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Chapter 9- Jeffersonians on the Winged Ox, pp. 403-474

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Jeffersonians On The Win~edOx The Win~ed Ox of Saint Luke

On Novembe r 24, 1975, a sc ulptu re of th e man, beca use his book begins with the tree of the Winged Ox of Saint Luke was placed. atop a col­ ancestors of Christ; M ark , depicted as a lion ; Luke, umn between th e Orlowitz Resid ence a nd th e Scott an ox, a sac rificial beast, a ssociated w ith th e sacri­ Library/ Administration Build ing (Fig. 1). It was fice by Zac hariah; and John , an eagle, the bird that dedicated on May 24,1976. The 18-f oot s upport­ flies nearest to heaven since his gospel gives ive co the lumn bears fifty great names in m edicine clearest vision of God. through out the ce ntu ries. Arranged in a s piral, Particularly re leva nt t o Luke the p hysician, the they sta rt with Hippocrates a nd end at th e top w ith sacrifice of a b ull, steer or calf at sacramental john H eysham Gibbon, jr, feasts was thought to imply superhuman The names were selected by George M. powers for fighting disease. The concept of self Norwood, Ir., Interim University P resident (1976/ sac rifice seemed a fittin g association t o the i dea 77) in l consultatio n with RobertT. Lentz, MS .,&. 0 ., of a p hysician. Head Librarian (1949-75). Five of t he na mes were The Winged Ox was the result of a sculpture those of jefferso n Al umni:Samuel D. Gross (1828), co mpetition in 1975 u nd er the mandate of the J. Mari on Sims (1835), Silas W eir Mitchell ( 850), Philadelphia Redevel opmentAuthority, w hich re­ Carlos F inlay (1855) ; and j ohn H eysh am Gibbon, qu ired the use of one percent of the construction Jr. (1927). The choice was d ifficult and arbit rary costs for the Scott and Orlowitz buildings for ar­ because there were so many na mes not o nly from tistic purposes. Mr. H en ry Mitchell , a sculptor liv­ the g rea t ph ysicians of th e world but also because ing a t th e time in Locarno, Swi tzerland, learned of of the necessity to excl ude worthy Jeffersonians thecontest just three weeks before the deadline for such as Robley Du nglison (Fat her of American entry. Once his idea of the Winged Ox was ron­ Physiology), William W. Keen (JMC, 1862, a pio­ ceived, he quickly finished a model in wax over neer neurosu rg eon) a nd Chevalier Jackson (JMC. copper armature. Mitchell took the precaution of 1886, inventor of t he b ronchosco pe) . From an in­ sending three bronze models, a security measure termediate distance the column with its s piral of that proved to be a wise one. They arrived safely names was intended by the sculptor t o rese mble a across the A tlantic but the firs t m odel was stolen caduceus, one of th e sy mbols of a physi cian. from the j ury room atJefferson. The second model How Sa int Luke the physici an became symbo l­ was substituted and chosen as the winner. The ized by the ox is a ma tter of conjecture and un­ third model was purchased by Mrs. WLiliam W. fou nded tradition. Iranaeus, a Bish op of Lyon, Bodine as a C hrist mas present for h er hu sband , France, who w as killed as a martyr in 202 A.D., i s Chairman of th e Board of Th omas Jefferson Uni­ credited with ascribing th e ox, the traditi onal sy m­ versity. It tookabout seven months for Mr . Mitchell 001 of sacrifice, to L uke beca use his gospe l opens to complete the en tire bronze casting. The steps in with a sac rifice b y Zac haria h in th e Temple and this co mplex p rocess are d etailed in t he JeffersolI also deals with the sac rificial d eath of C hris t. The Alumni Bulletin for su mmer, 1976, in an article by early Christian Church, which used much symbolic Joy Roff Mara "Fire and Excitement in Bronze." imagery, sometimes added wings to re presenta­ The fifty famous names listed on the Winged Ox tions of the fo ur evangelists. Medieval sc ho lars are as fo llows: sought for explana tion i n the gospels: M atthew, a Fig. I. The Winged O~ , 5.,. mbol o f saint Lulr;e the ~ic~n .

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Jeffersonians On The Win~ Ox 405 HIPPOCRATES, 460-370 B.C. MARCELLO MALPIGHI, 1628-94 Gave Greek med icine its scientific spirit and ethi­ Great microscopist and founder of histology. cal idea ls. ANTON VAN LEEUWENHOEK, 1632-1723 AULUS CORNELIUS CELSUS, 53 B.C. - 7 A.D. Dutch microscopist wh o first described sperm­ Compiled encyclopedic treatises on Roman atozoa and gave first complete accou nt of red medicine. blood cells. SORANUS OF EPHESUS, 2d century A.D. HERMAN BOERHAAVE, 1668-1738 Leading au thority on gynecology, obstet rics and Leading clinician of his time; great teacher and pediatrics of antiquity. chemist. GALEN, 131-201 A.D. GIOVANNI BATTISTAMORGAGNI, 1682-1771 Greek physician, anatomist and physiologist; most Founder of modern pathological anatomy. voluminous of all ancient writers and authority for ALBRECHT VON HALLER, 1708-77 nearly 14 centu ries. Master physiologist of his time; Samuel D. Gross RHAZES, 860-932 named one of his sons after him. Persian physician whogave first authenticaccount JOHN HUNTER, 1728-93 of smallpox and measles. Founder of scientific surgery based on physiology MAIMONIDES, 1135-1204 and pathology. Jewish physician and philosophe r w ho translated JOHN MORGAN, 1735-89 the authoritative storehouse of medieval medicine Early advocate of medical education in the United from Arabic into Hebrew. States and a founder of Medical School of Univer­ PARACELSUS, 1493-1541 sity of Pennsylvania. Founder of che mical pharmacology and therapeutics. PHILIPPEPINEL, 1745-1826 First to treat the insane in a humane manner. AMBROISE PARE, 151<1-90 Greates t of all anny surgeons; discredited th e use BENJAMIN RUSH, 1745-1813 of boiling oil in war wounds. First great physician in America and "Father of MICHAEL SERVETUS, 1509-53 American Psychiatry." Discovered that blood in the pulmonary circu la­ EDWARD JEN NER, 1749-1823 tion passes into the heart after being mixed with Developed preventive in ocu latio n against air in the lungs. smallpox. ANDREAS VESALlUS, 1514-;;4 RENE THEOPHILE HYACI NTHE LAENNEC, Mad e anatomy a science. 1781-1826 WILLIAM HARVEY, 1578-1657 Inventor of the stethoscope, putting diagnostic Greatest name in 17th century medicine; showed sounds of card iac and pulmonary diseases upon a the blood to bein motion and follow a definite path, reliable basis. establishing physiology as a dynamic science. RICHARD BRIGHT, 1789-1858 THOMAS WILLIS, 1621-75 Described inflammation of kidneys now known as London clinician; contributed to anatomy of the "Bright's Disease." nervous system and described circulation at base of the brain ("Circle of Willis").

Leg;end and Lore 406 THOMAS ADDISON, 1793-1660 CARLOS FINLAY, 1833-1915 Described pernicious anemia and disease of the Suggested a mosquito as the vector of yellow fever. suprarenal glands. ROBERT KOCH, 1843-1910 ROBERT JAMES GRAVES, 1796-1853 Discovered the tubercle bacillus. Described exophthalmic goiter associated with WILHELM KONRAD ROENTGEN, 1845-1923 hyperthyroidism. Discoverer of x-rays. SAMUEL DAVID GROSS, 1805-84 WILLIAM OSLER, 1849-1919 Greates t American surgeon of his time. Premie r teacher of clinical medicine and medical CLAUDE BERNARD, 1BI3-78 philosopher. Greatest physiologist of mod em Fra nce. IVAN PETROVICH PAVLOFF, 1849-1936 JAM ES MARION SIMS, 1813-B3 Nobel prize winner in experime ntal gastroenter­ Found a cure for vesicovaginal fistu la and open­ ology; described "conditioned reflex". ed first hospit al devo ted entirely to diseases WILLIAM H ENRY WELCH, 1850-1934 of women. "Fathe r of Mod ern Am erican Advanced the science of bacteriology and pathol­ Gynecology." ogy in America. FLORENCE NIGHTINGALE, 1823-1910 WALTER REED, 1851-1902 Instituted nursing as a profession. A conqueror of yellow fever. IGNAZ PHILLIPPSEMMELWEIS, 1818-65 RAMON Y CAJAL, 1852-1935 Pioneer in prevention of puerperal fever. Gifted illustrator of the nervous system. WILLIAM THOMAS GREEN MORTON, 1819-68 PAUL EHRLICH, 1854-1915 Introduced ether anesthesia to the medical Biochemical researcher who discovered salvarsan profession. ("606") for cure of syphilis. RUDOLPH VIRCHOW, 1821-1902 SIGMUND FREUD, 1856-1939 Founder of cellular pathology. Developed psychoanalysis. LOUIS PASTEUR, 1822-95 MADAM E MARIE CURIE, 1867-1934 Chem ist/Bacteriologist and pioneer in preventive Discov erer of radium. inoculation. HARVEY CUSH ING, 1869-1939 JEAN MARTIN CHARCOT, 1825-93 Pioneer neurosurgeon and investigator of diseases French master neurologist; created the greatest of the pituitary gland. neurologic clinic of his time in Paris. JOHN HEYSHAM GIBBON, jR., 1903-1973 Developed the heart-lung machine and performed LORD JOSEPH LISTER, 1827-I912 the first successful open heart operation. London surgeon who introduced antiseptic technic. The Winged Ox, as a fitting complement to the SILAS WEIR MITCHELL, 1829-1914 Scott Building, combines legend and lore with Physician, neuropsychiatrist, scientistand novelist. Jefferson's tradition and heritage.

Jeffersonians On The Winged Ox 407 Hndinq the Birthplace of Samuel D. Gross

In the Spring of 1990, an exciting event occurred able site at or near the Chesterfield Inn, where he in the ongoing research into the life of Samuel D. took some photographs on th e premises. The Gross, Jefferson's most famous alumnus. This was owner came out to inquire about his intentions, the find ing of the exact site of his birthplace. It is whereupon Dr. Waltman explained his historical not to be construed that the ge neral location of his interest. The intrigued owner took him to the rear birthplace had no t been known. Ind eed, it is stated of the Inn where there stood. a house whi ch ap­ in his many memoirs and autobiography tha t it peared identical to the antiquated one on the old was on a (ann wi thin two miles of Easton, Penn­ photograph (Fig. 2). This important finding was sylva nia. One might assu me that after the lapse of promptly circulated to all the interested parties. 185 years attempts to find the exact site would The editors could ha rdly wait to make a pilgrim­ prove fruitless. The editors' curiosity was aroused age to verify the facts. This took place in May, 1m, by a slide depicting the birthplace in the collect­ when the Waltmans, Wagners, and Sava rools met ion of Edward E. Harnagel OMc. '43), an avid for lunch at the Ches terfield Inn. historian of Gross . Unfortunately, Dr. Harnagel The Inn was located on Tatamy Road, Palmer could not recall how he had obtained the picture Township, p reviously Forks Township, of of the Gross birthplace 25 years previously. This Northampton County. As previously mention­ created a mystery and a cha llenge which the edi­ ed, the house of Gross's birth was located just tors pursued relentless ly. to the rear of the Inn. The beautiful ru ral land­ Through his associations in the American Osler scape described by Gross in hisautobiography was Society, Dr. Wagner was contacted by Dr. Mason fortunately well preserved and hardly affected by G. Robertson ofSavannah, Georgia, who at the time the urbanization not far distant. Fields of wheat, was researching the Easton years of Samue l D. com , alfalfa, and soy beans were being expertly Gross . Thequestion of the Gross birthplace accord­ farmed by modem method s. ingly became one of mutual interest and Dr. In comparing the present appearance of the Wagner supplied Dr. Robertson with a picture house with that of the 1912 photograph, it is clear taken from Dr. Hamagel's slide. Dr. Robertson that the stone of the left half was different from obtained the name of Dr. Cha rles Waltman, a re­ that of the righ t half on lxilll pictures, bu t no due tired Easton surgeon, who had been President was provided rega rding the age of eith er half. Ef­ of the Northampton Co unty Historical Society, forts to determine the date of construction of the and who volu n teered in th e searc h for th e hou se have to date proven fruitless. birth place. Dr. Waltman sent Dr. Robertso n an ar­ It is stated by Gross in his autobiography that ticle by C.W.G. Rohrer entitled Professor Samuel D. the original farm of his fath er, Philip, consisted Gross: America's ForemostSurgeon, wri tten in 1912, of two hundred acres of the "best land" at the whi ch contained a photograph of the Gross birth­ time of his birth and that his father "was high ­ place, the same as on Dr. Hamagel's slide (Fig. 1). ly d istinguished for his integri ty, for the elegance Tha t cleared th e mystery of th e origin of th e of his farm, and for the beauty of his horses which picture on the slide. were among the finest in the country." His father, Dr. Waltman, who knew the Easton area well, however, died in 1813 (Fig. 3) when Samuel was initially unsuccessful in find ing any residence was only eight years old and his will directed that resembling the one published in the article. In a the farm be sold. second search, however, he pin-pointed the prob- The deeds, which the editors researched in the

Legend and Lo re 40 8 Fig. 1. Restored birthplace ofSamuel D. Gross. The older half is on the right (Pholo laloenin 1912.)

Fig. 2. Restored birthplace of Samue l D. Gress. (Photo taken in 1990.)

Jeffersonians On The Winqed Ox 409 county courthouse in Easton relative to the sale, The Gross farm was located in a region long indicated that it was disposed of in several parcels known as "The Forks," meaning the confluence of and his mother moved to a rented house several the Lehigh and Delaware Rivers. It was impor­ miles aw ay. The continuity of the farm buildings tant as a colonial communication and trade junc­ has not been specifically determined but locally it tion as well as a frontier south of the Blue Moun­ is assumed that the present house is the same as tain Range. Many German immigrants from the the 1912one as pictured and that probably a part Rhineland settled there in the late seventeenth and of it was already in existence in 1805. early eighteenth centuries and developed a major One dissenting voice came from Gross himself. agricultural center,already a centuryold at the time Page 10of his autobiography states that he visited of Gross' father 's early career. The region was an his place of birth "fifty years after I left it as a important source of food and war materials du r­ boy...The very house in which I was born had dis­ ing the Revolution. Philip (Dr. Gross' father) was appeared; the grand bam and all the outhouses the grandson of the first Gross immigrant to the were gone..." Gross went on to describe the state Forks region and by the end of the eighteenth cen­ of the farm and orchard as dilapidated and over­ tury he had become a major landowner and a re­ grown. That some habitation was still evident was spected "upright citizen." During the Revolution, indicated by his further remark that the residents Philip spent his time and money freely in the ser­ were attending a neighborhood funeral, so he en­ vice of the government. His will indicates his countered no one. One can only speculate whether prosperity but reveals that none of his four sons he failed to identify a remnant of his houseof birth would succeed him on the farm . He directed or whether it had ind eed totally disappeared. that all of his real and personal property be sold Notwithstanding, the site was clearly the one of and after several specific bequ ests to his wife and his birth and the 1912 writer stated that the house two daughters, he left his residuary estate to existing then "a portion of which is still standing" three of his sons: Joseph, Samuel and Charles. was the place of Gross' birth. His oldest son Abraham was cut off with a bequest of five shillings. Several times during Samuel D. Gross's early years, he refers to the "patrimony" supporting his education and progress. Since he was only eight years old at his father 's death, the sum he inher­ ited must have been substantial. He stated that it was almost exhausted at the time of his marria ge in 1828. His guardian after the death of his father was a maternal uncle who must have lived nearby, since the school he attended was at the border of his farm birthplace (Fig. 4). This unde was prob­ ably Daniel Brown whose farm is stated in a deed recorded in 1814to adjoin the farm of Philip Gross, Fig. 3. Much weather-worn tombstone of Pbilip Gross (175&­ deceased. Philip Gross's wife (Samuel D's mother) 181 3 ), fat her of Sam uel D. Gross, in Fo rks Cemetery, was Juliana Brown Gross. Stockertown, Pennsylvania.

Legend and Lore 410 Fig. 4. Restored buildin g.. the site of which was possibly the boyhood schoo lhouse of Samuel O. Gross.

The Lighter Side of Dr. Samuel D. Gross

The elder Gross unquestionably was among the mad e them objects of particular inqu iry. During most serious of men. It is just as unquestioned that the eig htee n months of my co nnec tio n wit h he had a lighter side. These contrasting aspects of McClellan, I had witnessed man y important op­ his personality are wellexemplified in words taken erations, and had seen a good dea l of medical prac­ from his own autobiography as follows: tice.My mind, too, was well disciplined: Ihad not "I studied hard during the sessions of the col­ only industry, but ambition; my morals and habits lege as well as during the recesses; I was always were good, and I was a stranger to allamusements. punctually in my scat, and never missed a lecture, Med icine was the goddess of my idolatry. When, except d uring the second winter, when I was con­ therefore, the time for my examination arrived , I fined for two days to my room by an attack of had no misgivings in regan! to the resu lt. I had pleurodynia. I worked early and late, and lost no planted. carefully, and believed that I should ulti­ occasion to profit by the opportunities that were mately receive the rewa rds of my industry. The afforded me. I was determined to qualify myself thirty-five minutes which I spent in the 'Green welt especially in the practical branches. I was Room' of my Alma Mater were amongst the hap­ very fond of anatomy and surgery, and therefore piest of my life, and I could not help giving ex-

Jeffersonians On The Win ~ed Ox 411 pression to my fee lings in the presence of my as­ sembled t eachers . Such, i ndeed , was my hilarity that McClellan , my private preceptor who knew me intimately, was i nd uced to as k m e af terward 'whether I h ad not been drinking? '- alt hough he was well aware that I was one of the most tem­ perate of yo uth s and as sober as a judge on th e occasion in question." Dr. and Mrs . G ross (Figs. 1 and 2) en tertained a great deal in th eir home . These guests were not limited to t he medical profession but included in ­ tellectu als from the clergy, the military, the politi­ cal arena, as well as a rtis ts and literary people. During the Ke ntu cky years 0 840-56), it is s tated that "his wife was a c harm ing h ostess w ho kept Fi g. I. Samuel D. Gross while Professor of Surgery al Unn.er­ an ample table ready at all tim es for re unions in sily o f Louisville (1840-56) . (Cou rtesy of Kornhau ser Library which th e s trains of mu of Univt'rsity of L ouisville.) sic mingled with flashes of w it and hu mor."

