OF MANNER

“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, 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; 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 cautiously 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, 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, 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. Davis[69], 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 known 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 would 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. Wood[70], 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.’ 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 superiority 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 creditable[71]. 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 of his profession. John Hunter, upon reflecting on the
hæmorrhage 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 anastomosing[72] channels
for carrying on the circulation. The only question necessary to
be decided was—would _large_ arteries heal when tied? Every case
confirmed that 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 œsophagus,
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. 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 tetanus[73]. 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.”

“Non ego paucis,
Offendar maculis, quas aut incuria fudit,
Aut humana parum cavit natura.”

HORACE.

“I will not be offended by a few blemishes, the result of
inattention, or against which human frailty has not sufficiently
guarded.”

Mankind have long established, by universal consent, the great
importance of “Manner.” It has been so ably and so variously discussed
by different writers, that it is next to impossible to say any thing
new on the subject, or what has not been even better said on the
subject already. Still it is equally true that it is a thing very much
less cultivated than its influence demands; so that really easy, good
manners continue to be a very rare and enviable possession. But if
manner be thus influential in the ordinary intercourse of life, it is
still more important in ministering to disease. People, when they are
ill, have, for the wisest purposes, their susceptibilities more vivid;
and it is happy for them when those in health have their sympathies—as
is natural, we think, that they should be—quickened in proportion.
No doubt it is a great subtraction from whatever benefit the most
skilful can confer, if it be administered in a dry, cold, unfeeling, or
otherwise repulsive manner. There is too a very sound _physiological_
as well as _moral_ reason for kindness. It is difficult to overrate
the value of that calm which is sometimes diffused over the whole
system by the impression that there is an unaffected sympathy in our
sufferings. We have of course, in our time, observed abundant varieties
of manner in our professional brethren; and we have often listened with
interest to conversations in society, in which the manners of various
medical men have been the subject of discussion, from which good
listeners might, we think, have often taken valuable lessons.

We are convinced that the disguise, worn by some, of an artificial
manner, leaves, on many occasions, no one more deceived than the
wearer. Many patients have their perceptions remarkably quickened
by indisposition, and will penetrate the thin veil of any form of
affectation much more readily than people imagine. In common language,
good feeling and kind manner are said to spring from the heart. If a
man feels kindly, he will rarely express himself otherwise, except
under some momentary impulse of impatience or indisposition.

There is no doubt that the secret of a kind and conciliatory manner
consists in the regulation of the feelings, and in carrying into the
most ordinary affairs of life that principle which we acknowledge as
indispensable in serious matters—of doing to others as we would they
should do to us.

We are not speaking of a _polished_ manner; that is another affair.
A man’s manner to a patient may be unpolished, or as homely as you
please; but if he really feels a sympathy for his patient, it will,
with the exception to be stated, never be coarse or unkind.

Some men are absurdly pompous; others, hard and cold; some put on a
drawling, maudlin tone, which the most superficial observer detects
as being affected. An honest sympathy is more acceptable than even a
polished manner; though doubtless that is a very desirable grace to a
learned profession.

In general, our own experience—and we know something of indisposition
in our own person—has induced us to judge favourably of the manner of
medical men.

There are, no doubt, exceptions, and sometimes in men in whom you would
least expect it. We have known men “eye” a patient, as if looking at
some minute object; some, jocosely familiar. One man has an absurd
gravity; another thinks he must be all smiles. We have known, too, the
adoption of a tone characterized by a sort of religious solemnity.
These, when assumed, are generally detected, and of course always
vulgar. Some even say really rude and unfeeling things, before any
thing has happened to provoke them. We attended a gentleman who had a
great deal of dry humour, and who was very amusing on such matters. One
morning, he said, “I saw Dr. —— on one occasion, and the first thing
he said to me I thought he might as well have omitted. ‘I see, sir,’
said he, ‘that you have taken the shine out of your constitution.'”

Abernethy’s manner was at times—always, in serious cases, and, so far
as we ever observed, to hospital patients—invariably, as unaffectedly,
kind as could be desired. It is too true that, on many occasions of
minor import, that impulsiveness of character which we have seen in
the boy, was still uncontrolled in the man, and led him to say things
which, however we may palliate, we shall not attempt to excuse.

It is true his roughness was very superficial; it was the easiest thing
in the world to develop the real kindness of heart which constantly lay
beneath it; and it is very instructive to observe how a _very little
yielding_ to an infirmity may occasionally obscure one of the most
benevolent hearts that ever beat in a human breast, with the repulsive
exterior of ungentle manners. Still, patients could not be expected
to know this; and therefore too many went away dissatisfied, if not
disgusted.

The slightest reaction was, in general, sufficient to bring him to
his self-possession. A lady, whom he had seen on former occasions,
was one day exceedingly hurt by his manner, and burst into tears. He
immediately became as kind and patient as possible, and the lady came
away just as pleased as she had been at first offended.

Reaction of a different kind would answer equally well. One day, a
gentleman consulted him on a painful affection of his shoulder, which
had been of a very excruciating character. Before he had time to enter
on his case, Abernethy said, “Well, I know nothing about it.” The
gentleman sharply retorted: “I do not know how you should; but if you
will have patience till I tell you, perhaps you then may.” Abernethy at
once said, “Sit down;” and heard him out, with the greatest kindness
and patience.

I am indebted to Thomas Chevasse, Esq. of Sutton Coldfield, Warwick,
for the following letter to a patient in Surrey, who had complained
that he did not receive any sympathy from him.

“Dear Sir,

“I am sorry to have said any thing that has offended you. I may
have felt annoyed that I could not suggest any plan of treatment
more directly curative of your malady, and expressed myself
pettishly when you did not seem to understand my meaning; for I
am a fellow-sufferer, and had tried what are considered to be
appropriate remedies, unavailingly. I assure you that I did not
mean to hurt your feelings, and that I earnestly hope the state of
your health will gradually improve, and that your local maladies
will decline in proportion.

“I am, dear Sir,
“Your obedient servant,
“JOHN ABERNETHY.

“Bedford Row, October 25.”

A surgeon was requested to visit a patient in one of the suburbs of
the metropolis. When he arrived there, he had to mount two or three
dilapidated steps, and to read a number which had been so nearly worn
away, that he was enabled to determine whether it was the number he
sought only by the more legible condition of its two neighbours. Having
applied a very loose, dilapidated knocker, an old woman came to the
door.

“Does Captain —— live here?”

“Yes, sir.”

“Is he at home?”

“Yes, sir. Please, sir, may I be so bold—are you the doctor, sir?”

“Yes.”

“Oh! then, sir, please to walk up.”

The surgeon went up a small, narrow staircase, into a moderate-size,
dirty, ill-furnished room, the walls of which were coloured something
between yellow and red, with a black border. An old man, in a very
shabby and variegated _deshabille_, rose from his chair, and, with
a grace worthy of a court, welcomed the stranger. His manner was
extremely gentlemanly, his language well chosen, the statement of his
complaint particularly simple and clear. The surgeon, who, like most
of us, sees strange things, was puzzled to make out his new patient;
but concluded he was one of the many who, having been born to better
things, had been reduced by some misfortune to narrow circumstances.
Everything seemed to suggest that construction, and to warrant no
other. Accordingly, having prescribed, the surgeon was about to take
his leave, when the old gentleman said:

“Sir, I thank you very much for your attention;” at the same time
offering his hand with a fee.

This the surgeon declined, simply saying:

“No, I thank you, sir. I hope you will soon be better. Good morning.”

“Stay, sir,” said the old gentleman; “I shall insist on this, if you
please;” in a tone which at once made the surgeon feel that it would
be painful and improper to refuse. He accordingly took it. The old
gentleman then said, “I am very much obliged to you, sir; for had
you not taken your fee, I could not again have the advantage of your
advice. I sent for you because I had understood that you were a pupil
of Mr. Abernethy’s, for whom I could not send again, because he would
not take his fee; and I was so hurt, that I am afraid I was almost rude
to him. I suppose, judging from the appearance of things here that I
could not afford it, he refused his fee; on which I begged him not to
be deceived by appearances, but to take it. However, he kept retreating
and declining it, until, forgetting myself a little, and feeling
somewhat vexed, I said, ‘By G—, sir, I insist on your taking it!’ when
he replied, ‘By G—, sir, I will not!’ and, hastily leaving the room,
closed the door after him.”

This gentleman has been dead some years. He lived to a very advanced
age—nearly, if not quite, ninety—and had many instructive points of
character. He was really in very good circumstances; but he lived in
a very humble manner, to enable him to assist very efficiently some
poor relations. To do this, he saved all that he could; and although
he insisted on the surgeon taking a fee when he visited him, he said
that he should not hesitate to accept his kindness when he called on
the surgeon. The intercourse continued many years; but with rather a
curious result.

After a time, growing infirmities converted what had been a
visit—perhaps once or twice a year—into occasional attendances,
when the rule he had prescribed to himself, of paying visits at home,
became characterized by very numerous exceptions; and, at last, by so
many, that the rule and the exception changed places. The surgeon,
however, went on, thinking that the patient could not do other without
disturbing existing arrangements. When, however, the old gentleman
died, about four hundred guineas were found in his boxes, wrapped up,
and in various sums, strongly suggestive of their having been (under
the influence of a propensity too common in advancing life) savings,
from the somewhat unnecessary forbearance of his medical attendant. We
know one other very similar occurrence.

