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Gentlemen, rupture of the omentum renders persons very liable to the rupture of intestine. This liability I have had occasion to notice, and I remember very well that a gentleman, affected with omental hernia, and in whom the intestine would come down whenever he rode, or even when getting into bed, insisted on having an operation performed upon him. The operation was performed by Mr. Abernethy, during the time that I lived with him.
Wound of the Intestine in the Operation
Application of Ice and of Tobacco Enema in
Strangulated Hernia. Ice, gentlemen, as it is commonly usedthat is to say, pounded small, and put into a bladder, and then laid over the tumour, is as likely as any local application with which we are acquainted, to be servicable in irreducible hernia, whilst it is a resource which cannot produce any unfavourable consequences. It checks the progress of inflammation in the parts with which it is in contact: it causes a diminution in the size of the vessels-it lowers the temperature, and is, on the whole, an unobjectionable mode, certainly, of attempting to reduce a hernia. If it do no good, it will be sure to do no harm ; and in effect accomplishes, without risk of danger, all that can be effected by any local application whatever.
Tobacco, gentlemen, you are aware is employed in the form of an enema, in cases of hernia, for a specific purpose ; it causes, very speedily, a depression of the vital powers; it diminishes the energy, and brings on that state of general relaxation of the body under which inflammatory action is likely to give way. The influence of tobacco is indeed so considerable on our physical powers, that the greatest caution is requisite in its administration, even in the way that I have mentioned. We generally infuse a drachm of
Gentlemen, no person, I am sure, can have undertaken the difficult task of performing an operation for hernia, without feeling that he runs the risk of wounding the protruded bowel. It sometimes even happens that the surgeon is unable, for some time, to pass the director beneath the constriction, and having, under such circumstances, no other alternative than the employment of a cutting instrument, he incurs still greater risk than ever of such an accident. For my own part, gentlemen, I confess to you, that I never yet commenced the operation for reducing a strangulated hernia, without being sensibly alive to the danger of wounding the intestine. This is a sort of apprehension, from which no man, however cautious, however well-informed, should consider himself exempt, and it is only by acknowledging your
* Mr. Wheeler, the elder, late Apothecary to $t. Bartholomew's Hospital, a gentleman now not far from his soth year, and who exhibits in his healthy form, and his placid and cheerful spirit, a striking specimen of the blessings which a
youth, and a manhood of temperance and integrity, must secure to the period of old age, has been among the first to warn practitioners against the employment of tobacco clysters in hernia, of a strength greater than that which Mr. Lawrence recommends in his lecture.
liability to this danger, that you will be induced to take the necessary measures in order to avoid it.
You will naturally inquire what are the means by which we are most likely to prevent this occurrence.
I think, gentlemen, that one of your principal objects, with the view of guarding against the hazard I have mentioned, should be to carry your external incision so far, as completely to denude the aponeurosis of the external oblique muscle. By such a course only, can you expect to proceed to the successful termination of your measures with certainty. In the next place, let me advise you never to trust to a shallow director, when you are about to relax the constriction. I present to your notice a director, which I always employ in private practice; you perceive that the groove is rather deeper than you have been accustomed to see ; but this depth is essentially necessary, in order to prevent the intestine from being reflected over its edges, and in this way being imperceptibly placed in the way of the knife.
Now, gentlemen, when such an occurrence as a wound of the intestine takes place, your best course is to seize, without delay, the sides of the aperture with a strong forcepsto tie the mouth of the wound with a silken ligature, and cut the ends of the ligature close to the knot. I may mention to you that such an accident as this has taken place in the practice of Mr. Abernethy, who tied the bowel in the way I have mentioned, and returned it. *
In a case, which was operated on by myself some years ago, there was an opening in the protruded intestine, which could not be decided to have been inflicted by the knife. But the wound was tied, and that patient did well. It is my own impression, that when the bowel is wounded in the operation, if, in other respects the case goes on favourably, there is no reason to apprehend any dangerous consequences. You will find that an effusion oflymph generally envelopes the ligature, and that it is carried into the canal of the intestine, from which it ultimately passes off. has been found to take place in dogs, which have been made the subjects of experiments ; and I believe it has been proved, that if you even tie the intestine of one of these animals completely across, the obstruction will be soon removed, and the ligature will be carried into the canal-so extensive are the powers of nature.t
to undertake the examination of the body after death, quite as an ordinary part of his business; and yet how few are there who are really competent to the due performance of such a task. Few indeed are acquainted with all the changes which the structure of the body may experience under the various influence of disease; still fewer are capable of appreciating the distinctions that exist between the phenomena which belong to the condition of health and those which belong to the condition of disease. I am not, I must say, ashamed to confess, that I am not able, at all times, to estimate with certainty, the nature of the appearances which present themselves in the human body after death.
