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       ANSWER

           TO

DPv. A.  BTJPPANER,
WITH A REVIEW AND CRITICISM OX HIS RECENT REPORT OF A
                CASE OF
LARYNGO-TRACHEOTOMY,
INCLUDING ALL THE ATTESTED  FACTS REGARDING
    THE RECENT PARTRIDGE POISONING CASE
        AT THE FIFTH AVENUE HOTEL.
                  BY

          LEWIS A.  SAYRE, M. D.,
PROFESSOR OP ORTHOPEDIC SURGERY BELLEYrE HOSPITAL MEDICAL COLLEGE, SURGEOX AT
         BELLEVUE AXD CHARITT HOSPITAL, ETC., ETC.







              NEW ' YORK:
     D;  A P P L E T 0 X &  COMPANY,
           90, 92 & 94  GRAND STREET.
                 1870. 
100
52 75*
1870 
To  the President and Members of the American Medical
   Association, and the Medical Profession.
   Gentlemen : As one  of the Yice-Presidents of this Asso-
ciation, and Chairman of its Committee on Ethics, my char-
acter  should be above reproach, or  at least capable of with-
standing the strictest professional scrutiny.
   Within a few weeks past a pamphlet  has been published,
and very extensively circulated among the  profession and the
public—including the daily and weekly press,  and the  public
libraries of the country—by A. Ruppaner, M. D., who adds to
his name " member of the American  Medical Association."
   In this pamphlet I am accused of the most gross violation
of the code of ethics; which charges, if true, should certainly
remove me in disgrace from my present position as one of the
officers of this Association.  It is due to  me—it is due to the
Association—that these charges should be investigated by im-
partial and disinterested  parties, and  reported upon  to  this
convention, as to  their truthfulness or falsity.
   I  therefore  very respectfully but most earnestly request
that the subject be referred to some new Committee on Ethics,
or to  a special committee  to be  appointed  by the chair, with
instructions to report to this convention,  at the earliest prac-
ticable moment.
      All of which is most respectfully submitted.
                               Lewis A. Sayke, M. D.
                          Chairman Committee on Ethics.
   May 3, 1870.
   This petition was referred to the  Committee on Ethics, of
which Dr. Stille, of  Philadelphia, was chairman—I)rs. Davis, 
4
of Chicago ;  Askew, of Delaware ; Keller, of Kentucky;  and
Dr. Woodward, of the Army, composing the committee.
   The committee, having  their time so occupied with the
contesting delegates from the District of Columbia that they
could not investigate  the subject, and  as Dr. Ruppaner was
not present, returned the paper, with the request that it be
referred to the local Medical Society of New York, for ad-
judication.
   Dr. Murphy, of Ohio, stated that, as the slander was made
by a man who, in the same pamphlet in which he published the
slander, had confessed that he had before published two false-
hoods, he  was therefore unworthy of credence,  and  could do
my professional character no harm.   Dr. Maddox, of Mary-
land,  then moved that the whole subject be  laid upon  the
table.
   Having learned subsequently that Dr.  Ruppaner was a
member  of  the  New  York County  Medical Society,  Dr.
Hibbard, of Indiana, moved to  take  it from the table,  and
refer  it to the New  York  County  Medical Society, which
was done.
   I have, therefore, in accordance with this resolution,  pre-
pared the following narrative of facts, and present it to the
New York County Medical  Society for their official action—
and publish the same  for the information  of the profession
and the public:

   In the March number of the New Yokk Medical  Jour-
nal, 1870, I published a  review of Dr. Ruppaner's article
upon  " Laryngo-Tracheotomy,"  published  in the January
number of the same journal, for the reason that, in one of the
cases published by Dr. Ruppaner,  he claimed to have  per-
formed  an operation which I performed  myself, and  stated
that, in the " opening of the trachea and inserting  the tube, no
untoward circumstance occurred," whereas  the haemorrhao-e
and the insufflation of  the blood were so great as to endanger 
5
 life for some minutes; and, therefore, it  became my duty, in
justice to science, and to the profession, to correct this errone-
 ous statement.   So far as his claiming to have performed  the
 operation alone  was considered (which was false), I should
 have  paid no attention to it had he given a correct account of
 the operation itself, and the haemorrhage that occurred at  the
 time the trachea was opened.
    This latter accident was  aggravated very materially from
 the fact that no suitable instruments were  at hand to retain
 the trachea open, in order to insert the tube, which by its pres-
 ence and pressure might have prevented the haemorrhage; and,
 as this point is not emphatically dwelt upon by our authorities
 upon the  operation as distinctly as it should be, I deemed it
 my duty to  draw attention to the fact, in order that operators
 in future might he especially upon their guard at this  par-
 ticular point in the operation, which is in fact the only point
 of danger in it, namely, the invaginating of the incision, from
 the excessive desire to obtain air by a man who is suffocating;
 and at the instant the opening  is made the inspirations are so
 strong that, unless you are prepared to retract the opening  by
 proper instruments, there is great danger of immediate suffoca-
 tion.   It was to draw  the attention of the profession to this
particular point that I made my review of Dr. Ruppaner's
paper.
    The doctor, it seems, cannot understand a professional criti-
cism in any other sense than that of personal and pecuniary
advantage, for he has replied  to it, and states that the question
will reduce  itself simply to this : " Were you intentionally  in-
jured in  my report; have  I  tried to  correct my error?"   I
never  claimed to  be either intentionally or unintentionally
injured.   It was science and truth that were injured, not my-
self personally.   I had no personal interest  in the matter.
   The doctor, in his review, now states  that he always con-
sidered that the tumor was malignant, and denies having told
me that it was not malignant.   I repeat my assertion that  he
informed  me that  he had made microscopic examination of
the pieces of the tumor,  and ascertained  them to be  non-
malignant ;  and, in proof of  this assertion, I refer to his treat-
ment, which he  had pursued for months, that he  believed at 
6
that time that it was non-malignant; fur I cannot believe him
so ignorant of all the well-established principles of treatment
as to think that he would assume to treat a cancer successfully
by constantly tormenting it  with irritants and escharotics.
The very plan therefore, which he had been pursuing for some
months, is an evidence conclusive that at that time he consid-
ered it non-malignant. I also refer to the second letter of Mrs.
Bigelow, in which  she states that  the  doctor positively as-
sured  her  husband that  it was not malignant.  Yiewing it
myself as non-malignant at the time, accepting his description,
I suggested its removal; whereas, if I had deemed it malignant,
I should have  simply suggested  tracheotomy as a means of
temporary relief.  In my review, I state, I heard nothing from
it further until  I received  a telegram at Long Branch, which
telegram I  simply quoted from memory, stating, " the captain
is dying, come  immediately, he must be  operated  upon at
once.   A. Ruppanek."
   The exact telegram, as the doctor states, copied from the
books of the telegraph-office,  is :

   Db. L. A. Sayre, Mansion House, Long Branch : " Come immediately,
Bigelow must be operated upon at once."
   Now, mark—the simple addition of " the captain is dying "
is the difference between the two, and it is remarkable that,
having been made  simply from memory, it should be so ac-
curate as it is.
   The fact that he was dying, and made therefore the neces-
sity for the operation, may possibly account  for my mistake
in adding that  conclusion to the telegram.   I had no copy of
the telegram, it was merely one from memory.
   The doctor states that  after the first consultation we  had
several conversations about it, and that I expressed a great de-
sire to see it.  That is true; it was a case of professional inter-
est, and I was very anxious to see him perform the operation.
But he states that I had been engaged to  perform the opera-
tion—had  agreed to do it; that he  had so told the captain,
and also Mrs. Bigelow, on the very day of the operation,  and
their friends.  If that is true, so much greater  the crime of
his wilfully stating that he had done it himself.  I most un- 
7
hesitatingly state that, so far as I am concerned, he never re-
quested me to perform the operation until a few moments be-
fore it was done; and, so far as the falsehood of his statement
in  regard to Mrs. Bigelow and the captain,  1 refer to the
letter of Mrs. Bigelow, and to the published report of Dr.
Ruppaner in  the January  number, as  marked by Captain
Bigelow himself before his death; and more especially to that
part of Mrs. Bigelow's letter where she states that the cap-
tain himself " marked these  untruths.""
    As another proof that I  certainly did not  expect to per-
form  the operation, is the fact that I went to it without any
instruments whatever, except my ordinary pocket-case, which
I always carry, and, but a few moments before the operation
accidentally meeting Dr. Yance, informed him that Dr. Rup-
paner was going to perform the operation of laryngo-tracheot-
omy,  and asked him if he wished to see it; that if he did,  I
would see if I could  get him an invitation, and went and ob-
tained from Dr. Ruppaner permission to invite him.   If I were
to have  performed the operation myself, I certainly would
have felt at liberty to invite Dr. Yance, or anybody else whom
I liked; and most certainly, if I were going to perform so seri-
ous an operation as tracheotomy, and the removal of a tumor
from within the larynx, I should have taken a proper number
of assistants with me.  I again repeat that the first idea I had
that I was expected to perform the  operation was, when  Dr.
Ruppaner made the suggestion to me to perform it for  him,
a very few moments before it was done.  His statement that
I said, u Just let me know, as we progress with the operation,
what  you wish done, and I  will do it," I pronounce as most
unqualifiedly false.
    The doctor lays great stress upon my regarding  this  as an
operation of magnitude.  I  am aware  of the simplicity of
simple tracheotomy, and, probably having performed it as
many times  as Dr. Ruppaner, am fully competent to judge of
its magnitude  or simplicity; but, when tracheotomy is  com-
menced with an idea of being extended to the  removal of an
intra-laryngeal tumor, and is complicated by the necessity of
puncturing through a vascular tumor before you reach the air
passage (see Dr. Cheever's  letter), it is  an entirely different 
s
operation  from  simple tracheotomy, and its magnitude will
be  properly recognized by every competent surgeon.

