A History of The Surgical Clinics of North America

History of Surgery in the United States

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A History of The Surgical Clinics of North America Ira M. Rutkow, M.D., M.P.H., Dr.P.H. *

The beginnings of The Surgical Clinics of North America are closely related to events in the life of John Benjamin Murphy (1857-1916), one of America's surgical giants. 1-12 Murphy was an enigmatic and colorful personality. His biographer, Loyal Davis (1896-1982), labeled him the "stormy petrel of surgery," and no less an authority than William J Mayo (18611939) styled him "the surgical genius of our generation"13, 14 (Fig. 1), Murphy was born on December 21st in Appleton, Wisconsin. His parents were farmers and strong advocates of a solid education. He graduated from Appleton High School in 1876 and received his medical degree in 1879 from Rush Medical College. After serving 18 months as an intern at Cook County Hospital, he went into private practice until 1882, when he went to Europe. Two years of postgraduate medical studies were spent in Vienna, Munich, Berlin, and Heidelberg. Upon his return to the United States, he reestablished his office for the practice of surgery in Chicago. Murphy had a brilliant imagination and an indomitable personality which allowed him to pioneer many new fields. His career as a medical teacher began with his appointment as Lecturer in Surgery in Rush Medical College in 1884. In 1892, he was made Professor of Clinical Surgery in the College of Physicians and Surgeons, later the University of Illinois Medical School. He continued in this position until 1901, when he was elected Professor of Surgery in Northwestern University Medical School. Murphy stayed through 1905, when he moved back to Rush as Professor of Surgery. In 1908, Murphy made his last career transfer when he went again to Northwestern, where he remained until his death. Murphy also became chief of the surgical staff at Mercy Hospital in 1895, a position he held through 1916. In 1892, Murphy startled the surgical world by introducing the "Murphy button" (G-M #3507).15 This mechanical device allowed the approximation of hollow viscera without sutures. In 1896 appeared a report *Attending Surgeon, Freehold Area Hospital, Freehold, New Jersey

Surgical Clinics of North America-Vo!' 67, No.6, December 1987

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Figure 1. John Benjamin Murphy in 1914.

concerning his research and clinical work in sutures of arteries and veins, including one of the earliest repairs of a lacerated femoral artery (G-M #2967).16 Murphy performed one of the initial 'operations in early acute appendicitis, pioneered the use of local anesthesia in surgery of the lung, and introduced the drip method of saline infusion per rectum in the treatment of peritonitis. 17-19 His studies on surgery of the spinal cord and peripheral nerves paved the way for modern neurosurgery.20 In his later years, he was deeply interested in the subject of deformities, especially those due to infections of the bones and joints. 21 Murphy also wrote the first Year Book of General Surgery in 1901, and again in 1902. Beginning in 1903, he no longer authored the text but assumed general editorship and remained in that capacity for many years. In addition, he was the second editor-in-chief of the monthly journal Surgery, Gynecology and Obstetrics. Murphy was a dramatic figure in the operating room. Although he had a shrill, high-pitched voice, he was considered a superb teacher. George erile (1864-1943) said of him: l l ... He taught the nurse, he taught the medical student, he taught the intern,

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he taught the young physician, he taught the veteran, he taught the laboratory worker, he taught the young surgeon, he taught the master surgeon, he taught the teachers of surgery. He taught us by the example of his earnest intensive labor on behalf of his most humble patient; he taught by conferences, by lucid clinical demonstrations; he vitalized dull statistics with masterful logic; he wove and epitomized masses of evidence into convincing arguments and drew sound conclusions ... Murphy helped organize the Clinical Congress of Surgeons of North America, which was the forerunner of the American College of Surgeons, of which he was a founding member. He was also president of the American Medical Association in 1911. In recognition of his great service to surgery, the John B. Murphy Memorial Building was constructed in Chicago for the American College of Surgeons through various donations by his wife, relatives, friends, and admiring colleagues. Murphy was married to Jeannette C. Plamondon in 1885. From this marriage five children were born, a son and four daughters. For the last few months of his life, he suffered from severe angina, and he died at Mackinac Island from a coronary artery occlusion. As well known as Murphy was and as commanding a figure in American surgery as he was, he left no successor or disciples to carryon his enthusiasm for surgery and research. This is perhaps understandable when it is realized that Murphy's personality was considered by many to be grating. This is no more evident than in his relationship to the Surgical Clinics. It was the overwhelming success of Murphy in attracting large numbers of surgeons to his "wet clinics" which laid the groundwork for the Surgical Clinics. In the early years of this century, the Society of Clinical Surgery was established by Harvey Cushing (1869-1939), George Brewer (18611939), George Crile, Charles Frazier (1870-1936), James Mumford (18631914), and John Munro (1858-1910) as the first surgical travel club in the United States. It was unique in purpose and concept and allowed a select group of surgeons to witness the performance of surgery in various medical centers. Franklin Martin (1857-1935), chief organizer of the American College of Surgeons and its journal Surgery, Gynecology and Obstetrics, wished to expand on the theme of this Society and in an editorial stated: 22 For five years the Society of Clinical Surgery has quietly met several times a year in the principal clinical centers of the United States .... It is the spirit of clinical investigation carried to the practical point of "show me." The idea has been growing for the last two decades. Clinical schools, where the work of a limited number of operators could be observed, have been organized and rather liberally patronized; ... some of these clinics have become veritable surgical meccas. This tendency to learn by watching the actual work of the masters has become more and more popular, and the demand of the spirit this has engendered is for greater opportunities for clinical observation. A recognition of the above facts, ... has led the editors of Surgery, Gynecology and Obstetrics, in an endeavor to still further amplify the clinical idea, to invite to a clinical meeting, not a limited number to see the work of a few surgeons, but as far as practicable, every man in the United States and Canada who is particularly interested in surgery, to observe the principal clinics in one of the large medical centers.

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The initial test of this experiment will be inaugurated in Chicago, and the invitation is to be extended for the two weeks, November 7 to 19, 1910. The program will consist of operative clinics extending from 8 A.M. to 5 P.M. each day during the two weeks ....

