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+Project Gutenberg's Pioneer Surgery in Kentucky, by David W. Yandell
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Pioneer Surgery in Kentucky
+       A Sketch
+
+Author: David W. Yandell
+
+Release Date: March 13, 2009 [EBook #28322]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK PIONEER SURGERY IN KENTUCKY ***
+
+
+
+
+Produced by David Garcia, Woodie4 and the Online Distributed
+Proofreading Team at http://www.pgdp.net (This file was
+produced from images generously made available by The
+Kentuckiana Digital Library)
+
+
+
+
+
+
+
+
+
+  PIONEER SURGERY IN KENTUCKY:
+
+  A SKETCH.
+
+  BY DAVID W. YANDELL, M. D.,
+
+  PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF LOUISVILLE, KY;
+  PRESIDENT OF THE AMERICAN SURGICAL ASSOCIATION.
+
+  LOUISVILLE:
+
+  PRINTED BY JOHN P. MORTON & COMPANY.
+
+  1890
+
+
+  THE PRESIDENT'S ADDRESS:
+
+  DELIVERED AT THE
+  REGULAR ANNUAL MEETING OF THE
+
+  AMERICAN SURGICAL ASSOCIATION,
+
+  WASHINGTON, D.C., MAY 13, 1890.
+
+
+
+
+PIONEER SURGERY IN KENTUCKY.
+
+A SKETCH.
+
+
+FELLOWS OF THE ASSOCIATION: In the endeavor to chronicle the lives and
+achievements of Kentucky Pioneers in Surgery, I shall not attempt the
+resurrection of village Hampdens or mute inglorious Miltons. The men
+with whom I deal were men of deeds, not men of fruitless promise.
+
+It may with truth be said that from Hippocrates to Gross few in our
+profession who have done enduring work have lacked biographers to pay
+liberal tribute to their worth. In justice to the unremembered few, I
+turn back the records of medicine for a century, and put my finger upon
+two names that in the bustling march of science have been overlooked,
+while I try to set in fuller light two other names of workers in that
+day, which have and will hold an exalted place in history. The worthies
+to whom these names belong were pioneers in civilization as well as in
+surgery. I shall introduce them in the order of their work.
+
+1806. The earliest original surgical work of any magnitude done in
+Kentucky, by one of her own sons, was an amputation at the hip-joint.
+It proved to be the first operation of the kind in the United States.
+The undertaking was made necessary because of extensive fracture of the
+thigh with great laceration of the soft parts. The subject was a mulatto
+boy, seventeen years of age, a slave of the monks of St. Joseph's
+College. The time was August, 1806; the place, Bardstown; the surgeon,
+Dr. Walter Brashear; the assistants, Dr. Burr Harrison and Dr. John
+Goodtell; the result, a complete success. The operator divided his work
+into two stages. The first consisted in amputating the thigh through its
+middle third in the usual way, and in tying all bleeding vessels. The
+second consisted of a long incision on the outside of the limb, exposing
+the remainder of the bone, which, being freed from its muscular
+attachments, was then disarticulated at its socket.
+
+Far-seeing as the eye of the frontiersman was, he could not have
+discerned that the procedure by which he executed the most formidable
+operation in surgery came so near perfection that it would successfully
+challenge improvement for more than fourscore years.
+
+Hundreds of hips have since been amputated after some forty different
+methods; but that which he introduced has passed into general use, and
+(though now known under the name of Furneaux Jordan's) remains the
+simplest, the least dangerous, the best.
+
+The first genuine hip-joint amputation executed on living parts was done
+by Kerr, of Northampton, England, 1774. The first done for shot wounds
+was by Larrey, in 1793. I feel safe in saying that Brashear had no
+knowledge of either of these operations. He therefore set about his work
+without help from precedent, placing his trust in himself, in the
+clearness of his own head, in the skill of his own hands, in the courage
+of his own heart. The result shows that he had not overestimated what
+was in him. But whether or not Brashear had ever heard or read a
+description of what had been accomplished in this direction by surgeons
+elsewhere, the young Kentuckian was the first to amputate at the
+hip-joint in America, and the first to do the real thing successfully in
+the world.
+
+Dr. Brashear seems to have set no high estimate on his achievement, and
+never published an account of the case. Had he done so, the art of
+surgery would thereby have been much advanced, his own fame have been
+made one of the precious heritages of his country, and, what is better,
+many valuable lives would have been saved.
+
+Eighteen years after the Jesuits' slave had survived the loss of his
+limb, the report of the much-eulogized case of Dr. Mott appeared.
+
+Dr. Brashear came of an old and wealthy Catholic family of Maryland. He
+was born in February, 1776. His father journeyed to Kentucky eight
+years later, and cleared a farm near Shepherdsville, in Bullitt County.
+Walter was his seventh son, and was therefore set apart for the medical
+profession.
+
+When a youth he was enrolled in the literary department of Transylvania
+University, where it is said he ranked high as a scholar in Latin. At
+the age of twenty he began the study of medicine, in Lexington, with Dr.
+Frederick Ridgely, a very cultivated physician and popular man, who had
+won distinction in the medical staff of the Continental Army. After two
+years spent in this way, he rode on horseback to Philadelphia, and
+attended upon a course of lectures in the University of Pennsylvania. At
+this time Rush, Barton, and Physick were teachers in that venerable seat
+of learning. His was a restless nature, and after a year spent in
+Philadelphia he shipped to China as surgeon of a vessel. While among the
+Celestials he amputated a woman's breast, probably the first exploit of
+the kind by one from the antipodes. Unfortunately for science, he there
+learned the method used by the Chinese for clarifying ginseng, and
+thinking, on his return home, that he saw in this an easy way to wealth,
+he abandoned the profession in which he had exhibited such originality,
+judgment, and skill, and engaged in merchandising. Twelve years of
+commerce and its hazards left him a bankrupt in fortune, but brought
+him back to the calling in which he was so well fitted to shine. He
+moved, in 1813, from Bardstown to Lexington, where he at once secured a
+large practice, especially in diseases of the bones and joints. He was
+thought to excel in the treatment of fractures of the skull, for the
+better management of which a trephine was made in Philadelphia, under
+his direction, which, in his judgment, was superior to any then in use.
+
+The same temper which led him to leave Philadelphia without his medical
+degree, sail to China, and afterward enter commerce, again asserted
+itself, and he forsook for the second time his vocation. With his family
+he now moved to St. Mary's Parish, Louisiana, and engaged in
+sugar-planting. During his residence in the South he served his adopted
+State in the Senate of the United States. He employed much time in the
+study of the flora of the West. "During the winter of 1843-4, when Henry
+Clay was on a visit to New Orleans" (says a writer in the New Orleans
+Medical and Surgical Journal), "we had the pleasure, together with some
+twenty-five physicians, of spending the evening with him at the house of
+a medical friend. While at the table one of the company proposed the
+health of the venerable Dr. Brashear, 'the first and only surgeon in
+Louisiana who had successfully performed amputation at the hip-joint.'
+Mr. Clay, who sat next to Dr. Brashear, with characteristic good humor,
+immediately observed, 'He has you on the hip, Doctor,' to the great
+amusement of Brashear and the rest of the company."
+
+Dr. Brashear was a man of fine literary taste and many and varied
+accomplishments. In conversation he was always entertaining, often
+brilliant. His voice was pleasant, his manners affable. In stature he
+was short; in movement, quick and nervous. But in the make-up of the man
+one essential of true greatness--fixedness of purpose--had been omitted.
+He lacked the staying qualities. He was "variable and fond of change."
+"His full nature, like that river of which Alexander broke the strength,
+spent itself in channels which led to no great name on earth." By a
+single exploit, at the age of thirty, he carved his name at high-water
+mark among the elect in surgery. Most of his life thereafter he wasted
+in desultory labors. As the learned Grotius said of his own life, he
+consumed it in levities and strenuous inanities.
+
+He died at an advanced age at his home in Louisiana.
+
+1809. Three years after Brashear had won his unparalleled success at
+Bardstown, a practitioner already of wide repute as a surgeon, living in
+Danville, a neighboring village, did the second piece of original
+surgical work in Kentucky. It consisted in removing an ovarian tumor.
+The deed, unexampled in surgery, is destined to leave an ineffaceable
+imprint on the coming ages. In doing it Ephraim McDowell became a prime
+factor in the life of woman; in the life of the human race. By it he
+raised himself to a place in the world's history, alongside of Jenner,
+as a benefactor of his kind; nay, it may be questioned if his place be
+not higher than Jenner's, since he opened the way for the largest
+addition ever yet made to the sum total of human life.
+
+So much has been written of this, McDowell's chief work, that I feel it
+needless to dwell upon it. All students of our art are familiar with it
+as presented by abler hands than mine. What I shall say of him,
+therefore, will relate rather to his life and general work than to the
+one operation by which his name has come to be the most resounding in
+all surgery. This is a much more difficult task than at first it might
+seem to be, for McDowell made no sketch of himself, nor have his
+brothers or his children left us any record of his life. Even his early
+biographers failed to gather from his surviving friends those personal
+recollections of the man which would now be of such exceeding interest
+to us all. An authentic life-size portrait of Ephraim McDowell, as he
+was seen in his daily walk among men, can not now be made. The
+materials are too scant; the time to collect them has gone by. A
+profile, a mere outline drawing, is all that is possible to-day. The
+picture I have attempted, therefore, will be found deficient in many
+details which have passed into general acceptance.
+
+It is known that he came of a sturdy stock, his blood being especially
+rich in two of the best crosses--the Scotch-Irish. His great-grandfather
+rebelled against the hierarchy of his time, and enlisted as a Covenanter
+under the banner of James I. After honorable service, he laid down his
+arms, gathered his family together, and came to America. It was in honor
+of this ancestor that the subject of the present sketch was named.
+
+The maiden name of his mother was McClung. She was a member of a
+distinguished family of Virginia. McDowell was born in Rockbridge
+County, Virginia, on November 11, 1771. He was the ninth of twelve
+children. His father, Samuel McDowell, was a man of note and influence
+in the State, and was honored with many positions of trust. In 1773 he
+removed with his family to Kentucky, settling near Danville. He was made
+judge of the District Court of Kentucky, and took part in organizing the
+first court ever formed in the State. He lived to see his son
+confessedly the foremost surgeon south of the Blue Ridge. But it was
+not given to eyes of that day to see that the achievements of the
+village operator had illuminated all the work which has since been done
+in the abdominal cavity, that one had grown up and toiled in their
+midst,
+
+    "Whose influence ineffable is borne
+    Round the great globe to cheerless souls that yearned
+    In darkness for this answer to their needs."
+
+Ephraim's early education was gotten at the school of the town in which
+he lived. He completed his school studies at an institution of somewhat
+higher pretentions, situated in a county near by. No anecdotes are
+preserved of his childhood. During his school-age he clearly preferred
+the out-door sports of his companions to the in-door tasks of his
+teachers. On quitting school he crossed the Alleghanies and became an
+office pupil of Dr. Humphreys, of Staunton, Va. After reading under this
+preceptor for two years, he repaired to the University of Edinburgh. The
+Scotch metropolis was then styled the "Modern Athens." It afforded
+opportunities at that time for acquiring a medical education the best in
+all the world. It was then to the medical profession what Leyden had
+been in the days of Sir Thomas Browne, what Paris became when Velpeau
+and Louis taught there. He entered the private class of John Bell, whose
+forceful teachings and native eloquence made a lasting impression on
+the mind of his youthful hearer. It has been said that McDowell
+conceived the thought of ovariotomy from some suggestions thrown out by
+this great man. The only distinction he is known to have won while in
+Edinburgh was that of having been chosen by his classmates to carry the
+colors of the college in a foot-race against a professional. In this it
+appears he was an easy first. He came away without a diploma. But what
+was of far greater value than a degree, he brought back the anatomical
+and surgical knowledge which was to place him in the front of his
+profession.
+
+He returned to Kentucky in 1795, and settled among the people who had
+known him from boyhood. His success was immediate, and yet Dr. Samuel
+Brown, who knew him in Virginia, and was his classmate in Scotland, had
+said, when asked of him: "Pish! he left home a gosling and came back a
+goose." In a little while he commanded all the surgical operations of
+importance for hundreds of miles around him, and this continued till,
+some years later, Dudley returned from Europe to share with him the
+empire in surgery.
+
+In 1802, fully established in his profession, and with an income which
+rendered him independent, he married Sarah, daughter of Governor Isaac
+Shelby.
+
+In 1809 he did his first ovariotomy. He believed the operation to be
+without precedent in the annals of surgery, yet he kept no note of it or
+of his subsequent work. He prepared no account of it until 1817. This
+appeared in the Eclectic Repertory. It was so meagre and so startling
+that surgeons hesitated to credit its truth. He had not mastered his
+mother tongue. The paper was thought to bear internal evidence of its
+author's having "relied upon his ledger for his dates and upon his
+memory for the facts." The critics from far and near fell upon him. The
+profession at home cast doubt upon the narrative. The profession abroad
+ridiculed it. For all that, McDowell kept his temper and his course, and
+when he finally laid down his knife he had a score of thirteen
+operations done for diseased ovaria, with eight recoveries, four deaths,
+and one failure to complete the operation because of adhesions.
+
+It would be neither fitting nor becoming on this occasion, and in this
+presence, to speak in detail of the technic observed by McDowell in his
+work. That has long since passed into history. I may, however, be
+permitted the remark that the procedure, in many of its features, is
+necessarily that of to-day. The incision was longer than that now
+usually made, and the ends of the pedicle ligature were left hanging
+from the lower angle of the wound. But the pedicle itself was dropped
+back into the abdomen. The patient was turned on her side to allow the
+blood and other fluids to drain away. The wound was closed with
+interrupted sutures. This marvel of work was done without the help of
+anesthetics or trained assistants, or the many improved instruments of
+to-day, which have done so much to simplify and make the operation easy.
+McDowell had never heard of antisepsis, nor dreamed of germicides or
+germs; but water, distilled from nature's unpolluted cisterns by the
+sun, and dropped from heaven's condensers in the clean blue sky, with
+air winnowed through the leaves of the primeval forest which deepened
+into a wilderness about him on every hand, gave him and his patients
+aseptic facility and environment which the most favored living
+laparotomist well might envy. These served him well, and six out of
+seven of his first cases recovered. He removed the first tumor in
+twenty-five minutes, a time not since much shortened by the average
+operator.