                            1267 Washington Stkeet, Boston, )
                                          April 10, 1870.     \
Dear Doctor :
   I gladly embrace the opportunity to send you, through our mutual
friend, Dr. Brown, a brief account of the later hours and autopsy of youv
patient, Captain Bigelow.  I attended him from January 1st to March 26th,
when he died.  The tumor had then attained the size of a duck's-egg, and
projected so much externally that it constantly pushed out the tube, which
had to be lengthened from one-quarter  to one-half an inch every three
weeks.   The last tube he wore was three and a half inches long.. A week
before death, sloughing began and soon destroyed the tumor  down to a
level with the skin. He did not die of suffocation, as he had feared, but
of exhaustion, consequent on mal-nutrition, diarrhoea, and haemorrhage?.
The autopsy was made twenty-seven hours post mortem.   Dr. Ellis was
present.  The tumor surrounded the larynx, and had pushed forward the
hyoid group of muscles.  Externally, it nearly touched the sternum.  In-
ternally, it extended down very slightly beyond  the cricoid cartilage.   It
did not pass beyond the third ring of the trachea.  The tube was through
the lower edge of the tumor, between the cricoid and third or fourth rings
of the trachea.  The trachea was intensely congested, but clear.  The tu-
mor had sloughed inside and out.  It blocked the glottis, the vocal  chords
being covered and much altered.  The ventricle of the larynx was invaded.
The tumor had sloughed through into the pharynx on the right side.  The
epiglottis and tongue and throat were free.
   Pieces of the tumor were submitted to two microscopists, who pro-
nounced it cancerous.   The specimen is preserved in  the cabinet  of the
Boston City Hospital.                Very truly yours,
                                            David "W. Cheever.
   Dr. Sayre.

    The doctor  again asserts that " two tenaculums were on
hand, and Dr. Dudley asserts that one  of them was too weak."
I again affirm that this weak tenaculum, to which Dr.  Dudley
refers, was the one taken  from my pocket-case, which  was not
therefore  present  at the operation, except in my pocket, re-
quiring some time to be  obtained before  it could be used; and
the proof  of  it is  the fact that Dr. Dudley in his letter  states
that he " used  the open  ring from the handle  of my scissors
out of my pocket-case  to retract the opening, after finding
that this tenaculum was too weak."  How could Dr.  Dudley
have obtained the  hook from the scissors of my pocket-case,
unless I had previously removed it from  my pocket ? 
9
   The doctor acknowledges that he neglected  to refer to the
haemorrhage which occurred, but states that in the  original
draft of his report he wrote: "' No untoward event happened
when the incision was made and the canilla introduced, except
some  haemorrhage, the  unavoidable  result of the vascularity
of the tumor.""   The latter part of  this sentence, he  says, by
some unfortunate mishap, he neglected  to  copy in the manu-
script for the press.   This, which is really the only important
part of the whole operation  to be neglected, is  certainly most
extraordinary.   It is like the playing of Hamlet, and, on the
particular  evening of the play, Hamlet is entirely left out.
    The  doctor  next finds  fault with my  corresponding with
his patient, and says : " Shortly after the operation, I became
aware that you were working  up  my case."   After having
published  that  he  performed the operation, and now stating
that I did  it, and that he and  Bigelow expected me to do it,
I  am  at a loss to understand how he can call it his case.
Having  performed the  operation myself, I certainly had the
professional right to claim the  operation  as my own, and the
professional  right to watch and  keep an interest in it.   But
his statement that I corresponded with  his patient is not true,
as will be seen by reference to Mrs. Bigelow's second letter,
with the single exception of writing him a respectful answer,
to a  very long communication which  I  received from him,
most of which I had copied and sent to the doctor, and from
which I think  he obtained his first ideas of its  malignant
character,  and in which letter the captain refers to the doctor's
want of honor, which letter I have not  published in full; but
do now respectfully refer to the  committee his letter on  that
subject.
                  (Mrs. Bigeloitfs First Letter.)

                    92 Shawmttt Avenue,  Boston,  April 19, 1870.
Dr. L. A. Satee—
   Dear Sir: I have just received a note from  Dr. Cheever with your let-
ters to him of the 15th enclosed, in which  you say  " you have written to
me at New Braintree, but have not received any answer." I have not re-
ceived the letters, therefore  the cause of my silence.  I  will write you the
desired information as soon as I am  able.  When Dr. Euppaner's report
appeared in the New York Medical Jotjenal, Captain Bigelow read it and 
10
 marlced the untruths in it, and I have loaned it to a medical  friend, and
 when I get it again I will write you our  experience with, and regard for,
 Dr. Euppaner, which is not as pleasant as we hoped it might be, when  we
 first made his acquaintance.   I should be pleased to hear from  you before
 I leave here, which will be one week from next Friday.   If there is any
 thing particular which you wish to know I shall be glad to give you all
 the information I can.  With grateful remembrance, I am,
                                       Yours respectfully,
                                               Julia E. Bigelow.

    As  I  intended presenting  the whole  controversy to  the
 American Medical Association for adjudication—which was
 to meet in Washington on the 3d  of May—I wrote  to her to
 forward me the copy of the Medical Jouenal above  referred
 to, and  received the following reply :

                    (Mrs. Bigelow"ls Second Letter.)

                      Milbury, Mass., Monday, 3 p. m., May 2, 1870.
 Dr. L. A. Sayre—
   Dear Sir:  I have just received your letter of April  28th, forwarded
 from Boston.   I hasten to answer, and fear you will not receive it in time
 to do you any good.
   After you were called by Dr. Euppaner to examine Captain Bigelow's
 throat  the  first time,  Captain Bigelow  asked Dr. Euppaner, what  you
 meant by asking if it was malignant, not quite understanding the term.
   Dr. Euppaner explained, and said positively that it was not malignant,
 but never gave him to understand really what it was, only that it appeared
 like  what is called  a  cauliflower  growth.  You were called  the second
 time in consultation, and, after you were  gone, Dr.  Euppaner says: " That
 man" (speaking of you) uis one of the best surgeons in the city, and if there
 is an operation to be performed on  your  throat, Bigelow, I shall call  him
 to assist in doing it."  I was present and heard him say it.  That was just
 before we went to Norfolk, Virginia.
   We spoke of you to our friends, and  they all spoke  in the highest
 terras of  your skill as a surgeon, and we were quite at ease in our minds
 afterward.  On our arrival in New York, August 13th, Captain Bigelow
 called on Dr. Euppaner (Dr. Parish from Portsmouth, Virginia, was with
 him, having accompanied us  to New York, as it was not  considered  safe
 for me to come alone with him), and was  told that something must be done
 immediately, and that he would send for you, and the time was set on
 Monday,  twelve o'clock, August 16, 1869.
   Dr. Euppaner got vexed at what Captain  Bigelow said to  him, Satur-
 day morning before the operation, about  something our  Boston friends
had said about him (Dr. Euppaner), and in the evening sent for me to call 
11
at his office, as he desired to talk with me.  I went, and he then told  me
after what the captain  said to  him that morning, concerning our Boston
friends' opinion of him : he should never touch a Tcnife to Captain Bigelow's
throat; that he wished to drop the whole  affair and case, just where it
was, and we might get who we liked, and our Boston friends might man-
age the whole business to please themselves.
   Not knowing the man as well as I do now, I hardly knew what to say,
but finally told him something must be done for Captain Bigelow, and if
he chose to drop the case somebody would be  called, he could not live as
he was but a very short time.  Then Dr. Euppaner said to me : " But if it
is your wish I should go on, and do  for  the captain, I will, but I will on
no account whatever put a knife to his throat."
   I told him, from what I had heard  of your skill, I was satisfied to have
you perform  the operation, and he said he would be then at our rooms at
the time set,  and  assist you, as  he had already sent for  you, to come from
Long Branch.
   We saw nothing more of him until he came in, instruments in haud, at
the time set on  Monday.   Our friends,  Mr. Hobart, and  Mr. Worthley,
remained in  the  room, but were told  by Dr. Euppaner  to go out.  They
did not, as they afterward said, they "did not wish  to leave Captain
Bigelow alone, without a  friend near him."  Dr. Parish and Dr. Martin
were present all  the time, and both  stayed a few days with us after the
operation.   Dr. Euppaner did  not  dress the throat once.  He assisted in
removing the tapes, the first time.  I  did it myself as long as he lived.
    We questioned Dr. Euppaner about the operation, and all we could get
from him was: " Captain, you behaved splendid, every thing was all right,
and in a few days you go home, to your country place,  in Massachusetts,
and wait until I send for you, and we will then  see what can be done about
removing that thing in  your  throat, for you  will then be stronger, and
better able to bear it than you are now, it is  useless to make another  at-
tempt right  away."   He never answered  our questions satisfactorily to
any of us  (Captain Bigelow,  myself, and our sister Mrs. Harding), and
about that time Dr. Euppaner  left the city, and was very anxious to have
us go as soon as he did, but we did not  choose  to leave New York until
we knew something about the operation.   You had not called on us since
the operation, and knowing that you  used the knife, and did the most of
the work, we ventured to call  upon you at your office,  and ask you for the
particulars of the operation, which you kindly gave, and manifested sur-
prise at our not knowing any thing about it from Dr. Euppaner.
    You  never wrote to Captain Bigelow, except in reply to his letter.
    Dr. Euppaner claimed that he assisted you in the  operation.  He al-
 ways told Captain Bigelow that the tumor was not malignant.  I cannot
send  you the report that Captain  Bigelow marked, as  it is in my trunk,
 which lies at the railroad station at West  Brookfield.
    I  left Boston  last Friday, and stopped here over the Sabbath, on my
 way  to my home in New Braintree, Massachusetts. 
12
   I intended writing you  as  soon as I arrived  there, as I was not able
before I left Boston, being very weak and nervous, for I took the entire
care of my husband night and day, while he was spared to me.
   In the report Dr. Euppaner says he put down  a concealed knife, and
cut into the  tumor.  He never did it.  He showed the instrument to Cap-
tain Bigelow, and said he would like to try that.
   He put the forceps down but once,  but did not succeed in removing any-
thing, but made the  tumor bleed profusely.  He applied what he called
"hell-fire," Vienna paste.
   I was with Captain Bigelow; he appeared more nervous than I had ever
seen him before, and what we  both  did for him  brought his breath back
again, but he was never as well after it.
   On receipt of your letter to-day, I was sorry that I had not taken the
reports with me, and then I could have sent them to you ; but as it is now,
I do not think I can possibly get this letter to you in Washington in time,
and shall send it to your house in New York.
   Captain Bigelow lost all confidence in  Dr. Euppaner, and I can safely
say he has not a very good reputation  in Boston, and what he says  of you
will not injure you in the estimation of the Boston friends, and Captain
Bigelow always felt that, through your skill, his life was saved.  He lived
to settle all his worldly  affairs, and to prepare his mind for a final  separa-
tion from those he so fondly loved, and to be fully reconciled to God's will,
for "His will, not ours,  be done."  I will give you  the address of some of
our friends who were present at the time of the operation, and if you like
to communicate with them you  can  do so.  George II. Worthley, care
Cyrus Wakefield, Esq., Boston, Mass.;  Dr. S. E.  Martin, North Brookfield,
Mass.: Dr. James Parish, Portsmouth, Va., and Joseph Hobart, Esq., 189
Broadway, New York City.
   Eegretting  that I did not receive your letter in time for the answer to
reach you while in Washington, and hoping that this matter may be set-
tled to your  satisfaction,
               I remain yours, gratefully and respectfully,
                                               Julia E. Bigelow.
   By E. W. Peirce.

