Professors appointed to the endowed chairs at the Harvard Medical School in the clinical fields (medicine, surgery, pediatrics, radiology, anesthesiology, and psychiatry) perform their work at one of the several Harvard teaching hospitals. Once there, they become overseers of clinical care at that hospital. Endowed university full-time professorships are critical to the advancement of academic programs, teaching, learning, and—especially in surgery—new ways of caring for the sick. Only on rare occasions in Harvard’s history have such endowed chairs been transferred from one hospital to another. At whichever hospital surgical professors are situated, one of them by historic precedent becomes the chief surgeon at that hospital, as well as head of that Department of Surgery at the university.
Harvard’s first professor of surgery, John Warren, was the younger brother of another surgeon of colonial Boston, Joseph Warren. Both these eighteenth-century Warrens were at once surgeons and patriots. Joseph was a prime mover in the activist patriotic movement that led to the American Revolution. He dumped tea into Boston Harbor and wrote some of the Suffolk Resolves, a series of anti-Crown inflammatory tracts.
Joseph Warren must have been near the top of the British list of most-wanted rebels. He was killed on June 17, 1775, in the fighting north of the harbor on Breed’s Hill in the encounter known as the Battle of Bunker Hill. His body, buried in a shallow grave, was later found by his younger brother John and Edward A. Holyoke, a patriarch of Massachusetts colonial medicine and a Salem physician, of whom Joseph Warren had been a disciple. It is said that the decaying remains were identified by Paul Revere, who had made Joseph’s denture.
John Warren was appointed Professor of Anatomy and Surgery at Harvard College in 1782. Neither Joseph nor John Warren was designated as “Doctor” because they were not doctors. Like the majority of the physicians in the Colonies at that time, they had neither attended a medical school nor received a doctorate. They never signed their names with “Dr.” or “M.D.” appended. Their education was by apprenticeship.
In 1770 Ezekiel Hersey, a physician of Hingham and a graduate of Harvard College (1728), bequeathed an endowment of £1,000 to Harvard College for a professorship of anatomy. This endowment finally reached £3,400, an amount equivalent to the $1.5 to 2 million required to endow a Harvard professorship today. This very generous endowment made it possible to start up a medical faculty at Harvard College, and on John Warren was conferred the title Hersey Professor of Anatomy and Surgery.
Warren took a rather radical step for Bostonians of that era when he married Abigail Collins. Not only did she come from the South (Rhode Island), but she was of a different Protestant persuasion. Their son, John Collins Warren, became the second Hersey Professor. He was the operating surgeon in the first public demonstration of the use of ether for surgical anesthesia in October 1846. This operation was conducted at the Massachusetts General Hospital only 30 years after the hospital opened and was the basis of its worldwide reputation. In addition to performing this famous operation, John Collins Warren had helped found the MGH (1811), a medical journal (the predecessor of The New England Journal of Medicine) (1812), and the American Medical Association (1847). The Hersey endowment helped make all this possible, and the remarkable energy of these first two Warren surgical professors made it all happen.
Upon the death of John Collins Warren in 1856, the professor-
ship of surgery fell to his son Jonathan Mason Warren, and then in turn to his grandson J. Collins Warren, who thus became the fourth Warren surgeon to be made a professor at Harvard. By then, the Department of Surgery had generously given over the Hersey title and income to strengthen the newly separated Department of Anatomy. The Hersey endowment was later given to the Department of Medicine (Physic). So for about 70 years, three generations of Harvard professors of surgery, all of them carrying the name Warren, lacked a named chair and a suitable endowment, though they might not have put it quite that way.
In those days professors at Harvard Medical School earned part of their income by selling tickets to their lectures, which were open to the paying public. To us, this seems rather old-fashioned, even arcane. When there was no endowment, this practice helped support the senior faculty. (Those old lecture tickets are now collectors’ items at antique stores.) Whatever its shortcomings, this system of payment must have provided a strong incentive to the professors. They had better be good teachers and give smashing lectures if they wished to survive.
Finally, in 1897 the long-awaited endowment for a chair in surgery was given to the university. It came as the result of a family tragedy, when, on August 14, 1879, a recent graduate of the Harvard Medical School Class of 1878 was killed in Switzerland while climbing the Matterhorn. William Moseley was 30 years old when he died. In his memory, his parents, Mr. and Mrs. William Oxnard Moseley, gave several gifts to the medical school and to the MGH. The largest gift, made in 1897, endowed the Harvard Medical School professorship that bears his name.
