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 andachievements of Kentucky Pioneers in Surgery, I shall not attempt theresurrection of village Hampdens or mute inglorious Miltons. The menwith 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 ourprofession who have done enduring work have lacked biographers to payliberal tribute to their worth. In justice to the unremembered few, Iturn back the records of medicine for a century, and put my finger upontwo 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 thatday, which have and will hold an exalted place in history. The worthiesto whom these names belong were pioneers in civilization as well as insurgery. I shall introduce them in the order of their work. 1806. The earliest original surgical work of any magnitude done inKentucky, 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 thethigh with great laceration of the soft parts. The subject was a mulattoboy, seventeen years of age, a slave of the monks of St. Joseph'sCollege. The time was August, 1806; the place, Bardstown; the surgeon, Dr. Walter Brashear; the assistants, Dr. Burr Harrison and Dr. JohnGoodtell; the result, a complete success. The operator divided his workinto two stages. The first consisted in amputating the thigh through itsmiddle third in the usual way, and in tying all bleeding vessels. Thesecond consisted of a long incision on the outside of the limb, exposingthe remainder of the bone, which, being freed from its muscularattachments, was then disarticulated at its socket. Far-seeing as the eye of the frontiersman was, he could not havediscerned that the procedure by which he executed the most formidableoperation in surgery came so near perfection that it would successfullychallenge improvement for more than fourscore years. Hundreds of hips have since been amputated after some forty differentmethods; but that which he introduced has passed into general use, and(though now known under the name of Furneaux Jordan's) remains thesimplest, the least dangerous, the best. The first genuine hip-joint amputation executed on living parts was doneby Kerr, of Northampton, England, 1774. The first done for shot woundswas by Larrey, in 1793. I feel safe in saying that Brashear had noknowledge of either of these operations. He therefore set about his workwithout help from precedent, placing his trust in himself, in theclearness of his own head, in the skill of his own hands, in the courageof his own heart. The result shows that he had not overestimated whatwas in him. But whether or not Brashear had ever heard or read adescription of what had been accomplished in this direction by surgeonselsewhere, the young Kentuckian was the first to amputate at thehip-joint in America, and the first to do the real thing successfully inthe world. Dr. Brashear seems to have set no high estimate on his achievement, andnever published an account of the case. Had he done so, the art ofsurgery would thereby have been much advanced, his own fame have beenmade 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 hislimb, the report of the much-eulogized case of Dr. Mott appeared. Dr. Brashear came of an old and wealthy Catholic family of Maryland. Hewas born in February, 1776. His father journeyed to Kentucky eightyears later, and cleared a farm near Shepherdsville, in Bullitt County. Walter was his seventh son, and was therefore set apart for the medicalprofession. When a youth he was enrolled in the literary department of TransylvaniaUniversity, where it is said he ranked high as a scholar in Latin. Atthe age of twenty he began the study of medicine, in Lexington, with Dr. Frederick Ridgely, a very cultivated physician and popular man, who hadwon distinction in the medical staff of the Continental Army. After twoyears spent in this way, he rode on horseback to Philadelphia, andattended upon a course of lectures in the University of Pennsylvania. Atthis time Rush, Barton, and Physick were teachers in that venerable seatof learning. His was a restless nature, and after a year spent inPhiladelphia he shipped to China as surgeon of a vessel. While among theCelestials he amputated a woman's breast, probably the first exploit ofthe kind by one from the antipodes. Unfortunately for science, he therelearned the method used by the Chinese for clarifying ginseng, andthinking, 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 ofcommerce and its hazards left him a bankrupt in fortune, but broughthim back to the calling in which he was so well fitted to shine. Hemoved, in 1813, from Bardstown to Lexington, where he at once secured alarge practice, especially in diseases of the bones and joints. He wasthought to excel in the treatment of fractures of the skull, for thebetter management of which a trephine was made in Philadelphia, underhis direction, which, in his judgment, was superior to any then in use. The same temper which led him to leave Philadelphia without his medicaldegree, sail to China, and afterward enter commerce, again asserteditself, and he forsook for the second time his vocation. With his familyhe now moved to St. Mary's Parish, Louisiana, and engaged insugar-planting. During his residence in the South he served