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

and destroy the patient.

Now, Mr. Abernethy's plan was intended to prevent this last and dreaded issue. The chief points of excellence in his recommendations are—

First, the emphatic recognition of the constitutional origin and nature of the malady;

Secondly, the consequent necessity of a greater attention to the general health of the patient;

And lastly, if it could not be dispersed, to relieve the interior of its contents, so that its extensive surface should never be exposed.

The mode of proceeding was extremely simple, and there is no doubt that a great many lives have been saved by the practice thus recommended. I have heard, however, that some surgeons think the merits of the plan overrated, which I can only suppose explicable on the ground that it has been imperfectly followed out; and I am the more disposed to this view, because nothing can be more entirely opposed to Mr. Abernethy's principles and intentions, than the treatment of many cases said to have been treated after Mr. Abernethy's plan.

As a considerable number of families have really a painful interest in this question, I will, at the risk of being a little professional, state what has occurred under my own observation, in explanation of the apparent discrepancy. My own experience obliges me to coincide with those authorities on this subject, who, approving Mr. Abernethy's practice, adopted it. Amongst a host of eminent men, I will mention only two, Sir Astley Cooper, and a scarcely less eminent authority, Mr. Samuel Cooper, the laborious and distinguished author of the "Surgical Dictionary," who observes that Mr. Abernethy's plan deserves "infinite praise." Sir Astley Cooper, too, in speaking of a very dangerous period of the case to which Mr. Abernethy's plan has an important relation, says: "We should adopt the plan suggested by Mr. Abernethy, as it is the best ever invented by any surgeon." The apparent discrepancy in the results of the experience of different surgeons, is rather a matter of degree, and admits of easy explanation.

The feature whence the disease derives its name is merely a partial exposition of an exceedingly deranged state of the whole economy, not unfrequently complicated with organic disease. Although Mr. Abernethy's paper shows that even these cases are not necessarily fatal, still, in general, such will sooner or later terminate unfavourably under any treatment; but, in many others, the explanation which I first suggested has been a satisfactory solution of the failure: viz. that the principle on which Abernethy proceeded has not been seized, and that therefore the treatment has involved direct violations of it. In some, the local relief has been by no means conducted with the observance of those conditions which Mr. Abernethy has enjoined. In others, there has not been even any reasonable approximation to that careful attention to the general health which is the necessary basis of the plan.

Another point, which has in some cases impeded the adoption of the practice, is the increased responsibility it seems to involve. If a surgeon is to be mistrusted and charged with either, the "laisser mourir" is much less injurious to him than the "tuer." What we mean is this: Everything sometimes is going on well, until the opening of the deposited fluid. If it be left to open by the ordinary processes of nature, the subsequent symptoms are properly enough ascribed to the usual course of the disease; but if the surgeon has interfered, and, from any circumstances whatever, the opening does not heal, or bursts soon after from some slight accident (which has now and then happened), the surgeon is blamed. The only remedy for this, is to impress the necessary caution: repose of the part, and so forth.