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A RETROSPECT OF SURGERY IN KENTUCKY

THE PRESIDENTIAL ADDRESS

Delivered Before the Southern Surgical Association AT Louisville, December 16, 1925

THE HERITAGE OF KENTUCKY MEDICINE

THE PRESIDENTIAL ADDRESS

Delivered Before the Kentucky State Medical Association AT Frankfort, September 21, 1926

BY

IRVIN ABELL, M.D.

LOUISVILLE, KENTUCKY

1926

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EPHRAiM McDowell

1771-1830 The Father of Ovariotomy

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SURGERY IN KENTUCKY'

I WOULD be derelict in my appreciation of the honor you have conferred upon me did I not begin with an expression of my pro- found gratitude for your confidence in selecting me to preside over your deliberations. In viewing the roster of distinguished surgeons whom you have so honored, I am overcome with a sense of humility at my own shortcomings and at the same time stimulated as never before to make myself in some degree worthy of such association.

The task of selecting an appropriate subject for my address has not been an easy one. Having been reared professionally in the waning shadow of one school of thought, that founded on clinical observation alone, and in this golden age seeing the beautiful fruition of that built on accurate scientific knowledge, it occurred to me that a brief review of Kentucky surgery would not prove uninteresting, particularly if I could present to you on the screen the portraits and scenes from the environment of those who in this state did their part in advancing the growth and knowledge of surgery.

Sir Walter Scott wrote: ^'It is impossible for me to conceive a work which ought to be more interesting to the present age than that which exhibits before our eyes our fathers as they lived, accom- panied with such memorials of their lives and characters as enable us to compare their persons and countenances with their senti- ments and actions." The actions of those about whom I am to speak have carved their indelible imprint on the scroll of time and need no commendatory words of mine to enhance their value;

* The Presidential Address delivered before the Southern Surgical Association, at Louisville, Kentucky, December 16, 1925.

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their contributions live in daily action and in the history of medical literature— for the most part fully and accurately recorded; in small part the only-too-scant case reports and writings are buried in journals long out of print. Working without labora- tories and their accompanying refinements in making diagnoses, they acquired what might be termed a compensatory acumen in correctly assessing the value of symptoms, an accomplishment which, with the advent of the laboratory, for a time threatened to become a lost art. Some of them possessed to an uncanny degree insight and that most important attribute of the surgeon, surgical judgment. To them surgery was the application of mechanical principles to the solution of pathological problems without the knowledge and safeguards which have since been evolved. They enjoyed in large measure those qualities for which Americans are noted the world over— ingenuity of invention, independence of thought and enthusiasm of purpose, combined with discernment to perceive, courage to undertake and patience to carry through. Their vision of surgery and their achievements in its realm were but the promise of what it has become; their dreams but the seedlings of realities which have materialized. They fulfilled in greatest measure the unwritten law that those who enjoy the prestige of a profession should leave their profession better than they found it.

The earliest development of surgery in Kentucky centered around two towering and dominant personalities— Ephraim McDowell, of Danville, and Benjamin W. Dudley, of Lexington. Both were Virginians by birth, coming with their families to Kentucky shortly after its admission to the Union in 1792. Both had the advantage of the best academic training obtainable, and according to the custom of the time both entered upon the study of medicine in the offices of their preceptors. Dr. Humphreys, of Staunton, Virginia, and Dr. Ridgeley, of Lexington, Kentucky, respectively. Dr. McDowell attended the University of Edinburgh in 1793-1794, returning to and entering upon the practice of his profession in Danville in 1795. The degree of Doctor of Medicine was not conferred upon him until 1823, when, unsolicited on his part, the University of Maryland conferred on him the honorary degree of M.p. The Medical Society of Philadelphia, at the time the most distinguished of its kind in this country, sent him its

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diploma in 1807, two years before he performed his epoch-making ovariotomy, estabHshing the fact that he had attained national distinction before he prosecuted the work that was to make him world famous. Dr. Dudley received the degree of Doctor of Medicine from the University of Pennsylvania in 1806. After practising in Lexington until 1810, he spent four years in post- graduate work in Europe, returning to and entering upon practice in Lexington in 1814. For the next quarter of a century surgical progress in Kentucky emanated from these two distinguished gentlemen, McDowell being a profound thinker and brilliant opera- tor, to which qualities in Dudley was added that of renowned teacher.

McDowell became established in practice nine years before Dudley, and for years was almost the sole occupant of the field of surgery in the West. All the important operations that were required for hundreds of miles around were performed, for a number of years, exclusively by him. His contributions to literature were few, consequently there is no accurate knowledge at hand as to the extent and range of his surgical activities. It is known that he operated successfully for bladder stone 32 times and that he paid much attention to hernia, frequently relieving strangulation by operation. His epoch-making ovariotomy was performed in December, 1809, fourteen years after his entry into practice, between which time and his death in 1830 he is known to have operated upon 13 patients for the relief of ovarian tumors, with 8 cures, 4 deaths, and 1 failure, in the latter instance the operation being abandoned on account of adhesions. His first report appeared in the October, 1816, issue of the Philadelphia Eclectic Repertory and Analytical Review, one of the two journals published in this country at that time, under the title, "Three Cases of Extirpation of Diseased Ovaries." In October, 1819, he reported 2 additional cases in the same journal, the two papers being the only writings extant of this illustrious pioneer. His delay in the publication of his reports, the paucity of medical literature, the absence of facilities for rapid communication and the incredulity of the then surgical world deferred the recognition of his marvelous attainment and the bestowal of the honor which a grateful pro- fession now accords him. In 1876 the late Dr. Lewis S. McMurtry asked the consideration of the Kentucky State Medical Society in the matter of erecting a suitable local memorial to McDowell,

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with the result that Dr. McMurtry was appointed chairman of a committee to erect a monument to Dr. McDowell in Danville. Dr. McMurtry successfully accomplished this task, raising the money from subscriptions of members of the profession to provide the granite shaft which now marks McDowell's grave in McDowell Square in Danville. The monument was dedicated in 1879, during a meeting of the Kentucky State Medical Society, Prof. Samuel D. Gross delivering the dedicatory address. Of McDowell, Dr. Gross said: ''His whole character may be summed up in one sentence. He was a deep and original thinker; a bold, fearless, intrepid and original operator; a faithful and adroit physician; an honest, upright, conscientious and benevolent man— whose career, in whatever aspect it may be contemplated, affords an example worthy alike of our admiration and imitation." It is difficult for the modern surgeon to conceive of the courage and hardihood, the vision and the insight of this pioneer and trail- blazer in invading the sacred precincts of the abdomen, a domain the exploration of which in these days is compassed with such relative safety as to lead Dr. W. W. Keen to facetiously refer to it as "almost the surgeon's playground."

The career of Dr. Dudley is inseparably linked with that of the medical department of Transylvania University, located in Lex- ington, Kentucky, upon which his brilliant accomplishments shed so much luster. The medical department was established in 1799 and continued in existence until 1857, the records showing that in the fifty-eight years of its existence it taught 4656 pupils and conferred the degree of doctor of medicine on 1881 of that number. The endowments of Transylvania University at this time consisted of grants and donations from the states of Virginia and Kentucky, the city and citizens of Lexington, His Britannic Majesty and of sundry individuals, consisting of 32,005 acres of land, $267,882.00 in money and numerous records and books comprising one of the best libraries at that time in this country.

Colonel R. T. Durrett, president of the Filson Club, wrote of it in 1905 as follows: *'There is in our nature something like the love of the relic which makes us revere the memory of Transyl- vania University. Early in the year 1799, a medical department was attached to this University which was the first medical college in the great Mississippi Valley and the second in the whole United States. The medical department of the University of

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MONUMENT TO DR. McDOWELL

McDowell Square, Danville

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1829

1840

MEDICAL SCHOOL OF TRANSYLVANIA UNIVERSITY

Lexington, Kentucky

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Pennsylvania antedated it, but it antedated all others afterward established in our vast domain. We cannot, like our English cousins, go back along the pathway of centuries to the colleges of Oxford and Cambridge and revere them for their age: we have nothing in our new country that partakes of such age. We are a young people in a young country, and our Transylvania Medical College was old enough from our standpoint to be crowned with hoary years. We revere it as the first medical college on this side of the Alleghanies. We revere it for the efforts it made to prepare our young physicians to cope with the diseases which afflicted our people. We revere it for the good name it gave our state in the fame it acquired. We revere it for the success of Professor Brown in introducing vaccination in advance of its discoverer; for the brilliant and numerous operations in lithotomy by Professor Dudley, and for the noble efforts of others of its professors in prolonging human life and mitigating its pains."

