Digitized by the Internet Archive in 2016 https://archive.org/details/fairplayisjewel01eber FAIR PLAY IS 42l <0 31 W H / NEW- YORK. PUBLISHED BY ELAM BLISS, No. 208 BROADWAY .T. SETMOUR, PRINTER, 1819 f a. i r ? O.LJ PREFACE. The following unwarrantable attack on Dr Mott’s Case of Aneurism, appeared in the “ Me- dical Recorder,” published in Philadelphia. Presuming that the w'ork was governed by fair principles, and that it was open to liberal dis- cussion, the subjoined answer was sent to the editor, with a request that it might be inserted as soon as possible. But it appears that this gentleman, either swayed by personal dislike, or party animosity, refused it a place in his book. It was therefore determined to re-pub- lish the above-mentioned attack, with the an- swer annexed. The letter of Mr. Eberle, an- nouncing his refusal to give the answer an in- sertion, is also published, “ with all its imper- fections on its head,” that the public may have an opportunity of witnessing the singular talents and acquirements of the Editor of the “ Medi- cal Recorder.” A reply to that letter concludes the pamphlet. REVIEW FROM THE i AMERICAN MEDICAL RECORDER. Remarks on a Pamphlet entitled “ Reflections on Securing in a Ligature, the Arteria Innominata , to which is add- ed, a Case in which this Artery was tied by a Surgical Operation. By Valentine Mott, M. D Professor of Surgery in the University ofNew-York, &c. This case is of so important a nature as very pro- perly to excite much attention. Its circumstances are detailed by Dr. Mott so particularly as to leave no doubt that he tied the arteria innominata, and that the patient survived the operation twenty-six days. On attending carefully to its history, a question im- mediately arose on a subject which appears not to have been sufficiently attended to by the Doctor, ei- ther previous to, or after the operation ; and that is, whether M. Bateman’s tumour really was an aneu- rism, and of course w hether the operation done was necessary and justifiable. Dazzled by the brilliancy of such an operation, many practitioners, and particularly the younger part of the profession, would not, perhaps, think of investigating this 'subject. But we conceive it of great importance to do so, to show how careful eve- ry surgeon should be, not to perform painful and dangerous operations, except in cases where the ne- cessity of them is clearly ascertained. We observe, in the history of this case, that the first symptoms after the injury, were those of violent inflammation about the shoulder and arm. Now, as 4 far as we have seen, aneurism has not usually com- menced in that way ; a pulsating swelling from a dis- tended or ruptured artery is generally the first ap- pearance of the disease. On the subsidence of this inflammation, a tumefaction, situated above, and pos- terior to the clavicle, began to show itself in the form of an irregular tumour, but no circumstance occur- red which gave rise to a suspicion of its being aneu- rism. The occurrence which appears to have decided the nature of this swelling in Dr. Mott’s mind was, that on the 3d of May, about two months after the man’s admittance into the hospital, the patient felt something give way in the tumour; his shoulder was painful ; the tumour suddenly increased about one-third, and a pulsation was distinctly per- ceptible. Its most prominent part was below the clavicle, at which place the pulsation w r as most dis- tinct Next day the tumour Avas evidently increas- ed, though it was not so firm and resisting as it had been, and the pulsation not so distinct. Now all this appears to us contrary to what is commonly observed in aneurismal tumours, for in their early stages the pulsation is always most dis- tinct, where they are so situated as to form an exter- nal swelling. It may here be remarked, that no ap- pearance is noticed indicating the effusion of blood into the cellular membrane about the clavicle. Avhich, had the sensation, mentioned by the man of some- thing giving way, been owing to the rupture of an aneurismal sac, Avould, in all probability, have been observed. We think this symptom can be account- ed for, by supposing that some deep seated scrofu- lous abscess suddenly burst and discharged its con- 5 tents into the tela cellulosa, under the clavicle, form- ing the projecting tumour, which being now more in the vicinity of the subclavian artery, the influence of that artery was more distinctly felt, in causing the pulsation of the swelling*. Feeling these doubts on reading the history of the case, we fully expected to have had them cleared away by the dissection after death, but in this expec- tation we have been greatly disappointed. We ex* pected an aneurismal sac, or cavity would have been opened, the artery entering it named, and the aneu- rismal orifices of it described ; but instead of any satisfactory information on this highly important sub- ject, a profound silence is observed. Instead of first demonstrating the existence of an aneurismal tu- mour, and then proceeding to investigate the effects of the operation performed for its cure, we find the latter has almost exclusively received attention, and the appearances of the tumour are related in a very" cursory manner, in the last place. There is so much obscurity in the history