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  PIONEER SURGERY IN KENTUCKY:

  A SKETCH.

  BY DAVID W. YANDELL, M. D.,

  PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF LOUISVILLE, KY;
  PRESIDENT OF THE AMERICAN SURGICAL ASSOCIATION.

  LOUISVILLE:

  PRINTED BY JOHN P. MORTON & COMPANY.

  1890


  THE PRESIDENT'S ADDRESS:

  DELIVERED AT THE
  REGULAR ANNUAL MEETING OF THE

  AMERICAN SURGICAL ASSOCIATION,

  WASHINGTON, D.C., MAY 13, 1890.




PIONEER SURGERY IN KENTUCKY.

A SKETCH.


FELLOWS OF THE ASSOCIATION: In the endeavor to chronicle the lives and
achievements of Kentucky Pioneers in Surgery, I shall not attempt the
resurrection of village Hampdens or mute inglorious Miltons. The men
with whom I deal were men of deeds, not men of fruitless promise.

It may with truth be said that from Hippocrates to Gross few in our
profession who have done enduring work have lacked biographers to pay
liberal tribute to their worth. In justice to the unremembered few, I
turn back the records of medicine for a century, and put my finger upon
two names that in the bustling march of science have been overlooked,
while I try to set in fuller light two other names of workers in that
day, which have and will hold an exalted place in history. The worthies
to whom these names belong were pioneers in civilization as well as in
surgery. I shall introduce them in the order of their work.

1806. The earliest original surgical work of any magnitude done in
Kentucky, by one of her own sons, was an amputation at the hip-joint.
It proved to be the first operation of the kind in the United States.
The undertaking was made necessary because of extensive fracture of the
thigh with great laceration of the soft parts. The subject was a mulatto
boy, seventeen years of age, a slave of the monks of St. Joseph's
College. The time was August, 1806; the place, Bardstown; the surgeon,
Dr. Walter Brashear; the assistants, Dr. Burr Harrison and Dr. John
Goodtell; the result, a complete success. The operator divided his work
into two stages. The first consisted in amputating the thigh through its
middle third in the usual way, and in tying all bleeding vessels. The
second consisted of a long incision on the outside of the limb, exposing
the remainder of the bone, which, being freed from its muscular
attachments, was then disarticulated at its socket.

Far-seeing as the eye of the frontiersman was, he could not have
discerned that the procedure by which he executed the most formidable
operation in surgery came so near perfection that it would successfully
challenge improvement for more than fourscore years.

Hundreds of hips have since been amputated after some forty different
methods; but that which he introduced has passed into general use, and
(though now known under the name of Furneaux Jordan's) remains the
simplest, the least dangerous, the best.

The first genuine hip-joint amputation executed on living parts was done
by Kerr, of Northampton, England, 1774. The first done for shot wounds
was by Larrey, in 1793. I feel safe in saying that Brashear had no
knowledge of either of these operations. He therefore set about his work
without help from precedent, placing his trust in himself, in the
clearness of his own head, in the skill of his own hands, in the courage
of his own heart. The result shows that he had not overestimated what
was in him. But whether or not Brashear had ever heard or read a
description of what had been accomplished in this direction by surgeons
elsewhere, the young Kentuckian was the first to amputate at the
hip-joint in America, and the first to do the real thing successfully in
the world.

Dr. Brashear seems to have set no high estimate on his achievement, and
never published an account of the case. Had he done so, the art of
surgery would thereby have been much advanced, his own fame have been
made one of the precious heritages of his country, and, what is better,
many valuable lives would have been saved.

Eighteen years after the Jesuits' slave had survived the loss of his
limb, the report of the much-eulogized case of Dr. Mott appeared.

Dr. Brashear came of an old and wealthy Catholic family of Maryland. He
was born in February, 1776. His father journeyed to Kentucky eight
years later, and cleared a farm near Shepherdsville, in Bullitt County.
Walter was his seventh son, and was therefore set apart for the medical
profession.

