It might be supposed that, with ample means, the Governors of

Hospitals, by adopting such previous tests as were in their power,

would have secured the most efficient officers, by paying them

remunerative salaries; and, having retained them as long as their

services were deemed efficient, or the duration of them justified, that

they would have released them from the necessity of further exertion

by a retiring pension. No such thing. The Hospital gives nothing:

actually, there is a small nominal retaining fee, as it were, of about

£60 to £100 a year, and the medical officer is left to obtain his

remuneration for time, trouble, and health, by such private practice as

his reputation or the _prestige_ of being attached to an hospital may

afford; from fees from pupils, or such other means as the position he

occupies may place within his power.

He very naturally sets to work to do the best he can; and from this

first budding, we very soon arrive at the full blossom of the System;

one effect of which is, that, in hospitals, which have so large a care

of public health—institutions which, whether correctly or incorrectly,

give so much of the tone to the medical opinions of the day, which

exert, either directly or indirectly, an influence on the claims of

hundreds to public confidence—that in these hospitals there is _not

one single surgeoncy that is fairly and bonâ fide open to scientific

competition_.

Let us now examine a little into the machinery by which these results

are brought out.

The experience afforded by the hospitals necessarily supplies abundant

means for instructing students in surgery. They are accordingly

admitted on paying certain fees to the surgeon; and this at once

supplies a large revenue. This revenue is of course regulated by the

number of pupils; and as there are in London many hospitals, so it

follows that there is an active competition. Thus, some time before

the season commences, the advertisements of the medical schools occupy

a considerable space in the public journals, and circulars are also

liberally distributed.

Well, the points here, as in all other cases, are the advantages

offered, and the price paid—the maximum and minimum respectively. Here

we arrive at the elements of numerous evils.

Students are not always—and before they try, hardly ever—judges of

a school. The general reputation of a man (as he is never subjected

to open competition) is no test whatever of his comparative power

in _teaching_ students; but they are accustomed to ascribe great

importance to operations; and, _cæteris paribus_, they incline to

prefer that hospital where the greatest number are supposed to be

performed.

This arises from various causes; in some of which the public play no

unimportant part. The student has perhaps seen, in the country, a

good deal of medical and surgical practice; but very few operations.

His stay in London is comparatively short, averaging, perhaps, not

more than the better part of two years. Unnecessary length of time is

generally inconvenient, always expensive, and the student is naturally

anxious to see _most_ of that which he will have _least_ opportunity

of observing elsewhere. Moreover, he knows that when he returns to the

country he may save twenty limbs, before he obtains the same amount

of _reputation_ that he may possibly get by _one amputation_—the

ignorance of the public, here, not appreciating results which very

probably involved the exercise of the highest talent, whilst they are

ready to confer a very profitable distinction on that which does not

necessarily involve any talent at all.

We have no wish whatever, and certainly there is no necessity, for

straining any point in reference to this very serious matter; but these

two facts are indisputable—that the surgeons obtain their remuneration

from the hospitals by the fees they obtain from the pupils; and,

_cæteris paribus_, the pupils will flock the thickest where they expect

to see most operations.

The next thing that we would submit, is that the _prestige_ in favour

of operations is both directly and indirectly opposed to the progress

of scientific surgery. Almost all operations, commonly so termed, are

examples of defective science. To practical common sense, therefore,

it would appear a very infelicitous mode of obtaining the maximum of

a man's genius in aid of the _diminution_ of operations, to open to

him a prospect of enriching himself by the _multiplication_ of them.

We desire to consider the subject with reference to its scientific

bearings only, and would avoid entirely, were that possible, any appeal

merely to the feelings. Such impulses, however right, are apt to be

paroxysmal and uncertain, unless supported by the intellect. But, on

such a subject, the feelings must necessarily become more or less

interested. Wherever a system takes a wrong direction, a great many

minor evils insensibly grow out of it.

The erection of a theatre for the purpose of operating, though founded

on a feasible pretext, is a very questionable measure; and, unless of

clear advantage to the profession or the public, is surely not without

some character of repulsion. As regards art and science, it is certain

that not more than twenty or thirty can be near enough in the theatre

to see anything that can be really instructive in the performance

of operations. In the absence of actual advantage, therefore, an

exhibition of this kind is more calculated to give publicity to

the surgeon operating, than it is to raise the tone or chasten the

feelings of men about to enter a profession which almost daily

establishes requisitions for our highest faculties. Operations without

opportunities of real instruction, are merely unprofitable expenditure

of valuable time. That which is viewed as a sort of _exhibition_

to-day, may be with difficulty regarded in the light of a _serious

duty_ to-morrow. Were the object to tax the sensibility of a student,

and blind him to any higher association with pain and suffering than

that afforded by custom and chloroform, and to substitute for a

dignified self-possession and sympathy with suffering, which each kept

the other in due control, an indifference to everything save adroitness

of manipulation and mechanical display,—no machinery could be better

calculated to effect such objects; but science and humanity require

very different qualifications, and experience has shown that they are

neither incompatible nor beyond our power.

The humanity and science that beholds, in operative surgery, the lowest

of our employments, and which would thence be impelled to seek, and as

experience has taught us to seek successfully, to diminish the number

of such exhibitions, and to lessen the suffering of those which are

still retained, is perfectly compatible with coolness and skill in the

performance of them.

When we speak of lessening pain, we must not be understood as alluding

to chloroform, or agencies of that kind. We have, on the contrary, the

greatest distrust of their utility; we do not hesitate to admit the

propriety of their use in certain cases; but we are satisfied that,

as at present employed, a very few years will make a great change.

Many a so-called incurable case has been shown to be curable by the

hesitation of the patient to submit to an operation. We have published

some ourselves, wherein we joined in recommending the measure which the

patient declined. Many deaths that we _do know_ have already occurred

from the use of chloroform; and a _significant_ remark was made by a

man who had considerable reputation in this way. He said: "Chloroform

is a good thing for operating surgeons."

To return from this digression. The most distinguished surgeons ever

known in this country have shown us how to combine, in the highest

degree, dexterity and skill, with science and humanity; together with

a just estimate of the low position occupied by operations in the

scale of our important studies. I may allude to two more particularly,

Cheselden and John Hunter; the former, the most expert and successful

operator of his day, in the European sense of the word, has left us a

satisfactory declaration on this subject. Cheselden acknowledges that

he seldom slept much the night previous to the day on which he had any

important operation; but that, once engaged in operating, he was always

firm, and his hand never trembled. John Hunter was not only a good

operator himself, but he deduced from observation one of the greatest

improvements in operative surgery. His discovery had all the elements

of improvement that are possible in this branch of the profession.

An operation which had been founded upon erroneous views of the nature

and relations of the parts affected—which had been always tedious and

painful in performance—which, whether successful or not, entailed much

subsequent suffering, which in its results was highly dangerous, and

which was very commonly followed by the loss of the limb or life,—was

replaced by one founded on more correct views of the disease, easy and

simple in its execution, occupying not more than a very few minutes,

and which, so far as regards the purpose for which it was instituted,

and to which it should be restricted, is almost invariably successful.

If it be performed under circumstances implying conditions _contrary

to those on which Mr. Hunter's operation was founded_, very different

results have no doubt taken place; but, when properly applied, his

operation for aneurism is no doubt one of the greatest improvements in

operative surgery.

John Hunter treats of operations in terms which show how low he rated

that part of our duties. He speaks of them as humiliating examples of

the imperfection of our science, and figures to himself an operator

under the repulsive symbol of an armed savage. "No surgeon," said he,

"should approach the victim of his operation without a sacred dread and

reluctance, and should be _superior to that popular éclat generally

attending painful operations, often only because they are so_, or

because they are expensive to the patient"—p. 210. Abernethy, whose

keen observation saw the difficult web which various sophistries,

to use no harsher term, had thrown around the subject, was very

characteristic in the manner in which he dashed it aside, and pointed

to the salient source of error.

"Never perform an operation," he would say, "on another person, which,

under similar circumstances, you would not have performed on yourself."

The truth is, that operations, to be performed properly, must be

properly studied. They must be frequently performed on the dead, and

afterwards carefully examined. There is a wide difference between

neglecting a necessary study and making that the test of science which

is the most emphatic proof of its imperfection. We have ourselves had

no lack of experience in this branch of the profession, and have

included not a few operations which are too commonly delivered over to

men who are said to devote themselves to special objects. The result of

our experience satisfies us in entertaining the views which the most

distinguished men have held on this subject; whilst we are persuaded

that few things have contributed more to impede the progress of science

than the _abuse_ of operations.

To return to the surgical appointments of the hospital.

The positions which had at first been left without any remuneration,

become, by the machinery described, very lucrative; directly, by the

fees paid by the pupils; and indirectly, in some cases, by keeping the

surgeon constantly before the public. Any _prestige_, therefore, in

obtaining these appointments, is of great value; but, if that do not

really involve _professional excellence_, it is as plain as possible

that the public may be very badly served, and an evil generated equally

opposed to the interests of science and humanity. It is obvious that

the only legitimate grounds of eligibility are moral and professional

superiority, as determined by the test adopted at public schools and

universities—namely, public competition. Now, what are the tests

employed? Without meaning to insinuate that moral or professional

eligibility is _wholly_ disregarded—no system in these days will

support that—still the eligibility depends on a qualification which

few would beforehand have imagined. It is certainly something better

than Mr. Macaulay's joke in relation to the proposed franchise to

the Militia—namely, that the elector should be five feet two—but

something not much more elevated; namely, that a bounty should have

been paid to one of the hospital surgeons in the shape of an apprentice

fee; thus making the holding one of the most responsible offices in the

profession—a condition, which absolutely ignores relative eligibility

of skill, steadiness, assiduity, and humanity; and which recognizes

them only in such shape that the possession of office is practically

made to depend on a point absolutely extrinsic to any one important

requisition recognized by the public or the profession.

We need not insist on the tendency of this system to the protection of

idleness and incapacity, or the injustice inseparable from it to the

young gentlemen whose interests it is supposed to guard. One necessary

consequence is obvious—namely, that the hospitals, instead of having

to select from the general body of pupils, or from the more industrious

or talented of them, is obliged to choose from a very small minority.

It is, in fact, just as if scholarships and fellowships at public

schools and universities were conferred without any reference to the

proofs which the candidates might have given of their talents or

industry; but were distributed to those who had given a certain fee to

a particular professor. Would any man in his senses doubt as to the

influence of such a plan on the interests of classical literature or

mathematical science? It seems to us impossible that men should really

differ on that point, or hesitate to admit that, _mutatis mutandis_,

whatever the science might be, so far as the cultivation of it could

be influenced by system, the result must be alike prejudicial in all

cases. We are, however, far from arriving at the end of the System by

this general statement.

The public and the government, uninformed or unmindful of this

"system," wish to consult authorities on professional matters. They

not unnaturally look to those who hold public appointments, because

these afford the _prestige_ of extensive opportunity, which is supposed

to imply, and under a fair system would ensure, skill and experience.

Men are apt to look at a man's position, without stopping to inquire

_how_ it was obtained; and although position may cut both ways, and in

particular instances "throw a cruel sunshine" over incapacity, still

amongst gentlemen extreme cases are not to be expected; the rule is

much more likely to be a respectable and protected mediocrity, which is

just that tone which has rarely done anything to enlarge the boundaries

of any kind of knowledge.

It happens, however, from the "system," and the position thus given to

those who are supposed to profit by it, that the interests of the poor,

and, in a considerable degree, those of the rich also, are, in a very

large sense, confided to their care.

It thus follows that positions, in themselves highly desirable, and

which enable men to exert considerable influence on the progress of a

science, on the sound condition of which the physical comforts, and in

no small degree the moral condition, of mankind depend, are occupied

by men who have undergone none of those tests which public competition

alone affords, and which the _summi honores_ of almost every other

profession either directly or indirectly imply.