Sometimes Mr. Abernethy would meet with a patient who would afford
a useful lesson. A lady, the wife of a very distinguished musician,
consulted him, and, finding him uncourteous, said, “I had heard of your
rudeness before I came, sir; but I did not expect this.” When Abernethy
gave her the prescription, she said, “What am I to do with this?”

“Anything you like. Put it in the fire, if you please.”

The lady took him at his word—laid his fee on the table, and threw
the prescription into the fire, and hastily left the room. Abernethy
followed her into the hall, pressing her to take back her fee, or to
let him give her another prescription; but the lady was inexorable, and
left the house.

The foregoing is well-authenticated. Mr. Stowe knows the lady well, who
is still living. But many of these stories, to our own knowledge, were
greatly exaggerated. Abernethy would sometimes offend, not so much by
the manner as by the matter; by saying what were very salutary, but
very unpleasant truths, and of which the patient perhaps felt only the
sting. We know a gentleman, an old fox-hunter, who abused Abernethy
roundly; but all he could say against him was: “Why, sir, almost the
moment I entered the room, he said: ‘I perceive you drink a good
deal,'” which was very true. “Now,” added the patient, very _naïvely_,
“suppose I did, what the devil was that to him!”

Another gentleman, of considerable literary reputation, but who,
as regarded drinking, was not intemperate, had a most unfortunate
appearance on his nose, exactly like that which frequently accompanies
dram-drinking. This gentleman used to be exceedingly irate against
Abernethy, although all I could gather from him amounted to nothing
more than this, that when he said his stomach was out of order,
Abernethy observed, “Ay, I see that by your nose,” or some equivalent
expression.

However rough Abernethy could occasionally be, there was, on grave
occasions, no feature of his character more striking than his humanity.
Dr. Barnett[74] had a case where Abernethy was about to perform a
severe operation. The Doctor, at that time a young man, was anxious
to have every thing duly prepared, and had been very careful. When
Abernethy arrived, he went into the room into which the patient was to
be brought, and, looking on the instruments, &c. on the table, said:
“Ay, yes, that is all right;” then, pausing for a moment, he said: “No,
there is one thing you have forgotten;” and then, throwing a napkin
over the instruments, added: “It is bad enough for the poor patient
to have to undergo an operation, without being obliged to see those
terrible instruments.”

Few people get off so badly in the world as poor gentlemen. There are
multifarious provisions in this kingdom for all sorts of claimants; but
a poor gentleman slips down between those which are not applicable
to his case, and those which are too repulsive to be practicable. His
sensibilities remain—nay, perhaps are sharpened—and thus, whilst
they tend to exasperate his wants, they increase the difficulty of
supplying them. There is here afforded a grateful opportunity for the
indulgence of what we believe, amidst some exceptions, to be the ruling
spirit of medical men: a sensitive philanthropy, which no men in the
world are more liberal in disbursing. Abernethy had his full share of
this excellence. There are multitudes of instances exemplifying it.
We are indebted for the following to Mr. Brown, of the respected firm
of Longman and Co. Abernethy was just stepping into his carriage to
go and see the Duke of ——, to whom he had been sent for in a hurry,
when a gentleman stopped him to say that he should be very glad if
he could, at his leisure, pay Mr. —— another visit at Somers Town.
Abernethy had seen this poor gentleman before, and advised a course
which it appeared that the patient had not resolution to follow. “Why,”
said Abernethy, “I can’t go now, I am going in haste to see the Duke
of ——.” Then pausing a moment before he stepped into the carriage,
he looked up to the coachman and said, quietly, “Somers Town.” This is
very characteristic. The fidgetty irritability of his first impression
at interference, and the beneficence of his second thought.

Dr. Thomas Rees knew a gentleman who was a man of ability, who had
been a long time ill, and who got a scanty living by his writings. Dr.
Rees called on Abernethy, one morning, and told him that the gentleman
wished to have his opinion; but that he had heard such accounts of him,
he was half afraid to see him. “And if he were not,” said Dr. Rees, “he
is not able to pay you. He is a great sufferer, and he gets his living
by working his brains.” “Ah!” said Abernethy; “where does he live,
do you say?” “At ——,” mentioning a place full two miles distant.
Abernethy immediately rang the bell, ordered his carriage, visited the
gentleman, and was most kind to him.

One day, a pupil wished to consult him, and found him, about ten
minutes before lecture, in the museum, looking over his preparations
for lecture—rather a dangerous time, we should have said, for
consultation. “I am afraid, sir,” said the pupil, “that I have a
polypus in my nose, and I want you to look at it.” No answer; but when
he had sorted his preparations, he said: “Eh! what?” The pupil repeated
his request. “Then stand upon your head; don’t you see that all the
light here comes from a skylight? How am I to look up your nose? Where
do you live?” “Bartholomew Close.” “What time do you get up?” “At
eight.” “That can’t be then.” “Why, sir?” “You cannot be at Bedford Row
at nine.” “Yes, sir, I will.” “To-morrow morning, then.” The pupil was
punctual. Mr. Abernethy made a most careful examination of his nose,
entered into the causes and nature of polypi, assured him that there
was nothing of the sort, and exacted from him a promise that he would
never look into his nose again. The gentleman, in his letter to me,
adds: “This I have never done, and I am happy to say that there has
never been any thing the matter.”

The following we have from a source of unquestionable authority:

Abernethy was attending a poor man, whose case required assistance at
a given time of the day. One morning, when he was to see this patient,
the Duke of York called to say that the Prince of Wales wished him to
visit him immediately. “That I cannot do,” said Mr. Abernethy, “as I
have an appointment at twelve o’clock”—the time he promised to visit
the poor man. “But,” said the Duke, “you will not refuse the Prince; if
so, I must proceed to ——.” “Ah!” said Abernethy, “he will suit the
Prince better than I should.” He was, however, again sent for, a few
hours later, when he of course visited the Prince.

Very many instances of his liberality were constantly occurring. The
following is a specimen:

The widow of an officer of limited income brought her child some
distance from the country to consult Abernethy. After a few weeks’
attendance, the lady having asked Abernethy when she might return home,
was told that she must remain some weeks longer, or he could not answer
for the well-doing of the case. In the meantime, having learned how
the widow was situated, he continued to take the fees, folding them up
in a paper. When he finally took his leave, he returned home, enclosed
the fees which he had received, with the addition of a cheque for £50,
with a kind note, saying, that as he understood her income was limited,
he had returned the fees, with an addition, which would enable her to
give the child, who could not walk, a daily ride in the fresh air,
which was important to her recovery.

He was, indeed, as it appeared to us, most liberal in the mode of
conducting his practice. When asked by a patient when he desired to see
them again, it was at the longest period compatible with a reasonable
observation of the case; and we doubt whether he ever took a fee where
he had even a _doubt_ as to the circumstances of the patient justifying
his so doing. It would be easy to multiply examples of this; but it
would be a constructive injustice to others to appear to bring things
out in high relief, or as _special_ excellences, which (notwithstanding
some exceptions) from our hearts we believe to be a prevailing
characteristic of the profession.

Abernethy had been, nearly all his life, without being improvident,
habitually careless of money; and, although he provided his family
with a comfortable competency, which very properly left their position
unaltered by his death, yet we doubt if ever any man, with the
opportunity of making so much, availed himself of that opportunity so
little.

Many instances occurred of his carelessness in these matters.

He used to put his not very slowly accumulating fees anywhere;
sometimes by the side of his portfolio; sometimes on a shelf in his
bookcase, between something else which might be there. When he retired
from Bedford Row, they found a considerable heap of fees which he had
placed in the bookcase and forgotten—an anecdote which shows that he
must have been making some way in practice as early as his marriage,
exemplifies this sort of carelessness, and suggests its impropriety. He
was in the habit, even then, of leaving his fees on his table in his
private room. He thought, on more than one occasion, that some had been
removed: he, however, said nothing; but, having taken means to assure
himself of the fact, he marked some fees and allowed matters to go on
as usual. Again missing fees, he waited till the whole party, which
consisted of pupils residing in the house, were settled at breakfast.
“Gentlemen,” he said, “I must beg you to give me your purses.” This was
of course immediately done. In one of the purses he found the marked
fees. This individual has been dead many years. He turned out, as may
be supposed, _badly_.

It had become the fashion in Abernethy’s latter days to speak lightly
of him as an operator; and we have very little desire to rest any
portion of his reputation on this branch of our duty. Nevertheless,
when we first knew Abernethy, if we had had to be the subject of an
operation, we knew no man to whom we should have submitted with the
same confidence. He was considerate and humane; he did as he would
be done by; and we have seen him perform those operations which are
usually regarded as the most difficult, as well as we have seen them
ever performed by any body; and without any of that display or effect
too often observed, which is equally misplaced and disgusting.

His benevolent disposition led him to feel a great deal in regard
to operations. Like Cheselden and Hunter, he regarded them, as in a
scientific sense they truly are, the reproach of the profession; since,
with the exception of such as become necessary from accidents, they
are almost all of them consequent on the imperfection of Medicine or
Surgery as a science.

Highly impulsive, Abernethy could not at all times prevent the
expression of his feelings, when perhaps his humanity was most
earnestly engaged in his suppression of them. It was usually an
additional trial to him when a patient bore pain with fortitude.

