Jefferson Medical College - Clinic Yearbook (Philadelphia, PA)

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n ardent supporter of every moral, scientific and progressive advance in civic, state and national affairs .XR n.!:'I. 1' . :ff-.1 ' E5 , 'ep -- 3,3-. if rf- 1' ' . e 1' -1 'wi' lj ' ' '5 3 'if -'-if . ..1.' F-. ,'. ,V-'. Q'-'14 f 'f . -L.. ,: - . - 352: J ' -vf': . f !' J- ' x . r I .eil ' 1 :Q 1'i',Tr 4 ' i .. .,p M.: 5 u' ' -'37-7.i '19 if GW' illiam Williams Keen witnessed nearly a century of medical progress-and contributed significantly to the advance. When he died in 1932 at the age of 95, antibiotics had yet to revolutionize the treatment of infec- tious disease but medical practice had advanced more in his lifetime, per- haps, than in all of history. Imagine if you canf' Keen observed in l922, the forlorn condition of the doctor 60 years ago-without everything except his eyes, his ears and his fingers, then you can appreciate the triumphal march of medicine during a single life- timeg' Keen's lifetime in medicine lasted 70 years-beginning with his gradua- tion from jefferson in 1862, when he assumed the role of a 'herald of the dawn', according to Franklin H. Mar- tin, Chicago surgeon. The death of this eminent surgeon, Martin com- mented in Surgery, Gynecology and Obstetrics, has brought the whole thinking world to attention in admira- tion of a fine and useful life. Keen eschewed championship of the past, ' Martin wrote, and was an ardent sup- porter of every moral, scientific and progressive advance in civic, state and national affairs, as well as his primary concern, scientific medicine. Keen is probably best known as the first American neurosurgeon. He was the first surgeon to tap the ven- tricles of the brain and one of the first to remove a brain tumor successfully. He gained fame when a patient sur- vived more than 30 years after removal of a meningioma. He also participated in the celebrated secret operation to remove a cancerous growth from the mouth of President Grover Cleveland in I893. The diagnosis was established by examination of a tissue specimen and immediate surgery was recom- mended. The President agreed but in- sisted on absolute secrecy because the nation was in a financial crisis at the time and Cleveland feared that news of his illness would prove disastrous for the stock market. To insure secrecy. the President, Keen and a host of other doctors boarded a yacht and the oper- ation was performed while it WaS anchoi Sound had dc made dent's The r Opefiii. f0l' mg the pl were 1 QPPC Surge began barelv IICSSOI- the If he re Clinic He f iUStit1 Uflato C0lle rlemy, Meiic Slonal

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he Panama Canal is not an obvi- ous memorial to a medical man. lt seems more appropriate for an engi- neer. But it was medical science and not engineering skill that made the canal possible. Yellow fever had deci- mated the work crews and forced the French to abandon efforts to build such a canal. But Americans succeeded be- cause a little-known Cuban physician -an 1855 graduate of Jefferson-dis covered the vector of yellow fever and opened the door to control of the pesti- lence. Carlos Finlay won few honors during his lifetime, despite the signifi- cance of his work which Cen. Leonard Wood, a famed military physician, characterized as the greatest step for- ward made by the medical sciences since Jenner's discovery of vaccine. Jefferson was only 29 years old when Finlay matriculated in 1853, but it al- ready had the professors to inspire the student's subsequent work. Franklin Bache, Finlay's professor of chemistry, lost his father to yellow fever in the Philadelphia epidemic of 1798, which claimed nearly 4,000 lives. Another physician interested in yellow fever was John Kearsley Mitchell, professor of medicine, who published a historic monograph, On the Cryptogamous Ori- gin of Malarious and Epidemic Fevers, four years before Finlay's arrival at Jef- ferson. While Mitchell's thoughts on the etiology of the disease were incor- rect, he made the astute observation: We must, for the present, suppose that yellow fever is portable yet it is not contagious. This all but suggested a vector. Mitchell's influence on Finlay ap- parently was great, because the Cuban student chose the professor's brilliant son, S. Weir Mitchell, as a preceptor. The son later would outshine the father in his contributions to medical science, but this was early in his career and he spent many hours in his father's laboratory with Finlay. He taught the