When a youth he was enrolled in the literary department of Transylvania
University, where it is said he ranked high as a scholar in Latin. At
the age of twenty he began the study of medicine, in Lexington, with Dr.
Frederick Ridgely, a very cultivated physician and popular man, who had
won distinction in the medical staff of the Continental Army. After two
years spent in this way, he rode on horseback to Philadelphia, and
attended upon a course of lectures in the University of Pennsylvania. At
this time Rush, Barton, and Physick were teachers in that venerable seat
of learning. His was a restless nature, and after a year spent in
Philadelphia he shipped to China as surgeon of a vessel. While among the
Celestials he amputated a woman's breast, probably the first exploit of
the kind by one from the antipodes. Unfortunately for science, he there
learned the method used by the Chinese for clarifying ginseng, and
thinking, on his return home, that he saw in this an easy way to wealth,
he abandoned the profession in which he had exhibited such originality,
judgment, and skill, and engaged in merchandising. Twelve years of
commerce and its hazards left him a bankrupt in fortune, but brought
him back to the calling in which he was so well fitted to shine. He
moved, in 1813, from Bardstown to Lexington, where he at once secured a
large practice, especially in diseases of the bones and joints. He was
thought to excel in the treatment of fractures of the skull, for the
better management of which a trephine was made in Philadelphia, under
his direction, which, in his judgment, was superior to any then in use.

The same temper which led him to leave Philadelphia without his medical
degree, sail to China, and afterward enter commerce, again asserted
itself, and he forsook for the second time his vocation. With his family
he now moved to St. Mary's Parish, Louisiana, and engaged in
sugar-planting. During his residence in the South he served his adopted
State in the Senate of the United States. He employed much time in the
study of the flora of the West. "During the winter of 1843-4, when Henry
Clay was on a visit to New Orleans" (says a writer in the New Orleans
Medical and Surgical Journal), "we had the pleasure, together with some
twenty-five physicians, of spending the evening with him at the house of
a medical friend. While at the table one of the company proposed the
health of the venerable Dr. Brashear, 'the first and only surgeon in
Louisiana who had successfully performed amputation at the hip-joint.'
Mr. Clay, who sat next to Dr. Brashear, with characteristic good humor,
immediately observed, 'He has you on the hip, Doctor,' to the great
amusement of Brashear and the rest of the company."

Dr. Brashear was a man of fine literary taste and many and varied
accomplishments. In conversation he was always entertaining, often
brilliant. His voice was pleasant, his manners affable. In stature he
was short; in movement, quick and nervous. But in the make-up of the man
one essential of true greatness--fixedness of purpose--had been omitted.
He lacked the staying qualities. He was "variable and fond of change."
"His full nature, like that river of which Alexander broke the strength,
spent itself in channels which led to no great name on earth." By a
single exploit, at the age of thirty, he carved his name at high-water
mark among the elect in surgery. Most of his life thereafter he wasted
in desultory labors. As the learned Grotius said of his own life, he
consumed it in levities and strenuous inanities.

He died at an advanced age at his home in Louisiana.

1809. Three years after Brashear had won his unparalleled success at
Bardstown, a practitioner already of wide repute as a surgeon, living in
Danville, a neighboring village, did the second piece of original
surgical work in Kentucky. It consisted in removing an ovarian tumor.
The deed, unexampled in surgery, is destined to leave an ineffaceable
imprint on the coming ages. In doing it Ephraim McDowell became a prime
factor in the life of woman; in the life of the human race. By it he
raised himself to a place in the world's history, alongside of Jenner,
as a benefactor of his kind; nay, it may be questioned if his place be
not higher than Jenner's, since he opened the way for the largest
addition ever yet made to the sum total of human life.

So much has been written of this, McDowell's chief work, that I feel it
needless to dwell upon it. All students of our art are familiar with it
as presented by abler hands than mine. What I shall say of him,
therefore, will relate rather to his life and general work than to the
one operation by which his name has come to be the most resounding in
all surgery. This is a much more difficult task than at first it might
seem to be, for McDowell made no sketch of himself, nor have his
brothers or his children left us any record of his life. Even his early
biographers failed to gather from his surviving friends those personal
recollections of the man which would now be of such exceeding interest
to us all. An authentic life-size portrait of Ephraim McDowell, as he
was seen in his daily walk among men, can not now be made. The
materials are too scant; the time to collect them has gone by. A
profile, a mere outline drawing, is all that is possible to-day. The
picture I have attempted, therefore, will be found deficient in many
details which have passed into general acceptance.

It is known that he came of a sturdy stock, his blood being especially
rich in two of the best crosses--the Scotch-Irish. His great-grandfather
rebelled against the hierarchy of his time, and enlisted as a Covenanter
under the banner of James I. After honorable service, he laid down his
arms, gathered his family together, and came to America. It was in honor
of this ancestor that the subject of the present sketch was named.

