On September 28, 1934, at the annual meeting of the New England Surgical Society in Burlington, Vt, John Homans, MD, delivered an address entitled "Thrombosis of the Deep Veins of the Lower Leg Causing Pulmonary Embolism." Its importance was clearly recognized by publication as the lead article in the New England Journal of Medicine just 2 months later.1 In this report, he pointed out the differences between superficial thrombophlebitis, phlegmasia alba dolens, and a disorder that he called primary thrombosis in the calf, which had a more subtle presentation and a high incidence of fatal pulmonary embolism.
Patients with this disorder developed calf pain and ankle swelling that were relieved with bed rest, but that recurred with use of the leg. Autopsy findings showed thrombosis in calf veins but an unobstructed femoral vein. Dr Homans' hypothesis, based on his observations at the autopsy table, was that the thrombosis was