+
+It was not alone, however, in this hitherto unexplored field of surgery
+that McDowell showed himself a master. His skill was exhibited equally
+in other capital operations. He acquired at an early day distinction as
+a lithotomist, which brought to him patients from other States. He
+operated by the lateral method, and for many years used the gorget in
+opening the bladder. At a later period he employed the scalpel
+throughout. He performed lithotomy thirty-two times without a death.
+Among those who came to him to be cut for stone was a pale, slender boy,
+who had traveled all the way from North Carolina. This youth proved to
+be McDowell's most noted patient. He was James K. Polk, afterward
+President of the United States.
+
+Dr. McDowell's "heart was fully open to the lesson of charity, which
+more than all men we should feel," and he dispensed it with constant
+remembrance of the sacred trust imposed upon us. Yet he had a proper
+appreciation of what was due his guild from those whose means allowed
+them to make remuneration for professional services. He charged $500 for
+an ovariotomy that he went to Nashville, Tenn., to do. The husband of
+the patient gave him a check, as he supposed, for that sum. On
+presenting it, the doctor discovered that it was drawn for $1,500
+instead of $500, whereupon he returned the check, thinking a mistake had
+been made. The grateful gentleman replied that it was correct, and added
+that the services much outweighed the sum paid. When the fact is borne
+in mind that the purchasable value of money was much greater in the
+first than in this the last decade of the century, it will be seen that
+the "father of ovariotomy," at least, set his successors in the field a
+good example. This is made conspicuous by the fact that Sir Spencer
+Wells has seldom charged a larger sum, and has declared £100 to be a
+sufficient fee for the operation.
+
+In person Dr. McDowell was commanding. He was tall, broad-shouldered,
+stout-limbed. His head was large, his nose prominent and full of
+character, his chin broad, his lips full and expressive of
+determination, his complexion florid, his eyes dark-black. His voice was
+clear and manly; he often exercised it in recitations from Scotch
+dialogues, when he would roll the Scotch idiom upon his tongue with the
+readiness of a native. He was fond of music, especially comic pieces,
+which he sang with fine effect, accompanying his voice sometimes with
+the violin.
+
+He was a man of the times, taking an active interest in the affairs of
+the community in which he lived. He had many books for that day. Cullen
+and Sydenham were his chief authorities in medicine; Burns and Scott in
+literature. He was fond of reading, yet he was inclined to action rather
+than study.
+
+He placed great reliance on surgery and its possibilities; he placed
+little trust in drugs. He counselled against their too liberal use. In
+truth, he did not like the practice of medicine, and turned over most of
+his non-surgical cases to his associate in business. In manner he was
+courteous, frank, considerate, and natural. He was a simple, ingenuous
+man. His great deeds had given him no arrogance. His was a clean,
+strong, vigorous life. His spirit remained sweet and true and modest to
+the last. He lived a God-fearing man, and died on June 25, 1830, in the
+communion of the Episcopal Church.
+
+1813. While McDowell was so busily engaged in his special line of
+surgery, his colaborers elsewhere in the State were not idle. Four years
+after his first ovariotomy, the first complete extirpation of the
+clavicle ever done was accomplished by Dr. Charles McCreary, living in
+Hartford, Ohio County, Ky., two hundred miles, as the crow would fly,
+farther into the wilderness. The patient was a lad named Irvin. The
+disease for which the operation was done was said to be scrofulous.
+Recovery was slow but complete. The use of the arm remained unimpaired,
+and the patient lived, in good health, to be forty-nine years old.
+
+In 1829, sixteen years after the back-woods surgeon had achieved his
+success, Professor Mott repeated the operation, also on a youth, with a
+like fortunate result, and, believing he was first in the field, claimed
+the honor of the procedure for the United States, for New York, and for
+himself. He termed it his "Waterloo operation," not, however, because it
+surpassed, as he declared, in tediousness, difficulty, and danger any
+thing he had ever witnessed or performed, but because, as it appears,
+it fell on the 18th of June, the anniversary of the battle of Waterloo.
+
+Mott's operation required nearly four hours for its execution, and the
+tying of forty vessels; but after all it proved to be not a complete
+extirpation; for the autopsy, made many years later, showed three
+quarters of an inch of the bone at the acromial end still in its place.
+Yet the case passed quickly into the annals of surgery and added much to
+the already great renown of the operator. To this day it is referred to
+by surgical writers as "Mott's celebrated case," and the description of
+his procedure is often given in his own words.
+
+McCreary removed the entire collar bone, and that while a young
+practitioner, living in a village composed of a few scattering houses,
+situated in a new and sparsely settled country, where opportunities for
+cultivating surgical science were necessarily rare, and the means for
+acquiring anatomical knowledge necessarily small.
+
+The only published report of McCreary's case is from the pen of Dr.
+Johnson, in the New Orleans Medical and Surgical Journal for January,
+1850. The account, though all too brief, clearly establishes the date of
+the operation, its successful issue, and the removal of the entire bone.
+
+It is greatly to be regretted that more is not known of McCreary's
+personal and professional character. He is said, by one who met him
+often, to have been a serious, thoughtful man, given to study, devoted
+to his calling, and fatally fond of drink, to which he fell a victim
+when but thirty-seven years of age.
+
+1814. A younger man than either of those I have attempted to sketch, Dr.
+Benjamin Winslow Dudley, now came upon the stage. He, too, was the son
+of a pioneer. His early training was much like that of his
+contemporaries. Like Brashear, he had instruction in the office of Dr.
+Ridgely. Like him, he had attended lectures in the University of
+Pennsylvania. Unlike him, he carried away its diploma. This he did in
+1806, just two weeks before he was twenty-one years old. He came home,
+opened an office, and offered his services to the public. The public
+gave him little business. He was deficient either in the knowledge or in
+the self-trust necessary to professional success. McDowell was located
+in a village hard by--was applying himself mainly to surgery, and was
+already in full practice. Dudley resolved to still better qualify
+himself for the work he was ambitious to do. He longed to go into the
+hospitals and follow the great teachers of Europe, but lacked the means.
+To get these he made a venture in trade. He purchased a flat-boat,
+loaded it with produce, headed it for New Orleans, and floated down the
+Kentucky, the Ohio, and the Mississippi rivers to the desired port. He
+invested the proceeds of his cargo in flour. This he billed to
+Gibraltar, which he reached some time in 1810; there and at Lisbon he
+disposed of it at a large advance.
+
+The opportunities he had sought were now near at hand. He hastened
+through Spain to Paris. While there he heard Baron Larrey recite his
+wonderful military experience. He made the acquaintance of Caulaincourt,
+"the Emperor's trusted minister." Through him he was present with Talma
+and John Howard Payne in the Chamber of Deputies when Napoleon entered
+the building at the close of his disastrous Russian campaign. He saw the
+Emperor mount the tribune. He heard him begin his report with these
+portentous words: "The Grand Army of the Empire has been annihilated."
+
+Remaining in Paris nearly three years, he crossed the Channel to observe
+surgery as practiced in London. While there he listened to Abernethy as
+he dwelt with all his wonted enthusiasm on his peculiar doctrine. He
+heard him reason it; he saw him act it, dramatize it, and came away
+believing him to be "the highest authority on all points relating to
+surgery, as at once the observant student of nature, the profound
+thinker, and the sound medical philosopher." He always referred to him
+as the greatest of surgeons. He saw Sir Astley Cooper operate, and
+habitually designated him as the most skilled and graceful man in his
+work he had ever known.
+
+He returned to Lexington in the summer of 1814, "in manners a Frenchman,
+but in medical doctrine and practice thoroughly English." The public was
+quick to detect that he had improved his time while away. "His
+profession had become the engrossing object of his thought, and he
+applied himself to it with undeviating fidelity. He made himself its
+slave." One who knew him well wrote of him: "He had no holidays. He
+sought no recreation; no sports interested him. His thoughts, he had
+been heard to say, were always on his cases, and not on the objects and
+amusements around him." He found Lexington in the midst of an epidemic
+of typhoid pneumonia, the same that had prevailed in the older States.
+This singularly fatal disease was followed by a "bilious fever,
+characterized, like the plague, by a tendency to local affections.
+Abscesses formed among the muscles of the body, legs, and arms, and were
+so intractable that limbs were sometimes amputated to get rid of the
+evil." Recalling the use he had seen made of the bandage, while abroad,
+in the treatment of ulcers of the leg, Dudley applied this device to the
+burrowing abscesses he saw so frequently in the subjects of the fever.
+The true position and exceeding value of the roller bandage were not so
+generally recognized then as now. Dr. Dudley was no doubt himself
+surprised at the success which followed the practice. This success
+probably led him to urge that wide application of the bandage with which
+his name came in time to be so generally associated.
+
+The tide of practice now set full toward him. He had come home a
+thorough anatomist. With opportunity he exhibited surpassing skill in
+the use of the knife. His reputation soon became national.
+
+No medical school had at that time been founded west of the Alleghanies.
+The need of such an institution was felt on every hand. Transylvania
+University, already of established reputation, was in operation. It
+required only a school in medicine to make it complete in its several
+departments. The trustees met in 1817 and added this to its
+organization. Dr. Dudley was made its head and appointed to fill the
+chairs of anatomy and surgery. A small class of students assembled in
+the autumn. At the commencement exercises held the following spring, W.
+L. Sutton was admitted to the doctorate--the first physician given that
+distinction by an institution in the West. Troubles arose in the
+faculty. Resignations were sent in and accepted. Dr. Richardson, one of
+the corps, challenged Dr. Dudley. A meeting followed. Richardson left
+the field with a pistol wound in his thigh which made him halt in his
+gait for the rest of his life. The year following a second organization
+was effected, which included the two belligerent teachers.
+
+The history of the Medical Department of Transylvania University--its
+rise, its success, its decline, its disappearance from the list of
+medical colleges--would practically cover Dr. Dudley's career, and would
+form a most interesting chapter in the development of medical teaching
+in the Southwest. But it must suffice me here to say that Dr. Dudley
+created the medical department of the institution and directed its
+policy. Its students regarded him from the beginning as the foremost man
+in the faculty. That he had colleagues whose mental endowments were
+superior to his he himself at all times freely admitted. He is said to
+have laid no claim to either oratorical power or professional erudition.
+He was not a logician, he was not brilliant, and his deliverances were
+spiced with neither humor nor wit. And yet, says one of his biographers,
+in ability to enchain the students' attention, to impress them with the
+value of his instructions and his greatness as a teacher, he bore off
+the palm from all the gifted men who, at various periods, taught by his
+side. A friend and once a colleague described his manner while lecturing
+as singularly imposing and impressive. "He was magisterial, oracular,
+conveying the idea always that the mind of the speaker was troubled with
+no doubt. His deportment before his classes was such as further to
+enhance his standing. He was always, in the presence of his students,
+not the model teacher only, but the dignified, urbane gentleman;
+conciliating regard by his gentleness, but repelling any approach to
+familiarity; and never for the sake of raising a laugh or eliciting a
+little momentary applause descending to coarseness in expression or
+thought. So that to his pupils he was always and everywhere great. As an
+operator they thought he had distanced competition. As a teacher they
+thought he gave them not what was in the books, but what the writers of
+the books had never understood. They were persuaded that there was much
+they must learn from his lips or learn not at all." His hold upon the
+public was as great as that upon his classes. "Patients came to him from
+afar because it was believed that he did better what others could do
+than any one else, and that he did much which no one else in reach could
+do."
+
+During the larger part of Dr. Dudley's life few physicians in any part
+of America devoted themselves exclusively to surgery. The most eminent
+surgeons were general practitioners--all-round men. In this class Dr.
+Dudley was equal to the best. In one respect, at least, he took advance
+ground--he condemned blood-letting. He was often heard to declare that
+every bleeding shortened the subject's life by a year. Admiring
+Abernethy more than any of his teachers, his opinions were naturally
+colored by the views of this eccentric Englishman. Like him he believed
+in the constitutional origin of local diseases, but his practice varied
+somewhat from that of his master. Like him he gave his patients blue
+pill at night but omitted the black draught in the morning. He thought
+an emetic better, and secured it by tartarized antimony. Between the
+puke and the purge his patients were fed on stale bread, skim milk, and
+water-gruel. And this heroic practice he pursued day after day, for
+weeks and months together, in spinal caries, hip caries, tuberculosis,
+urethral stricture and other diseases.
+
+I said that as a physician he was equal to the best. As we see things
+to-day this would not, perhaps, be saying much; but in fact he was
+better than the best. Negatively, if not positively, he improved upon
+the barbaric treatment of disease then in universal favor. He wholly
+discarded one of the most effective means by which the doctors succeeded
+in shortening the life of man. This was just before those biological
+dawnings which were soon to break into the full light of physiological
+medicine and the rational system of therapeutics based thereupon. And
+it is not improbable that as a watcher in that night of therapeutical
+darkness, where the doings of the best strike us with horror, his
+prophetic eye caught some glimpses of the coming day which in old age it
+was given him to see. Though engaged chiefly with the great things in
+surgery, he deserves a place in the list of therapeutic reformers.
+
+Much of the renown acquired for Kentucky by her surgeons was in the
+treatment of calculous diseases. This State is believed to have
+furnished almost as many cases of stone as all the rest of the Union.
+Dr. Dudley stands the confessed leader of American lithotomists, heading
+the list with two hundred and twenty-five cases. Of these he presents an
+unbroken series of one hundred consecutive successful operations. He
+used the gorget in all. He preferred the instrument invented by Mr.
+Cline, of London. "In one case, when his patient was on the table, he
+discovered that his accustomed operation was impracticable from
+deformity of the pelvis, and while his assistants were taking their
+positions resolved to make the external incision transverse, which was
+executed before any one else present had remarked the difficulty."
+Through this incision he removed a stone three and a half inches in the
+long diameter, two and a half inches in the short, by eleven inches in
+circumference. The patient recovered.
+
+In an article contributed to the Transylvania Journal of Medicine by Dr.
