Few men have been more renowned in their day than the great “Sir Astley.”
Astley Cooper was the grandson of a surgeon at Norwich. His father was a very estimable clergyman in Norfolk; his mother wrote novels of some repute, and was noted for her benevolence and unselfishness. Astley, the fourth son of a numerous family, was born on August 23, 1768. His youth was marked by a succession of hairbreadth escapes and exploits, demanding coolness and audacity. He had no great taste for classics or literature in youth or through life. As a youth he had a handsome and expressive countenance, with much openness of manner and liveliness of conversation, so that he often charmed those who disapproved of his wild freaks. Like John Hunter, he had a free youth, and if unimproved was likewise unspoiled by systematic training.
Both the grandfather and the uncle of Astley Cooper, the latter a lecturer at Guy’s, are credited with some share in exciting a surgical bias in the boy’s mind. Visiting the Norwich hospital one day, and seeing a striking operation, he was strongly impressed with the utility of surgery. In 1784 a visit from his uncle, the London surgeon, led to the nephew being articled to him; but his progress here was limited, owing to the attraction which a free town-life had for him at first. One day he was met by his uncle disguised in the uniform of an officer, and the former recognising his nephew, the latter denied all knowledge of him. The detection of this escapade was soon followed by his transfer as a pupil from his uncle to Mr. Cline, who then shared with Abernethy the next honours as a surgeon to John Hunter. Under Cline, young Cooper imbibed the spirit of Hunter’s teaching from one of his most enthusiastic pupils: for Cline’s judgment about Hunter was that there seemed no comparison between his great mind and all who had preceded him.
Sir Astley Cooper at a later period thus depicts his old master: “Mr. Cline was a man of excellent judgment, of great caution, of accurate knowledge; particularly taciturn abroad, yet open, friendly, and very conversationable at home. In surgery cool, safe, judicious; in anatomy sufficiently informed. In politics a Democrat, living in friendship with Horne Tooke. In morals thoroughly honest; in religion a Deist. A good husband, son, and father. As a friend sincere, but not active; as an enemy most inveterate.”
Young Cooper was soon actively engaged in dissection, and his adventurous nature found scope in many a night-expedition with the body-snatchers or resurrectionists in their search for “subjects.”
He spent one winter session (1787-8) at Edinburgh, having already made considerable progress in anatomy and surgery. He greatly appreciated Cullen, Black, and Fyfe. Having returned from Edinburgh, he attended John Hunter and other celebrated lecturers, and in 1789, being only 21, he was appointed demonstrator at St. Thomas’s. Two years later Mr. Cline obtained for him the joint lectureship with himself in anatomy and surgery. In December 1791 he married Miss Anne Cock. The wedding was perfectly quiet owing to the recent death of the lady’s father, and on the evening of the same day Astley Cooper lectured on surgery with his usual composure, without any of his pupils becoming aware of his marriage. In June 1792 the young surgeon and his bride visited Paris, and were there during the three terrible months which followed. Cooper spent much time in studying Parisian methods of surgery and in attending the debates of the National Assembly. His safety was secured by a democratic badge, and by friendship with leading revolutionists in England to whom Cline adhered.
In addition to his income from his hospital lectures, Mr. Cooper came into possession by his marriage of a fortune of fourteen thousand pounds, so that he was at once placed beyond any pecuniary anxiety. He consequently was enable to devote himself mainly to study and teaching. He went to the hospital before breakfast to dissect for lecture, and he also demonstrated to students before the lecture-hour. He injected their subjects, lectured from two till half-past three, and three evenings a week lectured on surgery. Further, he persevered in visiting the interesting cases in the hospital and making notes of them. His lectures on surgery, which he was the first in the Borough hospitals to separate from anatomy and physiology, were not at the beginning a conspicuous success. He found that he had been too theoretical, but soon changed his plan, and selected cases in the hospital as the basis of his lectures. From this moment his class increased and became interested. He himself acquired a facility in recalling cases and circumstances illustrative of the disease under consideration which greatly added to the attractiveness of his style. The fact is, he was not the intellectual successor of John Hunter, and could not succeed by similar methods. Yet the influence of Hunter upon him was unmixedly beneficial; he had the wit to perceive that Hunter was not “an imaginative speculator, and any one who believed in him a blockhead and a blacksheep in the profession.” The improved lectures on surgery attracted twice as many entries in 1793 as in 1792, and Mr. Cooper was besides selected as lecturer on anatomy at the College of Surgeons. A chief part of his duties in this latter capacity was to lecture on and dissect the bodies of executed criminals. The lectures were most successfully given to crowded audiences. In 1797 the now rising surgeon removed from his early residence in Jeffries Square, St. Mary Axe, to 12 St. Mary Axe, long occupied by Mr. Cline, who now moved westward. In the next year he had a severe accident, being thrown from his horse on his head, and his life was in considerable danger for some time. The extent of Mr. Cline’s consolatory sympathy, when Cooper was lamenting the risk to his life because of its interference with some professional inquiry likely to be of public benefit, was thus expressed: “Make yourself quite easy, my friend; the result of your disorder, whether fatal or otherwise, will not be thought of the least consequence by mankind.”
An early pupil, Dr. William Roots, however, gives a very different account of Cooper’s “consequence to mankind.” “From the period of Astley’s appointment to Guy’s until the moment of his latest breath, he was everything and all to the suffering and afflicted; his name was a host, but his presence brought confidence and comfort; and I have often observed that on an operating day, should anything occur of an untoward character in the theatre, the moment Astley Cooper entered, and the instrument was in his hand, every difficulty was overcome, and safety generally ensued.” No doubt reference is here made to the fact recorded by Sir Astley himself as follows: “I was always of opinion that Mr. Cline and I gained more reputation at the hospitals by assisting our colleagues than by our own operations, for they were always in scrapes, and we were obliged to help them out of them.”
