"terra salutiferas herbas eademque nocentes
nutrit, et urtic? proxima s?pe rosa est."15
?
ovid.
a large london hospital is (if we may be excused the hibernianism, as mr. abernethy used to call it) a large microcosm. there is little in human nature, of which an observant eye may not here find types or realities. hopes and fears, joys and sorrows, solace and suffering, are here strangely intermingled. general benevolence, with special exceptions. there is no human good without its shadow of evil; even the benevolent must take care. impatient sensibility is much nearer a heartless indifference than people generally imagine. the rose, charity, must take care of the nettle, temper. the man who is chary or chafed, in yielding that sympathy which philosophy and feeling require, must beware lest he degenerate into a brute.
one of the brightest points in abernethy's character, was, that, however he might sometimes forget the courtesy due to his private patients, he was never unkind to those whom charity had confided to his care. one morning, leaving home for the hospital, when some one was desirous of detaining him, he said: "private patients, if they do not like me, can go elsewhere; but the poor devils in the hospital i am bound to take care of."
but to the hospital. here we find some that have had the best this world can give—some who have known little but misery: the many no doubt lie between; but all come upon the same errand. disease is a great leveller. there all flock, as to addison's32 mountain of miseries, to get rid of their respective burthens, or to effect such exchanges as benevolence may have to offer, or the grave can alone supply. our large hospitals have a most efficient "matériel;" the accommodations are extensive, the revenues princely. st. bartholomew's, for example, has a revenue of between twenty and thirty thousand pounds a year, and is capable of receiving six hundred patients.
as regards what is mechanically or physically necessary to the comfort of the inmates, the ample appliances of our large hospitals leave little or nothing to be desired. there is every facility for the execution of the duties, that convenient space and orderly arrangement can suggest; in short, everything, in the general sense of the word, that money can procure. then there are governors, whose hearts are as open as their purses, whose names are recorded in gold letters, as the more recent or current contributors to the funds of the establishment, and who rejoice in the occasional saturnalia of venison and turtle; all duties or customs which may be observed, with the gratifying reflection that they are taking the thorns out of the feet of the afflicted; provided only that they do not involve forgetfulness of other duties, the neglect of which may plant a few in their own. the governors determine the election of the medical men, to whom the welfare of the patients and the interests of science are to be entrusted.
we have said that money cannot procure all things, and one of these is mind—a remark requiring some qualification certainly; but this we must refer to a subsequent chapter. minds such as abernethy's are not to be found every day; and, notwithstanding the sumptuous bill of fare we have already glanced at, there are many things in a large london hospital yet to be desired—defects which, though it need no great penetration to discover, may, for aught we know, require public attention, a government altogether better informed as to the actual defects in medical science, and the plastic hand of power, to supply.
abernethy was elected assistant surgeon of st. bartholomew's hospital, july 15th, 1787. sir charles blicke, an assistant surgeon, had been appointed to the surgeoncy vacant by the resignation33 of mr. pott, and abernethy succeeded to the assistant surgeoncy thus vacated. the election was contested by two or three other candidates; amongst the rest, by mr. heaviside. this gentleman was an eminent surgeon, and a gentlemanly, facetious, and agreeable companion. he was originally in the guards, and practised in london many years with great credit and respectability. he was fond of science, and expended considerable sums in the formation of an interesting museum. in the earlier part of his life, he gave conversaziones, which were attended by great numbers both of the scientific and fashionable.
he lived in a day when, if a gentleman felt himself insulted, he had at least the satisfaction of being relieved from his sensibility by having his brains blown out in a duel—professionally speaking, by a kind of "operative surgery;" viz. the demolition of the organ in which the troublesome faculty resided. mr. heaviside, in his professional capacity, is said to have attended more duels than any other surgeon of his time. this gentleman, albeit not unused to one kind of contest, retired from that at the hospital; which then lay between mr. jones and mr. abernethy—the former polling twenty-nine, the latter fifty-three votes.
this was an important epoch in the life of abernethy. it is difficult to adjust the influence which it ultimately exerted, for good or evil, on his future prospects and happiness, or on his relations to science. the hospital had thus secured a man of extraordinary talent, it is true, and in spite of a system which indefinitely narrows the field of choice; but then the same "system" (which we shall by and by describe) kept abernethy, as regards the hospital, for no less a term than twenty-eight years, in a position which, although it did not exclude him altogether from the field of observation it afforded, did much to restrict his cultivation of it. his talents for observation, nevertheless, and the estimation in which he was soon held, no doubt enabled him, to a certain extent, to bring many of his views to the test of practice. still, as an assistant surgeon, except in the absence of his chief, he had officially nothing to do; whatever cases he conducted, were only by sufferance of his senior.
to a man of his ability, this was a false and miserably cramped34 position; one, in fact, much better calculated for detecting faults, than for developing the best mode of amending them. as assistant surgeon, he had no emolument from the hospital: he had, therefore, a very reasonable inducement to set about doing that for which he felt himself especially fitted, and to which he had early directed his attention—namely, to teach his profession. the event showed that he had by no means miscalculated his powers. these proved well-nigh unrivalled. the appointment to st. bartholomew's, besides other advantages, gave him an opportunity of lecturing with the prestige usually afforded by connection with a large hospital. he did not, however, at first give his lectures at the hospital, but delivered them in bartholomew close.
