[Extract from the New York Medical and Surgical Reporter, under the 
Editorial care of William R. Wagstaff, M. D. j 
DR. GREEN’S TREATISE ON THE AIR PASSAGES. 
A Treatise on Diseases of the Air Passages: comprising an 
' Inquiry Tnto the History, Causes, and Treatment of those Af- 
fections of the Throat, called Bronchitis, Chronic Laryngitis, 
Clergyman's Sore-throat, etc., etc., by Horace Green, M. D., 
formerly President and Professor of the Theory and Practice of 
Medicine in the Castle ton Medical College; Vice President of 
the New York Medical and Surgical Society, and Honorary 
Member of the Philadelphia Medical Society, etc., etc. New 
York and London: Wiley & Putnam, 161 Broadway. 1846. 
This work, which possesses the merit of having directed the 
attention of the medical practitioner to the true principles and 
treatment of those follicular diseases of the throat and larynx 
which have been for a long time very prevalent, and the manage- 
ment of which had been previously, and very generally, unsuc- 
cessful, has been received by the public press with an enthusiasm 
of eulogium almost unexampled, but has not escaped a most viru- 
lent and ungenerous system of assault from a certain portion of 
the profession. 
The eulogistic contributions to the daily press, referred to, have 
been principally from the pens of distinguished literary men, who 
have been restored to health by the skill of the author. Their 
gratitude is. very natural. One of them had been for five years 
under eminent physicians, suffering many plans of treatment; se- 
vere and protracted vomitings; the use of mercury; local bleed- 
ing ; blisters ; eruptions, produced by applications of tartar emetic 
and croton oil to the skin, &c., &c., without benefit. That they 
should be very deeply gratified with the rapid and permanent re- 
lief derived from a judicious use of local applications to the dis- 
eased parts, and that they should express their gratitude warmly, 
are not occurrences which, justly considered, ought to reflect on 
them or the fortunate subject of their commendation, any sort of 
disgrace. 
One of the newspaper panegyrists of our author is a gentleman 
of deservedly high character and standing, both in medicine and 
general science, and it has so happened that, although a stran- 
ger to the author, he has given the greatest offence of all, to some 
of the irritabile genus, of which he is himself a member. The 
comparison to Jenner is a sin absolutely unpardonable, in the 
opinion of some of his judges, while his regarding Dr. Green’s 
treatment a “ discovery,” is gall in their mouths. 
Now, however just or unjust these commendations of Dr. Green’s 
book may be, one thing is sure, that there are certain men in the 
profession of medicine in the city of New are thrown 2 
Dr. Green's Treatise 
into severe paroxysms of displeasure at any one being praised be- 
side themselves ! And the experience of our author will serve to 
establish the truth of the wise man’s proverb, “ I le that blesseth 
his friend with a loud voice, rising early in the morning, it shall 
be counted a curse unto him.” 
That it would be a great violation of medical decorum for Dr. 
Green to have connived at, or promoted the notices referred to, 
cannot be denied ; but it would, on the other hand, be monstrous 
injustice to charge a gentleman of known delicacy and propriety 
of manners, on no evidence too, with so disgusting a course of 
conduct. 
The names of the popular writers, wherever- they are known, 
present a sufficient and perfect defence against suspicions so con- 
temptible, and charges so unfounded. We have reason sufficient 
to assert, that these productions were all of them spontaneous, and 
appeared as much to his surprise as to that of any one else. They 
were also regarded by him very much in the same light as they 
were viewed by other medical men, not blinded by prejudice or 
party. 
So much we have thought right in defence of our author from 
the suspicion of having connived at, or been cognizant of, those pro 
ductions. 
Let us proceed to examine the work itself. And first, we will 
remind the professional reader, that what is now, through the la- 
bors and investigations of our fellow-citizen alone, a well estab- 
lished fact, was not only unknown previous to his researches, 
but that there existed on the professional mind a perfect incubus of 
prejudice and error in respect to it. The point alluded to is, that 
it was not previously believed that medicinal applications could 
be made at all to the interior of the larynx. 
