The Other Whipple

The The OtherOther Whipple Whipple

John R. Potts, III, M.D.Professor of Surgery

Program Director in SurgeryAssistant Dean Graduate Medical EducationUniversity of Texas Medical School Houston

The Other Whipple

Allen O. Whipple: The SurgeonAllen O. Whipple: The Surgeon

• Pancreaticoduodenectomy

• Pancreatic Endocrine Tumors

• Portocaval Shunt1881 - 1963

The Other Whipple

A.O. Whipple – Early YearsA.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

The Other Whipple

A.O. Whipple at Columbia-PresbyterianA.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

The Other Whipple

PancreaticoduodenectomyPancreaticoduodenectomy

Ann Surg 1935; 102:763-769

First Operation Second Operation End Result

The Other Whipple

Whipple’s Thoughts on WhipplesWhipple’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

The Other Whipple

Whipple’s Thoughts on WhipplesWhipple’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.”

The Other Whipple

Whipple’s Results With WhipplesWhipple’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

The Other Whipple

Whipple’s TriadWhipple’s Triad

• Symptomatic hypoglycemia while fasting

• Documented glucose <50 mg/dL

• Symptomatic relief with glucose administration

Ann Surg 1935; 101:1299-1335.

The Other Whipple

Portal HypertensionPortal Hypertension

Whipple AO Ann Surg 1945; 122:449-475

The Other Whipple

A.O. Whipple on Shunt SurgeryA.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

The Other Whipple

Whipple AO Ann Surg 122:449;1945

The Other Whipple

Portocaval Shunt ResultsPortocaval Shunt Results

• 1945 report

– 10 patients

– 5 portocaval

– 5 spenorenal [central]

– All survived operation

• Profound influence

Whipple AO Ann Surg 122:449;1945

The Other Whipple

Other Surgical ContributionsOther Surgical Contributions

• Combined Spleen Clinic

• Weekly M&M

• First chair to hire black surgeon

The Other Whipple

A.O. Whipple - HonorsA.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

The Other Whipple

A.O. Whipple - HonorsA.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

The Other Whipple

A.O. Whipple at MD Anderson Cancer Center 1948

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.

The Other Whipple

OtherOther Whipples Whipples

The Other Whipple

George Whipple: The Pathologist George Whipple: The Pathologist

1878 - 1976

The Other Whipple

George H. Whipple - PathologistGeorge H. Whipple - Pathologist

• Born 28 Aug 1878 Ashland, NH

• 3rd generation physician

• Andover → Yale → Hopkins

The Other Whipple

Hopkins 1905 - 1914Hopkins 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

The Other Whipple

U. California 1914 - 1921U. California 1914 - 1921

• Hooper Foundation

• Professor of Pathology

• Production of hemoglobin

to understand jaundice

• Acute anemia in dogs

• Diets & blood formation

• Dean, 1920 - 1921

The Other Whipple

U. Rochester 1921 - 1955U. Rochester 1921 - 1955

• Founding Dean (Age 43)

• Professor & Chair Pathology

• Chronic anemia & diet

• Tx pernicious anemia

The Other Whipple

G.H. Whipple’s Nobel PrizeG.H. Whipple’s Nobel Prize11

1 Prize shared with George Richards Minot & William Parry Murphy

The Other Whipple

G.H. Whipple’s Nobel PrizeG.H. Whipple’s Nobel Prize

The Other Whipple

GH Whipple – Other StudiesGH Whipple – Other Studies

Tuberculosis

Pancreatitis

Chloroform poisoning

Constituents of bile

Metabolism of iron

Regeneration plasma protein

Stroma of red cells

Protein metabolism

The Other Whipple

Whipple’s Disease (Duodenum)Whipple’s Disease (Duodenum)

Low PowerH & E

Low PowerPAS

EM

The Other Whipple

G.H. Whipple – Other HonorsG.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

The Other Whipple

Eck’s FistulaEck’s Fistula

The Other Whipple

OtherOther Whipples Whipples

The Other Whipple

USS Whipple (DD 15)

USS Whipple (DD 217)

USS Whipple (DE 1062)

Commodore Abraham Whipple1733 - 1819

The Other Whipple

Beverly Whipple, PhD, RN, FAAN

The Other Whipple

……and now,and now,““TheThe Other Whipple” Other Whipple”

The Other Whipple

Allen O. Whipple: The Educator Allen O. Whipple: The Educator

1881 - 1963

The Other Whipple

A.O. Whipple: The EducatorA.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

The Other Whipple

Allen O. Whipple: The EducatorAllen O. Whipple: The Educator

• First residency in New York

• American Board of Surgery

• The Whipple Society

• Activities in retirement

1881 - 1963

The Other Whipple

First Residency in New YorkFirst 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

The Other Whipple

First Residency in New YorkFirst 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

The Other Whipple

First Residency in New YorkFirst 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

The Other Whipple

A.O. Whipple and ABSA.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

The Other Whipple

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

The Other Whipple

Whipple SocietyWhipple Society

• Established 1952 by 300 former residents

• Soon accepted other members

• The Training of Surgeons in the Future (1967)

• ? other published proceedings

The Other Whipple

Whipple SocietyWhipple 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.”

The Other Whipple

Whipple SocietyWhipple 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

The Other Whipple

A.O. Whipple – The EducatorA.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

The Other Whipple

A.O. Whipple – The EducatorA.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”

The Other Whipple

SummarySummary

• Allen O. Whipple – The Surgeon

• George H. Whipple – The Pathologist

• Allen O. Whipple – The Educator

The Other Whipple

The Other Whipple