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SILVER SUTURES IN SURGERY.
TII E
\NNIVERSARY  DISCOURSE,
BEFORE THE
NEW YORK ACADEMY OF MEDICINE.
DELIVERED IN THE NEW BUILDING OF THE HISTORICAL
     SOCIETY, ON THE 18tii NOVEMBER, 1867.
            BY

   J. MARION SIMS, M.D.,

SURGEON TO THE WOMAN'S HOSTITAL
(published by order of the academy.)
        .NEW YORK:
SAMUEL  S. &  WILLIAM WOOD,
 ■y'i> M
fete,
389 BROADWAY.

     msa 1
1858.
 
i 
SILVER  SUTURES IN SURGERY.
THE
ANNIVERSARY  DISCOURSE
BEFORE THE
NEW YORK ACADEMY OF MEDICINE.
DELIVERED IN THE NEW BUILDING OF THE HISTORICAL
     SOCIETY, ON THE 18th NOVEMBER, 1857.
BY
    J. MARION SIMS, M.D.,

BURGEON TO THE WOMAN'S HOSPITAL.
(PUBLISHED BY ORDER OF THE ACADEMY.)

          NEW YORK:
SAMUEL S. & WILLIAM WOOD,
       389 BROADWAY.
            1858. 

66/4
 165
5

    JOHN F. TROW,

P EIN T E E AND StEBEOTYPER.

  377 & 379 Broadway, N. Y. 
NEWYORK ACADEMY  OF  MEDICINE.
   A special meeting of the Academy was held at the
new  building of the Historical Society, corner of Second
Avenue and Eleventh Street, on the 18th of November,
1857—Dr. Mott, President, in the chair.
   The reading of the minutes of the previous meeting
was dispensed  with, when Dr. J. Marion Sims delivered
the Anniversary Oration, being a paper on  Silver Su-
tures in Surgery.
   At its conclusion, on motion of Dr. John W. Francis,
seconded  by Dr. Beadle,  the  thanks of the Academy
were presented to the Orator.
   Dr. Smith  then offered the following resolution :
   Resolved, That a committee of three  be appointed to wait upon
Dr. Sims, and request a copy for publication.
   Whereupon Drs. John W. Francis, Joseph M. Smith,
and John Watson were appointed said Committee.
                       C.  F. Heywood, M.D.,
                                 Recording Secretary. 
   In consequence of the length of this Discourse, parts
of it were omitted at the  Anniversary Meeting.   Most
of the illustrations accompanying it are from original
drawings, by Dr. Thomas Addis Emmet, the accomplished
Assistant Surgeon to the Woman's Hospital.
                                           J. M. S. 
ANNIVERSARY  DISCOURSE.
Mr. President, and Fellows of the Academy of Medicine.
    On this happy return  of another Anniversary,
it must be a source of congratulation  with  every
well-wisher  of  this Academy, to  see here on the
platform with  our distinguished  President,  (Dr.
Mott,) so many of the eminent  men,  who, like
him, have at various times ably filled the same high
position.
    The presence  of  our  honored ex-presidents,
John  W.  Francis,  Alexander H.  Stevens,  Thomas
Cock, Isaac Wood, Joseph  Mather Smith, and Wil-
lard Parker, lends additional grace, dignity, and in-
terest to the occasion, well worthy of permanent
historic remembrance.  Long may they live  to re-
joice at the prosperity of this Academy,  and to shed
the lustre  of their great names upon its  labors. 
6
SILVER SUTURES.
    This  presidential galaxy,  too,  is  naturally
suggestive  of the names of those who have filled
the less important post of Orator.  Ten years ago
that venerable Nestor of the profession, the devoted
and eloquent Francis, inaugurated your anniversa-
ries by a characteristic oration, replete with learning,
anecdote, and historic incident, before an unprece-
dented audience of more than four thousand spell-
bound hearers, while thousands left unable to gain
admittance.  This mighty  effort  of the  great and
good  man  gave the community a just estimate of
the value and  importance of this learned body,
which, it is to be hoped, we  shall ever maintain.
He was followed  by the late  lamented Manly.
Then  came the truthful and lucid Post;  and next,
the learned and critical  Joseph M. Smith.  After
him,  the  elegant  and accomplished  F. Campbell
Stewart; then the eminent, exact, and public spir-
ited Griscom;   and last,  though not least, your
own classic Watson.
    Is it then a matter of surprise that I have mani-
fested so much diffidence in following  the footsteps
of these distinguished men ?   Apologies on such
occasions, are  too  frequently affected, but were I
to proceed without some explanation, I  should do
injustice to you, and great violence to my own sense
of propriety.  When a member  of this Academy
but little more than one  year, you conferred upon 
              SUBJECT  OF DISCOURSE.             7

me this  distinguished  honor; electing me  in my
absence,  and without my knowledge  or consent,—
a compliment that I appreciate with  all my  heart;
but a  consciousness of my unfitness  for the  place
prompted me at once to resign;  when  such men as
Mott,  Francis,  Stevens, Smith,  Green, Griscom,
White, and  others opposed  my withdrawal,  agree-
ing, (unofficially,) that my subject should be  purely
a professional one.   k
   Silver Sutures  in  Surgery, is a subject that
necessarily involves  frequent and constant reference
to my  o^n labors, and  their results;  indeed,  it has
been the theme of my life for the last twelve years.
In selecting it I am  not ignorant of the delicacy of
my position, and of my liability to be misinterpreted,
and to be criticised  by some who do not know me
as you do.  Nevertheless I shall  speak  as an Amer-
ican, plainly, frankly and fearlessly, feeling that you
and the great mass of the profession will understand,
and fully sustain me. • So far as it concerns my ex-
perience, personal narrative, claims as a discoverer,
or defence against aggression, I have a right to de-
clare  them openly "from the house-tops; " and for
this in the abstract I hold myself responsible.   But,
whether the subject  matter will be considered quite
appropriate for the  occasion, is a question only for
the fastidiously censorious;  and I shall  dismiss that
very summarily, by shifting its responsibility to the 
8                silver sutures.

broad  shoulders of  the gentlemen just named, at
whose  solicitation I stand here to-night.
    You, who are  familiar  with  the experience of
that noble charity, the Woman's Hospital, will  not
be  surprised, when I declare it as my honest and
heart-felt conviction, that the use of silver as a su-
ture IS THE GREAT SURGICAL ACHIEVEMENT  OF THE
NINETEENTH CENTURY.
    For my country I claim the honor of this imper-
ishable discovery, and seize this  auspicious occasion
to place permanently upon record a history of its
origin  and progress.
    Many of you  already know that it was  not  the
result of mere accident, but of long, laborious and
persevering effort, based upon the immutable princi-
ples of science, and forming one of the most beau-
tiful examples of inductive philosophy.
    Wishing  to  impress upon  the profession  its
importance and value in general surgery, as well as
in injuries from protracted parturition, I shall  ne-
cessarily be compelled  to  draw largely and some-
what minutely upon my past experience.   But this
will be readily tolerated by a liberal profession; for,
while I labor to establish principles, it will be legit-
imate  to refer to dates, and  times,  and places, and
persons, and circumstances,  all of  which are necessary
to place for ever beyond cavil my claims and agency
in this  discovery. 
                                                v

                 WHEN  FIRST USED.               9 '*

    In 1845 I conceived the idea of curing vesico-
vaginal fistula,  and entered upon the  broad field
of  experiment with all the ardor and  enthusiasm
of  a  devotee.   After nearly four years of fruitless
labor, silver wire was fortunately substituted for silk
as a suture, and lo! a new era dawns upon surgery.
    This was on the 21st of  June, 1849,  since which
time  I have used no other suture in  any  depart-
ment of surgery.
    The American Journal  of Medical  Sciences for
January, 1852, contains my article on uThe Treat-
ment of Vesico-vaginal  Fistula," with full and speci-
fic  directions for every  stage of the operation.  The
silver suture, as then  used, I called the " clamp
suture," on account of  its method of action in forc-
ing, or " clamping " firmly together the surfaces to be
united.  Merely for its historical value, and to show
the progress of improvement, it is here  introduced.
    Fig. 1,  represents the anterior wall of the vagina,
the posterior being cut  up and laid  open, thus
exposing the fistula closed by the clamp suture.
    By perforated shot  compressed upon the silver
wires, they  are  secured to  leaden  cross-bars  or
uclamps,"  which burrow in the vaginal tissue; the
whole remaining till union by the first intention be-
comes firm,  when, by  clipping  off the shots the
sutures are removed.
    In my  own  hands  this method of  using 
10
SILVER SUTURES.
                             the silver  wire  in
                             vesico-vaginal  fistu-
                             la was uniformly suc-
                             cessful, because I al-
                             ways took good care
                             to make a broad and
                             free scarification  of
                             the edges of the fis-
                             tula, and  to pass the
                             sutures so far from
                             them that the cross-
                             bars or clamps would
                             burrow in the vagi-
nal tissue, there to remain till the case was permanent-
ly cured.  But my followers were not so successful,
simply because these two important points were not
fully appreciated. They complained that the sutures
would cut out; a thing that never happened with me
in but three or four cases, and they  were amongst
my first experiments,  before  learning  thoroughly
the art of applying them.
    The city of Montgomery, Alabama, was the the-
atre of my  early operations.  Bad health compelled
me to leave  there  in 1853.    I then srave  Dr.
Bozeman of that place a partnership in business, and
indoctrinated him in my peculiar method of operat-
ing for vesico-vaginal fistula, instructing him in my
various modes of using silver  wire as a suture, not
Fig. 1. 
EFFORTS TO SUPPLANT AUTHOR.
11
only in this class  of affections, but in general sur-
gery.   Not understanding  its principle of action,
and therefore failing in its practical application, he
was quite disheartened with his ill success, when by
mere accident he fell upon  a plan of fastening the
wire, and so modifying my method, that in awkward
or inexperienced hands it
became easier of applica-
tion.   Instead of passing
the  wires  through  the
leaden bars on each side '
of the fistula, he  passed           Fi&-2-
them through a concave disk or "button"  which
rests upon the surface of the parts to be united, as
shown by fig.  2.
    Notwithstanding the fact that the doctor lived in
Montgomery for years, without any professional posi-
tion till  I  gave it to  him,  that he  is indebted to
me for what he could never have  obtained without
my aid,  he appropriates to himself every step of
the  operation that resulted  from m}r own indivi-
dual and unaided efforts,—even my silver wire and
perforated shot,  the only things of any  real value
whatever,  and publishes it  as his operation  by a
"new  mode of suture," making strenuous efforts to
place my labors  entirely in the background.
    I  do not complain  of modifications, but  I  do
 
12
SILVER SUTURES.
complain of a disingenuousness that would be dishon-
orable even under widely different circumstances.
    While I know that posterity will do me full jus-
tice, I do not even fear the verdict of my contempo-
raries, when  the whole of  the facts and their
philosophy are laid plainly before a just and discrimi-
nating profession.  But, Sir, if you wish to offer a pre-
mium for the encouragement of secret remedies, rob
me of my well earned claims,  as the discoverer and
propagator  of a  great principle  that  shall live  as
long as surgery is cultivated as a science, or practised
as an art;—and, if you are  particularly  desirous
to drive  your young  men ambitious of honorable
distinction, from  their high resolves to elevate and
ennoble our calling, show them that you are ever
ready to  thus endorse any attempt to detract from
the meed of their self-sacrificing efforts.
    An honorable sensitiveness on  the score of  pro-
fessional  claims and  personal  rights  is natural, and
comes home to  every man,  whether his reputation
be already established, or merely prospective.—And
no  one,  Mr. President,  is  more  capable  of fully
appreciating this than your  honored  self,  whose
brilliant surgical achievements have so often been the
object of envy and detraction.
    But to  the  facts and their analysis:—Dr. B.'s
paper " on vesico-vaginal fistula, by a new  mode of
suture," was published in the first No. of the Louis- 
EXPERIMENTS AT  WOMAN S HOSPITAL.
13
ville Review, for May, 1856.  He there labors to show
that nothing comparatively had been  done for this
injury till the use of his button, while with it, there
could  be  no such thing  as a failure.   Although I
knew very well  why he failed with the clamp, still I
was determined  to see what advantage the button
possessed over it, if any.
    Having at the Woman's Hospital an ample field
for experimental observation,  I lost no time in test-
ing his modification  of my suture;  and as my  ex-
periments were  valuable in establishing a principle,
I shall give a brief detail of them.