M. M. Trousseau and Belloc had claimed the honor of having 
made the first attempt to cauterize the larynx ; but they make no 
claim to having introduced their application with a sponge into the 
interior cavity of that organ, and Dr. Green awards them, in their 
own words, all the credit of their claim. He has made no attempt 
whatever to rob them of their proper merit. He expressly says, 
that these gentlemen were “ the first to prescribe and employ topi- 
cal medications in chronic diseases of the larynx.” Yet Dr. Green 
is the first man who ever boldly inserted into the larynx a sponge 
wet with a solution of lunar caustic. These are their expressions, 
“ When we wish to cauterize the pharynx, the base of the tongue, 
and the top of the larynx,” &c. “ When we wish to operate upon 
the upper part of the larynx and the epiglottis,” &c. So that 
the work of these writers does not convey the idea to a careful 
reader that they ever adopted the efficient manner of treating 
the diseases of the larynx, which has been iso successfully prac- 
tised in this city, much less that they ever attempted to give On tlic Air Passages. 
3 
the treatment which they did practice, any considerable promi 
nence. 
It is universally known to the public as well as to the profession, 
that gentlemen who are now earnestly endeavoring to establish 
the impression that the cauterization of the interior of the larynx 
as practised and inculcated by Dr. Green, is but the revival “ of an 
almost forgotten * * and very valuable mode of treatment,” (p. 156 
of the Annalist,) are the very men who, up to the time of the publi- 
cation of the book, have constantly and pertinaciously denied that 
any application of caustic or other medication whatever, could by 
any possibility, be made to the larynx at all. They scouted the idea. 
Said one, “ Have I been a teacher of anatomy for twenty years, 
and do not know where the larynx is ?” Said another, “ The in- 
troduction of a foreign body into the cavity beneath the epiglottis 
is physiologically and anatomically impossible.” Said another, 
“ The sensation produced by a drop which passes the wrong way 
is sufficient proof of the falsehood of asserting, that a solution of 
nitrate of silver can be applied by a sponge below the epiglottis.” 
Another asserted, that “ one drop of it, introduced into the larynx, 
would of course produce instant death.” Not one of the men who 
are now determined to establish by clamor, that the claim made 
by Dr. Green to a particular mode of applying the caustic, at once 
safe and certain, in the hands of a well informed operator, is not 
a discovery, but a revival of an old and neglected practice, that 
has not irretrievably committed himself to the former position, viz: 
That it never was done at all—that it was contrary to anatomy— 
contrary to the knowledge and experience which we already pos- 
sessed of the functions of the organ—in short, that it was a false 
and empirical pretension. 
Under these circumstances, it is not astonishing that they do not 
like to be very open in their mode of assailing the originality of 
the author. They employ an agent to transact business in which 
they are not ambitious of being very conspicuous. In vain he re- 
tracts under his own signature, “ Medicus,” on the 29th of Decem- 
ber, the charge of plagiarism which he preferred on the 16th. The 
parties employing him have gained their object. It is sufficient for 
their purpose. They will know nothing of the retraction of the 
second piece, but they will not fail to repeat the detraction of the 
first. 
Our author, however, may ask no favors of them. They are 
generally men of leisure. He has the sanction, the respect, and 
the support of their superiors. The majority of the profession, 
so far as they have examined the facts, generously give him their 
approbation and support. The Annalist and his semi-Reverend 
coadjutor are no fair representatives of the medical mind of this 
great metropolis. The best men of tUft our 
author. Dr. Greens Treatise 
4 
It is by the express liberty of the distinguished president of the 
Medical University of this city, that we record his conviction, pub- 
licly declared before his class, of the originality, the excellence 
and efficiency of the treatment for the cases in which it is recom- 
mended. Dr. Mott regards it as the only successful mode of man- 
aging those cases. 
