But there is another inconvenience which occasionally renders the

excision of these nævi very inadvisable. It sometimes happens that

they are so situated that they cannot be removed, without making the

disfigurement greater, or from some other still more serious objection;

as, for example, when small ones occur in the face, or when they

are placed near the eye. Under such circumstances, the contraction

consequent on a wound of any extent is a serious inconvenience; in

some of these cases, the adoption of Mr. Abernethy's plan allows us to

dispense with the operation by excision, as I have myself experienced.

As it illustrates the advantage of the plan in a case where it was

particularly applicable, I will briefly refer to one example. A

young lady had one of these marks at the root of the nose, where,

from the position, as well as from the contiguity of the eyes, any

dragging from the contraction of a scar, would have been particularly

undesirable. She was brought from the country to have it removed; but,

on representing the objections to that course, it was agreed to try Mr.

Abernethy's plan, which was completely successful.

At this period, Mr. Abernethy published sundry other interesting

papers, showing, in his observations of all that was passing around

him, that his views were not less circumspect and comprehensive than

they were clear. His "surgical cases" are all excellent; and if they do

not contain so full an account (the great vice of medical records) of

all the circumstances which preceded them, as are sufficient to furnish

future investigators with the elements of accurate generalization, they

are remarkably valuable for the qualities of clearness and candour.

We may have an opportunity of briefly alluding to some of these papers

in our summary; but they are hardly practicable subjects for popular

analysis, although they form some of the most valuable contributions to

the practical literature of the profession. They show also that he was

as penetrative and efficient in regard to the operative department of

practice, as he was in those higher and more extended views, which, in

enlarging the _science_ of surgery, has tended to diminish, of course,

the number of operations.

About the year 1785, John Hunter had invented his celebrated

improvement in the treatment of a disease of the arteries called

"Aneurism." It was a very simple deduction from observations on the

state of the arteries; and although it was one of those inquiries

which had been made the subject of experiments on living animals, it

was one on which _not the smallest light_ had been thrown by such

investigations.

Mr. Hunter had found that, in addition to many other serious objections

to an operation which had been usually performed for the relief of this

disease—which consists either of a giving way of a _portion_, or a

general enlargement, of a vessel (for it is sometimes one, sometimes

the other)—a great cause of failure had been, that the ligature which

was placed round the artery was too near the disease, and, in fact,

involved a portion of the tube which was unsound. He accordingly

proposed tying the artery a little farther off, and thus substituted,

for an operation which was extremely severe, very hazardous, and too

commonly fatal, a comparatively short and simple proceeding, which,

under _moderately favourable auspices_, is almost uniformly successful.

As with many other discoveries, accident and similarity of views had

suggested similar proceedings to others, so that continental surgeons

were disposed to dispute the merit of the discovery in favour of

Guillemeau, Guattani, Anel, Desault, &c., as their views favoured one

or other; but there can be no doubt that for the first clear exposition

of the _principles_ of the operation, as well as of the objects it was

designed to accomplish, we are indebted to John Hunter.

John Hunter's operation applied to the main artery supplying the lower

extremity, and surgeons have since extended the proceeding to many

other arteries. The first extension of it, however, occurred to Mr.

Abernethy, who, about this time (1797), placed a ligature on what is

called the external iliac artery; and as he seldom touched anything

which he did not improve, he made an important modification in the mode

of proceeding.

Subsequent experience, it is true, has, in some measure, rendered

that improvement no longer necessary; yet, whenever circumstances

arise which lead to any material disturbance of the artery from its

situation, we apprehend the caution of Abernethy in tying it in two

places close to its connection with the surrounding parts, is a

valuable condition.

He also sent, about this time, an ingenious paper to the Royal Society,

on certain small openings into the cavities of the heart. They are

called the "Foramina of Thebesius," from an anatomist who particularly

described them. This is to us one of the prettiest of his physiological

contributions. The facts are stated with great simplicity, their

relations to disease beautifully pointed out, and the inference from

the whole very striking, as being in harmony with the facts whence it

is deduced. Abernethy's idea being, that the holes were for the purpose

of obviating excessive repletion of the nutrient vessels of the heart,

by allowing them to relieve themselves by pouring a portion of their

blood through these holes into the general mass of the circulation.

It could hardly, however, be made interesting to the general reader

without going into the subject more than is suited to our present

object.

In 1799, Abernethy's reputation had gone on rapidly increasing. His

numerous pupils, too, had become the media for frequent consultations,

in addition to those which arose from his own connection, and his

reputation with the public.

He now moved from St. Mildred's Court, and took the house in Bedford

Row. This was some time previous to October, 1799, the September of

that year being the last time his name appears on the rate-book of St.

Mildred's Court. He never again changed his professional residence. The

move was an important step, but it was only the precursor to one still

more interesting.

In the January of the following year, an event occurred which seldom

fails to exert a greater influence on a man's future prospects and

happiness than any other. This was no less than his marriage—of which

we must say a few words in a separate chapter.

[Footnote 28: That the nature of a thing is not to be sought only out

of itself, but from things more in common.]

CHAPTER XIV.

HIS MARRIAGE.

"Ye solvers of enigmas—ye

Who deal in mystery—say,

What's cried about in London streets

And purchased every day?

"'Tis that which all, both great and small,

Are striving to obtain;

And yet, though common and quite cheap,

Is daily sought in vain."

OLD RIDDLE.

There are few subjects on which people are more agreed than the

value of "good matches;" neither do they seem to differ very widely

as to what that phrase is intended to convey. Not that everybody's

_beau-idéal_ implies identity of composition, but they are pretty well

agreed as to the more essential elements.

But if we observe the different ways by which people seek to obtain a

common object, we are puzzled to know how folks that set out in such

various directions should ever arrive at the same point. The travellers

are said, too, to provide themselves not unfrequently with various

disguises; not only in dress and externals, but even in manners and

sentiments, which they do not usually entertain. Thus we have heard of

one who professed a great love of music, who scarcely had an idea of

melody; of another who expressed an admiration of poets whom he had

never read, or voted unmitigated bores. Others have been known to avow

a perfect indifference to wealth, who have had scarcely an idea unmixed

with an instinctive admiration of the _æs in presenti_.

We once heard a curious fellow say that he could marry any lady he

liked, if he could only "bring himself to take the trouble;" and we

thought how happy he would be if he could live on as good terms with

his wife as he appeared to be on with himself. Some start with an

apothegm which they carry about like an amulet or charm; such as, "No

greater rogue than he who marries only for money, and no greater fool

than he who marries only for love." Apothegms, however, like many

things in this world—Macintoshes and umbrellas inclusive—are very apt

to be left at home when most wanted.

We are not informed whether table-turning or mesmerism have yet

discovered any prophylactics against the undoubted perils of an

expedition in search of a partner.

We are unfortunately not sufficiently versed in these mysteries to know

the "latest accounts;" but from the reputed effects of platinum and

other metals, we should not be surprised to hear that a person well

mesmerised would be found very clairvoyant of gold. We are not aware

of the achievements necessary to arrive at the exalted position of "a

Professor;" but it is said that "Professors" find gold without the

necessity of going to the "diggings."

Table-turning, we hear, has not as yet been found successful. By

shooting too much ahead of the slowly moving current of human affairs,

it skipped over one generation, and thus recently entrapped an Irish

gentleman of the "highest respectability" by giving a fortune to a lady

too soon; it happening to be found still in possession of its "right

owner"—or, as the technical phrase is, "in expectation."

Many aspirants for wedlock have sundry misgivings about certain

traditionary repulsions which are said to exist between love and

poverty, and, uninfluenced by the charms of matrimony, think only of

the possible consequences. Not a few, however, regard marriage as

too serious an affair for sport or speculation. They think it very

difficult for mortals who know so little of themselves to know much

about other people, and that though matches in rank and money are daily

seen to be very practicable, yet that matches in mind are still as

difficult as Dryden represented them—

"Minds are so hardly match'd, that e'en the first,

Though pair'd in Heaven, in Paradise were curs'd."

People of this sort contemplate marriage in a very unpoetical manner.

They have great faith that correct intention and common sense are the

best guides; and, although they may not feel less transported with

their prospects than other people, they are apt to remember that it is

"transportation for life."

A great deal has been said of the marriage of Abernethy, and very

much of it in proof of his eccentricity of character; but if a steady

reliance on earnestness, sincerity, and common sense, on an occasion on

which one or other of these qualities are sometimes laid aside, and the

employment of the highest qualities of the mind for the most important

purposes be wise, we must, if we admit the eccentricity of Abernethy,

concede to him the less-equivocal merit of practical wisdom. Himself a

sensible and clever man, and a great admirer of these qualifications in

others, he was not very likely to ally himself to any lady who appeared

deficient in such characteristics.

Abernethy had a very quick perception of character, and his profession

afforded him ample opportunities for the exercise and the cultivation

of this faculty. He would not have been very likely to lay it aside

on an occasion when a judicious and successful exercise of it, as

distinguished from mere impulse or first impression, is of more

consequence than on almost any other.

Miss Anne Threlfall was the daughter of a gentleman who had retired

from business, and who it appears had been residing in the town of

the far-famed Edmonton. This lady was intimate with the family of Mr.

Hodgson, where Abernethy was also a frequent visitor.

It was at Mr. Hodgson's that Mr. Abernethy first made the acquaintance

of her who was destined to exert so considerable an influence on his

future happiness.

In the unrestrained intercourse of the society of intimate mutual

friends, a man of Abernethy's penetration would not be long in

discovering the amiable or the estimable qualities of an agreeable

woman.

Mrs. Abernethy added to personal attractions of no common order, great

good sense, and a very lively, ladylike manner. These had not been

without their influence, on their first meeting; and a few additional

interviews, which the usual precursor of an undefinable pleasure in her

society served to accelerate, not only confirmed his first impressions,

but seem to have deepened them into sentiments of warm respect and

affection. Now, supposing his opinion formed, his resolution taken,

there was still a difficulty—Abernethy was remarkably shy, and

extremely sensitive.

His whole time was absorbed in teaching, studying, and practising his

profession; his rising ambition just getting success within its grasp.

How was resolution or opportunity to be found for the tardigrade,

time-consuming process of a regular siege? Still, after all, the

shyness was the real Rubicon which he felt a difficulty in passing.

Common Sense said to a sensitive Conscience, "You are about to ask a

lady to entrust to you her happiness for life." "Ah!" said Conscience,

"that is indeed a great deal to ask of any one." And Shyness said it

was equally difficult to know what to say, how to make the request, or

brook a refusal. The difficulty with Abernethy was so great, that there

is some reason to doubt whether he could have got over it, had he been

left entirely to his own resources.

Mr. Hodgson, it seems, did not sympathize with Abernethy's scruples

and difficulties, but simply encouraged him to overcome them. It is

wonderful how even the greatest minds are influenced sometimes by a

timely "pat on the back." We recollect a distinguished public man, and

a peculiarly single-minded one too, once observing, that few people

had any idea of the comfort which public men sometimes derived from

any one, whom they imagined sincere, simply saying, "You were quite

right, I think." Whatever Abernethy might, or might not, have owed to

some little help of this kind, it is quite certain that he at last

opened his heart to Miss Threlfall, or at least essayed so to do; but,

apparently not very well assured that he had said what he intended _to

say_, he supported it by a letter, which proved successful.

This letter is still extant, and an interesting document it is. It

forms a curious commentary on the numerous and dissimilar versions

which have been given of it by gossip; all the versions we ever heard

having had the common character of being in every respect entirely

unlike the original. Here it is:

"Tuesday.

