Nicholas Senn, MD (1844-1908), was the first Chief of the Editorial Board of Surgery, Gynecology & Obstetrics, which became the Journal of the American College of Surgeons in 1994.
Dr. Senn was born in Switzerland, raised in Wisconsin, and received medical degrees from the Chicago Medical College, which is now Northwestern University Feinberg School of Medicine in Chicago, Illinois, and the University of Munich in Germany. Later, he became a professor at Rush University Medical College and The University of Chicago, both in Illinois.
Dr. Senn also was Surgeon General of the National Guard of Illinois and founded the Association of Military Surgeons of the US National Guard (now known as the Association of Military Surgeons of the United States) to advance military medicine and the welfare of civilian soldiers.
In addition, Dr. Senn served as chief surgeon of the VI Army Corps during the Spanish-American War in 1898. He had an international reputation as a practitioner and educator, and traveled around the world twice. Notably, Dr. Senn’s writings filled 160 large volumes.1
Among Dr. Senn’s many contributions to the surgical research literature was the 1888 description of a diagnostic procedure to determine whether an abdominal gunshot or stab wound had resulted in a hollow viscus injury.
“As in private practice, the treatment of penetrating wounds of the abdomen usually involves great medico-legal responsibilities,” he argued. “It becomes of the greatest importance to arrive at positive conclusions in reference to the character of the injury before the patient is subjected to the additional risks to life incident to an abdominal section.”2
The procedure involved insufflation of pressurized hydrogen gas into the rectum through a rubber tube, while “the escape of air or gas from the rectum was prevented by an assistant pressing the margins of the anus firmly against the rectal tube.”
In a series of experiments, Dr. Senn showed that a pressure of “one-fourth of a pound to 2 pounds” (presumably 0.25-2 psi or 13-103 mmHg) was sufficient to overcome the ileocecal valve, after which the hydrogen would flow retrograde through the rest of the gastrointestinal tract.
A perforated viscus could then be diagnosed by the absence of liver dullness on percussion or, ideally, by holding a lighted match to any hydrogen gas escaping through a wound in the abdominal wall, which “will ignite with a slight explosive report, and burn with a characteristic blue flame.”
Dr. Senn himself was experimental subject number 52, having been preceded by 34 dogs (four without anesthesia, 17 with anesthesia, and 13 postmortem); a human cadaver (used three times); eight patients (including a “hysterical female” and a “middle-aged physician suffering from typhlitis”); and six other healthy volunteers, including two young doctors and a medical student.
Personally, Dr. Senn said he was “desirous of experiencing himself the sensations which would be caused by inflation of hydrogen gas,” but his report does not specify how the other subjects were recruited. His own symptoms included “a feeling of distention,” “colicky pains,” “a sensation of faintness,” and “profuse clammy perspiration.” The pains were somewhat relieved by “eructation” but did not completely resolve for an hour and a half.
A total of 13 additional anesthetized dogs were studied, most of them shot in the abdomen “at short range with a .32 caliber revolver” and examined for gastrointestinal perforation after rectal insufflation of hydrogen.
The animals underwent laparotomy and repair, with survival “in a few instances.” After presenting his method and results, Dr. Senn concluded, “I do not hesitate to recommend its adoption as an infallible diagnostic test in demonstrating the existence of a wound of the gastrointestinal canal.”2
In a lengthy editorial published in the Annals of Surgery, the procedure was described as providing “the greatest diagnostic value.”3 The principal American textbook of surgery contained a qualified endorsement in its 1892 edition,4 but the description was shortened in a subsequent edition in 1899 and absent altogether in the 1903 text.
Senn himself moved on to other clinical and research innovations, including the implantation of cancer cells from one of his patients into his own forearm in 1901.5
Contemporary institutional review boards would certainly prohibit using some of the research subjects described earlier in this column, but in Dr. Senn’s era, self-experimentation was considered heroic.
In addition to Dr. Senn, other researchers engaged in self-experimentation in pursuit of medical knowledge, including August Bier, a German surgeon, and his assistant who gave each other some of the first spinal anesthetics (and headaches). Members of the US Army Yellow Fever Commission, working under Major Walter Reed, a US Army pathologist and bacteriologist, were commended for allowing themselves to be bitten by infected mosquitoes. Werner Forssmann, a German surgeon, was awarded the Nobel Prize in 1956, for catheterizing his own heart.
Fellows of the ACS who have performed self-experimentation in the pursuit of knowledge, include Evan O’Neill Kane, MD, FACS (who performed an appendectomy and inguinal herniorrhaphy on himself); US Army Colonel William R. Lovelace II, MD, FACS (who parachuted from a B-17 bomber at 40,000 feet to test oxygen equipment); and John H. Crandon, MD, FACS (who gave himself scurvy to study wound healing).5
The motivations of a self-experimenter may not be entirely altruistic, and we are less likely to hear about such cases in the highly regulated research environment today.
The history of Dr. Senn demonstrates that even an experienced investigator can devote considerable effort and incur significant risks in pursuit of an idea that is soon discarded and ultimately considered absurd. Yet, we can respect the opinion of Rosalyn Yalow, an American medical physicist, who performed some pioneering radioimmunoassays on herself and maintained that “we are the only ones who can give truly informed consent.”5
Dr. David Clark is professor of surgery emeritus at the Tufts University School of Medicine in Boston, MA, and he formerly practiced trauma and general surgery at Maine Medical Center in Portland.
References
- Murphy JB. Nicholas Senn, PhD, MD, LL.D. Surgery, Gynecology & Obstetrics 1908;6:Unnumbered pages after 114.
- Senn N. Rectal insufflation of hydrogen gas an infallible test in the diagnosis of visceral injury of the gastro-intestinal canal in penetrating wounds of the abdomen. JAMA. 1888;10:767-777,807-811.
- Pilcher JE. Senn on the diagnosis of gastrointestinal perforation by the rectal insufflation of hydrogen gas. Ann Surg. 1888;8:190-204.
- Keen WW, White JW. An American Text-Book of Surgery: For Practitioners and Students. Philadelphia: W. B. Saunders, 1892, p.679.
- Altman LK. Who goes first? New York: Random House, 1987.
