- Email: [email protected]
William Hedley John Summerskill 1926–1977
GASTROENTEROLOGY 73:435-437, 1977 Copyrigh t © 1977 by the American Gastroenterological Association
Vol. 73. No.3 Printed in U.S A.
IN MEMORIAM WILLIAM HEDLEY JOHN SUMMERSKILL
1926-1977 On the morning of March 9, 1977, William Hedley John Summerskill , Director of the Gastroenterology Unit of the Mayo Clinic in Rochester, Minnesota, suddenly developed intense back pain. He abruptly canceled a lecture and went home to bed; he felt better and began to dictate letters. In the early afternoon, he suddenly died of an acute myocardial infarction. The world of gastroenterology has suffered an irreplaceable loss. His Achievements: Bill Summerskill was a productive and meticulous clinical investigator and a tireless and effective worker for his institution, for his specialty societies, and for government committees. He was a perfectionistic and an innovative leader of the Gastroenterology Unit. He was a leader among his peers and a developer of careers. He always demanded excellence, no matter how stringent the requirements. He accomplished two lifetimes of work in his 51 years. The Investigator: Bill Summerskill's investigative career was characterized by enormous output, remarkable diversity, and clarity and felicity of publication and presentation. His publications encompassed every organ of the gastrointestinal tract. His research career began at the Hammersmith where he was a co-investigator with Sheila Sherlock in classical studies defining the syndrome of hepatic encephalopathy and implicating ammonia in its pathogenesis. Awarded a Rockefeller Travelling Fellowship, he joined Charles Davidson at the Thorndike Laboratory and demonstrated the deleterious effect of protein meals in patients with hepatic insufficiency. In 1959, he authored the first description of benign recurrent cholestasis. Also in 1959, he joined the Staff of the Mayo Clinic and was charged with the development of a program of laboratory-based clinical investigation in that institution. He did just that. First came a series of classical papers on water and electrolyte problems in cirrhotic patients. His early description of a patient with malabsorption and jejunal ulceration due to gastric hypersecretion with pancreatic islet cell hyperplasia (1959) was followed 3 years later by a collaboration with Charlie Code who extracted a "gastric secretagogue" from the primary islet cell tumors. With Bill Baldus he carried out laborious but meticulous studies on azotemia in hepatic failure . Then the research program broadened. Bill Summerskill joined Charlie Code once again in a pioneering study of the transmucosal potential difference in man, using this new technique to identify the gastroesophageal junction. He carried out a brief study with Richard Hartley on secretion and pancreatic bicarbonate secre-
tion. Intestinal perfusion studies began with the arrival of Klaus Ewe, the first Fellow from Germany, who studied ammonia absorption in the human jejunum. Bill Summerskill believed that the investigator should be willing to undergo any procedure carried out in an experimental subject. Klaus Ewe studied the ammonia fluxes in the jejunum of his mentor (fig. 1). The Unit expanded in size and personnel. Sidney Phillips joined the Unit after 2 years with Charlie Code, and he and Bill Summerskill described the development of the occlusive intestinal balloon and began important studies on electrolyte movement in the gastrointestinal tract. Work on ammonia continued with studies of movements in the upper intestinal tract, gut urease, and effects of neomycin; the work also included attempts to explore hydroxamates as inhibitors of urease. Leslie Schoenfield, who had done pioneering studies on bilirubin excretion with Jesse Bollman, returned from a year at the Karolinska Institute where he had become skilled in techniques of bile acid analysis. Alan Hofmann was recruited from the Rockefeller Institute. Research on bile acids and cholelithiasis began. In 1967, the Unit moved to large, modern facilities that were superbly arranged for outpatient and inpatient clinical studies. The Unit slowly expanded and took over adjoining space until, in 1977, it occupied some 15,000 square feet and had 60 employees. Bill was adamant about the need for controlled studies, and he had always wanted to carry out a controlled trial of steroids in chronic active hepatitis (which he chose to call chronic active liver disease). With Michael Geall and Leslie Schoenfield, the disease was categorized and plans were made for a carefully controlled and well conceived double blind trial of steroid therapy, which was initiated in 1969. Bill Go, a new Research Fellow, adapted the intestinal perfusion technique to the measurement of secretion, and the first quantitative "outputs" of digestive secretions in health and disease were obtained. By using this technique , it was shown that essential amino acids and fat, but not nonessential amino acids or glucose, liberated cholecystokinin. Then Bill Go was sent to Bob Ryan, an endocrinologist skilled in radioimmunoassay, and the Unit's involvement with this revolutionary methodology began. By 1971, the first results of the controlled trial of steroid therapy were coming in; it was observed that steroids induced histological remission, which was shown to occur after biochemical remission. Determinants of response were elucidated by a series of Re435
