RARE \"Father of Laryngology\" Horace Green 1.25X3 Clipped Signature For Sale

Up for sale a RARE! "Father of Laryngology" Horace Green 1.25X3 Clipped Signature.  This is the only signature to come to sale in more than 30 years as most are in museums and university collections.

ES-7727E

Horace Green

(1802-1866) (figure 1) was the first specialized airway physician in the United

States and endures as one of the greatest pioneers in American medical history.

His life's work was committed to diseases of the pharynx, larynx, and trachea,

which are key missions of the American Broncho-Esophagological Association. The

founder of our society, Chevalier Jackson (1865-1958), was interested in

similar subject matter, which is keenly illustrated by the authors' writing and

research. [1-15] Additionally, both physicians were strong advocates of education.

[16, 17] Among Green's monumental seminal contributions are that he was the

first individual; 1. to directly treat diseased mucosa of the tracheo-bronchial

tree [1], 2. to perform direct laryngoscopy  and 3. to endoscopically resect a laryngeal

lesion with the visual control. Horace Green was born in Chittenden, Vermont on

December 24, 1802. Green's grandfather was a Massachusetts physician, who had

four sons that fought in the American Revolution. Green's father was the only

son who survived while his three brothers all died in combat. Green was the

youngest of four sons and graduated from Castleton Medical College in 1824. In

1830, he attended further lectures at the University of Pennsylvania. After

practicing for a few years in Vermont, Green moved to New York City in 1835. He

traveled to Europe in 1838 to advance his studies and initiated his

investigations in throat diseases upon returning to New York, where he

practiced most of his career. Descriptions of infectious diseases of the airway

date back thousands of years. There have been a wide variety of names including

phthisis, cynanche laryngeal, quinsy, laryngeal and pharyngeal angina,

diphtheria, tuberculosis, consumption, and croup. From ancient civilizations

through the 19th century, tracheotomy, a primary treatment, was seldom done due

to skepticism and limited understanding of human physiology and the biology of

these diseases. However, in the earlier 1800s, there was a substantial

expansion of investigations and reporting on these diseases. Bretonneau

(1778-1862) [18, 19], Ryland (1806-1857) [20], Trousseau (1801-1867) [21-23],

and Green [1-5, 7] led this effort. All were focused on surgical intervention

of the larynx and trachea to avert the moroffer and frequently fatal

complications of these diseases, however, Green was substantially more focused

on transoral instrumentation with topical administration of caustics to the

diseased laryngo-tracheal mucous membranes. Possibly the earliest description of endolaryngeal intubation

was by Avicenna (980-1037), who bent tubes of gold and silver to cannulate the

larynx and trachea for patients with airway distress. In the late 18th century,

Desault (1744-1795) [24-27], who was the Surgeon in Chief of the Great Hospital

of the Humanity in Paris revived intubation and described passing a

nasotracheal tube to secure the airway. He also was skilled in open

transcervical operative techniques and is probably the first surgeon to stress

the importance of surgeons retaining skill-sets in transoral and open surgical

methods. Desault's technique was well known at the time and described in the

famous surgical text by Malgaigne (1806-1865). [26, 27] A century later, this

philosophy was more firmly established by Solis Cohen who was probably the

first surgeon to specialize as a Laryngologist. There was a substantial need

and interest for novel transoral management of infectious airway diseases in

Green's era was due to potentially lethal consequences of these disorders as

well as the procedure of tracheotomy. However, the emotions of patient's and

clinicians were not surprisingly reflective of the severity of the problem and

the frustration of inconsistent treatment outcomes.  Despite the expanding acceptance and

performance of tracheotomy in the 19th century, the procedure continued to be

appropriately perceived by most clinicians as a heroic intervention to be done

in dire circumstances often when the patient was already in extremis. This was

especially so for those attempting tracheotomy in children. Billroth

(1829-1894), who successfully performed the first total laryngectomy for cancer

[29], provides a compelling description of tracheotomy in a six year-old child.

