Surgical Limits: The Life of Gordon Murray 9781442680265

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T E OF GORDON MURRAY

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Surgical Limits The Life of Gordon Murray

SHELLEY McKELLAR

UNIVERSITY OF TORONTO PRESS Toronto Buffalo London

www.utppublishing.com © University of Toronto Press Incorporated 2003 Toronto Buffalo London Printed in Canada ISBN 0-8020-3739-9 (cloth)

Printed on acid-free paper

National Library of Canada Cataloguing in Publication

McKellar, Shelley, 1967Surgical limits : the life of Gordon Murray / Shelley McKellar. Includes bibliographical references and index. ISBN 0-8020-3739-9 1. Murray, Gordon, 1894-1976. 2. Surgeons - Canada Biography. I. Title RD27.35.M86M35 2003

617'.092

C2002-905540-7

University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council for the Arts and the Ontario Arts Council. This book has been published with the help of a grant from the Associated Medical Services Inc., through the Hannah Institute for the History of Medicine Program. This book has been published with the help of a grant from the Humanities and Social Sciences Federation of Canada, using funds provided by the Social Sciences and Humanities Research Council of Canada. University of Toronto Press acknowledges the financial support for its publishing activities of the Government of Canada through the Book Publishing Industry Development Program (BPIDP).

Contents

PRKFACK VII

ACKNOWLEDGMENTS

Introduction: A Surgeon's Life

3

1 Rural Beginnings: The Formation of a Surgeon

8

2 Toronto Appointment: Heparin and Vascular Surgery 3 Delivering Miracles: Heart Surgery and an Artificial Kidney Machine 52 4 A Private Laboratory, a Second Artificial Kidney, and New Heart Operations 76 5 A Cure for Cancer? Sera, Vaccines, and the Theory of Immunity 105 6 Making Paraplegics Walk Again: The Spinal Cord Controversy 133 7 Time for Rest: Career Reflections Conclusion: Surgical Limits

175

161

29

vi

Contents

APPENDIX: DR CORDON MURRAY'S MEDICAL WRITING 181 NOTES 185 A NOTE ON SOURCES 251

INDEX

255

Illustrations follow page 86 and page 174

Preface

I did not intend to write a biography. Before I decided to undertake this project, I was not particularly interested in medical lives, much less great doctors, and shivered at the thought of doing 'dead white guy history.' My research interests range from medical technology to women's health issues, exploring innovation and change, medical knowledge diffusion, patient decision-making processes, and the concept of cure. I am intrigued by disease patterns, alternative therapies, technological fixes in medicine, and changing views of the body and of definitions of health. Gordon Murray interested me because he built the first North American artificial kidney machine, using it clinically during the 1940s in Toronto with mixed success. At the time, I was conducting research on the iron lung (mechanical respirator) and entertaining the idea of an expanded study of technology in the hospital. How were new technologies introduced and adopted (or rejected) into medical practice? Was it influenced by culture? What role did various social groups - doctors, hospital administrators, patients — or the media or the medical market place play? I decided to find out more about the Murray artificial kidney and was soon drawn into this surgeon's extraordinary and controversial career. I was apprehensive about writing a biography. Some scholars have criticized biography, or life writing, as antiquated, unsophisticated, dangerously narrow, and elitist. In the field of medical history, there are many hagiographic accounts of physicians, surgeons, and nurses. Few historians of medicine who were trained as historians seemed interested in individuals, preferring to study structures, institutions, ideas, and concepts. But good biographies in the history of medicine do exist, such

as Typhoid Mary: Captive to the Public's Health by Judith Leavitt and Langsta

viii Preface A Nineteenth-Century Medical Life by Jacalyn Duffin. Based on sound research and the critical use of sources, they recreate both the life and times of their subject, examining not only the historical figure's personality and life events but also the context in which the person lived in order to describe what happened and why. In this way, Murray is worth writing about. There deserves to be a spotlight highlighting the contributions of this Canadian surgeon who, perhaps regrettably, has been forgotten by many people. Equally important, his life offers insights into the medical and social changes that were underway during the mid-twentieth century. For instance, how did the practice of surgery and the conduct of medical research change during this period? Also, why did North America become the centre of innovative surgery in the twentieth century? How was society's understanding of disease altered with the rise of surgery as a perceived curative therapy? How was the concept of cure defined by society and by the surgical

community? What role did medical journalism play in perpetuating

society's hope in medical miracles? I have attempted to present a readable, accessible biography of a twentieth-century Canadian surgeon. In trying to appease both a general audience and specialists, I risk being accused of providing either too much medical detail or not enough, and of being too harsh or not critical enough of my subject. I have tried to write an interesting and illuminating account of a life, identifying shifting trends in medical practice, social attitudes, and concepts of cures without disrupting the flow of a good story. Not all readers will agree with my conclusions, but I hope they will find that I have treated Gordon Murray fairly in assessing his contributions and his impact on Canadian medicine and society.

Acknowledgments

I have many people to thank for their contributions to this book. This work began as a doctoral dissertation in history at the University of Toronto, supervised and examined by Michael Bliss, Edward Shorter, Jim Connor, Pauline Mazumdar, and Charles Roland. All offered constructive comments. Michael and Jim, in particular, challenged me in the research and writing phases, and continued to offer helpful suggestions during the thesis-to-book revision phase. I am deeply grateful to them. During the course of my research, generous financial support was provided by University of Toronto Open Fellowships, an Ontario Graduate Scholarship, an Associated Medical Services/Hannah Institute for the History of Medicine Doctoral Scholarship, a Rockefeller Archive Center Grant, and a University of Toronto History Department Research Travel Grant. I enjoyed the privileges of being a visiting research fellow at the Institute for the History and Philosophy of Science and Technology, Victoria College, University of Toronto. For this, I thank Pauline Mazumdar and Janis Langins. The George Cedric Metcalf PostDoctoral Research Fellowship at the University of Western Ontario allowed me to concentrate on the additional research and much-needed revision that was required to turn this dissertation into a book. I am extremely grateful to Ben Forster and others in the University of Western Ontario's History Department for providing me with such a stimulating and collegial environment in which to work. I thank Jack Hyatt for teaching me about First World War gunners. Most recently, I have enjoyed the collegial atmosphere of the History Department and History of Health and Medicine Unit at McMaster University and have benefited from the helpful advice of David Wright and Nancy Bouchier.

x Acknowledgments Facilitating my research, numerous archivists and librarians were helpful and courteous, and in some cases drew my attention to material that I would not have otherwise discovered. Larry McNally at the National Archives of Canada in Ottawa, Harold Averill and Marnee Gamble at the University of Toronto Archives, and Felicity Pope and Kathryn Rumbold, both formerly at the Toronto Hospital, deserve special mention for their assistance. My discussions and personal correspondence with anyone who knew or worked with Murray were a vital part of my research. The names of those who agreed to speak with me are listed in 'A Note on Sources.' I thank these men and women for sharing their stories, insights, and enthusiasm about my subject, especially those from whom I demanded much in the way of time and knowledge: Mrs Rosalind (Murray) Bradford, Dr Donald R. Wilson, Dr Wilfred G. Bigelow, Dr Ronald J. Baird, and Dr William R. Drucker. Dr Wilson and Dr Baird also agreed to read an earlier draft of this manuscript and saved me from embarrassing errors in my descriptions of surgical operations and techniques. Colleagues provided stimulation, motivation, and encouragement when most needed over the years. Their contribution to my work cannot be overstated. Thanks to Allison Kirk-Montgomery, Margaret Derry, Alison Meek, and Barbara Clow for their friendship and scholarship. I also benefited greatly from the tough questioning and opinions of participants of seminars and conferences at which I presented this work. Neither these individuals nor anyone else who helped me will necessarily agree with my conclusions, and they are certainly not to be held responsible for any of my interpretations, errors, or omissions. My positive experience with the University of Toronto Press was due to Len Husband, who patiently guided me through the publication process, met difficult deadlines on my behalf, and stayed involved through all stages in the production of this book. Frances Mundy and Carlotta Lemieux improved the manuscript with their suggestions and superb copy-editing. I am grateful for the financial support to publish this book provided by the Associated Medical Services Inc., through the Hannah Institute for the History of Medicine Program and the Aid to Scholarly Publications Programme. Finally, I am indebted to my family - Paul and Sandra McKellar, Frank and Lynne Stacey - who provided encouragement and support, not to mention computers, lodging, and meals, throughout this long process. Thank you for putting up with me. Most of all, it was my husband's patience, gende prodding, and unwavering faith in me that helped me complete this book. Thank you Doug for your love, support, and humour. I could ask for no better partner with whom to keep life adventuresome.

SURGICAL LIMITS: THE LIFE OF GORDON MURRAY

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Introduction: A Surgeon's Life

To a Surgeon From helpless beds they turn their eyes to you Oh, skilled surgeon with the velvet touch ... For them, your skilful hand and learned brain Bring back the age of miracles again.

Anon. 1

Gordon Murray stands as one of modern Canada's most prominent and controversial surgeons. His contributions in medicine range from the clinical application of heparin to organ transplantation and include vascular surgical procedures, heart operations, artificial kidney machines, and even a proposed cure for cancer. Throughout his forty-year career in Toronto, the press as well as grateful patients and friends applauded his bold, broad approach to medicine, his tenacity in tackling complex medical problems, and his courage to intervene with incredibly heroic measures to save lives. This biography charts an exceptional life in medicine, exploring the personality, training, practice, research, and contributions of a man who rose to the top of his profession only to have it come crashing down when he later overreached himself. Surgical Limits tells a personal story of triumph and tragedy, a drama of character and circumstances. In examining the field of twentiethcentury surgery and one of its practitioners, it explores many of the medical and social changes that occurred throughout Canada and the United States during this period. It highlights some of the dramatic developments in the practice of surgery and their impact on medical practice, disease, and society. Threaded through the book, several over-

4 Surgical Limits arching themes are discussed, including the expanding therapeutic role of surgery, the rising power and authority of its practitioners, surgical character and culture, changes in the conduct of medical research, and the quest for cures in medicine. Surgery is a craft as well as an art and a science. A good surgeon seems to operate effortlessly - cutting, excising, suturing, and knotting - working nimbly and quietly from incision to closing. Good hands, or technical proficiency, are fundamental to good results. The tool of the trade is the scalpel, a small pointed knife with variously shaped blades, essential in the task of cutting through tissues to remove and repair damaged body parts. The workshop is the operating room, in which the operation itself is highly ritualized. Compulsory garb and scrubbing up by staff are required to ensure sterility. Nurses and assistants prepare the surgeon's preferred tools, placing them near the operating table. Everything is ready for the surgeon's entrance. Then the students, nurses, and assistants take their supporting positions around the star performer to await the first incision. To cure by the scalpel - cutting and repairing the human body - is a solitary activity. The surgeon alone, through his or her decisions and actions, is responsible for the fate of the patient (though this surgical perspective minimizes the role of the surgical team, nurses, and other caregivers in the preoperative and postoperative phases).2 In the early and mid twentieth century, surgeons were often likened to frontiersmen or explorers because of their sense of independence, their individuality, courage, and authority in comparison with their physician colleagues. In general, surgeons were viewed as doers, interventionists, and risk takers. Murray's notoriety as a surgical innovator and 'miracle maker' came at the same time that surgery and surgeons were experiencing a substantial rise in professional and therapeutic power. Simply put, surgeons did more operations, tackling organs and cavities of the body that had been deemed untouchable by an earlier generation. Their proficiency improved and their range of procedures expanded as they began to offer surgical solutions to an increasing array of medical conditions previously treated in other ways. Diseased tissue was cut out, damaged structures were repaired, and lives saved. Surgery emerged as a relatively safe and painless, even curative, treatment. It became a celebrated medical therapy. Sick patients were transformed into healthy individuals. New technologies and innovations in medicine, such as heparin, blood transfusions, and antibiotics, further empowered both the surgeon and the

discipline. Surgeons emerged as the new medical supermen, retaining

Introduction

5

the courage and dramatics of their nineteenth-century predecessors but supported by twentieth-century science and technology. 2 Murray came to enjoy this superman status. Much of this had to do with the nature of his education and training, his appointment at an elite university hospital, and mid-twentieth-century advances in the fields of vascular, cardiac, renal, and transplant surgery. Murray trained in Canada, Britain, and the United States; as a result, his exposure to different cultural approaches influenced his outlook and style. The type of surgeon that Murray became was not unrelated to the hospitals and mentors through which he trained. Landing a plum appointment at the

Toronto General Hospital found him poised for a promising surgical

and research career. Murray emerged a leader in the new fields of vascular, cardiac, renal, and transplant surgery. During the 1930s, as part of a research team led by Charles Best, the co-discoverer of insulin, Murray defined procedures for the beneficial use of heparin, an anticoagulant (blood thinner), in treating pulmonary embolism and later in performing vascular surgical techniques successfully. With heparin, surgeons could prevent clotting, repair damaged blood vessels, and restore circulation. During the early 1940s, the infant field of vascular surgery grew, with Murray accumulating significant experimental and clinical experience in it because of his access to heparin through Toronto's Connaught Laboratories. He next dared to operate on the heart, specifically the small damaged hearts of dying children. As one of only a handful of successful heart surgeons in this period, Murray became known as Canada's celebrated 'blue baby doctor.' He went on to develop early heart valve replacement and coronary artery bypass procedures. In 1945-6 Murray built the first North American artificial kidney machine. A massive, odd-looking contraption, this experimental machine saved the life of a comatose patient in renal failure. Several years later, Murray performed a kidney transplant operation on a young woman suffering from a chronic renal disease. The experimental procedure saved her life. 'Murray was full of ideas,' stated surgeon Donald Wilson. 'He was always questioning things and he always not only questioned them but he pursued them and came up with answers.' 4 It was characteristic of Murray to move quickly from the laboratory to the operating room - prematurely in some cases, one might argue. But at times, the risk paid off and lives were saved. Murray succeeded because of his surgical skill and ingenuity. He seemed to make miracles' happen. 'Gordon Murray was a brilliant

6 Surgical Limits surgeon,' stated surgeon William T. Mustard, 'technically brilliant and also a technically brilliant mind. He was continually probing ... a fantastic mind.'5 Murray's mastery of anatomy and his mechanistic view of the body contributed to his superb operating skills and his expansive surgical outlook. Carefully and confidently he invaded the body, exposing blood, organs, and disease, to repair damaged parts. He was known for his precision, quickness, and use of sign language when performing surgery - he was a brilliant operator. Murray's surgical style reflected his personality: forthright, precise, and pragmatic. He loved to operate, and students, junior colleagues, and visiting medical men clamoured to observe him in action. Nurses and students admired him not only for his skill in the operating room but also for his caring manner with his patients. Yet at times he was demanding and brisk with hospital staff. To colleagues, he could be egotistical and cantankerous. Routinely asked to give a second opinion, Murray often disagreed with fellow physicians over the course of treatment. It was not uncommon for him to rescue less competent surgeons in the operating room. He never shared a close

camaraderie with his Toronto peers, and friction plagued almost all of his working relationships.

In the early 1950s Murray was on top of his game, with awards and recognition from the medical profession, with speaking engagements and teaching trips, and patient and media adulation. He now directed his own private laboratory, the W.P. Caven Memorial Research Foundation, or de facto Gordon Murray Institute. It was at this time, however, that he began to overreach himself. Murray's later dubious research activities threatened to eclipse his earlier contributions. Having treated cancer surgically for years, he became intrigued by the theory of immunity in cancer and began experimenting with anticancer sera and vaccines. His colleagues criticized him for dabbling in a field outside his expertise. Amidst professional scepticism, Murray reported some sensational clinical results, extending some patients' lives by months, even years. But since he was unable to prove immunity in cancer beyond patient testimony, many of his peers doubted his claims. In the 1960s, he began investigating spinal cord regeneration, with the aim of devising a surgical cure for paraplegia. Patient testimony was again paraded as clinical proof. Making paraplegics walk again promised to be a glorious finale to a long and impressive career. When the surgical procedure was declared fraudulent, an ugly public scandal erupted, effectively ending Murray's career and stripping the aging surgeon of his superman status.

Introduction

7

Murray's retirement gave him time to rest and to reflect upon his life's work. The final chapter of this book explores his legacy and comments on how such a brilliant career could end so tragically. The conclusion sets this biography in a broader context of mid-twentieth-century surgical and research practice. In examining Murray's career, Surgical Limits highlights the changing dynamics of surgery and surgical research during the twentieth century. Healing by the knife became more prevalent and successful. In a medical and cultural climate that embraced cures and technological fixes, Murray's boldness and individualism in the operating room were encouraged and rewarded during most of his career. He dared to perform experimental operations that were unthinkable and labelled as foolish by many of his peers. His was a life lived with great expectations and many successes. But a series of poor decisions, entangled with ego, and a peculiar perception of persecution tragically led him astray. He operated beyond the boundaries, challenging surgical limits, and in doing so, a career rose and fell.

1 Rural Beginnings: The Formation of a Surgeon

Donald Walter Gordon Murray was born on 29 May 1894 in Oxford County, Ontario, approximately a hundred miles southwest of Toronto. In the nineteenth century, Oxford County offered rich farmland 177 square miles of rolling land well supplied with streams, rivers, and creeks. At the time, southwestern Ontario enjoyed a strong agricultural economy, and most families in the county, including the Murrays, farmed. Compared with elsewhere in the country, farming families in this area earned higher incomes. Affordable land made crop and livestock production profitable.1 These factors made southwestern Ontario an attractive destination for Canadians and foreigners alike seeking to own land and pursue farming as their livelihood. Settlement in Oxford County began in 1795. By the mid-nineteenth century, its population was approximately 50,000, a mix of Scottish, Irish, and English immigrants, and American Loyalists. The Thames River threaded its way through the county, and on its bank the town of Woodstock was founded. Woodstock, along with Ingersoll and Tillsonburg, provided mercantile, banking, postal, shipping, and other services for the area. The Great Western Railway passed east to west through the centre of the county, an important link to larger economic centres. Cement manufacturing grew as a promising local industry, but Oxford County was best noted for its mixed farming: pure-bred Holstein and Jersey cattle raising, dairy farming, and tobacco growing. Successful crops grown in the county included wheat, barley, peas, oats, apples, quinces, and pears. The rolling land provided natural drainage for seasonal rains, with no marshy areas.2 John Conway, Gordon's maternal grandfather, came to Oxford County in 1852 to farm. He and his brother had emigrated from England seven

Rural Beginnings

9

years previously. Together, they purchased land and farmed in York Township, north of Toronto, before deciding to go their separate ways. At that time, Conway investigated less developed areas in the province where land was cheaper. He found a suitable lot in West Zorra Township of Oxford County, where for $500 he purchased two hundred acres of land, with a small house and some cleared acreage. His farmland was rather hilly, with considerable stone, and was covered with oak, rock elm, and hard maple trees. A branch of the Thames River ran directly through the farm, assuring a good water supply for cattle or crops. As in much of the township, rich, fertile soil promised excellent cash crops and fruit trees. The Conway farm proved a sound investment. 3 The same year that he purchased the Oxford County farm, Conway married his second wife, Elizabeth Anderson. She was the young Irish housekeeper Conway had hired a few years earlier, after his first wife had died leaving him with two small boys. Over the next ten years, Conway worked his land, at times accepting seasonal work at harvest or construction times to supplement the family income. He pursued mixed farming, predominantly raising livestock, including cattle, sheep, and hogs. In that same period, John and Elizabeth had four more children: Sarah, Elizabeth, Isabella, and William. Like most farm children, Lizzie, as daughter Elizabeth was called, shared in the chores, perhaps feeding the animals, assisting in the fields at harvest time, or working inside the house alongside her mother. Over time the Conway family farm prospered. 4 In 1864, at the age of ten, John Murray, Gordon's father, immigrated to Canada from Tain, Scotland, with his father and brother. 5 He later learned a trade, became a stonemason, and travelled to where he could secure work. It is unclear exactly how and why John arrived in West Zorra Township by the early 1880s. Certainly, the predominance of Scottish Highlander settlement in this area would have appealed to him. The majority of residents were Mathesons, Camerons, Sutherlands, Murrays, McKenzies, Olivers, McKays, Munros, and the like. But John was not related to any of the Murrays in Oxford County at that time, so perhaps he had gone there simply because of the availability of work; about this time, he secured masonry work on the Conway family farm. There he met and soon began to court Lizzie Conway. In 1884 John Murray and Lizzie Conway were married. John continued working as a stonemason, saving money while surveying the land in the area. The young couple soon began a family: their first son, William, was followed by a second, John. In 1889, they purchased a farm - a

10 Surgical Limits hundred-acre plot of land bordering the Conway farm in the northwest section of the county. Although hilly and stony in places, the Murray farm benefited from a winding creek and good drainage.6 Like his father-in-law, John managed both crops and livestock as well as operating a sugar bush. More children were born: Isabel, Sarah, Gordon, Allen, and Charles.7 Gordon - his full given name was Donald Walter Gordon - was the fifth of seven children and one of five boys. All of the children, in particular the boys, at an early age contributed to the running of the family farm - feeding the chicken, milking cows, splitting wood, or collecting sap.8 John and Elizabeth raised their family within a firm and loving environment that was shaped by the cultural and moral values of the Scottish Presbyterian rural community in which they lived. John believed in hard work and discipline. He did not tolerate idleness, laziness, or complaints. Both of Gordon's parents were strong advocates of education and self-improvement. The Murray family spent evenings reading together, sometimes from the Bible, other times from works of history, scientific achievement, or biography. They also sang and played music. As a church elder and choir member, John insisted on daily prayers and Sunday church attendance for his family. Within the Harrington West community, he was dubbed 'the peacemaker' because of his gentle and persuasive manner in handling many of the local squabbles.9 On numerous occasions, he acted as sword dancer, fiddler, and bagpipe player for various church- or community-sponsored events. He rarely turned down the opportunity to play his beloved musical instruments.10 Harrington West, at an earlier time called Springfield, was about two miles away, the closest village to the Murray farm. By the late 1800s, it boasted a population of about three hundred and a number of industries and businesses. The village offered a general store, hotel, blacksmith, flourmill, sawmill, post office, physician, cheese factory, brick manufacturer, and workshops housing carpenters, cabinetmakers, and wagon makers. All the Murray children attended and completed their grade school education at the Harrington West public school - a typical one-room stone schoolhouse with a brick addition - where the pupils were instructed by one (almost always male) schoolteacher. The two churches of Harrington West, a Presbyterian and Methodist Episcopal, stood out as the most prominent buildings in the community. The Conway family (Gordon's grandparents) supported the Methodist Episcopal church, while the Murray family regularly attended the Presbyterian church.11 The larger centre of Embro, with its population of five hundred, was

Rural Beginnings

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approximately ten miles from the Murray farm. Each fall, the family would have attended the Embro Agricultural Fair, enjoying its displays and competitions of produce, livestock, and the like. The Highland Society of Embro organized various traditional Scottish feats of strength, such as tossing the caber, shot putting, throwing the hammer, and the tug-of-war. For many years, Oxford County boasted a North American champion tug-of-war team, the Zorras. 12 The Highland gathering also featured dancers, pipers, musicians, and bands. Families packed picnics and all were encouraged to participate in the festivities. Thousands attended the event, few willing to miss such a grand social occasion to visit with friends, family, and fellow Scottish clansmen. 13 When young Gordon was not helping out on the Murray farm, studying in school, or attending church or community events, he disappeared with friends to swim in the Thames River or to participate in other adventures. He fished for trout, poked snapping turtles with iron rods, and explored pond life in the algae-growing backwaters on the family farm. He loved the outdoors and never tired of examining insects, frogs, trees, flora, and other living structures. His mother stirred his interest in nature at an early age, and he listened with fascination as she explained the numerous changes taking place around them. The shedding of a snake's skin, the hatching of hens eggs, and the sprouting of bean seeds were some of his first scientific observations. His imagination, energy, and determination emerged at an early age, characteristics encouraged and fostered by his mother. She nurtured his curiosity and investigative spirit, qualities that served him well throughout his life.14 In 1898 Gordon's sister, eight-year-old Isabel (nicknamed Elsie Bell), died of pneumonia. The family tragedy struck Gordon's mother particularly hard. Family reminiscences note that the remaining daughter, Sarah, was favoured and spoiled thereafter. The brothers stuck together, Gordon often teaming up with Allen, who was closest in age. When the time came, the two brothers attended Stratford Collegiate Institute, eight miles away. Like other children in the area, Gordon and Allen biked or walked to school. According to family lore, during the severe winters they jumped from fence post to fence post to stay out of the deep snow. Gordon performed well in high school, studying Latin, English, history, mathematics, and experimental science, which included introductory botany, zoology, physics, and chemistry. He also proved a good athlete and strong competitor, winning numerous races as well as broad jump, high jump, and other athletic contests at the school's annual sports day. In 1914 he matriculated with honours, which put him in good standing to enter university.15

12

Surgical Limits

It seems that all of the Murray children were encouraged to pursue professional careers, though they were not forced to do so. Gordon's oldest brother, William, studied at the University of Toronto and graduated as an engineer, securing a position with the Dominion Bridge Company. John decided to take up farming and, supported by his father, acquired a nearby farm and machinery. The youngest of the family, Charles, also chose to be a farmer. Sarah trained to be a nurse at Queen's University in Kingston, never married, and rose to be director of nursing at the Greater Niagara Hospital. Gordon was expected to follow in William's footsteps, if not in engineering then in some other profession at the University of Toronto. He decided on medicine. Gordon's interest and aptitude for the natural and medical sciences throughout his childhood support a conscious decision to enter medicine. Clearly, his mother had been a strong influence on his choice of career. With certainty and anticipation, Gordon prepared for a life in medicine.16 In the years before Gordon's enrolment in medical school, medical education in North America had undergone a series of dramatic changes. During the first half of the nineteenth century, medical education often consisted of superficial, brief instruction, little if any patient contact, and no laboratory or clinical experience. Practising physicians operated medical schools for profit (called 'proprietary schools') as a side business to their private practices. Few schools had university affiliations or connections with teaching hospitals, and no medical research was conducted. Beginning in the mid-nineteenth century in Europe, a greater emphasis on experimental medicine and clinical science emerged. North American doctors travelling to Europe learned new laboratory and hospital methods and introduced these approaches in North America. Scientific advances, notably the rise of bacteriology, forced medical educators to consider inclusion of the new laboratory sciences in the medical curriculum. They debated the appropriate balance between academic study and clinical experience. Which served as the better training ground for the medical student - the university or the hospital? What role did the new laboratory science play in the traditional clinical training of the physician? It constituted a conceptual revolution in how medical students should be taught.17 Great Britain, France, Germany, the United States, and Canada all came to realize the importance of scientific understanding to medicine. By the early 1900s, the debate was not if scientific preparation should be

Rural Beginnings

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included but how much science was needed and how it should be taught. As Thomas Bonner argues, the ideal was a unity of systematic academic study, especially in the sciences, with hands-on experience to create a physician who thinks critically, can solve problems, possesses a wide knowledge of underlying disease processes, and is skilled at applying what has been learned to real-life situations.' 18 Western countries began to incorporate experimental medicine and clinical science in their medical education programs, but in different ways. German universities more heavily emphasized scientific theory and research, while the French retained the centrality of the clinic and patient treatment. British universities began to include more of the new sciences into their medical training programs but were slow to alter the powerful position of the hospital over the university. In North America, selected universities, led by prominent educators and supported by substantial private funds, forged a judicious balance between laboratory science and clinical experience. 19 Regardless of location, the modern medical education required university affiliation, dissection tables, laboratories, qualified research and clinical instructors, and hospital access. Johns Hopkins Hospital and Medical School, created between 1889 and 1893 in Baltimore, Maryland, became the model for modern medical education in North America. Millionaire merchant and financier Johns Hopkins bequeathed $3.5 million to finance the institution, with instructions to create the best possible university and hospital. A large hospital was built, with 272 patients beds, along with laboratories and surgical facilities, on a fourteen-acre site. This was the teaching hospital for the medical program, which emphasized scientific theory and laboratory instruction, followed by clinical experience. It emulated the German model of medical education. This required ample lecture theatres, well-equipped laboratories, full-time professors, and a sizeable operating budget. Leading medical men, including William Welch, William Halsted, William Osier, and Howard Kelly, were hired to realize the Hopkins initiative. Under their innovative direction, by the turn of the century Johns Hopkins had become the leading medical school in North America for medical research, patient care, and teaching. 20 At about this time, Canadian medical educators, looking to Johns Hopkins as well as medical centres overseas, began discussing how to incorporate the new experimental medicine and clinical science in the training of doctors in Canada. They recognized the need for new laboratories, access to hospital facilities, and more formalized relations between universities and hospitals. Medical training in Canada was about

14 Surgical Limits to become longer, more arduous, and more demanding. This curriculum reform shifted control away from proprietary schools to the university and marked the beginning of modern medical education in Canada.21 No university adopted the new medical curriculum more wholeheartedly than Toronto. The University of Toronto and its teaching hospital, the Toronto General Hospital, came to boast one of the best medical programs in North America. In the early 1900s, both the university and the hospital were reorganized in response to larger medical education changes. In 1908 the University of Toronto Faculty of Medicine raised its admission standards and extended its medical program from four to five years to incorporate extra study in both the basic medical sciences and the clinical years.22 Students spent the first part of their program studying the basic sciences in university laboratories and finished their program with clinical instruction on the wards of the teaching hospital. That same year, the Toronto General Hospital formally became a university hospital - a move that established it as the academic setting for career advancement and peer recognition in the Toronto medical community. It was not a Johns Hopkins of the north, nor was it intended to be. Toronto's new medical program and hospital reorganization modified elements from both the German and the English system to suit local conditions. Toronto students studied basic research theory as well as gaining clinical experience, thereby combining science with the practice of medicine.23 In 1910 Abraham Flexner praised the University of Toronto medical program while condemning most other Canadian medical schools. Commissioned by the Carnegie Foundation in New York for the purpose of future philanthropic decision making, Flexner surveyed all 155 medical schools in the United States and Canada, evaluating curriculum, facilities, and the overall quality of performance of their medical education programs. The model of comparison was Johns Hopkins Hospital and Medical School, with its laboratories, hospital-university cooperation, and strong financial base. Flexner visited all seven Canadian medical schools but granted positive ratings only to Toronto and to McGill University in Montreal. He liked the recent university-hospital formal affiliation of the Toronto medical program and was impressed by the new research laboratories and the strength of the school's library and pathological museum.24 Further to this, a rebuilt Toronto General Hospital adjacent to the University of Toronto was opened in 1913, an

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impressive modern hospital for patients and physicians. This movement to modernize the medical program brought medical education reform, structural change, and overall public enthusiasm for Toronto's confirmed stature as the province's elite university.25 In September 1914 Murray enrolled in medicine at the University of Toronto. The entry standard was an Ontario high school matriculation certificate, and no one who met this standard was refused admission. With no 'premedical' course requirement, Murray stepped immediately into his medical coursework. He anticipated an excellent medical education, undoubtedly impressed by the recent program reforms and new buildings and by the prominence of his Toronto instructors. Professors Alexander McPhedran, James Metcalfe MacCallum, John Joseph Mackenzie, and Velyien Henderson lectured at the university. Professors Clarence L. Starr, Frederick Newton Gisbourne Starr, and Herbert A. Bruce instructed students on the hospital wards. If not overawed by his teachers, Murray may well have been overwhelmed by the medical knowledge he was expected to acquire. The field of medicine had grown rapidly since the turn of the century, expanding from its traditional base of anatomy, pathology, and physiology to include chemistry, physics, and biology. Medical students were expected to understand the scientific underpinnings of disease and its manifestations on the body. Enrolment that year was consistent with previous years, approximately 140 first-year medical students. Murray's classmates were predominantly white men, average age about twenty, and most were from professional and middle-class families. Ten women registered, Toronto being Ontario's only medical school accepting female students at the time. 26 Less than half of Murray's classmates came from non-urban centres (Ontario towns and villages); fewer came directly from farms.27 As R.D.Gidney and W.J.P.Millar have noted, this socio-economic distribution was typical compared with other faculties of the University of Toronto and with university students elsewhere in Canada. Nor is it surprising, given the high tuition fees for a medical education - at $150 a year until 1927, a considerable sum of money at the time. 28 Murray worked summers on the family farm to contribute to the cost of his education. At times, his simple Oxford County upbringing made him self-conscious in comparison with colleagues who had had more elite urban schooling. It was a needless worry for a young man who embraced learning and science so ardently. Murray's rural background did not serve as an impediment. In fact, it contributed to his strong work ethic and resourcefulness. Murray

16 Surgical Limits completed his first year of medical school without noted difficulties, yet he interrupted his studies when duty called. In 1914 Canada went to war. As a member of the British Empire, it automatically entered the hostilities when Britain declared war. Once involved, Canada provided military supplies, foodstuff, and large numbers of troops. Recruitment during the first year of the war went well. Patriotism and perhaps a sense of adventure motivated many young men to join the armed forces. Many left school and delayed their studies. Those who stayed in school mobilized in other ways. At the University of Toronto during the 1914-15 terms, medical students participated in military drill and training three afternoons a week.29 Most Canadian recruits went almost directly to the European front and fought in the trenches of France and Belgium, unprepared for the horrors of this protracted war. In March 1915 Murray enlisted for active duty. Seventeen of his male classmates also enlisted after completing one year of their medical education.30 Five feet ten inches tall, a hundred and forty pounds, and fit, the twenty-year-old Murray had no difficulty passing the military's medical examination. He was assigned to the 7th Brigade, 26th Field Battery, Canadian Expeditionary Force. This unit drew men from the university as well as from Peterborough and Belleville, and they initially trained at Barriefield, near Kingston. In July his unit joined the 25th, 27th, and 28th Batteries of the 7th Brigade in Valcartier, a military training camp about twenty miles northwest of Quebec City. In August his unit sailed from Halifax to England aboard the Metagama. According to ship records, it was an uneventful voyage through calm seas.31 Upon arrival in England, Murray was transferred to No. 2 Field Ambulance Depot and sent to the Moore British Hospital, undoubtedly because of his partial medical education. By November 1915, probably as a result of his own request, he returned to the 26th Battery to train near Shorncliffe as a gunner in the Canadian Field Artillery.32 The artillery worked in support of the infantry. Two or three miles behind the front line, the artillery fired over its own infantrymen, targeting German machine-gun emplacements, tunnel entrances, dug-outs, communication trenches, and other strongpoints. Artillery fire was also aimed behind the enemy lines - at road junctions, ammunition dumps, and railways - interfering with the movement of reserves and supplies to the front. The gunners in the field artillery operated howitzers and twelve-pounders, later replaced by eighteen-pounders. The units ranged

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in size from four to six guns, with several men required to haul ammunition, replacement parts, and barrels of water to keep the guns cooled, as well as loading and firing the guns. At Shorncliffe, Murray underwent the standard artillery exercises - gun drill, foot drill, manoeuvres, riding, and lectures - in preparation for action across the English Channel. 33 In January 1916, the 26th Battery embarked for France. Murray spent the next seventeen months fighting the Germans and also combatting the mud, rain, and lice. Casualties were high at the front, and at times Murray pitched in to treat the wounded. Heavy seasonal rains contributed to the fighting men's difficulties. Infantrymen in the trenches often stood thigh-deep in mud and water. Behind the lines, the gunners had the semiprotection of makeshift shelters — sheets of corrugated galvanized iron, bolted together and covered with layers of sandbags, sod, and netting. They dug pits, sixteen feet long by six to eight feet wide, deep enough to provide protection for the gun wheel and gunners. Sometimes they built platforms of brick, stone, or clay. Horses in the artillery units pulled the guns, ammunition, and rations over the rough terrain and muddy roads. Keeping the horses healthy in the cold, rainy weather proved a difficult challenge. Body lice, sometimes referred to as 'cooties' or 'greybacks,' lodged in the clothes and blankets of the men. It was a maddening irritation, and much time was spent picking off these loathsome insects by hand. Later in the war, lice were identified as a source of trench fever. Rats emerged as another menace. They nibbled at the dead and living, spreading disease and aggravating the men. In the midst of the mud, filth, and constant enemy shellfire, Murray emerged relatively unscathed physically. According to military service records, he was hospitalized only once, in December 1916 for about one week, to receive treatment for mild trench fever.34 It is difficult to trace Murray's exact movements at the front. In January 1917, he was most likely involved in the Bully-Grenay trench raid, twelve miles north of Arras, France. His field artillery unit provided cover for the Canadian infantrymen cutting the wire of the German trenches and the assault that followed two weeks later. In mid-March 1917 the Canadian field artillery was reorganized because of a shortage of experienced commanders in the field batteries. An unpopular decision broke up units that had been together since the beginning of the war. A number of the existing batteries, including Murray's 26th Battery, disappeared, and Murray was transferred to the 5th Brigade, 2nd Divisional Artillery. Less than a month later, the new artillery field units were in place for

18 Surgical Limits the attack at Vimy Ridge, with Murray most likely among them. Vimy Ridge, a nine-mile-wide piece of high ground in northeast France, had been captured by the Germans in 1914 and then attacked unsuccessfully by the French in 1915. It served as a key defence stronghold for the Germans, linking the main German lines to the Belgian coast. Seventy thousand Canadians under the British commander Julian Byng fought the Battle of Vimy Ridge and within hours captured the ridge. The artillery provided nearly one thousand guns and mortars to support the infantrymen in a thunderous bombardment of shells. The victory earned Canadians a reputation for success and raised the morale of the Allied

forces. But the cost was high, with more than 3500 Canadians dead and 7000 wounded.35 Shortly thereafter, Murray was discharged from the military to resume his medical studies. At the beginning of the war, the government had officially discouraged medical students from enlisting, and in 1917 it encouraged those who had enlisted to leave. The reason was insufficient doctors and a fear that the war would continue for more than another year, which would compound the medical shortage.36 In the seventeen months that Murray had spent fighting in Europe, he had been promoted to corporal and then sergeant. His military record stood without blemish, and he had served his country well.37 He was lucky to return home healthy and alive, as was certainly not the case for many Canadians. The number of casualties in Canada's army in the First World War totalled over 230,000. Of these, more than 10,000 had served with the Canadian artillery. Gordon's younger brother Allen was among the fatalities. The two young men were particularly close, and Gordon was devastated by the loss. The two brothers had never served together. Allen had enlisted in March 1916 when Gordon was overseas fighting in France. A strong and healthy nineteen year old, Allen, like his older brother, had chosen to join a field artillery unit. Initially, he was a gunner with the 55th Battery, of the Canadian Field Artillery, but in August 1916, after several months in England, he was transferred to the Canadian Overseas Railway Construction Corps to a depot in Newcastle. He worked as a private on railway construction in this unit for the next year. Then, in September 1917, he went to France. From 1917 to the end of the war, all light railway construction and maintenance on the British front was carried out by Canadian troops - and there was plenty to be done. New track had to be laid as the Allied forces pushed forward against the Germans. Despite bad weather and enemy shellfire, the railway units carried out

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their work with remarkable speed. Between April 1917 and the end of 1918, Canadian units laid more than 2500 miles of track, often under constant enemy fire.38 Allen's unit was involved in the Allies' final advance to the Belgian town of Mons in October 1918. Only weeks before the surrender of the Germans and the end of the war, Allen was fatally wounded by a gas shell. He died on 19 October 1918 at the age of twenty-two, and was buried in a nearby British cemetery. 39 William Paul, the eldest Murray son in the family, also served in the war. Age twenty-eight and an engineer at the time of his enlistment, William volunteered for the Canadian Railway Construction Corps and spent more than three years overseas. He rose in rank to lieutenant and was later awarded a Military Cross.40 John Murray, the second oldest son, remained on the farm. On the day of the armistice, 11 November 1918, the youngest son, Charles, was drafted for service. He was 19 years old, a farmer like his older brother John. Reporting for duty in London, Ontario, he was assigned the rank of private in the First Battalion Canadian Garrison Regiment. Charles served in Canada only and he was discharged from the army in April 1919.41 Thus four of the five Murray boys served their country during the First World War and, as was the case with many other Canadian families, not all survived. Gordon wanted to put the war behind him. Like other veterans, he kept most of his experiences to himself. He had considered himself unsuited for the nightmare overseas, and he refused to talk about it with his family. Their questions seemed frivolous - he felt that only those who had served overseas could possibly comprehend the horrors of this war. He had little respect for - even felt resentment against - the 'shirkers' who had chosen not to fight, had continued their medical training or, worse, had profited during the war. For many years, Murray attended the annual reunion of his artillery unit in Peterborough, keeping in touch with the men who shared his war experience and with whom he had served.42 After his two years of military service, Murray returned to medical school in the fall of 1917. He began the second year of the five-year Toronto medical program taking courses devoted to the basic and medical sciences, taught in classrooms and science laboratories. By the fourth and fifth years, his training was predominantly clinical instruction, carried on mainly in hospital wards, laboratories, and clinics.43 A serious student, Murray earned top grades and became a member of the Alpha Omega Alpha Honour Fraternity, a fourth- and fifth-year medical hon-

20 Surgical Limits our society based entirely on scholarship. In his senior years he joined the Daffydil Committee, which organized Daffydil Night, an annual evening of entertainment, usually satirical skits, put on by the graduating medical students. Murray thoroughly enjoyed the tongue-in-cheek event. It was also during his senior years in medical school that he met and dated the woman who eventually became his wife. Helen Tough was a student at the Toronto Conservatory of Music. Her musical talents had earned her a scholarship to the prestigious school. Seven years younger than Murray, she was a thin, attractive woman with bobbed brown hair and large dark eyes. The daughter of a minister, Helen had grown up in the small town of Hornby, thirty miles southwest of Toronto, with two brothers and one sister. Taught by her mother, Helen proved to be a remarkable pianist. She thrived at the conservatory, enjoying her music courses and the stimulation of performance. Her talents won her a gold medal (for highest marks on conservatory examinations) and numerous other awards. For most of her school years in Toronto, she lived at the Sherbourne House Club, a women's residence on Sherbourne Street that encouraged cultural and educational activities for single young women. Red Cross training sessions, courses in comportment, music concerts, and the like were organized for and by the women residents. Helen routinely gave performances at the residence, as well as community concerts. She also taught at the conservatory. Helen and Gordon shared a love of music, and it was not long before Helen had fallen for the handsome medical student with the fair hair and blue eyes. A lengthy courtship began. In 1921 Murray graduated in medicine at the age of twenty-seven. With medical degree in hand, he left Toronto and returned to Stratford to work with Dr Lome Robertson.44 The next eighteen months served as an apprenticeship for Murray. It was familiar and comforting to be home assisting Robertson as he had done the previous summers. 'Dr. Lorne,' as Robertson's patients affectionately called him, was a middle-aged, genial doctor and surgeon who served the residents of Perth County from a practice he had inherited from his father.45 He saw patients in his Stratford office as well as making house calls. Rural medicine was practical and often demanded creative medical solutions. On occasion, he performed surgery on a kitchen table by lamplight. Murray assisted Robertson in his operations and adopted his chief's attitude of 'fix it up' - doing what was necessary, using ingenuity and often only rudimentary tools. Murray also learned a great deal about the doctor-patient relationship; Robertson was known for his compassion and general therapeutic success, and he

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held the confidence of his patients. What Murray learned from Robertson he carried with him throughout his career.46 Rural practice in Stratford, however, was not enough for Murray. After little more than a year with Robertson, he decided to pursue surgical training abroad. Robertson had himself sought postgraduate medical training abroad many years earlier. Perhaps he had presented the idea to Murray. It was not unusual for young doctors to apprentice abroad in the great medical centres before settling into their own practice. Murray wanted to be more than a rural physician; he wanted to be a full-time surgeon. Surgery demanded dexterity, precision, and skill, and it appealed to Murray's bold nature. Since his medical undergraduate education had provided him with scant surgical training, he needed to learn the craft of the surgeon - technical proficiency, good judgment, and a sound knowledge of disorders and disease.47 The next several years were thus a self-imposed program of study for Murray under distinguished physicians and surgeons. An apprenticeship under the masters was still endorsed as the best way to train future surgeons, and hospitals offered resident positions for this purpose. Postgraduate sojourns overseas or in the United States were expected of those hoping to practise and instruct in prestigious teaching hospitals. At this time, the profession had not formalized the length or breadth of this postgraduate surgical training. Nor had it identified the centres qualified to offer this training. Individuals were left to make these choices themselves, to decide which hospitals and universities would provide them with the best training to learn and keep pace with the many surgical procedures being performed at that time. Leaving Helen behind with promises to return, Murray travelled to the United States and England to become a surgeon. The turn of the twentieth century was an exciting time to be a surgeon. Surgery was less risky and bloody than it had been in the past. Anaesthesia permitted pain-free procedures and gave the surgeon prolonged operating time to search out and eliminate disease. The practices of antisepsis and asepsis made surgery safer by creating sterile operating conditions and lowering the risk of infection. The new sciences of bacteriology, physiology, and microbiology gave legitimacy to antisepsis and asepsis and allowed surgery to ground itself in science. Based on the new laboratory sciences, the surgical point of view became a disease-specific point of view, and the body became an array of parts for potential surgical attention. Diseased and damaged tissues and organs could be

22 Surgical Limits removed, sometimes repaired, by the scalpel. In the early twentieth century, in what has been called surgery's heroic - even knife-happy age, surgeons introduced an array of new surgical techniques for medical disorders that previously had been treated non-surgically.48 Surgeons cut into their patients to relieve intestinal obstructions and to remove gastric cancers, inflamed ulcers, painful bladder stones, and diseased appendices. They operated on the pancreas, liver, kidney, thyroid, face, and throat. They treated knife and gunshot wounds, hernias and colon disorders, and various cancers. They performed colostomies, ovariotomies, gastrectomies, tonsillectomies, and even experimental brain surgery. Diagnostic tools, such as x-ray machines and advances in microscopy, assisted surgeons in making accurate diagnoses. It seemed that no organ or cavity in the body was beyond the purview of the surgeon. New operations of all kinds were tried. In time, many became established surgical treatments.49 Contemporary disease patterns influenced surgical innovation. In the early twentieth century, tuberculosis was a prevalent disease with high mortality rates. Physicians could counter with little more than therapy that consisted of rest and sunshine in a dry climate. Surgeons, with relatively little knowledge of the chest and respiration physiology, introduced several new procedures. They began to perform thoracoplasties (removal of portions of the ribs to collapse diseased areas of the lung), phrenicotemies (cutting the phrenic nerve to paralyse the diaphragm and thus immobilize the lung), and pulmonary resections (removal of diseased portions of the lung) with promising results.50 As an increasing number of successful operations were reported, patients gained greater confidence in accepting such treatments. To become a surgeon requires a longer period of preparation than almost any other profession. Years of study and clinical experience are required to transform the young, if not bumbling, general medical practitioner into a competent and skilled surgeon. Numerous training tales have described the long hospital hours and difficult professional examinations demanded of those pursuing a surgical career. More often than not, these stories celebrate the training as a necessary rite of passage for each doctor, who, according to these tales, inevitably emerges as hero and somehow unique.51 But rigorous surgical training does not always ensure the making of a good surgeon. The most basic requirement is technical proficiency, or 'good hands.' Skilled surgeons make operating look easy - cutting, excising, knotting, controlling bleeding, and so forth with apparent ease and quiet rhythm.

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A good surgeon also possesses a thorough knowledge of disease and disorders, of the anatomy and physiology of the body, and of medical procedures and treatments. Sound clinical judgment - what to do and when to do it - is the application of this knowledge. Surgeons have been described as doers, interventionists, and risk takers, and good surgeons tend to be decisive and self-disciplined. They are assertive in the operating room; they are able to concentrate and work patiently for long periods of time; and they are considered caring and trustworthy by patients and their families. An individual's training, aptitude, and personality all contribute to how well he or she manages the challenges and stresses of surgerv.52 The type of surgeon that Murray became owed much to his training. In 1923 Murray began his surgical training at one of the leading American surgical clinics, the Mayo Clinic in Rochester, Minnesota. The Mayo brothers, William and Charles, following in their father's footsteps, were respected surgeons specializing in abdominal and thyroid surgery, respectively. They had turned the local Minnesota hospital into a leading surgical centre, advancing new procedures and treatments. At the turn of the century, they and their team were performing more than 3000 operations a year; by the mid-1920s the number of operations at the Mayo Clinic had climbed to more than 23,000. In addition to excellence in patient care, the Mayo brothers integrated research and education with practice, and their clinic had become a centre of graduate medical education, attracting many doctors who came to observe the scope and new techniques of the clinic's numerous operations. 53 The Mavo Clinic and its reputation for embracing new surgical techniques appealed to Murray. Given the volume of cases that were treated at the hospital, he observed and studied a remarkable range of diseased tissues and organs in his position as junior assistant pathologist. Still, Murray remained in Minnesota only a few months. Since it was such an exciting medical centre with a lot of public attention, it is unclear why he did not remain longer. Perhaps a surgical intern position was not available, and eager to be in the operating room rather than pathology lab, he decided to move on. Or perhaps he never intended this to be more than a brief stop and his goal was to train overseas in the older, traditional medical centres.54 Medical training and certification abroad remained the gold standard until the mid-twentieth century. Young Canadians seeking expertise in a clinical field usuallv travelled to London, England, where they studied for the coveted specialist fellowship in one of the royal colleges. Post-

24 Surgical Limits graduate training courses in surgery did exist in North America at such universities as Johns Hopkins, Harvard, Michigan, Columbia, and Presbyterian,55 and at the University of Toronto a new master of surgery program was initiated in 1922.56 Still, it was not unusual for medical students in Canada and the United States to complete their medical education in the schools and hospitals of Europe. It was expected for anyone seeking an academic hospital position. So, following this tradition, Murray sailed for London in the fall of 1923. He had nothing more than letters of introduction from his Canadian instructors at the University of Toronto, including the professor of surgery, Clarence Starr, and the professor of medicine, Duncan Graham.57 Over the next three years, Murray rose through numerous clinical and research positions at several of London's notable hospitals. First, he secured the position of resident medical officer at the West End Hospital and St John's Clinic in Leicester Square. He then spent six months as house surgeon at Hampstead General Hospital and later as house surgeon and clinical assistant at All Saints' Hospital. Following these posts, he became temporary registrar at the London Hospital, demonstrator of anatomy at St Mary's Hospital, and demonstrator of anatomy and physics at the University of London. In 1926 he became house surgeon at the National Orthopaedic Hospital and St Bartholomew's Hospital.58 From resident to house surgeon, Murray learned surgery by observing and later participating in the practice. He walked the wards behind busy surgeons, observing and interacting with his instructors and their patients. He worked with many skilled medical practitioners, professors of medicine and surgery as well as local practitioners, and he completed rotations in general medicine, dermatology, genito-urology, and surgery.59 He gained experience treating a wide range of diseases and conditions such as disorders of the kidneys, bladder, and reproductive organs, chest problems, skin afflictions, and inflamed tonsils and adenoids - and he participated in a variety of procedures. In total, Murray performed over two hundred major operations during his various rotations.60 Murray greatly admired the medical men who surrounded him: general physicians Laming Evans and Harry Campbell, prominent bone surgeons Robert Milne, C.W. Rowntree, and C. Lambrinudi, worldrenowned general surgeons L. Bathe-Rawling and Sir Charles Ballance. But it was Professor Ernest Frazer, the anatomist, who had the greatest influence on Murray during his London training. In addition to acquiring an expertise in diagnosis and operative techniques, a surgeon must understand disease processes. Surgical students were required to study

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pathology, anatomy, bacteriology, and physiology. Anatomy most intrigued Murray, undoubtedly because of his anatomy instructor. Frazer was a genial, soft-spoken Scotsman who turned the dry bones of anatomy into captivating living structures for Murray. He lectured on the importance of anatomy for every medical practitioner, particularly the surgeon. He drilled anatomy into Murray, and Murray realized that he was becoming a better surgeon because of it. His respect for anatomy and his determination to master it came directly from Frazer. Murray never forgot this lesson, and in later years he repeated the pattern with his own students.61 Murray worked alongside many surgeons who conducted surgical research part-time. On occasion, he was asked to participate in the administration of experimental treatments to ward patients. He witnessed innovative surgical treatments that improved many patients' conditions. His British mentors encouraged him to experiment, both in the laboratory and on the ward. No established research procedures or protocols existed in British hospitals at this time. Experimental treatments that seemed promising in the laboratory were administered to patients with the hope of obtaining encouraging results. Surgical research in general possessed a strong clinical orientation. In Britain, there was more emphasis on clinical results than on scientific theory and process because the hospital, rather than the university, was the more influential institution. While Murray did not spend a lot of time involved in surgical research in London, the exposure he did receive was enough

to infuse a lifelong interest in research and an emphasis on clinical results over scientific theory and methodology. After nearly three years of hospital experience and additional university study, Murray felt prepared to sit the demanding fellowship examinations of the Royal College of Surgeons. Extraordinarily difficult, these examinations tested physicians' knowledge of general and operative surgical techniques, pathology, and anatomy. Passing the fellowship examinations conferred significant professional status, and it was a requirement for medical practitioners who wished to establish a specialty practice or secure a faculty appointment at the university and its teaching hospital. Murray succeeded on his first attempt in 1926. Only 34 of the 110 medical men who took the Royal College exam that year passed.62 Murray's accomplishment landed him the position of demonstrator of anatomy at the London Hospital and the University of London. Murray was becoming a good surgeon. At St Bartholomew's Hospital, where he continued to work as house surgeon after his fellowship examinations, senior surgeons and co-workers praised his surgical skills, op-

26 Surgical Limits erative techniques and sound medical judgment. They commented on his congeniality as a colleague and how popular and tactful he was with patients. One surgeon even remarked on his delightful sense of humour.63 Murray enjoyed these years in London, thriving in his chosen field of specialty. This apprenticeship significantly shaped his development as a surgeon, researcher, and teacher. Overall, Murray believed that the method and quality of British medical training was superior to North American schooling. In his mind, he was simply better trained than many other surgeons. British schools provided a broader classical education and a better foundation for investigation and practice. Murray was instructed by, and sometimes operated with, leading British medical practitioners. 'The teaching,' he said, 'was logical, analytical, based on current observations and those recorded in literature by the great men of past generations, and all founded on a profound and extensive knowledge of the basic sciences involved, including anatomy, physiology, chemistry, pathology and histology.'64 Anatomy was particularly important to the surgeon; Professor Frazer had convinced Murray of this. He saw how American surgeons, unsure of their anatomy, wasted time and lacked confidence. In contrast, Murray's mastery of anatomy and his extensive operating experience in London hospitals made him a skilful and confident surgeon. Murray's sojourn in London also left a cultural imprint on his character. An older first cousin, Gladstone Murray, and his wife took Gordon under their wing to introduce him to British society. (Gladstone's father and Gordon's father were the brothers who had immigrated to Canada together in the 1860s.) Gladstone had come to Oxford as a Rhodes Scholar in 1913 and had married an English woman in 1923. He worked for the BBC, holding a variety of public relations positions, the beginning of a long career in broadcasting. A big, burly man, the outgoing Gladstone was well connected in London society.65 He introduced the less gregarious Gordon to British forms of recreation — cricket, tennis, and golf- and schooled him in the ways of the English. Gordon wanted to learn British social etiquette and decorum. His 'Canadian manner of speaking' embarrassed him, and his rural upbringing made him selfconscious in large gatherings. He came to appreciate certain aspects of British society - politeness, reserve, and formality. After three years abroad, Gordon had become an anglophile.66 Despite his high regard for British medicine and the potential employment opportunities, Murray decided it was time to go home. He had accomplished what he had set out to do and he missed Helen, who was

Rural Beginnings 27 waiting patiently in Toronto. She had faithfully corresponded with him throughout their long-distance courtship.67 Murray made inquiries about surgical positions back home. As a fellow of the Royal College of Surgeons, he could have had the pick of several plum positions. He wanted an academic surgical position, which would support surgical research pursuits in addition to a private practice. Professor C.L. Starr offered him a one-year surgical residency at the Toronto General Hospital, hinting that a permanent staff position would be forthcoming thereafter. With this offer in hand, Murray left London in the fall of 1926.68 Back in Toronto, while renewing relations with Helen and visiting his family, Murrav had almost eight months to wait before the beginning of his residency at the Toronto General Hospital. So, without great difficulty, he secured a six-month appointment as house surgeon at the New York Hospital and at the Hospital for Ruptured and Crippled Children. The New York Hospital was one of the largest and oldest private hospitals in the United States. A highly respected institution, it was distinguished for the achievements of its surgical staff.69 The range and volume of its surgical cases appealed to Murray. The story goes that he arrived for his new position clothed in London attire - bowler hat, black overcoat, spats, gloves, and cane - much to the amusement of hospital staff.70 If Murrav was posturing or trying to impress anyone, he succeeded only in embarrassing himself. New York was not London, and he soon sorted out the differences. There was neither the academic thoroughness not the formal British structure to which he had become accustomed. What did he have to learn here in the New World when he had spent three full years in the Old? Murrav did learn many things, notably from Dr Eugene Pool, chief of surgery at New York Hospital. First, Pool had devised a system of sign language that he used in the operating room to reduce speech and thus the spreading of germs into the atmosphere. Murray later adopted this method when communicating with his operating room nurses.71 Secondly Murrav admired Pool's delicacy while operating. Pool handled all body tissues with gentle respect, and this prevented further inflammation or haemorrhages (excessive bleeding). Murray learned to appreciate the delicacy of the human body, its tissues and organs, and its remarkable ability to react and heal itself. Thirdly, Pool spent a considerable amount of his spare time doing surgical research and publishing the results, He took troubling clinical cases to the laboratory, experimenting on animals to devise improved methods of treatment. To Murray,

28 Surgical Limits Pool was an inspiring teacher as well as a gifted surgeon. British partiality aside, Murray was delighted by the American enthusiasm for experimentation and innovation.72 From Doc Robertson's rural practice to the elite operating theatres and innovative research centres in England and the United States, Murray had succeeded in securing an excellent surgical education. He had acquired the knowledge and techniques to practise skilfully and effectively, absorbing various aspects of the surgical cultures within which he had trained. These had been formative years that shaped the type of surgeon Murray became. While not unique in travelling overseas to further his medical education, his seven-year postgraduate training was unusual in its length and its range of assignments. His excellent training in Canada, Britain, and the United States exposed him to different cultural attitudes and approaches towards surgery and medicine, which influenced his own outlook and style. In addition to sound training, Murray's aptitude and personality also contributed to his becoming a good surgeon. He found out quickly that he loved to operate and that he excelled at it. Surgery suited his proclivity to act, intervene, and control. Patients felt secure in his capable hands, and for good reasons. Deservedly, he had landed a plum surgical appointment at the Toronto General Hospital - a proud homecoming for the farm boy from Oxford County. In July 1927 Murray moved back to Toronto for good and soon he began work alongside some of the country's most prominent medical practitioners.

2 Toronto Appointment: Heparin and Vascular Surgery

By 1927 the Toronto General Hospital had emerged as one of Canada's major academic hospitals. Located in the downtown core, the hospital stretched two city blocks on fourteen acres next to the University of Toronto. It encompassed medical, surgical, and private patients' buildings as well as nurses' residences. It contained over a thousand beds and each year cared for tens of thousands of patients from throughout the province. The hospital housed new forms of medical technology, modern laboratories, and had large public wards and luxurious privatepatient accommodation. It treated the greatest number of and most complex cases in the country. Its laboratory and hospital facilities were second to none and were especially celebrated for the discovery of insulin in 1921-2 by Frederick G. Banting, John J.R. Macleod, James B. Collip, and Charles H. Best. A very different place since Murray's undergraduate clinical rotations, the Toronto General had developed into an elite university hospital.1 Most significantly, the clinical departments of medicine, surgery, obstetrics, and gynaecology were undergoing extensive reorganization. Duncan Graham and Clarence L. Starr, the university hospital's first fulltime salaried professors in the Departments of Medicine and Surgery, respectively, directed the changes. During their tenure, they instigated a new direction in the teaching and practice of medicine and surgery. Graham had arrived in 1919 as the Eaton Professor of Medicine, an endowed position supported by a generous gift from Sir John and Lady Eaton. He remained in that position for the next twenty-eight years. During this time he was also the physician-in-chief at the Toronto General Hospital. With the backing of hospital and university administrators, Graham immediately discharged staff, appointed new professors,

30 Surgical Limits added courses, and increased student clinical hours. He cleaned house, fuelling resentment and arousing sharp criticism from many of the older clinicians in the department. In 1921 Starr became chair of the Department of Surgery and Toronto General Hospital's surgeon-in-chief, a position funded by the Rockefeller Foundation. Starr followed Graham's lead, initiating similar changes in the surgical domain, revoking university positions, reappointing only a handful of the most distinguished surgeons, and assigning more student-training responsibilities. He arranged for research equipment, animal accommodation, animal operating rooms, and other amenities necessary for surgical investigation. Both the professor of medicine and the professor of surgery wielded tremendous personal influence over the changing medical curriculum and structure, and consequently influenced the development of medicine in this country by the substantial number of physicians and surgeons who trained within this new framework and went on to become department heads and deans across Canada.2 Starr recognized Murray as a good fit with the new philosophy and direction of the Department of Surgery. Murray's surgical apprenticeships, teaching experience, and interest in research corresponded well with the faculty's growing orientation towards medical science.3 As this was a university hospital, an academic culture of inquiry, learning, and teaching was promoted and the scientific identity of surgeons emphasized.4 The new academic surgeon, or surgeon-scientist, was to be a skilled and confident technician in the operating room as well as an inspiring teacher and competent researcher. Starr sought to replace the older, 'scientifically untrained' practitioners in the department with surgeon-scientists such as Murray - younger, more scientifically trained surgeons, who alongside their private practices were oriented towards surgical research and clinical instruction. Murray liked Starr and his vision for the surgical department. He was impressed with Starr's postgraduate training abroad, his ten-year tenure as surgeon-in-chief at the Hospital for Sick Children in Toronto, and his military service as senior surgeon in a Canadian hospital in England during the First World War. Moreover, Starr was a skilled surgeon and an inspiring teacher, admired and respected by colleagues and students. His reputation was outstanding.5 Murray found the chief to be a pleasant and enthusiastic man. 'Very soon a close understanding and cooperation [contributing to] a sound and fundamental friendship developed,' recalled Murray.6 He had found a mentor in the older surgeon.

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Starr was quick to delegate work to his resident, and almost immediately upon arrival in 1927 Murray was immersed in a busy schedule. As resident, he lived in the hospital and was on call day and night. As the senior of all residents and interns in the surgical department, he had many duties and routine tasks. He assisted at all of Starr's operations as well as those performed by others on the surgical staff. He participated in official ward rounds, held three times a week, and at the daily morning and evening ward rounds with his chief. He organized the bimonthly staff meetings in the department, arranging patients, x-rays, slides, and other equipment. He provided surgical consultations to the medical department when requested. He responded to, and if necessary performed, all emergency surgery cases. In Starr's absence, Murray delivered lectures to medical students, and on many occasions he attended Starr's private patients in the chief's private office. Starr was heard to say to his secretary, 'This resident is the handiest man I ever had around the department'7 Murray enjoyed the confidence and respect of his chief, but his rapport with many other members of the staff was 'polite and cool.' Rationalizing this, Murray stated: My enthusiasm, curiosity and interest were received pleasantly in England and enthusiastically in New York, where I was a bird of passage, but in Toronto, with the prospects of becoming a permanent fixture, things were different. I was imbued with the erroneous idea that at the university level all would strive for the truth and would support every effort in its pursuit. This concept did not take into consideration the fact that in those days the staffs of Canadian hospitals were men of limited training, acquired usually in local hospitals only, and as a result their interest in research and progress was limited.8

Murray dismissed his difficulties with colleagues as fear, jealousy, and prejudice. Perhaps this was true, or perhaps they simply found Murray arrogant about his skills and training as a surgeon. Despite seeing his colleagues almost every working day, Murray, right from the beginning of his career, maintained a distinct distance, even secrecy, from other surgeons. It is not unusual for surgeons to be unaware of their colleagues' professional practices, their patient loads, diagnostic approaches, or surgical techniques. 9 Still, they tend to share a friendly, cooperative camaraderie with others in their department. Murray did not. Communication between him and his Toronto colleagues was noticeably strained from the outset. Perhaps this was due to Murray's

32 Surgical Limits unconcealed perception of the Toronto medical community as parochial. Or, more tellingly, it may demonstrate his preference to work alone, if not his inability to work with others. In 1928 Starr offered Murray a junior staff appointment in the Department of Surgery, and Murray accepted. A large department, it had approximately nine surgeons on staff, plus two fellows and thirty affiliated surgeons carrying a range of teaching and research responsibilities. Within the hospital, staff surgeons were divided among three surgical divisions, with general, obstetric, and neurosurgical patients distributed accordingly. Murray was assigned to Ward C, designated as general surgery, under senior surgeon and chief Norman Shenstone. Another junior surgeon, Robert Janes, was also on the ward, having been appointed six years earlier. All three general surgeons performed a range of chest, abdominal, and orthopaedic procedures. Each had his assigned operating time, usually one or two mornings a week, in the operating room on Ward C, and the nurses soon learned their various surgical routines, styles, and temperaments. The three surgeons treated their patients differently, operated differently, interacted with families and hospital staff differently, and pursued different research interests. Shenstone and Janes developed a collaborative working relationship on thoracic cases, most notably devising the Shenstone-Janes tourniquet. (The Shenstone-Janes tourniquet, devised in 1929, was placed around the root of the lung, pinching the blood vessels and the bronchus. By tightening the loop, the surgeon could remove the lung within a relatively bloodless field, after which he could tie off the ends of the arteries and veins.)10 Murray, however, worked alone and never shared a close camaraderie with either of these surgeons.11 In addition to his ward duties, Murray was cross-appointed to the University of Toronto as a clinical instructor in the Department of Surgery. He enjoyed lecturing and conducting hospital rounds with medical students. He soon became known as a demanding yet stimulating teacher. To second-year students, he participated in the 'inspirational lectures' series, of which his lecture on 'The Bones' included a clinical demonstration of simple surgical problems on the subject. To fourth- and fifth-year students, Murray delivered various lectures on the general principles of surgery, covering such subjects as inflammation, infection, wounds, haemorrhage, shock, ulceration, gangrene, tumours, and fractures and sprains in muscles, tendons, bones, and joints. On the

Toronto Appointment 33 wards, he discussed surgical practice at the bedside of patients with students in groups of ten. In the operating room, he directed senior students, who assisted in routine operations. He received a small honorarium for his clinical teaching. More important, his university affiliation gave him access to research laboratories and a small office in the Medical Arts Building on campus, where he kept private-patient appointments each afternoon. Shifting from his hospital residency to private practice posed few problems for Murray. Status, office space, support staff, and a surgical routine were more or less immediately conferred on him with his Toronto appointment. His private practice grew relatively quickly. His greatest difficulty, with which he truly wrestled, was setting his surgical fees for private patients. Under the capitalist system, everything is relative and there are no absolute values ... If there is no precise value for any material object, how possibly could the often intangible and sometimes abstract services of a doctor to a patient be evaluated? For example, what is the precise value to a patient who has been resuscitated, following drowning or some other serious accident? How much should the doctor be paid for his efforts? ... How could the earnings of a doctor with imagination, prolonged undergraduate and post-graduate training, vast hospital experience, knowledge of science and art, be assessed? The kindness and the generosity of both thought and time in caring for patients, and especially the great pleasure to the surgeon in being able to solve the problem, to provide expert and appropriate treatment and receive the gratitude of the patient - how can all this be assessed in dollars and cents? I had a great surge of feeling that money, whether paper or silver or gold, should not enter into this transaction between the patient in need and a dedicated doctor. Should not the fine relationship between the needy and those able to give the service be placed on a different basis? Some of the best services in all nations are provided differently.12

Murray was intrigued with the idea of socialized medicine, having read that the Scandinavian system of state medicine satisfactorily met the needs of patients and doctors. He found discussing money 'distasteful.' Nevertheless, a secure income was necessary for him 'to eat, to keep fit and to make plans involving the fair-haired blue-eyed beauty.' Murray established a fair fee schedule, comparable to other Toronto surgeons'

34 Surgical Limits rates, which gave him a comfortable income that would allow him to support a wife and begin a family. In August 1928, Gordon Murray, age thirty-four, married Helen Tough, age twenty-seven, in a small, quiet ceremony at a friend's home in Toronto. Helen had decided not to hold the wedding at her parents' home in Arthur (eighty miles northwest of Toronto) since they were in the midst of a move and her father was still suffering from the effects of a stroke. Ginger Nerlich, Helen's conservatory classmate, and her husband Louis hosted the nuptials. In the Nerlichs' drawing room, which was decorated with garden flowers, Helen and Gordon exchanged vows in an evening ceremony. Ginger Nerlich and William Murray, Gordon's older brother, served as attendants. Helen's father officiated, and her brother Leslie gave her away. Notably absent was Gordon's father, who had passed away only months before. For their honeymoon, the newlyweds took a driving trip through northern Ontario. The Nerlichs and Murrays remained close friends throughout their lives and for many years celebrated Christmas together, alternating between the two households.13 The newlyweds' first home was a lower duplex apartment at 29 Classic Avenue in Toronto. Their friends Norah and Roland Michener (he a future governor general of Canada) lived in the upper duplex. In addition to socializing with the Micheners, Murray became their family doctor, treating their children at home or in the office for routine vaccinations, removing their tonsils, and tending cuts and broken bones. Norah regularly telephoned Murray for medical advice. She wrote: 'We have all felt as a family that we were particularly favoured in having Dr. Gordon Murray look after us.'14 For over thirty years the Micheners and Murrays remained close friends, despite living as neighbours for only a short time. After a few years the Murrays moved to a house at the corner of Duncannon and College in Toronto. A larger home, it seemed a more appropriate house for a young doctor to entertain in and raise a family. Helen maintained it with household help, and they remained there for the next ten years. On Christmas Day 1928, C.L. Starr died unexpectedly of heart failure. Hospital staff had witnessed and worried about the chief's declining health for several years, aware of his heart problems. In recent years he had been performing fewer operations, seeing fewer patients, and passing on more of his lectures to others. His death had been sudden

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nonetheless. It hit Murray particularly hard: 'The pleasant experiences of hospital work, teaching, investigation and private practice were ... shadowed by the passing of the one stalwart, steadfast, supporting and admiring friend, Dr. Starr. This irrevocable loss removed the warmth and protection provided by an intrepid, distinguished and understanding man, who had made great plans and provisions for my future ... With my friend and benefactor gone, I had no comparable advisor to whom I could turn for advice.'15 Murray had lost his mentor, and he contemplated leaving the city. But he decided to stay, given that he 'was already under way in Toronto,' and he turned down an attractive offer to move to New York. This was the first of several occasions when he made the decision - which he would later regret - to remain in Toronto. 16 In early 1929 William E. Gallie became the new professor of surgery. The appointment surprised no one within the Toronto medical community. Seventeen years earlier, Starr had hired Gallie as a member of his surgical staff at Toronto's Hospital for Sick Children, and in 1921 Gallie had succeeded Stan as surgeon-in-chief at the Hospital for Sick Children when Starr became professor of surgery at the University of Toronto and surgeon-in-chief at Toronto General Hospital. Now, eight years later, Gallic was once again following in Starr's footsteps, ascending to one of the most coveted medical positions in the country. He remained in the position for the next eighteen years, during which time he carried on Starr's vision for the department, promoting greater surgical training and surgical research in the hospital and the university. Almost immediately, Gallie launched a new postgraduate surgical program so that Canadians would no longer have to leave the country to become qualified Although not the first such program in Canada, it was the first effective surgical training course. 17 Inaugurated in 1931, the 'Gallie course, as it became known, trained surgical interns for three years in pathology, general surgery, and the specialties of urology, neurosurgery, or paediatric surgery. In 1939, with the establishment of the Royal College of Physicians and Surgeons of Canada, the course was considered appropriate preparation for the prestigious fellowship examinations. 18 Gallie also strove to encourage surgical research among his staff. Surgical research is the application of scientific method to surgery. In general, it covers a great many approaches to the problems of surgical patients and their many diseases. Anything that might benefit the science and practice of surgery, including new ideas, observations, techniques, and technology, could be viewed as surgical research. Gallie

36 Surgical Limits encouraged his staff to explore different surgical procedures, investigative methods, and experimental approaches to unsolved problems. He was himself an accomplished surgical researcher. His most notable contribution was 'living sutures,' a cross-stitching surgical procedure to close wounds, using transplanted fascia (fibrous membrane covering, supporting, and separating muscles) and tendons (fibrous connective tissue that attaches muscles to bones and other parts).19 Reflective of his view of the importance of surgical research, Gallie fought for and secured lab space for the Department of Surgery on the fifth floor of the new Banting Institute, which was under construction on College Street, directly across from the Toronto General Hospital. He recognized that good surgical research required both laboratory investigation (basic science work as well as animal experimentation) and clinical testing (applied science).20 Gallie's attitude towards surgical research pleased Murray, who was quick to take advantage of the department's new laboratory space at the Banting Institute in order to explore new surgical procedures. In his first years, Murray's varied research interests reflected the range of his clinical cases at the hospital and his private practice. Surgical specialism was only just emerging. In Toronto, general surgeons performed most operations, and for Murray this included orthopaedic cases. His first laboratory experiments focused on the knee joint and tendons in the leg, and this became the subject of his first publication. Not a particularly strong paper, it summarized the nature of knee-joint injuries and assessed standard treatments from rest to operative procedures.21 Murray also devised a palliative procedure for a patient suffering from cancer of the oesophagus. Conventional treatment consisted of a feeding tube in the stomach to prevent starvation. Murray inserted a tube in the patient's throat, temporarily preventing obstruction by the cancer and allowing the patient to swallow. He successfully treated one patient with this procedure, though he aroused criticism from the Nose and Throat Department for encroaching on their territory.22 The most innovative contribution made by Murray during this early period was his bone-graft procedure for a fractured, non-united carpal scaphoid (one of the eight carpal bones of the wrist). After a period of rest from this severe wrist injury, the patient experienced inflammation and acute pain because fragments of the bone were not reuniting and setting properly. The conventional treatment was to remove these fragments to stop the inflammation and pain, but it left the wrist permanently weakened, even disabled. Murray's first patient with this wrist

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injury was a house painter, who was unable to use his brush without excruciating pain. Murray treated the injury by removing the bone fragments in the wrist and then inserting a piece of bone from the tibia (shin), which acted as a bone graft and splint. Within weeks, union of the bone occurred and the patient returned to work with full mobility and range of motion in his wrist.23 Murray presented his bone-graft procedure to the American College of Surgeons in 1934.24 He enjoyed this experience, feeling encouraged to continue with his work. He later wrote: 'The American surgeons were enthusiastic, ready as always to accept the truth, and anxious to hear what anyone has to say. They give [one] a fair hearing, also a thorough and polite discussion, all of which is in contrast to the more bigoted attitude of the leading British, European and Canadian surgeons.' 25 Such comments reflect the tensions that Murray experienced in the Toronto hospital culture during his early years of practice. Without clear cause, he appeared distrustful of his colleagues. The exceptions were William Boyd, professor of pathology, and John Grant, professor of anatomy. Murray respected and admired both these men and enjoyed discussing medical and non-medical topics with them. His bone-graft innovations marked the beginning of a pattern. Creative and forceful, Murray presented new treatment methods and became embittered when others were not equally enthusiastic. However, the results of his bonegraft procedure were published in more prominent journals than his

previous research work, and soon many surgeons were performing the

procedure with the same success.