"I have felt extremely anxious, dearest Lady, since I had

the pleasure to be with you, lest, from my embarrassment in

delivering my sentiments, I might have said any thing liable to

misapprehension. This anxiety induces me to trouble you with the

present letter. I had designed, in our last conversation, to have

said, that I had ever regarded the marriage state as that of the

greatest happiness. It always appeared to me that two persons

of different sexes living together in reciprocal benevolence

were placed at the summit of human felicity. Hard necessity has,

however, precluded me from the enjoyment of such bliss; and when

I had at length relinquished even the idea of it, by accident I

met with a lady in whom were concentred all the qualities which

I could have wished for in the moments of fondest expectation,

and from whom I was led to believe I might derive what I had ever

regarded as the greatest happiness. This was to me one of those

circumstances of the reality of which the mind seems doubtful, from

the excess of delight that it occasions. I had wished, dearest

Lady, at our last interview, to have convinced you that I was

capable of discerning and loving you, as well for the perfections

of your mind, as for the charms of your person. I have ever been an

enthusiastic admirer of intellectual excellence; and in the minds

of some ladies whom I have known, I have distinguished a purity of

thought and benevolence of design which I have never found, nor

can I expect to find, amongst men. In addition to these simple and

fascinating qualities, I have witnessed a clearness of perception

and judgment, an undeviating rectitude of principle, and, as the

result of these and other qualities, such a dignity of character,

that I have looked up to the possessor of them as to something

divine. I had wished to have made you acquainted, in some degree,

with my own character, as far as I might have been supposed to have

acquired that most difficultly attained information, a knowledge

of myself. I perceive, however, an impropriety in saying much upon

this subject; but I wish you to be assured, that I am incapable of

uttering any thing false or deceitful, and that consequently you

may rely upon my word. I have pursued every object in life with an

avidity which has appeared to many disproportionate to its value;

but surely, if an object be worth attaining, neither diligence

should be spared nor time lost in its attainment. How anxious

and earnestly interested must a person of this disposition, with

respect to subjects of little importance, feel when engaged in what

he considers as the most important concern of his life. I shall

suffer the greatest inquietude until I am assured of your good

opinion. This letter has been written by snatches, in the midst of

the avocations of this day, which now so call upon me, that I can

only add (what I hope may be an unnecessary assurance) that I shall

ever be, with the truest affection, and most faithfully yours.

"JOHN ABERNETHY."

This beautiful letter is very characteristic. The simplicity and

straightforwardness,—the respect and tenderness, "Dearest Lady,"—the

brief, modest, but truthful tone in which he alludes to his own

pretensions,—the plea for his earnestness deducible from his known

character in ordinary pursuits,—his frank confession of anxiety

and inquietude until he is assured of her "good opinion,"—and his

naïveté in saying that his occupations oblige him to conclude,—all

respectively sketch the natural warmth, tenderness, sincerity, and

earnestness of his real disposition.

The marriage took place accordingly in the parish church of All Saints,

Edmonton, on the 9th of January, 1800, and is thus entered in the

Register:

"John Abernethy, Bachelor, of the Parish of St. Andrew's, Holborn,

to Anne Threlfall, of this Parish, Spinster, were married in this

Church by licence, the 9th day of January, 1800, by me,

"D. WARREN, _Vicar_.

"This marriage was solemnized between us:

"JOHN ABERNETHY.

"ANNE THRELFALL.

"In the presence of

"JONATHAN PATTEN.

"WILLIAM HODGSON.

"J. HODGSON.

"MARY THRELFALL.

"CHARLOTTE HODGSON."

By marriage Abernethy obtained a partner for life who to personal

attractions added those social and moral excellences which combine

to form a superior woman—one to whom such a man as Abernethy could,

and always did, to his last moment, look up with equal respect and

affection, as the wife, mother, and the friend. As a husband, there can

be no doubt that, during the thirty years he lived after his marriage,

his conduct was a practical commentary on, and fulfilment of, the

preceding letter; and he endeavoured at all times to convey to the

children the warm sentiments of respect for, and reliance on, their

mother that he had seen so much reason himself to entertain. On the

other hand, it is impossible to overrate the grateful warmth with which

Mrs. Abernethy returned his affection, or the veneration and respect

with which she honored his memory.

Few persons, if any, have experienced a longer period of uninterrupted

happiness than that which followed the marriage of Abernethy. Mrs.

Abernethy survived him twenty-four years, having died in July, 1854.

She had for many years been afflicted with paralysis, which at times

was attended with considerable suffering. It was consolatory, however,

to feel that her faculties remained without being materially impaired

to the last.

Mr. Abernethy had, in his last illness, repeatedly expressed his

anxiety that every kindness and care should be shown towards her to

whom he felt so much indebted; and he had prophetically suggested, as

probable, what really happened. He said, "Take every care of your dear

mother. She may have many and perhaps serious illnesses; but she will

still be, most likely, a long-lived woman." This legacy, we have reason

to know, was most fully and kindly administered.

One circumstance, on the occasion of his marriage, is very

characteristic of him: namely, his not allowing it to interrupt,

even for a day, a duty with which he rarely suffered anything to

interfere—we mean the lecture at the hospital.

Many years after this, I met him coming into the hospital one day, a

little before two (the hour of lecture), and seeing him rather smartly

dressed, with a white waistcoat, I said:

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

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

"Indeed, Sir!" I said. "You should have given yourself a holiday on

such an occasion, and not come down to lecture."

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

myself!"

On another occasion, I recollect his being sent for to a case just

before lecture. The case was close in the neighbourhood, and it being

a question of time, he hesitated a little; but being pressed to go, he

started off. He had, however, hardly passed the gates of the hospital

before the clock struck two, when, all at once, he said, "No, I'll be

—— if I do!" and returned to the lecture-room.

CHAPTER XV.

OF ABERNETHY'S BOOK ON "THE CONSTITUTIONAL ORIGIN OF

LOCAL DISEASES," OTHERWISE "MY BOOK."

"From the barr'd Vizor of Antiquity

Reflected shines the Eternal light of Truth,

As from a mirror; all the means of action,

The shapeless masses, the materials,

Are everywhere around us. What we need

Is the celestial fire, to change the flint

Into transparent crystal, bright as fair."

LONGFELLOW'S "SPANISH STUDENT."

In all that Abernethy had hitherto published, it was easy to perceive

that, although he was carefully examining the prevailing opinions and

practice of the day, he was emphatically one of those independent

thinkers who had power to overlay the most established conventionalisms

with opinions of his own. Although hitherto his publications had

related to particular diseases or accidents which were held as

within the ordinary province of the surgeon, he was shadowing forth

_principles_—views which, if they were true, must necessarily have a

much wider range of application than to the particular cases which it

had been his object to consider. In 1804, he had sufficiently matured

his general views to think it right to publish them; and this he did in

his book on the "Constitutional Origin of Local Diseases," popularly

known as the "My Book," to which he not unfrequently referred his

patients for a more detailed account of his views, than he could find

time to give in the consulting room. When we reflect that diseases

consist entirely of altered conditions in the structure or function of

some part of the body, a formal announcement that they must be greatly

influenced by the organs on which _the whole body depends_ for its

nutrition, seems to have so much the aspect of an obvious truism, that

we scarcely know whether most to wonder at so formal an announcement of

it having been necessary, or the astonishing number and variety of the

reservations with which it has been admitted.

But, strange as this may appear, and although all the facts have been

before the eyes of man for ages—nay, though their relations have been

_more or less felt_ and acknowledged in cases usually submitted to the

physician,—we venture to say that nothing like an attention at all

adequate to their importance was obtained for them in the practice

of physic, and scarcely any at all in surgery, _until the time of

Abernethy_.

At the present time, a great deal has been done to establish, by the

most clear and indisputable demonstration, the practical usefulness

and necessity of the principles to which Abernethy conducted us,

in the cure of diseases, whether medical or surgical. Still, these

principles are much neglected, much misunderstood, or so _imperfectly

carried out_, as to excite, even in many of the public, expressions

of astonishment. It is, indeed, not too much to assert, that, even

in those cases in which their successful application has been most

incontestibly exemplified, his principles are _fully carried out on

comparatively few occasions_.

The causes of all this are, we fear, too easily detected; the removal

of them is indeed sufficiently difficult. We may possibly discuss both

points in the sequel.

Instead of the exquisite simplicity and clearness of Abernethy's

views, so far as he had gone, being carefully studied, and with a

view to the _extension_ of them beyond those limits which his time,

his opportunities, and his caution had assigned to them; instead of

examining into, and testing, the practical value of the deducible, and,

in fact, necessary sequences, on views of which he had demonstrated the

truth and value; practice appears to have taken a retrograde movement.

He who would advance even as far as Abernethy, is in danger of being

regarded as crotchety or peculiar; whilst any who should strive by

a more careful examination of his views to render their practical

application more definite and analytical, must be prepared to be looked

on simply as an enthusiast.

This has, indeed, been the case more or less in all sciences from the

earliest times. The _facts_ which conduct us to a true interpretation

of the _laws_ in obedience to which they occur, have been always before

us; the very same facts on which, as Professor Whewell[29] observes,

we have raised the stately structure of modern science. Butler[30]

had before made a similar remark. Poets too, as even the motto to

our chapter shows, have held the same sentiment; what everybody

_knows_, how few _consider_! Neither Copernicus nor Galileo altered or

invented _facts_. Those they _observed_! what they _discovered_, were

conclusions interpreting the true relations of them. Bodies fell to

the earth, and the crystal rain-drop had shown the composite nature

of light in the beautiful colours and wonderful illustrations of the

rainbow, ages before Newton discovered the true explanation of the one,

and the great law exemplified in the other.

The object of "the Book" is to set forth the great fact of the

reciprocal influence existing between the nervous system and the

digestive organs, and the power they mutually exert in the causation

and cure of diseases; and this, whether the diseases originate in

disturbance _primarily_ directed to the brain or any other portion of

the nervous system, or to the _digestive organs_; whether the result

of accident, such as mechanical injury, or other local manifestations

more commonly termed disease. In the book before us we shall find

an ample refutation of many misconstructions and misapprehensions

of Abernethy's views; misconstructions which have tended to obscure

principles, remarkable for their simplicity and truthfulness; to

impede the beneficial application of them in a manner which has been

equally injurious to the public and the profession, and which, have

impressed on mankind a very inadequate idea of the obligations due to

the distinguished author. His views were said to be theoretical and

exaggerated, whilst they were conclusions logically deduced from facts;

and so far from the pervading power of the influences to which he

proximately attributed the causation and cure of disease having been

exaggerated, the onward study of his principles only serves, by the

discovery of more multiplied and refined applications of them, to fill

in with additional illustrations the accurate outline which he has so

truthfully drawn. He never wrests a fact to a conclusion to which it

does not legitimately lead. In virtue of that suggestive quality of his

mind (so important an aid in philosophical inquiries), he occasionally,

in all his writings, puts forth suppositions, but these only as

_questions_, the next in the order of inquiry, and these he asks of

nature alone.

Mr. Hunter had been the first in this country to make the true use of

anatomy; I mean in the sense that whilst it was no doubt the basis

of our investigation into the functions or uses of parts, still it

was only _one_ of an extensive series of inquiries. He had _examined_

the _dead_ with no purpose more earnestly, than to assist him in his

endeavours to _observe the living_; examined _parts_, that he might

better understand the whole. He had made himself familiar with the

economy of animals, and generally with the habits of organized beings,

whether animal or vegetable, that he might know their relations to each

other, and that of the _whole_ to the phenomena, habits, and laws,

of the _Human_ economy. As he neglected no source whence it had been

customary to seek for information, so, notwithstanding his fondness for

animals, he made various experiments on living creatures. But whilst

these experiments afford additional proofs of the poverty, so to speak,

of this plan of investigation, they impress on us the truth of Sir

Charles Bell's assertion, that physiology is essentially a science of

_observation_. We have only to place Mr. Hunter's _observations_ and

_experiments_ here referred to, in juxtaposition, in order to bring

out in high relief the great meaning and value of the one, and the

unnecessary, or inconclusive, character of the other. He also examined

the various facts presented to him in the _living_ body with unequalled

patience and circumspection.