But hear what the editor of the Annalist says. Restrained by 
a salutary caution from letting out his whole heart, he betrays 
great anxiety to put a “ mark ” on our author, by which restoration 
is forbidden. “ The man that is once marked, is marked forever, 
and years of unobtrusive usefulness and immaculate bearing can 
never restore its original purity, or compensate for its loss.” “ Its 
loss !”—what that means passes our comprehension ! How would 
the editor enjoy the application of such implacable severity to him- 
self? Is he immaculate ? And should he be permitted with im- 
punity, despotically to “ mark ” for eternal infamy, any one whom 
he dislikes or disapproves ? Shall he be permitted to stain the re- 
putation of another whose life has been pure 7 And certainly a 
little more scholarship of expression would do him no barm as a 
learned editor; nor would a little more modesty injure him as a 
man—himself not immaculate. 
Reader, the man who thus endeavors to “ mark ” one whom he 
cannot avoid praising, would “ mark ” you, if you should ever be 
so unfortunate as to do a very good thing. 
He admits too much after this attempt to stab his author; as 
the lawyers say, he admits himself out of court. “ The work is 
able and creditable to its author, who deserves much praise for his 
long and faithful devotion to what may be justly called his ‘ spe- 
ciality,’ and will probably be instrumental in rendering known and 
useful a very valuable means of cure or relief in a class of dis- 
eases, many of which could not probably be cured in any other 
way.”—Annalist. 
Now this is great praise, and a degree of praise entirely incon- 
sistent with the censure the learned editor metes out. And farther 
on, the reader will find the extraordinary information, li We have 
not seen the work.” Yet the author sent the work to this editor 
but he never sent it to any secular or religious editor. 
We, therefore, take leaye to say, that profligacy could hardly be 
carried farther than this ; and whether for praise or blame, it is 
certainly manifest that the Annalist is not able to put a “ mark ” 
on the author of the work on diseases of the air passages. We 
trust we have then established the fact, that the knowledge of the 
possibility of making applications to the larynx down to the 
chordre vocales is a new acquisition, and we think we shall be 
able to prove that this credit is justly due our excellent fellow- 
citizen who has so ably established his claims to public gratitude 
that even his enemies cannot avoid bestowing upon him their praise. On the Air Passages. 
5 
It so happened that in pursuing the same inquiries, the two 
gentlemen in Paris, already referred to, MM. Trousseau and Bel- 
loc, ascertained through their friends that they both had fallen on 
the same expedients. Instead of assailing each other as pla- 
giarists, they resorted to the more manly method of uniting their 
labors, and thus produced a work of great merit, which received 
the honor of a prize from a learned society of Paris. 
The profession of that great metropolis reward their members 
in a manner at once honorable to themselves, and encouraging to 
genius and enterprize! 
Now if these two gentlemen in Paris happened simultaneously 
to apply themselves to the investigation of the possibility of mak- 
ing local applications “ to the top of the larynx,” is it at all wonderful 
that about the same time Dr. Green, in New York, without any 
knowledge of their researches, should have attained another and 
much more valuable result in the discovery of the practicability 
of making applications to the interior of the larynx ? Not to its 
•“ top,” but to its very bottom, down to the chordae vocales ? 
The quotation from the able work of MM. Trousseau and Bel- 
loc, on which the objectors to the originality of Dr. Green rely 
to establish the identity of his practice with theirs, when carefully 
examined, furnishes conclusive evidence of his entire originality. 
These French authors had no idea whatever of his treatment. 
They used a similar instrument, viz., a soft sponge securely at- 
tached to a bent whalebone. But here there was no originality 
in either of them. The recourse to such an instrument was ob- 
vious and natural. But it will be found that their solutions were 
of very different strengths. The French authorities used two or 
three drachms to the ounce, Dr. Green generally employs two 
scruples; that is a solution of about one-third the strength of 
theirs. Their mode of application, too, is different, from his. 
These are their own words :—“ When the isthmus of the gullet 
is passed, there occurs an effort of deglutition, which elevates the 
larynx, and we seize the opportunity to draw forward the sponge, 
which had been at the entrance of the oesophagus. By this 
manoeuvre we get at the glottis, and then it is easy to express the 
solution into the larynx ; the cough which now occurs favors the 
introduction ot the caustic. The operation often excites vomit- 
ing.” 