his adoptedState in the Senate of the United States. He employed much time in thestudy of the flora of the West. "During the winter of 1843-4, when HenryClay was on a visit to New Orleans" (says a writer in the New OrleansMedical and Surgical Journal), "we had the pleasure, together with sometwenty-five physicians, of spending the evening with him at the house ofa medical friend. While at the table one of the company proposed thehealth of the venerable Dr. Brashear, 'the first and only surgeon inLouisiana 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 greatamusement of Brashear and the rest of the company. " Dr. Brashear was a man of fine literary taste and many and variedaccomplishments. In conversation he was always entertaining, oftenbrilliant. His voice was pleasant, his manners affable. In stature hewas short; in movement, quick and nervous. But in the make-up of the manone 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 asingle exploit, at the age of thirty, he carved his name at high-watermark among the elect in surgery. Most of his life thereafter he wastedin desultory labors. As the learned Grotius said of his own life, heconsumed 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 atBardstown, a practitioner already of wide repute as a surgeon, living inDanville, a neighboring village, did the second piece of originalsurgical work in Kentucky. It consisted in removing an ovarian tumor. The deed, unexampled in surgery, is destined to leave an ineffaceableimprint on the coming ages. In doing it Ephraim McDowell became a primefactor in the life of woman; in the life of the human race. By it heraised 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 benot higher than Jenner's, since he opened the way for the largestaddition ever yet made to the sum total of human life. So much has been written of this, McDowell's chief work, that I feel itneedless to dwell upon it. All students of our art are familiar with itas presented by abler hands than mine. What I shall say of him, therefore, will relate rather to his life and general work than to theone operation by which his name has come to be the most resounding inall surgery. This is a much more difficult task than at first it mightseem to be, for McDowell made no sketch of himself, nor have hisbrothers or his children left us any record of his life. Even his earlybiographers failed to gather from his surviving friends those personalrecollections of the man which would now be of such exceeding interestto us all. An authentic life-size portrait of Ephraim McDowell, as hewas seen in his daily walk among men, can not now be made. Thematerials are too scant; the time to collect them has gone by. Aprofile, a mere outline drawing, is all that is possible to-day. Thepicture I have attempted, therefore, will be found deficient in manydetails which have passed into general acceptance. It is known that he came of a sturdy stock, his blood being especiallyrich in two of the best crosses--the Scotch-Irish. His great-grandfatherrebelled against the hierarchy of his time, and enlisted as a Covenanterunder the banner of James I. After honorable service, he laid down hisarms, gathered his family together, and came to America. It was in honorof this ancestor that the subject of the present sketch was named. The maiden name of his mother was McClung. She was a member of adistinguished family of Virginia. McDowell was born in RockbridgeCounty, Virginia, on November 11, 1771. He was the ninth of twelvechildren. His father, Samuel McDowell, was a man of note and influencein the State, and was honored with many positions of trust. In 1773 heremoved with his family to Kentucky, settling near Danville. He was madejudge of the District Court of Kentucky, and took part in organizing thefirst court ever formed in the State. He lived to see his sonconfessedly the foremost surgeon south of the Blue Ridge. But it wasnot given to eyes of that day to see that the achievements of thevillage operator had illuminated all the work which has since been donein the abdominal cavity, that one had grown up and toiled in theirmidst, "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 whichhe lived. He completed his school studies at an institution of somewhathigher pretentions, situated in a county near by. No anecdotes arepreserved of his childhood. During his school-age he clearly preferredthe out-door sports of his companions to the in-door tasks of histeachers. On quitting school he crossed the Alleghanies and became anoffice pupil of Dr. Humphreys, of Staunton, Va. After reading under thispreceptor for two years, he repaired to the University of Edinburgh. TheScotch metropolis was then styled the "Modern Athens. " It affordedopportunities at that time for acquiring a medical education the best inall the world. It was then to the medical profession what Leyden hadbeen in the days of Sir Thomas Browne, what Paris became when Velpeauand Louis taught there. He entered the private class of John Bell, whoseforceful teachings and native eloquence made a lasting impression onthe mind of his youthful hearer. It has been said that McDowellconceived the thought of ovariotomy from some suggestions