The maiden name of his mother was McClung. She was a member of a
distinguished family of Virginia. McDowell was born in Rockbridge
County, Virginia, on November 11, 1771. He was the ninth of twelve
children. His father, Samuel McDowell, was a man of note and influence
in the State, and was honored with many positions of trust. In 1773 he
removed with his family to Kentucky, settling near Danville. He was made
judge of the District Court of Kentucky, and took part in organizing the
first court ever formed in the State. He lived to see his son
confessedly the foremost surgeon south of the Blue Ridge. But it was
not given to eyes of that day to see that the achievements of the
village operator had illuminated all the work which has since been done
in the abdominal cavity, that one had grown up and toiled in their
midst,

    "Whose influence ineffable is borne
    Round the great globe to cheerless souls that yearned
    In darkness for this answer to their needs."

Ephraim's early education was gotten at the school of the town in which
he lived. He completed his school studies at an institution of somewhat
higher pretentions, situated in a county near by. No anecdotes are
preserved of his childhood. During his school-age he clearly preferred
the out-door sports of his companions to the in-door tasks of his
teachers. On quitting school he crossed the Alleghanies and became an
office pupil of Dr. Humphreys, of Staunton, Va. After reading under this
preceptor for two years, he repaired to the University of Edinburgh. The
Scotch metropolis was then styled the "Modern Athens." It afforded
opportunities at that time for acquiring a medical education the best in
all the world. It was then to the medical profession what Leyden had
been in the days of Sir Thomas Browne, what Paris became when Velpeau
and Louis taught there. He entered the private class of John Bell, whose
forceful teachings and native eloquence made a lasting impression on
the mind of his youthful hearer. It has been said that McDowell
conceived the thought of ovariotomy from some suggestions thrown out by
this great man. The only distinction he is known to have won while in
Edinburgh was that of having been chosen by his classmates to carry the
colors of the college in a foot-race against a professional. In this it
appears he was an easy first. He came away without a diploma. But what
was of far greater value than a degree, he brought back the anatomical
and surgical knowledge which was to place him in the front of his
profession.

He returned to Kentucky in 1795, and settled among the people who had
known him from boyhood. His success was immediate, and yet Dr. Samuel
Brown, who knew him in Virginia, and was his classmate in Scotland, had
said, when asked of him: "Pish! he left home a gosling and came back a
goose." In a little while he commanded all the surgical operations of
importance for hundreds of miles around him, and this continued till,
some years later, Dudley returned from Europe to share with him the
empire in surgery.

In 1802, fully established in his profession, and with an income which
rendered him independent, he married Sarah, daughter of Governor Isaac
Shelby.

In 1809 he did his first ovariotomy. He believed the operation to be
without precedent in the annals of surgery, yet he kept no note of it or
of his subsequent work. He prepared no account of it until 1817. This
appeared in the Eclectic Repertory. It was so meagre and so startling
that surgeons hesitated to credit its truth. He had not mastered his
mother tongue. The paper was thought to bear internal evidence of its
author's having "relied upon his ledger for his dates and upon his
memory for the facts." The critics from far and near fell upon him. The
profession at home cast doubt upon the narrative. The profession abroad
ridiculed it. For all that, McDowell kept his temper and his course, and
when he finally laid down his knife he had a score of thirteen
operations done for diseased ovaria, with eight recoveries, four deaths,
and one failure to complete the operation because of adhesions.

It would be neither fitting nor becoming on this occasion, and in this
presence, to speak in detail of the technic observed by McDowell in his
work. That has long since passed into history. I may, however, be
permitted the remark that the procedure, in many of its features, is
necessarily that of to-day. The incision was longer than that now
usually made, and the ends of the pedicle ligature were left hanging
from the lower angle of the wound. But the pedicle itself was dropped
back into the abdomen. The patient was turned on her side to allow the
blood and other fluids to drain away. The wound was closed with
interrupted sutures. This marvel of work was done without the help of
anesthetics or trained assistants, or the many improved instruments of
to-day, which have done so much to simplify and make the operation easy.
McDowell had never heard of antisepsis, nor dreamed of germicides or
germs; but water, distilled from nature's unpolluted cisterns by the
sun, and dropped from heaven's condensers in the clean blue sky, with
air winnowed through the leaves of the primeval forest which deepened
into a wilderness about him on every hand, gave him and his patients
aseptic facility and environment which the most favored living
laparotomist well might envy. These served him well, and six out of
seven of his first cases recovered. He removed the first tumor in
twenty-five minutes, a time not since much shortened by the average
operator.

