethy had seen this poor gentleman before, and advised a course
which it appeared that the patient had not resolution to follow. "Why,"
said Abernethy, "I can't go now, I am going in haste to see the Duke
of ——." Then pausing a moment before he stepped into the carriage,
he looked up to the coachman and said, quietly, "Somers Town." This is
very characteristic. The fidgetty irritability of his first impression
at interference, and the beneficence of his second thought.

Dr. Thomas Rees knew a gentleman who was a man of ability, who had
been a long time ill, and who got a scanty living by his writings. Dr.
Rees called on Abernethy, one morning, and told him that the gentleman
wished to have his opinion; but that he had heard such accounts of him,
he was half afraid to see him. "And if he were not," said Dr. Rees, "he
is not able to pay you. He is a great sufferer, and he gets his living
by working his brains." "Ah!" said Abernethy; "where does he live,
do you say?" "At ——," mentioning a place full two miles distant.
Abernethy immediately rang the bell, ordered his carriage, visited the
gentleman, and was most kind to him.

One day, a pupil wished to consult him, and found him, about ten
minutes before lecture, in the museum, looking over his preparations
for lecture—rather a dangerous time, we should have said, for
consultation. "I am afraid, sir," said the pupil, "that I have a
polypus in my nose, and I want you to look at it." No answer; but when
he had sorted his preparations, he said: "Eh! what?" The pupil repeated
his request. "Then stand upon your head; don't you see that all the
light here comes from a skylight? How am I to look up your nose? Where
do you live?" "Bartholomew Close." "What time do you get up?" "At
eight." "That can't be then." "Why, sir?" "You cannot be at Bedford Row
at nine." "Yes, sir, I will." "To-morrow morning, then." The pupil was
punctual. Mr. Abernethy made a most careful examination of his nose,
entered into the causes and nature of polypi, assured him that there
was nothing of the sort, and exacted from him a promise that he would
never look into his nose again. The gentleman, in his letter to me,
adds: "This I have never done, and I am happy to say that there has
never been any thing the matter."

The following we have from a source of unquestionable authority:

Abernethy was attending a poor man, whose case required assistance at
a given time of the day. One morning, when he was to see this patient,
the Duke of York called to say that the Prince of Wales wished him to
visit him immediately. "That I cannot do," said Mr. Abernethy, "as I
have an appointment at twelve o'clock"—the time he promised to visit
the poor man. "But," said the Duke, "you will not refuse the Prince; if
so, I must proceed to ——." "Ah!" said Abernethy, "he will suit the
Prince better than I should." He was, however, again sent for, a few
hours later, when he of course visited the Prince.

Very many instances of his liberality were constantly occurring. The
following is a specimen:

The widow of an officer of limited income brought her child some
distance from the country to consult Abernethy. After a few weeks'
attendance, the lady having asked Abernethy when she might return home,
was told that she must remain some weeks longer, or he could not answer
for the well-doing of the case. In the meantime, having learned how
the widow was situated, he continued to take the fees, folding them up
in a paper. When he finally took his leave, he returned home, enclosed
the fees which he had received, with the addition of a cheque for £50,
with a kind note, saying, that as he understood her income was limited,
he had returned the fees, with an addition, which would enable her to
give the child, who could not walk, a daily ride in the fresh air,
which was important to her recovery.

He was, indeed, as it appeared to us, most liberal in the mode of
conducting his practice. When asked by a patient when he desired to see
them again, it was at the longest period compatible with a reasonable
observation of the case; and we doubt whether he ever took a fee where
he had even a _doubt_ as to the circumstances of the patient justifying
his so doing. It would be easy to multiply examples of this; but it
would be a constructive injustice to others to appear to bring things
out in high relief, or as _special_ excellences, which (notwithstanding
some exceptions) from our hearts we believe to be a prevailing
characteristic of the profession.

Abernethy had been, nearly all his life, without being improvident,
habitually careless of money; and, although he provided his family
with a comfortable competency, which very properly left their position
unaltered by his death, yet we doubt if ever any man, with the
opportunity of making so much, availed himself of that opportunity so
little.

Many instances occurred of his carelessness in these matters.

He used to put his not very slowly accumulating fees anywhere;
sometimes by the side of his portfolio; sometimes on a shelf in his
bookcase, between something else which might be there. When he retired
from Bedford Row, they found a considerable heap of fees which he had
placed in the bookcase and forgotten—an anecdote which shows that he
must have been making some way in practice as early as his marriage,
exemplifies this sort of carelessness, and suggests its impropriety. He
was in the habit, even then, of leaving his fees on his table in his
private room. He thought, on more than one occasion, that some had been
removed: he, however, said nothing; but, having taken means to assure
himself of the fact, he marked some fees and allowed matters to go on
as usual. Again missing fees, he waited till the whole party, which
consisted of pupils residing in the house, were settled at breakfast.
"Gentlemen," he said, "I must beg you to give me your purses." This was
of course immediately done. In one of the purses he found the marked
fees. This individual has been dead many years. He turned out, as may
be supposed, _badly_.

It had become the fashion in Abernethy's latter days to speak lightly
of him as an operator; and we have very little desire to rest any
portion of his reputation on this branch of our duty. Nevertheless,
when we first knew Abernethy, if we had had to be the subject of an
operation, we knew no man to whom we should have submitted with the
same confidence. He was considerate and humane; he did as he would
be done by; and we have seen him perform those operations which are
usually regarded as the most difficult, as well as we have seen them
ever performed by any body; and without any of that display or effect
too often observed, which is equally misplaced and disgusting.

His benevolent disposition led him to feel a great deal in regard
to operations. Like Cheselden and Hunter, he regarded them, as in a
scientific sense they truly are, the reproach of the profession; since,
with the exception of such as become necessary from accidents, they
are almost all of them consequent on the imperfection of Medicine or
Surgery as a science.

Highly impulsive, Abernethy could not at all times prevent the
expression of his feelings, when perhaps his humanity was most
earnestly engaged in his suppression of them. It was usually an
additional trial to him when a patient bore pain with fortitude.

One day, he was performing rather a severe operation on a woman.
He had, before commencing, said a few words of encouragement, as
was usual with him, and the patient was bearing the operation with
great fortitude. After suffering some seconds, she very earnestly,
but firmly, said, "I hope, sir, it will not be long." "No, indeed,"
earnestly replied Abernethy; "that would indeed be horrible."

In fact, he held operations as occupying altogether so low a place
in our duties, and as having so little to do with the science of our
profession, that there was very little in most of them to set against
that repulsion which both his science and his humanity suggested.

As he advanced in life, his dislike to operations increased. He was apt
to be fidgetty and impatient. If things went smoothly, it was all very
well; but if any untoward occurrence took place, he suffered a great
deal, and it became unpleasant to assist him; but he was never unkind
to the patient. It is, however, not always easy to estimate correctly
the amount of operative dexterity. Hardly any man will perform a dozen
operations in the same manner. We have seen a very bungling operator
occasionally perform an operation extremely well; whilst the very worst
operation we ever saw was performed by a man whose fame rested almost
entirely on his dexterity; and what made it the more startling, was
that it was nothing more than taking up the femoral artery. But whether
it were that he was not well, or had been careless _in the site_ of his
first incision, or in _opening the sheath_ of the vessels before he
passed his ligature, or all of these causes in conjunction, we could
not tell, because we were not quite near enough; but we never witnessed
a more clumsy affair.

The conditions calculated to ensure good operating, are few and simple;
there are _moral_ as well as medical conditions; and no familiarity
ever enables a surgeon, on any occasion, _safely_ to dispense with any
of them. When they _are all_ observed, operating usually becomes steady
and uniform; when _any_ of them are dispensed with or wanting, there is
always risk of error and confusion.

We are afraid that we should be hardly excused in a work of this
kind, were we to lay down the canons to which we allude. We cannot,
therefore, enter any further into the subject.

Previously to offering a few remarks on the causes of Abernethy's
occasional irritability, we must not omit to mention a hoax that was
played on him. He had been in particularly good, boy-like spirits, and
had proposed going to the theatre; where he had enjoyed himself very
much. On reaching home, there was a message desiring his attendance at
Harrow. This was a very unwelcome finale. The hoax had been clumsily
managed, but it did not strike anybody at the moment; so it was decided
that Mr. Abernethy must go; and he took Mr. Skey with him. When they
got to Harrow, they drove to the house of the surgeon, and, knocking
him up, the surgeon came to the window in his night-cap, when the
following dialogue began. The name of the patient we shall suppose to
be Wilson.

"Does Mr. Wilson live here?"

"Who are you?"

"I say, then, is Mr. Wilson living here?"

"I say what do you want? Who the d——l are you?"

"I say that I want to find a Mr. Wilson; and my name is Abernethy."

"Immediately," says Mr. Skey, "off flew the night-cap."

"I beg your pardon, Mr. Abernethy; what can I do for you," &c.

"Is there a Mr. Wilson living here; and has he broken his leg?"

"Oh, yes, sir, he is living here; but he is very well, and has not met
with anything of the kind."

Abernethy laughed heartily, and ordered the post-boy to drive him home
again.

There would be no difficulty in multiplying anecdotes given to
Abernethy; but there are some objections to such a course. In the first
place, there are many told of him which never happened; others, which
may probably have happened, you find it impossible to authenticate;
and, lastly, there is a third class, which, if they happened to
Abernethy, certainly happened to others before Abernethy was born. In
fact, when a man once gets a reputation of doing or saying odd things,
every story in which the chief person is unknown or unremembered is
given to the man whose reputation in this way is most remarkable.
We need not say how impossible it is, in a Memoir of this kind, to
introduce, with propriety, matters thus apocryphal.

We have no doubt that, with a most benevolent disposition, Abernethy's
manner, particularly as he advanced in years, evinced great
irritability; and we believe that it was the result of two or three
different causes, which, in their combined influence, got a mastery
which the utmost resolution was not at all times able to control. It
had formed the subject of numerous conversations between Abernethy and
some of his most intimate friends, and we believe had arisen, and been
unconsciously fostered by the following causes: "In early life, he had
been," as he told Dr. Thomas Rees, "particularly disgusted with the
manner in which he had seen patients caressed and 'humbugged' by smooth
and flattering modes of proceeding, and that he had early resolved to
'avoid that at all events.'" He further observed: "I tried to learn my
profession, and thinking I could teach it, I educated myself to do so;
but as for private practice, of course I am _obliged_ to do that too."
We can easily understand how, in a sensitive mind, an anxiety to avoid
an imputation of one kind might have led to an opposite extreme; and
thus an occasional negligence of ordinary courtesy have taken the place
of a disgusting assentation.

A temper naturally impulsive, would find in the perplexities which
sometimes beset the practice of our profession, too many occasions
on which the suggestions of ruffled temper, and of fear of improper
assentation, would unfortunately coincide; and thus tend to intermix
and confound the observance of a praiseworthy caution, with a yielding
to an insidious habit. If to this were now added that increase of
irritability which a disturbed and fidgetty state of physique never
fails to furnish, and from which Abernethy _greatly suffered_, the
habit would soon become dominant; and thus an originally good motive,
left unguarded, be supplanted by an uncontrolled impulse. We believe
this to have been the short explanation of Abernethy's manner; all we
know of him seems to admit of this explanation. It was a habit, and
required nothing but a check from his humanity or his good sense to
correct it; but then this was just that which patients were not likely
to know, and could have been still less expected to elicit.

Again, most men so celebrated are sure to be more or less spoiled.
They become themselves insensibly influenced by that assentation
which, when detected, they sincerely despised. The moral seems to be,
that the impulses of the most benevolent heart may be obscured or
frustrated by an irritable temper; that habits the most faulty may rise
from motives which, in their origin, were pure or praiseworthy; that
it is the character of Vice to tempt us by small beginnings; that,
knowing her own deformity, she seldom fails to recommend herself as the
representative, and too often to assume the garb, of Virtue; that the
most just and benevolent are not safe, unless habitual self-government
preside over the dictates of the intellect and the heart, and that the
_impulse_ to which _assent_ is yielded to-day, may exert the influence
of a command to-morrow; that, in fact, we must be masters or slaves.

              "Rege animum qui nisi paret
      Imperat."

The views which we have thus ventured on submitting, are verbatim
those which appeared in the former editions of these Memoirs, and,
consequently, were written long before we were favoured with the
following letter. It was written to his daughter Anne, before her
marriage with the late Dr. Warburton, dated Littlehampton, August 13,
and is remarkably corroborative of some of the preceding remarks.

  "My dear Anne,

    "Lack of employment is, as I believe, the cause of your receiving
    this note in reply to the one I received from you by your mother.
    Certain I am that I never thought of writing an answer till just
    now, when it occurred to me that it would be polite to do so, which
    very phrase had nearly prevented the intention. Why have all the
    legitimate children of John Bull an aversion to politeness? 'Tis
    because it so commonly covereth a multitude of sins; because, with
    honest simplicity, they have often caught hold of the garb and
    found that it concealed deformity and malice. I frankly acknowledge
    that I may have carried my detestation too far, because it does not
    necessarily follow that our best friends should not wear becoming
    and fashionable apparel. I like to see them _en deshabille_,
    however. 'Tis the man, and not the dress, I am concerned about.
    I tell you, sincerely, that I take your note to be one of many
    evidences of your having both a good head and heart. Other young
    ladies would have spoken to mamma. Enough of this unprofitable chat.

  "Yours ever,
  "JOHN ABERNETHY.

  "Little Hampton, 13th August."


When the editors of the medical periodicals first began to publish
the lectures given at the different hospitals, there was considerable
discussion as to the propriety of so doing. The press, of course,
defended its own views in a spirit which, though not always unwelcome
to readers, is frequently "wormwood" to the parties to whom the press
may be opposed.

We are not lawyers, and therefore have no claim to an opinion, we
suppose, on the "right;" but, as regards the general effect of this
custom _as now practised_, we are afraid (however advantageous it may
be to the trade to obtain gratuitously these bulky contributions to
their columns) that doubts may not be unreasonably entertained whether
it is of advantage to science, to the character of our periodical
literature, or the profession.

The publicity which it gives to a man's name, induces men to contribute
matter which it would often have been, perhaps, more advantageous to
them to have suppressed; and the proprietors, so long as a periodical
"pays," are not likely to quarrel with that which they get for nothing
but the expense of publication.

Mr. Abernethy was very much opposed to the publication of his lectures;
but, though not insensible by any means to the occasionally caustic
remarks of the press, he does not seem to have been much annoyed by them.

The following is an extract from a letter, in which he expresses
himself as opposed to the conduct of those who publish lectures
without the permission of the authors. We suppress that part, because
it involves his opinion of the conduct of individuals. As regards his
personal feelings, he says:

    "Though I have been so long in replying to your letter, I have felt
    very grateful for the kindness which induced you to take up the
    cudgels in my behalf. At the same time, I must say that, had I been
    at your elbow, I should have hinted to you that the object was not
    worth the trouble you have been so good as to bestow upon it. No
    one can expect to escape slander and misrepresentation; and these
    are so commonly bestowed upon all, that they have little or no
    influence on the minds of persons of character and judgment.

    "With many thanks and best wishes,

  "I remain, my dear sir,
  "Yours very sincerely,
  "JOHN ABERNETHY."


SECTION.

When Mr. Abernethy was appointed _surgeon_ to St. Bartholomew's
Hospital, in 1815, he had already been twenty-eight years assistant
surgeon, and was therefore fifty years of age before he had an
opportunity of taking an active share in the practical administration
of the Hospital. This is one of the many effects of a System of
which we shall presently give a sketch. He was thus invested with
the additional duties of Surgeon of the Hospital, and Professor to
the College of Surgeons, at a time of life when most people, who
have commenced young and laboured hard with their intellects, as
distinguished from their hands, begin to feel their work. This was
the case with Abernethy. We do not think that his original physical
organization was to be complained of; he had been active and energetic,
he was of moderate stature and well-proportioned; a magnificently
poised brain, judging phrenologically; and, in short (under favourable
circumstances), he appeared to have had the elements of long life; but
we think that his organization—and especially the presiding power, the
nervous system—was ill-adapted either for the air, the anxieties, or
the habits of a crowded city; or the somewhat pestilential atmosphere
of a dissecting-room.

We saw him, therefore, ageing at fifty very sensibly, and rather more
than is in general observable at that period. He complained, in 1817,
of the fatigue of the College lectures, coming, as they did, on the
completion of a season of the "mill-round" of hospital tuition and
practice. So that, when we mentioned the period of his lectures at the
College as on so many accounts the zenith of his career, there was
the serious drawback arising from a certain diminution of strength
which had never been, at best, equal to the _physical_ fatigue of his
multiform avocations. All this arose partly out of a System, which,
although, like all evils, not allowed to proceed without being charged
with elements of remotely prospective correction, has been the parent
of much mischief. This is what we have called the "Hospital System,"
some of the more important features of which we will now present to our
readers.

[Footnote 74: This gentleman, who retired some years since from
practice, died at Norwood, about a month ago, at the age of 73. Dr.
Barnett was born at Malmesbury, and was an early pupil of Abernethy's,
and a friend of Dr. Jenner's; he practised many years as a general
practitioner in Charter-House Square, where he realized, we believe,
a comfortable competency. He was distinguished by a singularly mild,
gentlemanly, and inoffensive bearing, not less than by the confidence
reposed in his skill and judgment by a large list of patients and
friends.]




CHAPTER XXVIII.


THE HOSPITAL SYSTEM.

      "——Non hæc sine numine Divum
      Eveniunt."

      ÆNEID, lib. ii, 1. 777.

If we would view any human institution dispassionately, we must
distinguish the vices of System from the faults of those who administer
it.

Trite as this remark may be, the caution it involves is just that which
is too frequently overlooked or unobserved. By a careful attention to
the distinction it implies, we may develop the elements of rational
reform, as contrasted with Utopian schemes; which, whatever of abstract
truth they may contain, are frequently useless, simply because they are
impracticable. We cannot effect any material change in human nature
by any summary legislation, nor prevent the obtrusive necessities of
daily life from bringing down the soaring aspirations of mind, to the
humble level of the practicabilities of matter. Whoever, therefore,
expects that any body of men, invested with irresponsible power, will
hesitate to exercise it so as to procure, as they believe, the maximum
of advantage to themselves,—might just as hopefully quarrel with the
negro on account of his complexion. Do what you may, Man is Man "for
a' that;" but whilst it is necessary to remember this, it is by no
means so, to do it in a spirit of unkindness or hostility, nor in any
sense opposed to brotherly love; but, on the contrary, in a tone of
mind which, alike mild and uncompromising, desires to promote universal
harmony and good feeling, by removing the temptations which experience
has shown to be influential in disturbing such relations.

Neither should we quarrel with a man who endeavours to do the best
he can for his family and friends. Should he, even in this pursuit,
compromise his duty to the public, it is very _possible_ that the
objects which he had in view may have been in themselves praiseworthy,
and therefore, instead of exasperating our blame, may readily
_extenuate_ faults which it may be impossible to excuse.

The truth is, that the interests of the public and of individuals are
seldom, if ever, incompatible; the occasions on which they appear to be
so are not unfrequent; those in which they really clash are extremely
rare.

Wherever circumstances occur in which the temptation of a present
fruition is found habitually to lead men to courses which, however
apparently promotive of their own interests, are really detrimental to
those of the public,—it becomes very necessary that the public should
impose safeguards against such an injurious exercise of power.

The hospitals of London, as we formerly observed, are, in the main,
very fine institutions. They are many of them very wealthy, which
generally means powerful also.

The Governors, as they are termed, consist of certain noblemen and
gentlemen; the latter being, for the most part, drawn from the more
wealthy sections of the mercantile and trading classes.

The knowledge possessed by these gentlemen of the requisitions of
a large public hospital, must (special instances excepted) be very
measured; and be, in the main, derived from the medical officers with
whom they are associated.

It thus happens that the administration of the hospital is in great
part confided—as, with _some restrictions_, it ought to be—to the
medical officers. The interests of these gentlemen, it may be assumed,
would be best promoted by carrying out in the most efficient manner
the benevolent objects of the institution: and we believe, looked
at fairly and comprehensively, this would be really the case. The
duties of a large hospital, however—if they are to be performed
conscientiously—require much time, not a little labour, and some
health to boot. Now all these, in a crowded community, are very costly
articles; and which must, in justice—and, what is material, in fact
too—be fairly remunerated. The public never _really_ pay so dearly, as
when they _appear_ to get labour for nothing.

Here we come to the first defect in the "Hospital System."

It might be supposed that, with ample means, the Governors of
Hospitals, by adopting such previous tests as were in their power,
would have secured the most efficient officers, by paying them
remunerative salaries; and, having retained them as long as their
services were deemed efficient, or the duration of them justified, that
they would have released them from the necessity of further exertion
by a retiring pension. No such thing. The Hospital gives nothing:
actually, there is a small nominal retaining fee, as it were, of about
£60 to £100 a year, and the medical officer is left to obtain his
remuneration for time, trouble, and health, by such private practice as
his reputation or the _prestige_ of being attached to an hospital may
afford; from fees from pupils, or such other means as the position he
occupies may place within his power.

He very naturally sets to work to do the best he can; and from this
first budding, we very soon arrive at the full blossom of the System;
one effect of which is, that, in hospitals, which have so large a care
of public health—institutions which, whether correctly or incorrectly,
give so much of the tone to the medical opinions of the day, which
exert, either directly or indirectly, an influence on the claims of
hundreds to public confidence—that in these hospitals there is _not
one single surgeoncy that is fairly and bonâ fide open to scientific
competition_.

Let us now examine a little into the machinery by which these results
are brought out.

The experience afforded by the hospitals necessarily supplies abundant
means for instructing students in surgery. They are accordingly
admitted on paying certain fees to the surgeon; and this at once
supplies a large revenue. This revenue is of course regulated by the
number of pupils; and as there are in London many hospitals, so it
follows that there is an active competition. Thus, some time before
the season commences, the advertisements of the medical schools occupy
a considerable space in the public journals, and circulars are also
liberally distributed.

Well, the points here, as in all other cases, are the advantages
offered, and the price paid—the maximum and minimum respectively. Here
we arrive at the elements of numerous evils.

Students are not always—and before they try, hardly ever—judges of
a school. The general reputation of a man (as he is never subjected
to open competition) is no test whatever of his comparative power
in _teaching_ students; but they are accustomed to ascribe great
importance to operations; and, _cæteris paribus_, they incline to
prefer that hospital where the greatest number are supposed to be
performed.

This arises from various causes; in some of which the public play no
unimportant part. The student has perhaps seen, in the country, a
good deal of medical and surgical practice; but very few operations.
His stay in London is comparatively short, averaging, perhaps, not
more than the better part of two years. Unnecessary length of time is
generally inconvenient, always expensive, and the student is naturally
anxious to see _most_ of that which he will have _least_ opportunity
of observing elsewhere. Moreover, he knows that when he returns to the
country he may save twenty limbs, before he obtains the same amount
of _reputation_ that he may possibly get by _one amputation_—the
ignorance of the public, here, not appreciating results which very
probably involved the exercise of the highest talent, whilst they are
ready to confer a very profitable distinction on that which does not
necessarily involve any talent at all.

We have no wish whatever, and certainly there is no necessity, for
straining any point in reference to this very serious matter; but these
two facts are indisputable—that the surgeons obtain their remuneration
from the hospitals by the fees they obtain from the pupils; and,
_cæteris paribus_, the pupils will flock the thickest where they expect
to see most operations.

The next thing that we would submit, is that the _prestige_ in favour
of operations is both directly and indirectly opposed to the progress
of scientific surgery. Almost all operations, commonly so termed, are
examples of defective science. To practical common sense, therefore,
it would appear a very infelicitous mode of obtaining the maximum of
a man's genius in aid of the _diminution_ of operations, to open to
him a prospect of enriching himself by the _multiplication_ of them.
We desire to consider the subject with reference to its scientific
bearings only, and would avoid entirely, were that possible, any appeal
merely to the feelings. Such impulses, however right, are apt to be
paroxysmal and uncertain, unless supported by the intellect. But, on
such a subject, the feelings must necessarily become more or less
interested. Wherever a system takes a wrong direction, a great many
minor evils insensibly grow out of it.

The erection of a theatre for the purpose of operating, though founded
on a feasible pretext, is a very questionable measure; and, unless of
clear advantage to the profession or the public, is surely not without
some character of repulsion. As regards art and science, it is certain
that not more than twenty or thirty can be near enough in the theatre
to see anything that can be really instructive in the performance
of operations. In the absence of actual advantage, therefore, an
exhibition of this kind is more calculated to give publicity to
the surgeon operating, than it is to raise the tone or chasten the
feelings of men about to enter a profession which almost daily
establishes requisitions for our highest faculties. Operations without
opportunities of real instruction, are merely unprofitable expenditure
of valuable time. That which is viewed as a sort of _exhibition_
to-day, may be with difficulty regarded in the light of a _serious
duty_ to-morrow. Were the object to tax the sensibility of a student,
and blind him to any higher association with pain and suffering than
that afforded by custom and chloroform, and to substitute for a
dignified self-possession and sympathy with suffering, which each kept
the other in due control, an indifference to everything save adroitness
of manipulation and mechanical display,—no machinery could be better
calculated to effect such objects; but science and humanity require
very different qualifications, and experience has shown that they are
neither incompatible nor beyond our power.

The humanity and science that beholds, in operative surgery, the lowest
of our employments, and which would thence be impelled to seek, and as
experience has taught us to seek successfully, to diminish the number
of such exhibitions, and to lessen the suffering of those which are
still retained, is perfectly compatible with coolness and skill in the
performance of them.

When we speak of lessening pain, we must not be understood as alluding
to chloroform, or agencies of that kind. We have, on the contrary, the
greatest distrust of their utility; we do not hesitate to admit the
propriety of their use in certain cases; but we are satisfied that,
as at present employed, a very few years will make a great change.
Many a so-called incurable case has been shown to be curable by the
hesitation of the patient to submit to an operation. We have published
some ourselves, wherein we joined in recommending the measure which the
patient declined. Many deaths that we _do know_ have already occurred
from the use of chloroform; and a _significant_ remark was made by a
man who had considerable reputation in this way. He said: "Chloroform
is a good thing for operating surgeons."