thrown out bythis great man. The only distinction he is known to have won while inEdinburgh was that of having been chosen by his classmates to carry thecolors of the college in a foot-race against a professional. In this itappears he was an easy first. He came away without a diploma. But whatwas of far greater value than a degree, he brought back the anatomicaland surgical knowledge which was to place him in the front of hisprofession. He returned to Kentucky in 1795, and settled among the people who hadknown him from boyhood. His success was immediate, and yet Dr. SamuelBrown, who knew him in Virginia, and was his classmate in Scotland, hadsaid, when asked of him: "Pish! he left home a gosling and came back agoose. " In a little while he commanded all the surgical operations ofimportance for hundreds of miles around him, and this continued till, some years later, Dudley returned from Europe to share with him theempire in surgery. In 1802, fully established in his profession, and with an income whichrendered him independent, he married Sarah, daughter of Governor IsaacShelby. In 1809 he did his first ovariotomy. He believed the operation to bewithout precedent in the annals of surgery, yet he kept no note of it orof his subsequent work. He prepared no account of it until 1817. Thisappeared in the Eclectic Repertory. It was so meagre and so startlingthat surgeons hesitated to credit its truth. He had not mastered hismother tongue. The paper was thought to bear internal evidence of itsauthor's having "relied upon his ledger for his dates and upon hismemory for the facts. " The critics from far and near fell upon him. Theprofession at home cast doubt upon the narrative. The profession abroadridiculed it. For all that, McDowell kept his temper and his course, andwhen he finally laid down his knife he had a score of thirteenoperations 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 thispresence, to speak in detail of the technic observed by McDowell in hiswork. That has long since passed into history. I may, however, bepermitted the remark that the procedure, in many of its features, isnecessarily that of to-day. The incision was longer than that nowusually made, and the ends of the pedicle ligature were left hangingfrom the lower angle of the wound. But the pedicle itself was droppedback into the abdomen. The patient was turned on her side to allow theblood and other fluids to drain away. The wound was closed withinterrupted sutures. This marvel of work was done without the help ofanesthetics or trained assistants, or the many improved instruments ofto-day, which have done so much to simplify and make the operation easy. McDowell had never heard of antisepsis, nor dreamed of germicides orgerms; but water, distilled from nature's unpolluted cisterns by thesun, and dropped from heaven's condensers in the clean blue sky, withair winnowed through the leaves of the primeval forest which deepenedinto a wilderness about him on every hand, gave him and his patientsaseptic facility and environment which the most favored livinglaparotomist well might envy. These served him well, and six out ofseven of his first cases recovered. He removed the first tumor intwenty-five minutes, a time not since much shortened by the averageoperator. It was not alone, however, in this hitherto unexplored field of surgerythat McDowell showed himself a master. His skill was exhibited equallyin other capital operations. He acquired at an early day distinction asa lithotomist, which brought to him patients from other States. Heoperated by the lateral method, and for many years used the gorget inopening the bladder. At a later period he employed the scalpelthroughout. 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 tobe McDowell's most noted patient. He was James K. Polk, afterwardPresident of the United States. Dr. McDowell's "heart was fully open to the lesson of charity, whichmore than all men we should feel, " and he dispensed it with constantremembrance of the sacred trust imposed upon us. Yet he had a properappreciation of what was due his guild from those whose means allowedthem to make remuneration for professional services. He charged $500 foran ovariotomy that he went to Nashville, Tenn. , to do. The husband ofthe patient gave him a check, as he supposed, for that sum. Onpresenting it, the doctor discovered that it was drawn for $1, 500instead of $500, whereupon he returned the check, thinking a mistake hadbeen made. The grateful gentleman replied that it was correct, and addedthat the services much outweighed the sum paid. When the fact is bornein mind that the purchasable value of money was much greater in thefirst than in this the last decade of the century, it will be seen thatthe "father of ovariotomy, " at least, set his successors in the field agood example. This is made conspicuous by the fact that Sir SpencerWells has seldom charged a larger sum, and has declared £100 to be asufficient 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 ofcharacter, his chin broad, his lips full and expressive ofdetermination, his complexion florid, his eyes dark-black. His voice wasclear and manly; he often exercised it in recitations from