Surgical Career, University of Kansas School of Medicine and France

Dr. Walter S. Sutton returned to Kansas in 1909 after two years as an intern and house surgeon at Roosevelt Hospital in New York. His total of six years in New York was very productive. The two papers (Sutton, 1902, 1903) written as a graduate student under E. B. Wilson at Columbia University formulated the concept that chromosomes carried the units of heredity and explained Mendel's laws. This hypothesis carried him to the forefront of research biologists. He, and probably no one else at the time, could foresee that the code of these hereditary units, the genes, would be deciphered and the chemical basis of mutations understood. During his final two years of medical school at the College of Physicians and Surgeons and two years at Roosevelt Hospital, Sutton was recognized for his surgical skills and innovative work on medical instruments. With these successes and the opportunity to remain at the prestigious Roosevelt Hospital, one may wonder why he returned to Kansas. Sutton was a warm, friendly individual with very strong family ties, factors that made it quite natural for him to return to his home state. Also, he believed he could help make the medical school a first class institution.

On returning to Kansas City, Kansas, Sutton lived with his parents at 650 Everett St. His father was Wyandotte County Judge and a partner in a law practice with his son Will. The 1910 census lists the following individuals at the fashionable Everett Street home; William B. Sutton 61, Agnes 60, Walter 33, Everett 20 and Margaret Johnson 30, cook. Initially, Sutton was undecided as to what course to take on arrival in Kansas City and considered work as railroad surgeon. A letter to Mr. Evarts January 20, 1910 shows Sutton changed his mind as he was becoming more established at the medical school. "The work with the Medical School and with Dr. Binnie has grown up gradually so that from a sort of spectator and occasional assistant I have come into a regular position with corresponding responsibilities. ...However, after Dr. Binnie's return from Europe where he was at the time of my last letter to you, I continued my work with him and gradually came to be regarded as a regular assistant. ...About this time I was appointed to a place as Assistant Professor of Surgery in the State University with duties to be assigned later."

Eleanor Taylor Bell Memorial Hospital where Sutton began surgery as an Assistant Professor at the University of Kansas School of Medicine in 1909. The hospital was named to honor the wife of Dr. Simeon B. Bell who donated land and money so that the four-year medical school could be established in 1905. Two additional buildings were later added to this site on "goat hill" and then in 1924 a new hospital was built one mile south on 39th Street, Kansas City, Kansas.

Sutton was appointed assistant professor of surgery at the University of Kansas School of Medicine on September 30, 1909. The position was somewhat insecure in that the four-year-old university hospital (Bell Memorial Hospital) had a marginal budget with physicians in private practice staffing the clinics. Sutton started a private practice and shared rooms 810 - 815 in the Rialto building in Kansas City, Missouri with surgeon John G. Hayden. Sutton operated at St. Margaret's Hospital in Kansas City, Kansas as well as the University's Bell Memorial Hospital. The medical school was struggling. Associate Dean Sudler, a surgeon with practices in Lawrence and Kansas City and doctorates in both medicine and philosophy, was a competent, highly respected administrator but had considerable political pressures related to finances and faculty appointments.

Sutton's time at Bell Memorial Hospital was spent in surgery, surgical clinics and teaching medical students and nurses. For the six years prior to going to France, his surgery covered areas that have long since become subspecialties and included neurosurgery, orthopedic surgery, Ob-Gyn, oral surgery and plastic surgery. Patient histories and operative notes that have been preserved indicate this variety of procedures. Sutton wrote these records in black ink on 5 X 7 cards. Many have sketches of the surgical incision and the gross pathology. For example, on 7/13/1911 he did a hysterectomy and the pathology is described along with a sketch of the uterus and the site of a large fibroid tumor. On 11/21/1910 Sutton did a craniotomy and removed a bullet and bone fragments from a patient's cerebellum. Drs. Hayden and Skoog assisted him. On 12/1/1911 he treated a young man accidentally shot with a 12-gauge shotgun. He wired fragments of the jaw together and cleaned and drained the hole in the patient's hand that had been over the barrel opening when the gun fired. The operative note shows Sutton's sketch of the fractured jaw and placement of wires. On 1/10/12 he did an appendectomy on a 21-year-old medical student from Larned, Kansas; assisted by Dr. Finney. On 2/3/1914 he did a mid-thigh amputation on a 19-year-old female for periosteal carcinoma of the tibia. On 1/7/1914 he did a radical mastectomy for carcinoma of the breast; assisted by Dr. Hayden. On 3/12/1914 Sutton grafted bone from the tibia onto a non-union of the radius near wrist that followed a Colle's fracture. His surgical skills and artistic talents were increasingly used in correcting congenital abnormalities of the limbs and faces of children. Success in these procedures gave him recognition well beyond the state of Kansas and he took on complicated cases without pay if he thought he could help the patient. This attitude is indicated in a 1914 letter Sutton wrote to the mother of a prospective patient living in Fort Smith, Arkansas. "In regard to the hospital, it is a State Institution, and free patients are rarely taken in from outside the State. The lowest rates in the Hospital are Ten ($10.00) Dollars per week, and a small operative fee. .... If circumstances justify it, I should be glad to operate upon your daughter without charge."

