ORIGINAL ARTICLE

ANZJSurg.com

Famous discoveries by medical students ans_5142 901..908

Mark D. Stringer and Omid Ahmadi

Department of Anatomy & Structural Biology, University of Otago, Dunedin, New Zealand

Key words Abstract

discovery, medical student, research.
Correspondence
Professor Mark D. Stringer, Department of Anatomy &
Structural Biology, Otago School of Medical Sciences,
University of Otago, PO Box 913, Dunedin, New
Zealand. E mail: mark.stringer@anatomy.otago.ac.nz
M. D. Stringer MS FRCP FRCS; O. Ahmadi BSc, 4th
year Medical student
Heparin, insulin, the sinoatrial node and ether anaesthesia are just some of the major
discoveries made by medical students, all of which have had a huge impact on the
practice of surgery. This paper explores the breadth and depth of some of these talented
individuals and their extraordinary contributions to medicine. While some continued
to enjoy brilliant careers, others became embroiled in damaging disputes about priority
or were overtaken by illness or personal problems. Regardless of their fate, their
contributions are a potent reminder of what can be achieved by gifted and determined
medical students undertaking a period of basic scientific or clinical research.

Accepted for publication 6 October 2008. ‘Discovery consists in seeing what everyone else has seen and thinking what no one
else has thought.’ – Albert Szent-Gyorgyi (1893–1986), Hungarian biochemist and
doi: 10.1111/j.1445-2197.2009.05142.x
winner of the 1937 Nobel Prize for Medicine.

Introduction Howell. He was assigned to investigate procoagulants and reported

his findings later that year.1 During this research, he identified a
Who, today, would credit the discovery of heparin, insulin, the
phosphatide anticoagulant in canine liver tissue, but this substance
sinoatrial node, pancreaticobiliary sphincter and ether anaesthesia to
received little attention in his paper because Howell considered that
medical students? Who were these gifted students and what became
its anticoagulant activity should be investigated further.2,3 McLean
of them? This paper highlights the breadth and depth of some of
then moved to the University of Pennsylvania, where he published
these talented individuals and their extraordinary contributions to
a second paper on procoagulants. It would be 24 years before he
surgery and medicine. While some progressed to brilliant careers,
published again. Meanwhile, Howell continued to research the
others became embroiled in damaging disputes about priority or
were overtaken by illness or personal problems. But regardless of
their fate, their contributions are a potent reminder of what can be
achieved by able and hard working medical students undertaking
basic scientific or clinical research.

Anticoagulants and arteries

The discovery of heparin, a natural anticoagulant, revolutionized the
management of thromboembolic disorders and cardiac surgery after
its introduction into clinical practice in the 1940s. Its discovery is
commonly attributed to Jay Mclean (1890–1957).
McLean had a difficult start in life. His father died when he was
only 4 years old and the San Francisco earthquake and fire of 1906
destroyed his stepfather’s business and family home. To complete
his medical studies, McLean took on various jobs including scrub-
bing ferry boat decks. In 1916, as a second-year medical student at
Johns Hopkins University in Baltimore (Fig. 1), he began research- Fig. 1. Jay McLean as a surgical resident. Courtesy of the Alan Mason
ing in the coagulation laboratory of the physiologist William Henry Chesney Medical Archives of the Johns Hopkins Medical Institutions.

© 2009 The Authors

Journal compilation © 2009 Royal Australasian College of Surgeons ANZ J Surg 79 (2009) 901–908
902
Fig. 2. Illustration of the original Fogarty embolectomy catheter.8 Repro-
duced with kind permission of the Journal of the American College of
Surgeons.
anticoagulant that McLean had discovered, and in 1918, together
with another medical student, named it heparin (from hepar, Greek
for liver). Over the next 40 years, priority for the discovery of
heparin was to become the subject of dispute.3
After a brief spell in the American Ambulance Corps in France, in
1917, McLean returned to Baltimore and graduated in 1919. During
his surgical training, he worked for William Stewart Halsted and
Alan Whipple, among others. In 1925, he entered private practice but
his surgical career never thrived. He moved into radiotherapy and
oncology, returning intermittently to his research on heparin. His
attempts to write a definitive monograph on the compound failed.
