OF MANNER.
"Non ego paucis,
Offendar maculis, quas aut incuria fudit,
Aut humana parum cavit natura."
Horace.

    "I will not be offended by a few blemishes, the result of inattention, or against which human frailty has not sufficiently guarded."

Mankind have long established, by universal consent, the great importance of "Manner." It has been so ably and so variously discussed by different writers, that it is next to impossible to say any thing new on the subject, or what has not been even better said on the subject already. Still it is equally true that it is a thing very much less cultivated than its influence demands; so that really easy, good manners continue to be a very rare and enviable possession. But if manner be thus influential in the ordinary intercourse of life, it is still more important in ministering to disease. People, when they are ill, have, for the wisest purposes, their susceptibilities more vivid; and it is happy for them when those in health have their sympathies—as is natural, we think, that they should be—quickened in proportion. No doubt it is a great subtraction from whatever benefit the most skilful can confer, if it be administered in a dry, cold, unfeeling, or otherwise repulsive manner. There is too a very sound physiological as well as moral reason for kindness. It is difficult to overrate the value of that calm which is sometimes diffused over267 the whole system by the impression that there is an unaffected sympathy in our sufferings. We have of course, in our time, observed abundant varieties of manner in our professional brethren; and we have often listened with interest to conversations in society, in which the manners of various medical men have been the subject of discussion, from which good listeners might, we think, have often taken valuable lessons.

We are convinced that the disguise, worn by some, of an artificial manner, leaves, on many occasions, no one more deceived than the wearer. Many patients have their perceptions remarkably quickened by indisposition, and will penetrate the thin veil of any form of affectation much more readily than people imagine. In common language, good feeling and kind manner are said to spring from the heart. If a man feels kindly, he will rarely express himself otherwise, except under some momentary impulse of impatience or indisposition.

There is no doubt that the secret of a kind and conciliatory manner consists in the regulation of the feelings, and in carrying into the most ordinary affairs of life that principle which we acknowledge as indispensable in serious matters—of doing to others as we would they should do to us.

We are not speaking of a polished manner; that is another affair. A man\'s manner to a patient may be unpolished, or as homely as you please; but if he really feels a sympathy for his patient, it will, with the exception to be stated, never be coarse or unkind.

Some men are absurdly pompous; others, hard and cold; some put on a drawling, maudlin tone, which the most superficial observer detects as being affected. An honest sympathy is more acceptable than even a polished manner; though doubtless that is a very desirable grace to a learned profession.

In general, our own experience—and we know something of indisposition in our own person—has induced us to judge favourably of the manner of medical men.

There are, no doubt, exceptions, and sometimes in men in whom you would least expect it. We have known men "eye" a patient, as if looking at some minute object; some, jocosely268 familiar. One man has an absurd gravity; another thinks he must be all smiles. We have known, too, the adoption of a tone characterized by a sort of religious solemnity. These, when assumed, are generally detected, and of course always vulgar. Some even say really rude and unfeeling things, before any thing has happened to provoke them. We attended a gentleman who had a great deal of dry humour, and who was very amusing on such matters. One morning, he said, "I saw Dr. —— on one occasion, and the first thing he said to me I thought he might as well have omitted. \'I see, sir,\' said he, \'that you have taken the shine out of your constitution.\'"

Abernethy\'s manner was at times—always, in serious cases, and, so far as we ever observed, to hospital patients—invariably, as unaffectedly, kind as could be desired. It is too true that, on many occasions of minor import, that impulsiveness of character which we have seen in the boy, was still uncontrolled in the man, and led him to say things which, however we may palliate, we shall not attempt to excuse.

It is true his roughness was very superficial; it was the easiest thing in the world to develop the real kindness of heart which constantly lay beneath it; and it is very instructive to observe how a very little yielding to an infirmity may occasionally obscure one of the most benevolent hearts that ever beat in a human breast, with the repulsive exterior of ungentle manners. Still, patients could not be expected to know this; and therefore too many went away dissatisfied, if not disgusted.

The slightest reaction was, in general, sufficient to bring him to his self-possession. A lady, whom he had seen on former occasions, was one day exceedingly hurt by his manner, and burst into tears. He immediately became as kind and patient as possible, and the lady came away just as pleased as she had been at first offended.

Reaction of a different kind would answer equally well. One day, a gentleman consulted him on a painful affection of his shoulder, which had been of a very excruciating character. Before he had time to enter on his case, Abernethy said, "Well, I know nothing about it." The gentleman sharply retorted: "I do269 not know how you should; but if you will have patience till I tell you, perhaps you then may." Abernethy at once said, "Sit down;" and heard him out, with the greatest kindness and patience.

I am indebted to Thomas Chevasse, Esq. of Sutton Coldfield, Warwick, for the following letter to a patient in Surrey, who had complained that he did not receive any sympathy from him.