    Case I. — The
fistula was  trans-
verse,inthemedian
line, about an inch
above the neck of
the bladder, with
abundant   tissue,
and  every  thing
favorable  for  an
easy and success-
ful operation. The
wires were passed
as  usual  with me,
brought   through              Fig. s.
the "button,"  and  fastened with  the  perforated
 
14
SILVER SUTURES,
shot.  They were removed on the ninth day, leaving
two  small  fistulous openings in the line of union,
thus showing a failure  of the  u button," greatly to
my surprise, for I could not  imagine a better case for
         __ ;. ___,         success.  Fig. 4, a &, the
   1z\^^^^=:t=^t^^^--   line °f cicatrized union,
 ^^^^^^—:i^^igiES^   c c?, the two little fistu-
     ^^=^_^^_r- — ^     ^s left in its track.
           Fig. 4.
   Case II.—Aged 57. A sister to the above, with a
similar fistula,  but  a little nearer to the neck of the
bladder.   Sexual  organs  normally atrophied,  as
usual with  women  at her time  of  life.    Operation
on the same day, and in the same manner as Case I,
and  with  a like unfortunate result; for when the
sutures  were removed on the ninth day, there was
a small  fistulous opening  at the extreme end of the
new cicatrix on the right side.

   Case III.—Aged  37.   A  fistula extended
from the   meatus   urinarius  through  the  urethra
and neck of the bladder, laying the septum  open,
to within  f  of an inch  of the  cervix  uteri.   I
had  closed the  whole of this  fistulous track  by a
previous operation, except  a small point in the has
fond of the bladder,  which had been purposely-
left  open  for  a  catheter  during the  time the su-
tures were applied to  the injured  part below;
i 
        EXPERIMENTS AT WOMAN'S HOSPITAL.      15

and now it only remained  to  close up  this small
fistula thus so favorably situated.  The wires, (two,)
were passed transversely and secured by the button.
                      Fig. 5.
    Fig. 5 shows the little fistula a, above described.
The operation was similar to the two preceding, and
had a like unfavorable result; an opening half the size
of the former was left.   Thus three very favorable
cases for the clamp, had failed by the "button" of
Dr. B.
    Before  this  result was known I  had applied
it  in four other cases, three of them  unfavorable,
and where I  had not  succeeded  with the  silver
suture after my usual method  by the "clamp."

    Case IV.  is one  in which I  had united the
anterior and posterior walls of the vagina about an 
16
silver sutures.
inch above  the  urethra, leaving a small fistula not
larger than the point of a common probe.
   Fig. 6, shows the cervix uteri and the vesico-
vaginal septum destroyed by the sloughing process.
To convert  the  upper part of the vagina  and the
                       Fig. 6.
bladder into one common receptacle, the posterior
wall of the vagina, at c, had been united by the wire
and clamps to the anterior  at a, leaving a small
opening not larger than a No. 7, sewing needle.   To
this the button was applied, and failed.

    Case V. was similar, with a greater loss of sub-
stance.  There was but a  small part of the neck of
the bladder attached to the urethra.
    The mouth of the vagina had  been closed  by
uniting its posterior wall to the urethra just as they
lay naturally  in  contact,  leaving two little fistulae
not larger  than  a common-sized probe, one at each
extremity of the line of union.   I  had failed to 
        EXPERIMENTS AT WOMAN'S HOSPITAL.      17

close these by the  silver wires, secured by  the
clamps or leaden  bars, and now applied them with
the button.   The  operation in both instances failed.
   Case VI.-A small fis-
tula a, fig. 7, at the neck
of the bladder;  tissue
scanty and indurated;
button failed, [a, &, line
of union effected by a
distinguished  surgeon            Fig-7-
before her admission to the Woman's Hospital.]
    Case VIL—Here  the injury was at the neck of
the bladder,  (see  fig.  9,);—The button was used,
and union took place.
    Six successive failures * out of seven operations
with the silver suture, secured by Dr. B.'s method,
was a most astonishing result;  and it was but natu-
ral to inquire  into the cause.   I had supposed that
his success was due to the button, which  was not
the case, as the sequel will show.
    Anxious to test fairly the advantages of this
plan of securing the  silver wires, I had performed
these seven operations in as many days, and the last
one was executed before the result in any preceding
case was known.
  * Subsequently cured by the silver wire, as a simple interrupted suture.
  Since the above was written, Dr. B. has published cases in which his
button failed repeatedly in his own hands. 
18
SILVEK SUTURES.
   In the first six operations the wires were passed
precisely as I do when they are to be fastened by
leaden bars and  perforated shot, and they all fail-
ed;  thus establishing the fact, that the principle
in their  application essential to success with  the
a
a
Fig. 8.
clamps, was  the  one to produce a failure by the
button; and  vice versa,  the principle of success by
the button was that of failure by the clamp.
    Let me explain—
    If the clamps or leaden bars are to be used to
secure the wires, the sutures must  be passed  as
shown at 6,  fig.  8, so far from the edges of the
fistula as  to  allow the bars to sink down into the 
        PHILOSOPHY OF THEIR APPLICATION.      19

vaginal structure,  making it utterly impossible for
them to cut out.   But if the disk or button is to be
used, then the sutures are to  be passed very near,
it matters not how near, the edge of the fistula, as
at a.
    Now if the clamps are used  with  the  sutures
passed as at a, they will invariably cut out, because
there is not  space enough for them  to burrow;
whereas, if the button is used with the wires passed
as at b, the effort  necessary to draw the parts up
into its concavity will inevitably roll over, and force
together the undenuded surfaces between the edges
of the  scarification and the entrance of the wires,
which will to  some extent invert the fistulous edges
proper, while the traction by the  button will cause
the sutures to cut through, as at c and d, fig. 4.
    Thus it is clearly seen why my followers failed
with the clamp, and why I failed so signally with
the button.
    Fig. 9, is intended to show the relations of the
fistula in the seventh case, which was the only suc-
cessful one of the series.  It was just at  the neck of
the bladder, the tissue was deficient, and the edges
inverted, or turned towards the pubic arch.   Here
the sutures were passed close  to the edges of the
fistula, as shown in the figure; but when the but-
ton was to  be applied, I found that it had to be
convex instead of concave,  as so particularly recom- 
20
SILVER SUTURES.
mended  by Dr. B.   Notwithstanding this, union
took place.  If the button had been made with a
concavity, and  thus applied,  forcing the edges of
the fistula  up into it  whether or  not,  the  wires
would have cut out before  union could have been
effected.
   These cases  demonstrated very clearly  to  my
own mind that Dr. B. had mistaken the philosophy
of the suture.   He attributed  its success  in his
hands to the button or disk, whereas this is wholly
an unnecessary addendum.   The  truth is, that the
great success of these  operations is due entirely to 
          INTERRUPTED SUTURE  SUFFICIENT.       21

 the silver wire.  I had long ago demonstrated, over
 and over again, that the clamps or leaden bars and
 perforated shot were totally worthless, if used with
 silk as a suture; in other words, that the silver wire
 was the essential part, the sine qua non of success;
 and I had now seen that  the  button,  to which so
 much  importance was  attached, had  failed in  six
 successive  cases, while it succeeded in the  seventh
 when it no longer possessed the peculiar character-
 istic thought to be  essential  to  success.   Seeing
 thus that the much vaunted button was obnoxious
 in some cases, and nugatory in others, I now began a
 series of experiments with the wire as an interrupted
 suture, without  "clamps" or "buttons" so called.
    Past experience had shown me, that as  an inter-
 rupted suture, it was  alone sufficient in general sur-
 gery :  and there was no good reason why it should
 not prove equally  as effective in the injuries result-
 ing from tedious labor.   It was accordingly applied
 in the following case on the 24th of June, 1856.

   Ellen, aged 30,  had been the subject of repeated
 operations  in various hospitals,  when at last she fell
 into the  hands of Dr. B. Fordyce Barker,  the able
 Professor of Obstetrics  in  the New York  Medical
 College,  who sent her to the Woman's Hospital.
   The fistula was very large,  extending from the
cervix uteri down  to  the neck of the  bladder, and 
22
SILVER SUTURES.
involving the loss of nearly half of the vesical septum.
A large mass of inflamed and hypertrophied mucous
                      Fig. 10.
membrane from the cavity of the bladder protruded
through it into the vagina, often becoming strangu-
lated, and producing the most intense suffering.
    Fig. 10 shows its relations.   After proper scari-
fication, seven interrupted  silver sutures were pass-
ed transversely and fastened, each separately, by a
perforated  shot.   On  the 8th day they were  re-
moved.   The cure was perfect. 
                THEIR APPLICATION.              23

    This case with all its difficulties satisfied me that
the silver wire was all sufficient here, as I had
long known it to be in other departments of surge-
ry ; and I applied it with the same unvarying suc-
cess in other cases, dispensing with all unnecessary
addenda, even the perforated shot; simply tying or
twisting the wire.
    The wire  must be  made  of virgin silver, an-
nealed,  and small enough for a suture. *   In some
cases  the needle may be armed with it, and so used;
but in  the majority of operations about the vagina,
I prefer to pass silk ligatures first, and with these to
draw the  wires after.  The sutures should be passed
in, near the edge of the fistula, as at fig. 9, page 20,
taking care to embrace  the whole denuded surface,
but not to penetrate  the mucous lining of the blad-
der.  They should, as a general rule, be about T3T of
an inch apart, and each tied  separately, by twisting
the two ends of the wire together,  then cutting
them  off, and leaving the twisted ends at least half
an inch long, to facilitate their removal.  (See figs.
11, and 12.)
    Fig. 11, shows the method of twisting the wire.
Two sutures are represented as secured and  cut off,
with  the twisted ends bent flatly down on the sur-
  * Mr. Berenbroick, No. 83 Duane street, makes two sizes for me, No. 28
and 29, the last being the finest and most used. 
24               SILVER SUTURES.
                      Fig. 11.