To return from this digression. The most distinguished surgeons ever
known in this country have shown us how to combine, in the highest
degree, dexterity and skill, with science and humanity; together with
a just estimate of the low position occupied by operations in the
scale of our important studies. I may allude to two more particularly,
Cheselden and John Hunter; the former, the most expert and successful
operator of his day, in the European sense of the word, has left us a
satisfactory declaration on this subject. Cheselden acknowledges that
he seldom slept much the night previous to the day on which he had any
important operation; but that, once engaged in operating, he was always
firm, and his hand never trembled. John Hunter was not only a good
operator himself, but he deduced from observation one of the greatest
improvements in operative surgery. His discovery had all the elements
of improvement that are possible in this branch of the profession.

An operation which had been founded upon erroneous views of the nature
and relations of the parts affected—which had been always tedious and
painful in performance—which, whether successful or not, entailed much
subsequent suffering, which in its results was highly dangerous, and
which was very commonly followed by the loss of the limb or life,—was
replaced by one founded on more correct views of the disease, easy and
simple in its execution, occupying not more than a very few minutes,
and which, so far as regards the purpose for which it was instituted,
and to which it should be restricted, is almost invariably successful.
If it be performed under circumstances implying conditions _contrary
to those on which Mr. Hunter's operation was founded_, very different
results have no doubt taken place; but, when properly applied, his
operation for aneurism is no doubt one of the greatest improvements in
operative surgery.

John Hunter treats of operations in terms which show how low he rated
that part of our duties. He speaks of them as humiliating examples of
the imperfection of our science, and figures to himself an operator
under the repulsive symbol of an armed savage. "No surgeon," said he,
"should approach the victim of his operation without a sacred dread and
reluctance, and should be _superior to that popular éclat generally
attending painful operations, often only because they are so_, or
because they are expensive to the patient"—p. 210. Abernethy, whose
keen observation saw the difficult web which various sophistries,
to use no harsher term, had thrown around the subject, was very
characteristic in the manner in which he dashed it aside, and pointed
to the salient source of error.

"Never perform an operation," he would say, "on another person, which,
under similar circumstances, you would not have performed on yourself."

The truth is, that operations, to be performed properly, must be
properly studied. They must be frequently performed on the dead, and
afterwards carefully examined. There is a wide difference between
neglecting a necessary study and making that the test of science which
is the most emphatic proof of its imperfection. We have ourselves had
no lack of experience in this branch of the profession, and have
included not a few operations which are too commonly delivered over to
men who are said to devote themselves to special objects. The result of
our experience satisfies us in entertaining the views which the most
distinguished men have held on this subject; whilst we are persuaded
that few things have contributed more to impede the progress of science
than the _abuse_ of operations.

To return to the surgical appointments of the hospital.

The positions which had at first been left without any remuneration,
become, by the machinery described, very lucrative; directly, by the
fees paid by the pupils; and indirectly, in some cases, by keeping the
surgeon constantly before the public. Any _prestige_, therefore, in
obtaining these appointments, is of great value; but, if that do not
really involve _professional excellence_, it is as plain as possible
that the public may be very badly served, and an evil generated equally
opposed to the interests of science and humanity. It is obvious that
the only legitimate grounds of eligibility are moral and professional
superiority, as determined by the test adopted at public schools and
universities—namely, public competition. Now, what are the tests
employed? Without meaning to insinuate that moral or professional
eligibility is _wholly_ disregarded—no system in these days will
support that—still the eligibility depends on a qualification which
few would beforehand have imagined. It is certainly something better
than Mr. Macaulay's joke in relation to the proposed franchise to
the Militia—namely, that the elector should be five feet two—but
something not much more elevated; namely, that a bounty should have
been paid to one of the hospital surgeons in the shape of an apprentice
fee; thus making the holding one of the most responsible offices in the
profession—a condition, which absolutely ignores relative eligibility
of skill, steadiness, assiduity, and humanity; and which recognizes
them only in such shape that the possession of office is practically
made to depend on a point absolutely extrinsic to any one important
requisition recognized by the public or the profession.

We need not insist on the tendency of this system to the protection of
idleness and incapacity, or the injustice inseparable from it to the
young gentlemen whose interests it is supposed to guard. One necessary
consequence is obvious—namely, that the hospitals, instead of having
to select from the general body of pupils, or from the more industrious
or talented of them, is obliged to choose from a very small minority.

It is, in fact, just as if scholarships and fellowships at public
schools and universities were conferred without any reference to the
proofs which the candidates might have given of their talents or
industry; but were distributed to those who had given a certain fee to
a particular professor. Would any man in his senses doubt as to the
influence of such a plan on the interests of classical literature or
mathematical science? It seems to us impossible that men should really
differ on that point, or hesitate to admit that, _mutatis mutandis_,
whatever the science might be, so far as the cultivation of it could
be influenced by system, the result must be alike prejudicial in all
cases. We are, however, far from arriving at the end of the System by
this general statement.

The public and the government, uninformed or unmindful of this
"system," wish to consult authorities on professional matters. They
not unnaturally look to those who hold public appointments, because
these afford the _prestige_ of extensive opportunity, which is supposed
to imply, and under a fair system would ensure, skill and experience.
Men are apt to look at a man's position, without stopping to inquire
_how_ it was obtained; and although position may cut both ways, and in
particular instances "throw a cruel sunshine" over incapacity, still
amongst gentlemen extreme cases are not to be expected; the rule is
much more likely to be a respectable and protected mediocrity, which is
just that tone which has rarely done anything to enlarge the boundaries
of any kind of knowledge.

It happens, however, from the "system," and the position thus given to
those who are supposed to profit by it, that the interests of the poor,
and, in a considerable degree, those of the rich also, are, in a very
large sense, confided to their care.

It thus follows that positions, in themselves highly desirable, and
which enable men to exert considerable influence on the progress of a
science, on the sound condition of which the physical comforts, and in
no small degree the moral condition, of mankind depend, are occupied
by men who have undergone none of those tests which public competition
alone affords, and which the _summi honores_ of almost every other
profession either directly or indirectly imply.

So far for one mode in which the interests of the public are
compromised; but there are many other channels. The government,
ignoring the evils of this system, have placed the regulation of the
surgical branch of the profession in the hands of a body of men whom,
when we examine, we find to be no other than the apprentices we had
recognized at the hospital, grown into the full bloom of a legislative
body—whence again are chosen Presidents, Vice-Presidents, Examiners,
&c., of the Royal College of Surgeons of London!

If, fatigued with this machinery, we walk to the Royal Medical and
Chirurgical Society—a chartered body for the especial cultivation of
science—we meet, as its name would imply, a number of our honoured
brothers, the physicians; but here we find that, whether we observe
Presidents or any other Officers, the influence exerted by the
apprentice system continues; and that, in _almost_ everything surgical,
the _best possible_ individual is an apprentice who has attained his
first position without any public competition. Can any one be surprised
that the published transactions of this society are not of a higher
character. We hope and believe that the point of the wedge is already
inserted, which will, at no distant period, rend asunder this system,
which we shall not trust ourselves by attempting to characterize
farther. But there are points in connection with the interests of
science and of Abernethy which require yet to be noticed.

We need scarcely observe that it would be very desirable that the
interests of science should be entrusted to those who had shown most
assiduity or talent in the cultivation of them; that if operative
surgery be really, as a whole, a series of facts exemplifying the
defects of a science—that whilst every pains should be taken that what
is necessary should be done thoroughly well—all factitious inducement
to multiply their number should be avoided, and especially any which
tended to increase emolument commensurately with their multiplication.

That as operations (with some few exceptions) merely minister to
effects, their real bearings on disease can only be estimated by
knowing the _ultimate result_; and that, in order to this effect,
returns of all operations should be kept, with full accounts of the
cases; the addresses of the patients should also be taken, and such
means as were obvious and practicable employed to obtain the _ultimate
result_ of the case.

Another point which should be attended to in hospitals, is an accurate
notation and return of all cases whatever; so that we might obtain from
statistical records whatever light they might be capable of affording
in aid of the prosecution of a definite science. In this return, a full
history, and _all_ the phenomena of the case, which are known to have
an influence on the Body, should be accurately noted, and in tabular
forms convenient for reference.

The defects of the hospitals in this respect are too well known to
require comment; and we think the profession indebted to Dr. Webster
for the exertions he has made to draw attention to this subject.
In no respect are the hospitals more defective than as regards the
division of labour[75]. To supply the requisitions of a yet dawning
science, there is too much confided to one surgeon; for, at present,
the practical administration and the scientific investigation should be
confided to the same hand. If more be entrusted to one man than can be
performed without great labour, and the greater labour be voluntary, we
shall have little chance of obtaining that full and accurate notation
of facts which all cases furnish more or less the means of obtaining,
and without which the evolution of the maximum of human ability is
absolutely impossible. It seems to us also an imperative duty to avail
ourselves of the experience afforded by the history of other sciences,
in the cultivation of our own.

All sciences have been in as bad a condition as medicine and surgery,
or worse. All sciences have progressed immediately that they were
investigated on a rational plan—a plan, which, simply stated, is
little more than the bringing together _all the facts_ that can be
perceived to bear any relation to the inquiry, and reasoning on them
according to _well-established_ and necessary conditions. If this be
the case, and this plan have never been applied to the investigation
of medical science, we know not how those who are placed in positions
which supply the necessary means can be excused; or how we can halt
in condemning the system under which such a flagitious neglect of
the claims of science and mankind is exemplified. It is true, when
we arrive at the acmé of our convictions of the effects of such a
system, our reflections remind us that such things are "permitted,"
and that ultimately they will work for good; that Man is not destined
to interfere with the ultimate plan and designs of Providence, however
he may be allowed to place his intellect under the direction of a
responsible volition, and to discover the path to the temple of truth,
only after having fruitlessly threaded the mazes of error.

[Footnote 75: We are glad to see that there has at length arisen a
desire, at least in a degree, to correct this evil.]




CHAPTER XXIX.

      "Quanto quisque sibi plura negaverit
      Ab Dis plura feret."


We believe that there is no greater fallacy than that which supposes
that private advantage can be promoted at the expense of the public
good. We are very well disposed to believe that selfish people are the
very worst caterers for the real interests of the idol they worship.
The more we consider the Hospital system, the more reason shall we find
to distrust it; and we by no means exclude that very point wherein it
is supposed to be most successful—namely, in securing the pecuniary
advantage of those whose interests it is supposed to serve.

Of the apprentices, we shall say little more than to express our belief
that many of them have lived to obtain the conviction that they would
have done much better had they not been fed by hopes that were never
realized. All apprentices cannot, of course, be surgeons. Again, if,
in the course of a century, a solitary instance or two should occur
of the success of an unapprenticed candidate, they not unnaturally
feel it as an injustice in thus being deprived of that, the especial
eligibility to which was a plea for the exaction of a large apprentice
fee. But to the surgeons themselves, it seems to us that the system is
far from realizing the benefits that its manifold evils are supposed
to secure. The adage that "curses, like chickens, come home to roost,"
is far from inapplicable. After all, many of the hospital surgeons are
little known; and the public inference with regard to men invested with
such splendid opportunities of distinguishing themselves, is not very
flattering. Mr. Abernethy, so far from benefiting from the "System,"
appears to us to have suffered from it in every way.

His talents, both natural and acquired, would have given him every
thing to hope and nothing to fear from the severest competition;
whilst the positive effects of the system were such as to deprive him
of what was justly his due, and to embitter a retirement which in
the barest justice should have been graced by every thing that could
add to his peace, his honour, or his happiness, from the Institution
whose character he had exalted and maintained, and whose school he had
founded.

But let us look at the facts. The system which pronounces that there
shall be three surgeons to attend to some 500 or 600 patients (_for
the purposes of science_—the next thing to an impossibility), kept
Abernethy twenty-eight years an assistant surgeon. During this time he
was filling the hospital with students, to the amount of sums varying
from £2,000 to £3,000 a year, of which, in the said twenty-eight years,
he never received one farthing.

He saw, from time to time, many men, of whose capacities we know
he had the highest opinion, shut out from the hospital by the mere
circumstance of their not having been apprentices; and two of these
were the late Professor Macartney, of Dublin, and the present
distinguished Professor of Comparative Anatomy, Professor Owen. And
here we must pause to record one of our numerous obligations to the
perceptivity and justice of Abernethy. We have formerly observed
that, at the very commencement of life, he had been accustomed
to inculcate the importance of studying comparative anatomy and
physiology, in order to obtain clear views of the functions of Man;
but all arrangements made with this view, from the time of Mr. Hunter
onwards, though varying in degree, were still inefficient. It was next
to an impossibility to combine an availing pursuit of a science which
involves an inquiry into the structure and functions of the whole
animal kingdom, with the daily exigencies of an anxious profession.

When Mr. Owen had completed his education, his thoughts were directed
to a Surgeoncy in the navy, as combining a professional appointment
with the possibility of pursuing, with increased opportunities of
observation, his favorite study. Fortunately for science, he went to
Abernethy, who requested him to pause. He said, "You know the Hospital
will not have any but apprentices. Macartney left on that account.
Stay," said he, "and allow me to think the matter over." This resulted
in his proposing to the Council of the College of Surgeons that there
should be a _permanent_ Professor of Comparative Anatomy, and that the
appointment should be given to Mr. Owen.

This is among the many proofs of Abernethy's perception of character.
Mr. Owen had dissected for lecture; and Abernethy saw, or thought he
saw, a peculiar aptitude for more general and enlarged anatomical
investigation. The whole world now knows how nobly the Professor
has justified the hopes of his talented master. It would be out of
place for us to attempt a compliment to a man so distinguished in a
science, wherein the varied pursuits of a practical profession allow
us to be mere amateurs; neither do we wish to forget other gentlemen
who distinguish themselves in this branch of science; but we believe
that most competent judges allow that the celebrated Cuvier has not
left any one more fitted to appreciate his excellence, or who has
more contributed to extend that science of which the Baron was so
distinguished a leader, than Professor Owen.

There is one incident, however, in the Professor's labours which,
for our own purposes, we must relate; because we shall have to refer
to it in our humble exhortation to the public and the profession to
believe in the practicability of raising Medicine and Surgery into a
definite science. The incident shows what may be done by that mode of
investigation which is the still delayed desideratum in medicine and
surgery—namely, the _most comprehensive_ record of facts, and the
study of their _minutest relations_. Professor Cuvier was the first to
impress, in a special manner, that those beautiful relations in the
structure of animals, so many of which are even popularly familiar,
extended throughout the animal; so that if any one part, however
apparently subordinate, were changed, so accurate were the adaptations
in Nature, that all parts underwent some corresponding modification; so
that diversity of structure in parts, more or less affected the whole.

The beautiful result of all this is, that if these relations be once
thoroughly mastered, then any one part necessarily suggests, in general
terms, the nature of the animal to whom it belonged. Few instances,
however, so remarkable as the one we are about to mention, could have
been anticipated.

A seafaring man brought a piece of bone, about three or four inches in
length, as he said, from New Zealand, and offered it for sale at one or
two museums; amongst others, at the College of Surgeons. We shall not
here detain the reader by telling all that happened. These things are
often brought with intent to deceive, and with false allegations. Most
of those to whom the bone was submitted, dismissed it as worthless,
or manifested their incredulity. Amongst other guesses, some rather
eminent persons jocosely hinted that they had seen bones very like
it at the London Tavern; regarding it, in fact, as part of an old
marrow-bone, to which it bore, on a superficial view, some resemblance.
At length it was brought to Professor Owen, who, having looked at it
carefully, thought it right to investigate it more narrowly; and after
much consideration, he ventured to pronounce his opinion. This opinion,
from almost anybody else, would have been perhaps only laughed at;
for, in the first place, he said that the bone (big enough, as we have
seen, to suggest that it had belonged to an ox) had belonged to a bird.
But before people had had time to recover from their surprise or other
sensation created by this announcement, they were greeted by another
assertion, yet more startling—namely, that it had been a bird without
wings.

Now, we happen to know a good deal of this story; and that the
incredulity and doubt with which the opinion was received were too
great, for a time, even for the authority of Professor Owen to dispel.
But mark the truthfulness of a real science; contemplate the exquisite
beauty and accuracy of relation in nature! By and by, a whole skeleton
was brought over to this country, when the opinion of the Professor
was converted into an established fact. Nor was this all; there was
this appropriate symbol to perpetuate the triumph: that which had
appeared as the most startling feature of what had been scarcely better
received than as a wild conjecture, was so accurate in fact, as to
form the most appropriate name to the animal thus discovered[76].

It would be unjust to others to attribute Professor Owen's appointment
exclusively to Abernethy: that, the state of things did not place
within his single power; but his penetration was the first to suggest,
and his weight most potential in securing, an appointment which various
circumstances, besides the merits of the individual, bring up in high
relief, as the best ever made by the London College of Surgeons.

To return to the Hospital System, as affecting Abernethy. He continued
to lecture, and the emoluments arising thence he of course enjoyed.
Until 1815, the whole of the hospital fees had been taken by the
surgeons in chief. These fees, in twenty-eight years (allowing
a reasonable deduction for those pupils who went to the school
independently of the inducement offered by the most attractive lecturer
ever known), must have amounted to an enormous sum. Having founded the
school, he became surgeon at about fifty years of age; and then retired
at sixty-two. On retiring, unpleasant discussions arose, which, with
others long antecedent, rendered his concluding associations with the
hospital scarcely more agreeable than they had been at the College of
Surgeons.

The whole of Abernethy's closing career gave him no reason to
rejoice at the Hospital System. The circumstances, though they
convey a lesson in the History of the Lives of Men of Genius, were,
abstractedly, extremely unimportant. They show that Abernethy, in
his retiring hours, whilst his reputation had become European, and
Transatlantic[77]—whilst hundreds were benefiting their fellow
creatures, more or less, according to their talents and opportunities,
in every part of the world—seems to have been surrounded by men
who, so far as we can see, were little disposed to grace his
retirement either with much sympathy, or even with reasonably generous
appreciation of all that he had done, either for Science in general, or
the Hospital in particular.

Instead of considering how they could best do honour to the waning
powers of one who had not only raised the reputation of St.
Bartholomew's Hospital to a point it had never before attained, who
had founded a school there, constituting the largest single Hospital
Class in London, and who was leaving the inheritance of a rich annual
harvest to his successors,—the time was occupied in discussing whether
he could resign the surgeoncy without resigning the lectureship;
whether, on paying a hundred guineas, which there seemed no difficulty
in receiving, he could become a Governor whilst still an officer; and
then, whether his being a Lecturer without retaining the surgeoncy
did not so constitute him. These, and similar questions scarcely more
important, were the source of considerable annoyance.

In former editions, we were obliged to discuss some of these matters
more at large than is now necessary; because, amongst the individuals
associated in the transactions of the period, there was one to whom
Mr. Abernethy had been of especial service; but in regard to whom he
had been much misrepresented. Further, this had taken place in our own
hearing, in whose recollection all the facts were perfectly fresh,
but who were, at that time, without the documents which are now in
our possession. We accordingly sought to obtain whatever documents
there were from the source most likely to test the correctness of our
recollection; when a note was written which, as we now learn, quite
unintentionally conveyed the idea, or at least was susceptible of the
construction, that a disinclination to make any communication on the
subject proceeded from a desire to withhold something unfavourable to
Mr. Abernethy. This determined us on discussing the matter, so far as
was necessary to rebut such interpretation. And it was fortunate we
did so; for it very soon appeared, not only that such an impression
had been produced, but that "gossip," with its usual aptitude for
invention, had soon supplied the myth thus supposed to have been
charitably withheld.

It was not very long after the publication of these Memoirs, that
we learned, in a conversation with a highly distinguished member of
the profession, that he had been led to entertain the impression to
which we have alluded. Here we had, of course, an opportunity of
correcting the error; but it obviously became a subject of very serious
consideration, what must be done in dealing with this matter, and
other matters arising out of it, in a subsequent edition. To treat
the affair seriously, would have involved a reference to documents in
our possession which, though highly honorable to Mr. Abernethy, would
have been of no general interest, whilst they would have involved
details disagreeable to several persons. We therefore, after much
consideration, resolved on endeavouring to see whether it was not
possible to quash a tedious and painful discussion, and at the same
time to obtain, of course, all that was necessary to the memory of Mr.
Abernethy.

The following letter, and the reply, will, we think, sufficiently
develop the very difficult and disagreeable position in which we were
placed; our sole object being, so far as it was possible, to avoid
repeating or enlarging a discussion which we had learned would have
given pain to certain parties. The concluding paragraph has been
omitted, as being unnecessary to the point more immediately under
discussion.

  "3, The Court Yard, Albany,
  "July 17th, 1856.

  "Sir,

    "For reasons which may be gathered from this note, I think it
    proper to inform you that I am preparing another edition of the
    Memoirs of Abernethy. Impressions have been conveyed to certain
    persons, that the reasons on which you grounded your disinclination
    to make any communication in relation to your differences with
    Abernethy, were the desire you professed to withhold something
    which involved imputations unfavourable to him. Further, a sort
    of Body has been given to these vague impressions by inferences
    which the documentary and other evidence at my disposal enable me
    to disprove. In one quarter, the circumstances are so strongly
    suggestive as to the sources whence the erroneous impressions were
    derived, that it is impossible to leave that portion of the Memoirs
    which treats of your differences with Abernethy as it at present
    stands, without the risk of injustice. It is regarded as necessary
    that you should either recognize or ignore the inferences which
    (whether correctly or not I will not presume in this place to
    determine) have certainly been formed on your supposed authority.
    The justice of such a course is sufficiently obvious. I need
    scarcely say, it is immaterial to me what course is taken. If I
    am obliged to enter into the discussion of the subject, I shall
    take the opportunity of defending myself from the remarks that
    have been made upon me, and of showing what I did say, as well as
    what I might have said. These remarks are less excusable from it
    being known to me that a letter of mine to a third party was by my
    express permission read to you, in which was stated my willingness
    to alter or modify any passage which might have offended your
    feelings, provided only that such alteration involved no injustice
    to Mr. Abernethy. The (as I think) ill-advised rejection of the
    offer, coupled with the intimation, long after, which was given
    to Mr. Longman by a friend of yours, that certain papers would be
    forthcoming, provided only that certain passages relating to Mr.
    Stanley were suppressed, will involve a discussion in which I
    shall now be very unreserved; but which, I fear, will be scarcely
    less disagreeable to you than painful to myself. If you ignore the
    imputations to which I have referred, it seems to me that the whole
    discussion may be quashed by your simply writing me a note, in
    which you state as the reason for your not making any communication
    to me your dislike to revive the recollection of differences with
    one whose memory you will always regard with respect, gratitude,
    and affection, or whatever other terms your feelings may justify,
    or the claims of Mr. Abernethy require.

           *       *       *       *       *

           *       *       *       *       *

  "I am, Sir,
  "Your obedient servant,
  "G. MACILWAIN."

The following is Mr. Stanley's reply:

  "Brook Street, July 18th.

  "Sir,

    "Upon the subject of your communication to me, I can only say, that
    I have no information to give; for I am not in possession of any
    document relating to it; and so many years have elapsed since the
    occurrences to which you refer, that I could not trust my memory
    for the accuracy of any statement, if I were disposed to make it.
    You will therefore perceive that there exists no foundation for the
    supposition that 'I desire to withhold something which involved
    imputations unfavourable to Mr. Abernethy,' or that any other
    feelings than those of the utmost respect for the memory of Mr.
    Abernethy have existed in my mind.

  "I am, sir,
  "Your obedient servant,
  "EDWARD STANLEY.

  "G. MACILWAIN, ESQ."

We here conclude this subject.

A somewhat amusing illustration of one feature of the hospital system
occurred about this time. Sir Astley Cooper had, without the smallest
intention to give offence, made some observation on the somewhat too
free use of Mercury at that period in the Borough Hospitals. His
observations having been misunderstood or misrepresented, he took
occasion to remove any idea of intentional offence, by addressing
the class. Among other things, he is reported to have said: "Why,
gentlemen, was it likely that I should say any thing unkind towards
these gentlemen? Is not Mr. Green my godson, Mr. Tyrrell my nephew, Mr.
Travers my apprentice" (the three surgeons of St. Thomas's Hospital),
"Mr. Key my nephew, Mr. Cooper my nephew?" (surgeons of Guy's)[78].

This was very _naïve_, and is an illustration of the value of evidence
in proof of facts having no necessary connection with those it was
intended to establish.

It is difficult to conceive any one more disinterested than Mr.
Abernethy had been in relation to the surgeoncy of the hospital, from
the moment at which he was appointed to the hour of his resignation.
Although he had waited twenty-eight years as assistant, and not
participated in one farthing of the large sums accruing from his
reputation in hospital pupil fees—although, too, he had a large
family,—yet, so far was he from wishing to indemnify himself for
this long exclusion from office by a lengthened tenure of it, that
he at once announced his opinion as to the expediency of earlier
resignations of the surgeoncies, and his intention of acting on it when
he should have attained his sixtieth year. His reasons were liberal and
judicious. Amongst others, he said that he had "often witnessed the
evils resulting from men retaining the office of surgeons to hospitals
when the infirmities of age prevented them from performing their
duties in an efficient manner. That, at sixty, he thought they should
resign in favour of the juniors," &c.; thus contemplating a tenure of
only ten years. Again, he who had founded a school from such small
beginnings as could be accommodated in a private house in an obscure
neighbourhood (Bartholomew Close), taken for that purpose—who had
so increased it, that a theatre was built within the hospital—this
again pulled down and rebuilt of enlarged dimensions to receive his
increasing audiences—having, too, some time previously made over his
museum to the hospital, in trust for the use of the school,—required
that his only son (should he _prove competent in the opinion of the
medical officers_) should in due time—Do what? Succeed him? No; but be
admitted to a _share_ in the lectures.

Indeed, Mr. Abernethy's closing career at the hospital gave him no
great reason to rejoice at the "hospital system." Men, who could see
nothing in leaving very much more important situations to an indefinite
succession of apprentices, cavilled at a prospective lectureship for
his only son; whilst his lectures were delivered over to gentlemen—one
of whom had, from an early period, ridiculed, as he said, the opinions
which he taught as—and which we now know to have been—John Hunter's;
and another, with whom there had been of late several not very pleasing
associations.

