_SIR ASTLEY COOPER AND ABERNETHY: THE KNIFE_ VERSUS _REGIMEN._
Few men have been more renowned in their day than the great “Sir
Astley.”
ASTLEY COOPER was the grandson of a surgeon at Norwich. His father
was a very estimable clergyman in Norfolk; his mother wrote novels
of some repute, and was noted for her benevolence and unselfishness.
Astley, the fourth son of a numerous family, was born on August 23,
1768. His youth was marked by a succession of hairbreadth escapes
and exploits, demanding coolness and audacity. He had no great taste
for classics or literature in youth or through life. As a youth he
had a handsome and expressive countenance, with much openness of
manner and liveliness of conversation, so that he often charmed
those who disapproved of his wild freaks. Like John Hunter, he had a
free youth, and if unimproved was likewise unspoiled by systematic
training.
Both the grandfather and the uncle of Astley Cooper, the latter
a lecturer at Guy’s, are credited with some share in exciting a
surgical bias in the boy’s mind. Visiting the Norwich hospital one
day, and seeing a striking operation, he was strongly impressed with
the utility of surgery. In 1784 a visit from his uncle, the London
surgeon, led to the nephew being articled to him; but his progress
here was limited, owing to the attraction which a free town-life had
for him at first. One day he was met by his uncle disguised in the
uniform of an officer, and the former recognising his nephew, the
latter denied all knowledge of him. The detection of this escapade
was soon followed by his transfer as a pupil from his uncle to Mr.
Cline, who then shared with Abernethy the next honours as a surgeon
to John Hunter. Under Cline, young Cooper imbibed the spirit of
Hunter’s teaching from one of his most enthusiastic pupils: for
Cline’s judgment about Hunter was that there seemed no comparison
between his great mind and all who had preceded him.
Sir Astley Cooper at a later period thus depicts his old master: “Mr.
Cline was a man of excellent judgment, of great caution, of accurate
knowledge; particularly taciturn abroad, yet open, friendly, and
very conversationable at home. In surgery cool, safe, judicious; in
anatomy sufficiently informed. In politics a Democrat, living in
friendship with Horne Tooke. In morals thoroughly honest; in religion
a Deist. A good husband, son, and father. As a friend sincere, but
not active; as an enemy most inveterate.”
Young Cooper was soon actively engaged in dissection, and his
adventurous nature found scope in many a night-expedition with the
body-snatchers or resurrectionists in their search for “subjects.”
He spent one winter session (1787-8) at Edinburgh, having already
made considerable progress in anatomy and surgery. He greatly
appreciated Cullen, Black, and Fyfe. Having returned from Edinburgh,
he attended John Hunter and other celebrated lecturers, and in 1789,
being only 21, he was appointed demonstrator at St. Thomas’s. Two
years later Mr. Cline obtained for him the joint lectureship with
himself in anatomy and surgery. In December 1791 he married Miss
Anne Cock. The wedding was perfectly quiet owing to the recent death
of the lady’s father, and on the evening of the same day Astley
Cooper lectured on surgery with his usual composure, without any of
his pupils becoming aware of his marriage. In June 1792 the young
surgeon and his bride visited Paris, and were there during the three
terrible months which followed. Cooper spent much time in studying
Parisian methods of surgery and in attending the debates of the
National Assembly. His safety was secured by a democratic badge, and
by friendship with leading revolutionists in England to whom Cline
adhered.
In addition to his income from his hospital lectures, Mr. Cooper
came into possession by his marriage of a fortune of fourteen
thousand pounds, so that he was at once placed beyond any pecuniary
anxiety. He consequently was enable to devote himself mainly to
study and teaching. He went to the hospital before breakfast to
dissect for lecture, and he also demonstrated to students before the
lecture-hour. He injected their subjects, lectured from two till
half-past three, and three evenings a week lectured on surgery.
Further, he persevered in visiting the interesting cases in the
hospital and making notes of them. His lectures on surgery, which
he was the first in the Borough hospitals to separate from anatomy
and physiology, were not at the beginning a conspicuous success. He
found that he had been too theoretical, but soon changed his plan,
and selected cases in the hospital as the basis of his lectures. From
this moment his class increased and became interested. He himself
acquired a facility in recalling cases and circumstances illustrative
of the disease under consideration which greatly added to the
attractiveness of his style. The fact is, he was not the intellectual
successor of John Hunter, and could not succeed by similar methods.
Yet the influence of Hunter upon him was unmixedly beneficial; he had
the wit to perceive that Hunter was not “an imaginative speculator,
and any one who believed in him a blockhead and a blacksheep in the
profession.” The improved lectures on surgery attracted twice as
many entries in 1793 as in 1792, and Mr. Cooper was besides selected
as lecturer on anatomy at the College of Surgeons. A chief part of
his duties in this latter capacity was to lecture on and dissect the
bodies of executed criminals. The lectures were most successfully
given to crowded audiences. In 1797 the now rising surgeon removed
from his early residence in Jeffries Square, St. Mary Axe, to 12
St. Mary Axe, long occupied by Mr. Cline, who now moved westward.
In the next year he had a severe accident, being thrown from his
horse on his head, and his life was in considerable danger for some
time. The extent of Mr. Cline’s consolatory sympathy, when Cooper
was lamenting the risk to his life because of its interference with
some professional inquiry likely to be of public benefit, was thus
expressed: “Make yourself quite easy, my friend; the result of your
disorder, whether fatal or otherwise, will not be thought of the
least consequence by mankind.”
An early pupil, Dr. William Roots, however, gives a very different
account of Cooper’s “consequence to mankind.” “From the period of
Astley’s appointment to Guy’s until the moment of his latest breath,
he was everything and all to the suffering and afflicted; his name
was a host, but his presence brought confidence and comfort; and I
have often observed that on an operating day, should anything occur
of an untoward character in the theatre, the moment Astley Cooper
entered, and the instrument was in his hand, every difficulty was
overcome, and safety generally ensued.” No doubt reference is here
made to the fact recorded by Sir Astley himself as follows: “I was
always of opinion that Mr. Cline and I gained more reputation at the
hospitals by assisting our colleagues than by our own operations, for
they were always in scrapes, and we were obliged to help them out of
them.”
