Getting acquainted with the human body is the first task of the medical student. As it was 60 years ago, so it is (or should be) today. Learning how this awe-inspiring and remarkably intricate piece of machinery is assembled—how it works, its control and communication systems, and its central programming—occupied the full attention of the 120 young men (my classmates) as we dissected our first cadavers in the marble quadrangle of the Harvard Medical School. We had begun our journey toward a medical career. It was September 1935.

For any medical student, that first close-up view of a dead person is shocking, startling, and sometimes upsetting. But even when you have become accustomed to that inglorious, lifeless carcass as a suitable object for close examination, any sense of beauty or worship requires a bit of imagination, of sublimation. The object of our anatomical researches bore little resemblance to the real beauty of a living being. Brown, dried out, smelling strongly of formaldehyde, this cold, stiff flesh retained little that could be recognized as the fabric of man.

For me and many of my colleagues, this task of dissecting a human body also served as our introduction to surgery. Taking in our unskilled hands the ancient tools of sharp scalpel and grasping forceps we gently, at first gingerly, at times clumsily, exposed the inner workings to our view, with as much excitement as did those first Paduan anatomists

400 years before. These inner workings were to be the focus of our attention, one way or another, for about 50 years, the expectable career of most doctors. As we began to learn more, the beauty and efficiency of the body’s exquisite structure and organization would impress us and the impact of that knowledge would never leave us.

In those first few months we also studied physiology and biochemistry, the function of the human body. In the laboratory these functions were reduced to chemical assays, such as salts in the blood, protein in the plasma, urea in the urine. The minutiae of scientific reductionism. As we had with the cadaver, we carried out these analyses with our own two hands, breaking a lot of glassware as we went along. We tangled up or snapped the connections of elaborate and expensive devices used to analyze gases such as oxygen, carbon dioxide, nitrogen, and hydrogen in the blood. These baffling apparati were named after their inventors, Van Slyke or Haldane. Until we had mastered the procedures and ultimately recognized the genius of those inventive scientists, we daily cursed the devilish intricacy of their inventions. To understand the meaning of these measurements demanded a bit of imagination, lofty conceptualization, and, again, sublimation. In time we learned to appreciate these matters as examples of the magnificently sensitive chemical and physiological adjustments of lung, brain, heart, gut, liver, and kidney— the organs that keep us alive.

Dr. Robert Green, our Professor of Anatomy, was an obstetrician by trade, a classical scholar in his spare time, and an orator-actor at heart. Great stuff for a teacher of anatomy. Affectionately known as Bobby Green, he encouraged us to learn enough so we could add to the Roman platitude, “Nihil humanum mihi alienum est” (“Nothing human is foreign to me”), an additional assertion: “... et nihil anatomicum.” Thus we should strive always to improve our knowledge of anatomy through the decades ahead.

Huddled in groups of four around this dead bit of humankind, we dissected, made drawings, learned names and terms, and tried to reconcile what we saw with what was depicted in the textbook propped up on the bench nearby. John Adams, Guy Hayes, and Charlie Mixter were my dissection team-mates. Guy Hayes was to become a director of the international division of the Rockefeller Foundation and accomplish great

works, particularly the foundation of the medical school in Cali, Colombia. The rest of us were destined to become surgeons. Charlie Mixter and I would remain in Boston while John Adams became Professor of Neurological Surgery at the University of California, San Francisco.

The work was demanding and the hours as long as we wanted to make them. When we finished our anatomy course in January of 1936, we had in our minds at least a précis of human anatomy, that interwoven collection of structures that Andreas Vesalius had termed the “Fabrick of Man” in 1543. Although large gaps in our knowledge of anatomy remained, we retained at least a few details until the final examination and even a bit thereafter. We had spent four solid months in this concentrated effort.

How did he die, that person to whose remains we devoted so much attention? How did he live? Intuitively we did not consider the answers to those questions. The cadaver attended by our laboratory neighbors had a bullet lodged in the heart. But we found no such clues. A certain amount of austere impersonality and disconnectedness is probably best in this initial attempt to understand the fabric before we try to treat its tears or patch its holes.

