- .1LACILWAIN'S LIFE OF ABERNETHY.* Piregaia--surgery is more indebted to John Abernethy for being raised Jinni the position of a rather mechanical art, to the rank -of a Kismet 'that- even to John Hunter himself. Hunter rose Ahovetlie.surgion. Life3 in its largest extent was the subject of .hieltliougliti and Inquiries: even in science, he was not only a _comparative anatomist, but, if such a term may be used, a compa- rative physiologist. Able as a practical surgeon, original as the Ted founder of modern scientific surgery, in opposition to " bleed- ing.," !" bone-setting," and "operations," John Hunter is more assoeiated in the mind as a philosopher than as a practitioner how- ever eminent
It must not be supposed that Abernethy was devoid of philoso-
phy, or ignorant of comparative anatomy or other cognate science. From the outset of his career he called in chemistry to the aid of his investigations of human physiology ; he examined animals both in their parts and as wholes, though not with the depth or extent of Hunter ; and he saw as clearly as his great prototype, that practical surgery was a trade above a butcher, and that it was a surgeon's business to cure a patient, not to cut him up. As regards Abernethy's great achievements—the dependence of one organ upon another' the probability not to say certainty that in many cases the root of disease would be found in some organ differ- ent from that where the symptoms appeared, and the necessity of constitutional treatment in every case—the truth had been seen more or less dimly by Hunter and others' and doubtless acted upon by many without their realizing even to their own minds the prin-
ciples of their practice. Abernethy saw those principles, and. laid them down as laws ; he stamped them, too, upon the pro- fession, and even the public at large. He did this not only by the distinctness and certainty of his perception as an observer, and the clearness of his expression as a writer, but by his newer as a lecturer. As the head of a school, he impressed 1 h. •
0.,719ws upon many pupils, or rather disciples, who carried his ideas into practice in almost every direction. The Feat po- pulariiers of physiological, hygienic, and special medicine, were andonlitedly Southwood Smith and Andrew Combe. But Aber- nethy *as the first who aimed at giving the patient an idea of getiiral treatment applicable to particular disease. His peon- limities of manner, the strange, terse, or piquant anecdotes told of flitity'rand the stranger still ascribed to him, drew an attention to the'Views of the man, which the clearness of his style or the im- m . nee of his views would not of themselves have attained. •• read "my Book," from the social celebrity of the author, o would not have read the book of any other medical man. _s caking of Abernethy as a great surgical improver and refornier, it is not needful to swear by his words, or to principles in their extreme extent. It is possible that h' iiSb sonic of his doctrines too far. For example, a disease ofigiliating in disordered digestion may have so far injured other organs as to set up what is tantamount to original disease, which at be cured by general treatment, even if the digestion could bAlitbi6i1 to a healthy state. At the same time, as Mr. Mull- • IF trily observes, Abernethy's views as expounded in his works hav.'%en much exaggerated and distorted, either by the misre- preientations of opponents or the imperfect apprehension of foolish friends. Something may be ascribed to his singularity of illustra- tien.;and his terseness of style ; he was satisfied if he indicated the principle. For instance, his alleged prescription to the rich and idle gonrmand, "live upon sixpence a day and earn it," with sitliAiinting remarks, were not intended to be literally followed. TfleYii,ndicated the cause and the cure, however roughly. In such cases, it May be said in excuse for the physician, that he was a quick judge of character, and probably saw that the patient's habits were unchangeable. Is frequently the fate of reformers to be forgotten with the evils they reform. A quarter of a century has not elapsed since Abernethy's death, yet his memory with the public at large is rather -a traditicui connected with his oddities than a knowledge of hi'vietvEilor of the services he rendered. After every allowance is made for what had been done before Abernethy and what was done by men who it may be allowed accompanieerather than fol- lowed him, (though we remember none