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Philip Syng Physick's Last Major Operation

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Philip Syng Physick's Last Major Operation PHILIP SYNG PHYSICK’S LAST MAJOR OPERATION By ALEXANDER RANDALL, M.D., F.A.C.S. PHILADELPHIA T IS hardly necessary to present a for the Penn Family and custodian of biographic sketch of Philip Syng their estates. Dr. Physick took his med­ Physick. It has been performed so ical degree at Edinburgh, after study­ ably on many previous occasions ing under John Hunter in London and Ithat the man, worthy to be known havingto Jenner as one of his fellow stu­ posterity as the Father of American dents, and returned to take up his prac­ Surgery, gazes at us from a picture tice in Philadelphia in September, drawn by those who knew him, who 1792, establishing an office in Mulberry saw him in life, watched his work and Street, near Third. His son-in-law, personally received their life’s inspira­ Jacob Randolph, describes him as tion from actual contact with his per­ ... of a medium height; his counte­ sonality. From cold historical facts we nance was noble and expressive; he had a know him as the first full Professor of large Roman nose; his mouth was beauti­ Surgery at the University of Pennsyl­ fully formed, the lip somewhat thin, and vania; and though Wistar and Shippen he had a high forehead and a fine hazel preceded him in that chair, they each eye, which was keen and penetrating. His contaminated the role by being, at the personal appearance was commanding in same time. Professor of Anatomy and of the extreme. The expression of his coun­ Midwifery. Elected to the honor in tenance was grave and dignified, yet often 1805, by the pressure of student de­ inclined to melancholy, more especially mand, to whom he had lectured for four when he was engaged in deep thought, or years, at their earnest request and solici­ in performing an important and critical operation. tation, Dr. Physick held the rank with honor and increasing fame for thirteen Dr. Physick never enjoyed robust years, relinquishing it in 1819 during a health. In infancy he suffered so severe pseudo-political intrigue, and in its a reaction from his inoculation for place took over the Chair of Anatomy. smallpox that his life was despaired of. To this he gave his devoted attention In England, while working at St. and rare gift of teaching until 1831, George’s Hospital, he was again des­ when declining health forced his resig­ perately ill, and Dr. Hunter was greatly nation, and he was made Emeritus Pro­ alarmed about the health of his favorite fessor of Surgery and Anatomy. American student. In the yellow fever From a personal point of view we epidemic in Philadelphia, in 1793, he know him as having been born at a contracted the disease while working house on Arch Street, near Third, on among the destitute in the fever hos­ July 7, 1768, the son of Edward Physick, pital at Bush Hill; and he often said an Englishman who, before the Revolu­ that he did not think his constitution tion, was Keeper of the Great Seal of had ever completely recovered from the the Colony of Pennsylvania and, sub­ shock which it then received. He, never­ sequent thereto, the confidential agent theless, contracted the contagion again in 1797 and nearly died, though it is he immediately conceived and person­ recorded that Dr. Dewees bled him of a ally made a catheter with a bougie tip total of 176 ounces. In 1814 he had as a filiform guide. typhus fever, and for a number of years We know of his experimenting with had repeated attacks of kidney colic, animal tissues for ligatures that would passing several kidney stones. In his de­ be absorbed—buckstring, French kid clining years he suffered from myo­ and animal gut (1816) ; of presenting cardial weakness, and towards the end an appliance for correcting the outward hydrothorax caused great respiratory displacement in Pott’s fracture; of pre­ embarrassment, while a general ana­ ceding Baron Dupuytren in performing sarca and, later, peripheral gangrene, a successful operation for artificial anus made his terminal illness a severe trial (1809); of devising an instrument to to one so esthetic by nature, and yet tap a hydrocephalus through a trephine with such will power and self control. opening, and actually evacuating 8 He died on December 15, 1837, in the ounces of fluid; of perfecting a snare, by seventieth year of his life. a wire passed through a double cannula, Of his surgical skill and his original­ and, with it, removing hemorrhoidal ity in treatment, the qualities which ad­ tumors and performing tonsillectomies; vanced him to the exalted position of being the first to describe diverticu­ accorded him by his professional breth­ lum of the rectum, for he taught and