The surgical legacy of Lee Clark

By Charles M. Balch and Bryant Boutwell

1933年12月在加菲猫纪念医院in Washington, D.C., Drs. Lee and Bert Clark headed for Europe to round out their education. In Paris, he trained for two years as a surgical resident at the renowned American Hospital, the only private hospital in the city. Bert trained as an obstetrical resident at Tarnier Maternity Hospital, later switching to anesthesiology.

For Lee Clark, the American Hospital opened important doors, including the opportunity to spend time at the Institut Pasteur and the Radium Institute under the direction of Marie Curie. The holder of two Nobel Prize awards, Curie was in the last year of her life, dying July 4, 1934. At the Radium Institute, he saw firsthand the potential for developing a new treatment modality using irradiation to destroy cancer cells. Clark found Curie’s work transformational and was determined that the deadly power of atomic warfare could be harnessed as a healing tool.

这对年轻的夫妇一起花时间在他们的少量业余时间探索巴黎和欧洲。对于巴黎的德克萨斯人来说，这是一种文化唤醒，因为他和伯特在医院外的每一个时刻都在探索景点。他用他的话说：“我们会做我们所谓的'bistroin'。”，他解释说，这涉及确定他们想看到的巴黎周围的著名遗址，并骑着地铁以尽可能快地到达那里。

“Then we’d start walking back and we’d stop at every bistro along the way and have a glass of wine,” he recalled. “By the time we were halfway home, we’d be talking freely with the natives, trying out our French on them.”

We tend to think of Lee Clark foremost as a talented cancer surgeon. His professional activity during his postgraduate training and early career, however is a story of general surgical practice combined with an intricate knowledge of internal medicine. This was a time of little surgical specialization, limited availability of antibiotics and few options for cancer treatments other than surgical excision. General surgeons of that day had to be well-versed with a deep appreciation of body systems that was the hallmark of a good clinician.

美国医院由巴黎大学医学院的教职人员组成，为居民提供了培训机会。1934年，克拉克（Clark）担任巴黎萨尔佩特里（Salpêtrière）医院的首席居民，克拉克（Clark）有机会会议，这将以巨大的方式影响他的职业生涯。梅奥诊所普通外科主管克劳德·迪克森（Claude Dixon）博士恰好与克拉克（Clark）交叉道路，克拉克（Clark）为他的新熟人提供了美国医院的参观​​。两者将成为一生的朋友。迪克森（Dixon）将在整个职业生涯中成为他的主要导师，首先鼓励他来梅奥诊所（Mayo Clinic）接受培训（1935年4月至1939年10月），然后定期向他建议他在密西西比州杰克逊（Jackson）（1939-1942）的一般手术诊所。迪克森（Dixon）后来首次提倡克拉克（Clark）任命新医学博士安德森癌症医院的主任和主管。

At the Mayo Clinic, Clark’s general surgery surgical experience was prodigious and extensive. He had been involved in 2,000 operations at the Mayo Clinic, and cancer cases were about two-thirds of this caseload. He was Dixon’s first assistant for 18 months, and he shined. Dixon described Clark as “one of the most outstanding young men we have ever trained,” adding, “He also is one of the very few men who is both an excellent clinician and an outstanding surgeon, and who at the same time has maintained a keen interest in research.”

迪克森倡导克拉克（Clark）领导休斯敦的新癌症医院，他在推荐信中写道：“我对他会发展成为该行业的一位伟大领导人之一。”

Dr Albert C. Broders, who was director of surgical pathology at the Mayo Clinic (1912-1959) and known for his work establishing a tumor grading system used worldwide, had this to say: “Dr. Clark is one of those rare individuals in whom is combined imagination, sound judgment, energy, technical skill and integrity which is at all times above reproach.”

甚至传奇的威尔·梅奥（Will Mayo）博士也有兴趣招募他在他的手术培训完成后继续担任梅奥诊所外科手术人员的成员。然而，两个Drs。克拉克还有其他计划，并离开明尼苏达州罗切斯特，前往密西西比州的杰克逊，在南部抚养两个小孩。

命运为克拉克提供了一个独特的机会，可以在密西西比州的杰克逊（Jackson）充分利用他的外科技能，在那里他与三个外科伴侣成为一家私人诊所的首席外科医生。这个机会从一个大型地理区域中吸引了70名初级保健医生，当时该诊所的一位高级外科伴侣在一场汽车事故中悲惨地死亡时，就出现了。

Beginning in October 1939, Clark quickly developed a prodigious surgical practice at Mississippi Baptist Hospital, with his wife as his primary anesthesiologist. His caseload comprised mainly cancer surgery, as it had at the Mayo Clinic.

“Since my arrival here, we have had over a thousand surgical cases,” he said. “There is an abundance of pathology in these parts, and I have recently had quite a few neurosurgical cases.”