such,) those services were very great. They are shown daily in limbs preserved, which be- fore his time would certainly have been "whipped off" ; in greater and mere systematic efforts to check or mitigate inward complaints, so as to avoid, if possible, the necessity of operations ; and more than all, perhaps,, in a less mechanical and symptomatic treatment of eninplaints which were not strictly his province at all, but that of the physician. Those medical men who laugh at Abernethy have had their whole practice modified by his influence. The life of a hospital surgeon is rarely eventful. The rules of the inititation compel him to begin his education within its walls, and he generally remains there till he retires from practice. Such was Abernethy's case ; nor had he the poverty or long obscurity to struggle against which besets many men in the professions of law and medicine. His family, it is said, was Scotch in its origin, but had resided for some generations in Ireland, where both his ...Peat grandfather and grandfather were eminent as Dis- sentakm ministers. His father was a merchant in London; • ireh`Idiiii.teibtai Abernethy, F.A.S. With a View of his Lectures, Writings. and Character. By George Macilwain, F.R.S., Author of Medicine and Surgery One Inductive Science," &c. In tWo 'Volumes. Published by Hurst and Blackett. where (in Coleman Street) John Abernethy WAS born, in 1764. After an education at a provincial school, he was, in 1779, ap- prenticed to Sir Charles Elide, a surgeon of St. Bartholomew's Hospital, and "eminent" in his day. Bloke, it is well known, was addicted to making money, and 'pursued his art somewhat in the fashion of a trade. More than the common practice of sur- gery, as then followed, he could not teach ; but he probably did what he could ; for Abernethy dedicated one of his earlier publi- cations to him, and always seemed to look upon him with re- gard. In addition to the education at Bartholomew's Aber- nethy attended the London Hospital, and studied under Sir William Blizardt ; a man who lived to upwards of ninety, survi- ving his great pupil, and connecting the old " barber-surgeon " with the surgeon of the present day. Under Blizard, young Aber- nethy learned more than under Blicke ; for the former was lofty in his idea of a " professional " gentleman, and really enthusiastic in his profession : perhaps Blizard advanced him more in life than his own master, as Abernethy was a favourite pupil. Beyond the mechanics of his art, his true teacher was probably Yohn Hunter, whose lectures he attended whenever he had an opportu- nity, and with whose works he was thoroughly familiar. There is no doubt, however, that Nature was Abernethy's best instructor, combined with his observing and reflecting mind and his unflinch- ing industry. So high did his industry and ability raise his youth- ful reputation, that he was elected Assistant Surgeon to St. Bar- tholomew's at the early age of twenty-three. About the same time, he began to lecture in Bartholomew Close. His great acquirements, his original views even at that age, and perhaps more than all, his interesting and impressive mode of lecturing, drew many students to him. In a few years his rooms would not hold his pupils. In 1790-'91, the Hospital built a theatre, it may be said for Abernethy, for hardly anybody else lectured there at that time. He shortly after began to write; and in his papers on experiments connected with the skin, and his discussions on the connexion of the lungs, skin, and liver, in consumption, exhibited an accuracy of observation and reach of view which he perhaps never surpassed. Before he was thirty he may be said to have been well advanced in the world : his reputation was established as a teacher, his practice extensive, and his prospects of fortune sure. His labour, however, told upon him eventually. Mr. Macil- wain says he aged prematurely at fifty ; and, though he can- not be said to have died young, living to sixty-seven, his latter years were full of infirmities. He left a large family, with the means of maintaining the position in which he himself lived ; but nothing like so wealthy as he might have done had he cared for money, or not have driven it away by oddities, temper, and a spirit of independence, pushed at times to rudeness and offence. This to a great extent was constitutional irritability. The expression of his countenance, and his whole manner when not displeased, was that of benevolence, or more—a sort of paternal benignity.
