- Email: [email protected]
You Have Heard of the Award, But What Do You Know About Arthur M Shipley?
HISTORY
You Have Heard of the Award, But What Do You Know About Arthur M Shipley? Nancy D Perrier,
MD, FACS,
Minera A Romero,
MD,
MD, FACS
in his father’s name. At the direction of the then, Department Chair, Dr Gil Deithelm, the annual interest would fund an award that would give his father, Joseph, much deserved, everlasting recognition. Joseph practiced in Wilcox County, south of Birmingham. His father and grandfather were physicians and he was well known socially and medically. He attended the University of Alabama and received a Bachelor of Science degree (1921e1923), then Tulane Medical School (1923 1925), and then he completed an internship at Charity Hospital (1925 1926). He completed a surgical residency at the Mayo Clinic in Rochester, MN in 1932 (Fig. 1). He was a professor of clinical surgery in the Medical College of Alabama at Birmingham, and was active in the affairs of the American Cancer Society, for which he served as Director. He was also a member of the Medical Reserve Corps in the US Army and was a regent of the American College of Surgeons from 1958 until his untimely death. Both his father and grandfather and both of his sons were surgeons. In 1960, Dr Donald was elected as President of the Southern Surgical. He died unexpectedly of a myocardial infarction 3 months later and, sadly, could not enjoy his full year as president of the SSA.
One of the highlights at the annual meeting of the Southern Surgical Association (SSA) is the presentation of the Shipley Award. This tradition is of historical significance, as it has been an integral part of the annual meeting for 55 years. Dr Shipley died in 1956, and there are few contemporary members of the SSA who know of the qualities or reasons for recognition of this unique surgeon. We think this is of interest to SSA members. Dr Arthur M Shipley was recognized as one of the outstanding teachers of clinical surgery of his time. He served as Chairman of Surgery at the University of Maryland School of Medicine in Baltimore. He was a clinician with a compulsive attention to detail and development of an in-depth knowledge of the medical and surgical literature. His commitment to service was fulfilled during his long and successful life.
HISTORY OF MEDICINE LECTURE The first SSA meeting took place in 1887. One century later, in 1987, Robert (Bob) Sparkman, the SSA historian from Dallas, TX, proposed to the Society’s council the concept that there would be an annual award given to an individual to present a lecture on a historical figure contributing to Southern Surgery at the annual meeting of the association. The council confirmed and approved the suggestion. As the SSA’s historian, Bob was in search of a home to congregate memorabilia and archival material of the association. After multiple propositions were considered, the University of Alabama’s Lister Hill Library was chosen to house the Southern Surgical archives. In 2002, Joseph M Donald Jr (a member of the SSA) requested a tribute be made in honor of his father Joseph Marion Donald, the well-respected and prominent Alabama surgeon. To accomplish this, he contributed $80,000 to the University of Alabama as an endowment
SHIPLEY AWARD In 1956, the year after Dr Shipley’s death, one of his residents, Dr Hugh Alvin Bailey (1900 1958), Chief of Staff and General Surgery at Charleston General Hospital in West Virginia, made a gift of $1,300 to the SSA to provide a permanent memorial in the name of Dr Shipley. The council authorized and established the Arthur M Shipley Award, to consist of a gold medal to be given annually to the new member judged to have presented the best paper during either the first or second year of his/her membership. In 1957, Dr Felda Hightower was given the award for the first time to establish the additional study and practice of surgery. Since then, 57 subsequent Shipley Award winners have been named and the award has become an integral part of the heritage of the Southern Surgical (Table 1). In fact, 5 of the 57 Shipley award winners have become presidents of our association. The coauthors of this study are personally gratified that they have both been recipients of the Shipley Award, separated by a timespan of only 33 years (Fig. 2).
Disclosure Information: Nothing to disclose. Received December 8, 2014; Accepted December 9, 2014. From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Perrier), St Joseph Hospital, Baltimore, MD (Romero), and Medical University of South Carolina, Charleston, SC (van Heerden). Correspondence address: Nancy D Perrier, MD, FACS, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Dr, Unit 1484, Houston, TX 77030. email: NPerrier@ mdanderson.org
ª 2015 by the American College of Surgeons Published by Elsevier Inc.
Jon A van Heerden,
772
http://dx.doi.org/10.1016/j.jamcollsurg.2014.12.058 ISSN 1072-7515/15
Vol. 220, No. 4, April 2015
Figure 1. Joseph M Donald, MD, Mayo Clinic Surgery Fellow, 1932. (Reprinted with permission from the Mayo Clinic.)
A piece of marble slab from Dr Shipley’s historic operating room is on display as part of the SSA’s historical Reynold’s Archived Collection in the Lister Hill Library at the University of Alabama in Birmingham. The piece of foundation is indeed from the very room in which Dr Shipley resected the first preoperatively determined pheochromocytoma.
