American Medical Biographies/Green, Horace

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Green, Horace (1802–1866)

One of the interesting episodes connected with the history of American medicine is associated with the name of Horace Green who, in 1840, announced that he was able to pass a sponge-tipped probang into the larynx and thus apply medication directly to the laryngeal mucosa, and even to that of the trachea. The stormy discussion occasioned by this simple statement extended over a period of nineteen years and spread beyond this country to England and France.

Horace Green was born in Chittenden, Vermont, December 24, 1802, and died at his home at Sing Sing, now Ossining, New York, November 29, 1866, in the sixty-fourth year of his age. His father was one of four brothers, sons of a Massachusetts physician, who served in the Revolutionary War. Two of them fell with Warren at the battle of Bunker Hill; the third fell in the battle at Monmouth; the fourth fought through nearly the whole of the long struggle and raised four sons, the youngest of whom is the subject of this sketch.

Horace Green studied medicine with his brother, Dr. Joel Green, of Rutland, Vermont, and graduated at Middlebury, Vermont, in 1824, from the institution known later as the Castleton Medical College. The succeeding five years he spent in partnership with his brother, and in the fall of 1830 went to Philadelphia where he attended lectures at the medical department of the University of Pennsylvania. In the spring of 1831 he returned to Rutland where he continued in practice until 1835 when he removed to New York City.

In 1838 he spent some months in Europe, and on his return, late in the year, began at once his investigations into the pathology and treatment of diseases of the throat.

From 1840 to 1843 he was connected with Castleton Medical College as professor of medicine and as president of the institution. In 1850 he helped to found the New York Medical College. Here he occupied the chair of theory and practice of medicine and was elected president of the faculty and also of the board of trustees. In 1860 he retired from active service and was made emeritus professor. In 1854 he and his colleagues founded the American Medical Monthly. Dr. Green was A. M. (honorary) from Union College; LL. D. from the University of Vermont; a member of Phi Beta Kappa and the Society of the Cincinnati.

In the Boston Medical and Surgical Journal, 1850, vol. xlii, a good pen picture is given of Dr. Green. He is described "as tall and rather spare; very black hair, now a little grey; a sharp black eye, rather a brunette; and gentle and kind in his address. His manners are quiet and dignified, those of a gentleman accustomed to good society. They say a poet must be born. Cato (nom de plume of the author) opines that this is equally true of a gentleman; and he further thinks that nothing so deforms a man, especially a medical man, as rough or clownish manners. If any man should be gentle, in the highest sense of the word, it is he who ministers to our diseased bodies and minds." The account closes "long may he live to enjoy the honors and emoluments of the profession which he has well and truly labored in."

In the obituary notice of Dr. Green published in the New York Medical Journal, 1866, iv, it is stated: "Few men in the profession of medicine in this country have attracted so much attention to their professional career as did Dr. Green. Announcing, in his earlier writings, a plan of treatment for diseases of the air passages which was at once regarded as 'bold and novel,' it met, naturally, much skepticism and opposition. This induced investigation into the subject in dispute. An impetus was given to the study of laryngeal diseases, and, as a result, the means of their diagnosis and treatment have been immeasurably increased. Dr. Green lived to see the views he promulgated thoroughly proved by the aid modern science has placed in our hands."

Horace Green published his "Treatise on Diseases of the Air Passages" in 1846. In the introduction to this work he says: "More than six years ago, namely, in 1840, I brought before the New York Medical and Surgical Society, . . . the subject of the treatment of diseases of the larynx, by direct application of therapeutical agents to the lining membrane of that cavity. . . . Such, however, was the degree of skepticism on this subject, manifested, at the time, by a large proportion of the members, that for many years I have refrained from bringing the matter again before the society."

Green laid a great deal of stress on the proper education of the larynx in order that the probang could be properly, and with as little difficulty as possible, introduced into it. Disregard of this point caused numerous failures by the committee who investigated his method of treatment. The larynx should not be entered at the first sitting, but the solution shall be applied about the epiglottis and pharyngeal region on several successive days before this is attempted (this was before the days of cocaine).

The directions for passing the probang are explicit. "The instrument being prepared, and the patient's mouth open wide, and his tongue depressed; the sponge is dipped into the solution to be applied, and being carried over the top of the epiglottis, and on the laryngeal face of this cartilage, is suddenly pressed downwards and forwards, through the aperture of the glottis, into the laryngeal cavity" (the laryngoscope had not as yet come into use).

The year following the publication of Dr. Green's work on "Diseases of the Air Passages" there appeared in the Boston Medical and Surgical Journal a most bitter and, as later events showed, unwarranted attack on Dr. Green and his book. The book is designated as "a misnomer, for nothing whatever either novel, important or useful, is even suggested in relation to 'bronchitis.' The whole ten chapters are made up of a dissertation upon follicular disease." The reader "will expect to find the proofs that the novel feat of passing an armed probang, through the larynx, into the trachea down to the bifurcation, has been performed, thus curing bronchitis by the topical application of his curative means to the inflamed membrane. It is this monstrous assumption which was scouted by the profession, as 'ludicrously absurd, and physically impossible.'"

