Patrick D. Guinan, MD, MPH and George Dunea, MD

Chicago, IL 

 

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John Benjamin Murphy, Wellcome Library, London

The grand surgical auditorium of the American College of Surgeons in Chicago still bears the name of JB Murphy, the tall, slim, blue-eyed boy from Appleton, Wisconsin, born in 1857 on a farm into an Irish family that escaped the horrors of the potato famine to make a new life for themselves by farming in America. The youngest of six, he began life simply as John Murphy but at seventeen added Benjamin to his name and eventually became known simply as JB. The family had worked hard and successfully developed the farm, but John had early on displayed distinctive intellectual ability and curiosity. Not content to remain a farm worker, JB first became a teacher and later an assistant to the local druggist, sweeping out the store, running errands, and filling prescriptions for Blaud’s pills and other remedies for the local medical practitioner. One day this doctor needed JB’s help to resuscitate a man bleeding from extensive injury to his leg. The boy helped, fascinated and untroubled by the sight of blood, and decided to become a doctor.

This was the time when medicine on the frontier was still primitive. Local practitioners had to treat all surgical and medical cases primarily by prescribing calomel and paregoric and performing amputations. JB saved money to become the doctor’s trainee and assistant. His job was to sleep in the office, keep it clean, accompany the doctor on calls, run errands, study in his spare time, and pay the doctor a $200 a year honorarium. He sent to New York for copies of Gray’s Anatomy and Drapers Physiology and worked night and day, also studying and learning the muscles of the body and its bones.

After one year the old doctor said he had nothing more to teach him, and that he should go to medical school. He was twenty years old, and in 1889 was admitted to Chicago’s Rush Medical College after passing an examination in arithmetic, handwriting, spelling, and grammar. Tuition was $65 per year, and he had to attend two series of lectures, perform anatomical dissection, and take one course in chemistry, including urinalysis. He learned about the famous doctors of the past, Vesalius and Ambrose Paré, but was stimulated by the more recent discoveries, the invention of the ophthalmoscope, the cell theory, heredity, Pasteur’s discovery of bacteria, and Joseph Lister’s use of carbolic acid. He served his internship at Chicago’s Cook County Hospital, which at the time had a capacity of 450 patients, meeting the local greats such as Christian Finger and Frank Billings. In 1881 JB was offered a position in the practice of his mentor at a modest salary but with the right to build up his own practice. But he first spent a year visiting the great medical centers in New York, London, and Paris. He met Theodore Billroth in Vienna and went to Berlin as well as to Heidelberg.

But success in practice came slowly, too slowly for someone bent on becoming rich and famous. Patients notoriously did not pay their bills, and though he was specialized in surgery, he was spending his time on house calls and treating coughs and colds. Yet he was on the right track; he secured an appointment on the Rush faculty and became an attending surgeon at Cook County Hospital – one way to enhance his surgical skills, reputation, and referral base. One day he was called to the house of a wealthy patient of his partner’s whose daughter was ill with fever, perhaps the measles. He carried out an extensive examination and diagnosed typhoid. The patient recovered, fell in love with the tall young doctor with the red beard, and in November 1885 they were married at St. Patrick’s Church. JB had found the girl of his dreams: lovely, charming, and rich.

She was devoted to him and very interested in his cases. She encouraged him to set up a laboratory where he would experiment and operate on dogs. His great first success came in 1889 when he saw a young laborer with abdominal pain and made a diagnosis of what in those days was called perityphlitis, the development of a large mass of pus in the right lower part of the abdomen. He had read two recent papers showing that perityphlitis began as an inflammation of the appendix and could be prevented by early removal of the offending organ. He convinced the young man to agree to submit to surgery and removed a red-hot appendix with pus in it, and the man recovered. He operated on more such patients, later presenting his results to medical audiences that at first were skeptical and often hostile, but eventually convinced that appendicitis was best treated by early surgery.