Sutton published several papers related to his early clinical work. The paper "Anesthesia by colonic absorption of ether" was based on 140 patients that Sutton himself anesthetized while on the surgical services of Drs. Blake and Brewer at Roosevelt Hospital. The paper was written while he was in New York but it was published in 1910 when he was at the University of Kansas Medical School (Sutton, 1910a). In this paper Sutton notes that the colonic method of anesthesia and the related photographs published by N. B. Carson in the Interstate Medical Journal were done without his "knowledge or consent". Sutton had sent the materials only to help Carson use the method. Over the next several years Sutton wrote four papers (Sutton, 1910b, 1910c, 1911a, 1911b). He also took many photographs to follow the progress of his surgically treated patients and as a teaching aid in his surgical lectures to medical students. Photography was a lifelong hobby having its beginning when he built a camera as a boy on the family ranch at Russell, Kansas. Skinner reported that in later years, "Walter's photographic propensities led him into all manner of extravagances in special lenses, Graflex cameras, color photography, Cooper-Hewitt illumination, etc." (Skinner, Family memorial).

There is no record of why Sutton became interested in the military several years before the outbreak of World War I. Nevertheless, he received a commission in the Army and responded with a letter June 29, 1911 to Adjutant General Henry P. McCane, War Department, Washington, DC:

"Sir: - I have the honor to accept herewith the commission as First Lieutenant in the Medical Reserve Corps recently received thru your office and inclose my oath of office."

After WWI started, Sutton wrote to Dr. Hugh Auchincloss in New York on November 6, 1914 for information about the Military Hospitals sponsored by Mrs. Harry Payne Whitney. During the war, Mrs. Whitney started and maintained American Base hospitals in France that were manned by physicians and nurses from American universities. Mrs. Whitney was Gertrude Vanderbilt, daughter of Cornelius and Alice Vanderbilt. She studied sculpture in New York and Paris. When the Metropolitan Museum of Art turned down her donation of 500 pieces of modern American art, she started her own art museum, the Whitney Museum, which opened in 1931 in New York. Her own sculptures often reflected the WWI soldier.

Therefore, Sutton was familiar with the medical needs in France and had a reserve army commission when surgeons at Columbia University asked that he help them man Hospital B near the front. On Sunday, February 7 1915, Dr. Lyle at Columbia University sent a telegram to Sutton hoping to recruit him, with the plan that Sutton would later take over as officer in charge of the hospital. Sutton promptly wrote Lyle that he would make the boat on the 13th. Sudler secured a leave of absence from the university for Sutton through a letter to Chancellor Strong on Feb. 9, 1915. "Through Dr. George Bewer, Attending Surgeon of Roosevelt Hospital, New York City, Dr. Walter S. Sutton has been invited to accept a position with the American Hospital at Paris. ... Inasmuch as Dr. Sutton has given about three years of his time to the work in the medical school and hospital without vacation, with the exception of a period of twelve days last summer, I would respectfully recommend that he be granted leave of absence, on full pay, for this work..." The small surgical group met on the deck of the U.S.M.S "Philadelphia" on the morning of February 13 and sailed for France. They arrived in Liverpool, England and after a day there, crossed the English Channel to France. They arrived at College de Juilly February 23. It was now partially converted to a hospital 40 miles from the front and wounded had been received for about three weeks. Wounded French soldiers were first brought to College de Juilly for care during the first Battle of the Marne in September 1914 and several months later, in January of 1915, the French Government gave space in the buildings to Mrs. Harry Payne Whitney for a hospital.

