Biography: Henry T. Randall, MDDepartment of Surgical Research, Rhode Island Hospital, Providence, Rhode Island Correspondence: Jorge E. Albina, MD, Department of Surgical Research, Rhode Island Hospital, 593 Eddy Street, NAB-217, Providence, RI 02903. Electronic mail may be sent to albina{at}brown.edu.
The physiologist has become clinically oriented, and the clinician physiologically oriented so that now the practice of surgery demands a practical knowledge of surgical physiology including the changes produced by surgical diseases and by operations. Born in New York City, August 29, 1914, Dr Henry Thomas ("Tom") Randall was educated at Princeton and the Columbia University College of Physicians and Surgeons (Figure 1). He completed his surgical internship at Columbia Presbyterian Hospital in 1941. Randall became an Army Medical Officer in 1942 and landed in Normandy 6 days after D-day with the 83rd Infantry Division. He was twice awarded a Bronze Star with Oak-Leaf Cluster before his discharge as a Lieutenant Colonel in 1945. He returned to New York to complete his surgical residency and then joined the faculty of Cornell University Medical College in the Department of Surgery. He quickly rose through the ranks to become Professor of Surgery and Chairman at the Sloan-Kettering Memorial Institute in 1951.
In January 1948, a surgical metabolic unit was established by the Department of Surgery at New York Presbyterian Hospital. The unit allowed for detailed metabolic balance studies on surgical patients. The centerpiece of the unit was a flame photometer that afforded rapid and accurate measurements of electrolytes in biologic samples. Although such equipment may strike younger readers as trivial when compared with current laboratory technology, its availability in a clinical department was revolutionary for its time, having been invented in late 1946. A large number of publications authored by Dr Randall stemmed from the metabolic unit and from his further work at the Division of Experimental Surgery at Memorial Hospital, describing the pathophysiology of fluids and electrolytes in surgical patients. Notable among these papers was the first report of potassium deficiency in surgical patients,1 fluids, electrolytes, and acid-base physiology,2–4 and alterations in nitrogen and mineral balances after surgery,2,5,6 trauma,7,8 and shock.9 Randall's New York years were remembered by Dr Blake Cady, an internationally recognized surgical oncologist, in 1997: "Tom Randall was a gentle and intellectual man. As a senior medical student, I did a research rotation at the laboratory at Memorial Hospital, which he ran along with Parker Vanamee and Kay E. Roberts. The weekly research meetings were witty, informative, challenging, and fun, as Tom pushed the laboratory along in an exploratory and adventuresome way, looking at aspects of human physiology and electrolyte management, the major focus of the lab. He was a tall, slightly stooped, cheerful figure who was extraordinarily productive in the laboratory. For a period of time, his was one of the top research laboratories in the world studying human electrolyte physiology."
A different facet of Randall's personality and abilities is illustrated by reminiscences from his son, Hank Randall: "When we all lived in New York City, Dad had a Christmas tradition: as soon as we had finished opening presents Christmas morning, I would get dressed up and Dad and I would go over to Memorial Sloan Kettering where he was chief. We would do a tour of the wards and wish a Merry Christmas to the patients who were too sick to go home for the holidays, and a particular thank you (and Merry Christmas) to the nurses and staff who had to be there to keep an eye on the patients. Pop always seemed to have a special place in his heart for the nurses and staff and always spoke of how they were the ones who delivered the moment-to-moment care, while the doctors were really there to advise them. Every summer the family would go up to Saranac Lake in the New York Adirondack Mountains. Memorial owned a piece of property up there (a former Rockefeller hunting lodge) and the chiefs were allowed to use it for summer vacations, so we all would spend a month or so up in the `woods' at this amazing piece of property. At that time, we owned a Ford station wagon that had real wood trim along the sides. One piece or another of the wood was always rotting out during the winter, so every summer Pop would retire to the very extensive woodworking shop at the lodge and carve a replacement part for whichever section of the wood trim needed to be replaced. He'd shape the basic piece with power tools, and then carve the details by hand. As kids, our job was to chew gum so he could stick the nuts (which, with the screws, held the trim on the body of the car) on the inside of the fender, door, wherever the piece belonged. Occasionally, the gum would fail and a nut would fall down inside a door or fender. It was then when I gained my knowledge of the more colorful aspects of the English language from my father. Still, he persisted and the car always looked new when he was done." Dr Randall moved to Providence, Rhode Island, in 1967 as Professor of Medical Sciences at the Division of Biology and Medical Sciences at Brown University and Director of Surgical Research at Rhode Island Hospital (1967–1976). He served as Surgeon-in-Chief at Rhode Island Hospital from 1970 until 1979. At the time of Randall's arrival at Providence, Brown had developed a 6-year program in medical science that included all requirements