I have seen it stated, for instance, that the hemispheres of the brain have been coated with a stratum of lymph. I have known such a statement to be made by what one would be justified in considering as great authorities; but I must candidly inform you, that I have never seen lymph effused on the brain : that such an effusion may occur, I do not mean to deny, but such a thing as pus being poured out beneath the dura mater, is a circumstance that I will venture to say is, at all events,
Now in the majority of instances, where the appearance on the removal of the dura mater has been described to be purulent effusion, I have not the slightest doubt that this is nothing more than a serous infiltration into the pia mater, with which thickening and opacity of the arachnoid membrane are combined.
Delivered before the Fellows of the Medico
Botanical Society of London,
ON TIE PROGRESS OF MEDICAL BOTANY.
Difficulties of Post-Mortem Examinations.
There is scarcely any member of our profession who, if he were called on, is not ready
Informed by your learned secretary, that it is the duty of the Professor of Botany to deliver a lecture introductory to the combined course which the Council have decided shall be given by his colleagues and himself, during each session, upon the botanical, chemical, pharmaceutical and toxicological characters, principles, and properties of such plants as either have been, are, or might be used as medicines or as poisons, and not as yet having had an opportunity of consulting the professors of chemistry, materia medica, and toxicology, as to the first subject to be discussed, he hopes he shall stand excused in selecting for the present occasion a general, rather than a special topic, viz. a review of the late progress of medical botany, including in this
* [This is also the practice of Sir Astley Cooper..--Eds.)
† [This was amply proved by B. Bell, Travers, and others. See Appendix, Article Abdomen.... Eds.)
a retrospective notice of the changes which eyes over the field of conflict, even when it is have taken place in public opinion with re- a field we have won to leave, how doubly pleagard to its absolute value and its relative im- sant to have arrived in time, to share both the portance.
hazards and the honours of the war, and to Indeed, gentlemen, he has thought that a have still enough of strength remaining to summary account of the advances and im- secure the spoils, and life to enjoy the advantprovements which have been made in this age we have gained. science, since your society has been instituted, Gentlemen, to render the following detail will not be considered an uninteresting de- more specific, and to avoid assuming your tail by your new, nor an unwelcome offering authority even in appearance, before your by your older Fellows; the former of whom sanction has been given, I shall speak at first may have never known, and the latter, from as for myself alone-and yet it will not, in the ! the want of such a retrospect, may have in end, be for myself—but for all, as I am sure part forgotten, the improvements which have my statements will be verified by your expebeen wrought through the instrumentality of rience, and then you will adopt them as your your society, and of other societies kindred with your own; a progress so remarkable, When, gentlemen, only fifteen years of and a change so great, that they can only have age I became a student in the London schools, arisen from the unwearied exertions of good medical botany was at its lowest ebb—it had soldiers, fighting in as good a cause.
become almost a by-word of reproach, and the Gentlemen-retrospects are pleasing when study entailed both on teacher and on pupil long sought objects have become our own, sarcasm and contempt, as if familiarity with when labours which we feared would ever be his tools, which, as a workman, he must emin vain, not only have deserved, but have ploy, could weaken the hand by which they obtained success.
must be used, or as if a knowledge of the It is pleasant, I repeat, to look back from means by which diseases may be cured, could the vantage ground of successful enterprise, enfeeble the mind, that should minister relief. upon the arduous paths our feet have trod, Think not that I exaggerate—the above is no and reflect that the once future hope of years fancy sketch. Should any doubt, the follownow gone, has become the present possession ing anecdote will prove that the picture is of the time that is.
not too highly coloured ; indeed, it is far Such a view is grateful, even when arrived from being over-wrought. at its utmost vergewe have only to contem- A venerable botanist, and excellent man, plate a scene we soon must quit-how doubly who is an ornament to our profession, and a grateful when in early life we reach that point most successful practitioner (if we calculate in the vista of our past and future years, success by the relief administered, rather than whence on either side extends a prospect, by the lucre gained], was absolutely scoffed here of achieved, there of anticipated good. at in the wards of a London hospital, for his
Such, gentlemen, is our lot, such the pros- love of botany—publicly taunted, not for ignopects now before us, and such the feelings rance of anatomy, physiology, chemistry, or with which I now address you ; for not even pharmacy-not for insufficient knowledge of the youngest here is too young to have seen the principles and practice of his profession> many of the changes to which I have alluded, not for ignorance of any thing the scoffer and we most of us have watched with foster- knew, but for knowledge of that he knew ing care the gradual rise in reputation of that not-for his knowledge of botany-laughed department of natural knowledge, to which, at (I repeat the memorable words), for as a society, our attention is especially di- “ knowing a nettle under a hedge." Such rected. In truth, I know not the science was the head and front of his offending.' which has advanced more rapidly, or which This philosopher, indeed, was born, as it has made greater improvements than our were, before his time; he was too much in own. Gentlemen, you are my witnesses, that advance of the age in which he lived to have a few years since, medical botany was not his talents duly valued; for when amongst what it is, and that its reputation is not now us such things were too little thought of, he what then it was. To us its present care has added philosophy to physic, and both to great been committed, let us not prove unmindful classical attainments. of our charge, but urge on towards perfection, To some now present both the gentlemen that which already has so far advanced, and alluded to were personally known-by fame to strive to transmit with still greater improve- all they are known, and their names are only ments to our successors, that which so far im- withheld, because I am loath to offend the moproved is now inherited by us.