Murray enjoyed doing surgical research. In fact, most surgical staff were involved in some level of experimentation part-time. Most of it was straightforward: diseased or damaged conditions found in patients were reproduced in animals and experimental treatments were attempted; then, after a series of successes with animals, new or improved procedures were tried on patients. Murray was delighted when his orthopaedic procedure of wiring the clavicle (collar bone) in place permitted patients (specifically, labour workers) to return to their jobs almost immediately. The conventional treatment involved setting alignment of the collar bone in place by taping the arm and shoulder to the body and making the patient rest. By contrast, Murray set the collar bone by using steel wire as an internal splint to keep the bone in place. In one end of the clavicle he drilled a quarter-inch hole, through which he inserted a medium-sized Kirschner wire to fix the fractured clavicle in place. Patients enjoyed fullarm movement almost immediately and were pain-free.26

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had no idea of its chemical properties or how to isolate it.29 The substance they were searching for was heparin. Small amounts of heparin are normally present in the blood. It is a polysaccharide and is produced by many different cells in the body, particularly in the tissue surrounding the lungs and liver. It has both an antithrombotic effect (interferes with formation of thrombus intravascularly) and an anticoagulant effect (prevents clotting of red blood cells). 30 Jay McLean discovered heparin in 1916 while conducting research on the action of coagulants, specifically cephalin, at Johns Hopkins University, under the physiology professor William Henry Howell. Continuing McLean's research, Howell investigated blood coagulation more closely and described the properties of the newly found anticoagulant, naming it heparin. He purified and improved the potency of this substance. By 1922, Hyson, Westcott, and Dunning in Baltimore began to produce heparin commercially according to Howell's direction. For the next several years, heparin was made available to physiologists for experimental work. But it was crude, toxic, and expensive. Soon researchers elsewhere, dissatisfied with the commercial product, began to study heparin with the hope of developing a better form of the substance - less toxic, more potent, and less expensive - for use in medical research. 31 Canadian researcher Charles Best was searching for an effective anticoagulant, like heparin, to apply to his histamine research experiments. 32 In 1929 Best assembled a research team of biochemists, physiologists, and clinicians at the University of Toronto to develop heparin into a practical drug. At the university's Connaught Laboratories, biochemists David Scott and Arthur Charles worked on finding an abundant and inexpensive source of heparin. They quickly found that beef liver and beef lung were better sources of heparin than Howell's dog liver. It was more readily available from local abattoirs, and, through autolysis, greater yields of heparin could be produced. 33 Next they sought to purify the substance so that it could safely be injected into animals and humans. This took substantially more time. After several years of work, Scott and Charles successfully converted heparin from a crystalline barium salt into sodium salt - a potent, non-toxic form. 34 Samples of the Toronto heparin were sent to interested researchers throughout the world, with which to experiment, but a pure commercial form of heparin was not available until 1937.35 Meanwhile, Best and his co-workers in the physiology department were investigating heparin's antithrombotic properties, specifically the inhibitor characteristics of the drug. They conducted

40 Surgical Limits experiments to isolate and characterize heparin, as well as the mechanism of its action. What they were most interested in was the theoretical distinction between its anticoagulant and antithrombotic actions.36 It is unclear exactly when and who initiated the clinical phase of the heparin project. Best remembered asking Gallie to recommend an investigative surgeon to explore the clinical application of heparin. It was known that Gallie endorsed such interdepartmental cooperation and joint research ventures. At Gallie's suggestion, according to Best, Murray then joined his heparin project. Remembering it quite differently, Murray stated that he had approached Gallie on his own as a result of one of his clinical cases. In February 1932 an explosion in the engineering laboratory had caused a severe vessel injury in the arm of a student, who nearly died of excessive blood loss. Following the conventional treatment, Murray tied off the vessel to save his patient. Then, he recalled, I went through the agonizing experience of watching the upper extremity of this brilliant young man ... gradually go stiff and black and become completely gangrenous, with the whole hospital staff powerless to prevent it or help in any way. With no spark of genius involved, but rather with hard thinking and medical analysis involving the problem of vessels with embolism, the concept was finally evolved that some form of substance to prevent clotting was necessary ... As a result of these thoughts, generated by experience with sick people and with the obvious necessity for something to be done, and realizing that this was an unexplored field, I embarked on a plan of research.37

Murray wanted to investigate the possibility of surgically reattaching severed blood vessels. To do this he needed to study anticoagulation so as to prevent thrombosis and clotting at the site of injury within the vessel. Perhaps there is some truth in both stories and Gallie simply played matchmaker between Best's and Murray's research interests. In any case, in 1933 Murray began studying coagulation in dogs in his laboratory with the assistance of Winnifred Chute, a nursing student. Not long after, Best arranged for more appropriate research assistance for Murray for the rest of the project. Walter Cowan, a senior lab technician, joined Murray's laboratory staff, and Louis B. Jaques, a biochemistry graduate student, soon replaced Chute. For the next two years, Murray's research focused on determining the method, dosage, and length of time of heparinization necessary to prevent thrombosis and clotting. In dogs, Murray devised a surgical procedure to produce injury

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and thus clotting (replicating a thrombotic condition) which became his experimental model. 38 From this model, the group conducted at least five series of experiments. The early experiments focused on demonstrating heparin's effectiveness in preventing clot and thrombi formation at the site of injury. Later experiments explored local, regional, and general heparinization methods. Murray measured heparin dosage and treatment length by studying clotting times — in effect, experimenting to see what was too much or too little to prevent emboli formation without haemorrhaging. 39 The toxicity of heparin greatly influenced the experiments. In the beginning, only Howell's very toxic, weak (five-unit per milligram) heparin was available. As Charles and Scott worked on the toxicity and potency of the substance, Murray was provided with improved heparin. Nevertheless, many of his dogs had strong reactions, vomiting, becoming very weak, or even dying.40 The two years between 1933 and 1935 proved to be a productive research period for Murray and his group. Murray did all the necessary experimental surgery between 7:45 and 8:45 AM, before leaving for the hospital to start his clinical operations. Jaques and Cowan administered heparin to the dogs, took blood samples, monitored clotting times, and recorded their observations. 41 Murray held fortnightly meetings with his research assistants and over a cup of tea created an informal setting in which to discuss their heparin research. Jaques remembered his relationship with Murray as 'that of eager student and helpful, sympathetic teacher.' 42 Murray considered the opinions and views of all team members, showing particular support and sensitivity to junior men. For the most part, he worked well with his junior assistants and they liked him. But it was clear that Murray was in charge. Every morning he gave explicit directions to each of them concerning that day's research tasks.43 In 1935 the make-up and direction of the heparin research project shifted. Jaques had dutifully been recording all heparin data in his laboratory notebooks, and he decided to leave the project to write a master's thesis based on these notebooks. (This constituted the beginning of Jaques's lengthy career studying blood coagulation, on which he has published more than 450 articles.) Surgical fellow T.S. Perrett replaced Jaques. Perrett had both science and medical degrees, and from 1933 to 1935 he had been a fellow in the Department of Physiology. As a fellow in the Department of Surgery in 1935, he was assigned to the heparin project.44 At this juncture, changes were made in methodology and supervision within the project. For the most part, before 1935 Murray had enjoyed substantial au-

42 Surgical Limits tonomy, working quietly on the fifth floor of the Banting Institute with his assistants. No obvious friction among the team members existed; all worked busily on their own particular aspects of the project, with their results reinforcing one another's findings. While Murray performed his animal experiments, Best studied the physiological action of heparin microscopically. Best's research demonstrated that heparin prevented the build-up of platelets on the injured lining of the blood vessel, which corroborated Murray's findings.45 But this independent arrangement changed when Perrett joined the project. Best was shuffling the heparin team to prepare for the next stage of clinical trials. Murray expressed his opposition to Perrett's appointment to the research project. Based on Perrett's poor performance as a surgical fellow, Murray considered him a poor addition to the team. Best disagreed, arguing that Perrett was much better suited to the project than Jaques, for Perrett was both scientist and clinician. Best hoped that after gaining a year's experience working on the dogs, Perrett would become the clinical expert with the drug and would take the project's heparin work directly into the clinic.46 Perhaps this was an insight from Best's insulin research experience. As a result of Murray's personal feelings about Perrett, it is not surprising that the two men did not form a close working relationship.47 This mattered little, since unlike the preceding clinical assistants, Perrett reported to Best, not to Murray. But this disturbed Murray. In the end, his assessment of Perrett proved to be correct. Perrett did not work out as Best had hoped. It was clear at the time of Perrett's joining the project that Best and Murray did not share a close working or personal relationship. Easy interchange between participants, informal and formal, is a highly prized part of any research team. It was missing within this project. While Murray maintained an open, friendly rapport with the junior assistants in his laboratory, he did not work well with those outside his area and control. Best simply did not want to repeat his current predicament with Jaques, who had left with all the heparin data books and slides (Jaques's property), placing the research team in a vulnerable position when it came to publication time. Nevertheless, Murray interpreted Best's decision to supervise Perrett directly as an encroachment on his autonomy as the primary clinical investigator. Best's unilateral decision making had been consistent throughout the project. He never consulted Murray, who was junior to him in reputation and in position on the team. The two were very different types, as both researchers and men, and in time these differences became apparent to everyone on the team. According

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to Jaques, Murray refused 'to gloss over the failures and inabilities of other people ... Best was a remarkable scientist-politician [and] for Murray this attitude was anathema.' 48 The rift between Best and Murray grew. After Perrett joined the research team, Best instructed him to repeat the work on thrombosis carried out by Jaques, but with a change in technique. Clotting would be induced not by trauma or mechanical injury but by a chemical means - the injection of a solution of sodium ricinoleate (soricin). 49 Perrett's results showed that there was a lower percentage of patent heparinized vessels when injury was produced by chemical means than was shown in Murray's results, with injury produced by mechanical means. The difference, however, was inconsequential. Perrett's work supported the team's overall findings that the incidence of vessel obstruction by thrombus was decreased when heparin was administered. 50 The research team's results were clear: no clot or thrombus formation occurred when an appropriate dosage of heparin was injected. If heparin was continued after trauma, there was reduced tendency for occlusion during the healing. The experiments had presented controls, different methods of injection, resulting clotting times, and varying time lapses after trauma and heparinization to validate their

findings. The team now prepared to test heparin on patients.51 In April 1935 two groups of patients at the Toronto General Hospital underwent experimental heparin treatments. Postoperative patients received heparin to prevent the formation of blood clots; and patients who had survived an attack of pulmonary embolism were given heparin in an attempt to prevent a second embolus. In his first series of treatments, Murray injected nine patients by regional or general heparinization. Clotting time was increased threefold (approximately fifteen to twenty minutes), but five patients had a toxic reaction to the heparin. They experienced general weakness, headache, and chills, so the injections of heparin were discontinued. Murray decided to wait until a less toxic preparation of heparin became available. Six months later, in September 1935, he administered a more purified heparin to eight more patients, with much improved results.52 On average, these patients received heparin for two or three days, with no thrombosis occurring in almost all cases. Nurses monitored IV administration of the heparin closely. In fact, Murray had rigged up a flashing light at the nursing station that corresponded to the dripping of the IV at the bedside of each patient on heparin. 53 Thereafter, an increasing number of patients received heparin treatments, with some remarkable

44 Surgical Limits success stories. Murray recorded the case of one young mother who, two days after the birth of her baby, suddenly collapsed, turned blue, and began to gasp for air. Medical staff resuscitated her, but everyone feared a second fatal embolism. (At that time, doctors were reconciled to two out of five patients dying of a second embolism within a few days of the first attack.) Murray administered heparin intravenously to this patient, and after two weeks she went home with her new baby, with no ill effects.54 Unfortunately, heparin remained an expensive drug. It cost $20 a day for the typical patient to receive heparin, and in some cases it was necessary to continue the treatment for as long as three weeks.55 The price of heparin did not drop until the Connaught Laboratories began to manufacture the drug in greater quantity after 1937. In spite of Murray's successful cases, the medical community did not immediately embrace heparin. Practitioners were hesitant for two reasons. First, they did not have a clear understanding of clot formation, thrombus, and pulmonary embolism. Secondly, they were afraid that the patient might haemorrhage.56 Most medical men did not diagnose pulmonary embolism correctly, and as Thomas Belt and others were showing, there existed a higher incidence of embolism than commonly believed.57 Pulmonary emboli are clots that form in the leg or pelvis and break free to travel to the lungs, thereby obstructing the pulmonary artery or one of its branches. Peripheral emboli form in the heart and pass to the leg or arm arteries, thereby leading to ischaemia (deficiency of blood supply) and gangrene (tissue death). Embolectomies (the surgical removal of an embolus from a vessel) were rarely performed for pulmonary embolism, as most of these operations ended in fatality. Murray had unique success in operating on peripheral arterial emboli.58 By now, he was advocating the use of heparin to stop clots from forming in the pelvis and legs, thus eliminating the need for embolectomies. According to many practitioners, however, administering heparin was no better a solution in treating peripheral embolism because of the possibility of haemorrhage. Murray himself had lost animals to haemorrhage when too much heparin had been given. He responded to the criticism by stating that the prescribed amount of heparin should be administered two to three hours after an operation, thereby allowing time for haemostasis to occur before introducing the anticoagulant.59 Strict adherence to Murray's guidelines for administering heparin was crucial in the early days of its use. The whole problem became more complicated. In North America during the 1930s, two methods of treating pulmonary embolism emerged

Toronto Appointment 45 that were preferred by practitioners over embolectomies. One group, including Murray, used the anticoagulant (heparin) treatment to control the formation of clots, not only in the leg veins but in the entire body. The surgeons were careful to administer the proper dosage to prevent haemorrhage. The second group advocated surgical vein ligation, which would manage the problem of embolism without the threat of haemorrhage. When clotting was suspected, these surgeons tied off the appropriate femoral veins to prevent clots from travelling up into the lungs. Their critics argued that tying off the femoral veins or the vena cava would lead to future leg disability. Often the two sides - 'anticoagulants' verses 'vein ligators' - participated in panel discussions at surgical conferences, adamantly arguing their positions. During the 1940s, Murray's fundamental arguments were finally accepted. With an increasing number of reported successes with heparin, the use of anticoagulants in treating embolism became the more prevalent therapy.60 It seems ironic that Toronto, the site of heparin research, remained one of the last medical centres to fully endorse its use in the treatment of embolism. In the Toronto General Hospital, the professor of medicine, Duncan Graham, argued that heparin was dangerous. He had conducted his own small trial of heparin on patients with infected heart valves - subacute bacterial endocarditis, a uniformly fatal disease - and no one had survived. Regardless of treatment, they probably would not have survived anyway, but the trial confirmed Graham's belief in the dangers of heparin. Thereafter he prevented Murray from administering heparin treatment to any patients on his medical wards. Graham supported more conservative methods of therapy, a combination of nonoperative treatments, including suction and pressure therapy, antispasmodic drugs, and heat to the body.61 Consequently, heparin was not used on the medical wards (as opposed to the surgical wards, where it was used) of the Toronto General Hospital for almost ten years after Graham's decision. This was true for both pulmonary and peripheral arterial embolism. On the surgical wards, Murray successfully treated about seven hundred patients between 1935 and 1941. In 1950 Dr William Greenwood finally swayed the medical department into using heparin, after reviewing past peripheral arterial embolism cases.62 Worldwide, an increasing number of embolism cases successfully treated with heparin demonstrated its usefulness. It finally became accepted practice on the medical wards at the Toronto hospital. In contrast to the tensions and squabbles of his professional life, Murray's home life was filled with new joys and pleasure. In 1936 Helen

46 Surgical Limits and Gordon's first child, Rosalind, was born. She would be an only child. The parents doted on the new baby, and a close father-daughter bond was formed almost immediately. 'She grew into a real charmer, not only the apple of my eye but both apples of both eyes!' admitted Murray.63 When he could, he enjoyed taking walks with Rosalind, educating her about nature and his other passions. Often at Rosalind's bedtime, Murray sang 'The Nutbrown Maiden,' an old Scottish ballad, or he read her a story. As she grew older, it was not unusual at holiday time for Rosalind to accompany her father on his hospital rounds. The family sometimes travelled together to medical meetings or other professional out-of-town trips. In a busy schedule of long hours at the hospital and laboratory, Murray enjoyed what little time he could spend with his daughter. It was Helen, however, who took on the major responsibility of raising their child. In 1938 Murray shifted the focus of his heparin investigation from treating thrombosis and embolism to surgically repairing damaged blood vessels. Before 1900 little could be done with damaged blood vessels except to tie them off to stop the bleeding. There had been no technique for opening and closing arteries or veins, or for sewing two ends of a blood vessel together. Although there were many investigators exploring these possibilities, there was no agreement on the correct way to reunite arteries and graft veins. Were blood vessels best repaired directly or with various prostheses? What was the appropriate suture technique for doing this work?64 By 1910, experimental surgeon Alexis Carrel had ended the debate and was christened the father of vascular surgery. Carrel's triangulation technique - three sutures placed at equal distances from one another along the circumference of the divided vessels - and his 'everted' sutures, which left the inside of the vessel free of thread, reduced trauma on the artery or vein and lessened the chance of blood clotting. On dogs, Carrel had demonstrated the feasibility of suturing together blood vessels and thus had laid the foundations for vascular surgery, heart surgery, and organ transplantation. In 1912 he received the Nobel Prize in Physiology or Medicine for this research.65 But Carrel was never able to move his work beyond the laboratory. The risks of clotting and infection were still too high and prevented him from performing any clinical cases. Now that heparin was available, Murray dared to carry Carrel's work to the next stage, to apply his techniques of arterial anastomosis (surgical connection of vessels) and venous grafts on patients. Back in the lab, Murray attempted to duplicate Carrel's techniques on

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dogs. His notebooks for 1938 record his early failures and frustrations. Murray was working on small vessels, and this required great surgical skill. Moreover, he needed to determine the right amount of heparin to administer before and after the surgery. His first experiments were venous grafts, transplanting a segment of vein to replace part of a damaged artery. In each dog, Murray excised a segment of the carotid artery and then removed a similar length of the external jugular vein, which was anastomosed (put end-to-end) to take the place of the artery.66 The vein was placed in a reversed position so that its valves would allow the flow of blood to continue in its intended direction. It was unknown at this time whether the vein graft would be able to withstand the stronger arterial pressure. At the outset, Murray lost many of his dogs to haemorrhage or pneumonia. By the fall he was able to keep his dogs alive, but their blood vessels were not patent (open), despite varying heparin dosages and varying lengths of time during which it was administered. Murray plodded on, tediously repeating Carrel's techniques and refining heparin quantities. Months passed and more dogs died. It was exhausting work. In early 1939 it appeared that Murray had finally got it right. A series of sutured vessels remained open and viable.

Success at last, thought Murray. He photographed these prized grafts for

future publication. 67 Over two years, Murray performed a variety of vascular procedures on almost one hundred dogs. His research notebook recorded each dog, the experimental procedure, the dosage and administration of heparin, clotting times, and autopsy findings.68 Murray's experiments ranged from venous and arterial grafts to inserting glass cannula between vessels to work on coronary occlusion and kidney grafts.69 His biggest challenge remained administering the right amount of heparin to avoid clot formation while still allowing the grafts to fibrose. Once he had determined this, he had substantially more success. Murray reported that 'of over 50 experiments in which heparin was used, the arteries remained patent in more than 80 per cent, as compared with 35 per cent of the controls. In a similar group, with improved technic [sic] in administering heparin, all the vessels remained patent.' 70 In 1940 he began to perform his vascular procedure on patients. One of his first arterial suture cases was a Toronto man with an aneurysm in the brachial arterv (the artery that runs from the shoulder down to the elbow). Murray removed the aneurysm, brought the divided ends of the artery together, and sutured the ends together in anastomosis. A continuous intravenous injection of heparin was given for the next three

48 Surgical Limits days, keeping the patient's clotting time at about fifteen minutes. The patient returned to work four weeks after the operation.71 In another case, Murray replaced two and one-half inches of the femoral artery (the main artery of the thigh) with a venous graft: 'With this three inch piece of vein the gap in the artery was bridged successfully and heparin was injected. When the circulation was restored, excellent pulsation appeared in the vessels at the foot. Heparin was injected continuously for the next eight days and then stopped.'72 Murray reported many other cases in which he successfully repaired or replaced arteries. Newspapers reported a few of the more sensational cases, including how Murray had saved the severed hands of a factory worker from almost certain amputation after her heroic two-hundred-mile trek by train to Toronto.73 Together and individually, Best and Murray received praise and congratulations from both the medical profession and the media for their work on heparin. At first, the attention was undoubtedly due to Best's notoriety as a co-discoverer of insulin. Best had announced heparin and its clinical applications as significant contributions to medicine, and the public and profession accepted it. But in contrast to the dramatic impact of insulin on dying diabetic children, the contribution of heparin to medical and surgical problems was less visible, and doctors had yet to explore all of its new applications. Moreover, for Best, who considered insulin to be his greatest research, heparin was only a side interest.74 Nevertheless, Best's standing and experience from being the co-discoverer of insulin had led the heparin project to its successful end. He had played the key role of identifying the problem, making possible the financing, arranging the necessary facilities, and allowing each group of scientists to do its work. Furthermore, he used his contacts to promote the acceptance of heparin by the medical community. Best 'by just being there and setting up the project spelt out the "can do" - same as insulin,' commented Jaques.75 The media latched onto this insulin association when reporting on the success of heparin. Headshots of Best and Murray were printed alongside sensational headlines: 'Doom of Thousands ... Overcome in Toronto,' 'Save 1,000 Yearly,' and 'Heparin Miracle.'76 Like insulin, heparin was presented as a miracle drug.77 More than the press, the medical community recognized the significance of heparin and thus awarded greater attention to Best and Murray's work. Their first publication on the subject, a two-page article in the Canadian Medical Association Journal in 1936, established their precedence

in the clinical use of heparin. The next year, they presented a more complete report of their results in Surgery. These articles were well

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timed. Researchers at the Karolinska Institut in Stockholm, Sweden, were conducting the same experiments with similar results, and the Toronto team knew it. Within months of Best and Murray's publications, Clarence Crafoord, a thoracic surgeon and researcher at the Karolinska Institute, reported his work with heparin. His colleague Erik Jorpes, a research chemist, had begun purifying heparin soon after his 1929 visit to Connaught Laboratories. With Jorpes's heparin preparations, Crafoord had conducted his first clinical cases in August 1935, only four months after Murray, but with poor results. Two years later, Crafoord published more successful results. Crafoord's publication did not usurp credit for heparin; rather, it served to substantiate Murray's early findings. 78 The Swedish team was competing with the Toronto group to demonstrate the clinical application of heparin. There were clearly strained relations between Best and Jorpes as well as between Charles and Jorpes. 79 Their professional disagreements, however, were kept out of print and the nature of their falling out cannot be documented. In Best's mind (and probably Arthur Charles's too), Jorpes's interest and methods of purifying heparin had originated with his visit to the Connaught Laboratories. 80 Jorpes was a strong personality, and there were known tensions between him and his students as well as with his colleagues. Anyone working in Jorpes's laboratory knew that no one 'could differ with the Professor.' Many were surprised that there was no apparent friction between Jorpes and Crafoord.81 Relations between Murray and Crafoord were cordial, but there was almost no communication between these two surgeons. 82 In the end, the Toronto team was first in its discovery and description of the clinical application of heparin. The Toronto team, notably Best and Murray, emerged as the heparin experts. They received numerous professional honours and basked in the recognition, if sometimes competing for credit. After their first few co-authored publications, Best and Murray began to publish separate articles and ended their formal collaboration. Best worked the physiology and scientific audiences while Murray kept to the surgical circles, each focusing on his own role in the heparin project. 83 For Murray, his association with Best had been beneficial, boosting his standing as a clinical investigator. Professional recognition of the value of their heparin research was now secured, and Murray received invitations to speak at prestigious venues. Between 1938 and 1940, Murray presented papers before the three most important surgical groups in the Anglo-American medical world:

50 Surgical Limits the American Surgical Association, the American College of Surgeons, and the Royal College of Surgeons of England. For Murray, the most flattering of these was the Royal College of Surgeons, where in 1939 he was asked to deliver the Hunterian Lecture. He was only the second Canadian to do so, the first being W.E. Gallie in 1924. It was a sweet return to London. Murray's lifetime admiration for British culture and medicine deepened his pride in accepting the honour.84 Furthermore, he was pleased by the attention, praise, and hospitality of the London medical community. After little more than a decade as a surgeon, Murray was enjoying the professional spotlight - the accolades and prestige that came with medical breakthroughs and their discoverers. The Second World War redirected the medical community's attention. As in the last war, Canada mobilized vast numbers of young men for active service, as well as some women, and there arose a great demand for skilled physicians, surgeons, and nurses. Younger hospital staff were mobilized to serve in the No. 15 Canadian General Hospital (overseas), the No. 1 Neurological Hospital (overseas), the Toronto Military Hospital, and at Camp Borden. In his mid-forties, Murray and other older doctors remained on the home front and in the absence of younger staff members assumed a heavy workload of teaching and hospital duty. Hospital administrators called on retired professors and voluntary assistants to relieve their overworked staff. Lectures, ward clinics, ward rounds, outpatient clinics, and follow-up clinics continued. To remedy the shortage of trained medical personnel, the University of Toronto introduced an accelerated undergraduate medical program and raised enrolment numbers. Extra courses for medical officers were offered. Surgical resident training was reduced from three years to one, and later to six months, with intensive refresher courses offered to young surgeons home on leave. The abbreviated surgical course successfully provided competent young surgeons to the overseas surgical units, casualty clearing stations, and general hospitals.85 Despite the busy wartime routine at the Toronto General Hospital, Murray squeezed in time to continue his heparin research. On animals, he successfully experimented with glass and Vitallium tubes to reconnect damaged blood vessels and, with heparin, restore circulation. It was an expedient method of maintaining circulation until a venous graft was done to replace the tube. Although not tried clinically, Murray shared this procedure with medical officers in the War Office, recommending its use on wounded soldiers to save arms, legs, and indeed lives. (The

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French surgeon Theodore Tuffier had suggested a similar operation during the First World War, dipping the tubes in liquid paraffin to maintain circulation temporarily, but the tubes had plugged immediately with thrombus. By the Second World War, heparin, although not yet in wide supply, promised better results.) Overseas at No. 6 Casualty Clearing Station, Toronto-trained surgeons Wilfred Bigelow and William Mustard, acquainted with Murray's research, attempted various 'tube' procedures with heparin on cases where amputation or death was almost certain. Nearly all these operations were unsuccessful. 'The results were disappointing, but not discouraging,' wrote Mustard. 86 It is unknown if other surgeons experimented with similar vascular procedures on wounded soldiers. After the war, a greater supply of heparin and further study into vascular injuries perfected the procedure that would save the limbs of wounded soldiers in time for the Korean War of 1950-53. As a result of the vears Murray had spent operating on dogs and later humans, he emerged as one of the most experienced vascular surgeons in the world. 'Throughout the 1930s, he had had a virtual monopoly on the clinical use of heparin. Only Crafoord in Stockholm had had a similar supply, yet the number of his cases was substantially smaller. By 1940, Murray had reported on over four hundred clinical cases using heparin to treat embolism and thrombosis. In addition, he had accumulated two years of animal experiments, perfecting a surgical technique to reattach damaged blood vessels and defining the appropriate dosage of heparin to prevent the clotting that had previously accompanied such an operation. That year, he began to perform vascular surgery (with heparin) on patients, with noted success.87 Murray's success with the clinical application of heparin fed his drive and self-confidence, encouraging him to tackle more difficult operations. He enjoyed confronting surgical challenges, and he experimented with a range of techniques and applications, including a few early kidney transplant operations. At the time, there was little interest in organ transplantation. Instead, the attention of the profession shifted to the heart, one of the most sensitive organs of the body. Historically, practitioners had been unsuccessful in treating the various diseases of the heart. By the mid-1940s, surgeons boldly began applying their newly learned vascular techniques to the heart - once again, with Murray emerging as one of the leaders in the field.

3

Delivering Miracles: Heart Surgery and an Artificial Kidney Machine

Until the twentieth century, the heart was considered off-limits to the surgeon's scalpel. A few bold nineteenth-century surgeons may have sutured puncture wounds or drained the pericardium (the sac around the heart) to relieve chest pain, and in a few exceptional cases, foreign bodies lodged in the walls of the heart may have been removed. But patients rarely recovered from such injuries. This discouraged most surgeons from operating, and the profession thought this wise. In the 1880s, Theodor Billroth of Vienna, one of the world's most prestigious surgeons, stated, 'Any surgeon who would attempt an operation on the heart should lose the respect of his colleagues.' Similarly, in 1896, Sir Stephen Paget of London declared, 'The heart alone of all viscera has reached the limits set by nature to surgery. No new method and no new technique can overcome the natural obstacles surrounding a wound of the heart.'1 In the same year as Paget's pronouncement, Ludwig Rehn of Frankfurt successfully operated on a patient with a stab wound to the right ventricle of the heart. Rehn closed the wound with three sutures and the patient made a complete recovery. Still, heart surgery almost always resulted in fatality because of the technical difficulties of inadequate diagnosis, poor anaesthesia, blood clotting, and infection.2 As of 1909, the medical community reported 159 heart operations with a 60 per cent mortality rate. Doctors and patients remained properly wary of cardiac surgery.3 In addition to technical difficulties, different ideological understandings of the heart also acted as obstacles in the development of cardiac surgery. For example, the rise of the 'new cardiology' in Britain at the beginning of the twentieth century displaced the surgeon from treating heart disease. Previously, diagnosis and treatment had focused

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on the anatomy and mechanics of the heart. Replacing this, the concept of the 'living heart' shifted the clinician's focus to the physiology and dynamics of the heart. 4 Diseases of the heart were defined as medical and were increasingly treated with drugs rather than surgery.5 Chest surgeons, of course, challenged the concepts of the new cardiology, for they remained focused on anatomical lesions, such as diseased valves, as the fundamental cause of heart problems. The new cardiologists responded that valve surgery did not treat what was basically wrong, the functioning of the heart muscle.6 In 1925 Henry Souttar of London successfully performed a controversial procedure to treat mitral stenosis by inserting his finger through the mitral valve in the heart. (A commonly acquired heart defect, mitral stenosis is the narrowing of the opening of the mitral valve obstructing blood flow from the left atrium to the left ventricle of the heart; blood then pools in the atrium and into the lungs, retarding blood circulation, and this results in heart failure. Mitral stenosis can result from childhood rheumatic fever, which is caused by a specific streptococcal bacterial infection, which often does permanent damage to the heart valves.)7 Souttar's patient survived the operation and even showed some improvement. Nevertheless, British cardiologists refused to refer any more patients to Souttar, and he was never given the chance to repeat his operation. During the 1920s, both before and after Souttar's publicized case, the American surgeons Elliott Cutler, Claude Beck, Evarts Graham, Duff Allen, and others explored numerous heart valve procedures with no success. Sir James Mackenzie, King George V's personal physician and the acknowledged authority in England on heart disease, commented: 'Indeed! The only heart disease I know of is that of the muscles and no operation will correct it.' 8 Murray adhered to the anatomical school and believed in the surgical treatment of diseased valves and other lesions of the heart to improve heart function. In 1936, picking up where Souttar, Cutler, Beck, and others had left off, he began to explore the problem of mitral stenosis and regurgitation. Mitral regurgitation, or incompetency, occurs when the valve leaflets or flaps fail to stop blood from flowing back into the left atrium from the left ventricle after the surgeon has widened the opening of the mitral valve. Little was known about the exact anatomy and function of the valve leaflets at this time. Since the problem of regurgitation was graver than a stenosed valve, many surgeons left the original condition untreated. 9 Murray developed a vein graft procedure to treat mitral stenosis with-

54 Surgical Limits out the problem of regurgitation. With small clipping scissors, he cut out part of the diseased mitral valve to allow for easier blood flow. Then he delicately guided a vein, turned inside out, into place below the valve. The vein acted as a sling, allowing the blood to flow through the valve into the ventricle. When the ventricle contracted, the sling was forced back into the orifice to prevent backflow. It was flexible, strong, and not likely to induce blood clotting. In the laboratory, Murray performed the procedure on eight dogs; six died of infection within days of the operation, but the two surviving animals showed no signs of heart failure. This suggested to Murray that his vein graft procedure did work if no infection occurred. He reported his results in 1938 in the Canadian Medical Association Journal, but it garnered little attention.10 Not long afterwards, Murray attempted this surgery clinically. It was premature to operate on humans - he had performed only a limited number of animal cases, with poor results. Still, when presented with patients who were experiencing mitral regurgitation and suffering varying degrees of disability because of it, Murray decided to operate. These patients took the risk of the experimental procedure in the hope of improving their condition. Fortunately, a few of them did enjoy better health after the operation. One man who previously had led the life of an invalid was able to return to work and to play golf, and he enjoyed good health for many years after the operation. It is unknown if any died.11 Upon learning of this surgery, Toronto General Hospital medical authorities discouraged Murray from performing any more such operations without further laboratory data. In their mind, it was clearly an experimental procedure that was not ready to be tried clinically. Murray's laboratory results were not conclusive, since the success of two out of eight dog operations did not demonstrate that the procedure was safe for patients. Moreover, the authorities were not convinced that surgical treatment could improve weakened heart function, for they adhered to the physiological, not anatomical, view of heart disease. Cardiac surgeon William Mustard commented at that time in Toronto: 'The medical profession frowned on having anything to do with the valves in people who had diseases of the heart muscle ... It was a misconception.'12 Murray stopped doing the operation, both on animals and people. It did smack of experimentalism. It typified his trait of moving quickly - sometimes too quickly - from the laboratory to his patients with new therapies. To the medical community, this behaviour was deemed recklessly irresponsible.13

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Nevertheless, Murray's experimental heart procedure foreshadowed future heart operations based on vascular surgery techniques. Until the 1940s, clinical knowledge of heart disease had been slowly growing, much of it aided by new diagnostic instruments. The development of the electrocardiogram, or ECG machine, which recorded the electrical action of the heart, allowed doctors to document irregular heartbeats of their patients. Catheterization (injection of a flexible tube into the arm, up a vein, and into the atrium of the heart) and angiocardiograms (an x-ray of the blood vessels injected with a dye via a catheter) improved diagnosis of heart disease. Constricted arteries and swollen vessel walls (or aneurysms) could be detected. As more knowledge about the heart was gained, surgeons such as Robert Gross in Boston, Clarence Crafoord in Stockholm, and Alfred Blalock in Baltimore began to devise surgical procedures to treat various malformations of the heart. This was the prelude to the celebrated blue baby operations of the mid-1940s. 'Blue babies' are children born with malformed hearts, possibly holes in the interior heart walls, open foetal ducts, transposed heart vessels, or obstructed valves, which interfere with the normal flow of blood through the heart and lungs. 14 Prevented from properly circulating through the heart and into the lungs to be replenished with oxygen, deoxygenated blood is recirculated through the body, causing cyanosis - the child's skin, lips, and fingernails turn blue because of the insufficiency of oxygen in the blood. Blue babies may suffer unusual murmurs or thrills of the heart, a slow or stunted rate of growth and development, and an alteration in the size, shape, and/or position of the heart. As blue babies age, they suffer increasing shortness of breath, spells of unconsciousness, and respiratory distress from oxygen deprivation. Depending on the nature of the heart malformation, these infants live with varying degrees of incapacity. Most cyanotic children are not capable of participating in such normal activities as playing outside or walking to school. Prior to the mid-twentieth century, no improvement in their condition was to be expected and their prognosis was grim. Few blue babies lived to adulthood. Physicians could offer only palliative medical treatment of rest, oxygen, heart medication, and sometimes diuretics. In 1936 the Canadian doctor Maude Abbott of McGill University published the Atlas of Congenital Cardiac Disease based on one thousand cases, and in 1947 the American cardiac paediatrician Helen Taussig at Johns Hopkins University wrote the first comprehensive textbook on the subject, Congenital Malformations of the Heart. As physicians like Abbott

56 Surgical Limits and Taussig were improving the profession's ability to diagnose congenital heart conditions, several surgeons were working towards offering surgical treatment for these patients in a way that had never been attempted before - by operating on a beating heart.15 These surgeons operated on the great vessels of the heart (arteries leading away from the heart) in an attempt to repair or compensate for heart malformations. Such early cardiac operations were difficult procedures. Although the surgeon did not have to penetrate the heart, as Murray had done in heart valve surgery, these procedures demanded considerable surgical skill and the application of new vascular techniques. In Boston, Gross developed a procedure to correct 'patent ductus arteriosus.' The ductus arteriosus is a blood vessel in the foetus that connects the pulmonary artery directly to the ascending aorta, bypassing the pulmonary circulation. It normally closes after birth, but when it remains open, or patent, it allows a significant proportion of the infant's blood to flow back through the body without being replenished with oxygen from the lungs.16 In 1938 Gross operated on a baby dying from heart failure because of patent ductus arteriosus. He surgically closed the duct. The child's blood was no longer improperly routed to the lungs. What nature had failed to do, the surgeon was now able to fix. Gross's successful heart procedure was applauded by the profession, and soon other surgeons began to perform this operation. At the Children's Memorial Hospital in Montreal, Dudley E. Ross was the first Canadian surgeon known to perform this surgery. By June 1941, he had operated successfully on three children suffering from patent ductus arteriosus.17 In 1944 Clarence Crafoord in Stockholm and Gross in Boston independently developed a procedure to correct 'coarctation of the aorta.' Coarctation of the aorta is a congenital narrowing of a short segment of the aorta, which obstructs blood flow. In both Crafoord's and Gross's procedures, the narrowed portion of the aorta was excised and the two ends of the vessel were sutured together. In cases where the distance was too great for the two ends to meet, an arterial graft was performed. This heart procedure was in fact a form of vascular surgery, employing the techniques of vessel anastomosis and grafting.18 Correcting a heart malformation found in many children, the operation improved their condition by reducing their high blood pressure and their risk of heart failure. That same year in Baltimore, surgeon Alfred Blalock and cardiac paediatrician Helen Taussig developed a surgical procedure for blue babies with 'tetralogy of Fallot' heart malformations. Tetralogy of Fallot

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is a complex congenital heart disorder in which there are as many as four severe heart abnormalities that impede proper blood circulation and oxygenation.19 Blalock and Taussig developed an operation for this condition whereby a vascular shunt was constructed between the great vessels of the heart, specifically the subclavian and pulmonary arteries. 20 It was crude but effective. They rerouted the partially oxygenated blood flowing out of the aorta directly back into the lungs to receive oxygen. It was not a cure, but it was a palliative procedure to compensate for a multitude of circulatory problems. Blalock had been using this 'shunt' procedure to study pulmonary high blood pressure in animals, and Taussig realized its suitability to relieve the problems of cyanotic children.- 1 Prior to 1944, a child with a malformed heart had a poor prognosis, and surgical treatment was not considered an option. The new blue baby operations for patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot changed this. The Blalock-Taussig procedure had a great impact in erasing previous medical concerns about operating on critically ill heart patients, and it helped gain widespread acceptance for new heart surgery possibilities. Whereas most children suffering from coarctation of the aorta and patent ductus arteriosus lived to be adults, tetralogy of Fallot patients did not. Only one-fourth of these blue babies reached adolescence, and they suffered severe disabling symptoms. Dramatically, the Blalock-Taussig operation turned these blue babies pink, a much more visible 'cure' than the relief of high blood pressure and heart failure offered by other procedures. The Blalock-Taussig procedure demonstrated that such patients could safely receive anaesthesia, could endure a two-to-three hour operation, and could tolerate the clamping of their pulmonary arteries for anastomosis to be performed. Furthermore, the patient's arm, from which the new blood flow to the pulmonary artery was diverted, functioned properly despite the deprivation of blood supply.22 Surgeons could understand the procedure and many were able to repeat Blalock's success; since tetralogy of Fallot was one of the more common congenital heart disorders, they were quick to accept and use the shunt procedure. Along with the closure of ducti and the resection of coarctations, it became one of the first routine heart operations of the twentieth century.23 In his Toronto laboratory, Murray followed the work of Gross and Crafoord, duplicating their procedures himself on dogs. When he read about the new Blalock-Taussig operation, Murray, like so many other surgeons, travelled to Baltimore to observe and learn. He liked and

58 Surgical Limits respected Blalock. According to Murray, Blalock 'had the type of mind which led him to explore many fields of medicine and surgery. He was an experimenter of the first water, one of the leaders in this type of work in the United States ... He had a very pleasant and amiable personality, a kindly and gentle face ... Everybody was his friend and he was a friend of everybody.' Murray closely observed Blalock at work and was impressed. He returned to Toronto with 'keen enthusiasm,' and within a few short months he began to perform these operations clinically.24 In March 1946 Murray examined his first blue baby patient deemed suitable for surgery - thirteen-year-old Isabel Douglas of Toronto.25 Her lips, fingers, and toes were quite blue, and doctors had told her family that she would not live much beyond her early teens. The Douglas family had read about the new Blalock-Taussig heart operation in the newspaper. Another local blue baby, Gail Mitchell, had travelled to Baltimore to have the operation. Unfortunately, Gail's operation had been unsuccessful and the young girl had died. Nevertheless, the Douglas family wanted the same operation for Isabel, driven by the possibility of restoring her health and extending her life. They asked their family doctor about going to Baltimore for the procedure, but their doctor recommended Gordon Murray. He knew of Murray's success on animals and felt that the operation could be done just as well in Toronto as in Baltimore. Murray performed the surgery in secret at the Wellesley Hospital. Since it was his first blue baby operation, he probably wanted to avoid attention from his colleagues and the press. It was not unusual for Murray, when he wanted privacy, to book his more difficult operations as routine procedures in order to discourage visitors; sometimes he even covered the windows with towels to prevent casual observers from watching.26 At the time, he may also have been concerned about the Toronto General Hospital's policy of referring children to the nearby Hospital for Sick Children. One suspects that he may also have wanted to thumb his nose at his Toronto General Hospital seniors, with whom he was increasingly battling for more financial and professional support for his work. It was a period of mounting tension between Murray and the hospital. In the operating room at the Wellesley, the blue baby procedure lasted four hours. Delicately, Murray constructed new passages to the lungs to improve Isabel's blood circulation. When the clamps were released, blood rushed through Isabel's heart and lungs. Her colour turned from blue to pink before everyone's eyes. It was an exciting climax to what all believed to be a successful operation. But five hours

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after leaving the operating room, Isabel suffered a relapse and died shortly thereafter. An autopsy attributed her death to cerebral thrombosis - a blood clot on the brain - most likely as a result of the surgery.27 An upset Murray returned to the lab. 28 Three months later, Murray accepted a second blue baby case. Fiveyear-old Viola Ireland of Burks Falls, Ontario, wanted 'a new heart so that she could go to school like the other little girls.' 29 Her parents had been saving money to send her to Baltimore for the procedure, but instead they asked Murray to perform the operation. This time he did so at the Toronto General Hospital. At Murray's request, Dr Stephen Evelyn attended as the anaesthetist (and for most operations thereafter; Murray became reluctant to work with anyone else in this position). 30 After two hours in the operating room, Viola's colour changed from blue to pink. She had survived the surgery, and she recovered without complications. The child's family praised Murray and his surgical skill and the media hailed the operation as a glorious success, reporting Viola as the 'first baby to be rescued in Canada from the fate of a "blue baby." 31 To the press, Murray acknowledged the important role of the nurses, 'ever in attendance to supervise and provide the oxygen and other treatments necessary to comfort and console the children.' 32 Nevertheless, the media attention focused on the patient and the surgeon, and the dawn of a new Canadian era in heart surgery was celebrated. The Blalock-Taussig operation and other modified shunt procedures were not cures or even long-lasting palliative solutions for children with congenital heart disease. The shunts only partially corrected the problem, and blue babies often needed a second operation. 33 This fact stimulated surgeons to find other ways of repairing heart malformations, specifically how to correct these abnormalities directly rather than rerouting blood to compensate for them. One of the first heart malformations that surgeons attempted to correct were septal defects. The septum divides the two atria and two ventricles of the heart, and in some cases children are born with 'a hole in the heart' where the septum has not. dosed completely.34 The hole in the septum allows blood to pass improperly between the atria and ventricles. According to Murray, almost half of his blue baby cases had been diagnosed with this heart malformation - patent interventricular or interatrial septa. 35 How could he close these holes in the heart? At this time, one could not open the heart to suture the edges together or to graft a patch. 36 Murray set to work to develop a blind' procedure to correct the condition. With the blunt end of a needle, threaded with either a 'living suture' (for exam-

60 Surgical Limits pie, a strip of fascia lata from the thigh) or cotton thread, Murray proposed to enter the front of the heart and exit from the back, tying both ends in place. The inserted living suture or cotton thread would narrow the opening in the septum, partially blocking the hole. Thrombosis might then occur around the suture and perhaps close the opening more completely.37 Murray was proposing a difficult operation - it was a tremendous technical challenge to define the exact location of the hole in the septum and to insert the material without causing arrest of the heart. Alone in his lab at the Banting Institute - sometimes allowing a student to assist him - he practised locating the position of the septum from the exterior surface of the heart. Time and again he inserted a needle through the septum, taking care not to puncture the coronary arteries, the valves, or the bundle of His.38 He experimented on about thirty animals before taking any clinical cases. Then he operated on four children who were suffering from either interatrial or interventricular septal defects. Three survived the surgery, and they experienced moderate improvement.39 At the American Surgical Association meeting in 1948, Murray described his procedure and the results. Blalock commented, 'Certainly it never would have occurred to me to place sutures blindly in this manner ... I wish to congratulate Dr. Gordon Murray on his excellent work.'40 Murray's operation for interatrial and interventricular septal defects constituted only one of his many heart procedures for congenital heart cases. He used shunts, grafts, sutures, and vessel anastomoses to treat a range of heart cases. The number of blue baby operations he performed was second only to Blalock's. He lost fewer patients than almost any other surgeon operating on the heart.41 Dr M.E.J. Stalker stated, 'I don't know of anyone else in Canada who could attempt such an operation. It takes not only great surgical skill but also great courage and an outstanding knowledge of anatomy. It is an operation in which many of the great blood vessels must be severed.'42 A Toronto doctor, John Scott, said, 'It was known that he was technically outstanding; and that he would try things and succeed where others would hesitate even to attempt it.'43 Blalock was delighted with Murray's success and congratulated him on his 'creative approach to surgical science.'44 Leading surgeons came to Toronto to observe Murray perform these delicate operations.45 Medical and surgical students juggled their schedules so that they could attend his operations and watch him in action. Murray became an

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expert in blue baby surgery largely because of his skill as a surgeon but also because of the sheer number of operations he performed successfully each week. In the five-year period between 1946 and 1951, Murray performed almost six hundred heart operations. 46 He operated on infants, children, and adults, their ages ranging from ten months to forty-three years. He kept a demanding schedule, reluctant to turn away patients, and received great satisfaction in transforming the lives of the sick children. Often he stood quietly outside his blue baby ward, watching his young postoperative patients playing and laughing. In Toronto, medical reporters Ken MacTaggart, Joan Hollobon, Marilyn Dunlop, David Spurgeon, and Ron Kenyon followed Murray's success closely and began to refer to him as 'Canada's blue baby doctor.' Murray's cardiac surgery generated much more media attention than his earlier heparin and thrombosis work.47 While his previous contributions were relatively unknown to the general public, his heart operations were splashed across the front pages of major Canadian newspapers. In this period of emerging specialized journalism, medical reporters, who were not medically trained themselves, strove to present correct and detailed information to the public in an effort to keep society abreast of medical change. Doctors and hospital administrators, initially reserved, soon began to enjoy the publicity, especially the celebrity which the glowing news reports created, recognizing the potential value of 'success stories,' both professionally and financially. Often medical reporters had a rapport with various doctors, and once credibility was established, these doctors opened up to them. 48 Everyone enjoyed a good medical success story. Newspaper photos of Murray and his patients became common as reporters dramatically described his numerous blue baby cases. The headlines were glorious: 'Gladys Hie: Dr Murray's Third Triumph,' '"Blue Baby" for 16 Years: Doctor's Skill Frees Girl from Wheel-Chair Prison,' 'Surgeon Plays Santa Claus,' '"Blue Baby" Home for Yule: Murray's 20th Success,' 'Famed Blue Baby Doctor Reaching One-a-Day Rate, Once "Blue," Now Normal.' 49 His operations delivered miracles; blue babies suffering from congenital heart disorders, facing certain death, became pink robust children. Murray was a hero who could cheat death by his skill in the operating room. He saved lives, and what could be more selfless than saving the life of a child? He corrected malformations dealt by nature and offered a child a normal life. Even when he lost a patient, the media sympathized with the surgeon who had done all that

62 Surgical Limits he could. To the press, Murray was humble about his abilities, but he was delighted by their glowing words. 'Two-Year-Old Patty Reniewick Transformed into Healthy Child by Skill of Dr. Gordon Murray,' wrote one journalist; 'the operation was a surgical miracle' and 'Dr Murray is leading the way.'50 Another praised him for 'operating on a blue baby almost every other day, bringing new life and hope to them and to their parents.'51 Murray's media persona as created by journalists - hero, leader, and miracle maker - remained with him until the end of his career. He continued to work with journalists at different times, and they deferentially reported his work with praise and admiration. The blue baby newspaper coverage spread word of the expanding surgical possibilities now available, and the public's fears about heart surgery subsided with the increasing number of favourable reports. People were not concerned about which procedure Murray used or whether or not he had been the first to perform these operations. They celebrated the success of this daring surgeon who was saving the lives of children.52 Families and community clubs brought their blue babies to Toronto from all across Canada. Murray operated on children from Calgary, Edmonton, Winnipeg, northern Ontario, Montreal, Halifax, and as far as New Zealand.53 These were desperate parents who placed their hope in a surgeon who was able to improve, if not save, the lives of their children. In most cases, they were astonished at the results. Mrs Psutka, describing her five-year-old son, said, 'His lips, tongue and even finger nails were as blue as blueberries before the operation, and now his color is just like that of other healthy children.' Mrs Russell, mother of nineyear-old Vivian, said that Vivian 'had to be pulled to school last year ... in her cart. Now she can walk like other girls and not be as she was, so short of breath that she could not walk more than half a block with great difficulty.'54 Mrs Ireland, mother of the first transformed blue baby, praised Murray as 'a wonderful man and a wonderful surgeon.'55 Mrs Werezak, mother of the second blue baby, Mary, told reporters, 'Dr Murray is a wonderful man. He says our little girl will now be normal again. It seems like a dream.'56 Enjoying his son's improvement, one man wrote that it was 'something we never really expected ... death was so close.'57 Another father told Murray, 'When I see my little son playing with an energy he never knew before, a layman like myself feels that the medical profession is a godly one and that men like yourself are the glories of it.'58 There were numerous references by parents to the 'godly' powers of Murray: 'The work and type of work that you are doing daily is

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not of this world but of the supernatural... We fully realize that with men like you to watch over us and our loved ones that our future is safe and our hopes and prayers will be answered.' 59 Murray also received praise from the medical profession. He had earned professional honours before for his work on heparin, and during these heady days of early cardiac surgery he once again stood among the leaders in the field. He described various cardiac procedures at the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada in 1947, at the American Surgical Association in 1948, and at the Royal College of Surgeons of England as the Lord Moynihan Lecturer in 1949.60 All were important venues to which his colleagues flocked to learn of his successes. Murray basked in this glory. Professionally, he was now known worldwide. Donald R. Wilson, his former student, who became professor of surgery at the University of Toronto, commented, 'At one stage he was the doctor that was best known in the world from Toronto ... It was really the opening up of cardiovascular surgery and here was a man who was a leader in the field. It was a stimulating time to be around.' 61 Internationally renowned cardiovascular surgeon Denton Cooley, a former student of Alfred Blalock and founder of the Texas Heart Institute, recalled that Murray 'did some outstanding and unusual surgical operations and was considered one of the most progressive researchers of that era.' 62 The surgical profession recognized Murray's leadership by electing him to the American Surgical Association, which even today has only 260 active members, only a handful of whom are Canadians. 63 The American surgeon William Longmire, Jr, another student of Blakx k's, argued: 'From the standpoint of innovations and ideas [Murray] was indeed a leader. But from the standpoint of having his ideas generally accepted and applied at or about the time of presentation, my feeling |was| that he was too much ahead of his time to be considered a leader in the clinical field of surgery.' 64 Some of Murray's earlier ideas about heart surgery only took hold after the Second World War when numerous younger surgeons began working on the heart. Murray's practice boomed as Toronto physicians referred an increasing number of patients to him. His full-time secretary, Ethel Kerr, looked after his private-practice office, a position she held for nearly twenty years. Murray could not have managed without her. She answered his phones, booked patient appointments, answered his correspondence, and organized his days, which began at 7 AM and rarely ended before 6 PM. He spent his mornings operating and conducting hospital

64 Surgical Limits rounds, predominantly at the Toronto General Hospital on Ward C and in the Private Patients' Pavilion, though occasionally he also operated at other Toronto hospitals, such as the Wellesley. In addition to the wellpublicized heart operations, Murray continued to perform general, orthopaedic, and vascular surgery. Each afternoon, he kept patient appointments in his office across the campus at the Medical Arts Building on Bloor Street. His growing practice, coupled with the notoriety of the blue baby cases, prompted him to be more demanding within the Department of Surgery. Murray questioned the hospital's and university's reluctance to develop a new cardiovascular surgical centre. With his experience, he could establish Toronto as a leading medical institution in this field. He was one of the university's medical leaders, as proven by his heparin and thrombosis research, his vascular surgery, and now his heart operations.65 So why was Toronto's university hospital so reluctant to showcase his skills? Murray became increasingly frustrated by what he perceived to be institutional obstacles and personal jealousy of his continued success. The Toronto General Hospital did take steps to facilitate Murray's cardiovascular work, most notably by designating six beds on Ward C specifically for his blue baby cases. This was unusual, since all children were supposed to be operated on at the Hospital for Sick Children, next to the Toronto General Hospital. Still, Murray was looking over his shoulder at younger surgeons working in the field, perhaps anticipating their lead in heart surgery. In the immediate postwar period, younger surgeons who had been away for four years returned from Europe with tremendous surgical experience. Wilfred G. Bigelow and William T. Mustard both visited Johns Hopkins, observing Blalock and others, before returning to the Toronto General Hospital and Hospital for Sick Children, respectively, to launch successful careers in heart surgery. Not long after Murray's initial success, Mustard began performing blue baby operations at the Hospital for Sick Children. By the 1950s, Murray's blue baby beds were removed from the Toronto General Hospital; by then he was concentrating on performing heart operations on adults, notably on acquired heart disease conditions. Not long thereafter, Mustard emerged as the better-known blue baby specialist in Toronto. He performed the first successful open-heart blue baby surgery in Canada, correcting a septal defect. By 1958 he was performing closed-heart blue baby operations two to three times a week and open-heart blue baby surgery once a week. He later devised an open-heart procedure for transposition of the great vessels (another congenital heart disease), which became known as the Mustard procedure.66

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By the late 1940s and increasingly into the 1950s, there was no doubt that heart surgery was the new exciting field.67 It underwent rapid change in two generations, moving through three distinct phases extracardiac, closed-intracardiac (or closed-heart), and open-heart surgery. Successful new cardiac procedures spurred on the work of researchers in related fields of study.68 As Canada's blue baby doctor, Murray was a high-profile participant in the emergence and expansion of modern heart surgery. Blalock's blue baby operation of 1944 had marked the beginning of successful closed-heart surgery. Surgeons and researchers studied and performed these early palliative heart procedures, improving and devising new techniques, before corrective openheart surgery made these operations obsolete. Murray was among the surgical leaders of the closed-heart period. Numerous surgeons were working on the great vessels of the heart, but only a handful made key contributions to the field and could perform the new heart procedures with repeated success. These men included Russell Brock and Clarence Crafoord overseas; Murray and later Bigelow and Mustard in Canada; and in the United States, Robert Gross, Alfred Blalock, Dwight Harken, Charles Hufnagel. Charles Bailey, C. Walton Lillehei, Norman Shumway, Michael DeBakey, and later Denton Cooley. It was an elite company, and without realizing it, Murray was at the peak of his surgical career.69 As noted above, the public's feelings towards heart surgery had changed with the sensational blue baby operations of the 1940s. The surgeons' success in saving the lives of cyanotic children soon led to more successful procedures for other congenital, as well as acquired, heart disease conditions. Misgivings gave way to confidence in the skills of the surgeon. Society no longer imbued the heart with special cultural meanings as either the seat of the soul or the mysterious centre of emotional identity. Romantic notions of the heart were replaced by a mechanistic understanding of it as a pump that could be repaired. 70 Murray and others demonstrated their ability to treat heart disorders - confidently cutting into this sensitive organ, offering blue babies a longer life, correcting diseased valves and coronary arteries - thus deepening society's belief in medicine, surgery, and dramatic cures. While Murray was at the centre of all this, garnering public adulation for his dramatic heart operations, the newspapers announced another life-saving treat-

ment of his - one provided by a locally built artificial kidney machine. At the Banting Institute, Murray balanced a range of short- and longterm research projects, much as other researchers did. Intrigued by any problem for which no successful treatment existed, he never could

66 Surgical Limits contain his interest. So in addition to devising new surgical techniques for various cardiac defects, he explored ideas of how to save patients suffering from uraemia (the failure of kidneys to produce urine and excrete waste compounds). Diseased kidneys were a field far removed from damaged blood vessels and cardiac surgery. Some medical men argued that a general surgeon would be out of his league in the field of renal therapy. They underestimated Murray. Murray's interest in diseased kidneys led him to experiment with mechanically replicating the functions of the organ. The primary function of a kidney is the elimination of liquid waste. A number of conditions - such as acute toxaemia, acute nephritis, and injury or obstruction to the ureters and kidney - cause this organ (or pair of organs) to shut down. When the kidneys stop functioning, deadly poisons accumulate in the body; and when the body becomes unable to cope with the excess poisonous waste in the blood, the patient may experience nausea, vomiting, lethargy, and drowsiness, before lapsing into a coma. Eventually, the patient dies. An artificial kidney machine could provide the mechanism by which the accumulated poisonous wastes could be excreted.71 If not severely damaged or diseased, the patient's kidneys might recover completely once the excessive build-up of waste products was removed from the bloodstream. Murray had his work cut out for him. Like all his other research, this project was conceived, directed, and controlled by Murray himself, and he enlisted the help of only junior assistants to carry out activities in his absence. With the assistance of Edmund Delorme, a young surgeon from the University of Edinburgh, and Newell Thomas, a chemistry undergraduate at the University of Toronto, he began to build his machine in late 1945.72 The artificial kidney is a dialyser, a machine that 'cleans the blood' by removing waste materials, or poisons, from the blood by filtering the blood through a semipermeable membrane. By means of extracorporeal circulation, blood is taken from the patient and pumped through this membrane, or tube, into a dialysate bath. Blood cells and proteins remain in the tube, while water, salts, sugar, amino acids, and waste products pass into the dialysate, or dialysing solution, a mixture of water and salts. The blood, cleansed of waste products, is returned to the body. Successful vividiffusion experiments on dogs had been done as early as 1913 by John J. Abel, Leonard G. Rowntree, and B.B. Turner at Johns Hopkins University.73 However, clinical use of artificial kidney machines did not regularly occur until after the availability of heparin in the

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1940s. Early artificial kidney prototypes emerged in Holland and Sweden, and later in England and North America, where they were used on patients.74 Murray was familiar with the earlier vividiffusion research literature, but he claimed to be unaware of the work being conducted overseas in the 1940s. The artificial kidney contained three basic elements: a dialysing membrane, or tube; a dialysing solution, or dialysate; and a mechanism for circulating blood through the machine. For all three components, Murray had to overcome technical difficulties. First, the tube that led the blood through the dialysate had to be a semipermeable membrane. That is, it had to have 'perfect pores,' allowing tiny molecules of harmful waste to pass into the dialysate while retaining the larger protein molecules and blood cells Murray experimented with various natural and synthetic products, such as portions of skin, sheets of the peritoneum of animals, rayon, nylon, and wood products. 75 The semipermeability of the membrane was crucial; the efficacy of dialysis depended on it. In January 1946, Murray connected a 35 lb uraemic dog to a crude artificial kidney and circulated the animal's blood for thirty minutes before ending the experiment. He tested for the presence of sugar, urea, albumin, sulphate, and phosphate in the fluid of the rinsing bath, but found none. He concluded that the membrane used was nonpermeable. 76 He went back to testing other possible materials. The best semipermeable membrane proved to be a type of cellophane used for sausage casing.77 He experimented with the size and length of tubing before settling for the satisfactory size of 1/4 in. in diameter, varying in length from 35 to 150 ft.78 The tubing was coiled vertically around a wire-mesh cylinder and was contained in a large bath jar or drum filled with the dialysate. Next, Murray turned to his second major challenge: the dialysate. When tap water was used as the dialysate, Murray's animals died. The machine removed substances that were necessary for life, so Murray had to find a dialvsate that was consistent with some of the normal substances of the blood. When Ringer's solution - formulated to balance the chlorides, calcium, magnesium, potassium, sodium, phosphate, carbonate, and sugar in the animal's own blood - was used as the dialvsate. the dogs suffered no ill effects. Murray eventually settled on this solution. 79 The third difficulty concerned the method of circulating the blood through the machine. The availability of heparin now made extracorporeal circulation a possibility, preventing clotting. Initially, Murray extrac ted blood from an artery, but the artery could be used only once,

68 Surgical Limits and it did not provide sufficient force to propel the blood through the machine before returning it to a vein. Murray also had problems of haemorrhaging in his animals. He decided to work exclusively within the venous system, taking blood from and returning it to a vein, using a pump system. A rubber tambour was inflated and deflated by the action of the piston-syringe, acting as the pump, attached to an electric motor. Intake and outlet valves controlled the blood flow.80 For the most part, Murray's technical difficulties had now been sorted out. His artificial kidney machine was built, and he began a series of experiments to test its efficacy. According to his assistants Delorme and Thomas, 'Murray would slip over to the [Banting] Institute between operations, stay for perhaps two hours studying the results of the previous day's experiments and laying out the work for that day. He was a coldly scientific man ... Everything had to be tested a dozen times and a dozen different ways. When something went wrong he would just stare at it for a moment while he worked out some complicated solution in his head.' Murray continued his trials with uraemic animals, treating them for hours, even overnight, with relative success.81 Several months later, Murray had his first clinical case. Dr Hermon Brookfield Van Wyck, head of the Department of Obstetrics and Gynaecology at the Toronto General Hospital, presented Murray with a twentysix-year-old female who was lying in a uraemic coma in Ward F. An unmarried pregnant woman, she had attempted an abortion using a douche of mustard and water, causing severe toxicity and renal failure. Her body was bloated and her skin like putty. Her injured kidneys could not filter and flush away the poisons that had brought on the coma, and on the ninth day her doctors declared her case hopeless.82 At that point, Van Wyck called Murray. Van Wyck was not convinced that the artificial kidney would actually work, but he was at a loss as to what else to do for his patient.83 Murray quickly arrived on the ward with his odd-looking machine - and what a contraption it was! Massive and cumbersome, it took three men to carry it to the bedside. Murray, his interns, and additional nurses rushed around the ward to set up the machine. New dialysing tubing was mounted and the equipment sterilized. Electricians were brought in to provide the correct current on which to run it.84 Numerous large wires ran across the hall to various electric outlets. Curious observers took in all the commotion, wondering if this machine would actually work.85 That evening, after Murray's artificial kidney had been set up, the comatose woman was wheeled in. Working swiftly, Murray cut into

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the large femoral vein on the inside of her left thigh. A long plastic catheter was inserted into it and connected to the dialyser coils. Then Murray cut into the femoral vein in the right thigh, pushing another catheter up into the vessel until it reached the vena cava just below the patient's heart. Heparin solution was then injected into the patient's bloodstream and into the machine. When the machine was switched on and its pump began to move, dark red venous blood was carried into the cellophane tubing and slowly flowed through the coils in a fifteen-quart glass jar, which contained the dialysate and was perched on the bedside table. Bodily wastes escaped through the pores of the cellophane tubing in the fluid bath - just as they would have been filtered out by normal kidneys and flushed away as urine. The blood then passed through an air trap that removed any bubbles, and returned to the patient's circulatory system. A thermostat control had been built into the machine to maintain the patient's blood temperature outside the body. The noisy machine attracted constant onlookers - curious and perhaps a bit awed at the technology. The patient's condition appeared to improve, but after one hour she developed a severe chill. Murray discontinued the treatment immediately.86 The next day, the patient's condition was fair. The day after, she was much worse again and she received eight hours of treatment on the artificial kidney. Although her condition improved, her kidneys still produced little urine. Three days later, the patient again relapsed, and she was connected to the artificial kidney for six hours. She was comatose at the beginning of each treatment but was revived and alert by the end of the session. It was a trial-and-error approach to regulating the treatments. Since it was the first time that the Toronto artificial kidney had been used, Murrav did not know how long the patient's kidneys needed to rest before resuming their function. Would this third treatment prove to be enough? It seemed so. The day after the third treatment, there was an enormous output of urine — for which the doctors had been waiting. The patient's kidneys had begun to function, and residual poisons and excess liquids were soon washed out of her body. She made a steady recovery and was released from hospital thirty-three days after being admitted. 87 It was a celebrated case. Newspapers reported it as yet another lifesaving treatment by the blue baby doctor: 'Artificial Kidney Saves Human Life,' 'Dr Murray's Machine Restores "Dead" Girl,' 'Sausage Casing Used as Kidney Saves Lives'88 Murray described his mechanical inven-

tion and his success at treating acute kidney failure when he spoke to his

70 Surgical Limits medical colleagues at the meeting of the Central Surgical Association in Chicago in February 1947. The delegates were captivated, calling Murray a 'new trail blazer.'89 He spoke on the artificial kidney in London, England, as the Alexander Simpson-Smith Lecturer at Great Ormond Street Children's Hospital on11July 1949 - the same week he presented the Moynihan Lecture on 'Surgery of Congenital Heart Disease' before the Royal College of Surgeons of England.90 Doctors, hospitals, and manufacturing companies wrote to Murray asking for the specifications of his artificial kidney: 'Can we send someone to Toronto to observe and learn more about your machine?' 'Where did you acquire your cellophane membrane?' 'How much does it cost to build one?'91 According to Murray, anyone could build an artificial kidney: 'It is a very simple arrangement.' The most expensive item was the motor and pump component of the machine.92 He was shocked to learn that a Buffalo maker was selling a model for $600. Commenting on this Buffalo unit, Murray said, 'It is a very fancy machine with three gears, three speeds, different strokes adjustable in all directions, a plastic chamber with plastic valves ... a very expensive machine compared with the very simple apparatus we were able to build in the laboratory.'93 By 1951, the Allis-Chalmers Manufacturing Company in Wisconsin had sold six artificial kidneys at $3600 each.94 Murray's machine was the first successful North American model, but it was only one of several prototypes in the world.95 The Dutch physician Willem J. Kolff had invented the artificial kidney in 1943 in occupied Holland. Murray stated that he had not received any information about Kolff s work until after the war, and he maintained that 'our efforts have been going on apparently simultaneously and independently.'96 There were notable design differences in the two machines, which suggest that Murray was indeed unaware of Kolff' s unit. Unlike Murray's vertical cellophane coil in a glass jar,Kolff's artificial kidney had its cellophane membrane, or tubing, wrapped around a rotating horizontal drum that was contained in a tank of dialysate. As well, the two inventors had decided on different methods of blood circulation. Kolff took blood from the patient's femoral artery, and he depended on gravity as well as arterial pressure to move the blood through the rotating tubing; thus 'blood traversed the dialysate in a screw thread-like manner.'97 Murray worked through the patient's venous system exclusively and relied on a pump to circulate the blood through his machine and back to the patient. Kolff moved to Oxford, England, after the war and spent three years

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developing and refining his artificial kidney. He dialysed seventeen patients with varying degrees of success and accumulated more clinical cases and experience than Murray. More importantly, as argued by J.T.H. Connor, Kolff assembled a research manufacturing team of dialysis experts: 'This was one of Kolff s essential contributions for the development of the artificial kidney: a critical mass of technically skilled physicians imbued with the desire to implement and encourage the use of mechanical haemodialysis. These people, and the equipment they built, were instrumental in the successful process of technology transfer from post-war Netherlands.' 98 By 1950, Kolff had published a book in English on haemodialysis. He had visited and then moved to the United States, establishing closer ties to American manufacturing companies. He had also freely offered sketches, designs, and information for others to build their own artificial kidneys, further spreading Kolff-based machines around the world." Surgeons Carl Walter, George Thorn, John P. Merrill, and Henry Swan at Peter Bent Brigham Hospital in Boston recognized the potential of the apparatus and improved upon Kolff s machine during this period. 100 Numerous other doctors in various American centres and elsewhere also expressed interest in the artificial kidney - Kolff and Murray models - and they asked for more information, even design sketches, so that they too could build their own machines. These artificial kidneys, however, were still experimental and offered only short-term, intermittent treatment to patients suffering from acute renal failure. There remained problems of sustaining patients on the machine for lengthy periods and of exhausting the usable arteries and veins of patients for treatment. Many practitioners were reluctant to latch onto the device. British medical men outrightly rejected the new technology. Its success rates were not convincing, they argued. Although some patients who received treatment by the artificial kidney regained adequate renal function because their own kidneys were allowed a 'rest' and their body was detoxified' by the machine, many patients did not regain renal function.101 Consequently, opponents of this therapy viewed the artificial kidney as unsafe, and they cited occurrences of patient haemorrhaging, dehydration, and water overload. Artificial kidneys 'have no place in the treatment of acute renal failure,' stated one British practitioner in 1949.102 North Americans were more enthusiastic about the artificial kidney. The media reported the 'life-saving' capability of the machines and showcased the various homemade machines built by local doctors. 103 Most American and Canadian prototypes were based on Kolff-like de-

72 Surgical Limits signs, perhaps modified by their clinician inventors, each claiming advantages.104 Kolff s work and artificial kidney design were better known than Murray's. Indeed, few people outside Toronto even seemed to be aware of Murray's machine. The Montreal and Vancouver papers incorrectly reported that their cities had the first and second artificial kidneys in Canada, respectively.105 Murray stated that his 'interest in the artificial kidney came only as a side-line to his work being done with heparin.'106 He had built the machine and proved its efficacy in treating acute renal failure, but it was not used frequently at the Toronto General Hospital. By 1949, Murray had treated only eleven patients with the artificial kidney, of whom five survived.107 This number increased to sixteen by 1952, many of them public ward cases who were treated without charge, according to his secretary's records.108 But as Dr William Clarke observed, 'One of the major problems faced by Murray was a shortage of trained, knowledgeable personnel, which meant that he often had to be involved throughout the dialysis. The procedure usually had to be carried out overnight, with a full day's work scheduled for the next day.'109 Dr Gordon Grosvenor Caudwell, a resident of Murray's, remembers how Murray's interns 'dreaded the call' to attend a patient on the artificial kidney because it required 'twenty-four hours of continuous monitoring.'110 Murray's time was increasingly being spent performing heart surgery; his patient load consisted of more congenital and diseased heart cases than individuals suffering acute renal failure. His machine was moved to the basement of the Toronto General Hospital, and it was seldom used after 1949.111 Although it was a secondary line of investigation to his cardiac surgery, Murray did not abandon his artificial kidney work entirely, despite his frustration at the hospital's lack of support and interest in renal therapy. The range of Murray's abilities appeared limitless - from vascular and cardiac surgery to artificial kidney machines. His ingenuity was inspirational. He had succeeded in pushing the boundaries of medicine in new directions, and reporters and patients continued to glorify him as a genius, a miracle-maker, and a challenger of death.112 But Murray felt that he received little if any support from his colleagues at the Toronto General Hospital. Some medical men considered that too much media attention had been directed at him. Murray dismissed such criticism as jealousy. Friction and verbal altercations increased between him and his hospital superiors. But he had his supporters. In a letter to the Toronto

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Globe and Mail, Dr F.B. Bowman wrote: 'It seems about time that some endowment and provision be made for a department for research in surgery, and in Toronto there is a surgeon [Murray] who has brought more attention to the University of Toronto than anyone since Sir Frederick Banting, the discoverer of insulin. One surmises that he is getting about as much help from the university, perhaps even less, than young Banting got when he brought his first proposition to those in authority.'115 Bowman commented on Murray's selfless, personal expenditure of $10,000 for inventing the artificial kidney, the undue criticism he received from his colleagues over the blue baby publicity, and the obvious 'pangs of envy' apparent within the Toronto medical community. Much of this is unfounded. For example, Murray did not spend $10,000 building his artificial kidney, nor did he construct it in the basement of his home away from prying eyes. Such editorials did, however, bring attention to his perceived research obstacles at the Toronto General Hospital Murray complained openly about his limited funding and facilities. At the bottom of several of his medical publications, he pointed out: 'Some facilities were provided by the Banting Institute. Otherwise this work was carried on with private funds only and without other assistance.'114 He stated that the artificial kidney had been built through his own efforts and at his own expense. 115 These statements only served to alienate Murray further from his Toronto colleagues. They too struggled with limited research funding and facilities. 'I think Dr Murray's point of view is that he has tried to interest Professor Gallie in his research projects from time to time with hope of getting a grant, but that he received no help at all - and does not want to be given anything now,' wrote one surgeon. 116 Murray was frustrated with his Toronto colleagues' apparent lack of interest in new procedures and new technology. In his view, his artificial kidney was the perfect example of an invention launched into such a nonsupportive medical environment. What he did not understand was that manv doctors, including the chief of medicine, Duncan Graham, were concerned with protecting their patients from ill-conceived experiments. Murray would have resented this inference. Nevertheless, they were wary of machines, including his artificial kidney, and took a conservative stance towards the new technology being brought into the hospital. Unfortunately for Murray and for the Toronto General Hospital and its patients, his artificial kidney did not bring about a commitment by Toronto medical men to establish a dialysis treatment program.