Amongst others, he had paid particular attention to those which

exemplify that vivid, that watchful connection which exists between

various parts and organs, and by which impressions or sensations

excited in any one part are telegraphed, as it were, with the

swiftness of lightning to any or all of the organs of the body; facts

which may be observed by _anybody_, by no one better, and by few so

well, _as patients_ themselves. To take a common example: everybody

is familiar with the fact that certain disturbances of the stomach

produce pain or other annoyance in the head. Every one also knows that

in such cases there is very often no pain, and sometimes no sensation

of annoyance in the stomach; so that were it not from an innumerable

succession of such conditions, in connection with particular influences

on the stomach, we should, from the feeling of the _stomach only_,

never dream of the cause being in that organ. Now on these simple facts

hang not only the most practical of all John Hunter's observations,

not only the most valuable of Mr. Abernethy's, but (as far as we

can see) those relations through a philosophical examination of

which we shall still most auspiciously seek to extend our practical

knowledge of disease. We see here just that which Mr. Hunter had

asserted—namely, "that the organ _secondarily_ affected (in this case,

the head) sometimes appeared to suffer more than the organ to which the

disturbance _had first_ been directed."

He observed also that the connection thus manifested, existed equally

between _all other parts_ and organs; that although it might be

exemplified in different forms, still the association it implied was

indisputable. He adopted the usual terms by which these phenomena had

been designated. Parts were said to _sympathize_ with each other, and

no term could be better, as it simply expressed the fact of associated

disturbance or suffering. It is true the _facts_ were not at all new;

they had always existed; nay, they had been observed and commented on

by many persons ever since the time of Hippocrates; and if I were to

mention the whole of such facts, there is scarcely one which would not

be to some one or other as familiar as a headache from disturbance of

the stomach. Mr. Hunter, however, had a kind of instinctive idea of

the yet unseen value of the clue thus afforded to the investigation of

disease; and he observed these facts with a greater attention to all

their details than any one, or all, who had preceded him.

Hunter's observations on the subject in his lectures were extremely

numerous, and elaborate even to tediousness; Abernethy, who used to

give us a very humorous description of some of the audiences of John

Hunter on these occasions, was accustomed to say, "That the more

humorous and lively part of the audience would be tittering, the more

sober and unexcitable quietly dosing into a nap; whilst the studious

and penetrative few appeared to be seriously impressed with the value

of Mr. Hunter's observations and inquiries." Mr. Cline, an honoured

name in our profession, and one who, had he lived in later times, would

probably have been as distinguished in advancing science as he was for

his practical excellence, significantly expressed his impressions of

the future importance of the inquiries in which Hunter was engaged.

Addressing Mr. Clift, after one of the lectures, he said:

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

Mr. Abernethy carefully treasured up and pondered on what he heard. He

placed himself as much as he could near Mr. Hunter; took every pains,

which his time and occupations allowed, thoroughly to understand him;

and, with his characteristic tendency to simplification, said: "Well,

what Mr. Hunter tells us, resolves itself into this: _that the whole

body sympathizes with all its parts_."

His perceptivity, naturally rapid, was evidently employed in observing

the bearing of this axiom on the facts of disease. The digestive

organs, which, if we extend the meaning to all those engaged in

assimilating our food, compose nearly the whole viscera of the body,

could not escape his attention, nor indeed fail to be regarded in all

experimental investigations of any _one organ_. Accordingly, in his

paper on the skin and lungs, we have seen a very important application

of the relations between organs engaged in concurrent functions; we

have placed before us the physiological evidences of their being

engaged in a common function, and the sympathetic association it

rendered necessary; whence he had observed relations of great moment,

and pointed out the practical bearing they _must_ have on Consumption.

He had, however, been paying attention for some time to the digestive

functions, when his intimate friend, Mr. Boodle, of Ongar in Essex,

gave a fresh stimulus to his exertions. This gentleman requested him

to investigate the functions and conditions of the liver in various

nervous diseases, as also in certain affections of the lungs, which

had appeared to him, Mr. Boodle, to originate in the former organ.

Mr. Abernethy says: "I soon perceived that the subject was of the

highest consequence in the practice _of surgery_; for local diseases

disturb the functions of the digestive organs, and, conversely, a

deranged state of those organs, either occurring in consequence of such

sympathy, or _existing previously_, materially affects the progress of

_local complaints_."

At the very commencement, he hits on a great cause of evil, and

boldly assails one of the most mischievous of all conventionalisms.

"The division of medicine and surgery," he observes, "is mischievous,

as directing the attention of the two orders of practitioners too

exclusively to the diseases usually allotted to them." There is indeed

no exaggerating the evils of that partial mode of investigation to

which such a custom almost necessarily leads. We fall into error, not

because of the difficulty of the subject, but because we never can, by

looking _at one set of diseased processes only_, learn the whole of

the facts belonging to the subject. It was just this that prevented

Fordyce from arriving at correct views of fever. Nothing could be

more excellent than the way he _began_ to consider it; but he hardly

begins, before he tells us that he intends to exclude those febrile

affections which fall under the care of surgeons. In doing this, he

at once abandoned a series of facts which are absolutely essential

to the investigation. It must be obvious, on a moment's reflection,

that, if a particular condition of a part have a relation to the whole

body, the study of one without the other, or even if both be taken

up by different persons, nothing but the most imperfect views can

result. A jury, still more a judge, might in some cases guess from

partial evidence the issue of a legal investigation; but who ever

heard of either determining beforehand to examine a portion only of

that evidence? Yet it is not too much to say, that hardly any legal

question can be so recondite as many inquiries in physiology. The

nature of the case is always more or less obscured by a number and

variety of interfering circumstances. Diseases may be regarded, in

fact, as nothing more than natural laws, developed under _more or less

complicated circumstances of interference_.

Lord Bacon had warned all investigators of Nature of the danger of

attending only to a portion of the facts; it had been one of the great

bars to progress of knowledge in general. I regret to say that it still

continues the bane of _almost all medical inquiries_.

Abernethy's inference in relation to this mutilated sort of

investigation is too true, when he observes that "the connection of all

local diseases with the state of the constitution has obtained little

notice;" whereas the truth is, that "no part of an animal body can be

considerably disordered without affecting the whole system." Now here

Mr. Abernethy claims—what? Simply this: he claims for _function_—that

is, _the various offices fulfilled_ by the several parts and organs of

the body—that which Cuvier has so beautifully insisted on, and which

our own Owen has so instructively exemplified in regard to _structure

or formation_; namely, a _necessary relation_ between the whole and all

its parts.

In speaking of affections of the nervous system, Abernethy observes

that the brain may be affected by the part injured, and that _then_

it may affect the various organs by a "reflected" operation; but that

whatever _may be the mode_ (thus carefully separating the opinion from

the fact), "the fact is indisputable." He adds that it may affect

some organs more than others, and thus give a character or name to a

disease. For example, it might affect the liver, we will say, when the

name which would be given would probably be expressive of what was a

secondary circumstance—namely, a disturbance of the liver. This does

not so frequently happen, perhaps, nor so mischievously in relation to

local injuries; but in other cases it is the cause of a great deal of

erroneous and misleading nomenclature.

As we have seen, it often occurs that when the organs of the body

are disordered, the more salient "symptoms," perhaps the _whole_ of

those _observed_, are referred to a secondarily affected organ, and

the disease is named from that circumstance. The too frequent result

is, that attention is exclusively directed to that organ, whilst the

_cause_, being elsewhere, and where there _are no symptoms_, wholly

escapes observation.

This is a very important branch of inquiry; and as it closely connects

what Abernethy left us with what appears to us to be one of the next

things to be clearly made out, we will endeavour to illustrate it.

Suppose a person meet with a severe injury, a cut, bruise, fracture,

or any thing that we have seen a hundred times before, and, instead

of being succeeded by the _usual_ processes of repair, it be followed

by some others: the simple expression of the fact is, that something

has interfered with the _usual_ mode and progress of repair; and as

former experience has shown us that there was nothing in the nature of

the injury to account for this, we are naturally led to look for the

explanation of it in the state of the individual. But if the unusual

appearance be one which we have agreed to call "Erysipelas," and we

are accustomed to see long papers written upon this appearance as a

_distinct disease_, we acquire a tendency, as every day's experience

shows, to regard it as a kind of abstraction, or as an entity;

something composed of precise and definite relations, contained in

that particular description of case. Yet these relations may not be

in any two successive cases exactly alike. Again, all of them may be

subordinate to some more general character, probably a relation without

which we cannot readily explain the phenomena; but at which we cannot

arrive, because we have not comprehended a sufficient number of facts

in our inquiry to include it.

"Erysipelas" is nothing more than a natural law obscured; because,

as we have just hinted, it is developed under circumstances of

interference (from disordered conditions of the economy) which distort

the natural features of the law, modify its effects, or which may

prevent altogether its full development. But now, if we study the

means afforded by the various links _which other varieties of disease_

furnish, the ascertainment of the real relations becomes comparatively

_easy_; and we find that, whilst there are certain general relations

which belong to all cases, there are certain others which may in a

given number in succession be identical; or in no two exactly the same.

Partial investigations, leading, of course, to erroneous views, are

sure to entail on us a defective nomenclature; and then the two do very

materially contribute to continue the fallacies of each other. We may

have an affection of a lung, perhaps; the cause may not be in the chest

at all, although the lung may be inflamed or otherwise affected; but

we call it Pneumonia, or Pleuritis, or some other name which _simply

refers to what is happening to the part_; but all such names have

reference only to effects; they are extremely defective therefore, as

comprehending only a portion of the _nature_, and having no reference

whatever to the _seat_, of the _cause_ of the malady. The consequences

of all this may not be _necessarily_ mischievous; but they are so

lamentably common, as to continue to form a very large share of the

routine practice. The cause is elsewhere; but the remedies are directed

to the chest—that is, they are, in such cases, applied to effects,

not causes. If we must retain names so defective, it would be very

practicable to combine them with something which should indicate that

we had, at least, _looked_ for the cause. This would, at all events,

encourage a habit of looking beyond mere symptoms, and carry us at

least one link higher up the chain of causation.

Abernethy, in demonstrating the connection between local disease, or

injury, and general disturbance, judiciously takes cases where the

relation was most unequivocal; that is, where the local disturbance

consisted of a mechanical injury; such as in a gentleman who had

undergone an operation—in another who had met with a bad fracture

of his leg. In order to amplify his illustrations of the connection

between the brain and all parts with the digestive organs, he draws

them from all sorts of sources—from diseases the most severe and

dangerous, as well as from affections which are regarded as most common

or trivial—from the last stages of cancer and serious diseases of the

loins, to the common disturbances of teething in children—sources

which, from their apparent _dissimilarity_, confer, of course, the

strongest force on testimony in _which they combine_.

His delineation of the features by which disorders of the digestive

organs may be generally detected, is remarkably simple, clear, and

truthful.

Every word has the inestimable value also of being alike intelligible

to the public and the profession. His statement is interspersed

with remarks of great value, which, we trust, have not passed away

altogether unimproved: such as, that he had observed disorder of the

digestive organs produce states of health "similar to those" said to

be characteristic of the absorption of particular poisons—a most

recondite subject; but one, the obscurity of which has entirely, as

we think, resulted from the determination to regard the diseases to

which it refers as _abstractions_, and to investigate them under the

impenetrable shadow of _preconceived_ opinions.

