"quidquid enim justum sit id etiam utile esse censent; itemque quod honestum idem justum, ex quo efficitur, ut quidquid honestum sit idem sit utile."—cicero.
the first thing, in consulting abernethy, if you were a medical man, was to be clear, and "well up" in the nature of the case; and the next thing, not to state any opinion, unless you were prepared to give a good reason for it. these conditions premised, we never saw any one more unaffectedly deferential to the opinion of another.
a surgeon took a serious case to him, in which the question was as to the removal of a large tumour in the neck, which seemed to be acquiring connections of such depth and importance as to threaten (should that step be desirable) to render the removal of it impossible. the patient was advised to allow his surgeon in ordinary to state his case, and to interrupt him only if he omitted anything in regard to it within the patient's knowledge. this was done; the general habits of the patient described, with the difference which had existed antecedent to the age of thirty, and subsequently thereto. mr. abernethy examined the tumour.
to the surgeon. it is parotid, is it not?
surgeon. i think not, sir.
abernethy (hastily). why not?
surgeon. because, sir, reflecting on the depth and situation of the parotid gland, i should hardly expect the tumour to be so moveable.
abernethy. ah, i see! very well. (then to the patient). well, sir, i should advise you to attend to your general health,254 and continue to follow mr. ——'s advice on that subject. what i say is—— (then followed a short lecture on the digestive organs.)
patient. do you think, sir, i shall get rid of it?
abernethy. nay, i cannot tell that. but now suppose you pursue a plan steadily, say for a month, and the tumour does not increase, will it not be encouraging to you?
patient. certainly, sir.
abernethy. well, then, try it; for if its removal should become necessary, you will at least be in better condition for the operation. if it does not get larger, or otherwise inconvenience you, let it alone.
the patient had heard so much of abernethy's roughness, that he came away equally pleased and astonished.
a surgeon took a colonel in the army to him, with a case which was progressing fairly, but, as he conceived, in consequence of the patient not paying so much attention to his health as he was recommended to do, not so satisfactorily as he desired. the colonel briefly stated his case.
abernethy. show me your tongue. ah! that is bad enough.
colonel. you are quite right there.
abernethy. well, man, i don't require to be told that.
here the surgeon stated the treatment, which had, in addition to attention to the general health, involved some local administrations, of which, in general, abernethy approved, but, as it would seem, not in this case. his difference of opinion he thus stated, in the presence of the patient:
"well, i say that there is a sufficient disorder of your digestive organs to maintain the annoyances of which you complain; and i should confine my attention to endeavour to put that disorder right. mr. —— seems to think that, in adding to this treatment the plan he proposes, he will shorten the case. well, that may be so; he has paid, i know, a good deal of attention to this subject; and if i had one of my own family ill with this complaint, i should feel perfectly satisfied, if they were under his care. at the same time, i say what i think;255 and if you do not find the general plan successful, then the means he proposes might with propriety be added."
no harm resulted from this difference of opinion; but much benefit. the patient was not pleased with abernethy; but he thought him very skilful and very honest.
one day, a surgeon went to him under the following circumstances. a patient who had recently recovered from a lameness, which, as alleged, had its cause in the foot, on a relapse went to another surgeon. this gentleman had, as it ultimately appeared, hastily decided that the lady had a complaint in the hip; she was therefore consigned to bed, and treated for disease of that part. after about three months, feeling no better, she desired to see the surgeon under whose care she had formerly been.
the surgeon was now very much annoyed; for he found that he had been by many persons charged with having mistaken the case, which he had never even seen on the second attack, and which now presented a phase in which disease of the hip, to a hasty examiner, might easily be suggested. he was not much better satisfied, when, after a careful examination of the case, he felt convinced that there was no disease in the hip, although the symptoms were more severe than ever. he declined undertaking the case without a previous consultation with the surgeon who had decided it to be a disease of the hip; but the patient being immoveable in her opposition to this request, and offering any other surgeon, or more, if required, her wishes were acceded to, and mr. abernethy requested to visit the case. on going to the patient, the surgeon explained to mr. abernethy the points at issue, but without telling him to which view his own opinion inclined, or the positive dictum of his senior brother, a very eminent surgeon. "i shall, therefore," said he to abernethy, "feel particularly obliged to you, sir, if you will examine the case for yourself."
