"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 period328 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 permitted329 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 contend82) 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 them330 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 ordinary331 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 relations332 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; recollect333 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 not334 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 m?cenates, 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 the335 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 by336 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.
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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 to338 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 pharmacop?ia. 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. vincent83, and mr. lawrence in his professor's gown! but he has still a
"monumentum ?re 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 no339 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.
