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Jane C. Ballantyne
John Loeser
The Man Who Reimagined Pain
John Loeser
Jane C. Ballantyne
John Loeser
The Man Who Reimagined Pain
Jane C. Ballantyne
Anesthesiology and Pain Medicine
University of Washington Medical Center
Seattle, WA, USA
ISBN 978-3-031-39046-3 ISBN 978-3-031-39047-0 (eBook)

https://doi.org/10.1007/978-3-031-39047-0
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Foreword
“The brain is the organ responsible for all pain”: John Loeser packed enough dyna-
mite in fewer than ten words to blow up centuries of erroneous thinking about pain.
His statement, implausible to patients and controversial inside medicine, carries the
authority of a neurosurgeon who understands that the brain not only interprets elec-
trochemical signals from the peripheral nervous system but also interprets social
signals proceeding from outside the body. The brain thus serves as a matrix where
the interior biology of nerves and neurotransmitters meets the exterior environment
of history and culture—all played out in human consciousness. Consciousness, as a
product or an emergent property of the brain, is where our memories, fears, desires,
habits, dreams, and irruptions of concealed mental life all prove relevant to the
human experience of pain. Anesthesiologists and neurosurgeons, among the earliest
modern pain specialists, temporarily turn off pain by interrupting nerve transmis-
sion or by turning off consciousness. What happens, however, when the pain refuses
to disappear? Chronic or intractable pain is the dilemma that prompts John Loeser’s
revolutionary statement that the brain is the organ responsible for (as he puts it
boldly) “all pain.”
John Loeser’s statement appears in the September 1991 issue of Theoretical
Medicine. Specialists in the 1980s had begun to explore biopsychosocial models for
pain, John Loeser chief among them, but his statement constitutes (as I read it) a
bombshell shift in emphasis. The indispensable, underlying role of the brain implies
that pain—despite its neural substrates—can assume the contingent shapes of an
individual consciousness, as personal as a fingerprint. It can absorb any permutation
of variable influences from a particular era, a distinctive set of pain beliefs, chang-
ing sociocultural contexts, and even gender. Chronic pain especially, even if it coin-
cides with visible lesions or invisible tissue damage, requires a multidisciplinary
approach that extends beyond the traditional repertoire of drugs and neural
blockades.
The statement that the brain is the organ responsible for all pain did not rock the
field of pain medicine like the Melzack/Wall gate control theory. It was uniquely
John Loeser’s conclusion—the culmination of years of clinical observations and
v
vi Foreword
research—that remains in my view a concept deeply relevant to all fields concerned

with human pain.
John Loeser, as a major figure in the invention of the multidisciplinary pain cen-
ter, calmly presided over the conflicts that accompanied the growth of pain medicine
as a science-based clinical discipline. I witnessed arguments at pain conferences in
the early 1990s so acrimonious that the disagreements I was familiar with, in the far
more genteel humanities, looked like tea-party talk. Through it all, John Loeser
proved a sane and cohesive presence, keeping the dialogue open and moving the
discipline of pain medicine forward. He did all this largely through a personal power
so remarkable, as Jane Ballantyne shows, that it cries out for a biography.
Jane Ballantyne’s fine biography constitutes almost a sideways or stealth history
of the modern pain movement. She worked with John Loeser for many years, and
her detailed landscape of people, anecdotes, episodes, and ideas creates a rich con-
text for understanding a multitalented man who is equally at home in his command
of the operating room and in carving wooden masks based on northwestern indige-
nous traditions. A respectful, bantering way with children, for example, goes beyond
his professional role as a pediatric neurosurgeon to touch on the importance of fam-
ily ties—like his devotion to the family of his predecessor John Bonica. What John
Loeser accomplished in pain medicine is inseparable from qualities that, however
elusive and incomplete any description, add up to a remarkable and distinctive per-
sonal style.
Style is a useful term in thinking about John Loeser because it sidesteps the ideas
of personality and character rooted in the nineteenth century, when character sug-
gests a fixed moral center, and personality suggests an innate disposition, like cheer-
fulness. Style derives from the ancient Roman instrument used for writing (Latin
stilus), and it proves similarly useful in communication. Style, to modern thinking,
is not separate from content or substance: style is substance. John’s intellectual
grasp, his friendships, his willingness to fight for his beliefs, his love of argument,
and his tireless zest for travel in promoting new associations for the study of pain all
help constitute the personal style that makes him the substantial figure and the right
person to assist and to champion the timely growth of new multidisciplinary centers.
It is a personal style that communicates a way of being in the world that other peo-
ple almost instantly respect.
I had a privileged position to observe the respect that seems to spring, almost
unbidden, from John Loeser’s distinctive personal and professional style. The
Rockefeller Center at Bellagio offers its facilities for weeklong international confer-
ences on social issues, and the conference for which I was a co-chair brought
together specialists to discuss relations among pain, suffering, and narrative.
Narrative was not then and is not now a standard topic in pain medicine. As the three
co-chairs, which included pain specialist Daniel Carr, divided up the organizational
duties, John’s initial contribution was to invite prospective speakers. The conference
and the book that resulted owe their success directly to John. Amazingly, everyone
we invited to be a speaker accepted. No one, I learned, turns down an invitation
from John Loeser.
Foreword vii
There is something down-to-earth and accessible in John Loeser’s style that

lends an almost tangible weight to his evident intellectual power. A belief that the
brain is the organ responsible for all pain does not begin as an abstract or a theoreti-
cal idea. It originates in the clinic, and it has to prove its worth in the clinic. Its clini-
cal origin, in fact, depends on John’s close working relationship with psychologist
Wilbert Fordyce. Jane Ballantyne gets John to describe a eureka moment when he
first grasps the implications of Fordyce’s psychological approach. It is Loeser and
Fordyce together who create the new multidisciplinary hallmark of the University
of Washington Pain Center, as visitors arrive to transfer the model across the globe.
John, as its long-time Director, is thus at the center of an expansive new interna-
tional growth of pain medicine, for which he also provides (in his extended presi-
dencies of key organizations) a crucial stabilizing force.
His openness may be among the most important qualities that both invite respect
and help constitute his distinctive style. As an undergraduate at Harvard, his open-
ness finds expression in a particular interest in other people, other views, and other
ways of life. After quickly nailing down premed courses, as Jane Ballantyne
describes, he chooses an interdisciplinary major that combines courses in cultural
anthropology, sociology, social psychology, and psychology. I can add one support-
ing detail: as a resident, he takes an evening course at the UW on Pharaonic Egypt.
His intellectual openness and broad interests mean that any argument—whether you
are a fellow student, a professor, or later a colleague—is similarly open to question.
In a Festschrift published in honor of his good friend and distinguished colleague
Ronald Melzack, John criticizes the pro-opioid view that Melzack had proposed,
influentially, 10 years earlier in Scientific American. John Loeser’s high standards
mean that you would better bring your intellectual A-game and be ready for a
counter-argument. Anything less just will not cut it.
John Loeser continues (even retired in his 80s) to challenge colleagues with
arguments that threaten to upend settled views—as in “A new way of thinking about
pains” (2022). He also co-teaches a seminar on pain for UW undergraduates, both
engaging a new generation of thinkers and feeding his own need to keep on learn-
ing. The pilgrims that Chaucer describes with a few deft strokes in the Prologue to
the Canterbury Tales include a clerk (riding a lean horse) who prefers reading
Aristotle to pursuing worldly reputation or gain. “And gladly wolde he lerne,”
Chaucer sums up, “and gladly teche.” The description reminds me that John’s intel-
lectual openness includes an attractive sense of gladness. On the other hand, as
someone who enjoys the social pleasures of good food and fine wine, John (I sus-
pect) would also be glad to find a better ride.