At this 1910 Clinical Congress, Murphy's demonstrations proved the most popular. His stature was such that any clinical presentation he gave was automatically well attended. His amphitheater at Mercy accommodated 500 spectators, and the daily attendance at his clinic, apart from the week of the Clinical Congress, averaged 150. On Mondays and Thursdays, the student clinics were held; on Wednesdays and Saturdays, visiting doctors attended; and Tuesdays and Fridays were reserved for dressing wounds and calling on patients. Throughout the demonstration, Murphy would talk both for the patient's hospital record and for the Surgical Clinics' notes. "Let the record show" became a familiar expression in his clinic. It was a demand for publication of his clinical presentations which led to the Surgical Clinics. Physicians in communities outside Chicago wanted to benefit from his teaching. Because they had great difficulty in traveling to Murphy's operating room, they constantly badgered him for his notes. To help alleviate the problem, Murphy hired Margaret Maloney (?1890-?1970), fresh out of high school, as a stenographer. For a 2-year period, the stenographed notes were locally distributed; however, demand became such that by 1911, Murphy sought out a national publisher, the W. B. Saunders Company of Philadelphia. The Surgical Clinics of John B. Murphy, M.D., at Mercy Hospital, Chicago commenced publication on February 1, 1912. The publisher's announcement read: The Surgical Clinics of Dr. John B. Murphy, at Mercy Hospital, Chicago, of which this is the first number, are to be published bi-monthly, i.e., six times a year. They are the clinics that are held at the hospital every Wednesday and Saturday, for physicians only. There is, as is well known, a constantly growing demand for strictly clinical teaching, and it is universally conceded that in this Dr. Murphy stands without a peer. The profession is to be congratulated on the fact that Dr. Murphy has consented to allow us to report his clinics and publish them to the profession. From the profession all over the United States and Europe there has been a great demand to obtain for permanent record the teachings of Dr. Murphy, and it is in response to this demand that the Doctor finally yielded to our desire to place them before the profession. The history of each case is given, and then follow the comments of Dr. Murphy covering the technic of the operation, the diagnosis, the methods of arriving at the same, and all the points involved in the living pathology of the particular type of case. The publishers desire to emphasize that fact that these are verbatim stenographic reports of the famous clinical talks of Dr. Murphy, and are in no sense to be confused with a systematic book on surgery. They are edited only for the purpose of eliminating unnecessary repetition; repetitions, however, will be given where they accentuate certain conditions and points in the particular case. The Clinics will be illustrated with skiagrams, photographs, and sketches, wherever necessary.

The publication was an immediate success, and Murphy was forced to

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Figure 2. Murphy's "wet clinic" given at Mercy Hospital on November 12, 1913.

devote a great deal of time to the preparation of material and the reading of proofs. They were bound either in paper or cloth and sold for an annual rate of $8 or $12, respectively. The contents of the initial volume included twenty various topics, among them carcinoma of the breast, varicocele, nerve anastomosis, Salvarsan, pelvic tumor, Charcot's disease of the hip joint, duodenal ulcer, and fistula in ano. Throughout the years the breadth of Murphy's practice was simply staggering. In November 1913, the Clinical Congress returned to Chicago, and Murphy's clinic was the outstanding show of the meeting (Fig. 2). A list of cases operated on and demonstrated by Murphy during the week of November 10-15 totalled 149 patients, including more than 20 major operations. 23 In the December 1912 volume, Murphy included a talk by Raffaele Bastianelli (1863-1961) of Rome on carcinoma of the breast. 24 This was the first time that Murphy allowed another physician to take part in his Clinics and would be a starting point for the inclusion of other surgeons in future issues. In February 1914, for reasons unknown, the name of the publication was changed simply to The Clinics of John B. Murphy, M.D., at Mercy Hospital, Chicago. This arrangement lasted through 1916. During these years, Murphy made numerous attempts to find a young surgeon with editorial capabilities who might assist him with the preparation of the Clinics. It was no easy matter, for Murphy did not want his writing style changed, and those he interviewed could not be blamed for trying to change it. As eloquent and forceful a speaker as Murphy was, his writings were altogether the opposite. However, he felt any attempt to improve his literary style would lessen its effectiveness. Unfortunately, Murphy's true

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RUTKOW

Figure 3. An exterior view of Murphy's "hospital-based" office building.

genius was in the spoken not the written word. This partially accounts for the fact that he never wrote a systematic textbook of surgery and explains why his influence on future generations has been lessened. It was not until June 1916 that a sick Murphy finally relented and allowed Penn C. Skillern, Jr. (1882-1967), a surgeon from Philadelphia who had studied with him for a year, to assume full editorial responsibilities for the Clinics. In February 1914, Murphy made a decision to include in each issue of the Clinics a detailed talk by himself on some special topic connected with the general subject of surgical diagnosis. He also had to increase his clinic demonstrations for visiting doctors to every day of the week except Tuesday and Sunday. As his fame spread, the size of his practice became overwhelming. To increase efficiency, it became necessary for him to have an office near Mercy Hospital. On the hospital grounds was an old two-story building originally intended as an outpatient clinic. With the permission of the hospital's board of trustees, Murphy decided to remodel this building to house his activities and staff. Much attention was spent on detail, and Murphy was quite successful in creating an atmosphere far different from any physician's office in Chicago. Because of this unique arrangement with a hospital and Murphy's overall celebrity the building gained immediate attention (Fig. 3). In the December 1914 issues of the Clinics, the first article was titled "The new offices of Dr. John B. Murphy and his staff." It was devoted to a description of the building along with more than 20 photographs of the floor plan and interior settings. The article stated: 25

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We have received in the recent past a large number of requests for portraits and photographs, as well as for the plan and scope, of the new offices which Dr. Murphy and his staff now occupy. With the desire of meeting the wishes of the subscribers to the Clinics, we secured the consent of Dr. Murphy to make a complete series of photographs of the building and the offices which we present to the readers of the Clinics, feeling assured that the suggestions arising from them will be of value to physicians elsewhere. . . . It can be readily understood what a great saving of time is accomplished by having the offices in such close proximity to the hospital. As will be seen from the plan, all the offices are situated on one floor, together with the laboratories, the x-ray room, the photographic studio, filing-room, etc.; only the library and consultation room for the staff, in the front of the building, reached by a short flight of stairs, are on the second floor. All the offices open on the main center hallway, which runs the full depth of the building, making the arrangement a model of practicability .... The offices are replete with everything for the comfort and convenience of patient, with every facility for their examination and diagnosis. Our readers will realize the advantage of having all branches of a busy practitioner's work under one roof, all of which can be arranged without the involvement of enormous expense. We feel certain that our subscribers will welcome our presenting to them the views, and the amount of space in this number of the Clinics given to their presentation.

Murphy had many detractors who considered his approach to medicine to be overly pretentious. They believe his plans involving the new office had been specifically devised to lend an air of mystery and drama. Murphy's indulgence in lavishness and the subsequent descriptive "advertising" in the Clinics would be met by charges of impropriety and unethical conduct. At the next American Medical Association meeting in San Francisco (July 1915), members of the Judicial Council, as an indication of their seriousness in considering infractions of the Principles of Ethics, permitted the following minutes of the House of Delegates to be publicly reported: 26 The Judicial Council regrets to report that charges were brought before the Council that the accused had caused or permitted to appear in publication, with which his name was connected, photographs and an article which violated the Principles of Medical Ethics in that they were self-laudatory and defied the traditions and were contrary to the ideals of the medical profession. The Judicial Council condemned the publication in question as being offensive and in bad taste, but because it was evident from the testimony that the publication complained of was not, in this instance, intended by the accused to be self-exploiting advertising, the Council accepted the defendant's explanation and apology.

