Accepted Manuscript Instruments Used in American Oral and Maxilofacial Surgery: The Person Behind the Name Daniel M. Laskin, DDS, MS, Professor and Chairman Emeritus PII:
S0278-2391(15)00098-1
DOI:
10.1016/j.joms.2015.01.026
Reference:
YJOMS 56644
To appear in:
Journal of Oral and Maxillofacial Surgery
Received Date: 4 December 2014 Revised Date:
21 January 2015
Accepted Date: 26 January 2015
Please cite this article as: Laskin DM, Instruments Used in American Oral and Maxilofacial Surgery: The Person Behind the Name, Journal of Oral and Maxillofacial Surgery (2015), doi: 10.1016/ j.joms.2015.01.026. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
RI PT
ACCEPTED MANUSCRIPT
SC
Instruments Used in American Oral and Maxilofacial Surgery: The Person Behind the Name Daniel M. Laskin DDS, MS
M AN U
Professor and Chairman Emeritus
Department of Oral and Maxillofacial Surgery Virginia Commonwealth University School of Dentistry
Address Correspondence To:
EP
Dr. Daniel M. Laskin
TE D
Richmond, VA
Department of Oral and Maxillofacial Surgery
AC C
Virginia Commonwealth University School of Dentistry 521 N.11th St.
Richmond, VA 23298-0566 804-828-3547 (P) 804-828-1753 (F) [email protected]
ACCEPTED MANUSCRIPT
Instruments Used in American Oral and Maxillofacial Surgery: The Person behind the Name
Although in more recent times there has been a tendency to avoid the use of eponyms for surgical
RI PT
instruments, there are still many currently in use for years that bear the names of their creator. It is of historical interest to learn something about the life and work of these individuals, whose contributions during the 19th and early 20th century have made our surgical experiences much easier. Whereas some
SC
of these instruments were developed solely for use in oral and maxillofacial surgery (OMS), many others have been adopted from other surgical specialties. This article discusses some examples of both
M AN U
varieties. Also of interest is how some of the OMS instruments, such as dental forceps, received there unusual names.
Instruments Adopted FromOother Surgical Specialties Joseph elevator: Jacques L. Joseph (1865-1934)(Figure 1), a German, was a pioneer in rhinoplasty
TE D
techniques who performed the first reduction rhinoplasty from an external approach in 18981. He later was involved in the treatment of soldiers with facial trauma during World War I. He is widely considered
EP
as the father of facial plastic surgery. Dr. Joseph died of a heart attack on the way to his office in 1934. Adson forceps: Alfred W. Adson (1887-1951) (Figure 2), born in Iowa of Norwegian parents,
AC C
was a neurosurgeon who created the section of neurological surgery at the Mayo Clinic. Among the many operations he developed was the transcranial approach for the treatment of cerebrospinal fluid rhinorrhea2 . The delicate teeth on the Adson forceps make it particularly well suited as an aid when suturing the skin.
Frazier suction tip: Charles S. Frazier (1870-1936) was a neurosurgeon at the University of Pennsylvania School of Medicine known for his surgical treatment of trigeminal neuralgia. He designed this delicate
1
ACCEPTED MANUSCRIPT
suction tip to control the bleeding and maintain a clear operating field during treatment of the latter condition.
RI PT
Freer elevator: Otto “Tiger” Freer (1857-1932) was an otolaryngologist who was one of the originators of modern nasal septal surgery. It has been suggested that those unfamiliar with his name may have assumed that it was called a Freer elevator merely because of its use to “free” the nasal mucosa from the septum3. Actually, the correct pronunciation is “freer” (Long E, one syllable) and not “free-er”.The
SC
instrument has also been adopted by the neurosurgeons for use during the transphenoidal approach to
M AN U
the anterior cranial base.
Kocher clamp: Emil Theodor Kocher (1841-1917) (Figure 3) was a Swiss surgeon at the University of Bern who specialized in thyroid surgery and performed over 2000 thyroidectomies. He received the Nobel Prize in Physiology for discovering that the thyroid gland was an essential organ. His other contributions include his “Textbook of Operative Surgery”, his pioneering of ovariotomy, and his application of Lister’s
TE D
antiseptic techniques to reduce the mortality of thyroid surgery. The subcostal incision for a cholecystectomy is called the Kocher incision.
