ASH Oral History: William Moloney

Moloney: I became interested in medicine through my mother whose brother, Joseph Curry, was a graduate of Harvard Medical School in about 1899. He went directly from the English High School into Medical School and was one of the earlier bacteriologists, and my mother always told me many stories about him. Actually he was quite well known and worked in the department of pathology with the famous Dr. Councilman, who was one of the pioneers in the study of yellow fever.

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My mother continually talked about Joseph, and he was, as I say, a very distinguished, young man. He died in his thirties, unfortunately. He went out to the Philippines to study yellow fever during and after the Spanish War. I held him up as the prototype, or the hero, in my life. She was always very supportive of my going into medicine, and from an early age she encouraged me to do so. We weren't poor, but we were not rich. My mother worked. She was the first supervisor of Mother's aid in the country. Under Governor David Walsh, she headed up what was later called Aid to Dependent Children. In those rather unsophisticated days we had other institutions entitled the Home for Destitute Catholic Children, also the Rose Hawthorne Home for the Cancerous Poor, and in Cambridge there was the Holy Ghost Hospital for Incurables. My mother was one of the pioneer social workers and eventually her department developed during FDR's time into a very active social program. She was one of the architects of it. So I was always involved with a climate of social consciousness. My mother was a very tolerant person who actively engaged in communication with other people and also had a great sympathy for the poor and underprivileged, especially women whose husband's were in jail, or whose husbands were dead. She developed these ideas as a young woman and then went on from teaching into social work. So I think my social consciousness was developed through my mother. Certainly, she had driving ambitions for us and insisted on our going to the difficult Boston Latin School. You didn't have any ideas that you were going to go out and become anything else but a scholar of some sort, and I attribute a great deal of my career to my mother's influence. She was also a rigid, puritan-type, who would say, "I'd rather see you dead than drunk." As a result, I never smoked and I never drank until I got in the Army. And my brother, Frank, was abstinaneous; we both abstained from both smoking and drinking. My sister, who incidentally is a lawyer in New York, never smoked or drank. My mother would have been horrified at the very thought of it. On the other hand, she liked musical plays, and she was musical herself, so that we had a very warm and supportive family life. I was born in Charlestown, right near the Bunker Hill Monument on Chestnut Street. In fact, when my children were growing up they asked if I saw the Battle of Bunker Hill, which I assured them I hadn't. And then we moved from there to a variety of places. We went to West Roxbury, and finally landed in Roxbury in 1919. I spent most of my early years in Roxbury, and from there I went to Boston Latin School for four and a half years. My mother had a disagreement with the principle who insisted that her boys were not the Latin School type, because my second oldest brother was a real Peck's Bad Boy. He did everything anybody could conceive of, and a few other things that you wouldn't think of, such as nailing down all the desktops in a room, and then locking the doors in such a fashion that they had to get the fire department to get one of the teachers out of the room. After a few pranks like that, Mr. Campbell, who was the headmaster, fired him out of the school. My mother got in a row with him, so she took us all out, which was unfortunate. My younger brother, Frank, went with me to Jamaica Plain High School and graduated when he was fifteen. He got into Harvard when he was 15. I didn't do too badly in Medical School, so I think Mr. Campbell missed the mark about some of us. In any event, Roxbury was nothing like it is today. I lived on Townsend Street, over near Washington Street. We were surrounded by a variety of poor groups, mainly poor Jewish people. There weren't many Black people in the community at the time; they came in later. We had a close relationship with our neighbors who were mostly Irish Catholics.

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I grew up in Roxbury, and actually it was a very interesting community. Down the street from us, not far away, Dr. [William] Dameshak, the famous hematologist's mother, lived there up until a few years ago. Theodore White also grew up in what was considered to be a very poor neighborhood, but produced some very intellectual people, many of them went to Boston Latin School and later to Harvard. In any event, that was the type of environment I grew up in. The other factor was my mother's insistence on our going to public schools. She had been a public school teacher herself, and graduated from the normal school. She just didn't have any faith in parochial education, although she was a very devout Catholic. She did not think the nuns at that time were very good teachers, in many instances and absolutely insisted on us going to non-parochial schools. Later, I went to Tufts, my sister went to Portia Law School, my brother Tom went to BU, and Frank went to Harvard. So our background was not the ordinary or usual type found in our part of Roxbury.

In any event, having grown up in that kind of a household, when I started to get interested in medicine, my interests developed rather rapidly. I had a bad injury playing high school football which landed me in the Boston City Hospital for some weeks. Subsequently, over a long period of time, I was going back and forth as an outpatient. Later I worked around the hospital summers as an orderly. After graduation from high school, I then went to pre-med at Tufts. In those days, you could get into medical school with two years pre-med. You didn't have to have a degree. But you had to cram into those two years all of the scientific subjects. That included physics, chemistry and all the other biologic sciences. So we got very little cultural reward, and I regretted that, and I think it's a mistake. But in those days, as I said we were not well-off, in fact, the Depression years were approaching and we were pretty poor. I might point out in those days, I think the fee was $150 a year for the pre-med, and for medical school it was $360 a year. We had a very large class in pre-med, and it was competitive in the sense that only one out of four of us would get into medical school. So we all worked our tails off, and from being a somewhat unsophisticated person, I had to develop rather rapidly a competitive spirit about survival, and I did get into medical school. I did fairly well considering the fact that I used to work nights at the Motor Mart Garage in the lobby at the cigar counter and tried to go to medical school at the same time, which is kind of a chore as you might imagine. Fortunately, in my third year in medicine, I was offered the chance to become what was called a house officer at the St. Margaret's Hospital and St. Mary's Infant Asylum in Dorchester. The latter was a home for unwed mothers and was associated with a very good obstetrical hospital, which was manned by some of the best obstetricians in Boston. But in any event, I spent about a year and a half at that institution which firmly convinced me that I would never become an obstetrician. Not that I minded getting up at night, but it just was not my interest. I was all thumbs. I could never tie a decent knot which obviously would be a detriment to a surgeon, and I was just not cut out for it.

Very early on I began to develop ideas about looking into things. I was inquisitive, so I began to do little projects, some of them rather silly in retrospect. But I would gather data together and try to analyze it, for example, infections in the nursery, and one thing or another. I graduated from Tufts Medical School in 1932 and I was fairly well up in the class, although I remember one course I was so tired that I used to fall asleep in the classes, because I was up very late at night working. I missed several lectures and flunked one course in neuropathology which kept me off the dean's list. That really, at that time, bothered me. At any rate, I went then to King's County Hospital in New York for my internship. In those days, and now we're talking about the midst of the Depression, in 1932-34, I arrived in Brooklyn at one of the largest hospitals in the country. It had everything in it from leprosy to typhoid fever. I don't think I ever saw smallpox, but we saw everything else. Although associated with the Long Island Medical School (now downstate), there was very little teaching by the staff. I took the King's County internship because the fashion in those days was to get a rotating internship so when you came out you would know all branches of medicine. I soon found out after I got there that surgery and obstetrics were not my fields, and I was very strongly inclined toward pediatrics, neurology, or medicine. So I selected those fields for my training which you could do in this rotating internship.

During my internship, we only got our uniforms and food; we didn't get one cent in salary. Although we worked 10 to 12 working hours a day, often six or seven days a week. We often admitted 15 to 20 patients a day. It was absolutely hectic. In addition you had to ride the ambulance around Brooklyn, and in those prohibition days we were having all sorts of problems with bootleggers and gangsters. We were in the center of all these Irish, Jewish, and Italian gangs. So we saw a lot of trauma; more than I ever wanted to see. I quickly conceived the idea that I wanted to do something in medicine. In fact, I again conducted a variety of small investigations, in spite of all the other activities. I then decided I'd stay on for a medical residency. However, the Depression got so bad, and financially things got so desperate at home, that I had to leave the King's County. I came back to Boston because I had gotten married in my second year of internship, and my wife was working. In those days, doctor's wives didn't work, at least if you were going into general practice, which I had to do. I had no choice. I went to Jamaica Plain and we hired a small flat and set up housekeeping, and I started to do general practice including some obstetrics, which I was unhappy about. I made my living mainly by the emergency calls from the telephone operators. There was an emergency system in those days where the operator would get a call and then she'd have a list of doctors. There were a lot of older doctors out there, and I was the first new doctor for years in that part of Jamaica Plain which is right near the monument at the junction of Center and South Street. The point was that there would be all kinds of emergencies during the night and they'd get you up at any hour. I had many interesting experiences, and I never regret having been a general practitioner for that period of time. I could tell stories which people won't believe. I mean this. On one occasion in the midst of the Depression, I got called down to a street in a poor section of Jamaica Plain. A young couple asked me to see their newborn baby, just a few weeks old. The baby was frozen to death in bed; cold, blue, stiff as a board. They had no heat. Another family in Roxbury that my wife and I befriended had 10 children. They were very poor, though the father had a job in a meat packing firm in Brighton. They were a good couple, but they just didn't have any money. I remember going in and seeing this woman and her two infant twins. The house was cold, and they had practically nothing to eat in the house. Both twins had whooping cough. One baby was having convulsions and was cyanotic. Well I didn't know what to do, but I had read a letter in The Journal of American Medical Society, which said that sometimes in a convulsive state, you can control it with ether, which could be given in oil as a rectal instillation. So I got some olive oil from them, and I had some ether in the bag, and I made a suspension of oil and ether. Then I took a rectal tube, which I carried also, and a syringe, and I injected it. The convulsions ceased and the child fell asleep. We got this little one into the hospital, and she recovered. We talked to our friends about these people, and they bought them baskets of food, clothes, and one thing or another. Over the years we became very friendly. Later on this man who was a night watchman at the abattoir, supplied me with a lot of the tissues I needed to make different extracts which I used for clotting studies. I'd send some of the fellows from the hospital out there to get brains and other tissues from sheep and cows. The husband was very helpful in things like that, and also used to come and help around the house. So that was a nice story, but it reflects the close relationship you had with people. You'd go in and have a cup of tea in the kitchen and sit down and talk with them. Of course they never had any money. I never made much money, I think I made two or three thousand dollars the first year I was out. That's not a lot today, but it wasn't much even in those days. Well, what could you do? Many were on the WPA and came in and wanted a note saying they couldn't work. Some of them were fakes, you would just have to say "no way," but others were legitimate, but they couldn't pay you. I suppose if they were out on a farm someplace, they would have brought me a bag of potatoes or something, but these people didn't even have that.

So during the Depression, I did general practice. I got on the staff of the Faulkner Hospital, which is an excellent hospital and had some wonderful physicians on the staff. Several helped me more than I can tell. At the same time, I wanted to teach. I liked teaching. I always enjoyed it, so I became a member of the staff of the Carney Hospital in South Boston. Now that's quite a trip from Jamaica Plain, but I went over through Franklin Park, and I joined the outpatient staff there and became an instructor of medicine at Tufts Medical School. When I was at the Kings County Hospital, I developed an interest in blood disorders through seeing cases of pernicious anemia. We had a whole ward full of patients with neurologic complications, many of them were paralyzed completely from spinal cord involvement. Today we rarely see combined system disease in patients with pernicious anemia. I became very interested in the disease and began to do my own blood studies and investigations in a very minor way. At this time, I became also interested in blood transfusions. In those days, there were no blood banks, of course. Blood banks were not developed until the late 1930's - about '38, '39. The first blood transfusions I saw as a medical student were given by direct transfusion. The donor would lie down on the couch, next to the recipient. An arm vein would be isolated in both subjects. Then 500 cc of blood would be removed from the donor in a paraffin tube and quickly taken to the recipient where a vein was opened and the glass nipple was inserted. The blood was then pumped rapidly into the patient's vein. Sometimes the blood clotted, and then you were left with a big expensive blood clot. It was a very expensive procedure and only a few doctors were doing it at the time. However, at the King's County, a citrate solution had come into use as an anticoagulant. It was just a simple citrate solution, and it did not preserve the blood very long and had to be used right away. Later, more effective citrate solutions were devised and permitted the storage of blood in the blood banks. When I got to the Carney Hospital, I joined the medical service, where I was made an instructor in medicine. That was my first faculty appointment in 1935. I used to teach physical diagnosis there, and we used to go down to Boston City Hospital with the students. While I was at the Carney, I began seeing patients with various blood disorders, especially anemias. There was no lab available for outpatient people. I used to carry around a cigar box in which I had a bottle of alcohol with a needle and a stopper, also little bottles for the red counts and the white counts, and slides to take smears with. As time went by, I got one of the nuns, who was a very cooperative person, to allow me to use a room with a table for my laboratory. I would take their blood and bring it back to my office in Jamaica Plain where I had a microscope. That was the one thing that I really indulged myself in, a good microscope, and I used to do all these counts and look at the smears. So I built up a little blood clinic out there. Mind you, at this point, there were none of the developments we have today. We had only the four blood groups, the Rh factor hadn't yet been discovered. The clotting factors were the classic ones that had been discovered at the turn of the century, and it wasn't until during WWII that the fifth clotting factor was discovered. Also in the west, a group of people working with cows and cattle had noticed a hemorrhage disease in cattle which occurred when they ate rotten hay. When these animals were dehorned, it caused them to bleed to death. This was investigated and found due to lack of a clotting factor known as prothrombin. Eventually, an agent was isolated from spoiled hay which was the anticoagulant dicumerol. This substance blocked vitamin K, which was essential for the production of prothrombin. A test was developed by Armand Quick and others to determine prothrombin levels in the blood. In this test you took some plasma, the liquid part of the blood, and placed it in a small tube. A small amount of brain tissue extract, called thromboplastin, was added, and with a stop watch you measured how fast the little fibrin plaque formed. You could see it form as a white film. The test was called the prothrombin time.

