John Benjamin Murphy (1857 - 1916)

Abstract

Amale, 45 years of age, presents to the emergency room with complaints of fever and right upper quadrant abdominal pain. Could this patient have acute cholecystitis? How will you confirm your suspected diagnosis? Acute cholecystitis can be suspected in patients with a history of fever and right upper quadrant abdominal pain. Clinical examination often reveals fever, jaundice (often very subtle), and right upper quadrant tenderness. If pain with inspiratory arrest occurs when the inflamed gallbladder comes into contact with the examiner’s hand, the patient has a positive Murphy’s sign. Dr. John Benjamin Murphy (figure 1 ) will be best remembered for this clinical sign that is used in evaluating patients with acute cholecystitis. Other eponyms associated with him include Murphy drip, Murphy’s button, Murphy’s punch, Murphy’s test, and Murphy-Lane bone skid.1 His other pioneering works include performance of end-to-end anastomosis of hollow viscera, early surgical intervention in cases of appendicitis, use of pneumothorax to treat pulmonary tuberculosis, surgical intervention for prostate cancer, and reconstruction of ankylosed joints. His career spanned the fields of general surgery, orthopedics, neurosurgery, and cardiothoracic surgery gaining international prominence in the surgical profession. William J. Mayo described him as “the surgical genius of our generation.”2 Figure 1. John Benjamin Murphy, MD. Photo by Moffett Studio. Reprinted with permission by the American College of Surgeons. John Benjamin Murphy was born of Irish immigrant parents on a farm in Appleton, Wisconsin on December 21, 1857.3 His parents had immigrated to the United States to escape the scourge of the potato blight in Europe. Murphy was a very eager and hardworking student. He graduated from Appleton High School in 1876 and from Rush Medical College in 1879 at 22 years of age. Unlike many of his counterparts of that era, Murphy enrolled in an 18-month internship at Cook County Hospital (Illinois), practiced for a few years, and decided to go to Europe in 1882 for 2 years of further studies. While in Europe, he studied under prominent surgeons including Dr. Theodor Billroth. In 1889, Murphy advocated for early surgery in the treatment of appendicitis to prevent complications. He performed one of the first operations in early acute appendicitis,4 but his initial presentation to the Chicago Medical Society was met with much skepticism. Realizing this, he set out to document his cases and collected more than 250 cases over 4 years. During that time many physicians advocated conservative management of cases of appendicitis, and his recommendations for early surgery were met with considerable resistance until he was able to present his case records. When he next appeared before the Chicago Medical Society, he spoke with authority on this subject. Working far beyond his era, Murphy practiced evidence-based medicine. In 1892, at the age of 35, Murphy designed Murphy’s button that, in his own words, “…would revolutionalize intestinal surgery”.5 Murphy’s button is a mechanical device that allows approximation of hollow viscera without sutures. Though another surgeon had described a similar device, Murphy improved on the design, demonstrated its efficacy, and cleared the way for successful cholecystectomies. He first tested the device on a dog; later reporting on his animal experiments and human operations in a December 1892 article entitled “Cholecysto-intestinal, gastro-intestinal, entero-intestinal anastomosis and approximation without sutures.”6 Murphy’s interests spanned a variety of surgical fields. In 1897, he published an article on end-to-end anastomosis of vessels7 that was the pioneering work in the field of vascular surgery. He also promoted the treatment of pulmonary tuberculosis with injection of nitrogen into the pleural cavity to compress the lung, which he described as “therapeutic pneumothorax.”5 He introduced the method of saline infusion per rectum for the treatment of peritonitis,8 pioneered the use of local anesthesia in surgery of the lung,9 and also showed an interest in neurosurgery by studying surgery of the spinal cord and the peripheral nerves.10 At Mercy Hospital in Chicago, Murphy conducted “wet clinics” in which he operated and taught in front of an audience. These clinics were very popular and attracted physicians from throughout the United States, as well as from Canada and some foreign countries. In order to disseminate his presentations to a wider audience, he started the publication, The Surgical Clinics of John B. Murphy, M.D., at Mercy Hospital, Chicago. This publication formed the basis for The Surgical Clinics of Chicago, which were later named The Surgical Clinics of North America. 11 Some considered Murphy’s approach to medicine to be overly pretentious. In fact, his work was more highly regarded and accepted in Europe than in Chicago. Murphy died on August 11, 1916 on Mackinac Island, Michigan of aortitis after suffering from angina. Two days prior to his death he had written, “I think the necropsy will show plaques in my aorta” and, indeed, this was later confirmed at autopsy.5