The facultv embraced a coterie of brilliant teachers whose names and fame are cherished as a heritage by the profession of Kentucky: outstanding among them is the name of Benjamin W. Dudley who occupied the chair of surgery from 1809 to 1850, in which year he retired from active practice and spent his declining years at his beautiful suburban residence, "Fairlawn," in the vicinity of Lexington. It was as a teacher and practical surgeon that Dr. Dudley justly attained wide reputation. It was said of him that as a teacher and lecturer he was admirably clear; his terse and impressive sentences, with no attempt at eloquence, were the embodiment of the ideas to be conveyed, being couched in the most lucid and concise language. Dr. L. P. Yandell, editor of Transyl- vania Jcnirnal of Medicine, wrote of his ability as a teacher as follows: "He was not a logician, he was not brilliant, and he had neither humor nor wit. And yet in ability to enchain the attention of students, to impress them with the value of his instruction and his greatness as a teacher, he bore off the palm from all the gifted men who at various periods taught by his side. By common consent he stood as an instructor among the foremost of them, facile princeps.'' As a practical surgeon he attained eminence particularly as a successful operator in lithotomy. This operation he performed 225 times without losing a patient until after his one hundredth operation, the fatalities in the total series being but three, a record to which any surgeon of today might point with

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BENJAMIN WINSLOW DUDLEY

1785-1870

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E. L. DUDLEY

1818-1862

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justifiable pride. His first published paper appeared in 1829 in the Transylvania Journal of Medicine under the title ''Observa- tions on Injuries of the Head," showing by cases in his practice that epilepsy may be caused by pressure on the brain, the conse- quence of fracture of the skull, and, as demonstrated by five successive operations, might be cured by trephining, a fact and experience in surgery then quite new. Of the 5 cases reported 3 were successful, while the results of the others were not ascertained owing to the fact that his patients passed from under his observa- tion. His further writings covered the subjects of calculous diseases, fungus cerebri, the treatment of fractures, aneurysm, gunshot wounds and on the use of the roller bandage. In the use of the latter he was extraordinarily proficient and his articles evinced a clear conception as to its wide range of usefulness as well as to its dangers. Dr. Gross ascribes to Dr. Dudley the merit of having been the first in this country to call the attention of the American profession to the employment of the bandage as a cura- tive agent in the treatment of surgical affections.

Upon Dr. Dudley's retirement, in 1850, his nephew, Dr. E. L. Dudley, was appointed his successor as professor of surgery, a position which he filled with credit until the closure of the medical department in 1857. His mantle in private practice fell largely upon the shoulders of his associate, Dr. J. M. Bush, professor of anatomy and adjunct professor of surgery in the medical depart- ment of Transylvania, of whom it was said by one of his contem- poraries that no higher tribute can be paid to him than to say that he afterward held possession without a successful rival. The creditable work of Dr. Bush bore the distinguishing mark of his illustrious teacher. He was particularly successful in his opera- tion for stone, doing 97 lithotomies with 2 deaths, and 210 litho- lapaxies with 4 deaths. His writings, while not voluminous, were along similar lines to those of Dr. Dudley— epilepsy, the use of the bandage, lithotomy and a report of three autopsies.

The most eminent follower of Dr. McDowell as an ovariotomist in the early era of surgery in Kentucky was Dr. Joshua Taylor Bradford, of Augusta. Born in 1817, he attended both Transyl- vania University and Jefferson Medical College, and entered prac- tice in the little town of Augusta. The operation of ovariotomy had largely fallen into disuse both in this and continental countries

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J. M. BUSH

1808-1875

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SAMUEL BROWN

1769-1830 In 1802, four years after Jenner announced his discovery of vaccination. Dr. Brown, Professor of Medicine in Transylvania University Medical School, had vaccinated over 500 patients in Lexington.

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JOSHUA TAYLOR BRADFORD

1817-1871

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on account of its then higher mortality, ranging from 40 to 75 per cent. Clay, of Manchester, England, had taken it up and between the years of 1842 and 1856 had reduced the mortality to 25 per cent. By this time Dr. Bradford had revived the operation on its native soil of Kentucky in a series of 7 consecutive cases with- out a death. His complete series of ovariotomies numbered 30, with 3 deaths, a mortality of 10 per cent. When it is remembered that he died in 1871, before the dawn of surgical cleanliness, his work will stand as a wonderful record of achievement, unpar- alleled in all the world before the days of modern surgery. In 1857 he presented before the Kentucky State Medical Society an exhaustive report on ovariotomy, in which the experience of sur- geons both at home and abroad was carefully reviewed.

Pioneer contemporaries of McDowell, Dudley and Bradford were generally followers rather than leaders and their surgical activities were of definitely smaller volume; here and there a brilliant exploit brought fame and credit for priority to its daring originator. In 1806 Dr. Walter Brashear, of Bardstown, success- fully amputated the leg at the hip-joint, the first operation of its kind in the United States. The operation was undertaken because of extensive fracture of the thigh with great laceration of the soft parts. Brashear was specially skilled in the treatment of the diseases of the bones and joints, was successful in the management of fractures of the skull and in the operation of lithotomy. In 1799, while in China, he amputated the cancerous breast of the wife of one of the celestial dignitaries, being kept a prisoner in the palace of the latter for three days as a hostage guaranteeing the recovery of the patient, his head to be the forfeit in case of her death. Such evidence of courage and confidence permits of a readier comprehension of the man who, without precedent to guide him, successfully undertook a formidable hip-joint amputation.

In 1813 Dr. Charles McCreary, of Hartford, exsected the clavicle of a fourteen-year-old boy for scrofulous disease, the patient surviving the operation without recurrence for thirty-five years: a procedure at that time of no little magnitude, requiring con- summate skill and accurate anatomical knowledge.

Dr. Alban Gold Smith, an assistant and pupil of McDowell, him- self an early ovariotomist, visited Europe at the time that Civiale

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WALTER BRASHEAR 1776-1860

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attracted attention to the operation of lithotripsy. Under the teaching of this master he perfected his technic and, returning to his home in Lincoln County, in 1829, did the first lithotripsy ever performed in Kentucky or the United States. Dr. Gold Smith removed from Kentucky to Cincinnati and later to New York, where he enjoyed a distinguished career in his chosen specialty.

In December, 1852, Dr. Francis E. Polin, of Springfield, did the first Cesarean section in Kentucky: the child, a hydrocephalic, was dead upon delivery, the mother recovered and subsequently gave birth to two children per vias naturales.

According to the old adage, '^Necessity is the mother of inven- tion." The student of history, surgical or otherwise, becomes convinced of this; in fact, he subconsciously adds the children— initiative, ingenuity and adroitness— to the family of Mother Necessity. Note the extraordinary ingenuity of Dr. Bright, of New Castle, in removing a foreign body from the stomach in 1814: "A child playing with a fishhook incautiously swallowed it, while the line to which it was appended hung out of the mouth. Learn- ing that the hook was one of very small size, he made a hole through a rifle ball and, having passed the line through it, he dropped the ball into the child's throat, whence it was immediately swallowed. He then, by means of the line, withdrew the hook from the stom- ach, while the bullet prevented its point from injuring the cardia or esophagus."

"The environment by which these early pioneers were sur- rounded—including the lack of hospitals, trained nurses, anesthe- tists, modern surgical appliances, knowledge of asepsis and the other inherent and almost inconceivable difficulties under which their work was done— explains the incredulity of their contempor- aries and makes their achievements seem almost miraculous. In order to emphasize these surroundings and difficulties and the claims of these forbears of ours to eternal renown, it should be borne in mind that Bardstown, with the most illustrious courts and bar in the West and recognized as a center of learning and culture, had but 820 inhabitants when Brashear, in 1806, performed the first successful hip-joint amputation ever done in the world.

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Danville, the first capital of Kentucky, with the home of McDowell almost under the shadow of the state buildings when he was doing his early surgery, had only 432 inhabitants when he operated on Mrs. Crawford in 1809, and but 804 at the time of his death. Augusta had less than 600 inhabitants when Bradford began his surgical career and only 960 at the time of his death. Lexington, the Athens of the West, a remarkable town in a wonderful country, then as now, had but 1795 inhabitants when the medical school of Transylvania was established there, in 1799, and only 6997 when Dudley was in the zenith of his surgical labors." (J. N. McCormack.)