One day, he was performing rather a severe operation on a woman.
He had, before commencing, said a few words of encouragement, as
was usual with him, and the patient was bearing the operation with
great fortitude. After suffering some seconds, she very earnestly,
but firmly, said, “I hope, sir, it will not be long.” “No, indeed,”
earnestly replied Abernethy; “that would indeed be horrible.”

In fact, he held operations as occupying altogether so low a place
in our duties, and as having so little to do with the science of our
profession, that there was very little in most of them to set against
that repulsion which both his science and his humanity suggested.

As he advanced in life, his dislike to operations increased. He was apt
to be fidgetty and impatient. If things went smoothly, it was all very
well; but if any untoward occurrence took place, he suffered a great
deal, and it became unpleasant to assist him; but he was never unkind
to the patient. It is, however, not always easy to estimate correctly
the amount of operative dexterity. Hardly any man will perform a dozen
operations in the same manner. We have seen a very bungling operator
occasionally perform an operation extremely well; whilst the very worst
operation we ever saw was performed by a man whose fame rested almost
entirely on his dexterity; and what made it the more startling, was
that it was nothing more than taking up the femoral artery. But whether
it were that he was not well, or had been careless _in the site_ of his
first incision, or in _opening the sheath_ of the vessels before he
passed his ligature, or all of these causes in conjunction, we could
not tell, because we were not quite near enough; but we never witnessed
a more clumsy affair.

The conditions calculated to ensure good operating, are few and simple;
there are _moral_ as well as medical conditions; and no familiarity
ever enables a surgeon, on any occasion, _safely_ to dispense with any
of them. When they _are all_ observed, operating usually becomes steady
and uniform; when _any_ of them are dispensed with or wanting, there is
always risk of error and confusion.

We are afraid that we should be hardly excused in a work of this
kind, were we to lay down the canons to which we allude. We cannot,
therefore, enter any further into the subject.

Previously to offering a few remarks on the causes of Abernethy’s
occasional irritability, we must not omit to mention a hoax that was
played on him. He had been in particularly good, boy-like spirits, and
had proposed going to the theatre; where he had enjoyed himself very
much. On reaching home, there was a message desiring his attendance at
Harrow. This was a very unwelcome finale. The hoax had been clumsily
managed, but it did not strike anybody at the moment; so it was decided
that Mr. Abernethy must go; and he took Mr. Skey with him. When they
got to Harrow, they drove to the house of the surgeon, and, knocking
him up, the surgeon came to the window in his night-cap, when the
following dialogue began. The name of the patient we shall suppose to
be Wilson.

“Does Mr. Wilson live here?”

“Who are you?”

“I say, then, is Mr. Wilson living here?”

“I say what do you want? Who the d——l are you?”

“I say that I want to find a Mr. Wilson; and my name is Abernethy.”

“Immediately,” says Mr. Skey, “off flew the night-cap.”

“I beg your pardon, Mr. Abernethy; what can I do for you,” &c.

“Is there a Mr. Wilson living here; and has he broken his leg?”

“Oh, yes, sir, he is living here; but he is very well, and has not met
with anything of the kind.”

Abernethy laughed heartily, and ordered the post-boy to drive him home
again.

There would be no difficulty in multiplying anecdotes given to
Abernethy; but there are some objections to such a course. In the first
place, there are many told of him which never happened; others, which
may probably have happened, you find it impossible to authenticate;
and, lastly, there is a third class, which, if they happened to
Abernethy, certainly happened to others before Abernethy was born. In
fact, when a man once gets a reputation of doing or saying odd things,
every story in which the chief person is unknown or unremembered is
given to the man whose reputation in this way is most remarkable.
We need not say how impossible it is, in a Memoir of this kind, to
introduce, with propriety, matters thus apocryphal.

We have no doubt that, with a most benevolent disposition, Abernethy’s
manner, particularly as he advanced in years, evinced great
irritability; and we believe that it was the result of two or three
different causes, which, in their combined influence, got a mastery
which the utmost resolution was not at all times able to control. It
had formed the subject of numerous conversations between Abernethy and
some of his most intimate friends, and we believe had arisen, and been
unconsciously fostered by the following causes: “In early life, he had
been,” as he told Dr. Thomas Rees, “particularly disgusted with the
manner in which he had seen patients caressed and ‘humbugged’ by smooth
and flattering modes of proceeding, and that he had early resolved to
‘avoid that at all events.'” He further observed: “I tried to learn my
profession, and thinking I could teach it, I educated myself to do so;
but as for private practice, of course I am _obliged_ to do that too.”
We can easily understand how, in a sensitive mind, an anxiety to avoid
an imputation of one kind might have led to an opposite extreme; and
thus an occasional negligence of ordinary courtesy have taken the place
of a disgusting assentation.

A temper naturally impulsive, would find in the perplexities which
sometimes beset the practice of our profession, too many occasions
on which the suggestions of ruffled temper, and of fear of improper
assentation, would unfortunately coincide; and thus tend to intermix
and confound the observance of a praiseworthy caution, with a yielding
to an insidious habit. If to this were now added that increase of
irritability which a disturbed and fidgetty state of physique never
fails to furnish, and from which Abernethy _greatly suffered_, the
habit would soon become dominant; and thus an originally good motive,
left unguarded, be supplanted by an uncontrolled impulse. We believe
this to have been the short explanation of Abernethy’s manner; all we
know of him seems to admit of this explanation. It was a habit, and
required nothing but a check from his humanity or his good sense to
correct it; but then this was just that which patients were not likely
to know, and could have been still less expected to elicit.

Again, most men so celebrated are sure to be more or less spoiled.
They become themselves insensibly influenced by that assentation
which, when detected, they sincerely despised. The moral seems to be,
that the impulses of the most benevolent heart may be obscured or
frustrated by an irritable temper; that habits the most faulty may rise
from motives which, in their origin, were pure or praiseworthy; that
it is the character of Vice to tempt us by small beginnings; that,
knowing her own deformity, she seldom fails to recommend herself as the
representative, and too often to assume the garb, of Virtue; that the
most just and benevolent are not safe, unless habitual self-government
preside over the dictates of the intellect and the heart, and that the
_impulse_ to which _assent_ is yielded to-day, may exert the influence
of a command to-morrow; that, in fact, we must be masters or slaves.

“Rege animum qui nisi paret
Imperat.”

The views which we have thus ventured on submitting, are verbatim
those which appeared in the former editions of these Memoirs, and,
consequently, were written long before we were favoured with the
following letter. It was written to his daughter Anne, before her
marriage with the late Dr. Warburton, dated Littlehampton, August 13,
and is remarkably corroborative of some of the preceding remarks.

“My dear Anne,

“Lack of employment is, as I believe, the cause of your receiving
this note in reply to the one I received from you by your mother.
Certain I am that I never thought of writing an answer till just
now, when it occurred to me that it would be polite to do so, which
very phrase had nearly prevented the intention. Why have all the
legitimate children of John Bull an aversion to politeness? ‘Tis
because it so commonly covereth a multitude of sins; because, with
honest simplicity, they have often caught hold of the garb and
found that it concealed deformity and malice. I frankly acknowledge
that I may have carried my detestation too far, because it does not
necessarily follow that our best friends should not wear becoming
and fashionable apparel. I like to see them _en deshabille_,
however. ‘Tis the man, and not the dress, I am concerned about.
I tell you, sincerely, that I take your note to be one of many
evidences of your having both a good head and heart. Other young
ladies would have spoken to mamma. Enough of this unprofitable chat.

“Yours ever,
“JOHN ABERNETHY.

“Little Hampton, 13th August.”

When the editors of the medical periodicals first began to publish
the lectures given at the different hospitals, there was considerable
discussion as to the propriety of so doing. The press, of course,
defended its own views in a spirit which, though not always unwelcome
to readers, is frequently “wormwood” to the parties to whom the press
may be opposed.

We are not lawyers, and therefore have no claim to an opinion, we
suppose, on the “right;” but, as regards the general effect of this
custom _as now practised_, we are afraid (however advantageous it may
be to the trade to obtain gratuitously these bulky contributions to
their columns) that doubts may not be unreasonably entertained whether
it is of advantage to science, to the character of our periodical
literature, or the profession.

The publicity which it gives to a man’s name, induces men to contribute
matter which it would often have been, perhaps, more advantageous to
them to have suppressed; and the proprietors, so long as a periodical
“pays,” are not likely to quarrel with that which they get for nothing
but the expense of publication.

Mr. Abernethy was very much opposed to the publication of his lectures;
but, though not insensible by any means to the occasionally caustic
remarks of the press, he does not seem to have been much annoyed by them.

The following is an extract from a letter, in which he expresses
himself as opposed to the conduct of those who publish lectures
without the permission of the authors. We suppress that part, because
it involves his opinion of the conduct of individuals. As regards his
personal feelings, he says:

“Though I have been so long in replying to your letter, I have felt
very grateful for the kindness which induced you to take up the
cudgels in my behalf. At the same time, I must say that, had I been
at your elbow, I should have hinted to you that the object was not
worth the trouble you have been so good as to bestow upon it. No
one can expect to escape slander and misrepresentation; and these
are so commonly bestowed upon all, that they have little or no
influence on the minds of persons of character and judgment.