Bobby Green had reworded another platitude. He taught us not to say, “I am a body, I have a soul,” rather, “I am a soul, I live in a body.” This put human anatomy where it belongs, as the structure that serves as a dwelling place. Injury and disease can so destroy that warm dwelling place that it is no longer habitable, and the dweller—energy, mind, and soul—had best be permitted to depart.

We learned, as does every novice looking for the first time at the organization of the human brain, that the brain, despite its structural difference from all other organs and its additional complexity, is also but a dwelling place. This ultimate computer houses the thinking, cognitive mind. We know the mind is there because it communicates with us. Without its dwelling place or when its machinery ceases, when it ceases to convert energy into thought and ceases to communicate, the mind ceases its function and, as with the rest of the resident, no longer lives there.

Some consider the soul a religious concept, others a literary metaphor. However you define it, the soul is a transcendental entity tethered more to the mind than to the brain. Without embracing any concepts of

immortality, I have always interpreted the soul as an epiphenomenon of the mind that requires an observer, a “third party,” for its validation and to achieve reality. Just as the mind is an expansion of the brain, so also the soul is an extension, an expression, of the mind. This became part of our emerging picture of that former person and, by extension, the thousands of patients we would care for over the five decades ahead. Our job would be to keep their dwelling places suitable for habitation.

So here we were in the very first weeks of our courses, just setting out on our study of anatomy, physiology, and biochemistry, already beginning to think about the mind-body dualism. This might seem presumptuous for rank neophytes, a matter that has challenged the most profound philosophers for centuries and most advanced neurochemists for decades.

That’s just how it was. These concerns are inescapable in your first encounter with the basic human via the body and its workings. As beginning students of human biology we could not avoid considering (though often privately, personally) these issues of body, mind, and soul. We found ourselves thinking about them right from the start. If you plan to help maintain that dwelling place intact by treating injured or threatened people, these concerns become very important and practical. One question that would engage us many years later was, Could we, by treatment, keep the dwelling place warm and alive too long?

Maybe it seems a long transit from the dross of a preserved carcass to these transcendent musings. But it was exhilarating to be starting out on this pathway. What a prospect lay ahead!

Sometimes we found it hard to philosophize very much on those waning afternoons, as the New England twilight turned to darkness in the late fall, the leaves gone by. We would put down our instruments, take off our lab coats, and don our jackets. I, for one, wanted to get away from that smelly place and back to the apartment to see my bride, Laurie. Maybe the next day was a Saturday and we could get a ticket to the game. Or we might “spread it” and go out for supper in Chinatown.

The Harvard Medical School of 1935 was uncluttered and straightforward: proud, even splendid, in its simplicity. It had been pursuing a straight-line development in the teaching of college graduates to become physicians, a clear continuity of concept and curriculum dating back to its origin as the Medical Faculty of Harvard College in 1782. It had emerged from its miserable nineteenth century trough of mediocrity as a diploma factory, rescued by President Charles W. Eliot when, about 1870, he introduced entrance examinations and a final measure of achievement leading to the M.D. degree.

In 1935 the Harvard Medical School was still a simple graduate school. There was neither government nor corporate funding to speak of. Tuition was $400 per annum. The science was solid but not static, challenging but not arcane. Patients were looked after in a two-tiered system with charity wards for the care of the poor and for the teaching of students, interns, and residents, while the fancier private wings offered a more elegant version of hospital care with lots of amenities, private nurses, fancy accommodations, the operative hand (and fees) of senior staff only, and flowers on the breakfast tray.

In 1935 such matters as understanding human disease in terms of molecular mechanisms, looking for the responsible gene or its absence, still lay far in the future. Massive federal financing of research was not

even a dream. And at the same time, such nightmares as a plague of malpractice suits, open-ended government payment systems leading to excessive billing, paperwork by the forestful, insurance companies telling physicians what to do, were unheard of. Changes such as these were to start with a rush after World War II.