It was not alone, however, in this hitherto unexplored field of surgery
that McDowell showed himself a master. His skill was exhibited equally
in other capital operations. He acquired at an early day distinction as
a lithotomist, which brought to him patients from other States. He
operated by the lateral method, and for many years used the gorget in
opening the bladder. At a later period he employed the scalpel
throughout. He performed lithotomy thirty-two times without a death.
Among those who came to him to be cut for stone was a pale, slender boy,
who had traveled all the way from North Carolina. This youth proved to
be McDowell's most noted patient. He was James K. Polk, afterward
President of the United States.

Dr. McDowell's "heart was fully open to the lesson of charity, which
more than all men we should feel," and he dispensed it with constant
remembrance of the sacred trust imposed upon us. Yet he had a proper
appreciation of what was due his guild from those whose means allowed
them to make remuneration for professional services. He charged $500 for
an ovariotomy that he went to Nashville, Tenn., to do. The husband of
the patient gave him a check, as he supposed, for that sum. On
presenting it, the doctor discovered that it was drawn for $1,500
instead of $500, whereupon he returned the check, thinking a mistake had
been made. The grateful gentleman replied that it was correct, and added
that the services much outweighed the sum paid. When the fact is borne
in mind that the purchasable value of money was much greater in the
first than in this the last decade of the century, it will be seen that
the "father of ovariotomy," at least, set his successors in the field a
good example. This is made conspicuous by the fact that Sir Spencer
Wells has seldom charged a larger sum, and has declared L100 to be a
sufficient fee for the operation.

In person Dr. McDowell was commanding. He was tall, broad-shouldered,
stout-limbed. His head was large, his nose prominent and full of
character, his chin broad, his lips full and expressive of
determination, his complexion florid, his eyes dark-black. His voice was
clear and manly; he often exercised it in recitations from Scotch
dialogues, when he would roll the Scotch idiom upon his tongue with the
readiness of a native. He was fond of music, especially comic pieces,
which he sang with fine effect, accompanying his voice sometimes with
the violin.

He was a man of the times, taking an active interest in the affairs of
the community in which he lived. He had many books for that day. Cullen
and Sydenham were his chief authorities in medicine; Burns and Scott in
literature. He was fond of reading, yet he was inclined to action rather
than study.

He placed great reliance on surgery and its possibilities; he placed
little trust in drugs. He counselled against their too liberal use. In
truth, he did not like the practice of medicine, and turned over most of
his non-surgical cases to his associate in business. In manner he was
courteous, frank, considerate, and natural. He was a simple, ingenuous
man. His great deeds had given him no arrogance. His was a clean,
strong, vigorous life. His spirit remained sweet and true and modest to
the last. He lived a God-fearing man, and died on June 25, 1830, in the
communion of the Episcopal Church.

1813. While McDowell was so busily engaged in his special line of
surgery, his colaborers elsewhere in the State were not idle. Four years
after his first ovariotomy, the first complete extirpation of the
clavicle ever done was accomplished by Dr. Charles McCreary, living in
Hartford, Ohio County, Ky., two hundred miles, as the crow would fly,
farther into the wilderness. The patient was a lad named Irvin. The
disease for which the operation was done was said to be scrofulous.
Recovery was slow but complete. The use of the arm remained unimpaired,
and the patient lived, in good health, to be forty-nine years old.

In 1829, sixteen years after the back-woods surgeon had achieved his
success, Professor Mott repeated the operation, also on a youth, with a
like fortunate result, and, believing he was first in the field, claimed
the honor of the procedure for the United States, for New York, and for
himself. He termed it his "Waterloo operation," not, however, because it
surpassed, as he declared, in tediousness, difficulty, and danger any
thing he had ever witnessed or performed, but because, as it appears,
it fell on the 18th of June, the anniversary of the battle of Waterloo.