“With many thanks and best wishes,

“I remain, my dear sir,
“Yours very sincerely,
“JOHN ABERNETHY.”

SECTION.

When Mr. Abernethy was appointed _surgeon_ to St. Bartholomew’s
Hospital, in 1815, he had already been twenty-eight years assistant
surgeon, and was therefore fifty years of age before he had an
opportunity of taking an active share in the practical administration
of the Hospital. This is one of the many effects of a System of
which we shall presently give a sketch. He was thus invested with
the additional duties of Surgeon of the Hospital, and Professor to
the College of Surgeons, at a time of life when most people, who
have commenced young and laboured hard with their intellects, as
distinguished from their hands, begin to feel their work. This was
the case with Abernethy. We do not think that his original physical
organization was to be complained of; he had been active and energetic,
he was of moderate stature and well-proportioned; a magnificently
poised brain, judging phrenologically; and, in short (under favourable
circumstances), he appeared to have had the elements of long life; but
we think that his organization—and especially the presiding power, the
nervous system—was ill-adapted either for the air, the anxieties, or
the habits of a crowded city; or the somewhat pestilential atmosphere
of a dissecting-room.

We saw him, therefore, ageing at fifty very sensibly, and rather more
than is in general observable at that period. He complained, in 1817,
of the fatigue of the College lectures, coming, as they did, on the
completion of a season of the “mill-round” of hospital tuition and
practice. So that, when we mentioned the period of his lectures at the
College as on so many accounts the zenith of his career, there was
the serious drawback arising from a certain diminution of strength
which had never been, at best, equal to the _physical_ fatigue of his
multiform avocations. All this arose partly out of a System, which,
although, like all evils, not allowed to proceed without being charged
with elements of remotely prospective correction, has been the parent
of much mischief. This is what we have called the “Hospital System,”
some of the more important features of which we will now present to our
readers.

[Footnote 74: This gentleman, who retired some years since from
practice, died at Norwood, about a month ago, at the age of 73. Dr.
Barnett was born at Malmesbury, and was an early pupil of Abernethy’s,
and a friend of Dr. Jenner’s; he practised many years as a general
practitioner in Charter-House Square, where he realized, we believe,
a comfortable competency. He was distinguished by a singularly mild,
gentlemanly, and inoffensive bearing, not less than by the confidence
reposed in his skill and judgment by a large list of patients and
friends.]

“——Non hæc sine numine Divum
Eveniunt.”

ÆNEID, lib. ii, 1. 777.

If we would view any human institution dispassionately, we must
distinguish the vices of System from the faults of those who administer
it.

Trite as this remark may be, the caution it involves is just that which
is too frequently overlooked or unobserved. By a careful attention to
the distinction it implies, we may develop the elements of rational
reform, as contrasted with Utopian schemes; which, whatever of abstract
truth they may contain, are frequently useless, simply because they are
impracticable. We cannot effect any material change in human nature
by any summary legislation, nor prevent the obtrusive necessities of
daily life from bringing down the soaring aspirations of mind, to the
humble level of the practicabilities of matter. Whoever, therefore,
expects that any body of men, invested with irresponsible power, will
hesitate to exercise it so as to procure, as they believe, the maximum
of advantage to themselves,—might just as hopefully quarrel with the
negro on account of his complexion. Do what you may, Man is Man “for
a’ that;” but whilst it is necessary to remember this, it is by no
means so, to do it in a spirit of unkindness or hostility, nor in any
sense opposed to brotherly love; but, on the contrary, in a tone of
mind which, alike mild and uncompromising, desires to promote universal
harmony and good feeling, by removing the temptations which experience
has shown to be influential in disturbing such relations.

Neither should we quarrel with a man who endeavours to do the best
he can for his family and friends. Should he, even in this pursuit,
compromise his duty to the public, it is very _possible_ that the
objects which he had in view may have been in themselves praiseworthy,
and therefore, instead of exasperating our blame, may readily
_extenuate_ faults which it may be impossible to excuse.

The truth is, that the interests of the public and of individuals are
seldom, if ever, incompatible; the occasions on which they appear to be
so are not unfrequent; those in which they really clash are extremely
rare.

Wherever circumstances occur in which the temptation of a present
fruition is found habitually to lead men to courses which, however
apparently promotive of their own interests, are really detrimental to
those of the public,—it becomes very necessary that the public should
impose safeguards against such an injurious exercise of power.

The hospitals of London, as we formerly observed, are, in the main,
very fine institutions. They are many of them very wealthy, which
generally means powerful also.

The Governors, as they are termed, consist of certain noblemen and
gentlemen; the latter being, for the most part, drawn from the more
wealthy sections of the mercantile and trading classes.

The knowledge possessed by these gentlemen of the requisitions of
a large public hospital, must (special instances excepted) be very
measured; and be, in the main, derived from the medical officers with
whom they are associated.

It thus happens that the administration of the hospital is in great
part confided—as, with _some restrictions_, it ought to be—to the
medical officers. The interests of these gentlemen, it may be assumed,
would be best promoted by carrying out in the most efficient manner
the benevolent objects of the institution: and we believe, looked
at fairly and comprehensively, this would be really the case. The
duties of a large hospital, however—if they are to be performed
conscientiously—require much time, not a little labour, and some
health to boot. Now all these, in a crowded community, are very costly
articles; and which must, in justice—and, what is material, in fact
too—be fairly remunerated. The public never _really_ pay so dearly, as
when they _appear_ to get labour for nothing.

Here we come to the first defect in the “Hospital System.”

It might be supposed that, with ample means, the Governors of
Hospitals, by adopting such previous tests as were in their power,
would have secured the most efficient officers, by paying them
remunerative salaries; and, having retained them as long as their
services were deemed efficient, or the duration of them justified, that
they would have released them from the necessity of further exertion
by a retiring pension. No such thing. The Hospital gives nothing:
actually, there is a small nominal retaining fee, as it were, of about
£60 to £100 a year, and the medical officer is left to obtain his
remuneration for time, trouble, and health, by such private practice as
his reputation or the _prestige_ of being attached to an hospital may
afford; from fees from pupils, or such other means as the position he
occupies may place within his power.

He very naturally sets to work to do the best he can; and from this
first budding, we very soon arrive at the full blossom of the System;
one effect of which is, that, in hospitals, which have so large a care
of public health—institutions which, whether correctly or incorrectly,
give so much of the tone to the medical opinions of the day, which
exert, either directly or indirectly, an influence on the claims of
hundreds to public confidence—that in these hospitals there is _not
one single surgeoncy that is fairly and bonâ fide open to scientific
competition_.

Let us now examine a little into the machinery by which these results
are brought out.

The experience afforded by the hospitals necessarily supplies abundant
means for instructing students in surgery. They are accordingly
admitted on paying certain fees to the surgeon; and this at once
supplies a large revenue. This revenue is of course regulated by the
number of pupils; and as there are in London many hospitals, so it
follows that there is an active competition. Thus, some time before
the season commences, the advertisements of the medical schools occupy
a considerable space in the public journals, and circulars are also
liberally distributed.

Well, the points here, as in all other cases, are the advantages
offered, and the price paid—the maximum and minimum respectively. Here
we arrive at the elements of numerous evils.

Students are not always—and before they try, hardly ever—judges of
a school. The general reputation of a man (as he is never subjected
to open competition) is no test whatever of his comparative power
in _teaching_ students; but they are accustomed to ascribe great
importance to operations; and, _cæteris paribus_, they incline to
prefer that hospital where the greatest number are supposed to be
performed.

This arises from various causes; in some of which the public play no
unimportant part. The student has perhaps seen, in the country, a
good deal of medical and surgical practice; but very few operations.
His stay in London is comparatively short, averaging, perhaps, not
more than the better part of two years. Unnecessary length of time is
generally inconvenient, always expensive, and the student is naturally
anxious to see _most_ of that which he will have _least_ opportunity
of observing elsewhere. Moreover, he knows that when he returns to the
country he may save twenty limbs, before he obtains the same amount
of _reputation_ that he may possibly get by _one amputation_—the
ignorance of the public, here, not appreciating results which very
probably involved the exercise of the highest talent, whilst they are
ready to confer a very profitable distinction on that which does not
necessarily involve any talent at all.

We have no wish whatever, and certainly there is no necessity, for
straining any point in reference to this very serious matter; but these
two facts are indisputable—that the surgeons obtain their remuneration
from the hospitals by the fees they obtain from the pupils; and,
_cæteris paribus_, the pupils will flock the thickest where they expect
to see most operations.

The next thing that we would submit, is that the _prestige_ in favour
of operations is both directly and indirectly opposed to the progress
of scientific surgery. Almost all operations, commonly so termed, are
examples of defective science. To practical common sense, therefore,
it would appear a very infelicitous mode of obtaining the maximum of
a man’s genius in aid of the _diminution_ of operations, to open to
him a prospect of enriching himself by the _multiplication_ of them.
We desire to consider the subject with reference to its scientific
bearings only, and would avoid entirely, were that possible, any appeal
merely to the feelings. Such impulses, however right, are apt to be
paroxysmal and uncertain, unless supported by the intellect. But, on
such a subject, the feelings must necessarily become more or less
interested. Wherever a system takes a wrong direction, a great many
minor evils insensibly grow out of it.

