0013-7227/91/1295-2271$03.00/0 Endocrinology Copyright © 1991 by The Endocrine Society
Vol. 129, No. 5
Printed in U.S.A.
Henry Stanley Plummer Henry Stanley Plummer, whose father was a country physician and whose mother was a schoolteacher, was born in 1874 in Hamilton, a small village twenty miles south of Rochester, Minnesota. While much interested in studying toward the engineering profession, he later decided on medicine. He graduated from Northwestern University Medical School in 1898, and returned to join his father's practice in Racine, Minnesota, a town near Rochester, where the family had moved in 1893. At this time, Drs. William J. and Charles H. Mayo practiced medicine in Rochester in association with their father, Dr. William Worrall Mayo, and three other physicians. Henry Plummer's father, Dr. Albert Plummer, asked Dr. Will Mayo in 1900 to see a patient in consultation. When Dr. Mayo arrived with his horse and buggy at his destination, the elder Doctor Plummer was ill; so he asked his son to accompany Dr. Mayo to the patient's home. Henry carried his microscope, and on the way he conversed about the blood and its diseases. After he arrived, he made smears of the patient's blood, and showed that the patient had leukemia. He also made smears of the hired man's blood to demonstrate the marked differences between the normal blood and that of the patient. Dr. Mayo was greatly impressed by the young physician's brilliance and scientific approach to medical problems. When he returned home, he suggested to his brother that they invite Henry to join their association, which Dr. Plummer did, soon thereafter. Since Rochester was located in the "center" of the goiter belt, Henry Plummer saw many patients with many types of goiter. Dr. Louis B. Wilson, a pathologist who joined the group, noted that for some patients who had thyroidectomy because of hyperthyroidism, the removed tissue was that of diffuse parenchymatous hypertrophy, while for others this was not so. By meticulous observation, Plummer determined that patients whose thyroids contained diffuse parenchymatous hypertrophy had Graves' disease (called exothalmic goiter), while those whose glands did not show parenchymatous hypertrophy had nodular goiters and no eye changes, characteristic nervous status, or tendency toward the development of crisis as seen in Graves' disease. He first reported Received May 2,1991. "Remembrance," articles discuss people and events as remembered by the author. The opinion(s) expressed are solely those of the writer and do not reflect the view of the Journal or The Endocrine Society.
these observations in 1913 at a meeting of the American Medical Association; they were published in the same year in the Journal of the American Medical Association. At first, Plummer's views were not widely accepted by the medical community; but opinions soon recognized that "Plummer's disease" would become the eponym for hyperthyroidism with adenomatous (or nodular) goiter. Mayo Clinic's Edward C. Kendall isolated thyroxine from the thyroid gland in 1914. Over the next few years, Plummer hypothesized that the disease of toxic, nodular goiter was simply caused by the overproduction of normal thyroxine by the nodule or nodules. In Grave's disease, by contrast, the cause was an excess production of an "abnormal" thyroxine, perhaps deficient in its iodine content. While iodine-containing substances had been used for centuries in treating goiters, thyroidologists in Plummer's time generally believed that iodine should not be given to patients with goiters. This opinion probably arose from reports of Kocher in Switzerland, and others, that euthyroid patients with endemic goiters who were treated with iodine would sometimes become hyperthyroid. Graves' disease in Plummer's time was a very serious and sometimes fatal disorder. Plummer saw about 15 patients per year who arrived in thyroid crisis and died in spite of all treatment. Surgery on patients with Graves' disease sometimes involved risky procedures, usually resulting in a 3.5% mortality rate from postoperative thyroid crisis. Because of this, surgeons sometimes injected hot water into the thyroid or quickly ligated thyroid vessels with the hope of decreasing the toxic state before attempting thyroidectomy. By 1922, Plummer had decided that the administration of iodine to patients who had hyperthyroidism due to Graves' disease might ameliorate the symptoms. Thus, in March 1922, he prescribed iodine in the form of Lugol's solution in 10 minim doses—once, twice, or three times per day—to patients with Graves' disease. He immediately noted a gratifyingly marked improvement in symptoms and a reduced level of the metabolic rate. Moreover, within 10 days of starting treatment with Lugol's solution, the patients safely underwent thyroid surgery. Plummer found that after the introduction of preoperative iodide treatment the surgical mortality dropped to under 1%. In addition, whereas between 1918 and 1922 there had been 75 nonoperative deaths due to
2271
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REMEMBRANCE
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Endo • 1991 Voll29«No6