This was necessarily a result of the "hospital system;" a system that
gave a still more melancholy and fatal close to the labours of John
Hunter, whose death took place suddenly in the Board-room of St.
George's Hospital, whilst resisting an interference with a privilege
which his love of science rendered valuable to him, and which it was
for the interests of science that he should enjoy; but, mournful as
these results are, and many others that might be added, still, if we
found that the system worked well for science, we might rest satisfied;
but is it so? What advances have the hospital surgeons of London,
_under the apprentice system_, made in the science of surgery? Let
those answer the question who are desirous of maintaining this system.
For our own parts, the retrospect seems to show "the system" in a more
striking manner than any thing we have yet stated. John Hunter, that
_primus inter omnes_, was no hospital apprentice; he migrated from St.
Bartholomew's, where the rule was too exclusive to give him a chance,
to St. George's, where he obtained admittance; St. Bartholomew's
preserved "the system," and lost Hunter.

Abernethy was an apprentice, truly; but all those glorious labours
which shed such a lustre on his profession, and such a benefit
on mankind, were completed long before he became surgeon to St.
Bartholomew's Hospital; and it is material to repeat that at that time
the assistant surgeons, with the exceptions already stated, had nothing
to do. In casting our eyes over the retrospect of years, one honoured
name attracts our notice, in connection with a real advance in the
knowledge of the functions of nerves. We allude to Sir Charles Bell.
But here again "the system" is unfortunate; for Sir Charles was never
a hospital apprentice at all, and only succeeded to a post in a London
hospital after an open canvass in an institution in which the narrow
portal of the apprentice system is unrecognized.

We might have traced the effects of the apprentice system into the
more covert sites of its operations, as exemplified in the abortive
or mischievous legislation observed at different times in the College
of Surgeons of London; or have extended the catalogue we formerly
exposed as taking place in the Royal Med. and Chir. Society up to the
influence—proh pudor!—that it is allowed to exert in the Councils
of the Royal Society; but our so doing here would have led us into
discussions which are irrelevant or unnecessary to our present objects.
In the meantime, it is useful to remark that there are two sides to all
questions. If, in our corporate bodies, we see the prurient appetencies
of trade usurping the place of the lofty aspirations of science,—if we
see this carried to the extent of men allowing themselves to receive
money without rendering any intelligible account of its amount,—let
us not forget that there is a Public—aye, and a Profession too—which
calmly allows such things.

Let us also reflect on those numerous instances, in human affairs,
of things being only accomplished when there is a real necessity
for them; and, again, whether that necessity for a higher and purer
administration of corporate privileges and scientific distinctions
may not alone reside in a higher and purer moral standard on the
part of the public and the profession. Those who, in a worldly sense,
suffer from the system, have at least the consolation that they are
not obliged to participate in the administration of that which they
disapprove; and that the losses they so sustain are perhaps necessary
tests of their having achieved proper motives. No better proof of the
sincerity and earnestness of our love of science can be afforded us,
than a patient and thoughtful cultivation of it, independently of
patronage, position, or other auxiliaries, which too often mask from
us the true objects of research, sully the purity of mind by mixtures
of questionable motive, or mislead us from the temple of truth to the
altar of a fugitive and fallacious ambition. There are indeed signs of
a "_Delenda est Carthago_." As we have said, the point of the wedge is
inserted, and a very little extension of public information will at no
distant period drive it home.

In the meantime, Medical Science, instead of being in a position to
receive every quackery as a means of demonstrating the superior beauty
of truth, by placing it in contrast with error, is obliged to regard
any absurdity, however gross, as one of the hydra-headed fallacies
through which we are to evolve what is true, only by the circuitous
plan of exhausting the resources of hypothesis and conjecture: whilst
sweeping epidemics, which, wholesomely regarded, should be looked on
reverently as besoms of destruction, are hailed by the observant as
melancholy, but necessary, impulses, to drive us to the adoption of
measures, to which our capital of common sense is not sufficient to
induce us to listen.

Neither are the old hospitals the only parts of a defective system.
There is no hospital in London that, even yet, has any country
establishment for convalescents; whilst of two of those more recently
established, one is built over a church-yard; and the other, intended
only for the relief of decarbonizing organs, is placed in the immediate
neighbourhood of the most smoky metropolis in Europe. Both, therefore,
instead of standing out as the most distinguished illustrations of the
laws of sanitary and physiological science, being, on the contrary,
emphatic examples of their violation.

We are unwilling to conclude this chapter without observing that,
notwithstanding the coldness and discussions which threw somewhat of
melancholy and shade over Abernethy's retiring days, thus presenting
an unwelcome contrast with the more palmy periods of his career—a
contrast from which it might have been hoped his conscientious
retirement might have spared him,—we yet see how appropriate a
preparation it might have been for a transition from the exciting, and
adulatory, atmosphere which surrounds a popular and scientific teacher,
as compared with the calmness and peace of a life in the country. He
was now no more to enter the Hospital Square, where we have so often
seen him mobbed, as it were, by the crowding and expectant pupils;
no more to be daily addressing audiences who never seemed to tire
even with repetitions of that with which many were already familiar;
nor any more to see, as occasional visitors, men grown grey in the
successful practice of his early lessons, bringing their sons to the
same school, and both listening with equal pleasure. There is no
doubt that, contrasted with all this, retirement was a great, though
now probably a welcome, change. Eminent men unintentionally exert an
influence which is not without its evils; and we shall see that of this
he was fully aware. Assentation is too much the order of the day. The
multitude appear to agree. The few who differ, are apt to be cautious
or reserved. If a man is too sensible to be fed with such garbage as
direct flattery, there are always tricksters or tacticians, who have a
thousand ways of paying homage without detection.

Then, again, those who really admire a man, and are honest,—keep
aloof, and shrink from an association with those whom they know, or
believe, to be parasites. It thus happens that there are men to whom so
few venture to be honest, that the world may present little better than
a practical lie. It is a mercy then, when a man's sun is setting, that
he be blessed with a little twilight of truth.

There are, in the moral and intellectual constitution, as well as in
the physical endowments of Man, beneficent powers of adaptation, which
let us gently down to contrasts, which, too sudden, might be painful or
destructive.

There is, however, this difference—the external senses have intrinsic
powers of adaptation so ready, and perfect, as scarcely to be taken by
surprise by any natural transition. The moral and intellectual powers
do not appear to possess this electric activity; but require slower
gradations of impression, which, by some law in the progress of human
affairs, are (as the rule) mercifully supplied.

In his own lessons, whenever he met with any _apparent_ imperfection,
and wished to impress its _real_ beauty of adaptation, Abernethy was
very fond of what he termed his argumentum ex absurdo. He would suppose
various other arrangements, and point out in succession their unfitness
for the purposes required. Tried in the same manner, we can see nothing
better than that which really happened.

If Abernethy met with coldness where he expected warmth—and
dispute and discussion where he might have calculated on grateful
concession,—how well-fitted must have been that reverence and
affection which longingly awaited his retirement at home. If the
greatest worldly success, in that occupation in which he had always
felt most pleasure, was still not without its dark lights—shadowing
forth what the world really is,—what could he have had better to
concentrate his views on those substantial sources of comfort, of which
he had long believed and estimated the value, and on which he was
contented to repose. It had always been a favourite expression of his,
when in any doubt or difficulty: "Well, I will consult my pillow, and
we shall see." We believe that pillow seldom flattered.

[Footnote 76: It was accordingly named the Apteryx, or wingless, from
the Greek Alpha and Pterux.]

[Footnote 77: We have derived great pleasure from our correspondence,
during some years, with Professor Ethelbert Dudley, of Lexington,
Kentucky, and from the evidence it affords of Abernethy's principles
having been recognized, and practised with great success, by one
of the most distinguished surgeons and successful operators in the
Western World. Professor E. Dudley, himself a distinguished surgeon and
lecturer, and a man who unites with an extremely clear and vivacious
perceptivity, a most untiring zeal in his profession, is the nephew
of the celebrated B. Dudley, whose fame extends through the great
Mississippi Valley. This gentleman, now advanced in years, was an
early pupil of Abernethy, of whom he is a great admirer. He is a
remarkably successful operator, and, during his more active period,
was sometimes sent for several hundred miles. He is said to have
performed lithotomy 200 times, with the loss of only six cases. His
unusual success in operations he attributes not so much to any peculiar
dexterity as to the manner in which he conducts the preparatory and
subsequent portions of the Constitutional treatment of his cases. He
seems also to have practised some other of Abernethy's habits: the most
careful consideration of the pecuniary circumstances of his patients,
interspersed with not a few examples of almost unexampled generosity.]

[Footnote 78: _See_ Lancet, 1828.]




CHAPTER XXX.


HIS RELIGION.

    "Philosophy directs us to bear evils with patience and fortitude,
    because they are inevitable; but Christianity gives us consolation
    under sufferings, by assuring us that they are but the discipline
    of a Parent who loveth while he chastiseth, and that they are but
    for a moment, when compared with eternity. The Christian's Hope
    has made him whom it has supported rejoice under the greatest
    sufferings that mortality could endure; yet Hope is but the
    offspring of faith, and therefore it was necessary to make faith
    the foundation of the structure of the Christian Religion, and
    to assign and affix to it peculiar privileges and rewards." MR.
    ABERNETHY[79].

Whoever reflects on the influence produced on the mind by research in
Science, will, we think, arrive at a very important conclusion.

It is true that, at the commencement, numerous worldly motives tend to
place most prominently before us the temporal advantages of scientific
Inquiry. There are distinctions of wealth, rank, position, which not
unfrequently await its successful cultivation. Then there are the
multiform applications of science in extending the enjoyments, in
ministering to the wants, and, still better, relieving the calamities
of mankind; but when we have arrived at this, surely the acmé of its
_utilitarian_ allurements, we find there are still higher motives
engendered—that science has a still richer harvest to encourage its
onward cultivation. Nor is it too much to say, that, if cultivated
aright, the fruits may be more surely garnered than any of those
to which we have previously referred. The harvest we mean consists
of those moralizing influences which, however neglected, are never
separable from the study of Nature; which, however ordinary the
impulses with which the inquiry may have commenced, slowly overlay
it with motives and feelings which lead us to investigate Nature for
the sake of truth alone. And here, we think, first dawns upon us the
conclusion to which we have alluded: viz. that the highest attractions
of science are to be found in what we venture to term its "Religion."

However much the influences first mentioned tend to place the more
lofty suggestions of science in temporary abeyance, there always comes
a time when the sincere inquirer begins to feel a double current of
thought. In the one, the thoughts are open, aspiring—ambitious, it
may be—public, and directed only to the laws and phenomena of Nature;
in the other, they are calm, deep, humble, silent, and _will_ turn to
the Supreme Cause. The former may foster his ambition, animate his
research, sustain his industry. The latter carry him beyond those
influences, and supplies something which they cannot give. In loving
truth for its own sake, he learns by degrees to lean little on the
worldly appreciation of labour—convinced that whatever is true, will
one day find its own way, in the time best fitted for it. We cannot
help thinking that it is the force of this double current of thought
by which that climax has been reached by some of the greatest minds;
which has exemplified the coincidence of the utmost range of human
knowledge with the most profound humility; thus rendering the highest
aspirations of science subservient to the cultivation of a principle;
inseparable, we suppose, from all Religion; but certainly one of the
most distinguishing characteristics of Christianity.

An idea, however, has arisen in some minds, that the pursuit of science
has a tendency to make men sceptical in Religion. This we believe
to be not only a demonstrable, but a dangerous error—demonstrable,
as remarkably opposed to the evidences of fact and observation; and
dangerous, as withdrawing the minds of many from the study of science,
who would be perhaps especially fitted to estimate its advantages and
enjoy its pleasures.

History, who from her ample store of testimony has so often repealed
injustice and defeated error, is no where more conclusive than on the
question before us. The study of Nature not only has no tendency to
induce a state of mind unfavorable to the reception of the truths of
Religion, but just the contrary; for the proofs of a humble and sincere
reliance on the promises of the one, have been infinitely most striking
in those who have proved themselves the most successful cultivators of
the other.

The philosopher, regarding the universe as the dwelling of the Supreme,
sees in the laws of nature, and in the powers through which he is
permitted in a degree to interpret them, only another revelation—a
Divine recognition of his high relations and destiny; and grasps
in one comprehensive idea the Word and the Works, as an integral
communication—one extended privilege to Man. He does not indeed
confound the evidences on which philosophical and religious truths
respectively repose. He knows that they rest on different _kinds_ of
testimony, which he neither strives to identify, nor misapply. He
no more expects to deduce the generalizations of science from the
Scriptures, than he does the commands of the Deity from the facts of
the natural world. Philosophy and Religion, however, are constantly
impressing similar facts. In science, we learn—and no doubt the
deepest learn it best—that "there are more things in heaven and earth
than are dreamt of in our philosophy." Religion tells us there are many
things "past man's understanding." Religion and science teach us alike
that any inquiry into the positive and ultimate nature of anything
which exists, is entirely beyond our faculties; and respectively impress
on us the conviction, that our proper business is to search out the
phenomena and laws of the one, and to obey the Commandments of the other.

Philosophy is daily teaching us how little we know, as compared with
that which is unknown. Religion informs us that, at present, we see
"through a glass darkly." Yet, at the same time, both concur in
encouraging us to believe that everything that is really required of
us, everything that is good and useful to us both here and hereafter,
are alike open to human capacity. The pursuit of science, no doubt,
establishes requisitions which are essential to the proper study of
it. A mind undisciplined by any rule; a mind taking only a conjectural
view of nature; a mind allowing fancy or imagination to usurp the
place of intellectual power; a condition which ignores the guidance of
patience, circumspection, and industry, and which seeks the explanation
of the impressions made on the senses by ingenious hypotheses made to
fit them; or which sees no order or intelligibility in anything which
it does not at once comprehend; that these and many other states of
mind _may_ tend to confound the understanding, and replace anything
rational or profitable by anything else, is _possible_ enough. But is
it not equally true of Religion? Experience has abundantly shown us the
result of Man trying to fit the mysteries of Religion to the measure
of intelligibility set up by the human intellect. There surely is no
subject on which men have become more lamentably bewildered. This,
however, is merely one of the too common examples of abuse of our
faculties; and that such men may become sceptical, whether pursuing
Science or any subject whatever, is probable. It is, in truth, "Science
falsely so called," and has no more relation to the legitimate study of
Nature, than the most orderly formula of the mathematician has to the
wildest conjecture.

But that research in science, legitimately conducted, has any tendency
to produce what is usually intended by the term scepticism, is not only
improbable;—it is directly contradicted by the facts of experience.
So numerous are the examples of the contrary, to which we here add
the name of Abernethy, that it is difficult to select, so as not to
leave the evidence unjustifiably bald on the one hand; or to render
it superfluous even to tediousness on the other. That which confers,
however, the greatest interest on this part of the subject, is not so
much the _mass_ of testimony, not so much the _crowd_ of witnesses,
as the peculiar, yet varied, character of the august assemblage. It
is extremely significant to observe, that whilst we find amongst
the most earnest advocates of the paramount importance of Revealed
Truth, the names of the most successful students of the Truths of
Science,—so, on the other hand, no persons have laboured to impress
us with the important uses of the facts in nature with more zeal and
success than distinguished Divines. Amongst the many scientific men
who have exemplified the purifying tendencies of scientific pursuits
in promoting their reverence for Revealed Religion, it will suffice to
mention such names as Boyle, Bacon, Kepler, Newton, Locke. The latter
too reminds us that the medical profession has contributed no small
number of witnesses; of whom, Böerhaave, Linnæus, Sloane, and Haller,
are a few of the more illustrious examples. All the foregoing are men
who have explored one or more of the ample fields of Nature; some of
them, extending their views beyond the planet we inhabit, into the
whole visible universe, have come back, showing us how to understand
the necessity, and estimate the value, of Revealed Truth; converting,
it may be, in many instances, Belief (so called) into a positive Faith;
and a passive assent into an earnest and clear conviction.

But, as we have said, Divines have not been slow in contributing the
weight of their testimony to the value of natural evidence, and the
acceptable assistance afforded by a contemplation of the laws and the
mysteries of Nature. So abundant indeed are these mysteries, that
there is not a path of our progress by day, nor a waking thought by
night, that does not at times present some of them to our reflection.
Mysteries in operation so clear, that our very senses take cognizance
of them; so orderly, that when we are allowed to discover the law which
regulates them, we are at a loss which most to admire, the power, the
number, or the simplicity of its manifestations; and yet which, as to
their intrinsic nature, are so recondite as to be entirely beyond our
researches; leaving us, in fact, no faculty which can deal with them,
but faith alone. Divines have shown the value they attach to all such
facts, by the admirable application they have made of them in aiding
the cultivation of Religion—sometimes by teaching the necessity and
reasonableness of faith in the mysteries of Religion; at others, in
impressing the nature and attributes of the Supreme.

It would be easy to produce a longer roll of such men; but most
readers are acquainted with such names as Cudworth, Butler, Sturm,
Derham, Paley, Crombie, who have, in one or other sense, exemplified
the importance of natural knowledge, and the interest they took in
its cultivation. In every phase of the investigation, we meet with
fresh examples of the union of Religion with Science. Paschal and
St. Pierre are eminent illustrations. Paschal was a Divine, and an
eminent mathematician: mankind is surely under obligations to him for
his "Lettres Provinciales." These extraordinary compositions must
have operated with uncommon force against the sophistries of the
Jesuits; and, considering the nature of the subject, it could have
been no ordinary work that could have induced Voltaire to say that
he had never read anything more humorous than the earlier letters,
or more sublime than the later. St. Pierre[80], too, should not be
passed without mention. His book is, in some points of view, one of
the most interesting works ever written: occasionally fanciful or
enthusiastic, it is a most unusually rich collection of facts and
observations. How excellently adapted it is to encourage observation
of natural phenomena! How just and philanthropic—how circumspect
and comprehensive his observations in Nature! and how excellent and
free from cant the paramount importance he impresses of Religion as a
principle, and of Christianity as the perfect supply of all that is
necessary to us in time or in eternity. Yet St. Pierre was a soldier;
and it is to our present purpose that he was a scientific man, and an
engineer. Neither should we pass unnoticed the numerous associations of
pastoral care with the observation of nature, so pleasingly exemplified
in White of Selborne, and Gilpin of the New Forest—men whose books we
count now rather by generations than editions, and which suggest to
our imagination the additional gratification which such men must have
derived to their favourite pursuits, in the continued sanction afforded
by Scripture. We would reverently point to the site first chosen as
the abode of purity and innocence; and the numerous illustrations from
nature contained in the Sacred Volume; whether in enforcing general
rules, or a special command—impressing a particular principle, or
illustrating a recondite mystery,—and especially that which is a
_remarkable and necessary combination_ of mystery with faith. For
whilst it is, as well as other mysteries, beyond our comprehension, it
commands so entire a faith in its reality, as to be, in some form or
other, instinctive and universal[81].

Mr. Abernethy, it has been stated in former editions, was, as regards
his religious tenets, a member of the Church of England: and it would
have been gratifying to have included some of those sentiments on
religious and moral matters which we now record; but, although some of
these documents had been open to our inspection before the completion
of the second edition, they were not so entirely at our disposal as
Miss Abernethy has subsequently placed them. Of these documents,
those which relate to religious and moral subjects consist, first,
of a small book on the Mind, which Abernethy published a great many
years ago, anonymously; and certain reflections, found amongst the
very few MSS. which he had preserved. Amongst these papers, there
are two which are in the form of sermons; and, although they are all
somewhat fragmentary, they are in several points of view more or less
interesting.

As it appears to be an abuse of the proper business of biography
to publish every thing that an eminent man says or does, we shall
endeavour to make such selection as shall fall within its legitimate
objects—viz. as establishing some fact of importance, as illustrating
the tone and character of the man, or as placing some conclusion which
had been drawn more or less from general observation, on the more
secure basis of the sentiments he has himself recorded.


EXTRACTS.

There is "more moral certainty in the greater number of instances of
those things which we believe from the deduction of reason, than of
those we believe from the action of the senses."


Yet he would warn the students of science "from being proud of their
acquisitions; and against not believing any thing but what they learn
from the deductions of their reason, lest they _become most ignorant of
that of which they are most assured_."


"Man at this period of the world is still ignorant of the nature of
surrounding bodies; his information must be limited as his perceptions
are limited, and this should produce humility, the proper frame of mind
for Christians."


After saying that we have no means of forming any idea of the nature
of matter, but from the impressions we receive from it, those of
figure, divisibility, gravity, and disposition to move when impelled,
to continue in motion unless retarded, &c. &c.—in allusion to a
well-known theory, he adds: "But some have doubted whether we could be
sure even of those properties of matter of which we felt most confident
the existence were such as we conceived them to be. Certainly," he
says, "we know nothing of what matter really is; we only know certain
properties, without being at all acquainted with the substratum or
subject, as a logician would say, which supports these properties.
Yet," he says, "when we consider the ideas derived from external
objects, we _cannot but admire their correctness and suitability to our
present wants and state of existence_."


"If we are ignorant of the nature of the most common object of matter,
as we call it, how can we obtain any knowledge of what we call Spirit?"
He thinks that it is only from a knowledge of ourselves that we can
derive any ideas on the subject.


"When we examine our bodies, we see an assemblage of organs formed
of what we call matter, visible to the eye and cognizable to the
touch; but, when we examine our minds, we feel that there is something
sensitive and intelligible which inhabit our bodies." "We naturally
believe in the existence of a Supreme First Cause. We feel our own
free agency. We distinguish right and wrong. We feel as if we were
responsible for our conduct, and the belief in the existence of a
_future state seems indigenous to the mind of man_." "We are conscious
of our existence; we remember our sensations; we compare them, judge
of them, and Will and act in consequence of such judgment." He thinks
if we can form any notion of the actions of a Spirit, it must be
from reflections on such phenomena, and not from any hypothetical
definitions of Matter and Spirit.


Again, after insisting on the limitation of our powers, he says, "From
them we may conceive of God, that He approves what is right, and
condemns what is wrong; and that he may approve of our conduct when we
act right or wrong, according to our own ideas of rectitude or error.
We cannot conceive that God would have given us the power of judging
without deciding on the rectitude or error of our conduct in conformity
to such power or judgment. This is the sense in which I understand the
Scriptures—that God created man in His own image."


HIS TENDENCY TO REASON BY ANALOGY.

"As the Mind takes cognizance of what is passing in the body, and in
those which surround it and directs its notions and operations in
regard to them, so we may conceive of that Great Spirit, the Soul
of the universe, that He perceives and governs all its parts. That
Creator, Supporter, and Governor of the universe, whom we are taught to
address, not only as such, but by the more endearing appellation of the
Father of our Spirits."

In his little book on Mind, he thus lays out his plan:

"The attributes of the mind, which seem to be of a permanent nature,
are here considered as 'properties' (intending such as perception,
memory, &c.); those which are occasionally exerted and operate with
effort as 'powers;' and those which may be perceived only occasionally,
and which vary in degree or kind in different persons, as 'qualities.'
As Reason and Will are 'properties' of the mind, and yet exerted as
'powers,' they are treated under both heads."


OF IDEAS.

"As I may not use the word in a customary sense, I think it right
to explain what I mean by ideas. When I see a beautiful prospect
illuminated by the sun, I have a _perception_ of light and shade.
When, however, I have acquired such a knowledge of light and shade
as to be able to represent on paper a spherical or many-sided body,
I think I have acquired a knowledge of light and shade beyond that
which the _mere_ remembrance of my perception would have produced. I
shall, therefore, express myself as follows: Our knowledge consists
of perceptions and deduction from them, which may be called ideas,
opinions, thoughts. In reasoning, we employ these intellectual
deductions, as we employ the perceptions of the facts themselves."


OF ABSTRACTION.

He observes: "It does not appear that we have the power of abstracting
the mind from the consideration of any subject, except by engaging it
in some other."


OF BENEVOLENCE.

"Benevolence is necessary, because it enlarges our sphere of happiness
by rendering us participators in the happiness of others—besides
producing, by sympathy, similar feelings in others."


In a series of propositions on the exercise of mind, he impresses the
mischief of admitting or indulging erroneous trains of thought, as
illustrated by "the fears arising from bad management in childhood,—by
persistence in vice after the gratification has ceased and the
destruction certain; and also in contributing to the production of
insanity." Or, on the other hand, he considers the _advantage_ of
exercise in correct trains of thought; that the powers evinced by
Newton, and, in certain cases, by Johnson, to have been unattainable,
but as the result of such exercise. He enlarges on the moral effects
of habitual increase of power in diverting the mind at will to other
objects, and so subduing anger, mitigating calamity, &c.


In illustrating the intensity that recurrence of impression is apt to
give to the feelings, he says: "Benevolence indulged, leads to lasting
friendship; whilst the harbouring sensations of even trivial disgust
are too likely to develop animosity," &c.


In speaking of the difficulty of ascertaining all the _facts_ and
_feelings_ which enter into the formation of any one's opinions, he
says: "It ought to incline us to think modestly of our own, and pay
deference to those of others,"


The impropriety of "anything like compulsion to make men think alike
by other than _their own temperately induced convictions_ is never
more clear than in regard to religion; for the aim of Christianity is
general benevolence and individual humility—benevolence even to the
forgiveness of error. Has not this been illustrated in the highest
degree by its Supreme Author, when He said, 'Father, forgive them;
they know not what they do?' Does not Christianity enjoin the very
reverse of that which we are constantly pursuing, by which we excite
dissension and cultivate an arrogance incompatible with the character
of a Christian."


He concludes one chapter thus:

If we said to others, who agree in the main points of religion, "We are
brothers, let each think as his own mind dictates,—it is probable that
all would soon think alike, because all would think without passion or
prejudice."


He considers the most exalted of all manifestations of divine mercy,
"the atonement of sin by the sufferings of Christ, and the promulgation
of precepts which, if practised, ensure temporal and eternal
happiness." And, in another place, he speaks of the gratitude that
man should feel in "that his Creator has thus condescended to be his
Redeemer," &c.


