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najafidm
 Contributors

PAOLO ANGELINI, MD, FSCAI DANIEL BURKHOFF, MD MAURICIO G. COHEN, MD, FACC,
Medical Director Adjunct Associate Professor FSCAI
Center for Coronary Artery Anomalies Department of Medicine Associate Professor of Medicine
Texas Heart Institute at St. Luke's Columbia University Director
Episcopal Hospital New York, New York Cardiac Catheterization Laboratory
Houston, Texas RONALD P. CAPUTO, MD, FACC, FSCAI Cardiovascular Division

GABRIELE EGIDY ASSENZA, MD Director Department of Medicine

Boston Adult Congenital and Pulmonary Cardiac Services University of Miami Miller School of

Hypertension Program St. joseph's Hospital Medicine

Brigham and Women's Hospital Syracuse, New York Miami, Florida

Boston, Massachusetts BLASE A. CARABELLO M.D KEVIN CROCE, MD, PhD

Boston Children's Hospital Professor of Medicine Brigham and Women's Hospital
Boston, Massachusetts Vice-Chairman, Department of Medicine Cardiovascular Division
Department of Clinical and Molecular The WA. "Tex" and Deborah Moncrief, jr Harvard Medical School
Medicine Baylor College of Medicine Boston, Massachusetts
"Sapienza Universita' di Roma" Medical Medical Care Line Executive JAMES C. FANG, MD
School Veterans Affairs Medical Center Professor of Medicine
Rome, Italy Director, Center for Heart Valve Disease Chief
STEPHEN BALTER, PhD Chief of Cardiology Cardiovascular Division
Professor Texas Heart Institute at St. Luke's University of Utah
Clinical Radiology (Physics) (in Medicine) Episcopal Hospital Salt Lake City, Utah
Columbia University Houston, Texas TED E. FELDMAN, MD, FSCAI,
New York, New York JOHN D. CARROLL, MD FACC, FESC
ARNON BLUM, MD Professor of Medicine Director,
Director University of Colorado School of Cardiac Catheterization Laboratories
Department of Medicine Medicine Evanston Hospital
Baruch Padeh Poria Hospital and Faculty Director NorthShore University HealthSystem
of Medicine Interventional Cardiology Evanston, Illinois
Bar Ilan University Co-Medical Director Cardiac and Vascular MICHAEL A. FIFER, MD
Lower Galilee, Israel Center Associate Professor
BARRY A. BORLAUG, MD, FACC University of Colorado Hospital Department of Medicine
Associate Professor of Medicine Aurora, Colorado Harvard Medical School
Mayo Medical School SANDRA V. CHAPARRO, MD Director
Consultant Assistant Professor of Medicine Cardiac Catheterization Laboratory
Catheterization Lab Physician Medicine/Cardiovascular/Heart Massachusetts General Hospital
Cardiovascular Diseases Transplant Boston, Massachusetts
Mayo Clinic Rochester Cardiovascular Division PETER]. F ITZGERALD, MD, PhD
Saint Mary's Hospital Department of Medicine Professor of Medicine (Cardiology)
Rochester, Minnesota University or Miami Miller School or Stanford University
ARASH BORNAK, MD Medicine Stanford, California
Assistant Professor of Surgery Miami, Florida
G. RANDALL GREEN, MD,
Vascular and Endovascular Surgery KYUNG CHO, MD JD, MBA
University of Miami, Miller School of William Martel Professor of Radiology Program Director
Medicine University of Michigan Health System Cardiac Surgery
jackson Memorial Hospital Department of Radiology St. joseph's Hospital Health Center
Miami, Florida Division of Interventional Radiology Syracuse, New York
Ann Arbor, Michigan

VII
najafidm
 VIII Contributors

WILLIAM GROSSMAN, MD DAVID R. HOLMES, JR., MD AARON KUGELMASS, MD

Charles and Helen Schwab Endowed Professor of Medicine Chief, Division of Cardiology
Chair Department of Cardiovascular Diseases lecturer in Medicine, Tufts University
Preventive Cardiology Mayo Clinic School of Medicine
Director Rochester, Minnesota Medical Director, Heart and Vascular
Center for Prevention of Heart and YASUHIRO HONDA, MD, FACC, Center
Vascular Disease FAHA Baystate Medical Center
Professor of Medicine Clinical Associate Professor of Medicine Springfield, Massachusetts
University of California Co-Director ROGER J. LAHAM, MD
San Francisco, California Cardiovascular Core Analysis laboratory Associate Professor of Medicine
HARRIS M. HAQQANI, MBBS, PhD Division of Cardiovascular Medicine Harvard Medical School
Senior lecturer Stanford University School of Medicine Beth Israel Deaconess Medical Center
University of Queensland School of Stanford, California Boston, Massachusetts
Medicine MICHAEL R. JAFF, DO MICHAEL]. LANDZBERG, MD
Senior Electrophysiologist Associate Professor of Medicine Associate Director, Adult Pulmonary
Prince Charles Hospital Harvard Medical School Hypertension Program
Brisbane, Queensland Chair Director, Boston Adult Congenital Heart
Australia MGH Institute for Heart, Vascular and (BACH)
JOSHUA M. HARE, MD Stroke Care Boston Children's Hospital
Louis Lemberg Professor of Medicine Massachusetts General Hospital Harvard Medical School
Director of Interdisciplinary Stem Cell Boston, Massachusetts Boston, Massachusetts
Institute SAMIR R. KAPADIA, MD MICHAEL]. LIM, MD, FACC, FSCAI
Interdisciplinary Stem Cell Institute Professor of Medicine jack Ford Shelby Endowed Professor
Cardiovascular Division Director Director
Department of Medicine Sones Cardiac Catheterization laboratory Division of Cardiology and
University of Miami Miller School of Cleveland Clinic Co-Director
Medicine Cleveland, Ohio Center for Comprehensive Cardiovascular
Miami, Florida Care
MORTON J. KERN, MD, FACC,
ALAN W. HELDMAN, MD, FSCAI FSCAI, FAHA Saint louis University
Professor of Medicine Professor of Medicine Saint louis, Missouri
Interventional Cardiology University California Irvine JAMES E. LOCK, MD
Cardiovascular Division Chief Cardiology Alexander S. Nadas Professor of Pediatrics
Department of Medicine long Beach Veterans Administration Cardiologist-in-Chief
University of Miami Miller School of Health Care System Chairman, Department of Cardiology
Medicine Associate Chief of Cardiology Boston Children's Hospital
Miami, Florida University California Irvine Harvard Medical School
ROBERT C. HENDEL, MD long Beach, California Boston, Massachusetts
Professor AJAY J. KIRTANE, MD, SM, FACC, FRANCIS E. MARCHLINSKI, MD
Medicine and Radiology FSCAI Professor of Medicine
Director of Cardiac Imaging Chief Academic Officer, Center for Director, Electrophysiology Program,
Cardiovascular Division Interventional Vascular Therapy Director, Electrophysiology Laboratory,
Department of Medicine Director, Interventional Cardiology Hospital of the University of Pennsylvania
University of Miami Miller School of Fellowship Program and University of Pennsylvania Health System
Medicine Catheterization laboratory Quality Philadelphia, Pennsylvania
Miami, Florida Associate Professor of Clinical Medicine CLAUDIA MARTINEZ, MD, FSCAI
JOSE P.S. HENRIQUES, MD, PhD, MBA Division of Cardiology, Columbia Assistant Professor of Medicine,
Cardiologist University Medical Center Cardiovascular Division
University of Amsterdam New York-Presbyterian Hospital Department of Medicine
Head of Catheterization Laboratory New York, New York University of Miami Milles School of
Cardiology NILS KUCHER, MD Medicine
Academic Medical Center Senior Consultant Miami, Florida
Amsterdam, The Netherlands Clinics for Cardiology and Angiology
Bern University Hospital
Bern, Switzerland

najafidm
 Contributors IX

VALLERIE V. MCLAUGHLIN, MD STEPHEN R. RAMEE, MD, FACC, ROBERT J. SOMMER, MD

Professor of Medicine FSCAI Director
Director Medical Director of the Structural and Invasive Adult Congenital Heart Disease
Pulmonary Hypertension Program Heart Valve Program Center for Interventional Vascular
Department of Medicine John Ochsner Heart and Vascular Institute Therapy
Division of Cardiovascular Medicine Ochsner Medical Institutions Department of Medicine
University of Michigan Health System New Orleans, Louisiana Columbia University Medical Center
Ann Arbor, Michigan SUNIL V. RAO, MD New York, New York

