Presentation on theme: "The Other Whipple John R. Potts, III, M.D. Professor of Surgery"— Presentation transcript:
1 The Other Whipple John R. Potts, III, M.D. Professor of Surgery Program Director in SurgeryAssistant Dean Graduate Medical EducationUniversity of Texas Medical School HoustonI know that everyone here has heard of Allen Whipple, the surgeon. I’m going to say some things today about Allen Whipple, the surgeon, but in a surgical audience he should hardly qualify as being “The Other Whipple”.You’ve also heard of his operation for pancreatic resection. He did some other operations that were, in his day, considered to be more important contributions. So, I could talk about one of those operations and call that “The Other Whipple”. I am going to talk a little bit about those operations but neither one of them is “The Other Whipple” referred to in the title.Some of you have also heard of George Whipple, the pathologist. If nothing else, I’m sure you are familiar with the eponym. He made enormous contributions to medicine and I’m going to review some of those with you today. But, he is not “The Other Whipple” either.“The Other Whipple” is one who I only learned of a couple of years ago but the contributions made by this individual were enormous and still influence every general surgeon in America today. It’s been fun to learn about that individual and I hope you enjoy hearing the story.
2 Allen O. Whipple: The Surgeon The Other WhippleAllen O. Whipple: The SurgeonPancreaticoduodenectomyPancreatic Endocrine TumorsPortocaval ShuntFirst, though, we should talk about Allen Oldfather Whipple – the surgeon.
3 A.O. Whipple – Early Years The Other WhippleA.O. Whipple – Early YearsBorn Urmia, PersiaLived 14 years in PersiaWorked way through schoolPrinceton 1904MD Columbia P&S 1908Internship Roosevelt & Sloan HospitalsAllen Whipple was born in Urmia in what was then Persia.[Located in LUQ of map by lake]His parents, Levi Whipple and Mary Louise Allen were missionaries and he spent the first 14 years of his life in Persia.This experience, for obvious reasons, had a great influence on him throughout his life.His father died during his freshman year in college. He worked his way through school doing multiple jobs. Among them was tutoring fellow students in Latin and French.In spite of being a very serious student and having to work to support himself, he participated in a number of extracurricular activities on campus. One of those activities was the campus newspaper. Through that effort, he met and, seemingly, spent a fair amount of time with the president of the university. Now, it happens that the president of Princeton at the time was Woodrow Wilson – who later went on to be president of the United States.Whipple graduated Princeton in 1904 then entered Columbia College of Physicians and Surgeons where he graduated in 1908.He served internship at Roosevelt and Sloan Hospitals.There were no residencies in New York at the time.Allen Oldfather Whipple was born in Iran, the son of William Levi Whipple ( ) and Mary Louise Allen ( ), then serving as missionaries in Azerbaijan, Persia (now Iran). During the 14 years he spent in Persia, Whipple learned to read and speak English, French, Armenian, Syriac (Assyrian), Turkish and Persian. After working his way through school and college, Whipple attended Princeton University until 1904, and then went to the medical school at Columbia's College of Physicians and Surgeons in New York. He received his MD in 1908, and then spent three years in residency at the Roosevelt and Sloan Hospitals, N.Y. He commenced surgical practice in 1910, and in 1911, he was appointed to the faculty at the Columbia College of Physicians and Surgeons and the Presbyterian staff. On September 26, 1912, Whipple married Mary Neales in Falmouth, Barnstable, Massachusetts
4 A.O. Whipple at Columbia-Presbyterian The Other WhippleA.O. Whipple at Columbia-Presbyterian1911 faculty Columbia P&SStaff, Presbyterian Hospital1921 Professor of Surgery1921 Surgeon in Chief, PH1931 Valentine Mott Chair1946 RetiredDr. Whipple joined the faculty of his medical school in 1911 and went on the staff at Presbyterian Hospital.His qualities were clearly recognized and he rose rapidly to become Professor of Surgery and Surgeon in Chief only ten years after joining the faculty. He held those positions for 25 years.This is what the new Columbia-Presbyterian Hospital looked like when it opened in 1928.As a baseball fan, it is of interest to me that this facility was built on land that until 1914 held the stadium for the New York Highlanders Baseball Club. Unless you read a lot about the history of baseball you probably don’t know the name of the New York Highlanders but you probably do know them by their current name – the New York Yankees.In 1931 the Valentine Mott Chair in Surgery was created for and occupied by Dr. Whipple.Valentine Mott had attended medical school at Physicians and Surgeons then trained with Astley Cooper for three years before returning. He was a prominent New York surgeon and was the second Professor in the Department at P&S.[The 20-acre site in Washington Heights was donated by Edward S. Harkness, who was on the Presbyterian Hospital Board of Trustees, and his mother, Mrs. Stephen Harkness. Manhattan was largely built up by the early 1900s, but Mr. Harkness was able to buy the property upon which a stadium for the Highlanders, a professional baseball team that later became the New York Yankees, stood until 1914.].