Moloney: Yes. He was one of the group. Quick worked in Milwaukee, and there were a number of other people involved. The development of the prothrombin test was important to me. Most people couldn't care less about my interests in anemias. Everybody knew about iron. [William B.] Castle had done this tremendous work with [George R.] Minot in pernicious anemia. And that's all hematology knew practically. All the malignant diseases like leukemia, myeloma and those diseases, nobody was doing anything further. And no one had any great interest in the disorder any more than they did in the aplastic anemias, because there was nothing you could do for these people. We didn't understand them. We had no inkling on how to manage them. But here was a bleeding problem. Now it turned out there were two groups of physicians at the Carney Hospital who were very important people, and very busy and famous. One were the obstetricians, and then there were a group of surgeons. Some of them very outstanding. There was a disease in newborns called hemorrhagic disease of newborn which found to be due to lack of prothrombin. So it was necessary to do a prothrombin test on these children. And then it was discovered, the antidote for this disease was to give Vitamin K. This evolved over several years in the early 1930's, so Vitamin K was synthesized. You could treat Vitamin K deficiency which, in this case, was a deficiency due to the lack of the Vitamin K from the mother to the fetus. These children would bleed into the head, and either die or be left crippled. So it was very important for the obstetricians. The second group of conditions, and this is a curious story, which has not been well told. It was also observed that surgeons had a great problem operating on people with gall bladder disease, especially if they were jaundiced. It turned out that the obstructive jaundice occluded from the GI tract, bile salts, and bile, which enabled a fat-soluble vitamin like K to be absorbed from the GI tract. If you had your gall bladder out, and you were jaundiced and you had no Vitamin K, you'd bleed to death. Well when I learned how to do the prothrombin test, I went out to the abattoir, got brains from a sheep, made my own thromboplastin and was able to go around with a little set of bottles and do these tests. Now, at the Carney, as at many other hospitals -- I think this is especially an Irish characteristic, there's a hierarchy. You start at the bottom of the ladder and you didn't get your head up above the rest or you get it knocked off very promptly. No one helped you. Now they weren't vicious. They were just taking care of their own turf. And they weren't having some young upstart like me come in there and start doing things like this, because the first thing, some of the surgeons and the obstetricians started asking me to come into the hospital to do these tests. The chief of my service who was a nice, kindly gentlemen but not overly bright, and certainly not a distinguished physician by any means, was very resentful of the fact that he wasn't getting these consultations and I was. But he couldn't do the test. Well the surgeons just went to the supervisor, who was a very intelligent nun, a wonderful person, said this fellow has got to be allowed in the house, in the hospital. He's got to come in here. So I was put on the staff, long before some of the other fellows who had been laboring in the vineyard through the hot day. Some of them were very resentful and in fact, became bitter enemies. I was not exactly a prize in diplomacy, and I was very outspoken at the time. I got in some very furious discussions, nearly winding up in physical violence with my chief over the way he did certain things and didn't do others. I was always trying to get them to have little meetings and invite people over there and do things like that. And as a result I'd have a meeting and no one would come. I'd invite some distinguished physicians and there would be six or seven people in the audience. I was always interested in trying to teach and trying to develop things, and I was very closely related to the house staff. I spent a lot of time with them. And if they were interested, I was willing to sit down with them and go over the problems. I don't think -- I mean that's just -- I'm not bragging about it. It's something that was part of my temperament. That's the way I am. I've never been any different.

So we didn't have any blood banks, but in the meantime, the next thing that happened, and precipitated me into, almost an international thing, was the discovery of the Rh factor. This is one of the great episodes in American medicine. And again was sort of serendipity, but it came about through very basic research by Karl Landsteiner and his pupils, two of them who were [Philip] Levine and [Alexander] Wiener in New York. By a coincidence Wiener had discovered that rhesus monkeys' blood grouped like man but there were about 15 percent that did not have a blood factor, which monkeys and man had, which was then called the Rh factor or the rhesus factor. So it turned out that this basic observation was made. And mind you there had been no advances in blood transfusion at all up until 1938 or '39. This was just before World War II, nothing during World War I. At this time, we knew people that got transfusion reactions and died. It was a hemolytic reaction and yet they were compatible as far as we could tell from the ABO system. Well, with this new knowledge, people started to look at some of these reactions and found that indeed there was a factor which created an antibody. But the thing that precipitated the most interest was the fact that in pregnancy, the mother developed an antibody for her infant's blood cells.

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Moloney: Then the next step was Philip Levine was consulted about a patient who had a baby with hemolytic disease, a newborn. This hemolytic disease was caused by a very rapid red cell destruction, and the child would be born anemic and often jaundiced, and would become mentally impaired. It was not understood why this happened. Sometimes the patient, baby-patient, developed what was called hydrops fetalis. In other words, became so edematous it was like a monster puffed up with fluid. It was a fearsome thing. It was especially prevalent among multifarious women. In other words, it rarely happened in the first pregnancy -- it did but very rarely -- but in successive pregnancies it got worse and worse, and it was a tragic thing because it was often fatal. The antibody created in the mother passed through the placenta into the fetus. The reason was that the mother was Rh negative; she did not have the rhesus factor in her red cells. Therefore, the fetal red cells which could pass into the maternal circulation caused immunization from the mother to the fetus. Just like giving red cells which are Rh positive to a Rh negative person. This antibody in the mother passed through the placenta and rapidly destroyed the red cells of the child, so that right after birth or during the last month or so, the red cells were destroyed. By the time the baby was born it was jaundiced, edematous. In milder forms, of course, the child recovered. In severe forms it was fatal. After the antibody was found, this created a whole new episode in medicine. Subsequently it was found that an antibody, which they use nowadays, could prevent this hemolysis which has been a great triumph. Much of this work on the Rh factor was carried out in Boston. We had a very famous group of people at the Children's Hospital, of which Louis Diamond, who is still working out in the West Coast now, is one of the most distinguished and greatest people in my mind as ever worked in this field. I knew Lou Diamond from the time he was the chief resident over there, and when I was in practice I would call him up and tell him about problems. He was always very considerate and nice, which you couldn't say about a lot of staff people in their attitudes toward general practitioners. I've had some very arrogant young men in emergency rooms pay no attention to a practicing physician who would have given them some very good information, but they disdained it, unfortunately, with the arrogance of youth. But Lou Diamond would always listen to you and would help whenever he could. In any event, he developed the technique in which they took all the blood out of the baby, practically, so called exchange transfusion, and prevented the brain damage which occurred in many of these infants. It was called kernicterus. The bilirubin stained the various areas in the brain bright yellow. At autopsy you could see this, and the child either died or was left as a complete mental cripple. In the meantime the war came along. Just before the war, before your day, everybody got very conscious of the fact that we were going to need blood. The bombing in London, for instance, excited a great deal of interest because many of the lessons that were learned in World War I had to be re-learned. For example, crush syndrome from people getting crushed by walls and debris. Hepatitis and other diseases which were known for many years, and especially the problem of transfusion. Now at that point, unfortunately, we got off on the wrong track and people began to think that you could use plasma instead of blood. They visualized giving the troops plasma which could be carried unrefrigerated into battle, really, and giving it on the battlefield. The British had gone all through this in the desert. Of course, we didn't learn the lessons that our allies could have taught us, we never listened to them. They found out transfusing a man with plasma who had lost half of his blood volume, made it worse because it diluted it up, and he would die. And they knew that we had to have whole blood. Now this meant we had to develop blood banks. The first blood banks, I think, were set up in Chicago in about '39. And subsequently, and it was partly because of the influence of Russians who were using blood from cadavers, they had plenty of them in those days I guess, and they would bank this blood and then use it. Now nobody knew much about blood grouping, especially about the Rh factor. But again fortunately, I was able to set up a blood grouping lab in the hospital and then, since the obstetricians were calling me in all the time to see mothers who had prior pregnancies and to help manage these kids. Then I got involved with some of the Civilian Defense people and started to train people on how to draw blood and to select blood donors. Now mind you, we had no blood banks at the time, but we were getting prepared so we would get the blood, and eventually as blood preservation developed, from the British mainly, we would then be able to get whole blood, and put it in the bank, at first only for only a week or ten days or two weeks, but then later on, about three weeks, you could keep blood and transfuse it. Well when the war came along, and I had set up blood banks by that time in 1940, '41, helped set them up at the Faulkner Cambridge, Mt. Auburn, St. Margaret's, Carney, and a number of other hospitals. I did a lot of consulting work as I went along. Incidentally, I'm a little ahead of my story in a sense that as I developed my interest in hematology, I began to get a lot of consultation work so that in 1939 I stopped my practice in Jamaica Plain. I stopped doing general practice, and I went into Boston and hired an office on 39 Bay State Road, and patients would then be sent in there. I had a technician, and we would do the blood work in there. Hitherto, I did it in a kitchen in my house in Jamaica Plain. Finally I bought the house in 1938, and I then was able to have the downstairs part as the office, and a kitchen that I used for a laboratory, and we lived up-stairs. And that's where I did all my research on coagulation and things of that sort. Well, in any event, I began going around to numerous hospitals, maybe 15 or 20 hospitals, because nobody else in Boston would go out consulting. Certainly, Castle wouldn't. And people like Dameshak might go on a very special occasion with a VIP, but there was no one would go out and see the nitty gritty thing, like a bleeding problem. Or anybody like myself who would carry their own lab stuff with them and do it, because these hospital labs didn't have this capacity at the time. So that's how I got involved with coagulation problems and in blood banking. The third thing and a very vital factor in my training was that Harvard set up post-graduate training course. This was very unique and very early, and Bill Dameshak ran a course for 10 days at the Beth Israel, where he was then located. Dameshak trained at the Boston City Hospital. He built his own hematology business up and then started a hematology lab at the Beth Israel and was self-trained, as I was. Well there were a lot of people who wanted to get in there, and he wasn't accepted. Bill was somewhat of an abrasive personality at times, and I think they never liked him for various reasons because he disagreed with them on a lot of things, and he was very outspoken and very critical. He was a very good friend of mine. He was very good to me, and I respect him. I hold his memory, very warmly, but I also know he had a few warts, and diplomacy was not one of his good points. But any 2 rate, he set this lab up and did some great work. He ran this course, and at the time, I was broke. I had to borrow the money. I think it was $150 for the course, and it was a very good course. There were only four or five of us in it, and he gave us individual attention, and I learned how to do bone marrow aspirations and study bone marrows. I was very good in morphology and liked it, and worked very hard at it. So I was then running around with a bone marrow needle or two, and I'd boil it up, and do my own marrows. No one else was doing this. So again this was another asset. Mind you, this sounds very much like a braggart, but the point was that this was a fact, and this is how it came about. And that's why I developed this tremendous consultation practice. The problem was I was getting busier and busier, and I didn't have any teaching association except the one at the Carney. I was very busy at the Faulkner, which is a great place. We had wonderful doctors up there. Channing Frothingham, Richard Ohler, or people who were in the faculty at Harvard and on the staff at the City Hospital. There were some great people out there with very high standards. I learned so much from them, and they were so supportive. None of this business of being concerned about whether I was getting up in the world or not. And they were very kind and helpful to me. In the meantime, as I said, the war was coming on, and I volunteered, of course, as most people did, and they didn't accept me. The reason was I had a broken my arm during a football injury when I was 17 and I couldn't straighten my left arm out. Now I could out-run, out-wrestle, and out-fight practically any doctor that examined me for the Navy, for instance, and they said, "Oh, no we only want perfect physical specimens," and I said, "To hell with you." So I went home to my wife and four kids, one of them was born on Pearl Harbor Day, and went back to my office and back to my practice. About a year later, I went to the Air Force and was accepted --Some friends of mine heard I was going in so they thought the service could use me better in the blood banking business, so I got sent to the Walter Reed Hospital. Pulled out of the Air Force and was sent into the Army as a Captain, went up there in 1942, November 11^th, and joined the Army as a member of the group which was producing plasma, which turned to be not a very good idea, but I got involved in this.

