By Bryant Boutwell and Charles M. Balch
It’s tempting to focus on Lee Clark’s administrative work as the new director of MD Anderson and overlook his other title — surgeon-in-chief. Clark was a quintessential general surgeon. His training at the Mayo Clinic along with his extensive surgical practice in Mississippi and the Army Air Force molded him into one of the top surgeons of his day. He could operate in every anatomic area, including the brain. Procedures often involved radical amputations. Clark and fellow surgeons strived to improve outcomes and give patients new hope.
He knew that surgery was limited in providing true cures of cancer. He wanted to move away from debilitating surgery to a new direction where “less could be more.” He envisioned a day when that radium he first studied in Paris at Marie Curie’s Radium Institute would turn the deadly force of atomic bombs into a lifegiving resource to use against cancer.
As MD Anderson’s only surgeon in those early days, Clark was the front line of care. An ever-increasing number of patients found their way to the new cancer hospital, putting their lives in his hands. Often their cancers were advanced, whether the result of misdiagnosis, late detection or reluctance to seek treatment. Early on, Clark understood the importance of finding cancer sooner than later and considered prevention and education as essential functions.
When he arrived at the Oaks in 1946, he saw patients in temporary outpatient buildings and performed surgeries at Hermann Hospital and the Houston Negro Hospital. While he performed surgeries across all disease sites, he especially focused on thyroid cancer and was among the first to advocate total thyroidectomy for differentiated thyroid cancer.
In mid-1948, two years after Clark arrived, Ernst Bertner, now the president of the burgeoning Texas Medical Center, noticed a soreness in the muscles of his left thigh. He guessed wrong that it was just muscle strain from climbing a magnolia tree that week to fetch flowers for his wife, Julia. It was cancer, a rhabdomyosarcoma. By October, Clark had performed a radical soft part-resection. Even on crutches, Bertner barely slowed. Always the optimist, he was on a mission to turn that forest into a medical city, and he refused to give up. Then he developed a cough. Dr. Alton Ochsner, a close friend from New Orleans, found the cancer had spread to one of Bertner’s lungs. Ochsner performed a lobectomy, but the situation worsened. By February 1950, Clark had to amputate Bertner’s right leg after he suffered a pathological fracture from a second type of cancer, osteosarcoma.
Bertner laughed that he volunteered as a “guinea pig” for an experimental dose of radioisotope gallium. He began conducting his work from his Rice Hotel bedroom, with almost daily visits from his good friend, Jesse Jones. Though he was weak and received supplemental oxygen, he remained involved in every detail including a June 1, 1950 ceremony to lay the cornerstone of the new Methodist Hospital at the Texas Medical Center. Bertner’s driver pulled close to the podium so he could hear every word. That day he watched with pride and remarked to a friend who leaned close to the car window, “I’m done.” By July’s end (July 28, 1950) the father of the Texas Medical Center and former acting director of the new cancer hospital was gone at age 61.
“Volunteers” like Ernst Bertner moved the ball forward as experimental radium yielded to a lifesaving modality known today as radiotherapy. In 1971, Clark summarized:
“The philosophy of surgery is changing. We are now entering a new era. With the added level of sophistication of the other two treatment modalities, radiotherapy and chemotherapy, it is now possible for the surgeon to consider the very real possibility of reducing the volume of tumor rather than of total excision, a concept which was totally unacceptable in the past.”
Early Clark Recruits
When not filling the role of surgeon-in-chief, he was focused on his duties as director. A new era had arrived thanks in large part to Clark’s exceptional recruits to his faculty and staff during those first years at the Oaks. Researchers, clinicians, surgeons, nurses and support staff shared his vision of a team approach. He also needed educators and social workers, administrative support and someone who could sharpen his fundraising skills. In time, as a future story will tell, he mastered the art of not only asking legislators for more funds but also explaining how those funds could one day help save the lives of their children and their children’s children.
Ernst Bertner had started with a staff of five, mostly borrowed from UTMB in Galveston. By Aug. 31, 1947, Clark had 45 full-time employees. By the end of August 1950, he had 271 faculty and staff. By March 1954, when MD Anderson transferred patients from the Oaks to the new hospital in the medical center, the institution had 775 full-time employees.
So where did Clark begin? Recruitment started in earnest in March 1947, when he hired Brig. Gen. Roy C. Heflebower as superintendent of the hospital. Organized, precise and procedural, Heflebower instilled his strong work ethic in all who joined the new enterprise. Yes, some came and found the old estate not to their liking. Yet many more made it their home, and MD Anderson became their life’s work.
From the beginning, the institution centered around a departmental structure. Heflebower was Clark’s lieutenant, putting the day-to-day administrative structure in place. Clark’s instructions to his assistant director were precise including this 1947 directive: “The following personnel should be hired just as soon as suitable trained individuals can be found: Nurse, Medical Secretary, Stenographers (2), Accountant, Stock Room Clerk Supervisor, Anderson Annex Supervisor, Medical Artist.”
