HUNTER HOLMES MCGUIRE
CONFEDERATE SURGEON

John F. Rice, MD

 

Hunter Holmes McGuire was the most famous scion of Virginia's first family of medicine, the McGuires of Winchester in the Shenandoah Valley. Born in that small town in rural Virginia in the early 19th century, he would become a world renowned physician, the head of his profession in the United States, the innovative and irascible founder of medical and nursing schools, and he would live to see, albeit briefly, the 20th century. And he would be best known and beloved as Stonewall Jackson's surgeon and close friend.

Hunter McGuire was born October 11, 1835 in Winchester, Virginia, to Eliza Moss and Dr. Hugh Holmes McGuire. His parents on both sides traced their roots to Revolutionary War Virginia. Hugh McGuire had practiced in the small town at the lower end of the Shenandoah Va11ey since 1822, as both general surgeon and specialist in ophthalmology.

 Hugh Holmes McGuire was born in 1801, attended the Winchester Academy and graduated from the University of Pennsylvania with his M.D. in 1822. In 1826 he founded the Medical School of the Valley of Virginia, which became the Winchester Medical College in 1847. The elder Dr. McGuire had a national reputation for his skill as lithotomist and cataract surgeon, and was invited to join the faculties of several medical schools (including Louisville). He elected to stay in Winchester; however his associate, Dr. John Ester Coke, left their Winchester practice for Transylvania in 1826.

The Medical School of the Valley of Virginia was the first medical school established in Virginia, although it survived only from 1826 to 1829. With Dr. Hugh McGuire as the guiding force, the school was re-established as the Winchester Medical College in 1847, remaining open until the onset of hostilities in 1861.

The new school was housed in a purpose built three-story building which included an amphitheater, dissecting room and laboratories. The building no longer exists, having been burnt during Jackson's Valley Campaign. It seems that the passions of the medical students were aroused by the 1859 events of John Brown and Harper's Ferry. That the Kansas abolitionist would dare foment rebellion brought them into a high state of pique, so off they went to attend the hanging. On their return, they happened upon a fresh corpse, a prize for any medical school. The body was brought back to Winchester and prepared for dissection. In the clothing on the corpse were papers identifying it as Owen Brown, son of the aforementioned John Brown.

Word of the body's identity and fate at the hand of the medical student spread. In 1862 General Banks, during a Federal occupation of Winchester, ordered the school burned.

 Dr. Hugh McGuire served the Confederacy as an assistant surgeon under his son Hunter, sometimes chafing under what he thought were his son's overly protective orders.

 The McGuire family home still stands in Winchester, sadly the offices of lawyers. It was built by Lord Fairfax in 1790.

Young Hunter McGuire followed his father into the medical profession, enrolling in the Winchester Medical College at age 17, and emerging two years later with his M.D. Winchester offered five month courses which students often repeated. His mentors included Dr. William Bradford (Organic Chemistry), Dr. J.H. Strath (Ob-Gyn), and, of course, Dr. Hugh McGuire (Surgery).

After a period of practice with his father, Hunter chose to further his education in Philadelphia, at Jefferson Medical College. Links with the famous European schools gave the Philadelphia institutions, Penn and Jefferson, far more prestige than the local schools. In fact, Hunter's father had been apprenticed to Dr Philip Syng Physick at Penn. Physick was himself a pupil of the renowned John Hunter, and this association may be the source of his son Hunter's name.

A period of illness forced Hunter to delay his matriculation at Jefferson. When he arrived in 1858 he found himself among some of the foremost physicians in America: Joseph Pancoast (Anatomy), Charles Meigs (Ob-Gyn) and Samuel D. Gross (Surgery).

"Cram schools" were a fact of nineteenth century medical education. Professors augmented their income with extracurricular teaching, and brought in junior colleagues to help them. McGuire became associated with the well-known Dr. William Luckett, also a Virginian, at Jefferson and their tutoring attracted many southern medical students to Philadelphia. In fact, there were several hundred southerners enrolled in medical school in Philadelphia in 1859.

The Harper's Ferry incident and its aftermath, John Brown's heroic funeral procession, angered the southern students who felt that their northern hosts were pushing for a war with the South to solve the slavery issue.