Groundbreaking concepts sometimes come in pairs, as with Wallace and Darwin.
John Loeser reimagines pain and its treatment in concert with Bill Fordyce, but he
also possesses the singular style and widespread respect needed to help put this bold
new approach on the global map. Readers of Jane Ballantyne’s invaluable book now
get to see him in action, including a dangerous moment in a war he opposed when—
on a makeshift operating table cordoned off with sandbags—John surgically
removes a live grenade embedded in the skull of an elderly Vietnamese man. Who,
as the saying goes, does that? Meaning, nobody in his or her right mind. Who—to
viii Foreword
ramp up the apparent craziness—would volunteer to do that? (John did.) His calm
and skilled dedication to the neurosurgeon’s delicate work—as well as a desire to
relieve pain, a devotion to a knowing about other lives, and a resolute rejection of
self-display—offers only a start to thinking about the remarkable life of the truly
amazing John Loeser.
Emeritus of Literature David Brown Morris

University of Virginia
Virginia, USA
Preface
John Loeser will be remembered for his founding and sustained leadership in the
field of pain medicine. Yet, before the field of pain medicine even existed, he was a
highly respected neurosurgeon, co-author of the definitive text on neuroembryol-
ogy, a decorated Vietnam veteran, husband, and a father of three. When he became
swept up into the pain world, the idea that pain management should be a medical
discipline was new. The founders of the discipline believed that medicine could do
a much better job of reducing people’s physical pain (pain felt in the body) using
better diagnostics, newer technologies, better knowledge of pain mechanisms and
processes, focused pain interventions, and newly developed drugs. There was much
excitement in the air because the participants strongly believed that they were on the
road to significantly reducing human suffering. But as with many grand initiatives,
mistakes were made, some of which caused iatrogenic harm. John Loeser’s great
strength was that, despite sharing all initial enthusiasms, he always recognized
when assumptions had been wrong and spoke out early and clearly. Today, four
decades after the heady days of the founding of pain medicine, one can ponder what
those four decades have achieved. In fact, despite setbacks, what has been achieved
is much more than that was even hoped for: science has provided important insight
into the mysteries of pain. This insight is already helping those who suffer from pain
through improved channeling of resources, avoidance of iatrogenic harm, and real-
istic expectations. As the story of John Loeser unfolds in this book, so does the story
of pain medicine. That link exists because John’s involvement in pain medicine has
spanned its history, and so has become his primary identity.
But despite it being central to his later life and career, pain medicine is not all
there is to John Loeser. His friends describe him as a Renaissance man, which he is.
It is hard to imagine how he fits all his passions and interests into one life, but then
superhuman levels of activity go hand in hand with exceptionalism. He has always
read widely, with keen interest. He started his reading habit in childhood, since there
were shelves full of books in his childhood home (and no television). There is not
much he has read that gets forgotten, and he still reads prodigiously. His life has
been full of travel and cultural exploration. He has made friends all over the world.
He is a lover of art and creates beautiful replicas of native Northwest carvings. He
ix
x Preface
fell in love with the Northwest when he first moved to Seattle to be a neurosurgery
resident in 1962, and the lure of the Northwest never let either him or his children
go. He lives on Mercer Island, a short trip over a long bridge from the city of Seattle.
Three of his four children and his seven grandchildren also live on the Island. The
fourth lives in the eastern part of Washington state. They are all very close—chil-
dren, grandchildren, and grandparents—in no small part because of John’s strong
sense of family. They all work hard, mess about in boats when they can, and get
together often. How many of us are so lucky?
John Loeser is a warm and passionate man. His story is largely a happy one.
Dedication to family life is central to his life. That is not easy for a busy neurosur-
geon, but after a heartrending divorce from his first wife, he was especially careful
to remain a central figure in his children’s lives. He could not have done it without
the support, companionship, and love of his second wife Karen, with whom he
shares his fourth child David, and to whom he has been married for over 40 years.
Two years ago, John became paraplegic after surgery to relieve pain in his back of
sudden onset due to a bacterial discitis. The associated septicemia was a near-death
experience. But remarkably, he has rallied. He will tell you that he had not planned
on ending his life as a paraplegic. He worked to rehabilitate and can now walk short
distances unaided and longer distances with a walker. He threw away his wheel-
chair. He is driving, travelling, eating out, meeting friends and family, and still read-
ing prodigiously, doing wood carvings, writing papers, and teaching at the
University. A remarkable man, with a remarkable path through life.
Seattle, WA, USA Jane C. Ballantyne

People
Asgaard, George N 1914–1997 Dean of UW Medical School

Bailey, Percival 1892–1975 Professor of neurology and neurological surgery at
the University of Illinois, Chicago. Close colleague of Harvey Cushing
Bales, Robert Freed. 1916–2004 Social psychologist, small group interpersonal
interaction
Basbaum, Allan. Professor and Chair, UCSF Department of Anatomy
Beck, Aaron 1921–2021 psychiatrist, regarded as father of cognitive ther-
apy and CBT
Beecher, Henry K. 1904–1976 1941 first endowed chair in anesthesiology in
US. 1955 The Powerful Placebo.
Benedetti, Constantino (Nino) Anesthesiologist and leader in palliative and hos-
pice care
Bond, Michael Physician researcher, England
Bonica, John J 1917–1994 Anesthesiologist and founding father of pain medicine.
Brennan, Frank Palliative care specialist and lawyer
Brown, Roger 1925–1997 Social psychology, children’s language development
Bruner, Jerome S 1915–2016. Cognitive psychologist, learning theory, educa-
tional psychology
Burchiel, Kim Chairman Emeritus Department of Neurological Surgery at
Oregon Health Sciences University (OHSU)
Butler, Steven Anesthesiologist. Professor and pain specialist Utrecht,
SwedenWard, Arthur 1916–1997. 1st chief of neurosurgery at UW. Interests stereo-
tactic surgery and epilepsy.
Carr, Daniel B Anesthesiologist and endocrinologist
Cohen, Bernard 1914–2003 Professor of the history of science and author
Cushing, Harvey (1869–1939) Harvard and Yale. Pioneer in brain surgery.
Delateur, Barbara Psychiatrist, trained UW, later chief of the Johns Hopkins
Rehab Med
Devor, Marshall, Professor of Pain Research Hebrew University of Jerusalem.
xi
xii People
Ellenbogen, Richard G. Professor and Theodore S. Roberts Endowed Chair of

the Department of Neurological Surgery, UW
Engel, George L 1913–1999 Internist and psychiatrist, formulation of biopsy-
chosocial model
Fey, Steven UW psychologist
Fields, Howard, Professor of Neurology and Physiology emeritus UCSF
Fitzgerald, Maria Professor of Neuroscience, UCL
Foley, Kathleen Neurologist and cancer pain specialist
Foltz, Eldon L 1919–2013 neurosurgeon, developed frontal cingulumotomy for
pain treatment
Fordyce, Wilbur “Bill” E 1923–2009 Rehab psychologist, pioneering work on
chronic pain
Fowler, Roy S Jr. Rehab psychologist
Granum, Douglas Tacoma artist who has worked in multiple mediums
Halpern, Lawrence M. 1931–2009. Professor of Pharmacology, University of
Washington
Jensen, Troels Neurologist researcher, Denmark
Killam, Eva K 1920–2006. Research pharmacologist.