+Dudley, in 1828, he thus wrote of the trephine: "The experience which
+time and circumstances have afforded me in injuries of the head induced
+me to depart from the commonly received principles by which surgeons are
+governed in the use of the trephine. In skillful hands the operation,
+beyond the atmosphere of large cities, is neither dangerous in its
+consequences nor difficult in the execution." In this remark Dr. Dudley
+bore early testimony to the efficacy of aseptic surgery. He urged the
+trephine in the treatment of epilepsy and applied it in six cases--in
+four of which the disease was cured. The result in the two remaining
+cases is unknown, because the patients were lost sight of.
+
+Dr. Dudley believed himself to be the first surgeon who ever attempted
+to treat _fungus cerebri_ by gentle and sustained pressure made with dry
+sponge aided by the roller. Of the first cases in which he used it, he
+wrote: "By imbibing the secretions of the part, the pressure on the
+protruded brain regularly and insensibly increased until the sponge
+became completely saturated. On removing it the decisive influence and
+efficacy of the agent remained no longer a matter of doubt." He noted
+the difficulty experienced in removing the sponge because of its being
+extensively penetrated by blood-vessels springing from the surface of
+the brain. This inconvenience he afterward obviated by putting a thin
+piece of muslin between the fungus and the sponge. He saw in this
+property of the sponge what no doubt others had seen before, the
+phenomenon of sponge-grafting, but like them he failed to utilize it in
+practice.
+
+Dr. Dudley was not a student of books. He had no taste for literature.
+He wrote but little, and that only for the Transylvania Journal of
+Medicine, edited by two of his colleagues, Professors Cooke and Short.
+His first article did not appear until 1828, fourteen years after he had
+begun practice. It was on injuries of the head. It abounded in original
+views, and did much to shape surgical thought at the time. Today it may
+be consulted with profit. His second paper was on hydrocele; in this he
+advocated the operation by incision and removal of the sac. He read so
+little that he fell into the error of believing that he was the
+originator of the procedure. There are writers in our own day who would
+be able to hold their own against him in this particular. A paper on the
+bandage, another on fractures, and one on the nature and treatment of
+calculous diseases, embrace all his contributions to medical literature.
+
+Dr. Dudley was the son of Ambrose Dudley, a distinguished Baptist
+minister. He was born in Spottsylvania County, Va., April 25, 1785. When
+but a year old he was brought by his father to the then county of
+Kentucky. The family settled in Lexington, in which beautiful city the
+child became a man, and lived and wrought and died. The date of his
+death is January 25, 1870; his age was eighty-five years.
+
+Dr. Dudley was a man of affairs. His practice was always large and paid
+him well. He amassed a handsome fortune. His opinions were often sought
+in courts of justice on professional points, where his dignity,
+self-possession, and dry wit (which he seems to have suppressed at the
+lecturer's desk), commanded the respect of judge, juror, and advocate,
+while it made him the terror of the pettifogger. Once, while giving
+expert testimony in a case involving a wound made by bird-shot delivered
+at short range, he described the behavior of projectiles, and the danger
+of bullet wounds. The opposing counsel interrupted him: "Do you mean to
+say," said the lawyer, "do you mean to say, Dr. Dudley, that shot wounds
+are as dangerous as bullet wounds?" "Shot are but little bullets," was
+the unhesitating reply.
+
+Dr. Dudley had also a proper sense of the value of his professional
+services. He was called on one occasion to a town near Lexington to
+attend a patient in labor, who was the wife of a man made rich by
+marriage. The husband was too wise to engage a "night rider," and too
+purse-proud to call the village doctor. At that time most of the one
+hundred dollar notes in circulation in Kentucky were issued by the
+Northern Bank, at Lexington. On the reverse side of the bill was the
+letter C in Roman capital. This letter was so round in figure that it
+looked like a "bull's-eye," and in local slang was so called. The visit
+being over, and the doctor ready to leave, the young father handed him
+one of these notes. Eyeing it for a moment, Dr. Dudley said: "Another
+'bull's-eye,' Mr. X., if you please."
+
+In person Dr. Dudley was of medium size. His features were refined, the
+forehead wide and high, the nose large and somewhat thick, the lips
+thin, the eyes bluish-gray. His hair was thin, light, and of a sandy
+tint. He was a graceful man. His voice was pleasing; his manners
+courtly; his bearing gracious.
+
+He married Miss Short, daughter of Major Peyton Short, in 1821. He
+delivered his last lecture in 1850, and the last entry on his ledger
+bears the date of April 28, 1853.
+
+       *       *       *       *       *
+
+I can not give these remarks more fitting close than by describing
+briefly the surroundings which set their impress upon the character of
+the men whose lives I have attempted to portray. The picture is full of
+meaning, dignity, and simplicity. In this time "Canetuckee" was still a
+part of Virginia. The grounds on which, as boys, they played were held
+by their fathers under what is known as a "tomahawk claim." "Beyond lay
+endless leagues of shadowy forest." "The Illinois" had not been admitted
+into the sisterhood of the States. The vast domain west of the
+Mississippi River was unexplored. The city of St. Louis was but an
+outpost for traders. The name "Chicago" had not been coined. Fort
+Dearborn, occupied by two companies of United States troops, marked a
+roll in the prairie among the sloughs where stands to-day the queen and
+mistress of the lakes. Cincinnati had no place on the map, but was known
+as Fort Washington. General Pakenham had not attempted the rape of New
+Orleans, and General Jackson, who was to drive him with his myrmidons
+fleeing to his ships, was unknown to fame. Wars with Indians were
+frequent. Massacres by Indians were common. The prow of a steamboat had
+never cut the waters of a Western river. Railroads were unknown in the
+world. There were but two avenues by which Kentucky could be reached
+from the East. One was the water-way, furnished by the Ohio River. The
+other was the "Wilderness Road," "blazed" by Daniel Boone. The former
+was covered in keel-boats, flat-boats, and canoes. The latter was
+traveled on horseback or on foot. No wheel had broken it or been broken
+by it. The fathers of the subjects of this narrative followed this road
+after crossing the Alleghanies. They were a clear-eyed, a bold, an
+adventurous people. They wrested the land from the savage, made it
+secure by their arms, and by the toil of their hands fitted it for its
+present civilization. Among these, and such as these, these heroes in
+the bloody exploits of surgery were reared. From such ancestors they
+drew that dauntless courage which was so often tried in their
+achievements--achievements the fame of which will not lapse with the
+lapse of time. Boone had opened the way to the wilderness around them.
+He "blazed" a path through its unbroken depths, along which the stream
+of civilization quickly flowed. They blazed a path through the
+unexplored regions of their art along which surgeons continue to tread.
+His name is written in the history of his adopted State and embalmed in
+the traditions of its people. Their names are written in the chronicles
+of their beloved calling and upon the hearts of myriads of sufferers
+whom their beneficent labors have relieved. They may or may not have
+felt that their work was durable. But durable it is, and it hands down
+to posterity a _monumentum ære perennius_, the absolute worth of which
+passes computation. No present or future modification of this work can
+rob its authors of that glory which crowns the head of the original
+workman.
+
+Like their kinsmen in genius, these toilers devised measures and dealt
+with issues in advance of their time. Like them they enjoyed but scant
+recompense for labors the far-reaching significance of which they did
+not comprehend. Let us who are reaping in the harvest which they sowed
+forget not how much we are beholden to these immortal husbandmen. And as
+we contemplate the shining record of their deeds, let it counsel us to
+"bend ourselves to a better future." Not that we may hope to rival their
+sublime achievements, but that each in his walk, however humble it may
+be, may strive to enlarge the sphere of his usefulness by making surgery
+the better for his having practiced it.
+
+
+BIBLIOGRAPHY.
+
+  Gross's Report on Kentucky Surgery.
+  Gross's Medical Biography.
+  L. P. Yandell's Report on the Medical Literature of Kentucky.
+  L. P. Yandell's Life of Benjamin W. Dudley.
+
+
+
+
+Transcriber's Note:
+
+Page 27 The dot above the "i" in _fungus cerebri_ is not
+evident in the original publication.
+
+
+
+
+
+End of Project Gutenberg's Pioneer Surgery in Kentucky, by David W. Yandell
+
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+Project Gutenberg's Pioneer Surgery in Kentucky, by David W. Yandell
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+Title: Pioneer Surgery in Kentucky
+       A Sketch
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+Author: David W. Yandell
+
+Release Date: March 13, 2009 [EBook #28322]
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+
+<h1><span class="smcap">Pioneer Surgery in Kentucky</span>:<br /></h1>
+
+<h2>A SKETCH</h2>
+
+<hr style="width: 35%;" />
+
+<h4>BY DAVID W. YANDELL, M. D.,</h4>
+
+<h6>PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF LOUISVILLE, KY; PRESIDENT OF<br />
+THE AMERICAN SURGICAL ASSOCIATION.</h6>
+
+<hr style="width: 30%;" />
+
+<h6>LOUISVILLE:</h6>
+
+<h6>PRINTED BY JOHN P. MORTON &amp; COMPANY.</h6>
+
+<h6>1890</h6>
+
+<hr style="width: 50%;" />
+
+<h5>THE PRESIDENT'S ADDRESS:</h5>
+
+<h6>DELIVERED AT THE<br />
+REGULAR ANNUAL MEETING OF THE</h6>
+
+<h4><span class="smcap">American Surgical Association</span></h4>
+
+<h6><span class="smcap">Washington, D.C., May 13, 1890.</span></h6>
+
+
+
+
+<hr style="width: 65%;" />
+<p><span class="pagenum"><a name="Page_3" id="Page_3">[Pg 3]</a></span></p>
+<h2><a name="Pioneer_Surgery_in_Kentucky" id="Pioneer_Surgery_in_Kentucky"></a><span class="smcap">Pioneer Surgery in Kentucky.</span></h2>
+
+<h4>A SKETCH.</h4>
+
+
+<p><span class="smcap">Fellows of the Association</span>: In the endeavor to chronicle the lives and
+achievements of Kentucky Pioneers in Surgery, I shall not attempt the
+resurrection of village Hampdens or mute inglorious Miltons. The men
+with whom I deal were men of deeds, not men of fruitless promise.</p>
+
+<p>It may with truth be said that from Hippocrates to Gross few in our
+profession who have done enduring work have lacked biographers to pay
+liberal tribute to their worth. In justice to the unremembered few, I
+turn back the records of medicine for a century, and put my finger upon
+two names that in the bustling march of science have been overlooked,
+while I try to set in fuller light two other names of workers in that
+day, which have and will hold an exalted place in history. The worthies
+to whom these names belong were pioneers in civilization as well as in
+surgery. I shall introduce them in the order of their work.</p>
+
+<p>1806. The earliest original surgical work of any magnitude done in
+<span class="pagenum"><a name="Page_4" id="Page_4">[Pg 4]</a></span>Kentucky, by one of her own sons, was an amputation at the hip-joint.
+It proved to be the first operation of the kind in the United States.
+The undertaking was made necessary because of extensive fracture of the
+thigh with great laceration of the soft parts. The subject was a mulatto
+boy, seventeen years of age, a slave of the monks of St. Joseph's
+College. The time was August, 1806; the place, Bardstown; the surgeon,
+Dr. Walter Brashear; the assistants, Dr. Burr Harrison and Dr. John
+Goodtell; the result, a complete success. The operator divided his work
+into two stages. The first consisted in amputating the thigh through its
+middle third in the usual way, and in tying all bleeding vessels. The
+second consisted of a long incision on the outside of the limb, exposing
+the remainder of the bone, which, being freed from its muscular
+attachments, was then disarticulated at its socket.</p>
+
+<p>Far-seeing as the eye of the frontiersman was, he could not have
+discerned that the procedure by which he executed the most formidable
+operation in surgery came so near perfection that it would successfully
+challenge improvement for more than fourscore years.</p>
+
+<p>Hundreds of hips have since been amputated after some forty different
+methods; but that which he introduced has passed into general use, and
+(though now known under the name of Furneaux Jordan's) remains the
+<span class="pagenum"><a name="Page_5" id="Page_5">[Pg 5]</a></span>simplest, the least dangerous, the best.</p>
+
+<p>The first genuine hip-joint amputation executed on living parts was done
+by Kerr, of Northampton, England, 1774. The first done for shot wounds
+was by Larrey, in 1793. I feel safe in saying that Brashear had no
+knowledge of either of these operations. He therefore set about his work
+without help from precedent, placing his trust in himself, in the
+clearness of his own head, in the skill of his own hands, in the courage
+of his own heart. The result shows that he had not overestimated what
+was in him. But whether or not Brashear had ever heard or read a
+description of what had been accomplished in this direction by surgeons
+elsewhere, the young Kentuckian was the first to amputate at the
+hip-joint in America, and the first to do the real thing successfully in
+the world.</p>
+
+<p>Dr. Brashear seems to have set no high estimate on his achievement, and
+never published an account of the case. Had he done so, the art of
+surgery would thereby have been much advanced, his own fame have been
+made one of the precious heritages of his country, and, what is better,
+many valuable lives would have been saved.</p>
+
+<p>Eighteen years after the Jesuits' slave had survived the loss of his
+limb, the report of the much-eulogized case of Dr. Mott appeared.</p>
+
+<p>Dr. Brashear came of an old and wealthy Catholic family of Maryland. He
+was born in February, 1776.<span class="pagenum"><a name="Page_6" id="Page_6">[Pg 6]</a></span> His father journeyed to Kentucky eight
+years later, and cleared a farm near Shepherdsville, in Bullitt County.
+Walter was his seventh son, and was therefore set apart for the medical
+profession.</p>
+
+<p>When a youth he was enrolled in the literary department of Transylvania
+University, where it is said he ranked high as a scholar in Latin. At
+the age of twenty he began the study of medicine, in Lexington, with Dr.