Much of his energy – lectures, correspondence and even a radio
interview – was expended on his claim to priority in the discovery of
heparin. His unfinished autobiographical sketch published in 1959
was devoted to this topic. He considered that the discovery of
heparin was a result of his determination to accomplish something
by his own ability borne out of the hardship he had endured.4
McLean died of ischaemic heart disease at the age of 67 years. An
attempt to nominate him posthumously for a Nobel Prize failed.2
Dr Thomas J Fogarty is today an award-winning Californian
vintner,5 but he is best known for his invention of the balloon embo-
lectomy catheter. Born in 1934, he too had a hard childhood. After
losing his father at the age of 8, he sought part-time employment
in the sterile supply department of a local hospital in Cincinnati to
help his widowed mother make ends meet.6 As a teenager, he began
working as a surgical scrub technician when he witnessed long and
difficult operations undertaken to remove blood clots from arteries.
This inspired him to think of a new approach that he perfected as a
medical student at the University of Cincinnati. He took a latex
glove, cut off the fingertip and attached it to a plastic catheter, using
fly-tying techniques he learned as a fisherman. Fogarty recounts
how news of the unconventional device was received by the surgical
community – rejected by three mainstream surgical journals and
publicly criticized as being dangerous.7 He could not get manufac-
turers interested in the balloon catheter. Undaunted, he made the
catheters by hand for himself and other vascular surgeons during his
fellowship training in 1961 and 1962. The balloon catheter was
finally patented in 1963, the same year that he published an account
of its use in nine patients (Fig. 2).8 Two years later, Fogarty and
Stringer and Ahmadi
colleagues were able to report their experience of its use in treating
50 patients with femoral or aortoiliac emboli; 80% of the patients
survived and only two required an amputation.9 Today, more than
half a million Fogarty catheters are sold annually (Edwards Life-
sciences, CA, USA, pers. comm., 2008).
Fogarty was also a member of Dr Norman Shumway’s team that
performed the first heart transplant in the USA. Later, he became
Director of Cardiovascular Surgery and Professor of Surgery at
Stanford University School of Medicine. He maintained his passion
for invention and minimally invasive techniques, acquiring over
110 surgical patents (T. Fogarty, pers. comm., 2008). According to
Fogarty, the key to his success has been persistence to the point of
obnoxiousness and an unwillingness to give up.
Another important vascular discovery by a medical student was
made by Auguste-Maurice Raynaud (1834–1881). The thesis for his
medical doctorate in 1862 was entitled Local Asphyxia and Sym-
metrical Gangrene of the Extremities.10 In his thesis, he modestly
described 25 patients, mostly women, with episodic vasoconstriction
of the digits causing classical colour changes (white, blue and ver-
milion) associated with loss of sensation, pain and localized gan-
grene. Raynaud recognized that exposure to cold was a precipitant
but mistakenly rejected occupational factors. During the next
30 years, he expanded and updated his observations.11 Today,
Raynaud’s disease or phenomenon is recognized as a manifestation
of a wide spectrum of clinical disorders.
The son of a university professor, Raynaud studied medicine in
Paris, where he also excelled in the arts, gaining a doctorate in
literature in the same year as his medical degree. As an intern, he
won numerous medals.12 After Raynaud reached the position of
associate professor in 1866, his academic future looked bright but he
never progressed to a senior position. He was turned down for both
the anatomy and pathology chairs in Paris.11 Whether this was con-
nected to his fervent Catholicism or public criticism of the Faculty of
Medicine is uncertain. He was eventually elected to the Academy of
Medicine in 1879, having published more than 50 clinical papers. He
died from ischaemic heart disease at the age of 47 years.
Islets and Insulin
The son of a successful physician, Paul Langerhans (1847–1888)
was born in Berlin (Fig. 3). His mother died of tuberculosis when he
was just 6, but he enjoyed a good relationship with his stepmother
and half brothers (Hausen 1987). He studied medicine at the Uni-
versity of Berlin, where he was taught by the famous pathologist,
Rudolf Virchow (1821–1902). During this period, Langerhans made
not just one but two major discoveries. The first was the description
of dendritic cells in the skin (now known as Langerhans cells). The
second was the pancreatic islets.
The pancreas had been studied since the 16th century, but only the
secretory acini and ductal system were known about, and the organ
was classified anatomically as a salivary gland.13 Langerhans began
his research on the microscopic anatomy of the pancreas in the
summer of 1867 but interrupted this in order to compete for and win
the Berlin University medicine prize. He resumed his studies on the
pancreas in October 1868 and completed the work in 6 months.14,15
Using pancreatic tissue from the salamander, rabbit and human,
© 2009 The Authors
Journal compilation © 2009 Royal Australasian College of Surgeons
Medical student discoveries
Fig. 3. Paul Langerhans in 1873. © Bildarchiv Preußischer Kulturbesitz,
Berlin, 1873, Photographer: Ruf und Dilger.
