The year 1963 was the kickoff for the second half. I was halfway through my responsibility for the Department of Surgery of Harvard Medical School at the Brigham Hospital. Although it was the year of my 50th birthday, neither Laurie nor I thought of it as any kind of a milestone, because I had not yet given any thought as to when I would seek relief from all those committee meetings. I knew that my Harvard tenure as university full-time professor would end after my 67th birthday. This specified retirement date (soon to be revised and then revoked) went back in university tradition many years. Since I had received my first Harvard appointment in July 1941, I was part of the old guard and the old system and thus subject to this old rule. That academic retirement was 18 years off: June 30, 1981. Like all dates that lay far in the future, it bore little resemblance to reality. The year 1963 was one of national tragedy: at the end of that year we lost our young and charismatic president to a senseless assassin. But it was also a year of triumph: we did our first human liver transplant. And it was the year Time magazine gave our department front-cover treatment.

In 1963, Nancy, our eldest, was 27 years old and had presented us with two Hill grandchildren (Lucius Tuttle III and Elizabeth Thayer Hill),

two more yet to come (Peter Isham and Susannah Wyatt Hill). While a sophomore at Bryn Mawr, she had married a young gentleman, Lucius Hill, the son of a near neighbor in Brookline. Luke had graduated from Yale and was then a second-year medical student at McGill. Nancy therefore transferred from Bryn Mawr to McGill. In 1958 they both graduated on the same day: he from medical school, she from college. He became a Brigham surgical resident. In 1963 they lived near us in Brookline with their new family, and he was soon to start up surgical practice in Exeter, New Hampshire, which then became their home. In 1993 their oldest son Lucius and his wife Wendy became the parents of my first great-grandchild, Harry Bartlett Hill.

Peter, our eldest son, had graduated in 1957 from Milton Academy, long considered a prep school for Harvard College. During Peter’s senior year, the Harvard recruiter had made a strongly negative impression on the Milton graduating class, whereas the man from Yale had charmed them all. So, possibly for the first time in history (and maybe the last), many of the graduates of Milton Academy decided to apply to Yale. After finishing up at Yale (1961), Peter decided to return to Harvard to earn his Ph.D. in biophysics with James Watson. He was studying in the Harvard Biology Department at the time Watson won the Nobel Prize for the description, with Crick and Wilkins, of the double-helical structure and chemical bonding of DNA. We always enjoyed Peter’s story of coming into the classroom that day in early October and seeing written on the blackboard in the mock lettering of a 10-year-old child, “TEACHER WON THE NOBEL PRIZE.”

After this sojourn at Harvard, Peter did his postdoctoral work in Geneva and then at Cambridge (on the Cam, not the Charles) before returning to a faculty position in biochemistry and biophysics at Yale (1969). Within a few years he was given tenure (1976) and took his 3-year term as department head from 1987 to 1990. Peter Moore married Margaret Murphy in 1966. They have two children, Catherine Huston and Philip Wyatt Moore.

In 1963, our next oldest daughter, Sally, was about to complete her studies at Swarthmore College, following which she did graduate work at the University of Chicago (1964). She then married Richard Agassiz Warren (1965), son of Richard Warren, a close friend and mem-

ber of our faculty and staff. Dick was a teacher of high school students. Sally is a musician and an artist. She has started a new program called the Vermont Institute for Teaching the Arts (in 1989) to provide home-room teachers in small community schools with more tools and background to instruct their young charges in art and music. She creates her own art from home-made paper and has taken her turns as president of the local school board. Dick and Sally Warren have three children: Peter Agassiz, Rebecca Pepper, and Samuel Bartlett Warren.

In 1963, Caroline (Ceci), our youngest girl, was at Sarah Lawrence College, where her mother had received more learning in 2 years than I had in 4 on the banks of the Charles River. Ceci also had a fine college experience, graduating in 1966 from Sarah Lawrence before entering graduate school at Columbia (1967 to 1969) and becoming a city planner in New York City under Mayor Lindsay (from 1971 to 1977). Now she is Assistant Head for Communications and Enrollment at the Day School in New York, where she has been on the faculty since 1981. In 1965 she married James Tripp, a lawyer with the Environmental Defense Fund. They have two boys, Benjamin Baldwin and Zachary Daniels Tripp.

