Transcript The Other Whipple

The Other Whipple
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
The Other Whipple
Allen O. Whipple: The Surgeon
• Pancreaticoduodenectomy
• Pancreatic Endocrine Tumors
• Portocaval Shunt
1881 - 1963
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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 1909 - 1910
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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
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Pancreaticoduodenectomy
First Operation
Second Operation
End Result
Ann Surg 1935; 102:763-769
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Whipple’s 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; 102:763-769
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Whipple’s 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.”
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Whipple’s Results With Whipples
• First report (1935):
– 3 patients
– 2 died post-op
– F/U on 3rd about four months
• First one-stage resection 3/8/1940
• Whipple’s total experience: 37 cases
– 30 periampullary tumors
– 7 chronic pancreatitis
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Whipple’s Triad
• Symptomatic hypoglycemia while fasting
• Documented glucose <50 mg/dL
• Symptomatic relief with glucose administration
Ann Surg 1935; 101:1299-1335.
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Portal Hypertension
Whipple AO Ann Surg 1945; 122:449-475
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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
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Whipple AO Ann Surg 122:449;1945
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Portocaval Shunt Results
• 1945 report
– 10 patients
– 5 portocaval
– 5 spenorenal [central]
– All survived operation
• Profound influence
Whipple AO Ann Surg 122:449;1945
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Other Surgical Contributions
• Combined Spleen Clinic
• Weekly M&M
• First chair to hire black surgeon
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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
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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
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A.O. Whipple at MD Anderson Cancer Center 1948
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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.
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Other Whipples
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George Whipple: The Pathologist
1878 - 1976
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George H. Whipple - Pathologist
• Born 28 Aug 1878 Ashland, NH
• 3rd generation physician
• Andover → Yale → Hopkins
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Hopkins 1905 - 1914
• 1905 Asst Prof Pathology
• William H. Welch
• Hepatic repair & regeneration
after chloroform anesthesia
• Mechanisms of jaundice
• Formation of bile pigments
outside the liver
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U. California 1914 - 1921
• Hooper Foundation
• Professor of Pathology
• Production of hemoglobin
to understand jaundice
• Acute anemia in dogs
• Diets & blood formation
• Dean, 1920 - 1921
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U. Rochester 1921 - 1955
• Founding Dean (Age 43)
• Professor & Chair Pathology
• Chronic anemia & diet
• Tx pernicious anemia
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G.H. Whipple’s Nobel Prize1
1 Prize
shared with George Richards Minot
& William Parry Murphy
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G.H. Whipple’s Nobel Prize
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GH Whipple – Other Studies
Tuberculosis
Pancreatitis
Chloroform poisoning
Constituents of bile
Metabolism of iron
Regeneration plasma protein
Stroma of red cells
Protein metabolism
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Whipple’s Disease (Duodenum)
Low Power
H&E
Low Power
PAS
EM
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G.H. Whipple – Other Honors
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•
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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
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Eck’s Fistula
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Other Whipples
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USS Whipple (DD 15)
USS Whipple (DD 217)
Commodore Abraham Whipple
1733 - 1819
USS Whipple (DE 1062)
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Beverly Whipple, PhD, RN, FAAN
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…and now,
“The Other Whipple”
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Allen O. Whipple: The Educator
1881 - 1963
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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
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Allen O. Whipple: The Educator
• First residency in New York
• American Board of Surgery
1881 - 1963
• The Whipple Society
• Activities in retirement
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First 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. Whipple
The Evolution of Surgery in the United States, p.60
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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
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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
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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 1st Examination Committee
• Sponsored 1st examination in NYC (9/20/37)
• 2nd Chair ABS
• Chaired ABS during World War II
J.S. Rodman. History of the American Board of Surgery 1937-1952
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JS Rodman. History of the American Board of Surgery.
Philadelphia: JB Lippincott Company, 1956.
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Whipple Society
• Established 1952 by 300 former residents
• Soon accepted other members
• The Training of Surgeons in the Future (1967)
• ? other published proceedings
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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.”
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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
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A.O. Whipple – The Educator
After “Retirement” in 1946:
1941-1957 Trustee American Univ. Beirut
1946-1951 Reorganized training Memorial Hospital
1946-1954 Plans for Nemazee Hospital then
Pahlavi University Medical School
1951-1963 Trustee at Princeton
Pre-med advisor at Princeton
1957
The Evolution of Surgery in the United States
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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”
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Summary
• Allen O. Whipple – The Surgeon
• George H. Whipple – The Pathologist
• Allen O. Whipple – The Educator
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The Other Whipple