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

With respect to any influences immediately directed to the nervous system, these we apprehend to be few and simple; some kinds of medicine, are, no doubt, in particular cases useful, none are susceptible of general application. None of them are certain; and sedatives of all kinds, which appear to have the most direct influence on the nervous system, either require to be employed with the utmost caution, or are in the highest degree objectionable. But there are other direct influences, certainly; and very important they are. Quiet, avoidance of disturbing external impressions, whether of light, sound, temperature, &c. whether in fact of mind or body; but, in the majority of mankind, how few of them we can, in a strictly philosophical sense, command. We are therefore driven to other sources of disturbance; and in the digestive organs we find those on which we can exert great influence, and in which tranquillity, however procured or under whatever circumstances, is certain, pro tanto, to relieve the whole system. This Abernethy attempted, and with a success which was remarkable in no cases more than those which had resisted all more ordinary modes of proceeding; by general measures, by simplicity of diet, by occasional solicitation of this or that organ, by air and exercise, and measures which were directed to the general health. No doubt in some cases he failed, and so we shall in many; but let us look boldly at the cause, and see whether we do not fail a great deal more from our own ignorance than from any natural impossibility.

To examine the question, we must for the moment forget our admiration of Abernethy; be no longer dazzled by his genius, but look only to our duty; endeavour to discover his defects, or rather those of the state of the question when he left us, and see what further investigation has afforded in aid of supplying them.

In the first place, we must examine a little further that proposition which we have seen both in Hunter and Abernethy under different forms. Hunter says the disturbance of the organ sympathizing is sometimes more prominent than that of the organ with which it sympathizes. Abernethy says that the organ primarily affected is sometimes very little apparently disturbed, or not even perceptibly so.

Now, from both these statements, we find that there may be no signs in the primarily affected organ; which, practically rendered, is nothing more or less than saying that in many cases we must not seek for the primarily affected organ where the symptoms are; and this is a great fact: because, although it does not necessarily teach us what we must do, it exposes the broken reed on which so many rely. Now the further point, which, as we would contend, time and labour have supplied, is first this—that what Hunter had mentioned as one feature in the history of the sympathies of different organs, and Abernethy as an occasional or not unfrequent occurrence, is, in disorders of any standing, and with the exception of mechanical injury, in fact the rule—the symptoms of disorder being almost never in the primary organ; nay, even organic change (disease) is for the most part first seen in a secondarily affected organ. In regard to primarily affected parts, the skin only excepted, they will be found, in the vast majority of cases, to be one or other of the digestive organs.

I will endeavour to render the cause of this intelligible. A minute examination of what happens in a living person, especially if it be extended to some thousands of cases, will soon disclose to the most unlettered person a few instructive facts, showing that Nature has a regular plan of dealing with all injurious influences, which, however various many of the details may be, is in general character exquisitely simple, surprisingly beautiful, and intelligibly conservative; and that the various modes on which she exercises this plan, from the cradle to the grave, are, in frequency, directly in the order of their conservative tendency. Let us explain. There is no dearth of illustration; the facts are bewilderingly abundant; the difficulty is which to choose, and how to give them an intelligible general expression. Let us take a single case. We know that if a mote gets into the eye, there is irritation, immediately there is flow of blood to the part, a gland pours forth an abundant supply of tears, and the substance is probably washed out. Very well; we say that is intelligible. But suppose you have the vapour of turpentine, or any other irritant, the same thing happens; but still you cannot give quite the same mechanical explanation.

Again—substances which affect the mouth, nose, and stomach, will irritate the eye without any contact, and cause a flow of tears.

Lastly, you know that affections of the mind will do this, and where even we have no mechanical irritant at all.

In all these cases there has been activity of the vessels of the eye, and in all it has been relieved by secretion. Now this is the universal mode throughout the body; all irritation of the organs is attended by secretion; and where this is done, there is no disorder; or rather, the disorder is relieved: but if organs are irritated continuously, another thing happens, and that is, that an organ becomes unable to secrete constantly more than is natural, and then some other organ, less irritated in the commencement, takes on an additional duty—that is, the duty of the animal economy is still done, but not equally distributed.

This is the state in which most people are in crowded cities, and who live in the ordinary luxury or the ordinary habits of civilized society, according to the section to which they may belong. It is easy, in such cases, to detect those differences which distinguish this state from what is called condition or perfect health, as we have elsewhere shown[³²].