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

Amongst others, he had paid particular attention to those which exemplify that vivid, that watchful connection which exists between various parts and organs, and by which impressions or sensations excited in any one part are telegraphed, as it were, with the swiftness of lightning to any or all of the organs of the body; facts which may be observed by anybody, by no one better, and by few so well, as patients themselves. To take a common example: everybody is familiar with the fact that certain disturbances of the stomach produce pain or other annoyance in the head. Every one also knows that in such cases there is very often no pain, and sometimes no sensation of annoyance in the stomach; so that were it not from an innumerable succession of such conditions, in connection with particular influences on the stomach, we should, from the feeling of the stomach only, never dream of the cause being in that organ. Now on these simple facts hang not only the most practical of all John Hunter's observations, not only the most valuable of Mr. Abernethy's, but (as far as we can see) those relations through a philosophical examination of which we shall still most auspiciously seek to extend our practical knowledge of disease. We see here just that which Mr. Hunter had asserted—namely, "that the organ secondarily affected (in this case, the head) sometimes appeared to suffer more than the organ to which the disturbance had first been directed."

He observed also that the connection thus manifested, existed equally between all other parts and organs; that although it might be exemplified in different forms, still the association it implied was indisputable. He adopted the usual terms by which these phenomena had been designated. Parts were said to sympathize with each other, and no term could be better, as it simply expressed the fact of associated disturbance or suffering. It is true the facts were not at all new; they had always existed; nay, they had been observed and commented on by many persons ever since the time of Hippocrates; and if I were to mention the whole of such facts, there is scarcely one which would not be to some one or other as familiar as a headache from disturbance of the stomach. Mr. Hunter, however, had a kind of instinctive idea of the yet unseen value of the clue thus afforded to the investigation of disease; and he observed these facts with a greater attention to all their details than any one, or all, who had preceded him.

Hunter's observations on the subject in his lectures were extremely numerous, and elaborate even to tediousness; Abernethy, who used to give us a very humorous description of some of the audiences of John Hunter on these occasions, was accustomed to say, "That the more humorous and lively part of the audience would be tittering, the more sober and unexcitable quietly dosing into a nap; whilst the studious and penetrative few appeared to be seriously impressed with the value of Mr. Hunter's observations and inquiries." Mr. Cline, an honoured name in our profession, and one who, had he lived in later times, would probably have been as distinguished in advancing science as he was for his practical excellence, significantly expressed his impressions of the future importance of the inquiries in which Hunter was engaged. Addressing Mr. Clift, after one of the lectures, he said:

"Ah! Mr. Clift, we must all go to school again."

Mr. Abernethy carefully treasured up and pondered on what he heard. He placed himself as much as he could near Mr. Hunter; took every pains, which his time and occupations allowed, thoroughly to understand him; and, with his characteristic tendency to simplification, said: "Well, what Mr. Hunter tells us, resolves itself into this: that the whole body sympathizes with all its parts."

His perceptivity, naturally rapid, was evidently employed in observing the bearing of this axiom on the facts of disease. The digestive organs, which, if we extend the meaning to all those engaged in assimilating our food, compose nearly the whole viscera of the body, could not escape his attention, nor indeed fail to be regarded in all experimental investigations of any one organ. Accordingly, in his paper on the skin and lungs, we have seen a very important application of the relations between organs engaged in concurrent functions; we have placed before us the physiological evidences of their being engaged in a common function, and the sympathetic association it rendered necessary; whence he had observed relations of great moment, and pointed out the practical bearing they must have on Consumption. He had, however, been paying attention for some time to the digestive functions, when his intimate friend, Mr. Boodle, of Ongar in Essex, gave a fresh stimulus to his exertions. This gentleman requested him to investigate the functions and conditions of the liver in various nervous diseases, as also in certain affections of the lungs, which had appeared to him, Mr. Boodle, to originate in the former organ. Mr. Abernethy says: "I soon perceived that the subject was of the highest consequence in the practice of surgery; for local diseases disturb the functions of the digestive organs, and, conversely, a deranged state of those organs, either occurring in consequence of such sympathy, or existing previously, materially affects the progress of local complaints."

At the very commencement, he hits on a great cause of evil, and boldly assails one of the most mischievous of all conventionalisms. "The division of medicine and surgery," he observes, "is mischievous, as directing the attention of the two orders of practitioners too exclusively to the diseases usually allotted to them." There is indeed no exaggerating the evils of that partial mode of investigation to which such a custom almost necessarily leads. We fall into error, not because of the difficulty of the subject, but because we never can, by looking at one set of diseased processes only, learn the whole of the facts belonging to the subject. It was just this that prevented Fordyce from arriving at correct views of fever. Nothing could be more excellent than the way he began to consider it; but he hardly begins, before he tells us that he intends to exclude those febrile affections which fall under the care of surgeons. In doing this, he at once abandoned a series of facts which are absolutely essential to the investigation. It must be obvious, on a moment's reflection, that, if a particular condition of a part have a relation to the whole body, the study of one without the other, or even if both be taken up by different persons, nothing but the most imperfect views can result. A jury, still more a judge, might in some cases guess from partial evidence the issue of a legal investigation; but who ever heard of either determining beforehand to examine a portion only of that evidence? Yet it is not too much to say, that hardly any legal question can be so recondite as many inquiries in physiology. The nature of the case is always more or less obscured by a number and variety of interfering circumstances. Diseases may be regarded, in fact, as nothing more than natural laws, developed under more or less complicated circumstances of interference.

Lord Bacon had warned all investigators of Nature of the danger of attending only to a portion of the facts; it had been one of the great bars to progress of knowledge in general. I regret to say that it still continues the bane of almost all medical inquiries.

Abernethy's inference in relation to this mutilated sort of investigation is too true, when he observes that "the connection of all local diseases with the state of the constitution has obtained little notice;" whereas the truth is, that "no part of an animal body can be considerably disordered without affecting the whole system." Now here Mr. Abernethy claims—what? Simply this: he claims for function—that is, the various offices fulfilled by the several parts and organs of the body—that which Cuvier has so beautifully insisted on, and which our own Owen has so instructively exemplified in regard to structure or formation; namely, a necessary relation between the whole and all its parts.