Scotchdialogues, when he would roll the Scotch idiom upon his tongue with thereadiness of a native. He was fond of music, especially comic pieces, which he sang with fine effect, accompanying his voice sometimes withthe violin. He was a man of the times, taking an active interest in the affairs ofthe community in which he lived. He had many books for that day. Cullenand Sydenham were his chief authorities in medicine; Burns and Scott inliterature. He was fond of reading, yet he was inclined to action ratherthan study. He placed great reliance on surgery and its possibilities; he placedlittle trust in drugs. He counselled against their too liberal use. Intruth, he did not like the practice of medicine, and turned over most ofhis non-surgical cases to his associate in business. In manner he wascourteous, frank, considerate, and natural. He was a simple, ingenuousman. His great deeds had given him no arrogance. His was a clean, strong, vigorous life. His spirit remained sweet and true and modest tothe last. He lived a God-fearing man, and died on June 25, 1830, in thecommunion of the Episcopal Church. 1813. While McDowell was so busily engaged in his special line ofsurgery, his colaborers elsewhere in the State were not idle. Four yearsafter his first ovariotomy, the first complete extirpation of theclavicle ever done was accomplished by Dr. Charles McCreary, living inHartford, Ohio County, Ky. , two hundred miles, as the crow would fly, farther into the wilderness. The patient was a lad named Irvin. Thedisease 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 hissuccess, Professor Mott repeated the operation, also on a youth, with alike fortunate result, and, believing he was first in the field, claimedthe honor of the procedure for the United States, for New York, and forhimself. He termed it his "Waterloo operation, " not, however, because itsurpassed, as he declared, in tediousness, difficulty, and danger anything 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 thetying of forty vessels; but after all it proved to be not a completeextirpation; for the autopsy, made many years later, showed threequarters 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 tothe already great renown of the operator. To this day it is referred toby surgical writers as "Mott's celebrated case, " and the description ofhis procedure is often given in his own words. McCreary removed the entire collar bone, and that while a youngpractitioner, living in a village composed of a few scattering houses, situated in a new and sparsely settled country, where opportunities forcultivating surgical science were necessarily rare, and the means foracquiring 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 ofthe operation, its successful issue, and the removal of the entire bone. It is greatly to be regretted that more is not known of McCreary'spersonal and professional character. He is said, by one who met himoften, to have been a serious, thoughtful man, given to study, devotedto his calling, and fatally fond of drink, to which he fell a victimwhen 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 sonof a pioneer. His early training was much like that of hiscontemporaries. Like Brashear, he had instruction in the office of Dr. Ridgely. Like him, he had attended lectures in the University ofPennsylvania. Unlike him, he carried away its diploma. This he did in1806, just two weeks before he was twenty-one years old. He came home, opened an office, and offered his services to the public. The publicgave him little business. He was deficient either in the knowledge or inthe self-trust necessary to professional success. McDowell was locatedin a village hard by--was applying himself mainly to surgery, and wasalready in full practice. Dudley resolved to still better qualifyhimself for the work he was ambitious to do. He longed to go into thehospitals 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 theKentucky, the Ohio, and the Mississippi rivers to the desired port. Heinvested the proceeds of his cargo in flour. This he billed toGibraltar, which he reached some time in 1810; there and at Lisbon hedisposed of it at a large advance. The opportunities he had sought were now near at hand. He hastenedthrough Spain to Paris. While there he heard Baron Larrey recite hiswonderful military experience. He made the acquaintance of Caulaincourt, "the Emperor's trusted minister. " Through him he was present with Talmaand John Howard Payne in the Chamber of Deputies when Napoleon enteredthe building at the close of his disastrous Russian campaign. He saw theEmperor mount the tribune. He heard him begin his report with theseportentous words: "The Grand Army of the Empire has been annihilated. " Remaining in Paris nearly three years, he crossed the Channel to observesurgery as practiced in London. While there he listened to Abernethy ashe dwelt with all his wonted enthusiasm on his peculiar doctrine. Heheard him reason it; he saw him act it, dramatize it, and came awaybelieving him to be "the highest authority on all points relating tosurgery, as at once the observant student of nature, the profoundthinker, and the sound medical philosopher. " He always