Hugh Agnew Gamble, MD, FACS: A legacy to the College

Hugh Agnew Gamble, MD, FACS

Hugh Agnew Gamble, MD, FACS

Still from the film of a surgery performed by Dr. Gamble in the 1940s, Refrigeration Anesthesia in the Treatment of Arteriosclerotic and Diabetic Gangrene in the Poor Risk Patient.

Still from the film of a surgery performed by Dr. Gamble in the 1940s, Refrigeration Anesthesia in the Treatment of Arteriosclerotic and Diabetic Gangrene in the Poor Risk Patient.

Still from the film of a surgery performed by Dr. Gamble in the 1940s, Refrigeration Anesthesia in the Treatment of Arteriosclerotic and Diabetic Gangrene in the Poor Risk Patient.

Still from the film of a surgery performed by Dr. Gamble in the 1940s, Refrigeration Anesthesia in the Treatment of Arteriosclerotic and Diabetic Gangrene in the Poor Risk Patient.

Still from the film of a surgery performed by Dr. Gamble in the 1940s, Refrigeration Anesthesia in the Treatment of Arteriosclerotic and Diabetic Gangrene in the Poor Risk Patient.

Still from the film of a surgery performed by Dr. Gamble in the 1940s, Refrigeration Anesthesia in the Treatment of Arteriosclerotic and Diabetic Gangrene in the Poor Risk Patient.

Still from Refrigeration Anesthesia in the Treatment of Arteriosclerotic and Diabetic Gangrene in the Poor Risk Patient

Still from Refrigeration Anesthesia in the Treatment of Arteriosclerotic and Diabetic Gangrene in the Poor Risk Patient

Still from Refrigeration Anesthesia in Gangrene Bowel Resection, 1942

Still from Refrigeration Anesthesia in Gangrene Bowel Resection, 1942

Berry-Gamble Mechanical Cotton Picker in 1928

Berry-Gamble Mechanical Cotton Picker in 1928

Berry-Gamble Mechanical Cotton Picker

Berry-Gamble Mechanical Cotton Picker

Dr. Gamble’s ACS Fellowship certificate

Dr. Gamble’s ACS Fellowship certificate

A portrait of Dr. Gamble

A portrait of Dr. Gamble

Dr. Gamble's American Board of Surgery certificate, identifying him as a member of the Founders Group

Dr. Gamble's American Board of Surgery certificate, identifying him as a member of the Founders Group

Dr. Gamble

Dr. Gamble

The Mississippi Delta is defined as the 7,200 square-mile region stretching from Memphis, TN, to Vicksburg, MS, and lying in the alluvial floodplain between the Mississippi and the Yazoo Rivers. It is a storied, legendary place with an enduring influence on art, music, literature, cuisine, and culture, largely due to its socioeconomic history.1 It is perhaps an unlikely place for surgical success and medical innovation. However, Hugh Agnew Gamble, MD, FACS, who lived and worked in the Delta, became a nationally known surgeon who crossed racial boundaries in the Jim Crow South to provide all patients with high-quality surgical care. Dr. Gamble embodied professionalism and left a significant legacy to the American College of Surgeons (ACS).

Dr. Gamble’s family history laid the groundwork for his career. His father, William Gaston Gamble, MD, was born in 1834 in Wilcox County, AL. William Gamble graduated from the University of Alabama, Tuscaloosa, in 1855 and entered the University of Louisiana Medical Department, now Tulane University Medical School, New Orleans, graduating in 1860. During the Civil War, he served as an infantry private before he was confirmed as an assistant surgeon in the Confederate States Army in 1863. He served at hospitals in Auburn, AL; Catoosa County and Macon, GA; and Iuka, MS. Following the war, the senior Dr. Gamble practiced medicine in Saltillo, MS, before settling in Guntown in the northeast corner of the state in 1892, where he remained until his death in 1920. He married Iva Agnew in 1872 and they had seven children—two of whom, Hugh and Paul, became physicians.2,3

Education and early career

Hugh Agnew Gamble was born in 1876, near the end of the Reconstruction era, in Saltillo. He was educated locally in the public schools and then graduated from Mississippi Agricultural and Mechanical College, now Mississippi State University, Starkville, in 1898. He served in the First Mississippi Volunteer Infantry during the Spanish-American War. In 1899, he entered Vanderbilt University School of Medicine, Nashville, TN, completed the two-year course, and served a two-year internship at Natchez Charity Hospital, MS. Dr. Gamble then entered Tulane University School of Medicine and graduated in 1904.2 He did another two-year internship at Charity Hospital in New Orleans, where he trained under the renowned surgeon Rudolph Matas, MD, FACS, an ACS founder and Past-President. Dr. Matas is legendarily known as the “father of modern vascular surgery.” 4 Interestingly, Dr. Matas’ landmark pioneering operation in 1888, repair of a traumatic brachial artery aneurysm, was born from humanism. Dr. Matas opted for an untried procedure to avoid amputation for his patient, an African-American laborer, reasoning that he would need both arms to make a living and avoid becoming dependent on others. The operation was a success.4 This act of humanism would strongly influence Dr. Matas’ disciples, Dr. Gamble among them.