Killam, Keith F 1927–1998. Pharmacologist.
Kluckhohn, Clyde 1905–1960 Arthropologist and social theorist
Koella, Werner P 1917–2008. Neurophysiologist
Krusen, Frank H 1898–1973 Physiatrist, “founder” of field of PM&R
Lehmann, Justus 1921–2006 Physiatrist, founding chief of the UW Rehab
Medicine Dept
Liebeskind, John 1935–1997. Neuroscientist and pioneer in studying pain’s effects
Livingston, William K 1892-1966 Neurologist
Melzack, Ronald 1929–2019 Canadian psychologist, gate control theory of pain
Michael, Jack 1926–2020 Psychologist, pioneer in applied behavior analysis
Murphy, Terrence M 1937–1996 UW anesthesiologist, pain specialist
Noordenbos, William 1910–1990. Neurosurgeon. Netherlands.
Penfield, Wilder 1891–1976 Pioneer in epilepsy surgery and neural stimulation.
Founded the Neurological Institute and Hospital at McGill University
Ripley, Herbert S 1907–1968 Psychiatrist, Chief of UW Psychiatry
Saunders, Cicely 1918–2005 Physician and founder of the modern hospice
Silbergeld, Daniel L. Arthur A. Ward Professor of neurological surgery UW
Sweet, William H. 1910–2001 Chief of the Neurosurgical Service 1961-1977
Torgerson, Warren S. 1925–1999. Psychologist latterly Johns Hopkins, Baltimore
Turk, Dennis C. John and Emma Bonica Endowed Chair in Anesthesiology and
Pain Research
Turner, Judith A Psychologist, IASP past President
Van Orman Quine, Willard 1908–2000 Philosopher and logician in the analytic
tradition
Ventafridda, Vittorio 1925–2008 Anesthesiologist and leader in palliative care
Wall, Patrick D 1925–2001 British pain neuroscientist, gate control theory of pain
People xiii
White, James C. 1896–1981. Professor, Harvard, Massachusetts General

Hospital, specialized in surgical control of pain
White, Lowell “Bud” D. 1928–2018 Neurosurgeon, educator, published
poet, author
Winn, H. Richard Chairman of Neurological Surgery UW 1983-2002 Currently
Professor of Neurosurgery and Neuroscience at Mount Sinai School of Medicine
Woolf, Clifford Woolf Neurobiologist, Boston Children’s Hospital
Acknowledgements
My thanks must go first to John Loeser himself, whose unstinting support of this
project made my job easy. Apart from the hours we spent together, either going
through photographs or just chatting, he must have spent hours himself looking
through his whole life’s inventory. He dug out personal notes, letters, papers he had
written, mementos, and anything he thought might be useful to me. The strength of
his friendships became clear through his introduction to me of the many people who
have been important in his life, with all of whom he maintains contact, starting with
relatives and friends who shared his childhood and college years through friends he
made in pursuit of medical excellence. He encouraged his family to be completely
open with me, which they were. He was also willing to tell me his own story, warts,
and all.
Next, I must thank Francis (Frank) Keefe, who told me early on that he was
interested in the project and asked me to send him chapters as I wrote them. Frank’s
encouragement and critique were invaluable to me, especially since nobody other
than John himself was reading along. David B. Morris, author of the prize-winning
book “The Culture of Pain,” spent several hours with me at the beginning of the
project teaching me some of the pearls of biography writing. I would have written
the book very differently had I not been the beneficiary of his wise words. Louisa
Jones, who was the executive director of the International Association for the Study
of Pain (IASP) from its inception until her retirement in 2006, diligently recorded
IASP’s activities, a record I have relied upon. She was also kind enough to spend
time with me bombarding her with questions, remaining available to me whenever
I had further questions. Louisa’s sense of fun shines through in the stories she tells,
including in her much-treasured record of the early years of IASP, “First Steps: The
Early Years of IASP 1973–1984.” Louisa’s geniality colored the pioneering days of
IASP and made them much more than just hard work. Rosemary Kimmel was
John’s administrative assistant from 2003 until her retirement in 2019. She kept
John’s working life in order throughout the many years of her employment and is
still the keeper of his records and his resume. She supplied me with a treasure trove
of papers and photographs and spent time talking to me about her Loeser years.
xv
xvi Acknowledgements
I will simply list here other people since their roles are detailed throughout my
text. Thanks to living in the age of Zoom meetings, I was able to have fruitful
remote interviews with some of those I could not meet in person, including John’s
sister Jane Ransom, his niece Debbie Tauber, and his cousins Jim Newman and
Katherine Levy Hall. I was also able to remotely interview John’s very good child-
hood friend and later Harvard classmate Tony Levy, his Harvard roommate Bernie
Gross, and his medical school classmate Simon Stertzer. Kim Burchiel, who trained
in neurosurgery under John, and Tom Cikatz, surgical technician who spent years
working with him, both gave me valuable remote interviews, as did Ernie Volinn,
fellow thinker in pain; Tom Hornbein who succeeded John Bonica as Chair of the
Department of Anesthesiology and Pain Medicine; Richard Chapman and Dennis
Turk, successive heads of pain research at the University of Washington; and Lee
Glass, mentee. Even more pleasurable were my in-person meetings, which often
came with generous hospitality and always came with enjoyment. There were the
boat trips on Lake Washington with John’s sons, sitting on their decks talking about
their father; a memorable trip to Martha’s Vineyard to meet John’s cousin Tony
Levy; and a trip out to Doug Granum’s magical estate in Port Orchard cloaked in
artworks, both his own and from his travels. This says nothing of the warm meetings
in the homes and offices of John’s family, colleagues, and friends. His children, of
course, Sally, Tom, Derek, and David. His neurosurgery colleagues Richard
Ellenbogen, Dan Silbergeld, and Alexa Martin. His colleagues and others from the
pain world, Linda Bonica, Jonathan Meyer, Steve Butler, Rolf-Detlef Treede,
Supranee Niruthisard, Michael Nicolas, David Tauben, and Judith Turner. Last, but
by no means least, Karen, John’s wife of 46 years, who patiently tolerated my
appropriation of her husband, who cooked me many a lunch and dinner, and who
filled in many a feminine detail of John’s story and her own.