used for domestic needs, children and sometimes adults occasionally swallowed them. These accidents produced severe, acute inflammation of the esophagus, followed by ulceration and cicatricial obstruction. For the dilation of both cardiospasm and the constriction of lye burns, Plummer worked out a method of introducing the sound into the esophagus, guided by a previously swallowed, silk thread. Although he had not originated the concept of the hydrostatic dilator for such lesions, he pioneered its use in the midwest United States, and he made numerous modifications of the dilators in use. He also worked with the removal of foreign bodies from the bronchus and esophagus. Frequently, when he found he had no suitably designed instrument for removal of an object, he would make such an instrument in his well equipped workshop in his home. When he returned to the Clinic, he would amaze his surgical colleagues by the successful removal with his homemade instrument. When Willem Einthoven (1860-1927) described electrocardiography and its usage between 1903 and 1906, Plummer realized its importance. He obtained one of the
FIG. 1. Henry Stanley Plummer (1874-1936)
Graves' disease at the Mayo Clinic, in 1923 after the introduction of iodine use there was only one. Plummer reported these findings at meetings of both the Association of American Physicians and the Iowa State Medical Society, in 1923, and his announcement helped usher in the era of the great goiter surgeons. Interest in the thyroid was not the only subject of interest which occupied Henry Plummer's time; he was a man of many talents. His first activity after joining the Mayo practice in 1901 was the development of a medical laboratory. Before this time, urinalysis and simple blood tests marked the main laboratory procedures. His next interest pursued the development of x-ray diagnosis and therapy, a completely new field, since roentgenography had only been discovered and described by Wilhelm Konrad Roentgen in 1895. Plummer pioneered in the use and modification of x-ray procedures, and developed, as did so many early workers with x-rays, radiation burns on his hands. Dr. Plummer's practice drew him into the study of disease of the esophagus, including cardiospasm, diverticula, and stricture. Because lye solutions were often
nut FIG. 2. Bookplate of Dr. Plummer's Rare Book Collection.
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REMEMBRANCE
machines in 1914 and showed how to devise a string galvanometer to register electrical changes in the human heart, and to diagnose heart disorders. He greatly encouraged his associates to learn and use this innovative procedure. Henry Plummer was solely responsible organizing and implementing the excellent filing system, record storage, and cross-indexing of patient records, which is still used today in the Mayo Clinic, with great success. This procedure was unique to the Rochester practice, because the patients' histories and findings were formerly recorded and stored in large ledgers, a most cumbersome method. But Plummer devised printed record sheets for individual patients so that the complete record for each could be stored in one packet. Because of his special talents in engineering, mechanics, and architecture, he played a conspicuous, leading role in construction of new buildings on the Mayo campus. When it was decided in 1912 to construct a building for the use of the many members of the rapidly growing group, then called the Mayo Clinic, Plummer planned the room layout, the intra-Clinic communication system, special colored lights as signals above the doors of the examining rooms, and the central telephone office. He, again, was chiefly responsible for almost all of the design and planning of a 16-storied building, completed in 1929, to alleviate the pressing need for more adequate space. This building, named after him, is in full use today, and
2273
is an architectural and artistic gem. Plummer installed an intricate mechanical system for the transportation of patients' records and x-rays throughout the buildings. He also planned an extensive pedestrian-concourse subway system to interconnect the Mayo Clinic buildings and an adjacent hotel. Late in the day on a December afternoon in 1936, Henry Plummer left the Clinic to be driven home. On the way he realized that he was having serious trouble, and he later told his wife at his bedside that he was having a cerebral thrombosis. Because he knew that he would soon become unconscious, he asked to see his family, once more. He saw then shortly before he lapsed into a coma, and died next day at the age of 62. Dr. Plummer's collected works are located in the History of Medicine collection of the Mayo Medical Libraries and in the Archives of the Mayo Historical Unit. His letters and published papers and monographs reflect an unusual biobibliographical contribution to medical science. He was a brilliant man whom many described as a genius who lived far ahead of his time. William M. McConahey Professor Emeritus Mayo Clinic Donald S. Pady History of Medicine Library Mayo Foundation
The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 14 November 2015. at 16:46 For personal use only. No other uses without permission. . All rights reserved.