A few months after the Moseley endowment was accepted by the President and Fellows (the Harvard Corporation), J. Collins Warren was appointed to that chair and became the first Moseley Professor of Surgery. He held the professorship for 9 years, until his retirement in 1907. As the first Moseley Professor at Harvard, he enjoyed a notable career. He was the prime mover in establishing the new medical school buildings on Longwood Avenue in 1906. Construction had begun about 1895. A century later the medical school remains right there, where Warren and his colleagues put it, still a source of heated argument: wouldn’t it be better off in Cambridge, near the college and the other graduate schools?
In addition to his local leadership in Boston/Harvard circles, J. Collins Warren was a strong advocate of Joseph Lister’s system of surgical cleanliness, which was introduced to American surgery in the years between 1867 (when Lister published his first paper) and 1888 (when the practices of antisepsis and asepsis were finally adopted throughout the United States). As a young man, Warren had visited Lister in Scotland. He could clearly see the importance of Lister’s new methods. For example, it enabled patients with compound fractures (previously fatal) to recover. Most important, it led to the modern methods of asepsis that enable surgical operations to be carried out without inevitably introducing infection. Old-time surgeons had borne dried blood and pus on their garments and carried more sources of infection than they realized on their hands. “Listerism” was a move from primordial filth to systematic cleanliness, and the United States trailed years behind Europe in adopting this practice. A conservative faction that now, in retrospect, seems obviously to have been shortsighted and self-serving opposed the introduction of Lister’s methods. Warren led the charge for its acceptance.
The name Warren continues to be an important name in Boston surgery and medicine. The son of J. Collins Warren, John Warren, an anatomist, wrote the text we used in our anatomy course in 1935. Richard Warren, grandson of J. Collins Warren, is our contemporary. He is Professor of Surgery, Emeritus, at Harvard Medical School, a close friend, a staff colleague, and an expert vascular surgeon. Richard Warren edited a widely used textbook of surgery and was for many years Chief of Surgery at the West Roxbury Veterans Administration Hospital in Boston. An outstanding teacher and clinical surgeon who was particularly interested in surgery of the blood vessels, Richard Warren added luster to the Warren name. Some of Richard Warren’s grandchildren have a double legacy of surgery: his oldest son, Richard, married our second oldest daughter, Sally. Richard and I have three Warren grandchildren: Peter, Rebecca, and Samuel. Richard Warren’s nephew, Howland Shaw Warren, now carries on the Warren medical tradition in the younger generation as a microbiologist. Any more Warren surgeons? Not yet.
The second Moseley Professor of Surgery, succeeding J. Collins Warren, was Maurice Howe Richardson, who was later made Chief of Surgery at the MGH (the first and, as it turned out, the last to hold such a title). He was succeeded by Harvey Cushing, who held the Moseley Chair from 1912 until his retirement in 1932.
Cushing developed the field of neurosurgery and was one of its most expert exponents. He was an endocrinologist during the formative years of that field, describing the activity of the ductless glands. This work arose from his knowledge of the pituitary gland, which in turn resulted from his treatment of the many patients with pituitary tumors who sought his assistance. In 1912 the President and Fellows of Harvard College and the newly created Board of Trustees of the Peter Bent Brigham Hospital offered Cushing a joint appointment as Moseley Professor at Harvard and the first Surgeon-in-Chief at the Brigham hospital. He was on the scene when the Brigham opened its doors in 1913 and conducted the affairs of the surgical department for 20 years.
Elliott Cutler succeeded Cushing as Moseley Professor and Surgeon-in-Chief at the Peter Bent Brigham Hospital in 1932. He was a New Englander who sought to refine and standardize the teaching and performance of surgical operations. Early in his career Cutler had been interested in the surgical treatment of heart disease. In 1924 he carried out several operations to open the narrowed (stenotic) mitral valve. Only one of these first efforts to repair chronic valvular heart disease was in any sense successful. The patient lived several months, much improved. But important lessons were learned that helped Dwight Harken when he resumed this quest at the Brigham 24 years later in 1948. It was to be 30 years after Cutler before these operations became safe and widely performed. Cutler’s career as the fourth Moseley Professor was cut short in 1940 by World War II. He left his professorial duties after only 8 years to help organize a base hospital, later being given theater responsibilities for the care of the wounded in Europe. He was promoted to the rank of brigadier general, one of the few medical men of the civilian establishment to reach this rank in World War II. While on active duty in the European theater, he developed some pain in his back. X-rays showed
deposits of the fatal tumor that had metastasized from his prostate to his bones and led to his death on August 16, 1947.
