The surgical legacy of Lee Clark

By Charles M. Balch and Bryant Boutwell

With rotating internships completed in December 1933 at Garfield Memorial Hospital in Washington, D.C., Drs. Lee and Bert Clark headed for Europe to round out their education. In Paris, he trained for two years as a surgical resident at the renowned American Hospital, the only private hospital in the city. Bert trained as an obstetrical resident at Tarnier Maternity Hospital, later switching to anesthesiology.

For Lee Clark, the American Hospital opened important doors, including the opportunity to spend time at the Institut Pasteur and the Radium Institute under the direction of Marie Curie. The holder of two Nobel Prize awards, Curie was in the last year of her life, dying July 4, 1934. At the Radium Institute, he saw firsthand the potential for developing a new treatment modality using irradiation to destroy cancer cells. Clark found Curie’s work transformational and was determined that the deadly power of atomic warfare could be harnessed as a healing tool.

Together, the young couple made time to explore Paris and Europe in the little spare time they had. For a Texan in Paris, it was a cultural awaking as he and Bert used every available moment outside the hospital to explore the sights. In his words, “We would do what we called ‘going bistroin.’” That, he explained, involved identifying a famous site around Paris they wanted to see and riding the metro to get there as fast and frugally as possible. 

“Then we’d start walking back and we’d stop at every bistro along the way and have a glass of wine,” he recalled. “By the time we were halfway home, we’d be talking freely with the natives, trying out our French on them.” 

We tend to think of Lee Clark foremost as a talented cancer surgeon. His professional activity during his postgraduate training and early career, however is a story of general surgical practice combined with an intricate knowledge of internal medicine. This was a time of little surgical specialization, limited availability of antibiotics and few options for cancer treatments other than surgical excision. General surgeons of that day had to be well-versed with a deep appreciation of body systems that was the hallmark of a good clinician.   

The American Hospital, staffed by faculty from the University of Paris Medical School, gave residents training opportunities at affiliated hospitals. As chief resident in surgery at the Salpêtrière Hospital in Paris in 1934, Clark had a chance meeting that would influence his career in monumental ways. Dr. Claude Dixon, head of general surgery at the Mayo Clinic, happened to cross paths with Clark, who offered his new acquaintance a tour of the American Hospital. The two would become friends for life. Dixon would become his primary mentor throughout his career, first encouraging him to come to Mayo Clinic for training (April 1935-October 1939), then advising him regularly about his general surgery practice in Jackson, Mississippi (1939-1942). It was Dixon who later first advocated for Clark’s appointment as director and surgeon-in-chief of the new M.D. Anderson Cancer Hospital. 

At the Mayo Clinic, Clark’s general surgery surgical experience was prodigious and extensive. He had been involved in 2,000 operations at the Mayo Clinic, and cancer cases were about two-thirds of this caseload. He was Dixon’s first assistant for 18 months, and he shined. Dixon described Clark as “one of the most outstanding young men we have ever trained,” adding, “He also is one of the very few men who is both an excellent clinician and an outstanding surgeon, and who at the same time has maintained a keen interest in research.” 

Advocating for Clark to lead the new cancer hospital in Houston, Dixon wrote in his recommendation letter, “I do not have the slightest doubt that he will develop into one of the great leaders in the profession.”

Dr Albert C. Broders, who was director of surgical pathology at the Mayo Clinic (1912-1959) and known for his work establishing a tumor grading system used worldwide, had this to say: “Dr. Clark is one of those rare individuals in whom is combined imagination, sound judgment, energy, technical skill and integrity which is at all times above reproach.”  

Even the legendary Dr. Will Mayo was interested in recruiting him to stay on as a member of the Mayo Clinic surgical staff once his surgical training was complete. Yet the two Drs. Clark had other plans and left Rochester, Minnesota, for Jackson, Mississippi, to raise their two young children in the South.

Fate offered a unique opportunity for Clark to fully utilize his surgical skills in Jackson, Mississippi, where he became the chief surgeon in a private clinic with three surgical partners. This opportunity, which drew from a large geographic area with 70 primary care physicians, arose when one of the clinic’s senior surgical partners tragically died in an auto accident. 

Beginning in October 1939, Clark quickly developed a prodigious surgical practice at Mississippi Baptist Hospital, with his wife as his primary anesthesiologist. His caseload comprised mainly cancer surgery, as it had at the Mayo Clinic. 

“Since my arrival here, we have had over a thousand surgical cases,” he said. “There is an abundance of pathology in these parts, and I have recently had quite a few neurosurgical cases.”  

