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A profile of Dr Edward J. Quilligan

      Dr Edward J. Quilligan, Professor Emeritus of Obstetrics and Gynecology at the University of California–Irvine, pioneer of fetal heart rate monitoring, one of the founding fathers of the subspecialty of Maternal-Fetal Medicine, and former Editor-in-Chief of the Journal (Figure), is being recognized in this series of “Giants in Obstetrics and Gynecology.”
      Figure thumbnail gr2
      FigureFebruary 2003 cover of the Journal
      Shown as Editors-in-Chief are Drs Frederick P. Zuspan and Edward J. Quilligan.
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.

      Early life in the Midwest of the United States

      Born in Cleveland, OH, Ted was raised in the Midwest. His father, James, was President of Ross Laboratories in Columbus, which produced Similac, the popular baby formula; his mother, Maude Ryan, was a nurse. His parents said that since childhood, Ted wanted to be a physician.
      After attending public schools and the Western Military Academy in Illinois, Ted graduated early. World War II was underway, so, instead of enrolling in college, he enlisted in the Army, eventually achieving the rank of Second Lieutenant of the infantry.
      While on leave in Columbus, a friend called and asked Ted if he would like to go on a double date and arranged a blind date for him. Ted arrived at the Delta Gamma sorority house and was greeted by a stunning, elegant young woman, Betty, whose name he had forgotten. They saw each other often until Ted was called back to duty and married the following year at Christmas.
      Betty majored in business at Ohio State University and has been a constant companion of Ted during his journey in academic life. They have been married for 60 years and have 6 children: 4 live in California, 1 in Idaho, and 1 in Tennessee. Bruce, the eldest, is an attorney; Jay and Chris are ear, nose, and throat specialists; Carol is a pediatrician; Linda is a nurse practitioner; and Ted is an anesthesiologist. It is family lore that all of this happened despite Ted being late for his blind date and not remembering the name of the young lady he was going to meet.
      After World War II, Ted began medical school at Ohio State University and then did a rotating internship that included internal medicine, surgery, obstetrics and gynecology, and pediatrics. He loved most of the specialties, applied to 3, and was accepted by all. Ted's choice was to go into obstetrics and gynecology because he could combine surgery with medical care, and he found the discipline stimulating and diverse.
      During his residency at Ohio State University, Ted had the opportunity to work with towering figures of obstetrics and gynecology, including Alan Barnes (the Chair of the Department) and Charles Hendricks. Ted then met Frederick Zuspan, another resident, who would become a lifelong friend and academic partner. They did not know then that their names, Ted and Fred, would become inextricably linked and that they would go on to change obstetrics and gynecology and establish a subspecialty: maternal-fetal medicine.

      Ted’s first research project

      As a second-year resident, Ted was approached by Dr Charles Hendricks and asked whether he would be interested in doing some research. Professor Leo Sapirstein of the Department of Physiology, Chuck, and Ted began developing a method to measure cardiac output, which was published in the Journal of Applied Physiology.
      • Sapirstein L.A.
      • Mandel M.J.
      • Pultz A.
      • et al.
      Determination of cardiac output by a constant infusion technique in man: its employment to validate infusion-slope measurements of para-amino hippuric acid space and clearance.
      Ted then systematically applied this methodology to study cardiac output during pregnancy
      • Hendricks C.H.
      • Quilligan E.J.
      Cardiac output in pregnancy: correlation between Evans blue dye and blood pressure methods.
      and labor,
      • Hendricks C.H.
      • Quilligan E.J.
      Cardiac output during labor.
      after the administration of anesthetic agents,
      • Quilligan E.J.
      • Hendricks C.H.
      • Hingson R.
      Cardiac output: the acute effects of various anesthetic agents and techniques as measured by the pulse-pressure method.
      and to examine the effects of lateral and supine positions of cardiac output.
      • Quilligan E.J.
      • Tyler C.
      Postural effects on the cardiovascular status in pregnancy: a comparison of the lateral and supine postures.
      Many of these papers were published in the Journal.
      While residents at Case Western Reserve University Hospital in Cleveland, Ted and Fred decided to pursue academic medicine. Alan Barnes had moved from Ohio State University to Case Western Reserve University as chair and invited both Ted and Fred to join him, ultimately granting them their first academic appointments. Case Western Reserve was a forward-looking medical school that had introduced a new curriculum, emphasizing early exposure of medical students to clinical problems: there they became friends with Jack Pritchard, who subsequently became chair at Southwestern Medical School in Dallas.

