Champ Lyons, MD The Ochsner Years: 1945–1950

INTRODUCTION

The heritage of leadership at the Ochsner Clinic Foundation has been steeped in the surgical disciplines since its founding on May 2, 1941. From the beginning, the cornerstone of the selection of staff physicians was superior ability and integrity.1 On the first letterhead, in addition to the founders, surgical giants such as Rudolph Matas and Michael DeBakey, among others, are listed.1 Perhaps less well known, but nonetheless important, was a young staff surgeon who in 1945 had been separated from the US Army.1 The Ochsner Clinic would serve as the final building block of a solid foundation to the pinnacle of a brilliant, but brief, academic surgical career.

EARLY LIFE AND CAREER

Benjamin Champneys Lyons was born in Lancaster, Pa, on May 21, 1907, and would always be known as “Champ.”2 When he was 3, his parents divorced, and his mother remarried Joseph Henry Lyons of Mobile, AL, in 1911. The family moved to Mobile, where he grew up.2 His uncle on his stepfather's side was Luther L. Hill, MD, the first American to suture a wound of the heart successfully.3

Lyons attended the University of Alabama, Tuscaloosa, and graduated with honors in the spring of 1927. He then entered Harvard Medical School, Boston, MA, in the fall of 1927 and graduated in 1931. During medical school, he developed an interest in bacteriology and infection. He remained at Massachusetts General Hospital and received surgical training under the renowned Edward Churchill, MD. During this time, he married Naomi Currier, a nurse at Massachusetts General Hospital, on October 3, 1934. He remained on the faculty after completion of his surgical training and continued to generate new information regarding surgical infection and antibiotics. He was in charge of the first use of penicillin in mass casualties, taking care of victims of the infamous 1942 Cocoanut Grove nightclub fire in Boston.4

With the outbreak of World War II, Lyons served initially in a consulting capacity as a wound surgeon and microbiologist. In April 1943, he was placed in charge of a pilot project studying the use of penicillin on all wound infections from the Pacific theater at Bushnell General Hospital in Brigham, UT. This was so successful that he repeated the performance at the Halloran Hospital in Staten Island, NY, for soldiers of the European theater later that same year.5 Following this, he was commissioned a major and entered service in August 1943 and served under Colonel Edward Churchill in the Mediterranean theater of operations. One of his new associates was Michael DeBakey. Lyons performed admirably and was awarded the Legion of Merit.3

OCHSNER

In May 1945, Lyons contracted a severe case of infectious hepatitis and was treated at Walter Reed Army Medical Center, Washington, DC, receiving his military discharge there on June 21, 1945. He returned to Mobile to recuperate. Once recovered, his close military associate DeBakey arranged a meeting with Alton Ochsner, and Lyons was invited to join the Ochsner Clinic on October 1, 1945 (Figure 1). Having been raised in Mobile, Lyons must have considered an opportunity to return to the Gulf South to continue his career in academic surgery a perfect situation. Lyons was also appointed associate professor at Tulane University School of Medicine, New Orleans, LA, under Dr. Ochsner. He worked initially in a research and teaching environment with Dr. Ochsner until he received his Louisiana medical license in March 1946. He then began the clinical practice of surgery.3

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Figure 1 Alton Ochsner's letter to Champ Lyons (courtesy of Hon. Champ Lyons, Jr., reproduced with permission).

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Figure 2 Champ Lyons during his Ochsner years (courtesy of Ochsner Clinic Foundation Medical Library and Archives, reproduced with permission).

With Alton Ochsner, Champ Lyons, and Michael DeBakey on the faculty, spirited academic surgical interchanges would occur during the various conferences. Only with Dr. Ochsner present would these sometimes heated surgical debates tend to moderate and cool off.

The years at Ochsner enhanced Lyons' reputation for academic productivity and investigation, as well as his clinical acumen (Figure 2). He continued building the outstanding surgical career that began at Harvard Medical School and evolved through surgical training at Massachusetts General Hospital and his World War II experience with the US Army. At Ochsner, his interests centered on patient care and research. Although much was happening from an administrative and political standpoint relative to the growth and development of the clinic and hospital, Lyons seemed somewhat uninvolved in these activities. Rather, he focused on clinical surgery and surgical research. His venues included the original Ochsner Clinic on Prytania Street and the research building next door, the Foundation Hospital (“Splinter Village”), Touro Infirmary, and Charity Hospital.

In 1946, Lyons established penicillin as the most acceptable antibiotic to be used adjunctively to surgical debridement.6 He also demonstrated the prophylactic use of penicillin in gynecologic surgery and pelvic infection and began to use streptomycin with it.7 The neophyte specialty of infectious disease was emerging, and much like the initial reaction of cardiac surgeons some years later regarding balloon angioplasty (“it will never work”), Lyons declared with surgical dogmatism that “chemotherapy is solely an adjuvant to surgical competency in wound management.”8 In 1947, he initiated the hospital's research program by establishing a metabolism unit.1 He accurately advised excision of the affected vein in septic thrombophlebitis as opposed to ligation. He retained his appointment at Tulane and, with his Tulane colleagues, described a clinical syndrome of “chronic shock,” especially in patients with cancer, that included weight loss, decreased blood volume, reduced blood protein, and increased interstitial fluid volume. He and his colleagues believed that these patients were poor surgical candidates and could benefit from preoperative preparation.9 Transfusion of whole blood would work well toward this end. Lyons became interested in congenital heart disease after the introduction of the Blalock-Taussig shunt. Along with his colleagues, he demonstrated decreased red blood cell volume in Tetralogy of Fallot patients within a few weeks after surgery.10 With coworkers, he found penicillin to be the agent of choice for actinomycosis.11 He and a coauthor published an article on the surgical management of ileal atresia in a newborn in whom systemic penicillin was used to prevent peritonitis.12 During Lyons' tenure, the Ochsner training program for fellows was approved in April 1947 by the Council on Medical Education and Hospitals of the American Medical Association and by the American College of Surgeons.1 It is almost certain that Lyons was closely involved in this effort.