The accused was none other than Murphy, and the condemned publication was his Surgical Clinics. Alexander Lambert (1861-1939), Theodore Roosevelt's (1858-1919) family physician, was chairman of the Judicial Council. 3 Murphy had been Roosevelt's treating surgeon when an assassination attempt had occurred in October 1912. The relationship of Roosevelt, Murphy, and Lambert must have helped Murphy avoid any negative action which the Council might want to have taken. Mter all, another physician from Kansas had been brought up on similar charges at the same session as Murphy and was ordered expelled from the Association.

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By December 1915, Murphy was suffering tremendously from attacks of angina. He was experiencing periods of complete incapacitation, and this made it difficult for him to perform even the simplest of tasks. Editorial responsibility for the Clinics had been turned over to Skillern, although Murphy continued to give as many of his "wet clinics" as possible. Murphy died on August 11th. Two days prior, he had written the following note: 25 I think the necropsy will show plaques in my aorta. I had an infection of the kidney thirty-three years ag(}--probably that is the origin of my trouble. I had appendicitis when a child, but have had no symptoms since. Since my trouble began I have had a constant pain or uneasiness in the region of my pancreas. The pain is dull and steady. I cannot help feeling that the seat of my trouble is deep in the abdomen in the region of the pancreas. I think they will find that my trouble is due to metastasis from some point not causing any discomfort. The acute infection of my nose a few weeks ago added to the metastatic infection, but that is not the chief source. The chief source will be found in some area in which I have no discomfort. I think I could have won against my original trouble. I expected to win all the time until last Monday, when I found that I had sugar in the urine and acidosis. That, on top of the other, is too much for me. The acidosis is a starvation acidosis, but I cannot eat without causing pain.

Murphy was quite accurate in understanding his own failing health. Autopsy results showed several coronary artery occlusions. The cause of pain in the abdomen was attributed to "atheroma of the abdominal aorta." The "probable seat of old metastasis was the chronic thirty-year-old infection of the right kidney." It was felt that "had Dr. Murphy's right kidney been removed in 1883, or at any time within twenty years thereafter, his arteritis would have been prevented." The death of Murphy also brought an end to his Clinics. The last issue was published in December 1916 and contained the following editor's preface: Mindful of a deep sense of responsibility to the readers of the Clinics, to the profession at large, and especially to posterity, the Editor has sought to present in this last number not only Dr. Murphy's last teachings, but an account of his last illness and words In Memoriam by his most intimate colleagues. It is seldom that the achievements of the really great receive due recognition during their lifetime: this was not true of Dr. Murphy, although the perspective of time will make his achievements loom even greater upon the surgical horizon. Rarer is it that we, who live in the present, stop to consider that those who live after us will deify the luminaries of our time, just as we almost deify such as have lived before us .... It is with the feeling that these Clinics, and especially this last number, will be of historic value, that the latter has been planned. It is of interest to note that this publication has followed somewhat along the lines of that of one of Dr. Murphy's old teachers, Dr. Th. Billroth.... As is generally known, the contents of each number were based upon stenographic notes taken in Dr. Murphy's amphitheater during his morning clinics. These notes were then typewritten and prepared for the printed page, and where thought advisable, were elaborated upon by extracts from current literature. It must not be forgotten that Dr. Murphy's audience changed daily, so that his teachings, though repeated daily, were always new and fresh to his ever-changing hearers: this may serve to explain the occurrence of a certain amount of repetition in the published Clinics, although latterly this has been kept at a minimum, material from other sources

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having been put in its place. It was marvelous, the manner in which Dr. Murphy made additions to the edited manuscript for the press. The entire manuscript was read to him; and when Dr. Murphy interrupted the reader, it was to dictate in the most rapid fashion, and without any hesitation whatsoever, a line of thought which had been suggested to him by a certain passage in the text: often one word alone would be added to make the context clear, and just as often an extra page or two would have been dictated before Dr. Murphy's line of thought ran itself out....

Fortunately, Murphy's death did not signal an end to the concept of a "surgical clinics." The W. B. Saunders Company had begun publishing a Medical Clinics of Chicago in July 1915. This sister volume to Murphy's Clinics served as a model for a completely revamped surgical issue to be titled the Surgical Clinics of Chicago. It began publication in February 1917 and lasted through December 1920. Much of the strength and guidance which the new publication needed was provided by Ryland Greene (?1875-1949). Greene, although not a physician, was a dominant editorial force at Saunders during the first half of the 20th century. His urging and coaxing breathed life into the Clinics following Murphy's demise. It was, however, Murphy's stenographic assistant, Margaret Maloney, who truly provided the necessary administrative skills to keep the Clinics alive. She organized each issue and made certain the individual surgeons had completed their manuscripts on time for editorial review. Maloney, who never married, worked in one capacity or another on the Surgical Clinics for more than 50 years. Although not a fulltime employee of the W. B. Saunders Company (she was in fact on the payroll of various Chicago physicians), she was valued so highly that when she retired in the 1960s, Saunders presented her with a full pension. The new Surgical Clinics were quite distinct from Murphy's original concept. Instead of a single dominant surgeon (i.e., Murphy) the content was shared by a large number of contributors, often almost 20 in number. The established names of Chicago surgery were represented in the first issue. Included were E. Wyllys Andrews (1856-1927), Carl Beck (18641952), Arthur Dean Bevan (1860--1943), Daniel Eisendrath (1867-1939), Allen Kanavel (1874-1938), Dean Lewis (1874-1941), Lewis L. McArthur (1858-1934), Albert Ochsner (1858-1925), Dallas Phemister (1882-1951), Samuel C. Plummer (1865-1952), Edwin W. Ryerson (1872-1961), and Kellogg Speed (1879-1955). Each surgeon presented a case from his own clinic and discussed it much in the manner that Murphy had pioneered. There was considerable hue and cry over the fact that the Clinics were a Chicago-dominated publication. As American surgical successes increased, the Saunders Company, with the strong urging of Greene, decided to widen the scope of the Clinics. This was accomplished in February 1921, when the Surgical Clinics of North America was first published. The "number," as each issue was called, would have surgeons contribute cases from their respective clinics. However, each number would emanate from a single city or well-known medical center. This organitational set-up would last, in part, through the mid 1970s. The cities were varied and in any given year could consist of Philadelphia, Chicago, New York, Boston, San Francisco, St. Louis, Detroit, Kansas City, or others. The medical centers were mainly focused on the Lahey, Mayo, and Cleveland Clinics.

