Memoirs of John Abernethy / With a View of His Lectures, His Writings, and Character; with Additional Extracts from Original Documents, Now First Published

by George Macilwain

The humanity and science that beholds, in operative surgery, the lowest of our employments, and which would thence be impelled to seek, and as experience has taught us to seek successfully, to diminish the number of such exhibitions, and to lessen the suffering of those which are still retained, is perfectly compatible with coolness and skill in the performance of them.

When we speak of lessening pain, we must not be understood as alluding to chloroform, or agencies of that kind. We have, on the contrary, the greatest distrust of their utility; we do not hesitate to admit the propriety of their use in certain cases; but we are satisfied that, as at present employed, a very few years will make a great change. Many a so-called incurable case has been shown to be curable by the hesitation of the patient to submit to an operation. We have published some ourselves, wherein we joined in recommending the measure which the patient declined. Many deaths that we do know have already occurred from the use of chloroform; and a significant remark was made by a man who had considerable reputation in this way. He said: "Chloroform is a good thing for operating surgeons."

To return from this digression. The most distinguished surgeons ever known in this country have shown us how to combine, in the highest degree, dexterity and skill, with science and humanity; together with a just estimate of the low position occupied by operations in the scale of our important studies. I may allude to two more particularly, Cheselden and John Hunter; the former, the most expert and successful operator of his day, in the European sense of the word, has left us a satisfactory declaration on this subject. Cheselden acknowledges that he seldom slept much the night previous to the day on which he had any important operation; but that, once engaged in operating, he was always firm, and his hand never trembled. John Hunter was not only a good operator himself, but he deduced from observation one of the greatest improvements in operative surgery. His discovery had all the elements of improvement that are possible in this branch of the profession.

An operation which had been founded upon erroneous views of the nature and relations of the parts affected—which had been always tedious and painful in performance—which, whether successful or not, entailed much subsequent suffering, which in its results was highly dangerous, and which was very commonly followed by the loss of the limb or life,—was replaced by one founded on more correct views of the disease, easy and simple in its execution, occupying not more than a very few minutes, and which, so far as regards the purpose for which it was instituted, and to which it should be restricted, is almost invariably successful. If it be performed under circumstances implying conditions contrary to those on which Mr. Hunter's operation was founded, very different results have no doubt taken place; but, when properly applied, his operation for aneurism is no doubt one of the greatest improvements in operative surgery.

John Hunter treats of operations in terms which show how low he rated that part of our duties. He speaks of them as humiliating examples of the imperfection of our science, and figures to himself an operator under the repulsive symbol of an armed savage. "No surgeon," said he, "should approach the victim of his operation without a sacred dread and reluctance, and should be superior to that popular éclat generally attending painful operations, often only because they are so, or because they are expensive to the patient"—p. 210. Abernethy, whose keen observation saw the difficult web which various sophistries, to use no harsher term, had thrown around the subject, was very characteristic in the manner in which he dashed it aside, and pointed to the salient source of error.

"Never perform an operation," he would say, "on another person, which, under similar circumstances, you would not have performed on yourself."

The truth is, that operations, to be performed properly, must be properly studied. They must be frequently performed on the dead, and afterwards carefully examined. There is a wide difference between neglecting a necessary study and making that the test of science which is the most emphatic proof of its imperfection. We have ourselves had no lack of experience in this branch of the profession, and have included not a few operations which are too commonly delivered over to men who are said to devote themselves to special objects. The result of our experience satisfies us in entertaining the views which the most distinguished men have held on this subject; whilst we are persuaded that few things have contributed more to impede the progress of science than the abuse of operations.

To return to the surgical appointments of the hospital.

The positions which had at first been left without any remuneration, become, by the machinery described, very lucrative; directly, by the fees paid by the pupils; and indirectly, in some cases, by keeping the surgeon constantly before the public. Any prestige, therefore, in obtaining these appointments, is of great value; but, if that do not really involve professional excellence, it is as plain as possible that the public may be very badly served, and an evil generated equally opposed to the interests of science and humanity. It is obvious that the only legitimate grounds of eligibility are moral and professional superiority, as determined by the test adopted at public schools and universities—namely, public competition. Now, what are the tests employed? Without meaning to insinuate that moral or professional eligibility is wholly disregarded—no system in these days will support that—still the eligibility depends on a qualification which few would beforehand have imagined. It is certainly something better than Mr. Macaulay's joke in relation to the proposed franchise to the Militia—namely, that the elector should be five feet two—but something not much more elevated; namely, that a bounty should have been paid to one of the hospital surgeons in the shape of an apprentice fee; thus making the holding one of the most responsible offices in the profession—a condition, which absolutely ignores relative eligibility of skill, steadiness, assiduity, and humanity; and which recognizes them only in such shape that the possession of office is practically made to depend on a point absolutely extrinsic to any one important requisition recognized by the public or the profession.