HIS MARRIAGE

“Cogitatio in vero exquirendo maxime versatur. Appetitus impellit
ad agendum.”—CICERO.

“The Intellect engages us in the pursuit of Truth. The Passions
impel us to Action.”

In our brief sketches of Abernethy’s works, we are quite as desirous of
showing why he did not do more, as we are of setting down faithfully
our many undoubted obligations to him. This, indeed, is the best mode
of giving an onward impulse to those approaches towards a definite
science which (John Hunter excepted) he was the first to secure. If
we would increase the usefulness of those beautiful principles which
he has left us, we can hardly do better than endeavour to point out
any error or deficiency in the investigation of any subjects to which
such principles may be applicable. His work on “Tumours” contains much
that is interesting in regard to the peculiar character of his mind,
and his aptitude for simplification. He does not undertake a thorough
investigation of the subject. His object seems to have been to place in
an intelligible order, to chronicle and mark, that which was _really_
known; to pack together, as it were, that which was clear and positive,
in a form convenient for consideration; to remove that disorder and
obscurity which seem to hang about the threshold of all inquiries, and
substitute so much of arrangement and perspicuity as might invite, and
perhaps facilitate, further investigation.

He states the more important circumstances which he had observed, and
conducts his classification of the so-called “Tumours” on a basis
as scientific as it could be on an imperfect induction of facts. He
did this in a way eminently characteristic of his quick perception,
in seizing those properties on which a nomenclature should be based,
and in marking those distinctions which, in a practical science,
must always be regarded as of the greatest value. He founded his
nomenclature chiefly on certain resemblances, observed in these
diseases, to well-known structures of the body.

The simplicity of this plan, so long as the resemblance is obvious,
is just that which constitutes excellence in nomenclature. To take an
example, amongst others, he says there is a tumour the structure of
which resembles the Pancreas, or Sweetbread as it is popularly called,
and to this tumour he gives the name of Pancreatic. Now every one
knows a sweetbread, and the name implies no opinion whatever as to its
nature; it simply declares a fact. Whatever we may ultimately discover
with regard to tumours, a name of this kind, though it may possibly be
exchanged for one more significant of the nature of the disease, will
still leave us nothing to unlearn; for the tumour in question will
always have that resemblance from which Mr. Abernethy named it; and if
we should find (as indeed we do find), in course of time, that diseases
undergo alterations of type, the rarity of a tumour resembling the
sweetbread would record that circumstance.

Had he examined them by the microscope, and selected the appearances
so elicited as grounds for his classification, it would have been much
less useful. In the first place, comparatively few persons would have
had the opportunity or taken the pains to _observe_; and secondly, we
should have had the inconveniences resulting from that variety which we
generally find in the reports of microscopic researches. There is just
now a great disposition for microscopic inquiry, perhaps somewhat too
much; but no channel should be neglected, if it be not too exclusively
relied on. Abernethy amused himself at one period in examining ultimate
structure by the microscope; but he seems to have had but a very
measured reliance on this mode of investigation.

Judicious nomenclature is of immense importance in the framework of
science, and a want of care in this has probably done as much as
anything to impede the course of rational investigation. There is
nothing, perhaps, in the whole range of science more to be lamented
than many—indeed, I might say all—parts of medical nomenclature.
If our ignorance prevents us from giving a name to a thing which is
descriptive of its nature, we might easily avoid applying such as
are calculated to mislead. We can imagine the confusion which would
result from a druggist labelling a bottle of water, “poison;” and a
vessel containing poison, “water;” yet we doubt whether he would more
imperfectly express the true relations of these fluids, than the terms
“fever” and “inflammation” do the real nature of the conditions which
they are employed to designate.

Abernethy’s arrangement of tumours not only illustrates his disposition
to seize on the more salient points of a subject, but also his
inclination to seek for the essential relations of (so-called local)
disease in the general condition of the body. He consistently,
therefore, mentions them in an order founded on such relations. He
places those first which he had found least dangerous in their nature,
least destructive in their effects, and which appeared to him to have
been attended by the least disturbance to the general economy. In like
manner he placed those which had manifested more malignant or dangerous
characters, in the order of their severity; inferring their characters
respectively from the disturbance of the constitution, the resistance
of the disease to treatment, and the variety of structures destroyed in
its progress.

Between these two extremes, he placed, as the step of transition,
that tumour which he had observed to partake most strongly of
intermediate characters. But, besides the desire to throw some light
on the subject of tumours generally, he had another special object
in view. Few diseases exemplify the absence of scientific research
more than tumours. In regard to most of these morbid depositions, it
may be remarked that, even now, whenever a patient with one of these
so-called tumours applies for advice, the practicability of removal
is too often the only thing thought of; and it must be obvious to
common sense that the mere cutting away of a deposition of this kind
(however proper under some peculiar circumstances), can hardly ever
exert any influence on the causes of its production. Indeed the manner
in which these diseases are continually removed, without any previous
inquiry that is really worthy of the name, is amongst the many grounds
on which we found the opinion expressed in the sequel on the present
state of medical surgery, as contrasted with that in which it was
left by Abernethy. Now, while the gravity of the subject rendered
the consideration of all tumours important, there was one which in
an especial manner had eluded all efforts to expose its nature and
dependencies—this was the justly-dreaded cancer. In regard to this,
Mr. Abernethy hoped that further information might be obtained, by
investigating other tumours more closely, and thus bringing, as he
expresses it, collateral knowledge to bear on it, “like light shining
from various places to illustrate the object of our researches.”

Here was a suggestion in the true spirit of philosophical inquiry;
whilst, in taking so simple a basis for the names of tumours, and then
associating them in arrangement with their respective constitutional
tendencies, he adopted the best mode of recording in a general sense
their more important relations. But the fault lay in the suppressed
premise that the _relations_ of the so-called tumours were comprehended
by a division which is not founded in nature. Nothing indeed can be
more artificial than that division of diseases to which surgeons
usually restrict the term tumour; a defect which besets all medical
inquiries. The old division, in which all sorts of diseases were
jumbled together under the general name of tumours, defective as it
might be, was much more auspicious, had it ever been made the object
of a really philosophical inquiry; because the very diversity of the
phenomena they presented would, by the ordinary process of common sense
or inductive reasoning, have only served to bring out their common
characters—the most important first step in all investigations of this
nature.

Had Mr. Abernethy extended that collateral view which he justly insists
on, to _all sorts of new depositions_, instead of confining it to the
so-called “tumours,” he would have detected how artificial was the
division, and taken it at its just value; he would have found that he
had excluded circumstances which not only led to a much more intimate
knowledge of the relations on which those so-called tumours depend, but
which confer a power of demonstrating easily, and in a more particular
manner, to the most ignorant or prejudiced, those relations to a
disordered state of the body, of which, without such assistance, it
required a mind no less penetrative and suggestive than Abernethy’s to
give even a general enunciation. This defect essentially consisted in
the vice we have before alluded to, and is nothing else but a violation
of one of the rules most insisted on by Lord Bacon[28].

It proceeds, perhaps, from the habit of looking at subjects through a
medium too exclusively anatomical, and by which even Mr. Hunter was
sometimes, though exceptionally, hampered. Popularly, it was deducing
conclusions from only a portion of the facts of the subject; but if
Abernethy did not get the whole of the facts, and therefore missed
some portion of the conclusions to be drawn from them, he at least
avoided the error of inferring anything positive which the facts did
not warrant. We hope, however, that the paper has been valuable, in
enabling some of us to arrive at further views, which serve to confirm
the truth and extend the application of those entertained by Abernethy.