   I did not receive the promised pamphlet until a few days
since, when  her friend called and  left  it  with  the following
letter:

                    (Mrs. Bigelow's  Third Letter.)

                                   New Braintree, Mass.,      )
                                       Tuesday, May 17, 1870.   \
Dr. L. A. Satre—
   Dear Sir :  I wrote you from Milbury two weeks ago, but was not able
to send you the Medical Journal,  containing the report of my husband's
case,  as I did not have it with me. 
13
   Yesterday an acquaintance from New York called to see me, and, say-
ing he should return there this week, I asked him  if he would take the
book to you for your perusal.  He very kindly said he would do so, and
you will there see the untruths marked by Captain  Bigeloio's own hand,
and judge  something  what his feelings  were toward Dr. Euppaner.  I
would like the book, returned to me, as I desire to keep it for reference, for
he marked it for me at my request.  I have all the correspondence between
Dr. Euppaner and Captain Bigelow, which, if necessary, you can have  at
any time.   I do not think that what Dr. Euppaner can say about you will
injure you in Boston, but he has not raised himself at all there, since these
reports appeared, for I have never  heard a word spoken in his  favor, and
he is well known there.
   I shall be glad to hear that the affair is settled satisfactorily to yourself.
   Trusting that it will be, I remain, yours respectfully,
                                                Julia E. Bigelow.

    The side notes in small print are copies  of  Captain Bige-
low's  notes on the report, and the italicized sentences refer to
what he considered untrue.

Case III.—Large malignant tumor, involving the infraglottic
    space  and  trachea ;  cough,  dyspnoea, aphonia, danger of
    suffocation, attempt at extirpation ' laryngo-tracheotomy.
   Mr. B----, of B----, Mass., aged about thirty-six or forty, sea-captain,
was  sent to me for examination by his physician, Dr. Swan, of the Astor
House, New York.
   History.—Has always enjoyed good health, for a man subject to the ex-
posures and hardships of his calling. Three years "ago he was shipwrecked.
In consequence of several days of extreme exposure and
hardships in  the endeavor to save ship  and cargo, his  Have been doc-
                             /.-,,!            «  tenng, with loss
health  became impaired,  manifested by the  advent of  of voice most of
    ,    t       -ii    j-          a a.    -u          the  time, since
cough  and occasional  loss  ot voice.   Atter shorter or  November, 1863;
longer  periods, sometimes with, sometimes without treat-  ™embeTi868N°~
ment, he recovered his voice, though each renewed attack
left its traces behind;  its quality became more and more impaired.  Al-
though he p'aced himself again under  treatment, the hoarseness increased,
till most of the time he could only speak with a whisper.
   In this  condition Captain B. presented himself at my office, March 23,
1869, for examination.
   Condition.—Body well developed  and finely proportioned; chest large
and movements regular; breathing vesicular;  no developed disease; heart
normal.  The external  region of the larynx presented nothing abnormal;
slight pressure on either side, or upon  the anterior surface, caused no par-
ticular  pain.  Pharyngeal mucous membrane moderately congested; no
effusion; no evidence  of recent  or old ulcerations.  Inspiration easily 
/
                                 14