Fig. 2. Portrait of Mrs. Samuel D . Gross by Samuel B ell Waugh, donated by O rville H. 8ullilt, Ir., Ph of Dr . Gross. .D. , great -grea t grandson

Legend and Lore 412 In Louisiana Swamp Doctor: The WritingsofHenry "Stop! stop! No insult was intended, and though Clay lLwis (alias Madison Tensas, M .D.) there is a you with your wisdom ofalmost twenty-one years description of Dr. Gross examining this particular can not see the connection between soup and sur­ student in a final examination for the doctorate gery, I can tell you, young man, that the success of degree. While the anecdote cannot be accepted the surgeon depends very much upon kitchen as au thentic, it does give the flavor of a lighter medicine. Good soup is easily digested and side of Dr. Gross. strengthens the patient, but bad discomposes and "Now for Old Sawbones Dr. Samuel D. Gross. I prevents the reparative action of the system. But am su re of him, thoug h. Upo n surgery I was this is not answering my question. How do you, prepared, and my intimacy with that professor as­ sir, make chicken soup?' sured me he must be aware of it and would at­ "Seeing tha t if he was not in earnest it was the tribute the errors I might commit to natural trepi­ best imitation I had seen lately, I vouchsafed to dation under the circumstances. answer the subtle inquiry. "He was a man of too mu ch good sense to "After I had concluded -"Mr. Tensas, you wheedle or fool with , and not withstanding my have left out a very important item in the pre­ confidence in my good preparation and his appre­ paration of your soup. You forgot to mention in ciation of it, I anticipated a terrible time with him. the first instance whether you would kill the "My heart sank as Ientered his room. 'Beseated, chicken or not.' Mr. Tensas. Beautiful weather for this season. "The glance I shot at him was too much for his Have an apple? Here is an instrumen t for ligating gravity. Bursting into a hearty laugh, he said " the subclavian artery that the maker has done me 'Tensas, I knew you we re well prepared, but I the honor to call after me. How do you like it? thought I would teach you that nothing that may Think Imust order a dozen. Do to give to acquain­ be conducive to the recovery of our patient is tances: rattled on the kindhearted professor, try­ too trivial to be remembered by the physicians ­ ing to reassure me, which he failed to do, for I re­ also to try your temper. You have too much of the garded his pleasantry as somewhat akin to the cat latter. The sickbed is a fine moderator, however. sporting with its victim. 'You never shave,Tensas, Go, my dear fellow, study hard , and in ten years I I believe? Apropos, how old are you?' will hear from you.' "1jumped clear ou t of my seat at the question. " fears sprang into my eyes as I wrung his hand The institution required a candidate to be twenty­ and than ked him on leaving his room ." one, which I was not by several months. In a "Discourse Int rod uctory to the Forty­ "It's rath er late in the day to inquire that, pro­ third Course of Lectures" (1867) en titled Then and fessor,' replied t. 'You should have asked that be­ Now Dr. Gross bera ted unnecessary and meddle­ fore I paid for your ticket .' 'Well, you are old some surgery of the uterus as well as the mis­ enough to be examined for your degree, I expect , use of pessaries. Much of what he said might be as you'lJ be rejected in all probability. How do you applicable today, but, in addition, his com­ make chicken soup?' ments were humorous. "1began to get nettled, thinking he was sport­ "Dr. W.O. Buck, of New Hampshire, in an ad­ ing with me upon my embarrassed condi tion, but dress before the Medical Society of that State, has a glance at his face told me he was, orstrongly pre­ so admirably hit off this proclivity, that I cannot tending to be, in earnest. forego the pleasureof quoting some of his remarks. "Professor;"! said', 'I came here, sir, to be exam­ Speaking of the uterus as a harmless, inoffensive ined upon surgery, not to be insulted, sir. What little organ, stowed away in a qu iet place, 'it fur­ chicken soup has to do with it, I cannot imagine. nishes,' he jocosely says, 'a capital field for surgi­ If you are disposed to twit me with my early life cal operations, and is nowadays subject to all sorts and humble occupation, I can assure you, sir'- of barbarity from surgeons anxious for notoriety.

Jeffersonians On The Winqed Ox 413 Had Dame Nature foreseen this, she would have ma king a Chinese toyshop of it, is outrageous. Our made it iron-d ad. What with burning and cauter­ grand mo thers never knew they had wombs, only izing. cutting and slashing, and gouging. and spit­ as they were reminded of it by the struggles of a ting and skewering, and pessarying, the old-fash­ healthy fetus, which, by the way, they always ioned womb will cease to exist, except in history.' held on to. Nowadays, even our you ng women The Transactions of the American Medical Asso­ mus t have their wombs shored up, and if a baby ciation have figured one hundred and twenty-three accidentally gets in by the side of the machinery, different kinds of pessaries, embracing every vari­ and finds a lodgment in the uterus, it may per­ ety, from a simple plug to a patent threshing ma­ chance, have a knitting-needle stuck in its eyes chine, which can only be worn with the largest before it has any." hoops. They look like the d rawings of turbine Finally in the same discourse, Gross said: wa ter-wheels, or a leaf from a work on entomol­ "A so und hearty, who leso me laugh is medicine ogy. Pessaries, I suppose, are sometimes useful, for the soul and is one of the peculiar prerogatives but there are more than there is any necessity for. I of our nature." do think that this filling of the vagina with traps,

Eakins' Gross Clinic: The Acme of Medicine in Art

During the Renaissance, the new study of hu­ son and assured him of life-long financial security man anatomy provided common ground for both so that he could pursue art for its own sake. Tho­ scientist and artist. Leonardo Da Vinci participated mas Eakins passionately believed that the most in anatomical research from 1483 to 1515. The bea utiful thing in the world was the human body. Anatomy Lesson ofDr. Tu lpby Rembrandt (1632) and His natural inclination towards science and math­ The Anatomy Lesson of Dr. vetpeou by Feyen­ ematics furthered his intense interest in the body's Perrin (1864) were famous European precursors for anatomy. His fascination with medicine, although the American masterpiece of Thomas Eakins, The not for a career, led to his completions of the por­ Gross Clinic (875)1. Eakins, while an art student traits of seven professors of the Jefferson Medical in 1864, studied anatomy at the Jefferson Medical College. The most enduringly famous of these was College of Philadelphia. A decade later,after nearly Dr. Samuel D. Gross, but Drs. Benjamin H. Rand , four years abroad, he continued his anatomical John H. Brinton,JacobM. DaCosta,James Holland, studies in the same medical school with the re­ William S. Forbes, and William Thomson were men nowned father and son anatomists, Joseph and of great prominence in their fields. William Pancoast. He also atte nded the surgery In 1875, Eakins was 31 years of age; his formal clinics of Dr. Samuel D. Gross, acknowledged by artistic ed uca tion had been completed; and there Fielding Garrison as "the greatest American sur­ was a request for American artists to exhibit their geon of his time2." This association led to his paint­ best works in the Art Gallery of the forthcoming ing of The Gross Clinic. Philadelphia Exposition Celebrating the 1876Cen­ Thomas Eakins was a native Philadelphian, born tennial of American Ind epend ence. The time, in 1844. His father, Benjamin Eakins, was a well place, subject matter and challenge were ideal for known writing master who was successful in his Eakins' ambition, now at its peak, to express itself trade and also in investments. He provided every Fig. 1. 1M Gross Clinic by Thomas Eakins. advantage for the artistic education of his talen ted

Leqend and Lore 414 Jeffersonians On The Win ved Ox 415 in what he believed would be a masterpiece by of the master with his tenaculum. Dr. Charles S. executing the Portrait of Professor Gross, subse­ Briggs, later the Professor of Surgery at the Uni­ quently known as The Gross Clinic. versity of Nashville, is kneeling at the middle in On a purely voluntary basis, without commis­ front of Dr. Gross, holding the patient's legs to sion, Eakins worked with sketches and poses by avoid movement during the procedure. He was Dr. Gross for a monumental work that he knew sent by his father, Dr. W.T. Briggs of Nashville, to was by far the best he had ever done. Within easy study under Gross. The elder Briggs conside red access to the Committee of Selection of the Cen­ Dr. Gross to be the greatest physician in the United tennial Art Department, it was exhibited in States and presented him with a gold-headed Haseltine's Gallery in Center City Philadelphia in cane in 1880. April of 1876. Acrushing disappointment awaited At the head of the operating table is W. Joseph the expectan t artist. Hearn ijMC, 1867), in later years a Clinical Profes­ The canvas (Fig. 1) graphically depicts a scene sor of Surgery, holding the anestheticsoaked towel familiar to Jefferson Medical College students be­ to the patient's face. An unidentified figure, hid­ fore the use of Listerian antisepsis more than a cen­ den behind Dr. Gross, is holding a retractor in his tury ago. The figures are of life size in a vertically left hand from the left rear side of Gross while he oriented group 8 X 6 1/2 feet and mounted in a comforts the mother by intertwining his hand with massive gilded frame . The towering intellectual hers, giving the appearance of six fingers. The figure of Professor Gross with his tremendous mother is shrinking from the sight of her son's power of presence dominates the arena in which blood on the surgeon's knife and hand. Although he characteristically pauses for a moment to ex­ women were considered unfit to witness opera­ plain to his class the details of removal of a piece tions, the law permitted members of the families of dead bone (sequestrum) from the femur. His of charity patients to be present. intense but compassionate face is bathed in natu­ In the left middle ground of the portrait is the rallight from the overhead skylight of the upper recorder, Dr. Franklin West, a Jefferson graduate amphitheater of the College, known as the "pit" of 1873, taking notes at his desk. Dr. Gross always for its similarity to a bull ring. Since the incandes­ insisted on accurate records in his personal life, cent lamp would not be invented until four years clinics and societies he founded. later, the operations were performed on sunnydays The background of the painting is dark since it between the hours of 11 A.M. and 3 P.M. The ab­ realistically represents the poor illumination of that sence of caps, masks, gownsand gloves documents era. The figure of Samuel W. Gross the younger the high vulnerability of both patient and surgeon (JMC, 1857), is dimly seen in the doorway behind to infection. The bloody hand holding the scalpel, Dr. Barton. To his right is Hughey O'Donnell, the which is a feature as striking as the head of Gross orderly who served the College for many years and himself, contains pus as well, since there was an collected tumblers of "laudable pus" for Gross's abscess at the site of the incision. lectures. Sketching in the stands to the right of Dr. With their retractors and hooks to expose the Samuel W. Gross is Thomas Eakins. On the top wound, the assistants along with the anesthetizer, row, Robert c.v.Myers, a poet friend of Eakins, is all in street garb, form a pyramid abou t the pa­ portrayed. The medical students are poss ibly de­ tient lying on the right side with barebuttocks and picted from the Sketch Club classes. wearing heavy socks. Dr. Daniel Apple, who had For reasons that were not explicitly stated, the just grad uated that year, is in the right lower cor­ Committee ofSelection rejected wha t has undoubt­ ner holding a retracto r in one hand and ready to edly become one of the greatest med ical paintings hand an instrument in the other. James M. Barton of all time. Conjecture and recorded comments ijMC, 1868), Chief of Clinic and subseq uently a from the art critics of the newspapers suggest that Clinical Professor of Surgery, crouches to the side exposure of the nude buttocks and an open Inci-

Legend and Lore 416 Fig. 2. U.S. Post Hospit~1 Building OI l ClMten nial Ex hibition in Fainnount Park. Philadelphi a (1876).

Fig. 3. Gron Clinic as a medical exhibit in U.S. Post Hospital.

Jeffersonians On The Winqed Ox 417 sion on th e bare thigh were offensive to th e public; the painting from Ea kins f or $200 in 1 878 a nd p re­ that the bloody hand and scalpel of th e surgeon sented it to the Board of Trustees the following year . mad e people sick; that the pa inting was too dark; The delay o f th ree years must not be construed as that som e members of the Committee might have indifference, for th e a lumni h ad been intensely been je alous of a talent they could not emulate; or solicited to direct their funds to th e co nstruction pe rha ps th at Ea kins was a victim of th e New York of the firs t J efferson Med ical Co llege H ospital of establish ment. Open hostility toward Eakins must 1877"'. Since i ts acquisition, TIlt" Gross Clinic has bediscounted, however, because five of his paint­ remained within the institution for w hich it was ings, including the portrait of Professor Rand, were conceived and h as beco me a priceless s piritual accepted and exhibited . heritage jea lously guarded by the a lumni. Considered at th e time to bemore a rep resenta­ For twenty yea rs 0878-98), the painting hung tion in th e field of medicine rather than in art , TIle in the l ower lecture room of th e Medical Co llege Gross Clinic was allowed to be hun g in the Unit­ (Fig. 4), and for the n exl thirty years 0898-1928) in ed St at es Post Hospital Building ( Fig . 2). It the basement read ing roo m of the new College was ex hibited on l oan from Dr.Gross himself who Building at th e a djacent comer of Te nth and Wal­ was presiding over a medical co nvention in nut Streets. Its next hom e was in th e Medical Co l­ Philadelphia. The room was a pref abricated Army lege Building o f 1 928 ( Fig. 5) where i t was destined Post Hospital (Fig . 3) furn ished with pa per-m ache to be admired by s tude nts and faculty for th e nex t bed patients an d ph otographic pathol ogy ex hibits forty yea rs 0 929-69). Here it prominently occu­ on the wall s3• pied th e c enter of a tall w all on th e seco nd fl oor The Alumni Associati on of Jeff er son Med ical lobby wh ere it could also be seen f rom the street College, founded b y Dr. Gross in 1 870, purch ased through a large w indowed two-story archway.

fig. 4. Lower It''Ctu", nMMn or It'ffl1'f'SOn Mt'dic<11 Coltege IEty Building) wht'"' the Gross Clinic hung rrom 187810 1898.

Leqend and lore 418 Fig. S. Gross Clinicon secoed Roor of 1025 WalnUI Street Colle-ge. just ou tside of McC1ellan Hall. where il hung from 192910 1969.

Jeffer sonians On The Win~ed Ox 4 19 After the initial impact of the painting on students it was placed behind a bu llet-proof plastic shield wasexperienced, its daily viewing between classes wit h an alarm system. Unfortunately, this mea­ led to its casual acceptance as part of the institu­ sure rendered the portrait impossible to appreci­ tional decor. As Eakins became more and more ate because of reflected light (Fig. 6). recognized as an important artist, museumsbegan As offers for the portrait rose increasing well into increasingly to request a loan of The Gross Clinic the millions, the Connelly Foundation spearheaded for exhibit and tou rs. In 1961, the Na tional Ga l­ a movem ent to assure its permanence within the lery of Art was organizing such a tour of Eakins' institution by construction of an Eakins Gallery works and pointed out the urgent need for a con­ with The Gross Clinic as the center piece and the servation treatment of this particularone. Thiswas Eakins portraits of Professors Benjamin Howard carried out by the Philadelphia Museum of Art Rand, and William Smith Forbes at either end (Fig. which renewed the decaying masterpiece. 7). A wrought iron entrance ga te contributed by In 1969, The Gross Clinic was moved into a new the Alumni Association was custom built by the basic science building (jefferson Alumni Hall) and \,:orld renowned Samuel Yellin Company (Fig. 8). displayed in a specially designed Eakins Lounge. Thegallery, w hich opened in 1982,combined ideal By this time, increasingly su bstantial offers for its viewing and security for the painting considered purchase had been refused and its vu lnerability to by man y critics to be "the greatest masterpiece of theft or vandalism becamea concern. According ly, American art." In 1985, a diorama, approximately 12 inches squareand set into the wall , depicted the portrait figures in three dimensions. Eakins, the artist, sought vainly for recognition, faced many frustrations, and died in 1916 an un­ happy man without children. Gross, the surgeon, in contrast, won increasing recognition, was re­ warded with fame, and lived happily until 1884 with adoring children. Both, however, achieved immortality respectively in art and medi cine. Jefferson may justifiably be proud of its constantly improving physical face. On the other hand, visiting alumni frequently find their old haunts remodeled or altered in decor. The single landmark, however, which ignores the pas­ sage of time is The Gross Clinic . Indeed, it is not only the focal point of Jefferson's splendid art collection but more importantly is an entrenched spiritual symbol. It should come as no surprise that attempts have been made to po ke good-natured fun by means of misrepresentation, so-called "spoofs", of this great painting. One such appeared in the July 9, 1978, Los Angeles Herald Examiner by photo­ grapher Gus Gregory in w hich there was a rever­ sal of the sexes. The face of Gross was replaced by Fig.6. Gross Clinic in ukins Lounge of Jefferson Alumni HJl II a "foxy young blonde." In place of the mother from 1969 to 1982. A bullel-proof plastic shirld rendered lhe shrinking in honor he featured an elderly man. port rait j m~s i b le to appreciate. The women medical students were from North-

Lesend and Lore 420 western University (Fig. 9). References In 1979, Dr. Wagner enlivened a talk at surgical grand rounds with a spoofof the Gross Clinic. The 1. Borowitz, H.O.: Th~ Seilipel and the Brush. Cleveland head of Gross was replaced by Francis E. Rosato Clinic Quart.53(1986) 61 -73. (Chairman of the Surgery Department and Gross 2. Garrison. F.H.: A n Int roduction to th ~ History of Mtdi­ Professor), W.Joseph Hearn by Jay J. Jacoby (Chair­ cine. 4th Ed ., W.O. Saunders Co., Phila ., 1929, p. 599 man of Anesthesiology), Daniel Apple by Gordon F. Schwartz (Professor ofS urgery),James M. Barton 3. Sellin, D.: Tile First Pose.W.W. Norton & Co., Inc., N.Y., by Stanton N. Smullens (Clinical Professor of Sur­ 1976, p. 52. gery),Cha rles S. Briggs by Jerome J. Vernick (Clini­ cal Professor of Surgery) and Franklin West, the 4. Parry, E.C., III: TlI~ Gross Clinic as an A natomy Leeson and Memoriol Portrait. Art . Quart., 32 No. 4, 0%9) p. registrar, by John V. Cattie (Resident in Surgery). 384. This somewhat sacrilegious depiction was repro­ du ced by the graduating students in thei r 1980 Yrarbook (Fig. 10) and might have been appropri­ ately tolerated by Dr.Gross himself who was never Fig. 7. Gross Clin;c in E.J kins Gallery,opeeed in 1982, unde r loathe to enjoy well-meaning fun . main .auspices of Connt"lIy Founcbtion.

Jeffersonians On The Winqed Ox 421 Fig. 8. Alumni gate to Eakins Gallery, buill by Samuel Yellin Cornpdny.

Legend and Lore 422 Fig. 9. Spoof of Cross Clinic with reversal ofsexes.

Jeffersonians On The Wi n~ed Ox 423 Fig. 10. Spoof of Gross Clin ic with Iaces replaced by 1979 staff mem bers.