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Volume one had an introduction by William Williams Keen (18371932), and it would establish the manner in which the Clinics would be written for many years. Keen was one of the grand men of American surgery. Eighty-five years of age at that time, he was a pioneer neurosurgeon, having performed one of the first linear craniotomies (G-M #4866), and also treating spastic torticollis (G-M #4867).28 He was born in Philadelphia and graduated from Brown University as valedictorian of the class of 1859. His medical education was obtained at Jefferson Medical College, where he finished in March 1862. Soon thereafter, Keen joined the Army Medical Department as a contract surgeon. Following numerous transfers, he eventually became associated with S. Weir Mitchell (1829--1914) and George R. Morehouse (1829--1905) at the Turner's Lane Hospital in Philadelphia. These three physicians collected thousands of pages of notes on war injuries which culminated in their publication of Gunshot Wounds And Other Injuries of Nerves (G-M #2167).30 This treatise introduced the concept of causalgia and is considered one of the most important surgical contributions of the Civil War. Following the War, Keen's reputation and prestige as a surgeon rapidly increased, and upon the death of Samuel W. Gross (1837-1889), he was chosen to succeed him as Professor of Surgery at Jefferson Medical College. He held this chair until 1907. Keen was a prolific surgical writer. He authored one of the first United States surgical texts based on Listerian principles. The American Textbook of Surgery passed through four editions and was considered one of the most popular texts of its time. 31 It was superseded by Keen's eight-volume System of Surgery, which became the preeminent surgical text for United States' surgeons in the first decades of the 20th century.32 He was also well known as a medical historian, having written one of the best histories of early anatomy (G-M #442).33 Excerpts from Keen's introduction follow: It is most appropriate that the initial volume of the "Surgical Clinics of North America" should be the Philadelphia number, for Philadelphia was the first to employ this method of instruction in the Jefferson, the University, and the old Pennsylvania Hospital amphitheater .... The chief value of the clinical studies in the series now begun will come to the "general practitioner," the "family doctor." He is, after all, the backbone of the profession. Hampered too often by the necessity of constant and continuous practice for the support of his family, instead of his going to the clinic, in this and the succeeding volumes, the clinic will come to him, with but little expense in money, and almost none in time. He will learn the latest means of diagnosis, sometimes requiring instruments and skill beyond his means and his knowledge. But even then his horizon will be enlarged, and he will disclose means and methods which he can use or can learn. Hard experiences have often developed in the rural practitioner a resourcefulness far beyond that of his city brother in whom it remains undeveloped because it is unnecessary .... It is to be hoped that these clinical lectures will especially take up many of the common diseases and injuries, such as hemorrhoids, fractures of many individual bones, with the "end-results," syphilitic lesions, real and reliable serums and vaccines, with the evidence for their wonderful results, etc. The rare and curious cases will aid, from time to time, by exciting interest, and occasionally by bringing up from the well of memory of the readers other similar but as yet unrecorded cases ....

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May I make here two pleas, both addressed to the clinicians themselves and in the interest of their readers. It is only a question of time when the Metric System in thermometers, weights, and measures of length and capacity will surely be adopted. They are so far preferable, scientifically and practically, to our Fahrenheit scale, and the absurd and variable English measures, that it is most desirable to diffuse this knowledge among the rank and file of the profession. I hope therefore, that these metric scales will always be used by the various writers, adding, if they so desire, in parentheses, the English equivalents. Second, I hope that my age and long personal experience will warrant my pleading with every author to use the purest and best English style. Only by reading with an eye always to style and by severe self-criticism can one reach this goal. My own rule in every paper I write is first to be sure that my facts are right, my reasoning logical, my conclusions valid. Then, finally, I read over most carefully and usually more than once every word solely with a view to its English style. And how often I catch myself lacking in clarity, using too long sentences committing even grammatical blunders, or else a locution far inferior to one which now suggests itself to my mind. If possible, I always like to lay my paper aside for a month or more, and then revise it anew. One thus reads it almost as if it had been written by some one else. His mind is fresh, unleashed from the network of the wellworn familiar phrases, and he always finds means to improve and polish his English .... It is a pleasure to survey the constantly growing medical literature by our American colleagues. In value it is growing more and more indispensable for the practitioner who wishes to keep abreast of the times, be he American or European. Practically, I have seen all of this luxuriant growth from Gross' "System of Surgery" (1859) down to the present time. May it always grow in value and be dedicated solely to the cause of Scientific . Truth.

The Surgical Cli1lics were a monumental success. During the 1920s and 1930s, the Medical and Surgical Clinics combined accounted for onethird of all Saunders' business. Keen's exhortation that the major benefit would be to the rural family practitioner was evident in the manner that the Clinics were sold. The original advertisement for the series said this (Fig. 4): Making the circuit of the surgical centers of the United States-not only making them, but attending every worth-while clinic at each of the leading hospitals at those centers-is an unthinkable trip for the busy man. Nevertheless it is, admittedly, this sort of teaching-clinical postgraduate case-teaching-which really teaches best. But such a trip is not necessary in order to obtain this postgraduate instruction. You need not leave your office; for The Surgical Clinics of North America bring to you the actual amphitheater instruction of America's leading surgeons, giving subscribers to these bi-monthly publications the benefits of the experience of a staff of teacher-surgeons perhaps not equalled by any postgraduate staff anywhere the world over. What do subscribers get in these Clinics? They get case-teaching-the actual clinical instruction, the conduct and management of a case from the time the patient reports for treatment, operative technic, after-care, and results. Nothing could be more thorough, nothing could be more like actual postgraduate work-with the leading surgeons of America as the instructors.

The Clinics were sold with a cloth binding for $16 and paper bound for $12 annually. The interesting aspect of the marketing was how the busy practitioner found out about them: traveling salesmen, who were not

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The Surgical Clinics of North America. By leading surgeons. 188ued serially, one octavo of 300 page8, illustrated, every other month. Sold only by the Clinic Year (February to December). Cloth, 816.00 net; paper, 812.00 net.

aking the circuit of the surgical centers of the United States-not only making them, but attending every worth-while clinic at each of the leading hospitals at those centers-is an unthinkable trip for the busy man. Nevertheless it is, admittedly, this sort of teachingclinical postgraduate case-teaching-which really teaches best. But such a trip is not necessary in order to obtain this postgraduate instruction. You need not leave your office; for THE SURGICAL CLINICS OF NORTH AMERICA bring to you the actual amphitheater instruction of America's leading surgeons, giving subscribers to these bi-monthly publications the benefits of the experience of a staff of teacher-surgeons perhaps not equalled by any postgraduate staff anywhere the world over. What do subscribers get in these Clinics? They get case-teaching-the actual clinical instruction, the conduct and management of a case from t.he time the patient reports for treatment, on through examination, symptomatology, diagnosis, treatment, operative technic, after-care, and results. Nothing could be more thorough, nothing could be more like actual postgraduate work-with the leading surgeons of America as the instructors.

Endorsements "These publications bring the clinic to the doctor; they give to him who has not been able to hear it, the opportunity to read it; and such reading supplements and vivifies the more condensed and didactic teaching of his textbooks."-American Journal of Surgery. "The general practitioner as well as surgeon will find much of interest in these splendid Clinics. They are of real assistance in keeping a breast of scientific thought and development." -Journal of the American Medical Association. "The whole series is one of the very best and must prove a boon to all surgeons, as the articles are all of much value. The illustrations are superior in character."-The Canada Lancet. See also Medical Clinics on page 16 and The Mayo Clinic Volumes on page 4. Crile Clinic Volume on page 7.