when they were introduced to the lady, abernethy said: "well, now, i should be very well satisfied with mr. ——'s report of your case; but he says i must examine the limb for myself: so here goes."—a somewhat repulsive beginning to a delicate lady, perhaps; but nothing could be more cautiously256 gentle than his examination. in conducting it, he had avoided one test which usually does give a little pain. the other surgeon, deeming the decision to be very important, reminded him of this test (raising the limb and striking the heel gently), which he then proceeded to do with equal gentleness. "that will do," said he. "now, sir, shall we go into another room?" "no, sir," replied the surgeon. "if you please, mr. abernethy, i should prefer your at once telling the patient what is your opinion on the case."
he then declared his opinion; but, fearing he might injure one or other party, with the following exordium: "now, madam, we are all liable to mistakes: there is no man living who does not make more or less; and i am sure i make mistakes; therefore i may do so in my opinion of your case. but for the life of me i cannot perceive that you have any disease in your hip." he then gave a short, but most lucid view of what he conceived to be the cause of her pain, and illustrated it by referring to something which happened to himself in one of his own severe rheumatic attacks. the result proved that he was quite right as to his view of the case; the lady, by exercise and other means (which, had the hip been diseased, would have only exasperated her complaint), had a good recovery.
one very great charm in abernethy in consultation was, that there was no difficulty in getting him to speak out. some men are so afraid of being wrong, that they never give you the whole of their opinion in a case involving any difficulty. it is so obscure, and followed up by so guarded a prognosis, that it sometimes amounts to no opinion at all.
even with surgeons who were very unobjectionable, abernethy in his best manner contrasted very favourably. we recollect being very much struck with this when, very young, we had to meet mr. cline and mr. abernethy, within a few days of each other, in the same case. mr. cline was very kind to the patient, elaborately civil; nor was there anything which could be fairly regarded as objectionable; but his manner was too artificial; the contrast in abernethy was very agreeable. the case was serious, and (as we thought) hopeless. abernethy, the moment he saw it,257 had his sympathies painfully awakened. having asked a few questions, he, in the very kindest manner, said, "well, i will tell you what i would do, were i in your situation." he then proceeded to direct how she should regulate her living, how avoid mischievous experiments, and went into a rather lengthy series of directions, in the most unaffected manner, without leaving the room, or having any private consultation whatever. the lady, who was a distinguished person, and a very accomplished woman, was exceedingly pleased with him.
his manner, as we shall by and by admit, was occasionally rough, and sometimes rather prematurely truthful. one day, he was called, in consultation, by a physician, to give an opinion on a case of a pulsating tumour, which was pretty clearly an aneurism. on proceeding to examine the tumour, he found a plaister on it. "what is this?" said abernethy. "oh! that is a plaister?" "pooh!" said abernethy, taking it off and throwing it aside. "that was all very well," said the physician; "but that 'pooh' took several guineas out of my pocket."
on the other hand, he never failed to give the warmest and most efficient sanction he could to what he conceived to be judicious treatment on the part of a practitioner with whom he was in consultation. mr. stowe has kindly sent me a very good example of this; and it illustrates also another very valuable feature in a consultant: the forbearance from doing anything where nothing is necessary. a gentleman had met with a severe accident, a compound dislocation of the ankle, an accident that abernethy was the chief means of redeeming from habitual amputation. the accident happened near winterslow hut, on the road between andover and salisbury, and mr. davis of andover was called in. mr. davis placed the parts right, and then said to the patient, "now, when you get well, and have, as you most likely will, a stiff joint, your friends will tell you— 'ah! you had a country doctor.' so, sir, i would advise you to send for a london surgeon to confirm or correct what i have done." the patient consented, and sent to london for abernethy, who reached the spot by the mail about two in the morning. he looked carefully at the limb, and saw that it was in a good position,258 and was told what had been done. he then said, "i am come a long way, sir, to do nothing. i might indeed pretend to do something; but as any avoidable motion of the limb must necessarily be mischievous, i should only do harm. you are in very good hands, and i dare say will do very well. you may indeed come home with a stiff joint; but that is better than a wooden leg." he took a cheque for his fee (sixty guineas), and made his way back to london.
