The Remarkable Surgical Practice ofJohn Benjamin Murphy. Edited by Robert L. Schmitz and Timothy T. Oh. Urbana and Chicago: Univ. of Illinois Press, 1993. Pp. 207. $39.95. J. B. Murphy, 1857-1916, a Chicago surgeon who during his last twenty-one years was chiefof surgery at Mercy Hospital, has inspired this evaluation, written by fourteen current staff members of that institution. As the title indicates, they have focussed on Murphy's surgical prowess, which was considerable. His reputation persists in the Murphy button and the Murphy drip, and he pioneered the use of early operation for appendicitis, therapeutic pneumothorax, and blood vessel anastomosis. The Murphy button is a device that allows rapid performance of bowel anastomosis, an important advance during the early development of anesthesia and abdominal surgery. The drip, for rectal instillation of salt solutions, was widely used before intravenous fluids were practicable. A major scholarly achievement of this volume is provision of an extensive bibliography; an index, however, is lacking. Murphy was well known for his instructive talks, many delivered to packed amphitheaters during his operations; 617 transcriptions were published in the first five volumes of Surgical Clinks (now Surgical Clinics of North America) which he helped to found. More formal publications number 143; there are duplications in both groups, but the coverage of practically all important surgical topics is extraordinary even for those unspecialized times. In addition to what is now general surgery, Murphy contributed energetically to thoracic surgery, gynecology, orthopedics, neurosurgery, urology, and vascular surgery. Broad-based knowledge and a discursive style are represented in this sample from a four-part series on thoracic surgery (JAMA 1898, vol 31, p. 296): "The pathology of repair of pulmonary tubercular cavities involves certain physical conditions which are peculiar to the chest (they exist to a certain degree in abscess of the bone and brain), namely the constant resistance of the bony framework against contraction, the effort at expansion of the cavity in each inspiratory act." Illustrations from several other papers by Murphy, and other quotations, are reprinted in the book. Murphy's wealthy spouse fitted out a laboratory for him, placed in an outbuilding of his home, where he developed his button and other techniques by testing them in animals. He revealed at times an arrogant personality. He did not get along well with the Chicago medical community, whose members consequently were slow to recognize his merit even after he had earned a distinguished reputation nearly everywhere else. It appears that he sought publicity, which was then considered unethical. In two major public emergencies requiring surgical expertise—the Haymarket riots and the superficial bullet wound of Theodore Roosevelt— Murphy took complete charge with minimal consultation. He avoided sharing responsibility with other eminent Chicago surgeons such as Christian Fenger or Nicholas Senn who might have helped with the many patients seriously injured during the riot. The news featured Murphy. Although he was considered an outstanding teacher, partly because of his readiness to give clear and knowledgeable lectures, Murphy apparently had little interest in providing surgical training, which requires close guidance of apprentices as they begin to operate and to investigate. Unlike his famous conPerspectives in Biology andMedicine, 37, 2 ¦ Winter 1994 | 309 temporary, William Stewart Halsted, Murphy did not develop and promote a distinguished school of surgeons. There apparently was little interaction between these two giants. Murphy did describe a sort of radical mastectomy, but it was not guided by Halsted's principle (" . . . the suspected tissues should be removed in one piece"), Halsted was not mentioned in this article (Surg. Gyn. Obst. 2:84—89, 1906), nor was there a follow-up of patients. Murphy's gravest fault was a lack of simple honesty, documented in another interesting biography by Loyal Davis (J. B. Murphy, Stormy Petrel ofSurgery, N.Y., Putnam, 1938, p. 163). (I did not find this note in the present volume, which tends to be more laudatory.) Murphy wrote to a coauthor who was preparing a paper on the "button" for publication: "If Abbe's case terminates fatally, as I have some fear it will ... I would not include it in the numbers." This smoothing of reported facts, not of course acceptable, is perhaps justified...
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