Medical Terminology Daily - Est. 2012

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

You are welcome to submit questions and suggestions using our "Contact Us" form. The information on this blog follows the terms on our "Privacy and Security Statement" and cannot be construed as medical guidance or instructions for treatment.


We have 1500 guests online


A Moment in History

Marcia Crocker Noyes
(1869 – 1946)

Further to my comment on old books and research that started with an interesting bookplate (Ex-Libris). I continued my research and found that the person in charge of the Osler library bookplate was a fascinating individual that today maybe a ghost in the MedChi library and building in Baltimore... This is certainly an article that can be called "A Moment in History"

Marcia Crocker Noyes was the librarian at The Maryland State Medical Society from 1896 to 1946 and was a founding member of the Medical Library Association.[1][2][3]

Sir William Osler, MD. a famous Johns Hopkins surgeon was a noted bibliophile and had a large personal collection of books on various topics. When he became the President of MedChi in 1896, he was dismayed at the condition of the library and knew that with the right person and some stewardship, it could become a significant collection. Sir William asked his friend, Dr. Bernard Steiner, a physician and President of the Enoch Pratt Free Library in Baltimore for suggestions of a librarian, and Dr. Steiner recommended Marcia Crocker Noyes. A native of New York, and a graduate of Hunter College, Marcia had moved to Baltimore for a lengthy visit with her sister, and took a “temporary” position at the Pratt Library, which turned into three years. Although she had no medical experience or background, she was enthusiastic, and most importantly, she was willing to move into the apartment provided for the librarian, who needed to be available 24 hours a day.

The image in this article is Ms. Noyes on her first year on the job. Marcia developed a book classification system for medical books, based on the Index Medicus, and called it the Classification for Medical Literature. The system uses the alphabet with capital letters for the major divisions of medicine and lower-case ones for the sub-sections. The system was used for many years, but it's now dated and the Faculty's original shelving scheme was never changed. The card catalogs still reflect her classification and many of the cards are written in Marcia's back-slanting handwriting.

Marcia knew enough to ask the Faculty's members about medical questions, terminology and literature. She gradually won over the predominantly male membership and they became her greatest allies; Sir William at the start, and then for nearly 40 years, Dr. John Ruhräh, a wealthy pediatrician with no immediate family of his own. She made a point of attending almost every Faculty function, and in 1904, under guidelines from the American Medical Association, Marcia was made the Faculty Secretary. For much of her first 10 years, she was the Faculty's only full-time employee, only being assisted by Mr. Caution, the Faculty's janitor. Later in life Marcia would say that she hired him because of his name!

Within ten years, the library had outgrown its space, and plans, spearheaded by Marcia and Sir William before his move to Oxford, were made to build a headquarters building, mainly to house the library's growing collection of medical books and journals.

Marcia was instrumental in the design and building of the new headquarters. She travelled to Philadelphia, New York and Boston to look at their medical society buildings, and eventually, the Philadelphia architectural firm, Ellicott & Emmart was selected to design and build the new Faculty building. Every detail of the building held her imprimatur, from the graceful staircase, to the light-filled reading room, and all of the myriad details of the millwork, marble tesserae, and most of all, the four-story cast iron stacks. She was on-site, climbing up unfinished staircases, checking out the progress of the building, which was built in less than one year at a cost of $90,000.

Among the features of the new building was a fourth-floor apartment for her. She referred to it as the "first penthouse in Baltimore" and it had a garden and rooftop terrace. The library collection eventually grew to more than 65,000 volumes from medical and specialty societies around the world. Journals were traded back and forth, and physicians eagerly anticipated the arrival of each new issue. At the same time, Marcia was involved in the Medical Library Association as one of eight founding members. The MLA promotes medical libraries and the exchange of information. One of the earliest mandates of the MLA was the Exchange, a distribution and trade service for those who had duplicates or little-used books in their collections. Initially, the Exchange was run out of the Philadelphia medical society, but in 1900 it was moved to Baltimore and Marcia oversaw it. Several hundred periodicals and journals were received and sent each month, a huge amount of work for a tiny staff. In 1904, the Faculty had run out of room to manage the Exchange, so it was moved to the Medical Society of the Kings County (Brooklyn). But without Marcia's excellent administrative skills, it floundered and in 1908, the MLA asked Marcia to take charge once again.

