F 
 
 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES
 
 6 ^V P "
 
 ( A t icj J^^ d Ac ((^
 
 MEMOIR 
 
 AMOS TWITCH ELL, M.D. 
 
 AN APPENDIX, 
 
 CONTAINING JI I S ADDRESSES, ETC. 
 
 HENRY I. BOWDITCH, M.D. 
 
 BOSTON: 
 
 PRINTED BY JOHN WILSON AND SON 
 
 B, Bcuoox. Strut. 
 
 1851.
 
 Iplf-
 
 CONTENTS. 
 
 P0\: 
 
 CHAPTER I. 
 
 FROM 1781 TO 1797.- UNDER 17 YEARS OF AGE. 
 
 Paoe 
 
 Introduction. Early Ancestry. Rev. John Wilson. Father: Early Settler 
 at Dublin. Library. Mother : her Influence upon her Son's Destiny. 
 Birth of Amos Twitchell. Mountain Scenery of his Native Village. 
 Homestead. Early Infancy. Gentleness of Disposition. Expertness 
 at Swimming. Daring Feats. Love of Reading, of Arithmetic. Com- 
 mon Schools. Anecdote. New Ipswich Academy. Reputation of the 
 Lad with his Comrades 1 
 
 CHAPTER II. 
 
 FROM 1793 TO 1802. 2ET. 17-21. 
 
 Starts for College. Visits Cambridge. Rejected. Anecdote. Enters Dart- 
 mouth. Dartmouth in 179S. Professors. Associates. Extract of a 
 Letter from Daniel Webster. Character at College. Practical Jokes. 
 Anecdote. Repartee to President Wheelock. Swimming. Anecdote. 
 Love of Mathematics. Calculation of Eclipses. Greek Scholarship. 
 Graduation. School-teaching. Correspondence. Theory of Sudden 
 Frost. Greek Manuscript. 14 
 
 CHAPTER in. 
 
 FROM 1802 TO 1805. ^ET. 21-24. 
 
 Early Tendency to the Study of Medicine. Anxieties on leaving College. 
 Dr. Nathan Smith, Preceptor. Sketch of Dr. Smith's Life. Prelimi- 
 nary Education necessary to the Medical Student. Influence of Dr. 
 Smith on Mr. Twitchell. Practical Anatomy. Obstructions to the 
 Study of it. Dissection in former Times. Sir Astley Cooper on Resur- 
 rectionizing in England. Dissections in America. Difficulties of the 
 Physician. Necessary for him to brave Public Opinion. Mr. Twitchell 
 
 812301
 
 IV CONTENTS. 
 
 as a Practical Anatomist. Dissections should be legalized in New 
 Hampshire. Correspondence. Lecturer on Anatomy. Removal to 
 Norwich. Mr. Twitchell invited to deliver a Medical Dissertation at 
 Dartmouth College 25 
 
 CHAPTER IV. 
 
 FROM 1805 TO 1810. ^T. 24-29. 
 
 Mother's Death. Correspondence with Dr. Carter. Prospects. Despond- 
 ency, relieved by the Influence of Dr. Smith. Removal to Marlborough. 
 Operation of tying Carotid. History of the Subject. Views of Contem- 
 porary Surgeons, Dupuytren, Roux, Abernethy, Sir Astley Cooper, &.c 
 Several Minds always work towards one Discovery. Number of Times 
 the Operation had been performed. General Results. Twitchell to be 
 placed in the first ranks of Surgery for this Case 54 
 
 CHAPTER V. 
 
 FROM 1S10 TO 1815. ^T. 29-34. 
 
 Removal to Keene. Even Tenor of Life. Practice. "Spotted Fever." 
 Independence of Twitchell. Dislike of Nosologies. Letter from Dr. 
 Carter. New Hampshire Medical Society, Member, 1811. Offices held 
 by him during Life. President, &c. Orator. Engagement to Miss 
 Goodhue. Correspondence. Practice. Assemblies at Keene. Pupils. 
 News of Peace. Rejoicings. Horseback Rides. Marriage, 1315. Cha- 
 racter of Mrs. Twitchell. Influence on her Husband. Death, 1843. 
 Effect of her Death on Dr. TwitcheU. 
 
 CHAPTER YL 
 
 FROM IBM TO IS49. ^ET. 34—68. 
 
 Offered a Professorship at Dartmouth College, 1819 ; at Vermont Academy 
 of Medicine, 1894; at Castleton, 1S2G .; at Bowdoin College, 1826. In- 
 vited to reside at Boston. Trepanning of Tibia. Preceded by Sir 
 Benjamin Brodie. Extensive Rides. Dangers ; Labors. Circular to 
 Patients. Letter to a Young Friend. Temperance. Anecdotes. 
 Youths at the Tavern. Tobacco-chewing. Farmer and his Corn. 
 Visit to Philadelphia as Temperance Delegate. Anecdote. Tempe- 
 rance Addresses less successful than his Conversation. Temperance 
 Documents. Politics. Asylum for Insane. American Medical Asso- 
 ciation ; Origin ; Interest of Dr. Twitchell in its Welfare ; Delegate to 
 its Meeting
 
 CONTENTS. V 
 
 CHAPTER VII. 
 
 FROM 1815 TO 1850. ^3T. 34-69. 
 
 Pjlou 
 Social Qualities. Jokes at the Hotel. Repartee to a Lawyer ; to a Friend. 
 Intercourse with Medical Associates. Autocrat of Surgery. His Faith 
 in the Profession. Intercourse with Patients. Roughness at First. 
 Exquisite Tenderness. Behavior in the Chamber of Death. Kindness 
 to the Poor. Anecdote. Practical Tact. Violence occasionally. Alle- 
 gro and Penseroso. Delights of being Bled. Neuralgia Case. Hatred 
 of Quackery, and of all Mystery in the Treatment of Cases. Willing 
 to confess Error. His Operations ; Anxiety to act rightly about them ; 
 Calmness while performing them. Private Hospital. Intercourse with 
 his Family ; Children. Domestic Discipline. Religious Views. . . 108 
 
 CHAPTER Vin. 
 
 FROM 1848 TO 1850. JET. 67-69. 
 
 My own Acquaintance. Personal Appearance. Conversations. Instinct 
 and Reason. , Medical Chemistry. Cure of Himself by Strict Diet. 
 Account of this Case, dictated to me by Himself. Jocose Man. Anec- 
 dote of old " Bucephalus." My delightful Reminiscences of him. Lart 
 Illness and Death 130 
 
 CHAPTER IX. 
 
 Conclusion. Outlines of Dr. Twitchell's Character 149 
 
 APPENDIX. 
 
 The Influence of Natural Objects upon the Mind . ... 155 
 
 Ligature of the Common Carotid Artery 158 
 
 Cases of Morbid Anatomy 166 
 
 Cases of Tracheotomy 172 
 
 The Present Condition of the Medical Profession 183 
 
 Fracture of the Thigh-bone, and the Liability to a Subsequent Deformity 
 
 of the Limb 193 
 
 Effects of Ardent Spirits on the Human System 196 
 
 Carcinomatous Sarcoma in the Muscles of the Arm 198 
 
 Lithotomy. — Operation on a Female 202 
 
 Effects of Tobacco on the Human System 204 
 
 Observations on the Effects of Tobacco on the Human System . . . 207 
 
 List of Diplomas, &c. held by Dr. Twitchell 212
 
 MEMOIR.
 
 MEMOIR 
 
 CHAPTER I. 
 
 FROM 1781 TO 1797. — UNDER 17 YEARS OF AGE. 
 
 Introduction. — Early Ancestry. — Rev. John Wilson. — Father : 
 Early Settler at Dublin. — Library. — Mother : her Influence 
 upon her Son's Destiny. — Birth of Amos Twitchell. — Moun- 
 tain Scenery of his Native Village. — Homestead. — Early 
 Infancy. — Gentleness of Disposition. — Expertness at Swim- 
 ming. — Daring Feats. — Love of Reading, of Arithmetic. — 
 Common Schools. — Anecdote. — New Ipswich Academy. — 
 Reputation of the Lad w r ith his Comrades. 
 
 Invited by the friends of Dr. Twitchell to prepare a 
 brief memoir of him, I have approached the under- 
 taking with reverence and delight. I have felt 
 grateful that those who loved him, and knew him 
 most intimately, should have chosen me as his bio- 
 grapher ; for, while occupied in the study of his 
 life, I have been brought into immediate commu- 
 nication with one of the most exalted members of 
 my profession. 
 
 Convinced as I am, that, to appreciate justly and 
 portray clearly the lights and shadows of any cha- 
 racter, one must, to a greater or less extent, live over, 
 in his own individual consciousness, the life of him 
 l
 
 INTRODUCTION. 
 
 whom he would delineate ; and that the more the 
 writer loses himself in his subject, the more perfectly 
 he will succeed, — I have, throughout the following 
 pages, endeavored to display Dr. Twitchell's life 
 and character exactly as they were, uninfluenced, 
 if that be possible, by any bias of my own. It ill 
 becomes me to say aught in regard to my own suc- 
 cess in this endeavor. I would simply remark, that, 
 if a profound respect for the mind, and a heartfelt 
 love for the amiable traits, of an individual ; if, more- 
 over, a sincere desire to be truthful in every minute 
 particular, to the faults as well as to the virtues of a 
 deceased friend and professional brother, are quali- 
 ties which are useful in such an undertaking, I know 
 that I may claim them. My admiration for the origi- 
 nal gifts of Dr. Twitchell's mind and heart is un- 
 bounded. I regard him as second in surgical acu- 
 men to no man I have ever seen, and as perhaps 
 the most original mind our profession has produced 
 during the present generation in New England. 
 Yet he had his failings, which I have endeavored to 
 look at dispassionately. I would describe, as I be- 
 lieve him to have been, a noble specimen of humanity ; 
 although his life, like that of every other mortal, was 
 not altogether blameless. 
 
 The data upon which I shall rest have been ob- 
 tained from many sources. I have corresponded 
 with all who, in different parts of our country, knew 
 him intimately ; I have had personal interviews with 
 some. In the course of the narrative, I shall occasion- 
 ally introduce extracts from some of his letters, a very 
 few of which remain : in fact, he wrote but few. I
 
 ANCESTRY. o 
 
 take this occasion to thank my correspondents for 
 the alacrity with which they have endeavored to en- 
 able me to form a just estimate of his character. But, 
 for the main features of his mind and disposition, I 
 rely very much upon what I myself learned of them 
 during several interviews it was my good fortune to 
 have with him, subsequently to the summer of 1844, 
 until his death. Never shall I forget those social, 
 happy hours that I spent in his society, listening to 
 the graphic, but most child-like, descriptions of 
 his feats in operative surgery and medical practice. 
 How like a giant he seemed to wield the most ad- 
 verse circumstances, and make them bend before 
 his power, where even strong men would have been 
 overwhelmed ! How inimitable his conversational 
 powers ! How infinitely amusing his sallies of good 
 humor, arising from his keen sense of the ridiculous ! 
 How withering his scorn of hypocrisy and pre- 
 tence ! How glorious his love of truth ! 
 
 God grant that what I shall say may be strictly 
 true ! I write with the feeling that his disembodied 
 spirit is ever before me ; and I have always be- 
 lieved, that in no way could I give greater offence 
 to that great soul than by any unmerited or indis- 
 criminate praise. I fear that a few passages may 
 cause sorrow to some whom I love and respect. If 
 it should be so, I shall deeply regret it ; but I know 
 not how I could write otherwise, and be faithful to 
 the complete history of his life. 
 
 I can learn but little of the early paternal ancestry 
 of Dr. Twilchell. His grandfather, Capt. Joseph 
 Twitchell, was born Feb. 13, 1719. He lived at
 
 4 FATHER. 
 
 Sherburne, and died March 12, 1793. By his mo- 
 ther's side, he was a lineal descendant of the Rev. 
 John Wilson, a man famed in story, and whom 
 Cotton Mather* styles "the father to the infant co- 
 lonies of New England." Mr. Wilson arrived from 
 England in 1630. From him descended, in regu- 
 lar succession, as many worthy pastors as there 
 were generations, until the maternal grandfather of 
 Twitchell entered upon life. Forsaking the holy 
 office of his ancestors, he assumed the equally sacred 
 one of medicine. In the eyes of the pious of those 
 days, he was, however, believed to have brought 
 evil upon himself by so doing. He practised me- 
 dicine at Sherburne, where he died in early life ; 
 leaving a widow and an infant daughter, named 
 Alice, the mother of Dr. Twitchell ; so that, through 
 her, the destined autocrat in surgery in New Hamp- 
 shire received the united mantles of New England 
 theology and physic. Of theology he adopted all 
 that is contained in the resolution made, two hundred 
 and thirty years ago, by his great progenitor, viz. : 
 " to be content, if the Lord would grant him liberty 
 of conscience and purity of worship." Over the 
 domains of physic he was destined to shed new 
 lustre, by his admirable intellect and sound common 
 sense. 
 
 Samuel Twitchell, father of Dr. Twitchell, was 
 born at Sherburne, [Massachusetts, in 1740. He be- 
 came one of the earliest of the settlers at Dublin, 
 New Hampshire, where he died, April 16, 1S20, 
 after his son had risen to fame. When he went 
 
 * Magnalia, chap. iii. book iii. Wilsonia.
 
 FATHER. 
 
 thither, there were only twelve families in the place. 
 I learn from one who knew him intimately, that he 
 was a man of an active mind, though of the limited 
 education of that period. He was, however, fond 
 of reading and of conversing with men of superior 
 attainments, and, of course, was intimate with the 
 neighboring clergymen. He was a rigid Calvinist 
 in early life ; but he subsequently became a Resto- 
 rationist, and too liberal in his views of religious 
 matters to meet wholly the approbation of the clergy. 
 He was foremost to interest himself in the subject of 
 establishing town-libraries in that section of the coun- 
 try. In the year 1793, one was founded in Dublin ; 
 and Mr. Twitchell, at that time a member of the 
 legislature, procured for it a charter. His name 
 is second on the list of applicants for the charter. 
 He presided at the first meeting under the act of 
 the legislature, and afterwards became one of the 
 committee for the choice of books. He was fond of 
 the society of the young, particularly of the more 
 educated class. Hence young teachers and col- 
 legians were especial favorites. For a time he had 
 a private governess in his family. 
 
 He used frequently to take his son Amos, the 
 subject of this memoir, with his brothers to town- 
 meetings ; thus early training them to their duties of 
 citizenship. In those days, intemperance held its full 
 sway, and no election took place without an enter- 
 tainment to the voters being given by the candidates. 
 This custom Mr. T. strongly opposed, as being in- 
 consistent with genuine liberty and morality. From 
 his lips occasionally fell maxims, which were not 
 l*
 
 MOTHER. 
 
 lost by his young hearers. Alluding to a person 
 who would buy a vote, he remarked, " A man who 
 will buy a vote will likewise sell one." " Better 
 suffer wrong than do wrong," &c. 
 
 He was much beloved by his fellow-townsmen. 
 It has been said that he had not an enemy. He was 
 at one lime a magistrate, and, during the revo- 
 lutionary war, was commander of a company of 
 minute-men. In addition to all, and probably, it 
 may be said, before all these occupations I have 
 named, he was a substantial farmer and miller. 
 But he was poor, and would therefore have been 
 well satisfied if his son could have been willing 
 to settle down on his own paternal acres, and follow 
 the honorable calling of tiller of the soil, with an 
 occasional superintendence of the mill. In fact, 
 it was not until dire experience had proved that it 
 would be profitless to try to make an alter ego of 
 his son, that he freely gave him scope to pursue the 
 natural tendencies of his own genius. Dr. Twit- 
 chell, though he esteemed his father, rarely spoke 
 of him with that high reverence and regard which 
 he evinced when he alluded to his mother. 
 
 This most excellent woman was the daughter, as 
 we have already stated, of Dr. Wilson, of Sherburne. 
 She was married to Mr. Twitchell, Feb. 9, 1766. 
 They had nine children, and Amos was the seventh. 
 She was a strong-minded woman, of very domestic 
 habits, and of a kind and affectionate disposition. 
 Admirable in her social qualities, she was a thought- 
 ful neighbor and a practical Christian. She has been 
 famed for her qualities as a nurse to her sick friends,
 
 MOTHER. 7 
 
 although entirely free from any " old woman's quack- 
 ery." # Fond as she was of reading, her domestic 
 avocations prevented her from enjoying that relaxa- 
 tion, except when her husband or some of her chil- 
 dren were able to read aloud to her. This Amos 
 was wont to do, from his earliest years. She seems 
 to have fully appreciated the fine qualities of her son, 
 and to have determined, though struggling with po- 
 verty and surrounded by a numerous family, each 
 one of whom claimed and received her maternal care, 
 he nevertheless should have the best education that 
 could be obtained. Dr. Twitchell used to say, 
 that to her energy he owed his college-course ; 
 for his mother never swerved from the determina- 
 tion she made, that, whatever else might happen, he 
 should receive a college-education. 
 
 As an evidence of the untiring energy of this 
 worthy mother, he was wont playfully to say, that, 
 when he entered college, his coat had been almost 
 wholly renewed by her earnest and efficient needle- 
 work. This little incident, homely though it may 
 be in the eyes of some, speaks volumes to me in 
 her behalf. 
 
 In her religious opinions, Mrs. Twitchell was or- 
 thodox ; but evidently she thought for herself, and 
 her tendencies were to liberal views of Christianity. 
 On one occasion she did not allow her children to go 
 
 * In fact, there being no physician near, she was consulted on 
 all occasions of sickness in the village, and, not unfrequently, was 
 called from domestic pursuits to go to see distant friends, to whom 
 her practical common sense was often of inestimable value, in a 
 medical point of view.
 
 6 BIRTHPLACE. 
 
 to sabbath school; and, upon being questioned on 
 the subject by Father Sprague, the clergyman of the 
 village, she replied that she did not allow her chil- 
 dren to study the Westminster Catechism, which 
 contained many things that she did not believe in. 
 In the future course of this history, I think we shall 
 be able to trace the impress of parental influence in 
 some of the peculiar traits of character evinced by 
 Dr. Twitchell. 
 
 Amos Twitchell was born April 14, 1781. Dub- 
 lin, his native town, is beautifully situated among the 
 hills, in the southern part of New Hampshire. Its 
 ancient church, built by its earliest settlers, still 
 crowns the summit which divides the fertile valley of 
 the Connecticut from those of the Coontocook and 
 Merrimack. On a fair Sabbath morning, the vil- 
 lagers, when collected for divine worship, could see 
 afar off, in the west, the Green Mountains, skirting 
 the horizon with their shadowy outlines, while close at 
 hand arose to their view the hoary-headed " Moun- 
 tain of the Great Spirit."* To the east, the eye 
 could grasp twenty or thirty miles of the valley of the 
 Contoocook, with its pellucid stream rolling onward 
 to swell the waters of the Merrimack. 
 
 Resting on a gentle slope, about three miles from 
 the summit we have just spoken of, stood the substan- 
 tial square-built house of young TwitchelPs father. It 
 
 * Mr. S. G. Drake, well known for his archaeological researches, 
 more especially for his learning upon every subject relative to the 
 Indians, informs me that this is the signification of Monadnock, 
 or Monadnook.
 
 CHILDHOOD. 9 
 
 was fairly embosomed in a fertile valley ; but from 
 many parts of the extensive farm could the youth 
 have a view similar to that which I have attempted to 
 describe, as plainly visible from the highest spot of the 
 village. It was here, that, when a child, he learned 
 to love the hills, and gained with them that fellow- 
 feeling, which, in after-life, caused them always to 
 exert over him their divinest influences. 
 
 On the stream, about thirty rods from the house, 
 stood the small mill owned by his father. The vil- 
 lage-school was a mile off. Nothing remains now 
 to mark these places, save the huge willow-trees, 
 which, if tradition says true, were planted by young 
 Twitchell in front of his father's homestead. Instead 
 of the old places have arisen a modern house and a 
 more commodious mill. Nature, however, still re- 
 tains her loveliness, amidst all the changes wrought 
 by man ; and one can see at a glance, that a moun- 
 taineer's freedom of thought, and a hill-side species 
 of worship, might naturally have been aroused in the 
 boy's soul, from its earliest years. 
 
 Amos was weak and puny at his birth, fragile 
 during infancy; and, as his parents had previously 
 lost several children in early infancy, he was, of 
 course, guarded with every solicitude. From a very 
 early age he was remarkable for the extreme tender- 
 ness of his heart. He could not bear to see any animal 
 killed, and was distressed at seeing a cat torturing a 
 mouse. Hence it has been a marvel to some, that he 
 ever was able in after-life to amputate a limb from a 
 human body, apparently with the most perfect cool- 
 ness. The remark has been made, of course, by
 
 10 LOVE OF READING. 
 
 persons unacquainted with the philosophy upon 
 which is grounded the practice of surgery. 
 
 As the boy grew up, he became more robust, and 
 delighted in manly exercises. As a swimmer, he 
 was unequalled. His daring exploits in this parti- 
 cular are yet the theme of admiration for all who 
 remember him. One correspondent tells me, that, a 
 little later in life, he not unfrequently went two 
 miles, for the purpose of diving from a bridge thirty 
 feet high, and, a still greater distance, to a mill-pond, 
 where, from a lofty bank, he could dive to the 
 bottom, which was many feet deep. 
 
 From one who was a resident in the family, when 
 he was about six years of age, I learn that even 
 at this time he was fond of books. As he grew 
 older, this love of reading augmented, and he es- 
 pecially delighted in history, voyages, and travels. 
 Of the few books he could obtain, the Arabian 
 Nights' Entertainments were, as they have been to so 
 many others before and since, a never-failing resource. 
 Sir Charles Grandison was a great favorite. A 
 certain Dictionary of Arts and Sciences is also re- 
 membered as a work which he used to pore over with 
 delight. He early became one of the subscribers to 
 the Dublin Library. 
 
 A liking for the study of arithmetic was likewise 
 soon observable. The common schools at that time 
 were, throughout the country, in a very low con- 
 dition. How much more so must it have been in 
 this newly settled village ! # 
 
 * How different now, when, if fame says truly, Dublin is a 
 light to the towns around for the excellence of her common
 
 YOUTH. 11 
 
 He attended school, about four months in a year, 
 until the age of fourteen, when the following in- 
 cidents took place, which induced his father no 
 longer to oppose his inclination to go to college. 
 
 It was a fair day, towards the middle of the hay- 
 ing season of 1797. All the able-bodied men upon 
 the farm were fully occupied in the field, and young 
 Amos was ordered by his father to superintend the 
 mill. A neighbor arrived with his sack of corn, and 
 left it under the care of the boy. Into the hopper 
 the grain was thrown ; the wheels soon began to whirl, 
 and the mill-stones to pour down the meal ; but, 
 unfortunately for the worthy father, the boy had 
 procured, a short time before, a book on arithmetic, 
 and soon his mind was in the region of abstraction. 
 How long he continued so, he could not and cared 
 not to tell ; but the grist was finished, and still the 
 stones whirled around. Wholly absorbed in his 
 mental operations, Amos neglected every thing else; 
 thus bringing infinite injury to the unfortunate mill- 
 er's property. 
 
 A similar accident soon afterwards occurring, and 
 by which a quantity of flaxseed was spoiled, con- 
 vinced the father, that, as a matter of economy, if for 
 no other reason, it would be far better not to employ 
 
 schools ! All honor to the two clergymen to whom chiefly this 
 change is due ! To Father Sprague we would give praise for his 
 wise philanthropy and practical sagacity, in leaving a fund to the 
 town for the support of common schools. And to his Oberlin-like 
 successor is due more than can be expressed ; for, by his well- 
 balanced and admirably cultivated mind, his indefatigable, quiet 
 enthusiasm, his catholic spirit and gentle manners, he has led his 
 fellow- townsmen duly to value the privileges spread before them.
 
 12 
 
 NEW IPSWICH ACADEMY. 
 
 his son upon labor unsuited to his disposition. Ac- 
 cordingly, on the morning after this last accident, the 
 little bundle, tied up in the checked handkerchief, 
 long afterwards remembered, was ready for him, and 
 greeted his eyes on first rising. His father was 
 there with it, and cordially bade him God speed to 
 school, as he could not afford to keep him at home 
 any longer. 
 
 He immediately entered New Ipswich Academy, 
 then under the care of the Rev. Samuel Worcester, 
 who was afterwards settled over the Congregational 
 Church in Salem, Mass. 
 
 It has been my good fortune to meet with two 
 who were his school-mates while at New Ipswich, 
 and have been ever since among his most inti- 
 mate personal friends. By them I learn, that young 
 Twitchell was of a large, imposing frame, both of 
 body and mind ; and that he was universally con- 
 sidered one of the most ingenuous, noble-hearted, 
 and intelligent boys of the school. Of all those who 
 were at that time at school, no one retained as a 
 man so entirely the peculiarities of the boy. Upon 
 the form he was quick and active, rather than a hard 
 student. He saw rapidly through the intricacies of 
 a lesson, especially in mathematics ; and, to fill up his 
 leisure time, his wit and love of fun were amply 
 adequate. Abusive, obscene, or profane words 
 rarely, if ever, escaped his lips. He was, in fact, the 
 general favorite of the school, equally respected and 
 beloved by his mates, whether as a jocose, hearty, 
 robust football player, or as a scholar of the first 
 rank.
 
 NEW IPSWICH ACADEMY. 13 
 
 He remained at New Ipswich about seven or 
 eight months, was subsequently with the Rev. Mr, 
 Palmer, of Townsend, and finally was prepared to 
 enter college.
 
 14 
 
 CHAPTER II. 
 
 FROM 1798 TO 1802. JET. 17—21. 
 
 Starts for College. — Visits Cambridge. — Rejected. — Anecdote. 
 — Enters Dartmouth. — Dartmouth in 1798. — Professors. — 
 Associates. — Extract of a Letter from Daniel Webster. — 
 Character at College. — Practical Jokes. — Anecdote. — Re- 
 partee to President "SVheelock. — Swimming. — Anecdote. — 
 Love of Mathematics. — Calculation of Eclipses. — Greek 
 Scholarship. — Graduation. — School-teaching. — Correspond- 
 ence. — Theory of Sudden Frost. — Greek Manuscript. 
 
 The time had now arrived for Mr. Twitchell to enter 
 college. In those days, regular stage-coaches were 
 unknown at Dublin. Mounted on a good country 
 farm-horse, and with his saddle-bags on each side, 
 
 he and his friend G commenced their journey 
 
 towards Boston, with the intention of entering Har- 
 vard University. It was about the middle of the 
 month of August, in 1798. 
 
 The youth was just at the golden age of seven- 
 teen. Gaily did he pursue his course, and, arriving 
 at our venerable Alma Mater, demanded admission. 
 But her portals were not destined to open at his 
 request. He was refused admittance, on the ground 
 that he had not studied all the books required for 
 admission to Harvard. 
 
 Upon hearing the decision in regard to himself,
 
 DARTMOUTH COLLEGE. 15 
 
 he jocosely remarked to his chum that was to be, 
 as if nothing had happened, " Oh ! it is of very little 
 importance. As I was coming to visit Boston, I 
 thought I would just step out and see Cambridge. 
 I have seen it ; and, if I cannot slay here, it is of no 
 consequence whatever ; for I'll go elsewhere." Suit- 
 ing the action to the word, he again mounted his 
 horse, turned his head northward, and, with a 
 cheerful, merry heart, rode on steadily towards Han- 
 over. This institution received him, and thereby 
 gained one of the most remarkable of her many 
 sons; while Harvard lost the opportunity of en- 
 rolling upon her list one of the most honest and 
 intellectual men this country has produced. 
 
 Dartmouth in 1798 ! How shall we describe it ? 
 Twenty-seven years before, its royal charter had 
 been given at the instance of the earnest and pious 
 Dr. Eleazer Wheelock, who for many years had 
 been laboring, with the zeal of an apostle, for the 
 conversion of the Indian tribes, that at that time still 
 flourished among the woods of northern New Hamp- 
 shire. Chiefly for the civilization of the red man, 
 and incidentally only to " promote learning among 
 the English," did King George III. grant, in 1769, 
 to William, Earl of Dartmouth, and his associates, 
 the vested rights of trusteeship, which have de- 
 scended to the present time. In 1771 the first class 
 of four persons was graduated ; and among them 
 was he who presided with so much sagacity over 
 the college at the time Twitchell entered it, viz. the 
 Rev. John Wheelock, son of the pious founder of 
 the institution.
 
 16 COLLEGE JOKES. 
 
 By the side of Dr. Wheelock, in the government 
 of the college, were the Rev. Drs. ShurtlefF and 
 Smith ; the latter, Professor of Latin and Greek 
 literature. Nathan Smith also was just commencing 
 his brilliant career, as the founder of the Medical 
 School at Hanover, which now holds so high a rank. 
 This gentleman, as we shall hereafter see, was des- 
 tined to have great influence in the moulding of 
 young Twitchell's mind. 
 
 Among Mr. Twitchell's associates at college, stand 
 recorded some of the most eminent of our land. 
 James Dean, long Professor of Mathematics at 
 Montpelier, was in the junior, Hon. Daniel Webster 
 in the sophomore class, when Twitchell entered. 
 Hon. Henry Hubbard, Drs. Mussey and Shattuck, 
 were graduated in the class after him. With many 
 of these, he retained, during his whole life, a most 
 uninterrupted and generous friendship. Daniel Web- 
 ster writes to me in reference to Dr. T., under date of 
 July 8, 1850 ; and, after alluding in the highest terms 
 to his intellectual vigor, he says, " Having always 
 maintained with him relations of personal friendship 
 and kindness, I felt his loss as an affliction to myself." 
 
 While at college, he retained the same character 
 that he had gained at school, of open-hearted frank- 
 ness, and love of fun, which either broke out in prac- 
 tical college-jokes, or expended itself in humorous 
 stories, some of which certainly approached the 
 confines of pure wit. If any prank peculiarly bold 
 had been played, suspicion immediately fell on Twit- 
 chell, as having, either directly or indirectly, some 
 knowledge of it. He, however, always escaped from
 
 ANECDOTE. 17 
 
 being brought into real disgrace with the college- 
 government ; for his jokes had no character of mean- 
 ness or malice about them. They were simply the 
 innocent outpourings of an exuberant and boyish 
 nature ; and, as youth passed away, they left no 
 stain upon him, for the energy that directed them 
 was turned to higher aims. At times, however, his 
 boldness before the government took almost the as- 
 pect of impertinence ; and, had it not been for the 
 Hudibrastic absurdity and daring fearlessness of his 
 replies, he might have met with severe rebuke. The 
 following well-known and oft-repeated story has 
 been frequently told to me by his friends ; and it was 
 evident that he enjoyed with infinite glee the remini- 
 scence of the scene. A very grave offence had been 
 committed by some one ; the dignity of the parietal 
 government of the infant college had been sorely set 
 at defiance ; for, at the morning summons to prayers, 
 strange sounds had issued from the belfry. Instead 
 of the musical notes of the college-bell, sounding like 
 the sacred convent-bells of the old world, at early 
 dawn, and summoning every sleeper to matins, arose 
 plaintive sounds, as if the whole contents of a sheep- 
 fold had been suddenly transferred to the top of the 
 college chapel. Significant glances stole about 
 among the students. President Wheelock looked 
 grave. With each swing of the bell, the sounds of 
 woe arose, more and more earnestly, upon the still 
 morning air, and floated over the neighboring hills. 
 The solemn services of the day were, doubtless, some- 
 what interfered with ; and a conclave of the faculty 
 was held to bestow condign punishment upon the
 
 18 COLLEGE LIFE. 
 
 offender, who had been so daring as absolutely to 
 drag up into that narrow and lofty spot a " patriarch 
 of the flock" of sheep, belonging to a neighboring 
 farmer. Twitchell, as usual, was thought to know 
 all about the matter. It does not appear, however, 
 that he was really the author of the scheme. Dr. 
 Wheelock, as tradition informs me, was very keen 
 and lawyer-like in cross-questioning the students ; so 
 that he rather prided himself on his ability to dis- 
 cover all offenders against the true honor of Dart- 
 mouth. On this occasion, however, he may, like 
 some advocates, have overstepped those bounds 
 which are laid down to govern individuals in their 
 intercourse with other men. I do not mean to say 
 that Dr. Wheelock did any thing improper ; but 
 simply, that, in questioning Twitchell, he made some 
 very home, and probably uncalled-for thrusts. Twit- 
 chell parried them for some time : at length the 
 president said abruptly, " Well ! but, Twitchell, how 
 do you suppose that ram got into the belfry ? You 
 certainly have some notion about the matter. Give 
 us your opinion, sir." 
 
 Those of us w T ho knew Twitchell in after-life can 
 well imagine the twinkle of the eye and the internal 
 chuckle with which he solemnly answered as fol- 
 lows : " Well, sir ! as I was passing the chapel this 
 morning, I observed some peculiar marks upon the 
 wall near the lightning rod. Perhaps he climbed 
 up that way ! " All this was said, of course, with 
 a becoming gravity of manner, quite in accordance 
 with the circle of grave faces in whose presence 
 he stood. The very boldness, combined with the
 
 COLLEGE LIFE. 19 
 
 grotesqueness of the idea, saved the youth from 
 further questioning, and he was dismissed even with 
 a smile ; dignity evidently yielding to the genuine 
 impulse of nature. 
 
 Many a year afterwards, Dr. Twitchell related to 
 me the following practical joke, which he played 
 upon his companions. He was, as we stated, a most 
 excellent swimmer, and had accustomed himself to 
 dive and remain for a long while under water. Soon 
 after he entered the college, he went out to bathe 
 with his companions in a neighboring stream. He 
 found that it was thought a great feat to swim across 
 to a certain island ; and, as some of them were boast- 
 ing very much of their great powers in this respect, 
 he determined to humble them, and crack a joke at 
 the expense of all. He delayed until his compa- 
 nions had commenced bathing, and then pretended 
 to ask advice about the process ; as to how he 
 should move his limbs, and whether it would be dan- 
 gerous for one who did not know how to swim, to 
 jump off where the water was several feet deep. 
 He submitted to the jeers of the youths, and finally, 
 contrary to their advice, jumped off into the rushing 
 stream. The moment he arrived below the surface 
 of the water, he turned his head towards the down- 
 ward current, and went rapidly along beneath the 
 surface. As he arose to breathe, he floated in silence 
 down the stream, unseen by any one. It was about 
 twilight in the evening, and he was soon out of sight 
 of his comrades. He then landed, and concealed 
 himself among the bushes. Here he remained, 
 highly amused at the dismay of his schoolmates,
 
 20 COLLEGE LIFE. 
 
 who, after calling for him in vain, hastily dressed 
 themselves, and prepared to arouse the neighborhood 
 in order to drag the river. When he had sufficiently 
 enjoyed himself at their expense, and just as they 
 were starting in pursuit of their elders, Twitchell 
 called out to them, and quietly asked where they 
 were going, and why they were " making so much 
 fuss"! 
 
 But Twitchell was not a joker merely when in 
 college; and, although he was at times a source 
 of vexation to his superiors, he always commanded 
 their respect for his honesty, his pure morality, his 
 strong intellect, and high scholarship. He wasted not 
 his hours, but devoted himself especially to mathe- 
 matics, and likewise made himself a proficient in the 
 classics. He calculated the elements of the total 
 eclipse of the sun in 1806. With the assistance of a 
 friend, he prepared an almanac. From this friend, 
 I learn that he stood very high as a Greek scholar, 
 and that the Greek Oration, which was assigned to 
 him at Commencement, was considered among the 
 first four parts. It was a common remark among his 
 fellow-students, that his organs of voice seemed pe- 
 culiarly fitted for the pronunciation of that sonorous 
 language, so that it was a great pleasure to hear him 
 read or speak it. 
 
 Dr. Twitchell was graduated in 1802. During 
 the whole period of his pupilage, he had been strug- 
 gling with poverty. This had made it necessary for 
 him to keep school for support during the winter. 
 Accordingly, he had taken charge of district schools 
 in Rockingham, Marlborough, Dublin, and perhaps
 
 COLLEGE CORRESPONDENCE. 21 
 
 other places. Some of his pupils are still alive ; and, 
 from their account, I infer that he combined, in a 
 remarkable degree, a power of government with an 
 unusual degree of familiarity with his pupils. The 
 one, how r ever, never encroached on the other. He 
 had sagacity enough to prevent that catastrophe. 
 
 The following extracts from some of his letters 
 will afford a faint idea of the young man and of his 
 pursuits during his college-life. It can, I would 
 premise, be safely said that letter-writing was never 
 his forte. 
 
 " Dartmouth College, April 4, 1800. 
 
 " Friend ***, — The perusal of your letter led me 
 into an agreeable train of reflections. I hoped for the 
 perusal of another before this time. Wednesday last was 
 the day of our Sophomorial Exhibition, on which I had 
 the honor of pronouncing the Greek Oration, on the account 
 of which I have been unable to write ; but, if health per- 
 mit, I expect I shall have it in my power to write oftener. 
 It is very unhealthy this spring in college. Fevers rage 
 among the students to such a degree that it is very 
 gloomy indeed ; . . . . and now, instead of being decked 
 with the garlands of May, I am clad in the weeds of 
 mourning for a brother classmate. ... I sent, by last 
 mail, for the paper which is printed in Keene ; and I hope 
 I shall have the pleasure of perusing some of the produc- 
 tions of your fertile genius through that medium 
 
 Yours affectionately, Amos Twitchell. 
 
 "Dr. Carter." 
 
 The following indicates that he had already se- 
 lected his profession. As a junior under-graduate,
 
 22 COLLEGE CORRESPONDENCE. 
 
 he is attending with interest upon Dr. Nathan Smith's 
 lectures. 
 
 "Dartmouth College, Oct. 28, 1801. 
 
 " Respected Friend, — ... Having had my time, since 
 my arrival, principally taken up with Dr. Smith's lectures, 
 I have had no leisure for writing. . . . 
 
 " With regard to a school, I have heard nothing from 
 Esquire Sweetser, so I conclude he does not expect to 
 employ me. I have not yet engaged one ; but I have 
 some prospect of one at Westminster, Mass." . . . 
 
 Under date of June 14, 1S01, he writes thus, after 
 alluding to his delight at receiving a letter from Dr. 
 Carter : — 
 
 " We have been favoured with a beautiful season, 
 although on the seventh instant we had a very cold day, 
 attended with a frost the evening succeeding ; which per- 
 haps may be accounted for in the following manner : A 
 few days preceding the frost had been very warm, which 
 occasioned a wind to set in from a southerly direction, 
 which brought with it a great quantity of aqueous vapor, 
 which it was probable was raised into the atmosphere in 
 the warm regions surrounding the Mexican Gulf; and after 
 being wafted to the north, through a very high region 
 of the atmosphere, it there became mixed with a great 
 quantity of nitrous particles, which were floating in the 
 atmosphere from the cold regions of the north. Upon 
 the conjunction of the aqueous vapor with these nitrous 
 particles, it became immediately condensed, and descended 
 in rain. By these means, the atmosphere being freed 
 from vapor, and a great quantity of those nitrous parti- 
 cles being brought by the rain nigh to earth, occasioned a 
 coldness in the circumambient air, which produced the
 
 COLLEGE CORRESPONDENCE. 23 
 
 frost. This is the method in which I account for these 
 sudden transitions from heat to cold. If you have any 
 better theory for explaining such phenomena, I should be 
 very happy if you would communicate it to me." [He 
 alludes to illness still among the students, and concludes 
 thus:] "I am now attending Dr. Smith's lectures 
 upon Materia Medica, which I find agreeable and instruc- 
 tive." 
 
 He writes from Rockingham : — 
 
 "Feb. 2, 1802. 
 
 ..." I opened my school on the succeeding day, and 
 found it to consist of about eighty or ninety large igno- 
 rant scholars." . . . 
 
 "April 2, 1802. 
 
 " Friend Carter, — This day completes twenty-one 
 solar revolutions since my egress into the world. But 
 twenty-one years, when they are gone, do appear as short 
 as one. However fast time has fled heretofore with me, 
 it now drags heavily along. I can say, as the divines ex- 
 press it in their prayers, 'I have wearisome days and 
 nights appointed to me.' " 
 
 He then describes an attack of measles, from the 
 effects of which he was a long time in recovering. 
 He terminates by hoping that bad health will not pre- 
 vent him from attending Dr. Smith's lectures, which 
 were about to commence. He likewise constantly 
 alludes to this gentleman, in terms of respect, as his 
 medical attendant. 
 
 "May 5, 1802. 
 
 • • • " I have now been unable to study any for about 
 six weeks ; but I can't help myself, the president says, 
 and I must be resigned, for Providence never hurts any- 
 body."
 
 '-24 GREEK ORATION. 
 