+Frederick Ridgely, a very cultivated physician and popular man, who had
+won distinction in the medical staff of the Continental Army. After two
+years spent in this way, he rode on horseback to Philadelphia, and
+attended upon a course of lectures in the University of Pennsylvania. At
+this time Rush, Barton, and Physick were teachers in that venerable seat
+of learning. His was a restless nature, and after a year spent in
+Philadelphia he shipped to China as surgeon of a vessel. While among the
+Celestials he amputated a woman's breast, probably the first exploit of
+the kind by one from the antipodes. Unfortunately for science, he there
+learned the method used by the Chinese for clarifying ginseng, and
+thinking, on his return home, that he saw in this an easy way to wealth,
+he abandoned the profession in which he had exhibited such originality,
+judgment, and skill, and engaged in merchandising. Twelve years of
+commerce and its hazards left him a bankrupt in for<span class="pagenum"><a name="Page_7" id="Page_7">[Pg 7]</a></span>tune, but brought
+him back to the calling in which he was so well fitted to shine. He
+moved, in 1813, from Bardstown to Lexington, where he at once secured a
+large practice, especially in diseases of the bones and joints. He was
+thought to excel in the treatment of fractures of the skull, for the
+better management of which a trephine was made in Philadelphia, under
+his direction, which, in his judgment, was superior to any then in use.</p>
+
+<p>The same temper which led him to leave Philadelphia without his medical
+degree, sail to China, and afterward enter commerce, again asserted
+itself, and he forsook for the second time his vocation. With his family
+he now moved to St. Mary's Parish, Louisiana, and engaged in
+sugar-planting. During his residence in the South he served his adopted
+State in the Senate of the United States. He employed much time in the
+study of the flora of the West. "During the winter of 1843-4, when Henry
+Clay was on a visit to New Orleans" (says a writer in the New Orleans
+Medical and Surgical Journal), "we had the pleasure, together with some
+twenty-five physicians, of spending the evening with him at the house of
+a medical friend. While at the table one of the company proposed the
+health of the venerable Dr. Brashear, 'the first and only surgeon in
+Louisiana who had successfully performed amputation at the hip-joint.'
+Mr.<span class="pagenum"><a name="Page_8" id="Page_8">[Pg 8]</a></span> Clay, who sat next to Dr. Brashear, with characteristic good humor,
+immediately observed, 'He has you on the hip, Doctor,' to the great
+amusement of Brashear and the rest of the company."</p>
+
+<p>Dr. Brashear was a man of fine literary taste and many and varied
+accomplishments. In conversation he was always entertaining, often
+brilliant. His voice was pleasant, his manners affable. In stature he
+was short; in movement, quick and nervous. But in the make-up of the man
+one essential of true greatness&mdash;fixedness of purpose&mdash;had been omitted.
+He lacked the staying qualities. He was "variable and fond of change."
+"His full nature, like that river of which Alexander broke the strength,
+spent itself in channels which led to no great name on earth." By a
+single exploit, at the age of thirty, he carved his name at high-water
+mark among the elect in surgery. Most of his life thereafter he wasted
+in desultory labors. As the learned Grotius said of his own life, he
+consumed it in levities and strenuous inanities.</p>
+
+<p>He died at an advanced age at his home in Louisiana.</p>
+
+<p>1809. Three years after Brashear had won his unparalleled success at
+Bardstown, a practitioner already of wide repute as a surgeon, living in
+Danville, a neighboring village, did the second piece of original<span class="pagenum"><a name="Page_9" id="Page_9">[Pg 9]</a></span>
+surgical work in Kentucky. It consisted in removing an ovarian tumor.
+The deed, unexampled in surgery, is destined to leave an ineffaceable
+imprint on the coming ages. In doing it Ephraim McDowell became a prime
+factor in the life of woman; in the life of the human race. By it he
+raised himself to a place in the world's history, alongside of Jenner,
+as a benefactor of his kind; nay, it may be questioned if his place be
+not higher than Jenner's, since he opened the way for the largest
+addition ever yet made to the sum total of human life.</p>
+
+<p>So much has been written of this, McDowell's chief work, that I feel it
+needless to dwell upon it. All students of our art are familiar with it
+as presented by abler hands than mine. What I shall say of him,
+therefore, will relate rather to his life and general work than to the
+one operation by which his name has come to be the most resounding in
+all surgery. This is a much more difficult task than at first it might
+seem to be, for McDowell made no sketch of himself, nor have his
+brothers or his children left us any record of his life. Even his early
+biographers failed to gather from his surviving friends those personal
+recollections of the man which would now be of such exceeding interest
+to us all. An authentic life-size portrait of Ephraim McDowell, as he
+was seen in his daily walk among men, can not now be<span class="pagenum"><a name="Page_10" id="Page_10">[Pg 10]</a></span> made. The
+materials are too scant; the time to collect them has gone by. A
+profile, a mere outline drawing, is all that is possible to-day. The
+picture I have attempted, therefore, will be found deficient in many
+details which have passed into general acceptance.</p>
+
+<p>It is known that he came of a sturdy stock, his blood being especially
+rich in two of the best crosses&mdash;the Scotch-Irish. His great-grandfather
+rebelled against the hierarchy of his time, and enlisted as a Covenanter
+under the banner of James I. After honorable service, he laid down his
+arms, gathered his family together, and came to America. It was in honor
+of this ancestor that the subject of the present sketch was named.</p>
+
+<p>The maiden name of his mother was McClung. She was a member of a
+distinguished family of Virginia. McDowell was born in Rockbridge
+County, Virginia, on November 11, 1771. He was the ninth of twelve
+children. His father, Samuel McDowell, was a man of note and influence
+in the State, and was honored with many positions of trust. In 1773 he
+removed with his family to Kentucky, settling near Danville. He was made
+judge of the District Court of Kentucky, and took part in organizing the
+first court ever formed in the State. He lived to see his son
+confessedly the foremost surgeon south of the Blue<span class="pagenum"><a name="Page_11" id="Page_11">[Pg 11]</a></span> Ridge. But it was
+not given to eyes of that day to see that the achievements of the
+village operator had illuminated all the work which has since been done
+in the abdominal cavity, that one had grown up and toiled in their
+midst,</p>
+
+<div class="poem"><div class="stanza">
+<span class="i0">"Whose influence ineffable is borne<br /></span>
+<span class="i0">Round the great globe to cheerless souls that yearned<br /></span>
+<span class="i0">In darkness for this answer to their needs."<br /></span>
+</div></div>
+
+<p>Ephraim's early education was gotten at the school of the town in which
+he lived. He completed his school studies at an institution of somewhat
+higher pretentions, situated in a county near by. No anecdotes are
+preserved of his childhood. During his school-age he clearly preferred
+the out-door sports of his companions to the in-door tasks of his
+teachers. On quitting school he crossed the Alleghanies and became an
+office pupil of Dr. Humphreys, of Staunton, Va. After reading under this
+preceptor for two years, he repaired to the University of Edinburgh. The
+Scotch metropolis was then styled the "Modern Athens." It afforded
+opportunities at that time for acquiring a medical education the best in
+all the world. It was then to the medical profession what Leyden had
+been in the days of Sir Thomas Browne, what Paris became when Velpeau
+and Louis taught there. He entered the private class of John Bell, whose
+forceful teachings and native eloquence made<span class="pagenum"><a name="Page_12" id="Page_12">[Pg 12]</a></span> a lasting impression on
+the mind of his youthful hearer. It has been said that McDowell
+conceived the thought of ovariotomy from some suggestions thrown out by
+this great man. The only distinction he is known to have won while in
+Edinburgh was that of having been chosen by his classmates to carry the
+colors of the college in a foot-race against a professional. In this it
+appears he was an easy first. He came away without a diploma. But what
+was of far greater value than a degree, he brought back the anatomical
+and surgical knowledge which was to place him in the front of his
+profession.</p>
+
+<p>He returned to Kentucky in 1795, and settled among the people who had
+known him from boyhood. His success was immediate, and yet Dr. Samuel
+Brown, who knew him in Virginia, and was his classmate in Scotland, had
+said, when asked of him: "Pish! he left home a gosling and came back a
+goose." In a little while he commanded all the surgical operations of
+importance for hundreds of miles around him, and this continued till,
+some years later, Dudley returned from Europe to share with him the
+empire in surgery.</p>
+
+<p>In 1802, fully established in his profession, and with an income which
+rendered him independent, he married Sarah, daughter of Governor Isaac
+Shelby.</p>
+
+<p>In 1809 he did his first ovariotomy. He believed<span class="pagenum"><a name="Page_13" id="Page_13">[Pg 13]</a></span> the operation to be
+without precedent in the annals of surgery, yet he kept no note of it or
+of his subsequent work. He prepared no account of it until 1817. This
+appeared in the Eclectic Repertory. It was so meagre and so startling
+that surgeons hesitated to credit its truth. He had not mastered his
+mother tongue. The paper was thought to bear internal evidence of its
+author's having "relied upon his ledger for his dates and upon his
+memory for the facts." The critics from far and near fell upon him. The
+profession at home cast doubt upon the narrative. The profession abroad
+ridiculed it. For all that, McDowell kept his temper and his course, and
+when he finally laid down his knife he had a score of thirteen
+operations done for diseased ovaria, with eight recoveries, four deaths,
+and one failure to complete the operation because of adhesions.</p>
+
+<p>It would be neither fitting nor becoming on this occasion, and in this
+presence, to speak in detail of the technic observed by McDowell in his
+work. That has long since passed into history. I may, however, be
+permitted the remark that the procedure, in many of its features, is
+necessarily that of to-day. The incision was longer than that now
+usually made, and the ends of the pedicle ligature were left hanging
+from the lower angle of the wound. But the pedicle itself was dropped
+back into the<span class="pagenum"><a name="Page_14" id="Page_14">[Pg 14]</a></span> abdomen. The patient was turned on her side to allow the
+blood and other fluids to drain away. The wound was closed with
+interrupted sutures. This marvel of work was done without the help of
+anesthetics or trained assistants, or the many improved instruments of
+to-day, which have done so much to simplify and make the operation easy.
+McDowell had never heard of antisepsis, nor dreamed of germicides or
+germs; but water, distilled from nature's unpolluted cisterns by the
+sun, and dropped from heaven's condensers in the clean blue sky, with
+air winnowed through the leaves of the primeval forest which deepened
+into a wilderness about him on every hand, gave him and his patients
+aseptic facility and environment which the most favored living
+laparotomist well might envy. These served him well, and six out of
+seven of his first cases recovered. He removed the first tumor in
+twenty-five minutes, a time not since much shortened by the average
+operator.</p>
+
+<p>It was not alone, however, in this hitherto unexplored field of surgery
+that McDowell showed himself a master. His skill was exhibited equally
+in other capital operations. He acquired at an early day distinction as
+a lithotomist, which brought to him patients from other States. He
+operated by the lateral method, and for many years used the gorget in
+opening the bladder. At a later period he employed<span class="pagenum"><a name="Page_15" id="Page_15">[Pg 15]</a></span> the scalpel
+throughout. He performed lithotomy thirty-two times without a death.
+Among those who came to him to be cut for stone was a pale, slender boy,
+who had traveled all the way from North Carolina. This youth proved to
+be McDowell's most noted patient. He was James K. Polk, afterward
+President of the United States.</p>
+
+<p>Dr. McDowell's "heart was fully open to the lesson of charity, which
+more than all men we should feel," and he dispensed it with constant
+remembrance of the sacred trust imposed upon us. Yet he had a proper
+appreciation of what was due his guild from those whose means allowed
+them to make remuneration for professional services. He charged $500 for
+an ovariotomy that he went to Nashville, Tenn., to do. The husband of
+the patient gave him a check, as he supposed, for that sum. On
+presenting it, the doctor discovered that it was drawn for $1,500
+instead of $500, whereupon he returned the check, thinking a mistake had
+been made. The grateful gentleman replied that it was correct, and added
+that the services much outweighed the sum paid. When the fact is borne
+in mind that the purchasable value of money was much greater in the
+first than in this the last decade of the century, it will be seen that
+the "father of ovariotomy," at least, set his successors in the field a
+good example. This is made conspic<span class="pagenum"><a name="Page_16" id="Page_16">[Pg 16]</a></span>uous by the fact that Sir Spencer
+Wells has seldom charged a larger sum, and has declared £100 to be a
+sufficient fee for the operation.</p>
+
+<p>In person Dr. McDowell was commanding. He was tall, broad-shouldered,
+stout-limbed. His head was large, his nose prominent and full of
+character, his chin broad, his lips full and expressive of
+determination, his complexion florid, his eyes dark-black. His voice was
+clear and manly; he often exercised it in recitations from Scotch
+dialogues, when he would roll the Scotch idiom upon his tongue with the
+readiness of a native. He was fond of music, especially comic pieces,
+which he sang with fine effect, accompanying his voice sometimes with
+the violin.</p>
+
+<p>He was a man of the times, taking an active interest in the affairs of
+the community in which he lived. He had many books for that day. Cullen
+and Sydenham were his chief authorities in medicine; Burns and Scott in
+literature. He was fond of reading, yet he was inclined to action rather
+than study.</p>
+
+<p>He placed great reliance on surgery and its possibilities; he placed
+little trust in drugs. He counselled against their too liberal use. In
+truth, he did not like the practice of medicine, and turned over most of
+his non-surgical cases to his associate in business. In manner he was
+courteous, frank, considerate, and natural. He was a simple, ingenuous
+man.<span class="pagenum"><a name="Page_17" id="Page_17">[Pg 17]</a></span> His great deeds had given him no arrogance. His was a clean,
+strong, vigorous life. His spirit remained sweet and true and modest to
+the last. He lived a God-fearing man, and died on June 25, 1830, in the
+communion of the Episcopal Church.</p>
+
+<p>1813. While McDowell was so busily engaged in his special line of
+surgery, his colaborers elsewhere in the State were not idle. Four years
+after his first ovariotomy, the first complete extirpation of the
+clavicle ever done was accomplished by Dr. Charles McCreary, living in
+Hartford, Ohio County, Ky., two hundred miles, as the crow would fly,
+farther into the wilderness. The patient was a lad named Irvin. The
+disease for which the operation was done was said to be scrofulous.
+Recovery was slow but complete. The use of the arm remained unimpaired,
+and the patient lived, in good health, to be forty-nine years old.</p>
+
+<p>In 1829, sixteen years after the back-woods surgeon had achieved his
+success, Professor Mott repeated the operation, also on a youth, with a
+like fortunate result, and, believing he was first in the field, claimed
+the honor of the procedure for the United States, for New York, and for
+himself. He termed it his "Waterloo operation," not, however, because it
+surpassed, as he declared, in tediousness, difficulty, and danger any
+thing he had ever witnessed or performed, but<span class="pagenum"><a name="Page_18" id="Page_18">[Pg 18]</a></span> because, as it appears,
+it fell on the 18th of June, the anniversary of the battle of Waterloo.</p>
+
+<p>Mott's operation required nearly four hours for its execution, and the
+tying of forty vessels; but after all it proved to be not a complete
+extirpation; for the autopsy, made many years later, showed three
+quarters of an inch of the bone at the acromial end still in its place.