Mr. Travers, who became Astley Cooper’s articled pupil in 1800, says at that time he was the handsomest, most intelligent-looking and finely formed man he ever saw. According to the custom of his time, he wore his hair powdered, with a queue, and had always a glow of colour in his cheeks. In his daily ride he wore a blue coat and yellow buckskin breeches and top-boots. He was remarkably upright, and moved with grace, vigour, and elasticity, and would not unfrequently throw his well-shaped leg upon the table at lecture, to illustrate some injury or operation on the lower extremity. Cheerfulness of temper amounting to vivacity, and a relish for the ludicrous, never deserted him, and his chuckling laugh, scarce smothered while he told his story, his mirthful look and manner, and his punning habit, were well known. His personal habits were very simple; he drank water at dinner, and took two glasses of port after. A good digestion never forsook him; as he said, “he could digest anything but sawdust.” He was remarkable for requiring little amusement or company beyond what he found in his professional pursuits; and he read comparatively little medical literature.
It has often been alleged that Astley Cooper was somewhat unfeeling in nature; and it must be admitted that he had not a deep sympathy with bodily pain, for his own insusceptibility was equalled by his physical endurance. Yet he always sympathised deeply with mental suffering, and Mr. Travers, who saw him read a posthumous letter from a favourite pupil who had committed suicide, relates that his utterance was choked with sobs, and he wept as for the loss of an only child. That his affection was not restricted to his own immediate family is shown by the fact that on the deeply regretted death of his little daughter he adopted into his family a little girl who was no relative, but whose mother died early; and subsequently he himself brought from Yarmouth in the coach, a twenty hours’ journey, his little nephew, Astley, then two years old, who subsequently became his successor in the baronetcy.
More widely known than the nephew during Sir Astley’s life was his servant, Charles Osbaldeston—a name which in practice softened down into Balderson. He was keenly alive to his master’s interest, and had much tact and disposition for manœuvre; he boasted that in twenty-six years he never lost a patient for his master whom it was possible to retain. Wherever Mr. Cooper was, Charles would start after him, if urgently required, and at any cost of post-horses track him out and bring him triumphantly to the fore.
Mr. Cooper in his earlier years, when anatomy formed a great part of his work, was of necessity largely concerned with the resurrectionists, and was one of the main supporters, it may be equally conceded, of their practices, the details of which he was not unfrequently made acquainted with. But the state of the law, which almost made it impossible to gain possession of subjects for dissection legally, must be accepted as the apology for much that would now as then be regarded as shocking. It cannot be strictly germane to Sir Astley Cooper’s life to describe the procedure of the body-snatchers, as Mr. Bransby Cooper has done;[17] but it may be remarked that on occasions when public notice was threatened, Astley Cooper took prompt steps to obviate injurious publicity of his name. For a time the men of ill-fame reigned supreme, exacting almost what prices they chose. If any demur was made, they stopped the supplies, and then the medical students became angry, held indignation meetings, sent deputations to their teachers, sometimes asserting that their lecturers were not as active or as liberal as those of some rival school, and threatening to leave en masse. Thus the lecturers were in a manner forced to pay more for their subjects than they could receive from their pupils for dissecting them. Another disagreeable consequence was, that when the regular “resurrectionists” got into trouble, the surgeons had to make great exertions in their behalf, and often advanced large sums to defend them, or to keep them and their families during imprisonment. Sir Astley Cooper spent hundreds of pounds in this way. One of his accounts includes £14, 7s. for half the expenses of going down and bailing Vaughan at Yarmouth, £13 for Vaughan’s support during twenty-six weeks’ imprisonment, £50, 8s. for four subjects, paid to Murphy, and six guineas “finishing money” to three men, a douceur at the end of a session.
The high prices paid led some people to offer their bodies before death; but of course this was illegal. Sir Astley’s brief answer to one offer from a third party asking to know the truth, was—“The truth is that you deserve to be hanged for making such an unfeeling offer.” But under other circumstances, when the obtaining of the corpse of a person who had died after an operation interesting to the surgeon was in question, Sir Astley paid large sums, and was thus enabled to add many valuable specimens of surgical results to his museum. Thus his accounts for 1820 show the following entries in regard to obtaining the body of a man on whom he had operated twenty-four years before: “Coach for two there and back, £3, 12s.; guards and coachmen, 6s.; expenses for two days, £1, 14s. 6d; carriage of subject, and porter, 12s. 6d.; subject, £7, 7s.; total, £13, 12s.”
This subject was to be obtained, we read, “cost what it may.” It is no wonder, then, that of Sir Astley it might be said that no man knew so much of the habits, the crimes, and the few good qualities of the resurrectionists. He could obtain any subject he pleased, however guarded: and indeed offered to do so. No one could go further than he did before a Committee of the House of Commons, to whom he plainly avowed: “There is no person, let his situation in life be what it may, whom, if I were disposed to dissect, I could not obtain. The law only enhances the price, and does not prevent the exhumation.” At last the dreadful disclosures about the practices of “burking” in Edinburgh in 1829 led to the passing of the Anatomy Act, legalising dissection under proper regulations.
Nor were human bodies the only ones laid under contribution by Astley Cooper. When animals were wanted for some physiological illustration or investigation, his man Charles could always procure them, and he had at one time as many as thirty dogs, besides other animals, shut up in the hayloft. Half-a-crown a piece was paid by Charles on receipt of the dogs, however obtained, and no doubt dog-stealing was one source. The menagerie at the Tower was to Mr. Cooper, as it had been to John Hunter, a considerable resource for specimens for dissection. In 1801 an enormous elephant came under his knife, and being too unwieldy to be got into the dissecting-room, it had to be cut up in the courtyard, where, assisted by several students, Mr. Cooper gave himself no rest till all the interesting parts were preserved and deposited in St. Thomas’s Museum. Bird-stuffers, fishmongers, and poultry merchants were also among the sources of supply for his unwearying knife.