there was at this time, in fact, no school, properly so called, at st. bartholomew's. mr. pott had been accustomed to give about twenty-four lectures, which, as short practical discourses, were first-rate for that period; but there were no other lectures, not even on anatomy; which are essentially the basis of a medical school.
dr. marshall, who was a very remarkable man, and no less eminent for his general ability than for his professional acquirements, was at this time giving anatomical lectures, at his house, in bartlett's buildings, holborn. in a biographical notice of him, in the "gentleman's magazine," in which we read that he was giving lectures about the year 1787, it is incidentally remarked, that "in all probability he derived little support from st. bartholomew's hospital; for that recently an ingenious young gentleman, mr. abernethy, had begun to give lectures in the neighbourhood."
abernethy, who seems to have been always seeking information, certainly attended some of marshall's lectures; because he would occasionally refer to anecdotes he had heard there. he had thus listened to most of the best lecturers of his day—sir william blizard, dr. maclaurin, mr. pott, and dr. marshall. to the experience which he had thus acquired, and with the early intention of applying it, he added a remarkable natural capacity for communicating his ideas to others. we thus begin to perceive35 his early cultivation of that aptitude for lecturing which no doubt greatly contributed to the excellence which he ultimately achieved in that mode of instruction.
we desire to impress this feature in his education, because by and by it will, with other things, assist us in a rather difficult task: that is, an attempt to analyze the means by which he obtained such a power over his audience. he thus became a teacher at the age of twenty-three, at a large hospital where he was about to commence a school, of which he would be at first the sole support. this necessarily involved a fearful amount of labour, for an organization, active and energetic, but by no means of great physical power.
labour, to be sure, is the stuff that life is made of; but then, in a fine organization like abernethy's, it should be directed with economy of power, and in application to the highest purposes. such an organization should, if possible, have been relieved from the drudgery which lies within the sphere of more ordinary capacity. ready as we are, then, to congratulate the young philosopher, about to display his powers on a field where he was so successful, still misgivings creep in which restrain, or at least moderate, our enthusiasm. unusual ability, no doubt, allows men to anticipate the order which, as the rule, nature seems to have assigned to the pursuits of intellect; but we must not suffer ourselves to be blinded to the rule, by the frequency of the exception. youth is the time for acquiring knowledge; and, although there is no reason why the fruits may not be imparted to others as fast as they are gathered, still, when the larger space of a man's time at twenty-three is devoted to teaching merely, it may reasonably be doubted whether it be such a disposition of it as is best calculated to economise his power, or develop the maximum of its influence, in extending the science to which it is devoted.
john hunter declined undertaking to teach anatomy at forty (1768), because it would have "engaged his attention too much to admit of that general attention to his profession; to forming habits and established modes of thinking, which he thought necessary." in abernethy's after life, we think we saw a good36 deal of the wear and tear that early and diversified labour had impressed on his physical organization. in advancing life, the natural desire for ease, if not carefully guarded, may not be without its perils; but precocious labour, stinted rest, and the malaria of large cities, crowded hospitals, and filthy dissecting rooms, too certainly bring on a train of evils, not less grave because more distant.
we shall have to revert to these points when, in conclusion, we consider the variety and importance of his contributions to the science of his profession, and why they were not still more numerous. the latter, though perhaps the less grateful, is by no means the least useful portion of biographical analysis.
commencing his lectures in bartholomew close, they soon seem to have attracted notice. the anatomical courses, which were always on a similar plan, were very skilfully framed to interest and instruct the students. the arrangement of the matter was such, that the dry details of anatomy were lighted up by a description, not only of the purposes served by the various parts, but by as much as could be conveniently included of the diseases or accidents to which they were subject; and thus the juxtaposition of the structure, function, and diseases, naturally tended to impress the whole.
diseases of more general site, and which therefore did not fall conveniently under discussion in describing any one part, were reserved for a separate course of lectures. it was in this course that he more fully developed those general principles on which his reputation more especially rests. of his inimitable manner we shall speak hereafter.
he was one of the first who insisted on the great importance of comparative anatomy, in studying the uses of the several parts of the human body. were it not for the comparison of the relations of various parts in different animals, we should be continually the victims of hypotheses, which the juxtaposition or other characters of organs in any one animal are constantly suggesting. here necessity compels the observance of that rule of inductive philosophy, which seeks not for the true relation of any one thing in itself, but from universals, from uses and application37 which are common to other things. in one case nature makes that luminously clear, which is only dimly shadowed forth in another; and in seeing organs under every conceivable variety of circumstance, we learn to estimate at their full value characteristics which are common to and inseparable from all—the only point whence we can securely deduce their real uses in the animal economy. of this, abernethy early saw and inculcated the advantages.
as it was impossible to combine anything like a comprehensive study of a vast science in the same course with lectures on human anatomy, he was accustomed, at the conclusion of the course, to devote a lecture or two to select illustrations of this important subject. this he ultimately relinquished, the universal admission of the fact rendering it no longer necessary.
