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to the suggestions of the least judicious, probably, of those around them.*
In the first volume of my "Early Years " I mentioned, among my acquaintance at Gottingen, a Russian doctor of the name of Bouttatz; and I am glad of this opportunity to allude to a case which Abernethy was accustomed to speak of in his Lectures with much commendation, and of which he avails himself in his "Classification of Tumours," for the purpose of showing that what he has denominated Pancreatic Sarcoma, is occasionally distinct from any implication with surrounding glandular parts. He accordingly refers the reader to the curious case, published in London, by Dr. Bouttatz, of Moscow, of a tumour which grew beneath the conjunctiva of the eye, and protruded it between the eyelids. The tumour was seven inches long, and three inches and a half in circumference, and weighed two pounds and a half. It was closely connected with the tunica conjunctiva, as might be naturally supposed, but the base of it was easily elevated from the cornea, which still retained its natural transparency, and the patient regained his sight on its removal.
* Such suggestions and recommendations are far from being confined to the immediate vicinage of the sick, particularly when thepublic interest orsympathy is kindled, as in the case of the Queen Dowager, when, it is said—" Large doses of medicine—draughts, pills, and powders—were sent to Sudbury Hall by individuals residing in different parts of the country. Each person forwarded his favourite nostrum, with an urgent request that her Majesty might be pleased to try its virtue." The correspondent of the " Times", who gives this account, adds—" I feel convinced that none of the parties who have made such liberal presents of their drugs, will fail to participate in the general satisfaction when they learn that, though their physic remains untouched, her Majesty is getting better."
Dr. Bouttatz, when at Gottingen, A. D. 1799, talked of settling as an Oculist in London, but I have long since lost sight of him, and my hope is that he may have returned to his native city; where, from having less opposition to encounter, his dexterity in performing the most delicate operations would be more sure of finding its merited reward.
Before I ]quit the present subject of tumours, I am tempted to advert, somewhat at length, to a case which occurred in my own practice; on account not only of its appropriate interest, but because it will serve as a good example likewise of Abernethy's peculiar style of lectures, and its impression on the memory of his pupils.
"What can be the cause of the dreadful situation in which you find me ?" was the earnest question of a patient upon whom I was called to attend in the year 1833. "Is it a visitation of God?" "We are right," I replied, "in considering all heavy affliction as such." "About a year since," he then proceeded to say, "I was in rude health, but subject to cold extremities; and I found that, to obviate this inconvenience, Sir John Sinclair, in his 'Code of Health and Longevity,' which I had been reading, recommended friction; and to this I accordingly had recourse every morning and evening. It happened that, upon one occasion, in rubbing the left arm, I slightly injured a mole which had always been there without occasioning the smallest previous inconvenience. From this time, however, instead of healing, it began to enlarge, until I thought it of sufficient importance to consult a
S surgeon, who advised my having it cut out, to which I readily assented. At first the wound, occasioned by the operation, presented no unfavourable appearance; but ere long I began to feel considerable uneasiness in the part, extending thence to the arm-pit, with the appearance of a small tumour at the lower end of the line made by the excision. This occasioned so much dismay that I repaired to Plymouth for advice. There, alteratives were prescribed; and a second operation was recommended, to which I gave consent; but no good resulted from it. It became obvious that venom pervaded my whole frame; tumours formed in various parts of the body, setting further operations at defiance, and baffling the skill of my medical advisers. Under these desperate circumstances, nevertheless, I hastened to town to have the opinion of Mr. Lawrence, but neither could he give me any encouragement; and I have accordingly received as little benefit from his, as from all other prescriptions. My fate, I am fully convinced, is sealed; and I have requested to see you, in compliance with the wishes of my friends, not from having any hope that you can be of service to me."
There was, in fact, nothing more to be done for him: he was evidently labouring under that dreadful disease which Abernethy has denominated " tuberculated sarcoma;" a disease of so malignant a nature as to be considered by him incurable, and which no subsequent experience has rescued from the black list to which he consigned it. At the time of my visit, there were scores of tumours, from the size of a nutmeg to that of-a hen's egg, in every part of the body. Over the scalp, and along the course of the spine, they were almost innumerable; the glands in the neck were affected; and over the lower part of the bowels there were several of a larger size than the rest,—very irregular in shape, assuming a dark colour, and threatening to ulcerate. Over the surface of others, a thin crust, of a leprous hue, had formed; all were extremely tender; and how the poor sufferer was able to find a moment's repose in any position I was at a loss to conceive. His bed, until he sank under the spell of an opiate, must have been a bed of torture; and I remembered what Abernethy had said, more than thirty years before, that a person in this wretched predicament, "seemed to be lying on hobnails." This, my patient said, was precisely true; and although his feet were so tender that he could not stand on them without great pain, yet such was the weariness, as well as uneasiness, of every other position, that it was comparative relief to him to walk up and down his room, or even, as long as his strength would permit, to take a turn in his garden. His affliction was farther aggravated by the weakness of his sight, which was daily getting more imperfect; the ball of the right eye being distorted, and covered with the lid, which required to be raised with the hand before the eye itself could be examined. His hands and arms were always ice-cold. It is not surprising that, in such a state of misery as this, he should have expressed a wish to depart hence, and be no more seen. At the same time, no one could evince greater submission; and he seemed glad that I was able to bear testimony to the quiet way in which he VOL. II. Q
resigned himself to his inevitable fate. He felt that he had been a great sinner; and he seemed to derive much comfort from "not despising the chastening of the Lord." Professionally, this case was calculated to interest me, from the rareness of its occurrence, from its inherent malignity, and from the completeness of this particular instance, which could scarcely be exceeded in characteristic severity. It was, moreover, the case of an old schoolfellow, with whom, forty years previously, I had spent many a cheerful day, each "a stranger yet to pain." But its connexion with the fearful question, "Is not this dreadful sickness of mine retributive ?" made it doubly impressive.*
I may mention, in conclusion, that my poor suffering friend lived many weeks from the period of my first visit, and that when I saw him for the last time, which was a few days prior to his death, he only lamented that his sight had become so dim as to entirely prevent his reading. His sufferings upon the whole, he said, were less. The tumours,
* Believing, as we must, that the very hairs of our head are numbered, and that" not a sparrow falls to the ground, but thou, 0 Lord, knowest it," who will dare to deny the retributive tendency of any particular judgment? Yet, it is neither consistent with Christian charity, nor with a knowledge of the usual course of God's proceedings upon earth, to show a readiness upon all occasions to array the incidents of life in the characters of extraordinary interposition. In the parable of our Lord, the tares and the wheat are allowed to grow together until harvest; and what a world would this be were it otherwise! Were we liable, at every instant, to be arraigned for every evil thought, word, or action, at any other bar than that of our own consciences, what would become of the doctrines of repentance, of probation, of faith? The power of the Almighty to destroy or to save upon fitting occasions, known to himself alone, must be recognized by every pious and reflecting mind. If we go beyond this, we deprive rational beings of freedom of will; we depress them below the standard of instinct, and drive them, bereft of their moral attributes, upon the confines of fatalism itself.