The tax-supported city and county hospitals were the charity hospitals of the time. The Boston City Hospital was a prime example. The university hospitals, particularly those of the middle west, were coming into their own as unique institutions where the state owned both medical school and hospital. While these institutions contained charity beds reserved for the care of residents of their own states, private patients were also cared for. The ancient, privately endowed, trustee-operated, university-affiliated hospitals of the eastern cities and a few to the west and south (Chicago, New Orleans, San Francisco) seemed to dominate the quest for excellence. They set the standard for care and creativity.

In private as well as university hospitals many patients were cared for as a charitable enterprise. Few physicians were paid to give medical care to charity patients, surely not the interns and residents, most of whom received meager salaries of up to $25 a month or nothing at all. Even in those days such a pittance scarcely covered carfare or cigarettes. Reward to interns and residents took the form not of cash, but rather of the prestige of appointment, the privilege of teaching, the opportunity for research, and above all, the eventual possibility of being appointed to the staff. The Harvard Medical School was affiliated with no fewer than seven major hospitals, most of them private and trustee-governed. The Boston City and the Boston Psychopathic were the only exceptions.

The Harvard Medical School was serene, even complacent, in its social view. At Harvard College there was a beginning stir about inequities in the medical care system. The Committee on Costs of Medical Care had first published its report in 1929 at the University of Chicago. Fifteen years before this the Flexner Report on the State of Medical Education, critical of many medical schools and hospitals as being little more than tuition-hungry factories churning out diplomas, had also criticized the Harvard teaching hospitals because of their seeming commitment to community service rather than the advancement of learning. In 1935 the Harvard Medical School and its faculty careened (or serened)

along, brilliant professors leading the way, students’ families scratching up pennies for tuition, the faculty secure in their practice and university work. Secure, but less than prosperous.

For Laurie and me, existence was idyllic. From our apartment on Longwood Avenue, only a block from the medical school, we looked out on a scene of a few low buildings and quite a few open lots. Now this vista is filled with hospital skyscrapers and research towers. Across from us, in an old wooden tenement, lived a dark-complected, mustachioed Italian who tended his garden and, with a special pride, harvested his tomatoes in August. He gave us some. Our automobile could be parked at the curb 24 hours a day. Because we had bought our first car on our Wyoming honeymoon, it bore a Wyoming license plate that began with the number 3. This showed it was from Sheridan County. So, periodically, people would come up the stairs knocking at our door looking for “the people from Sheridan,” and we would talk about mutual friends.

I probably thought I was working pretty hard. Each student was given a box of bones to take home so he could study some hard-core anatomy. One evening as I took the box out from under the bed and started to pore over these bones, Laurie, rarely querulous or skeptical, said, “Alright, Moorie, let’s take the bones back to the morgue.”

At Harvard College our class consisted of about 1,000 young men, largely drawn from the eastern part of the country. Our class was a moderate, middle-of-the road group of congenial students, many of whom became lifelong friends. Only later did we learn—and then rather inadvertently—that our college class was hardly a hand-picked group! We had been admitted in 1931 during the steep economic downswing after the 1929 crash that was to lead to the depths of the Depression. Applicants to Harvard College in those days were not very numerous. There were not as many scholarships as now and many families couldn’t afford college. In 1931 every single applicant to Harvard College had been admitted. That was us.

Our Harvard Medical School class was filled with brilliant people. Many would later become leaders at medical schools all over the country

or research scientists or both. We were a small but interesting group, intentionally drawn from all parts of this country and a few foreign countries. Only a few of us came from monied or privileged families. We represented all economic groups, large towns, small towns, large colleges, small colleges. A stimulating mix. But there were no women. Harvard Medical School did not inaugurate coeducation until about 10 years later, admitting its first women in the class that entered in 1945.

The medical school curriculum is totally new to most incoming students. All have taken some chemistry at college and even some courses in the chemistry of living organisms (organic chemistry and biological chemistry). The rest is new. The underlying chemical reactions of disease, medical biochemistry, are new to every student. Many have studied some sort of physiology, especially in their biology and zoology courses at college, and have some idea of how the heart works, the structure of muscles, the function of endocrine glands. They may have dissected a frog, a dogfish, or even worked up to the pinnacle complexity of a cat. But the detailed study of human anatomy, of microbiology (the study of bacteria and viruses), and above all, of pathology is totally new to these young minds fresh from college. It is fascinating to watch bright young people with inquisitive minds as they grapple with scientific concepts with which they have had no prior experience.

