Pioneer Medicine in Virginia

PIONEER MEDICINE IN VIRGINIA By BLANTON P. SEWARD, A.B., M.D. ROANOKE, VIRGINIA (Concl usion *) HE most distinguished anat- appointment as a prosector in anatomy omist and surgeon in Virginia in one of England’s leading medical during the eighteenth century, schools, and in being associated with a and one of the most distin- prominent surgeon in a nearby com- guished that Virginia has produced,munity. was Mr. Else, however, soon in- TWilliam Baynham. Baynham completed duced him, upon terms that were flatter- the course in medicine offered by St. ing, to return to London. Thomas’ Hospital, in London, in 1772, although he did not receive a degree, as He was to superintend the anatomical that institution did not confer degrees. theater and dissecting room, prepare the While he was a student a friendship bodies for his public demonstrations, developed between him and Mr. Joseph make preparations for the museum, and Else, the Professor of Anatomy, and it to instruct his pupils in the arts of dis- continued until the death of Mr. Else secting, injecting, making anatomical preparations, &c. at a salary of eighty and several years later. Baynham became so ninety pounds the first two years, and proficient in anatomy that he was en- one hundred pounds a year for live suc- gaged, upon the completion of his ceeding years—at the expiration of which course, by Charles Collignon, Professor (having qualified himself in the interim of Anatomy in the University of Cam- for the office) Mr. Else was to relinquish bridge, as his prosector. During the to him the professor’s chair, or to take summer months he worked in part- him as joint professor on equal terms as nership with Mr. Slater, a prominent he (Mr. Baynham) might choose.35 surgeon of Margate.35 How much Col- lignon thought of his young prosector Baynham worked assiduously in his may be gathered from his letter of new position at St. Thomas’ Hospital. April 12, 1772, to Mr. Else35: There he acquired the minute knowl- edge of anatomy for which he became Sir—I beg leave to return you thanks famous. In addition to teaching and for being instrumental in prevailing on preparing many valuable specimens for Mr. Baynham to assist me, as his services have been entirely satisfactory, and his the museum, he mastered the art of in- private behaviour very amiable and en- jecting small arteries. His skill in the gaging. I am, sir, your very humble serv- latter was often compared with the skill ant, of Frederick Ruysch. Charles Collignon, During this period he settled, by his Professor of Anatomy in the method of injection, a long disputed University of Cambridge. question between Else, Pott, Hunter, Thus Baynham was fortunate in his and other surgeons, whether in the op- * Part 1 appeared in the January, 1938, issue of Annal s of Medic al Hist ory , n.s. vol. x, p. i. eration for hydrocele, the injection of out its whole extent.”35 Through this caustic solutions into the tunica vagi- work he became known as the discov- nalis testis destroyed the tunica or ob- erer of the rete mucosum. Unfortunately for Baynham, Else died five years after their association began without having communicated his plans for his successor to the Board of Governors. A candidate for the Pro- fessorship of Anatomy, Baynham failed by one vote to be elected. Then he turned to surgery and for five years he practiced in London. His election to Fellowship in the Royal College of Sur- geons in 1781 gave him equal rank with the eminent surgeons, Abernethy, Coo- per, John Hunter, and Percival Pott.35 After residing in London for sixteen years, Baynham returned to Virginia. Even though he lived in a remote rural district, he soon acquired a large prac- tice, and patients came from great distances to him for treatment. He also was frequently called in consultation long distances from home. While he performed with success all the operations that were known during his day, he became particularly famous for his lap- literated the sac between the two layers arotomies for extra-uterine pregnancy. of the tunica by the formation of adhe- Baynham was the second physician in sions. Else maintained that the tunica America to operate for this condition, was destroyed, while Hunter contended his first operation being performed in that irritants induced inflammation and 1791,3(5 twenty-nine years after that of the formation of adhesions. A patient John Bard of New York.37 After ex- whom Else was treating, and who was amining his patient Baynham made a thought to be improving, died suddenly diagnosis of extra-uterine pregnancy, from some other cause. Baynham skill- and advised an operation. When she re- fully injected