Musing of a Contemporary Pathologist

Medical Trivia #1: Sutton’s Law

There are many “laws” in science reflecting past observations and scientific proofs that have been shown to be either completely true or at least highly reliable. Many of these laws bear someone’s name. Some required understanding of complex scientific principles or refined mathematical reasoning to develop. Sutton’s law, in contrast, is based on logic, common sense and experience.

In high school physics students learn about Boyle’s law, sometimes remembering only the name and not the details: the volume and pressure of an ideal gas of fixed mass held at a constant temperature are inversely proportional. Robert Boyle (1627-1691) discovered this after a series of brilliant experiments and even more brilliant analysis. Although many remember the eponym, and may even recall that it has something to with volume and pressure, only a few people can describe Boyle’s law in detail. Very few know who Boyle was or when he lived. Boyle is considered to be the first modern chemist, one of the founders of modern chemistry and also one of the first proponents of the modern scientific method. He was a friend and colleague of Robert Hooke (1635-1703), the pioneering microscopist, architect and natural philosopher. Boyle was a brilliant and prolific investigator whose great book, The Skeptical Chymist, is considered a cornerstone of the discipline of chemistry.

Boyle, Robert copy

Robert Boyle

Avogadro’s law, proposed a century after Boyle, states that equal volumes of all gasses, at the same temperature and pressure, have the same number of molecules. Lorenzo Romano Amedeo Carlo Avogadro di Quaregna e di Cerreto (1776-1856) was an Italian scientist, born in Turin, in the then kingdom of Sardinia. He initially taught at a liceo (high school) but eventually became a professor of physics at the University of Turin.

Avogadro

Avogadro

Countless other scientists have been similarly honored by appending their name to their discovery.

Some “laws” are not necessarily scientific or medical. Many developed in the 20th century, especially those addressing the human condition, are either witty or at least provoke a warm response. Murphy is an eponym applied to a number of often related laws. As example, one of the best known is Murphy’s law (anything that can go wrong will go wrong), attributed to Edward A. Murphy, Jr. (1918-1990), an American aerospace engineer. Others include Murphy’s restatement (everything goes wrong all at once), Murphy’s law of thermodynamics (things get worse under pressure), Murphy’s law of copiers (the legibility of a copy is inversely proportional to its importance), Murphy’s law of research (do enough research and you will eventually find something to support your theory) and even the law of Murphy’s law (Murphy’s law was not proposed by Murphy, but by another man with the same name).

Murphy EA, Jr.

E.A. Murphy, Jr.

Sutton’s law is taught to every medical student and because of its validity continues to be widely known. Sutton’s law is a succinct statement of logic designed to preclude unnecessary, often incorrect and expensive, forays in search of a diagnosis where one may already be obvious.

Sutton’s law is named for the flamboyant, notorious, often successful bank robber and jail escapee Willie Sutton.

Francis (“Willie”) Sutton, Jr. (1901-1980), born in Brooklyn, New York at the start of the 20th century, was a folk hero of the 1930’s and ‘40s. In many ways he appeared to be a classic gentleman. Sutton was a fastidious dresser, in a pin-stripe suit, white shirt and tie. He continued to wear spats on his shoes long after they were out of style. He was always clean shaven with a carefully trimmed, pencil-line mustache. Reputed to be a gourmand who enjoyed poetry and opera, he was well read. But his crime life started when he was just eighteen and some speculated that he robbed banks so he could afford his fine clothes. He was incorrectly considered a modern Robin Hood because he stole from the rich but, in contrast to that semi-mythical 14th century figure, Willie did not give his money to the poor.

Wilie Sutton copyWillie Sutton in Philadelphia

In addition to being a very successful bank robber—reputed to have ‘earned’ more than two million dollars—he was also expert at escaping from jails, accomplishing this feat multiple times, including from three “escape-proof” penitentiaries. Although he always carried a pistol or a Thompson submachine gun or both while robbing banks he once claimed they were never loaded because he didn’t want anybody to get hurt. He explained the fact that he carried a gun by saying, “You can’t rob a bank on charm and personality.” Supporting this urbanity, it was also said that he never robbed a bank if a baby cried or a woman screamed. Because of his skills in disguise, sometimes appearing as a telegraph messenger, a maintenance man or even a policeman, he was sometimes referred to as “Willie the actor” or as “slick Willie.”

Reporter Mitch Ohnstad, of the long defunct New York Herald, ostensibly asked Willie, “Why do you rob banks?“ Sutton replied with straightforward logic, “That’s where the money is.”