face, while the third is undergoing the process of
torsion.
    The fulcrum of support is held firmly in the left
hand, while a pair of forceps in the right makes 
                 THEIR REMOVAL.               25

steady traction on the wire doubled on itself, when
by a rotary movement of the forceps  the  wire is
quickly and evenly  twisted, thus  looping firmly
together the edges already nicely co-apted.
Fig. 12. 
26
SILVER SUTURES.
   It is  unnecessary to allow the wires to remain
longer than the 8th day.  To remove them, take hold
of the  twisted end with a long delicate pair of for-
ceps, fig. 12, pull it gently out, till the loop which was
buried in the tissue becomes visible; slip the  blade
   -^   of a sharp-pointed pair of scissors within it,
     I   and  clip the wire.  Then it is easily re-
   Y    moved, straightening out and assuming the
        form of fig. 13.  Some care is needed to cut
        the wire in the loop instead of  the twist.
           It may not be amiss  here to say, that
beside this simplification of the suture, my  position
at the Woman's Hospital has afforded me facilities for
making other improvements in this operation  since
my first publication in 1852 ;  for instance, the spec-
ulum, fig. 14, is altered to give a greater leverage: the
handle curves back at about an angle of 30° instead
of being at right angles with the blade, having a
counter curve in the middle, while another  blade
of a  different  size mounts  the  other  extremity.
This arrangement gives  the assistant great power in
drawing the perineum back towards the os coccygis.
   I formerly used a needle  with  a long shaft, but
a visit to New York some three  or four months
after the publication of my paper,  (January, 1852,)
enabled me  to  have  some  short needles and  a
needle-holder made by Tieman, which among other
things have  been appropriated by the writer  in 
               author's speculum.             27

the Louisville Medical Review before alluded to;
but I  now  prefer  a simple pair of forceps with
                      Fig. 14

serrated jaws, properly  adapted to the needle as
seen in fig. 15.
   The catheter is also improved so as to project 
28
SILVER SUTURES.
Fig. 15.
beyond the vulva, and drop the urine in a cup, thus
protecting the person and bedding.
   Another improvement is in allowing a more 
        author's self-retaining catheter.      29
liberal diet than formerly, but still constipating by
anodynes and the recumbent posture.
                      Fig. 16.
    But the most useful  of all these  improvements
is in the position of the patient during the opera-
tion.  A few require to be placed on the knees with
the head and  thorax depressed, as I formerly did,
and as  my followers  do still;  but in  the  great
majority of cases, the patient may lie on  the  left
side, while the operation will be executed with equal
facility  to  the surgeon,  and, of course, with more
ease to the patient. 
30
silver sutures.
   In  this position  the thighs are to be flexed at
about right angles with the pelvis, the right a little
more than the left.   The left arm  is  thrown behind,
and  the chest rotated  forwards, bringing the ster-
Fig. 17.
num quite  closely in contact with  the table, while 
IN LACERATED  PERINEUM.
31
the spine is  fully extended, with the head resting
on the parietal bone.
    The patient being thus rolled over as much as
possible on the  front,  the assistant standing at her
back, elevates with the left hand the right side of
the nates, while the right holds the speculum which
draws up the perineum, allowing the pressure of
the atmosphere  to dilate the vagina so as  to bring
every part of it into view.   This position  permits
the use of anaesthetics  if desired, but I never resort
to them  in  these operations, because  they are not
painful enough to justify the trouble, and risk attend-
ing their administration.

    Having thus digressed  for  a  few moments to
speak of these  improvements,  for  which  we  are
indebted  to that prolific field  of observation, the
Woman's Hospital,  I  recur again  to the proper
theme.
    Previously to the experiments already  detailed,
I  had used  silver  sutures  with the leaden  bars
or clamps in all operations  about the vagina, and
perineum, and  had every  reason to  be perfectly
satisfied  with the  results;   but seeing  now  that
the simple interrupted silver suture was sufficient
in the most  difficult cases of vesico-vaginal fistula,
I lost no time  in extending its use to lacerations
of the perineum, and  found it here quite as  effec- 
32
SILVER SUTURES.
tual;  hence I adopted  it  in all  such cases, not
because it is more efficacious, but because it is sim-
pler in  its application, and  quite as certain in its
results.   And in no instance of lacerated perineum,
it matters not how extensive, have I ever resorted
to a division of the sphincter ani, which, (with the
silver suture,) is a horrible and wholly unnecessary
complication.

    It is strange that the Profession have been so
slow in  adopting  this suture.  From  the  day its
wonderful effects were witnessed in vesico-vaginal
fistula in 1849, I have never used any other suture
in any department of surgery.
    Wishing to impress upon the Profession its great
value in  general surgery, and at  the same time, to
render permanently historic  my claims  to priority,
I propose to show what it  has already done, as
contrasted with  the usual methods.  Hence some
little detail of facts, and dates.

    In plastic surgery it  is the great desideratum.
In May,  1850, a gentleman  had  the misfortune to
lose a good part of the left ala nasi.  In the opera-
tion eight interrupted silver sutures were used—they
were removed on the 7th day: union was perfect,
and he soon went home with some slight  tumefaction
of the parts, which gradually subsided. 
IN PLASTIC  SURGERY.
33
   In the course of a fortnight he returned, saying
that  in  wiping  the perspiration from his face, he
discovered some pricking substance at the seat of
the operation, which  he supposed  to  be a bit of
wire. He was right;  the  wire was  there, but easier
felt than seen.  It was  removed, and found to be
half an inch long: it had remained there four weeks,
producing no sense of soreness, and no inflammation
or suppuration as a silk  ligature would have done,
thus establishing the  great and important principle
that  silver was  as  innocuous as lead, and, like it,
might become sacculated, producing no irritant or
poisonous effect whatever.
   I have used  this simple suture with unvarying
success in other plastic operations, a detail of which
is here unnecessary.
   In 1852 a little boy
some 8 years  old  re-
ceived  a blow  on the
upper lip,  near the left
commissure,  cutting  it
through for f of an inch.
Three interrupted silver
sutures were applied,  and nip other  dressing.  I saw
no more of  him till the ninth day: union was per-
fect,  the wires remaining precisely as I had placed
them.  Their removal was like that  of a delicate ear-
ring  from the ear long used to wearing it.
Fig. 18. 
34
SILVER SUTURES.
   In  1853 a gentleman called on me with a very
bad  cancroid warty  excrescence, involving a large
part of the lower lip, which had resisted all  reme-
dial efforts.   Its removal was advised.  He said  he
could  not  possibly spare the time  necessary for a
cure ;  I told him that twenty minutes would suffice
for the operation and  dressing,  and that he could
then go home, (some 80 or 100 miles,) and return
in a week.  He consented.  The usual  operation
                      Fig. 19.
by a V incision was performed, and the cut surfaces
united by four  interrupted silver sutures, sustained
by a single strip of isinglass  plaster, with no other
dressing.  At the appointed time he returned with
the parts perfectly united throughout,  the wires
producing no inflammatory effect whatever.
   Would any surgeon have been justifiable in send-
ing such a case  as this away for so long a time with 
IN HARE-LIP.
35
 the  old-fashioned method by silk ligatures or the
 twisted suture ?  Certainly not.  And yet I felt  no
 anxiety about the result, so great was my confidence
 in the safety and security of the silver wire, as then
 demonstrated by daily experience.

    In Hare-lip the results of this  suture are beau-
 tiful.  They should not be further apart than T3¥ of
 an inch, or even less;  thus affording good support
 and perfect co-aptation.  It is necessary for them
 to remain till union is firm  enough to  prevent any
 widening  of the  cicatrice  by  muscular traction,
 which requires usually from  five to  eight  days.
 As  it is  important to  prevent  any  mark  from
 their unequal pressure, a thin  plate of some  trans-
 parent material may be placed, like a delicate splint,
 on  the co-apted edges, over which the wires may
 be  tied, thus protecting  the  tender  cuticle of the
 child's lip from their cutting pressure ;  while at the
 same time  it allows an  inspection  of  the united
 parts, which, if necessary, can be  more accurately
 fitted by gently insinuating a small probe under the
 translucent  medium: a thin bit of glass in the ab-
 sence of any thing  else answers the  purpose  admi-
rably well.
   For this purpose I have had prepared some little
plates  of ivory,  made transparent  by dissolving
its  earthy constituents.  This prepared ivory is 
36
SILVER SUTURES.
thin, light, and capable  of being cut or moulded
into  any form, but it  is objectionable, as it softens
at the temperature of the body.
   However, nature has given us a better  material
for this purpose, one  to be found everywhere and
at any time.  A clarified goose-quill split into sec-
tions, softened  in boiling water,  and then flattened
out by heavy pressure, fulfils every indication in this
"hare-lip suture."  So far as absolute success in the
operation is concerned, nothing can be added to the
silver wire to make it more certain, and these trans
lucent media are recommended merely for the pur
pose of preventing scars that may result from the
pressure of the wire.

    In Wounds of the Scalp, I have  often  applied
silver  sutures, and  here they possess a peculiar fit-
ness.   They do away  with the necessity for sticking
plasters, and there is no need of a razor.  Besides,
of all regions of the human body this is most liable
to traumatic  erysipelas, hence the importance of
dispensing with silk as  a suture.
    Dr. Emmet, the accomplished Assistant Surgeon
to the Woman's Hospital, removed in December,
1856, an encysted tumor from the  scalp of a lady
aged 62.  It  had existed some  forty years, giving
her no  inconvenience  until a few  months  before,
when it increased rapidly in size  and became tender 
             IN HEROIC OPERATIONS.           37

on pressure.  Six silver sutures and a water dress-
ing were  applied.  On the eighth  day they were
examined for the first time.  Found union by the
first intention—the wires had produced no irritation
whatever, and  from appearances they might have
remained there without it for  an indefinite pe-
riod, although she was below the average  state of
health.
    Having applied this simple suture with  the same
unvarying success in all the minor operations, which
it is here needless to detail, would it not have been
strange had I failed to try it in the bloody or heroic
ones ?  Indulge  me a moment  to  enumerate a few
of them.

     In   1849,  1852,   and  1853,  I removed  the
 Mamma,  applying this suture, the number in each
 case varying from eight  to  seventeen.   The wires
 were allowed to remain from seven to fifteen days.
 It is almost needless to say that in every case the re-
 sult was the same as in  the smaller operations,—
 complete cohesive union.

     In  1852, (February,) I removed the principal
 part of the lower jaw bone for osteo-sarcoma, in a
 negro  woman some 50 years old.  It was divided
 at the angles, thus necessitating an  incision of about
 ten inches  after Mott's  plan.   The wound  was 
38
SILVER SUTURES.
united by eighteen silver  sutures, and a simple sus-
taining bandage  applied.   The whole length of it
healed  by the first intention, except an isolated
point at the middle of the chin, through which the
retaining  ligature of the fraenum linguae had been
passed for security.  The  wires were  not removed
for ten days.  Had silk been used as a suture there
would have  been  an absolute necessity  for their
removal in three days at the farthest, and even then
it  is  almost  certain that  the bed  of each  suture
would have been  a suppurating sore.

   In 1849, 1850,  and  1852, I used  silver sutures
in Amputations of the thigh and leg, and in  every
case  produced union by the first intention through-
out  the whole extent  of  the wounds with  the
exception of the  point  left for the passage  of the
ligatures.
   In all amputations, surgeons knowing the bad
effects of ordinary silken sutures, have been  in the
habit of applying  as few as possible, and trusting
to adhesive  plasters  and  bandages  to retain the
edges of the flaps in contact.  The  poisonous prop-
erties of silk render its early removal imperative;
hence the wound  must be disturbed before adhesion
is firm,  and thus mischief results from the surgeon's
necessary interference.  But when  the  silver wires
are applied, there  is no  necessity whatever,  under 
IN AMPUTATIONS.
39
ordinary circumstances, for any interference till the
parts are firmly united.
    They must be placed near enough  together to
bring closely and accurately into contact every por-
tion of the  edges of the flaps, which may now be
sustained by a few  long narrow strips  of Liston's
Isinglass plaster.   It takes a little longer,  and it is
therefore a little more trouble, to apply nicely twelve
or fifteen silver wire sutures, than to stick in  clum-
sily four or five great silk ligatures;  but when the
stump is  dressed  there  is no more trouble with it,
and the wires may not be removed for eight or ten
days, or even longer.   Moreover, there is not so
much  excuse for compresses,  bandages,  Maltese
crosses,  and all  the  bungling contrivances  often
resorted to after  amputations, while  there is  every
facility for applying a light water dressing, which is
the only thing usually needed in such cases.*
    In 1855, at  the request of Dr. Willard Parker,
the distinguished  Professor of Surgery  in the Col-
lege of Physicians and  Surgeons, I  applied  silver
sutures to a large  abdominal  section in the case of a
young lady, the  subject of Ovariotomy.  They were
passed deeply through the parietes of the abdomen,
but not  perforating the  peritoneal coat.  Union by
the first intention was  complete—the  sutures re-
maining a week.
    Other surgeons, members of this Academy, have 
40               SILVER SUTURES.

been using this suture, amongst whom may be men-
tioned Mott, Post, Parker, Buck, Watson, Sayre, Van
Buren, James  R.  Wood, Markoe,  Henry  Weeks
Brown, and many others.  Professors Mott, Post and
Parker,  have  each for the  last  four  years  taken
great pains to instruct  their several  classes  in the
use of this American discovery.
    But amongst the earliest  to appreciate its impor-
tance in  connection with medical  education  stands
pre-eminent, Dr. Gilman, the learned Professor oi
Obstetrics, etc., in the  College of Physicians  and
Surgeons.
    Sufficient detail in  the way of facts  and dates
has now been given to place beyond controversy my
claims, not only to priority in the discovery and
promulgation of a great principle,  but in its univer-
sal application  in general surgery.
    But all the  special departments of surgery have
not been indicated in which this simple  and won-
derfully  beautiful  suture may be  successfully used.
As soon  as I became aware of its  value, I was very
anxious to apply it in  Wounds of the Intestines, and
particularly after the occurrence already alluded to,
where a  wire remained four weeks in the nose with-
out producing the slightest disturbance;  but no
opportunity presented till April,  1853.