EP
Senn retractor: Nicholas Senn (1844-1908) (Figure 4), a general surgeon, was professor of surgery and surgical pathology, and head of the department, at Rush Medical College in Chicago. He was the founder
AC C
of the Association of Military Surgeons of the United States and the 49th president of the American Medical Association. The Chicago Public Schools honored him in 1913 by naming a high school after him.
Kelly forceps: Howard Atwood Kelly (1858-1943) (Figure 5) was the first professor of obstetrics and gynecology at Johns Hopkins University. The so-called “mosquito” variant of this locking hemostatic forceps has smaller, finer tips. Among his other medical device inventions were a cystoscope and a rectal speculum. He was also one of the first to use radium to treat cancer. 2
ACCEPTED MANUSCRIPT
Metzenbaum scissors: Myron Firth Metzenbaum (1876-1944) was an otolaryngologist who specialized in oral and reconstructive surgery, including cleft lip and palate repair. Because he did not have a patent
“Her Majesty’s Most Excellent Dissecting” scissors in Great Britain4.
RI PT
on the scissors they are called “Mao Tse Tung” scissors in China, “Mahatma Gandi” scissors in India and
Crile retractor: George Washington Crile (1864-1943)(Figure 6), a co-founder of the Cleveland Clinic, is best known as the father of physiological surgery in the United States for his pioneering contributions on
SC
blood pressure and shock during operations, as well as for being the first to do a direct human blood
first to use cocaine for regional anesthesia.
M AN U
transfusion5. He also performed the first radical neck dissection for head and neck cancer and was the
Bard-Parker scalpel blade: Morgan Parker (1892-1976) was an engineer who developed the disposable scalpel blade in 1915, which revolutionized surgical practice. Prior to that time scalpels often had to be sharpened during the operation and then resterilized. The disposable blade had the advantages of being
TE D
mass produced in many shapes and sizes, packaged in sterile form, and replaceable when dull. BardParker was the name of the company that manufactured it. Although the name is still used, the original
EP
company is no longer in existence.
Oral and Maxillofacial Surgery Instruments
AC C
Extraction forceps
The documented history of dental extraction forceps goes back a least as far as the time of Aristotle (384 to 322 BC). Over the subsequent centuries these forceps underwent a variety of designs and shapes. The earliest forceps were non-anatomical devices that were used to grasp and lever the tooth from the socket. These were subsequently replaced by anatomically designed forceps whose beaks approximated the shape of the crown. Surprisingly, there does not appear to be any eponyms attached to the various dental forceps. The one exception is the
3
ACCEPTED MANUSCRIPT
Ash forceps, which is actually the name of a dental instrument company started in London, England in 1820 by Claudius Ash, who was not a dentist. Instead, the early dental extraction forceps were usually named after the jaw, beak, bill, claw or other part of the animal they
RI PT
resembled. Thus, we find such names as the pelican forceps, the hawk’s, parrot and crow bill forceps, the goat’s foot forceps and even the cow horn forceps, which is still in use day5. Dental elevators
SC
Although there are a number of dental elevators that have eponyms for names that are still used, it was not possible to find information about the creators of some, such as the Miller
M AN U
elevator, the Heidbrink elevator and the Crane pick, despite an extensive search. The following are several commonly used dental elevators for which information was available. Cryer elevator: Matthew Henry Cryer 1840-1921) (Figure 7) was born in England but moved to the United States with his family as a child. He had a great interest in craniofacial anatomy and wrote several anatomic textbooks, including “Studies of Internal Anatomy of the Face”. In 1901
TE D
he founded the first hospital dental service in America at the Philadelphia General Hospital. The paired Cryer elevators, used to remove dental roots, were modeled after dental scaling instruments known as SSW scalers6.