      Chair of a department at age 37 years at Cleveland Metropolitan General Hospital

      From Case Western Reserve, Ted’s first position as Chair of the Department of Obstetrics and Gynecology was at Cleveland Metropolitan General Hospital, achieved at the age of 37 (at the same time that Fred Zuspan became a chair in Augusta, GA). Cleveland Metropolitan, a prime teaching hospital of Case Western Reserve, was prestigious: indeed, the Chairman of Pediatrics was the 1954 Nobel Laureate Fred Robbins, who had successfully cultivated the poliomyelitis virus in tissue culture.
      Ted was working on acid base balance and trying to understand the effect of changes in oxygenation in the intervillous space on the acid base status of the fetus. In fact, he was the first to measure the partial pressure of oxygen in the intervillous space and umbilical vessels
      • Quilligan E.J.
      • Vasicka A.
      • Aznar R.
      • Lipsitz P.J.
      • Moore T.
      • Bloor B.M.
      Partial pressure of oxygen in the intervillous space and the umbilical vessels.
      and to compare oxygen tension in maternal and fetal blood, amniotic fluid, and cerebrospinal fluid of the mother and baby.
      • Vasicka A.
      • Quilligan E.J.
      • Aznar R.
      • Lipsitz P.J.
      • Bloor B.M.
      Oxygen tension in maternal and fetal blood, amniotic fluid, and cerebrospinal fluid of the mother and the baby.
      He also studied the amniotic fluid gas composition.
      • Quilligan E.J.
      Amniotic fluid gas tensions.
      At a conference held at Case Western Reserve, Edward Hon from Yale University presented his early work on fetal heart rate monitoring. Realizing their common interest, Ed provided Ted with equipment to conduct fetal heart rate monitoring studies at Case Western Reserve and correlate fetal heart rate patterns with acid base results. This collaborative work went on for a while. From 1965 to 1966, Ted spent 1 year as Professor and Chair at UCLA Harbor Hospital in Los Angeles, CA, before he was offered the Chair of the Department of Obstetrics and Gynecology at Yale in 1966.