+Yet the case passed quickly into the annals of surgery and added much to
+the already great renown of the operator. To this day it is referred to
+by surgical writers as "Mott's celebrated case," and the description of
+his procedure is often given in his own words.</p>
+
+<p>McCreary removed the entire collar bone, and that while a young
+practitioner, living in a village composed of a few scattering houses,
+situated in a new and sparsely settled country, where opportunities for
+cultivating surgical science were necessarily rare, and the means for
+acquiring anatomical knowledge necessarily small.</p>
+
+<p>The only published report of McCreary's case is from the pen of Dr.
+Johnson, in the New Orleans Medical and Surgical Journal for January,
+1850. The account, though all too brief, clearly establishes the date of
+the operation, its successful issue, and the removal of the entire bone.</p>
+
+<p>It is greatly to be regretted that more is not<span class="pagenum"><a name="Page_19" id="Page_19">[Pg 19]</a></span> known of McCreary's
+personal and professional character. He is said, by one who met him
+often, to have been a serious, thoughtful man, given to study, devoted
+to his calling, and fatally fond of drink, to which he fell a victim
+when but thirty-seven years of age.</p>
+
+<p>1814. A younger man than either of those I have attempted to sketch, Dr.
+Benjamin Winslow Dudley, now came upon the stage. He, too, was the son
+of a pioneer. His early training was much like that of his
+contemporaries. Like Brashear, he had instruction in the office of Dr.
+Ridgely. Like him, he had attended lectures in the University of
+Pennsylvania. Unlike him, he carried away its diploma. This he did in
+1806, just two weeks before he was twenty-one years old. He came home,
+opened an office, and offered his services to the public. The public
+gave him little business. He was deficient either in the knowledge or in
+the self-trust necessary to professional success. McDowell was located
+in a village hard by&mdash;was applying himself mainly to surgery, and was
+already in full practice. Dudley resolved to still better qualify
+himself for the work he was ambitious to do. He longed to go into the
+hospitals and follow the great teachers of Europe, but lacked the means.
+To get these he made a venture in trade. He purchased a flat-boat,
+loaded it with produce, headed it for New<span class="pagenum"><a name="Page_20" id="Page_20">[Pg 20]</a></span> Orleans, and floated down the
+Kentucky, the Ohio, and the Mississippi rivers to the desired port. He
+invested the proceeds of his cargo in flour. This he billed to
+Gibraltar, which he reached some time in 1810; there and at Lisbon he
+disposed of it at a large advance.</p>
+
+<p>The opportunities he had sought were now near at hand. He hastened
+through Spain to Paris. While there he heard Baron Larrey recite his
+wonderful military experience. He made the acquaintance of Caulaincourt,
+"the Emperor's trusted minister." Through him he was present with Talma
+and John Howard Payne in the Chamber of Deputies when Napoleon entered
+the building at the close of his disastrous Russian campaign. He saw the
+Emperor mount the tribune. He heard him begin his report with these
+portentous words: "The Grand Army of the Empire has been annihilated."</p>
+
+<p>Remaining in Paris nearly three years, he crossed the Channel to observe
+surgery as practiced in London. While there he listened to Abernethy as
+he dwelt with all his wonted enthusiasm on his peculiar doctrine. He
+heard him reason it; he saw him act it, dramatize it, and came away
+believing him to be "the highest authority on all points relating to
+surgery, as at once the observant student of nature, the profound
+thinker, and the sound medical philosopher." He<span class="pagenum"><a name="Page_21" id="Page_21">[Pg 21]</a></span> always referred to him
+as the greatest of surgeons. He saw Sir Astley Cooper operate, and
+habitually designated him as the most skilled and graceful man in his
+work he had ever known.</p>
+
+<p>He returned to Lexington in the summer of 1814, "in manners a Frenchman,
+but in medical doctrine and practice thoroughly English." The public was
+quick to detect that he had improved his time while away. "His
+profession had become the engrossing object of his thought, and he
+applied himself to it with undeviating fidelity. He made himself its
+slave." One who knew him well wrote of him: "He had no holidays. He
+sought no recreation; no sports interested him. His thoughts, he had
+been heard to say, were always on his cases, and not on the objects and
+amusements around him." He found Lexington in the midst of an epidemic
+of typhoid pneumonia, the same that had prevailed in the older States.
+This singularly fatal disease was followed by a "bilious fever,
+characterized, like the plague, by a tendency to local affections.
+Abscesses formed among the muscles of the body, legs, and arms, and were
+so intractable that limbs were sometimes amputated to get rid of the
+evil." Recalling the use he had seen made of the bandage, while abroad,
+in the treatment of ulcers of the leg, Dudley applied this device to the
+burrowing abscesses he saw so frequently in the subjects of the<span class="pagenum"><a name="Page_22" id="Page_22">[Pg 22]</a></span> fever.
+The true position and exceeding value of the roller bandage were not so
+generally recognized then as now. Dr. Dudley was no doubt himself
+surprised at the success which followed the practice. This success
+probably led him to urge that wide application of the bandage with which
+his name came in time to be so generally associated.</p>
+
+<p>The tide of practice now set full toward him. He had come home a
+thorough anatomist. With opportunity he exhibited surpassing skill in
+the use of the knife. His reputation soon became national.</p>
+
+<p>No medical school had at that time been founded west of the Alleghanies.
+The need of such an institution was felt on every hand. Transylvania
+University, already of established reputation, was in operation. It
+required only a school in medicine to make it complete in its several
+departments. The trustees met in 1817 and added this to its
+organization. Dr. Dudley was made its head and appointed to fill the
+chairs of anatomy and surgery. A small class of students assembled in
+the autumn. At the commencement exercises held the following spring, W.
+L. Sutton was admitted to the doctorate&mdash;the first physician given that
+distinction by an institution in the West. Troubles arose in the
+faculty. Resignations were sent in and accepted. Dr. Richardson, one of
+the corps, challenged Dr. Dudley. A meeting followed. Rich<span class="pagenum"><a name="Page_23" id="Page_23">[Pg 23]</a></span>ardson left
+the field with a pistol wound in his thigh which made him halt in his
+gait for the rest of his life. The year following a second organization
+was effected, which included the two belligerent teachers.</p>
+
+<p>The history of the Medical Department of Transylvania University&mdash;its
+rise, its success, its decline, its disappearance from the list of
+medical colleges&mdash;would practically cover Dr. Dudley's career, and would
+form a most interesting chapter in the development of medical teaching
+in the Southwest. But it must suffice me here to say that Dr. Dudley
+created the medical department of the institution and directed its
+policy. Its students regarded him from the beginning as the foremost man
+in the faculty. That he had colleagues whose mental endowments were
+superior to his he himself at all times freely admitted. He is said to
+have laid no claim to either oratorical power or professional erudition.
+He was not a logician, he was not brilliant, and his deliverances were
+spiced with neither humor nor wit. And yet, says one of his biographers,
+in ability to enchain the students' attention, to impress them with the
+value of his instructions and his greatness as a teacher, he bore off
+the palm from all the gifted men who, at various periods, taught by his
+side. A friend and once a colleague described his manner while lecturing
+as singularly imposing and impressive. "He was<span class="pagenum"><a name="Page_24" id="Page_24">[Pg 24]</a></span> magisterial, oracular,
+conveying the idea always that the mind of the speaker was troubled with
+no doubt. His deportment before his classes was such as further to
+enhance his standing. He was always, in the presence of his students,
+not the model teacher only, but the dignified, urbane gentleman;
+conciliating regard by his gentleness, but repelling any approach to
+familiarity; and never for the sake of raising a laugh or eliciting a
+little momentary applause descending to coarseness in expression or
+thought. So that to his pupils he was always and everywhere great. As an
+operator they thought he had distanced competition. As a teacher they
+thought he gave them not what was in the books, but what the writers of
+the books had never understood. They were persuaded that there was much
+they must learn from his lips or learn not at all." His hold upon the
+public was as great as that upon his classes. "Patients came to him from
+afar because it was believed that he did better what others could do
+than any one else, and that he did much which no one else in reach could
+do."</p>
+
+<p>During the larger part of Dr. Dudley's life few physicians in any part
+of America devoted themselves exclusively to surgery. The most eminent
+surgeons were general practitioners&mdash;all-round men. In this class Dr.
+Dudley was equal to the best. In one respect, at least, he took advance
+ground&mdash;he con<span class="pagenum"><a name="Page_25" id="Page_25">[Pg 25]</a></span>demned blood-letting. He was often heard to declare that
+every bleeding shortened the subject's life by a year. Admiring
+Abernethy more than any of his teachers, his opinions were naturally
+colored by the views of this eccentric Englishman. Like him he believed
+in the constitutional origin of local diseases, but his practice varied
+somewhat from that of his master. Like him he gave his patients blue
+pill at night but omitted the black draught in the morning. He thought
+an emetic better, and secured it by tartarized antimony. Between the
+puke and the purge his patients were fed on stale bread, skim milk, and
+water-gruel. And this heroic practice he pursued day after day, for
+weeks and months together, in spinal caries, hip caries, tuberculosis,
+urethral stricture and other diseases.</p>
+
+<p>I said that as a physician he was equal to the best. As we see things
+to-day this would not, perhaps, be saying much; but in fact he was
+better than the best. Negatively, if not positively, he improved upon
+the barbaric treatment of disease then in universal favor. He wholly
+discarded one of the most effective means by which the doctors succeeded
+in shortening the life of man. This was just before those biological
+dawnings which were soon to break into the full light of physiological
+medicine and the rational system of therapeutics based thereupon.<span class="pagenum"><a name="Page_26" id="Page_26">[Pg 26]</a></span> And
+it is not improbable that as a watcher in that night of therapeutical
+darkness, where the doings of the best strike us with horror, his
+prophetic eye caught some glimpses of the coming day which in old age it
+was given him to see. Though engaged chiefly with the great things in
+surgery, he deserves a place in the list of therapeutic reformers.</p>
+
+<p>Much of the renown acquired for Kentucky by her surgeons was in the
+treatment of calculous diseases. This State is believed to have
+furnished almost as many cases of stone as all the rest of the Union.
+Dr. Dudley stands the confessed leader of American lithotomists, heading
+the list with two hundred and twenty-five cases. Of these he presents an
+unbroken series of one hundred consecutive successful operations. He
+used the gorget in all. He preferred the instrument invented by Mr.
+Cline, of London. "In one case, when his patient was on the table, he
+discovered that his accustomed operation was impracticable from
+deformity of the pelvis, and while his assistants were taking their
+positions resolved to make the external incision transverse, which was
+executed before any one else present had remarked the difficulty."
+Through this incision he removed a stone three and a half inches in the
+long diameter, two and a half inches in the short, by eleven inches in
+circumference. The patient recovered.<span class="pagenum"><a name="Page_27" id="Page_27">[Pg 27]</a></span></p>
+
+<p>In an article contributed to the Transylvania Journal of Medicine by Dr.
+Dudley, in 1828, he thus wrote of the trephine: "The experience which
+time and circumstances have afforded me in injuries of the head induced
+me to depart from the commonly received principles by which surgeons are
+governed in the use of the trephine. In skillful hands the operation,
+beyond the atmosphere of large cities, is neither dangerous in its
+consequences nor difficult in the execution." In this remark Dr. Dudley
+bore early testimony to the efficacy of aseptic surgery. He urged the
+trephine in the treatment of epilepsy and applied it in six cases&mdash;in
+four of which the disease was cured. The result in the two remaining
+cases is unknown, because the patients were lost sight of.</p>
+
+<p>Dr. Dudley believed himself to be the first surgeon who ever attempted
+to treat <a name="cerebri" id="cerebri"><ins title="dot above i in original missing"><i>fungus cerebri</i></ins></a> by gentle and sustained pressure made with dry
+sponge aided by the roller. Of the first cases in which he used it, he
+wrote: "By imbibing the secretions of the part, the pressure on the
+protruded brain regularly and insensibly increased until the sponge
+became completely saturated. On removing it the decisive influence and
+efficacy of the agent remained no longer a matter of doubt." He noted
+the difficulty experienced in removing the sponge because of its being
+extensively penetrated by blood-vessels springing from the sur<span class="pagenum"><a name="Page_28" id="Page_28">[Pg 28]</a></span>face of
+the brain. This inconvenience he afterward obviated by putting a thin
+piece of muslin between the fungus and the sponge. He saw in this
+property of the sponge what no doubt others had seen before, the
+phenomenon of sponge-grafting, but like them he failed to utilize it in
+practice.</p>
+
+<p>Dr. Dudley was not a student of books. He had no taste for literature.
+He wrote but little, and that only for the Transylvania Journal of
+Medicine, edited by two of his colleagues, Professors Cooke and Short.