This individual was one of 12 laryngotomy/tracheotomy procedures that he

reported for treating croup in children.  ìThis is the only case in which a

patient has ever died immediately under the knife at my hands. It made a great

and permanent impression on my mind, and has been to me a most decided warning

against ever attempting tracheotomy again when single-handed. Intraprocedural

bleeding was commonplace during tracheotomy due to the thyroid gland and

anterior jugular veins. If excessive blood was aspirated into the trachea

and/or the patient was exhausted and unable to expectorate ominous

circumstances ensued. The surgeon would frequently be required to place a

catheter into the airway and clear the trachea by personally suctioning the

blood and purulence with his/her own mouth. [23, 27, 30, 31] Even today,

thoracic surgeons will similarly pass a flexible bronchoscope to aspirate blood

and debris on surgical patients. The majority of patients who underwent

tracheotomy died despite the airway procedure because the underlying systemic

disease process had not been reversed. As to be expected, most aspects of this

management were considerably more problematic in children. Indwelling tubes

were not yet perfected and often became occluded and/or dislodged. Adequate

lighting was frequently lacking and suction was not yet unavailable. In fact,

casts of blood, and mucopurulent sloughing membrane had to be removed manually

from the trachea by removing the tube. Regardless of whether surgeons

adopted a transoral/transnasal approach or tracheotomy to remedy airway

obstruction, infectious membranous airway maladies created a medical and

surgical imperative to access/treat the diseased mucosa. Profound medical or

surgical needs typically catalyze paradigm-changing interventions. [33] Topical

pharmacological agents such as silver nitrate or mercurial compounds were

mainstays of treatment in the 19th century and the aforementioned airway

interventions also provided a route of administration for delivering these agents.

However, these topical agents did not treat the underlying disorder, which is

why mortality rates remained high despite frequent successful airway

palliation. Despite a range of systemic pharmacological treatment strategies

leading to successful management of most infectious airway ailments in the 20th

century, aggressive recurrent respiratory papillomatosis remains as a the

21st-century vestige of this era since systemic control remains disappointing.

Possibly the earliest description of endolaryngeal intubation was by Avicenna

(980-1037), who bent tubes of gold and silver to cannulate the larynx and

trachea for patients with airway distress. In the late 18th century, Desault

(1744-1795) , who was the Surgeon in Chief of the Great Hospital of the

Humanity in Paris revived intubation and described passing a nasotracheal tube

to secure the airway. He also was skilled in open transcervical operative

techniques and is probably the first surgeon to stress the importance of

surgeons retaining skill-sets in transoral and open surgical methods. Desault's

technique was well known at the time and described in the famous surgical text

by Malgaigne (1806-1865). [26, 27] A century later, this philosophy was more

firmly established by Solis Cohen who was probably the first surgeon to

specialize as a Laryngologist. There was a substantial need and interest for

novel transoral management of infectious airway diseases in Green's era was due

to potentially lethal consequences of these disorders as well as the procedure

of tracheotomy. However, the emotions of patient's and clinicians were not

surprisingly reflective of the severity of the problem and the frustration of

inconsistent treatment outcomes. Despite the expanding acceptance and

performance of tracheotomy in the 19th century, the procedure continued to be

appropriately perceived by most clinicians as a heroic intervention to be done

in dire circumstances often when the patient was already in extremis. This was

especially so for those attempting tracheotomy in children. Billroth

(1829-1894), who successfully performed the first total laryngectomy for cancer

[29], provides a compelling description of tracheotomy in a six year-old child.

This individual was one of 12 laryngotomy/tracheotomy procedures that he

reported for treating croup in children. ìThis is the only case in which a

patient has ever died immediately under the knife at my hands. It made a great

and permanent impression on my mind, and has been to me a most decided warning

against ever attempting tracheotomy again when single-handed. Intraprocedural

bleeding was commonplace during tracheotomy due to the thyroid gland and

anterior jugular veins. If excessive blood was aspirated into the trachea

and/or the patient was exhausted and unable to expectorate ominous

circumstances ensued. The surgeon would frequently be required to place a

catheter into the airway and clear the trachea by personally suctioning the

blood and purulence with his/her own mouth.  Even today, thoracic surgeons will similarly

pass a flexible bronchoscope to aspirate blood and debris on surgical patients.

The majority of patients who underwent tracheotomy died despite the airway

procedure because the underlying systemic disease process had not been

reversed. As to be expected, most aspects of this management were considerably

more problematic in children. Indwelling tubes were not yet perfected and often

became occluded and/or dislodged. Adequate lighting was frequently lacking and

suction was not yet unavailable. In fact, casts of blood, and mucopurulent

sloughing membrane had to be removed manually from the trachea by removing the

tube.