 It would appear from the following, that demo- 
 cracy was not in the ascendant at Hanover, in June 
 30th, 1802: — 
 
 ..." The anniversary of our Independence will be 
 celebrated in this place on Monday next, when an oration 
 is expected by Thomas A. Merrill, A.B. preceptor of the 
 academy in this town, — a true federalist. Great were 
 the exertions of the democrats to prevent the triumphs of 
 federalism on this occasion ; but, with all their exertion, 
 they obtained but fourteen votes." 
 
 His last letter from Dartmouth is dated just before 
 the Commencement-day at which he was graduated, 
 viz. August, 1802. In it he urges his friend Carter 
 to come to Hanover. 
 
 A very neatly written Greek manuscript was 
 found among his papers after his death. I presume 
 it was the Oration delivered at the time of his gra- 
 duation. I do not suppose that it is written in the 
 purest Attic idiom. It doubtless shows something 
 of its origin in the backwoods of New Hampshire. 
 A translation of it, in his own handwriting, has 
 likewise been found ; and as it illustrates, in some 
 degree, his views of nature and of God, I have 
 thought it worth preservation. (Appendix A.)
 
 2d 
 
 CHAPTER III. 
 
 FROM 1802 TO 1805. JET. 21- 
 
 Early Tendency to the Study of Medicine. — Anxieties on leaving 
 College. — Dr. Nathan Smith, Preceptor. — Sketch of Dr. 
 Smith's Life. — Preliminary Education necessary to the Medi- 
 cal Student. — Influence of Dr. Smith on Mr. Twitchell. — 
 Practical Anatomy. — Obstructions to the Study of it. — Dissec- 
 tions in Early Times. — Sir Astley Cooper on Resurrectionizing 
 in England. — Dissections in America. — Difficulties of the 
 Physician. — Necessary for him to brave Public Opinion. — Mr. 
 Twitchell as a Practical Anatomist. — Dissections should be 
 legalized in New Hampshire. — Correspondence. — Lecturer on 
 Anatomy. — Removal to Norwich. — Mr. Twitchell invited to 
 deliver a Medical Dissertation at Dartmouth College. 
 
 From early childhood, Mr. Twitchell's thoughts had 
 been led to the profession of medicine. During his 
 college course, his intimacy with Dr. Nathan Smith 
 had tended still further to guide him onward in the 
 same path. It was therefore a matter of very little 
 diihculty for him to determine, when leaving college, 
 which of the three professions was most adapted to 
 his nature. He hesitated not a moment, and em- 
 braced that of medicine. But how cheerless was 
 the prospect before him ! 
 
 Poor, without rich friends or father to assist him, 
 the task of gaining an honorable fame and com-
 
 26 MEDICAL STUDIES. 
 
 petency seemed too great.* In consequence of this 
 thought, he was seized with one of those fits of 
 abstraction and despondency, which subsequently, 
 for nearly forty years, at times almost wrecked his 
 mind. On the occasion of his leaving college, he 
 was observed to be very sad. Once he stood, 
 wholly lost in thought, gazing at the open sky, and, 
 on coming to himself again, found that he had taken 
 no note of time ; for nearly two hours had passed 
 while he had been thus occupied. 
 
 Notwithstanding these occasional attacks of de- 
 pression, he entered, in 1802, with great zeal, on 
 the pursuit of his profession, under the care of Dr. 
 Nathan Smith. I have already alluded to the re- 
 markable character of this gentleman ; but the im- 
 mense influence he had over Twitchell's mind 
 makes it not inappropriate, that a few words should 
 be devoted to his life. This is in fact absolutely ne- 
 cessary, if we would trace all the great influences 
 that tended to mould the mind of Twitchell. 
 
 Nathan Smith f was born Sept. 30, 1762, at Reho- 
 both, Mass. ; but his parents soon migrated to Ches- 
 ter, Vt. He attended the common schools in early 
 life; and, while he was yet in early youth, the great 
 days of the Revolution of 1775 dawned upon this 
 country. At the latter part of that stormy war for 
 
 * He certainly possessed, in an eminent degree, what has been 
 quaintly styled " the wholesome stimulus of prospective -want." 
 
 f I have gleaned all my knowledge of Dr. Smith's life and 
 character from the interesting eulogy, delivered at the time of his 
 death, by his friend and colleague, Jonathan Knight, M.D. See 
 Medical and Surgical Memoirs, by Xathan Smith, edited by his 
 son Nathan R. Smith. Baltimore, 1831.
 
 DR. NATHAN SMITH. 27 
 
 independence, and while still in his teens, he was 
 drafted into the Vermont militia, to repel the incur- 
 sion of Indians on the frontiers. Encamped in the 
 wilderness, constantly in peril from the rifle and craft 
 of the savage, he gained a robust, manly form, as 
 well as a strong and bold mind. Exposed thus early 
 to laborious toil, he was, all unawares to himself, 
 preparing for the earnest battle of life that was des- 
 tined for him. 
 
 On his return from the wars, he became teacher 
 of the District School in the vicinity of his residence. 
 Whilst thus engaged, one of those curious events 
 occurred to him, which, the more we study biogra- 
 phy, the more commonly do we perceive to happen 
 in the life of every celebrated man. 
 
 Sir Christopher Wren's greatest fame can be di- 
 rectly traced to the fire which desolated London 
 in 1666. The whole energies of Clarkson's soul 
 were turned to the main object of his life of fifty 
 subsequent years, by his visit to the London and 
 Liverpool slave-ships, in 1784 and 1785. The 
 Revolution in our country has made the name of 
 Washington so mighty, that it will be, as expressed 
 by Lord Brougham in his splendid metaphor, one of 
 the grand tests of the progress of the human race. 
 Wherever we look, we see these " accidents of 
 fortune," as the skeptic calls them, or " special pro- 
 vidences," as the pious soul loves to regard them, 
 always happening just at the right time, to bring 
 forward a human being into the path to which his 
 nature leads him. " There is a divinity that shapes 
 our ends, rough hew them as we may ; " and who
 
 28 DR. NATHAN SMITH. 
 
 can tell what impulse first led Nathan Smith to 
 attend an operation upon the human body, per- 
 formed by Dr. Goodhue, then the most eminent sur- 
 geon of that district, subsequently father-in-law of 
 young Twitchell ? Smith was twenty-four years of 
 age when this happened ; and, although he had paid 
 no attention to medicine or surgery before, the sight 
 aroused all the latent fire within him. He asked Dr. 
 Goodhue to allow him to commence the study of me- 
 dicine in his office. Most wisely, however, did that 
 sagacious man tell him it could not be allowed. His 
 preliminary education was lamentably deficient. He 
 w T as therefore ordered to fit himself to enter col- 
 lege, before he could be received by Dr. Goodhue.* 
 
 * Dr. Perry, of this city, informs me that lie heard from Dr. 
 Goodhue the folio-wing account : Young Smith was a teacher of 
 the adjacent District School ; and it was rumored, that the impor- 
 tant operation of amputation of the thigh was to be performed 
 by Dr. Goodhue. The village -was alive upon the subject, and 
 many gathered at the house of the patient, apparently attracted 
 by simple curiosity. "When all was prepared, Dr. Goodhue, 
 not having sufficient medical assistance, asked of the assembled 
 company, whether any one would hold the limb that was to be 
 taken off. Immediately, a strange and rather ungainly back- 
 woodsman-looking youth stepped up boldly, and offered his aid. 
 Dr. Goodhue was struck with the apparently intense interest that 
 he took in the proceedings, and with his unflinching steadiness 
 of nerve. Smith even tied the arteries as Goodhue took them up, 
 and did so without tremor. After all was finished, and most of 
 the villagers had left, the youth still remained fixed on the spot, 
 with his hands in his pockets, apparently in deep thought. Sud- 
 denly, he exclaimed in Yankee phrase and tone, somewhat as fol- 
 lows : — " Look ye here ! I think I should like to study medicine 
 with you. I am the teacher in your District School ; and, after 
 my term has finished, I'll begin." Dr. Goodhue scanned him 
 well, and answered, " Stop, young man — not so fast. Let me see
 
 DR. NATHAN SMITH. 29 
 
 Nothing daunted, however, Smith placed himself 
 under the care of the Rev. Mr. Whiting, of Rock- 
 ingham, for three years ; and three years more he 
 studied medicine under Dr. Goodhue. How does 
 such counsel as this eminent physician gave the 
 young man put to shame the modern doctrines of 
 rapid courses of instruction, and quick grinding out 
 of medical students ! 
 
 Commencing practice, Dr. Smith still felt his im- 
 perfect knowledge of his profession. He therefore 
 resigned practice, and came down to Old Harvard, 
 to sit at the feet of the elder Warren and of Water- 
 house, under whose instructions he was graduated 
 with distinguished honors. Returning to his own 
 State, he projected alone the formation of the Medi- 
 cal School at Dartmouth. Aided by his friend, Dr. 
 Lyman Spaulding, as Lecturer on Chemistry, he 
 commenced a course of lectures on medicine and 
 surgery; thus embracing, in one grasp, the do- 
 mains of medicine in its widest sense, and which 
 
 what you know." Finding, as stated in the text, that he was 
 deficient in his preliminary education, Dr. Goodhue stated his 
 opinion, and the youth left. Dr. Goodhue never thought of 
 the subject afterwards, until, many months subsequently, an un- 
 known individual appeared suddenly at his house, with his pack 
 on his back, apparently prepared to stay. " Well," cried the 
 stranger, " I have come back to study with you ; but you must 
 let me earn my board, for I have spent all my money in fitting, as 
 you told me, for college." An explanation immediately took 
 place ; and Dr. Goodhue, perceiving the qualities possessed by 
 his extraordinary companion, generously offered him a home and 
 medical tuition, while the youth on his part was to assist, by 
 performing any manual labor that might arise in the country- 
 physician's family. 
 3*
 
 30 DR. NATHAN SMITH. 
 
 now occupies the attention of at least seven profes- 
 sors in every well-regulated school. Dissatisfied, 
 however, with any thing short of being as perfect 
 in his art as possible, he again resigned practice, 
 made a voyage to Europe, and spent one year in 
 Great Britain, most of the time under the guidance 
 of the professors of the then far-famed Edinburgh 
 school. 
 
 His return was a signal for unexampled success. 
 As a surgeon and a professor of surgery, he stood 
 preeminent. His active, inquisitive mind, his extra- 
 ordinary memory, his practical skill in the details 
 of life, his moral courage, his unbounded kindness of 
 heart, his purity of thought and deed, — all combined 
 to lead him on to fame. From 1798 to 1813, his 
 career was unbroken at and about Hanover. He 
 then removed to the wider sphere of the Professor- 
 ship of Surgery at New Haven ; and, finally, full of 
 honor, surrounded by those who loved him, and 
 mourned by all, he sunk in peace in the sixty-seventh 
 year of his age. 
 
 Undoubtedly, such a man was one to stir the blood 
 of a youth like Twitchell ; and equally certain is it, 
 that Dr. Smith must have appreciated all the good 
 qualities of his young friend. It is because I think 
 that Dr. Smith had more effect than any other man 
 or set of men in bringing the pupil up to what he 
 subsequently became, that I have felt it right to dwell 
 so long upon the character of the master. 
 
 A former friend and pupil of Smith, and a fellow- 
 student with Twitchell, speaks thus : " Dr. Smith 
 was remarkable for his profound views and for his
 
 PRACTICAL ANATOMY. 31 
 
 great disinterestedness. He would do any thing, and 
 perform any labor, for the sake of humanity and for 
 science. *Hence Twitcheli was attracted towards 
 him." 
 
 We can readily believe, that, with circumstances 
 so nearly allied, and with characters so marked, and 
 yet so similar, these two men Avould have been 
 united. In Twitcheli, Dr. Smith had just what he 
 wanted as a youthful assistant ; and in Smith, 
 Twitcheli found not merely a high-toned preceptor, 
 permeated with a mild and free philosophy, but 
 one of the most kind and self-sacrificing of friends. 
 Persons now living remember well the entire union 
 of the two ; and the pupil seems to have ever acted 
 towards his preceptor in accordance with the noble 
 Hippocratic rule, of entire devotion of himself, not 
 merely to his master in physic, but likewise to that 
 master's family.* 
 
 Twitcheli was very much occupied, during his 
 pupilage, with the thorough study of anatomy. Al- 
 most all the time, he was at the dissecting room. 
 This fact leads to a subject, which, though it may 
 be unpleasant to many, needs some notice. I allude 
 to the connection of these two men in the study of 
 practical anatomy. As an introduction, allow me to 
 allude to some of the difficulties that have attended 
 this study. 
 
 * " I will honor as my parents the master who has taught me 
 this art (medicine), and endeavor to minister to all his necessities. 
 I will consider his children as my own brothers, and will teach them 
 my profession, should they express a desire to follow it, without 
 remuneration or written bond." — Oath of Hippocrates.
 
 32 ITS IMPORTANCE. 
 
 Strange as it may seem, although a thorough 
 knowledge of the human frame is absolutely essen- 
 tial to perfection in the medical profession, and 
 dissections are the only groundwork of all true 
 knowledge in our art, the study of practical ana- 
 tomy has been, until recently, prohibited either by 
 public opinion or by statute law. Consequently, 
 dissections were much neglected in former ages. 
 Some physicians hoped to learn man's organization 
 by examining the bodies of lower animals, — a very 
 absurd and inaccurate mode of studying human ana- 
 tomy ! But the really great men of the profession, 
 feeling dissatisfied with this very superficial know- 
 ledge, have always braved public opinion, or, in 
 a secret way, have avoided its censure. Dissections 
 have been made by some few in every age.* 
 
 In England, till within the present generation, 
 a man convicted of dissecting a human body was 
 liable to be classed with felons; and the highest 
 penalties were inflicted on any one who procured a 
 corpse for that purpose. In consequence of these 
 enactments, a class of desperate men arose in Eng- 
 land, who for years carried on a trade in dead bodies 
 with the chief surgeons and teachers of anatomy 
 in Great Britain. So daring and successful were 
 they, that Sir Astley Cooper, in a reply to a com- 
 mittee of the House of Commons, said : " The law 
 does not prevent our obtaining the body of any 
 
 * The eminent anatomist, Vesalius, three hundred years ago, 
 was cited to appear before the Inquisition, on the ground of im- 
 piety in dissecting the human body ; and it is said, that the power 
 of the Spanish king alone saved him from destruction.
 
 ITS DIFFICULTIES. 33 
 
 individual, if we think proper; for there is no person, 
 let his situation in life be what it may, whom, if I 
 were disposed to dissect, I could not obtain." * Such 
 was the state of things up to 1832, when the British 
 Parliament took up the subject like reasonable 
 men, and passed a bill legalizing the study of ana- 
 tomy, and making provision for dissections. Under 
 this law, some of the most serious evils have sub- 
 sided, f 
 
 We now turn to our country, where the same 
 opinions and laws against dissections have likewise 
 existed, until within a very short period, in all the 
 States. And where is the physician of twenty years' 
 standing in his profession, who does not remember the 
 
 * Life of Sir Astley Cooper, by Bransby Cooper, 1843, vol. i. 
 407. 
 
 f Hansard (Parliamentary Debates, 1830 — 33) gives very in- 
 teresting reports of the discussions which took place before a law 
 could be passed. The Duke of Sussex, Sir Robert Peel, Sir Robert 
 Inglis, Messrs. Warburton, Macaulay, Hume, and O'Connell, bore 
 their parts on the affirmative side of the question. Mr. Hunt, the 
 representative of the ultra-opponents, proposed that no one should 
 ever be allowed to dissect, unless he would sign a paper that he 
 was willing his own body should be used for dissection. Mr. 
 Macaulay, as an illustration of the importance to all, to the rich 
 as well as the poor, that physicians should be experts in ana- 
 tomy, cites the case of Leopold, Duke of Austria, the conqueror 
 of Richard the Lion-hearted. This great commander was thrown 
 from his horse, and fractured his leg. The physicians said that the 
 limb should be amputated ; but none possessed sufficient skill to 
 undertake the task. In despair and agony, the duke seized a 
 hatchet, placed it on his mangled limb, and ordered an attendan t 
 to lop off the useless member. It was done ; and the duke died 
 of the hemorrhage from the spouting artery ! If anatomy were 
 not now studied, would not such cases be of constant occurrence ?
 
 34 PRACTICAL ANATOMY. 
 
 revolting scenes in which but too many of us were 
 forced to engage, however abhorrent the occupation 
 might have been to our own feelings ? We found 
 ourselves engaged in the study of an honorable art, 
 whose object is the relief of suffering humanity. 
 Practical dissections were absolutely essential to a 
 knowledge of this art. No one could ever hope to 
 gain a thorough insight into medicine, no one could 
 ever dare perform any operation upon the living 
 body, unless he had studied the intricate and curious 
 workmanship of the human frame. It was neces- 
 sary for him practically to lay out before his own eye 
 every principal artery, nerve, and vein ; otherwise 
 he could not operate with safety upon the quivering 
 fibres of a living brother-mortal ! But how was he 
 to obtain the means of pursuing this study ? He 
 looked at the law, and it said, A man who is found 
 with a human body in his possession, for the purpose 
 of dissection, shall be considered guilty of felony.* 
 Public opinion gave him no milder answer. Every 
 time he entered the dissecting room, he felt that he 
 
 * By a law of Massachusetts, passed March 2, 1815, any one 
 -who " dug up" or who "received " any human body for dissect- 
 ing purposes was liable " to be imprisoned not more than one 
 vear," or " to be fined not more than a thousand dollars." This 
 law (while at the same time no legal provision was made for dis- 
 sections) remained in full force until 1831, when the Legislature 
 of Massachusetts swept the absurd and impracticable document 
 from their statute-book, and thereby, I believe, became the first 
 Legislature of the Anglo-Saxon family that arose above prejudice 
 upon this point, and looked at the necessities of the medical pro- 
 fession face to face. Even the English law came after ours ; and, 
 as I am informed, English statesmen were not unwilling to seek 
 wisdom from our younger commonwealth.
 
 ITS INFLUENCES ON THE STUDENT. 3-J 
 
 shut himself out from much of human sympathy. 
 Nevertheless, love of his profession, necessity, a 
 laudable ambition to become an adept in his art, — 
 all summoned him to break, if necessary, the absurd 
 law, and violate public opinion. It was a dreadful 
 alternative, but what every educated physician, until 
 within the period above alluded to, has been sum- 
 moned to decide. And, without a single exception, 
 every one, either by his own act, or by that of 
 another, perhaps a fellow-student, has chosen to set 
 at nought the law. 
 
 But how much torture of mind — how much real 
 injury to the fine texture of the human soul, has 
 been often produced by this alternative, many can 
 tell. 
 
 Upon this subject, I feel that I can speak with the 
 authority of one who has known what it was, in for- 
 mer days, to dissect a human body. How vividly, 
 after a lapse of twenty years, come up now before 
 me visions of hours spent in the dissecting room ! 
 Some of them were among the most delightful and 
 ennobling of my life ; for I then learned to look 
 upwards in reverential awe, from the mystic harp of 
 the human body, to that higher Power which had 
 fashioned all its varied beauty. Other hours, how- 
 ever, were of a far different character, — not inherent 
 in the nature of the employment, but forced upon 
 me by the ignorant prejudices of a so-called enlight- 
 ened community. Deeds were to be done, either by 
 myself, or by some one else, with my knowledge 
 and fall consent, but abhorrent to my inmost nature. 
 The stern figure of an absolute fate seemed to rise,
 
 36 PRACTICAL ANATOMY. 
 
 and tell me that it was useless to resist; for it was 
 the irrevocable decree of society, that dissections 
 should be obtained by those very deeds. Let not 
 any one think that any trivial idea merely of a neces- 
 sity in the ca^e would ever have induced any one 
 to undertake the horrible task. In my early days 
 of professional life, it was, as I have stated, the ab- 
 solute and fixed fate of every medical student to do 
 this, or be recreant to humanity and his profession. 
 We in Boston were grateful to find one avaricious 
 miscreant to take upon himself the most onerous 
 part of the work ; but how country students were 
 obliged to do, may be learned from a letter which I 
 shall hereafter lay before the reader. With them, 
 every one had to bear his share of danger; and, 
 considering the amount of that danger, I wonder 
 that such a race of men, eminent in surgery, ever 
 arose amongst us. While I wonder, I glory in the 
 fact, that, notwithstanding all the fierce attempts of 
 society to dwarf the medical profession in this, its 
 primary elements of growth, there has always been 
 an elastic force within our body, capable of hurling 
 off the pressure which a narrow legislation has con- 
 stantly attempted to exert upon it. All honor, then, 
 to those bold men who were willing, like Smith and 
 Twitchell, to risk fame for the sake of a thorough 
 knowledge of the profession ! For one, I give my 
 most grateful thanks to all those fathers of the 
 profession, who, directly or indirectly, have listened 
 to " a higher law than human statute," whilst that 
 was base and grovelling, and have dissected in the 
 face of human law ; and who likewise, by unremit-
 
 PERILOUS ADVENTURES. 37 
 
 ting efforts in Massachusetts, have at length brought 
 us to the point that human dissection can be per- 
 formed openly and with the sanction of the State. 
 
 An undaunted courage, great sagacity and self- 
 possession, inflexible perseverance, and an iron frame, 
 were needed on the part of any one to enable him 
 to be repeatedly successful on such occasions as I 
 have hinted at. Mr. Twitchell, as the assistant 
 of Dr. Smith, then sole Professor of the Medical 
 School at Dartmouth, had these characteristics. 
 This gentleman, like other teachers, needed demon- 
 strations in practical anatomy for the instruction of 
 his class. They were as necessary for the life of his 
 school, as the air we breathe is essential to ourselves. 
 It has been reported to me, that Dr. Smith depended 
 almost wholly, if not entirely, upon his young and 
 ardent friend for the procurement of subjects for 
 dissection. Mr. Twitchell always w r ent alone when 
 engaged in these excursions, because he could not 
 trust any one's courage but his own. For many 
 years he labored thus a great deal for Dr. Smith. 
 He was himself constantly dissecting, and therebv 
 preparing for his future course of honorable repu- 
 tation as a surgeon. He was often in infinite peril. 
 On one occasion he was arrested ; but, by some easy 
 ruling of the law, he escaped. * Tradition has 
 
 * Another serious evil of these laws was the tendency to wink 
 at their violation, which was exhibited by the very magistrates 
 themselves. These gentlemen, in advance, as they were, of pub- 
 lic opinion, required strong proof of a fact before they would 
 commit a man. A most striking example of this I met with 
 during my own pupilage. A fellow-student had been, to my 
 certain knowledge, engaged in raising a body in the vicinity 
 4
 
 38 PRACTICAL ANATOMY. 
 
 handed down very many singular adventure?, which 
 he met with on these various occasions. They il- 
 lustrate his peculiar traits of character, — his bold 
 and fearless temper, his indefatigable perseverance, 
 his shrewdness in meeting all the diversities of human 
 nature, and even his love of drollery. I might tell 
 of his long rides, sometimes over a hundred miles 
 in extent, by night and by day, in sunshine and 
 storm, of his various accidents and hair-breadth 
 escapes; but it would be unwise to do more than 
 simply allude to this phase in his life. And, in doing 
 so, I do not put him forward, it will be perceived, as 
 an exception to the general rule. All engaged in the 
 same pursuits, either per se or per alios. Twitchell, 
 however, was unique in these transactions, as in every 
 thing else; unbounded in his energy, with a mind 
 ever fertile in resources, and a courage that never 
 faltered. 
 
 Some may doubt the expediency of even referring 
 to this question ; but truthful dealing with the pupil- 
 age and earlier professional life of Dr. Twitchell re- 
 quires me to do so, even if I had no other reasons 
 
 of where I now write. I knew it, and the students had consulted 
 about it; but, 11 o'clock at night, news came to us that he had 
 been arrested. His fate seemed certain, and yet he proved an 
 alibi. I have thought little of " alibis" ever since. I trust, how- 
 ever, that no one will suppose that I believe any person wilfully 
 perjured himself, or that the judge did wrong. In a question of 
 time, so small as five or ten minutes, an individual might be mis- 
 taken ; and, as the defendant obtained evidence of his whereabouts 
 during the evening from others than those who knew his exact 
 plans, a confusion of evidence was produced, which, I think, 
 would have piizzled any lawyer, however astute he might have 
 been.
 
 PRACTICAL ANATOMY IN NEW HAMPSHIRE. 39 
 
 which I deem amply sufficient. Some of these rea- 
 sons I will but very briefly mention in concluding 
 the subject. 
 
 The surreptitious obtaining of bodies for dissections 
 is not carried on now in New Hampshire or New 
 England. There is not the same necessity that 
 existed at the times I speak of. Neither the public 
 nor the profession would at present allow of any 
 such proceedings. But we give no thanks to the 
 statesmanship of New Hampshire for the great re- 
 lief, thus afforded to the profession in the Granite 
 State. In fact, were it not that other States are 
 more liberal in their provisions, and other means for 
 the procuring of bodies are partially at least laid 
 open to the profession, New Hampshire would still 
 be doomed to suffer from the same practices as 
 were needed in former days. Such a state of things 
 is unworthy of a free and enlightened commonwealth. 
 
 Every opportunity should be afforded for the study 
 of anatomy by the medical profession, in the same 
 way as common grammar-school education is, by 
 positive enactments, thrown open to the whole people. 
 The inconsistency of any other course becomes espe- 
 cially manifest, when it is remembered that the sta- 
 tute-book inflicts a severe penalty on any surgeon 
 or physician who is guilty of malpractice. It pun- 
 ishes a man for not doing well w T hat it virtually re- 
 fuses to aid him in learning. Nay, farther, so far as 
 any legislation now exists upon the subject, New 
 Hampshire really endeavors to restrain the medical 
 student from the thorough study of the profession.* 
 
 * In 1834 a law was passed, legalizing the study of anatomy.
 
 40 OBJECTIONS TO ANATOMICAL STUDIES. 
 
 But why has there always been this antagonism 
 between the medical profession and the public ? Let 
 us look fairly at the question. The right and pro- 
 priety, nay, the duty, of giving burial to the dead, 
 seems to have ever been one of the strongest senti- 
 ments in man. The pathetic appeal of Abraham 
 for the burial-place in the field of Machpelah, where 
 he might inter the body of Sarah his wife, moves us 
 as if it were a tale of yesterday. The equally beau- 
 ful death-bed request of Jacob, that he might be 
 carried back, and buried with Abraham and Sa- 
 rah, by the side of Leah, is still read as a most 
 touching natural appeal of a dying old man to a 
 pious son. Of the mighty anathemas of Jeremiah 
 against the Jews of later days, none strike us as 
 more appalling than that in which he proclaims that 
 the fathers and mothers, sons and daughters, shall 
 "die grievous deaths, and shall not be lamented, 
 neither shall they be buried," but shall be as ofTal 
 on the face of the earth. By the Greeks, it w r as 
 considered impious for any one to allow even a 
 stranger to remain uninterred ; for, according to 
 their mythology, the souls of these unfortunates 
 were obliged to wander for a hundred years, before 
 they could enter the mansions of the blessed. The 
 Romans held similar views in regard to the impor- 
 tance of properly caring for the dead, though with 
 some variation in their rites. And, finally, as we turn 
 to Christendom, and read the grand and solemn 
 
 In 1842 that was repealed, when, the Revised Statutes were passed ! 
 The reason for this omission was, as I hear, that the common law 
 allows of dissections !
 
 REVERENCE TO THE DEAD. 41 
 
 burial service which has been used for centuries in 
 the Catholic and English churches, or view the more 
 simple formulas of the various sects of Christians, 
 we feel convinced that the office of paying a last 
 service to those who have left this life has been 
 hallowed by time, and is in accordance with some 
 of the purest instincts of the human heart. If, then, 
 these rites are so sacred in the eyes of all, it is 
 natural that we should resist any proposition which 
 threatens to desecrate them. The idea of dissection 
 must at first suggest this mournful thought. 
 
 There is another and a still more influential 
 cause, which makes us shrink from the dissection of 
 a corpse. With the conception of death comes up, 
 by the closest train of associations, the awful idea 
 of that mysterious power which has laid low and 
 cold the living man. Not only do the dead seem 
 mutely to appeal to us to perform for them the 
 last and only act of affectionate respect which re- 
 mains, before their final return to their native dust ; 
 but God himself, working in our own hearts, likewise 
 urges us. It therefore becomes almost impious to 
 approach the dead with even seeming irreverence. 
 To the superficial observer, the thought of dissection 
 carries with it this idea of sacrilege. How dare we 
 touch with our profane hands that which has been so 
 recently a living temple of the eternal God ! 
 
 With these two objections, I presume, every high- 
 minded physician will fully sympathize. But, at the 
 same time, every man in our profession will feel that 
 there are duties to the living 1 that are more sacred 
 than those which we owe to the dead. To relieve 
 
 4*
 
 42 SURGERY DEPENDENT OX ANATOMY. 
 
 the sufferings of humanity is our object. I would 
 hope, that at times it is among our holiest privileges 
 to be the vicegerents of Heaven in the saving of hu- 
 man life. In order to fulfil this mission in strict 
 accordance with the nobleness of its aim, we must 
 dissect the dead. Where is there a community in 
 which human life has not been preserved by modern 
 surgery ? And how has modern surgery arisen ? 
 Solely by dissections of the dead. If we turn to 
 the domains of pure medicine, we shall find the 
 same ultimate answer. Pathological anatomy is an 
 essential element in every thorough medical educa- 
 tion. How shall we learn of disease, save by laying 
 open before our eyes the ravages of that disease, per- 
 chance, upon the body of a friend ? If, then, dis- 
 sections are necessary for the well-being of the living, 
 shall we neglect them, merely because we fear that 
 the veil of sanctity, which shrouds the form of a be- 
 loved one, may be rudely torn asunder, or that the 
 burial rite may be neglected ? I think not ; first, 
 because dissections are consistent with a due respect 
 for the human body ; and, second, because they may 
 not interfere with the burial rite. 
 
 I do not believe that, by the act of dissection, any 
 man ever was necessarily taught to disrespect a 
 corpse. I am well aware that this view of the sub- 
 ject is contrary to the commonly received opinions 
 of the day. I allow, moreover, that, to those unac- 
 quainted with this process, the medical profession 
 may seem to be little influenced by that awe which 
 naturally arises in the unsophisticated mind, while 
 in the august presence of the dead. We physicians
 
 PHYSICIANS RESPECT THE DEAD. 43 
 
 are able, it is true, to draw nigh, and touch without 
 fear the no longer living body. The intimate study 
 of anatomy becomes deeply absorbing to us. But I 
 deny, that by dissecting we necessarily show more 
 disrespect to the noblest of God's works, than the 
 clergyman does to the Bible by his daily opening of 
 the sacred pages. 
 
 The volume of natural religion is never so widely 
 opened, as when, with the microscope or the scalpel, 
 we trace evidences of beneficent design in our or- 
 ganization. I have never been able so surely to 
 touch a child's soul with the highest idea of re- 
 verence, as when in simple terms I have shown to 
 him the wonderful and various peculiarities of his 
 own frame. But it may be said, that, however much 
 the natural tendencies of dissections may not be 
 inconsistent with true reverence and respect, the real 
 fact is that physicians, as a class, do not honor the 
 bodies of the dead as others do. Upon this point I 
 join issue ; and I declare, that, so far as I have seen, 
 no class of men have more desire to treat with due 
 regard the relics of brother-mortals than our pro- 
 fession has. I cannot now bring to my mind more 
 than two, or at the utmost three physicians, to whom 
 I Avould not be willing to give up for dissection my 
 own dead body or that of a friend, with the full 
 conviction that they would treat those remains with 
 deference. And shall this essential means of instruc- 
 tion be refused, or granted with great unwillingness, 
 to our profession, because a few in it may be un- 
 worthy of confidence ? This surely is not justice. 
 
 But it may be urged by some, that, supposing
 
 44 JUSTICE TO PHYSICIANS. 
 
 every respect is paid to the body, the burial rites 
 will be neglected. By the laws of Massachusetts, 
 that is provided for ; and so they might be in any 
 State. In alluding, in this manner, as I have done 
 before, to Massachusetts, I do not mean to indicate 
 that the profession has no further rights to claim 
 of this commonwealth. Far from it. We are yet 
 in darkness upon the subject. Glimmerings only of 
 light are seen. For these we desire to be duly 
 thankful. The subject deserves a thorough investi- 
 gation; and the medical profession, as a whole, will 
 never rise in this country to the rank it ought to 
 hold, until better views are entertained by the public 
 upon this all-important matter. That investigation 
 should be made in another place. I should not have 
 alluded to it in this work, if it had not been somewhat 
 forced upon me by the history I am endeavoring to 
 portray. And feeling sure that these views, which 
 have now been given, would be wholly accepted by 
 Dr. Twitchell, I trust to be excused, if, in pursuing 
 them, I have seemed too prolix. I confess, more- 
 over, that during these remarks I have had in view 
 the future well-being of my profession. I have 
 wished to demonstrate, at least in some slight de- 
 gree, that the interests of the public and of the 
 medical profession are identical, and that exactly in 
 accordance with the wise liberality of the public 
 toward medical schools will be the class of physicians 
 who shall hereafter practise medicine and surgery in 
 America. 
 
 Twitchell remained two years under the imme- 
 diate care of Dr. Smith. They frequently rode
 
 MEDICAL STUDENT LIFE. 45 
 
 together to attend to the medical and surgical prac- 
 tice of the latter, which, at that time, was very 
 extensive. Twitchell likewise assisted him in the 
 chemical department of the school. But it is not 
 probable that the preceptor's influence was confined 
 to the mere professional training of Twitchell. Dr. 
 Smith's high-toned morality, his bold, free thought, 
 his spotless purity of life, all must have borne with 
 power on the opening mind of his pupil. 
 
 The following letters were written during his 
 pupilage. They serve as an index to Mr. Twitchell's 
 state of mind. I have selected them from a few, 
 now in the hands of Dr. Carter's daughter : — 
 
 "Nov. 8, 1803. 
 " Friend Carter, — In vain do I search the post-office 
 for your promised favors. I find I must first start my 
 quill, with an anticipation of then realizing the friendly 
 effusions of yours. Health with all her blushing train 
 are my attendants, whilst I, with insulated attention, con- 
 centrate my exertions to one object, that is, my profession. 
 Nevertheless, I can employ a few solitary moments in 
 contemplating the fruition of pleasures I once had with 
 now absent friends, and assign myself leisure to pour 
 forth the effusions of a grateful heart, in the acknow- 
 ledgment of their past favors. But when I reflect upon the 
 many obligations I am and shall be under to you, and 
 consider my incapacity to discharge them, I then find that 
 man is and must be a dependent being, since he was 
 formed for society ; notwithstanding Brother Timothy's 
 arguments to the contrary. Were it not, however, for the 
 anticipation of a time when it will be in my power to 
 repay obligations, and to assume more independence than 
 I now can, life would be irksome. But I will have done
 
 46 CORRESPONDENCE 
 
 -with such uninteresting observations, and attend to more 
 current incidents. I arrived at this place on Saturday 
 evening." . . . [He alludes to Dr. Smith and to two opera- 
 tions he saw him perform]. ..." During his absence [Dr. 
 Smith's] I have perused Haller's Physiology and Sharp's 
 Surgery. "Whilst he was on the plain, I perused che- 
 mistry, upon which he was lecturing. He is now be- 
 ginning upon anatomy, and I am reading Cheselden's. I 
 have ridden with Smith to a number of patients in the 
 neighboring towns, and find his practice and practical 
 
 observations highly instructive 
 
 " Dr. David Carter." 
 
 "Windsor, Vt., July 1, 1804. 
 
 " Respected Friend, — .... With regard to my own 
 situation, it is very agreeable. I room with Dr. Smith, 
 and board in a very respectable family a few doors off. 
 The circle of my acquaintance in this town at present is 
 not very large ; but, so far as it extends, I find the people 
 very civil and agreeable, which, I believe, is the general 
 character of the inhabitants. Their attention to strangers 
 is worthy of imitation. My acquaintance with the ladies is 
 not very extensive. I was introduced, a few evenings past, 
 to a very handsome, polite, and accomplished young lady ; 
 but still she is the .... coquette that ever walked the 
 earth ; but no more of this. 
 
 " I have ridden with Dr. Smith between two and three 
 hundred miles, and have seen a number of operations. . . . 
 I have hitherto kept, and intend to keep, a journal of me- 
 dical events,* so that I may review Dr. Smith's method 
 of operating in and treatment of different cases, which I 
 shall happen to see." . . . 
 
 * Unfortunately, this journal, if ever kept, cannot now be 
 found.
 
 WHILE A MEDICAL STUDENT. 47 
 
 111 subsequent letters he speaks much more of 
 his teacher, and gains confidence in his own powers, 
 as he says he shall operate, in certain cases, dif- 
 ferently from his great exemplar. 
 
 Pecuniary difficulties form a prominent topic in 
 his correspondence with Dr. Carter ; and the infinite 
 importance of five or six dollars to the poor youth 
 forms a striking contrast with the comfortable exist- 
 ence he enjoyed in subsequent life. In connection 
 with this subject appears, however, a determination 
 to keep clear of all debts, save to his brother-in- 
 law Dr. Carter, to whom he expresses unbounded 
 gratitude. 
 
 Under date of November 4, 1804, I find the 
 following proposition to a physician, which illustrates 
 what I have stated above in regard to dissections. 
 I do not believe that such a plan would be thought 
 of at the present time. I give it as a sad reminis- 
 cence of former intolerance and wretched ignorance 
 on the part of the public, which forced honorable 
 young men to conceal the act of dissection. 
 
 The extract is as follows : — 
 
 " In confidence, and at the request of two or three 
 of my fellow-students, I make the following communi- 
 cation : I, , N , and perhaps B , being de- 
 sirous to make dissections for a few weeks, would, if you 
 
 thought proper, and was willing, come and reside in 
 
 for that purpose. They would procure the subjects at a 
 distance, and out of the circle of your practice. I think 
 it might be carried on in your study, without any proba- 
 bility of detection. They would board at the neighbors', 
 and assign this spurious reason for their coming, viz.
 
 48 EARLY PRACTICE. 
 
 that Smith, going to he absent from home, advised them 
 to come and read, and ride with you till his return. 
 Should you go to New York, they would endeavor to 
 go through with the business before you went. If you 
 should not, they would take time, and make very accurate 
 anatomical investigations." 
 
 In 1805 he commenced practice at Norwich, di- 
 rectly opposite Hanover, on the other side of the 
 Connecticut river. He settled there at the request 
 of Dr. Smith. I learn, likewise, that at times he 
 lectured on anatomy and surgery, when the professor 
 was ill. His pecuniary success was not great at this 
 place. He suffered the pangs which every young 
 and poor physician has to undergo ; and his fits of 
 despondency were long and severe. He well knew 
 the estimate that had been formed of him ; but he 
 saw no evidence of the truth of that estimate, either 
 in his own sad heart, or in the reception he met with 
 from neighbors, although from his letters he ap- 
 pears to have had some warm friends. By others, a 
 disposition was evinced to destroy his reputation, by 
 the accusation of having been engaged in dissec- 
 tions. An anecdote is told of his having said to 
 a person who seemed disposed to accuse him of this 
 as a very grave offence to good morals, " Why, 
 sir, yes ; you say truly ; I have dissected about a 
 thousand ! " The listener was so astounded by the 
 statement, that he received it as a jocose denial of 
 the whole matter, and so ever after treated it. 
 
 The following extracts from letters to Dr. Carter, 
 written during this period, present points of some 
 interest : —
 
 CORRESPONDENCE. 49 
 
 "Norwich, Vt., May 11, 1805. 
 
 " Friend Carter, — As it respects myself, you appear to 
 doubt my existence ; but you may tell the fair daughters 
 of Israel to * weep not, for Amos is still alive.' I have 
 neglected writing hitherto, hoping that my prospects would 
 brighten, and I should be able to give a better account of 
 myself, especially to a creditor. ... I hope you will not be 
 discouraged with a plain narrative of facts. After I left 
 your house, I rode to Windsor, and tarried two days ; 
 then, with Dr. Smith, I rode to Hanover, and stayed 
 there till Monday, April 1, when I came to this town 
 with Dr. Smith, who introduced me to some of the most 
 respectable families in the place. 
 
 " Here I found four practitioners, Drs. — , — , — , — . 
 