referred to himas the greatest of surgeons. He saw Sir Astley Cooper operate, andhabitually designated him as the most skilled and graceful man in hiswork 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 wasquick to detect that he had improved his time while away. "Hisprofession had become the engrossing object of his thought, and heapplied himself to it with undeviating fidelity. He made himself itsslave. " One who knew him well wrote of him: "He had no holidays. Hesought no recreation; no sports interested him. His thoughts, he hadbeen heard to say, were always on his cases, and not on the objects andamusements around him. " He found Lexington in the midst of an epidemicof 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 wereso intractable that limbs were sometimes amputated to get rid of theevil. " 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 theburrowing abscesses he saw so frequently in the subjects of the fever. The true position and exceeding value of the roller bandage were not sogenerally recognized then as now. Dr. Dudley was no doubt himselfsurprised at the success which followed the practice. This successprobably led him to urge that wide application of the bandage with whichhis name came in time to be so generally associated. The tide of practice now set full toward him. He had come home athorough anatomist. With opportunity he exhibited surpassing skill inthe 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. TransylvaniaUniversity, already of established reputation, was in operation. Itrequired only a school in medicine to make it complete in its severaldepartments. The trustees met in 1817 and added this to itsorganization. Dr. Dudley was made its head and appointed to fill thechairs of anatomy and surgery. A small class of students assembled inthe autumn. At the commencement exercises held the following spring, W. L. Sutton was admitted to the doctorate--the first physician given thatdistinction by an institution in the West. Troubles arose in thefaculty. Resignations were sent in and accepted. Dr. Richardson, one ofthe corps, challenged Dr. Dudley. A meeting followed. Richardson leftthe field with a pistol wound in his thigh which made him halt in hisgait for the rest of his life. The year following a second organizationwas effected, which included the two belligerent teachers. The history of the Medical Department of Transylvania University--itsrise, its success, its decline, its disappearance from the list ofmedical colleges--would practically cover Dr. Dudley's career, and wouldform a most interesting chapter in the development of medical teachingin the Southwest. But it must suffice me here to say that Dr. Dudleycreated the medical department of the institution and directed itspolicy. Its students regarded him from the beginning as the foremost manin the faculty. That he had colleagues whose mental endowments weresuperior to his he himself at all times freely admitted. He is said tohave laid no claim to either oratorical power or professional erudition. He was not a logician, he was not brilliant, and his deliverances werespiced with neither humor nor wit. And yet, says one of his biographers, in ability to enchain the students' attention, to impress them with thevalue of his instructions and his greatness as a teacher, he bore offthe palm from all the gifted men who, at various periods, taught by hisside. A friend and once a colleague described his manner while lecturingas singularly imposing and impressive. "He was magisterial, oracular, conveying the idea always that the mind of the speaker was troubled withno doubt. His deportment before his classes was such as further toenhance 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 tofamiliarity; and never for the sake of raising a laugh or eliciting alittle momentary applause descending to coarseness in expression orthought. So that to his pupils he was always and everywhere great. As anoperator they thought he had distanced competition. As a teacher theythought he gave them not what was in the books, but what the writers ofthe books had never understood. They were persuaded that there was muchthey must learn from his lips or learn not at all. " His hold upon thepublic was as great as that upon his classes. "Patients came to him fromafar because it was believed that he did better what others could dothan any one else, and that he did much which no one else in reach coulddo. " During the larger part of Dr. Dudley's life few physicians in any partof America devoted themselves exclusively to surgery. The most eminentsurgeons were general practitioners--all-round men. In this class Dr. Dudley was equal to the best. In one respect, at least, he took advanceground--he condemned blood-letting. He was often heard to declare thatevery bleeding shortened the subject's life by a year. AdmiringAbernethy more than any of his teachers, his opinions were naturallycolored by the views of this eccentric Englishman. Like him he believedin the constitutional origin of local diseases, but his practice variedsomewhat from that of his master. Like him he gave his patients bluepill at night but omitted the black draught in the morning. He thoughtan