In 1909, when the new Faculty building opened, there was enough room to run the Exchange and with the help of MLA Treasurer, noted bibliophile and close friend, Dr. John Ruhräh, it once again became successful. Additionally, Marcia and Dr. Ruhräh combined forces to revive the MLA's bulletin, which had all but ceased publication in 1908, taking the Exchange with it. This duo maintained editorial control from 1911 until 1926. In 1934, around the time of Dr. Ruhräh's death, Marcia became the first “unmedicated” professional to head the MLA. During her tenure, the MLA incorporated, the first seal was adopted, and the annual meeting was held in Baltimore. Marcia wanted to write the history of the MLA once she retired from full-time work at the Faculty, but her health was beginning to fail. She had back problems and had suffered a serious burn on her shoulder as a young woman, possibly from her time running a summer camp, Camp Seyon, for young ladies in the Adirondack Mountains. In 1946, a celebration was planned to honor Marcia's 50 years at the Faculty. But she was adamant that the physicians wait until November, the actual date of her 50 years. However, they knew she was gravely ill, and might not make it until then, so a huge party was held in April. More than 250 physicians attended the celebration, but the ones she was closest to in the early years, were long gone. She was presented with a suitcase, a sum of money to use for travelling, and her favorite painting of Dr. John Philip Smith, a founder of the Medical College in Winchester, Virginia. It was painted by Edward Caledon Smith, a Virginia painter who had been a student of the painter Thomas Sully.[4] She adored this painting and vowed, jokingly, to take it with her wherever she went.

The painting was not to stay with her for very long, for she died in November 1946, and left it to the Faculty in her will. Her funeral was held in the Faculty's Osler Hall, named for her dear friend. More than 60 physicians served as her pallbearers, and she was buried at Baltimore's Green Mount Cemetery. In 1948, the MLA decided to establish an award in the name of Marcia Crocker Noyes. It was for outstanding achievement in medical library field and was to be awarded every two years, or when a truly worthy candidate was submitted. In 2014, the Faculty began giving a bouquet of flowers to the winner of the award in Marcia's name, and in honor of her work. Much evidence exists for this tradition, as we know that the physicians, especially Drs. Osler and Ruhräh, frequently gave her bouquets of flowers. Marcia also cultivated flower gardens at the Faculty and decorated the rooms with her work.

Today, the MedChi building is open for tours and if the rumors are to be believed Ms. Marcia Crocker Noyes is still at work in her beloved library as the "resident ghost" [1][5]

Marcia Noyes handwriting

NOTE: This article has been modified from the original Wikipedia article on Marcia Crocker Noyes. The article itself is well-written with interesting images of the subject. I would encourage you to visit it. The second insert is from book 00736 in my personal library and shows in pencil, the incredibly small handwriting of Marsha C. Noyes.

Sources:
1. "Marcia, Marcia, Marcia" MedChi Archives blog.
2. "Marcia C. Noyes, Medical Librarian" (PDF). Bulletin of the Medical Library Association. 35 (1): 108–109. 1947. PMC 194645
3. Smith, Bernie Todd (1974). "Marcia Crocker Noyes, Medical Librarian: The Shaping of a Career" (PDF). Bulletin of the Medical Library Association. 62 (3): 314–324. PMC 198800Freely accessible. PMID 4619344.
4. Edward Caledon BRUCE (1825-1901)"
5. Behind the scenes tour MedChiBuilding


 "Clinical Anatomy Associates, Inc., and the contributors of "Medical Terminology Daily" wish to thank all individuals who donate their bodies and tissues for the advancement of education and research”.

Click here for more information


bookplateink.com

 

 

This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

Leon C. Hirsch
Leon C. Hirsch


Leon C. Hirsch
(1927 – 2023). The story of the development of surgical staplers in America cannot be told without the presence and vision of Leon Hirsch, an American business executive and entrepreneur... 

After his 1958 trip to the USSR with two other surgeons, Dr. Mark Ravitch tried to have his colleagues take interest in the surgical stapling technology. Dr. Ravitch and Dr. Felicien Steichen stated in one of their books “Interestingly enough, a number of American manufacturers, knowing of our interest, visited our laboratories and operating rooms to see how the staplers performed, but for one reason or another decided that there was no future in stapling – to their later expressed regret! (1)”

There have been several apocryphal stories, including one where L. Hirsch was a down-on-his luck shoe salesman (not true) that met with his friend Ravitch as they both lived close to each other (not true either). So, what is the real story of how Leon Hirsch met Mark Ravitch and founded the United States Surgical Corporation (USSC).?

The original story, as told by Leon Hirsch, can be found in the May 1990 edition of the medical journal “Surgical Rounds” (2), an edition entirely dedicated as a “Festschrift (commemorative publication) to Mark Ravitch, MD”, after his death.