In 1907, Dr. Gamble settled in Greenville, MS, a river-port town in the northwest part of the state, and would remain there for the rest of his life. In his early years of practice, he delivered babies and made house calls on horseback and, after a time, he cultivated a remarkable surgical career.5

By the standards of the day, he was exceptionally well trained. He was an original Fellow of the College and later served as an ACS Governor. He was among the founders group of the American Board of Surgery, signifying his dedication to the high standards of quality care, professionalism, and ethics.6 He was a member of the Southern Surgical Association, Southern Medical Association, American Association of Railway Surgeons, American Association for the Study of Goiter, and the Southeastern Surgical Congress.6 He served as President of the Mississippi State Medical Association in 1929. He published 41 clinical articles in medical and scientific journals between 1910 and 1953, all while living and practicing in Greenville. Among these were articles on what we today know as abdominal surgery, vascular surgery, thoracic surgery, orthopaedic surgery, neurosurgery, trauma surgery, surgical oncology, endocrine surgery, anesthesia, and hospital and nursing care. His general surgical practice of the day could be described as “limited to skin and contents.”

In 1915, Dr. Gamble founded what would become a multispecialty clinic, the Gamble Brothers Clinic. Dr. Gamble provided surgical and gynecological care, and his brother Paul handled urologic cases. The specialties of eye/ear/nose and throat (EENT before it diverged into ophthalmology and otorhinolaryngology), dermatology, radiology, internal medicine, pediatrics, obstetrics, and pathology had been added by 1930. The clinic also employed anesthetists, a technician, and a physician who served as an assistant.5,7,8

When two members left the clinic and set up a local practice in 1935, the clinic enforced its non-compete clause, but it was not upheld in the local county chancery court. The clinic appealed to the Mississippi Supreme Court and prevailed. The two physicians left town, and the case is still cited as case law in Mississippi.8 The practice’s primary hospital facility, located adjacent to the clinic, was the white-only King’s Daughters Hospital. The clinic medical staff served as the faculty for the hospital’s nursing school.

Dr. Gamble maintained a longstanding interest in abdominal wound infection following contaminated surgery. He was an early advocate of open treatment of these wounds and, between 1925 and 1943, published six articles on his progressive experience and methodology with remarkably successful results in the pre-antibiotic era.9,10 Dr. Gamble successfully repaired arterial aneurysms (traumatic and syphilitic) before the advent of heparin.11 The breadth and depth of his surgical expertise is demonstrated by his report on repair of tracheo-esophageal fistula.12

An important friendship

Dr. Gamble’s many friendships included one with William J. Mayo, MD, FACS, which was likely fostered through their common professional societies. Dr. Mayo took semi-annual working vacations on the Mississippi River aboard the family yacht, the 124-foot North Star. The yacht was built for the Mayo brothers in 1922 at a cost of $105,000 and could accommodate 26 people.13 In the fall, they often sailed southbound to the Gulf of Mexico with necessary stops along the way. The Greenville stop was convenient to restock supplies and provisions and visit with Dr. Gamble and his colleagues. After the Great Mississippi Flood of 1927, the fall trip was made between October and November, and Dr. Mayo reported on the condition of the lower Mississippi River. Dr. Mayo visited the surgical infirmary of Drs. Hugh and Paul Gamble and reported on the relief work being done there.14 In 1929, the Greenville stop included a tour of the King’s Daughters Hospital with Dr. Hugh Gamble. Dr. Mayo complimented the hospital and medical staff as complete, modern, and advanced, with a national reputation.15

Dr. Mayo and his fellow travelers spent Saturday, November 14, 1931, in Greenville, “doing the town in a leisurely way” before “the men called on Dr. Gamble and visited clinics and hospitals.”16 The visits were reciprocated at the Mayo Clinic when Dr. Hugh Gamble visited his family’s Wisconsin lake cabin.5 Their correspondence between 1934 and 1938 reflected their ongoing friendship, mutual respect, and collegiality. Dr. Gamble sent a letter of introduction for a friend who was the physician in charge of a hospital at Tunda Station in the former Belgian Congo, and Dr. Mayo, welcoming him for a visit.