To Astley Cooper, as to most men who rise to eminence, remunerative practice came but slowly. “My receipt,” says he, “for the first year was £5, 5s; the second, £26; the third, £54; the fourth, £96; the fifth, £100; the sixth, £200; the seventh, £400; the eighth, £610; the ninth (the year in which he was appointed surgeon to the hospital), £1100.” This was in 1800, when his uncle, William Cooper, resigned the surgeoncy. It might have been supposed that the uncle would favour his nephew’s succession in every way possible; but he rather supported Mr. Morris, the strongest competitor. For the rising star made the elder jealous of his brilliancy, and moreover always regarded Cline, at St. Thomas’s, as his uncle’s superior. Thus Astley Cooper’s success was by no means certain, as his political associations with Horne Tooke and Thelwall were strenuously alleged against him. But Astley, ever preferring success to politics, resolved on giving up the latter and on being neutral for the future, at any rate as to all open proceedings. This resolve secured his appointment by Mr. Harrison, the well-known treasurer of Guy’s, who with Sir Astley shares the highest credit in the establishment of its medical school. He now absented himself from Mr. Cline’s political parties, and always advised young surgeons not to attach themselves to particular parties, as their duties must extend to persons of all views. He also, to leave no stone unturned, personally canvassed each of the seventy-two governors.
In 1800 Astley made his first communication to the Royal Society, on the effects of destruction of the tympanic membrane of the ear. He had found that considerable openings might be made in the membrane without impairing the hearing power. He consequently applied this operation to certain kinds of deafness resulting from disease or obstruction in the Eustachian tube, and in 1801 sent in another paper detailing the results of twenty cases. Although his success in restoring lost hearing was much less than he had anticipated, the operation has since been frequently performed, and the Royal Society in 1802 awarded him the Copley Medal for these papers. In the same year he was elected F.R.S.
Astley Cooper’s activities were at this time strongly directed towards the improvement of his profession by intercourse and discussion at societies, of several of which he was the life and soul. The Physical Society at Guy’s Hospital afforded his earliest opportunity of this kind, and long retained his active interest. During his short stay at Edinburgh his predominance was so evident that he was chosen president of a society to protect students’ rights against usurpations by the professors. Here also he joined a Speculative Society, and read a paper in favour of the Berkeleian theory of matter. One of the debates which he opened was on the subject “Is man a free agent?” He would have been a president of the Royal Medical Society at Edinburgh had he returned for a second winter, so much did he distinguish himself in debate. At a later period the strength of his association with Edinburgh was attested by his forming the Edinburgh Club in London for former Edinburgh medical students. The most important society, however, with the foundation of which he was connected, was the Royal Medical Chirurgical Society, which originated in a secession from the Medical Society of London. Dr. Yelloly, who was intimately connected with the new foundation, says of Mr. Cooper at this time: “I never saw any one more open-hearted as a companion, more unreserved in his remarks, with always a large store of information at his command, and who was at the same time more kindly disposed, and abounding in all sorts of material for the gratification of those with whom he associated. He was not a reading man; but he contrived to get the most valuable information of every description, whether professional or general, and always to use it in the best, the most attractive, and the readiest way.” The treasurer of the society was Astley Cooper, and he rendered essential service. The earliest volume of its Transactions, published in 1809, contained a paper recording his first operation for the relief of aneurism of the carotid artery by tying it below the aneurism—a method now established. But he had previously published (part 1 in 1804, part 2 in 1807) a work which largely contributed to his reputation, namely, on Hernia or Rupture. A second edition was published in 1827. The anatomical structures concerned were excellently expounded and illustrated, and the experience gained in frequently and successfully operating in cases of this disease gave Mr. Cooper a position of the highest authority. As so often happens to medical men, his attention was especially called to this disease from the fact that he had been subject to it from early life. The anatomical study he undertook in order to perfect his knowledge of this matter was immense. “I have related no case,” he says, “and given no remark, for the truth of which I cannot vouch.” When his pupils showed him some interesting appearance in a dissection, he would say; “That is the way, sir, to learn your profession. Look for yourself; never mind what other people may say, no opinion or theories can interfere with information derived from dissection.” The expense of the illustrations to this work was so great that Mr. Cooper was loser of a thousand pounds by it when every copy had been sold.
In 1806 Mr. Cooper left St. Mary Axe to occupy the house in New Broad Street which for nine years was crowded by his patients, during the most remunerative years of his life. In those years he rose at six, dissected privately till eight, and from half-past eight saw large numbers of gratuitous patients. At breakfast he ate only two well-buttered hot rolls, drank his tea, cool, at a draught, read his paper a few minutes, and then was off to his consulting-room, turning round with a sweet benign smile as he left the room. Patients crowded his rooms and besieged “Charles,” using manifold devices to get the earliest interview possible. At one o’clock he would scarcely see another patient, even if the house was full; but if detained half an hour later, would fly into a rage, abuse Charles, and jump into his carriage, leaving Charles to appease the disappointed patients. Sometimes the people in the hall and ante-room were so importunate that Mr. Cooper was driven to escape through his stables and into a passage by Bishopsgate Church. At Guy’s he was awaited by a crowd of pupils on the steps, and at once went into the wards, addressing the patients with such tenderness of voice and expression that he at once gained their confidence. His few pertinent questions and quick diagnosis were of themselves remarkable, no less than the judicious calm manner in which he enforced the necessity for operations when required. At two the pupils would suddenly leave the ward, run across the street to the old St. Thomas’s Hospital, and seat themselves in the anatomical theatre. After the lecture, which was often so crowded that men stood in the gangways and passages near to gain such portions of his lecture as they might fortunately pick up, he went round the dissecting-room, and afterwards left the hospital to visit patients, or to operate privately, returning home at half-past six or seven. Every spare minute in his carriage was occupied with dictating to his assistants notes or remarks on cases or other subjects on which he was engaged. At dinner he ate rapidly and not very elegantly, talking and joking; after dinner he slept for ten minutes at will, and then started to his surgical lecture, if it were a lecture night. In the evening he was usually again on a round of visits till midnight.