So far for one mode in which the interests of the public are

compromised; but there are many other channels. The government,

ignoring the evils of this system, have placed the regulation of the

surgical branch of the profession in the hands of a body of men whom,

when we examine, we find to be no other than the apprentices we had

recognized at the hospital, grown into the full bloom of a legislative

body—whence again are chosen Presidents, Vice-Presidents, Examiners,

&c., of the Royal College of Surgeons of London!

If, fatigued with this machinery, we walk to the Royal Medical and

Chirurgical Society—a chartered body for the especial cultivation of

science—we meet, as its name would imply, a number of our honoured

brothers, the physicians; but here we find that, whether we observe

Presidents or any other Officers, the influence exerted by the

apprentice system continues; and that, in _almost_ everything surgical,

the _best possible_ individual is an apprentice who has attained his

first position without any public competition. Can any one be surprised

that the published transactions of this society are not of a higher

character. We hope and believe that the point of the wedge is already

inserted, which will, at no distant period, rend asunder this system,

which we shall not trust ourselves by attempting to characterize

farther. But there are points in connection with the interests of

science and of Abernethy which require yet to be noticed.

We need scarcely observe that it would be very desirable that the

interests of science should be entrusted to those who had shown most

assiduity or talent in the cultivation of them; that if operative

surgery be really, as a whole, a series of facts exemplifying the

defects of a science—that whilst every pains should be taken that what

is necessary should be done thoroughly well—all factitious inducement

to multiply their number should be avoided, and especially any which

tended to increase emolument commensurately with their multiplication.

That as operations (with some few exceptions) merely minister to

effects, their real bearings on disease can only be estimated by

knowing the _ultimate result_; and that, in order to this effect,

returns of all operations should be kept, with full accounts of the

cases; the addresses of the patients should also be taken, and such

means as were obvious and practicable employed to obtain the _ultimate

result_ of the case.

Another point which should be attended to in hospitals, is an accurate

notation and return of all cases whatever; so that we might obtain from

statistical records whatever light they might be capable of affording

in aid of the prosecution of a definite science. In this return, a full

history, and _all_ the phenomena of the case, which are known to have

an influence on the Body, should be accurately noted, and in tabular

forms convenient for reference.

The defects of the hospitals in this respect are too well known to

require comment; and we think the profession indebted to Dr. Webster

for the exertions he has made to draw attention to this subject.

In no respect are the hospitals more defective than as regards the

division of labour[75]. To supply the requisitions of a yet dawning

science, there is too much confided to one surgeon; for, at present,

the practical administration and the scientific investigation should be

confided to the same hand. If more be entrusted to one man than can be

performed without great labour, and the greater labour be voluntary, we

shall have little chance of obtaining that full and accurate notation

of facts which all cases furnish more or less the means of obtaining,

and without which the evolution of the maximum of human ability is

absolutely impossible. It seems to us also an imperative duty to avail

ourselves of the experience afforded by the history of other sciences,

in the cultivation of our own.

All sciences have been in as bad a condition as medicine and surgery,

or worse. All sciences have progressed immediately that they were

investigated on a rational plan—a plan, which, simply stated, is

little more than the bringing together _all the facts_ that can be

perceived to bear any relation to the inquiry, and reasoning on them

according to _well-established_ and necessary conditions. If this be

the case, and this plan have never been applied to the investigation

of medical science, we know not how those who are placed in positions

which supply the necessary means can be excused; or how we can halt

in condemning the system under which such a flagitious neglect of

the claims of science and mankind is exemplified. It is true, when

we arrive at the acmé of our convictions of the effects of such a

system, our reflections remind us that such things are "permitted,"

and that ultimately they will work for good; that Man is not destined

to interfere with the ultimate plan and designs of Providence, however

he may be allowed to place his intellect under the direction of a

responsible volition, and to discover the path to the temple of truth,

only after having fruitlessly threaded the mazes of error.

[Footnote 75: We are glad to see that there has at length arisen a

desire, at least in a degree, to correct this evil.]

CHAPTER XXIX.

"Quanto quisque sibi plura negaverit

Ab Dis plura feret."

We believe that there is no greater fallacy than that which supposes

that private advantage can be promoted at the expense of the public

good. We are very well disposed to believe that selfish people are the

very worst caterers for the real interests of the idol they worship.

The more we consider the Hospital system, the more reason shall we find

to distrust it; and we by no means exclude that very point wherein it

is supposed to be most successful—namely, in securing the pecuniary

advantage of those whose interests it is supposed to serve.

Of the apprentices, we shall say little more than to express our belief

that many of them have lived to obtain the conviction that they would

have done much better had they not been fed by hopes that were never

realized. All apprentices cannot, of course, be surgeons. Again, if,

in the course of a century, a solitary instance or two should occur

of the success of an unapprenticed candidate, they not unnaturally

feel it as an injustice in thus being deprived of that, the especial

eligibility to which was a plea for the exaction of a large apprentice

fee. But to the surgeons themselves, it seems to us that the system is

far from realizing the benefits that its manifold evils are supposed

to secure. The adage that "curses, like chickens, come home to roost,"

is far from inapplicable. After all, many of the hospital surgeons are

little known; and the public inference with regard to men invested with

such splendid opportunities of distinguishing themselves, is not very

flattering. Mr. Abernethy, so far from benefiting from the "System,"

appears to us to have suffered from it in every way.

His talents, both natural and acquired, would have given him every

thing to hope and nothing to fear from the severest competition;

whilst the positive effects of the system were such as to deprive him

of what was justly his due, and to embitter a retirement which in

the barest justice should have been graced by every thing that could

add to his peace, his honour, or his happiness, from the Institution

whose character he had exalted and maintained, and whose school he had

founded.

But let us look at the facts. The system which pronounces that there

shall be three surgeons to attend to some 500 or 600 patients (_for

the purposes of science_—the next thing to an impossibility), kept

Abernethy twenty-eight years an assistant surgeon. During this time he

was filling the hospital with students, to the amount of sums varying

from £2,000 to £3,000 a year, of which, in the said twenty-eight years,

he never received one farthing.

He saw, from time to time, many men, of whose capacities we know

he had the highest opinion, shut out from the hospital by the mere

circumstance of their not having been apprentices; and two of these

were the late Professor Macartney, of Dublin, and the present

distinguished Professor of Comparative Anatomy, Professor Owen. And

here we must pause to record one of our numerous obligations to the

perceptivity and justice of Abernethy. We have formerly observed

that, at the very commencement of life, he had been accustomed

to inculcate the importance of studying comparative anatomy and

physiology, in order to obtain clear views of the functions of Man;

but all arrangements made with this view, from the time of Mr. Hunter

onwards, though varying in degree, were still inefficient. It was next

to an impossibility to combine an availing pursuit of a science which

involves an inquiry into the structure and functions of the whole

animal kingdom, with the daily exigencies of an anxious profession.

When Mr. Owen had completed his education, his thoughts were directed

to a Surgeoncy in the navy, as combining a professional appointment

with the possibility of pursuing, with increased opportunities of

observation, his favorite study. Fortunately for science, he went to

Abernethy, who requested him to pause. He said, "You know the Hospital

will not have any but apprentices. Macartney left on that account.

Stay," said he, "and allow me to think the matter over." This resulted

in his proposing to the Council of the College of Surgeons that there

should be a _permanent_ Professor of Comparative Anatomy, and that the

appointment should be given to Mr. Owen.

This is among the many proofs of Abernethy's perception of character.

Mr. Owen had dissected for lecture; and Abernethy saw, or thought he

saw, a peculiar aptitude for more general and enlarged anatomical

investigation. The whole world now knows how nobly the Professor

has justified the hopes of his talented master. It would be out of

place for us to attempt a compliment to a man so distinguished in a

science, wherein the varied pursuits of a practical profession allow

us to be mere amateurs; neither do we wish to forget other gentlemen

who distinguish themselves in this branch of science; but we believe

that most competent judges allow that the celebrated Cuvier has not

left any one more fitted to appreciate his excellence, or who has

more contributed to extend that science of which the Baron was so

distinguished a leader, than Professor Owen.

There is one incident, however, in the Professor's labours which,

for our own purposes, we must relate; because we shall have to refer

to it in our humble exhortation to the public and the profession to

believe in the practicability of raising Medicine and Surgery into a

definite science. The incident shows what may be done by that mode of

investigation which is the still delayed desideratum in medicine and

surgery—namely, the _most comprehensive_ record of facts, and the

study of their _minutest relations_. Professor Cuvier was the first to

impress, in a special manner, that those beautiful relations in the

structure of animals, so many of which are even popularly familiar,

extended throughout the animal; so that if any one part, however

apparently subordinate, were changed, so accurate were the adaptations

in Nature, that all parts underwent some corresponding modification; so

that diversity of structure in parts, more or less affected the whole.

The beautiful result of all this is, that if these relations be once

thoroughly mastered, then any one part necessarily suggests, in general

terms, the nature of the animal to whom it belonged. Few instances,

however, so remarkable as the one we are about to mention, could have

been anticipated.

A seafaring man brought a piece of bone, about three or four inches in

length, as he said, from New Zealand, and offered it for sale at one or

two museums; amongst others, at the College of Surgeons. We shall not

here detain the reader by telling all that happened. These things are

often brought with intent to deceive, and with false allegations. Most

of those to whom the bone was submitted, dismissed it as worthless,

or manifested their incredulity. Amongst other guesses, some rather

eminent persons jocosely hinted that they had seen bones very like

it at the London Tavern; regarding it, in fact, as part of an old

marrow-bone, to which it bore, on a superficial view, some resemblance.

At length it was brought to Professor Owen, who, having looked at it

carefully, thought it right to investigate it more narrowly; and after

much consideration, he ventured to pronounce his opinion. This opinion,

from almost anybody else, would have been perhaps only laughed at;

for, in the first place, he said that the bone (big enough, as we have

seen, to suggest that it had belonged to an ox) had belonged to a bird.

But before people had had time to recover from their surprise or other

sensation created by this announcement, they were greeted by another

assertion, yet more startling—namely, that it had been a bird without

wings.

Now, we happen to know a good deal of this story; and that the

incredulity and doubt with which the opinion was received were too

great, for a time, even for the authority of Professor Owen to dispel.

But mark the truthfulness of a real science; contemplate the exquisite

beauty and accuracy of relation in nature! By and by, a whole skeleton

was brought over to this country, when the opinion of the Professor

was converted into an established fact. Nor was this all; there was

this appropriate symbol to perpetuate the triumph: that which had

appeared as the most startling feature of what had been scarcely better

received than as a wild conjecture, was so accurate in fact, as to

form the most appropriate name to the animal thus discovered[76].

It would be unjust to others to attribute Professor Owen's appointment

exclusively to Abernethy: that, the state of things did not place

within his single power; but his penetration was the first to suggest,

and his weight most potential in securing, an appointment which various

circumstances, besides the merits of the individual, bring up in high

relief, as the best ever made by the London College of Surgeons.

To return to the Hospital System, as affecting Abernethy. He continued

to lecture, and the emoluments arising thence he of course enjoyed.

Until 1815, the whole of the hospital fees had been taken by the

surgeons in chief. These fees, in twenty-eight years (allowing

a reasonable deduction for those pupils who went to the school

independently of the inducement offered by the most attractive lecturer

ever known), must have amounted to an enormous sum. Having founded the

school, he became surgeon at about fifty years of age; and then retired

at sixty-two. On retiring, unpleasant discussions arose, which, with

others long antecedent, rendered his concluding associations with the

hospital scarcely more agreeable than they had been at the College of

Surgeons.