Langerhans recognized clusters of small ‘irregularly polygonal’ cells
with clear cytoplasm diffusely scattered throughout the gland, each
measuring 0.1–0.24 mm in diameter.16,17 He did not speculate on the
function of these cells and was rather apologetic about his findings,
stating, ‘With regret, I must begin my communication with the
declaration that I cannot in any way put forth the conclusive results
of a completed investigation. I can describe, at most, a few isolated
observations which suggest a much more complicated structure of
the organ (pancreas) than hitherto accepted’.13 It was not until 24
years later that the French histopathologist Edouard Laguesse
(1861–1927) suggested that the ‘islets of Langerhans’ were the site
of an internal secretion of the pancreas later named insulin.
At the age of 27 years, Langerhans was appointed full professor at
the University of Freiburg, but later the same month he was diag-
nosed with pulmonary tuberculosis, which forced him to eventually
give up this position.15 After seeking treatment in Switzerland, Italy
and Germany, he settled in Madeira. Here, he described more than
50 new species of marine worms, wrote a famous Handbuch für
Madeira and practised medicine. In 1885, Langerhans married a
widow, Margarethe Ebart; together with her daughter, they shared
‘three indescribably happy years’.18 In July 1888, just days before
his 41st birthday, he died from uraemia secondary to renal tubercu-
losis. He is buried in the British cemetery at Funchal, capital of
Madeira.
Insulin was discovered by Charles Herbert Best (1899–1978) and
Frederick Grant Banting (1891–1941) in Toronto during the swelter-
ing summer of 1921. In 1916, Best enrolled in a liberal arts pro-
gramme at the University of Toronto, but his studies were interrupted
by military service in World War I. Returning to Toronto in 1919, he
switched courses to study physiology and biochemistry in preparation
for a medical degree. In the autumn of 1920, Best’s physiology
professor, John JR Macleod, introduced him to Banting, a 28-year-old
medical practitioner from Ontario. Banting had persuaded Macleod
(with some difficulty) to let him use his laboratory for a research
project over the summer of 1921. Banting was convinced that the
crucial substance preventing diabetes mellitus would be found in the
islets of Langerhans. These cells could be isolated in the dog after
ligating the pancreatic duct, which caused the exocrine pancreas to
atrophy. Banting suggested that injecting an extract of the islets into
© 2009 The Authors
Journal compilation © 2009 Royal Australasian College of Surgeons
903
Fig. 4. Banting (right) and Best (left) standing on the roof of the Medical
School Building, University of Toronto, with one of the diabetic dogs used
in experiments with insulin. University of Toronto Archives, Frederick
Grant Banting and Charles H. Best, 1921. A1978-0041/001(53), Acc IB001.
a diabetic dog would relieve the symptoms of diabetes. He would do
the surgery but he needed an assistant to help with the animals’ blood
and urine tests. Another of Macleod’s students was also interested in
the job and the position was decided by the toss of a coin.
Banting and Best first tested their pancreatic extract in a diabetic
dog in July 1921 (Fig. 4). Within months they had confirmed its
efficacy in treating diabetes. Banting and Best worked hard, eating
and sleeping in the laboratory. Banting sold his car to raise money
for their research. Macleod, who had been on holiday in Scotland
during the summer, returned in September and advised further work
to confirm the results. He also hired James Collip, a biochemist, to
help purify the active component of the extract. By the time their
paper was published in February 1922, Banting and Best had already
treated a diabetic patient with the extract.19 Fourteen-year-old
Leonard Thompson was expected to live for just a few more weeks.
Before administering insulin to the boy, Banting and Best injected
each other with their extract. There seemed to be no major side
effects, and so, in January 1922, they went ahead and treated the boy.
Thompson lived another 13 years, dying from complications of a
road traffic accident. Banting and Best sold the rights to insulin to
the University of Toronto for one dollar, stipulating that royalties
would not be charged.20
The 1923 Nobel Prize in physiology and medicine was awarded to
Banting and Macleod for the discovery of insulin. Banting was
furious that Best had been left out and immediately decided to share
the prize money with Best. Macleod divided his portion of the prize
with Collip. Only later did the Nobel Foundation acknowledge that
Best should have shared the award.21 But this was only part of a
brewing controversy. A personal feud erupted between Banting
and Macleod over the latter’s role in the discovery22,23; later, this
extended to disagreements between Banting and Best.23
904
Fig. 5. Portrait of Group Captain Martin William Flack. With kind permis-
sion of the Wellcome Trust, London.