436
IN MEMORIAM
search Fellows including Roger Soloway, Gary Gitnick, Helmut Ammon, Melvyn Korman, Solko Schalm, and Al Czaja. The Institutional Supporter: No one worked harder than Bill Summerskill for the Mayo Clinic. He loved the Institution for its achievements, marvelled at its intricacies, despaired at its occasional weaknesses and mistakes, and was always hopeful and sometimes confident that it was moving in the right direction. He identified talent elsewhere and sought to get it to Mayo. He helped organize the Clinical Research Center. He served for years on the Research Committee, which is all powerful in the dispensing of research funds at Mayo. He became Vice-Chairman of Medicine in charge of Research and Subspecialty Training and sought to work within the system to make Mayo a more academic institution. But most of his institutional effort went to build the Gastroenterology Unit. Here his plan was rather simple: choose bright, self-directed associates who could generate their own funding; develop a broad base of financial support- governmental, institutional, and private; attack important problems with well-designed experiments that had extensive intramural peer review before they were initiated; and carry the work through to public presentation and publication. In addition, the Unit existed in association with an enormous clinical practice of gastroenterology, so that outstanding Fellows from abroad were numerous in the Unit. They came not only to do research but also to see how gastroenterology was practiced at the Mayo Clinic. Bill Summerskill always pushed his Fellows forward. He was respected by all of them and loved by some of them. At any national meeting, Bill Summerskill was inconspicuous during their presentations; it was their show. On Bill's 50th birthday, a small dinner party was organized for him by several of us who thought that we should pay some homage to one who had done so much for us. We bound reprints of the Unit-three massive volumes-as well as pictures of the former Fellows, each of whom wrote a note of congratulations and appreciation to Bill. Bill wrote me later of this: "(The event) transformed a milestone of uncertain palatability to an exhilarating experience. The occasion
Vol . 73, No.3
was memorable for numerous reasons, particularly the large number of our alumni who responded, the substantial number of Mayo alumni who attended, and the beautifully bound volumes encompassing the work achieved in the Unit since its inception and, more important, the memories conjured up by the comments and photographs of those who accomplished it. Since the organizers traded expertly (as they have for years!) on my frequent failure to notice what goes on under my nose in the Unit, the surprise was complete. "The event was by far the most gratifying of my Mayo career, exceeding even the excitement of that far-off time when the Unit first unfurled its·banner in the old Tower Section, preparing to do battle and force the bastions of established academe. I am indeed fortunate to have helped implement the dream, to have witnessed its fulfillment and now to share the fruits of the experience with those who made it possible. From the letters received, the Staff and I perceived a theme of identification with and solid support for our.Unit; an appreciation of having trained there (in some instances more noticeable after the event than at the time!); and indications of pioneering pride from our earliest Fellows, who worked in the old Unit when facilities were rudimentary and some of the research training was not much better!" The Public Servant: Bill Summerskill served on numerous national committees. He helped organize and chair the FDA Advisory Board on Gastrointestinal Drugs. He played a key role in transforming the AASLD into a national society with a strong financial base. He helped the American College of Physicians in its programming. He reviewed countless papers and served as an invisible advisor to numerous colleagues and many organizations. As an administrator, he had an uncanny knack for identifying the crux of the prob-
September 1977
IN MEMORIAM
lem, stating it eloquently, and mapping out in Teutonic detail the approaches to its solution. He seldom missed anything. He was a master at running committees. The Man: Bill Summerskill began every day at 7:45 AM, no matter when the preceding evening ended. Days were spent dictating letters-perhaps several thousand annually- discussing problems, meeting in regard to research protocols, analyzing papers and presentations, or attending committee meetings. His extraordinarily capable secretary, Mary Hanenberger, organized the input and output of material to his desk, which always maintained a steady state, never orderly but never disorganized. Nights and weekends were often spent doing more information processing. All of this extraordinary literary activity-for each of Bill's letters was a masterpiece-was fueled by a continuous inhalation of cigarette smoke and ingestion of coffee. Biannually, Bill routinely left for Acapulco, whence he returned fluorescent, full of stories of hobnobbing with the beautiful people. Bill Summerskill was a big generous man who dominated groups. He drew reaction from everyone-some