Meanwhile, our youngest, FDM, Jr. (Chip), 6 years younger than Caroline, was in 1963 struggling with the travails of secondary education at Browne and Nichols School in Cambridge before moving to Choate School in Wallingford, Connecticut. After Choate, Chip attended Harvard College (1972) and then Harvard Medical School (1976). He is now Associate Professor of Surgery at Harvard and the Brigham, pursuing the same schizoid combination of research and clinical surgery that his father did. His research in molecular immunology, elucidating the chemical details of the immune process, is a matter of great importance in surgery, not only in transplantation but also in immunity to infection. He and Carla now have six children ranging from 6 to 16 years old: Kyle Crescenzi, Lynsey Jean, Hadley Huston, Colby Daniels, Alessandra Laura, and Francis Colcord Daniels Moore.

In our surgical department many exciting changes were taking place in 1963. Staff and faculty were continuing to grow in numbers and

international distinction. Private practice, while small and consistent with an academic’s time limitations, continued to be challenging and rewarding. Although our department at the Brigham had succeeded in acquiring more hospital beds by new construction, we still needed an entirely new hospital (which would be many years in coming, as described in Chapter 30). On the side of research progress, we had completed the three signal transplantation operations carried out by Joseph Murray and others of our staff (1954, 1959, and 1962), making ours the leading transplant center in the world. I had started my work on liver transplantation. In 1963, we published our global summary of body composition, The Body Cell Mass and Its Supporting Environment. The King of Arabia and his entourage had been our patients. Possibly most important was the fact that the practical summary of our metabolic studies on surgical patients (Metabolic Care of the Surgical Patient), published in 1959, had now been translated into several languages and had attracted a large sale. It was read by medical students and surgical residents in many countries and was frequently quoted in the surgical and medical literature.

Whatever the significance of all this, the local press had started to pay a good deal of attention to our department, particularly with transplant operations, the opening up of new additions to the hospital, and the visit of Ibn Saud (Chapter 26). The Boston Globe and The New York Times mentioned our work from time to time.

In January 1963, I received a call from Gilbert Cant, then the medical editor of Time. We had become acquainted because the magazine had done a couple of other stories on surgical matters, and he had sought my advice about their interpretation. He was a knowledgeable and agreeable person. Also a sailor. He told me that Time was going to run a major story on recent advances in surgery and wanted to get the full story on my department, among others. I had no inkling that this was going to be the lead story, and I told him we would be happy to cooperate. He assigned Ruth Mehrtens (later Mrs. John Galvin), a young science reporter, to cover the story. Ruth came to Boston frequently. She immersed herself in both ancient and modern surgical history and visited

various departments of surgery over the country where important advances were taking place.

In a month or so, Cant asked me to go into town to have a portrait painted in color by one of the magazine’s artists. The portrait was painted using tempera, sort of a plastic material, and was clearly typical of Time cover portraits. I expressed the thought to him that there were other surgeons in the country who might better have their portrait painted for this purpose. He adroitly agreed; this was a good way of making it seem indefinite, thus keeping me in the dark as to specific plans for the cover.

I went over the stories about various aspects of surgery with Ruth. We tried to achieve accuracy, but somehow the story of David Hume’s early kidney transplantations got projected into 1954, and he was identified as the surgeon in that first identical twin operation instead of Joe Murray. I am not sure who owed the apology for this error to Joe Murray, but we both felt responsible.

The article had not yet appeared when Laurie and I went off to Mexico, where I attended a surgical congress. We had never been to Mexico before and enjoyed our visit tremendously, especially because of the kindness of many interesting people and the remarkable antiquity of so many things in Mexico City. If somebody finds a seventeenth-century church in New England, they declare it a historic place. In the center of Mexico City you can find a huge cathedral that dates back to the earliest years of the sixteenth century. On a May morning in Mexico I went to a newsstand and picked up a copy of Time, that picture on the cover and the entire story within.

Not many people knew where we were when the issue of May 3, 1963, was put on the newsstand. Nonetheless, the telephone began to ring in our hotel room and continued to ring (back home) for several weeks.

When one of their own achieves some sort of special public prominence, people have an ambivalent reaction. On the one hand, they are proud that their profession—in this case, physicians in general and surgeons in particular—is receiving favorable attention. On the other hand, some are apt to feel envy or jealousy. Others may consider themselves or their friends more worthy of such prominent mention, for example the head of their own department or the founder of their hospital.