Dr. Pettigrew, in his “Medical Portrait Gallery,” thus vividly describes the overpowering influence Sir Astley had upon his pupils: “I can never forget the enthusiasm with which he entered upon the performance of any duty calculated to abridge human suffering. This enthusiasm, by the generosity of his character, his familiar manner, and the excellence of his temper, he imparted to all around him; and the extent of the obligations of the present and of after ages to Sir Astley Cooper, in thus forming able and spirited surgeons, can never be accurately estimated. He was the idol of the Borough School. The pupils followed him in troops; and, like to Linnæus, who has been described as proceeding upon his botanical excursions accompanied by hundreds of students, so may Sir Astley be depicted traversing the wards of the hospital with an equal number of pupils, listening with almost breathless anxiety to catch the observations which fell from his lips. But on the days of operation this feeling was wound up to the highest pitch. The sight was altogether deeply interesting; the large theatre of Guy’s crowded to the ceiling—the profound silence obtained upon his entry—that person so manly and so truly imposing—and the awful feeling connected with the occasion—can never be forgotten by any of his pupils. The elegance of his operation, without the slightest affectation, all ease, all kindness to the patients, and equally solicitous that nothing should be hidden from the observation of the pupils; rapid in execution, masterly in manner; no hurry, no disorder, the most trifling minutiæ attended to, the dressings generally applied by his own hand. The light and elegant manner in which Sir Astley employed his various instruments always astonished me, and I could not refrain from making some remarks upon it to my late master, Mr. Chandler, one of the surgeons to St. Thomas’s Hospital. I observed to him, that Sir Astley’s operations appeared like the graceful efforts of an artist in making a drawing. Mr. C. replied, ‘Sir, it is of no consequence what instrument Mr. Cooper uses, they are all alike to him; and I verily believe he could operate as easily with an oyster-knife as the best bit of cutlery in Laundy’s shop.’ There was great truth in this observation. Sir Astley was, at that time, decidedly one of the first operators of the day, and this must be taken in its widest sense, for it is intended to include the planning of the operation, the precision and dexterity in the mode of its performance, and the readiness with which all difficulties were met and overcome.”
Mr. Cooper, notwithstanding his persevering industry in dissection, would not have found time to acquire all the knowledge he did, but for employing several assistants either to dissect the specimens he obtained from operations or from post mortem examinations, or as artists and modellers, amanuenses, &c. He was very peremptory in his orders to his assistants to obtain for him any specimen he required, and would not listen to suggestions of difficulties. “So and so must be done,” he said, and his tone did not admit of the possibility of failure. Thus he accumulated the large collection of morbid specimens which he contributed to St. Thomas’s Hospital, at a time when such collections were poohpoohed, and so little regarded, that he could readily obtain any specimen he desired which was at the disposal of his colleagues. With regard to his proceedings in these matters the utmost secrecy was observed, entrance to his private dissecting-rooms being jealously restricted to himself and his paid assistants. When it was difficult to obtain leave to make a post mortem examination in private practice, he would spend a long time in arguing most strenuously upon the matter with the relatives, pointing out the reasons which rendered it desirable in the interests of science. His only child was examined by his express wish by a friend; and he left strict injunctions and directions for the post mortem on his own body. In very few cases was his determination ever frustrated.
Astley Cooper reached his zenith in Broad Street. In one year his income reached £21,000; for many years it was £15,000. One merchant prince paid him £600 a year; the story of another, who tossed him a cheque for a thousand guineas in his night-cap, after a successful operation for stone, is well known. Many of his patients wrote a cheque for their fee when they consulted him, and never made it less than five guineas. It is amusing to contrast with his reputation as a surgeon and operator, the extremely limited pharmacopœia to which he trusted. “Give me,” he would say, “opium, tartarized antimony, sulphate of magnesia, calomel and bark, and I would ask for little else:” and from five or six formulæ he gave his poorer patients a constant stock of medicine.
Mr. Cooper was appointed Professor of Comparative Anatomy at the Royal College of Surgeons in 1813, being the first appointment after Sir Everard Home retired. He lectured during only two seasons, in 1814 and 1815. Not being deeply read in his subject, he resolved to see what industry could do, and restricted himself to three or four hours’ sleep, that he might gain additional time for the dissection of animals. He also employed several assistants to dissect for him, and the result was that his specimens came by coach-loads to each lecture. Mr. Clift remarks of one lecture, “This was an overpowering discourse, and highly perfumed, the preparations being chiefly recent and half-dried and varnished.” His lectures were very successful, though he would have preferred lecturing on surgery, which was allotted to Abernethy. In the year last mentioned he resigned the professorship and also moved to New Street, W., hoping thereby to diminish the fatigue occasioned by the numerous visits which he had to pay westward. In the following May he signalised his skill by his celebrated operation of tying the aorta or principal artery of the body, for aneurism, in a case in which life was in the extremest peril. The ease with which he prepared for the operation and the masterly skill and success with which he completed it—without the aid of chloroform, be it remembered—excited admiration throughout the profession, who could best judge of the difficulties which had to be overcome. The patient died of incurable disease, but the success of the operation was undoubted.
After having for some years attended Lord Liverpool, Mr. Cooper was in 1820 called in to George IV., who afterwards insisted on his performing a small operation upon him, although he then held no court appointment. He was very reluctant, fearing erysipelas, and only at length yielded to command. His success in this was followed by the conferment of a baronetcy, which was hailed with acclamation by all his friends both professional and public.