were fond of him, and some were not. He was frequently caustic, commonly ironic, and occasionally pompous; he was never at a loss for words and had an opinion on every issue. He disliked the soft-spoken or the hesitant; he had no tolerance for misuse of the English language. He made rather quick decisions, usually right, sometimes wrong. He had extraordinary vision and wanted individuals to give their best. He had no sympathy for the person who was unwilling to put in extra hours. He organized research in an exemplary manner; he taught all of us the ideal format for presentations. He wanted the Unit to excel. To appreciate Bill Summerskill, one had to judge what he was doing, and not always how he did it. Bill Summerskill had been a great sportsman in his youth, captaining the Oxford rugby team. In Rochester, summer weekends were spent on the Mississippi River,
437
where he skillfully piloted his twin-engine cruiser around Lake Pepin (fig. 2). A well-stocked bar was enjoyed by the community of gastroenterological scholars from around the world. Bill was a lover of fine cuisine and good wine. He was an effective President of the Rochester Chapter of the International Wine and Food Society, founded by Hugh Butt. He was a warm, gracious host. As a guest he was usually charming, but sometimes became a bit difficult, especially relishing a well-phrased defense of an obviously indefensible position. As a name and place dropper, he had few equals; as a raconteur, he could make a dull FDA committee meeting sound as if it were the event of the decade. Bill married Betsy Sheppard in 1950, and they had one son, "Wis," before her death in Rochester in 1965 of renal failure. Bill later married Barbara Ehmke who was his beloved and charming companion. His son inherited his father's love of the water and is coxswain on the crew team at Princeton; he plans a career in biomedical science. A Future Unrealized: In 1976 Bill Summerskill decided to accept one last challenge- to assume the Chairmanship of the Division of Gastroenterology at the University of California at San Diego. Here he hoped to use his enormous experience and extraordinary administrative ability to create the greatest Division of Gastroenterology in the New World, aided by the sun and sand which began to seem more inviting than the icy blasts of Rochester winters. Bill Summerskill did not live to carry out this new task and, tragically for all of us, we are suddenly bereft of a man who had so much more to give. In his last letter to me, he added a postscript describing the success of the Unit in getting most of its abstracts accepted for this year's AGA program in Toronto. He noted, all too prophetically, "It is good to leave on the crest of the wave!" ALAN F. HOFMANN, M.D.
Vol. 73. No.3 Printed in U.S A.
IN MEMORIAM WILLIAM HEDLEY JOHN SUMMERSKILL
1926-1977 On the morning of March 9, 1977, William Hedley John Summerskill , Director of the Gastroenterology Unit of the Mayo Clinic in Rochester, Minnesota, suddenly developed intense back pain. He abruptly canceled a lecture and went home to bed; he felt better and began to dictate letters. In the early afternoon, he suddenly died of an acute myocardial infarction. The world of gastroenterology has suffered an irreplaceable loss. His Achievements: Bill Summerskill was a productive and meticulous clinical investigator and a tireless and effective worker for his institution, for his specialty societies, and for government committees. He was a perfectionistic and an innovative leader of the Gastroenterology Unit. He was a leader among his peers and a developer of careers. He always demanded excellence, no matter how stringent the requirements. He accomplished two lifetimes of work in his 51 years. The Investigator: Bill Summerskill's investigative career was characterized by enormous output, remarkable diversity, and clarity and felicity of publication and presentation. His publications encompassed every organ of the gastrointestinal tract. His research career began at the Hammersmith where he was a co-investigator with Sheila Sherlock in classical studies defining the syndrome of hepatic encephalopathy and implicating ammonia in its pathogenesis. Awarded a Rockefeller Travelling Fellowship, he joined Charles Davidson at the Thorndike Laboratory and demonstrated the deleterious effect of protein meals in patients with hepatic insufficiency. In 1959, he authored the first description of benign recurrent cholestasis. Also in 1959, he joined the Staff of the Mayo Clinic and was charged with the development of a program of laboratory-based clinical investigation in that institution. He did just that. First came a series of classical papers on water and electrolyte problems in cirrhotic patients. His early description of a patient with malabsorption and jejunal ulceration due to gastric hypersecretion with pancreatic islet cell hyperplasia (1959) was followed 3 years later by a collaboration with Charlie Code who extracted a "gastric secretagogue" from the primary islet cell tumors. With Bill Baldus he carried out laborious but meticulous studies on azotemia in hepatic failure . Then the research program broadened. Bill Summerskill joined Charlie Code once again in a pioneering study of the transmucosal potential difference in man, using this new technique to identify the gastroesophageal junction. He carried out a brief study with Richard Hartley on secretion and pancreatic bicarbonate secre-