of the first 2 years of a medical school curriculum. Randall was one of the principal driving forces behind the establishment of the Brown Medical School in its present form and in the integration of surgical training programs through the Brown-affiliated hospitals in Rhode Island. He was the Chairman of the Section of Surgery at the Division of Medical Sciences at Brown between 1971 and 1979. Dr Randall's involvement in enteral nutrition and in the development of elemental or chemically defined diets started soon after his arrival at Rhode Island Hospital. As Randall described in his Jonathan E. Rhoads Lecture at the sixth annual A.S.P.E.N. conference,10 "In December of 1967, H. St. J., a 63-yr-old man with a history of auricular fibrillation and peripheral vascular disease was referred to Dr William R. Thompson of the general surgical staff, with acute abdominal pain of short duration. It was evident that he had an acute and life-threatening intraabdominal emergency, and at laparotomy was found to have infarcted and early gangrenous small bowel from shortly distal to the ligament of Treitz to midtransverse colon. All of the devascularized bowel was resected and a short jejunal segment of 4 cm was anastomosed to the left transverse colon. A central venous line was placed and parenteral nutrition (PN) begun." Rather than accepting long-term PN as inevitable in this case, Randall and his team "attempted to determine what the absorptive ability of his remaining gut was, with the hope that some combination of components not requiring digestion might be found.... Powdered Amigen was obtained from Mead Johnson (Evansville, IN) and gut nitrogen balance was assessed using 1%, 2%, and 3% solutions of Amigen (a glucose/casein hydrolysate mixture). The result was that up to 12 g of nitrogen representing 75 g of protein could be absorbed per day when administered slowly and continuously through an infant feeding catheter into the stomach." Randall learned at the time of a "space diet" composed of crystalline amino acids, glucose, minerals, and vitamins that had been developed in studies sponsored by the National Aeronautics and Space Administration (NASA) to explore the possibility of using defined-formula diets by man during space flight. Thompson and Randall obtained permission from the US Food and Drug Administration (FDA) for the use of this diet in their patient and demonstrated tolerance for the product, without diarrhea and with an improvement in total body nitrogen balance. Results in this first surgical patient to receive an elemental enteral diet were reported by Thompson et al11 at the New England Surgical Society in 1968 and published in the American Journal of Surgery. After this initial experience, Randall and coworkers expanded their use of elemental diets to the treatment of gastrointestinal fistulae12,13 and other catabolic conditions.14 By 1974, Randall and coworkers had treated and reported on 164 patients, infants to adults, with a variety of severe surgical and medical conditions, fed through the combined use of parenteral and enteral nutrition. Reports from Randall in the 1970s and 1980s not only supported and promoted the applicability of enteral nutrition in surgical patients, but did so while providing meticulous metabolic balance data that gave solid scientific basis to his clinical observations. Randall's dictum "if the gut works, use it" became a driving force for the expanded use of enteral nutrition support in medical and surgical diseases. Dr Randall was the author of more than a 150 publications, including many seminal contributions on electrolyte physiology and the nutrition care of surgical patients. Among other honors, Dr Randall was elected President of the Society of University Surgeons, the Halsted Society, and the New York City Division of the American Cancer Society, and served from 1966 to 1969 as Chairman of the American College of Surgeons Pre- and Postoperative Care Committee. Of the many awards he received, he particularly cherished the Alfred P. Sloan Award for Cancer Research (1965), the American College of Surgeons Distinguished Service Award (1977), and the Bronze Medal, the highest volunteer award presented by the National American Cancer Society (1986). This author joined the Brown faculty in 1983 and was fortunate to overlap with Dr Randall's tenure there. At the time, Dr Randall held an Emeritus Professor appointment at Brown and had an office at the Division of Surgical Research building in the Rhode Island Hospital campus. A great speaker and a better listener, he was perpetually in "teaching mode." The aroma of his pipe tobacco and the constant flicking of his inseparable Zippo lighter made it easy to know of his whereabouts. He had a remarkable tolerance for fools, and this author acknowledges being one of the fortunate recipients of such tolerance. It is only fitting to say that, above and beyond his qualities as a physician and a scientist, Dr Randall was a true gentleman. Dr Randall died in Providence on May 31, 1994, and his wife, Louise, passed away 3 years later. Louise Harman Randall and Tom Randall had been married for more than 50 years and had 3 children, Martha, Deborah, and Henry (Hank). Dr Randall's work on the physiology of fluids and electrolytes and in surgical nutrition has influenced generations of clinicians and researchers. His personal qualities made better people of those fortunate enough to have met him.
Nutrition in Clinical Practice, Vol. 21, No. 6,
623-625 (2006)
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