+His first article did not appear until 1828, fourteen years after he had
+begun practice. It was on injuries of the head. It abounded in original
+views, and did much to shape surgical thought at the time. Today it may
+be consulted with profit. His second paper was on hydrocele; in this he
+advocated the operation by incision and removal of the sac. He read so
+little that he fell into the error of believing that he was the
+originator of the procedure. There are writers in our own day who would
+be able to hold their own against him in this particular. A paper on the
+bandage, another on fractures, and one on the nature and treatment of
+calculous diseases, embrace all his contributions to medical literature.</p>
+
+<p>Dr. Dudley was the son of Ambrose Dudley, a distinguished Baptist
+minister. He was born in Spottsylvania County, Va., April 25, 1785. When
+but a year<span class="pagenum"><a name="Page_29" id="Page_29">[Pg 29]</a></span> old he was brought by his father to the then county of
+Kentucky. The family settled in Lexington, in which beautiful city the
+child became a man, and lived and wrought and died. The date of his
+death is January 25, 1870; his age was eighty-five years.</p>
+
+<p>Dr. Dudley was a man of affairs. His practice was always large and paid
+him well. He amassed a handsome fortune. His opinions were often sought
+in courts of justice on professional points, where his dignity,
+self-possession, and dry wit (which he seems to have suppressed at the
+lecturer's desk), commanded the respect of judge, juror, and advocate,
+while it made him the terror of the pettifogger. Once, while giving
+expert testimony in a case involving a wound made by bird-shot delivered
+at short range, he described the behavior of projectiles, and the danger
+of bullet wounds. The opposing counsel interrupted him: "Do you mean to
+say," said the lawyer, "do you mean to say, Dr. Dudley, that shot wounds
+are as dangerous as bullet wounds?" "Shot are but little bullets," was
+the unhesitating reply.</p>
+
+<p>Dr. Dudley had also a proper sense of the value of his professional
+services. He was called on one occasion to a town near Lexington to
+attend a patient in labor, who was the wife of a man made rich by
+marriage. The husband was too wise to engage a<span class="pagenum"><a name="Page_30" id="Page_30">[Pg 30]</a></span> "night rider," and too
+purse-proud to call the village doctor. At that time most of the one
+hundred dollar notes in circulation in Kentucky were issued by the
+Northern Bank, at Lexington. On the reverse side of the bill was the
+letter C in Roman capital. This letter was so round in figure that it
+looked like a "bull's-eye," and in local slang was so called. The visit
+being over, and the doctor ready to leave, the young father handed him
+one of these notes. Eyeing it for a moment, Dr. Dudley said: "Another
+'bull's-eye,' Mr. X., if you please."</p>
+
+<p>In person Dr. Dudley was of medium size. His features were refined, the
+forehead wide and high, the nose large and somewhat thick, the lips
+thin, the eyes bluish-gray. His hair was thin, light, and of a sandy
+tint. He was a graceful man. His voice was pleasing; his manners
+courtly; his bearing gracious.</p>
+
+<p>He married Miss Short, daughter of Major Peyton Short, in 1821. He
+delivered his last lecture in 1850, and the last entry on his ledger
+bears the date of April 28, 1853.</p>
+
+<hr style="width: 45%;" />
+
+<p>I can not give these remarks more fitting close than by describing
+briefly the surroundings which set their impress upon the character of
+the men whose lives I have attempted to portray. The picture is full of
+meaning, dignity, and simplicity. In this time<span class="pagenum"><a name="Page_31" id="Page_31">[Pg 31]</a></span> "Canetuckee" was still a
+part of Virginia. The grounds on which, as boys, they played were held
+by their fathers under what is known as a "tomahawk claim." "Beyond lay
+endless leagues of shadowy forest." "The Illinois" had not been admitted
+into the sisterhood of the States. The vast domain west of the
+Mississippi River was unexplored. The city of St. Louis was but an
+outpost for traders. The name "Chicago" had not been coined. Fort
+Dearborn, occupied by two companies of United States troops, marked a
+roll in the prairie among the sloughs where stands to-day the queen and
+mistress of the lakes. Cincinnati had no place on the map, but was known
+as Fort Washington. General Pakenham had not attempted the rape of New
+Orleans, and General Jackson, who was to drive him with his myrmidons
+fleeing to his ships, was unknown to fame. Wars with Indians were
+frequent. Massacres by Indians were common. The prow of a steamboat had
+never cut the waters of a Western river. Railroads were unknown in the
+world. There were but two avenues by which Kentucky could be reached
+from the East. One was the water-way, furnished by the Ohio River. The
+other was the "Wilderness Road," "blazed" by Daniel Boone. The former
+was covered in keel-boats, flat-boats, and canoes. The latter was
+traveled on horseback or on foot. No<span class="pagenum"><a name="Page_32" id="Page_32">[Pg 32]</a></span> wheel had broken it or been broken
+by it. The fathers of the subjects of this narrative followed this road
+after crossing the Alleghanies. They were a clear-eyed, a bold, an
+adventurous people. They wrested the land from the savage, made it
+secure by their arms, and by the toil of their hands fitted it for its
+present civilization. Among these, and such as these, these heroes in
+the bloody exploits of surgery were reared. From such ancestors they
+drew that dauntless courage which was so often tried in their
+achievements&mdash;achievements the fame of which will not lapse with the
+lapse of time. Boone had opened the way to the wilderness around them.
+He "blazed" a path through its unbroken depths, along which the stream
+of civilization quickly flowed. They blazed a path through the
+unexplored regions of their art along which surgeons continue to tread.
+His name is written in the history of his adopted State and embalmed in
+the traditions of its people. Their names are written in the chronicles
+of their beloved calling and upon the hearts of myriads of sufferers
+whom their beneficent labors have relieved. They may or may not have
+felt that their work was durable. But durable it is, and it hands down
+to posterity a <i>monumentum ære perennius</i>, the absolute worth of which
+passes computation. No present or future modification of this work can
+rob its authors of that<span class="pagenum"><a name="Page_33" id="Page_33">[Pg 33]</a></span> glory which crowns the head of the original
+workman.</p>
+
+<p>Like their kinsmen in genius, these toilers devised measures and dealt
+with issues in advance of their time. Like them they enjoyed but scant
+recompense for labors the far-reaching significance of which they did
+not comprehend. Let us who are reaping in the harvest which they sowed
+forget not how much we are beholden to these immortal husbandmen. And as
+we contemplate the shining record of their deeds, let it counsel us to
+"bend ourselves to a better future." Not that we may hope to rival their
+sublime achievements, but that each in his walk, however humble it may
+be, may strive to enlarge the sphere of his usefulness by making surgery
+the better for his having practiced it.</p>
+
+
+
+<hr style="width: 65%;" />
+<h2><a name="BIBLIOGRAPHY" id="BIBLIOGRAPHY"></a>BIBLIOGRAPHY.</h2>
+
+
+<div class="blockquot">Gross's Report on Kentucky Surgery.<br />
+Gross's Medical Biography.<br />
+L. P. Yandell's Report on the Medical Literature of Kentucky.<br />
+L. P. Yandell's Life of Benjamin W. Dudley.<br /></div>
+
+
+<hr style="width: 65%;" />
+<h4>Transcriber's Note:</h4>
+
+<p class="center">Page 27 The dot above the "i" in <i><a href="#cerebri">fungus cerebri</a></i> is not
+evident in the original publication.</p>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of Project Gutenberg's Pioneer Surgery in Kentucky, by David W. Yandell
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+Project Gutenberg's Pioneer Surgery in Kentucky, by David W. Yandell
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Pioneer Surgery in Kentucky
+       A Sketch
+
+Author: David W. Yandell
+
+Release Date: March 13, 2009 [EBook #28322]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK PIONEER SURGERY IN KENTUCKY ***
+
+
+
+
+Produced by David Garcia, Woodie4 and the Online Distributed
+Proofreading Team at http://www.pgdp.net (This file was
+produced from images generously made available by The
+Kentuckiana Digital Library)
+
+
+
+
+
+
+
+
+
+  PIONEER SURGERY IN KENTUCKY:
+
+  A SKETCH.
+
+  BY DAVID W. YANDELL, M. D.,
+
+  PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF LOUISVILLE, KY;
+  PRESIDENT OF THE AMERICAN SURGICAL ASSOCIATION.
+
+  LOUISVILLE:
+
+  PRINTED BY JOHN P. MORTON & COMPANY.
+
+  1890
+
+
+  THE PRESIDENT'S ADDRESS:
+
+  DELIVERED AT THE
+  REGULAR ANNUAL MEETING OF THE
+
+  AMERICAN SURGICAL ASSOCIATION,
+
+  WASHINGTON, D.C., MAY 13, 1890.
+
+
+
+
+PIONEER SURGERY IN KENTUCKY.
+
+A SKETCH.
+
+
+FELLOWS OF THE ASSOCIATION: In the endeavor to chronicle the lives and
+achievements of Kentucky Pioneers in Surgery, I shall not attempt the
+resurrection of village Hampdens or mute inglorious Miltons. The men
+with whom I deal were men of deeds, not men of fruitless promise.
+
+It may with truth be said that from Hippocrates to Gross few in our
+profession who have done enduring work have lacked biographers to pay
+liberal tribute to their worth. In justice to the unremembered few, I
+turn back the records of medicine for a century, and put my finger upon
+two names that in the bustling march of science have been overlooked,
+while I try to set in fuller light two other names of workers in that
+day, which have and will hold an exalted place in history. The worthies
+to whom these names belong were pioneers in civilization as well as in
+surgery. I shall introduce them in the order of their work.
+
+1806. The earliest original surgical work of any magnitude done in
+Kentucky, by one of her own sons, was an amputation at the hip-joint.
+It proved to be the first operation of the kind in the United States.
+The undertaking was made necessary because of extensive fracture of the
+thigh with great laceration of the soft parts. The subject was a mulatto
+boy, seventeen years of age, a slave of the monks of St. Joseph's
+College. The time was August, 1806; the place, Bardstown; the surgeon,
+Dr. Walter Brashear; the assistants, Dr. Burr Harrison and Dr. John
+Goodtell; the result, a complete success. The operator divided his work
+into two stages. The first consisted in amputating the thigh through its
+middle third in the usual way, and in tying all bleeding vessels. The
+second consisted of a long incision on the outside of the limb, exposing
+the remainder of the bone, which, being freed from its muscular
+attachments, was then disarticulated at its socket.
+
+Far-seeing as the eye of the frontiersman was, he could not have
+discerned that the procedure by which he executed the most formidable
+operation in surgery came so near perfection that it would successfully
+challenge improvement for more than fourscore years.
+
+Hundreds of hips have since been amputated after some forty different
+methods; but that which he introduced has passed into general use, and
+(though now known under the name of Furneaux Jordan's) remains the
+simplest, the least dangerous, the best.
+
+The first genuine hip-joint amputation executed on living parts was done
+by Kerr, of Northampton, England, 1774. The first done for shot wounds
+was by Larrey, in 1793. I feel safe in saying that Brashear had no
+knowledge of either of these operations. He therefore set about his work
+without help from precedent, placing his trust in himself, in the
+clearness of his own head, in the skill of his own hands, in the courage
+of his own heart. The result shows that he had not overestimated what
+was in him. But whether or not Brashear had ever heard or read a
+description of what had been accomplished in this direction by surgeons
+elsewhere, the young Kentuckian was the first to amputate at the
+hip-joint in America, and the first to do the real thing successfully in
+the world.
+
+Dr. Brashear seems to have set no high estimate on his achievement, and
+never published an account of the case. Had he done so, the art of
+surgery would thereby have been much advanced, his own fame have been
+made one of the precious heritages of his country, and, what is better,
+many valuable lives would have been saved.
+
+Eighteen years after the Jesuits' slave had survived the loss of his
+limb, the report of the much-eulogized case of Dr. Mott appeared.
+
+Dr. Brashear came of an old and wealthy Catholic family of Maryland. He
+was born in February, 1776. His father journeyed to Kentucky eight
+years later, and cleared a farm near Shepherdsville, in Bullitt County.
+Walter was his seventh son, and was therefore set apart for the medical
+profession.
+
+When a youth he was enrolled in the literary department of Transylvania
+University, where it is said he ranked high as a scholar in Latin. At
+the age of twenty he began the study of medicine, in Lexington, with Dr.
+Frederick Ridgely, a very cultivated physician and popular man, who had
+won distinction in the medical staff of the Continental Army. After two
+years spent in this way, he rode on horseback to Philadelphia, and
+attended upon a course of lectures in the University of Pennsylvania. At
+this time Rush, Barton, and Physick were teachers in that venerable seat
+of learning. His was a restless nature, and after a year spent in
+Philadelphia he shipped to China as surgeon of a vessel. While among the
+Celestials he amputated a woman's breast, probably the first exploit of
+the kind by one from the antipodes. Unfortunately for science, he there
+learned the method used by the Chinese for clarifying ginseng, and
+thinking, on his return home, that he saw in this an easy way to wealth,
+he abandoned the profession in which he had exhibited such originality,
+judgment, and skill, and engaged in merchandising. Twelve years of
+commerce and its hazards left him a bankrupt in fortune, but brought
+him back to the calling in which he was so well fitted to shine. He
+moved, in 1813, from Bardstown to Lexington, where he at once secured a
+large practice, especially in diseases of the bones and joints. He was
+thought to excel in the treatment of fractures of the skull, for the
+better management of which a trephine was made in Philadelphia, under
+his direction, which, in his judgment, was superior to any then in use.
+
+The same temper which led him to leave Philadelphia without his medical
+degree, sail to China, and afterward enter commerce, again asserted
+itself, and he forsook for the second time his vocation. With his family
+he now moved to St. Mary's Parish, Louisiana, and engaged in
+sugar-planting. During his residence in the South he served his adopted
+State in the Senate of the United States. He employed much time in the
+study of the flora of the West. "During the winter of 1843-4, when Henry
+Clay was on a visit to New Orleans" (says a writer in the New Orleans
+Medical and Surgical Journal), "we had the pleasure, together with some
+twenty-five physicians, of spending the evening with him at the house of
+a medical friend. While at the table one of the company proposed the
+health of the venerable Dr. Brashear, 'the first and only surgeon in
+Louisiana who had successfully performed amputation at the hip-joint.'
+Mr. Clay, who sat next to Dr. Brashear, with characteristic good humor,
+immediately observed, 'He has you on the hip, Doctor,' to the great
+amusement of Brashear and the rest of the company."
+
+Dr. Brashear was a man of fine literary taste and many and varied
+accomplishments. In conversation he was always entertaining, often
+brilliant. His voice was pleasant, his manners affable. In stature he
+was short; in movement, quick and nervous. But in the make-up of the man
+one essential of true greatness--fixedness of purpose--had been omitted.
+He lacked the staying qualities. He was "variable and fond of change."
+"His full nature, like that river of which Alexander broke the strength,
+spent itself in channels which led to no great name on earth." By a
+single exploit, at the age of thirty, he carved his name at high-water
+mark among the elect in surgery. Most of his life thereafter he wasted
+in desultory labors. As the learned Grotius said of his own life, he
+consumed it in levities and strenuous inanities.
+
+He died at an advanced age at his home in Louisiana.
+
+1809. Three years after Brashear had won his unparalleled success at
+Bardstown, a practitioner already of wide repute as a surgeon, living in
+Danville, a neighboring village, did the second piece of original
+surgical work in Kentucky. It consisted in removing an ovarian tumor.