Cuban the use of the micro- scope-a relatively new tool in clinical medicine at the time-and the latest research techniques. They remained friends and though Mitchell became a world figure he retained his faith in Finlay when his hypothesis on yellow fever was universally scoffed at. -After his training at Jefferson, Finlay returned to his native Cuba and enjoyed an active practice. He soon was devoting much of his spare time to yellow fever research. But re- search without inspiration often is fruitless and Finlay was rewarded with inspiration. One night while medi- tating, Finlay was distracted by a mosquito. As usual, yellow fever was in his thoughts. Suddenly it was clear: the mosquito could be the vector of death. Critics have claimed that seren- Clipity guided Finlay, but this doesn't nullify the hours of painstaking work in cooperation with a naturalist that allowed the physician to identify the offender specifically as Aedes aegypti. Though he was sure of his find- ings, Finlay needed proof that would stand up to the most thorough scrutiny. Human experimentation was needed, but Finlay shrank from the possible loss of life. Finally he proceeded, con- ducting experiments on 102 volunteers, including 20 Spanish soldiers and a Jesuit priest who later became a noted tropical meteorologist. Considering his limited research facilities and the ne- cessity of financing the work himself, Finlay's results were impressive. He addressed three international con- gresses, wrote 45 papers Cin Spanish, English, French and CermanD and spent countless hours explaining his theory in what must have seemed a fruitless crusade at times. Finlay continued his work through the Spanish-American War and after- ward when the Americans took over his native land. Among the organiza- tions established in Cuba was the American Yellow Fever Commission he greatest step for- ward made by the medical sciences since Jenner's dis- covery of vaccine headed by Maj. Walter Preed. Finlay had been proposing his theory for years, but Reed had not encountered it. He was impressed and ordered a de- finitive test in 1901. Finlay gladly co- operated, turning over his data and his mosquito eggs. The death of a com- mission member, Dr. Jesse Lezear, and others proved the hypothesis and prompted Preed to order eradication of mosquitos in Havana. Yellow Fever disappeared with the mosquitos, and the Americans were armed with the weapon they needed to drive a canal across Panama. - ln 1902, in the glow of Finlay's success came two prized honors: he became Cuba's first sanitary director and received an honorary degree from Jefferson. He died in 1915, still relatively un- heralded, but belated honors kept his memory green. ln 1933, the centenary of his birth, the Pan American Medi- cal Association proclaimed a Finlay Day. In 1935, the International Con- gress of the History of Medicine rati- fied his right to be called the discoverer of the vector of yellow fever. In 1955, Pennsylvania marked the centenary of his graduation from Jefferson with a Finlay Day. Jefferson arranged a two- day international symposium on yellow fever. Cuba erected a bust of Finlay in the great hall of its Academy of Medi- cal, Physical and Natural Sciences in Havana. A replica-a gift of the Cuban people-is in the Scott Memorial Li- brary at Jefferson. - a

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,n ardent sup- scientiiic anti vic, state and is his priniafl' ine. Est known 35 -osurgeon. He tap the ven- ne of 1116 flISi gnccessfulli- 3 patient Sur' after refnovas 0 pafiiclpafe Operation to wth from the ver Clwland ,as established ecimtrl 1-QCOIU' SSUC SP was ,n tl ' agfeed bu the becaU5e V , .a the 211 H1515 at v5 red that nexus . disttifo IOXC V. inSU'C Secriiiir ahostofo I and th, while I e0Pe' t Was anchored offshore on Long Island Sound. Keen employed a procedure he had devised using a new retractor that made it unnecessary to cut the Presi- dentis cheek open to remove the tumor. The result was so successful that the operation might have remained a secret for many years if the dentist who made the plate to replace the excised tissue were not forced to explain a canceled appointment. 