JORGE MONGE, MD Department of Medicine, Division of GREGG W. STONE, MD

Research Fellow Cardiology Professor of Medicine
Mayo Clinic Duke University Medical Center Columbia University
Scottsdale, Arizona Durham, North Carolina Director of Cardiovascular Research
and Education
MAURO MOSCUCCI, MD JOHN F. ROBE, MD, FAHA, FACC,
Professor of Medicine Center for Interventional Vascular
FSCAI
Chairman, Department of Medicine Therapy
Director
(Acting) New York Presbyterian HospitaV
Interventional Cardiology and Cardiac
Chief, Cardiovascular Division Columbia University Medical Center
Catheterization Laboratories
University of Miami Miller School of Co-Director of Medical Research and
Dartmouth-Hitchcock Medical Center
Medicine Education
Lebanon, New Hampshire
Miami, Florida The Cardiovascular Research
KENNETH ROSENFIELD, MD, FAHA,
Foundation
WILLIAM W. O'NEILL, MD, FACC FACC
New York, New York
Medical Director Section Head, Vascular Medicine and
Center for Structural Heart Disease ZOLTAN G. TURI, MD
Intervention
Henry Ford Hospital Professor of Medicine
Cardiology
Detroit, Michigan Cooper Medical School of Rowan
Massachusetts General Hospital
University
ROBERT N. PlANA, MD, FACC Boston, Massachusetts
Camden, New Jersey
Professor of Medicine JOHN RUNDBACK, MD
Director, Adult Congenital Interventional GILBERT R. UPCHURCH, JR., MD
Medical Director
Program Muller Professor of Surgery
Interventional Institute
Division of Cardiovascular Medicine Department of Surgery
Holy Name Medical Center
Vanderbilt Heart and Vascular Institute University of Virginia
Teaneck, New Jersey
Nashville, Tennessee Charlottesville, Virginia
MEHDI H. SHISHEHBOR, DO,
JEFF REY]. POPMA, MD OMAIDA C. VELAZQUEZ, MD
MPH, PhD
Professor of Medicine Professor of Surgery
Director
Harvard Medical School Chief of Vascular and Endovascular
Endovascular Services
Beth Israel Deaconess Medical Center Surgery
Cleveland Clinic
Boston, Massachusetts Executive Dean for Research, Research
Cleveland, Ohio
Education and Innovative Medicine
ABHIRAM PRASAD, MD DANIEL I. SIMON, MD, FACC, FAHA, University of Miami Miller School of
Professor of Medicine FSCAI Medicine
Cardiovascular Division Director
Miami, Florida
Mayo Clinic Harrington Heart and Vascular Institute
Rochester, Minnesota JUAN F. VILES-GONZALEZ, MD
Chief
Assistant Professor of Medicine
ROBERT A. QUAIFE, MD Division of Cardiovascular Medicine
Cardiovascular Division
Director University Hospitals Case Medical Center
Department of Medicine
Advanced Cardiac Imaging Herman K. Hellerstein Professor of
University of Miami, Miller School of
Associate Professor of Medicine and Cardiovascular Research
Medicine
Radiology Case Western Reserve University School
Miami, Florida
University of Colorado of Medicine
Denver, Colorado Cleveland, Ohio

najafidm
 X Contributors

SCOTT H. VISOVATTI, MD CHRISTOPHER]. WHITE, MD

Clinical Lecturer Professor and Chairman
Division of Cardiovascular Medicine Department of Cardiology
University of Michigan Ochsner Clinical School
Ann Arbor, Michigan University of Queensland

JOHN G. WEBB, MD New Orleans, Louisiana

Director, Interventional Cardiology and PAUL G. YOCK, MD

Cardiac Catheterization Weiland Professor of Bioengineering and
Interventional Cardiology Medicine
St. Paul's Hospital Director
Vancouver, British Columbia Program in Biodesign
Canada Stanford University
Stanford, California

najafidm
 Preface
to the Eighth Edition

My personal experience with Grossmans Cardiac Catheterization, Angiography, and Intervention textbook
started with the fourth edition, during my cardiac catheterization rotation in 1 9 9 1 as a cardiology fellow at
the University of Chicago. That rotation, working under the mentorship of]ohn Carroll and Ted Feldman,
was sensational and led to a maj or change in my career. For the next 6 months , Grossmans textbook became
my evening reading, cover to cover, and I made the decision that interventional cardiology was going to be
the future of my career. One year later, I moved to the Beth Israel Hospital in Boston for further training in
interventional cardiology under the mentorship of Donald Bairn and William Grossman. The richness of
the Beth Israel Hospital program , the quality of the training both from a clinical and research perspective ,
and the charismatic leadership of Don Bairn became unforgettable. Those two additional training years
further shaped my professional development, and the friendships that I developed with many colleagues
and with Don became a highlight for the next two decades. Beginning with the fourth edition and all the
way through the seventh edition of the textbook, I did not miss a single edition and I was delighted to see
the evolution of the textbook through the years .
The publication in 2006 of the seventh edition of Grossmans Cardiac Catheterization, Angiography, and
Intervention was a milestone. After 30 years of shaping the textbook through six editions , William Gross­
man had stepped down as coeditor and Don Bairn had taken the new duty as the lead editor. Unfortunately,
the unexpected and premature death of Don Bairn in 2009 was a maj or loss for the interventional commu­
nity and a personal loss for me.
I was thrilled to be asked to become the editor of the eighth edition of the textbook, which represents
a new milestone. Dr. Grossman's and Dr. Bairn's legacy remains and the title has been modified to Grossman
and Bairns Cardiac Catheterization, Angiography, and Intervention, to further reflect that legacy.
Returning readers will find the addition of color as a maj or, exciting new change in the textbook and
will be pleased to find that the basic structure has been retained. Furthermore , to address the tremendous
growth that has occurred in cardiac catheterization and interventional cardiology, the total number of
chapters has increased from 34 to 46, and every chapter from the prior edition has been updated where
needed and expanded with further emphasis on hemodynamic data, hemodynamic tracings , interventional
procedures , and the addition of new tables and images .
Section !-General Principles includes a new chapter on Integrated Imaging Modalities in the Cardiac
Catheterization laboratory and a separate chapter on Complications . Recognizing the expanding adoption
and value of radial artery access, a new chapter dedicated to this topic has been added to Section II-Basic
Techniques. In addition, the chapter on brachial artery cutdown has been expanded with the inclusion of
other open cutdown vascular access approaches , which have recently received enhanced interest due to the
development of percutaneous aortic valve replacement.
The acquisition and interpretation of hemodynamic data require a full understanding of the patho­
physiology of cardiovascular disease, of acquisition protocols of hemodynamic data, and knowledge of
potential pitfalls that could lead to misinterpretation of the data acquired. Recognizing the importance of
potential pitfalls leading to erroneous interpretation of hemodynamic data, Section III-Hemodynamic
Principles has been expanded with the inclusion of a new chapter entitled Pitfalls in the Evaluation of
Hemodynamic Data. We hope that returning and new readers will find this chapter helpful.
The anatomic classification of coronary artery anomalies has critical implications from a manage­
ment perspective. General textbooks on cardiovascular disease provide limited information on coronary
artery anomalies , as well as on the evaluation and management of patients who have been identified as
having a coronary artery anomaly. Section IV-Angiographic Techniques includes a new chapter on Coro­
nary Artery Anomalies. likewise, the evaluation of pericardia! disease and the differential diagnosis of
constrictive versus restrictive physiology continue to be a challenging area in cardiology. Therefore, in
this new eighth edition, the topic of pericardia! disease has been expanded across three chapters . Sec­
tion V-Evaluation of Cardiac Function includes a new chapter entitled Evaluation of Tamponade, Con­
strictive, and Restrictive Physiology. Section VII-Interventional Techniques includes a new chapter on

XI
najafidm
x11 Preface to the Eighth Edition

Pericardia! Interventions covering pericardiocentesis , balloon pericardiotomy, and epicardial approach to

cardiac procedures . In addition, the valuable chapter on Profiles in Pericardia! Disease in Section VIII has
been retained and updated with a new case.
Since the seventh edition was published, there has been a tremendous growth in interventions for struc­
tural heart disease, peripheral vascular disease, and cardiac arrhythmias, while primary PCI for ST segment
Elevation Myocardial Infarction has become the standard of care for patients with acute myocardial infarc­
tion, and cell therapies have emerged as a new exciting and promising option for patients with cardiovascu­
lar disease. Five new chapters addressing these exciting developments have been added to the eighth edition
in Section VII-Interventional Techniques. Chapter 30 outlines interventions for acute myocardial infarc­
tion. Chapter 32 provides a general overview of intervention for structural heart disease and Chapter 36
introduces the readers to the new field of interventions with cell therapies. Chapter 3 7 provides an overview
of aortic endovascular grafting, while interventions for cardiac arrhythmias including epicardial access for
ventricular arrhythmias are outlined in Chapter 3 9 . In addition, all the other chapters in this section have
been updated and expanded according to the tremendous growth that has occurred in this field.
Throughout the textbook, particular effort has been made in referring the reader to available guide­
lines , providing summary tables , illustrations, and images, while maintaining the overall structure and
historical character of the textbook and a focus on how the field of cardiac catheterization has evolved since
the first invasive human cardiac catheterization was performed by Werner Forssmann on himself in 1 9 2 9 .
I hope that this eighth edition of the textbook will go beyond providing j u s t an update , and that it will elicit
in new and returning readers the same excitement that I developed for this field during my reading of the
fourth edition more than two decades ago . Finally, I hope that all the work of the contributing authors and
the long weekends and nights that went into this endeavor will ultimately benefit our patients .

