Chapter XI: Section II: Curious Cases Published in the "philosophical

TRANSACTIONS," 1793.

"The Universal Cause
Acts to one end, but acts by various laws."

POPE.

However paradoxical it may appear, it is not the less true, that nothing more teachingly impresses the inquirer into nature with the _actual_ presence of general laws than the _apparent_ exceptions to them. Finite capacities in dealing with the Infinite must of course encounter multitudes of facts, the meaning of which they cannot interpret—portions of the Divine Government, as Butler has said, which they do not as yet understand.

In philosophical investigations, these are properly regarded as facts which, in the present state of knowledge, cannot be made to fall under any of our very limited generalizations.

At one period, departures from the ordinary structure or form in animals were simply regarded as unintelligible abstractions, and no more philosophical expression was given to them than "Lusus Naturæ"—sports of Nature. Progressive science, however, has thrown considerable light on such phenomena, and invested many of them with a new interest.

Physiologists have not arrived at the explanation of all such facts; but much has been done by comparative anatomy to show that many of them are merely arrests of development, and cases of interference with the ordinary law.

That, in fact, they show the mutual harmony and connection of the laws of nature to be such, that the development of any one law implies the concurrence, so to speak, of some other, just as the successful incubation of an egg, or any other familiar fact, implies the presence of certain conditions. We cannot boil a drop of water without the concurrence of various laws: we say it boils ordinarily at 212° of Fahrenheit; but how many conditions this involves!

Until understood, how few could have guessed that mechanical pressure could have so modified the degree of heat necessary, as to exalt it to more than double, or reduce it to less than half; and again, how few would have looked for the force which, under common circumstances, governed the point at which water was thus converted into steam, in the pressure of the atmosphere; yet so mutually influential are these conditions—namely, heat and a certain pressure in modifying this change of form or matter—that some of Faraday's most interesting results in experimental chemistry (we allude to his reducing several gaseous bodies to the liquid form) were obtained by _abstracting_ heat and increasing pressure.

It is of very great consequence to remember these interferences in relation to disease, because most diseases may be regarded as examples of them. Considered as "abstract wholes," as entities—diseases are necessarily unintelligible: but when looked at as natural processes obscured by interferences (if the inquiry be conducted with strict observance of those principles which are essential in all philosophical researches), they either at once become intelligible, or, at least, as open to investigation as any other facts in natural philosophy.

When we investigate the laws of nature with a view to the development of the sublime objects of natural theology, the concurrence of the various conditions, necessary to the most ordinary phenomenon, inclose the most irresistible proofs, from natural evidence, of the Unity of the Creator.

Regarded in the light of facts which we as yet may not be able to generalise, the cases here recorded by Abernethy are very interesting; although it is to be regretted that both cases were bodies brought in for dissection, in times when the circumstances baffled, if they did not forbid, any inquiry into the histories of them. It is lamentable to think of the state of the law with respect to Anatomy at that time.

Any surgeon who was convicted of _mala praxis_, resulting from ignorance of Anatomy, was severely fined, perhaps ruined; and yet so entirely unprovided were the profession with any _legitimate_ means of studying Anatomy, that they could only be obtained by a connivance at practices the most demoralizing and revolting.

Bodies were, in fact, chiefly obtained by the nightly maraudings of a set of men, who, uninfluenced alike by the repulsions of instinct or the terrors of law, made their living by the plunder of grave-yards.

Many a tale of horror, no doubt, might be told on this subject.

Graves were very commonly watched; and severe nocturnal conflicts occurred, which were conducted in a deadly spirit, not difficult to imagine. We believe all this has passed away; there is no necessity now for such revolting horrors. The public began to _think_ for themselves, the _real remedy_ for abuses. But to our cases. Both were curious; the one was the body of a boy, who did not appear to have been imperfectly nourished, but in whom the alimentary canal was found to be less than one-fourth of its natural length, and in which also the relative length of its two grand divisions was reversed. The smaller in diameter, usually very much the longer, was so unnaturally short, as not to exceed in length more than one half of the more capacious but normally shorter division of the canal.

