COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX64096483 R154.L52 D37 1921 George Morewood Leff Delavan • ..George %rewood -^efferts Ri5fi. ^2 D3T CoUege of ^fjpsiicianss anb ^urstonsi Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/georgemorewoodleOOdela GEORGE MOREWOOD LEFFERTS A.M., M.D., M.S. DAVID BRYSON DELAVAN M.D. Riy4.LJ2 mr intijeCitpoflrttigork College of ^l)j>s!itiansJ anb ^urgeonjf Hitirarp Gi/i Di^, D.B.DeUKo.n Ack. WCR October 16th, 1935. Dear Dr. Reppleye, I heve your letter of yester- day, and thoroughly appreciate your interest and kind cooperation. Perhaps the matter comes more appropriately from ne because I pm r member of the Historical Corxiittee/and tlie Lefferts* Clinic so-called is now not only e. thing of historical interest, but a valuable lesson in the methods of a certain kind of instruction to under-gradupts students. It is ivorthy of appreciation^ and full of suggestion ss to the possibilities of advanced torching. There is no place v/here the knovdedge of it could be more worthily perpetu- ated. I am hpppy to send to the College as many copies of the Lefferts Memorial as desira- ble, and v/ill not only follo^.7 your sugr-estion but will hold others st your command. I congratulate the Hedicj^l Department upon the incumbency of Dr. John D, Kernan - it could hardier find a better man. I am Thanking you for your letter Yours sincerely, l^i^OVi^vX-^ .aJ2-v^A.^)Ux•'^^■«^^ V GEORGE MOREWOOD LEFFERTS ^^y^^.£i^JuX!, GEORGE MOREWOOD LEFFERTS A.M., M.D., M.S. A Sketch of His Life and Work WITH A DESCRIPTION OF HIS TEACHING METHODS ILLUSTRATED BY THIRTY FULL PAGE HALFTONE PLATES BY DAVID BRYSON DELAVAN M.D. NEW YORK 1921 «\^\ IN GRATEFUL MEMORY FOREWORD The background of this sketch is an acquaintanceship begun almost in infancy, resumed in early manhood and thenceforth continued under conditions of peculiar intimacy for more than forty years. For twenty-one years his associate at the College of Physicians and Surgeons, where we together developed his system of instruc- tion; his alternate at the Demilt Dispensary in its palmj' days; his literary co-worker, and always his near neighbor and frequent companion, it was for me the opportunity of a lifetime to have been inspired by his enthusiasm and trained under the discipline of his matchless instruction. Recognizing the brilliant attain- ments of many of his contemporaries, it must be conceded that in certain accomplishments at least he stood preeminent. These, together with his teaching methods, we have tried to set forth, believing that the record of them is too valuable to be lost. D. B. D. GEORGE MOREWOOD LEFFERTS. 1846-1920 The passing of George ^Nlorewood Lefferts marks the close of an important era in the history of laryngology, as well as the departure of one whose lifework exercised no little influence in the development and dissemination of the knowledge of his art. Student, pioneer, organizer, instructor, practitioner and always leader, we may with profit to ourselves study the incidents of his brilliant and eminently useful career, and analyze the elements of character and of disposition which contributed to its success. Dr. Lefferts was born in Brooklyn, X. Y., February 24, 1846. His grandfather was of a distinguished Dutch family of Xew Amsterdam, the original member of which came over from Holland in 1660. The maternal grandfather was Gilbert Allen, an oldtime merchant of X'ew York, but like, the grandmother, of the purest and best of the original Xew England stock, one branch dating back to the Mayflower. ^larshall Lefferts, his father, was by profession an electrical engineer in X'ew York, and the inventor of improvements in telegraphy. He was a man of strong character and remarkable physical perfection, possessed of characteristics which easily placed him in successful command as Colonel of the 7th Regiment X^. G. S. X^. Y., then as now the best regiment of militia in the L'nited States. At the tune of the Civil War, with the Capital practically unprotected, the 7th Regiment was the first to reach Washington, thus relieving the keen anxiety of President Lincoln, who for eleven trying days and nights had watched from the windows of the White House the campfires of the enemy just across the Potomac. As a child the writer was one of the deeply moved throng which cheered the gray-clad regiment as it made its splendid march down Broadway, with Col. Lefterts at the head. Twice 12 MEMORIAL in these later days, under other fine leadership, has he witnessed this same stirring pageant, but neither these nor others of their kind have dulled for him the thrill of that early memory. So well had the men of the 7th been instructed and trained for military duty under the leadership of