Clark’s administrative team comprised Bertner recruits as well as his own including: John Musgrove (hired 1942), procurement and supply; Arthur Kleifgen (1947), administrative assistant overseeing patient care activities; Paul Yoder (1948), personnel and communications; Robert Kamrath (1948), supervisor of building and grounds (no relation to Karl Kamrath, the new hospital’s architect); Marian Wall (1949), Clark’s ever capable executive secretary; Frances Goff (1951), administrative assistant; and Joe E. Boyd (1952), finances.
In 1947, Clark’s childhood friend, Dr. Russell Cumley, joined as editor of the Cancer Bulletin. By 1951, the publication had over 100,000 paid subscribers in 37 states and territories. Clark also hired Edna Wagner in 1947 as head of the Department of Medical Social Services. She proved to be an invaluable community liaison as future stories will tell.
Early faculty recruits included Dr. Alondo J. Ballantyne who arrived in 1946 as MD Anderson’s first surgical resident. He completed his training at the Mayo Clinic and returned to the institution in 1952, joining MD Anderson’s Head and Neck Surgery team to work under the direction of Dr. William MacComb, whom Clark had recruited in 1951 from Memorial Hospital in New York. Dr. Benjamin Wells, a clinical pathologist, came in 1947 to take charge of clinical investigation.
In 1948, Dr. Charles L. Spurr became MD Anderson’s first full-time chief of clinics and Dr. Gilbert H. Fletcher joined the institution to head Radiology with a vision for developing radiotherapy. Together, Clark and Fletcher would capture the energy of the atomic bomb in the new delivery of supravoltage irradiation. Internationally renowned physicist Dr. Leonard G. Grimmett, hired in 1949 and key to that story, excelled as a physicist as well as a concert-level pianist.
Clark found Eleanor MacDonald (1948) in New York at Memorial Hospital and appointed her as chair of the first Department of Epidemiology in the nation with free reign to evaluate every aspect of the hospital’s activities. Clark relied on her over the years for the data he used in presentations and as his co-author on numerous institutional reports and publications. Interviewed in the 1970s, MacDonald remembered MD Anderson’s family atmosphere in those early days and how everyone begged the bashful Dr. Grimmett to play piano for them. Finally, she recalled, he gave in, rented a formal venue and, “wearing a beautiful tux with tails,” walked to center stage and wowed them all.
Lee Clark excelled at spotting talent. Back in his military days at Randolph Field he worked (and played baseball) with Drs. Clifton Howe (recruited in 1948) and Ed White (1949). He asked both if they might want to work with him after the war. They did. Howe, an internist, became chief of clinics and led the Department of Medicine as it was then known while playing a key role in the development of experimental chemotherapy. White would free up Clark’s surgical demands to focus on administrative matters and planning the new hospital.
From 1942 to 1948, the basic science departments at MD Anderson consisted of Biology and Biochemistry. Every department participated in research. Three other key hires in 1948 brought Drs. Jorge Awapara and William Wingo to Biochemistry, along with Dr. Horace Marvin, who joined as the institution’s sole biologist. That year MD Anderson received an American Cancer Society Institutional Research Grant of $7,500, the first cancer research grant the ACS awarded in the Southwest. Also that year the institution established the Department of Pathology under the leadership of Dr. William Russell.
Clark’s recruitment of MacComb deserves special attention. MacComb was the first senior faculty clinician recruited from outside Texas and a head and neck surgeon of international acclaim. 1951 was the year Mickey Mantle joined the New York Yankees. Imagine Mantle leaving the Yankees for a new startup team at the height of his career. MacComb’s decision to move to Houston was no doubt the talk in surgical circles for years. Clark had recruited one of the great surgical oncologists (in fact, the founder of the Society of Surgical Oncology). It was the beginning of an important recruitment trend as MD Anderson moved from new kid on the block to major leagues.
Nursing staff, pharmacy, medical communications library, food services — recruitment was ongoing. Space here allows mention of a few of these bright stars in a much larger constellation. To recruit the best, Clark had to sell them on his vision, given that working out of an old house with repurposed military barracks was not the best draw. Not everyone stayed. One part-time faculty member challenged Clark’s authority to make all the hiring decisions and took his complaint to Austin, only to be told by the UT System Board of Regents to like it or leave. He left.
On a humorous note, fleas from the pigeons in the stables at the Oaks caught the attention of Dr. C. P. Coogle, the institution’s microbiologist who arrived on loan from UTMB during Bertner’s tenure. Coogle was constantly plagued by the fleas in his stables-converted lab, to the point of distraction. Perhaps in revenge, he decided to capture them, devise a method for flea enemas and study their intestinal parasites. On her first day on the job, Marion Wall found a note posted on the bulletin board. It was from Dr. Clark to the night watchman (who often shot rats at night): “Dear Mr. Smith, if you see a man trying to climb up on the roof, don’t shoot him. It is Dr. Coogle, looking for pigeons.” One can only wonder what the neighbors thought.
Busy as Lee Clark was, it was the radium Ernst Bertner had purchased prior to his arrival that held his attention and reminded him of his time in Paris learning all he could at Madame Curie’s Radium Institute. He had picked up a bit of French, and it came in handy that morning in 1948 when a young physician, speaking with a thick Parisian accent and wearing a French beret, walked into his office. Dr. Gilbert Fletcher had arrived.
Next article: Gilbert Fletcher and radiotherapy