The erection of a theatre for the purpose of operating, though founded
on a feasible pretext, is a very questionable measure; and, unless of
clear advantage to the profession or the public, is surely not without
some character of repulsion. As regards art and science, it is certain
that not more than twenty or thirty can be near enough in the theatre
to see anything that can be really instructive in the performance
of operations. In the absence of actual advantage, therefore, an
exhibition of this kind is more calculated to give publicity to
the surgeon operating, than it is to raise the tone or chasten the
feelings of men about to enter a profession which almost daily
establishes requisitions for our highest faculties. Operations without
opportunities of real instruction, are merely unprofitable expenditure
of valuable time. That which is viewed as a sort of _exhibition_
to-day, may be with difficulty regarded in the light of a _serious
duty_ to-morrow. Were the object to tax the sensibility of a student,
and blind him to any higher association with pain and suffering than
that afforded by custom and chloroform, and to substitute for a
dignified self-possession and sympathy with suffering, which each kept
the other in due control, an indifference to everything save adroitness
of manipulation and mechanical display,—no machinery could be better
calculated to effect such objects; but science and humanity require
very different qualifications, and experience has shown that they are
neither incompatible nor beyond our power.

The humanity and science that beholds, in operative surgery, the lowest
of our employments, and which would thence be impelled to seek, and as
experience has taught us to seek successfully, to diminish the number
of such exhibitions, and to lessen the suffering of those which are
still retained, is perfectly compatible with coolness and skill in the
performance of them.

When we speak of lessening pain, we must not be understood as alluding
to chloroform, or agencies of that kind. We have, on the contrary, the
greatest distrust of their utility; we do not hesitate to admit the
propriety of their use in certain cases; but we are satisfied that,
as at present employed, a very few years will make a great change.
Many a so-called incurable case has been shown to be curable by the
hesitation of the patient to submit to an operation. We have published
some ourselves, wherein we joined in recommending the measure which the
patient declined. Many deaths that we _do know_ have already occurred
from the use of chloroform; and a _significant_ remark was made by a
man who had considerable reputation in this way. He said: “Chloroform
is a good thing for operating surgeons.”

To return from this digression. The most distinguished surgeons ever
known in this country have shown us how to combine, in the highest
degree, dexterity and skill, with science and humanity; together with
a just estimate of the low position occupied by operations in the
scale of our important studies. I may allude to two more particularly,
Cheselden and John Hunter; the former, the most expert and successful
operator of his day, in the European sense of the word, has left us a
satisfactory declaration on this subject. Cheselden acknowledges that
he seldom slept much the night previous to the day on which he had any
important operation; but that, once engaged in operating, he was always
firm, and his hand never trembled. John Hunter was not only a good
operator himself, but he deduced from observation one of the greatest
improvements in operative surgery. His discovery had all the elements
of improvement that are possible in this branch of the profession.

An operation which had been founded upon erroneous views of the nature
and relations of the parts affected—which had been always tedious and
painful in performance—which, whether successful or not, entailed much
subsequent suffering, which in its results was highly dangerous, and
which was very commonly followed by the loss of the limb or life,—was
replaced by one founded on more correct views of the disease, easy and
simple in its execution, occupying not more than a very few minutes,
and which, so far as regards the purpose for which it was instituted,
and to which it should be restricted, is almost invariably successful.
If it be performed under circumstances implying conditions _contrary
to those on which Mr. Hunter’s operation was founded_, very different
results have no doubt taken place; but, when properly applied, his
operation for aneurism is no doubt one of the greatest improvements in
operative surgery.

John Hunter treats of operations in terms which show how low he rated
that part of our duties. He speaks of them as humiliating examples of
the imperfection of our science, and figures to himself an operator
under the repulsive symbol of an armed savage. “No surgeon,” said he,
“should approach the victim of his operation without a sacred dread and
reluctance, and should be _superior to that popular éclat generally
attending painful operations, often only because they are so_, or
because they are expensive to the patient”—p. 210. Abernethy, whose
keen observation saw the difficult web which various sophistries,
to use no harsher term, had thrown around the subject, was very
characteristic in the manner in which he dashed it aside, and pointed
to the salient source of error.

“Never perform an operation,” he would say, “on another person, which,
under similar circumstances, you would not have performed on yourself.”

The truth is, that operations, to be performed properly, must be
properly studied. They must be frequently performed on the dead, and
afterwards carefully examined. There is a wide difference between
neglecting a necessary study and making that the test of science which
is the most emphatic proof of its imperfection. We have ourselves had
no lack of experience in this branch of the profession, and have
included not a few operations which are too commonly delivered over to
men who are said to devote themselves to special objects. The result of
our experience satisfies us in entertaining the views which the most
distinguished men have held on this subject; whilst we are persuaded
that few things have contributed more to impede the progress of science
than the _abuse_ of operations.

To return to the surgical appointments of the hospital.

The positions which had at first been left without any remuneration,
become, by the machinery described, very lucrative; directly, by the
fees paid by the pupils; and indirectly, in some cases, by keeping the
surgeon constantly before the public. Any _prestige_, therefore, in
obtaining these appointments, is of great value; but, if that do not
really involve _professional excellence_, it is as plain as possible
that the public may be very badly served, and an evil generated equally
opposed to the interests of science and humanity. It is obvious that
the only legitimate grounds of eligibility are moral and professional
superiority, as determined by the test adopted at public schools and
universities—namely, public competition. Now, what are the tests
employed? Without meaning to insinuate that moral or professional
eligibility is _wholly_ disregarded—no system in these days will
support that—still the eligibility depends on a qualification which
few would beforehand have imagined. It is certainly something better
than Mr. Macaulay’s joke in relation to the proposed franchise to
the Militia—namely, that the elector should be five feet two—but
something not much more elevated; namely, that a bounty should have
been paid to one of the hospital surgeons in the shape of an apprentice
fee; thus making the holding one of the most responsible offices in the
profession—a condition, which absolutely ignores relative eligibility
of skill, steadiness, assiduity, and humanity; and which recognizes
them only in such shape that the possession of office is practically
made to depend on a point absolutely extrinsic to any one important
requisition recognized by the public or the profession.

We need not insist on the tendency of this system to the protection of
idleness and incapacity, or the injustice inseparable from it to the
young gentlemen whose interests it is supposed to guard. One necessary
consequence is obvious—namely, that the hospitals, instead of having
to select from the general body of pupils, or from the more industrious
or talented of them, is obliged to choose from a very small minority.

It is, in fact, just as if scholarships and fellowships at public
schools and universities were conferred without any reference to the
proofs which the candidates might have given of their talents or
industry; but were distributed to those who had given a certain fee to
a particular professor. Would any man in his senses doubt as to the
influence of such a plan on the interests of classical literature or
mathematical science? It seems to us impossible that men should really
differ on that point, or hesitate to admit that, _mutatis mutandis_,
whatever the science might be, so far as the cultivation of it could
be influenced by system, the result must be alike prejudicial in all
cases. We are, however, far from arriving at the end of the System by
this general statement.

The public and the government, uninformed or unmindful of this
“system,” wish to consult authorities on professional matters. They
not unnaturally look to those who hold public appointments, because
these afford the _prestige_ of extensive opportunity, which is supposed
to imply, and under a fair system would ensure, skill and experience.
Men are apt to look at a man’s position, without stopping to inquire
_how_ it was obtained; and although position may cut both ways, and in
particular instances “throw a cruel sunshine” over incapacity, still
amongst gentlemen extreme cases are not to be expected; the rule is
much more likely to be a respectable and protected mediocrity, which is
just that tone which has rarely done anything to enlarge the boundaries
of any kind of knowledge.

It happens, however, from the “system,” and the position thus given to
those who are supposed to profit by it, that the interests of the poor,
and, in a considerable degree, those of the rich also, are, in a very
large sense, confided to their care.

It thus follows that positions, in themselves highly desirable, and
which enable men to exert considerable influence on the progress of a
science, on the sound condition of which the physical comforts, and in
no small degree the moral condition, of mankind depend, are occupied
by men who have undergone none of those tests which public competition
alone affords, and which the _summi honores_ of almost every other
profession either directly or indirectly imply.

So far for one mode in which the interests of the public are
compromised; but there are many other channels. The government,
ignoring the evils of this system, have placed the regulation of the
surgical branch of the profession in the hands of a body of men whom,
when we examine, we find to be no other than the apprentices we had
recognized at the hospital, grown into the full bloom of a legislative
body—whence again are chosen Presidents, Vice-Presidents, Examiners,
&c., of the Royal College of Surgeons of London!

If, fatigued with this machinery, we walk to the Royal Medical and
Chirurgical Society—a chartered body for the especial cultivation of
science—we meet, as its name would imply, a number of our honoured
brothers, the physicians; but here we find that, whether we observe
Presidents or any other Officers, the influence exerted by the
apprentice system continues; and that, in _almost_ everything surgical,
the _best possible_ individual is an apprentice who has attained his
first position without any public competition. Can any one be surprised
that the published transactions of this society are not of a higher
character. We hope and believe that the point of the wedge is already
inserted, which will, at no distant period, rend asunder this system,
which we shall not trust ourselves by attempting to characterize
farther. But there are points in connection with the interests of
science and of Abernethy which require yet to be noticed.

