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The Other Whipple John R. Potts, III, M.D. Professor of Surgery Program Director in Surgery Assistant Dean Graduate Medical Education University of Texas.

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Presentation on theme: "The Other Whipple John R. Potts, III, M.D. Professor of Surgery Program Director in Surgery Assistant Dean Graduate Medical Education University of Texas."— Presentation transcript:

1 The Other Whipple John R. Potts, III, M.D. Professor of Surgery Program Director in Surgery Assistant Dean Graduate Medical Education University of Texas Medical School Houston

2 The Other Whipple Allen O. Whipple: The Surgeon Pancreaticoduodenectomy Pancreatic Endocrine Tumors Portocaval Shunt

3 The Other Whipple A.O. Whipple – Early Years Born Urmia, Persia Lived 14 years in Persia Worked way through school Princeton 1904 MD Columbia P&S 1908 Internship Roosevelt & Sloan Hospitals

4 The Other Whipple A.O. Whipple at Columbia-Presbyterian 1911 faculty Columbia P&S Staff, Presbyterian Hospital 1921 Professor of Surgery 1921 Surgeon in Chief, PH 1931 Valentine Mott Chair 1946 Retired

5 The Other WhipplePancreaticoduodenectomy Ann Surg 1935; 102: First OperationSecond OperationEnd Result

6 The Other Whipple Whipples Thoughts on Whipples Urged the following factors be considered: The threat of disease The operative risk The probability of cure The assurance of relief of symptoms Patient ability to adapt to GI dysfunction Quality of the resident staff Experience, skill & integrity of the surgeon Ann Surg 1935; 102:

7 The Other Whipple Whipples Thoughts on Whipples Discussing 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.

8 The Other Whipple Whipples Results With Whipples First report (1935): –3 patients –2 died post-op –F/U on 3 rd about four months First one-stage resection 3/8/1940 Whipples total experience: 37 cases –30 periampullary tumors – 7 chronic pancreatitis

9 The Other Whipple Whipples Triad Symptomatic hypoglycemia while fasting Documented glucose <50 mg/dL Symptomatic relief with glucose administration Ann Surg 1935; 101:

10 The Other Whipple Portal Hypertension Whipple AO Ann Surg 1945; 122:

11 The Other Whipple A.O. Whipple on Shunt Surgery Rationale: Bleeding was NOT controlled by splenectomy Spontaneous loss of portal flow in cirrhosis Encephalopathy controlled by dietary measures New methods promised good shunt patency Whipple AO Ann Surg 122:449;1945

12 The Other Whipple Whipple AO Ann Surg 122:449;1945

13 The Other Whipple Portocaval Shunt Results 1945 report –10 patients – 5 portocaval – 5 spenorenal [central] –All survived operation Profound influence Whipple AO Ann Surg 122:449;1945

14 The Other Whipple Other Surgical Contributions Combined Spleen Clinic Weekly M&M First chair to hire black surgeon

15 The Other Whipple A.O. Whipple - Honors Honorary degrees: –Columbia –U Chicago –Washington U –Princeton Distinguished service awards: –Columbia-Presbyterian Medical Center –American College of Surgeons –American Medical Association

16 The Other Whipple A.O. Whipple - Honors President, American Surgical Assoc Honorary Fellow Royal College of Surgeons Honorary Member, Southern Surgical Assoc National Research Council (WWII) Consultant for Counsel of GB in North Africa Charter member ABS President, NY State Surgical Society (First) Graham Award, Washington U Charter Trustee, Princeton U Woodrow Wilson Award

17 The Other Whipple A.O. Whipple at MD Anderson Cancer Center 1948

18 The Other Whipple Samir Johna and Moshe Schein (eds). The Memoirs of Allen Oldfather Whipple: The Man Behind the Whipple Operation Harley, Shrewsbury, Shrops, UK, tfm Publishing Ltd, 2003.

