THE

HUNTERIAN ORATION,

FOR THE YEAR

1819.

DELIVERED BEFORE

THE ROYAL COLLEGE OF SURGEONS, IN LONDON;

BY

JOHN ABERNETHY, F.R.S., &c.

SURGEON TO ST. BARTHOLOMEW'S AND CHRIST'S HOSPITALS.

LONDON:

VOL. XIV.

Pam.

NO. XXVII.

K

2

HUNTERIAN ORATION,

1819.

IT is the expressed intention of the founders of this oration, that it should be rendered contributory to the honor of surgery, and of its intelligent professors; which design cannot, in my opinion, be better accomplished, than by showing what surgery really is; the nature and extent of the knowledge requisite for its clear comprehension; the intellect and talent necessary for its successful practice.

Had surgery and surgeons been merely what their names imply, handywork and handicrafts, I never would have appeared before you, Gentlemen, to do them honor. For honor is due alone to intellect, and can be paid to nothing else. Why do we honor those whose literary labors stand pre-eminent; or those who have exposed, or sacrificed their lives in the cause of their country, or in that of moral obligation? Is it not on account of their having evinced superior powers, or firmness of mind? They have thus done honor to the whole human race, and can only be repaid in the same coin; we r we return to them the tribute of honor, in proportion as they have conferred it on us. We indeed honor rank, but then it is either in blind obedience to the laws of custom, or because we associate the opinion of superior intelligence and elevation of mind with the possession of a dignified station.'

ge our respect or

The good qualities of the mind excite and engage

esteem.

Now, to show what surgery really is, it becomes necessary to divest it of that garb with which it has been clothed and obscured in times of ignorance; and it is useful to revert to the history of former times, in order to observe the circumstances which have promoted or retarded the progress of the medical sciences, or communicated to them that bias, by which they have been directed to their present situation.

Medicine, or the science which has for its object the prevention and cure of diseases, was held in the highest respect by ancient nations, and its most eminent professors were even venerated. But, surely, it was the beneficent object only of the science that attracted their applause and gratitude; for the means by which the object was to be accomplished were either not contemplated, or were merely supposed to be known. Various sovereigns have, doubtless, greatly promoted this science by their patronage, and encouragement ought to be given to it, as I shall afterwards show, not only by the government of countries, but also by the people in general. The successors of Alexander of Macedon first resolutely opposed the natural feelings and prejudices of mankind, by patronising the dissection of human bodies at Alexandria; which city they had made the great depository of knowledge, by the collection of an immense library, and which they also strove to make a splendid seat of science, and source of instruction.

It was at Alexandria, that persons in general first possessed the ready means of knowing what others knew and thought, by consulting their writings collected in its stupendous library. How different must have been the state of learning and learned men in ancient and in modern times! What surprising changes has the invention of printing produced! An ancient student of any subject of nature or science must have sought for the information which others possessed, by distant visits, to procure the perusal of any work of celebrity, or the conversation of those engaged in the same pursuits. His knowledge, therefore, must chietly have resulted from his own exertions, and if he deemed it worthy of being recorded for the benefit of others, he knew that it must be communicated to them very gradually and slowly. His fame, as a discoverer, or improver of science, could never spread so as to reverberate to his own ears. His reputation must necessarily be of slow growth, and therefore his endeavour would be to make it lasting. As he could not compare his knowledge with that of others, he would strive to make his own perfect, by completely mastering the subject he had engaged with, so that none should be able to do more. But now, when, by an industrious education, any one may possess himself of the knowledge of the whole world with respect to any subject of nature, art, or science; now, when every acces

sion of knowledge is published at annual, quarterly, or monthly periods; every little discovery is at once proclaimed, lest its author should be anticipated; and persons in general become desirous of contending for superiority more with one another, than with the subject, or with themselves. Yet this ready communication of knowledge greatly tends to its increase, by exciting general emulation and co-operation.