Contents
1
They Came from All Over the World �� 1
The Clinic to Which They Flocked�� 3
The Loeser Onion�� 8
2 Child. Draft�� 13
3 Draft. The Decorated War Hero �� 25
Was it Like MASH the Movie?�� 26
The Negatives�� 29
The Positives�� 30
The Decorated War Hero �� 32
Homecoming�� 34
4 Draft. Neurosurgeon�� 37
Arthur Ward �� 38
Neurosurgery at the University of Washington�� 40
Commanding Presence�� 42
Pediatric Neurosurgeon�� 44
Pain Neurosurgeon�� 46
5
Draft. It All Started in Issaquah �� 49
Going into Issaquah �� 49
The Remarkable Achievements of Issaquah�� 50
It All Began in Issaquah �� 54
The Heirs of Issaquah�� 55
Postlude�� 61
6 The Two Johns. Draft�� 63
7 Draft. The Man Who Refused to Meet the Pope �� 69
8 The Making of a Renaissance Man. Draft �� 79
xvii
xviii Contents
9
Threats to the Draft Mission �� 87
Threats to Pain Neurosurgery�� 89
Threats to Multidisciplinary Pain Medicine�� 90
The Opioid Epidemic�� 95
The Remarkableness of the Full Circle�� 97
10
Wives and Children. Draft�� 99
Susan�� 99
Sally Tom and Derek�� 104
Karen�� 109
David�� 112
11 Teacher Draft�� 117
Becoming a Dean�� 117
Travels with IASP�� 120
Bellagio�� 125
12 A Portrait of Passion and Tenacity. Draft�� 129
Appendix A: List of Photos �� 135
Appendix B Timeline �� 155
Appendix C Characters �� 157
Appendix D List of Delegates and Speakers—International

Symposium on Pain Issaquah, Washington, USA, May 21–26, 1973�� 159
Index�� 175
Chapter 1
They Came from All Over the World
They were all part of a pain revolution. Chronic pain was destroying lives, liveli-
hoods, economies, and families, and a solution was within grasp. They had heard
that an innovative pain program at the University of Washington, Seattle, was
achieving remarkable results. They came from all over the world to see how it was
done. They were greeted by the avuncular figure of the Center’s chief, John Loeser.
Tall, imposing, warmly welcoming, and delighted by their interest. He was in his
element. There was nothing he liked better than to interact with like-minded col-
leagues, to discuss their shared belief that there was a way out of unrelenting pain
and to proudly promote the methods used in his pain program. He also welcomed
the chance to make lifelong friends. The visitors were treated not only to a view of
a program that was helping turn lives around for people with pain, they were also
invited to the Loeser home. It was not unusual for John’s wife Karen to be told to
expect dinner guests. In fact, on one occasion, Karen was told on a Tuesday to
expect a busload of 60 Italian visitors for dinner the following holiday Monday
(luckily the sun shone, given the size of the house and Seattle’s common state of
rain). Those visits to the Loeser home in Madrona, with a gorgeous view from the
deck over Lake Washington, cemented the visitors’ memories of their trip to Seattle.1
They never forgot the hospitality, nor what they were inspired to develop once they
returned home. They became leaders in the pain field in their own countries and
became hosts for John and Karen’s subsequent world travels. As momentum built
and pain medicine became an established medical discipline worldwide, John
Loeser became a central figure in its evolution.
It was another John, John Bonica, who is given credit for being the founding
father of pain medicine, and John Loeser will be the first to say that John Bonica
deserves that credit. Bonica was Loeser’s senior. Bonica moved to the recently
1
The fact that the Loeser home in the 1980s was small and unpretentious helped embolden return
hospitality because it was a real American home, not the sort of large pristine American home
depicted by Hollywood that was so unlike their own homes.
© The Author(s), under exclusive license to Springer Nature 1

Switzerland AG 2023
J. C. Ballantyne, John Loeser, https://doi.org/10.1007/978-3-031-39047-0_1
2 1 They Came from All Over the World
opened University of Washington Hospital from down the road in Tacoma2 in 1960
to become the first Chairman of the new Department of Anesthesiology. John Loeser
graduated from medical school in New York the next year. One of the first things
Bonica did as Chief of Anesthesia was to develop a multidisciplinary pain clinic, as
he had in Tacoma. Meanwhile, Loeser received his training in neurosurgery, also at
the University of Washington. It was during his neurosurgical training that Loeser
began to attend Bonica’s pain rounds in the University Hospital.3 This brought him
into the then separate worlds of John Bonica and another person who was to become
a giant in the pain field, Wilbert (Bill) Fordyce.4
The multidisciplinary pain clinic developed by Bonica in 1961 was run on a
model that called itself multidisciplinary but was quite unlike the multidisciplinary
clinic that became famous in the 1980s.5 Two patients were evaluated as outpatients
each week. On Mondays the two patients were seen by a primary care physician
who decided which specialists the patients should visit during that week. If the
patient might benefit from an injection or medication, an appointment was set up
with an anesthesiologist in the pain clinic. If the patient might benefit from a neuro-
surgical procedure, an appointment was set up with the specialist neurosurgeon—
latterly John Loeser. Some were sent for a psychiatric evaluation, and some to rehab
medicine, which had its own pain program. On Fridays, all the specialists met to
discuss the two patients and decide next steps. Off the patients went to pursue the
recommended treatment, never to be discussed again in conference. The patient was
the passive recipient of whatever the gurus deemed the right treatment.
It was at the Friday meetings that John Loeser got to know and befriend Bill
Fordyce. This was more important than it might seem because Loeser became the
catalyst between Bonica and Fordyce. Bonica and Fordyce did not really under-
stand each other. As Loeser has said, they spoke different languages. Bonica
addressed pain from the perspective of pain pathways. Pain was carried along a
system of nerves that could be blocked, cut, or quelled using medication or exercise.
From his perspective, the pain that could not be so eliminated was a psychiatric
problem. Fordyce, on the other hand, believed that pain could be changed by behav-
ioral conditioning and that such conditioning was so powerful that it could obviate
the need for doing things to nerves. The Friday meetings could be fiery affairs, not
2
Prior to his move to the newly opened University hospital, Bonica had been chief of anesthesiol-
ogy in Tacoma and started a multidisciplinary pain clinic there.
3
Later, in 1969, Loeser was offered a faculty position predominantly in pain and pediatrics to take
over the subspecialty practice of two neurosurgeons, Lowell E. White Jr (pain) and Eldon L. Foltz
(pediatrics). Upon this appointment, Loeser became the official neurosurgeon in Bonica’s group.
4
Bill Fordyce was a psychologist and a behaviorist. When the University of Washington Hospital
opened in 1959, Fordyce moved to the new hospital from the Seattle Veterans Administration (VA)
Hospital, where he had worked for the previous 5 years. His appointment was in the Department
of Physical Medicine and Rehabilitation (PM&R).
5
Strictly, the Loeser/Fordyce clinic would be called interdisciplinary since it links the disciplines
into a coordinated and coherent whole, whereas the Bonica clinic did not and is correctly called
multidisciplinary. However, throughout this manuscript, I have called both multidisciplinary to
avoid confusion.
The Clinic to Which They Flocked 3
only because the Freudian psychiatrists at the table did not understand Fordyce’s
emphasis on behavior and conditioning but also because most of the specialists
were looking at peripheral causes of pain that fell into their own specialty area. Pain
was still considered a byproduct of disease.6 There was considerable discomfort
with the concept of a behavioral approach to pain management. There was a lot of
open debate, deliberate taking of extreme positions to provoke comments. The rela-
tionship that developed between Loeser and Fordyce during those meetings was key
to what happened next—the multidisciplinary pain clinic became the multidisci-
plinary pain clinic as we understand it today, which is a team effort with the patient
being an active participant. This was the model of a pain clinic developed at the
University of Washington that was visited from all over the world in the 1980s and
early 1990s.