Mr. Travers, who became Astley Cooper’s articled pupil in 1800,
says at that time he was the handsomest, most intelligent-looking
and finely formed man he ever saw. According to the custom of his
time, he wore his hair powdered, with a queue, and had always a
glow of colour in his cheeks. In his daily ride he wore a blue
coat and yellow buckskin breeches and top-boots. He was remarkably
upright, and moved with grace, vigour, and elasticity, and would not
unfrequently throw his well-shaped leg upon the table at lecture,
to illustrate some injury or operation on the lower extremity.
Cheerfulness of temper amounting to vivacity, and a relish for the
ludicrous, never deserted him, and his chuckling laugh, scarce
smothered while he told his story, his mirthful look and manner,
and his punning habit, were well known. His personal habits were
very simple; he drank water at dinner, and took two glasses of
port after. A good digestion never forsook him; as he said, “he
could digest anything but sawdust.” He was remarkable for requiring
little amusement or company beyond what he found in his professional
pursuits; and he read comparatively little medical literature.
It has often been alleged that Astley Cooper was somewhat unfeeling
in nature; and it must be admitted that he had not a deep sympathy
with bodily pain, for his own insusceptibility was equalled by his
physical endurance. Yet he always sympathised deeply with mental
suffering, and Mr. Travers, who saw him read a posthumous letter
from a favourite pupil who had committed suicide, relates that
his utterance was choked with sobs, and he wept as for the loss of
an only child. That his affection was not restricted to his own
immediate family is shown by the fact that on the deeply regretted
death of his little daughter he adopted into his family a little girl
who was no relative, but whose mother died early; and subsequently he
himself brought from Yarmouth in the coach, a twenty hours’ journey,
his little nephew, Astley, then two years old, who subsequently
became his successor in the baronetcy.
More widely known than the nephew during Sir Astley’s life was his
servant, Charles Osbaldeston—a name which in practice softened down
into Balderson. He was keenly alive to his master’s interest, and had
much tact and disposition for manœuvre; he boasted that in twenty-six
years he never lost a patient for his master whom it was possible to
retain. Wherever Mr. Cooper was, Charles would start after him, if
urgently required, and at any cost of post-horses track him out and
bring him triumphantly to the fore.
Mr. Cooper in his earlier years, when anatomy formed a great
part of his work, was of necessity largely concerned with the
resurrectionists, and was one of the main supporters, it may be
equally conceded, of their practices, the details of which he was
not unfrequently made acquainted with. But the state of the law,
which almost made it impossible to gain possession of subjects for
dissection legally, must be accepted as the apology for much that
would now as then be regarded as shocking. It cannot be strictly
germane to Sir Astley Cooper’s life to describe the procedure of
the body-snatchers, as Mr. Bransby Cooper has done;[17] but it may
be remarked that on occasions when public notice was threatened,
Astley Cooper took prompt steps to obviate injurious publicity of
his name. For a time the men of ill-fame reigned supreme, exacting
almost what prices they chose. If any demur was made, they stopped
the supplies, and then the medical students became angry, held
indignation meetings, sent deputations to their teachers, sometimes
asserting that their lecturers were not as active or as liberal as
those of some rival school, and threatening to leave _en masse_.
Thus the lecturers were in a manner forced to pay more for their
subjects than they could receive from their pupils for dissecting
them. Another disagreeable consequence was, that when the regular
“resurrectionists” got into trouble, the surgeons had to make great
exertions in their behalf, and often advanced large sums to defend
them, or to keep them and their families during imprisonment. Sir
Astley Cooper spent hundreds of pounds in this way. One of his
accounts includes £14, 7s. for half the expenses of going down
and bailing Vaughan at Yarmouth, £13 for Vaughan’s support during
twenty-six weeks’ imprisonment, £50, 8s. for four subjects, paid to
Murphy, and six guineas “finishing money” to three men, a douceur at
the end of a session.
The high prices paid led some people to offer their bodies before
death; but of course this was illegal. Sir Astley’s brief answer
to one offer from a third party asking to know the truth, was—“The
_truth_ is that you deserve to be hanged for making such an unfeeling
offer.” But under other circumstances, when the obtaining of the
corpse of a person who had died after an operation interesting to
the surgeon was in question, Sir Astley paid large sums, and was
thus enabled to add many valuable specimens of surgical results to
his museum. Thus his accounts for 1820 show the following entries
in regard to obtaining the body of a man on whom he had operated
twenty-four years before: “Coach for two there and back, £3, 12s.;
guards and coachmen, 6s.; expenses for two days, £1, 14s. 6d;
carriage of subject, and porter, 12s. 6d.; subject, £7, 7s.; total,
£13, 12s.”
This subject was to be obtained, we read, “cost what it may.” It is
no wonder, then, that of Sir Astley it might be said that no man knew
so much of the habits, the crimes, and the few good qualities of the
resurrectionists. He could obtain any subject he pleased, however
guarded: and indeed offered to do so. No one could go further than he
did before a Committee of the House of Commons, to whom he plainly
avowed: “There is no person, let his situation in life be what it
may, whom, if I were disposed to dissect, I could not obtain. The law
only enhances the price, and does not prevent the exhumation.” At
last the dreadful disclosures about the practices of “burking” in
Edinburgh in 1829 led to the passing of the Anatomy Act, legalising
dissection under proper regulations.
Nor were human bodies the only ones laid under contribution by Astley
Cooper. When animals were wanted for some physiological illustration
or investigation, his man Charles could always procure them, and
he had at one time as many as thirty dogs, besides other animals,
shut up in the hayloft. Half-a-crown a piece was paid by Charles on
receipt of the dogs, however obtained, and no doubt dog-stealing
was one source. The menagerie at the Tower was to Mr. Cooper, as
it had been to John Hunter, a considerable resource for specimens
for dissection. In 1801 an enormous elephant came under his knife,
and being too unwieldy to be got into the dissecting-room, it had
to be cut up in the courtyard, where, assisted by several students,
Mr. Cooper gave himself no rest till all the interesting parts were
preserved and deposited in St. Thomas’s Museum. Bird-stuffers,
fishmongers, and poultry merchants were also among the sources of
supply for his unwearying knife.