The whole of Abernethy's closing career gave him no reason to

rejoice at the Hospital System. The circumstances, though they

convey a lesson in the History of the Lives of Men of Genius, were,

abstractedly, extremely unimportant. They show that Abernethy, in

his retiring hours, whilst his reputation had become European, and

Transatlantic[77]—whilst hundreds were benefiting their fellow

creatures, more or less, according to their talents and opportunities,

in every part of the world—seems to have been surrounded by men

who, so far as we can see, were little disposed to grace his

retirement either with much sympathy, or even with reasonably generous

appreciation of all that he had done, either for Science in general, or

the Hospital in particular.

Instead of considering how they could best do honour to the waning

powers of one who had not only raised the reputation of St.

Bartholomew's Hospital to a point it had never before attained, who

had founded a school there, constituting the largest single Hospital

Class in London, and who was leaving the inheritance of a rich annual

harvest to his successors,—the time was occupied in discussing whether

he could resign the surgeoncy without resigning the lectureship;

whether, on paying a hundred guineas, which there seemed no difficulty

in receiving, he could become a Governor whilst still an officer; and

then, whether his being a Lecturer without retaining the surgeoncy

did not so constitute him. These, and similar questions scarcely more

important, were the source of considerable annoyance.

In former editions, we were obliged to discuss some of these matters

more at large than is now necessary; because, amongst the individuals

associated in the transactions of the period, there was one to whom

Mr. Abernethy had been of especial service; but in regard to whom he

had been much misrepresented. Further, this had taken place in our own

hearing, in whose recollection all the facts were perfectly fresh,

but who were, at that time, without the documents which are now in

our possession. We accordingly sought to obtain whatever documents

there were from the source most likely to test the correctness of our

recollection; when a note was written which, as we now learn, quite

unintentionally conveyed the idea, or at least was susceptible of the

construction, that a disinclination to make any communication on the

subject proceeded from a desire to withhold something unfavourable to

Mr. Abernethy. This determined us on discussing the matter, so far as

was necessary to rebut such interpretation. And it was fortunate we

did so; for it very soon appeared, not only that such an impression

had been produced, but that "gossip," with its usual aptitude for

invention, had soon supplied the myth thus supposed to have been

charitably withheld.

It was not very long after the publication of these Memoirs, that

we learned, in a conversation with a highly distinguished member of

the profession, that he had been led to entertain the impression to

which we have alluded. Here we had, of course, an opportunity of

correcting the error; but it obviously became a subject of very serious

consideration, what must be done in dealing with this matter, and

other matters arising out of it, in a subsequent edition. To treat

the affair seriously, would have involved a reference to documents in

our possession which, though highly honorable to Mr. Abernethy, would

have been of no general interest, whilst they would have involved

details disagreeable to several persons. We therefore, after much

consideration, resolved on endeavouring to see whether it was not

possible to quash a tedious and painful discussion, and at the same

time to obtain, of course, all that was necessary to the memory of Mr.

Abernethy.

The following letter, and the reply, will, we think, sufficiently

develop the very difficult and disagreeable position in which we were

placed; our sole object being, so far as it was possible, to avoid

repeating or enlarging a discussion which we had learned would have

given pain to certain parties. The concluding paragraph has been

omitted, as being unnecessary to the point more immediately under

discussion.

"3, The Court Yard, Albany,

"July 17th, 1856.

"Sir,

"For reasons which may be gathered from this note, I think it

proper to inform you that I am preparing another edition of the

Memoirs of Abernethy. Impressions have been conveyed to certain

persons, that the reasons on which you grounded your disinclination

to make any communication in relation to your differences with

Abernethy, were the desire you professed to withhold something

which involved imputations unfavourable to him. Further, a sort

of Body has been given to these vague impressions by inferences

which the documentary and other evidence at my disposal enable me

to disprove. In one quarter, the circumstances are so strongly

suggestive as to the sources whence the erroneous impressions were

derived, that it is impossible to leave that portion of the Memoirs

which treats of your differences with Abernethy as it at present

stands, without the risk of injustice. It is regarded as necessary

that you should either recognize or ignore the inferences which

(whether correctly or not I will not presume in this place to

determine) have certainly been formed on your supposed authority.

The justice of such a course is sufficiently obvious. I need

scarcely say, it is immaterial to me what course is taken. If I

am obliged to enter into the discussion of the subject, I shall

take the opportunity of defending myself from the remarks that

have been made upon me, and of showing what I did say, as well as

what I might have said. These remarks are less excusable from it

being known to me that a letter of mine to a third party was by my

express permission read to you, in which was stated my willingness

to alter or modify any passage which might have offended your

feelings, provided only that such alteration involved no injustice

to Mr. Abernethy. The (as I think) ill-advised rejection of the

offer, coupled with the intimation, long after, which was given

to Mr. Longman by a friend of yours, that certain papers would be

forthcoming, provided only that certain passages relating to Mr.

Stanley were suppressed, will involve a discussion in which I

shall now be very unreserved; but which, I fear, will be scarcely

less disagreeable to you than painful to myself. If you ignore the

imputations to which I have referred, it seems to me that the whole

discussion may be quashed by your simply writing me a note, in

which you state as the reason for your not making any communication

to me your dislike to revive the recollection of differences with

one whose memory you will always regard with respect, gratitude,

and affection, or whatever other terms your feelings may justify,

or the claims of Mr. Abernethy require.

* * * * *

* * * * *

"I am, Sir,

"Your obedient servant,

"G. MACILWAIN."

The following is Mr. Stanley's reply:

"Brook Street, July 18th.

"Sir,

"Upon the subject of your communication to me, I can only say, that

I have no information to give; for I am not in possession of any

document relating to it; and so many years have elapsed since the

occurrences to which you refer, that I could not trust my memory

for the accuracy of any statement, if I were disposed to make it.

You will therefore perceive that there exists no foundation for the

supposition that 'I desire to withhold something which involved

imputations unfavourable to Mr. Abernethy,' or that any other

feelings than those of the utmost respect for the memory of Mr.

Abernethy have existed in my mind.

"I am, sir,

"Your obedient servant,

"EDWARD STANLEY.

"G. MACILWAIN, ESQ."

We here conclude this subject.

A somewhat amusing illustration of one feature of the hospital system

occurred about this time. Sir Astley Cooper had, without the smallest

intention to give offence, made some observation on the somewhat too

free use of Mercury at that period in the Borough Hospitals. His

observations having been misunderstood or misrepresented, he took

occasion to remove any idea of intentional offence, by addressing

the class. Among other things, he is reported to have said: "Why,

gentlemen, was it likely that I should say any thing unkind towards

these gentlemen? Is not Mr. Green my godson, Mr. Tyrrell my nephew, Mr.

Travers my apprentice" (the three surgeons of St. Thomas's Hospital),

"Mr. Key my nephew, Mr. Cooper my nephew?" (surgeons of Guy's)[78].

This was very _naïve_, and is an illustration of the value of evidence

in proof of facts having no necessary connection with those it was

intended to establish.

It is difficult to conceive any one more disinterested than Mr.

Abernethy had been in relation to the surgeoncy of the hospital, from

the moment at which he was appointed to the hour of his resignation.

Although he had waited twenty-eight years as assistant, and not

participated in one farthing of the large sums accruing from his

reputation in hospital pupil fees—although, too, he had a large

family,—yet, so far was he from wishing to indemnify himself for

this long exclusion from office by a lengthened tenure of it, that

he at once announced his opinion as to the expediency of earlier

resignations of the surgeoncies, and his intention of acting on it when

he should have attained his sixtieth year. His reasons were liberal and

judicious. Amongst others, he said that he had "often witnessed the

evils resulting from men retaining the office of surgeons to hospitals

when the infirmities of age prevented them from performing their

duties in an efficient manner. That, at sixty, he thought they should

resign in favour of the juniors," &c.; thus contemplating a tenure of

only ten years. Again, he who had founded a school from such small

beginnings as could be accommodated in a private house in an obscure

neighbourhood (Bartholomew Close), taken for that purpose—who had

so increased it, that a theatre was built within the hospital—this

again pulled down and rebuilt of enlarged dimensions to receive his

increasing audiences—having, too, some time previously made over his

museum to the hospital, in trust for the use of the school,—required

that his only son (should he _prove competent in the opinion of the

medical officers_) should in due time—Do what? Succeed him? No; but be

admitted to a _share_ in the lectures.

Indeed, Mr. Abernethy's closing career at the hospital gave him no

great reason to rejoice at the "hospital system." Men, who could see

nothing in leaving very much more important situations to an indefinite

succession of apprentices, cavilled at a prospective lectureship for

his only son; whilst his lectures were delivered over to gentlemen—one

of whom had, from an early period, ridiculed, as he said, the opinions

which he taught as—and which we now know to have been—John Hunter's;

and another, with whom there had been of late several not very pleasing

associations.

This was necessarily a result of the "hospital system;" a system that

gave a still more melancholy and fatal close to the labours of John

Hunter, whose death took place suddenly in the Board-room of St.

George's Hospital, whilst resisting an interference with a privilege

which his love of science rendered valuable to him, and which it was

for the interests of science that he should enjoy; but, mournful as

these results are, and many others that might be added, still, if we

found that the system worked well for science, we might rest satisfied;

but is it so? What advances have the hospital surgeons of London,

_under the apprentice system_, made in the science of surgery? Let

those answer the question who are desirous of maintaining this system.

For our own parts, the retrospect seems to show "the system" in a more

striking manner than any thing we have yet stated. John Hunter, that

_primus inter omnes_, was no hospital apprentice; he migrated from St.

Bartholomew's, where the rule was too exclusive to give him a chance,

to St. George's, where he obtained admittance; St. Bartholomew's

preserved "the system," and lost Hunter.

Abernethy was an apprentice, truly; but all those glorious labours

which shed such a lustre on his profession, and such a benefit

on mankind, were completed long before he became surgeon to St.

Bartholomew's Hospital; and it is material to repeat that at that time

the assistant surgeons, with the exceptions already stated, had nothing

to do. In casting our eyes over the retrospect of years, one honoured

name attracts our notice, in connection with a real advance in the

knowledge of the functions of nerves. We allude to Sir Charles Bell.

But here again "the system" is unfortunate; for Sir Charles was never

a hospital apprentice at all, and only succeeded to a post in a London

hospital after an open canvass in an institution in which the narrow

portal of the apprentice system is unrecognized.

We might have traced the effects of the apprentice system into the

more covert sites of its operations, as exemplified in the abortive

or mischievous legislation observed at different times in the College

of Surgeons of London; or have extended the catalogue we formerly

exposed as taking place in the Royal Med. and Chir. Society up to the

influence—proh pudor!—that it is allowed to exert in the Councils

of the Royal Society; but our so doing here would have led us into

discussions which are irrelevant or unnecessary to our present objects.

In the meantime, it is useful to remark that there are two sides to all

questions. If, in our corporate bodies, we see the prurient appetencies

of trade usurping the place of the lofty aspirations of science,—if we

see this carried to the extent of men allowing themselves to receive

money without rendering any intelligible account of its amount,—let

us not forget that there is a Public—aye, and a Profession too—which

calmly allows such things.

Let us also reflect on those numerous instances, in human affairs,

of things being only accomplished when there is a real necessity

for them; and, again, whether that necessity for a higher and purer

administration of corporate privileges and scientific distinctions

may not alone reside in a higher and purer moral standard on the

part of the public and the profession. Those who, in a worldly sense,

suffer from the system, have at least the consolation that they are

not obliged to participate in the administration of that which they

disapprove; and that the losses they so sustain are perhaps necessary

tests of their having achieved proper motives. No better proof of the

sincerity and earnestness of our love of science can be afforded us,

than a patient and thoughtful cultivation of it, independently of

patronage, position, or other auxiliaries, which too often mask from

us the true objects of research, sully the purity of mind by mixtures

of questionable motive, or mislead us from the temple of truth to the

altar of a fugitive and fallacious ambition. There are indeed signs of

a "_Delenda est Carthago_." As we have said, the point of the wedge is

inserted, and a very little extension of public information will at no

distant period drive it home.