"A book worth reading at all

Postgraduate teaching should

be made part

of oneself"-Churchill

3

Figure 4. The first Saunders advertisement for The Surgical Clinics of North America. (From WB Saunders Catalogue, January 1922.)

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employees of Saunders, peddled the series from town to town. They worked strictly on commission, and it was this volume incentive which contributed to the enormous circulation of the Clinics. The rationale behind binding in either cloth or paper was that many physicians had the volumes rebound privately so as to appear attractive on their bookshelves. The paper binding lent itself more easily to this custom. Through the mid 1920s, the Clinics continued to present multiple topics within any given issue. In February and April 1927, the format changed, and an individual topic (cancer) was discussed in depth. Although the overall concept of a city or institutional "number" would continue, it was carried on with increasing emphasis on specific themes. By 1939, every "number" consisted of a specific symposia. In that year, the schedule included: February (Chicago), orthopedic surgery; April (New York), appendicitis; June (Lahey Clinic), surgical technic; August (Mayo Clinic), diseases of the gall bladder and biliary tract; October (Cleveland Clinic), diseases of the colon; and December (Philadelphia), treatment of wounds and first aid. It was at the beginning of World War II that Dwight Hotchkiss (?19001973) replaced Greene as overall Saunders editor for the Clinics. Hotchkiss would become the series' guiding light for more than a quarter of a century. He was an exceptionally capable individual all the more remarkable since he was totally deaf. Hotchkiss and various Saunders executives made a number of significant editorial and business decisions. First was that subscription prices would remain the same for as long as possible. It was a reflection of the management of Saunders that they wished to have increased Clinic sales substitute for any attempt at increasing fees. Not until 1949 did the yearly price increase to $18 for the cloth and $15 for the paper binding. It is a tribute to corporate responsibilities that for almost 30 years the Clinics were sold at the same price. The major editorial decision was that the Clinics would have a different consulting editor for each issue. This was instituted in the late 1940s and assured that a nationally renowned surgical figure would organize and arrange topics. It was an effective way to lend further prestige to the series. Through the 1960s, circulation figures for the Clinics were continually increasing. By the end of the decade, subscriptions numbered approximately 35,000. In 1969, Hotchkiss retired from Saunders. A publisher's foreword was printed in the February 1969 volume: For more than 25 years, editorial direction of the Surgical Clinics of North America has been in the hands of Mr. Dwight J. Hotchkiss. In large measure, the success of these Clinics during that time can be attributed to his unique ability to respond to the needs of readers and to attract America's leading surgeons as contributing editors. Mr. Hotchkiss is now retiring and can reflect on a remarkable record of achievement. As the practice of surgery bec{)mes ever more complex and demanding, the Surgical Clinics grow more vigorous. They have come in these 25 years to play an indispensable role in the continuing process of imparting new developments to practicing surgeons. Readers will naturally think first of the distinguished guest editors and writersmore than 3000 of them-as being responsible for the value and the appeal of the Surgical Clinics. And indeed there is a large debt owed to them. But surgeons as

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well as the publisher will acknowledge that the efforts ofthe Saunders house editor are equally vital. Much depends on his skill in bringing the contributors together and then in editing their manuscripts so as to facilitate communication from writer to reader. These tasks he has done exceptionally well, and he can look back on his years as house editor with the same feeling of excitement in being involved with the creation of the Surgical Clinics that will be brought to the work of his successors ....

Following Hotchkiss' retirement, there has been a succession of Saunders house editors. Their evolving editorial direction led to a gradual abandonment of the institutional "number," and by the mid 1970s it had been all but forgotten, having represented a vestige of the American surgical past when scientific advances were mostly confined to a few medical centers. The term "symposium" had also been eliminated in 1986. Paper binding was stopped in the 1950s, and the familiar dark orange cover was first utilized in 1971. Prices, too, started to change, from $21 in 1968, to $27 in 1975, $30 in 1978, $33 in 1981, $36 in 1982, $39 in 1984, $42 in 1985, $50 in 1986, and $59 in 1987. The circulation of the Surgical Clinics is currently 21,000. This decrease from the early 1970s is largely attributable to the spawning of more than 30 other Clinics including Anesthesiology (first published in 1983); Cardiology (1983); Chest Medicine (1980); Dental (1957); Dermatologic (1983); Emergency Medicine (1983); Endocrinology and Metabolism (1972); Gastroenterology (1972); Geriatric Medicine (1985); Hematology (1972); Immunology and Allergy (1981); Laboratory Medicine (1981); Medical (1915); Neurologic (1983); Nursing (1966); Oncology (1982); Pediatric (1953); Perinatology (1974); Primary Care (1974); Psychiatric (1978); Radiologic (1943); Rheumatic Diseases (1975); Veterinary-Small Animal Practice (1971); Veterinary-Equine Practice (1985); and Veterinary-Food Animal Practice (1985). Surgeons have their choice from among ten surgically oriented series including Critical Care (1985); Hand (1985); Obstetrics and Gynecology (1974); Orthopedic (1970); Otolaryngologic (1968); Plastic Surgery (1974); Podiatric Medicine and Surgery (1984); Sports Medicine (1982); and Urologic (1974). As Keen stated in 1921, the prime purpose of the Surgical Clinics is to "take up many of the common diseases and injuries," and that the "rare and curious cases will aid" but only "from time to time." Keen's precept of emphasizing clinical management as opposed to surgical research and esoterica has continued for 75 years. This article on the history of the Surgical Clinics presents a propitious opportunity to review the Clinics' contents and refresh our memories as to the many American surgeons who were guest editors and contributors. Four hundred and fifty-six editions have been published. During these years, more than 5000 surgeons have had articles published in the Clinics. I conclude this historical review by indexing every edition according to clinical subject and have included, where applicable, the city or institution from which the volume emanated and the name of the guest editor if one was utilized. This index provides graphic evidence of the enormous growth and changes which have occurred in American surgery. The Surgical Clinics of North America has a long and distinguished lineage. Its history is the story of American surgical triumphs, past, present, and future.

