Harris Miller Branham (1862-1936) was an American physician
Branham held numerous positions in Brunswick during his 50 years of general medical and surgical practice in Brunswick, Georgi including: United States Surgeon in charge of the Brunswick Quarantine station; head of the Brunswick medical society; Brunswick health officer; and president of the Brunswick Board of Health
Eponymously remembered for his description of bradycardia that follows the sudden occlusion of an artery entering an arteriovenous fistula – Branham sign – in 1890
- Born on March 30, 1862 in Fort Valley, Georgia
- 1883 – Graduated from Peabody Teachers’ College in Nashville, Tennessee and taught for the next 3 years in the schools of Screven County, Georgia
- 1886-1888 Medical training at the College of Physicians and Surgeons in Baltimore (now the University of Maryland School of Medicine); finished top of his class after the 2 years of medical school;
- 1888 – assistant resident surgeon of the Baltimore City Hospital
- 1889 – general practice in Brunswick, Georgia with equal emphasis on surgery and medicine.
- 1890 – published case report
- 1894 – first discoverer of yellow fever in the Brunswick section of Georgia during the 1894 epidemic, and a victim of the disease as well. “His careful administration and assistance to the United States health officers were credited with holding the death rate to a minimum.”
- Died after an illness of short duration on October 28, 1938, aged 76
Branham sign is the systemic bradycardia and hypertension that follows the sudden occlusion of an artery entering an arteriovenous fistula
In 1890 Branham reported a case of aneurysmal varix of the femoral artery and vein following a gunshot wound, and noted slowing of the heart rate if he occluded the femoral artery above the varix.
In April 1890, Branham had been called to the jail in Brunswick, Georgia to see a 24-year-old prisoner who had “...accidentally shot himself with a .32-caliber pistol” following a scuffle with the prison guards in which he had killed one guard; wounded another; whilst the third deflected the pistol so that the prisoner shot himself.
The bullet had entered the left thigh 4.5 inches below Poupart’s ligament; then ranged downward and backward to the posterior and external surface of the thigh 6 inches above the knee. Branham stated that “profuse haemorrhage occurred until checked by syncope...”
Branham reviewed the patient three days after the incident and noted a slight thrill and bruit over the wound. He made the diagnosis of a traumatic aneurysm of the superficial femoral artery (confirmed by prominent members of the Georgia State Medical Association who were meeting locally). Branham noted:
The most mysterious phenomenon connected with the case, one which I have not been able to explain myself, or to obtain satisfactory reason for from others, was slowing of the heart’s beat, when compression of the common femoral was employed. This symptom became more marked until pressure on the artery above the wound caused the heart’s beat to fall from 80 to 35 or 40 per minute, and so to remain until the pressure was relievedBranham, 1890
Compression of the femoral artery of the opposite limb was without effect. The heart was free from valvular disease.
The Operative Follow up
Two months later Branham reviewed the patient at his home in Cuthbert, Georgia. Branham was able to prove the nature of, and alleviate the circulatory issue:
Upon careful dissection of the vessel it was found that the artery and vein were adherent at the point where the thrill was most perceptible, and that the arterial blood was being pumped into the vein, as shown by pulsation of the vessel below the wound, and an almost entire absence of pulsation in the distal portion of the artery…a silk ligature was placed around the artery above and below the varix, tied and cut short
I report this case because of its unique character, in that the varix was caused by the passage of a ball between the vein and artery; and also to elicit some information as to the correct cause of the retarded heart actionBranham, 1890
The publication, and recognition
In 1890, Branham sent his case report describing the bradycardia following proximal occlusion of the feeding artery to the arteriovenous fistula to the International journal of Surgery, but never received any acknowledgment that it had been accepted for publication.
Branham was not aware that the report had been published until 25 years later, when he received a package of books and papers and a letter from the famous New Orleans surgeon Rudolph Matas (1860 – 1957) who had described Branham’s obersvation as ‘Branham’s Bradycardiac Reaction‘. Matas gave Branham clear priority for his description
In 1915 received a package of books and papers and a letter from the famous New Orleans surgeon Rudolph Matas (1860 – 1957) informing him of the importance of his discovery.
Branham’s Bradycardiac Reaction…This is by far the most important early sign of cardiovascular disturbance brought about by an arteriovenous fistula and is of great diagnostic significance in all cases in which arteriovenous communication is accessible to compressionMatas, 1923
DC. Elkin, also a well-known vascular surgeon at Emory University, believed that the sign had been observed by Nicoladoni. Dr. Matas persisted in calling the sign “Branham’s sign”, and owing to his effort, the name became attached to the slowing of the heart rate when an arteriovenous fistula is obliterated.
In 1997 Somkiat Wattanasirichaigoon and Frank B. Pomposelli, Jr proposed that Branham sign is an exaggerated Bezold-Jarisch reflex
- Branham HH. Aneurismal varix of the femoral artery and vein following a gunshot wound. International Journal of Surgery 1890; 3: 250-251
- Branham, Harris Miller, MD. In: Georgia; comprising sketches of counties, towns, events, institutions, and persons, arranged in cyclopedic form. 1906; 1: 219-221
- Blackford LM. Branham. The Southern Surgeon 1935; 4: 219
- Stevenson BA. Dr. Harris M. Branham. Journal of the Medical Association of Georgia. 1938; 27: 170
- Obituary: Harris Miller Branham. Journal of the Medical Association of Georgia 1939; 28: 35
- Sealy WC. Classics in thoracic surgery. On the care and preservation of eponyms: the case of Branham’s sign. Ann Thorac Surg. 1985 Sep;40(3):311-314.
- Hurst JW. Harris H. Branham. Clin Cardiol. 1986 Nov;9(11):589-90.