      Chair at Yale University: Yale-New Haven Hospital

      After Ted and Betty arrived in New Haven, they made friends quickly, and the department strengthened its research activities.
      Ted and Edward Hon’s work in fetal heart rate monitoring accelerated because of the synergy of the clinical studies in labor and delivery and the laboratory work led by Ted. He published the first paper to demonstrate a correlation between fetal heart rate patterns and blood gas values of the umbilical artery in 1964 in the Journal;
      • Quilligan E.J.
      • Katigbak E.
      • Nowacek C.
      • Czarnecki N.
      Correlation of fetal heart rate patterns and blood gas values. 1. Normal heart rate values.
      this was followed by the elucidation that early decelerations represented fetal head compressions
      • Paul W.M.
      • Quilligan E.J.
      • Maclachlan T.
      Cardiovascular phenomenon associated with fetal head compression.
      and, subsequently, a seminal study that correlated the different fetal heart rate patterns with umbilical cord blood gases in bradycardia
      • Quilligan E.J.
      • Katigbak E.
      • Hofschild J.
      Correlation of fetal heart rate patterns and blood gas values. II. Bradycardia.
      and tachycardia.
      • Quilligan E.J.
      • Katigbak E.B.
      Correlation of fetal heart rate and acid-base balance at birth. 3. Tachycardia.
      Ted also characterized the relationship between fetal acid base at birth and Apgar scores.
      • Khazin A.F.
      • Hon E.H.
      • Quilligan E.J.
      Biochemical studies of the fetus. 3. Fetal base and Apgar scores.
      Many basic science studies were possible because Ted had a sheep laboratory at Yale under the advisement of Professor Donald Barron of the Department of Physiology (who had trained with Sir Joseph Bancroft). It is not well known that Ted and his team were the first to obtain intrauterine electroencephalographic recordings in fetal sheep,
      • Jost R.G.
      • Quilligan E.J.
      • Yeh S.Y.
      • Anderson G.G.
      Intrauterine electroencephalogram of the sheep fetus.
      to characterize rapid eye movement sleep, and to study carotid blood flow.
      • Dunnihoo D.R.
      • Quilligan E.J.
      Carotid blood flow distribution in the in utero sheep fetus.
      The excitement about fetal heart rate monitoring focused on the detection of hypoxemia and acidemia with the hope of preventing intrapartum fetal death and permanent neurological damage. The interest and hope about the value of fetal heart rate monitoring in obstetrics were so high that it became a favorite subject at meetings, Grand Rounds, and in discussions about obstetrical practice.
      Research groups worldwide established units to study fetal heart rate monitoring; major contributions were made by Roberto Caldeyro-Barcia of Montevideo, Uruguay;
      • Caldeyro-Barcia R.
      [Mechanisms and significance of the variations registered in the heart rate of the human fetus during labor].
      Erich Saling in Berlin, Germany;
      • Saling E.
      Fetal blood analysis during labor.
      and many other groups. At the time, there was controversy about the relative value of fetal heart rate monitoring and acid base and pH evaluation. Professor Saling was a strong proponent of the evaluation of acid base status; his Fellow at the time, Dr Fred Kubli, spent time at Yale studying the relationship between fetal heart rate decelerations and pH.
      • Kubli F.W.
      • Hon E.H.
      • Khazin A.F.
      • Takemura H.
      Observations on heart rate and pH in the human fetus during labor.
      To rigorously test whether introduction of the technology in clinical practice was justifiable, Ed Hon discussed a potential grant application with the National Institutes of Health to test the efficacy of fetal heart rate monitoring. The proposed trial was not welcome as a submission because many thought withholding fetal heart rate monitoring information would allow hypoxemia to go undetected, and this could harm fetuses and infants. Thus, fetal heart rate monitoring found its way into clinical practice based on observational studies.

      Recruitment to the University of Southern California

      After only 3 years at Yale, Ted was then recruited to establish a new Department of Obstetrics and Gynecology at the University of Southern California (USC). The Dean of USC, Dr Roger Egeberg (who had been General Douglas MacArthur’s physician during World War II), wanted to build a Department of Obstetrics and Gynecology by joining 2 different departments in each separate specialty.
      The conditions were ripe to establish a unique department because Los Angeles County Hospital had approximately 15,000 deliveries annually, and Dr Egeberg had secured 25 faculty positions for the new Department of Obstetrics and Gynecology. Ted quickly recruited many stars to the faculty, including Edward Hon, Daniel Mishell Jr, Richard Paul, Jorge Mestman, Charles Ballard, Roger Freeman, Robert Israel, Chester Martin, Dean Moyer, Robert Nakamura, Val Davajan, Duane Townsend, Philip DiSaia, and Roger Morrow. Subsequently, Ted also recruited William Ledger, Barry Schifrin, Steven Gabbe, Uwe Goebelsmann, C. Paul Morrow, Frank Manning, Gary Oakes, and David Nochimson.
      There were many trainees in maternal-fetal medicine, including Frank Miller, Roy Petrie, David Sacks, Sze-Ya Yeh, David Cotton, Steven Clark, Jeffrey Phelan, Larry Platt, Michael Socol, Tom Benedetti, Peter van Dorsten, Maurice Druzin, Richard Lowensohn, M. Lynn Yonekura, Joseph Collea, Steve Golde, and Patricia Schmidt, among others. When Ted arrived at USC, he worked closely with Yuji Murata.
      USC became a magnet for talent and the epicenter for obstetrical research under Ted’s leadership. One of the reasons he enjoyed USC so much was that he “never had to worry about the funding of the department.” The faculty was funded by the County of Los Angeles and the University of California; therefore, Ted was a chair without the constant concerns of struggling for financial support for the department.
      He also recalled a time when National Institutes of Health funding was much easier to obtain, and pay lines were close to 30%. Free of financial pressures, the faculty could concentrate on patient care, teaching, and research.

