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, solace1 and suffering, are here strangely intermingled. General benevolence2, with special exceptions. There is no human good without its shadow of evil; even the benevolent3 must take care. Impatient sensibility is much nearer a heartless indifference4 than people generally imagine. The rose, Charity, must take care of the nettle5, Temper. The man who is chary6 or chafed7, in yielding that sympathy which philosophy and feeling require, must beware lest he degenerate8 into a brute9.
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 confided10 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 misery11: 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 Miseries12, 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 physically13 necessary to the comfort of the inmates14, 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 procure15. 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 afflicted16; 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 entrusted17.
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 sumptuous18 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 penetration19 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 eminent20 surgeon, and a gentlemanly, facetious21, 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 expended22 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 demolition23 of the organ in which the troublesome faculty24 resided. Mr. Heaviside, in his professional capacity, is said to have attended more duels25 than any other surgeon of his time. This gentleman, albeit26 not unused to one kind of contest, retired27 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 epoch28 in the life of Abernethy. It is difficult to adjust the influence which it ultimately exerted, for good or evil, on his future prospects29 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 cultivation30 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 miserably31 cramped34 position; one, in fact, much better calculated for detecting faults, than for developing the best mode of amending32 them. As assistant surgeon, he had no emolument33 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 discourses34, were first-rate for that period; but there were no other lectures, not even on anatomy36; which are essentially37 the basis of a medical school.
Dr. Marshall, who was a very remarkable38 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 derived39 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 anecdotes40 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 aptitude41 for lecturing which no doubt greatly contributed to the excellence42 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 analyze43 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 drudgery44 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 misgivings45 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 devoted46 to teaching merely, it may reasonably be doubted whether it be such a disposition47 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 undertaking48 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 diversified49 labour had impressed on his physical organization. In advancing life, the natural desire for ease, if not carefully guarded, may not be without its perils51; but precocious52 labour, stinted53 rest, and the malaria54 of large cities, crowded hospitals, and filthy55 dissecting56 rooms, too certainly bring on a train of evils, not less grave because more distant.
We shall have to revert57 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 skilfully58 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 juxtaposition59 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 fully50 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 luminously60 clear, which is only dimly shadowed forth61 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 relinquished62, the universal admission of the fact rendering63 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 proceeding64 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 distinguished65 his early Preceptor in Anatomy.
We have little doubt that we have now entered on the most laborious66 part of Abernethy's life, and that, during this and some succeeding years, his exertions67 were so great and unremitting, as to have laid the foundation of those ailments68 which, at a comparatively early period of life, began to embitter69 its enjoyment70, and to strew71 the onward72 path with the elements of decay and suffering.
He lectured himself on anatomy, physiology73, and pathology, besides surgery—subjects which are now usually divided between three or four teachers. There is abundant evidence that he was an attentive74 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 meditating75 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, truthful76.
He endeavoured further to mature an accurate perception of Mr. Hunter's views, by seeking private conferences with him; and Hunter kindly77 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 Axe78, 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 actively79 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 philosophical80 spirit in which they were conducted. His visit to France must have been made about this time, when the celebrated81 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 postpone82 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 peculiar83 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 attained84 to excellence more varied85 or attractive; yet many years elapsed before he had overcome the difficulty to which I have alluded86.
An old student, who attended his lectures, not earlier than 1795, told me that he recollected87 several occasions on which, before beginning the lecture, he had left the theatre for a time, to collect himself sufficiently88 to begin his discourse35. On these occasions, a tumult89 of applause seemed only to increase the difficulty. The lecture once commenced, I have no evidence of his having exhibited further embarrassment90. 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 inadequate91 for the increased number of students. The governors of St. Bartholomew's, therefore, in 1790, determined92 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 founder93 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 defectively94 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, sketch95 the objects he had in view, and the mode of investigation96.
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solace
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| n.安慰；v.使快乐；vt.安慰(物)，缓和 | |
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benevolence
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| n.慈悲，捐助 | |
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benevolent
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| adj.仁慈的，乐善好施的 | |
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indifference
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| n.不感兴趣，不关心，冷淡，不在乎 | |
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nettle
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| n.荨麻；v.烦忧，激恼 | |
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chary
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| adj.谨慎的，细心的 | |
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chafed
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| v.擦热（尤指皮肤）( chafe的过去式 )；擦痛；发怒；惹怒 | |
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degenerate
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| v.退步，堕落；adj.退步的，堕落的；n.堕落者 | |
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brute
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| n.野兽，兽性 | |
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confided
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| v.吐露（秘密，心事等）( confide的过去式和过去分词 )；（向某人）吐露（隐私、秘密等） | |
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misery
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| n.痛苦，苦恼，苦难；悲惨的境遇，贫苦 | |
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miseries
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| n.痛苦( misery的名词复数 )；痛苦的事；穷困；常发牢骚的人 | |
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physically
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| adj.物质上，体格上，身体上，按自然规律 | |
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inmates
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| n.囚犯( inmate的名词复数 ) | |
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procure
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| vt.获得，取得，促成；vi.拉皮条 | |
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afflicted
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| 使受痛苦，折磨( afflict的过去式和过去分词 ) | |
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entrusted
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| v.委托，托付( entrust的过去式和过去分词 ) | |
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sumptuous
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| adj.豪华的，奢侈的，华丽的 | |
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penetration
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| n.穿透，穿人，渗透 | |
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eminent
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| adj.显赫的，杰出的，有名的，优良的 | |
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facetious
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| adj.轻浮的，好开玩笑的 | |
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expended
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| v.花费( expend的过去式和过去分词 )；使用（钱等）做某事；用光；耗尽 | |
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demolition
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| n.破坏,毁坏,毁坏之遗迹 | |
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faculty
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| n.才能；学院，系；(学院或系的)全体教学人员 | |
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duels
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| n.两男子的决斗( duel的名词复数 )；竞争，斗争 | |
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albeit