Among the latter, there are always some who feel that the media attention was sought out by the recipient of that attention and is just another example of his general malfeasance and criminal desire for notoriety. Stated otherwise, reactions ranged from sweet grapes to sour grapes and then to grapes of wrath.

In due course any feeling of resentment passed off. While I can understand and forgive all sorts of negative reactions on the part of my colleagues, I was pleased and surprised that the great majority of them responded with kindness, were thrilled, and gave me the sort of backing you need when you are suddenly thrust into a spotlight position of unwonted and unwanted prominence.

So we went on with our work much as before.

As did Laurie, who was interested in the political process, in current events, and in the League of Women Voters of Brookline. As an active member of the league, Laurie was assigned the role of official observer at the meetings of town government. Meetings of the league were often held at our house, and whenever I could assist her with some audiovisual preparations, to help her presentations, I did so. Then I joined up. It may come as a surprise that quite a few men are members of the League of Women Voters.

I never knew John Kennedy personally; he was 4 years younger and in a later class at Harvard College. On one occasion in the middle 1940s the Boston Chamber of Commerce had selected several young men whom they regarded as “coming up fast” for special achievement awards and held a dinner in their honor. I met JFK at that dinner because both of us had been selected for one of the awards. He was a Massachusetts senator at the time. His Republican opposite number was Leverett Saltonstall.

Nearly everyone remembers where they were when they heard of Pearl Harbor and, 22 years later, when they heard of the death of President Kennedy. On that November day in 1963, I was idle, waiting for ducks to drop into our decoys on a small promontory (Browne’s Point) bordering Merrymeeting Bay in Maine. Richard Warren was there with

me. Mrs. Erle Browne, the wife of the farmer who was our guide and owned the point, came rushing out the half mile or so from the house. “The president’s been shot!” was her only statement, and she rushed back to her farmhouse. We picked up our gear, ran back to the house, and watched the T.V. for a moment or two. Then we hurriedly threw our heavy clothes in the back of the car and drove home, listening all the way to the nonstop radio account of the tragic events in Dallas. An era of immensely high hope for all of us, led by one of our own generation, now killed in the line of duty, seemed all at once uncertain and tragic. While we would forever grieve over this tragedy, just then the best thing to do was to get back to work.

Hospitals in small towns and rural communities do not like to merge, no matter the pressure of economic reality or the attraction of shared services. Like magnets of the same polarity, nearby community hospitals repel each other strongly. Each is the pride of its community, the crowning achievement of its board, the hallowed hospice for ills and injuries, scenes of the birth of babies who later grow up to become board chairmen.

When you are a patient in a small community hospital (as I have often been), you can understand their point. These are comfortable places, with kind people looking after you. Everyone knows everyone else. There is a personal flavor. Such hospitals are essential to the operation of the entire American system of medical care. Their function is to give the care at which they excel and then seek further help from others when necessary. In many cases, the smaller hospitals could do their task better if they joined forces, the way high schools in small communities began to do about 75 years ago. Together they could provide a more complete menu of shared services and lose fewer patients to the big hospitals in the nearest city.

By contrast, large urban hospitals (including teaching hospitals) are anxious to merge. While the same local chauvinistic pressures, loyalties, competing physicians’ interests, and cheerleader enthusiasm of the

ladies’ auxiliaries will struggle to avoid merger, cooler heads usually prevail. Economies of scale, shared use of extraordinarily expensive equipment, greater prestige, specialists, and drawing power are now measured in millions of dollars. Balance sheets speak louder than local pride. In many of our large cities over the past five decades, such hospitals have been merging by the dozens to form better balanced units.

In the 1950s, after several years at the Brigham, it seemed clear that the clinical sciences and arts—as they had developed after World War II—had rendered our hospital, at 250 beds, too small to fulfill its mission as a teaching hospital. Many argued that in voicing this opinion I had been overly impressed by the size of my alma mater, the MGH (then about 850 beds), and its breadth of clinical services—almost impossible to achieve in a smaller hospital. The stand-pat arguments pointed out, as all would agree, that the accomplishments of the Brigham, however small its size, were world-renowned and would doubtless continue to develop, as indeed they did. We all agreed that large size alone did not spell quality of care. Nonetheless, I was sure that the time had come to expand.

