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LESTER REYNOLD DRAGSTEDT October 2, 1893-July 1 6, 1 975 BY OWEN H. WANGENSTEEN AND SARAH D. WANGENSTEEN LESTER REYNOLD DRAGSTEDT, one of America s great sur- gical scientists, approaching his eighty-seconc! birthday, cried suddenly of an unexpected heart attack on July ~ 6, ~ 975 at his summer home at Wabigama, a colony he and other University of Chicago scientists had founded on Elk Lake, Michigan, in ~ 95 ~ . Dragste~lt had been active and apparently well up until the very encI. Dragstedt was born in Anaconda, Montana, on October 2, 1893, of Swedish immigrant parents. In his early life, Lester was encouraged by his father to memorize poetry with a special appeal to him, as well as Biblical passages and frag- ments of famous speeches. These he frequently reciter! from memory at various gatherings in Anaconda, a talent which founct ready favor with many audiences and served him well in informal presentations throughout his professional life. Young Dragstedt graduated valedictorian of his high school class and was offered scholarships at the University of Chi- cago and other institutions. At this juncture, A. I. CarIson, a long-time friend of the Dragstedts who had defected from the ministry to become an internationally renowned profes- sor of physiology at the University of Chicago, intervened and wisely advised the senior Dragstedt, "Senct the boy to Chicago. They will find out in three months if he has any 63
64 BIOGRAPHICAL MEMOIRS brains and, if he does not, you can bring him back to Ana- conda and put him to work in the copper smelter."* In the beginning, Dragstedt entertained the idea of becoming a physicist, having enjoyed the privilege of hearing lectures by Professor Robert Millikan. He was greatly in- fluenced, however, by the inquiring and critical mind of A. I. CarIson, and upon graduation with a Bachelor of Science degree in 1915, enrolled in the graduate program at the University of Chicago as a student in ohYsiolo - . Lester ac- · , _ . ~ , O' qu~rec~ a plaster ot Science degree in 1916 and a Doctor of Philosophy degree in physiology in 1920. An M.D. degree from Rush Medical College followed in 1921. During his graduate studies, Dragstedt became a talented operating surgeon, having acquired skills operating upon animals in pursuit of physiological experiments. Though attracted to surgery, he was convinced that a career in phys- iology held out greater promise for innovative accomplish- ments. Lester's first academic appointment was instructor of pharmacology at the State University of Iowa in 1916; the following year he became assistant professor of physiology of_ ~ ~ ~ ~ ~ ~ . . . . . . . . . there, a position to which he returned In 1919 alter military service in World War I. It was at Iowa that Lester met Gladys Shoesmith, then a student at the University. Four years later, in ~ 922, they were married, by which time this talented young lady was not only a teacher of English, but principal of a school. She gave up her own career for another for which she was eminently suited becoming Lester's constant com- panion and devoted supporter, in fair and stormy weather, throughout his illustrious life. Dragstedt returned to the University of Chicago in 1920 as assistant professor of physiology and in ~ 923 became pro- * John H. Landor, "~.R.D. Recollections and Reminiscences," Surgery, ~ (1977): 443.
LES rER REYNOLD DRAGS rED r 65 fessor and chairman of the Department of Pharmacology and Physiology at Northwestern University. He maintained throughout his career a very close association with CarIson, his loyal mentor and advisor. Dragstecit's second career began in 1925 when Dallas Phemister was appointed the first full-time professor and chairman of the new Department of Surgery at the Univer- sity of Chicago. Prior thereto, Phemister had been in active surgical practice but had exhibited strong academic leanings. Before taking up his new duties, Phemister went to London and Europe to work and observe in preclinical science departments and to ready himself for the new opportunities and responsibilities at the University. Phemister appointed Dragstecit consultant to the architect to design suitable re- search facilities for members of the Department of Surgery. At the conclusion of this service, Phemister remarked to Dragstecit, "I am interested in teaching physiology to sur- geons."* Phemister was convinced that Dragstedt, with his strong background} in physiology and pharmacology, could make an important contribution to the new Department of Surgery, and he persuacled Lester in 1925 to abandon a promising career in physiology to become a physiologist- surgeon. Already skilled in the performance of technically difficult operations upon clogs, Dragstedt emerged as one of the great surgeons of the alimentary tract of his generation. As a Rockefeller Fellow, Dragstedt went abroad! in ~ 925 to gain experience in surgical pathology and clinical surgery. This was a clozen years before the development of the Amer- ican Board of Surgery, which uncloubtecIly wouIc! not have lent its seal of approval to Dragstedt's unorthodox scheme of acquiring training in clinical surgery for the academic arena. Lester was accompanies} by his mother; his wife, Gladys; and (1976): 3. *E. R. Woodward, "Lester R. Dragstedt, M.D., Ph.D.," Gastroenterology, 70
66 BIOGRAPHICAL MEMOIRS their daughter, Charlotte. Carol was born during the two- year stay in Europe. Following temporary stops in Paris, at de Quervain's sur- gical clinic in Bern, Switzerland, and in Vienna with Eisels- berg, Dragstecit spent several months performing post- mortem examinations at the AlIgemeines Krankenhaus under the tutelage of Jakob Erc~heim, whom Dragstedt came to admire greatly. He then proceeded to Budapest and worked under the direction of the famed gastric surgeon, Eugen Polya, and later with Professor Humer HultI at St. Rochus Hospital. Lester fell heir to a rich experience in oper- ative surgery uncler these teachers for a fee of $150 a month. When Dragstedt returned, Phemister gave him an appoint- ment as associate professor of surgery at the University of Chicago. Phemister was unquestionably correct in his belief that Dragstedt could be persuacled to become a clinician. In fact, the titles of Dragstecit's papers- from his first publication in 1916 up to the time he accepted Phemister's proposal in 192~suggest that here was a clinician in spirit, employing physiologic approaches in the resolution of clinical problems, a practice that Dragstedt continued throughout his great career. Concerning Dragstedt's unusual training for clinical sur- gery, it may be recalled that Harvey Cushing remarked, con- cerning his own years in the laboratory with Hugo Kronecker in Bern and with Charles Sherrington at Liverpool, "I ac- quired more of real value for my surgical work than in my previous six years' service as a hospital intern."* Apart from native talent, it was Dragsteclt's prior training in physiology and consistent use of scientific methods that accounted for his unusual success as a clinical surgeon. * Harvey Cushing, "Instruction in Operative Medicine," Yale Medical.Journal, 12 (1906): 879.