On the morning of July 1, 1948, I arrived as the fifth Moseley Professor at Harvard, the eighth surgical professor in this line stretching back to the Revolution, and the third Surgeon-in-Chief at the Peter Bent Brigham Hospital. I pulled into the allotted parking space and went into my office (Cushing’s old digs) to start work.
Little of the history I have just recounted was known to me that first morning. I was not interested in history. I was mainly concerned with picking up the reins of this fine department, which included so many distinguished surgeons. It was getting started that counted.
The welfare of patients in the 140 surgical beds of the Brigham was our first responsibility. It was from their care that we were to learn so much. And it was to them that we owed our loyalty and later our gratitude. I performed my first surgical operation at the Brigham 2 weeks after I arrived. The patient was a young man suffering from severe ulcerative colitis. I carried out a total colectomy (removal of the colon) and made a new opening on his abdomen, an ileostomy, similar to the procedure described in Chapter 10.
I had already met with the Trustees of the Brigham to point out that, in addition to our long-established laboratory at the Medical School, we needed a laboratory to study patients at first hand. I was concerned about the processes of illness and of getting well and therefore requested a clinical research laboratory right there in the hospital. My work, already begun at the MGH on body composition and the biology of convalescence, needed the facilities to proceed at full speed.
The industrious and talented young Radcliffe graduate whom I have already mentioned, Margaret Ball, became my head technician and director of our laboratory staff and analytic work. I had brought her with me to the Brigham from Oliver Cope’s laboratory at the MGH. She remained in this important role for 27 years. The Trustees had given me the rooms of the old blood bank for our laboratory. They were right next to my office, conveniently situated between the two surgical wards and
just below the operating room. Miss Ball and I went to an abandoned fish processing plant and found some soapstone benches and sinks. We moved them to the Brigham, and the first Surgical Research Laboratory in the history of the hospital (smelling a little fishy) was ready to go.
I did not bring a large clinical staff with me to my new job. I was too young for that. But I did bring one surgeon who turned out to be tremendously important throughout the decades to come. This was John Robinson Brooks, who had attended Harvard College and Medical School (’43), served in the armed forces during the war, and took his residency at the Roosevelt Hospital in New York. Following those clinical years, he joined me at the MGH, assisting in our study of duodenal ulcer and vagotomy. He would soon become the Chief Resident Surgeon at the Brigham, later a member of the attending staff with increasing responsibility, and finally the right-hand man of the entire department.
My new hospital, the Peter Bent Brigham (the Brigham for short) was 35 years old when, on July 1, 1948, its new Surgeon-in-Chief arrived for work. I would be 35 the next month. The hospital and I were both opened in 1913. It was only 3 years after the war, and the surgical department was suffering from two disasters in addition to the residual effects of wartime absences. These two adversities were the aging of the senior staff and recent domination by a surgeon who was sure he could do anything and everything and therefore let the specialties wilt on the vine. In the unedited opinion of others, there was a third disaster: a callow youth taking over the department.
Our aging staff included two famous surgeons, David Cheever and John Homans, both of whom had been my teachers and one of whom (Cheever) had operated upon my wife. Another, Robert Zollinger, one of our most valued teachers, was not so very old at this time but had departed to take over the Department of Surgery at Ohio State University. Still, there was plenty of talent and young blood in general surgery, as will become evident.
As for Elliott Cutler, although an inspiring teacher who was much enjoyed by our class, he was one of the last of those who might truly be called a general surgeon. One morning (just before the war) I recall visiting the Brigham where I witnessed Cutler perform (in a single day) an
operation for a brain tumor, a hysterectomy, and a colon resection for cancer. While one operative virtuoso might of course encompass these three distinctly different kinds of operative surgery, no one person could possibly keep up with the literature; master new trends; attend the specialty meetings in neurosurgery, gynecology, and surgical oncology simultaneously; or provide leadership for residency training in all three fields.
