Abernethy, on the contrary, had a happy facility of expressing himself, and a power, rarely equalled, of singling out the difficult parts of a subject, and simplifying them down to the level of ordinary capacities. Hunter, though not without imagination, or humour even, had these qualities held in abeyance by the unceasing concentration of his intellectual faculty. As Abernethy used to say, "John Hunter was always thinking." Abernethy, on the contrary, had an active imagination; it always accompanied his intellect, like a young, joyous attendant, constantly lighting up the more sombre propositions of her grave companion with varieties of illustration. The most difficult proposition, directly Abernethy began to fashion it, had all its rough points taken off, and its essential features brought out clear and orderly to the plainest intellect. John Hunter, in laying down a series of facts having the most important influence in the formation of a medical science (take place when it may), was not able to keep people awake. Abernethy's treatment of the most dry and unimportant, kept his audience unceasingly interested. The obscurity of language in Hunter was happily replaced, not only by an unusual ease, but by a curiosa felicitas, in Abernethy. In sustained composition, Hunter was generally difficult, often obscure; Abernethy, if not faultless, always easy and unaffected. If his style failed sometimes in earnestness and vigour, it was always sincere; and whilst, though not deficient in eloquence, it asserted no special claim to that excellence, it was always pleasing and perspicuous.
Nothing could be further from the earnest and thinking John Hunter than anything dramatic. Abernethy had that happy variety of countenance and manner that can be conveyed by no other term. Hunter, without being slow, was cautious, circumspect: Abernethy, without being hasty, was rapid, penetrative, and impulsive. Never were two minds so admirably fitted for the heavy-armed pioneering in science, and the comparatively light-trooped intellect which was calculated to render the first clearing easily convertible to those practical necessities with which the science had to deal. Accordingly we find that Abernethy very soon extended Mr. Hunter's views, and applied them so powerfully, as at least to create the dawnings of a science. He showed that all processes in the economy—and of course, therefore, those of disease—are essentially nervous in their origin: that is to say, the nerves being the instruments through which our relations are established with surrounding nature (however much we may, in common language, speak of this or that feeling, this or that organ, or this or that part of the body), all impressions must still be made primarily on the sensitive or nervous system of that part; and this, of course, whether they imply consciousness, or be altogether independent of it; that disturbed nervous action was, as the case might be, either the forerunner—or the next link in the chain of causation (i. e. the proximate cause)—of the disease; and that therefore the relief of diseased or disordered actions, however attempted, consisted ultimately and essentially in the restoration of healthy nervous power, or adaptation.
This, then, is the first proposition. The next thing, and which necessarily follows, is, that in the prevention or cure of disease, the first object is the tranquillizing of nervous disorder.
Now, here there are many things to be regarded; for man is a moral as well as a physical being; and the circumstances by which he is surrounded, even the air he breathes, the moral and physical impressions to which he is subjected, are very often not under his own control, much less that of his medical attendant. On the other hand, the food is, in civilized communities, very much under the influence of his volition; and there are many circumstances which, instead of impeding those adaptations which disorder requires, renders them particularly easy—it frequently happening that those things which are really best, are most easily procured. This is important; because the next proposition is, that the nervous system is very easily and constantly disturbed by disorder of one or other, or of the whole of the digestive organs, and that therefore the tranquillizing of disturbance in them is of the highest consequence in the treatment of disease: few propositions in any science are more susceptible of proof than the foregoing. But if this be so, we must now recollect the full force of what we have observed with regard to relation; that is, we must not restrict our notion of it to the general loose assent that there is a relation in all parts of the body, and rest on the simple admission, for example, that animals are formed in adaptation to their habits; but we must sustain the Cuvier-like impression of the fact, the Owen-like application of it to the phenomena; recollect that preconceived ideas of magnitude and minuteness can do nothing but obscure or mislead; and that the relations established in the body are constant and universal, however they may at first—as in the case we have quoted—excite the surprise or the derision of the less informed and less reflecting. We must take their immensely potential power as existing as certainly in the most trifling headache, as in the most malignant fever—in the smallest scratch, as in the most complicated compound fracture. We have plenty of facts now to prove this; but the first plain, clear enunciation of it all, the successful demonstration of it at the bedside, and the consequent diminution of an enormous amount of human suffering, is the great debt we owe to Abernethy. Mankind in general admitted that Diet was of consequence. Nobody doubted its force as an accessory in treatment. Lactantius said: "Sis prudens ad victum sine quo cetera remedia frustra adhibentur." But no one had recognized the treatment of the Digestive Organs as the essential part of the treatment of surgical diseases, nor founded it on the same comprehensive view of its relations as addressed to organs which executed the nutritive functions of the body on the one hand, and were the most potential disturbers or tranquillizers of the nervous system on the other, and thus for ever linked them in their practical relations with the fact, that the essential element of disease, the fons et origo, is disturbed nervous power. But, as all diseases are merely the result of two conditions—namely, the injurious influence acting, and the body acted on—it matters not whether the injurious influence be sudden, violent, slow, moderate, chemical, mechanical, or what not; so the foregoing positions affect the whole practice of medicine, and must not be held as affecting any one part of it, but as influencing equally both medicine and surgery.