Lesend and lore 424 How Jefferson Acquired the Gross Statue

In 1895, the Jefferson Alumni Association, in tion in 1970. The statue had originally been lo­ conjunction wi th the American Surgical Associa­ cated in Adams Drive to the rear of a build ing at tion, raised sufficient funds to commission a bronze Seventh and Independence Ave nues, S.W. that statue of heroic size of Professor Samuel D. Gross housed. the Army Medical Museum. The museum who died in 1884. Gross was the venerated was started toward the end of the Civil War and Founder of both these organizations, the former the first Curator was John HillBrinton (JMC, 1852). in 1870 and the latter in 1880. Congress also ma de Later on, the museum became the National Library an appropriatio n for erection of the granite pedes­ of Medicine. Eventually, that library was moved tal. The statue wasa gift to the people of the United to Bethesda, Maryland, and in 1969 the Gross States and constituted the second ever erected in Statue wa s placed in storage. this country to a medical ma n. The first was to Dr. It happened that Harold L. Stewart, Chiefof the J.Marion Sims, the "Father of American Gynecol­ Laboratory of Surgical Pathology in the National ogy," unveiled in Bryant Park, New York City, in Ca ncer Institute, a loyal Jefferson Alumnus (jMC, the Autumn of 1894. Sims was a Jefferson gradu­ '26) and Washi ngto n, D.C. resident, ale r ted ate in the Class of 1835 and is the subject of an ac­ Norman J. Quinn (]MC, '48) about the statue. Dr. count lat er in this chapter. Quinn, who was the Centennial Committee Chair­ The scu lptor was Alexander Stirling Ca lder, al­ man, saw the situation as an opportunity to bring ready distinguished for his figures in the fountain the statue to Jefferson where Gross had focused in Philad elphia's Logan Circle. He was the son of most of his professional life. the sculptor of the William Penn Sta tue atop City Dr. Qu inn, along with John J. Mck eow n, Jr. Hall. The younger Calder copied the pose of Pro-­ (JMC, '47), contacted the Anny Institute of Pathol­ fessor Gross from Thomas Eakins' Gross Clinic. It ogy with the view of acquiring the statue not only was eleven years after Gross' death, at w hich time on long term, but most appropriately to mark the the 25-year old sculptor was well on his way to a Centennia l of the founding of the Alumni Asso­ brilliant career. The bronze was cas t in Paris. ciation. They negotiated successfully with Colo­ The sta tue was erected in the Smithsonian Park nel Frederick E. Moss, Legal Counsel for the Insti­ in Washington, D.C. in the immediate vicinity of tute, and with Helen R. Purtle, Acting Curator of the Anny Med ical Museum (Fig. I ).Itwas unveiled the Medical Mu seum. The signa ture of the Sur­ on May 5, 1897, wi th a d ed ication address by Pro-­ geon General authorized its transfer. fessor William Williams Keen, Jr. (JMC, 1862), w ho Following the Dean's Luncheon on Friday, May had su cceeded to the Chair of Surgery in 1889. 1,1970, the statue was presented to the University Jefferson Alumni attended the ceremony en masse, at its present loca tion behind the Scott Library/ reserving a train to Washington for the occasion. Ad ministration Building. At the ceremony, the They were joined by Fellows of the American Sur­ Alumni Association was represented by its Presi­ gical Association and Friend s. Keen's well pre­ d ent, Paul J. Poinsard (JMC, '4 1), the Medical pared speech paid fitting tribute to the "Nestor of School by Dean William F. Kellow, and the Un i­ the Profession" and may be read in the Transac­ versity by President Peter A. Herbu t (Fig. 2). tions of the American Surgical Association (1897) . The inscription on the pedestal of thestatue pays A fortuitous concatenation of circumstances led fitting honor to Gross w ho brought lasting fame to acquisition of the Gross Statue for the Centen­ not only to his alma ma ter, but to American Medi­ nial Celebration of the Jefferson Alumni Associa- cine as a whole:

Jeffer sonians O n The Win\led Ox 425 Fig. I. Sta tu e of Sam uel D. Gro~~ in th e Smith,,(ln­ ian Park, Wa..hingtun, D.C. Building in the b.uk­ ground is the Aml t Medical Mu.....um.

Legend and Lore 426 AMERICAN PHYSICIANS HAVE ERECTED THIS STATUE TO COMMEMORATE THE GREAT DEEDS OF A MAN WHO MADE SUCH AN IMPRESS UPON AMERICAN SURGERY THAT HE SERVED TO DIGNIFY AMERICAN MEDICINE 1897

Jefferson, through the University Art Committee, has provi ded for the maintenance of the patina of the statue aga inst wea thering and the soiling by birds. President Bl uemle arranged for replacement of the scalpel which had been missing from the surgeon's right hand. Although not prized as highly as the Gross Clinic, the statue enhances the spiritual presence of its subject on the campus.

Fig. 2. Dedication of Gross Statue (beh ind Scott Building) .111 Cee­ tennial of Alumni Associalion (1970). l eft to right: ONln William F. Kellow, Presidenl Peter A. Herout. and Alumni President Polull. Poinsard liMe ,'41).

Jefferson ians On The Wi n~ed Ox 427 The Cremation of Professor Samuel D. Gross

Samuel D. Gross died of congestive heart fail­ cation and redemption. ure on May 6, 1884. A postmortem exa mination, In 1874, an English society was formed to pro­ performed by Jacob Mendes DaCosta OMC, 1852), mote the practice of cremation. There were legal Professor of Med icine, revea led marked gastric in­ entanglements which delayed the first cremation flammation, fatty heart, and a largecyst ofthe right which fina lly took place on March 26, 1885, in kidney. Gross believed that crema tion was the Woking, England. most sa nita ry way to dispose of th e human body The first recorded instance of cremation in the and accordi ngly preferred urn burial. United Sta tes took place in 1792 when Henry The burning of human corpses for disposal of Laurens, a Revolutionary statesman, stipulated in the dead was widely practiced in the ancient world. his will that his body "be wrapped in twelve yard s Exceptions were in Egypt wh ere the bodies were of tow cloth and burnt untit it is entirely con­ embalmed; in [udaea wh ere they were buried in sumed." It was not until 1876, however, that the sepulchres; and in China where they were buried first crematory in the United States was erected in in the earth. Following cremation, the ashes were Washington, Pennsylvania, by Francis Julius Le stored in urns, buried in the earth, thrown to the Moyne, a physician and fearless outspoken aboli­ wind, or tossed at sea. tionist of slavery. The first cremation there was The pra ctice of crema tion in modern Europe the bod y of a Bavarian nobleman, Baron Joseph was stopped by the doctrine of the Christian faith Henry Louis Le Palm, who had come to the United which believed in the res urrectio n of the body. States in 1862. Le Moyne, himself, who died Octo­ As populations increased, the chu rchyards be-­ ber 14, 1879, at age 81, was cremated there. His came overcrowded and mad e cemeteries necess­ ashes are buried under a tombstone in front of the ary. Even cemeteries near inhabited houses some­ build ing (Fig. 1). There were 42 cremations car­ times provided insufficient space. The ultimate ried out there between 1876 and 1900. By the early resort was a sanitary on e, but was also accompa­ 1950s, more than 190 crematoria were in use in the nied by a modification in the concept of resurrec­ United States and Canada. tion from a pu rely ph ysical one to spiri tual purifi- The Le Moyne Crematory is a national histori­ cal site which may be viewed inside by arrange­ ment with the historical society of Washington, Pennsylvania. The right half of the building is a single office space where the paper work, records, and interviews with the family were conducted . The left half contains the incinerator with an inde­ pendent door of access . This modest brick struc­ tu re and its grounds are well maintained. Its loca­ tion at the top of a hill and the pleasant houses surrou nd ing it dispel morbid thou ghts that might otherw ise tend to occur. The ashes of Samuel D. Gross were returned from the Le Moyne Crematory in 1884 and buried Fig. 1.le Mayne Crema tory in Washi ngton, Pmnsytv.ani.t, wtMore within an urnbeside the coffin of his wife in Wood­ Gross was cremated in 1884. lands Cemetery, Philadelphia. The other members

Lesend and Lore 428 of his family buried here did not desire cremation, to Washington, Washington County, Pa., to be cre­ A handsome tombstone, topped with a symbolic mated in the Le Moyne Furnace in accordance with urn, marks the family lot and simply contains the his expressed wis h. He had long been a strong name Gross (Fig. 2). A visit to this spot gives one ad vocate of this mod e of di sposing of the dead. the feeling of standing upon hallowed ground. 'The authorities at the crematory had been no­ In more recent years, two other Jefferson surgi­ tified, and as 5(X)n as Dr.Gross's bodyarrived there cal greats have chosen crema tion, - namely W.W. it will be committed to the retort. The as hes will Keen (1932) and John H. Gibbon. Jr. (1973). probabl y arrive in this city on Saturday. NEWSPAPER, MAY 7, 1884 "An autopsy was mad e upon the body of Dr. DR. GROSS TO BECREMATED Gross at his house yesterda y morning by Drs. J. The Funeral Services Last Night Ewing Mears, Jacob Mendes DaCosta, and Orville The Body Sent To Horwitz. This was in accorda nce wit h the often Le Moyne Crematory expressed wish of the distinguished surgeon, who desired that his dead face should not be gazed "Funeral services over the remains of Dr.Samuel upon and that the cause of his dea th should be as­ D. Gross were held at six o'clock last evening at certa ined beyond question. Death, it was found, the residen ce, co rner of Eleventh and Walnut was due to the sheer wea ring out of the vital or­ streets. The Reverend Dr.Curry, of Sain t Luke's gans. No traces of disease were di scovered, but Episcopal Church, cond ucted the services. Out­ life had ceased because there was no longer suffi­ side of the immediate family there was no one cien t vitality to carry it on." present, except for Dr.Jacob Mendes DaCosta, who attended Dr. Gross during his illness and assisted at the autopsy yesterday morning. "About half past eight o'clock, a hearse which had been in waiting at the Livery Stable a short distance below on Eleventh Street, drove up to the residence. A plain black casket was placed within it and it drove slowly up Eleventh Street, attended by four men who walked on either side of the ve­ hicle. The body was taken to the workshop of the attending un dertaker, Bringhurst, on Cuthbe rt Street a small thoroughfare below, and placed in a plain pine chest. The hearse continued then to the Broad Street Sta tion, where the chest was for­ warded to Pittsburgh on the Western Express, which left at 9:10 p.m. The body was placed in the forward baggage car and Charles Draper, the col­ ored coachma n, who has been in the employ of the family of Dr. Gross for a number of years, was di­ rected to keep a last and lonely vigil on the mortal remains of his employer and benefactor. Accom­ panying the body were Dr. PhineasJ- Horwitz, ex­ surgeon General of the Navy; Benjamin Horwitz, of Baltimore, the son-in-law; and Councilman A. Haller Gross, the son of the deceased . Fig. 2. Family gravesne of Samuel D. Gross in Wood lands Cem­ "The body of Dr.Gross was being quietly taken elery, Philadelphia.

Jeffersonians On The Winqed Ox 429 1. Marion Sims (JMC. 1835): Father of Modern American Gynecology

Sims (Fig. 1) was born in Lancaste r Cou nty, rugal, Belgium and Italy. South Carolina, on January 25, 1813. He gradu­ Meanwhile, in 1867 a new Woman's Hospital ated from South Carolina College in 1832 and re­ was opened at Fiftieth Street and Fourth Avenue. turned to Lancaster where he began to study medi­ Sims returned in 1868 to become the Chief Con­ cine under the preceptorshipof Dr.Churchill Jon es. sulting Su rgeon to the new Hospital, but contin­ After a course of lectures at the Medical College of ued to make periodic visits to his private practice Charleston he came to Jefferson and gra d ua ted in in England, France and Germany. In 1874 Sims 1835.He retu rned to Lancas ter, bu t, on encoun­ resigned from the Woman's Hospital because the tering a p ractice too slow, moved to Montgomery, Board of Lady Managers would not allow more Alabama. There he developed his reputation as a than 15 physidan visitors at a timeor admit women surgeon, opera ting successfully for strabismus, suffering from uterine cancer. In 1875/76 he served clubfoot, harelip and tumors of the jaw. as President of the American Medical Association. In 1845 Sims discovered the knee-chest position During the last year of hi s life, Sims p re­ th at bears his na me and subsequently be nt a pared a n autobiography e n tit led The Story kitchen spoon to invent the Sims speculum. Over of My Life. A most fascinating chapter deals the nex t five years he experimented with tech­ with his student days at Jefferson which is re­ niqu es to repair vesicovaginal fistulae. Success was told in Chapter 2. achieved when he resorted to the use of fine silver In his final yea r of 1883 Sims was planning to wire for sutu re material. return to Rome to continue his successful practice In 1853 Sims moved to New York where he pur­ there. While still in New York City and apparently chased a large house in which he installed a pri­ in good health he was working in bed on his auto­ vate infirm ary. He became obsessed wit h the am­ biography early in the morning of November 3. bition to esta blish a special hospital for the trea t­ Suddenlyseized byan attack of dyspnea, he called me nt of women's diseases. After successful ap­ for his physicia n son, Dr. HarrySims, who, on rush­ pea ls to prominent citizens he was able to open ing to his father'sside, saw him die without utter­ the first Woman's Hospital in 1855. It was the first ing a further word . such hospital of its kind in the world. Located at THE STATUE OF JAMES MARION 83 Madison Avenue, near his home, and equipped SIMS: FIRST EVER ERECTED TO with 40 beds, it served mostly ind igent patients. AN AMERICAN PHYSICIAN The work flou rished in quantity and quality, lead­ 1894 ing to a prestigious reputation for Sims. In 1861Sims took refuge in Europe with his fam­ Within a few weeks after the death of Dr. James ily because of the Civil War which leveled anti­ Marion Sims (Fig. 1) on November 13, 1883, a sug­ Southern sentiment against him. He became very gestion was mad e through the Medical Record that prominent and successful in Paris, operating alike a statue be erected in his memory. The fame of on the poor, the rich, and on royalty, including Sims was so Widespread and the publicity so ef­ Empress Eugenic, wife of Napoleon III. In the fective that a large Committee was assembled with Franco-Prussian War of 1870 he attended the mem bers from New York City, Philadelphia, B0s­ wounded of both sides and received decorations ton, Chicago, Cincinnati, S1. Louis, San Francisco, from the go vern ments of these countries. He was Augusta, Memphis, New Orlea ns, Tuscaloosa, also decorated by the go vern me nts of Spain , Por- Cha rleston, Richmond, Washington , and Balti-

Leeend and Lore 430 more. The name of Gross from Philadelphia ap­ peared on the Committee, but the elder Gross died in 1884 and the younge r Gross in 1889, both well before the statue was finally erec ted in 1894. The Sims statue was the first ever to be erected in the United States in honor of a ph ysician . The one to Samuel D. Gross in 1897 was the second. Funds poured in from the profession in all parts of the country an d abroa d. Designs were obtained in competition by many artists. The commission was awarded to Muller of Munich whose work was com pleted for erection in Bryant Park, New York City, on October 20, 1894. Sims' grandson unveiled the statue for presentation to the City of New York (Fig. 2). f ig. 1. J. Marion Sims (JMC, 1835 ), Father of American Mod­ Some of the salient remarks in the eulogy to Sims ern Gynecology. at the ceremony were as follows: "In his own department Sims, a born and typi­ cal American, was a lead ing worker. He estab­ lished a school of his own, which has now won fame through out the wo rld. Indeed, it is safe to say that Sims' name is associated with more origi­ nal operations and more new instruments for mak­ ing such operat ions successful than that of any other American surgeo n. His was the germina l thou gh t implanted in a di sposition for untiring work, which cha nged im possibilities into tri ­ um phs, restoring health and happiness to count­ less nu mbers of suffering womanhood. "Th us while here, th e sta tue preserves the memory of the good man, of the faithful wor ker, of the great inven tor, of the broad phi lanthropist, the Woman 's Hospital becomes for him and all of us an eve r-living principl e, extend ing its charity, wide ning its influences, perfecting scientific skill, and fulfilling its divine mission of alleviating suf­ fering and saving the lives of waiting generations of stricken womanhood. "Among the many eminent physicians and sur­ geons whom America has produced, he stands pre­ eminent as the ma n through whose genius, perse­ verance, and energy a special branch of medical science and practice was so renovated , improved , and elevated as to create an era in medicine and raise America from the place of the docile and re­ ceptive pupil to the prou d posi tion of the teacher f ig. 2. Sial ue of J. Marion Sims in Bryant Park, New YorkCily.

Jeffersonians O n The Win~ed 0" 43 1 of older nations. speculum, the scissors, the knife, and the need le 'W ithout disparagement to the patient labors of for the cure of the diseases to which he paid previous workers in the same field, I (Dr. Paul F. particular attention. J. Marion Sims may, there­ Munde of New York City) mu st insist that the fore, with all propriety be called The Father greatest triumphs in this specialty have been of Modem Gynecology." achieved since Sims first taught us how to use his The inscription chronicled his career:

J. Marion Sims, M.D., LL.D. Born in South Carolina, 1813. Died in New York City in 1883, Surgeon and philanthrop ist. Founder of the Woman's Hospital of the State of New York. His brilliant achievements carried in the fame of American Surgery Throughout the civilized world. In recognition of his services in the cause of Science and mankind He received the highest honors in the gift of His countrymen And decorations from the gove rnments of France, Portugal, Spain, Belgium and Italy.

On the reverse was inscribed:

Presen ted To the City of New York By His professional friends and Many admirers Throughou t the World.

Legend and Lore 432 S. Weir Mitchell (JMC. 1850): Neuropsychiatrist. Physiologist and Novelist

Some of Jefferson's professors had illustrious the family. According to Ernest Earnest in S. Weir sons. One of George McClellan's was a famous Mitchell: Novelist and Physician, Weir "welcomed Civil War General. Sa muel D. Gross fathered the break as an escape from mathematics which Samuel W.Gross, a distingu ished surgeon and first he hated ." He thought of entering a chemical husband of Lady Oster. William Henry Pancoast factory, but his father objected on the grounds that con tinued th e traditio n of hi s father, Joseph an inves tment would be required. A relative of Pancoas t, in ana tomy and surgery. John H. Gib­ his mother offered him a partnership in a firm bon, Jr. invented the heart-lung machine and thus in Lancast er, England, with the promise that honored the professorship of his father, the senior Weir would ul timately inherit the business. Al­ John H. Gibbon. Another so n, even more famous thou gh the offer was accepted, the cousi n went than his father. Professor John KearsJey Mitchell, d o wn w it h the Lexington two weeks la ter. was S. Weir Mitchell (Fig. O. Mitchell thus escaped a business career for which Silas Weir Mitchell was born in Philadelphia on he had no inclination. February 15. 1829, the third of nine children. Both Further,according to Earnest, the elder Mitchell his father and mother, Sarah Matilda Henry, were objected to his son's desire to study med icine with Virginians. The Mitchell hou sehold was one of the tirade: "You have no appreciation of the life. refinement and culture. The elder Mitchell had a You are wa nting in nearl y all the qu alities that go lifelong passion for poetry and counted Edgar Alan to make a success in medicine. You have brains, Poe and Oliver Wendell Holmes among his liter­ but no industry." ary friends. You ng Mitchell as a boy and yo uth Weir grad uated from Jefferson in 1850 in a class showed little promise of what he was later in life of 211. His graduation thesis was on the "Intesti­ regarded, - a genius. He wassomewhat frail, book­ nal Gases." The "Famous Faculty of 1841 '" was at­ ish and inclined to be a private person. Like tracting largeclasses comparable to thoseof today. his father, however, he showed great interest in In accord with the standards of the time for an literature and was most fond of poetry. At agesev­ enteen he published his first poem "To A Polar Star." Man y peo ple were to encounter his name first as a novelist and discover later tha t he also was a promine nt physician. Alt hough not an outstanding student, Weir showed an interest in his father's chemistry lec­ tures and laboratory. He entered the University of Pennsylvania at the age of fifteen where he was cited for poor behavior and poo r scholarship. He also suffered from a lung ailment (tuberculosisf), which also afflicted his father. At the end of three years of college, yo ung Mitchell had to take leave (1847, at age 18) because his father 's illness (tuberculosis) , fortunately of short duration, required him as the eldest living Frs. 1. Si~ 5 Weir Mitcht-II. M.D.. Ll.D. liM e , 1850). noted son to find an occupation tha t would provide for neuropsychialriSI and noffiis1.