In 1822 Sir Astley first became an Examiner at the College of Surgeons. In this capacity he was very conscientious and considerate, never asking catch-questions, or making abstract inquiries, but invariably dwelling upon practical matters, and putting his questions in simple and straightforward language. In the same year appeared perhaps his most important work, that on Dislocations and Fractures of the Joints, and as was his fixed principle, he published it at a price just sufficient to cover the cost of the letterpress and engravings.
In January 1825 Sir Astley resigned his lectureship at St. Thomas’s, owing to the impairment of his health. Mr. Key had previously been delivering part of his surgical course, and his nephew Bransby Cooper had undertaken the anatomical lectures; and Sir Astley was determined to secure their succession to his appointments. He had only resigned in the firm conviction that this was generally agreed upon. His astonishment may be imagined when he learnt that Mr. South had been appointed anatomical lecturer. Sir Astley, desiring to withdraw his resignation, was informed that it was too late. Mr. Harrison, however, the then spirited treasurer of Guy’s, came to the rescue, and offered to establish a school of medicine at Guy’s, totally independent of St. Thomas’s, and to appoint Mr. Key and Mr. Bransby Cooper to the chairs of surgery and anatomy. This was at once agreed to, and a lecture theatre and other premises hastily built during the summer, so that the new school of Guy’s was opened in the succeeding October. A large proportion of the old pupils of the united schools of St. Thomas’s and Guy’s entered at Guy’s, and a considerable number of new pupils coming up, the now famous school was prosperously floated. Sir Astley did not lecture much for the new school, though he gave a few occasional lectures on anatomy and surgery, which of course were crowded to excess. He now became consulting surgeon to Guy’s, and evidenced his zeal by commencing the formation of a museum like that which he had already deposited at St. Thomas’s, and which he would have removed thence had it been in his power. In 1827 he was elected President of the College of Surgeons.
By this time Sir Astley had adopted the habit of spending as much of his time as possible on his estate at Gadesbridge, near Hemel Hempstead. Here he became a rural character, shooting and “making shoot” with eagerness and joviality. Lady Cooper, having lost her adopted daughter, Mrs. Parmenter, and having had no second child, could not endure living in London. In 1825, Sir Astley took his home-farm upon his hands, and kept it in consummate order, at considerable expense, it must be owned. He was always either experimenting or trying to carry out some new plan he had heard of or observed. He again and again became violently angry, as he grew older, when he found that his ideal farm only produced substantial loss: and used repeatedly to vow he would never allow such passion to overcome him again. One of his experiments in farming was the purchase of lame or ill-fed horses at Smithfield at from five to seven pounds apiece, feeding and doctoring them himself at Gadesbridge, and turning them into much better animals. He sometimes made a good profit in this way, and for years drove in his own carriage horses that had only cost him twelve pounds ten. If they were past cure, he would experiment upon them according to what investigation he might have in progress at the time.
Lady Cooper’s death in June 1827 was a heavy blow to Sir Astley, and he was so much affected by it that he resolved to retire altogether from practice. Before the end of the year, however, he found the ennui of retirement insupportable, and returned to town and full practice again. He was married a second time to Miss C. Jones in July 1828. The same year he was appointed Sergeant-Surgeon to the King, an appointment in which he was continued at William IV.’s accession. Having no lectures, he still dissected, and occupied himself largely with completing his various works for the press. His “Illustrations of Diseases of the Breast” appeared in 1829, and was followed by “Diseases of the Testis,” 1830, “The Anatomy of the Thymus Gland,” 1832. He was for a second time President of the Royal College of Surgeons in 1836.
In his old age, even when travelling about, Sir Astley never lost his passion for dissecting, and always visited every hospital and surgeon of note on his travels. He never liked staying more than a few days in one place; he soon began to pine after his accustomed pursuits. On several occasions, when detained longer than he liked in one place, he would get up early and leave by coach for London, without giving any warning of his intention.
On a visit which he made to Edinburgh in 1837, the freedom of the city was conferred upon him and the honorary LL.D. He had previously been made D.C.L. of Oxford. He continued his anatomical and surgical investigations to the last, publishing a splendid work on the Anatomy of the Breast in 1840, preliminary to a complete account of the diseases to which it is liable, which was never completed. He died on the 12th of October 1841, in the seventy-third year of his age, at Conduit Street, where he had practised latterly. He was buried, by his own particular request, beneath the chapel of Guy’s Hospital. A statue of him, by Baily, was erected, chiefly by the members of the medical profession, in St. Paul’s Cathedral, near the southern entrance. An admirable portrait of him by Sir Thomas Lawrence exists. Sir Astley’s name is commemorated by the triennial prize essay of three hundred pounds for the best original prize essay on a professional subject, to be adjudicated by the physicians and surgeons of Guy’s, who may not themselves compete.
A criticism on Sir Astley during his life accorded to him a great share in establishing pure induction as the only sure means of just diagnosis, and in introducing a simplicity of treatment in accordance with the processes of nature. Before his time, operations were too often frightful alternatives or hazardous compromises; he always made them follow, as it were, in the natural course of treatment; and he succeeded in a great degree in divesting them of their terrors by performing them unostentatiously, confidently, and cheerfully. He stated an opinion and fact to the Committee on Medical Education, which might well have been borne in mind by some examiners since his day: “Whenever a man is too old to study, he is too old to be an examiner; and if I laid my head upon my pillow at night, without having dissected something in the day, I should think I had lost that day.” Sir Astley left among his private papers an estimate of himself, written in the third person, which is worth quoting. “Sir Astley Cooper was a good anatomist, but never was a good operator where delicacy was required. He felt too much before he began ever to make a perfect operator.... Quickness of perception was his forte, for he saw the nature of disease in an instant, and often gave offence by pouncing at once upon his opinion. The same faculty made his prognosis good. He was a good anatomist of morbid, as well as of natural structure. He had an excellent and useful memory. In judgment he was very inferior to Mr. Cline in all the affairs of life.... His imagination was vivid, and always ready to run away with him if he did not control it.”