Best continued his studies, receiving his MD in 1924. After a
period of research in England, he returned to Toronto and, when
Macleod retired, took over the chair of physiology. He was just 30
years old. After Banting’s death in a plane crash in 1941, Best
became Director of the Department of Medical Research at the
University of Toronto. During his career, he received scores of
medals, awards and honorary degrees. He was honoured by the
Queen of England, the Pope and other heads of state. Charles Best
died in 1978 from a ruptured abdominal aortic aneurysm. A personal
biography was published by one of his sons in 2003.24
A pacemaker, a plexus and a sphincter
Another hot summer’s day, this time in 1906, was the setting for
another major discovery. Dr Arthur Keith (1866–1955), an anatomy
lecturer at the London Hospital, had just returned to his holiday
cottage from a cycle ride when Martin William Flack (1882–1931)
(Fig. 5), a medical student at the same hospital, excitedly showed
him the ‘wonderful structure he had discovered in the right auricle of
the mole’.25 Keith had persuaded Flack to spend the summer holi-
days studying the hearts of trapped moles, mice and frogs. Keith
quickly recognized that Flack’s findings closely resembled the atrio-
ventricular node, which had been identified the year before by Sunao
Tawara, a Japanese anatomist, and confirmed by Flack and Keith in
an earlier study.26 They rapidly established the presence of a ‘sino-
auricular node’ in other vertebrate hearts and in so doing discovered
the origin of ‘the dominating rhythm of the heart’ (Fig. 6).27
Arthur Keith subsequently enjoyed a career as a feted anatomist
and expert on human evolution, but what became of Martin Flack?
After graduating in 1908, he took up a travelling scholarship to
Europe before returning to the London Hospital as lecturer in physi-
ology. Here, he researched the invigorating effects of oxygen in
athletes28 and continued his studies on the sinoatrial node. During the
First World War, he worked for the Medical Research Council and, in
1919, was appointed as the first Director of Medical Research for the
Royal Air Force. He continued to investigate cardiorespiratory physi-
ology and developed techniques for assessing the physical fitness of
prospective pilots.28,29 Flack died in 1931 from bacterial endocardi-
tis,25 a complication of his childhood rheumatic heart disease.
Stringer and Ahmadi
Fig. 6. Coronal section of the mole’s heart (figure 8, p. 184).27 ‘At the
sino-auricular junction is a mass of tissue (A,E) totally different from
surrounding musculature, lying in intimate contact with nerves’.With per-
mission of Wiley-Blackwell Publishing.
Augusta Klumpke (1859–1927) famously championed the rights
of women doctors, but she is best known for her description of
inferior brachial plexus injuries as a medical student in 1885
(Fig. 7). She was born in San Francisco, the second of four daugh-
ters. Her older sister, Anna, fractured her femur in early childhood,
and when osteomyelitis set in, Augusta’s mother took her daughters
to Europe to seek medical advice. Two years later, they returned to
San Francisco, but after two more children, Augusta’s parents sepa-
rated. In 1871, Augusta’s mother took all six children back to
Europe, determined to raise her daughters to be independent.30
Augusta was destined to become a teacher until she read an article
in a fashion magazine about a woman who had recently graduated in
medicine in Paris. Augusta was excited by the prospect of medicine
and so the family moved to Paris, where, in 1877, she was admitted
to the Faculty of Medicine.31 Here she excelled, studying under such
notable figures as Ranvier (histology), Charcot (neurology) and
Fournier (dermatology). Her fluency in French, German and English
proved invaluable in understanding the contemporary literature.
While working at the Hôtel-Dieu, she diagnosed a brachial plexus
palsy associated with Horner’s syndrome. This, together with
experimental work, formed the basis of her undergraduate thesis and
her eponymous description of lesions of the inferior roots of the
brachial plexus.32 Her research won an Academy of Medicine prize
but was not enough to secure her an internship in the exclusively
male medical hierarchy. After repeated unsuccessful attempts and
much lobbying, Augusta was finally allowed to compete for an
internship and, in 1886, she became the first female full intern in a
Parisian hospital.
In 1888, she married Jules Déjerine, a distinguished neurologist.