LES rER REYNOLD DRAGS rED r DRAGSTED r'S VIEWS OF SURGICAL TRAINING AND HOW HE BECAME A SURGEON 67 Brief reference has been made to DragstecIt's preparation to become a surgeon, but who can speak better to the point than Dragstedt himself? In response to a letter of October 20, 197 I, complaining of the rigidity of the training program of the American Board of Surgery, Dragstedt replied with a long letter on December 29, in which he outlined his own unconventional scheme of surgical training. His letter is so unique and tells so much about Dragstedt that it deserves to be quoted as written: I enjoyed reading your letter of October 20 very much indeed. Like you, I believe there should be more than one road to Rome. I have an idea that there is actually more than one road to Rome, but at present there seems to be only one road to certification by the American Board of Surgery. I have long felt that the rigid program of the Board tends to stifle creative work. When I was in charge of surgery at Chicago I required that the applicants for residency in general surgery spend a full year in labora- tory research before entering upon the clinical part of their training in the residency. We maintained this full-time research year as an integral part of the residency training all during my tenure. I am not certain, however, that it is being maintained at the present time. During this year of research many of our prospective residents worked with me in my laboratory. I endeavored to get them to start thinking about research problems that were both important and practical for the limited time period. For the most part, however, when they began their research they worked with me on problems that I had already started, but not finished. On the way they learned the method of research and thought about problems of their own. I believe this method valuable for most of the young men who enter upon a research career. A few men had original ideas and some notion as to how to go about solving them. Usually after a year of work each of the residents has a fair concept of the method of research and how to go about it. Now you are interested in my own training and experience. Here is a brief rundown of my medical career. At the end of my second year in the medical school at the University of Chicago I received a B.S. in Science. I then entered upon the training for a Ph.D. in Physiology with Dr. A. J. Carlson. At the end of one year of this training, I secured a Masters Degree
68 BIOGRAPHICAL MEMOIRS in Physiology with a minor degree in Pathology. I then went on to the University of Iowa as Instructor in Pharmacology. After one year there I was promoted to Assistant Professor of Physiology at the University of Iowa. While at Iowa I introduced mammalian work in both physiology and pharmacology and continued my research on intestinal obstruction and succeeded in keeping dogs alive after complete removal of the duodenum. I was gratified many years later to get a letter from Dr. [Allen] Whipple telling me that it was this paper that suggested to him his radical operation for cancer of the pancreas. While I was in Iowa City the United States got into World War I and I joined the Army. I went first to Washington, D.C. to the Army Medical School and was assigned to work on typhoid vaccine with Colonel Vedder. I was a private second class at this time. After several months I got tired of this activity and requested a transfer. I was thereupon sent out to Fort Leavenworth, Kansas to get training in the Army Medical corps. When they found out that I had training in Pathology I was made a second lieutenant and sent to Yale. While I worked at Yale under Col- onel Winternitz in the toxicity laboratory I was assigned to teach toxicology to the officers of the medical corps stationed at Yale. The Spanish influenza became epidemic at that time and I was transferred to Camp Merritt, New Jersey as the camp pathologist. This was my best experience in the Army as I had to do autopsies from morning until night for about eight months. When the Armistice was signed I got the Dean at the Medical School in Iowa to request my return to teaching. After about half of a year of teaching at Iowa I decided to return to Rush Medical College and get my M.D. degree. While taking my last two years of medicine at Rush I also finished up the requirements for the Ph.D. degree at the University of Chicago. During this time I presented several papers on intestinal obstruc- tion, removal of the duodenum and parathyroid tetany for the Chicago Surgical Society. Dr. Phemister was one of my teachers at Rush and was apparently impressed by the papers that I gave at the Chicago Surgical Society. When I finished my medicine Dr. Phemister urged me to take an internship in the Presbyterian Hospital with a view to becoming a surgeon. At that time there was no regular residency of the present type available and one became a surgeon by becoming an apprentice to an operating surgeon. I was reluctant to give up research, and in this frame of mind Dr. Carlson persuaded me to come back to his Department of Physiology as an Associate Professor. I stayed there for two years and then became Profes- sor of Physiology and Pharmacology and Chairman of the Department at Northwestern University Medical School. Mrs. Montgomery Ward gave a large amount of money for the erection of a new medical school and this
LES rER REYNOLD DRAGS rED r 69 activity kept me quite busy. Along about this time the Rockefeller Founda- tion became interested in establishing a new type of medical school on the campus at the University of Chicago. They chose Dr. Phemister to be the first chairman of the department of surgery. Dr. Phemister wanted a department of surgery characterized by research activity. He prevailed upon me to give up my appointment at Northwestern and join the Depart- ment of Surgery as an associate professor of surgery. He said he thought it would be easier for a scientist to learn to be a surgeon than for a surgeon to learn to be a scientist. I was very happy at the appointment and taking his advice went to Europe for clinical training. I had no luck in Paris and then went on to Berne, Switzerland. I served as a voluntary assistant to Professor DeQuervain for three months. The work there was mostly thy- roid surgery. I wanted training in abdominal work and so went on to Vienna. While in Vienna I took advantage of the opportunity to work with Jacob Erdheim, one of the greatest teachers that I have ever met. I worked all morning in pathology with Erdheim and in the afternoon with a young surgeon named Goldsmith at the Rothschild Hospital. While I was working at the Rothschild Hospital with Goldsmith I got acquainted with Fritz Silverstein, Head of the Department of Experimental Pathology at the University of Vienna. Silverstein knew of my work on the duodenum and asked me if the dogs from whom I'd removed the duodenum developed pernicious anemia. I had to admit to my chagrin that I had not made any measurements of the blood to see if this was the case so I embarked on a program of taking out the duodenum for Fritz Silverstein in Paltauf~s old laboratory. While there I got acquainted with a number of the active research men at the University of ViennaPineles, Frolich, Winternitz, and many others. I was urged to go over and work with Professor von Eiselsberg which I did as a voluntary assistant for a short period. I was anxious to get to do some operating myself by this time and so took advantage of the economic conditions in this post-war period to go on to Budapest. I went immediately to Polya and told him that we knew about his fine work in America, that I would like to be his assistant and that I could pay him $150 a month for the privilege. All this was said in one breath. He readily assented and took me on as his first assistant. After he did a gastric resection for a duodenal ulcer he invited me to do the next one. I had done a lot of these, of course, in dogs, but had never done a gastric resection in man. I did the resection in the way that I customarily did in the dogs and he was apparently very pleased. I had been taught to close the duodenal stump by an ingenious method that I believe originated with Halsted. I had been taught this during my student period in the physiology laboratory in