A

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Table 1. Topical Index of the Surgical Clinics CLINICAL SUBJECT

INSTITUTION

AMBULATORY SURGERY August 1987 October 1953 October 1951 February 1948 Chicago Chicago February 1941 Chicago February 1938 ANESTHESIA August 1975 August 1965 June 1950 August 1945 June 1940 BASIC SCIENCE April 1979 December 1974 June 1969 December 1967 April 1965 October 1964 February 1962 December 1960 December 1955 April 1952 December 1949 August 1948 December 1946

Mayo Clinic Labey Clinic Mayo Clinic Labey Clinic

West Coast Chicago Philadelphia Philadelphia New York Philadelphia Mayo Clinic Philadelphia

BURNS February 1987 December 1978 December 1970 CANCER October 1987 December and October 1986 August 1986 December 1984 December 1981 August 1978 February 1978 August 1974 April 1969 June 1967 April 1962 June 1959 April 1953 August 1951 December 1950 June 1947 October 1944 August 1941 June 1938 February and April 1927

GUEST EDITOR(S)

James E. Davis L. Kraeer Ferguson Michael DeBakey Warren Cole

D. Eric Greenhow and Harry Wolhnan Albert Faulconer Frank H. Labey

Richard L. Simmons John E. Skandalakis and Stephen W. Gray Adolph Meltzer Arnold S. Leonard Carl A. Moyer Henry N. Harkins Leo M'. Zimmerman I.S. Ravdin I.S. Ravdin Frank Glenn I.S. Ravdin I.S. Ravdin

John A. Boswick John A. Boswick John A. Boswick

Nael Martini Michael M. Meguid and Stanley J. Dudrick

Memorial SloanKettering Memorial SloanKettering Labey Clinic Labey Clinic New York Mayo Clinic Georgetown Labey Clinic St. Louis Mayo Clinic Labey Clinic

G.V. Brindley Avram Cooperman and Robert E. Hermann Martyn W. Burk and Donald L. Morton Avram Cooperman and Caldwell B. Esselstyn Hugh R.K. Barber Edward J. Beattie Edward J. Beattie Malcolm C. Veidenheimer James D. Hardy and Curtis P. Artz Richard B. Cattell Alexander Brunschwig Robert J. Colfey

Table continued on following page

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Table 1. Topical Index of the Surgical Clinics Continued CLINICAL SUBJECT

INSTITUTION

CARDIAC SURGERY June 1985 October 1971 April 1961 August 1955

Cleveland Clinic New York Hospital Mayo Clinic

Lewis Wetstein and P.D. Pyerowitz Carl L. Nelson and Caldwell B. Esselstyn Frank Glenn O. Theron Clagett, John W. Kirklin, and F. Henry Ellis

Labey Clinic

Alfred V. Persson

Yale Lahey Clinic

William W.L. Glenn and Arthur E. Baue Blake Cady

CLINICAL TECHNIQUES April and February 1985 October 1980 June and April 1980 June 1979 June 1976 February 1976 October 1975 February 1975 June 1973 April 1973 February 1971 October 1970 June 1970 February 1970 December 1969 October 1969 August 1968 June 1968 February 1968 October 1967 February 1967 October 1966 February 1966 June 1965 October 1963

February 1963 December 1962 October 1961 August 1961 February 1961 June 1960 December 1959 October 1958 February 1958 December 1957 August 1956 June 1956 April 1956 February 1956 February 1955 October 1954 April 1954 December 1952 February 1952 December 1950 October 1950 October 1949 June 1949 December 1947 October 1947

Labey Clinic University of Chicago Cleveland Clinic

Labey Clinic Chicago Lahey Clinic Chicago University of Colorado Mayo Clinic Veterans Administration Lahey Clinic Chicago Jefferson and Penn State Chicago Chicago Labey Clinic Geisinger. Hitchcock, Jackson, Lovelace, Palo Alto and Straub Clinics Chicago University of Michigan Mayo Clinic Chicago Labey Clinic Detroit Chicago Philadelphia Lahey Clinic New York Chicago Chicago Pacific Coast New York Philadelphia Chicago Pennsylvania Hospital St. Louis Lahey Clinic Philadelphia Massachusetts General

GUEST EDlTOR(S)

Charles Abernathy Malcolm C. Veidenheimer George E. Block Caldwell B. Esselstyn and Floyd Loop Lloyd Nyhus Harry S. Goldsmith Malcolm C. Veidenheimer John M. Beal Steven Economou Malcolm C. Veidenheimer Frederic A. dePeyster B. Eiseman Hugh B. Lynn and Robert J. Spencer Mark W. Wolcott and Richard Warren Malcolm C. Veidenheimer Tilden C. Everson Thomas F. Nealon John M. Beal Frank Glenn Peter V. Moulder Kenneth W. Warren

Fredrick W. Preston Jonathan E. Rhoads Charles G. Child John Van Prohaska Conrad R. Lam and Harry C. Saltzstein Harold Laufrnan John T. Reynolds Jonathan E. Rhoads Warren H. Cole George H. Humphreys W.E. Adams E. Lee Strohl Alexander B. Hepler John H. Mulholland John H. Gibbon Arkell M. Vaughn John B. Flick Evarts A. Grabam Warren H. Cole William Bates Arthur W. Allen

Table continued on opposite page

!

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Table 1. Topical Index of the Surgical Clinics Continued CLINICAL SUBJECT

CLINICAL TECHNIQUES February 1947 April 1946 February 1946 October 1945 April 1945 December 1944 August 1944 October 1943 June 1943 December 1942 June 1942 February 1942 October 1940 August 1940 June 1939 October 1937 COLON AND RECTAL February 1983 June 1978 August 1972 October 1965 October 1955 June 1942 October 1939 COMPLICATIONS December 1983 April 1982 December 1977 October and August 1976 April 1970 April 1964 June 1963 June 1957 June 1944 CRITICAL CARE August 1985 April 1983 October and August 1976 June 1975 April 1968 Respiratory Care December 1980 October 1974 Nutritional Care December and October 1986 June 1981 EMERGENCIES February 1972 June 1966 October 1960 April 1955 April 1950 April 1935

INSTITUTION

(Continued) Chicago New York Chicago

New York Philadelphia Mayo Clinic

GUEST EDITOR(S)

Karl Meyer Henry Cave Alexander Brunschwig Frederic W. Bancroft Jonathan H. Rhoads

Lahey Clioic Philadelphia Lahey Clinic Chicago St. Louis Mayo Clinic Labey Clinic Cleveland Clinic

Lahey Clinic Cleveland Clinic

Victor W. Fazio James A. Ferguson Robert Turell Robert Turell Robert Turell Frank Labey

Larry C. Carey G. V. Brindley Robert J. Freeark George Clowes Straub Clinic New York Boston Lahey Clinic Labey Clinic

J.E. Strode Frank Glenn and John M. Beal Samuel F. Marshall and Claude E. Welch

William C. Shoemaker Herbert B. Hechtman George Clowes Boston City Hospital

James L. Berk John J. Byrne Robert H. Bartlett Watts R. Webb Michael M. Meguid and Stanley J. Dudrick James L. Mullen

University of Illinois Boston Canada New York New York New York

Lloyd Nyhus Samuel F. Marshall and George L. Nardi Walter C. MacKenzie James M. Winfield William DeWitt Andrus Table continued on follOwing page

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Table 1. Topical Index of the Surgical Clinics Continued CLINICAL SUBJECT

