Read Ebook: Memoirs of John Abernethy With a View of His Lectures His Writings and Character; with Additional Extracts from Original Documents Now First Published by Macilwain George

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"Nunquam ita quisquam bene subduct? ratione ad vitam fuit Quin res, aetas, usus, semper aliquid apportet novi Aliquid moneat; ut ill? quae te scire credas, nescias: Et quae tibi put?ris prim?, in experiundo repudias."

TER. AD. A. 5, SC. 4.

"Never did man lay down so fair a plan, So wise a rule of life, but fortune, age, Or long experience made some change in it, And taught him that those things he thought he knew, He did not know, and what he held as best In practice, he threw by."

COLMAN.

"Qui fit Maecenas ut nemo quam sibi sortem, Seu ratio dederit seu fors objecerit, ill?, Contentus vivat?"

is just as applicable as ever; and although human nature has almost everything ascribed to its natural infirmities, yet it appears quite as sensible, and not a whit less humble, to conclude, that paths chosen without consideration naturally lead to disappointment. The evil, like most others, carries with it the elements of self correction.

Parents are slow to encourage their children to select paths which they themselves have trodden with regret. This tends to distribute their professions to other families. Mutual interchanges of this kind serve to protect the interests of society, by, in some degree, limiting the number of cases in which men have failed to select the pursuits best adapted to them.

We may have opportunities by and by, perhaps, of further illustrating it. We will give one anecdote here. A gentleman, dining with him on a birthday of Mrs. Abernethy's, had composed a long copy of verses in honour of the occasion, which he repeated to the family circle after dinner. "Ah!" said Abernethy, smiling, "that is a good joke, now, your pretending to have written those verses." His friend simply rejoined, that, such as they were, they were certainly his own. After a little good-natured bantering, his friend began to evince something like annoyance at Abernethy's apparent incredulity; so, thinking it was time to finish the joke, "Why," said Abernethy, "I know those verses very well, and could say them by heart." His friend declared it to be impossible; when Abernethy immediately repeated them throughout correctly, and with the greatest apparent ease. To return. However useful this quality might have been at the Bar, Abernethy was destined to another course of life--a pathway more in need, perhaps, of that light which his higher qualifications enabled him to throw over it, and which "his position" "in time" afforded him an opportunity of doing just when it seemed most required. He probably thus became, both during life and prospectively, the instrument of greater good to his fellow-creatures than he would have been in any other station whatever.

I have not been able to discover what the particular circumstances were which determined his choice of the medical profession. It is probable that they were not very peculiar. A boy thwarted in his choice of a profession, is generally somewhat indifferent as to the course which is next presented to him; besides, as his views would not have been opposed but for some good reason, a warm and affectionate disposition would induce him to favour any suggestion from his parents. Sir Charles Blicke was a surgeon in large practice; he lived at that time in Mildred's Court, and Abernethy's father was a near neighbour, probably in Coleman Street.

"Shaving and tooth-drawing, Bleeding, cabbaging, and sawing,"

was by no means always sufficiently comprehensive to include the multifarious accomplishments of "the doctor." I have myself seen, in a distant part of this island, within twenty-five years, chemist, druggist, surgeon, apothecary, and the significant &c. followed by the hatter, hosier, and linen-draper, in one establishment; but as we shall have to discuss this subject more fully in relation to Abernethy in another place, we may proceed.

Sir Charles Blicke had a large and lucrative practice. He had the character of taking care to be well remunerated for his services. He amassed a considerable fortune; but we incline to think that the ideas of the profession which Abernethy derived from his experience of his apprenticeship were not very favourable. The astute, business-like mode of carrying on the profession, which seems to have characterized Sir Charles Blicke's practice, could have had few charms for Abernethy. Mere money-making had never at any time much attraction for him, and, at that period of his life, probably none at all; whilst the measured pretensions of surgery to anything like a science could hardly have been, at times, otherwise than repulsive.

The tone in which he usually spoke of Sir Charles's practice did not convey a very favourable idea of the impression which it had left on him. In relating a case, he would say: "Sir Charles was at his house in the country, where he was always on the look out for patients." On another occasion, speaking of patients becoming faint under peculiar circumstances, he observed: "When I was an apprentice, my master used to say: 'Oh, Sir! you are faint; pray drink some of this water.' And what do you think was the effect of his putting cold water into a man's stomach under these circumstances? Why, of course, that it was often rejected in his face."

He mentions a case of "Locked-jaw," that occurred as early as 1780 , which he appears to have noted with great accuracy. He mentions the medicine that was given to the man, the unusually large doses, and, lastly, the enormous quantity of it which was found in the stomach after death. It was opium, and amounted to many drachms.