Already he had incurred the suspicion and hostility of the Chicago medical profession for his part in the 1866 notorious Haymarket massacre, a deadly confrontation between police and striking workers in which policemen were fired at with revolvers. Called to the police station as he happened to be close nearby, he found a horrible scene of policemen injured or dead. He did what he could, ordering morphine, packing their wounds to stop the bleeding, then arranging for the wounded to be transferred to the County Hospital. He single-handedly operated through the night and the next morning, sewing up wounds, removing pieces of shrapnel and other foreign bodies, and essentially doing the work of three by never stopping.  The next day the newspapers praised his efforts, but soon rumors began to circulate that he had charged enormous sums of money to operate on the policemen. There was no proof that he had ever done so, but rumors and insinuations dogged him for the rest of his life.

Nor did he endear himself to his competitors by the publicity accorded to what later became known as the Murphy button. Ambitious and desirous to make his name in the surgical world, and working continuously, he decided to address the difficult problem of how to reconnect two severed ends of the intestine without using sutures that would lead to early gangrene or later obstruction. He invented a capsule or ball that would eventually be split into two, but over which the two adjoining loops of bowel would first be placed and eventually heal, then allowing the capsule to be released and excreted. He first used the capsule on dogs, later on humans, joining the two severed parts of the bowel, and later applying the technique also to the stomach and the gallbladder. It was a great advancement and received much publicity, again provoking hostility against this young whippersnapper deemed to be unethical, dishonest, and opportunistic.

His practice nevertheless grew, so did his reputation, and at various times he was invited to join the staff of several of Chicago’s hospitals as well as to assume professorships at the medical schools. Working tirelessly and possessed of great imagination, he expanded his endeavors to other areas of surgery. He performed the difficult operation of removing the Gasserian ganglion inpatients with trigeminal neuralgia.  In gynecology, he is remembered for exposing the uterus of a pregnant woman, removing a tumor and repairing the incision without disturbing the fetus. In 1897 he was the first in the United States to reconnect a femoral artery severed by gunshot; and he was one of the first to resect parts of a tuberculosis lung to allow the rest to heal by immobilizing it and enforcing physiological rest. He introduced new methods in orthopedics and for treating prostate cancer. He invented a device for administering rectal fluids to patients who could not take fluid by mouth (Murphy drip). He is also remembered for Murphy’s punch, a sign of tenderness on palpation or percussion in cases of inflammation or abscess formation of the kidneys or gallbladder.

He was a popular lecturer and an amazingly dexterous surgeon, acclaimed for his superior surgical skills. During his career he practiced at various hospitals, was affiliated with several medical schools, and received many honors, – was knighted by Pope Benedict XV, received honorary degrees from several universities, and was elected president of prestigious professional medical societies. But he was always controversial and easily antagonized people, repeatedly incurring the hostility of his competitors each time one of his advancements was announced or publicized in the press. One of the most notable incidents was his involvement in what became known as the kidnapping of President Theodore Roosevelt in 1912. The President had received a superficial chest wound following an assassination attempt in Milwaukee and at his request was transferred to Chicago to the care of Murphy in preference to other competing surgeons. Murphy met the train when it arrived in Chicago and had the president taken by ambulance to Mercy Hospital, where the superficial wound was managed correctly.

In 1912 JB developed angina pectoris, which became progressively severe and debilitating and lead to his death in 1915. Highly capable, ambitious, hard-working, and intolerant of dissent, he had been disliked by a conservative and jealous medical profession that imposed strict “ethical” standards and rules on self-promotion and advertising.  He had fought with many of his medical peers and had an extraordinary power to irritate, leading his biographer, Dr. Loyal Davis, to compare him to a stormy petrel, a seabird harbinger of bad weather or trouble.1 But despite his many critics, JB was a remarkable man and a great genius for technical and physiological innovation, who made many surgical innovations for which he is still remembered today.

 

Reference

Loyal Davis: J.B. Murphy. Stormy Petrel of Surgery. Putnam,New York, 1938. 

 

Patrick D. Guinan MD, MPH, is a Clinical Associate Professor in the Department of Urology in the College of Medicine at the University of Illinois at Chicago, and serves as Chairman of the Board of the Hektoen Institute of Medicine.

George Dunea, MD, Editor-in-Chief.