 These two are as malicious towards me as the d . I 
 
 hear but little from the others Thus, you see, 
 
 I shall have slow work in introducing myself into practice. 
 My business, as yet, has paid but about two-thirds of my 
 
 expenses. I have had two cases of surgery Both 
 
 did remarkably well. ... So you see prospects begin to 
 brighten a little. The other day I had the satisfaction 
 
 to be called to advise with Drs. and in a case 
 
 of epistaxis. Their conduct was a little ungentleman- 
 like ; but it has turned very much to my advantage, as the 
 spectators very highly approved of my conduct, and con- 
 demned theirs. It would be tedious to narrate the whole 
 transaction : however, if I could have a few more such 
 interviews, I should take courage. I have a considerable 
 number of warm friends, who appear very anxious that I 
 should tarry among them, and have endeavored to intro- 
 duce me into business, all that was in their power ; and 
 some of the merchants have gone so far as to offer me 
 any thing I may want out of their stores, and take their
 
 50 CORRESPONDENCE. 
 
 pay in doctoring ; and, rather than I should leave the 
 town, they would pay for my board one year." 
 
 The above shows some of the trials of a young 
 practitioner's life ; and it likewise points a moral to 
 the young and old of our profession. No physician 
 ever gained an honorable fame by traducing his neigh- 
 bor. Yet how many hope to rise by this meanness ? 
 By so doing, they injure themselves, lower the stan- 
 dard of medical ethics, and disgust the community in 
 which they reside. 
 
 Under date of June 4th, 1805, he writes as 
 follows : — 
 
 " Since my last, my business has rather increased ; but 
 I still have intervals, in which it is almost impossible 
 to restrain the hyps. When I reflect on the paucity of 
 enjoyments and the exuberance of misery in this world, 
 I think life is scarcely worth preserving. Yet, again, 
 ambition will call me from this state of apathy, and arm 
 me with resolution to overcome all opposition. Thus, 
 you see, my friend, my condition appears to be prepon- 
 derating between hope and despair. At present, hope 
 appears rather to prevail. I am doing business in two or 
 three of the best families in town. . . . 
 
 " On Saturday last, you will conclude I was somewhat 
 surprised, upon receiving the following lines from Dr. 
 Smith : ' Sir, — The executive authority of Dartmouth 
 College have appointed you to deliver an oration on some 
 medical subject, on the next anniversary Commencement- 
 day. Nathan Smith.' 
 
 " My ambition is great ; but my diffidence and conscious 
 inability, I believe, will prevent my accepting the appoint- 
 ment. It is true, if I should undertake the performance
 
 CORRESPONDENCE. 51 
 
 and meet with general approbation, it would be a fine 
 thing for me ; but, if, on the contrary, I should fail of 
 
 pleasing, it would me. Then, candor would 
 
 make allowance for adolescence and inexperience. You 
 know me and my situation : therefore be so kind as to 
 give me your advice upon the subject." 
 
 " Norwich, Vt., June 19, 1805. 
 
 " Friend Carter, — Yours of the 10th instant was duly 
 received, wherein you expressed a decided opinion, that 
 it would be best for me to attempt a medical performance 
 on Commencement-day. I think your remarks upon the 
 subject were just ; yet, I believe, you were not exactly ac- 
 quainted with my situation. You must know, that I shall 
 have to write a dissertation, to be read at my examination, 
 which will be six weeks previous to Commencement ; — 
 this will employ my attention until the examination. 
 And, as I am attending to chemical lectures, I shall not 
 have time to write a dissertation which would answer for 
 an oration. Thus, I shall have only the six weeks which 
 intervene between examination and Commencement to 
 write an oration and commit it. Another objection 
 which occurs is the extra expense I must be at for clothes 
 proper to appear upon the stage. And, indeed, some- 
 times I think I will not take a degree, as it will be un- 
 certain whether I can command cash sufficient ; and, at 
 the best, I shall have to involve myself to the amount of 
 what cash I then need. 
 
 " My business, since I wrote last, has rather exceeded 
 my expenses ; yet that is no object to a person so much 
 in debt as I am. Now, the question is, whether it would 
 be prudent for me to borrow twenty dollars, which I shall 
 expend, if I take the degrees of M.B. and A.M. But, 
 .... it ! why am I troubling you with my complaints ?
 
 52 CORRESPONDENCE. 
 
 I shall be as well off a thousand years hence as anybody. 
 You say you will attend Commencement, if I pronounce 
 an oration : that need not make any difference with you. 
 I shall be just as happy to see you if I do not, and you 
 will be much better entertained. Now, I shall depend 
 upon seeing you and Mrs. Carter here at that time. With 
 regard to the oration, I shall think no more about it till 
 I have completed my dissertation ; then, perhaps, I may 
 turn my attention that way. In the mean time, do write 
 often. Name some subject that would be proper for a 
 medical oration, if I should conclude to write. From 
 what I have written, you will conclude I am nearly 
 insane, and in fact your conclusions will not be far from 
 accurate ; for you know that it is written, ' Dull thinking 
 will make a man crazy.' Yours, Amos Twitchell. 
 " Dr. David Carter. 
 
 " X. B. — I give you many thanks for taking that note 
 T gave brother Timothy ; and perhaps it will be well for 
 you to endorse them on it, as you will never get any 
 thing else." 
 
 "Norwich, August 7, 1805. 
 " Friend Carter, — When I wrote by Mr. Cutter, it 
 was in such haste that I omitted mentioning my deter- 
 mination with respect to taking degrees the ensuing Com- 
 mencement. In your letter of the 10th ultimo, you 
 kindly offer me your pecuniary assistance, if I should 
 need. But I am already so much indebted to you, I dare 
 not accept your offer. A few days previous to my exami- 
 nation, I visited the president, — told him I had almost 
 determined not to take my degrees, on account of the ex- 
 pense. He told me I need not give myself any trouble 
 with respect to his fees ; he would wait till I could make 
 it convenient to pay them. Dr. Smith likewise made me
 
 CORRESPONDENCE. 53 
 
 the same offer, upon which I concluded to go forward. 
 So, I believe, I will not be obliged to you for any more 
 cash till my necessity shall be more urgent. 
 
 " With respect to my oration, after I completed my 
 dissertation, which was only the day before my exami- 
 nation, I began to turn my attention that way. But I 
 have had so much business since, that I have not pro- 
 gressed far. At present I have not much business ; but 
 I anticipate some soon. As it is but three weeks to Com- 
 mencement, it is very uncertain whether I shall be able to 
 complete an oration and commit it. 
 
 " I shall put the greatest dependence upon seeing you 
 and Mrs. Carter at Commencement. I have a great many 
 things I want to say to you ; and, if a man in your situa- 
 tion cannot afford himself the pleasure of such a journey, 
 J am surely living for nought. . . . Accept of the fullest 
 assurance of respect and gratitude from your friend and 
 servant, Amos Twitchell. 
 
 " Dr. David Carter." 
 
 The oration was never delivered ; but the young 
 physician took his degrees of A.M. and M.B. in regu- 
 lar academic course, in 1805.
 
 54 
 
 CHAPTER IV 
 
 FROM 1505 TO 1310. JET. -24— -20. 
 
 Mother's Death. — Correspondence with Dr. Carter. — Prospects. 
 — Despondency. — Anecdote. — Influence of Dr. Smith. — 
 Removal to Marlborough. — Operation of tying Carotid. — His- 
 tory of the Subject. — Views of Contemporary Surgeons, Du- 
 puytren, Rous, Abernethy, Sir Astley Cooper, &c. — Several 
 Minds always work towards one Discovery. — Number of Times 
 the Operation had been performed. — General Results. — 
 Twitchell to be placed in the first ranks of Surgery for this 
 Case. 
 
 Ox November 12, 1805, Dr. TwitchelTs excellent 
 mother died. She had been for years suffering with 
 a most painful and malignant disease. He had been 
 anticipating the event, as a moment of release for a 
 dear parent from a life of great torture. He met 
 it with calmness, and, I doubt not, joy. Who would 
 not wish for death to come, if it will bring peace 
 to a loved one who is a hopeless sufferer ? Nothing 
 but selfish nature could greet that mysterious power, 
 under such circumstances, otherwise than as the 
 choicest of heavenly blessings. It might have been 
 said, at her death, in the beautiful words of the 
 modern poetess, — 
 
 " And, friends ! dear friends ! when it shall be 
 That this low breath is gone from me, 
 And round my bier ye come to weep, —
 
 CORRESPONDENCE. 00 
 
 Let one, most loving of you all, 
 Say, ' Not a tear must o'er her fall ; 
 He giveth His beloved sleep ! ' " 
 
 The following letter refers to the event : — 
 
 " Hanover, N.H., Dec. 18, 1805. 
 
 "Friend Carter, — Yours of the 13th ultimo was duly 
 received, which gave me the unwelcome, though not 
 unexpected, intelligence of a mother's death. Filial affec- 
 tion bids me sorrow ; but philosophical reflection forbids, 
 saying this is only an unavoidable event in the revo- 
 lution of nature. You well know my ideas with regard 
 to such things : therefore I will not enlarge 
 
 " I have of late had the happiness to form an acquaint- 
 ance with Dr. Cowdery, who was a surgeon on board the 
 'Philadelphia' frigate, when captured by the Tripolitans. 
 He now is visiting his friends in Tunbridge, Vt. I find him 
 to be a very fine gentleman : he appears to be a man of 
 good information, as it respects his profession. I was 
 very much pleased with his company ; he repeated many 
 circumstances of his captivity, — the manners, customs, 
 &c. of Tripolitans, some of which you undoubtedly have 
 seen in his journal, which is now publishing in many of 
 the newspapers in the United States 
 
 " Dr. D. Carter." " Amos Twitchell. 
 
 I will here group together extracts from further 
 letters to the same correspondent, as they will afford 
 us a better idea of his actual condition, during his 
 residence at Norwich, than any general description 
 
 I can give : — 
 
 "Norwich, Vt., April 4, 1806. 
 " Friend Carter, — Yours of the 25th ultimo was gladly 
 received. It gave me pleasure to learn that you were
 
 56 
 
 CORRESPONDENCE. 
 
 giving B the privilege of a good school ; but you 
 
 did not inform me who her preceptor was. But, sir, it 
 was with regret that I believe you, when you say E. 
 
 L is dead. I am sure you do not submit to let 
 
 death pass unmolested among your neighbors, and seize 
 upon the most promising of your citizens. I like your 
 observations well respecting Dr. Rush : I am informed 
 that he has published a new edition of his works, which 
 undoubtedly are much improved. 
 
 " With respect to myself, it is now a year since I came 
 into this town. My business, including my services at the 
 College, has amounted to about 250 dollars, which is 
 trifling ; yet, considering the healthiness of the place, 
 and the multitude of physicians, it is doing as well as 
 could be expected .... 
 
 " Amos Tavitchell." 
 
 " Norwich, June 1, 1806. 
 " Friend Carter, — It is a long time since I wrote you, 
 but have had no return. I resume my pen once more. 
 Since I wrote you last, my business has been tolerably 
 good, — in April last I charged upwards of thirty dollars, 
 in May above forty, — and still seems to be increasing. 
 But it still remains a doubt in my mind, whether it is 
 best for me to remain in this place. I am confident I 
 shall obtain the chief of the business, if I do. Yet 
 I believe I might do more elsewhere. My other prospects 
 are about the same as they were when I saw you last. 
 Dr. Smith advises me to tarry. O has been endeavor- 
 ing to persuade me to go with him into York State ; he 
 says he will carry out about fifteen hundred dollars, and 
 go into some eligible place and open an apothecary store, 
 and we will share equally in the profits of the store and 
 our practice. You know my hobby, and I should like to
 
 CORRESPONDENCE. 57 
 
 converse with you upon the subject. I have a desire 
 to go to Philadelphia, and, ambition would even say, to 
 Europe. However, I will drop this subject. I believe I 
 shall see you before winter, when I will explain to you 
 fully. 
 
 " I have a number of interesting cases I should like to 
 relate to you ; but they are lengthy. Of course I must 
 omit them, and will barely mention to you, that, about 
 five weeks since, I operated upon a fistula lachrymalis, 
 which had been of ten years' standing, and succeeded to 
 a charm. Next week, I shall operate upon another. My 
 mode of operating is agreeable to Ware, which differs 
 
 considerably from Bell 
 
 " Amos Twitchell." 
 
 "Bemis's Room, Hanover, Nov. 26, 1806. 
 
 " Friend Carter, — .... It has been suggested to me 
 by a number, that they were desirous I should visit your 
 part of the country, and bring my knives. Your study 
 has been named. If it should meet your approbation, I 
 should willingly sacrifice something to the advantage 
 I think you might derive. They would not wish you to 
 take any part in the transaction, neither would they 
 molest any within your circuit. 
 
 " That .... doctor from Norwich might excite some 
 suspicions in your neighborhood ; but he has become 
 so hardened in iniquity, that he will pay no regard to 
 them except on your account. If you think such a pro- 
 cedure would injure you more than the benefit you should 
 derive from it, I think we had best desist. At least, be 
 pleased to express your opinion upon the subject. 
 
 " It would not be necessary for me to be with you more 
 than a week or ten days at farthest. . . . 
 
 " Amos Twitchell."
 
 58 CORRESPONDENCE. 
 
 "Norwich, Feb. 14, 1807. 
 " Friend Carter, — I have not heard from you since my 
 remembrance, but still hope you are living. I yesterday 
 received a letter from Mr. William P. Cutter, of JafFrey, 
 informing me that Dr. Abner Howe has left Jaffrey, and 
 commenced business in Beverly, Mass. He likewise 
 expressed a desire to come and tarry with me till he had 
 completed his study. I should be proud enough of taking 
 a pupil, provided I had a sufficient library of my own, 
 and was sure of continuing in this place any considerable 
 length of time. But, sir, I am not perfectly satisfied with 
 my situation. It is true, my circuit enlarges ; yet the 
 emoluments of my practice appear rather too small ; and 
 my future prospects are such (provided they should equal 
 my expectation), they would hardly warrant me in spend- 
 ing the prime of my life, before I could attain to any thing 
 like independence. It must be a number of years before 
 I can entirely extricate myself from debt. On the other 
 hand, a future day presents many allurements to entice 
 me to persevere. Thus I remain in suspense, doubtful 
 which way to direct my course. I was in hopes of seeing 
 you ere this time, that I might disclose to you my views 
 at large. But I could not do it without much sacri- 
 fice. . . . "Amos Twitchell." 
 
 "Norwich, April 29, 1807. 
 "Friend Carter, — Yours of the 17th instant has been 
 duly received ; but my present avocations must be my 
 excuse for delaying an answer till some future communi- 
 cation. What I wish now is you would give me your 
 advice in an affair of consequence. Yesterday a friend of 
 mine called upon me, and informed me that he had an 
 affair of honor to settle with a person, who had insulted 
 him in a public manner : consequently, he had invited
 
 CORRESPONDENCE. 59 
 
 him to visit Canada, where they could adjust the affair in 
 safety. He has not had a return as yet ; but the proba- 
 bility is, that the invitation will be accepted. My friend 
 told me he should depend on me as his second ; but I 
 told him I should utterly refuse him. He then said he 
 would excuse me, provided I would attend him as his 
 surgeon. Now, sir, be so kind as to inform me immedi- 
 ately, whether it would be improper for me to attend him. 
 They are both gentlemen of the first character and stand- 
 ing in society. My friend ranks high as a military 
 character. — Yours, sir, in haste, 
 
 "Amos Twitchell." 
 " P.S. Don't tell the old gentleman, my father, of this. 
 You shall hear from me soon." 
 
 "Norwich, May 9, 1807. 
 " Friend Carter, — ... With regard to leaving Norwich, 
 I have not as yet had Dr. Smith's advice upon the subject. 
 Not having had an opportunity of conversing with him, I 
 have barely mentioned it to him. But I have pretty 
 much concluded to quit. I have been looking over my 
 books. I find I am doing very poorly : some have run 
 away ; others are unable to pay ; and not any of them 
 do pay. Of course, I shall never be able to make remit- 
 tances to my creditors, so long as I tarry here. . . . 
 
 " Amos Twitchell." 
 
 "Norwich, August 16, 1807. 
 " Friend Carter, — You undoubtedly think it very 
 strange that I do not visit you ; but business has been 
 such, I have thought it best to delay the journey as yet. 
 I have, since the reception of the money you sent, charged 
 to the amount of seventy dollars. I think, as Com- 
 mencement is so nigh at hand, I shall not be down till 
 after it has past. You then may calculate to see me.
 
 60 ANECDOTE. 
 
 Your pupils, B and L , have called upon me, and 
 
 inform me that a young Esculapian has erected his stand- 
 ard in Jaffrey. What he is I do not learn. Perhaps he 
 may render my success doubtful : I can tell better when I 
 see him. When you see him, tell him he may calculate 
 upon my coming to Jaffrey. — After customary compli- 
 ments, I would in haste subscribe myself, your much 
 obliged and very humble servant, 
 
 "Amos Twitchell." 
 
 During his residence at Norwich, we perceive by 
 his letters that at times he suffered from great des- 
 pondency. Once this increased to a very great 
 degree, as the following anecdote, related a few years 
 ago by him to myself, satisfactorily proves. It gives 
 us also a nearer insight to the relations existing be- 
 tween Dr. Smith and Dr. Twitchell, while at the 
 same time it shows, in a clear light, the sagacious 
 good sense of the preceptor, and his willingness to 
 forget himself for the sake of his beloved pupil. 
 
 Darkness had been resting over the thoughts of 
 the young physician for many days. He sat alone, 
 brooding over his fate, which, as he thought, was 
 destined to deceive all those who loved him. Even 
 Dr. Smith w r as mistaken in him. It was impossible 
 to succeed. He had few patients, and still fewer 
 hopes of having any. At length, he confined him- 
 self wholly to his chamber, and sternly refused to 
 see even those who called professionally upon him. 
 When urged by those at whose house he resided 
 to send for Dr. Smith, or some other physician, he 
 angrily refused, saying he needed no medical atten- 
 dant. Finally, however, the alarmed family sent
 
 ANECDOTE. 61 
 
 over to the professor, and informed him of the circum- 
 stances, and likewise of Dr. Twitchell's absolute 
 refusal to see any physician, even himself. The next 
 day, at early morning, Smith entered the room of 
 the hypochondriac, and the following pointed dia- 
 logue took place between them : — 
 
 Twitchell. — What brought you here ? 
 
 Smith. — I was making my circuit, and it brought 
 me near to you ; and, as I wanted you to make 
 for me some .... (a chemical preparation, of which 
 the name is forgotten), that you used to prepare when 
 a student, I thought I would ask you to go home with 
 me, and make a little, and, at the same time, teach 
 my students the art. 
 
 Twitchell. — I can H go. 
 
 Smith. — But I cannot listen to any refusal. You 
 must go. Besides, I mean to show you a very severe 
 case of gun-shot wound, that I met with a few days 
 since. 
 
 Twitchell. — I repeat, sir, I cannot go. 
 
 " But at the same time," as he told me, " the 
 memory of former kindnesses smote my heart, and 
 immediately I felt that I ought not to refuse. Un- 
 willingly, therefore, I consented, and prepared for 
 the journey. Dr. Smith said nothing ; satisfied with 
 having gained the point of removing me from my 
 own apartment. We were soon in the carriage, and 
 my companion was in his liveliest humor. He told 
 me of every thing he was doing, of all his cases, of 
 the private jokes of the neighborhood ; and all with 
 the same earnestness as he would have done, had I 
 taken the warmest interest in the tales. 
 6
 
 62 ANECDOTE. 
 
 "Arrived at Hanover, I was kept hard at work all 
 day in the laboratory, making chemicals and teach- 
 ing the students until dark. 
 
 "Smith then came home, and thanked me very 
 much for what I had done, and then said, 'It is too 
 late to think of returning now. You will pass the 
 night here.' I protested in vain. ' Besides,' said 
 he, ' there is that patient I told you about: we must 
 get up early to-morrow morning, and go and see 
 him.' Unwillingly, again, I yielded; and the next 
 day, at early dawn, we were in the chaise. I ob- 
 served the doctor had his gun with him, but presumed 
 that his love of sporting, which he had gained in his 
 youth, was the cause of it. We visited two or three 
 patients, and drove farther and farther away from 
 home. About dinner-lime we stopped at a country 
 inn. "We took dinner, and, when we had finished, 
 it was proposed to the landlord, that he should put 
 up some turkeys for us to shoot at. The afternoon 
 passed away rather more pleasantly. We spent the 
 whole of it in sporting, and my mind was taken 
 from the fixed and morbid contemplation of my own 
 thoughts. Evening came, and we were still far 
 from home ; and the result was another night's so- 
 journ at Dr. Smith's, and another prospect of a ride 
 in the morning. The next day, we started again ; 
 and, as we were driving over hill and dale, I re- 
 member as vividly as possible how suddenly it 
 flashed upon me, that Smith, my honored master, 
 had been thus devoting two whole days to cure me 
 of a mere mental hallucination. I felt thoroughly 
 ashamed of mvself at the idea. The charm was
 
 TYING OF THE CAROTID ARTERY. 63 
 
 broken. I knew he had been reading me all the while, 
 and I had been behaving like a fool. We were ra- 
 pidly driving down hill, and Smith was talking as 
 usual, when I burst into a broad horse-laugh. Smith 
 turned, with his keen, kind glance, and said, 'Well, 
 what's the matter now ?' 'I have been thinking,' I 
 replied, i what a fool you must have thought me. 
 I feel heartily ashamed of myself.' t I rather think 
 you will be able to go home to-night,' shrewdly 
 replied my friend. From that moment I was a new 
 man ; and ever after, if I looked sad, Smith would 
 bring me up to a right frame of mind, by asking 
 whether it would not be well to go to Hanover to 
 make chemicals." 
 
 In the latter part of 1807 or first of 1803, Dr. 
 Twitchell removed to Marlborough, the residence of 
 his brother-in-law Dr. Carter, with whom he entered 
 into partnership. It was, moreover, understood at 
 the time that he came for the purpose of devoting 
 himself chiefly to surgery. 
 
 About the time of Dr. Twitchell's leaving Nor- 
 wich, and settling at Marlborough, he performed an 
 operation, which has been justly deemed the crown- 
 ing glory of his early fame as a surgeon. I allude 
 to his tying of the common carotid artery, — one of 
 the main blood-vessels leading to the brain. As this 
 case has given rise to some discussion, I propose 
 to examine the subject a little in detail. I would 
 premise, that, from experiments made upon the 
 horse and some other of the inferior animals, Dr. 
 Twitchell had become convinced that the main ar- 
 teries, going to the brain, could be closed without
 
 64 TYING OF THE CAROTID ARTERY. 
 
 injury to their life. He had not the same confidence 
 in regard to human beings. 
 
 In the month of October, 1807, a young lad, 
 named Taggart, had his jaw shattered by a pistol- 
 shot. All the adjacent parts were severely bruised, 
 and extensive mortifications of them occurred. On 
 the tenth day after the injury, while dressing it, 
 Dr. Twitchell observed that one of the mortified 
 parts lay directly over the carotid. The mother of 
 the lad, an aged woman, was standing near, as the 
 sole attendant ; and he remarked to her, " If that spot 
 goes through the coats of the vessel, your son may 
 bleed to death in a very few minutes." In a paper 
 on the subject, afterwards published, he says: — 
 
 " I applied the usual dressings, left the room, and was 
 about leaving the house, when some one of the family 
 cried out that he was bleeding. I hastened back to his 
 room, and found him deluged with blood. The dressings 
 were immediately removed, and the blood jetted forcibly, 
 in a large stream, to the distance of three or four feet. 
 With the thumb of my left hand, I instantly compressed 
 the artery against the base of the skull, and thus ef- 
 fectually controlled the hemorrhage. The patient had 
 fainted ; and fifteen or twenty minutes had elapsed before 
 he was so much revived that I dared to make any attempt 
 to secure the artery. Then, still keeping the thumb 
 firmly pressed on the orifice, I proceeded to clear the 
 wound from blood ; and, having done this, I made an in- 
 cision, with a scalpel, downward, along the course of the 
 artery, to more than an inch below the point where 
 the external branch was given off ; which, as stated 
 above, had been destroyed at the time of the injury. 
 Having but one hand at liberty, I depended upon the
 
 TYING OF THE CAROTID ARTERY. 65 
 
 mother of the patient to separate the sides of the wound ; 
 which she did, partly with a hook and occasionally with 
 her fingers. At length, partly by careful dissection and 
 partly by using my fingers and the handle of the scalpel, 
 I succeeded in separating the artery from its attachments ; 
 and, passing my finger under it, I raised it up sufficiently 
 for my assistant to pass a ligature round it. She tied it 
 with a surgeon's knot, as I directed, at about half an inch 
 below the bifurcation. 
 
 " I removed my thumb and sponged away the blood, not 
 doubting that the hemorrhage was effectually controlled. 
 But, to my surprise and disappointment, the blood imme- 
 diately began to ooze from the rupture in the artery ; and 
 in less than ten minutes it flowed with a pulsating jet. I 
 compressed it again with my thumb, and began to de- 
 spair of saving my patient. What further could I do ? 
 It was impossible to apply a ligature above the orifice : 
 compression, then, was the only alternative. How was 
 that to be effected ? Should some one sit by the patient, 
 and compress the artery constantly with the fingers till 
 adhesion should take place ? Possibly that might have 
 been done ; but I resolved to make another attempt first. 
 Raising my thumb, I placed a small piece of dry sponge 
 directly over the orifice in the artery ; and, renewing the 
 compression till a little larger piece of sponge could be 
 prepared, I placed that upon the first ; and so went on, 
 pressing the gradually enlarged pieces obliquely upwards 
 and backwards against the base of the skull, till I had 
 filled the wound with a firm cone of sponge, the base of 
 which projected two or three inches externally. Then 
 I applied a linen roller in such a manner as to press 
 firmly upon the sponge ; passing it, in repeated turns, 
 over the head, face, and neck. I directed that the patient 
 should be placed in bed, with his head moderately raised, 
 6*
 
 66 TYING OF THE CAROTID ARTERY. 
 
 and that he should be kept as quiet as possible ; and, as 
 his pulse was very feeble, he having lost at that time 
 between three and four pounds of blood by estimation, 
 he was allowed a little wine and water, and occasionally 
 some broth. We carefully watched him through the 
 night ; but no bleeding occurred, and he complained of 
 but little pain." 
 
 The patient recovered.* 
 
 No one, I think, can read this account without 
 being struck with the decision and masterly surgical 
 power evinced by the operator. And yet he never 
 published any report of the fact, until persuaded to do 
 so, many years afterwards ; and he yielded then to 
 the urgency of a friend, who wanted an article for a 
 medical journal. f His nephew, Dr. Bemis of Med- 
 ford, to whose active kindness in procuring data for 
 this memoir I owe very much, writes as follows: 
 "His unwillingness this case should be published, 
 with others I had drawn up, was partly for the 
 reason, if I remember rightly, that the operation had 
 been in some degree forced upon him in this in- 
 stance by the circumstances, which left him no op- 
 tion. Besides, before the time of putting his notes 
 in order, he had heard of Mr. Fleming's case ; % and 
 this increased the unwillingness he had to publish his 
 
 * For a full account of this case, see Appendix B. 
 
 t XeTv England Quarterly Journal of Medicine and Surgery, 
 vol. i. p. 188. 
 
 % Let it be remembered, that Dr. Twitchell operated in 1807. 
 Mr. Fleming operated in 1803, but did not publish until 1817. 
 Dr. Bemis arranged Dr. Twite-hell's notes in 1837 — 8, after the ope- 
 ration of tying the carotid had become an every-day occurrence.
 
 OPINIONS OF SURGEONS THEREUPON. 67 
 
 own, lest he should seem to claim the credit of ori- 
 ginating the operation." 
 
 Now, I contend that this operation, done at that 
 time, was most admirable ; and that, if Dr. Twit- 
 chell had chosen then to publish the case, he would 
 have gained, by that single act, a European fame, 
 which his subsequent life never would have belied. 
 In order to prove this, let us pass in review the exact 
 state of medical opinions upon the subject, and the 
 amount of knowledge as to the propriety of tying 
 the carotid, which had descended to us from the 
 earliest ages of surgery. 
 
 And first, to classical scholars, as all great sur- 
 geons were until the present century, during which 
 classical studies have been undeservedly neglected 
 by medical men, the very signification of the word 
 "carotid" must have suggested ideas of death. It 
 is derived from Jta^oco, to cause to sleep ; because 
 the earliest professors of our art proclaimed that 
 animals fell into a deep sleep, usually the precursor 
 of death, whenever the great blood-vessels leading 
 to the brain were tied. The opinion was founded 
 more on theory than absolute demonstration. It 
 was, however, a fixed and sacred law of surgery, 
 that, if the artery was tied, the brain would not 
 receive its accustomed stimulus — the blood, and 
 that death would result. 
 
 Another opinion had likewise prevailed until the 
 latter part of the last century, viz. that it would be 
 dangerous to the nutrition of any part, if the main 
 artery leading to it were tied. A priori, this would 
 seem natural ; but the genius of John Hunter had
 
 68 HUNTER, KENDRICK, AND ROUX. 
 
 proved, in 1785, that the main artery of the leg 
 could be tied without destroying the nourishment of 
 it ; and, by that proof, he brought to light one of the 
 most beautiful of God's laws which can be observed 
 in the animal organization, viz. that usually only a 
 few hours elapse, before the smaller arteries enlarge, 
 and take the place of the main trunk which has been 
 shut up. This great English surgeon first proposed 
 to tie the artery in the thigh, for disease in the ham. 
 This was thought a bold proposal. Now it is univer- 
 sally admitted to be correct, and the operation is suc- 
 cessfully done. None, however, suggested operating 
 upon the neck in this way, because of the fear of 
 trouble in the brain, and death. Even as late as 
 1807, Kendrick* does not mention the tying of the 
 carotid for aneurism. 
 
 Roux, the eminent French surgeon, in his " Me- 
 langes," f published in 1809, i. e. two years after 
 Twitchell had successfully tied the carotid, does not 
 allude to the possibility of doing so. 
 
 Still further, I am informed by an eminent sur- 
 geon of this city, that, even as late as 1809, much 
 doubt was felt by surgeons generally, in this coun- 
 try, as to the possibility of tying even the compa- 
 ratively small artery of the arm. [Moreover, Du- 
 puytren, who for a quarter of a century was the 
 chief of French surgery, performed in 1813 (six 
 years after Twitcheil's case) the operation of tying 
 the carotid, as Sir Astley had done for aneurism. 
 
 * Edinburgh Medical and Physical Dictionary. 
 
 t Melanges de Chirurgie et Physiologie, Paris, 1809.
 
 HEBENSTREIT AND ABERNETHY. (39 
 
 It was done, however, not in the presence of the 
 class, but in private, with a select few, and as a 
 " great operation." These facts show the views of 
 Twilchell's chief cotemporaries on the subject. 
 
 As, in every other grand discovery in any branch 
 of learning, no one man reveals the whole ; but 
 several minds work, while all tend towards the same 
 end, until finally one proclaims boldly what the 
 others have prophesied merely : so was this idea of 
 tying the carotid gradually emerging from the dark- 
 ness of preceding centuries of surgery, and was 
 destined to be fully brought out into a bright light 
 by the genius and courage of Sir Astley Cooper. Its 
 history is as follows : Hebenstreit, a German sur- 
 geon, seems to have been the first to mention a 
 successful case. The operation was performed on 
 account of a wound in the vessel, produced during 
 the removal of a scirrhous tumor from the neck. 
 The patient lived. As there is probably no edition* 
 of this work in America, we might safely conclude, 
 even if we had no other evidence, that our friend 
 never knew of the fact. 
 
 Next came the renowned English surgeon, Aber- 
 nethy,f who, in 1804, first published a case, almost a 
 fac-simile of that of Dr. Twitchell. A man had been 
 gored by an ox, and the carotid was injured in its 
 branches. Evidently fearing at first to tie the main 
 artery, Mr. Abernethy closed the superficial vessels. 
 Finding the blood still flowed, he felt compelled, as 
 Dr. Twitchell did three years afterwards, to lie the 
 
 * German Translation of Benjamin Bell's Surgery, 
 t Surgical Observations, 1801.
 
 70 FLEMING AND SIR ASTLEY COOPER. 
 
 vessel, as a mere chance to prevent immediate death. 
 The patient died, and the brain was affected ; so that 
 this case, if Twitchell had known of it, would rather 
 have tended to support the idea above mentioned, viz. 
 that a ligature upon the carotid would disturb the 
 cerebral functions, and cause death. It appears, 
 however, that Dr. Twitchell knew nothing of it. 
 
 In 1803, Mr. Fleming, a naval English surgeon, 
 tied the vessel in a man who had attempted suicide. 
 The patient was saved. This case was not published 
 until 1817.* 
 
 Contemporaneous with this, November, 1803, was 
 an operation of the same kind, by a surgeon of our 
 own country.f A tumor was removed from the neck 
 by Dr. Cogswell, of Connecticut; and, during the 
 operation, the carotid was necessarily cut and tied. 
 Twenty days after the operation, the patient died 
 from slight hemorrhage. This fact was likewise not 
 published until years had elapsed. So that Dr. 
 Twitchell could not have known of it, save by hear- 
 say ; and there is positive evidence, viz. his own 
 assertion, that he knew nothing of it. According to 
 Yelpeau4 Dubois had prepared to perform the ope- 
 ration in 1804 ; but the patient suddenly died on the 
 evening previous to the proposed time. 
 
 November 1, 1805, Sir Astley Cooper operated 
 for aneurism of the carotid. The patient died, 
 although Sir Astley did not give up the hope that 
 
 * Cooper's Surgical Dictionary. Article : Aneurism, 
 f Lectures Introductory to Medical Course of Instruction at 
 Yale College, by Jonathan Knight. 1838. 
 X Surgery, Mott's edition.
 
 INFERENCES. 71 
 
 the operation might, under favorable circumstances, 
 be performed. He was nevertheless obliged to wait 
 until the successful and brilliant result of a second 
 operation in 1808 (one year after Dr. Twitchell had 
 operated successfully),* before he could prove the 
 feasibility of tying this vessel with perfect safety 
 to life. He did not publish the result of this case 
 until 1809. f 
 
 The foregoing statements, I think, will sustain me 
 in the following propositions : — 
 
 1. The general voice of surgery was against any 
 attempt to tie the carotid artery, at the time, October, 
 1807, that Dr. Twitchell successfully tied that artery. 
 
 2. Although some cases had occurred in the hands 
 of a few surgeons, there is evidence that all except 
 one (Abernethy's) could not have been known to Dr. 
 Twitchell in a published form, when he operated on 
 Taggart. Moreover, as Abernethy's case proved 
 fatal, and only confirmed all previous fears on the 
 subject, it would hardly have induced any one to 
 follow the example. 
 
 * Sir Astley, in remarking upon this case, says : "Ina profes- 
 sional point of view, it was very desirable to ascertain the possibi- 
 lity of saving life in a case that had hitherto proved fatal, viz. 
 aneurism of the carotid ; and I could not but feel more than com- 
 mon interest in the fate of a man, who, although he well knew 
 that the trial was new and the risk considerable, never betrayed 
 the smallest signs of apprehension." AVherein consists the " de- 
 sirableness " in this case ? Aneurism of the extremities had been 
 cured by tying arteries. It was a settled point. The question 
 with Sir Astley doubtless was, whether the same operation that had 
 been successful in the leg could be done upon the neck with safety 
 to life. 
 
 t Medico- Chirurgical Transactions, vol. i. 1809.
 
 72 RANK OF TWITCHELL. 
 
 3. We have the positive assertion of Dr. Twitch ell, 
 that he was ignorant of the vessel having ever been 
 tied by any one, although, from his own experiments 
 on animals, he had been led to suspect that it could 
 be safely closed in men. 
 
 Why, then, should he not stand in the same rank 
 with Abernethy and Fleming, so far, at least, as one 
 operation shows the calibre of a man's mind ? Cer- 
 tainly he deserves thus much. Led by his native 
 sagacity, his fertility of resources under difficulties, 
 and by his previous experiments, he performed what 
 a man of smaller intellect and less fortitude would 
 have considered as impossible. By that decision 
 and boldness he saved a human life ! I would not 
 willingly claim any thing more than properly belongs 
 to him ; but really, when I think that he performed 
 the operation, contrary to many of his early medical 
 prejudices, at the risk of his own fame, while un- 
 assisted save by "an old woman" (as he told me) 
 " to wax his thread, and holding on with one hand 
 to arrest the hemorrhage from the open spouting 
 artery, while with the other he dissected down, and 
 displayed its trunk," — when I review all these 
 embarrassing circumstances, and see how nobly he 
 arose above them, I feel a most cordial respect for 
 his surgical genius, and regard him as one of the true 
 nobility of our profession. In saying this, I would 
 not detract an iota from the fair fame of either of his 
 contemporaries. There need be no discussion of 
 their relative claims. They were all discoverers, 
 and deserve equal praise. Sir Astley Cooper arose 
 at a fortunate time to proclaim that the carotid artery
 
 RANK OF TWITCHELL. 73 
 
 could be tied to cure aneurism ; but, if he had not 
 done so, it were very easy to prove that some others 
 would have soon done it ; for the general principles 
 laid down by John Hunter must, sooner or later, 
 have led surgeons to this result. 
 
 Newton was born, it has been said, at a lucky 
 time to discover gravitation. Others were just upon 
 the point of doing the same thing. Leibnitz con- 
 tends with the geometer for the honor of having 
 discovered the principles of the calculus ; and the 
 scientific world grants to each equal honor, because 
 each, by his own unaided efforts, brought out his 
 beautiful result. Leverier and Adams stand side by 
 side in the temple of honorable fame. Why should 
 not the same just rule of estimating a man's true 
 reputation be followed now, and Twitcheli's name 
 be put at least by the side of those of Abernethy and 
 Cooper ? This is all I claim, — that he should be 
 in the front rank of the hosts of modern surgery. 
 More especially do I claim such rank for him, because 
 this brilliant case was only the harbinger of a series 
 of triumphs of his surgical skill, which extended 
 through a period of over forty years. 
 
 I return now to his biography. He had made a 
 contract with his brother, Dr. Carter, to stay with 
 him for a certain period. As that period drew near 
 to its termination, Dr. Twitchell seems to have felt 
 that a larger sphere was needed for his powers. He 
 wished likewise to cultivate his own mind still more, 
 by a further attendance on some medical school. 
 
 The following letter is in answer to one written to 
 him by a resident in Rockingham : — 
 7
 
 74 INVITATION TO ROCKINGHAM. 
 
 " Marlborough, N.H. Jan. 10, 1809. 
 
 " Dear Sir, — Your polite letter of the 14th ult. has 
 been duly received. You mention the loss you have sus- 
 tained by the death of Dr. Levi Sabin. From what little 
 acquaintance I have had with the man, and with his 
 character as a physician, I conclude your vicinity will sin- 
 cerely lament his death, and the faculty will feel the loss 
 of a worthy member. 
 
 " I feel very sensibly the honor you do me in offering me 
 your patronage, with the assurance of that of the principal 
 inhabitants of Rockingham, provided I will make that my 
 permanent residence. True, sir, I do not consider myself 
 permanently settled in this place. My contract with my 
 brother will expire in one year from the first day of the 
 present month ; after which, I have not determined upon 
 any particular residence. I should like Rockingham on 
 many accounts ; yet I believe I should not be so well 
 situated there for the practice of surgery as I am now. I 
 should have Dr. Goodhue on one side ; and I believe, on 
 the other side, Dr. Badger, of "Westminster, is attempting 
 something in that line : how he will succeed I cannot 
 tell. It is very probable that you will be supplied before 
 the termination of my contract ; at which time I have it 
 in contemplation to visit some medical school, the better 
 to deserve the patronage of the public. This suggestion, 
 however, I would not wish to have made public. 
 
 " Thus, sir, I have given you a brief sketch of my 
 views, from which you will learn that it is not in my 
 power to comply with your request at present."'
 
 75 
 
 CHAPTER V. 
 
 FROM 1810 TO 1815. JET. 29—34. 
 
 Removal to Keene. — Even Tenor of Life. — Practice. — " Spotted 
 Fever." — Independence of Twitchell. — Dislike of Nosologies. 
 
 — Letter from Dr. Carter. — New Hampshire Medical Society, 
 Member, 1811. — Offices held by him during Life. — President, 
 &c. — Orator. — Engagement to Miss Goodhue. — Correspond- 
 ence. — Practice. — Assemblies at Keene. — Pupils. — News 
 of Peace. — Rejoicings. — Horseback Rides. — Marriage, 1815. 
 
 — Character of Mrs. Twitchell. — Influence on her Husband. — 
 Death, 1848. — Effect of her Death on Dr. Twitchell. 
 
 In 1810 Dr. Twitchell went to Keene, from which 
 place he never removed, although, as we shall see, 
 he had not a few invitations so to do. There he 
 labored for about forty years, gradually rising to a 
 fame of which any one might have been proud. 
 For years, I may say it without for one moment 
 seeming to underrate any other practitioner, he stood 
 literally at the head of the profession throughout that 
 portion of our country. He was also known, by 
 correspondence on medical cases, to most of the 
 ablest men in all parts of the United States. Never- 
 theless, the whole of his life flowed onward in a 
 quiet and even tenor, — always active, yet never 
 unduly excited ; so that, though we may see the
 
 76 LIFE AT KEENE. 
 
 result ill the solid fame which he acquired, it will 
 present in its recital no striking passages. 
 