To Astley Cooper, as to most men who rise to eminence, remunerative
practice came but slowly. “My receipt,” says he, “for the first
year was £5, 5s; the second, £26; the third, £54; the fourth, £96;
the fifth, £100; the sixth, £200; the seventh, £400; the eighth,
£610; the ninth (the year in which he was appointed surgeon to the
hospital), £1100.” This was in 1800, when his uncle, William Cooper,
resigned the surgeoncy. It might have been supposed that the uncle
would favour his nephew’s succession in every way possible; but
he rather supported Mr. Morris, the strongest competitor. For the
rising star made the elder jealous of his brilliancy, and moreover
always regarded Cline, at St. Thomas’s, as his uncle’s superior. Thus
Astley Cooper’s success was by no means certain, as his political
associations with Horne Tooke and Thelwall were strenuously alleged
against him. But Astley, ever preferring success to politics,
resolved on giving up the latter and on being neutral for the future,
at any rate as to all open proceedings. This resolve secured his
appointment by Mr. Harrison, the well-known treasurer of Guy’s, who
with Sir Astley shares the highest credit in the establishment of its
medical school. He now absented himself from Mr. Cline’s political
parties, and always advised young surgeons not to attach themselves
to particular parties, as their duties must extend to persons of all
views. He also, to leave no stone unturned, personally canvassed each
of the seventy-two governors.
In 1800 Astley made his first communication to the Royal Society, on
the effects of destruction of the tympanic membrane of the ear. He
had found that considerable openings might be made in the membrane
without impairing the hearing power. He consequently applied this
operation to certain kinds of deafness resulting from disease or
obstruction in the Eustachian tube, and in 1801 sent in another
paper detailing the results of twenty cases. Although his success in
restoring lost hearing was much less than he had anticipated, the
operation has since been frequently performed, and the Royal Society
in 1802 awarded him the Copley Medal for these papers. In the same
year he was elected F.R.S.
Astley Cooper’s activities were at this time strongly directed
towards the improvement of his profession by intercourse and
discussion at societies, of several of which he was the life and
soul. The Physical Society at Guy’s Hospital afforded his earliest
opportunity of this kind, and long retained his active interest.
During his short stay at Edinburgh his predominance was so evident
that he was chosen president of a society to protect students’
rights against usurpations by the professors. Here also he joined a
Speculative Society, and read a paper in favour of the Berkeleian
theory of matter. One of the debates which he opened was on the
subject “Is man a free agent?” He would have been a president of
the Royal Medical Society at Edinburgh had he returned for a second
winter, so much did he distinguish himself in debate. At a later
period the strength of his association with Edinburgh was attested by
his forming the Edinburgh Club in London for former Edinburgh medical
students. The most important society, however, with the foundation
of which he was connected, was the Royal Medical Chirurgical
Society, which originated in a secession from the Medical Society
of London. Dr. Yelloly, who was intimately connected with the new
foundation, says of Mr. Cooper at this time: “I never saw any one
more open-hearted as a companion, more unreserved in his remarks,
with always a large store of information at his command, and who was
at the same time more kindly disposed, and abounding in all sorts
of material for the gratification of those with whom he associated.
He was not a reading man; but he contrived to get the most valuable
information of every description, whether professional or general,
and always to use it in the best, the most attractive, and the
readiest way.” The treasurer of the society was Astley Cooper, and he
rendered essential service. The earliest volume of its Transactions,
published in 1809, contained a paper recording his first operation
for the relief of aneurism of the carotid artery by tying it below
the aneurism—a method now established. But he had previously
published (part 1 in 1804, part 2 in 1807) a work which largely
contributed to his reputation, namely, on Hernia or Rupture. A second
edition was published in 1827. The anatomical structures concerned
were excellently expounded and illustrated, and the experience gained
in frequently and successfully operating in cases of this disease
gave Mr. Cooper a position of the highest authority. As so often
happens to medical men, his attention was especially called to this
disease from the fact that he had been subject to it from early life.
The anatomical study he undertook in order to perfect his knowledge
of this matter was immense. “I have related no case,” he says, “and
given no remark, for the truth of which I cannot vouch.” When his
pupils showed him some interesting appearance in a dissection, he
would say; “That is the way, sir, to learn your profession. Look
for yourself; never mind what other people may say, no opinion or
theories can interfere with information derived from dissection.”
The expense of the illustrations to this work was so great that Mr.
Cooper was loser of a thousand pounds by it when every copy had been
sold.
In 1806 Mr. Cooper left St. Mary Axe to occupy the house in New Broad
Street which for nine years was crowded by his patients, during
the most remunerative years of his life. In those years he rose at
six, dissected privately till eight, and from half-past eight saw
large numbers of gratuitous patients. At breakfast he ate only two
well-buttered hot rolls, drank his tea, cool, at a draught, read his
paper a few minutes, and then was off to his consulting-room, turning
round with a sweet benign smile as he left the room. Patients crowded
his rooms and besieged “Charles,” using manifold devices to get the
earliest interview possible. At one o’clock he would scarcely see
another patient, even if the house was full; but if detained half
an hour later, would fly into a rage, abuse Charles, and jump into
his carriage, leaving Charles to appease the disappointed patients.
Sometimes the people in the hall and ante-room were so importunate
that Mr. Cooper was driven to escape through his stables and into
a passage by Bishopsgate Church. At Guy’s he was awaited by a crowd
of pupils on the steps, and at once went into the wards, addressing
the patients with such tenderness of voice and expression that he at
once gained their confidence. His few pertinent questions and quick
diagnosis were of themselves remarkable, no less than the judicious
calm manner in which he enforced the necessity for operations when
required. At two the pupils would suddenly leave the ward, run across
the street to the old St. Thomas’s Hospital, and seat themselves
in the anatomical theatre. After the lecture, which was often so
crowded that men stood in the gangways and passages near to gain
such portions of his lecture as they might fortunately pick up, he
went round the dissecting-room, and afterwards left the hospital to
visit patients, or to operate privately, returning home at half-past
six or seven. Every spare minute in his carriage was occupied with
dictating to his assistants notes or remarks on cases or other
subjects on which he was engaged. At dinner he ate rapidly and not
very elegantly, talking and joking; after dinner he slept for ten
minutes at will, and then started to his surgical lecture, if it were
a lecture night. In the evening he was usually again on a round of
visits till midnight.