soon after this, an old clergyman, in the same neighbourhood, had a violent attack of erysipelas in the head and arm. his family, becoming alarmed, wrote up to his brother, who resided near bedford row, to request mr. abernethy to go down and visit the patient. abernethy said, "who attends your brother?" "mr. davis69, of andover." "well, i told him all i knew about surgery, and i know he has not forgotten it. you may be perfectly satisfied. i shall not go." here, as mr. stowe observes, he might have had another sixty guineas.
he always felt a great deal of interest about compound dislocations of the ankle-joint; because of his conviction that amputation, then so commonly resorted to, was unnecessary. he used to tell several cases in his lectures. one of them we will briefly relate here. it was that of a labouring man, who fell off a scaffold in his own neighbourhood; and, amongst other surgeons, they had sent for abernethy. when he got to the house, he found, he says, "a poor wee man, lying on his mattress, with a very complete compound dislocation of the ankle-joint. the joint was completely exposed, and the torn skin was overlapping the edge of the bone." he placed the parts in their natural position, and drew the skin out of the rent; and when he had thus adjusted it, as he said, a horrible accident looked as if there had been very little the matter. "do you think, sir," said the poor little man, "that this can ever get well?" "yes, verily," said abernethy. "do not be out of heart about it; i have known259 many such cases do well." "why, sir," said the man, "they have gone for the instruments." "i now found," said abernethy, "that two other surgeons had seen him, and had determined that it was necessary to amputate. i felt that i had got into an embarrassing predicament, and was obliged to wait until these heroes returned. when they arrived, and saw the man lying so comfortably, they seemed a little staggered: but one of them said, 'mr. abernethy, you know the serious nature of these accidents, and can you give us an assurance that this will do well?' i said, 'no, certainly not; but if it does not do well, you can have recourse to amputation afterwards, and my surgical character is pledged no further than this. i give you the assurance that no immediate mischief will come on to endanger the man's life. you may wait and see whether his constitution will allow him to do well.' i added: 'i feel that i am got rather into a scrape; so you must allow me to manage it in my own way.' so i got splints, put up the limb, varnished the plaister, and then told them about sponging it continually, so as never to allow any increase of temperature. now there are two holds you have on a patient's mind—hope and fear; and i make use of both. so i said, 'if you lie perfectly still, you will do well; and if you move one jot, you will do ill—that's all.'" the remainder of the case need not be given. the man recovered, and saved his limb.
we have referred to that case because, though relating to a professional matter, there is a moral in it. he might easily have saved himself all the trouble he took, and on the plea of etiquette; but the poverty of the man pleaded for his limb, and the impossibility in such a case, of the imputation of any wrong motive, left free exercise for the prevailing feature of abernethy's character—benevolence. the mention of the instruments secured to the poor man that personal attention to details by abernethy himself which a more wealthy patient might not have so certainly obtained.
we have remarked before on his kindness to hospital patients; and sometimes the expression of their gratitude would be very touching. it is difficult or impossible to carry out mr. abernethy's principles of practice with perfect efficiency in the atmosphere of a large hospital in a crowded city, yet the truth of his views would260 sometimes be impressed by very extraordinary and unexpected results. we select the following as an example, for reasons which will be suggested by the narrative. we are indebted to mr. wood70, of rochdale, for the illustration; and, as we should only mar the scene by any abbreviation, we must allow him to tell it in his own manner:
"it was on his first going through the wards after a visit to bath, that, passing up between the rows of beds, with an immense crowd of pupils after him—myself among the rest—that the apparition of a poor irishman, with the scantiest shirt i ever saw, jumping out of bed, and literally throwing himself on his knees at abernethy's feet, presented itself. for some moments, everybody was bewildered; but the poor fellow, with all his country's eloquence, poured out such a torrent of thanks, prayers, and blessings, and made such pantomimic displays of his leg, that we were not long left in doubt. 'that's the leg, yer honnor! glory be to god! yer honnor's the boy to do it! may the heavens be your bed! long life to your honnor! to the divole with the spalpeens that said your honnor would cut it off!' &c. the man had come into the hospital about three months before, with a diseased ankle, and it had been at once condemned to amputation. something, however, induced abernethy to try what rest and constitutional treatment would do for it, and with the happiest result.