tion. Intestinal perfusion studies began with the arrival of Klaus Ewe, the first Fellow from Germany, who studied ammonia absorption in the human jejunum. Bill Summerskill believed that the investigator should be willing to undergo any procedure carried out in an experimental subject. Klaus Ewe studied the ammonia fluxes in the jejunum of his mentor (fig. 1). The Unit expanded in size and personnel. Sidney Phillips joined the Unit after 2 years with Charlie Code, and he and Bill Summerskill described the development of the occlusive intestinal balloon and began important studies on electrolyte movement in the gastrointestinal tract. Work on ammonia continued with studies of movements in the upper intestinal tract, gut urease, and effects of neomycin; the work also included attempts to explore hydroxamates as inhibitors of urease. Leslie Schoenfield, who had done pioneering studies on bilirubin excretion with Jesse Bollman, returned from a year at the Karolinska Institute where he had become skilled in techniques of bile acid analysis. Alan Hofmann was recruited from the Rockefeller Institute. Research on bile acids and cholelithiasis began. In 1967, the Unit moved to large, modern facilities that were superbly arranged for outpatient and inpatient clinical studies. The Unit slowly expanded and took over adjoining space until, in 1977, it occupied some 15,000 square feet and had 60 employees. Bill was adamant about the need for controlled studies, and he had always wanted to carry out a controlled trial of steroids in chronic active hepatitis (which he chose to call chronic active liver disease). With Michael Geall and Leslie Schoenfield, the disease was categorized and plans were made for a carefully controlled and well conceived double blind trial of steroid therapy, which was initiated in 1969. Bill Go, a new Research Fellow, adapted the intestinal perfusion technique to the measurement of secretion, and the first quantitative "outputs" of digestive secretions in health and disease were obtained. By using this technique , it was shown that essential amino acids and fat, but not nonessential amino acids or glucose, liberated cholecystokinin. Then Bill Go was sent to Bob Ryan, an endocrinologist skilled in radioimmunoassay, and the Unit's involvement with this revolutionary methodology began. By 1971, the first results of the controlled trial of steroid therapy were coming in; it was observed that steroids induced histological remission, which was shown to occur after biochemical remission. Determinants of response were elucidated by a series of Re435
436
IN MEMORIAM
search Fellows including Roger Soloway, Gary Gitnick, Helmut Ammon, Melvyn Korman, Solko Schalm, and Al Czaja. The Institutional Supporter: No one worked harder than Bill Summerskill for the Mayo Clinic. He loved the Institution for its achievements, marvelled at its intricacies, despaired at its occasional weaknesses and mistakes, and was always hopeful and sometimes confident that it was moving in the right direction. He identified talent elsewhere and sought to get it to Mayo. He helped organize the Clinical Research Center. He served for years on the Research Committee, which is all powerful in the dispensing of research funds at Mayo. He became Vice-Chairman of Medicine in charge of Research and Subspecialty Training and sought to work within the system to make Mayo a more academic institution. But most of his institutional effort went to build the Gastroenterology Unit. Here his plan was rather simple: choose bright, self-directed associates who could generate their own funding; develop a broad base of financial support- governmental, institutional, and private; attack important problems with well-designed experiments that had extensive intramural peer review before they were initiated; and carry the work through to public presentation and publication. In addition, the Unit existed in association with an enormous clinical practice of gastroenterology, so that outstanding Fellows from abroad were numerous in the Unit. They came not only to do research but also to see how gastroenterology was practiced at the Mayo Clinic. Bill Summerskill always pushed his Fellows forward. He was respected by all of them and loved by some of them. At any national meeting, Bill Summerskill was inconspicuous during their presentations; it was their show. On Bill's 50th birthday, a small dinner party was organized for him by several of us who thought that we should pay some homage to one who had done so much for us. We bound reprints of the Unit-three massive volumes-as well as pictures of the former Fellows, each of whom wrote a note of congratulations and appreciation to Bill. Bill wrote me later of this: "(The event) transformed a milestone of uncertain palatability to an exhilarating experience. The occasion
Vol . 73, No.3
