HIS ESSAY ON THE SKIN AND LUNGS

“L’art (de délicatesse) consiste à ne pas tout dire sur certains
sujets, à glisser dessus plutôt que d’y appuyer; en un mot, à en
laisser penser aux autres plutôt que l’on n’en dit.”—BOUHOURS.

One of the most beautiful poems in the English language, perhaps,
is Armstrong’s “Art of Health.” Whether it be that the title is
uninviting, or from some other cause, I know not, but it is very
little read; yet scarcely any one who has read it, has done so without
pleasure. Besides containing many admirable and valuable instructions,
it shows how an ordinary, and to many even a repulsive, subject can be
treated with such discretion, taste, and even elegance, as to render it
pleasing and attractive.

Such a writer could have conveyed, even in prose, explanations of
disease so as to interest and instruct his readers. With no such power,
we are almost inclined to regret the impossibility of doing Abernethy
justice, without saying something of nearly all his works. If, however,
in so doing, we make one more step towards familiarizing the public
with matters which affect their best interests, we shall not regret
any labour which this, the most difficult part of our task, may have
required.

We so usually connect pain with disease, that, in our haste, we are
apt to imagine that it is not merely the worst feature, but the only
sign of it. “I am very well, I am in no pain whatever,” is a common
expression, and yet a person may be irremediably stricken, without
suffering any pain. Pain is, in fact, often the best possible monitor,
and has saved many thousands of lives by the necessity it has imposed
of observing what is the best of all remedies, in a large class of
cases. Amongst hundreds of examples, we might cite several affections
of joints, wherein pain alone has sometimes exacted the observance of
that which surgeons were a long time before they had learned the full
advantage of; and which, when they had been taught it by Abernethy,
they have often failed, with all their endeavours, to accomplish, but
which, when efficiently secured, is of more consequence than any one
other remedy; we mean “_absolute repose_” There are plenty of diseases
marked by little or no pain, or which, at all events, are not painful;
but they are amongst the most fatal and insidious of human maladies.
Let us commence the record of some of the numerous improvements we owe
to the genius of Abernethy, by mentioning one of them.

We have, too many of us probably, observed something like the
following, on the assembling of a family of a morning: the usual
greetings interchanged, and that cheerful meal, breakfast, fairly
begun, our attention has been directed to some fine, comely, perhaps
beautiful girl, who, to the hilarious spirits of her laughing sisters,
has only contributed a somewhat languid smile. We may, perhaps, have
remarked that she is a little more spoken to by her mother than
any other of the family circle; we may, too, have observed a tone
compounded of confidence and gentleness, somewhat different from that
addressed to her sisters. Still, though less hilarious than the rest,
she has chatted away with considerable cheerfulness; she has, however,
a languor in her manner, which but for the surrounding contrast, might
not have occurred to us. On rising from the breakfast-table, we observe
that her gait is peculiar. She is not exactly lame; but her step has
something between firmness and faltering, that seems to indicate more
effort or less power.

Poor girl! she is about to have, if she have it not already, a stealthy
and hitherto almost painless disease; stealthy, because it is so far
a comparatively painless malady. Deep in the loins there has been the
smouldering fire of disease, which is to result in what is called
“Lumbar abscess.” This grievous malady, which in _many instances_
begins not less insidiously than I have mentioned, is found on inquiry
not to have been _wholly_ without some of those premonitory signs
which, in obedience to the beneficent laws of the animal economy,
almost invariably precede even the most insidious malady. Inquiry
generally elicits that, however little complained of, there has been at
times more or less of uneasiness, if not pain, felt in the loins; that
it has not been so much lately; but that it has become less in force or
frequency, since the appearance of some swelling, which may be in the
loins, or some other part, lower or more or less distant.

It is a malady very commonly connected with diseased spine, but
frequently without any such complication; and it is curious that
Mr. Abernethy at first met with as many as, I think, eight cases in
succession, which were not complicated with any disease of the spine.
Under any circumstances, it is a serious malady, and usually, when
the collection bursts, or is opened, severe constitutional symptoms
supervene, which, though not without exceptions, gradually usher in
what Armstrong calls

“The slow minings of the hectic fire,”

and destroy the patient.

Now, Mr. Abernethy’s plan was intended to prevent this last and dreaded
issue. The chief points of excellence in his recommendations are—

First, the emphatic recognition of the constitutional origin and nature
of the malady;

Secondly, the consequent necessity of a greater attention to the
general health of the patient;

And lastly, if it could not be dispersed, to relieve the interior of
its contents, so that its extensive surface should never be exposed.

The mode of proceeding was extremely simple, and there is no doubt that
a great many lives have been saved by the practice thus recommended. I
have heard, however, that some surgeons think the merits of the plan
overrated, which I can only suppose explicable on the ground that it
has been imperfectly followed out; and I am the more disposed to this
view, because nothing can be more _entirely opposed_ to Mr. Abernethy’s
principles and intentions, than the treatment of many cases _said to
have been treated_ after Mr. Abernethy’s plan.

As a considerable number of families have really a painful interest
in this question, I will, at the risk of being a little professional,
state what has occurred under my own observation, in explanation of
the apparent discrepancy. My own experience obliges me to coincide
with those authorities on this subject, who, approving Mr. Abernethy’s
practice, adopted it. Amongst a host of eminent men, I will mention
only two, Sir Astley Cooper, and a scarcely less eminent authority, Mr.
Samuel Cooper, the laborious and distinguished author of the “Surgical
Dictionary,” who observes that Mr. Abernethy’s plan deserves “infinite
praise.” Sir Astley Cooper, too, in speaking of a very dangerous period
of the case to which Mr. Abernethy’s plan has an important relation,
says: “We should adopt the plan suggested by Mr. Abernethy, as it is
the best ever invented by any surgeon.” The apparent discrepancy in the
results of the experience of different surgeons, is rather a matter of
degree, and admits of easy explanation.

The feature whence the disease derives its name is merely a partial
exposition of an exceedingly deranged state of the whole economy, not
unfrequently complicated with organic disease. Although Mr. Abernethy’s
paper shows that even these cases are not necessarily fatal, still, in
general, such will sooner or later terminate unfavourably under any
treatment; but, in many others, the explanation which I first suggested
has been a satisfactory solution of the failure: viz. that the
principle on which Abernethy proceeded has not been seized, and that
therefore the treatment has involved direct violations of it. In some,
the local relief has been by no means conducted with the observance of
those conditions which Mr. Abernethy has enjoined. In others, there has
not been even any reasonable approximation to that careful attention to
the general health which is the necessary basis of the plan.