74 Surgical Limits It was not until 1958 that a dialysis service was organized by members of the Department of Urology, the Department of Medicine and the Division of Laboratories; the first patient was treated in January 1959.117 The friction between Murray and his Toronto colleagues was well known. He often challenged his seniors over issues of treatment, research, and authority. This antagonistic approach did not endear him or his research projects to men of power. They tolerated him because he was a brilliant surgeon. Visiting surgeon Rowan Nicks commented: 'Somehow he seemed to arise [sic] the jealousy of his colleagues so that the atmosphere of the hospital was like that of the feuding Scots. They appreciated his distinction and ideas but were pursuing their own fields and did not wish to be overshadowed ... It was not very warm. Gordon Murray did not communicate with his colleagues and they did not discuss him.'118 Murray demanded much from those around him, and he had no time or tolerance for incompetence. He viewed most of his Toronto colleagues as extremely parochial. Yet despite his harsh comments about them, he was irritated and bothered by what they said about him. Murray was thin-skinned and extremely sensitive to professional comments, and he brooded over even the most meaningless of remarks.119 He often told people that he regretted his decision to come to Toronto; yet despite later offers, he never did leave the medical community that so frustrated him.120 Economic security was important to Murray. He had a successful private practice, one he had worked hard to build in order to provide for his family, his research, and his old age. Despite his reputation, he was reluctant to start over elsewhere, particularly since he and his family had only recently settled into their newly built residence. In the early 1940s, Murray had built Farnley, a large house on a secluded wooded lot in York Township, one and a half miles north of downtown Toronto. The house sat on almost three acres of land, and behind it a high hill and sheltered valley made for good family tobogganing. Helen worked closely with the architect, suggesting Corinthian pillars at the front door, decorative moulding in the interior, and other elegant features. She anticipated entertaining in their new home, so a sizeable dining room, sitting room, and guest rooms were included. But Helen had difficulty securing satisfactory household help. Many times, they hosted guests for drinks at the house and then had dinner at the King Edward club in the city. At home, Murray spent a good chunk of time in his study, reading late at night, which was often the only time he had to catch up on his journal articles. He did much of the yard and

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house maintenance himself, felling trees, even putting on a new roof when needed. He tended his fruit trees as well as a large vegetable garden. His love of the land and his farm roots clearly emerged. During the war, Murray purchased and tended a two-hundred-acre orchard in nearby Peel County, which he sold several years later. In time, he even bought the Murray farm in Oxford County to keep it in the family. With little Rosalind in tow, he chatted about the land, nature, and the family, much as his mother had done when he was a small boy. Tennis courts at Farnley provided exercise in what little leisure time Murray allowed himself. On most Sunday mornings, he played tennis, sometimes with Roland Michener or with the meat-packing magnate J. Stanley McLean - close friends with whom Murray could vent his frustration concerning hospital politics. Tennis was Murray's preferred game; it was physically demanding and quick, and it kept him lean and trim. Occasionally, he played golf with Helen; other times, he fished with McLean. The Murrays were not much for card playing or drinking, both of which Murray regarded as a waste of time, interfering with the work he wanted to do. Indeed, Murray was a workaholic, spending long hours at the hospital and laboratory, driven by his research and his passion for surgery. He never stayed away long, even on holidays, at most allowing himself ten days each summer for family camping. Farnley was his retreat, his safe family haven, where he escaped the increasing frustrations of the university-hospital environment. 121 In the immediate postwar years, Murray hoped for improvement in his research facilities and funding arrangements in the Department of Surgery. Changes in research support would be forthcoming, particularly as Toronto's university hospital came to value medical research as much as patient care and teaching. 122 But events unfolded differently from what Murray and others had anticipated. Change was coming, and Murray was forced to make some career-altering decisions.

4

A Private Laboratory, a Second Artificial Kidney, and New Heart Operations

When Murray did his postgraduate medical training in the mid-1920s, clinical research in general had been a relatively new field. For the clinician, doing research meant conducting a more or less systematic investigation of disease with the intention of improving methods of diagnosis and treatment.1 Older clinicians trained in the late nineteenth century relied on observation, analysis, and deduction in their study of disease. This older style of clinical research meant the compilation of hundreds of cases and reflection on one's past experience. By the early twentieth century, a new style of clinical research was emerging, one that incorporated laboratory analysis to produce clinical data and biopathological concepts.2 Research became less observational (use of case studies) and more experimental (use of laboratory methods). During the interwar period, the process of modern clinical research slowly evolved to incorporate the techniques and facilities of laboratory scientists. This included formulating a clinical problem, devising an experiment to answer specific questions, and finally observing, recording, and analysing the outcome. Clinical investigation required 'imagination, insight, ingenuity as well as clear and consecutive thought,' wrote Dr A. McGehee Harvey.3 Most clinical investigators during the first half of the twentieth century were practitioners who did research part-time. Their various research interests usually arose out of their cases; piqued by curiosity, they began to experiment. The tradition of surgical research as a specialized field within clinical research in general followed a similar pattern. Research-oriented surgeons such as George Crile, Harvey Cushing, William Mayo, Alfred Blalock, and Gordon Murray were motivated by practical significance in their research: designing experiments to repro-

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duce clinical situations, testing possible surgical solutions, and then transferring procedures from animals in the laboratories to patients in the clinics. The surgical research ideal still moves from the bedside to the laboratory and back; that is, the exposure to disease and medical disorders is arguably a constant stimulus to surgeons to carry problems from the bedside to the laboratory for investigation and then back to the bedside in the form of solutions. Research surgeons were less interested in pursuing basic science truths. They had neither the time nor the training (nor, arguably, the inclination) to purse rigorous basic science research; they were concerned with what could be applied successfully in the clinic.4 Some surgical innovations were dramatic and instantly recognized as beneficial to patients, such as anaesthesia. Other surgical ideas met resistance, such as Semmelweis's hand washing and Lister's antisepsis to control infection. By the turn of the twentieth century, laboratory work (both animal surgery and physiological study) had entrenched itself as an important aspect of surgical research. When successful, experiments on animals with similar conditions to those in humans often moved quickly from laboratory to clinic. The tradition of

experimental controls in humans developed later in surgery. The success of Second World War medical research, notably the development of penicillin, created an explosion in the field of clinical investigation. Medical students began to acquire training in both the practice of medicine and the basic sciences, developing research projects relevant to their particular clinical interests. 5 In the ten years after the war, the number of physicians seeking training in research rose tenfold in the United States.6 In North America, a stronger commitment to medical research by the government, the medical profession, and society emerged. Clinical investigation was becoming a more valid field of pursuit for many medical men, and further professionalization occurred through adaptation of more rigorous standards of investigation.7 Increasingly, young research-oriented surgeons began to acquire basic research skills as part of their training, studying and learning the methods of science in a laboratory so that they could apply the rigours of experimentalism to their surgical research. Murray was not one of these surgeons. It was predominantly the generation of surgeons after him who pursued this type of formal research education - men such as the American surgeon Francis D. Moore, who in 1940-1 spent a year doing research in a laboratory as part of his surgical training. 8 In Canada, the Royal College of Physicians and Surgeons has recently approved a clinician investigator program in which surgical residents can receive simul-

78 Surgical Limits taneous research training. Over time, changes in research training for surgeons occurred as a result of demand, as did the medical research facility and funding structure. During the interwar period in Canada, serious experimental work in medicine had taken place exclusively in research centres affiliated to, or part of, universities and hospitals. Well-equipped laboratories were only to be found in academic settings, and departments were allocated money from general university funds for research.9 There was never enough money for research, and department chairs made tough decisions in distributing funds to some projects over others.10 In the late 1930s, the Canadian government became involved, and it adopted an extramural system of funding medical research which supported investigations carried out in existing university facilities.11 (For comparative purposes, Britain and the United States supported mixed extramural and intramural systems. These governments provided funds for research at medical schools and universities as well as creating central laboratories at the National Institute for Medical Research at Mill Hill and the National Institutes of Health in Bethesda, Maryland respectively.) The Associate Committee on Medical Research of the National Research Council of Canada, chaired by Sir Frederick Banting, was established in 1938. Eight years later it became the Division of Medical Research, chaired by James B. Collip. Finally, in 1960, it was made independent of the National Research Council and renamed the Medical Research Council. In its various forms, the Medical Research Council coordinated and provided

funding for experimental work, stimulating and institutionalizing medical research in Canada.12 In addition, during the interwar period, several special research departments or institutes within universities were set up in an attempt to provide improved facilities and funding for both clinical and basic medical research.13 Support for these bodies came from both public and private monies. For example, after the discovery of insulin, the University of Toronto created a research chair for Frederick Banting, which later became the Banting and Best Department of Medical Research. In 1926 the Banting Research Foundation was established in Toronto to provide support for future medical breakthroughs. Money raised by the foundation was intended to support research done not only by Banting but by future Bantings who had good ideas but no money.14 However, in

the years before the Second World War the foundation rarely received

more than $35,000 a year in funding.15 The Montreal Neurological Institute (MNI) was opened in 1934 un-

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der Wilder Penfield, the famed neurosurgeon who had developed the 'Montreal procedure' to relieve epilepsy. The MNI was a hospital and research facility affiliated with McGill University and built with money from the Rockefeller Foundation. 16 Collip, co-discoverer of insulin, was appointed director of the Research Institute of Endocrinology at McGill in 1941.17 Also during the 1940s, a well-equipped Department of Experimental Medicine and Surgery - similar in program to the Department of Medical Research at other universities - was established at the University of Montreal under the directorship of Professor Hans Selye.18 It was largely because of their reputations that Banting, Best, Penfield, Collip, and Selye were able to secure research funding and facilities to continue their work, and they enjoyed the stability and recognition that came with being director of a medical institute. This was what Murray sought. The majority of clinical investigators in Canada lacked such security of income and tenure for their work.19 In the period after the Second World War, medical research was moving beyond the means of many practitioners who dabbled in research part-time. 20 Murray was able to combine his surgical practice and research interests because of his position as an academic surgeon and because the professor of surgery, Dr W.E. Gallie, supported surgical research. Most of the Toronto General Hospital's surgical staff conducted research at some level, but not all spent as much time in the laboratory as Murray. Despite Murray's ingenuity, his numerous innovations, and his rising celebrity, the university hospital did not seize the opportunity to institute either a leading cardiovascular surgical centre (for congenital or acquired heart disease operations) or a renal therapy unit (for dialysis treatment with his artificial kidney machine). During this period, the Toronto General Hospital was grappling with the rising cost of high technology as it sought to provide its patients with better x-ray equipment, oxygen tents, artificial respirators (iron lungs), and more. The hospital tried to respond to demands for increased research support from all departments, recognizing the growing movement towards specialization, both in the lab and in the clinic. Many questioned the extent to which specialties such as cardiovascular surgery (which was really in its infancy in the 1940s and 1950s) could support physicians full-time. Perhaps they preferred to 'wait and see' at a time when many new therapies were emerging. Competing with Murray were colleagues in neurosurgei v and thoracic surgery, who were also lobbying for the establishment of specialized units and greater funding for their work.21 But rather than negotiating possible arrangements to lead the hospital

80 Surgical Limits into new directions, Murray's demands and difficult personality exacerbated the situation.22 By the late 1940s, Murray's battle with the Department of Surgery for adequate research facilities and funding reached its breaking point. Gallie distributed the central funds of the department at his own discretion, and in the past he had supported many of Murray's research projects, including his work with heparin. Yet the two men rarely agreed on the terms of the departmental support. Over the years, they had developed an antagonistic relationship. Gallie recognized Murray's abilities as a surgeon and innovator, 'circling around him with care,' and providing him with as much as he could.23 Despite personality differences, he tried to secure satisfactory research facilities for Murray. But the reality was that departmental funds for surgical research were limited, and Gallie had to spread them thinly among all staff pursuing research. Most of the money went to cover basic laboratory costs, such as surgical materials and new dogs. It was always insufficient, according to Murray, and the two men constantly butted heads. In a heated threepage letter Murray wrote in 1947 to the chairman of the Board of Governors of the University of Toronto, he listed several senior medical men at the Toronto General Hospital, including Gallie, whose actions he said stifled his research: My object in writing [this letter] is to bring to your attention the difficulties under which my attempts in research have been carried out ... During the past year, three subjects have reached the stage in development where they have attracted widespread attention to this school. First is the blue baby work - next to Blalock, I have the largest series of successful operations and the lowest mortality rate on this continent... Secondly, the artificial kidney was developed single handed. Following a paper in Chicago in February 1947, there has been shown great interest by many American surgeons ... They all return to laboratories where they have many full time assistants to continue developments, and what chance have I single handed of competing with them? ... Thirdly, my paper, and the only paper from Canada, given at the American Surgical Association, on the Patho-physiology of the cause of death from Coronary Thrombosis, excited great interest... Many of the great surgeons of the great schools were much interested ... The work so far on many of these subjects has merely opened the door, and the great developments are to follow. As well, I have several other original investigations that I would like to proceed with. However the difficulties have been too great. I have tried repeatedly to approach the head of the Department

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of Surgery to obtain physical, financial and moral support in struggling on with this research, but my efforts have fallen on stony ground ... The question arises whether the board is aware of the attitude toward research, or it may be the attitude toward me personally ... There is no school on this continent or elsewhere which has produced as much original work in recent years as the Toronto School and that has been done mostly by one person . Therefore, sir, I am writing to ask your opinion whether this is the atmosphere in which you wish research and investigation to be done in the University of Toronto? 24

Murray received no formal response from the board. This was not the first and certainly not the last time that Murray would make known his frustrations with the Department of Surgery. According to one surgeon, he was the burr under the saddle of the surgical establishment.' 25 In 1947 Gallie retired after an eighteen-year tenure. With Gallie's endorsement, the University of Toronto Board of Governors selected Robert Janes as the next professor of surgery and surgeon-in-chief.26 Murray was not pleased with the appointment. He doubted that it would result in much change in the department. Perhaps he had wanted the job himself. He characterized their overlooking him as a typical action taken by the Family Compact (influential Toronto medical men) to ensure the appointment of one of their own.27 He would have enjoyed the professional recognition and the university standing that came with the position, and he would have liked the control over research funding and staffing that it. would have included. In fact, the Board of Governors had considered him. Murray was better known internationally and had great breadth as a surgeon. But Janes was the better candidate for the job. He had five years' seniority on Murray and held professional recognition for his contributions to thoracic surgery, notably the ShenstoneJanes lung tourniquet. More important, Janes was more diplomatic and was better liked by the departmental surgical staff. Murray simply did not have the personality to manage a department full of surgeons with difficult egos. Janes would also be the better administrator for the many postwar challenges: returning young veterans who sought surgical training; departmental research facilities and funding that needed to be

expanded; and a new hospital building program that was to be initiated. In all of this, Janes played a key role.28 To the new professor of surgery, Murray requested several changes within the department, to help him continue his research. He did not get what he wanted. Janes refused to give Murray more research money or

82 Surgical Limits increase his operating time on the ward or provide special facilities for his artificial kidney. He was also unwilling to relieve Murray of his teaching duties or make Murray's service independent within the department.29 At a time when medical research was becoming more interdisciplinary and cooperative, Murray continued to push for autonomy and isolation. So his antagonistic relationship with his superiors continued as he persistently demanded greater facilities, increased funding, and more privileges at the university hospital. Murray had influential friends outside the Department of Surgery who were making similar demands on his behalf, and their efforts generated more promising responses. Dr Herbert Bruce and J. Stanley McLean were strong supporters of Murray and were equally frustrated with university medical men and administrators for failing to provide acceptable space, money, and recognition for Murray's work. Most important, they both sat on the University of Toronto Board of Governors. Bruce was a respected surgeon and founder of the Wellesley Hospital in Toronto, and in 1932 he was appointed lieutenant-governor of Ontario. Years before, he had fought his own battles with the Toronto medical community, and he sympathized with Murray's frustrations. Bruce belonged to an earlier generation of surgeons, and Murray liked and admired the older practitioner. Their relationship was friendly and collegial. It had been in Bruce's hospital that Murray performed his blue baby operation one year earlier. McLean, president of Canada Packers Ltd, also was a good friend of Murray's. As mentioned earlier, their families socialized regularly, and they often fished and played tennis together. For years, McLean had been a generous benefactor to medical research, and he readily went to bat for Murray. Bruce and McLean set out to establish a new position for him — one they thought better suited his talents. As early as June 1947, McLean announced that he was prepared to offer $15,000 a year for five years to the Department of Surgery for Murray's research. He wanted a chair of research in surgery established specifically for Murray.30 The Board of Governors was interested; it wanted nothing more than to find 'some satisfactory solution of the personnel problem' with Murray and the department.31 Moreover, McLean was offering $75,000 at a time when the university needed funds for research. The Board of Governors asked Janes to submit a plan to set up a Division of Experimental Surgical Research within the Department of Surgery. In October 1947 Janes submitted his plan to the Board of Governors, with the endorsement of the dean of medicine Joseph A. MacFarlane,

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and the university president, Sidney Smith. He proposed the formation of a Division of Experimental Surgical Research that would include a coordinator to direct the work of the division, along with two fellowship positions, a chemist, an assistant technician, and a secretary, all with appropriate salary allocations. They were still looking for suitable space - aware that the present departmental research quarters at the Banting Institute could not handle additional researchers. Under the supervision of the professor of surgery, Janes would select personnel to work in the new division.32 Approving the proposed arrangements, Dean MacFarlane stated, 'It will fill a need long felt in that Department. Not only have they been lacking in the past the funds, equipment and facilities for those more senior members of the Department of Surgery to carry out important work, but there will be from time to time the accession to the Department of younger, well trained men who desire to give their whole time to teaching and research for a period of one, two or three years.' 33 The Board of Governors endorsed the department's report and left it to Smith, MacFarlane, and Janes to approach Murray.34 Murray was excited about the prospects of a research division under his control, with greater funding, facilities, and assistants to pursue his projects. He was not happy, however, with Janes's organization and reporting structure for the division. He demanded several key changes, and the two men haggled over several points. Murray wanted to be the "director." not the coordinator,' and he said the chemist should be working full-time for the division rather than being shared with other departments. Janes agreed to both these requests. Still unsatisfied, Murray asked for more than Janes could ultimately give him. He wanted two fulltime men assisting him in the division and at least two rooms at the Banting Institute made available to him immediately. Most important, lie wanted total independence 'so that work can be carried on under my own planning' 3 5 Murray wanted full administrative and financial autonomy. Perhaps he was using the Banting and Best Research Department, which was independent of the Department of Medicine, as his model.36 In any case, he could not persuade university administrators that this was the way to go. Janes and MacFarlane flatly refused, stating that the division would be 'part of the University Department of Surgery and not a separate department' and 'there shall be one budget.' They were willing to consider allocating more money to the division in order to hire two full-time men for Murray, but they could not give him complete autonomy from the Department of Surgery. 37 It was a deal breaker

84 Surgical Limits Janes and MacFarlane were structuring the new division based on principles of administration, not personalities, whereas Bruce, McLean, and Murray were catering to the concerns of the individuals involved.38 The two sides dickered back and forth. On 12 November Smith heard from Janes and MacFarlane that Murray would accept the position, but twelve days later Smith received a letter from Murray stating that he could not accept the post unless it was established as a separate department. Murray refused to be restricted by the Department of Surgery any longer; he wanted his own research department and control of the projects and allocated monies therein.39 Ultimately the Board of Governors, on the advice ofJanes, MacFarlane, and Smith, decided that there could not be a separate Department of Experimental Surgical Research, and thus they could not accept McLean's generous funding offer.40 The matter was closed, and Murray had lost an almost ideal opportunity to improve his research situation. Murray's research work remained limited to a small laboratory at the Banting Institute. His impression was that the university was determined to undermine his research. It was a repressive environment, he thought, with jealousy and lack of vision surrounding him. He had a further grievance. Only a few years earlier, McGill University had conducted a search for a chair of the Department of Surgery and surgeon-in-chief at the Royal Victoria Hospital. McGill was looking for a young man of some research experience to invigorate and lead this department. At the time, Murray was over fifty years old. But according to him, his chance at this position was eliminated by Gallie's giving a poor recommendation of him as an unsuitable candidate to McGill's dean of medicine, Jonathan C. Meakins. For Murray, this was yet another example of Toronto medical men working against him. No documentation exists to suggest that Murray was ever seriously considered for the McGill position. However, he felt unappreciated, perhaps even held back, by the Toronto university medical establishment. It was best just to get out, he felt. While he refused to leave Toronto - to go into exile, as he saw it - he did make plans to leave the Toronto university hospital research structure with help from Bruce and McLean.41 In November 1949, Bruce and McLean announced the opening of the W.P. Caven Memorial Research Foundation, with Murray as research director. This was the de facto Gordon Murray research institute and one of Canada's first independent medical research facilities. It was funded exclusively from private monies and set up completely inde-

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pendently of the University of Toronto. (Often, in government reports and directories of medical research institutes, the Caven Foundation would be mistakenly affiliated with the University of Toronto or Toronto General Hospital, probably because of Murray's continued teaching and operating privileges at these locations.) 42 Benefactors who had pledged money for the earlier proposed university hospital surgical research division redirected their funding to the new Caven Foundation. The money followed Murray. The most important funding in establishing this private laboratory was a bequest of $100,000 by the widow of Dr William Proudfoot Caven. Caven belonged to a wellknown Toronto family and had been a well-liked physician and a close friend of Bruce's. In fact, he had been one of the founders of the Wellesley Hospital. 43 Bruce was one of the trustees of this bequest, and he could think of no better way of honouring Caven's memory than by establishing a research institute under Murray's guidance. Once again, McLean announced his offer of $75,000 over five years as funding for Murray's research projects, this time to the Caven Foundation. Percy Gardiner and Joseph West also made generous donations to the new research institute; Bruce was an influential force among Toronto philanthropists. The University of Toronto attempted to secure these monies for its centralized research accounts - the Wellesley was now a division of the Toronto General Hospital - but was unsuccessful. No doubt, Bruce would have set up a research department for Murray within the Wellesley Hospital if it had not recently amalgamated with the Toronto General Hospital.44 The Caven trustees purchased a large red brick house at 73 Homewood Avenue in mid town Toronto at a bargain price, courtesy of one of the foundation's supporters. 45 Sections of the house were renovated for laboratory work, and a modest amount of research equipment was purchased. Animals were kept in the basement; the first floor displayed specimens in jars; and most work, such as experimental surgery, was done on the second floor.46 Besides Murray, the staff included Dr Richard Holden, a 1945 medical graduate from the University of Toronto, and Miss Margaret Stevenson deWolfe, who had recently graduated with a bachelors degree in biochemistry from the University of Toronto. They were hired as Murray's full-time research assistant and lab technician, respectively.47 A caretaker, Ralph Pearce, lived in the apartment on the third floor. As well as looking after the building and the animals, he assisted with some experimental surgery when Murray needed him.

86 Surgical Limits The Caven Foundation was a centre devoted to clinical and surgical research. According to its Board of Trustees - Dr RJ. MacMillan, a Wellesley doctor; Hugh McLaughlin, a solicitor; and Dr Herbert Bruce the foundation would support Murray's ongoing research on the artificial kidney machine and cardiovascular surgery. Murray's vision was broader. He told others that he was open to any research that investigated the cause and prevention of disease. 'Who knows the cause of rheumatism, kidney disease, appendicitis, cancer, varicose veins?' he asked.48 Such remarks show that while Murray was first and foremost a surgeon, he had an increasing belief hhin his skill and competence as a researcher. Moreover, he made no overtures of collaboration or interaction with colleagues conducting similar research. Most important, the Caven Foundation enabled Murray to work independent of outside pressure, and he told the press that he was relieved to escape the prejudices and jealousies of the university. Bruce reiterated that Murray could now carry on his research with complete freedom.49 Lord Webb-Johnson, past president of the Royal College of Surgeons, was in Toronto to open the Caven Foundation. He described Murray as a man of genius and said that under his direction the centre would see new discoveries, future expansion, and recognition as one of several leading research institutes in the world. Bruce and McLean told the press that Murray, now able to work without interference and distraction at the Caven Foundation, would 'be able to forge new weapons against disease and death.'50 There was enthusiastic applause from the small group of Toronto business and medical leaders who had assembled for the opening. University of Toronto President Sidney Smith, Dean of Medicine J.A. MacFarlane, and Dr W.E. Gallie attended the opening, endorsing Murray's new research arrangement. The anticipated success of Murray in his new laboratory appeared to signal an end to their confrontations over greater research funding and facilities at the university. The opening of the Caven Foundation was an occasion not missed by the media. Journalists had celebrated Murray's successes in the past, and now they heralded his directorship of the research institute as a triumph for the individual researcher at odds with the medical establishment. They saw it as a deserved honour for this famed surgeon who boldly operated on the hearts of blue babies and saved comatose patients in renal failure with his kidney machine. As usual, the newspapers led off with such headlines as 'Victory for Dr Murray ...'51 Reporters emphasized the need for more money and research in medicine and pointed out Murray's past battles. According to the Toronto Star, he had been

The Murray family. Left to right Gordon's aunt Belle, Charlie, John (standing), Sarah Christina (standing), Gordon's father John, William (standing), Allen, Gordon's mother Elizabeth, Gordon (Courtesy of Mrs Rosalind Bradford)

Gordon on the family farm before the First World War: Gordon, sister, horse and buggy (Courtesy of Mrs Rosalind Bradford)

The Murray brothers. Left to right Charlie, Allen, Gordon, John, William (Courtesy of Mrs Rosalind Bradford)

Gordon in front of farmhouse (Courtesy of Mrs Rosalind Bradford)

Gordon in uniform, circa 1915 (Courtesy of Mrs Rosalind Bradford)

Gordon as a gunner, Canadian Field Artillery, during the war (Courtesy of Mrs Rosalind Bradford). Gordon is on the right in the top photograph and second from the left in the bottom one.

Daffydil Committee, 1921. Gordon is seated in the front row, far right. Dating back to 1912, Daffydil Night was an annual event of entertainment - usually satirical skits - put on by the graduating medical students. On Daffydil Night in later years, Gordon's medical students presented 'Dissecting with Murray' (to the tune of 'Waltzing Matilda') and 'green baby' skits, to which Gordon laughed along. (University of Toronto Archives, Torontonensis [1921])

Gordon showing his athleticism, love of the outdoors, and lighter side during the 1920s (Courtesy of Mrs Rosalind Bradford)

Murray, on graduating from medicine, University of Toronto, 1921 (University of Toronto Medical Society)

Helen Tough as a young woman, 1910s (Courtesy of Mrs Rosalind Bradford)

Murray with colleague in London, 1924 (Courtesy of Mrs Rosalind Bradford)

Murray with nurse and child during his surgical training (Courtesy of Mrs Rosalind Bradford)

Murray's hospital senior: his mentor, Dr Clarence L. Starr, professor of surgery 1921-8 (University Health Network)

Toronto General Hospital, a large urban, academic hospital. A rear view of the hospital's public wards, on which Murray treated patients for more than twentyfive years. (University Health Network)

OR scrub room, Toronto General Hospital, circa 1930 (University Health Network)

Operating Room, Private Patients' Pavilion, Toronto General Hospital, circa 1930. Note the sparse operating environment. (University Health Network)

Banting Institute, 1930. Reflective of his view of the importance of surgical research, Professor of Surgery William E. Gallie fought for and secured lab space for the Department of Surgery on the fifth floor. Here, Murray conducted his best research. (University of Toronto Archives)

Dr William E. Gallie, professor of surgery 1929-47 (University of Toronto Archives)

Dr Robert M.Janes, professor of surgery 1947-57 (University Health Network)

Gordon and Helen on their wedding day, August 1928 (Courtesy of Mrs Rosalind Bradford)

Murray's cherished family: wife Helen and daughter Rosalind (Courtesy of Mrs Rosalind Bradford)

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'compelled from the start to pay for his research work himself ... and labored two years in his cellar to perfect his artificial kidney.' The opening of the Caven Foundation, said the Star, 'completely independent of the faculty of medicine at the University of Toronto marked a victory for a prominent section of the medical profession against those in official circles who had refused Dr Murray access to the Banting Laboratories.' 52 While the press did not always get it quite right (Murray had always had access to research facilities and some funding at the university), it made for a good story: it appeared that David had beaten Goliath. Murray received many letters of congratulation from those aware of his conflicts with the university. Abe Brodey, Murray's former pharmacology professor, wrote: 'My heartiest good wishes on the success of the Caven Foundation ... I can well imagine some of the organizational difficulties involved in your present set-up but at least you will not have to kowtow to higher authorities whose motives are sometimes not above reproach.' 53 His cousin Gladstone Murray, said, 'The recognition is singularly belated so I hope there are compensating considerations apart from heavy additional responsibilities and anxieties.' 54 Others, such as Dr Joseph A. Sullivan, wrote to Murray to offer their support for his decision to leave the university: 'I understand exactly your condition ... Many years ago when I was attempting to do experimental work at the Banting Institute, I was rebuffed and frustrated on every side.' 55 It was gratifying to Murray to receive such support. In a letter to Dr R.D. Defries of the Connaught Laboratories, Murray revealed: 'Having run the gauntlet before not too kindly eyes, I found the ploughshares very hot and painful, and at times have wondered whether one's efforts at forward groping were worthwhile. Such expressions of kindness by yourself, as well as by your collaborators in your department are most encouraging and very gratefully received.' 56 As research director at the Caven Foundation, Murray secured the facilities and funding that had not been forthcoming at the university. In Murray's view, the university had missed its chance to build a world-class cardiovascular centre or heart institute, and he had refused to compromise on his demands for autonomy as head of a research division. In actuality, it was Murray who had failed to recognize and seize a golden opportunity when he had turned down the position of surgical research director in the Department of Surgery. Conducting research within the university setting would have provided the part-time researcher an academic safety net of trained basic and clinical scientific investigators, as

88 Surgical Limits well as resources and assistance. In contrast, the Caven Foundation was a small private laboratory with potentially limited opportunities for crossfertilization and informal discussions across disciplines. Given the increasing sophistication of science and technology, the ability to communicate and the willingness to collaborate with other scientists in related fields were becoming important aspects of surgical research. For Murray, the Caven Foundation laboratory held the promise of something grander. The Ontario minister of health made overtures of support, which although never amounting to anything, aroused in Murray's mind thoughts of a new modern research institute. Architectural designs of an eight to ten storey building were drawn, and Murray and his staff often spoke of the future centre.57 He planned to bring in the best people, of international calibre, as well as younger men who had trained under him in Toronto. Murray was now out on his own director of an independent research facility and surgeon with a large private practice - distancing himself from the confines of the university hospital. It was a time of transition. Murray's new affiliation and physical surroundings at the Caven Foundation provided him with an opportunity to direct and expand his research interests. Time would tell if his plans, as well as the hopes of Caven Foundation supporters and the public for future cures, would be realized. In the first years of the Caven Foundation, Murray continued conducting part-time research, providing some supervision to staff. He juggled his time between 73 Homewood Avenue, Ward C at the Toronto General Hospital, and his private surgical practice. Working with Holden, Murray explored various experimental surgical procedures, the most promising being the transplantation of the kidney.58 Together, they also investigated the growth of bone, and their modest results were later published in the American Journal of Surgery.59 Miss deWolfe studied cancerous tissues, and attempts were made to grow human tumours in the yolk sac of chicks, and later in mice, for the purpose of study. Initially, deWolfe spent little time with Murray, studying with Dr Arthur W. Ham at the Banting Institute before transferring the research to the Caven Foundation.60 Murray's limited involvement in the research conducted at the lab was further reduced by his decision to embark on two lengthy teaching trips, in 1950 and 1951. In 1950, Murray and his family travelled to Brazil, where he introduced the newest cardiac surgery techniques to predominantly nonEnglish-speaking South American doctors. This was the first time that

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many of these doctors had observed such surgery. Teaching them required that Murray demonstrate the operations first on animals, then on patients. He performed procedures to treat congenital heart disease, acquired rheumatic heart disease, aneurysms, and other related vascular disorders. This marked the beginning of cardiac surgery for many South American countries. 61 In 1951 Murray and his family went to Australia and New Zealand on a similar teaching trip. As the Mcllrath Guest Professor of Surgery at the University of Sydney, Murray conducted surgical clinics, demonstrating surgical procedures on stomachs, colons, gall bladders, chests, hernias, and hearts while Australian doctors observed and assisted. He also lectured to undergraduates, residents, and postgraduates on various North American techniques in surgery, as well as delivering papers to various medical societies and hospital groups. At the Green Lane Hospital in Auckland, New Zealand, Murray co-delivered a training course with Dr Paul Wood, from the National Heart Hospital in London, on diagnosing and treating heart conditions. These first heart operations in New Zealand and Australia were all successful, and they served to introduce cardiac surgery in these countries, training local surgeons to perform such procedures — and, of course, improving the condition of many sick patients. Murray liked the respect and honour that accompanied these prestigious teaching trips, and he genuinely enjoyed sharing his love of surgery and innovative procedures with interested medical practitioners. 62 Less than two years after the opening of the Caven Foundation, the trustees - Bruce, MacMillan, and McLaughlin — expressed their concern for the future of the institute. Holden had resigned, and Murray's absences with lengthy teaching trips distressed them. They began to question Murray's dedication to the research centre. There had been no great 'discovery,' and Murray had yet to present any research contributions to the medical community under the auspices of the Caven Foundation. Bruce, MacMillan, and McLaughlin inquired whether the facilities were being used to the full. More directly, they asked Murray whether or not he had the time to devote to research at the Caven Foundation. In response, Murray threatened to carry on his research elsewhere if the Caven trustees were dissatisfied. Once again, he was quarrelling with those above him. He reminded them that several months earlier he had asked for additional senior research workers but had not received any. Murray wanted more staff and more money for his research, and refused to be anything more than a part-time researcher himself. In the end, the

90 Surgical Limits trustees backed down. They did not terminate the foundation, and they left Murray to replace Holden and carry on with the research in progress. But the honeymoon between Murray and his strongest supporters was over.63 In the years that followed this strained meeting, Murray became more adept at playing the game; that is, he became more oriented towards displaying the centre's productivity when need be, which pleased the trustees, and he made sure to acknowledge the support of the institute and its workers, which raised the profile of the Caven Foundation. He addressed the problems of staffing and research focus at the laboratory. For all his hopes of attracting high-calibre researchers, Murray could not entice them with a large salary, nor could he compete with the stature and resources available in a university setting. He hoped that leading researchers would come anyway, telling the Caven trustees that 'men seemed willing to make research their career at modest salaries.' In 1951 a biochemist was hired who, with the lab technician, focused on tissue chemistry and the study of cancer antigens in malignant tumours. That same year, Dr Walter Roschlau, a recent German immigrant with limited English, was hired as Murray's new research assistant. Trained in pharmacology at the University of Heidelberg, Roschlau had responded to Murray's advertisement in the Canadian Medical Association Journal.

He remained in the position for the next nine years, receiving an initial wage of only $150 a month (equivalent to the monthly rent of his Rosedale apartment), which was later increased to $300 a month.64 Most significantly, Murray returned to the research work on which the trustees had initially premised the founding of the laboratory - his artificial kidney machine and experimental cardiovascular procedures. As a result of the success of his first artificial kidney in 1945-6, Murray set out to build a second, improved machine in 1952-3. By this time, a greater number of commercial and homemade artificial kidney machines were being circulated and used in North American and European hospitals. During the 1950s, more than twenty different new designs emerged, predominantly modified versions of the Alwall kidney and the Kolff kidney. (The Kolff-Brigham kidney became the most widely used of the rotating-drum devices.) Murray found the Kolff kidney 'large and cumbersome ... quite expensive [with] certain drawbacks on that account,' and concluded that he might be able to design 'a small working model which will be very compact and not very expensive.'65 In addition to being large and clumsy, artificial kidney machines still produced

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mixed results in treating renal therapy. With Roschlau's assistance, Murray attempted to offer a more efficient machine to the medical marketplace.66 The Murray-Roschlau 'second generation' artificial kidney of 1952-3 had substantial differences from the original machine. The significant feature of this improved model was its parallel plate dialyser instead of the original vertical coil dialyser, making it much more compact. Roschlau (who appeared to have been unaware of similar designs by Drs Leonard Skeggs and Jack R. Leonards at Case Western Reserve University, Cleveland, and by Dr Arthur McNeil in Buffalo)67 had designed a plate-type dialyser with an enlarged surface area and reduced blood-volume requirements. He experimented with flow patterns, volume requirements, dialysing membrane surfaces, and the production of multiples of blood and dialysate chambers, cannibalizing the original artificial kidney machine for its electric motor, mounting boards, glassware, etc. A deliberate design change was the placement of the fluid storage container under a bedside table - an attempt to show 'less machine' at the bedside and thus be less 'frightening' to the patient. Its operation was simplified, it was easier to handle, and its efficiency was improved. In 1954 twentyseven experiments involving ten dogs were conducted to test the performance of the new machine, and in late 1955 it was used in two clinical cases. Roschlau assembled, sterilized, and transported the machine to the Toronto General Hospital and administered the dialysis treatment. The experimental therapy once again brought successful results. No flaws in the design or function of the machine were noted, yet these clinical cases were never reported. 68 Before Murray and Roschlau could announce the outcome of their work, one of the engineers, Erwin Halstrup, returned to Germany with the designs of the improved artificial kidney. Halstrup, who had recently arrived in Canada, had approached Roschlau, a fellow German immigrant, for a job. At the time, Murray and Roschlau were struggling with the increasing technological complexities of their new machine, so Halstrup was hired, and he helped them develop a new pump and change the prototype from plexiglass to metal. Halstrup left Canada soon after the work was done. Shortly thereafter Murray and Roschlau received letters from two German medical schools asking them for their experience with the Halstrup-Baumann artificial kidney. Recognizing the design, Roschlau was devastated and Murray outraged. With the help of Baumann, a German company, Halstrup was marketing to medical clinics and hospitals in Germany a parallel-plate dialyser machine

92 Surgical Limits that was strikingly similar to the Murray-Roschlau kidney.69 Murray had not sought patent protection, and Halstrup had done nothing illegal. At this point, Murray probably felt that he had lost control over his own machine. Furthermore, he was pursuing research in a more promising area that demanded his full attention: cancer. He dropped his work on the artificial kidney. However, the incident made Murray more secretive and suspicious of fellow researchers.70 During the 1950s Murray also explored kidney transplantation. The artificial kidney machine offered treatment for acute renal failure only. How could one treat chronic kidney disease? Again, his restless mind was looking for new frontiers. Murray returned to his earlier kidney transplant experiments. In the 1930s he had removed the kidneys of dogs and successfully transplanted them to veins in the dogs' necks as part of his experimental heparin and vascular surgery work.71 This was not a new procedure; Emerich Ullmann in Vienna had successfully performed this experimental operation, also on dogs, in 1902.72 After the Second World War there emerged a renewed interest in clinical kidney transplantation, not only by Murray in Toronto but also by the Paris surgeons Jean Hamburger, Rene Kiiss, and Marcel Legrain, as well as by the American surgeon David Hume at Peter Bent Brigham Hospital in Boston.73 Heart, kidney, and other organ transplant operations seemed ever more possible but as yet remained elusive to these investigators. Dr Jacob Markowitz, a research associate in physiology at the University of Toronto, argued that the difficulties of transplantation would be overcome by the work of a physiologist, not a surgeon: it is 'the physiologist... [who] has to find a way to keep the heart, kidney or other organ alive and make it grow into the place to which the surgeon has transplanted it. It may be that a serum will be found to make them live.'74 Murray was not deterred. In the early 1950s Murray ran a series of more than sixty transplant experiments, including four clinical cases. He experimented with autotransplantation (grafting an organ from one part of the body onto another) and homotransplantation (removing and implanting organs between individuals of the same species). Nearly all his experiments failed. However, he did learn successful methods of organ preservation - specifically, how to keep a kidney viable outside the body. Murray reported that if the organ was cooled, it could be deprived of its blood supply longer without damage. After its removal, it was irrigated thoroughly; this decreased the chance of rejection and prolonged its viabil-

A Private Laboratory 93 ity. But he was stumped by his transplant failures; complete necrosis (tissue death) of the kidneys eventually occurred in almost all his animals. He never considered that the host's immune system was rejecting the organ. He theorized that it had to do with inappropriate blood supply. 'The vital factor in transplantation of such organs lay in the careful management of the vascular tree,' wrote Murray. The organ's blood supply had to be maintained and thrombosis prevented. He continued with additional series of experiments, but these organ transplants were also unsuccessful.75 Murray refused to abandon his experiments. 'Despite our own results as well as the failure of others to obtain survival of transplanted kidneys in animals, this did not prove with certainty that such would be the case in human beings,' he wrote.76 Murray had successfully attached a kidney to the circulation system of a sick person via the arm, and this kidney had functioned temporarily to clear the blood stream, much like the mechanical kidney.77 In some of these cases, the kidney transplants to the arm had resulted in a fair secretion of urine, but it was believed that the vessels of the arm hampered the free flow of blood to the kidney because of their small size. This success with kidney transplants to the arm encouraged Murray to try permanent transplants in humans.78 This was highly unusual: failed laboratory research and related but limited clinical success would not have been viewed as encouraging to most scientists. Murray, however, was convinced and pressed on. In 1951 and 1952 he attempted kidney transplants on four patients, all suffering from late stages of uraemia. Three of these patients did not survive, despite the fact that the transplanted kidney appeared to function and had improved the condition of the poisoned blood.79 The fourth patient was twenty-six-year-old Dorothy Pezze, who was swollen with Bright's disease and wasfiftypounds heavier than her normal body weight. She had suffered chronic kidney disease for fifteen years and had no chance of survival without a new kidney. Pezze wanted the experimental surgery and understood the risks. She was admitted to the Toronto General Hospital and anxiously awaited a donor kidney. On 2 May 1952 she underwent the transplant operation.80 The transplant surgery was reminiscent of Murray's first blue baby operations. It was risky but potentially life saving. Murray's hand-picked O.R. team had known for months that these operations tended to be performed in the early hours of the morning because of the availability of donor kidneys at that time.81 For Pezze's operation, O.R. nurse Reta Smith and anaesthetist Dr Stephen Evelyn were called in at 2 AM and

94 Surgical Limits quickly assembled in the designated operating room. Then Murray began the surgery. He decided to leave Pezze's two diseased kidneys undisturbed and made room to add the donor organ as a third kidney. He made an incision into the abdomen, exposed her internal organs, and shifted them to the left side of the cavity without much difficulty. The donor kidney had been irrigated with heparin and Ringer's solution; it was almost white in colour and had shrunk to two-thirds its normal size. Murray retrieved the kidney from its large basin filled with a cold saline solution and placed it in the patient's right iliac fossa (the space above the right groin). He now had to attach its vessels to those of the patient so that circulation would be restored and necrosis prevented. He carefully sutured the kidney's vessels to the external iliac vessels in an end-to-side anastomosis. The ureter was transplanted through the wall of the bladder. Murray now tentatively removed the clamps. It had been two and a half hours since the kidney had been removed from the donor. Blood began to circulate through the kidney, and it changed from greyishwhite to bluish-red and finally to a bright pinkish-red. Within a few minutes, urine was trickling from the end of the ureter. Within four minutes, it was squirting a distance of eight inches beyond the end of the ureter. The anastomoses had held and the blood was circulating; the kidney was functioning. Murray could not have been more pleased the operation appeared to be a success.82 The kidney transplant made Toronto headlines, another celebrated case of Murray's. 'Transplanted Kidney Saves Dying Woman' - it was a sensational story.83 'Your pioneer work in so many fields has been an inspiration to countless young surgeons, including myself,' wrote a former student.84 'Congratulations in your most recent triumph,' wrote Murray's cousin Gladstone. 'You have cultivated a steady rhythm of progress moving forward from one pinnacle to the next with calm precision. The multitude of your admirers increases in number and enthusiasm; the envious few are distraught with frustration.'85 Dorothy Pezze became known as the 'woman with three kidneys,' and she lived another thirtyfive years. But there was little if any assessment of the cause of her longevity. Was it the transplanted kidney or her original two kidneys that saved her? When Murray reported the operation in 1954, he refrained from offering any conclusions. 'The best proof,' he said, 'is that a chronic invalid with alleged irreversible nephritis, high blood pressure, persisting edema and a low concentrating power has now returned to normal health and

A Private Laboratory 95 vigour.'86 In Murray's mind, the operation was a surgical success (if not a cure) since the intervention had relieved the manifestations of the disease, even though not eliminating the disease itself. Medical colleagues, however, demanded scientific proof, not patient testimony. It was a critical oversight by Murray not to follow Pezze's recovery over any length of time. This lack of follow-up with patients was a consistent pattern in Murray's career and consequently a repeated criticism of his research. So while the operation had been a technical success, no one knew how long the transplanted kidney actually worked.87 There were no postoperative studies of renal function or biopsies of Mrs Pezze's third kidney, so most medical men suspected that Pezze's own kidneys had recovered, and they questioned the long-term functioning of the transplanted kidney.88 For Murray, he had clinical proof- Mrs Pezze was alive and well - and that was enough for him. He was not interested in collecting further data on her or on other patients to prove that his procedure worked. There is no record of any further kidney transplant operations performed by Murray or any follow-up by him of his one success. Consequently, his work received little recognition from the profession. Nevertheless, researchers at Peter Bent Brigham Hospital in Boston had followed Murray's four transplant operations closely, and in 1954, two years after Murray's operation on Mrs Pezze, Dr Joseph E. Murray at Peter Bent Brigham successfully transplanted a kidney from one identical twin to another. He later performed other successful kidney transplants on fraternal twins, as well as on unrelated donors and recipients. His success was due to his incorporation of immunosuppressive therapies:first,whole body irradiation, then immunosuppressive drugs. Joseph Murray's transplant operation, based on years of perfecting the procedure on animals and drawing on techniques pioneered by surgeons Emerich Ullmann, Alexis Carrel, and other earlier investigators, became the model for subsequent transplant operations. Greater understanding of tissue typing and immunosuppression has reduced organ rejection and led to greater success. In 1990 Dr Joseph E. Murray received the Nobel Prize in Physiology or Medicine for the first successful transplants of vascularized human organs.89 After the successful blue baby operations of the mid-1940s, the field of cardiac surgery expanded rapidly. Congenital heart operations led to procedures for acquired heart disease conditions, in particular heart valve dilatations and repairs. Earlier, in 1938, Murray had received little

96 Surgical Limits recognition for his work on stenosis and incompetence of valves. In fact, cardiologists refused to refer patients to him for this procedure. Ten years later the medical profession celebrated the heart valve operations of the British surgeon Russell Brock and the American surgeons Horace Smithy, Charles Bailey, and Dwight Harken, who received joint credit for the first successful pulmonary and mitral valve commissurotomies.90 (The mitral valve, which channels the blood from the left atrium and into the left ventricle of the heart, is a bicuspid valve that can harden and close. To relieve mitral stenosis, or hardening, the surgeon splits the valve open.) Murray was not convinced of the value of the new mitral valve commissurotomy procedure. Returning to his earlier work on valve resection and replacement, he continued to argue that regurgitation, a condition often worse than stenosis, occurred after either division or resection of the hardened valve. In 1949 he operated on ten patients, with satisfactory results in eight, relieving their stenosis but also suturing a tendon sling valve beyond the mitral valve to prevent regurgitation.91 During the course of his valve surgery, Murray devised an improved cardioscope. This instrument provided the surgeon with direct vision of the operating field. It was not a new device. It had first been used in 1913 and later in the 1920s.92 Murray's cardioscope was a hollow tube with a glass window at the end. It was a 'home-made affair,' and those who inquired about purchasing one were told by Murray to make one themselves.93 'With this,' he wrote, 'one can inspect the interior of the heart chamber entered; can identify the opening of the mitral valve, and the site for resection can be selected. It can be inspected again following the resection to see if an adequate opening had been made. Then when the new valve is about to be placed, its position can be checked through the cardioscope to make sure it is in the desired position.'94 Toronto surgeon William T. Mustard remembers, 'I couldn't see a damn thing but he would put in an instrument [cardioscope] and take out a piece of the mitral valve ... He was a way ahead of his time.'95 By the end of 1950, Murray had performed twenty-eight mitral valve operations, 'with some very good results, others are fair only,' using his cardioscope.96 Murray continued to experiment with different procedures for diseased valves. In 1954 American surgeon Charles Hufnagel had reported his success in reducing the effect of a leaking aortic valve by placing a mechanical valve in the descending thoracic aorta. His mechanical valve consisted of a Lucite cage and a Silastic ball, and was implanted in a small series of patients.97 Hufnagel inserted the ball valve in the descending aorta, rather than in the exact anatomical position, the aortic

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ring. It provided only a partial and temporary relief of valve incompetency. Moreover, this first prosthetic valve was noisy - the opening and closing of the valve produced an audible clicking noise. 98 Surgeons were also having difficulty attaching the rigid metal cage within the delicate aorta. Hufnagel had no long-term survivors because the mechanical valve refused to remain in place permanently. Toronto surgeon Ronald J. Baird remembered: 'In the spring of 1955, as ajunior intern on Ward C, I recall watching a patient bleed to death within a minute or two when one of these valves dehisced.' 99 As an alternative to the mechanical valve and its problems, Murray began to experiment with tissue valves (homograft and heterograft). He transplanted aortic tissue valves into the descending aortas, or mitral valve rings, of dogs as partial correction for incompetent (leaking) valves.100 His animal experiments demonstrated that the transplanted tissue valve was avascular (lacking blood vessels or requiring low blood supply) and therefore avoided rejection, similar to the human corneal transplant. This disproved earlier American research that claimed that heart valves could not survive transplantation because of rejection.101 After two years of laboratory experiments, Murray performed his first clinical case. In 1955 he transplanted a healthy valve, obtained from a patient who had died days earlier at the Toronto General Hospital, into a young patient suffering from heart failure because of a leaky valve. The surgery was booked as a routine heart operation to ward off onlookers. The chief surgical resident Raymond Heimbecker, who assisted, described the event: Excitement was at a high pitch in ' C operating room that day. I had harvested the heart valve under sterile technique from the hospital morgue 24h before ... Dissection of the aorta as it left the heart was considered new and dangerous. The aorta was finally clamped off. This had to be done gradually and gently in order to avoid a sudden severe strain on the ailing heart. This huge artery was then divided, and the new valve was transplanted into place. Forty minutes later, the clamps were gradually released. The transplanted leaflets began to open and close with each heart beat. Our excited fingers could feel the vigorous throb as the fragile leaflets closed and opened with each contraction. As I placed my hand on the heart muscle, it too had dramatically changed to a much quieter and more peaceful contraction. What a change it would make for JP [the patient]. The aorta was now carrying a smooth, sustained flow of blood, where

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before it struggled, expanding and collapsing with every beat. In a few days, JP was back with his jubilant family. The world's first heart valve transplant had been a thrilling success.102 Eight months postoperatively, the patient continued to do well, but no steps were taken by Murray for continued follow-up.103 Murray published the results of his valve replacement procedure in an obscure Italian medical journal, Angiology, in 1956. His paper focused almost exclusively on his technique for aortic valve segment transplants. It provided scant laboratory research data other than reporting that 'many experiments were done,' but it did include an account of his clinical case. 104 Probably, Murray chose to submit his work to this European journal to secure early publication. More prominent medical journals, such as the New England Journal of Medicine, took longer to publish new work and almost certainly would have required more raw research data. At the time, no one knew the long-term outcome for transplanted delicate tissue such as valve leaflets. Surgical investigators in Toronto, England, and New Zealand carried on further laboratory research on tissue valve replacements. 105 Murray's operation contributed to the debate within the profession about the merits of tissue versus mechanical heart valves. Surgeons became more adept at using the Hufnagel valve, and improved mechanical valves soon became commercially available. Both Hufnagel's artificial valve and Murray's tissue valve procedure only partially relieved aortic valve insufficiency. Open-heart surgery permitted surgeons to repair more valve disorders. For those valves that still needed to be replaced, the subcoronary Starr-Edwards ball valve (1962) among others became available, providing complete correction of aortic insufficiency. In 1964 the Toronto surgeon Wilfred G. Bigelow reported on improved long-term functioning of tissue valves when positioned in the ascending aorta. His article also addressed the debate of artificial versus natural valves. Bigelow stated: 'We believe that a properly positioned aortic valve homograft has a better chance of long-term function, but the operative risk and the incidence of insufficiency may be higher.' 106 Today, both mechanical and tissue valve replacements are performed and the debate continues. American practitioners tend to favour mechanical valves, while British and Canadian surgeons tend to prefer tissue replacements. Another concern for cardiac surgeons and cardiologists during the 1950s was coronary artery disease. J.B. Herrick had identified the relativity

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between angina and obstruction in coronary heart disease forty years earlier, but little had been offered in the way of treatment. 107 At the base of the heart, two coronary arteries emerge from the narrow pedicle to nourish the wall of the heart with blood. Arteriosclerosis causes these arteries to narrow and eventually obstructs the passage of blood. Without this supply, the muscle weakens, loses it energy, causes chest pain, and eventually infarcts.108 Surgeons began experimenting with ways to correct the narrowed, or occluded, coronary arteries and to reroute and attach supplementary arteries to the wall of the heart as a third source of supplying blood to the muscle. It was natural that Murray, increasingly applying his vascular techniques to other heart problems, also experimented with surgical procedures to correct coronary artery disease. In fact, he had experimented with other possible sources of blood to the heart muscle as early as 1937. He had tried to graft the internal mammary artery into the cardiac muscle as a third source and thus improve coronary circulation. He had been unsuccessful, but other surgeons continued on, notably Arthur Vineberg in Montreal. By the early 1950s, Vineberg had successfully transplanted the internal mammary artery into the left ventricle wall, linking up with the vascular supply of the coronary artery. 109 Upon learning this, Murray returned to his earlier coronary artery work. He was able to repeat Vineberg's success, and he then operated on three patients suffering from severe angina pectoris. Murray reported: One patient was having about twenty-two attacks a day, taking about that number of nitroglvcerin tablets to be relieved of pain. He could not get out of bed nor take a few steps, nor move out of a chair without precipitating an attack. Following the operation, the patient's symptoms were relieved in short order and within a few months he was able to walk about a mile without discomfort. Another patient was having about twelve coronary anginal attacks a dav, which following the operation were relieved and the patient was able to go about without discomfort. In a third [case], a man who was disabled returned to work as a machinist. 110

Murray also experimented with a procedure by which the distal end of the coronary artery was perfused by way of a plastic tube placed through the branch of the divided internal mammary, subclavian, or other artery, and thus continued the essential supply of blood. The surgeon repaired the damaged coronary artery and then sutured either end-toside or end-to-end to the distal segment of the coronary. No local death

100 Surgical Limits of muscle or infarct occurred. It was a technically difficult procedure, and Murray lost many of his first lab dogs. In the end, five of the seventeen dogs survived this procedure of anastomosis of a systemic artery to the coronary.111 There were no clinical cases. When Murray shifted his attention from blue baby operations to acquired heart disease procedures, the media devotedly reported his surgical success. Murray's mitral valve procedure, which had received little attention in 1938, was described as 'amazing' in 1950.112 When Murray had success with his experimental coronary artery surgery, the newspapers reported: 'One man getting the spare [artery] had been having dozens of painful angina attacks daily, at the slightest exertion. For three years now he's been able to walk a mile daily.'113 Media coverage such as this continued to celebrate Murray as a leader in the field. Moreover, the volume and success rates of his operations made him one of the most experienced and best-known cardiac surgeons in Canada. All this attention reinforced Murray's commitment to clinical research and to his lone wolf approach to solving medical problems. In the mid-1950s the field of heart surgery underwent a transformation. Technological innovations began to alter dramatically how surgeons operated on the heart. This was the beginning of open-heart surgery. Surgeons were now exploring methods by which they could open the chest and, under direct vision, perform more complex, corrective cardiac operations on a quiet, bloodless heart. Toronto surgeon Wilfred G. Bigelow introduced hypothermia, a surgical technique involving total body cooling, to a sceptical audience at the American Surgical Association in 1950.114 Bigelow's idea was to 'cool the whole body, reduce the oxygen requirements, interrupt the circulation, and open the heart.'115 In 1952 John Lewis used the open-heart hypothermia technique in Minneapolis and successfully operated on a blue baby who was suffering from atrial septal defect.116 The hypothermia technique allowed surgeons to cut off the blood circulation from a beating heart for eight minutes, providing a bloodless field and direct vision in which to correct heart anomalies. However, this eight-minute window, in which the heart could be stopped without affecting the brain, limited the surgeon to simple cardiac operations.117 Several other investigators were experimenting with methods of extracorpeal circulation that would extend the operating time of the surgeon.118 Most promising were the heart-lung machines being built by Clarence Crafoord in Sweden, by J.Jongbloed in Holland, and by John

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Gibbon, Jr, in the United States. It was a steep technological challenge to remove the blood from the body, oxygenate it, and return it without damaging its properties. 119 Tubes were inserted in the inferior and superior venae cavae, redirecting oxygen-poor blood going into the heart to the machine. The machine then pumped the blood to an oxygenator, replicating the functions of the lungs by removing carbon dioxide and adding oxygen. The blood was then pumped through a filter to remove clots and bubbles before returning to the patient via a tube inserted in the aorta. 120 In 1953 Gibbon successfully operated on a blue baby suffering from atrial septal defect, using his heart-lung machine. Improvements to the pump needed to be made, but Gibbon had shown that it was possible. It took several more years to refine the machine and to encourage other surgeons to use the pump. Crafoord's, Jongbloed's, and Gibbon's heartlung machines all worked on the same operating principle, but they had different oxygenators, which were refined and improved upon. John Kirklin at the Mayo Clinic modified the Gibbon machine, and the inexpensive, easily assembled DeWall bubble oxygenator (or Lillehei pump oxygenator) became available after that. 121 By the late 1950s, heart surgeons almost everywhere were performing cardiac bypass, combining hypothermia with extracorporeal circulation. They succeeded in cooling and bypassing the heart, stopping it for up to an hour, and then starting it again without inflicting any damage to the organ. Heart operations became more numerous, complex, and successful. By the late 1960s, surgeons were performing previously unthinkable coronary bypass and cardiac transplant operations, most notably Michael DeBakey and Den ton Cooley at the Baylor College of Medicine and the Texas Heart Institute, respectively, in Houston. These institutions became the best-known cardiac surgical centres in the world, the 'Lourdes to heartdiseased pilgrims from everywhere.' 122 Murray was not an open-heart surgeon. He never performed a heart operation with a heart-lung machine or used the technique of hypothermia. The American cardiac surgeon Henry Bahnson suggests that 'Murray probably did not become involved in open heart surgery because he saw it as such a large field that he thought a younger person should be involved. Dr Blalock, born in 1899, was about the same age as Murray and did not get involved in open heart surgery.' 123 Murray was nearing sixty years of age, and many Toronto surgeons believed that he was stepping aside to let younger men through. 124 According to Dr Donald R. Wilson, ' [Murray] said this is as far as I am going and if I don't have

102 Surgical Limits to, I don't think I should get into that... So he never did an open pump case.'125 Yet his Stockholm colleague and contemporary, Clarence Crafoord, who was in his mid-fifties at the time, made the leap, performing the second successful open-heart operation with the heart-lung pump.126 Like his contemporaries, Murray was experimenting and performing numerous heart procedures through these early years of openheart surgery, and he probably would have been excited about the possibility of correcting more difficult heart conditions. Moreover, it is doubtful that Murray would have considered himself either too old or too conservative to try new surgical techniques. More likely, his decision not to perform open-heart surgery was due to a combination of local events. After the war, there had been a changing of the guard within the Toronto university hospital structure. In 1947 the chief of medicine Duncan Graham, chief of surgery William E. Gallie, and Ward C surgical head Norman Shenstone had all retired from the Faculty of Medicine, and Robert Janes had become chief of surgery. Murray had been promoted as head of Ward C at the Toronto General Hospital as well as associate professor in the Department of Surgery at the University of Toronto. Returning from overseas, Wilfred G. Bigelow and later Donald R. Wilson had been added to the surgical staff of Ward C as junior surgeons with promising careers ahead of them. In 1949, when Murray was set up with his own private laboratory, the Caven Foundation, he no longer conducted experiments at the Banting Institute. Nevertheless, he was well aware of Bigelow's research on hypothermia at the Toronto General Hospital and William Mustard's work with monkey lungs at the Hospital for Sick Children, as techniques for open-heart surgery, and he probably recognized both Bigelow and Mustard as new rising stars in the Toronto surgical community.127 On Ward C at the hospital, Murray and Bigelow developed a competitive, distant relationship. Although Bigelow was the number-two man on Murray's surgical service, Murray had not participated in his hiring. Like Murray, Bigelow was a skilled surgeon who spent as much time as possible doing surgical research, notably his hypothermia experiments. But he was a different man from Murray. Bigelow was not antagonistic with colleagues; he built good relationships with cardiologists in the Department of Medicine and had more hospital allies. By 1953 he was receiving more referrals from the Department of Medicine and performing more heart operations than Murray. Bigelow positioned himself as a cardiac surgical specialist, whereas Murray always considered himself a general surgeon with an interest in cardiac cases. He was not in

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favour of surgical specialization, probably for pragmatic financial reasons - it limited one's surgical caseload. With the increasing number of cardiac referrals to Bigelow, and fewer to Murray, there were rumours of setting up a new cardiac unit at the hospital directed by Bigelow. In November 1953 Murray abruptly resigned his university hospital staff position. Perhaps, as suggested by Bigelow, he 'saw the writing on the wall,' was fed up with the staff and administrators, and simply retired early.128 Perhaps the professor of surgery did plan to direct heart cases away from general surgical wards and Murray in favour of a specialist unit and younger cardiac specialists.129 When Murray left in 1953, Ward C changed from a general surgical service to one that was half cardiac and half orthopaedic under Bigelow's direction. (After much lobbying on the part of Bigelow, the new cardiac unit was realized in 1958.) Murray's retirement from the university hospital and Ward C surprised most hospital staff, but as nurse Reta (Smith) Macnab remembered, 'That was Murray - he didn't tell people ahead of time what he was going to do.' 130 Dr Joseph Sullivan, aware of departmental tensions, expressed his concern over the sudden resignation. 'I hope you did it of your own accord and that is what you wanted,' he wrote to Murray.131 No longer on the teaching staff at the Toronto General Hospital or the University of Toronto, Murray removed himself from the front line. He did retain operating privileges, and he continued to perform both general surgery and closed-cardiac surgery in the Private Patients' Pavilion. If he had remained as head of Ward C, it would have been difficult for him not to adopt the open-heart techniques that were replacing closed-heart operations, and he almost certainly would have battled Bigelow for control of the new cardiac unit. Despite leaving the hospital, he remained interested in the developments surrounding open-heart procedures, but he was never quite convinced of Bigelow's hypothermia technique. He received updates from others on the use of extracorporeal circulation being used in early Toronto General Hospital cardiac cases. One such source was a former resident of Murray's, who sent him a list of open-heart operations to date, writing, 'I hope you'll be free to see a case soon. It is really remarkable to see a bloodless heart lying there motionless for 40-50 minutes, and then literally "snap" back into activity.' On the bottom of this note, Murray scrawled: 'pump mortalities 6 deaths in 19 cases.'132 It was a time of advances, and he was watching Toronto developments closely. More than any other factor, Murray's resignation from the Toronto General Hospital in 1953 shifted the direction and increased the pace of

104 Surgical Limits research at the Caven Foundation. Murray spent more time at the centre and began to pursue new research projects with greater interest. He became more involved and dictatorial in the daily running of the foundation. During this period, his staff consisted of a research assistant, a lab technician, a biochemist, and a caretaker. In some years, there were vacancies because of lack of funds or the inability to find a suitable candidate to fill a position. Murray did not have a problem employing women, single or married, for any position. None of these positions paid particularly well, and perhaps that explains the relatively high turnover of staff and the strong representation of women and immigrants at the foundationfoundation.133Attimes,visitingresearchersandstudentsbecamein-.133 Attimes,visitingresearchersandstudentsbecameinvolved in the projects. Few doctors ever visited the Caven Foundation, and most of Murray's medical colleagues knew little about his research. Those who did visit were mostly Caven Foundation supporters or donors, and the first floor was set up to showcase various examples of the laboratory's research (such as specimen jars).134 Overall, a wide range of work was being done at the laboratory by a relatively small number of researchers. During the early 1950s, Murray experimented with new cardiovascular procedures, notably coronary artery anastomosis and transplantation of the aortic valve.135 At the same time, the second-generation Murray-Roschlau artificial kidney was developed, largely because of Roschlau's full-time efforts on the project in 1952 and 1954.136 Sideline projects for Murray included experiments on the new growth of bone in cavities137 and investigations into fat embolism.138 Biochemical experiments at the laboratory included cholesterol analyses, tumour transplantation in mice, glycogen analyses of dog hearts, blood glucose and lactic acid levels in rabbit blood, and non-protein nitrogen determinations.139 By the mid-1950s, one of the foundation's more controversial 'sideline projects' began to gain considerable attention - Murray's anticancer serum treatments. Disregarding professional scepticism, Murray felt that he was onto something and hoped to deliver that much-wanted breakthrough - a cure for cancer.