The most spectacular of the preclinical sciences, and the newest to us, was human pathology, the science of understanding human disease. It is largely descriptive. Phenomenology. Pathology examines how disease has changed cells, tissues, organs, and how those changes came about. Pathology is the science that underlies every detail of clinical medicine, surgery, and pediatrics. It has always been taught by the examination of diseased tissues as seen by the unaided eye or through the microscope. In our time this subject occupied the entire second year of medical school.

Of major importance in the development of this knowledge, and in teaching pathology, is the examination of the recently deceased by the autopsy. For the medical student, the first autopsy can be an emotional experience (like that first cadaver) as well as a scientific milestone. We

were required to attend several autopsies. There were many euphemisms or hospital double-talk for patients who had died. Some were referred to as having been “transferred to Ward X” or “sent to Allen Street,” that being the street behind the Massachusetts General Hospital where the hearses came to call. When an autopsy was imminent, such lingo was used to post the event on a bulletin board at the medical school. My first autopsy, that of a patient I had tried to help a few days before, proved to be more of a wrench than the first cadaver in the anatomy course. Again, it became essential for us as proto-physicians to remain disconnected.

Exposure to these new fields of human thought may be exciting, stimulating, and exhausting, but for some it can also be frightening, overwhelming, and discouraging. Happily, I found myself in the first group. I loved it, was thrilled by it all, considered each new field as a possible and attractive career, and was not overwhelmed, overburdened, or assaulted by this mass of learning.

Ecclesiasticus advises us, “Be not slow to visit the sick.” We began to follow this biblical admonition in our second and third years. I remember the first patient I saw in outpatient medicine, a third-year course we took at the Beth Israel Hospital. Three of us met together to talk with her and carry out a physical examination under the watchful eye of our instructor, Dr. Benjamin Banks. Her name was Mrs. Szintax. The three of us, a bit nervous, stood out in the hall with the instructor, while the nurse tended to the proper accoutrement of the patient: the usual immodest hospital johnny with a little extra covering. The nurse was slow. A bit nervous herself. Dr. Banks becoming restless (looking at his watch), opened the curtain a bit and said, “Are you ready, Mrs. Szintax?”

He used the tone usually reserved for a frightened child at Halloween, about to be assaulted by a team of hobgoblins. “Are you ready, Mrs. Szintax?” became a sort of jocular greeting that we used for years, remembering that very sober moment with our first patient, and Dr. Banks trying to put her at ease.

I remember Mrs. Szintax clearly because she later became my patient. I saw her periodically, operated on her, and some years later she

sent her daughter to me as a patient. I am very proud of the confidence she placed in me as a mere beginner. It is with fondness and respect that I remember that first moment in the autumn of 1937. In a manner of speaking, Mrs. Szintax was my first patient.

American medical students meet patients very early in their education. That it is possible for immature students to meet patients is one of the miracles of modern American medical education. In many other countries, the medical schools are too big for this sort of instruction so early in the curriculum; the European tradition sees the beginning medical student as a rowdy tramp (often intoxicated) yet to be civilized, not a person for whom such doors are to be opened.

Sometime during the first year, and possibly even during the first month or first week, the American medical student, clad perhaps for the first time in a white coat, will confront a sick and often apprehensive patient. The patient is apt to assume that the examiner is a physician. We were leery of this and took pains to tell the patient frankly that we were nothing but medical students. Most patients examined by students or whose care is discussed with students welcome this, both in the hope that it may help them and in the assurance that it will help others. The student’s humanity and human empathy are here given their first opportunity for display. Some students came to it naturally, others slowly, and still others, never. This relationship of patient with student was simple, straightforward. It was unquestioned. It gave us our first contact with sick people.