DR ARTHUR M SHIPLEY Dr Arthur M Shipley (1878 1955) was a renowned American surgeon and native Marylander (Fig. 3). In 1911, Dr Shipley was appointed Chairman of Surgery at the University of Maryland in Baltimore. He was a wartime surgeon and published 80 diverse articles ranging from femoral fractures to dehisced abdominal incisions. He was well known by his contemporaries as a clinician with compulsive attention to detail and in-depth knowledge of the medical and surgical literature. Dr Shipley was elected to membership in the SSA in 1927 and in 1943 served as vice president of the American Surgical Association. He remained at the University of Maryland School of Medicine and the University Hospital until his retirement in 1948. Background Dr Shipley was a fifth generation member of the Shipley family and was born in Maryland in 1878 to Roderick O and Wilhelmina Clark Shipley. As a student at the University of Maryland School of Medicine, Dr Shipley maintained a brilliant scholastic record and was recognized as a man of great potential. He graduated in 1902 after serving important administrative hospital duties,
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such as senior resident and superintendent in the university hospital. In providing this service, he demonstrated marked abilities and became recognized as a young man of great promise. In 1911, at the early age of 33 years, he became Professor of Surgery and Chief of the Surgical Service at the University of Maryland (1911). This position provided opportunity for the exercise and development of his gifts as a teacher and organizer. He was widely recognized as one of the outstanding teachers of clinical surgery in the United States, with a broad base of knowledge, expert organization, and a forceful and stimulating method of presentation. During the First World War (1917 1919), Dr Shipley was Chief of Surgical Services at the eighth American Evacuation Hospital in Juilly, France. This position afforded him the opportunity to see many soldiers with infected and nonhealing wounds. In this regard, he wrote, “These wounds were all heavily infected. The streptococci exist in various strains, some are more vicious than others and have an uncanny ability to break down the local defenses of the body. The time (for aggressive early treatment) factor was most important.”1,2 In addition, his administrative abilities found application in the organization of his own service and played a part in modernizing the medical school. In association with Dr Thomas R Boggs, he performed a similarly valuable and successful service at the Charity Hospital of the City of Baltimore, formerly known as Bayview Hospital. The surgical residency at this institution is a living memorial to Dr Shipley. Clinical activity Dr Shipley developed a large surgical practice, not only in Baltimore, but to a remarkable degree throughout the State of Maryland. He traveled frequently to the smallest cities and towns for consultations and operations. He was well known to many practicing physicians both locally and nationally. Endocrine surgery Dr Charles Mayo is credited with resecting the first pheochromocytoma in the United States. This resection was performed in 1926 on the now-famous patient, Sister Joachim. That it was a pheochromocytoma was, however, determined only by the final postoperative pathology of the specimen.3 The case was read before the section on obstetrics, gynecology, and abdominal surgery at the 78th Annual Session of the American Medical Association in Washington, DC on May 20, 1927. In 1928, Dr Shipley was called in to consult on a patient by Dr Maurice C Pincoffs, Chairman of Medicine in Baltimore. The patient was a 26-year-old woman with worsening “attacks
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Table 1.
Perrier et al
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Dr Shipley: Who Was the Man?
List of Shipley Award Winners
Table 1. Continued
Year
Winners
Year
Winners
1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Felda Hightower Curtis P Artz William W Shingleton Watts R Webb Osler A Abbott Edward T Krementz Ben Eiseman Frank C Spencer G Rainey Williams Lloyd M Nyhus Carl W Hughes John W Kirklin Norman C Nelson Edward R Woodward John C McDonald K Alvin Merendino George A Hallenbeck George A Higgins Jr James C Thompson M J Jurkiewicz Jon van Heerden Wallace P Ritchie Robert K Brawley Richard E Clark J David Richardson Robert H Jones Walter G Wolfe Robert C Batson Robert E Condon Gregory B Bulkey David V Feliciano Henry A Pitt Irving L Kron Larry H Hollier John B Banks Acjoes Demetriou Bruce G Wolff Jeffrey A Norton B Mark Evers William G Cheadle John H Pemberton Keith E Georgeson Douglas S Reintgen F Charles Brunicardi Benjamin D L Li Yuman Fong Charles D Fraser Jr Dai H Chung (Continued)
2005 2006 2007 2008 2009 2010 2011 2012 2013
Tien C Ko Devin E Eckhoff Steve Eubanks Ronald H Clements Taylor S Riall Nancy D Perrier William B Inabnet III John Christein Keith Delman
with palpitation of the heart” during a 10-year period. In addition to what would now be considered classical, paroxysmal hypertensive attacks, the patient had a positive family history of classical palpitations. Interestingly, her sister had a superior mediastinal mass “which interfered with breathing and caused distention of the neck vessels.” Physical examination of the patient revealed nothing remarkable at rest, however, during the attacks, her blood pressure rose from 120/90 mmHg to 219/110 mmHg and she was observed to have facial flushing, tremulous hands, tachycardia, and hyperpnea. A preoperative diagnosis of a medullary tumor of the adrenal gland was made by Dr Pincoffs. Because imaging and biochemical profiles were not available until the next decade, Dr Shipley had no information about the characteristics of the suspected mass, or of its laterality. Dr Shipley pondered: “The thing that immediately concerned us was to determine which gland was involved.” Undaunted, Dr Shipley planned an elective exploratory operation on June 14, 1928. The peritoneal cavity was entered via a high left rectus incision and the retroperitoneum and perirenal area were carefully explored, and it was determined that no tumor was present on the left side. The right side of the abdomen was then palpated and a large mass was felt above the kidney. “It could not be reached through the left rectus incision and so it was decided to close the abdomen and wait until healing had taken place and then to approach the tumor through a different incision.” Thirteen days later, the patient underwent the planned reoperation. After mobilizing the right colon, the tumor was visualized. “It was smooth, almost as large as the patient’s kidney and lay immediately above and in contact with the kidney and was tucked up close to the undersurface of the liver; laterally it lay against the posterior abdominal wall and medially it was abutting the inferior vena cava for several inches.” Shipley described the tumor as being firm, smooth, and surrounded by areolar tissue containing
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Figure 2. Shipley Award Winners Jon van Heerden (1977) and Nancy D Perrier (2010). A mentor and mentee pair of endocrine surgeons.