Another point, which has in some cases impeded the adoption of the
practice, is the increased responsibility it seems to involve. If a
surgeon is to be mistrusted and charged with either, the “laisser
mourir” is much less injurious to him than the “tuer.” What we mean is
this: Everything sometimes is going on well, until the opening of the
deposited fluid. If it be left to open by the ordinary processes of
nature, the subsequent symptoms are properly enough ascribed to the
usual course of the disease; but if the surgeon has interfered, and,
from any circumstances whatever, the opening does not heal, or bursts
soon after from some slight accident (which has now and then happened),
the surgeon is blamed. The only remedy for this, is to impress the
necessary caution: repose of the part, and so forth.

There is, however, a third point, of great practical consequence,
on which Mr. Abernethy has been misunderstood. I allude to the
local condition under which the puncture should be made. When,
notwithstanding our persevering observance of all measures calculated
to repress the diseased actions, or to procure the absorption of the
deposited fluid, we perceive it to be increasing or approaching the
surface, _then, before any inflammation_ of the skin has taken place,
it should be discharged.

In many cases, _this_ opening has been delayed until the skin _has
become inflamed_, or much attenuated. Now this risks the accomplishment
of an object which it is a material point with Mr. Abernethy to
secure—namely, the _immediate healing_ of the puncture.

On this point, even so good an authority as Sir Astley Cooper has given
a misdirection. “Let the abscess proceed,” says Sir Astley, “until you
observe a blush or redness on the skin, and then adopt Mr. Abernethy’s
plan.” Now this direction does not absolutely prohibit the opening
of the cyst with the object which Mr. Abernethy had in view; but, as
before stated, it deprives us of _one most desirable condition_. To
settle this point, we quote Mr. Abernethy’s own words. In discussing
the point of time at which the opening should be made, he asks: “Are
we to wait until evident _signs of inflammation_ appear? I think not.”
Accordingly, in a case where the surface had become red, we find he
took care to _avoid_ opening it _at that part_; because it risked the
security of at once healing the puncture.

The truth is, that the _whole_ of the plan is most valuable; but it
must be carefully followed _in its integrity_; and that this may be
done, the principles on which it is founded must be constantly kept
in mind. These are—the improvement of the general health, with the
view of arresting the action of disease, and producing the absorption
of the morbid secretion. This failing, to puncture the abscess, so as
to secure the discharge of its contents without the admission of air,
and on conditions calculated to _ensure_ the immediate healing of the
wound; then to favour the approximation of the sides of the cavity, by
relieving it of its contents, by puncturing it anew, _before_ it shall
have become so much distended.

Another misapprehension has arisen with regard to Mr. Abernethy’s
object in excluding air; and unnecessary pains have been taken to
show that the presence of air is not injurious to living surfaces.
It was not from any apprehension of this kind that he was anxious to
exclude the air; but from the tendency that the _presence of air_ had
to favour the _putrefactive decomposition_ of the new secretion. We
must not omit to mention the origin of this instructive paper, as it is
highly characteristic of Abernethy’s acuteness of observation, and his
promptitude in the practical application of it.

A lumbar abscess had been opened by caustic, and when the eschar had
nearly separated, the cyst was partly emptied; the sides of the cavity
collapsing on the imperfectly separated eschar, the opening was closed,
and _none of the usual constitutional disturbance followed_. When,
however, the eschar, finally separating, exposed the cyst,—within
twelve hours, the usual dreaded disturbance of the system supervened.
Abernethy took the hint thus disclosed to him, and produced the
improvement, of the merits of which we have endeavoured to give a brief
representation.

“It is madness and a contradiction to expect that things which were
never yet performed should be effected, except by means hitherto
untried.”—BACON, NOV. ORG. APH. 6.

When we consider the object which the distinguished Author had in view,
in the immortal Work whence we have taken the foregoing simple but
instructive aphorism, we cannot but perceive how highly suggestive it
is to those engaged in scientific researches, or how necessary to be
borne in mind by those who are really aware of the present state of
Medicine and Surgery, and desirous of seeing them become a definite
science. Nor does it appear inappropriate to the consideration of
Abernethy’s experimental inquiries into the functions of the skin
and lungs. An _extended_ investigation—of which his paper on these
subjects contains an excellent type, and is in part a practical
application—would be a great step towards the creation of a real
science, and would certainly fall within the “means untried” of Lord
Bacon.

Although the latter part of the last century, and the first half of
the present, have been very remarkable for the number of distinguished
men who have flourished during that period, in almost every branch of
knowledge; yet neither the bar nor the senate, neither literature nor
any of the sciences, can boast of greater men, nor lay claim to more
positive improvement, than Chemistry.

If we only consider that interval between the discovery of oxygen by
Priestley, in 1774, and the conclusion of Sir Humphrey Davy’s labours,
Chemistry almost seems like a new science; and it continues to advance
with such rapidity, and is daily opening out so many new questions,
that the most accomplished chemist of one year is never sure how much
he may have to learn the next; nor, unless he reasons with great
caution, how much he may have to _un_learn.

To a physiologist, who requires assistance _from all branches of
science_, Chemistry must always be an interesting study. When we lay
aside all speculations as to what is the abstract nature of Life, and
study that which is the proper object of philosophy—that to which it
seems the faculties of man are limited—namely, the _laws_ in obedience
to which the phenomena in nature occur; and apply the knowledge thus
obtained to the occurrences which take place in the human body; we
soon discover that, whatever the abstraction “Life” may be, we live
proximately, in virtue of certain changes in various forms of matter;
as food, air, the various constituents of our bodies, &c.; and that
these consist of multiplied separations and rearrangements of their
respective elements, which it is the special province of Chemistry to
examine.

If we investigate the changes of the living, or the structure of the
dead, with these objects,—we shall be in no danger of perverting
Chemistry to purposes to which it is inapplicable. When, however, we
proceed a step further, and seek to give a _chemical expression_ to
various uses and relations of different parts of the body, the greatest
caution is required.

In the first place, in a machinery which is a practical application of
a great _many_ sciences, it is to the last degree improbable that they
can be expressed by any _one_.

Again, to estimate the true meaning—the physiological interpretation
of many changes which might be in their proximate sense chemical,—a
greater familiarity with the phenomena of _disease_ is necessary than
_usually_ falls within the inquiries of _the most scientific chemist_.

To a person acquainted only with the ordinary phenomena of health,
or who is not even something also of a philosophical pathologist,
Chemistry is for ever suggesting tempting analogies, which are
constantly tending to mislead him to conclusions on insufficient data;
and to examine and rest too much on the _chemical_ facts deducible
from one or other function, without sufficiently attending to the
_physiological_ relations of that function with _all_ others.

