On the other hand, he never failed to give the warmest and most efficient sanction he could to what he conceived to be judicious treatment on the part of a practitioner with whom he was in consultation. Mr. Stowe has kindly sent me a very good example of this; and it illustrates also another very valuable feature in a consultant: the forbearance from doing anything where nothing is necessary. A gentleman had met with a severe accident, a compound dislocation of the ankle, an accident that Abernethy was the chief means of redeeming from habitual amputation. The accident happened near Winterslow Hut, on the road between Andover and Salisbury, and Mr. Davis of Andover was called in. Mr. Davis placed the parts right, and then said to the patient, "Now, when you get well, and have, as you most likely will, a stiff joint, your friends will tell you— 'Ah! you had a country doctor.' So, sir, I would advise you to send for a London surgeon to confirm or correct what I have done." The patient consented, and sent to London for Abernethy, who reached the spot by the mail about two in the morning. He looked carefully at the limb, and saw that it was in a good position, and was told what had been done. He then said, "I am come a long way, sir, to do nothing. I might indeed pretend to do something; but as any avoidable motion of the limb must necessarily be mischievous, I should only do harm. You are in very good hands, and I dare say will do very well. You may indeed come home with a stiff joint; but that is better than a wooden leg." He took a cheque for his fee (sixty guineas), and made his way back to London.
Soon after this, an old clergyman, in the same neighbourhood, had a violent attack of erysipelas in the head and arm. His family, becoming alarmed, wrote up to his brother, who resided near Bedford Row, to request Mr. Abernethy to go down and visit the patient. Abernethy said, "Who attends your brother?" "Mr. Davis[69], of Andover." "Well, I told him all I knew about surgery, and I know he has not forgotten it. You may be perfectly satisfied. I shall not go." Here, as Mr. Stowe observes, he might have had another sixty guineas.
He always felt a great deal of interest about compound dislocations of the ankle-joint; because of his conviction that amputation, then so commonly resorted to, was unnecessary. He used to tell several cases in his lectures. One of them we will briefly relate here. It was that of a labouring man, who fell off a scaffold in his own neighbourhood; and, amongst other surgeons, they had sent for Abernethy. When he got to the house, he found, he says, "a poor wee man, lying on his mattress, with a very complete compound dislocation of the ankle-joint. The joint was completely exposed, and the torn skin was overlapping the edge of the bone." He placed the parts in their natural position, and drew the skin out of the rent; and when he had thus adjusted it, as he said, a horrible accident looked as if there had been very little the matter. "Do you think, sir," said the poor little man, "that this can ever get well?" "Yes, verily," said Abernethy. "Do not be out of heart about it; I have known many such cases do well." "Why, sir," said the man, "they have gone for the instruments." "I now found," said Abernethy, "that two other surgeons had seen him, and had determined that it was necessary to amputate. I felt that I had got into an embarrassing predicament, and was obliged to wait until these heroes returned. When they arrived, and saw the man lying so comfortably, they seemed a little staggered: but one of them said, 'Mr. Abernethy, you know the serious nature of these accidents, and can you give us an assurance that this will do well?' I said, 'no, certainly not; but if it does not do well, you can have recourse to amputation afterwards, and my surgical character is pledged no further than this. I give you the assurance that no immediate mischief will come on to endanger the man's life. You may wait and see whether his constitution will allow him to do well.' I added: 'I feel that I am got rather into a scrape; so you must allow me to manage it in my own way.' So I got splints, put up the limb, varnished the plaister, and then told them about sponging it continually, so as never to allow any increase of temperature. Now there are two holds you have on a patient's mind—hope and fear; and I make use of both. So I said, 'If you lie perfectly still, you will do well; and if you move one jot, you will do ill—that's all.'" The remainder of the case need not be given. The man recovered, and saved his limb.
We have referred to that case because, though relating to a professional matter, there is a moral in it. He might easily have saved himself all the trouble he took, and on the plea of etiquette; but the poverty of the man pleaded for his limb, and the impossibility in such a case, of the imputation of any wrong motive, left free exercise for the prevailing feature of Abernethy's character—benevolence. The mention of the instruments secured to the poor man that personal attention to details by Abernethy himself which a more wealthy patient might not have so certainly obtained.
We have remarked before on his kindness to hospital patients; and sometimes the expression of their gratitude would be very touching. It is difficult or impossible to carry out Mr. Abernethy's principles of practice with perfect efficiency in the atmosphere of a large hospital in a crowded city, yet the truth of his views would sometimes be impressed by very extraordinary and unexpected results. We select the following as an example, for reasons which will be suggested by the narrative. We are indebted to Mr. Wood[70], of Rochdale, for the illustration; and, as we should only mar the scene by any abbreviation, we must allow him to tell it in his own manner:
"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—that 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 a 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 his 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.'"
The following letter, though containing nothing extraordinary, still shows his usual manner of addressing a patient by letter:
"Sir,
"In reply to your letter, I can only say what I must have said to you in part, when you did me the honour of consulting me.
"Firstly. That the restoration of the digestive organs to a tranquil and healthy state, greatly depends on the strict observance of rational rules of diet. My opinions on this subject, which are too long to be transcribed, are to be met with at page 72, of the first part of 'Abernethy's Surgical Observations,' published by Longman and Co., of Paternoster Row.
"Secondly. Upon keeping the bowels clear, yet without irritating them by over-doses of aperient medicine.
"Thirdly. I consider the blue pill as a probilious medicine, and only urge that the dose be such as to do no harm, if it fail to do good, and then to be taken perseveringly for some time, in order to determine whether it will not slowly effect the object for which it was given. In gouty habits, carbonate of soda, &c., may be given, to neutralize acidity in the stomach, with light bitters; but the prescription of medicines of this kind, as also any advice relative to the cold bath, must rest with your medical attendant."
Dated the 17th of September; as usual, with him, without the year, which was about 1824.
It is obvious that very few professional letters are adapted for introduction. This was one kindly sent us by Mr. Preston, of Norwich, and was written to a gentleman in Yorkshire.