The reason the plasma became so popular was that [Edwin J.] Cohn, Professor Cohn at Harvard, was one of the early pioneers in separating different fractions, and they had isolated different fractions from the plasma, an anti-hemophiliac factor that Lasky Taylor had found at the Thorndike. And they also had the plasma prepared in such a way that you could actually preserve it and give it, and it was thought this could be a real asset. It was helpful, but it was certainly not a substitute for whole blood.

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Moloney: Well when I got up in the Army Medical School, I stayed up there from November, December, and I was transferred to Lawson General Hospital in Atlanta with the same function. I was attached to the laboratory. Although I was a medical person, they attached me to the laboratory down there, and I was supposed to develop the blood banking business, to help them. I then got associated with the American Red Cross there because we were using all these blood donors, and I was helping supervise the blood donations. We went all around Atlanta to these big plants and bled people with a team, and then brought the blood back, and it was preserved and sent to the various camps where it was used.

In the course of this we made various observations. One paper I wrote which was published in The New England Journal of Medicine, actually, was on syncope, or fainting in blood donors. And that was the sort of thing that I would do. Well the Lawson General Hospital had the biggest aggregation of great physicians and various people you'd ever want to see gathered in one place. It was on Peachtree Street out at Buckhead, which is just out of town from Atlanta, and very near us was the Grady hospital which was outstanding municipal hospital.

[END OF SIDE ONE, TAPE ONE, BEGINNING OF SIDE TWO, TAPE ONE]

Moloney: So anyway the very propinquity of this group of medical people, especially over at Emory University was great because we would go every Sunday morning, a group of us, to what we called Gene Stead's Sunday School, and he would hold this clinic, in which he would show everything from Black Widow Spider bites, to typhus, to all kinds of exotic disorders, and syphilis in all its various aspects. He was a very strict disciplinarian, and he had a wonderful young staff. I met a fellow named Grant Taylor who was chief of laboratories at the Lawson General Hospital, who influenced me greatly. Grant was an ex-assistant dean at Duke, a pediatrician, and a lovely, lovely man. He was about ten or fifteen years older than I was, very encouraging, and he got me involved with what was then just beginning, called the Young, Young Turks Society. The American Society for Clinical Research was known as the Young Turks. The old Turks were the distinguished professors in the Association of American Physicians. The new society was called the American Federation for Clinical Research, and the members were all very bright young guys down there. I joined with Grant Taylor and some of the others, and became a member, which was very important, because when I came back to Boston I reestablished the local unit. It was also called the Young Man's Christian Society, because Henry Christian started it here in Boston.

In any event, this, of course, wetted my appetite for research and for involvement with people in the field. Then I suddenly got transferred. My family was in Atlanta, including our one year old baby, and we were all thinking we were going to stay there. I had been transferred to Fort McPherson, where there was a group preparing to go to the South Pacific sometime, and since I was a hematologist they put me in this group, since I looked in the microscope. I was sitting, telling my wife how good things would be and all, and then I suddenly got the command from Washington that everybody that rated Captain should go into a field group, or some active thing, and I suddenly found myself up in Fort Bragg going through basic training, and was told that I was now in charge of a station hospital laboratory, which meant a pathologist. I went in with my chief to see the officer-in- charge of assignments, who was a Colonel from World War I, a Lieutenant Colonel from World War I, a retread in the Army Administrative Corps. I, in the meantime, had taken my boards in medicine. In the midst of all this confusion with all these kids hanging off me, I took my boards at the Lawson General, went down that summer by train all the way to New Orleans. Took my orals at Charity Hospital, passed, and came back, very proud of myself becoming a board member. So I went in and I saluted. I said, "Colonel, I've come to talk about this assignment as pathologist and chief of laboratory in a station hospital. At that time station hospitals were designed presumably to go right to the front and do surgery right during the battle. The Colonel said, I said, "Well, Colonel, I'm an internist. I'm a certified board member in internal medicine." And he looked at me, and said, "You look in a microscope, don't you?" I said, "Yes, sir." "You're a pathologist." And I said, "Oh no." He said, "Don't talk back to me." So I saluted and went out, and I became a pathologist for the next two years in the Army. So I went up to Bragg and joined the 347th station hospital. We had a very rigorous training including qualifying with a carbine and doing all kinds of crazy field exercises. Very vigorous. We were transported to England in the Fall of 1943 via the Queen Mary. We then set up in an old English hospital and had some very hectic times. We were in tents all winter, believe it or not. I'd never slept out of a bed in my life, except when I was a Boy Scout. And here we were, some of us in our thirties. I was 37, I think, at the time.

Well the big invasion happened. We were just getting ready for casualties, and when D-Day came that following June, we set up a transient, sort of triage arrangement. After D-Day --they didn't have these MASH units available at the time, because there was no place for them to go. So they brought all these casualties back, in whatever kind of conveyance you could get, LST1s or anything. And they landed them down on the Channel, and they brought them up by ambulance or buses if they were walking wounded. We put them in tents and then separated them out, and sent some to our unit. We got as many as 300 casualties in one night. There was everything from head wounds to belly wounds. Incredible! Most of them were people with their limbs off, many with both legs, or an arm and a leg off. It was the most horrible experience you could imagine, because we were not prepared for this. We did not have enough qualified surgeons on our staff. It was a nightmare. I never forgot it. I got two sergeants, and we had a sort of cart. We had all 0-blood. We just had all this blood, and anybody that looked pale, we didn't even have a chance to do blood work on them. Forget the lab. Here were these guys, still many of them in battle dress, and we went around with this cart, and I'd say "Give him 4 units. Give him 6 units. He looks paler than the other." And you worked until you practically dropped. Four or five days --it gradually eased off, and they got some more help for us.

You know, we had some very curious experiences, and this may be an aside. We had a very tough Colonel who was looking for prestige. He wanted to be a big shot. And he was pushing us all the time. He was very GI. Everything was so proper. So the first group of casualties we got in, we had to give plasma first, and then get the blood started because we didn't have the blood supply we needed right away. And after the first day or two, I noticed two of the patients got violent chills. These fellows had wrapped them in casts before they transferred them up to us, these big bloody casts, just to hold them together, before they did definitive surgery on them. And this GI was rattling around in his cast like a nut in a shell. And I suddenly turned around and he was dead. Obviously due to an embolism. But the thing that started it all was this tremendous reaction. Then we went around and saw case after case getting terrible reactions from the plasma. This was before the blood went in.

Well I opened one of the bottles of plasma, and I smelled perfume coming out. This is a fact. Absolutely. Cross my heart. Now this goes all the way back to the time I was up in Washington. We were making plasma, which thank God, no one got much of it, because it wasn't very well done. One of the people who was a junior officer in this group, his family owned a lyophilizing set-up for a perfume company. Well everybody wanted to get in the plasma business. Baxter, and the big companies like Lilly. But this company came new on the scene, I forget the name of it. It's probably just as well. And they got involved with lyophilizing plasma. In other words, drying it. Now if it's not perfectly lyophilized dry, it forms a gummy substance when you try to dissolve it. It doesn't go into solution well. And I noticed a lot of this stuff wasn't going into solution well, and from this particular company, I smelled perfume in the bottle. This is the truth, as I'm sitting here. Well I went to the Colonel and said, "Colonel, we can't use this stuff. It's absolutely unless." He said, "Why do you say that?" I said, "Look, I made this stuff. This is no good. It's going to kill people." Well he thought that was interesting. "What do you suggest?" I said to him, "You impound it all. Put it in a tent. Leave it there until we get someone from the -Inspector General down here to look at the stuff.I1 In the meanwhile there's a hospital about 2 miles away, I went over with the jeep, and we got all the Baxter plasma we could. Brought it back and we never used the other plasma. Well the next day the Colonel called London, and an officer came down from the Inspector General. They dressed me down. They called me every kind of a stupid. What are you trying to do, make trouble? "What are you, a troublemaker?" "You're a troublemaker, Moloney." I said, "Colonel, I'm not going to give that stuff. I don't care what." The guy went back to London. Within 48 hours they had calls from all over England that they were having the same damn problem. The Colonel said, "I'm going to put you up for bronze star." I said, "Bronze, nothing." That really shook me up.

But at any rate, after we got through all these casualties, things quieted down, because by that time the hospital set ups were better. They had a chest center and a head center. They weren't dropping everybody into one place like ours which was ill-equipped to handle it. And they did a wonderful job. There's no question about it.

But in the meantime, I was transferred from a Station Hospital to a General Hospital, General Hospital was a thousand beds. Still as the chief of pathology. Now you have bacteriology, biochemistry, as well as pathology. And I hadn't done an autopsy since I was an intern at the Kings County Hospital. But I went around with the English doctors and did a little practice on cadavers and one thing or another. I also got a young man in the outfit who was a biochemist. Another was a bacteriologist; they were in the Sanitary Corps, it was called then, and they ran those special fields. Clinically we didn't have too much pathology. The blood bank was my special concern, and I really think we did a good job in that aspect. So then they sent me around to other hospitals to lecture on the different problems with reactions and blood typing.

One of the very fortunate things in my life, was one night when we had just set up, before we had any blood, a B17 on a training mission --it was in November or December 1943 --crashed in the woods. They ran out of gas about 5 miles from the hospital. Not everybody was killed. Five of them were killed out of the crew of 11 and the four or five others were brought in who were terribly injured, compound fractures and a mess. We didn't have any blood. We were stationed at that time, right outside of Cambridge, in Arrington near one of the bomber bases. So I went in to the Adenbrooks Hospital in Cambridge. It was around 8 or 9 o'clock at night. Knocked on the door, and a little man came down, introduced himself as George Taylor. And I asked him if they had any blood. He told me sternly, "of course." He gave me all the blood they had, and we put it in the jeep and brought it back. Well it happened Taylor was a very famous man. He worked with Rob Race. And Race, of course, was one of the people who described all the sub-groups (the Rh-factor) and had these great controversies with Wiener. So the next day I went back and met Race. We became very good friends, and I used to have very interesting talks with him. They were all very good to me. I did a study, for instance, on all the wounded men we admitted. We had a lot of casualties in the General Hospital. We were doing a lot of surgery with our key people on extremity wounds. The German 88 was very effective in causing extremity wounds and we had a lot of these cases and a lot of transfusions were required. So I once took all the patients that were there and typed them when they came in; and they were all Rh positive. After they had been there a while I retyped them and they returned to about 15% Rh negative. The reason was that they all got Rh positive blood. So I wrote a paper which Race helped me with and published it in The British Medical Journal. I also carried out quite a bit of work on hepatitis. We were interested in hepatitis for several reasons. That was the commonest disease we saw over there. We didn't have all the infectious diseases they had in World War I. That never materialized. But we were mainly interested in hepatitis because it was very prevalent, and we knew very little about it.

Well in the course of doing workups for jaundiced patients for the surgeons before the war, I had to determine whether the jaundice was due to the liver disease itself, or was it obstructive jaundice. So I had to use tests. In those days we had the ~romalfulein Test, and we had the Cephalm Cholesterol Flocculation Tests, and some very crude tests like that. The Cephalm Cholesterol Flocculation Tests (CCF) was really a test where you suspended an insoluble material called Cephalm and cholesterol made from fractions of the brain. Before the war, I made up my own CCF reagent. You placed serum in a test tube with the reagent. And if it was positive this flocculent material would come down which was due to the abnormal protein these people had in their serum. It was very helpful because in infectious jaundice the test was usually positive, but with obstructive jaundice it wouldn't be positive unless the obstruction had been there a long time and the liver was damaged. If it was due to severe hepatitis, you wouldn't want to operate, which was often done, because it was very difficult to tell clinically whether it was infectious or not. So that was how I became involved with the liver function tests.

While I was in England I had of plenty of opportunity to work on hepatitis cases. We had a huge lab and lots of help and believe me there weren't many other things to do, so I carried out a lot of research on patients to determine if they could go back to duty. That and infectious mononucleosis were among the more common diseases. So I did have some hematologic experience plus that and the transfusions. But for the rest of it, it would have been a waste of time.