We need scarcely observe that it would be very desirable that the
interests of science should be entrusted to those who had shown most
assiduity or talent in the cultivation of them; that if operative
surgery be really, as a whole, a series of facts exemplifying the
defects of a science—that whilst every pains should be taken that what
is necessary should be done thoroughly well—all factitious inducement
to multiply their number should be avoided, and especially any which
tended to increase emolument commensurately with their multiplication.

That as operations (with some few exceptions) merely minister to
effects, their real bearings on disease can only be estimated by
knowing the _ultimate result_; and that, in order to this effect,
returns of all operations should be kept, with full accounts of the
cases; the addresses of the patients should also be taken, and such
means as were obvious and practicable employed to obtain the _ultimate
result_ of the case.

Another point which should be attended to in hospitals, is an accurate
notation and return of all cases whatever; so that we might obtain from
statistical records whatever light they might be capable of affording
in aid of the prosecution of a definite science. In this return, a full
history, and _all_ the phenomena of the case, which are known to have
an influence on the Body, should be accurately noted, and in tabular
forms convenient for reference.

The defects of the hospitals in this respect are too well known to
require comment; and we think the profession indebted to Dr. Webster
for the exertions he has made to draw attention to this subject.
In no respect are the hospitals more defective than as regards the
division of labour[75]. To supply the requisitions of a yet dawning
science, there is too much confided to one surgeon; for, at present,
the practical administration and the scientific investigation should be
confided to the same hand. If more be entrusted to one man than can be
performed without great labour, and the greater labour be voluntary, we
shall have little chance of obtaining that full and accurate notation
of facts which all cases furnish more or less the means of obtaining,
and without which the evolution of the maximum of human ability is
absolutely impossible. It seems to us also an imperative duty to avail
ourselves of the experience afforded by the history of other sciences,
in the cultivation of our own.

All sciences have been in as bad a condition as medicine and surgery,
or worse. All sciences have progressed immediately that they were
investigated on a rational plan—a plan, which, simply stated, is
little more than the bringing together _all the facts_ that can be
perceived to bear any relation to the inquiry, and reasoning on them
according to _well-established_ and necessary conditions. If this be
the case, and this plan have never been applied to the investigation
of medical science, we know not how those who are placed in positions
which supply the necessary means can be excused; or how we can halt
in condemning the system under which such a flagitious neglect of
the claims of science and mankind is exemplified. It is true, when
we arrive at the acmé of our convictions of the effects of such a
system, our reflections remind us that such things are “permitted,”
and that ultimately they will work for good; that Man is not destined
to interfere with the ultimate plan and designs of Providence, however
he may be allowed to place his intellect under the direction of a
responsible volition, and to discover the path to the temple of truth,
only after having fruitlessly threaded the mazes of error.

[Footnote 75: We are glad to see that there has at length arisen a
desire, at least in a degree, to correct this evil.]

“Quanto quisque sibi plura negaverit
Ab Dis plura feret.”

We believe that there is no greater fallacy than that which supposes
that private advantage can be promoted at the expense of the public
good. We are very well disposed to believe that selfish people are the
very worst caterers for the real interests of the idol they worship.
The more we consider the Hospital system, the more reason shall we find
to distrust it; and we by no means exclude that very point wherein it
is supposed to be most successful—namely, in securing the pecuniary
advantage of those whose interests it is supposed to serve.

Of the apprentices, we shall say little more than to express our belief
that many of them have lived to obtain the conviction that they would
have done much better had they not been fed by hopes that were never
realized. All apprentices cannot, of course, be surgeons. Again, if,
in the course of a century, a solitary instance or two should occur
of the success of an unapprenticed candidate, they not unnaturally
feel it as an injustice in thus being deprived of that, the especial
eligibility to which was a plea for the exaction of a large apprentice
fee. But to the surgeons themselves, it seems to us that the system is
far from realizing the benefits that its manifold evils are supposed
to secure. The adage that “curses, like chickens, come home to roost,”
is far from inapplicable. After all, many of the hospital surgeons are
little known; and the public inference with regard to men invested with
such splendid opportunities of distinguishing themselves, is not very
flattering. Mr. Abernethy, so far from benefiting from the “System,”
appears to us to have suffered from it in every way.

His talents, both natural and acquired, would have given him every
thing to hope and nothing to fear from the severest competition;
whilst the positive effects of the system were such as to deprive him
of what was justly his due, and to embitter a retirement which in
the barest justice should have been graced by every thing that could
add to his peace, his honour, or his happiness, from the Institution
whose character he had exalted and maintained, and whose school he had
founded.

But let us look at the facts. The system which pronounces that there
shall be three surgeons to attend to some 500 or 600 patients (_for
the purposes of science_—the next thing to an impossibility), kept
Abernethy twenty-eight years an assistant surgeon. During this time he
was filling the hospital with students, to the amount of sums varying
from £2,000 to £3,000 a year, of which, in the said twenty-eight years,
he never received one farthing.

He saw, from time to time, many men, of whose capacities we know
he had the highest opinion, shut out from the hospital by the mere
circumstance of their not having been apprentices; and two of these
were the late Professor Macartney, of Dublin, and the present
distinguished Professor of Comparative Anatomy, Professor Owen. And
here we must pause to record one of our numerous obligations to the
perceptivity and justice of Abernethy. We have formerly observed
that, at the very commencement of life, he had been accustomed
to inculcate the importance of studying comparative anatomy and
physiology, in order to obtain clear views of the functions of Man;
but all arrangements made with this view, from the time of Mr. Hunter
onwards, though varying in degree, were still inefficient. It was next
to an impossibility to combine an availing pursuit of a science which
involves an inquiry into the structure and functions of the whole
animal kingdom, with the daily exigencies of an anxious profession.

When Mr. Owen had completed his education, his thoughts were directed
to a Surgeoncy in the navy, as combining a professional appointment
with the possibility of pursuing, with increased opportunities of
observation, his favorite study. Fortunately for science, he went to
Abernethy, who requested him to pause. He said, “You know the Hospital
will not have any but apprentices. Macartney left on that account.
Stay,” said he, “and allow me to think the matter over.” This resulted
in his proposing to the Council of the College of Surgeons that there
should be a _permanent_ Professor of Comparative Anatomy, and that the
appointment should be given to Mr. Owen.

This is among the many proofs of Abernethy’s perception of character.
Mr. Owen had dissected for lecture; and Abernethy saw, or thought he
saw, a peculiar aptitude for more general and enlarged anatomical
investigation. The whole world now knows how nobly the Professor
has justified the hopes of his talented master. It would be out of
place for us to attempt a compliment to a man so distinguished in a
science, wherein the varied pursuits of a practical profession allow
us to be mere amateurs; neither do we wish to forget other gentlemen
who distinguish themselves in this branch of science; but we believe
that most competent judges allow that the celebrated Cuvier has not
left any one more fitted to appreciate his excellence, or who has
more contributed to extend that science of which the Baron was so
distinguished a leader, than Professor Owen.

There is one incident, however, in the Professor’s labours which,
for our own purposes, we must relate; because we shall have to refer
to it in our humble exhortation to the public and the profession to
believe in the practicability of raising Medicine and Surgery into a
definite science. The incident shows what may be done by that mode of
investigation which is the still delayed desideratum in medicine and
surgery—namely, the _most comprehensive_ record of facts, and the
study of their _minutest relations_. Professor Cuvier was the first to
impress, in a special manner, that those beautiful relations in the
structure of animals, so many of which are even popularly familiar,
extended throughout the animal; so that if any one part, however
apparently subordinate, were changed, so accurate were the adaptations
in Nature, that all parts underwent some corresponding modification; so
that diversity of structure in parts, more or less affected the whole.

The beautiful result of all this is, that if these relations be once
thoroughly mastered, then any one part necessarily suggests, in general
terms, the nature of the animal to whom it belonged. Few instances,
however, so remarkable as the one we are about to mention, could have
been anticipated.

A seafaring man brought a piece of bone, about three or four inches in
length, as he said, from New Zealand, and offered it for sale at one or
two museums; amongst others, at the College of Surgeons. We shall not
here detain the reader by telling all that happened. These things are
often brought with intent to deceive, and with false allegations. Most
of those to whom the bone was submitted, dismissed it as worthless,
or manifested their incredulity. Amongst other guesses, some rather
eminent persons jocosely hinted that they had seen bones very like
it at the London Tavern; regarding it, in fact, as part of an old
marrow-bone, to which it bore, on a superficial view, some resemblance.
At length it was brought to Professor Owen, who, having looked at it
carefully, thought it right to investigate it more narrowly; and after
much consideration, he ventured to pronounce his opinion. This opinion,
from almost anybody else, would have been perhaps only laughed at;
for, in the first place, he said that the bone (big enough, as we have
seen, to suggest that it had belonged to an ox) had belonged to a bird.
But before people had had time to recover from their surprise or other
sensation created by this announcement, they were greeted by another
assertion, yet more startling—namely, that it had been a bird without
wings.

Now, we happen to know a good deal of this story; and that the
incredulity and doubt with which the opinion was received were too
great, for a time, even for the authority of Professor Owen to dispel.
But mark the truthfulness of a real science; contemplate the exquisite
beauty and accuracy of relation in nature! By and by, a whole skeleton
was brought over to this country, when the opinion of the Professor
was converted into an established fact. Nor was this all; there was
this appropriate symbol to perpetuate the triumph: that which had
appeared as the most startling feature of what had been scarcely better
received than as a wild conjecture, was so accurate in fact, as to
form the most appropriate name to the animal thus discovered[76].

