Book Review

The Remarkable Surgical Practice of John Benjamin Murphy

N Engl J Med 1993; 329:1208October 14, 1993

Article

The Remarkable Surgical Practice of John Benjamin Murphy
Edited by Robert L. Schmitz and Timothy T. Oh. 207 pp., illustrated. Champaign, Ill., University of Illinois Press, 1993. $39.95. ISBN: 0-252-01958-X

This collection of articles about John Benjamin Murphy resurrects an almost forgotten figure in the rise of surgery in the United States. Born in a Wisconsin log cabin in 1857, Murphy eventually became chief of surgery at the Mercy Hospital in Chicago, a position he held from 1895 until his death in 1916. His life was a combination of a Horatio Alger story and a Theodore Dreiser novel.

An inveterate self-publicist and social climber, Murphy was never short of enthusiastic detractors. His flamboyant style, his lavish office, and his knack for placing himself in the public arena drew patients as well as criticism. His enemies, more envious than offended, illustrate the truth of the Russian proverb “The dogs bark at the rider traveling the fastest.”

There was more to John Benjamin Murphy, however, than facade. His range of interests and accomplishments was astonishing. As this book documents, Murphy was a pioneer in making surgery a specialty. Ever in the forefront, he recognized early the validity of asepsis, the value of diagnostic and therapeutic radiography, the benefit of arsenicals for syphilis, and the importance of experimental research for the advancement of clinical surgery. He built a laboratory in his barn, where his wife assisted him by serving as technician and anesthetist for the animals.

Among Murphy's achievements were improved repair of nerves and blood vessels (he was among the first to perform an end-to-end arterial anastomosis in a patient), the use of induced pneumothorax for tuberculosis, the development of vaccines for infections, “early” elective appendectomy before rupture, the elucidation and treatment of intestinal obstruction, the recognition of the benefits of proctoclysis for peritonitis, the development of a simple, rapid, and effective technique for intestinal anastomosis (Murphy's button), and better operations for aneurysms, exstrophy of the bladder, paralysis after osteomyelitis, and joint ankylosis. He was far ahead of his contemporaries in treating cancer of the breast; he left the pectoral muscle but did remove the fascia and axillary lymphatics. To reduce the resultant deformity, he turned flaps from the major pectoral muscle or from the latissimus dorsi and subscapular muscles. His interest in what today we would call plastic surgery extended to devising flaps for reconstructing the face after ablation of cancer and for releasing burn scars of the upper and lower extremities. He was among the first surgeons to demand a sponge count (he refused, however, to wear rubber gloves).

Murphy was considered the outstanding teacher of his era. Twice a week hundreds of physicians from the United States and abroad crowded the amphitheater where he operated and lectured. He once stated:

The most valuable portion of my medical experience has been derived, I believe, from the fact that during all these years of practice, in spite of the not inconsiderable labor which it involves, I have not only seen, but also examined carefully, practically every patient on whom I am expected to operate. That is my system.

Many maneuvers in physical diagnosis bear his name; among the most famous is “fist percussion of the kidney” to detect acute urinary obstruction or renal infarct. His practice was enormous and on one occasion included Theodore Roosevelt, whom he supposedly pirated from other surgeons, after an assassin's bullet lodged in the former President's chest wall, sparing the lung. In fairness to Murphy, Roosevelt, who had heard of Murphy, requested that he be his primary physician.

As one might imagine from Murphy's fierce ambition and restless creativity, his energy was not confined to the operating room. He helped found the American College of Surgeons; Surgery, Gynecology and Obstetrics, of which he later became editor; and the Surgical Clinics of North America, whose forerunner was the published version of Murphy's weekly lecture notes.

Murphy's life mirrored the growth of the Midwest as well as its medicine and surgery. The Doctors Mayo, Crile, and Cushing were among his friends and admirers. Although Murphy did not have a true clinic, he was one in himself. Unfettered by the strictures of tradition he might have encountered in Boston, Murphy was free in Chicago to set the pace -- a remarkable one, indeed.

This book is a good introduction to a noteworthy contributor to 20th-century surgery, which will be enjoyed by surgeons, especially general surgeons with an interest in history. A source of mild frustration is the absence of an index, which is almost compensated for by a splendid bibliography of writings by and about Murphy. For those who wish to learn more personal details, including the story of Murphy's formative two years abroad, when he met Billroth (who became an important clinical model), I recommend Loyal Davis's J.B. Murphy: Stormy Petrel of Surgery (New York: Putnam, 1938).

Robert M. Goldwyn, M.D.
Harvard Medical School, Boston, MA 02115

Citing Articles (1)

Citing Articles

1. 1

   Kaushik Bhattacharya, Neela Bhattacharya. (2008) John Benjamin Murphy — Pioneer of gastrointestinal anastomosis. Indian Journal of Surgery 70:6, 330-333
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