numerous vessels (Fig. 4). Multiple clamps were “applied wherever veins were visible” and hemorrhage was noted below the tumor and between the tumor and kidney. Shipley noted the direct return of venous blood to the inferior vena cava, and that “considerable difficulty was encountered in finding room enough between the tumor and the vena cava to apply clamps.” Once removed “some bleeding in this area and a good deal of anxiety was felt in controlling it, as it was feared that the vena cava would be torn.” Altogether, the patient lost about 8 ounces of blood. The honor of resecting the first preoperatively diagnosed pheochromocytoma belongs clearly to Dr Shipley on that 27th day of June 1928. During the operation, Dr Pincoffs maintained a careful record of the patient’s blood pressure. Shipley wrote, “The patient’s blood pressure varied sharply during the operation and she was infused on the table with normal salt solution.” “The patient left the table badly shocked and her blood pressure remained very low for hours after the operation. Her condition during this time was critical,” he writes.1 By the first postoperative day, the patient’s condition markedly improved and she was reported to be free from attacks at 10 months after the operation. Her only complication was a thrombophlebitis of a leg that responded to treatment within a few
Figure 3. Dr Arthur M Shipley. Reproduction by Mark Teske, professional photographer at the University of Maryland School of Medicine. (Reprinted with permission from the University of Maryland.)
days. Pathology found an encapsulated tumor of the adrenal medulla weighing 115 g and measuring 9 7 3.5 cm. Gross examination revealed hemorrhage. On microscopic evaluation, the tumor tissue was positive
Figure 4. Illustration of the operative field (from Dr Shipley’s 1929 manuscript.4) (Reprinted with permission from UAB Archives, University of Alabama at Birmingham.)
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Figure 5. Dr Shipley relaxing while doing his favorite hobbies: (A) with a book in his library reading and (B) in his garden. (Reprinted with permission from the University of Maryland.)
on chromaffin staining and was diagnosed as a paraganglioma. This event generated a publication in the Annals of Surgery in November 1929 entitled, “Paroxysmal Hypertension Associated with Tumor of the Suprarenal.”4 Only 30 cases of medullary tumors had been reported in the literature at that time. Dr Shipley noted “No one has proven, up to the present, that an increase of epinephrine is found in the blood of patients with hypertension.” “The clinical aspects of the patient’s case were described as those not resembling any type of paroxysmal hypertension previously seen.” It is noteworthy that Dr George Crile, of Cleveland, OH, was in the audience and urged caution in proclaiming an effect of the tumor on the patient’s blood pressure. Describing his own experience of 12 cases, Crile was noted to be “unconvinced that he produced any results” after patients’ blood pressure would run an irregular course postoperatively after resection. Dr Shipley and the Southern Surgical Association Dr Shipley belonged to practically all of the medical and surgical societies to which he might be eligible, but he most highly valued his membership in the SSA. He was elected to membership in the SSA in 1927 and remained active in the Association throughout his professional
career. He always enjoyed the meetings and his contributions to the program were soundly based on his ample personal experience and good judgment. He was most desirous that his younger friends and associates should qualify for membership and be accepted to it. Personal interests Much could be said of Dr Shipley’s nonprofessional interests. He was a great reader, especially of history, with particular concentration on the Revolutionary Civil War periods (Fig. 5). He had a marked fondness of poetry and just a few days before his death cited word for word, and with much expression, numerous of his favorites from the Victorian and Edwardian eras of English and American verse. He liked to travel, fish, and to foregather with congenial spirits. A true and rare insight into who Dr Shipley really was is provided to us in a touching obituary written by Dr C Reid Edwards in the Bulletin of the School of Medicine of the University of Maryland. In his tribute, Dr Edwards comments on Dr Shipley’s attitudes to the following: Teaching: He was a constant exponent of the Socratic method of teaching and was always at his best when conducting a clinic where students and visitors would be afforded the opportunity to ask questions, and then he would be able to so properly classify and state signs and symptoms that they would never forget them.