ENDOCRINE April 1987 February 1979 April 1974 February 1969 June 1962 August 1952 June 1945 October 1941 December 1936 April 1932 GASTROINTESTINAL June 1987 August 1986 October 1979 June 1974 June 1971 August 1967 June 1964 October 1962 October 1959 April 1958 June 1955 February 1954 October 1952 October 1948 April 1947 October 1946 June 1944 June 1941 June 1937 Ulcer December 1976 August 1971 April 1966 August 1936 Esophagus August 1983 February 1951 Abdominal Surgery August 1957 December 1951 August 1950 April 1949 February 1944 August 1937 Endoscopy October 1982 October 1957 GYNECOLOGY February 1978 August 1962 August 1959 April 1957 December 1954 February 1953 February 1950 December 1948 August 1947 December 1945

GUEST EDITOR(S)

INSTITUTION

Chicago Labey Clinic Mayo Clinic Labey Clinic Cleveland Clinic Labey Clinic New York

Scott and White Clinic Massachusetts General Labey Clinic Mayo Clinic Labey Clinic New York Labey Clinic Chicago Scott and White Clinic Cleveland Clinic New York Cincinnati University Labey Clinic Labey Clinic Labey Clinic Mayo Clinic

John A. Boswick Steven G. Economou Donald S. Gann Rene Menguy and Edward Paloyan Kenneth W. Warren

Keith Kelly G.V. Brindley G.V. Brindley Ronald A. Malt Malcolm C. Veidenheimer Edward S. Judd Kenneth W. Warren Robert Turell Robert Turell Frank Glenn Loyal Davis

Avram Cooperman Donald McIlrath Walter F. Ballinger

Cleveland Clinic Chicago Mayo Clinic Philadelphia Mayo Clinic New York Chicago Mayo Clinic

Andre C. Duranceau Charles B. Puestow

John H. Mulholland Warren Cole Hiromi Shinya and David S. Zimmon Robert Turell

San Francisco Mayo Clinic New York Philadelphia Chicago Chicago Philadelphia Mayo Clinic Philadelphia

Hugh R. K. Barber C. Frederic Fluhmann R. Gordon Douglas Newlin Fell Paxson M. Edward Davis Frederick H. Falls Lewis C. Sheffey Norris W. Vaux Table continued on opposite page

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Table 1. Topical Index of the Surgical Clinics Continued CLINICAL SUBJECT

GYNECOLOGY (Continued) June 1945 February 1943 December 1938 February 1937 April 1936 February 1936

INSTITUTION

Lahey Clinic Chicago Philadelphia New York Philadelphia Chicago

HEAD AND NECK SURGERY February 1986 August and Mayo Clinic June 1977 February 1973 August 1963 Mayo Clinic August 1958 University of Wisconsin June 1953 Lahey Clinic HERNIAS April 1984 December 1971 INFECTIONS February 1980 December 1975 December 1972 December 1948 April 1942

GUEST EDITOR(S)

Edward A. Luce John E. Woods and Oliver Beahrs George E. Block Edward S. Judd Erwin R. Schmidt

Lloyd Nyhus Leon M. Zimmerman J. Wesley Alexander Robert E. Condon Irving Feller Veterans Administration New York

Frank L. Meleney

LIVER, SPLEEN, PANCREAS, AND BILIARY TRACT August 1986 G. V. Brindley February 1981 Avram M. Cooperman August 1981 Nathaniel M. Matolo April 1977 Gordon F. Madding and Paul A. Kennedy June 1975 Larry C. Carey October 1973 Marshall J. Orloff Lahey Clinic June 1958 Lahey Clinic June 1948 Lahey Clinic June 1943 August 1939 Mayo Clinic April 1932 New)'ork MISCELLANEOUS TOPICS December 1987 (History of American Surgery) (Laser surgery) October 1984 February 1984 (Radiology) June 1984 (Staplers) October 1983 (Surgery in the cardiac patient) August 1982 (Surgical health care delivery) April 1982 (Surgery in the medically compromised patient) December 1979 (Morbid obesity) (Personal perspectives in October 1978 surgery) April 1972 (Unexpected presentation of surgical disease) February 1964 (Ancillary surgical procedures) August 1960 (Surgery on the aged) New York State February 1959 (Surgical therapeutics) Chicago (Surgical judgement) October 1958

Ira M. Rutkow Ronald A. Kirschner and Michael Unger J. George Teplick and Marvin E. Haskin Mark M. Ravitch and Felicien M. Steichen John A. Waldhausen and Julien F. Biebuyck Ira M. Rutkow G.V. Brindley Henry Buchwald Rita McConn G.V. Brindley Warren H. Cole and Max S. Sadove John H. Powers F. John Lewis Harold Laufman

Table continued on following page

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Table 1. Topical Index of the Surgical Clinics Continued CLINICAL SUBJECT

INSTITUTION

MISCELLANEOUS TOPICS (Continued) December 1957 (Drug prophylaxis) June 1954 (Surgery of the aged) Lahey Clinic August 1942 (Industrial surgery) (Surgery of the aged) February 1940 Chicago April 1939 (Appendicitis) April 1938 (Amputations) New York June 1936 (Pain) New York February 1935 (Pain) Philadelphia April 1932 (Breast) New York NEUROSURGERY October 1972 August 1954 June 1952 April 1948 October 1935 ORTHOPEDIC June 1983 August 1969 February 1965 December 1963 December 1961 February 1957 December 1953 June 1952 April 1951 February 1949 August 1946 February 1945 August 1943 December 1940 February 1939 December 1937 April 1937 June 1935 Hand Surgery April 1981 October 1968 August 1964 April 1960 PEDIATRIC December and October 1985 October 1981 April 1976 August 1970 December 1964 August 1960 December 1956 October 1952 April 1947 October 1933 PLASTIC August 1984 October 1977 April 1971

GUEST EDITOR(S)

Edwin J. Pulaski Hart Ellis Fisher Charles Gordon Heyd

Frederick A. Simeone Paul C. Bucy Lahey Clinic New York Mayo Clinic

Robert B. Brigham Chicago Canada Chicago Philadelphia Lahey Clinic New York Chicago Mayo Clinic Chicago Mayo Clinic Philadelphia Chicago Philadelphia Chicago Chicago

University of Pittsburgh

Walter D. Shelden James H. Herndon Theodore A. Potter and Edward A. Nalebuff Harold A. Sofield H. Fred Moseley Crawford T. Campbell Edward L. Compere Paul C. Colonna Harrison L. McLaughlin Edward L. Compete H. Herman Young Fremont A. Chandler

Martin A. Entin Martin A. Entin Martin A. Entin William L. White Curtis A. Sheldon and Lester W. Martin

Mt. Sinai

Jay L. Grosfeld W. Hardy Hendren John J. White and J. Alex Haller Orvar Swenson Ivan D. Baronofsky Willis J. Potts

