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The Surgical Legacy of Randolph Lee Clark Jr, MD: First Surgeon-in-Chief and Director of University of Texas MD Anderson Cancer Center I. Training and Surgical Practice Before Recruitment to University of Texas MD Anderson Hospital

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A Correction to this article was published on 02 February 2021

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Abstract

Dr R. Lee Clark Jr was the first Surgeon-in-Chief and permanent Director of the University of Texas MD Anderson Cancer Hospital, leading the institution from 1946 to 1978. He is known for his visionary leadership as President, but much less about his prodigious activity as a general surgeon and for his academic contributions as a clinical researcher and surgical educator. His general surgery training at the Mayo Clinic from 1935 to 1939 was extensive, having been involved in over 2000 operations. Dr Clark then began a prodigious surgery practice for 2 years in Jackson, MS. He described his clinical practice: “I have done more than 600 major operations a year, of all types—from the brain to the colon”. He was commissioned into the Army Air Force in 1942, as Chief of Surgical Services, with 30 surgeons at a 1000-bed hospital in North Carolina. In 1944, he transferred to Wright Patterson Field in Dayton, OH, as Chief of the Experimental Surgical Unit. He published numerous articles about surgical problems in aviation medicine and edited the journal Air Surgeon’s Bulletin. His final assignment in 1945 was Chairman of the Department of Surgery at Randolph Field in San Antonio, TX. On 12 July 1946, after a rather turbulent and vacillating recruitment process, Dr Clark received a unanimous vote by the University of Texas Board of Regents to become the first permanent Director and Surgeon-in-Chief, and so, Randolph Lee Clark Jr began the most productive and impactful phase of his career.

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Notes

  1. Dr Clark’s title was changed to President and Surgeon-in-Chief in 1968.

  2. Three generations of the Clark family were educational leaders, notably in starting schools in Texas. Grandfather Randolph Clark, an ordained minister, founded Wichita Falls Junior College. He and his brother Addison Randolph Clark started the AddRan Christian University (named for the brothers Addison and Randolph Clark), first in Thorp Springs, TX, in 1873, then moving to Waco Texas in 1895, where it was renamed as Texas Christian University in 1902, and finally moved to Fort Worth in 1910.1

  3. His father, Randolph Lee Clark, was an educational leader in Wichita Falls, TX (where he was Superintendent of Schools and established Wichita Falls Junior College, which eventually grew into Midwestern State University), then in Gainesville, TX (as President of Gainesville Junior College, which became North Central Texas College), and then in Cisco, TX (as President of the Randolph College, named in honor of Randolph Clark, which is now Cisco College). He was also President of the Texas State Teachers Association in 1925.1

  4. During medical school, he was President of his medical school class, and Founding President of the MCV Alpha Omega Alpha Medical Honorary Fraternity; he coached a wrestling team and became the national amateur middleweight wrestling champion.8

  5. Dr Clark later wrote to Dr Dixon in 1957: “This visit [in Paris in 1934] became the guiding beacon that has determined the destiny that I have since pursued … Your intervention in my behalf, undoubtedly, was a major factor in my securing and accepting the (Mayo) Fellowship without benefit of an interview. This Fellowship, and the opportunity to work with you during the almost five years of my stay at the Mayo Clinic set the pattern and gave me, not only the vision, but the “working tools” with which to pursue my medical future”.12

  6. 18 August 1939.

  7. Dr Ochsner was also a primary mentor to Dr Michael DeBakey and was a major influence in his moving to Houston in 1948 to become the first Chair of the Department of Surgery at the newly relocated Baylor Medical School in the Texas Medical Center, just a short distance from where Dr Clark was planning the building of the MD Anderson Hospital (Fig. 5).27

  8. Most common non-colonic operations: 165 thyroidectomies, 43 cholecystectomies, 10 appendectomies, 19 gastric surgeries, 42 gynecological surgeries, 29 hernia repairs, 26 intestinal bypass procedures.