In addition to those notable early visits with hospital patients, we were each required to deliver 12 babies “on District” (i.e., at the patient’s home). Because of some happenstance, possibly the illness of an upperclassman, four of us were assigned to District at the end of our second year, rather than the third year. “District” was a term for a way of life for mothers, babies, and students in obstetrics, stretching back into the early nineteenth century, and within a few years to be swept away by Modern Medical Care. Medical students (externes) were assigned an area of Boston (a district) in which, under the watchful eye of first-year house officers

(internes) from the obstetrical hospital (the Boston Lying-In), they were to deliver the babies of very poor women.

Here was the bottommost layer of two-tiered medicine, carried to its extreme. No anesthesia. Instruments sterilized by boiling on a gas stove (unless the gas company had turned it off). These settings did not always display the loftiest of home life. There might be a single dangling electric bulb (again, assuming bills paid). A husband sometimes drunk. I remember on one occasion where the sniffling, dirty, measly children were huddled bug-eyed on a bed in the only other room, sneaking a door-crack preview of the advent of a new brother or sister, the young mother, grunting, panting, sometimes crying out, cussing the children, telling them to shut the door. She had been there before. Between uterine contractions she often told the sweating young externe what to do next.

After the slippery but perfect little neophyte slides out in a sudden rush, “Now you tie the cord and cut it,” the mother says. Then the placenta. Then clean up. Maybe glasses of Chianti all around from a straw-covered bottle. Another member added to a family already unable to enjoy the richness of their wonderful and rapidly growing brood because of the worry of caring for them.

In case of trouble during labor, our instructions were to give the husband a nickel. He was to go to a pay phone and call the interne, who would drive over to help us in his rickety jalopy, or maybe take the streetcar. Leisurely assistance.

I delivered the requisite 12 such babies. On two occasions I dispensed with the leisurely arrival of help and told the husband to call an ambulance to take his wife to the hospital immediately. One was a patient who had an epileptic convulsion while I was boiling up the kit on the stove. Not for a home delivery! The other patient looked sick when I first entered her room. Her ankles were swollen and her color a bit blue. Even to my second-year ear the telltale soft rumbling heart murmur of a narrowed mitral valve was detectable. Then she told me that she had been an outpatient at House of the Good Samaritan. This was a hospital devoted to the care—often terminal—of young people with rheumatic heart disease such as hers. I knew that there was a good chance this woman might die in labor. After her arrival at the hospital by ambulance

she was delivered by cesarean. I felt exonerated for my caution. The senior obstetrician grumbled that I had done a good job and that the system—which should have identified such a high-risk mother—had failed.

In addition to the discouraging derelicts, we saw some joyous members of our civilization out there in the slums, on District. One woman I recall particularly. She lived on Gold Street, then the most squalid street in South Boston. But her little apartment was spotlessly clean. Her few sticks of furniture were carefully placed on a clean floor, tiny pictures were arranged on the wall, a rusty old third-hand refrigerator, neat and clean inside. She was well-spoken, of dark brunette Irish beauty. When I went to see her and the baby a few days later (as we were supposed to do), she thanked me and gave me a prized silver dollar. This was the first money I had ever earned from a patient, and it was a gift at that. I had it framed. Years later it still hung on the wall of my office and I often told its story to interested visitors. Then one night it disappeared. Someone, I do not know who, saw the dollar, broke the glass, and stole it. Of such petty greed is one thread woven into the fabric of man.

The faculty of the Harvard Medical School included (then, as now) several figures of world renown. They were immensely impressive and inspiring to us. Walter Cannon elucidated the function of the autonomic nervous system. He showed by his experimental work that the mind and body work together, that fright, hunger, anger, produce bodily changes. Why are people still puzzled and amazed to find that mind and body work together? Why must we suffer the expensive rhetoric of Eastern cults and wealthy gurus to understand this? Walter Cannon taught us physiology. As a senior professor he met regularly with the most junior students and in small groups. A wonderfully human and inspiring figure.