70 BIOGRAPHICAL MEMOIRS Chicago by Dr. James J. Morehead EMoorhead], a local surgeon. More- head had taught me how to do gastroenterostomies, gastric resections, Pavlov pouches and so on during the course of our collaboration on the problem of intestinal obstruction. Of course I didn't say anything to Polya about this work on the dogs. He apparently thought I was a safe operator and told me to go ahead and do all the operating I wanted. After a short period with Polya, however, I heard that Professor Humer Hultl at the St. Rochus Hospital was a much better surgeon. Accordingly I went on to see Professor Hultl and used the same formula that had gotten me a place with Polya. Hultl accepted and again took me on as his first assistant. Again I helped him with one operation and the next one was a partial gastrectomy for duodenal ulcer. He asked me if I would like to do that operation. I agreed, did the operation the way I had done it on the dog, Hultl was pleased and told me to go on and do all the operating I wanted. I realized, however, that his assistants were there for that kind of work so I assured them I would not do all the operating but that I would like to assist each one of them so that I would learn the methods that they used. This proved to be a good formula and I had a happy time in this hospital for a period of about eight months. I then returned to Chicago and became an assistant to Dr. Phemister in the Presbyterian Hospital in the mornings and a volunteer resident in the Cook County Hospital in the afternoons. After about six months of this work Billings Hospital was completed and we moved over there. When the hospital was opened I started by serving as Dr. Phemister's assistant and began my research work in the laboratory. As soon as patients began to come in sufficient numbers Dr. Phemister wanted me to take my own service with a resident and an intern. At first I tried to send my big cases to Dr. Phemister, but he refused to take them and insisted that I do them. He was in the operating room next door so I was comforted by the thought that I could always call on him if I should get in a tight spot. Well, Owen, this is the way I became a surgeon. It is a road to Rome that I do not believe is practical anymore. It was made possible by the economic conditions in Vienna and Budapest and by the desire of the Rockefeller Foundation to build a department of surgery where some of the surgeons were investiga- tors. However, I think some sort of modification of this road to Rome might be possible in our modern world. DRAGS rED r'S GAS rRIC SECRETORY S rUDIES It is not the intent of the authors to examine every publi- cation by the subject of this memoir, but rather to look briefly
LESTER REYNOLD DRAGSTED r 71 at his main works. Dragstedt's most important work in a long and productive career concerned aspects of gastric secretion and digestion. It is entirely appropriate, therefore, to trace briefly the long story of theories and early experiments con- cerning the stomach's behavior. 'theories of the nature of gastric secretion are as old as Hippocrates (460 - 370 B.C.), who thought of that process as cookingwhich he termed "pepsis." rrheodor Schwann in 1936 confirmed the presence of William Beaumont's "chemical principle" in gastric juice, which he observed was destroyed by heating; being a student of Hippocratic writings, Schwann named the proteolytic en- zyme "pepsin." In an essay brought before London's Royal Society in 1686, Edward 'Dyson hacl established that the gas- tric juice container! a corrosive menstruum. In studies on the ostrich, the Italian Antonio Vallisnieri (1713) had ascertained the presence of an active digestive agent in the juice. In ~ 752, Rene Reamur had birds, ~logs, and a sheep swallow sponges placed in perforated spheres, permitting direct contact with the gastric juice. He definitely established the solvent power of juice, as did Edwarc] Stevens of Edinburgh in 1777 in similar studies on man, dogs, and sheep. Lazaro SpalIanzani, in 1780, experimented on fish, cats, dogs, and man, also affirming the presence of an active digestive agent within the gastric juice. In 1786, John Hunter performed experiments on fish, lizards, and frogs, confirming the findings of prior investigators. He established the idea of the "living princi- ple," concluding that gastric juice floes not digest living things, a thesis that Claude Bernard disproved in 1844. in his significant monograph of 1833, following studies extending back to 1825, Beaumont, a pioneer American mili- tary surgeon far removed from academic halls, concluder! his extentlecl studies on Alexis St. Martin, who had suffered a shotgun shell injury at close range (~822) to the lower left thorax and upper abdomen. Beaumont was able to close the thoracic wound, but throughout St. Martin's long life the
72 BIOGRAPHICAL MEMOIRS gastric fistula persistent. Beaumont completed his studies on the secretory behavior of St. Martin's stomach with fifty-one observations, two of which were original ant! fundamental. In conclusion #24, he established the presence of a "chemical principle," antedating by three years the observations of Johannes Muller and Schwann. In conclusion #25, Beau- mont demonstrated that the empty stomach contains no hy- drochIoric acid; that it takes the stimulus of ingested! food to provoke secretionan observation with which many dis- tinguished physiologists (lisagreecl. They failed to recognize that only patients with duodenal ulcer, one of the strongest manifestations of the ulcer diathesis, actually ctid have free hydrochloric acid in their stomachs, devoid of food.* GASTRIC FIS rULA S rUDIES With James Ellis, Dragstedt (1930) observed that total loss of gastric juice through a gastric fistula or total pyloric ob- struction was uniformly fatal, and as the New York surgeons I. A. Hartwell and I. P. Hoguet (1912) had demonstrated in cluodenojejunal obstructions in dogs, responded well to liberal intravenous administration of saline solution. Loss of the other gastrointestinal ion, potassium (K), W. B. O'Shaughnessy (~831) hac! recognized and successfully re- medied by intravenous infusions of both the K and Na ions for the severe diarrhea of cholera patients, deficits he re- placed in the amounts lost. James Gamble (1925) confirmed the importance of replacement of the K ion in high intestinal obstructions in animals ant! man. Dragste(lt's gastric secre- tory studies began in ~ 924, investigations he continued throughout the remainder of a long and creative career. * O. H. Wangensteen, "Claude Bernard's Work on Digestion," in Claude Bernard and Experimental Medicine, ed. Francisco Grande and M. B. Visscher (Cambridge, Mass.: Schenkman, 1967), pp. 45-74.
LESTER REYNOLD DRAGS rEDT VAGOTOMY STUDIES 73 Dragstedt pursued the problem of the pathogenesis of gastric and duodenal ulcer over many years, studies that cul- minated in Dragstedt's reintroduction ~ ~ 943) of transthoracic truncal section of both magi nerves for cluodenal ulcer, which Dragstedt and Frederick M. Owens announced they had per- formed upon patients with duodenal ulcer, the most refrac- tory to treatment of all common manifestations of the peptic ulcer cliathesis. The operation was not an innovation; Ivan Pavlov, the great Russian physiologist, and his associates had establisher! the significant influence of the vagi nerves upon canine gastric secretion in the early IS90's. Ancire Latarjet, of Lyons, France, had performe<1 both supra- and infradia- phragmatic vagotomy for gastric states in man, including several instances of cluocienal ulcer. Latarjet (1922-1924) learner] from his own experience that bilateral vagal section necessitated a drainage procedure because of impaired emptying. Laterjet performed supplemental pyloroplasty to correct the situation. Dragstedt, too, learned the need for a complemental gastrojejunostomy to provide adequate gastric emptying. The effect of vagal section on gastric secretion was to occupy a major share of Dragstedt's attention throughout the remainder of his professional life. The American Gastroenterolog~cal Association, domi- natec] primarily by clinicians, lent Dragstedt's contribution on vagotomy faint praise in the early 1950's. A. V. Pollock of Leeds saved the day for vagotomy (Lances 2: 785-800, 1952) in a report upon 1,524 vagotomies performed for peptic ulcer from scattered large metropolitan areas in Britain. Re- current neostomal ulcer occurred in 6 percent when clone for cluoclenal ulcer. When complemental gastric drainage was added, the recurrence rate was only ~ percent. Summarized Pollock, "this procedure Evagotomy] will stand or fall by the proved recurrence-rate" (p. 800~.