5 Pancreaticoduodenectomy The Other WhipplePancreaticoduodenectomyThe procedure pioneered by Whipple with which you are probably most familiar is pancreaticoduodenectomy.This is the title from his paper reported to the American Surgical Association and published in the Annals of Surgery in These illustrations come from that article as well.Dr. Whipple initially performed this operation in two stages.1st Operation: Anterior cholecystogastrostomy and gastrojejunostomyRationale: Allow resolution of jaundice, improve nutrition and correct coagulopathy2nd Operation: 3-4 weeks later. Resected descending duodenum and wedge of pancreas.Specifically ligated the Ducts of Wirsung and SantoriniFirst OperationSecond OperationEnd ResultAnn Surg 1935; 102:
6 Whipple’s Thoughts on Whipples The Other WhippleWhipple’s Thoughts on WhipplesUrged the following factors be considered:The threat of diseaseThe operative riskThe probability of cureThe assurance of relief of symptomsPatient ability to adapt to GI dysfunctionQuality of the resident staffExperience, skill & integrity of the surgeonIn the article, Dr. Whipple made several important observations. Among them, he urged the judicious use of pancreaticoduodenectomy and consideration of these factors – all of which are just as applicable today as they were in 1935.Ann Surg 1935; 102:
7 Whipple’s Thoughts on Whipples The Other WhippleWhipple’s Thoughts on WhipplesDiscussing prior attempts at pancreatic resection for cancer,“…the mistaken belief that the flow of pancreatic juice is essential to life, which led surgeons to attempt to reestablish this flow into the duodenum or jejunum by implanting the resected head of the pancreas or the cut end of the duct into the upper intestine. The activation of the pancreatic ferments by duodenal contents compromised any type of anastomosis in the human subject, especially around the posterior aspect of the duodenum devoid of peritoneum.”He also discussed what had been prior attempts at pancreaticoduodenectomy by at least four surgeons.He was convinced of two things:First, that the pancreatic anastomosis was prone to break down because of “the activation of pancreatic ferments by duodenal contents”.More importantly, he considered it a “mistaken belief” that pancreatic juice was necessary for digestion and he made a concerted effort to ligate the ducts of both Santorini and Wirsung.
8 Whipple’s Results With Whipples The Other WhippleWhipple’s Results With WhipplesFirst report (1935):3 patients2 died post-opF/U on 3rd about four monthsFirst one-stage resection 3/8/1940Whipple’s total experience: 37 cases30 periampullary tumors7 chronic pancreatitisIn his 1935 paper he reported on three patients.Two died in the immediate post-op period.The third was alive at the time of the presentation – probably about four months post-op.One important change that Dr. Whipple made after the first or second patient was to switch from using catgut sutures to silk to oversew the cut pancreas.Dr. Whipple did the operation in one stage for the first time some five years after his initial report. He did so rather by accident. He explored a patient he thought to have gastric carcinoma but found a periampullary tumor. The patient was not jaundiced or terribly malnourished so he proceeded with the one stage operation.In his career, Dr. Whipple performed only 37 of the operations that now bear his name.
