THE SHEPPARD ASYLUM.-Thirty-three years ago Mr. Sheppard, of Baltimore, died, and left the sum of $560,000 for the purpose of building an insane asylum. Only the interest of the money could be used, however, and the institution has been slowly building ever since. It is now announced that it is nearly finished, and as a result of the delay the trustees find that they have still a productive investment of $583,637.61, and buildings worth $881,262.27. The Sheppard Asylum will, therefore, when completed, be one of the richest institutions of the kind in the country.-Medical Record.

A BALTIMORE boy is said to have suffered a unique accident. While drinking coffee from a flask his tongue was drawn into the flask by suction, and becoming fast, swelled, requiring the services of a physician to release it. That boy certainly had a pretty strong breath.

THE vacancy among the Queen's Physicians in Ordinary, caused by the death of Sir Wm. Gull, is to be filled by the appointment of Dr. R. D. Powell, the senior of the three Physicians Extraordinary.

SPECIAL NOTICES.

SEXUAL DEBILITY.-Gordon G. Jones, F. R. C. S.. Edin., etc., Surgeon to the Hospital for Urinary Diseases, Soho, W., says, in the Medical Reprint (London England): Probably the most frequent,

and at the same time the most intractable cases which present themselves before a specialist in genito-urinary diseases, are those of "sexual debility;" and this, again, is most commonly exhibited in the forms of sexual impotence and nocturnal emissions. Both forms are usually the result of excess, but it is no uncommon thing to find a married man, with no trace of previous pernicious history, and of present temperate habits, complaining of oncoming sexual inability. These are of all cases the most unsatisfactory, owing to the serious mental depression which almost invariably accompanies them and which occasionally culminates in suicidal mania.

In all these cases much may be done by improving the patient's general condition, which is usually below par, by attention to hygienic surroundings and by electropathic treatment. It is all important, however, that we should have the assistance of a really reliable drug, but up to the present our efforts to procure such have not been over successful. Lately, however, Messrs. Eli Lilly & Co., of Indianapolis, have introduced a pill composed of extract of damiana, in combination with phos

phorus and nux vomica, which has produced, in my practice, more satisfactory results than I have obtained from other remedies." The author reports five cases in which this combination of drugs gave most satisfactory results.

HYSTERIONICA BAYLAHUEN.-Parke, Davis & Co. announce that they have obtained genuine supplies of this promising plant and are prepared to furnish samples to physicians of a fluid extract for further trial.

This plant, which is a native of Chili, has been brought forward in the February 28th number of the Bulletin General Therapeutique, by Dr. Baille, and also before him by Carvallo, of Valparaiso, as a remedy of very considerable value in gastro-intestinal troubles, such as dysentery, colitis, and flatulence from intestinal dyspepsia.

The conclusions reached by Baille as to the drug are as follows, after having studied it in each portion of the body seriatim: It is an excellent remedy for diarrhea, and acts very well in dysentery of the acute and chronic type, and bids fair to replace the balsams in the treatment of maladies of the respiratory passages..

"In genito-urinary troubles hysterionica is of great value, favorably modifying the secretion of urine and diminishing the bad odors. It can also be used in collodion as a dressing for ulcers, and seems under these circumstances to act very much like the tincture of benzoin."

THE THERAPEUTICS OF HEMOGLOBIN COMPOUND. The predigestion of foods has done much for the dietary of invalids and convalescents from acute disease or with anemia and enfeebled digestion.

It must be admitted, however, that many cases require frequently in devitalizing diseases some efficient method of rapid nutrition, capable of ready absorption without taxing the digestive functions to combat the anemia.

This is furnished most naturally by the circulating medium itself, blood containing the elements of nutrition in assimilable form, and a preparation of bullock's blood entitled Hemoglobin Compound has been prepared which seems to meet the indications admirably.

Experiments with this preparation have been in progress by its author, Dr. F. E. Stewart, for ten years past, and Hemoglobin as now marketed by Parke, Davis & Co. is the result.

This preparation has many advantages as a nutrient stimulant, and samples of it and literature descriptive of its application will be furnished physicians on request.

VIRGIL MCDAVITT, M. D., Quincy, Ill., says: I usually find Celerina to be a very agreeable and acceptable nerve tonic, quieting and calming nervous irritability and causing sleep oftentimes after spells of continued wakefulness, adapted to use in much the same cases as valerian, assafetida, etc., not a cure-all, but a valuable addition to our armamentarium in the treatment of a class of cases which are often most vexatious and trying to the physician and worrying to the patient. In these cases I have often prescribed it alone or combined with other remedies with much success.