EP
Potts elevator: Herbert Anthony Potts (1873-1942) was a teacher of oral surgery at Northwestern University Dental School when his career was interrupted by World War I. Upon his
AC C
return to Chicago, he started the Department of Oral and Maxillofacial Surgery at Cook County Hospital and was chief of the department for 14 years. It was during this time that he developed the elevator that bears his name. Cogswell elevator: Henry Daniel Cogswell (1820-1900) (Figure 8) was an eccentric dentist who moved west to San Francisco in 1849 at the time of the California gold rush. He opened a dental office and began a business of selling dental, medical and surgical instruments. He also invested in real estate and mining stocks and became a millionaire. A crusader in the
4
ACCEPTED MANUSCRIPT
temperance movement, he believed that people would not consume alcohol if they had cool drinking water available. He therefore designed and funded the erection of 32 elaborate drinking fountains in various cities throughout the United States, some of which are still in
RI PT
existence (Figure 9). Seldin periosteal elevator: Harry M. Seldin (1895-1975) (Figure 10), who was born in Russia, was both a practitioner and an educator. His textbook “Practical Anesthesia for Dental and Oral Surgery” was popular for many years. He was a member of the oral surgery faculty of New York
SC
University College of Dentistry from 1919-1926 and served as chief of anesthesia from 19261931. In 1956 he was president of the American Society of Oral Surgeons. Designed as an
M AN U
instrument to reflect the periosteum from the bone, the Seldin elevator’s broad surface also makes it an excellent soft tissue retractor and protector
Discussion
TE D
It is of interest that there are few, if any, eponyms attached to the most common instrument used in oral surgery, the extraction forceps. Instead, they are usually identified by numbers and the person who first developed the instrument remains unknown. However, these numbers are
EP
assigned by the manufacturers and can vary according to the company involved. Thus, one can have two identical forceps with different numbers. There is therefore a need to establish a
AC C
uniform numbering system. However, because there are so many minor variations in the configuration of the beaks and handles of the various extraction forceps, this can be a very challenging task.
With all of the various surgical instruments in existence, one wonders why some still have the name of their creator attached to them and others do not. It appears that most of those with eponymous names are instruments that serve a unique function that is not accomplished, or is more difficult to accomplish, with the usual standard instruments. Therefore, in a way,
5
ACCEPTED MANUSCRIPT
maintaining the eponym continues to honor those who made some aspect of a surgical
RI PT
procedure easier to achieve and thus improved patient care and treatment outcomes.
References
1. Saman M, Helman SN, Kadakia S, Naymagon L. Instruments in rhinoplasty: Who is behind the name? J Plastic, Reconstructive & Aesthetic Surgery (2014) doi: 10.1016/j.bjps.2014.10.018.
SC
2. Griessenauer CJ, Tubbs RS, Shoja MM, et al. Alfred W. Adson (1887-1951): his contributions to surgery for tumors of the spine and spinal cord in the context of spinal tumor surgery in the late
M AN U
19th and early 20th centuries. J Neurosurg Spine. 2013:19: 750-758.
3. Chittiboina P, Connor DE, Nanda A. Dr. Otto “Tiger” Freer: inventor and innovator. Neurosurg Focus. 2012 Aug:33(2):E12. Dol:10.3171/2012.6.FOCUS12137.
4. Whonamedit? A dictionary of medical eponyms. Myron Firth Metzenbaum.
TE D
5. Atkinson HF. Some early dental extraction instruments including pelican, bird or axe? Australian Dent J 2002;47:90-93.
6. Bussell MA, Graham RM. The history of commonly used dental elevators. Brit Dent J 2008; 205:
AC C
Legends:
EP
505-508.
Figure 1. Jacques L. Joseph Figure 2. Alfred W. Adson
Figure 3. Emil Theodor Kocher Figure 4. Nicholas Senn Figure 5. Howard Atwood Kelly
6
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Figure 6. George Washington Crile Figure 7. Matthew Henry Cryer
Figure9. Temperance fountain in Washington, DC
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EP
TE D
M AN U
SC
Figure 10. Harry M. Seldin
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Figure 8. Henry Daniel Cogswell
7
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EP
TE D
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SC
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ACCEPTED MANUSCRIPT
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EP
TE D
M AN U
SC
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ACCEPTED MANUSCRIPT
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EP
TE D
M AN U
SC
Figure 3. Emil Theodor Kocher
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EP
TE D
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Figure 4. Nicholas Senn
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ACCEPTED MANUSCRIPT
SC
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ACCEPTED MANUSCRIPT
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EP
TE D
M AN U
Figure 5. Howard Atwood Kelly
M AN U
SC
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ACCEPTED MANUSCRIPT
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EP
TE D
Figure 6. George Washington Crile
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SC
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ACCEPTED MANUSCRIPT
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EP
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Figure 7. Matthew Henry Cryer
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EP
TE D
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Figure 8. Henry Daniel Cogswell
EP
TE D
M AN U
SC
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ACCEPTED MANUSCRIPT
AC C
fountain in Washington, D.C.