It would be unjust to others to attribute Professor Owen’s appointment
exclusively to Abernethy: that, the state of things did not place
within his single power; but his penetration was the first to suggest,
and his weight most potential in securing, an appointment which various
circumstances, besides the merits of the individual, bring up in high
relief, as the best ever made by the London College of Surgeons.

To return to the Hospital System, as affecting Abernethy. He continued
to lecture, and the emoluments arising thence he of course enjoyed.
Until 1815, the whole of the hospital fees had been taken by the
surgeons in chief. These fees, in twenty-eight years (allowing
a reasonable deduction for those pupils who went to the school
independently of the inducement offered by the most attractive lecturer
ever known), must have amounted to an enormous sum. Having founded the
school, he became surgeon at about fifty years of age; and then retired
at sixty-two. On retiring, unpleasant discussions arose, which, with
others long antecedent, rendered his concluding associations with the
hospital scarcely more agreeable than they had been at the College of
Surgeons.

The whole of Abernethy’s closing career gave him no reason to
rejoice at the Hospital System. The circumstances, though they
convey a lesson in the History of the Lives of Men of Genius, were,
abstractedly, extremely unimportant. They show that Abernethy, in
his retiring hours, whilst his reputation had become European, and
Transatlantic[77]—whilst hundreds were benefiting their fellow
creatures, more or less, according to their talents and opportunities,
in every part of the world—seems to have been surrounded by men
who, so far as we can see, were little disposed to grace his
retirement either with much sympathy, or even with reasonably generous
appreciation of all that he had done, either for Science in general, or
the Hospital in particular.

Instead of considering how they could best do honour to the waning
powers of one who had not only raised the reputation of St.
Bartholomew’s Hospital to a point it had never before attained, who
had founded a school there, constituting the largest single Hospital
Class in London, and who was leaving the inheritance of a rich annual
harvest to his successors,—the time was occupied in discussing whether
he could resign the surgeoncy without resigning the lectureship;
whether, on paying a hundred guineas, which there seemed no difficulty
in receiving, he could become a Governor whilst still an officer; and
then, whether his being a Lecturer without retaining the surgeoncy
did not so constitute him. These, and similar questions scarcely more
important, were the source of considerable annoyance.

In former editions, we were obliged to discuss some of these matters
more at large than is now necessary; because, amongst the individuals
associated in the transactions of the period, there was one to whom
Mr. Abernethy had been of especial service; but in regard to whom he
had been much misrepresented. Further, this had taken place in our own
hearing, in whose recollection all the facts were perfectly fresh,
but who were, at that time, without the documents which are now in
our possession. We accordingly sought to obtain whatever documents
there were from the source most likely to test the correctness of our
recollection; when a note was written which, as we now learn, quite
unintentionally conveyed the idea, or at least was susceptible of the
construction, that a disinclination to make any communication on the
subject proceeded from a desire to withhold something unfavourable to
Mr. Abernethy. This determined us on discussing the matter, so far as
was necessary to rebut such interpretation. And it was fortunate we
did so; for it very soon appeared, not only that such an impression
had been produced, but that “gossip,” with its usual aptitude for
invention, had soon supplied the myth thus supposed to have been
charitably withheld.

It was not very long after the publication of these Memoirs, that
we learned, in a conversation with a highly distinguished member of
the profession, that he had been led to entertain the impression to
which we have alluded. Here we had, of course, an opportunity of
correcting the error; but it obviously became a subject of very serious
consideration, what must be done in dealing with this matter, and
other matters arising out of it, in a subsequent edition. To treat
the affair seriously, would have involved a reference to documents in
our possession which, though highly honorable to Mr. Abernethy, would
have been of no general interest, whilst they would have involved
details disagreeable to several persons. We therefore, after much
consideration, resolved on endeavouring to see whether it was not
possible to quash a tedious and painful discussion, and at the same
time to obtain, of course, all that was necessary to the memory of Mr.
Abernethy.

The following letter, and the reply, will, we think, sufficiently
develop the very difficult and disagreeable position in which we were
placed; our sole object being, so far as it was possible, to avoid
repeating or enlarging a discussion which we had learned would have
given pain to certain parties. The concluding paragraph has been
omitted, as being unnecessary to the point more immediately under
discussion.

“3, The Court Yard, Albany,
“July 17th, 1856.

“Sir,

“For reasons which may be gathered from this note, I think it
proper to inform you that I am preparing another edition of the
Memoirs of Abernethy. Impressions have been conveyed to certain
persons, that the reasons on which you grounded your disinclination
to make any communication in relation to your differences with
Abernethy, were the desire you professed to withhold something
which involved imputations unfavourable to him. Further, a sort
of Body has been given to these vague impressions by inferences
which the documentary and other evidence at my disposal enable me
to disprove. In one quarter, the circumstances are so strongly
suggestive as to the sources whence the erroneous impressions were
derived, that it is impossible to leave that portion of the Memoirs
which treats of your differences with Abernethy as it at present
stands, without the risk of injustice. It is regarded as necessary
that you should either recognize or ignore the inferences which
(whether correctly or not I will not presume in this place to
determine) have certainly been formed on your supposed authority.
The justice of such a course is sufficiently obvious. I need
scarcely say, it is immaterial to me what course is taken. If I
am obliged to enter into the discussion of the subject, I shall
take the opportunity of defending myself from the remarks that
have been made upon me, and of showing what I did say, as well as
what I might have said. These remarks are less excusable from it
being known to me that a letter of mine to a third party was by my
express permission read to you, in which was stated my willingness
to alter or modify any passage which might have offended your
feelings, provided only that such alteration involved no injustice
to Mr. Abernethy. The (as I think) ill-advised rejection of the
offer, coupled with the intimation, long after, which was given
to Mr. Longman by a friend of yours, that certain papers would be
forthcoming, provided only that certain passages relating to Mr.
Stanley were suppressed, will involve a discussion in which I
shall now be very unreserved; but which, I fear, will be scarcely
less disagreeable to you than painful to myself. If you ignore the
imputations to which I have referred, it seems to me that the whole
discussion may be quashed by your simply writing me a note, in
which you state as the reason for your not making any communication
to me your dislike to revive the recollection of differences with
one whose memory you will always regard with respect, gratitude,
and affection, or whatever other terms your feelings may justify,
or the claims of Mr. Abernethy require.

* * * * *

* * * * *

“I am, Sir,
“Your obedient servant,
“G. MACILWAIN.”

The following is Mr. Stanley’s reply:

“Brook Street, July 18th.

“Sir,

“Upon the subject of your communication to me, I can only say, that
I have no information to give; for I am not in possession of any
document relating to it; and so many years have elapsed since the
occurrences to which you refer, that I could not trust my memory
for the accuracy of any statement, if I were disposed to make it.
You will therefore perceive that there exists no foundation for the
supposition that ‘I desire to withhold something which involved
imputations unfavourable to Mr. Abernethy,’ or that any other
feelings than those of the utmost respect for the memory of Mr.
Abernethy have existed in my mind.

“I am, sir,
“Your obedient servant,
“EDWARD STANLEY.

“G. MACILWAIN, ESQ.”

We here conclude this subject.

A somewhat amusing illustration of one feature of the hospital system
occurred about this time. Sir Astley Cooper had, without the smallest
intention to give offence, made some observation on the somewhat too
free use of Mercury at that period in the Borough Hospitals. His
observations having been misunderstood or misrepresented, he took
occasion to remove any idea of intentional offence, by addressing
the class. Among other things, he is reported to have said: “Why,
gentlemen, was it likely that I should say any thing unkind towards
these gentlemen? Is not Mr. Green my godson, Mr. Tyrrell my nephew, Mr.
Travers my apprentice” (the three surgeons of St. Thomas’s Hospital),
“Mr. Key my nephew, Mr. Cooper my nephew?” (surgeons of Guy’s)[78].

This was very _naïve_, and is an illustration of the value of evidence
in proof of facts having no necessary connection with those it was
intended to establish.

It is difficult to conceive any one more disinterested than Mr.
Abernethy had been in relation to the surgeoncy of the hospital, from
the moment at which he was appointed to the hour of his resignation.
Although he had waited twenty-eight years as assistant, and not
participated in one farthing of the large sums accruing from his
reputation in hospital pupil fees—although, too, he had a large
family,—yet, so far was he from wishing to indemnify himself for
this long exclusion from office by a lengthened tenure of it, that
he at once announced his opinion as to the expediency of earlier
resignations of the surgeoncies, and his intention of acting on it when
he should have attained his sixtieth year. His reasons were liberal and
judicious. Amongst others, he said that he had “often witnessed the
evils resulting from men retaining the office of surgeons to hospitals
when the infirmities of age prevented them from performing their
duties in an efficient manner. That, at sixty, he thought they should
resign in favour of the juniors,” &c.; thus contemplating a tenure of
only ten years. Again, he who had founded a school from such small
beginnings as could be accommodated in a private house in an obscure
neighbourhood (Bartholomew Close), taken for that purpose—who had
so increased it, that a theatre was built within the hospital—this
again pulled down and rebuilt of enlarged dimensions to receive his
increasing audiences—having, too, some time previously made over his
museum to the hospital, in trust for the use of the school,—required
that his only son (should he _prove competent in the opinion of the
medical officers_) should in due time—Do what? Succeed him? No; but be
admitted to a _share_ in the lectures.