Mauro Moscucci, MD, MBA

Miami, Florida

najafidm
 Preface
to the Website to the Eighth Edition

The current (eighth) edition of Grossman and Bairn's provides a companion website that contains 1 7 1 cases
covering a broad range of classic findings , specific procedures (including percutaneous valve and other new
therapies) , and anomalies and complications . Following the structure of the prior edition, the cases include
a summary of important teaching points and references to the particular chapters in the printed textbook.
Most cases from the prior edition have been retained, and the contributions of Donald Bairn and Jeffrey
Popma in providing several of those cases are kindly acknowledged. The new cases reflect the new chap­
ters and the updates to other chapters that have been included in this eighth edition. I believe that from
a learning perspective there is nothing more valuable than the ability to review real images of procedures,
complications, and bailout techniques. Thus, the readers are encouraged to review these cases to enhance
their learning experience from this eighth edition.
Readers should also feel free to use the material included in the website for educational purposes such
as teaching conferences and presentations at meetings , with acknowledgment of the source.

Mauro Moscucci

XIII
najafidm
najafidm
 Acknowledgments

First and foremost, I would like to thank Dr. Donald Bairn and Dr. William Grossman for their charismatic
mentorship and guidance during my 2 years of training at the Beth Israel Hospital in Boston in the early
1 990s, and for their continued friendship and support during the following decades. I would also like to
thank Fran DeStefano , who in her role as the Acquisitions Editor of prior editions provided incredible
support while we were shaping and planning this eighth edition; in addition, I would like to thank julie
Goolsby, who following Fran's retirement has continued to provide the same enthusiastic support in her
role as Acquisitions Editor, and Leanne Vandetty for her outstanding assistance and patience as the Product
Manager. Finally, I am extremely grateful to all the authors and to the many colleagues and friends who
have contributed to this textbook during the past three decades.

XV
najafidm
najafidm
 Contents

Contributors vii
Preface to the Eighth Edition xi
Preface to the Website to the Eighth Edition xiii
Acknowledgments xv

SECTION I GENERAL PRINCIPLES 1

1. Cardiac CatheterizationHistory and Current Practice Standards 1
Mauro Moscucci

2. Cineangiographic Imaging, Radiation Safety, and ContrastAgents 17

Stephen Balter and Mauro Moscucci

3. IntegratedImaging Modalities in the Cardiac Catheterization Laboratory 44

Robert A. Ouaife and John D. Carroll

4. Complications 77
Mauro Moscucci

5. Adjunctive Pharmacology for Cardiac Catheterization 106

Kevin Croce and Daniel l. Simon

SECTION II BASIC TECHNIQUES 139

6. PercutaneousApproach, lncludingTransseptal andApical Puncture 139
Claudia A. Martinez and Mauro Moscucci

7. RadialArteryApproach 170
Mauricio G. Cohen and Sunil V. Rao

8. CutdownApproach: Brachial, Femoral, Axillary, Aortic andTransapical 191

Ronald P. Caputo, G. Randall Green, and William Grossman

9. Diagnostic Catheterization in Childhood andAdult Congenital Heart Disease 208

Gabriele Egidy Assenza, James E. Lock, and Michael J. Landzberg

SECTION Ill HEMODYNAMIC PRINCIPLES 223

10. Pressure Measurement 223
Mauro Moscucci and William Grossman

11. Blood Flow Measurement: Cardiac Output andVascular Resistance 245

Mauro Moscucci and William Grossman

12. Shunt Detection and Quantification 261

William Grossman and Mauro Moscucci

13. Calculation of StenoticValve OrificeArea 272

Blase A. Carabello and William Grossman

XVII
najafidm
 XVIII Contents

14. Pitfalls in the Evaluation ofHemodynamic Data 284

Zoltan G. Turi

SECTION IV ANGIOGRAPHIC TECHNIQUES 295

15. CoronaryAngiography 295
Mauro Moscucci

16. CoronaryArteryAnomalies 335

Paolo Angelini and Jorge Monge

17. CardiacVentriculography 354

Mauro Moscucci and Robert C. Hendel

18. PulmonaryAngiography 370

Kyung Cho and Nils Kucher

19. Angiography of theAorta and Peripheral Arteries 399

Michael R. Jaff, John Rundback, and Kenneth Rosenfield

SECTION V EVALUATION OF CARDIAC FUNCTION 43 1

20. StressTesting During Cardiac Catheterization: Exercise, Pacing,
and Dobutamine Challenge 431
William Grossman and Mauro Moscucci

21. Measurement ofVentricularVolumes, Ej ection Fraction,

Mass, Wall Stress, and RegionalWall Motion 456
Michael A. Fifer and William Grossman

22. Evaluation of Systolic and Diastolic Function of theVentricles

and Myocardium 467
William Grossman and Mauro Moscucci

23. Evaluation ofTamponade, Constrictive, and Restrictive Physiology 489

Mauro Moscucci and Barry A. Bar/aug

SECTION VI SPECIAL CATHETER TECHNIQUES 505

24. Evaluation of Myocardial and Coronary Blood Flow
and Metabolism 505
Morton J. Kern and Michael J. Lim

25. Intravascular lmagingTechniques 545

Yasuhiro Honda, Peter J. Fitzgerald, and Paul G. Yock

26. Endomyocardial Biopsy 576

Sandra V. Chaparro and Mauro Moscucci

27. Percutaneous Circulatory Support: Intra-aortic Balloon Counterpulsation,

ImpelIa, TandemHeart, and Extracorporeal Bypass 601
Daniel Burkhoff, Mauro Moscucci, and Jose P.S. Henriques

SECTION VII INTERVENTIONAL TECHNIQUES 627

28. Percutaneous BalloonAngioplasty andGeneral Coronary Intervention 627
Abhiram Prasad and David R. Holmes

29. Atherectomy, T hrombectomy, and Distal Protection Devices 665

Robert N. Piana and Jeffrey J. Popma

najafidm
 Contents XIX

30. Intervention forAcute Myocardial Infarction 697

William O'Neill

31. Coronary Stenting 7 1 0

Ajay J . Kirtane and Gregg W Stone

32. General Overview ofInterventions for StructuralHeart Disease 760

Mauro Moscucci, John D. Carroll, and John G. Webb

33. PercutaneousT herapies forValvularHeart Disease 772

Ted Feldman and Mauro Moscucci

34. PeripheralIntervention 805

Mehdi H. Shishehbor and Samir R. Kapadia

35. Intervention for Pediatric andAdult CongenitalHeart Disease 838

Robert J. Sommer

36. Cardiac Cell-BasedT herapy: Methods ofApplication

and Delivery Systems 871
Joshua M. Hare, Arnon Blum, and Alan W Heldman

37. Aortic EndovascularGrafting 891

Arash Bornak, Gilbert R. Upchurch, and Omaida C. Velazquez

38. Pericardia! Interventions: Pericardiocentesis, Balloon Pericardiotomy,

and EpicardialApproach to Cardiac Procedures 904
Mauro Moscucci and Juan F. Viles-Gonzalez