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Figure 6. Shipley’s retirement dinner June 19, 1947. (A) Table seating list. (B) Head table with guests seated. (Reprinted with permission from the University of Maryland.)
He regarded written examinations in surgery useless and although no teacher could have been busier, he always made time to orally examine each of the more than 5,000 students whom he taught in his professional career. Hobbies: He was a prodigious reader, being very familiar with history. Probably no civilian was more, or better acquainted with military history than was he. He was also fond of flowers and had one of the most beautiful gardens in suburban Baltimore. His familiarity with flowers constantly amazed his many friends, who frequently visited him in the garden (Fig. 5) Mental discipline: He realized that if he were to be a good teacher, he must be constant and consistent, that he must never miss classes, and in all of his teaching career, he never permitted a class
to be without a teacher. He instilled this attitude in the minds of the men who were associated with him in teaching, so that the Surgical Department, under his direction, had a record of never permitting a class to be unattended. His devotion to his duties and during his long tenure of office stand out as an unimpeachable record. These were unique characteristics that all surgeons can strive to emulate. Dr Shipley lived by them. Legacy The inaugural publication of Reflexions by the senior class of the school of medicine and nursing at the University of Maryland was dedicated to Dr Shipley in 1946. The dedication text reads: “To Arthur M. Shipley, surgeon,
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student, teacher and gentleman this first edition of Reflexions is dedicated as an expression of the admiration and esteem held for him by those of us who have come under his influence. May we in the days ahead pause to remember the sincerity of the efforts and wisdom of the teachings of the man known affectionately as ‘King Arthur.’” Later, in June 1947, a named dinner in his honor was organized and attendees included friends such as Alfred Blalock and Maurice Pincoffs (Figs. 6A and B). Dr Arthur M Shipley retired from the University of Maryland in 1948 and died 7 years later in 1955 at the age of 77 years. In paying tribute, Dr Stone wrote, “To the medical world and to younger men in the profession, his death meant the passing of a prominent figure. To those close to him, it meant the loss of a desired example and of a beloved friend.”5,6 A survivor of that era, and living legend, Dr Denton Cooley, aged 94 years, remembers his first introduction to Dr Shipley was not in Baltimore, but at the SSA by his own mentor, Dr Alfred Blalock. He recalls Dr Shipley was then and always favorably regarded as a true gentleman. In fact, Dr Cooley cites that his own father-in law and brother-in-law were surgeons trained by Dr Shipley. “He was known to treat his subordinates with dignity and to lead by inspiring example.” Dr Shipley was admired by his trainees and respected by his peers and, indeed, his legacy lives on. To the current surgeon, his death meant the passing of a giant who epitomized the most sound of clinical and surgical judgment. Today, an accurate preoperative endocrine diagnosis and tumor localization is a daily given. The courage and surgical fortitude to blindly explore a patient with a pheochromocytoma is worthy of wondrous contemplation and admiration. This was incidentally in 1928, the year after his admission into the SSA. Dr Shipley’s legacy and interest in adrenal medullary tumors continue to this day in the careers of multiple subsequent Shipley awardee, including the coauthors of this article.
Dr Shipley did indeed “pay it forward” and that is the way it should be. In closing, we wish to thank the society for the privilege of this award and offer a quote from Winston Churchill, “the further back you look the more forward you can see.” Acknowledgment: Much information and many quotes were obtained from the Memorial to Dr Shipley, written by Dr Harvey V Stone and archived in the collection of the SSA. The authors are indebted to the research assistance of Dr Milford Foxwell, Associate Dean for Admissions, University of Maryland School of Medicine. Drs Thomas Magnuson and Richard Bennett and Mr Richard Behles provided insight. The work of Dr Robert Sparkman is much appreciated and Dr Gilbert Diethelm, Dr Denton Cooley, and Dr Martin Dalton are to be thanked for providing us with information and insight for this project. The touching obituary written by Dr C Reid Edwards provided much insight to the soul of this man. Support for this work is from the Joseph M Donald Archival Collection and Endowment Fund of the SSA.
REFERENCES 1. E Roderick and Arthur Shipley papers, Special Collections, University of Maryland Libraries, Baltimore, MD. 2. Shipley AM, Considine AT. The Officers and Nurses of Evacuation Eight, with a Complete Roster of All Those Who Served with the Unit. New Haven: Yale University Press; 1929. 3. Mayo CH. Paroxysmal hypertension with tumor of the retroperitoneal nerve. Report of a Case, Vol xix. Collected Papers of the Mayo Clinic and the Mayo Foundation; 1927:732. 4. Shipley AM. Paroxysmal hypertension associated with tumor of the suprarenal gland. Ann Surg 1929;90:742e749. 5. Stone Harvey B. Obituary of Arthur M, Vol LXVII. Shipley. Transactions of the Southern Surgical Association; 1955. 6. Reid EC. Obituary of Arthur M. Shipley. Bull Sch Med Univ Md; 1955.
