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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..6833f05 --- /dev/null +++ b/.gitattributes @@ -0,0 +1,3 @@ +* text=auto +*.txt text +*.md text diff --git a/28322-8.txt b/28322-8.txt new file mode 100644 index 0000000..a04601b --- /dev/null +++ b/28322-8.txt @@ -0,0 +1,1115 @@ +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. 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Yandell + </title> + <style type="text/css"> + +body { + margin-left: 10%; + margin-right: 10%;} + + h1,h2,h3,h4,h5,h6 { + text-align: center; /* all headings centered */ + clear: both;} + +p { + margin-top: .75em; + text-align: justify; + margin-bottom: .75em;} + +hr { + width: 33%; + margin-top: 2em; + margin-bottom: 2em; + margin-left: auto; + margin-right: auto; + clear: both;} + +.pagenum { /* uncomment the next line for invisible page numbers */ + visibility: hidden; + position: absolute; + left: 92%; + font-size: smaller; + text-align: right;} /* page numbers */ + +.center {text-align: center;} + +.smcap {font-variant: small-caps;} + +.blockquot { + margin-left: 30%; + margin-right: 10%;} + +/* Poetry */ +.poem { + margin-left:10%; + margin-right:10%; + text-align: left;} + +.poem br {display: none;} + +.poem .stanza {margin: 1em 0em 1em 0em;} + +.poem span.i0 { + display: block; + margin-left: 0em; + padding-left: 3em; + text-indent: -3em;} + +.center {text-align: center;} + + </style> + </head> +<body> + + +<pre> + +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) + + + + + + +</pre> + + +<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 & 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—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.</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—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—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—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—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<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—all-round men. In this class Dr. +Dudley was equal to the best. In one respect, at least, he took advance +ground—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—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—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 + +*** END OF THIS PROJECT GUTENBERG EBOOK PIONEER SURGERY IN KENTUCKY *** + +***** This file should be named 28322-h.htm or 28322-h.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/2/8/3/2/28322/ + +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) + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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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. 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