39. Interventions for CardiacArrhythmias 921

Haris M. Haqqani and Francis E. Marchlinski

SECTION VIII CLINICAL PROFILES 943

40. Profiles inValvular Heart Disease 943
Ted Feldman, William Grossman, and Mauro Moscucci

41. Profiles in CoronaryArtery Disease 970

Robert N. Piana and Aaron Kugelmass

42. Profiles in PulmonaryHypertension and Pulmonary Embolism 991

Scott H. V isovatti and Val/erie V. Mc/aughlina

43. Profiles in Cardiomyopathy andHeart Failure 1 011

James C. Fang and Barry A. Borlaug

44. Profiles in Pericardia! Disease 1045

John F. Robb, Roger J. Laham, and Mauro Moscucci

45. Profiles in CongenitalHeart Disease 1060

Gabriele Egidy Assenza, Robert J. Sommer, and Michael J. Landzberg

46. Profiles in PeripheralArterial Disease 1078

Christopher J. White and Stephen R. Ramee

Index 1113

najafidm
najafidm
Discovering Diverse Content Through
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business. You go to camp to get needed rest and escape the fights
of a busy life, and no man has a right to interfere with another’s
pleasure; always provided that the other party behaves like a man
himself.
Now let us suppose that you have procured your outfits, selected
your camp ground, and have arrived at the place. Set to work
quickly to select a site for the tent, and get it ready for occupancy at
once. All hands take hold under the direction of your captain, and
the work will all be over in a short time. Pitch the tent and get your
beds ready; make a fireplace and get wood for a fire, so the cook
will be able to tend strictly to his cooking. If Joe or Tom grabs his
rod the moment it is taken from the conveyance, unless he is so
ordered by the captain, just insert your fingers under his coat collar
and politely kick a little sense into him.
When you get your first meals do not give way to the abnormal
appetite always generated by fresh air and exercise, but eat
moderately until you get accustomed to the changed conditions, and
thus avoid a multitude of ills. It is disgusting to a sensible man to
see a campmate gorge himself and then wake everyone in the small
hours of the night groaning with colic. A sick man in camp is a
nuisance at the best, and if the sickness is caused by the sufferer’s
own fault he will hardly get much sympathy.
Again, if you have any liquor in camp, put it in the hands of the
most level-headed man in the party, and use it only moderately. I
am not preaching a temperance lecture, but the use of liquor should
be in moderation, if used at all. When drinking, hunting and fishing
go together, the hunting and fishing get poor attention.
The first night that you are in camp will probably be destitute of
many of the conveniences, for you seldom get well settled. About all
that is really necessary is to get the beds well established and a light
supper prepared.
The next day, get all the camp luxuries fixed up. Make some hooks
on the trunks of the nearest trees to hang the odds and ends on.
These may be nails, or they may be forked twigs pinned to the
wood. Sort out the provisions and put them where they will keep
sweet and dry. Do not lay the pork on the sugar bag, nor the salt
against anything else.
The beds are of prime necessity. If you must economize on
anything, let it not be on the bedding. If you are where you can get
plenty of fir or spruce boughs, you have the finest bed in the world.
Cut a large supply and spread them over the sleeping place. Start
with the larger pieces and lay a row along the head of the bunking
place. Then work toward the foot, lapping them like shingles till the
bed is at least seven feet long. Next start again at the head and put
on another layer, forcing the butts down into the first layer. Continue
this process, using smaller branches with each layer, finishing off
with the fine tips on top. Make this bed as thick as you can, for it will
settle with use. When you have nothing else to do, put some more
fir tips on the top. Lay the rubber blankets on this, and make up
each man’s blanket separately, so that he can easily crawl into it and
cover up, without disturbing the others.
If “fir browse” is scarce or absent, make a pole bed. Cut four
sticks with a crotch at one end. They should be at least three inches
in diameter. Force these into the ground so that the head and foot of
the bed shall be about seven feet apart, and so placed that poles of
about the same size shall lie across the head and foot. Across the
poles lay other smaller ones close together till the frame is wide
enough to accommodate the party. On this foundation lay the brush
or dry leaves.
When nothing else is available, and I am in a camp that is to be
permanent, I generally buy a bale of cheap hay, if I can get it. There
is generally a farmer who can supply it, or it can be obtained at the
point of disembarkation and brought in with the luggage. This may
seem fussy, but I am supposed to be writing for the benefit of
people who are accustomed to soft beds, and who come to camp to
enjoy themselves. If you wish to “rough it,” spread your blanket for
one night on the ground beneath the starry sky. The next night you
will have a bed made.
A convenient bed is made of a strip of canvas, 6½ feet square,
doubled and sewn together at the sides, with the ends open. When
you put it up, drive four crotched sticks into the ground at the four
corners and stretch on poles placed on these crotches.
The next important adjunct is the camp fire. It seems almost
superfluous to tell a man how to build a fire, but it is an old saying,
that “It takes a wise man or a fool to make a good fire.” I take it the
reader classes himself as neither. The cooking fire will be the most
important. If you have flat stones, lay up a fireplace, placing the
stones close enough together so that the fire will play all around the
kettle, and with a space long enough to hang two pots. It is a good
idea to have a low place in front wide enough to set on the fry pan,
and high enough so that you may haul the live coals between them.
This will save you holding the pan in your hand all the time you are
using it.

Matasiso Stove

If you are in a permanent camp where there are plenty of rocks,

build a pier of stones about three feet high, leaving a hollow in the
center for a fireplace, which may have a bottom of turf.
This device will save a good many back aches. Make the fireplace
at the back a little narrower than the fry pan, and wider at the front.
On this you may boil your potatoes, make your coffee, and fry your
fish at the same time. The rocks will hold the heat, and food may be
kept warm while waiting, if care is taken to have the stones on the
top flat and level; in fact, I have often stewed fruit, etc., with the
dish on the edge of the fireplace.
In temporary camp, cut three logs, about a foot in diameter; lay
one for a back log, two for side logs, build your fire on top with
small stuff, and when it falls in coals you have a convenient place to
set your fry pan, coffee can, etc.
Remember that a small fire is better than a large one. With the
latter you cook your face more than your food, and there is more
liability of spoiling the cooking.
Hard wood is better than pine or spruce; the coals are what you
want, and the longer they will remain hot the better for the cook. By
no means use hemlock or cedar, as the sparks fly all over everything,
burning the towels and the cook, soiling the food and setting fire to
the surrounding dry leaves.
Although I prefer “frying pan bread,” I want an oven to bake
beans, fish, etc., and construct it as follows: Dig a hole in the
ground, preferably on the side of a knoll; line it with rocks, if
possible; build a fire of hard wood within it and keep it up for a half
hour at least, till the rocks or the surrounding earth is very hot; rake
out the coals and ashes, leaving three to four inches of live coals
and ash in the bottom. Put in whatever you have to bake, cover with
the ashes. The length of this operation will depend upon so many
conditions that it will be impossible to set a time, but a little
experience will soon settle the question.
The evening camp fire is a great comfort, and is an altogether
different proposition. Select a place in front of the tent, and some
ways from it, and place a big log, or pile up several smaller ones
with stakes to hold them in place, for a back log. Build the fire in
front of it. Start the bottom with fine dry chips, branches, or
shavings, place larger dry branches on these and top off with good
sized pieces. After it is well alight, it will consume damp or even
green wood. The back log will reflect the heat into the tent, and will
hold the fire for a long time.
Supposing that you wake in the morning with a steady rain
pouring down. Do not try to make a shift with “cold grub.” That is
the time you need a warm meal. Put your rubber blanket over your
shoulders, and go out. If you are wise, you will have prepared a
store of dry soft wood, which will be stored in the tent, but if you
have used it up or have neglected this precaution, hunt up a pine log
or a dead pine tree, and chop off the outside; you will find plenty of
dry wood inside. Rake open the ashes in the camp fire, where you
will probably find plenty of live coals, put on your dry chips, cover
with pine, fir or spruce boughs, blow up the fire and you will soon
have heat enough to keep the tent dry, and coals enough to cook by.
It will take a pretty hard rain to put out a good fire if once under
headway.
If there are any mosquitoes, as when are there not, fasten the
netting over the opening of the tent. Hard wood splinters will do the
trick. Keep this netting in place as much as possible. It is much
easier to keep these pests out, than to get them out afterwards. If
these insects are too troublesome use the Insect Repellent freely.
There are numerous preparations which can be purchased ready
made. The most of them answer the purpose very well. But if you
wish to make it yourself, the following recipe, furnished me by Dr. L.
O. Howard, the U. S. Entomologist, is easily mixed and very good.

INSECT REPELLENT
2 oz. Oil of Citronella
2 oz. Camphor
1 oz. Oil of Cedar

The recipe furnished by “Nessmuk,” one of the best old sportsmen

that the country ever knew, is made as follows:

PUNKEY DOPE.
Pine Tar 3 oz.
Castor Oil 2 oz.
Oil Pennyroyal 1 oz.

Simmer the tar and castor oil together; when well amalgamated
add the oil of pennyroyal, and set to cool. It is well not to have the
mixture too warm when the pennyroyal is added, because it may
evaporate, and it is the real life of the mixture. Bottle and cork it
tight. Use copiously and you will have no trouble with the pests of
the woods. It is equally efficacious for black flies, mosquitoes or
horse flies, and will do no injury to the skin. Please wash your
hands, however, before you mix the bread.
 CHAPTER IV
CLEANING FISH
The remarks that follow are intended for the novice in the
Waltonian pursuit, rather than for the experienced angler or camper,
the latter probably knowing from experience how to care for and
dress his catch to his own satisfaction, and probably in a better
manner than the writer; but for the benefit of the uninitiated I will
attempt to describe what I consider, after several years’ experience
in the sport of Uncle Izaak and the care of the results, the best
methods of procedure.
One of the most important points to be considered is, What means
shall we employ to insure our fish being in good condition on our
arrival at camp or at the point where the catch is to be cleaned.

Fish-bag

The angler who fishes the stream can, of course, only put his fish
in the creel, but if the sun is bright, a layer of damp moss will
prevent the fish from drying, which is of the utmost importance. But
to the boat fisher the ensuing remarks are of salient value. It has
been my experience that if the boat used has not a fish-well built in
it, it is best to use an open-mouthed knit fish bag, made of extra
heavy cotton cord with an inch mesh, which can be hung over the
shady side of the boat, thereby keeping the fish in their native
element, and generally alive for a long time, away from the sun. This
is of the utmost importance, as the sun has a very detrimental effect
on the fish, oftentimes softening them so that dressing them in a
presentable or skillful manner is out of the question. The result of
this is generally more bones in the frying pan than fish.