Dr. Pettigrew, in his “Medical Portrait Gallery,” thus vividly
describes the overpowering influence Sir Astley had upon his pupils:
“I can never forget the enthusiasm with which he entered upon the
performance of any duty calculated to abridge human suffering. This
enthusiasm, by the generosity of his character, his familiar manner,
and the excellence of his temper, he imparted to all around him;
and the extent of the obligations of the present and of after ages
to Sir Astley Cooper, in thus forming able and spirited surgeons,
can never be accurately estimated. He was the idol of the Borough
School. The pupils followed him in troops; and, like to Linnæus,
who has been described as proceeding upon his botanical excursions
accompanied by hundreds of students, so may Sir Astley be depicted
traversing the wards of the hospital with an equal number of pupils,
listening with almost breathless anxiety to catch the observations
which fell from his lips. But on the days of operation this feeling
was wound up to the highest pitch. The sight was altogether deeply
interesting; the large theatre of Guy’s crowded to the ceiling—the
profound silence obtained upon his entry—that person so manly
and so truly imposing—and the awful feeling connected with the
occasion—can never be forgotten by any of his pupils. The elegance
of his operation, without the slightest affectation, all ease, all
kindness to the patients, and equally solicitous that nothing should
be hidden from the observation of the pupils; rapid in execution,
masterly in manner; no hurry, no disorder, the most trifling minutiæ
attended to, the dressings generally applied by his own hand. The
light and elegant manner in which Sir Astley employed his various
instruments always astonished me, and I could not refrain from
making some remarks upon it to my late master, Mr. Chandler, one of
the surgeons to St. Thomas’s Hospital. I observed to him, that Sir
Astley’s operations appeared like the graceful efforts of an artist
in making a drawing. Mr. C. replied, ‘Sir, it is of no consequence
what instrument Mr. Cooper uses, they are all alike to him; and I
verily believe he could operate as easily with an oyster-knife as
the best bit of cutlery in Laundy’s shop.’ There was great truth in
this observation. Sir Astley was, at that time, decidedly one of the
first operators of the day, and this must be taken in its widest
sense, for it is intended to include the planning of the operation,
the precision and dexterity in the mode of its performance, and the
readiness with which all difficulties were met and overcome.”
Mr. Cooper, notwithstanding his persevering industry in dissection,
would not have found time to acquire all the knowledge he did, but
for employing several assistants either to dissect the specimens he
obtained from operations or from _post mortem_ examinations, or as
artists and modellers, amanuenses, &c. He was very peremptory in his
orders to his assistants to obtain for him any specimen he required,
and would not listen to suggestions of difficulties. “So and so must
be done,” he said, and his tone did not admit of the possibility
of failure. Thus he accumulated the large collection of morbid
specimens which he contributed to St. Thomas’s Hospital, at a time
when such collections were poohpoohed, and so little regarded, that
he could readily obtain any specimen he desired which was at the
disposal of his colleagues. With regard to his proceedings in these
matters the utmost secrecy was observed, entrance to his private
dissecting-rooms being jealously restricted to himself and his paid
assistants. When it was difficult to obtain leave to make a _post
mortem_ examination in private practice, he would spend a long time
in arguing most strenuously upon the matter with the relatives,
pointing out the reasons which rendered it desirable in the interests
of science. His only child was examined by his express wish by a
friend; and he left strict injunctions and directions for the _post
mortem_ on his own body. In very few cases was his determination ever
frustrated.
Astley Cooper reached his zenith in Broad Street. In one year his
income reached £21,000; for many years it was £15,000. One merchant
prince paid him £600 a year; the story of another, who tossed him a
cheque for a thousand guineas in his night-cap, after a successful
operation for stone, is well known. Many of his patients wrote a
cheque for their fee when they consulted him, and never made it less
than five guineas. It is amusing to contrast with his reputation as
a surgeon and operator, the extremely limited pharmacopœia to which
he trusted. “Give me,” he would say, “opium, tartarized antimony,
sulphate of magnesia, calomel and bark, and I would ask for little
else:” and from five or six formulæ he gave his poorer patients a
constant stock of medicine.
Mr. Cooper was appointed Professor of Comparative Anatomy at the
Royal College of Surgeons in 1813, being the first appointment after
Sir Everard Home retired. He lectured during only two seasons, in
1814 and 1815. Not being deeply read in his subject, he resolved to
see what industry could do, and restricted himself to three or four
hours’ sleep, that he might gain additional time for the dissection
of animals. He also employed several assistants to dissect for him,
and the result was that his specimens came by coach-loads to each
lecture. Mr. Clift remarks of one lecture, “This was an overpowering
discourse, and highly perfumed, the preparations being chiefly recent
and half-dried and varnished.” His lectures were very successful,
though he would have preferred lecturing on surgery, which was
allotted to Abernethy. In the year last mentioned he resigned the
professorship and also moved to New Street, W., hoping thereby to
diminish the fatigue occasioned by the numerous visits which he had
to pay westward. In the following May he signalised his skill by his
celebrated operation of tying the aorta or principal artery of the
body, for aneurism, in a case in which life was in the extremest
peril. The ease with which he prepared for the operation and the
masterly skill and success with which he completed it—without the aid
of chloroform, be it remembered—excited admiration throughout the
profession, who could best judge of the difficulties which had to be
overcome. The patient died of incurable disease, but the success of
the operation was undoubted.
After having for some years attended Lord Liverpool, Mr. Cooper was
in 1820 called in to George IV., who afterwards insisted on his
performing a small operation upon him, although he then held no court
appointment. He was very reluctant, fearing erysipelas, and only at
length yielded to command. His success in this was followed by the
conferment of a baronetcy, which was hailed with acclamation by all
his friends both professional and public.
