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Charles Bingham Penrose – a vision for the future

Srđan Petković (1), Goran Krstić (2), Milan Jovanović (1,3)

(1) CLINIC FOR GENERAL SURGERY, MILITARY MEDICAL ACADEMY, BELGRADE, SERBIA; (2) DEPARTMENT OF INTERNAL MEDICINE, MILITARY HOSPITAL NIŠ, NIŠ, SERBIA; (3) FACULTY OF MEDICINE, UNIVERSITY OF DEFENCE, BELGRADE, SERBIA

In the history of medicine, there have been widely used therapies that may seem almost laughable in light of modern knowledge about physiology and medical practice, yet they play an important role in the education of physicians. The past provides a lesson for the present and a direction for the future. However, we must persistently engage in critical examination of the past. We still do not have all the answers, but we can affirm that answers exist. One goal remains always important – believe in yourself and your ideas. And that is what defines exceptional people.
One of the exceptional doctors who believed in himself and his ideas was Charles Bingham Penrose, the father of modern surgical drainage. For this reason, this article was written in memory of the discovery of the drain named after him.

Picture 1. Charles Bingham Penrose
taken from :https://commons.wikimedia.org/wiki/Category:Charles_Bingham_Penrose#/media
/File:CharlesBinghamPenrose.jpg/2

Charles Bingham Penrose – Surgeon, Physicist, Naturalist, Adventurer. Charles Bingham Penrose was born in Philadelphia on February 1, 1862. Charles’s father, Richard Allen Fullerton Penrose Sr., was a physician and a professor of obstetrics at the University of Pennsylvania, while Charles’s mother, Sarah Hanna Boies Penrose, hailed from Maryland and was adopted by a wealthy Boston merchant. Shortly after marrying Richard, Sarah withdrew from high society and focused on educating her seven sons. Richard Allen Fullerton Penrose came from a prestigious Philadelphia family. One brother was a United States senator, and another was president of the National Academy of Sciences [1,2].
Charles initially received his education from private tutors. The proximity to the Delaware and Schuylkill rivers also allowed Penrose to enjoy fishing, ice skating, and swimming. His first school was the Episcopal Academy, located at Newton Square in Pennsylvania, which he graduated from with top honors [2].
Penrose attended Harvard College, where he graduated at the age of 19 with an AB degree and the highest honors in physics, just two months after his mother passed away from tuberculosis. Shortly thereafter, his articles on magnetism and electricity appeared in scientific journals [1].
In 1882, Penrose published his significant work, “The Relation Between Surface Energy and Thermoelectricity,” where he stated that a thermodynamic equation could be derived in an entirely different way if the energy of thermoelectric current is considered as part of the energy present on a different surface [3].
Penrose enrolled in the University of Pennsylvania’s medical school while simultaneously continuing his studies in mathematics and physics at Harvard University as a doctoral candidate. This study arrangement was allowed by the University Council on the condition that Penrose spent two months each semester at Harvard. In the spring of 1884, at the age of 22, he received his Doctor of Medicine (MD) degree from the University of Pennsylvania and a Doctor of Philosophy (PhD) in physics from Harvard University. His physics doctoral thesis was titled “Mathematical Theory of Thermoelectricity and the Relation Between Thermoelectricity and Surface Energy” [2,4].
After completing his physics doctorate, Penrose devoted himself to medicine. He served as a staff physician and ambulatory surgeon at a Pennsylvania hospital from 1885 to 1886 and at the Philadelphia Dispensary from 1888 to 1893 [2].
During his residency, Penrose participated in research on the diuretic effects of injected cocaine. The article, “Observations on the Diuretic Effect of Cocaine,” was published in the local medical journal The College and Clinical Record and suggested that the diuretic effect of injected cocaine was apparent [5].