9 Whipple’s Triad Symptomatic hypoglycemia while fasting The Other WhippleWhipple’s TriadSymptomatic hypoglycemia while fastingDocumented glucose <50 mg/dLSymptomatic relief with glucose administrationThe year prior to his report on pancreaticoduodenectomy, Dr. Whipple reported successful resection of an islet cell tumor of the pancreas.It was in that article that he described what has come to be known as Whipple’s triad – indicative of the presence of an insulinoma.It is interesting to note that endocrine tumors of the pancreas had first described only some 30 years before and that most such tumors had been described by surgeons rather than pathologists.His co-author on this paper, Virginia Frantz, graduated from P&S in 1919.She was the first woman to be a surgery resident at Presbyterian Hospital.She was the first woman to become President of the American Thyroid Society.She also did the pioneering work that led to the use of oxidized cellulose as an absorbable agent to control bleeding.Virginia Kneeland Frantz ’18 (M.D., Columbia University College of Physicians and Surgeons)First woman to be a surgery intern at New York’s Presbyterian Hospital,First woman to become president of the American Thyroid Society and,with Allen O. Whipple, to describe the insulin secretion of pancreatic tumors.Her studies with Raffaele Lattes of the control of bleeding during surgery led to the discovery of oxidized cellulose as an aid to wound healing that could be absorbed by the body.Ann Surg 1935; 101:
10 Portal Hypertension The Other Whipple A paper that was, at the time, much more important than his paper on pancreaticoduodenectomy was this article on portal hypertension. Note that it was the lead article in the Annals (which the pancreaticoduodenectomy paper had not been).Of note is the fact that this paper was accepted for presentation at the American Surgical Association meeting but that meeting was cancelled because of World War II. Instead, the paper was delivered as the E. Starr Judd lecture at the University of Minnesota.Whipple AO Ann Surg 1945; 122:
11 A.O. Whipple on Shunt Surgery The Other WhippleA.O. Whipple on Shunt SurgeryRationale:Bleeding was NOT controlled by splenectomySpontaneous loss of portal flow in cirrhosisEncephalopathy controlled by dietary measuresNew methods promised good shunt patencyIn this paper, Dr. Whipple provided the rationale for performing decompressive shunts in patients with variceal bleeding.His rationale was that:Bleeding was not controlled by splenectomy (as had often been attempted)That there were new methods of vascular anastomosis that promised good shunt patencyThat there was a spontaneous loss of portal flow in advanced cirrhosis anyway such that diverting that flow into the systemic circulation would hav no adverse affect.Finally, he believed from animal studies that he and others had done that if encephalopathy occurred postoperatively it could be controlled by dietary methods.Whipple AO Ann Surg 122:449;1945
12 The Other Whipple Whipple AO Ann Surg 122:449;1945 These drawings from his paper demonstrate how he created the initial porto-systemic shunts.This was a “sutureless” technique that utilized tubes made of a material called vitallium which were simply held in place by concentric pursestring sutures.Two interesting observations from the standpoint of the editing of this article.1. These illustrations NOT referred to in text2. These illustrations were precisely DUPLICATED in the very next article in the journal by Blakemore, who was one of Whipple's associates at ColumbiaWhipple AO Ann Surg 122:449;1945
13 Portocaval Shunt Results The Other WhipplePortocaval Shunt Results1945 report10 patients5 portocaval5 spenorenal [central]All survived operationProfound influenceIn that paper, Whipple reported on ten patients –Five of whom had undergone portocaval anastomoses andFive of whom had undergone what we now call central splenorenal anastomoses.All ten patients survived operation.This paper had enormous influence on the treatment of variceal bleeding in this country and around the world.Although different routes of decompression and different suture techniques evolved over the years, Dr. Whipple paved the road that was taken for surgical decompression of varices until Dr. Warren’s landmark article on selective shunting in Although residents rarely see these operations today in most centers when I was a resident we did about one of these a week in our VA.Although Whipple maintained an interest in portocaval shunts, most of the subsequent publications on this topic from his group were by Blakemore.Whipple AO Ann Surg 122:449;1945
14 Other Surgical Contributions The Other WhippleOther Surgical ContributionsCombined Spleen ClinicWeekly M&MFirst chair to hire black surgeon
15 A.O. Whipple - Honors Honorary degrees: Columbia U Chicago The Other WhippleA.O. Whipple - HonorsHonorary degrees:ColumbiaU ChicagoWashington UPrincetonDistinguished service awards:Columbia-Presbyterian Medical CenterAmerican College of SurgeonsAmerican Medical AssociationHe received numerous honorary degrees – some of which are listed hereAnd received distinguished service awards from numerous institutions including his alma mater, the ACS and the AMS
16 A.O. Whipple - Honors President, American Surgical Assoc The Other WhippleA.O. Whipple - HonorsPresident, American Surgical AssocHonorary Fellow Royal College of SurgeonsHonorary Member, Southern Surgical AssocNational Research Council (WWII)Consultant for Counsel of GB in North AfricaCharter member ABSPresident, NY State Surgical Society(First) Graham Award, Washington UCharter Trustee, Princeton UWoodrow Wilson AwardDr. Whipple had numerous honors during his life time – some of which are listed here.Most notably, he was President of the American Surgical Association inHe was an Honorary Fellow of the Royal College of Surgeons andHe was the second American ever elected to honorary membership in the Southern Surgical Association.