74 BIOGRAPHICAL MEMOIRS In studies of carefully gathered physiological data, ex- tending over many years, Dragstedt persuaded the surgical profession throughout the world that vagal section was an important component of any and all surgical procedures di- rected at overcoming the strong acid-peptic ulcer diathesis of duodenal ulcer. It came as a great surprise to many of his fellow surgeons and admirers to learn that Dragstedt (1936), the keenest and most ardent student of that problem, advised changing the name of peptic ulcer to "acid ulcer." Allusion has already been made to the important work of Beaumont (~833), more than a century earlier, and his conclusion that the gastric juice of his experimental subject, St. Martin, con- tained a "chemical principle" in addition to hydrochloric acid, a thesis arrived at by Beaumont in noting the influence of temperature upon the proteolytic quality of the gastric juice. He confirmed this finding by observing consistently the far greater digestive potential of gastric juice over HCI with a similar pH. Dragstedt's usual care in testing all premises had failed him in this instance. THE ANTRAL EXCLUSION OPERA rION In 1895, the Vienna surgeon Anton Eiselsberg devised the antral exclusion operation to facilitate removal of difficult pyloric cancers and duodenal ulcers. Two decades later, his protege Hans Haberer (1914) began to suspect that when gastric resection was accompanied by antral exclusion for duodenal ulcer, neostomal ulcer frequently occurred; by 1921, Haberer had given up the antral exclusion operation. It remained, however, for the London surgeon Heneage Og~lvie (1936, 1938) to demonstrate in two series of gastric resections for duodenal ulcer, one with antral exclusion and the other without, that Haberer had been correct in abandon- ing the antral exclusion operation for duodenal ulcer. Hans Smidt of Jena (1924) had shown in canine experiments that
LES rER REYNOLD DRAGS rED r 75 antral exclusion pyramided the occurrence of neostomal ulcer attending gastric resection for duoclenal ulcer; in dogs with an isolatecl gastric pouch, feel on a meat diet, Smidt observed that, following antral exclusion, such dogs secretes! 80 percent more HC} than did his controls. It remained for Dragstedt and his associates to confirm, in a succession of papers with solid data, Haberer's suspicion that antral exclu- sion was not a physiologic operation. DRAGSTEDT REJECTED AUTOINTOXICATION AS THE LETHAL FAC rOR IN OBSTRUC rION J. Z. Amussat (1839), a young Paris surgeon, operated upon his famous teacher, Frangois Broussais, for an obstruct- ing rectal cancer, attempting to destroy the cancer and relieve the obstruction with the cautery. Unfortunately, he per- forated the bowel, and peritonitis ensued. Appreciating that his reputation as a surgeon was at stake in this unhappy occurrence, Amussat formulates! the theory of autointoxica- tion as the responsible agent in his teacher's demise. For almost a century, this thesis dominated medical ant! surgical thinking as the chief lethal factor in death from bowel ob- struct~on. In a series of experiments, George Whipple (1913-1917), Nobel Laureate, appeared to have confirmed the autointoxi- cation theory, fincling a "toxic proteose" within the distended lumen of the obstructed bowel. Dragstedt was the first to cast serious cloubt upon this thesis (191~20~. He observed that isolated closed canine duodenojejunal loops perforated because of the secretory dominance of that segment of the bowel. However, when he left the ends of the isolated loop open to drain freely into the peritoneal cavity, such loops in time became sterile; when the encIs of such isolated loops were closed, the dogs tolerated the situation without incident. Through the work of Gamble, of Harvard's Children's Hos-
76 BIOGRAPHICAL MEMOIRS pital, and others, the autointoxication theory as the lethal factor in bowel obstruction has been permanently set aside. CANINE LIVER AUTOLYSIS It should be observed that Dragstedt, though not trained as a microbiologist, made another significant discovery con- cerning the lethal factor attendant on leaving a small frag- ment of adult canine liver free in the peritoneal cavity, cle- tached from its source of blood supply. Frank Mann (1923), of the Mayo Clinic research laboratories, had first made this observation in his classic studies on experimental canine hepatectomy. A number of experimentalists addressed them- selves unsuccessfully to its solution. Dragstedt and Ellis (1930) then (lid a novel and telling experiment. They per- formed cesarean section on female dogs about to deliver their young. The livers of these unfed puppies, which had not had the opportunity to enjoy their mothers' milk, were placed in the peritoneal cavities of adult clogs. Unlike situations in which liver segments of equal weight from adult dogs were introduced intraperitoneally which quite uniformly termi- nated in death of the recipient within 24 hours liver im- plants from newborn unnourished pups were well tolerated. When the abdomens of these canine recipients were explored a few weeks later, it was noted that the implants hac! been completely absorbed. An overiooke(l and forgotten observa- tion of S. B. Wolbach (1909), Harvard pathologist, served to resolve the mystery: the adult canine liver contains very pathogenic anaerobic bacteria of the Bacillus Welchii type. Dragstedt's surmise proved correct and confirmed Mann's observation that a small fragment of adult canine liver, un- attached to its normal source of blood supply, was lethal. DRAGSTEDT AND THE PARATHYROIDS F. D. Recklinghausen (1891) described osteitis cystica. Max Askanazy (1904), another distinguished German pathol-
LES rER REYNOLD DRAGS rED r 77 tight, first identifier! that condition with tumors of the para- thyroid gland. It remained! for Felix MandI (1925), a young surgeon at the AlIgemeines Krankenhaus in Vienna, to excise a tumor of the left inferior parathyroid gland and relieve the pain and stop spontaneous fractures in a patient with acI- vancec! osteitis fibrosa cystica who hac! a milky-white urine, owing to the inorclinately high excretion of calcium in the urine. This was about the time that Dragstedt began adciressing himself to the problem of parathyroicl tetany. The para- thyroid glands hacl been discoverer! by Ivan Sandstrom, a young Swedish medical student (~80), an observation he encountered clifficulty in getting publishecl. When thyroiclec- tomy was undertaken by Theoclor Kocher of Bern, the first surgeon Nobel Laureate (1909), he performed excision of both lobes of the thyroid glancl and its isthmus, and unwit- tingly excised the parathyroids too, the existence of which he was unaware. This sequel of thyroiclectomy he subsequently described as "cachexia strumipriva" (~83~. W. G. MacCal- lum, of The Hopkins, related (1909) that post parathy- roidectomy tetany could be controlled by the administration of calcium, (demonstrating that the parathyroids had an im- portant role in calcium metabolism. Dragstecit had formulated the thesis that loss of the para- thyroids impaired the resistance of the belly to toxins, a situa- tion that he combatted with some success in clogs with a milk diet complemented with lactose. The cliet factor again! Mean- while, Adolph Hanson (1923), a general surgeon of Fari- bault, Minnesota, isolated a potent bovine parathyroicl extract with the helpful advice of Arthur Hirschfelcler, pro- fessor of pharmacology at the University of Minnesota. I. B. Collip (1925) isolates! parathormone (which he initially called parathyrin), confirming MacCallum's (1909) thesis that the parathyroids control calcium metabolism. Had Dragstedt tested MacCallum's 1909 premise, his own address to the