In fact, for want of due caution, or it may be of a sufficient range
of information, the assistance which Chemistry has hitherto rendered
to Physiology has been attended with so many assumptions, that it is
extremely difficult to say on which side the balance lies—of advantage
or error. We are aware that at this moment there is a contrary
feeling—a kind of _furore_ for _chemical_ solutions of _physiological_
phenomena. We believe the caution we venture on suggesting was never
more necessary.

The discovery of oxygen gas by Priestley, not only gave a great
impetus to chemical inquiries, but affected Physiology in a very
remarkable manner; when it was found that the _more obvious_ phenomena
of all cases of ordinary burning—lamps, candles, and fires of every
kind—consisted mainly of the chemical union of charcoal and oxygen
(carbonic acid); and again, when it was discovered that animals, in
breathing, somehow or other produced a similar change, one may conceive
how ready every one was to cry, “I have found it. The heat of animals
is nothing more than combustion! We inhale oxygen; we breathe out
carbonic acid; the thing is plain. This is _the_ cause of animal heat!”

It has always struck us as a curious thing that _chemists_ should
have attached such a dominant influence, in the production of heat
in animals, to the union of carbon and oxygen; because nobody is
necessarily so familiar as they are with the fact that the evolution
of heat is not at all _peculiar_ to the union of these bodies, but is
a circumstance common to all changes of every kind, in all forms of
matter—there always being either the absorption or the evolution of
heat.

There is no doubt that the analogy is very striking between the changes
which _appear_ to be wrought in respiration, and those which take
place in ordinary combustion. A very little consideration, however,
shows that the idea that respiration is the cause of animal heat, or
that it is due to any other change of oxygen merely, is not only an
assumption, but in the highest degree doubtful. In the first place, the
carbonic acid thrown out when we expire, is certainly _not_ made by
the immediate union of the oxygen inspired with the charcoal expired;
secondly, nothing is so obvious that in respiration there is an immense
quantity of heat _thrown out_ of the body. But as it is very desirable
that the subject of this paper of Abernethy’s on the Skin and Lungs
should be understood, we will give the reader a simple view of the
nature of these important organs; and as one (functionally considered)
is as much a breathing organ as the other, we will say a few words
first of the lungs.

In all animals[19], the blood, or other fluid in which the elements of
nutrition are sent to all parts, is exposed to the action of the air;
and this is what we call breathing or respiration; and the exposing
of the blood to air is so arranged that both fluids are in _more or
less_ rapid motion. The staple constituents of the air, so to speak,
are about one-fifth oxygen and four-fifths nitrogen gases, with about
two parts perhaps in a thousand of carbonic acid; and although, as we
too well know, the air is occasionally polluted by many _additions_,
yet, whether we take air from the top of Mont Blanc, or a cellar in
London, the _staple_ principles of oxygen and nitrogen have their
proportions unchanged. The air breathed by animals who live in the
water is somewhat differently constituted; the proportion of _oxygen_
is considerably _greater_, probably about as much as one-third or
thirty-two parts in one hundred; so that fish breathe a more _highly
oxygenated_ air than we do.

Now it is found that, when we inhale the air of the atmosphere (that
is to say, one-fifth oxygen and four-fifths nitrogen), we expire some
oxygen, some carbonic acid, and some nitrogen also; and to ascertain
the _actual changes_ which took place, was the object of Abernethy’s
inquiry.

The subject is one of great interest to the public; and, in justice to
Abernethy, we should remark (that which perhaps a few more years may
render it more important to record), that this essay was written more
than half a century ago—1793.

Thousands die every year of affections of the lungs; and many diseases
of these organs, if not in their nature incurable, have too generally
in practice proved to be so. There are not wanting, however, many
persons who ascribe these mournful results, not so much to the abstract
difficulty of the case, as to imperfect and erroneous views of the
functions and relations of these important organs; and who entertain
the opinion that the investigation of the subject has been, either from
preconceived notions, from a too limited view of the phenomena, or from
some other cause, so infelicitously conducted, that the conclusions
arrived at have been either merely assumptions, extremely doubtful, or
absolutely erroneous.

It is sufficiently obvious that if we are ignorant of the use of any
part of a machine, it must be the most unlikely thing in the world that
we should know how to set about repairing it when it is out of order;
and the matter must be still worse, if we should happen to ascribe to
certain parts of it purposes different or contrary to that which they
as really fulfil. So, in an animal, if we are ignorant of the use and
relations of any organ, it is very improbable that we can understand
the nature of its disorders, or treat them in any case successfully,
except by the merest accident, which, though it may waken us up to a
sense of our ignorance, leaves us so blind to the causes of our success
that we have no power of repeating it.

Now this is pretty much the actual state of affairs in respect to
diseases of the lungs. No investigation of any organ is worth anything,
unless it include its relations with other organs in the same machine.

What should we ever learn by looking at the mainspring of a watch,
apart from the general machinery to which it belongs? Though we should
look for ever, and employ a microscope to boot, it is clear we should
never arrive at the perception of its true relations.

Abernethy’s inquiry derived great interest from the investigation of
the skin by which it was preceded, and which seems to have formed
his primary object. A few words on this wonderful organ may help the
unprofessional reader to form some estimate of its relations and
importance. As, in all animals, it is the surface in immediate contact
with external influences—the first which attracts our notice—the
first which we instinctively interrogate as to the state of the animal,
so it is of all others the first which presents to us the evidence of
design and adaptation. We tell the climate an animal inhabits, with
moderate certainty, by looking at the skin; and if we occasionally
meet with apparent exceptions, further examination usually shows that
they exemplify the more strikingly the unity of plan. Thus we may
find animals who inhabit _hot_ regions furnished with a somewhat warm
covering of the skin; as the tiger, for example: but when we examine
the eye, and inquire into the habits of the animal, we find that he
preys or feeds at night, when the atmosphere is charged with damp and
cold.