17 A.O. Whipple at MD Anderson Cancer Center 1948 The Other WhippleBringing it closer to home, Dr. Whipple was consulted on the design and construction of the first M. D. Anderson buildings on its current campus.This picture of one of those meetings was taken in From left to right: Dr Nesselrode, Univ of Kansas; Dr R. Lee Clark, first full-time president of M. D. Anderson; Dr Ernst Bertner, outgoing acting director of M. D. Anderson; and Dr. Whipple. From the M. D. Anderson Cancer Center Historical ArchivesA.O. Whipple at MD Anderson Cancer Center 1948
18 Samir Johna and Moshe Schein (eds). The Other WhippleTo wrap up on Allen Whipple, the surgeon, there is a new book of the Memoirs of Allen Oldfather Whipple now available.I suppose every medical historian should have a copy but as much as I admire the man this book was disappointing. He makes only passing reference to his most notable surgical accomplishments and really provides little insight into his personal life.Samir Johna and Moshe Schein (eds).The Memoirs of Allen Oldfather Whipple: The Man Behind the Whipple OperationHarley, Shrewsbury, Shrops, UK, tfm Publishing Ltd, 2003.
19 Other Whipples The Other Whipple It’s only about 20 minutes after the hour.There are, of course other Whipples to discuss.
20 George Whipple: The Pathologist The Other WhippleGeorge Whipple: The PathologistEven in a surgical audience, most are aware of George Whipple, the pathologist.
21 George H. Whipple - Pathologist The Other WhippleGeorge H. Whipple - PathologistBorn 28 Aug 1878 Ashland, NH3rd generation physicianAndover → Yale → HopkinsHouse in which George Hoyt Whipple was born.Historical marker near the home.
22 Hopkins 1905 - 1914 1905 Asst Prof Pathology William H. Welch The Other WhippleHopkins1905 Asst Prof PathologyWilliam H. WelchHepatic repair & regeneration after chloroform anesthesiaMechanisms of jaundiceFormation of bile pigments outside the liverDr. Whipple joined the faculty of the new Johns Hopkins in 1905 as an Assistant Professor of Pathology.There, he worked with the famous William Welch.This is the John Singer Sargeant portrait of “The Four Doctors” with Welch enlarged.This is what Hopkins looked like when Whipple was there.Whipple worked with Welch initially observing hepatic repair and regeneration after chloroform anesthesia.He then began to study mechanisms of jaundice and, in doing so, became interested in the formation of bile pigments outside of the liver.William H. Welch on pigments related to liver necrosis caused by chloroform anaesthesia, his aim being to gather information about repair and regeneration of the liver cells. This problem was studied in the dog, and Whipple found that the liver cells had an almost limitless power of regeneration. He then became interested in jaundice, which is always associated with chloroform poisoning and injury to the liver. He studied the route by which the bile pigments pass into the blood and thus produce jaundice of various parts of the body and he found that the lympathic system was of little importance in transporting them. He then studied, by means of bile fistulas and other means, the bile pigments and their production outside the liver, and in this work he collaborated with C. W. Hooper. Photo Hopkins 1898William Singer Sargeant’s, “The Four Doctors”William H. Welch, William S. Halsted, William Osler, Howard Kelly (Welch enlarged)
23 U. California 1914 - 1921 Hooper Foundation Professor of Pathology The Other WhippleU. CaliforniaHooper FoundationProfessor of PathologyProduction of hemoglobin to understand jaundiceAcute anemia in dogsDiets & blood formationDean,In 1914 he was recruited to the Hooper Foundation and the University of California in San Francisco.After his appointment at the Hooper Foundation, Whipple continued his work with bile fistulas, and soon found that a better understanding of the production of haemoglobin was needed if the metabolism of bile pigments was to be understood. In collaboration with C. W. Hooper and Mrs. Robscheit-Robbins, he did experiments on short-term anaemia in dogs due to loss of blood, and further work was done on this subject and on diets consisting of liver in relation to the regeneration of blood.I don’t know what he did to deserve this but he became Dean in 1920.University of California Medical School Hospital c. 1915G.H. Whipple at San Francisco c.1921 [Middle of picture. Others pictured?]
