Death of a Surgeon

Evarts Ambrose Graham, a Chicago surgeon's son, fainted when at twelve he first saw his father operate. But he soon conquered his queasiness, went through Chicago's Rush Medical College ('07), became a World War I Army surgeon and made a distinguished record. Example: he discovered that faulty surgical technique in the Army was the main cause of death in thousands of cases of massive chest abscess following influenza. In some camps the death rate hit 98%; after Major Graham's findings, it fell to 4%.

In 1919, at 36, he joined Washington University School of Medicine in St. Louis as professor of surgery, setting a notable precedent: he was to be a full-time professor, operating only for the instruction of junior surgeons, or in cases affording opportunity for scientific advance. Previously, professors had been part-time teachers and part-time surgeons making a living in private practice. At the university Dr. Graham made no more than perhaps a tenth of the income he could have commanded from fees. He became an outspoken and effective foe of such evils as fee splitting and ghost surgery. To his scientific achievements he soon added a dependable X-ray technique for diagnosing gall-bladder disease. But his most dramatic accomplishment did not come until 1933.

Cavities & a Grave. Dr. James L. Gilmore, a Pittsburgh obstetrician, had consulted Graham about what he believed to be a lung abscess. Graham jolted him with the news: it was cancer. Gilmore went home to Pittsburgh to decide whether he wanted an operation to remove the diseased part of his lung. In a few days he returned, ready for the operation, and told Surgeon Graham that while in Pittsburgh he had had some teeth filled. Said Graham with a laugh: "I like an optimistic patient." Replied Gilmore: "Yes, but I ought to tell you that I also bought a cemetery lot." The patient had with him a gynecologist friend, Dr. Sidney A. Chalfant, who sat in the gallery of Graham's famed Operating Room No. 1, looking down on the proceedings.

Surgeon Graham opened Gilmore's chest. What he saw brought him up sharp. The cancer was not, as he had expected, confined to one lobe of the left lung but had its origin in the bronchus (one of the two major branches of the windpipe) supplying air to the entire lung. Graham looked up to Chalfant. "I'm not going to be able to remove the cancer without removing the whole lung," he said through the muffling layers of his mask. "What do you think about it?"

Chalfant asked: "Has it ever been done before?"

"No," replied Graham, "but I've done it in animals and I don't see why it couldn't be done in a human. I think I'll go ahead."

He did, and for the first time in history an entire lung was removed.* Dr. Graham was worried about how to fill the huge cavity remaining. He need not have been: Dr. Gilmore made a good recovery; his remaining lung expanded to fill the space.

Half a Pack a Day. Like other chest surgeons, Graham began to see more and more cases of lung cancer in the '30s, especially among men. His friend and fellow surgeon, Alton Ochsner of New Orleans (TIME, Jan. 2, 1956), who did not smoke, had his own answer: it was caused by smoking. Dr. Graham, who smoked half a pack a day, was at first unconvinced by his ebullient colleague. World War II halted further studies of this problem, but in 1947 a second-year medical student named Ernest L. Wynder went to Graham and suggested a statistical study of lung cancer in relation to cigarette smoking.

The now familiar result of the study: of 200 lung-cancer patients, 95.5% had smoked at least a pack a day for at least 20 years, and only one was a nonsmoker; among noncancer patients, only 50% smoked so much, and 11% were nonsmokers. The evidence was highly suggestive, but it fell short of proof that there was anything in cigarette smoke to cause cancer. Graham and Wynder (now of Manhattan's Sloan-Kettering Institute) went to work again. With tar from machine-smoked cigarettes they produced cancers on the backs of mice. In 1951 Dr. Graham quit smoking. That same year he retired.

As professor emeritus Dr. Graham continued his research. Last fall he was working on a technical paper describing the time lag which may occur between the painting of tar on animals and the appearance of cancer, and speculating that heavy smokers may get lung cancer years after they quit. Said Graham then: "I shouldn't be surprised if I died of lung cancer."

Characteristic Candor. Early this year, unable to shake off the aftereffects of a bout with flu, Evarts Graham went for a checkup to Washington University's Barnes Hospital, where he had so long wielded the scalpel. X rays showed lung cancer, and by the harshest of ironies it was in both lungs, so that his own brilliant operation, now standard in better hospitals around the world, could not save him. Nitrogen mustard, which sometimes serves as a life-prolonging palliative in such cases, proved to be of little help; the cancer had already spread too far. Last week, just short of his 74th birthday, he died.

How many lung-cancer victims' lives have been saved by Graham's demonstration that a whole lung can be removed is not known. Far too many cases are not seen by doctors until it is too late to operate at all, and in many others the operation comes too late to offer much hope. With characteristic candor, Dr. Graham in the last weeks of his life was re-examining the pros and cons of his operation. One of the last visitors to Graham's bedside was Grateful Patient Gilmore. He still smokes; his cemetery lot is still vacant.

* In rare previous operations, lungs had been removed in stages, or had been forced to slough off gradually by having their blood supply cut.

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