Almost all his remarks have received more or less confirmation from

the experience of the whole civilized world. There are few things

in his observations more interesting than the emphatic way in which

they ignore the vulgar impression that he referred all diseases to

the stomach. In the whole round of scientific literature, it would be

difficult to find, in the same space, so complete or comprehensive a

view of _all_ those which we usually term the digestive organs.

Abernethy was very far from any such narrow views; whilst, in regard

to other organs, to which some of our most distinguished men had

paid particular attention, it is not too much to say, that, more

clear and precise than Curry, and equally careful with Hunter, not

less painstaking than our excellent Prout, he is more _practically_

penetrating and comprehensive on this subject than any of them. But as

to the charge of exclusive reference to the stomach, we shall easily

see there was no foundation for it.

In speaking of the reciprocal affections of the brain and the digestive

organs, he says: "The stomach is said to be chiefly concerned in

producing these effects; but the cause of the sympathetic affection is

probably more general." Page 48. He then goes on to exemplify causes

acting on the _Liver_, and so forth. Page 49.

He distinctly contends that _other_ of the chylopoetic organs may

disturb the brain as well as the stomach. Again, at page 52, he

repeats a similar opinion, and especially adds, that when the

alimentary canal _is_ affected, we can never be sure that it is

_primarily so_.

He also says, at page 53, that, in some cases, the disorder of the

digestive organs is dependent on disease of the brain.

I have alluded to these passages, because nothing is more unjust

to Abernethy than to suppose that he attributed everything to the

stomach, or restricted his attention to that or any other organ. Such

a misapprehension also tends indefinitely to impede the practical

application of his principles, and to deprive us of the advantages

which are so constantly derivable from them.

This is so important, that it may be useful to consider a little the

circumstances which may have thus misled the public, and we fear, not

unfrequently, the profession also, in the interpretation of Abernethy's

views.

In conducting the treatment of diseases of the digestive organs,

whatever organ we may desire to influence, either by inducing

tranquillity of the nervous system, or by the selection of food

appropriate to the actual condition of the organ specially affected,

the stomach is necessarily a primary consideration.

The reasons for this are sufficiently obvious, but have not perhaps

been always adequately regarded. Digestion is, on the whole, a

manufacture, so to speak, of a raw material (food) into a fluid

(blood), which is to be absolutely adapted to purposes for which it is

designed. This is effected not by one, but by several organs, which

each produce their respective changes in the materials submitted to

them. If we desire, therefore, to adapt the work to any organ which is

engaged in this process, however remote it may be from the stomach,

which, with the teeth and other auxiliaries, execute the _first_

process in the manufacture, it is quite clear that we must begin with

the _first process_ to which we subject the said raw material or

food. Say that in a machine for the manufacture of cloth the spinning

apparatus were out of order, we must begin by giving out a less

quantity of wool to the carding machine, or whatever represented the

first process; because, having once delivered the wrong quantity or

quality, we have no means of recalling it, and we should only still

further derange the defective machinery.

So in the body; the liver, kidney, and other organs, not excepting the

lungs and skin; their work must all bear relation to the quantity or

quality of raw material, whether their function be the manufacture of

the new product, or the rejection of that which is useless. So that

supposing there were no other reason, no other than this mechanical

relation (which is very far from the real state of the case), still we

must _de facto_ begin with the stomach, even where we entertain _no

idea of any_ special derangement of that organ. The stomach, however,

is very important in another sense, and has a power of indicating the

necessity of attention to those points which I have endeavoured to

illustrate by the homely similitude of a manufacture.

Wherever impressions _first_ act on the body, nature has placed a most

vigilant guard. This is variously managed in different cases; the

result is the same, and, as it would appear, the final cause also. In

the eye, there is the most beautiful contrivance for moderating the

ingress of light, as also any abrupt increase of intensity. Fringed

curtains are provided which can close with electrical celerity. Again,

the aperture by which light is finally admitted into the eye is vividly

contractile or expansive, as the occasion may require; then again

there are various media of different densities, through the influence

of which even the velocity of light undergoes practical retardation

by repeated refractions; and lastly, there are powers of sensual

adaptation in the nerve with which the light is ultimately brought in

contact, more wonderful than all.

The ear, being likewise a portal for external impressions, is guarded

with equal care. Not a single vibration of air can ever reach the nerve

of the ear with the crude intensity (if I may use the expression) with

which it is generated. Passing over preliminary apparatus, by which

the vibrations of air are first collected, the impressions of sound

are first received on the parchment of a little drum, which parchment

can be relaxed or tightened with the quickness of thought, so as to

modify the force of the impression. This impression is then, by means

of a little chain of bones, conveyed across the drum, which is filled

with air. It then reaches a portion of the ear in which are found very

curious cavities and canals, of various forms, and taking different

directions, and which, from the curious and complex arrangement of

the whole, is not inappropriately called the labyrinth. This is the

mysterious seat of those nerves which convey impressions to the brain.

There is, however, here, an arrangement more exquisite than any we have

yet mentioned.

In these cavities and canals, which are themselves so small as to be

not unfit objects for magnifying glasses, there are corresponding

delicate sacs and tubes, and these are filled with a limpid fluid.

On this delicate apparatus, so exquisitely calculated to modify any

undue force of impression, the sensitive extremities of the auditory

nerves are spread out, which convey impressions to the brain. We

see, therefore, how carefully these portals of the body are guarded;

arrangements equally conservative prevail throughout. We might show a

similarly exquisite arrangement in the laws governing the mind; but

that is not our present object. We have seen hitherto that, beautiful

as the arrangement is for securing us against painful impressions, it

has been in a great degree mechanical.

The stomach, however, is the portal to a vast series of important

organs, and is protected by a phalanx of sentinels, endowed with powers

proportioned to the importance of the organ which they guard. There

is little that falls within any idea which we can express by the term

mechanical; everything is subjected to an examination essentially

sentient; to powers residing in the nerves; the _laws_ and _operations_

of which, we can with proper attention trace out, but which exhibit

powers demonstrative of an intensity and refinement of which our

limited perceptions scarcely enable us to form a definite idea.

First, there is the olfactory nerve, between which and the stomach

there is the most vivid sympathy.

Until our tastes become vitiated, the stomach seldom admits anything

of which the nose reports unfavourably. The sense of smell, even in

the somewhat measured power possessed by man, is capable of detecting

forms of matter so subtle as to be beyond our powers of imagination.

Nothing which so plainly deals with "matter" impresses more strongly

the immense range which must exist between the chemistry of life and

that of the laboratory. We all know the extraordinary powers of musk.

I have myself a small mass of odorous matter (a Goa ball) which, from

the circumstances under which it came into my possession, must have

been emitting the odour for little less than a century. It has been

exposed to air, is covered by a film of gold (I believe), is in no

respect visibly changed, and for the last thirty years not detectably

in weight; yet at this moment it emits as strong an odour of musk as

ever. How exquisitely subtle must be the matter thus emitted; or how

still more wonderful if it merely so modifies the atoms of air in its

neighbourhood as to produce odour. We have no intellectual powers which

enable us to realize a conception of such infinite tenuity of matter;

yet the sense of smell instantly detects its presence.

Next come the nerves of the tongue; and here again, in natural

conditions, there is a constant harmony between them and the

stomach—that to which the taste readily gives admission being, in

_undisturbed_ conditions of the economy, some guarantee that it is

innoxious; but what these _functions are to the stomach_, the stomach

is _to the other organs_. In the first place, in natural conditions

it usually at once rejects any noxious material which, from being

disguised, or from any other circumstances, may have eluded the

vigilance of the sentinels I have mentioned; but it has a vivid

sympathy with every organ in the body. If anything deleterious be once

admitted, it has to go through various processes, which may render it

a source of indefinite disturbance; therefore, if any organ in the

series of the blood-manufacture be materially disturbed—that is, so as

to be disabled—the stomach usually refuses food; because there is no

other way of stopping the mischief. Illustrations of this occur in many

disorders of the kidney, in many affections of the alimentary canal, as

also of the liver, and other parts.

No doubt the stomach is therefore a most important organ; but to

suppose that it is therefore always the seat of disorder, is not only

a most mischievous error, but a complete blind to its most beautiful

and instructive relations; and as opposite to Mr. Abernethy's views as

the most narrow can be to the most comprehensive. Proceeding with his

illustrations, Mr. Abernethy cites a number of most instructive cases,

such as palsy and other affections of most serious character, which

too often result either from organic disease of some organ, or from

mechanical pressure on the brain or spinal marrow, but which in the

cases cited depend on disorder of the digestive organs.

It is impossible to exaggerate the interest or importance of these

cases; not only from the fact that they almost certainly would have

led to organic disease, but also for the value of that practical

discrimination which they exemplify. Again, the very treatment which

would have been proper, which had sometimes been begun, and which

was not inappropriate to cases of _organic_ disease, with which the

symptoms were in part identical, would have inevitably, in the cases

in question, only served to exasperate the very conditions they were

designed to relieve, and to hasten those processes against which they

were intended to guard.

No one can understand the force of these cases, without recollecting

the intense difficulty of ascertaining that point at which disorder

ceases to be merely functional, and at which organic disease begins.

This is of all things the most difficult to determine in the whole

circle of physiological or pathological inquiry.

The _symptoms alone_ are absolutely useless in any case of real

difficulty. Of that Abernethy was well aware, and he did much to guard

us against the error into which a reliance on them was calculated to

lead. He knew that organs which were diseased would sometimes afford

indications not distinguishable from those of health; and that,

conversely, organs essentially sound would sometimes only afford those

signs which were indicative of disorder. We have, we trust, made some

little progress in this very difficult branch of inquiry; and although

it is true that organic disease not unfrequently escapes detection

during life, yet, so far as we have observed, it is only in those cases

in which there is, notwithstanding the daily lessons of experience,

an _improper reliance_ on what are called the symptoms. We assert,

without the least hesitation, that organic diseases should seldom

elude detection where the investigation is sufficiently comprehensive;

but it must include _all the facts_ of the case, the early history,

and such circumstances which, however remote, have been over and over

again proved to be capable of exerting an influence on the body; an

investigation which, however vainly pleaded for in medical science,

however regarded as too exacting, involves nothing more in principle

than is required as a matter of course _in all other_ scientific

investigations.

When these conditions are observed, it is very rarely that we cannot

detect organic affections in organs in which there may be no _present_

symptoms. In relation to the _extent_ to which they may be affected,

it is true we have yet much to learn; still, if cases be judged of not

by the history _merely_, nor by the symptoms _merely_, but by both

in conjunction, and if to these be added a careful observation of

the _amount_ of work that the organs are separately or collectively

doing, as _compared with their natural proportions_; together with

a careful estimate of that which the actions of any visible disease

may be eliminating from the body; then, indeed, we have good ground

for hope that means will be opened to us of distinguishing more

accurately various states of the system; and additional principles and

powers disclosed of readjusting the disturbed balance of the various

functions, which is the essential element of disease.

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

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

CHAPTER XVI.

"MY BOOK" CONTINUED.

"La première chose qui s'offre à l'Homme quand il se regarde, c'est

son corps. Mais pour comprendre ce qu'elle est, il faut qu'il la

compare avec tout ce qui est au-dessus de lui, et tout ce qui

est au-dessous, afin de reconnoître ses justes bornes."—PASCAL,

PENSÉES, NATURE DES HOMMES, vol. ii, p. 57.