A picture of the College de Juilly in Juilly, France taken by Sutton. The French government gave space in this seminary for the American Base Hospital B that was financially supported by Mrs. Harry Payne Whitney of New York. By June of 1915, the space allotted for the hospital contained about 225 beds for the wounded soldiers. Remaining rooms were used for students. Sutton joined volunteer surgeons from Columbia University, New York, in manning this evacuation hospital a few weeks after the hospital was formed.  (Courtesy of the Clendening History of Medicine Library, University of Kansas Med. Ctr.)

A history of the College de Juilly, just north of Paris, is given in Pottle's book, Stretchers, (Pottle, 1929) and can be summarized as follows. Juilly is believed to have gotten its name from Julius Caesar who may have established a Roman camp in the area. A monastery for monks was built near a fountain at a spring in the city in the twelfth century, followed by a school in the thirteenth century. The monks left in 1637 and Louis the XIII converted the buildings to a seminary ("Academie Royale") for the education of his young nobles. This seminary, College de Juilly, was converted to a hospital three times before WWI, during the war with England in 1790, the Napoleonic battles of 1814 and the Prussian occupation in 1870.

This is a picture of Sutton at Hospital B of the American Ambulance Base Hospital in Juilly, France in the spring of 1915. He may have just turned 38 when this picture was taken. He was made surgeon-in-chief of the hospital about April 1915. (Courtesy of the Clendening History of Medicine Library, University of Kansas Med. Ctr.)

In a letter to his mother April 15, 1915, Sutton indicates he will take Dr. Lyle's place as head of the hospital until the arrival of Dr. Brewer the first of July. "That is pretty long and I don't like it much but there is no one else they want to ask to run the place..." He also states "We are having admissions right along but for some time no great numbers of serious cases. I evacuated 11 from my ward a few days ago but still have 39 left." As surgeon-in-chief at the hospital, Sutton's duties included chief administrative officer in addition to his surgical responsibilities. George E. Brewer stated, "It was, however, during his service in the American Ambulance Hospital at Juilly, France during the spring and summer of 1915 that Dr. Sutton achieved his greatest reputation. This hospital, founded and supported by Mrs. Harry Payne Whitney of New York, was at the time the nearest base hospital to the firing line in France or Belgium. As a result of this, the hospital was kept full of the seriously wounded, and cases requiring the highest degree of surgical judgment and skill." (Brewer, Family memorial). Brewer was one of the surgeons that operated on William Osler's son, Revere, near the front in 1917. Revere did not survive his internal shrapnel injuries.

Sutton, third from the right, with his medical staff at Hospital B, Juilly, France in 1915. (Courtesy of the Clendening History of Medicine Library, University of Kansas Med. Ctr.)

A Sutton picture of a staff car followed by a Ford ambulance bringing wounded to Hospital B in 1915. Wounded were brought in groups of 5 to 13 ambulances every other day from an evacuation hospital in Compiegne, a converted palace of Louis XV about 30 miles north of Juilly. (Courtesy of the Clendening History of Medicine Library, University of Kansas Med. Ctr.)

For generations the fields of France and Belgium were fertilized with manure. This resulted in heavy contamination of the muddy trenches with a variety of bacteria including the anaerobic gas forming "Welch" bacilli. Therefore, nearly all war wounds were heavily contaminated with bacteria. Metal, particularly from shrapnel and shells, carried contaminated clothing into the wounds, causing prolonged suppuration and lack of healing. Removal of foreign material and devitalized tissue from the wounds was essential. Effective methods to localize and remove foreign bodies were needed and many methods were tried with variable success. Sutton modified for general use a method Wullyamoz had used for removing foreign bodies from the brain (Skinner, 1917). In a letter home, March 18, 1915, Sutton indicates the instruments he designed for removing foreign bodies were being made in Paris. "I have 44 patients now in my exclusive care and it is a pretty good load. Have only been to Paris once and to Compeigne once. The dressings take the greatest time, as nearly all the wounds require dressing for a long time. Operations were quite frequent.... I expect to go to Paris tomorrow to get instruments for localizing bullets, etc. in the deep parts of the body and rather expect it to be my last chance before the big fighting is resumed." Sutton made additional comments on the use of the instruments in a letter to his father March 29, 1915. "Another factor in keeping things going in the operating room is a system I have developed for locating balls, shell fragments, etc. by X-ray so that we can cut down on them with absolute certainty. I have cleared up my ward so that only two cases now harbor foreign bodies and we expect to get those when the patients are in proper shape for another operation."