Col. Lefferts that of the 1100 com- posing its roster 620 were quickly selected as officers and placed in. command of less-experienced troops, a service nobly repeated in the Spanish and World Wars. The history of the father was exempli- fied in that of the son, who, no less a captain of men, trained an army of leaders in the march of scientific progress. The inventive genius, the initiative, the abihty and the power to command which were so conspicuous in the son were clearly inherited. Dr. Lefferts 's preliminary education was received in the public schools of New York, and he was graduated from the College of the City of New York in 1867. He at once entered the College of Physicians and Surgeons, Columbia University, receiving the degree of M.D. in 1870. In 1869 he received the Honorary Degree of A.M. from Dickinson College, Carlisle, Pennsylvania, and in 1901 the Degree of M.S. from Columbia University. Upon gradu- ating in medicine he filled a short interneship in Bellevue Hospital, New York, passing from that to an eighteen months' service at St. Luke's Hospital. Following the fashion of the day, he then went to Europe, where he spent two years of well-directed, earnest work at the laryngological clinics of London, Paris and Vienna. His earnest- ness and ability soon recommended him to his instructors, who recognized in him a pupil sure to do them credit and were accord- ingly interested in him. This was particularly true in Vienna, where he attended the clinic of Professor von Schrotter, and later that of Professor Karl Stoerk, of the Imperial University. Upon the latter he made such a favorable impression that he was soon appointed Chief of Clinic, which highly creditable and advanta- geous position he held during the years 1871-73, until his departure from Vienna, being the first young American to have attained that coveted distinction. Upon completing his studies at Vienna he received from Prof. Stoerk a testimonial of which the follow- ing is a translation: GEORGE MOREWOOD LEFFERTS 13 The undersigned hereby certifies that Dr. G. M. LefFerts has frequented his Laryngoscopic Clinic since October, 1871, with such zeal and success and has shown during his time of study such skill that he gave him the position of his assistant when it became vacant. During his time of service Dr. Lefferts has repeatedly performed both operations for laryngeal polypi and other difficult intralaryngeal operations with such skill that the undersigned can certainly term him one of the best laryngoscopists. Dr. Lefferts has won this acknowl- edgement particularly from the fact that he represented me so effi- ciently in my courses on laryngeal diseases and laryngoscopy, that during my absence he conducted both the instruction of my students and the clinical treatment of the patients quite independently and to my extreme satisfaction up to the present time. The only thanks for his efficient services that I can possibly offer him is to acknowledge them in documentary form and to recommend him most warmly to every one on account of his great attainments in medical science. (Signed) Dr. Karl Stoerk, Professor of Laryngoscopy and LarjTigeal Diseases, Imperial University of Vienna, etc. Vienna, March 13, 1873. Both of his Viennese instructors regarded his subsequent success with genuine pride. They were his warm friends for life. The same was true of those in London and Paris. His student companions of those early days have always reverted with pleasure to the delightful impression everywhere made by him. In 1873 he returned to New York, where he at once entered upon the practice of his profession, specializing upon diseases of the upper air-passages, and finding quite enough in that depart- ment to fully occupy his time and satisfy his ambition. The same year he was appointed extramural teacher of laryn- gology at the College of Physicians and Surgeons, and in 1875 full instructor; later in the same year, clinical lecturer, and in 1876 Clinical Professor of Laryngology and Rhinology. This position hie held until 1904, a period of service of over thirty years. Upon his retirement he was made Professor Emeritus by the Trustees of Columbia University. Dr. Lefferts regarded his professorship as the highest honor and the greatest opportunity of his life. Notwithstanding his other 14 MEMORIAL professional interests and accomplishments, this one was always his chief interest and pride. To it he devoted his best energies, unsparing of time, labor or financial outlay. Year after year his lectures were revised with scrupulous care, new illustrative material of every possible sort added, and improved arrangements made for the securing and demonstration of the best clinical material. The faithfulness