    A young negro man was stabbed in the left side 
IN INTESTINAL WOUNDS.
41
between the sixth and seventh ribs; and in the ab-
domen there were two cuts,  through  which pro-
truded large masses of wounded intestines.   These
intestinal  wounds  (some of them transverse, and
others diagonal) were closed with simple interrupted
silver sutures, which were cut off close to the intes-
tine, and the whole returned to the abdominal cavity.
He lived twenty-four hours.
    The post-mortem examination, made by Dr. B. C.
Jones  of  Montgomery,  Alabama, and  Dr.  Cum-
mings, now  of New  Orleans, showed  that  the
thoracic wound had passed  downwards through the
diaphragm into the stoihach.   The perforation in
the  diaphragm was completely plugged  by omen-
tum,  but  not  till the contents of the stomach had
passed through it into the pleural  cavity.
                     Fig. 20.

   There was no effusion or evidence  of active in-
flammation  in  the  peritoneal cavity;  the  silver
wires had neatly closed the wounds in the bowel, 
42
SILVER  SUTURES.
(duodenum cut, ileum and jejunum transfixed in
three-places,) and for an  inch around  them there
was a delicate little effusion of plastic lymph nicely
gluing the wounded parts to the  adjacent  perito-
neal coat, while every thing else was  in a perfectly
normal state.
    Fortunately  he lived  long enough  to  indicate
pretty clearly the propriety of using silver sutures
in wounds of the intestines.   I  expected them to
become  sacculated like lead, and  to  remain  there
innocuously, to be taken care of in nature's own way.
    I have long  felt satisfied that the  great danger
from  Wounds of the Peritoneum  was due not  so
much to the mere admission of atmospheric air as
to the universal use of ligatures and sutures, left like
setons to  irritate and inflame this  delicate  serous
membrane.   Operations for Hernia are of  frequent
occurrence,  and if performed before strangulation
results in sphacelus, are  amongst the safest of  all
grave operations.   They show very plainly that the
peritoneum may be opened and handled with com-
parative immunity.*  For the truth of this assertion
   * Dr. Warren Stone, the distinguished Prof, of Surgery in the Medical
Department of the University of Louisiana, who, as a great practical teacher,
ranks with the most eminent  in this  country, or any other, says  of hernia,
"That no disease is so dangerous to life, and yet so entirely remediable"__
that " the bowel is in danger from the moment it is strangulated, and should
be relieved as soon as possible "—that " the hernial sac can be exposed without
the slightest risk"—and that  " if it should be necessary to open the hernial
»ac, it can be done with as much safety as venesection can be performed at the
bend of the arm.,,  [New Orleans Medical Journal, Jan. 1858, page 79.] 
t
IN OVARIOTOMY.
43
 I appeal here to Mott and Stevens, to Watson and
 James R. Wood, and to every other surgeon in this
 Hall.  Why then such dread of peritoneal wounds ?
 Why  such fear of peritonitis in Ovariotomy ?
    But is there any wonder that Ovariotomy is so
 fatal,  when  a great silken cord  strangulates the
 pedicle  and  hangs  from the  abdomen, its whole
 track  a suppurating sinus ? And, when six, or eight,
 or ten silken sutures close the external wound, each
 one answering most admirably the purpose  of  a
 seton ?
    Simpson, the great European luminary of Obstet-
 ric Surgery, plainly saw the source of danger, and
 says, "If betimes it come to be recognized as a surgi-
 cal operation fit and proper  in such cases of ova.
 rian disease as he adverted to, he had no doubt the
 steps of the operation itself would meet with improve-
 ments," and that "probably it might be possible to
 devise some other measures of securing the large
 vessels, principally veins be it remarked, of the  ped-
 icle, and thus save the several dangers arising from
 the ligature."*
    Europe,  through this  great  man, thus calls for
improved measures  of safety, which America now
proudly lays at her feet.  For silver sutures  and
silver ligatures are to do more to rob this dread
operation of its dangers than all else that has  yet
* Obstetrical Works, 1st Series, page 256. 
 44              SILVER SUTURES.

 been suggested.  Let  the  pedicle of the tumor  be
 firmly tied with a silver, or leaden wire—let the ex-
 ternal wound be united by silver sutures—let the
 vaginal cul de sac be punctured, (as has already been
 done by our distinguished Fellow, Prof. Peaslee,)*
 for a canula to drain off, through  the most  depend-
 ent  point of the peritoneal cavity, any  exudation,
                              4
 whether of blood,  serum,  or pus, and a degree of
 security will be  given to  this operation that may
 yet rank it with hernia under its most favorable cir-
 cumstances.
    But enough has been said to fix attention upon
 the importance of this suture, and its universal ap-
plicability in general surgery.
    It is to revolutionize surgical  dressings, and  to
 ensure more beautiful  and  prompt cures.  With it,
 properly applied, there  can  be no gaping  wounds
 to  heal by the  suppurating process,  where  there
 is skin enough to cover a stump; and in many cases
 erysipelatous inflammation, and even hospital gan-
 grene, may be averted by  substituting it for silk as
 a suture.
    After all amputations  we must use sutures  of
 some sort; and how often  do we see silk ulcerating
 out, and  creating  such tendency to  suppuration,
 that we are compelled to remove them before there
 is sufficient uniop to resist the retraction of the tu-
         * American Journal of Medical Science, Jan. 1857. 
               THEIR GENERAL USE.             45

mefied flaps.   But with silver there is no inflamma-
tion, no suppuration, no cutting out of sutures, no
gaping or retraction of flaps, and therefore no neces-
sity  for  disturbing the dressing till  all is firmly
united and permanently well.
    This  is no vain imagining: though enthusiastic,
I am not wildly so, for  all  this has been familiar to
me for the last eight years, and  I but speak what I
know.   The next eight years will not find  an edu-
cated physician anywhere who will dare to  use silk
sutures,  for the silver thread will now become as es-
sential to the dressing case as the needle itself; and
if I  may be allowed to venture a prediction, I will
say that fifty years hence the statistics of our hospitals
will show a vast improvement in their bills of mor-
tality  after great operations, and this improvement
will be due mainly to the use of silver as a  suture.
    Look at  its results in injuries of the vagina.
Before this discovery,  operations for vesico-vaginal
fistula, and its  congeneric affections, were often at-
tended with  risk to life,  while  a  cure was a  mere
accident.  But how is it now ?  Why, every case is
easily and perfectly curable that has tissue enough
to render any operation whatever practicable ; while
a failure is  the exception  to  the rule.   Besides,
 there is not the  least  risk  to  life, as  there is
 never any fever, or the slightest constitutional dis-
 turbance. 
46
SILVER SUTURES.
   I am not claiming too much for this suture when
I say, that  the same relative results must be attain-
ed in all other surgical operations requiring sutures,
if the same method be adopted.
   My  language is in nowise extravagant;  and I
shall yet live to see the day, when the whole pro-
fession of the civilized world will accord to this sim-
ple discovery the high  position of being the most
important contribution as yet made to the surgery
of the present century.
   The only thing at  all comparable to it is Ether-
ization ; and in  practical results of permanent bene-
fit it is absolutely  contemptible, when compared
with those  from the universal  use of  silver sutures
in the broad domain of general surgery.

   Having now briefly shown that  I have used sil-
ver sutures with uniform success in  almost  every
imaginable  injury requiring sutures, these practical
remarks might very properly be here closed; but,
as concentrated efforts have been made in various
quarters to  rob  me of full credit for my labors, I
have thought it due to truth,  to justice, to poster-
ity, and to  myself, to place permanently upon rec-
ord a history of the  circumstances attending this
discovery.
   Some of my contemporaries will not  approve
the measure, but when this generation passes there 
PERSONAL NARRATIVE.
47
will be no difference of opinion amongst critics on
this point;  besides, it  will  not be unprofitable
should it stimulate but one young aspirant for fame
and fortune to redoubled efforts, under unpromising
circumstances and opposing obstacles, to the accom-
plishment  of still more  glorious triumphs for our
noble profession.
    Although fully fortified  by the necessity of self-
vindication, still  I hesitate  and tremble;  but why
should I be afraid to write, and speak, and publish
to the world, what I am not ashamed to acknowledge
to any individual, viz.—that it was all the result of
a  Providential train of circumstances over which I
had no control, and that  it pleased God  to lead me
in this direction in spite of my predilections.
    As the  field of my labors thus partakes somewhat
of a missionary  character,  a  labor  of love  under
Divine guidance for the furtherance of a truly be-
nevolent purpose, you will pardon a personal nar-
rative, which under other  circumstances would be
inexcusable.
    For the first ten years  of my professional life
the treatment of any disease peculiar to woman was
ignored as far as possible.   Surgery was my ambi-
tion, and  it was gratified,  for my head,  and  heart,
and hands  were full.  This was due, not to any par-
ticular merit on my part,  but, to a fortunate position
amongst a  liberal and enlightened profession in the 
•  48
SILVER SUTURES.
noble state of Alabama, a profession, which, for in-
telligence and a chivalric  esprit de corps, is not
behind that of any other state in this great confed-
eracy.
    Thus situated, a  case  of vesico-vaginal  fistula
was sent to me in July, 1845, which was investi-
gated more because I had a surgical reputation to
sustain than from any particular interest in the sub-
ject.   It  was, of course,  dismissed  as incurable.
Two months after this another presented,  which re-
ceived a like verdict.  Two cases in such quick suc-
cession in a country town, at that time, formed an era
in  one's life;  imagine my  surprise, when, • a few
weeks after this, a gentleman called to consult me
about a third  case.  I told him promptly that it was
useless to send her to me, as the  injury was wholly
incurable.   He  suggested that there was a  possi-
bility of my being mistaken in my ready diagnosis;
when I replied, that a leakage of urine following a
protracted labor was an infallible sign of a vesical
fistula.  But my remonstrances were unavailing, for
he sent her to town in spite of me.
    I investigated  the  case thoroughly, reading
every author  I could find on the subject, but to no
purpose, for  all was darkness and confusion; and
thus I was on the eve of sending her home, when a
little incident occurred that formed the turning point
of my professional career,  and without which the 
             PROVIDENTIAL INCIDENT.            49

discovery that has engaged our attention to-night
would not have been made.