Jeffer sonians On The WlnQed Ox 433 elite education in medicine, young Mitchell took eral Hammond, referring in disgust to what he off to Europe for a year of study at the important considered vile politics on the Board in the appoint­ clinical and research centers. He was greatly in­ ment, wrote in an attempt at consolation: "It is an fluenced by Claude Bernard in Paris. honor to be rejected by such a set of apes." Louis On return to Philad elphia he entered into prac­ Agassiz, the world renowned natural scientist, also tice with his father at the southwest comer of Elev­ wrote to Mitchell that his rejection "resulted from en th and Walnut Streets and remained in practice prejudice in American education circles aga inst until the tim e of the Civil War. men who pl aced scie ntific research ahead of The elder Mitchell died in April. 1858, and in facility in teach ing. Successful candidates for September Weir married Mary Middleton Elwyn. chairs are usually men of fluent speech who gained Their first son was born the following year and their knowledge fr om re ading rather than another in 1862. In that year his wife d ied of diph­ from independent inv estigation" (quoted from theria, and it was not until 1874 that he married Two Centuries of Medicine by George W. Comer, Mary Cadwalad er; a memberof the socially promi­ Lippincott Co., 1%5). nent Philadelphia famil y. When Robley Dunglison resigned as Professor In the several years before the Civil War, Mitchell of the Institu tes of Medicine and Med icaljurispru­ conducted experiments in physiology, pharmacol­ dence at Jefferson in 1868, there was open compe­ ogy and toxicology that established him as a sci­ tition for this chair between Mitchell and James entist. His most important publication during th is Aitken Meigs OMC, 1851l. They were both 39 years time (1860)wasa monograph on "Researches Upon of age and had bo th graduated from Jefferson the Venom of the Rattlesnake" which eventually Medical College within one year of each other. In consisted of ten papers. the light of what we know tod ay, both the Univer­ During the Civil War Mitchell initially secured sity and Jefferson missed their opportu nity to ap­ a part-time commission as a "contract surgeon" at point the man wh o has been called "the most ver­ the Filbert Street Hospital in Philadelphia, which sa tile American since Fran klin", "Philadelphia's he described in his novel, In War Time. In 1863 the Lost Physiologist," and acknowledged by many as Surgeon General, Dr. William Alexander a genius. Meigs, who had acquired an international Hammond, himselfa neurologist friend of Mitchell reputation as an ethnologist, received letters of acq uainted with his researches, assigned him to a su pport from Professor Joseph Henry of the special hospital of 400 beds (Turner 's Lane) to in­ Smithsonian Institution , Dr. Josiah Cla rk Nort. a vestigate injuries to the nervous system. There noted ethnologist from Alabama, Professor Wilson with two other Jefferson colleagues, his classmate from Toronto, Professor Richard Owen of the Brit­ Geo rge R. Moreh ouse. (jM C, 1850) and W.W. ish Museum, Professor William Tu rner of the Uni­ Keen (jMC, 1862), he developed th at hospital versity of Edinburgh, Dr. Paul Broca of the Acad­ into the foremost center of research on nerve inju­ emy of Medicine in Paris, and the scholars VonDu­ ries. They published Gunshot Wounds and Other ben of Stockholm and Pruner Bey of Cairo. Meigs Injuries of Nerves (864) and Injuries to Nerves and proved worthy of the appointment but died at the Their Consequences (1872). premature age of 50 and is mainly remembered It is im po rtant to stress that d uring the 18605 tod ay by the Meigs Medical Association, in contin­ Mitchell had high ambitions of obtaining an aca­ ual existence since 1880. Mitchell, on the other demic chair in either of his alma maters, - the Uni­ hand, lived to be 85 as one of the most broadly versity of Pennsylvania or Jefferson. His first dis­ based intellectuals of his day, a founder of American appointment came in 1863 when Samuel Jackson neurology, a gifted resea rche r, poet and novelist. resigned the Chair of the Institutes of Medicine in In 1876 the University of Pennsylvania did elect the University and the appointment was awarded him to its Board of Trustees on which he served to FrancisGurneySmith. His friend,Surgeon Cen- for 35 years. In 1880 Mitchell was a candidate for

Lesend end Lore 434 the Provostship at the University upon the resig­ Paris, he consulted the great Charcot, who asked nation of Charles J.Stille, but the post was awarded suddenly: 'Do I understand you come from Phila­ to the second William Pepper. Later in his career delphia?' 'Yes'. That is fortunate: said Charcot. he was elected Professor at the Philadelphia Poly­ Then he turned to his desk and started to write, clinic and College of Gradua tes In Med icine, where calling back: '1 am writing to a friend of mine, a he was regarded as an inspiring lecturer. He was most remar kable physician and I am going to put a founder of the Pathological Society of Philad el­ you under his care. I am offering him some opin­ phia and a member of the American Philosophical ions and recommendations:'Will you tell me to Society by the age of 33. He was a physician to the whom of my rivals, you are referring me?' 'Yes, to Southern Hospital, St.Joseph's Hospital, the Penn­ Dr. S. Weir Mitchell: 'Oh,' said Dr. Mitchell, '1am sylvania Institute for the Instruction of the Blind, he:'Oh', said Charcot, 'then you will not need Presbyterian Hospital, the Orthopaedic Hospital this letter: And he tore it up. Dr. Mitchell declared and Infirmary for Nervous Diseases where he col­ that he never ceased to regret that he failed to se­ laborated with William Osler, State Lying-in Hos­ cure and keep that letter to himselfabout himself: ' pital and Infirmary, and the Insane Depa rtm ent of Mitchell was reputed to have remarkable eye­ the Philadelphia (General) Hospital. He served as sight. This was attributed to the fact that one eye President of the College of Physicians of Philadel­ was far Sighted and the other near sigh ted . For phia for two terms 0886-88 and 1892-94). distance he used the far one and excluded the near Mitchell pioneered in the description and treat­ ment of nervous disorders such as reflex paraly­ sis, erythromelalgia, diseases of the cerebellum, neu ralgia, locomotor ataxia, head ache, facial tic, spastic paralysis, trophic disorders and neurologic complications of amputations such as "phantom HUGH WYNNE limb." Mitchell was willing to treat the neurotic FREE QLIAKER and mentally ill who were being ignored by ~ -.vJT uavTn n~ neuropsychiatrists of the da y who confined their ~ 'nUI.T.... M_IlI ·'*"'l' ~w~ efforts to those in asylums. Some of his success may be credited to two books written for the lay public. Wear and Tear, or Hints for the Overworked S. WEIR MITCHElL. M.D. 08?1) and Fat and Blood: An Essay on the Trea tment U-.P. Il .....VUII .....D JPIII..,.GIl of Certain Form s of Neurasthenia arid Hysteria ( 877) were widely read. His popularized "rest cure" in­ cluded bed rest, isolation, massage, and a rich diet HOWARD PYLE including extra amounts of milk. The story is told that when Mitchell's own nerves gave way he rushed to Europe and consulted a Viennese spe­ cialist. He was told: "In your own coun try is the man who can do you the most good. His name is S. Weir Mitchell of Philad elphia."

Another and probably more accurate version of NEW YORK this anecdote is narrated by J. Madison Taylor in THE CENTURY CO. his "Personal Glimpses of S. Weir Mitchell" in An­ .... nals ofMedical Hislory, Sept. 1929, p. 587. "One in­ cident he often cited with glee. When a young man he was suffering from som e ailment and, being in Fig. 2.Thit no\'~ by S.Wrir Milchell sold ~ r 500,000 copin.

Jeffersonians O n The Win ~ed Ox 435 one. For close work he reversed the process . This Mitchell's ex periences and im pressions fro m hi s apparently aff orded him a w ide range o f vision . psychiatric work were interwoven in these books He never had to wear glasses. He co ns i dered th is in which portrayal s o f p athologic personalities trait a bl essing from the Almighty. This arrange­ made fascinating characters. Hi s literary o utput ment of vision d oes not offer th e same ad­ also included many s hort stories , children's sto­ vantages to a ll humans. One of Mit chell's patients ries, and n earl y 150 poems . H e co mposed verses with one short and th e o ther t ong distance type of until the very end of hi s life, at which time Bara E>­ vision su ffered from eye pain and headaches. It bas was written. His Ode on a Lydo n Tomb (898), annoyed Mit chell that a refraction correction was one of hi s best poems, was written a fter th e required d eath for relief. of his daughter. Mitchell's name was ac claim ed as much by the Mitchell was very friendly with William Osler lay public as by the medical profession. This was and W.W. Keen. These three men were influential because of hi s literary output as a noveli st, s hort in building up the library of the Co llege of Physi­ story writer, and poet. It is interestin g that he did d ans of Phil adelphia to a statureof national promi­ not s tart publishing his n ovels until the age of 52. nence. Mitchell found much i n common with For many years he was famous as the author of Oliver Wendell Holmes, Professor of Anatom y a t Hugh Wymle (18%), a tal e of the Revolutionary War Dartmouth and later the Parkman Professor of written when he was 6 7 (Fig. 2 ). It even tually sold Anatomy a nd Ph ysiology at Harva rd Medical over five hundred thousand copi es . Two o ther School. In 1 892 Mitchell made a poetic tribute to successful war background novels were his Holmes on the occasion of the p resentation of Sa­ ConstanceTrescott, published when he was 76 and rah W. Whitman's Portrait of Holmes to the Col­ WestulQys at 84. Among his 19 novels ma y also be lege o f Ph ysicians . This portrait now hangs in mentioned Circumstance, Dr. NorthandHis Friends, the Cad wa la der Ro om. Not to be ou tdone , In War Time, and HephZibah Guinnese as notable. Mitchell Hall in the College contains portraits of Fig. J . Punerat of S . W~ir Mitche-Il from St. Slephen's Churrn Mitchell by F ranz Dvorak a nd R obert vonnoh, a (}.Inuary 6, 1914). marble b ust b y William Partridge a nd a bronze

Lege nd end Lore 436 relief by Otto Schweitzer. stone wit h his father, Professor john Kears­ Mitchell received honorary degrees from Ha r­ ley Mitchell (Fig. 4). vard, Princeton, jefferso n, Toronto, Bologna and Jefferson may proudly claim S. Weir Mitchell as Edinburgh Universities, in ad dition to honorary one of its most illustrious sons, and, in the light membership in many foreign scientific societies. of history, lament his loss as the most worthy of Dr. Mitchell's las t home was at 1524 Walnut the eligible successors to Robley Dunglison. In Street where he lived from 1873un til his death from 1975 he was chosen as one of the five jefferson pneumo nia on jan uary 4,1 914. The building was Alumni to be included among 50 great med ical demolished to make way for the Integrity Trust benefactors whose na mes were honored on the Company. A wh ite ma rble plaque is affixed to the Winged Ox Column. Walnut St reet wall, marking the site of Dr. fig. 4. Tombstone of S. Wf'ir MitcMlI in Woodlaoos CmM' teory, Mitchell's residence. Another physical testimony Philadeolphi.ll. still exists in the Franklin Club which was orga ­ nized under his guiding spirit in 1902. The house is at the comer of Camac and S1. James Streets. It was planned to bring authors, illustrators, and publishers of Philadelphia into closer contact. He was its president from its founding until his death. The funeral of Dr. Mitchell took place on Janu­ ary 6, 1914, after impressive ceremonies at St. Stephen's Episcopal Church, 19 South 10th Stree t, in Philadelphia , a site at which Benjamin Franklin is reputed to have flown the kite tha t d rew light­ ing from the sky (Fig. 3). He was buried in Wood ~ lands Cemetery, Philadelphia, and shares a tomb-

Juan Carlos Finlay (JMC. 1855): Discovered the Mosouito of Yellow Fever

"The confirmation of Dr. Finlay's doctrine is the cine in Havana, presented to Finlay in the name of greatest step forward made in medica l science since his admirers a bronze statuette by Barbedienne Jenner's discovery of the vaccination." entitled The Thought. After giving credit to his col­ Thesewere the words of General Leonard Wood, laborator, Dr. Delgado, and to Dr. Reed, Chairman a physician and military governor of Cuba on De­ of th e U.S. Army Board, Finlay modestly con­ cembe r 22, 1900, at a banquet in honor of Carlos cluded:"Tha nk you my friends." Finlay. Present were Reed, Carroll, Agramonte, Major William Crawford Gorgas, a career u.s. Gorgas, Guiteras, Albertini and more than 60 other Army physician, was appointed in charge of the Ameri can and Cuban physicians who were pay­ health of Havana in December, 1898. In February, ing homage to the man who had described the 1901, he was given the order to clear the city of the mosquito which transmitted yellow fever from an Stegomyia fasciata (Aedes aegypti) mosquitoes infected to a well person. Scientific organizations Singled out by Finlay and proven by the Reed Com­ and the world press were represented in this trib-­ mission as the carrier of yellow fever. In imple­ ute. Dr. Dominguez, Dean of the Faculty of Medi- menting the prophylactic measures long advocated

Jeffersonians On The Win~ed Ox 437 by Finlay, Gorgas sent out "Stegomyia" brigades versity of Havana was thwarted by refusal of the to destroy all water deposits where the mosqui­ ad ministra tion to accept him because his prelimi­ toes could lay their eggs and to pour oil on stag­ nary education had not been received there. His nant ditches. Six months later the last case of yel­ father then advised him that there was an excel­ low fever was recorded in Havana. This was lent medical college in Philadelphia that wou ld Finlay's greatest triumph. His work made possible take him, namely jefferson Medical College. This the American completion of the Panama Canal and young institution was by then outsta nding because saved millions of lives throughout South America, of its "Famous Faculty of 184t" which included: the Caribbean, Africa, and the southern United joseph Pancoast, the renowned anatomist/sur­ States. As an honoree on jefferson's Winged Ox geon; Franklin Bache, the great-grandson of Ben­ Column, the career of this glorious alumnus and jamin Franklin and Professor of Chemistry; Robley giant in medica l history is worthy of recount. Dunglison, the "walking dictionary," Professor of j uan Carlos Finlay (Fig . 1) was born in Institutes of Med icin e (Physiology); Charles Camaguey, Cuba, on December 3, 1833, the son of Delucena Meigs, a brilliant lectu rer in Obstetrics; Dr. Edward Finlay, a Scottish physician, and a Thomas Dent Mutter, a francophile surgeon who French gentlewoman, Eliza de Berres, from had imported the "quiz" system from Edinbu rgh; Trinidad. After being tutored at home, young Robert M. Huston, the popular Professorof Materia Finlay at the age of eleven was sent to France for Medica and Therapeutics; and John Kearsely his secondary education. His studies were inter­ Mitchell, the Professor of Medicine whose theories rupted there by political disturbances which com­ on epidemics were permanently to influence the pelled him to continue for a year in Germa ny. An rest of Finlay's life.He registered at jefferson in attack of rheumatic fever complicated by chorea 1853 as Charles Finlay and grad uated in 1855. then forced his temporary return to Cuba. On his Finlay's preceptor at jefferson was Silas Weir return to France he rounded out a solid founda­ Mitchell, the son of Professorj.K. Mitchell,· a man tion in the classics, mathematics, chemistry, phys­ only four years his senior and himself an 1850 ics, geography, and history. He intended to study jefferson Alumnus. medicine in France but once more had to return to Finlay stayed with the younger Mitchell for a Cuba, this time to recover from an attack of typhoid year after graduation in order to complete the three fever. His decision to study medicine at the Uni- years of preceptorship required for the M.D. de­ gree. Weir Mitchell had done work in Paris in the laboratory of Claude Bernard, where he had ac­ quired proper habits of scientificinvestigation that were able to insp ire Finlay. When the latter left Philadelphia, Mitchell saw to it that he took with him the best available binocular microscope, as well as a curiosity about the causes of epidemic fevers . Mitchell was to remain his advisor and friend for life. They ultimately died within a year ofeach other, - Mitchell in 191 4 at age 85and Finlay in 191 5at age 82. In 1856 Finlay began a series of travels, which included a period in Paris of postgraduate study in ophthalmology. He began permanently to practice medicine in Fig. 1. Carlos Finlay (JMC, 1855) discovered the mosquito thai Havana in 1864. Despite his busy practice, he al­ lransmitted yellow fever, ways found time to use his microscope in special

Legend and Lore 438 investigations. Even when he first arrived for vert (1) existence of a previous case; (2) a person med ical study in 1853, there occurred an outbreak capable of developing the disease; (3) an agent for of yellow fever in Philadelphia. It was endemic in its transmission. He pointed out six months later his own country. In 1858 he conducted an exten­ that the Aedes aegypti mosquito was the transmit­ sive study of the variable alkalinity of the air which ting agent. It would take about twenty more years he thought might relate to the variable occurrence before the Reed Commission would prove the ac­ of yellow fever in Havana. He also wrote articles curacy of his hypothesis. on cholera, leprosy, relapsing feve r, beriberi, In August, 1900, Dr.Jesse W. Lazear,a graduate filariasis, and trichinosis. In 1879the Spanish Gov­ of Columbia University (1892) who had received ernor of Cuba appointed Finlay, as a representa­ training in Berlinand the Pasteur Institute of Paris, tive, to collaborate with members of an American conducted expe riments as a member of the Reed Yellow Fever Commission (not to be confused with Commission in a station near Havana, in which he the later Reed Commission of 1900) which was sent applied infected mosquitoes to nine American sol­ to Havana for studies of this disease. The report diers as well as the Commission members them­ of the Commission on its return to the United States selves (in order to avoid criticism). Although the includ ed an account of Finlay's investigations on first experiment failed, Lazear tried again two days the alka linity of the air. It concluded that yellow later and also inoculated Dr.James Carroll with an fever was a transmissible disease for which the infected mosquito. Carroll, as well as a soldier, causa tive agent should be found in the air. The developed yellow fever. Lazear himself, after be­ Commission gave Finlay numerous specimens of ing bitten by an infected mosquito, died of the dis­ blood smears and histologic slides of blood ves­ ease. The ova of the correct species of mosquito sels for his further study. In the authori tative ar­ had been supplied by Finlay. The benefit from this ticle by Juan A. Del Regato, M.D. in the Jefferson conclusive know ledge would prove global. Medical College Alumni Bulletin for Summer, 1971 , One might well wonder as to what flash of in­ entitled Carlos Finlay and the Carrier of Death , tellect could have led Finlay to his persistent be­ Rudolph Matas, a junior member of the Ll.S.Com­ lief in the mosquito transmission of yellow fever. mission and later pioneer in vascu lar surgery, is Was it from experiment, pure logic, serendipity, quoted as saying: .....the image of Carlos Finlay clairvoyance or some combination of all? Dr. Juan remained in my mind as the model of exemplary A. Del Regato offers this explanation in the Alumni wisdom, of the laborious worker, wealthy in Bulletin article already referred to (Summer, 1971): strength of knowledge, in rectitude of principles, "Finlay, a man of varied interests, was reading a in conscientiousness and intellectu al integrity". book of botany by van lieghem. He was attracted Between 1865 and 1881 Finlay wrote ten papers by the description of the evolutionary cycle of a on yellow fever. parasite ofwheat (Puccinia graminis) whose spores Finlay became convinced. tha t the behavior and of the fungus were said to be unable to genninate frequency of mosquitoes related to the occurrence except on another plant (Berberis vulgaris) whose of yellow fever.He noted tha t during hot wea ther presence was necessary for the parasi te tocomplete it developed at low altitudes; that cases decreased its cycle and destroy wheat. Thus, Finlay was led with higher altitudes and fewer mosquitoes. He to think of an equally indispensable intermediary designed experiments in the attempt to prove that between one case of yellow fever and the next. As by mosquito inoculation he could produce a mild he sat beside his bed saying his rosary one night, type of disease that would confer immunity. Un­ Finlay was disturbed by a persistent mosq uito. fortunately, this line of investigation failed. On Distracted from his devotions, his mind starting February 18, 1881, at the International Sanitation the cycle of scientific discovery, first conceived an Conference in Washington, D.C., he proposed three idea that had never as yet occurred to any man: conditions necessary for propagation of yellow ie- that the mosquito could be that indispensable in-

Jeffersonians On The Winged Ox 439 Fig. 2. Cuban stamps issued in 1933 honoring the cenl enary of Finlay's birth. (ClMr. Robert Pete rsen, Senior V.P., Administra­ thanks to Dr. Finlay, w ho accorded us a most cour­ lion/Finance. flU) teous interview and had gladly placed at our dis­ termediary, the carrier, a veritable vector of death posal his several publications relating to yellow between the sick and the next victim. And, once fever during the past nineteen years; and also for again, as in numerous other instances of impor­ ova of the variety of mosquitoes with which he had tan t human discoveries, the genesis was not the made his several inoculations." resu lt of logical conclusion or the yield of an ex­ Finlay d id not rest on his laurels. He became periment, but ratherof a sudden thought, as a flash the first Director of Health of the Republic of Cuba of light in the darkn ess: a sudden illumination, a on May 20, 1902, a position in which he gave seven manifest sign of tong prior cogitation." years of devoted service before retiring at the age On October 23, )900, Dr. Walter Reed presented of 76. His Alma Mater, Jefferson Medical College, a paper entitled The Etiologyof Yellow Fever, A Pre­ awarded him an honorary degree of Doctorof Sci­ limiuary Note at the meeting of the American Pub­ ence (1902) and the Liverpool School of Tropical lic Healt h Association in Indianapoli s. He sta ted Medicine honored him wit h its Ma ry Kinsley authorita tively that the mosquito "serves as the Medal. He was nominated for the Nobel Prize in intermediate host for the pa rasi te of yellow fever." Physiology or Medicine in the years 1905, '06 and Included among the d etails of the work by his 'CJ1 as well as 1912, '13, '14 and '15, the latter being Commission, Reed stated this about Finlay: "We the year of his death. He was a serious contender have no space to refer, at length, to various inter­ on all of these occasions but "the numerous con­ esting and valua ble contributions made by Finlay temporary claims" and ot her indeterminate con­ to the mosquito theory for the propagation of yel­ siderations failed to render him justice. low fever...we here desi re to express our sincere Finlay's honors were notconfined to his lifetime.