of his attendance is attested by the fact that he missed but one lecture appointment in a period of more than twenty years. The lectures were conducted with true military promptness and precision. Every detail was prepared and arranged in advance with the most minute care. No stage setting could have been more elaborately planned. Promptly upon the appointed hour and at the stroke of the bell, followed by his staff, he appeared before the class, faultlessly attired as for a court reception, his countenance radiating the earnestness and the enthusiasm which possessed his mind. He was the personification of the ideal instructor, impressing his audience with the thought that he held matters of great value and importance which he was earnestly anxious to share with them and which he strove with all his power to impart. As a lecturer he was clear, emphatic, persuasive, and, if some- times a little sententious, always so with the object of being impressive, never failing to hold the interest of his hearers and to send them away having understood and mastered what he intended them to know. His assistants were carefully selected. Each was trained to the performance of a special duty, which duty, at the proper time, was expected to be executed with the promptness and accuracy characteristic of the professor himself. For the illustration of the lecture everything was added in the way of object- teaching that his remarkable ingenuity could devise.^ Each particular topic was illustrated by a series of charts, splendid pictures in water-color, showing every type and phase of the subject at hand. These were of large size, made by a specially trained and skilful artist under Dr. Lefferts's direct personal obser- vation, from life and from models taken from the best authorities, the subject of each being clearly inscribed upon it. During the lecture the charts pertaining to the subject were displayed in full view of the class. To the collection of charts, which included ' See ■' Appendix," page 25. GEORGE MOREWOOD LEFFERTS 15 upwards of 500 specimens, there was added a full collection of papier-mache models of the larynx, illustrating the anatomy and the various phases of the pathology, together with numerous well- mounted pathological specimens. The special instruments and forms of apparatus pertaining to the subject were displayed and as far as necessary described. Of these, as with the charts, there was a comprehensive and lavish outfit, carefully selected, instructive, and collected regardless of expense. But this was not all. Dr. Lefferts was a remarkable draughts- man. His blackboard drawings, with colored chalk, were superior to any of his time except those of the late Professor John C. Dalton. Wherever desirable the larynx or pharynx of the patient to be demonstrated was illustrated on the board in the presence of the class, the process of the drawing going on with the description of the case. These so-called "lectures'^ were by no means what is under- stood as "didactic." The lecture itself, fine as it was, was but a necessary preliminary, explanatory of the principal feature of the exercise. This was the actual exhibition of patients. From the resources of himself and his many assistants, each of whom conducted large outside clinics, numerous cases illustrative of the subject in hand, suitable for exhibition and easy of demonstration, were sent to the College, the best selected, and these demonstrated personally by the Professor, a line of students being formed behind him in the amphitheater, each student in turn standing in a posi- tion close to the side of the demonstrator from which a clear view of the image in the mirror could be obtained. Time enough was allowed to enable each one to recognize the lesion shown, a general idea of which had already been given by the lecture and by the drawings, models and charts. At the beginning of the annual session a printed scheme of the lectures was handed to the members of the class. Upon a printed folder was given the number, date and title of each lecture, with a comprehensive synopsis of its contents. By this means the student was apprised of the nature and scope of the course and was enabled in advance to prepare himself for each lecture by such reading and clinical observation as time and opportunity allowed. Subse- quently the synopsis furnished an excellent basis for review and for the refreshment of the memory. In addition to this, pam- phlets were distributed in the course of the lectures, some of which 16 MEMORIAL explained the differential diagnosis between the principal laryn- geal diseases, while others gave full and explicit directions for their treatment. Supplementary to the regular lectures was a course of special instruction in the practical demonstration of the upper air-pas- sages. This was carried on under the guidance of the Chief of Clinic and a corps of specially trained assistants. The class was divided into groups of six, and six lessons were given to each group —three lessons a week for a fortnight, the time devoted to each lesson being one hour. A special room was equipped for the purpose of this instruction, in which stalls for each student were provided, and these were furnished with the illuminators, models of the human head and the other appurtenances necessary for the examination of patients.