Indeed, Mr. Abernethy’s closing career at the hospital gave him no
great reason to rejoice at the “hospital system.” Men, who could see
nothing in leaving very much more important situations to an indefinite
succession of apprentices, cavilled at a prospective lectureship for
his only son; whilst his lectures were delivered over to gentlemen—one
of whom had, from an early period, ridiculed, as he said, the opinions
which he taught as—and which we now know to have been—John Hunter’s;
and another, with whom there had been of late several not very pleasing
associations.

This was necessarily a result of the “hospital system;” a system that
gave a still more melancholy and fatal close to the labours of John
Hunter, whose death took place suddenly in the Board-room of St.
George’s Hospital, whilst resisting an interference with a privilege
which his love of science rendered valuable to him, and which it was
for the interests of science that he should enjoy; but, mournful as
these results are, and many others that might be added, still, if we
found that the system worked well for science, we might rest satisfied;
but is it so? What advances have the hospital surgeons of London,
_under the apprentice system_, made in the science of surgery? Let
those answer the question who are desirous of maintaining this system.
For our own parts, the retrospect seems to show “the system” in a more
striking manner than any thing we have yet stated. John Hunter, that
_primus inter omnes_, was no hospital apprentice; he migrated from St.
Bartholomew’s, where the rule was too exclusive to give him a chance,
to St. George’s, where he obtained admittance; St. Bartholomew’s
preserved “the system,” and lost Hunter.

Abernethy was an apprentice, truly; but all those glorious labours
which shed such a lustre on his profession, and such a benefit
on mankind, were completed long before he became surgeon to St.
Bartholomew’s Hospital; and it is material to repeat that at that time
the assistant surgeons, with the exceptions already stated, had nothing
to do. In casting our eyes over the retrospect of years, one honoured
name attracts our notice, in connection with a real advance in the
knowledge of the functions of nerves. We allude to Sir Charles Bell.
But here again “the system” is unfortunate; for Sir Charles was never
a hospital apprentice at all, and only succeeded to a post in a London
hospital after an open canvass in an institution in which the narrow
portal of the apprentice system is unrecognized.

We might have traced the effects of the apprentice system into the
more covert sites of its operations, as exemplified in the abortive
or mischievous legislation observed at different times in the College
of Surgeons of London; or have extended the catalogue we formerly
exposed as taking place in the Royal Med. and Chir. Society up to the
influence—proh pudor!—that it is allowed to exert in the Councils
of the Royal Society; but our so doing here would have led us into
discussions which are irrelevant or unnecessary to our present objects.
In the meantime, it is useful to remark that there are two sides to all
questions. If, in our corporate bodies, we see the prurient appetencies
of trade usurping the place of the lofty aspirations of science,—if we
see this carried to the extent of men allowing themselves to receive
money without rendering any intelligible account of its amount,—let
us not forget that there is a Public—aye, and a Profession too—which
calmly allows such things.

Let us also reflect on those numerous instances, in human affairs,
of things being only accomplished when there is a real necessity
for them; and, again, whether that necessity for a higher and purer
administration of corporate privileges and scientific distinctions
may not alone reside in a higher and purer moral standard on the
part of the public and the profession. Those who, in a worldly sense,
suffer from the system, have at least the consolation that they are
not obliged to participate in the administration of that which they
disapprove; and that the losses they so sustain are perhaps necessary
tests of their having achieved proper motives. No better proof of the
sincerity and earnestness of our love of science can be afforded us,
than a patient and thoughtful cultivation of it, independently of
patronage, position, or other auxiliaries, which too often mask from
us the true objects of research, sully the purity of mind by mixtures
of questionable motive, or mislead us from the temple of truth to the
altar of a fugitive and fallacious ambition. There are indeed signs of
a “_Delenda est Carthago_.” As we have said, the point of the wedge is
inserted, and a very little extension of public information will at no
distant period drive it home.

In the meantime, Medical Science, instead of being in a position to
receive every quackery as a means of demonstrating the superior beauty
of truth, by placing it in contrast with error, is obliged to regard
any absurdity, however gross, as one of the hydra-headed fallacies
through which we are to evolve what is true, only by the circuitous
plan of exhausting the resources of hypothesis and conjecture: whilst
sweeping epidemics, which, wholesomely regarded, should be looked on
reverently as besoms of destruction, are hailed by the observant as
melancholy, but necessary, impulses, to drive us to the adoption of
measures, to which our capital of common sense is not sufficient to
induce us to listen.

Neither are the old hospitals the only parts of a defective system.
There is no hospital in London that, even yet, has any country
establishment for convalescents; whilst of two of those more recently
established, one is built over a church-yard; and the other, intended
only for the relief of decarbonizing organs, is placed in the immediate
neighbourhood of the most smoky metropolis in Europe. Both, therefore,
instead of standing out as the most distinguished illustrations of the
laws of sanitary and physiological science, being, on the contrary,
emphatic examples of their violation.

We are unwilling to conclude this chapter without observing that,
notwithstanding the coldness and discussions which threw somewhat of
melancholy and shade over Abernethy’s retiring days, thus presenting
an unwelcome contrast with the more palmy periods of his career—a
contrast from which it might have been hoped his conscientious
retirement might have spared him,—we yet see how appropriate a
preparation it might have been for a transition from the exciting, and
adulatory, atmosphere which surrounds a popular and scientific teacher,
as compared with the calmness and peace of a life in the country. He
was now no more to enter the Hospital Square, where we have so often
seen him mobbed, as it were, by the crowding and expectant pupils;
no more to be daily addressing audiences who never seemed to tire
even with repetitions of that with which many were already familiar;
nor any more to see, as occasional visitors, men grown grey in the
successful practice of his early lessons, bringing their sons to the
same school, and both listening with equal pleasure. There is no
doubt that, contrasted with all this, retirement was a great, though
now probably a welcome, change. Eminent men unintentionally exert an
influence which is not without its evils; and we shall see that of this
he was fully aware. Assentation is too much the order of the day. The
multitude appear to agree. The few who differ, are apt to be cautious
or reserved. If a man is too sensible to be fed with such garbage as
direct flattery, there are always tricksters or tacticians, who have a
thousand ways of paying homage without detection.

Then, again, those who really admire a man, and are honest,—keep
aloof, and shrink from an association with those whom they know, or
believe, to be parasites. It thus happens that there are men to whom so
few venture to be honest, that the world may present little better than
a practical lie. It is a mercy then, when a man’s sun is setting, that
he be blessed with a little twilight of truth.

There are, in the moral and intellectual constitution, as well as in
the physical endowments of Man, beneficent powers of adaptation, which
let us gently down to contrasts, which, too sudden, might be painful or
destructive.

There is, however, this difference—the external senses have intrinsic
powers of adaptation so ready, and perfect, as scarcely to be taken by
surprise by any natural transition. The moral and intellectual powers
do not appear to possess this electric activity; but require slower
gradations of impression, which, by some law in the progress of human
affairs, are (as the rule) mercifully supplied.

In his own lessons, whenever he met with any _apparent_ imperfection,
and wished to impress its _real_ beauty of adaptation, Abernethy was
very fond of what he termed his argumentum ex absurdo. He would suppose
various other arrangements, and point out in succession their unfitness
for the purposes required. Tried in the same manner, we can see nothing
better than that which really happened.

If Abernethy met with coldness where he expected warmth—and
dispute and discussion where he might have calculated on grateful
concession,—how well-fitted must have been that reverence and
affection which longingly awaited his retirement at home. If the
greatest worldly success, in that occupation in which he had always
felt most pleasure, was still not without its dark lights—shadowing
forth what the world really is,—what could he have had better to
concentrate his views on those substantial sources of comfort, of which
he had long believed and estimated the value, and on which he was
contented to repose. It had always been a favourite expression of his,
when in any doubt or difficulty: “Well, I will consult my pillow, and
we shall see.” We believe that pillow seldom flattered.

[Footnote 76: It was accordingly named the Apteryx, or wingless, from
the Greek Alpha and Pterux.]

[Footnote 77: We have derived great pleasure from our correspondence,
during some years, with Professor Ethelbert Dudley, of Lexington,
Kentucky, and from the evidence it affords of Abernethy’s principles
having been recognized, and practised with great success, by one
of the most distinguished surgeons and successful operators in the
Western World. Professor E. Dudley, himself a distinguished surgeon and
lecturer, and a man who unites with an extremely clear and vivacious
perceptivity, a most untiring zeal in his profession, is the nephew
of the celebrated B. Dudley, whose fame extends through the great
Mississippi Valley. This gentleman, now advanced in years, was an
early pupil of Abernethy, of whom he is a great admirer. He is a
remarkably successful operator, and, during his more active period,
was sometimes sent for several hundred miles. He is said to have
performed lithotomy 200 times, with the loss of only six cases. His
unusual success in operations he attributes not so much to any peculiar
dexterity as to the manner in which he conducts the preparatory and
subsequent portions of the Constitutional treatment of his cases. He
seems also to have practised some other of Abernethy’s habits: the most
careful consideration of the pecuniary circumstances of his patients,
interspersed with not a few examples of almost unexampled generosity.]

You may also like