      A sabbatical at Oxford and return to California

      After serving as chair of 3 departments (Cleveland Metropolitan, Yale University, and USC), Ted believed that he needed a break from administration and returned to research in a stimulating environment: he chose Oxford University, where Geoffrey Dawes was professor of physiology, to spend his sabbatical leave. The two had been acquainted since Geoff had visited Ted’s laboratory at Yale when Ted was working on fetal rapid eye movement sleep. The time at Oxford was a welcome break from the running of a department and a time of reflection that Betty and Ted enjoyed together.
      Upon his return to USC, Ted worked in the Department of Obstetrics and Gynecology and became an Assistant Provost for Medical Affairs. He was expected to set up a private practice for the faculty; yet, this was difficult to accomplish in the Los Angeles area and for the faculty practicing at Los Angeles County and USC hospitals. In time, he opted to become Director of Maternal-Fetal Medicine at the University of California–Irvine and did this for 3 years.
      Ted then felt the call of leadership again and the University of Wisconsin at Madison offered him the position of chair. Ted recruited Chester Martin, one of his former residents at Case Western Reserve and USC, who had great experience in fetal physiology, specifically, with nonhuman primates. While at Madison, Ted worked with Ben Curet, Valerie Parisi, and Perry Henderson.
      The time in Wisconsin was to be brief, 1983–1985, because Ted required a 5-vessel bypass, and he and Betty decided to return to California. He then became Professor and Chair of the Department of Obstetrics and Gynecology at the University of California–Davis, followed by Vice Chancellor and Dean of the College of Medicine at the University of California–Irvine in 1987, a position that he would hold for 2 years. While at University of California–Irvine, Ted worked with Tom Garite and Deborah Wing, among many others.
      When asked about his frequent moves from one leadership position to another, Ted jokes that he was “unable to hold a job.” However, he says that he hopes he left each place better than how he found it.

      Leadership style and advice

      Very few academicians have held such back-to-back positions of leadership as long as Ted. From the age of 37, he was appointed chair of one department after another, trained generations of physicians, inspired faculty, and improved the care of women and children.
      When asked how he accomplished all that he has, Ted shared his formula has been to find good people and provide them the freedom to pursue their dreams. He considers that his success is due to the remarkable people who came to work with him and were often willing to relocate with him to explore new horizons and to take risks. Ted acknowledges that the job description of a chair today is very different from the positions he held, in that the focus now is the running of a business enterprise in the rapidly changing financial environment of health care.