Everybody is against specialization except the patient. The patient always seeks the most expert care. By 1948 the surgical specialties were well developed. The events of the war had accelerated this trend because of urgent demands for expert surgical treatment of wounds involving all the organs and systems of the body.
Teaching hospitals provide the perspectives and opportunities that arise when young people work with senior specialists. This is how students get an idea of the many careers that make up the practice of medicine and surgery. Teaching hospitals should also instill, by example, the concept that you can be a specialist but still have a humanistic view toward the patient and the family, their social and emotional needs. The primary care physician or the family doctor must surely possess these empathetic traits, but he has no monopoly on them. Those specialists who are sought after by patients and other doctors exhibit these same traits.
With regard to leadership in the surgical specialties, the Brigham of 1948 was almost dead in the water. Our surgical service, which had been the birthplace of neurosurgery, the most highly specialized field of all, did not have a neurosurgeon on the staff who was entirely responsible for adult patients. But its most glaring deficiency was that no surgeon on the Brigham staff was performing adult thoracic and cardiac surgery, two fields that had rapidly expanded in scope and importance during the war. As my first major outside appointment I therefore asked Dwight Harken, then working at the Boston City Hospital, to join our service. This was November 1948. The story of his remarkable work and the beginnings of surgery within the heart is told in Chapter 23.
We had no one concentrating in gynecology, even though a half dozen of the general surgeons (including me) performed gynecological
operations. None of us was concerned with the rapidly opening fields of gynecological endocrinology, fertility and sterility, and the special problems of malignancy of the ovaries and uterus. I asked Somers Sturgis, then at the MGH and one of my teachers, to come and join our service. He had a long and brilliant career as a leader in gynecology at the Brigham, which included the first attempt to transplant human ovaries and the creation of the first full-time psychiatric unit in a surgical department in the United States to examine the emotional impact on women of removal of the ovaries and uterus or of the breast.
I asked Donald Matson—another classmate—to take over neurosurgery in the adult, working closely with his professor, Dr. Franc Ingraham, at the Children’s Hospital. Within a few years I asked Joseph Murray to take over in plastic surgery, Andrew Jessiman in oncology, Henry Banks in orthopedics, and Leo Chylack in ophthalmology. All turned out to be very strong appointments that led to strong divisions of surgery in those fields.
For a young man to take over leadership of a surgical department so lacking in full-time staff specialists for its 250 beds might have seemed a bad deal. But in retrospect it was a marvelous opportunity to appoint brilliant young people (only two of whom were my age or younger) to these important positions. I was repeatedly warned not to appoint anyone older (than I was); everyone thought that would turn out to be bad news. But since I was only 35 or so at the time, I didn’t have much choice.
As for anesthesia, it was still a division of the Department of Surgery. In the early 1930s nurse-conducted anesthesia in this country had just begun to yield to physician-led departments. The latter were the rule in all the teaching hospitals and universities of Great Britain and for the most part on the Continent. The United States was still reluctant to make this change, despite the fact that in 1914 Harvey Cushing had appointed a physician-scientist, Walter Boothby, to lead Brigham anesthesia. Boothby was a respiratory physiologist who was also expert in anesthesia. With the appointment of Boothby, Cushing was one of the first in the United States to enhance his surgical department with an expert physician-scientist as anesthetist. After a few years, Boothby left the Brigham to head up research at an institute in the southwest. Nurse anesthetists had staffed the Brigham department for almost 30 years under the leadership of Miss
Gertrude Gerrard, who was not only a fine anesthetist but an engaging person well known to all of us as medical students.
As fine as a nurse anesthetist might be, it was impossible for a person lacking a full medical education to absorb the increasingly complicated studies of pharmacology, physiology, biochemistry, and neurology on which the practice and teaching of anesthesia were based. A full curriculum in biomedical science was required for their understanding and incorporation into anesthesia practice. After the war a flood of bright young physicians began entering the field of anesthesia. Within a few years, physician-led departments began to dominate anesthesia in this country as they had in Great Britain for almost 75 years.
Upon Cutler’s death, William Quinby (the senior urologist of the hospital) had been asked by the Dean and the Trustees to take over the surgical department as acting head. It is to his credit that the Brigham moved into physician anesthesia during that difficult interim period by appointing William S. Derrick Chief of the Anesthesia Division of the Department of Surgery in 1947. And it was a credit to Bill Derrick that he accepted the job despite uncertainty as to who might become his boss as professor of surgery only a few months later.