This is the “ manoeuvre ” of Trousseau and Belloc, and is not 
by any means the practice of Dr. Green (see page 200 of Green’s 
work.) “ The sponge being carried over the top''of the epiglottis, 
and on the laryngeal face of this cartilage is suddenly pressed 
downward and forwards * * * * into the laryngeal cavity.” 
Need we appeal to the authority of Magendie or Richerand to 
.establish the point, that at the moment of deglutition, when the 
larynx rises, the epiglottis falls back and covers its aperture? 6 
Dr. Green's Treatises 
This must be conceded, or the objector must adopt the anatomi- 
cal notions of Dr. Green’s antagonists, that the epiglottis opens in 
front like a clam shell, or those of a certain physiologist under the 
immediate patronage of Dr. Green’s opponents, viz : That at the 
instant of deglutition the epiglottis does not fall on the glottis, hut 
on the contrary, stands up stiffer than ever, and blocks up the 
posterior nares and the back of the mouth. This philosopher 
does not deign to explain how the food enters the oesophagus at 
all from the mouth, being thus absolutely blocked up by the said 
epiglottis. 
Well, then, if during deglutition the epiglottis falls on the glottis, 
and at this moment the operator “ seizes the opportunity to draw 
forward the sponge,” he must draw it over the epiglottis, as it is 
applied to the aperture of the larynx. He must apply it to the 
lingual, and not the laryngeal side of the epiglottis. The sponge 
cannot enter then the cavity of the larynx ; and it is expressly 
called by the writers themselves “cauterizing the top of the larynx.” 
They also state tha they depend on the cough which then 
takes place to “favor” the introduction of the solution. But 
coughing is a forcible expulsion of air from the trachea and 
larynx. The only way in which it can be supposed to favor this 
introduction, is by the glottis opening during that action, and this 
would be the case, only that ‘simultaneously there is a vigorous 
emission of air, the tendency of which is to exclude it. On this 
point, the French gentlemen are by no means perspicuous. 
Their operation, or “ manoeuvre,” “ often excites vomiting,” Dr. 
Green’s does not. It is very natural that theirs should have this 
effect, for they insert the sponge into the “ gullet,” and thus do 
not claim to put it in the larynx. Thus we see that theirs is an 
entirely different “ manoeuvre,” performed when the patient swal- 
lows, or at the moment of deglutition, and from the back part 
forwards, being placed first in the isthmus faucium, or beginning 
of the gullet, and drawn forward when the larynx is closed and 
covered by the epiglottis lying exactly upon it, which is always 
necessarily the case at the moment of swallowing. 
But Dr. Green’s operation is performed when the patient is not 
swallowing, when the epiglottis is erect, and is effected by drop- 
ping the sponge just behind the epiglottis directly down into the 
cavity of the larynx. 
This simple analysis of the two methods displays their real 
character and establishes the originality of the plan adopted by 
Dr. Green. It reflects no small honor on the profession and cha- 
racter of the American physician, and discloses a means of relief 
and cure where very often death would otherwise be certain. 
A great effort has been made to show by dates that Dr. Green 
must have read the book of the French authors, some two or three 
years before it fell into his hands. On the Air Passages. 
7 
The facts are simply these. The translation of this work by Dr. 
Warder, was first published by Carey & Hart, in a volume by it- 
self, in 1841. It appears, however, that Dunglinson’s library con- 
tained it in 1839. But it had at that time attracted no attention, 
and to this day the work never would have been read if Dr. Green’s 
had not called attention to it. Any effort to fasten odium on our 
author in this way is too pitiable for contempt, and whether it is 
made by impudent and direct charges, or by cowardly and base 
insinuations, the man who descends to such meanness should be 
“ marked ” indelibly as a slanderer, and shunned by all respectable 
persons. 