audible, accompanied by  a peculiar shrill  sound.   Voice  gone; able to
whisper only.   General health good ; appetite fair;  sleeps well.
   Laryngoscopic Examination.—Epiglottis depressed posteriorly, so as
to hide from sight one-third of the  contour of the supraglottic space; its
free  border  and apex  show traces  of recent ulceration; anterior  surface
slightly inflamed; posterior surface much more so.  Owing to the depressed
and  irritated condition of the epiglottis, some days elapsed before  a  com-
plete view of the interior of the larynx could be obtained.  These obstacles
removed, the ary-epiglottic folds, ventricles,  and false  vocal  cords,  were
found to be congested.  The right vocal cord  presented a dirty-gray color,
yet normal  in its  action.   The left vocal cord, on the contrary, remained
stationary, held  back by a grayish red-looking  mass attached to its lower
surface.  During the act of expiration, when told to pronounce  the letter
a, or to shout, or  to laugh, the free border of this mass,  smooth,  thin,
readily moving to and fro, was clearly seen to project forward and upward
into  the free space  of the glottis, obliterating  it almost entirely.   Upon
inspiration,  this same part of the growth, the base of which was  clearly
attached to  the left wall of the trachea, would sink back  again into the
space below, leaving the free space in the glottis larger  than during expi-
ration.  The vibratory motion of this part  of  the  growth  might fitly be
compared to the opening and  shutting of a valve.
   Fig. -4 (see plate)  represents the glottis during the act of expiration with
that portion of the growth exposed to view, as I demonstrated it to nume-
rous medical gentlemen  on different occasions at my office—among them
Drs. Swan, Sayre, Dunster, Dudley, Cooper,  Kinney.
   Diagnosis.—From  the first  I was inclined  to  regard  this growth  as
very dangerous in character and malignant in type.  Appearance, rapidity
of growth, position, symptoms, all were against the case.  Still I hoped to
be able to arrest the disease  in its progress upward, by removing with
instruments portions of it, and  by local applications to keep its growth in
check.   My  great fear was its  downward progress—its descent into the
trachea—and then already suggested the possible necessity of the operation
of tracheo-laryngotomy.
   Subsequent  results  still more confirmed  my apprehension.  Whenever
an instrument was brought in contact with the mass in situ, it bled readily
—profusely at  times.  Pieces of the size of a large pin's  head were re-
moved with the forceps,  and  also coughed up at intervals  by the  patient,
followed always by  haemorrhage.   Much may have been expectorated, as
often the sputa were tinged considerably with blood.
   The portions, after being  removed or expectorated, when  examined
were of a lobular, cauliflower appearance, of a soft,  lardaceous consistency,
and  of a grayish-red color.  Examined under the microscope,  these lobules
were found to  consist of cancer-cells, varying in  type, some  being oval,
some round, others globular, with distinct nuclei, in some two, and more in
others.
    Considering, then,  these specific characteristics described with the rest
of the symptoms  collectively—pain, tendency  to haemorrhage, color, con- 
15
 shtency, form, and  rapidity of growth—the carcinomatous nature of the
 tumor was established beyond a doubt.
    Prognosis.—Unfavorable.
    Treatment.—To remove as much as possible of the growth, per vias
 naturales, thereby relieving the aphonia and dyspnoea, and later, if neces-
 sary, and as seemed most probable, to have recourse to laryngo-trache-
 otomy, should the growth encroach too rapidly upon the free space  of the
 trachea.
    After a week's practice with the mirrors, the irritability of the fauces
 was in a great measure overcome, and I had no trouble to demonstrate the
 neoplasm to my medical friends.
    I touched  the larynx  daily with Lugol's solution, bringing  the brush
 directly to bear upon the mass, which, after a short time, seemed to con-
 tract under its use.  Captain B. began to speak  louder, and to breathe
 freer, nor was there any pain in swallowing at that time.   Dr. Swan, who
 saw the patient from the first, was also of opinion that the tumor grew
 smaller and the voice more powerful.  This latter fact was apparent to all
 of the captain's friends.
    During a temporary absence of the patient the  good accomplished was
 nearly lost.   Then I decided to use the forceps to  remove what I could of
 the growth.   My efforts in that direction were, however, arrested  by the
profuse bleeding that followed each time small lobules were  torn away.
 I next  resorted  to decision of the part in situ.   Several incisions were
 made at the favorable moment with the catheter-shaped, covered lancet of
 Tobold.  Hemorrhage followed; the next day the part in situ showed signs
 of suppuration. The result of this operation was gratifying, as the patient,
 after a few days, when the result of the incision became evident, gained
 again in voice, and his breathing was much relieved.
    Fig. 5 (see plate) represents the larynx with the tumor in situ  in the
 glottis, after the operation of decision.
    Still another relapse followed, accompanied by considerable difficulty in
 swallowing.   I became more  and  more satisfied that, although I was op-
 posing the enemy with considerable success  in its progress  above,  the
 disease was, at the same moment, rapidly encroaching upon the trachea.
 This  truth was still more forcibly brought home to me by the appearance,
in the latter part of  July, of an enlargement in the left side of the trachea,
increased sensibility upon pressure, greater  difficulty  in  swallowing,  and
a feeling, when  lying down, as if something loose was hanging from its
attachment on the left to the right side.  Pain in the left  ear, dizziness in
the head, increased paroxysms  of coughing, and profuse expectoration, were
now added.  No wonder the captain became at times  alarmed about him-
self.  I now had recourse to  the application  of chromic
acid, followed  by some  relief,  at least, of the  distressing  or "hell  Arenas
symptoms.   Business called him repeatedly to Norfolk,  experiment near5-
Virginia, in June, July, and August, though he paid me  ly cost life on the
visits from  time to time.   Owing to the increased gravity 
16
of the  case, I laid before him the necessity of an operation  (extra-laryn-
geal, but could not get his consent at the time.
   August 13, 1869.—Captain B.  arrived by steamer from Norfolk,  in
company of Dr. Parish, late surgeon on the staff of General Lee.  Dyspnoea,
cough, paroxysms of strangulation, and inability to swallow food, had be-
come so alarming that the doctor had to accompany the captain.  Counte-
nance livid, hands cold, pulse weak, nervous system prostrated, expression
anxious: such was his condition.
   August 16.—Operation of Laryngo-Traoheotomy.—My friend, Dr.
L. Sayre, who had seen, at my request, the patient at a former consulta-
tion, consented to divide with me the responsibility and to aid me with his
experience and skill in performing the operation, so  as  to give me free
scope for observing  the course, position, extent,  and nature of the tumor,
and to direct such a course as the progress of the operation might demand.
I had also the valuable assistance of Drs. Dudley, Parish, Swan, Zolnow-
ski, and several others.
   It had been decided upon to perform, first, tracheotomy, so as to give
the already much-exhausted patient an opportunity to breathe freer; then
to divide the thyroid and cricoid cartilages in the median line in order  to
reach the tumor, and to extirpate if possible, if not the whole, at least
part  of it.  When the larynx and part of the trachea were exposed to view,
after careful dissection of the adjacent parts, the trachea, as far down as the
sixth ring, was found to be  enlarged, principally on the left side, though
the enlargement extended across the median line about half an inch.  To
the touch this enlargement was  rather hard and immovable.   None of us
had anticipated that the growth had progressed to such an extent into the
air-passage below.   The chances for a successful termination  of the opera-
tion  had nearly  vanished.  To attempt  to remove the tumor in the then
exhausted condition of the patient, coupled with the additional danger in-
volved on account of the extent of the disease and the parts affected, would
have been foolhardiness.  Division of the cricoid cartilage and first ring of
the trachea and  so  much of the mass lying below as was necessary  to get
the  canula into  the trachea, was at once determined upon.  This would
rescue the patient, at  least from immediate  danger of suffocation,  afford
   .            him a chance to recuperate his strength, and perhaps admit,
drowning16 with   at  some  future time,  of  a supplementary operation.  No
blood.          untoward event happened when  the incision was made and
Never attended   ^e canula introduced.   When the effect of the anesthetic
aid was always   ^a^ Passe^  away, the patient,  though much exhausted,
troubled  about  breathed easier, and fell into a  slumber.  When I visited
               him in the  evening he was a changed man.
   The next day, August 17, he exhibited some symptoms of pneumonia,
xohich yielded, however, to treatment in  twenty-four  hours.   Mucus and
blood  were discharged from the  canula, but the wound caused  little or no
pain.  The process of eating and  drinking, at first a little  difficult, soon
became perfectly easy.   On the fifth day the stitches were removed.   There 
17
teas some soreness and discharge around the canula.  The greater force of
the left larger division of the tumor twisted the canula somewhat toicard
the right.  On the sixth day the patient sat up, and could attend himself
to the cleaning of the tube, eat with comfort, and  move  about.  A laryn-
goscopy examination showed the growth  distinctly, grayish-red in color,
nearly closing the glottis.  He spoke, of course, only in a whisper; could
not articulate the first word, or make other than a  hissing sound.
   The  progress now made from day to day was surprising.  He lost that
anxious look, relished his food, and slept well.  He could breathe easier
and take a deeper breath than  he had done for years.  August 25, being
obliged  to visit a patient in Montreal, I saw Captain Bigelow for the last
time.  He  also made preparations to return home the next day.  Before
leaving, he called upon Dr. Sayre, who cauterized  the wound, as it had be-
come irritable.
   From a letter received from this patient, dated September 9, 1869, I
made the following  extracts: "I endured the journey from New York to
this  place  remarkably well, but was  considerably fatigued and troubled
with the dust; have been gaining ever since I came here.  Have walked
and rode, and am becoming expert in the arts of eating and drinking, both
of which  I do now without  putting my finger  on the tube or otherwise
closing  it.   The wound in the throat is  healing  full  as well as could be
expected."
   Nothing has been elicited from the captain since the
above date, till a short time since I came in possession of  |^y}.etter to Dr'
the following statement of his  case, brought down to  the
date of writing:
    " When I first got  home, I improved  in strength  and general health
very rapidly for eight or  ten days—but continued to cough a good deal—
raising much mucus, varying from clear white to yellow, often streaked
with blood—frequently a good deal of blood, as I had ever since the opera-
tion.  Scabs formed  below the tube, which I would several times each day
cough up with more  or less difficulty, and this has  continued to  the present
time.  At  first,  had four or five of them each twenty-four hours—raising
them always with severe  coughing and more or less blood, in quantities
from two tablespoonfuls down to occasionally a very minute quantity.  The
scabs sometimes are so large and hard, and  get stuck so fast, that, even with
small tube removed, I  have been many times nearly strangled.  Lately,
however, they have been much reduced in size, more irregular, and healthy
in appearance.
    " For two or three weeks my cough, though very frequent through the
day, was much  worse at night; and as I could not  cough alone, I was com-
pelled to have my wife up to assist me, sometimes  twenty times per night.
As this was wearing  us  both  out, I began to take,  on going to bed, twenty
to twenty-five  drops McMunn's Elixir, and this opiate immediately gave
me quiet sleep and  rest free from coughing.  To relieve my  cough and
pains, and give me quiet sleep,  I have continued this to  the present  time.
                2 
IS
I have had considerable bronchitis, and had one bad cold—just now I have
no  cold, and less bronchitis.   Still I cough up a good deal of mucus and
blood.  Some of this blood we know must come from the trachea below
the tube.  Some of it we also know comes from the tumor above the tube—
as,  when it has a bleeding-turn, we can see it dripping in through the hole
in upper part of the tube.  When I left New York, as you saw, suppuration
was going on inside and oozing out around the tube—this continued  and
increased, so it was difficult to keep my throat tolerably clean until middle
of September, when it ceased.  While active it had much odor, as also had
my mouth, when held open, though  kept  as  clean as possible.  We  had
great  hopes that this suppuration would work a favorable change, but it
stopped almost in a day.   The tumor had  previously somewhat enlarged,
but now it grew faster in size, and got very hard,  all around the tube,
especially above and on left side.  I had a good deal of soreness around
the tube—and as this hardness and swelling increased, so also did the pain.
My left ear began  to  ache severely and almost  constantly, as  before the
operation.
    " Immediately around  the tube, a ridge or swelling formed, harder than
any other part.  During all this time proud flesh had never ceased to grow,
since  the first that you cauterized in your office.   We had continued to
cauterize it—but as fast as it was killed in one place it appeared in another;
this fungus gradually changed in appearauce, cauterizing became painful—
burning, smarting pains lasted often  for hours after  the application—the
pains  of each  thorough dressing and cleaning of my throat morning  and
evening  were  exquisite.  Still  this fungus was pronounced ' proud flesh'
and cauterized.  At last Dr. Martin (our family physician, whom you may
remember as present at the operation) applied a paste, which he thought
would have different  and better effect than caustic—but two applications
were  made, as the swelling around  the tube increased—the ridge a bove
named was forced  up into quite a hillock, through  which the tube  ap-
peared, and was forced far away to the right  side of its original position.
During these painful days and weeks, the changes from day to day were
remarkable.  At last this ' ridge,' from  an angry red, grew purple, then
black, and at one  morning's dressing my wife  removed the whole  of it
without difficulty—a dead, rotten mass of decayed flesh—and it left a trench
around the tube, about three-eighths of an inch wide and deep, and not  a
bit  of proud flesh was to be seen; but on the left side, close against the tube,
was a dark, rough, warty growth, as large as a full-sized pea, and larger—
looking ugly enough.  It had no attachment to the flesh beside it, as it and
the flesh could be pressed apart easily.  While the flesh adjacent was ex-
quisitely sensitive to the  touch, this 'growth' had no sensitiveness at all,
but could be pressed  with the point of a knife, without any feeling, though
it was easily provoked to bleeding.  There can be no doubt but what this
is a part of the original tumor which  has forced itself out of the windpipe
and through to the surface, beside the tube.  From that time  till a week
since  (about eleven days)  my wife used morning  and evening to take away 
19
portions  of this matter, which would  'slough' off the  tumor.  As this
diminished, suppuration began again; the swelling all around the tube—or
rather the great tumor in  the trachea—which was  so large and swollen
and hard before, became greatly  reduced, and, when the ' sloughing off'
ceased, suppuration became more active, with very offensive odor; this has
gradually decreased, till now the suppuration is but slight, and the ' trench'
around the tube, that  for a time was a  ghastly sight, is now nearly healed
up; but  next the tube the tumor has  extended, and  at present it can b«
seen two-thirds the way around the tube, and the original tumor inside the
trachea has so enlarged  and expanded it, that it appears now more than
twice as  large as at the time of operation, and is almost as hard as a stone.
Coughing and bleeding continue as before, much blood comes from the
tumor, and considerable comes from the lower trachea, if not from the
bronchial passages.   I cannot believe that the tumor has extended below
the tube yet—but certainly there is more difficulty in breathing, that is,
even  when free from scabs and mucus.  I do not inflate my lungs as freely
or as easily as I did five or six weeks  ago, and breathing generally is not
as easy.
    " This  may be owing to  irritation  and inflammation about the inner
end of the tube, making the passage smaller, or it may  be the growth of
the  tumor, encroaching on the passage into  the tube—or something else
beyond my ken may occasion it; I cannot and dare not even guess what  it
is!   During the time the above-named  ' ridge' was forming, and even
 until the subsequent 'trench' was nearly healed, I had almost continually
 sharp, stinging, darting pains around the tube —not extending far from the
 tube, but all radiating from that as a centre—sometimes the  hole in  which
 the tube is inserted would feel as if filled with a red-hot iron or live coal,
 so intense would be  the pain; at other times the pain was less, and more
 as if it was filled with a chestnut-bur; at other times the stinging, burn-
 ing, darting pains would  follow each other in quick succession, appearing
 to me, especially when asleep, like so  many irregular shots fired from one
 centre, but mostly to the left side—all this time the pain was most exquisite
 while the throat was being cleaned and  dressed, and, soon  after the first
 application of warm water with a soft camel's-hair brush, it would inva-
 riably become so severe that I could scarcely endure it.
    " This has lately gradually diminished, till now I have none of the pains
 mentioned, and but little tenderness about the parts when under cleansing
 treatment, and I should  here say that,  through the most painful period
 mentioned, there were intervals of comparative comfort and relief, but they
 were short and irregular.  The tendency to left earache has been almost
 constant for nearly a month past—much of the time it is dull, and not very
 hard ; but it has paroxysms of very severe aching pain  in left ear—doubt-
 less  caused  by inflammation  and  enlargement of the throat, affecting the
 nerve in some way that you understand,  but I do not.  When  the earache
 comes on quick and sharp, it has frequently, within the last ten  or twelve
 days, been accompanied with aching of all the teeth on left upper jaw—but 
20
 this has never lasted more than fifteen or twenty minutes at a time.  Res-
 piration, as I have said, is not as free as it was a few weeks since.  I  have
 to be careful to  avoid  the cold air, as it goes so directly to my lungs that
 the  effect  is bad; when  the weather is warm I walk or ride out, but at
 other times I keep the house pretty closely, with rooms kept warm  with
 Avood-fires, and fresh water steaming to moisten the atmosphere.  I do not
 feel as strong,  nor can I endure the exertion I could a few  weeks ago, and
 my appetite, which was then strong and hearty, is now poor and variable.
   The  above account needs no  comment.  The rapid  progress of the
 growth foretells also the sequel.