"When I was a boy," said he, "I half ruined myself in buying oranges and other things, to ascertain the effects of different kinds of diet in this disease."

As a matter of course, he would have been allowed to attend any lectures which were given at the hospital to which Sir Charles Blicke was surgeon , and this would bring him in contact with Mr. Pott, who delivered a certain number of surgical lectures there.

It was about this time, we think, that he began to have more enlarged ideas of the nature and objects of surgical science; a state of mind calculated to enable him to thoroughly understand and appreciate Mr. Hunter, and to deduce from the principles which he was shadowing forth, those relations and consequences which we shall endeavour popularly to explain; principles which, though originally directed to the treatment of so-called surgical maladies, were found equally to affect the practice of medicine.

"There is not a more pleasing exercise of the mind than gratitude. Were there no positive command which enjoined it, nor any recompense laid up for it hereafter, a generous mind would indulge in it, for the natural gratification which accompanies it."--ADDISON.

Sir William Blizard was an eminent surgeon and an enthusiastic student of the profession, as studied in his day. He had a certain bluntness of manner, which was not unkind neither. He was very straightforward, which Abernethy liked; and he had nothing of a mercenary disposition, which Abernethy held in abhorrence. He was a kind of man very likely to excite in one of Abernethy's tone of mind many agreeable impressions. He early perceived the talents, and was probably the first to encourage the industry, of his distinguished pupil. Enthusiastic himself, he had the power of communicating a similar feeling to many of his pupils; and he appears to have contributed one of those impulses to Abernethy which are from time to time necessary to sustain the pursuit of an arduous profession.

Many years afterwards, he was fond of illustrating the true relations of anatomy and physiology, and at the same time contrasting the attractions of the one with the comparatively repulsive requisitions of the other, by saying, with Dr. Barclay, of Edinburgh, that "he never would have wedded himself to so ugly a witch , but for the dower she brought him ." The impressions which he derived from Sir William Blizard were deep and durable. More than thirty years after, when he himself was at the zenith of his career, we find his grateful feeling towards Sir William still glowing warm as ever. He seems to have considered the expression of it as the most appropriate opening to the first of the beautiful lectures which he delivered at the College of Surgeons in 1814. It must have been a moment of no small gratification to Sir William, who was present, now venerable with age, to have found that the honourable course of his own younger days, and the purity and excellence of his precepts, had all been garnered up in the heart of his grateful and most distinguished pupil. Nor could the evidence of it be well made more striking than when heralded forth before an audience composed of the most venerable and experienced, as well as of the most rising members of the profession; and, to crown the whole, with an eloquence at once modest and emotional, impressive of the depth and sincerity with which the eulogium was delivered.

When Abernethy entered the London Hospital, he soon gave proofs that Sir William's lessons were not unfruitful. He was early employed to prepare the subject for lecture. Anatomy is usually taught by combining three plans.

In one, the various structures--muscles, vessels, nerves, &c.--are exposed, by the removal of their covering and connecting-tissues, and so displayed as to be clear and distinct. This is "dissecting for lecture;" and it is the duty of the lecturer to describe the connections and immediate uses of the parts so displayed.

The body is then laid on a clean table, covered with a white cloth, and everything is ready. There is some difference in these matters in different hands; but attention to order and cleanliness goes a long way in facilitating anatomical pursuits. To many there may be much that is disagreeable in anatomy; but we are persuaded that a coarse and vulgar inattention to decency has often alone rendered it disgusting or repulsive.

Lastly, the pupil is required to make out the parts by dissecting them himself, with such occasional assistance as may be at first necessary, and which is given by the demonstrator, who attends in the room for that purpose.

I have already observed that Abernethy had the advantage of attending also the Surgical Lectures of Mr. Pott, at St. Bartholomew's. Mr. Pott was a gentleman, a scholar, and a good writer, and seems to have been a spirited and attractive lecturer. In an oration delivered by Sir William Blizard, in 1815, it is said that "it was difficult to give an idea of the elegance of his language, the animation of his manner, or the perceptive force or effect of his truths and his doctrines"--a character which is by no means inconsistent with Mr. Pott's more sustained compositions.

"Terra salutiferas herbas eademque nocentes Nutrit, et urticae proxima saepe rosa est."

OVID.

A large London Hospital is a large microcosm. There is little in human nature, of which an observant eye may not here find types or realities. Hopes and fears, joys and sorrows, solace and suffering, are here strangely intermingled. General benevolence, with special exceptions. There is no human good without its shadow of evil; even the benevolent must take care. Impatient sensibility is much nearer a heartless indifference than people generally imagine. The rose, Charity, must take care of the nettle, Temper. The man who is chary or chafed, in yielding that sympathy which philosophy and feeling require, must beware lest he degenerate into a brute.

