An excerpt from Dr. Koop: The Many Lives of the Surgeon General.

In spring of 1946 the young Koop was sent to Boston for several months to spend time with the giants of the nascent field of pediatric surgery, William E. Ladd (1880–1967), and his trainee and successor Robert Gross (1905–1988). In his survey of the history of the discipline, Judson Randolph baldly states: “Surgery for infants and children in the United States began with Dr. William E. Ladd.”

Ladd had joined the staff of the Children’s Hospital of Boston in 1910, occasionally performing surgery on children in his early days alongside his general surgical and gynecological practice.

“Ladd and Gross became very good friends and almost a father/son relationship…. Ladd was a doctor of the old school. He was the kind of gentleman who … wore a flower in his buttonhole when he made rounds. He was – when you got to know him – a very kindly gentleman, willing to share his knowledge with a young squirt like me. But … he was a formidable character…. I would say he probably had very little flexibility in his relationships with other people.”

Gross was known, like Ladd, for his meticulous preparation and procedure. His fastidiousness is the stuff of stories. On his operating room wall hung a sign: “If an operation is difficult you are not doing it properly.” He chided Dr. Judson Randolph in a memo: “In the dining room, coats should be worn.” (Randolph promptly framed it!) His 1952 surgery textbook ran to precisely 1,000 pages. Which made it all the more amusing that, when someone pointed out that there was no chapter on Sacrococcygeal Teratoma, Gross discovered to his chagrin that the typescript of that chapter had fallen off his work table and was lodged behind a radiator in his office.

Gross’s approach was meticulous, but also subtle. “The care of children,” he wrote, “requires a certain indefinable something … which might well be called the ‘art’ of pediatric surgery; it cannot be quantitated or characterized any more than one can describe adequately the tints of Titian or the bold strokes of Michelangelo; … this ‘extra something’ is a priceless attribute which is most sought for in members of the visiting and house staffs.”

Ladd, who was no longer operating, taught Koop the “philosophy” of pediatric surgery; Gross taught him the practice. While he spent most of his time observing, for six weeks he was able to join Gross’s surgical team as the “pup” (lowest on the totem pole). “I learned the most from William E. Ladd, although I never saw him operate. Ladd lived out in Natick, and he had a farm, and he’d get up in the morning and be the gentleman farmer. His chores took until noon, after which he went to the Harvard Club for lunch, then to the Children’s Hospital where he would sit on an empty crib, his long legs dangling, hoping a member of the house staff would come along for a chat. I tried to meet with him as often as I could.”

“Gross never appreciated me as a contender in the field until after I got back to Philadelphia,” he recalled. “The first time I returned to Boston, I even wondered whether I should go and see Gross,” whom he had found abrupt and unfriendly. Koop goes on to say he could hardly blame him, when he discovered what had been going on.

There had been a serious breach between Gross and Ladd some time before, and things kept getting worse. The initial rift in the relationship had occurred back in 1938, when Gross, Ladd’s chief resident, was the first to ligate a patent duct arteriosus. He had been forbidden to do this by Ladd, so Gross waited until Ladd went to Europe on vacation, and got permission to proceed from the associate surgeon-in-chief. Ladd was furious, and on his return peremptorily fired Gross (though the hospital insisted on reinstating him).

Back when Ravdin and Ladd had arranged Koop’s visit, Ladd was still surgeon-in-chief. Gross had not yet been appointed his successor, and Koop officially reported to Franc D. Ingraham (1898–1965), a neurosurgeon and evidently quite a character. Koop recalled a story that he instructed his secretaries never to open envelopes that addressed him as “Frank” rather than “Franc.”

Once they got talking, Gross confided in Koop that Ladd had made a series of accusations to the Board of Overseers in an effort to prevent Gross from succeeding him. Koop lists the charges in order. First, he was incompetent; second, he was dishonest in his handling of research funds; and, third, he was Jewish. Koop adds: The Jewish charge was “probably the most ignominious thing that the Ladd and Gross argument ever made Ladd do, and … Gross told me this, and so I presume it is true – he said he had to take the train and go to Baltimore and find the Lutheran church in which he had been baptized to get this great big book of the archives and take it to a photocopier and have a picture made of that page, take the book back to the church and then get back on the train and deliver the copy to the board of overseers … Note, this was never public, but eventually the board of overseers said they had chosen Robert E. Gross.” On December 5, 1946, Koop sent Gross his congratulations. “Word has come to Philadelphia via the grapevine that you have finally received the appointment to the chair of surgery you so richly deserve.” It was of course the chair named for Ladd to which he was appointed, an irony that cannot have been lost on either of them.

After this unburdening, the next time Koop visited Boston Gross greeted him “like a long-lost son” and canceled his appointments for the rest of the day, telling his assistant, “Chick Koop and I have got to talk about a lot of things.”

Nigel Cameron is a historian and ethicist whose work has spanned the disciplines of bioethics, history, and religion over a distinguished transatlantic academic career. He currently serves as a senior fellow at the University of Ottawa and was previously a research professor of bioethics at the Illinois Institute of Technology in Chicago, where he led pioneering projects on the social and ethical impact of emerging technologies and on diabetes policy. A former Fulbright visiting research chair at the University of Ottawa’s Institute for Science, Society and Policy, he continues to explore the intersection of medicine, ethics, and public policy.

Dr. Cameron was the founding editor of the journal Ethics and Medicine and has served as a hospital consulting ethicist. He has held board roles with UK think tanks 2020health.org and BioCentre, and has testified before committees of the U.S. Congress and the European Union. He has also represented the United States in diplomatic delegations to United Nations health-related agencies and was nominated by the U.S. government to serve as UN Special Rapporteur for the Right to Health.

His books include Dr. Koop: The Many Lives of the Surgeon General, Will Robots Take Your Job? A Plea for Consensus, and The New Medicine: Life and Death After Hippocrates. His current project, Ruth: The Psychiatrist Who Saved Sylvia Plath, Until She Couldn’t, continues his exploration of complex figures in medicine.

For more about his work, visit drkoop.bio, or connect with him on Facebook and LinkedIn.