5 A Cure for Cancer? Sera, Vaccines, and the Theory of Immunity

By the 1930s, cancer and heart disease had replaced influenza and tuberculosis as the country's top two fatal diseases. As deaths from cancer increased, it became a major public health concern. Labelled the 'dread disease,' cancer brought painful and lengthy infirmity, harsh treatments, and almost certain death. 1 At the time, treatment involved surgery, radium, or x-ray therapy, or a combination of all three, with mixed results, depending on the type and severity of the cancer. A cure had yet to be found, largely because of the lack of understanding of this disease. Cancer is a disorder of cell growth, characterized by uncontrolled cell division that invades adjacent tissue and overcomes healthy cells. Historically, researchers' view of cancer shifted from that of a single disease to one of many diseases with multiple causes. During the 1930s in Canada, various organizations were formed to support cancer research, treatment, and education. These included the Study Committee on Cancer appointed by the Canadian Medical Association; the King George V Silver Jubilee Cancer Fund; the Canadian Cancer Society; and the Department of Cancer Control of the Canadian Medical Association. In 1938 the Ontario legislature passed the Cancer Remedy Act and established the Commission for the Investigation of Cancer Remedies. Still, few inroads were made on the disease during this period, and the onset of the Second World War diverted attention away from the activities of these organizations. 2 After the war, there was greater federal coordination of cancer research, funding, and education. In 1947 the Honourable W.G. Blair told the House of Commons, 'Every year, cancer kills approximately 14,000 Canadians ... Canadian citizens are demanding action ... The problem will have to be met in the same way and with the same energy as research

106 Surgical Limits workers discovered the secrets of radar and atomic energy.'3 The 'battle against cancer' was underway. As Deborah Lupton has argued, the language of warfare was common in modern medical and public health discourse and can be traced back to the First World War campaigns against syphilis. With regard to cancer, the military metaphor worked well because of the disease's 'severity, mystery and evasion of medical solution' - it appealed to the public's fear of cancer.4 In Canada the minister of national health and welfare, Paul Martin, coordinated the 'fight' against cancer and announced two prongs of 'attack': improvement in diagnosis and treatment, and research into the cause of the disease with 'the ultimate objective of wiping it out.'5 To support research, the National Cancer Institute of Canada (NCI), later the Canadian Cancer Institute, was formed in 1947, and the resources of the King George V Cancer Fund were put at its disposal. The policy of the NCI was 'the promotion, stimulation and fostering of fundamental research and personnel training in the field of cancer with a view to assisting in the reduction of cancer morbidity and mortality.' The Board of Directors agreed that it was 'not a matter ofjust receiving applications and granting money, but the Institute should initiate new projects and contact research men in regard to them' (author's emphasis). Interestingly, they also agreed that a major emphasis should be laid upon cancer of the breast, because of the increasing number of women dying from the disease.6 To provide improved diagnosis and treatment, the Ontario Cancer Treatment and Research Foundation (OCTRF), formed in 1943, opened its first clinic in Kingston in 1947, and it later opened other centres throughout the province.7 Sometimes overlapping, the NCI tried to coordinate and fund basic research, while the OCTRF focused on the clinical aspects of diagnosis, treatment, and investigation.8 By the end of 1947, Martin could boast that research on twenty-eight separate cancer projects was being carried out in medical colleges and clinics across Canada, 'in order that a cure for this dread disease may be discovered.'9 Cancer research in Canada had begun long before the 1940s. One of those interested in the disease was Frederick Banting. As early as 1922 he had begun to think about cancer, after a trip to England and a visit to the laboratory of cancer researcher William Gye. In 1926 Banting began experiments to create cancer by transmitting Rous sarcoma, and he then attempted to find a way of stopping its creation by discovering some agent - vaccine, serum, antitoxin, or some such related therapy. Between 1928 and 1934, 1,768 birds were used in Banting's experiments. Of these, one bird in 164 became resistant to Rous sarcoma. Banting

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preferred to use the term 'resistance' rather than 'immunity' where cancer was concerned; he never produced a 'cure.' By the 1930s, more and more researchers were at work in this area, but as Michael Bliss states, they 'were finding the enigma of cancer in general, and these strange virus-induced cancers in particular, overwhelmingly complex.' 10 Like Banting, Murray was intrigued by Rous sarcoma, a strain of cancer caused by infective agents, later known as viruses. In London during his postgraduate training, he had studied the reaction of lymph tissues before and after invasion by malignant cells. He did not complete these experiments, but 'the ideas were kept active,' and he planned on investigating the problem of malignancy at a later date." Murrav returned to this research in 1949, perhaps influenced by the current national and provincial campaigns against the disease. That year, as one of his laboratory's secondary research projects, his staff began to investigate tissue malignancy. Murrav had treated cancer surgically for years. During the early part of his career, the medical profession had endorsed only two treatments for cancel - surgery and radiation therapy - despite Frederick Banting's (as well as others) belief in the possibility of resistance to cancer as a result of the ongoing research with animals.12 Surgery entailed locating and cutting out cancer tumours as well as the surrounding healthy tissue. Radiation therapy killed malignant cancer cells alongside healthy ones, and it appeared to be effective only on certain forms of cancer. Murray believed that conventional treatment, useful to a point, cured verv few people. He was right. Only about one cancer patient in four survived the disease by conventional methods at this time. 13 Murray sought to provide cancer sufferers with a more effective treatment. In the laboratory, he approached cancer as if it were an infectious disease. His early research had convinced him of the possibility of host immunity (protection against contracting the disease through antibodies) and resistance. (diminished tumour growth through antibodies) to cancer.14 This led him to experiment with anticancer sera and vaccines. This work represented a complete departure from his past investigations. It took him outside the domain of surgery and into the area of immunology. The viral theory of the causation of cancer was not new. During the nineteenth century, the theory of the parasitic origin of cancer gained credence after the identification of specific agents in various infectious diseases, for instance, malaria, diphtheria, pneumonia, cholera, and typhoid fever. However, by the 1910s, researchers such as Peyton Rous

108 Surgical Limits and Paul Ehrlich were unsuccessful in their attempts to isolate a virus as the cause of human cancers. Cancer immunity was proving to be no more than immunity to the transplantation of a strange tissue, whether normal or cancerous.15 Many researchers turned their attention to the cellular and molecular biology of cancer. In the 1950s cancer virus research and the study of tumour immunology once again became quite popular. Technological progress on virus cultivation brought this about, as did the success with measles and polio vaccination.16 Murray's research was based on the viral theory of cancer. He strongly argued that a toxin or poison was present in the malignant tissue, invading and overcoming healthy cells, and he theorized that 'there is a possibility that an anti-body might be made which would neutralize or overcome the toxin or poison.' After all, the development of vaccines and antisera against various toxoids and diseases had proved effective in the past. Therefore, surmised Murray, 'I decided to try to produce an antibody against this substance [toxin] coming off the cancerous area, an antibody against the cancer itself.'17 To produce an anticancer serum, Murray planned to inoculate horses with human cancer, then allow for immunization or the production of immunoglobulin (the gamma globulin fraction containing the antibodies) in the horse, and then extract and refine this solution so that it could be injected into cancer patients. Murray initially focused on breast cancer and collected malignant tissue from his breast cancer patients to inject into the horse. A few Toronto colleagues also supplied him with tumour material, sending it over to the Caven Foundation in aseptic containers. In the laboratory, Murray and his staff prepared the cancerous material for injection. The tumour tissue was minced with scissors, blended with equal amounts of saline, and then strained numerous times through layers of surgical gauze. What remained was the antigen solution, ready for injection, and from which the horse would produce antibodies. On advice from Connaught labmen, Murray bought a suitable horse and secured her accommodation at a stable in north Toronto.18 Injecting and extracting the solution from the horse was a system of trial and error for Murray and a delicate task for the assistant handling the horse. At the stables, a box stall was available for experimental animals, and a retaining plank was built so that the horse could be handled safely. The horse was injected daily with increasing amounts of the cancer antigen. Samples of the horse's blood were taken before and during the period

A Cure for Cancer? 109 of injections. After three months, not knowing exactly how long to continue the injections, Murray reckoned that the horse had been sufficiently immunized. Two gallons of its blood were taken and sent back to the Caven Foundation for the separation process. The task now was to fractionate the blood in order to isolate the immunoglobulin. After Murray had again sought advice from the Connaught Laboratories, first the blood cells, then the proteins, and finally the immunoglobulin allegedly containing the cancer antibodies were removed from the horse's blood.19 Murray and his team followed methods of separation and purification similar to those used in the commercial production of antitoxins, though they did make some alterations. In the end, the valuable immunoglobulin was less than one-tenth of the original volume taken from the horse. The biochemist then tested the serum for sterility to prevent contamination.20 A series of experiments was conducted, under the microscope, recording the effect of this serum on cancerous cell fluid aspirated from the chest and abdomen of patients in late stages of the disease. Malignant cells mixed with saline solution showed no change, and neither did malignant cells mixed with untreated horse serum. But when the immunized horse serum was added to the malignant cells, the cells appeared to undergo changes very quickly. Murray reported: 'Within a matter of an hour the cells looked sick in all respects. They had lost their regular outline and contour. The nuclei were beginning to show changes, and within a few hours they were completely broken up.' It was exciting for all involved, but Murray was careful to note that all that could be said for certain was that there had been a very distinct effect on malignant cells as a result of the ... antibody-filled horse serum.'21 Shockingly, Murray never tested his serum on animals. At the outset of his research, he attempted to develop an experimental animal model. Human breast tumour and other cancer tissue was transplanted into eggs (the yolk sac of chicks) and mice for the purpose of testing the potency of the immunized horse serum. Only a few transplantations survived, and these tumours failed to grow sufficiently in size for the experiment. Murray scrapped the idea of using animal models, stating, 'There is no proof that our particular serum would have any special influence in this particular type of mouse [or egg] tumour.'22 There is no evidence that Murray consulted with other cancer researchers who may have experienced similar difficulties and perhaps developed alternative testing mechanisms. Instead, he moved ahead with what had

110 Surgical Limits always been his original idea: to administer his anticancer serum to human sufferers. The only candidates for Murray's anticancer serum treatment were patients in the advanced stages of breast cancer who had undergone all modes of conventional treatment. The patients selected had to be able to walk around on their own, feed themselves, and have a life expectancy of at least three months.23 In some cases, these conditions were overlooked on account of family pressure or for compassionate reasons. Some women were therefore included who should not have been treated. All of these cancer sufferers knew that the serum was experimental, and no promises of a cure were made. Murray's first patient was treated on 9 February 1950, in hospital. The serum was injected intravenously, increasing initially from a small amount to about 20 cc. The serum was administered daily for three to four weeks until the total dosage of 300 cc had been given to the patient. Again, it was trial and error. How much serum was enough? In the early cases, many women experienced

reactions to the horse serum - chills, fever, backache, and general discomfort - and in some cases their treatment was stopped. Others continued after their reactions subsided — their last attempt to ward off death.24 There seemed to be 'mild improvement' in many breast cancer patients; ulcers healed and tumour growth slowed. A few of Murray's early patients had been 'utterly hopeless from the beginning' and died within weeks of his serum treatment. Others experienced lengthy periods of health, returning home or to work, for months after the treatment. During the early 1950s, this cancer research was not a high priority at the Caven Foundation compared with Murray's heart surgery and renal therapy. In fact, there were only sporadic periods of cancer research activity. When Murray left for the teaching trips in Australia and New Zealand in mid-1951, the foundation disposed of the horse that was used to produce the cancer antibodies. The research did not resume until November 1952. Two patients were treated that year, but in 1953 only one patient was treated. In 1954 nine 'runs' of serum were processed, and four patients received treatment.25 Then, in 1955, Murray decided to present his anticancer serum work to the medical community, though it was based on only fourteen cases. He had been reluctant to comment on his various cases before, but patients 'at death's door' had given their stories to the press, praising the miracle drug.26 The newspapers printed 'startling reports of a potential cancer cure,' and medical practitioners wanted to know more about it before patients arrived in their offices

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demanding the new treatment. 27 It was nonetheless a planned debut by Murray, after which cancer research became the primary focus of his laboratory. On 8 March 1955 Murray presented his cancer serum research and clinical results to the Toronto Academy of Medicine. The meeting room was filled to capacity with practitioners motivated by curiosity and suspicion of his new cancer treatment. It was a meeting not to be missed, and Murray did not disappoint his audience. He described his technique of producing and injecting the antigen, and showed slides of the reaction of the serum at the cellular level. Then, in somewhat dramatic fashion, Murray presented a vial of the greenish-tinged anticancer serum, holding it high in the air for everyone to see. This, he argued, was what had arrested cancer growth in patients described as 'hopeless' by his Toronto colleagues.28 Only women who had exhausted all conventional renredies, said Murray, had been treated with this anticancer serum — 'and free of charge,' he added, trying to reassure his colleagues that professionalism had been upheld. He then paraded two patients onto the stage. Here was the proof! Both women had breast cancer and now had secondary cancers in the chest and abdomen. The first woman walked slowly to the front of the room with the assistance of nurses. She was still receiving Murray's serum treatment and was living months longer than doctors had predicted. The second woman had received treatment some time ago while on her 'deathbed,' and she told the audience how she was now 'enjoying a normal life.'29 Murray's work was controversial. His anticancer serum research was received with cynicism, even laughed at by some practitioners, who knew that cancer was a much more complex disease. They criticized his research methods and his use of patient testimony as scientific proof. Many viewed his work as flawed, impossibly naive, and near quackery. Still others hoped that he was onto something. 30 Well aware of their scepticism and resistance to unconventional treatments, Murray was careful not to suggest that his serum was a cure for cancer.31 Controlling the story, he distributed to the press a prepared statement regarding his research.32 More than simply a professional update, Murray had a pressing reason for going public about his anticancer work in 1955. His research work at the Caven Foundation was in jeopardy. The year before, one of the laboratory's key benefactors, J.S. McLean, had died. That same year, the Caven Foundation received the last instalment of McLean's five-year

112 Surgical Limits funding commitment. As a result, the Caven trustees - Bruce, MacMillan, and McLaughlin - decided to dissolve the foundation and close the laboratory at 73 Homewood Avenue.33 According to Bruce, they wanted to preserve their $100,000 capital investment, redirecting the money to provide fellowships in research, under the control of the Medical Faculty of the University of Toronto, in the newly established Cancer Research Centre attached to the Wellesley Hospital.34 Money had been a constant issue, and the Caven Foundation had relied exclusively on private donations, predominantly on McLean's contribution, to cover daily operating expenses.35 Murray had difficulty managing money - there was never enough of it - and he often dipped into his own pocket to cover expenses. Moreover, Bruce was tired of battling with Murray. The Board of Trustees still found Murray uncooperative, secretive, and 'too hard to guide and control ... Murray would never confide what he was going to say or do.' 36 These complaints were not new, of course. Murray had been criticized for this behaviour throughout his career. Ironically, this man for whom Bruce had lobbied so supportively years earlier was now Bruce's vexation. The institute had simply not developed as the trustees had envisioned back in 1949, and it was time to pull out. It was a difficult summer for everyone who worked at the Caven Foundation. There was no five-year anniversary celebration as the fate of the laboratory hung in the air.37 Murray needed new backers for his research institute. His presentation on his serum results suggested that, with more research, a viable treatment for cancer might be at hand. This, he hoped, would raise the necessary funding. In addition, he hoped to receive more patients on which his serum could be tested.38 The media took their cue. Reporter Ron Kenyon wrote, 'Is This the Break-Through on Cancer?'39 Kate Aitken announced in her radio broadcast: 'Dr Murray can bring back hope and life to otherwise hopeless cases ... Here's a man whose stature will be as great as that of Banting and Best, Lister and Pasteur.'40 Journalists reported Murray's serum as an exciting new advance in cancer research. More importantly for Murray, his financial difficulties became well known, and public pressure was put on provincial and federal governments for support. In the House of Commons, Health Minister Paul Martin was asked, 'Is the government giving Dr Murray all possible help in connection with this very important work?'41 Statements were quickly issued to the press in an effort to demonstrate government support; politicians certainly did not want to appear indifferent or obstructive to research that might result in a cancer cure. Martin said that

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the government would certainly consider funding this serum research under the Cancer Control Grant, and he urged Murray to make an application for support. Likewise, the provincial health minister, Mackinnon Phillips, jumped on the bandwagon, announcing his government's intention to give Murray 'sufficient funds to maintain three horses,' as well as possible assistance from government virologists.42 Murray was very encouraged by this show of support, and it was his hope that the government would fund his research, ending his financial worries.45 Donations began to arrive from private benefactors in Toronto as well as from elsewhere in Canada and from the United States. Most often, family members of those who had been treated by Murray's serum were the first to offer large sums of money towards further research. Some people wanted to donate horses or offered their stables for Murray's use.44 Financier Percy Gardiner ultimately rescued Murray's laboratory from certain closure. Gardiner was one of Toronto's well-known philanthropists, making large contributions to a variety of causes, from the arts to sports. In the past, he had made sizeable donations to the city hospitals, the university, and medical research - including Murray's earlier work.45 What motivated Gardiner to underwrite Murray's research was the cancer serum work and the few 'hopeless' cases with whom Murray had reported success. In 1955 Gardiner bought the house from the Caven trustees and agreed to donate $12,500 a year to the laboratory for operating expenses. On 1 August, the Caven Foundation was renamed the Gardiner Medical Research Foundation, but there was little fanfare over the change. Of course, Murray was pleased that his laboratory would remain open, and he found Gardiner to be pleasant and supportive. Toasting Gardiner at a dinner in his honour, Murray said, 'Personally 1 am greatly indebted and in addition have the warmest feeling toward him. His kindness and understanding are beyond words to express. He has been most generous in supporting my research.' 46 Thereafter, Murray's cancer investigations became the institute's primary research project, and all employees became directly involved in the production of serum. Murray's 1955 address on his serum treatments achieved what he had 47 hoped: he had found a way to keep his research institute open. His work was published in a four-page article in the Bulletin of the Academy of Medicine, Toronto, but it had only a local circulation. Murray sent revised versions of this paper to Cancer Research and Cancer, but these were rejected because of lack of detail. 48 He received invitations from larger

114 Surgical Limits medical societies in Canada and the United States at which to present his serum research, but turned them down. Most likely, he realized that his work was not ready to stand the scrutiny of the profession, and he became reluctant to make further pronouncements about it, despite several notes of encouragement and interest from medical colleagues.49 Murray wrote: 'Everything I have said so far has been only in the form of a preliminary report. The experiment is only in the early stages and we are continuing as we have for some years, collecting further evidence.'50 Murray made the right decision to withhold making any more announcements; it would have been premature and damaging to his reputation. His laboratory work was rudimentary and (even if he did not realize it) amateurish, and he could not continue to parade clinical cases without becoming ridiculous. It would be another three years before he offered a more complete report on his serum treatments. Murray's research contributed to the old debate on the cause of cancer. Was cancer caused by a virus? By the 1950s, most researchers in the field described cancer as a cellular disorder. The viral theory and an immunological approach to its prevention challenged this theory. The idea of a cancer virus was not new; anticancer serum had first been produced in dogs and donkeys as early as 1895. But the theory was dropped in favour of the cell disorder concept when researchers failed to produce tumours in animals from human malignant tissue to test their virus hypothesis. By the late 1950s, the pendulum began to swing back to the virus thesis.51 Viruses are minute particles of complex proteins and nucleic acids, too small to be seen by a light microscope or to be trapped by filters. They can easily penetrate cells and force them to manufacture virus material instead of cell material. The body's immune system prevents the virus from taking over by producing immunoglobulin, a blood protein containing antibodies specifically matched to fight the antigens of the invading virus. Murray's anticancer serum, which allegedly contained the cancer antibodies of the horse, was designed to offer passive or temporary immunity for cancer patients who had been unable to produce enough antibodies on their own. Virologists in Canada and the United States had experimented with various types of animal cancer in which a virus origin had been proved, such as leukaemia in mice, and they had announced the possibility of a vaccine.52 Vaccines are non-virulent, antigenic disease material injected into patients to stimulate active immunity; the patient's own body is able to produce antibodies to counter the invading antigens. Researchers hoped they were onto something;

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one researcher stated, 'Immunology is the only hot lead we have as a direct route to possibilities of cancer control.' 53 They regarded a vaccine as 'science's best hope for a breakthrough against the disease.' 54 But the problem was that no scientist had been able to isolate the cancer virus. As one journalist reported, the virus theory was 'all based on circumstantial evidence.'" Whether the evidence was circumstantial or otherwise, the public embraced the idea of a cancer vaccine. Scientists' success over polio in 1953 with the Salk vaccine reinforced society's belief in a forthcoming cure for cancer - and what better than a similar vaccine? It was an appealing, simple solution to what the public failed to acknowledge as a complex disease. The same resources that had been used to 'fight' polio were now redirected to the 'war on cancer.'56 Fundraising campaigns helped amass large sums of money for cancer research. In April 1957, when the Canadian Cancer Society launched its annual drive for funds, leading Toronto cancer specialists were asked: 'How long do you think it will be before a cure for cancer is discovered?' The answers ranged from ten years to 'not within this lifetime.' 57 Understandably, researchers were reluctant to give an exact date, but they were optimistic about the 'progress' being made. Postwar faith in the power of research to solve many of the world's problems included the belief that if enough money, people, and effort were directed towards finding the cure for cancer, it would soon be forthcoming. 58 In 1957, on the front page of the Toronto Telegram, Murray was presented as one of the leading Toronto cancer specialists. His photo accompanied headshots of researchers and directors from the Ontario Cancer Institute, the Ontario Cancer Treatment and Research Foundation, the Hospital tor Sick Children, and the Toronto General Hospital.'' This was misleading. These other cancer researchers headed large research teams that were well funded by the government. Their research ranged from studying the basic biological processes of cell growth and reproduction to experimenting with new forms of radiotherapy. Only Murray was experimenting with an anticancer serum. A lesser-known surgeon injecting his patients with such a serum might have been publicliclydenounced as a quack, but as one reporter stated, 'Anything from Dr Murray deserves consideration and cancer scientists everywhere are watching his work carefully.'60 Murray was well aware of the professional scepticism about his cancer research. Thus he was careful to avoid the word 'cure and to ensure that his patients had exhausted conventional therapies before undergoing his serum treatments.

116 Surgical Limits Over the years, new cancer remedies and claims of a cure had emerged, which after a time were found to be groundless. During Murray's lifetime, there were various 'cancer cures' promoted, some more believable than others. Dr Hendry Connell's Ensol, developed during the 1930s and available well into the mid-1940s, was an enzyme solution that used the theory of immunity to explain its curative action.61 During the 1940s (and dating back to the 1920s), Dr Thomas Joseph Glover was treating patients with an anticancer serum produced by inoculating horses with the pleomorphic microorganism, which he believed to be the cause of cancer.62 Somewhat differently, Dr John Hett believed that cancer was due to a virus working in conjunction with hormone imbalance and activated by chronic irritation; he believed it was infectious but not hereditary. Hett had developed an immune serum, its basic ingredients being b-coli and streptococcus, and he treated cancer sufferers in southwestern Ontario from the 1930s to the 1950s.63 Also at this time, a London physician, Dr David Arnott, was promoting the Koch treatment. Dr William Koch, from Detroit, gave his patients injections (containing the allegedly active ingredient, the chemical glyoxylide) and high enemas, and put them on strict diets.64 During the 1950s, the Hoxsey treatment, developed by American naturopath Harry M. Hoxsey, was advertised in Canada and the United States. It consisted of a fluid or pill for 'internal' cancer and an ointment or powder for 'external,' or skin, cancer.65 Also making the headlines as a new cure for cancer was Krebiozen, a drug manufactured from the blood serum of horses inoculated with actinomyces bovis, a mould. It enjoyed 'an aura of high scientific prestige' on account of its sponsorship by Dr Andrew C. Ivy of the University of Illinois. But chemists analysing one sample of Krebiozen discovered that it was a common amino acid, creatine monohydrate; others found their Krebiozen to be little more than mineral oil.66 By the late 1950s, the Ontario Commission for the Investigation of Cancer Remedies had investigated at least sixty claims of cancer cures in Ontario. Medical director D.E. Cannell reported: 'In the majority of these there is a fairly constant pattern of lack of evidence of malignancy, inadequate information to validate or disprove many "cures" and finally in many instances refusal on the part of the discoverers to reveal the ingredients, method of preparation, proof of sterility, etc.'67 The number of drugs, tonics, herbal extracts, sera, vaccines, and energy treatments claiming to cure cancer seemed to increase over time - Mucchoricin, Sanders treatment, Millrue, Orgone energy, the Rand Vaccine, AntiCancer Hormones, Laetrile, and others.68

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Certainly, Murray was aware of these treatments and probably, like his colleagues, dismissed most of them as quackery. He certainly would not have placed his serum in the same category. The American Cancer Society summarized the characteristics of the 'quack' versus 'reputable doctor' as follows: The practitioner is a QUACK if- he offers a cancer treatment available only from himself; the treatment bears his own name, or is offered in the name of his private research organization whose other members are not listed; he claims he is being persecuted by the 'medical trust' or sabotaged by the medical profession; he uses testimonials or letters from patients in support of his treatment; his 'cured' patients and greatest supporters have only his word for it that they had cancer when they came to him; he refuses or discourages consultations with specialists in the medical profession. The practitioner is a REPUTABLE DOCTOR if - he does not offer 'exclusive' treatments when approved treatments are widely available in many hospitals; he does not patent' a treatment or cure that could help all mankind, and his membership in medical organizations is always a matter of public record; he belongs to medical organizations devoted to spreading - not blocking - the latest health knowledge; he does not divulge case histories to the public; he insists upon laboratory proof of cancer in making his final diagnosis, and before treatment is given; he always welcomes a consultation with colleagues in the medical profession.'19

Without question, Murray put himself in the latter group. He still advocated surgery - notably, radical mastectomies for breast cancer, of which he performed many - as the most effective way to contain the disease. He accepted cancer patients only after they had exhausted all conventional therapies, and he never sought to profit from selling his serum. Moreover, Murray still commanded respect from some of his medical peers, and he was seen by others outside the establishment as being part of that conventional order. Note the example of Ernest Frederick, a Toronto doctor who advertised his own alternative cancer therapy during the 1950s. Frederick advocated a cancer treatment based on vitamins and hormones and a carefully planned diet, as well as faith, hope, courage, determination, and the will to live. He argued: 'This simple, harmless treatment is foundational to every other type of treatment considered advisable, such as surgery, radiation or sera like Dr Murray's."70 Murray's serum was neither wholeheartedly accepted by the medical profession nor outwardly dismissed as quackery.

118 Surgical Limits Yet an event concerning one of the current unconventional therapies may have hit close to home for Murray. In 1952 Dr John Hett was charged with infamous and disgraceful conduct and barred from practising medicine in Ontario because he 'professed to have a serum, which will cure cancer, arthritis, diabetes and peptide ulcers but refused consistently to divulge the formula.'71 This action may have tempered Murray's remarks regarding his own cancer research and made him more cautious about his pronouncements. Murray was not afraid of controversy - he had a history of challenging orthodox medical theory and treatments - but he would not risk losing his medical licence. He stayed within the bounds of acceptable medical conduct, and at no time did the College of Physicians and Surgeons of Ontario investigate his treatment of patients.72 Perhaps his standing as a respected cardiovascular surgeon and his efforts at presenting his cancer work in the discourse of experimental research, and through professional venues, shielded him from being labelled a 'quack,' even though he was now working outside the traditional university hospital research structure.73 After his 1955 address, Murray concentrated his efforts on improving the serum, administering it to more patients, and producing more clinical data rather than relying only on patient testimony to support his theory of immunity in cancer. He increased the potency of his serum for breast cancer (SB), as well as experimenting with a new serum — a polyvalent serum (SP) — for chest and abdominal cancers. This SP serum was produced from malignant tumours other than cancerous breast tissue, with the expectation that the horse would generate antibodies specific to these antigens. Murray's operation now included three horses, courtesy of the Ontario government; one horse was inoculated against breast cancer only, the second horse was inoculated against gastric carcinoma only, and the third horse was inoculated against all other forms of cancer available from the operating rooms. When all three horses were in serum production, there was enough serum to administer treatment to twelve patients at a time. In 1956 Murray began injecting SP serum into patients suffering from a variety of different cancers, but he found that the serum had toxicity problems, causing severe reactions such as fever and infections in almost all his patients.74 One of Murray's greatest challenges was collecting enough malignant tissue to produce serum. He could not secure enough tissue from his patients, or from the patients of the few colleagues who assisted him, to

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inject the horses daily. He began experimenting with the transplantation of tumours in rats and hamsters treated with cortisone in an attempt to create his own source of malignant tissue. These experiments failed.75 Mackinnon Phillips, the Ontario minister of health, heard not only from Murray about this malignant tissue shortage, but he also received letters from cancer patients who had been turned away because of lack of serum. 76 To rectify the situation, Phillips organized a system of collection from hospitals within a hundred-mile range of Toronto. 77 At the conference of the Ontario Association of Pathologists in October 1957, he solicited the participation of pathologists for the Gordon Murray Research Project, outlining Murray's work and stressing the need to secure enough cancer specimens to either prove or disprove the anticancer serum experiments. Phillips made it clear that Murray and his associates were working without remuneration. He rallied the pathologists to the cause most persuasively: I can assure you gentlemen that this research project is being done to allay the fear of cancer, not only in this generation, but in generations to come ... The end result could be the answer to the cause, prevention and cure of cancer, and 1 am sure that you would agree with me that it would warm every person's heart here to know that he had played a small part in bringing about the answer to this long awaited question: - What is the cause of cancer? How can it be prevented? and How can it be cured?78 Sterile containers and specimen information forms were distributed to hospitals, and pathologists received instructions as to type and size, and the temperature at which to keep the requested material. The specimens that were needed most were identified as gastrointestinal tract, ovary, lung, brain, gall bladder, liver, and breast tissues. Samples would be picked up by special courier within three to five hours of notification and rushed to the Gardiner Medical Research Foundation. 79 In the ten-year period 1952-62, Murray recorded receipt of approximately 584 malignant tissue specimens. Until April 1955, most specimens had come from Murray's own patients. After Phillips enlisted the assistance of pathologists in 1957, Murray's specimen numbers increased substantially. Malignant tissue of the breast, colon, rectum, stomach, liver, bowel, thyroid, ovary, and kidney taken from both men and women between the ages of thirty and seventy was collected and sent to Murray. While several pathologists working in hospitals outside Toronto did send Murray specimens, the major contributors were the

120 Surgical Limits Toronto General Hospital, the Toronto East General Hospital, St Joseph's Hospital, and Women's College Hospital.80 For patients, Murray's serum represented their last chance to beat cancer or at least delay death. Privately to his patients, Murray exuded confidence in the treatment (in contrast to his more cautious public statements about his work). He was able to dismiss the patients' doubts, and in turn they placed their faith in him. One of Murray's talents was his ability to convince his patients that he could treat them successfully. In the case of cancer, the fear of incurability and death prompted most patients to accept Murray's serum treatments without question, since Murray himself believed in its physiological action against the disease.81 Moreover, the continuing number of reported success stories in the newspapers fuelled their belief in these treatments. A young Toronto businessman suffering from stomach cancer underwent an operation in October 1955 and was told he had only a few weeks to live. Nevertheless, the surgeon sent him to Murray, who administered serum injections. 'Today,' reported journalist Roy Greenaway in December 1956, 'he is back at work, leading a strenuous, normal existence.' A thirty-seven-yearold woman from Florida, battling breast cancer, developed a secondary growth in the brain that caused one of her eyes to bulge from its socket. Greenaway wrote, 'Fifteen months ago, she had her first injection [from Murray]. Her eye went rapidly back to normal and today she seems normal.' There were numerous other accounts: 'A young Toronto woman with breast cancer was rescued from her death bed 10 months ago' and an elderly woman from Winnipeg told others that 'a miracle had been performed' on her.82 Families sent gifts, cards, and other expressions of gratitude to Murray.83 Although the serum was not a cure, it relieved pain. In some cases, it appeared to put the cancer into remission, and a few were lucky enough to return to a 'normal' life temporarily. Others had severe reactions, and became very ill.84 Most died within weeks of treatment. In the end, no one overcame the disease. Nevertheless, more and more patients arrived at Murray's office for treatment, sometimes returning for a second series of injections. It was a matter of timing for most. Were they well enough to withstand treatment? Was there enough serum on hand? By the late 1950s, Murray was producing twelve to fourteen litres of SB serum and three to five litres of SP serum annually. It was not enough to meet the demand. Each time a horse was bled, about eight litres of blood was taken. This was taken back to the Gardiner Foundation, where the biochemist prepared the anticancer serum, a process that took about two weeks. This was enough

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for two or three patients, depending on whether the full treatment of 300 c.c's (or millilitres) was administered. In 1956 fifty-four patients received treatment, whereas in 1958, seventy-seven patients did.85 Equally critical, was a bed available at any of the nearby nursing homes so that treatment could begin right away? At first, cancer patients had been hospitalized at the Private Patients' Pavilion at the Toronto General Hospital, where Dr Walter Roschlau administered their treatments, or at the Wellesley Hospital, where Dr Neil Watters treated them with Murray's serum. Later, patients were sent to the Woodlands Private Hospital, the Roycroft Nursing Home, or the Bel Air Nursing Home, where doctors administered the serum treatments under Murray's directions.86 Murray's serum therapy lasted three to four weeks — a lengthy occupation of hospital beds by 'hopeless' patients. These individuals were not charged for their treatment, as Murray repeatedly made known, but they did assume the cost of their stay in a nursing home. Hospital insurance did not cover this care. Many cancer sufferers were frustrated with the limited number of beds and the amount of serum available. Leslie McKee, in a letter to her MPP, wrote: We waited nearly an hour in Dr Murray's waiting room, and could not help hearing the telephone calls coming into his office from different parts of the province, asking for appointments and treatments. Should the Government wait until a 100 per cent cure is discovered, or should they support this treatment that is already achieving good results in many cases? It would give hope to hundreds of apparently hopeless cases ... Whether or not the Government accepts this treatment at this time as worthy of support, we cancer patients have accepted it and only ask that it be made available as we have not the time to wait until the serum is 100 per cent perfected. 87

Understandably, cancer sufferers were impatient. Murray acknowledged public and government support, stating, 'We are inching along slowly ... Many patients are surviving for a longer period ... What a day it would be if we should eventually hit something that would wipe out cancer!'88 In 1958 Murray published 'Experiments in Immunity in Cancer,' in the Canadian Medical Association Journal. It was a more detailed and

complete report of his research than his first article and had widespread national circulation, but it attracted limited international attention. In the article Murray discussed serum production, selection of patients, treatment techniques, and his results. He described his difficulties in immunizing the horses - the mare produced serum better than the

122 Surgical Limits gelding - as well as his problem of diseases that affected the horses. He outlined his selection process of patients: only those in 'the late stage of massive recurrence of the disease, after having received benefit from the above [conventional] methods of treatment,' were considered. Early in his work, Murray had discovered that metastasis or damage to the liver interfered with his therapy. Because the liver played an important role in detoxifying the serum, all his cancer patients had to have healthy livers. He explained the optimum daily dosage, injection procedures, and the length of the full treatment, including the fact that some patients had strong reactions to the serum and were unable to complete the treatment.89 He also described his 'vaccine' treatment - an attempt to increase active immunity in the patient - whereby cancerous tissue excised from the patient was emulsified and then injected back into the patient. By this process, Murray hoped that he was stimulating the patient's own antibody production so that, in addition to serum treatments, the chances of resistance to the growing cancer would be increased. He reported that there had been 'some evidence in some patients of a possible increased antibody effect' but that it was difficult to isolate the action of the vaccine. In all cases, these patients had a recurrence of the disease and died. Still, Murray found it 'the most alluring of prospects ... the development of a vaccine with which the whole population might be injected in childhood to prevent malignant tumours, as is done in vaccination for smallpox or in Salk vaccination for poliomyelitis.'90 In his report, Murray described at length the various types of cancer treated and the moderate improvements resulting from the serum. He revealed that a total of 233 individuals had been administered the anticancer serum in the past eight years but only 91 had received what was considered the full dosage, 250 to 300 cc of serum. Of these, 62 were breast cancer patients. The majority of these women died within one year of the treatment; fourteen remained well after one year, seven were still well after two years, and one woman lived almost three years. There were no control groups.91 Those patients who received the SP serum and who suffered from cancer of the brain, stomach, bone, colon, or ovaries did not fare as well as his breast cancer patients, who were given the SB serum. A small percentage lived more than a year after treatments, but most did not. (The SP serum continued to cause adverse reactions in patients, and Murray discontinued production of it in June 1958.)92 The research community found his results meaningless. There was no evidence, only Murray's convictions, that his serum had prolonged the

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lives of any of these women. Murray acknowledged that his serum was certainly not a cure, but 'the relief of pain alone has justified it as a palliative measure. 1 Compared with other forms of palliation available for patients with such advanced carcinoma, he argued, his serum gave better results; many sufferers enjoyed relatively good health without symptoms or pain after their serum treatments, and some were even able to return to their usual routines. 93 These were patients in the terminal stages of cancer, and they were grateful if the treatment prolonged their lives by months or even days. Murray overlooked the cases in which patients took an adverse reaction to the serum. The fact that his serum seemed to arrest cancer in some advanced cases excited him about the potential of the treatment if administered earlier: 'What would happen if an early case of cancer were treated with the immune serum? The answer to that is, we do not know.' Murray admitted that this treatment was 'still in its infancy,' but he clearly felt that his experiments supported the view that 'cancer is caused by something against which, either actively or passively, antibodies may be made and host resistance to cancer improved.' 94 Critics of Murray's serum treatments considered his report superficial: 'Why did it cover only 91 cases though he had begun treatment on 233? ... Had all patients been in the hopeless state that he asserted? ... Could their improvement not be due to chance or delayed-action benefits from previous treatments?' 95 The most obvious criticism was that Murray, despite his standing as a leading surgeon, had little background in immunology. Murray's assistant, Dr Walter Roschlau, described their methodology as crude, and knowing that immunologists had much stricter criteria, felt that he had not been qualified to do the research that Murray had asked. 96 Some immunologists said bluntly that Murray's method would not work. Dr Arthur Ham, head of the Ontario Cancer Treatment and Research Foundation's biological research, urged Murray to seek advice and assistance from trained immunologists at various points in his research program, but Murray refused.97 In his report, Murray cited the work of other investigators conducting experiments on immunity or host resistance to cancer. These investigators were predominantly working on obtaining new knowledge of the structure of normal and malignant cells by using an electron microscope. Their results validated Murray's observations of cellular reaction and activity.98 But only Murray's work included clinical results. Based on Murray's CMAJ article, the Canadian Medical Association released a press statement on 18 August 1958 announcing that 'cancer was caused

124 Surgical Limits by something against which anti-bodies may be made and the resistance to cancer improved.' This created a great deal of excitement. Such an encouraging announcement in the 'battle against cancer' had never before been released by the CMA. Almost two hundred medical researchers and practitioners from all over the world requested reprints of Murray's article." Newspapers printed sensational headlines: 'Cancer Serum Adds to Life,' 'City Cancer Discovery - Serum Prolongs Life,' 'Canadian Serum in Cancer Fight Impresses U.K.'100 Reporters described the serum as 'surprising and promising'; they highlighted the case that could be called a success, and hinted at the possibility of a vaccine or even a future cure. 101 As they had done in the past, the reporters fostered a strong public discourse that accepted and promoted Murray's work. At the time of the CMA press release, Murray was at his cottage at Pointeau-Baril on Georgian Bay, writing his autobiography. Helen and Rosalind spent most of the summers there, and Murray joined them for as long as he could. It was a retreat for him. The rugged landscape of rock and trees, the inviting waters of Lake Huron in which to swim or sail, and the expansiveness of space all appealed to him, allowing him to relax, both physically and mentally. This particular summer of 1958, in response to numerous requests from the editor of Ryerson Press, Murray was writing a manuscript on surgical techniques up to 1939. The book evolved into a personal memoir. Aimed at both a lay and a medical audience, it described his early upbringing and medical training, and focused on his work: his innovative surgical techniques, his heparin work, kidney experiments, heart surgery, and cancer serum research. Highly specialized, it contained little personal information and credited only a handful of individuals with having an influence on his work. The editor suggested that Murray include his general views on the profession and on recent surgical innovations, and place his contributions in a larger context, mentioning medical colleagues who also had made surgical advances. Murray responded: I notice again that you are interested in having more names of my contemporaries added to the book. I will submit some here who could be placed in relation to the ward rounds and hospital work only where we pulled together and worked well as a team in the routine work. However, as they did not assist, but rather opposed my investigative work, it is not easy to include them in the various research projects of which only the book is comprised. I

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must emphasize that this book is a brief account in lay language, I hope, of my own personal research and investigation which is a feature quite separate from my practice in the city and my routine hospital work ... For that reason 1 have been hesitant to include those who contributed nothing either morally or physically to the work recorded here.102 In his memoir, Murray did not disguise his personal feelings. He clearly pointed out the conservatism of the profession and his difficult medical and surgical relationships in Toronto. The publisher edited out all potentially offensive references, delicately explaining to Murray: 'It is bound to occur, I suppose, that men doing original research such as you have done will encounter opposition and criticism. One expects that. I presume you have encountered a good deal, some of it unpleasant. You can afford to regard most of it with blind contempt. However, we shall double our watch and make sure that none of the sensitive sensibilities of the profession are in any way ruffled.' 103 The memoir describes Murray's feelings of working alone, more often than not against great obstacles, and offers sparing praise for the work of others who might have contributed to his various successes. The book's readers tended to be former patients, family, and medical men. In a handful of medical journals and newspapers, reviews of the two-volume memoir, which was entitled Medicine in the Making and Quest in Medicine (published three years apart), were kind and flattering. The memoir had a press run of more than 1200 copies, but substantially fewer than that were sold.104 Back in Toronto, Murray's office was inundated with telegrams, telephone calls, and visits from medical practitioners and cancer sufferers. No one had anticipated the great reaction to the CMA's press release or his recently published second article on his anticancer serum. His secretary, Ethel Kerr, worked long hours responding to the barrage of requests for information, appointments, and serum, and sent daily reports off to Murray in Pointe-au-Baril.105 The Medical Arts Building's switchboard was jammed with calls, the mailman began to deliver the bags of correspondence directly to Murray's office, and the waiting room overflowed with people wanting an appointment. Reporters pestered Murray's secretary to tell them where the doctor could be reached, but she refused, inventing a story about his lecturing in Scotland. 106 Families of cancer sufferers wanted to get their hands on this serum, seeing it as a "miracle cure' (which irritated their doctors, who knew better). One American woman wrote: 'Our little girl, our only child, has

126 Surgical Limits cancer of the eyes ... The doctors can do no more ... Please, please I beg you, won't you please have mercy.' From New York, one man wrote: 'Is there any hope for my father?' From Ghana, another pleaded: 'Dr Gordon, for the love of God, can you help? Please, please, if there is a chance ... we will fly to Toronto.'107 Many were desperate calls on behalf of individuals who were within days of dying. Several telegrams simply read 'Rush anticancer serum' and listed an address in New York or elsewhere. People camped in the halls of the Medical Arts Building, hoping to see Murray. They arrived without appointment and without telephoning in advance. They refused to believe that Murray was not in his office. His secretary gave appointments to as many suitable patients as possible, overbooking Murray's schedule, and after filling up beds in the nursing homes she began a waiting list. People soon became irritated by the delays in getting an appointment and undergoing the serum treatment. 'Why haven't I received an answer to my letter?' and 'What do you mean there is no serum to send out?' were common responses. Most did not understand that the treatment lasted four weeks with daily injections, which were administered by Murray, his assistants, or nursing-home doctors. Murray simply could not see all of these cancer patients, and he did not have enough serum or bed space to accommodate them. Moreover, his secretary had to balance these appointments, which were not billed, with regular surgical consultations and operating times at the hospital.108 In January 1959 Murray spoke at the American Academy of Orthopedic Surgeons in Chicago, an absurd venue to present cancer research. He downplayed any talk of a cure and focused on the possibility of immunity against cancer. 'The important thing to determine,' he said, 'is whether the serum caused the improvement or whether it resulted from some still-undetermined factor.'109 Although his words were guarded, Murray felt that his experiments did provide evidence of host resistance to cancer.110 He was convinced that he was onto something and believed he was close to finding a cure. He turned to the press, stating that it was time now for the federal and provincial governments 'to step in to quicken and expand the pace of research.' With only three horses, a small staff, and himself, his research was underfunded, slow, and amateurish. 'The more people who work on this, the faster will a vaccine be found, if one can be found,' pleaded Murray. 'It is time now for an intensive government-supported effort to pursue every angle on whether cancer is caused by a virus or looking toward a vaccine with which people could be inoculated against the disease.' He wanted noth-

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ing less than a nationally supported research program to investigate immunity in cancer. He criticized the National Cancer Institute of Canada and the Ontario Cancer Treatment and Research Foundation for spending too much money on trying to find a cure through orthodox methods, particularly through radiation. In thirty years of experiments, argued Murray, radiation had failed to offer a cure. Orthodox treatments left too many cancer patients to die, and an expanded drive against the disease was needed. 'This cry of humanity cannot be ignored,' he said.111 Toronto cancer specialists promptly attacked Murray's comments, partly to offset a public panic that orthodox medicine offered little hope in fighting cancer. They denounced his serum as extremely experimental and unproven. Defending conventional therapy, Dr Robert M. Taylor, executive director of the National Cancer Institute of Canada, argued that radiation or surgery or a combination of the two had proved effective in controlling cancer for many patients. Dr Arthur Ham claimed that there was a great deal of research being done on the virus theory as a cause of cancer, but not to the exclusion of other experimental research. 'I don't think we are shutting our eyes to any new field,' commented one radiologist. Other researchers complained that Murray would not provide them with serum to do their own investigations because the serum was in too short supply. More proof of Murray's success was needed. 'It should be proven or disproven,' argued Dr George Culnan. 'Statistically, his researches don't mean anything yet.' 112 In the House of Commons, Health Minister J.W. Monteith stated that the federal government had spent nearly $1,100,000 towards cancer under health grants in the past ten years.' 13 They were following Murray's work closely, he said, and once proof was established of its benefit, the government would 'spare no effort' to provide Canadians with this treatment. 114 It was confirmed that no formal request for money had ever been received from Murray.115 Murray's outburst against the cancer research community had been unwise. It further isolated him and his work. In 1960 Dr Walter Roschlau, Murray's research assistant for the past nine years, left and took a position at the Connaught Laboratories. He had become disillusioned, realizing that the Gordon Murray Institute would never be built, so he left to advance his career elsewhere. 116 His new research facilities were a sharp contrast to the working environment of the Gardiner Foundation. The large, team-oriented, professional laboratory at the Connaught was more collegial, possessed greater resources, and exercised more rigorous re-

128 Surgical Limits search conduct. Roschlau came to realize how naive he had been in his research with regard to structure, methodology, and evidence. He found the Connaught Laboratories more intellectually rewarding than the Gardiner Foundation, where all research had been limited to Murray's field of interests. Undeterred by Roschlau's departure, Murray continued to produce his sera and vaccines and to treat as many patients as he could handle, while others at the Gardiner Foundation carried on with their related experiments, all hoping for some kind of breakthrough. They had recently begun a new line of investigation: kidney perfusion and inoculation. Perfused kidneys were inoculated with fresh tumour suspensions and maintained by perfusion for up to eleven days. Murray hoped to grow and maintain the cancer virus in kidney tissue, just as the poliomyelitis virus can be grown in monkey tissue culture. This experiment was obviously based on the cancer virus theory, and the ultimate objective was to try to demonstrate and isolate a viruslike body by means of the techniques described. The experiments were not successful and were discontinued in May 1960.117 By the 1960s chemotherapy had proved to have more demonstrative effects than immune sera, and resources were redirected accordingly. Chemotherapy is the treatment of cancer by drugs, mainly chemical compounds called cytotoxic (or cell-poisoning) drugs, which have the ability to destroy living cells, cancerous or otherwise.118 The treatment is unpleasant but results in the regression of tumours, and sometimes their disappearance. When first introduced, chemotherapy was used only for advanced and recurrent cancers that had failed all other therapies, but its success soon started a trend towards using it earlier in the course of patient therapy.119 Cancer clinics and treatment centres began to endorse chemotherapy in combination with surgery and/or radiation. Surgery and radiation are local mechanical therapies, applied to particular areas of the body, whereas chemotherapy is systemic - its effects circulated throughout the body. By 1961 the Gardiner Foundation's main benefactor, Percy Gardiner, wanted out. He was no longer willing to support Murray's anticancer sera, probably well aware of the shifting focus of cancer research. By this time, the futility of finding 'a' or 'the' human cancer virus was becoming obvious, and cancer researchers were swinging back to the belief that this disease was an agglomeration of etiologically independent entities.120 Furthermore, Gardiner had been supporting the laboratory longer

A Cure for Cancer? 129 than he had originally intended. Still, he did not want to abandon Murray and his work at a crucial juncture. He asked Murray to complete his current investigations within the next six months and either prove or disprove the theory of immunity in cancer. But if this was not possible, Gardiner added, he would extend his support a little longer.121 This became a yearly dialogue between Gardiner and Murray. 'We originally intended to discontinue activities at the Laboratory this year but inasmuch as some interesting work remained unfinished I was both willing and pleased to extend my financial support [for yet another year],' wrote Gardiner.122 During this period, Murray continued to treat cancer patients with his anticancer serum, never wavering from his belief in the virus theory. But his work on cancer immunity received less assistance from the government and his medical colleagues. Dr A. Cameron Wallace, director of the Cancer Research Laboratory at the University of Western Ontario in London, was indirectly referring to Murray's work when he said: The possibility exists that eventually it may be possible to produce immunity to tumors ... This has been the dream of cancer workers for more than a half century - to be able to immunize people against cancer as against diphtheria, tetanus or typhoid. Countless attempts to produce an antiserum have failed, in spite of much initial optimism. Again, the central trouble seems to be that cancer cells, being derived from our own cells, are so much like them that our body will not recognize them as an enemy, as it does with germs and viruses. It is still common to read in the paper of someone producing an antiserum which it is claimed will cure cancer, then gradually the excitement wears off and everyone wonders what has become

ofit.123

By now, the public was confused about whether talk of an anticancer vaccine was bold theory, a clinical possibility, or quackery. In 1963 the journalist Barbara Moon of Maclean's magazine asked, 'Who is Dr Murray?' and 'How seriously does medicine now take cancer-serum experiments?'124 She reported on the 'distressing outbreak' of bogus anticancer drugs offered to the public as treatments or cures. In Toronto earlier that fall, two doctors had been under investigation for the harmful treatment of patients with anticancer injections. Dr Leo V. Roy's treatment consisted of a prescribed diet, electric shocks, and an injection of an unknown solution directly into the breast. Dr T.J. Glover gave

130 Surgical Limits his patients injections of horse serum that he prepared himself, and he was unwilling to divulge to investigators exactly how he produced the serum.125 Was everyone trying to jump on the immunity bandwagon? More important, how was Murray's serum any different from Roy's and Glover's? Moon did not answer the question. There was no insinuation that Murray was a quack, but some specialists expressed strong reservations about his clinical success. The public continued to revere its blue baby doctor and no doubt wanted to believe the possibility of his work providing a cure for cancer. Moon's article prefaced an excerpt from Murray's forthcoming autobiography in which he described 'his lengthy and continuing research' into cancer immunity. It was hardly a critical article, and it ended with a naive quotation from Murray, demonstrating his obvious lack of understanding of the complexity of cancer as a disease: 'Undoubtedly the facts are accumulating rapidly, and it is only a matter of a short time before the cancer problem is in the bag.'126 In 1965 Murray wrote a two-page article entitled 'Experiments in Host Resistance to Cancer (in Human Subjects),' which, strangely enough, was published in the American Journal of Surgery. It was brief and offered no more insight into his serum research than his 1958 report. Two hundred and forty-eight patients had been treated, experiencing 'favourable temporary responses,' but none were cured. Murray offered little information to qualify his work: the time period during which these treatments took place as well as details on patient selection, malignancy, and dosage were notably absent. He acknowledged the recent success of chemotherapy, which seemed to provide a 'cure in a few,' but argued, 'It still remains to find a universal cure for any and all the remaining groups. Until this happens, every prospect should be explored, for out of the least promising sometimes the unexpected happens.'127 In closing, he reiterated his stance about the possibility of a future cancer vaccine. The American Journal of Surgery article did not generate the popular fanfare that his earlier article had in 1958. In fact, it aroused professional criticism, even threats, according to Murray. Angry family members of women who had died while taking Murray's cancer serum may have sought to bring action against Murray in an effort to revoke his medical licence, though no such case record exist at the College of Physicians and Surgeons. Aside from a few cases in which women with cancer lived months longer than predicted by other doctors, Murray had not reduced the morbidity and mortality of this disease. It was a discouraging time for him and a low point in his research. Opposition to

A Cure for Cancer? 131 his cancer serum finally overwhelmed him. He 'thought it discreet to discontinue' and set his cancer investigations aside temporarily.128 In 1965 Percy Gardiner died. Fortunately for Murray, Gardiner had made arrangements for him to use the house on Homewood Avenue for as long as he wished.129 Still, Murray needed funding for operating expenses in order to continue conducting research. Granting agencies such as the Medical Research Council, the Heart and Stroke Foundation, the National Cancer Institute of Canada, the Canadian Arthritis and Rheumatism Society, and other philanthropic foundations required applicants to complete detailed research proposals and reports. Murray was unwilling to do this. He refused to divulge his research plans in case someone else, younger and better financed, took his ideas and conducted the work.130 He was extremely frustrated by these new rules concerning grants. He felt that funding should be awarded to him based on his reputation and research accomplishments. Murray was part of the tradition in which money had been directed towards talented individuals, such as Banting, in the hope that more life-saving discoveries would be made. But grants were now being awarded according to the merits of the research proposal. There was also a growing trend towards collaborative research efforts; the research team was more successful in securing funding and producing results than the individual investigator. However, friends such as the Micheners worked to put Murray in contact with sympathetic philanthropists and granting agencies.131 The J.P. Bickell Foundation was one such organization. Established in 1951 with an endowment of $13 million from the mining executive J.P. Bickell (18841951) to support health and education activities, the Bickell Foundation awarded Murray $12,000 a year for several years immediately following Gardiner's death, and it required only minimal disclosure of his research.132 In 1955 a journalist had reported: 'Murray only dares hope that his discovery of the cancer serum will be the crown of his career."133 But his cancer serum research did not become the celebrated innovation he had hoped for. It had been a lofty goal: to discover a cure for cancer. Perhaps it attracted Murray's attention because it would have been such a magnificent breakthrough. Many believed that Frederick Banting might have been capable of such a feat, and now some thought it possible of Murray. Regardless of the complexity of the cancer problem, the public believed that some genius researcher would find the cause and cure of the disease. As a result of his insulin contribution, Banting was revered

132 Surgical Limits as a hero, possessing the research instinct and potential capability of unravelling many other medical mysteries.134 Did Murray see himself as the next Banting? After years of working in the shadow of Banting, was Murray desperate to make a final mark, to secure a permanent legacy? At various times during the 1950s, Murray had enjoyed some level of government, professional, and public support for his cancer serum treatment. Yet his work was misleading to patients, and arguably it came dangerously close to quackery, as defined by the American Cancer Society. Although he was working outside his acknowledged surgical expertise in a field of study that had become highly specialized, he chose not to seek advice from immunologists. Scientists and colleagues told him that his cancer research was wrong, yet he refused to believe them. In the past, Murray's convictions had often placed him in opposition to the medical establishment. His work had always pushed the limits - vascular surgery, heart operations, renal therapy - and eventually his ideas had been accepted. But this was not the case now. Murray did not have a cure for cancer. Immunity in cancer was neither proven nor disproven by Murray or anyone else. His anticancer serum remained an experimental and unsanctioned treatment. He was working beyond credible research parameters and was unwilling to alter his practices. By 1965 Murray put his cancer research aside and directed his attention to a new research project: spinal cord regeneration. This work highlights even more his lone research practices, which were clearly out of step with contemporary medical research conduct. Once again, the senior surgeon took on the medical establishment, but this time he destroyed what remained of his reputation.

6

Making Paraplegics Walk Again: The Spinal Cord Controversy

In November 1967 Murray stunned the medical community, the press, and the public with his announcement of a cure for paraplegia. Paraplegics and quadriplegics would now be able to walk again! He had performed an operation to trigger regeneration of the spinal cord and thus restore lost motor and sensory function in people with spinal cord injury. He claimed that his animal experiments and eight clinical cases proved that he was onto something. A remarkable breakthrough for a medical condition that had stymied neurological researchers for years, it promised to be a glorious finale to a long and impressive surgical career. Despite what all the medical books had proclaimed - that the spinal cord could not regenerate - the seventy-three-year-old surgeon had proved them wrong. Other researchers and medical men had doubted Murray's hypothesis from the beginning and refused to become involved in his research. So Murray had worked alone in his small, sparse private laboratory. He hoped his discovery would now attract funding. The press praised Murray. It was a 'medical miracle' for individuals with spinal cord injuries who otherwise were left in 'helpless hopeless despair.' 'We can stack all the wheelchairs in a lump [now],' said Murray.1 He had done it again, and the public and press never questioned otherwise. But just like his kidney transplant and cancer research, Murray was presenting spectacular clinical results based on thin laboratory data. It was of little concern to the media, but the medical community was less certain and demanded scientific proof. Spinal cord injury is one of the most serious injuries that a person can survive.2 The spinal cord is part of the central nervous system, a large nerve trunk encased within the vertebral column, which consists of

134 Surgical Limits nerve cells and bundles of nerves that connect all parts of the body with the brain. Sensory and motor function messages travel from peripheral sites through the spinal cord to the brain and vice versa. When the spinal cord becomes injured, these messages are disrupted and function is affected. Medical science can repair most injuries to the body but not to the central nervous system. In cases of peripheral nerve damage, only the axon (or nerve fibre) is cut or damaged, and therefore it is possible for it to grow back. But this is not possible in cases of central nerve damage, where the cell out of which the axon grows dies. The task therefore is to remove dead cells (which act as barriers) and entice living cells to connect again through axons to continue communication routes through the spinal cord. No one has successfully been able to do this, and thus damage to the spinal cord is considered irreversible.3 Individuals with spinal cord injuries suffer either paraplegia (paralysis of the lower part of the body) or quadriplegia (paralysis affecting all four limbs - arms as well as legs). The level at which the injury occurs and the completeness of the lesion directly influence the outcome of the injury. A greater loss of function occurs in higher injuries in the spinal cord, and some sensation and movement is retained if the lesion is incomplete. Urinary, bowel, and sexual functions are almost always impaired in spinal cord injuries.4 The degree of paralysis (without negating personal resolve) determines the level of independence and medical management of individuals with spinal cord injuries. Historically, people with spinal cord injuries have had poor life expectancies. Until the mid-1940s, the mortality rate was 80 per cent. The most common cause of death was urinary sepsis. After the Second World War, advances in the management of spinal cord injury reduced the rate to less than 10 per cent. Spinal units and centres were built and specialized medical practitioners and nurses trained. New programs for treatment and rehabilitation were established. Previously, individuals with spinal cord damage were bedridden and died in hospital within months of their injury. Postwar medical and social changes - such as improved medical care, special education and training programs, and greater wheelchair accessibility in the community - offered a more promising future for men and women with spinal cord injuries. Some paraplegics managed to return to the workforce and to their homes instead of remaining in hospital awaiting an early death.5 Still, individuals with spinal cord injury clung to the hope of walking again. Paraplegics participated in exercise and strengthening programs directed by physiotherapists and nurses and learned how to walk with braces, crutches,

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and canes. Advances in medical treatment and rehabilitation prolonged their lives, provided them with greater mobility, and improved their overall quality of life; but the paraplegics wanted a cure, especially as social and physical barriers in the community continued to challenge their reintegration. This raised a debate between cure and care. Time and funding should be spent on looking for a cure, argued many medical practitioners and paraplegics. 6 Murray agreed. 7 In 1960 Murray began to study spinal cord injury in animals, looking into the possibility of spinal cord regeneration. Fractures, skin grafts, tendons, and incisions heal when treated and placed in close contact. Why, reasoned Murray, should not the same principle apply to the spinal cord? 8 He began to operate on rabbits, exposing the spinal cord at various levels, dividing and sectioning it in different places. In twentyseven rabbits the spinal cord was cut on one side (or hemisected), and although it was not severed completely, varying degrees of paralysis resulted. Two weeks after the operation, function began to return, and after ten weeks, paralysis had almost disappeared in each rabbit. Under the microscope, Murray saw that the axons had grown and crossed over the site of injury. He grew excited - he had proof that regeneration in the spinal cord was possible: 'If one motor tract could recover why not all tracts, provided the sectioned surfaces of the cord could be brought as accurately into apposition as were the individual tracts when we made these limited sections?' In his experiments, the intact portion of the spinal cord had acted as a splint, therefore the ends of the divided section remained in ideal apposition. 'What then would happen,' asked Murray 'if in a completely transected cord, the ends could be brought into neat and complete apposition?' 9 Over the next six years, Murray experimented with partially severing the spinal cords of hundreds of animals and then observing any regrowth of axons. He nicked the spinal cord in various locations - hemisections on the right, left, and centre - and noted the immediate paralysis and eventual recovery of function. Some rabbits died of infection or of causes unknown. Other rabbits recovered with almost no sign of impairment. These rabbits were sacrificed and their spinal cords removed for examination. Slides of the growth of nerve fibres across the line of hemisection were made, and the axon patterns studied. The spinal cords were then placed in glass jars of saline and became part of Murray's collection of specimens on display at the Gardiner Medical Research Foundation. In another series of animal operations, Murray experimented with shortening the vertebral column (the column that stabi-

136 Surgical Limits lizes and protects the spinal cord). He resected a complete circumference of the bone without damaging the cord and then fixated the bone to restore stability. It was delicate work and demanded great surgical dexterity. After numerous operations, Murray began to see encouraging results. He was now prepared to attempt a full transection of the spinal cord.10 Complete transection of the spinal cord is the severing of the nerve trunk and results in certain paralysis. Would the nerve axons, without the guidance of intact tracts, be able to regenerate and realign themselves? In a series of rabbit operations, Murray cut the spinal cord completely at about the twelfth dorsal vertebra, using scissors. When he cut the cord, it retracted like an elastic band, forcing him to shorten the vertebral column to allow the cord to be placed in apposition. It was imperative that the cord be snugly in apposition in order to prevent scar tissue from forming; nerve fibres cannot penetrate scar tissue. The gelatinous consistency of the cord made it impossible to sew the ends in place. Still, Murray applied one fine silk suture. He fixated the spinal column and hoped that this would suffice as a splint. Most rabbits did not survive the operation; within weeks of the procedure they died of shock, infection, or irregular bone growth due to poor fixation. In a formal report, Murray summarized the results as follows: [The operation] completely paralyzed the animal posterior to that level [twelfth dorsal vertebra]. They had no movement or sensation in the hindquarters and no sphincter control. After twelve to fifteen days there were signs of recovery of motor function which progressed, until at four or five weeks the animal [referring to all surviving rabbits] could pull the hind feet under his body and make some uncoordinated efforts at hopping. Of the twenty-six [of seventy rabbits] that survived, at about twelve weeks the animals had regained control of sphincters and were able to hop normally, not with complete coordination but with fairly good power and moderate coordination.11

These were encouraging results after years of experimental surgery twenty-six of seventy paralysed rabbits had made a full recovery after undergoing Murray's spinal cord operation. In 1965 Murray published his results in the American Journal of Surgery. In the paper, he directly challenged the accepted medical belief that the spinal cord could not regenerate. After outlining his experiments and results, he stated: 'There is experimental evidence that the transected

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spinal cord in rabbits can regenerate with concomitant return of motor, sensory and sphincter function when adequate apposition is obtained.' 12 Later that year, he presented his findings to the Toronto Memorial Society. It was a low-key affair and Murray was guarded with his statements. It might well be possible to reassemble human spinal cords effectively, he stated: 'It's a matter of experience, accident and good luck.' He refused to elaborate on his hope for clinical application when he realized that reporters were in the audience, and he made it clear to these journalists that his experiments were complicated and not yet complete. Consequently, the Toronto newspapers printed only minimal reports of the address the following day.13 Despite Murray's bold work, there was little fanfare from either the medical profession or the public over his rabbit experiments. This was partly due to the fact that Murray was not alone in his work on spinal cord regeneration. Numerous investigators, dating as far back as 1873, had explored regeneration in the central nervous system on a range of animals and also had questioned the long-held belief that spinal cord regeneration was simply not possible.14 During the mid1960s, researchers in the field seemed particularly hopeful that they were close to understanding axon growth in the central nervous system. For example, in 1966 the English neuropathologist Lionel Wolman reported evidence of well-developed axon regeneration in twelve of seventy-six human cases of traumatic paraplegia, and he cited Murray's 1965 article as well as the experimental results of other investigators in defence of his findings.15 Researchers in the field seemed to acknowledge that axon growth was possible, but they were not convinced that functional recovery, either motor or sensory, could be restored. Neurospecialists and other scientists were still grappling to understand the condition physiologically. In contrast, Murray had already accepted that axon growth and restored function were possible, and he was working towards devising a corrective treatment. Over the next twelve months, Murray started a series of experiments on dogs. He was not as successful with them as he had been with rabbits. One dog fell out of the sling and woke the caretaker in the middle of the night. In another dog, the bone splints punctured the skin and the animal had to be sacrificed. Efforts were made to encourage dogs to stand, urinate, and wag their tails as some measure of restored function. Some motor and sensory function seemed to return in some of the dogs, but no objective measurements were ever taken. The dog 'seems fine,' seems to be well and happy,' 'standing up and quite perky,' wrote

138 Surgical Limits Murray's assistants in the experiment notebook. In the end, none of the twenty-three dogs survived, all of them dying either of infection or of shock. Post-mortem examinations showed that none of the spinal cords and columns had remained in position.16 Yet Murray was not to be deterred; six years of rabbit experiments persuaded him otherwise. In mid-1966 Paraplegic News reprinted Murray's 1965 spinal cord article from the American Journal of Surgery. After reading the reprinted paper, a woman wrote directly to Murray on behalf of her quadriplegic son. She inquired if he had operated on humans yet, implying that her son was interested in the procedure. Murray sympathized with her situation. 'I am sure no one needs to remind you of the pathetic despair involved both in the patient and in the family of paraplegics,' he wrote. To date, he had not operated on any human patients, he told her, but he was hoping to do so soon.17 Perhaps the letter and the plight of this woman's quadriplegic son encouraged Murray to proceed more quickly, for it was only a few months later that he began to perform this experimental surgery on patients. Despite what all the medical books and experts had proclaimed - that the spinal cord could not regenerate Murray anticipated proving them wrong. Between January and May 1967, Murray operated on six individuals with spinal cord injuries. All of these patients were male, had been injured several years earlier, and had undergone conventional treatment. His first patient, D.C., was a twenty-two-year-old quadriplegic. In the operating room, Murray removed the bone from an earlier fusion operation and exposed the spinal cord. Dense scar tissue had built up around the site of the injury and this was cut away. A bluish cyst was then found and removed from the centre of the cord. Murray did nothing else, hoping that this was enough for improvement. It was not. Over the next few months, D.C.'s paralytic condition and general health remained as before.18 Murray's second patient, Purvis Damms, was a twenty-one-yearold paraplegic. As in the first operation, Murray removed the bone from an earlier fusion operation and exposed the spinal cord. He severed the cord in two at the point of injury and removed scarred tissue at each end for biopsy until living axons were found. When he was finished, there was a 5.5 cm gap between the viable cord. Murray then removed a corresponding amount of the spinal column, and the ends of the cord were placed snugly together. He carefully passed a fine silk suture through each end of the cord and tied it lightly. The spinal column was stabilized with heavy wire. After the operation, the patient was placed in plaster

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shells that were strapped firmly to prevent movement. Damms remained in hospital for eighty-six days. On his release, some improvement such as voluntary movement of both toes was noted, but he was lost to further follow-up when he returned home to the United States. Nevertheless, Murray felt that there was positive evidence of a return of communication across the site of the divided cord. 19 Murray's third and fourth patients were both paraplegics in their early thirties. Based on a myelogram (x-ray of the spinal cord), both men were suitable candidates for the surgery, but in the operating room it proved otherwise. The spinal cord injuries were too extensive for Murray's cord resection operation to have any effect.20 Murray's fifth patient, A.D., was a twenty-year-old quadriplegic. Bone from a previous fusion operation was removed and extensive scar tissue was cut away. A biopsy taken from the remaining intact cord at the site of the injury showed 50 per cent of living axons present. Murray did not proceed further and hoped that he had done enough for improvement. Within six weeks, A.D. had made 'worthwhile recovery,' with increasing movement and strength in his arms, hands, legs, and feet, and was released from hospital. 21 Murray's sixth patient, Bertrand Proulx, was a twenty-three-year-old quadriplegic. Again, the fusion bone from an earlier operation was removed and extremely dense scar tissue was cut away from the cord at the site of injury. A projecting bone located near scar tissue also was removed. A biopsy of this scarred area showed 50 per cent living axons present, so a radical transection was not done. Postoperatively, Proulx demonstrated improvement in arm and hand function and the beginning of voluntary power in both quadriceps. 22 Murray described his clinical experiences in an unpublished article entitled 'Encouragement in Spinal Cord Regeneration' written in the summer of 1967. Besides outlining his procedure in detail, Murray summarized his findings. In two cases — A.D. and Proulx — Murray attributed their improvement to his partial excision of the spinal cord. In the case of Damms, Murray noted that the complete transection of the spinal cord had resulted in an apparent return of muscular control and vague sensory functions; further improvements might develop in time. Murray wrote that two years were required to see the end result of peripheral nerve repair, so who knew how long the cord might need? Murray, now age seventy-three, wanted these findings published 'as a stimulus and encouragement for others to press on with this project.' 23 Instead, the Journal of the American Medical Association politely rejected the article. 'We do not believe that it adds enough definitive informa-

140 Surgical Limits tion,' wrote the senior editor. 'We are glad that encouraging progress is being made, but this, in itself, is not enough to justify publication in our journal.'24 It frustrated Murray that his medical colleagues could not recognize the extent to which his spinal cord operation might aid thousands of paraplegics throughout North America. Murray continued to perform his spinal cord procedure. In October 1967 he operated on another two male quadriplegics. His seventh patient was L.R., age twenty-two. Murray removed the bone fusion from an earlier operation and exposed the spinal cord. He attempted to relieve compression on the cord by removing fragments of bone and dense scar tissue at the site of the injury. A biopsy showed that no living axons were present, but because of 'problems with the anaesthetic and general conditions,' he did not proceed with a complete transection.25 Murray's eighth patient was eighteen-year-old S.K. As in the other cases, Murray removed the bone fusion and exposed the cord. A cyst was removed and scar tissue cut away from the site of the injury. A biopsy showed no living axons present; but again, because of 'problems with the anaesthetic and the poor condition of the patient,' nothing further was done.26 In both these cases, if no improvement occurred, Murray planned to proceed with the complete cord transection operation in a few weeks' time.27 On 14 November 1967 Murray was the keynote speaker at the fundraising dinner of the Toronto East General and Orthopaedic Hospital Research Foundation, held in the ballroom of the Inn-on-the-Park Hotel in Toronto. The foundation was entering its third year. Its research studies included barbiturate overdosage, the Rh factor, grease-gun injuries, factors in traffic accidents, and cervical spine studies. Since Murray was so well known in Toronto circles, his billing as guest speaker gave the foundation dinner added prominence.28 Nearly two thousand people medical practitioners, businessmen, society people, and others - attended the event.29 After a multi-course dinner, the guests waited patiently for Murray to begin his talk. No speech title or topic was printed in the program, but everyone knew that Murray would be an engaging speaker, regardless of the subject. The audience sat contentedly, sipping after-dinner drinks and coffee, and shifted their attention to the stage. After receiving a kind introduction, Murray took his place at the podium. He faced the audience and smiled. He thanked the foundation for inviting him to speak and praised it for its research efforts. To encourage and validate further much-needed efforts, Murray told the

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audience that he planned to share his current research with them. 30 He then made his announcement: he had had success with a new surgical technique that made spinal cord regeneration possible for the first time. In laymen's terms, Murray described his animal experiments and presented slides of rabbits - first paralysed and then hopping. Severed spinal cords were rejoined by removing some of the bone of the spinal vertebrae, he explained; nerve fibres crossed the site of injury, restoring function to areas previously paralysed. Where others had failed, Murray had succeeded. The secret was bringing the ends of the spinal cord into apposition with each other. At that moment, the audience was distracted by a noise at the back of the ballroom. The large rear doors were opened, and a hospital bed was wheeled through the audience and onto the stage. Murray introduced Bertrand Proulx, the French Canadian accident victim who had been paralysed from the shoulders down for more than three years. Proulx had had no leg or arm movement and had been unable to feed himself or control his bladder and bowel movements. Murray announced that he had recently operated on Proulx and, baiting the audience, asked, 'Would you like to see him sit up?' The audience jolted to attention. Six months ago, Proulx's arms had been useless, but now he used them to lift his body bv means of handstraps. The crowd applauded while Proulx rested and smiled. Then, as three nurses steadied him, Proulx slid to the floor and stood briefly in a walker. He smiled again and waved. The crowd clapped louder. Proulx returned to the bed, and from a sitting position, he held a glass of water in one hand before lifting it to his lips for a drink, This is a marvel,' said Murray. 'It's never happened on earth before ... This fellow's going to walk.' Murray praised the work of the nurses and others in caring and providing rehabilitation for these spinal cord patients after surgery. Continued exercise and strengthening programs promised further improvement. Leaving amid deafening applause, Proulx was escorted back to the Toronto General Hospital, and Murray returned to his dinner seat. 'Trust old Murray to bring it out like this.' remarked one observer. Physicians and the press quickly gathered around Murray to question him about his work.31 The next day front-page headlines glorified Murray's latest 'medical miracle': New Technique Permits Paraplegic to Sit, Stand' ... 'Quadriplegic Stands Up ... Waves,' ... 'Toronto Surgeon's Medical Miracle Brings Paralyzed Man to His Feet.' Pictures of Murray and Proulx accompanied congratulatory articles in all the Toronto newspapers, and the story was sent out on the Canadian and American newswires. Report-

142 Surgical Limits ers commended Murray for his eight years of research on spinal cord regeneration and his compassion for individuals with spinal cord injuries. 'He had become fascinated and horrified by the plight of paraplegics and quadriplegics doomed to helplessness ... [wondering] "surely something could be done for them,"' wrote Ken MacTaggart in the Toronto Telegram. Another journalist reported: 'He was driven by the knowledge that many of these people were so miserably unhappy that 27 per cent commit suicide.' Most articles listed Murray's earlier medical contributions, including his pioneering techniques in heart surgery, his blue babies, mechanical kidney, and kidney transplant operation. 'Doing the impossible is something that Dr Murray has been doing for 30 years,' wrote Don Dutton in the Toronto Star. 'The undeniable fact

about Dr Murray is that you can't write him off. Despite his bravado, his achievements are impressive,' wrote David Spurgeon in the Globe and Mail. As it had in the past, the press declared Murray a hero and a miracle maker.32 The day after the foundation's fundraising dinner, Murray repeated his performance at St Joseph's Hospital. This was an audience of doctors, well aware of what Murray was going to talk about, and they had many questions. Again, Murray described his animal research, showed slides of paralysed rabbits that had regained nerve function, and paraded Proulx as clinical application and proof. Still the doctors wanted to know more. They asked, 'What would hold the ends of the cord together if it is cut right across?' Murray explained that bone was removed from the spinal column to bring the ends of the cord together. Did he need special instruments? Murray said he had made his own instrument, which looked like a wire from a fence, to curve deep into the spinal column. How did he determine how much of the spinal cord was deadened and must be removed? Murray replied that bits of the cord were sliced off and tested to see if they were alive and active. Murray admitted that he did not know how long recovery would take, especially for paraplegics who had been bedridden for years. Furthermore, all of his patients were American, except for Proulx, and they were lost to any follow-up when they returned to the United States. He faced many limitations, he said, including the fact that he was doing almost all the research himself 'in a lousy little lab mostly at my own expense' and could not interest other Toronto medical men in his work. Reporters loved it! Murray's comments positioned him as the selfless lone researcher working towards a cure in order to help others. The media refused to see Murray any other way; and on that day, apparently,

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so did the doctors. They gave Murray a standing ovation, saluting him as a 'great surgeon, a great human and a great Canadian.' 33 No one praised Murray more than his patients. With his limited English, Proulx told reporters, 'It's wonderful. It's nearly a miracle.' Months ago, Proulx had learned of Murray's animal experiments from a television report, and he had promptly written to Murray and volunteered for the procedure. And it had paid off! He could now feed himself, write letters, and smoke cigarettes. He could stand and lift one foot at a tune from the floor. And he held high hopes for further improvement. One reporter asked him if he would be able to walk someday. Proulx replied, 'Of course I will.'34 Meanwhile S.K., Murray's eighth patient, was lying in plaster casts at the Toronto General Hospital waiting 'for a miracle of his own.' He had complete confidence in Murray, and Proulx's progress reassured him of his own future. 'I think Dr Murray is a brave man,' said S.K. 'I'm sure the operation has helped me. My breathing has improved. If I get better - even if I canjustwalkon crutches, it would be wonderful.'35 He would have to wait and see. Other paraplegics and quadriplegics were equally excited about Murray's spinal cord procedure. 'It means a new life for us,' said James Strachan, a thirty-eight-year-old paraplegic. 'He should get the Nobel Prize.' At Lyndhurst Lodge, a treatment centre in Toronto for people with spinal cord injuries, patients were demanding the operation. One man said to his wife, 'Don't give up hope. The doctor put one guy together, and now I got a chance to walk again.' Another patient told reporters, 'It would put me in life again. If anyone would come and ask me to go 1 would volunteer right away.' As James Strachan explained, 'You'll never realize what it's like to have to rely on others for everything. To take you places. To get you into bed. That's the worst part of it.' Still, some individuals guarded their optimism. Twenty-four-year-old Betty Higgins said that if Murray's operation works, 'I want it. But I want to be sure first. I don't want to build up my hopes too high. I can't afford a setback.'36 More and more people became aware of the potential impact of Murray's spinal cord procedure because of the daily newspaper, radio, and television reports. 'How fortunate we are to have the likes of Dr Murray in our country,' wrote one woman in a letter to the Globe and Mail37The media continued to report sensational updates and photos of an improving and smiling Proulx, as well as the sad stories of other paraplegics and quadriplegics. Murray had performed a miracle, said a Toronto Telegram editorial. 'It consists in the power of man to rise

144 Surgical Limits above barriers, to move what seems immovable in the faith and confidence that all things are possible if man cherishes the dream and exercises the will.'38 In the medical profession, reactions to Murray's announcement ranged from cheers of congratulation to serious reservations. Drjohn Mullan, chief of neurosurgery at the University of Chicago, called Murray's operation 'a major and dramatic breakthrough.' Dr Al Jousse, medical director of Toronto's Lyndhurst Lodge, said, 'Everything he has attempted in the past has succeeded, and I cheer him now.' Dr J.G. Love, senior neurological consultant at the Mayo Clinic, commented, 'If Dr Murray has actually successfully rejoined a severed spinal cord, he has done something very wonderful.' Neurosurgeon Arthur Ward asked directly, 'Was this patient an actual quadriplegic?' All of Proulx's Quebec doctors confirmed that he was. Yet other medical men were not convinced. British paraplegic specialist Dr Ludwig Guttmann said, 'A newspaper report describing Dr Murray's operation does not sound feasible.' Dr J. Lawrence Pool of the Columbia Presbyterian Medical Center told reporters, 'It sounds very exciting, but I'm inclined to be skeptical at this stage until this is verified by neurosurgeons of other clinics. Certainly it deserves investigation.'39 Most specialists wanted more information before commenting further. Toronto medical men were sceptical

but were unwilling to criticize Murray publicly without knowing more

details.40 Murray was inundated with requests from medical professionals, paraplegics, their families, and the media for more details about his procedure. Newspaper, radio, and television reporters phoned his secretary, staked out his office, and camped at the gates of his home in North York. Miss Kerr had retired not long ago, and Murray's daughter Rosalind was acting as his temporary secretary, having recently completed a master's degree in anthropology from Harvard University. Rosalind, seeing reporters at work and at home, attempted to shield her father from the barrage. When Murray did agree to speak with reporters, he repeated how he had experimented with rabbits, and he talked about the continued improvements in Proulx. CBC-TV broadcasted a lengthy segment on the spinal cord surgery in its news magazine The Way It Is on 19 November. The television report included separate interviews with Murray, Proulx, and Dr William Drucker, surgeon-in-chief of the Toronto General Hospital. Murray came off well in the program. He was relaxed and friendly to the reporter and seemed happy to answer all questions. When asked if other doctors would start developing his new

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spinal cord procedure, Murray responded, 'I hope so - I'm old, I'm obsolete and I'm trying to get the younger group going on this project.' CBC reporter Barbara Amiel commented that it was hard to understand why Murray, with his numerous medical achievements, was not as famous as William Osier or Wilder Penfield.41 Drucker and other Toronto General Hospital medical men were still reeling from Murray's announcement. The news had come as a complete surprise to them. The ensuing onslaught of inquiries from around the world made it a public relations nightmare. Surgeons, physicians, reporters, and individuals with spinal cord injury were telephoning and wiring the hospital wanting more information about this 'breakthrough.' The hospital authorities needed to gain control of the frenzied media situation that had erupted. First and foremost, they needed to find out more about Murray's operation - was it indeed a breakthrough? Murray had performed these operations in the Private Patients' Pavilion, unbeknown to his superiors at the hospital. They were caught in an embarrassing position, and they quickly organized an investigation into the matter.42 Hospital superintendent Dr J. Douglas Wallace, sent a stiff twopage letter to Murray explaining the press code that was to be used when the Toronto General Hospital was mentioned in statements to the press. 'It is particularly unfortunate that the name of this Hospital was included in this publicity and that we were not able to defend our reputation through having the proper information in advance.' Wallace asked Murray "to correct some of the overly enthusiastic impressions that were created by press stories' and to work through the proper channels to 'avoid this type of publicity' in future. 43 Wallace then turned to the hospital's medical director and the head of nursing to ask what the policy was regarding the provision of passes permitting patients to leave hospital. 'Passes' as such did not exist, but a patient could leave hospital on a written order by his doctor. 44 More important, why had senior hospital men not been aware of Murray's spinal cord operations? 'There are far too many loop holes in our present regulations to satisfy my desire for quality care and the protection of patients,' wrote Wallace.45 Tighter hospital patient controls needed to be enforced. Wallace met privately with Murray and Drucker to discuss a strategy to manage the publicity. If this was a breakthrough, the hospital and the university should support Murray's research with regard to financing, personnel, and project organization. Wallace recorded that 'this was accepted with enthusiasm by Dr Murray.' On 21 November a press

146 Surgical Limits conference was held at the Toronto General Hospital 'to announce the start of a hospital-organized and supported assessment of results to assist further in Dr Murray's work' and as a first step towards easing media attention.46 Hospital administrators saw this as an opportunity to set the record straight on the 'unfortunate publicity' and to protect the reputation of the hospital. Wallace, Drucker, Murray, Dr Thomas P. Morley (the hospital's chairman of neurosurgery), and Dr Aljousse (the medical director of Lyndhurst Lodge) constituted the panel. They sat uneasily in the hospital boardroom, bracing themselves for the glare of television lights and the barrage of questions from reporters. The five doctors looked 'tense, nervous and rather grim.'47 Drucker was appointed spokesperson and did most of the talking during the hour-long press conference. Murray sat slumped in his chair, his arms folded, with a disdainful look on his face. Drucker began by stating that Murray's work was preliminary and its announcement premature. The surgery was unproven, and Murray had not produced scientific evidence to back his claims.48 Drucker told reporters, 'We have absolutely no unassailable scientific evidence either for or against Dr Murray's findings and observations. This could be a very real breakthrough: all of us sincerely hope so. But we cannot document it scientifically and to allow it to be propagated throughout the world is doing harm.'49 He turned to Murray and commented, 'I have the greatest respect for this man ... but I don't believe him in this particular instance because I can't get the data that says this patient really improved.'50 Drucker focused on hospital protocol and the necessity of scientific rigour. It amounted to a public chastisement of Murray for his 'unsubstantiated, unscientific' announcement, and as the Medical Post reported, 'it highlighted the medical predilection for scientific method over "broomcloset" research.'51 Despite an earlier agreement to work with hospital authorities to reduce the intense press attention, Murray decided that he could no longer keep quiet. As one reporter whispered, 'The script went out the window.' Murray spoke out angrily and defensively: 'I'm not in the least interested in any of these opinions here, including you Dr Drucker, with the greatest respect ... I don't give a darn what you think. I know it's true.'52 Striking back at the sceptics, Murray said the reason why they did not have documentation was that the Toronto medical community had been uncooperative. 'Now everyone criticizes me for being a lone wolf... I tried to get cooperation in this but I didn't get it so I've done it alone. I'm satisfied. I'm quite certain there is regeneration.'53 Murray told his

