Joseph Murray

The Role of the Surgeon in Scientific Progress


Surgeons can be bridge-tenders for information traveling between the laboratory to the "living", as emphasized by Dr. Francis D. Moore in his Society of University Surgeons presidential address some 35 years ago. We surgeons should enlist basic scientists in the work we are doing so that they may participate with pleasure and interest. This sometimes involves taking them on rounds or including them in the decision making. The "bridge" carries with it another obligation - namely to see that laboratory findings are applied in an ethical and humane way.

All knowledge is basic, whether derived at the bedside or the bench. Some individuals erroneously imply that "pure" research is nobler and more intellectual and difficult than applied science. A statement by Pasteur denies this concepiton: "No category of science exists to which one could give the name of applied science. Science and the application of science are linked together as a fruit is to the tree that has borne it."

During the 1940s, the dogma of many bench scientists was that human organ transplantation could never be possible because the basis of individuality lay deep within every cell in the body. But clinical scientists persisted, motivated by the plight of their dying patients and their insight into human disease. When clinical transplantation did become a reality, Medawar was the first to give major credit to surgeons for their roles in the laboratory and hospitals.

The study of organ transplants was accentuated during World War II in the treatment of burn casualities, especially those in England suffered by aviators and civilians with severe burns.

The major reason for the initiation in the 1940s of the human kidney transplant program at the Peter Bent Brigham Hospital in Boston (now Brigham and Women's Hospital) was to control hypertension. Dr. George W. Thorn, Chief of Medicine, felt that hypertension could be cured if the diseased kidneys of patients with Bright's disease could be removed. The surgical service under Dr. Francis D. Moore became totally supportive with a broad program in many aspects of human transplantation, including the liver, pancreas, ovaries and bone marrow. Hemodialysis, the so-called articificial kidney using Dr. Carl Walter's modification of Willem Kolff's machine, was first used in a patient at the Brigham in 1948. Then followed a series of human cadaveric renal trasplants into unmodified recipients, transplanted in the thigh by Dr. David m. Hume. Some of Hume's Thigh transplants functioned for months, a mojor boost to our optimism about clinical transplantation.

One of the most significant human experimental works relates to the development of open heart surgery which, in my opinion, should have been recognized long ago by the Nobel selection committee. Dr. John H. Gibbon, Jr., while a resident at the Massachusetts General Hospital, demonstrated in the 1930s that a pump could sustain a dog's circulation after ligating the pulmonary trunk. Incidentally, after its use in a failed Trendelenberg operation, Dr. Churchill, the Chief of Surgery, felt that an external heart pump would never be feasible.

One of the foremost surgeon-scientists today undoubtedly is Dr. Judah Folkman. I had the good fortune to work on the same surgical service with him for 30 years. He is a superb caring clinical surgeon, an unparalleled teacher, and an inquisitive and productive scientist. His seminal investigations of angiogenesis are recognized worldwide and have led to new knowledge in tumor growth, culture and function of epithelial cells, and innovative therapy for peptic ulceration, to name only a few.

Accepting Pasteur's holistic view, the bioscientist, whether surgeon or internist, has a major advantage over the scientist confined to the laboratory. We, in clinical practice, regularly face interesting fundamental problems never observed by basic scientists. Clinical situations stimulate laboratory projects.

In today's technological world, it is easy to understand that team play is essential. We sometimes forget, however, that it has always been so. In his Nobel Prize address in 1902, the legendary carbohydrate, purine, and protein chemist, Emil Fischer, observed that scientific progress was no longer determined by brilliant personal achievements, but rather through planned collaborations with teams of workers. There are many examples of surgeon-scientists who have contributed in fundamental ways to transplantation, cardiac and vascular surgery, nutrition and metabolism, gastrointestinal and endocrine surgery, to mention only a few.

The field of clinical transplantation was started by clinicians who were faced with large numbers of young persons dying of terminal renal disease, whose only barrier to health was the fact that their kidneys were diseased. Clinicians felt frustrated realizing these patients were doomed to die at an early age.

Conceptually, the surgeon and bench scientist differ in three ways:

•The scientist knows that he doesn't know, whereas the clinical surgeon treating patients, is expected to know.

•The scientist can wait for all the data to become available, whereas the surgeon must make a decision based on available data.

•The scientist deals with mass data, whereas the surgeon deals with an individual patient.

Acknowledging these differences, is it possible for a surgeon, or any clinical, to be a scientist? The answer, of course, is yes. It is a difficult role to assume but, nevertheless, it is absolutely essential for medical progress that dedicated clinical surgeons and scientists understand and work with scientists of other basic disciplines. It is a simple fact that basic scientists can't be surgeons, so it is essential that surgeons be scientists.

We surgeons have a rich past and bright future as leaders for medical progress. The basic scientist does not have the daily stimuli that we receive from our clinical opportunities. The life of a surgeon scientist will never be a life for the faint-hearted. But with curiosity, imagination and persistence, a clinical surgeon can be a productive scientist.


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