In the meantime, Medical Science, instead of being in a position to

receive every quackery as a means of demonstrating the superior beauty

of truth, by placing it in contrast with error, is obliged to regard

any absurdity, however gross, as one of the hydra-headed fallacies

through which we are to evolve what is true, only by the circuitous

plan of exhausting the resources of hypothesis and conjecture: whilst

sweeping epidemics, which, wholesomely regarded, should be looked on

reverently as besoms of destruction, are hailed by the observant as

melancholy, but necessary, impulses, to drive us to the adoption of

measures, to which our capital of common sense is not sufficient to

induce us to listen.

Neither are the old hospitals the only parts of a defective system.

There is no hospital in London that, even yet, has any country

establishment for convalescents; whilst of two of those more recently

established, one is built over a church-yard; and the other, intended

only for the relief of decarbonizing organs, is placed in the immediate

neighbourhood of the most smoky metropolis in Europe. Both, therefore,

instead of standing out as the most distinguished illustrations of the

laws of sanitary and physiological science, being, on the contrary,

emphatic examples of their violation.

We are unwilling to conclude this chapter without observing that,

notwithstanding the coldness and discussions which threw somewhat of

melancholy and shade over Abernethy's retiring days, thus presenting

an unwelcome contrast with the more palmy periods of his career—a

contrast from which it might have been hoped his conscientious

retirement might have spared him,—we yet see how appropriate a

preparation it might have been for a transition from the exciting, and

adulatory, atmosphere which surrounds a popular and scientific teacher,

as compared with the calmness and peace of a life in the country. He

was now no more to enter the Hospital Square, where we have so often

seen him mobbed, as it were, by the crowding and expectant pupils;

no more to be daily addressing audiences who never seemed to tire

even with repetitions of that with which many were already familiar;

nor any more to see, as occasional visitors, men grown grey in the

successful practice of his early lessons, bringing their sons to the

same school, and both listening with equal pleasure. There is no

doubt that, contrasted with all this, retirement was a great, though

now probably a welcome, change. Eminent men unintentionally exert an

influence which is not without its evils; and we shall see that of this

he was fully aware. Assentation is too much the order of the day. The

multitude appear to agree. The few who differ, are apt to be cautious

or reserved. If a man is too sensible to be fed with such garbage as

direct flattery, there are always tricksters or tacticians, who have a

thousand ways of paying homage without detection.

Then, again, those who really admire a man, and are honest,—keep

aloof, and shrink from an association with those whom they know, or

believe, to be parasites. It thus happens that there are men to whom so

few venture to be honest, that the world may present little better than

a practical lie. It is a mercy then, when a man's sun is setting, that

he be blessed with a little twilight of truth.

There are, in the moral and intellectual constitution, as well as in

the physical endowments of Man, beneficent powers of adaptation, which

let us gently down to contrasts, which, too sudden, might be painful or

destructive.

There is, however, this difference—the external senses have intrinsic

powers of adaptation so ready, and perfect, as scarcely to be taken by

surprise by any natural transition. The moral and intellectual powers

do not appear to possess this electric activity; but require slower

gradations of impression, which, by some law in the progress of human

affairs, are (as the rule) mercifully supplied.

In his own lessons, whenever he met with any _apparent_ imperfection,

and wished to impress its _real_ beauty of adaptation, Abernethy was

very fond of what he termed his argumentum ex absurdo. He would suppose

various other arrangements, and point out in succession their unfitness

for the purposes required. Tried in the same manner, we can see nothing

better than that which really happened.

If Abernethy met with coldness where he expected warmth—and

dispute and discussion where he might have calculated on grateful

concession,—how well-fitted must have been that reverence and

affection which longingly awaited his retirement at home. If the

greatest worldly success, in that occupation in which he had always

felt most pleasure, was still not without its dark lights—shadowing

forth what the world really is,—what could he have had better to

concentrate his views on those substantial sources of comfort, of which

he had long believed and estimated the value, and on which he was

contented to repose. It had always been a favourite expression of his,

when in any doubt or difficulty: "Well, I will consult my pillow, and

we shall see." We believe that pillow seldom flattered.

[Footnote 76: It was accordingly named the Apteryx, or wingless, from

the Greek Alpha and Pterux.]

[Footnote 77: We have derived great pleasure from our correspondence,

during some years, with Professor Ethelbert Dudley, of Lexington,

Kentucky, and from the evidence it affords of Abernethy's principles

having been recognized, and practised with great success, by one

of the most distinguished surgeons and successful operators in the

Western World. Professor E. Dudley, himself a distinguished surgeon and

lecturer, and a man who unites with an extremely clear and vivacious

perceptivity, a most untiring zeal in his profession, is the nephew

of the celebrated B. Dudley, whose fame extends through the great

Mississippi Valley. This gentleman, now advanced in years, was an

early pupil of Abernethy, of whom he is a great admirer. He is a

remarkably successful operator, and, during his more active period,

was sometimes sent for several hundred miles. He is said to have

performed lithotomy 200 times, with the loss of only six cases. His

unusual success in operations he attributes not so much to any peculiar

dexterity as to the manner in which he conducts the preparatory and

subsequent portions of the Constitutional treatment of his cases. He

seems also to have practised some other of Abernethy's habits: the most

careful consideration of the pecuniary circumstances of his patients,

interspersed with not a few examples of almost unexampled generosity.]

[Footnote 78: _See_ Lancet, 1828.]

CHAPTER XXX.

HIS RELIGION.

"Philosophy directs us to bear evils with patience and fortitude,

because they are inevitable; but Christianity gives us consolation

under sufferings, by assuring us that they are but the discipline

of a Parent who loveth while he chastiseth, and that they are but

for a moment, when compared with eternity. The Christian's Hope

has made him whom it has supported rejoice under the greatest

sufferings that mortality could endure; yet Hope is but the

offspring of faith, and therefore it was necessary to make faith

the foundation of the structure of the Christian Religion, and

to assign and affix to it peculiar privileges and rewards." MR.

ABERNETHY[79].

Whoever reflects on the influence produced on the mind by research in

Science, will, we think, arrive at a very important conclusion.

It is true that, at the commencement, numerous worldly motives tend to

place most prominently before us the temporal advantages of scientific

Inquiry. There are distinctions of wealth, rank, position, which not

unfrequently await its successful cultivation. Then there are the

multiform applications of science in extending the enjoyments, in

ministering to the wants, and, still better, relieving the calamities

of mankind; but when we have arrived at this, surely the acmé of its

_utilitarian_ allurements, we find there are still higher motives

engendered—that science has a still richer harvest to encourage its

onward cultivation. Nor is it too much to say, that, if cultivated

aright, the fruits may be more surely garnered than any of those

to which we have previously referred. The harvest we mean consists

of those moralizing influences which, however neglected, are never

separable from the study of Nature; which, however ordinary the

impulses with which the inquiry may have commenced, slowly overlay

it with motives and feelings which lead us to investigate Nature for

the sake of truth alone. And here, we think, first dawns upon us the

conclusion to which we have alluded: viz. that the highest attractions

of science are to be found in what we venture to term its "Religion."

However much the influences first mentioned tend to place the more

lofty suggestions of science in temporary abeyance, there always comes

a time when the sincere inquirer begins to feel a double current of

thought. In the one, the thoughts are open, aspiring—ambitious, it

may be—public, and directed only to the laws and phenomena of Nature;

in the other, they are calm, deep, humble, silent, and _will_ turn to

the Supreme Cause. The former may foster his ambition, animate his

research, sustain his industry. The latter carry him beyond those

influences, and supplies something which they cannot give. In loving

truth for its own sake, he learns by degrees to lean little on the

worldly appreciation of labour—convinced that whatever is true, will

one day find its own way, in the time best fitted for it. We cannot

help thinking that it is the force of this double current of thought

by which that climax has been reached by some of the greatest minds;

which has exemplified the coincidence of the utmost range of human

knowledge with the most profound humility; thus rendering the highest

aspirations of science subservient to the cultivation of a principle;

inseparable, we suppose, from all Religion; but certainly one of the

most distinguishing characteristics of Christianity.

An idea, however, has arisen in some minds, that the pursuit of science

has a tendency to make men sceptical in Religion. This we believe

to be not only a demonstrable, but a dangerous error—demonstrable,

as remarkably opposed to the evidences of fact and observation; and

dangerous, as withdrawing the minds of many from the study of science,

who would be perhaps especially fitted to estimate its advantages and

enjoy its pleasures.

History, who from her ample store of testimony has so often repealed

injustice and defeated error, is no where more conclusive than on the

question before us. The study of Nature not only has no tendency to

induce a state of mind unfavorable to the reception of the truths of

Religion, but just the contrary; for the proofs of a humble and sincere

reliance on the promises of the one, have been infinitely most striking

in those who have proved themselves the most successful cultivators of

the other.

The philosopher, regarding the universe as the dwelling of the Supreme,

sees in the laws of nature, and in the powers through which he is

permitted in a degree to interpret them, only another revelation—a

Divine recognition of his high relations and destiny; and grasps

in one comprehensive idea the Word and the Works, as an integral

communication—one extended privilege to Man. He does not indeed

confound the evidences on which philosophical and religious truths

respectively repose. He knows that they rest on different _kinds_ of

testimony, which he neither strives to identify, nor misapply. He

no more expects to deduce the generalizations of science from the

Scriptures, than he does the commands of the Deity from the facts of

the natural world. Philosophy and Religion, however, are constantly

impressing similar facts. In science, we learn—and no doubt the

deepest learn it best—that "there are more things in heaven and earth

than are dreamt of in our philosophy." Religion tells us there are many

things "past man's understanding." Religion and science teach us alike

that any inquiry into the positive and ultimate nature of anything

which exists, is entirely beyond our faculties; and respectively impress

on us the conviction, that our proper business is to search out the

phenomena and laws of the one, and to obey the Commandments of the other.

Philosophy is daily teaching us how little we know, as compared with

that which is unknown. Religion informs us that, at present, we see

"through a glass darkly." Yet, at the same time, both concur in

encouraging us to believe that everything that is really required of

us, everything that is good and useful to us both here and hereafter,

are alike open to human capacity. The pursuit of science, no doubt,

establishes requisitions which are essential to the proper study of

it. A mind undisciplined by any rule; a mind taking only a conjectural

view of nature; a mind allowing fancy or imagination to usurp the

place of intellectual power; a condition which ignores the guidance of

patience, circumspection, and industry, and which seeks the explanation

of the impressions made on the senses by ingenious hypotheses made to

fit them; or which sees no order or intelligibility in anything which

it does not at once comprehend; that these and many other states of

mind _may_ tend to confound the understanding, and replace anything

rational or profitable by anything else, is _possible_ enough. But is

it not equally true of Religion? Experience has abundantly shown us the

result of Man trying to fit the mysteries of Religion to the measure

of intelligibility set up by the human intellect. There surely is no

subject on which men have become more lamentably bewildered. This,

however, is merely one of the too common examples of abuse of our

faculties; and that such men may become sceptical, whether pursuing

Science or any subject whatever, is probable. It is, in truth, "Science

falsely so called," and has no more relation to the legitimate study of

Nature, than the most orderly formula of the mathematician has to the

wildest conjecture.

But that research in science, legitimately conducted, has any tendency

to produce what is usually intended by the term scepticism, is not only

improbable;—it is directly contradicted by the facts of experience.

