Chapter XXXVII: Abernethy. 1763-1831

Distinguished as a practical surgeon and as a physiologist, Abernethy has earned his lasting reputation as having been one of the first to attack the old prejudice of the profession as to the origin of diseases, and as having sought for such origin, not in mere local and accidental but, in general causes--in the constitution and habits of the body.

A pupil of John Hunter, in 1786 he became assistant surgeon at St. Bartholomew’s Hospital, and shortly afterwards he lectured on anatomy and surgery at that institution, which to his ability and genius owes the fame which it acquired as a school of surgery. As a lecturer he had a reputation and popularity seldom or perhaps never before so well earned in the medical schools--founded, as they were, upon a rare penetration and logical method, united with clearness and perspicuity in communicating his convictions. In honesty, integrity, and in the domestic virtues his character was unimpeachable, but the gentleness of deportment for which he was noted in his home he was far from exhibiting in public and towards his patients. His roughness and even coarseness of manner in dealing with capricious valetudinarians, indeed, became notorious.

_The Constitutional Origin and Treatment of Local Diseases_--his principal work--in comparison with the vast mass of medical literature up to that time put forth, stands out in favourable relief. In it two great principles are laid down--that “local diseases are symptoms of a disordered constitution, not primary and independent maladies, and that they are to be cured by remedies calculated to make a salutary impression on the _general frame_, not by local treatment, nor by any mere manipulations of surgery.” This single principle changed the aspect of the entire field of surgery, and elevated it from a manual art into the rank of a science. And to this first principle he added a second, the range of which is, perhaps, less extensive, but the practical importance of which is scarcely inferior to that of the first--namely, that “this disordered state of the constitution either originates from, or is rigorously allied with, derangement of the stomach and bowels, and that it can only be reached by remedies which first exercise a curative influence upon these organs.” It will not detract from the merit of Abernethy to add to this account that his predecessor, Dr. Cheyne, and his contemporary, Dr. Lambe, have most satisfactorily and radically carried out into practice these just principles; or to remark that great public reputations ought not to be allowed, as too often is the fact, to overwhelm less known but not therefore less meritorious labours.

As to _dietetics_, the theory of Abernethy seems to have been better than his practice. When reproached with the inconsistency that the reformed diet which he so forcibly commended to others he himself failed to follow, he is related to have used the well-known simile of the sign-post with his usual readiness of repartee.

It was while Dr. Lambe was at the Aldersgate Street Dispensary that Abernethy formed the acquaintance of that unostentatious but true reformer--an acquaintance which was destined to have no unimportant influence upon the medical theories of the great surgeon. Abernethy was at that time writing his _Observations on Tumours_, and he had intrusted to his friend one of his cancer patients to be treated by the non-flesh and distilled water regimen. He carefully watched the effects, and he has thus given us the results of his observations:--

“There can be no subject which I think more likely to interest
the mind of a surgeon than that of an endeavour to amend and
alter the state of a cancerous constitution. The best timed and
best conducted operation brings with it nothing but disgrace if
the diseased propensities of the constitution are active and
powerful. It is after an operation that, in my opinion, we are
most particularly concerned to regulate the constitution, lest
the disease should be revived or renewed by its disturbance. In
addition to that attention, to tranquillise and invigorate the
nervous system, and keep the digestive organs in as healthy a
state as possible (which I have recommended in my first volume),
I believe general experience sanctions the recommendation of a
more vegetable because less stimulating diet, with the addition of
so much milk, broth, and eggs, as seems necessary to prevent any
declension of the patient’s strength.

“Very recently Dr. Lambe has proposed a method of treating
cancerous diseases, which is _wholly_ dietetic. He recommends
the adoption of a strict vegetable regimen, to avoid the use of
fermented liquors, and to substitute water purified by distillation
in the place of common water as a beverage, and in all parts of
diet in which common water is used, as tea, soups, &c. The grounds
upon which he founds his opinion of the propriety of this advice,
and the prospects of benefit which it holds out, may be seen in his
_Reports on Cancer_, to which I refer my readers.

“My own experience on the effects of this regimen is of course
very limited. Nor does it authorise me to speak decidedly on the
subject. But I think it right to observe that, in one case of
cancerous ulceration in which it was used, the symptoms of the
disease were, in my opinion, rendered more mild, the erysipelatous
inflammation surrounding the ulcer was removed, and the life
of the patient was, in my judgment, considerably prolonged. The
more minute details of the facts constitute the sixth case of Dr.
Lambe’s _Reports_. It seems to me very proper and desirable that
the powers of the regimen recommended by Dr. Lambe should be fairly
tried, for the following reasons:--

“Because I know some persons who, whilst confined to such diet,
have enjoyed very good health; and further, I have known several
persons, who did try the effects of such a regimen, declare that
it was productive of considerable benefit. They were not, indeed,
afflicted with cancer, but they were induced to adopt a change of
diet to allay a state of nervous irritation and correct disorder of
the digestive organs, upon which medicine had but little influence.

“Because _it appears certain, in general, that the body can be
perfectly nourished by vegetables_.

“Because all great changes of the constitution are more likely
to be effected _by alterations of diet and modes of life than by
medicine_.

“Because it holds out a source of hope and consolation to the
patient in a disease in which medicine is known to be unavailing,
and in which surgery affords no more than a temporary relief.”[217]

“The above opinion of Mr. Abernethy,” remarks an experienced authority upon the subject, “is most valuable, for he watched the case for three and a half years under Dr. Lambe’s regimen, which is directly opposed to the system of diet which he had advocated, before he met Dr. Lambe, in the first volume of his work on _Constitutional Diseases_, and from his rough honesty there is no doubt that had Dr. Abernethy lived to publish a second edition he would have corrected his mistake.” As it is, the candour by which so distinguished an authority was impelled to alter or modify opinions already put forth to the world, claims our respect as much as the too general want of it deserves censure.