Robert Edward Gross

Faculty of Medicine — Memorial Minute

On the wall of his operating room hung a sign, “IF AN OPERATION IS DIFFICULT YOU ARE NOT DOING IT PROPERLY”. This philosophy of perfection characterized the brilliant surgical career of Robert E. Gross, spanning 40 years from 1927 to 1967, at Harvard Medical School, Children’s Hospital and Peter Bent Brigham Hospital.

Gross burst onto the world stage of pediatric surgery on August 26, 1938, when he successfully ligated a patent ductus arteriosus (PDA) in a seven year old girl, Lorraine Sweeny. He was then Chief Resident in Surgery at Children’s under William E. Ladd, the Surgeon-in-Chief. Gross had carefully planned this bold operation by practicing it in the postmortem room and animal laboratory. He did it when Ladd was on summer vacation. Ladd never forgave Gross for that surgical coup. Gross was certain Ladd would not have allowed him to do it if he had been in town.

The operative note of this first ductus is a classic. In contrast to Gross’s cryptic operative notes for most cases, this was three pages of graphic prose: “Palpating finger placed on the heart disclosed an astounding coarse and very strong thrill which was felt over the entire cardiac musculature. When the stethoscope was placed on the pulmonic artery there was an almost deafening continuous sound like rushing steam, which was accentuated during systole. When the ductus was obliterated all of these murmurs disappeared. The clamp was taken off and the ductus was ligated with a single #8 braided silk circum-ambient suture. After this tie had been put in place it seemed as if everything was still in the operating field because previously there had been a continual buzz and thrill imparted to the finger through the instruments while working in the area, but now that the tie had been placed all of this buzzing completely disappeared”.

This bold adventure was the opening wedge for surgical correction of congenital cardiac malformations. Lorraine is now 76, in excellent health. By the time of his retirement more than 1,400 PDAs had been divided by Gross and his residents.

Gross was born in Baltimore, Maryland, July 2, 1905. He was the seventh of eight children. His father was a piano maker, whose father had come to Baltimore from Germany in 1856. As a boy Gross was described as quiet and contemplative. While sighting over a finger at a lighthouse in Atlantic City by closing one eye and then the other he discovered he had no vision in one eye. His father gave him a clock to take apart and reassemble and then another smaller one. This was to train Gross to develop depth perception with only one eye. None of us who trained with Gross knew that he had that problem. It was revealed when one of his former residents lost an eye to melanoma. Gross wrote him a letter of encouragement, divulging that he had operated his entire career with just one eye. His congenital cataract was removed after he retired.

Gross attended Baltimore Polytech High School, and then went to Carlton College in Minnesota, majoring in chemistry. While in college he married Mary Lou Orr, daughter of a surgeon. He graduated with Phi Beta Kappa honors. He won a scholarship to attend the University of Wisconsin for three years after graduation, but changed to medicine when he was given a two-volume set of the Life of Sir William Osler by Harvey Cushing. He entered Harvard Medical School.

Throughout his surgical career he was always cordial to the medical students. A month of pediatric surgery with Gross was offered as an elective for fourth year medical students, two at a time. That elective was always fully booked. It was that contact with Gross that steered the undersigned toward pediatric surgery. A letter of recommendation for Gross to Dr. Ladd dated January 30, 1931, by Charles F. McKhann, Professor of Pediatrics stated, “Mr. Gross is an interested, eager, and active student somewhere above the average, and has a pleasant personality and a good appearance. He should make a satisfactory house officer”. This lukewarm recommendation surely did not presage what lay in the future for this HMS student who would become one of the surgical greats of the 20th century and role model for pediatric surgeons the world over. In his class yearbook, Gross noted that his practice would be in Minneapolis someday and that he would be starting his postgraduate year at Children’s Hospital. He actually started as a House Office in Pathology for six months with S. Burt Wolbach, Pathologist in Chief at the Children’s and Brigham. He then had three months in surgery with Ladd. Gross then completed the pathology residency at the Brigham Hospital in 1935. He looked to Dr. Wolbach as his most important mentor. The next four years were spent in surgery, first under Elliot Cutler at the Brigham and then William Ladd at Children’s. He was Chief Resident in Surgery in both. He was a Peters Traveling Fellow in surgery for six months in 1937. He visited the clinic of world famous Ferdinand Sauerbruch in Berlin, just two years before Germany invaded Poland. Part of the fellowship was spent at the University of Edinburgh where he did a research project concerning the vagus nerves.