So numerous are the examples of the contrary, to which we here add

the name of Abernethy, that it is difficult to select, so as not to

leave the evidence unjustifiably bald on the one hand; or to render

it superfluous even to tediousness on the other. That which confers,

however, the greatest interest on this part of the subject, is not so

much the _mass_ of testimony, not so much the _crowd_ of witnesses,

as the peculiar, yet varied, character of the august assemblage. It

is extremely significant to observe, that whilst we find amongst

the most earnest advocates of the paramount importance of Revealed

Truth, the names of the most successful students of the Truths of

Science,—so, on the other hand, no persons have laboured to impress

us with the important uses of the facts in nature with more zeal and

success than distinguished Divines. Amongst the many scientific men

who have exemplified the purifying tendencies of scientific pursuits

in promoting their reverence for Revealed Religion, it will suffice to

mention such names as Boyle, Bacon, Kepler, Newton, Locke. The latter

too reminds us that the medical profession has contributed no small

number of witnesses; of whom, Böerhaave, Linnæus, Sloane, and Haller,

are a few of the more illustrious examples. All the foregoing are men

who have explored one or more of the ample fields of Nature; some of

them, extending their views beyond the planet we inhabit, into the

whole visible universe, have come back, showing us how to understand

the necessity, and estimate the value, of Revealed Truth; converting,

it may be, in many instances, Belief (so called) into a positive Faith;

and a passive assent into an earnest and clear conviction.

But, as we have said, Divines have not been slow in contributing the

weight of their testimony to the value of natural evidence, and the

acceptable assistance afforded by a contemplation of the laws and the

mysteries of Nature. So abundant indeed are these mysteries, that

there is not a path of our progress by day, nor a waking thought by

night, that does not at times present some of them to our reflection.

Mysteries in operation so clear, that our very senses take cognizance

of them; so orderly, that when we are allowed to discover the law which

regulates them, we are at a loss which most to admire, the power, the

number, or the simplicity of its manifestations; and yet which, as to

their intrinsic nature, are so recondite as to be entirely beyond our

researches; leaving us, in fact, no faculty which can deal with them,

but faith alone. Divines have shown the value they attach to all such

facts, by the admirable application they have made of them in aiding

the cultivation of Religion—sometimes by teaching the necessity and

reasonableness of faith in the mysteries of Religion; at others, in

impressing the nature and attributes of the Supreme.

It would be easy to produce a longer roll of such men; but most

readers are acquainted with such names as Cudworth, Butler, Sturm,

Derham, Paley, Crombie, who have, in one or other sense, exemplified

the importance of natural knowledge, and the interest they took in

its cultivation. In every phase of the investigation, we meet with

fresh examples of the union of Religion with Science. Paschal and

St. Pierre are eminent illustrations. Paschal was a Divine, and an

eminent mathematician: mankind is surely under obligations to him for

his "Lettres Provinciales." These extraordinary compositions must

have operated with uncommon force against the sophistries of the

Jesuits; and, considering the nature of the subject, it could have

been no ordinary work that could have induced Voltaire to say that

he had never read anything more humorous than the earlier letters,

or more sublime than the later. St. Pierre[80], too, should not be

passed without mention. His book is, in some points of view, one of

the most interesting works ever written: occasionally fanciful or

enthusiastic, it is a most unusually rich collection of facts and

observations. How excellently adapted it is to encourage observation

of natural phenomena! How just and philanthropic—how circumspect

and comprehensive his observations in Nature! and how excellent and

free from cant the paramount importance he impresses of Religion as a

principle, and of Christianity as the perfect supply of all that is

necessary to us in time or in eternity. Yet St. Pierre was a soldier;

and it is to our present purpose that he was a scientific man, and an

engineer. Neither should we pass unnoticed the numerous associations of

pastoral care with the observation of nature, so pleasingly exemplified

in White of Selborne, and Gilpin of the New Forest—men whose books we

count now rather by generations than editions, and which suggest to

our imagination the additional gratification which such men must have

derived to their favourite pursuits, in the continued sanction afforded

by Scripture. We would reverently point to the site first chosen as

the abode of purity and innocence; and the numerous illustrations from

nature contained in the Sacred Volume; whether in enforcing general

rules, or a special command—impressing a particular principle, or

illustrating a recondite mystery,—and especially that which is a

_remarkable and necessary combination_ of mystery with faith. For

whilst it is, as well as other mysteries, beyond our comprehension, it

commands so entire a faith in its reality, as to be, in some form or

other, instinctive and universal[81].

Mr. Abernethy, it has been stated in former editions, was, as regards

his religious tenets, a member of the Church of England: and it would

have been gratifying to have included some of those sentiments on

religious and moral matters which we now record; but, although some of

these documents had been open to our inspection before the completion

of the second edition, they were not so entirely at our disposal as

Miss Abernethy has subsequently placed them. Of these documents,

those which relate to religious and moral subjects consist, first,

of a small book on the Mind, which Abernethy published a great many

years ago, anonymously; and certain reflections, found amongst the

very few MSS. which he had preserved. Amongst these papers, there

are two which are in the form of sermons; and, although they are all

somewhat fragmentary, they are in several points of view more or less

interesting.

As it appears to be an abuse of the proper business of biography

to publish every thing that an eminent man says or does, we shall

endeavour to make such selection as shall fall within its legitimate

objects—viz. as establishing some fact of importance, as illustrating

the tone and character of the man, or as placing some conclusion which

had been drawn more or less from general observation, on the more

secure basis of the sentiments he has himself recorded.

EXTRACTS.

There is "more moral certainty in the greater number of instances of

those things which we believe from the deduction of reason, than of

those we believe from the action of the senses."

Yet he would warn the students of science "from being proud of their

acquisitions; and against not believing any thing but what they learn

from the deductions of their reason, lest they _become most ignorant of

that of which they are most assured_."

"Man at this period of the world is still ignorant of the nature of

surrounding bodies; his information must be limited as his perceptions

are limited, and this should produce humility, the proper frame of mind

for Christians."

After saying that we have no means of forming any idea of the nature

of matter, but from the impressions we receive from it, those of

figure, divisibility, gravity, and disposition to move when impelled,

to continue in motion unless retarded, &c. &c.—in allusion to a

well-known theory, he adds: "But some have doubted whether we could be

sure even of those properties of matter of which we felt most confident

the existence were such as we conceived them to be. Certainly," he

says, "we know nothing of what matter really is; we only know certain

properties, without being at all acquainted with the substratum or

subject, as a logician would say, which supports these properties.

Yet," he says, "when we consider the ideas derived from external

objects, we _cannot but admire their correctness and suitability to our

present wants and state of existence_."

"If we are ignorant of the nature of the most common object of matter,

as we call it, how can we obtain any knowledge of what we call Spirit?"

He thinks that it is only from a knowledge of ourselves that we can

derive any ideas on the subject.

"When we examine our bodies, we see an assemblage of organs formed

of what we call matter, visible to the eye and cognizable to the

touch; but, when we examine our minds, we feel that there is something

sensitive and intelligible which inhabit our bodies." "We naturally

believe in the existence of a Supreme First Cause. We feel our own

free agency. We distinguish right and wrong. We feel as if we were

responsible for our conduct, and the belief in the existence of a

_future state seems indigenous to the mind of man_." "We are conscious

of our existence; we remember our sensations; we compare them, judge

of them, and Will and act in consequence of such judgment." He thinks

if we can form any notion of the actions of a Spirit, it must be

from reflections on such phenomena, and not from any hypothetical

definitions of Matter and Spirit.

Again, after insisting on the limitation of our powers, he says, "From

them we may conceive of God, that He approves what is right, and

condemns what is wrong; and that he may approve of our conduct when we

act right or wrong, according to our own ideas of rectitude or error.

We cannot conceive that God would have given us the power of judging

without deciding on the rectitude or error of our conduct in conformity

to such power or judgment. This is the sense in which I understand the

Scriptures—that God created man in His own image."

HIS TENDENCY TO REASON BY ANALOGY.

"As the Mind takes cognizance of what is passing in the body, and in

those which surround it and directs its notions and operations in

regard to them, so we may conceive of that Great Spirit, the Soul

of the universe, that He perceives and governs all its parts. That

Creator, Supporter, and Governor of the universe, whom we are taught to

address, not only as such, but by the more endearing appellation of the

Father of our Spirits."

In his little book on Mind, he thus lays out his plan:

"The attributes of the mind, which seem to be of a permanent nature,

are here considered as 'properties' (intending such as perception,

memory, &c.); those which are occasionally exerted and operate with

effort as 'powers;' and those which may be perceived only occasionally,

and which vary in degree or kind in different persons, as 'qualities.'

As Reason and Will are 'properties' of the mind, and yet exerted as

'powers,' they are treated under both heads."

OF IDEAS.

"As I may not use the word in a customary sense, I think it right

to explain what I mean by ideas. When I see a beautiful prospect

illuminated by the sun, I have a _perception_ of light and shade.

When, however, I have acquired such a knowledge of light and shade

as to be able to represent on paper a spherical or many-sided body,

I think I have acquired a knowledge of light and shade beyond that

which the _mere_ remembrance of my perception would have produced. I

shall, therefore, express myself as follows: Our knowledge consists

of perceptions and deduction from them, which may be called ideas,

opinions, thoughts. In reasoning, we employ these intellectual

deductions, as we employ the perceptions of the facts themselves."

OF ABSTRACTION.

He observes: "It does not appear that we have the power of abstracting

the mind from the consideration of any subject, except by engaging it

in some other."

OF BENEVOLENCE.

"Benevolence is necessary, because it enlarges our sphere of happiness

by rendering us participators in the happiness of others—besides

producing, by sympathy, similar feelings in others."

In a series of propositions on the exercise of mind, he impresses the

mischief of admitting or indulging erroneous trains of thought, as

illustrated by "the fears arising from bad management in childhood,—by

persistence in vice after the gratification has ceased and the

destruction certain; and also in contributing to the production of

insanity." Or, on the other hand, he considers the _advantage_ of

exercise in correct trains of thought; that the powers evinced by

Newton, and, in certain cases, by Johnson, to have been unattainable,

but as the result of such exercise. He enlarges on the moral effects

of habitual increase of power in diverting the mind at will to other

objects, and so subduing anger, mitigating calamity, &c.

In illustrating the intensity that recurrence of impression is apt to

give to the feelings, he says: "Benevolence indulged, leads to lasting

friendship; whilst the harbouring sensations of even trivial disgust

are too likely to develop animosity," &c.

In speaking of the difficulty of ascertaining all the _facts_ and

_feelings_ which enter into the formation of any one's opinions, he

says: "It ought to incline us to think modestly of our own, and pay

deference to those of others,"

The impropriety of "anything like compulsion to make men think alike

by other than _their own temperately induced convictions_ is never

more clear than in regard to religion; for the aim of Christianity is

general benevolence and individual humility—benevolence even to the

forgiveness of error. Has not this been illustrated in the highest

degree by its Supreme Author, when He said, 'Father, forgive them;

they know not what they do?' Does not Christianity enjoin the very

reverse of that which we are constantly pursuing, by which we excite

dissension and cultivate an arrogance incompatible with the character

of a Christian."

He concludes one chapter thus:

If we said to others, who agree in the main points of religion, "We are

brothers, let each think as his own mind dictates,—it is probable that

all would soon think alike, because all would think without passion or

prejudice."

He considers the most exalted of all manifestations of divine mercy,

"the atonement of sin by the sufferings of Christ, and the promulgation

of precepts which, if practised, ensure temporal and eternal

happiness." And, in another place, he speaks of the gratitude that

man should feel in "that his Creator has thus condescended to be his

Redeemer," &c.