was memorable for numerous reasons, particularly the large number of our alumni who responded, the substantial number of Mayo alumni who attended, and the beautifully bound volumes encompassing the work achieved in the Unit since its inception and, more important, the memories conjured up by the comments and photographs of those who accomplished it. Since the organizers traded expertly (as they have for years!) on my frequent failure to notice what goes on under my nose in the Unit, the surprise was complete. "The event was by far the most gratifying of my Mayo career, exceeding even the excitement of that far-off time when the Unit first unfurled its·banner in the old Tower Section, preparing to do battle and force the bastions of established academe. I am indeed fortunate to have helped implement the dream, to have witnessed its fulfillment and now to share the fruits of the experience with those who made it possible. From the letters received, the Staff and I perceived a theme of identification with and solid support for our.Unit; an appreciation of having trained there (in some instances more noticeable after the event than at the time!); and indications of pioneering pride from our earliest Fellows, who worked in the old Unit when facilities were rudimentary and some of the research training was not much better!" The Public Servant: Bill Summerskill served on numerous national committees. He helped organize and chair the FDA Advisory Board on Gastrointestinal Drugs. He played a key role in transforming the AASLD into a national society with a strong financial base. He helped the American College of Physicians in its programming. He reviewed countless papers and served as an invisible advisor to numerous colleagues and many organizations. As an administrator, he had an uncanny knack for identifying the crux of the prob-
September 1977
IN MEMORIAM
lem, stating it eloquently, and mapping out in Teutonic detail the approaches to its solution. He seldom missed anything. He was a master at running committees. The Man: Bill Summerskill began every day at 7:45 AM, no matter when the preceding evening ended. Days were spent dictating letters-perhaps several thousand annually- discussing problems, meeting in regard to research protocols, analyzing papers and presentations, or attending committee meetings. His extraordinarily capable secretary, Mary Hanenberger, organized the input and output of material to his desk, which always maintained a steady state, never orderly but never disorganized. Nights and weekends were often spent doing more information processing. All of this extraordinary literary activity-for each of Bill's letters was a masterpiece-was fueled by a continuous inhalation of cigarette smoke and ingestion of coffee. Biannually, Bill routinely left for Acapulco, whence he returned fluorescent, full of stories of hobnobbing with the beautiful people. Bill Summerskill was a big generous man who dominated groups. He drew reaction from everyone-some were fond of him, and some were not. He was frequently caustic, commonly ironic, and occasionally pompous; he was never at a loss for words and had an opinion on every issue. He disliked the soft-spoken or the hesitant; he had no tolerance for misuse of the English language. He made rather quick decisions, usually right, sometimes wrong. He had extraordinary vision and wanted individuals to give their best. He had no sympathy for the person who was unwilling to put in extra hours. He organized research in an exemplary manner; he taught all of us the ideal format for presentations. He wanted the Unit to excel. To appreciate Bill Summerskill, one had to judge what he was doing, and not always how he did it. Bill Summerskill had been a great sportsman in his youth, captaining the Oxford rugby team. In Rochester, summer weekends were spent on the Mississippi River,
437
where he skillfully piloted his twin-engine cruiser around Lake Pepin (fig. 2). A well-stocked bar was enjoyed by the community of gastroenterological scholars from around the world. Bill was a lover of fine cuisine and good wine. He was an effective President of the Rochester Chapter of the International Wine and Food Society, founded by Hugh Butt. He was a warm, gracious host. As a guest he was usually charming, but sometimes became a bit difficult, especially relishing a well-phrased defense of an obviously indefensible position. As a name and place dropper, he had few equals; as a raconteur, he could make a dull FDA committee meeting sound as if it were the event of the decade. Bill married Betsy Sheppard in 1950, and they had one son, "Wis," before her death in Rochester in 1965 of renal failure. Bill later married Barbara Ehmke who was his beloved and charming companion. His son inherited his father's love of the water and is coxswain on the crew team at Princeton; he plans a career in biomedical science. A Future Unrealized: In 1976 Bill Summerskill decided to accept one last challenge- to assume the Chairmanship of the Division of Gastroenterology at the University of California at San Diego. Here he hoped to use his enormous experience and extraordinary administrative ability to create the greatest Division of Gastroenterology in the New World, aided by the sun and sand which began to seem more inviting than the icy blasts of Rochester winters. Bill Summerskill did not live to carry out this new task and, tragically for all of us, we are suddenly bereft of a man who had so much more to give. In his last letter to me, he added a postscript describing the success of the Unit in getting most of its abstracts accepted for this year's AGA program in Toronto. He noted, all too prophetically, "It is good to leave on the crest of the wave!" ALAN F. HOFMANN, M.D.