“His principle in practice was, never to suffer any who consulted him to quit him without giving them satisfaction on the nature and proper treatment of their case.”
Finally, he says, what is a fitting close to this narrative of his career, “My own success depended upon my zeal and industry; but for this I take no credit, as it was given to me from above.”
Another pupil of John Hunter, a man of very different mould, in several respects more akin to the master than Sir Astley, now claims our attention. Unlike many of the great men whose achievements we have recorded, John Abernethy was born in London, in the parish of St. Stephen’s, Coleman Street, on the 3d of April 1764. He was the second son of John Abernethy, merchant, descended from an Irish-Scotch family which had furnished more than one noted man to the Protestant dissenting ministry in Ireland. While very young he was sent to the Wolverhampton Grammar School under Dr. Robertson. Here he was reputed studious and clever, but was evidently passionate as well as humorous. The severe discipline common at that time does not seem to have worked very well with Abernethy, for he came out of it more excitable and impatient than he had been previously. School days were over at fourteen, however, and at fifteen the youth was apprenticed to Mr., afterwards Sir Charles, Blicke, his father’s neighbour in Mildred’s Court, one of the surgeons to St. Bartholomew’s Hospital. His own desire was to enter the legal profession, in which his fine memory would have rendered him important service; but his father did not agree with this choice, and the medical profession was selected. His master was an empiric; but Abernethy early determined to get to the bottom of things as far as possible, and engaged in investigations on his own account. The bent of his mind towards treatment by diet is shown by the following statement. “When I was a boy,” he said, “I half ruined myself in buying oranges and other things, to ascertain the effects of different kinds of diet in this disease” (of the kidney).
Abernethy’s interest in anatomy and surgery was first effectively stimulated by Sir William Blizard, who lectured at the London Hospital, and he warmly acknowledged this in his introductory lecture at the College of Surgeons in 1814, when he succeeded Sir William as professor. He was soon selected to dissect for Sir William’s lectures; he derived much benefit from Pott’s surgical lectures at St. Bartholomew’s, and from Dr. Marshall’s lectures in Holborn; but was most powerfully influenced by John Hunter, who noted him among his most intelligent pupils. The opportunity of becoming an assistant-surgeon, being reserved to apprentices of the surgeons to St. Bartholomew’s, came early to Abernethy, for his master’s promotion to the surgeoncy led to his election as assistant-surgeon in July 15, 1787, when only twenty-three years old, by a majority of fifty-three to twenty-nine votes. But he was under the necessity, owing to his senior’s remaining so long in office, of continuing as assistant-surgeon for the long period of twenty-eight years.
The young surgeon soon began to put his original powers in evidence by starting as a lecturer. Mr. Pott had for years given a course of lectures on surgery, but no other lectures had been delivered, and the medical school of St. Bartholomew’s must be regarded as owing its establishment to Abernethy. To be the life and soul of a new school is enough for any man in his maturest years; it was more than enough for Abernethy, beginning at twenty-three, when everything was new, and precedents were few, and when his own faculties and studies still lacked much. To this we must largely attribute the worn-out look which began to settle upon his face from the age of fifty. He was not content in his lecturing with any dry and orderly narration, but combined with his descriptive account the purposes of a structure, the diseases and accidents to which it is liable, and illustrations from comparative anatomy. He for a long time included in his courses at once anatomy, physiology, pathology, and surgery; at the same time he kept up his attendance on John Hunter’s lectures, and diligently studied in the wards of the hospital. His industry at this period was such that he rose at four, and sometimes went into the country that he might read with less interruption. It may seem strange, in connection with the well-known brusqueness of his manner, to read that he had an unconquerable shyness in his early years of lecturing, which often made him retire from the theatre to regain his composure before being able to commence his lecture. But this shyness is often a concomitant of real talent and originality before it has found means to display itself effectively; and brusqueness is in not a few instances the cloak of timidity. When his dramatic instincts had led him into his true path, he soon gained in ease, and his classes increased so rapidly that in 1790 the governors of St. Bartholomew’s resolved to build him a theatre, which was opened in October 1791.
Abernethy’s style in lecturing is described by those who heard him as unique both in communicating his ideas and in interesting his pupils. When his style had fully developed, it was spoken of as “Abernethy at Home.” His mode of entering the lecture-room, says Pettigrew, was often irresistibly droll; his hands buried deep in his breeches-pockets, his body bent slouchingly forward, blowing or whistling, his eyes twinkling beneath their arches, and his lower jaw thrown considerably beneath the upper. Then he would cast himself into a chair, swing one of his legs over an arm of it, and commence his lecture in the most outré manner. The abruptness, however, never failed to command silence, and rivet attention.
“‘The count was wounded in the arm—the bullet had sunk deep into the flesh—it was, however, extracted—and he is now in a fair way of recovery.’ That will do very well for a novel, but it won’t do for us, gentlemen: for ‘Sir Ralph Abercromby received a ball in the thick part of his thigh, and it buried itself deep, deep: and it got among important parts, and it couldn’t be felt; but the surgeons, nothing daunted, groped, and groped, and groped,—and Sir Ralph died.’” Thus he would introduce an admirable discourse on gunshot wounds, reprobating in the strongest language the perilous and painful practice of making prolonged searches for bullets in important organs. He always illustrated his subject by telling anecdotes, frequently of a side-splitting character, and so compelled his pupils to remember his doctrines.
His mental abstraction was not unfrequently manifested strikingly in the lecture-theatre. On one occasion it is related of him that at an introductory lecture at St. Bartholomew’s, when he had been received, as usual, with great applause, he appeared utterly indifferent to it, but quietly casting his eyes over the assemblage, burst forth in a tone of deep feeling, “God help you all! what is to become of you!”