About 5 years later, Derrick was offered a position as director of anesthesia in Houston, Texas. He accepted the offer but gave me only 3 weeks notice. I had to drop everything and undertake a search for a new anesthetist. If ever I was destined to develop a stress ulcer or high blood pressure, this would have been the moment. The search took me a lot longer than 3 weeks. For several months we had a very rough time conducting operations, because Derrick took the nurse anesthetists and most of the support staff with him to Houston. We began to use a great deal of local and spinal anesthesia (at that time administered by the surgeon himself).
I traveled far and wide, from San Francisco to New York and back again, in my search. In due course I discovered Leroy D. Vandam in the Department of Anesthesia under Robert Dripps at the University of Pennsylvania. With great good luck I convinced him and his wife Regina to join us in Boston. Within a few years he had built one of the finest teaching departments of anesthesia to be found anywhere. He later de-
clared independence and formed a separate department of anesthesia. He remains a near neighbor and close friend.
In general surgery we were fortunate in having on the staff J. Englebert Dunphy, who had been near the top of the list of the local candidates for the job as professor and head of surgery to which I was later appointed. Dunphy and I had known each other for many years, were good friends, and got along well even in times of stress and crisis. It was a sure thing that we would be unable to hang onto him for very long. Within a few years he was appointed head of the Harvard Surgical Service at the Boston City Hospital, later becoming Professor and Head of the Department at the University of Oregon in Portland. Finally, he culminated his career by serving for 25 years as Professor and Head of the Department of Surgery at the University of California at San Francisco. He was a joyous person, filled with good humor and known the world over for his leadership in surgery.
In urology, I was also blessed in having J. Hartwell Harrison in charge, likewise an old friend and a much beloved expert surgeon. That was one area of surgery I never had to worry about. As a loyal Virginian and graduate of Thomas Jefferson’s university, Hartwell’s principal interest outside of Harvard was clearly at Charlottesville, where he served for many years as member of the Board.
Adding new people to the staff would have been the height of folly unless we could open more beds for their patients and broaden our internship and residency training program beyond the confines of our own small hospital. In those hectic years just after World War II, many other teaching surgical departments were learning the hard way that breadth of competence requires width of bed capacity. A few were learning that their home-grown gospel was not the only source of truth.
The concept that surgical residents might do well to expand their vision beyond one hospital was introduced soon after the war. One of the jobs Churchill had given to me at the MGH was to be in charge of the resident staff assignments. We established an affiliation with the Salem Hospital (in Salem, Massachusetts) to give our residents a chance to expe-
rience the surgical life and times of a community hospital and contrast them with those of a university teaching hospital. Churchill had a wartime friend who was in charge of the surgical department in Winfield, Kansas, so we sent some residents way out there. Our men enjoyed both these assignments very much.
Inspired by these outreach adventures with Dr. Churchill, I began several experiments at the Brigham. We sent a resident to New York to Memorial Hospital, then under the surgical leadership of Alexander Brunschwig. The object was to give our residents the opportunity to work for a while with someone who was extending the scope of cancer surgery. This did not work out very well because the residents were unimpressed with the results. Before long I came to appreciate their view. Meanwhile, the New York affiliation had given one or two people a remarkable experience. One such was Joseph Murray, who had the opportunity to see the joining of plastic surgery with cancer surgery at its inception. He brought that message back to us and made it an important part of his career.
We also initiated an affiliation with the Beverly Hospital (in Beverly, Massachusetts), again to give our men a chance to see small-town hospital life, and likewise with the Burbank Hospital in Fitchburg, Massachusetts, then under the direction of one of my classmates, Fred Ross. The latter affiliation was the most successful, lasting for about 30 years. Many of the Brigham residents looked back on the months they spent in Fitchburg as among the most rewarding of their 5 years in training. There was a substantial volume of surgery, and they were able to carry out many operations themselves. There was less of the bustle and pressure of academia. They got a taste for surgery in a smaller community, and many of those who did not feel the pull toward academia entered practice in smaller communities, in part because of their experience with Dr. Ross.
