The distinguished service award medal of the Society for Vascular Surgery: Richard Warren's legacy to vascular surgery☆☆☆
Article Outline
Abstract
J Vasc Surg 1999;29:382-4.
Some years ago, I arrived in Boston, a poor young man with an empty bag of knowledge but with an eager spirit, anxious to breathe in the atmosphere of an institution highly renowned as a learning center. After some years at the Peter Bent Brigham, at Children's Medical Center, and at Harvard Medical School, I left Boston a rich man—rich not in material goods but in treasures of friendship, good fellowship, and experience. I learned there how some good men have become great men.
My first encounter with Dr Richard Warren (Fig. 1) was in 1957.
Fig. 1.
Dr Richard Warren.
In these pages, we honor an individual who represents the high principles of those men who have strived to keep our profession above the dark level of a commercial enterprise. Richard Warren belongs to a family of pioneer physicians and surgeons of New England who have made many contributions to medicine and surgery of the New World since the 18th century. His forebears came in the Mayflower and settled in Massachusetts. Their work has had a major and lasting impact on the history of our medical profession. Among the contributions of the doctors Warren who preceded Richard Warren are:
John Warren (1753-1815) founded the Medical School of Harvard University and also the Massachusetts Medical Society and was the first professor of Anatomy and Surgery at Harvard.
His son, John Collins Warren (1778-1856), was the cofounder of the Massachusetts General Hospital and its first surgeon. In 1846, he performed the first operation with ether anesthesia.
Jonathan Mason Warren (1815-1867) performed the first free transplant of human skin at the Massachusetts General Hospital.John Collins Warren (1842-1927) introduced surgical asepsis at the Massachusetts General Hospital and, in 1889, performed the first “clean” operation, designed to prevent infection, in the new operating room. With Henry Bowditch, he established the new Harvard Medical School in 1906.
Richard Warren was born in Boston in 1907. Few men have entered the challenging field of medicine with greater advantages than Dr Warren. To a handsome presence and a dynamic personality were added intellectual gifts of honesty, intelligence, and perseverance, which alone predict success. The formidable accomplishments of his ancestors must have been a challenge for Dr Warren. However, they were not a deterrent for his ideals. In 1932, he married Cora Lyman, with whom he had four children: Janet, Constance, Richard, and John. Cora died in 1983, and, in 1984, he married Kathleen, the widow of his close friend and colleague, Professor John Kinmonth of St Thomas's Hospital, London.
Dr Warren graduated cum laude from Harvard Medical School in 1934. He completed his surgical training at the Massachusetts General and Peter Bent Brigham Hospitals. After a productive fellowship in gastroenterology at the University of Pennsylvania, at the time considered to be one of the outstanding teaching universities in the country, he returned to Harvard and to Massachusetts General where he became Attending Surgeon and Clinical Professor of Surgery. Then came the second World War. He served in the Army Medical Corps for 4 years, joining a team of surgeons and nurses from Harvard and the Brigham who served as the 105th General Hospital, stationed first in Northern Ireland and then in Salisbury, United Kingdom. Dr Warren was Chief of Surgical Service. The Surgeon General, in making a tour of that hospital, was so impressed by the work of Dr Warren that he gave him a “battlefield promotion” from Major to Lieutenant Colonel. At the end of the war, he became Chief of Surgery and later Chief of Cardiovascular Surgery at the West Roxbury VA Hospital. Dr Warren's lively enthusiasm was the flame that ignited and kept alive in his collaborators the desire to work hard with honesty towards a clearly identified goal.
Dr Warren was appointed Clinical Professor of Surgery at Harvard and Tufts Medical School and also Staff Surgeon at the Peter Bent Brigham Hospital and Children's Medical Center in Boston. His professional stature and accomplishments led him to occupy the position of Chief of the General Surgery Section at the Veterans Administration Central Office in Washington, a position which he held for 16 years. As Director of Surgery, Dr Warren provided strong leadership in bringing the Cambridge City Hospital of Boston into the family of Harvard Teaching Hospitals as an effective unit. He was a major figure in the planning and reconstruction of new facilities and in the structure and staff organization of the Cambridge City Hospital in Boston. His peers have recognized his outstanding achievements. He was President of The New England Surgical Society, The Boston Surgical Society, The Society for Vascular Surgery, and Vice President of the prestigious American Surgical Association. His excellence in writing led him to the position of Editor-in-Chief of the journal Archives of Surgery. Since 1971, he has been a Professor of Surgery Emeritus at Harvard Medical School.