We know that the animals whence we obtain our furs inhabit cold
regions. The changes in the same animal are not less instructive.
Animals placed in certain circumstances, in which they require
greater warmth, have increase of covering, and _vice versâ_. Again,
the tendency to become white, in those inhabiting cold regions, is
a very interesting adaptation, although I am not aware that it has
been satisfactorily explained. Two things, however, are certain: that
they are placed in different circumstances as regards the relation
to heat, and would reflect a great quantity of light, which, in its
intensity in snowy regions, might be prejudicial, as there is no doubt
of the influence of this principle in animals. Again, it is a very
common arrangement that animals should take the colour of the ground
they occupy; and this is sometimes very curiously exemplified. I have
observed in the common hunting-spiders which inhabit some palings in
a garden in the country, that they are of different shades, but they
all more or less resemble that part of the old paling on which they
are found. Those which we see on the ground are generally of some dark
colour. Birds exemplify in a very remarkable manner the adaptation
of their external coverings to the requisitions which their habits
establish. All animals may be said to be surrounded by an atmosphere of
their own, and they are not therefore, strictly speaking, in contact
with the atmosphere; but when they are exposed to air in motion, this
stratum is blown aside, and the atmosphere is brought in contact with
the surface. Its refrigerating influence is now felt; and, just as a
boy cools his broth by blowing on it, a fresh stratum of cold air is
constantly brought to the surface.

The power of resisting or limiting this refrigerating influence is
somewhat differently conferred in different animals: in the healthy
human subject, by increased activity of the vessels of the skin, which
induces greater heat. Birds, in their rapid flight, and especially in
the more elevated regions of the atmosphere, are exposed to intensely
refrigerating influences. These are met by the surface being clothed
first by fine feathers, the worst of all conductors of heat, and these
are overlapped, where they meet the atmosphere, in such a way that the
bad-conducting property of the feathers is increased by the mechanical
arrangement of them. Again, the respiration of birds, which (_as we
contend_) is a refrigerating process, is very restricted; although,
for want of due consideration of all the circumstances, and especially
of certain analogies afforded by insects, very opposite views have
been entertained. Domestic animals (birds inclusive) impressively
suggest the refined adaptation of colour even, of the whole surface,
to the altered position of the individual. Nothing is more striking
than the general uniformity of colour in wild animals—few things
more familiar than their infinitely varied hues when domesticated.
Now it is certain that these differences have a meaning, and that
their relations are important; but when we extend these thoughts from
the coverings of animals to the consideration of surface, whether of
animals or vegetables, what wonderful things occur to us. Every variety
of colouring which we observe in domestic animals, every spot on an
insect’s wing, every pencilling on a a flower, places the individual in
a different relation, so far, to light, heat, and other powerful agents
in nature.

Or if we look from another point of view—we cannot walk by a hedge-row
in summer without observing how very small the differences of light and
aspect are, which seem on the same soil to confer on the same species
of flowers such numerous varieties of colour. I have most frequently
observed this in the common cranes-bill, or wild geranium.

In order to estimate correctly the value of these surfaces to the
animal or vegetable, it is obviously of great importance to us to know
what they do; and if they give off any thing, to ascertain its nature.
That either animal or vegetable may be healthy, the processes of
nature, whatever they are, must be carried on; and we may be assured,
that the fragrance of the rose is just as necessary an exhalation
_from_ the plant, as it is an agreeable impression _to_ us.

But all animals may be said to breathe quite as much by their skin as
by their lungs. Leaves, too, are the breathing surfaces of vegetables;
and, therefore, to ascertain the facts in the one, without inquiring
into those observable in the other, would be likely to fog our
reasoning and falsify our conclusions. The first impression we obtain
from all animals is from external form and appearance—from, in fact,
its outward covering. It was the first organ to which Abernethy devoted
his most particular attention; and here again his investigations show
how little those knew of his mind who imagined that his thoughts were
restricted to any one set of organs.

In whatever light we view it, the skin is, in all animals, a most
important organ; and so much so, as—drolly enough—with the exception
of the human subject, to have been long popularly so considered. Yet
so imperfect have been the investigation of its functions, that we are
at this moment chiefly indebted to the early experiments of Abernethy
for what we know that is positive on the subject. The original
experiments of Sanctorius were quantitative and, as general truths, of
sufficient importance to have excited more attention. Cruikshank’s were
highly acceptable; but they were less numerous and less varied than
those of Abernethy; whilst the labours of Edwards, though exhibiting
great industry and zeal, were by no means so conclusive as those of
Abernethy. Edwards’ experiments served to strengthen and confirm, by
the analogy afforded by other animals, conclusions drawn by Abernethy
from the more secure premises furnished by the _observation_ of
corresponding functions in man.

Mr. Abernethy’s inquiry was first directed to ascertain what the skin
actually gave off from the body; and secondly, what changes took
place in the air which we draw into the lungs (inspiration). We will
endeavour to give some idea of these experiments. They were very
simple—they involved no cruelty, like those of Edwards—and they were
many of them such as the public might repeat without difficulty.

Very useful would it be, if persons who have leisure would sometimes
engage in physiological inquiries. They would find them to be extremely
interesting; and a series of facts would be easily collected, from
which the physiologist might obtain the most valuable information,
but which, engaged as most of us are in applying physiology to
the correction of disordered functions, we can seldom collect for
ourselves, except in a few hours stolen from those occupied in an
arduous profession, and perhaps by the sacrifice of paramount duties.

Mr. Abernethy’s experiments were very numerous, and commenced in the
summer of 1791; but the winter’s cold obliging him to desist, they were
renewed in the spring of 1792. Having referred to the experiments of
Ingenhous and Cruikshank, together with an allusion to a paper (not
then made public) by Lavoisier, he proceeds to describe his own.

Having a trough containing a large quantity of quicksilver, he filled
a glass jar (sufficiently capacious to contain his hand and wrist)
with that metal. He inverted it into the trough in the usual way of
proceeding in collecting gases. He fixed the glass jar in a sloping
position, that he might introduce his hand the more readily beneath
the quicksilver. In this way, whatever was given off from the skin of
the hand, rising through the quicksilver to the top of the glass, and
of course displacing a proportionate quantity of quicksilver, could be
made the subject of analysis.

He describes his first experiment as follows: “I held my hand ten
minutes in the jar beneath the surface of the quicksilver, and
frequently moved it in that situation, in order to detach any
atmospheric air that might accidentally adhere to it, and afterwards
introduced it into the inverted jar. The quicksilver _soon acquired_ a
degree of warmth which rendered it not unpleasant. Minute air-bubbles
ascended to the top of the quicksilver, more speedily in the beginning
of the experiment, more tardily towards the conclusion. After an hour
had elapsed, I withdrew my hand; the bubbles of air, which now appeared
on the top of the quicksilver, were, I suppose, in bulk equal to one
scruple of water.