Legend and Lore 440 His statue in marble was erected in front of the Ministry of Health of Cuba, surrounded by the bronze busts of other yellow fever pioneers, . Lazear, Gorgas, Delgado and Giuteras . In 1927 the Gran Canciller, Order of Merit of Carlos Finlay, was dedicated in 1921 by the Cuban government for recognition of outstanding contributors to the field of health. In 1927 the Institute Finlay of Havana for research in tropical medicine and preventive medicine was dedicated. The Republic of Cuba issued twodenominations of Finlay stamps in 1933, the centenary of his birth (Fig. 2). In the S

Jeffersonians On The Winqed Ox 441 Fig. 4. Floral tributes placed under the medallion of Carlos Finlay at the dedication (195 2) of the memorial to the yellow fever worke rs.Leandro M.Tocanlins ()MC, '26) placed ill wreath in the namt' of It''fft''1''SOn Mt"dical Couege.

Jefferson in 1976. In 1983 he was once aga in re­ membered at Jefferson by a memorial lecture on the occasion of the 150th anniversary of his birth. As the eternal prid e of his Alma Mater, he is for­ ever enshrined in the annals of medical history. Fig. S. Marblt" bust of Finlay p-eseeted by the Repu blic of Cub.J in 195] in com memo ration of the Ct'ntt"fldry of his gradualion from lefferson Mt"dical College.

Carlos Finlay and S. Weir Mitchell: Relationship of Two Illustrious Jefferson Graduates by Leand ro M. Tocantins UMC, 26)

In 1829 a child was born in Philadelphia who as it were, in one of the most important and valu­ was destined to bring honor and to give service to able discoveries in medical history. They kept his native city and his country. His name was S. in touch all through their lives, sought advice Weir MitchelL Four years later, and thousa nds of fro m each other, and their deaths were only miles away, another child was born in Havana, one year apart. Cuba, who was also destined to bring honor and The background of both Finlay and Mitchell had give service to his native coun try and to hu man­ many similarities. Both were sons of doctors of ity. His name was Carlos Finlay. medicine, and interest in medical science seemed Very early in their young manhood these two to be part of the heritage of each one. Weir men met, and their meeting resulted eventually, Mitchell's father, John Kearsley Mitchell a Scotts­ during a life-long friendship, in "joining forces", man, was a physician in Philadelphia and a pro-

Lesend and Lore 442 fessor of medicine at Jefferson Med ical Co llege. first ind ication that there was a close contact main­ Carlos Finlay's father, also a Scottsma n, was a ph y­ tained between these two men is a publication in sician in Havana,Cuba. the American JOlmlQ lofMedical Sciences, which was Approx imately two years after his gradua tion then ed ited by I. Minis Hays and, incidentally, was from Jefferson Med ical College, Weir Mitchell re­ referred to at the time as The International; in fact, turned to Philadelphia from Europe where he had one of Mitchell's letters refers to the American Jour­ augmented his medical education with studies nal of Medical Sciences as The lnternational loumai, under the foremost men of tha t time. He had spent The reason for this is that the Journal was edited much of his time with Robin who was the lead ing both from Philadelphia by Min is Hays and from clinical microscopist of his day, and attend ed lec­ London by Malcolm Morris, and it is called The tu res given by Claude Bernard in the Palais de IntemationaIJoumaIofMedical Sciences. Itwas pub­ France. Bernard's influence was very strong u pon lished by Lea Brothers & Co., and the successors the young doctor and probably influenced hisgrea t of this firm are still the publishers of the Journal. interest in experimental demonstration. This particular volume is the volume of 1886, and It was at this time that he met Charles Finlay, it carries an article on yellow fever entitled: "Yel­ who had come from Havan a the year before and low Fever: Its Transmission by Means of the Culex registered at Jefferson College in 1853. It was then Mosquito" by Cha rles Finlay. And, harking back that a communion of inte rests was d iscovered, and to John Kearsley Mitchell for a moment, at one time Finlay chose Mitchell for his preceptor. He was in in analyzing the transmission of various d iseases reality Weir Mitchell's first pupil. After Finlay's he said that yellow fever, from its known cha rac­ graduation in 1855, he spent another year with teristics, might be considered to be " no t Mitchell who was so strongly impressed with the contagious but portable". In the light of Finlay's talent of his pupil tha t he tried to persuade him to later research and development. this statement remain in the United States. Finlay, however, de­ is sig nifica n t evidence o f John Kea rs ley cided to return to Havana. Mitchell's ad vanced thinking. Finlay's decision was perha ps influenced by In the above menti oned article, Carlos Finlay John Kearsley Mitchell, in an indirect way. John says, "in searching for a natural agent capable of Mitchell was far ahead of his time and a distin­ fulfilling this condition I was led to fix upon the guished authority on infectious diseases of hisday. Culex mosquito as the most likely one". That may have been one of the factors in Finlay's In a letter from Weir Mitchell to Carlos Finlay, decision to come to Jefferson College in the first dated September 23,1 887, there is a strong indica­ place. Finlay had a great sense of responsibility to tion that Mitchell had mu ch to do with the pub­ his own country and realized the many qu estion s lishing of this article. It would seem that having which challenged doctors in Cuba. John Kearsley heard from Finlay of his experiments with yellow Mitchell published a monograph advancing a fever, Mitchell wrote this letter in reply. The letter theory which, at that time, was far advanced over reads: "Mydear friend : This is glorious indeed! I the theories of his contemporaries. He believed wish you would at once write a condensed paper that the so-called infections of contagious diseases with enoug h of new to justify its reading. I will were caused by microorganisms. Working and read it to the College of Physicians and have it studying under this man must have contributed published at once. What Welch (this, of course, is much to Finlay's later experimental research. William Welch, famo us bacteriologist and patholo­ Finlay, then, returned to Havana and began to gist) may say can follow. The new cultures I will practice and, unfortunately, for the next twenty­ send to Osler (Sir William Osler, Professorof Medi­ five to thirty years we have not been able to find cine at the University of Pennsylvania) and my any documentary evide nce of communica tion be­ so n for study." (His son, John Kearsley Mitchell tween S. Weir Mitchell and his form er pupil. The was also a famous physician ). "Your papershould

Jeffersonians On The Win~ Ox 443 be about ten pages or so and resume all your work from Dr. Finlay in which the writer stated that he to the present time. It willatoncego into the News." had proven the transmissibility of yellow fever (The News was one of the prominent medical pub­ through the bite of the mosquito; that he had dem­ lications of the tirne.) onstrated a specific tetragenous microbe in the This was in 1887, when the controversy was rag­ blood, in the serum of blisters, and in the skin; and ing about the etiology of yellow fever. However, that he had obtained this same microbe in mild this whole matt er refers to one of those mistakes cases ofyellow fever,developed to a1l appearances which are made by every scientist who eventually from mosquito inoculation." acco mplishes anything. On e cannot judge the This was partly responsible for shaking some of worth or stature of an investigator by his errors, the confidence in Finlay'Searly work with the vec­ but by what his errors have taught him in achiev­ tor of yellow fever, because at the time it was al­ ing final acco mplishme nt. The erro r made by most fashionable for orga nisms, microorganisms, Finlay was in thinking that certa in tetragenous to be discovered from various portions of the microorganisms were the cause of yellow fever,and world. Sanarelli had one, Freire had another, Mexi­ he was sending these cultures and his paper to can workers had still another organism and Dr. Mitchell with the hope that Mitchell would give it Finlay had the one we have just mentioned. Dr. grea t dissemination. George Sternberg, who was a very distinguished Weir Mitchell fulfilled the promise to his friend bacteriologist of the da y, spent a good deal of his and brought the question of transmission of yel­ lifetime tracking down these supposed causes of low fever before the College of Physicians. In The yellow fever and showing that they did not have Transactions and Studies of the College of Physicians anything to do with the cause of the disease. in 1887 we find the following "Remarks in Regard In a letter which was presumably written about to Dr. Finlay's Researches with Reference to the August, 1890, Mitchell writes to Finlay, following Bacillus of Yellow Fever" by S.Weir Mitchell. "Dr. up the same matter: "I sent your photographs and Finlay, of Havana, has been studying yellow fever, papers, etc., to my friend Professor Welch, Johns and believes that he has made a series of valuable Hopkins University, Baltimore. I told him you discoveries. He has sent me some of the cultures would send him cultures and asked him as a favor which represent the bacteriological fonns he has to me to study the matter with care and to report found. Some of these I sent to Dr. William Welch, on it in print. No one is more competent." (This is of Baltimore and some to Dr. William Osler of this definite evidence that the Preceptor, Mitchell, was city. Dr. Finlay suspected that the mosquito was still sponsoring and applaudi ng the work of the the agent in certain cases in the transfer of the poi­ pupil, Finlay) "This seems to me better than to son of yellow fever from.one person to another. send it to the International, which will be a poor He has made a series of experiments on this sub­ affair and, of course, accepts only unpublished ject which were set forth in a paper published in papers. I presume yours to be in print, you do not the American Journal of the Medical Sciences of two say where or when. It seems to me a very impor­ years ago. He has finally, as he believes, succeeded, tant discovery. Dr. Sternberg. sent by our govern­ by placing the mosquitoes on the skin of a man ment to South America, is now studying Yellow affected with a severe fonn of the disease and then Fever. A note from you to him, would reach him transferring them to persons who never had the and perhaps induce him to go to Cuba on his way disease, in giving the latter a mild form of the dis­ home." (Sternberg was in South America tracking ease.. I believe that Dr. Finlay proposes to present down the organism which had been described by a paper to the College,giving the discoveries which Freire, a Brazilian bacteriologist as the cause of the he has made and the proof which supports them." disease. This wassubsequently proven not to have The account goes on; "Dr. Dock exhibited the cul­ anything to do with yellow fever.) tures referred to above. He first read from a letter A further note from Dr. Mitchell on September

Lesend and Lore 444 4th says briefly: "Dr. Sternberg has returned . You he wrote to Weir Mitchell abou t it. Wedo not have had best write to him at Johns Hopkins Univer­ Finlay's note, but we do have the letter Mitchell sity. Also, were I in your place, I'd ask Welch's wrote in reply: "My dear Finlay:Yourletterarrived advice as to any further step." this Christmas morni ng and I make haste to say a And now we come to one of those pu zzlin g few word s in reply. I have not yet seen the back lapses in the correspondence of these two men just numbers of the Journal, but I have the greatest con­ at the time when it would be most interesting. In fidence in your powers ofobservation, and neither one letter Mitchell says,"I enclose Welch's note," Sternberg nor anybody else will really shake it or but no note has been found . It would be most in­ make me believe that you are wrong in a matter of teresting to know what a ma n like William Welch observation until you, yourself, tell me so. I be­ would have to say about Finlay and his contribu­ lieve that you will come out all right and satisfy tion at this time. But we know that Sternberg did everybody, including Sternberg, who is a man of go to Cuba. Was it the result of intercession on fair mind. Kind Christmas regards to you and Mitchell's part? We could very well believe this you rs from, Your old and attached friend, S. Weir when we read Mitchell's address as President of Mitchell." The College of Physicians. In it we find these This letter surely gives strong proof that Weir words: "I am glad to say that the derision of the Mitchell not only had absolute faith in the skill and Government as to sending commissions to study integrity of his pupil, bu t unconsciously perhaps, cholera and yellow fever owed much to the influ­ and then again it may have been with full confi­ ence which, as your President, I was able to exert dence in his words, he prophesied what actually with the Department of State." Here we have very came to pass, Sternberg's admission eventually, clear evidence that Weir Mitchell was interceding that Finlay's theory of the transmission of yellow actively in trying to bring about what he thought fever was correct. would be further investigation into a subject which There must have been more correspondence was very dear to his heart, since it was initiated between these two friends after the above letter. and furthered by his pupil. Finlay. In 1902 Finlay was honored by the College of Phy­ In 1888, while Weir Mitchell was President of sicians and it was Weir Mitchell who proposed him. The College of Physicians,oneof the leading medi­ There were surely letters written at that time, but cal journals printed a paper which had been deliv­ as far as we can determine they do not exist now. ered before the College by George Sternberg. This Only one last letter has been found. from Mitchell paper had to do with "Investigations Relating to to Finlay (and we know it is in reply to one from the Etiology and Prophylaxis of Yellow Fever." Dr. Finlay, although we cannot find that letter). It Sternberg analyzes very thoroughly and very eas­ reads: "My dear old we ll remembered friend : ily the contributions that had been made up to tha t Thanks for the kindl y thought of me. It was but a time regarding the etiology of yellow fever, and few days ago I was talking of you. Now we are many felt that he wasa little too critical of the work both well or ill, on in years, and have seen which had been done by Finlay. He devoted only more things than Ulysses.I hope, my friend, a few lines to Finlay's experiments concerning that you are as well as I could desire. God Bless mosquito transmission and those few lines were you, Weir Mitchell ." not laudatory. The rest of the paper was of excel­ This is the last remaining written evidence of lent caliber because subsequent knowledge has the strong attac hment and friendship between fully jus tified that stand ofSternberg's, which was these two illustrious graduates ofJefferson College. tha t as far as he could determine, none of these They formed an intellectual partnership which in­ things which were supposed to be the cause of deed bore fruit; Charles Finlay in the experimen­ yellow fever had been proven. tal groundwork of discovering the transmission of This paper aroused Finlay. Hurt and indignant yellow fever, and Mitchell in the encouragement

Jeffer sonians O n The Wi n~ed Ox 445 of Finlay and in giving it to the medical world as applause and time has vindicated Mitchell's faith effectively as possible in both the published and in Finlay and his un failing support. the spoken word. Neither were seeking personal

John H. Gibbon. Jr.(JMC. '27): Inventor of the Heart-Luna Machine

Among the surgical giants in the history of Jeff­ sylvania Hospital (1929) and accepted a research erson. John H. Gibbon,Jr.stands as an equal in the fellowship in surge ry at the Harvard Med ical company of George McClellan, Samuel D. Gross, School <1930/30. There he conceived the idea of William W. Keen, [r., and John Chalmers DaCosta. developing an extracorporeal apparatus for tem­ Each made unique and lasting contributions in sur­ porarily supporting the function of the heart and gery. Additionally, they enhanced the reputation lungs while taking care of a patient dying of pul­ of Jefferson both locally and world wide. The fol­ monary embolism. lowing information highlights the career of Dr.Gib­ In 1931 /32 he served a Fellowship in Medicine bon with recollectionsof him by two of his residents. at the School of Medicine of the University of Penn­ Life and Career of Dr. Gibbon sylvania, but then returned to Harvard, again as a Research Fellow, for 1933/34. Dr.Gibbon then start­ John H. Gibbon, Jr. (Fig. 1), a fifth generation ed a surgical practice in Philadelphia but became ph ysician, was born on September 29, 1903, in so intrigued by the possibilities of a heart-lung Philadelphia. His father, a graduate in the Class machine that he devoted full time to this projectas of 1891 , was Professor of Surgery at Jefferson from a Harrison Fellow of Surgical Research at the Uni­ 1907 un til 1931. The younger Gibbon attended versity of Pennsylvania from 1936until World War PennCharterSchooland graduated from Princeton II intervened . He entered the service in January.. University (1923). After graduation from Jefferson 1942 (Fig. 2).. and was sent to New Caledonia in (1927). he completed his internship at the Penn- the China-Burma-India theater of operations. After Army service until 1945 and a one-month stay at the University of Pennsylvania, Dr.Gibbon resumed his investigations at Jefferson in 1946 as Professor of Surgery and Director of Surgical Re­ search. Supported by the International Business Machines Corporation and the National Heart In­ stitute.. his invention was proven practical after many successful trials on cats and dogs. It was ready for human surgery in 1953. In terms of the heart-lung machine being Dr. Gibbon's "baby", the idea was co ncei ved at Harvard.. the embryo developed at the University of Pennsylvania, and the fetus matured and was delivered at Jefferson. On May 6, 1953. Dr. Gibbon successfully re­ paired an interatrial septal defect in the heart of an Fig. 1. John H. Gibbon, Ir. C1 MC, '27). 18-year-otd girl from Wilkes-Barre, Pen nsylvania

Legend and Lore 446 (Fig. 3). She had been connected to the pump oxy­ fig. 2. Dr. .lnd Mrs. Gibbon tbe cby he Idt for overw.ls(1942). genator for 45 minutes, and for 26 minutes of that period all respiratory and circulatory functions were maintained extracorporealy, For the first time, a patient's heart and lung functions had been maintained entirely by a machine. This brillia nt achievement Initiated the era of open heart surgery for repair of congenital and acquired heart defects as well as the transplants of today (Fig. 4). Dr. Gibbon was active in matters relating to health, training, teaching. research, professional organizations, and community affairs. He served on the American Board of Surgery of which he be­ came Vice-Chairman, as Chainnan of the Confer­ ence Committee on Graduate Training in Surgery, on the Surgery Study Section of the U.S. Public Health Service, the National Board of Medical Ex­ aminers, the Sub-Committee on the Cardiovascu­ lar System of the National Research Council, the Advisory Committee on Research on the Therapy of Cancer of the American Cancer Society and the Board of Health of Philadelphia. He was Vice-President and President of the Philadelphia Academy of Surgery and of the Col­ lege of Physicians of Philadelphia. He was Presi­ dent of the Laennec Society of Philadelphia and the Pennsylvania Association of Thoracic Surgery, Treasurer and President of the Society for Vascu­ lar Surgery, Vice-President and President both of the AmericanAssociation for ThoracicSurgery, and the American Su rgica l Association and also Re­ corder of the latter. He was a long-time Governor of the American College of Surgeons and served on several of its important committees. Member­ ship was awarded him in the American Academy of Arts and Sciences, in the National Academy of Sciences, and honorary fellowship in the Society of Thoracic Surgeons of Great Britain and Ireland and in the Royal College of Surgeons of England. Although best known for his heart-lung ma­ chine, Dr. Gibbon made other research and clini­ cal con tributions. He was a distinguished edi tor of Annals of Surgery, author of Surgeryof tile Chest, and chapters in many books. He received honor­ ary degrees from Buffalo, Dickinson, Duke, fig . 3. Dr.Gibbon wilh patient on whom he performed the Jefferson, Pennsylvania, and Princeton. Other first successful operation with his heart-lung machine.