Mine was not the only voice to push this need for broader shoulders and major change. Money was scarce. Our hospital was experiencing a hard time financially. Our deficits were impressive and the annual charitable fund drives barely made them up. Our ancient and honorable endowment was about gone. One of our leading trustees actually wanted to close the hospital! Some of the staff wanted to shrink it even further, making it just a small research institute. To me, this would have been a fatal mistake. That way lay disaster. Such a small research institute certainly would have lost my interest entirely and (I am sure) that of many others. My voice, while not the only one, was one of the most persistent. And rightly so, as Surgeon-in-Chief. Surgery fills lots of beds, uses all the labs, the operating room, intensive care, blood bank, rehab. Surgery serves a very broad population of patients with urgent but varying demands and uses the whole hospital organism, not just one corner. The surgical voice carries some special clout. Despite antagonisms and the

many enemies I made (most of them temporary), things began to move our way in the late 1950s.

In 1958, in the surgical office, we quietly held the first organizational meeting designed to bring three of these hospitals together. Later this number became four. This was a meeting of George Van Sicklen Smith, William H. Baker Professor of Gynecology and head of clinical and research units in gynecology at the Free Hospital for Women of Brookline; Duncan Reid, William Lambert Richardson Professor of Obstetrics, who was in charge of the busy obstetrical service at the Boston Lying-In Hospital; and myself. The three of us were all surgeons at heart. We knew that our three surgical units could coexist and function peacefully and cooperatively in one building, strengthened by sharing essential services, working in more modern facilities, and with a better balanced nursing and support staff. Soon the Robert Breck Brigham Hospital, a specialized facility for medical and orthopedic care of rheumatic diseases, under its leaders K. Frank Austen in medicine and Clement Sledge in orthopedics, joined our effort toward a new combined hospital.

Twenty-two years later, in July 1980, we admitted our first patient to the new hospital. The Harvard Medical School now had a new 800-bed general hospital across the street from its science quadrangle, complementing the MGH down at the old harborside 4 miles away and helping the school and its biomedical science departments to enter a new century. And our hospital was able, now, greatly to expand its services in clinical surgery, teaching, and research. And expand it did, under the leadership of my successor as professor and head of surgery John Mannick.

Not many readers will be interested in what went on between conception in 1958 and delivery 22 years later, or in the details of how four Boston hospitals—often rivals—actually got together to form what is now known as the Brigham and Women’s Hospital. Mergers of teaching hospitals are awkward but commonplace. While the details of each are different, they do go through rather similar steps. I will tell a little bit about the one leading figure who emerged, who could see the economic, legal, clinical, and educational implications. He was Mr. F. Stanton Deland, the lawyer-trustee who later became President of the new hospital, who worked with four separate Trustee boards, three Harvard medical Deans, and the Massachusetts State Legislature to make it all happen.

Peter Bent Brigham, Esquire, a successful Boston merchant, was by birth a Vermonter. In 1877, having become affluent through his labors (labors largely of brain rather than hand) and through the acquisition of some valuable Boston real estate, he was able to bequeath a large sum of money to endow a hospital. This hospital was to be called the Peter Bent Brigham Hospital and was to be built immediately adjacent to the Harvard Medical School to care for the sick poor of Suffolk County. During the 25 years that the Brigham endowment was accruing interest, the Harvard Medical School moved from the Back Bay to its present site on Longwood Avenue, and the Brigham Trustees bought a spacious 14-acre field across from the medical school, on Francis Street.

The grand opening of the hospital was in 1913, and within 25 years the Peter Bent Brigham Hospital achieved a worldwide reputation based largely on the work of its staff and its first Surgeon-in-Chief, Harvey Cushing. Despite its initial wealth, the hospital soon became as poor as the proverbial church mouse. This poverty was said to have come about owing to clumsy management of real estate and railroad holdings exacerbated by the onset of the Great Depression in 1931, 18 years after the hospital opened.

