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

We should hardly refrain from laughter if we saw a man try to see with the point of his nose, or endeavour to examine the odour of a rose by his ear, or to listen with his eye; yet this is not a whit more absurd than to try to deduce conclusions from the impressions furnished by the eye, which can alone be afforded by the rational faculty. Nothing is more common than this sort of fallacy, nothing more easy than its correction; but then people must bestow at least a little of that time on their highest faculties which they so lavishly expend on inferior powers. How much time we consume, for example, in the study of various languages—those instruments for the communication of ideas—as compared with that bestowed on the collecting and marshalling of ideas themselves; which is little better than grasping at the shadow, and losing the substance; or, to use a humorous illustration, like a friend of our own, who, having a new dog, sent his servant forthwith to purchase sundry articles for him, in the shape of kennel, chains, engraved collars and food; all of which, at some expense, he safely accomplished to his master's satisfaction, expressing his sorrow at the same time for having accidentally lost the dog!

It is curious, however, to observe how the real business of the human mind is shadowed forth in the very abuses of its powers; nothing so bad but it is charged with a certain quantity of good; no error so great but carries with it the element of its own correction. The mind in its greatest aberrations is followed by the shadow of its real duty, which as it were waits on the time when clearer views shall burst on it. Nothing shows the real tendencies of mind more than its restless desire to arrive at some conclusion, some tangible evidence of its highest functions. It is the impulse of this instinct—the ungoverned abuse of a high faculty, impatient for illegitimate fruition—which lies at the bottom of much false reasoning, and which blinds men, even of great power, to obstacles which are luminously evident to the most ordinary capacity. Important as the next series of illustrations cited by Abernethy are, the conclusions he deduced from them were the necessary sequences of clear and correct reasoning on familiar and established facts.

The illustrations in question were those afforded by various cases of injuries of the head, in which certain consequences, however exceptional they may be, are too commonly referred to the abstract nature of the injury. We see that a man has a blow, we see that he does not recover in the usual way in which we have known many others to recover; but we do not, perhaps, consider that if a similar—nay, perhaps an identical force produces very different effects in different cases, the cause will probably not be in the nature or direction of the force so much as the condition of the body. Now the value of these cases of Abernethy's consists, first, in impressing the influence of this condition as modifying—in other words, sustaining—the disturbance consequent on injuries (in their origin) purely mechanical; and secondly, in showing that, in the cases in question, that condition depended on a disordered state of the digestive organs. We hardly know any cases more valuable than those in question. When a patient receives a blow, and, the immediate consequences having subsided, there still remains an impairment of sense or motion, the most usual thing, and no doubt very often the true view, is to refer it all to lesion of nervous structure. It is therefore of the highest consequence to know the facts of these cases. They not only prevent the hasty institution of treatment which would be injurious; not only secure the patient from being abandoned in despair; but supply at the same time the clues to a rational treatment, and the hope of a favourable issue.

There can now be few observant surgeons who have not met with cases in illustration of these circumstances; and yet I know not to whom the perusal of Mr. Abernethy's cases might not be useful. It is not without regret that I forego transcribing at least one of them; forgetful how impossible it is to do Abernethy full justice in a work intended for all readers. In his "Book," the cases in question begin at page 97, and occupy but a few pages.

The next class of cases, from which Abernethy illustrates the prevailing influence of the digestive organs, receives additional importance from the imperfect manner in which the phenomena have been interpreted in a vast variety of diseases; like small-pox and others, ascribed to the action of particular poisons. We may possibly have an opportunity of saying something more on this subject; but we may remark that when any disease has been presented to the physician or surgeon, supposed to be the result of specific poisons, it is just the last case in which any special attention is paid to the digestive organs. Now Abernethy observed that disorders of the digestive organs would sometimes produce diseases resembling maladies said to result from specific poisons. This is about the first indication or hint of that which, duly carried out by an advancing science, will, we trust, ere long, demonstrate what to us has long appeared only part of a general law. Of this we may by and by say a little more, when we endeavour to show the small quantity of truth which there is mixed with some of the prevailing errors; and how their occasional success results from blundering, as it were, on small portions of the principles enunciated by Abernethy.

In the meantime, we may refer to the illustration afforded by small-pox of the remarkable influence of the digestive organs in diseases called specific. We adduce this, because it is one which is popularly familiar, and a disease that, had it been studied under any but one particular phase, would have proved, of all others, the most instructive. There is no malady, under certain circumstances, more extensively fatal.

In the Spanish conquest in America—a history scarcely less interesting in a medical than in a moral point of view—it seems that not all the cruelties of the Spaniards were more destructive than the small-pox. In less than a century after the arrival of Columbus, it was computed that it had destroyed more than half the population; and in one year (1590), it so spread along the coast of Peru, that it swept away nearly the whole of the Indians, the Mulattoes, and the Mestichos, in the cities of Potosi and De la Hay[³¹].

As is well known, before the discovery of vaccination, persons were inoculated with the small-pox, because it was found that the disease could be thus rendered comparatively harmless; whilst, if it was taken naturally, as it was termed, it was always serious, and too frequently extremely fatal. The preparation for inoculation consisted of measures addressed to the digestive organs. Now the effect may be judged of by this fact: Inoculation was at first violently opposed; and, in reply to the alleged safety of it, an opponent wrote to prove that one in one hundred and eighty-two had died of it. I wish we could say so of many other diseases.

That such persons had, nevertheless, the genuine malady, was proved by the fact they were capable of infecting others (unprepared) with the disease in its most malignant form. But our notions of the mode in which the laws of the animal economy deal with injurious influences of this kind, are mischievously conventional. What quantities, for example, of mercury, in its different forms, have been administered in almost all diseases; and yet unquestionably there is a great deal of false reasoning in regard to this poison. Effects are attributed to it as mercury, which only belong to it in its general character of an injurious agent. All the (so-called) specific effects of it, most of which are become popularly familiar, may occur without any mercury at all. We have seen them induced by aloes, by scammony; and in a case where no medicine had been given, and where the only detectable poison was one which was to be sure bad enough, an enormously loaded liver.

We are obliged to say but little here in connection with this subject. Abernethy's cases were very important in relation to the influence of the digestive organs, although he did not see the generalization to which, as it appears to us, they help to conduct the pathologist. The subject is too extensive for discussion here. We will attempt something of a popular view of it, when we endeavour to explain the fallacy to which we have already referred.