Together they collaborated on numerous neurology and neu-
roanatomy texts, many of which were skillfully illustrated by
Augusta. Her doctoral thesis on polyneuritis, lead toxicity and neu-
© 2009 The Authors
Journal compilation © 2009 Royal Australasian College of Surgeons
Medical student discoveries
Fig. 7. Augusta Klumpke (left), at the age of 30 years, with the wife of Dr
Paul Dubois, a Swiss psychiatrist and close friend of Jules Déjerine. With
kind permission of the author Dr J. Bogousslavsky and European Neurol-
ogy 2005; 53: 113–120 published by S. Karger AG, Basel.
romuscular atrophies (1889) received much acclaim. During World
War I, she made important contributions to the care of soldiers with
spinal cord injury. She later became the first woman president of the
French Society of Neurology and was awarded the French Legion of
Honour.33 She died at the age of 68 years, survived by her only
daughter. She attributed her professional success (and that of her
sisters) to her mother about whom she said, ‘She taught us not to
give up when faced with difficulties, to persevere and to succeed’.30
The setting for the next famous discovery is late nineteenth
century Italy. As a 23-year-old, fourth-year medical student at the
University of Perugia, Ruggero Oddi (1864–1913) studied the
actions of the sphincter at the distal end of the common bile duct
(Fig. 8).34,35 He concluded that the sphincter controlled the intermit-
tent flow of bile from the liver to the duodenum. He also suggested
that dysfunction of the sphincter might cause biliary tract disease.
The University of Perugia could not at that time award a medical
degree, so Oddi continued his studies first at the University of
Bologna, where he measured pressure changes across the sphinc-
ter,36 and subsequently in Florence, where he gained his degree in
medicine and surgery in 1889. Two years later, Oddi married
23-year-old Teresa Bresciani Bartoli several months after their first
child was born.37 In 1894, at just 29 years of age, he moved from
Florence to Genoa to become Director of the Physiology Institute.
During his 7 years in Genoa, he gained substantial academic recog-
nition, but then for reasons that may have been related to family,
drug addiction or illness, Oddi’s career went into freefall, resulting
in him leaving both his job and Italy.
© 2009 The Authors
Journal compilation © 2009 Royal Australasian College of Surgeons
905
Fig. 8. Ruggero Oddi. Courtesy of the National Library of Medicine. The
photograph probably dates to 1906, when Oddi was 42 years old.
In Genoa, Oddi had become friends with an influential aristocrat,
Stefano Capranica, who owned the laboratory that Oddi used for his
research. After the death of his mistress, Capranica became addicted
to morphine and experienced a spiritual crisis that probably deeply
affected Oddi. Before his death in 1899, Capranica donated all his
property to the Genovese Curia, which duly confiscated Oddi’s
laboratory, uncovering financial irregularities and exposing Oddi’s
probable drug abuse in the process. Oddi either resigned or was
dismissed.38 In parallel with these events, Oddi had needed surgery
for appendicitis in 1898 and, 2 years later, for bowel obstruction. To
escape the scandal, he moved to Brussels (where he was treated for
depression) and thence to the Belgian Congo, where he worked as a
doctor. Ill health, mental instability and narcotic abuse forced him to
return to Belgium 6 months later.37 In 1905, he returned to Perugia,
where he practised medicine, widely advocating the administration
of Vitaline (a compound of glycerine, sodium borate, ammonium
chloride and alcohol) for infectious and malignant diseases. After the
death of one of his patients, he was accused of manslaughter and
charged with ‘abusive commerce of medicinal products’.38 He
became a broken man and left Perugia for Tunisia in 1911 where he
died 2 years later at the age of 48.37
Penicillin and Ether
This section consists of two discoveries by medical students that
were both overlooked and later credited to others. The first of these
was penicillin. In his 1897 graduation thesis entitled ‘Contribution to
the study of vital competition between microorganisms: antagonism
between moulds and microbes’, Ernest Duchesne (1874–1912), a
23-year-old medical student at l’École du Service de Santé Militaire
in Lyon (Fig. 9), France, demonstrated the ability of the fungus
Penicillium glaucum to treat pathogenic bacterial infections caused
by Escherichia coli or Salmonella typhi.39 His studies included in
vivo experiments in guinea pigs. Duchesne attributed this property to
the existence of a toxin (an antibiotic) produced by the fungus. He
also predicted its therapeutic potential. Unfortunately, Duchesne did
not continue his research and never saw his work confirmed by
Chain, Florey and Jennings in 1942 or the benefits of his discovery.
It appears that he never came to terms with his wife’s death from
906
Fig. 9. Ernest Duchesne (1874–1912). With kind permission of l’École du
Service de Santé Militaire de Lyon.
tuberculosis in 1903. He too contracted pulmonary tuberculosis and
by 1907 was on permanent sick leave. He died at the age of 37. His
work was only rediscovered in 194538 and was commemorated in a
postage stamp issued in Monaco in 1974 on the centenary of his
birth.
