In treating it—i. e. the primary organ—however, great discrimination is necessary. If it be already organically affected, that treatment which would be, under other circumstances, necessary, becomes either objectionable, or requiring the utmost caution. For although an organ diseased in structure will, under some circumstances, as Abernethy long ago observed, yield its characteristic secretion, yet, unless we know the extent of the disease, which is just the thing we can almost never be certain about, excitement of it is never without danger. We should therefore excite the primary organ with more or less energy, with more or less caution, or not at all, according to circumstances. If we determine on not exciting it, we should then act on organs with which it has ordinarily closest community of function, or on whose integrity we can most depend. For choice, we prefer organs which, in a natural state, have nearest identity of function, as having the readiest sympathy, it may be, with each other. Yet so universal is the sympathy between all the organs, that there is no one that will not, under certain circumstances, or which may not be induced, perhaps, by judicious management, to take on compensating actions.
We must not here pursue this subject further. We have endeavoured to sketch certain extensions of the views of Mr. Abernethy, and can only refer the profession and the public, for the facts and arguments which demonstrate and illustrate them, to those works in which they have been enunciated[34]. They have now been subjected to severer trials, and abundant criticisms. So far as we know, they have not been shaken; but if there be any merit in them, if they shall have made any nearer approach to a definite science, or sketched the proofs that Induction alone can place us in a position to talk of science at all, they are still sequences which have been arrived at by a steady analysis of Abernethy's views. It was he who taught us, in our pupil days, first to think on such subjects; to him we owe the first glimpse we ever had of the imperfect state of medical and surgical science; and if we do not wholly owe to him the means by which we conceive it can alone be rendered more perfect and satisfactory, he has at least in part exemplified the application of them. If we have made some advances on what he left us, and added to his beautiful and simple general views, something more definite on some points, something more analytical on others,—still, inasmuch as they are clear deductions from the views he has left us, and from such views alone, such advances remind us that the study of his principles serves but to demonstrate their increasing usefulness, and to augment the sum of our obligations.
SECTION.
Mr. Abernethy's book "On the Constitutional Origin of Local Diseases" had an extensive circulation, and excited a great deal of attention from the public as well as the profession.
As a work which may be read as it were in two days, so as a person read it with one or other subject, it produced a great variety of impressions. It may be read simply as a narrative of a number of facts, with the inferences immediately deducible from them. All this is plain and intelligible at once to anybody, and of great practical value; but the work contains numerous observations of a suggestive kind, which require careful thought, and some previous knowledge, to enable a person to estimate their value, or to trace their onward relations. The impression made by the work on different minds varied, of course, with the reader, his information, and, in some sort, with the spirit in which it was studied. Some, who had, in their solitary rides, and in the equally solitary responsibilities of country practice, been obliged to think for themselves, recognized, in the orderly statement of clearly enunciated views, facts and principles which they had already seen exemplified in their own experience, and hailed with admiration and pleasure a book which realized their own ideas, and supplied a rational explanation of their truth and value.
Some, who had never thought much on the subject, and were very ill-disposed to begin, regarded his ideas as exaggerated, and hastily dismissed the subjects, with the conclusion that he was a clever man, but too full of theory, and too much disposed to look to the stomach or the digestive organs. Others, making very little distinction between what they heard of the man, the book, or his practice, and probably not having seen either, but deriving only a kind of dreamy notion of a clever man with many peculiarities, would say that he was mad, or an enthusiast. Still, a great many of the thinking portion of the public and the profession held a different tone. The book was recognized as an intelligible enunciation of definite views—rather a new thing in medical science. The application of them became more and more general; his pupils were everywhere disseminating them, more or less, in the navy, in the army, in the provinces, and in America.
Still, it must not be imagined that his principles became diffused with that rapidity which might have been inferred from his numerous and attentive class. Constituted as medical education is, but more especially as it was at that time—for it is slowly improving—pupils were almost entirely absorbed in the conventional requisitions for examination. There, they were not questioned as to the laws of the animal economy, nor any laws at all, nor even on any real axioms in approximation to them; but simply as to plain anatomy, the relative situation of parts, and such of the ordinary surgery of the day as had received the approbation of the Examiners, who were, for the time, the authorities in the profession. Therefore, out of a large number, there were comparatively few whose attentions were not too much absorbed by the prescribed curriculum of hospital routine to study principles: a curriculum constructed as if the object were to see how much could be learnt in a short time, without detriment to the very moderate requisitions of the examination at the College of Surgeons. But if comparatively few had time to study Abernethy's lectures at the time, a great many had treasured up his remarks. As the impressions we receive in our childhood, before we are capable of thinking of their value, are vividly rekindled by the experience of real life, so many of the more suggestive lessons of Abernethy's lectures, which passed comparatively unheeded at the time, or were swamped in the "getting up" of the requisitions for an examination at the College, recurred in after days in all their force and truthfulness. Many, however, with more time, and perhaps more zeal, endeavoured to thoroughly master his views; and now and then he was gratified by evidence, that time had only served to mature the conviction of the pupils—in dedications and other complimentary recognitions, in the works of such of them as had been induced to publish any portion of their own experience.
However various, too, the impressions made by his book, there are two things certain; viz. that he was much talked of, and the book had an extensive sale, went through several editions, and served to give the public some notion of those principles which he was so beautifully unfolding to the younger portions of the profession in his lectures. Besides, although there were not wanting those who spoke disparagingly of him, still, as an old and very far-seeing colleague of our own used to say, with perhaps too much truth, when canvassing the various difficulties of a medical man's progress in the metropolis, "A man had better be spoken ill of, than not spoken of at all." He was now beginning to be very largely consulted. The Public had "got hold of him," as we once heard a fashionable physician phrase it, and he soon obtained a large practice. A great many consulted him for very good reasons, and probably many for little better reason than that he was the fashion.