In reaction to the tensions McGuire and several hundred southern medical students met to discuss their unwelcome presence amidst the abolitionist fervor. McGuire proposed an exodus to Virginia, and telegraphed the Dean of the Medical College of Virginia, asking if he would accept the Philadelphia students. An enthusiastic positive response followed, and in late December 1859 McGuire led his band south to Richmond where they were met by the Dean, the Governor, the Mayor and much fanfare. Thus began Hunter McGuire's association with MCV, which continues to this day.

Many of the students stayed at MCV; others traveled on to other schools in the South. McGuire was accused in the northern press of using the students for his personal gain. Upon his graduation from MCV in 1860 (his second M.D.), McGuire decided to leave Richmond to prove the sincerity of his intentions during the student turmoil.

 New Orleans was the next stop on young McGuire's itinerary. The Medical College of New Orleans, later Tulane University, was the focus for him to create another tutoring school in the style of the Philadelphia schools. After tiring of competition with Thomsonians and voodoo, Hunter returned to Winchester, his first alma mater and his father's practice in 1861.

 Virginia's somewhat reluctant secession came in April 1861. McGuire promptly enlisted-as an infantry private. The critical need for medical personnel soon caused him to obtain a commission in the Medical Department. Surgeon-General of the CSA, Dr. Samuel Preston Moore, assigned the twenty-six year old physician, standing a frail 6'3"', to the Army of the Shenandoah as Medical Director of the First Brigade, under the command of General Thomas Jonathan Jackson. It was May 1861. In two years the man who would be known as "Stonewall" would be dead. McGuire's long and productive career was just beginning.

In his first few months McGuire was busy with the common but deadly diseases which haunted both the CSA and USA-measles, dysentery, mumps and diarrhea of myriad causes. Most of the young soldiers had grown up in rural environs and had not been exposed to the innumerable viruses and bacteria concentrated in the camps. At war's end, the sad statistic would be that almost two-thirds of the men who died lost their lives to diseases, not the direct effects of battle.

 In July 1861 the Brigade made its first major encounter with Union forces at the battle which would be known as First Manassas. It was here that Jackson's brigade earned the title "Stonewall", and which nickname, courtesy of General Barnard Bee, would follow him to his death. It would also be the event which solidified the close relationship between Jackson and McGuire. A gunshot wound to Jackson's hand was felt by an assistant surgeon to warrant amputation; McGuire intervened and saved the injured digit.

In addition to endearing himself to Jackson because of his medical prowess, McGuire at this time also first showed signs of the organizational skills and energy which were evident throughout his career. The creation of the Confederate Ambulance Corps and the refinement of the Infirmary Corps (assistant surgeons and stewards assigned to a regiment) and Reserve Corps (mobile hospitals, supplies and personnel) were implemented by McGuire. He envisioned stationary hospitals at large cities or rail junctions, as well as mobile field hospitals, staffed two surgeons per brigade plus assistant surgeons. It was the chaos of First Manassas that led McGuire to implement this organization of the Confederate Medical Department. As a reward for his service Jackson presented McGuire with a captured Union saber inscribed “Medical Staff”.

As Medical Director McGuire served as a trusted member of Jackson's staff. On the march the two frequently road together; and they often shared the same tent while in camp. The series of battles in northern Virginia in early 1862, culminating with the Valley Campaign in May and June, were eventful for both Jackson and McGuire.

Jackson was now commander of the Shenandoah Valley District with several brigades under him. This increased McGuire's responsibilities as well. Winchester, McGuire's home, was central to these battles in early 1862 because of its location in the lower Shenandoah. McGuire was able to visit his family on occasion, but was also dismayed to leave his hometown to the Federals on the more than seventy occasions when control of the town changed hands. On one of these visits McGuire persuaded Jackson to sit for a photograph, the now famous likeness with the misaligned button.

For Stonewall Jackson the Valley Campaign became the signature battle. His clever baiting of the Union forces has been studied by military tacticians on both sides of the Atlantic. Jackson's rapid movements confused the enemy, but also created problems for his chief medical officer. On one occasion the Federals withdrew from Winchester leaving their wounded behind (which Jackson would never have done).

 The captured prisoners, including several surgeons theoretically could be sent to prisons or bartered for Rebel prisoners. Either alternative would have a deleterious effect on the treatment of the wounded. McGuire consulted Jackson and they decided to allow the Union physicians to remain behind Confederate lines treating their patients. In exchange for their parole when finished, McGuire had his Union counterparts carry a remarkable proposal to the Secretary of War.