given of the state of the inno- minata at the place of the operation, as to render it impossible to know what was its real condition. In describing its two extremities on each side of the place where the ligature had divided it, we are told in one paragraph, (page 41) that “the upper extre- mity of this vessel was considerably diminished in its diameter by the thickened state of its coats, oc- casioned by the surrounding inflammation and in the next paragraph it is stated, that the “ tripod of great vessels, consisting of the innominata, subclavi- i * That such a cavity existed, is rendered probable by the ac- count given in the dissection of a number of enlarged and suppu- rated glands being found under the clavicles. (i an, and carotid arteries, to the extent of nearly an inch, was dissolved and carried away by ulceration;” so that in the one we are told of the thickened state of the vessel, which, in the succeeding, is declared to have been carried away by the ulcerative process. In describing the operation, a thickened and dis- coloured state of coats of the subclavian artery was mentioned, which discouraged the Doctor from tying a ligature round it ; but in the dissection, nothing more is related concerning the state of this vessel, than what is contained in the following unsatisfacto- ry, and to us unintelligible, sentence : “ The subcla- vian artery, internally and externally to the disease, w r as pervious,” (page 42.) On opening the tumour, we are informed that it was much diminished, and that the clavicle was involved in it, found carious, and entirely disunited about the middle. A number of lymphatic glands under the clavicles, and particu- larly the left, were considerably enlarged, and when cut into, very soft, and evidently in a state of scrofu- lous suppuration ; and then the following sentence concludes the account, “No other morbid appear- ance was observed.” This is truly an important disclosure, and to us quite satisfactory, that poor Bateman's disease was not understood, and that he was unnecessarily sub- jected to the operation w hich w as performed. “Far from being of opinion that the “noblest ef- forts of scientific surgery” w ere made for the relief of this poor man ; we believe that the mode of ope- ration, and the after treatment, were highly objec- tionable; but want of time prevents us at present from entering fully on these subjects.” Answer to the foregoing Review. Having'noticed en passant your Review, 1 am in- duced, though relunctantly, to come forward upon the occasion. I say reluctantly, because I have little time to spare : but allow me to hope that no consi deration shall make me quiescent when merit is at- tacked by envy or assailed by malice. It may he necessary in the first place for me to assure you, that I have no acquaintance with the gentleman whom you attempt to traduce, because he was so unfortu- nate as to be the first surgeon in any age, or any country, who secured, with evident success, the arteria innominata. You are an odd surgeon, for you blame Dr. Mott for not being able to demon- strate on the dead subject, arterial coats, which had been previously dissolved by ulceration. You appear also, not to be acquainted with the word pervious. Having no inclination to become your in- structer in propria personae , allow me in this place to refer you to Dr. Johnson’s Dictionary ; it is probable thatyou have alreadylooked into little EntickI Do not conceive that I mean to detract from your acquire- ments : no, sir, I am aware that you are a surgeon ; your Review has satisfied me, the knife is percepti- ble in your operations on the English language, and the twisted suture is wound about your arguments. You commence by assuring the world “ that a pulsa- ting swelling from a distended or ruptured artery is generally the first appearance of the disease.” Here I might refer you to Charles Bell, but as it is proba- ble that his book may be scarce in Philadelphia, you will, I trust, forgive me for making a quotation. Doc- 8 tors, (agreeably to the old adage,) sometimes disa- gree. “ Aneurism,” says Bell, “ may be attended with pulsation, or the pulsation may have ceused , or it may never have been a characteristic of the disease .” 1 leave the matter for yourself and Mr. Bell to settle, and proceed : “ Dazzled by the brilliancy of such an operation, many practitioners, and particularly the younger part of the profession, would not think perhaps of investigating the subject.” Here, sir, you are correct, lor Youth is ingenuous; she awards the wreath of renown when due, though she strips her own temples of the leaves that compose it: Those leaves are unsoiled by the blast of detraction; unruffled by the breath of envy. It should seem then that you are old ; I honour your years, but condemn your malignity. After a few remarks you proceed, “ Now all this appears to us contrary to what has been commonly observed in aneurismal tumours, for, in their early stages, the pulsation is always most distinct, where they are so situated as to form an external swelling.” Do you judge of the individual correctness of an op - i - wlon ? or of an opinion by what commonly takes place ? If so, I cease to wonder, for it is reported that the arteria innominata was never tied before, not even in Philadelphia. Again, “ It may be here remarked that no appear- ance is noticed indicating the effusion of blood into the cellular membrane about the clavicle, which had the sensation mentioned by the man, of something giving way, been owing to an aneurismal sac, would, in all probability , have been observed.” Read Dor- sey’s Cooper, kind sir, and you will find that Profes- sor Scarpa disagrees with you. 9 It would, however, be unjust in me, not to allow you some credit for your penetration. You have dis- covered that the patient did not feel something give way, and furthermore, that Doctors Mott, Post, Kis- sam, and Stevens, were deceived when present, while you were perfectly correct, though a sojourner in Philadelphia. It appears also, that Dr. Hosack attended: his peculiar province is certainly not sur- gery; but allow me to remark, by the way, that he has an eye and an ear for every department. The pillars of the New- York College are firm, uniting the strength of the Doric column with the ornament of the Corinthian Capital. But to proceed : “ feeling these doubts , on reading the history of the case, we fully expected to have had them cleared away by the dissection after death, but in this expectation we have been greatly disappoint- ed.” — So it appears that you still entertain doubts, after having published your belief that the tumour was not an aneurism ; you should have kept this to yourself. If a man doubts what he has asserted, who will be generous enough to differ with him in opinion ? But, sir, how do you make up your mind with re- gard to the operation ? Not by comparison, for it was never performed before ; not by witnessing the mode, for you were in Philadelphia. It must, there- fore, either be attributed to your omnipresence or intuition. When the history of this case was publish- ed, it was not deemed important to enter into posi- tive or laboured discussions relative to diagnosis. The surgeons ofNew-York supposed it to be aneu- rism ; perhaps the Philadelphia students may agree with them, for students are obliged to read, in self- B 10 defence; whereas regular practitioners have, at least, a choice of remaining ignorant. Should you, how- ever, covet instruction, say so boldly ; and no doubt Dr. Mott will allow you a seat in his lecture room. gratis. For my own part, I did not witness the operation that offends, but I have seen it performed on the dead subject, with consummate skill, by the same person who established its certainty, and thereby “ sent a message to surgery.” Can any voice be wanting to decide that the no- blest efforts of scientific surgery” were employed ? Surely none, for your assault has proved it. The storm wastes its fury on the oak, the shrub is secure in its comparative insignificance. If Harvey was attacked for establishing the cir- culation of the blood, if Haller was aspersed and ne- glected in his native city, if Sydenham was persecu- ted, Rush libelled, and Lavoisier murdered, Mott may smile at the humble apostate who censures him for his success, and envies him for his expertness. You condemn the subsequent treatment. Me- thinks you should have pointed out the particular improprieties, and, at least, hinted at something, which, in your opinion, would have been more cor- rect. For this neglect I do not reproach you ; silence seldom betrays, and perhaps you prefer waiting till you perform some operation of importance yourself, when your opinions might deserve consideration, and command respect. You may, however, be able to handle the knife better than the pen ; with the for- mer you lacerate patients only, with the latter you soil the scroll of science, and deface the meed of reputation. But, sir, there is a vast difference be- 11 tween the clamours of aspersion, and the voice of truth. You may become eminent in time, for men have risen from the humblest situations to the summit of perfection. But beware — that summit is perilous, for the demons of assailing envy sear the roses of science, and give her fairest chaplets to the winds. Stifle your restless animosity, “be just and fear not,” remember that sterling talents, while it scorns to detract, is nevermore delighted than when proffer- ing merited honour, and conferring ingenuous ap- plause. We revere, respect, and love your celebra- ted professor, Dr. Physic ; dignified by acquirements, exalted by success, and honoured by renown. We gaze with delight, on the hemisphere of surgery, which glows with his declining splendours, w hile we anticipate the day when our own star shall become “ lord of the ascendant.” The gray hairs of Physic are hidden by the laurels that surround them : his name is deeply engraved on the tablets of immortal fame. The words of Pompey to Scylla, with a little alteration, may apply; Philadelphia has her setting , New-York her rising sun. Dr. Rush informs us, that many great men were in the habit of acquiring knowledge from ferrymen, facts from labourers, and the art of healing from old women. After noticing this, it may be superfluous to add, that I shall alw r ays be ready to look over your future communications. 