   A lady was riding in the suburbs of the city of
Montgomery, Alabama, and her pony taking fright,
jumped  suddenly, when she  fell  to  the  ground,
striking on the sacrum.  I saw her soon afterwards;
her sufferings were extreme, as she had rectal and
vesical tenesmus from a sudden retroversion of the
uterus.   To replace  the  dislocated organ was the
indication of  relief.   Following the  teachings of
learned  professors,  the  patient (covered  with  a
sheet) was placed on the knees with the pelvis ele-
vated, and the thorax depressed, when by manipu-
lation through the vagina and rectum, I hoped to
replace  it.  Introducing  the  right forefinger into
the vagina, but  remembering how a nervous gen-
tleman had suffered a few days before from a rectal
examination, I concluded not to subject this lady to
the same disagreeable operation, particularly as it
seemed  possible  to  overcome the difficulty if my
finger was only a little longer.  My middle finger
is more than half an  inch longer than the index, but
it could  not be used without its fellow; and thus
the two  were passed, and  in a few seconds I could
not touch the uterus, or even the walls of the vagina,
and  the fingers were swept around as it were  "in
empty nothingness," which was to me at the moment
                 4 
50
SILVER SUTURES.
a most puzzling mystery, and while I was endeavor-
ing to unravel it, my patient exclaims, " Oh doctor,
I am relieved!" My office was ended, for my mission
was to r.elieve her, but how it was done I could not
understand.   While I stood  doubting and wonder-
ing, my patient, now easy, threw herself down on
her side, producing  thereby a sudden escapement
of air from the vagina; and thus the whole mystery
of the accidental reduction of the dislocated  uterus
was explained on the principle of atmospheric pres-
sure.
   And what was its rationale ?  When the patient
was in  the position described, there being a natural
tendency of the pelvic viscera  to gravitate towards
the epigastric region, it would require no great vis
a tergo to produce the desired result in a recent case
of this kind.  One finger, however, was not long
enough to throw the organ  up, nor were the two;
but when  they were  both introduced, in my vary-
ing manipulations and  strenuous efforts, the hand
was  accidentally turned with its palm downwards,
which  thus brought the broad dorsal surface of the
two parallel fingers in contact  with the vulvar com-
missure,  thereby  elevating  the perineum and ex-
panding  the sphincter  muscle, which allowed the
air to rush into the vagina under the palmar surface
of the fingers, where, by its mechanical pressure of
fifteen pounds to the square inch, this canal was 
          NEW HOPES SUDDENLY  INSPIRED.       51

dilated  like a balloon, and the  uterus replaced by
its pressure  alone.   This accident—there are no
accidents in the  providence of  God !—this  inci-
dent, then, occurred just at the right time.  Had it
happened six months sooner, its importance would not
have been duly appreciated.  Had it been six  days
later, the golden opportunity for its practical appli-
cation would have been lost  forever;  for my mind
had  been sorely  perplexed  by the  obscurity sur-
rounding the  investigation of the  cases  before
alluded to, and I said to myself,  " If by this position
the atmospheric air can be made to dilate the vagina
to such an extent, even with a force  strong enough
to reduce a dislocated uterus, why will not the same
principle allow me to explore this region, and exam-
ine accurately any injury, or disease to which it may
be liable ?"  Full of the thought I hurried  home—and
the patient, (with vesico-vaginal fistula,)  who was to
have left on the next day, was placed in the position
described, with an assistant on each  side to elevate
and  retract the nates.  I cannot, nor is it needful to
describe my emotions, when the air rushed  in and
dilated  the vagina to its greatest capacity, whereby
its whole surface was seen at one view, for the first
time by any mortal  man..  With  this sudden  flash
of light, with the fistulous opening seen in its proper
relations, seemingly without any appreciable process
of ratiocination, all  the principles of the operation 
52
SILVER SUTURES.
were presented to my mind as clearly as at this time.
And thus in a moment, in the twinkling of an eye,
new hopes and new aspirations filled my soul, for a
flood of dazzling light had suddenly burst upon my
enraptured vision, and I  saw in the  distance the
great and glorious triumph that awaited determined
and persevering effort. From this moment my high
resolve was taken; nor did I think, or care for the
personal sacrifices I should have to make.  I thought
only of relieving  the loveliest of all God's creation
of one of  the most loathsome maladies that  can
possibly  befall poor human  nature; and in this, I
honestly confess that I was stimulated by feelings of
national pride, as well as by a desire to  advance our
glorious profession.  Full of sympathy  and enthusi-
asm, thus all at once I found myself running headlong
after the very class of sufferers that I had all my pro-
fessional  life most studiously avoided.   Ransacking
the country around, my medical brethren soon dis-
covered  and  placed at my disposal, some seven or
eight cases of vesico-vaginal fistula that had been
quietly laid up as incurable.   Building a little hos-
pital  as  a special field of  experiment,  I readily
got control of these cases, all of them healthy young
negro  women; promising to perform  no operation
that would endanger  life, or render their condition
any  worse.  Having no proper instruments, and no
instrument maker, dentists,  jewellers and  black- 
               FIRST  EXPERIMENTS.             53

smiths were laid under contribution, and soon such
rude instruments were made as were suggested by
the peculiar wants of  individual cases.   This occu-
pied a period from the  9th of December, 1845, to
the 10th of January, 1846, when the first operation
was performed.
    Several medical friends, amongst whom were
Drs. Boling, Holt,  Ames, Baldwin,  Jones, McWhor-
ter and Henry, were invited to the inauguration of
the  experimental  series.   When  the  mechanical
contrivances were exhibited,  the  peculiarities of
each  case  pointed out, and the principles  of  the
operation explained, they thought  my plan of pro-
cedure promised  well, while  some  were but little
less enthusiastic than myself in hopes for the  future.
    The first was a very simple case, and one that
any tyro  in surgery  could now cure in a  week's
time.  The fistula was an
inch  and  a quarter  long,
transverse, in the  base of
the bladder,  with  an  abun-
dance of tissue.  Its edges were accurately adjusted,
and I expected to effect at once  a magical cure ;
but greatly to my  surprise and mortification it  was
a  failure.   However,  the size of the opening  was
reduced from that seen  in the diagram to one not
larger than  a No. 4  bougie: this  encouraged me
considerably, and  the same operation was tried on
 
54
SILVER SUTURES.
another case with a like unfortunate result, and after
this, with various, and constantly varied modifica-
tions on others, till each one had suffered numerous
operations, but  all to no purpose.   And  thus  I
worked on, not for weeks and months, but for long
weary years, before a single case was cured.  My
repeated failures brought a degree of anguish that
I cannot now  depict,  even were it desirable.  All
my spare  time was given  to the development of  a
single idea, the  seemingly visionary one  of  curing
this  sad  affliction, which not unfrequently follows
the fulfilment of the law pronounced by  an  offend-
ed  God when  he said to  the woman, "In  sorrow
and suffering shalt thou bring forth children/'
    Soon my friends began to despair of my  efforts,
and one by one became tired of such profitless work.
At last Dr. B. R. Jones, my partner, an accomplished
physician, who had stood firmly by, giving his valua-
ble advice and assistance, importuned me to cease
my efforts; thus opposed at home, and deserted by the
professional  brethren  who once  cheered me  on by
their personal presence, I now stood  alone—alone!
did I say ? no, I was not alone, for I felt that  I had a
mission, if not of a Divine character, at  least but
little short of  it, of Divine origin.  I felt that the
God who had  called me to this good work, and in-
spired  me with  new views for its accomplishment,
was with  me,  and would  not  desert me.  I could 
            WOMAN'S MORAL COURAGE.          55

not have ceased my labors if I had tried, for some-
thing told me that the fulness of time had arrived,
that the work had to be done, and that if I should
fall,  God in his wisdom would  raise up some one as
an instrument to carry it forward to a glorious con-
summation.   I was not alone then;—nor was I alone
in another sense, for I had  succeeded in infusing my
own courage and enthusiasm into the hearts of the
half dozen sufferers who looked to me for help, and
implored me to repeat operations so tedious, and at
that time often so painful, that none but a woman
could have borne them.
    To the indomitable courage of these long-suffer-
ing women, more than to any one other  single cir-
cumstance, is the world indebted for the results of
these persevering efforts.   Had they faltered, then
would woman have continued to  suffer from the
dreadful injuries produced  by protracted parturi-
tion, and then should the broad domain  of surgery
not  have known one of the most useful improve-
ments that shall forever hereafter grace its annals.
    In my first experiments the quilled  suture was
used, securing the ligatures by passing them through
little canulae that projected from the vulva.
    Fig.  22,  shows the  rude  contrivance,  which
was made  of silver.   The  canulae  were  firmly
soldered to the proximal  quill, and when the liga-
tures were tightened and wrapped  round the end 
56
SILVER SUTURES.

 that projected from the vagina, the fistulous edges
                        were  neatly co-apted  by
                        the quills.  This is intro-
                        duced merely to show the
                        slow  degrees  by   which
                        practical truths  are some-
                        times  developed.   After
                        using this machine various-
                        ly modified for nearly three
                        years,   giving   attention
                        mostly  to  the  perfection
                        of the self-retaining  cathe-
                        ter, I at last concluded that
                        the projecting canulae were
                        a chief  cause  of failure,
                        and  consequently   deter-
                        mined  to  dispense with
                        them:  but how to  secure
                        the ligatures was the ques-
                        tion.  A detail of the num-
 berless expedients resorted to is useless ; suffice it to
 say, that I was at last driven completely to the wall.
 I had  resolved never to  repeat  another  operation
 till I had devised some plan of fastening the quill
suture without the canulae—of tying a knot where
I could not reach it with the fingers. Thus my brain
was sorely puzzled ; I had not performed an opera-
tion for nearly  six weeks, and my devoted patients
 
              THE PERFORATED SHOT.           57

 were begging me from day to day, to " try only one
 more time."  Notwithstanding their importunities, I
 had determined first to invent a knot for my sutures;
 but it  seemed that my usual readiness of  expedient
 had now deserted me.   My brain was oppressed; my
 heart was hea/vy ; but never for one moment did I
 despair of eventual success.   At last I happened to
 remember that, when  a boy, I used to make sinkers
 to my  fishing lines by  cutting a shot  half in two, lay-
 ing the line in the cut, and  then  compressing the
 shot on it with my teeth.  I cannot express the de-
 light that filled my heart at this simple suggestion.
 The idea occurred to me  on the night of the 14th
 November, 1848.  The contemplation of  its beauty,
 simplicity, and perfect  adaptation to the purpose,
 gave me a sleepless  night; for there I lay with
 etherealized  brain, performing  in  imagination  a
 magical cure on each of my devoted patients.  This
 was, as I thought, the  consummation of all ray plans.
 After a struggle for three years, victory was about
 to crown my efforts.    How I longed for the morn-
 ing, that I might put to the test of experiment what
 seemed so beautiful in theory.   But  I was doomed
 to wait another twenty-four  hours  before proving
 my principle; for just as I was  preparing  for the
 operation, a call to the country appropriated the day,
and thus the longest day of my life was lengthened
out by hope deferred.  But bright and early on the 
58               SILVER SUTURES.

