Abernethy, John (1764-1831) (DNB00)
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Abernethy, John (1764-1831)
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ABERNETHY, JOHN (1764–1831), an eminent surgeon, was born in London 3 April 1764, the son of John Abernethy, a London merchant belonging to an Irish family of Scotch extraction, whose father and grandfather, both of the same name, were Irish nonconformist divines, the second in descent especially being of some eminence. Claims have been made both for Ireland and for Scotland as the native country of Abernethy; but his baptismal certificate, dated 24 April 1765, at St. Stephen's, Walbrook, is given by Macilwain (Life of Abernethy, i. 16), who states other facts on the authority of Abernethy himself. He was educated at the Wolverhampton Grammar School under Dr. Robertson, and at the age of fifteen was apprenticed to Mr. (afterwards Sir Charles) Blicke, surgeon to St. Bartholomew's Hospital. He followed the surgical practice of the hospital and also the course on surgery (the only lectures then given there) of Mr. Pott. At the same time he attended the lectures on anatomy given at the London Hospital by Dr. Maclaurin and Sir William Blizard, the latter of whom by his instructions, and further by appointing Abernethy prosector for his lectures, gave him his first impulse to the study of anatomy. In 1787 he was elected assistant-surgeon to St. Bartholomew's, and held this appointment for twenty-eight years till he succeeded as full surgeon. He then began to lecture on anatomy at his house in Bartholomew Close, and speedily attracted a large class, the numbers of which were swollen when Dr. Marshall, the most popular anatomical teacher in the city, ceased to lecture. Abernethy's success was one of the causes which induced the governors of St. Bartholomew's to build a lecture theatre, where in 1791 he began to lecture on anatomy, physiology, and surgery, and thus became the founder of the medical school attached to that ancient hospital. About this time he was himself a diligent attendant at the lectures of John Hunter, with whom he had also private conferences on scientific matters, and whose influence greatly determined the bent of his mind.
Throughout this period Abernethy was much occupied with anatomical and physiological observations, and published three short papers on anatomical subjects in the ‘Philosophical Transactions’ from 1793 to 1798. In 1796 he was elected a fellow of the Royal Society. In 1814 he was appointed to lecture on anatomy and physiology at the College of Surgeons (there was no regular professorship), and held the office till 1817. His lectures were mainly devoted to explaining the Hunterian museum, then lodged in the college, and to expounding the views of John Hunter, of whose theory of life Abernethy constituted himself an ardent champion.
In 1800 he married Miss Anne Threlfall, of Edmonton, by whom he left a family.
Abernethy's scientific reputation and his popularity as a teacher grew rapidly, and his private practice was subsequently very large. In 1815 he became full surgeon to St. Bartholomew's Hospital, and resigned this appointment in 1827. He died after a lingering illness at Enfield 28 April 1831.
Abernethy enjoyed during his lifetime the highest reputation as a surgeon, anatomist, and physiologist, and exercised great influence on his profession. Though his reputation has not quite stood the test of time, his influence is still felt in certain departments of practice. In anatomy he did no original work of any value, but was a very brilliant lecturer, and as such instructed most of the eminent men of the coming generation. As a physiologist he became known for some desultory and not very important researches, but chiefly as the defender of John Hunter, whose views, after his death and before the posthumous publication of his lectures, Abernethy had almost a monopoly in expounding. As an operating surgeon Abernethy early became distinguished for extending John Hunter's operation for the cure of aneurism (by ligature at a distance) by tying the external iliac artery. This was in 1797, but he afterwards attained no great fame as an operator—a fact which may have been partly due to his long tenure of office as assistant-surgeon where few opportunities were allowed him. In later life he became extremely averse to operate. His other chief contributions to practical surgery were a paper on injuries to the head, in which he deprecated the indiscriminating use of the trephine, which was at that time customary; and an important improvement which he introduced in the opening of lumbar abscesses by early incision without admitting air. His memoir on the Classification of Tumours deserves perhaps more attention than it has received. It is a rough but masterly sketch, quite in the spirit of recent investigations, and had it been more carefully worked out might have been of great value. But the work by which he was best known, and on which he would himself have rested his fame, is the Essay on the Constitutional Origin of Local Diseases, which has profoundly influenced surgical practice. The title implies a truth little recognised when the essay first appeared, though now universally admitted; but the scope of the work does not bear out the title. At the present day the constitutional origin of diseases is conceived of in a different and far wider sense than it was by Abernethy, whose work deals almost entirely with the relations of local diseases to certain disorders of the digestive system. The first sketch of this paper appeared in ‘Surgical Observations,’ part ii. (1806); it was afterwards published in a more complete form in ‘Surgical Works,’ vol. i. (1811). In it he shows that on the one hand local irritation will produce disorders of the digestive organs, and that this takes place by a reflected operation through the nervous system (pp. 6–10). On the other hand, he insists upon the variety of diseases which may result from disorders of the digestive organs, such as ‘diminution of the functions of the brain, or delirium, partial nervous inactivity and insensibility, muscular weakness, tremors, palsy, convulsions . . .’ ‘Also local diseases in such a constitution will become peculiar in their nature and difficult of cure’ (p. 61). Although evincing great power of generalisation, these views were clearly extravagant and one-sided. ‘In his lectures and practice,’ says a witness of the highest authority (Sir James Paget), Abernethy ‘simplified still more, and seemed to hold only that all local diseases which are not the immediate consequence of accidental injury are the results of disorders of the digestive organs, and are all to be cured by attention to the diet, by small doses of mercury, and by purgatives.’ These views were not only imparted by Abernethy to the profession, but impressed upon his private patients, who were referred to ‘page seventy-two of my book, published by Messrs. Longman;’ while the medicinal treatment indicated above, which has become known all over the world as characteristic of English practice, suited admirably the well-fed and free-living Londoners who crowded his consulting-room. On the surgeons of his time the ‘system’ had a happy effect in leading them to study the general health of their patients, and it may be said to have introduced a new principle into surgical practice in England.