desty of the illustrious living, or the memory To some of the soldiers of science, victory of the illustrious dead. I tell the tale in pity, must always come a day too late ; but if the not in anger, accounting the error rather that rewards be reaped by their survivors, who of the age than of the individual. He had have followed in their footsteps, and have never studied the science he contemned, and fought their fight, the honours must be given . was therefore incompetent to form an origiboth to the living and the dead; and if then nal opinion ; his mouth but spake, his voice it be pleasant (as none can doubt) to cast our but echoed the prevailing prejudices of his
time, prejudices which have only lately been subdued, for many were the attacks made by the intelligent on the strong holds of ignorance, before medical education became established on its present enlarged and liberal basis. How often was the necessity of a knowledge of botany urged before its study was required; how often were the premises admitted, and the conclusion irrationally denied ?
Such, gentlemen, was the state of medical botany when I commenced the study, and nearly such its state when I began to lecture; as things could not be
I adopted as my motto, “ Spero meliora," and better things have come.
Various attempts had previously been made to establish a botanical class in the medical schools of London. Wheeler, Smith, Thornton, Emerson, and others, convinced of the importance of botany to physic, had successively essayed the task, but were severally compelled to relinquish the attempt, for, although they were willing to teach, not finding students willing to learn, they abandoned the project in despair.
Thus while botany in general, and out of the schools was advancing, botany, in the schools, and especially medical botany, receded alunost to extinction.
The Society of Apothecaries seem almost alone to have kept the feeble spark alive by their herbarizings and garden demonstrations, but even in this last London refuge for the science, although the lectures were delivered gratuitously, and food provided for the body as well as for the mind, few comparatively were the students who would accept the proffered breakfast, dinner, and tea, which were to be associated with a medico-botanical demonstration, and even of the few that ate the viands, still fewer were there that listened to the lecture.
Thus the early fate of each succeeding lecturer resembled that of his predecessors, for even when the lectures were gratuitouslygiven,woefully small was the class attending-sometimes the dual number was all too large for its enumeration, and often the
lecturer was barely privileged to address his audience as gentlemen.
How great is the contrast now, for instead of your Prosessor being almost the only lecturer in London, at one time, I believe left quite alone, there is a botanical lecturer in almost every school; and still, notwithstanding the competition, the classes have been rapidly increasing, and the botanical courses are now esteemed among the most popular and numerously attended in our schools. So that a pupil in his noviciate might be well excused for doubting whether it could ever have been otherwise, and this the more especially, when he finds that even the first dawnings of the science bring to light many points of interest and importance, which had hitherto been shrouded in impenetrable obscurity. When
he finds, to take but a few isolated, and hence much weakened illustrations, when he finds that vegetable anatomy discloses the primordia of vital organization, exhibits the simple drafts or outlines of those afterwards elaborate systems, which in animals seem obscure from their connexions, and startling from their complexity. Yes, here are to be found the first out-shadowings of the muscular, digestive, nervous, and other systems, even before they have become such in reality; and those who are curious in these matters, may consult Dutrochet's Treatise on the Motive Organs of the Sensitive Plant, and also an account of some experiments performed by Mr. Mayo and myself, to show the nature of its contractile apparatus, published in the Journal of Science, aswell as several essays of mine in the same Journal, “ on the Adumbrations of a Stomach in Vegetables," on the digestion and respiration of plants, and on the development of their several organic systems.
Again ; well might a freshman feel disposed to doubt the accuracy of our reminiscences, when he learns that vegetable physiology brings him acquainted with the various functions of automatic life in their most distinct and simple forms; when he finds that he can trace absorption through all its stages, and demonstrate the extraordinary power of endosmose, by which fluids permeate organic membranes, and are forced to rise in tubes and vessels, against the force of gravity ; when he sees in plants the circulation of the sap, and its motion shown to exist, independent of an impelling heart; and also among many other privileges, he finds that he can, in plants, examine the actions of organic, separate from those of animal life; i. e. can investigate the phenomena of irritability unmixed with those of sense and instinct.
[The various examples given by the Professor, want of space compels us to omit.]
Well might a novice be incredulous with regard to the late neglect of botany by physiologists, when he finds that phytochymics will explain the influence of vegetable life on matter, the conversion through the agency of the growth of plants of inorganic into organic, the change of refuse into useful things.