What does an internist do during the war? You know, really, with healthy young men outside of gonorrhea and syphilis which was very prevalent, there was nothing much in the way of infectious diseases. And so I finished up my time in England by 1945. Came home in November of that year. And the day afterwards, I went back to 39 Bay State Road with a hired truck and my office furniture which we had stored during the war. Put it back in and started to work again.

Now I had the Rh problem, and I had met Race and Taylor and lots of other people in England and had become very well acquainted with the field. I renewed my acquaintance with Lou Diamond, and Lou said to me, "You know you're at the Carney and at St. Margaret's, and they have more babies at St. Margaret's practically than any place else. There's nobody doing any Rh work there. You've got to get involved with these people. And why don't you have them send the bloods to you." So I hired another technician and we started doing the Rh tests which we charged a fee for, which helped me keep going.

Meanwhile, I was spending a lot of time out of my practice. The rest of the time running around all over New England seeing patients. And at that point I had no close affiliation. I was still on the staff at the Carney. They made me an assistant professor before the war, and then later on I still taught at the Carney. At the Faulkner, we didn't have a teaching appointment. Many of the people there were from Harvard but they didn't use it as a teaching institution. The Carney was still my primary teaching institution and was associated with Tufts. When I came back from the war, I had become very friendly with Dr. John Spellman. John's brother, the Cardinal, was the Vicar General of the Armed Forces, and a very prominent and important person. John was an excellent surgeon. He was trained at the MGH [Massachusetts General Hospital] and worked at the

Baker Memorial, and was a very outstanding surgeon. He became chief of surgery at St. Elizabeth's. He was friendly with Cardinal Cushing, and Cushing had this idea that he wanted to make St. Elizabeth's Hospital a great teaching hospital, a great hospital. As I said, like the Beth Israel. And I've always felt that way too, that this should be done. Unfortunately, John got the idea that I should be chief of medicine at St. Elizabeth's out there which I did not want. I wanted to stay in hematology. I didn't want anything else. I wasn't well trained in the other fields. But he talked the Archbishop into having me go out to St. Elizabeth's, and I had to make the decision whether to go back to the Carney or go to St. E's. So in 1946, I went out to St. Elizabeth's and was received there with less than enthusiasm, in fact with a good deal of antipathy, I said "We're going to now straighten things out. We want board men only." A lot of them weren't. And a lot of them were practitioners that had been there for years and resented any change that I was trying to make, and as a result I made myself thoroughly disliked. Everything I tried to do was blocked in spite of John's great weight with the Archbishop behind him.

Well it came down to selecting the chief of medicine there in 1947. It turned out they selected another fellow who was a competent MD, but not very much involved in teaching, and he really didn't have the interest of the hospital at heart. But I called him up the day after his appointment and said, "John, you're the chief of medicine. I never wanted it, and I am glad to help organize a program." There was a dead silence, and he said, "If I need any advice from you I'll ask for it.'' Whap! Up went the phone. Well, the next day I was over at the Holy Ghost Hospital where I'd become a member of the staff, and reorganized that place for the Cardinal. I got myself in all kinds of fights over there. John ~attigan who was chief of one of the services for the BU (Boston University) at the Boston City Hospital said, "Look. You visit at the Boston City and make rounds down here, and they like the way you teach." He said, "I've been authorized to tell you, to offer you the job as chief of one of the medical services here. We'll give you a salary and you'd be made professor of medicine.'' Which, incidentally, I never became professor of medicine at Tufts until a year before I left there in 1966. I was clinical professor but they never made me a full professor until 1966.

In any event, I said, "John, while that's very flattering. I'm up to my ears with St. E's. They don't want any part of me out there, and I'll never get anywhere, and I just don't want to stay there. But I'll talk to the Dean at Tufts because I've always been at Tufts and I am loyal to them.'' I was at least at that time, and I talked with Dwight O'Hara who was the Dean. He said, ''What do you mean leave Tufts? You're being considered for possible job down here and you are one of the principal people we have in mind." And he added, "No, we can't allow that. We'll give you anything that BU will. Dr. Fernando Begiuria, chief of our two medical services there, and the director of teaching for Tufts, is very enthusiastic about you, and we want you there very much." So I took the job.

One of my chief contributions was that I had knowledge of the Rh factor. The BCH was doing nothing in this field. These babies were being born there with no Rh testing. Nothing. Also, they had no useful blood bank. They had a blood bank run by a surgeon who was just awful, absolutely terrible. He's dead and all these people are gone, so it doesn't matter. But it was a horrible situation.

Now the BCH was being dominated by a famous character who was a pediatrician on the board of trustees, named Martin English, and he was a martinet. He ran that place. The one thing that he liked about me was I didn't smoke. That was the only good thing he could think about me. Because I called English up, at the behest of a namesake of my name, Albert Moloney who was a radiologist down there. He said, "Look, you really should talk to Dr. English about this Rh problem. It's a disgrace. If anybody finds out about this and kids die, someone's head is going to fall." So I called Martin English up, and I told him exactly who I was. I was a friend of Albert Maloney's. "Yes. And what do you have to say.'' And I said, Well, I think if you don't do something about your blood bank and the Rh problems, you're going to be in trouble." He said, "If I need any advice from you, I'd ask for it. Furthermore, we have the best blood facilities in the world. We have the Thorndike Memorial Lab." And I said, "But no one over there is interested in this." "I don't need any help from you." And he hung up right in my ear. Bam! So I said so much for that.

Well anyway I went to the BCH and I set up a laboratory in a mop closet which was dreadful. No facilities, nothing. No support. The school never gave me any salary which they promised me at first. They gave me a title of clinical professor of medicine and assistant director of one of the two medical services. I think it was the First Medical Service and there was lots of work. Meanwhile I was working weekends and nights to make a living and I was at the BCH practically full time.

So anyway, be that as it may, English called me up about three days later. Apparently someone got on his ear and said, "You've got to do something about this Rh thing. This is awful." A1 Moloney called him back. So he asked to see me. And I went to see him at the BCH. And he said, ''1 want to talk with you. What do you need?" And I said, "We need a lab." So he took me up to the top floor of the Mary Curley Building, which is the Children's Building. It was one of the newer buildings. On the very top floor there was an unused sun parlor for kids and several kitchens and other things up there. No one ever used it. So I indicated what I wanted, and I really went overboard a little bit and no problem.

Within about a few months, they tore down several rooms and a kitchen, made a lovely lab up there for the Rh business, which, I promptly turned into a hematology lab, and we did all kinds of things, coagulation and everything else. Pretty soon I had so many people in there you couldn't move, and we started a fellowship program. The first fellows I had, one was an Irishman from Galway. The son of the dean of the Galway Medical School. Brilliant. And the other one was a young man I met in 1950 at the Pasteur Institute named Michel St. Paul. And Michel came in 1950.

Moloney: His name was Shea. Steven Shea and Steven was an intellectual. And never trust an Irishman who doesn't drink. He was one of these Father Powers people, who not only never drank, but if you drank he didn't like it much. But he was a lovely man. And his family were very distinguished intellectuals. His mother was professor of German. His father was professor of anatomy and the Dean, and I visited them in Galway later. But Steven didn't stay the course with me. He went from there, actually, to Harvard in the Department of Pathology. Well, he had some training at the Mallory and one place or another, and came back. Stayed here at Harvard for a long time and then he went to Yale. Meanwhile Michel St. Paul was a very interesting young man. Little mustache, wax mustache. Debonair and very intellectual. He spoke German and English and read all these esoteric literary works. He and Shea used to make me feel ashamed as I'd sit and listen while they talked about Moliere and one thing or another. And anyway, Michel brought to me the first concepts of immunologic things in medicine. He worked at the Pasteur Institute and he had a wonderful brain. He had some great ideas about things. And we worked on a number of things. We got interested in dogs, blood transfusions in dogs. And I used to go over to the old Angel Memorial Hospital on Longwood Avenue. They had some problems over there with a dog with hemolytic anemia, so I went over and saw the dog. And then they had a cat. Once they had a bulldog who had leukemia but the damn dog was very ferocious so I didn't examine him! They just gave me his blood. So I got interested in the animal blood groups --One of the first things we did was try to make an antibody for lymphocytes in dogs. We first had to learn something about the dog blood groups, and we did set up our own classifications. Dog one (Dl), two (D2), and three (D3). We had a patient at BCH with chronic lymphatic leukemia. And we had one dog in the animal research lab in the BCH. That was our only facility. We would bring these quarts of white cells over and inject them in the dog. And sure enough the dog developed a beautiful antibody for human lymphocytes.

I wrote a paper with Michel about a week before I left for Japan in 1952. It went into Nature and they turned it down on very bad grounds. It was one of the first papers on the immunologic aspect of lymphocytes and some hypercritical guy said I hadn't used lymph nodes for the source. I still have the paper in my drawer someplace. It was a really landmark thing in my view. Of course, it's so crude nowadays, people would laugh at it. But still we did it. And Michel went off back to Paris and then became the chief forensic medical officer for the City of Paris. So if you ever get murdered in Paris, Michel will probably supervise the autopsy or the investigation. But at any rate when Michel went I had another Irishman named Bill O'Connell who subsequently became the most distinguished hematologist in Ireland, and he's now at St. Vincent's Hospital, the teaching hospital in Dublin for the National University in Dublin.

Moloney: Liam, William. He was on the BU service for two years then he came over to me. He came over in 1952, and I left in March of '52. He came in June. I went to Japan in 1952, which is another story, another long one. At any rate, in the meantime, we had set up this fellowship program. We had no money. Tufts gave us nothing, no support at all, except a travel fund. I think the largest sum we ever got was $1200 for research, and we were carrying out a variety of things, especially in coagulation. See all you needed to have in those days was some test tubes and a water bath. So we looked into all kinds of coagulation defects, since we had a lot of cirrhotics, and liver diseases at the BCH, we looked at the liver diseases, and Jane Desforges then came back from Utah where she'd been working with [Max] Wintrobe as a chief resident. In 1949, '48. This was the group: Jane Desforges, she is now a very distinguished professor of medicine at Tufts, and she was our chief resident. Bill Harrington was also with me and is now professor of medicine and hematology at the University of Miami Medical School. And then there was the famous Fred Stohlman.

Now these people were full-time medical interns and residents, working their heads off, long hours. And yet they took the time and interest whenever we had a project to do the research. We made some very good observations and wrote the first papers at that time. All three of them. Jane went on to the Thorndike and has become very distinguished and was recently president of the American Hematology Society. Harrington went out with Carl Moore, one of the more distinguished people in the business and ended up professor of medicine and chief of hematology at the University of Miami Medical School. Fred Stohlman was probably, historically, one of the outstanding cell biologists that ever lived, I think. Had he lived instead of dying tragically in that airplane crash, he would have gone on to greater levels than he had before he died. But I was very stimulated by this younger crowd, and we all worked together and we did some rather crazy things in the way of investigation. We didn't have computers, and we didn't have a lot of the facilities we have today, but we were curious and we investigated these things the best way we could. So that started me off in that area, but my research fellowships and the fellowships I was developing were not funded. So I was having increasing troubles getting funding for people in the early 50's and was getting no help from Tufts or anyplace else. Mind you the fellowship program at the NIH and just started practically, 48-49, but people like myself had no access to that sort of thing because none of our people had worked at the NIH. By late 1951, I had become very busy as a consultant and began to make some money even though my fee was only $25. I went to so many different places and had so many people seeking my help that I was beginning to really make money. However, I would come home so exhausted that I could hardly even get in my front door. Then I stopped and looked at myself and said, "Well I've seen 10 patients in five or six different hospitals and I really don't know what's the matter with some of them. It's not fair because I'm not doing a good job." I couldn't very well refuse if someone called me up and said, "Look we have this terrible problem here."

Moloney: OK.

[END OF SIDE TWO, TAPE ONE.]

July 6, 1989

Moloney: I think perhaps I had, like most people, most adult males, somewhat of a crisis in my fifties or late forties in the sense that at the time I was very busy and beginning to see a lot of patients in consultation, but I was working many hours a day and into the night. At the same time, I was trying to develop the hematology laboratory at the Boston City Hospital where Tufts had never had that kind of establishment. I had some very nice young fellows, one from Ireland and one from the Pasteur Institute in Paris, and I was trying to develop a fellowship program, but at this point I got absolutely no help from Tufts.

