HIS REMARKS ON TUMOURS.

    "Cogitatio in vero exquirendo maxime versatur. Appetitus impellit ad agendum."—Cicero.

    "The Intellect engages us in the pursuit of Truth. The Passions impel us to Action."

In our brief sketches of Abernethy\'s works, we are quite as desirous of showing why he did not do more, as we are of setting down faithfully our many undoubted obligations to him. This, indeed, is the best mode of giving an onward impulse to those approaches towards a definite science which (John Hunter excepted) he was the first to secure. If we would increase the usefulness of those beautiful principles which he has left us, we can hardly do better than endeavour to point out any error or deficiency in the investigation of any subjects to which such principles may be applicable. His work on "Tumours" contains much that is interesting in regard to the peculiar character of his mind, and his aptitude for simplification. He does not undertake a thorough investigation of the subject. His object seems to have been to place in an intelligible order, to chronicle and mark, that which was really known; to pack together, as it were, that which was clear and positive, in a form convenient for consideration; to remove that disorder and obscurity which seem to hang about the threshold of all inquiries, and substitute so much of arrangement and perspicuity as might invite, and perhaps facilitate, further investigation.

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He states the more important circumstances which he had observed, and conducts his classification of the so-called "Tumours" on a basis as scientific as it could be on an imperfect induction of facts. He did this in a way eminently characteristic of his quick perception, in seizing those properties on which a nomenclature should be based, and in marking those distinctions which, in a practical science, must always be regarded as of the greatest value. He founded his nomenclature chiefly on certain resemblances, observed in these diseases, to well-known structures of the body.

The simplicity of this plan, so long as the resemblance is obvious, is just that which constitutes excellence in nomenclature. To take an example, amongst others, he says there is a tumour the structure of which resembles the Pancreas, or Sweetbread as it is popularly called, and to this tumour he gives the name of Pancreatic. Now every one knows a sweetbread, and the name implies no opinion whatever as to its nature; it simply declares a fact. Whatever we may ultimately discover with regard to tumours, a name of this kind, though it may possibly be exchanged for one more significant of the nature of the disease, will still leave us nothing to unlearn; for the tumour in question will always have that resemblance from which Mr. Abernethy named it; and if we should find (as indeed we do find), in course of time, that diseases undergo alterations of type, the rarity of a tumour resembling the sweetbread would record that circumstance.

Had he examined them by the microscope, and selected the appearances so elicited as grounds for his classification, it would have been much less useful. In the first place, comparatively few persons would have had the opportunity or taken the pains to observe; and secondly, we should have had the inconveniences resulting from that variety which we generally find in the reports of microscopic researches. There is just now a great disposition for microscopic inquiry, perhaps somewhat too much; but no channel should be neglected, if it be not too exclusively relied on. Abernethy amused himself at one period in examining ultimate structure by the microscope; but he seems to have had but a very measured reliance on this mode of investigation.

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Judicious nomenclature is of immense importance in the framework of science, and a want of care in this has probably done as much as anything to impede the course of rational investigation. There is nothing, perhaps, in the whole range of science more to be lamented than many—indeed, I might say all—parts of medical nomenclature. If our ignorance prevents us from giving a name to a thing which is descriptive of its nature, we might easily avoid applying such as are calculated to mislead. We can imagine the confusion which would result from a druggist labelling a bottle of water, "poison;" and a vessel containing poison, "water;" yet we doubt whether he would more imperfectly express the true relations of these fluids, than the terms "fever" and "inflammation" do the real nature of the conditions which they are employed to designate.

Abernethy\'s arrangement of tumours not only illustrates his disposition to seize on the more salient points of a subject, but also his inclination to seek for the essential relations of (so-called local) disease in the general condition of the body. He consistently, therefore, mentions them in an order founded on such relations. He places those first which he had found least dangerous in their nature, least destructive in their effects, and which appeared to him to have been attended by the least disturbance to the general economy. In like manner he placed those which had manifested more malignant or dangerous characters, in the order of their severity; inferring their characters respectively from the disturbance of the constitution, the resistance of the disease to treatment, and the variety of structures destroyed in its progress.