The proposal asked that all medical officers taken prisoner be released unconditionally. Within two weeks Gen. Robert E. Lee received from Gen. McClellan the response that all medical officers would be henceforth viewed as non-combatants. This initiative by McGuire is certainly one of his most important legacies, and established the precedent which is still operative in military medicine. As luck would have it, McGuire was himself captured near the end of the war and released by Gen. Sheridan.

McGuire's considerable ability to organize and direct his medical teams earned him much praise from Jackson. For his services he received less than $200 per month in Confederate scrip, with the rank of Major.

Major campaigns in the Peninsula and at Second Manassas convinced all that the War would not be over quickly. At Manassas McGuire was called on to amputate the leg of Gen. Richard Ewell, known as "Old Baldy" to his troops. Ironically, Ewell would return to command the Army of Northern Virginia after Jackson's death.

The most famous amputation that McGuire would perform came during the battle of Chancellorsville, in May 1863. After a daring decoy march to the south and west of Federal lines, Jackson led his "foot cavalry" in a sweeping movement which caught the Yankees totally by surprise, driving them from the field. This remarkable feat turned the battle solidly in favor of the Confederacy. That evening, May 2, Jackson and several of his men rode out to locate the perimeter of their lines. In the darkness and confusion, pickets from the 18th North Carolina Infantry Regiment opened fire on the party. Jackson fell, wounded severely in the left arm.

Twice Jackson was dropped as he was hurried to an aid station. When McGuire arrived at his side, he found an open fracture of the proximal humerus with arterial bleeding. Early the next morning, May 3, McGuire amputated Jackson's arm about two inches below the shoulder.

General Lee was deeply disturbed by Jackson's injury and his loss to the Confederacy; he was also worried about Jackson's safety so close to the fighting. Lee ordered Jackson to be taken to Guiney Station and the home of Dr. Thomas Chandler, south of Fredericksburg. McGuire accompanied Jackson on that painful journey, and remained with Jackson until his death on Sunday May 10.

McGuire had noted the deterioration in Jackson, including fever and delirium, and diagnosed "pleuropneumonia". Several consultants were brought in, and all agreed. When informed of their diagnosis, Jackson accepted it with his typical equanimity, saying only that he preferred to die on the Sabbath. McGuire and Jackson's wife Anna watched the brave artilleryman pass, and the young surgeon recorded the most famous dying words of American history "Let us cross over the river and rest under the shade of the trees.

After the death of Jackson, McGuire came under the new command of his former patient, General Richard Ewell, complete with artificial leg. McGuire was at Gettysburg, and was instrumental in evacuating the thousands of wounded Rebels back to Virginia hospitals. Ewell did not have the stamina to remain long in command, and he was replaced by Gen. Jubal Early as head of the Second Corps. The heady conquests of Jackson's years also evaded "Old Jube", and Hunter McGuire ended the Civil War in Appomattox at the side of Robert E. Lee.

A few weeks before the surrender McGuire was captured by troops of Gen. Sheridan. The surgeon was able to gain his parole from Sheridan himself under the very agreement which he had proposed four years earlier.

With the war finally over, two issues confronted McGuire: family and profession.

McGuire was well known as Stonewall Jackson’s surgeon, and was highly thought of in Southern medical circles. The governor of Virginia appointed him Professor of Surgery at the Medical College of Virginia in Richmond. With $300 borrowed from his father, young Hunter established himself in practice in the former capital of the Confederacy. Reconstruction fee schedules were even less reimbursement than today's, so McGuire augmented his income as paid attendant to the numerous duels waged by hot-blooded army officers as well as the cream of Richmond Society. The mammoth Chimborazo Hospital in Richmond served as training ground for McGuire's students. In his early years at MCV he would hike the two miles down Broad Street two or three times a week for teaching rounds.

On the domestic front Hunter finally had the time to begin a family. His close friend Sandie Pendleton, also a member of Stonewall's staff, had introduced McGuire to Mary Stuart of Staunton. Mary needed a tall escort for her part in Pendleton's wedding in 1864, and at 6'3" McGuire filled the bill. Hunter McGuire and Mary Stuart were married on December 19, 1866, and nine children followed. The size of his family was a source of amusement to McGuire-he told his children not to congregate together on their front porch lest some passerby think it was an orphan asylum.