Abernethy, in impressing any anatomical fact, would sometimes say

that we carried about with us in our own bodies excellent means of

refreshing our impressions on many points of anatomy; but we may say

this in a much more extensive sense with regard to the interpretation

of that for which anatomy is alone useful—namely, the _uses_ or

_functions_ of the body. It would be very possible for any observant

person, who was moderately versed in the ordinary principles of

correct reasoning, to detect many defects in medical investigations

and practice; in the correction of which many of Abernethy's practical

contributions consisted; but the mind, restlessly impatient to arrive

at conclusions, often overlooks the most important facts, and deduces

inferences _directly_ from the evidence of the eye or other senses,

without submitting it to such test as the intellectual faculty can

alone supply. Nothing can exceed the mischief of this in serious

matters, nor the absurdity of it, when we _think awhile_.

We should hardly refrain from laughter if we saw a man try to see with

the point of his nose, or endeavour to examine the odour of a rose by

his ear, or to listen with his eye; yet this is not a whit more absurd

than to try to deduce conclusions from the impressions furnished by

the eye, which can alone be afforded by the rational faculty. Nothing

is more common than this sort of fallacy, nothing more easy than its

correction; but then people must bestow at least a little of that time

on their highest faculties which they so lavishly expend on inferior

powers. How much time we consume, for example, in the study of various

languages—those instruments for the communication of ideas—as

compared with that bestowed on the collecting and marshalling of

ideas themselves; which is little better than grasping at the shadow,

and losing the substance; or, to use a humorous illustration, like a

friend of our own, who, having a new dog, sent his servant forthwith

to purchase sundry articles for him, in the shape of kennel, chains,

engraved collars and food; all of which, at some expense, he safely

accomplished to his master's satisfaction, expressing his sorrow at the

same time for having accidentally lost the dog!

It is curious, however, to observe how the real business of the human

mind is shadowed forth in the very abuses of its powers; nothing so bad

but it is charged with a certain quantity of good; no error so great

but carries with it the element of its own correction. The mind in its

greatest aberrations is followed by the shadow of its real duty, which

as it were waits on the time when clearer views shall burst on it.

Nothing shows the real tendencies of mind more than its restless desire

to arrive at _some_ conclusion, _some_ tangible evidence of its highest

functions. It is the impulse of this instinct—the ungoverned abuse of

a high faculty, impatient for illegitimate fruition—which lies at the

bottom of much false reasoning, and which blinds men, even of great

power, to obstacles which are luminously evident to the most ordinary

capacity. Important as the next series of illustrations cited by

Abernethy are, the conclusions he deduced from them were the necessary

sequences of clear and correct reasoning on familiar and established

facts.

The illustrations in question were those afforded by various cases

of injuries of the head, in which certain consequences, however

exceptional they may be, are too commonly referred to the abstract

nature of the injury. We _see_ that a man has a blow, we _see_ that he

does not recover in the usual way in which we have known many others to

recover; but we do not, perhaps, _consider_ that if a similar—nay,

perhaps an identical force produces very different effects in different

cases, the cause will probably not be in the nature or direction of

the force so much as the condition of the body. Now the value of these

cases of Abernethy's consists, first, in impressing the influence

of this condition as modifying—in other words, _sustaining_—the

disturbance consequent on injuries (in their origin) purely mechanical;

and secondly, in showing that, in the cases in question, _that

condition_ depended on a disordered state of the digestive organs.

We hardly know any cases more valuable than those in question. When

a patient receives a blow, and, the _immediate_ consequences having

subsided, there still remains an impairment of sense or motion, the

most usual thing, and no doubt very often the true view, is to refer

it all to lesion of nervous structure. It is therefore of the highest

consequence to know the facts of these cases. They not only prevent

the hasty institution of treatment which would be injurious; not only

secure the patient from being abandoned in despair; but supply at

the same time the clues to a rational treatment, and the hope of a

favourable issue.

There can now be few observant surgeons who have not met with cases in

illustration of these circumstances; and yet I know not to whom the

perusal of Mr. Abernethy's cases might not be useful. It is not without

regret that I forego transcribing at least one of them; forgetful how

impossible it is to do Abernethy full justice in a work intended for

all readers. In his "Book," the cases in question begin at page 97, and

occupy but a few pages.

The next class of cases, from which Abernethy illustrates the

prevailing influence of the digestive organs, receives additional

importance from the _imperfect_ manner in which the phenomena have been

interpreted in a vast variety of diseases; like small-pox and others,

ascribed to the action of particular poisons. We may possibly have an

opportunity of saying something more on this subject; but we may remark

that when any disease has been presented to the physician or surgeon,

supposed to be the result of specific poisons, it is just the last

case in which any special attention is paid to the digestive organs.

Now Abernethy observed that disorders of the digestive organs would

sometimes _produce_ diseases resembling maladies said to result from

specific poisons. This is about the first indication or hint of that

which, duly carried out by an advancing science, will, we trust, ere

long, demonstrate what to _us_ has long appeared only part of a general

law. Of this we may by and by say a little more, when we endeavour to

show the small quantity of truth which there is mixed with some of

the prevailing errors; and how their occasional success results from

blundering, as it were, on small portions of the principles enunciated

by Abernethy.

In the meantime, we may refer to the illustration afforded by

small-pox of the remarkable influence of the digestive organs in

diseases called specific. We adduce this, because it is one which is

popularly familiar, and a disease that, had it been studied under any

but one particular phase, would have proved, of all others, the most

instructive. There is no malady, under certain circumstances, more

extensively fatal.

In the Spanish conquest in America—a history scarcely less interesting

in a medical than in a moral point of view—it seems that not all the

cruelties of the Spaniards were more destructive than the small-pox. In

less than a century after the arrival of Columbus, it was computed that

it had destroyed more than half the population; and in one year (1590),

it so spread along the coast of Peru, that it swept away nearly the

whole of the Indians, the Mulattoes, and the Mestichos, in the cities

of Potosi and De la Hay[31].

As is well known, before the discovery of vaccination, persons were

_inoculated_ with the small-pox, because it was found that the disease

could _be thus rendered_ comparatively harmless; whilst, if it was

taken naturally, as it was termed, it was always serious, and too

frequently extremely fatal. The preparation for inoculation consisted

of _measures addressed to the digestive organs_. Now the effect may be

judged of by this fact: Inoculation was at first violently opposed;

and, in reply to the alleged safety of it, an opponent wrote to prove

that _one_ in _one_ hundred and eighty-two had died of it. I wish we

could say so of many other diseases.

That such persons had, nevertheless, the genuine malady, was proved

by the fact they were capable of infecting others (unprepared) with

the disease in its most malignant form. But our notions of the mode in

which the laws of the animal economy deal with injurious influences

of this kind, are mischievously conventional. What quantities, for

example, of mercury, in its different forms, have been administered in

almost all diseases; and yet unquestionably there is a great deal of

false reasoning in regard to this poison. Effects are attributed to it

_as mercury_, which only belong to it in _its general character of an

injurious agent_. All the (so-called) specific effects of it, most of

which are become popularly familiar, may occur without any mercury at

all. We have seen them induced by aloes, by scammony; and in a case

where no medicine had been given, and where the only detectable poison

was one which was to be sure bad enough, an enormously loaded liver.

We are obliged to say but little here in connection with this subject.

Abernethy's cases were very important in relation to the influence of

the digestive organs, although he did not see the generalization to

which, as it appears to us, they help to conduct the pathologist. The

subject is too extensive for discussion here. We will attempt something

of a popular view of it, when we endeavour to explain the fallacy to

which we have already referred.

Abernethy next adduces various illustrations from cases of other

diseases; as indurations, tumours, carbuncles, scrofulous affections,

and others; in proof of the dependence of a "numerous and dissimilar

progeny" of so-called local diseases, on that "fruitful parent,"

disorder of the digestive organs. Of one of the most interesting

and remarkable cases of tumour, Mr. Abernethy did not live to see

the termination. It was of a lady who consulted him previous to the

proposed infliction of an operation. She had been recommended by my

father, in the country, to consult Abernethy before submitting to

it; because he disapproved of it, as did Abernethy—not because they

doubted of the nature of the disease, but because it was not confined

to the part on which it was proposed to operate.

The lady used to call on Abernethy when she came to town; and after his

death she came to me—as she said, just to report her condition. She

had at times various disturbances of her digestive organs; but always

from some imprudence; for, although habitually very simple in her

habits, she would be sometimes careless or forgetful.

She died at a very advanced age—between seventy and eighty—but

there had been no return of the disease for which she had originally

consulted Abernethy, nor had she undergone any operation. It is a

significant circumstance, too, that she had a sister who died of cancer.

The whole of the cases are, however, scarcely less valuable. In the

fifth section, he treats of disorders of parts having continuity of

surface with the alimentary canal, certain affections of the nose, of

the eye, and of the gullet or œsophagus. His observations on the latter

are especially valuable. They strike at that meddling practice which

is too common in the treatment of diseases of these parts. Many of us

have recommended a practice which, without neglecting either, relies

_less_ on manipulatory proceedings, and more on measures directed to

the general health, in such cases; as producing effects which are not

to be obtained by other means; but, if we are to judge from the medical

periodicals, without much success; so inveterate is the habit of

imagining that, whatever the causes of disease may be, if the _results_

be but _mechanical_, mechanical means can alone be applicable. Public

attention, and the perusal of such cases as those of Abernethy, can

alone correct these errors.

Lastly, he describes the results of his dissections as bearing on the

whole subject. Here he shows, that whilst disordered function may

take place coincidentally with, or as a consequence of, change of

structure, yet that such change, so _as to afford visible or detectable

departures_ from natural appearances, is by no means necessary, in

_organs which, during life_, had afforded the most incontrovertible

evidence of impaired function. He also shows that disease has

_terminated_ in _disorder_ which had its original seat in the

digestive organs. And again—that, in cases where the cause of death

had been in the abrogated _function_ of the brain, he found no actual

_disease_ in that organ, but in the _abdominal viscera_. He very justly

observes that the conclusions he has drawn can be _neither_ ascertained

nor disproved by anatomical evidence _alone_. He mentions especially,

and illustrates by a remarkably successful case, how _diseases of the

lungs_ may be engendered by disorders of the digestive organs, and

_entirely_ subdued by correction of that disorder.

He speaks also suggestively of the possibility of that which is

certainly now an established fact. He says: "In cases of diseased

lungs, where no disease of the digestive organs is discovered, yet

considerable _disorder_ does exist, and may continue for many years

without any _organic_ disease being _apparent_; it is possible that

such disorder may excite disease of the lungs, and thus produce a

_severer_ disease of the latter organs than what existed in the

former. Accurate attention to the _digestive organs may determine

this important subject, and lead to the prevention and cure of the

sympathetic diseases which I have mentioned_." "This attention must

not be merely of that general kind which adverts only to the quality

of the ingesta, &c., but one which more strictly observes whether the

viscera" (that is, reader, not merely the stomach, not merely the

digestive organs, but the whole viscera of the body) "and whether these

secretions are healthy or otherwise." After speaking of the heart also,

as affected by the digestive organs; and of the infinity of diseases

which arise from the reciprocal disturbance excited between them and

the brain;—he says: "But even these are not the worst consequences.

The disorder of the sensorium, excited and aggravated (by the means

which he has described), affects the mind. The operations of the

intellect become enfeebled, perplexed, and perverted; the temper

and disposition, irritable, unbenevolent, and desponding. The moral

character and conduct appears even to be liable to be affected by these

circumstances. The individual in this case is not the only sufferer,

but the evil extends to his connections and to society. The subject,

therefore, appears to me to be of such importance, that no apology

need be offered for this imperfect attempt to place it under general

contemplation." Here is that suggestion which, when carried out, leads

to the detection of cases of insanity which depend on disturbances of

the digestive organs.