VOL. X. [NEW SERIES.]

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

PIONEER SURGERY IN KENTUCKY.*

BY DAVID W. YANDELL, M. D.

Professor of Clinical Surgery in the University of Louisville, Ky.; President of the American Surgical Association.

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

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

1806. The earliest original surgical work of any magnitude done in Kentucky, by one of her own sons, was an amputation at the hipjoint. It proved to be the first operation of the kind in the United States. The undertaking was made necessary because of extensive fracture of the thigh with great laceration of

The President's Address, delivered at the regular annual meeting of the American urgical Association, Washington, D. C., May 13, 1890.

age,

No. 1.

the soft parts. The subject was a mulatto boy, seventeen years of a slave of the monks of St. Joseph's College. The time was August, 1806; the place, Bardstown; the Surgeon, Dr. Walter Brashear; the assistants, Dr. Burr Harrison and Dr. John Goodtell; the result, a complete success. The operator divided his work into two stages. The first consisted in amputating the thigh through its middle third in the usual way, and in tying all bleeding vessels. The second consisted of a long incision on the outside of the limb, exposing the remainder of the bone, which, being freed from its muscular attachments, was then disarticulated at its socket.

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

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

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

by surgeons elsewhere, the young Kentuckian was the first to amputate at the hip-joint in America, and the first to do the real thing successfully in the world.

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

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

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

When a youth he was enrolled in the literary department of Transylvania University, where it is said he ranked high as a scholar in Latin. At the age of twenty he began the study of medicine, in Lexington, with Dr. Frederick Ridgely, a very cultivated physician and popular man, who had won distinction in the medical staff of the Continental Army. After two years spent in this way, he rode on horseback to Philadelphia, and attended upon a course of lectures in the University of Pennsylvania. At this time Rush, Barton, and Physick were teachers in that venerable seat of learning. His was a restless nature, and after a year spent in Philadelphia he shipped to China as surgeon of a vessel. While among

the Celestials he amputated a woman's breast, probably the first exploit of the kind by one from the antipodes. Unfortunately for science, he there learned the method used by the Chinese for clarifying ginseng, and thinking, on his return home, that be saw in this an easy way to wealth, he abandoned the profession in which he had exhibited such originality, judgment, and skill, and engaged in merchandising. Twelve years of commerce and its hazards left him a bankrupt in fortune, but brought him back to the calling in which he

was so well fitted to shine. He moved, in 1813, from Bardstown to Lexington, where he at once secured a large practice, especially in diseases of the bones and joints. He was thought to excel in the treatment of fractures of the skull, for the better management of which a trephine was made in Philadelphia, under his direction, which, in his judgment, was superior to any then in use.

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

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

Most of his life thereafter he wasted in desultory labors. As the learned Grotius said of his own life, he consumed it in levities and strenuous inanities.

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

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

it.

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

ance.

It is known that he came of a sturdy stock, his blood being especially rich in two of the

His great

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

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

"Whose influence ineffable is borne

Round the great globe to cheerless souls that yearned

In darkness for this answer to their needs."

He

Ephraim's early education was gotten at the school of the town in which he lived. completed his school studies at an institution of somewhat higher pretensions, situated in a county near by. No anecdotes are preserved of his childhood. During his school-age he clearly preferred the out-door sports of his companions to the in-door tasks of his teachers. On quitting school he crossed the Alleghanies and became an office pupil of Dr. Humphreys, of Staunton, Va. After reading under this preceptor for two years, he repaired to the University of Edinburgh. The Scotch metropolis was then styled the "Modern Athens." It afforded opportunities at that time for acquiring a medical education the best in all the world. It was then to the medical profession what Leyden had been in the days of Sir Thomas Browne, what Paris became when

Velpeau and Louis taught there. He entered the private class of John Bell, whose forceful teachings and native eloquence made a lasting impression on the mind of his youthful hearer. It has been said that McDowell conceived the thought of ovariotomy from some suggestions thrown out by this great man. The only distinction he is known to have won while in Edinburgh was that of having been chosen by his classmates to carry the colors of the college in a foot-race against a professional. In this it appears he was an easy first. He came away without a diploma. But what was of far greater value than a degree, he brought back the anatomical and surgical knowledge which was to place him in the front of his profession.

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

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

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

score of thirteen operations done for diseased ovaria, with eight recoveries, four deaths, and one failure to complete the operation because of adhesions.

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

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