the testis with a solution turned Baynham attempted the opera- colored with vermilion through the tion, but did not complete it as he had spermatic artery, and demonstrated that “neither books to consult nor medical the tunica was not destroyed but that friends to advise me what to do.” A few adhesions had formed. months later, when it became evident About the same time he “injected that something must be done to save the and demonstrated a fine vascular mem- patient’s life, he operated again, making brane on the surface of the cutis, imme- the incision longer and deeper. The diately under the rete mucosum, sepa- patient recovered satisfactorily and was rate and distinct from the cutis, and in good health nineteen years after- capable of separation from it through- wards. He performed the operation sue- cessfully in another case in 1799. When the gastric juice of herbivorous animals reporting these cases Baynham men- could not digest meat, and that the gas- tioned having seen two other cases of tric juice of carnivorous animals had no extra-uterine pregnancy, although he effect on vegetable substances, Ewell did not operate in either case on ac- proved by a two weeks’ experiment that count of the poor condition of the pa- a horse would “eat eighteen ounces of tient. In commenting upon ectopic meat mixed with meal, at once, without pregnancy he said: “’I am inclined to hesitation.” This and other experi- think cases of extra-uterine conception ments in which herbivorous animals ate are not as rare as is generally supposed, meat led him to conclude that the stom- although I find no account of any opera- ach is “capable of adjusting itself to tion for the extraction of the fetus in various kinds of food,” the stomach of all my reading; nor did I ever meet with man possessing “this accommodating a case 'where the fetus had grown to principle in the most eminent degree.” full size and maturity, until that of In attempting to explain how the stom- Mrs. Cocke presented itself.”36 Mrs. ach digests different kinds of food, he Cocke was the first patient upon whom supposed that the ingestion of animal he operated. While Baynham’s report and vegetable foods stimulated differ- reveals his skill in making a diagnosis ent secretions in the stomach. of extra-uterine pregnancy in the days In another experiment he isolated, when such a diagnosis was seldom made, with ligatures, two feet of the jejunum and his boldness in carrying out the of a fasting dog, and injected into it well proper treatment, yet it also shows that boiled meat with an ounce of gastric he exercised judgment in selecting pa- juice obtained from a hog. The intes- tients for operation, and in directing tine was replaced in the abdomen, and the post-operative treatment. the wound closed. When the animal was A few years after Baynham died a killed three hours later an examination physician who knew him well wrote: showed about “one-third of the mixture “He was of those very few men whose was absorbed, and the mesenteric loss will be a public misfortune, for I glands coming from the tied intestine know not who is to succeed him in Vir- contained a small quantity of chyle; ginia as a surgeon. In his profession he there was also a small quantity in the was second to Dr. Physick only, . thoracic duct, which as well as the for- Dr. Physick and Mr. Baynham are the mer was more limpid than usual, being only two persons, whom I know in blended with the lymph with which the America, that have really improved the remaining glands were filled.” In exper- surgical profession.”35 imenting with other dogs, he injected Soon after the dawn of the eighteenth gastric juice, saliva, and bile separately century, Thomas Ewell made a notable into sections of the intestine isolated contribution to the physiology of di- in the same manner. When these dogs gestion. While a student at the Univer- were killed and examined three hours sity of Pennsylvania, from which he later, he found from one-half to three- graduated in 1805, Ewell made a num- fourths of the gastric juice had been ber of experiments and reported the re- absorbed, less than one-fourth of the sults in his graduating thesis: “Notes on saliva had been absorbed, while all of the Stomach and Secretion.”38 the bile still was in the intestine. He Doubting Spallanzani’s theory that concluded that gastric juice acts as a “peculiarly powerful stimulus to the formal treatise on physiology composed lacteals,” an idea he had suggested in a in America.40 It soon became a standard paper which he read at a meeting of the textbook, superseding the American Philadelphia Medical Society in 1803.

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