Now, to put the whole thing popularly, and to direct the public view to
the common sense of the matter, it is obvious that if we want to know
the real nature of any growth whatever—say a tumour, a plant, or an
animal—we cannot do this by any examination of its structure _alone_.
If we desire to know its nature, we must also examine its habits, food,
climate, and the various influences to which it is subjected. If,
indeed, this were once done, then it is very possible, on again seeing
the structure _merely_, we might recognize its real relations, although
we might still be glad to have any well-known substance to which we
could compare it, if only to _record_ its identity. This is right
enough, thus to _obtain_ the general knowledge before we _assume_
the particular. Again, suppose I had some ground growing all manner
of plants, and twenty different sorts of fungi, what should I get by
_merely_ examining the fibres of one or the other?

But I should easily discover that some plants grew best in one soil,
some in another, some with more moisture, some with less; whilst the
very circumstances of soil, moisture, and so on, which were essential
to some, might be enfeebling or destructive to others. No one will for
a moment doubt that the kind of nutrition was of great importance in
all, and this would necessarily lead me to infer that, “If I desired to
get such a fungus, I must have more moisture, less air, less heat or
light, or another soil,” and so on.

In a plant, you must also look to the roots and other parts of the
organism. Now this is exactly what should be done in regard to tumours;
and for no reason more cogent than that the great beauty and beneficent
effects of Mr. Abernethy’s views may become practically useful; for
in the same manner that we would desire to influence the plant or
the fungus through the sources whence it derives its nourishment, as
air, water, various ingredients in the earth, and so on; so the only
channels by which _we_ can effect any influence, are those organs by
which these matters are ultimately changed into the structures we
wish to maintain, or we desire to get rid of, as the case may be.
Now, although the number and relations of these organs may render the
investigation more difficult in one case than in another, as they
become more multiplied, or as the animal or vegetable is more or less
simple or complicated in structure; yet, whether we take our example
from man, or any other animal—or, in fact, any organized being of
the countless modifications we find in nature—the instrumentality
through which the vital power acts is neither more nor less than the
assimilating organs.

If we have been too professional in this discussion, we plead, as an
apology, that in no one point in the whole range of surgical practice
would unnecessary suffering be avoided more frequently than on the
subject before us; provided only that what is clear and positive,
as distinguished from what is conventional and erroneous, were once
popularly familiar; for, amongst other evils, most of the operations
in this department of surgery are not only superfluous—to use no
stronger term—but they practically _interfere more than any one thing
whatever_ with the progress of the scientific investigation of the
nature of these maladies.

The removal of them by operation is too commonly undertaken, not
only under circumstances which, as Abernethy said, “add cruelty to
calamity,” but for reasons which logically forbid such a proceeding;
and although there are conditions which call for such interference,
yet those under which it is usually instituted help only to obscure
the real relations of the disease, and to throw the shadowy veil of an
irrational empiricism over the operations of nature.

Those who recollect the remarkable results which Abernethy sometimes
obtained in regard to this intractable and often formidable class of
diseases, will, I think, be disposed to agree in thinking that few
maladies are more open to improved investigation, or promise a more
encouraging prospect of enlarging the boundaries of philosophical
medicine.

SECTION.

HIS PAPER ON A CURIOUS CIRCUMSTANCE SOMETIMES

FOLLOWING INJURY TO THE LUNGS.

Fractured ribs are common accidents, and illustrate very beautifully
those conservative principles in animal bodies which give such interest
to the study of their economy.

When first we consider that the ribs form the greater part of that
box in which the lungs and heart are enclosed, and by which they are
protected, we are disposed to regard a fracture of one or more ribs as
a very serious affair.

Nevertheless, these accidents generally do extremely well. In the first
place, the gristles, or cartilages as they are called, by which the
ribs are attached to the sternum in front, give, in conjunction with
the spine behind, considerable elasticity to the whole structure of the
chest. Most injuries have therefore to overcome this elasticity, before
anything gives way; and when the rib has done so, and is fractured, the
resiliency of the cartilage or gristle to which it is attached _tends_
to restore it to its place, or to set it, as we phrase it.

Another very curious thing in accidents is the instantaneity with which
muscles which are _ordinarily_ under the dominion of the will, become
reluctant to obey it, or altogether repudiate its authority. In all
fractures, of course, the most material thing is absolute repose; and
there is very little chance of a man moving his rib when it is broken.
He instinctively begins to expand his chest, for the admission of the
necessary air, by other muscles, usually to the exclusion of those
which are attached to the broken bone.

The Lung, which may be considered as a series of tubes, some conveying
blood, and others air, is often wounded; but the blood immediately
stops the leak, from its tendency to coagulate when out of the
vessels; and no harm ensues. Occasionally, however, a circumstance
occurs, which, until it is understood, appears curious and alarming.
Either from the extent, the scratching of the surface, or some other
peculiarity in the wound of the lung, the air escapes from it, and the
patient is as it were blown up, as to the chest, neck, and face, by
the air impelled from the lung beneath the skin into the connecting
tissue, exactly in the same manner as the butcher does when he is
preparing veal. This blowing-up is called, from the Greek word for it,
_Emphysema_; and it was on this feature in these accidents that Mr.
Abernethy wrote a short paper.

There is not much which is absolutely new in it. It is chiefly
remarkable for the clear manner in which it places before us what is
required, as distinguished from what is officious and unnecessary, and,
in fact, reduces the treatment to that of ordinary cases, with one
clearly defined modification.

He shows his familiarity with Pneumatics, so far as they are touched
by the case, just as he does his knowledge of Chemistry elsewhere. The
exceptional cases, in which the air is confined in the chest, the mode
of procuring it an exit by operation, and the condition regulating this
proceeding, are very simply and clearly laid down.

The paper also contains remarks on the collapse of the lungs when the
chest is opened, and on certain exceptions which have been observed,
which, from their general interest and suggestive character, will well
repay an attentive perusal.

He next offers a few remarks on those mothers’ marks, as they are
popularly called, and which are technically styled nævi. They are
generally little more than clusters of enlarged blood-vessels, and are
usually removed by excision or other operative proceedings. As the
essential character of these marks is increased action and size of
vessels, Mr. Abernethy thought that, if well-regulated pressure were
made on them so as to impede the flow of blood into them, and this were
conjoined with Cold (which represses vascular action), many of them
might be got rid of in this manner. He found his idea realized, and
published three cases of its success. The value of these suggestions
consists, first, in the opposition they offer, _pro tanto_, to that
absurd tendency there is to remove everything like a tumour; and the
impediment thence arising to any searching inquiry into the causes on
which they depend.

But there is another inconvenience which occasionally renders the
excision of these nævi very inadvisable. It sometimes happens that
they are so situated that they cannot be removed, without making the
disfigurement greater, or from some other still more serious objection;
as, for example, when small ones occur in the face, or when they
are placed near the eye. Under such circumstances, the contraction
consequent on a wound of any extent is a serious inconvenience; in
some of these cases, the adoption of Mr. Abernethy’s plan allows us to
dispense with the operation by excision, as I have myself experienced.
As it illustrates the advantage of the plan in a case where it was
particularly applicable, I will briefly refer to one example. A
young lady had one of these marks at the root of the nose, where,
from the position, as well as from the contiguity of the eyes, any
dragging from the contraction of a scar, would have been particularly
undesirable. She was brought from the country to have it removed; but,
on representing the objections to that course, it was agreed to try Mr.
Abernethy’s plan, which was completely successful.