In 1838 the medical school of the University of Louisville was established, antedated as a municipal university in this country only by that of New York. Organized as the Medical Institute of Louisville, largely by the efforts of members of the faculty of Transylvania IMedical School w^ho desired the greater clinical facilities afforded by Louisville, it shortly thereafter by amendment of the city charter became the School of Medicine of the Univer- sity of Louisville. LTnder the egis of the brilliant teachers who successively and concurrently served in its surgical department, the surgical center of Kentucky was shifted from Lexington to Louisville. Dr. Dudley declined an invitation to accept a chair in the new school : some of his confreres taught in Louisville for a few sessions, but with the exception of Dr. Lunsford P. Yandell returned to Transylvania, the medical department of which was closed in 1857. Those who came to establish the medical school at Louisville were pioneers bearing forward the light of our beneficent science in the direction in which the ''Star of Empire" so long held its way. With the completion of the old university building, in 1838, ''it was in its day the last reared in honor of medicine upon which the sun shone in his journey down the evening sky, the first to greet the traveler coming from the 'farWest.^"

Dr. Joshua B. Flint was the first incumbent of the chair of sur- gery, holding this position for three sessions, when he was suc- ceeded by Dr. Samuel D. Gross (1805-1884) in 1840. With the exception of one year, 1850, when he was professor of surgery in the University of the City of New York, during which time the chair in Louisville was filled by Dr. Paul F. Eve, Dr. Gross remained

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SAMUEL D. GROSS

1805-1884

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as head of the surgical department for sixteen years. During this time, under the stimulating influence of his leadership, assisted by his colleagues in the University, notably Daniel Drake and Austin Flint, Louisville became the leading medical center of the West. Dr. Gross' years in Louisville were filled with ceaseless activity. In addition to discharging the duties of a large practice, in w^hich he was the first to use chloroform in Kentucky, and the responsibilities of a teacher, he was one of the founders of the Kentucky State Medical Society, in 1851, and its president in 1854. In 1852 he presented to the state society an exhaustive survery of the history of surgery in Kentucky, in w^hich he estab- lished the fact that McDowell was the Father of Ovariotomy. Most of the work on his monumental System of Surgery was done during these years. His work on Diseases, Injuries and Mai- formations of the Urinary Organs was published in 1851, followed in 1854 by that on Foreign Bodies in the Air-passages. He was the editor of the Louisville Medical Review, the success of which was in large measure due to his facile pen. He resigned from the Universitv of Louisville in 1856 to return to his alma mater in his native state of Pennsylvania, leaving behind him the indelible stamp of the master upon the followers of surgery in Kentucky. He died in 1886, full of the emoluments and honors of a profession to which he had contributed so much and in whose bright crown he occupies an immortal place.

During the greater part of the past century the system of medical education consisted of apprenticeship and attendance upon lectures. There were but few hospitals, medical literature was in its infancy, and the advantages and opportunities aff'orded by the medical societies of today were unknown. The professors in the medical colleges were the accepted leaders, hence men of ability and ambition sought such positions as a means of winning recognition and distinction. ^Yith such conditions prevailing, it was but logi- cal that with the growth of Louisville, both as a medical center and in population, the number of men aspiring to such positions became so great as to result in the establishment of new schools. The Kentucky School of Medicine was founded in 1850, the Louis- ville Medical College in 1868, the Hospital College of ]Medicine in 1878 and the INIedical Department of Kentucky University in 1898. In 1908 these schools were merged into one, under the title of the Medical School of the University of Louisville. Medicine

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DAVID W. YANDELL

1826-1898

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had ceased to be empirical, had become more and more a science, and medical education conformed to the inevitable change. The men who during this transition period moulded surgical thought in Kentucky were the connecting links between the old and the new eras: the introduction of anesthesia and the principles evolved from bacteriology enabled them to take up the work of McDowell, Dudley, Gross and their contemporaries, and, in conjunction with their confreres of the surgical world, to do their part in the further development of surgical science and art.

David W. Yandell (1826-1898), a native of Tennessee, son of Lunsford P. Yandell, a pioneer in medical education in the West, began his distinguished career as demonstrator of anatomy in the University of Louisville in 1850. During the Civil War he entered the Confederate service and was medical director of the Department of the West under Gen. Albert Sydney Johnston. In 1869 he took the chair of clinical surgery in the University of Louisville, which position he retained until forced by ill health to relinquish it a few years before his death in 1898. He was a brilliant operator, a splendid teacher, a forceful writer, scintillating litterateur and orator. In 1870 he established the American Practitioner, which held a high place in medical literature for six- teen years, when it was combined with the Medical News, under the name American Practitioner and News, of which he was editor until his death. Dr. YandelFs writings covered a rather wide range of topics, both literary and professional, among the best known of the latter being ''A Review of 415 Cases of Tetanus," published in the second volume of the America7i Practitioner, He was a member of the Southern Surgical and Gynecological Association, president of the American Surgical and American Medical Associations and an honorary member of several conti- nental medical societies.

James M. Holloway, (1834-1905), a native of Kentucky, a graduate of the University of Louisiana in 1858, after an honored career in the Confederate Army, having been in control of the hospital service in Richmond, entered practice in Louisville. Dr. Holloway successively held teaching positions in the Univer- sity of Louisville, the Kentucky School of Medicine, the Louis- ville Medical College, and the medical department of Kentucky

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JAMES M. HOLLOWAY 1834-1905

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University. He was the last of the older surgeons to accept the teachings of bacteriology, doing so only after an extended tour of the continental clinics shortly before his death in 1905. The writer's only remembrance of the acclaim of laudable pus traces back to his lectures. His most noted writing was a contribution upon ''Diseases of the Veins" to Surgery by American Authors, edited by Roswell Park.

A. M. Cartledge (1858-1908) graduated and began practice in Louisville in 1882. Possessed of a magnetic personality and an unusual ability, he rapidly assumed a leading position in the profession. A clear thinker, an interesting talker, an ardent advocate of the newer principles of surgery, he became one of the best-known teachers of his day, teaching first in the Hospital School of Medicine, then in the Kentuckv School of Medicine, and finallv in the Louisville Medical College from 1890 until his death in 1908. He was a member of the Southern Surgical Association and its president in 1900. He did pioneer work in the surgery of the gall-bladder and the appendix, the account of most of which was presented before this Society. He had the distinction of removing the largest ovarian cyst in medical history, a report of which appeared in the January, 1900, xbinals of Surgery, ^TMammoth Ovarian Tumors, with Report of a Cyst Weighing Two Hundred and Forty-five Pounds."

William H. Wathen (1846-1913) graduated and began practice in Louisville in 1870. Early in his career he restricted his work to surgery of the pelvis and abdomen, attaining a preeminent position in the field of vaginal surgery. He was a tireless and indefatigable worker, a contributor of many papers to the journals and society transactions. He took a deep interest in medical education, was dean of and teacher in the Kentucky School of Medicine for over thirty years and did much to improve the standards in Kentucky and the South. He was an active par- ticipant in the amalgamation of the Louisville schools, retaining the chair of gynecology until his death in 1913. He was a ''foun- der" of the Southern Surgical Association, a fellow of the American Gynecological Association, chairman of the section on obstetrics and gynecology, 1889, and orator in surgery, 1907, American Medical Association.

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A. M. CARTLEDGE

1858-1908

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WILLIAM H. WATHEN

1846-1913

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AP MORGAN VANCE 1854-1915

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Ap Morgan Vance (1854-1915), a native of Tennessee, graduated and began practice in Louisville, in 1878, as an associate of Dr. D. W. Yandell. He was eminent as a surgeon and an orthopedist, being the first in Kentucky to limit his practice to surgery and for years the only one devoting special attention to orthopedics. While a master of the surgical art, he was especially adept in its orthopedic branch, making many pioneer contributions to the latter, notably that of subcutaneous, bloodless osteotomy in 1887. He was one of the first in Kentucky to espouse the cause of asepsis and his operations were always characterized by the technic of the finished workman. Dr. Vance steadfastly declined offers of teaching positions, preferring to remain, as he expressed it, ''a free lance." His rather bluft' exterior housed a heart filled with human kindness, which with his nobility of character and rugged integrity won for him an enviable situation in the esteem of the profession and the community. He aided in founding and was the chief benefactor of the Children's Free Hospital. A Vance memorial ward was established therein shortly after his death by the voluntary contributions of an appreciative public. His public-spiritedness and his hold upon the confidence of the com- munity led to his appointment as a member of the commission which erected the Louisville Public Hospital: this splendid struc- ture is in large measure a tribute to his efficient supervision. He was a fellow of this and the American Medical Association, a fellow of the College of Surgeons, a member of the American Orthopedic Association and its vice-president in 1890, and presi- dent of the Kentucky State Medical Association the year of his death, 1916.

W. L. Rodman (1858-1916), a native of Kentucky, graduated at the Jefferson Medical College in 1879. After a service in the medical corps of the Army he entered practice in Louisville as the assistant of Dr. D. W. Yandell, in the surgical department of the University of Louisville in 1889. He retained this position until 1893, when he became professor of surgery in the Kentucky School of ]\Iedicine, filling this position until 1898, when he moved to Philadelphia, having accepted the chair of surgery in the Medico- Chirurgical College of that city. Dr. Rodman enjoyed a deserved reputation as a teacher and as an operator. He was interested in medical education, was instrumental in the founding of the National

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W. L. RODMAN

1858-1916

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Board of ]\Iedical Examiners, president of the American Associa- tion of Medical Colleges, a member of the Southern Surgical Asso- ciation, orator in surgery in 1900, and president of the American Medical Association the year of his death, in 1916. His out- standing contributions to literature were on gastric ulcer and cancer of the breast.