We do trust that these few propositions will induce some to think; for, as Abernethy used to say, lectures will never make surgeons: and we feel equally confident that no books, no individual efforts, however costly or sincere, will really benefit or inform any portion of the public or the profession, except such of them as may be induced to think for themselves. They have only to recollect that, in carrying out such principles, they must not measure their influence by their previously conceived notions; they must encourage labour when they see the profession willing, and not thwart them by showing that it will be labour in vain. There will soon be science, if it is encouraged:
"Sint Mæcenates, non deerunt Flacci."
If they are disposed to think investigation too minute to be practical, or precision too unpleasant to be necessary, let them remember the story of Professor Owen's beautiful application of minute relation, and that the distinction between a huge common quadruped and an unknown wingless bird could alone be discovered by particulars far more minute than they will be called on once in a hundred times to observe or to follow. The obligation we have already noticed has in some sense revolutionized the practice of medicine and surgery, and is no doubt the capital debt we owe to Abernethy; but there are many others. His application and adjustment of the operation of the trephine was a beautiful and discriminating achievement, and would alone have been sufficient to have raised an ordinary reputation.
His first extension of John Hunter's operation for aneurism, shows how ready he was—when he could do so with advantage—to enlarge the application of that branch of our duties which he least valued—namely, operative surgery.
His proposal to add to the treatment of the diseases of joints the apparatus of splints, for ensuring absolute quiescence of the affected surfaces, has saved a most incalculable number of limbs from amputation. It here becomes necessary to repeat a remark we have made in a former work. Sir B. Brodie recommends this plan only in the third edition, I think, of his discriminative work on the joints, not appearing to have been aware that Abernethy taught it for nearly thirty years previously, about ten years of which we ourselves had repeatedly tested its great value, and taught it, but contemporaneously from Abernethy, in our own lectures. Indeed, so important an element is it in the treatment of diseases of the joints, that we have never seen it fail, when fairly applied and accompanied by a reasonable attention to the general health, except in the following cases: First, when the patient has been nearly worn out by disease, before being subjected to treatment; and, secondly, where the complaint has been proved to be accompanied by internal organic disease.
We have always thought that one of the most valuable of our obligations to Abernethy was his lesson on fracture of the neck of the thigh bone within the capsule of the joint. For thirty years, Sir Astley Cooper taught, and boasted that he had taught, that this fracture could not unite by bone; Sir Astley reasoning on the anatomy of the part only, and conceiving that the neck, in its somewhat isolated position, would be imperfectly nourished; and, seeing that, in point of fact, this fracture did generally unite by ligament only, unfortunately adopted the foregoing idea as the cause of the fact, and concluded that bony union was impracticable. Experiments on animals—at all times extremely fallacious, in this case singularly imperfect in the analogy they afforded—appeared to confirm his views. Despairing of effecting a proper union, he adopted a treatment which rendered it impossible. Abernethy's beautiful reasoning on the subject led him to an opposite conclusion. It embraced certain views of Hunter's, and some common phenomena in other accidents where the union by ligament is coincident with motion of the part. He therefore treated all cases with a view to secure bony union; and he and many of his pupils had no doubt but that they had seen examples of its success. Still, people got well and were lost sight of, and therefore it was said that the fracture was not wholly within the capsule of the joint. At length a specimen was procured from the examination of a dead body, and the question set at rest, we believe, in the minds of every body, that this fracture, though it require especial care to keep parts steady and in apposition, will unite just like other fractures in the way taught (and since proved) by Abernethy. Let those who can calculate the number of surgeons who have been educated by these two gentlemen, and who, for the first few years, would have almost certainly followed the practice of their instructors, compute the number of those of the lame who, under Providence, have walked in consequence of the clear-sighted reasoning of Abernethy.