In 1822 Sir Astley first became an Examiner at the College of
Surgeons. In this capacity he was very conscientious and considerate,
never asking catch-questions, or making abstract inquiries, but
invariably dwelling upon practical matters, and putting his questions
in simple and straightforward language. In the same year appeared
perhaps his most important work, that on Dislocations and Fractures
of the Joints, and as was his fixed principle, he published it at
a price just sufficient to cover the cost of the letterpress and
engravings.
In January 1825 Sir Astley resigned his lectureship at St. Thomas’s,
owing to the impairment of his health. Mr. Key had previously been
delivering part of his surgical course, and his nephew Bransby
Cooper had undertaken the anatomical lectures; and Sir Astley was
determined to secure their succession to his appointments. He had
only resigned in the firm conviction that this was generally agreed
upon. His astonishment may be imagined when he learnt that Mr. South
had been appointed anatomical lecturer. Sir Astley, desiring to
withdraw his resignation, was informed that it was too late. Mr.
Harrison, however, the then spirited treasurer of Guy’s, came to
the rescue, and offered to establish a school of medicine at Guy’s,
totally independent of St. Thomas’s, and to appoint Mr. Key and Mr.
Bransby Cooper to the chairs of surgery and anatomy. This was at
once agreed to, and a lecture theatre and other premises hastily
built during the summer, so that the new school of Guy’s was opened
in the succeeding October. A large proportion of the old pupils of
the united schools of St. Thomas’s and Guy’s entered at Guy’s, and a
considerable number of new pupils coming up, the now famous school
was prosperously floated. Sir Astley did not lecture much for the
new school, though he gave a few occasional lectures on anatomy
and surgery, which of course were crowded to excess. He now became
consulting surgeon to Guy’s, and evidenced his zeal by commencing the
formation of a museum like that which he had already deposited at St.
Thomas’s, and which he would have removed thence had it been in his
power. In 1827 he was elected President of the College of Surgeons.
By this time Sir Astley had adopted the habit of spending as much
of his time as possible on his estate at Gadesbridge, near Hemel
Hempstead. Here he became a rural character, shooting and “making
shoot” with eagerness and joviality. Lady Cooper, having lost
her adopted daughter, Mrs. Parmenter, and having had no second
child, could not endure living in London. In 1825, Sir Astley took
his home-farm upon his hands, and kept it in consummate order,
at considerable expense, it must be owned. He was always either
experimenting or trying to carry out some new plan he had heard of
or observed. He again and again became violently angry, as he grew
older, when he found that his ideal farm only produced substantial
loss: and used repeatedly to vow he would never allow such passion
to overcome him again. One of his experiments in farming was the
purchase of lame or ill-fed horses at Smithfield at from five
to seven pounds apiece, feeding and doctoring them himself at
Gadesbridge, and turning them into much better animals. He sometimes
made a good profit in this way, and for years drove in his own
carriage horses that had only cost him twelve pounds ten. If they
were past cure, he would experiment upon them according to what
investigation he might have in progress at the time.
Lady Cooper’s death in June 1827 was a heavy blow to Sir Astley, and
he was so much affected by it that he resolved to retire altogether
from practice. Before the end of the year, however, he found the
_ennui_ of retirement insupportable, and returned to town and full
practice again. He was married a second time to Miss C. Jones in July
1828. The same year he was appointed Sergeant-Surgeon to the King,
an appointment in which he was continued at William IV.’s accession.
Having no lectures, he still dissected, and occupied himself largely
with completing his various works for the press. His “Illustrations
of Diseases of the Breast” appeared in 1829, and was followed by
“Diseases of the Testis,” 1830, “The Anatomy of the Thymus Gland,”
1832. He was for a second time President of the Royal College of
Surgeons in 1836.
In his old age, even when travelling about, Sir Astley never lost his
passion for dissecting, and always visited every hospital and surgeon
of note on his travels. He never liked staying more than a few days
in one place; he soon began to pine after his accustomed pursuits. On
several occasions, when detained longer than he liked in one place,
he would get up early and leave by coach for London, without giving
any warning of his intention.
On a visit which he made to Edinburgh in 1837, the freedom of the
city was conferred upon him and the honorary LL.D. He had previously
been made D.C.L. of Oxford. He continued his anatomical and surgical
investigations to the last, publishing a splendid work on the
Anatomy of the Breast in 1840, preliminary to a complete account
of the diseases to which it is liable, which was never completed.
He died on the 12th of October 1841, in the seventy-third year of
his age, at Conduit Street, where he had practised latterly. He was
buried, by his own particular request, beneath the chapel of Guy’s
Hospital. A statue of him, by Baily, was erected, chiefly by the
members of the medical profession, in St. Paul’s Cathedral, near
the southern entrance. An admirable portrait of him by Sir Thomas
Lawrence exists. Sir Astley’s name is commemorated by the triennial
prize essay of three hundred pounds for the best original prize essay
on a professional subject, to be adjudicated by the physicians and
surgeons of Guy’s, who may not themselves compete.
A criticism on Sir Astley during his life accorded to him a great
share in establishing pure induction as the only sure means of just
diagnosis, and in introducing a simplicity of treatment in accordance
with the processes of nature. Before his time, operations were too
often frightful alternatives or hazardous compromises; he always made
them follow, as it were, in the natural course of treatment; and he
succeeded in a great degree in divesting them of their terrors by
performing them unostentatiously, confidently, and cheerfully. He
stated an opinion and fact to the Committee on Medical Education,
which might well have been borne in mind by some examiners since his
day: “Whenever a man is too old to study, he is too old to be an
examiner; and if I laid my head upon my pillow at night, without
having dissected something in the day, I should think I had lost
that day.” Sir Astley left among his private papers an estimate of
himself, written in the third person, which is worth quoting. “Sir
Astley Cooper was a good anatomist, but never was a good operator
where delicacy was required. He felt too much before he began ever to
make a perfect operator.... Quickness of perception was his forte,
for he saw the nature of disease in an instant, and often gave
offence by pouncing at once upon his opinion. The same faculty made
his prognosis good. He was a good anatomist of morbid, as well as of
natural structure. He had an excellent and useful memory. In judgment
he was very inferior to Mr. Cline in all the affairs of life.... His
imagination was vivid, and always _ready_ to run away with him if he
did not control it.”