The brother of Mr. Peter Bent was Mr. Robert Breck Brigham. Not to be outdone by his older and somewhat wealthier brother, he also endowed a new hospital in Boston, the Robert Breck Brigham. Instead of being across the street from the medical school on what we might call the “plains of Longwood,” it was up on nearby Parker Hill, looking out toward Boston harbor in the distance. It opened its doors in 1915, and by 1970, the Robert Breck Brigham Hospital had achieved a remarkable preeminence in medical and orthopedic care as well as basic biological research in rheumatic joint diseases.

Much older than either of the two Brigham hospitals was a nearby hospital that provided the obstetrical care for women and neonatal care for their newborn babies. This was opened in 1865 as the Boston Lying-In Hospital, a quaint name based on the fact that women in labor prefer to lie down on the way to the hospital. By the turn of the century the Boston Lying-In Hospital was the leading obstetrical hospital in New

England, concentrating on the birthing care for thousands of women each year. These patients were largely of the Protestant and Jewish faiths by custom, not by exclusion. Catholic women often chose to be cared for at one of the several Church-affiliated hospitals.

Larger and more ancient than these hospitals beyond the limits of downtown Boston was the Massachusetts General Hospital, founded in 1811 and admitting its first patient in 1817. Right from the start it covered nearly all clinical phases of medical care. The one major exception was obstetrics. By the late 1920s and early 1930s, the MGH had a capacity of around 850 beds and included a small psychiatric wing (the Hall-Mercer Hospital), wedged into the larger general hospital, a gynecologic unit (the Vincent Memorial Hospital), and a pediatric unit (the Burnham), which also had merged into the MGH. Immediately adjacent was the Massachusetts Eye and Ear Infirmary. In the view of most people the whole complex was a single hospital unit famous for both the breadth and the excellence of its care. The MGH was my professional home for 10 years, and I cherish a great affection and respect for its eminence despite my being cast as a leader of its smaller rival. This great hospital, the MGH, with its closely allied Eye and Ear Infirmary, was the dominant force among the privately endowed trustee-operated hospitals of New England. The cluster of seven hospitals around the Longwood area could become a clinical force balancing to the west of Boston the downtown strengths of the MGH and the Boston City Hospital, but it would be somewhat larger in the total number of beds and closer to the Harvard Medical School.

Merger of four of these into one would strengthen the work of the whole area through shared services, cross-fertilization in teaching, and shared support of research.

In gynecology there was yet another hospital to be included. Just beyond the plains of Longwood, on the river formerly called Muddy (now distinguished as The Fenway), was the Free Hospital for Women of Brookline. This hospital was established by local endowment for the specific purpose of providing gynecologic care to the needy women of Brookline (a suburb virtually surrounded by Boston) and nearby Roxbury (a part of Boston). It became a center for gynecologic surgery and for research on reproductive physiology and endocrinology and was one of

the smallest and most specialized of the Harvard-affiliated teaching hospitals.

Several hospitals on the plains of Longwood shared facilities and services with the Brigham and were supportive in this new conjunction of their neighbors. These hospitals included (in addition to those already mentioned) the Beth Israel, Children’s Hospital, Boston Psychopathic (a state hospital), and New England Deaconess. The Deaconess had been a private hospital of high quality that was largely unassociated with Harvard surgery until 1963, when William V. McDermott, Jr., Cheever Professor of Surgery at Harvard Medical School and Director of the Sears Department at Boston City Hospital, moved that surgical service to the Deaconess. From that time forward, the Deaconess became a major collaborator in research and in undergraduate and graduate surgical teaching at the medical school. Bill McDermott was the only Harvard professor during those 50 years to start up a new Harvard Department of Surgery. Before his retirement in 1985, he brought his department to international eminence.

If a merger is to succeed, it needs a leader. During the preliminary first step, in which the Lying-In merged with the Free Hospital, such a leader emerged and Stan Deland first showed his mettle. He led Trustees and staff of both hospitals through a maze of obstacles to merge these two into a new entity, the Boston Hospital for Women (BHW). It was on the basis of this achievement (in 1965) that his talent was recognized and he rose through the ranks of trusteedom to assume the leadership position that later became so important.

With the new BHW firmly in place, it was clear that the next step—merging the BHW with the two Brigham hospitals—would be welcomed by those who felt (as Smith, Reid, and I had since 1958) that the two Brighams should join forces with the Lying-In and the Free. Their shared orthopedic, medical, and surgical services should round out the whole. This struggle for union embodied several salient features common to all hospital mergers.