Indeed, when I went there, they promised me a salary and a clinical professorship which they did not give me and they gave me very little money at all and no support for this new division. By dint of a little politics, we were able to get a laboratory because at that time the Rh factor had become very important; the BCH had nobody interested in blood banking in that sense or knew anything about the Rh problem, and I did. I had furthermore gotten involved to a slight degree with Race in England during the war and did some work in the army there in blood grouping and blood typing to improve that aspect of care of patients who were receiving enormous quantities of blood.

So when I came back I set up blood banks all around Boston: St. Elizabeth, St. Margaret's, Carney, a lot of places. As I was trying to build this up at the BCH, Dr. Martin English, who had not retired, was still on the board of trustees, exerted tremendous influence there. Through some friends, he got interested and was able to get me a laboratory up in the top of the Mary Curley Building, which is the children's building at BCH, and gave me some very nice laboratory facilities: limited, but excellent.

At that point, Jane Desforges, who had been chief resident, went into the Thorndike as a Fellow. We were very close friends and she collaborated with me. The purpose was to have her come back and work with me since she was especially interested in red cells. But at that point, I was so busy, seeing so many patients, running around, and I was in a fair way of becoming rich because nobody else would go out and see these people. Then I'd come home nights and I'd be so exhausted I could barely stagger through the front door, and I saw no future as long as Sam Proger and the group at the New England Center Hospital were determined to build up, and I can understand why, their medical reputation. Bill Dameshek down there was an overwhelming personality. It just seemed to me at that point a matter of almost despair getting anywhere.

In any event, I got a letter from a former friend of mine who was in medical charge of removing Japanese people from Korea back to Japan. Many of them came through Hiroshima and Nagasaki. He became involved with this process and then was made Director of the Atomic Bomb Casualty Commission which had been set up in 1948. This was a committee on atomic casualties set up to study the long-term effects of radiation. The field unit was named the Atomic Bomb Casualty Commission. That survived until 1975 when it was taken over by the Japanese. It was a collaborative effort with the Japanese who were not hostile, openly, to us and cooperated to a degree, but that particular effort was never received very well by the higher echelons of Japanese science. Part of the reason was, I think, inadvisedly, they had first appointed a Director who was a colonel in the army, and obviously the Japanese were not going to feel kind about that.

In any event, Grant Taylor, the man I referred to, I had met in the Army in Atlanta, and he'd been Assistant Dean at Duke and professor of pediatrics. Grant was very public spirited and a wonderful person and he wrote a letter to me and said: "We're now seeing some leukemia in the survivors. There's nobody out here who knows anything about the blood field." He said, "It is your duty, you owe it to humanity to come out here and study these cases." Well, I had four kids ranging in age from about five to fifteen--

[Knock at door. Tape recorder turned off].

Moloney: Grant insisted that I go out there, but I had these four children. They had never been outside Massachusetts except for a year we spent during the war, in Atlanta before I went overseas; never been up in an airplane even. So we were pretty naive. I broached this to my wife. She said, "Where you go, we're going." So off this crowd of Moloneys in 1951 went to Washington and got all our orders. In those days, since Japan was an occupied country, we had to be either on military orders, or on the State Department, so they gave us State Department visas, traveling orders, gave us all kinds of inoculations, injections, and of course we all got sick with them, and off we went to Japan. The way over there was marked by a near disaster which was very exciting but nearly fatal. We left Los Angeles about four o'clock one morning in March, 1952, and we proceeded to go to Honolulu on our way through Midway to Japan on a four-engine Pan American clipper. Now, those planes did not fly at the altitude that jet planes do, and they could just make these hops. It's about 2400 miles to Honolulu. When we got half way over, I looked out one of the windows and I saw one of the propellers wind milling that is, idly flapping around. I thought, well, we had three other motors. But I wasn't very happy, because we'd only come halfway across and we couldn't go back. So I didn't say anything, of course, to my wife. I just went up and got a drink from the bar. There was a bar in this plane: it was a two- deck affair. I went back and sat for awhile, but half an hour later the hostesses came around and said, "We're going to have a drink and "These are Mae West's. Now, you're not going to open them in the cabin. Never do that, but in case of emergency, you have to have these. You should also look up there. There are dinghies up in the ceiling. These are collapsible, inflatable dinghies, and if we need them, we'll bring them out. Then they'll be put out in the water and inflated, and you will then proceed out on the wings and drop into these dinghies." You know, about twenty-five, thirty feet above the ocean with the waves about twenty feet high. That was some prospect. Then we begin to notice that the hatch was open in the back, we were losing altitude, and they started throwing stuff out from the kitchen. Finally, the pilot came on and said, "We're in trouble. We have a problem and he said, "We don't know if we're going to be able to make land or not, so within the next hour, we'll have to make a decision." He said, "We've notified the air/sea rescue, the coast guard, ships in the vicinity and I want you to prepare to ditch. My oldest boy was about twelve or thirteen. He said, "Isn't this exciting, Daddy, but you look awful pale." I was awful pale.

So everybody started making their wills and saying their prayers and one thing or another. The pilot came on the speaker just after that, about fifteen, twenty minutes, and he said, "We think we might be able to make it to an island called Hilo. It's about 300 miles west of Honolulu. So, in we came. No circling, nothing. He came in to this small airport, tried to apparently reverse his engines, and one caught fire. So we landed with this flaming engine and went down over the runway, off into some brush. They swung the plane around. Nobody got hurt, except for minor scrapes and stuff. We flew out of the chutes and ran to get away from the plane, but there was no fuel left. What happened, the Captain told me was that they broke an oil line halfway over and they were nursing three engines, and then one went out, and then another, and he said we had about sixty seconds left when we landed. Well, you know, the kids thought this was a great adventure, but it scared the dickens out of me. We took a small plane to Honolulu, and then we flew right away to Tokyo, and without incident. From Tokyo we went down to Hiroshima by train and we stayed there for the next two years. My two older children didn't tolerate the lack of their companions and they weren't receptive to the Japanese culture at all. It was very strange. At that time, Japan was flat broke. Things were terrible. All around us were the vestiges of the bombing. People were not hostile. They were very decent, but they were extremely poor. The situation we were in, we were in a zone occupied by the Australians. The Korean War was on and it was teeming with troops of the Commonwealth Division, because that part of Japan was occupied by the Australians, and everything you did had to go through the Australians: your driver's license, everything. They policed the area. But there were four contingents there; there were the New Zealanders, the Australians, and the English, or British, "the superior race," as the colonists call them, and the Canadians. Unfortunately, there were some pretty hard people, because Canada apparently took anybody for the Prince's Rat regiment. It was a very unpopular war, and a lot of people were pushed into the service and we had awful problems, not with the Japanese, but with our allies, and no American contingent down there except a company of bakers out on one of the islands. The kids didn't have a proper school, so we sent the 2 older ones home to their grandmother. The other two children and my wife stayed for about eighteen months, but at that point they decided they'd better get home because I was coming back anyway, and they came back to Jamaica plain. We'd rented our house to some people and it was a terrible mess, so my wife spent most of the time getting things cleaned up, straightened out. I stayed on as Director of Research for the two years, and I became very much interested in leukemia occurring in this particular group of people. Not only that, we did a lot of studies on all kinds of things, general health, survival, blood pressure, and we learned a lot about the Japanese health problems. It was compounded by the fact that, as I said, poverty was rampant. These people were still on a rice ration. They were all undernourished. All of them, or at least 60 -70% of them seemed to have worms, because we had a lot of eosinophilia in our blood studies. The studies were set up very well, and we had excellent laboratories and excellent people running them. There were various groups; the genetics group did a tremendous job under Jim [James] Neill and Jack Schull. These people were human geneticists and they were there to study birth defects and genetic defects in irradiated populations. They looked at 86,000 Japanese kids over a period of about five years, and published a monograph which is a classic. Nobody seems to have read it or reads it, but it showed that there were no significant genetic defects in the first generation of children born to mothers and fathers who were irradiated: mothers irradiated, fathers not; fathers irradiated, mothers not and those with no radiation. So they had internal control of all people living in the area. They were able to do a very good job. This did not, of course, obviate the possibility of genetic defects in successive generations, but if you get involved with numbers like that and then extrapolate it out to another generation, you'd be dealing with hundreds of thousands, perhaps millions of people, so it becomes impossible. The study was called off in 1955 and then they went on and published it. That was a very significant contribution, and there were others. There was also a growth and development program in which they wanted to see whether children were retarded by exposure, and indeed some of them were. For instance, mothers who had babies in utero, if they were irradiated in the first trimester, a group of about nineteen children were discovered who had what we call pinheads, small heads, because of the damage to the cranial sutures and to the development of the skull. That was one of the most grotesque and obvious things, but considering the numbers of people involved, there were probably some 300,000 survivors in both cities, the actual numbers of damaged babies was small, pathetic as it was.

Interestingly enough, they found no increases in leukemia in children exposed in utero, in spite of the studies done in England, and subsequently in other places, that said radiation to mothers caused increases in leukemia and malignancies of various types. These people had very carefully measured doses and were carefully followed. The way they followed these children was very interesting and it was not only the scientific expertise, but also the managerial skills these people had. What they did was acquired a cadre of young Japanese doctors and excellent Japanese nurses.

Incidentally, the nursing profession in Japan was used like handmaidens and had no status. They were absolutely subjugated to the medical profession, which could be quite arrogant. When General MacArthur came, among some other great things he did, we got there just before he left --what he did over there, regardless of what people think of him for anything else, was magnificent. He established many precedents, but one of them that affected us was: he raised womanhood to a status never achieved before. Through his influence, eventually they got rid of all the red light districts. You know, there were five of them in Nagasaki and several in Hiroshima. The whole concept of a woman's place changed, and this happened in the nursing profession. They brought over from Duke and from Texas, the University of Texas at Houston, some outstanding nurses. These were unsung heroines, and they created a whole new concept in nursing, I think, in that area. The genetic people would go out to visit each newborn child, and this is why I speak of managerial skills. They were pragmatic about this, and I wish we had been more so. About ninety percent of the babies were delivered by midwives and they had a union, a midwives union. Women would get a little more rice and other perks so that they would join the program and agree to have these studies done. There were telephones scattered around through the city-

[Telephone interruption.]

Moloney: They went to the midwives and they said, "We'll give you 100 yen." The yen then was worth about a 360th of a dollar, believe it or not, and for that sum, which was maybe thirty-five cents, the midwives would call up when a baby was born, in the middle of the night or any time. A jeep would be dispatched from our good motor pool with a young Japanese doctor and a nurse and they would go down into these homes and they would weigh the baby, they would measure it, and look for any classical defects, like polydactylism or too many fingers, or imperforate anus, or cleft palate, or any of those gross abnormalities you can see. They would take other information from the mother. Now if the baby died or was born dead, they put the fetus in a little shoe box and brought it up to the Commission's laboratories, and did an autopsy. So they had a very complete follow-up to these infants. When they were nine months old, they all came back to the clinic. We had a very good pediatric group out there. Those children were then given many studies, all kinds of measurements, muscular development, all kinds of things, head measurements, under the auspices of a person who was interested in growth and development. The pediatric group carried this out. Between the genetics and the growth and development program, they did some very good studies out there. I was in charge of the adult medical program, and specifically the hematology. We had excellent facilities and complete blood studies were carried out. These studies were carried out on a twenty percent proportion of all the survivors, which I guess was considered to be statistically significant. These people would come in and go through a complete physical which I supervised, and I had a number of younger physicians with me, and then all these blood studies were done including all the chemistries and complete blood, x-rays of the chest, and a very complete follow-up. Unfortunately, at that time, the doses of radiation were still up in the air, and to some extent they still are. At that time they hadn't finished what they call a "shielding study.'' In other words, if you were out in the open and were given a dose of radiation, it's one thing. If you were in a house, a Japanese house which is very flimsy, or in a bank or a concrete building, then you can't say that everyone got a uniform dose. So they went around and carefully evaluated shielding as well as they could and tried to come up with a dose related to where the person was at the time and whether he was out in the open or shielded. Those doses have been a matter of great controversy ever since. Part of it was due to the fact that they didn't recognize very early on the differences between Hiroshima and Nagasaki. The Hiroshima bomb was uranium and was detonated at about 1200 feet over the city, and incidentally, directed at a military establishment within the city. There was a military objective there, and I've seen pictures, and everybody else has, of soldiers who were badly burned. In any event, the point of all this was until several years after I first got there, they had not included the fact that with uranium there's a neutron flux as well as gamma radiation, and the neutrons induce radioactivity when they hit any kind of a substance and produce a heavy dose of radiation. So they had to adjust the dose to a neutron flux.