One of the brightest points in Abernethy's character, was, that, however he might sometimes forget the courtesy due to his private patients, he was never unkind to those whom charity had confided to his care. One morning, leaving home for the hospital, when some one was desirous of detaining him, he said: "Private patients, if they do not like me, can go elsewhere; but the poor devils in the hospital I am bound to take care of."

As regards what is mechanically or physically necessary to the comfort of the inmates, the ample appliances of our large hospitals leave little or nothing to be desired. There is every facility for the execution of the duties, that convenient space and orderly arrangement can suggest; in short, everything, in the general sense of the word, that money can procure. Then there are governors, whose hearts are as open as their purses, whose names are recorded in gold letters, as the more recent or current contributors to the funds of the establishment, and who rejoice in the occasional Saturnalia of venison and turtle; all duties or customs which may be observed, with the gratifying reflection that they are taking the thorns out of the feet of the afflicted; provided only that they do not involve forgetfulness of other duties, the neglect of which may plant a few in their own. The governors determine the election of the medical men, to whom the welfare of the patients and the interests of science are to be entrusted.

Abernethy was elected assistant surgeon of St. Bartholomew's Hospital, July 15th, 1787. Sir Charles Blicke, an assistant surgeon, had been appointed to the surgeoncy vacant by the resignation of Mr. Pott, and Abernethy succeeded to the assistant surgeoncy thus vacated. The election was contested by two or three other candidates; amongst the rest, by Mr. Heaviside. This gentleman was an eminent surgeon, and a gentlemanly, facetious, and agreeable companion. He was originally in the Guards, and practised in London many years with great credit and respectability. He was fond of science, and expended considerable sums in the formation of an interesting museum. In the earlier part of his life, he gave conversaziones, which were attended by great numbers both of the scientific and fashionable.

He lived in a day when, if a gentleman felt himself insulted, he had at least the satisfaction of being relieved from his sensibility by having his brains blown out in a duel--professionally speaking, by a kind of "operative surgery;" viz. the demolition of the organ in which the troublesome faculty resided. Mr. Heaviside, in his professional capacity, is said to have attended more duels than any other surgeon of his time. This gentleman, albeit not unused to one kind of contest, retired from that at the hospital; which then lay between Mr. Jones and Mr. Abernethy--the former polling twenty-nine, the latter fifty-three votes.

This was an important epoch in the life of Abernethy. It is difficult to adjust the influence which it ultimately exerted, for good or evil, on his future prospects and happiness, or on his relations to science. The hospital had thus secured a man of extraordinary talent, it is true, and in spite of a system which indefinitely narrows the field of choice; but then the same "system" kept Abernethy, as regards the hospital, for no less a term than twenty-eight years, in a position which, although it did not exclude him altogether from the field of observation it afforded, did much to restrict his cultivation of it. His talents for observation, nevertheless, and the estimation in which he was soon held, no doubt enabled him, to a certain extent, to bring many of his views to the test of practice. Still, as an assistant surgeon, except in the absence of his chief, he had officially nothing to do; whatever cases he conducted, were only by sufferance of his senior.

There was at this time, in fact, no school, properly so called, at St. Bartholomew's. Mr. Pott had been accustomed to give about twenty-four lectures, which, as short practical discourses, were first-rate for that period; but there were no other lectures, not even on anatomy; which are essentially the basis of a medical school.

Dr. Marshall, who was a very remarkable man, and no less eminent for his general ability than for his professional acquirements, was at this time giving anatomical lectures, at his house, in Bartlett's Buildings, Holborn. In a biographical notice of him, in the "Gentleman's Magazine," in which we read that he was giving lectures about the year 1787, it is incidentally remarked, that "in all probability he derived little support from St. Bartholomew's Hospital; for that recently an ingenious young gentleman, Mr. Abernethy, had begun to give lectures in the neighbourhood."

We desire to impress this feature in his education, because by and by it will, with other things, assist us in a rather difficult task: that is, an attempt to analyze the means by which he obtained such a power over his audience. He thus became a teacher at the age of twenty-three, at a large hospital where he was about to commence a school, of which he would be at first the sole support. This necessarily involved a fearful amount of labour, for an organization, active and energetic, but by no means of great physical power.

We shall have to revert to these points when, in conclusion, we consider the variety and importance of his contributions to the science of his profession, and why they were not still more numerous. The latter, though perhaps the less grateful, is by no means the least useful portion of biographical analysis.

Commencing his lectures in Bartholomew Close, they soon seem to have attracted notice. The anatomical courses, which were always on a similar plan, were very skilfully framed to interest and instruct the students. The arrangement of the matter was such, that the dry details of anatomy were lighted up by a description, not only of the purposes served by the various parts, but by as much as could be conveniently included of the diseases or accidents to which they were subject; and thus the juxtaposition of the structure, function, and diseases, naturally tended to impress the whole.