      Editor-in-Chief of AJOG

      In 1969, Professor Howard Taylor of Columbia University was Editor-in-Chief of the Journal; Alan Barnes and John Brewer were editors. Alan asked Ted and Fred to become associate editors of the Journal. A few years later, John became Editor-in-Chief until 1990; Ted and Fred then took over as Editors-in-Chief from 1990 to 2008. During that time, they recruited Thomas Garite, Moon Kim, Alberto Manetta, Steven Gabbe, Jay Iams, Richard Bump, and finally me as associate editors. Our editorial managers, Sandy Perrine and Donna Stroud, were also recruited by Ted and Fred, respectively, and have always worked closely with Ted, especially Sandy, who considers him an exemplary mentor and friend. In 2008, Ted and Fred became Editors Emeriti and were followed by Thomas Garite and Moon Kim as Editors-in-Chief.
      Ted recalls that the Journal was published by the company C. V. Mosby: it was run as a family, and, before the Internet, the editorial process relied heavily on the US Postal Service. When he and Fred took over the Journal, there was no peer review process: the editors had the final decision as to whether a manuscript was accepted or declined. Ted and Fred then initiated the peer review process at the Journal. Its introduction was not easy: authors were not accustomed to receiving comments or having to reply to criticism; however, Ted believed that the process was helpful because it provided a rationale for their editorial decisions.
      The most rewarding aspects of being an Editor-in-Chief were the excitement of learning of discoveries in the field, getting to know the young people who were making contributions and advancing the discipline, and promoting the publication and dissemination of good work. Ted told me that being an Editor-in-Chief was a lot of work, but enjoyable, and considered that publishing work that changed the practice of medicine was very gratifying. Challenges included trying to balance basic science and clinical studies.
      When asked what makes a good editor, Ted said, “Someone who has a good grasp of the scientific method, likes to read, and is able to look at manuscripts published from a scientific and communicative point of view.” Important qualities are impartiality, a willingness to work very hard, and the ability to move quickly through the processes of peer review and publication.
      Regarding the future of biomedical journals, Ted believes that “more and more clinical medicine is being governed by algorithms and guidelines.” His view is that these guidelines should be based on scientific evidence, and there must be a place for dialogue and discussion of the recommendations of professional societies: biomedical journals are the place for such dialogue. Ted believes that one of the strengths of the Journal is its independence, which makes the pages of the Journal a unique venue for medical and scientific debate.

      Professional roles and awards

      Despite being chair of so many departments, Ted found the time to support our discipline as a leader. He served as President of the Society of Gynecologic Investigation (SGI), the Association of Professors of Obstetrics and Gynecology, the American Gynecological Society, and the American Gynecological and Obstetrical Society, among others.
      Ted also played a role in the No Name Society. The society took pride in being dedicated to research and scholarship, not having dues, officers, or even publications. The society has no bylaws and no charter and allows presentations of unpublished work only for discussion among a group of friends. The plaque of the society is stolen during the meeting by one of its members, who then becomes the host of the future meeting.
      Ted’s contributions have been recognized by multiple awards, too many to list really. However, some deserving of mention include an Honorary Master of Science from Yale (1966), Fellow at the Silliman College at Yale (1968), Alpha Omega Alpha (1975), Fellow ad eundem of the Royal College of Obstetricians and Gynecologists (1987), the Harry Towsley Award (1991), the Nicholson J. Eastman Professorship and Lecture Award at Johns Hopkins (1991), the Joseph Bolivar DeLee Humanitarian Award at the University of Chicago (1993), and the President–Distinguished Researcher Award (SGI 1998), and he is the namesake of the Edward J. Quilligan Endowed Chair in Maternal-Fetal Medicine (2000). Ted was also recognized with a Lifetime Achievement Award from the Society of Perinatal Obstetricians, now known as the Society for Maternal-Fetal Medicine.

      Founding the subspecialty of maternal-fetal medicine

      Dr Gordon Douglas, former President of the American Board of Obstetrics and Gynecology, approached Ted and asked him to chair a special meeting to consider whether there should be subspecialty certification for maternal-fetal medicine within obstetrics and gynecology. At that time, the board was considering other subspecialties such as gynecologic oncology and reproductive endocrinology. The representative for gynecologic oncology was Dr John Lewis from Sloan Kettering Memorial Hospital and Dr Kenneth Ryan from Harvard for reproductive endocrinology.
      The American Board of Obstetrics and Gynecology decided that the time had come to establish a certification process for the subspecialties, and Ted was asked to appoint a committee that included Fred Zuspan, Ed Makowski, and Donald Hutchinson. They formulated the scope of the specialty, the examination process, and the training requirements over the course of a year.