+The deed, unexampled in surgery, is destined to leave an ineffaceable
+imprint on the coming ages. In doing it Ephraim McDowell became a prime
+factor in the life of woman; in the life of the human race. By it he
+raised himself to a place in the world's history, alongside of Jenner,
+as a benefactor of his kind; nay, it may be questioned if his place be
+not higher than Jenner's, since he opened the way for the largest
+addition ever yet made to the sum total of human life.
+
+So much has been written of this, McDowell's chief work, that I feel it
+needless to dwell upon it. All students of our art are familiar with it
+as presented by abler hands than mine. What I shall say of him,
+therefore, will relate rather to his life and general work than to the
+one operation by which his name has come to be the most resounding in
+all surgery. This is a much more difficult task than at first it might
+seem to be, for McDowell made no sketch of himself, nor have his
+brothers or his children left us any record of his life. Even his early
+biographers failed to gather from his surviving friends those personal
+recollections of the man which would now be of such exceeding interest
+to us all. An authentic life-size portrait of Ephraim McDowell, as he
+was seen in his daily walk among men, can not now be made. The
+materials are too scant; the time to collect them has gone by. A
+profile, a mere outline drawing, is all that is possible to-day. The
+picture I have attempted, therefore, will be found deficient in many
+details which have passed into general acceptance.
+
+It is known that he came of a sturdy stock, his blood being especially
+rich in two of the best crosses--the Scotch-Irish. His great-grandfather
+rebelled against the hierarchy of his time, and enlisted as a Covenanter
+under the banner of James I. After honorable service, he laid down his
+arms, gathered his family together, and came to America. It was in honor
+of this ancestor that the subject of the present sketch was named.
+
+The maiden name of his mother was McClung. She was a member of a
+distinguished family of Virginia. McDowell was born in Rockbridge
+County, Virginia, on November 11, 1771. He was the ninth of twelve
+children. His father, Samuel McDowell, was a man of note and influence
+in the State, and was honored with many positions of trust. In 1773 he
+removed with his family to Kentucky, settling near Danville. He was made
+judge of the District Court of Kentucky, and took part in organizing the
+first court ever formed in the State. He lived to see his son
+confessedly the foremost surgeon south of the Blue Ridge. But it was
+not given to eyes of that day to see that the achievements of the
+village operator had illuminated all the work which has since been done
+in the abdominal cavity, that one had grown up and toiled in their
+midst,
+
+    "Whose influence ineffable is borne
+    Round the great globe to cheerless souls that yearned
+    In darkness for this answer to their needs."
+
+Ephraim's early education was gotten at the school of the town in which
+he lived. He completed his school studies at an institution of somewhat
+higher pretentions, situated in a county near by. No anecdotes are
+preserved of his childhood. During his school-age he clearly preferred
+the out-door sports of his companions to the in-door tasks of his
+teachers. On quitting school he crossed the Alleghanies and became an
+office pupil of Dr. Humphreys, of Staunton, Va. After reading under this
+preceptor for two years, he repaired to the University of Edinburgh. The
+Scotch metropolis was then styled the "Modern Athens." It afforded
+opportunities at that time for acquiring a medical education the best in
+all the world. It was then to the medical profession what Leyden had
+been in the days of Sir Thomas Browne, what Paris became when Velpeau
+and Louis taught there. He entered the private class of John Bell, whose
+forceful teachings and native eloquence made a lasting impression on
+the mind of his youthful hearer. It has been said that McDowell
+conceived the thought of ovariotomy from some suggestions thrown out by
+this great man. The only distinction he is known to have won while in
+Edinburgh was that of having been chosen by his classmates to carry the
+colors of the college in a foot-race against a professional. In this it
+appears he was an easy first. He came away without a diploma. But what
+was of far greater value than a degree, he brought back the anatomical
+and surgical knowledge which was to place him in the front of his
+profession.
+
+He returned to Kentucky in 1795, and settled among the people who had
+known him from boyhood. His success was immediate, and yet Dr. Samuel
+Brown, who knew him in Virginia, and was his classmate in Scotland, had
+said, when asked of him: "Pish! he left home a gosling and came back a
+goose." In a little while he commanded all the surgical operations of
+importance for hundreds of miles around him, and this continued till,
+some years later, Dudley returned from Europe to share with him the
+empire in surgery.
+
+In 1802, fully established in his profession, and with an income which
+rendered him independent, he married Sarah, daughter of Governor Isaac
+Shelby.
+
+In 1809 he did his first ovariotomy. He believed the operation to be
+without precedent in the annals of surgery, yet he kept no note of it or
+of his subsequent work. He prepared no account of it until 1817. This
+appeared in the Eclectic Repertory. It was so meagre and so startling
+that surgeons hesitated to credit its truth. He had not mastered his
+mother tongue. The paper was thought to bear internal evidence of its
+author's having "relied upon his ledger for his dates and upon his
+memory for the facts." The critics from far and near fell upon him. The
+profession at home cast doubt upon the narrative. The profession abroad
+ridiculed it. For all that, McDowell kept his temper and his course, and
+when he finally laid down his knife he had a score of thirteen
+operations done for diseased ovaria, with eight recoveries, four deaths,
+and one failure to complete the operation because of adhesions.
+
+It would be neither fitting nor becoming on this occasion, and in this
+presence, to speak in detail of the technic observed by McDowell in his
+work. That has long since passed into history. I may, however, be
+permitted the remark that the procedure, in many of its features, is
+necessarily that of to-day. The incision was longer than that now
+usually made, and the ends of the pedicle ligature were left hanging
+from the lower angle of the wound. But the pedicle itself was dropped
+back into the abdomen. The patient was turned on her side to allow the
+blood and other fluids to drain away. The wound was closed with
+interrupted sutures. This marvel of work was done without the help of
+anesthetics or trained assistants, or the many improved instruments of
+to-day, which have done so much to simplify and make the operation easy.
+McDowell had never heard of antisepsis, nor dreamed of germicides or
+germs; but water, distilled from nature's unpolluted cisterns by the
+sun, and dropped from heaven's condensers in the clean blue sky, with
+air winnowed through the leaves of the primeval forest which deepened
+into a wilderness about him on every hand, gave him and his patients
+aseptic facility and environment which the most favored living
+laparotomist well might envy. These served him well, and six out of
+seven of his first cases recovered. He removed the first tumor in
+twenty-five minutes, a time not since much shortened by the average
+operator.
+
+It was not alone, however, in this hitherto unexplored field of surgery
+that McDowell showed himself a master. His skill was exhibited equally
+in other capital operations. He acquired at an early day distinction as
+a lithotomist, which brought to him patients from other States. He
+operated by the lateral method, and for many years used the gorget in
+opening the bladder. At a later period he employed the scalpel
+throughout. He performed lithotomy thirty-two times without a death.
+Among those who came to him to be cut for stone was a pale, slender boy,
+who had traveled all the way from North Carolina. This youth proved to
+be McDowell's most noted patient. He was James K. Polk, afterward
+President of the United States.
+
+Dr. McDowell's "heart was fully open to the lesson of charity, which
+more than all men we should feel," and he dispensed it with constant
+remembrance of the sacred trust imposed upon us. Yet he had a proper
+appreciation of what was due his guild from those whose means allowed
+them to make remuneration for professional services. He charged $500 for
+an ovariotomy that he went to Nashville, Tenn., to do. The husband of
+the patient gave him a check, as he supposed, for that sum. On
+presenting it, the doctor discovered that it was drawn for $1,500
+instead of $500, whereupon he returned the check, thinking a mistake had
+been made. The grateful gentleman replied that it was correct, and added
+that the services much outweighed the sum paid. When the fact is borne
+in mind that the purchasable value of money was much greater in the
+first than in this the last decade of the century, it will be seen that
+the "father of ovariotomy," at least, set his successors in the field a
+good example. This is made conspicuous by the fact that Sir Spencer
+Wells has seldom charged a larger sum, and has declared L100 to be a
+sufficient fee for the operation.
+
+In person Dr. McDowell was commanding. He was tall, broad-shouldered,
+stout-limbed. His head was large, his nose prominent and full of
+character, his chin broad, his lips full and expressive of
+determination, his complexion florid, his eyes dark-black. His voice was
+clear and manly; he often exercised it in recitations from Scotch
+dialogues, when he would roll the Scotch idiom upon his tongue with the
+readiness of a native. He was fond of music, especially comic pieces,
+which he sang with fine effect, accompanying his voice sometimes with
+the violin.
+
+He was a man of the times, taking an active interest in the affairs of
+the community in which he lived. He had many books for that day. Cullen
+and Sydenham were his chief authorities in medicine; Burns and Scott in
+literature. He was fond of reading, yet he was inclined to action rather
+than study.
+
+He placed great reliance on surgery and its possibilities; he placed
+little trust in drugs. He counselled against their too liberal use. In
+truth, he did not like the practice of medicine, and turned over most of
+his non-surgical cases to his associate in business. In manner he was
+courteous, frank, considerate, and natural. He was a simple, ingenuous
+man. His great deeds had given him no arrogance. His was a clean,
+strong, vigorous life. His spirit remained sweet and true and modest to
+the last. He lived a God-fearing man, and died on June 25, 1830, in the
+communion of the Episcopal Church.
+
+1813. While McDowell was so busily engaged in his special line of
+surgery, his colaborers elsewhere in the State were not idle. Four years
+after his first ovariotomy, the first complete extirpation of the
+clavicle ever done was accomplished by Dr. Charles McCreary, living in
+Hartford, Ohio County, Ky., two hundred miles, as the crow would fly,
+farther into the wilderness. The patient was a lad named Irvin. The
+disease for which the operation was done was said to be scrofulous.
+Recovery was slow but complete. The use of the arm remained unimpaired,
+and the patient lived, in good health, to be forty-nine years old.
+
+In 1829, sixteen years after the back-woods surgeon had achieved his
+success, Professor Mott repeated the operation, also on a youth, with a
+like fortunate result, and, believing he was first in the field, claimed
+the honor of the procedure for the United States, for New York, and for
+himself. He termed it his "Waterloo operation," not, however, because it
+surpassed, as he declared, in tediousness, difficulty, and danger any
+thing he had ever witnessed or performed, but because, as it appears,
+it fell on the 18th of June, the anniversary of the battle of Waterloo.
+
+Mott's operation required nearly four hours for its execution, and the
+tying of forty vessels; but after all it proved to be not a complete
+extirpation; for the autopsy, made many years later, showed three
+quarters of an inch of the bone at the acromial end still in its place.
+Yet the case passed quickly into the annals of surgery and added much to
+the already great renown of the operator. To this day it is referred to
+by surgical writers as "Mott's celebrated case," and the description of
+his procedure is often given in his own words.
+
+McCreary removed the entire collar bone, and that while a young
+practitioner, living in a village composed of a few scattering houses,
+situated in a new and sparsely settled country, where opportunities for
+cultivating surgical science were necessarily rare, and the means for
+acquiring anatomical knowledge necessarily small.
+
+The only published report of McCreary's case is from the pen of Dr.
+Johnson, in the New Orleans Medical and Surgical Journal for January,
+1850. The account, though all too brief, clearly establishes the date of
+the operation, its successful issue, and the removal of the entire bone.
+
+It is greatly to be regretted that more is not known of McCreary's
+personal and professional character. He is said, by one who met him
+often, to have been a serious, thoughtful man, given to study, devoted
+to his calling, and fatally fond of drink, to which he fell a victim
+when but thirty-seven years of age.
+
+1814. A younger man than either of those I have attempted to sketch, Dr.
+Benjamin Winslow Dudley, now came upon the stage. He, too, was the son
+of a pioneer. His early training was much like that of his
+contemporaries. Like Brashear, he had instruction in the office of Dr.
+Ridgely. Like him, he had attended lectures in the University of
+Pennsylvania. Unlike him, he carried away its diploma. This he did in
+1806, just two weeks before he was twenty-one years old. He came home,
+opened an office, and offered his services to the public. The public
+gave him little business. He was deficient either in the knowledge or in
+the self-trust necessary to professional success. McDowell was located
+in a village hard by--was applying himself mainly to surgery, and was
+already in full practice. Dudley resolved to still better qualify
+himself for the work he was ambitious to do. He longed to go into the
+hospitals and follow the great teachers of Europe, but lacked the means.
+To get these he made a venture in trade. He purchased a flat-boat,
+loaded it with produce, headed it for New Orleans, and floated down the
+Kentucky, the Ohio, and the Mississippi rivers to the desired port. He
+invested the proceeds of his cargo in flour. This he billed to
+Gibraltar, which he reached some time in 1810; there and at Lisbon he
+disposed of it at a large advance.
+
+The opportunities he had sought were now near at hand. He hastened
+through Spain to Paris. While there he heard Baron Larrey recite his
+wonderful military experience. He made the acquaintance of Caulaincourt,
+"the Emperor's trusted minister." Through him he was present with Talma
+and John Howard Payne in the Chamber of Deputies when Napoleon entered
+the building at the close of his disastrous Russian campaign. He saw the
+Emperor mount the tribune. He heard him begin his report with these
+portentous words: "The Grand Army of the Empire has been annihilated."
+
+Remaining in Paris nearly three years, he crossed the Channel to observe
+surgery as practiced in London. While there he listened to Abernethy as
+he dwelt with all his wonted enthusiasm on his peculiar doctrine. He
+heard him reason it; he saw him act it, dramatize it, and came away
+believing him to be "the highest authority on all points relating to
+surgery, as at once the observant student of nature, the profound
+thinker, and the sound medical philosopher." He always referred to him
+as the greatest of surgeons. He saw Sir Astley Cooper operate, and
+habitually designated him as the most skilled and graceful man in his
+work he had ever known.
+
+He returned to Lexington in the summer of 1814, "in manners a Frenchman,
+but in medical doctrine and practice thoroughly English." The public was
+quick to detect that he had improved his time while away. "His
+profession had become the engrossing object of his thought, and he
+applied himself to it with undeviating fidelity. He made himself its
+slave." One who knew him well wrote of him: "He had no holidays. He
+sought no recreation; no sports interested him. His thoughts, he had
+been heard to say, were always on his cases, and not on the objects and
+amusements around him." He found Lexington in the midst of an epidemic
+of typhoid pneumonia, the same that had prevailed in the older States.