Picture 2. Penrose as a Professor of Gynecology at the University of Pennsylvania
taken from: https://www.findagrave.com/memorial/16166622/flower

As a physician, Penrose ran a medical practice specializing in gynecology. This led him to establish the Gynecean Hospital in 1887, the first medical institution in Philadelphia dedicated exclusively to gynecological issues. After contracting tuberculosis in 1891, Penrose temporarily left his medical practice and moved to Wyoming for recovery. There, he fully committed to physical activity: in the mornings, he worked with a pickaxe and shovel, and in the afternoons, he rode horses. By early the following year, his health had significantly improved. Returning to Philadelphia in 1893, he was appointed Professor of Gynecology at the University of Pennsylvania. Colleagues regarded Penrose as a skilled and competent surgeon [1,6].
In 1889, Penrose presented his views defending drainage in abdominal surgery to the American Medical Association. In the late 19th century, surgeons were divided over whether drainage tubes in abdominal surgery should be used rarely or frequently. At that time, most surgical drains were made of glass tubes or gauze. These types of drains could damage surrounding tissue or become embedded in it, leading to infection. Additionally, bowel damage often occurred during drain removal [7].
Penrose acknowledged that many surgeons feared using drainage tubes and explained that, with proper handling and careful cleaning, such fears were unfounded. He described a rubber drain inserted directly through the wound into the abdominal cavity, forming a channel through which blood and other fluids could exit the abdomen. In his book "Textbook of Women's Diseases," published in 1897, he illustrated a drain made from tubular rubber sheeting and filled with gauze. His famous advice to surgeons was: "When in doubt, drain!" [1,2].

Picture 3. Principle of Operation of the Penrose Drain
taken from: https://www.drugs.com/cg/penrose-drain.html

An interesting fact is that the first rubber drain designed by Penrose was made from a condom with its tip cut off. Another fact is that the Penrose drain became the dominant method of surgical drainage until the introduction of the Jackson-Pratt (suction) drain in the 1950s [8].
Penrose’s physical appearance and impressive stature matched his intellectual and professional impeccability. In the summer of 1882, at the age of 20, he rode a horse from Philadelphia to Niagara Falls and back. At 28, he swam 15 miles (24 km) in the ocean in 5 hours [1]. A few years later, while hunting in Montana, Penrose shot a silver bear (grizzly) cub. After the bear's mother discovered this, she severely injured Charles. Penrose saved his own life by shooting the bear in the neck during the struggle [9].
Although he was one of seven brothers, Penrose was the only one to have children. He married Catherine Drexel in 1892. They had a daughter named Sarah in 1896, and four years later, a son named Charles, who unfortunately died in 1901. Their third child, Boys Penrose, became a writer and historian [2,10].
Due to the advanced form of pulmonary tuberculosis, in 1899, at the age of 38, Penrose retired from medical practice for the rest of his life. He occasionally traveled west, hoping that the air, altitude, sunlight, and exercise would cure him [9].
In his final years, Charles's health deteriorated significantly. He spent the winter of 1924/25 in South Carolina, trying to recover from tuberculosis. Penrose planned to return to Philadelphia by train to visit relatives, accompanied by two nurses and his cousin Sarah. He was found dead in his train compartment near Washington, D.C., on February 28, 1925, at the age of 64. A heart attack was suspected to be the cause of death [9].

Picture 4. The Family Tomb of Charles Bingham Penrose
taken from: https://www.findagrave.com/memorial/16166622/charles-bingham-penrose

He was buried at Laurel Hill Cemetery in Philadelphia. The majority of his fortune was left to his children, and $100,000 was bequeathed to the nurse who cared for him until his death [1].
Conflict of Interest: The authors declare no conflict of interest.

REFERENCE:

1. Sharon R. The Person Behind the Name- Charles Bingham Penrose Plastic and Reconstructive Surgery 1982;70(3):397-399.
2. Powell J. Charles Bingham, MD (1862–1925), Journal of Pelvic Surgery 2002;8(3):129-130.
3. Penrose C.B. Relation between Superficial Energy and Thermo-Electricity, Proceedings of the American Academy of Arts and Sciences, 1885;20:417-434.
4. Harvard Physics PhD Theses, 1873–1953. Harvard University. 2020.
5. Da Costa, J.M.; Penrose, C.B. Observations on the diuretic influence of cocaine. The College and Clinical Record. 1886;7(7):131.
6. Davis J. W. Wyoming Range War: The Infamous Invasion of Johnson County. University of Oklahoma Press. 2012;132–135.
7. Baskett T.F. Eponyms and Names in Obstetrics and Gynaecology. Cambridge University Press. 2019;316.
8. Giakoumis M. Use of drains in foot and ankle surgery. The Podiatry Institute. 2012:51;253-5. (Retrieved April 17, 2017.)
9. Emerson Brown C. Charles Bingham Penrose Journal of Mammalogy, 1925;6(3):203-205.
   10. Biddle N. Wainwright Boies Penrose, 1902-1976 The Pennsylvania Magazine of History and Biography 1976;100(3):390-394.