Vol. 129, No. 5
Printed in U.S.A.
Henry Stanley Plummer Henry Stanley Plummer, whose father was a country physician and whose mother was a schoolteacher, was born in 1874 in Hamilton, a small village twenty miles south of Rochester, Minnesota. While much interested in studying toward the engineering profession, he later decided on medicine. He graduated from Northwestern University Medical School in 1898, and returned to join his father's practice in Racine, Minnesota, a town near Rochester, where the family had moved in 1893. At this time, Drs. William J. and Charles H. Mayo practiced medicine in Rochester in association with their father, Dr. William Worrall Mayo, and three other physicians. Henry Plummer's father, Dr. Albert Plummer, asked Dr. Will Mayo in 1900 to see a patient in consultation. When Dr. Mayo arrived with his horse and buggy at his destination, the elder Doctor Plummer was ill; so he asked his son to accompany Dr. Mayo to the patient's home. Henry carried his microscope, and on the way he conversed about the blood and its diseases. After he arrived, he made smears of the patient's blood, and showed that the patient had leukemia. He also made smears of the hired man's blood to demonstrate the marked differences between the normal blood and that of the patient. Dr. Mayo was greatly impressed by the young physician's brilliance and scientific approach to medical problems. When he returned home, he suggested to his brother that they invite Henry to join their association, which Dr. Plummer did, soon thereafter. Since Rochester was located in the "center" of the goiter belt, Henry Plummer saw many patients with many types of goiter. Dr. Louis B. Wilson, a pathologist who joined the group, noted that for some patients who had thyroidectomy because of hyperthyroidism, the removed tissue was that of diffuse parenchymatous hypertrophy, while for others this was not so. By meticulous observation, Plummer determined that patients whose thyroids contained diffuse parenchymatous hypertrophy had Graves' disease (called exothalmic goiter), while those whose glands did not show parenchymatous hypertrophy had nodular goiters and no eye changes, characteristic nervous status, or tendency toward the development of crisis as seen in Graves' disease. He first reported Received May 2,1991. "Remembrance," articles discuss people and events as remembered by the author. The opinion(s) expressed are solely those of the writer and do not reflect the view of the Journal or The Endocrine Society.
these observations in 1913 at a meeting of the American Medical Association; they were published in the same year in the Journal of the American Medical Association. At first, Plummer's views were not widely accepted by the medical community; but opinions soon recognized that "Plummer's disease" would become the eponym for hyperthyroidism with adenomatous (or nodular) goiter. Mayo Clinic's Edward C. Kendall isolated thyroxine from the thyroid gland in 1914. Over the next few years, Plummer hypothesized that the disease of toxic, nodular goiter was simply caused by the overproduction of normal thyroxine by the nodule or nodules. In Grave's disease, by contrast, the cause was an excess production of an "abnormal" thyroxine, perhaps deficient in its iodine content. While iodine-containing substances had been used for centuries in treating goiters, thyroidologists in Plummer's time generally believed that iodine should not be given to patients with goiters. This opinion probably arose from reports of Kocher in Switzerland, and others, that euthyroid patients with endemic goiters who were treated with iodine would sometimes become hyperthyroid. Graves' disease in Plummer's time was a very serious and sometimes fatal disorder. Plummer saw about 15 patients per year who arrived in thyroid crisis and died in spite of all treatment. Surgery on patients with Graves' disease sometimes involved risky procedures, usually resulting in a 3.5% mortality rate from postoperative thyroid crisis. Because of this, surgeons sometimes injected hot water into the thyroid or quickly ligated thyroid vessels with the hope of decreasing the toxic state before attempting thyroidectomy. By 1922, Plummer had decided that the administration of iodine to patients who had hyperthyroidism due to Graves' disease might ameliorate the symptoms. Thus, in March 1922, he prescribed iodine in the form of Lugol's solution in 10 minim doses—once, twice, or three times per day—to patients with Graves' disease. He immediately noted a gratifyingly marked improvement in symptoms and a reduced level of the metabolic rate. Moreover, within 10 days of starting treatment with Lugol's solution, the patients safely underwent thyroid surgery. Plummer found that after the introduction of preoperative iodide treatment the surgical mortality dropped to under 1%. In addition, whereas between 1918 and 1922 there had been 75 nonoperative deaths due to
2271
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REMEMBRANCE
2272
Endo • 1991 Voll29«No6