You Have Heard of the Award, But What Do You Know About Arthur M Shipley? Nancy D Perrier,
MD, FACS,
Minera A Romero,
MD,
MD, FACS
in his father’s name. At the direction of the then, Department Chair, Dr Gil Deithelm, the annual interest would fund an award that would give his father, Joseph, much deserved, everlasting recognition. Joseph practiced in Wilcox County, south of Birmingham. His father and grandfather were physicians and he was well known socially and medically. He attended the University of Alabama and received a Bachelor of Science degree (1921e1923), then Tulane Medical School (1923 1925), and then he completed an internship at Charity Hospital (1925 1926). He completed a surgical residency at the Mayo Clinic in Rochester, MN in 1932 (Fig. 1). He was a professor of clinical surgery in the Medical College of Alabama at Birmingham, and was active in the affairs of the American Cancer Society, for which he served as Director. He was also a member of the Medical Reserve Corps in the US Army and was a regent of the American College of Surgeons from 1958 until his untimely death. Both his father and grandfather and both of his sons were surgeons. In 1960, Dr Donald was elected as President of the Southern Surgical. He died unexpectedly of a myocardial infarction 3 months later and, sadly, could not enjoy his full year as president of the SSA.
One of the highlights at the annual meeting of the Southern Surgical Association (SSA) is the presentation of the Shipley Award. This tradition is of historical significance, as it has been an integral part of the annual meeting for 55 years. Dr Shipley died in 1956, and there are few contemporary members of the SSA who know of the qualities or reasons for recognition of this unique surgeon. We think this is of interest to SSA members. Dr Arthur M Shipley was recognized as one of the outstanding teachers of clinical surgery of his time. He served as Chairman of Surgery at the University of Maryland School of Medicine in Baltimore. He was a clinician with a compulsive attention to detail and development of an in-depth knowledge of the medical and surgical literature. His commitment to service was fulfilled during his long and successful life.
HISTORY OF MEDICINE LECTURE The first SSA meeting took place in 1887. One century later, in 1987, Robert (Bob) Sparkman, the SSA historian from Dallas, TX, proposed to the Society’s council the concept that there would be an annual award given to an individual to present a lecture on a historical figure contributing to Southern Surgery at the annual meeting of the association. The council confirmed and approved the suggestion. As the SSA’s historian, Bob was in search of a home to congregate memorabilia and archival material of the association. After multiple propositions were considered, the University of Alabama’s Lister Hill Library was chosen to house the Southern Surgical archives. In 2002, Joseph M Donald Jr (a member of the SSA) requested a tribute be made in honor of his father Joseph Marion Donald, the well-respected and prominent Alabama surgeon. To accomplish this, he contributed $80,000 to the University of Alabama as an endowment
SHIPLEY AWARD In 1956, the year after Dr Shipley’s death, one of his residents, Dr Hugh Alvin Bailey (1900 1958), Chief of Staff and General Surgery at Charleston General Hospital in West Virginia, made a gift of $1,300 to the SSA to provide a permanent memorial in the name of Dr Shipley. The council authorized and established the Arthur M Shipley Award, to consist of a gold medal to be given annually to the new member judged to have presented the best paper during either the first or second year of his/her membership. In 1957, Dr Felda Hightower was given the award for the first time to establish the additional study and practice of surgery. Since then, 57 subsequent Shipley Award winners have been named and the award has become an integral part of the heritage of the Southern Surgical (Table 1). In fact, 5 of the 57 Shipley award winners have become presidents of our association. The coauthors of this study are personally gratified that they have both been recipients of the Shipley Award, separated by a timespan of only 33 years (Fig. 2).
Disclosure Information: Nothing to disclose. Received December 8, 2014; Accepted December 9, 2014. From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Perrier), St Joseph Hospital, Baltimore, MD (Romero), and Medical University of South Carolina, Charleston, SC (van Heerden). Correspondence address: Nancy D Perrier, MD, FACS, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Dr, Unit 1484, Houston, TX 77030. email: NPerrier@ mdanderson.org
ª 2015 by the American College of Surgeons Published by Elsevier Inc.
Jon A van Heerden,
772
http://dx.doi.org/10.1016/j.jamcollsurg.2014.12.058 ISSN 1072-7515/15
Vol. 220, No. 4, April 2015
Figure 1. Joseph M Donald, MD, Mayo Clinic Surgery Fellow, 1932. (Reprinted with permission from the Mayo Clinic.)
A piece of marble slab from Dr Shipley’s historic operating room is on display as part of the SSA’s historical Reynold’s Archived Collection in the Lister Hill Library at the University of Alabama in Birmingham. The piece of foundation is indeed from the very room in which Dr Shipley resected the first preoperatively determined pheochromocytoma.