Of the Scripture precept—"To do justice, to love mercy, and to walk
humbly with thy God"—he observes, "that it contains precepts so clear
as to be intelligible to any capacity—so strikingly just as to gain
our immediate accordance—and so comprehensive as to include every
event which can occur in life," &c. Yet he says, "it is the property of
truth, however beautiful it may appear at first sight, to seem more
and more so, in proportion as it is minutely examined." MSS.


In deprecating pride, whether of mind, body, or estate, after
discussing the latter, he remarks on the more seductive influence of
intellectual superiority; he says: "The mind is no more ours than
the body;" that the success of intellect depends on varieties of
opportunity, qualities of mind, &c.; that all are alike given us, and
that any merit which the mind may bring, consists, not in the successes
of intellect, but in the purity of the motive by which they are guided.


PRIDE OF POSITION.

"It requires great and constant reflection to prevent a man from
becoming vain, who is placed in high office. He receives such constant
deference and respect to his opinions and wishes from all around him,
such ready obedience, that he might be led to imagine he was a creature
of superior order."


In some memoranda connected with things which had vexed him, we find:
"If justice, good will, and candour, were common, the world would be
too happy; it would not be what it now is—a state of exertion and
trial; of strenuous efforts, which contribute to the general good;
and, when efforts are unavailing, of trials which demand fortitude,
patience, and submission." MSS.


In allusion to some preceding reflections, "It being intended to
show that the conduct enjoined by the Scriptures is the same that
philosophy should inculcate, and that the preceding considerations
would not only almost persuade, but oblige every one to be a Christian
in conduct, whatever he might be in creed."


"To me it seems that the inspired origin of Christianity may be fairly
inferred from its wonderful adaptations to the wants and feelings of
the human mind. The Author of the Christian Religion knew the mind
of man, and all those feelings and considerations which support and
confirm him in well-doing. That feelings, to become vivid, strong, and
habitual, must be often repeated; and therefore that prayer and the
ceremonials of Religion were not only right, but due to that Power by
whose ordinances we live, and move, and have our being. How perfect a
knowledge of the human mind evince those precepts which instruct us,
distrusting our own constancy, to shun temptation and evil society. To
engage ourselves in constant and useful employment, and to suppress
the first movements of the mind, which, if continued, would urge us
with increased force and velocity to error. Human observation teaches
that the feelings of man are the source of their happiness or misery,
and the causes of their conduct. The Christian Religion operates on
our feelings, by teaching us the government of the mind, and showing
that Christianity does not consist merely in evil doing, but in evil
thinking."


We here conclude the extracts which we think it necessary to submit to
the reader, and we hope that they have not been more than in keeping
with the objects we proposed to observe. In all the reasoning in his
papers, Abernethy, whether we suppose him right or wrong, is remarkably
clear and consistent. If he discourses on matter, or spirit, or any
other principle, he simply regards the phenomena they can be made
to exhibit, regardless of any opinion mankind may have formed as to
their _real_ nature. He regards our ignorance of the intrinsic nature
of matter or spirit merely as an example of our ignorance of that
which is beyond the scope of our present faculties. This, in science,
is _studying_ facts and laws, as contrasted with speculation and
conjecture; in religion, it seems to be attention to the Command and
the study of the Word, as contrasted with that of the intrinsic nature
of Him who gave it; and, in thus suggesting the legitimate path of mind
in regard to both, is at once philosophical and religious.

It would have been easy to have multiplied the analogies of science
and religion, and especially those which, in warning us before hand
of those difficulties which occur in the prosecution of science, tend
to gird us with the requisite firmness and moderation in bearing up
against, or in surmounting them. Few have cultivated science with
success, without encountering more or less of those evils which have
been so commonly opposed to the more devoted advocates of religion. So,
also, some of the most useful discoveries have been the mission of men
of obscure origin. Again, discoveries in science have frequently had
to brave distrust, ridicule, injustice, and all kinds of opposition.
It would, indeed, seem that nothing really good can in this world be
attained without sacrifice; much less truth—that best of all; and he
among us who is not prepared, in his search for the truths of Science,
to add his mite of something that the world most values, might perhaps
as well take Science as he finds it, and avoid a labour which, without
sacrifice, will be almost certainly abortive.

That Abernethy's idea of religion was eminently practical, is every
where apparent in his reflections; yet, while he seems to have felt
that "faith, without works, is dead," he unmistakeably evinces his
conviction as to the foundation on which he thinks _good_ works can
alone be secured.

The extracts we have made, and all Abernethy's writings, appear to bear
witness to a marked sincerity of character. We see that, whether he
lectured at the College of Surgeons, or spoke to his pupils, who paid
him for his instructions—whether he addressed the public who joined
with the profession in establishing his eminent position—whether he
published with his name or without it; or addressed his sentiments to
his family, unheard but in the sacred precincts of home,—we find his
thoughts and his language always the same. He had no dress thoughts,
no company mind-clothing; he was always the same, simple, earnest, and
sincere. In his very earliest papers, in his lectures at College, or
in those of the Hospital, we never entirely lose sight of the golden
thread to which I have before alluded. The bulk of the discourse is
always the question that is really and properly before him; yet he
seldom concludes the argument philosophical, without glancing (and it
is in that just keeping as to be seldom more) at its ethical or its
theological relations.

[Footnote 79: From his Essay on Mind, and his MSS.]

[Footnote 80: Études de la Nature.]

[Footnote 81: St. Paul, I Cor. xv, v. 36-37.]




CHAPTER XXXI.

    "It is the duty of Criticism neither to depreciate, nor dignify
    by partial representations; but to hold out the light of reason,
    whatever it may discover."

  JOHNSON.


In tracing the progress of science, it is difficult to assign to each
individual his just share of merit. The evidence, always incomplete,
seldom allows us to do more than to mark the more fortunate, to whom,
as it were, the principal parts have been allotted. The exposition of
truth generally implies a previous contest with error. This may, in one
sense, be compared with military achievements. We hear of the skill and
wisdom of the General and his associate Chiefs; but little is known
of individual prowess, on the multiplication of which, after all, the
result depends.

To one who conferred so many obligations on his country and on mankind
as Abernethy, it is difficult to assign only his just share; and yet
it is desirable that nothing be ascribed to him which is doubtful or
disputable.

Antecedently to Abernethy's time, and contemporaneous with the date
of Mr. Hunter's labours, surgery had, in the best hands, and as a
mere practical _art_, arrived at a respectable position; still,
in Abernethy's early day, barber-surgeons were not yet extinct;
and, as he jocosely phrased it, he himself had "doffed his cap" to
barber-surgeons. There is no doubt that some of them had arrived
at a very useful knowledge. The celebrated Ambrose Paré was a
French barber-surgeon. When Abernethy entered into life, the best
representative of the regular surgery _of that day_ was Mr. Pott, who
was contemporary with the period of Mr. Hunter's labours. Mr. Pott
was a good surgeon, an eloquent lecturer, a scholar, and a gentleman;
and he gave some surgical lectures at St. Bartholomew's Hospital. We
have perused two manuscript copies of these lectures, which are in
the library of the Royal Medical and Chirurgical Society, and they
contain many useful and judicious observations. There are ripples
of a more humane and scientific surgery, and many parts that are
suggestive of onward study. Pott had also the good sense to perceive
the measured pretensions of his own time, and to predict advances on
it, as great as that itself was on the surgery of his predecessors:
but we do not perceive anything in Pott's lectures in the shape of a
science. _Extensive_ generalizations we are not thinking of; we have
them _yet_ to get; but we see nothing, in the true sense of the word,
even axiomatic. There are no steps, no axioms, by which we can reach
the platform of more general propositions. In some of his operations,
the most elementary principles are either not perceived or neglected;
and, although there are general recognitions of the state of the health
influencing the so-called surgical maladies, there is no definite
principle developed. It is a recognition scarcely more than that
implied in the older surgical writers, when, if the surgical part of a
case did not go on well, they recommended the calling in of a physician.

In this state of things, John Hunter began a beautifully simple,
and, in its bearings on surgery, we may add, a new mode of inquiry.
He saw that there was much in all animals that was common, and that
there were analogies in the whole organic kingdom of nature; hence he
sought to develop, by observation of the various processes in various
animals, and their nearest analogies in vegetables also, the _true
relations_ of the phenomena observable in man. It was not that he did
that which had never been attempted before, in the abstract, but that
he undertook it with a new, a concentrated unity of purpose. He did
not employ, as it were, a different instrument to collect the rays
of light from surrounding nature; but he concentrated them into a
focus on a different object—the nature and treatment of disease. His
labours, though not permitted to endure for many years, interrupted by
indisposition, and suddenly stopped by death, were abundantly fruitful;
they enabled him to simplify much of surgery that was officious and
hurtful, and to correct many errors. He first gave a reason for this or
that proceeding, founded on actual observation of natural processes:
thus, in healing of wounds, the natural and healthy were distinguished
from unnatural and unhealthy processes, and so forth. But as Mr.
Hunter's enlarged views taught him the the value of the _relations_
observable throughout the whole animal creation, he contemplated
_parts_ of the body only as a step to the more successful observation
of the _whole_. As before stated, he observed the phenomena exhibited
by the various organs, both separately and in connection; traced
them with elaborate circumspection, and concluded by justifying what
Abernethy said, when he observed: "Hunter proved that the whole body
sympathized with all its parts."

Now, many of the facts which Mr. Hunter remarked in the relations
established between different parts of the body, were, in the
strictest sense, axiomatic—that is, they were exemplifications of
laws to which they were the necessary steps. Take one for example:
that the part sympathetically affected by an impression primarily
made on another part, appeared to be frequently _more disturbed_
than the part with which it had appeared to sympathize. This we now
know to be no exception, but rather the law; because the exceptions
(as we contend[82]) are explicable; but that was not then perceived.
Abernethy, however, made use of this so far as to impress the fact,
that organs might be seriously disordered without there being
_apparently_ any symptoms referable to them.

Now, Abernethy might have continued to labour as Hunter did in
collecting facts as the materials for axioms, or as elements for
future and more extensive generalization; or he might have at once
taken Mr. Hunter's views, so far as he had gone, and, working on them
with his remarkable aptitude for perceiving the more salient and
practicable relations of facts, have applied them at once to practical
purposes; gleaning more facts as his extremely acute observation might
have enabled him on the way. He pursued, perhaps, neither course
exclusively; but the latter appeared to be the one he chiefly adopted;
and, from the more immediate fruition it affords, no doubt it was best
adapted to the existing exigencies of a practical profession.

John Hunter was a man of indefatigable industry, and exceedingly
_circumspect_ in his observance of facts. Abernethy was fagging too,
but more impulsive and not so dogged; mere facts were mere bores to
him; he panted for _practical_ relations, and was most wonderfully
quick in perceiving them. His vision was as penetrative as Hunter's
had been circumspect and cautious. Hunter would have sifted all the
useful things out of any heap, however heterogeneous; Abernethy would
have looked through it, at once found the one jewel that it concealed,
and left the rest for the next comer. They were both most perfectly
honest and truthful, both careless of money, both enthusiastic in
science—that is, both ardent in the pursuit of truth, with that kind
of feeling which does not stop to examine the utilitarian relations
of these pursuits; but which, carried on by a continually increasing
impulse, takes the good for granted, and is impelled by the love of
truth for its own sake.

But, interesting as it is to contemplate those requisitions which, as
indispensable, are common to the successful investigators of science,
it is yet more so to observe the _distinctive_ characters of John
Hunter and John Abernethy. The former, with many ideas to tell, and
most of them new, had a difficulty in expressing himself. With more
need than any man before him for additional facilities in this way,
he had a restricted vocabulary. Again, in making use of it, his style
was seldom easy, often obscure; so that things which, when thoroughly
understood, had no feature more striking than their simplicity, were
often made to appear difficult, and by many readers, no doubt, had
often been left unexamined.

Abernethy, on the contrary, had a happy facility of expressing himself,
and a power, rarely equalled, of singling out the difficult parts
of a subject, and simplifying them down to the level of ordinary
capacities. Hunter, though not without imagination, or humour even,
had these qualities held in abeyance by the unceasing concentration
of his intellectual faculty. As Abernethy used to say, "John Hunter
was always thinking." Abernethy, on the contrary, had an active
imagination; it always accompanied his intellect, like a young, joyous
attendant, constantly lighting up the more sombre propositions of her
grave companion with varieties of illustration. The most difficult
proposition, directly Abernethy began to fashion it, had all its
rough points taken off, and its essential features brought out clear
and orderly to the plainest intellect. John Hunter, in laying down a
series of facts having the most important influence in the formation
of a medical science (take place when it may), was not able to keep
people awake. Abernethy's treatment of the most dry and unimportant,
kept his audience unceasingly interested. The obscurity of language
in Hunter was happily replaced, not only by an unusual ease, but by a
_curiosa felicitas_, in Abernethy. In sustained composition, Hunter was
generally difficult, often obscure; Abernethy, if not faultless, always
easy and unaffected. If his style failed sometimes in earnestness and
vigour, it was always sincere; and whilst, though not deficient in
eloquence, it asserted no special claim to that excellence, it was
always pleasing and perspicuous.

Nothing could be further from the earnest and thinking John Hunter than
anything dramatic. Abernethy had that happy variety of countenance and
manner that can be conveyed by no other term. Hunter, without being
slow, was cautious, circumspect: Abernethy, without being hasty, was
rapid, penetrative, and impulsive. Never were two minds so admirably
fitted for the heavy-armed pioneering in science, and the comparatively
light-trooped intellect which was calculated to render the first
clearing easily convertible to those practical necessities with which
the science had to deal. Accordingly we find that Abernethy very soon
extended Mr. Hunter's views, and applied them so powerfully, as at
least to create the dawnings of a science. He showed that all processes
in the economy—and of course, therefore, those of disease—are
essentially nervous in their origin: that is to say, the nerves being
the _instruments_ through which our relations are established with
surrounding nature (however much we may, in common language, speak of
this or that feeling, this or that _organ_, or this or that part of the
body), all impressions must still be made primarily on the sensitive or
nervous system of that part; and this, of course, whether they imply
_consciousness_, or be altogether independent of it; that disturbed
nervous action was, as the case might be, either the forerunner—or the
next link in the chain of causation (i. e. the proximate cause)—of
the disease; and that therefore the relief of diseased or disordered
actions, however attempted, consisted ultimately and essentially in the
restoration of healthy nervous power, or adaptation.

This, then, is the first proposition. The next thing, and which
necessarily follows, is, that in the prevention or cure of disease, the
first object is the tranquillizing of nervous disorder.

Now, here there are many things to be regarded; for man is a moral
as well as a physical being; and the circumstances by which he
is surrounded, even the air he breathes, the moral and physical
impressions to which he is subjected, are very often not under his own
control, much less that of his medical attendant. On the other hand,
the food is, in civilized communities, very much under the influence
of his volition; and there are many circumstances which, instead of
impeding those adaptations which disorder requires, renders them
particularly easy—it frequently happening that those things which
are really best, are most easily procured. This is important; because
the next proposition is, _that the nervous system is very easily and
constantly disturbed by disorder of one or other, or of the whole
of the digestive organs_, and that therefore the tranquillizing of
disturbance in them is of the highest consequence in the treatment of
disease: _few_ propositions in _any_ science are more susceptible of
proof than the foregoing. But if this be so, we must now recollect
the full force of what we have observed with regard to relation; that
is, we must not restrict our notion of it to the general loose assent
that there is a relation in all parts of the body, and rest on the
simple admission, for example, that animals are formed in adaptation
to their habits; but we must sustain the Cuvier-like impression of the
fact, the Owen-like application of it to the phenomena; recollect
that _preconceived_ ideas of magnitude and minuteness can do nothing
but obscure or mislead; and that the relations established in the
body are constant and universal, however they may at first—as in the
case we have quoted—excite the surprise or the derision of the less
informed and less reflecting. We must take their immensely potential
power as existing _as certainly in the most trifling headache, as
in the most malignant fever_—in the smallest scratch, _as in the
most complicated compound fracture_. We have plenty of facts now to
_prove_ this; but the first plain, clear enunciation of it all, the
successful demonstration of it at the bedside, and the consequent
diminution of an enormous amount of human suffering, is the great
debt we owe to Abernethy. Mankind in general admitted that Diet
was of consequence. Nobody doubted its force as an _accessory_ in
treatment. Lactantius said: "Sis prudens ad victum sine quo cetera
remedia frustra adhibentur." But no one had recognized the treatment
of the Digestive Organs as the essential part of the treatment of
_surgical_ diseases, nor founded it on the same comprehensive view
of its relations as addressed to organs which executed the nutritive
functions of the body on the one hand, and were the _most potential
disturbers or tranquillizers of the nervous system on the other_,
and thus for ever linked them in their practical relations with the
fact, that the essential element of disease, the _fons et origo_, is
disturbed nervous power. But, as all diseases are merely the result of
two conditions—namely, the injurious influence acting, and the body
acted on—it matters not whether the injurious influence be sudden,
violent, slow, moderate, chemical, mechanical, or what not; so the
foregoing positions affect the whole practice of medicine, and must not
be held as affecting any one part of it, but as influencing equally
both medicine and surgery.

We do trust that these few propositions will induce some to think; for,
as Abernethy used to say, lectures will never make surgeons: and we
feel equally confident that no books, no individual efforts, however
costly or sincere, will really benefit or inform any portion of the
public or the profession, except such of them as may be induced to
_think_ for themselves. They have only to recollect that, in carrying
out such principles, they must not measure their influence by their
previously conceived notions; they must encourage labour when they see
the profession willing, and not thwart them by showing that it will be
labour in vain. There will soon be science, if it is encouraged:

    "Sint Mæcenates, non deerunt Flacci."

If they are disposed to think investigation too minute to be practical,
or precision too unpleasant to be necessary, let them remember the
story of Professor Owen's beautiful application of minute relation, and
that the distinction between a huge common quadruped and an unknown
wingless bird could alone be discovered by particulars far more minute
than they will be called on once in a hundred times to observe or
to follow. The obligation we have already noticed has in some sense
revolutionized the practice of medicine and surgery, and is no doubt
the capital debt we owe to Abernethy; but there are many others. His
application and adjustment of the operation of the trephine was a
beautiful and discriminating achievement, and would alone have been
sufficient to have raised an ordinary reputation.

His first extension of John Hunter's operation for aneurism, shows
how ready he was—when he could do so with advantage—to enlarge the
application of that branch of our duties which he least valued—namely,
operative surgery.

His proposal to add to the treatment of the diseases of joints
the apparatus of splints, for ensuring absolute quiescence of the
affected surfaces, has saved a most incalculable number of limbs from
amputation. It here becomes necessary to repeat a remark we have made
in a former work. Sir B. Brodie recommends this plan only in the
third edition, I think, of his discriminative work on the joints, not
appearing to have been aware that Abernethy taught it for nearly thirty
years previously, about ten years of which we ourselves had repeatedly
tested its great value, and taught it, but contemporaneously from
Abernethy, in our own lectures. Indeed, so important an element is it
in the treatment of diseases of the joints, that we have never seen it
fail, when fairly applied and accompanied by a reasonable attention to
the general health, except in the following cases: First, when the
patient has been nearly worn out by disease, before being subjected to
treatment; and, secondly, where the complaint has been proved to be
accompanied by internal organic disease.

We have always thought that one of the most valuable of our obligations
to Abernethy was his lesson on fracture of the neck of the thigh bone
within the capsule of the joint. For thirty years, Sir Astley Cooper
taught, and boasted that he had taught, that this fracture could not
unite by bone; Sir Astley reasoning on the anatomy of the part _only_,
and conceiving that the neck, in its somewhat isolated position,
would be imperfectly nourished; and, seeing that, in point of fact,
this fracture _did generally_ unite by ligament only, unfortunately
adopted the foregoing idea as the _cause_ of the fact, and concluded
that bony union was impracticable. Experiments on animals—at all
times extremely fallacious, in this case singularly imperfect in the
analogy they afforded—appeared to confirm his views. Despairing of
effecting a proper union, he adopted a treatment which rendered it
impossible. Abernethy's beautiful reasoning on the subject led him to
an opposite conclusion. It embraced certain views of Hunter's, and some
common phenomena in other accidents where the union by ligament is
_coincident_ with _motion_ of the part. He therefore treated all cases
with a view to secure bony union; and he and many of his pupils had no
doubt but that they had seen examples of its success. Still, people
got well and were lost sight of, and therefore it was said that the
fracture was not _wholly_ within the capsule of the joint. At length
a specimen was procured from the examination of a dead body, and the
question set at rest, we believe, in the minds of every body, that
this fracture, though it require especial care to keep parts steady
and in apposition, will unite just like other fractures in the way
taught (and since proved) by Abernethy. Let those who can calculate the
number of surgeons who have been educated by these two gentlemen, and
who, for the first few years, would have almost certainly followed the
practice of their instructors, compute the number of those of the lame
who, under Providence, have walked in consequence of the clear-sighted
reasoning of Abernethy.

How the French surgeons may have been influenced by Abernethy on
this subject, I do not know. When I was first in Paris, in 1824, they
were divided; but I recollect Baron Larrey showing me a case which
he regarded as a clear example of this fracture in course of firm
consolidation, and he was well aware of the opinion of Abernethy.

The bearing which Abernethy's acuteness of observation of the influence
of the state of the digestive organs on so-called specific poisons in
producing or maintaining diseases resembling them, opposed as it was to
the most powerful conventionalism, is a proof of his clear judgment;
and, if we mistake not, will one day prove to have been the first
ripple of a most important law in the animal economy, which will shed
a light as new on specific affections as his other principles have on
diseases in general.

His treatment of that severe malady, "lumbar abscess," is, in our view,
a most acceptable addition to humane and successful surgery; and as
regards one of its distinctive characters, he has, as we have shown,
received the encomiums of the most distinguished of his contemporaries,
including Sir Astley Cooper.

The manner in which he applied that law which prevails in voluntary
muscles to the replacement of dislocations—namely, that muscles
under the influence of the will cannot ordinarily act long and
unremittingly—was an amendment as humane as scientific; and, whilst
it has removed from surgery a farrier-like roughness in the treatment
of dislocations, as repulsive as unnecessary, it has adjusted the
application of more sustained force, when it becomes necessary, on
principles at once humane, safe, and effectual. In short, whatever
part of surgery we consider, we should have something to say of
Abernethy—either something new in itself, or improved in application.
We find him equally patient and discriminative, wherever there is
danger; thus there is the same force and originality on the occasional
consequences on the simple operation of bleeding in the arm, and the
more serious proceeding of perforating the cranium. He is every where
acute, penetrating, discriminative, humane, and practical; so that it
is difficult which most to admire, his enlarged views in relation to
important general principles, or the pervading science and humanity
with which he invests their minutest details.

Hunter's method of investigation was highly inductive; and, whenever he
adhered to it, the structure he has left is stable, and fit for further
superadditions. Whenever he proceeded on any preconceived notions,
or on an induction manifestly imperfect, his conclusions have, as we
think, been proved unsound. His definition of disease, as distinct
from accidental injury, is one instance which we formerly noticed in
our own works; and some of his conclusions in regard to poisons—as
mercury, for example—will not hold; but all that Abernethy made use
of, either in developing his own views or maturing their practical
applications, were sound and most careful deductions from obvious and
incontrovertible facts. Abernethy took equal care to deduce nothing
from them, or from anything of his own observations, but the most
strictly logical inferences—conclusions which were, in truth, little
more than the expression of the facts, and therefore irrefragable. He
showed that, however dissimilar in kind, nervous disturbance was the
essential element of disease; and that the removal of that disturbance
was the essential element of cure. That no mode should be neglected,
therefore, which was capable of exerting an influence on the nervous
system; but that, whether he looked at the subject as mere matter of
fact, or as assisted by the phenomena of health or disease generally,
or merely to that which was _most within our power_, no more potential
disturbers of the nervous system were to be found, than disordered
conditions of the digestive organs; and that the tranquillizing of
these must always be a leading object in our endeavours to achieve the
still greater one of tranquillizing nervous disorder.

The absurd idea that he looked chiefly to the stomach—that he thought
of nothing but blue pills or alterative doses of mercury—need scarcely
detain us. His works show, and his lectures still more, that there
was no organ in the body which had not been the object of his special
attention; in almost all cases, in advance of his time; and not
exceeded in practical value by any thing now done. We know of nothing
more valuable or clear _now_ than his paper on the skin; nothing so
advanced or important as his observations on the lungs and skin, and
the relations of these important organs; and it is unnecessary to
repeat what has been already said about the digestive organs. His
medical treatment was always very simple, and, if its more salient
object was to correct disorders of the liver, it was because he knew
that the important relations of that organ not only rendered it very
frequently the cause of many disorders, but that there could be nothing
materially wrong in the animal economy, by which it must not be more
or less affected. He carried the same clearness and definiteness of
purpose into his prescriptions, as that which characterized all his
investigations; and, indisposed to employ any means except on some
principle, used but few remedies; although he by no means wished to
deter others from having recourse to a more extended pharmacopæia. We
regret, indeed, the impossibility of doing full justice to Abernethy
in any thing less than a running commentary on the publication of his
works; but we have said enough, we trust, to show how largely the
profession and mankind are indebted to him.

Now, in these days of testimonials, what memorials have we of
Abernethy? It is true there is no monument at Westminster Abbey, and
only a bust at St. Bartholomew's. His portrait, to be sure, given by
his pupils, hangs at St. Bartholomew's, exalted where it can hardly be
distinctly seen, to be replaced by those of Mr. Vincent[83], and Mr.
Lawrence in his Professor's gown! But he has still a

    "Monumentum ære perennius,"

in the claim he has established to the rarely so truly earned honour of
"nihil quod non tetigit, et nihil quod tetigit, quod non ornavit;" in
the grateful hearts of many a pupil who had no other obligation to him
than his beautiful lessons; and in an improved medical Surgery, which,
though it may have in _London_ rather retrograded than otherwise since
his time, is felt more or less in its moral as well as its medical
bearings, and in a diminution of suffering and an improved practice
throughout the civilized world.