Of the Scripture precept—"To do justice, to love mercy, and to walk

humbly with thy God"—he observes, "that it contains precepts so clear

as to be intelligible to any capacity—so strikingly just as to gain

our immediate accordance—and so comprehensive as to include every

event which can occur in life," &c. Yet he says, "it is the property of

truth, however beautiful it may appear at first sight, to seem more

and more so, in proportion as it is minutely examined." MSS.

In deprecating pride, whether of mind, body, or estate, after

discussing the latter, he remarks on the more seductive influence of

intellectual superiority; he says: "The mind is no more ours than

the body;" that the success of intellect depends on varieties of

opportunity, qualities of mind, &c.; that all are alike given us, and

that any merit which the mind may bring, consists, not in the successes

of intellect, but in the purity of the motive by which they are guided.

PRIDE OF POSITION.

"It requires great and constant reflection to prevent a man from

becoming vain, who is placed in high office. He receives such constant

deference and respect to his opinions and wishes from all around him,

such ready obedience, that he might be led to imagine he was a creature

of superior order."

In some memoranda connected with things which had vexed him, we find:

"If justice, good will, and candour, were common, the world would be

too happy; it would not be what it now is—a state of exertion and

trial; of strenuous efforts, which contribute to the general good;

and, when efforts are unavailing, of trials which demand fortitude,

patience, and submission." MSS.

In allusion to some preceding reflections, "It being intended to

show that the conduct enjoined by the Scriptures is the same that

philosophy should inculcate, and that the preceding considerations

would not only almost persuade, but oblige every one to be a Christian

in conduct, whatever he might be in creed."

"To me it seems that the inspired origin of Christianity may be fairly

inferred from its wonderful adaptations to the wants and feelings of

the human mind. The Author of the Christian Religion knew the mind

of man, and all those feelings and considerations which support and

confirm him in well-doing. That feelings, to become vivid, strong, and

habitual, must be often repeated; and therefore that prayer and the

ceremonials of Religion were not only right, but due to that Power by

whose ordinances we live, and move, and have our being. How perfect a

knowledge of the human mind evince those precepts which instruct us,

distrusting our own constancy, to shun temptation and evil society. To

engage ourselves in constant and useful employment, and to suppress

the first movements of the mind, which, if continued, would urge us

with increased force and velocity to error. Human observation teaches

that the feelings of man are the source of their happiness or misery,

and the causes of their conduct. The Christian Religion operates on

our feelings, by teaching us the government of the mind, and showing

that Christianity does not consist merely in evil doing, but in evil

thinking."

We here conclude the extracts which we think it necessary to submit to

the reader, and we hope that they have not been more than in keeping

with the objects we proposed to observe. In all the reasoning in his

papers, Abernethy, whether we suppose him right or wrong, is remarkably

clear and consistent. If he discourses on matter, or spirit, or any

other principle, he simply regards the phenomena they can be made

to exhibit, regardless of any opinion mankind may have formed as to

their _real_ nature. He regards our ignorance of the intrinsic nature

of matter or spirit merely as an example of our ignorance of that

which is beyond the scope of our present faculties. This, in science,

is _studying_ facts and laws, as contrasted with speculation and

conjecture; in religion, it seems to be attention to the Command and

the study of the Word, as contrasted with that of the intrinsic nature

of Him who gave it; and, in thus suggesting the legitimate path of mind

in regard to both, is at once philosophical and religious.

It would have been easy to have multiplied the analogies of science

and religion, and especially those which, in warning us before hand

of those difficulties which occur in the prosecution of science, tend

to gird us with the requisite firmness and moderation in bearing up

against, or in surmounting them. Few have cultivated science with

success, without encountering more or less of those evils which have

been so commonly opposed to the more devoted advocates of religion. So,

also, some of the most useful discoveries have been the mission of men

of obscure origin. Again, discoveries in science have frequently had

to brave distrust, ridicule, injustice, and all kinds of opposition.

It would, indeed, seem that nothing really good can in this world be

attained without sacrifice; much less truth—that best of all; and he

among us who is not prepared, in his search for the truths of Science,

to add his mite of something that the world most values, might perhaps

as well take Science as he finds it, and avoid a labour which, without

sacrifice, will be almost certainly abortive.

That Abernethy's idea of religion was eminently practical, is every

where apparent in his reflections; yet, while he seems to have felt

that "faith, without works, is dead," he unmistakeably evinces his

conviction as to the foundation on which he thinks _good_ works can

alone be secured.

The extracts we have made, and all Abernethy's writings, appear to bear

witness to a marked sincerity of character. We see that, whether he

lectured at the College of Surgeons, or spoke to his pupils, who paid

him for his instructions—whether he addressed the public who joined

with the profession in establishing his eminent position—whether he

published with his name or without it; or addressed his sentiments to

his family, unheard but in the sacred precincts of home,—we find his

thoughts and his language always the same. He had no dress thoughts,

no company mind-clothing; he was always the same, simple, earnest, and

sincere. In his very earliest papers, in his lectures at College, or

in those of the Hospital, we never entirely lose sight of the golden

thread to which I have before alluded. The bulk of the discourse is

always the question that is really and properly before him; yet he

seldom concludes the argument philosophical, without glancing (and it

is in that just keeping as to be seldom more) at its ethical or its

theological relations.

[Footnote 79: From his Essay on Mind, and his MSS.]

[Footnote 80: Études de la Nature.]

[Footnote 81: St. Paul, I Cor. xv, v. 36-37.]

CHAPTER XXXI.

"It is the duty of Criticism neither to depreciate, nor dignify

by partial representations; but to hold out the light of reason,

whatever it may discover."

JOHNSON.

In tracing the progress of science, it is difficult to assign to each

individual his just share of merit. The evidence, always incomplete,

seldom allows us to do more than to mark the more fortunate, to whom,

as it were, the principal parts have been allotted. The exposition of

truth generally implies a previous contest with error. This may, in one

sense, be compared with military achievements. We hear of the skill and

wisdom of the General and his associate Chiefs; but little is known

of individual prowess, on the multiplication of which, after all, the

result depends.

To one who conferred so many obligations on his country and on mankind

as Abernethy, it is difficult to assign only his just share; and yet

it is desirable that nothing be ascribed to him which is doubtful or

disputable.

Antecedently to Abernethy's time, and contemporaneous with the date

of Mr. Hunter's labours, surgery had, in the best hands, and as a

mere practical _art_, arrived at a respectable position; still,

in Abernethy's early day, barber-surgeons were not yet extinct;

and, as he jocosely phrased it, he himself had "doffed his cap" to

barber-surgeons. There is no doubt that some of them had arrived

at a very useful knowledge. The celebrated Ambrose Paré was a

French barber-surgeon. When Abernethy entered into life, the best

representative of the regular surgery _of that day_ was Mr. Pott, who

was contemporary with the period of Mr. Hunter's labours. Mr. Pott

was a good surgeon, an eloquent lecturer, a scholar, and a gentleman;

and he gave some surgical lectures at St. Bartholomew's Hospital. We

have perused two manuscript copies of these lectures, which are in

the library of the Royal Medical and Chirurgical Society, and they

contain many useful and judicious observations. There are ripples

of a more humane and scientific surgery, and many parts that are

suggestive of onward study. Pott had also the good sense to perceive

the measured pretensions of his own time, and to predict advances on

it, as great as that itself was on the surgery of his predecessors:

but we do not perceive anything in Pott's lectures in the shape of a

science. _Extensive_ generalizations we are not thinking of; we have

them _yet_ to get; but we see nothing, in the true sense of the word,

even axiomatic. There are no steps, no axioms, by which we can reach

the platform of more general propositions. In some of his operations,

the most elementary principles are either not perceived or neglected;

and, although there are general recognitions of the state of the health

influencing the so-called surgical maladies, there is no definite

principle developed. It is a recognition scarcely more than that

implied in the older surgical writers, when, if the surgical part of a

case did not go on well, they recommended the calling in of a physician.

In this state of things, John Hunter began a beautifully simple,

and, in its bearings on surgery, we may add, a new mode of inquiry.

He saw that there was much in all animals that was common, and that

there were analogies in the whole organic kingdom of nature; hence he

sought to develop, by observation of the various processes in various

animals, and their nearest analogies in vegetables also, the _true

relations_ of the phenomena observable in man. It was not that he did

that which had never been attempted before, in the abstract, but that

he undertook it with a new, a concentrated unity of purpose. He did

not employ, as it were, a different instrument to collect the rays

of light from surrounding nature; but he concentrated them into a

focus on a different object—the nature and treatment of disease. His

labours, though not permitted to endure for many years, interrupted by

indisposition, and suddenly stopped by death, were abundantly fruitful;

they enabled him to simplify much of surgery that was officious and

hurtful, and to correct many errors. He first gave a reason for this or

that proceeding, founded on actual observation of natural processes:

thus, in healing of wounds, the natural and healthy were distinguished

from unnatural and unhealthy processes, and so forth. But as Mr.

Hunter's enlarged views taught him the the value of the _relations_

observable throughout the whole animal creation, he contemplated

_parts_ of the body only as a step to the more successful observation

of the _whole_. As before stated, he observed the phenomena exhibited

by the various organs, both separately and in connection; traced

them with elaborate circumspection, and concluded by justifying what

Abernethy said, when he observed: "Hunter proved that the whole body

sympathized with all its parts."

Now, many of the facts which Mr. Hunter remarked in the relations

established between different parts of the body, were, in the

strictest sense, axiomatic—that is, they were exemplifications of

laws to which they were the necessary steps. Take one for example:

that the part sympathetically affected by an impression primarily

made on another part, appeared to be frequently _more disturbed_

than the part with which it had appeared to sympathize. This we now

know to be no exception, but rather the law; because the exceptions

(as we contend[82]) are explicable; but that was not then perceived.

Abernethy, however, made use of this so far as to impress the fact,

that organs might be seriously disordered without there being

_apparently_ any symptoms referable to them.

Now, Abernethy might have continued to labour as Hunter did in

collecting facts as the materials for axioms, or as elements for

future and more extensive generalization; or he might have at once

taken Mr. Hunter's views, so far as he had gone, and, working on them

with his remarkable aptitude for perceiving the more salient and

practicable relations of facts, have applied them at once to practical

purposes; gleaning more facts as his extremely acute observation might

have enabled him on the way. He pursued, perhaps, neither course

exclusively; but the latter appeared to be the one he chiefly adopted;

and, from the more immediate fruition it affords, no doubt it was best

adapted to the existing exigencies of a practical profession.

John Hunter was a man of indefatigable industry, and exceedingly

_circumspect_ in his observance of facts. Abernethy was fagging too,

but more impulsive and not so dogged; mere facts were mere bores to

him; he panted for _practical_ relations, and was most wonderfully

quick in perceiving them. His vision was as penetrative as Hunter's

had been circumspect and cautious. Hunter would have sifted all the

useful things out of any heap, however heterogeneous; Abernethy would

have looked through it, at once found the one jewel that it concealed,

and left the rest for the next comer. They were both most perfectly

honest and truthful, both careless of money, both enthusiastic in

science—that is, both ardent in the pursuit of truth, with that kind

of feeling which does not stop to examine the utilitarian relations

of these pursuits; but which, carried on by a continually increasing

impulse, takes the good for granted, and is impelled by the love of

truth for its own sake.

But, interesting as it is to contemplate those requisitions which, as

indispensable, are common to the successful investigators of science,

it is yet more so to observe the _distinctive_ characters of John

Hunter and John Abernethy. The former, with many ideas to tell, and

most of them new, had a difficulty in expressing himself. With more

need than any man before him for additional facilities in this way,

he had a restricted vocabulary. Again, in making use of it, his style

was seldom easy, often obscure; so that things which, when thoroughly

understood, had no feature more striking than their simplicity, were

often made to appear difficult, and by many readers, no doubt, had

often been left unexamined.