Diseases of more general site, and which therefore did not fall conveniently under discussion in describing any one part, were reserved for a separate course of lectures. It was in this course that he more fully developed those general principles on which his reputation more especially rests. Of his inimitable manner we shall speak hereafter.

We shall have occasion, by and by, to record the circumstances under which one of the most important steps was taken for securing the interests of Comparative Anatomy in this country--a proceeding in a great degree owing to the good sense and personal influence of Abernethy, and exemplifying, in the admirable fitness of the individual, the penetrative perception of character which distinguished his early Preceptor in Anatomy.

We have little doubt that we have now entered on the most laborious part of Abernethy's life, and that, during this and some succeeding years, his exertions were so great and unremitting, as to have laid the foundation of those ailments which, at a comparatively early period of life, began to embitter its enjoyment, and to strew the onward path with the elements of decay and suffering.

He endeavoured further to mature an accurate perception of Mr. Hunter's views, by seeking private conferences with him; and Hunter kindly afforded him facilities for so doing. We have Abernethy's own acknowledgment of this, coupled with his regret that he could not more frequently avail himself of them. Indeed, when we consider that Abernethy lived at this time in St. Mary Axe, or in Mildred's Court in the Poultry,--that he was lecturing on the sciences I have mentioned,--that he was observant of cases at the hospital ,--and consider the distance between these points and Mr. Hunter's residence in Leicester Square, or his school in Windmill Street,--we see there could not be much time to spare. It was not, however, merely during the time at which he was delivering his lectures that he was thus actively employed. We have, not unfrequently, evidence that he was often at the hospital late in the day, in the most leisure season of the year, when perhaps his senior had, during his absence in the summer, confided the patients to his care.

We used to get, occasionally, such passages as these in the lectures: "One summer evening, as I was crossing the Square of the hospital, a student came running to me," &c. Very significant of continued attention during the summer or leisure season--he not being, be it remembered, other than an assistant-surgeon, and not, therefore, necessarily having duties at the hospital.

As we shall be obliged again to mention Desault in connection with a material item in the catalogue of our obligations to Abernethy, we postpone for the present any further remarks on that distinguished French surgeon.

Abernethy now continued actively engaged in the study and teaching of his profession. The most remarkable circumstance at this time of his life, and for several years, was his peculiar diffidence--an unconquerable shyness, a difficulty in commanding at pleasure that self-possession which was necessary to open his lecture. Everything connected with his lectures is of importance to those who may be engaged in this mode of teaching, or who may desire to excel in it. No man ever attained to excellence more varied or attractive; yet many years elapsed before he had overcome the difficulty to which I have alluded.

An old student, who attended his lectures, not earlier than 1795, told me that he recollected several occasions on which, before beginning the lecture, he had left the theatre for a time, to collect himself sufficiently to begin his discourse. On these occasions, a tumult of applause seemed only to increase the difficulty. The lecture once commenced, I have no evidence of his having exhibited further embarrassment. He seems early to have attained that happy manner which, though no doubt greatly aided by his peculiar and in some sense dramatic talent, there is every reason to believe had been carefully cultivated by study and observation.

His lectures continuing to attract a larger and larger class, the accommodation became inadequate for the increased number of students. The governors of St. Bartholomew's, therefore, in 1790, determined on building a regular theatre within the hospital. It was completed in 1791, and Abernethy gave his October courses of anatomy, physiology, and surgery of that year in the new theatre. He had thus become the founder of the School of St. Bartholomew's, which, for the approaches it made towards giving a more scientific phase to the practice of Surgery, was certainly superior to any other.

In expressing this opinion, we except, of course, John Hunter's lectures, for the short time that they were contemporaneous with those of Mr. Abernethy; John Hunter dying, as we have said, in 1793. As St. Bartholomew's Hospital was our own Alma Mater, we may, perhaps, speak with a fallible partiality; but we think not. We are far from being blind to the faults which Bartholomew's has, in common with other schools; and, we believe, regret as much as anybody can do, that the arrangements of our hospitals, excellent as in many respects they are, should still so defectively supply many of the requisitions which the interests of science demand. Some of these defects we may endeavour to point out in their proper place. We shall now leave the subject of Mr. Abernethy and his lectures, and begin to consider some of his earlier efforts at authorship, sketch the objects he had in view, and the mode of investigation.

"All things are but altered, nothing dies, And here or there the unbodied spirit flies."

DRYDEN.

The most universal character impressed on all created things that sense allows us to recognize, or philosophical inquiry to demonstrate, is "change."

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