^ The course consisted of instruction in the use of the instruments necessary in demonstrating the upper air-passages, including pharyngoscopy, laryngoscopy, anterior and posterior rhinoscopy, and the examination of infants. Life-size dissected models of the human head were supplied. These were invariably used pre- liminary to exercises upon the living subject, for the purpose of instructing students in the technic of the management of the head-mirror and in the rules for the application of laryngoscopy, pharyngoscopy, and posterior rhinoscopy. This method— em- ployed by Tiirck and by the best of the other old masters— enables the student to first acquire the principles of the technic of the examination without his attention being disturbed by the discomforts of the living subject. The principles having been mastered, normal subjects were at once supplied, and, later, more extended courses were given in the examination and diagnosis of pathological conditions. Scrupulous care was taken to superintend the work of each individual student and to see that the rules taught were thoroughly explained, understood and mastered. At the close of the course of instruction the men were well grounded in the rudiments of the work and reasonably prepared for its further advancement. The admirable working of this system of practical instruction began to be impaired when the number of students in a group was increased to eight; when the number became twelve it was almost impracticable; and when, at last, the order went forth that the class 1 See "Appendix." GEORGE MOREWOOD LEFFERTS 17 should number twenty, the time for the method had gone by. Students who had profited by the course of lectures and practical instruction herein described graduated with a profound respect for laryngology and a clear knowledge of its principles. The system of instruction thus instituted, organized and con- ducted has been described in detail because never in the de- partment of laryngology had there been a similar course. Others had taught the specialty, some wonderfully well; but nowhere, either in this country or in Europe, had the undergraduate ever had the subject placed before him with such clearness, such comprehensiveness and such practical success. The department thus founded at the College of Physicians and Surgeons was the result of lavish expenditure and of patient, unremittingly labor covering the period of a generation, by a man peculiarly endowed. He left it a perfect thing, a splendid model for the whole system of clinical instruction in general, and as such alone it was most desirable that it should have been permanently preserved. In 1904, completing an active service of over thirty years. Dr. Lefferts resigned his professorship and was at once elected Emeritus Professor by the Trustees of Columbia University and at the following commencement was awarded the Honorary Degree of "Master of Science" (M.S.). The minute entered upon the archives of the institution reads as follows: The Faculty of the College desires to express its high appreciation of the distinguished services of Dr. George M. Lefferts, which through three decades he has rendered to the institution. The organization and maintenance of an important, practical, clinical department in the College — eagerly sought by the students of successive generations and a model of efficient administration — we recognize as a large achievement in the career of a practitioner. This long and faithful service and the generous gift to the College of a valuable collection of illustrative specimens and charts are held in high appreciation by his colleagues. This collection, by resolution of the Trustees of Columbia University, adopted November 2, 1903, is known as the "Lefferts Museum of Teaching Apparatus in Laryngology and Rhinology."^ Dr. Samuel W. Thurber, for many years Dr. Lefferts's associate, has prepared an elaborate "order-book" of the Lefferts lectures. 1 See " Appendix." 