    Resume.—For  six  years the patient was suffering  and
 constantly getting worse, yet his true condition remained un-
 told until he was subjected by myself to a laryngoscopic ex-
 amination.  This much the captain used to grant, that for the
 first time he  had been told what ailed him:  and I think  also
 my  diagnosis  and prognosis were correct.  "What might have
 been the  result, had the disease been discovered in its incipient
 stage  and treated  accordingly, cannot now be told.   It may,
 however, be asserted, that if the disease, as subsequent results
 have shown, was malignant,  it would  not have been arrested
 or eradicated.  Still, could not its progress have been retarded,
 and thereby  the patient's life prolonged %
    Again, local interference through the mouth accomplished
 all that reasonably can be claimed for it in a case of this  na-
 ture.  It gave the patient comfort—it helped to prolong his
 life.
    The operation of the tracheo-laryngotomy, had it been per-
formed earlier,  to  which Captain B., however, most  strenu-
 ously objected, as well as his friends, might  have resulted in
 great good.   Undertaken, as it was, at the very latest moment,
 under conditions of great danger, it  still was a success, and
 accomplished all we had a right to expect.


    As to the doctor's statements of the thanks, gratitude, and
 confidence of the  captain in him, I refer simply to the widow's
 letters, and the marked copy of the doctor's report in the cap-
 tain's own handwriting.   I would draw especial  attention to
 another sentence in the  doctor's  reply, in which  he confesses
 that he had written the report with the intention of conveying 
21
the idea that he performed the  operation, but, when carefully
read, could only be interpreted  that I could have done it, but
that he did not punctuate his  sentences  too correctly, so as to
parse  grammatically that "I" instead of "himself" had per-
formed the operation;  and in the very next sentence he states :
" Upon  reading, however, that rather,  I should  think,  com-
plimentary than disparaging  sentence, your injured sense of
justice is  aroused, you  swear vengeance, and, presto, you ad-
dressed  questions in writing  to the  gentlemen who were my
guests, not yours, at the operation,''  thereby inferring that it
was his operation, and certainly contradicting his previous
expression that it was my operation.   I  leave  it to the doctor
to explain this discrepancy.
    The  doctor now states that he  wished to make the amende
honorable, and wrote me the following note :

                                     Fifth Avenue Hotel,   )
                         New York, December 31,  1869, 11 a. m. \
My dear Doctor :
   I regret to learn, from  a mutual friend of ours, that you feel  yourself
aggrieved, inasmuch as that I had not done you justice in my report of Cap-
tain Bigelow's case.
   Allow me here, therefore, to state that, when I wrote the report of my
case, I had not the" remotest intention to  claim  for myself what credit, in
my case, really belongs to you.  I trust you have known me long enough
to know that I am not willing to  compromise the good opinion and fame
of a professional friend in a few printed lines.   I disavow any sinister mo-
tives in toto.
   If there is any doubt as to who performed the operation, I shall be hap-
py to clear up that doubt in a supplementary note to the Journal, as well
as in reference to the haemorrhage, which fact, I  acknowledge, I overlooked
in my report.
   I  am not willing that the dear old year should pass away, and the new
one come in, without my addressing you, in the sincere hope of a satisfac-
tory solution of the difference.
   AYith the compliments of the season, I remain very truly yours,
                                          A. Ruppaner, M. D.
Dr. L. A. Sayre, Fifth Avenue.


   L' This  letter/' he states, " written in a  most kindly spirit,
for an hone-t purpose, you never condescended to answer," and
finds great fault  because I have not quoted  the whole letter in 
00
my first report, but only sentences of it.   In looking over my
manuscript, I find that asterisks are placed at the proper posi-
tions showing the parts of the letter left out, but which were
neglected to be inserted by the printer; but compare the two
letters as quoted, and you will find that they are perfectly cor-
rect so far as quoted.
    The doctor finds fault that I have not replied to his letter.
No gentleman could reply to a letter from one who confessed
that he had published a falsehood until he had  as  publicly
corrected his error as he had  publicly committed it.  His let-
ter to me individuallv, containing  the statement that he had
no  sinister motives, was  of no  moment.  His statement had
been made to the public, and it was to the public, through the
same source that he had propagated the  falsehood, that he
should have made the correction, and not to me individually ;
and the fact of  answering his letter at all until  this  correc-
tion had been  made, would have been an admission that I con-
sidered him a gentleman, which, as a, publisher of falsehoods,
of course was impossible.  As to the fifty operations of a simi-
ilar sort in which Dr. Zolnowski assisted during the space of
a year and a half, I have  nothing  to state, except  that in my
opinion  it  is  a much larger  number of cases than even Dr.
Ruppaner, who makes a specialty of diseases of the throat, has
performed  in the same space  of time.
    The  fact is, that Dr. Ruppaner never intended to  correct
his error in the Medical Journal, as is  apparent from  the fol-
lowing letter from Dr. Reuben A. Yance.  And it shows, also,
the animus of the  doctor, and that he had been dwelling  on
this subject for nearly two years—without ever speaking to me
about it—on  the contrary, all this time pretending to be my
greatest friend.   The  doctor being near my office, and very
convenient of access, I had called at his office on two separate
occasions, when  suffering from a slight  laryngitis,  and he ap-
plied a solution of iodine to my throat very satisfactorily, and
I felt grateful to him for his attention ;  sent him quite a num-
ber of patients ;  was instrumental in helping him  to get up a
dispensary for the treatment  of throat-diseases, and my name
is published as one  of the incorporators  and trustees of this in-
 stitution. 
23
    So far, therefore, as  the  influence of my name may go, I
am responsible to the community for  indorsing and  recom-
mending him to public patronage.  This was  done at  a time
when I had confidence both in his capacity and integrity.
    But discovering  his deficiency in both of these  essential
qualifications, and that  he had hired a building, opened  the
institution, obtained money from the city and private individ-
uals for its support, and publicly advertised its existence by
distributing circulars announcing himself as physician, along
with the names of the other medical officers of the institution,
without any knowledge or consent of the Board  of  Trustees
—in fact,  the Trustees had never been  called together  at this
time, and there was no organization of the Board of Trustees
for some weeks after this public advertisement of the opening of
the institution, of which he was the self-appointed physician—
and as the  Board of Trustees were the only legally authorized
persons to make appointments, or direct the management of the
institution,  I looked upon this  action of  Dr. Ruppaner as  a
fraud, and, to absolve myself from any responsibility in  the de-
ception, narrated these facts in my first  review of  his case.
But the editor of the Medical Journal advised its erasure, as
it was irrelevant and personal matter.
    I therefore here repeat these facts, in order to absolve my-
self before the community from any responsibility for his pres-
ent official  position in the New York Dispensary for the Treat-
ment of Diseases of the Throat.
    A few days after I had operated upon Captain Bigelow, I
met Dr. Ruppaner in front of the Fifth Avenue Hotel,  and he
then told me that the " Boston doctors  were opposed  to  the
operation,'" and said they had told Captain Bigelow  " those
New York doctors would cut his throat and kill him ... In
fact I thought he would die myself, but I thought he had better
die on your hands than on mine."  This  remark was made
with a strange, sardonic laugh,  and so surprised  me  that  I
scarcely knew what  to  reply  to  it, as I could hardly  under-
stand its meaning.   Yiewed,  however,  in  the light  which is
thrown upon  Dr. Rivppaner's feelings toward me  by  Dr.
Yance's letter, this remark has a very significant meaning in-
deed. 
21
                          144 East Twentt-seoond Street,   )
                               New York City, June 1, 1870. )
Dr. Lewis A. Satre, 285 Fifth Avenue—
   Dear Sir: In reply to yours of May 27th, I have to state that, early in
January of the present year, Dr. Ruppaner called at this office to see  me
in  regard to the case  of Captain Bigelow, I having been present  at the
operation performed upon  that gentleman in August, 1869.  During the
course of the conversation, I urged Dr. Ruppaner to correct the phraseology
of  his report published in the New York Medical Journal of January,
1870, so that there could be no misapprehension as to who performed the
operation, and thus obviate the threatened difficulty.  This he declined to
do, saying that, as you  had injured him, on a prior occasion, you would
not dare to have any trouble with him about the present case, as you knew
it was in his power to  expose what he designated as your falsehoods about
the poisoning cases at the Fifth Avenue Hotel.
   There was nothing in our interview that partook of the nature of a pri-
vate conversation, Dr. Ruppaner expressly  disclaiming any such interpre-
tation of his communication.            Yours truly,
                                           Reuben A. Vance.