 Slowly and amid many tribulations, as we have 
 already in some measure seen, did his strong mind 
 develop itself. We can but dimly trace its progress, 
 though we may feel it when comparing one epoch 
 with another. I shall speak of his life at Keene 
 under various heads, among which I shall weave 
 whatever of correspondence I can gather. 
 
 We have brief records of all his operations per- 
 formed between 1808-14. This record was made 
 in 1842, according to the dictation of Dr. Twitchell, 
 from his day-book. It is unfortunate that these notes 
 are not taken more in detail ; but, meagre as they 
 are, they prove that at that period he must have been 
 well known ; for, out of between ninety and a hun- 
 dred operations, many of them are the most impor- 
 tant in surgery. 
 
 Within a year or two after he commenced practice 
 in Keene, the " spotted fever," so called, began to 
 appear as an epidemic ; and a panic was the result. 
 The country practitioners in general might be divided 
 into two classes ; viz. the learned, who were bound 
 hand and foot to their nosologies, and who con- 
 sidered it of infinite importance to name and classify 
 a disease before commencing treatment ; and the 
 grossly ignorant, who, though independent of the 
 shackles of classifications, were disposed to treat 
 all cases, which they supposed to be spotted fever, in 
 one and the same way. Twitchell's native vigor of 
 mind came gloriously into play on this occasion ; 
 and he gained much reputation for his successful
 
 SPOTTED FEVER. 77 
 
 treatment of this alarming complaint. Feeling that 
 the idea of the necessity of classification, in order to 
 a proper treatment, had been carried to an absurd 
 extent, he renounced the doctrine. He would give 
 no name, but would treat symptoms as they arose. 
 If a man were burning with fever, he would prescribe 
 ice ; if shivering with cold, he would stimulate until 
 fever came on, and then have recourse again to refri- 
 gerants. All this seems very sensible, according to 
 our present medical theories ; yet, such is the power 
 of habit, he was considered somewhat singular in his 
 day. His course was, however, in fact the really 
 wise combination of the heroic and expectant treat- 
 ments. The following letter, from his witty brother- 
 in-law Dr. Carter, so quietly informs us of the 
 absurdities of the profession, and the alarm created 
 by the appearance of the disease, that I cannot for- 
 bear quoting it : — 
 
 "Marlborough, 28, 1810. 
 
 " Friend Twitchell, — After hearing very alarming ac- 
 counts from the frequency of the spotted fever at Fitzwil- 
 liam, I had the curiosity to go down there this morning 
 
 to learn of Drs. , , and , the symptoms 
 
 as it appeared with them. I had the good luck to find them 
 
 all at home. Dr. is unwell. Perhaps they would 
 
 say he is convalescing ; therefore I made not much inquiry 
 of him, except as the monster attacked him, and the treat- 
 ment, &c. Dr. has had all the violent cases, — he 
 
 thinks to the amount of twenty cases ; and I think it pro- 
 bable he has been called to twenty patients that have 
 complained of something. But I cannot learn to my 
 satisfaction that there has been a single case in Fitz- 
 7*
 
 73 NEW HAMPSHIRE MEDICAL SOCIETY. 
 
 williara. They make it appear like a hundred-headed 
 monster, attacking in every form imaginable : therefore 
 
 they have no other complaints. Dr. tells me, 
 
 that he has not bled, puked, nor purged for three weeks 
 past ; but gives from ten to fifteen grains of opium, once 
 in three or four hours, for forty-eight hours ; at which time 
 he begins to lessen his doses, and tapers down ; and by 
 that time they are safe. Queer complaint indeed ! 
 
 " You had better go down, and learn how to make all 
 anomalous complaints put on one and the same type, and 
 yield to one and the same treatment : it will save you 
 much thinking in future. 
 
 " If they have had a case of it, I have no doubt but I 
 have had several ; but I am not so fortunate as to make 
 brandy and opium cure mine, therefore am put to the 
 trouble of thinking a little before I prescribe. 
 
 "To be serious, I had rather have the spotted fever in 
 Fitzwilliam than the itch ; for I should rather drink 
 brandy freely than roast with brimstone. — Yours, 
 
 " D. Carter." 
 
 In 1811 Dr. Twitchell was chosen a member of 
 the New Hampshire Medical Society, and from that 
 time until death always felt the liveliest interest in 
 it. He was, as a friend writing to me says, " the 
 idol of the association." In 1815 he was elected 
 one of the censors ; subsequently, in 1823, became 
 a counsellor. Each of these offices he held several 
 years. For three years from 1S27, he was its presi- 
 dent. On some of these occasions he read scientific 
 papers.* In 1833 he was orator. Later he was 
 elected to represent the society in the American 
 * See Appendix, B, E, H.
 
 MARRIAGE. 79 
 
 Medical Association, and the convention for the re- 
 vision of the Pharmacopoeia. It is interesting to 
 notice, that, although he had probably more business 
 than any other physician in New Hampshire, he 
 almost invariably attended the meetings of each and 
 all of these societies. This doubtless arose in part 
 from his social qualities ; but he had higher reasons. 
 His confidence was great, that by these unions we 
 elevate the profession. Wherever man meets with 
 man in friendly interchange of thought, nay, Ave may 
 sav that wherever a human being meets another with 
 a kindly look, even if no words be spoken, by that 
 very contact and that look the two are benefited and 
 elevated in the scale of human existence. None but 
 a misanthrope thinks otherwise. Dr. Twitchell was 
 no hater of his race. 
 
 Some time in the early part of 1314 or latter por- 
 tion of 1813, Dr. Twitchell became interested in the 
 excellent woman who subsequently became his wife. 
 She was the daughter of Dr. Josiah Goodhue, of 
 whom we have already spoken, as the chief surgeon 
 previously to Dr. Smith's appearance at Hanover. 
 As usual, the course of true love did not run with 
 entire smoothness, and Dr. Twitchell's letters evince 
 great anxiety lest clouds may come to overshadow 
 their fair prospects. Occasionally, he lets forth 
 his thoughts in scraps of quoted poetry, which, to 
 those of us who knew him in later days, seem as 
 incongruous with his nature as the idea of a philoso- 
 pher flirting with a lady's fan. We find allusions to 
 his increasing practice, which prevents the lover from 
 leaving his post, especially in 1814, when the typhus
 
 80 CORRESPONDENCE. 
 
 fever seems to have been very prevalent. Under 
 date of Feb. 23, 1814, he says, " The cries of dis- 
 tress have prevented me from being with you this 
 evening, and are likely to prevent for days to come." 
 He then states that he had been called that day to 
 several cases of fever, and describes the panic which 
 had seized the friends. On another occasion he 
 pleads the same difficulty of constant and perplexing 
 business, as a reason why he cannot write so often as 
 he would like. Dr. Twitcheli's letters I do not feel 
 at liberty to quote from very freely. They are 
 models of the quiet, affectionate expression of an 
 honest and unimaginative mind to a woman whom it 
 loves sincerely. Reason is the governing power. 
 Love-rhapsodies are unknown. On the death of her 
 sister, he tries to support her heart by the follow- 
 ing : " It is the duty of rational beings not to make 
 themselves miserable at events which are beyond 
 their reach to control, but with a calm resignation to 
 consider that He who governs the universe orders 
 every thing for the good of the whole." 
 
 Under date of January 1st, I find as follows *. — 
 
 " I hope my expectations are governed by reason, al- 
 ways keeping in view the frailty of human nature, and 
 endeavoring as much as possible to smooth the asperities 
 of life by an equanimity of temper. . . . Last Tuesday 
 evening, we had an assembly, or an assemblage. I went 
 at half-past eight, and was called away at nine ; so you 
 see that my enjoyment or suffering could not be great. . . . 
 I am now called to visit a patient at JafFrey this evening, 
 the distance of fifteen miles. To prevent being lone- 
 some, I shall carry you with me. I cannot say how you
 
 CORRESPONDENCE. 81 
 
 will like the ride ; but, as you are not here to refuse, I 
 don't see how you can help yourself; and, as the vulgar 
 saying is, I will do as much for you some time. 
 
 " Yours affectionately, " Amos Twitchell." 
 
 The above is almost the sole specimen of even a 
 disposition to be jocose while writing to Miss Good- 
 hue. 
 
 It appears by one letter, that he has already a 
 class of students : — 
 
 "Oct. 28, 1814. 
 
 " Yours of the 24th was received with pleasure. The 
 contemplated visit will give me pleasure, if it be in my 
 power to be of the party, which shall be my endeavor. 
 My pupils have all left me to attend lectures at Xew 
 Haven ; * and I have this day performed a very important 
 surgical operation ; and, whether it will be safe to leave 
 the patient at that time, I cannot say ; but you may cal- 
 culate upon seeing me, unless very urgently detained. . . . 
 Believe me when I tell you, that I sincerely join in your 
 supplication that we may have entire confidence in each 
 other's lasting friendship and affection." 
 
 "Feb. 19, 1815. 
 " Dear Elizabeth, — Your promised letter has not ar- 
 rived. I conclude that William has not passed through 
 this town, and you are waiting for a few of my scrawls 
 before you send it by mail. You shall have them. Time 
 passes with me much as usual, — much engaged in 
 business, and constantly anticipating future enjoyments. 
 Last Tuesday, about eleven o'clock a.m. we received 
 the joyful news of peace being concluded between our 
 minister and the British. You scarcely can conceive 
 
 * Dr. Smith was transferred to New Haven in Oct. 1813.
 
 82 PEACE WITH GREAT BRITAIN. 
 
 what effect it produced upon all classes of people in this 
 place. Business was entirely neglected. The bell was 
 kept constantly ringing from the time the news arrived 
 until ten o'clock in the evening ; and there was a good 
 deal of powder burnt upon the occasion. In the even- 
 ing, we had a very splendid illumination of all the 
 houses, shops, and stores, with the meeting-house and 
 court-house. The next day, the street was very much 
 thronged with people from the vicinity, who assembled 
 here to learn the foundation of the news, and rejoice with 
 each other. They kept the bell ringing most of the time 
 this day also. Parker's company of light infantry, and 
 Perry's company of cavalry, turned out in uniform. We 
 are all waiting anxiously to hear that the president has 
 signed the treaty." * . . . 
 
 I presume that this description of the intense joy 
 with which news of peace was received by all parties 
 in Keene, is only a slight exemplification of the great 
 and unanimous voice of exultation which arose on 
 that occasion from every quarter of our common 
 country. Each party seemed to vie with the other 
 in the utterance of the joyful hopes of peace. 
 
 Here is another specimen of his country surgeon's 
 life, under date of March 1, 1815 : — 
 
 " Had I the poetic talents of , I might amuse 
 
 you with the description of my tour to Stoddard yester- 
 day. I met with as many disasters as he did in his 
 sleigh-ride, when he ' came across back from Pomfret to 
 the Sound on horseback.' In short, I found such snow- 
 drifts, that I was obliged to leave my horse, and travel on 
 
 * Peace had been concluded at Ghent, Dec. 12, 1814.
 
 COUNTRY RIDING. 83 
 
 foot three miles out and back again. I was very much 
 fatigued, and took some cold ; but I have felt so well 
 to-day that I have ridden thirty miles on horseback ! " 
 
 The next letter is chiefly occupied with details of 
 arrangements for housekeeping, and anxieties natu- 
 ral to these new hopes. The riding seems still to be 
 any thing but agreeable. He writes thus : — 
 
 "We have had so bad riding in this vicinity, that I 
 have delayed visiting Chester, hoping that it would soon 
 be better ; though there is scarcely a day passes that I do 
 not ride thirty miles. Yet, after dashing through mud 
 that distance, I am not in a situation to enjoy comfort. 
 If the roads do not become passable for a chaise soon, I 
 shall take the stage and visit you." 
 
 In the early part of June, 1815, the worthy couple 
 were married ; and, for more than thirty-three years, 
 they enjoyed life together in the quiet daily progress 
 of their wedded state. Mrs. Twitchell had an active 
 mind, which was almost wholly absorbed in domestic 
 duties, and in thoughtfulness for her husband. Her 
 life was one unbroken tissue of devotion to him who 
 was her glory. It has been thought by some who 
 were warm admirers of both, that her great anxiety 
 for his physical well-being did not tend to develop 
 some of the finer qualities of his mind. This remark, 
 however, applies more to the influences exerted by 
 her upon the husband's relations to the world than 
 to their own married state. No man, I believe, ever 
 had a wife who sought more to make home a haven
 
 ^4 MRS. TWITCHELL. 
 
 of rest and of gentle quiet, after long and severe 
 labors. The moment Dr. Twitchell entered the 
 house was the signal for her quiet but efficient 
 energy to display itself in behalf of his comfort. 
 All sounds were hushed, and the repose of his 
 body and mind was considered paramount to every 
 thing else. Unquestionably, this entire rest was 
 at times necessary. It doubtless contributed to his 
 health and long life ; and we should therefore be 
 chary of suggesting that any other course would 
 have been better. It is possible that his excessive 
 bodily toil, combined with his great love of social 
 intercourse, might have for ever prevented him from 
 directing much time to literary labor. His natural 
 indisposition to writing was, however, fostered even 
 by the good qualities of his wife, as evinced in 
 this constant and untiring watchfulness for his com- 
 fort. Had she been otherwise constituted, it is 
 possible that his life might have been, it is true, less 
 happy, and perhaps it would have been shorter; 
 but he would have had a wider influence and a more 
 enduring fame. If, instead of constantly suggesting 
 quiet sleep for body and mind on his return from 
 business, she had gently led him to overcome his 
 repugnance to writing, — had she stimulated him, as 
 any truly beloved woman can stimulate a man, with 
 a desire for literary reputation, — it is possible that 
 Dr. Twitchell would have left in print a work upon 
 which our profession in future time might have 
 looked with great pride, as upon a monument really 
 significant of his intellectual power. No compre- 
 hensive work on surgery, such as a mind like his, and
 
 HOME INFLUENCE. 85 
 
 with his ample opportunities should have left, ever 
 issued from his pen. Comparatively speaking, his 
 life dies with him. 
 
 I make these remarks with some sorrow; but, 
 recognizing the mighty influence of woman on man's 
 destiny, I cannot do otherwise ; for the records of 
 biography, and the deductions of reason, alike prove 
 that the marriage-vow should not chiefly promote 
 the repose of husband or of wife, but should tend to 
 elevate both. While alluding thus to a wife who 
 was so beloved by our departed friend, let me add 
 that regret is merged in pleasure at the thought, that, 
 though her nature did not lead her to the hope of 
 literary reputation for her husband, she seemed 
 verily to worship the great traits of his manly charac- 
 ter. By that adoration, her life was made one con- 
 tinued series of self-sacrificing tenderness and love. 
 Her uniform quiet cheerfulness was frequently his 
 support. She was, moreover, a model of a physi- 
 cian's wife, in the care and many kindnesses with 
 which she ministered to those who called to consult 
 him. If he were absent, Mrs. Twitchell knew how 
 to bestow upon them those thousands of apparently 
 unimportant attentions a loving wife will give, when 
 she thinks substantial good will result therefrom to a 
 dear husband's cause. 
 
 Growing up thus together, year after year, their 
 ties became more and more close, so that at last they 
 seemed inseparable, and all who knew them felt that 
 to take one from the other would shatter the heart of 
 the survivor. For many years, the wife looked 
 anxiously at the husband, who seemed slowly, but
 
 ^G wife's death. 
 
 surely, wending his way to the tomb with malignant 
 disease. Yet, so strange are the mutations of this 
 life, the husband recovers from his disease, and the 
 wife is stricken down suddenly from his side. She 
 died of lung fever, October, 1848. Dr. Twitchell 
 was wholly prostrated by his loss, and for hours he 
 was afflicted with one of his severe fits of despond- 
 ency. At length, however, his stern reason tri- 
 umphed, and he came forth again among his fellows. 
 He resumed his rides over his beautifully romantic 
 native hills. Nature spoke to him, as of old, of an 
 all-powerful, all-beneficent Being ; and he submitted 
 cheerfully to his lot. Those who knew him inti- 
 mately tell me, that they think he was never quite 
 himself again. So far as his life was concerned, 
 " the golden bowl was broken, and the pitcher 
 broken at the fountain." He assumed many duties 
 which w r ere new to him in the domestic arrange- 
 ments, and the current of his existence appeared to 
 go onward in its accustomed routine of daily profes- 
 sional labors. 
 
 In speaking thus of Mrs. Twitchell, in order to 
 condense into one passage every circumstance that 
 it was important to relate concerning her, I have an- 
 ticipated my story. I will now return to it. 
 
 Among his papers, I find the following letter, which 
 I transcribe as somewhat indicative of his charac- 
 ter : — 
 
 (Tom off) 18, 1818. 
 
 "Rev. Sir, — As you have long been the friend and 
 acquaintance of my wife's connections in Chester, it is 
 her wish, together with mine, that you or Mrs. would
 
 CORRESPONDENCE. 87 
 
 be so kind as to give to N B the intelligence 
 
 that her sister Elizabeth, who has resided with us, and 
 been the delight of our eyes, died this morning a quarter 
 before eight o'clock. She was attacked two weeks since 
 
 with a complaint of the head. ... As N is a child 
 
 of great sensibility, we concluded, as you were intimately 
 acquainted with her, that you would be the most suitable 
 person to give her the information. ... In complying with 
 the above request, you will confer a great favor upon your 
 afflicted friend, " Amos Twitchell. 
 
 " , Esq."
 
 CHAPTER VI. 
 
 FROM 1815 TO 1849 jET. 34- 
 
 Offered a Professorship at Dartmouth College, 1819 ; at Vermont 
 Academy of Medicine, 1824 ; at Castleton, 1826 ; at Bowdoin 
 College, 1826. — Invited to reside at Boston. — Trepannning 
 of Tibia. — Preceded by Sir Benjamin Brodie. — Extensive 
 Bides. — Dangers ; Labors. — Circular to Patients. — Letter 
 to a Young Friend. — Temperance. — Anecdotes. — Youths at 
 the Tavern. — Tobacco-chewing. — Farmer and his Corn. — 
 Visit to Philadelphia as Temperance Delegate. — Anecdote. — 
 Temperance Addresses less successful than his Conversation, 
 — Temperance Documents. — Politics. — Asylum for Insane. — 
 American Medical Association ; Origin ; Interest of Dr. Twit- 
 chell in its "Welfare ; Delegate to its Meeting. 
 
 In the spring of 1819, Dr. Twitchell received over- 
 tures from gentlemen belonging to the Medical 
 Faculty of Dartmouth College, in regard to his ac- 
 ceptance of a professorship, which was about to 
 beome vacant. 
 
 I find the following letter thereupon : — 
 
 "June 28, 1819. 
 "Rev. and dear Sir, — Your polite letter of the 17th 
 instant was duly received. I have maturely considered 
 the propositions therein contained, and have consulted 
 some friends upon the subject; and have come to the 
 conclusion, that to accept of a professorship under the 
 circumstances which Dr. proposed would be making
 
 HANOVER PROFESSORSHIP. s 9 
 
 too great a pecuniary sacrifice. Were it probable that 
 I could discharge the duties of the station in a suitable 
 manner, and that the emolument would be sufficient to 
 indemnify me for the sacrifice of business and extra ex- 
 pense attending so long an absence from my family, I 
 would cheerfully accept of the appointment; but I am 
 
 fully convinced that would not be the case. Dr. 
 
 informed me that the fees of each professor heretofore have 
 averaged about one thousand dollars, a greater part of 
 which would be students' notes, which, in my hands, 
 would not be worth fifty per cent. Besides, I am appre- 
 hensive that the number of students will be less than for 
 several years past. All those in this vicinity, who have 
 money to defray the expense, are calculating upon attend- 
 ing lectures either at Boston or New Haven. Had you 
 sufficient funds to give your professors a suitable salary, 
 they would be more useful to the institution by devoting 
 their time and talents exclusively to its promotion; but 
 circumstanced as you are, when the only salary you can 
 afford your medical professors is what they can obtain 
 from young men who are struggling hard with poverty in 
 the pursuit of their profession, it cannot be expected that 
 any one situated as I now am should feel willing to 
 accept of the office. I should anticipate much pleasure 
 in being connected with a literary institution, no small 
 share of which would arise from a personal intercourse 
 with its officers and other literary men. But the uncer- 
 tainty of health and life is such that I consider it a duty 
 I owe to myself and my connections to devote my time 
 and talents to the pursuit of such objects as will be most 
 beneficial to my fellow-creatures, and at the same time 
 be most likely to afford me a competence when my labors 
 shall fail. Taking this view of the subject, you will not 
 think it surprising that I should decline accepting an 
 8*
 
 90 CASTLETOX PROFESSORSHIP. 
 
 office, the emolument of which would be less than what 
 I derive from my practice. 
 
 " I am, sir, with sentiments of great respect and esteem, 
 your obedient, humble servant, 
 
 " Amos Twitchell. 
 
 " JRev. Francis Brown, President of 
 Dartmouth College." 
 
 In 1824, on the resignation by Dr. Gallup of his 
 professorship at the Vermont Academy of Medicine, 
 the late Dr. Allen consulted Dr. Twitchell about 
 accepting that office. He did so simply as an indi- 
 vidual, and I mention the fact merely to show the 
 reputation of Dr. Twitchell. I am not aware that 
 any formal proposition was made to him on the 
 subject. In April, 1826, he received a private letter, 
 informing him, that, if he would consent to accept 
 of the office, he would be appointed Professor of 
 the Theory and Practice of Medicine, Medical Juris- 
 prudence, and Clinical Practice, at Castleton. Dr. 
 Twitchell seems to have felt as on the previous occa- 
 sion, and to have answered much in the same terms. 
 He proceeds thus : — 
 
 " My professional business now is worth more than 
 three thousand dollars a year, and I am so situated that 
 the probability is that it will not diminish, if my health 
 remains good. But, sir, if I should leave my business 
 two or three months in a year, it would go into other 
 hands ; it would be thought an object for a man of talents 
 to endeavor to divide it with me, and he would most 
 assuredly be able to accomplish it. These considerations 
 induced me to decline a Professorship in the Medical In- 
 stitution at Dartmouth College, to which I was appointed
 
 PROFESSORSHIP AT BOWDOIN. 91 
 
 by the corporation a few years since. Had you found 
 that you could give your professor twelve or fifteen hun- 
 dred dollars per year, then no person qualified for the 
 office would hesitate to accept of the appointment. . . . 
 Taking this view of the subject, you will not think me 
 unreasonable in saying that I should feel unwilling to 
 undertake to discharge the duties of the professorship, 
 unless I can be assured of at least twelve hundred dol- 
 lars per year. 
 
 " I am, sir, with respectful consideration, your very 
 humble servant, "Amos Twitchele. 
 
 " Hon. Chauncy Langdon." 
 
 In June of the same year, he was invited to be the 
 successor of his able and beloved master, Dr. Nathan 
 Smith, at Brunswick, Me. He received a letter 
 from Professor Cleveland, informing him that Dr. 
 Smith was about to retire. To this letter the follow- 
 ing reply was given : — 
 
 "Keene, July 28, 1826. 
 
 " Dear Sir, — Sickness has hitherto prevented me from 
 answering your very polite letter of the 17th ult. I have 
 yet an affection of the lungs, which renders it doubtful 
 whether I shall be able to attend to much business at pre- 
 sent, if ever. Thus circumstanced, you will readily per- 
 ceive the impropriety of my accepting of a professorship in 
 your institution. Was my health firm, it would be folly 
 in me to relinquish a practice worth between three and 
 four thousand dollars a year in a pleasant part of the 
 country, unless I could be as pleasantly situated else- 
 where. I should anticipate much pleasure in being 
 connected with a literary institution, would my health 
 warrant an engagement of the kind, provided I could 
 have a salary that would remunerate me for giving up a
 
 92 INVITED TO RESIDE AT BOSTON. 
 
 lucrative practice ; but, as my situation now is, I must 
 renounce any idea of the kind. 
 
 " Accept, sir, the assurance of my respect and esteem. 
 
 " Amos Twitchell. 
 
 " Parker Cleveland, Esq." 
 
 Finally, in 1827, he was requested to accept of 
 the office of Professor of Surgery and Midwifery in 
 the University of Vermont. These offers, made by 
 so many literary institutions, prove that his fame was 
 widely spread. There were likewise many efforts 
 made at various times by individuals to induce him 
 to leave Keene, and to settle in a large city, where a 
 wider field for the display of his talents might have 
 been afforded. It will be perceived by the following 
 extract from a letter, that some wished him to take 
 up his residence at Boston. He did at times think 
 seriously of so doing ; but the dread of leaving a 
 certainty, such as he had at Keene, for an uncer- 
 tainty in a large city, probably prevented him. 
 
 " Boston, oth January, 1821. 
 " Dear Sir, — It was my intention, before I left Keene, 
 further to converse with you respecting your fixing your 
 residence in this town ; but the bustle and confusion of two 
 or three of the last days prevented. In urging you to this 
 measure, if I know myself, I am governed by friendly mo- 
 tives. I have advised with your acquaintance, and others 
 who are acquainted with your reputation, and they enter- 
 tain but one opinion on the subject, and that altogether 
 favorable to your coming. All the gentlemen of your 
 profession, save two of high standing, would be delighted 
 to see you in practice here. I have conversed with 
 Drs. , , , : they express their warmest
 
 TREPANNING OF THE TIBIA. 93 
 
 wishes in your behalf. If you will take a view of the 
 whole ground, you find that not one argument can be 
 brought in favor of your remaining in that cold, inhospi- 
 table clime." .... 
 
 In 1840 he performed an operation, from which 
 he derived an enviable reputation among his friends, 
 and not a few medical practitioners. The follow- 
 ing account of that case I have obtained from Dr. 
 Hosmer of Watertown, who, in a letter to me, 
 writes thus : — 
 
 " E W , of N , Mass. at the date of the 
 
 operation, February, 1840, was thirty years of age, and of 
 a scrofulous habit. He had suffered almost constant and 
 often very severe pain, just below the knee, for eighteen 
 years. It was always referred to the same place, which 
 presented scarcely any change in the external appearance, 
 save that, under a very careful examination, a slight en- 
 largement could be observed. He had been under the 
 care of the most eminent of the faculty without any per- 
 manent relief. At the time above named, while on a visit 
 to his (Dr. Twitchell's) house, I described the case ; and, 
 to illustrate his character for rapidity of diagnosis, and as 
 evidence of his professional decision and readiness to pro- 
 ceed at once to a formidable operation in a case extremely 
 rare, I will state his reply. * There is matter in the 
 bone.' 'Why do you think so?' 'I have seen just 
 two cases.' ■ How did you ascertain their character : ' 
 ' I amputated and examined the bones.' * On my return 
 
 * I have heard from good authority that a deaf and dumb man 
 was at the last operation ; and that, when he saw the pus running 
 from the bone, he gave a significant glance at the doctor, and imi-
 
 94 BRODIE ANTICIPATED HIM. 
 
 home, I stated to the patient Dr. Twitchell's opinion ; and 
 the next day he was on his journey to Keene, where, on 
 the day after his arrival, Dr. Twitchell trephined the 
 bone, and discharged one and a half ounces of pus. The 
 wound closed in a few weeks, since which time the patient 
 has been perfectly well." * 
 
 Dr. Twitchell thought this operation of trepanning 
 the bone was his own, and that no one had preceded 
 him, although it is certain that he never publicly pro- 
 claimed this opinion. Most of his neighbors and 
 friends, however, believed it was his. Eminent sur- 
 geons regarded it as such. I do not think that he 
 ever saw the paper published by Sir Benjamin 
 Brodie f in 1332 ; that is, eight years before Dr. 
 Twitchell performed the operation. In this interest- 
 ing paper, that eminent surgeon gives details of his 
 proceedings in three cases. In the first, amputation 
 was performed. In the second, after partial relief 
 had been obtained by cutting down merely on the 
 bone, trepanning was proposed, and performed with 
 entire success. Subsequently another case hap- 
 pened, in which trepanning was performed imrae- 
 
 tated with his hand the motions necessary in using a gimlet or 
 awl ; indicating that he perceived the leg might have been saved, 
 had the bone been perforated. 
 
 * Since writing the above, I have seen a full account of the 
 case as described by the patient himself. By it, it appears that he 
 had consulted the most eminent surgeons in Massachusetts, some 
 of whom had treated him for months. No one, however, had dis- 
 played the diagnostic subtlety evinced by Twitchell. 
 
 t Med.-Chirurg. Trans, vol. xvii. ; 1832 ; " Chronic Abscess of 
 the Tibia." James Deane, M.D. of Greenfield, Mass. has lately 
 published some interesting cases of the same kind : Boston Medi- 
 cal and Surgical Journal, 1850.
 
 EXTENSIVE MEDICAL PRACTICE. 9-J 
 
 diately, and with a like result. These cases, as I 
 have stated, were published in 1832, in a work which 
 much too rarely found its way, at that time, to this 
 country. I believe that to Twitchell's sagacity his 
 patient owes his restoration to health ; and, although 
 I cannot prove to indifferent persons that the cases by 
 Brodie were not seen by him, I have reasons which 
 satisfy me that such was the fact. 
 
 Dr. Twitchell's medical and surgical practice, 
 during the last twenty years of his life, was very ex- 
 tensive. Before his marriage, as we have already 
 seen, he used to ride on horseback thirty or forty 
 miles a day. In later life he always drove a sulky ; 
 and his custom was, when called to a distant spot, to 
 tell the physician he was going to meet in council, 
 that he would be at the appointed spot by a certain 
 hour ; that he should wait for him, if necessary, fif- 
 teen minutes, but he wanted no one to wait even five 
 for himself. Rising before daybreak, he immediately 
 took breakfast, and was usually far on his way 
 before the dawn. He allowed himself time enough 
 to go the distance required, at the rate of six miles 
 an hour. He, however, always travelled faster than 
 that, and had a series of post horses at the various 
 country inns. In the cold morning hour, the drowsy 
 ostler of some of them would be awakened by 
 Twitchell with orders for a change of horses. At 
 times he was stopped on his route by some patient. 
 If in a great hurry, he would prescribe without 
 getting from his chaise. In the winter time these ex- 
 cursions were very severe ; and not a few times he 
 was overtaken, when many miles from home, by one
 
 96 LONG DRIVES AND DANGERS. 
 
 of those furious storms of snow that sweep over 
 New Hampshire. He was perhaps wholly unable 
 to proceed ; the roads being all blocked up, and the 
 storm driving pitilessly upon his wearied horse. On 
 one or two occasions, he nearly gave up all hopes of 
 getting safely home, and thought his last hour was 
 come. Chilled through by the severity of the cold, 
 and covered with snow, there seemed no escape for 
 him. However, his own brave heart and practical 
 common sense sustained him, and he always con- 
 trived to overcome the difficulty. Returning home, 
 he would throw himself at full length upon the sofa. 
 " Tired nature's sweet restorer, gentle sleep," 
 would come over him, and in a few hours he would 
 be again able to repair to his accustomed place 
 about the village-tavern to discuss temperance, crack 
 jokes, or talk about his profession, &c. On the next 
 day, he was all ready for another and perhaps simi- 
 lar trip to the mountains. Such has been his course 
 from year to year for more than a third of a cen- 
 tury. Towards the latter part of his life, his wide 
 practice and these long rides became so oppressive 
 to him by their very number, that he was obliged to 
 refuse some of them. Accordingly, he prepared the 
 following circular, which is found among his pa- 
 pers : — 
 
 " I regret to say, that it is not in my power to attend 
 to half the calls which I have. I do all that I can ; and I 
 endeavor, as far as I am able, to do my duty, by attending 
 those cases which have a superior claim to my services. 
 It would be gratifying to my feelings, could I comply with 
 the wishes of all ; but that is impossible.
 
 CIRCULAR TO PATIENTS. 97 
 
 " I consider that capital surgical operations have the first 
 claim, as there is no other operator in this vicinity ; after 
 which, my immediate friends and neighbors ; and then I 
 enlarge the circle, according to the urgency and import- 
 ance of the cases : and in this way do all I can." 
 
 After he had arisen to fame and to an honorable 
 independence, he did not forget the trials of a young 
 man when just commencing medical practice. The 
 recipients of his bounty were not a few, and the 
 depth of their gratitude their own hearts can alone 
 tell. The following letter to one of them, under 
 date of Nov. 20, 1841, I transcribe : — 
 
 "Yours of the 14th instant was received night before 
 last. You say you have not as yet taken a ticket for 
 dissection, and shall wait till you hear from me, as you 
 have not much time, and shall be short of funds. I think 
 it is all-important you should dissect as much as your 
 health will admit, and should advise you by all means to 
 take your tickets for that purpose. Now is your time 
 to lay a sure foundation for future eminence. Your op- 
 portunities now are superior to any which I had the means 
 of enjoying when I was a student; and I have no doubt 
 you will, by your industry and perseverance, make the 
 most of them. It certainly will be a great gratification to 
 me if I should live to see you taking a high stand in the 
 profession, and should consider myself remunerated for all 
 I have done or shall do for you. I know that you will not 
 spend money for nought, and I shall be willing to furnish 
 all necessary funds. I wish you to write me frequently 
 how you get along. If you learn of any improved surgical 
 instrument, or any valuable medical or surgical treatise, 
 which will be very useful, I wish you to purchase them, 
 9
 
 98 TEMPERANCE ADVOCATE. 
 
 and I will forward you a draft or cash for what you may 
 want at the close of the term ; a short time before which, 
 I wish you to write the exact amount that will be want- 
 ing. — Yours arlectionately, 
 
 "A. TWITCHELL." 
 
 Dr. Twitchell seems to have early learned the ad- 
 vantages of temperance in the use of alcoholic and 
 intoxicating drinks, and most steadily did he adhere 
 to the opinions instilled into him by his parents. He 
 was at times quite severe in his denunciations of the 
 habitual drunkard, and was not afraid to speak to 
 any one on the subject. In fact, some of those who 
 were disposed to drink regarded it as his favorite 
 " hobby," and thought he was officious in proffering 
 advice. He often alluded to it whenever an opportu- 
 tunity offered. The following is an amusing illustra- 
 tion of his method of treating the subject: It was a 
 very cold winter's day, and Twitchell had been riding 
 far and long, and had stopped to rest and warm him- 
 self at a country inn. While waiting, and enjoying 
 the genial glow of the roaring fire, two young men 
 entered the bar-room, and in boisterous tones asked 
 for liquor. Decanters were placed before them, and 
 their potations were by no means small. After look- 
 ing at them a short time, Twitchell, in a similar 
 manner, went to the bar-keeper, and asked for a glass 
 of water. The water-jug and tumbler were given 
 to him, and he drank as much as he wished. He 
 then took out his purse, and laid a ninepence upon 
 the counter. The attendant stared, — the youths 
 smiled at the " greenhorn." " We don't ask any 
 thing for water," said the waiter, with a suppressed
 
 ANECDOTE. 99 
 
 titter. " Oh ! " said Twitchell, " I can better afford 
 to pay you ninepence for a glass of water and the 
 benefits of this warm fire, than these young men can 
 afford to pay half that sum for liquor." As a general 
 rule, he held no long arguments. He desired to 
 produce the requisite effect by a style more simple. 
 In case of poor men, he tried to overcome the habit 
 by keeping the individuals at work. One poor fellow 
 came to split his wood, when so full of tremor from 
 the effects of recent debauch that he could hardly 
 stand. Whilst there was a will to resist the tempter, 
 he was gentle as a woman with the sinner ; but, if 
 he perceived a dogged determination to continue the 
 evil course, the vials of his wrath would be opened 
 upon the unhappy victim of appetite. He was 
 probably more severe on these persons, from the fact 
 that he was so constituted as to be able to control 
 entirely the indulgence of his own appetite for food 
 and drink. 
 
 His dislike for tobacco-chewing and smoking was 
 equally great. He had a theory upon that subject, 
 which he undoubtedly carried too far, but which is 
 true in many instances. He told me that he believed 
 that tobacco killed more persons than intemperance. 
 The following anecdote is related of him : A farmer 
 who lived some twenty miles from Keene, and who 
 had often supplied the doctor with grain, was met 
 by Dr. Twitchell one day when he was looking 
 miserably out of health. On being questioned as 
 to his health, he replied, with a very serious face, 
 " Almost gone, doctor ! I shall never bring you any 
 more corn. The physicians have all given me up,
 
 100 TEMPERANCE DELEGATE. 
 
 and tell me I am dying of consumption." " Ah ! 
 indeed," replied our friend, in his lively tones ; " I 
 am quite sorry I shall have no more of your corn ; 
 but possibly, after all, it may not be so bad as you 
 think : I may be able to cure you." " It is too late," 
 solemnly replied the man ; " I must put my house 
 in order, and prepare to die. So all tell me, and I 
 believe them." "But," said Dr. Twitchell, "I will 
 make a bargain with you. You shall agree to fol- 
 low my prescriptions three months : if you recover 
 your health, you shall pay me fifty bushels of corn ; 
 and, if you fail to follow the prescription, you are 
 likewise to pay me fifty bushels of corn : but, if you 
 follow the prescription without getting well, I will 
 pay to you or your heirs the value of fifty bushels 
 of corn, without receiving any compensation." To 
 this, after some demur on his part, the invalid 
 agreed ; and was immediately directed to take the 
 quid from his mouth, to dash it to the ground, and 
 never to touch tobacco in any form again. Six 
 months or more passed away, when Dr. Twitchell 
 met the man, apparently in perfect health, and 
 claimed the corn. The farmer declined paying it, 
 saying that his wife thought it more than his life was 
 worth ! He, however, finally compromised the mat- 
 ter, by leaving three or four bushels of corn and a 
 bushel of white beans ! (See Appendix L.) 
 
 In 1832, Dr. Twitchell made a visit to Philadel- 
 phia, as a delegate from the New Hampshire State 
 Medical Society to a convention of the friends of 
 temperance in America. While there, the following 
 anecdote occurred : Twitchell met many old ac-
 
 ANECDOTE. 101 
 
 quaintances, and made several new ones. With one 
 or another of these he was constantly conversing, 
 when at the hotel ; and invariably his bright, eager, 
 and jovial mode of talking would draw a crowd 
 around the party. This was just the element he 
 liked ; and usually he would engage in long discus- 
 sions on any subject that happened to be brought 
 up, or perhaps he would give an extemporaneous 
 lecture on the pathological effects of alcohol or 
 tobacco. One day he had been describing, in his 
 exquisitely graphic manner, the gradual inroads 
 made by tobacco upon the human system. He first 
 displayed the gentlest effects of this " celestial drug." 
 The slightest nervousness or most trivial pain was 
 perhaps all that the sufferer noticed. Then came 
 the horrid dreams and nightmares dire, with indiges- 
 tion and all its miserable train. After talking thus 
 for some time, he proceeded still farther, and had 
 just touched upon the point where, according to Dr. 
 Twitchell's theory, the victim of appetite will see 
 death staring at him. All his audience were listen- 
 ing with deep interest, and silence reigned in the 
 room, when suddenly one gentleman dropped sense- 
 less. He had listened with great attention, and was 
 horror-struck at fancying that he had arrived at the 
 fatal point in his journey as a tobacco-chewer. He, 
 however, soon recovered from his swoon, and from 
 that moment forswore the use of the article in any 
 shape. 
 
 Dr. Twitchell was not unfrequently invited to 
 deliver temperance addresses. He sometimes did 
 so, although he was not so successful in a lecture or 
 
 9*
 
 102 TEMPERANCE DOCUMENT. 
 
 continued speech as he was in simple conversation 
 on the great topic to which he devoted so much of 
 his life. It is well known that he gained for himself 
 many enemies by his bold denunciations of those 
 who sold intoxicating liquor. It has been intimated 
 to me, that the venders of the poison intended, by a 
 deeply contrived plot, to utterly ruin, or at least 
 injure, him in his pecuniary resources ; and that a 
 trivial occurrence, though very honorable on the part 
 of one of his enemies, alone prevented the catastro- 
 phe. Twitchell was not one to think of consequences 
 to himself, when a principle was involved. Would 
 that we had more men like him in this respect ! 
 