. It was at Alexandria, also, that persons of the medical profession first possessed an opportunity of studying the subject-matter of medical science, the structure and functions of the parts of the human body. How absurd should we deem the conduct of a mechanic, whose business it was to rectify the errors of any complex machine, should he merely provide himself with the finest and fittest tools for the purpose, and neglect to learn its mechanism, by which alone he can be able to discover the causes of the error, or stoppage of its different movements, and consequently what is wanting to be done, to render it again perfect or useful. Yet equally absurd would be the conduct of medical men, were they to study botany, pharmacy, chemistry, and natural philosophy, searching indeed through all the paths of nature, and the stores of art, for means of cure, and yet neglect anatomy, by which alone they can be able to distinguish the nature of the difference between health and disease, and consequently what is requisite to recouvert the lat ter into the former; which is the only circumstance that can render medicine a science.

It seems to be my fate, Gentlemen, whenever I address you, to be doomed to speak of the importance of opinions; yet I cannot avoid it, the necessity of the case absolutely demands it; for the reasoning powers of man, which, when well directed, lead to the discovery of truth, and the formation of useful opinions, when misemployed, elicit nothing but error and pernicious notions. It is a very great but very common misemployment of our reasoning pow→ ers, to draw inferences from facts belonging to different subjects, which are incommensurate with one another. Such irrelevant facts have been often designated by the whimsical and contradictory expression of false facts. We are indeed sometimes induced to reason from analogy, but then the similarity of the facts is so precise, as to warrant us in believing that the subjects, concerning which we thus comparatively reason, are essentially alike.

Now without any knowledge of anatomy, or the animal economy, persons of the medical profession, by drawing inferences from mixed facts, might suppose, that a fire was kindled throughout the body to warm and cherish it, which, if in excess, might set our juices into fermentation, and thus produce partial or general disorder; they might suppose, that there were elements in the body,

which ought to be combined in definite proportions, and that different diseases might result from the excess or deficiency of one of other of these elements. They might suppose, that diseases were of an acid or of au alkaline nature; they might say, that there were powers, capable of performing functions, nay even poetically, imagine essences endowed with such powers, and speak of animæ presiding over the different functions, and of an archæus or masterworkman superintending the whole. You know, Gentlemen, that all this and more of the same kind has been thought and said by reputed sages of the medical profession.

Since, then, reasoning from false, insufficient, or irrelevant premises is productive of error, we cannot wonder, that when medical men in general first began to reason on the causes and nature of diseases, and the effects of remedies, if their speculations were wild, and the conduct which such opinions gave rise to, highly injurious. We can feel no surprise, therefore, that a large party of the medical profession should segregate themselves, and resolutely interdict the use of reasoning in medical practice, stead fastly resolving, in their conduct to be guided solely by the dietates of experience. Neither indeed can we wonder, that even erring reason still found advocates in the minds of men. Now you know, Gentlemen, that not very long after the formation of the Alexandrian school, in the beginning of the second century, before the Christian æra, Serapion and Phillinus, pupils of Herophi lus, were the founders of a sect called the empiric, which was numerous, highly respectable, and which long continued to florish, whilst the remaining party of the medical profession were distinguished by the appellation of the dogmatic or rational

sect.

In the very feeble and almost blind state attendant on the infancy of medical science, a caution not to attempt to advance, unless supported and conducted by an unerring guide, seemed really requisite, yet to prohibit such endeavours in the present vigor ous and enlightened state of medical science, would be as prepos terous as to recommend the conduct proper to be pursued in infancy, to be continued during the whole state of manhood. Though much might be said on this subject, it really seems unnecessary to do more than to remind you, Gentlemen, that the sagacious Lord Bacon has, in this respect also, well displayed the results of different dispositions or powers of mind, by the following simile: "The empirics," says he, "like ants, only lay by stores and use them; the rationalists, like spiders, spin webs out of themselves; but the bee takes a middle course, collecting her matter from the flowers of the field and garden, and digesting, and elaborating it by her native powers.”