“In _sixteen hours_, I collected a half-once measure of air, which
makes fifteen grains the average product of an hour. No kind of
moisture appeared on the surface of the quicksilver. Some sucking-paper
was put up, which was withdrawn unmoistened. My hand was always damp
when taken out of the quicksilver. Whatever aqueous perspiration was
produced, adhered to its surface, whilst the aeriform ascended to
the top of the jar. To the air I had thus collected, I threw up some
lime-water[20], when about two thirds of it were rapidly absorbed;
to the remainder, I added a bubble of nitrous gas[21]; but could not
discover any red fumes, nor any diminution of the quantity. I repeated
this experiment six times, with similar though not uniform results. I
believe it will be found that the air perspired consists of carbonic
acid gas, or fixed air, a little more than two thirds; of nitrogenous
gas, a little less than one-third. In one experiment, the nitrogen made
only one-fourth part of the air collected; in another, I thought it
exceeded one-third.”

He then made a series of experiments of the same kind, but substituting
water for the quicksilver, sometimes heating himself previously by
exercise. The results of these were not materially different from
those in which he held his hand in quicksilver; but they are less
clear, because the carbonic acid gas given off seemed absorbed by the
water. In the next series of experiments, he held his hand and arm
in atmospheric air. In this case, he found that, in addition to the
giving off of carbonic acid, a portion of the oxygen of the air became
absorbed. This is exactly what happens in the lungs. Now, as the
carbonic acid, when given off, is in both cases coincident with the
disappearance of oxygen, and as carbonic acid is composed of oxygen
and carbon, it _had been_ usually conceived that the oxygen taken in,
contributed to form the carbonic acid given off; and the idea is still
entertained very generally.

The experiments of Abernethy, however, presently to be adverted to, in
regard to the skin; and those of Edwards, long after, in regard to the
lungs; satisfactorily prove, we think, that the carbonic acid is not
_at all derived_ in the manner supposed[22].

To test this matter, Mr. Abernethy confined his hand and arm in various
gases containing _no oxygen_—as hydrogen, and then in nitrogen; but he
found the carbonic acid gas _still given_ off as before. He then placed
his hand in a gas (nitrous oxide) _containing_ oxygen; and lastly, in
oxygen itself, to see if it _increased_, or otherwise affected the
elimination of carbonic acid; but in neither of those experiments was
the carbonic acid thrown off, _increased_, or in any way affected by it.

In a subsequent part of the paper, he remarks on the idea that
physiologists entertained of the carbonic acid given off by the lungs
being made by the oxygen inspired; but he says, very justly, that the
quantity of oxygen is too small for the formation of so much carbonic
acid gas as we find given out by those bodies; and that his experiments
on the skin clearly prove that the exhaling vessels of the skin emit
carbonic acid in a state of _complete formation_; and then adds, what
it is difficult to estimate the merits of, without recollecting that it
was said half a century ago (and before the experiments of Edwards),
“and, doubtless, those of the lungs perform a similar office.”

This is one of those bold, and, we believe, successful reasonings
from analogy which were very characteristic of Abernethy. The truth
is, that even the experiments of Edwards, some of which were, a long
time since, repeated by ourselves, with the same results, are not, I
conceive, so conclusive as the analogy of Abernethy. It is true, they
consisted of placing frogs and other animals in gases not containing
oxygen, when it was found, notwithstanding, that there was _no_
diminution in the quantity of the carbonic acid produced, and which
therefore could not have been compounded of any oxygen in the gas. But
even here many possible sources of fallacy suggest themselves. The
previous expulsion _of all_ the oxygen from the animal is obviously a
matter of uncertainty. There are, besides, those sources of fallacy
which are inseparable in some form or other from all experiments on
animals which disturb their natural habits, especially when these
disturbances are so great as to amount to suffering. From all such
experiments Abernethy _instinctively_ shrunk. His repulsion to them
seems not to have rendered it necessary to him to have shown that
they were as _physiologically inconclusive_ as they were morally
questionable. At all events, his present experiments were not obscured
by any such sources of fallacy.

Still the idea of the carbonic acid exhaled by the lungs, being made up
of the union of the carbon exhaled with the oxygen taken in, continued
to be very extensively entertained. We can only say that to us it seems
entirely a child of the imagination; what Horace calls

“Mentis gratissimus error;”

and shows not only how few people can find leisure to investigate, but
how few venture to observe or think for themselves. Abernethy also
experimented by holding his hand in carbonic acid, when he found that
in about nine hours, three ounces, by measure, of carbonic acid were
absorbed by the skin; and in the remaining gas, a considerable quantity
of other gas which had been given off, which appeared to be nitrogen.

Desirous of ascertaining the quantity of carbonic acid gas given off by
his hand, in different gases in a single hour, he introduced his hand
into various gases. In the experiment with

Drs.
Nitrous oxide, there came off 6
Hydrogen 4
Atmospheric air 3

The test for the carbonic acid was, as before, in all cases,
lime-water. He also found that the skin absorbed oxygen much more
readily than most other gases. One remarkable experiment we will
notice, to show how laborious all these investigations were, and for
the interesting nature of the result. He placed his hand alternately in
vessels containing each twenty-four ounces, by measure, of nitrogen and
oxygen gases. After eight hours’ exposure in each, two-thirds of the
oxygen had disappeared, whereas only _one twentieth_ of the nitrogen
was absorbed. Indeed, there is no one feature of these experiments
perhaps more interesting than those which suggest the stronger aptitude
of the skin to absorb oxygen in comparison with other gases. For
example, Abernethy found that the skin absorbed, by measure,

Ozs.
Of oxygen gas, in eight hours 8
Of nitrous gas, in five hours 3
Of hydrogen, in five hours 1-1/2
Of nitrogen, in eight hours 1

Mr. Abernethy then made some experiments on his own lungs, after the
manner that Mr. Cruikshank had done, to find the quantity of _water_
exhaled, by breathing into glass jars filled with and inverted in
quicksilver, and by other methods, and also to ascertain the change
produced in the air by respiration. These are all interesting; but we
can only give general results, referring to the work itself, as full of
material for thought and future observation. He considered that, on the
whole, the change in the air was, that in one hundred parts, consisting
of

Parts.
Nitrogen 80
Oxygen 18
Carbonic acid 2

about _three_ parts of the oxygen were absorbed, whilst about _twelve_
parts of carbonic acid were exhaled, the nitrogen being little altered,
or even receiving some small addition. The quantity of _inspired_
oxygen which disappeared varied in different experiments, probably
depending on the depths of the inspiration, and the duration between
it and the following expiration—the time, in fact, during which it
was retained in the lungs. The smallest quantity which disappeared was
one-twelfth; the largest, one-sixth. The moisture (water) exhaled, he
found to be about three drachms in an hour.