succeeding morning, I applied the quill suture se-
cured by the  perforated shot.  It was all I could
desire—I was  never so well satisfied with any ope-
ration in all my life.  How anxiously I waited  for
its results.  I had at last gotten  rid of the canulae
that had  so long  been  such a serious  obstacle to
success,  and every thing was propitious; but these
bright hopes were of short duration, for I soon had
unmistakable  evidence  that the  operation was a
total failure.   What was the cause of it ? why, said
I, it must be because the silver quills are too large;
so I began to lessen their size  till  they were not
more than a line in  diameter, and on account of the
expense of silver, lead was substituted:  but notwith-
standing these modifications, there was no more suc-
cess than at the beginning.   What now was to be
done ?   The principles of the operation were clear,
and its mechanism seemed  to be perfect.   At first  I
had supposed  my failures were due to the imperfec-
tion of  the catheter;  that was perfected, and then
I laid the blame on the method of securing the su-
tures by means of the  canulae; they were replaced
by the  perforated shot, and then I looked to the
size of  the quills, and reduced them, so  that they
burrowed nicely in  the tissues: it  then seemed that
success  was  inevitable,  but  still disappointment
awaited me at every turn.
    Thus far all my  experiments were conducted on 
               HOW FIRST SUGGESTED.           59

 the  principles of a rational inductive philosophy.
 The operation was  mechanically perfect, but with
 no better results than when it was rude and clumsy.
 There must be a reason for all this—what was  it ?
 Why,  said I, perhaps it is in the nature of the mate-
 rial  more than in its  principle of action;  what  a
 happy thought!—Of course it was,  for a silk thread
 introduced under the skin, and allowed to remain  a
 week, becomes a seton, giving rise  to the suppura-
 tive process, and certainly the same thing must oc-
 occur  with it  in the vagina;  and how then could
 there be cohesive union ?  Here  then was the diffi-
 culty at last; how strange it now seemed to  me that
 this  fact  had not long ago forced itself upon  my
 mind.   Now the question arose, was there a substi-
 tute for silk  that would answer the same purpose,
 and yet not poison the animal tissue ?   Why, lead
 remains indefinitely in the body, becomes sacculated,
 and  produces no  poisonous, or  suppurative effect
 Dr. Levert * of Mobile, had demonstrated the innoc-
 uousness  and efficiency of leaden  ligatures on the
 arteries in the lower animals, and Mettauer and Dief-
 fenbach had actually used leaden  sutures  in these
 very cases; and  I had in my various  experiments
 tried them in two cases of vesical, and one of rectal
fistula, but fortuijately for science, the clumsy leaden
wire was unsuccessful in my hands.   Was there any
    * American Journal of Medical Sciences, No.  VII., May, 1829. 
60
SILVER SUTURES.
other metal that could be substituted for lead, pos-
sessing its valuable property of harmlessness ?
    In this train  of inquiry what  would be  more
readily suggested to the reasoning mind than silver,
gold, and platinum ?*  Just at this stage of affairs I
happened to pick up a piece of brass wire, that had
been used in a pair of old fashioned suspenders made
before the days of India rubber; it was as fine as or-
dinary sewing thread.   I took it to a jeweller, who
imitated it in silver.  I was  now quite as anxious to
see the  result  of an experiment with this, as  I was
seven months before to see the perforated shot ap-
plied.   On the 21st June, 1849,  it was done.   A
young colored woman, who had  never murmured
at the preceding  failures,  was placed on the ope-
rating table for the thirtieth time,  and  the  silver
sutures were applied, with  the leaden  bars and the
perforated shot.  In all previous operations the ure-
thra, in a day or two,  would become red and ten-
der, and the  urine loaded with  thick tenacious
mucus,   thus  showing the  inflammatory process,
which was adverse to  union; but after  this  opera-
tion, the urine remained perfectly  limpid all  the
time, and  on  the eighth day the parts were per-
fectly healed;  the  suture apparatus remaining just

  * All these I have used, but adopt the silver, because it is as good as gold,
and cheaper. 
WHEN FIRST  PUBLISHED.
61
as it was placed, with the crossbars somewhat bur-
rowed in the vaginal tissue.
   I shall not dwell upon my feelings at this time. At
last I had attained what I had worked for nearly four
years; and it was but a few weeks before  all  the
cases were  cured that had been the  subject of ex-
periment for so long a time.  I was anxious to get
a few more cases to settle some doubtful points, be-
fore publishing to the world my discovery; but un-
fortunately with  the realization of my dreams,  and
in the full fruition of my most sanguine hopes, came
a sad reverse.   An exacting practice and the  ex-
treme mental tension  of  the past four years  had
produced a collapse, long foreseen by friends, with-
out my consciousness of its approach.   Having con-
tracted the chronic disease of a warm climate, which
is almost universally fatal,  and struggled hard for
more than  two years, and as it seemed, hopelessly
against my fate, thus seeing that death was inevitable,
and fearing- that I might  die  without  the  world's
reaping  the  benefit of my labors, I determined to
give my experience, crude as it was,  to the profes-
sion that I loved so much.   And accordingly, in Oct.
1851, my paper " On Vesico-Vaginal Fistula"  was
dictated, and sent to Dr. Isaac Hays, of Philadelphia,
who published it in the Am.  Jour, of Med. Sciences
for Jan. 1852, as my last free-will offering on the
altar of science.   I little thought of living to see it 
62
SILVER SUTURES.
in print, but  it has pleased an All-wise God to re-
store me again to health, and by a mysterious Prov-
idence  to place me in your midst, where I  have
found nought but friends and kindness.

    Mr.  President,  I have thus  hastily  sketched  a
truthful, unexaggerated statement of the train of cir-
cumstances, which led to results  that must ever be
remembered  as an achievement of American  Sur-
gery.   But, Sir, I feel that an apology is due this
Academy, for a personal  narrative, although neces-
sary for the vindication of right and the establish-
ment of truth.

Fellow Associates :
    I have said  much of Silver Sutures, showing
what they have already done, and pointing out the
great revolution  they are to effect in all surgery;
but my  task would be unfinished were I not to lay
before you in this connection every good work they
have achieved,—indulge me then a moment longer.
    In justice to  the  Medical  Profession of this
mighty Metropolis, which is truly represented by this
Academy, I beg leave here to state a few facts that
must necessarily become historic; and,  if historic,
could the occasion be more propitious than now, in
this beautiful new edifice of the New York Histori-
cal Society,  which was  but last night  dedicated 
          origin of woman's hospital.        63

by  an eloquent address from the venerable and
learned Dr.  Francis.
    But for  Silver  Sutures, that  noble  Charity, the
Woman's Hospital, would not have been called into
existence.—Do you ask how  this is so?  Let me
glance briefly at its origin.
    As before remarked, driven  by a seemingly in-
exorable fate  from my Southern home and  friends
in  search of  health, repeated  observations made
during  the  summers  of 1850, 1851,  and 1852,
showed that I could regain it in this  great city—
and nowhere  else—for whether  I  crossed over to
Brooklyn, sailed up the Sound to  the  "land of
steady habits," roamed  over  the Highlands of the
noble Hudson, quaffed  the waters of the  far-famed
Saratoga, loitered  by  the  seaside, or  scaled  New
England's lofty mountains, it was all the same with
me—but, whenever I tarried in New York, its pure
soft Croton  water and bracing air,  would invariably
banish  my  dread disease.   Thus the law  of self-
preservation drove  me  here  in spite of sectional
prejudice and an innate horror of a large city.  Soon
after my arrival, on the  15th of October, 1853, Dr.
Mott called, and gave me the  first patient I ever
had in New York.  It was a very bad case of utero-
vesico-vaginal fistula, which had been sent to him
from Canajoharie.
    Having  read an account  of Silver Sutures, he 
64
silver  sutures.
honored me with a request to  apply them in this
case, which, so far as the records show, was the first
of the kind ever  remedied in  the State of New
York.   This brought me frequently in contact with
Dr. Mott, who encouraged and sympathized with
my views on  the  necessity of establishing a great
hospital in this city to be devoted to the treatment
of the diseases peculiar to woman.   He  sent me to
Dr. Francis, whose broad and comprehensive views
greatly contributed to  shaping its  destiny.  Dr.
Francis saw at once its bearings upon the  interests
of humanity, the advancement  of science, and the
cause of Medical  Education.   He  was  its earliest
advocate,  its unwavering  friend.   To his  personal
influence  and  overpowering eloquence is  due  in a
great measure the  hold it  has upon the sympathies
of the community, and the confidence of  the Pro-
fession—well may he be styled God-Father to the
Woman's Hospital.
   Dr. Horace Green, the founder of the New York
Medical College, was too  much interested in the
cause of medical education not to see its importance,
and  he aided it  with wise  counsel' and earnest
effort.
   Dr. Griscom, Dr.  Barker, Dr. Gardner, and Dr.
Reese, were amongst its earliest friends.  But the
first man to suggest a proper method of co-operative
action was Dr. Alexander  H. Stevens, who, though 
       ENDORSEMENT OF  MEDICAL PROFESSION.    65

little  given to enthusiasm on  ordinary  occasions,
seemed to be fired with this idea of a Woman's
Hospital, and wrote a letter to Bishop Wainwright,
(which is  now in the possession  of the Rev.  Dr.
Muhlenberg,)  and taking a broad  view of the sub-
ject, he at once said: "You  are right in thinking
this movement should  emanate from the  Medical
Profession; a meeting must be called, and you must
address it."  But I declined, because I was unused
to public speaking, and feared  to  endanger a good
cause by a possible failure.
    However,  I soon discovered  that I could do
nothing otherwise, and was forced  to adopt the sug-
gestion of Dr. Stevens, inviting the  Profession to a
lecture on the subject at the Stuyvesant Institute,
No. 659 Broadway, on the 18th of May, 1854.
    The interest  felt was manifested by  a large
attendance, representing every  phase of the Profes-
sion.  After the lecture, Dr. Delafield was called to
the chair, and Dr. Beadle requested  to act as secre-
tary, when Dr. Griscom moved  " That the meeting.
coincide to the utmost extent with the views  of the
lecturer of the evening," sustaining his motion ably
and eloquently.  He was followed successively by
Drs.  Gardner, Greene,  Kissam, Reese, and others,
when the meeting unanimously  adopted the hospital
movement as its own, authorizing the chairman to
appoint at his leisure, a committee of ten, five  lay-
                5 
66
SILVER SUTURES.
men and five medical  men, to  organize plans for
future  action;  Dr.  Delafield was added  by  this
meeting to the  committee which it authorized him
to appoint.
   The selection of this committee was a matter of
grave importance,—how could it be composed so as
to combine all interests in the Profession into  one
harmonious whole ?   How else but by representing
the cause of Medical Education ?   Accordingly, Dr.
Stevens, from the College of Physicians and  Sur-
geons,—Dr.  Mott,  from  the University  Medical
College,—Dr. Green, from the New York Medical
College, — Dr. Francis, as the Father of Obstetric
Medicine in New York,—with Dr. Delafield  and
your Orator, comprised the medical branch of the
Committee—while Mr.  Peter Cooper,  and Mr. Eras-
tus C. Benedict, were the only laymen ever selected.
   This endorsement by the united  voice of the
Profession was the quickening principle in this hos-
pital movement; without it, there could have been
no vitality—no existence.
    The kindly  sympathy  of the Profession  was
shown, too, by a liberal patronage in  placing at my
command  a large number of surgical  cases, fit sub-
jects for Silver Sutures, that were clamorous for aid.
Having no place for them, and feeling the urgency
of prompt action, then it was that the members of
this Committee allowed me to appeal  to the mothers 
          woman's hospital association.       67

of our city to aid us in this good work for their suf-
fering sisters.
   The time has not arrived for a complete histori-
ography of the Woman's Hospital,  and it is not my
intention  here to  individualize  the noble band of
heroic women, who, when we had been working for
several months with  no practical  results, called  a
meeting of some thirty ladies in the quiet parlor of
a private residence, (No. 27 St. Mark's Place,) on
Saturday  the 10th of February,  1855,  when the
"Woman's  Hospital  Association"  was  formed,
which elected a  Board  of Managers with  the fol-
lowing officials, viz.:—

Mrs. David Codwise,   .   .     .   .  1st Directress,
  "  Wm. B. Astor,......2d     "
  "  Ogden Hoffman,.....3d      "
  "  Jacob Leroy,......Treasurer,
  "  T. C. Doremus,.....Assist. Treas.
  "  Dr. Horace Webster, .... Secretary.