Abernethy, on the contrary, had a happy facility of expressing himself,

and a power, rarely equalled, of singling out the difficult parts

of a subject, and simplifying them down to the level of ordinary

capacities. Hunter, though not without imagination, or humour even,

had these qualities held in abeyance by the unceasing concentration

of his intellectual faculty. As Abernethy used to say, "John Hunter

was always thinking." Abernethy, on the contrary, had an active

imagination; it always accompanied his intellect, like a young, joyous

attendant, constantly lighting up the more sombre propositions of her

grave companion with varieties of illustration. The most difficult

proposition, directly Abernethy began to fashion it, had all its

rough points taken off, and its essential features brought out clear

and orderly to the plainest intellect. John Hunter, in laying down a

series of facts having the most important influence in the formation

of a medical science (take place when it may), was not able to keep

people awake. Abernethy's treatment of the most dry and unimportant,

kept his audience unceasingly interested. The obscurity of language

in Hunter was happily replaced, not only by an unusual ease, but by a

_curiosa felicitas_, in Abernethy. In sustained composition, Hunter was

generally difficult, often obscure; Abernethy, if not faultless, always

easy and unaffected. If his style failed sometimes in earnestness and

vigour, it was always sincere; and whilst, though not deficient in

eloquence, it asserted no special claim to that excellence, it was

always pleasing and perspicuous.

Nothing could be further from the earnest and thinking John Hunter than

anything dramatic. Abernethy had that happy variety of countenance and

manner that can be conveyed by no other term. Hunter, without being

slow, was cautious, circumspect: Abernethy, without being hasty, was

rapid, penetrative, and impulsive. Never were two minds so admirably

fitted for the heavy-armed pioneering in science, and the comparatively

light-trooped intellect which was calculated to render the first

clearing easily convertible to those practical necessities with which

the science had to deal. Accordingly we find that Abernethy very soon

extended Mr. Hunter's views, and applied them so powerfully, as at

least to create the dawnings of a science. He showed that all processes

in the economy—and of course, therefore, those of disease—are

essentially nervous in their origin: that is to say, the nerves being

the _instruments_ through which our relations are established with

surrounding nature (however much we may, in common language, speak of

this or that feeling, this or that _organ_, or this or that part of the

body), all impressions must still be made primarily on the sensitive or

nervous system of that part; and this, of course, whether they imply

_consciousness_, or be altogether independent of it; that disturbed

nervous action was, as the case might be, either the forerunner—or the

next link in the chain of causation (i. e. the proximate cause)—of

the disease; and that therefore the relief of diseased or disordered

actions, however attempted, consisted ultimately and essentially in the

restoration of healthy nervous power, or adaptation.

This, then, is the first proposition. The next thing, and which

necessarily follows, is, that in the prevention or cure of disease, the

first object is the tranquillizing of nervous disorder.

Now, here there are many things to be regarded; for man is a moral

as well as a physical being; and the circumstances by which he

is surrounded, even the air he breathes, the moral and physical

impressions to which he is subjected, are very often not under his own

control, much less that of his medical attendant. On the other hand,

the food is, in civilized communities, very much under the influence

of his volition; and there are many circumstances which, instead of

impeding those adaptations which disorder requires, renders them

particularly easy—it frequently happening that those things which

are really best, are most easily procured. This is important; because

the next proposition is, _that the nervous system is very easily and

constantly disturbed by disorder of one or other, or of the whole

of the digestive organs_, and that therefore the tranquillizing of

disturbance in them is of the highest consequence in the treatment of

disease: _few_ propositions in _any_ science are more susceptible of

proof than the foregoing. But if this be so, we must now recollect

the full force of what we have observed with regard to relation; that

is, we must not restrict our notion of it to the general loose assent

that there is a relation in all parts of the body, and rest on the

simple admission, for example, that animals are formed in adaptation

to their habits; but we must sustain the Cuvier-like impression of the

fact, the Owen-like application of it to the phenomena; recollect

that _preconceived_ ideas of magnitude and minuteness can do nothing

but obscure or mislead; and that the relations established in the

body are constant and universal, however they may at first—as in the

case we have quoted—excite the surprise or the derision of the less

informed and less reflecting. We must take their immensely potential

power as existing _as certainly in the most trifling headache, as

in the most malignant fever_—in the smallest scratch, _as in the

most complicated compound fracture_. We have plenty of facts now to

_prove_ this; but the first plain, clear enunciation of it all, the

successful demonstration of it at the bedside, and the consequent

diminution of an enormous amount of human suffering, is the great

debt we owe to Abernethy. Mankind in general admitted that Diet

was of consequence. Nobody doubted its force as an _accessory_ in

treatment. Lactantius said: "Sis prudens ad victum sine quo cetera

remedia frustra adhibentur." But no one had recognized the treatment

of the Digestive Organs as the essential part of the treatment of

_surgical_ diseases, nor founded it on the same comprehensive view

of its relations as addressed to organs which executed the nutritive

functions of the body on the one hand, and were the _most potential

disturbers or tranquillizers of the nervous system on the other_,

and thus for ever linked them in their practical relations with the

fact, that the essential element of disease, the _fons et origo_, is

disturbed nervous power. But, as all diseases are merely the result of

two conditions—namely, the injurious influence acting, and the body

acted on—it matters not whether the injurious influence be sudden,

violent, slow, moderate, chemical, mechanical, or what not; so the

foregoing positions affect the whole practice of medicine, and must not

be held as affecting any one part of it, but as influencing equally

both medicine and surgery.

We do trust that these few propositions will induce some to think; for,

as Abernethy used to say, lectures will never make surgeons: and we

feel equally confident that no books, no individual efforts, however

costly or sincere, will really benefit or inform any portion of the

public or the profession, except such of them as may be induced to

_think_ for themselves. They have only to recollect that, in carrying

out such principles, they must not measure their influence by their

previously conceived notions; they must encourage labour when they see

the profession willing, and not thwart them by showing that it will be

labour in vain. There will soon be science, if it is encouraged:

"Sint Mæcenates, non deerunt Flacci."

If they are disposed to think investigation too minute to be practical,

or precision too unpleasant to be necessary, let them remember the

story of Professor Owen's beautiful application of minute relation, and

that the distinction between a huge common quadruped and an unknown

wingless bird could alone be discovered by particulars far more minute

than they will be called on once in a hundred times to observe or

to follow. The obligation we have already noticed has in some sense

revolutionized the practice of medicine and surgery, and is no doubt

the capital debt we owe to Abernethy; but there are many others. His

application and adjustment of the operation of the trephine was a

beautiful and discriminating achievement, and would alone have been

sufficient to have raised an ordinary reputation.

His first extension of John Hunter's operation for aneurism, shows

how ready he was—when he could do so with advantage—to enlarge the

application of that branch of our duties which he least valued—namely,

operative surgery.

His proposal to add to the treatment of the diseases of joints

the apparatus of splints, for ensuring absolute quiescence of the

affected surfaces, has saved a most incalculable number of limbs from

amputation. It here becomes necessary to repeat a remark we have made

in a former work. Sir B. Brodie recommends this plan only in the

third edition, I think, of his discriminative work on the joints, not

appearing to have been aware that Abernethy taught it for nearly thirty

years previously, about ten years of which we ourselves had repeatedly

tested its great value, and taught it, but contemporaneously from

Abernethy, in our own lectures. Indeed, so important an element is it

in the treatment of diseases of the joints, that we have never seen it

fail, when fairly applied and accompanied by a reasonable attention to

the general health, except in the following cases: First, when the

patient has been nearly worn out by disease, before being subjected to

treatment; and, secondly, where the complaint has been proved to be

accompanied by internal organic disease.

We have always thought that one of the most valuable of our obligations

to Abernethy was his lesson on fracture of the neck of the thigh bone

within the capsule of the joint. For thirty years, Sir Astley Cooper

taught, and boasted that he had taught, that this fracture could not

unite by bone; Sir Astley reasoning on the anatomy of the part _only_,

and conceiving that the neck, in its somewhat isolated position,

would be imperfectly nourished; and, seeing that, in point of fact,

this fracture _did generally_ unite by ligament only, unfortunately

adopted the foregoing idea as the _cause_ of the fact, and concluded

that bony union was impracticable. Experiments on animals—at all

times extremely fallacious, in this case singularly imperfect in the

analogy they afforded—appeared to confirm his views. Despairing of

effecting a proper union, he adopted a treatment which rendered it

impossible. Abernethy's beautiful reasoning on the subject led him to

an opposite conclusion. It embraced certain views of Hunter's, and some

common phenomena in other accidents where the union by ligament is

_coincident_ with _motion_ of the part. He therefore treated all cases

with a view to secure bony union; and he and many of his pupils had no

doubt but that they had seen examples of its success. Still, people

got well and were lost sight of, and therefore it was said that the

fracture was not _wholly_ within the capsule of the joint. At length

a specimen was procured from the examination of a dead body, and the

question set at rest, we believe, in the minds of every body, that

this fracture, though it require especial care to keep parts steady

and in apposition, will unite just like other fractures in the way

taught (and since proved) by Abernethy. Let those who can calculate the

number of surgeons who have been educated by these two gentlemen, and

who, for the first few years, would have almost certainly followed the

practice of their instructors, compute the number of those of the lame

who, under Providence, have walked in consequence of the clear-sighted

reasoning of Abernethy.

How the French surgeons may have been influenced by Abernethy on

this subject, I do not know. When I was first in Paris, in 1824, they

were divided; but I recollect Baron Larrey showing me a case which

he regarded as a clear example of this fracture in course of firm

consolidation, and he was well aware of the opinion of Abernethy.

The bearing which Abernethy's acuteness of observation of the influence

of the state of the digestive organs on so-called specific poisons in

producing or maintaining diseases resembling them, opposed as it was to

the most powerful conventionalism, is a proof of his clear judgment;

and, if we mistake not, will one day prove to have been the first

ripple of a most important law in the animal economy, which will shed

a light as new on specific affections as his other principles have on

diseases in general.

His treatment of that severe malady, "lumbar abscess," is, in our view,

a most acceptable addition to humane and successful surgery; and as

regards one of its distinctive characters, he has, as we have shown,

received the encomiums of the most distinguished of his contemporaries,

including Sir Astley Cooper.

The manner in which he applied that law which prevails in voluntary

muscles to the replacement of dislocations—namely, that muscles

under the influence of the will cannot ordinarily act long and

unremittingly—was an amendment as humane as scientific; and, whilst

it has removed from surgery a farrier-like roughness in the treatment

of dislocations, as repulsive as unnecessary, it has adjusted the

application of more sustained force, when it becomes necessary, on

principles at once humane, safe, and effectual. In short, whatever

part of surgery we consider, we should have something to say of

Abernethy—either something new in itself, or improved in application.

We find him equally patient and discriminative, wherever there is

danger; thus there is the same force and originality on the occasional

consequences on the simple operation of bleeding in the arm, and the

more serious proceeding of perforating the cranium. He is every where

acute, penetrating, discriminative, humane, and practical; so that it

is difficult which most to admire, his enlarged views in relation to

important general principles, or the pervading science and humanity

with which he invests their minutest details.