78 BIOGRAPHICAL MEMOIRS likely function of the parathyroids undoubtedly would have followed a different pattern. To be thrust into an unexplored field of investigation, almost devoid of guidelines, is always a risky undertaking. PA N C REAT I C S TU D I E S One of Dragstedt's broadest investigative efforts con- cerned the pancreas. He demonstrated that a complete external pancreatic fistula was compatible with life; that a complete biliary fistula was not lethal, but did diminish pan- creatic juice recovered through an inlying pancreatic duct cannula. He and his associates reported that the adult canine pancreas, like the liver, contained anaerobic bacilli of the Welchii pattern, responsible for the high lethal factor of acute hemorrhagic pancreatitis or necrosis, occasioned by retrojec- tion of bile into the duct of Wirsung, or other factors predis- posing to pancreatitis. Dragstedt began his historic studies on canine pancreatectomy in 1936, observing, as had Frank N. AlIan and co-workers at the University of roronto in 1924, that total pancreatectomy in the dog was lethal, even though supported by insulin. Dragstedt observed that the addition of a liberal amount of raw bovine pancreas to the diet offered considerable protection against fatty infiltration of the liver, prolonging the lives of the dogs. Dragstedt went on to develop an alcoholic extract of the raw pancreas that also prolonged the lives of depancreatized dogs, concluding the protective agent to be another pancreatic hormone. Dragstedt called the raw pancreatic extract lipocaic ("burns fat") (1938~. The Toronto biochemist I. L. Chaikoff observed J. Biol. Chem., 160: 489, 1945) that a liberal oral intake of methionine, added to a low-fat, high-protein diet, offered the same protection against fatty liver, with prolongation of life, as did raw pancreas or the alcoholic extract of Dragstedt. Chaikoff and his associates believed that the amino acid
LES rER REY N OLD D RAGS rEDT 79 methionine enhances! the synthesis of choline, which they believed to be the primary lipotropic factor, but which Drag- stedt denied. The exact mechanism of the protection pro- vided by raw pancreas, an alcoholic extract thereof (lipocaic), or methionine has not been completely resolved. Most in- vestigators believe that Dragstedt's alcoholic pancreatic ex- tract is not a true pancreatic hormone. Dragstecit and several associates worked very assiduously ant! persistently upon this complicated ant! intricate problem over the 193~1946 decacle, writing a succession of twenty journal articles upon the subject. The term lipocaic is still to be founc! in medical dictionaries, but that it meets the criteria of a hormone has not been clefinitely establishecI. It is quite clear that Dragstedt's impact upon the importance of the liver-pancreas relationship has been very significant, even though his conclusion concerning the exact operative nature of that relationship has been challengecI. The Council on Pharmacy anc! Chemistry of the AMA assessed the status of lipocaic (JAMS, ~14: 145~55, 19401. The Council concluded: "In view of the experimental status of lipocaic, the Council postponed consideration to await clevelopment of further critical evidence and expresser! the view that the preparation should not be recognized for rou- tine practice." Dragstedt and his co-workers demonstrated that the ex- ternal secretion of the pancreas die! not preclude the deposi- tion of fat in the liver attending canine pancreatectomy, as did feeding raw pancreas. At this time, Dragsteclt had be- come completely absorbed in the clinical role of vagotomy as an effective anti-peptic ulcer remedy and ctic! not pursue the lipotropic action of lipocaic further. In his many and broach addresses on problems of the pancreas (l 933~6), Dragstedt clid not become involved in the controversy over the hyperglycemic effect occasionally
80 BIOGRAPHICAL MEMOIRS observed following insulin administration. This was long be- lieved to have been an insulin contamination, but after more than a quarter of a century of consecutive work in competent hands, it has turned out to be another powerful pancreatic hormone, glucagon, a discovery which emerged also from experimental pancreatectomy. The recent interesting work of Thomas E. Starz! of Denver on the liver-pancreas axis has shown that the problem is far more complicated than the initial workers had contem- plated. Recognizing that protocaval shunts predispose to fatty infiltration of the liver, Starz! assessed the role of splanchnic blood flow upon isolated liver segments. He de- monstrated that the pancreatico-gastric segment of the splanchnic blood flow had a far greater influence in support- ing portal insulin than did the intestinal segment of the splanchnic blood supply and also retarded fatty infiltration of the liver more effectively (Lances 2:1241~2, 1975~. DRAGS rEDT SUCCEEDS PHEMISTER AS SURGICAL CHAIRMAN In 1947, Cornelius P. Rhoads, known to his friends as Dusty, and ~ (O.W.) spent a long evening at my hose! in New York, discussing surgery's role in the management of cancer. The eminent pathologist James Ewing ~ ~ 855- 1943), who had long been in command at the Memorial Cancer Hospital in New York, had suffered from painful conditions for which surgery in very competent hands had offered incomplete relief. Ewing was not, therefore, partial to surgery or surgeons. The coming of Rhoads to the Memorial was a great boon for surgery in cancer management. We talked well into the wee hours of the morning, and Dusty urged me to come on as their chief surgeon, a generous offer which ~ declined. ~ advised Rhoads to offer the opportunity to Alexander Brunschwig at the University of Chicago, a far
LESTER REYNOLD DRAGSTEDT 81 better qualifies] surgeon than ~ for the task. Brunschwig hacl published a nice monograph on pancreatico-duodenec- tomy. He was an aggressive cancer surgeon and well suited for the task. Little did ~ then know that this suggestion was to have an important repercussion on Dragstedt's career. It had come to his attention that Phemister, chairman of the Department of Surgery, who had encouraged Lester in 1925 to enter sur- gery, favored Brunschwig as his own successor; Dragstedt apparently was being overlooked in the selection process. Phemister was powerful enough in the University to make his recommendation stick. In a conversation many years later, Lester affirmer] this circumstance, subsequently confirmed in a letter exchange with Loyal Davis (December 2, 1975), then chairman of the Department of Surgery at Northwestern University. Davis toIc! Lester he would have a place for him and wouIc3 welcome him in Northwestern's Department of Surgery should he be bypassed in the selection process. Davis added that he had no funds for the position, and Lester wouIcl have to earn his salary by practice an arrangement to which Dragstedt assented. Indirectly, therefore, and unwit- tingly, this surgeon had a Hans! in making Dragstecit Phe- mister's successor at the University of Chicago. The migra- tion of Brunschwig to New York served the careers of both · · ~ men In a very satisfying manner. DRAGSTEDT'S 1954 APPRAISAL OF HIS SCIENTIFIC ACHIEVEMENTS In a letter to Academy Home Secretary A. Wetmore on March 22, ~ 954, Dragstedt inclicated the following as his most significant contributions to medical literature: I) that removal of the duodenum is compatible with life (1918~; 2) that dogs undergoing total parathyroidectomy can be kept alive indefinitely when maintained on a milk diet fortified
