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 Medi-