These experiments, for the particulars of which we must refer to the
book itself, contain a calculation of the extent of surface of the
body, which he estimates at about two thousand seven hundred square
inches—that is, about thirty-eight times that of the hand and wrist,
on which he experimented. Thus, if we multiply any of the results he
obtained by thirty-eight, we shall obtain some idea of the prodigious
power of this wonderful organ, and of the vast influence which its
various conditions must exert on the whole animal economy. The whole
of the experiments in the paper are just as interesting as ever,
and would, we are well persuaded, be found amply to repay further
investigation.

They exemplify in every line his clearness of thought, and his care in
deducing no other conclusion from the premises than that which they
logically justify. The observations which he has annexed to his paper
also are just, and of great practical value; they discuss the bearing
that the whole has to the relation which exists between the skin and
lungs, and the influence of this on the causes of that fell destroyer,
popularly known under the title of Consumption.

They are a portion of that investigation of relation between various
organs, on which anything like the formation of a definite and
practical science must ultimately depend. We shall endeavour, in the
sequel, to explain the ulterior consequences which necessarily arise
out of such considerations, when they are duly followed out. We shall
endeavour to point out the share they had, in conjunction with other
considerations, in leading to those beautiful and simple principles
which Mr. Abernethy was led more especially to advocate; and show how
far _he_ went, as describing the starting point of those who have
endeavoured at a fuller development of the consequences of his views.

He remarks, justly enough, on the determination to the lungs consequent
on the repression of the surface, and the necessary _additional duty
thrown on those_ important organs engaged in a common function with
the skin, where the duty of the latter is not performed; and on
the elements thus supplied for disease, _especially_ in persons of
restricted chest; relations, _be it remembered_, which exist between
the various other organs of the economy, and which exemplify in a
single case truly, what has been, we trust, since shown in regard
to organs generally; how the organ, which may be the seat of the
_disease_, _may not be_ the seat of the original _cause_, but really
a secondarily affected organ—a hint which, when followed out, is of
_immense practical importance_.

The skin is by no means the only organ which has a community of
function with the lungs, or through which these important parts become
affected; but if this be so, and diseases of the lungs be treated
as an _integral thing_, it requires no great penetration to see how
diseases so handled must be incurable; since the real cause may never
be ministered to.

Again, if a case should be successfully treated, by means which
afford all possible relief to the _lungs_, whilst the _primarily
affected_ organ is also properly treated, it by no means follows that
the treatment should be the same in _every case_; for the primarily
affected organ may be different in different cases. There is, in fact,
no organ of the body which, when subjected to disordering influences,
may not _secondarily_ affect the lungs.

The liver is especially apt to affect them. It is engaged, like the
lungs, in throwing off large quantities of carbon or charcoal from the
system, and has been not very improperly termed the “abdominal lung.”
It is constantly also sending through the medium of the heart a large
quantity of blood to the lungs. Now, if this blood have not the proper
quantity of carbon extracted from it by the liver, or if even the blood
be excessive in quantity, why the lungs must have more to do; and many
diseased lungs have been produced in this manner in cases where the
chest has been well formed.

There are, however, many intimate relations between organs which do not
depend on mere community of function. It is very important that the
public should have clear views on this subject; and if they would only
give a little of that attention which they so often bestow on things
infinitely more difficult, there is no doubt many lives would be saved
that are irremediably damaged, as Abernethy says, sometimes even before
any symptoms have suggested that there is anything the matter.

But if there be a shadow of truth in Mr. Abernethy’s views, and still
more in those extensions of them to which they have naturally led, we
may learn how necessary is that discrimination which traces disease to
_primarily_ affected organs; and how little success we may expect by
treating the lungs, as the integral seat of disease, by specifics, or
such remedies as tar, naphtha, cod-liver oil, various gases, &c. which
come in and go out of fashion in a manner sufficiently significant of
the claims they can have in a scientific point of view.

Mr. Abernethy also remarks on the comparatively restricted influence
of scrofula in constituting consumption. “At one time,” he observes,
“I examined the bodies of many people who died of consumption.” After
describing other appearances which he found, he says, “the greater
number were bestudded with larger or smaller tubercles, or _made
uniformly dense_ (consolidated).” He says, this disease (consolidation)
is _very insidious_, that it is often established beyond the
possibility of removal before it is suspected; but, he says, he thinks
it might be known, for the capacity of the lungs is diminished; and
suggests that this should be tested, by allowing a suspected case to
_breathe into a glass vessel over water_, by which the quantity of air
they can receive is rendered perceptible.

His remarks, too, on the treatment are highly interesting and
discriminative, and will not only well repay attentive perusal, but
that study which is necessary to the perception of their full force and
beauty. When we have to sum up the various influences of the views of
Abernethy, we may probably find space for a few facts on that which
they exert on the treatment of the lungs and skin; and this not merely
as affecting the health in general, but also complexion, and other
conditions of these curious and important organs.

We are unwilling to dismiss this paper without directing attention
to the illustration it affords of the erroneous views of those who
imagine that Abernethy’s investigations were confined to the digestive
organs, and still less, of course, to one of them (the stomach). It
would, on the contrary, be difficult to find any paper on physiology
so comprehensive in its views, so simple and clear as to its object,
so cautious and logical in its reasonings, so free from any bias,
or with so little reference, either directly or indirectly, to what
are usually understood by the digestive organs. On the other hand,
it is an investigation which (as regards the relation which exists
between two organs having a common function) is an exact type of what
physiological investigation should be. For we have only to extend the
idea of a relation which exists between _two_ organs, to those which
exist between _all_ organs; to regard as their _combined_ functions,
the sustentation of the life and health of the individual, just as we
have been regarding respiration, the common function of the skin and
lungs; and we thus arrive at what must be the basis of any sound or
comprehensive inquiry into the true relations of the various parts of
the economy; by which alone we can interpret the phenomena of health
and disease.

Moreover—however presumptuous the assertion may appear on the one
hand, or however humiliating the view it implies of the present
state of medicine as a science on the other—we must regard this
investigation, in every philosophical sense of the term, as still among
the “means untried” of the illustrious author whose words we have
ventured to place at the head of this chapter.

[Footnote 19: This statement does not hold in regard to Entozoa (animals
living in the bodies of others), or at all events is not proved.]

[Footnote 20: The test for carbonic acid.]

[Footnote 21: A test for the presence of oxygen.]

[Footnote 22: It is in this paper that he uses the significant
expression “ventilating the blood,” which looks as if the refrigerating
effect of respiration—and which we have endeavoured to show is the
real, though perhaps not sole, purpose of it—had not wholly escaped
his notice.]