      Knowing Ted

      I know Ted to be exceedingly forward looking. For example, you can count that Ted would have the latest smartphone and computer and know how to use them. At an editors’ meeting of the Journal many years ago, Elsevier (the publisher of the Journal) was advising us on the importance of social media and asked who among the editors had a Facebook page. Of all the editors, only one hand went up: Ted’s.
      When it comes to books, Ted is a fan of fiction, thrillers in particular. His taste in movies is eclectic, and his favorites include Casablanca and several musicals. Environmentally conscious, Ted drives a Prius. He loves golf and, for a while, all editors of the Journal felt the need to join Ted and Fred on the course. He continues to play golf with Moon Kim, Robert Resnik, and other old and new friends. Recently, I called him to discuss a paper, and he asked whether he could get back to me because he was in the middle of a session with his personal trainer, so is the discipline and rigor of a man with Ted’s success.
      My personal observation from attending meetings with Ted is that he is thoughtful, analytical, and open minded. He is parsimonious when expressing his opinion, and every word counts. In the moment Ted speaks, rooms typically still because everyone wants to hear what he has to say. The respect he has earned for his wisdom, judgment, and fairness is unparalleled.
      Ted’s approach to conflict resolution is always trying to see the best in people. He says, “If you don’t look for the best, you will probably get something else.”
      At 92, Ted remains active and engaged, continuing to serve as Professor Emeritus at the University of California–Irvine, and as Chair of the Human Investigations Committee at Long Beach Memorial Hospital, where he works every week.

      Closing thoughts

      Ted is confident about the future of obstetrics and gynecology and sees the influx of women into our specialty as a transformative force and a step in the right direction. Acknowledging some major challenges facing Departments of Obstetrics and Gynecology, he is convinced that we will be able to adapt and thrive.
      The legendary stature of Ted Quilligan stems, in my opinion, from his forward-looking vision, leadership, unshakable integrity, commitment to clinical, basic, and translational science, and an unusual knack to attract talent. He has always been willing to give an opportunity to new ideas. The grace and ease with which Ted has led over the decades is as much a part of his story as his accomplishments (Supplemental Figure 1, Supplemental Figure 2, Supplemental Figure 3, Supplemental Figure 4, Supplemental Figure 5, Supplemental Figure 6, Supplemental Figure 7, Supplemental Figure 8, Supplemental Figure 9, Supplemental Figure 10, Supplemental Figure 11). An exceptional clinician, teacher, investigator, leader, mentor, editor, and pioneer in our specialty, Edward Quilligan is a “giant among giants.”

      Acknowledgment

      I acknowledge Tom Garite, who has been the Edward Quilligan Endowed Chair of Obstetrics and Gynecology at the University of California–Irvine, for providing the photographs for the supplemental material; Moon Kim, a close friend of Ted, for his advice and input in this piece; Richard Paul and David Nochimson for their advice; and Ron Magness for providing information about the No Name Society.

      Appendix

      Figure thumbnail fx1
      Supplemental Figure 1Seventh Grade Football Team: “I wasn't very good”
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx2
      Supplemental Figure 2Military School - Sophomore Year
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx3
      Supplemental Figure 32nd Lieutenant, Infantry - World War II
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx4
      Supplemental Figure 4Ted and Betty, Wedding Day: “I married the most wonderful woman in the world”
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx5
      Supplemental Figure 5My first Chair, 1963 - Cleveland Metropolitan General Hospital
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx6
      Supplemental Figure 6The Quilligan Family Christmas photo, 1960
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx7
      Supplemental Figure 7The Z: “My best friend”
      Fred Zuspan (left) and Ted at an Editorial Board meeting of AJOG.
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx8
      Supplemental Figure 8Betty and Ted - 50th Wedding Anniversary
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx9
      Supplemental Figure 9With Jane and Fred Zuspan: “Our two favorite people”
      Jane and Fred Zuspan and Ted and Betty Quilligan are shown at a reception at LaQuinta Resorts, concluding their tenure as Editors-in-Chief of the Journal.
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx10
      Supplemental Figure 10The editors of AJOG at play
      (left to right: Tom Garite, Ted, Fred Zuspan, and Moon Kim).
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.
      Figure thumbnail fx11
      Supplemental Figure 11Edward J. Quilligan, M.D.
      Romero. Profile of Dr Edward J. Quilligan. Am J Obstet Gynecol 2017.

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