But, if Abernethy's views are so true or so excellent as we allege that
they are, they must have _some_ relation to anything that is good in
every kind of medical or surgical treatment; and this equally, whatever
the system (so called) whence it may arise, however much of truth or
error it may contain, or however perplexingly these qualities may be
blended together. These are points on which we have yet something to
say; and as we are anxious that the public and the profession should
favour us with their attention to the very few remarks we have the
space to offer, we must have a new chapter.

[Footnote 82: See "Medicine and Surgery One Inductive Science." 1838.]

[Footnote 83: A contemporary of the Hospital, of whom, as a practical
surgeon, Mr. Abernethy expressed a very high opinion. Until the matter
was explained, Mr. Vincent's son was afraid that something "sneerlike"
was intended in this passage; and we were glad of an opportunity of
correcting that impression. Nothing could be farther from the intention
than anything of the kind in regard to either. But it seemed to us an
infelicitous result of the Governors probably having no better rule
for the disposition of their portraits than that which some of us are
obliged to observe in the shelves for our books—we mean the rule which
has twelve inches to the foot.]




CHAPTER XXXII.

      "Quæ res neque consilium neque modum habet ullum
      Eam consilio regere non potes."

      TER. Eun. Act i, Sc. i.

      "Master, the thing which hath not in itself
      Or measure or advice—advice can't rule."

      COLMAN.


POSITION, PROGRESS, AND PROSPECTS OF THE PROFESSION—OF

HYDROPATHY—OF HOMŒOPATHY—OF QUACKERY—OF PUBLIC

IGNORANCE.

A writer[84], of no ordinary judgment and discrimination, has observed,
that "it often happens in human affairs that the evil and the remedy
grow up at the same time: the remedy unnoticed, and at a distance
scarcely visible perhaps above the earth; whilst the evil may shoot
rapidly into strength, and alone catch the eye of the observer by the
immensity of its shadow; and yet," he adds, "a future age may be able
to mark how the one declined and the other advanced, and how returning
spring seemed no longer to renew the honours of the one, while it
summoned into maturity and progress the perfection of the other."

We know not how it may appear to the reader, but we cannot help
thinking that, in the foregoing sentence, there is a far-seeing
perception of a very leading character in human affairs. There is no
evil but which is charged with a certain degree of good. At first,
it is indeed "scarcely visible"—nay, it escapes alike the most
penetrative perception and faithful confidence, in the surpassing
working-to-good of all things around us; but so soon as the evil begins
to tell—so soon as the full flood of mischief becomes obtrusive or
remarkable,—the small ripple of some corrective principle rises into
view.

It would be easy to illustrate the foregoing proposition from general
history, from the progress of nations, or even from the contracted
area of individual experience. But we will confine ourselves to an
illustration more directly in relation to our immediate object—namely,
the present condition and prospects of medical science.

There are, no doubt, many persons who view the present state of
Medical Science as little better than the triumphant domination of a
conjectural art, which has long obscured, and is still very imperfectly
representing, a beautiful science; and that the perception of the
true relations which it bears to such science has been veiled by the
impression that it involved some mystery from which the general public,
who were most interested in its development, were necessarily excluded.

There have been at all times individuals, perhaps, sufficiently
astute to see the real truth of the matter; but still they were
rare exceptions, and did not prevent Mystery from conferring, on
a very considerable section of people, the social advantage of a
gainful profession; that property being enhanced, of course, in that
it ministered to an ignorant public. But, even in an early stage,
correctives to an equivocally-earned advantage began to appear; for a
thing which had no character but its indefiniteness, and its apparent
facility of acquisition, obtained many followers: the supply, such
as it was, was thus so close in relation to the demand, that what in
theory seemed necessarily very gainful, in practice, on the whole,
proved anything but a lucrative profession. As contrasted with any
other, or a variety of commercial pursuits, medical men were neither so
affluent, nor always so secure of their position. Retiring competency
in well-conducted callings has, in a rich country, been rather the
rule. We fear, in the medical profession it is the exception; which,
we are apprehensive (in its bereaved dependents), contributes more
applicants for eleemosynary relief than any other.

This surely is not a state of things which can be well made worse.
Public ignorance, the _real mischief_, has, in the meantime, been
left uninformed; and any attempt to enlighten it has too often been
branded with some kind or other of corrupt motive. Public positions
have been conferred without competition—the surest test of fitness
or excellence; and the public have been further doubly barred out,
in that the chance of eliciting men of spirit and enthusiasm has
been diminished, by the first positions having been often rendered
contingent on the payment of money in the right quarter.

But all this time corrections were slowly springing up. Hundreds were
beginning, under the light of a more liberal diffusion of general
knowledge, to feel that the so-called Science of medicine and surgery
was very different from science usually so termed; and, whilst other
sciences were affording that which was definite and positive, the
juxtaposition only seemed to bring out in higher relief the prevailing
character of conjecture and uncertainty in medicine.

People began to see that, in mere human occupation, mystery is but
mystery, to whatever it is applied; and that one man can see in the
dark about as well as another; that, where all is obscure, any one
may scramble with a chance of success. Accordingly, we observe that
a state of things has gradually been rising up, which, if it do not
justify the expression of _quot medici tot empirici_, at least leads
us to deplore that, of all callings in life, no one had ever such a
legion of parasites as are represented by the hydra-headed quackeries
which infest the medical profession. Naturally enough, too, Quackery
attacked chiefly those disorders in regard to which Mystery avowed its
incapacity, or declared to be incurable; and thus, while the regular
profession made their _own limited_ knowledge the measures of the
_powers of nature_, the quacks unconsciously proceeded, _de facto_,
more philosophically, when they neither avowed nor acknowledged any
other limits than those of observation and experience.

Amongst, no doubt, innumerable failures, and, as we know, a
multiplicity of fictions, they would now and then, in acting violently
on the various organs, blunder on the last link in the chain—the
immediate cause of the disorder; and perhaps effect the removal of a
so-called incurable malady. Thus, whilst the regular profession were
making their own knowledge the _measure_ of remedial possibility, and
were reposing contentedly on the rule, they were every now and then
undermined, or tripped up, by unexplained exceptions.

It is difficult to conceive any state of things, when once observed,
more calculated to drive men to the obvious remedy that a definite
science would alone afford; nor should it be forgotten that multiform
quackeries, with mesmerism to boot, are coincident with a system which
allows _not one single appointment_, which the public are requested to
regard as implying authority, to be open to scientific competition. Of
late, many persons have begun to examine for themselves questions which
they had been wont to leave entirely to their medical adviser.

The sanitary movement has shown that more people die every year from
avoidable causes than would satisfy the yawning gulf of a severe
epidemic, or the most destructive battle. In a crowded community, many
events are daily impressing on the heads of families, besides the
expedience of avoiding unnecessary expenses, that long illnesses are
long evils; that their dearest connections are sometimes prematurely
broken; and that parts are not unfrequently found diseased which are
not suspected to be so during life. The thought will sometimes occur
whether this may have been always consequent on the _difficulty_ of
the subject, or whether it may not have been sometimes the result of
_too hasty or too restricted_ an inquiry; that not only (as the Spanish
tutor told his royal pupil of kings) do patients die "sometimes," but
very frequently.

These and other circumstances have induced many of the public to
inquire into the reason of their faith in us; and to ask how
it happens that, whilst all other sciences are popularized and
progressing, there should be any thing so recondite in the laws
governing our own bodies as to be accessible only to comparatively few;
especially as they have begun to perceive that their interests, in
knowing such laws, is of the greatest possible importance.

Amongst various attempts to better this condition of things, the
imagination of men has been very active. Too proud to obey the
guidance, or too impatient to await the fruition, of those cautious
rules which the intellect has imposed on the one hand, and which have
been so signally rewarded (whenever observed) on the other, imagination
has set forth on airy wing, and brought home curiosities which she
called science, and observations which, because they contained _some_
of that truth of which even fancies are seldom entirely deprived,
blinded her to the perception of a much larger portion of error.

Two of these curiosities have made considerable noise, have been not a
little damaging to the pecuniary interests of the medical profession,
and have been proportionately species of El Dorados to the followers of
them. We allude to the so-called Homœopathy and Hydropathy.

Homœopathy proceeds on an axiom that diseases are cured by remedies
which excite an action similar to that of the disease itself; "_Similia
similibus curantur_."

Our objection to this dogma is twofold, and, in the few hints we are
giving, we wish them not to be confounded.

1st. It is _not_ proven.

2nd. It is _not_ true.

Take the so-called fever. The immediate and most frequent causes of
fever are bad air, unwholesome food, mental inquietude, derangement of
the digestive organs, severe injuries. Now it is notorious that very
important agents in the cure of all fevers are good air, carefully
exact diet or temporary abstinence, and correction of disordered
functions, with utmost repose of mind and body, and so forth.

So of small-pox, one of the most instructive of all diseases. All the
things favourable to small-pox are entirely opposite to those which
conduct the patient safely through this alarming disease; and so
clearly is this the case, that, if known beforehand, its virulence can
be indefinitely moderated, so as to become a comparatively innoxious
malady.

We might go on multiplying these illustrations to almost any extent.
What, then, is the meaning of the _similia similibus curantur_? This
we will endeavour, so far as there is any truth in it, to explain. The
truth is, that Nature has but one mode, principle, or law, in dealing
with injurious influences on the body. Before we offer the few hints
we propose to do on these subjects (and we can here do no more), we
entirely repudiate that sort of abusive tone which is too generally
adopted. That never can do anybody any good. We believe both systems
to be dangerous fallacies; but, like all other things, not allowed
to be entirely uncharged with good. We shall state, as popularly as
possible, in what respect we deem them to be dangerous fallacies, and
in what we deem them to be capable of effecting some good; because it
is our object to show, in respect to both, that the good they do is
because they accidentally, as it were, chip off a small corner of the
principles of Abernethy.

Homœopathy is one of those hypotheses which show the power that a
minute portion of truth has to give currency to a large quantity of
error; and how much more powerful in the uninformed are appeals to
the imagination than to the intellect. The times are favourable to
homœopathy. To some persons, who had accustomed themselves to associate
medical attendance with short visits, long bills,—a gentleman in
black, all smiles,—and a numerous array of red bottles, homœopathy
must have addressed itself very acceptably. It could not but be welcome
to hear that all the above not very pleasing impressions could be at
once dismissed by simply swallowing the decillionth part of a grain
of some efficacious drug. Then there was the prepossession so common
in favour of mystery. How wonderful! So small a quantity! What a
powerful medicine it must be! It was as good as the fortune-telling of
the gipsies. There! take that, and then you will see what will happen
next! Then, to get released from red bottles tied over with blue or red
paper, which, if they were not infinitesimal in dose, had appeared
infinite in number, to say nothing of the wholesome repulsion of the
palate.

Besides, after the bottles, came the bill, having no doubt the
abominable character of all bills, which, by some law analogous to
gravitation, appear to enlarge in a terrifically accelerating ratio,
in proportion to their longevity; so that they fall at last with an
unexpected and a very unwelcome gravity. Then homœopathy did not
restrict itself to infinitesimal doses of medicine, but recommended
people to live plainly, to relinquish strong drinks, and, in short, to
adopt what at least seemed an approximation to a simple mode of living.
To be serious—what, then, are the objections to homœpathy?

Is there no truth, then, in the dogma, "_Similia similibus curantur_?"
We will explain. The _laws_ governing the human body have an
established mode of dealing with all injurious influences, which is
identical in principle, but infinitely varied and obscured in its
_manifestations_, in consequence of multifarious _interferences_; in
that respect, just like the laws of light or of gravitation. As we
have no opportunity of going into the subject at length, we will give
a hint or two which will enable the observing, with a moderate degree
of painstaking, to see the fallacy. You can _demonstrate_ no fallacy
in a mathematical process even, without some work; neither can you
do so in any science; so let that absence of complete demonstration
be no bar to the _investigation_ of the hints we give. All medicines
are more or less poisons; that is, they have no nutritive properties,
or these are so overbalanced by those which are injurious, that the
economy immediately institutes endeavours for their expulsion, or for
the relief of the disturbance they excite. All organs have a special
function of their own, but all can on occasions execute those of some
other organ. So, in carrying out injurious influences, organs have
peculiar relations to different forms of matter; that is, _ordinarily_.
Thus, the stomach is impatient of ipecacuanha, and substances which
we call emetics; the liver, of mercury, alcohol, fat, and saccharine
matters; and so forth. In the same way we might excite examples of
other organs which ordinarily deal with particular natural substances.
But then, by the compensating power they have, they _can_ deal with
any substance on special occasions.

Now the natural mode in which all organs deal with injurious
substances, or substances which tend to disturb them, is by pouring
forth their respective secretions; but if, when stimulated, they
have not the power to do that, then they evince, as the case may be,
disorder or disease. Thus, for example: If we desire to influence the
secretion from the liver, mercury is one of _the many things_ which
will do it. But if mercury cease to do this, it will produce disease;
and, if carried to a certain extent, of no organ _more certainly_ than
the liver. Thus, again, alcohol, in certain forms, is a very useful
medicine for the liver; yet nothing, in continuance, more notoriously
produces disease of that organ. So that it happens that all things,
which in one form disorder an organ, _may_, in another form, in greater
or more continued doses, tend to correct that disorder, by inducing
there a greater, and thus exciting stimulation of its secretions.

This is the old dogma, long before homœopathy was heard of, of one
poison driving out another. This is the way in which fat bacon, at
one period, or in one case, may be a temporary or a good stimulant of
a liver which it equally disorders in another; for as the liver is a
decarbonizing agent, as well as the lungs, so articles rich in carbon
are all stimulants of that organ; useful, _exceptionally_; invariably
disordering, if _habitual_ or _excessive_.

But if this be so, what becomes of the "_curantur_?" To that, we say
it is far from proven. Medicine hardly ever—perhaps never, _strictly
speaking_—cures; but it often materially assists in putting people
in a _curable condition_, proper for the agencies of more natural
influences. True. Well, then, may not homœopathy be good here? We
doubt it; and for this reason: Medicine, to do good, should _act_ on
the organ to which it is directed; it is itself essentially a poison,
and does well to relieve organs by which _it is expelled_; but if you
give medicine in very small doses, or so as to institute an artificial
condition of _those sentinels_, the nerves, you may _accumulate a
fearful amount of injurious influence in the system before you are
at all aware of it_. And it is the more necessary to be aware of
this in respect to homœopathy; because many of the medicines which
homœopathists employ are active poisons; as belladonna, aconite,
and so on. We have seen disturbed states of nerves, bordering on
paralysis, which were completely unintelligible, until we found that
the patient had been taking small doses of narcotic poisons. We have no
desire whatever to forestall the cool decisions of experience; but we
earnestly request the attention of the homœopathist to the foregoing
remarks; and, if he thinks there is anything in them, to peruse
the arguments on which we found the law of which we have formerly
spoken[85].

We must in candour admit that, as far as the inquiry into all the facts
of the case go, as laid down by Hahnemann, we think the profession may
take a hint with advantage. We have long pleaded for more accuracy
in this respect; but we fear, as yet, pleaded in vain. Homœopathic
influences may be perhaps more successful. Practically, the good that
results from homœopathy, as it appears to us, may be thus stated: that
if people will leave off drinking alcohol, live plainly, and take very
little medicine, they will find that many disorders will be relieved by
this treatment alone.

For the rest, we fear that the so-called small doses are either inert,
or, if persisted in so as to produce effect, that they incur the risk
of accumulating in the system influences injurious to the economy;
which the histories of mercury, arsenic, and other poisons, show to be
nothing uncommon: and, further, that this tends to keep out of sight
the real uses and the _measured influences_ of medicine, which, in the
ordinary practice, their usual effects serve, as the case may be, to
suggest or demonstrate.

Practically, therefore, the effects of homœopathy resolve themselves,
so far as they are good, into a more or less careful diet, and small
doses of medicine; which, as we have said, is a chipping off of the
views of Abernethy.

We regret we have no space to consider the relation of homœopathy to
serious and acute diseases. We can therefore only say that the facts
which have come before us have left no doubts on our minds of its being
alike dangerous and inapplicable.


One morning, a nobleman asked his surgeon (who was representing to
him the uselessness of consulting a medical man without obeying his
injunctions) what he thought would be the effect of his going into a
hydropathic establishment? "That you would get perfectly well," was the
reply; "for there your lordship would get plain diet and good air, and,
as I am informed, good hours; in short, the very things I recommend to
you, but which you will not adopt with any regularity."

Hydropathy sets out, indeed, with water as its staple, and the skin as
the organ to which it chiefly addresses itself; but we imagine that the
hydropathic physician, if he sees nothing in philosophical medicine,
discovers sufficient in human nature, to prevent him from trading on so
slender a capital. There was, no doubt, in the imperfection of medical
science, a fine opening left for a scheme which proposed to rest its
merits chiefly on an organ so much neglected.

There has never been anything bordering on a proper attention to the
skin, until recently; and even now, any care commensurate with the
importance of the organ, is the exception rather than the rule. Thirty
years ago, Abernethy, when asked by a gentleman as to the probable
success of a bathing establishment, said that the profession would not
be persuaded to attend to the subject; and that, in respect to the
capital which the gentleman proposed to invest in it, he had better
keep the money in his pocket. This was said in relation to the general
importance of attention to the skin, and also in connection with
making it the portal for the introduction of medical agents generally.
Abernethy was, in fact, the first who introduced into this country
Lalonette's method of affecting the system by mercury applied to the
skin in vapour.

Hydropathy deals with a very potent agent, and applies it to a very
powerful and important organ, the skin; and it employs in combination
the energetic influences, temperature and moisture; so that we may be
assured there will be very little that is equivocal or infinitesimal in
_its_ results; that in almost every case it must do good or harm.

But it does not limit itself to these agencies. It has
"establishments;" that is to say, pleasant rural retreats, tastefully
laid-out gardens; plain diet; often, no doubt, agreeable society;
rational amusements; and, as we understand, good hours, with abstinence
from alcohol. These are, indeed, powerful agencies in a vast variety
of diseases. So that, if hydropathy be not very scientific, it is
certainly a clever scheme; and as there are very many people who
require nothing but good air, plain living, rest from their anxious
occupations, with agreeable society,—it is very possible that many
hydropathic patients get well, by just doing that which they could not
be induced to do before.

But here comes the objection: The skin is, in the first place, only
_one_ of the organs of the body, and it is in very different conditions
in different people, and in the same people at different periods.

It has, like other organs, its mode of dealing with powerful or with
injurious influences; and _if it deal with them_ in the full force
of the natural law, it affects (and, in disease, almost uniformly)
favourably the internal organs; but, on the other hand, _if there
be interfering influences opposed to the healthy_ exhibition of the
natural law, so that the skin do not deal with the cold, or other
agencies, to which it is subjected, _as it naturally should do_, then
the cold, moisture, or other agent, increases the determination of the
blood to the internal organs, and does mischief. This it may do in one
of two ways: we have seen both. 1st. The blood driven from the surface,
increases, _pro tanto_, the quantity in the internal organs: it must
go somewhere; it can go nowhere else. Or, if cold and moisture produce
not this effect, nor be attended with a reactive determination to the
surface, there may be an _imperfect_ reaction; that is, _short_ of the
surface of the body. In the first case, you dangerously increase the
disorder of any materially affected organ; in the latter, you incur the
risk of diseased depositions; as, for example, Tumours. We here speak
from our own experience, having seen tumours of the most malignant and
cancerous character developed under circumstances in which it appeared
impossible to ascribe the immediate cause to anything but the violently
depressing influence of hydropathic treatment on the skin, with a
co-existing disordered condition of internal organs.

In one very frightful case indeed, the patient was told, when he first
stated his alarm, that the tumour was a "crisis" or reaction; as sure
enough it was; but it was the reaction of a cancerous disease, which
destroyed the patient. But, as we have said, hydropathy has many
features which obviously minister very agreeably and advantageously
to various conditions of indisposition, whilst they favour the _bonâ
fide observance_ of something like a rational diet—a point of immense
consequence, and too much neglected in regular practice. Here again
we speak from actual observation. One man allows his patient to eat
what he pleases. An eminent physician replied to a patient who, as he
was leaving the room, asked what he should do about his diet, "Oh, I
leave that to yourself;" showing, as we think, a better knowledge of
human nature than of his profession. Another restricts his patient to
"anything light." Others see no harm in patients eating three or four
things at dinner, "provided they are wholesome;" thus rendering the
solution of many a question in serious cases three or four times, of
course, as difficult. Now we do not require the elaborate apparatus
of a hydropathic establishment to cure disorders, after such loose
practice as this; and we do protest against the assertion that any such
treatment can be called, as we have sometimes heard it, "Abernethy's
plan, attention to diet," and so forth.

So far from anything _less_ than the beautifully simple views held
out by Abernethy being necessary, we trust that we have, some of us,
arrived, as we ought to do, at several improvements. But people will
confound a _plain_ diet, or a select diet, with a _starving_ diet, and,
hating restrictions altogether, naturally prefer a physician who is
good-natured and assenting; still this assentation is being visited, we
think, with a justly retributive reaction.

Hydropathy, in many points, no doubt, tends to excite attention to
the real desiderata; but it is nevertheless imperfect and dangerous,
because evidently charged with a capital error. It entirely fails in
that comprehensive view of the relations which exists in all animals
between the various organs; and on a sustained recollection and
examination of which, rests the safe treatment of _any one_ of them. It
is, therefore, unsafe and unscientific. Again, it is illogical, because
it proceeds, as regard the skin, on the suppressed premise, that it
will obtain a natural reaction; a thing, in a very large number of
cases, and those of the most serious kind, seldom to be calculated on.

It is quite clear, therefore, that, so far as hydropathy does good, it
effects it by the institution of diet, abstinence from alcohol, country
air, exercise, agreeable society, and, _we_ will suppose, in some
cases, appropriate care of the surface; all of which are, in a general
sense, beneficial to the nervous system and the digestive organs—the
points insisted on by Abernethy.

So long as the Public are not better informed, and until medicine
is more strictly cultivated as a science, they will necessarily be
governed by the first impression on their feelings; and so long as
this is the case, fallacies can never be exposed, except by the severe
lessons of experience. To hope to reason successfully with those whose
feelings induce them to adopt that which they decline to examine with
their intellect, is madness, and is just what Terence says of some
other feelings:

                    "Nihilo plus agas
      Quam si des operam ut cum ratione insanias."

But, although, therefore, we are neither hydropathists nor
homœopathists, we begin to see, in the very success of these things,
some good; and that the "great shadow of the evil" of a conjectural
science will one day be replaced by another example of the triumph of
an inductive philosophy; that the retiring confidence of the public
will induce in us a more earnest and successful effort to give them
a more definite science; and that, as Professor Smythe says, the
"returning spring will no longer renew the honours of the one," whilst
it will gradually evolve the development of the other.

The efforts, too, which the profession are already making, though,
as we humbly consider, not in the right direction, will certainly
arrive in time at a path that is more auspicious. When we see the
hydropathist looking so much to the skin, homœopathy leading people to
think of _quantities_ of medicine; when, in the regular profession, we
see one man restricting his views to one organ, another to another,
a third thinking that _everything_ can be learnt only by examination
of the dead, thus confounding morbid anatomy with pathology—a fourth
_restricting_ his labours to the microscope, as if the discovery of
laws depended rather on the enlargement of sensual objects than on the
improvement of _intellectual_ vision; still we cannot but perceive
that these isolated labours, if _once concentrated by unity of purpose
and combined action_, would be shadowing forth the outline of a really
inductive inquiry.

Hydropathy and homœopathy are making powerful uses, too, of the
_argumenta ad crumenam_. Their professors are amassing very large sums
of money, and that is an influence which will in time probably generate
exertions in favour of a more definite science. Still, Medicine and
Surgery cannot be formed into a science so long as men consider it
impossible; nor can there be any material advance, if they will persist
in measuring the remedial processes of nature by their present power
of educing them—a presumption obviously infinitely greater than any
in which the veriest quack ever dared to indulge. Well did Lord Bacon
see the real difficulties of establishing the dominion of an inductive
philosophy, when he laboured so much in the first place to destroy the
influence of preconceived opinions—idols, as he justly called them.

You cannot, of course, write truth on a page already filled with
conjecture. Nevertheless, mankind seem gradually exhausting the
resources of Error: many of her paths have been trodden, and their
misleading lures discovered; and by and by that of Truth will be
well-nigh the only one left untried. In the meantime, we fear the
science is nearly good enough for the age. The difficulty of advance
is founded deeply in the principles of human nature. People know that
there are physical laws as well as moral laws, and they may rely on
it that disobedience and disease, sin and death, are as indissolubly
bound up with infractions of the one as well as the other.

It is true there are many who have (however unconsciously) discovered
that the pleasures procured by the abuses of our appetites, are a
cheat; and that permanent good is only attained by obeying those laws
which were clearly made for our happiness.

Error has, indeed, long darkened the horizon of medical science; and,
albeit, there have been lightning—like coruscations of genius—from
time to time; still they have passed away, and left the atmosphere as
dark as before. At length, however, there has arisen, we hope, a small,
but steady, light, which is gradually diffusing itself through the
mists of Error; and which, when it shall have gained a very little more
power, it will succeed in dispelling.

Then, we trust, Medicine will be seen in the graceful form in which
she exists in nature; as a Science which will enable us to administer
the physical laws in harmony with that moral code over which her
elder sister presides; but, whenever this shall happen, Surgery will
recognize, as the earliest gleams of light shed on her paths of
inquiry, in aid of the progress of science and the welfare of mankind,
the honoured contributions of John Hunter and John Abernethy.

[Footnote 84: Professor Smythe, Lectures on Modern History, vol. i, p.
74.]

[Footnote 85: See "Medicine and Surgery One Inductive Science" (the
so-called Law of Inflammation).]




CHAPTER XXXIII.

      "Eheu fugaces Postume Postume
      Labuntur anni: nec pietas moram
      Rugis et instanti senectæ
      Adferet, indomitæque morti."

      HOR.

      "How swiftly glide our flying years,
      Alas! nor piety, nor tears,
        Can stop the fleeting day;
      Deep-furrow'd wrinkles, frosting age,
      And Death's unconquerable rage,
        Are strangers to delay."

      FRANCIS.