Mott's operation required nearly four hours for its execution, and the
tying of forty vessels; but after all it proved to be not a complete
extirpation; for the autopsy, made many years later, showed three
quarters of an inch of the bone at the acromial end still in its place.
Yet the case passed quickly into the annals of surgery and added much to
the already great renown of the operator. To this day it is referred to
by surgical writers as "Mott's celebrated case," and the description of
his procedure is often given in his own words.

McCreary removed the entire collar bone, and that while a young
practitioner, living in a village composed of a few scattering houses,
situated in a new and sparsely settled country, where opportunities for
cultivating surgical science were necessarily rare, and the means for
acquiring anatomical knowledge necessarily small.

The only published report of McCreary's case is from the pen of Dr.
Johnson, in the New Orleans Medical and Surgical Journal for January,
1850. The account, though all too brief, clearly establishes the date of
the operation, its successful issue, and the removal of the entire bone.

It is greatly to be regretted that more is not known of McCreary's
personal and professional character. He is said, by one who met him
often, to have been a serious, thoughtful man, given to study, devoted
to his calling, and fatally fond of drink, to which he fell a victim
when but thirty-seven years of age.

1814. A younger man than either of those I have attempted to sketch, Dr.
Benjamin Winslow Dudley, now came upon the stage. He, too, was the son
of a pioneer. His early training was much like that of his
contemporaries. Like Brashear, he had instruction in the office of Dr.
Ridgely. Like him, he had attended lectures in the University of
Pennsylvania. Unlike him, he carried away its diploma. This he did in
1806, just two weeks before he was twenty-one years old. He came home,
opened an office, and offered his services to the public. The public
gave him little business. He was deficient either in the knowledge or in
the self-trust necessary to professional success. McDowell was located
in a village hard by--was applying himself mainly to surgery, and was
already in full practice. Dudley resolved to still better qualify
himself for the work he was ambitious to do. He longed to go into the
hospitals and follow the great teachers of Europe, but lacked the means.
To get these he made a venture in trade. He purchased a flat-boat,
loaded it with produce, headed it for New Orleans, and floated down the
Kentucky, the Ohio, and the Mississippi rivers to the desired port. He
invested the proceeds of his cargo in flour. This he billed to
Gibraltar, which he reached some time in 1810; there and at Lisbon he
disposed of it at a large advance.

The opportunities he had sought were now near at hand. He hastened
through Spain to Paris. While there he heard Baron Larrey recite his
wonderful military experience. He made the acquaintance of Caulaincourt,
"the Emperor's trusted minister." Through him he was present with Talma
and John Howard Payne in the Chamber of Deputies when Napoleon entered
the building at the close of his disastrous Russian campaign. He saw the
Emperor mount the tribune. He heard him begin his report with these
portentous words: "The Grand Army of the Empire has been annihilated."

Remaining in Paris nearly three years, he crossed the Channel to observe
surgery as practiced in London. While there he listened to Abernethy as
he dwelt with all his wonted enthusiasm on his peculiar doctrine. He
heard him reason it; he saw him act it, dramatize it, and came away
believing him to be "the highest authority on all points relating to
surgery, as at once the observant student of nature, the profound
thinker, and the sound medical philosopher." He always referred to him
as the greatest of surgeons. He saw Sir Astley Cooper operate, and
habitually designated him as the most skilled and graceful man in his
work he had ever known.

He returned to Lexington in the summer of 1814, "in manners a Frenchman,
but in medical doctrine and practice thoroughly English." The public was
quick to detect that he had improved his time while away. "His
profession had become the engrossing object of his thought, and he
applied himself to it with undeviating fidelity. He made himself its
slave." One who knew him well wrote of him: "He had no holidays. He
sought no recreation; no sports interested him. His thoughts, he had
been heard to say, were always on his cases, and not on the objects and
amusements around him." He found Lexington in the midst of an epidemic
of typhoid pneumonia, the same that had prevailed in the older States.
This singularly fatal disease was followed by a "bilious fever,
characterized, like the plague, by a tendency to local affections.
Abscesses formed among the muscles of the body, legs, and arms, and were
so intractable that limbs were sometimes amputated to get rid of the
evil." Recalling the use he had seen made of the bandage, while abroad,
in the treatment of ulcers of the leg, Dudley applied this device to the
burrowing abscesses he saw so frequently in the subjects of the fever.
The true position and exceeding value of the roller bandage were not so
generally recognized then as now. Dr. Dudley was no doubt himself
surprised at the success which followed the practice. This success
probably led him to urge that wide application of the bandage with which
his name came in time to be so generally associated.