+This singularly fatal disease was followed by a "bilious fever,
+characterized, like the plague, by a tendency to local affections.
+Abscesses formed among the muscles of the body, legs, and arms, and were
+so intractable that limbs were sometimes amputated to get rid of the
+evil." Recalling the use he had seen made of the bandage, while abroad,
+in the treatment of ulcers of the leg, Dudley applied this device to the
+burrowing abscesses he saw so frequently in the subjects of the fever.
+The true position and exceeding value of the roller bandage were not so
+generally recognized then as now. Dr. Dudley was no doubt himself
+surprised at the success which followed the practice. This success
+probably led him to urge that wide application of the bandage with which
+his name came in time to be so generally associated.
+
+The tide of practice now set full toward him. He had come home a
+thorough anatomist. With opportunity he exhibited surpassing skill in
+the use of the knife. His reputation soon became national.
+
+No medical school had at that time been founded west of the Alleghanies.
+The need of such an institution was felt on every hand. Transylvania
+University, already of established reputation, was in operation. It
+required only a school in medicine to make it complete in its several
+departments. The trustees met in 1817 and added this to its
+organization. Dr. Dudley was made its head and appointed to fill the
+chairs of anatomy and surgery. A small class of students assembled in
+the autumn. At the commencement exercises held the following spring, W.
+L. Sutton was admitted to the doctorate--the first physician given that
+distinction by an institution in the West. Troubles arose in the
+faculty. Resignations were sent in and accepted. Dr. Richardson, one of
+the corps, challenged Dr. Dudley. A meeting followed. Richardson left
+the field with a pistol wound in his thigh which made him halt in his
+gait for the rest of his life. The year following a second organization
+was effected, which included the two belligerent teachers.
+
+The history of the Medical Department of Transylvania University--its
+rise, its success, its decline, its disappearance from the list of
+medical colleges--would practically cover Dr. Dudley's career, and would
+form a most interesting chapter in the development of medical teaching
+in the Southwest. But it must suffice me here to say that Dr. Dudley
+created the medical department of the institution and directed its
+policy. Its students regarded him from the beginning as the foremost man
+in the faculty. That he had colleagues whose mental endowments were
+superior to his he himself at all times freely admitted. He is said to
+have laid no claim to either oratorical power or professional erudition.
+He was not a logician, he was not brilliant, and his deliverances were
+spiced with neither humor nor wit. And yet, says one of his biographers,
+in ability to enchain the students' attention, to impress them with the
+value of his instructions and his greatness as a teacher, he bore off
+the palm from all the gifted men who, at various periods, taught by his
+side. A friend and once a colleague described his manner while lecturing
+as singularly imposing and impressive. "He was magisterial, oracular,
+conveying the idea always that the mind of the speaker was troubled with
+no doubt. His deportment before his classes was such as further to
+enhance his standing. He was always, in the presence of his students,
+not the model teacher only, but the dignified, urbane gentleman;
+conciliating regard by his gentleness, but repelling any approach to
+familiarity; and never for the sake of raising a laugh or eliciting a
+little momentary applause descending to coarseness in expression or
+thought. So that to his pupils he was always and everywhere great. As an
+operator they thought he had distanced competition. As a teacher they
+thought he gave them not what was in the books, but what the writers of
+the books had never understood. They were persuaded that there was much
+they must learn from his lips or learn not at all." His hold upon the
+public was as great as that upon his classes. "Patients came to him from
+afar because it was believed that he did better what others could do
+than any one else, and that he did much which no one else in reach could
+do."
+
+During the larger part of Dr. Dudley's life few physicians in any part
+of America devoted themselves exclusively to surgery. The most eminent
+surgeons were general practitioners--all-round men. In this class Dr.
+Dudley was equal to the best. In one respect, at least, he took advance
+ground--he condemned blood-letting. He was often heard to declare that
+every bleeding shortened the subject's life by a year. Admiring
+Abernethy more than any of his teachers, his opinions were naturally
+colored by the views of this eccentric Englishman. Like him he believed
+in the constitutional origin of local diseases, but his practice varied
+somewhat from that of his master. Like him he gave his patients blue
+pill at night but omitted the black draught in the morning. He thought
+an emetic better, and secured it by tartarized antimony. Between the
+puke and the purge his patients were fed on stale bread, skim milk, and
+water-gruel. And this heroic practice he pursued day after day, for
+weeks and months together, in spinal caries, hip caries, tuberculosis,
+urethral stricture and other diseases.
+
+I said that as a physician he was equal to the best. As we see things
+to-day this would not, perhaps, be saying much; but in fact he was
+better than the best. Negatively, if not positively, he improved upon
+the barbaric treatment of disease then in universal favor. He wholly
+discarded one of the most effective means by which the doctors succeeded
+in shortening the life of man. This was just before those biological
+dawnings which were soon to break into the full light of physiological
+medicine and the rational system of therapeutics based thereupon. And
+it is not improbable that as a watcher in that night of therapeutical
+darkness, where the doings of the best strike us with horror, his
+prophetic eye caught some glimpses of the coming day which in old age it
+was given him to see. Though engaged chiefly with the great things in
+surgery, he deserves a place in the list of therapeutic reformers.
+
+Much of the renown acquired for Kentucky by her surgeons was in the
+treatment of calculous diseases. This State is believed to have
+furnished almost as many cases of stone as all the rest of the Union.
+Dr. Dudley stands the confessed leader of American lithotomists, heading
+the list with two hundred and twenty-five cases. Of these he presents an
+unbroken series of one hundred consecutive successful operations. He
+used the gorget in all. He preferred the instrument invented by Mr.
+Cline, of London. "In one case, when his patient was on the table, he
+discovered that his accustomed operation was impracticable from
+deformity of the pelvis, and while his assistants were taking their
+positions resolved to make the external incision transverse, which was
+executed before any one else present had remarked the difficulty."
+Through this incision he removed a stone three and a half inches in the
+long diameter, two and a half inches in the short, by eleven inches in
+circumference. The patient recovered.
+
+In an article contributed to the Transylvania Journal of Medicine by Dr.
+Dudley, in 1828, he thus wrote of the trephine: "The experience which
+time and circumstances have afforded me in injuries of the head induced
+me to depart from the commonly received principles by which surgeons are
+governed in the use of the trephine. In skillful hands the operation,
+beyond the atmosphere of large cities, is neither dangerous in its
+consequences nor difficult in the execution." In this remark Dr. Dudley
+bore early testimony to the efficacy of aseptic surgery. He urged the
+trephine in the treatment of epilepsy and applied it in six cases--in
+four of which the disease was cured. The result in the two remaining
+cases is unknown, because the patients were lost sight of.
+
+Dr. Dudley believed himself to be the first surgeon who ever attempted
+to treat _fungus cerebri_ by gentle and sustained pressure made with dry
+sponge aided by the roller. Of the first cases in which he used it, he
+wrote: "By imbibing the secretions of the part, the pressure on the
+protruded brain regularly and insensibly increased until the sponge
+became completely saturated. On removing it the decisive influence and
+efficacy of the agent remained no longer a matter of doubt." He noted
+the difficulty experienced in removing the sponge because of its being
+extensively penetrated by blood-vessels springing from the surface of
+the brain. This inconvenience he afterward obviated by putting a thin
+piece of muslin between the fungus and the sponge. He saw in this
+property of the sponge what no doubt others had seen before, the
+phenomenon of sponge-grafting, but like them he failed to utilize it in
+practice.
+
+Dr. Dudley was not a student of books. He had no taste for literature.
+He wrote but little, and that only for the Transylvania Journal of
+Medicine, edited by two of his colleagues, Professors Cooke and Short.
+His first article did not appear until 1828, fourteen years after he had
+begun practice. It was on injuries of the head. It abounded in original
+views, and did much to shape surgical thought at the time. Today it may
+be consulted with profit. His second paper was on hydrocele; in this he
+advocated the operation by incision and removal of the sac. He read so
+little that he fell into the error of believing that he was the
+originator of the procedure. There are writers in our own day who would
+be able to hold their own against him in this particular. A paper on the
+bandage, another on fractures, and one on the nature and treatment of
+calculous diseases, embrace all his contributions to medical literature.
+
+Dr. Dudley was the son of Ambrose Dudley, a distinguished Baptist
+minister. He was born in Spottsylvania County, Va., April 25, 1785. When
+but a year old he was brought by his father to the then county of
+Kentucky. The family settled in Lexington, in which beautiful city the
+child became a man, and lived and wrought and died. The date of his
+death is January 25, 1870; his age was eighty-five years.
+
+Dr. Dudley was a man of affairs. His practice was always large and paid
+him well. He amassed a handsome fortune. His opinions were often sought
+in courts of justice on professional points, where his dignity,
+self-possession, and dry wit (which he seems to have suppressed at the
+lecturer's desk), commanded the respect of judge, juror, and advocate,
+while it made him the terror of the pettifogger. Once, while giving
+expert testimony in a case involving a wound made by bird-shot delivered
+at short range, he described the behavior of projectiles, and the danger
+of bullet wounds. The opposing counsel interrupted him: "Do you mean to
+say," said the lawyer, "do you mean to say, Dr. Dudley, that shot wounds
+are as dangerous as bullet wounds?" "Shot are but little bullets," was
+the unhesitating reply.
+
+Dr. Dudley had also a proper sense of the value of his professional
+services. He was called on one occasion to a town near Lexington to
+attend a patient in labor, who was the wife of a man made rich by
+marriage. The husband was too wise to engage a "night rider," and too
+purse-proud to call the village doctor. At that time most of the one
+hundred dollar notes in circulation in Kentucky were issued by the
+Northern Bank, at Lexington. On the reverse side of the bill was the
+letter C in Roman capital. This letter was so round in figure that it
+looked like a "bull's-eye," and in local slang was so called. The visit
+being over, and the doctor ready to leave, the young father handed him
+one of these notes. Eyeing it for a moment, Dr. Dudley said: "Another
+'bull's-eye,' Mr. X., if you please."
+
+In person Dr. Dudley was of medium size. His features were refined, the
+forehead wide and high, the nose large and somewhat thick, the lips
+thin, the eyes bluish-gray. His hair was thin, light, and of a sandy
+tint. He was a graceful man. His voice was pleasing; his manners
+courtly; his bearing gracious.
+
+He married Miss Short, daughter of Major Peyton Short, in 1821. He
+delivered his last lecture in 1850, and the last entry on his ledger
+bears the date of April 28, 1853.
+
+       *       *       *       *       *
+
+I can not give these remarks more fitting close than by describing
+briefly the surroundings which set their impress upon the character of
+the men whose lives I have attempted to portray. The picture is full of
+meaning, dignity, and simplicity. In this time "Canetuckee" was still a
+part of Virginia. The grounds on which, as boys, they played were held
+by their fathers under what is known as a "tomahawk claim." "Beyond lay
+endless leagues of shadowy forest." "The Illinois" had not been admitted
+into the sisterhood of the States. The vast domain west of the
+Mississippi River was unexplored. The city of St. Louis was but an
+outpost for traders. The name "Chicago" had not been coined. Fort
+Dearborn, occupied by two companies of United States troops, marked a
+roll in the prairie among the sloughs where stands to-day the queen and
+mistress of the lakes. Cincinnati had no place on the map, but was known
+as Fort Washington. General Pakenham had not attempted the rape of New
+Orleans, and General Jackson, who was to drive him with his myrmidons
+fleeing to his ships, was unknown to fame. Wars with Indians were
+frequent. Massacres by Indians were common. The prow of a steamboat had
+never cut the waters of a Western river. Railroads were unknown in the
+world. There were but two avenues by which Kentucky could be reached
+from the East. One was the water-way, furnished by the Ohio River. The
+other was the "Wilderness Road," "blazed" by Daniel Boone. The former
+was covered in keel-boats, flat-boats, and canoes. The latter was
+traveled on horseback or on foot. No wheel had broken it or been broken
+by it. The fathers of the subjects of this narrative followed this road
+after crossing the Alleghanies. They were a clear-eyed, a bold, an
+adventurous people. They wrested the land from the savage, made it
+secure by their arms, and by the toil of their hands fitted it for its
+present civilization. Among these, and such as these, these heroes in
+the bloody exploits of surgery were reared. From such ancestors they
+drew that dauntless courage which was so often tried in their
+achievements--achievements the fame of which will not lapse with the
+lapse of time. Boone had opened the way to the wilderness around them.
+He "blazed" a path through its unbroken depths, along which the stream
+of civilization quickly flowed. They blazed a path through the
+unexplored regions of their art along which surgeons continue to tread.
+His name is written in the history of his adopted State and embalmed in
+the traditions of its people. Their names are written in the chronicles
+of their beloved calling and upon the hearts of myriads of sufferers
+whom their beneficent labors have relieved. They may or may not have
+felt that their work was durable. But durable it is, and it hands down
+to posterity a _monumentum aere perennius_, the absolute worth of which
+passes computation. No present or future modification of this work can
+rob its authors of that glory which crowns the head of the original
+workman.
+
+Like their kinsmen in genius, these toilers devised measures and dealt
+with issues in advance of their time. Like them they enjoyed but scant
+recompense for labors the far-reaching significance of which they did
+not comprehend. Let us who are reaping in the harvest which they sowed
+forget not how much we are beholden to these immortal husbandmen. And as
+we contemplate the shining record of their deeds, let it counsel us to
+"bend ourselves to a better future." Not that we may hope to rival their
+sublime achievements, but that each in his walk, however humble it may
+be, may strive to enlarge the sphere of his usefulness by making surgery
+the better for his having practiced it.
+
+
+BIBLIOGRAPHY.
+
+  Gross's Report on Kentucky Surgery.
+  Gross's Medical Biography.
+  L. P. Yandell's Report on the Medical Literature of Kentucky.
+  L. P. Yandell's Life of Benjamin W. Dudley.
+
+
+
+
+Transcriber's Note:
+
+Page 27 The dot above the "i" in _fungus cerebri_ is not
+evident in the original publication.
+
+
+
+
+
+End of Project Gutenberg's Pioneer Surgery in Kentucky, by David W. Yandell
+
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