According to Lyman,40 a medical student by the name of William
E. Clarke was the first to administer ether anaesthesia for surgery.
This event took place in Rochester, New York, in January 1842,
enabling a dentist to perform a painless tooth extraction. Priority for
the use of ether anaesthesia is usually given to others including
Crawford Williamson Long (1815–1878), who, as a young country
doctor in Georgia in March 1842, administered ether to a young man
from whom he painlessly excised a small cyst from his neck.41,42
Although Long performed several further operative procedures
under ether anaesthesia, he did not publish an account of his activi-
ties until 1849, several years after Horace Wells’ personal experi-
ment with nitrous oxide (1844) and William Morton’s public
demonstration of ether anaesthesia (1846).
Spermatozoa
We end this review at the beginning of life. Spermatozoa were first
discovered in 1677 by Johan Ham (1651–1723), a medical student
from Leiden who brought Antoni van Lewenhoeck (alt. Leeuwen-
Stringer and Ahmadi
Fig. 10. Lewenhoeck’s drawings of spermatozoa,46 reproduced with per-
mission of The Royal Society. Figure 1 depicts a living rabbit spermato-
zoon, while figures 2–4 are dead.
hoek) (1632–1723), a specimen of urethral discharge from a man
with gonorrhoea in which Ham had found small living ‘animalcules’
with tails.43 Lewenhoeck was a poorly educated Dutchman whose
passion for making lenses and studying biological tissues and micro-
organisms later earned him a place in history as the father of micros-
copy.44,45 According to one source, Ham may have first identified
spermatozoa in the semen of a rooster.43 He also noted the absence
of spermatozoa in the semen of sterile men43 and the fact that they
did not survive beyond 24 hours.46 After Ham’s visit, Lewenhoeck
studied his own semen (obtained by ‘conjugal coitus’ and not from
‘sinfully defiling’ himself) and confirmed the presence of motile
animalcules, less than a millionth the size of a coarse grain of sand,
with blunt round bodies and thin, undulating transparent tails. A
month later, Lewenhoeck reported these findings in a letter to the
Royal Society in London in which he credited Johan Ham with
the discovery (Fig. 10).46,47 The letter was in Latin because of the
delicate nature of its content. The impact of Ham’s discovery and
Lewenhoeck’s observations on the theory of generation was
immense. Although Ham may have first suspected the relevance of
spermatozoa to reproduction, it was Lewenhoeck who proposed that
fertilization followed the penetration of the ovum by the sperm,
although he mistakenly believed that the spermatozoon contained a
preformed individual.43
Comment
This account of famous discoveries by medical students is neither
comprehensive, nor are the biographies exhaustive. Figures such as
© 2009 The Authors
Journal compilation © 2009 Royal Australasian College of Surgeons
Medical student discoveries
Galileo and Keats who never completed their medical studies but
made such profound ‘discoveries’ in other walks of life have been
overlooked. So too have some notable other discoveries by medical
students such as the roller pump invented by Michael DeBakey
(1908–2008), which subsequently became an essential component
of the heart lung machine.48 However, from the selected biographical
sketches, a few common themes emerge.
All of these achievements have impacted on the practice of
surgery. They were the result of intense effort. To quote the great
inventor Thomas Edison (1847–1931), ‘Success is ten percent inspi-
ration and ninety percent perspiration.’ Several of these students
suffered loss of a parent and/or particular hardship in childhood,
which undoubtedly strengthened their resolve to succeed. This is
well demonstrated by Klumpke and Fogarty. Another thread that
binds many of these discoveries together is the opportunity for
research by medical students. In the latter half of the 19th century,
European medical students had to write and defend a research thesis
for their doctorate in medicine. This was the platform on which the
discoveries of Raynaud, Langerhans, Klumpke, Oddi and Duchesne
were built. In England and North America, summer research projects
seem to have been particularly fruitful for Flack, McLean and Best.
Opportunities for research by medical students in an increasingly
crowded undergraduate curriculum need to be preserved. Although
some of the spontaneity and freedom of research are restricted by
today’s bureaucracy, the opportunity for discovery is still there.
In a world overwhelmed with biomedical publications, modern
medical students might wonder if there is anything left to discover.
A quick search on the Internet is usually enough to suggest that any
idea has already been exhaustively explored or that new discoveries
are only possible in molecular biology. But students and teachers
must not be discouraged. The most naive questions are often the
best. John Shaw Billings (1838–1913), founder of the National
Library of Medicine, vowed to establish the world’s greatest medical
library when he was a medical student. He said, ‘There is nothing
really difficult if you only begin. Some people contemplate a task
until it looms so big it seems impossible. But I just begin and it gets
done somehow. There would be no coral islands if the first bug sat
down and began to wonder how the job was to be done’.49
Acknowledgements
We wish to thank Dr Thomas J Fogarty for kindly commenting on
his biographical details; Jonathan Evans, Trust Archivist, Royal
London Hospital Archives and Museum, for biographical informa-
tion on Martin Flack; Rachael Cross, Picture Researcher, The
Wellcome Trust, London, for her help with the portrait photograph
of Flack; Eva Galamand, librarian at the Ecole du Service de Santé
des Armées, Bron, France for the photograph of Ernest Duchesne;
and Dr K John Dennison for kindly translating parts of van Lewen-
hoeck’s Latin manuscript.