Something is said of Dr. Johnson’s not noticing the French work 
in the conversation alluded to in the book of Dr. Green. But this 
only shows that Dr. Johnson’s suggestion of cauterizing the lar- 
ynx, was not that entertained and practised by these gentlemen. 
If any capital can be made out of that conversation, it seems all 
to be on the side of our author. If Dr. Johnson knew anything 
about the book, he must have regarded the application which they 
recommend as very superficial, or he would have referred to it. If 
he knew nothing of it, it shows still that the work had attracted 
no attention in London, as it certainly did not here. The opposers 
of Dr. Green can enjoy either position they prefer. 
In conclusion, Dr. Green has discovered that the mucous 
membrane of the interior of the larynx is excessively unirritable 
when compared with the former general opinion on that subject. 
He has discovered a mode of saving lives otherwise sure to be 
lost, and he has written a good book, which will do him honor, 
and benefit mankind when death has rendered him insensible of 
the praises or censures of his fellow-men. JUSTUS. 
[We observe in the above able vindication of Dr. Green, from 
the unjust aspersions of his envious detractors, that our learned cor- 
respondent has omitted one point of argument which furnishes in- 
contestible proof that the distinguished French practitioners refer- 
red to, were not fully aware of the feasibility of making direct me- 
dicinal applications to the cavity of the Larynx. In an article 
from the pen of M. Trousseau, recently published in the work of 
M. M. Riellet and Barthez, on the diseases of children, and which 
is also noticed in the 13th volume of Braithwaite’s Retrospect, he 
states that he had performed the operation of Tracheotomy in 112 
cases of croup, in many of which, before introducing the canula. 
he had injected a strong solution of the Nitrate of Silver into the 
trachea; and he recommends, if there is reason to believe that the 
Larynx alone is the seat of the diptheritis, a sponge moistened with 8 
Dr. Green's Treatise on the Air Passages. 
the solution of the Nitrate of Silver, be introduced through the ar- 
tificial opening, and passed over the tracheal membrane; thus 
showing as we think that the French physicians have no idea of 
the efficient manner in which laryngeal disease may be reached 
by the method promulgated by Dr. Horace Green, 
By a reference to No. 21, of the New York Journal of Medicine,, 
it will be found among the proceedings of the New York Medical 
and Surgical Society, that Dr. Green “ mentioned having recently 
made application of the Nitrate of Silver to the mucous membrane 
of the Larynx in a hopeless case of croup, during the stage of col- 
lapse, which was followed with decided relief to the patient. Al- 
though the case finally terminated fatally, Dr. Green urged upon the 
members of the society, the propriety of employing this local reme- 
dy in cases of croup, where other means shall prove inadequate.” 
Since that time further attempts have been made by other medical 
men in this city, to employ this remedy, and as we have been in- 
formed, in two cases of croup, with perfect success, where every 
ordinary means had been ineffectually tried. 
As stated by the reviewer, the treatment of laryngeal and bron- 
chial diseases, as described and recommended by Dr. Green in his 
recent work, meets with the full approbation of Dr. Mott, and ma- 
ny other practitioners in this city ; and certainly Dr. G. cannot 
ask for, or obtain higher authority for his practice, than is given in 
the sanction of the President of the Medical University. 
Dr. Revere, the learned Professor of Theory and Practice in the 
University of this city, in his lectures before his class on Monday 
and Tuesday last, spoke at considerable length upon the mode of 
treatment pursued and inculcated by Dr. Horace Green, for the 
cure of Chronic Laryngitis. He awarded to Dr. Green, most une- 
quivocally, the credit of having, in a thorough and practical man- 
ner, illustrated, not only the possibility, but the immense utility of 
topical applications to the very cavity of the larynx. The Profes- 
sor explained, in his usual eloquent style, the great acquisition 
which this mode of treatment was to our present list of curative 
means. We understand he has given the most positive testimo- 
nial of his entire confidence in this method, by having it employ- 
ed by Dr. Green upon his own throat for a follicular disease of the 
larynx.—Editor. ]