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Abernethy as a Lecturer.
suggestive and scrutinizing quality of his mind, together with his talent for clear statement of complicated truths, enabled him to carry his inquiries, in this direction, farther, and announce them more luminously, than had previously been done. The facts, indeed, or at least some of them, had been known and commented upon since the time of Hippocrates. John Hunter had paid considerable attention to the subject, and had asserted "that the organ secondarily affected (as, for instance, in head-ache from deranged stomach) sometimes appeared to suffer more than the organ to which the disturbance had first been directed." It was Abernethy's function to trace out this sympathy, as it is called, more fully, and to add ampler illustrations of its nature, its complications, and its range.
Abernethy's strong point, after all, was his lecturing. In this he was unrivalled. His thorough acquaintance with his subject, and wonderful facility in conveying his knowledge, were assisted by a combination of physical and intellectual accessories, which greatly added to the effect. His person was graceful, slender, and delicate-looking, with a pleasing combination of benevolence and humour in his eye. He was remarkably free from technicality, and unusually rich in illustration. By the first he smoothed the rudimentary progress of his pupil, and avoided a premature burthening of the memory. The latter peculiarity was so prominent as to suggest the possession of no small portion of genius, and gave an indescribable charm to his discourses. But his chief characteristics were his humour and his dramatic power. The combination of these sufficed to make him equally entertaining and impressive. He thus could rouse the attention, stamp a fact or principle upon the mind, or touch the moral sensibilities, at will. In relating a case, particularly when repeating a dialogue with a shrewd or witty patient, he was inimitably droll, especially when the recital made against himself. But Abernethy's humour, unlike that of Sydney Smith and other wits, was greatly indebted to manner, and is not effective on repetition. His directions for making a poultice are amusing, as found in his published lectures; but those who heard them, say that nothing could exceed the raciness with which they were given. Parts of his lectures, printed exactly as they were delivered, are as amusing as any book of light reading; and in the "Eventful History of a Compound Fracture," may be seen how important information may be conveyed, upon a subject undoubtedly grave, without a trace of dulness. But it was in the more serious portion of his discourse, when reciting some act of neglect or cruelty, that the better qualities of the lecturer were apparent. His voice faltered with emotion, his eye flashed fire, and his whole soul seemed stirred within him. His sympathy with poverty in distress frequently appeared in his illustrations, and proved,
when taken in connexion with his many recorded acts of benevolence to the poor, the kindly nature of the man.
The foundation of Abernethy's character was unswerving honesty. He not only abhorred what was absolutely false, but detested the exaggeration which is relatively or inferentially so. He declined either to say or to do more than the welfare of his patient required, even when, owing to the weakness of human nature, such abstinence was unfavourable to his interests. Early in life he had seen, with indignation and contempt, the means by which some men attain success; and the sight affected his whole future career. Beneath the varnish of a courtly manner and an elaborate toilet, he had seen the coarse-minded and ignorant man in great prosperity. He had seen the fears of the timid invalid coined into ducats by those whose mission it was to chase them away. He had seen an extensive machinery erected, whose main-spring was self-interest, and whose purposed end was to do nothing, though mischief was too often the result. Long before Mrs. Wittiterly and her Doctor had been drawn by the hand of a master, he had studied their types in the school to which that master afterwards resorted. He had seen all this, and was resolved that his own relations with his patients should be free from all mystery, and based upon a clear understanding of their mutual positions. He explained to his patient his actual condition, and what was requisite to be done for him, in language so simple, as to be easily intelligible, and then considered he had done his duty. He no more thought of pretending to a power or a prescience which he did not possess, than he would to property which did not belong to him. He declined to imitate some of his brethren of the gold-headed cane, and erect himself into an oracle as awful, as mysterious, and as false as that of Delphi. It was not necessary that he should grow rich; but it was essential to his comfort, as an honest, upright man, that he should avoid getting money under false pretences. So far all was right; had Abernethy gone no farther than this, no friend to truthfulness could cast a reproach upon him: but alas! he was to prove another instance of the folly of too exclusively directing the attention to one truth, or one view of a question. In his endeavour to avoid a recognised evil, he fell into another not perceived. From being honest in intention, he sank into uncouthness and rudeness of manner, and inflicted upon the feelings of many injuries they would rather have suffered in their pockets.
The question of the proper bearing of the medical man to his patient is not without interest; and, strange as it may appear, there are different views taken on the subject. Some seem to think that it is proper for the Physician to adopt a conventional artificial voice and manner, and to infuse a degree of empressement into his language and tones; in short,
Abernethy's Faults of Manner.
63 that he should have a technical professional manner, as marked as the "My Lud," and other peculiarities, of the Bar. cannot assent to this. In addition to the requisite skill, we should expect to find in our Physician all the sympathy that the case may claim from a feeling man; all beyond that, all that is merely called up by art to serve a purpose, we had rather be without. By all means let him be natural; if demonstrative, let him be demonstrative; if naturally reserved, let him not try to play a part:-in a word, let him be honest. A doubt once thrown upon his honesty in one particular, would lead us to fear deception in more important things.
But having said thus much in favour of honesty, we would turn again to Abernethy, and protest against the rudenesses in which he allowed himself to indulge. We believe he fell into this bad habit, primarily, from his thorough honesty of character; and, secondarily, from an irritability arising from physical causes, induced by his early and prolonged exertions. But whatever explanation be given, it admits of no justification, and it is to be lamented as unworthy of a man whose real claims to public attention required no factitious aid. But it is to be lamented, not only as a serious blot upon the reputation of an able and honourable man, but also as a precedent which seems to keep in countenance a herd of vulgar imitators, who, devoid of his talents and real benevolence, aim at similar celebrity by copying his greatest defects. It is to be lamented, moreover, since it has served to call away the attention of the public from Abernethy's true merits, and caused him to appear, in the eyes of many, who only know him through the medium of stories,-a large number of which are apocryphal,-in the character of a savage or a buffoon.