Fish-knife

We have now arrived at the point where the fish, after having
furnished sport for the angler, are of no use until some of the party
displays his skill with the knife, and the speed and results exhibited
by one who will take pains to render himself thoroughly conversant
with the following instructions will be a revelation to the man who
spends an hour in cleaning a dozen fish for his supper.
After landing, the first question often asked is, “Who has a knife?”
and everybody pulls one out, ranging from a penknife to an 8-inch
hunting knife, neither of which, in my mind, is worth a last year’s
bird’s nest, for reasons which we have not here space to explain.
After trying all shapes, kinds and sizes, I for my own use prefer the
shape shown in the cut.
This may be made out of a good pocket knife, by breaking its back
and fitting a hardwood strip in slot for blade and winding the entire
handle with strong twine.
The advantage in the blade being at an angle is in its tendency to
always cut deeper into the flesh, instead of coming out of the cut,
thereby enabling the user to make long, clean cuts down each side
of the dorsal fin, which can then be removed entirely, leaving none
of the annoying small bones to cause an inelegant flow of language
on the part of the hungry sportsman and numerous cuts on thumb
and forefinger.
After seeing that your knife has a keen edge, pick out a firm-
fleshed yellow perch from the bag, grasp firmly in the left hand,
belly down, the hand being closed firmly along the sides to prevent
the sharp points of the gill covers entering the hand. Make a cut
crosswise at the nape of the neck, insert point of knife in cut and
run entire length of fish, each side of the dorsal fin, which can then
be removed entire by catching the lower end between the thumb
and knife blade and pulling quickly upward toward the head. Then
grasp the flap of skin at the nape between the thumb and the point
of the knife and pull outward and downward, tearing the skin from
the side down nearly to the anal fin; repeat this on the other side;
then grasp in the same manner the skin on the under side as near
the vent as possible, so that both sides may be removed at the same
time, and tear quickly down to the tail, the anal fin nearly always
coming off with the skin; pull off the head and the entrails will come
with it, the whole operation requiring five cuts with the knife and
eight motions of the hand, and less time than it takes to tell it.
In dressing white perch, first scale them thoroughly, which
operation consists in holding knife blade at an angle of about 100
degrees to the skin of the fish; press lightly and by a series of quick,
short, scraping movements from the tail toward the head, remove all
the scales thoroughly. The dorsal fin is best removed as in dressing
yellow perch. Next, with fish in left hand, belly up, make a
downward cut from directly back of the pectoral fins to a point just
back of the gills; insert point of knife into this cut and run entire
length of belly, continuing down one side of anal fin, make a cut on
the opposite side and remove the fin entire; turn the fish over, sever
the neck at the nape, and the head and entrails will be removed as
in previous case.
Pickerel should be thoroughly scaled, and afterwards cleanly
scraped with the knife until the slime is entirely removed, leaving the
fish nice and white, which takes away all the disagreeable muddy
flavor so common in this fish. Fins should be removed as in previous
cases.
Of all fish that the novice may be called on to dress, the Hornpout,
bullhead, or Eastern cat-fish, as it is variously called, will probably
give him the most trouble. The best and quickest way is to remove
fins by cutting down each side and tearing out; cut the entire length
of the belly to a point a little beyond the vent; then sever the head
from the body from the under side, without cutting the skin; grasp
the body with the fingers of the left hand, take the head in the right
and a quick pull will take off head, skin and entrails entire, if a little
care is taken in starting the operation.
Of all fresh-water fish the trout is the easiest to dress, no knife
being needed. Remove the gills and entrails with the thumb and
forefinger, wash thoroughly, and the fish is ready for the pan.
In closing, a word to the camper. Never use fish that have lain in
the sun or have begun to soften. They are not only less palatable
than freshly caught fish, but at times positively dangerous to the
health. Take all such fish, chop them up and take them, with the
entrails and other refuse of the cleaned fish, out to the fishing
ground and throw them overboard. If this is done daily at the same
spot, especially if near some sunken ledge, you will be able to catch
a dinner there at any time, as the fish will congregate there in large
numbers. This is called ground-baiting.
 CHAPTER V
WHAT TO DO IF LOST IN THE WOODS
Every man who goes camping in the woods, at a distance of more
than five miles from civilization, and does what nearly every man
does do, i. e., “take a walk to see the country,” is liable to miss his
way and if he is not lost, the camp is. I have talked about this with a
few people who have been in that unenviable position and the
answer to the question is difficult and varied. “You just can’t tell
what you would do.” You may theorize all you choose beforehand,
but when the time comes and your brain is bewildered, you would
take the most solemn oath that your compass is wrong. It is a most
horrible sensation to find that you do not know how to get out of the
woods, with perhaps miles of almost trackless forest before you; the
one safe place, perhaps, is only a short distance away, but you do
not know where that way is.
I have roamed the woods for thirty years, sometimes being in
camp from May 1st to December 1st. I have hunted summer and
winter in strange localities, as naturalist, sportsman and surveyor,
and while I do not know as much woodcraft as I wish I did, I have
had some experience in getting lost—and finding myself again; in
fact, I have a faculty for getting lost. When I am following a rare or
unknown bird I endeavor to keep my eye on it, irrespective of the
direction in which it may take me, sometimes across country and
often in circles, and when I get ready to resume my quiet path I
know not where I am. So I have adopted a positive maxim:
“Whatever you do, do not get rattled and lose your head.”
I often have had to caution a “novo” who looked to me for
instruction in the woods, to remember the above every minute, and
to add to it “Always carry a compass and never think that it lies.”
Most people have heard of local attraction in the compass, and they
always think they have found it. There is only about one per cent. of
the country that will show anything of the kind and even then it
would not deflect the needle enough to carry the traveler far astray.
If it were deflected, the needle would keep you from wandering in
circles in which lies the greatest danger of being lost.
Now supposing that you are camping on the shore of a lake in the
woods, and you want to look over the neighborhood. Your first duty
is to look at a map of the locality, if you have not already done so, so
that you may have a general idea of the characteristics of the
surrounding country; especially of the trend of the hills, the locations
of streams or roads or the direction of the coast or lake shore, as
compared with your camp. If you cannot do this do not go.
When you find that you do not know where you are, and you are
positive that the sun is setting in the east or in some other
impossible quarter, endeavor to make up your mind as to where you
are within a radius of five miles, and think in which general direction
lies some river, road or other landmark, and then set up a stick or
blaze a tree in that direction. If it is not too late in the day, make up
your mind in which direction you ought to go, set your compass,
take a bearing on some prominent tree or other mark in that course,
and go to it. If the woods are so thick that you cannot pick out a
mark, set up a peeled stick or blaze a tree once in a while so you
can look back and see your trail. When you have gone as far in any
direction as you are certain of your course, lay it out again, always
by compass, and you will come out somewhere at a place that you
will recognize as leading to some known point.
If it is late in the day, do not wander around in the dark, but pick
out a comfortable place, cut some boughs to lie upon and to build a
lean-to; gather fire-wood enough to last through the night or as long
as you want it to, and make yourself as comfortable as possible until
morning. If you are fortunate enough to have some lunch with you,
you will probably get a fair night’s sleep. You will not starve in one
night, and you can usually find something to eat, even if it is not so
nice. In very few places would there be the slightest danger of
molestation from any source. Next morning you may follow the
instructions for getting out, as shown in the preceding paragraphs.
Methinks I hear someone say, suppose you have no map,
compass, matches, etc. I reason that you are a rational being and if
you have not these things you will not be foolish enough to go out.
If you do not know how to provide yourself with the necessary
comforts, you have not read this book understandingly.
In the case of a hunting party in the deep woods, it is the custom
among the parties with which I have been associated, to have a
“lost call.” We generally separate in the morning to hunt in different
sections, which are duly allotted beforehand, so that each member
knows just where the other men ought to be. In case any one of
them becomes so overcome with the ardor of the chase, or in the
following of wounded game, that he does not know how to get back
to camp, he gives the call, three shots of the rifle in succession. If
not replied to, the lost one starts in the direction that he believes the
camp to be situated, repeating the signal occasionally. Usually he is
heard before much time has elapsed and is answered. If he does not
show up by dark, a search party is formed, and he is trailed by the
light of birch bark torches, or the lanterns. Seldom is a man
compelled to stay out all night.
 CAMP COOKING
The following receipts for cooking are the result of many years’
actual experience, and have all been tried in actual camp-life. They
are all comparatively simple, and may be prepared by aid of the
utensils mentioned in these pages. The materials may generally be
easily obtained at the stores, when fitting out, or of the farmers in
the neighborhood.
It is assumed that a certain judgment will be exercised in the
selection of rations, to govern the personal tastes of the various
members of the party, and the resources of the surrounding country.
One would not expect to have a variety of fresh vegetables in the
Maine Woods; nor would it be reasonable to neglect such
opportunities when offered. Hence a selection is presented, which
may be presumed to fit all conditions.
“We can live without Love—what is passion but pining?
“But where is the man who can live without dining?”

“As we journey through life, let us LIVE by the way.”

