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and William Hunter. Rec'd from Dr. Andrew Fergus of Glasgow, Feb. 14, 1885, J. S. Billings."

Long Calderwood, on a small estate, seven miles from Glasgow, is described by Mather, in his biography of the two Hunters, as "A good stone house of two stories, situated near the road leading from East Kilbride to Blantyre, quite like the residence of the laird of the small estate. The house has the appearance of having been all along the abode of 'bein' substantial people, and has behind it a fine large court, enclosed by farm buildings,

himself defeated them at Bothwell Brig (1679). In the eighteenth century, the historic shire was unusually productive of medical talent. Cullen, Smellie, Matthew Baillie, as well as the two Hunters, were all of them Lanarkshire men. The Lanark branch of the Hunters was an offshoot of the Hunters of Hunterston (Ayrshire), an old Norman family of the thirteenth century. As it stands, this stern, gray house, over two centuries old, is representative and typical of the old granite Scotchtheir intense love of plainness and simplicity in externalities, their dislike of the showy

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THE greatest and most dangerous disease, and one that proved fatal to the greatest number, was consumption. With many persons it commenced during the winter, and of these some were confined to bed, and others bore up on foot. Most of those who were confined to bed died early in the spring; of the others the cough left not a single person, but it became milder through the summer; during the autumn all these were confined to bed, and many of them died, but in the greater number of cases the disease was long protracted. The onset was usually sudden, with frequent rigors, often continual and acute fevers; unseasonable, copious, and cold sweats throughout; great coldness, from which they had great difficulty in being restored to heat; the bowels variously constipated and again immediately loosened, especially toward the end of

each attack; . . . coughs frequent throughout, sputa copious, congested and liquid, but not brought up with much pain. . By far the greatest mischief attending these and the other complaints was the aversion to food, as has been described. For neither had they any relish for drink along with their food, but continued without thirst. There was heaviness of the body, disposition to coma, in most cases swelling, which ended in dropsy; they had rigors, and were delirious towards death.

The habit of body peculiarly subject to phthisical complaints was the smooth, the whitish, that resembling the lentil; the hectic, the blue-eyed, the lymphatic, and that with the scapula having the appearance of wings.

HIPPOCRATES. "Epidemics." Book III, 13, 14.

T

AND RHINOLOGY1

By JAMES J. WALSH, M.D., PH.D., Sc.D.

NEW YORK CITY

HE writings and addresses of Dr. D. Bryson Delavan have been especially important in calling attention to the fact that the special chapter in the history of medicine of which physicians in New York have most right to be proud is that of laryngology and rhinology. He has shown that members of the medical profession in New York, during the latter half of the nineteenth century, revolutionized the treatment of diseases of the nose and throat and were pioneers, not only for America, but for the medical and surgical world in this great modern development of medical and surgical practice. The story of the striking evolution of these specialties in New York, beginning with Horace Green and not yet ended, for there are men still alive who have done thoroughly original work and very precious work in this department, is of the greatest interest and significance. Unfortunately, it is not known as well as it should be even by those most deeply interested in the practice of the specialties in question, but then until very recently physicians generally have not been interested in the history of their great profession, though they are waking up now and are learning how many practical, valuable hints might be secured from the history of medicine.

Some of the details of this chapter of surgery in New York must be repeated for their significance to be appreciated. In 1817 Dr. Cheesman, the worthy head of a distinguished series of generations in New

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York medicine, published an article upon "Growths and Tumors of the Throat,' which represented an appropriate beginning of serious interest in throat diseases. In the late thirties Dr. Horace Green, here in New York, began his epoch-making work in the direct treatment of affections of the larynx and trachea. The surest sign that his work was a real advance and far ahead of anything that had been done before is the fact that it met with decided opposition. I have often quoted Dean Swift with regard to such incidents of opposition to real advance in science which, until we knew history properly, used almost to be attributed to religious intolerance or bigotry of some kind related to religion. The incidents in question are practically always due to the conservative tendencies of mankind. These make them resent important advances, when they are really new, though they are so prone to welcome novelties of no significance. Dean Swift said, in his own bitter frame of mind, of course, but still with an approach to truth that has made the expression one of the oft-quoted passages from his works, "When a true genius appears in the world in the world you may know him by this sign—that all the asses are in confederacy against him." Dr. Green had to struggle on in spite of opposition, which seems lamentable to us as we look back, though our generation has and doubtless will react similarly to other genuine advances.

