OF ABERNETHY\'S BOOK ON "THE CONSTITUTIONAL ORIGIN OF
LOCAL DISEASES," OTHERWISE "MY BOOK."
"From the barr\'d Vizor of Antiquity
Reflected shines the Eternal light of Truth,
As from a mirror; all the means of action,
The shapeless masses, the materials,
Are everywhere around us. What we need
Is the celestial fire, to change the flint
Into transparent crystal, bright as fair."
Longfellow\'s "Spanish Student."
In all that Abernethy had hitherto published, it was easy to perceive that, although he was carefully examining the prevailing opinions and practice of the day, he was emphatically one of those independent thinkers who had power to overlay the most established conventionalisms with opinions of his own. Although hitherto his publications had related to particular diseases or accidents which were held as within the ordinary province of the surgeon, he was shadowing forth principles—views which, if they were true, must necessarily have a much wider range of application than to the particular cases which it had been his object to consider. In 1804, he had sufficiently matured his general views to think it right to publish them; and this he did in his book on the "Constitutional Origin of Local Diseases," popularly known as the "My Book," to which he not unfrequently referred his patients for a more detailed account of his views, than he could find time to give in the consulting room. When we reflect that diseases consist entirely of altered conditions in the structure or function of some part of the body, a formal announcement that127 they must be greatly influenced by the organs on which the whole body depends for its nutrition, seems to have so much the aspect of an obvious truism, that we scarcely know whether most to wonder at so formal an announcement of it having been necessary, or the astonishing number and variety of the reservations with which it has been admitted.
But, strange as this may appear, and although all the facts have been before the eyes of man for ages—nay, though their relations have been more or less felt and acknowledged in cases usually submitted to the physician,—we venture to say that nothing like an attention at all adequate to their importance was obtained for them in the practice of physic, and scarcely any at all in surgery, until the time of Abernethy.
At the present time, a great deal has been done to establish, by the most clear and indisputable demonstration, the practical usefulness and necessity of the principles to which Abernethy conducted us, in the cure of diseases, whether medical or surgical. Still, these principles are much neglected, much misunderstood, or so imperfectly carried out, as to excite, even in many of the public, expressions of astonishment. It is, indeed, not too much to assert, that, even in those cases in which their successful application has been most incontestibly exemplified, his principles are fully carried out on comparatively few occasions.
The causes of all this are, we fear, too easily detected; the removal of them is indeed sufficiently difficult. We may possibly discuss both points in the sequel.
Instead of the exquisite simplicity and clearness of Abernethy\'s views, so far as he had gone, being carefully studied, and with a view to the extension of them beyond those limits which his time, his opportunities, and his caution had assigned to them; instead of examining into, and testing, the practical value of the deducible, and, in fact, necessary sequences, on views of which he had demonstrated the truth and value; practice appears to have taken a retrograde movement.
He who would advance even as far as Abernethy, is in danger of being regarded as crotchety or peculiar; whilst any who should strive by a more careful examination of his views to render their128 practical application more definite and analytical, must be prepared to be looked on simply as an enthusiast.
This has, indeed, been the case more or less in all sciences from the earliest times. The facts which conduct us to a true interpretation of the laws in obedience to which they occur, have been always before us; the very same facts on which, as Professor Whewell29 observes, we have raised the stately structure of modern science. Butler30 had before made a similar remark. Poets too, as even the motto to our chapter shows, have held the same sentiment; what everybody knows, how few consider! Neither Copernicus nor Galileo altered or invented facts. Those they observed! what they discovered, were conclusions interpreting the true relations of them. Bodies fell to the earth, and the crystal rain-drop had shown the composite nature of light in the beautiful colours and wonderful illustrations of the rainbow, ages before Newton discovered the true explanation of the one, and the great law exemplified in the other.
The object of "the Book" is to set forth the great fact of the reciprocal influence existing between the nervous system and the digestive organs, and the power they mutually exert in the causation and cure of diseases; and this, whether the diseases originate in disturbance primarily directed to the brain or any other portion of the nervous system, or to the digestive organs; whether the result of accident, such as mechanical injury, or other local manifestations more commonly termed disease. In the book before us we shall find an ample refutation of many misconstructions and misapprehensions of Abernethy\'s views; misconstructions which have tended to obscure principles, remarkable for their simplicity and truthfulness; to impede the beneficial application of them in a manner which has been equally injurious to the public and the profession, and which, have impressed on mankind a very inadequate idea of the obligations due to the distinguished author. His views were said to be theoretical and exaggerated, whilst they were conclusions logically deduced from facts; and so far from the pervading power of the influences to which129 he proximately attributed the causation and cure of disease having been exaggerated, the onward study of his principles only serves, by the discovery of more multiplied and refined applications of them, to fill in with additional illustrations the accurate outline which he has so truthfully drawn. He never wrests a fact to a conclusion to which it does not legitimately lead. In virtue of that suggestive quality of his mind (so important an aid in philosophical inquiries), he occasionally, in all his writings, puts forth suppositions, but these only as questions, the next in the order of inquiry, and these he asks of nature alone.