We have already observed that Abernethy had begun to feel the wear and
tear of an anxious and active life, when, after a tenure of office
for twenty-eight years as assistant, he was appointed surgeon to St.
Bartholomew's Hospital. After a few years, he took a house at Enfield,
where he occasionally went at leisure hours, on Wednesday and Saturday;
and, as the Spring Course of Lectures came near to a conclusion, and
in the summer, sometimes on other afternoons. At this season, he had
been accustomed to doff the black knee-breeches, silk stockings, and
shoes, sometimes with, sometimes without, short gaiters, and refresh
one's rural recollections with drab kerseymeres and top-boots; in which
costume he would at that season not unfrequently come down to lecture.
He was fond of riding, and had a favourite mare he called Jenny; and
many a time have we seen her jogging along on a fine summer afternoon,
and her master looking as happy as any schoolboy that he was escaping
from the botherations of Bedford Row and the smoke of London. Jenny was
a favourite mare, which Abernethy had for nearly twenty-five years. She
was a great pet, and her excellent qualities had been associated with
almost every little excursion of relaxation or pleasure. All things,
however, must have an end. At last, the poor animal became affected
with a kind of rheumatism, attended with much suffering. After various
hesitations, the pain of which those who are fond of animals can very
well understand, the order was given that she should be destroyed. This
took place in the stables behind Bedford Row. The family were all in
one apartment, except Mr. Abernethy, who was heard pacing up and down
his private room. A short pause, and the coachman is seen running from
the stable to say that Jenny was no more. One of his daughters ran to
Mr. Abernethy's room to say, "it is all over, papa." "Good girl," said
he, patting her head, "to come and tell me so soon." He is said to have
suffered greatly on this occasion.

Some years before this, he met with what might have been a serious
accident: in stooping forward, his horse threw up his head and struck
him a violent blow on the forehead and nose; as Mr. Abernethy first
thought, breaking the bones of the latter. He rode up a gateway, and,
having dismounted, was endeavouring to adjust the bruise and staunch
the blood, when some people ran to assist him, and, as he said, very
kindly asked him if they should fetch him a doctor; "but," said
Abernethy, "I told them I thought they had better fetch me a hackney
coach," which they accordingly did. He was conveyed home, and in a
short time recovered from the accident.

His taking the house at Enfield was probably a prudent measure; he
seemed to enjoy it very much, and especially in getting a quiet friend
or two down on a Saturday to stay over till the Monday; amongst whom, a
very favourite visitor was our respected friend Mr. Clift, of whom we
have already spoken. Abernethy had always, however, had what he used
aptly enough to term a fidgetty nervous system. From early life he had
been annoyed by a particularly irritable heart. The first time he ever
suffered materially from it was while he was yet a young man. He had
been exceedingly depressed by the death of a patient in whose case he
had been much interested, and his heart became alarmingly violent and
disordered in its action. He could not sleep at night, and sometimes
in the day it would beat so violently as to shake his waistcoat. He
was afterwards subject to fugitive returns of this complaint, and few,
unless by experience, know how distressing such attacks are.

We suspect that surgeons are more frequently thus affected than is
generally supposed. A cold, half-brutal indifference is one thing, but
a calm and humane self-possession in many of our duties is another,
and, as we saw in Cheselden, not obtained always without some cost;
the effects of this sometimes appear only when the causes have ceased
to recur, or are forgotten. A lively sensibility to impressions was
natural to Abernethy; but this susceptibility had been increased by
the well-known influence of the air and excitement of crowded cities
on people who are engaged in much mental exertion. His physical
organization, easily susceptible of disturbance, did not always shake
it off again very readily. At one period he suffered an unusually long
time from the consequences of a wound in dissection.

These not uncommon accidents occur perhaps a hundred or a thousand
times without being followed by any material results; but, if they
happen in disordered conditions of health, either of mind or body,
they are sometimes serious affairs, and usually of a more or less
active kind—that is, soon terminating in death or recovery. Not so in
Abernethy. The complaint went through various phases, so that it was
nearly three years, he used to tell us, before he fairly and finally
got rid of the effects of it. One of the most difficult things for a
man so actively engaged in a profession in London as was Abernethy,
is to get the requisite quantity of exercise; whilst the great mental
exertion which characterizes a London, as distinguished from almost any
other kind of life, requires that the digestive organs should be "up
to" pretty good living.

Then, again, Abernethy lived in the days of port wine; when every
man had something to say of the sample his hospitality produced of
that popular beverage. Abernethy, who was never intemperate, was very
hospitable, and always selected the finest port wine he could get,
which, as being generally full and powerful, was for him perhaps the
least fitted.

Mr. Lloyd, of Fleet Street, who was one of the old-fashioned family
wine-merchants, and one of the best men of his day, was the purveyor
of his Falernian; never was there a more correct application of
nomenclature than that which gave to him the title, by which he was
best known, of "Honest John Lloyd." He was one of the kindest-hearted
men I ever knew: he had a great regard for Mr. Abernethy; and was
treated himself by almost everybody as an intimate friend. One day I
went there just as Abernethy had left. "Well," says Mr. Lloyd, "what
a funny man your master is!" "Who?" said I. "Why, Mr. Abernethy. He
has just been here, and paid me for a pipe of wine; and threw down a
handful of notes and pieces of papers with fees. I wanted him to stop
to see if they were right, 'for,' said I, 'some of these fees may be
more than you think, perhaps.' 'Never mind,' said he; 'I can't stop;
you have them as I took them,' and hastily went his way."

Sedentary habits, however, as people now begin to find, do not
harmonize well with great mental exertion, or constant and anxious
occupation. In 1817, Abernethy felt his combined duties as surgeon to
the hospital, as lecturer there, and also at the College, becoming too
onerous, and therefore in that year resigned the Professorship. On this
occasion, the Council sent him the following unanimous expression of
their appreciation of his services.

  "At the Court of Assistants of the Royal College of Surgeons in
  London, holden at the College on the 15th day of July, 1817;

  "Resolved unanimously:

    "That the thanks of this Court be presented to John Abernethy,
    Esq. for the series of Lectures delivered by him in the theatre
    of this College, in the years 1814, 1815, 1816, 1817, with
    distinguished energy and perspicuity, by which he has elucidated
    the physiological and pathological opinions of John Hunter,
    explained his design in the formation of the Hunterian Collection,
    illustrated the principles of surgery, and thereby has highly
    conduced to the improvement of anatomical and physiological
    knowledge, the art and science of surgery, and to the promotion of
    the honour of the College."

This seems to have gratified him, as, under all circumstances, we can
readily understand it might do; and he accordingly replied to it as
follows:

  "TO THE MASTER, GOVERNORS, AND COUNCIL OF THE ROYAL
  COLLEGE OF SURGEONS.

  "Sir and Gentlemen,

    "To obtain the good opinion of others, is a universal object of
    human actions; and we often strive to acquire it by circuitous
    and absurd means; but to obtain the approbation of eminent and
    judicious characters, by pursuing the direct path of professional
    duty, is the most gratifying mode of seeking and receiving this
    object of general ambition.

    "I have ventured to premise these observations, to show you,
    gentlemen, that I do not write inconsiderately, or merely as a
    matter of form, when I thus return you my warmest thanks for the
    distinguished honour you have conferred on me by your public
    approbation of my _endeavours_[86] to discharge the duties of an
    arduous office, to which I was elected through your kindness and
    confidence.

  "I have the honour to remain,
  "Sir and Gentlemen,
  "Your very grateful and obedient servant,
  "JOHN ABERNETHY."

We insert in this place a letter which he wrote about this time to Sir
William Blizard; because it shows two things which are characteristic:
the one, how constant he was in not allowing any considerations to
interfere with the lectures; and the other, the endurance of his old
attachment to Sir William Blizard. It is an apology for not having been
present at the Council.

  "Dear Sir William,

    "I was yesterday desired to see a patient residing seven or eight
    miles from London. I could not go that day, for it was lecture
    evening; I cannot go to-morrow for the same reason; consequently I
    must go this evening. I hope you will consider these circumstances
    as an apology for my _absence_ from the Board.

    "If you cite my example as one misleading future Professors, be so
    good as to remember that I retired, leaving the task which I had
    undertaken incomplete, wherefore it became necessary to _explain
    publicly_ to an indulgent audience my _motives_ for resigning the
    Professorship.

  "I remain, dear Sir William,
  "Yours unremittingly,
  "JOHN ABERNETHY."

Abernethy had at various periods of his life been subject to an
inflammatory sore throat of a very active kind, which would on some
days impede so as almost to prevent his swallowing, and then suddenly
terminate in abscess, leaving him perfectly well again. He was young
when these sorts of attack began; for in his lectures he used to speak
of one of them having subsided only the night before he had some
lectures to deliver before the Council of the College, when they were
accustomed to meet in the Old Bailey.

As he advanced in life, the disposition to disorder of the digestive
organs, which had hitherto shown a tendency to terminate in
inflammation of the mucous membrane of the throat, began to affect
other structures; and he became teazed and subsequently greatly
tortured by rheumatism. The disorder so termed (a kind of general name
for various conditions of disorder very different from each other, and
which occasionally affect, not only joints, but other structures) is
in many cases, as we all know, extremely painful; and is never more
excruciating than when muscular parts thus conditioned are affected by
spasm. These spasms were a source of much acute suffering to Abernethy.
His constant occupations gave him no opportunity of relieving himself
from work, except there was that accommodation of indisposition to
convenient times, which of course seldom happens.

In the early parts of his life, Abernethy, when he was out of health,
would take the first opportunity which his occupations allowed of going
a little way into the country; and there, by diet, and amusing himself
by reading and exercise, he would soon get well. But as he advanced
in life, he was not so ready to attend to himself as perhaps he ought
to have been. Besides, he would occasionally do things which incurred
unnecessary risks, which we ourselves have sometimes ventured to
mention to him.

Living, at the time to which we are now alluding, in Ely Place, and
attending his lectures long after we had commenced practice, we
frequently walked down with him to lecture; sometimes in the rain,
when we used to think his knee-breeches and silk stockings looked most
uncomfortable. Besides this, he was very careless about his umbrella;
I never recollect him on such occasions calling a coach, and I hardly
ever knew him come down to his evening lecture in his carriage. He
generally came to the two-o'clock lecture some minutes before the time;
and, as he often complained of cold feet, he would stand opposite one
of the flue openings in the Museum. One day, I ventured to suggest to
him that the transition of temperature to the cold place he occupied in
the theatre rendered this hardly prudent, when he said, "Ay!" and moved
away. Though temperate, without being very particular in his diet,
these other imprudences were unfortunate; because we saw him, every
year almost, becoming troubled more and more by his painful visitor.
The time, however, was now arriving when he was about to resign the
Surgeoncy of the hospital.

We have seen that, when elected to that appointment, he had been no
less than twenty-eight years assistant surgeon; he, however, took no
pains to indemnify himself for this long and profitless tenure of
a subordinate post; but, mindful of what he had himself suffered,
immediately on his appointment he did the best he could at once to
provide against others being subjected to such an unrequited service.
He accordingly, on his election, addressed a letter to the Governors of
the Hospital, of which, when the first edition went to press, we had
no copy. As we then stated, our friend, Mr. E. A. Lloyd, a friend and
favourite pupil of Abernethy's, had found one, and kindly laid it aside
for us; but he unfortunately again mislaid it; and there is no copy of
it on the books of the hospital. Subsequently, Mr. Pettigrew has most
kindly sent us a volume containing the letter in question. To us it is
a very interesting document; but as we had already mentioned the most
important fact in it, we have not thought it necessary to reprint the
letter. We must not fail to repeat publicly our thanks to Mr. Pettigrew
for his kind assistance.

The object of the letter was to recommend some alteration in the
arrangement of the duties of the surgeons of the hospital; and, amongst
other things, that they should resign at the age of sixty, with a
retiring salary. Nothing could, we think, be more just or considerate
than such a proposal; and it came very well from Abernethy, who had
just stepped into the lucrative appointment. The proposal, however,
was not acted upon; and it would appear that his successors, however
much they may have at the time approved of the precept, have not been
in haste to follow the example. There is little doubt that Abernethy's
proposal was as just and considerate of the interests of all parties,
as it was in favour of those of science. We cannot think that any one,
who considers the whole subject without prejudice, will arrive at any
other conclusion.

The absence, however, of any law on the subject, made no difference
to Abernethy; he had expressed his own intention of resigning at
the age of sixty; and when that time arrived, he accordingly did
so. The Governors, however, would not, on that occasion, accept his
resignation, but requested him to continue. This he did for about
another year, when, in 1827—having been elected in 1815,—he finally
resigned the hospital, in the following letter, addressed to the
President of the Hospital:

  "St. Bartholomew's Hospital,
  "July 24, 1827.

    "Finding myself incompetent to discharge the duties of surgeon to
    your Hospital in a satisfactory manner, and having led my junior
    to believe that I should resign my office at a certain period of
    my life, I hereby tender my resignation accordingly. At the same
    time, I beg leave to assure the Governors of my gratitude for their
    appointment to the offices which I have held under them, and for
    the good opinion and confidence which they have manifested towards
    me. I annex a draft for £100 for the use of the Hospital.

  "I am, dear Sir,
  "Your obedient servant,
  "JOHN ABERNETHY."

  "To Rowland Stephenson, Esq."

At the next meeting of the "Court" of Governors, it was proposed by Dr.
Latham, seconded by Mr. Wells, and unanimously resolved:

    "That this Court accept, with great regret, the resignation of Mr.
    Abernethy as one of its Surgeons, an office which he has discharged
    with consummate ability for forty years; and the Court offers him
    their best, their most unanimous, and warmest thanks for his very
    long and important services.

  "July 25, 1827."

There is something significant in this vote of thanks, merging his long
period of assistant surgeon in the general expression of his services
as surgeon. It is very suggestive of the influence which had been felt
from the presence of his master mind, although so long in a position
which necessarily restricted its useful energies in regard to hospital
matters. We have little doubt that, had Abernethy become surgeon to the
hospital at a time of life when his physical energies were unimpaired,
he would have suggested many improvements on the system; but, with
little real power in this respect, and with men who were opposed to
him, he was just the last man in the world to commence a crusade
against the opinions of those with whom he was associated. The moment
he became surgeon, we see him endeavouring to remove an evil from which
he had greatly suffered, and which is obviously a most undesirable
state of things; namely, that men should so often arrive at a post
in which their active energies are most required, at a time of life
when those energies have been, perhaps, necessarily addressed to other
objects, have become weary with hope deferred, or already on the wane.

He was, also, very averse to so spacious a portion of the hospital
being devoted to the festive meetings of the Governors; and, on showing
it, would sometimes go so far as to say—"Ay, this is what I call the
useless portion of the hospital." He continued to lecture another year,
when he resigned the lectures; and, in 1829, his appointment at the
College of Surgeons also.

In May, 1829, he wrote to Mr. Belfour, the Secretary of the College of
Surgeons (whose politeness and attention in facilitating our inquiries
at the College we are happy thus publicly to acknowledge), as follows:

  "My dear Sir,

    "Early in April, the thermometer was above 70°, and I had so
    violent a relapse of rheumatism, that I have not been able (nor
    am I now able) to leave this place since that time. Apologize to
    the President, therefore, for my non-attendance on Monday. _Entre
    nous_: as I think I shall not be able to perform the duties of
    those situations which I now hold at the College, I think of
    resigning them; yet I will not decide till I have talked with
    Clift[87] upon it. If he could come down this or the following
    Saturday, I should be glad to see him.

  "I remain, my dear Sir,
  "Yours very sincerely,
  "JOHN ABERNETHY.

  "Enfield, May 21.
  "To Edmund Belfour, Esq."

He accordingly, in July of 1829, resigned his seat at the Court of
Examiners, when the following Memorial was sent him by the Court of
Examiners:

    "At the College, at the Court holden on Friday, the 17th of July,
    1829:

    "Present: Mr. Thomas, President; Mr. Headington, Mr. Keate,
    Vice-Presidents; Sir William Blizard, Mr. Lynn, Sir A. Cooper,
    Bart., Sir A. Carlisle, Mr. Vincent, and Mr. Guthrie:

    "Resolved, that the following Memorial be entered in the minutes of
    this Court:

    "Conscious of having been enlightened by the scientific labours
    of Mr. Abernethy; convinced that teachers of anatomy, physiology,
    and of surgery (and consequently their pupils), have derived
    most important information from these sources of knowledge; and
    impressed that the healing art has been eminently advanced by the
    writings of that excellent individual; the Members of the Court
    of Examiners lament the tendered resignation of an associate
    so endowed, and whose conduct in the Court has always been so
    exemplary.

    "Resolved also, that a copy of the foregoing Memorial be delivered
    by the Secretary to Mr. Abernethy."

He had by this time become a great sufferer—walked very lamely; and
this difficulty, interfering more than ever with his exercise, no doubt
tended to make matters worse. He consulted nobody, I believe, but his
old friend Dr. Roberts, of St. Bartholomew's. He was induced to go for
some time into the country; and on his return, hearing that he was
again in Bedford Row, and not having seen him for some time, I called
on him one morning, about eleven o'clock.

I knew that he had been very ill; but I was not in the least prepared
to see him so altered. When I was shown into his room, I was so
struck with his appearance, that it was with difficulty I concealed
the emotion it occasioned; but I felt happy in observing that I had
succeeded.

He appeared, all at once as it were, to have become a very old man;
he was much thinner; his features appeared shrunk. He had always
before worn a good deal of powder; but his hair, which used to hang
rather thickly over his ears, was now thin, and, as it appeared to me,
silvered by age and suffering.

There was the same expressive eye which I had so often seen lit up
by mirth or humour, or animated by some more impassioned feeling,
looking as penetrating and intellectual as ever, but with a calmness
and languor which seemed to tell of continued pain, and which I had
never seen before. He was sitting at a table, on a sort of stool, as
it appeared to me, and had been seeing patients, and there were still
several waiting to see him. On asking him how he was, his reply was
very striking.

It was indeed the same voice which I had so often listened to with
pleasure; but the tone was exceedingly changed. It was the subdued
character which is expressive of recent suffering, and sounded to me
most mournfully. "Ay," say he, "this is very kind of you—very kind
indeed!" And he somewhat distressed me by repeating this several times,
so that I hardly knew what to reply. He said he was better, and that he
could now walk pretty fairly again, "as," said he, "you shall see."

He accordingly slowly dismounted from his seat, and, with the aid of
two sticks, began to walk; but it was a melancholy sight to me. I had
never seen him nearly so lame before.

I asked him what he was going to do. He said he was going to Enfield
on the morrow, and that he did not think he should return. I suggested
that he might possibly try a drier air with more advantage; that I
feared Enfield might be a little low and damp, and not, possibly, the
best place for him. "Well," he said, "anything is better than this."
I very shortly after took my leave; not sorry to be again alone; for
I felt considerably depressed by the unexpected impressions I had
received from this interview. It was too plain that his powers were
rapidly waning. He went to Enfield on the following day (a Wednesday, I
think), and never returned again to practice. He lingered about another
year, during which time I once went to see him, when I found him
something better. He was able to see his friends occasionally, and at
times seemed to rally. In the spring, however, of 1831, he gradually
got weaker, and died on the 20th of April in that year.

He perfectly retained his consciousness to the last, and died as
tranquilly as possible. In exhausted conditions of the body, persons
will sometimes linger much longer than the medical attendant had
considered possible; in other cases, the flickering lamp becomes
extinguished many days before they had been apprehensive of immediate
danger. The latter was the case with Mr. Abernethy. Dr. Roberts had
just been to see him; and the family, who scarcely ever left him,
had followed the Doctor down into the dining room, anxious to hear
his report. This, although it gave them no hope as to the ultimate
result, expressed no apprehension of immediate danger. On returning to
Mr. Abernethy, but a few minutes had elapsed when he gently laid his
head back and expired; but with such entire absence of any struggle,
alteration of countenance, or other indication, that for a short time
it was difficult to realize the fact that he was no more. His body
was not examined; but, from the history and symptoms of his case,
there could be little doubt that there would have been found organic
changes, in which the valvular structures of the heart had more or less
participated.

He was buried in the parish church of Enfield. The funeral was a
private one; and there is a plain tablet on the wall over his vault,
with the following inscription:

                               H. S. E.

                     JOHANNES ABERNETHY, R. S. S.
              REGII CHIRURGORUM COLLEGII QUONDAM PRÆSES,
                  QUI INGENIO, PROBITATE, BENIGNITATE
                            EXIMIE PRÆDITUS
                   ARTEM MEDICAM PER ANNOS PLURIMOS,
              SUMMA CUM DILIGENTIA, SOLERTIA, FELICITATE
                   COLUIT, EXERCUIT, DOCUIT, AUXIT,
                 ET SCRIPTIS HOC MARMORE PERENNIORIBUS
                         POSTERITATI TRADIDIT,
                   MORBO DEMUM GRAVISSIMO CONFECTUS
                  CUJUS ANGORES HAUD ALITER DOMANDOS
                    PIO ET CONSTANTI ANIMO SUBEGIT.
                 CONJUGI, LIBERIS, AMICIS, DISCIPULIS,
               HUMANO GENERI, CUI TANTOPERE SUCCURRERAT
                               FLEBILIS,
              APRILIS DIE 20, A. D. 1831, ÆTATIS SUÆ 67.
                    PLACIDE IN CHRISTO OBDORMIVIT.

[Footnote 86: Underscored in the original.]

[Footnote 87: Our excellent Conservator at that time, of whom we have
already spoken, and a great favorite of Abernethy's.]




CHAPTER XXXIV.

    "It is as much commendation as any man can bear, to own him
    excellent; all beyond it is idolatry."—DRYDEN.


It has been stated by an acute observer that it was impossible for
any man to be with Abernethy, even for a short time, without feeling
that he was in communion with no common mind; and it was just, I
think, the first effect he produced. In person, he was of middle
stature, and well proportioned for strength and activity. He had a most
interesting countenance; it combined the character of a philosopher and
a philanthropist, lighted up by cheerfulness and humour. It was not
that his features were particularly well formed or handsome, though
there was not a bad one in the whole countenance; but the harmony of
composition (if we may be allowed the expression) was so perfect.

A sufficiently high and ample forehead towered over two of the most
observant and expressive eyes I almost ever saw. People differ about
colour; they appeared to me always of a greyish-blue, and were
characterized as the rule by a mirthful yet piercing expression, from
which an overlaying of benevolence was seldom wanting; yet, as we have
before observed, they would sometimes launch forth gleams of humour,
anger, or pathos, as the case might be, which were such as the term
dramatic can alone convey.

There was another expression of his eye which was very characteristic;
it was when his benevolence was excited without the means of gratifying
it, as would sometimes happen in the case of hospital patients, for
whom he wanted good air, and things which their position did not
allow them to procure. He would in this case step a pace or two from
the bed, throw his head a little aside, and, talking to the dresser,
exhibit an expression of deep feeling which was extremely peculiar; it
was a mixture of suffering, of impatience, and sympathy; but the force
which the scene drew from the dramatic character of his expressive
countenance is entirely lost in the mere relation. If, at such times,
he gave utterance to a few words, they were always extremely touching
and expressive. On an occasion, for example, like the following, these
characters were combined. A woman came into the hospital to have an
operation performed; and Abernethy, as was his invariable custom, took
some time to get her health into a more favourable condition. When the
day for the operation was at hand, the dresser informed him that she
was about to quit the hospital.

"Why, my good woman," said Abernethy, "what a fool you must be to come
here to have an operation performed; and now, just as you are in a fit
state for it, to go out again." Somebody here whispered to him that her
father in the country "was dying." With a burst of indignation, his
eyes flashing fire, he turned to the dresser, and said: "You fool, why
did you not tell me this before?" Then, after a moment or two looking
at the patient, he went from the foot up to the side of the bed, and
said in the kindest tone possible: "Yes, my good woman, you shall go
out immediately; you may come back again when you please, and I will
take all the care I can of you."

Now there was nothing in all this, perhaps; but his manner gave it
immense force. And I remember one of the old pupils saying to me: "How
kind he was to that woman; upon my soul, I could hardly help crying."

Abernethy exemplified a very rare and powerful combination of
intellectual qualities. He had a perception of the facts of a subject
at once rapid, penetrating, and comprehensive, and a power of analysis
which immediately elicited those relations which were most important to
the immediate objects of the investigation; a power, of course, of the
utmost value in a practical profession.

This faculty was never more marvellously displayed than sometimes in
doubtful or difficult cases; and this had been always a striking
excellence in him, even when a young man. I recollect hearing my
father say, that to see Abernethy to advantage, you must observe him
when roused by some difficulty, and in a case where other men were
at fault, or puzzled. It was just so; his penetrating mind seemed to
remove to either side at once what was foreign or doubtful, and go
straight to the point with which alone he had to grapple. Allied to
this, if not part of it, was that suggestive power which he possessed
in so remarkable a degree, and which by a kind of intuition seemed
to single out those pertinent relations and inquiries which the
judgment is to examine, and reject, or approve, as the case may be; a
faculty absolutely necessary to success in endeavours at extending the
boundaries of a science. He was thus sometimes enabled, as has been
shown, to convert facts to the highest purposes, in aid of practical
improvement, which, with an ordinary observer, would have passed
unnoticed.

These qualities, combined with a memory, as we have seen, peculiarly
ready, capacious, and retentive, placed his resources at once at
hand for practical application. Then, while his quick perception of
relation always supplied him with abundant analogies, his imaginative
faculty enabled him to illustrate, enforce, and adorn them with such a
multitude and variety of illustration as seemed well-nigh inexhaustible.

Of his humour we have already spoken; but the same properties which
served him so well in more important matters were really, as it appears
to us, the foundation of much of that humour by which his conversation
was characterized—we mean his quick perception of relation, and his
marvellously retentive memory. Many of the things that he said, "told,"
not because they were original, so much as that they were ready at
hand; not because they were intrinsically good, as so apposite in
application; and, lastly, because they were further assisted by his
inimitable manner. Nevertheless, sometimes his quick perception would
be characterized by a corresponding felicity of expression. Bartleman
was an intimate friend of Abernethy's; and those who remember the
magnificent voice and peculiarly chaste style of that celebrated
singer, will appreciate the felicity of the expression applied to him
by Abernethy, when he said, "Bartleman is an orator in music."