Henry Horace Grant (1853-1921), a native of Kentucky, graduated at the Jefferson Medical College in 1878 and entered practice at New Castle, Kentucky, coming to Louisville two years later. Dr. Grant taught anatomy in the Kentucky School of Medicine for ten years, becoming professor of surgery in the Hospi- tal Medical College in 1895, continuing in this position until the merging of the schools in 1908, from which time until his death in 1921 he was professor of surgery in the University School of Medicine. Dr. Grant invented a number of instruments which are now in wide use, was a frequent contributor to surgical journals, one of the editors of the Louisville Monthly Journal of Medicine and Surgery, and the author of Principles of Surgery and Diseases of the Jaw, published in 1902. He was a fellow of the College of Surgeons, American Medical and Southern Surgical Association, and president of the Mississippi Valley Medical Association.

W. O. Roberts (1849-1921), a native of Kentucky, graduated from the University of Louisville in 1870 and Bellevue Medical College in 1871. He engaged in practice with his father-in-law. Dr. D. W. Yandell, which association continued until the death of the latter. After serving as demonstrator of anatomy in the University School of Medicine for a number of years, he entered the surgical department under Dr. Yandell, becoming his associate and successor in the chair of surgery, which position he held until 1912, when he was made emeritus professor. In addition to surgical ability. Dr. Roberts was blessed with a lova- ble and jovial disposition, which attracted to him a host of friends and admirers. He was a pioneer in industrial surgery, being chief surgeon of the L. & N. Railroad for many years. In 1883 he performed the first successful operation for penetrating wound of the abdomen, with perforation of the intestine, graciously giving credit to Dr. Gross, who, in 1843, in writing of knife-wounds of the abdomen, had suggested that they be enlarged and the

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H. H. GRANT

1853-1921

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W. O. ROBERTS 1 849- 1921

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J. N. McCORMACK 1847-1923

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damaged viscera repaired. Dr. Roberts was a member and presi- dent of the Southern Surgical Association, president of the Ken- tucky Medical Association, Fellow of the College of Surgeons and American Medical Association.

J. N. McCormack (1847-1923), a native of Kentucky, graduated in Cincinnati in 1870. Beginning practice in his native state, he did, in 1874, the second Cesarean section done in Kentucky, for which the University of Louisville conferred on him the ad eundem degree of doctor of medicine. In 1877 he successfully resected 22 inches of colon, with end-to-end anastomosis, for gunshot wound. In the same year he revived Battey's operation, and in 1878 performed a trephining operation on a man aged twenty-three years, who had suffered a depressed fracture of the skull at the age of four. Upon the recovery of the patient the latter returned to his fourth year, being one of the few cases of double identity ever reported. He learned to walk and read and wTite, never recognized his wife and children as belonging to him and eighteen years later impetuously married another woman. In 1879, Dr. McCormack was appointed a member of the Kentucky State Board of Health, became its secretary in 1883 and continued in this office until his death, in 1923, writing all of the health stat- utes of Kentucky excepting the one in regard to smallpox, which had been passed earlier in the century. In 1881 he declined the proffered chair of surgery in the University of Louisville because of his interest in public health and largely devoted the remaining years of his life to the service of his state in public health work and to the better development and organization of his profession, playing a most important role in the reorganization of the Ameri- can Medical Association.

Lewis S. McMurtry (1850-1924), a nativeof Danville, Kentucky, the home and scene of the achievements of McDowell, had as a preceptor Dr. John D. Jackson, a surgeon of distinction and an enthusiastic admirer and ardent follower of McDowell. Reared in an atmosphere of surgical tradition and history, Lewis S. McMurtry graduated from Tulane University of Louisiana in 1873, and, returning to Danville, entered upon practice. Becoming more and more interested in surgery, he developed a profound admiration for Pasteur and Lister and became an ardent advocate

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LEWIS S. McMURTRY 1850-1924

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of the principles enunciated by them. In order to fully acquaint himself with their teachings he spent some time abroad, during which he served as assistant to Lawson Tait. Upon his return to Kentucky he removed to Louisville and limited his work to gynecology and abdominal surgery. During the many years of his professional activity his brilliant endowments as surgeon, teacher, author and speaker, combined with gentle, lovable traits of character, gave him a preeminent position as one of the leaders of his profession. He was a president of his state Association, American Medical Association and the Southern Surgical Associa- tion, a member of the American Surgical Association, one of the founders of the American Society of Obstetricians and Gynecolo- gists and of the American College of Surgeons, a fellow of the Brit- ish Gynecological Society and of the Edinburgh Society of Obstet- ricians. He lived in two generations of surgery, seeing the decline of the old and the rise of the new, he attentively followed the march of surgical events, keeping his own judgment poised and his nature ever genial. In surgical affairs he played a leading part: blest with vision and ideals beyond those of the average man, he did much for the cause of medical education; he possessed the mind of the pioneer, the poise of a man who knew men and loved to work with them. No two men in their generation did more for the public and the medical profession than he and his friend, J. N. McCor- mack. Of his genial and lovable character it is difficult to speak except in the superlative degree; the sobriquets by which he was known, 'The Cavalier," and ''The Professor," indicate the affec- tionate regard and esteem of those who were blessed with the privilege of basking in the sunshine of his friendship.

Propriety all but forbids me to speak of Joseph M. Mathews, who still survives, a noble link in the all-but-broken chain binding the past to the present. Reared in Kentucky he graduated from the University of Louisville in 1867 and did a general practice in his home county until 1872, when he removed to Louisville. Shortly thereafter he became interested in the investigation and treatment of the diseases of the colon and rectum, and in 1877 started on a tour of investigation. Failing to find anyone in this country interested in the subject, he went to London, where he observed the excellent work of Sir William Allingham, who was at that time senior surgeon in St. Mark's Hospital. After a stay of

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JOSEPH M. MATHEWS

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one year he returned to Louisville and announced that he would confine his professional work to proctology, being the first surgeon in this country to limit his work to diseases of the lower bowel. He was made professor of rectal diseases in the Kentucky School of Medicine in 1883 and in 1895 published the first American text- book on rectal diseases. He was a president of the American Editors' Society, of the Kentucky State Board of Health, Kentucky State Medical Association, American Medical Association, a founder and twice president of the American Proctologic Society. Winning, affable, eloquent, magnetic. Dr. Mathews is one of Kentucky's distinguished pioneers. In 1912 he retired from prac- tice and is spending his declining years in the sunshine of the golden West.

In the contemplation of the lives and work of these pioneers it is obvious that they have been accorded a great privilege, that of adding to the sum total of human knowledge and of contributing substantially to the improvement of human welfare, thereby rendering an unselfish public service that stamps them as bene- factors of mankind. They have done their part in building the roadway which we now so readily travel, the inscriptions upon its milestones bearing fruitful evidence of the truth of the proverb, i:)er aspera ad astra. Their powers, material and intellectual, were the fruits of efforts: they were thoughts completed, objects accomplished, visions realized. They followed the injunctions of the Greeks who said, 'Tvnow Yourself," and of Marcus Aurelius, who bade, "Be Yourself," and of the Master who taught, ''Give Yourself." They developed that intangible something which might be called surgical character, which is no mere symbol of success, but success itself. They voluntarily encountered trials, struggles and failures in order to gain that sine qua non, experi- ence, which has been and must continue to be the guiding light of all human endeavor; they exhibited courage of the degree that Marie Heinstreet had in mind when she penned the following lines :

Drink of the chalice of courage! Pressed to the shrinking lip The dark veiled fears From the passing years Like dusty garments slip.

Drink of the chalice of courage!

The mead of mothers and men

And the sinewed might

Of the victor's fight

Be yours, again and again.

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LABORATORY BUILDING

New School of Medicine, University of Louisville

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THE HERITAGE

OF

KENTUCKY MEDICINE'

I AM deeply appreciative of the honor you have conferred upon me in selecting me to preside over your deliberations. Coming, as it does, at the hands of confreres with and among whom I have labored for more than a quarter of a century, it possesses an appeal- ing sentiment which arouses within me a profound gratitude for your confidence. One of the duties entailed by the office which I hold through your courtesy is that of delivering the annual address. Feeling that a brief review of what our forefathers in medicine accomplished in Kentucky w^ould not only be of interest, but attest our reverence for the spirit which led them ever onward and upward, as well as instil inspiration into those of us who follow, I beg your indulgence in presenting some of their claims to renown and to our gratitude for the heritage which they have transmitted to us.