Mr. Hunter had been the first in this country to make the true use of anatomy; I mean in the sense that whilst it was no doubt the basis of our investigation into the functions or uses of parts, still it was only one of an extensive series of inquiries. He had examined the dead with no purpose more earnestly, than to assist him in his endeavours to observe the living; examined parts, that he might better understand the whole. He had made himself familiar with the economy of animals, and generally with the habits of organized beings, whether animal or vegetable, that he might know their relations to each other, and that of the whole to the phenomena, habits, and laws, of the Human economy. As he neglected no source whence it had been customary to seek for information, so, notwithstanding his fondness for animals, he made various experiments on living creatures. But whilst these experiments afford additional proofs of the poverty, so to speak, of this plan of investigation, they impress on us the truth of Sir Charles Bell\'s assertion, that physiology is essentially a science of observation. We have only to place Mr. Hunter\'s observations and experiments here referred to, in juxtaposition, in order to bring out in high relief the great meaning and value of the one, and the unnecessary, or inconclusive, character of the other. He also examined the various facts presented to him in the living body with unequalled patience and circumspection.
Amongst others, he had paid particular attention to those which exemplify that vivid, that watchful connection which exists between various parts and organs, and by which impressions or sensations excited in any one part are telegraphed, as it were,130 with the swiftness of lightning to any or all of the organs of the body; facts which may be observed by anybody, by no one better, and by few so well, as patients themselves. To take a common example: everybody is familiar with the fact that certain disturbances of the stomach produce pain or other annoyance in the head. Every one also knows that in such cases there is very often no pain, and sometimes no sensation of annoyance in the stomach; so that were it not from an innumerable succession of such conditions, in connection with particular influences on the stomach, we should, from the feeling of the stomach only, never dream of the cause being in that organ. Now on these simple facts hang not only the most practical of all John Hunter\'s observations, not only the most valuable of Mr. Abernethy\'s, but (as far as we can see) those relations through a philosophical examination of which we shall still most auspiciously seek to extend our practical knowledge of disease. We see here just that which Mr. Hunter had asserted—namely, "that the organ secondarily affected (in this case, the head) sometimes appeared to suffer more than the organ to which the disturbance had first been directed."
He observed also that the connection thus manifested, existed equally between all other parts and organs; that although it might be exemplified in different forms, still the association it implied was indisputable. He adopted the usual terms by which these phenomena had been designated. Parts were said to sympathize with each other, and no term could be better, as it simply expressed the fact of associated disturbance or suffering. It is true the facts were not at all new; they had always existed; nay, they had been observed and commented on by many persons ever since the time of Hippocrates; and if I were to mention the whole of such facts, there is scarcely one which would not be to some one or other as familiar as a headache from disturbance of the stomach. Mr. Hunter, however, had a kind of instinctive idea of the yet unseen value of the clue thus afforded to the investigation of disease; and he observed these facts with a greater attention to all their details than any one, or all, who had preceded him.
131
Hunter\'s observations on the subject in his lectures were extremely numerous, and elaborate even to tediousness; Abernethy, who used to give us a very humorous description of some of the audiences of John Hunter on these occasions, was accustomed to say, "That the more humorous and lively part of the audience would be tittering, the more sober and unexcitable quietly dosing into a nap; whilst the studious and penetrative few appeared to be seriously impressed with the value of Mr. Hunter\'s observations and inquiries." Mr. Cline, an honoured name in our profession, and one who, had he lived in later times, would probably have been as distinguished in advancing science as he was for his practical excellence, significantly expressed his impressions of the future importance of the inquiries in which Hunter was engaged. Addressing Mr. Clift, after one of the lectures, he said:
"Ah! Mr. Clift, we must all go to school again."
Mr. Abernethy carefully treasured up and pondered on what he heard. He placed himself as much as he could near Mr. Hunter; took every pains, which his time and occupations allowed, thoroughly to understand him; and, with his characteristic tendency to simplification, said: "Well, what Mr. Hunter tells us, resolves itself into this: that the whole body sympathizes with all its parts."