emetic better, and secured it by tartarized antimony. Between thepuke and the purge his patients were fed on stale bread, skim milk, andwater-gruel. And this heroic practice he pursued day after day, forweeks 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 thingsto-day this would not, perhaps, be saying much; but in fact he wasbetter than the best. Negatively, if not positively, he improved uponthe barbaric treatment of disease then in universal favor. He whollydiscarded one of the most effective means by which the doctors succeededin shortening the life of man. This was just before those biologicaldawnings which were soon to break into the full light of physiologicalmedicine and the rational system of therapeutics based thereupon. Andit is not improbable that as a watcher in that night of therapeuticaldarkness, where the doings of the best strike us with horror, hisprophetic eye caught some glimpses of the coming day which in old age itwas given him to see. Though engaged chiefly with the great things insurgery, he deserves a place in the list of therapeutic reformers. Much of the renown acquired for Kentucky by her surgeons was in thetreatment of calculous diseases. This State is believed to havefurnished almost as many cases of stone as all the rest of the Union. Dr. Dudley stands the confessed leader of American lithotomists, headingthe list with two hundred and twenty-five cases. Of these he presents anunbroken series of one hundred consecutive successful operations. Heused the gorget in all. He preferred the instrument invented by Mr. Cline, of London. "In one case, when his patient was on the table, hediscovered that his accustomed operation was impracticable fromdeformity of the pelvis, and while his assistants were taking theirpositions resolved to make the external incision transverse, which wasexecuted before any one else present had remarked the difficulty. "Through this incision he removed a stone three and a half inches in thelong diameter, two and a half inches in the short, by eleven inches incircumference. 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 whichtime and circumstances have afforded me in injuries of the head inducedme to depart from the commonly received principles by which surgeons aregoverned in the use of the trephine. In skillful hands the operation, beyond the atmosphere of large cities, is neither dangerous in itsconsequences nor difficult in the execution. " In this remark Dr. Dudleybore early testimony to the efficacy of aseptic surgery. He urged thetrephine in the treatment of epilepsy and applied it in six cases--infour of which the disease was cured. The result in the two remainingcases is unknown, because the patients were lost sight of. Dr. Dudley believed himself to be the first surgeon who ever attemptedto treat _fungus cerebri_ by gentle and sustained pressure made with drysponge aided by the roller. Of the first cases in which he used it, hewrote: "By imbibing the secretions of the part, the pressure on theprotruded brain regularly and insensibly increased until the spongebecame completely saturated. On removing it the decisive influence andefficacy of the agent remained no longer a matter of doubt. " He notedthe difficulty experienced in removing the sponge because of its beingextensively penetrated by blood-vessels springing from the surface ofthe brain. This inconvenience he afterward obviated by putting a thinpiece of muslin between the fungus and the sponge. He saw in thisproperty of the sponge what no doubt others had seen before, thephenomenon of sponge-grafting, but like them he failed to utilize it inpractice. 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 ofMedicine, edited by two of his colleagues, Professors Cooke and Short. His first article did not appear until 1828, fourteen years after he hadbegun practice. It was on injuries of the head. It abounded in originalviews, and did much to shape surgical thought at the time. Today it maybe consulted with profit. His second paper was on hydrocele; in this headvocated the operation by incision and removal of the sac. He read solittle that he fell into the error of believing that he was theoriginator of the procedure. There are writers in our own day who wouldbe able to hold their own against him in this particular. A paper on thebandage, another on fractures, and one on the nature and treatment ofcalculous diseases, embrace all his contributions to medical literature. Dr. Dudley was the son of Ambrose Dudley, a distinguished Baptistminister. He was born in Spottsylvania County, Va. , April 25, 1785. Whenbut a year old he was brought by his father to the then county ofKentucky. The family settled in Lexington, in which beautiful city thechild became a man, and lived and wrought and died. The date of hisdeath is January 25, 1870; his age was eighty-five years. Dr. Dudley was a man of affairs. His practice was always large and paidhim well. He amassed a handsome fortune. His opinions were often soughtin courts of justice on professional points, where his dignity, self-possession, and dry wit (which he seems to have suppressed at thelecturer's desk), commanded the respect of judge, juror, and advocate, while