The dramatic advances in medicine in the last half of the nineteenth century were not lost on Hunter McGuire. His civil war experience afforded him enormous practical experience which he vigorously applied to the new methods and theories.

 The teachings of Semmelweiss, and subsequently Lister, Pasteur and Koch revolutionized the treatment of wounds and communicable diseases, both of which McGuire had dealt with in spades. Penetrating abdominal trauma particularly interested him, and he was one of the original advocates for exploring these wounds surgically. He had too much experience with the "expectant" treatment of many of his civil war colleagues, and its certain fatal outcome. He published his results, comparing the benefits of opening the abdomen, repairing the tears in bowel, viscera and blood vessels, cleaning out the "effusion", and closing with allowance for drainage. His "Operative interference in gunshot wounds of the peritoneum" from the AMA journal of 1881 is an important piece of nineteenth century surgical literature.

 McGuire also wrote about the standardized treatment of appendicitis, operative of course, and numerous works on genito-urinary surgery. He was a pioneer in the use or suprapubic cystotomy as the approach to bladder stone and other causes of outlet obstruction. One feat which early on brought him national recognition was the ligation of an abdominal aortic aneurysm in 1868.

One of McGuire's secrets to relatively low complications in a dangerous era of surgery was his use of anesthetic agents. He and the assistant surgeons under him in the CSA claimed 40,000 operations during the war with chloroform anesthesia without a single anesthetic death. Of course there were ample other factors to kill a patient before the chloroform, but still, among his peers, McGuire was held in very high regard as a skillful surgeon with a very low complication rate. His bibliography shows sixty articles published and four chapters in medical texts.

Surgeons like McGuire frequently operated on patients in their home. Hospitals were largely recuperative or confinement facilities in the mid-nineteenth century. In reconstruction Richmond there was only the charity infirmary at MCV and the vast military facility at Chimborazo. In 1877 McGuire and Mrs. Anabel Jenkins led a movement to create the Retreat for the Sick, open to all of Richmond's medical community who could treat their indigent patients in a hospital setting rather than the squalor of poverty. Retreat Hospital still exists as an active facility in Richmond.

In 1882, following a disagreement over an intern refusing to catheterize a female patient, McGuire set about the creation of a new hospital, St. Luke's Home for the Sick. St. Luke's was a four story purpose-built hospital with a nursing staff, and, very soon, one of the first nursing schools in the South. St. Luke's was also one of the first private hospitals in the South.

McGuire's association with MCV was long and occasionally marked by " controversy. In 1881" as he was beginning to have an international reputation as a surgeon, McGuire resigned from his gratis position at MCV. His practice was quite large, and he had become involved in medical societies and organizations. He was president of the Richmond Academy of Medicine in 1869, and a founder of the Medical Society of Virginia in 1870. He was its president in 1881. In 1887 he was elected president of the American Surgical Association. As president of the American Medical Association in 1893, McGuire is the subject of a brief biography by Dr. Morris Fishbein in his 1947 work "A History of the AMA". Hunter McGuire received the honorary degree of Doctor of Laws from the University of North Carolina and from Jefferson Medical College.

In 1892 McGuire, at the peak of his powers and popularity, agreed to assist in the establishment of a new medical school, the University College of Medicine. As the founding President and Professor of Clinical Surgery McGuire was emulating his father's founding of the Winchester Medical College.

Because of the prestige McGuire's name lent it, University College became a success, setting the tone for medical education in Richmond. A three-year curriculum was instituted, forcing MCV and other schools in the south to expand their teaching. Stuart McGuire, Hunter's son, was named Professor of Medicine. Ultimately, University became a four-year school. MCV and University merged in 1913, after years of acrimony over state funding of MCV.

In 1878 McGuire made the first of several trips to Europe. As his stature as a physician grew, his circle of acquaintances in scientific Europe expanded. Not only was his medical expertise sought after, but also his intimate knowledge of the American Civil War.

Colonel George F. R. Henderson, Professor at the Royal Army College in England became a close friend of McGuire's on one of the latter's trips to Britain. Henderson, author of an 1898 biography of Jackson, announced to his students that "I use the Shenandoah Valley Campaign as a model of strategy and tactics." Through that friendship McGuire met Lord Wolsley, c-in-c of the British Army, who told him that "within the past 200 years the English-speaking race has produced but five soldiers of the first class-Marlborough, Washington, Wellington, Robert Lee and Stonewall Jackson." At Wolsley's invitation, McGuire reviewed 35,00 troops from horseback at Aldershot in September 1896.