“His principle in practice was, never to suffer any who consulted him
to quit him without giving them satisfaction on the nature and proper
treatment of their case.”
Finally, he says, what is a fitting close to this narrative of his
career, “My own success depended upon my zeal and industry; but for
this I take no credit, as it was given to me from above.”
* * * * *
Another pupil of John Hunter, a man of very different mould, in
several respects more akin to the master than Sir Astley, now claims
our attention. Unlike many of the great men whose achievements we
have recorded, JOHN ABERNETHY was born in London, in the parish
of St. Stephen’s, Coleman Street, on the 3d of April 1764. He was
the second son of John Abernethy, merchant, descended from an
Irish-Scotch family which had furnished more than one noted man to
the Protestant dissenting ministry in Ireland. While very young he
was sent to the Wolverhampton Grammar School under Dr. Robertson.
Here he was reputed studious and clever, but was evidently passionate
as well as humorous. The severe discipline common at that time does
not seem to have worked very well with Abernethy, for he came out
of it more excitable and impatient than he had been previously.
School days were over at fourteen, however, and at fifteen the
youth was apprenticed to Mr., afterwards Sir Charles, Blicke,
his father’s neighbour in Mildred’s Court, one of the surgeons
to St. Bartholomew’s Hospital. His own desire was to enter the
legal profession, in which his fine memory would have rendered him
important service; but his father did not agree with this choice,
and the medical profession was selected. His master was an empiric;
but Abernethy early determined to get to the bottom of things as far
as possible, and engaged in investigations on his own account. The
bent of his mind towards treatment by diet is shown by the following
statement. “When I was a boy,” he said, “I half ruined myself in
buying oranges and other things, to ascertain the effects of
different kinds of diet in this disease” (of the kidney).
Abernethy’s interest in anatomy and surgery was first effectively
stimulated by Sir William Blizard, who lectured at the London
Hospital, and he warmly acknowledged this in his introductory lecture
at the College of Surgeons in 1814, when he succeeded Sir William
as professor. He was soon selected to dissect for Sir William’s
lectures; he derived much benefit from Pott’s surgical lectures at
St. Bartholomew’s, and from Dr. Marshall’s lectures in Holborn;
but was most powerfully influenced by John Hunter, who noted him
among his most intelligent pupils. The opportunity of becoming an
assistant-surgeon, being reserved to apprentices of the surgeons
to St. Bartholomew’s, came early to Abernethy, for his master’s
promotion to the surgeoncy led to his election as assistant-surgeon
in July 15, 1787, when only twenty-three years old, by a majority of
fifty-three to twenty-nine votes. But he was under the necessity,
owing to his senior’s remaining so long in office, of continuing as
assistant-surgeon for the long period of twenty-eight years.
The young surgeon soon began to put his original powers in evidence
by starting as a lecturer. Mr. Pott had for years given a course of
lectures on surgery, but no other lectures had been delivered, and
the medical school of St. Bartholomew’s must be regarded as owing its
establishment to Abernethy. To be the life and soul of a new school
is enough for any man in his maturest years; it was more than enough
for Abernethy, beginning at twenty-three, when everything was new,
and precedents were few, and when his own faculties and studies still
lacked much. To this we must largely attribute the worn-out look
which began to settle upon his face from the age of fifty. He was
not content in his lecturing with any dry and orderly narration, but
combined with his descriptive account the purposes of a structure,
the diseases and accidents to which it is liable, and illustrations
from comparative anatomy. He for a long time included in his courses
at once anatomy, physiology, pathology, and surgery; at the same time
he kept up his attendance on John Hunter’s lectures, and diligently
studied in the wards of the hospital. His industry at this period
was such that he rose at four, and sometimes went into the country
that he might read with less interruption. It may seem strange, in
connection with the well-known brusqueness of his manner, to read
that he had an unconquerable shyness in his early years of lecturing,
which often made him retire from the theatre to regain his composure
before being able to commence his lecture. But this shyness is often
a concomitant of real talent and originality before it has found
means to display itself effectively; and brusqueness is in not a few
instances the cloak of timidity. When his dramatic instincts had
led him into his true path, he soon gained in ease, and his classes
increased so rapidly that in 1790 the governors of St. Bartholomew’s
resolved to build him a theatre, which was opened in October 1791.
Abernethy’s style in lecturing is described by those who heard him
as unique both in communicating his ideas and in interesting his
pupils. When his style had fully developed, it was spoken of as
“Abernethy at Home.” His mode of entering the lecture-room, says
Pettigrew, was often irresistibly droll; his hands buried deep in
his breeches-pockets, his body bent slouchingly forward, blowing or
whistling, his eyes twinkling beneath their arches, and his lower jaw
thrown considerably beneath the upper. Then he would cast himself
into a chair, swing one of his legs over an arm of it, and commence
his lecture in the most _outré_ manner. The abruptness, however,
never failed to command silence, and rivet attention.
“‘The count was wounded in the arm—the bullet had sunk deep into
the flesh—it was, however, extracted—and he is now in a fair way of
recovery.’ That will do very well for a novel, but it won’t do for
us, gentlemen: for ‘Sir Ralph Abercromby received a ball in the thick
part of his thigh, and it buried itself deep, deep: and it got among
important parts, and it couldn’t be felt; but the surgeons, nothing
daunted, groped, and groped, and groped,—and Sir Ralph died.’”
Thus he would introduce an admirable discourse on gunshot wounds,
reprobating in the strongest language the perilous and painful
practice of making prolonged searches for bullets in important
organs. He always illustrated his subject by telling anecdotes,
frequently of a side-splitting character, and so compelled his pupils
to remember his doctrines.
His mental abstraction was not unfrequently manifested strikingly in
the lecture-theatre. On one occasion it is related of him that at an
introductory lecture at St. Bartholomew’s, when he had been received,
as usual, with great applause, he appeared utterly indifferent to it,
but quietly casting his eyes over the assemblage, burst forth in a
tone of deep feeling, “God help you all! what is to become of you!”