Gross taught his trainees that success in academic surgery requires “burning the midnight oil”. He authored 19 peer-reviewed papers by the time he finished his residencies. Gross compiled the clinical material which had been cared for by Ladd and others at Children’s Hospital. In 1941 a book was published, Abdominal Surgery of Infancy and Childhood, by Ladd and Gross. Comparison of this book with other writings by Gross suggests that Gross composed most of the book.

Gross saw many unsolved problems in the Department of Pathology, and later solved many of them. In 1945 he successfully treated an infant with respiratory distress who had a double aortic arch compressing the trachea and esophagus. He had studied that anomaly at a postmortem he had performed in 1931. He was the first to successfully graft a human aorta in coarctation, which was too long to excise and perform end-to-end anastomosis. The grafts were human aortas taken at postmortem, freeze dried, and sterilized in a cyclotron at MIT.

Gross frequently told of a visit from Helen Taussig, Head of Pediatric Cardiology at Johns Hopkins Hospital. Taussig suggested making an artificial patent ductus arteriosus, connecting the pulmonary artery to the aorta as a palliative measure for blue babies who lacked pulmonary artery blood flow. Gross dismissed that idea. Taussig then presented it to Alfred Blalock at Hopkins. With help from his gifted laboratory technician Vivian Thomas, the Blalock-Taussig shunt from a subclavian artery to a pulmonary artery was developed. Hopkins was soon the center for “blue baby surgery”. Gross retold that story as a lesson to young surgeons to listen to others around them.

Gross was appointed as Ladd Professor and Surgeon in Chief in 1947. In 1953 Gross published his classic book , The Surgery of Infancy and Childhood. It was published in four languages, and over 40,000 copies were sold. This book is still sought by surgeons perusing the old book seller booths at the American College of Surgeons.

During his tenure Gross inspired many to enter the field of pediatric surgery. Of the 24 training programs extant in pediatric surgery at the time of his demise, 8 were headed by surgeons trained by Gross and 12 by a “second generation Gross trainee”, i.e. a surgeon trained by one of Gross’ pupils. Gross received many important honors: First president of the American Pediatric Surgical Association in 1970, and president of the American Thoracic Association. He received honorary degrees from Carlton College, Louvain University, Turin University, Suffolk University and Harvard. He was given 26 medals, including the Gold Medal for Distinguished Service by the American Surgical Association, the Albert Lasker Award twice, the Dennis Brown Medal of the British Association of Pediatric Surgeons, and the William E. Ladd Medal of the American Academy of Pediatrics, the Bigelow Medal of the Boston Surgical Society and the Sheen Award of the American Medical Association. Gross modestly attributed his success to being at the right place at the right time. In addition to being an innovator, an inspiring teacher, and a lucid writer, he was a master surgeon. Displeasure in the OR was signaled by a gentle tapping of his foot accompanied by an icy stare. Conversation was minimal.

Gross authored 240 peer-reviewed articles. His first two books were illustrated by Edith Piotti. A third book in 1970 entitled “An Atlas of Children’s Surgery” was illustrated by Mr. Janis Cirulis. All three of these books are collector’s items today.

Gross retired in 1972 and settled in Brattleboro, Vermont. In 1985 on the occasion of his 80th birthday a Festschrift was held at HMS to honor Dr. Gross. Dean Daniel Tosteson announced the establishment of the Robert E. Gross Chair in Surgery with W. Hardy Hendren, Chief of Surgery since 1982, as its first incumbent. Gross remarked later that this dinner would be memorial service—one he had lived to enjoy! He died from Alzheimer’s disease in the Newfield House in Plymouth, MA on October 11, 1988 at age 83 years. His wife, Mary Lou, predeceased him in the same facility two years before. He is survived by his two daughters Marcie Moore and Edith Smith, and Jean Lootz, his devoted companion for three decades.

Children the world over benefitted from the many contributions of this great surgeon, scholar, and teacher. His influence in surgery will long continue through the hands and minds of his many pupils.

W. Hardy Hendren, M.D.
M. Judah Folkman, M.D.