Between these two extremes, he placed, as the step of transition, that tumour which he had observed to partake most strongly of intermediate characters. But, besides the desire to throw some light on the subject of tumours generally, he had another special object in view. Few diseases exemplify the absence of scientific research more than tumours. In regard to most of these morbid depositions, it may be remarked that, even now, whenever a patient with one of these so-called tumours applies for advice, the practicability of removal is too often the only thing thought of;109 and it must be obvious to common sense that the mere cutting away of a deposition of this kind (however proper under some peculiar circumstances), can hardly ever exert any influence on the causes of its production. Indeed the manner in which these diseases are continually removed, without any previous inquiry that is really worthy of the name, is amongst the many grounds on which we found the opinion expressed in the sequel on the present state of medical surgery, as contrasted with that in which it was left by Abernethy. Now, while the gravity of the subject rendered the consideration of all tumours important, there was one which in an especial manner had eluded all efforts to expose its nature and dependencies—this was the justly-dreaded cancer. In regard to this, Mr. Abernethy hoped that further information might be obtained, by investigating other tumours more closely, and thus bringing, as he expresses it, collateral knowledge to bear on it, "like light shining from various places to illustrate the object of our researches."

Here was a suggestion in the true spirit of philosophical inquiry; whilst, in taking so simple a basis for the names of tumours, and then associating them in arrangement with their respective constitutional tendencies, he adopted the best mode of recording in a general sense their more important relations. But the fault lay in the suppressed premise that the relations of the so-called tumours were comprehended by a division which is not founded in nature. Nothing indeed can be more artificial than that division of diseases to which surgeons usually restrict the term tumour; a defect which besets all medical inquiries. The old division, in which all sorts of diseases were jumbled together under the general name of tumours, defective as it might be, was much more auspicious, had it ever been made the object of a really philosophical inquiry; because the very diversity of the phenomena they presented would, by the ordinary process of common sense or inductive reasoning, have only served to bring out their common characters—the most important first step in all investigations of this nature.

Had Mr. Abernethy extended that collateral view which he justly insists on, to all sorts of new depositions, instead of confining110 it to the so-called "tumours," he would have detected how artificial was the division, and taken it at its just value; he would have found that he had excluded circumstances which not only led to a much more intimate knowledge of the relations on which those so-called tumours depend, but which confer a power of demonstrating easily, and in a more particular manner, to the most ignorant or prejudiced, those relations to a disordered state of the body, of which, without such assistance, it required a mind no less penetrative and suggestive than Abernethy\'s to give even a general enunciation. This defect essentially consisted in the vice we have before alluded to, and is nothing else but a violation of one of the rules most insisted on by Lord Bacon28.

It proceeds, perhaps, from the habit of looking at subjects through a medium too exclusively anatomical, and by which even Mr. Hunter was sometimes, though exceptionally, hampered. Popularly, it was deducing conclusions from only a portion of the facts of the subject; but if Abernethy did not get the whole of the facts, and therefore missed some portion of the conclusions to be drawn from them, he at least avoided the error of inferring anything positive which the facts did not warrant. We hope, however, that the paper has been valuable, in enabling some of us to arrive at further views, which serve to confirm the truth and extend the application of those entertained by Abernethy.

Now, to put the whole thing popularly, and to direct the public view to the common sense of the matter, it is obvious that if we want to know the real nature of any growth whatever—say a tumour, a plant, or an animal—we cannot do this by any examination of its structure alone. If we desire to know its nature, we must also examine its habits, food, climate, and the various influences to which it is subjected. If, indeed, this were once done, then it is very possible, on again seeing the structure merely, we might recognize its real relations, although we might still be glad to have any well-known substance to which we could compare it, if only to record its identity. This is right enough, thus111 to obtain the general knowledge before we assume the particular. Again, suppose I had some ground growing all manner of plants, and twenty different sorts of fungi, what should I get by merely examining the fibres of one or the other?

But I should easily discover that some plants grew best in one soil, some in another, some with more moisture, some with less; whilst the very circumstances of soil, moisture, and so on, which were essential to some, might be enfeebling or destructive to others. No one will for a moment doubt that the kind of nutrition was of great importance in all, and this would necessarily lead me to infer that, "If I desired to get such a fungus, I must have more moisture, less air, less heat or light, or another soil," and so on.

In a plant, you must also look to the roots and other parts of the organism. Now this is exactly what should be done in regard to tumours; and for no reason more cogent than that the great beauty and beneficent effects of Mr. Abernethy\'s views may become practically useful; for in the same manner that we would desire to influence the plant or the fungus through the sources whence it derives its nourishment, as air, water, various ingredients in the earth, and so on; so the only channels by which we can effect any influence, are those organs by which these matters are ultimately changed into the structures we wish to maintain, or we desire to get rid of, as the case may be. Now, although the number and relations of these organs may render the investigation more difficult in one case than in another, as they become more multiplied, or as the animal or vegetable is more or less simple or complicated in structure; yet, whether we take our example from man, or any other animal—or, in fact, any organized being of the countless modifications w............