The Clinic to Which They Flocked
Fordyce tells a rather self-deprecating story about how it all began.7

“We had on our ward a chemist with rheumatoid arthritis, disease in remission,
the sed rate was down; but there was a lot of residual immobilization. He had been
referred to rehab for reactivation. He had been there for a couple of weeks, what-
ever. On Thursday, he announced with great feeling to the nurses and everyone else
that the pain was so great that he could not even tolerate the touch of his sleeve on
his arm and that he could not get out of bed to go exercise. That was on Thursday. I
was on the ward that time, in those days with Justus Lehmann, the chairman of the
department, and Barbara Delateur, his senior resident. We’d made walking rounds
each day. Friday Jack Michael (who would qualify as a radical behaviorist I guess)
gave a lecture and pointed out what seems so obvious now but didn’t seem so obvi-
ous then, that social feedback has a lot of influence potentially.
The following Monday—now our chemist friend had been in bed Thursday and
Friday and Saturday and Sunday—the following Monday we came walking around
the ward and came to his room on ward rounds. I don’t know where the idea came—
I got this hairbrained idea. “What do you say, if he says anything about pain, let’s
look out the window.” It was crass, it was cold, it was whatever. But we did it. We
walked into the room ……. and began talking with him at the bedside. He was lying
in bed, and immediately, he began to tell us how bad his pain was. So all three of us
looked out the window, turned our heads ninety degrees or whatever it was. It was
just crude. And he stopped. So then we turned back to him and he started talking
about pain again—looked out the window again. We went through this little charade
2 min, 3 min, something like that, and then left. The darndest thing happened. He
6
JDL to JCB, interview 11th May 2022.
7
Oral History Interview with Wilbert E. Fordyce, John C. Liebeskind History of Pain Collection,
Louise M. Darling Biomedical Library, UCLA.
got up and got dressed. He hadn’t been out of bed since Thursday, except to go to
the bathroom, I guess. He got up and got dressed and went to PT and OT and did
his exercises. He never missed another session of treatment. I was just
flabbergasted.”
The idea that social feedback could change pain behavior had taken root. The
effect of social feedback on activity and exercise had been dramatic. They continued
the experiment, not with anything as “crass” as ignoring the patient, but just not
flapping around, instead encouraging positive behaviors. This continued to be suc-
cessful. If exercise could be affected by social feedback, what about medication?
Many of the patients in rehab at the time were weighed down by dependence on
medication, so maybe a behavioral approach could help that too. Within days of the
chemist friend story, Fordyce sat down for coffee with one of his psychology col-
leagues, Roy S. Fowler Jr., and within the course of 1 h had come up with the “time-
contingent”, “pain-cocktail” gambit. The patient would no longer be given or be
able to request medication at will; all the medications would be given at set times
during the day (“time-contingent”) and would be disguised by being mixed together
in syrup.8 The idea of calling this a “pain cocktail” came later, intended as a joke,
but it stuck. Again, they were astonished that when given in this blinded time-
contingent manner, the medication could be tapered relatively easily, even though
the troublesome medication might include both opioid and benzodiazepine,9 each
notoriously difficult to taper.10
More patients followed, and they continued to be astonished at the results they
were achieving. “A man who hadn’t worked for 2 years came in with canes and
addiction and walked out whistling. And hell, our eyes bugged and we thought,
well gee, let’s try it again. So we tried a second one and that worked and then tried
a third one and she set all kinds of records, so that by the time we got the third
one—hey, we’ve got something here. We were opportunistic enough, Roy and I, we
wanted to establish ourselves academically—so we’re going to write this up right
now. So the next week or so we wrote that first paper.” That paper is now considered
seminal.11 However, perhaps the most consequential aspect of the way it all devel-
oped was that the first patient, the man who went out whistling, had been referred
by a downtown psychiatrist who suggested rehabilitation for his patient for no
8
It was the pharmacologist Larry M. Halpern PhD who formulated the “pain cocktail” that they
used for their “time-contingent” idea.
9
Initially, all sedatives were converted to phenobarbital. Later, Mark Sullivan convinced them to
convert clonazepam.
10
The so-called “pain cocktail” gambit became a key component of the pain program under
Loeser’s leadership. From Fordyce’s perspective, it was a behavioral intervention designed to
reduce the patients’ focus on the next dose of medication. However, with hindsight, getting the
patients off their opioids and benzodiazepines was likely helpful in itself, even though the doses
used in the 1980s and 1990s would rarely reach the levels used today.
11
Fordyce, Fowler and DeLateur. An application of behavior modification technique to a problem
of chronic pain. Behavioral Research and Therapy 1968;6:105–107.
other reason than being disabled by pain. The team had never heard of this before,
but they found a bed and so began pain rehabilitation.
In fact, there were several portentous developments in clinical medicine under-
way that combined to enable the development of the University of Washington’s
model multidisciplinary rehabilitation pain clinic. The Second World War not only
changed the philosophy of human rights and healthcare provision but also sent
home scores of injured and fragile men. The suffering of those men was a trigger
for the rapid development of pain medicine, rehabilitation medicine and clinical
psychology, none of which existed as established clinical practices until the
Second World War. However, during and after the war, these three new healthcare
disciplines developed in parallel. Bonica had been moved by the terrible pain and
suffering of the injured military, which was what drove him to dedicate his life to
the study of pain and the development of pain clinics. There had been fledgling
rehabilitation programs even before the great wars,12 but the growth of this spe-
cialty accelerated under the continued leadership of Frank H. Krusen after the
Second World War. The specialty was eventually codified by the American Board
of Medical Specialties in 1947. Clinical psychology, although not new, was newly
asserting itself into psychiatry’s dominance within healthcare, by Fordyce’s
record, “trying to establish itself not only within psychology, but even more point-
edly within the mental health/mental illness domain. The warfare, open and other-
wise, with psychiatry was profound.” Feeling undervalued within the sphere of
mental health, when Fordyce was recruited to the new University Hospital in 1959,
and the chairs of both Psychiatry (Herbert S. Ripley) and Rehab Medicine (Justus
F. Lehmann) offered him a position, he chose Rehab Medicine. It was vision and
leadership in the new University of Washington medical program that led to its
rehab program being, in Fordyce’s admittedly biased opinion, “the strongest medi-
cal rehab program in the world for most of his 30 years in the program”. In the
1960s, the University of Washington program was one of only three rehab pro-
grams in the entire United States. The Dean of the medical school, George
N. Aagaard, was strongly committed to setting up rehabilitation medicine in a way
that was “broad-gauge”, in other words, multidisciplinary. When they appointed
Fordyce to Rehab Medicine, it was a first for clinical psychology within rehab
medicine and a brilliant move on the part of the leadership.