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colleagues: 'You can drop it if you like; I've carried on individually up to this stage and I can do it again. I'm going to continue to do others — if I get support here I'd welcome it, I'd love i t - I love the cooperation going on now, but I'm going to go on with it regardless.' 54 The press conference exposed the strained relationship between Murray and his Toronto colleagues. 'It revealed strong undercurrents of personality conflicts,' wrote David Spurgeon. 'It also illustrated the conflict between the lone wolf and the organization men of modern medicine and between the intuitive approach of the brilliant, old-style surgeon and the rigorous, impersonal demands of modern medical science.' 55 In the end, Drucker agreed to set up a panel of leading doctors to study the procedure, but it would be at least two years before even a tentative conclusion could be reached. He made it clear that much more work would have to be done before any more claims could be made. Murray smiled as he listened to Drucker committing financial, medical, and moral support to his research. 56 'The profession, I agree, must be conservative,' said Murray. 'There are all kinds of hare-brained ideas proposed, and they must be examined. We're all earnestly trying ... However as he says, it will be two years or so before we can produce the data that will prove it.'" The press conference did not go as Wallace had wanted, and the hospital came off looking bad once again. 'Dr Murray took this opportunity to reverse his field and give the impression that the "Medical School and Hospital Establishment" was attempting to minimize his discovery,' Wallace reported to the hospital's Board of Trustees. 'The Press, as usual, tended to support the underdog.' 58 Toronto medical men were under enormous pressure from the profession to clarify the sensational reports arising from Murray's spinal cord research. Medical specialists and members of international paraplegia associations expressed grave concern about any publicity claiming such extraordinary results. Dr Ludwig Guttmann, president of the International Medical Society of Paraplegia and founder and former director of the National Spinal Injuries Centre at Stoke Mandeville Hospital, wrote to Dr A.L. Chute, dean of medicine at the University of Toronto, and to Dr A. Jousse, urging action: I feel very strongly that an international commission of expert specialists in the field of paraplegia and tetraplegia should be set up to investigate these 7 cases bv Dr Murray. Having regard to the universal furor which these reports have aroused and in particular the hopes which they have already given to paraplegics and tetraplegics, their families and friends, no stone

148 Surgical Limits should be left unturned to investigate and verify or refute the extraordinary claims made by Dr Murray.59

Dr Alain Rossier, vice-chairman of the World Committee of Spinal Paraplegia, was 'deeply disturbed' by the publicity generated by Murray's announcement.60 Dr A. Tricot, a specialist in the treatment of paraplegics at Brugmann University Hospital in Brussels, wrote: 'I think it is my duty, as a member of the Executive Committee of the International Medical Society of Paraplegia to express my total disapproval about the very regrettable publicity conducted by the press concerning works of Dr Gordon Murray. Those reports have given false hopes to several paraplegics.'61 Chute assured Guttmann, Rossier, Tricot, and others that he shared their concern and that Murray's work was currently being investigated.62 On 24 November, three days after the press conference, Murray was in Ottawa as a house guest of the governor general, his longtime friend Roland Michener. Murray was one of thirty-five Canadians to be invested into the Order of Canada, and he was delighted to be so highly honoured. The creation of the Order of Canada medal - a symbol of service and achievement - had been announced by Prime Minister Lester Pearson only months earlier. Its first recipients were an elite group that included Vincent Massey, the first Canadian-born governor general, former prime minister Louis St Laurent, novelists Hugh MacLennan and Gabrielle Roy, neurosurgeon Dr Wilder Penfield, and historian Donald Creighton. All these individuals had 'served their country and their fellows with singular accomplishment and they deserve a full measure of recognition from Canada and its people,' stated Michener.63 The Order of Canada ceremony was timely. It allowed Murray and his family to escape Toronto and the unrelenting media attention. They enjoyed visiting the Micheners and were grateful for the protection of being inside the walls of Government House.64 The awards ceremony was a formal and intimate affair. Murray sat patiently, in his white tie and tails, appreciating the stately atmosphere of the evening. When his name was announced, he rose and walked to the platform. The governor general placed the Companion of the Order of Canada medal around his friend's neck. Michener smiled at Murray, shook his hand, and spoke to him briefly. There was applause from the audience and Murray returned to his seat, a broad smile across his face. Such recognition had been long awaited and was now being savoured.65

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While Murray was being awarded the Order of Canada, Toronto General Hospital authorities were receiving phone calls from local reporters armed with the tip that Murray had not rejoined the spinal cord as he had stated. Somehow, the preliminary findings of the hospital review committee, which had not yet completed its investigation or filed a formal report, had been leaked to the press. With rumours circulating, Drucker felt compelled to make a public statement. 66 His decision was supported by Wallace, who felt that the 'public good took first priority in this situation.''" The timing could not have been worse for Murray. While he was out of town accepting a prestigious national honour, Drucker dropped the bombshell. 'On review of the operative record and x-rays, it is evident that no operation was performed on Bertrand Proulx to shorten the cervical spine nor was the spinal cord transected and rejoined,' announced Drucker.68 The operation that had been hailed as a medical miracle never took place, according to hospital investigators. The newspapers rushed to press with the news: 'Spinal Cord Not Joined' ... 'Surgeon Discounts Spinal "Miracle"' ... 'Dr Murray Controversy Still Boiling.' 69 After examining Proulx and reviewing his medical records, the hospital investigators had concluded that Proulx had undergone a decompression of the spinal cord, a thirty-year-old procedure. Part of one vertebra had been operated on and a piece removed, relieving pressure on the patient's pinched spinal cord. After considerable rehabilitation, Proulx had regained much-improved motor, sensory, and sphincter function. Previously a quadriplegic, he had become a highly functioning paraplegic as a result of Murray's operation. However, the procedure conducted was not a spinal cord resection, as Murray had led all to believe. Drucker told reporters that he had not been successful in contacting Murray in Ottawa to relay the hospital's findings. Murray was stunned by the newspaper headlines the next day. He refused to talk to reporters while in Ottawa and drove straight back to Toronto. Murray was furious that the hospital had breached their agreement about issuing press statements with the consent of both parties. 70 (Drucker told reporters that there was no such agreement.) When Murray and his family arrived home, two reporters met them at the gates. Murray refused to speak with them. An hour later, a CBC television crew arrived. They eventually made their way into the house, and Warren Davis interviewed Murray. Davis asked him to set the record straight. 'We operated on a man and several of them, with improving recovery,' began Murray. 'We operated on the cord. We did what was necessary. In this man we didn't take out a vertebra as Drucker said and I never said

150 Surgical Limits we did. Now that's the truth. I've operated on a man's cord. He's moving, he's doing well. Isn't that enough?' What about Drucker's statement? asked Davis. 'Well he's off the beat. He doesn't know what he's talking about,' replied Murray. 'I didn't claim anything that I didn't do. I operated on the man's cord and he's recovering now. That's good enough.' Davis asked, 'Did you cut the cord?' Murray's temper flared: 'I'll cut your goddam head off if you don't shut up. I'm not going to have any of this bunk around here. None of it.' When Davis asked Murray again about the procedure, Murray exploded: 'You get the hell outa here.' There was a brief scuffle between Murray and the television crew before Mrs Murray and her daughter ushered them out of the house.71 The question every reporter wanted answered was, Did Murray do what dozens of doctors thought he said he did?72 Everyone thought that Murray had transected the spinal cord and then removed part of the spinal column to place the cord in apposition, and that - for the first time ever - the spinal cord had regenerated. Now the hospital authorities had announced that this had not been done on Proulx and they were investigating Murray's other surgical cases. It was all a misunderstanding, argued Murray. At no time had he claimed to have shortened Proulx's spine. He had been misinterpreted from the outset.73 'Some assumed that in all patients I resected both cord and vertebral column, confusing this with the statements made about the experimental animals,' explained Murray. 'In the eight patients I have operated upon I removed varying amounts of bone in each depending on the requirements.'74 Nevertheless, as one reporter pointed out, Murray had had ample opportunity to correct the impression that he had performed eight spinal transections.75 It would be unfair and inaccurate to attribute the whole controversy to misquotation by journalists. Did Murray purposely deceive them? 'It was very wrong of Murray to imply he did something he did not do, but don't let this stop us from being humane,' pleaded K.S. Edey, information officer at the University of Toronto. 'I am among the fortunate ones who have not been involved in any Faculty-Murray confrontations over the years. Therefore I could argue, "Here's an old man who wants one more achievement. When you and I are 73 we may want to score another goal too."'76 Murray's age was a factor raised by several Toronto medical men. Toronto gossip whispered that his mental capacities were slipping.77 Many medical men had seen this type of case before: doctors

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who continued to practise beyond the limits of age or fitness because they could not bring themselves to give up the occupation that had been their life.78 Age was used to explain Murray's unprofessional actions, and hospital authorities scrambled to neutralize the situation created by, according to their perception, a grandstanding, pathetic old man. Still, Murray had many loyal supporters. One woman, in a letter to the Toronto General Hospital, wrote: 'I think Dr Murray should be treated better than some quack on his past record alone, and the money made available to him to go ahead with his research and train younger men. These people live (or should I say exist) a miserable life and anything you could do to help this along would be appreciated.' 79 But possible advances in treating paraplegia soon became secondary to exposing past and present rivalries between Murray and the hospital authorities. The Toronto medical men 'love picking on him,' Roland Michener told reporters. 80 Angry letters were printed in Toronto newspapers: I cannot understand why a man of Dr Gordon Murray's stature should be subject to such criticism from the medical profession,' wrote Louis Galperin. 81 'This is indicative of the terrific politics that goes on behind the scenes among the top brass in hospitals,' wrote Harold Fine. 'So let us give Dr Murray a vote of confidence and the moral support such as he has deserved, and not received, during all the years he has served humanity, limited by lack of support and assistance.'82 Many supporters wrote encouraging notes to Murray directly. One family wrote: 'We want you to know how deeply concerned and heartsick we are for you and your very devoted family to be caught in this bizarre nightmare. The injustice is incredible that such a wonderful doctor and human being as you, who has dedicated his life to help mankind could be treated so shabbily. We are appalled and shocked to think that your colleagues would question your integrity. Jealousy would have to be their only motive and it is very disillusioning that civilized, educated men would resort to such means.' 83 Floyd Chalmers told Murray that the Order of Canada medal 'reminded people of your magnificent work over a long term of years and got some perspective into this "dispute" which is the product of long-standing jealousies which I would have hoped to see disappear with the passing from the scene of some of the old TGH clique ... Their conduct is most unethical and non-professional ... [You] should pay no attention to any statements or comments, many of which have already been based upon obvious pettiness and malice and plough ahead.' 84 In early December, Murray agreed not to perform any more spinal

152 Surgical Limits cord operations at the Toronto General Hospital, and he discharged all his waiting paralysed patients.85 A form letter was sent to those who requested the operation, telling them that they were placed on a waiting list.86 Until the hospital finished its investigation, there were to be no more public statements made by either Murray or the hospital. Their 87 sudden silence left the press and public with many unanswered questions, the most important being, Did Murray perform a medical miracle or not? An editorial in the Medical Post summarized the confusion: 'What are we to believe? Are we to be stampeded by the public press into picturing Dr Murray struggling single-handed against the malice and indifference of the department of surgery for which he works? Or are we to take the view of the department of surgery at the Toronto General Hospital that Dr Murray's evidence of spinal cord regeneration is unscientific and in one case even suspect?'88 Regardless, it was bad for the profession. Sidney Katz agreed, calling the dispute 'a tragic comedy of errors ... characterized by indiscretion, concealed truths, the violation of scientific principles and unanswered questions.' No one involved in the controversy could be absolved completely.89 Behind the scenes, the hospital authorities were working towards finding more complete answers. Murray agreed to meet with senior members of the Department of Surgery on 13 December in an effort to work out how to proceed with his spinal cord research.90 Hospital medical men wanted to set up a 'scientifically acceptable experiment to assess Murray's claim.'91 Early in the meeting, Drucker stated that Murray would receive support for his research, but only if he cooperated. Hospital protocol had to be followed; experimental operations had to be approved in advance through proper channels. Murray said he would work with a hospital team only 'if the hospital lifted restrictions on his spinal cord operations' and 'if they corrected every statement in press under his name.' Murray mentioned specific incidents in which he had been slandered, he said that Drucker's statements at the press conference had implied that his research was doubtful and 'made him out to be an amateur or charlatan'; worse yet, Drucker's announcement that Murray had not transected Proulx's spine made for an 'embarrassing situation in Government House.' Drucker repeated that there was 'only one way to do research' and that was the 'scientific way,' with adherence to protocol. The other doctors present at the meeting jumped in at various times, trying to gain more information on the nature of Murray's work. How many operations had Murray performed? Eight, he replied. Had he

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shortened the cord of any of these patients? In one, answered Murray, but he refused to elaborate. Murray doubted that they were interested in supporting his work. Drucker's only intentions, he said, were 'to smear my name, to damage my reputation and to limit my hospital privileges.' 92 The hospital was trying to 'cut him off,' and as had happened in the past, he 'would be completely left out, having introduced and developed it.' He dredged up other examples of times he had 'been burnt' or 'blackballed' by senior Toronto medical men. Murray jeered that the meeting was nothing more than a 'Kangaroo court.' 93 In the end, although the meeting gave Murray a forum to express his anger face-toface and vent his long frustration with the Toronto medical establishment, it settled nothing. Two days after the strained meeting with the hospital administrators, Murray attended the city's annual awards ceremony, where he was presented with a City of Toronto Award of Merit. I don't deserve it ... I've made nothing but horror, desperation and dissatisfaction,' he told reporters. 94 The words sounded phony, and Murray should have said nothing. Wanting to avoid any more publicity, the hospital authorities hoped to keep silent until their investigation was complete and a full report was presented to the Medical Advisory Board. Still, a hospital statement was prepared and kept on hand for release if necessary. Wallace told his staff, 'I sincerely hope that it won't be necessary and that we can allow the heat to dissipate before an official statement is released.'95 On 21 December 1967 the long-awaited hospital report on Murray's spinal cord operations was formally presented to the Medical Advisory Board. Dr William Anderson, chief of surgical pathology at the Toronto General Hospital, reported that there were no improper procedures undertaken by Dr Murray but that, with the exception of one case, the procedures could only be termed exploratory laminectomies. In one case it was recorded that the 5.5 centimetres of the spinal cord had been excised as well as 2l/2 vertebrae ... No subsequent information as to the clinical course of that particular patient was available ... In the case of Bertrand Proulx, the committee did not find that shortening of the body spine or excision of the spinal cord had been recorded or undertaken.96 The hospital released an official statement to the press (the same statement that had been prepared before the report was written - demon-

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strating that they had anticipated what the findings would be). It said that no evidence of a major advance in the treatment of paraplegia had been made in Toronto, and the hospital apologized for raising the hopes of paraplegics around the world.97 This statement was published verbatim in Paraplegia and the Journal of Neurosurgery 'in order that the Profession be made aware of the true situation.' 98 As usual, the news about Murray made the headlines. 99 The papers announced that no 'miracle operation' had been performed on Proulx - it had been routine surgery. Only one of Murray's eight patients had received the complete spinal operation, and it had failed. Purvis Damms of Convoy, Ohio, was still paralysed from the waist down, still dependent on a wheelchair and crutches, and still unable to control his bladder and bowel movements. He was also shorter than he had been. Damms told reporters, 'The operation didn't help me - didn't hurt me,' but he was firmly convinced that Murray was on the right track. Murray commented that this patient's 'condition might be due to lack of proper physiotherapy following the operation,' and that it was unfortunate he was lost to follow-up.100 Ken MacTaggart of the Toronto Telegram called Damms a pawn in the medical controversy. Legal and ethical restrictions prevented the Toronto General Hospital from reporting further on this particular case. But if Damms was a successful case, why was Murray not parading him in front of his medical colleagues? Murray replied that he could see no benefit in producing Damms now.101 The hospital authorities had hoped to put the controversy to rest with their report and press release, but Murray refuted their findings and expressed his anger and bitterness on how he was being treated. In a letter to Thomas Bell, chairman of the Board of Trustees, he wrote: The recent world approval and the spectacular results of the heart transplantation by Dr Christiaan Barnard in South Africa emphasizes the contrast in the response in the Toronto General Hospital... All my patients are alive, none are worse and several are much improved, whereas Dr Barnard's single patient is dead. Why then is there the contrast in the medical assessment? ... The accusations are made by those who know nothing about this investigation and refused to cooperate when I requested such, on several occasions. Without justification they have brought the work to a halt and have denied possible improvement and hope to those in utter despair. Is this a desirable attitude of the Hospital? ... This is submitted to express my impressions on what I am sure must give you some concern, whether some of the medical staff on the Toronto General Hospital have the proper perspective.102

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Bell's reply, prepared by Wallace's office, endorsed the hospital's position and disregarded Murray's accusations of professional sabotage.103 In a long, heated letter to Wallace, Murray wrote: You all have treated this as a whimsical fancy and have treated me as an inexperienced upstart without scientific background. As already stated little do any of you know the immense amount of work that was done over several years with carefully studied results and proof both under the microscope and with recovery of function. Moreover the operations on none of the patients was the routine exploration decompression and laminectomy... As this work has received wide acclaim in four continents and is of great importance to so many, it obviously will be developed further, elsewhere than under the vindictive community of Toronto General Hospital. The reaction here is so typical of events on former occasions; ... [and he lists numerous past procedures] ... If your committee had been in charge it would all have been stopped - as you now intend to do with the spinal cord work. This effort on your part has already damaged the Toronto General Hospital in public opinion, as evidenced by many hundreds ofletters ... As proof are more than 1000 letters many from doctors all of whom without exception have commented on yours and the Toronto General Hospitals committee's stupidity and all have expressed confidence and faith in me and my work. It would do you good to read a few hundred of these. Having obstructed the most important advance in the care (if paraplegics and quads .. the interesting question arises, what is your committee's motive? In brief it is obvious your efforts are to annihilate me. All Dr DrDrucker'sstatements have cast doubt on my experience and integrity. He has evaded the essential point that the patients are recovering. Dr Drucker's insidious effort to influence City Hall, with the purpose which it accomplished of damaging me, was a further set back to this vital work in which I am engaged. In scurrilous fashion he has played the man and not the ball, which I doubt if either of you know, isn't cricket ... If both you and Dr Drucker contribute to the Toronto General Hospital's reputation one tenth as much as I have vou will have to improve your record. 104

In Murray's mind, the shabby treatment he had received from the hospital over his spinal cord research topped a career of frustration and obstruction from the same medical community. On 22 January 1968 the hospital made one final announcement. The Toronto General Hospital would not be supporting any further studies of Murray's controversial spinal cord surgery; Murray had declined to participate in a hospital committee to establish an acceptable protocol

156 Surgical Limits towards continuing this research.105 The matter was thus closed for the Toronto General Hospital. Murray refused to offer a statement to the press. After weeks of media interference and frustration with the hospital authorities, he had decided to end it. He had been beaten.106 The spinal cord controversy was finally over. The public had been deceived Murray could not make paraplegics walk again. 'It is too bad that the publicity caused us all some bad moments,' wrote Wallace.107 The dispute had been ugly and damaging to all involved. Murray did not entirely abandon his spinal cord research, despite being forced to retire from active practice at the hospital on 1 July 1968. (In 1963 the Board of Trustees had approved a change in the by-laws that required surgical consultants to retire from active practice in the hospital at age seventy, with a five-year period of grace. Murray was thus grandfathered and retained his operating privileges until 1968. Had this not been the case, no doubt the hospital authorities would have taken action to restrict his hospital privileges earlier on account of the spinal cord controversy.)108 Over the first few years of his retirement, Murray received letters from several of his spinal patients, who kept him abreast of their improvement and encouraged him to continue with his research.109 Meanwhile, Murray continued trying to get his research findings on spinal cord regeneration published. The Journal of the American Medical Association, the American Journal of Surgery, and the Journal of

Trauma all rejected his papers. One anonymous reviewer wrote, 'The report is unscientific and not capable of contributing to the problem which the paper purports to discuss.' Another reviewer said, 'On the basis of the information reported, the lack of complete objective preoperative findings, and the scanty incomplete postoperative findings, one must conclude that there was no evidence of spinal cord regeneration in this case, or if there were, it is not presented in this paper.'110 Murray's paper was finally accepted by Panminerva medica, an obscure Italian medical journal, and published in September 1972. It provoked no reaction from either the medical or public press. Moreover, neither this article nor his 1965 article was ever cited thereafter by others working in the field.

As journalist Sidney Katz stated, the spinal cord controversy was 'a tragic comedy of errors and needless humiliation' that saddened and embarrassed the Toronto medical community.111 What might have been yet another medical feat for Murray and a splendid finale to his surgical career resulted instead in a public fall from grace. More lamentable was

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the false hope given to thousands of paraplegics who believed they would be able to walk again. Murray, the hospital authorities, the medical professionals, and the reporters involved in the spinal cord controversy all contributed to the ugly escalation and mishandling of the dispute. Most obviously, the fundraising dinner of the Toronto East General and Orthopaedic Hospital Research Foundation was an inappropriate occasion at which to announce the discovery of any 'medical breakthrough.' But at seventy-three years of age, Murray was probably impatient, and he was frustrated with protocol and upset over the recent rejection of his paper on the subject. He was driven to get others interested, if not directly involved, in his spinal cord research. He was too old to carry his ideas to a successful conclusion, and he wanted younger Toronto men to take up his work. A recent visit by Dr E. Shannon Stauffer, an American neurospecialist from the spinal cord research centre Rancho Los Amigos Hospital in California, who had studied spinal cord injury and functional recovery, may also have contributed to Murray's decision to announce his 'breakthrough' surgery.112 (There is no published record that confirms Murray's belief that soon after his visit Stauffer performed the Toronto procedure successfully in California or that he altered his research to incorporate Murray's spinal cord regeneration theory.) 113 Murray claimed that he had been unaware that reporters were present at the fundraising event. 'Nuts,' said Marilyn Dunlop, the medical writer for the Toronto Daily Star. 'I phoned him before the dinner and he told me he was bringing along a quadriplegic he'd operated on, so we covered it.' 114 Murray did not want to be seen as a doctor who courted publicity, as he had been accused of doing by some medical men. In any case, the press had shown minimal interest in his spinal cord research, so what did he have to worry about? Whether he was being naive or cunning, he did not anticipate such an overwhelming reaction to his after-dinner speech. When it became evident that Murray had not performed a complete spinal transection on Proulx, his defence of 'misinterpretation' looked feeble. On numerous occasions he could have clarified the issue instead of allowing reporters - and the world - to believe that Proulx was clinical proof of his transection surgery. But presumably the end justified the means; he was onto something, and with greater resources, his research on spinal cord regeneration would be recognized as pioneering. 115 Murray believed that his surgery would work and that time would confirm it. He was convinced he had made an important discovery. It is

158 Surgical Limits possible that there was no intended fraud - that he had deceived himself as well as others in his ability to perform miracles. 'All I have tried to do is help the sick and maimed,' wrote Murray.116 He reacted angrily to accusations of 'experimenting' on humans. These spinal cord operations were not experiments; they were treatments for sick patients, marking Murray as a practitioner rather than a scientist.117 He was less interested in protocol and scientific measurements than in clinical application and results. The fact that several of his patients had improved because of the surgery was enough justification for him to continue. Murray belonged to an earlier generation of clinical investigators. Like his work on cancer, his spinal cord research lacked objective standards, clinical trials, and strict methodology at a time of expanding research specialism and sophistication. On various occasions, Murray refused to collaborate with neuropathologists and neurophysiologists or to share his research data with other specialists in the field.118 His work failed to meet basic scientific criteria that were now standard in surgical research, such as objectivity, measurability, repeatability, avoidance of bias, and ethical soundness.119 His secretive nature worked against his greater goal of enticing others to carry on his work. It also damaged his reputation and left him defenceless against accusations of scientific dishonesty and 'broomcloset' research. Murray's older style of conducting research was unacceptable to the Toronto General Hospital medical authorities, and rightly so. Nevertheless, they might have been more adept at managing the controversy; at times they played into the 'lone wolf imagery of Murray generated by the press. 'In our society one man standing out against the medical establishment, or any other establishment, has large sections of the public on his side. Fair or not, that's the way it works,' said the hospital's information officer K.S. Edey. Moreover, Edey had warned the hospital administrators that 'Dr Murray ... had the status of hero to begin with. He could not be dismissed as a charlatan or a quack.'120 Dr William Drucker played an unpopular but necessary role in revealing the details of Murray's spinal cord operations. An American, installed as professor of surgery and surgeon-in-chief in Toronto in 1966, Drucker had been hired to reorganize the Department of Surgery, specifically to apply the new ideas about medical education and research that had worked at his previous university, Case Western Reserve in Cleveland. Drucker encountered staff resistance. His informality and ideas of democratizing the department ran contrary to the Toronto tradition of formality, seniority, and rites of succession. Considered an

Making Paraplegics Walk Again 159 outsider, he was not particularly well liked by many of his medical colleagues.121 During the spinal cord controversy, Murray took Drucker's public expressions of scepticism personally, later extending his anger and bitterness to include all the senior hospital medical men. 'Nothing but treason and vindictiveness, [they are] trying to annihilate me,' wrote Murray privately. 'The struggle between good and evil is just as vivid today as it was years ago.'122 Drucker found himself in a tough position, swarmed by media people who were eager to keep the controversy alive, and flooded by inquiries from the medical profession for clarification of the procedure. It was inevitable that Drucker would make enemies when he declared Murray's procedure fraudulent. Yet never did he attack Murray personally. Still, he was criticized by some individuals who thought he was too zealous to prove Murray wrong. 'By all means, give the public all the facts about the new spinal operation. But why was Dr Drucker in such haste that he had to make his announcement during the brief period that Dr Murray was out of town? ... Why, through the lack of tact, should a distinguished medical scientist - whose life has been devoted to the sick - be subject to unnecessary humiliation?' argued a Toronto Star reporter.123 At times, hospital and university authorities were noticeably silent, and Drucker alone had to respond to accusations from the media or Murray. As hospital and university authorities saw it, 'he was up to his neck in the affair anyway.124 For ten weeks, the press had released dramatic stories. Journalists had reported the miraculous surgery without checking its validity with the hospital. They as well as the public had congratulated Murray without suspecting otherwise. The media were pro-Murray and anti-establishment, and they only desisted when the facts could no longer be ignored. Then the story was dropped altogether. They had been hoodwinked; they had few qualifications to report medical procedures critically and analytically - little understanding of science or of the ethical issues involved. The result was a great disservice to the public, especially to individuals suffering from paraplegia. It fell upon their doctors to explain medically why the publicized claims were untrue.125 The spinal cord controversy ended Murray's career. He had no one to blame but himself. He had deceived his patients and the public (and possibly even himself at some level) into believing he had made an important discovery and could restore lost function in individuals with spinal cord injury. He had confused his clinical cases with his laboratory experiences, and had balked at those who demanded scientific data.

160 Surgical Limits Although convinced that he was on the right track and could prove it if money were forthcoming, he had rejected Drucker's offer of help, since it involved surrendering control of his research. It was a characteristic inconsistency in his career: he wanted assistance but was never able to relinquish data or direction of his work to more qualified researchers. In the end, he had mistakenly overstated his research and misled the medical community, and this was inexcusable. The authorities had no choice but to expose the truth. Friends and colleagues were deeply saddened by the outcome of the controversy; allegations of fraud and scientific dishonesty seemed unfitting for this surgical pioneer. It was a harsh end to an extraordinary career.126 Murray's work on spinal cord regeneration had relatively little impact on the field of spinal cord injuries. Several years after the controversy, Dr William Windle of New York University called together a small group of neuroscientists to launch a new research effort into the subject. No promises were made. Historically, scientists had dismissed research in this field as a waste of time, but new advances, such as the recently acquired understanding of cellular behaviour, had given rise to more interest in it.127 Late-twentieth-century scientific thinking on spinal cord regeneration involved placing the cord in apposition (as Murray had advocated); preventing the formation of scar tissue; protecting the cord from inflammation or reactions; promoting axon growth by chemical stimulants; and finding a way to control axon growth. In 1980 the First International Symposium on Spinal Cord Reconstruction was held 'to review again the problems of spinal cord regeneration.' New research was presented, including experiments similar to Murray's transection procedure, but no encouraging results towards restoring motor and sensory function were produced. The participants at the conference concluded that despite increased understanding of nerve regeneration and central nervous system processes, 'functional restitution after spinal cord transection remains an unrealised dream.'128 Researchers have continued to study the problem, but experiments conducted as recently as 1997 offered negligible gains towards the goal of repairing severed spinal cords.129 More than three decades after Murray's premature announcement, medical scientists have still not found a cure for paraplegia.

7 Time for Rest: Career Reflections

After the spinal cord controversy, Murray semi-retired. In 1968 he stopped operating and closed his private practice. Until then, he had continued to perform routine general surgery, aided by interns and assistants who enjoyed watching the legendary surgeon in action. Despite the recent public airing of his difficult relationship with the hospital, Murray did not disappear completely from the scene. He was often seen eating lunch in the cafeteria or visiting with former residents and colleagues, even the professor of surgery, W.R. Drucker. As well, he still went to the Toronto Academy of Medicine to attend meetings or use the reference library. He visited with the librarians and frequently shared a cup of tea. It was a period of adjustment for Murray, who for the past forty years had managed a busy surgical practice as well as doing hospital service, teaching, and surgical research. Now only his research remained, which he conducted on a part-time basis. At the Gardiner Foundation laboratory, Murray returned to his cancer research and the theory of immunity. Between 1968 and 1974, he conducted a series of experiments on rats in an effort to provide proof that it was possible and practical to increase immunity against cancer.1 A control group of rats were implanted with Walker 256 sarcoma and all died. Another group of rats were implanted with the same cancer in similar fashion, and when tumour growth reached 2.5 to 3 cm in diameter, they received 1 cc of immune serum daily for five days. According to Murray's records, tumour growth stopped in every rat, and the animals lived with no recurrence of cancer. Another group of rats was 'vaccinated' against cancer for twelve weeks and then implanted with cancer. Seventeen of twenty-six rats did not develop tumours. Rats immunized for periods less than three months did not fare as well. One

162 Surgical Limits group of rats that had developed cancer, been treated, and recovered were bled. Their blood was given to rats newly injected with tumour material to test whether blood from immune rats could be used. The experiment worked; tumour growth receded and the rats lived. Another group of rats with advanced cancer were given the immune serum. Tumour growth was slowed but there were no survivors. Many experiments were repeated with hamsters with similar results. From this lab work, Murray concluded that if serum and vaccine treatments were administered before the development of late stages of cancer, the animals survived the cancer.2 During the early 1970s, Murray treated several cancer patients with his anticancer serum and obtained similar results to those of his earlier clinical cases.3 One such 'success' case was Mrs G, age forty-seven, who had suffered a recurrence of cancer three years after a radical mastectomy. Since she did not live in Toronto, her local physician administered the serum treatment, as advised by Murray by phone, beginning in June 1974. Her therapy lasted well over a year. She experienced healthy, painfree periods as well as bouts of chills, headaches, and reaction to the serum. Overall her pain was reduced and tumour growth was stopped temporarily.4 But by 1975, Murray had difficulties providing Mrs G with a continual supply of his serum. He was no longer producing it at the Gardiner Foundation. By this time, his laboratory staff consisted only of Cecil Wilding, the caretaker who lived in the upstairs apartment. Contracting out the work, Murray paid boarding fees at a nearby stable for the foundation's only horse, and an hourly wage to a stable employee to inject and bleed the horse. He then made arrangements with the Connaught Laboratories to prepare the serum.5 Mrs G. died while still receiving sporadic serum treatments. Few people were aware of these later clinical treatments, for Murray could not get his work published. The American Journal of Surgery, Cancer Research, Cancer, the International Journal of Cancer, and the Canadian

Medical Association Journal all rejected his articles on immunity in cancer. The reviewers commented that Murray's investigations were described in the most general terms, with no particulars of the methodology, thus making it almost impossible for other researchers to repeat his experiments in order to confirm or refute his conclusions. They found fault with Murray's standards, form, controls, and evaluation as a researcher.6 His results were not made known until after his death, when an obscure Italian medical journal, Panminerva medica, published his work.7 By 1970 Murray's laboratory operating expenditures had been re-

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duced to a lean $10,000 a year as a result of the Bickell Foundation's decision to decrease its funding. Murray was finding it more and more difficult to meet his research costs. He hated trying to eke out enough money each year in order to do his work.8 Members of the business community and former patients, aware of Murray's chronic lack of funding, made small personal donations, ranging from $100 to $5,000.9 9 Ifit had not been for these gifts, secured mostly through the efforts of Murray's friends, the Gardiner Foundation would have closed years earlier. Yet it was only a temporary solution to a much larger problem. Business friends of Murray's recommended that he retain someone to sort out his financial records, outlining a budget and making plans on how to secure the appropriate amount of money. 'This will relieve you of a great deal of the burden of ways and means and leave you free to pursue the more important objectives of the foundation,' urged one supporter. 10 Murray ignored the advice. In any case, concern over his age, isolation, and field of research, expressed by the medical community and others, was enough to make philanthropists shy away from investing money in his various projects. Only on one occasion did Murray submit a formal grant application for funding, and he did so only after much prodding by influential friends. In 1972 Governor General Roland Michener arranged for Robert M. Taylor, the executive director of the National Cancer Institute of Canada (NCIC), to meet Murray and himself to discuss possible funding for Murray's cancer research. 11 Murray did not enjoy a close relationship with individuals at the NCIC or at the Ontario Cancer Treatment and Research Foundation — professional criticisms had been exchanged over the years. Murray was disappointed that these agencies had never funded his serum work, especially given the encouraging action of the federal and provincial governments in the mid-1950s. But Murray had never formally applied for funding, because he refused to divulge the details of his proposed experiments. 'He has felt in years past that to do so is to reveal plans which he would prefer remained known only to himself,' stated Taylor.12 However, encouraged by his meeting with Taylor and Michener, Murray submitted a grant application to the NCIC requesting $52,000. The NCIC representative, P.G. Scholefield, returned the application to Murray, asking for more research program details and a further breakdown of costs. He pointed out that the average size of a grant awarded to an individual investigator was only $14,000.13 Murray responded tersely, citing his articles and reiterating much the same infor-

164 Surgical Limits mation as on his original application.14 Scholefield then sent another letter to Murray, politely asking for more details: 'I think you have amplified in your recent letter the nature of your objectives but what we really need is a complete statement of how you propose to achieve these objectives.'15 Scholefield also did something unusual; he sent Murray a copy of a competing grant application requesting approximately the same amount of funding. In contrast to Murray's submission, this investigator had submitted a detailed application. 'I hope this material will give you a much clearer idea of the amount of detail which is required concerning any proposed research program and I must repeat that a similar detailed analysis of the proposed expenditure is also needed,' wrote Scholefield.16 It is unknown whether the investigator of the detailed grant application knew that his submission had been copied and sent to Murray. Regardless, it demonstrated the extent to which Scholefield was attempting to extract a proper grant application from Murray. This preferential treatment was unfair, if not unprofessional, and it was done not because the NCIC liked Murray or favoured his serum research but because it was indulging Roland Michener in his wish to get Murray this funding. Within days, Murray mailed off a short letter expanding on the purpose of his research and including an itemized listing of his costs.17 Normally, the NCIC arranged for a group of ten scientists to congregate in Toronto once a year to review research grant applications, but Taylor agreed to consider Murray's application immediately, without adhering to usual deadlines and procedures.18 Copies of the application were sent to four outside referees - in Sweden, the United Kingdom, the United States, and Canada - who were considered to be experts in the field of immunology.19 All of them ripped Murray's research proposal apart. They were extremely sceptical about his clinical results. Extensive work of the same kind had been done without significant success by others better trained in the field, they wrote, so what made Murray think he would be different? He was out of his league. One reviewer wrote that Murray lacked 'a good understanding of basic immunological mechanisms' and said 'there existed grave deficiencies in the project.'20 Another reviewer reported: 'Dr Murray states that he is now curing rats and hamsters of cancer by treatment with immune sera, and is preventing cancer in these species by vaccination. These are indeed exciting statements but no substantiating data are presented, and since other investigators have had very little success with either immunotherapy of

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established tumours or prevention of autochthonous tumours, one must be sceptical until the data are presented.'21 Based on such damning comments, the NCIC had no choice but to reject Murray's application for funding. In 1973 Floyd Chalmers, courted by Norah Michener (wife of the governor general), expressed interest in donating $30,000 to the Gardiner Foundation. He had a few conditions for Murray to agree to, such as hiring a younger researcher in the field of immunology, securing a secretary to manage office records, and maintaining a closer association with other medical men working in immunology.22 Murray was either unable or unwilling to meet these conditions. The year before, he had sought to hire a younger researcher, a former employee, Eileen Graves. He had told her, 'There is the possibility of expanding the lab and facilities. With the world wide interest in immunity in cancer, we might lead the way to make this a centre to diffuse information and also a great centre for treatment of great numbers of patients. The

nihilistic attitude that stopped the project in the past seems to have subsided and there is a general search in this direction ... Would you consider returning to 73 Homewood to take part in what I hope might become a great institution?'23 Graves, having now completed her medical training, did not accept Murray's offer. Murray approached no one else after this. No new funding emerged, either from the NCIC or from Floyd Chalmers, and increasingly Murray used his own money to pay for his research.24 By this time, the Gardiner Foundation was little more than a rundown house, with outdated research equipment and no staff, under the direction of an eighty-year-old surgeon. Any hope Murray had of leaving as his legacy a thriving independent institute, which supported leading research work by numerous talented scientists and clinicians, was long gone. Support from individuals and smaller foundations eventually dried up, and beset by high taxation and low income, Murray was forced to close the Gardiner Medical Research Foundation on 30 June 1974. The house was sold, all debts were cleared, and what little was left was deposited in the foundation's research account.25 Later that year, Murray terminated his medical practice insurance policy.26 During the 1970s, Murray increasingly spent his time on activities not related to his work. He puttered around the house, tended his apple trees, did more woodworking, and spent more time with his wife Helen.27

166 Surgical Limits He also indulged his love of the outdoors. His good friend John B. Grant, professor of anatomy at the University of Toronto, commented: He would have known the songs and would have known the habits of most birds. He could have also conversed on the stars from the great bear in the north to the southern cross below. He could have discussed the rocks around and what was in them - the trees as well. He would have shown where to look in the spruce trees for bud worms and, unfortunately, he might have found some. He would have identified the various virus diseases on the leaves and would have known how to get rid of them. And, amongst the wild flowers he would have found and distinguished half-a-dozen varieties of clover, some merely by their perfume. A fishing rod in his hand would have been in keeping as well.28

Murray even tried his hand at writing a children's book, entitled 'Sandy' about a stray collie adopted by a family, but it was not particularly well written and was never published.29 In the years following the spinal cord controversy, several people approached Murray in the hope of writing his biography.30 His autobiography, published in the early 1960s, ended with his cancer research, and it was largely an account of his work and highly specialized. The timing was right for a biography for a more general audience. Murray was cooperative with all who interviewed him, but no biography was ever written. His celebrated career also attracted the attention of the dominion archivist, who wrote to Murray to inquire about his personal papers. In his study and garage, Murray stored boxes of patient files, personal and office correspondence, research notes, published and unpublished work, professional societies and associations material, newspaper clippings, and photographs that spanned his entire surgical and research career. An agreement was reached, and Murray's will was amended to include the deposit of his records in the Public Archives of Canada after his death. Almost certainly this arrangement would have pleased Murray. His prominent role in Canadian medicine was recognized and would now be preserved.31 In retirement, Murray and his wife lived more than comfortably. Raised in a family that did not have a lot of money, Murray had cultivated a successful surgical practice in order to ensure financial security for his family. Yet he had not been a society doctor, courting wealthy patients or charging richer patients higher fees to line his own pockets. Indeed, he was known to waive the fee when operating on family, friends,

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colleagues, and charity cases. Murray managed his personal finances well enough to build a country home, purchase farmland, and maintain a cottage on Georgian Bay. The Murrays were well off, but not extravagant, and they lived modestly. Their generosity was discreet. On more than one occasion, Murray offered to assist his surgical interns financially in setting up a practice. In 1975 he donated funds to establish several scholarships, including the Helen Murray Scholarship at the Royal Conservatory of Music of Toronto, the Rosalind Murray Bradford Scholarship at the University of Toronto; and a general scholarship at the Oxford County Board of Education.32 Murray valued education, and having paid his own way through much of his schooling, he sought to provide opportunity for others. In December 1975 Murray and Helen drove to Aylmer, Quebec, to spend Christmas with their daughter Rosalind and her husband and two children. On past visits, Murray had helped his son-in-law chop wood and put in a new oak porch floor. On this trip, he played with his grandchildren and visited with Rosalind. It was a delightful family holiday, but it would be Murray's last. Shortly after his return home, he suffered a massive stroke while having a cup of tea in his favourite easy chair. He was paralysed on one side and became almost totally blind. He was taken to Sunnybrook Hospital but later moved to the Toronto General Hospital. There was little the doctors could do for him. Against resuscitation, Murray died on 7 January 1976 at the age of eighty-one.33 The Murray family opted for a private funeral at the Bloor Street United Church in Toronto. At the request of the family, there was minimal publicity, perhaps because of the unpleasant experiences with the media and the Toronto medical community in the recent past. Numerous residents and colleagues attended the funeral and followed the procession to Paris, Ontario. There, Murray was buried alongside his wife's family, the Toughs. Helen and Rosalind received numerous notes of condolence from both medical and non-medical people around the world.34 One such correspondent wrote: Though I cannot comprehend the feelings you must have at this time, I know that you must realize that he left an unusual legacy that will be perpetuated through the many lives he touched during his active years. He left a host of patients, better for his ministrations, and he set fire to hundreds of students and residents who are now better and more capable than they could have been without their contact with this man. Dr Murray was one of the few 'kings' of medicine and surgery - outstanding in combining

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the traits of energy, enthusiasm - and truly an innovator, in fact a genius with both his hands and brain, and mixed with this a certain lightness and a true compassion for the patients ... His span here with us ... produced a job well done.35

Kind obituaries were printed in newspapers and medical journals, all praising a Canadian surgical pioneer and his numerous medical achievements. In almost all accounts, Murray's controversial cancer serum and fraudulent spinal cord procedure were downplayed or omitted entirely. The exception was a piece in the Globe and Mail. Several medical men were outraged. Dr Arthur Parks called the obituary 'a shocking example of bad taste and an affront to the memory of a very distinguished surgeon.' He told the paper: 'Your account of the controversy that raged over his work on paraplegia was exaggerated beyond all reason ... The entire subject might better have been omitted.' Parks listed the numerous accomplishments and awards that Murray had received throughout his career, and in closing stated: Dr Murray was a superb surgeon who devoted his life to the care of his patients and the advancement of medical and surgical knowledge. Very much an individualist, he was an imaginative thinker who was never content with the status quo but always searching for better ways to relieve suffering humanity. Meticulous in detail, he was unusually kind and considerate of his patients ... No man can deny the tremendous contributions that he made to relieve human suffering.36

In Murray's memory, the family donated the remaining Gardiner Foundation research funds, in the amount of $55,000, to the University of Toronto.37 The Gordon Murray Lecture was established, and it remains an important part of Gallie Day, the clinical meeting in Toronto arranged by the professor of surgery every spring. As intended, the Gordon Murray Lecture provides a venue where young researchers with new ideas, struggling or otherwise, can share their work with others.38 It continues to showcase leading medical scientists each year, and serves to honour one of their own surgical leaders. Ironically, after a lifetime of contention, Murray's final tribute came from the University of Toronto and the Toronto General Hospital. The legacy that Murray wanted to leave did not materialize. He did not develop a leading research institute, nor did he invent or discover any

Time for Rest 169 device, procedure, or cure that would bear his name. In the latter part of his career, he seemed driven to accomplish both of these ambitions. He sought recognition and ways to ensure the continuation of his research after a lifetime dedicated to medicine. Near the end of his career, he became frustrated, even saddened, when he was unable to achieve these goals. While others may be proud of a single accomplishment and do little else thereafter, Murray never seemed able to rest. Perhaps it was his Presbyterian upbringing and his belief in selfimprovement and social responsibility. Throughout his career, he exuded a sense that there was still much to do, exploring ever greater medical possibilities. It was a life lived with great expectations, many successes, and, indeed, disappointments. Murray operated beyond the boundaries, challenging and expanding surgical possibilities in vascular, heart, renal, and transplant surgery. He redefined the limits of surgery through his contributions. He confronted conventional medical practices with innovative approaches, at times defying professional protocol and standards. As he did so, his career rose and fell dramatically - from celebrated blue baby 'miracles' and daring cardiac procedures to controversial anticancer sera and spinal cord regeneration operations. By the end of his career, his reputation lay in tatters. What went wrong? How did such a brilliant career end so tragically? Like many surgical leaders, Murray demonstrated distinct ingenuity and skill, which led to innovation and saved lives. He was unable, however, to translate this leadership role beyond the operating room by becoming, for instance, professor of surgery or obtaining a prestigious research chair. Murray had difficulty working with others and heeding the advice of experts. He blamed his difficulties on professional jealousy and medical politics, refusing to acknowledge his own poor judgment and bad decisions, his ego, and his peculiar perception of persecution in Toronto. Whereas many surgeons fear that they will not know when to quit and may go on operating for too long and may make mistakes, Murray continued to perform surgery until his mid-seventies, as well as conducting research that was, arguably, far afield from his area of expertise. He refused to stop, to admit that new fields of science were emerging or that his time of contributions was over. Most surgeons would have laid down their scalpels years earlier. From the outset of his career, Murray seemed driven to be a great achiever, to do it his way and to do it alone. His individualism, boldness, and ambition were both strengths and weaknesses. In the 1930s and 1940s, these qualities contributed to his success with heparin, vascular

170 Surgical Limits surgery, and heart operations. By the 1950s and 1960s, however, these same characteristics, compounded by poor decisions, became liabilities. His individualism and isolation fostered a misguided self-confidence and a certainty in his research, which had long gone astray. Each accomplishment fuelled his drive for a grander achievement. His commitment and determination to solve many of medicine's complex problems became entangled with his ego and the need to secure research sponsors. He came to believe his own press, and it was his undoing. 'Every great discovery is made always by one man alone,' reflected Murray in his autobiography. He admired Louis Pasteur, Joseph Lister, and Frederick Banting for their contributions, respectively, on bacteria and infection, the practice of antisepsis in surgery, and the discovery of insulin. He identified with their reputed struggle against the medical establishment. Individual hard work and imagination may bring forth innovation, but not always acceptance. Murray lamented how new ideas and experimental work were often ridiculed and were hardly ever adopted immediately by the profession. He wrote that Lister, 'who had contributed so much in his day and by whose efforts were made possible all the advances in modern surgery, was to walk through the fiery furnace of prejudice in his own profession.' Pasteur's claims got him expelled from most societies of medicine and science in Paris. This, commented Murray, 'has been a common response of organized society or professions to one who has the audacity to introduce a note of progress into an accepted system.' Great men and great discoveries are not always recognized by their contemporaries. Had this not been his own experience? Poorly chosen analogies though these may be, this was how Murray rationalized the harsh professional criticism of his work. More often than not, he believed that his innovative therapies had met resistance if not outright scepticism because of personality conflicts and professional pettiness, not because of medical science. The 'individual with an enquiring mind' must nevertheless persist, wrote Murray.39 Yet the record shows that Murray's individualism was indulged and rewarded for most of his career, both professionally and publicly. His accolades ranged from national and civic awards to medical society honours and peer acknowledgments, predominantly from outside the Toronto medical community. In Toronto, one of Murray's supporters argued that he had brought more attention to the city than anyone since Frederick Banting. Murray loved being likened to Banting. It was a generous reference and an interesting comparison. Like Banting and his discovery of insulin, Murray and his work shared the venerated

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qualities of individualism, boldness, success in the face of adversity, and selflessness in saving dying children. Both men were surgeons, and both conducted their research at the University of Toronto. But whereas Banting reaped copious rewards, Murray felt that the Toronto medical community undervalued his own work. Many of his experimental therapies, such as the artificial kidney machine, were never adopted or realized in the way he had envisioned. Murray remained hurt and disappointed (a disappointment that eventually developed into bitterness and contempt) with the Toronto medical community's failure to promote one of its own - him. The circumstances in which Murray worked also added to his professional demise. Postwar medical research was changing from being 'an activity pursued by a few, lone investigators with little financial aid and institutional support to a profession, carried out by full-time workers in large teams, with systematic governmental funding and established institutional roles.'40 Murray had difficulty working with others, as was demonstrated early in his career with the heparin project. No one, however sympathetic, could work with him, as Herbert Bruce found out. Murray seemed to need absolute control of his projects. Most probably he would have stayed in the Toronto university hospital setting if he had been assured full financial and research autonomy. When this was not possible, he left, hoping to build a large and successful institute, independent of the university, with private funding. The modest lab on 73 Homewood Avenue did not become that institute. For twenty-five years, Murray conducted experiments at the Gardiner Medical Research Foundation before it eventually closed. In the end, it was little more than a third-rate institute, substantially smaller than university laboratories, and representing a desperate attempt to continue his research. It offered Murray the freedom to conduct various research projects, but in the end it further isolated him from the changes occurring in research. He became entrenched as a lone investigator, working with limited equipment and expanding into new areas for which he was not trained. He became increasingly secretive about his investigations and did not make any attempt to coordinate his work with researchers elsewhere. 41 What might have been an alternative to the university research setting failed because Murray was unable to adjust to the many changes occurring in medical research funding and conduct in the postwar period. The university remained the dominant setting for both basic and clinical medical research in Canada - an extramural funding strategy chosen by the Associate Committee on Medical Research of the National Research

172 Surgical Limits Council (later the Medical Research Council). As increased public and private funding was directed towards medical research, a new process of detailed research proposals and reports was put into place. Murray chose not to participate in this system. He belonged to the older generation of researchers who expected support based on their professional standing and past accomplishments, and he refused to disclose his research plans to others. During the 1950s and 1960s, his professional standing among researchers suffered as a result of his controversial work on immunity in cancer and spinal cord regeneration. Over time, his legitimacy as a researcher waned within the medical community, a pattern that became common among investigators who worked outside the university setting. Murray was an original but undisciplined investigator. He was never able to utilize the peer appraisal (at times ruthless) or the self-criticism that is necessary in research. He nearly always experimented on animals before attempting any new procedure on patients, but sometimes he operated on only a few animals, unsuccessfully, before trying the procedure out on patients, as in the case of his kidney transplant work. With his cancer serum, there were no animal tests - a most reckless behaviour by any standard. His serum treatments bordered on quackery, however reluctant the Toronto medical community may have been to admit this publicly. For Murray, the ultimate test for any new procedure or discovery took place in the clinic, not the laboratory. Yet he was disgracefully sloppy in following up successful cases, the most obvious example being Mrs Pezze and her transplanted kidney. According to Marks, 'Considered as an attitude, experimentalism was potentially accessible to all. Considered as a technology, however, experiments were the domain of the few - experts with the training, intelligence, and resources to produce and interpret their findings.'42 Postwar standards of surgical research matched the ethical and methodological standards in any clinical investigative research. By the end of his career, Murray was doing shoddy research by anyone's standards. As a result, he was having difficulty publishing his work in leading medical journals. Murray was more surgeon than scientist, an amateur in an increasingly sophisticated research world. He did not alter his lone style of surgical research and never fully adapted to the new postwar standards of investigation.43 The old-style surgeon was out of place in the changing world of hospital and medical research. At the Caven Foundation he worked on projects that other medical researchers viewed with increasing reservations if not outright scepticism. At the Toronto General Hospital he

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operated around hospital bureaucracy, performing experimental procedures without seeking approval from institutional review committees. To understand what went wrong in this surgeon's career, both his character and the environment in which he worked should be considered. Facilitated by circumstances, Murray's unyielding individualism and his refusal to recognize limits, both in surgery and in his own abilities, are the most striking and constant aspects of what might be referred to as a 'flawed genius' personality.44 In a variety of ways, Murray had an impact on a great number of other lives. To patients, his commitment to medicine and his compassion for the suffering were evident; in their eyes, his skill and abilities as a surgeon were godlike. Thousands of Canadians benefited from his surgical treatments. One such patient was a blue baby toddler about whom Murray wrote: I remember especially one child from Northern Ontario. A great Swedish six-foot-three father had brought his tiny two-and-a-half-year old flaxenhaired daughter to the hospital in a pitiable state of shortness of breath, very great cyanosis and complete disability, so that she had not stood on her feet even in her crib. Then he had returned to his job in the bush country. Everything had gone well with the operation, the child had made a good recovery, and the father was notified to come to pick up his little daughter. As he entered the door of the ward, the child was at the far end of the corridor. He saw the pretty nurse in her starched uniform and her trim nursing cap leading by the hand a tiny little tot, who was jabbering gaily and walking quite freely and joyfully toward the door. With her screams of 'Daddy!' she ran to his enfolding arms, while the great tears rolled down his twitching weather-beaten face.45

This was what Murray was best at - healing by the knife. He operated on the severed limbs of workers, the malformed hearts of children, the damaged kidneys of the uraemic, and the broken backs of paraplegics. His interest lay, above all, in treating patients. For a while at least, it seemed that Murray had indeed brought back the age of miracles. A complex personality, Murray was most often characterized by those with whom he worked as being reserved and a loner. Yet when he chose, he could be affable and witty, and an engaging raconteur. To students, he was a challenging, knowledgeable, and resourceful teacher. To colleagues, nurses, and other medical staff, Murray could be intimidating and sharp-tongued or warm and paternalistic. He frightened some, was

174 Surgical Limits adored by others, and admired by most. To hospital administrators, Murray showed little respect or patience, and they in turn regarded him as difficult. With Helen and Rosalind, Murray enjoyed a close relationship; he loved them deeply. After long hours at the hospital or in the laboratory, home was his safe haven, the one place where he truly rested. But with other people, Murray's characteristics as a good surgeon individualistic, creative, forthright, demanding, precise, and pragmatic - as well as several of his personal traits, made it difficult though not impossible for him to maintain intimate relationships. What was consistent was the time and energy he spent with people who needed him patients, students, family - for whom he cared in varying roles as doctor, teacher, husband, and father. Happiness for Murray came from his family who loved him, the students who shared his passion for surgery, and his patients who went on to lead improved, full lives.

Murray at work in a ward case (Gordon Murray, Surgery in the Making [London, U.K.: Johnson Publications, 1964], n. pag.

Murray at work in the laboratory (Murray, Surgery in the Making, n. pag.)

The Heart and How It Works

The Heart and How It Works. (Reproduced with permission: Your Heart and Hmv It Works, c. 2002, Copyright American Heart Association)

The Blalock-Taussig procedure used by Murray in many blue baby cases. The end of the left subclavian artery was anastomosed to the side of the left pulmonary artery. (Journal of the American Medical Association, Vol 128 [1945])

Murray checking up on a postoperative blue baby patient (Murray, Surgery in the Making, n. pag.)

Murray {front left) and his vertical coil artifical kidney machine (Reprinted with permission from the Saturday Evening Post, c. 1950 [renewed], BFL&MS, Inc., Indianapolis)

Dr William P. Caven, the well-liked Toronto doctor whose bequest provided Murray with a new research environment (Wellesley Hospital Archives)

Dr Herbert A. Bruce: trustee of the Caven bequest and strong supporter of Murray (Wellesley Hospital Archives)

The W.P. Caven Memorial Research Foundation, later renamed the Gardiner Medical Research Foundation, located at 73 Homewood Avenue, Toronto. It served as Murray's private laboratory for twenty-five years. (Wellesley Hospital Archives)

Murray in 1949 (Courtesy of Mrs Rosalind Bradford)

Murray and his family in Brazil (Courtesy of Mrs Rosalind Bradford)

Murray and daughter holding hands in front of plane in Brazil (Courtesy of Mrs Rosalind Bradford)

Murray (in glasses) introducing new cardiac procedures to New Zealand at Green Lane Hospital, Auckland (Murray, Surgery in the Making, n. pag.)

View of a mitral valve operation (Murray, Surgery in the Making, n. pag.

X

Another view of a mitral valve operation, in which Murray can be seen working on the right (Murray, Surgery in the Making, n. pag.)

Murray's kidney transplant operation made sensational front-page news in Toronto on 2 July 1952. (Reprinted with permission from the Toronto Daily Star)

A reunion of the kidney transplant team twenty-one years later. Left to right Dr Walter Roschlau (assistant); Dr Gordon Murray; Mrs Dorothy Pezze (patient); Mrs Reta Macnab (operating room nurse) (Reprinted with permission from the Globe and Mail)

Toronto General Hospital staff at the Murray residence, 1953 (Courtesy of Mrs Rosalind Bradford)

Percy Gardiner: Toronto philanthropist and Murray's benefactor (University Health Network)

Murray remained frustrated with lack of support for his cancer serum research. (Reprinted with permission from the Toronto Daily Star)

Family fun. Left to right, front Mrs Helen Murray, Mrs Ella Murray; back: Gladstone Murray, Rosalind Murray, Ann Murray, Gordon Murray (Courtesy of Mrs Rosalind Bradford)

At the cottage at Pointe-au-Baril on Georgian Bay. The rugged landscape of rock and trees, swimming in the cool waters of Lake Huron, fishing, and the expansiveness of space all appealed to Murray, allowing him to relax physically and mentally. (Courtesy of Mrs Rosalind Bradford)

Throughout his lifetime, Gordon Murray received numerous awards for his 1955. Left to right Gordon Murray, wife Helen, daughter Rosalind, and brother William Murray. (Reprinted with permission from the Globe and Mail)

The spinal cord controversy (Reprinted with permission from the Toronto Daily Star)

Bertrand Proulx: improved mobility after spinal cord procedure (Reprinted with permission from the Toronto Daily Star)

Gordon Murray receiving the Order of Canada from long-time friend Roland Michener, governor general of Canada, 1967 (Courtesy of Dr W.G. Bigelow)

Gordon Murray (1894-1976) (Courtesy of Dr W.G. Bigelow)

Conclusion: Surgical Limits

Gordon Murray's work both shaped and reflected dramatic developments in the practice of surgery, altering medical practice and social expectations in the treatment of diseases and disorders during the twentieth century. In his lifetime, Murray witnessed and in some cases contributed to advances in corrective and curative surgery, innovative diagnostic and therapeutic technologies, and the development of new drugs to prevent, control, and eliminate pain and disease. It was an unprecedented era of breakthroughs that saved more lives than any earlier period. New diagnostic capabilities in medicine came with such technological innovations as electron microscopes, endoscopes, lasers, ultrasound, and computerized imaging. Iron lungs, artificial kidneys, heart-lung machines, and pacemakers offered mechanical solutions to organ disorders. Magic bullets emerged in the form of antibiotics and vaccines to treat syphilis, infection, meningitis, diptheria, tuberculosis, poliomyelitis, and similar diseases. The 'biomedical paradigm of cause and cure' took hold, and society began to expect that the control and conquest of all disease by medical science was only a matter of time.1 Above all, surgery seemed to know no bounds. Surgeons, including Murray, boldly performed previously unthinkable heart, brain, and transplant operations - experimenting, innovating, and saving lives. Murray's time and place in medical history can thus be viewed as a period of redefining limits, specifically surgical limits, but also a dynamic period of surgical research, experimentation, and cures. During the twentieth century, surgery as a therapy expanded from simply cutting out disease (excising tumours) to repairing damaged structures (vascular and heart surgery) and later replacing body parts (organ transplantation). The growth in surgical scope and success was

176 Surgical Limits directly linked to the discipline's ability to manage pain, bleeding, and infection through such innovations as anaesthesia, heparin, and penicillin. For the majority of surgeons in the generation preceding Murray, their caseload most likely consisted of strictly accident and orthopaedic cases, focusing on bones, joints, and superficial tumours. Around 1900, surgeons began to invade the abdomen and the cranium; they operated on bowel inflammations, the pancreas, the liver and biliary tracts, peptic ulcers, gallstones, and a range of cancers. Surgery grew in scope. Several operations became popular - appendectomies, hysterectomies, tonsillectomies - while others were tried but did not become established.2 Surgeons of Murray's generation performed these operations and more. They participated in a new period of restoration and replacement in surgery, and penetrated the most delicate body organs: the heart and brain. With heparin to control the lethal problem of clotting, blood vessel surgery became a reality early in Murray's career. Severed arteries and veins were rejoined or transplanted to restore blood flow - techniques that were transferred to new heart operations. Cardiac surgery developed in steps from limited closed-heart procedures of closing holes and dilating valves to open-heart operations of grafting coronary arteries and valve replacement. Then came the giant leap to transplantation of kidney, liver, marrow, lung, and heart, replacing diseased organs with healthy ones. These successes in the high-profile fields of cardiac and transplant surgery realized surgery's promise, which was also illustrated in surgical advances in thoracic surgery, neurosurgery, plastic (or reconstructive) surgery, orthopaedics, urology, ophthalmology, obstetrics and gyneacology. Unbounded optimism in healing by the knife grew. The generation of surgeons after Murray embraced the minimally invasive operations of laser surgery and 'keyhole' techniques using fibreoptic telescopes and new instruments to reduce exposure of organs. They took advantage of new diagnostic technologies, such as ultrasound and computerized tomography, as well as the vast array of patient-monitoring equipment. Surgeons and engineers worked closely to explore the possibilities of technology, forging new procedures such as hip replacements, cardiac device implants, and numerous prosthetic operations. The era of rebuilding bodies had begun. Today's high-technology operating room and surgical devices contrast greatly with the kitchen table and rudimentary equipment with which operations were often conducted at the beginning of the twentieth century. It was the surgical researcher with a vision of surgical possibilities that

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expanded the boundaries of the discipline by introducing new procedures. In the early decades of the twentieth century, George Crile pioneered direct blood transfusion. Neurosurgeon Harvey Cushing made great gains in brain surgery, delicately removing tumours and tissue with previously unheard-of low mortality rates, and Alexis Carrel devised a technique of vascular anastomosis (joining of vessels). During the 1940s, Baltimore surgeon Alfred Blalock applied his surgical techniques from his hypertension experiments to congenital heart cases, rerouting the greater vessels of the heart to prolong the lives of blue babies. In Britain during the world wars, surgeons Harold Gillies and Archibald Mclndoe operated on disfigured veterans, devising new skin-grafting and remodelling techniques in the management of burns and reconstructive surgery. The American surgeon Joseph Murray pioneered transplant surgery, performing the first operation in 1954 and continuing to research organ rejection and immunosuppression. Several surgical researchers, including the Swede Ake Sening and Americans Michael DeBakey and Denton Cooley, blazed new trails in the implantation of medical devices such as pacemakers and artificial hearts. In Canada, several surgeons in addition to Murray have made noteworthy contributions during the twentieth century. During the Spanish Civil War, Norman Bethune introduced the mobile blood bank to the battlefield, where he performed countless blood transfusions. At the Montreal Neurological Institute, the American-born neurosurgeon Wilder Penfield contributed to the understanding and treatment of various forms of epilepsy and of brain scars resulting from trauma. Neurosurgeon Charles Drake devised new surgical techniques in the repair of ruptured brain aneurysms. Cardiac surgeons Wilfred Bigelow, William Mustard, and Wilbert Keon contributed operative hypothermia, corrective blue babv procedures, and transplant operations. Robert Salter developed an operation for hip dislocation in children. Although this is not an exhaustive list by any means, it represents Canadian surgical innovation in the fields of neurosurgery, cardiac surgery, and orthopaedic surgery in particular, and attests to the significant activity in the field of surgical research in Canada over the past century.3 Good surgical researchers share several attributes: open-mindedness, enthusiasm and determination. Also, they face obstacles that are specific to surgeons. Surgeon-scientists negotiate a balancing act between building and maintaining a surgical practice and spending time in the laboratory doing experimental research. At times, basic scientists have criticized surgical researchers as being unable to conduct meaningful research.

178 Surgical Limits They point to the surgeon's lack of basic research training and insufficient time in the laboratory.4 This simply is not true. One of the strengths of surgical researchers is often their aptitude for research; that is, they tend to be curious people, driven to investigate how things work or how to fix problems, medical or otherwise. However, the surgical persona can also be a weakness in conducting research. The characteristics most used to describe surgeons, such as decisiveness and the ability to act promptly, may work against the patience, thoughtful contemplation, and diligence required for doing good science; and whereas operating focuses on the individual surgeon, good research necessitates communication and collaboration with others. Successful surgical investigators resolve these differences during the course of their careers. The changes in surgery during the twentieth century are evident, but what about the consistencies? The conduct and facilities in undertaking surgical research have become more collaborative and sophisticated, yet surgical innovation towards improved treatment remains the goal. The surgical texts, instruments, and operating tables may have changed over time, yet the tasks of the operator continue to be cutting, joining, removing, and adding to parts of a patient's body. Manual dexterity and technical innovation remain of prime importance. Most clearly, surgeons continue to share a strong belief in the efficacy of their surgical interventions.5 Surgeons seek to cure by the scalpel and to arrest disease if not vanquish it. This reflects a surgical mindset. Anthropologist Pearl Katz observed that 'unlike most physicians, surgeons do not see themselves merely as healers; they see themselves as curers. They are not only frequently convinced that their active interventions may cure or save a patient, they are also convinced that they are the only medical practitioners with the ability to make such heroic interventions.'6 According to Katz, a surgeon's concept of cure is defined by the success of his or her intervention, not necessarily by the elimination of the disease. For example, removing all visible disease, such as a tumour, or repairing malformation or damage, such as a blocked coronary artery, arguably constituted a surgical cure. As a result of this definition of cure and the promotion of surgical solutions, surgeons tend to deny the existence of any limits to their surgery.7 For Murray, who envisioned surgical solutions for a wide range of disorders, the limitations were technical and thus surmountable. At various times in his career, he had in fact proved this. His work on heparin, vascular repair, and heart surgery are examples of Murray's

Conclusion

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surgical research resulting in successful techniques to suture blood vessels and operate on a beating heart. But there were other cases in which a new or improved surgical technique was not enough to correct the problem. Technically, Murray could transplant a kidney, but he failed to understand the body's rejection of the foreign organ. Technically, he figured out how to suture the spinal cord together; fractures, skin grafts, tendons, and incisions heal when splinted or sutured together, he reasoned, so why should not the same principle apply to the spinal cord? But it did not work. Murray's surgical view of the body - as or like a machine and thus consisting of an array of parts — overlooks the complexity of the various physiological systems of the human body and disease. It raises the issue of the part versus the whole and the problem of using the mechanical analogy in understanding human health and disease in the body Surgery presents certain therapeutic limits. Not all surgery is curative. Murray's early heart operations on blue babies were palliative, not corrective. In terms of treating chronic illnesses, surgery can only alleviate symptoms and sometimes postpone death. Furthermore, there still remains no absolute guaranteed outcome for any surgery. Going under the knife always involves some level of risk to the patient. Additional limits in surgery include ideological and cultural ones. Concepts of disease and malformation are not always compatible with the surgical view (body as an array of parts). Nor are surgical definitions of disease and treatment always compatible with cultural beliefs or society's position regarding disease, malformation, and quality of life. Healing by the knife challenges what a society thinks surgery can achieve as medical therapy. People want cures, though their definition of cure is probably different from the surgeon's. Public confidence in biomedical science reached new heights in the postwar era. The media's reporting of surgical triumphs further encouraged society's acceptance of the new operations and other developments. The emerging technological imperative characteristic of twentieth-century medicine - the idea that any technology that may show benefits should be used — was more or less already entrenched in North American values by this time.8 Society's view of surgery was similar. Surgery as life saving struck a chord with the public, reassuring people that surgeons could offer relief against disease and even cure it. Society played a contributing role in the rising power of the surgeon during the twentieth century. The new operations could be successful

180 Surgical Limits only if patients agreed to the experimental procedures. The fears of patients concerning surgery had to be alleviated; the public had to believe in the feasibility of surgical solutions for medical conditions previously treated in other ways. Within the larger context of people's emerging faith in science and technology came their eventual acceptance and, later, strong endorsement of surgical intervention. The media and its reporting of surgical successes played a large part in this process. Their role in shaping lay perceptions can be examined through their laudatory reporting of Murray's endeavours. The media conferred power and authority to surgeons as providers of new, wondrous curative treatments. With this came rising expectations with the public's anticipation of more medical advances. The potential of surgery appeared limitless. Despite the hope of both surgeon and patient, Bertrand Proulx's surgical miracle of being able to walk again never happened. There are no miracles in surgery. Successful surgery reflects knowledge, training, and technology, not supernatural powers. Nor are surgeons to be confused with gods.9 Surgeons are humans, like everyone else, but their foibles can result in harming others. Not all surgeons exercise good skills, judgment, or communication, and no surgery carries a guaranteed outcome. Still, patients continue to hope for miracles, thereby contributing to the powerful image of the surgeon and to the selfconfidence of surgeons, such as Murray, to deliver such results. After his surgery, Proulx remained confined to a wheelchair, but he told other paraplegics, 'Continuer a se batter, ne jamais dire tout est fini.' (Continue to fight, never say it is over.) Writing to Murray in the early 1970s to ask about new procedures to cure his paraplegia, he said, 'Je suis toujours pret.' (I am always ready.)10 Not surprisingly, many patients, like most surgeons, also are reluctant to accept surgical limits after a century of dramatic surgical innovation.