Figure 9. Temperance
S0278-2391(15)00098-1
DOI:
10.1016/j.joms.2015.01.026
Reference:
YJOMS 56644
To appear in:
Journal of Oral and Maxillofacial Surgery
Received Date: 4 December 2014 Revised Date:
21 January 2015
Accepted Date: 26 January 2015
Please cite this article as: Laskin DM, Instruments Used in American Oral and Maxilofacial Surgery: The Person Behind the Name, Journal of Oral and Maxillofacial Surgery (2015), doi: 10.1016/ j.joms.2015.01.026. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
RI PT
ACCEPTED MANUSCRIPT
SC
Instruments Used in American Oral and Maxilofacial Surgery: The Person Behind the Name Daniel M. Laskin DDS, MS
M AN U
Professor and Chairman Emeritus
Department of Oral and Maxillofacial Surgery Virginia Commonwealth University School of Dentistry
Address Correspondence To:
EP
Dr. Daniel M. Laskin
TE D
Richmond, VA
Department of Oral and Maxillofacial Surgery
AC C
Virginia Commonwealth University School of Dentistry 521 N.11th St.
Richmond, VA 23298-0566 804-828-3547 (P) 804-828-1753 (F) [email protected]
ACCEPTED MANUSCRIPT
Instruments Used in American Oral and Maxillofacial Surgery: The Person behind the Name
Although in more recent times there has been a tendency to avoid the use of eponyms for surgical
RI PT
instruments, there are still many currently in use for years that bear the names of their creator. It is of historical interest to learn something about the life and work of these individuals, whose contributions during the 19th and early 20th century have made our surgical experiences much easier. Whereas some
SC
of these instruments were developed solely for use in oral and maxillofacial surgery (OMS), many others have been adopted from other surgical specialties. This article discusses some examples of both
M AN U
varieties. Also of interest is how some of the OMS instruments, such as dental forceps, received there unusual names.
Instruments Adopted FromOother Surgical Specialties Joseph elevator: Jacques L. Joseph (1865-1934)(Figure 1), a German, was a pioneer in rhinoplasty
TE D
techniques who performed the first reduction rhinoplasty from an external approach in 18981. He later was involved in the treatment of soldiers with facial trauma during World War I. He is widely considered
EP
as the father of facial plastic surgery. Dr. Joseph died of a heart attack on the way to his office in 1934. Adson forceps: Alfred W. Adson (1887-1951) (Figure 2), born in Iowa of Norwegian parents,
AC C
was a neurosurgeon who created the section of neurological surgery at the Mayo Clinic. Among the many operations he developed was the transcranial approach for the treatment of cerebrospinal fluid rhinorrhea2 . The delicate teeth on the Adson forceps make it particularly well suited as an aid when suturing the skin.
Frazier suction tip: Charles S. Frazier (1870-1936) was a neurosurgeon at the University of Pennsylvania School of Medicine known for his surgical treatment of trigeminal neuralgia. He designed this delicate
1
ACCEPTED MANUSCRIPT
suction tip to control the bleeding and maintain a clear operating field during treatment of the latter condition.
RI PT
Freer elevator: Otto “Tiger” Freer (1857-1932) was an otolaryngologist who was one of the originators of modern nasal septal surgery. It has been suggested that those unfamiliar with his name may have assumed that it was called a Freer elevator merely because of its use to “free” the nasal mucosa from the septum3. Actually, the correct pronunciation is “freer” (Long E, one syllable) and not “free-er”.The
SC
instrument has also been adopted by the neurosurgeons for use during the transphenoidal approach to
M AN U
the anterior cranial base.
Kocher clamp: Emil Theodor Kocher (1841-1917) (Figure 3) was a Swiss surgeon at the University of Bern who specialized in thyroid surgery and performed over 2000 thyroidectomies. He received the Nobel Prize in Physiology for discovering that the thyroid gland was an essential organ. His other contributions include his “Textbook of Operative Surgery”, his pioneering of ovariotomy, and his application of Lister’s
TE D
antiseptic techniques to reduce the mortality of thyroid surgery. The subcostal incision for a cholecystectomy is called the Kocher incision.