In 1948, he and a coauthor described radical debridement and systemic penicillin for suppurative fasciitis caused by hemolytic streptococcus.13 Lyons recommended penicillin and streptomycin for peritonitis combined with excision of necrotic tissue and correction of any bowel fistulae.14 Using phosphorus 32, he and his Tulane colleagues demonstrated direct measurement of the total circulating red blood cell volume.15–17 Lyons postulated a technique for the nonsuturing control of hemostasis and coaptation of wound edges.3 He and a coauthor demonstrated that catgut sutures produced an undesirable inflammatory reaction.18 Lyons preferred fine cotton in his practice and postulated that nylon may cause an undesirable hypersensitivity reaction.3

In 1949, Lyons published a study on fluids and electrolytes in surgery,19 making recommendations that are still in vogue today. He and his colleagues also performed experimental work with amino acids, nitrogen metabolism, and nutrition as they relate to the surgical patient,20 helping lay the groundwork for further studies of nitrogen metabolism. Lyons' surgical abilities were clearly demonstrated by a remarkable trauma case on November 18, 1948, in which a young man from Poplarville, MS, had become impaled through the chest with a 2 × 4 timber bridge railing when a car in which he was a passenger hit a bridge near Bogalusa, LA. On arrival of the patient at the Ochsner Foundation Hospital, his only hope was to be taken emergently to the operating room, where Lyons was prepared for his arrival. The injuries included multiple rib fractures, lacerated lung, ruptured diaphragm with stomach herniation, splenic injury, and soft tissue loss. The surgical approach connected the entrance and exit wounds, and the operation included removal of the timber remnant, splenectomy, repair of the ruptured diaphragm and other torn tissues, and chest wall closure. The patient survived and 30 years later was alive and well in Poplarville.21

By all accounts, Lyons' Ochsner years were happy and prosperous. He published 21 articles and enjoyed collegiality with such surgical associates as Alton Ochsner, Michael DeBakey, Mims Gage, and J.D. Rives. His 2 sons attended Isadore Newman School in New Orleans, and his older son would return to New Orleans years later as a Tulane medical student. John Ochsner recalls Champ Lyons as a knowledgeable and well-respected surgeon who could be autocratic but also a loving and attentive father.3 The final building block to the pinnacle had been set, and Lyons now had behind him a pioneering, insightful, and worthwhile body of work.

ALABAMA

On October 3, 1949, Roy R. Kracke, dean of the Medical College of Alabama, invited Lyons to consider coming to Birmingham as professor and chairman of the Department of Surgery. On November 18, Lyons interviewed and agreed, effective January 1, 1950, to begin the new position.3 Much like his college friend, Paul “Bear” Bryant (who would later return “home”), Lyons undoubtedly believed that the opportunity to return to a desirable position in his native state should not be missed. Lyons' publishing productivity reflected the Ochsner years, as several articles written with his colleagues in New Orleans appeared after he had departed.22–24 Lyons was the first full-time Chairman of the Department of Surgery of the Medical College of Alabama (subsequently the University of Alabama at Birmingham). He was also the first full-time faculty member of the medical school since its relocation from Tuscaloosa in 19453 and was instrumental in building and developing its renowned Department of Surgery. As his professional accolades accumulated, Lyons continued to receive the friendship and support of Alton Ochsner and returned to Ochsner as a Guest Speaker in April 1964.25 Lyons' career at Alabama was initially recounted by Tinsley Harrison, MD,26 and was later chronicled by definitive biographer Martin Dalton, MD.1,2

In July 1965, Lyons was noted to have left facial weakness by his residents, of which he was unaware. A brain scan confirmed a left cerebral lesion. In August 1965, craniotomy confirmed a grade IV nonresectable astrocytoma.3 He died on October 24, 1965, at age 58.

EPILOGUE

Champ Lyons became a surgeon's surgeon. By definition, he was a surgical giant.27 The Ochsner Clinic would become renowned for cardiovascular surgery under the direction of Dr. John Ochsner. The University of Alabama at Birmingham would also become renowned for cardiovascular surgery under the direction of Dr. John Kirklin. The dedication, hard work, attention to detail, and productivity, both clinically and academically, of Champ Lyons during his Ochsner years furthered the surgical traditions started by Alton Ochsner and provided a final step to the pinnacle of his career, which was the foundation of the outstanding Department of Surgery at the University of Alabama at Birmingham. Some of my mentors were trained by Lyons, and the heritage of an exemplary surgeon and teacher remains intact and has been passed down. Although his tenure at the Ochsner Clinic was brief, it was nonetheless outstanding. It is fortunate that this bright shining star of post-World War II American surgery influenced, and was influenced by, Ochsner. It adds a remarkable heritage and a strong legacy to the vibrant history of the Ochsner Clinic.