There were severe tugs of war among the staff: stand-pat versus

change. These differences were soon resolved. Our neighbors were quite understandably concerned at the sudden appearance of a new giant in their midst. The women’s auxiliaries, so much the soul of each hospital family, at first were wary of merger but now work together as one. Jealousy between the members of the several boards of trustees was keen. This was a surprise to me and quite a contrast to the rapidly emerging sense of unity among the professional staffs. Real estate is a problem in many hospital mergers, but the old Peter Bent Brigham was land-rich. We had extra property on which new construction could start promptly. Most of all we needed a helmsman to guide these four hospitals through those tortuous 22 years from that first joint meeting to a new hospital ready to admit its first patient.

In this new venture Deland continued his leadership. He was a Boston lawyer, Harvard College class of 1936, Harvard Law 1939, who displayed a unique combination of understanding and good humor mixed with the determination and legal and political know-how needed for such a massive public venture. I had known Stan since college days and was immensely pleased and confident of our success by dint of his appointment as Board Chairman.

Under his guidance the merger agreement was signed in 1971 and from there things moved rapidly forward. It was Stan who asked Thomas Dudley Cabot, a distinguished senior citizen of Boston, long a benefactor of Harvard University and its hospitals, to be in charge of our fund drive. While Stan was supremely effective, he could not have accomplished this four-way merger without the help of Charles B. Barnes, John Lowell, George Kuehn, Lawrence Damon, the Alan Steinerts (père et fils), Joseph Powell, and the other presidents and chairmen of the four constituent boards. They all deserve full credit for their important contributions to the formation of this new member of the Harvard hospital family.

The rest of the story is less complicated. The requisite millions of philanthropic dollars were gathered. While the sinking fund was established, the bond issues were floated. The new hospital was built as a tower consisting of four round, linked units, resembling a cloverleaf as

seen from above. By its detractors it was likened to four large beer cans full of square holes. Now almost 15 years old, it is one of the more successful new hospital buildings in the United States. The architect, Bertrand Goldberg, deserves an architectural laurel wreath for his achievement.

For a long while during its early gestation, the project was referred to as the hospital complex (often disparagingly as the “complex hospital”). Then it became the Affiliated Hospitals Complex. Then the Affiliated Hospitals Center, Inc. After the building was built, a name was still needed. Finally, one was selected by Stan Deland and his trustee executive committee: The Brigham and Women’s Hospital (BWH). This name combines the interests of all four of the participants, acknowledging the two Brigham hospitals and the two women’s hospitals that made up its whole.

In July 1980 the new hospital was opened, and by a supreme effort over the course of 48 hours, hundreds of patients were moved into their new rooms in the 16-story tower. On the first evening, a patient with acute appendicitis entered the emergency ward and the first operation was carried out. Stan Deland donned a surgical “monkey suit” and was in attendance for that landmark event.

Thus it came about that Stan Deland, more than any other one person, brought about this merger. He lived to see his new hospital become a reality, increasing satisfaction among those who, years before, had threatened to disrupt the project. Gradually a new Board of Trustees was created from the four original Boards.

A practicing lawyer, Stan was the exceptional hospital trustee who understood enough law to put through new state charters as part of the merger; enough politics to keep the mayor, governor, and legislature on our side; enough human values, humor, and good will to assuage dissension; and enough clinical common sense to realize that the whole project had but one purpose: the care of the sick. This was the main reason for its existence, despite the pressures of its two strong subsidiary missions of teaching and research. To achieve this objective he worked with three

successive Deans of the Harvard Medical School: George Packer Berry, Robert H. Ebert, and finally Daniel C. Tosteson.

In July 1987 Stan Deland, only 73 years of age, died rather suddenly of a recurrent lymphoma. He had been Chairman of the Board of Overseers of Harvard University and President of our hospital, had merged four hospitals and built a new one to make a glorious new hospice for patients and students alike. John McArthur, Dean of the Harvard Business School, succeeded Stan as Chairman of the Board. H. Richard Nesson has been the President and Chief Executive Officer.

The year of his death, his wife Susan Deland, with our help, established a fellowship in Stan’s name to provide an educational opportunity for young clinicians who might wish to go into hospital administration. But equally important, and as it turned out somewhat more frequently, it offered a clinical opportunity for observation and immersion in medical care for those individuals with a legal, business, or administrative background who wanted to learn the administration of a teaching hospital.