    "Dear Sir,

    "I am sorry to have said any thing that has offended you. I may have felt annoyed that I could not suggest any plan of treatment more directly curative of your malady, and expressed myself pettishly when you did not seem to understand my meaning; for I am a fellow-sufferer, and had tried what are considered to be appropriate remedies, unavailingly. I assure you that I did not mean to hurt your feelings, and that I earnestly hope the state of your health will gradually improve, and that your local maladies will decline in proportion.

    "I am, dear Sir,???????
    "Your obedient servant,??
    "John Abernethy.

    "Bedford Row, October 25."

A surgeon was requested to visit a patient in one of the suburbs of the metropolis. When he arrived there, he had to mount two or three dilapidated steps, and to read a number which had been so nearly worn away, that he was enabled to determine whether it was the number he sought only by the more legible condition of its two neighbours. Having applied a very loose, dilapidated knocker, an old woman came to the door.

"Does Captain —— live here?"

"Yes, sir."

"Is he at home?"

"Yes, sir. Please, sir, may I be so bold—are you the doctor, sir?"

"Yes."

"Oh! then, sir, please to walk up."

The surgeon went up a small, narrow staircase, into a moderate-size,270 dirty, ill-furnished room, the walls of which were coloured something between yellow and red, with a black border. An old man, in a very shabby and variegated deshabille, rose from his chair, and, with a grace worthy of a court, welcomed the stranger. His manner was extremely gentlemanly, his language well chosen, the statement of his complaint particularly simple and clear. The surgeon, who, like most of us, sees strange things, was puzzled to make out his new patient; but concluded he was one of the many who, having been born to better things, had been reduced by some misfortune to narrow circumstances. Everything seemed to suggest that construction, and to warrant no other. Accordingly, having prescribed, the surgeon was about to take his leave, when the old gentleman said:

"Sir, I thank you very much for your attention;" at the same time offering his hand with a fee.

This the surgeon declined, simply saying:

"No, I thank you, sir. I hope you will soon be better. Good morning."

"Stay, sir," said the old gentleman; "I shall insist on this, if you please;" in a tone which at once made the surgeon feel that it would be painful and improper to refuse. He accordingly took it. The old gentleman then said, "I am very much obliged to you, sir; for had you not taken your fee, I could not again have the advantage of your advice. I sent for you because I had understood that you were a pupil of Mr. Abernethy\'s, for whom I could not send again, because he would not take his fee; and I was so hurt, that I am afraid I was almost rude to him. I suppose, judging from the appearance of things here that I could not afford it, he refused his fee; on which I begged him not to be deceived by appearances, but to take it. However, he kept retreating and declining it, until, forgetting myself a little, and feeling somewhat vexed, I said, \'By G—, sir, I insist on your taking it!\' when he replied, \'By G—, sir, I will not!\' and, hastily leaving the room, closed the door after him."

This gentleman has been dead some years. He lived to a very advanced age—nearly, if not quite, ninety—and had many271 instructive points of character. He was really in very good circumstances; but he lived in a very humble manner, to enable him to assist very efficiently some poor relations. To do this, he saved all that he could; and although he insisted on the surgeon taking a fee when he visited him, he said that he should not hesitate to accept his kindness when he called on the surgeon. The intercourse continued many years; but with rather a curious result.

After a time, growing infirmities converted what had been a visit—perhaps once or twice a year—into occasional attendances, when the rule he had prescribed to himself, of paying visits at home, became characterized by very numerous exceptions; and, at last, by so many, that the rule and the exception changed places. The surgeon, however, went on, thinking that the patient could not do other without disturbing existing arrangements. When, however, the old gentleman died, about four hundred guineas were found in his boxes, wrapped up, and in various sums, strongly suggestive of their having been (under the influence of a propensity too common in advancing life) savings, from the somewhat unnecessary forbearance of his medical attendant. We know one other very similar occurrence.

Sometimes Mr. Abernethy would meet with a patient who would afford a useful lesson. A lady, the wife of a very distinguished musician, consulted him, and, finding him uncourteous, said, "I had heard of your rudeness before I came, sir; but I did not expect this." When Abernethy gave her the prescription, she said, "What am I to do with this?"

"Anything you like. Put it in the fire, if you please."

The lady took him at his word—laid his fee on the table, and threw the prescription into the fire, and hastily left the room. Abernethy followed her into the hall, pressing her to take back her fee, or to let him give her another prescription; but the lady was inexorable, and left the house.

The foregoing is well-authenticated. Mr. Stowe knows the lady well, who is still living. But many of these stories, to our own knowledge, were greatly exaggerated. Abernethy would sometimes offend, not so much by the manner as by the matter; by saying what were very salutary, but very unpleasant truths,272 and of which the patient perhaps felt only the sting. We know a gentleman, an old fox-hunter, who abused Abernethy roundly; but all he could say against him was: "Why, sir, almost the moment I entered the room, he said: \'I perceive you drink a good deal,\'" which was very true. "Now," added the patient, very na?vely, "suppose I did, what the devil was that to him!"