we shall have occasion, by and by, to record the circumstances under which one of the most important steps was taken for securing the interests of comparative anatomy in this country—a proceeding in a great degree owing to the good sense and personal influence of abernethy, and exemplifying, in the admirable fitness of the individual16, the penetrative perception of character which distinguished his early preceptor in anatomy.
we have little doubt that we have now entered on the most laborious part of abernethy's life, and that, during this and some succeeding years, his exertions were so great and unremitting, as to have laid the foundation of those ailments which, at a comparatively early period of life, began to embitter its enjoyment, and to strew the onward path with the elements of decay and suffering.
he lectured himself on anatomy, physiology, and pathology, besides surgery—subjects which are now usually divided between three or four teachers. there is abundant evidence that he was an attentive observer of what was going on in the hospital. he was assiduous in visiting most places where any information was to be obtained. we find him attending mr. hunter's lectures, and constantly meditating on what he heard there; thus seeking38 opportunities of making himself more and more familiar with those opinions which, in his view, on most of the points to which they related, were definite—cautiously deduced—not always clear, perhaps; but, when understood, truthful.
he endeavoured further to mature an accurate perception of mr. hunter's views, by seeking private conferences with him; and hunter kindly afforded him facilities for so doing. we have abernethy's own acknowledgment of this, coupled with his regret that he could not more frequently avail himself of them. indeed, when we consider that abernethy lived at this time in st. mary axe, or in mildred's court in the poultry,—that he was lecturing on the sciences i have mentioned,—that he was observant of cases at the hospital (a very timeful occupation),—and consider the distance between these points and mr. hunter's residence in leicester square, or his school in windmill street,—we see there could not be much time to spare. it was not, however, merely during the time at which he was delivering his lectures that he was thus actively employed. we have, not unfrequently, evidence that he was often at the hospital late in the day, in the most leisure season of the year, when perhaps his senior had, during his absence in the summer, confided the patients to his care.
we used to get, occasionally, such passages as these in the lectures: "one summer evening, as i was crossing the square of the hospital, a student came running to me," &c. very significant of continued attention during the summer or leisure season—he not being, be it remembered, other than an assistant-surgeon, and not, therefore, necessarily having duties at the hospital.
at this period, it was a common practice with him to rise as early as four in the morning. he would sometimes go away into the country, that he might read, more free from interruption. he also instituted various experiments, some of which we shall have shortly to notice, for the philosophical spirit in which they were conducted. his visit to france must have been made about this time, when the celebrated desault was at the height of his reputation. his stay could not have been long, in all probability; but we have evidence showing how quickly he perceived, amidst39 the success of desault, the more important defects of the hospital—the h?tel dieu—to which he was chirurgien-en-chef, and the influence exerted by them on his practice.
as we shall be obliged again to mention desault in connection with a material item in the catalogue of our obligations to abernethy, we postpone for the present any further remarks on that distinguished french surgeon.
abernethy now continued actively engaged in the study and teaching of his profession. the most remarkable circumstance at this time of his life, and for several years, was his peculiar diffidence—an unconquerable shyness, a difficulty in commanding at pleasure that self-possession which was necessary to open his lecture. everything connected with his lectures is of importance to those who may be engaged in this mode of teaching, or who may desire to excel in it. no man ever attained to excellence more varied or attractive; yet many years elapsed before he had overcome the difficulty to which i have alluded.
an old student, who attended his lectures, not earlier than 1795, told me that he recollected several occasions on which, before beginning the lecture, he had left the theatre for a time, to collect himself sufficiently to begin his discourse. on these occasions, a tumult of applause seemed only to increase the difficulty. the lecture once commenced, i have no evidence of his having exhibited further embarrassment. he seems early to have attained that happy manner which, though no doubt greatly aided by his peculiar and in some sense dramatic talent, there is every reason to believe had been carefully cultivated by study and observation.
his lectures continuing to attract a larger and larger class, the accommodation became inadequate for the increased number of students. the governors of st. bartholomew's, therefore, in 1790, determined on building a regular theatre within the hospital. it was completed in 1791, and abernethy gave his october courses of anatomy, physiology, and surgery of that year in the new theatre. he had thus become the founder of the school of st. bartholomew's, which, for the approaches it made40 towards giving a more scientific phase to the practice of surgery, was certainly superior to any other.
in expressing this opinion, we except, of course, john hunter's lectures, for the short time that they were contemporaneous with those of mr. abernethy; john hunter dying, as we have said, in 1793. as st. bartholomew's hospital was our own alma mater, we may, perhaps, speak with a fallible partiality; but we think not. we are far from being blind to the faults which bartholomew's has, in common with other schools; and, we believe, regret as much as anybody can do, that the arrangements of our hospitals, excellent as in many respects they are, should still so defectively supply many of the requisitions which the interests of science demand. some of these defects we may endeavour to point out in their proper place. we shall now leave the subject of mr. abernethy and his lectures, and begin to consider some of his earlier efforts at authorship, sketch the objects he had in view, and the mode of investigation.