References
1. Mclean J. The thromboplastic action of cephalin. Am. J. Physiol. 1916;
41: 250–7.
2. Baird RJ. Presidential address: ‘Give us the tools . . .’. The story of
heparin – as told by sketches from the lives of William Howell, Jay
McLean, Charles Best, and Gordon Murray. J. Vasc. Surg. 1990; 11: 4–18.
© 2009 The Authors
Journal compilation © 2009 Royal Australasian College of Surgeons
907
3. Marcum JA. The origin of the dispute over the discovery of heparin.
J. Hist. Med. 2000; 55: 37–66.
4. McLean J. The discovery of heparin. Circulation 1959; 19: 75–8.
5. White T. Father of invention: What’s the master medical device maker’s
secret? 2006. [Cited 18 February 2008] Available from URL: http://
stanmed.stanford.edu/2006fall/fogarty.html
6. Riggins C. Great inventions don’t happen overnight. 2000. [Cited 17
February 2008] Available from URL: http://stanmed.stanford.edu/
2000fall/inventions.html
7. Quinn J. Failure is the preamble to success. 2006. [Cited 1 May 2008]
Available from URL: http://www.americanheritage.com/articles/
magazine/it/2004/3/2004_3_60.shtml
8. Fogarty TJ, Cranley JJ, Krause RJ, Strasser ES, Hafner CD. A method
for extraction of arterial emboli and thrombi. Surg. Gynecol. Obstet.
1963; 116: 241–4.
9. Fogarty TJ, Cranley JJ. Catheter technic for arterial embolectomy. Ann.
Surg. 1965; 161: 325–30.
10. Raynaud M. ‘De l’asphyxie locale et de la gangrène symétrique des
extrémités’, Doctoral Thesis (University of Paris, Paris, 1862).
11. Andrews J, Maurice R. Raynaud and his protean disease. J. Med. Biogr.
1997; 5: 46–50.
12. Bowling JCR, Dowd PM. Raynaud’s disease. Lancet 2003; 361: 2078–
80.
13. Morrison H. Contributions to the Microscopic Anatomy of the Pancreas.
By Paul Langerhans (Berlin, 1869). Reprint of the German original with
an English translation and an introductory essay. Bull. Inst. Hist. Med.
1937; 5: 259–97.
14. Hausen BM. The man behind the eponym. Paul Langerhans – life and
work. Part I. Childhood, early education, and college education. Am. J.
Dermatopathol. 1987; 9: 151–6.
15. Hausen BM. The man behind the eponym. Paul Langerhans – life and
work. Part II. Postgraduate studies, travels, first signs of disease,
Madeira. Am. J. Dermatopathol. 1987; 9: 157–62.
16. Hausen BM. The man behind the eponym. Paul Langerhans – life and
work. Part III: Scientific research, marriage, and death. Am. J. Dermato-
pathol. 1987; 9: 264–9.
17. Hausen BM. Paul Langerhans – life and work. Part IV: Publications. Am
J. Dermatopathol. 1987; 9: 270–5.
18. Ebling FJ. Homage to Paul Langerhans. J. Invest. Dermatol. 1980; 75:
3–5.
19. Banting FG, Best CH. The internal secretion of the pancreas. J. Lab.
Clin. Med. 1922; 7: 251–66.
20. The CBC Digital Archives. Radio interview with Charles Best. 1977.
[Cited 30 March 2008] Available from URL: http://archives.cbc.ca/
clip.asp?IDClip=4060&IDCat=321&IDCatPa=258
21. Rosenfeld L. Charles Best. Margaret and Charley: The personal story of
Dr Charles Best, the Co-Discoverer of Insulin by Henry BM Best. JAMA
2004; 291: 1903–4.
22. The CBC Digital Archives. Dr Frederick Banting. Radio interview
with Michael Bliss. 1981. [Cited 2 May 2008] Available from URL:
http://archives.cbc.ca/clip.asp?page=1&IDClip=9599&IDCat=321&
IDCatPa=258
23. Bliss M. Rewriting medical history: Charles Best and the Banting and
Best myth. J. Hist. Med. Allied Sci. 1993; 48: 253–74.