The articles shown are the instruments Sutton designed and had made in Paris for the localization of foreign bodies in war wounds. The cannula containing a sharp pointed trochar (B) was inserted through the skin and the tip was guided to the bullet or shrapnel using a fluoroscope. The trochar was then removed from the cannula and a wire was inserted hook first (A) down the cannula where the hook was held in place by the soft tissues next to the piece of metal. The cannula was then withdrawn over the wire. In the operating room, under local anesthesia, the surgeon opened the skin and tissue along the wire and removed the foreign body and devitalized tissue at the wire's end. A blunt stylet (C ) could replace the trochar in the cannula. For more superficial foreign bodies, a short probe (D) could be used. (These instruments are in the Clendening History of Medicine Library, University of Kansas Medical Center and are probably the instruments Sutton's father sent to the U.S. Government as a pattern for their manufacture after Sutton's death).

Sutton would make 15 or 20 foreign body localizations then go to the operating room and remove the foreign bodies located at the end of the piano wire. By this time the fluoroscope was cool enough to explore for foreign bodies in another group of patients.

In this photograph, Sutton is seen inserting the cannula with trochar into a soldier's thigh in the process of localizing a foreign body with the instruments he designed. The X-ray tube beneath the table emits X-rays that pass up through the soldier's thigh and onto a movable fluorescent screen. Sutton can visualize the foreign body on the screen and directs the trochar tip to the foreign body. After touching the foreign body, the trochar is removed and a fine wire with a hook at one end will be passed down the cannula. The hooked wire will be left in the soft tissues near the foreign body as the cannula is removed. The flange on the cannula (also seen in the instrument figure above - B) is being grasped by a hemostat in Sutton's left hand. (Annals of Surgery 63:115, 1916).

A New York Times article (New York Times October 14, 1915.) reported on a New York Surgical Society meeting, where Dr. Walton Martin and Dr. H. M. Lyle talked about Sutton's method for localizing metal foreign bodies in war wounds. Dr. Lyle demonstrated it before the society and in a note to Sutton on November 11, 1915 he encouraged Sutton to publish the method. Sutton replied that he planned to include the method in Binnie's new edition of "Operative Surgery". When Sutton returned to Kansas City, he re-established his friendship with Binnie and the article, "War Surgery" (Sutton, 1916), appeared in the appendix of J. F. Binnie's Manual of Operative Surgery. The procedure was also included in an article by Martin in the Annals of Surgery (1916), the American Journal of Roentgenology in July 1917 (Skinner, 1917), and Military Surgeon (1917). On June 17, 1917, a Committee of Military Roentgenologists selected "The Sutton Localizing Method" and two other methods as the techniques all military roentgenologists must learn in Government schools used to train radiologists for military duty. After Sutton's death, his father sent the localizing instruments to the U.S. Government as a pattern for their manufacture. (Binnie, Family memorial).

Sutton sailed from France June 26, 1915 and was back at the University by July 16. He had taken many photographs during his stay and used lanternslides of landscapes, war scenes, patients and hospital settings to accompany about 50 presentations in the Kansas City area, often for charitable causes.

The newspaper notice above represents one of the many presentations Sutton made locally and in the surrounding communities on his return to Kansas City from France in the summer of 1915. (Courtesy of the Clendening History of Medicine Library, University of Kansas Med. Ctr.)

Sutton resumed his teaching and surgical activities and joined the surgical staff at the new Christian Church Hospital in Kansas City, Missouri, where colleague John Binnie was chief of staff. He was active in local and national medical organizations that included the American College of Surgeons, American Medical Association, Western Surgical Society, Kansas State Medical Society, Jackson County Medical Society and Medical Association of the Southwest. One of his last presentations was to the Tri-state Medical Society, October 1916. This address titled "Spondylolisthesis" was published in the Osteopathic Physician. In a footnote to the article, the editor notes he was a boyhood friend of Sutton in the late 1880's on the Kansas plains. R. J. Bunting may have been this editor because the article was sent to Sutton's mother with a note at the top, "Dear Mrs. Sutton, to show that our "Walter" is still with us. With love from R. J. Bunting". He also states that the presentation was published in the Chicago Medical Recorder about the time Sutton died, in November.