82 BIOGRAPHICAL MEMOIRS with lactose; 3) that an alcoholic extract of raw pancreas con- stitutes the hormone lipocaic, which with complementary insulin will sustain dogs in good health following total pan- createctomy, obviating fatty infiltration of the liver; 4) the pathogenesis of gastric and duodenal ulcer and the demon- stration of complete vagal section as an effectual method of treating refractory duodenal ulcers. Indeed, this was a very modest appraisal of his life's work five years prior to retirement from the University of Chicago. Dragstedt was to survive yet another twenty-one years and was to continue the diligent pursuit of his scientific endeavors through that entire period. Dragstedt's research upon the parathyroids began in 1922, three years before their function had been clarified by Mand} (1925~. Lester's work on the control of tetany attend- ing complete parathyroidectomy had persuaded him that the parathyroids had an important role in complementing the liver in detoxifying alimentary tract toxins, a thesis that died when the work of Hanson (1923) and Collip (1925) provided strong support for MacCallum's thesis (1929) that the para- thyroids controlled calcium metabolism. RETIREMENT FROM CHAIRMANSHIP AT rHE UNIVERSITY OF CHICAGO At a dinner at the University of Chicago, May 28, 1959, honoring Lester Dragstedt's long years of successful scientific endeavor, in reply to brief speeches by the Toastmaster Per- cival Bailey, Paul Cannon, Dean Lowell Coggeshall, and this surgeon (O.W.), Lester rose to make his response. He had notes, but did not use them. He spoke warmly of his gratitude to the University, said he, a truly great University, "one of the best in the world." He spoke of the loyalty of his family, children, and grandchildren; of his debt to his University
LES rER REYNOLD DRAGSTEDr 83 colleagues, both current and departed; of his gratitude to his many surgeon-friends in the Chicago area; and finally of his wife, Gladys, concerning whom he said, "To her ~ owe every- thing; my success and my friends." Lester obviously greatly appreciated the splendid opportunity the University had provided him and the loyalty of his friends and family. PERS O NAL H EAL rH C H ALLE N GES Dragstedt was a man of great vigor and indomitable spirit who enjoyed good health throughout most of his long life. He did, however, come to know the threat to a career that illness can bring. Perhaps few, if any, surgeons have had so large an experience in the performance of autopsies as Lester Drag- stedt. It is not surprising, therefore, to learn that he con- tracted tuberculosis, which necessitated spending nine months in a tuberculosis sanatorium in Arizona. Subse- quently, he underwent examination of his urinary tract at the hands of Chicago's well-known urologic surgeon, Herman Kretschmer, who discovered that Lester had a unilateral tuberculous kidney, demanding nephrectomy. Lester's brother Carl, a distinguished pharmacologist, was on hand for the operation and relates that the right renal artery was so short that Kretschmer was forced to leave a clamp on it. After the first wound dressing the next morning, Car! grad- ually released the clamp at intervals, latch by latch, until it was completely free, a somewhat risky practice that, with ad- vances in vascular surgery, surgeons today are happy to forego. Lester fortunately survived a severe bout with typhoid fever in 1927, during which he lost fifty pounds. Throughout most of his adult life, Lester was hard of hearing, a handicap he bore without complaint.
84 BIOGRAPHICAL MEMOIRS DRAGS rED r JOINS HIS PRO rEGE WOODWARD AT rHE UNIVERSI rY OF FLORIDA When Dragstedt retired from his professorship at the University of Chicago in 1959 at age sixty-six, his protege Edward Woodward invited him to come to the newly formed medical school at the University of Florida at Gainesville. The Dragstedts adapted happily to the Florida environment, delighted with the lush tropical vegetation, the bright birds that came to their feeders, and the delicate camelias that bloomed in the yard so abundantly under their care. As in Chicago, their home became a mecca for visiting scientists from America and abroad. Colleagues, students, children, and grandchildren recall the warmth and gaiety of gather- ings in the Gainesville house, Lester's jovial and cheery hospi- tality, and Gladys' charm as hostess. They continued to travel widely; it was never a surprise to meet Lester in some remote airport, hospital, or art gallery always with Gladys, his steadfast and perceptive companion, by his side. Summer- times they returned to their beloved Wabigama for family vacations. A feature of Dragstedt's training program, pursued throughout his career at Chicago and in Florida, was the four o'clock afternoon tea in the laboratory, to which all Dragstedt proteges allude with nostalgic memories. These gatherings were always informal, with no prearranged agenda. The dis- cussions were frank and open, permitting participation by all with a special interest in the subject matter. At Gainesville, Dragstedt continued his productive career as an experi- mental physiologist of the secretory behavior of the stomach, pancreas, and liver. Woodward (1976) related that Dragstedt, without a note or lantern slide, presented a brilliant and lucid review of his
LESTER REYNOLD DRAGSTED-r 85 life's work in a commencement adctress in June 1975, to which his audience of students, faculty, anti friends re- sponcied with a prolonged stancting ovation, affirming Dragstecit's ability to instruct, hold the attention of, and charm his audience with any subject upon which he chose to speak. That parting commencement aciciress, no doubt, took exhaustive ancl exhausting preparation. Upon its completion, Dragstecit departed with his family for his favorite and cus- tomary vacation spot on Elk Lake, Michiganwhere he cried, shortly after arrival, from a sudden, massive coronary occlu- sion. All efforts clirected at resuscitation by his son, Dr. Lester Dragstedt TI, proved unsuccessful. Gladys Dragstecit diec! two years after Lester. They left four children: Charlotte (Mrs. Thomas Jeffrey), of Gaines- ville; Carol (Mrs. Robert N. Stauffer), of Atlanta; Lester R. TI, surgeon of the Veterans Hospital, Des Moines, Iowa; and John Albert, of St. Mary's College, Oaklancl, California. The grandchildren number thirteen. So passed into memory and history one of the great sur- gical physiologists of this century, who left an indelible and durable imprint upon every area in which he worked; an eminent surgical teacher who enIargec! notably upon Phem- ister's training school for surgical academicians at the Uni- versity of Chicago. All privileged to have worked with Lester Dragstedt recognized that here was an extraorclinarily giftec! individual, compassionate and friencIly, sympathetically interested in all the problems of his associates. Is it any wonder that his memory is cherished with great pride and warm affection? THE AUTHORS WISH to express their gratitude to Mrs. Jeffrey and to Dr. Lester R. Dragstedt II for helpful suggestions concern- ing various facets of the lives of their parents. Dr. Carl A. Dragstedt also supplied valuable data about his brother's life and career.