Hans Zinsser was one of the great bacteriologists of his day, a dynamic ego, lecturer, and writer (Rats, Lice and History) and autobiographer (As I Remember Him). Zinsser was a showman, but he could show real accomplishment and we enjoyed his showy lectures. One of the young members of his department was John Enders, who was awarded the Nobel Prize 20 years later for discovering how to culture the poliomyelitis

virus, making it possible for Salk and Sabin to develop vaccines. In so doing Enders helped to wipe out a major disease of mankind in his lifetime. John Enders sat with the other members of the department in the front row of each of Professor Zinsser’s lectures. All the faculty in that department were assigned to this sometimes hard duty. In later years, I often wondered what John Enders thought when Zinsser voiced his doubt that a vaccine against poliomyelitis would ever be possible. Later on, through other circumstances, John Enders became a close friend of mine (though 15 years older), adviser, and role model.

A. Baird Hastings was a leading biochemist, who brought arcane chemical methods to bear on clinical medicine. Now, they are all commonplace. He had a strong impact on me, as I later tried to bring quantitative chemistry to the study of surgical convalescence and the care of surgical illness. A few years later, as a young surgical instructor, I was asked by Baird Hastings to give clinics for the whole first-year class in their biochemistry course, discussing some surgical problems (hemorrhage, shock, fracture, infection) to demonstrate how biochemical understanding underlies many aspects of surgical care and how prompt and skillful surgical operation can minimize complications and metabolic burdens during convalescence.

On the clinical side, our professors of medicine and surgery were also prominent not only in Boston, but over the world. During World War II the care of all the wounded American soldiers in the European theater was supervised by one of our professors of surgery, Elliott Cutler, later promoted to brigadier general. Military surgery in the Mediterranean theater was under the leadership of Edward D. Churchill, another professor of surgery, and later my boss at the Massachusetts General. It is not generally known that the care of our wounded in both the European and the Mediterranean theaters was guided by these two fellow professors of surgery from the Harvard Medical School. Cutler was our principal teacher at the Peter Bent Brigham, as was Churchill at the Massachusetts General. Both men were deeply imprinted on our class and contributed to its apparent bias toward surgery. To observe and assist such men as these while they were operating, to hear them think out loud, and to gather a little of their skill and their philosophy was an immense privilege.

In internal medicine few exceeded Fuller Albright and Soma

Weiss in their influence on our class. Albright was an endocrinologist, the prototypical clinical investigator, who showed the world about metabolic bone disease and hyperparathyroidism (in which the parathyroid glands are overactive). He showed us both the joy and the effectiveness of his researches in the care of the sick, translating their sometimes subtle message into everyday practical experience. Soma Weiss was the brilliant Hungarian clinician who led us through the intricate mysteries of diseases of the heart and blood vessels. He died at an early age. While on an airplane he had a sudden severe headache, recognized the ominous symptoms, made his own diagnosis of a brain hemorrhage, knew the prognosis, and died a few days later at the age of 42. I still quote his teachings. His widow remains a close friend.

College students also teach each other. They influence each other strongly. In medical school the influence is even stronger. The impact of each student on the thought and learning of fellow students is often more crucial than the knowledge imparted by learned professors. Not only is it group learning, it is group teaching. Physiology and biochemistry were often taught with students working in groups or teams. Students often saw patients together, one or two students interviewing or examining a patient (such as Mrs. Szintax) and talking to the patient’s family. We carried out minor operations together in the outpatient department or stitched up cuts and lacerations. The influence we had on each other was so much a part of the educational process that now, in retrospect, it is almost impossible to distinguish it from the impact of the faculty.

Research was a key component of our medical education because our teachers were deeply involved in the biomedical sciences. Many of them were guilty of talking too much about their research when they should have been talking about broader issues. But the research of these men was usually at the cutting edge of thought anyway, so it was not too distracting.

Participation in research is now a requirement at many medical schools. While this was not so in the 1930s, doors were opened and research was made possible. In our second and third years Bill Carleton

and I carried out a research study that occupied Sundays and holidays for many months. We were studying the dramatic and abrupt fall in a certain pregnancy hormone that disappeared from the mother soon after delivery. The source of this hormone was unknown, but its absence a few days after delivery suggested that the hormone (present during pregnancy in huge amounts) arose either in the placenta or in the infant. We discovered that the infant’s urine showed almost none of this hormone, ruling out the baby as its source. If the hormone came from the placenta, its secretory rate would fall to zero very rapidly when the placenta was expelled from the mother’s body at the time of birth. We showed, by documenting the exact rate of the hormone’s disappearance after delivery, that the placenta had to be the source. The hormone was all gone in about 2 hours. Such a finding had not been previously recorded.