Appendix Dr Gordon Murray's Medical Writings

'Injuries to the Knee Joint.' University of Toronto Medical Journal 7 (May 1930): 222-7 A Method of Palliative Treatment of Carcinoma of the Oesophagus.' Canadian Medical Association Journal (CMAJ) 25 (1931): 271-5 'The Effect of Infection on the Insulin Content of the Pancreas' (with E.T. Waters). Transactions of the Royal Society of Canada, section 5 (1932): 169-72 'Abdomine-Perineal Excision of the Rectum with Primary Healing' (with R.M. Janes). CMAJ 26 (1932): 598-602 'Bone Graft for Non-Union of the Carpal Scaphoid.' British Journal of Surgery 22, no. 85 (1934): 63-8 'Bone Graft for Non-Union of the Carpal Scaphoid.' Surgery, Gynaecology and Obstetrics 60 (February 1935): 540-1 "Gonococcal Tenosynovitis of the Hand' (with J.R.E. Morgan). CAM/34 (1935): 374-5 'Fractures of the Carpal Scaphoid.' CMAJ 34 (1936): 180-2 'Embolism in Peripheral Arteries.' CMAJ 35 (1936): 61-6 'Heparin and Vascular Occlusion' (with L.B. Jaques, T.S. Perrett, and C.H. Best). CMAJ 35 (1936): 621-2 'Heparin and Thrombosis of Veins following Injury' (with C.H. Best, L.B. Jaques, and T.S. Perrett). Surgery 2 (August 1937): 163-87 'Heparin and Thrombosis (the Present Situation)' (with C.H.Best). Journal of the American Medical Association (JAMA), 110 (January 1938): 118-19 'Reconstruction of the Valves of the Heart' (with F.R. Wilkinson and Ross Mackenzie). CMAJ 38 (1938): 317-19 'The Use of Heparin in Thrombosis' (with C.H. Best). Annals of Surgery 108 (August 1938): 163-73

182

Appendix

'Appendicitis.' CAM/41 (1939): 134-8 'Diabetic Infection and Gangrene.' CAM/41 (1939): 246-50 'The Effect of Heparin on Portal Thrombosis: Its Use in Mesenteric Thrombosis and Following Splenectomy' (with Ross Mackenzie) CAM/41 (1939): 38-40 'Heparin in Thrombosis and Embolism.' British Journal of Surgery 27, no. 107 (1940): 567-98 (Royal College of Surgeons Hunterian Lecture, 1939) 'Some Experimental and Clinical Aspects of the Use of Heparin.' Surgery, Gynaecology and Obstetrics 70 (February 1940): 246-9

'Heparin in Surgical Treatment of Blood Vessels.' Archives of Surgery 40 (February 1940): 307-25 'Compression Fractures of the Os Calcis.' CAMJ 42 (1940): 422-4 'A Method of Fixation for Fracture of the Clavicle.' Journal of Bone and Joint Surgery 22 (July 1940): 616-20 'Fixation of Dislocations of the Acromioclavicular Joint and Rupture of the Coraco-Clavicular Ligaments.'CMAJ43(1940): 260-71 'The Use of Heparin in Vascular Surgery.' In Surgery in Modern Warfare, ed. Hamilton Bailey. Edinburgh: E. & S. Livingstone, 1941 'Heparin in Thrombosis and Blood Vessel Surgery.' Surgery, Gynaecology and Obstetrics 72 (February 1941): 340-4 'Postoperative Thrombosis and Embolism' (with Ross Mackenzie). American Journal of Surgery 57 (September 1942): 414-28 'Small Bone Grafts of Extremities.'CMAJ48(1943): 127-39 'Aortic Embolectemy.' Surgery, Gynaecology and Obstetrics 77 (August 1943): 157-62 'Root Neuritis vs. Appendicitis.' CAM/51 (1944): 309-12 'The Use of Longitudinal Wires in Bones in the Treatment of Fractures and Dislocations.' American Journal of Surgery 67 (February 1945): 156-67 'Fractures and Dislocations of Carpus.' In Surgical Treatment of the Motor-Skeletal System, part 2, ed. Frederick W. Baneroft and Clay Ray Murray. Philadelphia: Lippincott, 1945 'The Healing of Arteries and the Relationship to Secondary Haemorrhage.' Surgery 18 (November 1945): 624-7 'Resection of the Rectum with Reconstruction of Canal through the Perineal Approach.' Surgery, Gynaecology and Obstetrics 82 (March 1946): 283-9

'Treatment of Extremities following Sudden Failure of Circulation' (with J.S. Simpson and N.AWatters). Surgery 20 (September 1946): 315-23 'End Results of Bone-Grafting for Non-Union of the Carpal Navicular.' Journal of Bone and Joint Surgery 28 (October 1946): 749-56 'Anti-coagulants in Venous Thrombosis and Prevention of Pulmonary Embolism.' Surgery, Gynaecology and Obstetrics 84 (April 1947): 665-8

Dr Gordon Murray's Medical Writings

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'Anti-coagulant Therapy with Heparin.' American Journal of Medicine 3 (October 1947): 468-71 'The Pathophysiology of the Cause of Death from Coronary Thrombosis.' Annals of Surgery 126 (October 1947): 523-34 'Development of an Artificial Kidney: Experimental and Clinical Experiences' (with E. Delorme and N. Thomas). Archives of Surgery 55 (November 1947): 505-22 'The Tetralogy of Fallot and Its Surgical Treatment.' British Medical Journal 2 (December 1947): 905-8 'Surgical Treatment of Congenital Heart Disease (Tetralogy of Fallot).' CMAJ 58 (1948): 10-12 'Artificial Kidney' (with E. Delorme and N. Thomas). JAMA 137 (August 1948): 1596-9 'Closure of Defects in Cardiac Septs.' Annals of Surgery 128 (October 1948): 843-53 'Artificial Kidney' (with E. Delorme and N. Thomas), British Medical Journal 2 (October 1949): 887-91, 920-1 (The Alexander Simpson-Smith Lecture, Great Ormond Street Hospital in London, England, July 1949) 'Surgical Treatment of Coarctation of the Aorta.' CAM/62 (1950): 241-3 'The Surgical Treatment of Mitral Stenosis.' CMAJ 62 (1950): 444-7 'A Cardioscope.' Angiology 1 (August 1950): 334-6 'Treatment of Mitral Valve Stenosis by Resection and Replacement of Valve Under Direct Vision.' Archives of Surgery 61 (November 1950): 903—12 'Some Dangers of Blood Transfusion.' Angiology 2 (June 1951): 225-6 'Surgical Treatment of Funnel Sternum.' American Journal of Surgery 82 (July 1951): 144-8 'The Surgical Treatment of Mitral Stenosis.' CMAJ 65 (1951): 307-12. (Mayo Foundation Lecture, 1951) 'Surgical Repair of Injuries to Main Arteries.' American Journal of Surgery 83 (March 1952): 480-3 'The Surgical Treatment of Coronary Thrombosis.' CAM/67 (1952): 100-2 'Cardiac Standstill.' CAM/68 (1953): 227-31 'Cardiac Standstill.' Surgery, Gynaecology and Obstetrics 96 (April 1953): 500-1 'Blood Vessel Surgery.' CMAJ 69 (1953): 296-9 'Peripheral Embolism.' Chicago Medical Society Bulletin (November 1953) 'Surgery of Coronary Heart Disease' (with J. Hilario, R. Porcheron, and W. Roschlau). Angiology 4 (December 1953): 526-31 'Grafts in Vessels' (with W. Roschlau). Report to the Fifteenth Congress of the International Society of Surgeons, Lisbon, 1953 'Transplantations of Kidneys, Experimentally and in Human Cases' (with R. Holden). American Journal of Surgery 87 (April 1954): 508-15

184

Appendix

'The Dry Incision.' CAM/71 (1954): 439-40 'Anastomosis of a Systemic Artery to the Coronary' (with R. Porcheron, J. Hilario and W. Roschlau). CMAJ 71 (1954): 594-7 'Experimental Restoration of the Common Bile Duct' (with Jos. M.Janes). CAM/73 (1955): 216-17 'The Clinical Results of Serum Treatment of Carcinoma of Breast.' Bulletin of the Academy of Medicine, Toronto 28 (June 1955): 196-9

'Homologous Aortic-Valve-Segment Transplants as Surgical Treatment for Aortic and Mitral Insufficiency' (with W. Roschlau and W. Lougheed). Angiology 7 (October 1956): 466-71 'Experimental and Clinical Study of New Growth of Bone in a Cavity' (with R. Holden and W.Roschlau). American Journal of Surgery 93 (March 1957): 385-7 'Experiments in Immunity in Cancer.' CAM/79 (1958): 249-59 'A Method of Tendon Repair.' American Journal of Surgery 90 (March 1960): 334-5 'Aortic Valve Transplants.' Angiology 11 (April 1960): 99-102 'A Curette for Embolectomy' with R.O. Heimbecker). American Journal of Surgery 90 (June 1960): 918-20 'Fat Embolism and a Fat Centre.' American Journal of Surgery 100 (November 1960): 676-81 Medicine in the Making. Toronto: Ryerson Press, 1960 (vol. 1 of autobiography) 'The Trend in Medicine.' American Journal of Surgery 103 (February 1962): 155-6 Quest in Medicine. Toronto: Ryerson Press, 1963 (vol. 2 of autobiography) Surgery in the Making. London, England: Johnson Publications, 1964 (British edition of condensed two-volume autobiography) 'Experiments in Host Resistance to Cancer.' American Journal of Surgery 109 (June 1965): 763-4 'Regeneration in Injured Spinal Cord.' American Journal of Surgery 109 (April 1965): 406-9 'Surgery for Massive Myocardial Infarcation: An Experimental Study of Emergency Infarctectomy' (with R.O. Heimbecker, C. Chen, and N. Hamilton). Surgery 61 (January 1967): 51-8 'Durability and Fate of the Fresh Aortic Allograft Valve in the Descending Aorta' (with R.O. Heimbecker, M.D. Silver, and H.E. Aldridge). Chapter in book, 16 March 1971 'Surgical Treatment of Paraplegia.' Panminerva medica 14 (September-October 1972): 296-303 'Immunity in Cancer.' Panminerva medica 19 (September-October 1977): 357-60

Notes

INTRODUCTION: A SURGEON'S LIFE

1 Poem sent to Murray by grateful patient. National Archives of Canada (NA), D.W.G. Murray Papers, MG 30, B 110, vol. 38, file 2, Clippings, 1949. 2 Pearl Katz, The Scalpel's Edge: The Culture of Surgeons (Boston: Allyn & Bacon, 1999), 31. 3 James H. Cassedy, Medicine in America (Baltimore: Johns Hopkins University Press, 1991), 140. 4 University of Toronto Archives (UTA), Hannah Institute for the History of Medicine Oral History Collection, vol. 46, Dr D.R. Wilson. 5 UTA. Hannah Institute for the History of Medicine Oral History Collection, vol. 33, Dr W.T. Mustard. CHAPTER 1: RURAL BEGINNINGS

1 Margaret Derrv, Ontario's Cattle Kingdom (Toronto: University of Toronto Press. 2001). 3-13. 2 Illustrated Historical Atlas of Oxford County, Ontario, 1876 (Belleville, Ont., 1972); Oxford County Directory, 1862, 1881, 1895, 1900. 3 Assessment roll for West Zorra Township, 1875. 4 National Archives of Canada (NA), D.W.G. Murray Papers, MG 30, B 110, vol. 49, tile 13, Historic Sketch of the Conway Family.' 5 Census of Canada, 1901, Ontario, Oxford County, West Zorra Township. 6 Illustrated Historical Atlas of Oxford County, Ontario, 18 76 (Belleville, Ont., 1972). 7 Census of Canada, 1901, Ontario, Oxford County, West Zorra Township. 8 Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto

186 Notes to pages 10-15 9 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 3. 10 University of Western Ontario Regional Collections, Oxford County scrapbooks; Stratford Perth Archives, Laing family history. 11 Oxford County Directory, 1900. 12 See Herbert Milnes, 'Zorra's Men of Might,' Oxford Museum Bulletin, no. 6, April 1976. 13 University of Western Ontario Regional Collections, Oxford County scrapbooks. 14 Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 2-13. 15 Stratford Perth Archives, Stratford Collegiate Institute Announcement, 1913-14, and Laing family history; Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto; personal correspondence, Mrs Hilton (Rosina) Morris to author, August 1996; personal correspondence, Mrs Jack (Ann) Scholefield to author, 7 October 1996. 16 Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 13. 17 Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), 3-5. 18 Thomas Neville Bonner, Becoming a Physician: Medical Education in Britain, France, Germany, and the United States, 1750-1945 (New York and Oxford: Oxford University Press, 1995), 347. 19 Ibid., 280-308. 20 Ibid., 292; Michael Bliss, William Osier: A Life in Medicine (Toronto: University of Toronto Press, 1999), chap. 5. 21 R.D. Gidney and W.P.J. Millar, 'The Reorientation of Medical Education in Late Nineteenth-Century Ontario: The Proprietary Medical Schools and the Founding of the Faculty of Medicine at the University of Toronto,' Journal of the History of Medicine and Allied Sciences 49 (1994): 62. 22 University of Toronto Archives (UTA), A83-0036/001, University of Toronto, University Historian, 'Professional Education 1906-32' (unpaginated typescript). 23 J.T.H. Connor, Doing Good: The Life of Toronto's General Hospital (Toronto: University of Toronto Press, 2000), 175-80. 24 Abraham Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (New York: Carnegie Foundation for the Advancement of Teaching, Bulletin no. 4, 1910). 25 J.T.H. Connor, Doing Good: The Life of Toronto's General Hospital (Toronto: University of Toronto Press, 2000), 180-1; W.G. Cosbie, The Toronto General Hospital, 1891-1965: A Chronicle (Toronto: Macmillan of Canada, 1975), 165; R.D. Gidney and W.P.J. Millar, 'Medical Students at the University of Toronto, 1910-40: A Profile,' Canadian Bulletin of Medical History 13 (1996):

Notes to pages 15-19 187 42; Michael Bliss, Banting: A Biography (Toronto: McClelland & Stewart, 1984), 31-2. 26 R.D. Gidney and W.P.J. Millar, Professional Gentlemen: The Professions in Nineteenth-CenturyOntario (Toronto: University of Toronto Press, 1994), 486. 27 University of Toronto, Faculty of Medicine, 'Register of Students, 1920-21'; UTA, box P78-0023(02), Faculty of Medicine, University of Toronto Calendar for the year 1921-2, 35-6; UTA, University of Toronto Calendar, years 1914 to 1921. 28 R.D. Gidney and W.P.J. Millar, 'Medical Students at the University of Toronto, 1910-40: A Profile,' Canadian Bulletin of Medical History 13 (1996): 32, 34-5. 29 UTA, box P78-0021 (30), Faculty of Medicine, University of Toronto Calendar for the year 1916-17, 433. 30 UTA, box P78-0021 (29), Faculty of Medicine, University of Toronto Calendar for the year 1915-16, 27-8. 31 G.W.L. Nicholson, The Gunners of Canada: The History of the Royal Regiment of Canadian Artillery, vol. 1: 1534-1919 (Toronto: McClelland & Stewart, 1967), 239. 32 NA, RG 150, Military Service Records: WWI, Ace. 1992-93/166, box 652515. D.W.G. Murray, no. 02985. 33 (>,W.L. Nicholson, The Gunners of Canada: The History of the Royal Regiment of Canadian Artillery, vol. 1: 1534-1919 (Toronto: McClelland & Stewart, 1967), 246-53. 34 Ibid., 246-53; NA, RG 150, Military Service Records: WWI, Ace. 1992-93/ 166, box 6525-15, D.W.G. Murray, no. 02985. 35 G.W.L. Nicholson, The Gunners of Canada: The History of the Royal Regiment of Canadian Artillery, vol. 1: 1534-1919 (Toronto: McClelland & Stewart, 1967), 277-83, 389. 36 1 thank Professer Jack Hyatt, military historian, for this information. 37 NA, RG 150, Military Service Records: WWI, Ace. 1992-93/166, box 652515, D.W.G. Murray, no. 02985. 38 G.W.L. Nicholson, Official History of the Canadian Army in the First World War: Canadian Expeditionary Force, 1914-1919 (Ottawa: Queen's Printer, 1962), 489-90. 39 NA, RG 150, Military Service Records: WWI, Ace. 1992-93/166, box 652217, A.A. Murray, no. 332880. 40 NA, RG 150, Military Service Records-WWI, Ace. 1992-93/166, box 654328, W.P. Murray, no. 653. 41 NA, RG 150, Military Service Records: WWI, Ace. 1992-93/166, box 652410, G.R. Murray, no. 2707098.

188

Notes to pages 19-23

42 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 13-15; information also provided by the Murray family. 43 R.D. Gidney and W.P.J. Millar, 'Medical Students at the University of Toronto, 1910-40: A Profile,' Canadian Bulletin of Medical History 13 (1996): 42. 44 UTA, Torontonensis, 1914 to 1921, and University of Toronto Calendars, years 1914 to 1921; Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto. 45 'Veteran Stratford Medical Doctor, Lorne F. Robertson, Celebrates 73rd Birthday,' c. 1949, and 'Prominent Stratford Doctor Dr Lorne F. Robertson, Dead,' Stratford Beacon-Herald, 27 October 1952. See Stratford Perth Archives, Stratford, Ont., Clipping Book no. 3, 85. 46 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 16-17. 47 As quoted from Joan Cassell, who stated that a good surgeon needs to know 'when to operate, when to stop cutting, and how to take care of what you did.' See Joan Cassell, Expected Miracles: Surgeons at Work (Philadelphia: Temple University Press, 1991), 15. See also William A. Nolen, The Making of a Surgeon (New York: Random House, 1968), and Richard Selzer, Letters to a Young Doctor, 2nd ed. (New York: Harcourt Brace, 1996). 48 Roy Porter, The Greatest Benefit to Mankind (London: W.W. Norton, 1987), chap. 19. 49 Brief summary of modern surgical developments taken from Frederick F. Cartwright, The Development of Modern Surgery (London: Arthur Barker, 1967); Richard Meade, An Introduction to the History of General Surgery (Philadelphia: W.B. Saunders, 1968); Robert G. Richardson, Surgery: Old and New Frontiers (New York: Charles Scribner's Sons, 1968); Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Surgery: From Empiric Craft to Scientific Discipline (Minneapolis: University of Minnesota Press, 1978); W.F. Bynum and Roy Porter, eds., Companion Encyclopedia of the History of Medicine (London and New York: Routledge, 1993); Roy Porter, The Greatest Benefit to Mankind (London: W.W. Norton, 1987), chap. 19. 50 Definitions taken from the Oxford Medical Dictionary, 4th ed. (Oxford University Press, 1994). 51 Donald Pollock, 'Training Tales: U.S. Medical Autobiography,' Cultural Anthropology 11(December 1996): 343, 350; William Nolen, The Making of a Surgeon (New York: Random House, 1968); Elizabeth Morgan, The Making of a Woman Surgeon (New York: Berkely Books, 1980). 52 Joan Cassell, Expected Miracles: Surgeons at Work (Philadelphia: Temple University Press, 1991), chap. 1; Pearl Katz, The Scalpel's Edge: The Culture of Surgeons (Boston: Allyn & Bacon, 1999), chaps. 2 and 4.

Notes to pages 23-8 189 53 Helen Clapesattle, The Doctors Mayo (Minneapolis: University of Minnesota Press, 1941); Victor Johnson, Mayo Clinic: Its Growth and Progress (Bloomington, Minn.: Voyagcur Press, 1984). 54 Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 210-11; Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 22. 55 Gert H. Brieger, 'Surgery,' in The Education of American Physicians: Historical Essays, ed. Ronald L. Numbers (Berkeley: University of California Press, 1980), 199-201. 56 Robert A. Macbeth, 'The "Pre-Gallie Course" Surgical Training Program at the University of Toronto,' Annals of the, Royal Society of Physicians and Surgeons of Canada (RCPSC) 32 (April 1999), 169-73. 57 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, file 5. 58 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, files 4, 5, and 6. 59 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 26-45. 60 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, file 5. 61 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 33. 62 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 35, 'Royal College of Surgeons: New Fellows,' Times (London), 11 June 1926; UTA, D.W.G. Murray file, A73-0026/343(68), 'Canadian Doctor Wins Honor by His Studies in Britain,' Globe (Toronto), 13 July 1926. 63 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, file 5. 64 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 42. 65 NA, W.E.G. Murray Papers, MG 30, E 186, vol. 14, Scrapbook, article by James Wedgwood Drawbell, 'Canada's New Radio Head,' Maclean's, 15 November 1936, 66; NA, W.E.G. Murray Papers, MG 30, E 186, vol. 2, biographical file, article by Carleton J. Ketchum, 'Responsible Enterprise Has Important Function,' Observer, 28 December 1961, 7. 66 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 46. 67 Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto. 68 NA, D.W.G. Murray Papers, MG 30, B 110, file 5, 'Correspondence Gordon Murray to C.L. Starr, 1 October 1926,' and 'Correspondence F.N.G. Starr to Lorne Robertson, 19 October 1926.' 69 Joel D. Howell, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (Baltimore: Johns Hopkins University Press, 1995), 21-9. 70 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 49. 71 Personal interviews by author. 72 Gordon Murrav, Medicine in the Making (Toronto: Ryerson Press, 1960), 50-2.

190 Notes to pages 29-34 CHAPTER 2: TORONTO APPOINTMENT

1 J.T.H. Connor, Doing Good: The Life of Toronto's General Hospital (Toronto: University of Toronto Press, 2000), chap. 5. 2 University of Toronto Archives (UTA), A83-0036/001, University of Toronto University Historian, 'Professional Education 1906-32,' (unpaginated typescript); Thomas Fisher Library, University of Toronto, Academy of Medicine Collection, biographical files, 0597 Duncan Graham; W.G. Cosbie, The Toronto General Hospital, 1819-1965: A Chronicle (Toronto: Macmillan of Canada, 1975), 167-9; Robert Kerr and Douglas Waugh, Duncan Graham: Medical Reformer and Educator (Toronto: Dundurn Press, 1989); J.T.H. Connor, Doing Good: The Life of Toronto's General Hospital (Toronto: University of Toronto Press, 2000), 206. 3 A.B. McKillop, Matters of Mind: The University in Ontario, 1791-1951 (Toronto: University of Toronto Press, 1994), 349-52. 4 Pearl Katz, The Scalpel's Edge: The Culture of Surgeons (Boston: Allyn & Bacon, 1999), 12. 5 W.G. Cosbie, The Toronto General Hospital, 1819-1956: A Chronicle (Toronto: Macmillan of Canada, 1975), 173-4. 6 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 55. 7 Ibid. 8 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 56. 9 Pearl Katz, The Scalpel's Edge: The Culture of Surgeons (Boston: Allyn & Bacon, 1999), chap. 5. 10 W.G. Cosbie, The Toronto General Hospital, 1819-1965: A Chronicle (Toronto: Macmillan of Canada, 1975), 195-6; Thomas Fisher Library, University of Toronto, Academy of Medicine Collection, biographical files, 1539 N. Shenstone and 0802 R.M.Janes; personal interviews by author. 11 UTA, A89-0030/001, Department of Surgery, file 1, Staffing Estimates; W.G. Cosbie, The Toronto General Hospital, 1819-1965: A Chronicle (Toronto: Macmillan of Canada, 1975); Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 55-6, 64. 12 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 64-5. 13 'Murray-Tough,' Globe (Toronto), 20 August 1928; UTA, D.W.G. Murray file, A73-0026/343(68); Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996. 14 National Archives of Canada (NA), D.W.G. Murray Papers, MG 30, B 110, vol. 49, file 4, Correspondence, Norah Michener to Ethel Kerr, 13 January 1958; Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996.

Notes to pages 35-7 191 15 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 66. 16 Ibid. 17 See Robert A. Macbeth, 'The "Pre-Gallie Course" Surgical Training Program at the University of Toronto,' Annals RCPSC 32 (April 1999): 169-73. 18 Thomas Fisher Library, University of Toronto, Academy of Medicine Collection, biographical Files, 1620 C.L. Starr; W.G. Cosbie, The Toronto General Hospital, 1819-1965: A Chronicle (Toronto: Macmillan of Canada, 1975), 169-75; Herbert A. Bruce, Varied Operations (Toronto: Longmans, Green, 1958), 127-32. The Gallie Club, William Edward Gallie: Surgeon, Seeker, Teacher, Friend (Toronto: University of Toronto Press, 1978), 1-17. 19 W.E. Gallie and A.B. LeMesurier, 'The Use of Living Sutures in Operative Surgery.' Canadian Medical Association Journal (CMAJ) 11 (1921): 504-23, 'Clinical and Experimental Study of Free Transplantation of Fascia and Tendon,' Surgery 4 (1922): 600-12, 'Living Sutures in Treatment of Hernia,' CMA] 13 (1923): 469-80, 'Transplantation of Fibrous Tissue in Repair of Anatomical Defects,' British Journal of Surgery 12 (1924): 289-320, and Use of Free Transplants of Fascia as Living Sutures in the Treatment of Hernia,' Archives of Surgery 9 (1924): 526-9. 20 H. Troidl et al., eds., Surgical Research: Basic Principles and Clinical Practice, 3rd ed. (New York: Springer, 1998); Wiley W. Souba and Douglas W. Wilmore, Surgical Research (New York: Academic Press, 2001). 21 National Archives of Canada (NA), D.W.G. Murray Papers, MG 30, B 110, vol. 36, file 1, Experiment Notebook: Early Work, 1928-32; D.W.G. Murray, 'Injuries to the Knee Joint,' University of Toronto Medical Journal 7 (May 1930): 222-7. 22 D.W.G. Murray, 'A Method of Palliative Treatment of Carcinoma of the Oesophagus,' CMAJ 25 (1931): 271-5. 23 D.W.G. Murray, Bone Graft for Non-Union of the Carpal Scaphoid,' British Journal of Surgery 22, no. 85 (1934): 63-8, 'Bone Graft for Non-Union of the Carpal Scaphoid,' Surgery, Gynaecology and Obstetrics 60 (February 1935): 540-1, Fractures of the Carpal Scaphoid,' CMAJ 34 (1936): 180-2, and Medicine in the Making (Toronto: Ryerson Press, 1960), 68—9. 24 D.W.G- Murray, Bone Graft for Non-Union of the Carpal Scaphoid,' Surgery, (Gynaecology and Obstetrics 60 (February 1935): 540, n. 1. 25 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 69, n. 1. 26 See D.W.G. Murray, 'A Method of Fixation for Fracture of the Clavicle,' Journal of Bone and Joint Surgery 22 (July 1940): 616-20, 'Fixation of dislocations of the Acromioclavicular Joint and Rupture of the Coraco-Clivicular Ligaments,' CMAJ 43 (1940): 260-71, 'Small Bone Grafts of Extremities,'

192

Notes to pages 38-40

CMAJ 48 (1943): 127-39, and 'The Use of Longitudinal Wires in Bones in the Treatment of Fractures and Dislocations,' American Journal of Surgery 67 (February 1945): 156-67. 27 A Text Book of Physiology (1987), 21, quoted in James A. Marcum, 'Discovery of Heparin: Contributions of William Henry Howell and Jay McLean,' American Physiology Society 7 (October 1992): 238. 28 Medical definitions taken from W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990), 26-7; Jack Hirsh and Elizabeth A. Brain, Hemostatsis and Thrombosis (New York: Churchill Livingstone, 1983), 5-18; Oxford Concise Medical Dictionary, 4th ed. Oxford: Oxford University Press, 1994), 79; Penguin Medical Encyclopedia, 4th ed. (New York: Penguin Books, 1996), 94. 29 Ronald J. Baird, 'Give Us the Tools ...: The Story of Heparin - As Told by Sketches from the Lives of William Howell, Jay McLean, Charles Best and Gordon Murray, Journal of Vascular Surgery 11 (January 1990): 5. 30 See Best's definition of heparin in C.H. Best, 'Preparation of Heparin and Its Use in the First Clinical Case,' Circulation 19 (January 1959): 84. 31 Ronald J. Baird, 'Give Us the Tools ...: The Story of Heparin - As Told by Sketches from the Lives of William Howell, Jay McLean, Charles Best and Gordon Murray,' Journal of Vascular Surgery 11 (January 1990): 4—18; W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGrawHill Ryerson, 1990); James A. Marcum, 'Discovery of Heparin: Contributions of William Henry Howell and Jay McLean,' American Physiology Society 7 (October 1992): 237-42. 32 W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990): 31. 33 A. Charles and D. Scott, 'Studies on Heparin: I. The Preparation of Heparin,' Journal of Biological Chemistry 102 (1933): 425, 'Studies on Heparin: II. Heparin in Various Tissues,' Journal of Biological Chemistry 102 (1933): 431, and 'Studies on Heparin: III. The Purification of Heparin, 'Journal of Biological Chemistry 102 (1933): 437. 34 Charles H. Best, 'Preparation of Heparin and Its Use in the First Clinical Cases,' Circulation 19 (January 1959): 83; W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990): 39. 35 Thomas Fisher Library, University of Toronto, C.H. Best Papers, MS coll. 241, box 70, Heparin Correspondence 1930-72, file 70-8, 'December 1935,' Gordon Murray to C.H. Best, 20 December 1935. 36 Charles H. Best, 'Preparation of Heparin and Its Use in the First Clinical Cases,' Circulation 19 (January 1959): 81; James A. Marcum, 'The Development of Heparin in Toronto,' Journal of the History of Medicine vol. 52 (July 1997): 334-5.

Notes to pages 4 0 - 2

193

37 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 75-6, 77. 38 Murray's surgical procedure to produce injury and thus clotting (replicating a thrombotic condition) that became his experimental model was to insert a thread up the vein and then crush the vessel with artery forceps. The thread was then removed, stripping the lumen, and the wound was closed by silk sutures. 39 To determine the onset of clotting, Murray used a 'coagulometer' — a device designed two decades earlier. A picture and detailed description of the coagulometer is provided in D.W.G. Murray, L.B. Jaques, T.S. Perrett, and C.H. Best, 'Heparin and Thrombosis of Veins Following Injury,' Surgery 2 (August 1937): 164-6. This was not a new invention. As Murray states, the principle of his coagulometer was similar to that developed by W.B. Cannon and W.I.. Mendenhall ('Factors Affecting the Coagulation Time of Blood. I. The Graphic Method of Recording Coagulation Used in These Experiments,' American Journal of Physiology 34 [ 1914]: 225) and modified by S.B. Stoker ('Coagulation Time of Normal Human Blood,' Journal of Physiology 82 | 19.84]: 8). 40 D.W.G. Murray, 'Kmbolism in Peripheral Arteries,' CMAJ 35 (1936): 61-6; D.W.G. Murray, L.B. Jaques, T.S. Perrett, and C.H. Best, 'Heparin and Vascular Occlusion,' CMAJ 35 (1936): 621-2, and 'Heparin and Thrombosis of Veins Following Injury,' Surgery 2 (August 1937): 163-87; W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990): 43-50. 41 McMaster UniveRSity Archives, Oral History Collection, L.B.Jaques interviews, Louis Barker Jaques: Experiences as a Medical Scientist,' interview no. HCM 13-80 transcript: L.B. Jaques no. 2 conducted by Charles G. Roland, 23 Oct. 1980; interview no. HCM 1-81/ transcript: L.B.Jaques no. 3 conducted by Charles G. Roland, 9 January 1981. 42 Connaught Labor atones Archives, Heparin Papers, Correspondence, L.B. jaques to J.F.W. Ferguson, 20 February 1986. 43 L.B. Jaques, Reminiscences on Completing Twenty-five Years of Research in the Blood Coagulation Field,' University of Saskatchewan Medical Journal 4 (1960): 5. 44 (lonnaught LaboRAtories Archives, Heparin Papers, Correspondence, J.F.W. Ferguson to L.B. Jaques, 9 January 1987, and L.B.Jaques toJ.F.W. Ferguson, 17 January 1987; UTA, employment personnel card. 45 W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990), 50. 46 McMaster University Archives, Oral History Collection, L.B. Jaques interviews. 1 ouis Barker Jaques: Experiences as a Medical Scientist,' interview

194

Notes to pages 42-5

no. HCM 13-80/ transcript: L.B. Jaques no. 2 conducted by Charles G. Roland, 23 October 1980, 15. 47 Connaught Laboratories Archives, Heparin Papers, Correspondence, L.B. Jaques toJ.F.W. Ferguson, 17 January 1987. 48 Connaught Laboratories Archives, Heparin Papers, Correspondence, L.B. Jaques to J.F.W. Ferguson, 27 December 1986. 49 Connaught Laboratories Archives, Heparin Papers, Correspondence, L.B. Jaques toJ.F.W. Ferguson, 20 February, 21 March, and 27 December 1986. 50 D.W.G. Murray, L.B. Jaques, T.S. Perrett, and C.H. Best, 'Heparin and Thrombosis of Veins Following Injury,' Surgery 2 (August 1937): 173, 185. 51 D.W.G. Murray, L.B. Jaques, T.S. Perrett, and C.H. Best, 'Heparin and Vascular Occlusion,' CMAJ 35 (1936): 621. 52 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 39, file 2, note, 1936. 53 D.W.G. Murray, L.B. Jaques, T.S. Perrett, and C.H. Best, 'Heparin and Thrombosis of Veins Following Injury,' Surgery 2 (August 1937): 175-7; 183-4; Hannah Institute for the History of Medicine Oral History Collection, vol. 33, Dr W.T. Mustard, 30. 54 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 89-92. 55 'Doom of Thousands - Blood Clot Declared - Overcome in Toronto,' Toronto Star, 4 November 1937. 56 W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990), 56, 87. 57 As early as 1931, Thomas Belt had reported that pulmonary embolism was present in 14 per cent (not 1 per cent as previously thought) of routine autopsies at Toronto General Hospital. See T.H. Belt, 'Thrombosis and Pulmonary Embolism,' American Journal of Pathology 10 (1934): 129-44; W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGrawHill Ryerson, 1990): 62. 58 D.W.G. Murray, 'Embolism in Peripheral Arteries,' CMAJ 35 (1936): 61-6. 59 D.W.G. Murray, L.B. Jaques, T.S. Perrett, and C.H. Best, 'Heparin and Thrombosis of Veins Following Injury,' Surgery 2 (August 1937): 177. 60 W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990), 104-6. 61 H.E. Rykert and Duncan Graham, 'Some Problems in the Diagnosis, Prognosis and Treatment of Acute Arterial Occlusion,' American Heart Journal 15 (1938): 395-401; W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990), 107-8. 62 William F. Greenwood, unpublished article presented by John Hepburn to

Notes to pages 46-7

195

the annual meeting of the Canadian Medical Association, 1950, cited in W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990), 109-11. 63 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 126. 64 Steven G. Friedman, A History of Vascular Surgery (Mount Kisco, N.Y.: Putura Publishing, 1989), 30, 73-80; Knut Haeger, The Illustrated History of Surgery (London: Harold Starke, 1988), 247-50; Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Surgery: From Empiric Craft to Scientific Discipline. (Minneapolis: University of Minnesota Press, 1978), 264—9. 65 See Shelley McKellar, 'Innovations in Modern Surgery: Alexis Carrel (1873— 1944),' in Creating a tradition of Biomedical Research: The RockefellerUniversity, ed. Darwin H. Stapleton (New York: Rockefeller University Press, forthcoming); Theodore I. Malinin, Surgery and Life: Fhe Extraordinary Career of Alexis Carrel (New York and London: Harcourt Brace Jovanovich, 1979), x. See also W. Sterling Edwards, Alexis Carrel: Visionary Surgeon (Springfield, 111.: Charles C. Thomas, 1974). 66 D.W.G. Murray, 'Heparin in Surgical Treatment of Blood Vessels,' Archives of Surgery 40 (February 1940): 309. 67 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 36, file 2, 'Experiment Notebook: Venous Grafts and Occlusions, 1938-1939.' 68 For example, dog 21 was a female black mongrel, part scotty with hound ears: 'Oct 24/39 - venous graft to right carotid, 500 VH on table, hooked to pump at 12:45 noon, 2:09 pm clotting time 6 minutes, approx 600 cc of saline containing approx 12 VH per cc; 'Oct 25/39 - 1 1 am clotting time 4 min, 800 cc of saline 22 units per cc at 1 1:05 am; 'Oct 26/39 - 10:35 am clotting time 2 hour, 4:00 pm 200 cc normal saline added to flask; 'Oct 27/39 - 10:29 am clotting time 50 minutes; 'Oct 28/39 - dog drowsy not eating, 9:30 am 700 cc saline containing 10 VH per cc; Oct 29/39 - found dead at 10 am; 'Oct 30/39 - considerable oedema of lower jaw area and neck, no gross evidence of bleeding but tissues blood stained, oedema and hemorrhage extended down into superior mediastinum, catheter was out, graft did not leak when water forced through with syringe, when opened was a large frutile [?] vegetation at the proximal end of the graft, the rest of the graft was filled with a dark red semi-solid material, here was a small thrombus clinging to the wall but not pulling the lumen of the artery just above the

196

Notes to pages 47-9

superior ansto [?] of the junction, cause of death septicaemia (had been receiving non-sterile intravenous solutions)' (NA, D.W.G. Murray Papers, MG 30, B 110, vol. 36, file 3, 'Experiment Notebook: Venous Grafts, 1939'). 69 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 36, files 2-7, 'Experiment Notebook: Venous Grafts and Occlusions, 1938-9, Experiment Notebook: Venous Grafts, 1939, Experiment Notebook: Venous Grafts and Aorta Ligation, 1939-40, Experiment Notebook: Coronary Occlusion and Release, 1939-40, Experiment Notebook: Homologous Transplants, 1939-40, Experiment Notebook: Homologous Grafts and Transplants, 1939-40.' 70 D.W.G. Murray, 'Heparin in Surgical Treatment of Blood Vessels,' Archives of Surgery 40 (February 1940): 309. 71 D.W.G. Murray, 'Heparin in Thrombosis and Blood Vessel Surgery,' Surgery, Gynaecology and Obstetrics 72 (February 1941): 341. 72 Ibid., 342. 73 'Heparin Saves Girl's Hands after 200-Mile Engine Ride,' Toronto Star, 21 February 1945. 74 In fact, Michael Bliss argues that Best spent much of his career protecting his identity as co-discoverer of insulin. See Michael Bliss, 'Rewriting Medical History: Charles Best and the Banting and Best Myth,' Journal of the History of Medicine 48 (1993): 253-74. 75 McMaster University Archives, Oral History Collection, L.B.Jaques interviews, box 001, Correspondence, L.B.Jaques to M. Bliss, 28 June 1986; W.G. Bigelow Papers, Private Collection, Correspondence, L.B.Jaques to W.G. Bigelow, 25 June 1988. 76 'Doom of Thousands - Blood Clot Declared - Overcome in Toronto,' Toronto Star, 4 November 1937; 'Hopes to Save 1,000 Yearly by Using Heparin in City,' Toronto Star, 19 November 1937; 'Heparin Miracle May Save Limbs of Many in War,' Toronto Star, 18 April 1940. 77 James Marcum argues that insulin and heparin shared a similar research strategy, including the researchers' roles, their research methods and protocols, and the presentation of their results as 'a miracle drug.' See 'Research in the "Best" Tradition,' American Society for the History of Medicine conference, Buffalo, N.Y., May 1996; personal correspondence, James Marcum to author, 5 February 1996. 78 Clarence Crafoord, 'Preliminary Report on Postoperative Treatment with Heparin as a Preventive of Thrombosis,' Ada Chirugia Scandinavia 79 (1937): 407-26. In 1941 Crafoord published a second article on heparin, but it was clear that Murray, with his vast clinical experience, had emerged as the expert in the field. See Clarence Crafoord and Erik Jorpes, 'Heparin as a Prophylaxis against Thromboses,' Journal of the American Medical Associa-

tion 116 (1941): 2831-5.

Notes to pages 49-52 197 79 James Marcum also comments that a 'tension' existed between the two research groups. See James Marcum, 'The Development of Heparin in Toronto, 'Journal ofthe History of Medicine 52 (July 1997): 323. 80 Best makes this very clear in his 1959 article, with little other reference to Jorpes. See C.H. Best, 'Preparation of Heparin and Its Use in the First Clinical Case,' Circulation 19 (January 1959): 83. 81 Connaught Laboratories Archives, Heparin Papers, Correspondence, L.B. faques to J.K.W. Ferguson, 5 May 1986. 82 Ibid., L.B. Jaques to W.G. Bigelow, 17 October 1987. 83 Best's publications include 'Heparin and Thrombosis,' British Medical Journal 2 (1938): 977-84, 'Heparin and Coronary Thrombosis in Experimental Animals,' Lancet 2 (1938): 130-2, and 'Production and Prevention of Cardiac Mural Thrombosis in Dogs,' Lancet 3 (1939): 592-5. 84 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 108. 85 UTA, A86-0025/016, University of Toronto, annual reports, 1939-45, Department of Surgery; W.G. Cosbie, The Toronto General Hospital, 18191965: A Chronicle (Toronto: Macmillan of Canada, 1975), chap. 15. 86 W.T. Mustard, 'The Technique oflmmediate Restoration of Vascular Continuity after Arterial Wounds,' Annals of Surgery 124 (1946): 46, quoted in W.G. Bigelow, Mysterious Heparin: The Key to Open Heart Surgery (Toronto: McGraw-Hill Ryerson, 1990), 96-101. 87 Ronald J. Baird Papers, Private Collection, 'The Development of Cardiac and Vascular Surgery in Canada: Personal and Anecdotal Reflections on an Era,' 41. CHAPTER 3: DELIVERING MIRACLES

1 These statements by Billroth and Paget are often quoted. See Lael Wertenbaker. To Mend the Heart (New York: Viking Press, 1980), 50; Robert G. Richardson, The Scalpel and the Heart (New York: Charles Scribner's Sons, 1970), 27-8. 2 Harris B. Shumaker, Jr, The Evolution oj Cardiac Surgery (Bloomington: Indiana University Press, 1992), 107; Robert G. Richardson, The Scalpel and the Heart (New York: Charles Scribner's Sons, 1970), 99; Christopher Lawrence, Democratic, Divine and Heroic: The History and Historiography of Surgery,' in Medical Theory, Surgical Practice: Studies in the History of Surgery, ed. Christopher Lawrence (London and New York: Routledge, 1992), 33. 3 Stephen L.Johnson, The History of Cardiac Surgery, 1896-1955 (Baltimore: Johns Hopkins University Press, 1970), 3-5; Harris B. Shumaker, Jr, The Evolution of Cardiac Surgery (Bloomington: Indiana University Press, 1992),

198

Notes to pages 53-6

3-16; Robert G. Richardson, The Scalpel and the Heart (New York: Charles Scribner's Sons, 1970), 26-32. 4 Christopher Lawrence, 'Moderns and Ancients: The "New Cardiology" in Britain, 1880-1930,' in The Emergence of Modern Cardiology, ed. W.F. Bynum, C. Lawrence, and V. Nutton (London: Wellcome Institute for the History of Medicine, 1985), 12. See also Christopher Lawrence, 'Democratic, Divine and Heroic: The History and Historiography of Surgery,' in Medical Theory, Surgical Practice: Studies in the History of Surgery, ed. Christopher Lawrence (London and New York: Routledge, 1992), 33. 5 Robert G. Richardson, The Scalpel and the Heart (New York: Charles Scribner's Sons, 1970), 27. 6 Christopher Lawrence, 'Moderns and Ancients: The "New Cardiology" in Britain, 1880-1930,' in The Emergence of Modern Cardiology, ed. W.F. Bynum, C. Lawrence, and V. Nutton (London: Wellcome Institute for the History of Medicine, 1985), 33 and n. 139. 7 Robert Carola, John P. Harley, and Charles R. Noback, Human Anatomy and Physiology, 2nd ed. (Toronto: McGraw-Hill, 1992), 613. 8 Lael Wertenbaker, To Mend the Heart (New York: Viking Press, 1980), 74. 9 American surgeons Elliott Cutler and Claude Beck had experienced failure with this operation in the 1920s, so little else was tried, and a successful and universally accepted procedure for mitral stenosis did not emerge until 1948. See Harris B. Shumaker, Jr, The Evolution of Cardiac Surgery (Bloomington: Indiana University Press, 1992), 107-8; Lael Wertenbaker, To Mend the Heart (New York: Viking Press, 1980), 69-73. 10 Gordon Murray, F.R. Wilkinson, and R. MacKenzie, 'Reconstruction of the Valves of the Heart,' Canadian Medical Association Journal (CMAJ) 38 (1938): 317-19; National Archives of Canada (NA), D.W.G. Murray Papers, MG 30, B110,vol. 36, file 9, Experiment Notebook: Heart Valves. 11 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 135. 12 Hannah Institute for the History of Medicine Oral History Collection, vol. 33, DrW.T. Mustard, 133. 13 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 135. 14 S.C. Mitchell, S.B. Korones, and H.W. Berendes, 'Congenital Heart Disease in 56,109 Births: Incidence and Natural History,' Circulation 43 (1971): 323. 15 Maude E. Abbott, 'Congenital Heart Disease,' reprinted from Nelson Looseleaf Medicine 4 (1932): 207-321, and Atlas of Congenital Cardiac Disease (New York: American Heart Association, 1936); Helen B. Taussig, Congenital Malformations of the Heart (New York: Commonwealth Fund, 1947). 16 Robert Carola, John P. Harley, and Charles R. Noback, Human Anatomy and Physiology, 2nd ed. (Toronto: McGraw-Hill, 1992), 632.

Notes to pages 5 6 - 8

199

1 7 McGill University Archives, Scrapbook for 1941, 152: 'Montreal Doctor Cures Blood Stop,' Gazette (Montreal), 28 June 1941; Montreal Children's Hospital, annual reports, Report of the Department of Surgery for 1940, 46. 18 C. Crafoord and G. Nylin, 'Congenital Coarctation of Aorta and Its Surgical Treatment.' Journal oj Thoracic Surgery 14 (October 1945): 347; R.E. Gross and C.A. Hulhagel, 'Coarctation of the Aorta: Experimental Studies regarding its Surgical Correction.' New England Journal of Medicine 233 (September 1945): 288. 19 Cordon Murray, The Tetralogy of Fallot and Its Surgical Treatment,' British Medical Journal 2 (December 1947): 905, and 'Surgical Treatment of Congenital Heart Disease (Tetralogy of Fallot),' CAM/58 (1948): 10. 20 As mentioned above, the great vessels of the heart are the superior vena cava, the ascending aorta, and the pulmonary trunk. The left and right pulmonary arteries branch off the pulmonary trunk. Off the aorta arch (the top of the ascending aorta), the brachiocephalic, carotid, and subclavian arteries branch off. The Blalock-Taussig shunt therefore connects the pulmonary artery (of the pulmonary trunk) and the subclavian artery (of the aortic arch). See Robert Carola, John P. Harley, and Charles R. Noback, Human Anatomy and Physiology, 2nd ed. (Toronto: McGraw-Hill, 1992), 586. 21 Alfred Blalock and Helen B. Taussig, 'The Surgical Treatment of Malformations of the Heart,' Journal of the American Medical Association (JAMA) 128 (May 1945): 189-202. 22 Dan G. McNamar a, The Blalock-Taussig Operation and Subsequent Progress in Surgical Treatment of Cardiovascular Diseases,' JAMA 251 (April 1984): 2140. 23 Harris B. Shumaker, Jr, The Evolution of Cardiac Surgery (Bloomington: Indiana University Press, 1992), 66-75; W.G. Bigelow, Cold Hearts: The Story of Hypothermia and the Pacemaker in Heart Surgery (Toronto: McClelland & Stewart, 1984), 39. 24 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 30, file 18, Correspondence, I).W.G. Murray to Helen Murray [1946]; Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 201. 25 On 11 March the Toronto newspapers announced that Murray's operation on Isabel Douglas was the first blue baby operation in Canada. This was incorrect. The next day, a small three-paragraph article appeared in the Toronto Daily Star stating that Dudley Ross, surgeon-in-chief of the Children's Memorial Hospital in Montreal, had in fact performed the first blue baby operation in Canada (to correct tetralogy of Fallot) in June 1945. At the time of the article, Ross had operated on three blue babies, only one of whom had survived, with 'just fair' results. See 'Blue Baby Operation in

200 Notes to pages 58-9 1945, Doctor Says,' Toronto Daily Star, 12 March 1946. By October 1949, Ross had performed sixty blue baby operations (substantially less than Murray), with a higher mortality rate of between 15 and 20 per cent (McGill University Archives, RG 38, Faculty of Medicine, box 17, file 233, Scrapbook, 241: 'Blue Baby Feels "Wonderful" Doctors Meeting Here Are Told,' (newspaper unknown), 7 October 1949. Although Murray was not the first Canadian surgeon to perform the operation, he had the greatest volume, success, and notoriety in regard to blue baby surgery. 26 Hannah Institute for the History of Medicine Oral History Collection, vol. 46, Dr D.R. Wilson, 33; Miss Jean Dodds, interview by author, 9 April 1996, Toronto. 27 'Death Follows Canada's First "Blue" Operation,' Globe and Mail, 11 March 1946; 'Blue Baby,' Globe and Mail, 11 March 1946; '"Blue Baby's" Father Hopes Others Won't Be Deterred,' Toronto Star, 11 March 1946; 'Toronto "Blue Baby" Dies: Post-Operation Relapse Defeats Surgical Success,' Evening Telegram (Toronto), 11 March 1946. 28 Miss Jean Dodds, operating room nurse for Murray, remembers how upset he always was when a patient died in the operating room. He found it difficult to see the family when he lost the patient (Jean Dodds, interview by author, 9 April 1996). 29 'Blue Baby No Longer: She Asked for Mother,' Toronto Star, 3 July 1946. 30 NA, D.W.G. Murray Papers, MG 30, B110,vol. 28, file 37, Correspondence, SJ. Evelyn to Ethel Kerr [c. 1958]. 31 'Toronto Doctor Gives Blue Baby "New Heart,"' Globe and Mail, 4 July 1946; '"Blue Baby" Operation Here,' Evening Telegram, 4 July 1946. 32 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 217. 33 Dan G. McNamara, 'The Blalock-Taussig Operation and Subsequent Progress in Surgical Treatment of Cardiovascular Diseases,' JAMA 251 (April 1984): 2140-1. 34 In the foetal heart, the foramen ovale serves as a flap between the two atria. This provides an opening, through the atrial septum, for blood to flow from the right atrium to the left atrium, bypassing the lungs. At birth, the foramen ovale spontaneously closes, sealing the atrial septum. When there is a hole in the ventricular septum, this is an embryonic malformation. See Robert Carola, John P. Harley, and Charles R. Noback, Human Anatomy and Physiology, 2nd ed. (Toronto: McGraw-Hill, 1992), 632. 35 Gordon Murray, 'Closure of Defects in Cardiac Septa,' Annals of Surgery 128 (October 1948), 843. 36 When open-heart surgery arrived, this became the acceptable surgical

Notes to pages 60-1 201 treatment and produced better results because of improved accuracy in locating and completely closing the hole (NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 40, Correspondence, to Murray, 1975. 37 Gordon Murray, "Closure of Defects in Cardiac Septa,' Annals of Surgery 128 (October 1948), 844. 38 Coronal v arteries carry blood to nourish the heart muscle. Valves restrict the flow of blood within the heart to one direction only. The bundle of His, or atrioventricular bundle, is a bundle of heart nerve fibres that transmit contraction waves from the atria, via the AV node, to the ventricles. See Oxford Medical Dictionary, 4th ed. (New York: Oxford University Press, 1994), 55-6, 151,694. 39 'Hole in the Heart Sewn Up: Boy Off for Big Summer,' Telegram (Toronto), 19 June 1948; 'Doctor Sews Up Hole in Heart to Cure Organ's Abnormal Si/.e, London Free Press, 29 May 1948; Gordon Murray, 'Closure of Defects in Cardiac Septa,' Annals of Surgery 128 (October 1948): 848-52. 40 Gordon Murray, 'Closure of Defects in Cardiac Septa,' Annals of Surgery 128 (October 1948): 853. 41 In 1948 Murray reported a mortality rate of 11.3 per cent in a series of sixtytwo blue babv operations. Blalock's mortality rate was 17 per cent in a series of more than two hundred blue baby operations. It was an unfair comparison, but one of the newspapers picked up on it in order to glorify Murray's success in Toronto. See Over 200 Blue Babies Saved in Two Years of Operations,' Exmiing Telegram, 29 November 1946; Alex Henderson, 'Success in 90 p.c. in Dr. Murray's 190 Blue Babies,' Toronto Star, 9 February 1949; Gordon Murray, The Tetralogy of Fallot and Its Surgical Treatment,' British Medical Journal"2.(December 1947): 907-8, and 'Surgical Treatment of Congenital Heart Disease (tetralogy of Fallot),' CM4/58 (January 1948): 11-12. 42 Surgeon Here Wins Acclaim of Continent,' Exiening Telegram, 24 October 1946. 43 Personal correspondence, John W. Scott to author, 24 March 1996. 44 James Maloney, ]r, a surgeon close to Blalock, holds that Blalock 'considered Gordon Murray a close personal friend and had very great admiration for Dr. Murray's creative approach to surgical science' (personal correspondence, Dr James V. Maloney, Jr, to author, 12 December 1996); NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, file 25, Correspondence, Alfred Blalock to D.W.G. Murray, 3 October 1946. 45 According to Murray's daughter, people came from all over the world to observe his operations (Rosalind Bradford, interview by author, lOJuly 1996, Toronto); Roy Greenaway, 'U.S. Surgeons Come to See TorontoCured "Blue Babies,"' Toronto Star, 16 September 1946.

202

Notes to pages 61-2

46 NA, D.W.G. Murray Papers, MG 30, B110,vol. 1, file 1, 'Heart Operations: Patient List, 1946-51.' 47 I refer almost exclusively to newspaper coverage of Murray's heart operations at this time. Radio also highlighted his success. For example, Larry Henderson on CJAD 800 in Montreal started a series called 'Canadians Who Head the Field,' for which Murray, the 'Blue Baby Doctor,' was selected (NA, D.W.G. Murray Papers, MG 30, B110,vol. 48,file5, Clippings: 'New Series,' Montreal Monitor, 26 October 1950). 48 Marilyn Dunlop, interview by author, 18 January 1997; Joan Hollobon, interview by author,18January 1997; Ron Kenyon, interview by author, 19 January 1997; David Spurgeon, interview by author, 18 January 1997. 49 'Gladys Hie, 5, "Blue Baby": Dr. Murray's Third Triumph,' Toronto Star, 3 August, 1946; '"Blue Baby" for 16 Years: Doctor's Skill Frees Girl from Wheel-Chair Prison,' Evening Telegram (Toronto), 8 October 1946; 'Surgeon Plays Santa Claus,' Spectator (Hamilton), 27 November 1946; '"Blue Baby" Home For Yule: Murray's 20th Success,' Toronto Star, 26 December 1946; 'Famed Blue Baby Doctor Reaching One-a-Day Rate,' Toronto Star, 12 July 1948; 'Once "Blue," Now Normal,' Sudbury Daily Star, 16 September 1948. 50 'Hamilton Blue Baby Healed by Daring Heart Operation,' Spectator, 27 November 1946. 51 '19, Was "Blue Baby," She Can Sing Again,' Toronto Star, 13 January 1948. 52 One good example is June Callwood's 'A Day in the Operating Room,' Maclean's, 15July 1953, 8-10, 54. She reports on the nurses, doctors, surgeons, families, and patients at the Hospital for Sick Children, focusing on the blue baby operation performed by W.T. Mustard. The article represents the celebratory tone journalists took towards medical advancements and the men and women responsible, as well as being an attempt to inform the public on these great operations. 53 'Windsor's "Blue Baby" Is Taken to Toronto for Treatment,' Windsor Daily Star, 31 October 1946; 'Hamilton Blue Baby Healed by Daring Heart Operation,' Spectator, 27 November 1946; 'Ardent "Blue Baby" Enjoys Music: Normal Life Foreseen for Marjorie Walker,' Winnipeg Free Press, 22 December 1947; 'Cobalt Kiwanis Pays All Costs for "Blue Baby,"' Timmins Daily Press, 30 July 1947; 'Carleton Place's "Blue Baby" Given New Lease of Life,' Carleton Place Canadian, 22 January 1948; 'Sioux Lookout: "Blue Baby" from Pickle Crow on Way to Toronto,' Daily Times Journal (Fort William), 24 April 1948; ""Blue Baby" Op. a Success: Child Returning June 14,' Daily News (Medicine Hat), 8 June 1948; 'Prairie Blue Baby Arrives for Operation,' Telegram (Toronto), 9June 1948; 'New Year's Happy for N.Y. Blue Baby,' Evening Telegram (Toronto), 3 January 1949; 'Ottawa "Blue Baby" Cured,'

Notes to pages 62-5 203 Ottawa Evening journal, 26 January 1949; 'Calgary "Blue Baby" Flown to Toronto," Edmonton Journal, 16 May 1949; 'Edmonton Blue Baby Here for Operation,' Telegram (Toronto), 15 February 1950; 'Halifax Child Normal alter Heart Operation,' Halifax Mail Star, 9 June 1950; 'N.Z. Girl of 13 Soon Going Home: Her Life Saved by Dr Murray,' Toronto Star, 17 July 1950; "Blue Baby" Doctor Helps Rio Children,' Toronto Star, 16 Sept. 1950. 54 Roy Greenaway, 'l.'.S. Surgeons Come to See Toronto-Cured "Blue Babies,"' Eoronto Star, 16 September 1946. 55 Blue Baby No Longer: She Asked for Mother,' Toronto Star, 3July 1946; 'Toronto Doctor Gives Blue Baby "New Heart,"' Globe and Mail, 4July 1946. 56 'Doll Mary's Only Concern: "Blue Baby" Is Now Pink,' Toronto Star, 22 July 1946, 57 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 13, Correspondence, - to Murray, 1948 58 Ibid. 59 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 13, Correspondence, - to Murray, 1951. 60 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 226-7. 61 Hannah Institute for the History of Medicine Oral History Collection, vol. 46, Dr DR. Wilson, 36-7. 62 Personal correspondence, Denton A. Cooley to author, 27 November 1996. 63 Personal correspondence, C.B. Mueller to author, 11 April 1997. 64 Personal correspondence, William P. Longmire,Jr, to author, 8 December 1996. 65 Personal correspondence, Rosalind Bradford to author, 21 April 1997. 66 Marilyn Dunlop, Bill'Mustard: Surgical Pioneer (Toronto: Hannah Institute and Dundurn Press, 1989), 45-8, 65-8; Thomas Fisher Library, University of Toronto. Academy of Medicine Collection, biographical files, 1235 W.T. Mustard. 67 Commenting on the early blue baby operations of 1938, 1944, and 1945, Bill Mustard stated that this was 'the golden era of heart surgery in which I was fortunate to be in at the beginning. So that's how I became a cardiac surgeon I just fell in love with it, that's all. It was so exciting and the time was so exciting" (Hannah Institute for the History of Medicine Oral History Collection, vol. 33, Dr W.T. Mustard, 73-4). 68 Not. all of the surgical firsts have been presented, only those that represent key operations in the technical or ideological shift from one phase to another as related to Murray's participation in these changes. For example, lor an account of the development of the cardiac pacemaker, invented in

204

Notes to pages 65-7

1952, see Kirk Jeffrey, Machines in Our Hearts (Baltimore: Johns Hopkins University Press, 2001). 69 Sample biographies of these leading heart practitioners include G.Wayne Miller, King of Hearts (New York: Random House, 2000); Harris B. Shumaker, Jr, A Dream of the Heart (Santa Barbara: Fithian Press, 1999); Thomas Thompson, Hearts (New York: McCall, 1971); Lael Wertenbaker, To Mend the Heart (New York: Viking Press, 1980). 70 Kirk Jeffrey, Machines in our Hearts (Baltimore: Johns Hopkins University Press, 2001), 4-6. See also Lynn Payer, Medicine and Culture (New York: Holt, 1988). 71 Gordon Murray, Edmund Delorme, and Newell Thomas, 'Artificial Kidney,' British Medical Journal 2 (October 1949): 887. 72 In January 1946, Murray began conducting his first dog experiments using an early artificial kidney machine. See June Callwood, 'The Amazing Mechanical Kidney,' Maclean's, 15 (August 1949), 21; NA, D.W.G. Murray Papers, MG 30, B 110, vol. 39,file11,Artificial Kidney: Notes (undated), and file 13, Artificial Kidney: Experiment Notes, 1946-7; also vol. 45,file2, Medicine in the Making: Drafts, Notes (undated). 73 The Hopkins artificial kidney machine was crude and dependent on hirudin — an anticoagulant extracted from leeches - to prevent blood clotting outside the body. Hirudin was difficult to work with and often toxic. The First World War interrupted the work of the Hopkins group, and there was little activity on dialysis in the interwar period that followed. One notable exception was German Georg Haas, who attempted the first human hemodialysis in 1924 as well as a second clinical case in 1925. His work gave promising but inconclusive results for the clinical use of the artificial kidney machine. See Allen B. Weisse, 'Turning Bad Luck into Good: The Alchemy of Willem Kolff, the First Successful Artificial Kidney, and the Artificial Heart,' Hospital Practice, 28 February 1992, 109-10. See alsoJJ. Abel, L.G. Rountree, and B.B. Turner, 'On the Removal of Diffusible Substances from the Circulating Blood by Means of Dialysis,' Transactions of the Association of American Physicians 28 (1913): 51; Journal ofPharmacology and Experimental

Therapy 5 (1914): 275, 611. 74 J.T.H. Connor, 'Dutch Technological Migration and North American Commercial Exploitation: Dr Willem Kolff and the Development of the Artificial Kidney,' in Connecting Cultures: The Netherlands in Five Centuries of

Transatlantic Exchange, ed. Rosemarijn Hoefte and Johanna C. Kardux (Amsterdam: Vu University Press, 1994), 281-303; W. Thalhimer, 'Artificial Kidney and Experimental Exchange Transfusion for Reducing Azotemia,' Proceeds of the Society for Experimental Biology and Medicine 37 (1938): 641;

Notes to pages 67-9 205 Patrick T. McBride, Cenesis of the Artificial Kidney (Deerfield, 111.: Baxter Healthcare Corporation, 1987). 75 Cordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 3-4. 76 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 39, file 11, Artificial Kidney: Notes (undated). 77 Cordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 4. 78 Gordon Murray, Edmund Delorme, and Newell Thomas, 'Development of an Artificial Kidnev,' Archives of Surgery 55 (November 1947): 507. 79 Ibid., 512. 80 Ibid., 508-9. 81 June Callwood, 'The Amazing Mechanical Kidney,' Maclean's, 15 August 1949, 36. See also Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 6. 82 As June Callwood correctly notes, 'According to medical practice he could not experiment on a human being until it had been established that he could do no harm because the patient was going to die in any case. Three sets of specialists certified this' ('The Amazing Mechanical Kidney,' Maclean's. 15 August 1949,20). 83 David MacDonald. The Woman in Ward F,' Header's Digest, March 1986, 61-2. 84 The motor ran on a 25-cycle, alternating current - what Murray had in the lab. The Toronto General Hospital ran power on direct current, and the motor was not universal. See Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 7. 85 Jean Dodds, who became the director of nursing at the Toronto General Hospital, was a general duty nurse on Ward F when Murray used his artificial kidney on his first clinical case. She remembers Murray on the ward around the clock and how he had his interns (not Ward F interns) looking alter the patient. It received much attention and was very exciting (Miss Jean Dodds, interview by author, 9 April 1996, Toronto); Dr Murray Enkin, interview by author, 14 November 1996, Hamilton; Dr G.G. Caudwell, interview by author, 13 November 1996, Hamilton; Raymond O. Heimbecker, 'Questions and Reflections: Geraldine's Kidney Machine,' Pharos, Spring 1993, 35. 86 Murray found that the problem had been inadequate washing of the tubing. Mv description of this case and the use of the artificial kidney is taken from Gordon Murray, Edmund Delorme, and Newell Thomas, 'Artificial Kidney/ British Medical Journal 2 (October 1949): 890; David MacDonald, 'The Woman in Ward F,' Reader's Digest, March 1986, 64; Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 8-9; June Callwood, 'The

206

Notes to pages 69-70

Amazing Mechanical Kidney,' Maclean's,15August 1949, 20-1; Greer Williams, 'What You Should Know about Your Kidneys,' Saturday Evening Post, 28 January 1950, 32. 87 Gordon Murray, Edmund Delorme, and Newell Thomas, 'Artificial Kidney,' British Medical Journal 2 (October 1949): 891; Gordon Murray, Edmund Delorme, and Newell Thomas, 'Artificial Kidney,' JAMA 137 (August 1948): 7-11; Gordon Murray, Edmund Delorme, and Newell Thomas, 'Development of an Artificial Kidney,' Archives of Surgery 55 (November 1947): 516— 22. 88 Roy Greenaway, 'Saves Life of Woman, 26, with Artificial Kidney,' Toronto Star, 20 December 1946; 'Artificial Kidney Invented by Former Stratford Doctor,' Beacon Herald (Stratford), 21 December 1946; 'Artificial Kidney Saves Human Life,' Daily Times Journal (Fort William), 21 December 1946; George Mann, 'Artificial Kidneys Snatch Doomed Patients Out of Jaws of Death,' Toronto Star, 6 November 1948; Roy Greenaway, 'Dr Murray's Machine Restores "Dead" Girl: Now She Is a Mother,' Toronto Star, 30 April 1949; 'Sausage Casing Used as Kidney Saves Lives,' Toronto Star, 29 October 1949. 89 Roy Greenaway, 'U.S. Lauds Dr. Murray as New Trail Blazer,' Toronto Star, 21 February 1947. 90 W.G. Cosbie, The Toronto General Hospital, 1819-1965: A Chronicle (Toronto: Macmillan of Canada, 1975), 258; Gordon Murray, Edmund Delorme, and Newell Thomas, 'Artificial Kidney,' British MedicalJournal 2 (October 1949), 887. 91 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 42, file 43, Correspondence, C.F. Kemper to Murray, 6January 1949, and FJ. Wallace (American Cystoscope Makers Inc.) to Murray, 26 October 1948; file 37, Correspondence, Chas. B. Ripstein to Murray, 27 February 1948; file 28, Correspondence, Edwin H. Brown (Allis-Chalmers Manufacturing Company) to Murray, 9 March 1949, and Solomon Goldenberg to Murray, 20 December 1949. 92 NA, D.W.G. Murray Papers, MG 30, Bl 10, vol. 28, file 27, Correspondence, Murray to R.H. Goetz, 28 October 1948. 93 NA, D.W.G. Murray Papers, MG 30, B110, vol. 28, file 28, Correspondence, Murray to Solomon Goldenberg, 27 December 1949. 94 Firms such as Westinghouse Corporation and the Allis-Chalmers Manufacturing Company constructed three and fifteen artificial kidney machines, respectively, but abandoned production in the early 1950s because of cumbersome designs and the expense. The Kolff-Baxter unit of 1956-7 was a better product, cheaper, and market demand existed. See NA, D.W.G. Murray Papers, MG 30, Bl 10, vol. 28, file 30, Correspondence, Edwin H. Brown to Murray, 11 January 1951;J.T.H. Connor, 'Dutch Technological

Notes to pages 70-1 207 Migration and North American Commercial Exploitation: Dr Willem Kolff and the Development of the Artificial Kidney,' in Connecting Cultures: The Netherlands in Five Centuries of Transatlantic Exchange, ed. Rosemarijn Hoefte and Johanna C. Kardux (Amsterdam: Vu University Press, 1994), 281-303. 95 Willem Kolff is credited with the invention, building his artificial kidney in 1943; Nils Alwall in Sweden developed his machine in 1946; American G.W. Thorn built one in the late 1940s. See NA, D.W.G. Murray Papers, MG 30, Bl 10 vol. 35, file 5, Lecture Notes, 1941-9 (artificial kidney);J.T.H. Connor, 'Dutch Technological Migration and North American Commercial Exploitation: Dr Willem Kolff and the Development of the Artificial Kidney,' in Connecting Cultures: The Netherlands in Five Centuries of Transatlantic Exchange, ed. Rosemarijn Hoefte and Johanna C. Kardux (Amsterdam: Vu University Press, 1994), 281-303. 96 Gordon Murray, Edmund Delorme, and Newell Thomas, 'Development of an Artificial Kidney: Experimental and Clinical Experience,' Archives of Surgery 55 (November 1947): 506. 97 J.T.H. Connor, 'The Artificial Kidney in North America: Gordon Murray and the Canadian Connection,' Biomedical Instrumentation and Technology 23 (1989): 385. 98 J.T.H. Connor, Dutch Technological Migration and North American (Commercial Exploitation: Dr Willem Kolff and the Development of the Artificial Kidney,' in Connecting Cultures: The Netherlands in Five Centuries of Transatlantic Exchange, ed. Rosemarijn Hoefte and Johanna C. Kardux (Amsterdam: Vu University Press, 1994), 281-303. 99 In 1945 R.A. Palmer visited Kolff, observed his machine in action, and returned to British Columbia with sketches to build his own artificial kidney. He built a replica of Kolff's machine and had successful results dialysing patients. See R.A. Palmer and PS. Rutherford, 'Kidney Substitutes in Uraemia: The Use of Kolff's Dialyser in Two Cases,' CMAJ60 (1949): 261-6; R.A. Palmer et al., 'The Management of Acute Renal Failure,' CMAJ 77 (1957): 11-19. Taken from J.T.H. Connor, 'Dutch Technological Migration and North American Commercial Exploitation: Dr Willem Kolff and the Development of the Artificial Kidney,' in Connecting Cultures: The Netherlands in Five Centuries of Transatlantic Exchange, ed. Rosemarijn Hoeite and Johanna C. Kardux (Amsterdam: Vu University Press, 1994), 281-303. 100 J.P Merrill, 'Early Days of the Artificial Kidney and Transplantation,' Transplantation Proceedings13,suppl. 1 (March 1981): 4; D.N.S. Kerr, 'Treatment of Acute Renal Failure with Artificial Kidneys,' British Medical Journal?! (July 1979): 251. 101 Renee C. Fox and |udith P. Swazey, The Courage to Fail: A Social View of Organ

208

Notes to pages 71-2

Transplants and Dialysis, 2nd ed. (Chicago: University of Chicago Press, 1978), 201-2. 102 The British medical community advised giving up the use of the artificial kidney in favour of a high-calorie low-protein diet and a controlled fluid intake of a litre a day. See 'The Artificial Kidney,' British Medical Journal2 (October 1949): 920-1. An editorial in the Lancet (February 1948) had reported that only two out of fifteen dialysed patients had made complete recoveries; taken from J.T.H. Connor, 'Dutch Technological Migration and North American Commercial Exploitation: Dr Willem Kolff and the Development of the Artificial Kidney,' in Connecting Cultures: The Netherlands in Five Centuries of Transatlantic Exchange, ed. Rosemarijn Hoefte and Johanna C. Kardux ( Amsterdam: Vu University Press, 1994), 281-303. 103 'Artificial Kidney Is Developed Here,' Gazette (Montreal), 10 December 1946; 'Second in Canada: Artificial Kidney in Use at VGH Saving City Man's Life,' Vancouver Sun, 6 November 1948; 'Life-Saving Artificial Kidney Built Here,' London Free Press, 12 January 1949. 104 J.T.H. Connor, 'Dutch Technological Migration and North American Commercial Exploitation: Dr Willem Kolff and the Development of the Artificial Kidney,' in Connecting Cultures: The Netherlands in Five Centuries of Transatlantic Exchange, ed. Rosemarijn Hoefte and Johanna C. Kardux (Amsterdam: Vu University Press, 1994), 281-303; J.T.H. Connor, 'The Artificial Kidney in North America: Gordon Murray and the Canadian Connection,' Biomedical Instrumentation and Technology 23 (1989): 384. 105 'Artificial Kidney Is Developed Here,' Gazette, 10 December 1946; 'Second in Canada: Artificial Kidney in Use at VGH Saving City Man's Life,' Vancouver Sun, 6 November 1948; 'Life-Saving Artificial Kidney Built Here,' London Free Press,12January 1949. 106 Gordon Murray, Edmund Delorme, and Newell Thomas, 'Artificial Kidney,' British Medical Journals (October 1949): 887. 107 June Callwood, 'The Amazing Mechanical Kidney,' Maclean's, 15 August 1949,21. 108 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 41, file 16, Correspondence, Ethel Kerr to M. Wilson, 27 February 1961. 109 William Clarke, 'A Canadian Giant: Dr Gordon Murray and the Artificial Kidney,' CMAJUl (1987): 247. 110 Dr G.G. Caudwell, interview by author, 13 November 1996, Hamilton. 111 June Callwood, 'The Amazing Mechanical Kidney,' Maclean's, 15 August 1949,21. 112 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 9, Correspondence, -

Notes to pages 73-4 209 to Murray, 1944; file 12, Correspondence, - to Murray, 1947; file 13, Correspondence, - to Murray, 1948; file 16, Correspondence, - to Murray, 1951; file 17, Correspondence, - to Murray, 1952. 113 F.B. Bowman, Aiding Research in Surgery,' Globe and Mail, 26 September 1949. 114 Gordon Murray, K. Delorme, and N. Thomas, 'Development of an Artificial Kidney: Experimental and Clinical Experience,' Archives of Surgery 55 (November 1947): 522, 'Artificial Kidney, 'JAMA 137 (August 1948): 1596, and 'Artificial Kidney/ British Medical Journal? (October 1949): 891. Mm ray also stated that he received limited assistance for his heart operations and lacked moral support of my colleagues'; see Gordon Murray, Treatment of Mitral Valve Stenosis by Resection and Replacement of Valve under Direct Vision,' Archives of Surgery 61 (November 1950): 906, and 'Surgical Treatment of (Congenital Heart Disease,' CAM/58 (1948): 12. 115 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 42, file 43, Correspondence, Murray to Walter P. Richman, 12 November 1948; June Callwood, 'The Amazing Mechanical Kidney,' Maclean's, 15 August 1949, 35; Greer Williams, 'What You Should Know about Your Kidneys,' Saturday Evening Post, 28January 1950,93. 1 16 University of Toronto Archives (UTA), Department of Surgery, A89-0030/ 001, file (05) Estimates (194x), note to file signed T.M., 3 March 1947. 117 l)r W.T.W. Clarke, interview by author, 20 August 1996, Toronto; Dr Raymond Heimbecker, interview by author, 1 November 1996, Toronto; |.T.H. Connor, 'The Artificial Kidney in North America: Gordon Murray and the Canadian Connection,' Biomedical Instrumentation and technology 23 ( 1989): 386; W.G Cosbie, The Toronto General Hospital, 1819-1964: A Chronicle (Toronto: Macniillan of Canada, 1975), 337. 1 18 Personal correspondence, Rowan Nicks to author, 13 September 1996. Murray's antagonistic relationships confirmed by Mrs Rosalind Bradford, interview bv author, 26 [une, 3 and 20July 1996, Toronto; Dr D.R. Wilson, interview bv author, 27 February 1996 and 14 April 1997, Toronto; Dr W.G. Bigelow, interview by author, 26 March and 2 April 1996, 17 April 1997, Toronto; Dr G.G. Caudwell, interview by author, 13 November, 1996, Hamilton; Dr J.K.W. Ferguson, interview by author, 18 March 1996, Thornhill; Dr John Moffat, telephone interview by author, 21 December 1996. 1 19 Dr ).K.W. Ferguson, interview by author, 18 March 1996, Toronto; Dr W.G. Bigelow, interview by atithor, 26 March and 2 April 1996, 17 April 1997, Toronto; Dr D.R Wilson, interview by author, 27 February 1996 and

210 Notes to pages 74-5 14 April 1997, Toronto; Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto; Dr H. Hoyle Campbell, interview by author, 28 August 1996, Inglewood. 120 Over the years, Murray received various offers to set up surgical units (for example, in Australia, New Zealand, and New York), but only one was tempting - McGill University after the Second World War. According to his daughter, McGill officials were considering Murray as their new (and first full-time) professor of surgery. However, W.E. Gallie would not recommend him and refused to tell Murray why. DeanJ.C. Meakins of McGill had asked Gallie to suggest someone for the position, saying they were looking for someone 'under forty-five and preferably under forty ... He should have the reputation of solely being a good surgeon, but should have shown evidence of a capacity to be a good teacher and direct research within his department, as well as carry out such himself.' Of the nine men eventually short-listed for the post, Murray's name was absent. In January 1946, Dr Gavin Miller was appointed professor of surgery at McGill University and surgeon-in-chief at the Royal Victoria Hospital. Interestingly, Gallie felt that while 'surgery in McGill was [not] beyond redemption,' it did need reorganization along Toronto lines. In letters to Dr Fred Kergin, who had been short-listed by the McGill selection committee, Gallie wrote that he expected great resistance by McGill staff: 'Frankly I mistrust Meakins.' In the end, due to Gallie's advice against taking the job, Kergin turned down the position. In an effort to entice Kergin back to Toronto, Gallie described the exciting new surgery taking place at TGH under Janes, who 'is almost in a class by himself in chest surgery,' and under Harold Wookey and Roscoe Graham. Gallie did not mention Murray. See Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto; UTA, Private Papers, F.G. Kergin, B 81-0016/003, Correspondence, W.E. Gallie to F.G. Kergin, 10 May, I7june 1945, and n.d. [1946]; McGill University Archives, RG 38, Faculty of Medicine, box 7, file 169, Correspondence, DeanJ.C. Meakins to W.E. Gallie, 5 October 1944, and DeanJ.C. Meakins to F.G. Kergin, 29July 1945; Selection Committee on the Chair of Surgery, Summary of Minutes of Meetings held to date, 7 September 1944 and 1 May 1945; McGill University, annual report, 1945-6, 'Principal's Report,' 28. 121 Mrs Rosalind Bradford, interview by author, 26June, 3 and lOJuly 1996, Toronto. 122 J-T.H. Connor, Doing Good: The Life of Toronto's General Hospital (Toronto: University of Toronto Press, 2000), 232-3.