24 U. Rochester 1921 - 1955 Founding Dean (Age 43) The Other WhippleU. RochesterFounding Dean (Age 43)Professor & Chair PathologyChronic anemia & dietTx pernicious anemiaHe was recruited to the new University of Rochester College of Medicine in 1921 where he was the founding Dean and the founding professor and chair in pathology.This is what the new medical center looked like at the time.Here are the “Founding Fathers” of Rochester: Rush Rhees (President, University of Rochester) , Abraham Flexner (November 13, 1866-September 21, 1959), George Eastman ( , Kodak Founder), George Hoyt WhippleHe continued his work on anemia – now using a chronic model – and demonstrated the effect of diet on red cell production.This was “translational research” in that it found immediate application in patients with pernicious anemia.In Rochester, however, he decided to use anaemias due to blood loss which were uniformly sustained and were long maintained, and to study the effects on these of various factors in diets added to the rations. This work showed that the most effective addition to the diets was raw liver itself. For this work on the therapeutic value of liver in the treatment of pernicious anaemia he was awarded, together with George R. Minot and William P. Murphy, the Nobel Prize for Physiology or Medicine in 1934.
25 G.H. Whipple’s Nobel Prize1 The Other WhippleG.H. Whipple’s Nobel Prize1For his work, George Hoyt Whipple was awarded the Nobel Prize for Medicine in 1934.This diagram, which accompanied his Nobel Lecture manuscript, clearly shows the salutory effect of a liver diet as opposed to those of salmon, bread and milk or rice, bread and milk.1 Prize shared with George Richards Minot& William Parry Murphy
26 G.H. Whipple’s Nobel Prize The Other WhippleG.H. Whipple’s Nobel PrizeHere he is at the Nobel ceremonies in 1934.
27 GH Whipple – Other Studies The Other WhippleGH Whipple – Other StudiesTuberculosisPancreatitisChloroform poisoningConstituents of bileMetabolism of ironRegeneration plasma proteinStroma of red cellsProtein metabolismWhipple has, in addition to the researches just described, worked on tuberculosis, pancreatitis, chloroform poisoning in animals, the metabolism of pigments and iron, the constituents of the bile, and the regeneration of plasma protein, and he has studied protein metabolism by means of lysine labelled with 14C, and also vitamin B12 labelled with 60Co, and its distribution and functions in the body. He has also made studies of the stroma of red blood cells.
28 Whipple’s Disease (Duodenum) The Other WhippleWhipple’s Disease (Duodenum)He is of eponymic fame, though, for his description of Whipple’s disease.This is a multisystem disorder but most clinical manifestations are secondary to gastrointestinal involvement.These photomicrographs show specimens from the duodenum of an affected man and clearly demonstrate the PAS positive, bacteria laden macrophages characteristic of the disease.Or so I’m told…Whipple's disease is a rare multisystem disorder that occurs mostly in middle-aged Caucasian males. It may affect any organ of the body but most clinical manifestations are secondary to gastrointestinal and joint involvement. It is caused by infection with the actinomycete, Tropheryma whippelii. The diagnosis is suspected when large aggregates of PAS-positive , bacteria-containing macrophages are seen in the small intestine and/or other affected organs. The bacteria exhibit an unusual trilaminar cell wall ultrastructure by electron microscopy. Diagnosis is established by polymerase chain reaction amplification of the 16S rRNA gene sequences of these bacteria in tissue. The organism has been isolated in tissue culture. There is evidence indicating that Tropheryma whippelii is a ubiquitous environmental or commensal organism causing Whipple's disease in a small subset of individuals. Macrophage dysfunction appears to be a prerequisite for the development of Whipple's disease.whipples_disease.htmlLow PowerH & ELow PowerPASEM
29 G.H. Whipple – Other Honors The Other WhippleG.H. Whipple – Other HonorsHonorary doctorates – U.S., Athens, GlasgowPopular Science Gold Medal & Annual AwardWilliam Wood Gerhard Gold MedalTrustee, Rockefeller FoundationCorresponding memberAssociation of Physicians, ViennaRoyal Society of Physicians, BudapestEuropean Society of HaematologyBritish Medical AssocHonorary MemberAmerican Philosophical SocietySociety of Experimental Biology and MedicineAmong the many honours and distinctions he received are honorary doctorates of several American Universities as well as of the Universities of Athens and Glasgow; the Popular Science Monthly Gold Medal and Annual Award in 1930 (with Dr. Minot), and the William Wood Gerhard Gold Medal of the Pathological Society of Philadelphia, in He is a Trustee of the Rockefeller Foundation. He is also a Corresponding Member of the Association of Physicians in Vienna and of the Royal Society of Physicians in Budapest, and of the European Society of Haematology, and a Foreign Corresponding Member of the British Medical Association. He is an Honorary Member of the Pathological Society of Great Britain and Ireland, and of the American Philosophical Society and the Society of Experimental Biology and Medicine. He was, from , a member of the Board of Scientific Directors of the Rockefeller Institute, a member of the Board of Trustees of this Foundation from , Vice-Chairman of its Board of Trustees from , and in 1960 he was appointed Trustee Emeritus.