Our wives had served as the subjects of this research at the time of the birth of our children, so we had lots of cooperation in collecting the urine samples! While our findings were original and conclusions correct, this research was never published. Based on too few cases. It taught us a lot of things about research, how mistakes could be made and how hard it is to do it right. It also showed that simple theories could be sound, and research was the way to elucidate them. Other students in our class carried out research that was more telling and soon published.

Another bit of my research was more historical than scientific. The Boylston Medical Society was an undergraduate group that required a member to give a talk at one of the meetings. It is said to be the oldest medical society in the western hemisphere (founded 1811). I had become interested in Civil War surgery. During spring vacation of our third year (1938), Laurie and I borrowed an old book of photos by Matthew Brady and took off to drive over some of the battlefields. We visited Chancellorsville, Fredericksburg, and the Wilderness, all within one area of Northern Virginia. We stood where Brady seemed to have had his camera, and we took pictures to show the same scenes 70 years later. The sunken road at Fredericksburg, the Inn at Chancellorsville. They bore a strong resemblance to Brady’s gruesome scenes right after the battles. No more corpses. But even some of the small trees were recognizable. Bigger, now. Today those same scenes have weathered 130 years since their epic battles.

We visited Richmond where a classmate, Dan Ellis, showed us the Confederate Museum with its store of medical records and memorabilia. By a curious coincidence we were invited to a small dinner given for Douglas Southall Freeman, the author of Robert E. Lee’s biography and Lee’s Lieutenants. Freeman was a famous patriarch of the history of the War Between the States. It was a great privilege for Laurie and me to dine with him on our visit to the battlefields.

When we returned from Virginia, I presented my paper on Civil War surgery before the Boylston Medical Society. I asked two senior surgeons whose fathers had been surgeons in that war—Dr. John Homans and Dr. Thaddeus Stevens—to discuss my paper. I showed the pictures and told of the accounts of treating the wounded. It was quite an evening. For many years students looking over the records and seeing my title in the list came to see me for references and memoirs so they could enjoy that remarkable bit of surgical history: the care of the wounded in a huge military action with hundreds of thousands of casualties. It defined the state of surgery after the discovery of anesthesia (chloroform was used more than ether) but before the advent of surgical cleanliness (Lister’s first paper on antisepsis was not published until 1867). Amputation was the most common major operation in that war. Open fractures were universally fatal unless the limb was amputated.

Married students were rare in those days. There was still a bias against marriage by medical students. In a class of 120 only two of us were married at the beginning (John Adams and I); a third, also a close friend (Henry Swan), was married the next summer. Clearly the fiscal realities of the Depression fed this bias. Few parents could undertake, as mine did, to support a medical student and his wife. The going theory was that this bias against marriage was supported if not instituted and promoted by Harvey Cushing, who was engaged to Kate Crowell for 6 or 8 years before taking the plunge. If he had waited so long, certainly others should! Considering that such a bias was almost universal in medical schools, I doubt we can blame it all on Cushing. The bias against medical student marriage rapidly diminished and was about gone by 1940,

even before Pearl Harbor, which ended it completely. After the war, medical schools were filled with men (and later women) who had already seen military service. They were older and many were already married.

Because Laurie and I did not live in the dormitory, I had less daily contact with fellow students than did my unmarried classmates. Laurie often cooked supper for our small group of students, and each supplied his share of steak, green peas, and beer. They came to love this petite, brilliant, hospitable, and unselfish lady I could proudly call my wife. During those Depression years, senior members of the Harvard College faculty gave evening extension courses. Laurie enrolled in them as an extension (i.e., night) student for a year or two, until our children occupied all her time. She thought it was great to take a course in Chinese history under John Fairbank. About 45 years later a small group of us visited China. The knowledge Laurie had gained as a young student made the trip more interesting for all of us.