Notes to pages 76-8 211 CHAPTER 4 : A PRIVATE LABORATORY, A SECOND ARTIFICIAL KIDNEY, AND NEW HEART OPERATIONS

1 A. McGehee Harvey, Science at the Bedside: Clinical Research in American Medicine, 1905-1945 (Baltimore:Johns Hopkins University Press, 1981), xvi; 'Clinical Research in Canada,' Canadian Medical Association Journal (CMAJ) 86 (1962): 700. 2 See Keith Wailoo, "A Disease Sui Generis": The Origin of Sickle Cell Anemia and the Emergence of Modern Clinical Research, 1904-1924,' Bulletin of the History of Medicine 65 (1991): 185-208; Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore: Johns Hopkins University Press, 1997). 3 A. McGehee Harvey, Science at the Bedside: Clinical Research in American Medicine, 1905-1945 (Baltimore: Johns Hopkins University Press, 1981), xviii. 4 Peter C. English, Shock, Physiological Surgery, and George Washington Crile: Medical Innovation in the Progressive Era (Westport, Conn.: Greenwood Press, 1980), 69, 107, 127. 140-2, 146. See also J.K.W. Ferguson, 'Canadian Milestones in Medical Research,' Bulletin of the Medical Library Association 48 (January 1960): 24; University of Toronto Archives (UTA), A89-0030/002, file 2; W.G. Bigelow, Medical Research: A Triple Responsibility,' an address to the

Canadian Heart Foundation, reprinted in Varsity Graduate 12 (Spring 1966). 5 'Clinical Research in Canada,' CMAJ86 (1962): 700. 6 Harvey, Science at the Bedside: Clinical Research in American Medicine, 1905— 1945 (Baltimore: |ohns Hopkins University Press, 1981), 119. 7 I thank Alison Ei for our discussions on the changes occurring in the basic and clinical sciences during this time. See Alison Li, 'J.B. Collip and the Making of Medical Research in Canada' (PhD thesis, University of Toronto, 1992). 8 Francis D. Moore, A Miracle, and a Privilege: Recounting a Half Century of Surgical Advance (Washington, D.C.: Joseph Henry Press, 1995), 100-1. 9 General university funds consisted of private donations from wealthy alumni, businessmen, and philanthropic agencies as well as public monies from the provincial government. 10 During Murray's heparin research in the 1930s, Professor of Surgery W.E. Gallic used departmental funds to pay for Murray's dogs, and in 1940 Murray received funding from the Banting Research Foundation for his expenses. (Kerall. these costs were not high. There was no record of department funding for Murray after 1940. During and after the war, the University of Toronto was one of the more successful institutions in soliciting and

212 Notes to pages 78-9 receiving federal as well as agency funding for research. See UTA, Department of Surgery, A89-0030/001, file (07); Office of the Dean, Correspondence, A76-0044/095, file Research (Advisory Committee for Medical Research), Faculty of Medicine Research Funds, 1950-1, and Faculty of Medicine Research Grants and Fellowships, 1953-4; Toronto Hospital Archives (THA), W.G. Bigelow papers, box 39, file 0094-11-0-51. 11 Alison Li argues that the National Research Council did not have much choice but to support an extramural program, because of financial constraints and the availability of personnel. There was not a critical mass of researchers and they were widely dispersed, as described by Banting in his 1939 survey of research centres in Canada. I thank Alison Li for our discussion. See also National Archives of Canada (NA), National Research Council of Canada, Division of Medical Research, RG 77, series A-l, vol. 279, files 40-1-1 and 2; Archives of Ontario (AO), Ontario Ministry of Health, files RG, 10-6-0-1529 and 1530, Medical Research Projects in Canada, 1949-63. 12 Alison Li, 'Expansion and Consolidation: The Associate Committee and the Division of Medical Research of the NRC, 1938-1959,' in Building Canadian Science: The Role of the National Research Council, ed. Richard A. Jarrell and Yves Gingras, special edition of Scientia Canadensis 15 (1991): 89-103; Samuel Solomon and Alan Lawley, 'Medical Research in Canada: A History of Accomplishment, a Future of Uncertainty,' Annals of the Royal College of Physicians and Surgeons of Canada 19 (March 1986): 119-22. 13 The establishment of special research departments or institutes within universities was a common practice in nineteenth-century Germany and later in other European and North American universities. 14 Michael Bliss, Banting: A Biography (Toronto: McClelland & Stewart, 1984), 152-3. 15 J.K.W. Ferguson, 'Canadian Milestones in Medical Research,' Bulletin of the Medical Library Association AS (January 1960): 24—5; 'Clinical Research in Canada,' CMAJ86 (1962): 700-1. 16 Jefferson Lewis, Something Hidden: A Biography of Wilder Penfield (Toronto: Doubleday Canada, 1981), 127-8; 141-8; 153-4. 17 Alison Li, 'J.B. Collip and the Making of Medical Research in Canada' (PhD thesis, University of Toronto, 1992), 229-31. 18 G.H. Ettinger, History of the Associate Committee on Medical Research, 1938-1946 (Ottawa: National Research Council of Canada, 1946), 32. 19 The Special Committee Appointed to Review Extramural Support of Medical Research by the Government of Canada, Report to the Honourable Gordon Churchill, Chairman, the Committee of the Privy Council on Scientific and Industrial Research (Farquharson Committee) 1959; 'Ask $45 Million Aid for Medical

Notes to pages 79-82 213 Research,' Globe and Mail9 Aug. 1960; THA, W.G. Bigelow Papers, box 52, file 0094-8-0-106. 20 Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (Cambridge: Cambridge University Press, 1997), 3,5-6,31. 21 J.Max Findlay, 'Neurosurgery at the Toronto General Hospital, 1924—1990,' Canadian Journal oj'Neurological Sciences 21 (1994): 146-58, 278-84; T.P. Morley, ed. The Opening of the Neurosurgical Unit, Toronto General Hospital, November H, 1958 (Toronto: Toronto General Hospital, 1960); Norman C. Delarue. Thoracic Surgery in Canada: A Story of People, Places, and Events, the Evolution of a Surgical Specialty (Toronto: B.C. Decker, 1989); J.T.H. Connor, Doing Good: The Life of Toronto's General Hospital (Toronto: University of Toronto Press, 2000), 214-33. 22 Subsequent to Murray, Toronto medical men Wilfred Bigelow (b. 1913), VV'.T. Mustard (1914-87), and others continued the Toronto tradition of experimental heart surgery innovations. After much lobbying on the part of Bigelow, who was much more adept at working with Toronto authorities and administrators, the new cardiac unit was realized in 1958. Interviews by author. 23 Personal correspondence, Hugh R. Gallie to author [May 1996]. 24 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, file 28, p. 1, and vol. 30, file 17, pp. 2 and 3, Correspondence, Murray to W.E. Phillips, 8 May 1947. 25 l)r Robert Harris, interview by author, 19 April 1996, Toronto. 26 The appointment of Gallie's successor was debated behind closed doors by the Board of Governors. Gallie handpicked Janes, while Herbert Bruce and J.S. McLean (a strong voice because of his generous donations to the university) lobbied hard for Murray. Unfortunately for Murray, Bruce and McLean were •outsiders,' while Janes's supporters held prestigious positions at TGH and the university (Dr W.G. Bigelow, interview by author, 26 March and 2 April 1996, 1 7 April 1997, Toronto; Dr D.R. Wilson, interview by author, 27 February 1996 and414April 1997, Toronto). 27 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 44, file 13, Medicine in the Making, draft. 51 I 28 Thomas Fisher Library, University of Toronto, Academy of Medicine Collection, biographical files, 0802 R.M. Janes; obituary, Bulletin of the Academy of Medicine, Toronto 40 (February 1967): 71-2; obituary, CM4/95 (1966): 1399-401: W.G. Cosbie, The Toronto General Hospital, 1819-1965: A Chronicle (Toronto: Macmillan of Canada, 1975), 195, 265. 29 NA, D.W.G. Munav Papers, MG 30, B 1 10, vol. 28, file 26, Correspondence, R.M. Janes to Munav, 30 September 1947.

214

Notes to pages 82-4

30 UTA, Board of Governors, Minutes, A73-0024, microfilm roll no. 15, 26 June 1947, 155, and 11 September 1947, 164; Executive Committee, Minutes, A79-0038, box 2, file 1,17 October 1947. 31 UTA, Board of Governors, Minutes, A73-0024, microfilm roll no. 15, 23 October 1947, 224. 32 UTA, Board of Governors, A73-0025/007, file 27, Appropriations by Faculties and Divisions 1947-53, Minutes abstract, Correspondence, R.M.Janes toJ.A. MacFarlane, 20 October 1947. 33 UTA, Board of Governors, A73-0025/007, file 27, Appropriations by Faculties and Divisions, 1947-53, Minutes abstract, Correspondence, J.A. MacFarlane to Sidney Smith, 20 October 1947. 34 UTA, Board of Governors, Minutes, A73-0024, microfilm roll no. 15, 23 October 1947, 224. 35 UTA, Office of the President (Sidney Smith), Correspondence, (subject files), A68-0007/036, file 2, Medicine, July 1947 to June 1948, D.W. Gordon Murray to Sidney Smith, 24 November 1947. 36 Michael Bliss, Banting: A Biography (Toronto: McClelland & Stewart, 1984), 120, 182. 37 UTA, Office of the President (Sidney Smith), Correspondence, (subject files), A68-0007/036, file 2, Medicine, July 1947 to June 1948, J.A. MacFarlane to Sidney Smith, 27 November 1947. 38 UTA, Office of the President (Sidney Smith), Correspondence (subject files), A68-0007/036,file2, Medicine, July 1947 to June 1948, handwritten notes. 39 Writing in the third person, Murray gave the following account of these events: 'Pressure was brought to bear on the young surgeon [Murray] to accept a research set-up under the supervision and control of the head of the department. The young surgeon, however, having had previous bitter experiences and now nine negatives to his request in this direction, together with the attitude of the Dean, he was well aware how little he would be free to develop his ideas. Once under the control of the Head of the Department, who had neither experience nor interest in research and was highly prejudiced, it was obvious that his days as an investigator and contributor were numbered. Having considered it all very carefully, and having decided that added to this removal by legislation of his privileges, he would not add further to his own sorrow by selling the mess of pottage. He, therefore, at his peril resisted the trifold pressure [from the president of the university, the dean of the Faculty of Medicine, and the head of the Department of Surgery] and decided to keep under his own control the future developments which he had in mind' (NA, MG 30, B 110, vol. 44,file13, Medicine in the Making, drafts, 516A and 516B.

Notes to pages 84-5 215 40 UTA, Board of Governors, Minutes, A73-0024, microfilm roll no. 15, 11 December 1947, 268. 41 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 44, file 13, Medicine in the Making, drafts, 158; McGill University Archives, RG 38, Faculty of Medicine, box 7, file 169, Correspondence, Dean Meakins to W.E. Gallie, 5 October 1944; Minutes of the Selection Committee on Chair of Surgery, 7 September 1944 and 1 May 1945. See also NA, MG 30, B 110, vol. 45, file 2, Medicine in the Making, drafts, notes (undated); Mrs Rosalind Bradford, interview by author, 26June, 3 and lOJuly 1996, Toronto; Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 98—9. 42 NA, National Research Council of Canada, Division of Medical Research, RG 77, series A-l, vol. 279, file 40-1-2. 43 'He [Caven] was almost worshipped by his patients,' said Bruce. 'His gentle sympathetic attitude and kindly manner gave patients immediate confidence in his ability to help them.' Caven's elder brother, Dr John Caven, was the first professor of pathology at the University of Toronto, and Caven's younger brother, Dr James G. Caven, also practised medicine in Toronto. Caven's father, the Rev. Dr William Caven, was principal of Knox College. Roy Greenaway, 'Victory for Dr Murray Seen as New Lab Opens Ends Centralization,' Toronto Star, 24 November 1949; Thomas Fisher Library, University of Toronto, Academy of Medicine Collection, biographical, files, 0279 W.P. Caven; H.A. Bruce, Varied Operations (Toronto: Longmans, 1958), 176-8; W.G. Cosbie, The Toronto General Hospital, 1819-1965: A Chronicle (Toronto: MacMillan of Canada, 1975), 259. 44 Roy Greenaway, Victory for Dr Murray Seen as New Lab Opens Ends Centralization,' Toronto Star, 24 November 1949; 'Medical Research "Completely Free" Spurred by Bequest,' Telegram (Toronto), 24 November 1949. 45 The house was purchased from Joseph West at the reduced rate of $17,000 (Wellesley Hospital Archives, W.P. Caven Memorial Research Foundation, file, notes of Miss Arnot, archivist, from discussion with Miss Jean West, including pictures, 27 October 1978). 46 Mrs Paul Phelan, interview by author, 18 November 1996, Toronto; Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto. 47 Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 98-9; Roy Greenaway, Victory for Dr Murray Seen as New Lab Opens Ends Centralization,' TorontoStar,24 November 1949; 'Medical Research "Completely Free" Spurred by Bequest,' Telegram, 24 November 1949; H.A. Bruce, Varied Operations (Toronto: Longmans, 1958), 176-8; W.G. Cosbie, The Toronto General Hospital, 1819-1965: A Chronicle (Toronto: MacMillan of Canada, 1975), 259.

216

Notes to pages 86-8

48 'Medical Research "Completely Free" Spurred by Bequest,' Telegram, 24 November 1949; Roy Greenaway, 'Victory for Dr Murray Seen as New Lab Opens Ends Centralization,' Toronto Star, 24 November 1949. 49 Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 98; Roy Greenaway, 'Victory for Dr Murray Seen as New Lab Opens Ends Centralization,' Toronto Star, 24 November 1949. 50 Roy Greenaway, 'Victory for Dr Murray Seen as New Lab Opens Ends Centralization,' Toronto Star, 24 November 1949. 51 Roy Greenaway, 'Victory for Dr Murray Seen as New Lab Opens Ends Centralization,' Toronto Star, 24 November 1949; 'Medical Research "Completely Free" Spurred by Bequest,' Toronto Telegram, 24 November 1949; 'Found Research Centre with Doctor's Bequest,' Globe and Mail 19 August 1949; Roy Greenaway, '"Baby Blue Doctor" Heads New Medical Foundation: Dr W.P. Caven Memorial Will Conduct Research in Heart and Kidney,' Toronto Star, 18 August 1949; 'Noted Doctor Is Foundation Research Head,' Telegram, 18 August 1949. 52 Roy Greenaway, 'Victory for Dr Murray Seen as New Lab Opens Ends Centralization,' Toronto Star, 24 November 1949. 53 NA, D.W.G. Murray Papers, MG 30, B110,vol. 28, file 28, Correspondence, Abe Brodey to Murray, 26 August 1949. 54 NA, D.W.G. Murray Papers, MG 30, B110,vol. 28,file28, Correspondence, Gladstone Murray to Murray, 18 August 1949. 55 NA, D.W.G. Murray Papers, MG 30, B110,vol. 28, file 28, Correspondence, Joseph A. Sullivan to Murray, 26 November 1949. 56 Connaught Archives, Robert Davies Defries Papers, 83-7, Correspondence, Murray to R.D. Defries, 5 December 1949, and R.D. Defries to Murray, 24 Nov. 1949. 57 John T. Phair, Ontario deputy minister of health, had been present at the Caven Foundation opening in November 1949 but was not able to commit government funds to the centre. Mackinnon Phillips, Ontario minister of health, hinted to Murray about an electron microscope (approximately $1 million) and talked about the possibility of building a 'Gordon Murray Institute' (interviews by author). 58 Gordon Murray and Richard Holden, 'Transplantation of Kidneys, Experimentally and in Human Cases,' American Journal of Surgery 87 (April 1954), 508-15. 59 Gordon Murray, Richard Holden, and Walter Roschlau, 'Experimental and Clinical Study of New Growth of Bone in a Cavity,' American Journal of Surgery 93 (March 1957), 385-7. 60 NA, D.W.G. Murray Papers, MG 30, B110,vol. 47, file 32, W.P. Caven

Notes to pages 89-92 217

61

62

63

04

65 66

67

68 69

Memorial Research Foundation, Minutes and Correspondence, 12July 1951; file 31, VV.P. Caven Memorial Research Foundation, Minutes, 1951; Cordon Murray, ' 1 he Clinical Results of Serum Treatment of Carcinoma of Breast," Bulletin o)'the Academy ofMedicine, Toronto28(June 1955), 196-9. NA, D.VV.C. Murray Papers, MC 30, B 110, vol. 28, file 29, Correspondence, Jorge Crey to Marray, n.d., E. Magalhaes Comes to Murray, 15 January 1950, and A. de Carvalho Azevedo to Murray, 7 February 1950. NA, D.W.C. Murray Papers, MC 30, B 110, vol. 28, file 30, Correspondence, H. Selle to Murray, 12 February 1951, H.H. Schlink to Murray, 14 March 1951, and H. Selle to Murray, 10 May and 2 July 1951; Royal Prince Alfred Hospital Archives, Royal Prince Alfred Gazette, September 1951, 6; Royal Prince Alfred Hospital, annual report for 1951-52, 'Visits of Distinguished Medical Consultants/ n.p. NA, D.W.C. Murray Papers, MC 30, B 110, vol. 47, file 32, W.P. Caven Memorial Research Foundation, Minutes and Correspondence, 12 July 1951, NA, D.W.C Murray Papers, MC 30, B 1 10, W.P. Caven Memorial Research Foundation, vol. 47, file 32, Minutes of the Meeting of Directors, 6 July 1951; Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto; personal correspondence, Mrs Rosalind Bradford to author, 21 Apr. 1997. NA, D.W.(. Murrav Papers, MC 30, B 1 10, vol. 28, file 31, Correspondence, Murray to Doros Oesconomos, 14 March 1952. NA.D.W.C. Murray Papers, MC 30, B 1 10, vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual report, 1952; vol. 28, file 31, Correspondent e, Murrav to Ian Paiton, 8 April 1952, and file 30, Correspondence, William W Allis to Murray, 25 January 1951. 1, I. Skeggs, 1 Leonards, and J.R. Leonards, 'Studies on an Artificial Kidney: Preliminary Results with a New Type of Continuous Dalyzer,' Science 108 (1948). 212-13: -VC. McNeill, 'Blood Dialvzer Design,' Bulletin of Cardiovascidai Dneast (1953). ! 73-7. NA, D.W.C. Murray Papers, MC 30, B 110, vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual report, 1955. N \, D.VV.C; Murrav Papers, MC 30, B 110, vol. 42, file 43, Artificial Kidney, newspaper dipping: "Artificial Kidney" in Freilbourg Clinic,' Suedkurier, 1 5 February 1954 Fnglish translation. It is unknown when Murray read this dipping See also NA, D.W.C. Murray Papers, MC 30, B 110, vol. 39, file 12, Artificial Kidney. Notes and Correspondence. Dated 9/7/54, Roschlau provided Murrav with an English summary of Hans J. Sarre's articles 'The Tieannent ol \i me Toxic Kidney Insufficiencies' and 'The Artificial Kidney

218 Notes to pages 92-3 and Other Extrarenal Detoxication Processes for Treatment of Anuria and Uraemia' (articles in German). A footnote regarding the artificial kidney as used by Sarre states: 'Gratitude is expressed towards the German Research Community for making available the so-called artificial kidney which has been built by engineer Halstrup in cooperation with us.' 70 William Clarke, 'A Canadian Giant: Dr Gordon Murray and the Artificial Kidney,' CAM/137 (1987), 247; Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto. 71 Gordon D.W. Murray, 'Heparin in Thrombosis and Embolism,' British Journal of Surgery 27 (January 1940), 581. 72 David Hamilton, 'Kidney Transplantation: A History,' in Kidney Transplantation: Principles and Practice, 2nd ed., edited by Peter J. Morris (Toronto: Harcourt BraceJovanovich, 1984), 1. 73 J.P. Merrill, 'Early Days of the Artificial Kidney and Transplantation,' Transplantation Proceedings 13, suppl. 1 (March 1981), 7; Francis D. Moore, 'A Nobel Award to Joseph E. Murray, MD: Some Historical Perspectives,' Archives of Surgery 127 (May 1992), 628. 74 Dr Jacob Markowitz was the first doctor to transplant successfully the heart of one warm-blooded animal to another. He and Dr Frank Mann, of the Mayo Clinic, grafted new hearts into the necks of dogs and rabbits in 1931. Markowitz and others anticipated the need of immunosuppressive drugs in organ transplants. 'Easy to Transplant Heart - Keeping It Alive Problem,' Toronto Star, 1 February 1946; Ross Harkness, 'Heart, Other Organs to Be Transplanted,' Globe and Mail, 1 February 1946; 'Sees Early Transplanting of Human Hearts, Kidneys,' Evening Telegram (Toronto), 1 February 1946. 75 Gordon Murray and Richard Holden, 'Transplantation of Kidneys, Experimentally and in Human Cases,' American Journal ofSurgery 87 (1954), 508-13. 76 Ibid., 513. 77 Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 20. 78 Gordon Murray and Richard Holden, 'Transplantation of Kidneys, Experimentally and in Human Cases,' American Journal ofSurgery 87 (1954), 513. 79 Young Fred Moffat was training at the Toronto General Hospital at this time and remembers witnessing one of these unsuccessful transplant operations, as well as transplanted kidneys to vessels in the patient's arm (personal correspondence, Dr Fred Moffat to author, 21 January 1997); Gordon Murray and Richard Holden, 'Transplantation of Kidneys, Experimentally and in Human Cases,' American Journal ofSurgery 87 (1954), 513. 80 'Transplanted Kidney Saves Dying Woman,' Telegram (Toronto), 2 July 1952. 81 Mrs Reta (Smith) Macnab, interview by author, 14 May 1996, Toronto; Miss Jean Dodds, interview by author, 9 April 1996, Toronto.

Notes to pages 94-6 219 82 Gordon Murray and Richard Holden, 'Transplantation of Kidneys, Experimentally and in Human Cases,' American Journal of Surgery 87 (1954), 514; Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 21-6. 83 'Transplanted Kidney Saves Dying Woman,' Telegram, 2 July 1952; Roy Greenaway, 'Transplant Dead Man's Kidney - Bring Health to Dying Woman," Toronto Star, 2 July 1952; Ken MacTaggart, 'Transplants Kidney,' Globe and Mail, 3 July 1952. 84 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, file 31, Correspondence, R.F. Warren to Murray, 3 July 1952. 85 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, file 31, Correspondence, Gladstone Murray to Murray, 11 July 1952. 86 Gordon Murray and Richard Holden, 'Transplantation of Kidneys, Experimentally and in Human Cases,' American journal of Surgery 87 (1954), 515. In 1973 Murray repeated his position, saying, 'The proof is, she's alive and well and still active.' 'Pioneer Operation Carried Out on a Dying Woman: Patient and Doctor Meet, 21 Years after Early Kidney Transplant,' Globe and Mail, 19 January 1973. 87 Dr Raymond Heimbecker, interview by author, 1 November 1996, Toronto; personal correspondence, Dr Lloyd D. MacLean to author, 25 November 1996; Dr C.B. Mueller, interview by author, 15 November 1996, Hamilton. 88 Renee C. Fox and [udith P. Swazey, The Courage to Fail: A Social View of Organ Transplants and Dialysis, 2nd ed. (Chicago: University of Chicago Press, 1978), 70. 89 E. Donnal Thomas was a co-recipient of this award for his pioneering work on the transplanting of bone marrow from one person to another. See Francis I). Moore, 'A Nobel Award to Joseph E. Murray, MD: Some Historical Perspectives,' Archives of Surgery 127 (May 1992), 627-8; J.P. Merrill, Early Days of the Artificial Kidney and Transplantation,' Transplantation Proceedings, 13, suppl. 1 (March 1981), 7-8; Robert M. Goldwyn, 'Joseph E. Murray, MD, Nobelist: Some Personal Thoughts,' Plastic and Reconstructive Surgery, |une 1991, 1111-12; Peter J. Morris, 'Kidney Transplantation, 19601990,' Advances in Nephrology 20 (1991), 3-17. 90 Lael Wertenbaker, To Mend the Heart (New York: Viking Press, 1980), 4. 91 Gordon Murray, The Surgical Treatment of Mitral Stenosis,' CMAJ62 (1950), 444-7. 92 Lawrence Rhea and f.C. Walker first used one in 1913, and Allen and Graham later tised it in 1922. Cutler and Beck developed one in 1924 for their procedures. See Allen and Graham, Tntracardiac Surgery - a New Method: Preliminary Report,' JAMA 79 (1922), 1028, and E.G. Cutler, S.A. Levine, and C.S. Beck. 'The Surgical Treatment of Mitral Stenosis: Experi-

220

Notes to pages 96-8

mental and Clinical Studies,' Archives of Surgery 9 (1924), 689. All this is taken from Gordon Murray, 'A Cardioscope,' Angiobgy 1 (August 1950), 334. 93 NA, D.W.G. Murray Papers, MG 30, B 110, Vol. 42, file 47, Correspondence, Murray to D. Hickey, 3 November 1950. 94 Gordon Murray, 'A Cardioscope,' Angiobgy 1 (August 1950), 334-5. 95 Hannah Institute for the History of Medicine Oral History Collection, vol. 33, Dr W.T. Mustard, 133. 96 NA, D.W.G. Murray Papers, MG 30, B 110, Vol. 42, file 47, Correspondence, Murray to D. Hickey, 3 November 1950. 97 C.A. Hufnagel, W.P. Harvey, PJ. Rabil, and T.F. McDermott, 'Surgical Correction of Aortic Insufficiency,' Surgery 35 (1954), 673. 98 Stephen L.Johnson, The History of Cardiac Surgery, 1896—1955 (Baltimore: Johns Hopkins University Press, 1970), 104-7. 99 Taken from Ronald J. Baird, 'The Development of Cardiac and Vascular Surgery in Canada: Personal and Anecdotal Reflections on an Era,' Private Collection. 100 NA, D.W.G. Murray Papers, MG 30, B 110, Vol. 43, file 13, Experimental Notes on Homologous Aortic-Valve-Segment Transplants, 1952-4. 101 C.R. Lam, H.H. Aram, and E.R. Munnell, 'An Experimental Study of Aortic Valve Homografts,' Surgery, Oynecology, Obstetrics 94 (1952), 129-35. 102 Raymond O. Heimbecker, 'World's First Heart Valve Transplant (Partial Correction) 1955: Heart Valves,' Canadian Journal of Cardiology 10, (June 1994), 571-2. 103 Four years later, Murray did offer a follow-up report on three patients with tissue valve replacements, courtesy of reassessment summaries by Doctors Alfred Kerwin, Ramsay Gunton, and Harold Aldridge in Toronto. It concluded that transplanted tissues survive and function for at least four years. See Gordon Murray, 'Aortic Valve Transplants,' Angiology11,(April 1960), 99-102. 104 Gordon Murray, W. Roschlau and W. Lougheed, 'Homologous AorticValve-Segment Transplants as Surgical Treatment for Aortic and Mitral Insufficiency,' Angiology 7, (October 1956), 466-71. 105 AJ.Kerwin, S.C. Lenkei, and D.R. Wilson, 'Aortic Valve Homograft in the Treatment of Aortic Insufficiency: Report of Nine Cases, with One Followed for Six Years,' New England Journal ofMedicine 266 (1962), 852-7; R.O. Heimbecker, 'The Homograft Cardiac Valve,' Journal of Thoracic Cardiovascular Surgery 44 (1962), 768-9; B.G. Barratt-Boyes, 'Homograft Aortic Valve Replacement in Aortic Incompetence and Stenosis,' Thorax 19 (1964), 131-50; R.O. Heimbecker etal., 'Homograft Replacement of the

Notes to pages 98-100

221

Human Mitral Valve,' CMAJ86 (1962), 805-9; D.N. Ross, 'Homograft Replacement of the Aortic Valve,' Lancet 2 (September 1962), 487; Raymond O. Heimbecker, 'Canadian Contributions to Heart Valve Transplantation for Cardiac Valve Replacement,' Canadian Journal of Cardiology 15 (May 1999), 585-6. 106 W.G. Bigelow et al., 'Clinical Homograft Valve Transplantation,' Journal of Thoracic and Cardiovascular Surgery 48 (Sept. 1964), 342; R.J. Baird, 'The Development of Cardiac and Vascular Surgery in Canada: Personal and Anecdotal Reflections on an Era,' Private Collection. 107 J.B. Herrick, 'Clinical Features of Sudden Obstruction of the Coronary Arteries,' JAMA 59 (1912), 2015. 108 An infarct is an area of tissue that has died because of inadequate blood supply. See Robert Carola, John P. Harley, and Charles R. Noback, Human Anatomy and Physiology, 2nd ed. (Toronto: McGraw-Hill, 1992), 612. 109 A.M. Vineberg and W.D. Miller, 'An Experimental Study of the Physiological Role of the Anastomosis between the Left Coronary Circulation and Left Internal Mammary Artery Implanted in the Left Ventricular Myocardium/ Surgical Forum, Proceedings of the American College of Surgery (1950), 294. 1 10 Gordon Murray, The Surgical Treatment of Coronary Thrombosis,' CMAJ 67 (1952), 102. 1 1 1 Gordon Murray, Redmond Porcheron,Jose Hilario, and Walter Roschlau, 'Anastomosis of a Systemic Artery to the Coronary,' CMAJ7\ (1954), 5947; Gordon Murray, J. Hilario, R. Porcheron and W. Roschlau, 'Surgery of Coronary Heart Disease,' Angiology4 (December 1953), 526-31. 112" "Amazing" Operation Eases Heart Condition: Local Woman Benefits from Rare Surgery,' Courier Express (Buffalo), 2 February 1950; Ron Kenyon, Delicate Heart Operation Done First Time Here,' Telegram (Toronto), 14January 1950; 'Opens Valve in Heart of Woman: -Toronto Surgeon Operates,' Spectator (Hamilton), 16January 1950. 1 13 'Detouring of Arteries to Supply Ailing Heart Outlined by Toronto MD,' dlobe and Mail, 4 September 1952; 'Blow-Out Patches for Heart: Spare Arteries Described by Doctor,' Toronto Star, 4 September 1952. 1 14 Bigelow remembers his colleagues' scepticism; he wrote, 'It was a blasphemy. This concept completely contradicted currently accepted teaching, which was to avoid any fall in body temperature.' See W.G. Bigelow, Cold Hearts: The Story of Hypothermia and the Pacemaker in Heart Surgery (Toronto: McClelland & Stewart, 1984), 51. 115 Ibid., 40. 116 FT. Lewis and M. Taufic, 'Closure of Atrial Septal Defect with the Aid of

222

Notes to pages 100-1

Hypothermia: Experimental Accomplishments,' Surgery 33 (1953), 52. Taken from W.G. Bigelow, Cold Hearts: The Story of Hypothermia and the Pacemaker in Heart Surgery (Toronto: McClelland & Stewart, 1984), 56. 117 This technique became a world standard in the next four to five years (personal interviews by author). 118 Biological oxygenators, not mentioned, were experimented with in addition to mechanical oxygenators or heart-lung machines. In the early 1950s, W.T. Mustard at the Hospital for Sick Children used a Cowan perfusion pump and a monkey lung as an oxygenator in cardiac bypass operations to correct transposition of the great vessels (a complex congenital heart disorder). There were obvious problems with using animals this way, notably, deterioration of lung function and pulmonary congestion during the operation. See Stephen L.Johnson, The History of Cardiac Surgery, 18961955 (Baltimore: Johns Hopkins University Press, 1970), 155; Marilyn Dunlop, Bill Mustard: Surgical Pioneer (Toronto: Hannah Institute and Dundurn Press, 1989); 'Monkey's, Infant's Lungs Switched,' Globe and Mail, [April 1953]; Ken MacTaggart, 'Monkey's Lungs Used to Help Save Babies,' Globe and Mail, 10 June [1955]; 'Toronto Heart-Lung Machine Shown U.S. Doctors,' [n.d.]; 'Unique Method Saves Child's Life in Operation at Children's Hospital,' [n.d.] (newspaper articles found at Thomas Fisher Library, University of Toronto, Academy of Medicine Collection, biographical files, 1235 W.T. Mustard). 119 Problems of filming and bubbling of the blood, the two main principles of the design of the heart-lung machine of oxygenation, were continually being improved. See Robert G. Richardson, The Scalpel and the Heart (New York: Charles Scribner's Sons, 1970), 221-4. 120 Robert Carola,John P. Harley, and Charles R. Noback, Human Anatomy and Physiology, 2nd ed. (Toronto: McGraw-Hill, 1992), 608-9. 121 See Stephen L.Johnson, The History of Cardiac Surgery 1896-1955 (Baltimore: Johns Hopkins University Press, 1970), 145-58; UTA, A89-0030, Department of Surgery, box 002, Department Chair, files, file 1, Dr R.O. Heimbecker, 'Open Heart Surgery Performed by Extra-Corporeal Circulation through Pump Oxygenators,' March 1957. 122 Journalist Lael Wertenbaker wrote: 'For many years, Houston was Lourdes to heart-diseased pilgrims from everywhere, and even Texas-sized pride was satisfied. High-profile surgeons DeBakey and Cooley were considered to be 'two of the most exhilarating and egotistical heart surgeons in the world.' They were competitive and strong personalities, a mentor and his protege who eventually became enemies. Their success came from their volume of heart operations, performing in one week the number of cardiac proce-

Notes to pages 101-4 223 dures other medical centres saw in a month. Their leading-edge reputations were somewhat marred after unsuccessful heart transplant operations in the late 1960s, their previous surgical success and experience driving these immodest surgeons to attempt the procedure before immunosuppressive drugs became available to ward off rejection.' See Thomas Thompson, Hearts (New York: McCall, 1971); Lael Wertenbaker, To Mend the Heart (New York: Viking Press, 1980), 196. 123 Personal correspondence, Dr Henry T. Bahnson to author, 22 November 1996. 124 Dr D.R. Wilson, interview by author, 14 April 1997; Dr RonJ. Baird, interview by author, 2 April 1996. 125 Hannah Institute for the History of Medicine Oral History Collection, vol. 46, Dr D.R. Wilson, 37. 126 W.G. Bigelow, Cold Hearts: The Story of Hypothermia and the Pacemaker in Heart

Surgery (Toronto: McClelland & Stewart, 1984), 62. 127 Ronald J. Baird, interview by author, 2 April 1996. 128 W.G. Bigelow, interview by author, 2 April 1996 and 17 April 1997, Toronto. 129 Rosalind Bradford, interview by author, 10 July 1996. 130 Mrs Reta (Smith) Macnab, interview by author, 14 May 1996. 131 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, file 32, Correspondence,Joseph A. Sullivan to Murray, 27 November 1953, Murray toJ.A. MacFarlane, 15 October 1953, and Sidney Smith to Murray, 27 November 1953. 1 32 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 23, Correspondence, - to Murray, 28 March 1958. 1 33 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual reports for 1951, 1952, 1953, 1954, 1955, 1956, and 1958. 134 Dr Raymond Heimbecker, interview by author, 1 November 1996, Toronto; Mrs Paul Phelan, interview by author, 18 November 1996, Toronto. 135 Gordon Murray, The Surgical Treatment of Coronary Thrombosis,' CMAJ 67 (1952), 100-2; Gordon Murray, J. Hilario, R. Porcheron, and W. Roschlau, Surgery of Coronary Heart Disease,' Angiology 4, (December 1953), 526-31; Gordon Murray and Walter Roschlau, 'Grafts in Vessels,' Report to the 15th Congress of the International Society of Sur-geons, Lisbon, 1953, published in Ada Scandinavia, 1953; Gordon Murray, R. Porcheron, J. Hilario and W. Roschlau, 'Anastomosis of a Systemic Artery to the Coronary,' CMAJ71 (1954), 594-7; Gordon Murray, assisted by W. Roschlau and W. Lougheed. Homologous Aortic-Valve-Segment Transplants as Surgical

224

136

137

138

139

Notes to pages 104-6 Treatment for Aortic and Mitral Insufficiency,' Angiology 7 (October 1956), 466-71. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 41, file 16, 'Improvement in Artificial Kidney,' unpublished work by Murray, n.d.; Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto. For an excellent labelled photo of Murray's second artificial kidney, see William Clarke, 'A Canadian Giant: Dr Gordon Murray and the Artificial Kidney,' CMAJ137 (1987): 247. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual report, 1954; Gordon Murray, with R. Holden and W. Roschlau, 'Experimental and Clinical Study of New Growth of Bone in a Cavity,' American Journal of Surgery 93 (March 1957), 385-7. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual reports for 1952 and 1953; Gordon Murray, 'Fat Embolism and a Fat Center,' American Journal of Surgery 100 (November 1960), 676-81. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual reports for 1952, 1953, and 1954.

CHAPTER 5: A CURE FOR CANCER?

1 See James Patterson, The Dread Disease: Cancer and Modern American Culture (Cambridge: Harvard University Press, 1987). 2 National Archives of Canada (N)A, MG 28,1 224, National Cancer Institute of Canada, Minutes of the Third Annual Meeting, 16 May 1949; Barbara Clow, 'The Problem of Cancer: Negotiating Disease in Ontario, 1925-1945' (PhD dissertation, University of Toronto, 1994). 3 House of Commons, Debates, 4 March 1947. 4 Deborah Lupton, Medicine as Culture: Illness, Disease and the Body in Western Societies (London: SAGE Publications, 1994), 61-6. 5 NA, Paul Martin Papers, MG 32, B 12, vol. 81, file Cancer, January-May 1947: 'A Nation's Health Is a Nation's Wealth: The Attack on Cancer,' Montreal Star, 28 January 1947, and 'Canada Starts Drive on Cancer,' Ottawa MorningJournal, 29 January 1947; House of Commons, Debates, 4 March 1947, p 1028-9; 12 May 1947, 2956-7; 28 May 1947, 3513; 19 May 1947, 3565. 6 NA, MG 28,1 224, National Cancer Institute of Canada, Minutes of the First Annual Meeting, National Research Council, Ottawa, 30 September 1947.

Notes to pages 106-9 225 7 University of Toronto Archives (UTA), A81-0047/004, Ontario (dancer Institute 1951-65, Brief of the Ontario Cancer Treatment and Research Foundation to the Royal Commission on Health Services, 16 May 1962. 8 NA, MG 28, 1 224, National Cancer Institute of Canada, Minutes of the Seventh Annual Meeting, 9 May 1953; NA, Paul Martin Papers, MG 32, B 12, vol. 81, tile, Cancer, January-May 1947: 'Great Hopes in Cancer Fight,' Windsor Daily Star, 12 March 1947. 9 NA, Paul Martin Papers, MG 32, B 12, vol. 81, file, Cancer, January-May 1947: '28 Research Projects Seek Cancer's Cause,' Winnipeg Free Press, 15 November 1947. 10 Michael Bliss, Banting: A Biography (Toronto: McClelland & Stewart, 1984), 157, 211, NA, RG 29, Department of Health and Welfare, Central Registry Subject, files Series, vol. 188, file 311-C1-1, Epidemiology - Disease - Cancer General: 'Progress Is Seen in Experimental Cancer Research,' Globe, and Mail 2 November 1938. 1 1 Gordon Murray, {hiest. in Medicine (Toronto: Ryerson Press, 1963), 98. 12 NA, RG 29, Department of Health and Welfare, Central Registry Subject, files Series, vol. 188, file 31 1-Cl-l, Epidemiology - Disease - Cancer General 'Progress Is Seen in Experimental Cancer Research,' Globe and Mail 2 November 1938. 13 See Bervl I.ieff Benderly, 'From Poison Gas to Wonder Drug,' Invention and Technology 18 (Summer 2002), 48-54, for an overview of cancer treatments in the late 1940s and early 1950s and of the origins of chemotherapy out of wartime chemical weapons laboratory research. 14 |oan Austoker, A History oj the Imperial Cancer Research Fund, 1902-1986 (Oxford: Oxford University Press, 1988), 44-5. 15 Ibid. 1 (i Sigismund Peller. Cancer Research since 1900 (New York: Philosophical I-ibrarv. 1979). 279. 17 Gordon Murray, {hiest in Medicine (Toronto: Ryerson Press, 1963), 99-100. 18 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual report for 1953, and file 32, Minutes of Caven Foundation Board Members, 6 July 1951. 19 NA. I).W.(,. Murray Papers, MG 30, B 110, vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual report for 1952. Murray's cancer research was also described in earlier annual reports. 20 Gordon Murray, Experiments in Immunity in Cancer,' Canadian Medical Association journal (CMAJ) 79 (1958), 251; Gordon Murray, 'The Clinical Results of Serum Treatment of Carcinoma of Breast,' Bulletin oj the Academy of Medicine, Ibmnto 28, (June 1955): 196-9; NA, D.W.G. Murray Papers,

226 Notes to pages 109-11 MG 30, B110,vol. 41, file 35, G. Murray and W. Roschlau, 'Observations,' 1955-6; vol. 36, file 16, Experiment Notebook: A-C Serum Lab Book no. 2, 1952-3; file 17, Experiment Notebook: A-C Serum Lab Book no. 5, 1953-4; vol. 37, file 1, Experiment Notebook: A-C Serum Lab Book no. 6, 1954-5; file 2, Purification of Horse Serum Notes; file 17, Experiment Notebook: Tumor Suspensions Book no. 8, 1959-61; vol. 39, file 21, Method of Production of Anti-Cancer Serum in Horses. 21 Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 99-106. 22 Gordon Murray, 'The Clinical Results of Serum Treatment of Carcinoma of Breast,' Bulletin of the Academy of Medicine, Toronto 28 (June 1955), 1; NA,

D.W.G. Murray Papers, MG 30, B110,vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual report for 1951 and 1952. 23 Ben Rose, 'Murray Tells Government - Need Research, Cash for Cancer Vaccine,' Toronto Star, 5 February 1959. 24 Gordon Murray, 'Experiments in Immunity in Cancer,' CMAJ79 (1958), 251; Gordon Murray, 'The Clinical Results of Serum Treatment of Carcinoma of Breast,' Bulletin of the Academy of Medicine, Toronto 28 (June 1955);

NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, file 7, Correspondence, Murray to Dr AJ. Stuart Boyd, 26 September 1955. 25 NA, D.W.G. Murray Papers, MG 30, B110,vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual reports for 1951, 1952, 1953, 1954; file 32, Minutes and Correspondence, 6 July 1951. 26 'Given Up for Dead Toronto Wife Well after Cancer Serum,' Toronto Star, 1 March 1955; Ron Kenyon, 'Toronto MD Develops New Cancer Treatment,' Telegram (Toronto), 28 February 1955. 27 'New Serum Treatment Tried in Cancer Cases,' Globe and Mail, 1 March 1955; Ron Kenyon, 'City MD's Cancer Serum Seen Key to Other Types,' Telegram, 1 March 1955; Ron Kenyon, 'Science Report (Editorial),' Telegram, 2 March 1955. 28 J.E. Belliveau, 'Murray Serum Discovery Starts Controversy on Germ as Cancer Cause,' Toronto Star, 12 March 1955; Dr Bruce Charles, interview by author, 9 February 1997, Toronto; Dr D.R. Wilson, interview by author, 27 February 1996 and 14 April 1997, Toronto; Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto. 29 'Given Up for Dead Toronto Wife Well after Cancer Serum,' Toronto Star, 1 March 1955; 'New Serum Treatment Tried in Cancer Cases,' Globe and Mail, 1 March 1955; Ron Kenyon, 'City MD's Cancer Serum Seen Key to Other Types,' Telegram, 1 March 1955. 30 Dr Raymond Heimbecker, interview by author, 1 November 1996, Toronto; Dr D.L. Macintosh, telephone interview by author, 29 March 1997; Mrs Reta

Notes to pages 111-12 227 (nee Smith) Macnab, interview by author, 14 May 1996, Toronto; Mrs Paul Phelan, interview by author, 18 November 1996, Toronto; Dr D.R. Wilson, interview by author, 27 February 1996 and 14 April 1997, Toronto; Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto; Dr Neil Watters, interview by author, 23 May 1996, Toronto; J.E. Belliveau, 'Murray Serum Discovery Starts Controversy on Germ as Cancer Cause,' Toronto Star, 12 March 1955. 31 'Fourteen Patients Improved after Cancer Serum - Dr G. Murray,' Toronto Star, 9 March 1955; 'Serum from Horses Aids Cancer Patients - Dr G. Murray Finds,' Toronto Star, 9 March 1955; 'New Serum Treatment Tried in Cancer Cases,' Globe and Mail, 9 March 1955; 'MD Tells of Serum Halting Fatal Cancers,' Globe and Mail, 9 March 1955. 32 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 43, file 11, Correspondence, Ian Macdonald to Murray, 4 March 1955, and Murray to Ian Macdonald, 7 March 1955. 33 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 28, file 33, Correspondence, Hugh J. McLaughlin to Murray, 21 May 1954. 34 Since 1928, Bruce had advocated a cancer hospital for Toronto to study and treat the disease. For years, he had lobbied the government to set up the provincial centre for cancer treatment at the Wellesley Hospital. See J.T.H. Connor, Doing Good: The Life of Toronto's General Hospital (Toronto: University of Toronto Press, 2000), 214-29; Herbert A. Bruce, Varied Operations (Toronto: Longmans, Green, 1958), 178. 35 in reality, the laboratory operated on a modest budget, almost half of it going to pay salaries. Murray did not receive a salary. For the year 1949, income was $105,000 (Caven bequest); expenses, $44,286. For the year 1950, income was $19,500; expenses, $23,889; For the year 1951, income was $17,500; expenses, $15,772; For the year 1952, income was $27,500 ($10,000 not until 1953); expenses, $15,745 (NA, D.W.G. Murray Papers, MG 30, B 110,vol. 47, file 34, W.P. Caven Memorial Research Foundation, Financial Statements, 1949, 1950, 1951, 1952). 36 Hannah Institute for the History of Medicine Oral History Collection, vol. 5, Mrs Herbert Bruce, 81-2. 37 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 31, W.P. Caven Memorial Research Foundation, annual report for 1954. 38 Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto. 39 Ron Kenyon, 'Is This the Break-Through on Cancer?,' Telegram (Toronto), 9 March 1955. 40 NA, D.W.G. Murray Papers, MG 30, B 1 10, vol. 52, file 7, transcript of'Kate Aitken: Tamblyn Broadcast, Wednesday, March 9, 1955.'

228

Notes to pages 1 1 2 - 1 4

41 National Library, House of Commons, Debates, 10 March 1955, 1884. 42 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, file 7 Correspondence, Paul Martin to Roy Greenaway, 29 March 1955, and Arthur C. Sanderson to Murray, 4 April 1955; Bruce Byrnes, 'Ontario May Back Cancer Serum Work,' Telegram, 26 March 1955; Roy Greenaway, 'Had Only One Horse for Cancer Aid Serum - Will Get Funds for 3,' Toronto Star, 29 March 1955. 43 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, file 7, Correspondence, Murray to Arthur C. Sanderson, 11 April 1955, and Murray to E.W. Tyrrill, 4 May 1955. 44 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, file 7, Correspondence, W.C. Hoyt to E.W. Tyrrill, 24 March 1955, E.W. Tyrrill to Murray, 28 March 1955, BoydJ. Bell to Murray, 31 March 1955, Murray to BoydJ. Bell, 11 April 1945, and Murray to E.W. Tyrrill, 4 May 1955; 'Yank Gives $5,000 to Toronto Doctor,' London Free Press, 1 April 1955. 45 'Obituary, 'Percy R. Gardiner financier,' Toronto Star, 2 July 1965; 'Heart Attack Kills Percy R. Gardiner,' Telegram, 3 July 1965; 'Percy R. Gardiner: Baseball Benefactor Set Up Medicine Fund,' Globe and Mail, 3 July 1965. 46 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 41, file 18, Toast Made by Murray to Gardiner, 12 February 1963. See also 'Medical Research Foundation Set Up,' Telegram, 30 November 1955; NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 33 Gardiner Medical Research Foundation, annual report, 1955; Gordon Murray, Quest in Medicine (Toronto: The Ryerson Press, 1963), 99. 47 Gordon Murray, 'The Clinical Results of Serum Treatment of Carcinoma of Breast,' Bulletin of the Academy of Medicine, Toronto28 (June 1955): 196—9. 48 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 41, file 35, Correspondence, Fred W. Stewart to Murray, 11 July 1956, and Elizabeth B. Pohle to Murray, 10 September 1956. 49 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 43, file 11 Correspondence, J.A. Gravel to Murray, 31June 1955, Hamilton Baxter to Murray, 4July 1955, and Charles Huggins to Murray, 31 August 1955. 50 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, file 7, Correspondence, S. Clyde Strickland to Murray, 5 April 1955 and Murray to S. Clyde Strickland, 11 April 1955. 51 Graham Currie, Cancer and the Immune Response, 2nd ed. (London: Edward Arnold, 1980), 95. For media coverage of the converging views, see 'Clinical Team Seeking New Anti-Cancer Drug,' Whig Standard (Kingston), 26 March 1955; Earl Ubell, 'See Virus Cancer Cause,' Telegram (Toronto ), 11 April 1955; Bess Furman, 'Breakthroughs in Cancer Work Claimed Near,' Globe and Mail, 2 April 1958; 'Many Think Virus Cause Cancer: Researcher,' Globe

Notes to pages 1114-16 229 and Mail, 25 April 1958; Lotta Dempsey, 'Team Believes Cancer Is Virus,' Globe and Mail, 16 June 1958; Pat McNenly, 'Cancer Virus Theory Grows,' Toronto Star, 15 June 1960; Helen Allen, 'Virus Theory on Cancer Gets Thorough Workout,' Telegram, 15 June 1960; David Spurgeon, 'The Advance of Medicine: Search for Cancer-Causing Viruses,' Globe and Mail, 9 August 1960; 'Step Toward Attack: Virus Link Reported with Human Cancers,' Globe and Mail, 29 September 1960. 52 Janice Tyrwhitt, 'Can Science Beat the Virus Diseases?' Maclean's, 4 August 1956,44, 53 'Vaccine Called Best Hope for Control of Cancer,' Toronto Star, 14June 1962. 54 rbid. 55 Ken Madaggar t, This Virus Could Lead to the Missing Link: We May Rid the World of Cancer,' Telegram, 29 September 1962. 56 New Victories in War on Cancer,' Toronto Star Weekly, 19 May 1956; 'Polio Success Linked with War on Cancer,' Port Arthur N.C., 29 April 1955 (taken from Archives of Ontario, MS 755, Press Clippings, Ontario Legislature — Office of the Clerk of the Legislature). 57 Phyllis Griffiths, ' 10-Year Target Set to Find a Cure for Cancer,' Telegram, 1 April 1957. 58 Records of the (Canadian Cancer Society, Ontario Division, Toronto, Minutes of the Annual Meeting, 24 February 1956, appendix A. 59 Accompanying Murray in this elite category of 'leading Toronto cancer specialists' were the following: Dr Clifford L. Ash, director of the Toronto General Hospital's Cancer Clinic and director of the new Ontario Cancer Institute; Dr R.M Taylor, executive director of the Canadian Cancer Society and the National Cancer Institute; Dr William L. Donohue, director of pathology at the Hospital for Sick Children; Dr W. Gerald Cosbie, medical director of the Ontario Cancer Treatment and Research Foundation; Dr Arthur W. Ham, director of Biological Research at the Ontario Cancer Institute; and Dr Harold E. Johns, head of the Physics Division of the Ontario Cancer Institute and designer of the Cobalt 'bomb.' See Phyllis Griffiths, ' 10-Year Target Set to Find a Cure for Cancer,' Telegram, 1 April 1957. 60 John Edwards, 'Serum Offers New Approach to Cancer,' Toronto Star Weekly, 1 1 June 1955. 61 See Barbara Clow, Negotiating Disease: Power and Cancer Cure, 1900-1950 (Montreal and Kingston: McGill-Queen's University Press, 2001). 62 Archives of Ontario (AO), RG 10-106, Ministry of Health, Public Health Central Files, 1916-70, box 18, file 18.3, Cancer Cures: Glover, DrT.J.,

230 Notes to pages 116-17 1944-63, 'Some Degree of Success Seen in Glover's Cancer Research,' Globe and Mail, 31 March 1944; Robert Noble to Mackinnon Phillips, 23 January 1953, and Dr M.E. Gordon to MacKinnon Phillips, 26 Jan. 1953. 63 AO, RG 10-138, transfer no. 74-584, R.C., box 5, Ace. 14576/12, 'Cancer Cures - Hett Clinic 1937-1948' and 'Cancer Cures - Hett Clinic 19501959,' Report of the Commission for the Investigation of Cancer Remedies on the Hett Cancer Treatment and Research Foundation, 3 April 1959; Warren E. Schaller and Charles R. Carroll, Health, Quackery and the Consumer (Toronto: W.B. Saunders, 1976), 296. 64 Warren E. Schaller and Charles R. Carroll, Health, Quackery and the Consumer (Toronto: W.B. Saunders, 1976), 297; Wallace F. Janssen, 'Cancer Quackery: The Past in the Present,' Seminars in Oncology 6 (December 1979), 527-8; AO, RG 10-106, Ministry of Health, Public Health Central Files, 1916-70, box 13, file 13.5, Cancer Cures: Arnott, 1942-4, 'Serum Shipment Indicts Doctor,' Globe and Mail, 11 April 1942; 'Koch Treatment for Cancer Is Being Probed by Government Commission,' Lethbridge Herald, 16 September 1941; [Report] Dr David H. Arnott re Glyoxylide, 7 February 1942. 65 AO, RG 10-6-0-428, box 39, file: Hoxsey Treatment for Cancer, 1957-8, Correspondence, Mackinnon Phillips to L.M. Frost, 27 March 1958; Report of a Committee of Faculty Members of the University of British Columbia concerning the Hoxsey Treatment for Cancer, 1957. 66 Warren E. Schaller and Charles R. Carroll, Health, Quackery and the Consumer (Toronto: W.B. Saunders, 1976), 297, 306-7; James Harvey Young, American Health Quackery (New Jersey: Princeton University Press, 1980), 234—6; Morris Fishbein, 'History of Cancer Quackery,' Perspectives in Biology and Medicine 18 (Winter 1965), 161-5; Wallace F. Janssen, 'Cancer Quackery: The Past in the Present,' Cancer Quackery 6 (December 1979), 530-1; Dennis Connaughton, 'Krebiozen: The Scandal That Would Not Die,' in Warren Cole, MD and the Ascent of Scientific Surgery (Chicago: Cole Foundation, 1991), 131-67; Patricia Spain Ward, 'Who Will Bell the Cat? Andrew C. Ivy and Krebiozen,' Bulletin of the History ofMedicine58 (1984), 28-52; George D. Stoddard, Krebiozen: The Great Cancer Mystery (Boston: Beacon Press, 1955); Herbert Bailey, K: Krebiozen: Key to Cancer? (New York: Hermitage House, 1955), and A Matter of Life and Death: The Incredible Story of Krebiozen (New

York: G.P. Putnam's Sons, 1958). 67 AO, RG 10-6-0, Deputy Minister's Files, Legislation, box 100, file 1024, Cancer 1938-65, The Cancer Remedy Act, 1938; Deputy Minister's General Correspondence, Disease, box 39, file 10-6-0-431, Cancer Treatments, Correspondence, D.E. Cannell to M.B. Dymond, 13July 1966. 68 James Young suggests that the four major 'unorthodox' cancer treatments

Notes to pages 117-18 231

69

70

71

72

73

in the United States were the Koch treatment, the Hoxsey treatment, Krebiozen, and Laetrile. See James Harvey Young, Amecan Health Quackery (New Jersey: Princeton University Press, 1980), 234-6; Morris Fishbein, 'History of Cancer Quackery,' Perspectives in Biology and Medicine 18 (Winter 1965), 139-66; Wallace F. Janssen, 'Cancer Quackery: The Past in the Present,' Cancer Quackery6(December 1979), 526-36; AO, RG 10-1-1-18.25, Ontario Cancer Treatment and Research Foundation, re Anti-Cancer Hormone (ACH) - Dr Mirkovitch, 1966, Statement in the Legislature by Hon. M.B. Dyrnond on Anti-Cancer Hormone developed by Doctors V.A. and J.J. Mirkovitch. These characteristics taken directly from Warren E. Schaller and Charles R. Carroll, Health, Quackery and the Consumer (Toronto: W.B. Saunders, 1976), 307-8. See also James Harvey Young, American Health Quackery (New Jersey: Princeton University Press, 1980). NA, D.W.C. Murray Papers, MG 30, B 110, vol. 52, file 7, Announcement of private clinic practice treating malignant disease, Ernest Frederick, MD, Toronto (c. 1955); AO, RG 10-106, Ministry of Health, Public Health Central Files, 1916-70, box 17, file 17.8, 'Cancer Cures: Frederick, Dr E.W. 1955-60,' Correspondence, Dr E.W. Frederick to Dr MacKinnon Phillips, 1 1 August 1958, and Dr E.W. Frederick to Dr M.B. Dymond, 30 December 1958; Report of the Commission for the Investigation of Cancer Remedies on Dr E.V. Frederick, 10 February 1956. "Bar "Cancer Serum" MD for "Infamous Conduct,"' Telegram (Toronto), 16 April 1952; Bar Dr J. Hett from Practice of Medicine,' Toronto Star, 16 April 1952; AO, RG 10-138, transfer no. 74-584, R.C., box 5, Ace. 14576/ 12, 'Cancer Cures - Hett Clinic 1937-1948' and 'Cancer Cures - Hett Clinic 1950-59,' Report of the Commission for the Investigation of Cancer Remedies on the Hett Cancer Treatment and Research Foundation, 3 April 1959. It was rumoured that steps were taken to bring Murray before the college on account of one particularly bad death allegedly resulting from his serum treatments. I could find no written documents to substantiate this story (Hannah Institute for the History of Medicine Oral History Collection, vol. 35, Dr Arthur Evan Parks, 228; College of Physicians and Surgeons of Ontario Archives, annual reports for 1950—76). Barbara Clow argues that professional standing and conduct influenced acceptance of unconventional treatments by the medical community. This was the case with Dr Hendry Connell's Ensol in comparison with Hett's serum or Rene Caisse's essiac tea. She states: 'Connell's methods may have been flawed but his ideas were communicated in the language both familiar

232 Notes to pages 118-20 and acceptable to the scientific and medical communities ... Combined with his medical qualifications and his professional connections, these factors won for Connell a measure of tolerance and support.' I would argue that, to the same extent, this argument is applicable to Murray's situation. See Barbara Clow, 'The Problem of Cancer: Negotiating Disease in Ontario 1925-45' (PhD dissertation, University of Toronto, 1994), 77-8, and Negotiating Disease: Power and Cancer Cure, 1900-1950 (Montreal and Kingston:

74

75 76

77

78

79 80 81

McGill-Queen's University Press, 2001). NA, D.W.G. Murray Papers, MG 30, B110,vol. 47, file 23, Gardiner Medical Research Foundation, annual report for 1956. See also Roy Greenaway, 'Toronto Doctor Reveals Second Cancer Serum,' Toronto Star, 1 December 1955; 'Treat Intestinal Cancer with New Serum Produced at New Centre,' Peterborough Examiner, 7 December 1955; Roy Greenaway, 'Cancer Patients Say Toronto Serum Gives New Lease on Life,' Toronto Star, 5 December 1956; Gordon Murray, 'Experiments in Immunity in Cancer,' CMAj79 (1958), 253; Ben Rose, 'Murray Tells Government - Need Research, Cash for Cancer Vaccine,' Toronto Star, 5 February 1959. NA, D.W.G. Murray Papers, MG 30, B110,vol. 47, file 23, Gardiner Medical Research Foundation, annual report for 1956. AO, RG 10-106, Public Health Central Files, 1916-70, box 19, Cancer Cures, 1937-61, file 19.23, 'Cancer General Correspondence, 1957-65,' Murray to Mackinnon Phillips,15January 1957, and Leslie J. McKee to John Hanna, 15 January 1957. AO, RG 10-106, Public Health Central Files, 1916-70, box 19, Cancer Cures, 1937-61, file 19.23, 'Cancer General Correspondence, 1957-65,' Mackinnon Phillips to Murray, 22 July and 31 October 1957, Murray to Mackinnon Phillips, 1 November 1957. AO, RG 10-106, Public Health Central Files, 1916-70, box 19, Cancer Cures, 1937—61, file 19.23, 'Cancer General Correspondence, 1957—65,' Dr Gordon Murray Research Project, address given to the Pathologists, Conference, King Edward Hotel, 17 October 1957, by the Hon. Mackinnon Phillips, Minister of Health for the Province of Ontario. Ibid. NA, D.W.G. Murray Papers, MG 30, B110,vol. 52, Gardiner Medical Research Foundation, annual report for 1958; vol. 35, file 22, Specimen Book 1, 1952-7; file 23, Specimen Book 2, 1957-62. Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto; Barbara Clow, 'The Problem of Cancer: Negotiating Disease in Ontario, 1925-45' (PhD dissertation, University of Toronto, 1994), 151.

Notes to pages 120-3 233

82 83 84

85

86

87

88 89 90

91 92 93

See also Warren E. Schaller and Charles R. Carroll, Health, Quackery and the Consumer- (Toronto: W.B. Saunders, 1976), 286. Roy Greenaway, 'Cancer Patients Say Toronto Serum Gives New Lease on Life,' Toronto Star, 5 December 1956. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 41, Correspondence, n.d. Dr Edward Mullens, interview by author, 20 January 1997, Toronto; Dr Neil Watters, interview by author, 23 May 1996, Toronto; Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 23, Gardiner Medical Research Foundation, annual report for 1956; vol. 52, Gardiner Medical Research Foundation, annual report for 1958; Dr Walter Roschlau, interview by author, 1 7 April and 24 July 1996, Toronto. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52 Gardiner Medical Research Foundation, annual report for 1958; Dr Walter Roschlau, interview by author. 17 April and 24 July 1996, Toronto; Dr Neil Watters, interview by author, 23 May 1996, Toronto. AC), RG 10-106, Public Health Central Files, (1916-70), box 19, Cancer Cures, 1937-61, file 19.23, 'Cancer General Correspondence 1957-65,' Leslie J. McK.ee to John Hanna, 15 January 1957. See also Ben Rose, 'Murray Fells Government- Need Research, Cash for Cancer Vaccine,' Toronto Slat, 5 February 1959. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 26, Correspondence, Murray to Arthur C. Sanderson, 30 April 1956. Gordon Murray, "Experiments in Immunity in Cancer,' CAM/79 (1958), 249-59. The autogenous vaccine was given to patients in addition to serum treatments - both being administered in an attempt to bolster active and passive immunity, respectively, in the patient. See Gordon Murray, 'Experiments in Immunity in Cancer,' CAM/79 (1958), 257-8; NA, D.W.G. Murray Papers, MG 30, B 1 10, vol. 43, file 15, abstract of paper on 'Experiments in Immunity in (lancer,' bv Murray to the American Academy of Orthopedic Surgeons in January 1959. Gordon Murray, Experiments in Immunity in Cancer,' CAM/79 (1958), 253-7. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, Gardiner Medical Research Foundation, annual report for 1958. Gordon Murray, 'Experiments in Immunity in Cancer,' CAM/79 (1958), 253-5.

234

Notes to pages 123-6

94 Ibid. 95 'Serum against Cancer?' Time, (Canadian edition), 8 September 1958, 48-9. 96 Dr Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto. See also 'Serum against Cancer?' Time (Canadian Edition), 8 September 1958, 48-9. 97 According to R.M. Taylor, Murray had responded that 'this was not necessary and proceeded to develop a serum and to publish one or two reports on this material.' NA, D.W.G. Murray Papers, MG 30, B 110, vol. 30,file7, Correspondence, R.M. Taylor to M.J. Grimes, 14 August 1969. 98 Gordon Murray, 'Experiments in Immunity in Cancer,' CMAj79 (1958), 259. 99 NA, D.W.G. Murray Papers, MG 30, B110,vol. 43, file 15, Experiments in Immunity in Cancer, 1958-63, press release from Canadian Medical Association, 18 August 1958, and list of names requesting reprints. 100 'Cancer Serum Adds to Life, Doctor Finds,' Globe and Mail, 18 August 1958; 'City Cancer Discovery - Serum Prolongs Life,' Telegram (Toronto), 18 August 1958; 'Canadian Serum in Cancer Fight Impresses U.K.,' Globe and Mail, 10 October 1958. 101 William L. Laurence, 'Canadian Scientists Are Testing a Serum That Seems to Help Cancer Victims,' New York Times, 24 August 1958. 102 NA, D.W.G. Murray Papers, MG 30, B110,vol. 29, file 2, Correspondence, Murray to Lome Pierce, 20 October 1959. 103 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 29, file 2, Correspondence, Lome Pierce to Murray, 9 November 1959. 104 NA, D.W.G. Murray Papers, MG 30, B110,vol. 29, file 2, and vol. 48, files 17 and 20. 105 NA, D.W.G. Murray Papers, MG 30, B110,vol. 31, file 23, Correspondence, - to Murray, 18, 25, and 27 August 1958 and 9 September 1958. 106 NA, D.W.G. Murray Papers, MG 30, B110,vol. 31,file23, Correspondence, - to Murray, 20, 21, and 22 August 1958. 107 'All World Pleads for Cancer Vaccine - MD Asks Gov't Aid,' Telegram (Toronto), 5 February 1959. 108 NA, D.W.G. Murray Papers, MG 30, B110,vol. 31,file23, Correspondence, Ethel Kerr to Murray, 9 September 1958. 109 'Dying of Cancer - Better after Serum,' Toronto Star, 27 January 1959. 110 NA, D.W.G. Murray Papers, MG 30, B110,vol. 39, file 19, news release from the American Academy of Orthopedic Surgeons, 27 January 1959, and vol. 43, file 15, abstract of paper on 'Experiments in Immunity in Cancer,' by Murray to the American Academy of Orthopedic Surgeons, January 1959.

Notes to pages 127-9 235 111 'All World Pleads for Cancer Vaccine - MD Asks Gov't Aid,' Telegram, 5 February 1959; Ben Rose, 'Murray Tells Government - Need Research, Cash for Cancer Vaccine,' Toronto Star, 5 February 1959. 1 12 'Defend Radiation, Surgery in Cancer Fight,' Toronto Star, 5 February 1959; Asks Government Aid Battle against Cancer,' Globe and Mail, 6 February 1959; 'Unwise Murray Blasted by Cancer Researchers,' Telegram, 6 February 1959. 113 House of Commons, Debates,11February 1959, 908-9; 'Anti-Cancer Serum Work Being Watched by Ottawa,' Globe and Mail, 12 February 1959. For a further breakdown of annual allocations of the Cancer Control Grants by province, see House of Commons, Debates, 18 February 1954, 2201. 114 House of" Commons, Debates, 11 February 1959, 908-9; 'Anti-Cancer Serum Work Being Watched by Ottawa,' Globe and Mail, 12 February 1959; 'When Perfect Ottawa to Give Cancer Serum,' Toronto Star, 12 February 1959; 'Await Tests for Support of Vaccine,' Ottawa Citizen, 12 February 1959. 115 'Asks Government Aid Battle against Cancer,' Globe and Mail, 6 February 1959. 116 l)r Walter Roschlau, interview by author, 17 April and 24 July 1996, Toronto. 117 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, Gardiner Medical Research Foundation, annual report for 1958; vol. 36, file 12, Kidney Perfusion, October 1958 to May 1959; file 13, Kidney Perfusion, May 1959 to May I960 1 18 (Ihemotherapy destroys cancer cells by interfering in some way with their ability to reproduce themselves. The drawback is that cytotoxic drugs are not selective enough and do not discriminate between cancer and noncancer cells. But once the tumour is destroyed, the damaged normals cells can recover. Some chemotherapy drugs are administered orally; others by injection or intravenous drip. The side effects of these drugs include hair loss, nausea, vomiting, tiredness, depression, diarrhoea, skin rashes, general soreness, and possible loss of fertility. All information on chemotherapy taken directly from Understanding Cancer (Consumers' Association, June 1986), 78-82. 119 R. Grant Steen, A Conspiracy of Cells: The Basic Science of Cancer (New York: Plenum Press, 1995), 155. 120 Sigisinund Pellet. Cancer Research since 1900 (New York: Philosophical Library, 1979), 279. 121 NA, D.W.Ci. Murray Papers, MG 30, B 110, vol. 47, file 26, Correspondence, Murray to Percy Gardiner, 15 September 1961. 122 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 26, Correspondence, Percy Gardiner to Murray, 15 October 1963.

236

Notes to pages 129-33

123 Records of the Canadian Cancer Society, Ontario Division, Toronto, Minutes of the Annual Meeting, 22 November 1961, appendix A. 124 Barbara Moon, 'Who Is Dr Murray? How Seriously Does Medicine Now Take Cancer-Serum Experiments?' Maclean's, 16 November 1963, 27. 125 Ibid. 126 Ibid. Murray quote taken from Gordon Murray, Quest in Medicine (Toronto: Ryerson, 1963), 120. 127 Gordon Murray, 'Experiments in Host Resistance to Cancer (in Human Subjects),' American Journal of Surgery 109 (June 1965), 763-4. 128 Personal interviews by author; personal correspondence, Dr Fred Moffat to author, 21 January 1997; NA, D.W.G. Murray, MG 30, B 110, vol. 43, file 30, Correspondence, Murray to P.G. Scholefield, 10 April 1972. 129 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 47, file 26, Correspondence, Percy Gardiner to Murray, 6 April 1964; vol. 30, file 8, Correspondence, Murray to L.V. Kilmury, 16 March 1970. 130 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 30, file 11, Correspondence, Floyd S. Chalmers to Murray, 5 June 1973; vol. 52, file 9, Correspondence, Norah Michener to Murray, 15 November 1971. 131 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, file 9, Correspondence, R. Michener to Murray, 1 July 1964 and Norah Michener to Murray, 15 November 1971; vol. 30, file 11, Correspondence, Norah Michener to Murray, 23 May 1973. 132 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 49, file 11, Correspondence, Murray to Rolland Michener, 8 January 1965; vol. 47, file 29, J.P. Bickell Foundation Report, 1965 and 1967; vol. 30, file 7, Correspondence, PJ. Sewell to Murray, 1 April 1969 (Murray received $4,000 that year); vol. 47, file 25, Correspondence, Murray to S.E. Bernier, 12 February 1970; 'Ontario Arts Get Big Boost [Bickell Foundation],' Globe and Mail, 26June 1996. 133 John Edwards, 'Serum Offers New Approach to Cancer,' Toronto Star Weekly, 11 June 1955. 134 Banting's work on cancer taken from Michael Bliss, Banting: A Biography (Toronto: McClelland & Stewart, 1984), 121-2. CHAPTER 6: MAKING PARAPLEGICS WALK AGAIN

1 Don Dutton, 'Toronto Surgeon's Medical Miracle Brings Paralyzed Man to His Feet,' Toronto Star,15November 1967. 2 Martha Freeman Somers, Spinal Cord Injury: Functional Rehabilitation (Norwalk, Conn.: Appleton and Lange, 1992), 1.

Notes to pages 134-6 237 3 Lynn Phillips et al., Spinal Cord Injury: A Guide for Patient andFamily (New York: Raven Press, 1987), 10-12; M. Oliver etal., Walking into Darkness: The Experience of Spinal Cord Injury (London: Macmillan, 1988), ix. I thank Dr William Geisler for helping me understand the science of spinal cord regeneration (interview by author, 17 April 1997, Toronto). 4 Lynn Phillips et al., Spinal Cord Injury: A Guide for Patient and Family (New York: Raven Press, 1987), 12-16. 5 Geoffrey Hewelcke, 'They Walk ... Though Paralyzed,' Maclean's, 1 February 1946, 21-2, 37; E.H. Botterell and A.T.Jousse, 'Paraplegia Following War,' Canadian Medical Association journal (CMAJ) 55 (1946), 249; E.H. Botterell et al., 'A Model for the Future Care of Acute Spinal Cord Injuries,' Canadian journal of Neurological Sciences, November 1975, 361-80; M. Oliver et al., Walking into Darkness: The Experience of Spinal Cord Injury (London: Macmillan, 1988), 1-6; Mary Tremblay, 'The Canadian Revolution in the Management of Spinal Cord Injury,' Canadian Bulletin of Medical History 12, no. 1 (1995): 125-55; Mary Tremblay, 'Going Back to Civvy Street: A Historical Account of the Impact of the Everest and Jennings Wheelchair for Canadian World War II Veterans with Spinal Cord Injury,' Disability and Society11.no. 2 (1996): 149-69. 6 See Geoffrey Hewelcke, 'They Walk ... Though Paralyzed,' Maclean's, 1 February 1946, 21-2, 37; Mary Tremblay, 'Going Back to Civvy Street: A Historical Account of the Impact of the Everest and Jennings Wheelchair for Canadian World War II Veterans with Spinal Cord Injury,' Disability and Society11.no. 2 (1996): 158. 7 Gordon Murray, Quest in Medicine (Toronto: Ryerson Press, 1963), 99; Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto 8 Gordon Murray, Treatment of Spinal Cord Injuries,' unpublished article. See National Archives of Canada (NA), D.W.G. Murray Papers, MG 30, B 110,vol. 43, file 16, On Spinal Cord Regeneration in Humans, 1967-8. 9 Gordon Murray, 'Regeneration in Injured Spinal Cord,' American Journal of Surgery 109 (April 1965): 406-7. 10 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 37, file 19, Experiment Notebook. Animal Series I, Spinal Transections, 1960-1; vol. 38, file 10, Experiment Notebook: Spinal Series I and II, 1961-2; file 11, Experiment Notebook. Spinal Series III, A to O, 1962-3; file 12, Experiment Notebook: Spinal Series III, P to Z, 1962-3; file 13, Experiment Notebook: Spinal Series IV, A to V, 1962-3; Gordon Murray, 'Regeneration in Injured Spinal Cord," American Journal of Surgery 109 (April 1965): 407-8. 11 Gordon Murray, 'Regeneration in Injured Spinal Cord,' American Journal of

238

Notes to pages 137-9

Surgery 109 (April 1965): 408. See also NA, D.W.G. Murray Papers, MG 30, B 110, vol. 38, file 14, Experiment Notebook: Spinal Series V, Complete Transection, 1964; file 15, Experiment Notebook: Spinal Series V, Complete Transection, 1964; file 16, Experiment Notebook: Spinal Series V, Complete Transection, 1964; file 18, Experiment Notebook: Spinal Series, Complete Transection Books 1-4, 1964-5. 12 Gordon Murray, 'Regeneration in Injured Spinal Cord,' American Journal of Surgery 109 (April 1965): 406-9. 13 'Animal Tests Provide Hope for Paraplegics, Toronto Doctor Says,' Globe and Mail, 16 November 1965; 'Spine Slicing Technique: Doctor Gives Hope Paraplegic May Still Walk,' Toronto Star, 16 November 1965. 14 P. Dentan, Quelques recherches sur la regeneration fonctionnelle et anatomique de la moelle epiniere (Berne: Diss. Inaug. CJ. Wyss, 1873). A historical review of the pertinent literature on regeneration in the spinal cord after injury both in humans and in the experimental animal provided in Lionel Wolman, 'Axon Regeneration after Spinal Cord Injury,' Paraplegia 4 (1966-7): 175-84. 15 Lionel Wolman, 'Axon Regeneration after Spinal Cord Injury,' Paraplegia 4 (1966-7): 175-6. 16 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 38, file 17, Experiment Notebook: Spinal Dogs, November 1965 to December 1966. 17 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 31, Correspondence, - to Murray, 1966. 18 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 41, file 10, 'Encouragement in Spinal Cord Regeneration,' unpublished paper, n.d. 19 Toronto Hospital Archives (THA), Minutes of the Medical Advisory Board, 21 December 1967, Operation Report for Purvis Damms, 10 February 1967; Gordon Murray, 'Surgical Treatment of Paraplegia,' Panminerva Medica 14 (September 1972): 303; NA, D.W.G. Murray Papers, MG 30, B 110, vol. 41, file 10, 'Encouragement in Spinal Cord Regeneration,' unpublished paper, n.d. 20 THA, Minutes of the Medical Advisory Board, 21 December 1967, Operation Report for R.H., 17 February 1967, and Operation Report for H.N., 13 April 1967. 21 THA, Minutes of the Medical Advisory Board, 21 December 1967, Operation Report for A.D., 21 April 1967; NA, D.W.G. Murray Papers, MG 30, B 110, vol. 41, file 10, 'Encouragement in Spinal Cord Regeneration,' unpublished paper, n.d. 22 Ibid. 23 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 41, file 10, 'Encouragement in Spinal Cord Regeneration,' unpublished paper, n.d.