Jeffersonians On The Winqed Ox 447 e-

Le~nd and Lore 448 awards of distinction were the john Scott (Board Fig. 5. Dr. Gibbon with Dr. Rudolph Matas, a pioneer in sur­ of Directors ofCity Trusts of Philadelphia),Charles ge...,. for aneu rysms. Mickle (Toronto), Shaffrey Med al (51. Joseph's), Matas Award in Vascular Surgery (Fig. 5), Distin­ guished Service Medal (Pennsylvania Medical 5<>­ ciety), Research Achievement Award (American Heart Association), Roswell Park Medal, Albert Lasker Award in Med ical Science, Dixon Prize in Medicine (Pittsburgh). Strittma tter Award of the Philad elp hia County Medical Society, and the Philadelphia Award. His portrait was presented to Jefferson Medical College by the Class of 1963 and his nam e was inscribed on jefferson 's Winged Ox Column of the 50 most notabl e ph ysician s in medical history. Last but not least, the Medi­ cal College students continued the tradition of the Gross Surgical Society, followed by the Keen Su rgical Society, and then as Gi bbon Sur­ gical Society (Fig. 6). Dr. Gibbon retired to his farm in Media, Penn­ sylvania , in 1967 at the age of 64 (Fig. 7). On Feb­ ruary 5,1973, he died while playing tennis (Fig. 8), just prior to the planned celebration of the 20th an­ niversary of his first successful open heart opera­ tion, and just short of age 70. In 1985 a combined M.D./Ph.D. program was initia ted at jefferson under the aegis of the Medi­ cal College and College of Graduate Studies. It was named the Gibbon Scholar Program. It in­ volved seven years of study divided between the two colleges, in which the first, fourth and fifth were spent in the College of Graduate Studies and the second, third , sixth and seventh in the Medical College. The attractiveness of this unique program was further enhanced by financial aid. Given his vast investigative and clinical ac­ complishments, it was fitting that his jefferson alma ma ter honored this scientific giant with an annual John H. Gibbon, Jr. Lectureship of which the first was in 1987. jefferson finally paid Dr. Gibbo n a remaining highest honor in 1991. On january 9, in an impres­ sive ceremony, it renamed its New Thomas Jeff­ Fig. 6. Left to right: 'ohn H. Gibbon, [r, (JMC,' 27), Dr. erson University Hospital the Gibbon Building (Fig.9). Gordon Thomas, Director of Grenf ell Mission in l abrador, and John Y. Templeton, III (JMC, '41), 411 m~ling of Gibbon Fig. 4. Dr. Gibbon wilh his h~art·lung machine. Surgical Sociely.

Jeffersonians On The Wi ng:edOx 449 Fig. 7. Dr. Gibbon in relif'ftllent on his fann in Media. PA.

Lesend and Lore 450 . ·-..­~

•

Fig. 9. PLlqueo in Tmlh Sl~t ent....fKlP of 1978 Thom.n )foff~ U njye~ly Hospilal. named in honor of Dr. Gibbon.

Fig. 8. Dr. Gibbon plol ying lennis at his home in Media .

Jeffersonians On The Wi n~ Ox 451 Development of the Heart-Lung Machine at Jefferson and Its First Application in the Surgery of the Heart by Berna rd J. Miller (jMC, '43)

(Editorial note:This highl y technical accou nt docu­ pati ent during open cardiotomy for the repair ments what has proven to be the most significant of congenital defects. of Jefferso n's contributions to cardia c surgery. It As a result of Dr.Gibbon's effort with Mr. Tho­ has brought lasting fame to this institution and mas Watson, Chairman of the Board of the Inter­ untold benefit to mankind.] national Business Machines Corporation, the first The Surgical Research Laboratory was located machine was constructed. Don Rex was the engi­ in Room 831 of the College Building at 1025 Wal­ neer at IBM involved in the construction of the nut Street. The primary direc tion of the labora­ mod ified Gibbon heart-lung device.' The machine tory was continued stud ies of ex tracorpo rea l was a physical improvement of the original extra­ circuits and their ultimat e applica tion in main­ corporeal circu it described by Gibbon differing taining the ca rdiorespira tory fu nctions of a only in its external appeara nce and mechanical configu ration. The collecting bo wl at the bottom of the oxygenator cylinder was heavily gold plated, as a means of providing a metal interface which was presumably less reactive with the elements of the blood. The rotating cylinder oxygenator had been enlarged with the expectation of increasing the oxygena tion capacity sufficiently to maintain total perfusion of small dogs. As a result of anima l experimentation with the new device it became clearl y obvious that this ex­ tracorporeal circuit was unsuitable for maintain­ ing the cardiorespiratory functions of a large dog. There were multiple deficiencies in the device. The oxygenating capacity of the cylinder, despite the fact that it presented a large surface area at the blood interface could not oxygenate blood at a flow rate of five liters per minute which wou ld be nec­ essary for human ca rd iac bypass. Hemolysis within the extracorporeal circuit was unduly high. The automatic arterial control was erratic in per­ formance and could not berelied upon for precise control of the speed of the arterial pump. Un­ known at that time was the fac t that air fig. 1. Sbtch of the .appar.llhrs used in testing tbe OJlygt"f1 up­ embolization, as a result of open cardiotomy in the lake of blood filmed on two-inch strips of ~ . nd other presence of septal defects either in the interatrial mat erials. or ventricular septum during extracorporeal per-

Lesend and Lore 452 fusion, presented the hazard of air embolization to the systemic circulation, particularly to the heart and brain. In addition, the volume of cardiac venous blood returning from the coronary sinus, the anterior cardiac veins and the Thebesian sys­ tem was of unexpected volume and presented a significan t problem insofar as recovery during open cardiotomy and total perfusion was con­ cerned. Also, unknown a t that time was the fact that respiratory acidosis incident to the anes­ thesia during thoracotomy resulted in pro­ found respiratory insufficiency and high mortal­ ity in experimental animals. The method of exposing both surfaces of a ver­ tical blood film to oxygen and the use of turbu­ lence as the blood film descended, as originally described by Drinker and Richards-, was now ap­ plied by Stokes and F1ick.3 This resulted in sig­ nifican t improvemen t in oxygenation. Accord­ ingly, the first experiments with an oxygenator embodying turbulence involved lining the cylin­ der with a stain less steel screen. At this point, the engineering staff of the International Business Machines Corporation,consisting of Mr. Malmrose, Senior Engineer, john Engstrom and Leo FaIT be­ came involved in the design of a new machinecon­ taining an oxygenator using turbulence. In addition, much consideration was to be given to the major problem of precise control of blood volume and the prevention of ma lfunctio n of the arterial pump. In 1950, this aut hor beca me Dr.Gibbon's re­ search assistant and subsequently research associ­ ate until the end of 1954. There developed a close working relationship between the laboratory at jefferson and the engineers at IBM, including fre­ quent telephone conversations and visits to the laboratoriesat jefferson and the International Busi­ ness Machines Corporation. An experimental pro­ gram was undertaken with the purpose of deter­ mining the most efficient turbulent surface and geometric design for the oxygenator. Accordingly, strips of varying types of stainless steelscreen vary­ fig. 2. Photograph of the stationary screen q lindef ollyge'n­ alor with bullet-shaped lop on which the blood is filmed by a ing in gauge and configurations were studied for rolaling jet. The screen cylinder is enclosed in a plaslic cvlln­ their oxygenation efficiency. In orde r to secure der, The' rotating [et at the top and the collecting cup at the' comparative data on the oxygenating capacity of bottom are not shown.

Jeffersonians On The Win~d Ox 453 Fig. 3. Pholographs of the side (A) and the lop (8) of the bat­ genator to nitrogen with resulting elevation of the lery-type ollygen.alor. pH to a normal level. various turbulent su rfaces, a simple apparatus con­ Various turbulent su rfaces were studied with sisting of a trough type weir (a slot through which this apparatus. Among the materials used were bl<.X.XI passed in order to form a film of uniform stainless steel sc reens of different wire sizes, thickness) with a sliding side for regulating the mes hes and con figurations. Screens made of plas­ thickn ess of the bl<.X.XI film was made to accom ­ tic materials and perforated smooth metal surfaces modatea strip of either metal screen, smooth metal were found to be physically unsuitable. The screen plate, or similar plastic surface, measuring 2.54on. selected was made of stainless steel wire of O.029 ~ in width and 30 em. in length. Th e entire appara­ in di ameter with rectangular meshes horizontally tus wa s then placed within a plastic cylinder and arranged. The scree n provided an ideal turbulent exposed to an atmosphere of oxygen at room tem­ surface and provided the highest degree of satu­ perature

Legend and Lore 454 produced a film of unpredictable quality and thick­ tic member reduced the volume of blood held in ness. It was found necessary to initially brush the the pool at the bottom of the case. screen with blood in orde r to establish a complete The distributing chamber at the top of the oxy­ film The film once established was maintained as genator was made of clear plastic which tapered long as blood continued to flow from the rotatin g to a tube at the apex providin g a means of evacu­ jet at the top of the bullet shaped head. Once the ating air which might have entered during filling flow of blood was interru pted, the film was then or inadvertently asa result ofan un recognized leak lost and could be reestablished only by brushing on the negative pressure side of the venous or re­ the screen surface again. Contamination of the circulating pumps. The floor of the distributing blood was a serious concern in this instance. This chamber consis ted of a series of weirs or slits mea­ particular oxygenator had been designed to in­ suring 0.15 mm. in width and 16 mm. in depth. crease the satura tion of blood from 65 to 95% at a The volume of blood in the dis tributing chamber flow of 1000ml. per minute and was found to ful­ was held to a minimum in order to reduce the to­ fill the design specifications. tal holdup of blood within the circuit. Oxygen In order to carry the entire circulation of an av­ entered the case through a long vertical tube with erage sized dog, it was necessary to provid e an perforations on one side and escaped through oxygenator capable of oxyge nation from 65 to 95% the open ends of three tubes that varied in length ata flow rateofa minim um of 2,000ml. per minute. and positioned on the opposite side of the screens A vertical screen oxygenator of this configu ratio n in orde r to provi de unifo rm exposure of both sur­ and size would require a surface area of at least faces of all screens. 8,000 square centimeters and would have been Electrically heated nichrome wires were embed­ cum bersome and impractical to use. ded within the oxygenator case in order to main­ The geometric form was then changed to a se­ tain the case temperature slightly above bod y tern­ ries of six flat screens suspended in parallel from a perature and so prevent condensation of aqueous distributing chamber containing six weirs or slits vapor on the interior of the case. In addition, and enclosed in a clear plastic case (Fig. 3). This an electrode consisting of a small me tal plate design,so called "storage battery oxygenator", was was sea led within the wall of the case at the suggested by Mr. Alf Malmrose the engineer di­ position at which the blood level was to be main­ recting this phase of the project. Each screen mea­ tained in the pool at the bottom of the oxygenator sured 45 em. in height and 30.5 em. in width pro­ by the arterial pump. viding the required surface area to effect an increase In ord er to establish the film on the screens of in saturation with oxygen from 65 to 95%at a flow the oxygenator, the entire case was flood ed to the rate of 2,000 ml. per minute. Since the blood film top with saline solution . With both the venous and was exposed to oxygen on both sides of each recirculating pumps, blood was pumped into the screen, the area exposed to oxygen was approxi­ weir chamber. The mixture of saline and blood mately 1.6square meters. In order to maintain the was rapidly drained by means of a large drainage film on the screen after initial filming and sta nd­ port at the bottom of the oxygenator case and as by periods, it was necessa ry to provide a continu­ the mixture of blood and saline descended, the ous flow of blood over the screen surfaces. Ac­ thick layer of blood at the very top of the saline cordingly, a recirculating pump was introduced wiped the screens on both surfaces and established into the extracorporeal circuit for this purpose. a unifonn film on all screens. The drainage valve The screen assembly was suspended in a plastic was then closed when only a very small amount of case and was further stabilized by securing the blood remained in the pool at the bottom of the ox­ bottom of each screen in a separate slot within a ygenator case; the venous pump was stopped and block of plastic positioned at the bottom of the case. the recirculating pump set at the predetermined In addition to stabilization of the screens, the plas- speed. The mod ified circuit is shown in Fig. 4.

Jeffersonians On The Winqed Ox 455 E H • A I: '.

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Fig. 4. Sch~matic of the moo ifif'd heart-lung machine in 1951: A. blood rest"rvoir; B, venous pf'l"Ssure lransducet"; C, ;lutomillic fixed po rtion of the flanged tubing, the roller at venous pump shutdown control; 0 , venous pump; E. recircu­ the other end of the revolving arm began to en­ l.aliog pump: F. Oll)'gt"n input; G. rewrvoir prenure relief v;II l ~ ; gage the tubing in order to prevent back flow. H, oxygen t'llhausl; I .lind I', wt'ir assembly; I, stainless steel screens; K, ollygenalor (";I ~ ; L. filler block and screen spacers The sucking action of the pump was produced M, drain \'

Legend and Lore 456 venae cavae during both partial and total circula­ blood drawn from the bottom of the oxygenator tion. The burette provided a means of introduc­ for recirculation. The resulting rise in blood. level ing ad ditional blood to the circuit to correct sma ll in the pool at the bottom of the case then automati­ losses in blood volume during the period of total cally energized the arterial pump to retu rn an perfusion. When the flow rate through the venous equivalent volume of arterial blood to the subject pump exceeded the volume of blood supplied by being perfused by means of a cannula placed the vena cava, collapse of the veins from wh ich within the femora l artery. The pump could be the blood was withdrawn resulted in immediate manually controlled but during perfusion the cessation of blood flow into the extracorpo real cir­ speed of the pump was automatically con trolled cuit unless the suction produced by the venous by the position of the blood volume in the bottom pump was quickly terminated. As the flow rate of the oxygenator case by a new electronic device. through the circuit was increased or the volume of It was critical that the blood volume in the bot­ blood in the circuit decreased, there was usually a tom of the oxygenator be held constant in order to preliminary fluttering or intermittent collapse of prevent changes in both the animal's circulating the vein from which the blood was being with­ blood volume and the volume of blood within the drawn before complete occlusion occurred. Itwas circuit. It was also of great importance that the then necessary to diminish the rate of the venous level of blood in the reservoir should never fall so pump or adding blood to the extrarorporeal cir­ low that oxygen would be pumped into the arte­ cuit depend ing upon which was need ed. It was rial line. In such a case, the resulting gas embo­ found advantageous to provide some warning lism was rapidly fatal. when a critical flow rate through the venous pump The origi nal photoelectric con trol circuit was was approached. A small segment of this walled co mpletely unreliabl e and malfunctioned fre­ rubber tubing sensitive to small cha nges in pres­ quently. Accordingly, a newly devised electronic sure was interposed in the venous line. Cha nges circuit continually measured the capacity between in diameter of this segment of tubing weredetected the blood level and the electrode wh ich had been by a sensor consisting of a spring loaded plunger sealed within the wall of the oxygenator case. The placed in contact with the tubing wall. The posi­ blood level and the electrode functioned as part of tion of the plunger was then monitored by a vari­ a tuned capacitance across the ind uctance in a high able linear differential transformer. Change in the frequency oscillator operating at 10.7 megacycles. tube diameter resulting from intermittent collapse The capacity was proportional to the rise or fall in produced a warning audible signal and also a blood level and resulted in a frequency shift of the visible indication on a meter which al erted oscillator. The signal produced was then used to the perfusionist to either reduce the flow rate of control the current to the armature of the direct the venous pump or provide additional blood current motorof the arterial pump. With this con­ to the circuit. trol the pump could be driven to full speed by a Pump (P), the recirculation pump, had a two­ change in blood level of 3/16ths of an inch. This fold pu rpose. One function was to maintain a uni­ amounted to a change in volume at the bottom of form and complete blood film over the screens af­ the oxygenator of approximately 50 mI. at a flow ter it had once been esta blished . The second pur­ rate of 2,000 mI. per min ute. pose was to prevent change and maintain the vol­ Before return to the subject being perfused, the ume of blood in the oxygenator with varying flow arterialized blood was first passed through a Monel rates through the extracorporeal circuit. This pump metal filter on the output side of the arterial pump. was set at a constant flow rate which was higher This filter was made of Monel metal with a wire than that required for perfusion. size of0.14 mm. diameter and mesh of .3mm. which As the flow from the venous pump increased, was contained within a transparent plastic case there was a resulting decrease in the volume of with a side tube whi ch provided a means of re-

Jeffersonians On The Winqed Ox 457 I •

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fig. S. Secood IBM machin~ UK'd by Dr. Gibbon in 11K- fim o~ Mart ~r;ltion (or the ~ir of an inleralrial septal defect in 1953 (A, fron l vi~ ; 8, top view ).