86 BIOGRAPHICAL MEMOIRS Many of Dragstedt's proteges were extremely helpful in providing information concerning his professional and scientific career, espe- cially Drs. John H. Landor and Edward R. Woodward. fo Dr. Charles F. Klinger, the authors acknowledge their gratitude for aid in the collection of many of Dragstedt's scientific papers and the arrangement of the bibliographic references.
LES rER REYNOLD DRAGSTED r HONORS AND DIS-rINC rIONS DEGREES B.S., University of Chicago M.S., University of Chicago Ph.D., University of Chicago M.D., Rush Medical College, Chicago HONORARY DEGREES Doctor Honors Causa, University of Guadalajara, Mexico Docteur Honors Causa, University of Lyons, France Sc.D., University of Florida, Gainesville Doctor Honoris Causa, University of Uppsala, Uppsala, Sweden 87 UNIVERSITY APPOINrrMEN'rS 191~1917 1917-1919 192~1923 1923-1925 1925-1930 1930-1948 1948-1959 1916 Assistant, Department of Physiology, University of Chicago Instructor, Pharmacology, State University of Iowa Assistant Professor of Physiology, State University of Iowa Assistant Professor of Physiology, University of Chicago Professor and Head, Departments of Physiology and Pharmacology, Northwestern University Associate Professor of Surgery, University of Chicago Professor of Surgery, University of Chicago Thomas D. Jones Distinguished Service Professor of Surgery and Chairman of the Department of Surgery, University of Chicago 195~1975 Research Professor of Surgery, University of Florida, Gainesville MEMBERSHIPS IN AMERICAN ORGANIZATIONS AND SOCIE TIES National Academy of Sciences Phi Beta Kappa Sigma Xi Alpha Omega Alpha American Association for the Advancement of Science American Physiological Society
88 B I OGRAPH I CAL MEMOI RS Society for Experimental Biology and Medicine American Surgical Association American Society for Clinical Surgery American Gastroenterological Association American College of Physicians American College of Surgeons American Medical Association Central Surgical Society Institute of Medicine of Chicago American Academy of Arts and Sciences Honorary Member of the Surgical Societies of Seattle, Los Angeles, Detroit, Minneapolis, Southern California, Graduate Surgeons of Los Angeles, and Boston HONORARY MEMBERSHIPS IN FOREIGN ORGANIZATIONS AND SOCIETIES Surgical Society of Lyons Surgical Society of Paris Swedish Surgical Society Argentine Society of Gastroenterology Fellow of the Royal College of Physicians and Surgeons of Canada Fellow of the Royal College of Surgeons of England National Academy of Medicine of Mexico Royal Academy of Arts and Sciences of Uppsala, Sweden (Foreign Corresponding Member) Academy of Surgery of France Association of Mexican Gastroenterologists AMERICAN HONORS AND AWARDS 1945 Silver Medal of the American Medical Association for origi- nal investigation 1946 Gold Medal of the Illinois State Medical Society for original investigation 1950 Gold Medal of the American Medical Association for origi- nal Investigation 1961 Samuel D. Gross Prize of the Philadelphia Academy of Surgery 1963 Distinguished Service Award of the American Medical Asso- ciation for research, teaching, and surgical practice
LESTER REYNOLD DRAGSTEDT 89 1964 Julius Friedenwald Medal of the American Gastroentero- logical Association for "Outstanding Achievement in Gas- troenterology" 1964 Golden Plate from the Academy of Achievement 1964 Henry Jacob Bigelow Medal of the Boston Surgical Society for "Contributions to the Advancement of Surgery" 1965 Annual Award of the Gastrointestinal Research Foundation 1969 Distinguished Service Award (the first) and Gold Medal of the American Surgical Association FOREIGN HONORS AND AWARDS 1953 Honorary Professor of Surgery at the University of Guada- lajara, Mexico 1965 Gold Medal of the Surgical Society of Malmo, Sweden 1967 Royal Order of the North Star of Sweden, bestowed by the King of Sweden, for "Outstanding Contributions to the Science of Surgery" 1969 Silver Plaque of the Institute of Digestive Diseases and Nu- trition of Mexico City 1969 Silver Plaque of the Association of Mexican Gastroenter- ologists
go BIOGRAPHICAL MEMOIRS SELEC rED BIBLIOGRAPHY* 1916 With l. I. Moorhead and F. W. Burcky. The nature of the toxemia of intestinal obstruction. Preliminary report. Proc. Soc. Exp. Biol. Med., 14:17-19. 1917 Contributions to the physiology of the stomach. XXXVIII. Gastric juice in duodenal and gastric ulcers. I. Am. Med. Assoc., 68:33(~33. With I. l. Moorhead and F. W. Burcky. An experimental study of the intoxication in closed intestinal loops. l. Exp. Med., 25:42 1-39. 1922 The pathogenesis of parathyroid tetany. I. Am. Med. Assoc., 79: 1593-94. 1923 The pathogenesis of parathyroid tetany. Am. J. Physiol., 63:408-9. With S. C. Peacock. Studies on the pathogenesis of tetany. I. The control and cure of parathyroid tetany by diet. Am. I. Physiol., 64:424-34. With S. C. Peacock. The influence of parathyroidectomy on gastric secretion. Am. I. Physiol., 64:49~502. With K. Phillips and A. C. Sudan. Studies on the pathogenesis of tetany. II. The mechanism involved in recovery from para- thyroid tetany. Am. J. Physiol., 65:368-78. 1924 , , _ , The resistance of various tissues to gastric digestion. Am. I. Physiol., 68:134. 1926 With A. C. Sudan. Studies on the pathogenesis of tetany. V. The prevention and control of parathyroid tetany by calcium lactate. Am. I. Physiol., 77:296-306. *A complete bibliography of the works of Lester Dragstedt, numbering 341 entries, is available from the Archives of the National Academy of Sciences.
LESTER REYNOLD DRAGS rED r 91 With A. C. Sudan. Studies on the pathogenesis of tetany. VII. The prevention and control of parathyroid tetany by the oral administration of kaolin. Am. l. Physiol., 77:314-20. 1927 The physiology of the parathyroid glands. Physiol. Rev., 7:490530. 1929 With l. C. Ellis. Effect of liver autolysis in viva. Proc. Soc. Exp. Biol. Med., 26:304-5. With I. C. Ellis. Fatal effect of total loss of gastric juice. Proc. Soc. Exp. Biol. Med., 26:305-7. 1930 With l. C. Ellis. Liver autolysis in viva. Arch. Surg., 20:8-16. With M. L. Montgomery, W. B. Matthews, and J. C. Ellis. Fatal effect of the total loss of pancreatic juice. Proc. Soc. Exp. Biol. Med., 28:110-11. 1931 With M. L. Montgomery, I. C. Ellis, and W. B. Matthews. The pathogenesis of acute dilatation of the stomach. Surg. Gynecol. Obstet., 52: i 075-86. 1932 With W. L. Palmer. Direct observations on the mechanism of pain in duodenal ulcer. Proc. Soc. Exp. Biol. Med., 29:753-55. With W. B. Matthews. The etiology of gastric and duodenal ulcer. Experimental Studies. Surg. Gynecol. Obstet., 55 :265-86. 1933 Ulcus acidum of Meckel's diverticulum. I. Am. Med. Assoc., 101 :20-22. 1934 With H. E. Haymond and I. C. Ellis. Pathogenesis of acute pancrea- titis (acute pancreatic necrosis). Arch. Surg., 28:232-91.