Now, in Nagasaki, where they were running comparative studies in the two cities, it was a plutonium bomb, and plutonium does not have much of a neutron flux, therefore the dose is somewhat different. The way this was found was very interesting. It wasn't found by the physicists, who apparently didn't recognize this neutron flux; at least, they never told us about it. But in the course of studying patients, it was found that children and young adults were developing cataracts. Now, this was not a major health problem in the sense that there were great numbers of them, or that all the cataracts were severe, but you don't expect cataracts in a twelve-year-old or fifteen-year-old child. They sent an ophthalmologist group; one of the leading ones was a Doctor David Cogan from the Eye and Ear Infirmary in Boston. He went out there and they identified these cataracts, and then made a very extensive study of them. The point is this: the lens is very sensitive to radiation, and especially sensitive to the neutron effect. It acts as a memory of injury. So people said, "Well, why do these people have radiation damage to the lens, and yet they only got twenty-five rads?" You're supposed to get a hundred, hundred-and-fifty, two or three hundred rads before cataracts develop, and these people got nothing like that dose. The neutrons are cataractogenic; much more so than ordinary x rays or gamma rays. So we said to the physicists, [William Lawrence was one of them who came out there, ''Why is this?" They went back to their laboratories and they took another small uranium bomb out in the desert and detonated it and found out that there was a neutron flux and they measured it. That was a curious and ironic sort of finding, whereas people like ourselves, who were not knowledgeable at all in nuclear physics, at least to any extent helped them identify one of the physical properties of the bomb. They never, of course, detonated another uranium bomb.

In any event, those are some of the things we did. I was especially interested in leukemias, anemias and related disorders, e.g. and hematologic malignancies, of which we didn't see very many other than leukemia. A young man was working named Robert Lange who had come from Carl Moore's group in St. Louis at the Barnes Hospital at Washington University, a very intelligent young fellow. He was down in Nagasaki and I got Dr. Taylor, the Medical Director, to bring him up to Hiroshima. We set up a central laboratory there and went over the bone marrows of all the patients up to that time, and we published, I think, the second article on radiation induced leukemia in the survivors. There was one published before I got out there, on leukemia among atomic bomb survivors; we then proceeded to study these people and I published six or seven articles, by the time I left Japan, or shortly thereafter coming from Japan, So I made a special effort in that area, I might point out, there's been a tremendous amount of talk about radiation causing leukemia. It's not a very good leukemogen. The incidence of leukemia in this country --probably less than two or three percent of all the people who get leukemia have any appreciable radiation. Whether they got it from radiation you don't know because radiation leukemia is very similar to the de novo variety. In any event, the numbers, even in a big event like that, are rather small. In the entire period of time since 1945, which is now some forty-four years, there have been maybe seven hundred leukemias in both cities among 300,000 survivors. Now many of those were people who got so low a radiation dose that they really didn't get the leukemia from exposure. And indeed, if you took 100,000 people a year in Japan, there'd be, maybe five or six or seven per 100,000. If you multiply that by the forty-four years, then you're up in the millions of years at risk, so there'd be, probably, two- or three-hundred leukemias appearing spontaneously. You subtract that from the total number and there may be 350 leukemias, in my opinion, in both cities in forty-five years caused by radiation. Now, I'm not trying to minimize and this was a horrible, terrible disaster, about which, most people would agree. Not that it shouldn't have happened, because we don't know what the casualties would have been if we had to drive the Japanese from their homeland. In any event, it would have been nice if it could have been prevented. When you examine those people, as I did, physically, and saw some of the scars; blast and heat killed about eighty percent of the people there, not radiation. If you're in close, you get a lot of radiation, but you'd be dead. If you use an H-bomb, that's quite a different problem, because it represents a million or more tons of dynamite. It would cause enormous destruction, but in addition, would cause a tremendous problem with fallout. So, if you detonated a bomb over Boston, and the wind was blowing southeast down along the coast, we'd be almost down to Hartford, and getting very high doses of radiation from the pulverization of the buildings and everything else, causing the fallout. Not to say what would happen destructively in the radius of the actual detonation.

So, I think that clearly there were lessons we learned from this event. The ABCC [Atomic Bomb Casualty Commission] went on until 1975. As the Japanese economy picked up, they assumed much more financial obligation for it, and then they took it over, but they have Americans out there as co-directors. It is now called the Radiation Effects Research Foundation (RERF). It's headquarters are in Hiroshima, and they study the Hiroshima and Nagasaki people. Dr. Schull [W.J. Schull, PhD], who is the Professor of Human Genetics at Houston, the University of Texas, goes out there part of the year and the rest of the year, he's down in Texas as Chairman of the Department of Human Genetics. He's played a very important role over the years with government agencies and in advising the government on radiation casualties, especially on the fetus and all these problems of dose and exposure.

I think that the experience, as far as I am concerned, has turned my life around, because there weren't many people who'd had this experience and I became an immediate expert, willy nilly. When I got back, I was put on committees, and all kinds of groups asked me to participate in various studies which I've done over the last thirty-five years.

Moloney: No, the Japanese had practically no radiation therapy. Japanese people at the time had practically nothing. There wasn't a pathologist practicing in Hiroshima, or very few, and few facilities were left after the bombing. So in that city we saw very little pathology until the laboratory set up by the ABCC brought pathologists from different university medical schools there and they set up their pathology groups, but they could only handle a small proportion. Medicine in Japan, at that point, was at a very low ebb. Hiroshima was considered to be in the boondocks. People from Tokyo thought they were country people, and they had a very strict sort of social consciousness. Imperial universities like Kyushu, Kyoto, Tokyo of course, and others were upper crust. In many of these provinces like Hiroshima, the medical schools only started during the war and they had a two year medical course where they put these people out in the service to take care of wounded. But now, the Hiroshima medical school is evolving into a much more reputable school. I gave some lectures at the Hiroshima medical school in an old, unused site in a hangar-like building where we didn't have any heating. They had barrels and were burning wood in them and we were standing around freezing to death. It got quite cold down there; it was something like the climate of North Carolina, but in the winter it gets pretty cold. They had no facilities at all, practically. But today, of course, they've gone rapidly ahead.

Moloney: When I was out there a rather revolutionary thing happened in Boston. I was offered a job in Houston with the M.D. Anderson [hospital], and I went down there, and actually gave a talk on one of the subjects I was especially interested, the early phases of chronic myelogenous leukemia. Also I spent three months at the Oak Ridge Institute of Nuclear Studies because I wanted to learn more about the use of isotopes. At the time, there was a new attitude at the BCH and a new superintendent, Dr. John Conlin, who was a very fine person. I'd known him as an intern at St. Elizabeth's Hospital when I was in Boston. He and other people approached me and asked if I'd come back to BCH. I was on a leave of absence from Tufts and from the Tufts' Medical Services, and they wanted me to come back and set up the blood bank again and an isotope lab for the Tufts' medical school, and establish the hematology lab on a better basis. They also paid me a magnificent salary of $15,000 a year full time to run all the laboratories. At the same time, I had the privilege of seeing patients. Jane Desforges, while I was away, took over the Tufts Hematology Division, and, together, we built up the lab. We had a very large grant from the government, some four or five hundred thousand dollars, and rebuilt an old building. It dates back to 1862; actually, Florence Nightingale visited that building once. It's the old FHbG Building: a very antiquated building with ceilings about twenty-five feet high. But they went in and renovated the whole place, and through these grants we got, we built the hematology lab on the first floor, a respiratory group on the top floor, and on the middle floor, the cardiology group. So Tufts at last had some decent facilities. It was the first hematology lab Tufts ever had there. In July, '54, I went there; I left in '67. Fortuitously, during that period we developed a very active referral group because I was still running around seeing patients. Now I had to admit patients mainly to the Faulkner or places like St. E's or the Carney; but mainly the Faulkner because the BCH, in those days, was pretty decrepit. There were no accommodations for private patients at all, which was a big mistake in a sense because, if you were on the staff there, all you got was a parking space and lunch, and you'd make rounds four or five days a week, and there were no third-party payments in those days, as you know. Over that period, from '54 up until about '60, we built up a very active group and got our first fellowship grants. After that, we really started to get some of the long-term five year fellowship grants from the NIH and other groups like the American Cancer Society and Leukemia Society of America, so we were off and running.

Fortunately, and very strangely, there happened in 1949 and -50 a curious historical fact. Jane was outstanding and did a lot of good work on red cells, and I was interested in leukemia, but there wasn't much that you could offer leukemia patients in those days; we didn't have any of the drugs we have now. Up until 1946 or -47 when Methotrexate came in, outside of nitrogen mustard, which was found during the war to be effective against Hodgkin's disease, lymphosarcoma and some tumors, we had nothing. Then in that period, all these new drugs started to appear in the late fifties and early sixties, but they were still relatively new. We got in on the ground floor, and we started to collaborate with people in the Jimmy Fund (now the Dana Farber Cancer Foundation); for instance, with new drugs and new programs, and that really helped because we got support for this. Jane got support because she was doing some excellent work with red cells, and at that point, the NIH was giving grants and encouraging research people, so the quality of our fellows improved. But the thing that was really kind of spectacular was we had outstanding interns as residents --Jane was Chief Resident. She'd been trained with Bill Castle who was chief of the Thorndike, so she was outstanding. Then we had a young man named ill Harrington, William Harrington. He went with Carl Moore and later became professor and chief of medicine at University of Miami Medical School and is one of the world's outstanding hematologists. At the same time, a young fellow from Georgetown Medical School named Fred Stohlman came and was physically and mentally a giant. He left BCH in 1950 and went up to George Brecher at the National Institutes of Health and became one of the best cell biologists in the world. As you know, he was unfortunately killed by a terrorist in 1975. He and his wife were in a plane in 1975 coming from Israel. Fred did a tremendous job at the NIH, and then he came back to Boston, on my recommendation incidentally, to St. E's, at least partly through that, and then he came and became the chief of hematology there, and continued his outstanding work in the development of many fine investigators. But the presence of these young people and our hard work with everybody collaborating got our first papers published.

I stayed at the BCH until 1967 when I came over to the Peter Bent Brigham Hospital, but those were very productive years, and it was unfortunate that cracks began to appear in the structure and you could see what was coming for the BCH. When I was offered the job here in 1966, I was glad to take it because I knew the future at the BCH was very limited. And it was, because in 1975, Tufts and Harvard pulled out of there, and under rather disagreeable circumstances, and they left B.U. to run it. It's been besieged by all kinds of political, economic, and social problems ever since, and it wasn't a happy environment anymore. So I was frankly glad to leave, though I love the BCH --I think anybody who went through the BCH got an inestimable sense of values from taking care of patients, whether it was giving someone a bedpan or wheeling them down the aisle, but everybody pitched in. You worked under some terrible conditions. But it separated the chaff from the wheat, and if you could stand up to that kind of environment and the difficulty therein, I think that may have made a man of you, or a woman, and I think better physicians.

Moloney: I think the kindest phrase is to say it was adversarial, however, that changed, and it changed because, as you gained respect from the Harvard people, they then collaborated with you. I was warned not to go there, that they would wipe me out; that I'd never have any chance to do anything. Bill Castle was there, also Hale Ham, a lot of the other outstanding people; F.H.L. Taylor, Lasky Taylor, was one of the outstanding physical chemists on the staff of the Thorndike and a good friend of mine, as were many others. We became very good friends, and especially James Jandl I knew as a resident and a fellow, and we developed very good relationships. In fact, towards the end of my career there, I used to see many cases of malignancy like lymphomas, myelomas, Hodgkin's disease, because they had nobody very much interested in them; they were more interested in red cells. Bill Castle couldn't have been nicer.

The first time I went there, you couldn't use B-12 unless you got permission from the Thorndike. But they had certain deficiencies: they had very few coagulation, clotting people to do the actual work. Taylor was a physical chemist and knew all about fractionation, but they had no one to do the nitty-gritty, to go out and decipher what kind of a problem it was. So we'd get into those areas, in the blood bank, in the Rh problems, and Jane did a lot of work in enzymology that they wouldn't do. B.U. was one of the poorer groups, we sort of got together and we did the hematology. In each medical school we duplicated some areas, like cardiology, but in other areas, for instance, we did not have an infectious disease group, so Max Finland's group did it. Then there were certain areas that we had that they didn't have and we sort of grew together, I think, especially towards the end. I remember going down in the elevator about a year before I left and just when I was deciding to go. I was in the same elevator as the famous Franz Ingelfinger who had just left, and he looked at me in the elevator and he said, Bill, I hear you're leaving." I said, "Yes." He said, "The rats are deserting the ship.'' I felt guilty in a sense, but in the long run it was better.

