IX. The Ear, Nose, Mouth, and Throat

Roberts CS.

Publication Details

Horace Green of Vermont

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The first American physician to specialize in diseases of the throat was Horace Green, whose classic book, A Treatise on Diseases of the Air Passages, was published in 1846. Born in 1802 in Chittenden, Vermont, Green was the son of a Revolutionary War veteran whose three brothers died in that war. Green graduated from Castleton Medical College in Vermont in 1824 and undertook an apprenticeship with his brother in Rutland, Vermont, for 6 years. In 1830 he attended two courses of medical lectures at the University of Pennsylvania and then returned to general practice in Vermont.

In 1838, at age 36, Green went to Europe for 5 months to attend lectures and clinics. In London he engaged in a conversation with James Johnson, editor of the British and Foreign Medical Review, who inspired Green by remarking that all modes of treating laryngeal disease would fail until proper agents could be applied directly to the membranous lining of the larynx. On his return in 1838 to the United States, Green took residence in New York City and began 18 exciting years in laryngology, publishing his treatise in 1846 at age 43. He was professor in Castleton Medical College from 1840 to 1843 and professor in New York Medical College from 1850, until his resignation in 1860 at age 59. He was the author of three books and numerous articles and helped found the American Medical Monthly in 1854.

Green was the first physician to apply topical medication to the larynx using a probang, and his claim in 1846 caused an international controversy. His method was to soak silver nitrate in a sponge attached to the tip of a 10-inch, curved whale bone, and apply the sponge directly to the larynx. Because so few physicians believed that the larynx could tolerate the presence of a foreign body, Green was accused of fraud. He suffered disrepute for a decade until he demonstrated his technique on patients in 1855 before a committee appointed by the New York Academy of Medicine. In a private autobiography, he described the circumstances:

After my return from my second trip to Europe in 1851, I entered with more spirit than ever into the practice of my "specialty," the employment of local treatment of the air passages. My practice had greatly increased. My patients came from all parts of the world, but with this came also an increase of opposition from my professional brethren. Those who were unfortunate in business or from some other cause were envious of my success. They evinced a very unkind spirit and denied the possibility of my doing what I was doing in my office every day. But I would not quarrel with them, trusting that the truth would ultimately be known, and my word vindicated. For several, years now I have heard nothing of this opposition. (Green, 1865)

The following passage from letters by a patient, Julia Robertson Pierpont, who underwent a throat operation, vividly describes the appearance, manner, and practice of Green at his home in Vermont in 1850:

Everything was done to make me comfortable and at home. The house is very large and furnished elegantly—costly paintings and statuary are scattered over the building. It is lighted by gas, and the Croton water, hot and cold, is carried all over it. There are speaking trumpets in the walls, in fact everything elegance or comfort could suggest. Dr. keeps his carriage and I don"t know how many servants. We dine by candle light and have lunch at one o'clock. The dinner is a very ceremonious affair, and I get almost tired out before it is over. But I learn a great deal at the table, for the conversation is quite refined and intellectual. Dr. Green is about forty, young looking, handsome, polite, but sometimes absent minded, has traveled in Europe and likes style but not dashing. Dr. Jenkins is Dr. G's junior partner is talented, amiable, kind, polite, witty, and a great talker, but always talks to the point.

Last not least I will tell you about my throat—Dr. Green sent for me to go to the office a few days after I came and looked at my throat. "Bad enough," was his exclamation. "There is a deep ulceration out of sight, your physicians have not discovered it." Said he, "What would you say Miss R. if I should be obliged to cut away some of that bad flesh that is in your way there?" I replied, "Whatever you think best to do I will endeavor to submit to patiently"—"Well then the sooner it is over the better, do you not say so?" I answered, "Yes by all means"—I seated myself and while he prepared his instruments, he said it would soon be over and spoke low and sweetly to me, but he was mistaken in his lady, I needed no coaxing and had determined before hand to make no fuss, if it killed me—so I smiled and said nothing. Dr. Jenkins came behind me, I afterward learned, to hold my hand, but that was unnecessary and he did not touch it. I sat perfectly still, and the Dr. cut off my left tonsil. The blood streamed from my mouth for about half an hour, and then I sat down and had the right one cut off,—after it stopped a little, a sponge application of nitrate of silver was applied and almost strangled me. The bleeding began again and continued until two o'clock—and for a few days I suffered a great deal of pain, but I had kind nursing and "French fixins" to get well on. (Pierpont, 1850)

A laryngoscope was first used by Garcia in Europe in 1855, but Green was largely responsible for advancing its use in the United States. In 1858 he obtained one from Vienna through a New York surgeon, and in the company of his partner, John H. Douglas, later physician to U. S. Grant, Green began to use the instrument in his practice. After his retirement in 1860, Green was deeply affected by the Civil War, for "it was a great trial to him to be unable to do as his forefathers had done—bear arms in his country's defense; and he had no sons old enough to send to the war" (Francis, 1867). A year after that war ended, he died of tuberculosis at age 66.

References

  1. Francis SW. Horace Green, M.D., L.L.D. , etc. Med Surg Reporter 1867;16:64–66.
  2. Green H. Autobiography. MSS, New York Academy of Medicine, New York, 1865.
  3. Pierpont JR. Letters. MSS, New York Academy of Medicine, New York, 1850.
  4. Synder C. The investigation of Horace Green. Laryngoscope. 1975;85:2012–22. [PubMed: 1105039]