His dramatic power was much employed in imitating his patients’ peculiarities, with a mixture of the serious and the humorous which was most effective. Many of his stories were most apt in their bearing on some important fact or principle. One of these we may be allowed to quote from Macilwain.[18]
“Ah, there is no saying too much on the importance of recollecting the course of large arteries; but I will tell you a case. There was an officer in the navy, and as brave a fellow as ever stepped, who in a sea-fight received a severe wound in the shoulder, which opened his axillary artery. He lost a large quantity of blood, but the wound was staunched for the moment, and he was taken below. As he was an officer, the surgeon, who saw he was wounded severely, was about to attend to him, before a seaman who had been just brought down. But the officer, though evidently in great pain said: ‘Attend to that man, sir, if you please, I can wait.’ Well, his turn came; the surgeon made up his mind that a large artery had been wounded; but as there was no bleeding, dressed the wound, and went on with his business. The officer lay very faint and exhausted for some time, and at length began to rally again, when the bleeding returned; the surgeon was immediately called, and not knowing where to find the artery, or what else to do, told the officer he must amputate his arm at the shoulder-joint. The officer at once calmly submitted to the additional but unnecessary suffering; and as the operator proceeded, asked if it would be long; the surgeon replied that it would be soon over; the officer rejoined: ‘Sir, I thank God for it!’ but he never spake more.”
Amidst death-like stillness, Abernethy quietly concluded: “I hope you will never forget the course of the axillary artery.”
It has been, we believe, a somewhat general impression, that Abernethy as a lecturer indulged in tricks or extraordinary gesticulations. But this is by no means correct. There was a method in every item of his procedure, and all he aimed at was to impress upon the students’ minds in the most forcible and abiding way the ideas he wished to convey. He gained, it is said, the appearance of perfect ease without the slightest presumption; and had no offensive tricks. Macilwain, who was his pupil at his best period, says: “The expression of his countenance was in the highest degree clear, penetrative, and intellectual; and his long but not neglected powdered hair, which covered both ears, gave altogether a philosophic calmness to his whole expression that was peculiarly pleasing. Then came a sort of little smile, which mantled over the whole face, and lighted it up with something which we cannot define, but which seemed a compound of mirth, archness, and benevolence.... There was a sort of running metaphor in his language, which, aided by a certain quaintness of manner, made common things go very amusingly. Muscles which pursued the same course to a certain point, were said to travel sociably together, and then to part company. Blood-vessels and nerves had certain habits in their mode of distribution, contrasted in this way; arteries were said to creep along the sides of or between muscles: nerves, on the contrary, were represented as penetrating their substance without ceremony.... He was particularly happy in a kind of cosiness or friendliness of manner which seemed to identify him with his audience; as if we were all about to investigate something interesting together, and not as if we were going to be ‘lectured’ at at all. He spoke as if addressing each individual, and his discourse, like a happy portrait, always seemed to be looking you in the face.”
In consultation or in ordinary practice, Abernethy was only rough and hasty when something annoyed him. Towards his fellow-practitioners who could give a reason for their opinions or their treatment, he was polite and even deferential. He never recommended interference with judicious plans of cure in order to gain éclat for himself, nor unless some important end were to be obtained. He was no party to concealments or deceptions being practised on the friends of patients, and in many cases told the plainest of plain truths to patients themselves. “Pray, Mr. Abernethy, what is a cure for gout?” was the question of an indolent and luxurious citizen. “Live upon sixpence a day—and earn it,” was the cogent reply. He is reported to have been consulted by the Duke of York; and to have stood before him, as usual, whistling, with his hands in his breeches-pockets. The astonished Duke remonstrated: “I suppose you know who I am.” “Suppose I do,” replied Abernethy, “what of that?” And he advised the Duke, in reference to his complaint: “Cut off the supplies, as the Duke of Wellington did in his campaigns, and the enemy will leave the citadel.” A barrister came to Mr. Abernethy with a small ulcer on his leg, which had proved difficult to heal. Having heard much of his impatience and peculiar manners, he began to pull down his stocking as soon as he entered his consulting-room. “Holloa! holloa! what the devil are you at?” exclaimed the surgeon. “I don’t want to see your leg; that will do, put it up, put it up.” The patient did so, but marked his displeasure by placing only a shilling upon the table when he left. “What is this?” asked Abernethy. “Oh,” replied his patient, “that will do, put it up, put it up,” and coolly retired.
It is said that Abernethy’s impatience frequently arose from his anxiety to be at his hospital duties; and that instead of representing this in a proper manner, he would sometimes almost push patients from his door. Sir Astley Cooper received many a fee from those who had quitted Abernethy, or would not venture to encounter his rudeness. To his hospital patients, especially those who were in great distress, he was all kindness. Their gratitude was sometimes amusingly demonstrated. Mr. Stowe relates one example of this: “It was on his first going through the wards after a visit to Bath, that, passing up between the rows of beds, with an immense crowd of pupils after him, myself among the rest—the apparition of a poor Irishman, with the scantiest shirt I ever saw, jumping out of bed, and literally throwing himself on his knees at Abernethy’s feet, presented itself. For some moments everybody was bewildered; but the poor fellow, with all his country’s eloquence, poured out such a torrent of thanks, prayers, and blessings, and made such pantomimic displays of his leg, that we were not long left in doubt. ‘That’s the leg, yer honnor! Glory be to God! Yer honnor’s the boy to do it! May the heavens be your bed! Long life to your honnor! To the divole with the spalpeens that said your honnor would cut it off!’ &c. The man had come into the hospital about three months before, with diseased ankle, and it had been at once condemned to amputation. Something, however, induced Abernethy to try what rest and constitutional treatment would do for it, and with the happiest result. With some difficulty the patient was got into bed, and Abernethy took the opportunity of giving us a clinical lecture about diseases and their constitutional treatment. And now commenced the fun. Every sentence Abernethy uttered Pat confirmed. ‘Thrue, yer honnor, divole a lie in it. His honnor’s the grate dochter entirely!’ While at the slightest allusion to his case, off went the bed-clothes, and up went the leg, as if he were taking aim at the ceiling with it. ‘That’s it, by gorra! and a bitther leg than the villin’s that wanted to cut it off!’ This was soon after I went to London, and I was much struck with Abernethy’s manner in the midst of the laughter. Stooping down to the patient, he said with much earnestness: ‘I am glad your leg is doing well; but never kneel, except to your Maker.’”