 CHAPTER VI
CAMP COOKING
There is a favorite saying in camp, that “the Lord sends grub, but
the devil sends cooks.” This expression is old and homely, but it is
apt, and many times, when it is the turn of the greenest man in
camp to get dinner, we find reason to consider it true. We have seen
an old woodsman toss together a few ingredients and turn out a
meal that would cause our stomachs to cry, “Encore, encore,” and
we have most of us experienced the sad results from guides who
pretended to be finished cooks and had the whole party homesick
before they had been in camp three days. The best supplied camp
cuisine in the world would not keep off the “blue horrors” when in
the hands of such bunglers.
Of course, everyone must first learn the how to do it, and equally
of course some fail to ever learn. The latter could not boil water
without burning it. I well remember my own first experience, and I
remember, too, the experiences with some of the boys that I have
tried to teach to cook.
The genuine camper is, certainly, the man who, taking but little
food with him, lives upon the spoils of his rod and gun. This is, in
most cases, impracticable to the ordinary camper. In the first place,
it takes some experience to do it. In the second place, but few
desire to do so, and there is no reason why they should. A party can
live just as well in camp as they can at home, if they wish to, and
can afford it. And also a party can live on a dollar a week apiece, if
they choose; and live well, too.

BREAD AND CEREALS.

Baked Bread:—Put in the mixing dish (I use the stew pan), 1 quart
of flour, 4 teaspoonfuls of baking powder, and a teaspoonful of salt,
and mix together; then work in a little butter with the hand or
mixing spoon, add cold water, stirring all the time, till you have a
stiff dough without lumps. Turn it out on a plate, wash the dish
thoroughly, grease the inside so the dough will not stick. Put the
dough back in the dish, cover it with a tin plate, place it on the coals
in the oven, and cover with the hot coals and ashes that you have
just raked out. Leave it for from one to two hours. A little experience
will be needed to know just how long to bake it, for a rock oven,
with a heavy bed of coals, will bake more quickly than a hole in the
ground with pine embers. (N. B. I use double the quantity of baking
powder in camp, that I use at home, because I have found it
necessary to obtain the desired result. Why it is, I do not know.)

Spider-cake:—Mix 1 pint wheat flour, 1 teaspoonful salt and 2 of

baking powder. Add water to make a thick batter. Grease the fry pan,
and turn in the batter; bake very slowly over the fire. As soon as the
crust forms on the bottom, so that it can be moved without
breaking, loosen it in the pan with a thin knife, and shake it
occasionally to keep it from scorching. When baked on one side, turn
it over and bake the other side. (This is not called spider-cake on
account of the insects that might fall into it, while in process of
cooking, but because in olden times the fry pan was called a spider.)

Flapjacks or Batter-cakes:—Mix 1 quart of flour, 1 teaspoonful of

salt, 4 of baking powder, and 4 of sugar or a little molasses. Add
water to make a thin batter. If you have milk, it may be used instead
of the water, to the benefit of the cakes. A teaspoonful of condensed
milk dissolved in the water is also good. Grease the fry pan and drop
in enough batter to make a thin layer. As soon as the cake browns
on the under side, slip a thin knife or cake-turner under it and turn it
over. When baked, take it off onto a plate, placed where it will keep
warm: grease the pan again and repeat the operation. The best
results will be obtained by keeping the inside of the pan smooth,
and using as little grease as possible. This receipt may be varied in
many ways. A mixture of corn meal and flour in equal parts will give
variety.
 Rice-cakes and Oatmeal-cakes are simply the above mixture with
the addition of 2 cups of boiled rice or rolled oats or hominy mixed
with one-half the above quantity of flour. If eggs are obtainable, one
or two stirred into the batter just before cooking, improves the cakes
immensely. If whortleberries or dangleberries or blueberries are in
season, stir in a cupful. The boys will like them. My experience has
taught me that an extra quantity of berry flapjacks will be about the
right size. Maple syrup, molasses, or sugar, may be used with these.

Boiled Rice:—Wash clean 1 pound of rice, and put in 2 quarts of

boiling water with 2 teaspoonfuls of salt. Boil one-half hour. Take off
and drain, cover the dish tightly and set aside to steam.

Corn-meal Mush:—Have a dish of boiling water, salted to taste. Sift

in the cornmeal slowly with the one hand, while stirring briskly with
the other, until the porridge is thick enough. This may seem very
trivial, but it takes patience to do it properly or it will be full of lumps
of dry meal. Set it on one side the fire and steam slowly for 15
minutes. If your patience is not sufficient for this process, mix your
meal in cold water to make a thick batter. Have your dish of water
boiling, and turn in the batter slowly, so as not to stop the boiling.
When properly done, and it is not so easy either, this makes a good
dish for the camper. The remainder may be put one side until cold,
sliced in pieces about one-half an inch thick, and fried in butter. This
is improved by dipping the slices in beaten egg, before frying. If the
mush has not been properly made at first, the slices will fall in
pieces.

Milk Toast:—If you have any stale bread in camp (as when do you
not, if anybody goes near a bakeshop on the visit to town), make it
up for milk toast. Put on the stew pan, with a cup of milk. Put in a
pinch of salt, a generous lump of butter, and allow it to come to a
boil. In the meanwhile toast your bread to a nice brown, and when
of the right complexion, drop it into the boiling milk.
 Cereals:—Of these various preparations, their name is legion, and
nearly all of them have directions for cooking, printed on the
package. I have tried a number of them, and the receipts hold as
good in camp as at home. This is not, however, a guarantee that the
rule will always hold good. Why it is I do not know, but some things
cannot be handled the same in camp as when prepared over the
stove at home.
There are various makes of prepared flours in the market, under
as many various names. As a rule they are very handy to the
camper, as they are put up in small packages, by which the necessity
of breaking out a large package is avoided, and they also avert some
mistakes of omission common to men doing work they are not
accustomed to do.

Fils-d’une-chienne:—Fry out the fat from some salt pork. Soak

hard-tack in water till it is soft. Drop it in the hot fat and cook.

SOUPS.

Beef Stew:—Take 1 pound of lean meat, wash clean, and put it in

cold water over a slow fire. Cook until the meat falls in pieces when
stirred; this will take from 3 to 4 hours, during which time there
must be enough water to cover the meat. Now add about a quart of
sliced potatoes, a small onion, sliced very thin, and cook until the
potatoes are soft. Season with salt and pepper to taste.

Camp Stew:—Prepare the beef by boiling as in the previous

receipt, except that a large onion is needed, and it must be added at
the same time the meat is put on. When the meat is done, add the
potatoes as before, and a can of tomatoes. Flavor with salt, pepper
and curry powder. Just before serving, take some wheat flour and
mix with water to make it about the consistency of cream; beat it
together thoroughly so there will be no lumps; have the stew
boiling, and turn in the flour, which will thicken the liquid. This dish
may be varied by the addition of any or all of the vegetables which
may happen to be within reach. Carrots, turnips, cabbage,
cauliflower, parsnips, etc., should be peeled and cut into dice of
about a half-inch in diameter. These vegetables should be cooked a
little longer than the potatoes. So far as the meat component goes,
almost any flesh is suitable. The leftovers from the broiled steaks or
chops; chickens or fowls, ducks, grouse, shore birds or any other
meat from the roast or spit; the greater the variety, the better the
stew. If fresh meat is purchased, get the neck, shin, bottom of the
round, or any of the inferior pieces in preference to the, so-called,
choicer cuts. Although not so tender, they have a far richer flavor. It
is needless to say that venison, rabbits, or squirrels are adapted to
this dish.
A word of caution just here may not be out of place. When making
venison stew, look out that the meat has been well bled and hung
for forty-eight hours, if possible. Otherwise you will think you have
been taking a dose of Epsom salts.
When preparing rabbits and squirrels, skin and dress, then soak
the flesh in salt water over night. This will remove the strong flavor,
which is obnoxious to many.

Turtle Soup:—Parboil the meat in water, in which has been put a

small handful of salt, for about a half hour. Take out the meat and
throw away the water. Put the meat in fresh cold water and stew
slowly till it will pull into pieces; add a sliced onion and four large
sliced potatoes, season with salt and poultry dressing (sage, savory,
thyme and pepper or other fragrant herbs will do as well), and
thicken the same as the Camp stew. This is for the common “mud
turtle,” and be it known that an unreasonable prejudice exists
against this animal. Properly prepared, it is a dish for the gourmet.

Skunk Stew:—I was in doubt whether to insert this here, on

account of the prejudice that some people have against this animal.
Properly prepared, it is really a delicacy. When you catch a skunk, of
course you kill him, if you can, before he explodes. If the odor is
strong, hang the carcass over a smudge of hemlock twigs, being
careful not to scorch the fur. Skin and dress, being careful not to
break the musk-glands, which must be carefully removed. Put in cold
water over a slow fire, and boil for an hour, or as long as any fat will
rise to the top. Skim off this fat and carefully preserve it in a bottle,
against the time when the baby has the croup, or you yourself have
a sprained muscle; it is very penetrating. Throw away the water, and
boil the meat with a sliced onion in fresh water, till the meat will slip
off the bones. Add sliced potatoes and season with salt, pepper, and
a very little sage or poultry dressing. Many a man has become a
confirmed mephitiphagist after partaking of the above without
knowing what he was eating until he had finished his meal.