19 The Other Whipple Other Whipples

20 The Other Whipple George Whipple: The Pathologist

21 The Other Whipple George H. Whipple - Pathologist Born 28 Aug 1878 Ashland, NH 3 rd generation physician Andover Yale Hopkins

22 The Other Whipple Hopkins Asst Prof Pathology William H. Welch Hepatic repair & regeneration after chloroform anesthesia Mechanisms of jaundice Formation of bile pigments outside the liver

23 The Other Whipple U. California Hooper Foundation Professor of Pathology Production of hemoglobin to understand jaundice Acute anemia in dogs Diets & blood formation Dean,

24 The Other Whipple U. Rochester Founding Dean (Age 43) Professor & Chair Pathology Chronic anemia & diet Tx pernicious anemia

25 The Other Whipple G.H. Whipples Nobel Prize 1 1 Prize shared with George Richards Minot & William Parry Murphy

26 The Other Whipple G.H. Whipples Nobel Prize

27 The Other Whipple GH Whipple – Other Studies Tuberculosis Pancreatitis Chloroform poisoning Constituents of bile Metabolism of iron Regeneration plasma protein Stroma of red cells Protein metabolism

28 The Other Whipple Whipples Disease (Duodenum) Low Power H & E Low Power PAS EM

29 The Other Whipple G.H. Whipple – Other Honors Honorary doctorates – U.S., Athens, Glasgow Popular Science Gold Medal & Annual Award William Wood Gerhard Gold Medal Trustee, Rockefeller Foundation Corresponding member –Association of Physicians, Vienna –Royal Society of Physicians, Budapest –European Society of Haematology –British Medical Assoc Honorary Member –American Philosophical Society –Society of Experimental Biology and Medicine

30 The Other Whipple Ecks Fistula

31 The Other Whipple Other Whipples

32 The Other Whipple USS Whipple (DD 15) USS Whipple (DD 217) USS Whipple (DE 1062) Commodore Abraham Whipple

33 The Other Whipple Beverly Whipple, PhD, RN, FAAN

34 The Other Whipple …and now,The Other Whipple

35 The Other Whipple Allen O. Whipple: The Educator

36 The Other Whipple A.O. Whipple: The Educator Missionary parents Poor but well educated Read and spoke: Arabic, Armenian, Persian, French, Latin, Syriac, Turkish Authority on literature, history, anthropology, archeology & art

37 The Other Whipple Allen O. Whipple: The Educator First residency in New York American Board of Surgery The Whipple Society Activities in retirement

38 The Other Whipple First Residency in New York By far the greatest contribution to American Surgery was Halsteds initiating the Surgical Residency Training Program when he began his operative work at Hopkins. A.O. Whipple The Evolution of Surgery in the United States, p.60

39 The Other Whipple First Residency in New York Residency not looked favorably upon by: –Senior attendings, –Young attendings –Interns Acceptance delayed by observing Halsted –Long operations –Dominated by [Chief] Resident A.O. Whipple. The Evolution of Surgery in the United States, p.54-55

40 The Other Whipple First Residency in New York Columbia-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 A.O. Whipple. The Evolution of Surgery in the United States, p.55

41 The Other Whipple A.O. Whipple and ABS Appointed by ASA to National Committee (Edward W. Archibald, President 1935) Attended every organizational meeting of ABS Appointed by ASA to newly formed ABS First Vice-Chair ABS Chaired 1 st Examination Committee Sponsored 1 st examination in NYC (9/20/37) 2 nd Chair ABS Chaired ABS during World War II J.S. Rodman. History of the American Board of Surgery

42 The Other Whipple JS Rodman. History of the American Board of Surgery. Philadelphia: JB Lippincott Company, 1956.

43 The Other Whipple Whipple Society Established 1952 by 300 former residents Soon accepted other members The Training of Surgeons in the Future (1967) ? other published proceedings

44 The Other Whipple Whipple 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.

45 The Other Whipple Whipple Society The first organization for surgical education The only such organization 1957 – 1978 Only after Whipple society disbanded: –Association for Surgical Education –Association of Program Directors in Surgery

46 The Other Whipple A.O. Whipple – The Educator After Retirement in 1946: Trustee American Univ. Beirut Reorganized training Memorial Hospital Plans for Nemazee Hospital then Pahlavi University Medical School Trustee at Princeton Pre-med advisor at Princeton 1957 The Evolution of Surgery in the United States

47 The Other Whipple A.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

48 The Other WhippleSummary Allen O. Whipple – The Surgeon George H. Whipple – The Pathologist Allen O. Whipple – The Educator

49 The Other Whipple

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