I think that's a good point to stop because, you know, what happened after that is present history in a sense. It's twenty- two years this month since I came here.

[END OF SESSION]

September 28, 1989

Moloney: Well, in 1967 I came to Brigham on the first of July, officially. I had been coming the year before that as a consultant and looking over the place, and I must say, I was terribly unimpressed with the facilities, and the laboratories were really in dreadful shape. I was surprised because of the obvious reputation that Brigham has as a medical institution, but the routine laboratories for hematology were a disgrace. I told Dr. George Thorn at the time that I wouldn't come unless they did something about cleaning them up and putting some decent people in there. We had to get rid of the whole lot--practically all but two people, and bring in some excellent technicians who revolutionized it was interesting that at the time this big explosion about computerized hematology came in. Everybody got right in on that. It revolutionized the whole practice of laboratory medicine. Now everything is mechanical, and we've lost a lot of what I think is the hands-on, technical things; of looking at things ourselves. They're all machine processed. Everything. And I still have to insist that we have to go back and look at slides ourselves at times. But obviously when you're handling the volume of work that's necessitated by the social revolution of having people get medical care at the level we're giving it then you have to come up with some way of handling a great many tests that really are often not relevant in the sense that they don't tell us anything except that they're normal. So, you do an SMA and you get 20 or 30 biochemical tests and maybe you only want one, but it's less expensive to send it right through and get the whole group. And this is the trap that we're in, really. The same with hematology. We have to get blood counts on people that come in here, but if you stop and think of it, if they come in on the "orthopedic" service or other services where they probably won't have any hematologic disorders, they still go through the whole routine of getting complete bloods and everything else. But it goes through a mechanical process which separates the abnormal from the normal at least, and then you can concentrate on that.

I have no quarrel with that, except some people think people like me are enlists because we insist on a certain quality to our work. The only thing that differentiates us from any other group is our expertise and what you can apply as a way of judgment and knowledge to something. Like bone marrow, this is my special interest now.

In any event, we got the laboratories squared away and we started to build up a different kind of hematology group. George Minot, who was the first hematologist here, and he discovered the liver therapy for pernicious anemia, for which he received the Nobel Prize. He went to the Thorndike in about 1925 or '26 and was then the very eminent chief there and built up a tremendous group, with Castle and all the others. Clem [Clement] Finch became the hematologist here, I think, in the '40s and '50s. Then Frank Gardner came and I am the successor to Frank Gardner. Gardner left in '66, and I came in '67, but that year I came as a consultant. I had an entirely different philosophy than Dr. Gardner did, and his group. They dealt mostly with private patients. The house cases they saw, of course, but they didn't utilize private patients. At the BCH everybody shared care of the patients, no matter who he or she was practically. Of course we had certain VIPs or people like clergy or physicians that we'd handle privately. But in general, if a patient wanted to see me, one of the fellows would see him with me. I only had one fellow, David Rosenthal, at the time, who came over from the BCH with me. He'd been an intern and a resident, and then took a first-year residency and a fellowship and then came with me in '67. Unfortunately, after a year he had to go into the service, but fortunately, for me, Art [Arthur T.] Skarin was available, and Arthur stayed for two years. David came back and Arthur went over to the Dana-Farber Center where he's been since, and he's an outstanding oncologist. One of the best, and a very good physician.

Moloney: Mary [Mike] Smart brought in several fine girls. She was tremendous. She was only about 27-28 years old, but she was a martinet but a good one. She was fair but tough, and she got very good people, which is the key to the whole thing. The house staff prior to this wouldn't trust anything and I don't blame them.

So, then, after Mike, we got a girl who was for years with me at the BCH, Lila Fleigelman. She came in, and really did a wonderful job in further establishing the level of competence we had in the technical end of the lab. When she left we then had a succession of people, but then they took the laboratory out of our control, really, and it's now a hospital laboratory which is run by a director who's come in, who is a Ph.D./M.D. type, and the whole thing is we don't have anything to do with it except for special hematology. Fortunately, we've maintained that. They bring up the bone marrow slides and I look at them, and I can ask them to do special stains and histochemistry and things like that, which again is the one thing we can add to the expertise we have.

We've also done something here which is not unique but I think it's really special because we had a very close association with the pathology group. This is unique because at the BCH, where Frank B. Mallory was so famous, you'd never think of going up to the path people and discussing something or sitting down and looking at slides with them. They would never look at a smear, in the sections they didn't think that we, you know, should look at. And we were always terrified of people like Theodore Parker, and we'd never think of going to him. Kenneth Mallory was much more approachable, but he wasn't interested in hemopathology, and there weren't many people involved at the time. Stanley Robbins was very good, he wrote that big textbook on pathology. But again, he wasn't interested in hemopathology, so that we never had that association. But when we came here, and when Ramsey Cotrain became chief of pathology here, he had a young woman named Gerry Pincus, who's still here--Geraldine Pincus--and she's outstanding. She's developed a whole cadre of young hemopathology fellows and residents who have been just great, and each year we've had a new one. You always say, "Well, he can't be as good as that one," but we've had a whole series of them. We meet every Wednesday afternoon. I meet the pathologist at 1:00. We go over the slides and the sections together. Then from 1:30-2:30 we present, by projecting slides on a new television- like apparatus, and show the slides of the smears and the fixed sections. Then the fellows or the residents present the case very briefly and we discuss not only hematology, but a lot of other things surrounding it. It's been a very active and a very successful conference and it makes me feel that I'm useful--I'm getting ahead of my story a little. What happened over the years- -We built up this practice around the fellows, residents, and students that wanted to look at slides. That was not done before then, because it was run more or less as a private practice. This is how we did it at the BCH, and actually how people like Carl Moore did it out in St. Louis and other people around the country. We found that that was the best approach, and we maintained that ever since. Some things that happened, we gradually got more grant support and we got very fine applicants coming from Harvard. That was one great advantage. We really got some outstanding people. Not that we didn't have good ones at the Tufts lab at the BCH. We did, but never the numbers of the Ph.D./M.D. types that we got here. I had meanwhile become Professor of Medicine and I was chief of the Division of Hematology. At that point in 1975, I had to leave the faculty as I turned 66, but Dr. Braunwald told me, "You've got to stay on. You'll be emeritus, so what's the difference." And Frank [H. Franklin] Bunn took over as Director of the Hematology Division. Now, Frank Bunn had been with Castle and Jandl at the Thorndike, and we were just delighted when he came to the Brigham. I had known Dr. Bunn for a number of years before that at the BCH. He's one of the most famous people in the field of molecular biology as far as hemoglobin goes. He's written a couple of books on hemoglobin with Bernie Forget. But he turned out to be an exceptionally good clinician. When he was at the horned dike, he did mostly laboratory work and he didn't see many patients, and he saw very few white cell problems. But when he came here (he was very humble about it), he came and said, "I want to learn something. This formidable person coming to me! But he revolutionized the group, because he was a scientist. He immediately built up the research lab, developed people who were outstanding, and he's done that over the last 15 years or so, and he's really been the chief proponent of the scientific approach here. He's gotten now into cell culture and molecular biology. He took a year off and went to the NIH, where he learned all the techniques of cell culture and using DNA probes. He's doing some very exciting work in that field. For years he just worked with "hemoglobinopathies," sickle cell and the Mediterranean anemias and other hemoglobin problems, but now he's heavily involved with basic investigation into cell proliferation, which I think is going to be the eventual answer to problems such as leukemia.

Well, Frank then gave up the job as director in 1982, and Bob Handin took it over. Bob was our intern in 1967, and then resident and senior resident. He then went over for two years with Dr. Robert Valarie at the old Chelsea Naval Hospital and did a lot of work on platelets. We were desperately looking for someone to do coagulation work. Most people in medicine, like surgeons, are not interested in whether you're anemic or if you're leukemic, but they're darn well interested if you bleed. And we needed people here because we were having a lot of problems with renal transplant patients. They were having all kinds of problems in controlling the platelets and water hemorrhage. So, when Bob came along and signified that he would be willing to undertake the job, he went ahead and developed an excellent, outstanding group of people in the coagulation field.

I used to do a lot of coagulation work years ago, as long as all you had to have was some test tubes and a water bath, but now this field has become one of molecular biology. They clone cells that produce different coagulation factors and the whole thing has become very complicated. Bob has done a very good job in this field, and he is a very outstanding administrator. He's tough and at times tends to be, I think, a little high handed about things, but he really has turned this division around financially, Frank and I were not very good administrators. I think I ran the division in the red and I'm sure Frank did. But Bob came in with a two-fisted approach and he's really straightened that part of the Hematology Division out. Frank Bunn has built up a tremendous research group, and he's facing the same problems everybody does with space, with competition, I hope they realize how valuable he is to us, because his group is doing the best work of all of us.

In 1982 I stopped my research, which was mainly on rats, and closed the lab up, and then I tried to find a role for myself, because at that time I stopped seeing patients at Dr. [Eugene] Braunwald's request, which was all right with me--

Moloney: '82. And then over the past seven years I've been assigned the role of reviewing all the bone marrow specimens for the Hematology Division. I looked at 560 last year, for instance. The fellows come in the morning, and we sit at this two-headed microscope. They present the case to me and we go over the specimen and discuss not only the diagnosis, but other aspects of the problem. On Wednesdays, we get together with the pathologist and review the marrow sections and look at the smear. Slides of these specimens are projected for the group of students, house staff, fellows, and senior staff. This Heme/Pathology conference has been well attended and is a very successful exercise.

Moloney: Yes. And it is one of the things I've done in my life which represents a fairly important contribution. Some years ago I became interested in histo-chemistry, which is a method of applying stains which distinguish different enzymes in the cell. There had been only a few successful methods; one was alkaline phosphatase, which goes back to the 1940s. I got involved with that very early on because it turns out that in patients with chronic myelogenous leukemia (CML), the white cells don't have any alkaline phosphatase. I got interested in that aspect of it, and then I tried to branch out into other enzymes such as enzymes called esterases. A physician named Gomori (he's Hungarian, I think, originally) described an esterase in which only white cells of the granulocyte variety would stain positively. Monocytes, lymphocytes, and erythrocytes would not. It turned out that this stain was also very active in leukemic myeloid cells. Gomori investigated all the tissues in the body and found that mature and immature myelocytes in the bone marrow took up this stain. I seized on this--this was in the late '50s, early '60s--and I called him up in Chicago and I said, "Dr. Gomori, I have a young pre-medical student here for the summer who's an outstanding student, and we want to synthesize the substrate for this esterase reaction and try this method on all kinds of diseases and in other species. How do you make it?'' He was very off-hand. He said, "Well, you put in a pinch of this, and a pinch of that," and I had to laugh on the phone, it was so funny. It sounded like he was baking a cake. So I told this to the young man whose name was Kenneth MacPherson. He was a pre-medical student at Boston College in his senior year and a summa cum laude graduate. He spent the summer with one of the faculty at BC and synthesized this substrate. Lila Fleigelman was our chief technician, and Lila and Kenneth and myself published a paper in the Journal of Histochemistrv in 1960, and this was the first paper in the hematological literature about the use of this stain. It depends on the fact that the substrate, if it's substituted by one chlororadical will only stain the myelocyte cells. If there is no chlororadical, it is positive in monocytes. I had some very nice photo-micrographs and I paid $300 to have them published in the Journal of Histochemistry. However, it was buried in that kind of obscure literature, so we never got very much credit for this discovery. Very shortly thereafter a German investigator took it over, and it's usually attributed to him. In any event, you have to look back and say to yourself, "Well,did you do anything worthwhile in your life?" and I think I did in that case. Then we looked at cells from a variety of species. We looked at rats and mice and rabbits and we did all kinds of interesting things. I got very involved in the field, but I got in over my head. It turned out that to work with the esterases, you had to know something about lipid chemistry and all the rest, and you run into that sort of problem. I didn't have anybody to work with me. His boy went back to medical school and graduated summa cum laude from Tufts Medical School. Then of all things, he was in a naval program, and they put him in the submarine service. This is a very sad story. He was in the Navy, and he came to see me one November day and said he was going to get out the following spring. I had arranged with Gene [Eugene] Cronkite before he got out of the Navy to take him into the Naval radio-biological lab, and he was going to be one of their prize people. We had lunch at the Athens Olympia on a Friday afternoon. On Saturday I got a call from a Navy investigative team and was told that Kenneth was found dead in bed. Now, he was on a nuclear sub, and they immediately instituted an investigation. I suspect he may have committed suicide, but they never revealed anything about it. He came from Revere, he had a widowed mother, and it was a very pathetic story. This fellow was absolutely brilliant. I had never seen any evidence of depression in him, but it became just a closed chapter. Nothing else was ever said about it. The investigators never came to visit me, they only called me up.