it made him the terror of the pettifogger. Once, while givingexpert testimony in a case involving a wound made by bird-shot deliveredat short range, he described the behavior of projectiles, and the dangerof bullet wounds. The opposing counsel interrupted him: "Do you mean tosay, " said the lawyer, "do you mean to say, Dr. Dudley, that shot woundsare as dangerous as bullet wounds?" "Shot are but little bullets, " wasthe unhesitating reply. Dr. Dudley had also a proper sense of the value of his professionalservices. He was called on one occasion to a town near Lexington toattend a patient in labor, who was the wife of a man made rich bymarriage. The husband was too wise to engage a "night rider, " and toopurse-proud to call the village doctor. At that time most of the onehundred dollar notes in circulation in Kentucky were issued by theNorthern Bank, at Lexington. On the reverse side of the bill was theletter C in Roman capital. This letter was so round in figure that itlooked like a "bull's-eye, " and in local slang was so called. The visitbeing over, and the doctor ready to leave, the young father handed himone 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, theforehead wide and high, the nose large and somewhat thick, the lipsthin, the eyes bluish-gray. His hair was thin, light, and of a sandytint. He was a graceful man. His voice was pleasing; his mannerscourtly; his bearing gracious. He married Miss Short, daughter of Major Peyton Short, in 1821. Hedelivered his last lecture in 1850, and the last entry on his ledgerbears the date of April 28, 1853. * * * * * I can not give these remarks more fitting close than by describingbriefly the surroundings which set their impress upon the character ofthe men whose lives I have attempted to portray. The picture is full ofmeaning, dignity, and simplicity. In this time "Canetuckee" was still apart of Virginia. The grounds on which, as boys, they played were heldby their fathers under what is known as a "tomahawk claim. " "Beyond layendless leagues of shadowy forest. " "The Illinois" had not been admittedinto the sisterhood of the States. The vast domain west of theMississippi River was unexplored. The city of St. Louis was but anoutpost for traders. The name "Chicago" had not been coined. FortDearborn, occupied by two companies of United States troops, marked aroll in the prairie among the sloughs where stands to-day the queen andmistress of the lakes. Cincinnati had no place on the map, but was knownas Fort Washington. General Pakenham had not attempted the rape of NewOrleans, and General Jackson, who was to drive him with his myrmidonsfleeing to his ships, was unknown to fame. Wars with Indians werefrequent. Massacres by Indians were common. The prow of a steamboat hadnever cut the waters of a Western river. Railroads were unknown in theworld. There were but two avenues by which Kentucky could be reachedfrom the East. One was the water-way, furnished by the Ohio River. Theother was the "Wilderness Road, " "blazed" by Daniel Boone. The formerwas covered in keel-boats, flat-boats, and canoes. The latter wastraveled on horseback or on foot. No wheel had broken it or been brokenby it. The fathers of the subjects of this narrative followed this roadafter crossing the Alleghanies. They were a clear-eyed, a bold, anadventurous people. They wrested the land from the savage, made itsecure by their arms, and by the toil of their hands fitted it for itspresent civilization. Among these, and such as these, these heroes inthe bloody exploits of surgery were reared. From such ancestors theydrew that dauntless courage which was so often tried in theirachievements--achievements the fame of which will not lapse with thelapse of time. Boone had opened the way to the wilderness around them. He "blazed" a path through its unbroken depths, along which the streamof civilization quickly flowed. They blazed a path through theunexplored regions of their art along which surgeons continue to tread. His name is written in the history of his adopted State and embalmed inthe traditions of its people. Their names are written in the chroniclesof their beloved calling and upon the hearts of myriads of suffererswhom their beneficent labors have relieved. They may or may not havefelt that their work was durable. But durable it is, and it hands downto posterity a _monumentum ære perennius_, the absolute worth of whichpasses computation. No present or future modification of this work canrob its authors of that glory which crowns the head of the originalworkman. Like their kinsmen in genius, these toilers devised measures and dealtwith issues in advance of their time. Like them they enjoyed but scantrecompense for labors the far-reaching significance of which they didnot comprehend. Let us who are reaping in the harvest which they sowedforget not how much we are beholden to these immortal husbandmen. And aswe 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 theirsublime achievements, but that each in his walk, however humble it maybe, may strive to enlarge the sphere of his usefulness by making surgerythe 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 notevident in the original publication.