At this period, Mr. Abernethy published sundry other interesting
papers, showing, in his observations of all that was passing around
him, that his views were not less circumspect and comprehensive than
they were clear. His “surgical cases” are all excellent; and if they do
not contain so full an account (the great vice of medical records) of
all the circumstances which preceded them, as are sufficient to furnish
future investigators with the elements of accurate generalization, they
are remarkably valuable for the qualities of clearness and candour.

We may have an opportunity of briefly alluding to some of these papers
in our summary; but they are hardly practicable subjects for popular
analysis, although they form some of the most valuable contributions to
the practical literature of the profession. They show also that he was
as penetrative and efficient in regard to the operative department of
practice, as he was in those higher and more extended views, which, in
enlarging the _science_ of surgery, has tended to diminish, of course,
the number of operations.

About the year 1785, John Hunter had invented his celebrated
improvement in the treatment of a disease of the arteries called
“Aneurism.” It was a very simple deduction from observations on the
state of the arteries; and although it was one of those inquiries
which had been made the subject of experiments on living animals, it
was one on which _not the smallest light_ had been thrown by such
investigations.

Mr. Hunter had found that, in addition to many other serious objections
to an operation which had been usually performed for the relief of this
disease—which consists either of a giving way of a _portion_, or a
general enlargement, of a vessel (for it is sometimes one, sometimes
the other)—a great cause of failure had been, that the ligature which
was placed round the artery was too near the disease, and, in fact,
involved a portion of the tube which was unsound. He accordingly
proposed tying the artery a little farther off, and thus substituted,
for an operation which was extremely severe, very hazardous, and too
commonly fatal, a comparatively short and simple proceeding, which,
under _moderately favourable auspices_, is almost uniformly successful.

As with many other discoveries, accident and similarity of views had
suggested similar proceedings to others, so that continental surgeons
were disposed to dispute the merit of the discovery in favour of
Guillemeau, Guattani, Anel, Desault, &c., as their views favoured one
or other; but there can be no doubt that for the first clear exposition
of the _principles_ of the operation, as well as of the objects it was
designed to accomplish, we are indebted to John Hunter.

John Hunter’s operation applied to the main artery supplying the lower
extremity, and surgeons have since extended the proceeding to many
other arteries. The first extension of it, however, occurred to Mr.
Abernethy, who, about this time (1797), placed a ligature on what is
called the external iliac artery; and as he seldom touched anything
which he did not improve, he made an important modification in the mode
of proceeding.

Subsequent experience, it is true, has, in some measure, rendered
that improvement no longer necessary; yet, whenever circumstances
arise which lead to any material disturbance of the artery from its
situation, we apprehend the caution of Abernethy in tying it in two
places close to its connection with the surrounding parts, is a
valuable condition.

He also sent, about this time, an ingenious paper to the Royal Society,
on certain small openings into the cavities of the heart. They are
called the “Foramina of Thebesius,” from an anatomist who particularly
described them. This is to us one of the prettiest of his physiological
contributions. The facts are stated with great simplicity, their
relations to disease beautifully pointed out, and the inference from
the whole very striking, as being in harmony with the facts whence it
is deduced. Abernethy’s idea being, that the holes were for the purpose
of obviating excessive repletion of the nutrient vessels of the heart,
by allowing them to relieve themselves by pouring a portion of their
blood through these holes into the general mass of the circulation.
It could hardly, however, be made interesting to the general reader
without going into the subject more than is suited to our present
object.

In 1799, Abernethy’s reputation had gone on rapidly increasing. His
numerous pupils, too, had become the media for frequent consultations,
in addition to those which arose from his own connection, and his
reputation with the public.

He now moved from St. Mildred’s Court, and took the house in Bedford
Row. This was some time previous to October, 1799, the September of
that year being the last time his name appears on the rate-book of St.
Mildred’s Court. He never again changed his professional residence. The
move was an important step, but it was only the precursor to one still
more interesting.

In the January of the following year, an event occurred which seldom
fails to exert a greater influence on a man’s future prospects and
happiness than any other. This was no less than his marriage—of which
we must say a few words in a separate chapter.

[Footnote 28: That the nature of a thing is not to be sought only out
of itself, but from things more in common.]

“Ye solvers of enigmas—ye
Who deal in mystery—say,
What’s cried about in London streets
And purchased every day?

“‘Tis that which all, both great and small,
Are striving to obtain;
And yet, though common and quite cheap,
Is daily sought in vain.”

OLD RIDDLE.

There are few subjects on which people are more agreed than the
value of “good matches;” neither do they seem to differ very widely
as to what that phrase is intended to convey. Not that everybody’s
_beau-idéal_ implies identity of composition, but they are pretty well
agreed as to the more essential elements.

But if we observe the different ways by which people seek to obtain a
common object, we are puzzled to know how folks that set out in such
various directions should ever arrive at the same point. The travellers
are said, too, to provide themselves not unfrequently with various
disguises; not only in dress and externals, but even in manners and
sentiments, which they do not usually entertain. Thus we have heard of
one who professed a great love of music, who scarcely had an idea of
melody; of another who expressed an admiration of poets whom he had
never read, or voted unmitigated bores. Others have been known to avow
a perfect indifference to wealth, who have had scarcely an idea unmixed
with an instinctive admiration of the _æs in presenti_.

We once heard a curious fellow say that he could marry any lady he
liked, if he could only “bring himself to take the trouble;” and we
thought how happy he would be if he could live on as good terms with
his wife as he appeared to be on with himself. Some start with an
apothegm which they carry about like an amulet or charm; such as, “No
greater rogue than he who marries only for money, and no greater fool
than he who marries only for love.” Apothegms, however, like many
things in this world—Macintoshes and umbrellas inclusive—are very apt
to be left at home when most wanted.

We are not informed whether table-turning or mesmerism have yet
discovered any prophylactics against the undoubted perils of an
expedition in search of a partner.

We are unfortunately not sufficiently versed in these mysteries to know
the “latest accounts;” but from the reputed effects of platinum and
other metals, we should not be surprised to hear that a person well
mesmerised would be found very clairvoyant of gold. We are not aware
of the achievements necessary to arrive at the exalted position of “a
Professor;” but it is said that “Professors” find gold without the
necessity of going to the “diggings.”

Table-turning, we hear, has not as yet been found successful. By
shooting too much ahead of the slowly moving current of human affairs,
it skipped over one generation, and thus recently entrapped an Irish
gentleman of the “highest respectability” by giving a fortune to a lady
too soon; it happening to be found still in possession of its “right
owner”—or, as the technical phrase is, “in expectation.”

Many aspirants for wedlock have sundry misgivings about certain
traditionary repulsions which are said to exist between love and
poverty, and, uninfluenced by the charms of matrimony, think only of
the possible consequences. Not a few, however, regard marriage as
too serious an affair for sport or speculation. They think it very
difficult for mortals who know so little of themselves to know much
about other people, and that though matches in rank and money are daily
seen to be very practicable, yet that matches in mind are still as
difficult as Dryden represented them—

“Minds are so hardly match’d, that e’en the first,
Though pair’d in Heaven, in Paradise were curs’d.”

People of this sort contemplate marriage in a very unpoetical manner.
They have great faith that correct intention and common sense are the
best guides; and, although they may not feel less transported with
their prospects than other people, they are apt to remember that it is
“transportation for life.”