    I will now leave the case of Captain Bigelow, and refer to the
particular charges  which  I have  to make against Dr. Ruppa-
ner for unprofessional conduct in his reference  to what  he
styles u The great poisoning case, by partridges, at the Fifth
Avenue Hotel," which occurred on the 15th of February, 1868.
    In reply to this I would state, and as will be seen by Mr.
Suit's, Grimes's, Guthrie's,  Willmarth's, and other letters, that
for many years I had  been Mr. Suit's family physician ; that
a messenger came  to me on the  evening in question at about
six o'clock, just as I was  sitting down to dinner, requesting
me  to see  Mr. Suit immediately /  that on going to the door
to ascertain whether it was a  case that required immediate at-
tention or could be  postponed until  after  my dinner, the mes-
senger informed me  that " Mr. Suit and his friend had been on
a  lark and  were at  the hotel pretty drunk," when  I replied,
" That being the case, he could wait until I had got my dinner,"
and told him I would be down as soon after dinner as possible.
In a very few minutes after, another messenger, Thomas Wise-
man, arrived, requesting me  to go in haste (whose letter stat-
ing the facts will  be found  attached  to this report).   He
also stated that Mr. Suit  was pretty drunk, and  that I had
better come  as soon as  possible.   I immediately went with 
25
this messenger to the hotel, and found Mr. Suit and his friend
both there sick, and two or three gentlemen in the room.
Upon asking Mr. Suit what was the matter, he stated that he
did not know ; when I  asked him how long he had been sick,
he stated " Only a  few minutes; a little while ago, coming
through the reading-room, my legs all went to pieces, and some
fellow there reading a  paper said it was a pity to see such a
handsome fellow as  I was set up that way; I  replied to him,
I thought I was pretty well set down."  This remark giving
no evidence of drunkenness, caused me to smile, and after ask-
ing him  a few more questions I said to him, " I do not think
you are drunk, Suit; " he replied that he did not think he was
himself.  Upon  asking him to get up and let me  see what
was the matter, he said he could not, and upon his making the
effort apparently fainted and fell backward, and I sent to  the
bar-room and got some brandy to restore him.  The bar-keeper
remembers very well having sent it in a very few  minutes
after my arrival, and will testify to that  fact. Finding that
his pupils  were immensely dilated, his pulse  very weak and
feeble, and when in the erect posture almost  ceased, and  yet
his intellect  was clear, I stated to Mr. Suit  that he did not
seem to be drunk at all, but acted as if he had been poisoned;
he  replied that it  must  be the whiskey, that he knew what
whiskey was made of, and, thinking that he was correct, I re-
plied to him that I guessed he was right; some  gentleman pres-
ent, whose name I do not now remember,1 stated that Imust be
mistaken about  the whiskey, that  he had drunk as much as
either Suit or Grimes, and wanted to know if I thought he was
drunk or poisoned; I told him, no; he seemed to be all right,
and asked him what was the real truth about the whole story;
what had they eaten and drunk, and to let me know what had
passed the whole day.  He stated that] they  returned in the
New Haven cars from  Canada too late for lunch and too early
for dinner, and had  gone to the St. James's Hotel to get din-
ner ; he had eaten of something which I  have now forgotten,
but that the  other two men  made their  dinner  of par-
tridges ;  and Suit stated that he had  eaten twice of  the par-
   11 have since learned that the gentleman referred to was Mr. Frank
Turk, of Washington City,  whose letter will be found annexed. 
26
fridges, and the balance that  was left Grimes finished,  and
when they came to dessert Mr. Grimes complained of feeling
very faint, that he never felt so faint in all his life, and felt as
if he wanted a drink of brandy; Mr. Suit remarked that he felt
exactly the same way, and would like to take a drink too ; the
other gentleman who was telling me the story began to laugh,
and said it was rather novel for two fellows to eat themselves
faint;  that it was the first time that he had  ever seen such a
thing in his life; that upon  getting up to  get a drink, or else
ordering it, I have forgotten precisely which, they got so much
worse that they hurried to the front door and got into a  car-
riage which stood in front of the hotel, and drove immediately
to the  Fifth Avenue Hotel  on the Twenty-third-Street side.
In getting into the carriage Mr. Grimes fell down  and vom-
ited  very freely.  Upon arriving at the hotel they mustered
up all  their courage  and strength, and succeeded in walking
as far as the reading-room, where they both fell down almost
at the  same  time and in a similar way, and were carried into
the room.    I  was then  sent for immediately, as will be seen
by referring to Mr. Hasimer's letter,  the  clerk in  the book-
store, who assisted  in carrying Mr. Suit into  the  room, and
also to Mr. Suit's and Mr. Turk's letters.
   Yiewing the case with the evidences before me :  three men
having drunk of the same wines and whiskey, in nearly equal
quantities, but eating of different food, and the  two men who
had eaten of the partridges being very sick, and  the one who
had eaten the most partridge being the sickest of the two, but
the same kind of sickness, I  naturally inferred that the sick-
ness  by poison was due to the partridge which they had eaten,
and so stated  to them.  Mr. Turk replied that he thought I
was  correct—as the  birds could get nothing to eat in deep
snow, except from the laurel-berries,  which were  poisonous.
Mr. Grimes was very much exhausted  and very faint, and had
vomited  very freely, and was still vomiting.   Mr. Suit not
having vomited so freely, and still  complaining of  sickness at
his stomach, I caused him to drink large  quantities of water
for the purpose of distending his stomach, and by mechanical
distention excite muscular contraction, and so cleanse  him
from whatever it contained. 
27
   After having done this,  still finding  him with a feeble
pulse,  and dilated pupils, I  feared that whatever poison he
had taken had been absorbed into the system, and I so stated
to him, and that I would go into the drug-store and ascertain
what was the proper remedy to give him, which I did; and
stating, in Messrs. Caswell &  Mack's drug-store, that the two
gentlemen  were poisoned from the eating of the partridges,
some person in the store  said it was the poison of the laurel-
berry ; that the birds were compelled to feed on them on ac-
count of the depth of the snow;  and when I asked him what
was the antidote he stated he did not know, and requested one
of the  clerks to get out the book, either Christison on Poisons,
or Wood and Bache's Dispensatory; and we were reading over
this book in order to ascertain the proper remedy to be admin-
istered, when Dr. Ruppaner came into the drug-store, which
I  think was  the first time  I had ever seen  him;  he  intro-
duced himself to me as Dr. Ruppaner, and informed me that
he had seen two of my patients that evening who were " very
sick, very sick indeed, in fact they were pretty tight, doctor."
I told  him I did not think they were drunk, I thought* they
were poisoned from eating partridges, and I was trying to hunt
up a remedy for them;  he said they were poisoned with the
bad whiskey  we had in  this country," Pretty  bad whiskey,
doctor."  I again informed him I thought they were poisoned
from eating the partridges, and the  gentleman who was hunt-
ing over for the remedy which he wanted had succeeded in
finding it,  and  he hastily prepared it and  put  it up for me,
which  I took to their room, not having written any prescrip-
tion for it.
   I requested Dr. Ruppaner to come back to the room with
me and see them; he refused, stating that  he merely lived  in
the hotel, that he was very glad  to have been able to do any
thing for me, very happy  to do any thing of the kind, but they
were my patients, and he declined to do any thing further.  I
asked  him to  go in as matter of curiosity, as it was a very
interesting  case, which he did, and after having given them
the medicine, which they continued to  take for a couple  of
days afterward, I requested him, as he lived in the hotel, to
come in and see  them frequently, as I had  to go home to my 
28
dinner and attend to my office business ; that I would be back
again at ten o'clock and  see  them again with him, which I
did.   So far as  the statement made in the Sunday JTews, I
never knew any thing of it until I read it in Dr. Ruppaner's
report.  I have since ascertained that it was written by a gen-
tleman of the name of Pittman, whose letter, which is here-
unto annexed, will  explain fully that I knew nothing  at all
about it.  I received from  Mr. Roosevelt,  the  gentleman who
has  published a book on   the birds and fishes of the State of
New York, a very respectful communication, asking  for infor-
mation  in  regard to the  case, which I replied to, and  which
is copied in Dr.  Ruppaner's report precisely as  I wrote it, but,
as will be seen by his letter hereto annexed, was not written
for the purpose of publication, although I think it our duty to
thus disseminate, useful  information to the people, to protect
them against an unsuspected danger.


                      Coleman House, New York,  April 28, 1870.
To Dr. Lewis A. Sayre—
   Dear Sir : My attention has been called to a pamphlet, purporting to
have been written by one A. Ruppaner, M. D., in which he published an
article  written by me on the well-known partridge-poisoning case that
occurred at the Fifth Avenue Hotel, February, 1868, and which appeared
in the columns of the Sunday News, on the 1st of March, 1868. In com-
menting on this article, Ruppaner intimates that it was written and pub-
lished with your knowledge and  consent.
   In justice to you I beg to say, most  emphatically, that it was not writ-
ten or published with your knowledge or consent;  and I do not know that
you ever saw it in the News.  I am certain I neither directed your atten-
tion to it,  nor sent you a copy of the paper.  I heard of  the case the night
it occurred, and having met Mr. Suit  some time previous, in company
with  Hon. Benjamin Wood, I took an  interest in the  matter, and ascer-
tained the facts from  authentic sources, and so published them, believing
the public to be as much interested in such a case as the medical fraternity.
   Had Dr. Ruppaner taken some pains to have ascertained my knowledge
about the  " great master of surgery and wonderful decoction that mys-
teriously kills poison," he would  have been spared the labor of his unjust
comments, and his ungenerous attack on your professional reputation.
                   With great respect, yours truly,
                                          Thomas W. Pittman. 
29
                  New York Commissioners of Fisheries :
                             Horatio Seymour, Utica,
                             George Gr. Cooper, Rochester,
                             Robert B. Roosevelt, New York,
                                             32 Beelman Street.
Dr. Lewis A. Sayre—
   My dear Sir: I regret to  hear that any complaint has been made
against you, concerning the publication of a letter which  you wrote to me
some  years ago in reference to the danger  of  eating partridges (ruffed
grouse) out of season.
   I had written  several works on sporting matters, and had mentioned
the fact that the flesh of these birds occasionally became poisonous in con-
sequence  of their feeding on laurel-berries.
   This assertion of mine had been disputed, when the effect of the game
laws was under discussion, and I, hearing that you had a case in point,
wrote to  you, asking you for an account of it.  You kindly sent me the
answer, which I, without thinking it could possibly be misconstrued, pub-
lished, the matter being one of serious public concern, and about which
there seemed to be some doubt.
    The first time I saw you after such publication, you complained to me
of what I had done, and said that you had not intended your letter for use
in the paper, but merely meant it for my own information.
    I was quite surprised at this, as I knew of no professional rule on the
subject requiring a matter of such vital importance to the public  to be
kept secret.  I hope that the medical fraternity do not desire to keep the
people in ignorance of danger,  that they may have the pleasure of curing
them, after they shall have unwittingly poisoned themselves.
    In any event, if there is any one to blame, it is myself, through my un-
intentional error.
    In justice to you, I will be happy to substantiate this statement in any
 manner that you may desire.           Yours, very respectfully,
                            (Signed)        Robert B. Roosevelt.