Notes to pages 140-3 239 24 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 43, file 26, Correspondence, Lester S. King to Murray, 15 August 1967. 25 THA, Minutes of the Medical Advisory Board, 21 December 1967, Operation Report for L.R., 16 October 1967. 26 THA, Minutes of the Medical Advisory Board, 21 December 1967, Operation Report for S.K., 30 October 1967. 27 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 43, file 16, 'On Spinal Cord Regeneration,' unpublished paper, 1967-8. 28 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 29, file 15, Correspondence, E. Cullen Bryant to Murray, n.d. 29 'Success of Spinal Operation Discounted - Hospital Says More Proof Needed,' Telegraph-Journal (Saint John, N.B.), 22 November 1967. 30 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 39, file 29, Statement written by Murray, n.d. 31 Don Dutton, 'Toronto Surgeon's Medical Miracle Brings Paralyzed Man to His Feet,' Toronto Star, 15 November 1967; David Spurgeon, 'New Technique Permits Paraplegic to Sit, Stand,' Globe and Mail, 15 November 1967; Ken MacTaggart, 'Quadraplegic Stands Up ... Waves,' Telegram (Toronto), 15 November 1967: 'Dr Murray's Work Praised,' Telegram, 15 November 1967; 'Dr G. Murray - Curiosity Began with an Egg,' Telegram, 15 November 1967; David Spurgeon, 'Gordon Murray: A Brilliant Surgeon Who Walks Alone,' Globe and Mail, 16 November 1967. 32 Don Dutton. 'Toronto Surgeon's Medical Miracle Brings Paralyzed Man to His Feet," Toronto Star, 15 November 1967; David Spurgeon, 'New Technique Permits Paraplegic to Sit, Stand,' Globe and Mail, 15 November 1967; Ken MacTaggart, 'Quadraplegic Stands Up ... Waves,' Telegram, 15 November 1967. 33 David Spurgeon, 'Gordon Murray: A Brilliant Surgeon Who Walks Alone,' Globe and Mail, 16 November 1967; Marilyn Dunlop, 'A Doctor Who Proved the Textbooks Wrong,' Toronto Star, 16 November 1967; 'Miracle Operation Result of Eight Years of Research,' Daily Nugget (North Bay), 16 November 1967; "Spinal Cord Injuries,' Telegram, 16 November 1967. 34 Ken MacTaggart, 'A Fresh Life Follows Four Long Years of Agony,' Telegram, 16 November 1967; "Miracle" Bertrand Proulx Wants to Wed His Former Nurse,' Toronto Star, 18 November 1967. 35 'Steve Lies in Body Cast: Still Expects Own "Miracle,"' Toronto Star, 25 November 1967, 36 John Gault, 'Promise of New Life - Paraplegics Are Exultant,' Telegram, 16 Novembei 1967. 37 Letter to the editor, Globe and Mail, 17 November 1967.

240

Notes to pages 144-6

38 'The Miracle' (editorial), Telegram, 16 November 1967. 39 'Dr Murray's Work Praised,' Telegram, 15 November 1967; 'Surgeons: Optimistic, Skeptical,' Telegram, 16 November 1967; Ken MacTaggart, 'The Bertrand Proulx Case: 'A Quadriplegic' - MDs,' Telegram, 17 November 1967. 40 Due to his past contributions, Murray still commanded respect among his colleagues, despite their obvious disbelief in his spinal cord regeneration announcement (personal interviews by author, Toronto). 41 NA, audio-visual materials, VI 8402-0035, ISN 16510, 'The Way It Is,' 19 November 1967. 42 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, W.R. Drucker to J.C. McCulloch, 20 November 1967, J.C. McCulloch to W. Anderson, 29 November 1967, and J.D. Wallace to John S. Young, 18 December 1967. 43 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to Murray, 20 November 1967. 44 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to Dr H.S. Doyle and Miss MJ. Dodds, 20 November 1967, Miss MJ. Dodds to J.D. Wallace, 21 November 1967, Dr H.S. Doyle to J.D. Wallace, 28 November 1967, and J.D. Wallace to H.S. Doyle, 1 December 1967. 45 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to J.C. McCulloch, 29 November 1967. 46 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to Members of the Board of Trustees, 29 November 1967; NA, D.W.G. Murray Papers, MG 30, B110,vol. 39, file 29, statement written by Murray, n.d. 47 Joan Hollobon, 'Hospital Surgeon Emphasizes Proof Lacking for Spinal Cord Operation,' Globe and Mail, 22 November 1967; NA, audio-visual materials, VI 9601-0016, ISN 178361, CBC News Filmpack, 22 November 1967. 48 Ken MacTaggart, 'Procedure Questioned, but Dr Murray's Tests Go On,' Telegram, 22 November 1967; Marilyn Dunlop, 'Dr Murray Clashes with Hospital over Effect of Spinal Surgery,' Toronto Star, 22 November 1967; David Spurgeon, 'Lone Wolf at Odds with Modern Men of Medicine,' Globe and Mail, 22 November 1967;Joan Hollobon, 'Hospital Surgeon Emphasizes Proof Lacking for Spinal Cord Operation,' Globe and Mail, 22 November 1967. 49 David Spurgeon, 'Lone Wolf at Odds with Modern Men of Medicine,' Globe and Mail, 22 November 1967.

Notes to pages 146-9 241 50 Joan Hollobon, 'Hospital Surgeon Emphasizes Proof Lacking for Spinal Cord Operation,' Globe and Mail, 22 November 1967. 51 'Error in Interpretion," Medical Post, (Toronto), 5 December 1967. 52 Joan Hollobon, 'Hospital Surgeon Emphasizes Proof Lacking for Spinal Cord Operation," Globe and Mail, 22 November 1967. 53 Marilyn Dunlop, Dr Murray Clashes with Hospital over Effect of Spinal Surgery,' Toronto Star, 22 November 1967. 54 Joan Hollobon, Hospital Surgeon Emphasizes Proof Lacking for Spinal Cord Operation/ Globe and Mail, 22 November 1967. 55 David Spurgeon, Lone Wolf at Odds with Modern Men of Medicine,' Globe and Mail, 22 November 1967. 56 'Spinal Regeneration: The Uproar Grows,' Medical Post, 5 December 1967. 57 Ken MacTaggart, Procedure Questioned, but Dr Murray's Tests Go On,' Telegram, 22 November 1967. 58 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to members of the Board of Trustees, 29 November 1967. 59 University of Toronto Archives (UTA), Faculty of Medicine, Office of the Dean, A76-0044, box 231, file 21, Dr Gordon Murray, Correspondence, Ludwig Guttmann to A.L. Chute, 22 November 1967. 60 UTA, Faculty of Medicine, Office of the Dean, A76-0044, box 231,file21, Dr Gordon Murray, Correspondence, Alain Rossier to A.L. Chute, 30 November 1967. 61 UTA, faculty of Medicine, Office of the Dean, A76-0044, box 231,file21, Dr Gordon Murray, Correspondence, A. Tricot to A.L. Chute, 27 December 1967. 62 UTA, Faculty of Medicine, Office of the Dean, A76-0044, box 231,file21, Dr Gordon Murray, Correspondence, A.L. Chute to Ludwig Guttmann, 1 December 1967, A.L. Chute to Alain Rossier, 6 December 1967, and A.L. Chute to A. Tricot, 8 January 1968. 63 'Why 1 1 in Toronto Area Won Canada Awards,' Toronto Star, 7July 1967; '35 Invested in Order of Canada while 55 get Medal of Service,' Globe and Mail, 25 November 1967. 64 Mrs Rosalind Bradford, interview by author, 26June, 3 and 1ojuly 1996, Toronto. 65 NA, D.W.G. Murray Papers, MG 30, B110,vol. 49, file 5, Order of Canada Investiture Program and Peter Sypnowich and Janice Tyrwhitt, 'Dr Murray's "Miracle": The Whole Story,' Star Weekly Magazine, 16 December 1967, 6. 66 Dr W.R. Drucker, interview by author, 24 August 1998, Bethesda, Md. Peter Sypnowich and Janice Tyrwhitt, 'Dr Murray's "Miracle": The Whole Story,' Star Weekly Magazine, 16 December 1967, 6.

242

Notes to pages 149-51

67 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to members of the Board of Trustees, 29 November 1967. 68 Joan Hollobon, 'Chief Surgeon's Statement - Claims Spine Not Rejoined,' Globe and Mail, 25 November 1967. 69 'Storm over Dr Murray- Spinal Cord Not Joined: MD,' Telegram (Toronto), 25 November 1967; 'Hospital Chiefs Statement: Surgeon Discounts Spinal "Miracle,"' Toronto Star, 25 November 1967; Joan Hollobon, 'Chief Surgeon's Statement - Claims Spine Not Rejoined,' Globe and Mail, 25 November 1967. 70 NA, D.W.G. Murray Papers, MG 30, B110,vol. 39, file 27, note to file, n.d. 71 Peter Sypnowich and Janice Tyrwhitt, 'Dr Murray's "Miracle": The Whole Story,' Star Weekly Magazine, 16 December 1967, 4 (transcript of interview). See also earlier CBC broadcast: NA, audio-visual materials, VI 8402-0035, ISN 16510, 'The Way It Is,' 19 November 1967. 72 Mack Laing, 'Dr Murray Controversy Still Boiling,' Telegram, 27 November 1967. 73 'Spinal Regeneration: The Uproar Grows' and 'Error in Interpretation,' Medical Post, 5 December 1967. 74 NA, D.W.G. Murray Papers, MG 30, B110,vol. 39, file 29, satement written by Murray, n.d. 75 Peter Sypnowich and Janice Tyrwhitt, 'Dr Murray's "Miracle": The Whole Story,' Star Weekly Magazine,1616December 1967, 6; Joan Hollobon, 'Murray Denies Claiming Vertebrae Removed,' Globe and Mail, 27 November 1967; 'Dr Murray - How Story of Operation Broke,' Telegram, 27 November 1967; 'Murray Defends Spine Surgery,' Toronto Star, 27 November 1967. 76 UTA, Office of the Dean, A76-0044/231, file 21, Dr Gordon Murray, Correspondence, K.S. Edey to A.L. Chute, 29 November 1967. 77 Many medical men believed that Murray had ruined his reputation by staying on too long and not retiring earlier. Yet one resident commented on Murray's remarkable surgical dexterity 'even at that age' (personal interviews by author, Toronto). 78 As Jurgen Thorwald says, 'Doctors, like other mortals, do grow old, do lose the full possession of their faculties and make professional mistakes because of this.' See Jurgen Thorwald, The Dismissal: The Last Days of Ferdinand Sauerbruch (New York: Pantheon Books, 1962). 79 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, Mrs E. Reynolds to Thomas Bell, 16 January 1968. 80 'Michener Stands Up for Surgeon Murray,' Toronto Star, 29 November 1967. 81 Louis Galperin, letter to the editor, Toronto Star, 25 November 1967.

Notes to pages 151-4 243 82 NA, D.W.G. Man ay Papers, MG 30, B 110, vol. 30, file 1, Correspondence, Harold S. Fine to Murray, 22 November 1967. 83 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 32, Correspondence, - to Murray, 1967. 84 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 30, file 1, Correspondence, Floyd S. Chalmers to Mrs Helen Murray, 28 November 1967. 85 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to H.S. Doyle, W.R. Drucker, and J.R. Hagerman, 27 November 1967; NA, D.W.G. Murray Papers, MG 30, B 110, vol. 39, file 26, handwritten note, 7 December 1967; 'Operation under Study: Murray to Suspend lest Surgery in TGH,' Globe and Mail, 2 December 1967. 86 NA, D.W.G Murray Papers, MG 30, B 110, vol. 29, file 15, form letter dated 6 December 1967 87 Peter Sypnowich and Janice Tyrwhitt, 'Dr Murray's "Miracle": The Whole Story," Slat Weekly Magazine, 16 December 1967; Marilyn Dunlop, 'Doctor Watchdogs "too busy to check,"1 Toronto Star, 16 December 1967; David Spurgeon, Why the Medical Fraternity Is Leery of Dr Gordon Murray's Findings,' Globe and Mail, 2 December 1967. 88 'Editorial Comment: Dr Gordon Murray,' Medical Post, 5 December 1967. 89 Sidnev Rat/, The Dr Murray Case: A Tragi-Comedy of Errors and Needless Humilation,' Toronto Star, 28 November 1967. 90 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 39, file 30, Correspondence, Murray to j.l). Wallace, n.d. 91 ''Toronto General Mounts New Attack on Surgeon Murray,' Toronto Star, 23 January 1968. 92 NA, D.W.G. Munav Papers, MG 30, B 110, vol. 40, file 19, Notes of meeting with Drucker and Wallace, n.d. 93 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 29, file 27, Minutes of meeting at TGH. 13 December 1967. 94 4)r Gordon Murray to Receive City Award,' Globe and Mail, 25 November 1967; '"I Don i Deserve Gold Medal": Dr Murray,' Toronto Star, 16 December 1967. 95 THA, Public Relations Department, Spinal Cord Controversy, Correspondence. J.D. Wallace to Miss M.J.P. Lundie, 19 December 1967. 96 THA, Minutes of the Medical Advisory Board, 21 December 1967. 97 THA, Public Relatiorrs Department, Press Statement from the Toronto (.eneral Hospital on the Treatment of Spinal Cord Injuries; Minutes of the Medical Advisory Board, 21 December 1967. 98 1 HA, Public Relations Department, Spinal Cord Controversy, Memorandum to file by ) 1) Wallace re Dr Murray Case, 3 January 1968; Journal of

244 Notes to pages 154-6 Neurosurgery (March 1968), 'Special Notice: Statement to Medical Publications from the Toronto General Hospital on the Treatment of Spinal Cord Injuries,' dated17January 1968; 'Announcement: Statement to Medical Publications from the Toronto General Hospital on the Treatment of Spinal Cord Injuries,' Paraplegia5(1967-8): 246. 99 'No Spinal Miracles by Murray,' Toronto Star, 2 January 1968; 'Dr Murray's Spinal "Cure" Denied,' Telegram, 2 January 1968; 'Survey Finds Murray Made One Spinal Cut,' Globe and Mail, 3 January 1968; 'Stricken from the Record,' Time,12January1968. 100 Douglas Stuebing, 'Dr Murray DID Shorten My Spine,' Telegram, 16January 1968; '"Miracle" Operation Fizzles,' unknown newspaper taken from NA, D.W.G. Murray Papers, MG 30, B110,vol. 48,file24. 101 Ken MacTaggart, 'Murray's Spinal Patient Called a Pawn in Medical Controversy,' Telegram, 17 January 1968. 102 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, D.W.G. Murray to Thomas J. Bell, 4 January 1968. 103 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, Thomas Bell to J.D. Wallace, 5 January 1968, and Thomas Bell to Murray,16January 1968. 104 NA, D.W.G. Murray Papers, MG 30, B110,vol. 39, file 30, Correspondence, J.D. Wallace to Murray, 15 January 1968, and reply, Murray to J.D. Wallace, n.d. 105 Joan Hollobon, 'Dr Murray Declines Invitation from Hospital to Submit Information on Spinal Operations,' Globe and Mail, 23 January 1968; Ken MacTaggart, 'Murray-Type Spine Operations Barred,' Telegram, 23 January 1968; 'Toronto General Mounts New Attack on Surgeon Murray,' Toronto Star, 23 January 1968. 106 Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto. 107 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to Murray, 30 January 1968. 108 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to members of the Board of Trustees, 29 November 1967. 109 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 33, Correspondence, - to Murray, 1968; file 35, Correspondence, - to Murray, 1970;file39, Correspondence, - to Murray, 1974; file 42, Correspondence, - to Murray, 1967, 1969, 1970, 1971, 1972, and 1974. 110 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 43,file26, Correspondence,

Notes to pages 156-9

245

Charles G. Roland to Murray, 31 January 1968; file 29, Correspondence, Murray to American Journal of Surgery, 28 July 1970, and Journal of Trauma, to Murray, 9 November 1970. 1 11 Sidney Katy, 'The Dr Murray Case: A Tragi-Comedy of Errors and Needless Humiliation,' Toronto Star, 28 November 1967. 1 12 Peter Sypnowich and Janice Tyrwhitt, 'Dr Murray's "Miracle": The Whole Story,' Star Weekly Magazine, 16 December 1967, 3. 113 See Albert Bosch, E. Shannon Stauffer, and Vernon L. Nickel, 'Incomplete Traumatic Quadriplegia: A Ten-YearReview,'Journal of the American Medical Association216(April 1971): 473-8. 114 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to members of the Board of Trustees, 29 November 1967. NA, D.W.G. Murray Papers, MG 30, B 110, vol. 39, file 29, statement written by Murray, n.d.; personal interviews by author, Toronto. Peter Sypnowich and Janice Tyrwhitt, 'Dr Murray's "Miracle": The Whole Story,' Star Weekly Magazine,16December 1967, 5. 1 15 Scientists accused of fraud commonly cite the excuse that 'the ends justified the means.' See Norman Swan, 'Baron Munchausen at the Lab Bench?' in Fraud and Misconduct in Medical Research, 2nd ed., edited by Stephen Lock and Frank Wells (BMJ Publishing Group, 1996), 140. 116 NA, D.W.G. Murray Papers, MG 30, B 1 10, vol. 39, file 26, handwritten notes of Murray's, 5 January 1968. 117 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 39, file 24: news article, Surgery: End and Beginning,' Time, 29 December 1967; file 27, Minutes of meeting at TGH, 13 December 1967. 1 18 THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to Murray, 16 January 1968; personal interviews by author, Toronto. 119 H. Troidl, et al., Surgical Research: Basic Principles and Clinical Practice, 3rd ed. (New York: Springer, 1998), 640. 120 UTA, Office of the Dean, A76-0044/231, file 21, Dr Gordon Murray, Correspondence, K.S. Edey to A.L. Chute, 29 November 1967. 121 Personal interviews by author, Toronto. 122 NA, D.W.G. Murray Papers, MG 30, B 1 10, vol. 39, file 26, handwritten notes, 2, 3, 4, and 5 January 1968. 123 Sidney Katy, The Dr Murray Case: A Tragi-Comedy of Errors and Needless Humiliation," 'Toronto Star, 28 November 1967. 124 UTA, Faculty of Medicine, Office of the Dean, A76-0044/231, file 21, Dr Gordon Murray, Correspondence, K.S. Edey to A.L. Chute, 29 November

246 Notes to pages 159-62 1967; THA, Public Relations Department, Spinal Cord Controversy, Correspondence, J.D. Wallace to W.R. Drucker, 28 November 1967, and W.R. Drucker to J.D. Wallace, 4 December 1967. 125 See, for example, A.T. Jousse, 'Medical Report,' Caliper: Journal of the Canadian Paraplegic Association 23 (Spring 1968): 11-12. 126 Donald Jones, 'A Sensational Speech Soured Doctor's Career,' Toronto Star, 19 March 1983. 127 Barbara J. Culliton, 'Spinal Cord Regeneration: Scientists Are Calling for Research on a Not-So-Impossible Dream,' Neurobiology, 24 October 1970, 337-8. 128 Lawrence R. Borges, 'Spinal Cord Regeneration: A Review of the First International Symposium on Spinal Cord Reconstruction,' Neurosurgery 7, no. 1 (1980), 71-3. 129 Dr William Geisler, interview by author, 17 April 1997' Toronto; 'Steps to Recovery: Researchers Find Ways of Coaxing Spinal Nerves to Regrow,' Scientific American, January 1997, 26—8; W.F. Collins, 'A Review and Update of Experiment and Clinical Studies of Spinal Cord Injury,' Paraplegia 21 (1983), 204-19;J. Trevor Hughes, 'Regeneration in the Human Spinal Cord: A Review of the Response to Injury of the Various Constituents of the Human Spinal Cord,' Paraplegia 22 (1984): 131-7; A. Hadi Khalili and M. Hayawi Hamash, 'Spinal Cord Regeneration: New Experimental Approach,' Paraplegia26(1988), 310-16. CHAPTER 7: TIME FOR REST

1 G. Murray and W.W. Bartlett, 'Immunity in Cancer,' Panminerva rnedica 19 (September-October 1977): 357. 2 National Archives of Canada (NA), D.W.G. Murray Papers, MG 30, B 110, vol. 37, file 12, Experiment Notebook: Tumor Implants, 1968-9; file 13, Experiment Notebook: Tumor Growth no. 1, 1970-2; file 14, Experiment Notebook: Tumor Growth no. 2, 1973-4; vol. 38, file 19, Experiment Notebook: Tumor Implants, 1971-4; G. Murray and W.W. Bartlett, 'Immunity in Cancer,' Panminerva medica 19 (September-October 1977): 357-60. 3 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 30, file 16, Correspondence, Murray to R.J. Wilson, 17 August 1973; vol. 39, file 22, unpublished article, March 1974. 4 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 39, Correspondence, Mrs G to Murray, 23 July, 8 August, and 15 December 1974, 16 March 1975; G. Murray and W.W. Bartlett, 'Immunity in Cancer,' Panminerva medica 19 (September-October 1977), 358-9.

Notes to pages 162-4

247

5 NA, D.W.G. Murray Papers, MG 30, B110,vol. 39,file21, Memorandum, MJ. Walcroft to Murray, 15 September 1972; vol. 30, file 11, Correspondence, R.J. Wilson to Murray, 9 August 1973, and Murray to RJ. Wilson, 17 August 1973; vol. 39, file 25, Correspondence, G.M. Healey to Murray, 10 June 1974. 6 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 43, file 30, Correspondence, American journal of Surgery to Murray, 26 January 1972; Cancer Research to Murray, 16 March 1972; Cancerto Murray, 27 March 1972; InternationalJournal of Cancer to Murray, 26 July 1972; Canadian Medical Association Journal to

Murray, 21 March 1974. 7 D.W.G. Murray, 'Immunity in Cancer,' Panminerva medica 19 (SeptemberOctober 1977): 357-60. 8 Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto. 9 NA, D.W.G. Murray Papers, MG 30, B110,vol. 52, file 9, Correspondence, L.M. Nichols to Murray, 8 September 1970 ($5,000); H.R. Jackman to Murray, 20 October 1970 ($2,500); Mrs Pauline Harris to Murray, 18 December 1970 ($500); H.C. Hiltz to Murray, 12 January 1971 ($500); H.R.Jackman to Murray, 11 March 1971 ($7,000, Bickell Foundation); H.R. Jackman to Murray, 24 December 1971 ($2,000); K.B. Andras to Murray, 28 December 1971 ($2,000); H.R.Jackman to Murray, 12 December 1972 $3,500); K.B. Andras to Murray, 27 December 1972 ($2,000); H.R.Jackman to Murray, 27 December 1973 ($2,500); K.B. Andras to Murray, 27 December 1973 ($1,700); H.R. Jackman to Murray, 28 December 1973 ($2,500); and Mrs G.H. Forster to Murray, 12June 1974 ($100). 10 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 30, file 7, Correspondence, Kenneth LeM. Carter to Murray, lOJanuary 1969. 11 NA, D.W.G. Murray Papers, MG 30, B110,vol. 43, file 30, Correspondence, R.M. Taylor to Murray, 24January 1972. 12 NA, D.W.G. Murray Papers, MG 30, B110,vol. 30, file 7, Correspondence, R.M. Taylor to MJ. Grimes, 14 August 1969. 13 NA, D.W.G. Murray Papers, MG 30, B110,vol. 43, file 30, Correspondence, P.G. Scholefield to Murray, 13 March 1972. 14 NA, D.W.G. Murray Papers, MG 30, B110,vol. 43, file 30, Correspondence, Murray to P.G. Scholefield, 10 April 1972. 15 NA, D.W.G. Murray Papers, MG 30, B110,vol. 30, file 10, Correspondence, P.G. Scholefield to Murray, 13 April 1972. 16 Ibrd. 17 NA, D.W.G. Murray Papers, MG 30, B110,vol. 30, file 10, Correspondence, Murray to P.G. Scholefield, 19 April 1972, and P.G. Scholefield to Murray, 3 Mav 1972

248

Notes to pages 164—7

18 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 43, file 30, Correspondence, P.G. Scholefield to Murray, 13 March 1972. 19 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 30, file 11, Correspondence, R.M. Taylor to Murray, 7 July 1972. 20 Ibid. 21 Ibid. 22 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 30, file 11, Correspondence, Norah Michener to Murray, 23 May 1973, and Floyd S. Chalmers to Murray, 18 December 1973. 23 NA, D.W.G. Murray Papers, MG 30, B110,vol. 30, file 10, Correspondence, Murray to Eileen Graves, 25 January 1972. 24 NA, D.W.G. Murray Papers, MG 30, B110,vol. 30, file 8, Correspondence, Murray to L.V. Kilmury, 16 March 1970; vol. 47, file 25, Correspondence, Murray to S.E. Bernier, 12 February 1970. 25 NA, D.W.G. Murray Papers, MG 30, B110,vol. 52, file 7, handwritten notes re Gardiner Foundation, 1974; file 11, Correspondence, Murray to Gordon Coogan, 3 September 1974, and Paul P. Ginou to Murray, 2 December 1974. 26 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 30, file 12, Correspondence, F. Norman Brown to Murray, 10 December 1974. 27 Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto. 28 NA, D.W.G. Murray Papers, MG 30, B110,vol. 45,file9, 'Quest in Medicine,' draft preface by Prof. John B. Grant. 29 NA, D.W.G. Murray Papers, MG 30, B110,vol. 41, files 26 and 27, 'Sandy,' draft manuscript, n.d.; vol. 30, file 11, Correspondence, D. Brian Noble to Murray, 25 April 1973; file 12, Correspondence, Richard H. Lee to Murray, 4 February 1974. 30 NA, D.W.G. Murray Papers, MG 30, B110,vol. 30, file 8, Correspondence, Susan Goldenberg to Murray, 19 November 1970, and John E. McBirnie to Murray, 7 December 1970; file 9, Correspondence, Susan Goldenberg to Murray, 19 March and 16 April 1971. 31 NA, D.W.G. Murray Papers, MG 30, B110,vol. 30, file 10, Correspondence, W.I. Smith to Murray, 11 April and 4 May 1972. 32 NA, D.W.G. Murray Papers, MG 30, B110,vol. 52, file 11, Medical Research Expenditures. 33 'Gordon Murray: Surgeon Pioneered Kidney Transplants,' Globe and Mail, 9 January 1976; 'Renowned Surgeon Gordon Murray, 81, Saved "Blue Babies,"' Toronto Star, 9 January 1976; Mrs Rosalind Bradford, interview by author, 26 June, 3 and lOJuly 1996, Toronto.

Notes to pages 167-73 249 34 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, file 16; Mrs Rosalind Bradford, interview by author, 26June, 3 and 10 July 1996, Toronto. 35 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 52, file 16, Correspondence, William E. Ortved to Mrs Murray, 19January 1976. 36 'Gordon Murray: Surgeon Pioneered Kidney Transplants,' Globe and Mail, 9 January 1976; James C. Fallis, 'Dr Gordon Murray' (letter to the editor), Globe and Mail, 21 January 1976; Arthur E. Parks, 'Dr Gordon Murray' (letter to the editor), Globe and Mail, 27 January 1976. See also 'Renowned

Surgeon Gordon Murray, 81, Saved "Blue Babies,"' Toronto Star, 9 January 1976;W.G. Bigelow, 'Obituary: D.W.G. Murray,' Bulletin of the Academy of Medicine49 (April 1976): 89-90; Toronto Hospital Archives (THA), W.G. Bigelow Papers, box 27, file 0094i-7-0-18, Correspondence, Rowan Nicks to W.G. Bigelow, 31 December 1976; 'First Kidney Transplant,' Toronto General Hospital'Monitor (in-house publication), 1 February 1976, 1. 37 NA, D.W.G. Murray Papers, MG 30, B 1 10, vol. 52, file 11, Medical Research Expenditures 38 Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto; Dr D.R. Wilson, interview by author, 27 February 1996 and 14 April 1997, Toronto. 39 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 22-5. 40 Alison Li, J.B. Collip and the Making of Medical Research in Canada' (PhD dissertation, University of Toronto, 1992), 279. 41 Mrs Rosalind Bradford, interview by author, 26 June, 3 and 10 July 1996, Toronto; Dr William Geisler, interview by author, 17 April 1997, Toronto; Dr E. McCulloch said, 'I know that he [Murray] did a lot of research and I know that much of it didn't have the impact it should have' (Hannah Institute for the History of Medicine Oral History Collection, vol. 30, Dr Ernest Armstrong McCulloch, 16). 42 Harry M. Marks, The Progress oj Experiment: Sciences and Therapeutic Reform in the United States, 1900-1990 (Cambridge: Cambridge University Press, 1977), 3, 30. 43 Dr Ronald J. Band, interview by author, 2 April 1996 and 16 April 1997, Toronto; Dr Edward Mullens, interview by author, 20January 1997, Toronto; Dr William Geisler, interview by author, 17 April 1997, Toronto; Dr D.R. Wilson, interview by author, 27 February 1996 and 14 April 1997, Toronto; personal correspondence, Dr N.T. McPhedran to author, 23 January 1997. 44 I thank Allison Kirk-Montgomery for this discussion, and Peter Montgomery for the term 'flawed genius.' 45 Gordon Murray, Medicine in the Making (Toronto: Ryerson Press, 1960), 219.

250 Notes to pages 175-80 CONCLUSION: SURGICAL LIMITS

1 Allan M. Brandt and Martha Gardner, 'The Golden Age of Medicine?' in Medicine in the Twentieth Century, ed. Roger Cooter and John Pickstone (Harwood Academic Publishers, 2000), 23. 2 Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (New York: W.W. Norton, 1997), 592-627. 3 Jacalyn Duffin, History of Medicine: A Scandalously Short Introduction (Toronto: University of Toronto Press, 1999), 233-4. 4 Clyde E. Barker, 'History and Philosophy of Surgical Research,' in Surgical Research, ed. Wiley W. Souba and Douglas W. Wilmore (New York: Academic Press, 2001), 1262-3. 5 Christopher Lawrence and Tom Treasure, 'Surgeons,' in Medicine in the Twentieth Century, ed. Roger Cooter and John Pickstone (London: Harwood, 2000), 653-70. 6 Pearl Katz, The Scalpel's Edge: The Culture of Surgeons (Boston: Allyn & Bacon, 1999), 33. 7 Ibid. 8 See David J. Rothman, Beginnings Count: The Technological Imperative in American Health Care (New York: Oxford University Press, 1997). 9 See Joan Cassell, Expected Miracles: Surgeons at Work (Philadelphia: Temple University Press, 1991), 9-32. 10 NA, D.W.G. Murray Papers, MG 30, B 110, vol. 31, file 42, Correspondence, Bertrand Proulx to Gordon Murray, 21 February 1974 and 2 May 1972.

A Note on Sources

The Donald Walter (iordon Murray Papers in the National Archives of Canada in Ottawa consist of fifty-two volumes of material, including patient files, personal and office correspondence, research notes, published and unpublished work, professional societies and associations material, newspaper clippings, and photographs. Deposited by Murray's estate in 1978, these records cover his entire surgical and research career. Murray retained the services of a clipping service throughout his career, which accounts for a near complete set of newspaper clippings in the collection. Records of the W.P. Caven Memorial Research Foundation and later Gardiner Medical Research Foundation, plus his extensive laboratory and experiment books, were useful when tracing the progress of his various research projects. It is suspected that the family, if not perhaps Murray himself, destroyed sensitive letters. There are, however, drafts of his autobiography, other unpublished writings, and private scribblings that candidly present his views of I'oronto opposition. Further to this, his two-volume autobiography, Medicine in the Making (I960) and Quest in Medicine (1963), were analysed as primary documents. He published seventy-eight articles and book chapters in his lifetime, of which various drafts and related correspondence are in the collection. For a complete listing of these publications, refer to the appendix. Unfortunately, onlv.")()per cent of the Murray collection is open to researchers. The other half, which is predominantly patient medical files and some patient letters, is closed until 2008. I was granted restricted access to some of these files, which allowed me to glean a certain insight into the breadth of Murray's surgical practice. The University ol Toronto Archives, the Toronto Hospital Archives, and the Toronto Academy of Medicine Collection held at the Fisher Library in Toronto contain records relating to the activities and personalities of the Toronto medical community, including material on Murray's surgical career. Most useful were

252 A Note on Sources the numerous departmental and faculty reports, correspondence, and minutes of meetings discussing Murray and his endeavours, which circulated among senior medical and administrative men at the university and the hospital. Simply put, these records presented the other side of Murray's story. This material was reviewed extensively. In addition to the institutional record, the University of Toronto Archives made available to me the private papers of W.E. Gallie, R.O. Heimbecker, R.M. Janes, F.G. Kergin, and F.N.G. Starr. I thank the Public Relations Office of the Toronto Hospital for allowing me to view their Spinal Cord Controversy files, 1967-8. Other archival collections consulted in the research of this biography include the following: National Archives of Canada (RG 150, Military Service Records: WWI; MG 30, E 186, W.E. Gladstone Murray Papers; RG 77, National Research Council of Canada, Division of Medical Research; RG 29, Department of Health and Welfare; MG 28, I 224, National Cancer Institute of Canada; MG 32, B 12, Paul Joseph James Martin Papers; MG31,J 31, John A. Hopps Papers); Archives of Ontario (RG 10, Department of Health records); Connaught Laboratory Archives (heparin papers); Wellesley Hospital Archives (annual reports and H.A. Bruce files); McGill University Archives (RG 38, Faculty of Medicine records; RG 95, Royal Victoria Hospital records; RG 96, Montreal General Hospital records, annual reports, and scrapbooks); Women's College Hospital Archives (annual reports); McMaster University Archives (Oral History Collection); Stratford Perth Archives (Laing family history and Stratford Collegiate records); Canadian Museum of Health and Medicine at the Toronto Hospital (Artifact Collection); College of Physicians and Surgeons of Ontario (annual reports); National Research Council of Canada (minutes of meetings and annual reports); National Cancer Institute of Canada (annual reports and minutes of board meetings); Canadian Cancer Society, Ontario Division (annual reports and minutes of board meetings); University of Western Ontario Regional Collections (Oxford County scrapbooks). I thank Dr Wilfred G. Bigelow, Dr Ronald J. Baird, Miss Jean Dodds, and Dr G.G. Caudwell for providing me with material from their personal collections. Oral history constituted an important part of my research, allowing me to understand more fully the personality and actions of Dr Gordon Murray as a researcher, practitioner, and individual than would have been possible from personal papers and institutional records alone. I reviewed transcribed interviews from the Hannah Institute for the History of Medicine Oral History Collection, which includes interviews with forty-eight members of the University of Toronto's medical community who were practising between 1930 and 1975. These interviews were conducted by Ms Valerie Schatzker between 1982 and 1992. The following volumes were of particular value for my research on Dr

A Note on Sources 253 Gordon Murray: Mrs Herbert Bruce (vol. 5), Dr Fred Fallis (vol. 14), Dr A.W. Farmer (vol. 15), Dr John Drennan Hamilton (vol. 19), Dr Irwin M. Hilliard (vol. 20), Dr Robert L. MacMillan (vol. 28), Dr Ernest A. McCulloch (vol. 30), Dr W.T. Mustard (vol. 33), Dr Arthur E. Parks (vol. 35), Dr E. Bruce Tovee (vol. 42), Dr Allan Walters (vol. 45), and Dr D.R. Wilson (vol. 46). I also conducted my own oral history by corresponding and talking with more than fifty colleagues, friends, and family members of Dr Murray's between February 1996 and August 1998. With the exception of one interview, I did not use a tape recorder but took detailed notes. I hope that those who participated in these discussions will find that I have interpreted these conversations in good faith. Most individuals were enthusiastic and helpful; some provided me with additional personal papers and photos that I would not have had access to otherwise. I am grateful to all participants for their insights, time, and interest in my research. 1 thank Dr Henry T. Bahnson, Dr Ronald J. Baird, Dr Wilfred G. Bigelow, Mrs Rosalind (Murray) Bradford, Dr H. Hoyle Campbell, Dr G.G. Caudwell, Dr Bruce Charles, Dr W.T.W. Clarke, Dr Denton A. Cooley, Miss Jean Dodds, Dr William R. Drucker, Ms Marilyn Dunlop, Dr Murray Enkin, Dr James Kenneth Wallace Ferguson, Dr Hugh R. Gallie, Dr William Geisler, Dr W.H. Harris, Dr Robert Harris, Dr Raymond O. Heimbecker, Ms Joan Hollobon, Dr Robert W.Jackson, Dr William P. Longmire, Jr, Dr James V. Maloney, Jr, Mr Ron Kenyon, Dr Lloyd D. Maclean, Mrs Reta (Smith) Macnab, Dr N.T. McPhedran, Mrs Alex (Margaret) Millar, Dr John Moffat, Dr Fred Moffat, Dr T.P. Morley, Mrs Rosina (Mrs Hilton) Morris, Dr C.B. Mueller, Dr Edward Mullens, Dr Rowan Nicks, Mrs Paul Phelan, Dr J.C. Portnuff, Mrs Marion Reid, Dr Walter Roschlau, Dr David C. Sabiston, Jr, Mrs Ann Scholefield, Dr John Scott, Dr Harris B. Shumacker, Jr, Mr David Spurgeon, Mrs Douglas (Mary McLean) Stewart, Mr and Mrs Clair and Amy (nee McLean) Stewart, Dr Robert Stone, Mrs Sheila Swanson, Dr Neil Watters, Ms Rosalind Waxman, and Dr D.R. Wilson. It was my first experience with oral history and one of the more enjoyable components of my research. Other primary and secondary sources were consulted during the course of my research for this book. Many of these sources are cited in the notes.

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Index

Abbott, Maude, 55 Abel,john J., 66 Aitken, Kate, 112 Aldridge, Harold, 220n1()3 Alexander Simpson-Smith Lecture, 70 Allen, Duff, 53, 219n92 Alpha Omega Alpha Honour Fraternity, 19 Alwall, Nils, 207n95 Alwall kidney machine, 90 American Academy of Orthopedic Surgeons, 1 26 American Cancer Society, 117, 132 American College of Surgeons, 37, 50 American journal of Surgery: GM's papers in, 88, 130, 136-7, 138, 156; rejection of GM's writing, 156, 162 American Surgical Association: GM's election to, 63; GM's presentations to, 50, 60, 63, 80, 100 Amiel, Barbara, I 15 anatomy, 25, 26 Anderson, William, 153 angina, 99 angiocardiograms, 55

Angiology, 98 animals, experimentation with: for cancer research, 106-7, 108, 11819, 161-2; for cardiac surgery, 97, 99-100, 218n74, 222n118; at Caven Foundation, 85; for heparin research, 40—1,195n68;for kidney dialysis, 66, 68, 91, 204n72; for kidney transplants, 92; role in research, 27, 77, 172; for spinal cord research, 135-8; for vascular surgery, 46—7, 54 Anti-Cancer Hormones, 116 anticancer serum (developed by GM), 108-32, 122, 161-5; absence of animal tests for, 109; demand for, 125-6; as experimental and unsanctioned treatment, 115, 132; GM's belief in, 117, 126, 129; GM's publications and reports on, 11112, 113-14, 121-4, 125, 130; horses for, 108-9, 110, 118, 162; malignant tissue for,108,118-20; medical community's views of, 111, 115, 117, 122-4, 127, 129; as palliative measure, 123; patients treated with, 110, 120-1, 122, 162; produc-

256 Index tion of, 108, 118-19, 120-1, 162; public questioning of, 129-30; quality of research, 109, 114, 122, 130; research funding for, 126-7, 129, 162-5; toxicity problems, 118, 122; tumour transplantation experiments, 119. See also cancer research and treatment Arnott, David, 116 arteriosclerosis, 99 artifical kidney machines. See kidney machines, artificial Ash, Clifford L., 229n59 Associate Committee on Medical Research (of NRC), 78, 171 Atlas of Congenital Cardiac Disease

(Abbott), 55 Australia, 89, 110 autobiography, 124-5, 166 autotransplantation, 92 axon (nerve fibre), 134, 135 Bahnson, Henry, 101 Bailey, Charles, 65, 96 Baird, Ronald J., 97 Ballance, Charles, 24 Banting, Frederick G.: cancer research, 106-7, 131-2; discovery of insulin, 29; GM compared to, 73, 131-2, 170-1; research funding for, 78, 79; survey of research centres, 212nll Banting and Best Department of Medical Research, 78, 83 Banting Institute (University of Toronto), 36, 83, 88; GM's research at, 42, 60, 68, 73, 83, 84, 87, 102 Banting Research Foundation, 78, 211nl0

Barnard, Christiaan, 154 Bathe-Rawling, L., 24 Baumann (German company), 91-2 Baylor College of Medicine (Houston), 101 Beck, Claude, 53, 198n9, 219n92 Bel Air Nursing Home (Toronto), 121 Bell, Thomas, 154-5 Belt, Thomas, 44, 194n57 Best, Charles H.: discovery of insulin, 29, 48, 196n74; and GM, 42-3, 49; role in heparin research, 5, 39, 42, 48-9 Bethune, Norman, 177 Bickell.J.R, 131 Bickell Foundation, 131, 163 Bigelow, Wilfred G.: as cardiac surgeon, 65, 98, 100-3, 177, 213n22, 221n114; experience in Second World War, 51, 64; and GM, 102-3 Billroth, Theodor, 52 biological oxygenators, 222n118 Blair, W.G., 105 Blalock, Alfred, 177; Blalock-Taussig vascular shunt, 57-9, 177, 199n20; as cardiac surgeon, 55, 64, 65, 76, 80, 101; and GM, 57, 60, 201n41 Bliss, Michael, 107, 196n74 Bloor Street United Church (Toronto), 167 blue babies (cyanosis), 55-64; first operations in Canada, 199n25, 203n67; GM as 'blue baby' doctor, 5, 200n25; GM's operations on, 58-9, 61, 64, 65, 80; mortality rates, 200n25, 201n41; surgical treatment for, 56-9, 199n20 bone-graft procedures, 36-7

Index 257 bone growth, 88, 104 bone-marrow transplants, 219n89 Bonner, Thomas, 13 Bowman, F.B., 73 Boyd, William, 37 Bradford, Rosalind (nee Murray, daughter), 46, 124, 144, 167, 174, 200n45; scholarship named for, 167 Brazil, 88-9 Bright's disease, 93 Britain: GM as an anglophile, 26, 27, 50; GM's training in, 24—6; kidney machine use in, 71, 208n1()2; medical schools, 13, 26; 'new cardiology,' 52-3; research funding, 78 Brock, Russell, 65, 96 Brodey, Abe, 87 Bruce, Herbert A.: and Caven Foundation, 84-6, 89, 112; and GM, 82, 84, 112, 171, 213n26; as professor, 15; at Wellesley Hospital, 82, 227n34 Brugmann University Hospital (Brussels), 148 Bulletin of the Academy of Medicine, Toronto, 1 1 3

Byng, Julian, 18 Caisse, Rene, 231 n73 Callwood, June, 202n52, 2()5n82 Campbell, Harry, 24 Canadian Arthritis and Rheumatism Society, 131 Canadian Cancer Institute, 106 Canadian Cancer Society, 105, 115, 229n59 Canadian Expeditionary Force, 16 Canadian Field Artillery, 16-17, 18

Canadian Medical Association, 63, 105; cancer research statement (1958), 123-4, 125 Canadian Medical Association Journal, 90, 162; GM's articles in, 48, 54, 121 Canadian Overseas Railway Construction Corps,18-19 cancer, 105-32, 161-2; 'battle against,' 106, 115; breast, 106, 110, 111,117, 118; oesophagus, 36; Rous sarcoma, 106, 107 Cancer,113,162 Cancer Control Grant, 113 cancer organizations, 105 Cancer Remedy Act (Ontario, 1938), 105 Cancer Research, 113, 162

cancer research and treatment: chemotherapy, 128, 235n118; collection of tissue for (Gordon Murray Research Project), 119; funding for, 105-6, 112-13, 115, 127; immunological approach to, 6, 107-8, 114-15, 116, 122;in 1920s and 1930s, 105, 106-7; radiation, 107, 127; surgery for, 107, 117, 127; unorthodox or questionable remedies, 116, 12930, 230-1 n68, 231-2n73. See also anticancer serum Cannell, D.E., 116 cardiac pacemaker, 203n68 cardiac surgery, 52-5, 92, 95-8; for acquired disease conditions, 95; attitudes toward, 65; on beating heart, 56; Blalock-Taussig vascular shunt, 57-9, 199n20; cardiac bypass, 101; cardiac pacemaker, 203n68; cardioscope, 96; closed-

258 Index heart (closed-intracardiac), 65, 103; for coronary artery, 99-100, 104; for cyanosis (blue babies), 569, 80, 199n20, 199n25, 200n25, 201n41, 203n67; extracardiac, 65; GM's procedure for septal defects, 59-60; for mitral stenosis, 53-4, 96; Mustard procedure (open-heart), 64; open-heart, 64, 65, 98, 100-3, 200n36; research and developments in, 52, 53, 65, 100, 176; valve transplants, 96-8, 100; as vascular surgery, 56. See also heart disease; vascular surgery cardioscope, 96 Carnegie Foundation, 14 Carrel, Alexis, 46, 95, 177 Case Western Reserve University (Cleveland), 91, 158 Casselljoan, 188n47 catheterization (of the heart), 55 Caudwell, Gordon Grosvenor, 72 Caven, James G., 215n43 Caven, John, 215n43 Caven, Rev. William, 215n43 Caven, William Proudfoot, 85, 215n43 Caven Foundation (W.P. Caven Memorial Research Foundation), 6, 84-6, 172; facilities, 85; funding for, 85, 111-13, 227n35; GM's research activity at, 6, 88, 89, 102, 104, 108-11, 172; GM's vision for, 86, 88; government funding for, 86, 216n57; isolation of, 104; opening of (1949), 86; renamed Gardiner Medical Research Foundation (1955), 113; staff, 85, 90, 104; trustees, 86, 89-90,112.See

also Gardiner Medical Research Foundation central nerve damage, 134 Central Surgical Association, 70 cephalin, 39 cerebral thrombosis, 59 Chalmers, Floyd, 151, 165 Charles, Arthur, 39, 41 chemotherapy, 128, 235n118 Children's Memorial Hospital (later Montreal Children's Hospital), 56, 199n25 Chute,A.L., 147, 148 Chute, Winnifred, 40 City of Toronto Award of Merit, 153 Clarke, William, 72 clinical research. See research: clinical and surgical Clow, Barbara, 231n73 coagulation (blood clotting), 38-9 'coagulometer,' 193n39 coarctation of the aorta, 56 cobalt bomb, 229n59 College of Physicians and Surgeons of Ontario, 118, 130 Collip,James B., 29, 78, 79 Columbia Presbyterian Medical Center, 144 Commission for the Investigation of Cancer Remedies (Ontario), 105, 116 Congenital Malformations of the Heart

(Taussig), 55 Connaught Laboratories (Toronto): and GM's anticancer serum, 108, 109, 162; GM's relationship with, 87; heparin production, 5, 39, 44, 49; W. Roschlau at, 127-8 Connell, Hendry, 116, 231-2n73

Index 259 Connor, J.T.H., 71 Conway, Elizabeth (nee Anderson, grandmother), 9 Conway, Isabella (aunt), 9 Conway, John (grandfather), 8-9 Conway, Sarah (aunt), 9 Conway, William (uncle), 9 Cooley, Demon, 63, 65, 101, 177, 222-3n122 coronary artery disease, 98-100 coronary thrombosis, 80 Cosbie, W. Gerald, 229n59 Cowan, Walter, 40, 41 Cowan perfusion pump, 222n118 Crafoord, Clarence: cardiac surgery, 55, 56, 57, 65, 102; and heart-lung machine, 100, 101; heparin research, 49, 51, 196n78 Creighton, Donald, 148 Crile, George. 76, 177 Culnan, George, 127 Gushing, Harvey, 76, 177 Cutler, Elliott. 53, 198n9, 219n92 cyanosis. .SVeblue babies cytotoxic drugs, 128. 235n I 18 Daffydil Coinmittee. 20 Damms, Purvis (patient), 138-9, 154 Davis, Warren, 149-50 DeBakey, Michael, 65, 101, 177, 2223n122 Defries, R.D., 87 Delorme, Edmund, 66, 68 DeWall bubble oxygenator, 101 deWolie, Margaret Stevenson, 85, 88 diagnostic tools, 22 Division of Medical Research (of NRG), 78 Dodds, jean, 20()n28, 205n85

Dominion Bridge Company, 12 Donohue, William L., 229n59 Douglas, Isabel (patient), 58-9, 199n25 Drake, Charles, 177 Drucker, William R., 161; and GM's spinal cord surgery, 144—7, 149-50, 152-3, 155, 158-60 Dunlop, Marilyn, 61, 157 Dutton, Don, 142 Eaton, Sir John and Lady, 29 Edey, K.S., 150, 158 Ehrlich, Paul, 108 electrocardiogram (ECG machine), 55 emboli: peripheral, 44, 45; pulmonary, 5, 38, 43-5, 45, 194n57 Embro (Ontario), 10-1 'Encouragement in Spinal Cord Regeneration' (Murray), 139 Ensol (cancer remedy), 116, 231n73 epilepsy, 79 Evans, Laming, 24 Evelyn, Stephen, 59, 93 'Experiments in Host Resistance to Cancer' (Murray), 130 'Experiments in Immunity to Cancer' (Murray), 121-4 extracorporeal circulation, 100—1 Earnley (Murray home), 74-5 fat embolism, 104 fibrin, 38 fibrinogen, 38 Fine, Harold, 151 First International Symposium on Spinal Cord Reconstruction, 160 First World War, 16-9, 30, 204n73;

260 Index Canadian casualties, 18; conditions at front, 17; Murray brothers' war service, 18-19 Flexner, Abraham, 14 Frazer, Ernest, 24-5, 26 Frederick, Ernest, 117 Gallie, William E.: career, 35-6, 50; and GM, 73, 80, 84, 86, 210nl20; postgraduate surgical program ('Gallie Course'), 35; retirement, 81, 102, 213n26; support of research, 35-6, 40, 79, 80, 211nl0 Galperin, Louis, 151 Gardiner, Percy, 85, 113, 128-9, 131 Gardiner Medical Research Foundation: closure of (1974), 165, 168; founding of (1955), 113; funding for, 128-9, 131, 162-3, 165; GM's research at, 119, 127-8, 135, 1612; staff at, 162, 165; status of, 127, 171. See also Caven Foundation Geisler, William, 237n3 Germany, 13,91-2 Gibbon, John, Jr, 100-1 Gidney, R.D., 15 Gillies, Harold, 177 Glover, Thomas Joseph, 116, 129-30 golf, 75 Gordon Murray Lecture (at University of Toronto), 168 Graham, Duncan, 24, 29-30, 73, 102 Graham, Evarts, 53, 219n92 Graham, Roscoe, 210nl20 Grant, John B., 37, 166 Graves, Eileen, 165 Greater Niagara Hospital, 12 Great Ormond Street Children's Hospital (London), 70 Great Western Railway, 8

Greenaway, Roy, 120 Green Lane Hospital (Auckland), 89 Greenwood, William, 45 Gross, Robert, 55, 56, 57, 65 Gunton, Ramsay, 220nl03 Guttmann, Ludwig, 144, 147, 148 Gye, William, 106-7 Haas, Georg, 204n73 haemorrhage: with heparin, 44, 47; with kidney dialysis, 68 haemostasis (arrest of bleeding), 38 Halsted, William, 13 Halstrup, Erwin, 91-2, 218n69 Halstrup-Baumann artificial kidney, 91-2, 218n69 Ham, Arthur W., 88, 123, 127, 229n59 Hamburger, Jean, 92 Hampstead General Hospital (London), 24 Harken, Dwight, 65, 96 Harrington West (formerly Springfield, Ontario), 10 Harvey, A. McGehee, 76 Heart and Stroke Foundation, 131 heart disease: angina, 99; coarctation of the aorta, 56; coronary artery disease, 98-100; cyanosis (blue babies), 55-64, 65, 80, 200n25, 201n41; ideological views of the heart, 52-3; mitral stenosis, 53-4; patent ductus arteriosus, 56; research pre-1940, 55; septal defects, 59-60, 64, 101, 200n34; subacute bacterial endocarditis, 45; tetralogy of Fallot, 56-7, 199n25; treatment with drugs, 53; treatment with surgery, 56, 65. See also cardiac surgery

Index 261 heart-lung machines, 100-1, 222n 119 heart surgery. See cardiac surgery Heimbecker, Raymond, 97 Helen Murray Scholarship, 167 Henderson, Larry, 202n47 Henderson, Velyien, 15 heparin, 39-45; acceptance of, 44, 45, 48-9; anticoagulant effect, 39, 40, 45; antithrombotic effect of, 39—40; compared to insulin, 196n77; discovery and development of, 38-9, 41; dosage and treatment, 41; expense of, 44; experimentation with animals, 40-1, 195n68; experimentation with patients, 43-4, 47-8; GM on research team, 5, 40, 41, 42; GM's access to, 5, 51; haemorrhage with, 44, 47; importance for surgical procedures, 176; Jaques's data notebooks for, 41, 42; production of, 39, 44; publications on, 48-50; research during Second World War, 50-1; toxicity of, 41, 43; use with kidney dialysis, 66, 67-8; use with kidney transplants, 94; use with vascular surgery, 40—50 Herrick, J.B., 98 Hett, John, 116, 118 Hett's serum (for cancer), 231n73 Higgins, Betty, 143 Highland Society of Embro, 11 hirudin, 38, 204n73 Holden, Richard, 85, 88, 89 Hollobon, Joan, 61 homotransplantation, 92 Hopkins, Johns, 13 Hornby (Ontario), 20 Hospital for Ruptured and Crippled Children (New York), 27

Hospital for Sick Children (Toronto): cardiac surgery at, 64, 202n52, 222n118; children referred to, 58, 64; doctors at, 30, 35, 115, 229n59 Howell, William Henry, 39 Hoxsey, Harry M., 116 Hoxsey treatment (for cancer), 116, 231n68 Hufnagel, Charles, 65, 96-7, 98 Hufnagel valve, 98 Hume, David, 92 Hunterian Lecture (Royal College of Surgeons of England), 50 hypothermia (surgical technique), 100, 103, 221nll4 immunoglobulin, 108, 109, 114 immunology: and cancer research, 6, 107, 114-15, 116, 122; GM's lack of background in, 123, 164 immunosuppressive therapies, 95, 218n74,223nl22 infarct, 99, 221nl08 Ingersoll (Ontario), 8 insulin, 29, 48, 73, 196n74, 196n77 InternationalJournal of Cancer, 162

International Medical Society of Paraplegia, 147, 148 intravascular thrombosis, 38 Ireland, Viola (patient), 59 Ivy, Andrew C, 116 Janes, Robert, 32, 81-4, 102, 210nl20, 213n26 Jaques, Louis B., 40, 41, 42, 43 Johns, Harold E., 229n59 Johns Hopkins Hospital and Medical School (Baltimore), 13, 14 Johns Hopkins University (Baltimore), 39, 55, 64, 66

262 Index Jongbloed,J., 100, 101 Jorpes, Erik, 49 Journal of Neurosurgery, 154 Journal of the American Medical Associa-

tion,139-40,156 Journal of Trauma, 156

Jousse,Al, 144, 146, 147 Karolinska Institut (Stockholm), 49 Katz, Pearl, 178 Katz, Sidney, 152, 156 Kelly, Howard, 13 Kenyon, Ron, 61, 112 Keon, Wilbert, 177 Kergin.Fred,21On 120 Kerr, Ethel, 63, 125-6, 144 Kerwin, Alfred, 220n103 kidney disease and failure, 66-7, 204n73 kidney machines, artificial, 5, 65, 66-72; Alwall kidney machine, 90; commercial production of, 90, 206n94; cost of, 70; design elements of, 67, 70, 91, 205n84; experimentation with animals, 66, 68, 91, 204n72; GM's machine ('first generation'), 66, 67-8, 80, 90, 205n84; Halstrup-Baumann model, 91-2, 218n69; Kolff model, 70-1, 90, 206n94, 207n99; MurrayRoschlau machine ('second generation'), 91-2, 104; trials with patients, 68-9, 91, 205n85 kidney transplants, 88, 92-5; to the arm, 93, 218n79; experimentation with animals, 92; trials with patients, 93-5; with twins, 95 King George V Silver Jubilee Cancer Fund, 105, 106 Kirklinjohn, 101

Koch, William, 116 Koch treatment (for cancer), 116, 231n68 Kolff, Willem J., 70-2, 207nn95, 99 Kolff-Brigham kidney machine, 90 Krebiozen (cancer drug), 116, 231n68 Kuss, Rene, 92 Laetrile (cancer remedy), 116, 231n68 Lambrinudi, C, 24 leeches, 38, 204n73 Legrain, Marcel, 92 Leonards, Jack R., 91 Lewis,john, 100 Li, Alison, 211n7, 212nll lice, 17 Lillehei, C. Walton, 65 Lillehei pump oxygenator, 101 London Hospital, 24, 25 Longmire, William, Jr, 63 LoveJ.G., 144 Lupton, Deborah, 106 Lyndhurst Lodge (Toronto), 143, 144, 146 MacCallum,James Metcalfe, 15 McCulloch, E., 249n41 MacFarlane, Joseph A., 82-4, 86 McGill University, 14, 55, 84, 210nl20; Montreal Neurological Institute, 78-9, 177; Research Institute of Endocrinology, 79 Mclndoe, Archibald, 177 McKee, Leslie, 121 Mackenzie, James, 53 Mackenzie, John Joseph, 15 McLaughlin, Hugh, 86, 89, 112

Index 263 McLean,J. Stanley, 75, 82, 84-6, 111, 213n26 McLean, Jay, 39 Maclean's, 129-30 MacLennan, Hugh, 148 Macleodjohn J.R., 29 MacMillan, R.J., 86, 89, 112 Macnab, Reta (nee Smith), 93, 103 McNeil, Arthur, 91 McPhedran, Alexander, 15 MacTaggart, Ken, 61, 142, 154 Maloney, James, jr, 2()ln44 Mann, Frank, 218n74 Marcum, James, 196n77, 197n79 Markowitz,Jacob, 92, 218n74 Martin, Paul, 106, 112-13 Massey, Vincent, 148 Mayo, Charles, 23 Mayo, William, 23, 76 Mayo Clinic (Rochester, Minn.), 23, 101, 144, 218n74 Meakins,j.C., 84, 21()nl20 media coverage (concerning GM): of cancer research, 110, 111, 112, 115, 120, 124, 129-30, 131;of cardiac surgery, 61-2, 100; of Caven Foundation opening, 86-7; of GM's death, 167-8; of heparin research, 48; of kidney machine, 69, 72; of kidney transplant, 94; in Maclean's, 129; medical journalism, 202n47; on radio, 1 12, 202n47; of spinal cord surgery, 133, 137, 141 — 5, 146-7, 149-52, 154, 156-7, 159; on television, 144-5, 149-50 Medical Arts Building (Toronto), 33, 64, 125, 126 Medical Education in the United States and Canada (Flexner Report), 14-15

medical journalism. See media coverage Medical Post, 146, 152 Medical Research Council, 78, 131, 171-2 medical schools and education, 12— 14; postgraduate surgical training, 21—4, 35; role of laboratory sciences in, 12-13,77-8 Medicine in the Making (Murray), 124-5 Merrill,John P., 71 Methodist Episcopal Church, 10 Michener, Norah, 34, 165 Michener, Roland, 34, 75, 131, 148, 151, 163, 164 Millar, W.J.P., 15 Miller, Gavin, 210n120 Millrue (cancer remedy), 116 Milne, Robert, 24 Mitchell, Gail (patient), 58 mitral regurgitation, 53—4, 96 mitral stenosis, 53-4, 96, 198n9 Moffat, Fred, 218n79 Monteith, J.W., 127 Montreal Children's Hospital (formerly Children's Memorial Hospital), 56, 199n25 Montreal Neurological Institute, 789, 177 'Montreal procedure' (for epilepsy), 79 Moon, Barbara, 129-30 Moore, Francis D., 77 Morley, Thomas P., 146 Mucchoricin (cancer remedy), 116 Mullan.John, 144 Murray, Allen (brother), 10, 11, 18-19 Murray, Charles (brother), 10, 12, 19

264 Index Murray, Donald Walter Gordon (GM): - Life and career: age and retirement, 150-1, 156, 161, 165-7; childhood and youth, 8, 10, 11; as clinical instructor, 32-3; death, 167-8; decision to leave university hospital structure, 84, 87-8, 103; decision to stay in Toronto, 35, 74,21On 120; financial affairs, 33, 166-7; in First World War, 16-18, 19; as general surgeon, 101-3; home and family life, 34, 45-6, 74-5, 165, 166, 174; honours and awards, 148, 151, 153; marriage, 34; media persona of, 61-2, 86-7, 142-3; medical training, 5,12, 15, 19-20, 21, 23-8; in New York (1926-7), 27; obituaries and tributes to, 167-8; personal papers, 166; private practice, 33, 63-4, 74, 88, 166; public support for, 151; recreation activities, 75, 124; as reputable physician (not a quack), 117-18, 130; return to Canada (1926), 26-7; rise and fall of career, 7, 169-74; rural background, 15, 75;during Second World War, 50-1; surgical skill, 6, 25-6, 28, 51, 60, 136,173, 242n77; teaching trips, 88-9, 110 - Personality: as an anglophile, 26, 27, 50; character, 6, 80, 171, 173-4; as 'flawed genius,' 173; individualism, 169-70; perception of persecution, 80-1, 153, 158,169, 170; relationship with colleagues and Toronto medical community, 6, 31-2, 37, 72-4, 81, 84, 146-7, 171; relationship with patients, 120, 143, 173, 200n28

- Research: demands for independent facility, 79-84, 87, 214n39; early surgical projects, 36-8; experimental procedures on patients, 54, 73-4, 93,138, 205n82; GM's weaknesses in, 158, 162, 171-3; Gordon Murray Research Project (collection of malignant tissue) ,119; isolation and secrecy, 31-2, 66, 86, 92, 100, 124-5,131, 158, 170; lack of consultation and collaboration, 88,109, 123, 131, 158, 169; lack of follow-up, 94-5, 98, 139, 220nl03; use of patient testimony, 6, 95, 111; view of clinical research, 76-7, 94—5, 179. See also specific topics (cancer, heparin, kidney machines, etc.) - Writing and publications: autobiography, 124-5, 166; on bone graft, 37; on bone growth, 88; on cancer, 111-12, 113-14, 121-4, 125, 130, 162-3; on cardiac surgery, 60, 63, 98; on heparin, 48, 49-50; on knee injuries, 36; letter to T. Bell (1968), 154; letter to University of Toronto Board (1947), 80-1; letter toJ.D. Wallace (1968), 155; publishers' rejection of later work, 139-40, 156, 162; 'Sandy' (children's book), 166; on spinal cord surgery, 136-7, 138,139-40,156; on vascular surgery, 54 Murray, Elizabeth ('Lizzie,' nee Conway, mother), 9-10 Murray, Gladstone (cousin), 26, 87, 94 Murray, Helen (nee Tough, wife): GM's courtship of, 20, 26-7, 34; home and family life, 34, 45-6,

Index 265 74-5, 124, 165, 174; scholarship named for, 167 Murray, Isabel ('Elsie Bell,' sister), 10, 11 Murray,john (brother), 9, 12, 19 Murray, John (father), 9-10 Murray, Joseph E., 95, 177 Murray, Rosalind (daughter). See Bradford, Rosalind Murray, Sarah (sister), 10, 11,12 Murray, William Paul (brother), 9, 12, 19,34 Murray-Roschlau artificial kidney machine ('second generation'), 91-2, 104 Mustard, William I.: as cardiac surgeon, 54, 64, 65, 177, 2()2n52, 203n67, 213n22, 222n1 18; on GM, 6, 96; Mustard procedure (openheart),.64; in Second World War, 51 myelogram. 1 39 National Cancer Institute of Canada, 106, 127, 131,229n59; GM's grant application to, 163-5 National Heart Hospital (London), 89 National Institute for Medical Research (Mill Hill), 78 National Institutes of Health (Bethesda, Md), 78 National Orthopaedic Hospital (London). 24 National Research Council, 78, 1712, 212n11 National Spinal Injuries Centre (Stoke Mandeville Hospital, England), 147 Nerlich, Ginger, 34

Nerlich, Louis, 34 nerve damage, 134 nerve fibre (axon), 134, 135 New York, 27, 35 New York Hospital, 27 New York University, 160 New Zealand, 89, 110 Nicks, Rowan, 74 Nobel Prize in Physiology or Medicine,46,95cine,46,95 Ontario Association of Pathologists, 119 Ontario Cancer Institute, 115, 229n59 Ontario Cancer Treatment and Research Foundation, 106, 115, 123, 127, 163, 229n59 Ontario Commission for the Investigation of Cancer Remedies, 105, 116 Order of Canada, 148, 151 organ transplants, 92, 95, 176; heart valves, 96-8, 100; immunosuppressive therapies with,95,218n74, 223nl22; kidney, 88, 92-5, 218n79; organ preservation for, 92—3 Orgone energy (cancer remedy), 116 orthopaedic surgery, 36—7 Osier, William, 13 Oxford County (Ontario), 8-9, 75; Board of Education, 167 Paget, Stephen, 52 Palmer, R.A., 207n99 Panminerva medica,156,162 paraplegia, 6,134 Paraplegia, 154 Paraplegic Neivs, 138 Parks, Arthur, 168

266 Index patent ductus arteriosus, 56 patients (of GM): cancer treatments, 110, 111, 120-1,122,125-6,130, 162; cardiac surgery, 54, 58-9, 61, 64, 65, 80, 97-8, 100, 173; heparin, 43-4, 47-8; and hopes for cures, 62-3, 112-13, 115, 143, 154,17980; kidney machine, 68-9, 91, 205n85; kidney transplant, 93-5; orthopedic prodedures, 36-7; spinal cord operations, 138-40, 143, 152, 154, 180; support for GM, 62-3, 120, 143, 151,159 Pearce, Ralph, 85 Pearson, Lester, 148 Penfield, Wilder, 79, 148, 177 penicillin, 77 peripheral emboli: heparin treatment for,44,45;surgical treatment for, 44 peripheral nerve damage, 134 Perrett, T.S., 41-3 Perth County (Ontario), 20 Peter Bent Brigham Hospital (Boston), 71, 92, 95 Pezze, Dorothy (patient), 93-4, 172 PhairJohnT., 216n57 Phillips, Mackinnon, 113, 119, 216n57 polio, 115 Pool, Eugene, 27-8 Pool,J. Lawrence, 144 Presbyterian Church, 10 press coverage. See media coverage Proulx, Bertrand (patient): GM's operation on, 139, 141, 149, 150, 157; GM's use of as demonstration, 141, 142, 143; hope for future cure, 180; media coverage of, 143, 144, 154 Public Archives of Canada, 166

pulmonary embolism, 38, 194n57; heparin treatment for, 5, 43-5; surgical treatment for, 45 quackery, 117-18, 130 quadriplegia, 134 Queen's University (Kingston), 12 Quest in Medicine (Murray), 124—5

Rancho Los Amigos Hospital (California),157 Rand vaccine (for cancer), 116 Rehn, Ludwig, 52 research, clinical and surgical, 27; in Britain, 25; in Canada, 177; clinical orientation of, 25, 172; collaborative aspect of, 88; development of, 76-9, 176-8; experimental procedures on patients, 25, 77, 172, 205n82; Gallie's encouragement of, 35-6; government funding for, 78; laboratory science and methods, 76, 77; in 1920s, 30; in 1930s, 78; post-Second World War, 77; practical orientation of, 76; role in medical education, 13; training for, 77-8; university setting for, 78-9, 171,212nl3 Research Institute of Endocrinology (Montreal), 79 Rhea, Lawrence, 219n92 rheumatic fever, 53 Ringer's solution, 67, 94 Robertson, Lome, 20-1, 28 Rockefeller Foundation, 30, 79 Rosalind Murray Bradford Scholarship, 167 Roschlau, Walter, 90, 91-2, 104, 121, 217n69; on GM's work, 123, 127-8 Ross, Dudley E., 56, 199n25

Index 267 Rossicr, Alain, 148 Rons, Peyton, 107 Rons sarcoma, 106.107 Rowntree, C.W, 24 Rowntree, Leonard (»., 06 Roy, (labrielle, 148 Roy, Leo V.. 129, 130 Royal ("ollege of* Physicians and Surgeons of Canada, 35, 63, 77 Royal College of Surgeons of England, 86; GM as fellow of, 25, 27; GM's presentations to, 50, 63; Huuterian Lecture, 50; Moynihan Lecture, 63, 70 Royal Conservatory of Music (formerly Toronto Conservatory of Music), 20, 167 Royal Victoria Hospital (Montreal), 84,21 On I 20 Rove TO ft Nursing Home (Toronto), 121 rural medicine, 20 Ryer son Press, 1 24 St Bartholomew's Hospital (London), 24.25 St John's Clinic (London), 24 St Joseph's Hospital (Toronto), 120, 142 St Laurent, Louis, 148 St Mary's Hospital (London), 24 Salk vac cine 1 1 5 Saltei. Robert, 1 77 Sanders treatment (tor cancer), 116 Sane, Hans )., 217-18n69 scholarships. 167 Scholefield, PC . 163-4 Scott. David. 39. 41 Scott. John. 60 Second World War, 50-1, 77

Selye, Hans, 79 Sening, Ake, 177 septal defects, 59-60, 64, 101 Shenstone, Norman, 32, 102 ShenstoneJanes tourniquet, 32, 81 Sherbourne House Club (Toronto), 20 Shumway, Norman, 65 sign language, 27 Skeggs, Leonard, 91 Smith, Reta (later Reta Macnab), 93, 103 Smith, Sidney, 83, 86 Smithy, Horace, 96 socialized medicine, 33 soricin, 43 Souttar, Henry, 53 spinal cord, 133—4; hemisection of, 135; myelogram (x-ray) of, 139; transection of, 136, 150 spinal cord injury, 133-4; cure vs. care for, 134—5; impossibility of regeneration, 160; mortality rates with, 134; research on, 137 spinal cord regeneration (GM's procedure for), 133—60; effect on GM's career, 6-7, 159-60; experimental procedures with patients, 138-40; experimentation with animals, 135-8; GM's belief in, 146-7, 157-8; GM's statements on his spinal cord operations, 136, 141, 142, 149-50, 157; investigation of GM's claims, 147-8, 149, 152-4; medical community's reaction to GM's work, 144; weakness of research, 137, 142, 154, 158-9 Spurgeon, David, 61, 142, 147 Stalker, M.E.J., 60

268 Index Starr, Clarence L., 15, 24, 29, 34-5; andGM, 27, 30-1,35 Starr, Frederick Newton Gisbourne, 15 Starr-Edwards ball valve, 98 Stauffer, E. Shannon, 157 Strachan, James, 143 Stratford (Ontario), 20-1 Sullivan, Joseph A., 87, 103 surgeons: acceptence of innovations, 76; J. Cassell on, 188n47; clinical judgment, 23; concept of cure, 178-9; as medical supermen, 4-5, 180; as researchers, 177-8; specialization of, 36, 103; technical proficiency of, 22-3; training for, 22-3; use of sign language, 27 surgery, 21-3; as craft, 4; as cure, 4, 7, 21-2, 173, 176, 178; delicacy of, 27; developments in, 4, 21-2, 175-80; role of nurses in, 59; as solitary activity, 4; therapeutic limits of, 179-80 Surgery, 48

surgical research. See research, clinical and surgical Swan, Henry, 71 Taussig, Helen, 55, 56-7 Taylor, Robert M., 127, 163, 229n59, 234n97 teaching trips, 88-9, 110 tennis, 75 tetralogy of Fallot, 56-7, 199n25 Texas Heart Institute (Houston), 101 Thames River (Ontario), 8, 9, 11 Thomas, E. Donnal, 219n89 Thomas, Newell, 66, 68 Thorn, George W., 71, 207n95 Thorwaldjurgen, 242n78

thrombosis: cerebral, 59; coronary, 80; effect of heparin on, 39-40; intravascular, 38 Tillsonburg (Ontario), 8 Toronto Academy of Medicine, 111, 161 Toronto Conservatory of Music (later Royal Conservatory of Music), 20, 167 Toronto East General and Orthopaedic Hospital Research Foundation, 140, 157 Toronto East General Hospital, 120 Toronto General Hospital: Cancer Clinic, 229n59; cancer research at, 115; cardiac unit at, 79, 103, 213n22; children at, 58, 64; College Street building, 14—15; Department of Surgery, 32, 80-1, 82; GM as junior surgeon, 32; GM as resident, 31; GM's appointment to, 5, 27, 28, 31; GM's battle for research funding at, 64, 73, 79-84; GM's blue baby operations at, 59, 64; GM's colleagues at, 72-4; GM's experimental procedures at, 54, 73-4, 91, 93-4, 172-3; and GM's spinal cord operations, 145-8, 152-6; heparin endorsement, 45; Nose and Throat Department, 36; Private Patients' Pavilion, 64, 103, 121, 145; proposed Division of Experimental Surgical Research, 82-4; reorganization in 1920s, 2930; and tissue collection for GM's anticancer serum, 120; university affiliation, 14, 29; use of GM's kidney machine at, 72, 73-4; Ward C, 64, 88, 102; Wellesley Hospital as division of, 85

Index 269 Toronto Memorial Society, 137 Tough, Leslie (brother-in-law), 34 trench fever, 1 7 Tricot, A., 148 tuberculosis, 22 Tuffier, Theodore, 51 Turner, B.B., 66 Ullrnann, Emerich, 92, 95 University of Chicago, 144 University of Edinburgh, 66 University of Heidelberg, 90 University of Illinois, 116 University of London, 24, 25 University of Montreal, 79 University of Sydney, 89 University of Toronto, 12; affiliation with Toronto General Hospital, 14, 29; Board of Governors, 80-1, 82-4; during First World War, 16; students at, 15 - Faculty of Medicine: Banting and Best Department of Medical Research, 78; Caven Foundation funding for, 112; Department of Medicine, 29; Department of Physiology, 41; Department of Surgery, 29, 30, 32, 36, 41, 80-1, 82; in early 1900s, 14; Eaton Professor of Medicine, 29; and Flexner Report, 14-15; Gallie Course, 35; GM as student at, 15, 19-20; GM as teacher at, 32-3; GM' s access to research laboratories at, 33, 36; Gordon Murray Lecture, 168; postgraduate studies in surgery, 24, 35; proposed Division of Experimental Surgical Research, 82-4; during Second World War. 50; students at, 15

University of Western Ontario, 129 uraemia, 66, 93 urinary sepsis, 134 vaccines, 114, 115, 122, 233n90 Van Wyck, Hermon Brookfield, 68 vascular surgery, 46-50; arterial graft, 56; Carrel's suture techniques, 46; for coronary artery disease, 99100; early research, 46; experimentation with animals, 46-7, 92; GM's expertise in, 38, 51; during Second World War, 50-1; use of heparin with, 5, 40, 46-50; vein grafts, 47, 48, 50, 53-4. See also cardiac surgery vertebral column: encasement of spinal cord, 133; shortening of, 135-6 Vimy Ridge, 18 Vineberg, Arthur, 99 viruses, 114 Walker,J.C., 219n92 Wallace, A. Cameron, 129 Wallace,J. Douglas, 145-7, 149, 155, 156 Walter, Carl, 71 Ward, Arthur, 144 Watters, Neil, 121 Webb-Johnson, Lord, 86 Welch, William, 13 Wellesley Hospital (Toronto), 82; amalgamation with Toronto General Hospital, 85; Cancer Research Centre, 112, 227n34; GM's work at, 58, 64, 82, 121 West, Joseph, 85, 215n45 West End Hospital (London), 24 West Zorra Township (Ontario), 9

270

Index

Wilson, Donald R., 5, 63, 101-2 Windle, William, 160 Wolman, Lionel, 137 Women's College Hospital (Toronto), 120 Wood, Paul, 89 Woodlands Private Hospital (Toronto), 121 Woodstock (Ontario), 8 Wookey, Harold,21On 120

World Committee of Spinal Paraplegia, 148 W.P. Caven Memorial Research Foundation. See Caven Foundation York Township (Ontario), 9 Young, James, 230n68 Zorras (tug-of-war team), 11