The author of the article in question states that in all probability the armed probang entered the oesophagus and on its withdrawal some of the contents of the sponge "has descended into the laryngeal cavity." The article goes on to say "he has the name of having accomplished, what the profession declared to be impossible, by swabbing out the larynx, trachea and bronchi themselves."

But the author brings a still more serious charge against Dr. Green—plagiarism. Trousseau and Belloc published in Paris, in 1837, a work entitled "Traité pratique de la phthisie laryngée." This was translated into English and published in Philadelphia in 1839; this is the work that Green is charged with plagiarizing. Green had affirmed that he had been using his method of treatment for two years before he heard of Trousseau and Belloc; but the author scorns his statement saying that as Green was in London in 1838, it was impossible for him not to have heard of Trousseau and Belloc.

An extended review of Green's book appeared in the New York Journal of Medicine, 1847, viii, in which Green is highly complimented for the work he has accomplished and the advance he has made in the treatment of laryngeal affections, but the reviewer fails to distinguish between the expression of medication from a sponge-tipped probang and the passage of a sponge-tipped probang into the larynx thus applying the medication directly to the mucosa.

In 1851 Green returned from a second visit to Europe and we now find that the discussion of his method of treatment had extended to the other side of the Atlantic, for Erichsen, in his "Science and Art of Surgery," London, 1853, declares that "Not only does physiology and ordinary experience tend to disprove the possibility of such a procedure, but repeated experiments, both on the living and on dead subjects, have led me to the conclusion that it is utterly impossible to pass a whalebone, whether curved or straight, armed with a sponge, beyond, or even between, the true vocal chords."

It was Marshall Hall who suggested to Green the use of a tube and the passage out of it of the expired air as a proof of tracheal catheterization. Green accordingly procured a number of Hutchings' flexible tubes and attaching a sponge, the size of that used by him in ordinary practice, to the extremity of one which was 13 inches long be introduced it into the trachea of a patient.

"On withdrawing the wire the patient was directed to blow and breathe through the tube. This he did for several moments filling and emptying the chest of air repeatedly. A lighted lamp was then brought, and this was extinguished promptly, several times, by blowing through the tube." In still another test a bladder was tied to the free end of the tube and it was inflated and collapsed a dozen times. These and numerous other experiments are described by Green in his paper read December 6, 1854, before the New York Academy of Medicine, to prove that he was able to enter the larynx for the direct application of medication.

A committee appointed to consider Dr. Green's claims came to no definite conclusion, and the Academy of Medicine failed to take a vote on the report of the committee.

This seems to have ended, for the time being, the active campaign against Horace Green. It had been a bitter contest and one difficult to understand; in its course he had been compelled to resign from one of the medical societies of New York and just escaped expulsion from the Academy of Medicine (Wright). Green laid himself open to criticism by his faulty pathology; and yet, except in the origin of pulmonary phthisis from follicular pharyngitis, Morell Mackenzie supported him. In spite of the opposition and jealousy of many of the physicians in New York, Green built up a very lucrative practice, and, confining his work to laryngeal affections, became the first specialist in this country to devote himself to diseases of the throat.

1839. Trousseau and Belloc: A practical treatise on laryngeal phthisis, chronic laryngitis, and diseases of the voice. Philadelphia.
1846. Green, Horace: A treatise on diseases of the air passages. New York.
1847. Boston Medical and Surgical Journal, vol. XXXV.
1847. New York Journal of Medicine, vol. viii.
1848. Green, Horace: Observations on the pathology of croup: with remarks on its treatment by topical medications. New York.
1850. Boston Medical and Surgical Journal, vol. xlii.
1853. Erichsen, John: The Science and Art of Surgery. London.
1854. Green, Horace: On the employment of injections into the bronchial tubes, and into tubercular cavities of the lungs. American Medical Monthly, vol. iii.
1855. Reports of the special committee to which the paper of Dr. Horace Green, on "Injections into the bronchial tubes, and into tubercular cavities of the lungs," was referred. Majority and minority report. Transactions of the New York Academy of Medicine, vol. i.
1855. Discussion on the reports of the committee of the New York Academy of Medicine, to whom was referred the paper of Dr. Horace Green "On the employment of injections into the bronchial tubes and tubercular cavities of the lungs." American Medical Monthly, vol. iii.
1867. Remarks and resolutions on the death of Horace Green. Bulletin of the New York Academy of Medicine, vol. iii.
1914. Wright, Jonathan: A history of laryngology and rhinology. Philadelphia.
1919. Miller, W. S. Horace Green and his probang. Johns Hopkins Hosp. Bull., vol. xxx.