His dramatic power was much employed in imitating his patients’
peculiarities, with a mixture of the serious and the humorous which
was most effective. Many of his stories were most apt in their
bearing on some important fact or principle. One of these we may be
allowed to quote from Macilwain.[18]
“Ah, there is no saying too much on the importance of recollecting
the course of large arteries; but I will tell you a case. There was
an officer in the navy, and as brave a fellow as ever stepped, who
in a sea-fight received a severe wound in the shoulder, which opened
his axillary artery. He lost a large quantity of blood, but the wound
was staunched for the moment, and he was taken below. As he was an
officer, the surgeon, who saw he was wounded severely, was about
to attend to him, before a seaman who had been just brought down.
But the officer, though evidently in great pain said: ‘Attend to
that man, sir, if you please, I can wait.’ Well, his turn came; the
surgeon made up his mind that a large artery had been wounded; but
as there was no bleeding, dressed the wound, and went on with his
business. The officer lay very faint and exhausted for some time,
and at length began to rally again, when the bleeding returned; the
surgeon was immediately called, and not knowing where to find the
artery, or what else to do, told the officer he must amputate his arm
at the shoulder-joint. The officer at once calmly submitted to the
additional but unnecessary suffering; and as the operator proceeded,
asked if it would be long; the surgeon replied that it would be soon
over; the officer rejoined: ‘Sir, I thank God for it!’ but he never
spake more.”
Amidst death-like stillness, Abernethy quietly concluded: “I hope you
will never forget the course of the axillary artery.”
It has been, we believe, a somewhat general impression, that
Abernethy as a lecturer indulged in tricks or extraordinary
gesticulations. But this is by no means correct. There was a method
in every item of his procedure, and all he aimed at was to impress
upon the students’ minds in the most forcible and abiding way the
ideas he wished to convey. He gained, it is said, the appearance
of perfect ease without the slightest presumption; and had no
offensive tricks. Macilwain, who was his pupil at his best period,
says: “The expression of his countenance was in the highest degree
clear, penetrative, and intellectual; and his long but not neglected
powdered hair, which covered both ears, gave altogether a philosophic
calmness to his whole expression that was peculiarly pleasing. Then
came a sort of little smile, which mantled over the whole face,
and lighted it up with something which we cannot define, but which
seemed a compound of mirth, archness, and benevolence.... There was a
sort of running metaphor in his language, which, aided by a certain
quaintness of manner, made common things go very amusingly. Muscles
which pursued the same course to a certain point, were said to travel
sociably together, and then to _part company_. Blood-vessels and
nerves had certain habits in their mode of distribution, contrasted
in this way; arteries were said to _creep_ along the sides of
or between muscles: nerves, on the contrary, were represented
as penetrating their substance _without ceremony_.... He was
particularly happy in a kind of cosiness or friendliness of manner
which seemed to identify him with his audience; as if we were all
about to investigate something interesting _together_, and not as if
we were going to be ‘lectured’ at at all. He spoke as if addressing
each individual, and his discourse, like a happy portrait, always
seemed to be looking you in the face.”
In consultation or in ordinary practice, Abernethy was only rough and
hasty when something annoyed him. Towards his fellow-practitioners
who could give a reason for their opinions or their treatment, he
was polite and even deferential. He never recommended interference
with judicious plans of cure in order to gain _éclat_ for himself,
nor unless some important end were to be obtained. He was no party
to concealments or deceptions being practised on the friends of
patients, and in many cases told the plainest of plain truths to
patients themselves. “Pray, Mr. Abernethy, what is a cure for gout?”
was the question of an indolent and luxurious citizen. “Live upon
sixpence a day—and earn it,” was the cogent reply. He is reported to
have been consulted by the Duke of York; and to have stood before
him, as usual, whistling, with his hands in his breeches-pockets. The
astonished Duke remonstrated: “I suppose you know who I am.” “Suppose
I do,” replied Abernethy, “what of that?” And he advised the Duke,
in reference to his complaint: “Cut off the supplies, as the Duke
of Wellington did in his campaigns, and the enemy will leave the
citadel.” A barrister came to Mr. Abernethy with a small ulcer on his
leg, which had proved difficult to heal. Having heard much of his
impatience and peculiar manners, he began to pull down his stocking
as soon as he entered his consulting-room. “Holloa! holloa! what the
devil are you at?” exclaimed the surgeon. “I don’t want to see your
leg; that will do, put it up, put it up.” The patient did so, but
marked his displeasure by placing only a shilling upon the table when
he left. “What is this?” asked Abernethy. “Oh,” replied his patient,
“that will do, put it up, put it up,” and coolly retired.
It is said that Abernethy’s impatience frequently arose from
his anxiety to be at his hospital duties; and that instead of
representing this in a proper manner, he would sometimes almost push
patients from his door. Sir Astley Cooper received many a fee from
those who had quitted Abernethy, or would not venture to encounter
his rudeness. To his hospital patients, especially those who were in
great distress, he was all kindness. Their gratitude was sometimes
amusingly demonstrated. Mr. Stowe relates one example of this: “It
was on his first going through the wards after a visit to Bath,
that, passing up between the rows of beds, with an immense crowd of
pupils after him, myself among the rest—the apparition of a poor
Irishman, with the scantiest shirt I ever saw, jumping out of bed,
and literally throwing himself on his knees at Abernethy’s feet,
presented itself. For some moments everybody was bewildered; but the
poor fellow, with all his country’s eloquence, poured out such a
torrent of thanks, prayers, and blessings, and made such pantomimic
displays of his leg, that we were not long left in doubt. ‘That’s the
leg, yer honnor! Glory be to God! Yer honnor’s the boy to do it! May
the heavens be your bed! Long life to your honnor! To the divole with
the spalpeens that said your honnor would cut it off!’ &c. The man
had come into the hospital about three months before, with diseased
ankle, and it had been at once condemned to amputation. Something,
however, induced Abernethy to try what rest and constitutional
treatment would do for it, and with the happiest result. With some
difficulty the patient was got into bed, and Abernethy took the
opportunity of giving us a clinical lecture about diseases and their
constitutional treatment. And now commenced the fun. Every sentence
Abernethy uttered Pat confirmed. ‘Thrue, yer honnor, divole a lie in
it. His honnor’s the grate dochter entirely!’ While at the slightest
allusion to his case, off went the bed-clothes, and up went the
leg, as if he were taking aim at the ceiling with it. ‘That’s it,
by gorra! and a bitther leg than the villin’s that wanted to cut it
off!’ This was soon after I went to London, and I was much struck
with Abernethy’s manner in the midst of the laughter. Stooping down
to the patient, he said with much earnestness: ‘I am glad your leg is
doing well; but never kneel, except to your Maker.’”