"with some difficulty the patient was got into bed, and abernethy took the opportunity of giving us a clinical lecture about diseases and their constitutional treatment. and now commenced the fun. every sentence abernethy uttered, pat confirmed. 'thrue, yer honnor, divole a lie in it. his honnor's 'the grate dochter entirely!' while, at the slightest allusion to his case, off went the bed clothes, and up went his leg, as if he were taking aim at the ceiling with it. 'that's it, by gorra! and a bitther leg than the villin's that wanted to cut it off.'261 this was soon after i went to london, and i was much struck with abernethy's manner; in the midst of the laughter, stooping down to the patient, he said with much earnestness: 'i am glad your leg is doing well; but never kneel, except to your maker.'"
the following letter, though containing nothing extraordinary, still shows his usual manner of addressing a patient by letter:
"sir,
"in reply to your letter, i can only say what i must have said to you in part, when you did me the honour of consulting me.
"firstly. that the restoration of the digestive organs to a tranquil and healthy state, greatly depends on the strict observance of rational rules of diet. my opinions on this subject, which are too long to be transcribed, are to be met with at page 72, of the first part of 'abernethy's surgical observations,' published by longman and co., of paternoster row.
"secondly. upon keeping the bowels clear, yet without irritating them by over-doses of aperient medicine.
"thirdly. i consider the blue pill as a probilious medicine, and only urge that the dose be such as to do no harm, if it fail to do good, and then to be taken perseveringly for some time, in order to determine whether it will not slowly effect the object for which it was given. in gouty habits, carbonate of soda, &c., may be given, to neutralize acidity in the stomach, with light bitters; but the prescription of medicines of this kind, as also any advice relative to the cold bath, must rest with your medical attendant."
dated the 17th of september; as usual, with him, without the year, which was about 1824.
it is obvious that very few professional letters are adapted for introduction. this was one kindly sent us by mr. preston, of norwich, and was written to a gentleman in yorkshire.
few things were more pleasing or valuable in abernethy, than his modesty and his sense of justice. he knew his superiority262 well enough, but he measured it—as science shows us all should do—with reference to what was still beyond him, and not by the standard afforded by the knowledge of others. his sense of justice was, we think, never appealed to in vain. the following letter has appeared to us significant in relation to these points. amid the peaceful glories of a useful profession, there is nothing that sinks deeper or interests our regard more, than a man, in the hour of success, remembering what is due to others. we think this remark particularly applicable to the late mr. tait, in the following case. the letter from abernethy was obligingly sent us by mr. tait's son and successor. the remarks with which mr. tait concludes his case, are as creditable to the writer as to him whom they were intended to honour.
we have stated that mr. abernethy had been the first to extend the application of john hunter's celebrated operation for the cure of aneurism, to a vessel nearer the heart (the external iliac artery), on which mr. abernethy placed a ligature in 1797. mr. tait, of paisley, had an extraordinary case of aneurism in both lower extremities, so high up as to oblige him to place a ligature on the external iliac artery on both sides of the body. the case occurred in an old dragoon, and the two operations were performed at separate times, with great judgment and with complete success. the case of course made some noise, and was highly creditable71. in closing his account of the patient, mr. tait observes: "the complete success which has attended these operations, while, certainly, it affords me one of the highest gratifications the practice of my profession can procure me, chiefly affects mr. abernethy.