We in New York had another example of the truth of Dean Swift's expression when sensitive Dr. O'Dwyer found himself alone,

1 This article is an extension of some remarks at the meeting of the Section on Historical Medicine of the New York Academy of Medicine, when "A Description of a Tonsilectomy Done Seven Centuries Ago" was presented.

with practically all the world in opposition to him, on the occasion of his presentation of the subject of the intubation of the larynx for diphtheria and other stenotic affections. As a matter of fact Dr. Horace Green was laying the foundation on which O'Dwyer was to build, demonstrating clearly that the larynx would tolerate foreign bodies to a much greater degree than had been thought possible. Both of them suffered, but only as did many another discoverer in the history of medicine and science from the ultraconservatism of their contemporaries, and it is well for us to remember that such incidents are not mediæval nor distant in history, but occur in our own time.

Horace Green's work bore fruit, however, in spite of opposition, and by his writings he laid the foundation of the great specialty. His contemporary, Dr. Gurdon Buck, by his studies of conditions of the larynx and especially his epoch-making paper upon "Edematous Laryngitis and Its Treatment by Scarification," made an important advance for all the world. Dr. Ernest Krackowizer received a laryngoscope from Vienna in 1858 and demonstrated its value. Dr. Horace Green predicted that the instrument would work a revolution in laryngology, as it did. Already an American, Dr. Ephraim Cutter, who later practiced in New York, had devised a laryngoscope and the development of the specialty was assured. As early as 1873 the first laryngological society ever organized was established in New York. In 1878 the American Laryngological Society was organized in the city of Buffalo, the main influence in it being New Yorkers. In 1871 the first clinic devoted exclusively to the diseases of the nose and throat was established by Dr. Louis Elsberg. Dr. George M. Lefferts, beginning May 1875, collected a bibliography of laryngology until 1880, when a special journal known as the Archives of Laryngology, the first of its kind in the world, was founded.

In the eighties Dr. Joseph O'Dwyer completed the series of experiments on which his method of intubation is founded, and added one of the world's great practical discoveries to this specialty. Dr. O'Dwyer's work was really that of a genius, and he must ever be considered as one of the great men of American medicine.

In the meantime had come the inventions of the Bosworth saw for bone and nasal obstructions and of the Jarvis snare for the removal of enlarged turbinates, and the work of Dr. Roe, of Rochester, in the submucous resection and correction of deformed septum and other nasal obstructions or deviations. The nasal trephine was invented by Dr. James H. Goodwillie, and a whole series of valuable instruments, modifications of preceding less available instruments, were designed. Dr. Rufus P. Lincoln devised the method for the removal of retropharyngeal fibromata through the natural passages instead of by an external wound, which would have required extensive, dangerous dissection, involving serious bleeding and many risks. In 1886 Dr. Thomas French, in Brooklyn, devised a special camera for photographing the larynx, a purpose which had been attempted often enough before, but without any success. In 1897 Dr. Bryson Delavan of New York recommended, instead of cautery, submucous puncture of intumescent inferior turbinate by means of a cataract knife, some of the vessels being divided and becoming obliterated by the resultant cicatricial tissue. He has also carried out numerous investigations, among them the treatment of atrophic rhinitis by applications of the galvanic current and the value of the x-ray in the treatment of malignant tumors of the larynx. Dr. Morris Asch of New York finally developed and perfected the means of securing correction of certain deformities of the nasal septum which had proved serious obstacles to any improvement in a number of cases where interfer

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