“Quis talia fando
Temperet a lachrymis.”

VIRGIL.

Perhaps, of all known torments, there is none that can be compared,
either in intensity or duration, with that curious disease which has
been called Tic Doloreux. Like the term Neuralgia, it is merely a hard
word to express a violent pain in a nerve. Conventionally, the term
neuralgia, or nerve-pain, is generally used to express a case where
the suffering is of a more or less diffused character. The term “tic”
is more usually applied in cases where the seat of pain is found in
some superficial nerve. Neither term has much claim to the character of
scientific nomenclature; they are merely equivalent to saying that we
know very little of the matter. This obscurity, however, may be soon
lessened, if not entirely cleared, by any one who will go to work in
the way suggested by Mr. Abernethy’s principles, and in which, to a
certain point, they will conduct him. He must, however, recollect that
the pain, though a most distressing symptom, is still a _symptom_, and
not the _disease_ which gives rise to it.

This disease teaches us how beneficently framed we are in relation to
all around us; and how small a deviation from a healthy condition of
our sensations converts all usual sources of pleasure into so many
elements of agony. The breeze, of late so grateful and refreshing,
may produce more suffering than would be excited by the most
intensely-heated furnace. In other cases, the cool spring, or the
most delicious fruit, become causes of torture. We should exceed
all reasonable limits if we were to enumerate all the usual sources
of pleasure which, in different cases, are converted into so many
instruments of suffering.

Tic doloreux is indeed a horrible malady; but one which, when properly
considered, becomes very instructive. It admirably illustrates
the views of Abernethy; and how ready he was to concede all that
examination of the views of others which modesty and common sense
require, as well as how superior his own were, both in philosophical
acumen and practical value; first examining the views of others, and
finding them defective, he, with the true philosophical spirit which
first discovers what is wrong—

“Primus gradus est sapientiæ falso intelligere,”

then proceeds to develop his own.

The nerves are the organs from which we receive all our impressions
from without; and when their ordinary sensibility is thus morbidly
augmented, we may be persuaded that there is _something_ very wrong
within.

The tic doloreux is one of the examples showing how cautious and
circumspect, and how modest withal, Abernethy was in advancing to his
own comprehensive views of disease; and how entirely antithetical the
method he pursued in arriving at them was to that which attempts to cut
the knot of difficulty by gratuitous hypotheses.

When this disease first began to attract attention, it was suggested
that it might be cured by the division of the nerve. The phenomena
of the nervous system afforded abundant grounds for mistrusting the
soundness of this view. The tendency, however, to confound the more
salient symptom of a disease with its intrinsic nature, caused such
phenomena to be overlooked or little considered; and the consequence
was, that where the nerve was divided, the treatment was sometimes
entirely confined to that proceeding.

In the end, the operation disappointed expectation; and that which
careful reasoning might have predicted as probable, was left to be
determined by experiment, In some cases, circumstances concurred to
produce temporary relief; but on the whole the operation was a failure.

In the case he here published, Abernethy removed a little bit of
nerve from a lady’s finger. As she had suffered severely, and he was
anxious to give her more permanent relief, he did not rest satisfied
with merely dividing the nerve. For about nine months the lady was in
comparative ease; but then the sensation returned. He remarks on the
interest attached to this return of sensation, and observes on the
analogy it suggests between the supply of blood, and that of nervous
power. For if the vessels conveying the former be tied or obstructed,
the supply is gradually restored through collateral channels. The
return of the nervous functions, after the removal of a portion of the
nerve, seemed to favour that view of the nervous system which regarded
as the proximate cause of the phenomena some subtle principle or other,
like electricity or magnetism, or some analogous power, of which the
nerves might be the conductors.

Perhaps the most interesting fact of this case, however, was the
significant bearing it had on those views which he was beginning
to deduce from a multitude of other sources. The fact being, that
when the lady died, which she did about four years afterwards, _she
died of disordered digestive organs_. Showing, therefore, at least,
the coincidence of the most severe form of nervous disturbance with
disorder of these important functions.

We shall see, by and by, that Mr. Abernethy made this and other cases
the instruments of much future good; but as we shall not be able to
digress from that Summary of our obligations, which we shall then be
employed in taking, we will add a few words here in aid of removing
that difficulty which some people have in understanding how such
dreadful pain can result from any organ in the interior of the body,
where no pain is felt at all. In order to do this, it is only necessary
to have a clear general notion of the nervous system. If you could
take away everything but the nerves, you would have the brain, spinal
marrow, and certain knot-like pieces of nervous substance (ganglions,
as we term them) from which myriads of cords proceeded, varying in size
from the smallest imaginable filaments up to moderate sized cords; the
ends of the delicate filaments terminating in the various organs and
on the surface of the body; millions of messengers of the most extreme
sensibility, by which impressions are telegraphed with the swiftness of
lightning between all parts of the body. There is, however, a habit or
rule which is ordinarily observed, and that is one of the most curious
things in the whole range of physiology—namely, that the immediate
cause of our recognition of sensation is never in the part itself,
but the action is constantly transferred to the extremity of the
nerve. When you strike the ulnar nerve at the elbow (popularly termed,
sometimes, the funny-bone), you feel it in the fingers to which its
branches are distributed.

If you place your finger in cold or warm water, the action that makes
you feel it is in the brain; and we infer this, because if we divide
the communication between the brain and the finger, you no longer
feel the sensation. Now, bearing this in mind, you easily understand
how anything disturbing the nerves of any internal organ may produce
pain in some distant branch; and that this is really so, many cases
of tic doloreux have furnished conclusive and triumphant proofs. Now,
as to _why_ it should be seated in this or that particular site, is
a question of extreme difficulty; as also in what organ the primary
disturbance is seated, supposing it to have been in any of them. The
former, I believe, is a question we have yet been unable to solve; the
_latter_ may usually be accomplished, _if sufficient pains be taken_.

Abernethy, in his lectures on this subject, when observing on the
inefficiency of this division of the nerve—which was ministering to
effects only—was accustomed to remark, with that peculiar archness of
expression which his pupils must so well remember: “I wonder that it
never entered into the head of some wise booby or other to divide the
nerve going to a gouty man’s toe.” This was a very characteristic mode
of terminating a discussion of any point which he wished to impress on
the memory of the pupil.

SECTION.

OF HIS PAPER ON OCCASIONAL CONSEQUENCES OF BLEEDING.