 The following documents I find among his pa- 
 pers : — 
 
 11 Your plan meets my views, and shall have my cor- 
 dial approbation and support. For thirty years have I 
 unceasingly labored to convince my friends, that ardent 
 spirit is not only an useless but a dangerous beverage ; 
 and for more than twenty-five years have I professionally 
 and publicly borne testimony to its pernicious and 
 poisonous effects upon the human constitution. Never 
 have I used it myself, or offered or given it to others, ex- 
 cept as a medicine in sickness, and as such but seldom. 
 The exertions which I had for so long a time used induced 
 the friends of temperance, when societies were formed in 
 this State, to elect me president of the town and the county, 
 and subsequently of the State society. The two former 
 offices I still hold ; but, at the last meeting of our State 
 society, I was not present, and have not seen any official 
 account of their proceedings, but have understood that 
 Edmund Parker, Esq. of Amherst, was elected presi- 
 dent."
 
 POLITICS. 103 
 
 "Keene, January 3, 1832. 
 
 " Dear Sir, — Your letter bearing date December 1st, 
 1831, directed to Salisbury, N.H. enclosing a circular of 
 the New York Temperance Society, has but just reached 
 me. The cause in which you are engaged has long been 
 the object of my most strenuous exertions. The plan 
 which you propose [Sentence unfinished.] 
 
 " I should consider it an honor to have my name attached 
 to the circular, as you propose ; but, although there is no 
 date to the one you enclosed, yet I suppose it would be 
 desirable that the names of the present officers should 
 be attached ; but of that you can best judge. You have 
 full liberty to use my name if you think best : if you do 
 not obtain the name of the president for the time being, 
 and you date your circular the present year, I would sug- 
 gest the propriety, if you use my name, to attach it as 
 president of the Cheshire County Temperance Society, and 
 late president of the New Hampshire State Temperance 
 Society. Our county society will meet in a few days. I 
 shall read your circular to them, and have no doubt but 
 that they will highly approve of the plan, and will order 
 a large number for immediate distribution. 
 
 " Our State society will not hold a meeting again till 
 next June, unless there is one specially called : of course 
 your plan cannot be laid before them till that time, pre- 
 vious to which I think much may be done by our town 
 and county societies. If it is your desire, I will forward 
 your letter and circular to ." . . . 
 
 In politics, Dr. Twitchell was in early life a federal- 
 ist, and afterwards a staunch whig. He followed, 
 like many others, the rule of the party leaders ; and 
 yielded, as it seemed to some of his friends, a blind 
 deference to the opinions of the great men of that
 
 104 ASYLUM FOR INSANE. 
 
 party. He was, however, what might be called a 
 reasonable conservative, — not a zealot in whiggism ; 
 but at the same time he had an almost holy horror of 
 any taint of democracy, as he saw it in New Hamp- 
 shire. Daniel Webster was his file leader, his 
 Magnus Apollo ; and he listened to his voice as to 
 that of a god. 
 
 Dr. Twitchell was very much interested in the 
 establishment of the Asylum for the Insane in New 
 Hampshire, and continued to be so for some months, 
 until he thought that politics, which in this country 
 creep in everywhere, were associated with the 
 management of the institution ; then he retired in 
 disgust. 
 
 In 1845-6, the germs of the present American 
 Medical Association were planted in the State of 
 New York. Chiefly to the labors of Professor N. S. 
 Davis, now of Chicago, then resident at Binghamton, 
 New York, does the medical profession owe the 
 scheme of this association, which has already done 
 very much towards raising the standard of the medical 
 profession in the United States. It has done this, not 
 so much by the enactment of specific laws and the 
 adoption of certain votes ; for upon some of these lat- 
 ter measures there is a great discrepancy of opinion. 
 But for the stimulus it gives to individual action, in 
 consequence of the congregating together of so many 
 of the really zealous and learned of the profession ; 
 for the kindly sympathies its re-unions excite in the 
 bosoms of all ; for the liberal opinions which the 
 members gain by meeting and comparing views, as 
 diverse as those of a profession extended over so
 
 AMERICAN MEDICAL ASSOCIATION. 105 
 
 large an extent of country must necessarily be ; 
 above all, for the noble esprit de corps which it raises 
 amongst us, — for these benefits, and others inci- 
 dental thereto, this association and its founders 
 deserve high praise. 
 
 Dr. Twitchell early took an active interest in it. 
 He was not, however, present in New York in 1846. 
 At Philadelphia, he appeared as delegate from the 
 New Hampshire Medical Society. He was a mem- 
 ber of the National Committee that year. He 
 enjoyed very much the society of the magnates of 
 our profession, about whom he had heard so long, 
 some of whom, however, he had never seen. In 
 1848, his nephew, Dr. George Twitchell, attended in 
 his stead ; for it seems to have been his purpose that 
 one or the other should always be present, as had 
 been the case for years with regard to the New 
 Hampshire Medical Society. In truth, he believed 
 that actual bodily presence is a more manifest proof 
 of the interest that one takes in any association than 
 any amount of writing or talking upon the subject. 
 "We all remember him at the meeting in Boston, at 
 which time he presided over the National Business 
 Committee, which was composed of the elite of the 
 profession. In the general meetings of the asso- 
 ciation he never spoke, save on business connected 
 with this committee. He was one of those men who 
 talk little in public, but much in the private circle ; 
 so that his influence, perhaps unseen, was all-power- 
 ful. I have learned that he was particularly de- 
 lighted at this meeting with the attentions paid to 
 him by the younger members of the profession, whose
 
 106 DELEGATE TO PHILADELPHIA. 
 
 spontaneous outpourings of respect he received with 
 a modest self-complacency, which was at times 
 quite naive in its manifestations. He possessed the 
 attribute common to every commanding intellect, — 
 a consciousness of power, which demands no ex- 
 ternal tributes of respect, nor are they necessary 
 to its happiness ; but, if given, they are accepted 
 with the simplicity and delight a child may mani- 
 fest when receiving the caresses of its friends. 
 In Boston, as in Philadelphia, he met with most 
 of those who, in different quarters of the Union, 
 had gradually like himself been rising to an 
 honorable fame : A. H. Stevens, the Nestor of New 
 York Surgery ; the distinguished President of the 
 Association, J. C. Warren, of Boston; his early 
 friend, Shattuck, whose heart had been well knit to 
 his, ever since they bathed while youths in the 
 waters of the Sowhegan ; Dr. Knight, of Connecti- 
 cut, who, though still in the prime of life, reminds us, 
 by his elegant and accomplished mind and manner, 
 of the perfect gentleman "of the old school ; " a 
 host of worthies from Philadelphia, young and old, 
 among whom rise pre-eminent the two Jacksons, — 
 the veteran and well-beloved professor, and he, of 
 sterling worth, from Northumberland ; his old pupil, 
 Bond ; and, drawn towards him in a particular man- 
 ner by the kindred pursuit of surgery, the young, 
 earnest, and rising Mutter. From Maryland ap- 
 peared to greet him the honored son of an honored 
 father, Nathan R. Smith ; and, finally, from the Far 
 West, his long-tried friend, Professor Mussey, of 
 Cincinnati. In addition to these, I may, not invi-
 
 AMERICAN MEDICAL ASSOCIATION. 107 
 
 diously I hope, allude to Parker of New York, and 
 Johnson of Missouri, as two of the younger scions 
 of surgery who were delighted to do him reverence. 
 How much he enjoyed the society of these and of 
 many others none now can tell ; but it is certain that 
 he returned to the Granite Hills refreshed and invigo- 
 rated for new labor ; and one of the severest trials of 
 his latter days, to which he could scarcely allude 
 without tears, was the fact that he could not meet 
 again the hosts of our honorable calling at the Queen 
 City of the West, where Drake and Caldwell, Mil- 
 ler and Gross, Johnson and Mussey, would have 
 received him with open arms upon their own ground. 
 Fate had decided otherwise. His failing health 
 warned him not to try such a journey ; and, in a few 
 weeks subsequent to the meeting in Cincinnati, he 
 was no more.
 
 108 
 
 CHAPTER VII. 
 
 FROM 1815 TO 1850. JET. 34—69. 
 
 Social Qualities. — Jokes at the Hotel. — Repartee to a Law- 
 yer ; to a Friend. — Intercourse -with Medical Associates. — 
 Autocrat of Surgery. — His Faith, in the Profession. — Inter- 
 course with Patients. — Roughness at First. — Exquisite Ten- 
 derness. — Behavior in the Chamber of Death. — Kindness to 
 the Poor. — Anecdote. — Practical Tact. — Violence occasion- 
 ally. — Allegro and Penseroso. — Delights of being Bled. — 
 Neuralgia Case. — Hatred of Quackery. — Open Confidence in 
 Patients. — "Willing to confess Error. — His Operations ; Anxi- 
 ety to act rightly about them ; Calmness -while performing 
 them. — Private Hospital. — Intercourse -with his Family : 
 Children. — Domestic Discipline. — Religious Views. 
 
 No one ever enjoyed better than Dr. Twitchell the 
 society of human beings. He found a certain degree 
 of pleasure in the contact of any man, however hum- 
 ble or ignorant. This tendency, combined with his 
 jovial spirit, led him, as we have seen, frequently to 
 the village tavern. In former days, when an arrival 
 of the coach was an important event in the history 
 of each day, and in later times, since the car's 
 whistle has superseded the coachman's horn, he was 
 always present, if professional business would allow, 
 at the time of the arrival of passengers. Cordially 
 did he greet old well-known friends ; and how slily
 
 SOCIAL QUALITIES. 109 
 
 did his bright gray eye shine out inquisitively upon 
 the face of the stranger ? 
 
 Whenever a knot of merry laughers was seen near 
 the main hotel, one might be almost certain to find 
 Twitchell among them. It was in these coteries 
 that he preached upon intemperance in the use of 
 wine and tobacco. At the inn, too, he would tell 
 his jokes ; and, in early life, it is said that he often 
 spent half the night at whist, after having passed the 
 day in riding far and near. Such associations might 
 seem likely to contaminate ; but this was not the 
 case with him. His amusements were innocent. 
 
 His powers at a quiet repartee were great. I have 
 heard the following anecdotes : — 
 
 Dr. Twitchell, in the early part of his residence at 
 Keene, had been called as a witness in a case of mal- 
 practice. As was usual with him, he gave his evi- 
 dence coolly, but decidedly. The opposing lawyer 
 had, at a cross-examination, a great deal of the pe- 
 culiar skill for which the bar of New Hampshire has 
 been always celebrated ; and on this occasion he 
 pressed hard upon the young physician. The doc- 
 tor, in his testimony, had stated some things in 
 reference to medical cases among the Indians, and 
 the lawyer thought to make him confess ignorance 
 upon the subject. In vain did the advocate ap- 
 proach the matter. Twitchell was armed at all 
 points with simple truth. Finally, his opponent ab- 
 ruptly asked, " Why, how can you know about this ? 
 Have you ever been among the Indians ? " Twit- 
 chell stopped a moment, and then, looking steadily 
 at the advocate, said with the most gentle and yet 
 10
 
 110 ANECDOTE. 
 
 culling irony in his manner, " I have sometimes been 
 with half-civilized persons ! " The shock was electric ; 
 the whole court was convulsed with laughter at the 
 " palpable hit." The lawyer was taken by surprise, 
 and completely silenced so far as cross-questioning 
 further in that case was concerned. I believe very 
 few members of the bar ever afterwards wanted to 
 try their skill at making Dr. Twitchell contradict 
 himself. He was quite a match for any one. 
 
 At times his repartees were severe. Some years 
 since, two noted persons were at Keene at the 
 
 same time, namely, Gov. D , of , and a 
 
 celebrated convict, who had escaped from several 
 places of confinement, and at length was safely 
 secured in the stone jail at Keene. One day, a 
 friend met Dr. Twitchell, and said jocosely, "Well, 
 doctor, have you called at the Cheshire upon Gov. 
 
 D ? " " Oh, no ! " instantly replied Twitchell, 
 
 " I have not yet paid my respects to Hicks ! " 
 
 An eminent jurist informs me, that Dr. Twitchell 
 was not generally sought for as a witness in favor of 
 wills made during the last illness of the testator, be- 
 cause he had great doubts as to the perfect sanity of 
 a person when near death. These doubts arose 
 from the following incident : A patient was supposed 
 to be near dying ; but, as his mind seemed perfect, 
 his will was made, and the doctor was a witness 
 of it. The man did not die ; but, on his recovery, 
 he had not the least recollection of ever having 
 attempted to make a will, and could not tell any of 
 its provisions ! This incident, of course, shook his 
 faith in all wills made towards the end of life. While
 
 INTERCOURSE WITH PHYSICIANS. Ill 
 
 appearing as a medical witness, Dr. Twitchell was 
 unusually clear and precise, and avoided as much as 
 possible merely technical terms, so that the court and 
 jury always bore testimony to his skill. 
 
 In his intercourse with physicians, he was a man 
 who never asked for a consultation. He was a law 
 unto himself. Doubtless he felt himself quite equal 
 to any, and altogether superior to most physicians. 
 Whenever he did meet his professional brethren, he 
 was scrupulously fair and courteous. His innate 
 sense of justice kept him true, and he was too proud 
 to be unjust even if he disliked a man. Sometimes, 
 when dealing with a pretender, who covered his igno- 
 rance with high-sounding words, he would, with 
 perfect Socratic simplicity, ask what he meant by 
 some peculiar idiom or word, knowing all the while 
 that he was about to make the fool prove his own 
 folly. He was a most thorough hater of all hypoc- 
 risy in medicine as in religion ; and his powers of 
 vituperation were not small, when he came closely in 
 contact with a quack. Rarely has any one appeared 
 to me to desire more to avoid even the semblance of 
 quackery. If a physician had once treated him im- 
 properly, he never forgot it. The remembrance 
 would at times peer forth ; but this prejudice seemed 
 rarely to influence his reason, and he always treated 
 such a man impartially unless he had been guilty of 
 some moral obliquity, and then he refused to meet 
 him by the bedside of the sick. A tenderness, how- 
 ever, to the failings of those who had been his pupils 
 was quite a marked trait in his character. Early ac- 
 knowledged by the profession as the great man of
 
 112 INTERCOURSE WITH PATIENTS. 
 
 that region of the country, he became at length, says 
 one of my correspondents, " the autocrat of surgical 
 matters over an immense body of the profession, — 
 the great operator and the grand arbiter of all their 
 surgical disputes." He had a beautiful faith in the 
 profession as a body. If any one told him that 
 other physicians had spoken ill of him, he would 
 always try to explain the fact in the most favorable 
 manner, or he would laugh it away with the sunny 
 remark, " No ! no ! he is a clever fellow, he never 
 said so of me. You are mistaken." 
 
 At the first introduction of patients to Dr. Twit- 
 chell, there seemed to some a certain degree of 
 stern brusquerie about his manners, that was rather 
 repulsive. Women, in an especial manner, seemed 
 to fear an unkind and perchance coarse mind. But 
 how soon did they discover their mistake ! for the 
 liveliness of his conversation, his thoughtfulness of 
 their peculiar state of mind, and his almost feminine 
 delicacy of sentiment, quickly overcame their doubts. 
 He was to them gentle as a mother, and perfectly 
 regardful of all those little niceties of expression 
 which a true regard for woman begets in any manly 
 soul. I do not mean by this expression, that he 
 indulged in small talk, and the infinitesimal nothings 
 with which some think they should address a female. 
 Far from it. His tenderness towards the other sex 
 arose from a delicate regard for the noble nature of 
 woman, which springs naturally up in the heart of a 
 great-minded man. How versatile his talent for 
 winning away the thoughts of the sick man from his 
 despondency, or of the woman from her restlessness !
 
 INTERCOURSE WITH PATIENTS. 113 
 
 How soothing the pressure of his hand as he sat by 
 the side, and told perhaps of merry scenes that were 
 enacting abroad ! What admirable adaptation of 
 language and sentiment, so as just to suit the tem- 
 perament, age, and sex of his patient ! # Early in 
 his practice he formed a high estimate of the moral 
 power which the physician may exert. Hence he 
 sought always to control the mind of the invalid, — 
 knowing full well that thereby he should wield a 
 mighty lever for the perfect restoration to health. 
 Thinking very little of his fees, but much about the 
 cure of his patient, he was equally devoted to the rich 
 and the poor. His tenderness and consideration for 
 the feelings of the poor have been mentioned to me 
 by some of them with deep emotion. The result was, 
 that all looked to his visits as the brightest hours of 
 the day. One of my correspondents, to whom I am 
 much indebted for the earnest interest he has taken 
 in giving me a life-like sketch of Dr. Twitchell, 
 
 * I cannot forbear quoting the following, written to me by one 
 whose strong mind renders her fully capable of appreciating intel- 
 lectual and moral greatness, while at the same time her sex teaches 
 her to value delicacy of thought and of action : " Dr. Twitchell' 8 
 tender-heartedness, concealed under his rough exterior, was an- 
 other very beautiful point in his character. I remember, on the 
 occasion of the death of a brother of mine, I had been quite 
 shocked with his apparent indifference during the illness ; but, 
 after his death, which occurred perhaps at 2 a.m. he spent nearly 
 the remainder of the night with us, uttering thoughts full of 
 consolation and wisdom. The next day, too, looking at the little 
 face, he said, ' This reminds me of Byron's lines, — 
 
 Before decay's effacing fingers 
 
 Have swept the lines where beauty lingers.' 
 
 It was an unexpected revelation of sweetness and refinement, for 
 which I was not prepared." 
 10*
 
 114 PRACTICAL TACT. 
 
 writes thus : " The influence of his conversational 
 powers in a sick-room cannot be described. The 
 first time he visited me in a protracted illness, hardly 
 a word was said about my case ; and yet, by amus- 
 ing and apparently irrelevant stories, he had managed 
 to let me understand my condition better than I ever 
 had before, and to leave in my mind a conviction 
 that he, at least, knew all about it. I have never," 
 he continues, " in more than two or three instances, 
 met a man who has given me so decided an impres- 
 sion of a strong original genius. No man could be 
 less formal, or more entirely without pretension. 
 His professional skill, to us out of the profession, 
 seemed like intuition." 
 
 Another correspondent says " he had a great deal of 
 what is called practical tact. His extensive business 
 rendered time precious to him ; but in the sick-room 
 he seldom appeared to be in haste. He would listen 
 patiently ; but, by a few questions, he would, without 
 seeming to interrupt, cut short the details of the sick 
 person, or of the attendants, and proceed forthwith 
 to give his directions. Some persons of his own pro- 
 fession, on their first acquaintance with him, regarded 
 him as too hasty in his diagnostic conclusions ; but 
 they soon found that it was not best to question their 
 correctness, for the result of further examination 
 was pretty certain to verify the accuracy of his 
 judgment." 
 
 Some amusing anecdotes are told of his eventful 
 career of practice, illustrative of his influence over 
 patients. He used to say, " When a person sends 
 for von from a great distance, you may be sure that
 
 ANECDOTES. 115 
 
 he will be better for your visit, whatever may be 
 your prescription." 
 
 An old woman called on him to be relieved of a 
 tumor, which she was fearful would eventually de- 
 stroy her life. Dr. Twitchell found it was of such a 
 character as not to be injurious, if the patient could 
 be persuaded to give up touching and thinking so 
 constantly upon it. Accordingly, he prescribed a 
 simple ointment, to be applied at certain stated and 
 distant periods ; and that, during the intervals, the 
 part should not be touched. He assured her she 
 would get well, if she would implicitly pursue his 
 directions. Having entire confidence in her physi- 
 cian's powers, she followed to the exact letter every 
 rule he laid down, and a cure was the result. 
 
 The following was related to me by the patient 
 himself: Some thirty years, or thereabouts, a cou- 
 ple of worthy deacons were travelling for pleasure in 
 their own one-horse chaise, towards the White Moun- 
 tains. In their dispositions, they might be said to 
 be fair representatives of the difference between 
 L' Allegro and II Penseroso. Under these names, 
 therefore, I shall continue my tale. Penseroso, being 
 somewhat of an invalid, resigned most of the active 
 duties of a traveller to his more jovial friend ; and 
 so, jogging on together, they were a mutual aid and 
 source of contentment. Hard by Keene, however, 
 are some very rough mountains, as Dr. Twitchell 
 well knew by experience, and which our worthy 
 friends were destined to learn by experience, still 
 more dire ; for suddenly, while descending a wind- 
 ing road, L' Allegro's powers of driving were set at
 
 116 ANECDOTES. 
 
 nought ; the chaise was npset, and both were thrown 
 heavily to the ground. By dint of the assistance of 
 passers-by, they were set upon their journey again. 
 But it was no longer a laughing matter for poor 
 L* Allegro; for every time an uneven place occurred 
 in the road, or even a disposition to be merry came 
 over him, and the action was suited to the thought, 
 he was seized with a most violent pain in the side of 
 the chest. He said nothing, however, for fear of 
 disturbing the equanimity of his pensive companion, 
 and rode on with the trouble gradually augmenting, 
 until it seemed to him as if the slightest approach to 
 a laugh was agony. Arrived at Keene, he informed 
 Penseroso that they must resign their respective 
 duties. He himself must now be the patient, and he 
 hoped his friend would assume the responsible duties 
 of nurse. Meanwhile, however, he begged that his old 
 friend Twitchell might be sent for. One can readily 
 imagine the unhappy state of things, when two inve- 
 terate jokers and old friends meet, and have to restrain 
 their mirth. " I must bleed you," said the doctor. 
 "For Heaven's sake don't! " gasped the sick man; 
 11 I never could bear the sight of blood without faint- 
 ing, and I shall certainly faint with the first drop I 
 see of mv own ! " The doctor said nothing more 
 about bleeding, but began talking in his old jovial 
 strain, and immediately the mind of his friend was 
 transported to scenes long past, and revelled in the 
 jokes of former days. Meanwhile, the preparations 
 for bleeding w T ent silently on ; the arm was bound 
 up ; even the vein was opened, and still no tremor: 
 no serious thought on the part of the patient of what
 
 ANECDOTES. 117 
 
 was going on ; and finally, at the termination of the 
 whole operation, he concluded that he would sub- 
 mit willingly to be bled by such a man as Twitchell 
 every week of his life ! He had really made a 
 pastime of what had been so dreaded. This patient 
 soon recovered, and now lives in the genial atmos- 
 phere of a happy and robust age, enjoying the plea- 
 sures of a well-spent life. He fully appreciated the 
 real value of his early friend, when he said to me in 
 the last interview I had with him : " If I had not seen 
 Twitchell for twenty years, we should have met 
 however as boys, so hearty and youthful did his tem- 
 perament remain to the last. I never," he added, 
 " was in TwitchelPs society half an hour, without 
 finding something in his conversation that was ori- 
 ginal, refreshing, and exhilarating." 
 
 Another anecdote illustrative of his rapid diag- 
 nostic powers and of his quaint prescriptions may 
 be told. He was riding one day rapidly onward 
 to meet an appointment, and had stopped on the 
 banks of a river for the ferry-boat to return. The 
 rumor of Dr. Twitcheli's presence being noised 
 abroad, a neighboring devotee of St. Crispin rushed 
 forth from his hammer and last to consult him. The 
 doctor was in his sulky, and, having only a few 
 moments to spare, cried out, "Go into the house and 
 boil your hammer, and touch it to the part." Saying 
 this, Dr. Twitchell sprung from his vehicle, and, hav- 
 ing heated the hammer in the good housewife's pot 
 of boiling water, applied it with instant relief to the 
 part affected. I have understood from good autho- 
 rity, that the sufferer never had another paroxysm,
 
 118 SCORN OF QUACKERY. 
 
 and the surgeon was considered as having performed 
 a miracle. The prescription, however, was not origi- 
 nal; the peculiar method of applying it was his own. 
 
 At times he was very violent, and especially 
 was this the case with those who, knowing the right, 
 still did wrongly. Such a course being so entirely 
 contrary to his own principles of action, he retained 
 no patience for any one who followed it. On one 
 occasion, a man, whose family he had attended, and 
 who was himself known to be intemperate, called 
 him very hastily to go to see his daughter. " I wont 
 go," said the doctor. " For God's sake," replied 
 the agonized father, " go and see my child, and I 
 will pay you what you ask, or work for you as long 
 as you wish." " I wont go," again sternly shouted 
 the doctor ; " you may offer whatever you wish, and 
 you will not persuade me ; but, if you will promise 
 to give up your beastly intemperance, to become an 
 honest man, and to take care of your family, then I 
 will hereby agree to attend you all for nothing." 
 Rumor does not say whether the pledge w r as taken. 
 The doctor is believed to have seen the patient. 
 
 Dr. Twitchell scorned all quackish cajoling of 
 patients, and despised that pettiness of soul which 
 some of our most eminent practitioners avow and 
 act upon ; namely, that there must be some air of 
 mystery around the recipe of a physician. To those 
 who say that a physician cannot succeed in gaining 
 an honorable practice, if he talk freely with his 
 patients upon their diseases and his own treatment, 
 I might quote Dr. Twitchell as an illustrious ex- 
 ample of the falsity of their views. He conversed
 
 OPERATIONS. 119 
 
 with perfect openness, and was not afraid even to con- 
 fess that he had erred in his diagnosis or his treat- 
 ment. To me this seems a trait of surpassing 
 beauty ; for " to err is human," to be willing to 
 confess that error is divine. His desire to avoid all 
 circumlocution, and to state precisely what he 
 thought and in the plainest manner, led him to avoid 
 the use of Latin in his prescriptions, and the usual 
 heathenish symbols of measures and weights that 
 have descended from the dark days of our profession 
 until now. 
 
 In his operations, he was slow, deliberate, and con- 
 scientious. I have elsewhere mentioned, that as a boy 
 his feelings were so tender that he would weep at 
 the sight of a cat torturing a mouse ; yet in after-life 
 he dared to perform any operation upon the human 
 frame. How shall we account for this ? Not cer- 
 tainly from any callousness having gradually come 
 over the fine structure of his heart ; for on the nights 
 preceding all operations he was restless, and uneasily 
 inquiring, " Is it right for me to operate ? Would I, 
 were I similarly circumstanced, allow the same ope- 
 ration to be made upon me, or any of my family ? " 
 But, when he came to the hour for operating, he was 
 cool and calm as a man at prayer. Was that heart 
 hardened to the sight of human suffering ? Oh, no ! 
 far from it. It was ready to gush forth with the ten- 
 derest emotions ; but duty called upon him to stifle 
 them, and he did so. It is not true that the practice 
 of medicine or surgery leads to carelessness of 
 human life and suffering, as some ignorantly sup- 
 pose.
 
 120 DOMESTIC DISCIPLINE. 
 
 For several years before his death, he had a pri- 
 vate hospital of his own ; and his devotion to all the 
 really sick and suffering, whatever might be their 
 condition, was admirable. He has been known to 
 leave his own house and visit them several times 
 during the night, in order that they might not suffer. 
 They were all regarded as his children ; for whether 
 rich or poor, beautiful or ugly, or afflicted with loath- 
 some disease, — to each and all were his attentions 
 unceasing. 
 
 In his intercourse with the immediate members of 
 his household, he was proverbially benignant. Stern, 
 slightly abrupt, and perhaps a little irritable, he might 
 be at times, on his return from long and fatiguing 
 drives, but never violent. Almost a spoiled child, as 
 he was in certain respects, by the tenderness of his 
 wife, every thing was yielded to him on such occa- 
 sions. Every noise must be stilled. Even the 
 merry tones of childhood, when bursting forth like 
 the joyous notes of the birds in spring, were hushed. 
 The doctor usually threw himself upon his sofa, 
 covered his face with his handkerchief, and either 
 seemed to be or did actually fall asleep. At times, 
 however, some of the more roguish of his young com- 
 panions would test his powers of endurance ; and, 
 by that winning way which childhood alone, in its 
 beautiful unconsciousness, knows how to tread, per- 
 suade him to forget his fatigue of body and the various 
 discomforts arising from his intercourse with man, in 
 perhaps boisterous merriment with the child. Alas ! 
 how little do most of us appreciate in older life the 
 rich enjoyment we might experience, if we would only
 
 LOVE OF CHILDREN". 121 
 
 have perfectly unfettered intercourse with the soul of 
 childhood ! As nothing mortal can be more fra- 
 grant than the babe in its mother's arms just emerg- 
 ing from its morning bath, so in the spiritual world 
 nothing can be to us, in the meridian or decline of 
 life, so pure or holy as the native outgushing confi- 
 dence and love w r ith which a child will always nestle 
 to the bosom of one older than itself. The ages are 
 complements of each other. An orphan girl and a 
 childless old man are correlative terms. Thrice hap- 
 py are they who, while the cares of the world have 
 been gradually enclosing them, have still kept their 
 hearts so warm that even the vivacious roguery 
 of childhood will lighten instead of increasing their 
 already heavy burdens. Dr. Twitchell was such a 
 one. There are those now alive who will remember 
 the quiet and peculiar laugh with which on such oc- 
 casions their stealthy touch of the apparent sleeper 
 was sometimes greeted ; and how they climbed at 
 last, unchecked in their wildest glee, high upon his 
 shoulders. These may seem minute details ; but to 
 my mind they illustrate one of the fairest traits of his 
 character. Need I remind those who once were the 
 recipients of his bounty, of those formidable-looking 
 pockets with which he entered the house on Christ- 
 mas-eve ? What a multitude of questions as to their 
 contents, and what earnest efforts of young hands to 
 enter the forbidden precincts ! Can those who then 
 were young ever forget the mock-heroic and stern 
 style with which all points of approach were guarded, 
 while the formidable words " medicines," " you must 
 not touch," &c. were wholly contradicted by that 
 11
 
 122 FAMILY DISCIPLINE. 
 
 peculiar twinkle of his eye, and the inimitable half- 
 suppressed laugh, so suggestive of a merry soul, and 
 which was as Tivitchellian in its characteristics as the 
 roll of Dr. Johnson's huge frame was all his own ? 
 The heavily-laden stockings of the young folks al- 
 ways subsequently proved the generosity of their 
 domestic Santa Claus. 
 
 At times he was called upon to rebuke for wrong- 
 doing the young people under his charge. How 
 shall I describe his rebukes, which were not so much 
 in words as in the depth and tenderness of his tones, 
 rather of grief than of anger ? On such occasions 
 his words pressed like hot iron into the heart of 
 the offender, leaving indelibly impressed the idea 
 of its error, and bringing a determination never to 
 do a like deed. It will be seen by this that he was 
 by no means a believer in Solomon's rule of the rod. 
 The wise man therein fails of reaching the loftiest 
 wisdom ; that is, if we take the passage in its literal 
 sense. As a metaphor, and as meaning discipline, 
 Dr. Twitchell had an entire confidence in the doc- 
 trine. Who, in fact, could think otherwise ? But 
 he was not satisfied with merely playing with, or 
 correcting, the children that were under his influence. 
 Philosopher-like, he desired that some instruction 
 should be generally mingled with their sports. He 
 had no regular hours of study with them ; but he 
 often taught them while they were silting upon his 
 shoulder, — a favor which he granted a longer or 
 shorter time, according to the attention paid by them 
 to his instruction. Not seldom did he summarily drop 
 one of his young friends from that place so attractive
 
 RELIGIOUS VIEWS. 123 
 
 to a child, on the first evidence of carelessness in 
 giving heed to his words. 
 
 Nothing is more interesting to me than the con- 
 templation of the earnest inquiries of a strong soul 
 after philosophical and religious truth. The religious 
 sentiment being the first around which all others 
 must revolve at one time or another during one's 
 earthly life, and the idea of Deity being the greatest 
 that any human being can grapple with, we naturally 
 turn with some anxiety to learn what any great man 
 thinks on the subject. I have sought to obtain cor- 
 rect views of the opinions of Dr. Twitchell upon 
 the nature of man, and of his relations to others of 
 God's creatures. I have endeavored also to find out 
 his opinions in regard to God and Christ. Surely 
 no nobler themes for contemplation can be presented 
 to the human mind ! I would premise that I never 
 conversed with him upon these great topics, and 
 the following statements rest upon the evidence of 
 others. A correspondent says, " On religious sub- 
 jects he was reserved. He supported the institutions 
 of Christianity ; but if any one attempted to draw 
 him out, and get his distinctive views on questions of 
 controversy, the inquirer would find himself defeated. 
 He could hardly tell how ; for the doctor kept on talk- 
 ing, and generally ended by getting the questioner 
 interested in some other topic, so that the subject of 
 his inquisitiveness was forgotten." 
 
 There seems to be no doubt that his tendencies 
 were not towards the highest spiritualism, while at 
 the same time he denied that a materialist view of 
 the universe was inconsistent with the doctrine of the
 
 124 RELIGIOUS VIEWS. 
 
 immortality of man, which he fully held. His view 
 of the creation was that now adopted by some of the 
 most able writers of the present day, viz. that, 
 in the Almighty's system, man and the smallest of 
 the zoophytes form but two extremities of one vast 
 chain of life. He thus linked himself with all beings 
 of a higher or a lower order, as we usually estimate 
 them, but which are only different parts in the one 
 great plan of God. According to Dr. Twitchell, man 
 is endowed with intelligence, in consequence of his 
 higher physical organization. The chimpanzee is 
 his " cousin," however "ugly" he may be; and the 
 horse knows well his voice, and reasons with him. 
 With the nature of God he troubled himself but 
 little ; probably esteeming it as a subject far above 
 his comprehension. To the Unity and Trinity, and 
 other minor views held by various sects, he paid no 
 attention ; although he told a friend who asked him 
 to subscribe for an orthodox work, that he was " as 
 much orthodox as any thing." As I view him, his 
 soul was too great to be trammelled by any of the 
 puny creeds that divide the world. Perhaps he 
 would have agreed with Aime Martin,* that " mere 
 sects are impieties before God." God to him was 
 an ever-present, eternal, illimitable, beneficent Being, 
 who knew all his thoughts, and looked kindly even 
 upon his errors. He regarded him as a Father rather 
 than as a Judge, and quietly rested in that faith, even 
 till the last hour of his life. 
 
 Another of his friends, in a letter to me, says, " I 
 
 * Education des Meres.
 
 RELIGIOUS VIEWS. 125 
 
 have heard him declare his unqualified belief in God 
 and immortality. I have heard him, while holding 
 the dissecting-knife in his hands and pointing out the 
 delicate structure of the valves of the heart, or some 
 other wonder of our frame, repeat with earnest 
 emotion the lines of the poet : — 
 
 • Strange that a harp of thousand strings 
 Should keep in tune so long.' 
 
 He dwelt feelingly on the goodness and skill of God 
 in the creation, and enjoined it upon one of his mor- 
 bidly disposed patients to turn to their contemplation 
 as a remedy for his dark thoughts." 
 
 He, however, rarely attended church. Probably 
 this was owing in some degree to the fact, that his 
 extensive business occupied most of his time. In 
 later life, his health would have prevented. I ques- 
 tion much, however, whether he was not one of those 
 who feel that the services of the church have lost for 
 them most of that holy unction with which, in ages 
 gone by, they used to impress the hearts of all wor- 
 shippers. He perceived, moreover, in his intercourse 
 with the world, that men too frequently seem to think 
 that attendance regularly upon divine worship twice 
 each sabbath absolves them from a life of stern 
 integrity, instead of strengthening them to high re- 
 solves and perfect truth. In his jocose manner, he 
 used to say that a deacon cheated him on a week- 
 day worse than any one. Yet he had a sincere and 
 hearty respect for a devoted and active minister of 
 religion. No one ever had a higher regard than he 
 11*
 
 126 RELIGIOUS VIEWS. 
 
 had for a man like that noble ideal given by Herder 
 of the -Preacher of God."* 
 
 " The manifestations of piety," says one of my 
 correspondents, " he always treated with respect." 
 I may add, that, when he perceived a true heart was 
 the cause of it, even religious oinciousness and im- 
 pertinence always met with kindness from him. A 
 remarkable illustration of this occurred several years 
 ago. A female of his acquaintance, while under 
 high religious excitement, called upon him, and said 
 she had an important matter on which she wished 
 to converse with him. She seemed, however, to 
 shrink from speaking, for fear of giving offence. He 
 begged her to proceed with the utmost frankness, 
 and assured her that she could say nothing that would 
 offend him. She then stated that she had been 
 called by God to speak with him boldly upon the 
 state of his soul. She felt that he was living 
 alienated from God, that he should awaken from his 
 lethargy, and prepare by religion and the church for 
 death, which might happen to him at any moment. 
 Having heard her with much gentleness, he thanked 
 her for her kind thoughts on his behalf, and said that 
 he honored her for her frankness, at which he could 
 not for a moment take offence. He concluded thus : 
 
 * " He stands in the midst of his friends and children. They 
 press around their father ; around the man -who is anxious for the 
 welfare of their souls ; who knows them in their houses and in 
 their hearts ; "who consoles them in the troubles of this life, and seeks 
 their happiness for eternity ; whom they know as a pious, upright, 
 and judicious man, who speaks every word from the heart. lie is 
 the Preacher of God ! " — Christian Examiner, 1835, vol. viii. new 
 series, page 179.
 
 RELIGIOUS VIEWS. 127 
 
 " But, my friend, you are mistaken. God never 
 told you to call on me. He knows my heart better 
 than any one else, and I know that he never sent 
 you. Qur prayers," he said, " should arise in 
 every action of our lives, and we should be con- 
 stantly prepared for death by always living rightly." 
 — Noble thoughts, kindly expressed by a true 
 heart ! * 
 
 Of hypocrisy in religion, and in attending reli- 
 gious worship, he had a most thorough hatred ; and 
 he would be very sure to apply the lash of his 
 cutting but quiet humor whenever he saw evidences 
 of this meanness. He spared neither high nor low. 
 Anecdotes might be related illustrative of his keen- 
 ness, but generally modified by his excellent good 
 nature on such occasions. 
 
 His views of Christ and of his religion may be in- 
 ferred somewhat from what I have already said. 
 He has been called by some, " an aboriginal 
 Christian ; " — an expression which seems to me very 
 happy, and exactly descriptive of him. In those great 
 elements of a religious soul and Christian life, justice, 
 truthfulness, and benevolence, he stands pre-eminent. 
 His great reverence for goodness and for natural 
 simple piety, wherever found, prove that he had a 
 corresponding chord in his own bosom. Above all, 
 the calmness which possessed his soul at the approach 
 of death indicates the religious spirit, although, as 
 
 * I have been told, that, when this good woman appealed to 
 the doctor to allow her minister to call upon him, and talk with 
 him about religion, he told her, rather irreverently perhaps, that 
 he could teach her minister his A B C of religion.
 
 1*23 RELIGIOUS VIEWS. 
 
 one correspondent says, he went not to that bourne 
 by the way of the church. 
 
 Yet he was not a Christian, if a belief in the 
 miraculous birth and acts of the divine Founder of 
 the religion of love be necessary to justify one in 
 assuming this epithet. The miracles, as such, were 
 to him no proof of a divine mission. Nay, truth 
 compels me to say, that they were an absolute 
 stumbling-block to him. They marred the holy 
 beauty of Christ's character and life, instead of 
 deepening Dr. Twitchell's reverence for that noble 
 being. I say this in sorrow, and thrice happy are 
 we who can look without difficulty through them or 
 over them at the transcendent glories of that life 
 of self-sacrifice. Probably these views may have 
 tended to prevent his attendance upon the worship 
 of any church made by man. His church was the 
 temple of all nature, and his hours of worship were 
 while on his rides on professional business for the 
 relief of humanity. " How can any one help ador- 
 ing," he said once to a near friend, " if he will ride 
 as I do some early morning, and see the break of 
 day over Monadnock ? I observe the first faintest 
 trace of light, and watch its gradual increase until 
 the full burst of the sun over the highest peak brings 
 to me the idea of a God. People lose half the beauty 
 of their lives by not being up to enjoy such scenes." 
 It was fitting that such a man should have been born 
 at the base of the mountain of the Great Spirit. It 
 was under its benign influences, exerted upon him 
 from earliest years, that he learned to enjoy that 
 hill-side species of worship, belonging to " absolute
 
 RELIGIOUS VIEWS. 
 
 129 
 
 religion " alone, to which I alluded in the earlier part 
 of this memoir, and which, growing with his increas- 
 ing years, became at last one of the strongest ele- 
 ments of his character. " But he did not believe as 
 we do," cries the bigot. Be it so. I grant that his 
 speculative faith differed from that usually held 
 sacred by Christians of the present day. But did 
 he not act out in common life the principles of 
 Jesus ? And how can any one doubt his practical 
 belief in those principles, when we see him daily 
 going about doing good ? His profession was not a 
 mere money-making trade, but a noble art, which he 
 wielded in the service of humanity. His religion, 
 like that of Abou Ben Adhem's in Eastern poetry, 
 consisted more in acts of practical good-will to 
 man than in talk of his love to God. All ages were 
 attracted to him. To the little children gathered 
 around him upon the door-step, he told pleasant 
 tales, and they loved him ; the middle-aged, when 
 in joy or sorrow, found a sympathizing chord in 
 his heart ; the sick and aged relied upon his visits 
 and his conversations, ever pure and hopeful, for the 
 support of their souls. To none did his religion 
 ever bring aught inconsistent with temperance, jus- 
 tice, and truth. Surely, if he be not worthy of the 
 Christian name, I pray Heaven we may have many 
 more such men among us Christians; and I feel 
 certain, that, in so saying, I express a thought which 
 will be warmly reciprocated by all who knew and 
 duly appreciated him.
 