During his professional life, Dr Warren wrote three books and 242 publications—46 of which were published in the New England Journal of Medicine. His writings encompass the whole spectrum of surgery. In his early years, he published on gastrointestinal surgery,1 a reflection of his Pennsylvania training. However, his heart and soul were in cardiovascular surgery, a field to which he dedicated the best years of his life. Shortly after returning from the war in 1946, he published War Wounds of Arteries2 and stated that vascular injuries need to be repaired. This concept was re-emphasized in 1952 in his Consultant's report during the Korean conflict.3 There were many publications on the fundamental mechanisms and basic science behind the phenomena of blood coagulation, thrombosis, and fibrinolysis. The prevention and treatment of pulmonary embolism exerted on him a particular fascination. His deep interest in thromboembolism led him to establish guidelines for the management of acute pulmonary embolism at the Peter Bent Brigham Hospital. Pulmonary embolectomy without cardiopulmonary bypass had been performed without long-term success in the European operating theaters and in the United States. Dr Warren performed the first successful pulmonary embolectomy with long-term survival in the United States in 1957. This report was published in 1958.4
Thousands of amputees owe their limb reconstructions and well being to Dr Warren's keen interest in their rehabilitation and his special interest in this subject. From all corners of the world, all of those who trained with Dr Warren carried with them, like benign metastases, the seeds of his teachings on amputations. His book on Lower Extremity Amputations for Arterial Insufficiency5 is a compendium of wisdom and experience. In collaboration with Drs David Littmann and Arthur Sasahara, he developed new methods of coronary angiography and coronary reconstruction with arterial venous patches. Arteriosclerosis, coronary surgery, arterial reconstruction, thromboendarterectomy, and surgery of the venous system were subjects that were beautifully taught and elegantly performed in his service.
The reflections of his friendship with Professor Kinmonth led him to study the lymphatic system. As early as 1957, Dr Warren and I designed an instrument to measure lymphatic pressures and performed the tedious and exacting direct lymphangiography in many patients. Dr Warren was one of those rare cardiovascular surgeons with a balanced interest in the cardiac, arterial, venous, and lymphatic disorders.
However, it was the venous system, the “Cinderella” of the vascular system, that received his distinct attention. A great deal of investigations on the superficial and deep venous systems led to the first publication on the subject of ambulatory venous pressures in normal, varicose, and post-thrombotic limbs.6, 7 The first efforts towards reconstruction of the venous system for post-thrombotic damage saw the light in his laboratory, where he led a dedicated team of fellows. His pioneer work with transplantation of the saphenous vein for postphlebitic obstruction began in 1949 and was written about in the journal Surgery in June of 1954.8 Some of the initial work on reconstruction of the large veins with compilation venous grafts, the use of autogenous vein patches for arteriotomy closure, and the use of venous bypass grafting for post-thrombotic obstruction were among procedures first performed in his surgical service. A great deal of his time and publications were dedicated to the subjects of graduate surgical education, foreign medical graduates, and medical writing.
In the midst of his multiple activities, Dr Warren found time to sail and race with his friends. He navigated and skippered his boat three times across the Atlantic, long before this had become an every day occurrence. In the years of retirement, not satisfied with his extensive work on the human vascular tree, he devoted himself to the classification and identification of the coniferous trees of the Arnold Arboretum in Boston, where he updated and re-edited Sargent's Manual of Trees.9 He worked in the verification project to update and verify the Arboretum's lists and records of the plants growing on its 265 acres. In Dedham, where he still lives, he created a small pinetum of over 200 different specimens of conifers.
This brief account of Dr Warren's personal and professional achievements must also include mention of the kind and genuinely human interest that he constantly demonstrated for the well being of his students, residents, and collaborators. To Dr Warren, the study and teaching of surgery were absorbing passions. He chose the path of excellence and pursued it with honesty and unswerving devotion. His mind was always alert to new avenues. An indomitable energy propelled him in the midst of overwhelming tasks to keep alive the flame that he had lighted in his students and collaborators. He was an exemplary mentor who was always willing to communicate with the student. Since my years in Boston, I have met many colleagues and I have seen many teachers, but I have never known one in whom the stern sense of honesty and duty were more happily combined with the ever present freshness of mind than in Dr Richard Warren.
To close this tribute to a remarkable man, let me share with you a paragraph from one of the first letters that Dr Warren sent to me shortly after my return to Mexico. This represents an advise to the young physician that was sound then, is good now, and will be true forever:
“In the years to come, I would hope that you will be known as an academic leader who puts out very careful, controlled and beautifully presented contributions rather than the man who does more cardiovascular surgery than anyone else in Mexico. I do not think that contributions need to be measured in quantity but rather in quality.” (Written communication, December 1962).
References
- . Hepatic origin of plasma-prothrombin. Observations after total hepatectomy in dog. Am J Med Sci. 1939;198:103–197
- . War wounds of arteries. Arch Surg. 1946;53:86–99
- . Surgical visit to the far east. The News (Massachusetts General Hospital). 1952;
- . A new look at pulmonary embolectomy. In: SG & O. 107:1958;p. 214–220
- In: Warren R, Record EE editor. Lower extremity amputations for arterial insufficiency. Boston: Little, Brown and Company; 1967;
- . Venous pressures in the saphenous systems in normal, varicose and postphlebitic extremities. Surgery. 1949;26:435–445
- . The walking venous pressure test as a method of evaluation of varicose veins. Surgery. 1949;26:987–1002
- . Transplantation of the saphenous vein for postphlebitic stasis. Surgery. 1954;35:867–876
- . The Fire pines. Arnoldia. 1978;38:1–11
☆ Reprint requests: J. Leonel Villavicencio, MD, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD 20814-4479.
☆☆ 0741-5214/99/$8.00 + 0 24/39/95741
PII: S0741-5214(99)70392-7
© 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter. Published by Elsevier Inc. All rights reserved.