The only person around the table at the Friday meetings who truly understood
Bill Fordyce was John Loeser. Loeser’s childhood, education and experience had
prepared him for an open mindedness and intellectual curiosity that meant that
rather than skepticism about Fordyce’s ideas, he embraced them. Being a neurosur-
geon was his life’s ambition and pride, but when he became drawn into the pain
world, he found intellectual satisfaction that simply was not present in day-to-day
neurosurgery. His relationship with Fordyce would provide exactly what he sought
and become one of the most fruitful intellectual partnerships in the growth of pain
medicine. The two men truly liked each other. They were open to learning from
12
Frank H. Krusen founded the first Department of Rehabilitation at Temple Hospital in 1928.
each other. They had the same values and the same political leanings. When in
1976–1977, they were selected, together with Terry Murphy,13 to teach on a Circuit
Course in the WAMI region,14 visiting a total of 46 regional towns over 2 years, their
evenings spent eating, drinking and talking cemented their friendship. Fordyce’s
success in his two designated beds in the inpatient rehab ward in the University
Medical Center convinced both men that if only they had more inpatient beds, they
could work miracles.15 However, for a while the hospital leadership was not ready
to give the multidisciplinary pain clinic the space it sought. Loeser and Fordyce
were so frustrated that they talked about setting out on their own and building
exactly what they wanted outside the university. But this idea was quickly dis-
missed, especially by Loeser, because he wanted to continue being a neurosurgeon,
and he valued being an academic. However, in 1982, Loeser became director of the
Pain Center,16 and as fortune would have it, the hospital finally came forward with
the space needed to fulfil the Loeser/Fordyce vision, just as Loeser was taking over
leadership. The hospital had built a new wing that had more beds than allowed by
their certificate of need, so it suited the hospital to give a whole ward to the Pain
Center, knowing that the Pain Center could use inpatient beds on one side and pro-
vide outpatient services on the other, thus reducing the bed capacity of the space by
half. What they went on to create in this space is the program that attracted visitors
from all over the world, not in small part because John Bonica, who was no longer
running the Pain Center, was traveling and proselytizing about the revolutionary
work going on at the University of Washington. The people back home were rather
amused by this because they had created something quite different from Bonica’s
own clinic!
The outpatient side of the new space ran like any other outpatient pain clinic. If
physical therapy or injections were indicated, these were carried out in nearby pre-
existing areas. Many of the patients coming to the center could be managed on the
13
Terry Murphy was one of the anesthesiologists in the pain clinic and later ran the pain center. He
is reputed to be one of the funniest individuals ever, which added to the fun they all had on the
Circuit Course.
14
A four-state medical education initiative of the University of Washington, states being
Washington, Alaska, Montana and Idaho. (Wyoming joined in 1996, making it WWAMI, a five-
state endeavor). The circuit course was a pride of the medical school, and being invited to take part
was considered an honor. The visits spanned 2 years, and they spent 1 week at each state, often
speaking in 5 or more towns that week.
15
Fordyce had only two beds through the Rehab Medicine Department, but the multidisciplinary
pain clinic initially had no proprietary space until 1977, when pain clinic space was created next to
the emergency room with 4 exam rooms, a nerve block room with recovery room, an office and a
conference room. Even later, the anesthesia department was given 6 inpatient beds to which pain
patients could be admitted for pain triage by the anesthesia residents (similar to the outpatient tri-
age by primary care physicians). These beds were no longer needed after 1982.
16
Bonica stopped being chair of anesthesia in 1978 and stopped seeing patients in the mid-1970s.
He appointed a succession of people to run the Pain Center (a designation agreed upon by the
University in 1978), which did not work out. However, he had his eye on John Loeser, who agreed
to take over the leadership of the Pain Center once his term as Assistant Dean for Curriculum (a
half-time position that he loved) was over in 1982.
outpatient side, while patients selected for inpatient treatment were a special group,
selected on the basis that rehabilitation might be the most successful approach. The
two sides worked together, but it was the inpatient program that engendered the
most excitement because no one had previously seen the success that was being
achieved with intractable cases. John, speaking years later, commented that the gift
of space “gave us the chance to start a truly multidisciplinary inpatient treatment
program. And Bill and I literally out of thin air created it. I mean, we decided that
this would be a 3-week treatment. Why 3 weeks? Well, because four was too much,
two was too short. So that was the way we picked that.”17 Many of the practitioners
who would be involved in the new pain program were already involved in the mul-
tidisciplinary pain center under the direct management of their own various depart-
ments. However, in a stroke of genius, John persuaded the various services to assign
named practitioners through the pain program. In this way, they could accrue train-
ing and experience in the management of pain specifically and thus become pain
specialists. John insisted that they all become equal partners in the care of the inpa-
tients, regardless of discipline. Understanding the strains of looking after patients
with complex pain problems, they were limited to 3-week duty periods on the inpa-
tient service, and duty meant 24 h per day. Despite the anesthesiologists’ fears that
the psychologists would be unhappy about being on call, the psychologists valued
being on equal terms with the physicians.18 Once a true sense of team had devel-
oped, all those involved came to appreciate the satisfaction that arose from the team-
work that was changing their patients’ lives. Regular conferences to discuss the
patients’ progress were critical to the success of the program, and it was at these
conferences that John demonstrated his extraordinary leadership skills. He made
everyone around the table feel valued and heard, so they became united in the cru-
sade to find a way to help people out of pain’s vicious cycle.
The vision had come from two minds—Loeser’s and Fordyce’s. But John Loeser
was the person who made it happen. Naturally, not every patient admitted to the
program walked out whistling like the first patient described by Fordyce. However,
it would be rare if they were not helped, largely by being provided with the tools
needed to manage their own pain at home. And there were, indeed, some miracles.
Steven Butler, one of the anesthesiologists in the Loeser-Fordyce program, recalls
one such patient.
We had this woman who was a secretary for a rheumatologist out in Eastern
Oregon. She had developed some sort of chronic pain, and he was convinced it was
rheumatologic. He tried her on many medications, and he sent her to a professor of
rheumatology in a teaching hospital in Portland, Oregon. The professor said clearly
this wasn’t rheumatological. But the rheumatologist, her boss, continued to insist
17
JDL to JCB 11th April 2022.
18
Decisions under Loeser’s leadership were team decisions (at least ostensibly). One of the stron-
gest dissenters of this idea was anesthesiologist Peter Buckley. One of the strongest supporters was
psychologist Kelly Egan. One day, Kelly took Peter into the back office, sat him down and said,
“Sit down, you little s***”, you need just do it. It always amused John that Kelly and Peter later
married.
that it was. He had her on low-dose steroids and something else, but she was con-
fined to a wheelchair. They revamped the house so that it had wheelchair access.
She had a hospital bed in the living room, and she was completely incapacitated.
The only thing that she did socially was play bridge. However, she had so much
problem with pain that someone else had to deal the cards. She did our course for 4
weeks and went from being completely incapacitated to being able to walk 100 m,
do a 25-m speed walk in under 25 s, do aerobics on an exercise cycle, target heart
rate for 20 min, walk up and down 8 flights of stairs.
On her last week, we walked into her room, and she was in tears. We did not
understand what the problem was, she was doing so well. She said, Dr. Fordyce, I
want to talk to you in private. Bill was her hero. And her problem was that she said,
I feel so stupid. What am I gonna tell all my friends when I come home. I was in this
program, and they said it was just rehabilitation. And now I have no pain. And it’s
as if I did something wrong before. So Bill said to her very quietly, I think you have
to say that the problem was due to the healthcare system, and you were just follow-
ing advice, and we had different advice that you could follow and that’s why you got
better. And that woman used to come to Seattle sockeye fishing. They had a trailer,
and they drove through Oregon and Washington every summer. Every year she
dropped into the pain clinic to see Bill Fordyce. We saw her for 5 years, and she was
still at full function after 5 years.”19
The Loeser Onion
Pain that is not an expected symptom of some underlying disease or trauma has
never been easy to understand. While pain still has its mysteries, the twentieth cen-
tury saw enormous advances in how pain could be understood. Why does a fixed
cause produce pain in some people and not others? How is pain experienced differ-
ently in different circumstances? Is it possible that an injury that looks so terrible,
could come with no pain at all? Throughout most human history, lacking any knowl-
edge of pain pathways and pain physiology, pain was thought of as a punishment
coming from outside the person. However, the great anatomists and physiologists of
the nineteenth century provided the twentieth century pioneers of pain medicine
with a concept of pain that was distinctly internal and that could be understood
through neural pathways. Nevertheless, some of the very early pioneers—
W. K. Livingston, H. K. Beecher, P. D. Wall and R. Melzack—recognized that pain
could not be completely explained as a signal from the periphery to the brain. There
had to be other factors to explain the mysteries of pain. John Bonica’s perspective
was that modern anesthetic and surgical techniques could be utilized to relieve pain
as never before. If medications and these techniques failed, then the likely cause of
19
Steve Butler to JCB 9th September 2022
The Loeser Onion 9
pain was psychiatric. John Loeser could see that what Fordyce and the behavioral-
ists were demonstrating was beginning to explain the “other factors”.