 130 
 
 CHAPTER VIII. 
 
 FROM 1S43 TO 1850. JET. 67—69. 
 
 My ovm. Acquaintance. — Personal Appearance. — Conversations. 
 — Instinct and Reason. — Medical Chemistry. — Cure of Him- 
 self by Strict Diet. — Account of his Cases dictated to me by 
 Himself. — Jocose Man. — Anecdote of old " Bucephalus." — 
 My delightful Reminiscences of him. — Last Illness and Death. 
 
 I remember well the first time I met Dr. Twitchell. 
 It was in the spring of 1346, and I had just alighted 
 from the cars at Keene. I had no thought of meet- 
 ing him, as I was at that time unaware of his habit 
 of resorting to the station-house on the arrival of the 
 cars. I had, however, long known him as the great 
 surgeon of the three Northern or Eastern States. I 
 glanced around, and was struck with the appearance 
 of one man. I said immediately, " That must be 
 Dr. Twitchell. Two such heads cannot be found 
 in one New England village." Subsequently, I 
 found that my diagnosis had been correct. He was 
 a man somewhat beyond the noon of life. He 
 moved about actively, but with a semi-shuffling gait. 
 He was below the medium height, of a large and 
 farmer-like figure, which was awkwardly set off 
 by an old-fashioned blue coat that hung loosely 
 upon his body. He looked at me with that quiet, 
 searching glance habitual to him. His massive
 
 INSTINCT AND REASON. 131 
 
 head, half covered as it was with a hat that had seen 
 many summers, gave instant evidence of its intellec- 
 tual power. The traces of a benevolent heart, which 
 flitted occasionally over the face, confirmed my opi- 
 nion that he was no other than Twitchell. His eye 
 I never shall forget. It was small, gray, and mildly 
 piercing, yet modest and retiring ; and, though half 
 hidden under its thick, shaggy brows, I fell, by its 
 very depth, the intensity of his gaze. Soon after 
 this, I became personally acquainted with him ; and 
 we had many conversations, profitable to myself, 
 during that visit and at subsequent periods. 
 
 Among these conversations, I may quite cursorily 
 allude to the following : A discussion had arisen 
 among a party, while seated around his own tea- 
 table, on the difference between instinct in animals 
 and reason in man. Some of the company limited the 
 possession of reason to man, and were equally dis- 
 posed to deny instinct to him. Dr. Twitchell's face 
 lighted up as he took the opposite view. The young 
 of man and of all animals seek instinctively their nou- 
 rishment. Instinct, therefore, belongs to man with 
 the lower animals. But Dr. Twitchell was too old 
 a horseman not to know that reasoning powers 
 existed in his favorite beast. He cited instances of 
 memory and reflection that he had seen in the lower 
 animals. Modern science, I believe, fully confirms 
 his views. If you take the young star-fish from its 
 parent, and put it on the opposite side of the vessel, 
 the mother will shortly seek her child, and take it 
 again under her maternal charge. You may call this 
 instinct or reason as you please. To an unpre-
 
 132 MEDICAL CHEMISTRY. 
 
 judiced mind, however, it seems marvellously like 
 the process by which a human mother would seek 
 her lost offspring. Dr. Twitchell never would con- 
 sent to the elevation of man by a degradation of the 
 brutes. 
 
 In medical chemistry he was much interested. 
 He believed that upon this subject the dawn was but 
 just opening on medicine, and that to medical che- 
 mistry would be due some of the grandest triumphs 
 of the profession in future times. On one occasion 
 he said to me, " If I were a young man, I would 
 devote myself thoroughly to animal chemistry. I 
 would analyze the blood and every organ in the 
 human body while in health. Having done this, I 
 would repeat the same processes upon man in a dis- 
 eased state." These views, I am well aware, are 
 very different from those held by the body of the 
 medical profession. In fact, too many physicians 
 seem to regard practical chemistry as of no import- 
 ance to a medical man. But how many curious and 
 complex processes are daily carried on by chemical 
 laws in the human frame ! Dr. Twitchell believed 
 that here was a great field for the energy of the 
 young scientific physician to display itself in the path 
 of discovery. My own opinion coincides with Dr. 
 Twitchell' s ; but it seems to me that the only way by 
 which a general elevation of the profession on this 
 point can be attained is by means of the various 
 medical schools of the country. Practical chemistry 
 should be taught in every school as practical ana- 
 tomy is taught, not merely by lectures, but by actual 
 demonstrations.
 
 HIS OWN CASE. 133 
 
 One of the principal subjects of our conversation 
 was his own recovery from an apparently malignant 
 disease, by means of diet alone. I was astonished 
 at that history ; and as he was kind enough to enter 
 into full details on the subject, I will relate it here, 
 very nearly as it was printed in the " Charleston 
 (S.C.) Medical Journal."* It will give the reader 
 an idea of the surpassing power which he had over 
 his own appetites, while it affords an illustration of 
 the influence which simple diet has over the human 
 frame. The history is as follows : — 
 
 " 1. Cancer had appeared in his family. His grand- 
 mother died of cancer of the breast ; his sister, of that of 
 the stomach. These are all the data of his hereditary 
 tendencies that bear upon our main topic. 
 
 " 2. In very early life, Dr. Twitchell was in delicate 
 health. As a youth, he was stronger, and was among the 
 foremost in all athletic sports. While at college, he 
 became dyspeptic, had jaundice, &c. ; subsequently, he 
 passed gall-stones. Whilst pursuing the studies of his 
 profession, he began to suffer from asthma ; and, for 
 about twenty years, was very much subject to violent 
 attacks of it, causing him during the winter to sit up in 
 bed half of every night. During all this period he ate 
 animal food very freely, three times every day, and 
 digested it with ease ; whereas vegetable food caused dys- 
 peptic difficulties. Being induced, owing to a severe 
 eruption of the face, to abandon this course, he gave up, 
 for nine years, the use of meat. After some months, his 
 face was cured ; and, from the period at which he first 
 abandoned meat, he never had an attack of asthma ; and 
 
 • The Charleston Medical Journal and lleview, Nov. 1849. 
 12
 
 134 INFLUENCE OF DIET 
 
 Dr. Twitchell considers these two facts related to each 
 other as cause and effect. Moreover, vegetable food was 
 soon easily borne. After the nine years of vegetable 
 regimen, he began gradually to resume the milder kinds 
 of animal food, such as poultry and somewhat of the 
 more solid meats, until two years since (1847), when he 
 commenced the very rigid diet, to be described when 
 treating of the local disease which is the more immediate 
 object of this paper. Finally, I will state, as indicative 
 perhaps of the tendencies of the cutaneous system to 
 morbid action, that about four years ago he had a papular 
 eruption lasting six weeks ; and, likewise, that very many 
 years ago he had a wart-like tumor on the scalp, which 
 disappeared under the use of creosote, externally applied. 
 
 " 3. The local disease, the course and result of which 
 I present as the chief object of interest, commenced eight 
 or ten years since, as a small but hard tumor at the inter- 
 nal angle of the right eye. When first noticed, it was 
 about as large as a mustard-seed, and not painful. He 
 occasionally touched it, and had some suspicion that it 
 might eventually prove to be of a malignant character. 
 It was imbedded in the substance of the skin, and from 
 the first seemed very slowly to augment in size. At 
 times he thought he felt some lancinating pains in it, 
 which radiated to the brow. It did not, however, inter- 
 fere with the functions of the lachrymal ducts, &c. About 
 1843, the tumor had become nearly as large as a pea, and 
 a tendency to the formation of a scab was observed. He 
 was then induced to try some local applications, and fre- 
 quently, until 1845, used Jennings's ointment.* This 
 would remove the scab, and display three small lobes, 
 from which exuded a little purulent fluid. At first, the 
 morbid growth seemed lessened by this and other milder 
 * Mackenzie on the Eye.
 
 ON MALIGNANT DISEASE. 135 
 
 applications; but no permanent effect was produced. At 
 times the discharge ceased, but only to return again, and 
 the tumor gradually lost its trilobed aspect. It was at 
 this period quite conspicuous to every bystander. 
 
 "August, 1845, Dr. George Hay ward, of this city, re- 
 moved it with the scalpel. For a short time, the wound 
 seemed doing well ; but, finally, it did not heal, and two 
 months afterwards it was operated on again, and nitrate 
 of silver was applied. Meanwhile, however, much local 
 pain had been experienced. It was deeper seated, less 
 transitory, and radiated towards the brow and cheek. 
 Sometimes it was severe enough to awaken him at night, 
 and was worse usually after long journeys. 
 
 " The applications during 1846-7 were chiefly of a very 
 similar character, — cold cream, preparations of zinc, &c. 
 and once the iodide of lead. All active applications 
 caused inflammation of the eye. The tumor continued 
 to augment slightly, and in the spring of 1847 it pre- 
 sented to my eye a decidedly malignant appearance. It 
 was an ulcer, about the size of the top of the finger, with 
 ragged, hard, elevated edges ; and the irritation from the 
 discharge caused the patient frequently to apply his hand- 
 kerchief to the part. At night it caused a gluing of the 
 lids, and a discharge at the side of the nose. I certainly 
 believed, and Dr. Twitchell tells me that he thought, at 
 the time, that the disease would gradually augment, and 
 involve the eye ; and he had determined, if necessary, to 
 have this organ extirpated. His general health, as it has 
 been already stated, continued good ; but, when not 
 actively employed, the mind was somewhat depressed at 
 the prospect before him. At the meeting of the Ameri- 
 can Medical Association in Philadelphia, May, 1847, he 
 consulted several of the eminent men whom he met ; and 
 I believe, I may say, that all regarded it as a disease of a
 
 136 INFLUENCE OF DIET ON THE 
 
 most serious nature, although some thought it might be 
 cured by local applications, and others advised a further 
 operation. 
 
 " Dr. Twitchell returned home discouraged, and he de- 
 cided to give up all use of medicines internally or of 
 external applications, but to try a course of the most 
 rigid diet. Starting from a theory that malignant dis- 
 eases arise from the fact that we take too much carbon 
 into our systems, he determined to live from that time 
 upon a bread-and-milk diet ; and if, at the end of some 
 months, he did not find any diminution in the disease, he 
 intended to use nothing but bread and water. After his 
 return from Philadelphia, he adhered strictly to the bread 
 and milk. He used three times daily from four to six 
 ounces of cream, or the richest milk, and same quantity 
 of either white or brown bread. He continues that diet 
 still (1849). 
 
 " The results upon the local disease were the following : 
 The pains in the part were lessened almost immediately* 
 The purulent discharge very soon began to diminish, and 
 in two or three months it was evident that the disease 
 was not augmenting. During the following winter, the 
 improvement was more decided. In the spring of 1848, 
 being obliged to ride over dusty roads to great distances, 
 the eye was more irritated. Nevertheless, he felt, and 
 his friends assured him, that the diseased part was really 
 lessening, and tending towards a cure. After that period, 
 a steady improvement took place. The ulcerated mass, 
 which was so perceptible to me two years since, has 
 wholly gone; and now (August, 1849) I can discover no 
 difference between the angles of the two eyes, save that 
 in the right one there is a minute white spot, about a line 
 in diameter, looking like a scar. It is not harder than 
 the adjacent parts ; and, had I not known of the existence
 
 CURE OF MALIGNANT DISEASE. 
 
 137 
 
 of previous disease, I should not have noticed even this. 
 There is no discharge, no pain ; and a perfect cure seems 
 to have been accomplished of a disease that had been exist- 
 ing for about ten years, in a patient aged sixty-eight years. 
 
 44 The effects of this rigid diet upon the constitution, as 
 a whole, are interesting. 
 
 44 Respecting his mental condition, Dr. Twitchell thinks 
 he has been much less irritable than when he was omnivo- 
 rous. 
 
 44 He had, at one time, an attack of vertigo (to which, 
 however, he has been always liable) ; and, finding that he 
 was growing corpulent under the diet, he for a time took 
 less of it. 
 
 44 He has always been as strong as when indulging in a 
 more generous diet. 
 
 44 He has been able to breathe better. 
 
 44 His digestion has been good, but with a slight ten- 
 dency to costiveness. 
 
 44 His organs of circulation have been unaffected. 
 
 44 Renal excretion, for years a little disturbed, as is not 
 unfrequently the case in persons of his age. 
 
 44 Finally, Dr. Twitchell presents, to my mind, the pic- 
 ture of a hale, robust man, in perfect health, so far as one 
 can perceive, and but slightly touched by the influence of 
 his many years of honorable and successful labor. 
 
 44 Reflections upon Dr. TwitchelVs Case. — 1. The most 
 important topic involved in the foregoing record is the 
 restoration to health from what seemed to be malignant 
 disease, and that this result followed the strict diet of 
 bread and milk for two years. 
 
 44 2. The cessation of asthmatic difficulties, after they 
 had troubled the patient for twenty years, and that this 
 cure likewise followed the change of diet, — from an 
 12*
 
 138 
 
 CURE OF MALIGNANT DISEASE. 
 
 almost strictly animal diet to one quite the reverse, viz. 
 strictly vegetable. 
 
 " 3. Some readers may ask, if these two cures are not 
 merely examples of the post hoc ; and they may deny 
 that there is any complete evidence of the propter hoc. 
 I consent to the doubt, for it has entered my own mind. 
 Nevertheless, if mere coincidences, they are pregnant 
 with important suggestions. I confess that, in my own 
 practice, I have never met with any cases so significant of 
 the power which diet, simply and heroically used, has 
 to re-organize a man. 
 
 "4. Dr. Twitchell's case becomes interesting as an evi- 
 dence of the power of a man to subject his body to strict 
 rule. In this epicurean age, it is quite refreshing to find 
 one who ' eats to live, and does not live to eat.' A wor- 
 thy professional brother, of this city, said, when the case 
 was related to him, ' It might certainly be a question 
 whether life were desirable under such a regimen ! ' I 
 honor a hero wherever I find him ; and the heroism of Dr. 
 Twitchell, in undertaking and pursuing this course so 
 long, merely in consequence of a theory,* excites in me 
 the greatest delight. In this sceptical, unbelieving era, I 
 delight to see any one having faith. Whether the theory 
 was correct or not, it matters little : the fixed will of its 
 follower arouses my enthusiasm ; and this brings me to 
 another topic of interest. f 
 
 " 5. The theory which governed Dr. Twitchell — was it 
 correct ? I confess that I am unable to solve the ques- 
 
 * That Dr. Twitchell was not influenced wholly by theory, the 
 additional case, which I have presented below, will prove. 
 
 t One of my correspondents says, " When Dr. Twitchell had 
 prescribed for himself a certain course of diet, it was no unmean- 
 ing remark ; but, with a deep sense of religious duty, he kept 
 to it without swerving in any degree."
 
 CURE OF MALIGNANT DISEASE. 139 
 
 tion ; I merely suggest it. Some, whom I consider as 
 our ablest animal chemists, think it was by the pro- 
 cess of starvation, as described by Liebig,* 4 that the cure 
 was wrought. It seems to me that this cannot be the 
 true explanation, — for Dr. Twitchell has always been 
 stout ; and it will be remembered that at one time he ac- 
 tually gained flesh under the diet." 
 
 The above account I published in the " Charleston 
 Journal." It was subsequently printed in the " Bos- 
 ton Medical and Surgical Journal ; " and appended 
 to the article was the case of a man, the result of 
 which probably had much influence towards in- 
 ducing Dr. Twitchell to undertake his dietetic course. 
 Dr. W. H. Thayer, in a letter to me, says : — 
 
 " I have obtained from Dr. Twitchell all the particulars 
 of the case of treatment of osteo-sarcoma (cancer), which 
 he could give me ; and, as his memory is so accurate, I 
 suppose he has not forgotten any thing of importance con- 
 nected with it. You know the doctor never takes notes. 
 
 " A man about forty years of age consulted Dr. Twit- 
 chell, in relation to a tumor on his scapula (shoulder 
 blade), as large as a pint bowl. It was evidently osteo- 
 sarcoma, had its usual crackling feel, and resembled very 
 closely one in the same position which Dr. Twitchell had 
 seen a short time previously, and for which he had 
 removed the whole upper extremity, even scapula and 
 clavicle (collar-bone). In that case, the wound healed ; 
 but the man died a year or two afterwards, with carci- 
 noma of some internal organ. When the second case 
 applied for advice, Dr. Twitchell declined an operation, 
 and the man returned home to Vermont. Soon after- 
 
 t Animal Chemistry, Cambridge edition, page 25 ; 1812.
 
 140 CURE OF MALIGNANT DISEASE. 
 
 wards, he heard of somebody in New York who could 
 cure him, and, applying to this person for advice, received 
 the following : — 
 
 " He was to take from the brook which ran through his 
 native farm a plant which grew there (the adviser did not 
 know what it would be), and use a weak infusion of it for 
 his only drink every day until the tumor had disappeared. 
 His diet, besides this, was to consist of bread alone. This 
 advice was strictly followed ; the plant he used was 
 * water dock.' Dr. Twitchell happened to see the man 
 two years afterwards, when he was still following this 
 course. He found the tumor had nearly disappeared, 
 there being apparently only a trifling thickening of the 
 skin." 
 
 These two histories must be deeply interesting to 
 all. Presenting as they do the evidence of the power- 
 ful influences of diet upon the well-being of man, 
 they are of great importance. I should not wish, 
 however, to make the inference which some may be 
 disposed to draw, that they prove the propriety of an 
 almost strictly vegetable diet for all. They simply 
 suggest that a long-continued, mild, and spare diet 
 may cure, when other remedies are of no avail. I 
 am likewise well aware, that, under the modern re- 
 velations given by the microscope in regard to the 
 nature of tumors, some may doubt as to the malignant 
 character of Dr. Twitchell's disease. Whether it be 
 malignant or not, I am satisfied of the truth of the 
 following proposition : Dr. Twitchell had a disease 
 thought to be of a malignant character by the most 
 eminent of the profession, one of whom had once 
 extirpated it ; it had continued to augment for eight
 
 DR. TWITCHELL AS A HUMORIST. 141 
 
 years in spite of local treatment ; and, finally, under 
 a strict diet, it began soon to lessen in severity, and, 
 after a gradual improvement for a year, was wholly 
 cured. 
 
 Some of my most vivid reminiscences of Dr. 
 Twilchell are as a jocose man. Had he been less 
 devoted to temperance than he was, he would have 
 been distinguished as a boon companion, and would 
 have enjoyed himself over a foaming mug of ale as 
 much as Burns ever did over the punch-bowl of 
 "the illustrious lord of Laggan's many hills,"* or 
 during those hours of exquisite delight which he 
 experienced from his newly-found literary fame at 
 Edinburgh. Dr. Twitchell possessed all the bois- 
 terous joviality of Burns, without the " thoughtless 
 follies" which "laid low" the Scottish bard. 
 
 On one occasion, he slily tried to make himself 
 merry at the expense of myself and several friends, 
 who were taking tea at his house. With great 
 soberness he informed us of a certain fact, which 
 seemed at a first glance very peculiar ; but which, 
 after a moment's thought, was perfectly plain. I 
 think, however, he hardly enjoyed the puzzle of the 
 company so much as he did the immediate discovery, 
 by one of us, of the attempted cheat. His laugh 
 was contagious. It was not one of your simple 
 smiles, a spasmodic twist of one or two muscles 
 
 * " Here are we met, three merry boys ; 
 Three merry boys, I trow, are wc ; 
 And mony a night we've merry been, 
 
 And mony mac we hope to be ! " 
 Allan Cunningham' a Edition of Barns, vol. iv. p. 1G9.
 
 142 ANECDOTE. 
 
 about the face, but a real, substantial, embodied laugh. 
 He was not a man to do things by halves; and his 
 laugh was contagious from its very universality. A 
 story never lost any thing with the various editions 
 he gave of it. They were numberless, and he en- 
 tered with equal zest into their relation with every 
 new-comer. The following is more than a " thrice- 
 told tale ; " but it is so characteristic of him, and it 
 will bring him up to so many minds, that I cannot 
 forbear telling it, although it would be impossible to 
 give even the faintest idea of his manner of relating 
 it. I have already alluded to his humanity towards 
 animals. It was especially manifested to one of his 
 old horses, who had become almost worn out in 
 his service. It was so great that he would not 
 allow the animal to be sold or killed. This creature 
 had been a noble beast in its youth, and was pos- 
 sessed of an unusual degree of intelligence. At the 
 time at which the following incident occurred, and 
 in which he and his old master figured as the two 
 chief characters, he was shorn of his early powers. 
 He was old and decrepit ; he did no work ; but, 
 day after day, having received his wonted allowance 
 of grain at the good doctor's stable, would wan- 
 der forth to snuff the air, and to browse in the main 
 street of Keene. Everybody knew him, and his 
 virtues were descanted upon by the villagers, as he 
 quietly and with difficulty moved along. It was a 
 fair morning of a court-day. All the purlieus of the 
 taverns were occupied by groups of visitors from the 
 neighboring towns, who had come in to attend at 
 the regularly returning festival of litigation that we
 
 BUCEPHALUS. 143 
 
 Christians hold in all our shire towns. Dr. Twit- 
 chell, as usual, was out among the crowd, talking, 
 joking, arguing with the bystanders. The old horse, 
 too, made his appearance, and very soon became 
 unconsciously the " observed of all observers," 
 as he daintily picked here and there a choice bit. 
 One of the numerous parties began to discuss his 
 merits; and it appears that the undue warmth of 
 some earnest friend caused others to doubt whether, 
 after all, he had ever been much of an animal. It 
 so happened that one of the backbiters was a man 
 upon whom suspicion had fallen by no means credit- 
 able to his fame. A trial was at hand, in which he 
 was to appear as defendant. As the discussion 
 grew warmer, Dr. Twitchell approached, and the fol- 
 lowing dialogue took place : — 
 
 Stranger : " Doctor, we have been talking about 
 your horse, and some here are disposed to doubt 
 about his good qualities." 
 
 " Ah ! " says the doctor, " whoever may doubt 
 his excellent qualities, I assure you, gentlemen, 
 that he is the most intelligent horse I ever saw. 
 Why," continued he, glancing at the person above 
 alluded to, " he can tell, at any time, the difference 
 between a rogue and an honest man. For instance 
 now, if our friend here is guilty of the charge he is 
 accused of, my horse will recognize it in his face, and 
 will fly at him and give tokens that he considers him 
 a scoundrel ; and, if my horse decides against him, I 
 shall want no jury to act upon the question. What- 
 ever others may think, /shall be wholly satisfied." 
 
 A long and loud laugh at the remark arose from
 
 144 ANECDOTE. 
 
 the bystanders. " You may laugh, if you please," 
 quietly continued the doctor ; " but I will prove the 
 
 fact to you, if you choose to try. Now Mr. , 
 
 and you, Mr. , may go up and speak to 
 
 him, and he will receive you pleasantly, and will 
 take your caresses with becoming modesty. Every- 
 body knows you are honest men. But, as for our 
 friend here, I tell him to beware of going even 
 within sight of the animal, unless he feels perfectly 
 innocent in his own heart." " Pooh ! " interrupted 
 the defendant, " it is all nonsense. Your horse can 
 hardly walk ; but I suppose he is a surly old beast, 
 and will bite any one." " By no means," replied 
 the doctor ; and, again addressing himself to the 
 other bystanders, he said, " Gentlemen, I beg of you 
 to go up, and see how kindly he will treat you ; but 
 (turning again to the man) beware how you try it, 
 unless you are innocent." Upon this, two or three 
 of the party walked towards the old creature, who 
 received them with a quiet lack-lustre eye, and a 
 manner which seemed to indicate that he felt he was 
 receiving nothing more than his due, namely, the 
 respect of all honorable men. " Well," perse- 
 veringly cried the doctor, " are not you going to try 
 to prove your innocence by the same test ? " "I 
 am not afraid of the beast," ejaculated the man, and 
 moved boldly forth towards him. The doctor 
 stepped quickly and quietly behind him; and, as 
 they came nearer the animal, raised his forefinger 
 far above the head of this victim of his love of 
 joking, and pointed it towards his old Bucephalus. 
 What a change has come over the spirit of the dumb
 
 REMINISCENCES. 145 
 
 beast ! He raises his head, his eyes glance with 
 their ancient fires, his neck is stretched forth appa- 
 rently with intense indignation, while, with dis- 
 tended nostrils, open mouth, and gnashing teeth, he 
 is rushing towards the culprit ! The man retreated 
 precipitately; the doctor dropped his finger, and 
 took his place in the crowd ; and the horse, having 
 apparently driven off an intruder, quietly resumed 
 his grazing. " There," says the doctor, " it is of no 
 use to go to a jury : I am satisfied. My horse has 
 decided the question." And, amid uproarious laugh- 
 ter, and much inward chuckling, I doubt not, on the 
 part of the doctor, he retired, leaving his opponent 
 wholly discomfited, and unable to unravel what to 
 him was a perfect mystery. He did not learn, until 
 years afterwards, that the horse had been taught by 
 Dr. Twitchell's students, in his earlier days, to run 
 at any one who should point his forefinger at him, as 
 Twitchell did on this occasion.* 
 
 This practical joke is a sample of our friend. No 
 one ever enjoyed such a scene more than he. 
 
 I have thus glanced at some of his characteristics, 
 as I saw them in my various interviews with him. 
 And now, as I review his many excellent qualities, 
 his native golden intellect, unpolished though it may 
 have been by the deepest study or highest art, his 
 noble love of truth, his hatred of all pretence, his ten- 
 
 * Dr. Twitchell was unwilling to sell this old and faithful ani- 
 mal ; so that at last the poor creature became so decrepit, that, if 
 he once lay down, he could not arise without assistance. Others 
 finally gave orders for his death, out of pure pity for his infirmi- 
 ties. But his master is said to have wept on hearing of his fate. 
 13
 
 146 LAST ILLNESS. 
 
 derness of heart, his versatility of genius as mani- 
 fested in his profession, while a genuine spirit of 
 mirth shed over them its mild and beautiful lustre, — 
 when I think of all these, I feel an esteem and love 
 for his great spirit which no words can convey, and 
 I shall ever remember the hours passed with him 
 as some of the choicest of my life. 
 
 From the spring of 1S42, Dr. Twitchell had been 
 more or less troubled with a disease not unfrequent 
 in aged persons ; and, a few months before his death, 
 some diabetic symptoms appeared. The appetite 
 failed, and his tongue became dry. On Sunday, 
 May 19, 1850, he had some nausea, which was, 
 however, soon relieved. He continued in bed dur- 
 ing the day, with his mind bright and cheerful ; his 
 thoughts and conversation running chiefly upon his 
 early days. 
 
 On Monday he was better, and went down stairs, 
 though weak and faint. He spoke of his will, and 
 seemed to anticipate that his last hours were drawing 
 near. On Monday night, his friend, who slept in 
 the adjacent room, spoke to him soon after midnight ; 
 and he said that he had passed a good night. Soon 
 afterwards he arose from bed. He stretched out his 
 arm to take a cup from the table, and succeeded in 
 grasping it ; but instantly it fell and broke. He was 
 paralyzed on one side of the body, and became 
 unable to speak or move. He lay partially reclining 
 upon the bed until assistance arrived. His mind 
 still seemed perfectly clear, and closely attentive to 
 his own symptoms. He had no pain, and referred to 
 cases similar to his own, in which certain treatments
 
 DEATH. 147 
 
 had been successful. From this time until the follow- 
 ing Sunday, when he died, he continued in the same 
 tranquil state. On the third day, he asked for his 
 purse, and took from it some sums of money, giv- 
 ing them as remembrances to the domestics of his 
 family. Many times he desired to have some young 
 children who were in the house brought near to his 
 bed ; and, on these occasions, always wished they 
 should kiss him. Resting upon his pure thoughts 
 and his good life, he was quietly passing away ; 
 and, by his beautiful serenity, was instilling into the 
 hearts of the loved ones around him lofty views of 
 human life and of human death. Consistently with 
 all his former course, he asked for no vocal prayers 
 to be uttered by his bedside. He felt not the need of 
 any human mediator between himself and his God. 
 His whole life had been one of prayer and of 
 thanksgiving, and his death was about to be to that 
 life its crowning grace of resignation to the almighty 
 will of Heaven. On Sunday, his voice failed him, 
 and his power of swallowing was gone. He after- 
 wards made no vain efforts at conversation, though 
 capable of recognizing the children, who were still 
 allowed to climb upon his bedside. In the afternoon, 
 that holy unconsciousness, that sweet sleep, which 
 precedes death, came over him. A few gasps, a 
 little rattling, and the great soul had departed. As 
 he had always desired, he was preserved from long 
 illness. It was amid the deep stillness of a Sabbath 
 evening that he died. 
 
 In one of the finest of Beethoven's sonatas is a 
 portion entitled a " Funeral March on the Death of
 
 148 DEATH. 
 
 a Hero." In the solemnity of its pathos, in the holy 
 thoughts it inspires, it seems no mortal hymn, but, 
 with a seraph's power, transports us far above the 
 little transitory existence of this earth into the realms 
 of immortal life. There we see, as with a prophet's 
 eye, the souls of the noble of our race, who have 
 preceded us from earliest times, coming forward to 
 meet the brother-spirit of a great mortal, who, 
 newly transfigured, has just left the earth. As the 
 music slowly wells up, we seem to hear from afar 
 the mystic choral hymn, and even the measured 
 movement of the spirits. All countenances beam 
 with the calmness of truth and of love. Not a ray 
 of sadness flits across the brow of any of the 
 heavenly host. The music ceases, but its hopeful 
 influences still cling around us. Thoughts entirely 
 similar to these, suggested by the Miltonic strains of 
 the divine composer, arise in my mind as I stand by 
 the deathbed of any wise and good man, — some hero 
 of our race. He seems to have left us merely to 
 join the hosts of the great dead; and, on such an 
 occasion, sorrow appears to me sacrilege and im- 
 piety. Need I say that such have been my most 
 vivid thoughts, while reviewing the active and true 
 life, with the tranquil end, of the strong-minded 
 Twitchell ? May we not all reverently hope, that, 
 even now, he is holding communion with the glorious 
 ones who in past ages have gone down like him 
 honored to their graves !
 
 149 
 
 CHAPTER IX. 
 
 Conclusion. — Outlines of Dr. TwitchelTs Character. 
 
 Dr. Twitchell was no shadow of another, nor the 
 exponent of any set of opinions, but a living speci- 
 men of what a great, self-relying mortal may become. 
 In summing up his character, I recognize that of a 
 man possessed of infinite humor, of a strong, vigor- 
 ous intellect, and a reverence for truth in speech and 
 act, which, while it made him always ready to ac- 
 knowledge his own errors, likewise aroused his in- 
 dignation against hypocrisy and pretence wherever 
 seen. Joined to these traits, and in beautiful har- 
 mony with them, was his warm heart. Ardent in 
 his attachment to friends through every stage of life, 
 and wisely benevolent to those less closely united to 
 him, he went about daily doing good. " Like the 
 sun," says one of my correspondents, " he poured 
 forth of his abundance, and sought no return." 
 " His great nature," says another, " had all the ele- 
 ments of justice, truth, and integrity, love and ten- 
 derness, though perhaps not in all respects refined, 
 compounded, and harmonized, so as to realize the 
 
 13*
 
 1.50 
 
 CHARACTER. 
 
 perfect man, as in how very few even of the most 
 sincere Christians they are. But, in the robust vigor 
 and straightforwardness of his life, and in the melt- 
 ing sympathy of his heart in sickness and trial ; in 
 his tender domestic affections, and in his early and 
 long-tried efforts in the cause of temperance, none 
 could fail to see the essential good man, by whatever 
 name called." 
 
 In confirmation of my views of Dr. Twitchell's 
 intellectual power, I will quote from the opinion of 
 one who perhaps is as good a judge of purely intel- 
 lectual greatness as this or any other country can 
 present. Daniel Webster, in the letter already 
 quoted,* writes thus : " Dr. Twitchell and myself 
 were members of Dartmouth College at the same 
 time, and I have known much of him since, as in 
 the earlier part of my professional practice my duties 
 often called me to the place of his residence. From 
 first to last, I have entertained for him the highest 
 respect and most cordial esteem. His mind was 
 remarkable for strength, vigor, and originality, and 
 much given to deep and profound thinking ; " and 
 again he writes, " I should have looked to Dr. Twit- 
 chell, as soon as to almost any other man, for what- 
 ever could be accomplished by intellectual energy 
 and application." 
 
 Standing pre-eminent among his fellows of the 
 medical profession, no one can accuse him of an 
 illiberal or unjust course. Autocrat in surgery for 
 all the country round, he was, on all occasions, very 
 friendly to those younger than himself. He helped 
 * Page 16.
 
 CHARACTER. 151 
 
 them onwards, and they all loved him as a father. 
 Cordial, though commanding, with those who were 
 his equals in years, he gained their respect for his 
 perfect fairness. Without formality or pretence, 
 his professional skill seemed to the uninitiated like 
 intuition. He said little, but was prompt in his de- 
 cisions, from which he never swerved ; he was ener- 
 getic and thorough in the performance of what he 
 determined to do. Never appalled by unforeseen 
 circumstances, he always had an expedient ready 
 for the occasion. Hence he has been called " a man 
 of expedients." It has been well said that he would 
 have made a good general, had a military life been 
 his choice, instead of the more quiet paths of profes- 
 sional duties ; for " he was secret in counsel, prompt 
 and overwhelming in execution." He was unable, 
 from his excessive bodily toil and his long excur- 
 sions, to keep up with the medical literature of the 
 day. But, by means of his keen perceptive facul- 
 ties and power of concentrating his whole mind 
 rapidly on a subject, he contrived to get at the 
 essentials of every valuable improvement ; and, at 
 times, the quickness of his apprehension and the vigor 
 of his judgment, combined with his extraordinary 
 memory and practical common sense, supplied the 
 defects in his knowledge of what had been done by 
 others in the particular subject on which he hap- 
 pened to be engaged. As an operator, he was bold, 
 yet cautious ; and he never forgot that mere manual 
 dexterity is but a small element in the requisites for 
 a great surgeon. 
 
 He has left no permanent monument of his fame
 
 152 CHARACTER. 
 
 in the form of a written book. His memory will be 
 kept green by all his contemporaries ; but their chil- 
 dren's children will know of him only by the tradi- 
 tions which the people will hand down of his powers 
 as the great surgeon and well-beloved physician of 
 the North. How much do I regret that he had no 
 Boswell by his side during life ; no one to report his 
 " Table Talk " ! A few transitory papers alone 
 remain to mark the labors of his life ; but the seeds 
 that he has planted in many minds will arise, and, 
 all-unconscious of their origin, bring forth fruit. 
 For us his light is now for ever set. The twilight of 
 sweet memories will, however, long gild his grave ; 
 and the secret moaning of thousands of human hearts 
 will be his appropriate requiem.
 
 APPENDIX.
 
 APPENDIX A. 
 
 The following is the translation of the Greek oration referred to 
 on page 24 of the Memoir. It is the unfinished production of 
 a youth not accustomed to the egression of his thoughts in any 
 written form. It is printed because it illustrates in some degree 
 his philosophical turn of mind. 
 
 THE INFLUENCE OE NATURAL OBJECTS UPON THE 
 MIND. 
 
 Happy the man who follows the lessons which nature 
 continually dictates ! "What a striking similarity do we 
 behold between the natural face of a country and the 
 mental abilities of its inhabitants ! Whence it appears that 
 the genius and understanding of men are greatly affected 
 by natural objects. If we look at the Arabs, surrounded 
 by scorching sands and fanned by poisonous winds, what 
 are their abilities, and what their manners ? Surely they 
 are a complete emblem of the country which they inhabit. 
 The barren sand represents their minds, and the rugged 
 mountains their manners. And thus, wherever nature 
 has been parsimonious of her gifts to the earth, there we 
 observe a deficiency in the minds of the inhabitants. 
 
 But why need we thus labor to show this correspond- 
 ence ? We may affirm, that, from natural objects, we derive 
 all our knowledge, and consequently all our happiness.
 
 156 * APPENDIX A. 
 
 By the medium of our senses, they stimulate our minds 
 to action, which otherwise would be entirely dormant. 
 They lay the sole foundation of all morality, leading us 
 to contemplate their Author ; and they are the source of 
 all our enjoyments. 
 
 On whatever part of creation we turn our eyes, we 
 everywhere find something which interests either our 
 senses, our imagination, or our reason. Our love of 
 variety is constantly excited, and constantly gratified. 
 There is no part of the day which does not afford us plea- 
 sures both for our senses and for our minds. While the 
 sun illuminates our horizon, the plants, the animals, and 
 a thousand other agreeable objects, strike our eyes; and, 
 when night spreads its veil, the majesty of the sky trans- 
 ports and charms us. On every side, nature labors to 
 surprise us with new pleasures. Even the smallest worm, 
 a grain of sand, presents us with objects of admiration, 
 pleasure, and improvement. 
 
 Those pleasures which are only the work of our own ima- 
 gination are transitory and vanish like a dream, the charms 
 and illusions of which are lost on the moment of waking. 
 But the pleasures which we derive from the contemplation 
 of the works of nature are solid and lasting, because they 
 open to us an inexhaustible source of new delights. The 
 God of nature seems to have had in view the happiness 
 of his creature man, in the erection of all his works. Be- 
 hold ! he has clothed the earth with a lively green color, 
 which is the most mild, and pleasing to the sight ; he has 
 accommodated us with an atmosphere fit for the respiration 
 of animals, and continually supplies its expenditures by 
 exhalations from vegetables. As the contemplation of 
 these objects promotes civilization, and civilization makes 
 mankind capable of receiving more pleasure from the 
 beauties of nature ; as we advance in the path of science,
 
 GREEK ORATION. 157 
 
 we are enabled to observe a greater number of connec- 
 tions, dependencies, and relations among the objects of 
 nature, the beauty and harmony of which impress our 
 minds with agreeable ideas, and give us a more just con- 
 ception of their Author than we otherwise should have. 
 
 How stupid must that man be who does not receive 
 lessons of morality from the display of such wisdom, 
 power, and goodness as is manifested in all the work of 
 creation ! They naturally lead us to inquire, To whom do 
 we owe these numerous and varied gifts of nature ? Who 
 is he who provides for our wants and pleasures with 
 such goodness and munificence ? Let us ask it of all 
 nature ! The hills and valleys will tell us ; the earth 
 points him to our sight ; the sky is a mirror in which we 
 may behold him ; the storms and tempests proclaim him ; 
 the voice of thunder, the rainbow, and snow declare his 
 wisdom and goodness ! And all the numerous host of 
 animals, which are the inhabitants of the air, the earth, 
 and the sea, declare the glory of the Almighty, and pro- 
 claim his existence. Those rich lands where our flocks 
 graze ; those forests which afford us shade and fuel, and 
 a vast multitude of divine gifts, invite us to grateful joy. 
 It is thus that nature becomes an admirable lesson for the 
 heart. If we listen to it, we shall know the true wisdom 
 which leads to happiness. We shall find that there is no 
 satisfaction more sincere or more lasting, or more con- 
 formable to human nature, than the pleasures which are 
 afforded by the contemplation of the works of nature. 
 
 14
 
 158 
 
 APPENDIX B. 
 
 LIGATURE OF THE COMMON CAROTID ARTERY, 
 
 AS PERFORMED BY DR TWITCILELL IN 1807. 
 
 During a mock-fight, at a regimental review in Temple, 
 in New Hampshire, on the 8th October, 1807, John Tag- 
 gart, of Sharon, a cavalry soldier, set. twenty years, 
 received a wound (supposed to have been caused by the 
 wadding and burning powder from a pistol discharged 
 near him) on the right side of the neck and face, extend- 
 ing from behind obliquely forward into the mouth.* He 
 was immediately conveyed to a public-house, where, at 
 the request of Dr. Crombie, then surgeon to the regi- 
 ment, I assisted in the examination and dressing of the 
 wound, and subsequently took charge of the case. We 
 found the whole of the right side of the head, face, and 
 neck, very much burned ; and a large wound penetrating 
 the pharynx and mouth, by which were destroyed, or 
 greatly lacerated, nearly the whole of the parotid gland, 
 the temporal, masseter, and pterygoid muscles ; and also 
 parts of the muscles on the anterior part of the neck 
 between the inferior maxillary bone and the os hyoides. 
 The angle, ramus and coronoid process of the inferior 
 maxillary bone, and the pterygoid process of the sphenoid 
 
 * The treatment of this case is discussed in the Memoir. See 
 pages 63—73.
 