92 BIOGRAPHICAL MEMOIRS 1936 Acid ulcer. Surg. Gynecol. Obstet., 62:118-20. With I. Van Prohaska and H. P. Harms. Observations on a sub- stance in pancreas (a fat metabolizing hormone) which permits survival and prevents liver changes in depancreatized dogs. Am. J. Physiol., 117: 175-81. 1938 Lipocaic. A new pancreas hormone. Northwest Med., 37:33-36. With W. C. Goodpasture, C. Vermeulert, and P. B. Donovan. The Bromsulphalein liver function test as a method of assay of lipocaic. Am. J. Physiol., 124:642-46. 1939 With C. D. Stewart, D. E. Clark, and S. W. Becker. The experi- mental use of lipocaic in the treatment of psoriasis. A preliminary report. l. Invest. Dermatol., 2:219~30. With P. B. Donovan, D. E. Clark, W. C. Goodpasture, and C. Ver- meulen. lithe relation of lipocaic to the blood and liver lipids of depancreatized dogs. Am. I. Physiol., 127:755~0. With C. Vermeulen, W. C. Goodpasture, P. B. Donovan, and W. A. Geer. Lipocaic and fatty infiltration of the liver in pancreatic diabetes. Arch. Intern. Med., 64: 1017-38. 1940 With D. E. Clark, O. C. Julian, C. Vermeulen, and W. C. Good- pasture. Arteriosclerosis in pancreatic diabetes. Surgery, 8:353 - 1. 1942 With C. Vermeulen, D. E. Clark, O. C. Julian, and I. G. Allen. Effect of the administration of lipocaic and cholesterol in rabbits. Arch. Surg., 44:26(}67. 1943 With F. M. Owens, tr. Supra-diaphragmatic section of the vagus nerves in treatment of duodenal ulcer. Proc. Soc. Exp. Biol. Med., 53: 152-54.
LESTER REYNOLD DRAGSTEDT 93 1945 With T. F. Thornton, Jr. and E. H. Storer. Supra-diaphragmatic section of vagus nerves and gastric secretion in patients with peptic ulcer. Proc. Soc. Exp. Biol. Med., 59:140 41. With D. E. Clark and M. L. Eilert. Lipotropic action of lipocaic. A study of the effects of lipocaic, methionine and cystine on dietary fatty livers in the white rat. Am. I. Physiol.,144:62~25. 1946 With M. L. Eilert. Lipotropic action of lipocaic: A study of the effect of oral and parenteral lipocaic and oral inositol on the dietary fatty liver of the white rat. Am. i. Physiol., 147:346-51. 1948 With E. R. Woodward, E. B. Tovee, H. A. Oberhelman, Jr., and W. B. Neal, Jr. A quantitative study of the effect of vagotomy on gastric secretion in the dog. Proc. Soc. Exp. Biol. Med., 67:35(}51. With E. R. Woodward and R. R. Bigelow. Quantitative study of effect of antrum resection on gastric secretion in Pavlov pouch dogs. Proc. Soc. Exp. Biol. Med., 68:473-74. 1950 With E. R. Woodward, W. B. Neal, fir., P. V. Harper, ir., and E. H. Storer. Secretory studies on the isolated stomach. Arch. Surg. 60:1-20. With E. R. Woodward and R. R. Bigelow. Effect of resection of antrum of stomach on gastric secretion in Pavlov pouch dogs. Am. J. Physiol., 162:99-109. 1951 With H. A. Oberhelman, fir. and C. A. Smith. Experimental gastro- jejunal ulcers due to antrum hyperfunction. Arch. Surg., 63 :298-302. 1952 With I. M. Zubiran, A. E. Kark, I. A. Montalbetti, and C. l. L. Morel. Peptic ulcer and the adrenal stress syndrome. Arch. Surg., 65:809-15.
94 BIOGRAPHICAL MEMOIRS 1953 With S. O. Evans, Jr., }. M. Zubiran, I. D. McCarthy, H. Ragins, and E. R. Woodward. Stimulating effect of vagotomy on gastric secretion in Heidenhain pouch dogs. Am. I. Physiol., 174:21~25. 1957 With C. M. Baugh, I. Barcena, and l. Bravo. Studies on the site and mechanism of gastrin release. Surg. Forum, 7:356 60. With C. F. Mountain, I. H. Landor, J. D. McCarthy, and P. V. Harper, fir. The secretory effect of gastric transection. Surg. Forum, 7:375-79. With l. Barcena, C. M. Baugh, I. L. Bravo, and C. F. Mountain. Effects of total pancreatectomy on gastric secretion. Surg. Forum, 7:380 82. 1962 Section of the vagus nerves to the stomach in the treatment of duodenal ulcer. In: Surgery of the Stomach and Duodenum, ed. H. N. Harkins and L. M. Nyhus, pp. 461-72. Boston: Little, Brown. 1963 With E. R. Woodward, C. L. Park, Jr., and H. Schapiro. Signifi- cance of Meissner's plexus in the gastrin mechanism. Arch. Surg., 87:512-15. 1965 With C. de la Rosa and E. R. Woodward. Localization of the gastrin- producing cell. Surg. Forum, 16:327-29. 1968 With D. R. Kemp, F. Herrera-Fernandez, and E. R. Woodward. Meissner's plexus and the mechanism of vagal stimulation of gastric secretion. Gastroenterology, 55:7080. 1971 With J. R. N. Curt, J. Isaza, and E. R. Woodward. Potentiation between intestinal and gastric phases of acid secretion in Heidenhain pouches. Arch. Surg., 105:70012.
LESTER REYNOLD DRAGS FEDS 1973 95 With G. Wickbom, M. A. Kamal, and E. R. Woodward. Corrosive effects of digestive juices on legs of living frogs. Am. Surgeon, 39:571-81. 1974 With G. Wickbom, F. L. Bushkin, and C. Linares. On the corrosive properties of bile and pancreatic juice on living tissue in dogs. Arch. Surg., 108 :68~84. 1976 With }. B. Weeks, G. C. Petridis, and E. R. Woodward. A simplified method for chemical induction of gastric hypersecretion. l. Surg. Res., 21:357-58.