Medical students enjoy raucous jokes and risque humor, and in those days we often drank too much. Prohibition had been repealed in 1934 while we were at college, and a widespread tendency to uproarious alcoholic parties was certainly notable in our medical school years. While these parties sometimes bothered the neighbors, they seemed to be a generally harmless way of blowing off steam and getting out from under the intense pressures of medical school. The biggest party of all came in the spring of our fourth year, when interns were appointed and we learned where each of us was going for that all-important next step.

Sometime during the second year of medical school or early in the third year, I had decided to go into surgery. This resolve was further strengthened by the fact that I did not enjoy my fourth-year courses in internal medicine. Too much talk and theory; not enough action. It was commonplace at that time for students to move around and take courses at other medical schools. I took courses in New York at the Columbia-Presbyterian Medical Center and at the University of Chicago (Billings Hospital), where I intended to return to practice. Whatever turned my resolve to surgery is unclear and probably unimportant. Possibly, my

early encounters with three remarkably able and appealing surgeons in Winnetka and Chicago—Fred Christopher, Vernon David, and Dallas Phemister—two of whom (FC, VD) practiced their craft on me, and the third (DP), a close friend of my father, was a strong factor. George Dick was a friend of my mother. He was Professor and Head of the Department of Medicine at the University of Chicago. It was he who, on hearing I was going into surgery, said, “Surgery is the specialty of getting people well.” Coming from a professor of internal medicine, that was an impressive endorsement!

While most of our class took internships in internal medicine (some heading toward pediatrics or psychiatry), we were a very surgical class with an unusually large number of internships in surgery. Eighteen professors of surgery emerged from those 120 men. The intern year was merely the first of 3 to 5 years of residency. The hospital of internship became the hospital for those crucial years of residency. Our 4 years at medical school had somehow produced weathered veterans of learning the medical sciences and arts, with little practical experience. Internship and residency supplied just that.

Education consists of a series of peaks scaled, followed by a fall to the bottom of the abyss before the next pinnacle looms ahead. This boom-and-bust phenomenon is nowhere more apparent than at the time when recent medical graduates first proudly flourish their medical degrees, realizing among other things that for the rest of their lives they will be addressed as “Doctor.” A few short days or weeks later they reappear in a white suit as the lowly intern, the lowermost icon on the vast totem pole of medical practice in the United States.

We all expected this transition, this sic transit gloria. We were not the least worried about our change in status. Instead, we were terribly worried about where we would intern, since we wanted to intern at a hospital that would give us the best possible residency and a good start in our profession. Along with seven other fourth-year students I was appointed to the surgical internship at the Massachusetts General Hospital. I felt grateful and tremendously excited by this opportunity. I remember only the first hour or so of the party that followed these internship announcements. My long-suffering wife, who shared fully the joy of our joint triumph in this appointment, had dinner with all of us out on the

town. Though small in stature, she was able to prop me up and get me home.

How did I come to this happy moment that marked the beginning of my surgical life? My decision to become a doctor was not grounded in any ambitions my parents had for me, nor was I one of those youngsters who always knew that medicine was going to be his life’s work. Yet, when I think back on it, there were several influences that might have made more of an impression on me than I knew at the time.

I must have been a fairly bookish child, though I didn’t think of myself in those terms. The public library was not far from our school. I avidly read books to feed my interest in the history of World War I, a subject on which I had become a self-taught expert. Then one of my teachers suggested that I read Valery-Radot’s Life of Pasteur. While I enjoyed the book, I could not understand the chemistry described in it. It told the story of a research academic in biomedical science, the kind of career I was later to follow, but I cannot honestly claim that the book affected me deeply.

Still, I had developed an interest in science, which was encouraged by my mother who had a love of science in her soul. Among her circle of friends were several physicians, including Dr. Rollin Woodyatt, of the Presbyterian Hospital in Chicago, an early pioneer in the study of insulin and diabetic physiology; Dr. C. Anderson Aldrich, pediatrician and author of one of the leading texts in pediatrics; and Dr. David Danforth, a prominent obstetrician. Our family doctor was George Dick, alluded to above. The surgeons I mentioned previously, inspiring men, gave me a very attractive image of what it would be like to be a doctor, and I am certain that the many personal and friendly contacts I had with them played a role in my ultimate choice.