Our most remunerative training arrangement for the residents was one made with the Sun Valley Hospital in Ketchum, Idaho. This came about because John Moritz, the brother of our pathologist Alan Moritz, was in charge of surgery there. This hospital took care of all the skiing casualties from Sun Valley and was owned by the Union Pacific Railroad. They needed extra hands during the height of the skiing season and were willing to pay handsomely for them. We grabbed this opportunity. While
our men were out there, they treated lots of fractures in addition to being treated to some good skiing. They were paid a rather generous salary by the Union Pacific. Several of our residents saw as many as 250 fractures during their 3-month stay. I often thought it would make a great advertisement for a skiing resort if we emphasized the tremendous experience to be gained in fixing up broken bones. One of the annual hospital spoofs of that time included the song, “O Franny! Please send me to Sun Valley!”
Through an unexpected happy circumstance we established an exchange arrangement with St. Mary’s Hospital, a teaching unit of the University of London. This came about because the guiding spirit of St. Mary’s at that time was Sir Arthur Porritt (later Lord Porritt), who had been a track star in the Olympics some years before and a visiting professor at the Brigham a year or two previously. A Boston financier and benefactor of many causes, Mr. F. Murray Forbes had also been an Olympic runner and had met Porritt at that time. Forbes was in charge of the George Gorham Peters Fund. With his help and this fund, we were able to bring an English surgeon to Boston and pay him with dollars while he was here, and in exchange send an American surgeon to London where he was paid in pounds by the National Health Service.
This was a pretty slick arrangement, and for many years we had a marvelous annual trans-Atlantic exchange of residents. The Bostonians enjoyed the variegated clinical work and the generality of surgery in London. As for our London visitors, young surgeons in Britain did not have an opportunity to do research, certainly not that involving large animals, which was proscribed by the antivivisection laws of the British Commonwealth. Therefore, many of those who came to our hospital worked at least for a while in our laboratories as well as on the resident service. The men who graduated from these jobs later occupied many leading positions in both Great Britain and the United States. Many years later, when I was made an Honorary Fellow of the Royal College of Surgeons of England, it was an unexpected pleasure for me to witness the formal procession being led by several surgeons—then of senior age—who had spent part of their training at the Brigham. Old friends.
Early in this period (1948-1955) our residents were paid almost nothing, enjoying the same hair shirt that had been our lot before the war. This changed rapidly after an intern strike or “heal-in” at the Boston City Hospital. By the mid 1950s most interns and residents were beginning to get a wage that, while it would not provide a living in itself, at least made it possible for their wives to take an occasional vacation! In those days, up until about 1965, countless young American residents in medicine and surgery got through their training because of the industry and earning power of their wives.
The surgical service needed more beds. Thanks to George Thorn’s personal acquaintance with the Coolidge family, we were able to build a whole new wing of the hospital named in honor of Thomas Jefferson Coolidge, formerly president of the United Fruit Company. After I took care of the King of Arabia (Chapter 26), the Saudi Royal Family gave us a generous gift for some more beds. Before long we were up to about 300 beds and a higher rate of surgical operative experience for staff and residents. While this was a big improvement, it was still perfectly obvious that we needed a new hospital to break out of the confines and physical constraints of the old Brigham. That finally came, but it took many years and is another story (Chapter 30).
So, as we filled the need for more people to represent the various specialties of surgery, the hospital grew apace. With hospitals, beware of mere growth! Specialization sometimes takes hold of a hospital and the hospital cannot stop it, like an eagle flying with too big a fish in its talons. Can’t let go. Domination by one specialty is not healthy for either public service or the balance of teaching. Domination becomes damnation.
That almost happened to us. Within a few years we became a center for kidney disease, transplant surgery, the care of burns, and cardiac surgery. While this was a result of the work of our own staff, specialization threatened to take over to a greater extent than we had wished. Nothing like the hardship of being too much in demand. But with lots of cooperation from the Board of Trustees, we weathered that threat and kept the balance needed for teaching.
Right from the start I took on a big load of teaching, having
opportunities to teach in all 4 years of the 4-year medical curriculum. This helped interest the students in entering surgery, witnessing some of its fascinations both inside and outside of the operating room.
Early on, as Moseley Professor, I was asked to take over the first-year anatomy clinics. These teaching sessions took place on Saturday mornings, addressing the entire first-year class during their first 3 months of medical school. The name of the game was to present a real patient (or two) in person, discuss the patient’s problem, and then (after the patient left the auditorium) describe the exact anatomical arrangements or misarrangements involved with the disease in question. And, in some cases, the students could observe the ensuing operation from the old Brigham operating amphitheater that was built for Harvey Cushing and could accommodate a whole class (at that time about 120 students).