used for domestic needs, children and sometimes adults occasionally swallowed them. These accidents produced severe, acute inflammation of the esophagus, followed by ulceration and cicatricial obstruction. For the dilation of both cardiospasm and the constriction of lye burns, Plummer worked out a method of introducing the sound into the esophagus, guided by a previously swallowed, silk thread. Although he had not originated the concept of the hydrostatic dilator for such lesions, he pioneered its use in the midwest United States, and he made numerous modifications of the dilators in use. He also worked with the removal of foreign bodies from the bronchus and esophagus. Frequently, when he found he had no suitably designed instrument for removal of an object, he would make such an instrument in his well equipped workshop in his home. When he returned to the Clinic, he would amaze his surgical colleagues by the successful removal with his homemade instrument. When Willem Einthoven (1860-1927) described electrocardiography and its usage between 1903 and 1906, Plummer realized its importance. He obtained one of the
FIG. 1. Henry Stanley Plummer (1874-1936)
Graves' disease at the Mayo Clinic, in 1923 after the introduction of iodine use there was only one. Plummer reported these findings at meetings of both the Association of American Physicians and the Iowa State Medical Society, in 1923, and his announcement helped usher in the era of the great goiter surgeons. Interest in the thyroid was not the only subject of interest which occupied Henry Plummer's time; he was a man of many talents. His first activity after joining the Mayo practice in 1901 was the development of a medical laboratory. Before this time, urinalysis and simple blood tests marked the main laboratory procedures. His next interest pursued the development of x-ray diagnosis and therapy, a completely new field, since roentgenography had only been discovered and described by Wilhelm Konrad Roentgen in 1895. Plummer pioneered in the use and modification of x-ray procedures, and developed, as did so many early workers with x-rays, radiation burns on his hands. Dr. Plummer's practice drew him into the study of disease of the esophagus, including cardiospasm, diverticula, and stricture. Because lye solutions were often
nut FIG. 2. Bookplate of Dr. Plummer's Rare Book Collection.
The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 14 November 2015. at 16:46 For personal use only. No other uses without permission. . All rights reserved.
REMEMBRANCE
machines in 1914 and showed how to devise a string galvanometer to register electrical changes in the human heart, and to diagnose heart disorders. He greatly encouraged his associates to learn and use this innovative procedure. Henry Plummer was solely responsible organizing and implementing the excellent filing system, record storage, and cross-indexing of patient records, which is still used today in the Mayo Clinic, with great success. This procedure was unique to the Rochester practice, because the patients' histories and findings were formerly recorded and stored in large ledgers, a most cumbersome method. But Plummer devised printed record sheets for individual patients so that the complete record for each could be stored in one packet. Because of his special talents in engineering, mechanics, and architecture, he played a conspicuous, leading role in construction of new buildings on the Mayo campus. When it was decided in 1912 to construct a building for the use of the many members of the rapidly growing group, then called the Mayo Clinic, Plummer planned the room layout, the intra-Clinic communication system, special colored lights as signals above the doors of the examining rooms, and the central telephone office. He, again, was chiefly responsible for almost all of the design and planning of a 16-storied building, completed in 1929, to alleviate the pressing need for more adequate space. This building, named after him, is in full use today, and
2273
is an architectural and artistic gem. Plummer installed an intricate mechanical system for the transportation of patients' records and x-rays throughout the buildings. He also planned an extensive pedestrian-concourse subway system to interconnect the Mayo Clinic buildings and an adjacent hotel. Late in the day on a December afternoon in 1936, Henry Plummer left the Clinic to be driven home. On the way he realized that he was having serious trouble, and he later told his wife at his bedside that he was having a cerebral thrombosis. Because he knew that he would soon become unconscious, he asked to see his family, once more. He saw then shortly before he lapsed into a coma, and died next day at the age of 62. Dr. Plummer's collected works are located in the History of Medicine collection of the Mayo Medical Libraries and in the Archives of the Mayo Historical Unit. His letters and published papers and monographs reflect an unusual biobibliographical contribution to medical science. He was a brilliant man whom many described as a genius who lived far ahead of his time. William M. McConahey Professor Emeritus Mayo Clinic Donald S. Pady History of Medicine Library Mayo Foundation
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