As a result of Stan Deland’s efforts, one corner of Boston has been rebuilt. The Harvard Medical School has a major new clinical and research center. Patients from all over the world have access to that remarkable combination of wisdom and mercy, science and humanism that has characterized these four hospitals—now merged into one—since their earliest beginnings over 100 years ago.

As this book nears completion, a new merger is under way between the two Harvard hospital giants, MGH and BWH. Just what the anatomy and physiology of that huge organism will be and how each partner will continue true to its own genes remain for the future. The merger that went before may provide some guidance to a new generation expressing the urge to merge.

In October1990, two years after Laurie’s death, Kathie and Iwent to San Francisco for the annual meeting of the American College of Surgeons. We had been married less than 6 months, and this was an occasion where I was introducing her to the phenomenon of a large surgical meeting in a delightful city where we would surely meet and dine with a great many of our friends in American surgery, as well as many from abroad.

Early Monday morning, October 8, we were awakened by a call from Susan Lang, my secretary in Boston. It was then about 8:30 AM in Boston, and she asked the age-old question, “Have you heard the news?”

“What news?”

“Dr. Murray has been awarded the Nobel Prize,” she replied. I got a few more details before announcing this remarkable news to Kathie.

Within the next half hour we received several more telephone calls, either from officials of the American College of Surgeons who wanted to arrange a reception for Joe—the first surgical Nobelist since Huggins, 44 years before—or from friends and reporters. We were able to contact Joe quite early, though as I recall he had checked in only the night before and had heard about the award only a few moments before Susan's call.

There was great excitement among surgeons, not only those at

the meeting, but throughout the world. This excitement spread of course to all Harvard Medical alumni and all transplanters. Somehow, the Nobel award casts a glow of pride over all those associated with the recipient through their field of science, their professions, or their institutions.

Joseph Murray’s partner in the prize, E. Donnall Thomas of Seattle, had been a resident in medicine with George Thorn at the Brigham at the same time the identical twin transplant had taken place (1954). In fact, Don had written a consultant’s note in the record. His Nobel Prize– winning work had been in bone marrow transplantation, recognizing the many ways in which he had made this procedure safer and more reliable.

On a cold, dark December afternoon in 1990, Kathie and I sat in the State Theatre in Stockholm, in our best formal garb, long gown for her, white tie and tails for me. We watched while Joseph Murray was called from his seat on the stage to receive a sheepskin from the King of Sweden along with a medal designating him as the recipient of one of the two 1990 Nobel Prizes in physiology or medicine. His citation was read in Swedish, translated into English, summarizing his pioneer work in kidney transplantation.

We were pardonably proud not only because of Joe’s remarkable work, but also because I was possibly the first American professor of surgery to witness that prize being awarded to a staff member, a teacher on his faculty, a man who had done the honored work in his laboratories and in the regular line of study and surgery.

The story of Alfred Nobel, the Nobel Foundation, and the establishment of the Nobel Prizes has been told on many occasions with various emphases. Possibly the most engaging detail is that attested to in the official history. This is the story of Alfred Nobel reading his own mistaken obituary, an item published in a Swedish newspaper on the occasion of his brother’s death. Evidently the reporter got the two Nobels mixed up and wrote an elaborate account of how Alfred had stabilized dangerously explosive gunpowder by spacing out the particles with diatomaceous earth so it would maintain its explosive power but would be easier and less dangerous to handle. The new explosive powder was called

dynamite. And how, over the years, dynamite had been used for the building of inter-ocean canals and epic structures throughout the world, and it was Nobel’s hope that his discovery would benefit mankind. But the paper also emphasized how this discovery revolutionized gunfire, artillery, and bombs and had led to the deaths of hundreds of thousands of young men. Alfred, very much alive, was shocked at what the world would think of him after his death. So he resolved to do some good. He endowed a foundation and made possible what has become the prototype of all honorary awards. The Nobel Prize is large in amount, is overlain with great ceremony, is given in several fields of endeavor, and is unmatched worldwide in prestige.

The Karolinska Institute of Stockholm had known of the work being done in our department for many years. In 1960 I had been invited to participate as a scientist in the celebration of their 150th anniversary, as mentioned previously. Their professor of surgery at the Karolinska, Jack Adams Ray, was a friend of ours, and we have had many Swedish visits and visitors over the years.