The other case presented a no less curious departure from the ordinary arrangement of parts than a reversed position of the heart; which, instead of being placed with its point as usual on the left side, was found to have that part situated on the right. In the natural condition of things, there is a difference on the two sides of the body, in the manner in which the large vessels are given off to supply the head and upper extremities. These differences existed, but were reversed; the arrangement of vessels ordinarily found on the right, being here on the left side, and _vice versâ_.

In all this, there would be nothing to prevent the heart from pumping the blood to all parts in the natural way. But another very singular arrangement was found in relation to the liver. To the unprofessional reader we should observe, that usually, whilst all other things are made, or secreted as we term it, from the purer or arterial blood; in the _human body_, the Bile is secreted from a vein which enters the liver for that purpose.

Now, in the case before us, this great vein never entered the liver at all; so that here the bile was separated, like other animal fluids, by the arteries. The arteries going to the liver were found much larger than usual.

Mr. Abernethy examined the bile by submitting it to various tests; and comparing the results with those obtained from ordinary bile, he found them to be the same. His remarks are, as usual, ingenious and to the point, and very characteristic of the penetrative perception with which he seized on the proximate and practical relations of facts. "When we see the unusual circumstance," says he, "of secretion taking place from a _vein_[18], we are apt to conclude that the properties of such a secretion require that it should be made from venous blood. But, in this case, we see that bile could be prepared from _arterial_ blood; and we are led, therefore, so far to modify our conclusion as to infer, not that venous blood is _necessary_, but that it can be made to answer the purpose."

We must not omit that these remarks are supported by comparative anatomy. As we descend in the scale of creation from the more complicated organizations to those which are more simple in their structure or their relations, the arrangement which I have stated as usual in man no longer obtains, but the bile is secreted from the arteries as the other fluids of the animal—showing, in fact, that the inference drawn by Abernethy was the legitimate conclusion.

Since the discovery of this case, one or two others have been observed; and the opinions of several eminent men, in relation to the bearing such cases have on the ordinary sources of bile, are described in Mr. Kiernan's interesting paper on the Anatomy and Physiology of the Liver, in the "Philosophical Transactions." It is very interesting, particularly to a professional reader, to peruse that discussion, in order to estimate Mr. Abernethy's comparatively simple, ready, and, as it would seem, correct view of the subject.

One other thing we learn from these cases—the extreme importance of examining bodies whilst their histories and symptoms can be recorded. It might have been highly useful to science, had the histories of these cases been known; and the circumstance should be mentioned, as, in some measure, tending to counterbalance in the public that not unnatural but (as regards their real interest) not less to be lamented aversion to the inspection of the dead—a branch only, it is true, but a very important one of physiological inquiry. It is the only means of which we can have the comfort of knowing that, however unable we may have been to arrest disease, we were at least right in the seat we had assigned to it; but it is infinitely more valuable in disclosing to us affections of organs which _had given no sign_, and in thus impressing on us the necessity of taking a wider range in our investigations, and comprehending in them all _those injurious influences_ which have, _at various periods_, acted on the body; for we _thus_ obtain an insight into the nature of disease which _no mere present symptoms_ can ever afford us.

The repulsions which the public have to overcome are admitted; but let us not, in common justice, forget those sacrifices of time, labour, and too often of health also, which are made by the profession. Nor is it immaterial to mention that it is a service for which they seldom receive any remuneration, the only incentive being one which, if it excite no sympathy, is at least entitled to respect—namely, the desire to improve their knowledge of their profession. There is no doubt of the deep and common interest which the public and the profession have in this question; and it is from that conviction that I have ventured on these few remarks. Abernethy, when he introduced any subject in his lectures, was accustomed to say at once all that he intended to remark on it. I beg, in the foregoing observations, to follow his example, which I trust the reader will accept as an apology for the digression.

[Footnote 17: "Forest Scenery."]

[Footnote 18: The ordinary plan in respect to bile in the _human_ body.]