The 1970s was a decade during which the biopsychosocial nature of chronic ill-
ness was increasingly recognized.20 Chronic pain emerged as perhaps the archetypal
biopsychosocial condition, while heart disease, diabetes and many other chronic
illnesses would qualify. Yet there was an important difference between chronic pain
and many other chronic illnesses, which was that chronic pain was entirely subjec-
tive. Unlike other biopsychosocial illnesses that had objective markers to guide
treatment, chronic pain diagnosis relied on a patient report. How was one to under-
stand that whatever pain was expected was not necessarily reflected in the patient’s
report of pain or the patient’s behavior. The specialists were beginning to under-
stand that the signal (nociception)21 did not become pain until it was processed in
the brain to become perceived pain. Without such processing, it was not pain as
such, merely a signal that might become pain. Pain itself requires a conscious, pro-
cessing and learning brain. Pain so understood was entirely personal and internal:
there was no way the doctor could access it. And this internal event, pain, was not
necessarily reflected in suffering. Even if the signal had produced pain, an aversive
process by definition and intent, the amount of suffering associated with the pain
could only be based on the person’s experience. In turn, this was dependent on fac-
tors such as past events, culture, current circumstances, and the purpose of the pain,
to name just a few. These factors were all particularly relevant for chronic pain,
which emerges as a biopsychosocial condition. But still, the doctor had no access,
could not see the suffering, and could only gain access through the behaviors of the
person in pain, including the person’s report of pain. It was the behaviors that
unlocked the pain, but the behaviors could only be properly interpreted if the doctor
understood the underlying layers and could then use clinical judgment to address
the relative role of each to the suffering, behaving individual. How could the spe-
cialists explain this to the nonspecialists, who may not have even heard of nocicep-
tion and probably did not understand that there could be a disconnect between pain
and the only thing they could detect—pain behavior? While Murphy, Fordyce and
Loeser were touring the northwest (WAMI region) giving lectures to community
physicians on an almost daily basis, Loeser was mulling over how to get their con-
cepts across to the primary care physicians. This is when he came up with the Loeser
onion (Fig. 1.1).
He did not even think of it as an onion, but he drew it exactly the way it is
depicted to this day, with nociception at the core and behavior forming the outer
layer. People thought it looked like an onion and have since drawn it as an onion,
sometimes adding layers and sometimes adding colors. But to John, it was just a
20
The promotion of the concept and term biopsychosocial is attributed to George L. Engel “The
Need for a New Medical Model: A Challenge for Biomedicine” 1977. However, the term biopsy-
chosocial was coined earlier in 1954 by Roy Grinker.
21
Nociception is the transmission of a painful stimulus to the brain via the spinal cord. Many fac-
tors can alter nociceptive input, including continued pain generation, inflammation and descending
modifiers.
Fig. 1.1 Loeser onion
way to show the layers as they built, and as they contributed to what presented to the
doctors—pain behaviors. John thought of his onion as a simple teaching tool.
However, it has helped countless people, not just doctors, conceptualize chronic
pain as a biopsychosocial condition, and it has helped define and link areas for pain
research. There is a reason that all these years later people still use the Loeser onion
in their teaching materials, and that is it was superbly conceived.What Loeser and
Fordyce did was completely change the way people were thinking about pain at the
time. In John’s own words, “What we did more than anything was break the mold
that clinical pain is what it is. And we came along and said, no it isn’t.22 Loeser
understood only too well that there were approaches through the nervous system
that could help. He was, after all, a neurosurgeon, and many of the early approaches
had been neurosurgical, even before Bonica’s time. He also knew that medications
could help. But observing the results of Fordyce’s rehab and behavioral approach
convinced him that these approaches could dovetail with what Bonica was doing.
Although initially skeptical, Bonica could see that what was being achieved was
answering a prayer for people with pain who had not responded to needles or medi-
cations, and he became fully supportive. They built a model of pain care that remains
the best way to manage complex chronic pain and is in fact the only model that is
strongly supported by evidence. Although it was developed as an inpatient rehab
program, there are two essential ingredients that have been carried forward: the
22
JDL to JCB, 26th April 2022.
The Loeser Onion 11
team approach and patient engagement. In the words of Loeser and Egan, “Our
belief is that the conceptual framework is not as important as the presence of a team
of concerned health care providers who work cooperatively and a patient who
wants to return to gainful life”.23
John Loeser was a generation behind John Bonica, who is rightfully given credit
for founding the field of pain medicine. However, we forget that Bonica’s eventual
legacy was shaped to a large extent by John Loeser. Loeser would never challenge
the great man, but he quietly incorporated psychology and rehabilitation medicine
into the Bonica pain clinic. The reader of this biography will quickly learn that John
Loeser’s achievements are many and varied. But perhaps his signature achieve-
ments perhaps his greatest achievements are, its beautiful simplicity, and its endur-
ing value as a teaching tool that has helped so many people understand that pain is
not just a signal or a broken part, and the model clinic he developed with his friend
Bill Fordyce brought the patient into the proceedings as a working partner and
became the way complex chronic pain is managed all over the world.
Taken from Chapter 1, Loeser JD and Egan KJ History and Organization of the University of
23
Washington Multidisciplinary Pain Center in Managing the Chronic Pain Patients, ed Loeser JD &
Egan KJ, Raven Press, New York 1989.
Chapter 2
Child. Draft
The baby John David Loeser was adored by his parents, as tends to be the case with
parents and their newborn. However, in John’s case, the parents’ delight in their
beautiful chubby baby was lovingly recorded. Every week of John’s first year of
life, his father Lewis produced a photograph of the baby so winsome you could love
the baby even if you had never met him. Lewis Loeser was a physician by profes-
sion, but his creative outlet was photography. With considerable artistry, he took
black and white photographs and developed them in a dark room in the basement.
He must have understood lighting, shadows and composition, and he certainly
understood sentiment, for the photographs could move you as much as any photo-
graph in a gallery. The baby grew up, and the photographs became less frequent but
continued as a magnificent record of John’s childhood.
John was born into a comfortable home in a leafy suburb of Newark, New Jersey,
a home befitting of his father’s standing. His grandparents on both sides had their
own successes and were able to amply equip their children for adult life. On the
maternal side, grandfather Levy was a physician of considerable repute. On the
paternal side, grandfather Loeser, a “druggist”, had made his fortune developing
and patenting the sealable glass ampules that soon became ubiquitous for single-
dose injectable drugs. All John’s six known great grandparents were European Jews
who immigrated to the United States independent of each other in the mid-nineteenth
century. Whether they came to the U.S. out of expediency or necessity is not com-
pletely clear, but a charming story of the Loeser great grandmother (nee Bertha
Wolf) suggests the former, at least for the Loeser line.1
Bertha was born in 1837 in the little town of Bacharach on the Rhine in Germany.