I took over those anatomy clinics, trying to follow in the wonderful tradition of David Cheever, who had provided this combination of science and humanism for our class 15 years before. I enjoyed giving these clinics and always spent a lot of time preparing for them. The patients were carefully picked as being those who might enjoy describing their symptoms or telling (sometimes critically) about their care.
One Friday evening in the fall of 1949, while I was preparing for a clinic on the gallbladder, Laurie was seized with a severe pain in the right upper part of her abdomen. Her pain crescendoed to a high pitch and then backed off. It did not take much skill on the part of her husband to make a diagnosis of gallstone colic.
We called our family physician who gave her a suitable shot, and she had a reasonably comfortable night. The next morning was Saturday, the day of the clinic. I asked her if she would mind describing exactly what it felt like to have the pain of gallstone colic, the stone trying to get out, as it were, down the narrow ducts. This would be an experience that the medical students would remember for a long time.
So, the pain having subsided and she more beautiful than ever, Laurie was wheeled into the main amphitheater in a wheelchair with a snappy looking nurse in a crackling starched uniform at her side. I asked a
few questions. The students could then ask her all the questions they wanted and ask what gallstone colic really felt like. The clinic went along swimmingly, and I do not think anyone suspected a rather special relationship between the patient and the surgeon giving the clinic, until, at the very end, one of the students asked, “Didn’t you have any medicine around the house for this sort of thing?”
Laurie replied, “Well, my husband...” (and at this point she inadvertently glanced over at me) “looked in all the medicine cabinets and couldn’t find anything of any use.” For some reason this was both a big laugh and a giveaway. The students, realizing in a flash that the patient was my wife, howled with glee, Laurie smiled happily, and it all ended as the nurse turned and, in a very businesslike way, wheeled her out and back to her bed on the floor. A short while later she was operated upon by Dr. Dunphy, who removed a gallbladder full of stones.
The students never forgot this particular clinic. Many years later, walking down the streets of San Francisco or Chicago or Atlantic City, where there might be a meeting of the American College of Surgeons, we were sure to meet one or two surgeons who had been students at that clinic. When they saw Laurie, they would say to her, “Well, Mrs. Moore, I hope you are feeling better now.” And there would be a happy laugh of recognition and reminiscence. The rumor was that at least for that period in the Harvard Medical School, this was the most famous anatomy clinic. To cap the climax of that particular Saturday morning, one of the students present at that clinic was John Mannick, who later succeeded me as Moseley Professor.
We also kept up the Brigham tradition of visiting professor pro tempore. We arranged for a series of surgeons to come to the Brigham in that capacity. These “Pro Tems,” as they were called, were selected because of their ability to teach, the fields in which they were interested, and the breadth of view they would bring to our residents and students. It was rumored that the Pro Tem tradition had been commenced by Harvey Cushing. We had many visitors who were the leaders of surgery in various cities in this country and abroad. One of the more remarkable was Sir
James Paterson Ross, head of the surgical department at St. Bartholomew’s Hospital in London. He made ward rounds with the students, as did all such visiting Pro Tems. Any English surgeon who had “Sir” in front of his name always made a big hit with our patients. We later found that to many Americans the “Sir” suggests some kind of connection with the British royal family. In any event, when Sir James made his rounds, he encountered a certain talkative and friendly Irish patient who was charmed by him and talked with him at length. He examined her and then scrubbed in on her operation the next day. We later discovered that over the course of many years she exchanged Christmas cards with Sir James and Lady Ross.
During those early years we were successful in drawing a sizable number of applicants for our internship. Many young men (and a small number of women) also came to learn by working in our laboratories.
We were studying three topics that attracted people to our department. First, we were using tiny tracer doses of both radioactive and stable isotopes to discover some of the eternal verities of physiology and biochemistry. Second, we were looking at disorders of body composition, not only in surgical patients, but also in heart failure, starvation, infection, shock, and seriously overweight patients. And third, we were trying to improve physiological care in surgery, which came to be known as metabolic care, particularly after the publication of The Metabolic Response to Surgery. Many people from this country and abroad applied for research jobs, fellowships, and openings on the team. In all, over the course of the next 30 years, over 300 young surgeons, physicians, and scientists came to work in our laboratories. Some of those from other countries and other disciplines who came to work with us are mentioned below.