  9. By 1943, there were 2.4 million airmen in the Army Air Force that provided air combat and support until 1947, with the creation of the Air Force as a separate component of the military. Military airplanes were flying much faster and higher than ever before, creating new medical problems for airmen, including injuries from crashes, G-forces, and high-altitude frostbite. By the end of the war, the AAF had successfully acquired its own medical system oriented to the special needs of air warfare, with over 8300 doctors. This accomplishment reflected the determined leadership of AAF medical leaders and the dedication of thousands of medical practitioners who volunteered for aviation medical responsibilities that were often undefined or unfamiliar to them.36

  10. Seymour Johnson Field was activated on 12 June 1942 as Headquarters Technical School, Army Air Forces Technical Training Command, and, in 1943, with a secondary mission to prepare officers and men for overseas duty. More than 250,000 troops trained there during the war.

  11. Dr Clark recruited both Dr Edgar White and Dr Clifton Howe to the MD Anderson Hospital; Dr White became the Head of the Department of Surgery in May 1949 and Dr Howe became the Head of the Department of Medicine in July 1950.

  12. Wright Patterson Field expanded from 40 buildings to over 300 in 1944, with a workforce of over 50,000. It operated as the wartime center of aeronautical research, development, and procurement. The AAF Aeromedical Laboratory here developed the first flying suits. Here, the AAF housed more than 100 aircraft models, and, at its peak, had almost 80,000 planes on hand.44

  13. The Randolph Field School of Aviation has a long history of training pilots and engineers since it began in 1930. From 1941 to 1943, and again in 1945–1946, it housed Army Air Forces Central Instructors School (CIS), which trained instructors for ground schools, and instructor pilots (including civilian contract instructors) for all three phases of flying training. By the end of the war, the CIS had graduated more than 12,500 instructors. In 1945, primary pilot training was added for transitioning candidates to become B-29 bomber pilots and engineers (United States Department of Interior, National Register of Historic Places).

  14. The School of Aviation Medicine was created in Randolph Air Force Base in 1931 and became known worldwide for its work in research, experiments, and education of physicians and medical staff in Aviation Medicine. The School was responsible for the dissemination of all medical information to the AAF.49,50 Dr Clark was also trained to fly the B-29.55

  15. The Legion of Merit is one of the US Military’s most prestigious awards. It is one of only two decorations to be issued as neckwear, the other being the Medal of Honor.

  16. Alfred R. Shands Jr, MD, was a legendary orthopedic surgeon. He was the Founding Chair of Orthopedics Surgery at Duke Medical Center from 1930 to 1937. Dr Clark worked closely with him during the war, first as surgeons at the Army Air Force Hospital in Goldsboro, NC, and then on the Surgical Consultants’ Board of the Army Air Force.1 Colonel Shands became Chief of the Surgical Branch, Office of the Air Surgeon, Army Air Force (1944–1945). Later, Dr Shands was the Founding Medical Director of the Alfred I. DuPont Institute for Crippled Children, Wilmington, DE, and was President of the American Orthopedic Association in 1954–1955.

  17. Manford W. Comfort, MD, was a Professor of Medicine at the Mayo Clinic and President of the American Gastrointestinal Association in 1957. He was a native Texas who was also a friend of Dr Ernst Bertner, when he was Acting Director of MD Anderson Hospital.

  18. Dr Clark wrote: “The three chief aims of the project are the education, treatment, and research activities relative to the disease of cancer. These aims are the theme of the whole enterprise and are likewise the keynote of function of each single department”.62

  19. University of Texas Board of Regents minutes, 12 July 1946: “Upon the recommendation of President Painter and upon the motion of Mr. Bullington, seconded by Dr Terrell, the Board elected Dr Randolph Lee Clark as Director of the MD Anderson Hospital for Cancer Research at a salary rate of $12,000.00 for twelve months, effective August 1, 1946”.64

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  64. Minutes of the University of Texas Board of Regents Meeting, July 12, 1946. McGovern Medical History Library of the Texas Medical Center. Series VIII; Box 185: file 8.

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  1. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Charles M. Balch MD, FACS, FACSCO

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Balch, C.M. The Surgical Legacy of Randolph Lee Clark Jr, MD: First Surgeon-in-Chief and Director of University of Texas MD Anderson Cancer Center I. Training and Surgical Practice Before Recruitment to University of Texas MD Anderson Hospital. Ann Surg Oncol 28, 4782–4793 (2021). https://doi.org/10.1245/s10434-020-09511-5

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