Surgery: The Best Hope of All

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veins. But to understand any one of these mechanisms, young Dr. Moore realized, demanded understanding of broader and more fundamental subjects. What is the body's normal content of such common components as water, sodium and potassium? What changes occur after injury or surgery? Astonishingly, no one knew how to measure the amount of water in the human body.

Dr. Moore had an idea. (He found out years later that somebody else had had the idea before him, but had not pursued it.) Why not make use of some of the techniques of nuclear physics and inject into the patient a carefully measured dose of heavy water (D20, the oxide of deuterium, the nonradioactive isotope of hydrogen)? When the D20 and the body's ordinary water (H2O) were thoroughly mixed, the dilution of the heavy water would show the body's total water volume. All this was easier said than done; it took 2½ years to get results that satisfied Moore's meticulous demands. Today, with the aid of radioactive tritium and an ultramodern scintillation counter, the job can be done in minutes.

Big Blue Book. In the midst of such work, which he calls "a chemical dissection of the body by isotope dilution,'' Dr. Moore was named simultaneously to two of the most honored posts in U.S. surgery: surgeon in chief at the Brigham and Moseley Professor of Surgery at Harvard Medical School. It was 1948. and Dr. Moore was all of 34. But this was in the new American tradition. Gushing had been only 43 when he took the twin jobs. Of equal rank. Dr. Edward D. Churchill was only 35 when he became a full Harvard professor and a chief surgeon at the big (950-bed). old Massachusetts General Hospital. Dr. Owen H. Wangensteen was 32 when he was named head of surgery at the University of Minnesota.

By 1952, Moore was ready to publish The Metabolic Response to Surgery, a slim (156-page) volume, listing Margaret R. Ball, his chief lab technician, as coauthor. Despite its unimpressive size and its coldly scientific title, the book became a surgical landmark. And it was only a beginning. What Moore calls his "big blue book" appeared in 1959. Metabolic Care of the Surgical Patient, a six-pound omnibus of 1,011 pages, would be monument enough for most men; it is a basic and irreplaceable text for modern surgeons. But Moore is still enlarging the dimensions of his monument. W. B. Saunders Co. has just published The Body Cell Mass and Its Supporting Environment (helpfully subtitled "Body Composition in Health and Disease"), with Dr. Moore as lead-off man among the six coauthors.

Back of all his research is the question that Dr. Moore asks himself: What is surgery? He answers that. "Surgery has assumed responsibility for the entire range of injuries and wounds, local infections, benign and malignant tumors, and many of the pathologic processes and anomalies which are localized in the organs of the body. The practice of surgery is the assumption of complete responsibility for the welfare of the patient suffering from these conditions." The statement ranges widely, but surgeons defend it jealously.

The American College of Surgeons—which, like the Brigham. is celebrating its 50th anniversary this year—is composed of specialists who believe that the exercise of their art or craft requires concentrated training. The A.C.S. now has more than 25,000 fellows