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| conj.即使；纵使；虽然 | |
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retired
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| adj.隐退的，退休的，退役的 | |
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epoch
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| n.(新)时代；历元 | |
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prospects
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| n.希望，前途(恒为复数) | |
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cultivation
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| n.耕作，培养，栽培（法），养成 | |
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miserably
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| adv.痛苦地；悲惨地；糟糕地；极度地 | |
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amending
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| 改良，修改，修订( amend的现在分词 )； 改良，修改，修订( amend的第三人称单数 )( amends的现在分词 ) | |
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emolument
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| n.报酬，薪水 | |
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discourses
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| 论文( discourse的名词复数 )； 演说； 讲道； 话语 | |
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discourse
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| n.论文，演说；谈话；话语；vi.讲述，著述 | |
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anatomy
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| n.解剖学，解剖；功能，结构，组织 | |
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essentially
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| adv.本质上，实质上，基本上 | |
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remarkable
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| adj.显著的，异常的，非凡的，值得注意的 | |
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derived
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| vi.起源；由来；衍生；导出v.得到( derive的过去式和过去分词 )；（从…中）得到获得；源于；（从…中）提取 | |
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anecdotes
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| n.掌故，趣闻，轶事( anecdote的名词复数 ) | |
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aptitude
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| n.(学习方面的)才能，资质，天资 | |
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excellence
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| n.优秀，杰出，(pl.)优点，美德 | |
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analyze
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| vt.分析，解析 (=analyse) | |
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drudgery
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| n.苦工，重活，单调乏味的工作 | |
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misgivings
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| n.疑虑，担忧，害怕；疑虑，担心，恐惧( misgiving的名词复数 )；疑惧 | |
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devoted
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| adj.忠诚的，忠实的，热心的，献身于...的 | |
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disposition
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| n.性情，性格；意向，倾向；排列，部署 | |
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undertaking
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| n.保证，许诺，事业 | |
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diversified
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| adj.多样化的，多种经营的v.使多样化，多样化( diversify的过去式和过去分词 )；进入新的商业领域 | |
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fully
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| adv.完全地，全部地，彻底地；充分地 | |
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perils
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| 极大危险( peril的名词复数 )； 危险的事（或环境） | |
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precocious
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| adj.早熟的；较早显出的 | |
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stinted
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| v.限制，节省（stint的过去式与过去分词形式） | |
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malaria
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| n.疟疾 | |
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filthy
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| adj.卑劣的；恶劣的，肮脏的 | |
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dissecting
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| v.解剖（动物等）( dissect的现在分词 )；仔细分析或研究 | |
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revert
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| v.恢复，复归，回到 | |
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skilfully
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| adv. (美skillfully)熟练地 | |
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juxtaposition
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| n.毗邻，并置，并列 | |
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luminously
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| 发光的； 明亮的； 清楚的； 辉赫 | |
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forth
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| adv.向前；向外，往外 | |
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relinquished
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| 交出，让给( relinquish的过去式和过去分词 )； 放弃 | |
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rendering
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| n.表现，描写 | |
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proceeding
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| n.行动，进行，(pl.)会议录，学报 | |
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distinguished
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| adj.卓越的，杰出的，著名的 | |
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laborious
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| adj.吃力的，努力的，不流畅 | |
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exertions
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| n.努力( exertion的名词复数 )；费力；（能力、权力等的）运用；行使 | |
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ailments
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| 疾病（尤指慢性病），不适( ailment的名词复数 ) | |
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embitter
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| v.使苦；激怒 | |
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enjoyment
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| n.乐趣；享有；享用 | |
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strew
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| vt.撒；使散落；撒在…上，散布于 | |
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onward
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| adj.向前的，前进的；adv.向前，前进，在先 | |
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physiology
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| n.生理学，生理机能 | |
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attentive
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| adj.注意的，专心的；关心(别人)的，殷勤的 | |
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meditating
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| a.沉思的，冥想的 | |
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truthful
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| adj.真实的，说实话的，诚实的 | |
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kindly
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| adj.和蔼的，温和的，爽快的；adv.温和地，亲切地 | |
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axe
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| n.斧子；v.用斧头砍，削减 | |
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actively
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| adv.积极地，勤奋地 | |
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philosophical
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| adj.哲学家的，哲学上的，达观的 | |
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celebrated
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| adj.有名的，声誉卓著的 | |
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postpone
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| v.延期，推迟 | |
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peculiar
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| adj.古怪的，异常的；特殊的，特有的 | |
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attained
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| （通常经过努力）实现( attain的过去式和过去分词 )； 达到； 获得； 达到（某年龄、水平、状况） | |
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varied
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| adj.多样的，多变化的 | |
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alluded
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| 提及，暗指( allude的过去式和过去分词 ) | |
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recollected
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| adj.冷静的；镇定的；被回忆起的；沉思默想的v.记起，想起( recollect的过去式和过去分词 ) | |
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sufficiently
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| adv.足够地，充分地 | |
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tumult
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| n.喧哗；激动，混乱；吵闹 | |
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embarrassment
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| n.尴尬；使人为难的人(事物)；障碍；窘迫 | |
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inadequate
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| adj.(for,to)不充足的，不适当的 | |
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determined
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| adj.坚定的；有决心的 | |
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Founder
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| n.创始者，缔造者 | |
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defectively
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| adv.有缺陷地，缺乏地 | |
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sketch
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| n.草图；梗概；素描；v.素描；概述 | |
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investigation
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| n.调查，调查研究 | |
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