Abernethy had the talent of conveying, by his manner, and apparently
without the smallest effort, that which in the drama is scarcely known
but as the result of constant and careful study. It was a manner
which no analysis of his character can convey, of which none of his
own compositions even give an adequate idea. The finest colours are
often the most fugitive. This is just the case with that heightened
expression which we term dramatic. Who can express in words the
thrilling effect that an earnest, heartfull delivery of a single phrase
has sometimes conveyed. But brilliant as these endowments were, they
were graced by moral qualities of the first order.

Quick as he was to see everything, he was necessarily rapid in his
perception of character, and would sometimes at a glance hit on the
leading influence of this always difficult assemblage of phenomena,
with the same rapidity that marked his dealings with facts which were
the more usual objects of his inquiries. But, though quick in his
perception of character, and therefore rapidly detective of faults, his
views were always tempered by generosity and good sense. Indignant at
injustice and oppression, and intolerant only of baseness or cruelty,
he was kind and charitable in his construction of more common or
excusable failings.

He loved man as his brother, and, with enlarged ideas of the duties of
benevolence, never dispensed it as a gift which it was creditable to
bestow, so much as an obligation which it would have been immoral to
have omitted. It was not that he did anything which the world calls
noble or great in giving sums of money to this or that person. There
were, indeed, plenty of instances of that sort of generosity and
benevolence, which would creep out, in spite of him, from those whom he
had benefited; and no man knew how to do it better. A gentleman, for
example, came up from the country to the school, and went to Bedford
Row, to enter the lectures. Abernethy asked him a few questions about
his intentions and his prospects, and found that his proceedings would
be little doubtful, as they were contingent on the receipt of some
funds which were uncertain. Abernethy gave him a perpetual ticket
to all his own lectures. "And what made so much impression on me,"
said the gentleman, "was, that instead of paying me less attention,
in asking me to his house, than the other pupils, if there were any
difference, he paid me rather more." We have seen this gentleman within
a few days, and we are happy to say he has had a happy and prosperous
career.

The benevolence, however, to which we allude, was not merely shown
in giving or remitting money; that, indeed, would be a marvellous
overcoming of the world with many people, but not with Abernethy;
his benevolence was no fitful suggestion of impulse, but a steadily
glowing principle of action, never obtrusive, but always ready when
required. It has been said, "a good man's life is a constant prayer."
It may be asserted that a good surgeon's life should be a gentle
stream of benevolent sympathies, supporting and distributing the
conscientious administration of the duties of his profession. That this
really intrinsic part of his character should have been occasionally
overlaid by unkindness of manner, is, indeed, much to be regretted;
and, we believe, was subsequently deplored by no one more sincerely
than himself, and those who most loved and respected him. The faults
of ordinary acquaintances are taken as matters of course; but the
errors of those who are the objects of our respect and affection, are
always distressing. We feel them almost as a personal wrong; and, in a
character like Abernethy, where every spot on so fair a surface became
luminously evident, such defects gave one a feeling of mortification
which was at once humiliating and oppressive. But, whilst we are the
last to conceal his failings, we cannot but think he was, after all,
himself the greatest sufferer; we have no doubt they originated, at
least, in good motives, and that they have been charged, after all,
with much good.

Unfortunately, we have at all times had too many Gnathos in our
profession, too much of the

      "Quidquid dicunt laudo, id rursum si negant, laudo id quoque.
      Negat quis? nego. ait? aio."

These assenting flatterers are the bane of an honest man, and, under
the name of tact and the influence of an uncompromising ambition to
get on, merge the highest duties into a mere desire to please; and,
adopting the creed of Gnatho, appropriately arrive at the same climax
as their conclusion:

              "Postremo imperavi egomet mihi
      Omnia assentari."

Now, Abernethy knew this well, and detested it with a repulsion deep
and sincere. He had no knowledge of Gnathonics. He felt that he was
called on to practise a profession, the legitimate object of which
was alone achieved when it ministered to real suffering; and that
mere assentation to please patients was a prostitution of the highest
qualities of mind to the lowest purposes. If one may so say, he felt
like a painter who has a feeling for the highest department of his art,
and who could see nothing in an assenting Gnathonicism but an immoral
daub.

Neither was this without use to others; for though he looked, as the
public may be assured many others have done, on a "parcel of people
who came to him with nothing the matter," yet even in his roughness he
was discriminate, and sometimes accomplished more good than the most
successful time-server by all his lubricity. One day, for example, a
lady took her daughter, evidently most tightly laced—a practice which
we believe mothers now are aware is mischievous, but scarcely to the
extent known to medical men. She complained of Abernethy's rudeness to
her, as well she might; still he gave her, in a few words, a useful
lesson. "Why, madam," said he, "do you know there are upwards of thirty
yards of bowels squeezed underneath that girdle of your daughter's? Go
home and cut it, let Nature have fair play, and you will have no need
of my advice."

But, if we must acknowledge and regret, as we do, his occasional
rudenesses of manner, let us also give him the credit of overcoming
these besetting impulses. In all hospitals, of course, there are
occasional vexations; but who ever saw Abernethy really unkind to
a hospital patient? Now, we cannot affirm any thing beyond our own
experience. We had, as dresser, for a considerable period, the care
of many of his patients, and we continued frequently to observe his
practice from the commencement of our pupilage, which was about a year
or a little more after his appointment as surgeon, until the close of
his hospital labours. We speak subject to correction, therefore, but
we cannot charge our memory with a single instance of unkindness to
a hospital patient; whilst we are deeply impressed by the constant
prevalence of a generally kind and unaffected sympathy with them.

The quickness with which he observed any imperfection in the execution
of his directions, was, on the contrary, the source of many a "rowing,"
as we apprehend some of his dressers well enough remember; whilst he
seldom took a dresser without making more than usual inquiries as
to his competency. In private practice, also, any case that really
required skill and discrimination was pretty sure to meet with the
attention that it deserved. This was noticed in the remarks made on
the character of Abernethy, at the time of his death, by the Duke of
Sussex, at the Royal Society, at their anniversary meeting on the 30th
of November, 1831, of which the following is a report, copied from the
books of the Society:

    His Royal Highness observed that "Mr. Abernethy was one of those
    pupils of John Hunter who appears the most completely to have
    caught the bold and philosophical spirit of his great master. He
    was the author of various works and memoirs upon physiological
    and anatomical or surgical subjects, including papers which have
    appeared in our Transactions. Few persons have contributed more
    abundantly to the establishment of the true principles of surgery
    and medical science in those cases which require that minute
    criticism of the symptoms of disease, upon the proper knowledge and
    study of which the perfection of medical art must mainly depend.

    "As a lecturer, he was not less distinguished than as an author;
    and he appears to have attained the art of fixing strongly
    the attention of his hearers, not less by the just authority
    of his opinions than by his ready command of apt and forcible
    illustrations. He enjoyed, during many years of his life, more
    than an ordinary share of public favour in the practice of
    his profession; and, though not a little remarkable for the
    eccentricities of his manner and an affected roughness in his
    intercourse with his ordinary patients, he was generally kind and
    courteous in those cases which required the full exercise of his
    skill and knowledge, and also liberal in the extreme when the
    infliction of poverty was superadded to those of disease."

The high character of his benevolence was shown also in the ready
forgiveness of injuries; and he was as grateful as he was forgiving.
How constant his attachment to his early friend and teacher, Sir
William Blizard. There is something very characteristic of this, when,
in the decline of life, he writes "Yours unremittingly," to one whose
unusually lengthened years had enabled him to witness Abernethy's entry
into life, and, at the conclusion of the labours of his distinguished
pupil, to join with a public body in expressing the high sense
entertained of the obligations which he had conferred on science and
mankind. Few men could have been placed in positions more trying than
that in which he found himself in his controversy with Mr. Lawrence.
When the time arrived at which, in the ordinary course, that gentleman
would have been elected into the Council of the College, there was a
very strong feeling on the part of some of the members against his
admission. Abernethy, however, proposed him himself, and it was by his
casting vote that the election terminated in Mr. Lawrence's favour.

A member of the Council having expressed his surprise that Mr.
Abernethy should propose a gentleman with whom he had had so unpleasant
a difference—"What has that to do with it?" rejoined Abernethy. Some
friends of Mr. Lawrence wished to pay that gentleman the compliment of
having his portrait drawn, and a subscription was to be entered into
for this purpose. It was suggested that it would be very desirable to
get Mr. Abernethy to allow his name to be in the list; and our friend,
Mr. Kingdon[88], with the best intentions no doubt, ventured to ask
Mr. Abernethy to put his name at _the head_ of the list. But there was
nothing of Quixotism in Abernethy. He would have been very glad to do
a kind thing to anybody; and any obstacle affecting him personally
was much more likely to be an argument in favour than otherwise. He
liked justice for its own sake; but he was circumspect as well as
penetrative. At first he seemed inclined to do it, but asked a day
to consider of it; and then wrote the following letter, into a more
particular examination of which we need not enter:

  "1828-9.

  "My dear sir,

    "'_Fiat Justitia_' is, as I flatter myself, the rule of my conduct.
    At all times have I expressed my approbation and respect for
    William Lawrence, on account of his professional learning, and of
    his ability as a writer and public speaker. But, if I do what you
    would have me, I should do much more, and be made to appear as
    a leader in a scheme the object of which is indefinite; so that
    persons will be at liberty to put what construction they please
    upon my conduct. Being desirous of doing what you wish, I have been
    for some time in a state of perplexity and hesitation.

    "At length I have resolved—that since I cannot determine what
    ought to be done—to follow a useful rule of professional conduct,
    and to do nothing. Vexed to refuse you anything, I hope you will
    still believe me,

  "My dear sir,
  "Your obliged and very sincere friend,
  "JOHN ABERNETHY."

The question of how far letters are to be relied on as expositions of
character, has been much discussed.

The remarks of Dr. Johnson on the subject, in his Life of Pope, are put
with great force, and almost carry us with him; but, on reflection,
they appear too general; they do not, perhaps, get close enough to the
question in which the student in Biography is chiefly interested.

Although letters obviously afford opportunities for a variety of
affectation—and Pope seems to have seldom been quite natural—yet we
cannot think that "friendship has no tendency to produce veracity."
But it seems impossible to generalize on the subject. We might as well
ask whether oral evidence is to be relied on. There is no one quality
that we can think of that can be said to be so universally distributed
in letters as to be safe to generalize on. Common sense tells us that
the testimony they give may be false or true. They are, like witnesses,
capable of telling truth, but having, under different circumstances,
all the characters of all other kinds of witnesses. Strictly, the
dependence one would place on them would be on the abstract probability
of that which they suggest; or as supported by any corroborative
evidence.

The following is a note to his daughter, the late Mrs. Warburton,
thanking her for a watch-chain:

  "Bedford Row,
  "Sept. 30.

  "My dear Anne,

    "I am quite accablé by the liberality of the Dr. and yourself; but
    I've been thinking that the Dr. is leading me into temptation,
    and that you are spending your money for an ornament which will
    never be seen, and which will only increase my apprehensions of
    having my pocket picked. However, what is meant in kindness should
    be received according to its design. Thus occasionally shall I
    taste the old rum; though, according to the phrase of the Doctor's
    schoolfellow (who reiterated that the wine was capital), blue
    ruin might have done as well. Thus also shall I wear the chain in
    remembrance of a chain which attaches me to you; one forged by
    Nature, and riveted by your good conduct and excellent disposition.

  "I am, my dear Anne,
  "Your affectionate and attached
  "JOHN ABERNETHY."


TO MRS. ABERNETHY.

  "My dear Anne,

    "Sir James, becoming a Governor, observed, he could not be both
    master and servant, and therefore _must_ relinquish his labours. I
    was three hours going round the hospital for the first time. It is
    Sir James's taking-in day on Thursday. The admitted patients must
    be seen on Friday. I cannot leave town until Saturday, unless Mrs.
    A.[89] pleases to encounter the chance of sleeping on the road. I
    suppose she will have luggage; and I cannot in reason allow less
    than seven hours, with a rest of two to Miss Jenny, with such
    additional weight.

    "I wish you had seen Dr. Powell; not that I believe he could do
    aught more than your own reason would suggest, or else you should
    never, with my goodwill, have gone to Southend. I know nought
    of —— Could you not return by water? By engaging a suitable
    vessel, the whole party might then be transported—ay, even to
    Putney. I should think ten or twelve pounds well bestowed on such
    a desideratum. Do not think of expense; for money cannot be put in
    competition with your welfare. If you are healthy and long-lived, I
    should be surprised if the children were not good and prosperous. I
    say nothing about myself, because I am no Professor, although they
    so nickname me.

  "Yours in all events,
  "JOHN ABERNETHY."

The following has some points of interest. The reason why merciful; the
observance of approved custom in shutting up the house; yet connecting
so much of "forms, modes, shows of grief," as Hamlet calls them,
with the best feelings, because "she had loved you," &c.; the gentle
tenderness with which he alludes to the excellence of the Mother;
and the graceful compliment with which he concludes; seem excellent
teaching.

  "My dear Anne,

    "I am much concerned to tell you that your Grandmother died last
    night, about nine o'clock. Death came to her unattended with pain
    or terrors. It is highly probable that she neither felt uneasiness
    of body or mind, from the time she was first seized with the fit.
    To have lived to her age, respectably and respected, in health,
    and to die without bodily or mental sufferings, is a fate which
    falls but to the lot of few; so that her friends have no reason to
    repine at her death; and it seems to be a merciful dispensation
    of Providence. If the servant has left Putney for Radcliff, of
    course the house is shut up; if not, it ought to be so. You and
    the children ought also to stay within doors, and have the front
    windows closed. She loved you all very much, and you ought to
    love and respect her memory. To you, who are apt to indulge your
    feelings too much, I must add, that it would be wrong to grieve
    much for what is in reality, as I have said, a cause to rejoice.
    I mean that the pains and decrepitude of age should be spared to
    the Individual whose fate we mourn. I have always esteemed it
    an excellence in your Mother's character, that though she feels
    acutely, yet she bears her lot in the dispensations of Providence
    with a gentleness and submission which indeed serve to diminish
    their severity. I trust she will do so on this occasion. You will
    see her to-morrow at Putney, if not before. On all occasions, and
    under every circumstance, rely on it that I remain

  "Most affectionately yours,
  "JOHN ABERNETHY."

  "Bedford Row,
  "Friday Morning, August, 1812."


TO MRS. ABERNETHY.

  "Dearest,

    "The first incident worth relating happened at Cirencester. I
    hobbled in haste to Mr. Lawrence's; his dressing room was open,
    and articles of apparel, &c. lay about, as if he had been lately
    engaged in the (to some agreeable, to others annoying) operation
    of dressing himself. His maid servant, however, sought him in
    vain, even in the church-yard. She looked mysterious and alarmed.
    'Perhaps,' said I, 'he is gone to Mr. Warner's.' Sure enough there
    he was, examining a shoulder said to have been dislocated; and
    he would make me examine it likewise. So much time having been
    lost as to the object of my visit, I had merely time to tell him
    that you were at Cheltenham, and would come to see him; and he
    to tell me that Mrs. Lawrence was at Malvern. The guard sounded
    his tin horn in an imperative manner; the sound was repeated, and
    I received a verbal reproof from the coachman for not instantly
    obeying the summons. A little way out of Cirencester, on the road
    to Tetbury, there is a neat and stile-ish house and grounds which
    I anticipated belonged to Charles Lawrence; and my presentiment
    was confirmed by a Compagnon de Voyage. Arrived at the York House,
    Bath, I was shown into a bed-room which had not been dusted, as
    you would think, properly since a fortnight before the fire. So,
    with the fear of bugs and other blood-sucking insects, I took
    up those of the papilionacious tribe belonging to Mr. Marriott,
    and proceeded to his abode; approaching which, I encountered Mr.
    Wood. By his recommendation, I procured apartments in a house,
    as Bourdillon would say, the entirety of which could only be
    obtained by persons in general. Behold me, then, sole occupant
    of a spacious and well-furnished house (being No. 9, St. James's
    Square), with a garden terminating in a road, beyond which fields
    only are visible, and within ken of the brow of Lansdown. The
    front and back rooms communicate, and the windows of each being
    open, there is perflation in excess. (Diary.) Monday. Descending
    Gay Street, in my way to the bath, I called at Soden's, and found
    him in great distress, and that Hodgson had gone forth to seek
    for me. Mrs. Soden is very ill, and Hodgson had come once to
    see her. She has lots of medical attendants, who, to use ——'s
    phrase, dovetail their opinions and practice before they prescribe
    for their patient. In perambulating Bath with Mr. Hodgson, we
    encountered Mr. Leifchild, who recited his case to the former,
    in proof of the efficacy of diet, with the eloquence of a public
    orator; and it happened to be a case in point. I scrubbed myself
    for half an hour, and drank half a pint of water at the pump room;
    then reascended the hill; looked in at Wilson Brown's, whose wife
    is quite well. No doubt the state of her digestive organs was the
    source of her various maladies. Her father, Dr. Chichester, whom
    you saw at Mr. Acres', now resides at Cheltenham. I went with Mr.
    Brown to the Riding School, thinking that if I could meet with a
    kind of shooting pony, I might be tempted to get on his back. But
    I escaped temptation, dined on mutton chop or chops, drank half a
    pint of ale, felt quiet, dosed a little. Descended to Queen Square;
    left a card for Sir George Gibbs, who is at Weymouth; called on Mr.
    Gore, who had been called out to a casualty (Bath phrase); went to
    the White Hart, found the coach did not come in until nine o'clock;
    thinking that if I did not see Mr. Battiscombe until then, we
    should both be as weary of seeing each other as of the day's toil,
    I reascended the hill, and went to bed. It was necessary that a
    day should elapse, that I might tell you how time passed; so that
    I have complied with your request of writing as soon as possible.
    No doubt that the days will be so monotonous as to render a second
    account unnecessary. I calculate I shall be tout-à-fait ennuyé in a
    fortnight; so that I expect I shall set off to Cheltenham, in the
    coach I came by, next Monday sennight, which I believe will arrive
    there about eight or nine in the evening, when I hope to find
    you all well. On Friday I think we might visit Oxford, and house
    ourselves again at the Angel; from whence, if we start at nine, we
    may be in London by four o'clock on Saturday.

    "I think I have written a ladylike letter: no attempt at
    condensation. I hope to hear from you in return, and that you will
    be able to say all's well. I will write to Anne to-morrow, because
    you say she wishes it—perhaps to-day.

    "Love to Miss Moggy and Miss Madge.

  "Yours for ever and for aye,
  "JOHN ABERNETHY.

  "Bath, 8th September, 1828."

He was fond of joining in anything that could delight and amuse his
children. In summer, when he returned home, the "upstairs bell" was
generally the signal for the young people to come to have a game of
play. Of games, battledore and shuttlecock was a favourite, at which he
was as expert and pleased as any of them. Sometimes there would be a
petition for stories; and he would delight them all by little histories
or tales, in which he appears to have shown the same talent as he did
in his lectures. The same stories were often repeated, yet they always
had something of the fun or freshness, as the case might be, of things
that were heard for the first time. One Christmas, the family, desirous
of amusing some friends, proposed to get up some private theatricals.
The anxious question being, what papa would say to it? Well, this was
very soon known, by a ready assent. But what was the play to be? They
replied, "The Iron Chest." But now rather an important difficulty
arose, of who was to take the part of Sir Edward Mortimer? This was as
unexpectedly as joyfully solved, by Mr. Abernethy taking it himself.

But, of all the home sports to which he seems to have given such zest,
all yielded to the superior attractions of the Magic lantern. This was
generally a gambol reserved for Christmas, when the whole establishment
were admitted. The fun lay in the number and variety of the stories and
remarks which accompanied the optical illustrations.

Every "slide" had remarks and stories made off-hand, which, as stories
were of this or that kind, either greatly increased the interest or
were the occasion of hearty merriment or peals of laughter.

He was very fond of the country and his garden, and nothing he enjoyed
more than driving down to Enfield with Mr. Clift, and having a holiday.
On such occasions, sometimes, even before he went into the house he
would set to work in the garden. They used both to be very active in
cutting out the dead wood from the laurels and other shrubs. In these
domestic operations the children would assist without any of the party
recollecting that bonnets and gowns were not the best costume for
making way amongst the trees and shrubs, which, however, only assisted
to increase the fun and excitement. At other times, there would be an
expedition against the duck-weed on the water. In short, he always
seems to have been the life of the party, and to have invested even the
most ordinary occupations with liveliness and interest, for which he
was certainly gifted with unwonted powers. Occasionally he would go to
the theatre, which he sometimes enjoyed very much. Like his brother,
he was a great lover of our immortal Shakspeare, and scarcely less
familiar with most of the wonderful creations of his mighty genius.

When we contemplate Abernethy in a single phase only of his character,
we see a "fidgetty" physical organization, influencing an habitual
irritability of which it was too much a supporter, if it were not
the original cause; but the moment we penetrate this thin and only
occasional covering, we meet with nothing but rare and splendid
endowments; and, as we proceed in our examination, we are at a loss
which most to admire, the brilliant qualities of his intellect, or the
moral excellences of his heart.

But, in estimating the one or the other, we must view them in relation
to the other feelings with which they were accompanied, as impeding
or assisting their development and application; or otherwise we shall
hardly estimate in its due force the powers of that volition over which
the moral sense so constantly presides.

Abernethy had considerable love of approbation—a quality which,
regarded in a religious point of view, may be said to embrace all
others; but it is one which, in the ordinary relations of life, is apt
to dilute the character, bringing down the mind from the contemplation
of more elevated motives to the level of those suggested by worldly
considerations and conventionalisms. To one shy, even to timidity,
and whose organization fitted him rather for the rapid movements of a
penetrative and impulsive perception, than the more dogged perseverance
of sustained labour, love of approbation, even in the ordinary
application of it, might have been a useful stimulus in maintaining
exertion; and we believe it was. Yet, though he avowed it as a dominant
principle in our nature, as the great "incentive" to human action, he
never sought it but by legitimate channels; nor, potential as its
influences might have been, when sharpened by shyness and timidity, did
he hesitate one moment to throw them all aside whenever the interests
of truth or justice rendered it necessary.

When Mr. Hunter's views were little noticed, less understood, and
apparently in danger of being forgotten—when the more speculative
of his views were not even known as his by any _published_
documents—when, therefore, in addition to other objections, he
was, as we have seen, subjected to the imputation of advocating
opinions as Hunter's, of which there was no other testimony than the
precarious memories of contemporaries,—he stood boldly forward as
the fearless, earnest, and eloquent advocate of John Hunter. In this
case, he overcome his natural dislike to contest and publicity, and
encountered just that individualizing opposition which is most trying
to a sensitive organization; exemplifying a rare tribute of truth and
justice paid by genius to the claims of a departed brother. At the
same time, the power he displayed of moulding views, scarcely even
acknowledged, into the elementary beginnings of little less than a new
science, strikingly testifies the superiority of his intellectual power.

Whilst, however, he advocated John Hunter's views, and, with a creative
spirit, made them the basis of additional structures which were
emphatically his own, we find him modestly reverting again and again to
John Hunter, as if afraid of not awarding him his just due,—and for
ever linking both the early bud put forth by Hunter's inquiries and
the opening blossom afforded by his own, with the imperishable efforts
of his distinguished master,—exemplifying the modesty of genius, and
how superior it is, when guided by virtue, to any but the most exalted
motives.

Another example of his independence of mind and of his conquest over
difficulty, when the interests of truth appeared to him to render it
necessary, was the manner in which, in defiance of ridicule and all
sorts of opposition, he advocated his own views; with ultimate success,
it is true, but obtained only through a variety of difficulties,
greatly augmented by his naturally shy, if not timid, organization.
Still, amidst all his brilliant endowments, we feel ourselves fondly
reverting to the more peaceful and unobtrusive efforts with which he
daily inculcated the conscientious study of an important profession.

That he had faults, is of course true; but they were not the faults
of the spirit so much as of the clay-bound tenement in which it
resided—not so much those of the individual man as those necessarily
allied to humanity. The powerful influences of education had not been
very happily applied in Abernethy; its legitimate office is, no doubt,
to educe the good, and suppress the evolution of bad qualities. In
Abernethy, we can hardly help thinking that his education was more
calculated to do just the contrary. "To level a boy with the earth,"
because he ventured on "a crib to Greek Testament," is, to say the
least of it, very questionable discipline for a shy and irritable
organization. To restore to its original form the tree which has been
bent as a sapling, is always difficult or impossible.

But, in virtue of those beneficent laws which "shelter the shorn
lamb," Abernethy was allowed ultimately, less in consequence than
in spite of his education, to develop one of the most benevolent of
dispositions. To this was joined a powerful conscientiousness, which
pervaded everything he did, and which could hardly be supported but by
sentiments of religious responsibility; and it is certain that his mind
was deeply imbued with the precepts of a vital Christianity, that took
the most practical view of his duty to God and to his neighbour; and,
in the very imperfect sense in which human nature has ever attained
to the full obedience of either, he regarded a humble and practical
observance of the one as the best human exposition of the other. His
favourite apothegm on all serious occasions, and especially in those
parts of his profession where its guidance was most required, was the
divine precept of doing to others as we would wish done to ourselves.

In his reflections he strikingly exemplifies how humble and
single-minded were his modes of thinking. After the manner of Bishop
Butler, but with a simplicity highly characteristic, he identifies that
which is truly religious with that which is truly philosophical; and,
instead of finding difficulties in those barriers which necessarily
lie before finite capacities, when endeavouring to approach the
Infinite, he seems to regard them as things which rather direct and
limit, than obstruct, legitimate inquiry.

In concluding this imperfect sketch of a difficult character, we
have merely endeavoured to state our own impressions. We cannot help
thinking that Abernethy has left a space which yet remains unoccupied;
it would be presumptuous to say that it will long continue so. In his
life he has left us an excellent example to follow, nor has it been
less useful in teaching us that which we should avoid.