   This Board raised funds, rented a building, No.
83 Madison Avenue, and opened the hospital on the
4th  of May, 1855, electing  the gentlemen as its
Medical Board who had been previously appointed
as a  committee of  organization.
   Nor did they stop here;  for as soon as they saw
the  need of more room, they joined  the  Medical
Profession in an appeal to the Legislature for funds 
      68              SILVER SUTURES.

      and a new Charter, merging it into a State Institu-
      tion, of which the present  Board of lady Managers
      will constitute a Board of Supervisors having charge
      of its domestic management, while its Board of Gov-
      ernors, composed of New York's choicest sons, will
      organize it and manage its finances.   And what are
      now its  prospects for the  future?   With  fifty-six
      thousand  dollars  in  hand, with an  implied under-
      standing in our Charter to get from the State a large
      appropriation as soon as her financial condition will
     allow it, with a sympathy for its  success that  per-
     vades every intelligent family in the city, and many
     throughout the State, and with the expectation of
     obtaining from the  city a site valued  at a hundred
     thousand  dollars—does not  the Woman's  Hospital
     bid fair to take its place as one of the  fixed institu-
te    tions of the country ?  And who should feel  prouder
      of this than this  Academy ?  Although the Acad-
      emy had no opportunity, as  such,  of moving in the
     matter, still the leading members of this  learned
     body are its prominent friends.  The  Medical Pro-
     fession have never before, in any country, shown
      such unity of purpose as here, in  regard to this
      Woman's  Hospital.   Look  for a  moment  at  their
      Memorial to the Legislature last year  in its behalf.
      It was signed  by every Professor in the College
      of Physicians  and  Surgeons;  by every Professor
      in the  University Medical College; by  every  Pro- 
UNITED MEDICAL PROFESSION.         69
fessor in the  New York Medical College ;# by all
the leading practitioners of the city to whom it was
presented;  by  every Physician to each of our five
Dispensaries; by the Surgeons and Physicians to all
our other Hospitals, and when it was sent to Albany,
it  received the  unanimous endorsement of  the
State Medical Society.   Was ever before such union
seen in  the  Medical Profession?'  Pardon me if I
should  call  it  a  "Union by  the first intention,"
effected by Silver Sutures. 
0
% 
CATALOGUE   OF   THE
OFFICERS AND CORRESPONDING  AND RESIDENT FELLOWS
OF THE
NEW  YORK  ACADEMY OF MEDICINE.
-•"•-«-
             OFFICERS FOR 1847.

           President, John Stearns, M.D.
                    {Francis U. Johnston, M.D.
                    Thomas Cock, M.D.
                    John B. Beck, M.D.
                    John W. Francis, M.D.
    Recording Secretary, F. Campbell Stewart, M.D.
Domestic Corresponding Secretary, William C. Roberts, M.D.
  Foreign Corresponding Secretary, Benjamin Drake, M.D.
          Treasurer, Robert W>tts, Jr., M.D.
          Librarian, Thomas M. Markoe, M.D.
            Orator, John W. Francis, M.D.
             OFFICERS FOR 1848.

          President, John W. Francis,  M.D.
                      f Thomas Cock, M.D.

          Itce-PresidenUA j  R r0Dgers, M.D.
                      [w. W. Miner, M.D.
    Recording Secretary, F. Campbell Stewart, M.D.
       Assistant Secretary, Marcus L. Taft, M.D.
Domestic Corresponding Secretary, William C Roberts, M.D.
 Foreit/n Corresponding Secretary, Gurdon Buck, Jr., M.D.
            Treasurer, James 0. Pond, M.D.
           Librarian, Thomas F. Cock, M.D.
            Orator, James R. Manley, M.D. 
OFFICERS,  ETC., OF  THE


  OFFICERS FOR  1849.
         President, Valentine Mott, M.D.
                    'Isaac Wood, M.D.
       T7.   -.  .,     James R. Manley, M.D.
       Vun-PrwtoOsA Qalen q^^ M'a
                     Thomas Cock, M.D.
  Recording Secretary, John L. Vandervoort, M.D.
      Assistant Secretary, T.  M. Franklin, M.D.
Domestic Corresponding Secretary, Wm. C. Rorerts, M.D.
Foreign Corresponding Secretary, John G. Adams, M. D.
          Treasurer, James 0. Pond, M D.
         Librarian, Thomas F. Cock, M.D.
           Orator, Alfred C. Post, M.D.
             OFFICERS FOR 1850.

            President, Isaac Wood, M.D.
                     ^ Galen Carter, M.D.
        Tr-  r>   -j  *   Joseph M. Smith, M.D.
        Vice-Presidents A j. c. BlisSj m .d/
                     [A. C. Post, M.D.
       Recording Secretary, John G. Adams, M.D.
       Assistant Secretary, Jackson Bolton, M.D.
 Domestic Corresponding Secretary, Wm. C. Roberts, M.D.
Foreign Corresponding Secretary, Edward L. Beadle, M.D.
            Treasurer, James 0. Pond, M.D.
           Librarian, Thomas F. Cock, M.D.
            Orator, Joseph M. Smith, M.D.
             OFFICERS FOR 1851.

        President, Alexander H. Stevens, M.D.
                    '"Galen Carter, M.D.
      t"  nu.  -j  *  > Joseph M. Smith, M.D.
      v ice-Presidents, < T    ir t»        a t t^
                  '  John K. Rodgers, M. D.
                    John P. Batchelder, M.D.
       Recording Secretary, John G. Adams, M.D.
       Assistant Secretary, Jackson Bolton, M.D.
 Domestic Corresponding Secretary, Wm. C. Roberts, M.D.
Foreign Corresponding Secretary, Edward L.  Beadle, M.D.
           Treasurer, James 0. Pond, M.D.
          Librarian, Thomas F. Cock, M.D.
          Orator, F. Campbell Stewart, M.D. 
NEW  YORK ACADEMY  OF MEDICINE.
OFFICERS FOR 1852.
Vice-Presh
           President,  Thomas Cock, M.D.

                     f Joseph M. Smith, M.D.
               .;    1 James Anderson, M.D.
               n<ients,< j  p Batchelder, M.D.
                      Gurdon Buck, Jr., M.D.
      Recording Secretary, Jackson Bolton, M.D.
      Assistant /Secretary, George A Peters, M.D.
 Domestic Corresponding Secretary, Wm. C. Roberts,  M.D.
Foreign Corresponding Secretary, Edward L. Beadle, M.D.
           Treasurer, James 0. Pond,  M.D.
           Librarian, Thomas F. Cock, M.D.
         Orator, F. Campbell Stewart, M.D.
              OFFICERS FOR 1853.

             President,  Isaac  Wood, M.D.
                      f E. L. Beadle, M.D.
        „.   D  .,     F. C Stewart, M.D.
        \ice-PresidentsA Wm Dctmolp? m d.
                      I^Willard Parker, M.D.
      Recording Secretary, Samuel A. Purdy, M.D.
       Assistant Secretary, J. Foster Jenkins, M.D.
Domestic Corresponding Secretary, Samuel T. Hubbard, M.D.
 Foreign Corresponding Secretary, S. Conant Foster, M.D.
            Treasurer, James 0. Pond, M.D.
           Librarian, Thomas F. Cock, M.D.
              Orator, J. A. Swett, M.D.
              OFFICERS  FOR 1854.

           President, Joseph M. Smith, M.D.
                      f James Anderson, M.D.
         Tr.   •    .,  .  j E. L.  Beadle, M.D.
         lice-PresidentsA Wm> Detmold, M.D.
                      [j. H.  Griscom, M.D.
      Recording Secretary, Samuel A. Purdy, M.D.
      Assistant Secretary, Edwin B. Stimson, M.D.
Domestic Corresponding Secretary,  Samuel T. Hubbard, M.D.
 Foreign Corresponding Secretary, S. Conant Foster, M.D.
            Treasurer, Jamks 0. Pond, M.D.
           Librarian, Thomas F. Cock, M.D.
            Orator, John H. Griscom, M.D. 
OFFICERS,  ETC,  OF THE
              OFFICERS FOR 1855.

       President, John  W.  Francis, M.D., LL. D.

                      f E. L. Beadle, M.D.
         Vice-President*  J F* C' Stewart> MD-
         vice ^residents, <j GuRDON BuCR> M D

                      ^Wm. Detmold, M.D.
       Recording Secretary, S. Conant Foster, M.D.
        Assistant Secretary, John W. Green, M.D.
Domestic Corresponding Secretary, Samuel T. Hubbard, M.D.
   Foreign Corresponding  Secretary, John G.  Adams,  M.D.
            Treasurer, James O. Pond, M.D.
           Librarian, Thomas F. Cock, M.D.
              Orator, John Watson, M.D.
              OFFICERS  FOR 1856.

          President, Willard Parker,  M.D.

                    f John  Watson, M.D.
      Vice-Presidents,\ ^ckson Bolton  M.D.
                  ' j Gurdon Buck, M.D.
                    [_ Edward L. Beadle,  M.D.
      Recording Secretary, S. Conant Foster, M.D.
        Assistant Secretary, Wr. F. Holcomb,  M.D.
Domestic Corresponding Secretary, Samuel T. Hubbard, M.D.
  Foreign Corresponding Secretary, John W. Green, M.D.
            Treasurer, James O. Pond, M.D.
           Librarian,  Thomas F. Cock, M.D.
              Orator, Wm. Detmold, M.D.
              OFFICERS FOR 1857.

           President, Valentine Mott, M.D.

                    f James R. Wood, M.D.
       Vice-Presidents,] *!DWA2? L- Bl™, M.D.
                   '  John Watson, M.D.
                    [B. Fordyce Barker, M.D.
        Recording Secretary, C. F. Heywood, M.D.
       Assistant Secretary, F. U. Johnston, Jr., M.D.
Domestic Corresponding ,sv cretary, Samuel T. Hubbaud" M D.
  Foreign Corresponding Secretary, John W. Green, M.D.
           Treasurer, James 0. Pond,  M.D.
           Librarian, Thomas F. Cock, M.D.
              Orator, J. Marion Sims, M.D. 
      NEW YORK  ACADEMY OF  MEDICINE.         75


               OFFICERS FOR 1858.

            President,  J. P. Batchelder, M.D.
                        [ C. E. Isaacs, M.D.
          Tr.  n  • 7  ,    W. H. Van Buren, M.D.
          ^ce-ZW^s, J John WatsqN) m ^
                         S. C< >nant Foster,  M.D.
         Recording Secretary, C. F. Heywood,  M.D.
          Assistant Secretary, F. U. Johnston, M.D.
  Domestic Corresponding Secretary, Samuel T. Hubbard, M.D.
    Foreign Corresponding Secretary, John  W. Green, M.D.
              Treasurer, James 0. Pond, M.D.
              Librarian, Samuel Rotton, M.D.
               Orator,------------------


                    TRUSTEES.

R. S. Kissam, M.D.                   J. H. Griscom, M.D.
James Anderson, M.D.               E. L. Beadle, M.D.
Benjamin Ogden, M.D.               Galen Carter, M.D.
                  W. N. Blakeman, M.D.
               CORRESPONDING  FELLOWS.

                 [Those marked with an asterisk are deceased.]

