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

by G. T. Bettany

The leading topics under which these famous lectures are comprised are: Nutrition, Hypertrophy, Atrophy, Repair, Inflammation, Mortification, Specific Diseases, and Tumours. The concluding passage of the second lecture, on “The Conditions Necessary to Healthy Nutrition,” is a fine exposition of a view of the relation between the mind and a changing brain. “In all these things, as in the phenomena of symmetrical disease, we have proofs of the surpassing precision of the formative process, a precision so exact that, as we may say, a mark once made upon a particle of blood or tissue is not for years effaced from its successors. And this seems to be a truth of widest application; and I can hardly doubt that herein is the solution of what has been made a hindrance to the reception of the whole truth concerning the connection of an immaterial mind with the brain. When the brain is said to be essential, as the organ or instrument of the mind in its relations with the external world, not only to the perception of sensations, but to the subsequent intellectual acts, and especially to the memory, of things which have been the objects of sense—it is asked, how can the brain be the organ of memory when you suppose its substance to be ever changing? or how is it that your assumed nutritive change of all the particles of the brain is not as destructive of all memory and knowledge of sensuous things as the sudden destruction by some great injury is? The answer is—because of the exactness of assimilation accomplished in the formative process; the effect once produced by an impression upon the brain, whether in perception or in intellectual act, is fixed and there retained; because the part, be it what it may, which has been thereby changed, is exactly represented in the part which, in the course of nutrition, succeeds to it. Thus, in the recollection of sensuous things, the mind refers to a brain in which are retained the effects, or rather the likenesses of changes that past impressions and intellectual acts had made. As, in some way passing far our knowledge, the mind perceived and took cognisance of the change made by the first impression of an object, acting through the sense organs on the brain; so afterwards, it perceives and recognises the likeness of that change in the parts inserted in the process of nutrition.

“Yet here also the tendency to revert to the former condition, or to change with advancing years, may interfere. The impress may be gradually lost or superseded, and the mind, in its own immortal nature unchanged, and immutable by anything of earth, no longer finds in the brain the traces of the past.”

In 1854 Mr. Paget gave one of the series of lectures on Education at the Royal Institution, in which Whewell, Faraday, and others took part. His lecture on the Importance of the Study of Physiology as a branch of education for all classes, was marked by elevation of thought and practicality of aim. One interesting point that he dwelt on was that a wider scheme of education would be more likely to discover men fitted for particular work. “It has seemed like a chance,” he said, “that has led nearly every one of our best physiologists to his appropriate work; like a chance, the loss of which might have consigned him to a life of failures, in some occupation for which he had neither capacity nor love.” The value of physiological instruction is now generally admitted, but the practical application is almost as generally neglected.

Sir James Paget has published but too few of his thoughts to the public and the profession; but all that have been given to the world have been of sterling worth. His Clinical Lectures and Essays, collected in 1875, include some of the most interesting reading imaginable. He deals among other subjects with the various risks of operations, the calamities of surgery, stammering with other organs than those of speech, cases that bone-setters cure, dissection poisons, and constitutional diseases. Some of the most instructive of the series are those which describe forms of nervous mimicry of serious diseases. An extract from “The Calamities of Surgery” gives clear expression to Sir James Paget’s views on preparation for operating:—

“Look very carefully to your apparatus. I have no doubt that you will look very carefully to the edges of your knives and your saws and all things that are mighty to handle; but look to the plaster, look to the ligatures and the sutures, and all the things which are commonly called minor. When I have seen Sir William Fergusson and Sir Spencer Wells operate, I have never known which to admire most; the complete knowledge of the things to be done, the skill of hand, or the exceeding care with which all the apparatus is adjusted and prepared beforehand. The most perfect plaster, the most perfect silk, not one trivial thing left short of the most complete perfection it is capable of. I have no doubt that the final success of their operations has been due just as much to these smaller things as to those greater things of which they are masters.”

The lecture on Dissection Poisons was especially called forth by an illness from which he suffered for three months in 1871, caught from attending the post mortem examination of a patient who had died of pyæmia. Yet he had no wound or crack of the skin of any kind. In closing the lecture Sir James remarked: “Sir William Lawrence used to say that he had not known any one recover on whose case more than seven had been consulted. Our art has improved. I had the happiness of being attended by ten: Sir Thomas Watson, Sir George Burrows, Sir William Jenner, Sir William Gull, Dr. Andrew, Dr. Gee, Mr. Cæsar Hawkins, Mr. Savory, Mr. Thomas Smith, Mr. Karkeek. In this multitude of counsellors was safety. The gratitude I owe to them is more than I can tell—more than all the evidences of my esteem can ever prove.”

In an address on Theology and Science, delivered to students at the Clergy School at Leeds, in December 1880, Sir James Paget remarks that “in theology, and in the Christian faith which it expounds, there are not only clear evidences which, in their accumulated force, cannot, I think, be reasonably resisted by those who will fairly collect and try them; but there are convictions of religious faith, not always based on knowledge, or on other evidence than the faith which is ‘the evidence of things unseen,’ which may justly be held as unalterable, because they are consistent with revelation, and have been sustained by the testimony of clouds of witnesses, and, I believe, have in many minds the testimony of God’s indwelling Spirit.” He expresses the belief that the truths and highest probabilities of science and religion may justly be held together, though on different grounds, and that they are not within reach of direct mutual attack. He advises clerical students, if they touch upon such questions, to undertake some real study in science, by observation, by experiment, by collecting, as well as by reading. “And let your reading be in the works of the best masters, that you may learn their true spirit, their strength, their methods of observing and thinking, their accuracy in describing.”

Sir James Paget appears as a champion of moderation in the Contemporary controversy on the Alcohol Question. He says that the presumption in favour of moderation is strengthened by comparing those of our race who do not and those who do habitually use alcoholic drinks. “As to working power, whether bodily or mental, there can be no question that the advantage is on the side of those who use alcoholic drinks. And it is advantage of this kind which is most to be desired. Longevity is not the only or the best test of the value of the things on which we live. It may be only a long old age, or a long course of years of idleness or dulness, useless alike to the individual and the race. That which is most to be desired is a national power and will for good working and good thinking, and a long duration of the period of life fittest for these; and facts show that these are more nearly attained by the people that drink alcohol than by those who do not.”

Sir James Paget holds or has held appointments too numerous to mention. After a long and honourable career as Assistant-Surgeon and Surgeon to St. Bartholomew’s, he became Consulting Surgeon. As a member of the Council of the College of Surgeons and for some years President, and also as a member of the Senate, and for some years Vice-Chancellor of London University, he has exercised powerful influence on the improvement of medical education and on medical politics generally. He is Surgeon to the Prince of Wales and Serjeant Surgeon-Extraordinary to the Queen. A baronetcy was conferred upon him in August 1871, and he has received honorary distinctions in abundance from both British and foreign universities.

In 1882 in his Bradshawe lecture, “On some Rare and New Diseases,” Sir James Paget remarked on the increase in the number of real students, which he has had a large share in creating. “I have been often made happy by the contrast which I have seen while working at the new edition of the catalogue of the pathological specimens in the College of Surgeons’ museum. While I was writing the last edition, between thirty and forty years ago, scarcely a student ever entered the museum. Hour after hour I sat alone; I seemed to be working for no one but myself, or for nothing but the general propriety that a museum ought to have a catalogue, though no one might ever care to study with it. Now, and for some years past, a day rarely passes without many pupils and others being at work in every part of the museum.”