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.