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In many doctors' offices, a hanging print of Thomas Eakins' masterpiece The Gross Clinic is as common a sight as a tongue depressor.

At the center of that famous painting, heroically lit amid the anatomy amphitheater's shadows, is Samuel Gross, a giant of nineteenth-century surgery.

Although it depicts Gross in his Philadelphia clinic in 1875, the painting vividly illustrates what Gross was doing between 1840 and 1856 when he was the preeminent professor of surgery at the Medical Institute of Louisville, the precursor of the University of Louisville School of Medicine. While in Louisville, Gross made some of the greatest surgical advances of his time, many of which were later detailed in his famous text, A System of Surgery: Pathological, Diagnostic, Therapeutic, and Operative.

In a span of time that began before the Civil War and continues through the war on cancer,
U of L has played an important role in the advancement of medical research. Gross and other pioneers serve as role models for today's researchers as they strive to reach the ambitious goals of U of L's 10-year Challenge for Excellence initiative.

The Gross Clinic
Standing at the center of Thomas Eakins' famous painting, The Gross Clinic, is U of L medical pioneer Samuel Gross, one of the giants of nineteenth-century surgery.
Gross Anatomy

Gross, together with Daniel Drake and Austin Flint, Sr., turned Louisville into the most important medical center in what was then considered "the West." Many prominent surgeons of the day were attracted to the city because, as a river port, it provided a steady stream of injured riverboat workers.

In 1841, Gross performed the first surgery in the West's first clinical amphitheater, at the Louisville Marine Hospital. There, he successfully ligated, or surgically tied, an aneurysm in a man's subclavian artery, the main artery of the arm.

During his 16 years in Louisville, Gross conducted extensive research on intestinal wounds in dogs and devised new suturing techniques for repair. He emphasized that sutures must pass through the submucosa, a procedure still recognized today as vital for keeping sutures in place.

Lone before the age of "publish or perish" in academic research, Gross was one of the first American physicians to write books and articles on medical topics. Previously, much of the available literature was translated from European texts.

Taking a Stab at New Techniques

The first successful operation on a human abdominal stab wound was performed in 1883 in Louisville by William Owen Roberts, a U of L graduate and professor of surgery.

By then, use of anesthesia was standard, which was not the case just a few years before. In 1847, U of L's first chair of surgery, Joshua B. Flint, administered ether for the first time in the West. At the same time, Gross used chloroform for the first time in the state.

When Gross left Louisville in 1856, his assistant, David Wendel Yandell, became the South's most prominent surgeon. A U of L graduate and professor of surgery, Yandell established the West's first clinic, the Stokes Free Dispensary, to treat Louisville's poor and educate students in clinical medicine.

Yandell and his colleague, Lewis Samuel McMurtry, professor of abdominal surgery and gynecology, were early promoters of antiseptic procedures. Joseph Nathaniel McCormack, professor of hygiene, studied in Europe with renowned English surgeon Joseph Lister, and brought infection reducing techniques back to the U.S.

Other notable surgeons of the late nineteenth century include: William Christopher Dugan, a U of L graduate and professor of surgery, who performed the first appendectomy in Kentucky and possibly in the South during the 1880s; Tobias Gibson Richardson, a U of L graduate and professor of surgery, who wrote the first anatomy book published in the West, Richardson's Elements of Human Anatomy, in 1853; Joseph McDowell Matthews, also a U of L graduate and professor of surgery, who is known as the father of modern proctology (his The Rectum, Anus, and Sigmoid Flexure, published in 1893, was the first American textbook on rectal diseases); Turner Anderson, professor of abdominal surgery and gynecology, who was the first surgeon west of the Alleghenies to do pneumo-notomy to drain a pulmonary abscess; and, finally, in the believe-it-or-not category, A. Morgan Cartledge, professor of abdominal surgery and gynecology, who removed a 245-pound ovarian cyst, the largest in medical history.

Pioneering Trauma Research and Care

At the turn of the century, Louisville was on the vanguard of modern emergency care. The nation's first "Accident Service" opened at Louisville City Hospital in 1911. It, as well as trauma surgery techniques, were greatly improved in the 1930s and '40s by a bold U of L surgeon, Arnold Griswold.

Long before EMS, Griswold equipped police vehicles with medical supplies and trained officers to give emergency care while en route to the hospital.

At the hospital, severely wounded patients would undergo radical new procedures researched by Griswold, professor and chair of the U of L Department of Surgery. A case from the 1930s demonstrated Griswold's eagerness to debunk the status quo. A stabbing victim was taken to Louisville City Hospital with four puncture wounds to his heart. Although then- standard procedure for heart injuries was mostly watchful waiting, Griswold opened the chest immediately and sutured holes in the damaged heart. It was a bold approach, but Griswold proved it was a valid one by establishing the best survival rate for penetrating heart wounds in the United States.

Griswold developed auto transfusion, the use of the patient's own blood during surgery, and helped establish the first blood bank in Louisville. An innovator in treating broken bones, he also perfected the use of pins and walking casts and invented a skeletal traction device, dubbed the Griswold Machine, for treating fractures.

On March 28, 1985, Laman A. Gray, Jr. and a team of U of L surgeons working at Jewish
Heart Surgery
Laman A. Gray, Jr. and his team performed Kentucky's first heart transplant in 1984, and later performed pioneering heart surgery using the Thoratec Ventricular Assist Device.

Hospital performed pioneering heart surgery when they used the Thoratec Ventricular Assist Device on Michael Charles Jones as a bridge to transplantation. The device kept the 16-year-old Hoosier alive for five days until a donor heart could be found. This was the first successful heart transplant in the United States following the use of the Thoratec device. It was also the first time that two VADs were used anywhere. Jewish Hospital was one of two centers experimenting with the VAD.