Many are the stories in which Abernethy’s name appears; many have
been exaggerated; many are falsely connected with his name. Sometimes
he would, instead of crushing a victim, become sufficiently the
victim himself. A lady once said to him: “I had heard of your
rudeness before, but I did not expect this.” When he handed her his
prescription, she asked: “What am I to do with this?” The rough reply
was, “Anything you like. Put it in the fire if you please.” The lady
took him at his word, laid down her fee, threw the prescription
into the fire, and left the room; nor could Abernethy persuade her
to receive her fee again, or a fresh prescription. Notwithstanding
all stories to his disadvantage, there is no doubt that Abernethy’s
intentions were most kind, and that he never took a fee from a
patient who might possibly be unable to afford it comfortably. For
these two reasons, his not unfrequent roughness, and his leniency
about fees, he certainly had a much smaller income than he might have
secured. Yet his income was very considerable, but not carefully
managed. One day calling to pay his wine merchant for a pipe of wine,
he threw down a handful of notes, and pieces of paper with fees. On
being asked to wait till all were accurately counted, as some of the
fees might be more than he thought. “Never mind,” said he, “I can’t
stop; you have them as I took them,” and hurried away.
It is now time to refer to some of Abernethy’s principal
publications. In 1793 he published his first volume of Surgical
and Physiological Essays, including his celebrated essay on lumbar
abscess, in which he details a simple and beautiful method of cure
which has since been largely followed. In the second volume of these
essays, a paper on the functions of the skin details some careful
experiments upon the air in which the hand or foot had been confined
for some time. He detected some carbonic acid in such air, and
founded upon the experiments important views as to the necessity of
keeping the skin cleansed and in healthy action. The third part of
these essays, published in 1797, contained an important paper on
injuries of the head, deprecating among other things all unnecessary
interference, and so preventing many a fruitless operation. In 1806
appeared Abernethy’s Surgical Observations, including an account of
the disorders of health in general, and of the digestive organs in
particular, which accompany local diseases, and obstruct their cure.
Whenever he wished to impress upon a patient or a practitioner the
importance of attending to the general health, and the stomach in
particular, if some local disease was to be cured, he always referred
to his book, so that his phrase “read my book” was expected as a
certainty. But it appeared sometimes as if he perceived disorder
of the digestive organs in every case. A lady who had an affection
outside the knee-joint occasioned by a blow against the edge of a
step, went to Mr. Abernethy, and was about to show the affected part,
when he rudely exclaimed, “I don’t want to see your knee, ma’am!
allow me,” and pressed his fist with force against her stomach. She
of course cried out, and he of course attributed her disorder to her
stomach. Nevertheless she recovered without medicine, by strictly
local treatment of the knee, under Dr. Pettigrew.
In all Abernethy’s writings there was manifested a lack of good
arrangement which contrasts strikingly with his excellence as a
lecturer: but in the latter capacity his audience was always before
him, and he could see and test the suitability of his matter.
Education had not furnished him with real literary training, and his
aptness of expression and his wit do not appear to striking advantage
in his written works.
Abernethy was married on the 9th January 1800 to Miss Anne Threlfall,
whom he had met at a house to which he had been professionally called
in. His courtship was brief; his proposals were made by letter; he
characteristically deprecated too much “dangling,” gave the lady a
fortnight to consider her reply; and was successful. Not for one day
did he interrupt his hospital lectures.
In 1815, after twenty-eight years’ tenure of the office of
assistant-surgeon, Abernethy became full surgeon on the retirement
of his old master, Sir Charles Blicke. He made the appointment
the occasion for publishing a pamphlet on the evils attending the
prolonged tenure of office by old surgeons. He himself had lectured
for twenty-eight years, and been largely influential in filling the
hospital with students, from whose hospital fees he received nothing
whatever. About the time of his succession to the surgeoncy he took a
house at Enfield, to which he resorted on Saturdays, gladly quitting
his own house in Bedford Row for a quiet country ride. In the summer
he would retire to Enfield on most evenings. This tended very much to
the benefit of his fidgety nervous system. From early life his heart
had been particularly irritable, causing him frequent suffering. A
wound which he accidentally gave himself in dissecting at one time
caused him such a severe illness that it was three years before he
had recovered from its effects, which appeared in very varied forms.
It must be acknowledged, too, that he was not as moderate in eating
as he exhorted his patients to be. He frequently was attacked by
inflammatory sore-throat, terminating in abscess.
Abernethy resigned his professorship at the College of Surgeons in
1817, and was gratified by a resolution sent to him, thanking him
for the distinguished energy and perspicuity which had characterised
his lectures. This resignation, however, was not sufficient relief
to his overstrained system, which was now often tormented with
rheumatism. He took insufficient care of himself, would walk down
from Bedford Row to the hospital in knee-breeches and silk stockings
when it was raining, without a thought of protecting himself from
a drenching. With very cold feet he would stand opposite one of
the flue openings in the museum, and this with other imprudences
gradually sapped his strength. At the age of sixty, according to
the plan he had suggested and strongly advocated, he resigned his
appointment as surgeon, but the governors would not accept it. He was
persuaded to remain in office some time longer, but finally resigned
on July 24, 1827. The succeeding winter was the last in which he
lectured, and in 1829 he gave up his examinership at the College of
Surgeons. He had now become very lame, thin and old-looking. His eye
retained its expressiveness, but showed evidences of the continual
pain he suffered. He died on the 20th April 1831, quite worn out, but
conscious to the last: he was buried in the parish church of Enfield.
Thus early, like John Hunter, died one of his pupils, who, in the
words of the Duke of Sussex at the anniversary meeting of the Royal
Society in 1831, appears the most completely to have caught the bold
and philosophical spirit of his great master.
FOOTNOTES:
[17] Life of Sir Astley Cooper, i. 334-448.
[18] Memoirs of John Abernethy.