Thomas W. Blatchford, M.D., Troy, *Bureaud de Riofrey, M.D., Paris.
    N. Y.                         Samuel D. Gross, M.D.,  Philadelphia,
Jean Civiales, M.D., Paris.              Penn.
♦Theodoric Romeyn Beck, M.D., Al- Philip  Ricord, MD., Paris.
    bany, N. Y. "                  Alfred  L. M. Velpeau, M.D., Paris.
Thomas Harris, M.D., Washington.   J. C. Townsend, M.D., Long Isl., N.Y.
Louis Agassiz, Prof. Harvard Univer- Jean Jacques Joseph  Leroy d'Etiolles,
    sity.                              M.D., Paris.
Sir Henry Holland, M.D.,  London.    Prince  Krom  Luang  Wongsa  Tirat
Martial Dupierris, M.D., Havana.         Sanit, Siam.
Ashbel Smith, M.D., Texas.         Paul Dubois, M.D., Paris.
William Fergusson, M.D., London.    G. Andral, M.D., Paris.
Samuel H. Dickson, M.D, Charleston, F. Rilliet, M.D., Paris.
    S. C.                          E. Barthez, M.D., Paris.
Worthington Hooker, M.D., New Ha- J. Guggenbuhl,  M.D., Paris.
    ven, Conn.                     Jacob Bigelow, M.D., Boston.
E. D. Fenncr, M.D., New  Orleans.    James Y. Simpson, M.D., Edinburgh.
P. M. Roget, M.D., London.         John  Hughes  Bennett,  M.D.,  Edin-
P. V.  Z. Aimissat, M.D., Paris. •          burgh.
Edward Reynolds, M.D., Boston, Mass. Edward K. Peaslee, M.D., N. Hamp-
♦Joel A. Wing, M.D., Albany, N. Y.       shire. 
OFFICERS,  ETC., OF  THE
RESIDENT   FELLOWS.
Abbott, Norman
Acosta, Elisha
Adams, John G.
*Andariese, James W.
Anderson, James
Andrews, Jarvis M.
Ashburn, Robert A.
Aylett, Philip Augustus
Ayres, Daniel, Jr.

*Barker, Luke
Bartles, 0. S.
Barker,  B. Fordyce
Barry, Robert A.
Batchelder, J. P.
Bay, John W.
Baylies, Bradford S. B-
Baylies, Hersey
Beadle, E. L.
Beales, J. C.
*Beals, Gorham
*Beck, John B.
Bedford, G. S.
Benedict, George
Berger,  Francis E.
Blakeman, Wm. N.
*Bliss, James 0.
Bliven, J. P.
Blois, Samuel
Blumenthal, Mark
Bogert, Cornelius R.
Bogert,  S. V. R.
Bolton, Jackson
Borrowe, J. H.
Bowen, William
♦Boyd, Thomas
Booraem, Augustus C.
*Brady, Patrick J.
Brown, Henry Weeks
Brown, William K.
Brueninghausen, Charles
Buck, Gurdon
Buel, W. P.
Bulkley, H. D.
Bum stead, F. J.
*Bullus, Edward
Budd, Chas. A.
Burke, Wm. C.
Busteed, John
Burrill,  James
Byrne, John
*Cameron, James
Cameron, John S.
* Campbell, James
Campbell, N. L.
Carroll, Daniel J.
Carter, Galen
Carter, J. S.
Catlin, S. H.
Chalmers, Thomas C.
Chapin, E. R.
*Chapin, John R.
Cheesman, John C.
Childs, S. Russell
Church, Allen S.
Clark, Alonzo
Clark, Patrick
Clark, Peter F.
Clarkson, C. V.
Clements, J. W. G.
Clinton, Alexander
Cock, Thomas
Cock, Thomas F.
Collins, C. T.
Conant, D. S.
Cooke, John
Cooper, James S.
Corson, J. W.
Covel, John C.
Cox, Abm. L.
Crane, James
Crane, John J.
*Creveling, Abm.
Cullen, H. J.

Dalton, J. C, Jr.
Davis, E. H.
Davis, John
Delafield, Edward
Detmold, William
Douglas, J. Hancock
Douglas, Robert
Downs, Henry S.
Drake, Benjamin
Dudley, Wm. H.
Dwight, Wm. W.

Eadie, W. G.
*Earle, Edward
Earle, Pliny
Edgar, David A.
Edwards, Frank S.
Eliot, Ellsworth 
NEW  YORK  ACADEMY  OF  MEDICINE.
Elliot, Augustus G.
Elliot, Fredk. W.
Elliot, Geo. T., Jr.
Elliott, James W.
Elliott, Thomas W.
Elder, Alexander
Ellis, Samuel C.
Emmet, Thomas Addis
Enos, Dewitt C.

Ferguson, John G.
*Ferris, Floyd  T.
Ferris, Lynde C.
Fields, Edward
Finnell, T. C.
Fisher, George  S.
Fisk. Lyman
Fitch, James D.
Forrester, James C.
Foster, Joel
Foster, S. Conant
Fo/, Michael E.
Francis, John W.
Franklin,  Edward C.
Franklin,  Thomas M.

Gallagher, John
Gardner, Augustus K.
Garrish, John P.
Geer, Seth
Gescheidt, Anthony
Gilford, Jacob T. '
Gilman, Chandler R.
Gibert, James T.
Goodrich, Charles S. J.
Gluck, Isidor
Gomez, Horatio
Gouley, J. W.
*Graham, John
Gray, H. M.
*Green, David
Green, Horace
*Greene, Isaac
Green, John W.
Gray, F.  C.
Griscom, John H.
Guernsey, H.
Guernsey, Peter B.
Gunn, A.  N.

Hall, Edwards
Hall, Samuel
*Halsted, J.
Halsted, Thad. M.
Harcourt,  James
Hardenbrook, J. R.
Harris, Elisha
Harris, Stephen R.
Hart, John
Heard, John S.
Henriques, A. J.
Henschel, Charles
Hepburn, James C.
Herriot, George
Herzog, M.
Heywood, Charles F.
Hills, Samuel A.
Hintoti, J. H.
Hirscb, Simon
*Hobart, W. H.
*Hogan,  Daniel M.
Hoit. Moore
Holcomb, Wm. F.
Horsfield, R. T.
Horsfield, T. W.
Hubbard, Samuel T.
Huntington, G.  F.
*Hunter, Abraham T.
Husted, N. C.
Hutchison, J. C.
*Hutchinson, E. F.
Hyslop, George L.

Isaacs, Charles E.
Ives, George W.
Ives,  John

Jackson, Wm. H.
Jackson, Francis H.
Jacobi, A.
Janes, E. H.
Jenkins, J. Foster
* Johnston, F. U.
Johnston, F. U., Jr.
Jones, E. Lee
Jones, Wm. W.
Jones, A. S.
Johnson, Wm. S.

Kammerer, J.
*Kearney, Ravaud
Keene, Stephen S.
Kennedy, James
Kilbourne. J. Sage
Kimbark, Everett H.
♦Kingsbury, G. H.
Kissam, Richard S.
Krackowitzer, E.
Kuypers, S. S. 
OFFICERS, ETC., OF  THE
Ladd, John G.
Learning, James R.
Lee, Charles A.
Lee, J. C.
Lee, Thomas D.
Leo-Wolf, George
Leo-Wolf, Morris
Leveridge, Benjamin C.
Levings, N. C.
Lewis, Geo.
Lewis, W. C.
Linsly, Jared
Livingston, W. C.
Ludlow, E.  G.
Lyon, James L.

McCaffrey,  Charles
McClelland, John
McCready,  B. W.
McClaury, J.
McLeod,  S. B. W.
*Macdonald, James
Macfarlan, Ebr.
*MacNeven, W. H.
Manley, James
*Manley, James R.
Markoe, Thomas M.
Martin, Joseph
*Marvin, David D.
Maxwell, W. H.
*Meikleham, D. S.
Metcalfe, John T.
Merritt, J. R.
Miller, Francis
Miller, John
*Miller, W. Ellison
Millett, Nicholas
Miner, William
Miner, William  W.
Minor, James M.
Mitchell, Chauncey L.
Monell, J. A.
Moore, Edward
* Moore,  S. W.
*Moran, Thomas
Morris, R. L.
Moses, Israel
Mott, Valentine
McNulty, John
Mullen, P.  A.
Murray, Alexander

*Neilson, John
Nelson, James B.
Newcomb, George
Nichols, Elias S.
Nichols, Henry W.
Ogden, Benjamin
Ogden, John D.
Olmsted, Roger S.
O'Reilly, John
O'Rorke, James
Owen, J. Leech

Palmer, L. N.
Parker,  E. H.
Parker,  Willard
* Parkinson, W. B.
Paul, James C.
Peaslee, Edmund R.
Pennell, Richard
Pentz, Elias J.
Perry, Joseph S.
Peters, George A.
Phelps, James L.
*Phillips, S. B.
*Platt, Wm. F.
Pond, James 0.
Porter, Mortimer G.
Post, Alfred C.
Powers, T. W.
Power, William
Pratt, Peter
Priestley, John
Proudfoot, L.
Punnett, John
Purdy, Alfred S.
Purdy, S.  A.
Purple, S. S.
Putnam, F.  A.

Quintard,  Charles T.

Randolph, Israel
Ranney, E. W.
Ranney, M. H.
Raphael, B.
Reese, David M.
Revere, F. B.
Richards, T. W.
Rising,  J. C.
Roberts, Wm. C.
*Robeson, A. B.
Rockwell, William
*Rodgers, J. Kearny
* Rogers, J. Smyth
Ross, James
Rotton, Samuel 
NEW  YORK  ACADEMY  OF  MEDICINE.
Sabine, Gustavus A.
Sayre, Lewis A.
Schilling, E.
Schirmer, William
Schmidt, J. W., Jr.
Seaman, Richard S.
Sewall, John G.
Shanks, John
* Sherwood, Burritt
Sims, J. Marion
South worth, M. A.
Smith, Charles D.
Smith, David
*Smith, Gilbert
Smith, J. Lewis
Smith, Joseph M.
Smith, James 0.
Smith, Stephen
*Snowden, John
* Spring, Edward
Stearns, John
 Stephens,  James J.
Stephenson, Mark
Stevens, Alexander H.
Sterling, John W.
 • Stickney, J. Dwight
Stewart, James
Stillman, J. D. B.
Stillwell, J. E.
Stewart, F. Campbell
Stimson, Edwin B.
 Stone, John 0.
Storer, Ebenezer
Stout, Arthur B.
Strube, F.
Sweeny, Hugh
Sweeny, Owen
*Swett, John A.
Swift, H.  S.

*Taft, Marcus L.
Taylor, Isaac E.
Tellkampf, Theodore A.
Thayer, Henry W.
Thomas, T. Gaillard
•Thompson, A. G., Jr.
Tomes, Robert
*Townsend, Peter S.
Trudeau, James
Tucker, C. P.
Tuttle, John T.

Underhill, Alfred
Uhl, David

*Vache', Alexander F.
Van Arsdale, Henry
Van Arsdale^ Henry
Van Arsdale, Peter
*Van Buren, Thomas
Van Buren, P.
Van Buren, William H.
Vanderpoot, Edward S.
Vandervoort, John L.
Van Hovenburgh, H.
Van Kleek, John R.
Van Pelt, M.  D.
Van Rensselaer, Alex.
Van Roth, W.
Van Winkle, Ed. H.
Varick, Theodore R.
Vermilye, Wm. E.
Voss, L.  H.

Wallace, W. W.
Wralsh, Hugh
Warner,  E B.
Warren,  James
* Washington, James A.
Watson,  John
Watson,  Alex. T.
Watts, Robert
Weed, John W.
Weeks, Cyrus
Wells, Daniel
Wells, Ovid P.
Westervelt, John S..
White, Ambrose L.
White, Francis W.
White, Oliver
White, Samuel P.
Wight, L. L.
Wilhelm, H. N.
Wilkes, George
Williams, M. W
Wilson, William
Wood, Isaac
Wood, James R.
Wood, Stephen
 Woodhull, H. B. W.
Woodward, George F.
Worster, Joseph
Wright,  Aaron

Young, William. t 
I 
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