He described his practice in 1942 in two letters. He wrote the first when he applied for his commission in the Air Division of the Army Medical Corp: “I have done a large volume of surgery in private practice since I left the Mayo Clinic nearly three years ago, having done more than 600 major operations a year, of all types – from the brain to the colon.”   

Upon returning from patient rounds one Sunday morning, he learned Pearl Harbor had been attacked. While he was deemed essential to remain a physician in Jackson, “service” was a word Clark knew well: “I asked to be relieved of my responsibilities in Jackson and went into the Army Air Corps Medical Department.”

After receiving his commission, he wrote to Dixon at the Mayo Clinic: “I am enclosing a list of patients I had in the hospital on the day I received my (Army) Commission. All of these patients were on my personal service, and I had operated upon them personally, and, as you will see, there is considerable variety. I have been very pleased all along with the great amount of pathology that I have seen since working in Mississippi. ... We had no mortality on this list. I must admit, however, that this was the biggest list to date, though I have consistently had over 25 postoperative patients in the hospital for the past year and a half.” 

Years later, he summarized his Mississippi surgical practice in one sentence: “We were there two years, and I did over 1,000 major operations, of which a disproportionate number were cancers or tumors.” Bert was equally herculean in her work ethic, having performed over 1,400 anesthesia procedures during the same two-year period, many of those as her husband’s anesthesiologist.  

Surgeons were expected to be “board certified” after completion of surgical training plus two years of surgical practice. In January 1942, Clark applied to take the American Board of Surgery exam. As required, he listed his caseload of 820 operations at Mississippi Baptist Hospital, including 411 “colonic surgery” with 43 deaths (10.46% mortality) and 409 cases listed as “others,” with eight deaths (1.9%), for a total mortality rate of 6.2%. The most common causes of postoperative deaths, he noted, were peritonitis (14 patients), sepsis (7), intestinal obstruction (7), embolus (6) and pneumonia (5). These outcomes are truly remarkable, given the diversity of caseload in every anatomic area. He was, at the time, the only surgeon between New Orleans and Memphis performing these large-scale operations. Even more impressive, he had only sulfa antibiotics to treat surgical infections. 

In the Army Air Force (AAF), Captain Clark was promoted to the rank of major in October 1943. In March 1944, he was appointed as a member of the Surgical Advisory Board to the Air Surgeon and as one of five consulting surgeons for the entire AAF Medical Services. 

In 1944, he was transferred to Wright Patterson Field in Dayton, Ohio, as chief of the experimental surgical unit, where he supervised surgical experiments and clinical application of surgical problems in aviation medicine. He was editor of the Air Surgeons’ Bulletin, which was distributed to all Air Force physicians. He was an educator at heart, so it seems only natural that in 1949 he would retool the concept and reach of the Air Surgeon’s Bulletin as the Cancer Bulletin at MD Anderson. During his military service he also developed an animal surgery laboratory with experimental programs studying frostbite, arterial anastomosis, skin grafting and effects of various chemotherapy and biological agents on tissue growth and wound repair.  

In addition to significant trauma research, Clark and his colleagues conducted research on vascular and orthopedic injuries resulting from parachuting. When he learned that two of every eight men who parachuted from an airplane died, and four were injured, he made up his mind to fix that problem. 

“We worked on this [parachute injuries] and on the trauma associated with the forces resulting from crashes,” he recalled. “We worked on ways of anastomosing blood vessels and other things to keep from losing legs. For the first time in the history of wars … there was a real opportunity to save legs and arms and lives.”  

His results, published in the Annals of Surgery, covered a host of timely topics in aviation medicine, including aircraft accident casualties, enemy gunfire, parachute injuries, frostbite at high altitude and the recommended surgical treatment for each.  

His final assignment in the AAF was at Randolph Field Air Base in San Antonio. He served as director of a newly formed department of surgery at the 250-bed station hospital and as director of experimental animal surgery at the AAF School of Aviation Medicine, where he was surgical consultant for the 17-state U.S. central district. From December 1944 until his discharge in July 1946, he frequently performed major surgery on enlisted military and their dependents, treating trauma, hernias, gallstones, appendicitis, varicose veins, gynecologic conditions and head and neck pathologies.

From Paris to the Mayo, from Mississippi to the military, Lee Clark’s training was stellar. His surgical expertise was vast and his network of mentors, leaders in academic medicine and the military, was impressive and diverse. As his military career came to a close in 1946, the story of the new cancer hospital in Houston was just unfolding. Ernst Bertner was hard at work at the Oaks and reminding The University of Texas president and UT System Board of Regents to find his replacement so he could assume leadership to build the Texas Medical Center. Clark knew little about the new cancer hospital and pondered his future after his military service. Little did he know that the UT Regents were soon to put him on their radar as they searched for the cancer hospital’s permanent director.

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