    Let us now compare the statement of this poisoning  case,
 as published by Dr. Ruppaner, and the  facts as testified to by
 a number of credible witnesses.
    Dr. Ruppaner, in  his pamphlet, says, " February  15, 1868,
 between four and five o'clock (the italics are mine), I was has-
 tily  summoned from my office  to room H, on the same  floor
 of the  hotel  as my own, where I found two gentlemen,  lying
 each on a bed, surrounded by a few gentlemen, friends of the
 patients—one  the father-in-law of one  of  the sufferers," etc.
 This latter gentleman referred to is Mr. Willmarth, the father-
 in-law  of Mr. Suit.  By  referring  to the  annexed letter  of 
30
Charles Ledworth, the  usher  at the dining-room of the Fifth
Avenue Hotel, it will be seen that Mr. Willmarth was at  din-
ner at  the time Mr. Suit was brought into room  II, and  it
must  therefore have been after half-past five  o'clock, as the
room  is not opened until that hour.  It is  highly probable
that it  was nearer six, as the  regular boarders of an hotel are
not apt to rush into the dining-room  the moment the doors
are opened.
                           FiFTn Avenue Hotel, May 2, 1870.
   A little after six o'clock, on Saturday, February 15,1866, one of the hall-
boys came after me and wished me to call Mr. Willmarth out from the din-
ner-table, stating that his son-in-law, Mr. Suit, was down-stairs very sick,
and wanted him to come at once.
   I always open the dinner-door at five and a half o'clock.
                                   Charles Ledworth, Usher.

    The doctor made a hurried examination of  the patients,
and says:
    " Satisfied that no time was to  be lost—my diagnosis being
poisoning  by hydrocyanic acid—I ordered the by-standers to
apply friction, with speed and force, so as to keep up the cir-
culation, and to'produce warmth.   Ordered hot  fomentations
to the bowels; sent a servant  for mustard and  warm  water,
and, in the mean while, rushed to Caswell & Mack's drug-store,
where, not having time to prescribe, I had handed to me, with
the utmost dispatch, some muriate of ammonia and sesquichlo-
ride of iron, rushed back, prepared and administered the anti-
dote in  the presence of the by-standers.  Immediately after,  I
prepared myself the emetic of mustard and warm water, ad-
ministered it in large  quantities, got powerful action therefrom
soon; kept  this  action  wrell  up by additional  doses  of the
same emetic.   Later  I gave an active  purgative, which acted
promptly  and  powerfully,  and thus, after some three hours
(the italics are mine)  of hard,  very hard work—thanks  to the
kind and humane assistance of the friends present—I had, un-
der Providence, the great satisfaction to see  my  two patients
out of danger.   These were indeed three hours of intense sus-
pense, of the result of which  any medical man  might justly
feel proud."
    By  referring to the  letters of  Mr.  Suit, Henderson, Turk, 
31
and Hasimer, it will be seen that I was sent for immediately
after Mr. Suit was carried into room H, and, by referring to
the letter of Wm. Henderson, it will be seen that he took the
recipe from Dr. Ruppaner and got the medicine from the drug-
store, and took it back to him.


                              Fifth Avenue Hotel, April 9, 1870.
Dr. Lewis A. Sayre—
   Dear Sir : I am the clerk of the book-stand in the reading-room of the
Fifth Avenue Hotel, and saw Mr. Suit and his friend fall down in the room
some two years ago, at the time they were poisoned.
   The evening papers were just coming in at the time, about half-past
five or six o'clock, when two gentlemen fell very suddenly on the floor in
front of the book-stand.
   I ran out and helped one of the gentlemen to room H, back of the bar-
room.
   Dr. Ruppaner was immediately called to see them, but Mr. Suit said,
" I want Dr. Sayre; he is my doctor." Dr. Ruppaner replied : " Oh, I will
fix you all right in a little while; you are in no danger—a little tight, my
boy, a little tight; but, if you want Dr. Sayre, you had better send for him ; "
and a messenger was immediately sent for you.      John B. Hasimer.


                                      New York,  April 29, 1870.
Dr. L. A. Sayre—
   Dear Sir: I have read the pamphlet of Dr. Ruppaner's,  and particu-
larly that part relating to Messrs. Suit  and Grimes's  case of poisoning  at
the St. James's Hotel about two years ago.
   I was employed at the Fifth Avenue Hotel  at that time, and was in at-
tendance on the sick men from the time they were brought to the house
until they recovered.  Dr. Ruppaner was in attendance on the men imme-
diately after they were taken ill, and I heard him say they were suffering
from the effects of drink.
   A messenger  was sent for you, and, as you did not come immediately,
Mr. Suit sent me to hurry you up; you came, I think, about six o'clock  in
the evening, and, after some conversation with the sick men, you said they
were not drunk,  but poisoned.  Mr. Suit said:  "It must be that bad whis-
key, I know what whiskey is made of," and you said you  guessed he was
right. Some other gentleman * standing by said : " Doctor, it cannot be the
whiskey, as I drank as much as they did, and I am not drunk." You said he
was all right, and asked him all they had to eat and drink that day. He said
they had dined at St. James's Hotel, and  that the sick men had  eaten par-
tridge, the sickest man having eaten the largest quantity.
1 Turk, lawyer in Washington. 
32
   You made one of them drink a large quantity of water, and vomit, and
went to the drug-store and returned in company with Dr. Ruppaner:
   You were with the sick men some time later that night.
   I was almost continually in the room with the sick men, and do not be-
lieve they got any medicine until you came, and I am sure Dr. Ruppaner
said drink caused their sickness.  On that night, and on several occasions
afterward, both Mr. Suit and Mr. Grimes told me  they thought Dr.  Rup-
paner knew very little about their case.
                   Yours, very respectfully,
                           TnoMAS Wiseman, 448 Fourth Avenue.

                           150 West 28th Sreet, April 27, 1870.
   I was hall-boy at the Fifth Avenue Hotel in 1868, at the time Mr. Suit
and Mr. Grimes were poisoned, and was  called on to  answer the  bell of
room letter II, as near as I can recollect about 6 o'clock or between 6 and
7 o'clock.  When I got there, Dr. Ruppaner wanted me to go to the apothe-
cary store for some medicine.
   He gave me a  paper, which I took to the drug-store  of Caswell &
Mack, and they gave me a bottle, which I  took back to the room and gave
to Dr. Ruppaner.
                                            Wm. Henderson.

   The  doctor's treatment, as  above described by himself, is
certainly most remarkable.  He  says that  he  " prepared  and
administered  the antidote in the presence of  the by-standers.
Immediately  (the  italics are  mine) after  I prepared, myself,
the emetic of mustard  and  warm  water, administered it in
large quantities, got powerful action therefrom  soon;  kept
this  action well up by additional doses of the same emetic."
   The  poison  had already been  absorbed into the system;
and  what good could be expected  from an antidote, if it was
vomited out of the stomach immediately after it had been put
in, I am unable to see.   Comment  on this part of the doctor's
treatment seems to me unnecessary.
    "After over three hours  of  friction, vomiting, purging,
taking of antidotes, hot applications, and any amount of anxi-
ety  all around,  the patients  were quite comfortable, warm,
pulse lower and fuller, and an inclination on their part to con-
verse, manifest."
    " At this  stage of the  case, Mr.  S. said to  me: ' Doctor,
what ails me, anyhow ?'   ' You were poisoned, by eating those
partridges,' I replied.  ' Oh, no; I know it was that vile whis- 
33
key  we  were drinking  that  did the work,' rejoined Mr. S.
' Sorry for your whiskey, then,' was my reply.
   '"Mr. S.,  still continuing to doubt, asked me: 'Do you
know Dr. Sayre 2'   I replied affirmatively.  ' Have you any
objection to my sending for him, to see whether he thinks  as
you do, for he has attended me before when I was sick ?'   ' Not
at all,' was  my answer;  'I shall be glad  to have Dr. Sayre
see you.'
  "A messenger  was immediately  dispatched.   During his
absence, I was called to  see another patient up-stairs.  When
I returned to the room where my patients were, I was told
that you (Dr. Sayre) had been there, and gone into the apoth-
ecary-store.   Following  you there, I met you."
   " All of my prescriptions can be found entered at Caswell's,
in their books,  corresponding to the dates, number of room,
and patients in question.   But I have taken the trouble care-
fully to look  for your prescriptions, particularly the antidote,
but there is not one of yours  to be found in the prescription-
book of that period!   Very singular, indeed!  Perhaps you
sent out for the medicines, as more handy than to get  them
right in the house !  Is this, too, a question of veracity between
you and me ?"
    This certainly is a question of veracity between us, and by
referring to the letter of Mr. WHlmarth, and the certificate of
Drs. Jordan,  Newman, Katzenbach, and Storer, it will at once
be seen who is entitled to belief.  I request especial attention
to the postscript of Mr. Willmarth's letter:

                                    New York, April 13, 1870.
   Dear Sir :  We have carefully examined the prescription-books of Cas-
well & Mack,  for the date of February 15, 1868, and find two prescriptions
of Dr. Ruppaner's on that day.  The copies are  herewith enclosed, but we
do not find any prescription, or the trace of one, containing iron and am-
monia.                Respectfully, etc.,
               W. C. Jordan,  M. D., 304 Madison Avenue,
                W. H. Katzenbach, Esq., 225 East Thirty-first Street,
               Robert Newman, M. D., 107 West Forty-fifth Street,
                Horatio R. Storer, M. D., Boston, May 1, 1870.
  To Dr. L. A. Sayre, Thirtieth  Street and Fifth Avenue.
               3 
34
                R. Bismuth subnit. 3j<
                    Infus. gent. co. § iss,
                    Aq. menth. pip. § ss.
f\[.  S. A teaspoonful every half hour till relieved.—Ruppaner.

                  R. Pil triplex, No. xii,
                     Two pills night and morning.
Company, )
ad way.   f
                       R. Sodse bicarb., 3 ij.—Ruppaner.

                                    Home Insurance C<
                                        Office, 135 Broadway.
                                       New York, Aprils, 187<i.
Dr. Lewis A. Sayre—
   Dear Sir: In response to certain inquiries in your note of the 16th
inst., I will say:
   1.  That when you were called to Mr. Suit at the time he was poisoned,
at the Fifth Avenue Hotel, while I should hardly feel willing to testify that
Dr. Ruppaner was not in the room at the time of your arrival, I think he
was not.  Indeed, I am quite positive that he was not.
   2.  I remember distinctly  that you made, or rather  continued, Mr.
Suit's vomiting by administering very large quantities of  warm water after
your arrival; and—
    3.  Please  bear in mind that I do not retract nor amend the statement
made  to Dr. Ruppaner, that in my opinion the lives of both Mr. Suit and
Mr. Grimes were saved by him prior to your arrival, and while I knew that
he had prescribed for them I did not so inform you (at least I have no recol-
lection of doing so), neither did I know of what the prescription consisted.
                                     Very truly yours, etc.,
                                                A. F. Willmarth.
    P. S.—It is proper for me to add that Dr. Ruppaner informed me a few
weeks since that the prescription referred to might be found on the books
of Caswell, Mack & Cp., giving number of room, etc., and that to my knowl-
edge you had previously been Mr. Suit's family physician.     A.  F.  W.