Lob-scouse:—Boil corned beef till the excess of salt is out of it.

Drain off the water and fill up with fresh water; put any vegetables
that you happen to have, except the potatoes, and boil till the meat
will come to pieces; about half an hour before it is done, add some
sliced potatoes and hard bread. This is not a dainty dish, but it
affords a variety when the stomach is cloyed with a hard-times diet.
Start with cold water.

Fish Chowder:—Fry out two slices of pork in the bottom of the

kettle, and when well cooked, turn in 2 quarts of boiling water. Add 6
large potatoes, sliced thin, and cook until they can be broken by the
mixing spoon. Have about 3 pounds of fish cut into convenient
pieces, which should now be put in and cooked till it will break in
pieces. Then add 1 quart of milk and season to taste with salt and
pepper. When it comes to the boiling point, break in 12 crackers. Set
it off the fire till the crackers are steamed soft and serve. Some think
that the chowder is improved by the addition of a small onion, sliced
thin, and added when the potatoes are put in.

Fish Chowder, Southern Style:—Cover the bottom of the pot with

slices of fat salt pork; over that put a layer of sliced raw potatoes;
then a layer of chopped onions; then a layer of fish, cut into pieces,
leaving out all the bones possible; on the fish put a layer of crackers,
first soaked in water or milk. Repeat the layers, except the pork, till
a sufficient quantity is obtained. Each layer should be seasoned with
salt and pepper. Put in enough cold water to moisten the whole
mass well, cover the kettle closely, and cook slowly for an hour or
more. When it appears rather thick, stir it gently and serve.

Webster Chowder:—The famous Daniel Webster lived in the

section where my ancestors passed their lives, and his neighbors, for
miles around, gleaned a portion of their sustenance from the
contiguous waters. Many of them were professional fishermen and
their wives were famous cooks in the direction of these products. As
Webster’s Chowder was a noted receipt, it being said that he
furnished the following to his friends, we need no excuse for its
insertion here.
“Cod of 10 or 12 pounds well cleaned, leaving on the skin, cut into
slices of 1½ pounds each, preserving the head whole; 1½ pounds
clear, fat salt pork cut in thin slices; slice twelve potatoes. Take the
largest pot you have, try out the pork first, take out the pieces of
pork, leaving in the dripping; add to that three pints of water, a layer
of fish so as to cover the bottom of the pot, next a layer of potatoes,
then two tablespoonfuls of salt, one teaspoonful of pepper, then the
pork, another layer of fish and the remainder of the potatoes; fill the
pot with water enough to cover the ingredients; put it over a good
fire, let the chowder boil twenty-five minutes; when this is done
have a quart of boiling milk ready and ten hard crackers split and
dipped in cold water; add milk and crackers, let the whole boil five
minutes. The chowder is then ready and will be first rate if you have
followed the directions. An onion is added if you like that flavor.”
Once or twice each summer, it was the custom of the farmers to
make up a party and go to some beach for a picnic. A chowder was
considered a necessary adjunct of the festivities, and I still retain
lively recollections of the quality of this toothsome dish. Perhaps it
was flavored with the sauce of youth and hunger, but it was good
then and is now.

Clam Chowder:—Shuck out a peck of clams and add to the

chowder instead of the fish. For those who have never learned the
art of shucking clams, the shellfish may be put on the fire in a kettle,
with just enough water to cover them. Please use hot water, turned
over the clams, so as to avoid trouble with the Society for P. O. C. T.
A. When the clams open their shells, take the kettle off the fire, turn
them out into a pan to cool, saving the liquor to use in the chowder.
Shell out the clams. Make the chowder as by the first receipt given,
using as much of the clam water as is necessary; the children will
take care of the remainder as a beverage. Do not put the clams into
the chowder until it is nearly done, or they will be tough.

Bean Soup:—Wash 2 quarts of beans, and either put them to soak

over night or parboil them till the skins begin to peel off. Scrape
clean one pound of salt pork and cut into thin slices. Boil the beans
for an hour or longer if necessary, then mash the beans into a pulp;
put in the pork and cook slowly for another hour. Stir occasionally so
it will not burn. Season with salt and pepper to taste. It is a fussy
job to make this and not burn it, and at the same time have it good;
but it is worth the while.

Pea Soup:—Take a ham bone, from which the most of the meat
has been sliced. There is no objection if it has been once boiled. Put
over the fire with cold water and cook until the bone will slip out of
the meat. Then add split peas and cook till soft. Have some cubes of
bread, about one inch square, prepared, fried in lard or butter. When
the soup has thickened, which it will do as soon as the peas are
cooked soft, put in the bread, and serve immediately.

Oyster Stew:—Half a cup of oysters (shucked, if you please), with

a very little water; simmer over the fire till the beards wrinkle. Turn
in a pint of milk, a piece of butter, salt and pepper; let it come to a
boil, stir in a little thickening, and it is ready to eat. Don’t burn your
tongue.

MEATS.

Unless camping in a game country, we seldom have any other

meat than what may be brought into camp on the occasional visits
to town. But it has been thought advisable to treat the subject as if
there were a market within easy access, for the benefit of those who
may be thus advantageously placed. Deer, bear, hares, squirrels,
rabbits, grouse, quail and shore birds, however, will be at times
available. And as the acme of the camper’s art is to live, so far as
possible, off the country, due attention will be paid to those dishes
which can be prepared from those products. No hard and fast rules
can be made, for individual preferences vary to such an extent that
what would be luxury to the one, would be starvation to another.
Nevertheless, it may be considered that all wild meats should be well
done, except in the case of an occasional chop from some member
of the deer family. With fowl, however, it is different. All dark meated
birds should be rare done; all white meated birds well cooked. I
consider that criticism of a man’s epicurean tastes is pure
impudence, if not insult. It is none of my business if a man wants to
make a salmi of his woodcock: I simply deplore his taste or
ignorance.
I shall commence with what has probably been brought in when
the party arrived, so the cook will not have to hunt far to know how
to cook supper. Beef, pork, lamb, ham, bacon, sausage, etc.

Broiled Steaks:—Camp is a poor place for tough meat; so when

you buy, get something so that you can, at least, stick a fork in the
gravy when it is cooked. Have a good bed of hardwood coals, if
possible. At any rate, have no smoke. Put the broiler over the hot
coals and get it hissing hot. Then put on the steak and hold it over
the fire till one side is seared; turn the other side to the fire and sear
that, after which it should be turned back and forth till cooked to suit
the taste. Lay on a warm plate, put on a liberal piece of butter, a
little salt and pepper, and give thanks that you have been given a
palate to appreciate good food. This rule applies to lamb as well as
beef; to venison as well as to pork chops. In cooking pork chops,
however, my preference is, to heat the fry pan very hot, drop in the
meat, and cook till well done. If there is no broiler, this plan may be
followed with any meat, but a little butter must be used, if there is
not sufficient fat in the meat to prevent its sticking to the pan. But
by all means, use as little grease as possible, and have the pan hot,
to start with, so as to quickly sear the surface and keep in the juices.
In cooking meats, in the fry pan, if there is any fat left, especially
that from pork and bacon, turn it into a clean can (I use the empty
condensed milk cans), and save it to fry fish.

Fried Salt Pork:—Slice clear, fat pork; slash the rind edge, so it will
not curl in the pan; scrape off all bits of salt or other attachments;
put in a cold fry-pan and cook till well done. Do not get the pan too
hot, for it will burn the grease, and spoil the flavor. Drain off grease
and serve with hot potatoes. Good salt pork is smooth and dry.
Damp, clammy pork is unwholesome.

Broiled Salt Pork:—Slice thin and toast on the broiler, the same as
steaks. Or hold the slices over the fire, on the end of a green switch.
Look out that the smoke from the drippings does not reach the
meat.

Fried Bacon:—Slice thin and drop into a hot pan. Watch carefully
that it does not cook too much, or it will be hard and dry; remove
each piece as soon as it is done and drain dry. Some cooks always
lay the cooked meat on paper to absorb the grease. Do not soak in
water before cooking; it renders it hard when done.

Ham and Eggs:—Fry the ham the same as pork. When cooked,
break the eggs separately into a cup, and drop into the hot fat. The
white of the egg will spread out and should be turned up against the
yolk as soon as it gains sufficient consistency; this prevents the
outside of the albumen from becoming leathery. The object of
breaking the eggs into a cup before dropping into the pan, is to
avoid getting an ancient egg among the others.

Fried Sausages:—Cut the links apart, prick each sausage with a

sharp fork so they will not burst in cooking. Place in the cold fry pan,
and cook until well done. It is not safe to eat any pork product
unless it is well cooked.
 Boiled Beef:—Put the meat into boiling water, so that it will be
covered and cook till tender; about 15 minutes to the pound will
generally be sufficient. Use a teaspoonful of salt for every 5 pounds
of meat, added when it is nearly cooked. This method will be proper
for corned beef, also, but omit salt and use cold water. If the beef is
not corned, just before it is done allow the liquor to boil away to
about a pint, season with pepper, and thicken with flour; this makes
an excellent gravy. If no gravy is desired, the liquor should be set
one side till cool, the hardened fat removed and saved to fry with.
Afterward, if desired, this liquor may be used for a foundation for a
vegetable stew.