"accident has placed under my care a case which, so far as i know, is unparalleled in the history of surgery, and it has been cured; but i have only put in practice what every surgeon of the day ought to have done. when, thirty years ago, mr. abernethy formed the firm resolve of cutting open the walls of the abdomen and seizing the external iliac artery, he made a mighty step in advance, he formed an epoch in the history of263 his profession. john hunter, upon reflecting on the h?morrhage proceeding from the vessel below the sac, after an operation in 1779, when mr. broomfield, 'for security,' had tied the artery three or four inches above the aneurism, had probably the first glimpse at his great improvement of tying the artery, in cases of aneurism, nearer the heart. his eminent successor has extended the principles of the illustrious hunter.
"so firmly impressed was mr. abernethy with the certainty of ultimate success, that, nothing daunted by the unfortunate issue of his two first cases, he persevered, and at length successfully secured the external iliac artery. his steps have been followed by a host, till at length it needed but such a case as mine to add the finishing touch to his well-earned fame. in doing justice to the merits of such men, we act but the part of prudence; since, if we do not, indignant posterity will.
"paisley, january, 1826."
the following is abernethy's reply to a communication from mr. tait on the subject, and couched in a tone, just in relation to mr. hunter, modest and characteristic as regards himself.
"to david tait, esq.
?
"surgeon, paisley.
"dear sir,
"i have read your interesting case in the 'edinburgh journal,' but have no comments to offer. i have therefore only to thank you for the honourable mention you have made of me. the progress of science has given us reason to confide in the anastomosing72 channels for carrying on the circulation. the only question necessary to be decided was—would large arteries heal when tied? every case confirmed that264 point, and therefore there was little merit in perseverance. nevertheless, i feel grateful for your good opinion, and with congratulation and best wishes,
"i am, dear sir,?????
"yours very sincerely,?
"john abernethy."
"bedford row, july 14."
(post mark 1826.)
the following portion of a note, necessarily mutilated by the suppression of professional matter, we copy as a written evidence of his not in any way appearing to alter or add to a treatment which he approved. it is written to a highly esteemed member of our profession, mr. beaman, of king street, covent garden. mr. beaman had sent a patient alone to mr. abernethy, who, having seen him, gave him the following note:
"my dear sir,
"the patient says"—here the symptoms referring to the point to be investigated are stated—"and if this be true, i have no wish * * * * nor can i suggest better treatment than that which you have adopted.
"yours very sincerely,??
"john abernethy."
(no date, post mark 1825.)
the following letter to mr. wood, of rochdale, reiterates his opinion on a very important disease, contraction of the gullet or ?sophagus, and conveys a practical truth, which, if we may judge from the cases published in the periodicals, is just as necessary as ever. we allude to the too officious use of instruments in this affection, a lesson of abernethy's, of the practical excellence of which mr. wood had convinced himself by his own experience, as we ourselves have on many occasions.
"my dear sir,
"i think as you do with regard to the difficulty of swallowing.265 it seems likely to be the effect of irritability of the stomach; and if so, the passing of instruments, however soft and well-directed they may be, is not likely to be beneficial.
"indeed, i have seen so little good from such measures, that i should feel reluctant to employ them until impelled by stronger necessity than exists in the present case. spasmodic affection in the part is, as you know, exceedingly common, and continues for a great many years without producing permanent contraction. with respect to the main object of the treatment of this case, i cannot say more than you are already acquainted with, and which is suggested at page 72.
"i have of late been personally convinced of the benefit of the strictest attention to diet. last summer, my stomach was so disordered that it would not digest any thing, and i was constantly tormented by the chemical changes which the food underwent in that organ. i had scarcely any flesh on my bones, and sometimes every ten minutes was seized with rheumatic spasms, which were as general and severe as those of tetanus73. i went into the country, where i could get good milk and eggs, and lived upon three ounces of baked custard taken three times a day, drinking, four hours after each meal, some boiled water that had been poured upon a small quantity of ginger. upon this quantity of food i regained my flesh, and uniformly got better as long as i continued this plan of diet, which was but for one month, for then i returned to town. from the very first day, i had no more of these spasms. as for medical treatment, i repeat that i cannot say more than you already know. it gives me pleasure to find that you are settled to your satisfaction.
"i remain,
"my dear sir,
"very sincerely yours,?
"john abernethy.
"bedford row, january 9."