                                   Washington, D. C, May 4, 1870.
Dr. L. A. Sayre—
    Dear Sir : In answer to your verbal request  as to my knowledge of a
 case of poisoning which occurred at the Fifth Avenue Hotel, New York
 City,  on  the 15th of February, 1868, I have to say that Mr. S. T. Suit
 and Mr. Grimes, with myself, on that day, took lunch together at the St.
 James's Hotel, those gentlemen partaking  of a  partridge, of which they
 ate heartily,  and soon after complained of feeling unwell.  I advised their
 taking a drink of whiskey, which was the only liquor they took during the
 day.   I soon after left them, and went to  the reading-room of the Fifth
 Avenue Hotel, where they soon after made their appearance seriously ill
 and complaining that they had been poisoned; they were carried to a room 
35
on the same floor, and, learning  that a Dr. Ruppaner hadj an office in the
house, I called him in to render such aid as they might require.  Mr. Suit
was desirous that Dr. Sayre should be called in, and I dispatched one or
more messengers for him ;  until his arrival, Dr. Ruppaner devoted himself
to the care of both gentlemen.  Dr. Sayre arriYed about one hour after they
were taken.  Dr. Ruppaner having just then left the room, the impression
seemed  prevalent that the gentlemen were under the influence of liquor;
but I  informed Dr. Sayre, as I had already done Dr. Ruppaner, that they had
evidently been poisoned by eating the partridge.  I think Dr. Sayre imme-
diately recognized the fact, and treated them accordingly—administering
various remedies and large quantities of water.  I should fix the hour 4J
to 5 o'clock, and that of Dr. Say re's arrival from 5£ to 6 p. m.
   Mr. Suit was unwilling to believe that he had been poisoned by eating
the bird, but insisted that it was  the drink of whiskey he had taken, in-
timating that there might be parties interested in getting rid of him, and if
I knew  as  much about  the  way whiskey was made as he  did, I would
know it was that that caused the trouble.
                                       Truly yours,
                                                    Frank Turk.

                                       Grand Hotel, May 25, 1870.
Dr. Lewis  A. Sayre—
   Dear Sir : In answer to your note of April 16th, I will state that I am
positive that, when you were called in to see Messrs. Suit and Grimes,  at
the Fifth Avenue Hotel, at the time they were poisoned, Dr. Ruppaner
was not in the  room at the time of your arrival, nor did I hear any one
inform yon that he had been there.
   You did administer large quantities of warm water to Mr. Suit, which
caused him to vomit very freely.  I wish to state further, that I find from
Dr. Ruppaner's pamphlet that I used the term antidote in my note to him.
Not being a medical man,  I am, of course, not competent to judge whether
his prescription was an antidote to the poison or not, and should, therefore,.
have used the word remedy instead of antidote.
                                Very respectfully, your friend,
                                                   L. T. Guthrie.

                                         Silver Hill, May 2, 1870.
Dr. Lewis  A. Sayre:—
   Dear Sir: In reply to your note of the 16th of April, I distinctly re-
member of Mr. S. T. Suit ordering some one to send for you  immediately
after we were carried in room II,  in the Fifth Avenue  Hotel.  I also re-
member of him having sent a second time, seeming very anxious to see you,
said you had been his physician before.   Prior to your arrival, Dr. Rup-
paner had been in to  see us.   I do not remember that he, Dr. Ruppaner,.
told'me, before I saw you, that we had been poisoned'by eating partridge
or any thing else. 
36
    I remember of taking some brandy, with something else in the shape of
 medicine, ordered by Dr. Ruppaner.  On your arrival I do not remember
 of Dr. Ruppaner being in the room at the time. I remember of you saying,
 as I had vomited freely, I needed no emetic at the time, but you went directly
 to work on Mr. Suit with cold water.   I think he must have drunk four or
 live pitchers of water, and threw it up as fast as his stomach would fill; you
 said, if there was any portion of the poison left in his stomach, you wished
 to fill it so full with water as to fill up all the cracks and take the puckers
 out of it.
    I know Suit protested against taking any more water, and said he could
 not possibly get any more in him; you said he could drink a quart more,
 and he did do it; some one remarked to Suit  he  was pretty  well set up,
 Suit remarked  he was pretty well set down.  This remark was made in the
 hall, and, when this was repeated to you, you, Sayre, said, "That don't talk
 much like a drunken  man," and said, "Suit, I don't believe you are drunk
 anyhow ; I believe you are poisoned."
    I remember of your talking with some gentlemen in the room, and was
 asking what we had been eating;  you soon found out we had been eating
 partridge, and, as I understood, you came to the  conclusion the partridge
 was poisoned.  I do not remember of telling you, or hearing any  one  else
 tell you, that Dr. Ruppaner had been to see us before you came ;  I do re-
 member of you both  being in the room at the same time.
                               Very respectfully, your friend,
                                                   R. G.  Grimes.

                Silver Hill, Prince George's County, Maryland, )
                                            April 30, 1870.     j
    My dear Dr. :  Yours of  the 19th,  directed to  me at Louisville, Ky.,
 reached me yesterday, in which you ask the following questions:  "Was
 Dr. Ruppaner in the room at the time  of my arrival? "  I answer, he was
 not.  "Did I give  you an emetic of warm water  before  I  went into the
 drug-store? "   I  am under the impression you did.  " Did you tell me that
 Dr. Ruppaner had already prescribed for you before I brought him in with
 me from the drug-store? "  In answer to which I wish to say my  memory
 was very much affected, being, at the time, on the point of death.   But, as
 well as I can remember, I think your prescription of warm water  was the
 first I took, which was given in the absence of Dr. Ruppaner, who  had
 left the room for the drug-store.  I believe I have answered all your ques-
 tions ; now I wish to add a word or two regarding the  letter I gave Dr.
 Ruppaner.  He called on me several times at the  Fifth Avenue Hotel, and
 asked me for a letter giving the facts in the poisoning case.   I  refused at
first, and at the same time stated  my  reasons, which were, that I did not
 wish to be mixed up in any newspaper controversy.  He then pledged his
honor as a gentleman that the letter should not be used in print, or in  any
other way. without my knowledge and consent.  He also stated he wanted
the letter to show some friends who were interested in the case. 
37
   I have known Dr. Ruppaner several years, having boarded with him in
the Fifth Avenue Hotel two or three years.  He would be about the last
doctor in New York I would  call to my bedside if I thought my life was
in danger.  When I was poisoned and found myself fast approaching death,
I thought any doctor was better than none; therefore, I had him called in,
but at the same time dispatched two or three waiters for you.  When you
entered the room, I was satisfied my life would be saved.
                                   Yours, very respectfully,
                                                 S.  T. Suit.
  To Dr. Lewis A. Sayre, New York.

    The following was on a slip of paper, and  was enclosed
with the preceding letter:

   My dear Friend:  I very much regret having given Dr. Ruppaner the
letter I did.   He has proven himself unworthy of the confidence of any
gentleman, and I shall  tell him so when I see him.  I have given you a
plain statement of facts as I remember them ; if you can better the letter,
let me know, and I shall do all I  can to place you where you belong, and
to let the public know what I think of Dr. Ruppaner.  . . .
                                      As ever, your friend,
                                                 S.  T. Suit.

    In referring to this  subject in my  introductory  lecture
at Bellevue Hospital, and about which the doctor makes such
strong comment, it was  done  for  the  purpose  of impressing
upon the students the necessity of a knowledge of all the dif-
ferent departments of our profession.  In both of these cases,
the lecture and the letter, I  did not refer to Dr. Ruppaner, for
the  simple reason  that  / knew nothing  of his  having any
ideas, or of his having prescribed for these patients previous
to my being called  to see them.  Mr. Suit was one of my old
patients; two hurried messengers coming within a  very few
minutes of each  other,,  and  almost immediately,  as  proved
by their testimony, and by his letter  after his having been
taken sick, upon my arrival I found no doctor present; was not
informed that any doctor had been there, either by him or any
of his friends / and I, therefore, had not the remotest idea that
Dr. Ruppaner, or  any other physician, had seen the patients
previous to my arrival;  and  the  first knowledge that I had
that Dr. Ruppaner had seen  them was by his informing me
of the fact when he met  me in  the drug-store, where he says
he went and found me..   In that conversation he informed, me 
                            3>

that he considered them  drunk, or  suffering from the effects
of liquor; and consequently, on my referring to the partridge
poisoning case, I had no more idea  that the doctor  had  any
thing to do with the treatment of them as a case of poisoning,
than I had of the  name of the servant who called me to at-
tend them, and therefore  did not refer to his name, as it did
not occur to me that it had any claim to mention.
   For two years past, since this occurrence, Dr. Ruppaner
has seen me frequently, and has never spoken of  the subject,
or even referred to it in a single instance;  on the contrary, I
have letters in which he refers to me with the highest  consid-
eration and, warmest friendship, and according to his own pub-
lished  account, insisted to  Captain  Bigelow and his  friends
that I should be the surgeon to perform the operation upon
him, although other surgeons were mentioned and preferred;
and it is the most extraordinary thing that, if he felt that I
had done him this great injustice and  wrong, he should have
been so warm an admirer, so distinguished a friend, and should
have attempted to force upon Captain Bigelow a  person whom
he now confesses to have held for two years in such contempt,
and from whom he had suffered such great professional injury.
   There are many more  points on which I could have dwelt
in answer to Dr.  Ruppaner's pamphlet, but,  as I have dis-
tinctly proved his entire want of veracity in the  Bigelow case,
and his malicious and wilful professional injustice  in the  poi-
soning case, I have not thought it  advisable to prolong  this
answer.
                               Lewis A. Sayke,  M. D.
  June 1, 1870. 
 
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