EP
Senn retractor: Nicholas Senn (1844-1908) (Figure 4), a general surgeon, was professor of surgery and surgical pathology, and head of the department, at Rush Medical College in Chicago. He was the founder
AC C
of the Association of Military Surgeons of the United States and the 49th president of the American Medical Association. The Chicago Public Schools honored him in 1913 by naming a high school after him.
Kelly forceps: Howard Atwood Kelly (1858-1943) (Figure 5) was the first professor of obstetrics and gynecology at Johns Hopkins University. The so-called “mosquito” variant of this locking hemostatic forceps has smaller, finer tips. Among his other medical device inventions were a cystoscope and a rectal speculum. He was also one of the first to use radium to treat cancer. 2
ACCEPTED MANUSCRIPT
Metzenbaum scissors: Myron Firth Metzenbaum (1876-1944) was an otolaryngologist who specialized in oral and reconstructive surgery, including cleft lip and palate repair. Because he did not have a patent
“Her Majesty’s Most Excellent Dissecting” scissors in Great Britain4.
RI PT
on the scissors they are called “Mao Tse Tung” scissors in China, “Mahatma Gandi” scissors in India and
Crile retractor: George Washington Crile (1864-1943)(Figure 6), a co-founder of the Cleveland Clinic, is best known as the father of physiological surgery in the United States for his pioneering contributions on
SC
blood pressure and shock during operations, as well as for being the first to do a direct human blood
first to use cocaine for regional anesthesia.
M AN U
transfusion5. He also performed the first radical neck dissection for head and neck cancer and was the
Bard-Parker scalpel blade: Morgan Parker (1892-1976) was an engineer who developed the disposable scalpel blade in 1915, which revolutionized surgical practice. Prior to that time scalpels often had to be sharpened during the operation and then resterilized. The disposable blade had the advantages of being
TE D
mass produced in many shapes and sizes, packaged in sterile form, and replaceable when dull. BardParker was the name of the company that manufactured it. Although the name is still used, the original
EP
company is no longer in existence.
Oral and Maxillofacial Surgery Instruments
AC C
Extraction forceps
The documented history of dental extraction forceps goes back a least as far as the time of Aristotle (384 to 322 BC). Over the subsequent centuries these forceps underwent a variety of designs and shapes. The earliest forceps were non-anatomical devices that were used to grasp and lever the tooth from the socket. These were subsequently replaced by anatomically designed forceps whose beaks approximated the shape of the crown. Surprisingly, there does not appear to be any eponyms attached to the various dental forceps. The one exception is the
3
ACCEPTED MANUSCRIPT
Ash forceps, which is actually the name of a dental instrument company started in London, England in 1820 by Claudius Ash, who was not a dentist. Instead, the early dental extraction forceps were usually named after the jaw, beak, bill, claw or other part of the animal they
RI PT
resembled. Thus, we find such names as the pelican forceps, the hawk’s, parrot and crow bill forceps, the goat’s foot forceps and even the cow horn forceps, which is still in use day5. Dental elevators
SC
Although there are a number of dental elevators that have eponyms for names that are still used, it was not possible to find information about the creators of some, such as the Miller
M AN U
elevator, the Heidbrink elevator and the Crane pick, despite an extensive search. The following are several commonly used dental elevators for which information was available. Cryer elevator: Matthew Henry Cryer 1840-1921) (Figure 7) was born in England but moved to the United States with his family as a child. He had a great interest in craniofacial anatomy and wrote several anatomic textbooks, including “Studies of Internal Anatomy of the Face”. In 1901
TE D
he founded the first hospital dental service in America at the Philadelphia General Hospital. The paired Cryer elevators, used to remove dental roots, were modeled after dental scaling instruments known as SSW scalers6.