It has been generally thought that Daniel Boone, who came to what is now Kentucky in 1769, was the first white man to penetrate this domain : this honor, however, is to be accorded to a member of our profession. Dr. Thomas Walker, of King and Queen County, Virginia, who, in 1750, came through Cumberland Gap, pursued what is now known as the Wilderness Trail as far as the Kentucky River, turned up one of its branches to its head and crossed over the mountains to New River, in Virginia, at the place now called Walker's Meadows. He made a second trip in 1758, at which time he penetrated as far as Dick's River. While Dr. Walker

* The Presidential Address delivered before the Kentucky State Medical Asso- ciation, at Frankfort, September 21, 1926.

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was both a practising physician and one of the first statesmen of Virginia, his expeditions into Kentucky were aside from his pro- fessional activities and of exploratory character only. It seems, therefore, particularly appropriate that this state, first explored by a physician, should have developed a long story of medical leadership. The first physician to practise in the state was a Dr. George Hart, who came from Maryland in 1775 and settled at Harrodsburg, and thereby became the pioneer of regular medicine in Kentucky. He later engaged in practice in Louisville and still later removed to Bardstown, at which place he died. A partly receipted bill, rendered while practising in Louisville in 1780, is interesting as illustrating the then current charges for professional services and, as well, the willingness of patients to pay such; it was rendered by Dr. Hart to George Clews, as follows: May 23, 1780—4 doses calomel, S240.00; 4 blistering plasters for your child, S240.00. Total, $480.00.

The growth of medicine in Kentucky is inseparably linked with the history of its distinguished pioneers and with the institutions which thev fostered. Time forbids more than a brief discussion of those who, by priority achievement or distinguished work, wrote their names on Kentucky's scroll of fame. Foremost among these was Ephraim McDowell (1771-1830). Dr. McDowell attended the L^niversity of Edinburgh in 1793-1794, returning to and entering upon practice in Danville in 1795. The degree of Doctor of ]\Iedicine was not conferred upon him until 1823, when, unsolicited on his part, the University of Maryland conferred on him the honorary degree of M.D. The Medical Society of Philadelphia, at the time the most distinguished of its kind in this country, sent him its diploma in 1807, two years before he per- formed his epoch-making ovariotomy, establishing the fact that he had attained national distinction before he prosecuted the work that was to make him world famous. For years he was almost the sole occupant of the field of surgery in the West. All the important operations that were required for hundreds of miles around were performed for a number of years exclusively by him. He operated successfully for bladder stone 32 times and frequently relieved strangulated hernia by operation. His epoch-making ovariotomy was performed in 1809, fourteen years after his entry into practice, between which time and his death, in 1830, he is known to have operated upon 13 patients for the relief of ovarian

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tumors with 8 cures, 4 deaths and 1 failure, in the latter instance the operation being abandoned on account of adhesions.

It is difficult for the modern physician to conceive of the courage and hardihood, the vision and insight of this pioneer who, without precedent to guide him or the safeguards of asepsis and the blissful insensibility of anesthesia to aid him, invaded the sacred precincts of the abdomen, a domain the exploration of which in these days is compassed with such relative safety as to lead Dr. W. W. Keen to facetiously refer to it as "almost the surgeon's playground."

Dr. David W. Yandell, in contrasting the fame of the statesmen, the orators and the military men of Kentucky, said: ''Chief among all of these is he who bears the mark of our guild, Ephraim IMcDowell. For the labors of the statesman will give way to the pitiless logic of events, the voice of the orator grow fainter in the coming ages and the deeds of the soldier find place only in the library of the student of military campaigns; while the achieve- ment of the village surgeon, like the widening waves of the inviolate sea, shall reach the uttermost shores of time, hailed by all civiliza- tion as having lessened the suffering and lengthened the span of human life."

The most eminent follower of McDowell in Kentucky, as an ovariotomist, was Dr. Joshua Taylor Bradford (1817-1871), of Augusta, whose complete series of ovariotomies numbered 30, with but 3 deaths, a mortality of 10 per cent, the lowest attained by any operator in the world up to that time. When it is remem- bered that Dr. Bradford died in 1871, before the dawn of surgical cleanliness, his work will stand as a wonderful record of achieve- ment, unparalleled in all the world before the days of modern surgery.

The pioneer lithotomists of Kentucky were the gifted Dr. Ben- jamin W. Dudley (1785-1870), professor of surgery in Transylvania School of Medicine; his associate, Dr. J. M. Bush (1808-1875), and Dr. Alban Gold Smith. Dr. Dudley occupied the chair of surgery in Transylvania from 1809 to 1850. A forceful teacher and a brilliant operator, particularly in lithotomy: this opera- tion he performed 225 times without losing a patient until after his one hundredth operation, the fatalities in the total series being but 3, a record to which any surgeon of today might point with justifiable pride. Dr. Bush followed in the footsteps of his illus- trious predecessor, doing 97 lithotomies with 2 deaths and 210

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"O

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^^iiii-JitKolapaxies with 4 deaths. Dr. Gold Smith, an assistant and pupil of McDowell, himself an early ovariotomist, visited Europe at the time that Civiale attracted attention to the operation of lithotripsy. Under the teaching of this master he perfected his technic and, returning to his home in Lincoln County, he, in 1829, did the first lithotripsy ever performed in Kentucky or the United States.

Dr. Samuel Brown (1769-1830), professor of medicine in the Transylvania Medical School, had in 1802, four years after Jenner announced his discovery of vaccination, vaccinated more than 500 people when the first attempts at it were being made in New York and Philadelphia.

In 1806 Dr. Walter Brashear (1776-1860), of Bardstown, suc- cessfully amputated the leg at the hip joint, the first operation of its kind in the United States, if not in the world.

In 1813 Dr. Charles McCreary, of Hartford, exsected the clavicle of a fourteen-year-old boy, for scrofulous disease, the patient sur- viving the operation without recurrence for thirty-five years; a procedure at that time of no little magnitude, requiring consum- mate skill and accurate anatomical knowledge.

Dr. Robert Peter (1805-1894), professor of chemistry in Tran- sylvania, did much priority analytical work, as a result of which he became know^n as the Analytical Chemist of the West.

The Eastern State Hospital was founded in 1816 as the Fayette Asylum. It was the first ever established in the Western country and the second state asylum opened in the United States. Dr. W. S. Chipley (1810-1880), for years its superintendent, made it known at home and abroad by his valuable reports and other papers on mental alienation.

The Institute for Deaf-mutes, in Danville, was founded in 1823, the first institution of the kind established in the West. Owing to the results obtained in the education of deaf-mutes it attained an international reputation.

The Louisville Marine Hospital was founded in 1817, and the Louisville City Hospital in 1818. On the staff of the former was Dr. John P. Harrison, who brought the first stethoscope to Ken- tucky, although Dr. H. M. Bullitt, in 1838, was the first to carry it into the daily study of his cases.

In 1852 Dr. Gross, in his report on Kentucky surgery made to this society, gives credit for the invention of the truss in the

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treatment of hernia to a Mr. Stagner, with modification of same by Dr. Hood.

The Kentucky Institute for the Bhnd was incorporated in 1842, and for thirty years had for its guiding star the kindly Dr. Theodore S. Bell.

In 1852 Dr. Francis E. Polin (1827-1860), of Springfield, did the first Cesarian section in Kentucky.

A. M. Cartledge (1858-1908) did pioneer work on the gall- bladder and the appendix and enjoyed the distinction of having removed the largest ovarian tumor in medical history, a mammoth cyst weighing 245 pounds.

William H. Wathen (1846-1913) w^as a pioneer in vaginal sur- gery and attained a preeminent position in his chosen field.

Ap Morgan Vance (1854-1915), the first in Kentucky to limit his work to surgery, made many pioneer contributions to its ortho- pedic branch, notably that of bloodless osteotomy in 1887.

W. L. Rodman (1858-1916) contributed valuable work on gastric ulcer and cancer of the breast.

W. O. Roberts (1849-1921), in 1883, performed the first success- ful operation for penetrating wound of the abdomen with perfora- tion of the intestine.

J. N. McCormack (1847-1923), in 1874, performed the second Cesarian section done in Kentucky and in 1877 successfully resected 22 inches of the colon with end-to-end anastomosis for gunshot wound.

Lewis S. ]\IcMurtry (1850-1924) made many contributions to the development of pelvic surgery and enjoyed the distinction of being one of the world's pioneer abdominal surgeons.

Dr. Luke Blackburn was one of the foremost sanitarians of his time and as a result of his self-sacrificing service in the yellow fever epidemic of 1878 a grateful commonwealth made him its governor.

When one considers the difficulties under which these men labored, the lack of scientific knowledge as it is understood today, for many of them the absence of aseptic technic and anesthesia, their accomplishments and attainments in the field of medicine and surgery are to be regarded as almost miraculous and as bearing fruitful evidence of their ability, foresight and vision.