'Keen was not only an outstanding surgeon but an excellent teacher. He began teaching at Iefferson in 1868, barely six years after his graduation, and served in many capacities until 1907, when he became emeritus pro- fessor of surgery. His appointment to the top surgical chair came in 1889 and he remained professor of surgery and clinical surgery until his retirement. He also offered his talents to other institutions, serving as professor of anatomy at both the Womens Medical College of Pennsylvania and the Aca- demy of Fine Arts at various times. Meticulous in his private and profes- sional habits, he was known for the extreme care he took in preparing his lectures-and his students profited from rt. He preceded his lectures with syn- opses so that students, notes were in- variably well organized and complete. He viewed his relationship with his students as mutually beneficial, com- menting once: 1 always feel at the lefferson Hospital as if I were on the run with a pack of lively dogs at my heels. Students are the best whip and spur 1 knowf, Students weren't the only major beneficiaries of his knowledge, for he shared his discoveries and observations with his colleagues through prolific contributions to the medical literature of his time. He published nearly 200 professional papers Clong before the modern 'ipublish or perish mentality forced vast expansion of the medical publishing industryl His textbooks were described by Fielding Carrison, medical historian, as probably the best American Works of their kind. He gained early recognition for a surgical work that laid the groundwork for his later achievements in neuro- surgery. Entitled Cumshot Vlforirtds and Other Injuries of Nerves, it was produced in collaboration with S. VVeir Mitchell, another great name in leffer- son's history, and Ceorge Pr. More- house, also a leff man. While most of Keen's writings concerned medical topics he did not limit himself to that field. Cnc sub- ject that captured his interest was the debate over Darwin's theory of evolu- tion, which was a controversial topic of the 1920's. Keen was a deeply religious man but he failed to sec any conHict between religion and science. He wrote two books on the subject. 1 Relieve in Cod and Evolrrtion and Everlasting life. His philosophy on the issue can be summed up succinctly in this passage from the former pub- lication: Cod deliberately made man out of the smue stuff as the animals and . . . on the same plan as animals. Body- wise, man is an animal, but, thanks be to Cod, his destiny is not the same as that of the beasts that perish. To develop great men, such as Aristotle, Plato, Shakespeare, Milton, VVash- ington, Lincoln and then by death to quench them in utter oblivion, would be unworthy of Cmnipotence. To my mind it is simply an impos- sible conclusion. Man's soul must be immortal. Keen combined his deep religious faith with an intense patriotism. It prompted him to don his countrv's uni- form in two wars and to volunteer for action in a third. His first military serv- ice came during the Civil VVar. He entered combat at Bull Run and served for the duration, being mustered out as a maior. A halffenturv later he felt the need to serve again when the United States entered World War 1. At the age of 80, he was the oldest member of the Medical Reserve Corps. Even at that advanced age his con- tribution to the health of the troops was immeasurable, since he success- fully repulsed the efforts of antivivi- sectionists, who attempted to prevent immunization of soldiers against typh- oid fever. He volunteered for Spanish- American War service, but hostilities concluded before he reported for duty. There have been few American Surgeons so universally respected and honored, a colleague observed follow- ing Keen's death. One outstanding physician who was most vocal in his acclamation of Keen was Chalmers Da Costa, the first Cross professor of surgery at lefferson, who remained ever grateful for his early surgical training under Keen. John H. Gibbon, Sr., who worked intimately with Keen for nearly 40 years mentioned some of the surgeons more notable honors, in- cluding the presidencies of the College of Physicians of Philadelphia, Ameri- can Society of Surgery and American Philosophical Society. His honorary de- grees were many and his invitations to lecture were legion. It all seemed, in effect, a proof of the simple philosophy he once espoused to a group of new lefferson graduates: If in your own life you realize the characteristics of the ideal physician . . . if you attain to old age, when the hairs whiten and the crow's feet begin to show, when your natural forces are abated, you will then not be alone in the world but will have honor, love, obedience, troops of friends. . , . We know this was and is his reward, Martin commented. His monument is built in the hearts of his thousands of friends, and his memory will live on through the ages.