Mr. Macilwain's work is less a biography of his old master than a memoir of his medical career, and a notice of his principal works. Both of these are well, done ; but the effect of the book is some- what marred by a habit of digression, not always even appropriate. The very able remarks on the skin, which introduce the analysis of Abernethy's Essay on the Skin and Lungs, are valuable for their information and their philosophy. The scattered notices of the state of the profession at various periods are pleasant in them- selves and are connected with the career of Abernethy. The re- marks on the abuses attending our system of hospitals, if not en- tirely grounded, are useful. Almost every topic, however, as it turns up is accompanied by reflections that might well have been omitted ; and the best, except the strictly medical remarks, are somewhat encumbered by needless periods. As a sketch of a career which it is well to have, before those who remem- ber its subject follow him to the tomb—as a memento of Aber- nethy's claims upon the world, and a notice of his works and views —though that might have admitted of greater fulness—these volumes are welcome. The life of Abernethy has yet to be written. The best account of his contributions to healing science would be, as Mr. Macilwain intimates, a well-edited republication of his works, or at least the best of them : but that, we suppose, might not pay. Mr. Macilwain has one of the first requisites for any subject—a living knowledge of it. He knew Abernethy both as a pupil and as a medical friend in after life and he is thoroughly acquainted with his works. This knowledge appears in whatever topic he handles. Here is a graphic though minute picture of his old mas- ter as a lecturer.
"There was no peculiarity in Abernethy more striking than the power he possessed of communicating his ideas, and cf sustaining the interest of the subject on which be spoke. For this there is no doubt he was greatly in- debted to natural talent, but it is equally clear that he had cultivated it with much care. His ability as a lecturer was, we think, unique. We never saw his like before ; we hardly dare hope we shall again. "There is no doubt that a great part of his success depended on a facility of giving that variety of expression, and that versatility of manner, which falls within the province of what we must call dramatic; but then it was of the very highest description, in that it was perfectly natural. It was of that kind that we sometimes find in an actor, and which conveys the impression that he is speaking his own sentiments rather than thoso of the author. It is a species of talent which dies with its possessor, and cannot, we think, be con- veyed by description. Still there were many things in Abernethy that were observable, and such as could hardly have been acquired without study.
• C •
"The unnecessary use of technicalities should surely be avoided. Aber- nethy was obliged to use them because there were often no other terms, but he always avoided any needless multiplication of them. When they were t A brief notice of Blizard's Life will be found in the Spectator for 1830, page 68.
difficult or objectionable, he tried some mancauvre to lighten the repulsive- ness of them.
" There are many muscles in the neck with long names, and which am generally given with important parts of surgical anatomy. Here he used to chat a little : he called them the little =soles with the long names ; but he would add, that after all, they were the best-named muscles in the body, because their names expressed their attachments. This gave him an excuse for referring to what he had just described, in the form of a narrative, rather than a dry repetition. Then, with regard to one muscle that he wished particularly to impress, the name of which was longer than any of the others, he used to point it out as a striking feature in all statues ; and then, repeat- ing its attachments, and pointing to the sites which they occupied, say it was impossible to do BO without having the image of the muscle before us.
"We have sometimes thought that lecturers, who have had several de- sirable qualifications, have materially diminished the attraction of them by faults which we hardly know how to designate by a better term than vul- garity, ill-breeding, or gaucherie. Now Abernethy had in the first place that most 'difficult thing to acquire, the appearance of perfect ease, without the slightest presumption. Some lecturers appear painfully in company', others have a self-complacent assurance, that conveys an unfavourable im- pression to most well-bred people. Abernethy had a calm, quiet sort of ease, with that expression of thought which betokened respect for his task and his audience, withlust enough of effort only to show that his mind was in his business.
"Abernethy had stories innumerable. Every case almost was given with the interest of a tale • and every tale impressed some lesson, or taught some relation in the structure, functions, or diseases of the body. We will give one or two, but their effect lay in the admirable manner in which they were related.