 LIGATURE OF THE CAROTID ARTERY. 159 
 
 bone, were shattered; and that part of the superior 
 maxillary bone which covers the antrum Highmorianum 
 was so broken, that the finger could be readily introduced 
 into the cavity ; the right side of the tongue was also 
 somewhat lacerated. Although the external carotid 
 artery and its branches had been divided, yet, at the time 
 of the injury, the hemorrhage was not copious. All the 
 fragments of bone which were so situated that they could 
 be extracted without much difficulty were removed ; sim- 
 ple dressings applied to the wound ; the patient was put 
 to bed, and an anodyne draught administered. 
 
 Oct. 9. — The patient had rested but little ; there was 
 a good deal of arterial excitement ; and so much inflam- 
 mation and swelling of the throat and fauces, that he was 
 unable to swallow or to articulate intelligibly. His 
 respiration was somewhat impeded ; his face very much 
 swollen; and he had great pain in the head. I directed 
 V. S. §xx. ; an evaporating lotion to be applied to the 
 head and face ; and a cathartic enema to be adminis- 
 tered, which procured two or three dejections. These 
 remedies appeared to give some relief for a few hours ; 
 but, in the evening, the excitement and pain increased. 
 Ten or twelve ounces more of blood were taken ; the 
 lotion to the head and face was directed to be continued ; 
 and an emollient poultice to be applied to the wound. 
 
 Oct. 10. — The patient had slept some during the 
 night; the pain and swelling were diminished; and, with 
 much difficulty, he swallowed a little cold water, though 
 a part of it escaped from the wound in the attempt. The 
 local applications were directed to be continued ; a tea- 
 spoonful of a solution of borate of soda to be put into 
 the mouth every half-hour ; and a little gruel to be given 
 if he could swallow it. In the afternoon he was removed 
 to his father's house in Sharon, a distance of eight or
 
 160 APPENDIX B. 
 
 nine miles, without any unfavorable symptom being de- 
 veloped. A cathartic of magnes. sulph. was ordered to 
 be taken as soon as practicable. 
 
 Oct. 12. — The inflammation, pain, and swelling were 
 much diminished. Pulse 70 — 80, soft. He could arti- 
 culate more distinctly, and the deglutition was improved ; 
 though, in the attempt to swallow liquids, a part still 
 escaped through the wound. Suppuration had com- 
 menced ; and the dead parts were beginning to separate. 
 The posterior upper tooth of the side affected appeared 
 in the wound, and was removed. The magn. sulph. had 
 procured three or four dejections. The emollient poul- 
 tices were continued ; and he got a little broth. 
 
 Oct. 14. — Suppuration copious; some portions of the 
 dead parts had become detached, and were removed ; and 
 some fragments of bone came away. 
 
 Oct. 16. — Since the last visit, the disorganized parts 
 had very much separated ; and the coronoid process, angle 
 and ramus of the inferior maxillary bone, as far as the 
 posterior molar tooth, had now been removed. The 
 patient could sleep quietly, and could take as much food 
 as was necessary. I discontinued the poultice, and 
 directed simple cerate spread on pledgets of lint to be 
 applied. 
 
 Oct. 18. — (Ten days after injuryi) The wound had 
 now become cleared of all dead portions of muscle and 
 cellular membrane, and presented a large circular aper- 
 ture from two to three inches in diameter ; at the bottom 
 of which might be distinctly seen the internal carotid 
 artery denuded from near the bifurcation of the common 
 trunk, to where it forms a curve to enter the canal in the 
 petrous portion of the temporal bone. Directly upon this 
 curve of the artery might be seen a dark speck, of a line 
 or two in diameter, which seemed to be a dead portion of
 
 LIGATURE OF THE CAROTID ARTERY. 161 
 
 cellular membrane adhering to the coats of the vessel. I 
 carefully touched it with a probe; but, finding that it 
 adhered, I desisted from the attempt to remove it, and 
 expressed to the patient and his friends my fears of a dan- 
 gerous if not fatal hemorrhage when that should separate. 
 I applied the usual dressings, left the room, and was 
 about leaving the house, when some one of the family 
 cried out that he was bleeding. I hastened back to his 
 room, and found him deluged with blood. The dressings 
 were immediately removed, and the blood jetted forcibly, 
 in a large stream, to the distance of three or four feet. 
 "With the thumb of my left hand, I instantly compressed 
 the artery against the base of the skull, and thus ef- 
 fectually controlled the hemorrhage. The patient had 
 fainted ; and fifteen or twenty minutes had elapsed before 
 he was so much revived that I dared to make any attempt 
 to secure the artery. Then, still keeping the thumb 
 firmly pressed on the orifice, I proceeded to clear the 
 wound from blood ; and, having done this, I made an in- 
 cision, with a scalpel, downward, along the course of the 
 artery, to more than an inch below the point where 
 the external branch was given off; which, as stated 
 above, had been destroyed at the time of the injury. 
 Having but one hand at liberty, I depended upon the 
 mother of the patient to separate the sides of the wound ; 
 which she did, partly with a hook and occasionally with 
 her fingers. At length, partly by careful dissection and 
 partly by using my fingers and the handle of the scalpel, 
 I succeeded in separating the artery from its attachments ; 
 and, passing my finger under it, I raised it up sufficiently 
 for my assistant to pass a ligature round it. She tied it 
 with a surgeon's knot, as I directed, at about half an inch 
 below the bifurcation. 
 14*
 
 162 APPENDIX B. 
 
 I removed my thumb and sponged away the blood, not 
 doubting that the hemorrhage was effectually controlled. 
 But, to my surprise and disappointment, the blood imme- 
 diately began to ooze from the rupture in the artery ; and 
 in less than ten minutes it flowed with a pulsating jet. I 
 compressed it again with my thumb, and began to de- 
 spair of saving my patient. What further could I do r 
 It was impossible to apply a ligature above the orifice : 
 compression, then, was the only alternative. How was 
 that to be effected ? Should some one sit by the patient, 
 and compress the artery constantly with the fingers till 
 adhesion should take place ? Possibly that might have 
 been done ; but I resolved to make another attempt first. 
 Raising my thumb, I placed a small piece of dry sponge 
 directly over the orifice in the artery ; and, renewing the 
 compression till a little larger piece of sponge could be 
 prepared, I placed that upon the first ; and so went on, 
 pressing the gradually enlarged pieces obliquely upwards 
 and backwards against the base of the skull, till I had 
 filled the wound with a firm cone of sponge, the base of 
 which projected two or three inches externally. Then 
 I applied a linen roller in such a manner as to press 
 firmly upon the sponge; passing it, in repeated turns, 
 over the head, face, and neck. I directed that the patient 
 should be placed in bed, with his head moderately raised, 
 and that he should be kept as quiet as possible ; and, as 
 his pulse was very feeble, he having lost at that time 
 between three and four pounds of blood by estimation, 
 he was allowed a little wine and water, and occasionally 
 some broth. We carefully watched him through the 
 night ; but no bleeding occurred, and he complained of 
 but little pain. 
 
 Oct. 20. — (Forty-eight hours after the operation.) 
 There had been no hemorrhage ; and there was but little
 
 LIGATURE OF THE CAROTID ARTERY. 163 
 
 excitement. Pulse 95 — regular. I directed the patient 
 to take gruel and broth ; and a little wine and water, if 
 faint. This course was pursued till 
 
 Oct. 24, — when the bandage was removed and a fresh 
 one applied, without disturbing the sponge. 
 
 Oct. 26. — The fetor arising from the accumulation of 
 matter in the sponge had become so offensive as to nau- 
 seate the patient. I carefully removed several of the 
 external pieces of sponge, washed the wound with a weak 
 solution of potass, carb., substituted lint in the place of 
 the sponge which had been removed, and applied the 
 bandage as before. 
 
 Oct. 28. — All the sponge was removed, except a small 
 piece directly on the artery ; the wound was washed with 
 a weak alkaline lotion ; and pledgets of lint, spread with 
 simple cerate, were applied. 
 
 Oct. 30. — The ligature on the carotid came away, and 
 the wound was rapidly filling up with granulations. 
 
 Nov. 1. — The remaining piece of sponge was removed. 
 The patient attempted, for the first time since the injury, 
 to masticate his food; but the under jaw was drawn so 
 much to the left that the teeth would not meet. To 
 remedy this inconvenience, I caused an ingenious black- 
 smith in the neighborhood to make an instrument some- 
 thing like Hull's truss ; one end of this being fitted to 
 the top of the head, it was brought down, on the right 
 side, under the chin ; and the pad on the other end was 
 made to press on the left side of the inferior maxillary 
 bone. He wore this instrument most of the time during 
 the remainder of the treatment; and it effectually 
 answered the purpose. 
 
 Nov. 11. — The patient had very much improved. 
 Several pieces of bone and a tooth had passed out from 
 the wound, which was rapidly cicatrizing. There was
 
 164 APPENDIX B. 
 
 but little discharge of matter ; he was able to move his 
 lower jaw, and to masticate solid food with ease. 
 
 Dec. 30. — Some small fragments of bone, and a tooth 
 from the upper jaw, had been cast off. The wound was 
 completely cicatrized, and the parts consolidated. There 
 was, however, some little deformity, in consequence of the 
 depression on the right side of the face. 
 
 This case seemed to me at the time highly important 
 and valuable ; since it established surgical facts, which, as 
 far as my knowledge extended, had not till then been 
 known. The question of the practicability of the safe 
 application of the ligature to the common carotid artery 
 was, in my opinion, now solved. I had entertained that 
 opinion for some time before ; having repeatedly tied the 
 vessels in dogs, and in one instance in a horse, without 
 causing them much inconvenience ; but, at that time, I 
 had seen no account of its having been attempted on the 
 human subject. 
 
 Sir Astley Cooper's claim of priority in the successful 
 application of the ligature to the common carotid artery 
 has been generally acknowledged. He performed the 
 operation in June, 1808; eight months after the above 
 operation. Sir Astley's case was undoubtedly the first 
 published ; but it appears from some recent publications, 
 that Mr. Fleming, of the British navy, tied the vessel on 
 the 17th October, 1803, for a servant on board ship who 
 had attempted to commit suicide. The patient recovered. 
 Mr. Fleming died abroad ; and the case was first pub- 
 lished by his assistant-surgeon, Dr. Coley, in January, 
 1817. 
 
 Of late, this operation has become very frequent, not 
 to say fashionable, in this country at least ; and in some 
 cases, accounts of which have been published, I should 
 think it had been performed unnecessarily. The case
 
 LIGATURE OF THE CAROTID ARTERY. 165 
 
 related above, in my opinion, clearly demonstrates the in- 
 utility and consequent impropriety of tying the carotid 
 artery for the purpose of preventing the growth of tumors 
 about the head and neck, or as a step preparatory to the 
 removal of such tumors by the knife. Although the com- 
 mon carotid had been tied, but a few moments only 
 elapsed before the hemorrhage from above was so profuse 
 as to require immediate and continued compression. If the 
 circulation is so soon restored by anastomozing branches, 
 of what use can the ligature be under such circumstances, 
 or what prospect can it offer of preventing the growth of 
 such tumors ? Reason, and the experience of all practical 
 surgeons, concur to show, that, whenever an arterial trunk 
 is tied, or in any way obstructed, the circulation is 
 promptly restored by anastomosis ; else mortification would 
 be the consequence.
 
 166 
 
 APPENDIX C. 
 
 CASES OF MORBID ANATOMY. 
 
 Case I. 
 
 April 18, 1808. 
 Urinary Organs. 
 
 J. F. aged eighty-two, had for nearly twenty years past 
 been attended with pain in the region of his kidneys, with 
 painful micturition. His urine was very often turbid 
 ■with blood, and sometimes the discharge from the bladder 
 would for several days appear to be entirely blood, which 
 was frequently voided in a coagulated state. He had 
 resorted to various medicines for the relief of the above 
 symptoms ; but he scarcely received a temporary benefit 
 from any. After death, permission was obtained to ex- 
 amine the viscera of the abdomen. The liver, spleen, 
 pancreas, stomach, and intestines were severally attended 
 to, but did not appear to be much diseased. The left 
 kidney was next examined. The membrana adiposa was 
 very much thickened and indurated ; upon the removal of 
 which, the proper coat of the kidney was discovered like- 
 wise to be in an indurated state. The body of the kidney 
 was rather diminished in size, but completely filled with 
 pus. The ureter and pelvis were enlarged to nearly three 
 times their natural size.
 
 URINARY ORGANS. 167 
 
 Upon examining the right kidney, the membrana adi- 
 posa did not appear so much diseased as upon the other 
 side, but was somewhat indurated upon its superior part. 
 The substance of the kidney itself on this side had fallen 
 a prey to disease, excepting a small portion of the cortical 
 part on the convex side, which was the only remaining 
 portion to be found. Attached to this part was a sack, 
 which was judged to contain about half a pint of a fluid 
 which had a resemblance to water turbid with blood. 
 From this bladder issued the ureter, which was about 
 three-fourths of an inch in diameter. Upon opening the 
 before-mentioned bladder or sack, it appeared to be an 
 enlargement of the pelvis and infundibula of the kidney. 
 Some of the infundibula were still to be discovered 
 attached to the remaining portion of the kidney, but so 
 enlarged that some of them were an inch in diameter. 
 
 The urinary bladder was very much contracted, and 
 filled with a substance resembling cheese-curd, or what is 
 frequently observed in scrofulous glands. The muscular 
 coat of the bladder was very much thickened. 
 
 Remarks. — The above appearances lead us to conclude, 
 that the disease began in the first place in the urinary 
 bladder, producing an obstruction to the discharge of 
 urine from the right ureter, which became distended and 
 very much enlarged ; the distention and enlargement ex- 
 tending to the pelvis of the kidney. As this process 
 advanced, the substance of the kidney became more and 
 more compressed till it was in a great measure lost ; being 
 converted into a sack containing cells, which were the en- 
 largement of the infundibula. 
 
 It has been remarked by writers, that the kidney will 
 secrete urine when the natural structure is almost entirely 
 lost. After this process had advanced considerably, it is 
 probable that the left ureter became obstructed, that the
 
 163 APPENDIX C. 
 
 pelvis began to enlarge; but the pressure upon the kid- 
 ney produced inflammation and suppuration. What 
 should produce the first obstruction to the free passage of 
 the urine into the bladder, it is difficult to tell. May it 
 not have arisen from a scrofulous affection of the blad- 
 der? 
 
 Case II. 
 Hydrocephalus Internus. 
 
 In the month of December, 1807, a child of T. T. aged 
 three months, was attacked with the hooping-cough. 
 After a violent course of the disease, she appeared to 
 recover so far, that the parents considered her well, ex- 
 cepting they observed " something singular," as they 
 expressed it, in the appearance of her eyes. She fre- 
 quently was observed to apply her hand to her head, and 
 to cry in a moaning voice. 
 
 The first of May, 1808, she was troubled with diarrhoea, 
 for which magnesia, &c. were prescribed, and appeared 
 to check it. 
 
 May 5. — The child showed evident symptoms of the 
 hydrocephalus internus. The fontanelle became very pro- 
 minent and tense. An emetic was prescribed. 6th. The 
 emetic has operated very powerfully, without mitigating 
 the symptoms. Calomel and opium in small doses were 
 now administered. 7th. Symptoms become violent. 
 There is a strabismus of left eye. Medicine as yesterday, 
 with addition of a cath. with calom. 8th. Much as yes- 
 terday ; the skin has become very dry, especially in the 
 palms of the hand ; some sweating about the head. 
 Tinct. of canth. Avas applied externally, particularly to 
 the head and neck and spine. 9. She has had convul- 
 sions, and the urine is diminished in quantity. She
 
 HYDROCEPHALUS INTERNUS. 169 
 
 shrieks and cries upon being moved. A blister was ap- 
 plied to the back of the neck, and the tinct. digitalis 
 given internally. 10. The right side has become para- 
 lytic, and the left is frequently convulsed. There is a 
 strabismus now upon both eyes. The tumor at the fon- 
 tanelle continues to increase ; she voids urine pretty freely, 
 and has had as many as two or three stools in twenty- 
 four hours. A blister is now applied to the fontanelle. 
 11. Symptoms and medicines as yesterday. 12. The 
 blister at the fontanelle does not discharge much ; it is 
 repeated. The patient has had frequent convulsions ; she 
 now lies stupid. The left arm and legs are in a con- 
 vulsed state, the hand is clenched, and the arm raised 
 towards the head. The leg is drawn up to nearly a right 
 angle with the knee. The right side continues in a para- 
 lytic state ; the mouth drawn to the right side. 14. Con- 
 tinues to have frequent convulsions, with frequent shriek- 
 ings ; opiates have been continued through whole dis- 
 ease, and appear to mitigate the convulsions. When she 
 winks, the globes of the eye roll to the right. The 
 digitalis appears to produce a considerable flow of urine. 
 15. All her symptoms appear worse. 16. She died in 
 convulsions. 
 
 Dissection. — After death, the brain collapsed, and the 
 tumor at the fontanelle disappeared. On removing the 
 cranium, the dura mater appeared in a natural state. 
 After separating it from the membrane beneath, the blood- 
 vessels, returning the blood from the brain to the different 
 sinuses, were very much distended with coagulated blood. 
 In some of them, the coagulating lymph appeared dis- 
 tinctly separated. In several places between the tunica 
 arachnoides and pia mater, there was a fluid resembling 
 pus, together with a considerable quantity of serum. 
 Upon removing that portion of the cerebrum which covers 
 15
 
 170 APPENDIX C. 
 
 the corpus callosum, there appeared a distinct fluctuation 
 in the right ventricle, which was then opened, and there 
 issued from it four or five ounces of serum. In the left 
 ventricle there was not so much serum, but there was a 
 quantity of matter resembling pus rather hardened. The 
 third and fourth ventricles contained some serum ; and, 
 indeed, it appeared to be generally diffused throughout 
 the brain, and extended down the spinal marrow. There 
 was an inflammatory crust surrounding the optic nerves, 
 as likewise the left one of the sixth pair. 
 
 These were the principal morbid appearances that were 
 discovered upon the brain. Upon comparing these with 
 the foregoing symptoms, we shall discover that the side of 
 the body most affected was opposite to the side of the 
 brain most diseased, and vice versa. 
 
 Case III. 
 
 Of a Diseased Stomach. 
 
 Miss R , aged forty years, had complained for seve- 
 ral years of a burning pain, as she expressed it, at her 
 stomach ; for which she had made application to several 
 physicians, but had obtained scarcely any mitigation of 
 her complaint. The only temporary relief she could pro- 
 cure was from large draughts of milk and water. She 
 died June 17th, 1808. It was the desire of her friends 
 that the viscera of the abdomen should be examined. On 
 dividing the cellular substance, there escaped a consider- 
 able quantity of serum. After the parietes of the 
 abdomen were divided, there was a large quantity dis- 
 charged, together with some pus. The peritoneum and 
 the peritoneal coat of all the viscera was covered with 
 pus. The lower part of the stomach, the pylorus, and all 
 the duodenum above where the ductus cholideous commu-
 
 DISEASED STOMACH. 171 
 
 nis enters it, were very much enlarged and thickened, 
 assuming the appearance of a cancer. On handling the 
 tumor, it was so ulcerated that the finger readily passed 
 through it, and some ill-conditioned matter issued out. 
 On laying the tumor freely open, it was found to contain 
 some excrementitious substance, together with something 
 resembling the dregs of indigo and flakes of charcoal. 
 The pancreas was very much enlarged, and in a scirrhous 
 state, and adhered to the stomach and duodenum. The 
 liver appeared in a pretty healthy state ; yet the gall blad- 
 der was much contracted, and was very firmly attached to 
 the tumor of the stomach, and contained a small quantity 
 of viscid bile. The other viscera were healthy, excepting 
 being covered with pus, as was before mentioned.
 
 172 
 
 APPENDIX E. 
 
 The following cases of tracheotomy, with the remarks thereon, 
 were read before the New Hampshire Medical Society, at its 
 annual meeting, 1830. They were subsequently published in the 
 New England Quarterly Journal, vol. i. p. 305 : Boston, 1843. 
 
 CASES OF TRACHEOTOMY. 
 
 In the great variety of operations which the surgeon is 
 called upon to perform, perhaps there is no one more ap- 
 palling to spectators, or which requires more decision and 
 presence of mind in the operator, than that of broncho- 
 tomy or tracheotomy. And when performed for the 
 removal of a foreign substance from the larynx or trachea, 
 there is no case in which the patient receives more imme- 
 diate and manifest relief, and in which the skill and dex- 
 terity of the surgeon are more duly appreciated. Yet the 
 operation itself, if properly performed, is not a dangerous 
 one. 
 
 Case I. 
 
 August 5, 1827, was called to visit a child aged twenty- 
 two months, and found her with symptoms of suffocation. 
 The report given by her parents was, that, about two
 
 CASES OF TRACHEOTOMY. 173 
 
 hours before, she had been playing with some common 
 field beans, had put some of them into her mouth, and, in 
 the act of laughing, they supposed one of the beans had 
 slipped into the windpipe. She was immediately seized 
 with a difficulty of breathing, with occasional paroxysms 
 of suffocation. Upon attentive examination, and listen- 
 ing to the manner of her breathing, I came to the 
 conclusion that the bean was in the trachea, near its 
 bifurcation, and probably lodged on or over the left bron- 
 chial tube, as the lung on that side of the chest did not 
 expand in respiration. 
 
 The necessity of an operation was manifest, and was 
 proposed as the only means of rescuing the child from 
 immediate danger. Her parents would not consent to it ; 
 and, as the foreign substance appeared to be fixed or sta- 
 tionary in the situation it then was in, it was thought not 
 proper to urge it at that time. The attendants were 
 directed to watch the child attentively, and, if the bean 
 appeared to come up into the upper part of the trachea or 
 larynx, and strangle her, to endeavor to force it back 
 again by rubbing or pressing the throat with considerable 
 force. 
 
 I then left the patient, and was absent two or three 
 hours. Upon my return, I was met at the door by some 
 one saying, " The child was dying." I found her with 
 a livid countenance, tossing herself about in various direc- 
 tions, and gasping for breath. By pressing and rubbing 
 the larynx and trachea, the bean appeared to descend 
 again to its former situation. An operation was no 
 longer objected to, as it was evident she must have imme- 
 diate relief, or death would be the consequence. 
 
 Preparations were soon made. The child was placed 
 upon a table on her back, with a roll of cotton under her 
 neck, and her head bent backward over it, so as to stretch 
 15*
 
 174 APPENDIX E. 
 
 the integuments on the fore part of the neck, which was very 
 short and fleshy. An incision was made through the skin 
 and cellular substance, extending from near the thyroid 
 cartilage to the sternum, continuing the dissection on the 
 fore part of the trachea. Some small blood-vessels were 
 divided, but the hemorrhage was not so profuse as to delay 
 the operation. The thymus gland, apparently very large, 
 was next observed extending up the trachea till it came in 
 contact with the thyroid gland. It was carefully de- 
 tached ; and the assistants, with some difficulty, succeeded, 
 with small blunt hooks, in holding the two glands asunder 
 sufficiently to denude the trachea, through which an inci- 
 sion was then made, nearly half an inch in length. The 
 air came hissing through the wound. A pair of small 
 forceps were passed into the trachea and up through the 
 glottis, by which it was ascertained that the foreign sub- 
 stance was not above the opening. Then a pair of com- 
 mon dressing forceps were introduced, and the blades 
 separated so as to hold apart the sides of the slit. They 
 were but just placed in that situation, when the bean, 
 during some little struggle of the child, came up, and 
 was instantly seized with the forceps and removed. The 
 patient was turned face downwards to prevent the blood 
 from getting into the trachea. She immediately breathed 
 easy and natural. The glands and integuments closed 
 over the slit, so that no air escaped through it, and within 
 five minutes she was sleeping. After letting her rest for 
 a short time, the wound was sponged clean, and accurately 
 brought together and retained by strips of adhesive plas- 
 ter ; a small compress placed upon each side, and secured 
 by a roller passed several times round the neck. She was 
 then put to bed, and rested quietly through the night. 
 The next day, August 6, when I visited the child, found 
 her running about the house, apparently well.
 
 CASES OF TRACHEOTOMY. 175 
 
 August 8. — Removed the dressings for the first time. 
 The wound had completely adhered by the first intention, 
 and there had been no febrile action after the operation. 
 
 August 12. — The dressings were discontinued, and the 
 child was in perfect health. 
 
 Case II. 
 
 March 1, 1830. — A child, aged one year and sixteen 
 days, laboring under a slight catarrhal affection or in- 
 fluenza, while creeping upon the floor, put a piece of 
 broken earthen cup into the mouth ; and in the act of 
 coughing or laughing, as stated by the parents, it slipped 
 into the throat, and produced, in their language, " a 
 choking, or an inability to swallow, and a difficulty of 
 breathing." Within half an hour after the accident, I 
 saw the child ; his breathing was somewhat hoarse and 
 hissing ; but his friends said, " Not much more so than 
 before the accident happened." He could not be induced 
 to swallow any thing ; but when a little water was put 
 into his mouth, after holding it a short time, he ejected 
 it. A probang was passed into the oesophagus, after 
 which he swallowed readily, and the breathing was less 
 impeded. Some castor oil was administered, and mucilagi- 
 nous drinks directed. 
 
 March 2. — Nine o'clock, a.m. eighteen hours after the 
 accident, the father of the child came running to me, and 
 said he was suffocating ; or, to use his expression, " was 
 choking to death." When I arrived, they had the child 
 in their arms, carrying it about the room in nearly an 
 erect posture. He was restless, tossing his arms, and en- 
 deavoring frequently to change his position. His coun- 
 tenance was livid, his breathing very much impeded, and 
 sounded hissing and husky, and was only in gasps. It
 
 176 APPENDIX E. 
 
 was evident that the foreign substance was in the larynx 
 or trachea, and that he must be relieved immediately by 
 an operation, or death would ensue. Preparations were 
 quickly made ; and, with the assistance of Dr. J. B. Daus- 
 man, I proceeded in the operation. The child was placed 
 upon a table on his back, a small pillow rolled hard and 
 placed transversely under his neck, and his head bent 
 back over it so as to elevate his chin and make the integu- 
 ments tense, and the cartilages of the larynx and trachea 
 prominent. 
 
 An incision, two inches in length, was made through the 
 integument. The thyroid and guttural veins were seen, 
 very turgid. They were carefully detached sufficiently 
 to be pushed aside, and were not divided. Continuing 
 the dissection on the fore part of the trachea, an artery, 
 the thyroidea anastomotica, was divided. At first, it 
 bled very freely, so that we were obliged to suspend the 
 operation a few minutes. The bleeding soon ceased ; an 
 incision was then made through the trachea, half an inch 
 in length. The air came freely through the wound, and 
 the child breathed with more ease. After delaying a 
 short time, that he might in some measure recover from 
 his exhausted and suffocated state, a small pair of forceps 
 were passed through the slit in the trachea upwards 
 towards the glottis. It immediately came in contact with 
 the piece of earthen cup, and the sound was distinctly 
 heard by the bystanders. Every attempt to seize it with 
 the forceps proved ineffectual. A probe was then curved 
 and passed into the trachea, and endeavors made to dis- 
 lodge it, but did not succeed ; during which the child 
 struggled much, and at length became so much exhausted, 
 that the spectators thought him about expiring. A large 
 probe was then introduced, and with it the foreign sub- 
 stance was pushed up through the glottis into the pha-
 
 CASES OF TRACHEOTOMY. 177 
 
 rynx, and the child swallowed it. Afterwards a bougie 
 was passed up throgh the larynx and glottis, with which 
 it was ascertained that all obstruction was removed. 
 
 In the various attempts made to dislodge this substance, 
 it was pretty well ascertained that it was sharp and an- 
 gular, and being so firmly fixed that it required consider- 
 able force to push it into the pharynx. The probability 
 was that the delicate and sensible membrane, lining the 
 larynx and upper part of the trachea, was very much 
 lacerated and wounded. Under these circumstances, it 
 was thought advisable not to close the wound, that respi- 
 ration might go on by the air passing through the slit in 
 the trachea, in case that the subsequent inflammation 
 should be so great as to close the glottis, and prevent it 
 passing that way. Some superficial dressings were ap- 
 plied ; but a portion of the incision was left open and 
 naked. The child was then put into bed ; and, although 
 very much exhausted, his respiration was tolerably free 
 and easy. In the evening he was very quiet, had slept 
 some, and had taken some light nourishment. The air 
 had occasionally passed through the wound. 
 
 March 3. — There was considerable febrile action ; the 
 breathing was rather more laborious ; some portion of the 
 air passed through the incision at almost every breath. A 
 cathartic of castor oil was administered. In the evening, 
 the oil had purged two or three times, and he was resting 
 quietly, breathing as in the morning. 
 
 March 4. — The external parts appeared considerably 
 swollen and inflamed. In respiration, the air passed 
 wholly through the incision in the trachea. The glottis 
 was apparently closed by the inflammation, and he could 
 make no vocal sound. Six grains of calomel was to be 
 given, followed with castor oil to purge freely. 
 
 March 5. — The cathartic had operated several times;
 
 178 APPENDIX E. 
 
 but the symptoms continued much as they were on the 
 fourth. 
 
 March 6. — Suppuration had commenced in the wound, 
 and he breathed at intervals rather laboriously. The air 
 continued to pass wholly through the opening in the tra- 
 chea. He could neither cry aloud, nor make any noise. 
 
 March 7. — Suppuration was copious : he coughed a 
 good deal, and, when coughing, some air was forced 
 through the glottis, carrying with it pus and mucus. 
 
 March 8, 9. — He appeared to be failing; took but lit- 
 tle nourishment. Suppuration continued very copious, 
 pus very thick and glutinous ; and, when any of it was 
 carried with the air through the wound in the trachea, it 
 produced violent fits of coughing and strangulation. At 
 intervals, that is, after he had expelled a good deal of pus 
 and mucus during a paroxysm of coughing, he breathed 
 more freely, and mostly through the glottis ; could cry 
 aloud, and articulate some words. 
 
 March 10. — His breathing was more laborious, with 
 apparent inability to cough and expectorate. Granula- 
 tions had sprung up in the wound, and appeared to im- 
 pede the passage of the air ; and, either from inability or 
 disinclination, he had ceased taking any nourishment, and 
 his mouth and jaws were covered with aphthce, for which 
 a gargle of borax and honey was prescribed. 
 
 March 11. — In the morning, a messenger came in 
 great haste, and said " the child was suffocating." I 
 found him breathing very laboriously and croupy. Coun- 
 tenance livid, with the expression of great anxiety; 
 unable to make any sound. Granulations had nearly 
 filled up the wound. The incision in the throat was 
 mostly covered by them, and the trachea itself in that 
 part appeared very much contracted, which was ascer- 
 tained by passing a probe through the opening ; but very
 
 CASES OF TRACHEOTOMY. 179 
 
 little air appeared to pass into the lungs any way. In 
 this situation, we concluded the indication was, if possi- 
 ble, to dilate the stricture of the trachea, and to clear it 
 of the tenacious, muco-purulent secretion, with which it 
 appeared to be filled. With that view I passed a pretty 
 large-sized urethra bougie into the trachea, and first 
 passed it up through the glottis, and afterwards passed 
 it downwards towards the lungs. It produced consider- 
 able coughing, and a good deal of mucus and pus was 
 discharged into the mouth, and either ejected or swal- 
 lowed, and some came through the wound. This appeared 
 to give immediate relief: it restored his voice, and he 
 breathed with much more ease. A decoction of seneca 
 and squills, prepared after the formula for Coxe's hive- 
 syrup, was directed to be given in doses of a teaspoonful 
 every half-hour, till it produced vomiting, and the gargle 
 of borax and honey to be continued. In the evening, the 
 child had vomited several times, and had two or three 
 alvine discharges : breathed more freely, and took some 
 nourishment. 
 
 March 12. — Much improved ; respiration was natural 
 and easy ; but little air escaped through the wound, and 
 that only when he coughed, cried, or was agitated. He 
 took sufficient food, and the aphthous appearance of the 
 mouth was principally removed. 
 
 March 14. — He had gained rapidly. He was sitting 
 up in bed, diverting himself with playthings, and breathed 
 perfectly natural. 
 
 March 10. — He had continued to improve. The open- 
 ing in the trachea was closed, the wound filled up and 
 nearly cicatrized. Discontinued my visits. 
 
 April 4. — Called to see my patient ; found him in per- 
 fect health. The cicatrization of the wound had been 
 complete for several days.
 
 180 APPENDIX E. 
 
 Case III. 
 
 March 30, 1830. — Was called to visit S. W. aged four 
 years and four months. Met in consultation with Drs. 
 Carpenter, E. Hatch, and Bliss, at eight o'clock, a.m. 
 The report given by the parents of the child was, that, the 
 evening before, she was amusing herself with some large 
 kidney-shaped garden beans. She had some of them in 
 her mouth, and by some means one of them slipped into 
 the windpipe. She was immediately seized with a diffi- 
 culty of breathing, which had continued ever since, with 
 occasional violent suffocating attacks. At the time of our 
 consultation, the breathing was hissing and husky ; and, 
 by auscultation, we found that the right bronchial tube 
 was obstructed, and concluded that the bean was lodged 
 near the bifurcation of the trachea. An operation was 
 immediately determined upon, as the only means of afford- 
 ing the relief the case so urgently required. 
 
 Preparations were soon made, and the child placed 
 upon a table, as in the preceding cases. An incision was 
 made through the integuments two inches in length. The 
 dissection was continued till the fore part of the trachea 
 was laid bare. No blood-vessel of importance was 
 divided, and there was no hemorrhage to impede the ope- 
 ration. A longitudinal incision was then made into the 
 trachea, rather more than half an inch in length. The 
 air passed freely through the wound. The bean soon 
 made its appearance, presenting its broad or flat side to 
 the slit in the trachea, the sides of which would not sepa- 
 rate sufficiently to let it pass. Endeavoring to seize it 
 with a pair of forceps, it slipped from my grasp, was 
 forced up, and stuck fast in the larynx or glottis, which 
 it so completely filled, that it prevented any air passing 
 that way. An attempt was made with a large probe to
 
 CASES OF TRACHEOTOMY. 181 
 
 force the bean up through the glottis ; but it was so laro-e 
 it would not pass without too much violence. The child 
 at that time struggled considerably, and the assistants 
 who held apart the sides of the incision lost their hold. 
 The integuments of the neck, which was very fleshy, im- 
 mediately closed over the opening in the trachea, and 
 stopped respiration entirely. The lungs collapsed, the 
 child straightened herself, her countenance became livid, 
 her eyes motionless and glassy. The spectators declared 
 she was dead. The sides of the incision were instantly 
 separated and held asunder by the assistants, and the 
 blades of a pair of dressing forceps were introduced into 
 the slit in the trachea, and with them the sides were kept 
 apart; but no air passed — respiration did not return — 
 the child was still motionless. I called for a tube or some 
 instrument to inflate the lungs ; but the agonized feelings 
 of the friends, and the agitation of the attendants and 
 spectators, prevented their heeding my call, or rendering 
 any assistance. I then seized a bougie which was at 
 hand, passed it through the wound into the trachea down- 
 wards towards the lungs, at the same time directed an 
 assistant to press the chest in different directions with his 
 hands. The bougie appeared to irritate and produce 
 some little motion in the chest ; and, upon removing it, 
 some little air appeared to rush into the lungs. The mo- 
 tion of the chest increased, respiration was gradually 
 restored, and life and action returned. She swallowed a 
 few drops of camphorated spirit. I then passed a pair of 
 small forceps up towards the glottis, seized the bean, and 
 removed it. 
 
 She immediately breathed free and easy. As soon as 
 she had recovered a little from her exhaustion, the wound 
 was sponged clean, and dressed with strips of adhesive 
 plaster ; and she was put to bed, and was soon asleep. 
 16
 
 182 APPENDIX E. 
 
 The next day, March 31, one o'clock, p.m. there was 
 considerable febrile excitement, with croupy breathing. 
 A cathartic of calomel and jalap was given, and followed 
 by sulphate of magnesia, which purged freely and gave 
 relief. A solution of tartarized antimony was directed to 
 be given occasionally till the febrile symptoms were re- 
 moved. 
 
 April 2. — The wound was dressed, and very little air 
 escaped through the incision. It had principally adhered 
 by the first intention. 
 
 April 7. — The incision was entirely healed, and the 
 child in perfect health.
 
 183 
 
 APPENDIX F. 
 
 THE PRESENT CONDITION OF THE MEDICAL 
 PROFESSION ; 
 
 THE IMPEDIMENTS TO ITS PROGRESS AND REPUTATION; WITH SUG- 
 GESTIONS ON THE PROPER METHODS TO BE PURSUED FOR THE 
 ARREST OF EMPIRICISM ; — AN ADDRESS DELIVERED AT THE AN- 
 NUAL MEETING OF THE NEW HAMPSHIRE MEDICAL SOCIETY. 
 
 Gentlemen, — Occupied, as I have constantly been, in 
 the practice of our laborious profession, I have found no 
 leisure to digest, and prepare for the present occasion, a 
 regular essay upon any medical topic. But the honora- 
 ble station in which, by the suffrages of this society, I am 
 placed, imposes upon me the duty of addressing you upon 
 some subject connected with medicine. 
 
 Ever anxious to see the character of our common pro- 
 fession elevated to a proper standing, which will exempt 
 it alike from a suspicion of selfishness and from being the 
 butt of ridicule among all classes of society, and placed 
 on an eminence which will command the respect and de- 
 serve the confidence of the community at large, I have 
 been induced at this time to occupy your attention, a very 
 few moments, with some reflections upon the present con- 
 dition of the medical profession, and an inquiry into the 
 causes which hinder its advancement, and what course we
 
 184 APPENDIX F. 
 
 ought to pursue to promote its respectability, and to re- 
 tard the progress of empiricism, or banish it from amongst 
 us. 
 
 Within the last half-centuiy, there has been a very 
 rapid improvement in the science of medicine; under which 
 title I wish to be understood to include, not only the 
 science which is at present so denominated, but likewise 
 surgery, which was formerly the case. Within the period 
 named, there have been great numbers who have engaged 
 in the pursuit, who have brought with them a vast fund 
 of talents, industry, and acquirements, the whole of which 
 they have unremittingly devoted to the subject : in short, 
 almost all those who are now engaged in the profession 
 appear to pursue it with an ardor heretofore unexampled. 
 Medical schools have now become very numerous and 
 respectable, w r here medicine and its collateral branches are 
 taught and studied in a systematic manner. From these 
 fountains issue annually many young men, not only well 
 informed in the principles of the profession, but possess- 
 ing talents and industry to pursue it with credit to them- 
 selves, and advantage to the public. As a natural result 
 from the causes we have named, the fact is, that the regu- 
 lar profession generally is now much more learned and 
 better qualified to practise than formerly, and are much 
 better entitled to the confidence and patronage of society. 
 But do they obtain it? Are they any more respected 
 now than they were, when their whole stock of medical 
 information was contained in a bundle of recipes ? Do 
 we not see the ignorant and itinerant quack still employed 
 to their exclusion ? If this is the fact, — and I think no 
 one can doubt it, — how is it that the public are thus 
 imposed upon ? and how shall the evil be remedied ? 
 
 The liability of mankind to imposition, and of becom- 
 ing the dupes of the cunning and crafty, is in an inverse
 
 CONDITION OF THE MEDICAL PROFESSION. I8t) 
 
 proportion to their intelligence and general information. 
 Wherever we find the common mass of people well in- 
 formed, not only in the objects of their particular pursuit, 
 but upon subjects generally, — that is, they have been 
 from their infancy rationally and philosophically edu- 
 cated, — there we find no impostor fattening upon their 
 credulity ; but where we find them generally ignorant, 
 and consequently credulous and superstitious, there we 
 find the hypocritical and fanatical priest, the pettifogging 
 lawyer, and quack doctor. 
 
 It is a lamentable fact, that the learned professions have 
 heretofore found it too much for their interest to keep the 
 rest of mankind in ignorance ; and, by so doing, they have 
 frequently obtained, not only the good things of this 
 world, but a character for learning, wisdom, and sanctity, 
 to which they were not entitled, either by their talents, 
 integrity, or acquirements. 
 
 If we recur to the history of medicine, as handed down 
 to us by its professors, we shall find that the practition- 
 ers in the art or science have always been induced to 
 assume some mysterious or supernatural skill, and have 
 studiously endeavored to keep their patients in ignorance, 
 by clothing their prescriptions in a technical garb, and by 
 holding their communications with each other in a lan- 
 guage intelligible only to themselves ; thus inspiring the 
 uninformed with a belief, that there is something in the 
 profession beyond the comprehension of ordinary minds, 
 and that they have been supernaturally endowed with 
 faculties which enable them to penetrate into and com- 
 prehend all the mysteries of nature. 
 