18 MEMORIAL This book is now deposited in the department of "Columbiana" in the Library of Columbia University. It presents in detail, drawn to scale, the precise position in the amphitheater of all the apparatus used in the illustration of each lecture, together with photographs showing the amphitheater so prepared and equipped. A full collection of these pictures is given in the appendix to this memorial. It is an interesting and instructive exhibition in itself and, incidentally, an example of the finished exactness character- istic of the man. When Dr. Lefferts returned to New York, in 1873, there was no society of laryngologists in any city in the world. In October of that year the New York Laryngological Society, now in successful existence for nearly half a century, was founded by Dr. Clinton Wagner. Dr. Lefferts was one of its charter members. This society, in 1885, became the Section in Laryngology of the New York Academy of Medicine. In 1878, Dr. Lefferts was one of the founders of the American Laryngological Association. His address delivered at the opening of the first meeting clearly and eloquently set forth his ideals of the aims and functions of such a society. It was he who originated the name of the Association, and, as its first secretary, was chiefly instrumental in its successful organization and in establishing for it those high ethical and scientific standards under which it has flourished preeminent for more than forty years. The development of his system of undergraduate instruction, and the part which he played as a pioneer in the establishing of not only the first, but by far the best, of the societies devoted to his specialty were by no means his only notable achievements. His career in the field of clinical medicine was conspicuous. Prompt, energetic, efficient, a specialist skilled in every depart- ment of his art, his personality combined with the interest which he invariably manifested towards his patients caused his private practice and his public clinics to grow rapidly in numbers and in fame. He was appointed laryngologist to the then popular Demilt Dispensary, in 1873, in company with Dr. Charles McBurney. This department soon gained a name for itself. Dr. Lefferts serving it for six years. It was at the Demilt Dispensary, in 1873, that Dr. Lefferts, with others, estabhshed a regularly organized system of instruction GEORGE MOREWOOD LEFFERTS 19 for graduates in medicine, nearly ten years before the founding of the New York PolycHnic and the New York Post-Graduate Schools. He was the leading member and largely the organizer of the throat department of the New York Eye and Ear Infirmary, receiving his appointment in 1874 and holding it until 1891. He was appointed consultant to the outdoor department of Bellevue Hospital in 1886, and was consulting surgeon to St. Luke's Hospital from 1877 until 1901. These appointments, together with his large clinic at the College of Physicians and Surgeons, were filled by him with the utmost zeal. The amount of material at his disposal for his own observation and for use in the course of his lectures from his own clinics and those of his numerous assistants was enormous. His extensive private and consultation practice embraced a clientele of the very first order of influence and import- ance. Always with the advance guard, Dr. LeflPerts distinguished himself in the literature of laryngology. His original theses, in a style well written, terse, and to the point, covered a variety of subjects and were valuable additions to the knowledge of the special topics with which he dealt. In the editorial department of laryngology he was again a leader. In 1880 there was no joiu-nal in this country which represented our special department of medicine. Dr. Lefterts, in association with Dr. Louis Elsberg, of New York, Dr. J. Solis-Cohen, of Phila- delphia, and Dr. Frederick Irving Knight, of Boston, founded a quarterly magazine which was named The Archives of Laryn- gology. This periodical furnished another exemplification of the controlling principle of Dr. Lefferts's life. What his ambition demanded and what he ever strove to attain was, the best. In company with his distinguished collaborators, The Archives of Laryngology was made by far the best journal of laryngology that had ever appeared, in beauty of form and excellence of material surpassing anything abroad. Ably and generously conducted by its patriotic editors, at the end of four useful years it was discontinued by reason of lack of support, a grievous loss to the scientific world. Dr. Lefferts was collaborator for the Archives de Laryngologie of Paris, and from 1884 to 1910 an active collaborator of the 20 MEMORIAL Internationales Centralblatt fur Laryngologie, Rhinologie, etc., of Berlin. He was associated with a number of other foreign periodi- cals. His name also appears as contributor to various systems of medicine and