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J Thorac Cardiovasc Surg 1998;116:673-674
© 1998 Mosby, Inc.

HISTORICAL PERSPECTIVES

ETHAN FLAGG BUTLER (1884-1964)

Ethan Flagg Butler, thirteenth president of The American Association for Thoracic Surgery, was born on January 4, 1884, in Yonkers, New York.

At the age of 12 he announced his choice to be a doctor, and he wrote, "A liberal father made a thorough education possible." He prepared at Hotchkiss for Princeton (AB, '06) and Johns Hopkins (MD, '10). His early intimate exposure to clinical medicine came as a volunteer with the Grenfell mission on the Labrador coast during his 3 summers in medical school. The influence of that most charismatic of men, Sir Wilfred Grenfell, was particularly memorable in the summer of 1909, for that year Butler, with 6 fellow Princetonians, sailed the Andrew J. McCosh, an auxiliary yawl that had been thoroughly equipped as a hospital ship, from New York to Labrador as a gift to the mission. Deep-water sailing was Butler's great love, and he wrote a highly entertaining account of the voyage and activities along "the coast" to the Princeton Alumni Office, which has been most helpful in making his lively reunion reports available.

In 1911 he accepted an internship at the Mayo Clinic, followed by 3 years as a surgical assistant at the clinic with prospects of further surgical appointment. With the outbreak of the war in Europe in 1914, however, his plans changed as he volunteered his services to the American Red Cross European Relief Detachment and spent the next 2 years in Serbia battling the lethal typhus epidemic, so vividly described by Hans Zinnser in "Rats, Lice and History." After 2 years he returned to private practice in Yonkers until the United States entered the war in 1917. Long a member of the medical reserve, he promptly entered the medical corps as captain with orders to work with Alexis Carrel at the Rockefeller Institute. He later transferred to Bellevue Hospital, where he conducted classes in Carrel Methods of wound treatment. In 1918 he was promoted to the rank of major and chief of the empyema section at Walter Reed. In 1920 he became chief of Surgery at US Public Health Hospital No. 51 in New York City for 6 months, before reentering private practice at Bellevue. In 1922 he moved again to become an associate surgeon in Donald Guthrie's clinic in Sayre, Pennsylvania. He remained in this capacity with surgical teaching responsibilities to graduate students of the University of Pennsylvania until 1929, when he returned to the private practice of thoracic surgery and bronchoscopy in Elmira, New York. Now solidly identified as a thoracic surgeon, he became director of the Chest Clinic at the Arnot-Ogden Memorial Hospital and consulting surgeon to Tioga County General Hospital. In 1935 he was appointed principal thoracic surgeon to the New York State Tuberculosis Hospitals, holding this important post for the next 9 years. In 1944 he reentered private practice in Elmira, continuing in this capacity for 3 years, and then returned to government service in the newly reorganized Veterans Administration Hospitals.

In 1954 he had his first coronary occlusion and retired from clinical and administrative activities to spend the last 10 years of his life happily devoted to the affairs and history of The American Association for Thoracic Surgery in the heyday of collapse therapy (lacking effective antibiotics) for tuberculosis. He also became part of the Trudeau mystique, a band of upper New York State airborne surgical consultants to their sanatoria. He had his second and lethal coronary occlusion in January 1964 at the age of 80 years.

A most devoted and knowledgeable secretary of the AATS during the twenties, Butler served as its president in 1931. Although he was not a founding member, when any matter of protocol or interpretation of by-laws arose, his opinion was immediately sought. Each year, no member at the annual business meeting who heard his reading of the necrology report could doubt the gravity of the occasion.

In view of the somewhat peripatetic and kaleidoscopic nature of Butler's career, it is impressive how many valuable contributions he made to review articles in the thoracic surgical literature, particularly in the management of pulmonary tuberculosis in those days before antibiotics. Like many of his time, he described useful myoplastic techniques to increase the value of thoracoplasty and made useful comments on the value of bronchoscopy in the management of atelectasis.

Meade, in his classic History of Thoracic Surgery, acknowledged Butler's many contributions to the role of national societies in the development of the AATS and the specialty of thoracic surgery. In 1925, Butler and Robert T. Miller represented the AATS in a congress to decide on the feasibility of a certifying board for thoracic surgery. They reported back that it was not yet time. Butler was not on Carl Eggers' committee of the American Board of Surgery that finally gave the green light some 20 years later.

Many years before (1922, in fact), after 4 years in the Medical Reserve Corp in Washington, Butler produced a Wellcome Prize Essay on the influences of the world war on civilian practice. He argued that the scope of thoracic surgery had been so greatly increased that for best results its prosecution should be placed in the hands of those specially accustomed.

A son and daughter from his first marriage have not survived. A step-daughter from his second marriage, who lives in Elmira, remembers his enthusiastic devotion to his thoracic surgical society, and to Princeton, and his identification with a generation of thoracic surgeons, for example, Max Chamberlain, who flourished in upper New York State. As Richard Meade wrote, "He was truly a devoted member of this organization [the AATS] and a man admired by all."

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