Johns Hopkins New York Chicago

Sharon Romm Hugh A. Johnson Thomas D. Rees Table continued on opposite page

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Table 1. Topical Index of the Surgical Clinics Continued CLINICAL SUBJECT

PLASTIC (Continued) April 1967 April 1959 April 1944 August 1934 THORACIC October 1987 August 1980 August 1973 December 1966 June 1961 August 1954 December 1948 October 1946 October 1938 TRANSPLANTATION June 1986 April 1978 October 1971 TRAUMA February 1982 February 1977 December 1973 June 1972 December 1968

April 1963 December 1958 October 1956 August 1953 August 1949 December 1943 April 1943 October 1942 December 1941 April 1941 December 1939 UROLOGIC December 1982 December 1965 August 1959 June 1951 February 1950 October 1946 April 1940 October 1936 VASCULAR April 1986 June 1982 August 1979 February 1974 August 1966 February 1960 August 1958 August 1953 April 1948

INSTITUTION

New York New York Chicago

Mayo Clinic Ochsner Clinic Lahey Clinic University of Toronto Veterans Administration Duke St. Louis

Mayo Clinic

Wayne State

Los Angeles County and University of Southern California Colorado

Wayne University Mayo Clinic Philadelphia New York Baltimore

GUEST EDITOR(S)

John Marquis Converse John Marquis Converse

Nael Martini Walter G. Wolfe Philip E. Bernatz Alton Ochsner Robert M. James

Arthur J. Roberts and G. Arnuad Painvain Satya N. Chatterjee Carl L. Nelson and Caldwell B. Esselstyn

Donald D. Trunkey Alexander J. Walt John A. Boswick Gordon F. Madding and Paul A. Kennedy Clarence J. Berne and Leonard Rosoff William R. Waddell James H. Forsee Cecil D. Snyder Charles G. Johnston Walter Estell Lee

James C. Magee New York Philadelphia

Veterans Administration Mayo Clinic Lahey Clinic Chicago Tulane New York Baltimore

Lahey Clinic

Chicago Marquette University Ochsner Clinic New York

William R. Fair George T. Mellinger

Herman L. Kretschmer

Alfred V. Persson John E. Connolly John A. Mannick John J. Bergan and James S.T. Yao Michael DeBakey Ormand C. Julian James M. Sullivan Alton Ochsner

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REFERENCES 1. Channing WB: John Benjamin Murphy. AM, MD, LLD, FACS, FRCS(Eng). Am J Obstet Dis Women Child 75:299-305, 1917 2. Meyer KA, Hyman S: John B Murphy: an inquiry into his life and scientific achievements. J Int Coli Surg 34:118-126, 1960 3. ScatliffHK: Medical highlights in Chicagoland: Theodore Roosevelt and Dr. J.B. Murphy. Chicago Med 67:397-400, 1964 4. Hall DP: John B Murphy. Am J Surg 109:686-687, 1965 5. Siegel 1M: John B. Murphy---early American orthopaedic surgeon. Int Surg 64:83--85, 1979 6. Anonymous: Biographies of physicians and surgeons (John Benjamin Murphy, pp 73-76). Chicago, JH Beers, 1904 7. Johnson A, Malone D: Dictionary of American biography (John Benjamin Murphy [by James M. Phalen], pp 353-354). New York, Charles Scribner's Sons, 1930 8. Fishbein M: A history of the American Medical Association, 1847 to 1947 (John Benjamin Murphy, pp 717-720). Philadelphia, WB Saunders, 1947 9. Leonardo R: Lives of master surgeons (John Benjamin Murphy, pp 298-299). New York, Froben Press, 1948 10. Kaufman M, Galishoff S, Savitt TL: Dictionary of American medical biography (John Benjamin Murphy, pp 547-548). Westport, Greenwood Press, 1984 11. Andrews EW, Binnie JF, Crile GW, et al: In memoriam-John Benjamin Murphy. Clinics of John B Murphy 5:989-1000, 1916 12. Skillern PG: The writings of John B. Murphy, M.D. Clin John B Murphy 5:1173--1175, 1916 13. Davis L: J. B. Murphy, stormy petrel of surgery. New York, GP Putnam's Sons, 1938 14. Kelly HA, Burrage WL: Dictionary of American medical biography (John Benjamin Murphy, p 892). New York, D Appleton, 1928 15. Murphy JB: Cholecysto-intestinal, gastro-intestinal, entero-intestinal anastomosis, and approximation without sutures. Med Rec (NY) 42:665--676, 1892 16. Murphy JB: Resection of arteries and veins injured in continuity---end to end sutureexperimental and clinical research. Med Rec (NY) 51:73-88, 1897 17. Murphy JB: Early treatment of perityphlitis. West Med Rep 11:282-291, 1889 18. Murphy JB: The choice of anesthetic in operating for abscess of the lung: report of 2 cases operated upon under local anesthesia. Ann Surg 60:36-41, 1914 19. Murphy JB: Proctoclysis in the treatment of peritonitis. JAMA 52:1248-1250, 1909 20. Murphy JB: Neurological surgery. Surg Gynecol Obstet 4:385-500, 1907 21. Murphy JB: Surgery of bones, joints and tendons. JAM A 58:985-990, 1094-1104, 16601666, 1178-1189, 1254-1265, 1345--1352, and 1428-1431, 1912 22. Martin F: Editorial. Surg Gynecol Obstet 11:310, 1910 23. Murphy JB: List of cases operated on and demonstrated by Dr. John B. Murphy at Mercy Hospital during the week of the Clinical Congress of Surgeons of North America. Surg Clin John B Murphy 2:1093--1098, 1912 24. Bastianelli R: Carcinoma of breast. Surg Clin John B Murphy 1:789-793, 1912 25. Murphy JB: The new offices of Dr. John B. Murphy and his staff. Clin John B Murphy 3:1063-1076, 1914 26. Anonymous: Minutes of House of Delegates. JAMA 65:74, 1915 27. Mix CL, Babcock RH, Keefe JE, et al: The medical history and last illness of John B. Murphy. Clin John B Murphy 6:1001-1019, 1916 28. Keen WW: Linear craniotomy. Philadelphia, Lea Brothers, 1891 29. Keen WW: A new contribution for spasmodic wry neck, namely, division or exsection of the nerves supplying the posterior rotator muscles of the head. Ann Surg 13:44-47, 1891

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30. Keen WW: Gunshot Wounds and Other Injuries of Nerves. Philadelphia, JB Lippincott, 1864 31. Keen WW: An American Textbook of Surgery, for Practitioners and Students. Philadelphia, WB Saunders, 1893 32. Keen WW: Surgery, Its Principles and Practice (8 volumes + index). Philadelphia, WB Saunders, 1906-1922 33. Keen WW: A Sketch of the Early History of Practical Anatomy. Philadelphia, JB Lippincott, 1874 7 Pamela Street Marlboro, New Jersey 07746