A few years ago, I was very uncertain as to what my role would be here. I now come up from Chatham two days a week. My wife isn't very well and I don't spend much time away. I come up on Wednesday morning, I stay all day, and then the following day go back as early as I can; I try to get my work done here. In the meantime, if I don't, I bring it down to the Cape, where I have a microscope. What has really occupied a lot of my time and effort has been the consulting work for the National Cancer Institute, and I've done a lot of work for them over the past 25 years. I have been involved with studies in three large series of women who have been radiated, and I've become very much interested in radiation effects on the hematopoietic system. The first study was on cervical cancer in which 180,000 women were studied beginning in the mid-I60s, and I've been the Hematology consultant on this program ever since. The Committee used to meet once a year at first in Geneva and later in Lyon. The study finished in 1986, and it was found that there was an increase in leukemia, which is minimal. The relative risk was about 1.8 or at most two. In other words, if you expected seven cases per hundred thousand; you got 14. Well, 14 per hundred thousand isn't exactly an epidemic, and we were astonished, because these women got a lot of radiation. They got up to 1,500 rads to the bone marrow on the average, and by all standards, there should have been hundreds of leukemia cases. The reason this did not occur was probably that large dose radiation killed the marrow cells. That is the one observation that came out of this study, i,e., that large doses of X-rays probably aren't as leukemogenic as lower doses. Subsequently, it was decided to look at some other groups of irradiated patients.

This second study was carried out on women with cancer of the body of the uterus who also received radiation therapy. However, the doses to the marrow are lower than those given to cervical cancer patients. Also, uterine cancer patients receive either X-ray to the pelvic region or intra-uterine radium. Cervical cancer patients were treated with both radium and X-ray. This study is now being completed, and I believe it is an excellent one. John Boice is the chief of the Radiation Epidemiology Branch, NCI and has conducted a number of these studies, including the cervical cancer study. Rochelle Curtis has been the Project Director for Dr. Boice and has done an outstanding job. There were 9 sites involved: two in Europe, one in Canada, and 6 in the USA. Excellent records here obtained on the radiation doses; also good information was available on the hematological and pathological aspects of the leukemias. To date, 215 cases have been accepted, of which 151 were irradiated and 54 were not. Unlike many other studies, actual controls were employed; for each case of leukemia, three women with uterine cancer who were irradiated, but did not develop leukemia, were selected. In other studies, the incidences of leukemia in irradiated women were compared to reported incidences of leukemia in women of the same age group. Unfortunately, this practice is open to serious error, and this was avoided in the uterine cancer study. Analysis of the data which have been gathered is now on- going. It should also be mentioned that the clinical, hematological, and pathology data was much more abundant and accurate than in previous studies. The chief reason for this was the fact that these cases occurred within one to ten years from the start of the study. In recent years, marked advances have occurred in the fields of hematology and hemopathology. Much better specimens were available for me to review, especially bone marrow aspirates, and new histochemical and immunological techniques were available for more accurate diagnoses.

The third study with the Epidemiological Branch of NCI is, as far as I am concerned, rather controversial. About five years ago, I was at a conference in Washington, and one of the epidemiology group, Ruth Kleinerman, came to me and asked me to act as hematology consultant on a study of women irradiated for benign gynecological disorders (BGD), e.g., fibroids, endometriosis, etc. In those days, from 1935 to 1964, these patients were treated with intra-uterine radium and, in some cases, X-ray therapy to the pelvic region. The doses employed were much smaller than those used for treating cervical or uterine cancer. This seemed to be an opportunity to study the effects of relatively low doses of radiation. This was important since in 1969 Joseph Wagoner had studied a group of women with BGD treated with radium or X-ray. Wagoner claimed that there was a significantly higher risk of developing leukemia following doses of 40 to 126 rads (RR = 3.2) compared to higher doses, e.g. 100 to 300 rads (RR = 1.3) and 300 to 1500 rads (RR = 1.1). He attributed this effect to cell killing at higher doses. Ruth Kleinerman told me that they wished to reevaluate Wagoner's studies and add additional cases. However, there were only 21 cases of leukemia in the Wagoner study and no details were provided in his paper on the types of leukemia. Since chronic lymphatic leukemia is not considered to be radiation induced, I decided to investigate, as far as possible, the actual clinical and hematological information on these cases. I found that Wagoner had included cases of CLL, as well as several cases of leukemia not clearly classified (e.g., "chronic leukemia lymphatic leukemia"). At this point, I wrote to Ruth expressing my misgivings over these findings and stated that I would act as consultant, but insisted that every effort had to be made to establish a correct diagnosis. She, of course, agreed to this condition, and collection of cases from New York to Connecticut was undertaken. Also, all the material on like cases reported by Wagoner was reviewed. Since the patients were treated from 1925 to 1964, chiefly prior to 1950, collection of clinical and pathological data was difficult. Moreover, changes in classification and nomenclature of the leukemias during the past thirty years complicated the problem. As a result, many cases had to be accepted on death certificate diagnoses only; no slides of bone marrow aspirates, biopsy material, or autopsies were available for my review. To further complicate matters, a young PhD candidate at Harvard School of Public Health undertook to do an independent study based on Wagoner's cases plus additional cases from Massachusetts and Rhode Island. Peter Inskip wrote his PhD thesis on these findings and then submitted a manuscript (which has since been accepted for publication) presenting his views on the subject. Inskip included in his analysis all the CLL cases and several cases which I had discarded. My reaction to this was to request that my name be omitted from the list of authors of this paper. Meanwhile, Ruth Kleinerman has gone ahead and incorporated cases from Rosewell Park in New York. The latter furnished some of the best documented cases for the study. At present, an analysis is being carried out on all the cases. I have reviewed 63 cases; 14 CML, 24 acute leukemias, and 24 CLL. It will be of interest to note if the cases I indicated were not eligible and the CLL cases are included in the analysis. The conclusion that smaller doses of radiation are more leukemogenic than larger ones has, of course, important practical implications. The number of leukemia cases in this study is small, some cases are not well documented and certainly CLL cases should not be included. If these cases are excluded, the relative risk (RR) will be probably lack statistical significance. But, I don't know, after this, what my next step will be to tell you the truth. I'm going to stay here, because Dr. Braunwald and Bob Handin want me to, and the fellows and people here feel I'm making a useful contribution. I'm sure something else is going to come along in the way of work, in the field of radiation epidemiology, and I've got several other things I'm doing. Hopefully, 1'11 be able to continue at this level and enjoy five days on the Cape and two days up here.

Moloney: I'm going to be kind of optimistic about this. I think before the next ten years (We're always saying, "Well, it's the breakthrough"), we are really on the verge of some really important developments. I've been rewriting a chapter in a book on the history of chronic myelogenous and chronic lymphatic leukemia, and I've had to revise this chapter rather extensively because it was originally published 10 years ago, and so many things happened that I had to completely rewrite the chapter. I could not just patch it, because of the important things that have happened, and there isn't any room in this chapter unless I drastically revise it. So I've cut down some of the ancient history and included several things; Interferon, which I'm very impressed with now, and I never was before. Also the molecular biology associated with the gene rearrangements in chronic myelogenous leukemia. Now, you may think that this is far fetched, but the basic fact is that this could be a prototype for all malignancies. First of all, in 1960, Norwell and Hungerford discovered the Ph chromosome, which turned out to be a small 22. Janet Rowley, about 10 years later or so, when chromosome banding came in, found the reason this chromosome was small was due to a translocation from 22 to 9, and when that translocation occurred, there was an oncogene, a protooncogene (which means a potential oncogene) was activated, and thus released a gene product which seemed to have a tyrosinase associated with it. This turns out to be a factor which promotes cell growth, and which may not be the cause of leukemia, but certainly is involved with the leukemogenic process. This oncogene is made up of genetic material originally from the abelson mouse leukemia virus which became a human genome and was incorporated with it. It is turning out to be a very exciting factor in the control of hemopoiesis. It probably controls normal cells as well, but at least in this situation it's found in chronic myelogenous leukemia. This is one of the things that will lead to a very much more physiological method of management, because it brings you back to the Interferon problem. For years, Interferon has been around and it's not been very effective therapeutically. We didn't have much of it, it had all kinds of complications because of impurities and there were dreadful problems with it. But now they've cloned the cells that produced it and are getting a lot of Interferon. It's still fairly expensive and rare, but there's enough so people can use it, and some very dramatic things are happening. Hairy cell leukemia--I've seen marrows filled with hairy cells, and after the people were on Interferon, it completely cleaned the marrow out. Now, not all cases of hairy cell leukemia go into remission, and they don't stay in remission, but this shows it can be done. It's changing the whole field.

Now, Interferon is a negative regulator, apparently. At least, this is the theory. In other words, it is suppressing, possibly, a clone, and causing normal clones to get back their ascendancy. This has also been true in chronic myelogenous leukemia. In chronic myelogenous leukemia, the success has only been minimal. But there have been enough cases (over 200 or more now) treated, and many of them go at least into a partial remission, but, which is much more important, if you look at the bone marrows, which contain about 100% Ph positive cells, the Ph cells decrease to 20 to 50% and, in some cases, completely disappeared It is quite possible that other interferons may be developed and more specific regulating factors may emerge able to regulate the cell rather than to bill it. I've always felt that while radiation has saved many lives, especially in Hodgkin's and in patients with cervical cancer, and it's very useful and important, but it's like surgery. It doesn't get at the cause or correct the basic, fundamental defect. Chemotherapy has the same objections. You know what happens to people who go through a bone-marrow transplants? Well, you have to first ablate the leukemia, and it's terribly difficult for the patient. It wipes out the marrow; they can go through all kinds of problems. There's a 30% fatality rate in allogeneic bone marrow transplants from the procedure itself. Then you have graft vs. host reactions and all kinds of other problems that come up. It's the best way to go, probably, for chronic myelogenous leukemia in a patient that has a good match, and for patients certainly who are twins, in chronic myelogenous leukemia, also for acute myelogenous leukemia in young adults after the first remission, it is probably a better way to go than anything else, although we're not clear yet whether very aggressive chemotherapy would be equivalent as far as long-term survival. But marrow transplantation is still confined to people under 45 and to people who have a good match, which makes it very difficult. So, that, basically, is not going to be the answer. The answer is going to be to employ these regulatory factors and come back to that principle of regulating a cell on a biologic level. You know; for years, I've looked at patients with pernicious anemia or folic acid deficiency, and the marrow in those patients is wild. There are more mitoses, there is more dysplasia, there is more abnormality going on. But those patients never develop malignancy. The cells are proliferating, they're ineffective, and they have all kinds of growth problems and maturation problems. You give them a little vitamin B12 and folic acid and the whole thing turns around in six hours. To me, that would be ideal if you could come up with something like that. People laugh at this, they say, "Well, you can't expect that sort of thing." But I don't know why you can't. There must be some deficiency, or some type of so far undisclosed factor that could regulate that cell, and I think there's every possibility, from these basic discoveries I've told you about, that this is actually feasible. And that's my hope; that in the next 10 years, with all the new things--DNA probes, new culture methods and all the technical advances we have to work with, computers and all the others--I think we're going to come up with a much more rational way of management.

Moloney: Not exactly. This is mostly concerned with actually taking pieces of DNA--They can take peripheral white cells, for instance, in molecular genetics, and show you whether you've got von Willebrand's disease or some of the other hereditary disorders like amniocentesis. They can identify not just the chromosome, but pieces of DNA which carry these telltale footprints of whatever disorder you have. So, I think that's the most encouraging thing I can think of, and I'm glad I've lived this long to see it.

Moloney: I beg your pardon?

Moloney: I really don't have much more, except, people always say, well, you look back at your life and what is the most satisfactory thing? To me, the most satisfactory thing of all is the fact that you've been able to provide something to the training of a lot of young people. We've had a lot of wonderful people go through here, who are now working all over the world, and I think that's my proudest achievement. Not my own accomplishments, which are somewhat limited, but the point is -that you get so much satisfaction out of teaching and taking care of patients. The gratitude, the respect and friendship are the real rewards in this profession. They are the values in life I think, rather than degrees and monuments and naming rooms after you. There's plenty of that. I'm much more proud of the fact that many of the people that have gone out of here, and have come back--Like on my 80th birthday, all the people who came to be with me on that occasion! It was just wonderful that they would feel that way about you. You can't buy that.

Moloney: Yes.

Moloney: Thank you.

[END OF SESSION]

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