The tide of practice now set full toward him. He had come home a
thorough anatomist. With opportunity he exhibited surpassing skill in
the use of the knife. His reputation soon became national.

No medical school had at that time been founded west of the Alleghanies.
The need of such an institution was felt on every hand. Transylvania
University, already of established reputation, was in operation. It
required only a school in medicine to make it complete in its several
departments. The trustees met in 1817 and added this to its
organization. Dr. Dudley was made its head and appointed to fill the
chairs of anatomy and surgery. A small class of students assembled in
the autumn. At the commencement exercises held the following spring, W.
L. Sutton was admitted to the doctorate--the first physician given that
distinction by an institution in the West. Troubles arose in the
faculty. Resignations were sent in and accepted. Dr. Richardson, one of
the corps, challenged Dr. Dudley. A meeting followed. Richardson left
the field with a pistol wound in his thigh which made him halt in his
gait for the rest of his life. The year following a second organization
was effected, which included the two belligerent teachers.

The history of the Medical Department of Transylvania University--its
rise, its success, its decline, its disappearance from the list of
medical colleges--would practically cover Dr. Dudley's career, and would
form a most interesting chapter in the development of medical teaching
in the Southwest. But it must suffice me here to say that Dr. Dudley
created the medical department of the institution and directed its
policy. Its students regarded him from the beginning as the foremost man
in the faculty. That he had colleagues whose mental endowments were
superior to his he himself at all times freely admitted. He is said to
have laid no claim to either oratorical power or professional erudition.
He was not a logician, he was not brilliant, and his deliverances were
spiced with neither humor nor wit. And yet, says one of his biographers,
in ability to enchain the students' attention, to impress them with the
value of his instructions and his greatness as a teacher, he bore off
the palm from all the gifted men who, at various periods, taught by his
side. A friend and once a colleague described his manner while lecturing
as singularly imposing and impressive. "He was magisterial, oracular,
conveying the idea always that the mind of the speaker was troubled with
no doubt. His deportment before his classes was such as further to
enhance his standing. He was always, in the presence of his students,
not the model teacher only, but the dignified, urbane gentleman;
conciliating regard by his gentleness, but repelling any approach to
familiarity; and never for the sake of raising a laugh or eliciting a
little momentary applause descending to coarseness in expression or
thought. So that to his pupils he was always and everywhere great. As an
operator they thought he had distanced competition. As a teacher they
thought he gave them not what was in the books, but what the writers of
the books had never understood. They were persuaded that there was much
they must learn from his lips or learn not at all." His hold upon the
public was as great as that upon his classes. "Patients came to him from
afar because it was believed that he did better what others could do
than any one else, and that he did much which no one else in reach could
do."

During the larger part of Dr. Dudley's life few physicians in any part
of America devoted themselves exclusively to surgery. The most eminent
surgeons were general practitioners--all-round men. In this class Dr.
Dudley was equal to the best. In one respect, at least, he took advance
ground--he condemned blood-letting. He was often heard to declare that
every bleeding shortened the subject's life by a year. Admiring
Abernethy more than any of his teachers, his opinions were naturally
colored by the views of this eccentric Englishman. Like him he believed
in the constitutional origin of local diseases, but his practice varied
somewhat from that of his master. Like him he gave his patients blue
pill at night but omitted the black draught in the morning. He thought
an emetic better, and secured it by tartarized antimony. Between the
puke and the purge his patients were fed on stale bread, skim milk, and
water-gruel. And this heroic practice he pursued day after day, for
weeks and months together, in spinal caries, hip caries, tuberculosis,
urethral stricture and other diseases.

I said that as a physician he was equal to the best. As we see things
to-day this would not, perhaps, be saying much; but in fact he was
better than the best. Negatively, if not positively, he improved upon
the barbaric treatment of disease then in universal favor. He wholly
discarded one of the most effective means by which the doctors succeeded
in shortening the life of man. This was just before those biological
dawnings which were soon to break into the full light of physiological
medicine and the rational system of therapeutics based thereupon. And
it is not improbable that as a watcher in that night of therapeutical
darkness, where the doings of the best strike us with horror, his
prophetic eye caught some glimpses of the coming day which in old age it
was given him to see. Though engaged chiefly with the great things in
surgery, he deserves a place in the list of therapeutic reformers.