DR ARTHUR M SHIPLEY Dr Arthur M Shipley (1878 1955) was a renowned American surgeon and native Marylander (Fig. 3). In 1911, Dr Shipley was appointed Chairman of Surgery at the University of Maryland in Baltimore. He was a wartime surgeon and published 80 diverse articles ranging from femoral fractures to dehisced abdominal incisions. He was well known by his contemporaries as a clinician with compulsive attention to detail and in-depth knowledge of the medical and surgical literature. Dr Shipley was elected to membership in the SSA in 1927 and in 1943 served as vice president of the American Surgical Association. He remained at the University of Maryland School of Medicine and the University Hospital until his retirement in 1948. Background Dr Shipley was a fifth generation member of the Shipley family and was born in Maryland in 1878 to Roderick O and Wilhelmina Clark Shipley. As a student at the University of Maryland School of Medicine, Dr Shipley maintained a brilliant scholastic record and was recognized as a man of great potential. He graduated in 1902 after serving important administrative hospital duties,
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such as senior resident and superintendent in the university hospital. In providing this service, he demonstrated marked abilities and became recognized as a young man of great promise. In 1911, at the early age of 33 years, he became Professor of Surgery and Chief of the Surgical Service at the University of Maryland (1911). This position provided opportunity for the exercise and development of his gifts as a teacher and organizer. He was widely recognized as one of the outstanding teachers of clinical surgery in the United States, with a broad base of knowledge, expert organization, and a forceful and stimulating method of presentation. During the First World War (1917 1919), Dr Shipley was Chief of Surgical Services at the eighth American Evacuation Hospital in Juilly, France. This position afforded him the opportunity to see many soldiers with infected and nonhealing wounds. In this regard, he wrote, “These wounds were all heavily infected. The streptococci exist in various strains, some are more vicious than others and have an uncanny ability to break down the local defenses of the body. The time (for aggressive early treatment) factor was most important.”1,2 In addition, his administrative abilities found application in the organization of his own service and played a part in modernizing the medical school. In association with Dr Thomas R Boggs, he performed a similarly valuable and successful service at the Charity Hospital of the City of Baltimore, formerly known as Bayview Hospital. The surgical residency at this institution is a living memorial to Dr Shipley. Clinical activity Dr Shipley developed a large surgical practice, not only in Baltimore, but to a remarkable degree throughout the State of Maryland. He traveled frequently to the smallest cities and towns for consultations and operations. He was well known to many practicing physicians both locally and nationally. Endocrine surgery Dr Charles Mayo is credited with resecting the first pheochromocytoma in the United States. This resection was performed in 1926 on the now-famous patient, Sister Joachim. That it was a pheochromocytoma was, however, determined only by the final postoperative pathology of the specimen.3 The case was read before the section on obstetrics, gynecology, and abdominal surgery at the 78th Annual Session of the American Medical Association in Washington, DC on May 20, 1927. In 1928, Dr Shipley was called in to consult on a patient by Dr Maurice C Pincoffs, Chairman of Medicine in Baltimore. The patient was a 26-year-old woman with worsening “attacks
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Table 1.
Perrier et al
J Am Coll Surg
Dr Shipley: Who Was the Man?
List of Shipley Award Winners
Table 1. Continued
Year
Winners
Year
Winners
1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Felda Hightower Curtis P Artz William W Shingleton Watts R Webb Osler A Abbott Edward T Krementz Ben Eiseman Frank C Spencer G Rainey Williams Lloyd M Nyhus Carl W Hughes John W Kirklin Norman C Nelson Edward R Woodward John C McDonald K Alvin Merendino George A Hallenbeck George A Higgins Jr James C Thompson M J Jurkiewicz Jon van Heerden Wallace P Ritchie Robert K Brawley Richard E Clark J David Richardson Robert H Jones Walter G Wolfe Robert C Batson Robert E Condon Gregory B Bulkey David V Feliciano Henry A Pitt Irving L Kron Larry H Hollier John B Banks Acjoes Demetriou Bruce G Wolff Jeffrey A Norton B Mark Evers William G Cheadle John H Pemberton Keith E Georgeson Douglas S Reintgen F Charles Brunicardi Benjamin D L Li Yuman Fong Charles D Fraser Jr Dai H Chung (Continued)
2005 2006 2007 2008 2009 2010 2011 2012 2013
Tien C Ko Devin E Eckhoff Steve Eubanks Ronald H Clements Taylor S Riall Nancy D Perrier William B Inabnet III John Christein Keith Delman
with palpitation of the heart” during a 10-year period. In addition to what would now be considered classical, paroxysmal hypertensive attacks, the patient had a positive family history of classical palpitations. Interestingly, her sister had a superior mediastinal mass “which interfered with breathing and caused distention of the neck vessels.” Physical examination of the patient revealed nothing remarkable at rest, however, during the attacks, her blood pressure rose from 120/90 mmHg to 219/110 mmHg and she was observed to have facial flushing, tremulous hands, tachycardia, and hyperpnea. A preoperative diagnosis of a medullary tumor of the adrenal gland was made by Dr Pincoffs. Because imaging and biochemical profiles were not available until the next decade, Dr Shipley had no information about the characteristics of the suspected mass, or of its laterality. Dr Shipley pondered: “The thing that immediately concerned us was to determine which gland was involved.” Undaunted, Dr Shipley planned an elective exploratory operation on June 14, 1928. The peritoneal cavity was entered via a high left rectus incision and the retroperitoneum and perirenal area were carefully explored, and it was determined that no tumor was present on the left side. The right side of the abdomen was then palpated and a large mass was felt above the kidney. “It could not be reached through the left rectus incision and so it was decided to close the abdomen and wait until healing had taken place and then to approach the tumor through a different incision.” Thirteen days later, the patient underwent the planned reoperation. After mobilizing the right colon, the tumor was visualized. “It was smooth, almost as large as the patient’s kidney and lay immediately above and in contact with the kidney and was tucked up close to the undersurface of the liver; laterally it lay against the posterior abdominal wall and medially it was abutting the inferior vena cava for several inches.” Shipley described the tumor as being firm, smooth, and surrounded by areolar tissue containing
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Figure 2. Shipley Award Winners Jon van Heerden (1977) and Nancy D Perrier (2010). A mentor and mentee pair of endocrine surgeons.