ren, much could be written. A great personally practiced the great advan­ deal of his work was related to urolog­ tage to be gained by autopsy study; of ical surgery, as the clinical problems of designing a gorget, with interchange­ urinary obstruction and of vesical stone able blades, for severing the bladder were early developed in the history of neck in perineal lithotomy; and of shar­ surgery and formed a large proportion ing with Dr. Alexander Munro, of of the surgical work of Dr. Physick’s Edinburgh, the honor of being the first day. We find him making his own (though entirely independent of each bougies, of “fine new linen and pure other) to wash out the stomach and ac­ yellow bee’s wax,” and describing their tively lavage the same through a tube, proper taper; modifying Desault’s using for this purpose “a large flexible splint for fracture of the thigh; tapping catheter” and “a common pewter a hydrocele with a trocar, and washing syringe.” out the cavity with wine for permanent But brilliant and original as was his cure; perfecting the internal angular surgery, it was his teaching that made splint for fracture and injury at the el­ him famous and beloved by his col­ bow joint; devising an early (1795) in­ leagues. I have already pointed out that strument for internal urethrotomy in it was in 1800 that a request, in writing, stricture, by concealing a delicate lancet was made to Dr. Physick, by a number in a cannula; outlining his treatment of of gentlemen attending the medical lec­ ununited fracture by means of a seton; tures delivered in the University of showing a whip-maker how to weave, Pennsylvania, that he lecture to them with silken threads, a flexible woven on surgery. They had probably recog­ catheter, coating it with copal varnish. nized his ability and fallen under his On an occasion, being able to pass a spell at the Pennsylvania Hospital flexible bougie, but not a catheter, in a amphitheater. He responded with great man suffering from urinary retention. diligence in the preparation of each lec­ ture, and Dr. Charles Caldwell, of the tenaculum, arrested the bleeding Louisville, Kentucky, an early friend completely. This promptly led to the and associate, tells us that: invention of his celebrated armed nee­ As a public lecturer, Physick’s style and dle, contained in a curved forceps, for manner were altogether peculiar—alto­ the purpose of carrying a ligature under gether his own. He imitated no one—he such deep vessels. I find no record of attempted to imitate no one, and no one his showing unusual skill in the rapid perhaps was able to imitate him. He was removal of stone, and, apparently, it not eloquent, in the far too common ac­ was his firm control of himself under ceptation of that term. He never in­ all conditions, the directness of his at­ dulged, I mean, in a tempest of sound—in tack, his ability to avoid surgical blun­ loud declamation—or pomp of expres­ der and his judgment as to when he sion. Such arts and efforts were as far be­ had done enough that constituted the neath his standing, and as foreign from his taste as they would have been inappro­ solid foundation on which his success priate to the place he occupied and the was built. subject he taught. In a different and more I cannot help but relish the thought substantial sense of the word, however, that he appreciated the obstructive role he was eloquent. If to expound his sub­ played by the hypertrophied prostate; ject with a clearness of a sunbeam, to be for in a seventy-year-old man he passed abundant in solid matter and rich and a novel contrivance, consisting of a pertinent in illustration and argument, to small flexible catheter, over the inner command the respect and observance of end of which he had placed 3 inches of his class, to rivet their attention, to pour sheep’s cecum and fastened the edges out to them a stream of instruction which securely and smoothly to the shaft of they were eager to imbibe to the last drop, the catheter with fine silk. After its in­ to carry along with him their feeling and troduction into the bladder, the sheep’s- mould them at pleasure, to make them grave when he was grave, and light up gut sac was filled, through the catheter, their countenances with an approach to a with tepid water, and after plugging smile when his features relaxed, and to the catheter with a peg, it was gently, dismiss them brimfull of the remem­ but with some firmness, retracted. This brance of his lecture, and anxious to re­ afforded relief, long unknown, to the tain it to the minutest portion—if this patient, and the instrument was used were eloquence (and I know not by what again, after an interval of some months, other name to call it) Physick, I say, was with great advantage.
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