Although this background has nothing whatsoever to do with the selection by the Nobel Committee of two transplant scientists (Joseph Murray and E. Donnall Thomas) for the prize in 1990, it does account for the fact that I was one of many university department heads in this country asked annually to submit a Nobel nomination in physiology or medicine. Over the years I had nominated several American, British, and French surgeons with whose work I was well acquainted. When the committee asks a representative of some special field of study for nominations, they of course expect him or her to know of the outstanding people in that field and to discriminate among noteworthy discoveries as to which are of Nobel caliber.

The Nobel Committee has clearly been aware of progress in the field of transplantation and in the underlying study of immunogenetics and pharmacology. Prizes in this area have included those awarded to Alexis Carrel (1912) for his study of kidney transplantation in the cat and the method for suturing blood vessels (Chapter 19), to Peter Medawar and

MacFarlane Burnet (1960) for their studies in immunogenetics, and to George Hitchings and Gertrude Elion (1988) for the chemical engineering of highly specific drugs (Chapter 20). Among the drugs cited by the Nobel Committee was azathioprine, the use of which in transplantation was pioneered in our department. In fact, even before the Nobel recognition of Joseph Murray, we had dedicated a new laboratory in immunogenetics at the Brigham to those two pioneer workers most prominent in this field: Hitchings and Murray. Baruj Benacerraf, Jean Dausset, and George Snell had been awarded the prize in 1980 for their work on the histocompatibility gene that recognizes self versus nonself when new proteins are introduced into the body.

Previous surgical Nobelists given the prize for work by their own hands in their own fields of surgery have been few. In addition to Carrel, there was the Swiss surgeon Theodor Kocher (1909), recognized for his work on the thyroid, and Charles Huggins, a surgeon at the University of Chicago (1966), for his work showing the close association between the male sex hormone (testosterone) and the growth of cancer of the prostate. Several other surgeons have been recognized as being part of Nobel Prize teams, although their work was not a part of their regular clinical studies.

The Swedish, like the British, enjoy laying it on with public ceremonies of pomp and circumstance. The Nobel ceremony is one of their greatest annual events, and the entire celebration lasts about 10 days.

At this time of year (December), the sun as viewed from Stockholm does not get more than a couple of inches above the horizon. The nights are long, cold, damp, and intrinsically gloomy, while the days are very short. What better time to have this huge, colorful, exciting international celebration with several events attended by leading figures from all over the world? It is a time for fancy clothes, evening gowns, and medals pinned to wide red stripes from shoulder to bellyband for the European gentlemen. But in point of fact, none of that is why the ceremony is held in December. It happens to be the time of Alfred Nobel’s death, and this was designated as the time for the event.

Our trip to Sweden was largely uneventful save for the fact that I

forgot my pants. I discovered this crippling omission on Sunday, the day before the big ceremony. In Sweden, stores are open on Sunday. When I got to the men’s dress-clothes department, a cheerful young lady said, in perfect English, but with a charming Swedish smile, “Well, well. Another American who forgot his trousers!” This is what most people would call tact.

Suitably attired, we attended the festivities. Joe’s scientific presentation of his work was well done, modest, giving credit to his colleagues and predecessors. George Thorn and many members of the Murray family were present to enjoy the ceremony.

Kathie looked marvelous in her floor-sweeping gown and long, white gloves, an item I thought had disappeared from our society when I ceased to attend Boston debutante cotillions. We danced at the formal ball after the banquet. One of the Murrays’ daughters-in-law is a singer (as is Joe’s wife, Bobby) and had performed in Sweden before. So as a specialty of the ball, she sang some jazzy American pieces in Swedish and charmed the large gathering.

The banquet itself is held in the huge town hall, said to be the largest single-room banquet hall in the world. The 1,800 guests were precisely arranged by field of study and therefore possibly prior acquaintance. We were seated among friends and not too far from the young and sparkling queen, diamond tiara and all, and the rather stiff and formal young king.

This Nobel ceremony seemed a long way from the smelly dog lab in which the first experimental transplants had been done, the workaday world of developing organ transplantation, the gloom of death and failure, and our excitement in the successes of our long-surviving animals and, later, patients.