Eminent doctors: Their lives and their work; Vol. 1 of 2

by G. T. Bettany

“Ah, there is no saying too much on the importance of recollecting the course of large arteries; but I will tell you a case. There was an officer in the navy, and as brave a fellow as ever stepped, who in a sea-fight received a severe wound in the shoulder, which opened his axillary artery. He lost a large quantity of blood, but the wound was staunched for the moment, and he was taken below. As he was an officer, the surgeon, who saw he was wounded severely, was about to attend to him, before a seaman who had been just brought down. But the officer, though evidently in great pain said: ‘Attend to that man, sir, if you please, I can wait.’ Well, his turn came; the surgeon made up his mind that a large artery had been wounded; but as there was no bleeding, dressed the wound, and went on with his business. The officer lay very faint and exhausted for some time, and at length began to rally again, when the bleeding returned; the surgeon was immediately called, and not knowing where to find the artery, or what else to do, told the officer he must amputate his arm at the shoulder-joint. The officer at once calmly submitted to the additional but unnecessary suffering; and as the operator proceeded, asked if it would be long; the surgeon replied that it would be soon over; the officer rejoined: ‘Sir, I thank God for it!’ but he never spake more.”

Amidst death-like stillness, Abernethy quietly concluded: “I hope you will never forget the course of the axillary artery.”

It has been, we believe, a somewhat general impression, that Abernethy as a lecturer indulged in tricks or extraordinary gesticulations. But this is by no means correct. There was a method in every item of his procedure, and all he aimed at was to impress upon the students’ minds in the most forcible and abiding way the ideas he wished to convey. He gained, it is said, the appearance of perfect ease without the slightest presumption; and had no offensive tricks. Macilwain, who was his pupil at his best period, says: “The expression of his countenance was in the highest degree clear, penetrative, and intellectual; and his long but not neglected powdered hair, which covered both ears, gave altogether a philosophic calmness to his whole expression that was peculiarly pleasing. Then came a sort of little smile, which mantled over the whole face, and lighted it up with something which we cannot define, but which seemed a compound of mirth, archness, and benevolence.... There was a sort of running metaphor in his language, which, aided by a certain quaintness of manner, made common things go very amusingly. Muscles which pursued the same course to a certain point, were said to travel sociably together, and then to part company. Blood-vessels and nerves had certain habits in their mode of distribution, contrasted in this way; arteries were said to creep along the sides of or between muscles: nerves, on the contrary, were represented as penetrating their substance without ceremony.... He was particularly happy in a kind of cosiness or friendliness of manner which seemed to identify him with his audience; as if we were all about to investigate something interesting together, and not as if we were going to be ‘lectured’ at at all. He spoke as if addressing each individual, and his discourse, like a happy portrait, always seemed to be looking you in the face.”

In consultation or in ordinary practice, Abernethy was only rough and hasty when something annoyed him. Towards his fellow-practitioners who could give a reason for their opinions or their treatment, he was polite and even deferential. He never recommended interference with judicious plans of cure in order to gain éclat for himself, nor unless some important end were to be obtained. He was no party to concealments or deceptions being practised on the friends of patients, and in many cases told the plainest of plain truths to patients themselves. “Pray, Mr. Abernethy, what is a cure for gout?” was the question of an indolent and luxurious citizen. “Live upon sixpence a day—and earn it,” was the cogent reply. He is reported to have been consulted by the Duke of York; and to have stood before him, as usual, whistling, with his hands in his breeches-pockets. The astonished Duke remonstrated: “I suppose you know who I am.” “Suppose I do,” replied Abernethy, “what of that?” And he advised the Duke, in reference to his complaint: “Cut off the supplies, as the Duke of Wellington did in his campaigns, and the enemy will leave the citadel.” A barrister came to Mr. Abernethy with a small ulcer on his leg, which had proved difficult to heal. Having heard much of his impatience and peculiar manners, he began to pull down his stocking as soon as he entered his consulting-room. “Holloa! holloa! what the devil are you at?” exclaimed the surgeon. “I don’t want to see your leg; that will do, put it up, put it up.” The patient did so, but marked his displeasure by placing only a shilling upon the table when he left. “What is this?” asked Abernethy. “Oh,” replied his patient, “that will do, put it up, put it up,” and coolly retired.