30 Eck’s Fistula The Other Whipple No family relationship between Allen Whipple (the surgeon) and George Whipple (the pathologist) but they did correspond and they did share a common bond in Eck’s fistula. George Whipple had utilized this shunt from early in his career in his experimental studies and, of course, Allen Whipple created the first successful Eck fistula in a human being.
31 Other Whipples The Other Whipple Well, its now about 30 minutes after the hour so surely you know that there are other Whipples yet to be described.
32 Commodore Abraham Whipple The Other WhippleUSS Whipple (DD 15)In preparing this talk, I came across Commodore Abraham Whipple after whom three different US Navy ships have been named.Commodore Whipple was the first American to fire on British ships in the Revolutionary War and in short order captured five of them.He was also the first to fly the new American flag into port in England.He is an interesting character and certainly bears further study BUT he is not the other Whipple.USS Whipple (DD 217)Commodore Abraham WhippleUSS Whipple (DE 1062)
33 Beverly Whipple, PhD, RN, FAAN The Other WhippleDr. Beverly Whipple wrote…Well, she is not the other Whipple, either.Beverly Whipple, PhD, RN, FAAN
34 …and now, “The Other Whipple” So, now we come to “The Other Whipple”Of those in the audience, I suspect only Dr. Moody may know his identity at this point and may have actually met him.The Other Whipple is…
35 Allen O. Whipple: The Educator The Other WhippleAllen O. Whipple: The EducatorAllen Oldfather Whipple – The Educator.
36 A.O. Whipple: The Educator The Other WhippleA.O. Whipple: The EducatorMissionary parents“Poor but well educated”Read and spoke:Arabic, Armenian, Persian,French, Latin, Syriac, TurkishAuthority on literature, history, anthropology, archeology & artDr. Whipple, the man, was as fascinating as Dr. Whipple the surgeon.He was an authority in many areas including literature, history, anthropology, archeology and art.He could read and speak at least seven different languages.Clearly, these interests and abilities were an outgrowth of his youth having been spent in Persia.And, he was known as a man of integrity among his peers.
37 Allen O. Whipple: The Educator The Other WhippleAllen O. Whipple: The EducatorFirst residency in New YorkAmerican Board of SurgeryThe Whipple SocietyActivities in retirementIn the time remaining, I’m going to briefly describe some of Dr. Whipple’s contributions to surgical education, including…
38 First Residency in New York The Other WhippleFirst Residency in New York“By far the greatest contribution to American Surgery was Halsted’s initiating the Surgical Residency Training Program when he began his operative work at Hopkins.”A.O. WhippleDr. Whipple was a great devotee of Dr. Halsted.In his book “The Evolution of Surgery in the United States”, Dr. Whipple devoted several pages to Dr. Halsted. There, he wrote admiringly of Halsted’s surgical technique. He also wrote in a very polite and understanding way of Halsted’s cocaine addiction.Most important to Dr. Whipple, though, and the area to which he devoted the most writing about Dr. Halsted was Halsted’s organization of residency at John’s Hopkins which Whipple called, “by far the greatest contribution to American Surgery”.The Evolution of Surgery in the United States, p.60
39 First Residency in New York The Other WhippleFirst Residency in New YorkResidency not looked favorably upon by:Senior attendings,Young attendingsInternsAcceptance delayed by observing HalstedLong operationsDominated by [Chief] ResidentAt the time, residency was not looked upon favorably by almost anyone in surgical education.Senior attendings in the various hospitals wanted to attract to themselves the top “quiz men”Young attendings feared that residents would deprive them of the few operative cases they got to do.Interns were convinced that a residency system would ruin their operative experience. (Some interns today may still agree with that opinion).Acceptance of residency into New York hospitals was, ironically, delayed by Halsted himself. This was, of course, not an act of volition on his part. However, his colleagues from his days in New York City went to see him work at Hopkins. What they found was that his operations had become very slow. A hernia repair that would have taken him twenty minutes in New York now took him well over an hour because he was teaching the operation in meticulous detail to his housestaff.Also, the New York surgeons who visited him noted that the operative schedule was run, not by Dr. Halsted, but by his resident. (Who happened to be a man by the name of Harvey Cushing).The surgeons returned to New York convinced that they wanted nothing to do with a residency system.A.O. Whipple. The Evolution of Surgery in the United States, p.54-55