His uprightness of character, and entire freedom from selfishness, might be illustrated by many examples. A gentleman had the misfortune to meet with a compound dislocation of the ancle, (an accident, by the bye, which Abernethy was mainly instrumental in redeeming from habitual amputation,) on the road between Andover and Salisbury. An able practitioner of the former place was called in, and replaced the parts. He then said to the patient, "Now, when you get well, and have, as you most likely will, a stiff joint, your friends will tell you, 'Ah! you had a country Doctor;' so, Sir, I would advise you to send for a London Surgeon, to confirm or correct what I have done." The patient consented, and sent for Abernethy, who reached the spot by mail about two in the morning. He looked carefully at the limb, saw that it was in a good position, and was told what had been done. He then said, "I am come a long way, Sir, to do nothing. I might, indeed, pretend to do something; but, as any unavoidable motion of the limb must necessarily be mischievous, I should only do harm. You are in very good
hands, and I dare say will do very well. You may, indeed, come home with a stiff joint, but that is better than a wooden leg." He took a cheque for his fee, sixty guineas, and made his way back to London. Soon after, a wealthy Clergyman in the same neighbourhood had a violent attack of erysipelas in the head and arm. His family, becoming alarmed, wrote up to his brother to request Mr. Abernethy to go down and visit the patient. Abernethy inquired, "Who attends your brother?" "Mr. Davis, of Andover." "Well, I told him all I knew about surgery, and I know that he has not forgotten it. You may be perfectly satisfied. I shall not go." Here, as the narrator says, he might have had another sixty guineas. We are aware that these and similar instances in which he combated the morbid exaggerations of those who consulted him, and endeavoured to reason them into abstaining from undue indulgence in medicine, are looked upon by some as foolish instances of abnegation; but we trust that the claims of honesty and conscience will generally (we cannot expect invariably) be held paramount by the members of an honourable profession, even when self-interest comes backed by a plausible but lax morality.
But has this subject no bearing upon the present state of the profession? Would the existing prevalence of medical heresies have occurred, had the straightforward conduct of Abernethy (without, of course, his peculiarities of manner) been more general among his brethren? We see at present a state of things which cannot, we sincerely believe, be altogether accounted for by the weakness and credulity of the public; we cannot but attribute something to the mystery and the machinery to which we have referred. The public were greatly to blame for the mystery, since they persisted in attributing a power to the medical man beyond all reason: they were to blame in leading to an undue use of medicine, since they supposed that in that alone consisted his power to do them good; and if one declined to prescribe for them, they went to another. But still the profession were consenting parties. There was a want of confidence in the force of truth, when urged with simple earnestness. Had the profession been sufficiently alive to the danger of reaction in the public mind; had they calculated upon the growing intelligence of society; had they sacrificed their immediate interests to the permanent welfare of the profession, they would have prevented the present discreditable state of things. We are not now speaking of vulgar quackery : that must always exist while the masses are ignorant and unreflecting, and thus exposed to become the prey of designing men. We allude to those fashionable systems which are followed by so many otherwise thoughtful and intelligent men and women, who are not to be led astray by mere credulity, but require some one guiding principle, of which they must be convinced.
Modern Medical Heresies.
This has been with many the conviction that the former practice of over-drugging with medicine was wrong. Satisfied of this fact, they have dwelt upon the discovered truth so long, as to have little thought to expend upon the foundations of the system they have adopted. They know themselves to be right on one point of the inquiry; and they too lightly assume the correctness of the rest. Tired of so much physic, they fix upon water, a remedial agent of good repute, and erect a temple of health in which she is the exclusive goddess. As Hydropaths, they can, at least theoretically, get rid of the drugs they so much detest. Or, if unprepared absolutely and ostensibly to "throw physic to the dogs," they tamper with their reason so far as to substitute a semblance for a reality, and, having minutely subdivided the "dummy," swallow it with the greatest possible gravity. Prove to them, if they will listen,-which they will seldom consent to do,-that their fundamental principle is a falsehood; remind them that, for the production of every positive effect, there is required an exactly adequate cause; show them that their great conclusive arguments, their reputed cures, are but prime examples of the logic of Post hoc, ergo propter hoc, and that the same syllogism would equally establish all the competing systems of quackery that now exist, or have ever existed; do all this, and more, yet they fall back upon their first strong conviction, and behind that intrenchment stand, till events prove to them the fallacy into which a partial truth has led them.
We submit the above theory-in explanation of the present state of medical belief, and in which the blame is pretty equally divided between the public and the profession-for what it may . be worth, satisfied that it is borne out by all the facts of the case. Abernethy's reputation steadily increased, until there were few practitioners in London more consulted by the sick of all classes. From distant parts of the country they flocked, returning, in many cases, with strange tales of his odd and brusque manner. These tales added fresh wings to his fame. Nor were there wanting traducers, who maintained that the rude speeches and uncouth behaviour were adopted as means of acquiring notoriety. But his merits were sufficient to support his fame. He was no charlatan, collapsing as soon as his trick is discovered from very emptiness. The honours of his profession were bestowed upon him by his brethren, who have more accurate means of judging of scientific and practical merit than the public can possess. The fact has recently transpired, that it was the intention of the King to create him a Baronet,―an honour which he modestly declined, partly from indifference to titular honours, and partly from prudential reasons connected with his comparatively limited fortune. During the last few years of his life, he curtailed his engage