It is said that Abernethy’s impatience frequently arose from his anxiety to be at his hospital duties; and that instead of representing this in a proper manner, he would sometimes almost push patients from his door. Sir Astley Cooper received many a fee from those who had quitted Abernethy, or would not venture to encounter his rudeness. To his hospital patients, especially those who were in great distress, he was all kindness. Their gratitude was sometimes amusingly demonstrated. Mr. Stowe relates one example of this: “It was on his first going through the wards after a visit to Bath, that, passing up between the rows of beds, with an immense crowd of pupils after him, myself among the rest—the apparition of a poor Irishman, with the scantiest shirt I ever saw, jumping out of bed, and literally throwing himself on his knees at Abernethy’s feet, presented itself. For some moments everybody was bewildered; but the poor fellow, with all his country’s eloquence, poured out such a torrent of thanks, prayers, and blessings, and made such pantomimic displays of his leg, that we were not long left in doubt. ‘That’s the leg, yer honnor! Glory be to God! Yer honnor’s the boy to do it! May the heavens be your bed! Long life to your honnor! To the divole with the spalpeens that said your honnor would cut it off!’ &c. The man had come into the hospital about three months before, with diseased ankle, and it had been at once condemned to amputation. Something, however, induced Abernethy to try what rest and constitutional treatment would do for it, and with the happiest result. With some difficulty the patient was got into bed, and Abernethy took the opportunity of giving us a clinical lecture about diseases and their constitutional treatment. And now commenced the fun. Every sentence Abernethy uttered Pat confirmed. ‘Thrue, yer honnor, divole a lie in it. His honnor’s the grate dochter entirely!’ While at the slightest allusion to his case, off went the bed-clothes, and up went the leg, as if he were taking aim at the ceiling with it. ‘That’s it, by gorra! and a bitther leg than the villin’s that wanted to cut it off!’ This was soon after I went to London, and I was much struck with Abernethy’s manner in the midst of the laughter. Stooping down to the patient, he said with much earnestness: ‘I am glad your leg is doing well; but never kneel, except to your Maker.’”

Many are the stories in which Abernethy’s name appears; many have been exaggerated; many are falsely connected with his name. Sometimes he would, instead of crushing a victim, become sufficiently the victim himself. A lady once said to him: “I had heard of your rudeness before, but I did not expect this.” When he handed her his prescription, she asked: “What am I to do with this?” The rough reply was, “Anything you like. Put it in the fire if you please.” The lady took him at his word, laid down her fee, threw the prescription into the fire, and left the room; nor could Abernethy persuade her to receive her fee again, or a fresh prescription. Notwithstanding all stories to his disadvantage, there is no doubt that Abernethy’s intentions were most kind, and that he never took a fee from a patient who might possibly be unable to afford it comfortably. For these two reasons, his not unfrequent roughness, and his leniency about fees, he certainly had a much smaller income than he might have secured. Yet his income was very considerable, but not carefully managed. One day calling to pay his wine merchant for a pipe of wine, he threw down a handful of notes, and pieces of paper with fees. On being asked to wait till all were accurately counted, as some of the fees might be more than he thought. “Never mind,” said he, “I can’t stop; you have them as I took them,” and hurried away.

It is now time to refer to some of Abernethy’s principal publications. In 1793 he published his first volume of Surgical and Physiological Essays, including his celebrated essay on lumbar abscess, in which he details a simple and beautiful method of cure which has since been largely followed. In the second volume of these essays, a paper on the functions of the skin details some careful experiments upon the air in which the hand or foot had been confined for some time. He detected some carbonic acid in such air, and founded upon the experiments important views as to the necessity of keeping the skin cleansed and in healthy action. The third part of these essays, published in 1797, contained an important paper on injuries of the head, deprecating among other things all unnecessary interference, and so preventing many a fruitless operation. In 1806 appeared Abernethy’s Surgical Observations, including an account of the disorders of health in general, and of the digestive organs in particular, which accompany local diseases, and obstruct their cure. Whenever he wished to impress upon a patient or a practitioner the importance of attending to the general health, and the stomach in particular, if some local disease was to be cured, he always referred to his book, so that his phrase “read my book” was expected as a certainty. But it appeared sometimes as if he perceived disorder of the digestive organs in every case. A lady who had an affection outside the knee-joint occasioned by a blow against the edge of a step, went to Mr. Abernethy, and was about to show the affected part, when he rudely exclaimed, “I don’t want to see your knee, ma’am! allow me,” and pressed his fist with force against her stomach. She of course cried out, and he of course attributed her disorder to her stomach. Nevertheless she recovered without medicine, by strictly local treatment of the knee, under Dr. Pettigrew.

In all Abernethy’s writings there was manifested a lack of good arrangement which contrasts strikingly with his excellence as a lecturer: but in the latter capacity his audience was always before him, and he could see and test the suitability of his matter. Education had not furnished him with real literary training, and his aptness of expression and his wit do not appear to striking advantage in his written works.

Abernethy was married on the 9th January 1800 to Miss Anne Threlfall, whom he had met at a house to which he had been professionally called in. His courtship was brief; his proposals were made by letter; he characteristically deprecated too much “dangling,” gave the lady a fortnight to consider her reply; and was successful. Not for one day did he interrupt his hospital lectures.

In 1815, after twenty-eight years’ tenure of the office of assistant-surgeon, Abernethy became full surgeon on the retirement of his old master, Sir Charles Blicke. He made the appointment the occasion for publishing a pamphlet on the evils attending the prolonged tenure of office by old surgeons. He himself had lectured for twenty-eight years, and been largely influential in filling the hospital with students, from whose hospital fees he received nothing whatever. About the time of his succession to the surgeoncy he took a house at Enfield, to which he resorted on Saturdays, gladly quitting his own house in Bedford Row for a quiet country ride. In the summer he would retire to Enfield on most evenings. This tended very much to the benefit of his fidgety nervous system. From early life his heart had been particularly irritable, causing him frequent suffering. A wound which he accidentally gave himself in dissecting at one time caused him such a severe illness that it was three years before he had recovered from its effects, which appeared in very varied forms. It must be acknowledged, too, that he was not as moderate in eating as he exhorted his patients to be. He frequently was attacked by inflammatory sore-throat, terminating in abscess.