12 The following is the Letter from the Editor of the Medical Recorder. Dear Sir The answer to the review of Dr. Mott’s case, you send for publication, cannot be admitted into the Recorder; — It is, therefore, according to your request returned. However willing I may be to keep the pages of the Recorder open to free discussion, I can- not allow its pages to become the vehicle of violent crimination and irrelevant remark — It appears to me that this answer could be of no service to the person whome it intends to vindicate — The personal allu- sions in it are wholly inapplicable — The Author of the criticism on Dr. Mott’s case is no beardless tyro • — his charracter both as a man and a Surgeon, exhone- rate him from the charge of malignant envy — inexpe- rience & ignorance — Notwithstanding these objec- tions, however, if Dr. Mott, on reading your answer, will sanction its publication, If he will rest his vindi- cation upon it, I will give it a place in the Re- corder — Yours respectfully J EBERLE 3 Editor of the Med. Re’d. 13 To J. Eberle , Editor of the Medical Recorder. Dr. Bacon has just presented me your answer to his communication, requesting you to publish a re- view of the unwarrantable attack which appeared in the “ Medical Recorder,” on Dr. Mott’s “ case of Aneurism.” It seems you have refused to give the said review an insertion : allow me, therefore, to hope that you will not deem the present mode of obtaining a hearing, indirect or malicious. As Editor of the “ Medical Recorder,” you have certainly a right to govern yourself by personal ani- mosity or party feeling ; and I shall be among the last to insist on your having any respect for jus- tice, or any reverence for truth. The press is open to all; and public opinion, I presume, is not either governed or misled by your endeavours. Under this impression, it has been determined to publish your letter, without the smallest alteration ; and it may not be irrelevant to remark, that little doubt exists in my mind, of your opinions on many subjects being better than the unhappy orthography which partly conveys them. Your diamonds are perhaps of the purest water, but the setting is certainly abominable. Thank heaven, I am no Editor of a literary work, which may account for my spelling tolerably. In or- der to assist your investigation, the interlineations in your letter are totally omitted, and the words spelled incorrectly are placed in italics # . You remark that “ the personal allusions in the review are totally inapplicable,” after having be- fore declared that “ the pages of the ‘ Recorder’ * See the words in italics in Eberle’s letter. 14 should not become the vehicle of violent crimina- tion, and irrelevant remark.” Now, if the allusions are inapplicable, they certainly cannot be inju- rious. But what do you mean by personal al- lusions ? Pray, Sir, whose fame was assault- ed? Whose name or person was brought into jeo- pardy ? Some unknown and perhaps inconsiderable being endeavours to tarnish the fame of Dr. Mott ; another unknown, inconsiderable being steps forward on the defensive. Where is this personal allusion, this violent crimination ? Does it affect you ? It is necessary first to identify the victim, or there can be no sacrifice. Reader, consider the following remarks attentively, and perhaps you may discover dregs of personal animosity, mingled with the poison of ma- lice, and the gall of envy. “ Notwithstanding these objections, (says the Edi- tor of the Recorder, a work published in America , that cradle of free discussion ,) notwithstanding these objec- tions, however, if Dr. Mott, on reading your answer, will sanction its publication, if he will rest his vindi- cation upon it, I will give it a place in the Recorder." Now what does this mean ? To whom does this in- dividually apply ? What has Dr. Mott to do with the answer ? He may find time to smile with con- tempt upon your feeble imbecility, but will, I trust, never condescend to notice your frivolous objections, or ephemeral attacks. You have betrayed yourself: for it appears, under your own hand, that you “ cannot allow r the pages of the 4 Recorder’ to become the vehicle of violent crimination and irrelevant remark,” unless it be with the express intention, the fixed design of injuring Dr. Mott. Your poignard is still aimed at the same ob- 15 ject, but it shall fall from your nerveless grasp, and betray you. ■ “ this even handed Justice Commends the ingredients of the poisoned chalice, To our own lips.” — 1 have confessed myself to be an inconsiderable being in the world of literature, but you may depend upon my announcing my name, whenever your cham- pion, “whose character as a man and a surgeon, ex- onerate him from malignant envy, inexperience and ignorance,” shall go forward and do the same. Nay more — so far from requesting Dr. Mott to rest his vindication on what my humble hand has already traced, I shall ever hold myself in readiness to meet and repel any future detraction. This is not predica- ted upon any intimacy with that gentleman ; a sense of justice alone urges me forward. Fearless I enter the lists, and await the summons of the herald. “ Thrice is he armed that hath his quarrel just, And he but naked, though lock’d up in steel, Whose bosom with injustice is corrupted.” To conclude: allow me to hope that you will be able to procure some expert gladiator to assist you, — let me not war with Thersites — let us have hard fighting, and then “ Lay on Macduff, And damn’d be he, who first cries hold, enough !”