A great deal has been said of the marriage of Abernethy, and very
much of it in proof of his eccentricity of character; but if a steady
reliance on earnestness, sincerity, and common sense, on an occasion on
which one or other of these qualities are sometimes laid aside, and the
employment of the highest qualities of the mind for the most important
purposes be wise, we must, if we admit the eccentricity of Abernethy,
concede to him the less-equivocal merit of practical wisdom. Himself a
sensible and clever man, and a great admirer of these qualifications in
others, he was not very likely to ally himself to any lady who appeared
deficient in such characteristics.

Abernethy had a very quick perception of character, and his profession
afforded him ample opportunities for the exercise and the cultivation
of this faculty. He would not have been very likely to lay it aside
on an occasion when a judicious and successful exercise of it, as
distinguished from mere impulse or first impression, is of more
consequence than on almost any other.

Miss Anne Threlfall was the daughter of a gentleman who had retired
from business, and who it appears had been residing in the town of
the far-famed Edmonton. This lady was intimate with the family of Mr.
Hodgson, where Abernethy was also a frequent visitor.

It was at Mr. Hodgson’s that Mr. Abernethy first made the acquaintance
of her who was destined to exert so considerable an influence on his
future happiness.

In the unrestrained intercourse of the society of intimate mutual
friends, a man of Abernethy’s penetration would not be long in
discovering the amiable or the estimable qualities of an agreeable
woman.

Mrs. Abernethy added to personal attractions of no common order, great
good sense, and a very lively, ladylike manner. These had not been
without their influence, on their first meeting; and a few additional
interviews, which the usual precursor of an undefinable pleasure in her
society served to accelerate, not only confirmed his first impressions,
but seem to have deepened them into sentiments of warm respect and
affection. Now, supposing his opinion formed, his resolution taken,
there was still a difficulty—Abernethy was remarkably shy, and
extremely sensitive.

His whole time was absorbed in teaching, studying, and practising his
profession; his rising ambition just getting success within its grasp.
How was resolution or opportunity to be found for the tardigrade,
time-consuming process of a regular siege? Still, after all, the
shyness was the real Rubicon which he felt a difficulty in passing.
Common Sense said to a sensitive Conscience, “You are about to ask a
lady to entrust to you her happiness for life.” “Ah!” said Conscience,
“that is indeed a great deal to ask of any one.” And Shyness said it
was equally difficult to know what to say, how to make the request, or
brook a refusal. The difficulty with Abernethy was so great, that there
is some reason to doubt whether he could have got over it, had he been
left entirely to his own resources.

Mr. Hodgson, it seems, did not sympathize with Abernethy’s scruples
and difficulties, but simply encouraged him to overcome them. It is
wonderful how even the greatest minds are influenced sometimes by a
timely “pat on the back.” We recollect a distinguished public man, and
a peculiarly single-minded one too, once observing, that few people
had any idea of the comfort which public men sometimes derived from
any one, whom they imagined sincere, simply saying, “You were quite
right, I think.” Whatever Abernethy might, or might not, have owed to
some little help of this kind, it is quite certain that he at last
opened his heart to Miss Threlfall, or at least essayed so to do; but,
apparently not very well assured that he had said what he intended _to
say_, he supported it by a letter, which proved successful.

This letter is still extant, and an interesting document it is. It
forms a curious commentary on the numerous and dissimilar versions
which have been given of it by gossip; all the versions we ever heard
having had the common character of being in every respect entirely
unlike the original. Here it is:

“Tuesday.

“I have felt extremely anxious, dearest Lady, since I had
the pleasure to be with you, lest, from my embarrassment in
delivering my sentiments, I might have said any thing liable to
misapprehension. This anxiety induces me to trouble you with the
present letter. I had designed, in our last conversation, to have
said, that I had ever regarded the marriage state as that of the
greatest happiness. It always appeared to me that two persons
of different sexes living together in reciprocal benevolence
were placed at the summit of human felicity. Hard necessity has,
however, precluded me from the enjoyment of such bliss; and when
I had at length relinquished even the idea of it, by accident I
met with a lady in whom were concentred all the qualities which
I could have wished for in the moments of fondest expectation,
and from whom I was led to believe I might derive what I had ever
regarded as the greatest happiness. This was to me one of those
circumstances of the reality of which the mind seems doubtful, from
the excess of delight that it occasions. I had wished, dearest
Lady, at our last interview, to have convinced you that I was
capable of discerning and loving you, as well for the perfections
of your mind, as for the charms of your person. I have ever been an
enthusiastic admirer of intellectual excellence; and in the minds
of some ladies whom I have known, I have distinguished a purity of
thought and benevolence of design which I have never found, nor
can I expect to find, amongst men. In addition to these simple and
fascinating qualities, I have witnessed a clearness of perception
and judgment, an undeviating rectitude of principle, and, as the
result of these and other qualities, such a dignity of character,
that I have looked up to the possessor of them as to something
divine. I had wished to have made you acquainted, in some degree,
with my own character, as far as I might have been supposed to have
acquired that most difficultly attained information, a knowledge
of myself. I perceive, however, an impropriety in saying much upon
this subject; but I wish you to be assured, that I am incapable of
uttering any thing false or deceitful, and that consequently you
may rely upon my word. I have pursued every object in life with an
avidity which has appeared to many disproportionate to its value;
but surely, if an object be worth attaining, neither diligence
should be spared nor time lost in its attainment. How anxious
and earnestly interested must a person of this disposition, with
respect to subjects of little importance, feel when engaged in what
he considers as the most important concern of his life. I shall
suffer the greatest inquietude until I am assured of your good
opinion. This letter has been written by snatches, in the midst of
the avocations of this day, which now so call upon me, that I can
only add (what I hope may be an unnecessary assurance) that I shall
ever be, with the truest affection, and most faithfully yours.

“JOHN ABERNETHY.”

This beautiful letter is very characteristic. The simplicity and
straightforwardness,—the respect and tenderness, “Dearest Lady,”—the
brief, modest, but truthful tone in which he alludes to his own
pretensions,—the plea for his earnestness deducible from his known
character in ordinary pursuits,—his frank confession of anxiety
and inquietude until he is assured of her “good opinion,”—and his
naïveté in saying that his occupations oblige him to conclude,—all
respectively sketch the natural warmth, tenderness, sincerity, and
earnestness of his real disposition.

The marriage took place accordingly in the parish church of All Saints,
Edmonton, on the 9th of January, 1800, and is thus entered in the
Register:

“John Abernethy, Bachelor, of the Parish of St. Andrew’s, Holborn,
to Anne Threlfall, of this Parish, Spinster, were married in this
Church by licence, the 9th day of January, 1800, by me,

“D. WARREN, _Vicar_.

“This marriage was solemnized between us:

“JOHN ABERNETHY.
“ANNE THRELFALL.

“In the presence of

“JONATHAN PATTEN.
“WILLIAM HODGSON.
“J. HODGSON.
“MARY THRELFALL.
“CHARLOTTE HODGSON.”

By marriage Abernethy obtained a partner for life who to personal
attractions added those social and moral excellences which combine
to form a superior woman—one to whom such a man as Abernethy could,
and always did, to his last moment, look up with equal respect and
affection, as the wife, mother, and the friend. As a husband, there can
be no doubt that, during the thirty years he lived after his marriage,
his conduct was a practical commentary on, and fulfilment of, the
preceding letter; and he endeavoured at all times to convey to the
children the warm sentiments of respect for, and reliance on, their
mother that he had seen so much reason himself to entertain. On the
other hand, it is impossible to overrate the grateful warmth with which
Mrs. Abernethy returned his affection, or the veneration and respect
with which she honored his memory.