Much of the renown acquired for Kentucky by her surgeons was in the
treatment of calculous diseases. This State is believed to have
furnished almost as many cases of stone as all the rest of the Union.
Dr. Dudley stands the confessed leader of American lithotomists, heading
the list with two hundred and twenty-five cases. Of these he presents an
unbroken series of one hundred consecutive successful operations. He
used the gorget in all. He preferred the instrument invented by Mr.
Cline, of London. "In one case, when his patient was on the table, he
discovered that his accustomed operation was impracticable from
deformity of the pelvis, and while his assistants were taking their
positions resolved to make the external incision transverse, which was
executed before any one else present had remarked the difficulty."
Through this incision he removed a stone three and a half inches in the
long diameter, two and a half inches in the short, by eleven inches in
circumference. The patient recovered.

In an article contributed to the Transylvania Journal of Medicine by Dr.
Dudley, in 1828, he thus wrote of the trephine: "The experience which
time and circumstances have afforded me in injuries of the head induced
me to depart from the commonly received principles by which surgeons are
governed in the use of the trephine. In skillful hands the operation,
beyond the atmosphere of large cities, is neither dangerous in its
consequences nor difficult in the execution." In this remark Dr. Dudley
bore early testimony to the efficacy of aseptic surgery. He urged the
trephine in the treatment of epilepsy and applied it in six cases--in
four of which the disease was cured. The result in the two remaining
cases is unknown, because the patients were lost sight of.

Dr. Dudley believed himself to be the first surgeon who ever attempted
to treat _fungus cerebri_ by gentle and sustained pressure made with dry
sponge aided by the roller. Of the first cases in which he used it, he
wrote: "By imbibing the secretions of the part, the pressure on the
protruded brain regularly and insensibly increased until the sponge
became completely saturated. On removing it the decisive influence and
efficacy of the agent remained no longer a matter of doubt." He noted
the difficulty experienced in removing the sponge because of its being
extensively penetrated by blood-vessels springing from the surface of
the brain. This inconvenience he afterward obviated by putting a thin
piece of muslin between the fungus and the sponge. He saw in this
property of the sponge what no doubt others had seen before, the
phenomenon of sponge-grafting, but like them he failed to utilize it in
practice.

Dr. Dudley was not a student of books. He had no taste for literature.
He wrote but little, and that only for the Transylvania Journal of
Medicine, edited by two of his colleagues, Professors Cooke and Short.
His first article did not appear until 1828, fourteen years after he had
begun practice. It was on injuries of the head. It abounded in original
views, and did much to shape surgical thought at the time. Today it may
be consulted with profit. His second paper was on hydrocele; in this he
advocated the operation by incision and removal of the sac. He read so
little that he fell into the error of believing that he was the
originator of the procedure. There are writers in our own day who would
be able to hold their own against him in this particular. A paper on the
bandage, another on fractures, and one on the nature and treatment of
calculous diseases, embrace all his contributions to medical literature.

Dr. Dudley was the son of Ambrose Dudley, a distinguished Baptist
minister. He was born in Spottsylvania County, Va., April 25, 1785. When
but a year old he was brought by his father to the then county of
Kentucky. The family settled in Lexington, in which beautiful city the
child became a man, and lived and wrought and died. The date of his
death is January 25, 1870; his age was eighty-five years.

Dr. Dudley was a man of affairs. His practice was always large and paid
him well. He amassed a handsome fortune. His opinions were often sought
in courts of justice on professional points, where his dignity,
self-possession, and dry wit (which he seems to have suppressed at the
lecturer's desk), commanded the respect of judge, juror, and advocate,
while it made him the terror of the pettifogger. Once, while giving
expert testimony in a case involving a wound made by bird-shot delivered
at short range, he described the behavior of projectiles, and the danger
of bullet wounds. The opposing counsel interrupted him: "Do you mean to
say," said the lawyer, "do you mean to say, Dr. Dudley, that shot wounds
are as dangerous as bullet wounds?" "Shot are but little bullets," was
the unhesitating reply.