numerous vessels (Fig. 4). Multiple clamps were “applied wherever veins were visible” and hemorrhage was noted below the tumor and between the tumor and kidney. Shipley noted the direct return of venous blood to the inferior vena cava, and that “considerable difficulty was encountered in finding room enough between the tumor and the vena cava to apply clamps.” Once removed “some bleeding in this area and a good deal of anxiety was felt in controlling it, as it was feared that the vena cava would be torn.” Altogether, the patient lost about 8 ounces of blood. The honor of resecting the first preoperatively diagnosed pheochromocytoma belongs clearly to Dr Shipley on that 27th day of June 1928. During the operation, Dr Pincoffs maintained a careful record of the patient’s blood pressure. Shipley wrote, “The patient’s blood pressure varied sharply during the operation and she was infused on the table with normal salt solution.” “The patient left the table badly shocked and her blood pressure remained very low for hours after the operation. Her condition during this time was critical,” he writes.1 By the first postoperative day, the patient’s condition markedly improved and she was reported to be free from attacks at 10 months after the operation. Her only complication was a thrombophlebitis of a leg that responded to treatment within a few
Figure 3. Dr Arthur M Shipley. Reproduction by Mark Teske, professional photographer at the University of Maryland School of Medicine. (Reprinted with permission from the University of Maryland.)
days. Pathology found an encapsulated tumor of the adrenal medulla weighing 115 g and measuring 9 7 3.5 cm. Gross examination revealed hemorrhage. On microscopic evaluation, the tumor tissue was positive
Figure 4. Illustration of the operative field (from Dr Shipley’s 1929 manuscript.4) (Reprinted with permission from UAB Archives, University of Alabama at Birmingham.)
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Figure 5. Dr Shipley relaxing while doing his favorite hobbies: (A) with a book in his library reading and (B) in his garden. (Reprinted with permission from the University of Maryland.)
on chromaffin staining and was diagnosed as a paraganglioma. This event generated a publication in the Annals of Surgery in November 1929 entitled, “Paroxysmal Hypertension Associated with Tumor of the Suprarenal.”4 Only 30 cases of medullary tumors had been reported in the literature at that time. Dr Shipley noted “No one has proven, up to the present, that an increase of epinephrine is found in the blood of patients with hypertension.” “The clinical aspects of the patient’s case were described as those not resembling any type of paroxysmal hypertension previously seen.” It is noteworthy that Dr George Crile, of Cleveland, OH, was in the audience and urged caution in proclaiming an effect of the tumor on the patient’s blood pressure. Describing his own experience of 12 cases, Crile was noted to be “unconvinced that he produced any results” after patients’ blood pressure would run an irregular course postoperatively after resection. Dr Shipley and the Southern Surgical Association Dr Shipley belonged to practically all of the medical and surgical societies to which he might be eligible, but he most highly valued his membership in the SSA. He was elected to membership in the SSA in 1927 and remained active in the Association throughout his professional
career. He always enjoyed the meetings and his contributions to the program were soundly based on his ample personal experience and good judgment. He was most desirous that his younger friends and associates should qualify for membership and be accepted to it. Personal interests Much could be said of Dr Shipley’s nonprofessional interests. He was a great reader, especially of history, with particular concentration on the Revolutionary Civil War periods (Fig. 5). He had a marked fondness of poetry and just a few days before his death cited word for word, and with much expression, numerous of his favorites from the Victorian and Edwardian eras of English and American verse. He liked to travel, fish, and to foregather with congenial spirits. A true and rare insight into who Dr Shipley really was is provided to us in a touching obituary written by Dr C Reid Edwards in the Bulletin of the School of Medicine of the University of Maryland. In his tribute, Dr Edwards comments on Dr Shipley’s attitudes to the following: Teaching: He was a constant exponent of the Socratic method of teaching and was always at his best when conducting a clinic where students and visitors would be afforded the opportunity to ask questions, and then he would be able to so properly classify and state signs and symptoms that they would never forget them.