surgery. With that ever-dominant desire to disseminate knowledge, one of his most useful missions was accomplished through the medium of abstracts, that is, the placing before the medical public the best of the new thought and ideas of the leaders of the laryngological world. In the classic work of Sir Morell Mackenzie, published in 1880, there was given an invaluable bibliography, dating from the earliest times. In May, 1875, Dr. Lefferts, in the New York Medical Journal, initiated the publication of a series of laryngo- logical references accompanied by abstracts of such articles as were worth while. In this particular department there does not appear to have been any one by whom he was antedated. In 1880 the abstract department was transferred from the New York Medical Journal to The Archives of Laryngology. By the time the Archives went out of existence the Index Medicus, which had been instituted by Dr. John S. Billings, took over the bibliography, while the abstracts were continued in the Centralblatt. Thus, with the books of Sir Morell Mackenzie, the contribution of Elsberg,^ the current records of Lefferts, the Index Medicus and the continuation of Lefferts's work in the Centralblatt, the Laryngo- scoye and other periodicals, the bibliography of laryngology is remarkably complete to date. Here, again, Dr. Lefferts was the pioneer. As collaborator with him for many years in this work, the writer well knows the importance which he attached to it and the tireless energy with which he carried it out. Having thus sketched the life-work of Dr. Lefferts, let us now consider the personality of the man and the elements of character and of intellect which determined his success. Early in life he had suffered a condition of lameness never entirely recovered from, and necessarily, to one of his sensitive nature and active temperament, a serious affliction. The eldest of seven children, the favorite of an indulgent family circle, one less resolute and of weaker moral courage might easily have failed of great accomplishment. Refusing to yield to the allurements of a life of indolent self-gratification, the burden of his disabihty was borne by him with the calmness of a philosopher and the fortitude of a 1 Trans. Am. Lar. Assn. vol. i. 1878. "A Bibliography of American Laryngology." GEORGE MOREWOOD LEFFERTS 21 brave man. Far from bringing bitterness and discouragement, it but served to stimulate his ambition and to quicken the energy of his intellect, as proved by the ever-recurring testimony of his history; for, with every temptation to the contrary, neither excellent social position, ample means for gratifying his luxurious tastes, nor his well-developed capacity for the enjoyment of the higher pleasures of life could divert him from his chosen calling nor quench the enthusiasm with which he followed it. Of miusually attractive personality. Dr. Lefferts was possessed of a countenance strikingly alert, intelligent, and handsome— blonde, with features well-modeled and refined but nevertheless strong. The gentleness and cordiality of his impulses, the readi- ness of his sjTnpathy, the charm of his manner, were such as to induce enduring friendships. The recollection of his mirthful pleasantries and the inimitable radiance of the smile which ac- claimed them will long be treasured among the happy memories of his friends. Bright and genial in conversation, he was a wel- comed companion and a charming host. Inheriting elegant and refined tastes, he strove for perfection in all that he undertook, from faultlessness of attire and of the surroundings of his dail}' life to every detail of his work. One of the chiefest of his characteristics was the love of order. Every- thing connected with his affairs, whether professional, business, or social, was carried out with the utmost regard for system. Even the records of his routine work were models of thoroughness and elegance, set forth with consummate clearness and perfection of arrangement. AYith keen prevision, nothing was left to chance. His watchword was "preparedness." His whole life-work, was an eloquent exemplification of that idea. Of sterling integrity, he was in all things the soul of honor. Strong and positive by nature, his decisions were quickly made and as promptly executed. His handwriting was unique in its clearness and marked individuality. He was an excellent draughts- man both with crayon and pen, and with the latter often evinced a keen sense of humor. Having distinctly artistic tastes, his judgment of art in its various departments was excellent. Fond of travel, he spent many summers abroad, one in particular in Japan at a time when fine specimens of its antique art were still obtainable. It was then that he secured the