Whilst amongst us, as he taught us how to exercise some important
duty, he would occasionally endeavour to impress matters of detail,
by showing, first, how they should not be done. His life instructs us
after the same manner. In all serious matters, we may generally take
him as a guide; in occasional habits, we may most safely recollect
that faults are no less faults—as Mirabeau said of Frederick—because
they have the "shadow" of a great name; and we believe that, were it
possible, no good man would desire to leave a better expiation of any
weakness, than that it should deter others from a similar error. This
is the view we would wish our young friends to take of the matter. We
cannot all reach the genius of Abernethy, but we may be animated by the
same spirit.

If great men are endowed with powers given only to the few, their
success generally turns on the steady observance of the more homely
qualities which are the common privilege of the many—caution,
circumspection, industry, and humility. Again, genius is often
charged with weaknesses by which more ordinary minds are unfettered
or unembarrassed. We may emulate the justice, the independence of
mind, the humanity, the generosity, the modesty, and, above all,
the conscientiousness of Abernethy, in all serious cases; without
withholding from the more ordinary and lighter duties of our profession
a due proportion of these feelings, or necessarily laying aside the
forbearance and courtesy which must ever lend an additional grace to
our various duties.

We may endeavour with all our power to avoid a disgraceful flattery
and compliancy, without replacing them by contrasts which, though not
equally mischievous, we may be assured are equally unnecessary: whilst
we may, in our various stations, emulate his kindness, his constancy
as a husband, father, and friend; and yet not refuse a becoming share
of such endearing qualities to others, from any fear that we shall be
subject to misconstruction.

We may remember that intellect alone is dry, cold, and calculating;
that feeling, unsupported or uncontrolled, is impulsive, paroxysmal,
and misleading; and that the few rare moments of moral excellence which
human nature achieves, are, when these powers combine, in harmony of
purpose and unity of action.

We may be assured that, however much we admire that rapid and searching
perceptivity,—that sound, acute, and comprehensive judgment which
Abernethy brought to bear on the study of the profession,—or the
honourable, independent, generous, and humane manner in which he
administered its more important and serious duties,—the greatest,
and, for good, the most potential influence of all, was the manner in
which he employed his manifold and varied excellences as a teacher in
endeavouring to infuse a truly conscientious spirit into the numbers
who, as pupils, he sent forth to practise in all parts of the world.
This is still an unknown amount of obligation. Those resulting from
his works may be proximately calculated, and such as are necessarily
omitted in a review essentially popular, _may be chronicled hereafter
in a more suitable manner_; but, as a teacher, we cannot as yet
calculate the amount of our obligations to him. They are only to be
estimated by reflection; and by recollecting the _moral influence of
every man_ who honestly practises an important profession.

Finally, whether we think of the interests of the public, the
profession, or those of each, as affecting the other, or of both as
affecting the progress of society; we shall, I think, be disposed to
agree with one of our most distinguished modern writers, that the
"means on which the interests and prospects of society most depend, are
the sustained influence that invariably attends the dignity of private
virtue."

In a world which presents so much of violated faith and broken ties,
the mind experiences a grateful repose in the contemplation of long and
uninterrupted friendship.

Of all men, perhaps Sir William Blizard had known Abernethy the
longest, and loved him the best; and an intercourse of more than half a
century had only served to cement a friendship entirely reciprocal with
sentiments of increased respect and regard.

Sir William had been one of the first to excite in Abernethy that
love for his profession which led to such brilliant results. He had
witnessed his career with all the pleasure that a teacher regards the
success of an early pupil, and no doubt with that satisfaction which is
inseparable from a prediction fulfilled. He had lived, also, to receive
a public and affectionate tribute of gratitude for his early lessons,
when Abernethy was in the zenith of his power.

Sir William, however, lived nearly a century, and was still alive and
well, when Abernethy's sun was setting, and when that fire which he had
been the first to kindle for such useful and benevolent purposes was
soon to be extinguished for ever.

When Abernethy retired from the College of Surgeons, Sir William was
requested to draw up the memorial in which his services were to be
recorded.

These circumstances invest even formal documents with an unusual
interest; and we therefore trust that Sir William's encomium may not be
thought an inappropriate conclusion to our humble story.

This almost ancient friend and early instructor observed, of Abernethy,
"that his life has been devoted to the improvement of the healing art.
His luminous writings breathe simplicity, humanity, reverence of truth,
and disdain of worldly art; and have placed the art and science of
surgery on the permanent basis of anatomy and physiology; whilst the
contemplation of his character excites emulative ideas of public virtue
in the cultivation of useful knowledge."

[Footnote 88: An old and respected pupil of Abernethy's, whose merits,
as an excellent man and kind-hearted professional brother, we are happy
thus publicly to acknowledge.]

[Footnote 89: Mrs. James Abernethy.]




INDEX.


  CHAPTER I.

                                                          PAGE.

  Retrospect                                                  1

  Progress of Discovery—Missions of individuals—Galileo,
    Bacon, Kepler                                             2

  Berzelius, Davy, &c.—Combined effect                       3

  Difficulty of estimating individual
    efforts—Physiological laws                               4

  Meaning of events seldom seen at the time                   5

  Propose to point out the position occupied by Abernethy   ib.

  Necessity of clearly seeing what is required                6

  Medical science—False ideas on                             7

  Birth of Abernethy                                          8

  Goes to School                                              9


  CHAP. II.

  Predictions often erroneous—Dryden, Swift, Sheridan,
    Niebuhr, Galileo, Newton, Wren                           11

  Individuality of Abernethy                                 12

  Schoolfellows of Abernethy                                 13

  School reminiscences                                       14

  Mr. Thacker's letter                                       15

  Leaves school for London                                   16


  CHAP. III.

  Of the choice of a profession                              17

  Of steadiness and industry                                 18

  Abernethy's ready memory                                   19

  Becomes a pupil in surgery                                 20

  Apprenticed to Sir C. Blicke                               22

  Early indications                                          23


  CHAP. IV.

  Sir W. Blizard—His influence                              25

  Abernethy's view of anatomy                                26

  His gratitude to Sir William                               27

  How expressed—Quotation                                   28

  Demonstrates for Sir W. Blizard                            28

  Mode of teaching anatomy described—Mr. Pott               30


  CHAP. V.

  A large London hospital                                    21

  Elected Assistant Surgeon—Important epoch in his life     33

  His position—Lectures in St. Bartholomew Close            34

  Dr. Maclaurin, Dr. Marshall, Mr. Pott                     ib.

  His education as a lecturer                                35

  Of teaching too early                                     ib.

  Its disadvantages—His lectures soon attractive—His
    arrangement                                              36

  Impresses the importance of comparative anatomy            37

  His labours—Zeal and industry—Early rising               38

  Shyness of Abernethy                                       39

  Theatre built in the hospital—His winter courses given
    in it, 1791—Thus the founder of the school in St.
    Bartholomew's                                           ib.


  CHAP. VI.

  Of change in all created things                            41

  Experiments                                                42

  Grows vegetables in distilled water—Boyle,
    Fordyce—Tadpoles, observations on                       43

  Experiments on eggs, curious                               44

  On the ultimate particles of matter                        44

  Dissection of a whale                                      46

  Of the absorbent vessels                                   47

  Of glands or kernels                                       48

  Curious cases                                              49


  Combination of natural laws                                50

  Dissection—How formerly supplied                          51

  Curious position of heart and liver                        52

  Of the public aversion to the inspection of the dead       53


  CHAP. VII.

  Of painless diseases                                       56

  Of insidious maladies                                     ib.

  Of his essay on lumbar abscess, &c.—Of his plan           57

  How misunderstood                                          58

  Misinterpreted by Sir A. Cooper                            59

  Real objects of his plan                                   60

  Suggested by an accident                                  ib.


  CHAP. VIII.

  His paper on the skin and lungs                            61

  Of the progress of chemistry                               62

  Objects of his inquiry                                     64

  Of the uses of the lungs                                   65

  Consequences, if mistaken                                 ib.

  Of the coverings of animals                                66

  Of the clothing of birds                                   67

  Of breathing by the skin                                   68

  Leaves, the lungs of vegetables                           ib.

  Great importance of the skin                              ib.

  Sanctorius, Cruikshank, Edwards                           ib.

  Experiments of Abernethy                                   69

  —— in quicksilver, in water                              70

  Carbonic acid—How formed                                  71

  Errors on this point                                      ib.

  Experiments on his own lungs                               73

  Immense surface of the skin                                74

  Importance of relations of lungs and other organs          75

  His remarks on consumption                                 76

  Investigation required—What?                              77


  CHAP. IX.

  Tic douloureux—What?                                      78

  His remarks on                                            ib.

  Use of the nerves                                          79

  Case                                                       80


  Of his paper on the consequences of bleeding               82

  Comparative infrequency of                                 83

  Abernethy's rising reputation                              85

  Moves to St. Mildred's Court                              ib.

  Publishes first part of "Physiological Essays"            ib.


  CHAP. X.

  Of his paper on injuries of the head                       86

  His powers of analysis                                    ib.

  Pierre Joseph Desault                                      87

  Of Bichat's eulogium on Desault                           ib.

  Parallel of Desault and Abernethy                          88

  Their solution of a difficulty                             89

  Abernethy's improvement                                    91


  CHAP. XI.

  His experiments on muscles, &c.                            93

  Of their contraction after death                          ib.

  Of Galvanism—Its importance in aid of discovery           94

  Of Fontana—His experiments                               ib.

  Experiments of Abernethy                                   95

  Of the respiration of fish                                 97

  Of the temperature of animals                             ib.


  CHAP. XII.

  Expts. on animals, involving cruelty, questioned           99

  Claims of physiology                                    100-1

  Orfila, Charles Bell                                      101

  Cruel experiments useless                                 ib.

  Spalanzani                                              100-3

  Cruelty as opposed to the interests of science as to
    moral feeling                                         104-5


  CHAP. XIII.

  Abernethy on tumours                                      106

  Simplicity of his plan                                    107

  Importance of names—His arrangement—Defects of
    plan                                                  108-9

  Popular illustration                                      110

  Analogies in vegetables                                   111

  His paper on certain curious results of wounds in
    the lungs                                               112

  His paper on mothers' marks, or nævi                      114

  Hunter's celebrated operation—First extension of it
    by Abernethy                                          115-6

  His paper on the Heart      116

  His increasing reputation—Removes to Bedford Row         117


  CHAP. XIV.

  His marriage                                              118

  False reports concerning                                  119

  His difficulty                                            121

  His letter                                                122

  Marriage at Edmonton                                      123

  Lectures the same day                                     125


  CHAP. XV.

  His book on the Constitutional Origin of Local
    Diseases, otherwise called "My Book"                    126

  Slow progress of truth                                    127

  Importance of simple facts                                128

  Mr. Hunter                                                129

  Sir C. Bell—Physiology a science of observation          ib.

  Popular illustrations                                     130

  Remarks on John Hunter's audience                         131

  Mr. Cline—His remarks on J. Hunter                       ib.

  A great Evil                                              132

  Mr. Boodle                                                ib.

  Important inferences and cautions—Lord Bacon             133

  Names of diseases—Their importance                       134

  Defective nomenclature—Result of partial views which
    it tends to perpetuate                                  135

  Misconceptions of his views                             136-7

  Popular illustrations                                   137-8

  Subtle nature of odours                                   140

  Vigilance of the stomach                                140-1

  Abernethy's illustrations of his views                    141


  CHAP. XVI.

  Influence of digestive organs                             146

  Of specific poisons                                       147

  A suggestive case                                         148

  Mr. Boodle—Recapitulatory—Causes of failure
    examined                                              150-3

  How nature deals with injurious influences              154-7

  Impressions produced by "My Book"—Abernethy's
    increasing practice—Sir James
    Earle—Anecdote—Retrospect                          159-63


  CHAP. XVII.

  Abernethy's position—His high reputation               164-

  Pupils present plate—Subscribe for his portrait        167-8

  Offered a Baronetcy, which he declines                    169

  Note from Sir B. C. Brodie                                170

  Anecdote—Painful impressions in prospect                 171


  CHAP. XVIII.

  Lincoln's-Inn Fields                                      173

  Hunterian Museum                                          174

  Mr. Clift                                                 175

  Abernethy lectures at the College                         176

  His faithful representation of Hunter—His additional
    illustrations—Illustrations not opinions            173-80


  CHAP. XIX.

  Effects of anatomy                                        181

  Bacon, Pope, Addison                                      182

  Abernethy—Lawrence                                       ib.

  Mr. Lawrence's exordium                                   183

  Its comprehensive fidelity                                ib.

  Mr. Lawrence's first lectures                             184

  Mr. Abernethy in relation to the opinions advocated       185

  Personal application by Lawrence of Abernethy's
    observations                                            186

  Others engage in the discussion                           187


  CHAP. XX.

  Review of the controversy                                 188

  Difficulty of Abernethy's position                        189

  Discussion of the pupils                                  ib.

  Difficulty of Abernethy's position                        190

  Of "tendency" as an argument                              191

  Abernethy's moderation                                    ib.

  Of the poverty of language                                192

  Of the conduct of the College                             ib.

  Of imputed scepticism                                     193

  Alleged neglect of the Sabbath                            194

  Conduct of the College                                    195

  Apathy of the College                                     ib.

  Abernethy's moderation                                    196


  CHAP. XXI.

  Abernethy's style of lecturing                            167

  Extracts from lectures                                197-216


  CHAP. XXII.

  Abernethy as a teacher                                    217

  Communication of ideas                                    218

  Of simplicity                                             ib.

  Of unnecessary technicalities                             219

  Some lecturers very technical                             ib.

  An example                                                220

  A sentence from Abernethy                                 ib.

  Of tricks—Good breeding                                  221

  Vulgarity—Abernethy's freedom from                       ib.

  Of quantity—Expression                                   222

  Of Metaphorical language—Mode of impressing
    facts—Anecdote of Dr. T. Rees—Of his stories        222-4

  His dramatic power—Anecdote—Of the
    pathetic—Anecdote—Tone of voice never
    declamatory                                           225-7

  Inconveniences of declamation—Of sympathy with the
    student—Of order—Favourite passages—His
    liveliness                                            228-9

  His successful manner—In referring to adaptation       230-1

  Inconvenience of marvellousness                           232

  Of the passions or feelings—Of illustrations
    addressed to the external senses                        233


  CHAP. XXIII.

  Abernethy's humour—Anecdote—His self-possession—Of
    his excellent moral tone                              234-7

  Salutary impressions—Gentleness—Its importance—An
    important improvement—General effects of his
    lectures—His negative excellences very great         238-9


  CHAP. XXIV.

  Of immoralities of trades and professions, &c.            240

  Of habit and fashion—Of conventional
    morality—Influence of fashion—Honesty the best
    policy—Of public credulity—Of legal practice        241-3

  Mischief of conventional morality, Examples
    of—Illustrations of conduct—Decisions of
    doubtful operations—Moral influence of
    Abernethy                                             244-6


  CHAP. XXV.

  Of consultation                                           247

  Of differences of opinion                                 249

  Consultation—Examples of                               250-2


  CHAP. XXVI.

  Abernethy in consultation                                 253

  Anecdote                                                  260

  Abernethy's extension of John Hunter's operation for
    Aneurism                                                262

  Abernethy in consultation                               263-4


  CHAP. XXVII.

  Of manner                                                 266

  Of Abernethy's manner—His roughness and benevolence    268-9

  Anecdotes                                               270-4

  His liberality                                            275

  His humanity                                              276

  Anecdote                                                  277

  Of operative dexterity                                    ib.

  Of operating                                              ib.

  A hoax                                                    278

  Of anecdotes generally                                    ib.

  His manner considered                                     279

  Self-government                                           280

  Of publishing lectures                                    281

  Extract from a letter                                     282


  SECTION.

  Appointed Surgeon to St. Bartholomew's in 1815            282

  Ageing at fifty                                           283


  CHAP. XXVIII.

  The hospital system                                     284-7

  Of operations—Of chloroform                              289

  John Hunter on operations                                 290

  Hospital system resumed                                   221

  Of apprentice qualification                               292

  Of imperfect records of cases                             293

  Of division of labour                                     294

  Hospital system a failure—Its Various evils              295


  CHAP. XXIX.

  Hospital system continued                                 296

  Abernethy and The System                                  296

  Professor Owen—Cuvier                                297-300

  Discussions at the hospital                             301-4

  Sir A. Cooper in illustration of The System               305

  Sir Charles Bell—Abernethy's disinterestedness           307

  Failure and unsatisfactory result of the Hospital
    System—Concluding remarks                           308-10


  CHAP. XXX.

  Influence of research in science—Its first
    impulses—Its higher aspirations—Its Religion       311-12

  The idea of some that scientific men have a
    tendency to scepticism in Religion opposed to
    evidences of experience                                 313

  Of the analogies of Religion and Science                  314

  No more avowed believers in religious truth than
    scientific men—Boyle, Bacon, Kepler, Newton,
    Locke—Many, too, of the medical profession, as
    Locke, Böerhaave, Linnæus,
    Sloane, Haller, &c.                                    315

  Divines, on the other hand, recognize the importance
    of the study of the laws of nature—Cudworth,
    Butler, Sturm, Derham, Paley, Crombie, &c.              ib.

  Of Paschal, St. Pierre, Gilpin, White                     316

  Extracts from MSS. &c.                                    317


  CHAP. XXXI.

  Obligations to Abernethy                                327-8

  John Hunter                                               329

  Hunter and Abernethy                                    330-1

  Obligations to Abernethy                                332-9


  CHAP. XXXII.

  Of evils and their correction                           340-1

  Signs of public distrust                                  342

  Thoughts of the public                                    343

  Homœopathy—Hydropathy                              344-52

  Lord Bacon—Of perceptions                                353

  Hopes and predictions                                     354


  CHAP. XXXIII.

  His favourite mare—House at Enfield                    355-6

  Wounded in dissection—His irritable Heart                357

  Anecdote                                                  358

  Receives thanks of the Council—His reply                 359

  Letter to Sir W. Blizard                                  360

  Of illness in medical men                                 361

  Resigns the hospital                                      362

  His resignation                                           363

  Letter to Mr. Belfour                                     364

  Memorial addressed to him                                 365

  An interview                                              366

  His death—Tablet to his memory                         367-8


  CHAP. XXXIV.

  Of his character                                       369-70

  Impressions of his character                              372

  Too many Gnathos                                          373

  Abernethy's dislike of this kind of assentation           ib.

  Anecdote                                                  374

  Kindness to hospital patients                             375

  His benevolence                                           376

  Letters, how far to be relied on as expositions of
    character—To Mr. Kingdon, to Mrs. Warburton, to
    Mrs. Abernethy                                       376-82

  His pleasures at home with the children                   383

  Battledore and shuttlecock—Theatricals—Magic
    lantern—At Enfield—Gardening, &c.                     384

  Impressions of his character                            385-9

  Conclusion                                                389


FINIS


PRINTED BY J. MALLETT, WARDOUR STREET, LONDON.




BY THE SAME AUTHOR.

  MEDICINE AND SURGERY ONE INDUCTIVE SCIENCE:

    Being an attempt to improve its Study and Practice on a plan in
    closer alliance with Inductive Philosophy, and offering, as first
    fruits, the "Law of Inflammation."

    In this Treatise, the Author claims to have developed the Law
    regulating, in a general sense, the sites occupied by diseased
    actions, as the highest generalization yet reached in Pathological
    Science.

  [HIGHLEY.


  AN ANALYSIS OF FEVER;
  IN LECTURES,

  In which it is endeavoured to show, by strictly logical and inductive
  processes, in what Fever really exists.

  Published hitherto only in the American "Transylvanian Journal," and
  the London "Medical Times."


  SURGICAL OBSERVATIONS ON
  THE MOST IMPORTANT DISEASES OF THE MUCOUS
  CANALS OF THE BODY.      8vo.[LONGMAN & CO.


  ON THE APPLICATION OF TRACHEOTOMY,
  AS APPLIED TO THE
  TREATMENT OF CHRONIC LARYNGITIS.
  [LONGMAN & CO.


  ON THE
  MODE OF DISTINGUISHING HERNIAL AND OTHER
  TUMOURS,
  OCCURRING IN THE INGUINAL REGION OF THE BODY.
  [LONGMAN & CO.


  ON TUMOURS IN GENERAL;
  THEIR NATURE, THE MODE OF INVESTIGATING IT, AND THE
  TREATMENT.      [CHURCHILL.


  ON THE UNITY OF THE BODY;

    As illustrated by some of the more striking phenomena of Sympathy,
    both Mental and Corporeal; with a view of enlarging the grounds,
    and improving the application of the "Constitutional Treatment" of
    Local Diseases.

  [LONGMAN & CO.


  CLINICAL OBSERVATIONS OF
  THE VARIOUS FORMS OF PORRIGO,

    Commonly known by the names of Tenea, Scald Head, Ringworm, &c.
    enforcing a more scientific and successful treatment for these
    usually obstinate affections.


  ON THE INUTILITY OF
  CRUEL EXPERIMENTS ON LIVING ANIMALS,
  IN THE PROSECUTION OF PHYSIOLOGICAL RESEARCHES.

  [HATCHARD & CO.




A LIST OF ABERNETHY'S WORKS.


  _Edition in 4 vols, 8vo. Longman and Co. 1830._

    In these Volumes there are one or two valuable papers, which
    have not been particularly noticed in these Memoirs, as being
    scientifically impracticable in a popular work.


  NOT INCLUDED IN THE ABOVE ARE SOME EARLY PHYSIOLOGICAL
  ESSAYS—VIZ.

    1. On the Functions of the Skin and Lungs.

    2. On the Composition and Analysis of Animal Matter.

    3. Experiments on Irritability.


  IN THE PHILOSOPHICAL TRANSACTIONS, THREE PAPERS—VIZ.

    1713. An Account of Two Cases of Uncommon Formation of the Viscera
    of the Body.

    1797. Some Particulars in the Anatomy of the Whale.

    1798. Observations on the 'Foramina Thebesii' of the Heart.


  AN ESSAY ON MIND, AND ON MORAL EDUCATION.
  [LONGMAN. 1814.


    He is the Author, also, of the Anatomical and Physiological
    Articles of "Rees' Encyclopedia," as far as the Article 'Canal.'

  G. M.




  _November 1856._

Works Published

BY

THOMAS HATCHARD,

187 PICCADILLY, LONDON.


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FORSYTH, Rev. J. H.—Sermons by the late Rev. JOHN HAMILTON FORSYTH,
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GRAGLIA, C.—A Pocket Dictionary of the Italian and English Languages.
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GRAY, Mrs. H.—Emperors of Rome from Augustus to Constantine: being
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—— History of Rome for Young Persons. With numerous Wood Engravings.
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GRAY, Miss A. T.—The Twin Pupils; or, Education at Home. A Tale
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GRIMSTON, Hon. Miss.—Arrangement of the Common Prayer-Book and
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HANKINSON, Rev. T. E.—Poems. By THOMAS EDWARDS HANKINSON, M.A., late
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HARE, Rev. A. W.—Sermons to a Country Congregation. By AUGUSTUS
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HASTINGS, Rev. H. J.—Parochial Sermons, from Trinity to Advent. By
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JEFFREYS, Archdeacon.—The Almighty's Everlasting Circles: an Essay.
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Light in the Dwelling; or, a Harmony of the Four Gospels, with very
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MARSHALL, Miss.—Extracts from the Religious Works of Fenelon,
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MEEK, Rev. R.—The Mutual Recognition and Exalted Felicity of Glorified
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NATT, Rev. JOHN.—Posthumous Sermons. By the Rev. JOHN NATT, B.D.,
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        "The most striking point in Mr. Woodward's writings, the point
        which most excites our admiration, and, we trust, improves our
        hearts, is the high and elevated standard of holiness which he
        ever places before us, the deeply practical tendency of all his
        thoughts," &c.—_English Review._

YORKE, Rev. C. J.—Original Researches in the Word of God. By the Rev.
C. J. YORKE, M.A., Rector of Shenfield. Fcap. cloth, 5_s._

     I. Christ Known before His Advent.
    II. The Beauty of the Mosaic Law.
   III. Inspiration and Genius.
    IV. The Divine Recognition of the Spiritual Church.
     V. The Development of Pure Religion.
    VI. The Apostolic Motive.
   VII. God Apparent in His Miracles and Prophecies.
  VIII. Scriptural Imagery: its Uses, Marks, and Sources.
    IX. God Traced in the World, and Found in Christ.
     X. The Human Conscience.




THE ILLUSTRATED EDITION OF

TUPPER'S PROVERBIAL PHILOSOPHY.

4to. cloth, gilt edges, 1_l._ 11_s._ 6_d._; morocco extra, 2_l._ 8_s._;
morocco by Hayday, 2_l._ 12_s._ 6_d._

[Illustration

_The Designs by_

  C. W. Cope, R.A.
  Fred. R. Pickersgill, A.R.A.
  John Tenniel.
  Edward H. Corbould.
  George Dodgson.
  Edward Duncan.
  Birket Foster.
  John Gilbert.
  James Godwin.
  William Harvey.
  J. C. Horsley.
  William L. Leitch.
  Joseph Severn.
  Walter Severn.
  H. N. Humphreys.]


SPECIMENS OF THE ILLUSTRATIONS.

[Illustration]


[Illustration: OF HUMILITY.

      Vice is grown aweary of her gawds, and donneth russet garments,
      Loving for change to walk as a nun, beneath a modest veil:
      For Pride hath noted how all admire the fairness of Humility,
      And to clutch the praise he coveteth, is content to be drest in
                hair-cloth;]


[Illustration: OF BEAUTY.

      Beauty is dependence in the babe, a toothless tender nurseling;
      Beauty is boldness in the boy, a curly rosy truant;
      Beauty is modesty and grace in fair retiring girlhood;
      Beauty is openness and strength in pure high-minded youth;]


  LONDON: THOMAS HATCHARD, PICCADILLY.

  London:—Printed by G. BARCLAY, Castle St. Leicester Sq.




      *      *      *      *      *      *




Transcriber's note:

  Obvious typographical errors have been silently corrected. Variations
  in hyphenation have been standardized but all other spelling and
  punctuation remains unchanged.

  Table of Contents was created by the transcriber.

  Index page references left as printed.





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