Hash:—Take of boiled beef, or the scraps left in slicing the boiled

ham, one part; cold, boiled potatoes, two parts. Chop into small bits,
and warm up in the fry pan with a little pork fat. If desired this may
be varied in several ways. Have the fry pan hissing hot. Put in a little
pork fat and drop in an onion, sliced very fine. Stir rapidly, so it will
not burn. Have the hash prepared, which roll into flat croquettes, dip
in sifted corn meal and fry brown in the fat, from which the pieces of
onion have been removed. Or, have the pan half filled with clean,
sweet grease (lard, or beef drippings), slightly salted. Break one or
two eggs into the hash and mix thoroughly; roll into croquettes or
balls, drop into the hot fat and fry brown. The fat should be as hot
as it can be without burning.

Barbecued Meat:—Ribs of mutton, thin pieces of beef, rabbits,

squirrels or almost any other flesh can be prepared in this manner.
Lay your meat on the broiler over hot coals, so as to singe the
outside immediately. After a few minutes, move away from the
intense heat a little and cook till done through, basting frequently
with the following dressing:

Barbecue Dressing:—One pint of vinegar, half a can of tomatoes,

two teaspoonfuls of red pepper (chopped pepper-pods are better), a
teaspoonful of black pepper, same of salt, two tablespoonfuls of
butter. Simmer together till it is completely amalgamated. Have a bit
of clean cloth or sponge tied on the end of a stick, and keep the
meat well basted with the dressing as long as it is on the fire. The
preparation of this dish is a lot of work, but it pays.

Fried Egg on Hash:—Make your hash of meat and potato; fry out
the fat from a few slices of pork; roll your hash, wet with enough
water to make it stick together, into flat cakes large enough for a
single service, and fry brown. Lay in a dish where they will keep
warm; grease the fry-pan and drop in the eggs in couples, and fry till
the whites congeal; roll the edges of the white over the yolk and slip
off on to the hash cakes, one couple to each cake. When served,
which should be as soon as the egg is done, break the yolk and let it
run down over the cake.

GAME.

This word, like sweet Charity, covers a multitude of sins. I might

read you a homily on the sin of killing the creatures of the wood and
field; but I am not going to do it, for several reasons. First ’twould
do no good, for you would keep on killing. Second, it is none of my
business anyway. My business now, is to tell you how to cook so that
you will come out of the woods well and hearty, and without a bad
case of dyspepsia. With this digression, I want to start in with a few
words of advice. In the first place, always bleed your game as soon
as killed. The flesh of an animal that has not been bled is not fit to
eat. Always let the animal heat get out of the body before you cook
it. The fact that it will not rest well on your stomach is proof positive
that it is not healthful. So unless you are on the verge of starvation,
heed these words. Fish is the only meat that is not subject to this
rule.

Fried Squirrel:—The most common four-legged game that the

ordinary camper will get, are squirrels and rabbits. The latter,
however, are not suitable for food till the late summer, and in most
sections are protected by law for a certain season of the year. We,
however, are not just now interested in the getting of them, but the
cooking. Skin and dress them carefully, and parboil for half an hour
in salt and water, to take out the strong flavor. Drain off the water,
drop the meat in the pan, with a bit of butter and a dash of curry
powder, and brown. Those who like the gamey flavor, sometimes
soak the squirrels in salt and water for an hour, wipe dry, and broil
over the coals with a slice of pork fat laid over the meat to baste it
so it will not be dry.

Fried Rabbit:—Dress four rabbits; parboil in salt and water till the
bones will slip out of the meat. Drain off the water and fry the meat
in butter. It is much better if the bones are all taken out before
frying, although not at all necessary.
Woodchucks, porcupines and skunks are not strictly game, but
they are fully as edible as other animals, and, if properly cooked,
very delicate. They should be parboiled thoroughly, and then roasted
or stewed like any game.

Roast Woodcock or Quail:—Dress and impale with a green stick

(black birch is the best for the spit), and put a slice of fat pork on
the end of the spit, so the fat will drip down over the bird as it
roasts. Have a large quantity of very hot coals; thrust the stick into
the ground in front of the fire, in an inclined position, so the bird will
be over the heat. Turn frequently, in order to cook on all sides and
also to avoid burning. The hotter the coals, the better the bird, for
the intent is to sear over the outside as quickly as possible to avoid
loss of the juices. Any small bird, like snipe, plover or other
sandpipers may be cooked in the same manner.

Rabbit Curry:—Dress two rabbits and boil till the flesh will come
off the bones. Take the bones out and put the meat in the kettle
with a large cupful of the water in which it was boiled. (Do not use
too much of this liquor; it will make the curry taste rank.) Add two
slices of bacon, cut in strips; season with curry powder, salt and
pepper. If you have it, put in a small glass of Burgundy. Cook slowly
for twenty minutes. Have dish lined with boiled rice; take out the
meat from the stew, and lay it in the dish; thicken the liquor left in
the kettle with a little flour rubbed up in cold water; turn over the
meat in the dish. Serve.

Roast Grouse au naturel:—Take out the “innards” and fill the cavity
with the following dressing. Roll crackers into crumbs and mix with a
little salt, pepper and sage; turn a little hot water on to moisten the
crackers. Put this in the bird, cover with a thin slice of pork and sew
the skin together tightly. Have a pail of water in which stir clay until
it is of the consistency of thick porridge or whitewash. Now take the
bird by the feet and dip into the water. The clay will gather on and
between the feathers. Repeat till the bird is a mass of clay. Lay this
in the ashes, being careful to dry over the outside of the clay, before
you get it into the fierce heat of the fire. Bake it till the clay is almost
burned to a brick. Rake the bird out of the fire, and rap the ball of
clay with a stone or stick, till it cracks open. The feathers and skin
will all come off with the clay, leaving the meat as clean as possible.
This is the perfect way of cooking game. Any fowl or animal may be
cooked in the same way. If you try ducks, woodchucks or hedgehogs
chop an onion and add to the stuffing.

Partridge Fricassee:—Divide your birds into joints and roll them in

flour; put in the fry pan a generous lump of butter, heat very hot
and put in your pieces of bird. Cook for about ten minutes, then add
water to keep from burning and cook slowly till the meat is tender.
Take up the meat and put in a dish; turn in the pan enough water to
make a gravy, thicken it with a little flour rubbed up in cold milk; salt
it a little and pour it over the birds.

FISH.

There is such a difference in fish taken from different waters, that

any general rule for cooking may lead to distaste and
disappointment by reason of the poor quality of the flesh. Fish taken
from sluggish, muddy waters are decidedly inferior to the same
species taken from the cold, clear streams and ponds. Soaking in
salt and water before cooking will improve these inferior fish, but all
the preparation in the world will not make them taste like the fish
caught in clear waters. Again, if you have not a fish car or net, or a
well in the boat, by which means they can be kept alive till they are
ready for use, always kill your catch at once, and keep them out of
the sun. Fish that have lain in the sun for a half hour are unfit for
food. Reference to the article on Fish Cleaning, by Mr. Bosworth, will
give you needed instructions, which it will be well to follow. Trusting
that you have studied this, I will say no more on the subject, but
proceed to the cooking.

Fried Perch:—Have the pan well supplied with hot fat. If there is
not a supply in camp, fry the fat out of a half-pound of salt pork. Roll
the fish, previously skinned and well washed, in corn meal or cracker
crumbs. If you wish to do it up in real fine shape, roll them first in
well beaten egg and then in crumbs. Drop in the fat and fry brown,
turning frequently, so as to have them evenly cooked. Serve hot.
This rule holds good for all kinds of fish not over a half-pound in
weight. If larger, either cut them in slices across the body, or slice
the meat of the sides from the backbone.

Boiled Fish:—Do not attempt to boil a fish under three pounds in

weight. Have your water boiling. Put in a couple tablespoonfuls of
salt, and drop in your fish. It is a good plan to wrap it in a clean
white cloth, so it will not fall in pieces. Cook until the fish will easily
cleave away from the bones. A three-pound fish will cook in half an
hour or less, and about five minutes for every extra pound may be
considered about right. But there is a difference in species. Too
much cooking will spoil the flavor of some fish, the salmon for
instance, or the lake trout. Serve with some sauce.

Fish Sauce:—Have a quart of water boiling in the stew pan or the

fry pan. Put in two tablespoonfuls of butter, one teaspoonful of salt.
Mix in a cup three tablespoonfuls of flour rubbed up in a little cold
water till the lumps are all broken, and it is of the consistency of
cream. Stir this into the boiling water slowly, so it will not form
lumps, and the sauce will thicken. Milk in place of the water is
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