Another gentleman, of considerable literary reputation, but who, as regarded drinking, was not intemperate, had a most unfortunate appearance on his nose, exactly like that which frequently accompanies dram-drinking. This gentleman used to be exceedingly irate against Abernethy, although all I could gather from him amounted to nothing more than this, that when he said his stomach was out of order, Abernethy observed, "Ay, I see that by your nose," or some equivalent expression.

However rough Abernethy could occasionally be, there was, on grave occasions, no feature of his character more striking than his humanity. Dr. Barnett74 had a case where Abernethy was about to perform a severe operation. The Doctor, at that time a young man, was anxious to have every thing duly prepared, and had been very careful. When Abernethy arrived, he went into the room into which the patient was to be brought, and, looking on the instruments, &c. on the table, said: "Ay, yes, that is all right;" then, pausing for a moment, he said: "No, there is one thing you have forgotten;" and then, throwing a napkin over the instruments, added: "It is bad enough for the poor patient to have to undergo an operation, without being obliged to see those terrible instruments."

Few people get off so badly in the world as poor gentlemen. There are multifarious provisions in this kingdom for all sorts of claimants; but a poor gentleman slips down between those which273 are not applicable to his case, and those which are too repulsive to be practicable. His sensibilities remain—nay, perhaps are sharpened—and thus, whilst they tend to exasperate his wants, they increase the difficulty of supplying them. There is here afforded a grateful opportunity for the indulgence of what we believe, amidst some exceptions, to be the ruling spirit of medical men: a sensitive philanthropy, which no men in the world are more liberal in disbursing. Abernethy had his full share of this excellence. There are multitudes of instances exemplifying it. We are indebted for the following to Mr. Brown, of the respected firm of Longman and Co. Abernethy was just stepping into his carriage to go and see the Duke of ——, to whom he had been sent for in a hurry, when a gentleman stopped him to say that he should be very glad if he could, at his leisure, pay Mr. —— another visit at Somers Town. Abernethy had seen this poor gentleman before, and advised a course which it appeared that the patient had not resolution to follow. "Why," said Abernethy, "I can\'t go now, I am going in haste to see the Duke of ——." Then pausing a moment before he stepped into the carriage, he looked up to the coachman and said, quietly, "Somers Town." This is very characteristic. The fidgetty irritability of his first impression at interference, and the beneficence of his second thought.

Dr. Thomas Rees knew a gentleman who was a man of ability, who had been a long time ill, and who got a scanty living by his writings. Dr. Rees called on Abernethy, one morning, and told him that the gentleman wished to have his opinion; but that he had heard such accounts of him, he was half afraid to see him. "And if he were not," said Dr. Rees, "he is not able to pay you. He is a great sufferer, and he gets his living by working his brains." "Ah!" said Abernethy; "where does he live, do you say?" "At ——," mentioning a place full two miles distant. Abernethy immediately rang the bell, ordered his carriage, visited the gentleman, and was most kind to him.

One day, a pupil wished to consult him, and found him, about ten minutes before lecture, in the museum, looking over his preparations for lecture—rather a dangerous time, we should have274 said, for consultation. "I am afraid, sir," said the pupil, "that I have a polypus in my nose, and I want you to look at it." No answer; but when he had sorted his preparations, he said: "Eh! what?" The pupil repeated his request. "Then stand upon your head; don\'t you see that all the light here comes from a skylight? How am I to look up your nose? Where do you live?" "Bartholomew Close." "What time do you get up?" "At eight." "That can\'t be then." "Why, sir?" "You cannot be at Bedford Row at nine." "Yes, sir, I will." "To-morrow morning, then." The pupil was punctual. Mr. Abernethy made a most careful examination of his nose, entered into the causes and nature of polypi, assured him that there was nothing of the sort, and exacted from him a promise that he would never look into his nose again. The gentleman, in his letter to me, adds: "This I have never done, and I am happy to say that there has never been any thing the matter."

The following we have from a source of unquestionable authority:

Abernethy was attending a poor man, whose case required assistance at a given time of the day. One morning, when he was to see this patient, the Duke of York called to say that the Prince of Wales wished him to visit him immediately. "That I cannot do," said Mr. Abernethy, "as I have an appointment at twelve o\'clock"—the time he promised to visit the poor man. "But," said the Duke, "you will not refuse the Prince; if so, I must proceed to ——." "Ah!" said Abernethy, "he will suit the Prince better than I should." He was, however, again sent for, a few hours later, when he of course visited the Prince.

Very many instances of his liberali............