Back in Richmond McGuire felt the need to ensure that northern revisionist history of the civil war, or war of sectionalism, as he preferred it, would not poison the minds of Virginia schoolchildren. He chaired a committee to evaluate history textbooks then available to the schoolchildren of Virginia, and they found that a good many of the texts put a decided Yankee spin on the war. The results of McGuire's study, and that of subsequent committees, was published in 1907 as "The Confederate Cause and Conduct in the War Between the States", co-authored by Judge George Christian. Far from being a hate-strewn polemic, this small book is the considered testimony of some of the most learned men of Virginia, reflecting on their life experience as it related to the Civil War. Various books were extensively evaluated and recommendations made to the Virginia School Board as to the fitness of each for the instruction of history.                   

Although trips to medical meetings and Europe occupied much of each summer for McGuire, He continued his medical practice up until shortly before his death. On March 19, 1900 McGuire was being driven in a buggy to the hospital when he was stricken with a paralytic stroke, rendering him aphasic and plegic on the right side. He banged for attention on his driver, who took him home. When his wife and physician reached him, he was seated at his desk, crying, and pointing to the left side of his head.

Although he regained much of his strength, McGuire never was able to speak again. Six months later he died, on September 19, 1900.

After an appropriately elegant funeral service, McGuire was buried in Richmond's lovely Hollywood Cemetery. Also buried there are Presidents Monroe and Tyler, Confederate President Jefferson Davis, and J.E.B. Stuart. Among the honorary pallbearers was William Osler of Baltimore, an old friend.

In 1904 a memorial statue of Dr. Hunter McGuire was unveiled at the State Capitol in Richmond, an honor reserved for the likes of Washington and Jackson.

Among his many achievements McGuire could list:

Founder and President of the Medical Society of Virginia President of the American Surgical Association

President of the American Medical Association

Numerous family members, either direct descendants or cousins, followed McGuire into the medical field. The large VA Medical Center in Richmond is, appropriately, The Hunter McGuire VAMC. Dr. Hunter McGuire, Jr., an indirect descendant, served as a dean at the MCV and presently is chief of surgery at the McGuire VAMC.

The continued national interest in the War Between The States places men such as Hunter McGuire on our stage for analysis. He led a rich and extensive life, centered not only on his skill as a physician and surgeon, but also his innate worth as a human being. His career evolved from the pre-Listerian Barbary of the Civil War to the sophisticated surgery of the late nineteenth century; he expanded his advocacy for physicians from local politics to the state house and onto a national and international scene. For this he is worthy of our respect.

8-8-79

H.H. McGuire bibliography (probably not complete)

"Clinical remarks on gunshot wounds of the joints." Richmond Med. J., v.l, l866.

"Aneurism of the external iliac of the left side, both common iliacs, and lower end of aorta; ligation of the aorta; death." Am. J. Med. Sc., v.56, n.s., 1868.

"Removal of retained testicle complicated with hernia and hydrocele; cure."

Am. J. Med. Sc., v.56, n.s., 1868.

"Stone in the bladder; operation; death in two months from pyelitis and

nephritis.'" Richmond and Louisville Med. J., v.9, 1870.

"Excision of the os calcis” Medical Times (Phila.), .v.l, 1870.

"Ligation of subclavian artery; recovery.” Va. Clin. Record, v.l, 1871.

"Gunshot wound of the bladder, followed by stone.” Va. Clin. Record, v.l,

1871.

"Varicocele: operation for radical cure.” Va. Clin. Record, v.l, 1871.

"Stricture of urethra of fifteen years' duration; external perineal

urethrotomy; recovery.” Va. Clin. Record, v.l, 1.872.

"Fibrocystic tumor of the uterus."  Medical Times (Phila.), v.3, 1872.

"Drainage in obstinate chronic inflammation of bladder." Va. Med. Monthly,    

v.l, 1874

"Gunshot and other wounds of the peritoneum.” Va. Med. Monthly, v.1, 1874

"Certain and easy way of fastening a catheter in the male bladder." Va.     

Med. Monthly, v. 1, 1874

“Cases showing some of the advantages of Esmarch's bandage.” Va. Med.

Monthly, v.l, 1.875.