In September 1994, U of L surgeons working at Jewish Hospital performed the first cardiomyoplasty, wrapping a portion of the back muscle around the heart, in Kentucky. This operation was also the first in the U. S. to use the Medtronic stimulator to help the muscle contract around the heart.

Other recent research of international stature at U of L includes Hiram Polk's studies of surgical infection; the Department of Ophthalmology and Visual Sciences' work in glaucoma, cataract, and other eye conditions; and Stephen Peiper's work on the cellular and genetic processes of AIDs infection and cancer development.

Advancing Early Orthopedic Techniques

Griswold was an inspiration for K. Armand Fischer and Kenton D. Leatherman, two pioneering orthopedic surgeons at U of L.

As residents, Fischer and Leatherman performed Kentucky's first spinal fusion operation for scoliosis in 1941, supervised by William Barnett Owen. Owen had established the Orthopedics Division of the Surgical Department in 1940.

Fischer headed the Orthopedics Division from 1943 to 1967, during a time of great innovation in the School of Medicine. Under Fischer's watch, colleague Leatherman burst upon the orthopedic surgery scene with techniques that left the profession initially aghast. In 1957, Leatherman performed the world's first thoracic vertebral body resection for scoliosis-a procedure many deemed too dangerous to attempt. It soon became commonplace, and improved countless lives. In 1967, Leatherman again changed the profession when he performed the world's first anterior thoracic approach to the scoliotic spine.

An International Hand Surgery Mecca

The specialty of hand surgery was practically nonexistent in 1953 when Harold Kleinert came to Louisville to practice and teach at the U of L medical school. At the time, no techniques existed to save severely damaged hands from becoming useless appendages.

Throughout the 1950s, Kleinert began perfecting improved surgical techniques. In 1959, he reattached a woman's nearly amputated arm, successfully restoring the nerves, blood flow, and muscles. In 1965, Kleinert and area hand surgeon Morton Kasdan '63M successfully repaired the smallest blood vessels that had ever been fixed in the finger.

In 1967, Kleinert and colleague Joseph Kutz shocked the hand surgery establishment with a paper on "Primary Repair of Lacerated Flexor Tendons in 'No Man's Land.'" Conventional wisdom was to wait and graft tendons from elsewhere. Even then, finger movement could fail or be limited.

Kleinert and Kutz wanted to repair the tendons right away, and still have a functional hand. In addition to fine stitching, repair of the sheaths surrounding the tendons, and attention to blood supply, they added something new-controlled early motion, achieved with the use of a moveable splint. The technique prevented scar tissue, promoting healing and movement.

In 1977, Kleinert performed the first known successful bilateral arm replant, the reattachment of a tin miner's two severed arms. Kleinert, Kutz and Associates, now practicing at Louisville's Jewish Hospital, has not only done groundbreaking work in replantation, implantation, carpal tunnel repair, and orthotics, but also claims more hand surgery trainees than any other practice in the world.

Microsurgical Advances

More innovations occurred when Scottish microsurgeon Robert Acland was recruited in 1975. Although Kleinert, Kutz, and others were pioneering advances in small blood vessel repair, skin and tendon grafting, and transferring tissue and body parts to other areas, efforts to educate fellows and residents in how to perform surgery in the tiniest scales lagged behind.

Acland, a professor in the Division of Plastic and Reconstructive Surgery, started the Center for Microsurgical Studies to train the division's fellows. It has since become an independent, self-supporting operation open to all doctors who want to learn microsurgical techniques.

From Acland's U of L lab have come sharper, smaller needles for finer surgical stitching and better designed and built microsurgical instruments used by surgeons worldwide. Acland's lab has trained thousands of doctors, and produced internationally renowned training videos.

Before the War on Cancer

Even before the National Cancer Act of 1971 heralded a "war on cancer," maverick U of L doctors conducted vital research on the disease. Cervical cancer was a common scourge until use of the Pap Smear aided early diagnosis. In 1956, Louisville became one of five U.S. Pap Smear trial centers, with the research project headed by U of L pathologist William Christopherson.

Mass screenings demonstrated that the best samples came from cells scraped from the cervix, not cells that had shed into the vagina. The study also found a correlation between poverty and cervical cancer incidence, and established a link between Pap Smears and a decrease in cervical cancer death rates.

In 1957, former surgery chairman Rudolf J. Noer co-directed the federally sponsored Surgical Adjuvant Breast Cancer Study, the first to show that chemotherapy was effective in some women after breast cancer surgery.

Condict Moore, former director of the surgical oncology division and surgery professor emeritus, published groundbreaking studies linking mouth and throat cancer to smoking in the Journal of the American Medical Association in 1965, followed by a larger series in 1971. His work thrust him into posts on national cancer committees, including one formed to implement the National Cancer Act.

Since then, U of L researchers have pioneered free-flap plastic surgery to repair the ravages of head and neck cancers; methods of protecting workers exposed to the cancer-causing chemical vinyl chloride; development of sex-hormone receptor tests to aid hormone therapy for breast cancer; the use of tamoxifen to treat breast cancer; and laser light-activated chemical therapy to kill tumors.

A Preeminent Metropolitan Research University

Today, U of L physicians and surgeons are building upon the legacy of these bold medical pioneers as they explore new frontiers in the treatment of wounds and disease as part of the Challenge for Excellence. Through new procedures in heart surgery, as well as cutting edge research in cancer treatment; surgical infection; glaucoma, cataract, and other eye conditions; and the genetic processes of AIDS infection, U of L researchers continue to make medical history. They are also strong contributors to U of L's goal of becoming a nationally recognized, preeminent metropolitan research university.