The secret of Abernethy's ascendency over the profession is not, however, to be found in his books, which, though clearly written, are flimsy in texture. They contain fewer valuable observations than those of many men who have made much less figure in the world, and are quite wanting in that best originality which is based upon thoroughness of investigation. ‘Indeed,’ says Sir James Paget, ‘for the observation of particular facts, and for the strict induction of general truths from them, his mind was altogether unsuited; for he was naturally indolent, and early success rendered industry unnecessary.’ So that to a student of the present day Abernethy's writings are disappointing, and his celebrity an enigma.
The solution of the mystery is to be found in his vigorous and attractive personality, and in a power of exposition to which contemporaries have borne striking testimony. Sir Benjamin Brodie writes: ‘Mr. Abernethy was an admirable teacher. He kept up our attention so that it never flagged; and that which he told us could not be forgotten. He did not tell us so much as other lecturers, but what he did he told us well. His lectures were full of original thought, of luminous and almost poetical illustrations, the tedious details of descriptive anatomy being occasionally relieved by appropriate and amusing anecdotes. . . . Like most of his pupils, I learned to look upon him as a being of a superior order’ (Brodie's Autobiography, p. 23). He seems, indeed, to have possessed enough of the arts of the advocate and the actor to secure unhesitating acceptance for whatever he chose to put forth. ‘He reserved all his enthusiasm,’ says Dr. Latham, ‘for his peculiar doctrine. He so reasoned it, so acted, so dramatised it, and then in his own droll way he so disparaged the more laborious searchers after truth, calling them contemptuously “the Doctors,” and so disported himself with ridicule of every system but his own, that we accepted his doctrine in all its fulness. We should have been ashamed to do otherwise. We voted ourselves by acclamation the profoundest of medical philosophers at the easy rate of one half-hour's instruction. . . . We never left his lecture-room without thinking him the prince of pathologists, and ourselves only just one degree below him.’
To this should be added that such admiration was not wasted on an unworthy character. Abernethy was a man of blameless life, highly honourable in all his dealings, generous to those in need of help, incapable of meanness or servility. His blunt independence and horror of ‘humbug’ were doubtless among the factors of that rudeness and even brutality of manner for which he was notorious, and of which many strange stories are told. This defect was fostered by a physical irritability probably connected with the latent heart-disease which ultimately closed his life. In the end it seems to have become a wilful and almost calculated eccentricity, in which he was confirmed by the experience that a masterly roughness commanded the confidence of his patients even better than an amiability, possibly suggestive of weakness, would have conciliated it.
The following is a condensed list of Abernethy's writings. All but one are in octavo, and all published in London: 1. ‘Surgical and Physiological Essays.’ Part i. On Lumbar Abscess, &c., 1793; Part ii. On Matter perspired, &c., by the Skin, 1793; Part iii. Injuries of the Head, &c., 1797. 2. ‘Surgical Observations on Tumours,’ &c., 1804. Part ii. Disorders of the Digestive Organs, &c., 1806. 3. ‘Surgical Works’ (containing the surgical papers of the above, with additions), 2 vols. 1811, and later. 4. ‘Account of Disease in the Upper Maxillary Sinus’ (Transactions of Society for Improvement of Medical and Surgical Knowledge, 1800). 5. ‘An Inquiry into Mr. Hunter's Theory of Life,’ 1814. 6. ‘Physiological Lectures,’ 1817. 7. ‘Introductory Lecture exhibiting Mr. Hunter's Opinions respecting Life and Disease,’ 1819. 8. The ‘Hunterian Oration,’ 1819, 4to. 9. ‘Reflections on Gall and Spurzheim's System of Physiognomy and Phrenology,’ 1821. 10. ‘Lectures on Surgery,’ 1830; also in ‘Lancet,’ 1824–5; reprinted 1828. (All the above, except three early physiological papers, are included in the ‘Works,’ 4 vols. 1830.) 11. Three Memoirs in ‘Philosophical Transactions:’ ‘On Two Malformations,’ 1793; ‘On Anatomy of the Whale,’ 1796; ‘On the Foramina Thebesii,’ 1798. 12. ‘Memoir on a Case of Heart-disease’ in ‘Medico-Chirurgical Transactions,’ vol. i. 1806.[Macilwain's Memoirs of John Abernethy, London, 1853, where a portrait is given; Biog. Dict. of Useful Knowledge Society (memoir by James Paget); Latham's Lectures on Clinical Medicine, London, 1836, p. 75.]