Lastly, as if, notwithstanding his own previous attention to the

important question of the influence of the digestive organs in

disease, he felt that the inquiry had grown upon him in consequence of

Mr. Boodle's endeavour to concentrate his attention to the subject,

he concludes by expressing his past obligations to Mr. Boodle; for

he says, with admirable modesty and candour, "for Mr. Boodle first

instructed me how to detect disorders of the digestive organs, _when

their local symptoms were so trivial as to be unnoticed_ by the

patient." He urges Mr. Boodle to publish also his own observations on

the subject, because any remarks from one who observes the progress of

disease "with such sagacity and accuracy, cannot but be interesting."

We are quite aware how feeble our attempt has been to do justice to

this admirable book. But nothing can do that but a careful study of the

various principles which it either suggests, dimly shadows forth, or

deeply and beautifully unfolds.

Through not a very short life, we have had ample opportunity of testing

these principles by the bedside, and of endeavouring to connect some

of them with the laws in obedience to which they occur; and we are

free to declare our impression that when the book is studied with the

requisite previous knowledge, and freedom from preconceived opinion;

and when tested and carried out in _principle_, as distinguished from

any adhesion to mere matters of _detail_; we think it infinitely more

valuable than all other professional works whatever. In examining

the truths it unfolds, or in our humble endeavours elsewhere at a

more analytical or extended application of them, like Abernethy, we

have rested our reasoning wholly on facts and observations which are

acknowledged and indisputable.

Whilst other views have only led to a practice in the highest degree

empirical, or, what is worse, conjectural, those of Abernethy's lead

often directly, but always _when duly studied_, to a practice at once

clear, definite, and in the sense in which we shall qualify the word

"positive,"—that is, one which gives us the power (when we really have

the management of the case) of predicting the success or failure; which

is at least a ripple indicative of a coming science.

In order, however, to carry out this clearly, we shall at once add what

we think necessary to the profession and the public on the subject.

The _general relation_ of Abernethy's labours to a real and definite

science will be better developed in our concluding Summary; when we may

have an opportunity of stating what further appears to have been done,

and what is yet required. It will have been perhaps already observed

that Abernethy's views involve a few very simple propositions: first,

that disturbance of a _part_ is competent to disturb the whole system;

and conversely, that disturbance of the _whole system_ is competent to

disturb any _part_. That the disturbance may _commence_ in the brain or

nervous system, may then disturb the various organs, and that these may

again by reflected action disturb the brain, and so reciprocally; and

that in all these cases tranquillity of the digestive organs is of the

very first consequence; not merely from its abstract importance, but

from the influence it exerts on the state of the nervous system.

With respect to any influences immediately directed to the nervous

system, these we apprehend to be few and simple; some kinds of

medicine, are, no doubt, in particular cases useful, none are

susceptible of _general_ application. None of them are _certain_;

and sedatives of all kinds, which appear to have the most direct

influence on the nervous system, either require to be employed with

the utmost caution, or are in the highest degree objectionable. But

there are other _direct_ influences, certainly; and very important

they are. Quiet, avoidance of disturbing external impressions, whether

of light, sound, temperature, &c. whether in fact of mind or body;

but, in the majority of mankind, how few of them we can, in a strictly

philosophical sense, command. We are therefore driven to other sources

of disturbance; and in the digestive organs we find those on which we

can exert great influence, and in which tranquillity, however procured

or under whatever circumstances, is _certain_, _pro tanto_, to relieve

the whole system. This Abernethy attempted, and with a success which

was remarkable in no cases more than those which had resisted all more

ordinary modes of proceeding; by general measures, by simplicity of

diet, by occasional solicitation of this or that organ, by air and

exercise, and measures which were directed to the general health. No

doubt in some cases he failed, and so we shall in many; but let us look

boldly at the cause, and see whether we do not fail a great deal more

from our own ignorance than from any natural impossibility.

To examine the question, we must for the moment forget our admiration

of Abernethy; be no longer dazzled by his genius, but look only to our

duty; endeavour to discover his defects, or rather those of the state

of the question when he left us, and see what further investigation has

afforded in aid of supplying them.

In the first place, we must examine a little further that proposition

which we have seen both in Hunter and Abernethy under different forms.

Hunter says the disturbance of the organ sympathizing is sometimes more

prominent than that of the organ with which it sympathizes. Abernethy

says that the organ primarily affected is sometimes very little

apparently disturbed, or not even perceptibly so.

Now, from both these statements, we find that there may be no signs

in the primarily affected organ; which, practically rendered, is

nothing more or less than saying that in many cases we must not seek

for the primarily affected organ where _the symptoms are_; and this

is a great fact: because, although it does not necessarily teach us

what we must do, it exposes the broken reed on which so many rely. Now

the further point, which, as we would contend, time and labour have

supplied, is first this—that what Hunter had mentioned as one feature

in the history of the sympathies of different organs, and Abernethy as

an occasional or not unfrequent occurrence, is, in disorders of any

standing, and with the exception of mechanical injury, _in fact the

rule_—the _symptoms_ of disorder being almost _never_ in the primary

organ; nay, even organic change (disease) is for the _most part_ first

seen in a _secondarily_ affected organ. In regard to primarily affected

parts, the skin only excepted, they will be found, in the vast majority

of cases, to be one or other of the digestive organs.

I will endeavour to render the cause of this intelligible. A minute

examination of what happens in a living person, especially if it

be extended to some thousands of cases, will soon disclose to the

most unlettered person a few instructive facts, showing that Nature

has a regular plan of dealing with _all_ injurious influences,

which, however _various_ many of the _details_ may be, is in general

character exquisitely simple, surprisingly beautiful, and intelligibly

conservative; and that the various modes on which she exercises this

plan, from the cradle to the grave, are, in _frequency, directly in

the order of their conservative tendency_. Let us explain. There is no

dearth of illustration; the _facts_ are bewilderingly abundant; the

difficulty is which to choose, and how to give them an intelligible

_general expression_. Let us take a single case. We know that if a mote

gets into the eye, there is irritation, immediately there is flow of

blood to the part, a gland pours forth an abundant supply of tears,

and the substance is probably washed out. Very well; we say that is

intelligible. But suppose you have the vapour of turpentine, or any

other irritant, the same thing happens; but still you cannot give quite

the same _mechanical_ explanation.

Again—substances which affect the mouth, nose, and stomach, will

irritate the eye without any contact, and cause a flow of tears.

Lastly, you know that affections of the mind will do this, and where

even we have no _mechanical_ irritant at all.

In _all_ these cases there has been activity of the vessels of the eye,

and in all it has been relieved by secretion. Now this is the universal

mode throughout the body; all irritation of the organs is attended by

secretion; and where this is done, there is no disorder; or rather,

the disorder is relieved: but if organs are irritated _continuously_,

another thing happens, and that is, that an organ becomes unable to

secrete constantly more than is natural, and then _some other_ organ,

less irritated in the commencement, takes on an additional duty—that

is, the duty of the animal economy is _still done_, but _not equally_

distributed.

This is the state in which most people are in crowded cities, and

who live in the ordinary luxury or the ordinary habits of civilized

society, according to the section to which they may belong. It is easy,

in such cases, to detect those differences which distinguish this state

from what is called condition or perfect health, as we have elsewhere

shown[32].

But of course there is _a limit to this power_ in organs of taking on

additional or compensating actions; and when this limit is exceeded,

then those actions are instituted which we call Disease. The site is

_seldom found_ to be that of the original disturbance; and usually

for a very plain reason—because there it would be more dangerous, or

fatal. It would be scarcely less serious in many cases, even though

placed on organs _secondarily_ affected; and therefore it is more

usually determined _to the surface_ of the body; where, taking them

simply in the order of their greatest number, or frequency, we find the

first class of diseased appearances, and which strikingly impress the

real nature of _the law_. They are the most numerous, most obviously

dependent on general disturbance, and most conservative, as being least

fatal. Diseases of the skin are those to which we allude, and which, in

the characters I have mentioned, exceed all other diseases.

Again—the next surface is that involution of the skin which covers the

eye, and which lines the mouth, throat, and the whole of the interior

surface of the respiratory tubes and the digestive organs. Here again

we find the _next_ seat of greatest frequency, and the conservative

tendency, to coincide. We need only refer to the comparative frequency

of what are called colds, ordinary sore throat, and so forth; as

contrasted with those more serious diseases which occur in the

corresponding surfaces of the respiratory organs and alimentary canal.

In tracing diseases onwards in the order of their number, we never lose

sight of this conservative tendency. When _organs_ become involved

in disease, we find that, for once that the _substance_ of the organ

is so _affected_, the _membrane covering_ it is affected a hundred,

perhaps a thousand times. This is equally observable with respect to

the brain, heart, lungs, digestive organs, and some other parts; and it

is of great importance practically to know how readily affections are

transferred from the _lining_ of the alimentary canal and other parts

to the membrane _covering_ it, rather than to the intermediate texture

of the organ; again impressing, though now in a dangerous type truly,

the conservative _tendency_ of the law.

Finally, then, we arrive at diseases of Organs; and here we see this

conservative tendency still typed in the site first chosen, which is

almost always (where we can distinguish the two structures) not so

much in the _actual tissue_ of the organ as in that which connects it

together—what we term the _cellular tissue_.

This is remarkable in the lungs; where tubercular deposits are first

seated; not in the essential structures of the organs, but in those

by which they are joined together. All those various depositions also

which are called tumours, generally begin in, and are frequently

confined to, the _cellular tissue_; and even though there is, in

certain malignant forms of tumour, a disposition to locate themselves

in organs, there is a very curious tendency towards such, as may have

_already fulfilled_ their purposes in the animal economy.

We might multiply these illustrations to a tedious extent. We might

show, for example, in the eye, how curiously the greatest number of

diseases in that organ are placed in structures least dangerous to

the organ; and even when the organ is spoiled, so to speak, how much

more frequently this is in relation to its function as _an optical

instrument_, than to the structure which forms the link with the brain,

as _an organ of sensation_. I must, however, refer those who wish to

see more of the subject, to the work[33] in which it is more fully

discussed, under the term, "The Law of Inflammation," which is a bad

phrase, as imperfectly expressing the law; but as the greatest evils it

exposes occur in cases of Inflammation, and as it shows the essential

nature of that process to be entirely distinct from the characters

which had been usually ascribed to it, every one of which may be absent

so that expression was somewhat hastily given to the generalization

which seemed best to express a great practical fact.

To return to the bearing of all this on Abernethy's views, and in

relation to organs primarily or secondarily affected. In obedience to

the conservative law to which I have above alluded, defective function

in one organ is usually accompanied by increased action in some other;

and thus it happens that the symptoms are _almost always_ in one organ,

whilst the cause, or originally injurious influence, has acted on

another. The general reader will, of course, understand that we are not

speaking of direct mechanical injury to an organ. _Now_ all the most

recondite diseases of the kidney are already acknowledged by many to

be seated in a secondarily affected organ. Still the practice is, in

too many instances, a _strange mixture_ of that which is in accordance

with the true view, more or less marred by much _that is in opposition

to it_; because it often includes that which is certain more or less to

_disturb_ the organ which it should be the object to tranquillize or

relieve.

In the same manner, the lungs and heart are continually disordered,

and ultimately diseased, from causes which primarily act on the liver;

and I have seen such a case treated with cod-liver oil and bitter

ales, with a result which could not but be disastrous. The liver sends

an enormous quantity of blood to the heart and lungs, from which

it ought previously to have extracted a certain quantity of carbon

(bile). If this be not done, the heart and lungs are oppressed both

by the quantity and the quality of the blood sent to them. If nothing

happen in either of the various sites I have mentioned, the blood must

be got rid of; and it is so. In many cases, a vessel gives way; or

blood is poured out from a vessel; or blood is employed in building

up the structures of disease; but then the _symptoms_ are frequently

altogether in the chest, and not a sign of anything wrong in the liver.