The medical schools of Kentucky played an important part in the development of medicine within the state and exercised an appreciable influence on that of the West and South. The first

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medical college in Kentucky and the first west of the Alleghanies was founded in Lexington, where, in 1780, Transylvania University was established; in 1799 a medical school was added, with the appointment of Drs. Samuel Brown and Francis Ridgely as pro- fessors therein. From 1799 to 1817 various appointments were made in the medical department and partial courses of lectures were delivered. Following this year the school entered upon a remarkable career of service, becoming not only the medical center of Kentucky, but one of the foremost in the country. In addition to Drs. Brown and Ridgely its faculty embraced a coterie of other brilliant teachers, among whom are found Benjamin Winslow Dudley, internationally known surgeon; James ]\I. Bush, pioneer lithotomist; William Hall Richardson; the erratic but brilliant Charles Caldwell; John Esten Cooke, known for his humoral theory of disease and his heroic dosage of calomel therefor, admin- istering as much as a pound to a patient in twenty-four hours; Daniel Drake, who with Samuel Brown were the really great doctors or internists of their day; Constantine Samuel Rafinesque, world-known botanist; Charles Wilkins Short, a botanist of national repute; L. P. Yandell, Sr., chemist, forceful writer and accomplished speaker, sire of a distinguished generation of Ken- tucky doctors; Robert Peter, who ''performed a greater number of reliable, detailed, practically useful analyses of soils than any living chemist of his time;" John Eberle, teacher and writer of medicine; Thomas D. Mitchell, teacher in the schools of Kentucky and Philadelphia; Nathan Ryno Smith, who later returned to Balti- more, where, as a surgeon and teacher in the University of Mary- land, he established an enduring fame; L. M. Lawson, teacher and writer; Henry M. Bullitt and Henry M. Skillman, beloved practi- tioners; William Short Chipley, distinguished alienist, and others who, while faithful workers in the profession, failed to scale the lofty heights attained by their fellow teachers in the University of Transylvania. During the thirty-nine years of its active teaching existence the medical school taught 4656 pupils and conferred the degree of doctor of medicine on 1881 of that number, a contribu- tion in medical education, to the welfare of our people and to the fame of our state of incomparable value. The library of Tran- sylvania today contains one of the rarest collections in this or any country of books and manuscripts published during the seventeenth and early part of the eighteenth centuries.

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In 1838 the medical school of the University of Louisville was established, antedated as a municipal university in this country only by that of New York. Organized as the Medical Institute of Louisville, it thereafter by amendment of the city charter, in 1845, became the School of Medicine of the University of Louisville. Under the egis of the brilliant teachers who successively and concurrently served in its various departments the medical center of Kentucky was shifted from Lexington to Louisville. The torch of our beneficent science which burned so brightly in Lexington was borne in the direction in which the "Star of Empire" so long held its way. With the completion of the old university building, in 1838, "it was in its day the last reared in honor of medicine upon which the sun shone in his journey down the evening sky, the first to greet the traveler coming from the 'Far West.' " The roster of the early teachers in this school contains the names of many whose bright stars now gleam from the diadem of immortality; men of energy, ability and impressive personality, they molded the thought of medical science as taught in America and educated a generation of practitioners of medicine. Samuel D. Gross, Henry Miller, Jebediah Cobb, Lunsford P. Yandell, Benjamin Silliman, Lewis Rogers, Daniel Drake, T. G. Richardson, Austin Flint, Paul F. Eve and Benjamin R. Palmer constituted a galaxy of teachers and practitioners beyond compare.

During the greater part of the past century the system of medical education consisted of apprenticeship and attendance upon lectures. There were but few hospitals, medical literature was in its infancy and the advantage and opportunities afforded by the medical societies of today were unknown. The professors in the medical colleges were the accepted leaders, hence men of ability sought such positions as a means of winning recognition and distinction.

In 1836 Louisville had but thirty-two graduate physicians, the number increasing to eighty-nine in 1848, at which time the state had an approximate population of 950,000. With such conditions prevailing, it was but logical that with the growth of Louisville as a medical center the number of men aspiring to teaching posi- tions became so great as to result in the establishment of new schools. The Kentucky School of Medicine was founded in 1850, the Louisville Medical College in 1868, the Hospital College of Medicine in 1873, and the Medical Department of Kentucky

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University in 1898. Intense rivalry existed between the various schools, with the result that we find rather constant shifting of faculty members from one school to the other, indicative of an eflFort on the part of the school to strengthen its force of teachers, and a desire on the part of the teacher to secure greater opportunity and prestige.

The list of men who at various times taught in these five schools is a long one, and both time and a consideration of your patience forbids its complete enumeration. A sense of perspective and appreciation, however, bids us call to mind some whose ability, striking personality, likable character or other impressive attribute made them outstanding personages in the history of medical education in Louisville. Classifying them by their spheres of activity the writer would select the following :

Deans. J. M. Bodine, for forty years dean and professor of anatomy, University of Louisville; W. H. Wathen, for more than thirty years dean and professor of gynecology, Kentucky School of Medicine; C. W. Kelly, for many years dean and professor of anatomy, Louisville Medical College; P. R. Taylor, dean and professor of ophthalmology, otology and laryngology. Hospital College of Medicine, and T. C. Evans, dean and professor of ophthalmology, otology and laryngology, Kentucky Lniversity.

Surgery and Clinical Surgery. J. B. Flint, S. D. Gross, P. F. Eve, B. R. Palmer, D. W. Yandell, A. B. Cook, R. O. Cowling, Tobias G. Richardson, W. O. Roberts, H. H. Grant, W. L. Rodman, J. M. Holloway, A. M. Cartledge, Turner Anderson and L. S. McMurtry.

Medicine. Austin Flint, Charles Caldwell, Daniel Drake, John E. Cooke, T. S. Bell, L. P. Yandell, James W. Holland, Samuel Bemiss, John A. Ouchterlony, W. H. Gait, George Warner, E. D. Force, L. J. Frazee, Lewis and Coleman Rogers, William Bailey, F. C. Wilson, J. B. Marvin, John G. Cecil and P.B.Scott.

Obstetrics and Diseases of Women. Henry IMiller, John E. Crowe, John Hardin, Theophilus Parvin, H. B. Ritter, W. H. Boiling, J. A. Ireland.

Afiatomy. Jebediah Cobb, J. W. Benson, J. D. Burch, G. W. Bayless, J. M. Bodine, C. W. Kelly.

Physiology. H. M. Bullitt, E. R. Palmer, Sam Cochran.

Chemistry. Benjamin Silliman, L. D. Kastenbine.

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Ophthalmology, Otology, Laryngology and Rhinology. Dudley S. Reynolds, M. F. Coomes, J. M. Ray, William Cheatham, T. C. Evans, P. R.Taylor.

Diseases of Children. R. B. Gilbert, John A. Larrabee and H. E. Tuley.

Dermatology. I. X. Bloom.

Of these, Drs. Samuel Gross, Theophilus Parvin and James Holland removed to Philadelphia; Dr. Austin Flint to Xew York, and Drs. Tobias Richardson and Samuel Bemiss to X^ew Orleans, in which cities they enjoyed distinguished careers as recognized leaders in the profession.

Propriety forbids me to mention by name those who, still living, constitute links in the all-but-broken chain between the past and the present. They are entering upon the evening of life, where, let us hope, the shadows will be softened by the warmth and glow of the regard, affection and respect of their colleagues.

These men who taught during a transition period molded medical thought in Kentucky and were the connecting links between the old and the new eras. In the words of Dr. L. S. McMurtry, WTitten in 1917, ''The old system had its day and the men who instructed with lecture and quiz prepared the way for the greater achievements of the present age. The science of medicine has made wonderful strides in these latter years, but there were great men and master minds in the olden time." With the advent of the laboratory, the growth of biology, chemistry and physiology, and the development of hospitals, medicine ceased to be empirical, became more and more a science, and medical education conformed to the inevitable change.

In 1908 these five schools were merged into one, under the title of the Medical School of the University of Louisville. Ways and means of imparting knowledge under the approved methods of today were inaugurated and the old school is now approaching the century mark of service, having with its component units conferred the degree of doctor of medicine upon approximately 15,000 of its graduates, of whom nearly 7000 are engaged today in the practice of their profession. Its history furnishes one of the brightest chapters of Kentucky medicine and its record portrays the progressive march of enduring achievements.