 Even in this country, where the principles of all the 
 
 other arts and sciences are placed within the reach and 
 
 comprehension of the common people, that of medicine is 
 
 still, in a great measure, hidden from their view. The 
 
 16*
 
 186 APPENDIX F. 
 
 language of medical men and medical writers is not 
 brought to the understanding of mankind generally ; it 
 is not the common language of this country, nor of any 
 other country now existing upon earth. 
 
 So long and so generally has this method of writing 
 and speaking prevailed among the most learned of the 
 profession, that now, the physician and surgeon, who, in 
 his intercourse with his patients, should use a language 
 perfectly intelligible to them, would be considered by 
 many as very unlearned, and not deserving of their 
 confidence. Is it strange, then, if the regular and learned 
 physician thus keeps himself aloof, and suffers not the 
 common mass of people to approach him and know 
 him, that the crafty quack, destitute alike of information 
 and moral honesty, should frequently palm himself upon 
 the public as one of those duly initiated into all those 
 mysteries which are supposed to belong to the profession ? 
 
 All this secrecy and mystery in the practice of medicine 
 is an imposition, is quackery, let who will adopt it ; and, 
 so long as there is so much of it in the profession, persons 
 of common education cannot discover the difference be- 
 tween the learned quack and the ignorant one. A few 
 years since, a gentleman, after having had an interview 
 with a noted empiric whose fame was then spreading far 
 and wide, observed to me, " Well, I have been to see the 
 Indian doctor." And what do you think of him ? "I 
 cannot for my life discover in any thing why he is not as 
 learned and as skilful as any M.D. I ever saw. He con- 
 verses in a language as unintelligible as the best of you." 
 1 considered this a severe and just rebuke upon the pro- 
 fession generally. 
 
 There are various ways of playing the quack. As Rush 
 observes, " It is not necessary for this purpose that a man 
 should advertise his skill or his cures, or that he should
 
 QUACKERY IN THE MEDICAL PROFESSION. 187 
 
 mount a phaeton and display his dexterity in operating to 
 an ignorant and gaping multitude. A physician acts the 
 same part in a different way, who assumes the character 
 of a madman or a brute in his manners, or who conceals 
 his fallibility by an affected gravity and taciturnity in his 
 intercourse with his patients.' 
 
 There are some who are continually boasting how much 
 more successful they are in their practice than their neigh- 
 bors, — of the marvellous cures and operations, which, in 
 fact, they have never effected or performed. Others mag- 
 nify the danger and importance of the most trifling indis- 
 position, or make a great parade about any surgical 
 operation, let it be ever so simple, by calling in a large 
 number of physicians and surgeons to hold a council (as 
 they term it) upon the case ; thus unnecessarily alarming 
 the patient and his friends, for no visible purpose, unless 
 it be to secure a retreat from blame if they are unsuc- 
 cessful, or to enhance their credit should they effect 
 a cure, and enable them to augment the amount of their 
 charge for services. 
 
 Some boast of their superior attainments, and of the 
 great opportunities they have had for acquiring medical 
 information. I know a physician, who was never in his 
 life a hundred miles from the place of his nativity ; yet 
 he says it must be strange if he does not know more 
 than other practitioners in his neighborhood. He says, 
 and many believe it, that he has obtained all the in- 
 formation that was to be had from the best medical 
 schools in this country, and then he has spent two or 
 three years in Europe. He is intimately acquainted and 
 corresponds with all of the most eminent and learned 
 men in the profession. What they know, he knows ; 
 whatever they learn or discover, they immediately com- 
 municate to him.
 
 188 APPENDIX F. 
 
 When a patient, upon -whom he had been attending a 
 long time, expressed a wish for other advice, he said, " I 
 have written to the greatest doctor in England, and stated 
 your case to him, and he has sent me a medicine which 
 he says never fails in such cases. You had better delay 
 calling other advice, till I have had an opportunity to 
 give it a fair trial." This course had the desired effect : 
 it prevented at that time the consultation, which he 
 dreaded. How much less deception and falsehood was 
 here, than is practised by the ignorant impostor, who 
 boasts of having obtained his skill of the Indians ! 
 
 There are some physicians, who are very well qualified, 
 who deceive and impose upon their patients by administer- 
 ing inert or useless remedies, and by taxing them for 
 much unnecessary attention. Within the last year, a 
 young gentleman of a fair mind, well educated in the pro- 
 fession, possessing liberal and correct principles, com- 
 menced practice in a town in this state. He was called 
 to visit a child in a respectable family : he found it 
 affected with some slight febrile symptoms. He pre- 
 scribed the remedies he thought indicated ; but the anxiety 
 of the parents was such that they were unwilling to trust 
 the young doctor alone, and an older one was called. He 
 came and examined the case, and was informed of the 
 treatment which had been pursued. He inquired, " Did 
 you give the submuriates r " meaning calomel ; which name 
 he avoided, lest it should be understood that a portion of 
 mercury had been administered : he was answered in the 
 affirmative. He then took the young physician aside, to 
 hold a consultation, as he termed it. When by them- 
 selves, he said to him, " You have treated the case very 
 properly, and have done all the case really requires ; but 
 that will not do : you must give more medicine, or you 
 will never never be able to satisfy the people, and obtain
 
 CONDITION OF THE MEDICAL PROFESSION. 189 
 
 their confidence. In this case, I should advise you to 
 color some water, or a weak solution of nitre, with red 
 sanders, and give the child a teaspoonful once in two or 
 hours, until it recovers its usual health." 
 
 A few days afterwards, the young gentleman called 
 upon me, and inquired if such was the course that regular 
 physicians generally pursued, and whether this society 
 tolerated such practice. 
 
 The following circumstances were related to me by a 
 respectable clergyman of this State : A farmer, one of his 
 parishioners, had the misfortune to fall from his cart, and 
 one of the wheels passed over him, directly across his ab- 
 domen. Although the vehicle was not heavily loaded, 
 yet he was somewhat bruised, and very much frightened. 
 A messenger was despatched with all possible haste for 
 the doctor who resided in the neighborhood, who came 
 with due speed, and, as a thing of course, bled him 
 largely, and administered a dose of castor oil. The doctor 
 was then informed that they had sent for a surgeon, who re- 
 sided some twenty or thirty miles distant, whose reputation 
 was unrivalled in that part of the country. The next day, 
 the minister was sent for, who, with the neighboring physi- 
 cian, was present when the surgeon arrived. The patient 
 had passed the night with a great deal of anxiety, although 
 with but little pain. The arrival of the great doctor was 
 announced, the family and friends all crowded around the 
 bed of the patient, the surgeon entered the room, with his 
 saddle-bags upon his arm, and turned his eyes directly 
 upon the wounded man. He stood several minutes gaz- 
 ing upon him, during which time his countenance put on 
 the most direful and portentous aspect. At length he 
 shook his head, set down his saddle-bags, and laid off his 
 hat, drew up a chair, and seated himself by the bed, 
 placing one hand upon the abdomen of the patient, and
 
 190 APPENDIX F. 
 
 with the other felt his pulse, and said nothing. Some 
 minutes passed in this manner, when the deathlike silence 
 of the room was interrupted by the anxious and affec- 
 tionate wife, tears streaming down her cheeks, by " Doc- 
 tor, what do you think ? r ' A shake of the head was the 
 only reply. The children burst into tears. One little 
 urchin, too young to fully realize what was going on, 
 hearing the sobs of his brothers and sisters, threw down 
 the cat with which he was playing, and ran to his mother 
 for an explanation. Unfortunate for poor puss, the doctor 
 espied him, seized him by the hind legs, and smashed his 
 head upon the hearth, drew forth a knife, and convinced 
 the spectators that he was a dexterous operator, by in- 
 stantly depriving the cat of her skin, and applying it 
 directly upon the abdomen of the suffering man, again 
 seating himself with one hand upon the wrist, feeling the 
 pulse ; in which posture he continued half an hour, and 
 then, for the first time after his arrival, broke silence by 
 inquiring if they had any sheep. Being answered in the 
 affirmative, he requested that a skin might be stripped 
 from one of them, and brought to him immediately ; which 
 was accordingly done. The doctor instantly removed the 
 cat-skin, and enveloped the patient in the warm sheep- 
 skin, and continued silently watching him as before. The 
 anxiety of the patient and family was extreme during this 
 farce, which was manifested by the inquiry of "Doctor, 
 what do you think : is there no hope r " but not a word 
 could they obtain. After remaining in suspense nearly 
 an hour longer, closely watching the countenance of the 
 doctor, they discovered that the muscles of his face began 
 to relax. At length he smiled, and then broke silence 
 and said, " We have gained it ; you are safe ! If I had 
 been five minutes later, all the world could not have saved 
 vou : the mortification was just beginning."
 
 PREVENTION OF QUACKERY. 191 
 
 In the course of a day or two, the farmer was able to 
 pursue his labor as usual, believing that his life was pre- 
 served by the great skill of the surgeon. 
 
 Numerous other instances might be related, if not 
 equally ridiculous and absurd as those we have named, 
 yet very improper in any gentleman of the profession who 
 wishes to be considered an honorable and honest practi- 
 tioner. 
 
 If such are the impositions and deceptions practised by 
 regular physicians, as they are called, by those who have 
 had the honorable degree of Doctor in Medicine conferred 
 upon them, and are in regular standing in respectable me- 
 dical societies, it will be in vain for our legislature to 
 enact laws against the ignorant pretender. So long as 
 there are learned and licensed quacks in this country, so 
 long will the ignorant and unlicensed ones obtain patro- 
 nage from the public. 
 
 The most rational, and I presume the only successful, 
 method, for us to combat quackery, will be, in the first 
 place, to avoid it ourselves ; and then endeavor to en- 
 lighten the common people as much as possible. Let 
 them understand that the principles of the profession are 
 founded upon reason and science, and that we are 
 governed by those principles. We make no pretensions 
 to supernatural powers. Let us banish all technical 
 phraseology from our conversation and prescriptions, if 
 not from our pharmacopoeias. Let us be unwearied in our 
 efforts to investigate the nature and causes of disease, and 
 the effects of remedies. When called to the bed of sick- 
 ness, let us be very critical in our inquiries and examina- 
 tions, and patiently investigate every circumstance relating 
 to the case ; and, after having formed an opinion, let us 
 be candid in stating our views of the case to the patient 
 or his friends, explain to them, if possible, the location
 
 192 APPENDIX F. 
 
 and nature of the disease, the indications of cure which 
 are to be pursued, and the remedies we intend to pre- 
 scribe, with the effect we expect they will produce. If 
 we have any doubt in the case, or think we do not rightly 
 understand it, let us acknowledge it, and call for advice, 
 if thought necessary. 
 
 By pursuing this course, we shall soon enlighten the 
 common mass of people, so that they will in a measure 
 comprehend the general principles of the profession ; and 
 thus we shall obtain their confidence, and quackery and 
 quacks will soon be banished from amongst us, without 
 the aid of legislative enactments.
 
 193 
 
 APPENDIX G. 
 
 This affidavit, relative to fracture of the femur, was found among 
 Dr. Twitchell's manuscripts. Its date is unknown. 
 
 FRACTURE OF THE THIGH-BONE, AND THE LIABI- 
 LITY TO A SUBSEQUENT DEFORMITY OF THE 
 LIMB. 
 
 I, Amos Twitchell, of lawful age, do testify and say, 
 that I have ever considered a fracture of the thigh-bone 
 attended with a great risk of deformity, in the hands 
 of even the best of surgeons. I have been uniformly of 
 opinion, that, let the reduction and first dressing be ever 
 so skilfully performed, it would be of little importance, 
 unless the subsequent management was judicious, and 
 adapted to the circumstances as they occur from time to 
 time, ever maintaining an inflexible command over the 
 patient; restraining and directing him in all his mo- 
 tions. Believing this, I have sometimes refused to visit 
 a patient for the purpose of reducing a broken thigh, who 
 lived at the distance of twenty or thirty miles; think- 
 ing that my services would benefit him but little, as I 
 could not control the subsequent treatment, and knowing 
 that all deformity which might occur in the limb would 
 probably be unjustly attributed by the ignorant to the 
 •surgeon who first dressed it. This was the case with a 
 17
 
 194 APPENDIX G. 
 
 person with whom I am acquainted, whose thigh was 
 broken. Dr. Nathan Smith, being in the neighborhood, 
 was called : he reduced and dressed the limb. After- 
 wards, owing to the restlessness of the patient, it was dis- 
 placed, and was never attempted to be righted by the 
 attending surgeon. The consequence was, the man was 
 a cripple, and Dr. Smith received the opprobrium of many. 
 In cases which have fallen under my care, I have con- 
 sidered that I have done but little towards securing to the 
 patient a good limb, by reducing and dressing it in the 
 best possible manner ; but I consider that it must be care- 
 fully and perseveringly managed both by surgeon and 
 nurses for the space of thirty or forty days, inspecting 
 frequently the situation of body and limb of the patient ; 
 altering position of one or both, whenever their appear- 
 ance should indicate ; bearing in mind, when we compare 
 the broken with the sound limb, that there is a possibility 
 of our being deceived in the length of the thigh by the 
 position of the body. If I succeed in keeping the limb 
 perfectly in place the first fifteen or twenty days, I con- 
 sider the risk of after-displacement but small, with a 
 common share of prudence ; but, on the contrary, if there 
 is frequent movement of the fractured bone during this 
 period, the confinement must be much longer and more 
 rigid ; and, even then, there will be a greater liability to 
 deformity. Whenever I find the least displacement, 
 which is frequently the case, I immediately endeavor to 
 remedy it, either by altering the position of the limb, or 
 by the application of compresses and splints, or by exten- 
 sion, as the case may require. In one case, the third 
 week after the accident, the union of the fragments hav- 
 ing commenced, I left my patient for a few days, when I 
 returned and found a very considerable curvature of the 
 thigh laterally and outwardly, which I succeeded in re-
 
 FRACTURE OF THE THIGH-BONE. 195 
 
 moving completely in a few days, without any extension, 
 merely by the proper application of compresses, splints, 
 and bandages. The time necessary for a perfect consoli- 
 dation of a broken bone is very different in different sub- 
 jects, under the various circumstances of age, health, and 
 the injury received. Owing to this, there is sometimes 
 an unexpected shortening of the limb after the fragments 
 have been retained in place the usual time necessary for a 
 complete union, and the patient then prematurely begins to 
 use his legs. Taking the foregoing view of the subject, 
 in my opinion it must appear evident to every well-in- 
 formed person, how unreasonable it is that a surgeon who 
 first dresses a broken thigh, and has afterwards no special 
 care, should be considered accountable for every deformity 
 which may take place.
 
 196 
 
 APPENDIX H. 
 
 Like the preceding paper, the following was found among Dr. 
 TwitchelTs manuscripts. Its date is unknown ; but it is evidently 
 the rough draft of an answer to a Committee who had consulted 
 him on the subject of Temperance. 
 
 EFFECTS OF ARDENT SPIRITS ON THE HUMAN 
 SYSTEM. 
 
 To say what proportion of our diseases are produced 
 by ardent spirits would be impossible ; for, in many in- 
 stances, the remote cause of disease is hidden from our 
 sight. But all who have paid any attention to the sub- 
 ject will agree with me in saying, that the effect upon the 
 human constitution, even when they are used only in what 
 is called a temperate manner, is to dispose to almost every 
 form of acute disease ; and there is scarcely any form of 
 chronic disease which has not at times been excited by 
 the habitual use of ardent spirits. Persons who are pre- 
 disposed to diseases from other causes frequently excite 
 them by the use of ardent spirits ; whereas by a total ab- 
 stinence they might escape. This predisposition to disease 
 is sometimes inherited from intemperate parents. 
 
 To point out the various ways in which ardent spirits 
 produce disease cannot be expected of me at this time. 
 But, from the attention I have paid to the subject, in
 
 EFFECTS OF ARDENT SPIRITS. 197 
 
 watching their effects upon the human system, and investi- 
 gating the remote and proximate causes of disease, I have 
 come to the conclusion, that more than one-half of all the 
 disease amongst us, especially in adults, is in one way or 
 another produced by their use. 
 
 You inquire in what degree ardent spirits are useful in 
 preserving health, or in curing disease. They are not 
 absolutely necessary in either case. I am aware that the 
 celebrated Rush points out two cases in which spirits may 
 be administered with safety and advantage: 1. When 
 the body has been suddenly exhausted of its strength, 
 and a disposition to faintness is perceived ; 2. When the 
 body has been exposed for a long time to wet weather, 
 more especially if combined with cold. These are the 
 only two cases in which he allows distilled spirits to be 
 useful to persons in health. In the first of which, water 
 of ammonia or sulphuric ether will answer every purpose ; 
 and, in the latter, a cup of warm tea or coffee, and at the 
 same time rubbing the surface with a warm flannel, or 
 with tepid water in which is dissolved a little salt would 
 be far preferable. 
 
 In curing diseases, ardent spirits are entirely unneces- 
 sary. 
 
 It is the vulgar opinion, that the use of spirits is bene- 
 ficial in preventing contagion. But every medical practi- 
 tioner of any observation will bear testimony against this 
 error. I am fully convinced from observing facts, that 
 nurses and other attendants upon sick, who totally abstain 
 from drinking alcoholic liquors, are not so liable to contract 
 disease as those who are in the habitual use of them. 
 
 The Committee will excuse this hasty and imperfect 
 reply to their inquiries, when they reflect that my time 
 and attention are constantly taken up by my professional 
 duties. 
 
 17*
 
 198 
 
 APPENDIX I. 
 
 The following very interesting case, which occurred under the 
 care of Dr. Twitch ell, was published by his nephew, Dr. Bemis, 
 of Medford, in the " Boston Medical and Surgical Journal," 
 vol. xviii. p. 120. Dr. Bemis was, at the date of publication, one 
 of Dr. Twitchell's students. The case is referred to on page 139 
 of Memoir. 
 
 CARCINOMATOUS SARCOMA IN THE MUSCLES OF 
 THE ARM. 
 
 21st February, 1838. — I. P. a man of twenty-two 
 years of age, presented himself with a disease of the left 
 arm. He says that, about three years since, in lifting a 
 heavy weight, he sprained the shoulder-joint of this arm 
 severely ; and, a day or two afterwards, he was exposed 
 to cold and wet, which, he thinks, had some effect in ag- 
 gravating the injury. The functions of the joint remained 
 somewhat impaired for about two months after this acci- 
 dent ; at the expiration of which time, he perceived several 
 hard gristly prominences on the arm, near the insertion 
 of the deltoid muscle. These gradually increased, and 
 subsequently coalesced ; so that a hard, gristly ridge com- 
 pletely encircled the arm at this part. The swelling gra- 
 dually extended upwards and downwards ; so that ulti- 
 mately the whole upper arm, and portions of the muscles 
 over the scapula, and of the pectoralis major, became im-
 
 CASE OP CARCINOMATOUS SARCOMA. 199 
 
 plicated in the disease. The arm is nearly three times 
 larger than the other. The glands in the axilla are a 
 little larger and harder than is natural. The swelling is 
 hard and firm ; it does not give the irregular, scaly feel- 
 ing of osteo-sarcoma, but seems to be fibro-cartilaginous, 
 rather than bony. The superficial veins over the diseased 
 parts are much enlarged. The disease has been almost 
 unremittingly attended with sharp, lancinating pain, ex- 
 tending downwards to the elbow joint, and upwards to 
 the neck and back of the head ; and the patient has been 
 at times troubled with very severe headache, which he 
 referred to the back of the head. 
 
 The patient has employed a variety of remedies, by the 
 advice of different professional gentlemen. The arm has 
 been freely leeched and cupped. He has taken largely 
 of iodine, in the form of potass, hydriod. ; an issue was 
 kept open, for two or three months, on the lower part of 
 the upper arm, the discharge from which was copious, 
 consisting of thin, sanious pus. In short, all the reme- 
 dies usual in such cases have been unavailingly exhibited, 
 not even mitigating the pain. He is, of course, much 
 emaciated and weakened ; but his general health seems 
 to be pretty good. The functions of the digestive organs 
 are unimpaired ; he has no cough ; and auscultation gives 
 the healthy sound. He is very desirous that an operation 
 should be performed ; and, as it is thought the removal 
 of the diseased parts will afford him some chance of at 
 least temporary benefit, the operation of removing the 
 arm, together with the scapula and a part of the clavicle, 
 has been decided upon. 
 
 24th February. — The operation was performed to-day, 
 at ten o'clock. The axilla having been shaved, an inci- 
 sion was made through the integuments, commencing near 
 the inferior point of the scapula, extending upwards and
 
 200 APPENDIX I. 
 
 forwards, and passing about two and a half inches in front 
 of the coracoid process ; another incision, commencing 
 over the middle of the clavicle, was carried downwards 
 and forwards to meet the first. The integuments were 
 then dissected up from over the clavicle : this bone was 
 sawed through, with Hey's saw, at about its middle, and 
 disarticulated from the scapula. The subclavian artery, 
 which had been compressed on the first rib, was easily 
 secured. The integuments were next dissected up from 
 over the scapula ; that bone was removed from its attach- 
 ment on the under side ; and the sub-scapular artery, and 
 two small branches which required the ligature, were 
 secured. The operation was concluded by forming a 
 small portion of flap from the axilla. The whole opera- 
 tion occupied twenty-five minutes ; part of this time was 
 lost on account of the fainting of the patient. Not more 
 than half a pint of blood was lost. 
 
 On dissection, it was found that the muscles of the 
 upper arm, with the exception of a small part of the 
 biceps flexor cubiti, were entirely converted into a hard, 
 fibro-cartilaginous mass, through which irregular striated 
 lines passed in different directions. The inter-muscular 
 fascia seemed to have resisted the disease longest: it 
 could be distinctly made out in many places. The bra- 
 chial artery was unobstructed ; but its coats were con- 
 verted into something very like cartilage. The articular 
 cartilages of the shoulder and elbow joints were partially 
 absorbed. On the outer side of the fore arm, two or three 
 small indurated spots were observed ; which, when cut 
 into, were found to correspond in appearance to the dis- 
 ease on the upper arm. The os brachii was of the natural 
 size, but very rough and fragile ; it was accidentally broken 
 at the neck, during dissection, by the fingers. The dis- 
 ease was undoubtedly carcinomatous sarcoma.
 
 CASE OF CARCINOMATOUS SARCOMA. 201 
 
 The patient supported the operation very well. Imme- 
 diately on its conclusion, he was put to bed, and tinct. 
 opii. gtts. 70, were directed. 
 
 4 o'clock, p.m. — The patient, considering the circum- 
 stances, is comfortable. Re-action has come on mode- 
 rately. Breathing regular. Pulse 82, full. He is 
 somewhat incommoded by spasmodic twitching in the 
 wound. An opiate was ordered at bedtime. 
 
 The dressings were removed seventy-two hours after 
 the operation. Union by the first intention had taken 
 place. There was no suppuration, except what was 
 caused by the ulceration around the stitches. The liga- 
 ture on the subclavian came away on the nineteenth day. 
 Some portions of the cut surface around the ligature, 
 which were not united by the first intention, healed kindly 
 by granulation. The patient recovered his strength very 
 rapidly, sitting up most of the time, and walking out 
 daily, after the removal of the ligature.* 
 
 * This patient died, about two years after the operation, of car- 
 cinoma of an internal organ.
 
 202 
 
 APPENDIX J. 
 
 The account of this case may be found in the " Boston Medical 
 and Surgical Journal," vol. xviii. p. 169. It is republished as ori- 
 ginally communicated by Dr. Bemis. 
 
 LITHOTOMY. — OPERATION OX A FEMALE. 
 
 A S. a deaf and dumb married woman, aet. thirty- 
 three years, presented herself on the 7th February, 1838, 
 for admission into the private hospital of my medical in- 
 structor, Dr. Twitchell. On examination, this patient 
 was found to present the ordinary symptoms of urinary 
 calculus ; and, on the introduction of the sound, a stone 
 was distinctly felt. The urethra was exquisitely tender, 
 the introduction of a common-sized catheter causing great 
 pain ; and an application was made of an ointment con- 
 taining ext. belladonnae and plumb, acet. with the view 
 of diminishing this morbid sensibility. The usual attempt 
 to extract the stone by dilating the urethra was made ; 
 but, on account of its large size and the tenderness of the 
 urethra, its removal, by this means, was not effected ; and 
 the operation of lithotomy was decided upon. 
 
 The operation was performed on the 13th February. 
 The patient having been placed on the table, and bound 
 in the usual manner, the bladder being full, a sound was 
 introduced, and the position of the stone ascertained. It 
 occupied the same place as when first sounded, and was 
 not movable. The sound was then withdrawn, and a 
 grooved staff introduced in its place. Two fingers of the
 
 CASE OF LITHOTOMY. 203 
 
 left hand of the operator being in the vagina to protect 
 that from injury, the beak of the gorget was introduced 
 into the groove, and pushed along through the whole 
 course of the urethra, dividing it laterally. The staff and 
 gorget having been withdrawn, a small pair of forceps 
 was introduced ; and the stone was readily found and 
 grasped, and easily extracted, though it was slightly ad- 
 herent to the bladder. The hemorrhage was trifling. 
 
 The patient was put to bed, and an opiate was directed. 
 No dressings or stitches were made ; but she was kept 
 on the back, with the thighs drawn together. On the 
 third day after the operation, an examination was made 
 by introducing a catheter into the urethra, and the fingers 
 into the vagina ; and it was found that there was a perfect 
 union. The patient amended rapidly ; and on the 26th 
 February went home, perfectly well, except that, on ac- 
 count of irritability of the coats of the bladder, she was 
 unable to contain so large a quantity of urine as is usual. 
 
 I take the liberty to send you this account, not as 
 being that of a very unusual or remarkable case, but from 
 having noticed a report of a similar operation in the 7th 
 No. of vol. xviii. of your Journal ; in commenting upon 
 which, the writer reprobates very strongly the method 
 of operating pursued, ridiculing the idea that the urethra 
 can unite under the circumstances, and asking if " the 
 dividing the urethra does not perfectly destroy all chance 
 of recovery. " In this case, at least, it did not. Many 
 surgical writers on lithotomy say nothing of the operation 
 on the female ; but, in answer to the inquiry, " Is there 
 any authority, to say nothing about common sense, in the 
 matter?" I would refer him to Desault's Surgery, to Mr. 
 Benjamin Bell's System of Surgery, and to Sir Astley 
 Cooper's Lectures as reported by Mr. Travers ; — authori- 
 ties which no one will probably feel inclined to question.
 
 204 
 
 APPENDIX L. 
 
 In the Memoir, page 101, I have alluded to Dr. Twitchell's views 
 on the effects of tobacco upon the human system. The following 
 is an abstract of a lecture delivered by him : * — 
 
 EFFECTS OF TOBACCO ON THE HUMAN SYSTEM. 
 
 At the meeting of the Western District New Hamp- 
 shire Medical Society, at the Temperance House in 
 Keene, May 5, 1842, Dr. Twitchell, having been ap- 
 pointed to address the meeting, selected for his subject 
 the habitual use of tobacco, and its effects on the consti- 
 tution. 
 
 In discussing this subject, the doctor first described the 
 effects it has on the nervous system, particularly the nerves 
 of involuntary motion, — those whose function it is to 
 carry on the action of the lungs, heart, and stomach. 
 These nerves are placed beyond the power of the will, 
 acting without our consciousness, in sleep as well as when 
 awake. And it is on these, he said, the habitual use of 
 tobacco produces its most pernicious effects, by paralyzing 
 their action. 
 
 It first manifests itself in the respiration, which is im- 
 perfectly performed ; the blood is not fully purified, and 
 a sense of anxiety or incipient suffocation is felt ; to re- 
 
 * Lectures to Young Men on their Moral Dangers and Duties, 
 by Abiel Abbot Livcrmore. Boston : James Munroe and Co. 1847.
 
 EFFECTS OF TOBACCO. 205 
 
 lieve which, a voluntary effort is made to expand the chest 
 to take in more air ; and, every now and then, a deep in- 
 spiration or sigh is the result, giving momentary relief. 
 
 But, during sleep, especially when first going to sleep, 
 the will not being so easily excited to action, the sense of 
 suffocation is longer endured, till, at length, becoming 
 urgent and painful, a degree of consciousness is awakened, 
 the individual begins to feel his condition, and rouses, 
 perhaps suddenly starts, and sits up in the bed in alarm, his 
 heart palpitating violently ; and, having obtained relief, 
 soon goes to sleep, to pass through the same scenes again. 
 
 But, as the habit continues, the whole nervous system 
 becomes affected, — the muscles become tremulous, the 
 sensibilities diminish, respiration and the action of the 
 heart become more imperfect, and suffocation more urgent : 
 but consciousness now fails to be roused to put forth a 
 voluntary effort for relief; and the poor abused and lan- 
 guishing nerves, whose office it is to stand sentinel at the 
 fountains of life, obtaining no help from the muscles of 
 volition, at last are compelled quietly to yield up the 
 struggle; and the person is found dead in his bed, the 
 cause not known. Yet it is a foolish sacrifice of life to 
 the vile but enchanting habit of using tobacco. 
 
 There are doubtless some few who are found dead from 
 disease of the heart. But the doctor said he had for 
 many years been extending his inquiries on this subject ; 
 that he had found almost every individual, who had died 
 during sleep, had long been in the habit of the free use 
 of tobacco, and it was his full conviction that that was 
 almost the only cause of such deaths. 
 
 The habitual use of tobacco, he said, was a most fruit- 
 ful source of disease. And this would appear evident 
 when we consider its effects upon the nervous system. It 
 lowers down the power of those nerves upon which life 
 18
 
 203 
 
 APPENDIX L. 
 
 depends ; the blood does not fully undergo that change 
 in the lungs which respiration is designed to effect, and 
 goes to the heart impure and purple ; the heart has not 
 its original power to send it forward in its circulation 
 through the body ; and an impure, sluggish circulation 
 is the consequence, which predisposes to almost every 
 disease the human system is subject to. 
 
 Among the diseases caused by tobacco, the doctor enu- 
 merated palsy, inveterate nervous headache, palpitation 
 of the heart, disease of the liver, indigestion, ulceration of 
 the stomach, piles, and many others ; and finally, he said, 
 he hardly knew that there was any disease it did not at 
 times produce. He did not undertake to assert, that all 
 who use tobacco must necessarily have these diseases 
 fully developed. But he said individuals often experienced 
 annoying, and sometimes alarming symptoms, the result 
 of tobacco, which render them infirm and wretched, while 
 they are altogether ignorant of the cause. He mentioned 
 giddiness, pain in the head, palpitation of the heart, 
 faintness, and gnawing sensation of the stomach, neu- 
 ralgic pains, trembling, sudden loss of strength, loss of 
 recollection, starting in sleep, &c. ; that he had been 
 called to prescribe for a great many persons, whose dis- 
 eases have spontaneously disappeared on their discon- 
 tinuance of tobacco. 
 
 The particular form in which tobacco is used is not of 
 very material consequence. He thought tobacco more 
 frequently produces palsy than all other causes, and that 
 snuff is more likely to bring it on than any other form in 
 which it is used; but that chewing is more injurious to 
 the digestive organs, affecting them in a threefold way. 
 It robs the stomach of its saliva, lessens its nervous 
 power, and diminishes its peristaltic motion ; and all 
 the cases he had seen of ulceration of the stomach were 
 manifestly the effects of tobacco.
 
 207 
 
 APPENDIX M. 
 
 The following paper was prepared by the author of the Memoir, 
 and is the result of investigations made by members of the 
 Boston Society for Medical Observation. The subject seems 
 appropriate, because the investigation was undertaken in conse- 
 quence of a conversation held with Dr. Twitchell upon the 
 symptoms attending the use of tobacco. See Memoir, p. 101, 
 and Appendix L. 
 
 OBSERVATIONS ON THE EFFECTS OF TOBACCO ON 
 THE HUMAN SYSTEM. 
 
 In 1848, it was proposed to the Boston Society for 
 Medical Observation to investigate some of the points 
 suggested by Dr. Twitchell, particularly with reference to 
 the dyspnoea and disposition to sigh, and to have night- 
 mare, evinced by those in the habitual use of tobacco. 
 In one hundred and eighty-five cases, questions were 
 made; and the results, though in some respects imper- 
 fect, rather confirm the views of Dr. Twitchell. It ap- 
 peared from these investigations, that some may continue 
 the use of tobacco, in a moderate way, for many years, 
 without any apparent symptoms ; but, if disposed to use 
 it more freely, they will be very liable to various func- 
 tional diseases. The following table illustrates this as- 
 sertion : —
 
 203 APPENDIX M. 
 
 Among thoso Amonr those 
 
 hiring efmptomj. not having symptom*. 
 
 Average time tobacco was used . . . 15 yrs. 13i-3yrs. 
 
 „ amount of cigars daily ... 42-5 cig. 2 1-4 cig. 
 „ amt. of tobacco chewed per mo. . 16 2-3 oz. 13 i3-is oz. 
 
 Dyspnoea, taking the word in its most general sense, 
 was as liable to occur in those who had not used tobacco, 
 as in those who had indulged in that habit. But it was 
 trifling in character, and scarcely noticed in the former ; 
 while, at times, it was very severe in the latter class. 
 
 A disposition to sigh or gape frequently was noticed in 
 both classes of persons ; but it was much more manifest 
 in the tobacco-chewers than in others. One said, he 
 6ighed voluntarily to " fill his chest." In two, the habit 
 and need wholly disappeared, when, under the advice of 
 physicians, they abstained from the use of tobacco. 
 
 Night-mare, usually in the early part of the night, was 
 at times a most horrible accompaniment of an inordinate 
 use of tobacco, although, of course, it is a symptom liable 
 to occur in any class of patients. 
 
 The following exceedingly interesting case occurred in 
 my own practice : A large, gross, sallow-looking man, 
 with congested eyes, and having all the aspect of a bon 
 vivant in a coarse way, consulted me for what he supposed 
 to be disease of the lungs or heart. His chief complaints 
 were some palpitation and a pain, with soreness of the 
 breast. He attributed these symptoms to a strain re- 
 ceived many years ago. He had always led an active life, 
 and all his functions seemed healthy. Upon auscultation 
 of the chest, the thoracic organs were found to be normal. 
 It appeared, however, first, that he had used on an average 
 twelve cigars daily for the five previous years, having 
 been, moreover, an inveterate smoker for some time before 
 that period. He had not chewed or taken snuff. The 
 description he gave of his "horrible" nightmare, as he
 
 OBSERVATIONS ON THE EFFECTS OF TOBACCO. 209 
 
 expressed himself, was as follows : " Soon after going to 
 sleep, I suddenly awake to a consciousness of intense 
 difficulty of breathing, and a sensation as of approaching 
 suffocation. I feel, however, unable to free myself. I 
 cannot move, although sensible that, if any one will vio- 
 lently shake me, the spell will be broken. It hurts me to 
 attempt to move. "Under these circumstances, I begin to 
 groan aloud, and endeavor to make as many signs of 
 distress as I can in order to arouse my friends. While I 
 was married, my wife usually shook me, and after a time 
 the fit went off." Unfortunately, the worthy gentleman 
 became a widower ; and then, continued he, " I made an 
 arrangement for my sister to sleep in the adjacent room, 
 with a door open between the apartments, in order that 
 she might do me the same favor that my wife had per- 
 formed. In fact, I really believe that I was induced to 
 marry a second time, much more on this account than 
 any other ! On one occasion, before my second marriage, 
 I think I was very near dying. My sister was a long 
 while before coming to my aid ; and I was so exhausted by 
 my efforts at groaning, that, when she entered the room, 
 I ceased making any exertion. You may imagine my hor- 
 ror at seeing her turn to leave, thinking that the fit was 
 over. I began again with great difficulty to show my usual 
 signs of distress, and I did not and could not arouse my- 
 self until the accustomed shaking had been undergone." 
 He told me that he had frequently felt his pulse, when 
 recovering from these fits of nightmare, and had found it 
 fluttering. These accesses were almost sure to happen, if 
 he indulged in any excitement. I advised him wholly to 
 throw aside the use of tobacco. Being a resolute man, 
 he followed my advice ; and for three months he abstained 
 wholly, with entire relief to his symptoms about the chest, 
 and to his nightmare. At the end of that period, he had
 
 210 APPENDIX M. 
 
 a slight paralysis of the arm, with a short fit of uncon- 
 sciousness. By the advice of another physician, he re- 
 sumed in moderation, about one or two cigars daily ; 
 and, at the time I saw him last, he had not experienced 
 any return of the difficulty. 
 
 In regard to the various symptoms of indigestion, I 
 have no doubt, from our investigations, that they are 
 liable to occur from the use of tobacco. These symptoms 
 are often produced by a slight use of the narcotic ; but, 
 of course, they are worse in those persons who use it in- 
 ordinately. 
 
 The following very interesting case was related to me 
 by Dr. Buckingham, of this city : The patient was an 
 old woman, who had been for years an inveterate smoker. 
 After smoking much of the day, she could not sleep with- 
 out lighting her pipe two or three times during the night. 
 For two years before Dr. Buckingham saw her, she had 
 not walked two rods from her own door-step, and always 
 used a staff for her support. She had had constant pain 
 in the occiput, and cramp in the legs, with obstinate con- 
 stipation, the bowels never operating unless stimulated by 
 the most drastic purges. In July, 1848, she had cholera 
 morbus, and was treated with opium and recovered. 
 Since that period, she has used no tobacco. She can now 
 walk a mile without a cane, is free from headache and 
 constipation, having not used a cathartic since her illness. 
 
 In six cases, palpitations were produced ; and in eight, 
 pains in chest usually over the heart, but at times at the 
 right side of the breast. In two of these it was noticed 
 particularly after immoderate use of tobacco. 
 
 Headache was observed four times, and frightful and se- 
 vere dreams in four more cases. Xervous tremors, cramps, 
 starting, <kc. were found eleven times. In one case the 
 memory was benumbed, and the patient became stupid.
 
 OBSERVATIONS ON THE EFFECTS OF TOBACCO. 211 
 
 The following was told to me as the personal expe- 
 rience of a very sagacious medical man : " For five years 
 I had been accustomed to chew one cubic inch of tobacco 
 daily. From April, 1847, to April, 1848, I had been 
 liable to attacks of severe headache, of an entirely local 
 character, usually over one or the other parietal bone. It 
 seemed as if an instrument were boring into my skull, and 
 caused intense suffering. With this were slight nausea 
 and diarrhoea, commonly in the morning before the pain 
 began. This last began at nine, a.m. and continued till 
 sundown. At first, these attacks were but seldom ; but, 
 by the middle of April, they recurred three times a week, 
 wholly unfitting me for all mental or physical labor. 
 My father (a physician) at length persuaded me to give 
 up the use of tobacco. For three weeks I gained no relief, 
 either in the frequency or severity of the attacks. Then 
 they became less severe and gradually less frequent, so 
 that, by July 1, 1 was wholly rid of all trouble, save a slight 
 occasional headache, to which I was always subject from 
 early life." The above, besides being a very interesting 
 example of the effects of tobacco, illustrates their gradual 
 growth, and their almost equally gradual disappearance. 
 
 From the above remarks and facts, it seems evident that 
 Dr. Twitchell has not exaggerated, when saying that 
 symptoms connected with the cephalic, thoracic, or abdo- 
 minal organs may arise in tobacco-chewers. From a re- 
 view of all these investigations, I infer, first, that, though 
 under " moderate " use of tobacco some may escape, 
 they are by no means certain of doing so ; second, that 
 habitual, inordinate chewers or smokers will almost inevi- 
 tably suffer more or less, and in some instances they will 
 have to undergo an amount of torture to which it seems 
 almost impossible to believe that any man would volun- 
 tarily subject himself, merely for the sake of gratifying a 
 beastly appetite.
 
 212 
 
 APPENDIX N. 
 
 LIST OF DIPLOMAS, &c. HELD BY DR. TWLTCHELL. 
 
 The following is the list of Dr. Twitchell's diplomas, 
 and certificates of membership of various societies : — 
 
 Degree of Bachelor of Arts, 1802. 
 „ Master of Arts, 1805. 
 ,, Bachelor of Medicine, 1805. 
 
 New Hampshire Medical Society, 1811. 
 
 Overseer of Dartmouth College, 1816. 
 
 Dartmouth Medical Society, 1819. 
 
 Massachusetts Medical Society, Honorary Member, 1838. 
 
 Trusteeships of the New Hampshire Insane Asylum, 
 1840, &c. 
 
 National Institution for the Advancement of the Sciences, 
 Washington, 1841. 
 
 Northern Academy of Arts and Sciences, Hanover, 1841. 
 
 Philadelphia College of Physicians, Honorary Mem- 
 ber, 1843. 
 
 New Hampshire Historical Society. 
 
 American Medical Association. 
 
 THE END.
 
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