Legend and Lore 458 moving any bubbles or fibrin which might inad­ produced by a Ven turi jet wi thin the circuit. The vertently have been present. The filter functioned rate of insufflation and the ratio of expiration to in reverse fashion with the blood filtering throu gh in spiration was controlled by an electronic the scree n from the exterior surface. multivibrator circuit. With the new device it was Experi ments with the modified appa ratus con­ possible to supersatu rate blood with oxygen uti­ taining the new battery type oxygenator, showed lizing room air for ventilation. Carbo n dioxide the new arteria l control and flutt er ind icator were could be removed from the circu lating blood of the encouraging and a significant improvement over subject to the point where the animal would re­ previous experiments.! In a series of twenty-one main apneic for a number of minutes after anes­ such experiments the mortality rate at this point thesia was terminated . This d evice was used in was ap proximately 60%. This was a significan t all subsequen t experiments and hy poxia and improvement over the mortality rateof 80% which acidosis were no longer perplexin g problems. had been reported prior to 1950. The mortality rate Th e principle of ex pi rato ry assistance was was unduly high despite the apparently satisfac­ subseque ntly applied clinica lly by Dr. George tory cond ition of the animals during perfusion . Haupt in the design of a mechanical counterpa rt Gasometric stud ies of the subject's arterial and to the electronic respirator," venous blood during anesthes ia with the labora­ During this period, in the development of addi­ tory respirator revealed marked hypoxia and aci­ tional co mponen ts to the circuit a nd design dosis. The concept of increasin g gas exchange by changes there were frequent consultations with the further evacua ting reserve gas from the lungs with engineers from IBM, either by phone or by very the use of suction duri ng expira tion wasconceived. frequent visits to the laboratory. Thenew electronic Anew respirator containing a timing circuit wh ich devices which had been designed and constructed alternately operated solenoid valves on both the inspiratory and expiratory sides of the device was Fig. 6. Diagram of final extracorporeal blood circuit . (For de­ constructed .' Expiration was assisted by suction scription see text.I

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Jeffersonians On The Win~ed Ox 459 in the laboratory were first demonstrated in actual the moment of occlusion of the vena cava as a re­ operation to the enginee rs. Fu rther improve­ sult of excessive flow rate, the event was sensed ments in the circuits and mechanical configu r­ by this d evice and the venous pump motors were ation were made by the engineers at IBM. Th e instantaneously stopped by the application of di­ final form of the devices was then sent to the labo­ rect current. Th e moment of intermittent pressure ratory for fu rther evalua tion in anima l experi­ variation preceding complete occlusion of the vena ments (Fig. 5 a and b). cava was indicated by a loud audible signal and Many prominent scientists from th e United also visible fluctuation on a meter. In the previous States and abroad were frequent visitors to the device, all pumps were activated by d irect cu rrent laboratory. To name some, Drs. Clarence Crafoord motors which charac te ristically produced low and Ake Senning from Sweden, Dr. Clarence Den­ torque at low speed. To overcome this feature, the nis from the University of Minnesota, Dr. Michael venous and recirculating pumps were now acti­ DeBakey from the University of Texas, Dr. Wilem vated by alternating current motors operating at Kolf of the Cleveland Clinic and many others. In a fixed speed. Variation in pump speed was ad dition, Dr. Nicholas Gimbel from the University then produced by variable mechanical transmis­ of Pennsylvania and Dr. Hans Engell from Denmark sions interposed between the pump head and the spent prolonged periods in the laboratory either motor. The motor controlling the arterial pump observing or participating in thedaily experiments. was a direct cu rren t motor con tro lled by the Significantly, one of the very strong features of variable capacitor circuit. the su rgical residency at that tim e, was the oppor­ Four self balancing record ing potentiometers tunity afforded to the residents to rotate through mounted on the front panel of the machine were the laboratory for a major pa rt of their training. used for bo th monitoring and control purposes. Among these were Dr. Anthony Debell who sub­ One recorder received the signals from three ther­ sequently becameChainnanof Cardiovascularand mocouples indicating the blood temperatureon the Thoracic Surgeryat McGill University in Montreal, venous and arterial limbs of the machine and the Dr.Charles Fineberg, Dr. Ha l Cohn, Dr. Victor subject's body temperature by means of a rectal Greco, Dr. Burgess Sm ith and a number of others. thermocou ple. In order to maintain a normal tem­ This was indeed an outstanding experience for perature, an electrically operated heater assembly the residents in cardiac su rgical technique and ob­ was positioned at the inputof the oxygenator. The serving card iovascu lar and respiratory physiology mass of the heater assembly was insufficient and during total perfusion. the high temperature gradient necessary for this Pumps (C) and (D) withdrew venous blood purpose resulted in excessive hemolysis and its use from each vena cava (Fig. 6). Pump (F) was the therefore was discontinued. recircu la tion pump that provided continuous Another recorder indicated the flow rate through flo w in excess of th e maximal expected flow the extracorporeal circuit. The transducer for this rateover thescreensand maintained the blood.film purpose was a square wave magnetic flowmeter in the oxygenator. Pump (K) returned oxygena ted. placed within the arterial limb of the circuit. A blood from the pool at the bottom of the oxygen­ third recorder continuously indicated the pH of the ator to the subject. arterial blood by means of electrodes placed in the In the final design of the flutter controls, the sen­ arterial limb for the purpose of maintaining a nor­ sor was changed to the variable capacitor which ma l pH. During standby periods, the flow of oxy­ functioned extremely well in the arterial circu it and gen across the screens resulted in alka losis. At this further simplified the mechanical design. Minute point, a mixture of oxygen and 5% carbon d ioxide changes in the diameter of the tube, as a result of was automatically substitu ted for the pure oxygen variations in pressure, produced the necessary con­ until the pH was lowered to a normal range. Dur­ trol signal to effect reliable automatic control. At ing perfusion alkalosis was no t present and the

Legend and Lore 460 ventilating mixtu re containing carbon dioxide was stopped the venous and arterial pumps but recir­ automatically interru pted and pure oxygen was culation continued within the oxygenator circuit introduced into the oxygenator, so that the film was not lost. Perfusion could then The fourth recorder indicated the saturation of be resumed after the problem was corrected . arterialized blood with oxygen before returning to The control valves for the ventilating oxygen or the subject. A cuvette placed. within the arterial oxygen carbon dioxide mixturewere located to the limb measured the light tra nsmission at 620 and side of th e machine. Th ere was al so a gas 540 Angstrom units. All data derived from the re­ flowmeter and provisions for humidification of corders was imprinted on a strip chart. both gases prior to their entry into the oxygenator Pressure se nsi ng devices were incorporated case. Viewed from the front, the six meters situ­ within the extraco rporeal circuit. One sensor was ated at the very top of the machine were either ta­ positioned proximal to the weirs and sensed pres­ chometers ind icating the speed of the pumps or in sure wit hin the recircu lating circu it. A pressure in the instance of the two venous pumps two were excess of 300 mm. Hg. resulting from dotting or additional flutter ind icators. The pilot ligh ts lo­ the accumulatio n of fibrin at the weirs ind icated cated above the meters indicated whether or not complete malfunction of the oxygenator and au ­ the machine was operating in automatic or manual tomatically sto pped all pumps. The blood film mod e. The large metal knobs located at the side of would d rain from the scree ns into the collecting the meters were used to control the speed of the chamber at the bottom of the case and could be A.c. motors by means of the mechanical transmis­ retu rned to the subject by manual control of the sions. Small knobs located just beneath these were arterial pump. Further perfusion was not feasible used to select th e mode of o pe ra tion, nam ely at this point. An increase in pressure in the arte­ manual or automatic, The panels on the left side rial line as a result of obstruction automatically of the front of the machine containi ng a number of

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Jeffersonians On The Winqed 011 461 the current requireme nt and the mac hine could then be operated manually. A numberof experiments were then undertaken with th e ne w machine in wh ich the cardiorespira­ tory functions of medium s ized d ogs were main­ tained for prolonged periods. The survival rate was 80% and th e pe riod for complete total perfu­ sion wa s ex tended to 100 minutes w ith prol onged survival. It was then apparent th at perfusion with a mechanical heart and lung device was complete­ ly fea sible and its a pplication in ca rdiotomy was seriously envisioned . A number of experi­ ment s were performed i n which the a trium was widely opened during total bypass and the bloodless interior of the heart chamber exposed with prolonged surviva l. The vo lume of ve nous bl ood re turning by way of the coro nary sinus and Thebesian system was surprisingly much grea ter th an a nticipated. This large volume o f b lood needed Fig. 8. TedJnique for lE'~pe ri m lffl la l production a to be recovered and nd repair of returned inleratrial M'ptal defect with perica rdium du ring com plete to the extracorporeal circuit in order to by...... precisely maintain the patient's blood. volume and that o f th e machine . In addition, when t he first controls w ere part of the o ximeter circuit. A dd i ­ interatrial septal d efects were produced, the haz­ tional controls pl aced be neath th e ox imeter w ere ard of air embolization as a result of air being used to activa te th e reco rders. trapped beneath the mitra l leaflets th en forced into The e ntire m achine was enclosed, although n ot the aorta became a pparent. During these experi­ sealed h erm et ically. The a tmos p here within ments the heart co ntinued t o pulsate d ur ing the machine was co nverted t o pure nitrogen cardiotomy. A number of a nimals were lost as a from a tank of co mpressed gas an d m aintained result of ai r embolization to the coronary arteries. at a few ce ntimeters positi ve pressure . At tha t time The problem was so lved b y the introduction of volatile g ases w ere utilized in the o peratin g room a ve nt int o the left v entricle. S ince t he aortic pres­ and since th e a rterial m otor co ntained a co mutato r sure duri ng perfusion is many times greater than and brushes there w as the possibility th at a n the pressure within the ve nt tube, the blood and explosive gas mixture might ent er th e ca binet re­ air p resent in th e left ve ntricle would th en be ex­ su lting in an e xplosion. pelled t hrough the ven t tube rather th an in to the There was in a ddition, an em ergency power aorta during ventricular systole? source consisting of a bank ofsto rage batteries pro­ Durin g tota l bypass a nd p rior to a right viding 32 volts D.C. a nd a m otor g enerator to p ro­ atriotomy in t he presence o f either an interatrial vide liD vo lts A'C . In th e eve nt of failure in th e or interventricu lar septal defect, a sma ll tygon tube main e lectrical supply of the hos pital, t he e lectri­ was introduced into the left ventricle through a stab cal supply f or the machine wo uld th en transfer woun d in a rela tively avascular area at the apex. automa tica lly t o th e emergency pow e r supply. The tube was then co nnected to a specially de­ Becau se of limited capacity in t his e me rgency signed chamber capable of d ispersing any air power supply, the recorders and au tomatic con­ bubbles that might be present. In addition, suffi­ trol circuits would then be inactivated beca use of cient negative pressure was maintained within thi s

Lesend and Lore 462 chamber to aspirate blood from the open cardiac chambers. The negative pressu re was limited to 30 mm . Hg. to prevent extraction of gas and the formation of foam. Blood from both sources then accumulated in a pool at the very bottom, the position of which was sensed by the variable capacitor circuit previously described . Aseparate pump then reintrod uced this blood to the extracorporeal circuit (Fig. 7) . Using this particular device there was no blood loss from the left ven tricle and the blood loss from the open cardiac chamber was minimal, thu s accu­ rately main taining the respective blood volumes. Air embolization was consistently avoided in a large number of animals in which atrial septal de­ fects were experimentally produced during cardiac bypass and subsequently repaired with a patch graft of pericardium. Interatrial septal defects were then produced under direct vision and measured an average of 2 8 ems. in size. These were repaired by perica rdial fig. 9.l. bpt'rimenully produced intenltriol l wpl.ll cMofKt re­ grafts . In some situa tions the pericardia! flap was paired wi1h pedicled periardioll p.llch in a dog M.lrl. placed withi n the atrium through a stab wound at the base of the auricular appendage in order to maintain a pedicle and ensure some degree of v i~ ability. In all instances in which these animals were subsequently examined aftersurviving sufficiently long to ensurehealing, all grafts were noted to have healed completely to the rim of the defects. In ad­ dition, those in which the pedicle had been main­ EXP 0-569 tained exhibited marked fibrosis in the pedicle. As a result of this the procedure utilizing the pedicle graft was subsequen tly abandoned . This repre­ sents the first attempt at producing interatrialsep­ tal defects during cardiopulmonary bypass and repairing them with pericardium (Fig. 8). A simi­ lar series of expe riments" involved the production and repair of interventricular defects during by­ pass with repair by direct suture closure or graft (Fig. 9a and b). Because venous pumps were at hea rt level a moderate degree of suction was needed to ensure maximum flow rate of caval blood . Tofurther minimize the problem of flutter­ ing, additional modifica tion was made using mild fig. 9b. bperi~ nl .l lly produced inte"n'fl1lricuLa r sepl.ll de­ negative pressure. Caval blood was directed into fed in .l dog's heart with parlial correct ion. a separate collecting chamber such as the collect-

Jeffersonians On The Win~ Ox 463 ing chamber for cardiac venous blood. The level of the device in human applications. of blood in the pool at the bottom of the chamber In preparation for this pha se it was necessary to was again sensed by the variable capacitor circuit increase the capacity of the oxygenator which had and from there on the circuit was as before (Fig. been designed to oxygenate blood at a flow rate of 10). Under normal conditions aUthat was needed 2CXXJ ml per minute. The oxygenator fulfilled the to initiate bypass and perfusion was the removal original engineering specifications. In order to of hemostats from the venous and arterial line and provide a flow rate of 5,000 rot. per minute which securing the ligatures about the vena cava, thus was necessary for human application, the oxygen­ directing all venous blood into the cannulae within ator was enlarged to a series of six flat screens 30.5 them. As blood from the subject entered the extra­ em in width and the length was increased to 60 corpo real circuit, the heart-lung machine would em. This oxygenator was capable of oxygenating then function automatically requiring only occa­ blood from 65% to 95% saturation with oxygen at sional adjustment to the negative pressure in the a flow rate of 5OOOml. per minute. collecting chambers and the addition of small Two children failed to survive for reasons other amounts of blood as needed. than failure of perfusion. Finally in May of 1953, As a result of a large and successful experimen­ the first open cardiotomy for the repair of an tal experience with the apparatus which functioned interatri al septal defect in an 18-year old female splendidly, Dr. Gibbon and this author, together patient was performed by Dr. Gibbon. The same with the laboratory group had every confidence heart-lung machine was mov ed to the hospital that the next phase, namely the use of the appara­ operating room along with the laboratory device tus in operations upon humans would also be suc­ used to aspirate the left ventricle and also remove cessfu l. Accordingly, Dr. Gibbon initiated the use the blood from the open right atrium. The ultimate safe outcome of this performance Fig. 10. Schematic of the extrecerpcreal circuil of the machine used in the first seccessful human bypass. (For de­ can be attributed to the complex controls which scription see text.) had been incorporated into the device. During the

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Legend and Lore 464 end phases of the repair of the interatrial septal bypass was quickly established between the bu­ defect, the weirs in the oxygenator suddenly oc­ rette and the input to the arterial pump allowing cluded. As a result of the increase in pressu re in sufficient time for the atriotomy wound to be se­ the recirculating circu it, the sensor proximal to the cu red with a clamp. At this point the remainder of oxygenator activated and all pumps were stopped the operation was terminated without incident. and perfusion ceased. Fortunately the problem This first human performance established was immediately recognized. The arterial pump without doubt the feasibility of ca rd iotomy in was placed on manual operation. Theoxygenated a bloodless field while the card iopulmonary func­ blood w hich had d rained from the screens on the tions were maintained by a heart-lung apparatus. bottom of the pool was slowly retu rned to the sub­ Th is opened the vista to open heart surgery as we ject by means of manual control of the arteria l know it today. pump. Some additional blood was required and a

Referen ces

1. Cibbon, J.H., Jr., Artificial Maintenanceof th~ Circula­ Deflation Phase of Respira tioll During An~ th~ia forSurgi­ tion During Experimental Occlusion of the Pulmonary Ar­ cal Operations. Ann. Surg. 140:569-582, 1954 . t~ry . Arch. Surg. 34:1105, 1937. 7. Miller; B.j., Cibbon, J.H., Jr., Greco, V.P., and Others. 2. Richards, A.N. and Drinker, c.K. An Apparatus for T1f~ Use of a Vf1It From Tile Left Ventricle as a Means of the Perfusion of lsotat~d Organs. J. Phannacol. Exp. Ther. Avoiding Air Embolism to the SystemicCirculation During N 76,1915. Open Ca rdiotomy with theMaintenanceof the Cardiorespi­ 3. Stokes, T.L And Rick, J.B., jr., An ImprotJlt'd Vertical ra tory Functions of Animals byQ Pump Oxygenator. Surg. Cytind" Oxygenator. Proc. Soc. Exp. BioI. Med. 75:528, Forum, P.32; 1954. 1950. 8. Miller, B.J.; Cibbon, J.H., Jr.•Greco, V.P., and Others. 4. Miller, B.J., Cibbon, J.H., jr., and Gibbon. M.H. Re­ The Productionand Repair of l1Iteratrial Septal Defects Un­ cent Advances in the Devtlopment of a Mechanical Hea rt der Direct vision with the Assistance of All Extracorporeal and Lung Apparatus. Ann. Surg. 134:694, 1951. Pum!' OxygenatorCircuit. J.Thorac. Surg. 26:598, 1953. 5. Miller, B.j., A Respira torfor lAboratory Animals Utiliz­ 9. Gibbon, J.H.; Jr., Miller, 8.J., and Debell. A. The R~­ ing Compressed Air and NegatiVt! Pressure. J. Surgery pair of InterventricularSeptal Deferts Under Direct Vision 42:722, 1957. withtheAssistana ofa PumpOxygenator. J.Thorac.Surg. 6. Albritten, EE, Haupt; C.P. and Amadeo; J.: Chang~ 28:235, 1954. In Pulmonary AlveotarVentilation Achieved By AidingThe

John H. Gibbon, Jr., (JMC, '27): A Resident's Reflections by Robert K. Finley, Jr. (JMC, '48)

To imprint is to es tablish a response in behav­ had su ch an influence on our lives and on the ior. An example in anima l husbandry is Mary's course of surgery. lamb, who followed her wherever she would go . He was a member of 33 societies and President Teachers imprint students with an indelible dis­ of six; including the American Associ ation of tinguishing influence. Thoracic Surgery, the American Surgical Associ a­ Dr. Gibbon imprinted a generation of sur­ tion, the College of Physicians of Philadelphia; gica l residents who served at Jefferson d uring the Heart Association of Southern Pennsylvania, the 19505 (Fig. I). the Society for Clinical Surgery, and the Society Toexplain this, I need to sketch out the man who for Vascular Surgery.

Jeffersonians On The Winved Ox 465 • ., •

fig. 1. Or. Gibbon with rnidt'l1tsand staff in franklin Inn (1954). laboratory. Dr. Gibbon always gave Maley's work He published 125 articles in scientific journals, due credit (Fig. 2). authored one book, and was ed itor of the Annalsof The second phase of work on the heart -lung Surgery for 10 years. apparatus moved to the Harrison Department of He received 11 awards, includi ng the Albert Surgical Research at the University of Pennsylva­ Lasker Award for Clinical Research and the Dis­ nia in Philadelphi a later in 1935. The work was tinguished Service Award of the International S0­ sponsored by Isidore Ravdin, then Chairman ofthe ciety of Surgery. Department of Surgery at the University of Penn­ He served as a visiting professor at the medical sylvania. The device was improved and enlarged schools of Baylor, Harvard, Indiana and Vanderbilt to support the complete circulation of dogs. Universities, and presented a number of d istin­ Dr. Gibbo n served in the Army in the war years gu ished lectures, including the Harvey Lecture of (Fig. 3); then returned to Jefferson in 1946 as Di­ the New York Academy of Medicine, the Conner rector of Surgical Research and Head of a Division Memori al Lecture of the Ameri can Heart Associa­ of Surgery. He continued work on the heart-lung tion, and the Arthur Dean Bevan Lecture of the machine at Jefferson. On May 6, 1953, it was used Chicago Surgical Society. successfully on a human to close an interatrial sep­ Dr. Gibbon worked as a surgical fellow with tal defect (Fig. 4), I was fortunate to be a surgical Edward Churchill at Harvard, where he met and resident with him during that time. married Mary Hopkinson, Churchill's laboratory He felt stro ngly that research should be assistant. Together they built the original heart­ combined with clinical surgery. The two disci­ lung machine. Duri ng that year, 1935, the machine plines should be practiced together. The first year had supported the circulation of a cat. He never of the surgical residency was spent in research tired of telling of the elation that he and Maley, in the laboratory. as he called her, shared the first time an animal In 1950, work on the heart-lung apparatus was was su ccessfully mainta ined without any pul­ Dr.Gibbon's most consuming interest, but he had monary circulation by using the machine. He Fig. 2. Or. and Mrs. Gibbon working together on Ileart-Iu ng said they were so joyful they danced around the machine.