24. Best HM. Margaret and Charley: The Personal Story of Dr. Charles Best,
the Co-Discoverer of Insulin. Toronto, Ontario, Dundurn Press, 2003.
25. Silverman ME, Hollman A. Discovery of the sinus node by Keith and
Flack: on the centennial of their 1907 publication. Heart 2007; 93:
1184–7.
26. Keith A, Flack MW. The auriculo-ventricular bundle of the human heart.
Lancet 1906; ii: 359–64.
908
27. Keith A, Flack M. The form and nature of the muscular connections
between the primary divisions of the vertebrate heart. J. Anat. Physiol.
1907; 41: 172–89.
28. Anon. Group Captain Martin Flack CBE, MAOxon, MB, BchOxon
Obituary. Br. Med. J. 1931; 2: 402–4.
29. Anon. Martin William Flack CBE, MB Oxf Obituary. Lancet 1931; ii:
430.
30. Bogousslavsky J. The Klumpke family – memories by Doctor Déjerine,
born Augusta Klumpke. Eur. Neurol. 2005; 53: 113–20.
31. Satran R. Augusta Dejerine-Klumpke. First woman intern in Paris Hos-
pitals. Ann. Intern. Med. 1974; 80: 260–4.
32. Klumpke A. Contribution a l’étude des paralysies radiculaires du
plexus brachial. Paralysies radiculaires totales. Paralysies radiculaires
inférieures. De la participation des filets sympathiques oculo-pupillaires
dans ces paralysies. Revue de Médicine 1885; 5: 591–616, 739–90.
33. Yildirim FB, Sarikcioglu L. Historical note: Augusta Déjerine-Klumpke
(1859–1927) and her eponym. J. Neurol. Neurosurg. Psychiatry 2008;
79: 102.
34. Oddi R. Di una speciale disposizione a sfintere allo sbocco del coledoco.
Annali della Libera Università di Perugia 1886–1887; Vol. II, Anno II:
249–65.
35. Oddi R. D’une disposition a sphincter spéciale de l’ouverture du
canal cholédoque (1). Archives Italiennes de Biologie 1887; 8: 317–
22.
36. Oddi R. Sulla tonicita dello sfintere del coledocho. Archivio Per Le
Scienze Mediche 1888; 12: 333–9.
37. Morelli A, Sorcetti F. Ruggero Oddi’s life. Zeitschrift für Gastroenter-
ologie Verhandlungsband 1988; 23: 203–7.
Stringer and Ahmadi
38. Modlin IM, Ahlman H. Oddi: the paradox of the man and the sphincter.
Arch Surg 1994; 129: 549–56.
39. Duckett S. Ernest Duchesne and the concept of fungal antibiotic therapy.
Lancet 1999; 354: 2068–71.
40. Lyman HM. Artificial Anaesthesia and Anaesthetics. New York: William
Wood & Co, 1881.
41. Rutkow IM. Crawford Williamson Long. Arch. Surg. 1999; 134: 578.
42. Thomas RK. Crawford William Long’s discovery of anesthetic ether:
mesmerism, delayed publication, and the historical record. Paper pre-
sented at the Key Barkley Symposium on the History if Psychology,
Southern Society for Philosophy and Psychology, 17 April 2003,
Atlanta, GA. [Cited 3 May 2008] Available from URL: http://
rkthomas.myweb.uga.edu/LongSSPP.htm
43. Ruestow EG. Images and ideas: Leeuwenhoek’s perception of the sper-
matozoa. J. Hist. Biol. 1983; 16: 185–224.
44. Howards SS. Antoine van Leeuwenhoek and the discovery of sperm.
Fertil. Steril. 1997; 67: 16–7.
45. Tan SY. Medicine in stamps. Antoni van Leeuwenhoek (1632–1723):
Father of microscopy. Singapore Med. J. 2003; 44: 557–8.
46. Lewenhoeck DA. Observationes D. Anthonii Lewenhoeck, De Natis E
Semine Genitali Animalculis. Philosophical Transactions 1678; 12
(142): 1040–6.
47. Houtzager HL. Antonie van Leeuwenhoek. Europ. J. Obstet. Gynecol.
Reprod. Biol. 1983; 15: 199–203.
48. Schmidt PJ. Technology transfer: the DeBakey roller pump. Transfusion
2007; 47: 953–4.
49. Gibson WC. Discoveries in the pulmonary and cardiovascular systems.
Chest 1972; 61: 283–6.
© 2009 The Authors
Journal compilation © 2009 Royal Australasian College of Surgeons