Few persons, if any, have experienced a longer period of uninterrupted
happiness than that which followed the marriage of Abernethy. Mrs.
Abernethy survived him twenty-four years, having died in July, 1854.
She had for many years been afflicted with paralysis, which at times
was attended with considerable suffering. It was consolatory, however,
to feel that her faculties remained without being materially impaired
to the last.

Mr. Abernethy had, in his last illness, repeatedly expressed his
anxiety that every kindness and care should be shown towards her to
whom he felt so much indebted; and he had prophetically suggested, as
probable, what really happened. He said, “Take every care of your dear
mother. She may have many and perhaps serious illnesses; but she will
still be, most likely, a long-lived woman.” This legacy, we have reason
to know, was most fully and kindly administered.

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—we mean the lecture at the hospital.

Many years after this, I met him 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 to-day, Sir.”

“Ay,” said he; “one of the girls was married this morning.”

“Indeed, Sir!” I said. “You should have given yourself a holiday 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 case 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. He had, however, hardly passed the gates of the hospital
before the clock struck two, when, all at once, he said, “No, I’ll be
—— if I do!” and returned to the lecture-room.

“From the barr’d Vizor of Antiquity
Reflected shines the Eternal light of Truth,
As from a mirror; all the means of action,
The shapeless masses, the materials,
Are everywhere around us. What we need
Is the celestial fire, to change the flint
Into transparent crystal, bright as fair.”

LONGFELLOW’S “SPANISH STUDENT.”

In all that Abernethy had hitherto published, it was easy to perceive
that, although he was carefully examining the prevailing opinions and
practice of the day, he was emphatically one of those independent
thinkers who had power to overlay the most established conventionalisms
with opinions of his own. Although hitherto his publications had
related to particular diseases or accidents which were held as
within the ordinary province of the surgeon, he was shadowing forth
_principles_—views which, if they were true, must necessarily have a
much wider range of application than to the particular cases which it
had been his object to consider. In 1804, he had sufficiently matured
his general views to think it right to publish them; and this he did in
his book on the “Constitutional Origin of Local Diseases,” popularly
known as the “My Book,” to which he not unfrequently referred his
patients for a more detailed account of his views, than he could find
time to give in the consulting room. When we reflect that diseases
consist entirely of altered conditions in the structure or function of
some part of the body, a formal announcement that they must be greatly
influenced by the organs on which _the whole body depends_ for its
nutrition, seems to have so much the aspect of an obvious truism, that
we scarcely know whether most to wonder at so formal an announcement of
it having been necessary, or the astonishing number and variety of the
reservations with which it has been admitted.

But, strange as this may appear, and although all the facts have been
before the eyes of man for ages—nay, though their relations have been
_more or less felt_ and acknowledged in cases usually submitted to the
physician,—we venture to say that nothing like an attention at all
adequate to their importance was obtained for them in the practice
of physic, and scarcely any at all in surgery, _until the time of
Abernethy_.

At the present time, a great deal has been done to establish, by the
most clear and indisputable demonstration, the practical usefulness
and necessity of the principles to which Abernethy conducted us,
in the cure of diseases, whether medical or surgical. Still, these
principles are much neglected, much misunderstood, or so _imperfectly
carried out_, as to excite, even in many of the public, expressions
of astonishment. It is, indeed, not too much to assert, that, even
in those cases in which their successful application has been most
incontestibly exemplified, his principles are _fully carried out on
comparatively few occasions_.

The causes of all this are, we fear, too easily detected; the removal
of them is indeed sufficiently difficult. We may possibly discuss both
points in the sequel.

Instead of the exquisite simplicity and clearness of Abernethy’s
views, so far as he had gone, being carefully studied, and with a
view to the _extension_ of them beyond those limits which his time,
his opportunities, and his caution had assigned to them; instead of
examining into, and testing, the practical value of the deducible, and,
in fact, necessary sequences, on views of which he had demonstrated the
truth and value; practice appears to have taken a retrograde movement.

He who would advance even as far as Abernethy, is in danger of being
regarded as crotchety or peculiar; whilst any who should strive by
a more careful examination of his views to render their practical
application more definite and analytical, must be prepared to be looked
on simply as an enthusiast.

This has, indeed, been the case more or less in all sciences from the
earliest times. The _facts_ which conduct us to a true interpretation
of the _laws_ in obedience to which they occur, have been always before
us; the very same facts on which, as Professor Whewell[29] observes,
we have raised the stately structure of modern science. Butler[30]
had before made a similar remark. Poets too, as even the motto to
our chapter shows, have held the same sentiment; what everybody
_knows_, how few _consider_! Neither Copernicus nor Galileo altered or
invented _facts_. Those they _observed_! what they _discovered_, were
conclusions interpreting the true relations of them. Bodies fell to
the earth, and the crystal rain-drop had shown the composite nature
of light in the beautiful colours and wonderful illustrations of the
rainbow, ages before Newton discovered the true explanation of the one,
and the great law exemplified in the other.

The object of “the Book” is to set forth the great fact of the
reciprocal influence existing between the nervous system and the
digestive organs, and the power they mutually exert in the causation
and cure of diseases; and this, whether the diseases originate in
disturbance _primarily_ directed to the brain or any other portion of
the nervous system, or to the _digestive organs_; whether the result
of accident, such as mechanical injury, or other local manifestations
more commonly termed disease. In the book before us we shall find
an ample refutation of many misconstructions and misapprehensions
of Abernethy’s views; misconstructions which have tended to obscure
principles, remarkable for their simplicity and truthfulness; to
impede the beneficial application of them in a manner which has been
equally injurious to the public and the profession, and which, have
impressed on mankind a very inadequate idea of the obligations due to
the distinguished author. His views were said to be theoretical and
exaggerated, whilst they were conclusions logically deduced from facts;
and so far from the pervading power of the influences to which he
proximately attributed the causation and cure of disease having been
exaggerated, the onward study of his principles only serves, by the
discovery of more multiplied and refined applications of them, to fill
in with additional illustrations the accurate outline which he has so
truthfully drawn. He never wrests a fact to a conclusion to which it
does not legitimately lead. In virtue of that suggestive quality of his
mind (so important an aid in philosophical inquiries), he occasionally,
in all his writings, puts forth suppositions, but these only as
_questions_, the next in the order of inquiry, and these he asks of
nature alone.

Mr. Hunter had been the first in this country to make the true use of
anatomy; I mean in the sense that whilst it was no doubt the basis
of our investigation into the functions or uses of parts, still it
was only _one_ of an extensive series of inquiries. He had _examined_
the _dead_ with no purpose more earnestly, than to assist him in his
endeavours to _observe the living_; examined _parts_, that he might
better understand the whole. He had made himself familiar with the
economy of animals, and generally with the habits of organized beings,
whether animal or vegetable, that he might know their relations to each
other, and that of the _whole_ to the phenomena, habits, and laws,
of the _Human_ economy. As he neglected no source whence it had been
customary to seek for information, so, notwithstanding his fondness for
animals, he made various experiments on living creatures. But whilst
these experiments afford additional proofs of the poverty, so to speak,
of this plan of investigation, they impress on us the truth of Sir
Charles Bell’s assertion, that physiology is essentially a science of
_observation_. We have only to place Mr. Hunter’s _observations_ and
_experiments_ here referred to, in juxtaposition, in order to bring
out in high relief the great meaning and value of the one, and the
unnecessary, or inconclusive, character of the other. He also examined
the various facts presented to him in the _living_ body with unequalled
patience and circumspection.