Well might he disbelieve our record, when he learns that botanical geography will enable him to tell the mean and the extreme temperature of countries, and not only their temperatures, but their relative and their positive degrees of salubrity, by the presence or absence of various plants. Well might he indeed impugn our veracity, in saying that any one had ever declared such science useless, when botanical geology not only indicates the nature of various soils and strata, as unerringly as the rule of the mineralogist, or the crucible of the chemist; but when fossil botany unfolds a page turned down by nature, and reads to us the history of changes long since forgotten, if indeed to man they were ever known.
Gentlemen, I have selected my illustrations of the utility of botany from the general, rather than from the medical departments of the science, and for two reasons: first, because I have previously discussed at some length the advantages of botany to medicine ; and, secondly, because if medical botany has ever deserved reprobation, it has been from the tendency exhibited during the time this science was disgraced by being made a subordinate branch of materia medica, to confine the attention of the medical student merely to the diagnostic characters of plants, neg. lecting those more interesting and philosophic inquiries which alone constitute the study of plants a science, and distinguished modern botany from ancient herbcraft.
Unwillingly do I hint at, rather than describe, and still more reluctantly do I wholly omit many topics of importance, and yet am I compelled to the omission; for I should fatigue you, were I but barely to enumerate the various fruits which this lovely science bears profusely on every branch, and proffers freely to every uplifted hand. The more immediate utilities of botany I have not even named, for if the less practical points be deserving your attention, the more useful cannot be unworthy your regard. Such I mean as the diagnosis of plants, which is the province of systematic botany; and economic botany, which teaches to apply to useful purposes the plants which are thus distinguished, either as articles of diet, as medicines, or in the arts, and tells us how, by culture, to ameliorate our food, increase or regulate the power of our drugs, and insure for trade regular supplies of proper materials for many different uses.
These and other advantages of botany are so notorious, that I should have thought it a waste of words for them even to have been named, had they not been peremptorily denied, and bearing in mind that such as I have faintly indicated, is the real tenor and scope of botany, although much allowance must be made for the shortness and feebleness of the detail; such, I repeat, being the scope of the science, and such the points to which it has been progressively advancing, and to which it has now advanced, you will probably feel surprised to hear that the reproaches, which were manifestly unjust, when preferred against it formerly, have been lately reiterated, and that by an annalist, pretending to sketch physic and its professors truly as they now exist.
These papers containing this attack are too curious to be allowed to drop wholly into oblivion; they are perhaps the last efforts of that expiring prejudice, which even now is not quite extinct, and as such, I shall beg your permission to make some extracts; they will require but little comment for their refutation.
“ Botany," says this veracious historian,
“ Botany is in a declining state," (and all whose notable advances to which I have cursorily alluded, are represented as symptoms of this decline; for he continues,) “ Botany has indeed been growing up of late ; but it is with a sickly wild luxuriancy, the common precursor of premature decay; and the time is not very far distant when it will have completely dropped off, as a useless branch of medical education."
A prophecy, as you will perceive, not yet fulfilled, nor under the present aspect of affairs, very likely to be accomplished.
But to our extracts.
“ How it could have so long contrived to occupy a place, and a prominent place too, among those branches of knowledge, deemed indispensable to the physician, can only be explained by the fortuitous arrangement of circumstances."
Chance is a very unphilosophic cause for any thing; and we who understand the true value of botany, can easily comprehend the cause of its being made an indispensable study to the physician. But I will conclude the extracts without further comment. The writer thus continues,
“ There is certainly no sort of knowledge, however humble, that does not possess some little share of intrinsic importance; and it is in this respect only that botany can be deemed worthy of a certain degree of consideration."
“ That it is of the least possible use to the physician, in the practice of his profession, I am strongly inclined to deny. No doubt the extensive knowledge requisite for completing the education of the accomplished physician, should embrace this branch of natural history also, but for the purposes of the healing art, botany is positively worse than useless." And a little further on,
“ Concerning the medicinal efficacy of plants, botany teaches us nothing."
“ Again ; it may be observed, that most other sciences tend to develope the faculties, imparting a comprehensive and expanding influence; but botany, numerous instances show, has a tendency quite of an opposite character.
" By fixing the attention upon minute objects and considerations, it contracts the intellectual as well as moral qualities.”
“ Further, it may be stated as an authenticated fact, that few great men have been distinguished as botanists merely; those who have ever obtained a character in this way, were such as would have been as great in the path of celestial mechanics, had they turned their attention to that study. We cannot forget the multifarious talents and pursuits of Linnæus and of Haller. Haller, like Rousseau, studied botany merely as a recreation; and indeed, Rousseau himself was as much an enthusiast upon this as upon many other subjects equally useless."
The above are but parts of the virulent