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

In speaking of affections of the nervous system, Abernethy observes that the brain may be affected by the part injured, and that then it may affect the various organs by a "reflected" operation; but that whatever may be the mode (thus carefully separating the opinion from the fact), "the fact is indisputable." He adds that it may affect some organs more than others, and thus give a character or name to a disease. For example, it might affect the liver, we will say, when the name which would be given would probably be expressive of what was a secondary circumstance—namely, a disturbance of the liver. This does not so frequently happen, perhaps, nor so mischievously in relation to local injuries; but in other cases it is the cause of a great deal of erroneous and misleading nomenclature.

As we have seen, it often occurs that when the organs of the body are disordered, the more salient "symptoms," perhaps the whole of those observed, are referred to a secondarily affected organ, and the disease is named from that circumstance. The too frequent result is, that attention is exclusively directed to that organ, whilst the cause, being elsewhere, and where there are no symptoms, wholly escapes observation.

This is a very important branch of inquiry; and as it closely connects what Abernethy left us with what appears to us to be one of the next things to be clearly made out, we will endeavour to illustrate it.

Suppose a person meet with a severe injury, a cut, bruise, fracture, or any thing that we have seen a hundred times before, and, instead of being succeeded by the usual processes of repair, it be followed by some others: the simple expression of the fact is, that something has interfered with the usual mode and progress of repair; and as former experience has shown us that there was nothing in the nature of the injury to account for this, we are naturally led to look for the explanation of it in the state of the individual. But if the unusual appearance be one which we have agreed to call "Erysipelas," and we are accustomed to see long papers written upon this appearance as a distinct disease, we acquire a tendency, as every day's experience shows, to regard it as a kind of abstraction, or as an entity; something composed of precise and definite relations, contained in that particular description of case. Yet these relations may not be in any two successive cases exactly alike. Again, all of them may be subordinate to some more general character, probably a relation without which we cannot readily explain the phenomena; but at which we cannot arrive, because we have not comprehended a sufficient number of facts in our inquiry to include it.

"Erysipelas" is nothing more than a natural law obscured; because, as we have just hinted, it is developed under circumstances of interference (from disordered conditions of the economy) which distort the natural features of the law, modify its effects, or which may prevent altogether its full development. But now, if we study the means afforded by the various links which other varieties of disease furnish, the ascertainment of the real relations becomes comparatively easy; and we find that, whilst there are certain general relations which belong to all cases, there are certain others which may in a given number in succession be identical; or in no two exactly the same.

Partial investigations, leading, of course, to erroneous views, are sure to entail on us a defective nomenclature; and then the two do very materially contribute to continue the fallacies of each other. We may have an affection of a lung, perhaps; the cause may not be in the chest at all, although the lung may be inflamed or otherwise affected; but we call it Pneumonia, or Pleuritis, or some other name which simply refers to what is happening to the part; but all such names have reference only to effects; they are extremely defective therefore, as comprehending only a portion of the nature, and having no reference whatever to the seat, of the cause of the malady. The consequences of all this may not be necessarily mischievous; but they are so lamentably common, as to continue to form a very large share of the routine practice. The cause is elsewhere; but the remedies are directed to the chest—that is, they are, in such cases, applied to effects, not causes. If we must retain names so defective, it would be very practicable to combine them with something which should indicate that we had, at least, looked for the cause. This would, at all events, encourage a habit of looking beyond mere symptoms, and carry us at least one link higher up the chain of causation.

Abernethy, in demonstrating the connection between local disease, or injury, and general disturbance, judiciously takes cases where the relation was most unequivocal; that is, where the local disturbance consisted of a mechanical injury; such as in a gentleman who had undergone an operation—in another who had met with a bad fracture of his leg. In order to amplify his illustrations of the connection between the brain and all parts with the digestive organs, he draws them from all sorts of sources—from diseases the most severe and dangerous, as well as from affections which are regarded as most common or trivial—from the last stages of cancer and serious diseases of the loins, to the common disturbances of teething in children—sources which, from their apparent dissimilarity, confer, of course, the strongest force on testimony in which they combine.

His delineation of the features by which disorders of the digestive organs may be generally detected, is remarkably simple, clear, and truthful.

Every word has the inestimable value also of being alike intelligible to the public and the profession. His statement is interspersed with remarks of great value, which, we trust, have not passed away altogether unimproved: such as, that he had observed disorder of the digestive organs produce states of health "similar to those" said to be characteristic of the absorption of particular poisons—a most recondite subject; but one, the obscurity of which has entirely, as we think, resulted from the determination to regard the diseases to which it refers as abstractions, and to investigate them under the impenetrable shadow of preconceived opinions.

Almost all his remarks have received more or less confirmation from the experience of the whole civilized world. There are few things in his observations more interesting than the emphatic way in which they ignore the vulgar impression that he referred all diseases to the stomach. In the whole round of scientific literature, it would be difficult to find, in the same space, so complete or comprehensive a view of all those which we usually term the digestive organs.