I cannot go on with the multitudinous illustrations of these

principles. The law is to determine injurious influences to the

surface. Deposition in the cellular tissue of the lung is bad enough;

but it is better—that is, less certainly fatal—there, than in the

respiratory tubes: and that is the explanation.

But now comes the practical point. How is the primary organ to be

got at? because that is the way to carry out the removal of the

impediments to the sanative processes of nature, which, in many cases,

no _mere general_ treatment can accomplish. This is to be found by an

examination into the _whole_ (that is, the former _as well as_ the more

recent) history of the case, and adding the further test of a real and

careful observation of all the secretions.

By going back to the former life of the patient, we shall seldom fail

to discover the various influences to which he has been subjected, and

the organs to which they have been originally addressed. Having made up

our minds, from our previous knowledge of injurious influences, on what

organ they will most probably have acted, we now test this, not merely

by inquiry after symptoms—and it may be not by symptoms at all—but

by careful observation of the _actual work_ of the suspected organ.

In this way we almost certainly discover the real offender; in other

words, the organ primarily affected. This is of immense importance;

for we confidently affirm that _one single beneficial impression made

on it_ will do more in a short time—nay, in some rare instances,

_in a single day_—than years of routine treatment, that has been,

nevertheless, of good _general_ tendency.

In treating it—_i. e._ the primary organ—however, great

discrimination is necessary. If it be already organically affected,

that treatment which would be, under _other circumstances_, necessary,

becomes either objectionable, or requiring the utmost caution.

For although an organ _diseased in structure_ will, under some

circumstances, as Abernethy long ago observed, yield its characteristic

secretion, yet, unless we know the _extent_ of the disease, which is

just the thing we can almost never be certain about, excitement of

it is _never without danger_. We should therefore excite the primary

organ with more or less energy, with more or less caution, or _not at

all_, according to circumstances. If we determine on not exciting it,

we should then act on organs _with_ which it has ordinarily closest

_community_ of function, or on whose integrity we can most depend.

For choice, we prefer organs which, in a natural state, have nearest

identity of function, as having the readiest sympathy, it may be, with

each other. Yet so universal is the sympathy between all the organs,

that there is no one that will not, under certain circumstances, or

which may not be induced, perhaps, by judicious management, to take on

_compensating_ actions.

We must not here pursue this subject further. We have endeavoured to

sketch certain extensions of the views of Mr. Abernethy, and can only

refer the profession and the public, for the facts and arguments which

demonstrate and illustrate them, to those works in which they have

been enunciated[34]. They have now been subjected to severer trials,

and abundant criticisms. So far as we know, they have not been shaken;

but if there be any merit in them, if they shall have made any nearer

approach to a definite science, or sketched the proofs that Induction

alone can place us in a position to talk of science at all, _they are

still sequences which have been arrived at by a steady analysis of

Abernethy's views_. It was he who taught us, in our pupil days, first

to think on such subjects; to him we owe the first glimpse we ever

had of the imperfect state of medical and surgical science; and if we

do not wholly owe to him the means by which we conceive it can alone

be rendered more perfect and satisfactory, he has at least in part

exemplified the application of them. If we have made some advances on

what he left us, and added to his beautiful and simple general views,

something more definite on some points, something more _analytical_ on

others,—still, inasmuch as they are clear deductions from the views he

has left us, and from such views alone, such advances remind us that

the study of his principles serves but to demonstrate their increasing

usefulness, and to augment the sum of our obligations.

SECTION.

Mr. Abernethy's book "On the Constitutional Origin of Local Diseases"

had an extensive circulation, and excited a great deal of attention

from the public as well as the profession.

As a work which may be read as it were in two days, so as a person

read it with one or other subject, it produced a great variety of

impressions. It may be read simply as a narrative of a number of facts,

with the inferences immediately deducible from them. All this is plain

and intelligible at once to anybody, and of great practical value; but

the work contains numerous observations of a suggestive kind, which

require careful thought, and some previous knowledge, to enable a

person to estimate their value, or to trace their onward relations.

The impression made by the work on different minds varied, of course,

with the reader, his information, and, in some sort, with the spirit in

which it was studied. Some, who had, in their solitary rides, and in

the equally solitary responsibilities of country practice, been obliged

to think for themselves, recognized, in the orderly statement of

clearly enunciated views, facts and principles which they had already

seen exemplified in their own experience, and hailed with admiration

and pleasure a book which realized their own ideas, and supplied a

rational explanation of their truth and value.

Some, who had never thought much on the subject, and were very

ill-disposed to begin, regarded his ideas as exaggerated, and hastily

dismissed the subjects, with the conclusion that he was a clever man,

but too full of theory, and too much disposed to look to the stomach or

the digestive organs. Others, making very little distinction between

what they heard of the man, the book, or his practice, and probably

not having seen either, but deriving only a kind of dreamy notion of a

clever man with many peculiarities, would say that he was mad, or an

enthusiast. Still, a great many of the thinking portion of the public

and the profession held a different tone. The book was recognized as

an intelligible enunciation of definite views—rather a new thing in

medical science. The application of them became more and more general;

his pupils were everywhere disseminating them, more or less, in the

navy, in the army, in the provinces, and in America.

Still, it must not be imagined that his principles became diffused

with that rapidity which might have been inferred from his

numerous and attentive class. Constituted as medical education is,

but more especially as it was at that time—for it is _slowly_

improving—pupils were almost entirely absorbed in the conventional

requisitions for examination. There, they were not questioned as to

the laws of the animal economy, nor any _laws_ at all, nor even on any

real axioms in approximation to them; but simply as to plain anatomy,

the relative situation of parts, and such of the ordinary surgery of

the day as had received the approbation of the Examiners, who were,

for the time, the authorities in the profession. Therefore, out of a

large number, there were comparatively few whose attentions were not

too much absorbed by the prescribed curriculum of hospital routine to

study principles: a curriculum constructed as if the object were to see

how much could be learnt in a short time, without detriment to the very

moderate requisitions of the examination at the College of Surgeons.

But if comparatively few had time to study Abernethy's lectures at the

time, a great many had treasured up his remarks. As the impressions we

receive in our childhood, before we are capable of thinking of their

value, are vividly rekindled by the experience of real life, so many

of the more suggestive lessons of Abernethy's lectures, which passed

comparatively unheeded at the time, or were swamped in the "getting

up" of the requisitions for an examination at the College, recurred in

after days in all their force and truthfulness. Many, however, with

more time, and perhaps more zeal, endeavoured to thoroughly master his

views; and now and then he was gratified by evidence, that time had

only served to mature the conviction of the pupils—in dedications and

other complimentary recognitions, in the works of such of them as had

been induced to publish any portion of their own experience.

However various, too, the impressions made by his book, there are two

things certain; viz. that he was much talked of, and the book had an

extensive sale, went through several editions, and served to give the

_public_ some notion of those principles which he was so beautifully

unfolding to the younger portions of the profession in his lectures.

Besides, although there were not wanting those who spoke disparagingly

of him, still, as an old and very far-seeing colleague of our own

used to say, with perhaps too much truth, when canvassing the various

difficulties of a medical man's progress in the metropolis, "A man

had better be spoken ill of, than not spoken of at all." He was now

beginning to be very largely consulted. The Public had "got hold of

him," as we once heard a fashionable physician phrase it, and he soon

obtained a large practice. A great many consulted him for very good

reasons, and probably many for little better reason than that he was

the fashion.

Abernethy had now an amount of practice to which neither he nor any

other man could do full justice. Finding it impossible to make people

understand his views in the time usually allotted for consultation, he

now referred his patients to his book, and especially page 72. This has

been made the subject of a great deal of quizzing, and of something

besides, not altogether quite so good-natured. For our parts, we

think it the most natural thing in the world to refer a patient to a

book, which may contain more in full the principles we desire them to

understand, than we can hope to find opportunity to explain at the time

of consultation. We think that if asking a few questions, and writing

a prescription (and we are here only thinking of a reasonably fair

average time visit), be worth a guinea, the explaining a principle,

or so placing a plan before a patient that his following it may be

assisted and secured, is worth fifty times as much; and it came

particularly well from Abernethy, one of whose lessons, and a most

excellent lesson too, was the remark, "That if a medical man thought

he had done his duty when he had written a prescription, and a patient

regarded his as fulfilled when he had swallowed it, they were both

deceived."

As we are convinced that, _cæteris paribus_, success in medical

treatment is indefinitely promoted by both patient and surgeon _clearly

understanding_ each other as to _principles_, we think it would be of

great use if every medical man, who has any definite principles of

practice, were to explain them in short printed digests. Nay, we have

sometimes thought it would be useful to both parties, if, in addition

to the inquiries and advice given at consultation, a medical man should

have brief printed digests of the _general_ nature and relations of

most of the well-defined diseases. A careful perusal of one of these

would help the patients to comprehend the nature and objects of the

advice given, tend to the diffusion of useful knowledge, and in time

help them to understand whether their treatment were conducted on

scientific views, or merely a respectable sort of empiricism. What is

here intended might be printed on a sheet of note paper; and, whilst it

would be of great service to the patient, would form _no bad test of

the clearness and definite principles of the medical attendant_. There

is no doubt that Abernethy did good service by referring patients to

his book. It led some to think for themselves, and it also assisted,

_pro tanto_, in doing away with that absurd idea which supposes

something in medical practice inappreciable by the public.

At this time, whilst, with a considerable indifference to money, he

was making a large income, still he was obliged to work hard for it.

He had as yet no emolument from the Hospital; he was still only an

assistant surgeon. The tenacity of office, of which assistant surgeons

so commonly complain, they have themselves seldom failed to exercise

when they have become surgeons (Mr. Abernethy, however, excepted). The

long tenure of office by his senior (Sir James Earle) wearied him, and

was at times a source of not very agreeable discussions.

On one occasion, Sir James was reported to have given Abernethy to

understand that, on the occurrence of a certain event, on which he

would obtain an accession of property, he, Sir James, would certainly

resign the surgeoncy of the hospital. About the time that the event

occurred, he happened one day to call on Abernethy, and was reminded

of what he had been understood to have promised. Sir James, however,

having, we suppose, a different impression of the facts, denied ever

having given such a pledge. The affirmative and negative were more than

once exchanged, and not in the most courteous manner. When Sir James

was going to take his leave, Abernethy opened the door for him, and,

as he had always something quaint or humorous to close a conversation

with, he said, at parting, "Well, Sir James, it comes to this: you say

that you did not promise to resign the surgeoncy of the hospital; I, on

the contrary, affirm that you did: now all I have to add is, —— the

liar!"

In 1813, Abernethy accepted the surgeoncy of Christ's Hospital, which

he held until 1828, a short time before he retired from practice.

In 1814, he was appointed Professor of Anatomy and Surgery to the

College of Surgeons—an appointment which could be, at this period, of

little service to him, whatever lustre it might reflect on the College,

where he gave lectures with a result which has not always followed

on that appointment: namely, of still adding to his reputation. He

was one of the few who addressed the elders of the profession without

impressing the conviction that he had been too much employed in

addressing pupils. He had given lectures two years in succession, when,

in 1816, circumstances occurred which will occupy us for some little

time. A new scene will be opening upon us; and this suggests the period

(1815-16) as convenient for taking a retrospect, and a sort of general

view of Abernethy's position.

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

Solano, July, 1590.]

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

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

1838. Highley.]

[Footnote 34: "Medicine and Surgery One Inductive Science;" and "On

Tumours," Art. "Treatment of Organs."]

CHAPTER XVII.

"Sperat infestis, metuit secundis,

Alteram sortem bene preparatum Pectus."