Dr. Mayo noted his moratorium on the Mississippi River trips due to the economic impact of the Great Depression on those around him. Nonetheless, the pair remained in contact during this period. They exchanged article reprints with comments, and Dr. Mayo encouraged Dr. Gamble to write and speak more often. They exchanged Christmas greetings, and Dr. Mayo expressed his appreciation for Dr. Gamble’s gift of “perfect” Mississippi pecans.17

Innovation

It is clear that Dr. Gamble loved his profession, and he continually explored ways to improve upon outcomes and results. In the early 1930s, he designed and constructed a patient carriage to maintain the Trendelenburg position after spinal anesthesia to optimize the effect and safety of the anesthetic.18 He also designed and had built a recumbent stationary bicycle-type exerciser, termed a “bedcycle,” for the prevention of the often fatal postoperative pulmonary emboli, and he advocated for early (day of surgery) postoperative mobilization.5,19,20

In the 1930s and 1940s, Dr. Gamble made a series of 16mm films, both color and black-and-white, of various operations. There were 12 complete films and 48 short films. The making of these surgical films likely reflected the influence of his mentor Dr. Matas, who first recognized the educational value of the cinematograph and reported his experience with this new teaching methodology in 1912.21 In 2004, the films, camera, and projector were donated to the College by Dr. Gamble’s grandson, Hugh A. Gamble II, MD, FACS. In December 2012, the films were digitized at the University of Chicago, IL. Thanks to the efforts of the College, two of the films are now online and available for viewing, with more planned to be accessible in the future.22 These films are expected to add to the rich and growing legacy of the College and the body of information being archived by the College in conjunction with the newly formed ACS History Group headed by LaMar S. McGinnis, Jr., MD, FACS.

Dr. Gamble also had a lifelong interest in agriculture and farming.2 It has been said that many physicians were involved in farming at the time Dr. Gamble was professionally active simply to make a living, as medical practice would often not generate sufficient income. Whether farming income supplemented medicine or medical income supplemented farming would likely require examination of the business ledgers, but it is hardly surprising that Dr. Gamble was involved in one of the pivotal developments in agricultural history—the mechanical cotton picker. Starting in 1922, Dr. Gamble financed the development of a mechanical cotton picker with local Greenville mechanics H. N. Berry and his son Charles. The Berry-Gamble Mechanical Cotton Picker picked the first large shipment of mechanically picked cotton to be shipped out of the area. The machine proved as effective in Arizona as it had in the Mississippi Delta. This endeavor continued over the next 30 years and produced more than 30 patents. Dr. Gamble had invested approximately $200,000 before International Harvester and John Deere & Co. were able to mass-produce simpler machines, although he did not receive any income for his efforts. The machine is currently on display in the Mississippi Agricultural & Forestry Museum in Jackson. 2,23

Hospital care

Dr. Gamble was deeply involved in the development of hospital care in the Delta. In his professional life, he witnessed the evolution from private sanitaria to segregated hospitals to hospitals built in accordance with the Hospital Survey and Construction Act of 1946, also called the Hill-Burton Act. This federal law provided government funding to hospitals provided certain criteria were met. These criteria included non-discrimination based on race but allowed separate but equal facilities. In 1953, the 200-bed Washington County General Hospital opened in Greenville with separate but equal facilities (100 beds + 100 beds).24 Dr. Gamble was instrumental in pursuing and accomplishing this via the Hill-Burton Act and was the first chief of staff of the hospital.6 The Delta Democrat Times, in a section devoted to welcoming the new hospital, proudly noted, “Qualified Negro doctors of the county, as well as white doctors will care for patients in the Negro wing of the hospital.”25 This was clearly intended to be a reference to quality of care, as African-American physicians did not provide care for white patients.

Dr. Gamble was instrumental in developing the Colored King’s Daughters Hospital in Greenville.26 As the only existing hospital in the city prior to 1953, King’s Daughters Hospital did not admit African-American patients. The Colored King’s Daughters Hospital was primarily a 65-bed charity surgical hospital that often exceeded its capacity.7 African-American physicians did not practice there, likely because of the charity care. The surgical care rendered appears to have been comprehensive and included such successful operations as pneumonectomy and repair of cardiac wounds. Dr. Gamble personally provided funding to the hospital and recruited the services of colleagues to provide care for these patients.7,26 He was able to conduct some degree of clinical research there, and all patients, rich or poor, received the same quality of care from him.

Dr. Gamble married Innes Starling in 1911 and had one son, Lyne Starling Gamble. Lyne Gamble finished medical school at Vanderbilt and embarked on an internship there, intending to carry on the family tradition of surgery. He had survived rheumatic fever as a child but sustained another episode as an intern. The elder Gamble and his friend Barney Brooks, MD, FACS, chairman of surgery at Vanderbilt University, Nashville, TN, conferred about the rigors of surgical training and its perceived impact on Lyne’s health. Subsequently, Lyne completed EENT training at Tulane and practiced ophthalmology in Greenville until his death in 1984 at age 72.27

“His full measure”

Dr. Gamble served his community as well as his patients. He was a Greenville City Councilman for 13 years and was an elder of the First Presbyterian Church of Greenville. He died of renal cancer in 1954 at age 77.