Hunter's method of investigation was highly inductive; and, whenever he

adhered to it, the structure he has left is stable, and fit for further

superadditions. Whenever he proceeded on any preconceived notions,

or on an induction manifestly imperfect, his conclusions have, as we

think, been proved unsound. His definition of disease, as distinct

from accidental injury, is one instance which we formerly noticed in

our own works; and some of his conclusions in regard to poisons—as

mercury, for example—will not hold; but all that Abernethy made use

of, either in developing his own views or maturing their practical

applications, were sound and most careful deductions from obvious and

incontrovertible facts. Abernethy took equal care to deduce nothing

from them, or from anything of his own observations, but the most

strictly logical inferences—conclusions which were, in truth, little

more than the expression of the facts, and therefore irrefragable. He

showed that, however dissimilar in kind, nervous disturbance was the

essential element of disease; and that the removal of that disturbance

was the essential element of cure. That no mode should be neglected,

therefore, which was capable of exerting an influence on the nervous

system; but that, whether he looked at the subject as mere matter of

fact, or as assisted by the phenomena of health or disease generally,

or merely to that which was _most within our power_, no more potential

disturbers of the nervous system were to be found, than disordered

conditions of the digestive organs; and that the tranquillizing of

these must always be a leading object in our endeavours to achieve the

still greater one of tranquillizing nervous disorder.

The absurd idea that he looked chiefly to the stomach—that he thought

of nothing but blue pills or alterative doses of mercury—need scarcely

detain us. His works show, and his lectures still more, that there

was no organ in the body which had not been the object of his special

attention; in almost all cases, in advance of his time; and not

exceeded in practical value by any thing now done. We know of nothing

more valuable or clear _now_ than his paper on the skin; nothing so

advanced or important as his observations on the lungs and skin, and

the relations of these important organs; and it is unnecessary to

repeat what has been already said about the digestive organs. His

medical treatment was always very simple, and, if its more salient

object was to correct disorders of the liver, it was because he knew

that the important relations of that organ not only rendered it very

frequently the cause of many disorders, but that there could be nothing

materially wrong in the animal economy, by which it must not be more

or less affected. He carried the same clearness and definiteness of

purpose into his prescriptions, as that which characterized all his

investigations; and, indisposed to employ any means except on some

principle, used but few remedies; although he by no means wished to

deter others from having recourse to a more extended pharmacopæia. We

regret, indeed, the impossibility of doing full justice to Abernethy

in any thing less than a running commentary on the publication of his

works; but we have said enough, we trust, to show how largely the

profession and mankind are indebted to him.

Now, in these days of testimonials, what memorials have we of

Abernethy? It is true there is no monument at Westminster Abbey, and

only a bust at St. Bartholomew's. His portrait, to be sure, given by

his pupils, hangs at St. Bartholomew's, exalted where it can hardly be

distinctly seen, to be replaced by those of Mr. Vincent[83], and Mr.

Lawrence in his Professor's gown! But he has still a

"Monumentum ære perennius,"

in the claim he has established to the rarely so truly earned honour of

"nihil quod non tetigit, et nihil quod tetigit, quod non ornavit;" in

the grateful hearts of many a pupil who had no other obligation to him

than his beautiful lessons; and in an improved medical Surgery, which,

though it may have in _London_ rather retrograded than otherwise since

his time, is felt more or less in its moral as well as its medical

bearings, and in a diminution of suffering and an improved practice

throughout the civilized world.

But, if Abernethy's views are so true or so excellent as we allege that

they are, they must have _some_ relation to anything that is good in

every kind of medical or surgical treatment; and this equally, whatever

the system (so called) whence it may arise, however much of truth or

error it may contain, or however perplexingly these qualities may be

blended together. These are points on which we have yet something to

say; and as we are anxious that the public and the profession should

favour us with their attention to the very few remarks we have the

space to offer, we must have a new chapter.

[Footnote 82: See "Medicine and Surgery One Inductive Science." 1838.]

[Footnote 83: A contemporary of the Hospital, of whom, as a practical

surgeon, Mr. Abernethy expressed a very high opinion. Until the matter

was explained, Mr. Vincent's son was afraid that something "sneerlike"

was intended in this passage; and we were glad of an opportunity of

correcting that impression. Nothing could be farther from the intention

than anything of the kind in regard to either. But it seemed to us an

infelicitous result of the Governors probably having no better rule

for the disposition of their portraits than that which some of us are

obliged to observe in the shelves for our books—we mean the rule which

has twelve inches to the foot.]

CHAPTER XXXII.

"Quæ res neque consilium neque modum habet ullum

Eam consilio regere non potes."

TER. Eun. Act i, Sc. i.

"Master, the thing which hath not in itself

Or measure or advice—advice can't rule."

COLMAN.

POSITION, PROGRESS, AND PROSPECTS OF THE PROFESSION—OF

HYDROPATHY—OF HOMŒOPATHY—OF QUACKERY—OF PUBLIC

IGNORANCE.

A writer[84], of no ordinary judgment and discrimination, has observed,

that "it often happens in human affairs that the evil and the remedy

grow up at the same time: the remedy unnoticed, and at a distance

scarcely visible perhaps above the earth; whilst the evil may shoot

rapidly into strength, and alone catch the eye of the observer by the

immensity of its shadow; and yet," he adds, "a future age may be able

to mark how the one declined and the other advanced, and how returning

spring seemed no longer to renew the honours of the one, while it

summoned into maturity and progress the perfection of the other."

We know not how it may appear to the reader, but we cannot help

thinking that, in the foregoing sentence, there is a far-seeing

perception of a very leading character in human affairs. There is no

evil but which is charged with a certain degree of good. At first,

it is indeed "scarcely visible"—nay, it escapes alike the most

penetrative perception and faithful confidence, in the surpassing

working-to-good of all things around us; but so soon as the evil begins

to tell—so soon as the full flood of mischief becomes obtrusive or

remarkable,—the small ripple of some corrective principle rises into

view.

It would be easy to illustrate the foregoing proposition from general

history, from the progress of nations, or even from the contracted

area of individual experience. But we will confine ourselves to an

illustration more directly in relation to our immediate object—namely,

the present condition and prospects of medical science.

There are, no doubt, many persons who view the present state of

Medical Science as little better than the triumphant domination of a

conjectural art, which has long obscured, and is still very imperfectly

representing, a beautiful science; and that the perception of the

true relations which it bears to such science has been veiled by the

impression that it involved some mystery from which the general public,

who were most interested in its development, were necessarily excluded.

There have been at all times individuals, perhaps, sufficiently

astute to see the real truth of the matter; but still they were

rare exceptions, and did not prevent Mystery from conferring, on

a very considerable section of people, the social advantage of a

gainful profession; that property being enhanced, of course, in that

it ministered to an ignorant public. But, even in an early stage,

correctives to an equivocally-earned advantage began to appear; for a

thing which had no character but its indefiniteness, and its apparent

facility of acquisition, obtained many followers: the supply, such

as it was, was thus so close in relation to the demand, that what in

theory seemed necessarily very gainful, in practice, on the whole,

proved anything but a lucrative profession. As contrasted with any

other, or a variety of commercial pursuits, medical men were neither so

affluent, nor always so secure of their position. Retiring competency

in well-conducted callings has, in a rich country, been rather the

rule. We fear, in the medical profession it is the exception; which,

we are apprehensive (in its bereaved dependents), contributes more

applicants for eleemosynary relief than any other.

This surely is not a state of things which can be well made worse.

Public ignorance, the _real mischief_, has, in the meantime, been

left uninformed; and any attempt to enlighten it has too often been

branded with some kind or other of corrupt motive. Public positions

have been conferred without competition—the surest test of fitness

or excellence; and the public have been further doubly barred out,

in that the chance of eliciting men of spirit and enthusiasm has

been diminished, by the first positions having been often rendered

contingent on the payment of money in the right quarter.

But all this time corrections were slowly springing up. Hundreds were

beginning, under the light of a more liberal diffusion of general

knowledge, to feel that the so-called Science of medicine and surgery

was very different from science usually so termed; and, whilst other

sciences were affording that which was definite and positive, the

juxtaposition only seemed to bring out in higher relief the prevailing

character of conjecture and uncertainty in medicine.

People began to see that, in mere human occupation, mystery is but

mystery, to whatever it is applied; and that one man can see in the

dark about as well as another; that, where all is obscure, any one

may scramble with a chance of success. Accordingly, we observe that

a state of things has gradually been rising up, which, if it do not

justify the expression of _quot medici tot empirici_, at least leads

us to deplore that, of all callings in life, no one had ever such a

legion of parasites as are represented by the hydra-headed quackeries

which infest the medical profession. Naturally enough, too, Quackery

attacked chiefly those disorders in regard to which Mystery avowed its

incapacity, or declared to be incurable; and thus, while the regular

profession made their _own limited_ knowledge the measures of the

_powers of nature_, the quacks unconsciously proceeded, _de facto_,

more philosophically, when they neither avowed nor acknowledged any

other limits than those of observation and experience.

Amongst, no doubt, innumerable failures, and, as we know, a

multiplicity of fictions, they would now and then, in acting violently

on the various organs, blunder on the last link in the chain—the

immediate cause of the disorder; and perhaps effect the removal of a

so-called incurable malady. Thus, whilst the regular profession were

making their own knowledge the _measure_ of remedial possibility, and

were reposing contentedly on the rule, they were every now and then

undermined, or tripped up, by unexplained exceptions.

It is difficult to conceive any state of things, when once observed,

more calculated to drive men to the obvious remedy that a definite

science would alone afford; nor should it be forgotten that multiform

quackeries, with mesmerism to boot, are coincident with a system which

allows _not one single appointment_, which the public are requested to

regard as implying authority, to be open to scientific competition. Of

late, many persons have begun to examine for themselves questions which

they had been wont to leave entirely to their medical adviser.

The sanitary movement has shown that more people die every year from

avoidable causes than would satisfy the yawning gulf of a severe

epidemic, or the most destructive battle. In a crowded community, many

events are daily impressing on the heads of families, besides the

expedience of avoiding unnecessary expenses, that long illnesses are

long evils; that their dearest connections are sometimes prematurely

broken; and that parts are not unfrequently found diseased which are

not suspected to be so during life. The thought will sometimes occur

whether this may have been always consequent on the _difficulty_ of

the subject, or whether it may not have been sometimes the result of

_too hasty or too restricted_ an inquiry; that not only (as the Spanish

tutor told his royal pupil of kings) do patients die "sometimes," but

very frequently.

These and other circumstances have induced many of the public to

inquire into the reason of their faith in us; and to ask how

it happens that, whilst all other sciences are popularized and

progressing, there should be any thing so recondite in the laws

governing our own bodies as to be accessible only to comparatively few;

especially as they have begun to perceive that their interests, in

knowing such laws, is of the greatest possible importance.

Amongst various attempts to better this condition of things, the

imagination of men has been very active. Too proud to obey the

guidance, or too impatient to await the fruition, of those cautious

rules which the intellect has imposed on the one hand, and which have

been so signally rewarded (whenever observed) on the other, imagination

has set forth on airy wing, and brought home curiosities which she

called science, and observations which, because they contained _some_

of that truth of which even fancies are seldom entirely deprived,

blinded her to the perception of a much larger portion of error.

Two of these curiosities have made considerable noise, have been not a

little damaging to the pecuniary interests of the medical profession,

and have been proportionately species of El Dorados to the followers of

them. We allude to the so-called Homœopathy and Hydropathy.

Homœopathy proceeds on an axiom that diseases are cured by remedies

which excite an action similar to that of the disease itself; "_Similia

similibus curantur_."

Our objection to this dogma is twofold, and, in the few hints we are

giving, we wish them not to be confounded.

1st. It is _not_ proven.

2nd. It is _not_ true.

Take the so-called fever. The immediate and most frequent causes of

fever are bad air, unwholesome food, mental inquietude, derangement of

the digestive organs, severe injuries. Now it is notorious that very

important agents in the cure of all fevers are good air, carefully

exact diet or temporary abstinence, and correction of disordered

functions, with utmost repose of mind and body, and so forth.

So of small-pox, one of the most instructive of all diseases. All the

things favourable to small-pox are entirely opposite to those which

conduct the patient safely through this alarming disease; and so

clearly is this the case, that, if known beforehand, its virulence can

be indefinitely moderated, so as to become a comparatively innoxious

malady.