"Three cases of gunshot wound of pelvis followed by stone in the bladder."

Va. Med. Monthly, v.2, 1875.

"Injecting the male bladder without the aid of a catheter, and some of its 

advantages." Va. Med. Monthly, v.3, 1876.

"Ovarian tumor; both ovaries removed; recovery." Trans. Med. Soc. Va., v.2, 

1879.

"Operative interference in gunshot wounds of the peritoneum." Trans. Am.

Med. Assn., v.32, 1.881.

"Case of death following the administration of Chloroform." Va. Med. 

Monthly, v.9, 1882-83.

"Progress and development of medical science." Coll. and Clin. Red.

(Phila.) v.8, 1887.

"The choice of general anesthetics in surgery and obstetrics." Va.  Med. 

Monthly, v.14, 1887-88.

"The formation of an artificial (suprapubic) urethra in prostatic

obstruction." Trans. Am. Surge Assn., v.6, 1888.

"Operative treatment in cases of enlarged prostate.”  Va. Med. Monthly,

v.15, 1888-89.

"Extra-uterine pregnancy; removal of the decomposing fetus by themo-cautery

through Douglas' cul de sac." Va. Med. Monthly, v.15, 1888-89.

"Treatment of chronic cystitis in women." University Med. Mag. (Phila.)

v.2, 1889-90. 

“Nervous disorders following organic urethral stricture." Gaillard’s Med.

            J. (N.Y.), v.51, 1890.

"Report of twenty-one cases of supra-pubic cystotomy, with remarks."

            Trans. Am. Surg. Assn., v.8, 1890.

[with G.F. Lydston.]  "Sexual crimes among Southern Negro’s,

scientifically considered." Va. Med. Monthly, v.20, 1893-94.

“Tuberculosis of the bladder, drainage and rest." Va. Med. Monthly,

v.20, 1893-94.

“Suprapubic cystotomy for the formation of an artificial urethra."

Internat. Clinics (Phila.), v.l, 1894 (4th series).

"Cataphoresis and cocaine in localized neuritis; with report of case.”

 Gaillard's Med. J. (N.Y.), v.60, 1895.

"Operative treatment of cancer of the male genitals." Ann. Surg., v.22,

1895.

"Seventeen cases of chronic (relapsing) appendicitis, treated by

operation.”  Va. Med. Monthly, v.22, 1895-96.

"Modification of Whitehead's operation for removal of tongue." Internat.

Clinics (Phila.), v.4, 1896 (5th series).

"A plea for the more general use of normal saline solution in cases of

severe hemorrhage." Bi-Monthly Bull. Univ. Coll. Med., v.l, 1896.

"Some of the dangers following surgical operations and how to prevent and

treat them." Bi-Monthly Bull., Univ. Coll. Med., v.l, 1896.

"Secondary hemorrhage." [Idem.], v.1,. 1.896.

"Cases of tuberculosis cured by cancrum oris." [Idem.], v.2, 1897.

"Cystic calculus." [Idem.], v.2, 1897.

"Remarks on appendicitis with a report of twenty-six cases operated on

during the past twelve months." South. Med. Rec. (Atlanta), v.27, 1897.

"Treatment of acute exudative nephritis following infectious diseases." Bi-

Monthly Bull., Univ.Coll. Med., v.3, 1898.

"Malignant tumors of the breast." Charlotte (N.C.) Med.J., v.14, 1899. "Four recent cases of gall-stones." Va. Med. Monthly, v.4, 1899-1900.

[the chapter] "Gunshot wounds" in Holmes' System of Surgery (1.st Amer. 

ed.), v.III, 1882, pp.443-521.

[the chapter] "Contusions" in J. Ashhurst' s Internationa1 Encyclopedia of

Surgery, v.II, 1882, pp.1-10 also the chapter "Diseases of the bladder and prostate," v.VII, 1895, pp.911-922.

[the chapter] "Contusion, strangulation, frolement" in J. Ashhurst

Encycl. internat. de chir. (Paris), v.II, 1883, pp.531-538.

[the chapter] "Intestinal obstruction" in W. Pepper's System of Medicine,

v. II, 1885, pp.835-867. 

FROM STUART MCGUIRE’S "HUNTER HOLMES MCGUIRE, M.D., LL.D." IN ANNALS OF MEDICAL HISTORY,  v.10, n.s., 1938. Copyright 1938.