Legend and Lore 466 Jeffersonians On The Win~ed Ox 467 Fig. 3 . Dr. Gibbo n in World War II. other interests as well. Fred Coller, M.D., of the University of Michigan had described water into xi­ cation in surgical p atients . This co ndition arose from the use of glucose in wat er given post-opera­ tively to surgical patients for a long period of time , producing an e lectrolyte d epletion a nd water in­ toxication. Dr. John T empleton, ' 41, and I worked on th is subject by noting cha nges in electrolytes in serum and urine o f surgica l patients w ho h ad esophageal resections. Dr.Gibbon obtained for us one of the f irst flame photometers in Phil adelphia to s tudy sodi um, potassium and chloride . My in­ troduction to research and its application t o clini­ cal medicine c ame as a res ult of my s urgery resi­ d ency with Dr. Gibbon. The laboratory was part of t he suite that con­ tained the whole so-ca lled "B" surgical d epart ­ ment, or Dr. Gibbon's part of t he clinical surgery. The other part of th e s urgical d epartment was headed by Dr . Thomas Shallow. Dr. Gibbon w as also in charge of s urgical research. He had as as ­ sociates Drs . Frank Albritten and J ohn Templeton, and Dr. Bernard Miller as research director. All had offices in the s uitealong with t he l aboratories. -----. The h eart and lun g apparatus under development _ Ce _... was housed in the l __ .... r '-i _+4 / arger part of the laboratory. --~,.." John Templeton and Ishared an office a nd a s , '6 .... ~"'---1r:"-_ , maller lab further down the hall. Frank Albritten's o ffice -c:- :.: - 1= ;;; ;.: J was across from th e larger laboratory co ntaining the h eart-lung machine. At that tim e much of the I• thrust was to prov e I that the heart-lung machine could sustain an animal for a reasonable length of i time, allowing the surgery to be perf ormed on th e heart in a dry field. • _ ...... ,..,<.Mo. I Survival after such an in tracardiac procedure I was importa nt and the recoverin g . :&';*< : C . c' " c. ' '-; _ ...! animals had to be e_ C M nursed during the eve ning h ours. Often they e 4 _ ..... L ' I -".41(~ _ . « ti l::' ...... ~ would wander through the suite during th e -~ . j J r- evening and occasionally use w hatever f aci "---"' e~ lities -,~~ " _"_ .... _"- """.e;::.:>0 .. . __e I were open to re lieve th emselves. - 7 I _ Frank Albritt en's - - -"'" - - - - - J - - --....- ... ~~ "' - -"-~ - l office was a co nvenient spot and h e was so metimes ---...... -_7 - --.....-=------greeted in the morning by such a deposit. Dr.Gib­ - - bon was always able to smooth t hings over with grace. He a ssured all concerned that it would n ot Fig. ... Anl"Sthesi.oro reco rd of worl d's first successful operalton happen again, the animals would with Dr. Gibbon's heart- lung machine . be suitabl y co n­ fined, and so forth .

Lesend and Lore 468 During that time, there was intense interest in a bit of heat. We had just opened the atrium so the progress of the heart-lung machine. Many visi­ Frank wanted a picture of it but got a little close to tors came to the labora tory to see Dr.Gibbon and the back of Dr. Gibbo n's neck, flashed it, and Dr. the work in progress. Dr.Gibbon always discussed Gibbon jumped in respo nse. We were all quite in­ and disclosed openly all of his wo rk with the visi­ tent on the subject at hand, but Dr. Gibbon had tors who includ ed Drs . DeBa key, Crafoord, time for an expletive, at least. The case went on Shumacker; Blalock, Bahnsen, Gerbode and many satisfactorily. Wefelt ready for the first humancase. others. Much of the engineering for the machine May 6th, 1953, started ea rly for Dr. Bernard. was done by International Business Machines Co. Miller who got the machine up well before dawn. through the courtesy ofMr.Tom Watson , who came There was a great crowd of people in the operat­ at least on one occasion to visit tha t I recall. ing room so Dr.Gibbo n eliminated a nu mber of Dr. Gibbon was careful to give credit to those them. Torn Nealon, 5'44, the senior resident, exer­ who helped.He often referred to Mr.Tom Watson's cised his status and replaced me as the assistant to support as well as to the roller pump described Dr.Gibbon, while FrankAlbritten acted as his first first by Dr. Michael DeBakey. Drs. Lane Stokes and assistant. My role was to monitor the blood pres­ John Rick had modified the oxygenator to make sure through an arteria l line in the radia l artery. it mu ch more efficient and he always referred I recorded a brief operative note at the close of to that. Dr. Bernard Miller did a great deal of the operation. The case wen t well, the patient work on the circuitry of the machine, which Dr. was cured, and the news of the procedure spread Gibbon acknowledged. rapidly. We were all elated at the tangible The clinical part of the residency was interest­ success we saw. ing. Dr. Gibbon had recruited a loyal group to Dr. Gibbon conducted teaching rounds on the operate the service co nsisting of Drs. Geo rge wa rd each week when he was on.He would also Willauer, John De'Iu erk,Frank Albritten, John come in to help a resident with a difficult case at Templeton and Adolph Walkling. Others made im­ night. 1 remember a particularly sick patient Dr. porta nt contributions but that group seemed to Charles Fineberg had, with a bleeding ulcer. Dr. shoulder much of the work. Gibbon helped him in surgery during the night by Dr. Gibbon operated in a spirited fashion and pumping blood and starting IV's. felt that the whole operatio n should move briskly. He conducted student clinics in the amphithe­ He operated in tennis shoes, which were appro­ ater. It always amazed me that he would approach priate. I recall an instance when one of the resi­ a case cold and give a very learned discussion of dents caught Dr. Gibbon's hand in the rib spreade r it. He would come down to the "pit" just before as he was removi ng it. That produced even more the clinic, ask a few questions about the cases, and action. Ou r operating rooms were not equipped start with the clinic. He had a tremendous grasp with air-conditioning then, so there was consider­ of the field of surgery. able mopping of brows during a procedure. Dr. Gibbon and his wife, Maley, usually had a Closing of the intera trialseptal defect was sched­ Christmas party at their home on Pine Street for uled for May 6, 1953. We practiced the procedure the people in the lab and the residents. There were in the laboratory before that da y. As I recall, it was few residen ts at that time so the group was not too unreasonably warm, so the windows had to be large. He loved to make "fishhouse punch" in the open for air. The hospital was under construction bathtub. It was a beverage to induce conviviality then and pile drivers were used to drive steel sup­ in short order. I recall some very memorable con­ ports into the earth just outside the lab. The heat versations at those parties. and noise were intense. Remembering Doctor Gibbon's energy, enthu­ Frank Albritten had a new camera which he siasm, optimism and naivete seems to have im­ wanted to use. It had flashbulbs which produced pressed me most. He usually bounded the stairs,

Jeffersonians On The Winqed Ox 4 69 which m ay have kep t him in shape for hi s tennis. lesson in English as well as scien ce. He felt strongly He did smoke and n ever apologized fo r it. A t th e that a ll of th e data s hould be presented, while I time smoking was still common , although most of like averages, means, and so forth . The f avorite the residents did not smoke afte r ca ring for patients time fo r paper writing was Sunday afternoon at with carcinoma of th e lung. He see med eternally his home. So me of t hose sessions could best be optimistic. I can remembe r a patient who devel­ described as a learning experience. oped a lea k from th e du odenal s tump after t otal I was introd uced t o morbidity a nd mortality gastrectomy. She was very ill, bu t h e was ever rounds at j efferson with Dr. Gibbon. I w as i m­ optimistic about her and helped me as a resident pressed that we discussed every death and every caring for h er. He was extremely h elp ful to the complication on the s urgical service. I believe he family and that impressed me. He see med very got the i dea from his time in Boston , and I hav e intelligent, yet naive in a refresh ing way. He wo uld carried it to my community. It is one of th e more always accep t whatever was told to him as fact. It valuable teaching mechanisms. Dr. Gibbon was was a characteristic which a llowed him to deal with always careful to present his own complications people very ef ficiently. They were all a li ttle more and be very f rank about th em. He a lways led the careful about what they sai d t o him, knowing that d iscussion away from any personal confronta­ it was accepted as truth. He seemed to a lways say tions. Those guidelines have helped us all in in ­ yes and never r efused a req ues t, t hat I witnessed. stalling such sessions. Many times the r esponsibility fo r carryi ng out There are a few people who influence us during much of the task fell to ot her members of the staff , our life. 1think most of us hav e someone in med i­ but he cou ld get anyone t o do just abou t anything. cine w hom we a dmire and from whom we can Dr. Gibbon was good to ta lk with. A resident team. At jefferson, in th e 1950s, there were many needs such a person. He was available t o most people who were influen tial in shaping my career of us an d n ever be littled anything we said or did. in surgery, but Dr.Gibbon was probably the great ­ He had approvals and disapprovals, but would est example. He created an atmosphere for young listen a tten tively while th e posi tion was exp lain­ people t o grow and t o lea rn. an environment that ed . He enco uraged us to t hink and to spea k of allowed one to make mistakes a nd l earn by them. what we thought. He was always supportive and stimulating to all He e ncouraged our research efforts by review­ of us. At a time of imprinting, he was there to ing projects set with us, and helped in t he prepara­ an example for u s. tion of papers. Writing a paper with him was a

From the Era of Physiology to the Era of Technology: Recollections o f a Gi bbon Resident by Anthony R C. Dobell, M.D.

I would lik e to reca ll Dr . Gibbon as 1 knew him we talked about. He exuded a vitality that stimu­ in the early 1950s , when Iwas a resident at jefferson lated the people around h im. And f rom this inter­ Medical College. Serend ipity had l ed me to him view, I began t o learn one important l esson : what­ as a s tudent f rom a nother medical school, and my ever subject we were going to discuss, I h ad better first recollectio n is of a brief interview I had with have an opinion ready because he w as going to him at t hat tim e. I r emem ber how energetic he ask fo r it. Later on, I realized that Dr. Gibbon was and how he as ked m y opinion of the things treated all opinions with great respect, sometimes

Legend and Lore 47 0 greater than they deserved, and that it was there­ fore important to present well-considered judg­ ments and information. But let us set the scene. In the early 1950s, the Korea n War was still in progress, commercia l flights were propeller-d riven, the few television sets were black and white, the West had all the atomic bombs, and mathematical calculations were done with slide rules. During this period, Dr. Gibbon was at the peak of his career. He was a Professor of Surgery at Jefferson, where his father (Fig. 1) had also been a Professor of Surgery. Born three years after the tum of the century, Dr. Gibbon was in his early fifties when I was a resident. His surgical preparation had begun with a research fellowship under Edward D.Churchill, M.D. at Harvard Medical School, and had contin­ ued in surgery and research at the University of Pennsylvania School of Med icine. Dr. Churchill, he ld in g reat res pect by many later leaders of American surgery whom he trained, is rega rded fig. I. John H. Gibbon, If. (JMC, '27) with his father (left), as Dr. Gibbon's mento r. Certainly, Dr. Gibbon al­ prof~W), John H. Gibbon (JMe, 1891 ). Note the strong physi­ ways spoke of Dr. Churchill with affection and a cal fewmblance. certain reverence, and echoed Dr. Churchill's con­ viction that surgery was a sing le broa d discipline, m a jor advances in Am erica n surgery. The a conviction shared by many lead ers of that pe­ ed itorship was a responsibility that particularly ri od w ho o pposed the establish men t o f suited Dr. Gibbon because he had a facility for the subspecialties. Dr. Churc hill has been described English langu age, a love of words, and a passion as a great humanist, and if this term is taken to for learning of any ad vance in surgical knowledge. ind icate a lover of people, then it certainly would He told me once that he read and dictated an opin­ apply to Dr.Gibbon also. Dr.Gibbon married Mary ion on eve ry paper submitted to the Atl1la ls while Hopkinson, Dr. Churchill's chief technician, and he was editor, and that sometimes he would over­ the marriage was so close and so central to the lives ride the opinion of those formally assigned to re­ of Dr. and Mrs. Gibbon that it is no wo nder they view a paper. I remem ber wa iting in his office always spoke of Dr. Churchill with affection. while he dictated some of these evalua tions on to a At the University of Pennsylvania, Dr.Gibbon floppy belt. He would tum on the machine and worked closely wit h Dr. Eugene Land is, who sub­ dictate straight throu gh with no hesitation , no loss sequently became professor of physiology at of his train of thou gh t, no corrections. And his Harvard Medical Schoo l. Dr. Gibbon's prepara­ comments wo uld incl ude recommendation for tory years seem to have been d ivided equa lly be­ changes in this table or that figure and always an tween physiology and surgery. analysis of whether the conclusions were justified In recalling the ea rly 1950s, I th ink th at Dr. by the data presented. Gibbon's major interest was the ed itorship of the In those days, professorsstill taught entire medi­ Annalsof Surgery, the prestigious journal of great cal school classes. One of the weekly features was tradition that had long served as the vehicle for Dr. Gibbon's "Pit," so called because the floor of

Jeffersonians On The WinQed Ox 471 Dr. Gibbo n had a sizable practice, though lim­ ited by his many other interests, and it consisted pri marily of patients referred for lung. or, less of­ ten, esophageal cancer. The bronchoscopies or esophagoscopies were done by Lou is H. Clerf, M.D. (jefferson ' 12) and his associates, who then di rected the bronchoesophagology clinic set up by Chevalier Jackson, M.D. ijefferson 1886). Aconse­ quence was that the thoracic residents were ex­ cluded from this activity. At any rate, the result w as a steady flow of patients with lung and esoph­ ageal cancer. Dr. Gibbon's tou r de force was the radical pneumon ectomy. I can recall hi s tall, ene rgetic figure as he scrubbed for such an operation. Clad in the white scrub suit of the time, wea ring old sneakers and likely a white sweatband, he might talk of what a splend id fellow the patient was and of how we must get the cancer out and save his life. The operation tended to be slightly hyperactive. All vessels were clamped and tied with cotton thread, and the electroca utery was never used. Often, ties were passed on instruments that multi­ fig. 2. Dr. Gibbon (left) Iwuring in "Pil" ofThornpson Annell. plied the movements in the operative field. The pulmonary artery and veins were secured with the aud itorium was depressed and you reached it transfixion sutures, and the divided bronchus was via a subterranean pa ssageway, as in a Roman closed with interrupted sutures - of silk, as 1 re­ amphitheater (Fig. 2). Residents and interns sat in member. The paratracheal and subca rinal nod es the front row and behind them ranged the entire were removed wit h the specimen and the opera­ senior class. The format was consistent: patien ts tion was aggressively d one, yet in relative safety. were presented by clinical clerks, and Dr. Gibbon The patient would be returned to his or her room would interrogate as he soug ht to bring out wherever it might be located in the hospital, and im portant d iagnostic or. therapeutic points. He the residents would make rounds every few hours, was not informed in ad va nce w hich patients day and night, ofte n pe rforming nasotracheal had been chosen by the resid ents, and sometimes aspi ra tion to remove accumulating secretions they would conspire to lead him astray with an from the remaining bronchus. The results were atypica l presentation. outsta nd ing, and Dr. Gibbon too k great pride. On the other hand, the residents were always in the postresection su rviva l ac hieved by his slightly nervous, lest some diagnostic study had associates and himself. been omitted or a resu lt forgotten, The sessions Dr. Gibbon's laboratory was located in the suite were good teaching and good entertainment. In containing the surgical offices. I was the resident addition to specific surgical instruction, Dr. Gib­ assigned to the extracorporeal circuit in 1953/54, bon taught the students to trea t patients with dig­ together with Dr. Hans Engell, a research fellow nity and human interest, and medical and surgical from Copenhagen, who subsequently had a dis­ colleagues with respect and consideration. tingu ished and productive career in his nati ve

Legend and Lore 472 Denmark. The daily activities of the laboratory were overseen by Bernard J. Miller, M.D. (Jefferson '43), a brilliant individ ua l with broad su rgical knowledge and interests. Dr. Gibbon rarely came to the laboratory at that tim e. He came when there were visitors like Crafoord or Senning or Bjork or Hen ry Bahnsen, all of wh om were determined to expand surgery to include intraca rd iac operations. But, in truth, there was little such d rive at Jefferson in tha t year despite the successful closure of an atrial septal defect in May 1953, and possession of the only proven heart-lung machine in the world. The superb appa ratus was primaril y a laboratory tool, and a series of experiments were cond ucted throughout that year, first on closing ventricular Fig. 3. Or. Gibbon perfonning first successful open heart op­ septal d efects and later on cardiopulmo nary by­ eraucn (May 6, 19531. passes of two hours' duration. It is hard to explain why successes were no t period ofseveral years. Mr. Watson stipulated that forthcoming after the successful open-heart opera­ IBM would build a prototype and that it would tion of May 6, 1953 (Fig. 3), w hich was o nly never engage in co m mercial development. repo rted a year later in a regi o nal surgical In fact, IBM constructed a prototype, improved journal. Certai nly, Dr. Gibbo n knew the signifi­ it with a seco nd d esign , and improved that with cance of his accomplishment and telephoned his the final mod el. frien d Dr. Clarence Cra foord in Stockholm the The goa l was to reprod uce normal physiology ­ evening of the proced ure. normal flow, normal pressures, normal acid-base Why was the ad vantage no t exploited? I think balance, normal temperature, and so forth. Venous that wit h the successful procedure, Dr.Gibbon had drainage, for example, wasby gentlesuction rather achieved his goal, which was to takeover the func­ than siphon drainage, so that normal venous pres­ tion of the heart and lungs of a human for a sig­ sure would prevail in the venae cavae. No azygos nificant period of time. Initially, back in the 19305, flow here! No physi ologic liberties were to he had thou ght the indication might be for pul­ be taken . Large paper reco rders were to chart mon ary embolectomy. After the war, Dr. Gibbon physiologic parameters during card iopulmonary had thought the initial use mightbein pati ents with bypass. Unfortunately, most of the sensors were intractable heart failure - that is, as a circuit to re­ not up to this tas k and these reco rds were not verse secondary organ deterioration. The point is read ily available, but the objectives of the appara­ that Dr. Gibbon's focus was not the repair of con­ tus were evident. genital cardiac lesions, but rather the establishment It is clear that Dr.Gibbon was a physiologic sur­ of the heart-lung machine. gam. His career spanned the era of physiologic Fortunately, in the late 19405 Dr. and Mrs. Gib­ surgery. Earlier, d uring the professional life of Dr. bon (they had wo rked together) had been be­ Gibbon's father (John H. Gibbo n, M.D., Jefferson friended by Thomas Watson, the patriarch of IBM 1891) and before, the age of anatomic surgery was Corporation

Jeffersonians On The Winqed Ox 473 Fig. 4. Mr. Thoma ~ Watson of IBM Corpo ration .

Legend and Lore 474