Amongst others, he had paid particular attention to those which
exemplify that vivid, that watchful connection which exists between
various parts and organs, and by which impressions or sensations
excited in any one part are telegraphed, as it were, with the
swiftness of lightning to any or all of the organs of the body; facts
which may be observed by _anybody_, by no one better, and by few so
well, _as patients_ themselves. To take a common example: everybody
is familiar with the fact that certain disturbances of the stomach
produce pain or other annoyance in the head. Every one also knows that
in such cases there is very often no pain, and sometimes no sensation
of annoyance in the stomach; so that were it not from an innumerable
succession of such conditions, in connection with particular influences
on the stomach, we should, from the feeling of the _stomach only_,
never dream of the cause being in that organ. Now on these simple facts
hang not only the most practical of all John Hunter’s observations,
not only the most valuable of Mr. Abernethy’s, but (as far as we
can see) those relations through a philosophical examination of
which we shall still most auspiciously seek to extend our practical
knowledge of disease. We see here just that which Mr. Hunter had
asserted—namely, “that the organ _secondarily_ affected (in this case,
the head) sometimes appeared to suffer more than the organ to which the
disturbance _had first_ been directed.”

He observed also that the connection thus manifested, existed equally
between _all other parts_ and organs; that although it might be
exemplified in different forms, still the association it implied was
indisputable. He adopted the usual terms by which these phenomena had
been designated. Parts were said to _sympathize_ with each other, and
no term could be better, as it simply expressed the fact of associated
disturbance or suffering. It is true the _facts_ were not at all new;
they had always existed; nay, they had been observed and commented on
by many persons ever since the time of Hippocrates; and if I were to
mention the whole of such facts, there is scarcely one which would not
be to some one or other as familiar as a headache from disturbance of
the stomach. Mr. Hunter, however, had a kind of instinctive idea of
the yet unseen value of the clue thus afforded to the investigation of
disease; and he observed these facts with a greater attention to all
their details than any one, or all, who had preceded him.

Hunter’s observations on the subject in his lectures were extremely
numerous, and elaborate even to tediousness; Abernethy, who used to
give us a very humorous description of some of the audiences of John
Hunter on these occasions, was accustomed to say, “That the more
humorous and lively part of the audience would be tittering, the more
sober and unexcitable quietly dosing into a nap; whilst the studious
and penetrative few appeared to be seriously impressed with the value
of Mr. Hunter’s observations and inquiries.” Mr. Cline, an honoured
name in our profession, and one who, had he lived in later times, would
probably have been as distinguished in advancing science as he was for
his practical excellence, significantly expressed his impressions of
the future importance of the inquiries in which Hunter was engaged.
Addressing Mr. Clift, after one of the lectures, he said:

“Ah! Mr. Clift, we must all go to school again.”

Mr. Abernethy carefully treasured up and pondered on what he heard. He
placed himself as much as he could near Mr. Hunter; took every pains,
which his time and occupations allowed, thoroughly to understand him;
and, with his characteristic tendency to simplification, said: “Well,
what Mr. Hunter tells us, resolves itself into this: _that the whole
body sympathizes with all its parts_.”

His perceptivity, naturally rapid, was evidently employed in observing
the bearing of this axiom on the facts of disease. The digestive
organs, which, if we extend the meaning to all those engaged in
assimilating our food, compose nearly the whole viscera of the body,
could not escape his attention, nor indeed fail to be regarded in all
experimental investigations of any _one organ_. Accordingly, in his
paper on the skin and lungs, we have seen a very important application
of the relations between organs engaged in concurrent functions; we
have placed before us the physiological evidences of their being
engaged in a common function, and the sympathetic association it
rendered necessary; whence he had observed relations of great moment,
and pointed out the practical bearing they _must_ have on Consumption.
He had, however, been paying attention for some time to the digestive
functions, when his intimate friend, Mr. Boodle, of Ongar in Essex,
gave a fresh stimulus to his exertions. This gentleman requested him
to investigate the functions and conditions of the liver in various
nervous diseases, as also in certain affections of the lungs, which
had appeared to him, Mr. Boodle, to originate in the former organ.
Mr. Abernethy says: “I soon perceived that the subject was of the
highest consequence in the practice _of surgery_; for local diseases
disturb the functions of the digestive organs, and, conversely, a
deranged state of those organs, either occurring in consequence of such
sympathy, or _existing previously_, materially affects the progress of
_local complaints_.”

At the very commencement, he hits on a great cause of evil, and
boldly assails one of the most mischievous of all conventionalisms.
“The division of medicine and surgery,” he observes, “is mischievous,
as directing the attention of the two orders of practitioners too
exclusively to the diseases usually allotted to them.” There is indeed
no exaggerating the evils of that partial mode of investigation to
which such a custom almost necessarily leads. We fall into error, not
because of the difficulty of the subject, but because we never can, by
looking _at one set of diseased processes only_, learn the whole of
the facts belonging to the subject. It was just this that prevented
Fordyce from arriving at correct views of fever. Nothing could be
more excellent than the way he _began_ to consider it; but he hardly
begins, before he tells us that he intends to exclude those febrile
affections which fall under the care of surgeons. In doing this, he
at once abandoned a series of facts which are absolutely essential
to the investigation. It must be obvious, on a moment’s reflection,
that, if a particular condition of a part have a relation to the whole
body, the study of one without the other, or even if both be taken
up by different persons, nothing but the most imperfect views can
result. A jury, still more a judge, might in some cases guess from
partial evidence the issue of a legal investigation; but who ever
heard of either determining beforehand to examine a portion only of
that evidence? Yet it is not too much to say, that hardly any legal
question can be so recondite as many inquiries in physiology. The
nature of the case is always more or less obscured by a number and
variety of interfering circumstances. Diseases may be regarded, in
fact, as nothing more than natural laws, developed under _more or less
complicated circumstances of interference_.

Lord Bacon had warned all investigators of Nature of the danger of
attending only to a portion of the facts; it had been one of the great
bars to progress of knowledge in general. I regret to say that it still
continues the bane of _almost all medical inquiries_.

Abernethy’s inference in relation to this mutilated sort of
investigation is too true, when he observes that “the connection of all
local diseases with the state of the constitution has obtained little
notice;” whereas the truth is, that “no part of an animal body can be
considerably disordered without affecting the whole system.” Now here
Mr. Abernethy claims—what? Simply this: he claims for _function_—that
is, _the various offices fulfilled_ by the several parts and organs of
the body—that which Cuvier has so beautifully insisted on, and which
our own Owen has so instructively exemplified in regard to _structure
or formation_; namely, a _necessary relation_ between the whole and all
its parts.

In speaking of affections of the nervous system, Abernethy observes
that the brain may be affected by the part injured, and that _then_
it may affect the various organs by a “reflected” operation; but that
whatever _may be the mode_ (thus carefully separating the opinion from
the fact), “the fact is indisputable.” He adds that it may affect
some organs more than others, and thus give a character or name to a
disease. For example, it might affect the liver, we will say, when the
name which would be given would probably be expressive of what was a
secondary circumstance—namely, a disturbance of the liver. This does
not so frequently happen, perhaps, nor so mischievously in relation to
local injuries; but in other cases it is the cause of a great deal of
erroneous and misleading nomenclature.

As we have seen, it often occurs that when the organs of the body
are disordered, the more salient “symptoms,” perhaps the _whole_ of
those _observed_, are referred to a secondarily affected organ, and
the disease is named from that circumstance. The too frequent result
is, that attention is exclusively directed to that organ, whilst the
_cause_, being elsewhere, and where there _are no symptoms_, wholly
escapes observation.