"If he was telling anything at all humorous, it would be lighted up by his half-shut, half-smiling, and habitually benevolent eye. Yet his eye would easily assume the tire of indignation when he spoke of cruelty or ne- glect; showing how really these things were repulsive to him. Then his quiet, almost stealthy, but highly dramatic imitation of the manner of some singular patient. His equally finished mode of expressing pain, in the sub- dued tone of his voice • and then, when something soothing or comfortable was successfully administered, his Thank you, sir, thank you, that is very comfortable,' was just enough always to interest, and never to offend. Now and then be would sketch some patient who had been as hasty as he himself was sometimes reported to be. Mr. Abernethy, I am come, sir, to consult you about a complaint that has given me a great deal of trouble." Show me your tongue, sir. Ah, I see your digestive organs are very wrong.' I beg your pardon, sir, there you are wrong yourself; I never was better in all my life,' 8ce. All this, which is nothing in telling, was delivered in the half-serious, half Idunden-like, humorous manner, and yet so subdued as
never to border on vulgarity or farce. •
"One of the most interesting facts in relation to Abernethy's lecturing was, that however great his natural capacity, he certainly owed very much to careful study and practice ; and we cannot but think that it is highly en- couraging to a more careful education for this mode of teaching, to know the difficulty that even such a man as Abernethy had for some few years in coca- mending his self-possession. To those who only knew him in his zenith or his decline, this will appear extraordinary; yet, to a careful observer, there were many occasions when it was easy to see that he did not appear so en- tirely at ease without some effort. He was very impatient of interruption : an accidental knock at the door of the theatre, which, by mistake of some stranger, would occasionally happen, would disconcert him considerably; and once when he saw some pupil joking or inattentive, he stopped, and with a severity of manner I hardly ever saw before or afterwards, said, 'If the lec- ture, sir, is not interesting to you, I shall beg you to walk out.'"
Abernethy's industry and attention were very great. In early life he sometimes rose at four ; and he did not neglect lecture even on his wedding-day. Mr. Macilwain thus tells the story.
"One circumstance on the occasion of his marriage is very characteristic of him—namely, his not allowing it to interrupt, even for a day, a duty With which he rarely suffered anything to interfere—namely, the lecture at the hospital.
"Many years after this, I met bins coming into the hospital one day, a little before two, (the hour of lecture,) and seeing him rather smartly dressed, with a white waistcoat, I said= You are very gay today, sir ? ' " • Ay,' said he ; one of the girls was married this morning.' "'Indeed, sir,' I said. You should have given yourself a holyday on such an occasion, and not come down to lecture.'
"'Nay,' returned he. 'Egad! I came down to lecture the day I was married myself!'
"On another occasion, I recollect his being sent for to a ease just before lecture. The case was close in the neighbourhood, and it being a question of time, he hesitated a little ; but being pressed to go, he started off. Ile bad, however, hardly passed the gates of the hospital before the clock struck two - when all at once he said, No, I'll be — if Idol' and returned to the lecture-room."
These were his habits late in life.
"About this time  he took a house at Enfield, where he occasionally went at leisure hours on Saturday, and as the spring course of lectures came near to a conclusion, and in the summer pretty constantly, on other afternoons. At this season he used to doff the black knee-breeches, silk stockings, and shoes, sometimes with sometimes without short gaiters, and refresh one's rural recollections with drab kerseymeres and top-boots; - in which costume he would at that season not unfrequently come down to lee- tore. He was fond of riding, and had a favourite mare he called Jenny ; and many a time have we seen her jogging along on a fine summer after- noon, and her master looking as happy as any schoolboy that he was going home and escaping from the botherations of Bedford Row and the smoke of
"Some years before this he met with what might have been a serious ac- cident: in stooping forward, his horse threw up his head and struck him a violent blow on the forehead and nose ; as Mr. Abernethy at first thought, breaking the bones of the latter. He rode up a gateway, and having dis- mounted, was endeavouring to adjust the bruise and stanch the blood, when some people ran to assist him, and, as he said, very kindly asked him if they should fetch him a doctor ; but, said Abernethy, told them I thought they had better fetch me a hackney-coach' ; which they accordingly did. He was conveyed home and in ,a short time recovered from the accident.
"His taking the house at Enfield was probably a prudent measure: he seemed to enjoy it very much, and especially in getting a quiet friend or two down on the Saturday to stay over till the Monday ; amongst whom a very favourite visitor was our respected friend Mr. Clift, of whom we have already spoken. Abernethy had always, however, had what he used aptly enough to term a fidgetty nervous system. From early life he had been an- noyed by a particularly irritable heart. The first time be ever suffered ma- terially from it was while he was yet a young man. Re had been exceed- pikly depressed by the death of a patient in whose case he had been much intrusted, and his heart became alarmingly violent and disordered in its ac- tion. He could not sleep at night, and sometimes in the day it would beat so violently as to shake his waistcoat. He was afterwards subject to fugitive returns of this complaint ; and few, unless by experience, know how distress.. lagsuch attacks are."