The clarity of Sutton's writing in papers and in his "War Surgery" article in Binnie's Manual of Operative Surgery did not go unnoticed. In a letter of May 16, 1916, C.V. Mosby, President of Mosby, the medical publisher, asked Sutton to write and illustrate a book of general surgery. He knew that with Sutton's writing ability and drawing skills a very successful book was likely. He encouraged Sutton to get in touch with "our mutual friend, Dr. [Richard] Sutton and get his opinion of the service that we are able to render". Mosby at the time was completing Richard L. Sutton's (no relation to Walter Sutton) book on dermatology. Richard Sutton taught dermatology at the medical school. On September 26, 1916, Mosby wrote Sutton that he was making plans to come to Kansas City so that they could discuss the book of general surgery. A meeting in the middle of October was agreed upon and a contract was signed shortly thereafter.

Sutton had moved back into his parents home after returning from France and shortly after his return family members noted that he appeared increasingly tired. At least by February 1916 Sutton knew he was not well and was considering the need for surgery. This is indicated in a letter Sutton received from a patient, Florence Maddox, Feb. 6, 1916.

"Dear Dr. Sutton,
In a letter we received from Mrs. Darnall the other day she said you were not feeling at all well and that you might have to have an operation. We are both sorry to hear this and hope that you will soon be feeling allright again, and above all, we hope that you will not have to go on the operating table for we both know what a lot of suffering it means. ..."
On Monday evening, November 6, Sutton went to bed early but was called to the hospital during the night for an emergency case and returned at 4 AM. He left again at 6AM and performed two operations at the University Hospital (Bell Memorial Hospital) and another at the Christian Hospital. Later, in a letter to the Dean of the Medical School, C. Arden Miller, Dr. Don Carlos Guffey wrote, "I saw Walter that morning at Bell Hospital. He said he had a terrific pain in his abdomen. I tried to persuade him to go to bed and let me call Dr. Sudler. He said he was going to Christian Hospital and would see someone there." He reached his office at noon, exhausted and ill. He had acute appendicitis. Surgery was performed at 3:30 PM, Tuesday November 7 at the Christian Hospital, Kansas City, MO. On November 9, 1916, Mosby wrote Sutton, "I have just learned through our mutual friend, Dr. Richard L. [Sutton], that you were suddenly stricken with appendicitis and have been operated on. .... my sympathy goes out to you and I sincerely hope that everything is going well and that you will pull through this ordeal in fine shape. I shall think of you constantly and shall hope daily that all is well." Sutton improved briefly after surgery, then his condition deteriorated and he died at 9:30 PM on Friday, November 10, 1916, three days after the operation.

The funeral service was held in the First Presbyterian Church in Kansas City, Kansas, at 3PM on Sunday November 12. The service was described in a Kansas City Times article on November 13, 1916 and stated the 800 seats in the church were filled long before the service began. Three local ministers conducted the service. Presentations were given by Olin Templin, University of Kansas Dean of the College of Liberal Arts and Sciences; Samuel Williston, a mentor of Sutton at the University of Kansas; S. J. Crumbine, Dean of the University of Kansas School of Medicine and F. W. Perry, President of the Christian Church Hospital in Kansas City, Missouri.

A newspaper article stated burial would be at the Highland Park Cemetery, however, there is no record of burial in this cemetery. Sutton's body may have been moved to a temporary site before being placed in its final location in the Sutton family division of a mausoleum that was built in 1917 at the Oak Hill Cemetery in Lawrence, Kansas.

Sutton's body was placed in the Sutton family division of this mausoleum in the Oak Hill cemetery, Lawrence, Kansas. Sutton's parents and several brothers are also in the mausoleum.

Because of Sutton's early death, at age 39, his parents, and most of his contemporaries and mentors were alive when he died. The outstanding esteem and affection held for Walter Sutton prompted the family to publish a 156-page memorial to him in 1917, "Walter Stanborough Sutton, April 5, 1877 - November 10, 1916". This volume includes contributions from a wide range of friends and colleagues. From this memorial one gathers, even now, the warm, cheerful personality and accomplishments of this creative scientist-surgeon. His greatest scientific contribution was his relating the chromosomes with heredity and Mendel's laws. However, his surgical inventiveness, treatment of soldiers during the WWI years and teaching surgery at the University of Kansas were all noteworthy accomplishments.

Sutton's nephew (son of Everett and Lena Sutton), also named Walter S. Sutton and a graduate of the School of Business at the University of Kansas, established the Walter S. Sutton Award at the University of Kansas School of Medicine in 1964. "...an honor to be conferred annually in recognition of outstanding research or scholarly study by a student in the School of Medicine of the University of Kansas. Preference in making the award is to be given to students working in the field of genetics."