Pioneer Surgery in Kentucky: A Sketch

by David Wendel Yandell

I said that as a physician he was equal to the best. As we see things to-day this would not, perhaps, be saying much; but in fact he was better than the best. Negatively, if not positively, he improved upon the barbaric treatment of disease then in universal favor. He wholly discarded one of the most effective means by which the doctors succeeded in shortening the life of man. This was just before those biological dawnings which were soon to break into the full light of physiological medicine and the rational system of therapeutics based thereupon. And it is not improbable that as a watcher in that night of therapeutical darkness, where the doings of the best strike us with horror, his prophetic eye caught some glimpses of the coming day which in old age it was given him to see. Though engaged chiefly with the great things in surgery, he deserves a place in the list of therapeutic reformers.

Much of the renown acquired for Kentucky by her surgeons was in the treatment of calculous diseases. This State is believed to have furnished almost as many cases of stone as all the rest of the Union. Dr. Dudley stands the confessed leader of American lithotomists, heading the list with two hundred and twenty-five cases. Of these he presents an unbroken series of one hundred consecutive successful operations. He used the gorget in all. He preferred the instrument invented by Mr. Cline, of London. "In one case, when his patient was on the table, he discovered that his accustomed operation was impracticable from deformity of the pelvis, and while his assistants were taking their positions resolved to make the external incision transverse, which was executed before any one else present had remarked the difficulty." Through this incision he removed a stone three and a half inches in the long diameter, two and a half inches in the short, by eleven inches in circumference. The patient recovered.

In an article contributed to the Transylvania Journal of Medicine by Dr. Dudley, in 1828, he thus wrote of the trephine: "The experience which time and circumstances have afforded me in injuries of the head induced me to depart from the commonly received principles by which surgeons are governed in the use of the trephine. In skillful hands the operation, beyond the atmosphere of large cities, is neither dangerous in its consequences nor difficult in the execution." In this remark Dr. Dudley bore early testimony to the efficacy of aseptic surgery. He urged the trephine in the treatment of epilepsy and applied it in six cases—in four of which the disease was cured. The result in the two remaining cases is unknown, because the patients were lost sight of.

Dr. Dudley believed himself to be the first surgeon who ever attempted to treat [fungus cerebri] by gentle and sustained pressure made with dry sponge aided by the roller. Of the first cases in which he used it, he wrote: "By imbibing the secretions of the part, the pressure on the protruded brain regularly and insensibly increased until the sponge became completely saturated. On removing it the decisive influence and efficacy of the agent remained no longer a matter of doubt." He noted the difficulty experienced in removing the sponge because of its being extensively penetrated by blood-vessels springing from the surface of the brain. This inconvenience he afterward obviated by putting a thin piece of muslin between the fungus and the sponge. He saw in this property of the sponge what no doubt others had seen before, the phenomenon of sponge-grafting, but like them he failed to utilize it in practice.

Dr. Dudley was not a student of books. He had no taste for literature. He wrote but little, and that only for the Transylvania Journal of Medicine, edited by two of his colleagues, Professors Cooke and Short. His first article did not appear until 1828, fourteen years after he had begun practice. It was on injuries of the head. It abounded in original views, and did much to shape surgical thought at the time. Today it may be consulted with profit. His second paper was on hydrocele; in this he advocated the operation by incision and removal of the sac. He read so little that he fell into the error of believing that he was the originator of the procedure. There are writers in our own day who would be able to hold their own against him in this particular. A paper on the bandage, another on fractures, and one on the nature and treatment of calculous diseases, embrace all his contributions to medical literature.

Dr. Dudley was the son of Ambrose Dudley, a distinguished Baptist minister. He was born in Spottsylvania County, Va., April 25, 1785. When but a year old he was brought by his father to the then county of Kentucky. The family settled in Lexington, in which beautiful city the child became a man, and lived and wrought and died. The date of his death is January 25, 1870; his age was eighty-five years.

Dr. Dudley was a man of affairs. His practice was always large and paid him well. He amassed a handsome fortune. His opinions were often sought in courts of justice on professional points, where his dignity, self-possession, and dry wit (which he seems to have suppressed at the lecturer's desk), commanded the respect of judge, juror, and advocate, while it made him the terror of the pettifogger. Once, while giving expert testimony in a case involving a wound made by bird-shot delivered at short range, he described the behavior of projectiles, and the danger of bullet wounds. The opposing counsel interrupted him: "Do you mean to say," said the lawyer, "do you mean to say, Dr. Dudley, that shot wounds are as dangerous as bullet wounds?" "Shot are but little bullets," was the unhesitating reply.

Dr. Dudley had also a proper sense of the value of his professional services. He was called on one occasion to a town near Lexington to attend a patient in labor, who was the wife of a man made rich by marriage. The husband was too wise to engage a "night rider," and too purse-proud to call the village doctor. At that time most of the one hundred dollar notes in circulation in Kentucky were issued by the Northern Bank, at Lexington. On the reverse side of the bill was the letter C in Roman capital. This letter was so round in figure that it looked like a "bull's-eye," and in local slang was so called. The visit being over, and the doctor ready to leave, the young father handed him one of these notes. Eyeing it for a moment, Dr. Dudley said: "Another 'bull's-eye,' Mr. X., if you please."

In person Dr. Dudley was of medium size. His features were refined, the forehead wide and high, the nose large and somewhat thick, the lips thin, the eyes bluish-gray. His hair was thin, light, and of a sandy tint. He was a graceful man. His voice was pleasing; his manners courtly; his bearing gracious.

He married Miss Short, daughter of Major Peyton Short, in 1821. He delivered his last lecture in 1850, and the last entry on his ledger bears the date of April 28, 1853.