This was his appearance about sixty-six. "He bad by this th time become a great sufferer—walked very lame ; s.nd this difficulty interfering more than ever with his exercise no doubt tended to make matters worse. He consulted nobody, I believe, tut his old -friend Dr. Roberts, of St. Bartholomew's. He was induced to go for souse tins into the country ; and on his return, hearing that he was again in Bedfsrd Row, and not haring seen him for some time, I called on him one morning about eleven o'clock.
"I knew that he had been very ill, but I was not in the least prepared to see him so altered. When I was shown into his room, I was lo struck with his appearance that it was with difficulty I concealed the emotion it cam. sioned ; but I felt happy in observing that I had succeeded. "Ile appeared, all at once as it were, to have become a very old man—he was much thinner ; his features appeared shrunk. Ile had always befell° worn a good deal of powder; but his hair, which used to hen rather thickly over his ears, was now thin, and, as it appeared to me, silvered by age and suffering.
"There was the same expressive eye which I had so often seen lit up by mirth or humour; or animated by some more impassioned feeling, looking as penetrating and intellectual as ever, but with a calmness and languor which seemed to tell of continued pain, and which I had never seen before. He was sitting at a table on a sort of stool, as it appeared to me, and had been seeing patients, and there were still several waiting to see him. On asking him how he was, his reply was very striking. "It was indeed the same voice which I had so often listened to with plea- sure, but the tone was exceedingly changed. It was the subdued character which is expressive of recent suffering, and sounded to me most mournfully. Ay,' said he, this is very kind of you—very kind indeed !' and he some- what distressed one by repeating this several times, so that I hardly knew what to reply. He said he was better, and that he could now walk pretty fairly again, 'as,' said he, 'you shall see.' He accordingly slowly dismounted from his seat, and with the aid of two sticks began to walk ; but it was a melancholy sight to me."
A.bernethy's public life, or at least his life as regarded the public, really depended upon stories, and a notice of it would be incomplete without some of them.
"Sometimes Mr. Abernethy would meet with a patient who would afford a useful lesson. A lady, the wife of a very distinguished musician, con- sulted him, and finding him uncourteous, said—' I had heard of your rude- ness before I came, sir, but I did not expect this.' When Abeenethy 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 only felt the sting. 'We know a gentleman, an old fox-hunter, who abused Abernethy'reundly ; but all that 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 *as very true.) Now,' added the patient, very naively, suppose I did, what the Devil was that to him ?'
"Another gentleman, of considerable literary reputation, but who, as re- garded drinking, was not intemperate, had a most unfortunate appearance on his nose, exactly like that which accompanies dram-drinking. This gen- tleman 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 said, '11, I see that by your nose ' ; or some equivalent expression. " 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 ex- ceedingly 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 bad 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 pa- tience till I tell you, perhaps you then may.' Abernethy at once said, Sit down,' and beard him out with the greatest kindness and patience. * * • "Abernethy lived in the days of port wine, when every man had scene- thing to say of the sample his hospitality produced of this popular beverage. Abernethy, who was never intemperate, was very holipitsble, and 'always se- lected the finest port wine he could get, which, as being generally full and powerful, was for him perhaps the least fitted. " Mr. Lloyd, of Fleet Street, who was one of the oldfashioned family wine-merchants, and one of the best men Of his day, was the purveyor of his Falernian -, and never was there a more correct application of nomen- clature than that which gave to him the title by which he was best knowit, of Honest John Lloyd. He was one of the kindest-hearted men I ever knew ; he had a great regard for Mr. Abernethy, and was treated himself by almost everybody as an intimate friend. One day I went there just as Abernethy had left. Well,' says Mr. Lloyd, 'what a funny mall yeur master is." Who ? ' said I. Why, Mr. Abernethy. He has just been here, and paid me for a pipe of 'wins; and threw down a handful of notes, and pieces of paper with fees. I wanted him to stop to see if they were right ; for,' said I, some of these fees may be more than you think' per- haps." Never mind,' said be, I can't stop ; you have them as' I toek them,' and hastily went his way."