EP
Potts elevator: Herbert Anthony Potts (1873-1942) was a teacher of oral surgery at Northwestern University Dental School when his career was interrupted by World War I. Upon his
AC C
return to Chicago, he started the Department of Oral and Maxillofacial Surgery at Cook County Hospital and was chief of the department for 14 years. It was during this time that he developed the elevator that bears his name. Cogswell elevator: Henry Daniel Cogswell (1820-1900) (Figure 8) was an eccentric dentist who moved west to San Francisco in 1849 at the time of the California gold rush. He opened a dental office and began a business of selling dental, medical and surgical instruments. He also invested in real estate and mining stocks and became a millionaire. A crusader in the
4
ACCEPTED MANUSCRIPT
temperance movement, he believed that people would not consume alcohol if they had cool drinking water available. He therefore designed and funded the erection of 32 elaborate drinking fountains in various cities throughout the United States, some of which are still in
RI PT
existence (Figure 9). Seldin periosteal elevator: Harry M. Seldin (1895-1975) (Figure 10), who was born in Russia, was both a practitioner and an educator. His textbook “Practical Anesthesia for Dental and Oral Surgery” was popular for many years. He was a member of the oral surgery faculty of New York
SC
University College of Dentistry from 1919-1926 and served as chief of anesthesia from 19261931. In 1956 he was president of the American Society of Oral Surgeons. Designed as an
M AN U
instrument to reflect the periosteum from the bone, the Seldin elevator’s broad surface also makes it an excellent soft tissue retractor and protector
Discussion
TE D
It is of interest that there are few, if any, eponyms attached to the most common instrument used in oral surgery, the extraction forceps. Instead, they are usually identified by numbers and the person who first developed the instrument remains unknown. However, these numbers are
EP
assigned by the manufacturers and can vary according to the company involved. Thus, one can have two identical forceps with different numbers. There is therefore a need to establish a
AC C
uniform numbering system. However, because there are so many minor variations in the configuration of the beaks and handles of the various extraction forceps, this can be a very challenging task.
With all of the various surgical instruments in existence, one wonders why some still have the name of their creator attached to them and others do not. It appears that most of those with eponymous names are instruments that serve a unique function that is not accomplished, or is more difficult to accomplish, with the usual standard instruments. Therefore, in a way,
5
ACCEPTED MANUSCRIPT
maintaining the eponym continues to honor those who made some aspect of a surgical
RI PT
procedure easier to achieve and thus improved patient care and treatment outcomes.
References
1. Saman M, Helman SN, Kadakia S, Naymagon L. Instruments in rhinoplasty: Who is behind the name? J Plastic, Reconstructive & Aesthetic Surgery (2014) doi: 10.1016/j.bjps.2014.10.018.
SC
2. Griessenauer CJ, Tubbs RS, Shoja MM, et al. Alfred W. Adson (1887-1951): his contributions to surgery for tumors of the spine and spinal cord in the context of spinal tumor surgery in the late
M AN U
19th and early 20th centuries. J Neurosurg Spine. 2013:19: 750-758.
3. Chittiboina P, Connor DE, Nanda A. Dr. Otto “Tiger” Freer: inventor and innovator. Neurosurg Focus. 2012 Aug:33(2):E12. Dol:10.3171/2012.6.FOCUS12137.
4. Whonamedit? A dictionary of medical eponyms. Myron Firth Metzenbaum.
TE D
5. Atkinson HF. Some early dental extraction instruments including pelican, bird or axe? Australian Dent J 2002;47:90-93.
6. Bussell MA, Graham RM. The history of commonly used dental elevators. Brit Dent J 2008; 205:
AC C
Legends:
EP
505-508.
Figure 1. Jacques L. Joseph Figure 2. Alfred W. Adson
Figure 3. Emil Theodor Kocher Figure 4. Nicholas Senn Figure 5. Howard Atwood Kelly
6
ACCEPTED MANUSCRIPT
Figure 6. George Washington Crile Figure 7. Matthew Henry Cryer
Figure9. Temperance fountain in Washington, DC
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EP
TE D
M AN U
SC
Figure 10. Harry M. Seldin
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Figure 8. Henry Daniel Cogswell
7
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EP
TE D
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ACCEPTED MANUSCRIPT
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EP
TE D
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SC
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EP
TE D
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Figure 3. Emil Theodor Kocher
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EP
TE D
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Figure 4. Nicholas Senn
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EP
TE D
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Figure 5. Howard Atwood Kelly
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EP
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Figure 6. George Washington Crile
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SC
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EP
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Figure 7. Matthew Henry Cryer
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EP
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Figure 8. Henry Daniel Cogswell
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fountain in Washington, D.C.
Figure 9. Temperance