superb collection of 22 MEMORIAL ancient Japanese armor which, deposited as his gift, is now one of the chief treasures of the Metropohtan Museum of Art. The dinners given by him annually to the members of his clinical staff at the old Delmonico's, now things of the past, were to us one of the important events of the year. He was a good horseman and greatly enjoyed that form of exercise. During the season there were few days which did not find him in the saddle either upon the bridle-paths of the park or in the ring of the riding club. That he succeeded brilliantly in the work of his profession was due to no mere chance of fortune or of meretricious favor. The grace and talent that were his by fine inheritance he fully recog- nized, and, recognizing, used and cultivated with untiring industry and zeal, devoting them with unwavering fixedness of purpose to the special object of his life. This, his profession, he mastered in all its details and by every possible means. Clinical experience, wide reading, study, writing, teaching, travel, intimate association with the most distinguished authorities at home and abroad : these were the weapons with which he steadily fought his way to pre- eminence. Excellent as a writer, of remarkable initiative as an organizer, great as a practitioner, he himself would have wished us to believe, as in fact we do, that his highest usefulness was attained in the teaching of his beloved art. Indeed, the keynote of his philosophy was expressed in his chosen motto: "Docendo discimus"— by teaching we learn. A gentleman by birth and breeding, his character, temperament and ability were such that in any department of effort he would have been a leader, a highly efficient man of affairs. If he could have left to the world but one legacy, the example of the lifelong courage, industry and enthusiasm with which, by all the varied means we have enumerated he strove to relieve the sufferings of humanity, would be to us a priceless example, a rich inheritance. Dr. Lefferts was married June 11, 1891, to Miss Annie Cuyler Van Vechten, of Albany, New York, the daughter of Abraham Van Vechten, Esq., an eminent lawyer of that place. Miss Van Vechten had attained distinction in the social life of her home and in Washington, where, during the presidency of Mr. Cleveland, she was a frequent guest of his sister, ]\Iiss Rose Elizabeth Cleveland, at the White House, and a brilliant addi- tion to its chosen circle. Following her marriage, Mrs. Lefferts 's GEORGE MOREWOOD LEFFERTS 23 residence in New York City included a period of nineteen years. At the end of this time Dr. LeflFerts's health began to show signs of impairment. For thirty-seven years, as student and practitioner, he had pursued continuously an arduous professional career. Never physically robust, and recognizing that the limits of his endurance seemed to have been reached, he wisely acquiesced, and withdrawing from all medical interests removed to his country seat at Katonah, in the Bedford Hills, New York. There, with Mrs. Lefferts, amid surroundings which he loved, he rested for ten peaceful years, cheered and sustained until the end by the companionship which had been the crowning happiness of his life. Long a sufferer from cardiac angina, he died at his home September 21, 1920. Dr. Lefferts was Fellow of the Academy of Medicine, New York; past-President (1876), New York Laryngological Society; past- President (1882), of the American Lar^^ngological Association; past-President (1891), of the Alumni Association of the College of Physicians and Surgeons; Honorary Fellow of the Laryngological Societies of London, of Vienna and of Berlin; and a member also of the Siu-gical Society of New York, American Medical Association, New York State and County Medical Societies, and the University and Riding Clubs of New York. APPENDIX A COLLECTION OF HALFTONE ILLUSTRATIONS REPRESENTING THE TEACHING EQUIPMENT OF THE LEFFERTS CLINIC OF THE COLLEGE OF PHYSICIANS AND SURGEONS NEW YORK U) D H < a: < a. CL < z >- E O u < J LU h- z U. X cc 2 Q D z U < U) D >- 2 o U) _i i- li. z >- UJ q: _l < _i u I z h "■ u. z h u u Ul JUKjIKll ^fLm-r^^-jgg [ I |Mf8(-J>^l:-;?^:i < u . tt 1- ^§ 111 q: 01 UJ I i5 Ul < a: X z >■ < X a. Q z < X z > a: < _i UJ I H U. O CD G) CD li. Ll < H 0) UJ I H 05 W 1- t^ z g 51 (f) . — ui en . (J) Z X < X d z =: Q > X X 1 COLUMBIA UNIVERSITY LIBRARIES This book is due on "the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the library rules or by special arrangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE . 1 1 C28(2B1)tOOM ,YL\MOUNT .APHLET BINDER Manufactured by : GAYl.ORD BROS. Inc. Svrccuse, N.Y. Stockton. Calif. R154 .L52 Dela'van GQO rge j^r ewopa T.efferts D37 cop. I C. U. bUMyi^i^'-