Leon Hirsch says: “In 1963, I was engaged in a discussion with a patent broker in New York City when I noticed a strange-looking metal object on his desk, which he described to be a Russian surgical stapler. Further inquiry led to the disclosure that this patent broker had been retained by the Russian government to try to market Soviet-made surgical staplers in America”. This patent broker had tried to garner the attention of at least five companies (Ethicon, Davis & Geck, American Hospital Supply, Aloe Corp., and Ipco, Inc) with no success.

This statement by Leon Hirsch goes against everything I knew, that is, that Dr. Ravitch was the one trying to bring the patents from the then USSR to the USA. In another version of this story Dr. Ravitch bought the patents and tried to sell them to USA medical companies! None of these are true.

Mark M. Ravitch, MD

Mark M. Ravitch, MD 

Felicien Steichen, MD

Felicien Steichen, MD

Leon Hirsch continues “The patent broker offered to lend me his information book on Russian stapling… the package disclosed that recently, three American surgeons had been to Moscow to study Russian surgical techniques, including the technique of surgical stapling”. This statement by the Soviet government is not correct, as Dr. Ravitch and two other surgeons had been to Moscow, yes, but to study Russian transfusion and resuscitation techniques, and the fact that they ended observing surgery (and seeing surgical staplers at work) was serendipitous. That in itself is another story.

Leon Hirsch phoned Dr. Ravitch who at the time was working at John Hopkins. They planned to meet for 15 minutes, which stretched into lunch, then back to Dr. Ravitch’s office for a demo of the staplers. The discussion veered into the difficulty of loading the staples one by one in this large, cumbersome device. “Intrigued, I asked Dr. Ravitch to borrow the instrument, took it back to my home workshop, and realized that the answer to the loading problem was to separate the instrument from the staples. I made a model of a cartridge (in balsa wood) that could be preloaded with staples and easily slipped into the instrument. Dr. Ravitch was elated”. The idea of the interchangeable cartridge was Hirsch's!

With this idea, and financial support that he pursued, Leon Hirsch proceeded to form the United States Surgical Corporation, with four initial employees. It took three years (1964-1967) to develop a stainless steel surgical stapler that had interchangeable preloaded stapler cartridges that were up to American standards. Since then, thousands of patients have benefited from these devices.

An interesting side note is that Leon Hirsch wanted Mark Ravitch to play a part in this new company, but Ravitch declined. Hirsch states: "Dr. Ravitch said that he had no commercial interest in pursuing such a project but he would be willing and happy tp evaluate, first in the laboratory and if successful clinically, such new devices. In typical Ravitch fashion he added that he planned to report exactly what he found, good or bad". 

The story of USSC continued through acquisitions, so USSC became Tyco, then Tyco Healthcare, Covidien, and today is the Stapling Division of Medtronic.

Leon Hirsch and USSC confronted the conundrum of training surgeons in the use of the new staplers. To this end he initially hired eight nurses, but eventually created a six-week extremely difficult grueling training program that took sales representative from basic medical terminology to being able to direct the surgeon through the steps on the use of the surgical staplers in the procedure. By doing this, he changed the way medical devices surgical representatives operate in the medical arena. Some of the readers of this article probably went through this challenging training program! In fact, some medical companies started trying to hire people that had been trough this training.

Drs. Ravitch and Steichen continued their quest training surgeons on the benefits of surgical stapling, while at the same time testing and improving the newer devices that Leon Hirsch and USSC developed.

In 2018, The Mullings Group interviewed Leon Hirsch (then 91 years old) and published a video of this interview, where he covers these topics and more. This video now forms part of the History of Surgical Stapling.

My personal thanks to Joe Mullings, Chairman & CEO of the Mullings Group Companies for his permission to share this video and some video captures for this article.

Sources:
1.  “Current Practice of Surgical Stapling” Ravitch, M; Steichen, F; Welter, R. 1991 Lea & Febiger Publishers, USA.
2. “Festschrift to Mark Ravitch, MD” Surg Rounds J. May 1990. Romaine Pierson Publication.
3. "Stapling in Surgery" Ravitch, MM; Steichen, FM.1984 Yearbook Medical Publishers USA.
4. The Origin of Medical Terms" Skinner 1970
5. "Notes by Dr. Mark Ravitch on Trip to Russia - September 1958" Personal notes.
6.“Leon Hirsch: Opportunity is Everywhere” YouTube video by the Mullings Group. Oct 2018
7.  “Tribute to Felicien Steichen” SAGES Minimally Invasive Surgery Videos. April 2012 
All images are in the public domain, or. have been authorized for use.