Dr. Gamble was much more than a rural community surgeon. He was instrumental in providing high-quality surgical care in the Mississippi Delta despite the obstacles of racial segregation and socioeconomic status in the Jim Crow South. As a practicing general surgeon he achieved professional success and national prominence in an unlikely rural setting, and he embodied the ideals of the ACS. He was memorialized by Eugene R. Nobles, MD, with the statement: “As a laborer in the field of medicine he gave his full measure.”28


References

  1. Trotter MC. Healthcare in the Mississippi Delta: A Journey of Historical Significance. Presentation at The Delta—Everything Southern! Conference. University of Memphis, Memphis, TN. June 8, 2012. Available at: www.memphis.edu/deltaconference. Accessed October 17, 2014.
  2. Black JT. The Gamble family. Delta Focus. Delta Democrat Times. Greenville, MS. 2011;23-26.
  3. Evers K. Asclepiad. J Miss State Med Assoc. 2012;53(11):392. Available at: http://issuu.com/jmsmamanagingeditor/docs/november_12_jmsma_epub_b4_press. Accessed October 17, 2014.
  4. Trotter MC. Rudolph Matas and the first endoaneurysmorrhaphy: “A fine account of this operation.” J Vasc Surg. 2010;51(6):1569-1571.
  5. Black JT. The Gamble family. Second in a series. Delta Focus. Delta Democrat Times. Greenville, MS. Spring, 2012;8-9, 40.
  6. Parsons WH. Hugh Agnew Gamble. 1876–1954. Trans So Surg Assn. 1953;65:410-411.
  7. Black JT. The Gamble family. Third in a series. Delta Focus. Delta Democrat Times. Greenville, MS. Summer, 2012;35-37.
  8. Black, JT. The Gamble family. Fourth in a series. Delta Focus. Delta Democrat Times. Greenville, MS. Fall, 2012;30-34.
  9. Gamble HA. Postoperative infection of the abdominal wall. New Orleans Med and Surg J. 1925–1926;8:208-213.
  10. Gamble HA. The application of the open treatment to all potentially infected abdominal wounds and results. Mississippi Doctor. June 1943;21:8-13.
  11. Gamble HA. Treatment of aneurisms by Matas’ method of endoaneurismorrhaphy—with report of six cases. Surg J. 1927;34(5):13-15.
  12. Gamble HA. Tracheo-esophageal fistula. Description of a new operative procedure and case report. Ann Surg. 1938;107(5):701-707.
  13. Bought as training ship. The Waterways Journal. Oct. 25, 1941;55:15.
  14. Report on Three Medical Societies: Remarks on Conditions on the Lower Mississippi River As a Result of the Floods. Proceedings of the Staff of the Mayo Clinic. 1927;2(49):289-291.
  15. Dr. Mayo, famous surgeon, spends a few hours here. Daily Democrat Times. Greenville, MS. April 6, 1929.
  16. MHU-0620: William James Mayo Collection. Subgroup 02; Series 8. North Star Log Book 1931–1933. Mayo Clinic Historical Unit, Rochester, MN.
  17. MHU-0620: William James Mayo Papers. Letters dated 1934–1938. Mayo Clinic Historical Unit, Rochester, MN.
  18. Gamble HA. Description of carriage for spinal anesthesia patients. So Med J. 1931;24(10):867.
  19. Gamble HA. The prevention of postoperative embolism and phlebitis. Am J Surg. 1935;28:93-95.
  20. Gamble HA, Barnes TG. Phlebitis and its prevention. Trans So Surg Assn. 1952;64:220-226.
  21. Matas R. The cinematograph as an aid to medical education and research. So Med J. 1912;5(8):511-527.
  22. American College of Surgeons. About ACS. Online Resources. Films. Available at www.facs.org/archives/films.html. Accessed August 3, 2014.
  23. Long-Staple Picker here. Arizona Farmer. January 3, 1953:10-11.
  24. Washington County opens fine new hospital. Delta Democrat Times. Greenville, MS. March 5, 1953.
  25. Medical staff of new hospital will be: All qualified doctors. Delta Democrat Times. Greenville, MS. March 5, 1953.
  26. Pohl L. Long waits, small spaces, and compassionate care: Memories of race and medicine in a mid-twentieth century southern community. Bull Hist Med. 2000;74(1):107-137.
  27. Black JT. The Gamble family. Sixth in a series. Delta Focus. Delta Democrat Times. Greenville, MS. Spring, 2013;14-15, 30.
  28. Nobles ER. Memorial Address Before the American Cancer Society, Mississippi Division, February 1, 1955.

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