40 First Residency in New York The Other WhippleFirst Residency in New YorkColumbia-Presbyterian residency started 1921“I did not call the men residents, but to initiate the program with as little prejudice as possible, called them Fellows in Surgery. It was not until several years later, when George Heuer came to New York Hospital and began his residency there…that we called our men Residents”Dr. Whipple started the first residency in New York City in 1921 – the year he was appointed Chair at Columbia-Presbyterian.Because of the aversion to residents of New York surgeons – including his own faculty – Dr. Whipple used an interesting ploy. He established what was, in almost every way, a Halstedian residency but he didn’t call it that. He called the men (as they all were in those days) fellows in surgery. He didn’t call his program a residency until George Heuer (who had, himself, trained under Halsted) started a residency in town at the New York Hospital.I suppose this demonstrates the kind of political savvy that got Dr. Whipple to all the important positions that he held!A.O. Whipple. The Evolution of Surgery in the United States, p.55
41 A.O. Whipple and ABS Appointed by ASA to “National Committee” The Other WhippleA.O. Whipple and ABSAppointed by ASA to “National Committee”(Edward W. Archibald, President 1935)Attended every organizational meeting of ABSAppointed by ASA to newly formed ABSFirst Vice-Chair ABSChaired 1st Examination CommitteeSponsored 1st examination in NYC (9/20/37)2nd Chair ABSChaired ABS during World War IIOne of Dr. Whipple’s great contributions that very much remains with us today is his efforts in creating and leading the American Board of Surgery.The creation of the Board and its early days are a fascinating story in itself and may be the topic of a future talk but I’ll tell it briefly here.The immediate impetus for the American Board of Surgery came from the 1935 meeting of the American Surgical, which was held at Harvard.Edward Archibald of Montreal and said to be the most prominent Canadian surgeon of his day was president. In his presidential address, he called for the formation of an examining board to assure quality among American Surgeons.Note that this was the same year that Whipple presented to the ASA his paper on pancreaticoduodenectomy. I’m not sure whether or not that influenced his selection but Dr. Whipple was one of six ASA members appointed to a committee to study the creation of such a board.The minutes of those early meetings are fascinating reading but suffice it to say that Dr. Whipple attended each and every organizational meeting of the Board and was then appointed to the newly formed Board by the ASA.He was elected as the first Vice-Chair of the Board (Evarts Graham was the first Chair).He oversaw the creation of the first ABS exam and sponsored the examination in New York City the first day that the test was given.When Dr. Graham stepped down as Chair (against the unanimous opinion of the members of the Board) Dr. Whipple was elected to fill his position.He served with distinction and did so during the very difficult days of World War II.Many, if not most, of the practices of the Board were initiated by or in concert with Dr. Whipple.J.S. Rodman. History of the American Board of Surgery
42 The Other Whipple JS Rodman. History of the American Board of Surgery. Here is the photo of the original members of the American Board of Surgery.The first Chairman, Evarts Graham, is shown in the center and Dr. Whipple is immediately to his right.Graham and Whipple had attended Princeton together. In fact, while he was a student at Princeton he spent one summer tutoring the son of a wealthy family in Chicago. Many of his afternoons that summer he traveled to nearby Evanston to observe the surgical clinics held there by Evarts Graham’s father.JS Rodman. History of the American Board of Surgery.Philadelphia: JB Lippincott Company, 1956.