Many are the stories in which Abernethy’s name appears; many have been exaggerated; many are falsely connected with his name. Sometimes he would, instead of crushing a victim, become sufficiently the victim himself. A lady once said to him: “I had heard of your rudeness before, but I did not expect this.” When he handed her his prescription, she asked: “What am I to do with this?” The rough reply was, “Anything you like. Put it in the fire if you please.” The lady took him at his word, laid down her fee, threw the prescription into the fire, and left the room; nor could Abernethy persuade her to receive her fee again, or a fresh prescription. Notwithstanding all stories to his disadvantage, there is no doubt that Abernethy’s intentions were most kind, and that he never took a fee from a patient who might possibly be unable to afford it comfortably. For these two reasons, his not unfrequent roughness, and his leniency about fees, he certainly had a much smaller income than he might have secured. Yet his income was very considerable, but not carefully managed. One day calling to pay his wine merchant for a pipe of wine, he threw down a handful of notes, and pieces of paper with fees. On being asked to wait till all were accurately counted, as some of the fees might be more than he thought. “Never mind,” said he, “I can’t stop; you have them as I took them,” and hurried away.
It is now time to refer to some of Abernethy’s principal publications. In 1793 he published his first volume of Surgical and Physiological Essays, including his celebrated essay on lumbar abscess, in which he details a simple and beautiful method of cure which has since been largely followed. In the second volume of these essays, a paper on the functions of the skin details some careful experiments upon the air in which the hand or foot had been confined for some time. He detected some carbonic acid in such air, and founded upon the experiments important views as to the necessity of keeping the skin cleansed and in healthy action. The third part of these essays, published in 1797, contained an important paper on injuries of the head, deprecating among other things all unnecessary interference, and so preventing many a fruitless operation. In 1806 appeared Abernethy’s Surgical Observations, including an account of the disorders of health in general, and of the digestive organs in particular, which accompany local diseases, and obstruct their cure. Whenever he wished to impress upon a patient or a practitioner the importance of attending to the general health, and the stomach in particular, if some local disease was to be cured, he always referred to his book, so that his phrase “read my book” was expected as a certainty. But it appeared sometimes as if he perceived disorder of the digestive organs in every case. A lady who had an affection outside the knee-joint occasioned by a blow against the edge of a step, went to Mr. Abernethy, and was about to show the affected part, when he rudely exclaimed, “I don’t want to see your knee, ma’am! allow me,” and pressed his fist with force against her stomach. She of course cried out, and he of course attributed her disorder to her stomach. Nevertheless she recovered without medicine, by strictly local treatment of the knee, under Dr. Pettigrew.
In all Abernethy’s writings there was manifested a lack of good arrangement which contrasts strikingly with his excellence as a lecturer: but in the latter capacity his audience was always before him, and he could see and test the suitability of his matter. Education had not furnished him with real literary training, and his aptness of expression and his wit do not appear to striking advantage in his written works.
Abernethy was married on the 9th January 1800 to Miss Anne Threlfall, whom he had met at a house to which he had been professionally called in. His courtship was brief; his proposals were made by letter; he characteristically deprecated too much “dangling,” gave the lady a fortnight to consider her reply; and was successful. Not for one day did he interrupt his hospital lectures.
In 1815, after twenty-eight years’ tenure of the office of assistant-surgeon, Abernethy became full surgeon on the retirement of his old master, Sir Charles Blicke. He made the appointment the occasion for publishing a pamphlet on the evils attending the prolonged tenure of office by old surgeons. He himself had lectured for twenty-eight years, and been largely influential in filling the hospital with students, from whose hospital fees he received nothing whatever. About the time of his succession to the surgeoncy he took a house at Enfield, to which he resorted on Saturdays, gladly quitting his own house in Bedford Row for a quiet country ride. In the summer he would retire to Enfield on most evenings. This tended very much to the benefit of his fidgety nervous system. From early life his heart had been particularly irritable, causing him frequent suffering. A wound which he accidentally gave himself in dissecting at one time caused him such a severe illness that it was three years before he had recovered from its effects, which appeared in very varied forms. It must be acknowledged, too, that he was not as moderate in eating as he exhorted his patients to be. He frequently was attacked by inflammatory sore-throat, terminating in abscess.
Abernethy resigned his professorship at the College of Surgeons in 1817, and was gratified by a resolution sent to him, thanking him for the distinguished energy and perspicuity which had characterised his lectures. This resignation, however, was not sufficient relief to his overstrained system, which was now often tormented with rheumatism. He took insufficient care of himself, would walk down from Bedford Row to the hospital in knee-breeches and silk stockings when it was raining, without a thought of protecting himself from a drenching. With very cold feet he would stand opposite one of the flue openings in the museum, and this with other imprudences gradually sapped his strength. At the age of sixty, according to the plan he had suggested and strongly advocated, he resigned his appointment as surgeon, but the governors would not accept it. He was persuaded to remain in office some time longer, but finally resigned on July 24, 1827. The succeeding winter was the last in which he lectured, and in 1829 he gave up his examinership at the College of Surgeons. He had now become very lame, thin and old-looking. His eye retained its expressiveness, but showed evidences of the continual pain he suffered. He died on the 20th April 1831, quite worn out, but conscious to the last: he was buried in the parish church of Enfield. Thus early, like John Hunter, died one of his pupils, who, in the words of the Duke of Sussex at the anniversary meeting of the Royal Society in 1831, appears the most completely to have caught the bold and philosophical spirit of his great master.