Dr. Dudley had also a proper sense of the value of his professional
services. He was called on one occasion to a town near Lexington to
attend a patient in labor, who was the wife of a man made rich by
marriage. The husband was too wise to engage a "night rider," and too
purse-proud to call the village doctor. At that time most of the one
hundred dollar notes in circulation in Kentucky were issued by the
Northern Bank, at Lexington. On the reverse side of the bill was the
letter C in Roman capital. This letter was so round in figure that it
looked like a "bull's-eye," and in local slang was so called. The visit
being over, and the doctor ready to leave, the young father handed him
one of these notes. Eyeing it for a moment, Dr. Dudley said: "Another
'bull's-eye,' Mr. X., if you please."

In person Dr. Dudley was of medium size. His features were refined, the
forehead wide and high, the nose large and somewhat thick, the lips
thin, the eyes bluish-gray. His hair was thin, light, and of a sandy
tint. He was a graceful man. His voice was pleasing; his manners
courtly; his bearing gracious.

He married Miss Short, daughter of Major Peyton Short, in 1821. He
delivered his last lecture in 1850, and the last entry on his ledger
bears the date of April 28, 1853.

       *       *       *       *       *

I can not give these remarks more fitting close than by describing
briefly the surroundings which set their impress upon the character of
the men whose lives I have attempted to portray. The picture is full of
meaning, dignity, and simplicity. In this time "Canetuckee" was still a
part of Virginia. The grounds on which, as boys, they played were held
by their fathers under what is known as a "tomahawk claim." "Beyond lay
endless leagues of shadowy forest." "The Illinois" had not been admitted
into the sisterhood of the States. The vast domain west of the
Mississippi River was unexplored. The city of St. Louis was but an
outpost for traders. The name "Chicago" had not been coined. Fort
Dearborn, occupied by two companies of United States troops, marked a
roll in the prairie among the sloughs where stands to-day the queen and
mistress of the lakes. Cincinnati had no place on the map, but was known
as Fort Washington. General Pakenham had not attempted the rape of New
Orleans, and General Jackson, who was to drive him with his myrmidons
fleeing to his ships, was unknown to fame. Wars with Indians were
frequent. Massacres by Indians were common. The prow of a steamboat had
never cut the waters of a Western river. Railroads were unknown in the
world. There were but two avenues by which Kentucky could be reached
from the East. One was the water-way, furnished by the Ohio River. The
other was the "Wilderness Road," "blazed" by Daniel Boone. The former
was covered in keel-boats, flat-boats, and canoes. The latter was
traveled on horseback or on foot. No wheel had broken it or been broken
by it. The fathers of the subjects of this narrative followed this road
after crossing the Alleghanies. They were a clear-eyed, a bold, an
adventurous people. They wrested the land from the savage, made it
secure by their arms, and by the toil of their hands fitted it for its
present civilization. Among these, and such as these, these heroes in
the bloody exploits of surgery were reared. From such ancestors they
drew that dauntless courage which was so often tried in their
achievements--achievements the fame of which will not lapse with the
lapse of time. Boone had opened the way to the wilderness around them.
He "blazed" a path through its unbroken depths, along which the stream
of civilization quickly flowed. They blazed a path through the
unexplored regions of their art along which surgeons continue to tread.
His name is written in the history of his adopted State and embalmed in
the traditions of its people. Their names are written in the chronicles
of their beloved calling and upon the hearts of myriads of sufferers
whom their beneficent labors have relieved. They may or may not have
felt that their work was durable. But durable it is, and it hands down
to posterity a _monumentum aere perennius_, the absolute worth of which
passes computation. No present or future modification of this work can
rob its authors of that glory which crowns the head of the original
workman.

Like their kinsmen in genius, these toilers devised measures and dealt
with issues in advance of their time. Like them they enjoyed but scant
recompense for labors the far-reaching significance of which they did
not comprehend. Let us who are reaping in the harvest which they sowed
forget not how much we are beholden to these immortal husbandmen. And as
we contemplate the shining record of their deeds, let it counsel us to
"bend ourselves to a better future." Not that we may hope to rival their
sublime achievements, but that each in his walk, however humble it may
be, may strive to enlarge the sphere of his usefulness by making surgery
the better for his having practiced it.


BIBLIOGRAPHY.

  Gross's Report on Kentucky Surgery.
  Gross's Medical Biography.
  L. P. Yandell's Report on the Medical Literature of Kentucky.
  L. P. Yandell's Life of Benjamin W. Dudley.




Transcriber's Note:

Page 27 The dot above the "i" in _fungus cerebri_ is not
evident in the original publication.





End of Project Gutenberg's Pioneer Surgery in Kentucky, by David W. Yandell

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