Based on this wisdom, Sutton’s law is used to remind students that they should direct their diagnostic efforts to the most logical first, setting the rare choices aside until they exhaust their efforts to find “the money.” Another common phrase for young physicians that mirrors the wisdom of Sutton’s law is: “if you hear hoof beats, it’s most likely a horse.”

In his autobiography Sutton denied ever saying, “That’s where the money is,” ascribing the words, instead, to Ohnstad’s imagination. Sutton wrote that he robbed banks “because I enjoyed it. I loved it. I was most alive when I was inside a bank, robbing it, than any other time in my life.”

Despite his protestations, I continue to believe that Willie actually did state what became Sutton’s law, perhaps because I admired his style and charm, as well as the fact that he was from Brooklyn and was, like me, an avid fan of the Brooklyn Dodgers.

Willie Sutton was captured for the last time in February, 1952 when Arnold Schuster, a 24-year-old Brooklyn clothing salesman and amateur detective, recognized him on the subway and followed him. Schuster appeared on television in the weeks after and described how he assisted in Sutton’s capture. In March, 1952, a month after Willie’s capture, Schuster was shot to death outside his home, supposedly by order of Albert Anastasia, a Mafia boss, who didn’t like a “squealer.” Although some thought Sutton arranged the murder, many attested to his being despondent when he heard of the young man’s murder.

Sutton received a sentence of 30 to 120 years in Attica State Prison but, in consideration of his worsening emphysema and lower extremity arterial insufficiency, he was released in 1969 for good behavior. In the years following he lectured on prison reform and consulted with banks on how to avoid being robbed. He made a television commercial for a Connecticut bank promoting their then new credit card and, in a Time magazine article, was described as the “Banker’s friend.” He died in 1980, at the age of 79, and is buried in Holy Cross Cemetery in Brooklyn.

Sutton was a fascinating man, paradoxically both a hardened criminal and a cultured, erudite, highly articulate gentleman. He was deeply concerned about young people and was troubled when he heard they regarded him as a hero. I was one of those who admired him, since, as I noted above we grew up in the same neighborhood and were both devoted to the Brooklyn Dodgers, but mostly because of his style and daring. He insisted that the proceeds from the Quentin Reynolds biography about his life, which I read in the early ‘50s, be turned over to youth programs.

A documentary about his life, In the Footsteps of Willie Sutton (http://williesutton.com/documentary.html) was released in 2011.

Sutton’s law remains one of the most widely cited guidelines in the practice of medicine. Willie Sutton was not related to either Henry Gawen Sutton (1837-1891), whose name is on Gull-Sutton disease (arteriosclerotic fibrosis of the kidney) or to Richard L. Sutton (18??-19??) who, in 1912, described the skin lesion leukoderma acquisitum centrifugum, later called Sutton’s halo nevus, a benign mole (nevus) with a surrounding depigmented zone imparting the appearance of a halo. Willie Sutton was also not related to Thomas Sutton (1767-1835) who is remembered in Saunders-Sutton syndrome, better known as delerium tremens or DTs, an acute psychotic condition seen in advanced chronic alcoholism and marked by delirium, trembling, hallucinations, anxiety and other manifestations.

Addendum (June 20, 2016): Donald Shea, 90, one of the police officers who captured Willie Sutton in 1952 recently died: (http://www.nytimes.com/2016/06/20/nyregion/donald-shea-officer-who-captured-infamous-bank-robber-dies-at-90.html?hpw&rref=obituaries&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well&_r=0)

 

References:
1. Skinner HA. The Origin of Medical Terms. Baltimore, Williams & Wilkins, 1961.
2. Jablonski S. Illustrated Dictionary of Eponymic Syndromes and Diseases and their synonyms. Philadelphia, WB Saunders, 1969.
3. Magalini SI. Dictionary of Medical Syndromes. Philadelphia, JB Lippincott, 1971.
4. Firkin BG, Whitworth JA. Dictionary of Medical Eponyms. Park Ridge NJ, Parthenon Publishing, 1987.
5. Rodin AE, Key JD. Medicine Literature & Eponyms. Malabar FL, Krieger Publishing, 1989.
6. en.wikipedia.org/wiki/list_of_eponymous_laws
7. www.murphyslaws.net/edition.htm
8. Reynolds Q. I, Willie Sutton. New York, Farrar Strauss, 1953.
9. Sutton W, Linn E. Where the Money Was: the Memoirs of a Bank Robber. New York, Viking Press, 1976.
10. Jardine L. The Curious Life of Robert Hooke. New York, HarperCollins, 2004.

One Response to “Medical Trivia #1: Sutton’s Law”

  1. michael whiteman says:

    Enjoyed the history lesson and, of course, the Brooklyn connection. Glad to learn that even the best of the worst came from here.

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