HOR.

"Whoe'er enjoys th' untroubled breast,

With Virtue's tranquil wisdom blest,

With hope the gloomy hour can cheer,

And temper happiness with fear."

When we look abroad amongst mankind—nay, even in the contracted

sphere of our own experience—it is interesting to observe the varied

current of human life in different cases. In some, from the cradle

to the grave, life has been beset with difficulties; it has been a

continued struggle; the breath seems to have been first drawn, and

finally yielded up, amidst the multifarious oppositions and agitations

of adversity. In other instances, life seems like an easy, smoothly

gliding stream, gently bearing Man on to what had appeared to be the

haven of his wishes; and the little voyage has been begun and completed

without the appearance of a ripple. All varieties are, no doubt, the

result of constantly operating laws. Of these, many are probably

inscrutable by us; many more, no doubt, escape our observation. The

unforeseen nature of many events confers the character of mystery on

any attempt at foresight; yet, when we take a careful retrospect of

a life, it is curious to observe how naturally the secondary causes

appear to have produced the results by which they were followed; but

which, beforehand, no one had thought of predicting.

Varied, however, as is the course of human life, few men have

arrived at eminence without difficulty. We do not mean that ephemeral

prominence of "position" which makes them marked in their day;

but that which leaves the impression of their minds on the age in

which they lived, or on the science or other pursuit which they had

chosen—original minds, who have enlarged the boundaries of our

knowledge. Such men usually have the ample gifts of nature with

which they are endowed, somewhat counterbalanced by the difficulty

experienced in the successful application of them.

Abernethy had not been altogether exempt from such difficulties. With

a sensitive organization, he had had to make his own way; he had

experienced the difficulties which attend the advocacy of opinions

and principles which were opposed to, or at all events different

from, those generally entertained. He had had to encounter that

misconstruction, misrepresentation, ridicule, even malice—save the

mark!—which are too frequently provoked by any attempts to tell people

that there is something more correct than the notions which they have

been accustomed to value. Still, when we compare Abernethy's course

with that of _many_—we had almost said _most_—benefactors to science,

he might be said to have been a fortunate man. If a man has power, and

a "place to stand on"—and Abernethy had both—truth will tell at last.

A retired spot, a room in an obscure street, near St. Bartholomew's,

had been by his unaided talents expanded into a theatre within the

walls of the hospital. This was becoming again crowded; and, although

it formed a satisfactory arena for the development and illustration of

his principles, the increasing audiences were significant of the coming

necessity of a still larger building; which was, in fact, a few years

afterwards, constructed. He had indeed arrived, as we imagine, at a

point which was comparatively smooth water, and which we are inclined

to regard as the zenith of his career.

In the opening of his beautiful lectures at the College, Abernethy,

in one of his warm and earnest endeavours to animate his audience to

regard benevolence, and the love of truth, as the impulses which could

alone urge on, and sustain, industry in cultivating the "Science" of

our profession, had observed that, "unfortunately, a man might attain

to a considerable share of public reputation without being a real

student of his profession." There have been indeed too many examples

of that, as also of those who, after years of labour, have failed to

obtain a scanty living.

Abernethy had been a real and laborious student in science, and he

was now reaping an abundant and well-deserved fruition. Few surgeons

have arrived at a position so calculated to satisfy the most exacting

ambition. Although the full extent and bearing of his principles were

by no means universally understood, yet the general importance of them

was so, and in some measure appreciated. In a greater or less degree,

they were answering the tests afforded by the bedside in all parts of

the world.

Ample, therefore, as might be the harvest he was reaping in a large

practice, he was enjoying a still higher fruition in the kind of

estimation in which he was held. He had a high reputation with

the public; one still higher amongst men of science. His crowded

waiting-room was a satisfactory evidence of the one, and the manner in

which his name was received here, on the Continent, and in America, a

gratifying testimony of the other. He was regarded much more in the

light of a man of enlarged mind—a medical philosopher—than merely as

a distinguished surgeon.

From the very small beginnings left by Mr. Pott, he had raised the

school of St. Bartholomew's to an eminence never before attained by

any school in this country. I think I may say that, in its _peculiar

character_, it was at that time (1816) unrivalled.

Sir Astley Cooper was in great force and in high repute at this time;

and, combining as he did the schools of _two_ large hospitals, had, I

believe, even a larger class. Both schools, no doubt, endeavoured to

combine what is not, perhaps, very intelligibly conveyed by the terms

practical and scientific; but the universal impression, assigned the

latter as the distinguishing excellence of Mr. Abernethy, whilst the

former was held to express more happily the characteristic of his

eminent contemporary.

Whatever school, however, a London student might have selected as

his Alma Mater, it was very common for those whose purse, time, or

plans permitted it, to attend one or more courses of Abernethy's

lectures; and it was pleasing to recognize the graceful concession to

Mr. Abernethy's peculiar excellence afforded by the attendance of some

of Sir Astley's pupils, and his since distinguished relatives, at the

lectures of Abernethy.

As I have said, his practice was extensive, and of the most lucrative

kind; that is, it consisted largely of consultations at home. Still, he

had patients to visit, and, as he was very remarkable for punctuality

in all his appointments, was therefore not unfrequently obliged to

leave home before he had seen the whole of those who had applied to

him. The extent of his practice was the more remarkable, as there was

a very general impression, however exaggerated it might be, that his

manners were unkind and repulsive. His pupils were enthusiastically

fond of him; and it was difficult to know which was the dominant

feeling—their admiration of his talents, or their personal regard.

Some of the most distinguished men had been of their number; and it

would be gratifying to us to enumerate the very complimentary catalogue

of able men who have been indebted for much of their eminence and

success to the lessons of Abernethy; but as, in doing so, we might

possibly, in our ignorance, omit some names which ought to be recorded,

we forego this pleasure, lest we should unintentionally appear to

neglect any professional brother whom we ought to have remembered.

In 1812-13, the pupils had presented Mr. Abernethy with a piece of

plate, "as a testimony of their respect and gratitude." The arrangement

of the matter was confided chiefly to the present Sir James Eyre, Mr.

Stowe of Buckingham, and Mr. George Bullen. In a very interesting

letter, with which I have been favoured by Mr. Stowe, amongst other

matters hereafter to be mentioned, it is stated that the plate was

delivered at Abernethy's house on the 1st of April; and as he had no

more entirely escaped such things than other medical men, he at first

regarded it as a hoax. But when the contents were exposed, and he

discovered the truth, he became much affected.

The regard of the pupils was always the thing nearest his heart. On

meeting the class at the hospital, he essayed to express his feelings;

but finding that he should only break down, he adopted the same course

as he had employed on another memorable occasion, and _wrote_ his

acknowledgments, a copy of which was suspended against the wall of the

theatre.

It is due to our worthy and kind-hearted contemporary, Sir James Eyre,

to add that Mr. Stowe observes in his letter, that, of all others, Sir

James was the most zealous promoter of a movement so creditable to all

parties. Some years after this, another subscription was commenced by

the pupils for a portrait of Abernethy, which was painted by Sir Thomas

Lawrence, and engraved by Bromley. It was after this engraving that

Mr. Cook executed the portrait which forms the frontispiece of the

present volume. Sir Thomas, and the engraver after him, have been most

successful. He has caught one of Mr. Abernethy's most characteristic

expressions. We see him as he often stood when addressing the

_anatomical_ class. We think it impossible to combine more of of him

in one view. We fancy we see his acute penetration, his thoughtful

expression, his archness and humour, and his benevolence, all most

happily delineated, whilst the general position and manner is eminently

faithful. In his surgical lectures, he was generally seated; and in

the lithograph, he is represented in the position which he almost

invariably assumed when he was enunciating the proposition which is

placed beneath the engraving. It is the work of a young artist who was

considered to evince great promise of future excellence; but who, we

regret to say, died last year—Mr. Leighton.

In 1815, he had been appointed surgeon to the hospital, after

twenty-eight years' tenure of the assistant surgeoncy; a subject that

we merely mention now, as we shall be obliged to revert to it when we

consider the subject of the "Hospital System."

At the time to which we allude, lecturing had become so easy as to

appear little more than amusement to him; yet there were (we speak of

about 1816) no signs of neglect or forgetfulness. His own interest in

the subject was sustained throughout; but as his unrivalled lecturing

will be more fully described, we must not anticipate. Few old pupils

visited London without contriving to get to the hospital at lecture

time. The drudgery of the early morning anatomical demonstration was

taken off his hands by a gentleman who performed his task with credit

to himself and with justice to his pupils.

Abernethy, at this time, in addition to a successful school, a large

and attached class, a solid and world-wide reputation, was receiving

numerous proofs that his principles were recognized; that, however

imperfectly adopted, they were gaining ground; and that if all his

suggestions were not universally admitted, they were becoming axiomatic

with some of the first surgeons, both in this and other countries.

We think it not improbable that it was somewhere about this period

that it was proposed to confer on him the honour of a Baronetcy. We

had long been familiar with the fact; but not regarding it as very

important, and having nothing in proof of it but the generally received

impression, we omitted any reference to it in the first edition

of these Memoirs. Finding, however, more interest attached to the

circumstance than we expected, we have communicated with the family on

the subject, and have ascertained that all the circumstances are fresh

in their recollection, although they cannot recall the exact period at

which they occurred.

His first announcement of the fact to his family was at table, by his

jocosely saying: "Lady Abernethy, will you allow me to assist you

to—?" &c. Having had his joke, he then formally announced to them

the fact, together with the reasons which had induced him to decline

the proffered honour—namely, that he did not consider his fortune

sufficient, after having made what he regarded as only a necessary

provision for his family.

It is probable that his motives were of a mixed character. We do not

believe that he attached much value to this kind of distinction, and

that, had he availed himself of the offer, it would have been rather

from a kind of deference to the recognition it afforded of the claims,

and thus indirectly promoting the cultivation of Science, than for

any other reason. It was not but that he held rank and station in the

respect which is justly due to them; but that he regarded titles as

no very certain tests of scientific distinction. Enthusiastic in his

admiration of intellectual, still more of moral excellence, he had

something scarcely less than coldness in regard to the value of mere

titles; whilst he beheld, with something like repulsion, the flattery

to which their possessors were so often exposed.

There are men who have so individualized themselves that they seem

to obscure their identity by any new title. John Hunter was scarcely

known by any less simple appellation. We hardly now say "_Mr._" Hunter

without feeling that we may be misunderstood. It begins to have a sound

like "Mr." Milton or "Mr." Shakspeare; Abernethy and John Abernethy are

fast becoming the only recognized designations of our philosophical

surgeon, for even the modest prefix of _Mr._ is fast going into disuse.

Be this as it may, it is certain he declined the honour; and to us it

is equally so that he felt at least indifferent to it; for although

the good sense and good feeling implied in the reasons alleged were

characteristic, yet, had they constituted the only motive, he might,

with his abundant opportunities, have removed that objection in a very

reasonable time, without difficulty.

It is perhaps significant of the measured interest with which

Mr. Abernethy regarded the acquisition of a Baronetcy, that the

family could not recollect the period at which it was offered. This

information, however, I obtained from Sir Benjamin Brodie, who has

kindly allowed me to record the fact in the following reply to my

inquiry on the subject.

"14, Saville Row,

"November 16, 1854.

"MY DEAR SIR,

"My answer to your inquiry may be given in a very few words. I

perfectly well remember the having been informed by the late Sir

John Becket that he had been commissioned by Lord Liverpool to

offer Mr. Abernethy, on the part of the Crown, the honor of being

created a Baronet, which, however, Mr. Abernethy declined.

"I am, dear SIR,

"Yours faithfully,

"B. C. BRODIE.

"G. MACILWAIN, Esq."