He described his practice in 1942 in two letters. He wrote the first when he applied for his commission in the Air Division of the Army Medical Corp: “I have done a large volume of surgery in private practice since I left the Mayo Clinic nearly three years ago, having done more than 600 major operations a year, of all types – from the brain to the colon.”

一个星期天早上，他得知珍珠港受到袭击。虽然他被认为是杰克逊（Jackson）的医生至关重要的，但“服务”是克拉克（Clark）的一个词：“我要求解除我在杰克逊（Jackson）的责任，并进入陆军航空公司医疗部门。”

收到佣金后，他在梅奥诊所写信给迪克森：“我在接受（陆军）委员会的那天在医院里列出了一份病人。所有这些患者都在我的个人服务中，我亲自对他们进行了操作，如您所见，有很多种类。自从在密西西比州工作以来，我一直很高兴与我看到的大量病理。...我们在此清单上没有死亡率。但是，我必须承认，这是迄今为止最大的清单，尽管在过去的一年中，我一直在医院有25多名术后患者。”

Years later, he summarized his Mississippi surgical practice in one sentence: “We were there two years, and I did over 1,000 major operations, of which a disproportionate number were cancers or tumors.” Bert was equally herculean in her work ethic, having performed over 1,400 anesthesia procedures during the same two-year period, many of those as her husband’s anesthesiologist.

Surgeons were expected to be “board certified” after completion of surgical training plus two years of surgical practice. In January 1942, Clark applied to take the American Board of Surgery exam. As required, he listed his caseload of 820 operations at Mississippi Baptist Hospital, including 411 “colonic surgery” with 43 deaths (10.46% mortality) and 409 cases listed as “others,” with eight deaths (1.9%), for a total mortality rate of 6.2%. The most common causes of postoperative deaths, he noted, were peritonitis (14 patients), sepsis (7), intestinal obstruction (7), embolus (6) and pneumonia (5). These outcomes are truly remarkable, given the diversity of caseload in every anatomic area. He was, at the time, the only surgeon between New Orleans and Memphis performing these large-scale operations. Even more impressive, he had only sulfa antibiotics to treat surgical infections.

In the Army Air Force (AAF), Captain Clark was promoted to the rank of major in October 1943. In March 1944, he was appointed as a member of the Surgical Advisory Board to the Air Surgeon and as one of five consulting surgeons for the entire AAF Medical Services.

1944年，他被转移到俄亥俄州代顿的赖特·帕特森（Wright Patterson Field），担任实验手术单元的负责人，在那里他监督了手术实验和航空医学中手术问题的临床应用。他是空军公告的编辑，该公报分发给了所有空军医生。他是一位内心的教育家，因此似乎很自然，1949年，他将空中外科医生公告的概念和覆盖范围作为MD Anderson的癌症公告。在他的服役期间，他还开发了一个动物外科实验室，该实验程序研究了自早期的，动脉吻合，皮肤移植以及各种化学疗法和生物学剂对组织生长和伤口修复的影响。

除了重大的创伤研究外，克拉克及其同事还对降落伞引起的血管和骨科损伤进188bet体育网址行了研究。当他得知从飞机上跳伞的八名男子中有2人死亡，四人受伤时，他下定决心解决这个问题。

他回忆说：“我们处理了这场[降落伞伤害]，并处理了与撞车事故相关的创伤。”“我们致力于吻合血管和其他因素以防止腿部失去的方式。战争历史上的第一次……有一个真正的机会来挽救腿部，武器和生命。”

His results, published in the Annals of Surgery, covered a host of timely topics in aviation medicine, including aircraft accident casualties, enemy gunfire, parachute injuries, frostbite at high altitude and the recommended surgical treatment for each.

他在AAF的最后任务是在圣安东尼奥的Randolph Field Air Base。他曾在250张病床医院担任新成立的手术系主任，并在AAF航空医学院担任实验动物外科主任，在那里他是美国17州美国中央区的外科手术顾问。从1944年12月到1946年7月出院，他经常对入伍军人及其家属进行重大手术，治疗创伤，疝气，胆结石，阑尾炎，静脉曲张，静脉曲张，妇科疾病以及头颈病理。

From Paris to the Mayo, from Mississippi to the military, Lee Clark’s training was stellar. His surgical expertise was vast and his network of mentors, leaders in academic medicine and the military, was impressive and diverse. As his military career came to a close in 1946, the story of the new cancer hospital in Houston was just unfolding.恩斯特·伯特纳was hard at work at the Oaks and reminding The University of Texas president and UT System Board of Regents to find his replacement so he could assume leadership to build the Texas Medical Center. Clark knew little about the new cancer hospital and pondered his future after his military service. Little did he know that the UT Regents were soon to put him on their radar as theysearchedfor the cancer hospital’s permanent director.

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