This is a very important branch of inquiry; and as it closely connects
what Abernethy left us with what appears to us to be one of the next
things to be clearly made out, we will endeavour to illustrate it.

Suppose a person meet with a severe injury, a cut, bruise, fracture,
or any thing that we have seen a hundred times before, and, instead
of being succeeded by the _usual_ processes of repair, it be followed
by some others: the simple expression of the fact is, that something
has interfered with the _usual_ mode and progress of repair; and as
former experience has shown us that there was nothing in the nature of
the injury to account for this, we are naturally led to look for the
explanation of it in the state of the individual. But if the unusual
appearance be one which we have agreed to call “Erysipelas,” and we
are accustomed to see long papers written upon this appearance as a
_distinct disease_, we acquire a tendency, as every day’s experience
shows, to regard it as a kind of abstraction, or as an entity;
something composed of precise and definite relations, contained in
that particular description of case. Yet these relations may not be
in any two successive cases exactly alike. Again, all of them may be
subordinate to some more general character, probably a relation without
which we cannot readily explain the phenomena; but at which we cannot
arrive, because we have not comprehended a sufficient number of facts
in our inquiry to include it.

“Erysipelas” is nothing more than a natural law obscured; because,
as we have just hinted, it is developed under circumstances of
interference (from disordered conditions of the economy) which distort
the natural features of the law, modify its effects, or which may
prevent altogether its full development. But now, if we study the
means afforded by the various links _which other varieties of disease_
furnish, the ascertainment of the real relations becomes comparatively
_easy_; and we find that, whilst there are certain general relations
which belong to all cases, there are certain others which may in a
given number in succession be identical; or in no two exactly the same.

Partial investigations, leading, of course, to erroneous views, are
sure to entail on us a defective nomenclature; and then the two do very
materially contribute to continue the fallacies of each other. We may
have an affection of a lung, perhaps; the cause may not be in the chest
at all, although the lung may be inflamed or otherwise affected; but
we call it Pneumonia, or Pleuritis, or some other name which _simply
refers to what is happening to the part_; but all such names have
reference only to effects; they are extremely defective therefore, as
comprehending only a portion of the _nature_, and having no reference
whatever to the _seat_, of the _cause_ of the malady. The consequences
of all this may not be _necessarily_ mischievous; but they are so
lamentably common, as to continue to form a very large share of the
routine practice. The cause is elsewhere; but the remedies are directed
to the chest—that is, they are, in such cases, applied to effects,
not causes. If we must retain names so defective, it would be very
practicable to combine them with something which should indicate that
we had, at least, _looked_ for the cause. This would, at all events,
encourage a habit of looking beyond mere symptoms, and carry us at
least one link higher up the chain of causation.

Abernethy, in demonstrating the connection between local disease, or
injury, and general disturbance, judiciously takes cases where the
relation was most unequivocal; that is, where the local disturbance
consisted of a mechanical injury; such as in a gentleman who had
undergone an operation—in another who had met with a bad fracture
of his leg. In order to amplify his illustrations of the connection
between the brain and all parts with the digestive organs, he draws
them from all sorts of sources—from diseases the most severe and
dangerous, as well as from affections which are regarded as most common
or trivial—from the last stages of cancer and serious diseases of the
loins, to the common disturbances of teething in children—sources
which, from their apparent _dissimilarity_, confer, of course, the
strongest force on testimony in _which they combine_.

His delineation of the features by which disorders of the digestive
organs may be generally detected, is remarkably simple, clear, and
truthful.

Every word has the inestimable value also of being alike intelligible
to the public and the profession. His statement is interspersed
with remarks of great value, which, we trust, have not passed away
altogether unimproved: such as, that he had observed disorder of the
digestive organs produce states of health “similar to those” said to
be characteristic of the absorption of particular poisons—a most
recondite subject; but one, the obscurity of which has entirely, as
we think, resulted from the determination to regard the diseases to
which it refers as _abstractions_, and to investigate them under the
impenetrable shadow of _preconceived_ opinions.

Almost all his remarks have received more or less confirmation from
the experience of the whole civilized world. There are few things
in his observations more interesting than the emphatic way in which
they ignore the vulgar impression that he referred all diseases to
the stomach. In the whole round of scientific literature, it would be
difficult to find, in the same space, so complete or comprehensive a
view of _all_ those which we usually term the digestive organs.

Abernethy was very far from any such narrow views; whilst, in regard
to other organs, to which some of our most distinguished men had
paid particular attention, it is not too much to say, that, more
clear and precise than Curry, and equally careful with Hunter, not
less painstaking than our excellent Prout, he is more _practically_
penetrating and comprehensive on this subject than any of them. But as
to the charge of exclusive reference to the stomach, we shall easily
see there was no foundation for it.

In speaking of the reciprocal affections of the brain and the digestive
organs, he says: “The stomach is said to be chiefly concerned in
producing these effects; but the cause of the sympathetic affection is
probably more general.” Page 48. He then goes on to exemplify causes
acting on the _Liver_, and so forth. Page 49.

He distinctly contends that _other_ of the chylopoetic organs may
disturb the brain as well as the stomach. Again, at page 52, he
repeats a similar opinion, and especially adds, that when the
alimentary canal _is_ affected, we can never be sure that it is
_primarily so_.

He also says, at page 53, that, in some cases, the disorder of the
digestive organs is dependent on disease of the brain.

I have alluded to these passages, because nothing is more unjust
to Abernethy than to suppose that he attributed everything to the
stomach, or restricted his attention to that or any other organ. Such
a misapprehension also tends indefinitely to impede the practical
application of his principles, and to deprive us of the advantages
which are so constantly derivable from them.

This is so important, that it may be useful to consider a little the
circumstances which may have thus misled the public, and we fear, not
unfrequently, the profession also, in the interpretation of Abernethy’s
views.

In conducting the treatment of diseases of the digestive organs,
whatever organ we may desire to influence, either by inducing
tranquillity of the nervous system, or by the selection of food
appropriate to the actual condition of the organ specially affected,
the stomach is necessarily a primary consideration.

The reasons for this are sufficiently obvious, but have not perhaps
been always adequately regarded. Digestion is, on the whole, a
manufacture, so to speak, of a raw material (food) into a fluid
(blood), which is to be absolutely adapted to purposes for which it is
designed. This is effected not by one, but by several organs, which
each produce their respective changes in the materials submitted to
them. If we desire, therefore, to adapt the work to any organ which is
engaged in this process, however remote it may be from the stomach,
which, with the teeth and other auxiliaries, execute the _first_
process in the manufacture, it is quite clear that we must begin with
the _first process_ to which we subject the said raw material or
food. Say that in a machine for the manufacture of cloth the spinning
apparatus were out of order, we must begin by giving out a less
quantity of wool to the carding machine, or whatever represented the
first process; because, having once delivered the wrong quantity or
quality, we have no means of recalling it, and we should only still
further derange the defective machinery.

So in the body; the liver, kidney, and other organs, not excepting the
lungs and skin; their work must all bear relation to the quantity or
quality of raw material, whether their function be the manufacture of
the new product, or the rejection of that which is useless. So that
supposing there were no other reason, no other than this mechanical
relation (which is very far from the real state of the case), still we
must _de facto_ begin with the stomach, even where we entertain _no
idea of any_ special derangement of that organ. The stomach, however,
is very important in another sense, and has a power of indicating the
necessity of attention to those points which I have endeavoured to
illustrate by the homely similitude of a manufacture.