First was André Monsaingeon, who came to join our lab from Paris while I was at the MGH working on metabolic problems as well as ulcerative colitis and burns. These were problems he had confronted in Paris. Shortly after the war several large foundations made funds available for young French doctors who had been isolated (if not captured) during the war to come to this country to study. This was true of André, whose family had been involved in the French Resistance. He himself had narrowly escaped being shot by the Nazis. He came and worked with me as a Rockefeller Fellow early on. Soon Laurie and I visited him and his charm-
ing wife Geneviève in Paris. He became Head of Surgery at l’Hôpital Paul Brousse, in Paris, and Professor (later Dean) at the University of Paris. Subsequently he returned as visiting professor pro tem, and over the years we visited back and forth across the Atlantic to form one of those lasting family friendships that stem from scientific work, from academia. If I had been practicing surgery in Boston and doing nothing else, he never would have come and stayed a year. He came to study and to join in my research. An important reward of the academic life.
Next was a young pediatrician from Copenhagen, Bent Friis-Hansen. Like so many Scandinavians, he did not say a great deal but thought a lot. He made no pretense but understood everything. He worked with me in the early days of the total body water method and later became the world’s expert on body composition in the newborn. One day I asked him if he would like to play some tennis. I had never been very good at the game but enjoyed trying. When we went to pick him up at his apartment to take him to The Country Club, he appeared in one of those spotless European-style tennis outfits such as you might see at a tennis club on Long Island. A white sweater with a blue V down the front. He was carrying three tennis rackets. Beware. It was evident after a short time on the court that I was no match for him and was unable to provide him with enough of a challenge even to give him exercise. When Laurie came back to pick us up, he politely told Laurie that he would like to run home in order to get some exercise. So much for my tennis. Laurie told the story to our kids and knowing my tennis they howled with glee. Despite this, he became a close friend. He and his wife Bente visited us many times since, as we have visited in Copenhagen, where he became Professor of Pediatrics.
Also among my early afficionados in research was a brilliant young biochemist, Isidore Edelman. He was sent to me by the Atomic Energy Commission, who wished him to obtain some grounding in isotope research. He stayed with me for a couple of years and helped in some of our early basic work on deuterium disappearance curves in humans, demonstrating the half-life of the water molecule in the body. He then worked with Arthur Solomon, Professor of Biochemistry, on developing the mass spectrometer for deuterium measurement. In 1950 he joined me in writing a review of the status of body composition and soon became the
expert in internal medicine and biochemistry in this field. After leaving us he went to the University of California and was a key figure at the Cardiovascular Research Institute before being made Professor and Head of the Department of Biochemistry at Columbia University.
Paul Schloerb of Kansas and Rochester, New York, was a native son, a surgeon, and also an important early collaborator in isotope dilution studies. Recently he has improved on our ancient methods using modern biophysical methods. Graham Wilson of London was one of several men in internal medicine and cardiology who came to work with me because of the importance of body composition in heart disease. He later became Regius Professor of Medicine at Oxford.
Martin Moore-Ede, who was interested in the daily flux of body potassium, came to us from his studies in England. He later became an expert in biorhythm physiology and the need to plan the work of human beings according to their circadian (daily) rhythms. He was founding president of the Institute for Circadian Physiology in Boston.
Hugh Dudley, a surgeon of Aberdeen and of Edinburgh, came to our laboratories for 2 years and was one of the prime exponents of metabolism and metabolic care in surgery, in both Australasia and the British Isles. He became Professor of Surgery in Melbourne, Australia, and then moved to London as Professor and Head of the department at St. Mary’s.
It would have been impossible to attract people with such a range of interests had it not been for the breadth of these studies and financial support from many sources. Some brought fellowships with them from abroad; others I was able to finance with my own research grants. The special fellowship programs of the National Institutes of Health and the American Cancer Society supported our people right from the start.
Because of our work on shock and burns, the Army was among our strongest backers. The Atomic Energy Commission took over funding of our isotope program from the Navy (which had picked it up right after the war). The Commonwealth Fund supported David Hume’s work on the pituitary gland. The Harvard Medical School and the Brigham continued to be mainstays of our support by providing space and administrative backing as well as a hard-money budget. Within a few years a similar network of support would develop for organ transplantation and the several other fields of study being pursued in our department.