The early medical literature of Kentucky, much of it out of print, holds much that is of historic interest, in many instances

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containing the only writings of its illustrious pioneers. The first paper published by a Kentucky physician came from the pen of Dr. Samuel Brown and appeared in the June, 1799, American Medical Repository, at that time the only journal of medicine published in the United States. Although Dr. Ephraim McDowell performed his epoch-making ovariotomy in December, 1809, his first report appeared in the October, 1816, issue of the Phila- delphia Eclectic Repertory and Analytical Review, one of the two journals published in this country at that time, under the title, "Three Cases of Extirpation of Diseased Ovaries." In October, 1819, he reported two additional cases, the two papers being the only writings extant of this distinguished physician. His delay in the publication of his reports, the paucity of medical literature, the absence of facilities for rapid communication and the incredu- lity of the then surgical world deferred the recognition of his mar- velous attainment and the bestowal of the honor which a grateful profession now accords him. Drs. B. W. Dudley and J. M. Bush were not voluminous writers, their themes being along similar lines— calculous disease, injuries of the head, fungus cerebri, fractures, aneurysms, gunshot wounds and the use of the roller bandage, all appearing in the Transylvania Journal of Medicine and the Associated Sciences, the first journal published in Ken- tucky—established in 1828, it continued to be the leading journal until its close in 1838. Its successive editors were Drs. John Esten Cook, Charles Wilkins Short, Lunsford P. Yandell and Robert Peter. The Transylvania Medical Journal was revived in Lexington in 1849, with Dr. Ethelbert Dudley as editor, and continued in Louisville until 1854, being then published as the Kentucky Medical Recorder and edited by Drs. Henry M. Bullitt and Robert J. Breckinridge. The Louisville Journal of Medicine and Surgery appeared in 1838, edited by Drs. Henry Miller, L. P. Yandell and T. S. Bell. In 1840 the Western Journal of Medicine and Surgery appeared, edited at first by Drs. Daniel Drake and L. P. Yandell, later by Drs. Yandell and Bell. In 1856 these two journals were consolidated and continued by Drs. Gross and Richardson as the Louisville Medical Review. This, in 1857, became the North America?! Medico-Chirurgical Review, the publication of which was transferred to Philadelphia. The Western and Southern Medical Recorder was established by Dr. James Conquest Cross in Lexington in 1841. The Louisville

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Medical Gazette appeared in 1859, edited by Dr. L. J. Frazee, and was continued by Drs. Bemiss and Benson. The Louisville Medical Journal, edited by Dr. Colescott, appeared in 1860 and, with the preceding one, enjoyed but a brief existence. The Sanitary Reporter was pubHshed by the United States Sanitary Commission in Louisville 1863-1864. The American Medical Weekly was published from 1874 to 1879. The Richmond and Louisville Medical Journal appeared in the seventies. In 1870, Dr. David Yandell and T. Parvin established the Americdn Practitioner, which, in 1886, was united with the Louisville Medical Neics (the latter having been established in 1876 by Drs. Richard O. Cowling and William H. Gait), to form the American Practi- tioner and Netvs, which continued publication until 1911. Progress, a monthly journal, was established in 1886, and continued from 1890 to 1916 as Medical Progress. The Louisville Medical Monthly and Mathews' Medical Quarterly appeared in 1894, Mathews' Medical Quarterly became the Louisville Journal of Surgery and Medicine in 1898, and in 1899 was consolidated with the Louisville Medical Monthly, becoming the Louisville Monthly Journal of Medicine and Surgery, the publication of which was continued until 1916. Drs. Joseph Mathews, Dudley S. Reynolds, Horace H. Grant, and Henry E. Tuley were the outstanding journalists of their day, at the close of which private medical journalism in Kentucky disappeared, following the inauguration of the official journal of the Kentucky State Medical Association. The Ken- tucky State Medical Journal began publication in 1904 and after twenty-two years of steady growth is the only journal published in Kentucky at the present time. These journals abound with articles, essays, monographs and case reports from Kentucky doctors, many of which are genuine classics. The editorial con- tributions, in many instances characterized by forceful diction, clearness and brilliancy, full of facts, common sense and philo- sophic comment, constitute an epic of Kentucky history.

The first medical book published in Kentucky was not a scientific dissertation, but one intended for home use by the sparsely set- tled population, entitled, American Medical Guide for the Use of Families, written by Dr. Thomas W. Ruble, and printed in 1810 by E. Harris, of Richmond, Kentucky.

In 1819 Dr. H. ]McMurtrie published a History of Louisville, being the earliest book printed in the city still in existence. While

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not a medical book, the profession owes Dr. McMurtrie a debt of gratitude for his warm appeal to the authorities of Louisville in behalf of a hospital.

Dr. Charles Caldwell, who had become widely known as an author before coming to Kentucky, was one of the most prolific of American medical authors. Dr. L. P. Yandell says of him: "His writings were fragmentary, consisting of essays, reviews and discourses, scattered through the literary magazines and medical journals of the day, but if collected would make not less than ten octavo volumes of a thousand pages each. Many of his best years were devoted to the exposition and defense of phrenology, which, toward the close of his career, was superseded by mesmer- ism and spiritualism. He was a man of varied attainments, but his learning was remarkable for extension of surface rather than accuracy or depth, and while he wrote on a great variety of subjects it cannot be said that he added much to the stock of medical science."

Dr. John E. Cooke, in 1828, published a System of Pathology and Therapeutics J in two volumes. Narrow and faulty in concep- tion, it soon fell into the discard.

Dr. Samuel A. Metcalfe, in 1823, published a New Theory of Terrestrial Magnetism. In it were the germs of the great philosophical theory called "the correllation of forces." In 1838 the work was expanded into a treatise, entitled. Caloric: its Mechanicaly Chemical and Vital Agencies in the Phenomena of Nature.

Dr. Wm. A. McDowell, of Cynthiana, a cousin of the great ovariotomist and one of his aids in the performance of his opera- tions, in 1843 published A Demonstration of the Curability of Pulmonary Consumption in all of its Stages, a treatise containing many extravagant claims, but far in advance of the times.

Dr. Samuel D. Gross, in 1843, published An Experimental and Critical Inquiry into the Nature and Treatment of Wounds of the Intestine; in 1850, A Practical Treatise on Diseases and Injuries of the Urinary Bladder; in 1852, A Co7nprehensive Report on Kentucky Surgery; and in 1854, Foreign Bodies in the Air Passages. During his stay in Louisville he did much of the work on his monumental System of Surgery, which appeared after his removal to Philadelphia.

Dr. Robert Peter, in 1846, published An Analysis of the Calculi

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in the Museum of Transylvania University, with a discussion of calculous affections and their probable causes.

Dr. Henry Miller, in 1849, published A Theoretical and Practical Treatise on Human Parturition; and several years later. Principles and Practice of Obstetrics, which for years was an accredited text-book in the medical schools of the day.

Dr. Daniel Drake, in 1850, published A Treatise on the Diseases of the Great Interior Valley of America, a vast repository of facts collected by himself in a long experience, representing one of the really great contributions to American literature. While a prolific writer, Drake's fame as an author rests largely on this work.

Dr. Austin Flint, in 1852, issued a volume of Clinical Reports on Continued Fever, the first of a series of publications which placed him at the head of American writers on practical medicine.

T. G. Richardson, in 1854, issued A Text-book on the Elements of Human Anatomy.

Many of the distinguished men who at one time or another taught in the Kentucky schools attained distinction as authors while engaged in other fields, notably Drs. John Eberle, Elisha Bartlett, T. D. Mitchell, Leonidas M. Lawson, J. P. Harrison, Benjamin Silliman, Jr., and W. L. Rodman. The contributions of the men who were later dominant factors in the medical life of Kentucky were largely monographs and articles which appeared in the current journals, with here and there chapters in compiled text-books and a few complete volumes. The journals of the entire country are replete with productions of the first mentioned; those of Dr. James M. Holloway, on Diseases of the Veins; of Dr. L. S. McMurtry, on various phases of gynecic surgery, are instances of the second; while A Text-book of Rectal Diseases, published by J. M Mathews, in 1895; Principles of Surgery and Diseases of the Jaw, by H. H. Grant, in 1902, and Pediatrics, by Henry E. Tuley, in 1904, are examples of the third.

The first medical society in the state was formed at Louisville, February 24, 1819. This was the forerunner in the development of societies, culminating in the organization of the Kentucky State Medical Society in 1851. A convention of the physicians of Kentucky was held in the senate chamber at Frankfort, October 1 of that year, at which the society was duly organized, constitution and by-laws adopted and officers elected, as follows: Dr. W. L. Sutton, Georgetown, president, Dr. W. O. Chiply, Lexington,

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senior vice-president; Dr. W. C. Sneed, Frankfort, recording secretary; Dr. R. J. Breckinridge, Jr., Louisville, corresponding secretary, and Dr. Ben ]Moore, Frankfort, librarian.

The second annual meeting was held in Louisville in October, 1852, the volume of transactions for that year containing much that is of historic interest, notably the address of the president, Dr. W. L. Sutton; a voluminous and detailed report of approximately 7000 words on the improvements in surgery by Dr. Samuel D. Gross, in which he establishes Dr. Ephraim McDowell as the Father of Ovariotomy; the report of the Committee on Medical Ethics; and particularly the report of the Committees on Vital Statistics and on Registration. Kentucky was one of the first states in the West, probably the very first, to comprehend the incalculable value of a careful registration of the marriages, births and deaths of her citizens.