His perceptivity, naturally rapid, was evidently employed in observing the bearing of this axiom on the facts of disease. The digestive organs, which, if we extend the meaning to all those engaged in assimilating our food, compose nearly the whole viscera of the body, could not escape his attention, nor indeed fail to be regarded in all experimental investigations of any one organ. Accordingly, in his paper on the skin and lungs, we have seen a very important application of the relations between organs engaged in concurrent functions; we have placed before us the physiological evidences of their being engaged in a common function, and the sympathetic association it rendered necessary; whence he had observed relations of great moment, and pointed out the practical bearing they must have on Consumption. He had, however, been paying attention for some time to the digestive132 functions, when his intimate friend, Mr. Boodle, of Ongar in Essex, gave a fresh stimulus to his exertions. This gentleman requested him to investigate the functions and conditions of the liver in various nervous diseases, as also in certain affections of the lungs, which had appeared to him, Mr. Boodle, to originate in the former organ. Mr. Abernethy says: "I soon perceived that the subject was of the highest consequence in the practice of surgery; for local diseases disturb the functions of the digestive organs, and, conversely, a deranged state of those organs, either occurring in consequence of such sympathy, or existing previously, materially affects the progress of local complaints."
At the very commencement, he hits on a great cause of evil, and boldly assails one of the most mischievous of all conventionalisms. "The division of medicine and surgery," he observes, "is mischievous, as directing the attention of the two orders of practitioners too exclusively to the diseases usually allotted to them." There is indeed no exaggerating the evils of that partial mode of investigation to which such a custom almost necessarily leads. We fall into error, not because of the difficulty of the subject, but because we never can, by looking at one set of diseased processes only, learn the whole of the facts belonging to the subject. It was just this that prevented Fordyce from arriving at correct views of fever. Nothing could be more excellent than the way he began to consider it; but he hardly begins, before he tells us that he intends to exclude those febrile affections which fall under the care of surgeons. In doing this, he at once abandoned a series of facts which are absolutely essential to the investigation. It must be obvious, on a moment\'s reflection, that, if a particular condition of a part have a relation to the whole body, the study of one without the other, or even if both be taken up by different persons, nothing but the most imperfect views can result. A jury, still more a judge, might in some cases guess from partial evidence the issue of a legal investigation; but who ever heard of either determining beforehand to examine a portion only of that evidence? Yet it is not too much to say, that hardly any legal question can be so recondite as many inquiries in physiology. The nature of the133 case is always more or less obscured by a number and variety of interfering circumstances. Diseases may be regarded, in fact, as nothing more than natural laws, developed under more or less complicated circumstances of interference.
Lord Bacon had warned all investigators of Nature of the danger of attending only to a portion of the facts; it had been one of the great bars to progress of knowledge in general. I regret to say that it still continues the bane of almost all medical inquiries.
Abernethy\'s inference in relation to this mutilated sort of investigation is too true, when he observes that "the connection of all local diseases with the state of the constitution has obtained little notice;" whereas the truth is, that "no part of an animal body can be considerably disordered without affecting the whole system." Now here Mr. Abernethy claims—what? Simply this: he claims for function—that is, the various offices fulfilled by the several parts and organs of the body—that which Cuvier has so beautifully insisted on, and which our own Owen has so instructively exemplified in regard to structure or formation; namely, a necessary relation between the whole and all its parts.
In speaking of affections of the nervous system, Abernethy observes that the brain may be affected by the part injured, and that then it may affect the various organs by a "reflected" operation; but that whatever may be the mode (thus carefully separating the opinion from the fact), "the fact is indisputable." He adds that it may affect some organs more than others, and thus give a character or name to a disease. For example, it might affect the liver, we will say, when the name which would be given would probably be expressive of what was a secondary circumstance—namely, a disturbance of the liver. This does not so frequently happen, perhaps, nor so mischievously in relation to local injuries; but in other cases it is the cause of a great deal of erroneous and misleading nomenclature.
As we have seen, it often occurs that when the organs of the body are disordered, the more salient "symptoms," perhaps the whole of those observed, are referred to a secondarily affected134 organ, and the disease is named from that circumstance. The too frequent result is, that attention is exclusively directed to that organ, whilst the cause, being elsewhere, and where there are no symptoms, wholly escapes observation.
This is a very important branch of inquiry; and as it closely connects what Abernethy left us with what appears to us to be one of the next things to be clearly made out, we will endeavour to illustrate it.
Suppose a person meet with a severe injury, a cut, bruise, fracture, or any thing that we have seen a hundred times before, and, instead of being succeeded by the usual processes of repair, it be followed by some others: the simple expression of the fact is, that something has interfered with the usual mode and progress of repair; and as former experience has shown us that there was nothing in the nature of the injury to account for this, we are naturally led to look for the explanation of it in the state of the individual. But if the unusual appearance be one which we have agreed to call ............