43 Whipple Society Established 1952 by 300 former residents The Other WhippleWhipple SocietyEstablished 1952 by 300 former residentsSoon accepted other membersThe Training of Surgeons in the Future (1967)? other published proceedingsThe third, and final, aspect of Allen Whipple – The Educator that I would like to discuss is the Whipple Society.This was established in 1952 by some 300 of Dr. Whipple’s former residents.They soon accepted membership by other surgeons from around the country who had not trained with Dr. Whipple.They did publish a fascinating book reflecting a 1967 symposium on, “The Training of Surgeons in the Future”. In this book is a good history of the evolution of surgical training and some very interesting speculation on the effect of Medicare on the training of surgeons. Of course, Medicare was just new at the time.If there are other published proceedings by the Whipple Society, I have been unable to find them.
44 The Other WhippleWhipple Society“The purpose of the Society shall be to foster and preserve the ideals and teachings of Allen O. Whipple, to promulgate the practice of these principles in the teaching of surgery, and to make a continuing study of surgical education.”This is a statement from the Constitution of the organization that clearly depicts this as an organization devoted to surgical education.
45 Whipple Society The first organization for surgical education The Other WhippleWhipple SocietyThe first organization for surgical educationThe only such organization 1957 – 1978Only after Whipple society disbanded:Association for Surgical EducationAssociation of Program Directors in SurgeryIt was the first such organization and was the only such organization until its demise in about 1978.Out of the ashes rose the Phoenix in the form of the ASE and the APDS, the two organizations that have now replaced the Whipple Society as the surgical education societies in this country.
46 A.O. Whipple – The Educator The Other WhippleA.O. Whipple – The EducatorAfter “Retirement” in 1946:Trustee American Univ. BeirutReorganized training Memorial HospitalPlans for Nemazee Hospital thenPahlavi University Medical SchoolTrustee at PrincetonPre-med advisor at PrincetonThe Evolution of Surgery in the United States
47 A.O. Whipple – The Educator The Other WhippleA.O. Whipple – The Educator“Among his greatest contributions has been his selfless devotion to the teaching, guidance and encouragement of others.”“He stimulated not only dedication in others but integrity, moral force and responsibility as well…”“He was respected by scholars and loved by his students.”“One of his primary concerns was excellence in surgical education”Perhaps the best tribute to Dr. Whipple – The Educator comes in the form of rememberences by his students, a few of which are shown here.
48 Summary Allen O. Whipple – The Surgeon The Other WhippleSummaryAllen O. Whipple – The SurgeonGeorge H. Whipple – The PathologistAllen O. Whipple – The EducatorSo, we’ve reviewed Allen O. Whipple, the surgeon.We’ve reviewed George Hoyt Whipple, the pathologist.And, I’ve introduced you to Allen Oldfather Whipple, the Educator who so influences everything we do today in surgical education.I hope you’ve enjoyed meeting this fascinating man as much as I’ve enjoyed describing him.
49 The Other Whipple A Brief History The story of Columbia-Presbyterian Medical Center and its Department of Surgery is the story of two institutions and their subsequent affiliation in 1911.In 1767, the Medical School of King's College (the predecessor to Columbia University) became the first chartered medical school in the Americas and the first school in the colonies to award a doctorate in medicine. The physician and surgeon who founded the school had hoped to create an academic medical center combining a medical school and a hospital and founded New York Hospital for that purpose. Unfortunately, that merger was never fully realized. Instead, the professors of the medical school practiced at a succession of hospitals, including New York Hospital and Roosevelt Hospital.However, in 1868 a new hospital was founded at Madison and 71st by James Lenox. Although initially reserved for Presbyterians, following the guidance of Mr. Lenox's personal physician, it began to welcome all comers and became, as noted in a tablet which remains on the hospital today, "For the Poor of New York without Regard to Race, Creed, or Color."In 1911 an alliance agreement was signed between Columbia University and its medical school (the College of Physicians and Surgeons or P&S) and Presbyterian Hospital. Four years later a site for the new Medical Center was identified in Washington Heights. Finally, following delays due to World War I and further financing, in 1928, the doors of Columbia-Presbyterian Medical Center were opened at 168th Street and Broadway.Since that move, the Department of Surgery has had only 5 chairmen. Each has provided his own contribution to the Deparment and its surgical training program.Allen O. Whipple, chairman until 1946 is best known for his performance of the pancreaticoduodenectomy which bears his name. But at Columbia he instituted a training program, modeled on that of Halstead at Hopkins which would form the basis for the residency program in place today. He raised the Department from relative obscurity to the top rank of surgical training programs.Past ChairmenChairmen of the Department of Surgery (1921 to 2003)1994-Eric A. Rose Keith Reemtsma Frederick P. Herter (acting) George H. Humphreys II Allen O. Whipple
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