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Figure 6. Shipley’s retirement dinner June 19, 1947. (A) Table seating list. (B) Head table with guests seated. (Reprinted with permission from the University of Maryland.)
He regarded written examinations in surgery useless and although no teacher could have been busier, he always made time to orally examine each of the more than 5,000 students whom he taught in his professional career. Hobbies: He was a prodigious reader, being very familiar with history. Probably no civilian was more, or better acquainted with military history than was he. He was also fond of flowers and had one of the most beautiful gardens in suburban Baltimore. His familiarity with flowers constantly amazed his many friends, who frequently visited him in the garden (Fig. 5) Mental discipline: He realized that if he were to be a good teacher, he must be constant and consistent, that he must never miss classes, and in all of his teaching career, he never permitted a class
to be without a teacher. He instilled this attitude in the minds of the men who were associated with him in teaching, so that the Surgical Department, under his direction, had a record of never permitting a class to be unattended. His devotion to his duties and during his long tenure of office stand out as an unimpeachable record. These were unique characteristics that all surgeons can strive to emulate. Dr Shipley lived by them. Legacy The inaugural publication of Reflexions by the senior class of the school of medicine and nursing at the University of Maryland was dedicated to Dr Shipley in 1946. The dedication text reads: “To Arthur M. Shipley, surgeon,
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student, teacher and gentleman this first edition of Reflexions is dedicated as an expression of the admiration and esteem held for him by those of us who have come under his influence. May we in the days ahead pause to remember the sincerity of the efforts and wisdom of the teachings of the man known affectionately as ‘King Arthur.’” Later, in June 1947, a named dinner in his honor was organized and attendees included friends such as Alfred Blalock and Maurice Pincoffs (Figs. 6A and B). Dr Arthur M Shipley retired from the University of Maryland in 1948 and died 7 years later in 1955 at the age of 77 years. In paying tribute, Dr Stone wrote, “To the medical world and to younger men in the profession, his death meant the passing of a prominent figure. To those close to him, it meant the loss of a desired example and of a beloved friend.”5,6 A survivor of that era, and living legend, Dr Denton Cooley, aged 94 years, remembers his first introduction to Dr Shipley was not in Baltimore, but at the SSA by his own mentor, Dr Alfred Blalock. He recalls Dr Shipley was then and always favorably regarded as a true gentleman. In fact, Dr Cooley cites that his own father-in law and brother-in-law were surgeons trained by Dr Shipley. “He was known to treat his subordinates with dignity and to lead by inspiring example.” Dr Shipley was admired by his trainees and respected by his peers and, indeed, his legacy lives on. To the current surgeon, his death meant the passing of a giant who epitomized the most sound of clinical and surgical judgment. Today, an accurate preoperative endocrine diagnosis and tumor localization is a daily given. The courage and surgical fortitude to blindly explore a patient with a pheochromocytoma is worthy of wondrous contemplation and admiration. This was incidentally in 1928, the year after his admission into the SSA. Dr Shipley’s legacy and interest in adrenal medullary tumors continue to this day in the careers of multiple subsequent Shipley awardee, including the coauthors of this article.
Dr Shipley did indeed “pay it forward” and that is the way it should be. In closing, we wish to thank the society for the privilege of this award and offer a quote from Winston Churchill, “the further back you look the more forward you can see.” Acknowledgment: Much information and many quotes were obtained from the Memorial to Dr Shipley, written by Dr Harvey V Stone and archived in the collection of the SSA. The authors are indebted to the research assistance of Dr Milford Foxwell, Associate Dean for Admissions, University of Maryland School of Medicine. Drs Thomas Magnuson and Richard Bennett and Mr Richard Behles provided insight. The work of Dr Robert Sparkman is much appreciated and Dr Gilbert Diethelm, Dr Denton Cooley, and Dr Martin Dalton are to be thanked for providing us with information and insight for this project. The touching obituary written by Dr C Reid Edwards provided much insight to the soul of this man. Support for this work is from the Joseph M Donald Archival Collection and Endowment Fund of the SSA.
REFERENCES 1. E Roderick and Arthur Shipley papers, Special Collections, University of Maryland Libraries, Baltimore, MD. 2. Shipley AM, Considine AT. The Officers and Nurses of Evacuation Eight, with a Complete Roster of All Those Who Served with the Unit. New Haven: Yale University Press; 1929. 3. Mayo CH. Paroxysmal hypertension with tumor of the retroperitoneal nerve. Report of a Case, Vol xix. Collected Papers of the Mayo Clinic and the Mayo Foundation; 1927:732. 4. Shipley AM. Paroxysmal hypertension associated with tumor of the suprarenal gland. Ann Surg 1929;90:742e749. 5. Stone Harvey B. Obituary of Arthur M, Vol LXVII. Shipley. Transactions of the Southern Surgical Association; 1955. 6. Reid EC. Obituary of Arthur M. Shipley. Bull Sch Med Univ Md; 1955.