Largely due to Dr. W. L. Sutton repeatedly emphasizing the importance of such legislation both upon the public and the profes- sion, the Kentucky legislature, in 1852, passed an act to provide for such registration, the first effort in the West to procure the compilation of vital statistics. The transactions of the Society, published in book form from 1852 to 1900, covering a period of marvelous development in medicine made possible by the intro- duction of anesthesia, the dawn of surgical cleanliness and the advent of the laboratory, constitute in themselves a history of this period of Kentucky medicine that is replete with invaluable material. Beginning in 1900, the proceedings were published in the form of a monthly bulletin which, in 1904, was superseded by and continued as the Journalofthe Kentucky State Medical Association.

Time presses, but one cannot pass without paying tribute to the splendid physicians, representing the highest type of manhood, who have given unstintedly of their time, energy and ability in upbuilding and upholding the state association in the interests of the doctors and of the people of this commonwealth. The names upon its roster of officers during the seventy-five years of its existence come from the flower of the medical manhood of Kentucky. Five of its presidents, Henry H. Miller, Samuel D. Gross, David W. Yandell, Joseph Mathews and Lewis S. McMurtry later became presidents of the American Medical Association, attaining the most distinguished honor which a discriminating profession has at its command. The Association stands today,

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as it has always stood, for the honor, character, usefulness and efficiency of the profession in its service to humanity.

The Kentucky State Board of Health was created in 1878, with Dr. Pinckney Thompson as president and Dr. J. X. ]\IcCor- mack as secretary, primarily to protect the people from yellow fever, cholera and smallpox, being expected to devise methods and means for this purpose, a truly difficult task when one considers that preventive medicine, as we understand it today, at that time did not exist. Pestilences w^ere considered as visitations from God, and many otherwise intelligent people felt that it was almost sacrilegious to make any attempt to prevent sickness, which they considered a divine chastisement. Sanitation at this time was under the control of the fiscal courts, which knew nothing about it and did nothing with it. In 1882 an act providing for the appointment of local boards of health was approved by the general assembly, which, in 1886, also provided for the establishment of city boards of health. As a result of this legislation state, local and city boards of health became governmental agencies, with authority from the general assembly to do everything necessary to protect the public health. In 1882 laws concerning compulsory vaccination and granting health boards authority to abate nui- sances were approved. Before the creation of the state board of health a statute had been approved, in 1874, to protect the citizens of this commonwealth from empiricism. This was amended in 1888 and again in 1893, experience having demonstrated the ineffi- cacy of the original statute. This medical-practice law placed a great responsibility upon the state board of health in delegating to it the authority to exclude from Kentucky quacks, charlatans and doctors of known incompetency. Many in this audience will recall the legal annoyances which ensued and the decision of the court that the legislature may enact laws requiring persons who undertake to practice medicine to give evidence of their qualifica- tion. This decision enabled the board to protect the public health by freeing the state of flagrantly dishonest practitioners and the vultures who preyed upon the ills of its people.

In 1889 the first pure-food law, as well as one looking to the examination and purification of w^ater supplies, were submitted to the legislature by the board. Sanitary inspectors were first appointed during the epidemics of 1879-1886 and 1888, and again w^hen yellow fever threatened in 1897.

During all these years the state board of health had learned a

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great deal about the prevalence of diseases in Kentucky. Seven hundred physicians in as many different parts of the state had been serving as members of local boards of health without com- pensation, and in annual meetings and local conferences much had been learned of importance to the health of the people. At the beginning the health authorities had thought their only function was to prevent epidemics of yellow fever, cholera, smallpox and similar pestilences, but the reports coming into the office of the board showed that more people were dying every year with con- sumption, typhoid fever and other common, every-day diseases than had died in fifty years from all the epidemic plagues together. It dawned upon the sanitarians of the board of health that its most important function was to study the every-day diseases and how to prevent them. The vital statistics law, passed in 1874, before the creation of the board, was worse than useless, and the board inau- gurated a voluntary system of vital statistics which for the first time gave it a more or less definite basis upon which to work. From the creation of the board, in 1878, the appropriation for its maintenance had been $2500 annually; this was increased in 1900' to $5000, to permit of the employment of an all-time inspector whose duty was to be to study the common diseases, their preva- lence and methods of propagation, and to help organize the profes- sion in an educational fight for their prevention. Dr. J. N. McCormack, who had been secretary of the board since its organi- zation, was invested with the additional duties of inspector. When one considers that up to this time the appropriation for the activi- ties of the board had constituted an insignificant sum, one can only marvel at the accomplishments of Dr. McCormack. In 1910 the appropriation of the board was increased to $30,000, afford- ing means for executive, sanitary engineering, bacteriological and registration bureaus. In this same year, with the help of an appropriation from the Rockefeller Commission for the Eradication of Hookworm Disease, Drs. I. A. Shirley, W. W. Richmond and J. S. Lock, three ex-presidents of the state medical association, made the sacrifice of time and money to undertake the study of the problem of intestinal parasites. Under their supervision more than 500,000 persons were examined and more than 200,000 treated for hookworm and other intestinal parasites. This was really the beginning of local health work in the state. A survey showed more than 50,000 cases of trachoma, which number under appropriate treatment has been reduced to less than 3000 at the

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present time. The death-rate from typhoid fever in 1910 was 46, and this has been reduced more than (50 per cent through the active work of the bureau of sanitary engineering. The death-rate from tuberculosis in 1900 was 202 per 100,000 and this has been reduced more than 50 per cent. The average length of life in Kentucky in 1900 was thirty-two years, and in 1925 it was fifty-eight years. From this record it will be deduced that the bureaus of the state board of health have been very active: the laboratory bureau examines more than 30,000 specimens annually from the physicians of the state; the bureaus of sanitary engineering, maternal and child hygiene and venereal diseases have accomplished untold good— at the present time there is less than one-third of the venereal diseases that existed at the time of the establishment of this latter bureau in 1918.

The first all-time county health department in the United States was organized in Jefferson County in 1908, there being at present seven such in the state.

In 1918 the legislature consolidated all public health activities under the state board of health, this being the first instance in this country where a state board of health was invested with such responsibility.

The members of the board of health are selected by the governor of the state from nominees of the state organizations of the various schools of practice. This method of nomination of health officials puts the responsibility for public health upon the shoulders of the medical profession, rightfully on the ground that it has the knowl- edge and is so organized that it can best promote public health.

Dr. Pinckney Thompson served as president from 1878 to 1894, Dr. J. M. Mathews from 1894 to 1909, Dr. William Bailey from 1909 to 1911, Dr. John G. South from 1911 to 1921, and Dr. L. S. McMurtry from 1921 to 1924. Dr. J. N. McCormack served as secretary from 1879 to 1910, secretary and sanitary inspector from 1910 until his death in 1923.

While credit and honor for the achievements of the state board of health of Kentucky are freely accorded to all those who have been privileged to share in its work, the lion's share must go to J. N. McCormack. He it was who wrote all the health statutes of Kentucky except the one relating to smallpox, which had been written earlier in the century; he it was who practically devoted his life to the welfare of the profession and the prevention of disease in this commonwealth. Tyndall has said : ' 'There is in the human

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intellect a power of expansion— I might almost call it a power of creation— which is brought into play by the simple brooding on facts." Dr. McCormack, with but a pittance for an appropria- tion, gathered around him a group of willing workers and garnered facts about the disease problems of Kentucky which enabled him to inaugurate sanitary and preventive measures in advance of the health officers of our sister states. It has been said that preventive medicine is the keystone of the triumphal arch of modern civilization, since the prevention of disease and, therefore, the prevention of suffering and death, is certainly a more important and glorious achievement than the reduction of mortality from a given disease. Dr. McCormack's work as a public health officer and sanitarian has contributed materially to the erection of this arch.

I regret that my address has attained such length, and yet it does but briefly and incompletely chronicle the glories of the past ; glories which constitute our heritage, one of priceless inspiration and unsurpassed in the annals of American medicine. A heritage which demonstrates that good work does not come by itself or by any inevitable law of progress, but by maintaining high ideas and ideals and patiently working them out. "As the heirs of the past century we find that the labors of our predecessors have removed from our path many of the difficulties with which they had to contend: pain and sepsis have been reduced; the 'fate' of scourge and pestilence has gone; facilities and institutions have been provided; instruments of precision have been invented; education and equipment have been vastly improved; the age of humours and miasmata has given place in the medical mind to the reaction of the body as between seed and soil, as between pre- disposition and resistance, as between certain cause and known effect." Preventive medicine has come into existence, with its enormous possibilities in the protection of the individual and public health. We face, then, a conqucist of disease undreamt of by our predecessors. As a result of the evolution of democratic ideas and spiritual ideals the profession recognizes a sense of respon- sibility to the body politic; it has become a direct agent of the community in working for the health of the community as well as of the individual. "These circumstances make the practitioner of today something more than the heir of the past, for they give him new powers of using the legacy of the past to its highest

advantage."

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