In these days of improved statistical inquiry, it would be a curious
document which should give us the comparative number of persons who are
now bled, and that of only fifty years ago; and whilst it would present
very instructive data as to the progress of medical science, it would
give also some significant hints as to the relations of fashionable
remedies. First, almost every barber was a bleeder; and within my own
recollection, a lady, who for any serious ailment consulted the most
eminent physician in the neighbourhood in which she lived, would allow
no one to bleed her but the barber.

Formerly, multitudes of people lost a little blood every “spring and
fall.” Accidents of all kinds afforded a fine opportunity for bleeding.
The papers announced accidents generally by the usual—”It is with
regret that we learn that Sir Harry —— was thrown from his horse
in the Park. It was feared that the honourable baronet had sustained
serious injury; but, fortunately, Mr. Sharpe was on the spot, so that
the patient was immediately bled. He was conveyed home, and we rejoice
to hear that he is doing well. The accident, which it had been feared
was a fracture, proved to be only a ‘dislocation.'”

The questions in regard to bleeding were said to be—who, when, and
how much (_quis, quando, quantum?_); but, to our minds, Aretæus
has a better saying: “When bleeding is required, there is need
of deliberation (_cum sanguinem detrahere oportet, deliberatione
indiget_).” We like this better; because, in addition to the little
words quoted above, it suggests another, more important than
either—namely, _cur?_ why—on many occasions, a favourite inquiry of
Abernethy’s.

We recollect a surgeon being called to a gentleman who was taken
ill suddenly, and he found two or three servants and the medical
attendant struggling very vigorously with the patient. Whilst this
was continuing, the first question put to the surgeon by the medical
attendant was:

“Shall I bleed him, Sir?”

“Why should you desire to bleed him?”

“Oh! exactly; you prefer cupping?”

“Why should he be cupped?”

“Then shall I apply some leeches?”

This, too, was declined; in short, it never seemed to have occurred
that neither might be necessary, still less that either might therefore
do mischief.

It is the most curious thing to see the force of a well-grown
conventionalism. As long as it led to moderately bleeding plethoric
baronets in recent accidents, no great harm would have been done;
but the frequency in other cases, in which bleeding was instituted
with “apparent impunity,” was too commonly construed into “bleeding
with advantage,” until the practice became so indiscriminate as to be
extensively injurious. _Now_, comparatively, few persons are bled; and
some few years ago I had a curious illustration of it.

In a large institution, relieving several thousand patients annually,
and in which, a very few years before, scarcely a day passed without
several persons having been bled; nearly a month elapsed without a
single bleeding having been prescribed by either of the three medical
officers.

No doubt many persons are still bled without any very satisfactory
reason; but we believe that the abuse of bleeding is much diminished,
and that the practice is much more discriminate and judicious. From
this, and perhaps other causes, a very important class of cases which
engaged the attention of Abernethy, as it had that of Hunter before
him, is become comparatively infrequent. When bleeding, however, was
practised, with as little idea of its importance as some other of the
barber-surgeon’s ministrations, on all sorts of people, and in all
sorts of disturbed states of health, and probably with no attention at
all to the principles which should alike guide the treatment of the
largest or the smallest wound; this little operation was frequently
followed by inflammation of the vein, nerve, or other contiguous
structures. These cases were, most of them, more or less serious, often
dangerous, and occasionally fatal.

Taking up the subject where it had been left by Mr. Hunter, Abernethy
refers to the cases published in the two volumes of the “Medical
Communications,” by Mr. Colly of Torrington, and by Mr. Wilson, and
then proceeds to give some of his own. It is in this paper that he
first moots two questions which have since grown into importance, by an
extension of some of the practices to which they refer. We allude to
the division of fasciæ, and tendinous structures, and also of nerves in
states of disease or disorder.

In many cases we see, in the application of such measures, how much
that clear and quick-sighted discrimination is required which so
eminently distinguished Abernethy. He, however, only _mooted_ these
questions at that time; for he observes that he had not had sufficient
experience to give an opinion. The chief value of the paper _now_ is,
the good sense with which it inculcates a more careful and cleanly
performance of bleeding; a more scientific treatment of the puncture,
by neatly bringing its edges into apposition, and by keeping the _arm
quiet_ until it has healed. Neglect of these cautions in disordered
states of constitution, had no doubt been not infrequently accessory
to the production of some of the serious consequences against which it
is the object of this paper to guard. I need scarcely observe that the
whole subject is important, and should be thoroughly studied by the
young surgeon.

In 1793, Abernethy, by his writings and his lectures, seems to have
created a general impression that he was a man of no ordinary talent.
His papers on Animal Matter, and still more his Essay on the functions
of the Skin and Lungs, had shown that he was no longer to be regarded
merely in the light of a rising surgeon, but as one laying claim to the
additional distinction of a philosophical physiologist. The subject (of
the skin and lungs) had engaged the attention of Böerhaave a long time
before; Cruikshank also, and other very able men, had followed in the
same wake of investigation; therefore there was an opportunity of that
test which comparison alone affords. Abernethy was, in fact, regarded
at this time more in the light of a rising man, than merely a promising
surgeon. He now moved from St. Mary Axe (as I am informed), and took a
house in St. Mildred’s Court, in the Poultry.

Sir Charles Blicke had moved to Billiter Square. I find, by the
rate-books, which Mr. B. L. Jones was so good as to inspect for me,
that this was in April, 1793. He could hardly fail at this time to have
had a very acceptable portion of practice, although we apprehend it was
not as yet extensive. His reputation was, however, fast increasing,
which the attention paid to his opinion at the hospital at this time
must have materially accelerated.

Certainly not later than 1795, there were very few cases of doubt
or difficulty, in which (independently of that participation in the
consultation at the hospital common to all the medical officers) there
was not especial value and influence attached to his opinion; and I
have heard a pupil of that day assert, that in cases of real doubt
and difficulty, there was nothing more beautiful in itself, nor more
characteristic of Abernethy, than the masterly way in which he would
analyze a case, bring the practical points before his colleagues, and
at the same time suggest the course he preferred. As, from his other
occupations, it would often happen that some consultation might be
pending whilst he was engaged at the theatre or in the museum, it would
often happen that a consultation would terminate for the time by some one
observing: “Well, we will see what Mr. Abernethy says on the subject.”

In 1796, he became a Fellow of the Royal Society, his old preceptor,
Sir William Blizard, being one of those who signed the proposal
for his election. He only contributed one paper after this to the
“Philosophical Transactions.” After his death, the Duke of Sussex
pronounced a very well-deserved eulogium, of which a copy will be found
in another part of this volume. He had not been idle, however; but, in
1797, published the third part of the “Physiological Essays,” which we
will consider in the next place.

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