Wherever impressions _first_ act on the body, nature has placed a most
vigilant guard. This is variously managed in different cases; the
result is the same, and, as it would appear, the final cause also. In
the eye, there is the most beautiful contrivance for moderating the
ingress of light, as also any abrupt increase of intensity. Fringed
curtains are provided which can close with electrical celerity. Again,
the aperture by which light is finally admitted into the eye is vividly
contractile or expansive, as the occasion may require; then again
there are various media of different densities, through the influence
of which even the velocity of light undergoes practical retardation
by repeated refractions; and lastly, there are powers of sensual
adaptation in the nerve with which the light is ultimately brought in
contact, more wonderful than all.

The ear, being likewise a portal for external impressions, is guarded
with equal care. Not a single vibration of air can ever reach the nerve
of the ear with the crude intensity (if I may use the expression) with
which it is generated. Passing over preliminary apparatus, by which
the vibrations of air are first collected, the impressions of sound
are first received on the parchment of a little drum, which parchment
can be relaxed or tightened with the quickness of thought, so as to
modify the force of the impression. This impression is then, by means
of a little chain of bones, conveyed across the drum, which is filled
with air. It then reaches a portion of the ear in which are found very
curious cavities and canals, of various forms, and taking different
directions, and which, from the curious and complex arrangement of
the whole, is not inappropriately called the labyrinth. This is the
mysterious seat of those nerves which convey impressions to the brain.
There is, however, here, an arrangement more exquisite than any we have
yet mentioned.

In these cavities and canals, which are themselves so small as to be
not unfit objects for magnifying glasses, there are corresponding
delicate sacs and tubes, and these are filled with a limpid fluid.
On this delicate apparatus, so exquisitely calculated to modify any
undue force of impression, the sensitive extremities of the auditory
nerves are spread out, which convey impressions to the brain. We
see, therefore, how carefully these portals of the body are guarded;
arrangements equally conservative prevail throughout. We might show a
similarly exquisite arrangement in the laws governing the mind; but
that is not our present object. We have seen hitherto that, beautiful
as the arrangement is for securing us against painful impressions, it
has been in a great degree mechanical.

The stomach, however, is the portal to a vast series of important
organs, and is protected by a phalanx of sentinels, endowed with powers
proportioned to the importance of the organ which they guard. There
is little that falls within any idea which we can express by the term
mechanical; everything is subjected to an examination essentially
sentient; to powers residing in the nerves; the _laws_ and _operations_
of which, we can with proper attention trace out, but which exhibit
powers demonstrative of an intensity and refinement of which our
limited perceptions scarcely enable us to form a definite idea.

First, there is the olfactory nerve, between which and the stomach
there is the most vivid sympathy.

Until our tastes become vitiated, the stomach seldom admits anything
of which the nose reports unfavourably. The sense of smell, even in
the somewhat measured power possessed by man, is capable of detecting
forms of matter so subtle as to be beyond our powers of imagination.
Nothing which so plainly deals with “matter” impresses more strongly
the immense range which must exist between the chemistry of life and
that of the laboratory. We all know the extraordinary powers of musk.
I have myself a small mass of odorous matter (a Goa ball) which, from
the circumstances under which it came into my possession, must have
been emitting the odour for little less than a century. It has been
exposed to air, is covered by a film of gold (I believe), is in no
respect visibly changed, and for the last thirty years not detectably
in weight; yet at this moment it emits as strong an odour of musk as
ever. How exquisitely subtle must be the matter thus emitted; or how
still more wonderful if it merely so modifies the atoms of air in its
neighbourhood as to produce odour. We have no intellectual powers which
enable us to realize a conception of such infinite tenuity of matter;
yet the sense of smell instantly detects its presence.

Next come the nerves of the tongue; and here again, in natural
conditions, there is a constant harmony between them and the
stomach—that to which the taste readily gives admission being, in
_undisturbed_ conditions of the economy, some guarantee that it is
innoxious; but what these _functions are to the stomach_, the stomach
is _to the other organs_. In the first place, in natural conditions
it usually at once rejects any noxious material which, from being
disguised, or from any other circumstances, may have eluded the
vigilance of the sentinels I have mentioned; but it has a vivid
sympathy with every organ in the body. If anything deleterious be once
admitted, it has to go through various processes, which may render it
a source of indefinite disturbance; therefore, if any organ in the
series of the blood-manufacture be materially disturbed—that is, so as
to be disabled—the stomach usually refuses food; because there is no
other way of stopping the mischief. Illustrations of this occur in many
disorders of the kidney, in many affections of the alimentary canal, as
also of the liver, and other parts.

No doubt the stomach is therefore a most important organ; but to
suppose that it is therefore always the seat of disorder, is not only
a most mischievous error, but a complete blind to its most beautiful
and instructive relations; and as opposite to Mr. Abernethy’s views as
the most narrow can be to the most comprehensive. Proceeding with his
illustrations, Mr. Abernethy cites a number of most instructive cases,
such as palsy and other affections of most serious character, which
too often result either from organic disease of some organ, or from
mechanical pressure on the brain or spinal marrow, but which in the
cases cited depend on disorder of the digestive organs.

It is impossible to exaggerate the interest or importance of these
cases; not only from the fact that they almost certainly would have
led to organic disease, but also for the value of that practical
discrimination which they exemplify. Again, the very treatment which
would have been proper, which had sometimes been begun, and which
was not inappropriate to cases of _organic_ disease, with which the
symptoms were in part identical, would have inevitably, in the cases
in question, only served to exasperate the very conditions they were
designed to relieve, and to hasten those processes against which they
were intended to guard.

No one can understand the force of these cases, without recollecting
the intense difficulty of ascertaining that point at which disorder
ceases to be merely functional, and at which organic disease begins.
This is of all things the most difficult to determine in the whole
circle of physiological or pathological inquiry.

The _symptoms alone_ are absolutely useless in any case of real
difficulty. Of that Abernethy was well aware, and he did much to guard
us against the error into which a reliance on them was calculated to
lead. He knew that organs which were diseased would sometimes afford
indications not distinguishable from those of health; and that,
conversely, organs essentially sound would sometimes only afford those
signs which were indicative of disorder. We have, we trust, made some
little progress in this very difficult branch of inquiry; and although
it is true that organic disease not unfrequently escapes detection
during life, yet, so far as we have observed, it is only in those cases
in which there is, notwithstanding the daily lessons of experience,
an _improper reliance_ on what are called the symptoms. We assert,
without the least hesitation, that organic diseases should seldom
elude detection where the investigation is sufficiently comprehensive;
but it must include _all the facts_ of the case, the early history,
and such circumstances which, however remote, have been over and over
again proved to be capable of exerting an influence on the body; an
investigation which, however vainly pleaded for in medical science,
however regarded as too exacting, involves nothing more in principle
than is required as a matter of course _in all other_ scientific
investigations.

When these conditions are observed, it is very rarely that we cannot
detect organic affections in organs in which there may be no _present_
symptoms. In relation to the _extent_ to which they may be affected,
it is true we have yet much to learn; still, if cases be judged of not
by the history _merely_, nor by the symptoms _merely_, but by both
in conjunction, and if to these be added a careful observation of
the _amount_ of work that the organs are separately or collectively
doing, as _compared with their natural proportions_; together with
a careful estimate of that which the actions of any visible disease
may be eliminating from the body; then, indeed, we have good ground
for hope that means will be opened to us of distinguishing more
accurately various states of the system; and additional principles and
powers disclosed of readjusting the disturbed balance of the various
functions, which is the essential element of disease.

[Footnote 29: “History of the Inductive Sciences.”]

[Footnote 30: Butler’s “Analogy.”]

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