The Rhine used to overflow in the spring, and the family had to move to higher
ground until the floods settled. They carried Bertha’s great grandmother, who lived
to be 101, in a laundry basket, since she was too frail to walk up the hill. In 1853,
1
From Loeser Family History by Sandy Berg and Loeser Boskey.

Switzerland AG 2023
14 2 Child. Draft
when Bertha was 17, the family sent her to America to marry a second cousin who
had succeeded there in business. But she did not like the second cousin and refused
to marry him. She met and soon married Louis M. Loeser, who had emigrated 2
years earlier from a larger town on the Rhine, Bingen am Rhine, a mere 10 miles
from Bertha’s family home in Bacharach. Whether that proximity was a coinci-
dence is unknown.
The name Loeser, a derivative of Elieser and various other adaptations of
Lazarus, is thought to have originated in medieval Saxony.2 Throughout much of
postmedieval European history, the Loesers were concentrated in Rhineland-
Palatinate. However, after America opened up, an increasing number of Loesers
left Europe for America, so Loesers are now more prevalent in the U.S. than any
other country.3 At the time Bertha Wolf and Louis M. Loeser left Rhineland, the
area was a border territory between the French occupied left bank of the Rhine and
Prussia’s Rhine Province. Jews had settled in the area over many centuries, but due
to flight and emigration, the Jewish population had gradually dwindled. By 1942,
the Jewish population of Bingen am Rhine had shrunk from approximately 700 at
the turn of the century to only 169. The entire remaining population was deported
by the Nazis, and only four persons ultimately returned. The town’s synagogue
was demolished in 1945, and the Jewish community was not reestablished after
World War II.4
Bertha and Louis went on to have 13 children, mostly daughters. David Loeser,
John’s grandfather, was the tenth child born to Bertha and Louis. Apart from two
children who died in infancy, only three of David’s siblings were boys: Philip, who
married but had no children, Max, who died young and never married, and Alexander,
who died in combat during World War I. After David married Estelle Cohn, his
eight sisters never spoke to him again for reasons unknown. The sisters mostly mar-
ried and had many children but did not carry the Loeser name. John therefore had a
glut of great aunts and cousins he never knew, and his grandfather David was the
only child of Bertha and Louis to continue that particular Loeser line.
John’s mother Rhoda was a Levy, and the Levy ancestry was more diverse.
Whereas all the Loeser immediate ancestors (husbands and wives) had come from
Germany, the Levy great grandparents had come from Russia, Ukraine and Austria.
But just as the Loeser great grandparents immigrated independently to the
U.S. before meeting and marrying in the U.S., so had the Levy great grandparents.
The Levy story is less easy to trace because Levy is a common name. What is
known is that John’s great grandfather Jacob Levy was born in Austria and probably
emigrated to the U.S. in his twenties, in approximately 1876. He was described in
an early census as a butcher in Manhattan’s lower east side, but whether that contin-
ued to be an apt representation is uncertain. He married Hannah Wetzler, of unknown
2
https://www.houseofnames.com/loeser-family-crest.
3
https://forebears.io/surnames/loeser.
4
R. Gruenfeld, Zur Geschichte der Juden in Bingen am Rhein (1905); Germ Jud, 1 (1963), 26f.; 2
(1968), 82–85.
2 Child. Draft 15
origin, and they had their first child Charles in 1878. Their second, John’s grandfa-
ther Julius Levy, was born in 1881 in Newark, New Jersey. There were two other
children, Simon and Bertha. All four of Jacob and Hannah’s children married and
had children, supplying John’s mother with plenty of cousins. Both Charles and
Julius went to Princeton University, a remarkable achievement at a time when
Jewish quotas for Ivy League (Northeastern U.S. elite) colleges were highly
restrictive.
The other maternal great grandparents, on John’s grandmother Sophie’s side,
emigrated to the U.S. in approximately 1875, from Ukraine and Russia. The story
goes that they were given the name Diamond at Ellis Island. Whatever the truth of
that story, their name became Diamond. Although their emigration was during the
reign of Czar Alexander II, the so-called “liberator- Czar”, liberation did not extend
to Jews in the Pale, a western region of the Russian Empire that included much of
Ukraine and Poland where permanent residency of Jews was allowed and beyond
which it was not. Liberation for the Jews merely meant that if you had achieved a
higher level of education, you could settle outside the Pale. For non-Jews, “libera-
tion” meant an abolishment of serfdom, which also meant that Jews could not
employ non-Jews and had to let go many family retainers. The likelihood is that the
Levys, unlike the Loesers, emigrated for necessity, not expedience. It was a good
time for Jews to get out of the Russian Empire, since what followed was that Jews
were falsely blamed for the assassination of Alexander II in 1881 and suffered
rebound persecution under probably the most antisemitic Czar in history,
Alexander III.
John’s parents, Lewis and Rhoda, never dwelled on the past, to the extent that the
young John Loeser was barely aware of the road traveled toward his comfortable
existence. The Lewis Loeser family moved three times during John’s childhood to
accommodate changing circumstances, but the community did not change. South
Orange, where they lived, was a bedroom community where people who worked in
Newark or New York City found respite from frenetic city life. At the time, the resi-
dents of South Orange were majority white Anglo Saxons and minority Jewish,
integrated to the extent that their differences were barely noticed.
Because of zoning, the properties came with large gardens, and the streets were
tree lined. The residents were mostly upper middle class and had servants, since
servants at the time were cheap, and automation had not yet made housework some-
thing one could (theoretically) throw off in the first hour of the day. John has no
recollection of his mother Rhoda doing housework when he was a child. Whether
that recollection is correct or not, the family did have servants. Annie came every
Monday to do the family’s washing, which took all day. At the end of the day, all the
laundry was dry, folded and left in the basement laundry room. There was an elec-
tric washing machine that agitated the washing but required manual emptying and
rinsing. There was a manual hand ringer, and the washing was then hung out to dry
in the back yard. Washing on the line in the back garden was common to most of the
houses since they all had similar domestic arrangements. Annie had worked for the
Levy family through 2 generations, and on the other days of the week, she did the
laundry for various Rhoda’s cousins who lived nearby. Annie was Polish and
16 2 Child. Draft
brought the family poppy seed Kolache pastries every Easter. It fell to the nurse-
maid, cleaning lady or live-in maid to make up the beds and distribute the laundry
to its rightful places. They also accomplished all the other household chores, largely
without help from modern electric gadgets.
The Jews who settled in the bedroom communities of New Jersey were well
integrated, but whether you were Anglo Saxon, Jewish, or something else, there
were ways in which cultural differences somehow raised their heads periodically.
This was less true for the children than for the adults, children generally being ethni-
cally blind. The Jews in the community were mostly third generation Americans,
the country being young enough that anything older was unlikely, and anything
younger unusual. The first generation escaped from centuries of piecemeal emanci-
pation in Europe to a vast new country that was founded on the right to the pursuit
of happiness for all humans equally. They were so grateful to the country for the
emancipation they were able to achieve that they regarded themselves first as
Americans and only a distant second as Jewish. Even though the country was
founded on equality, it was still a predominantly white and Christian country, and
there was still an undertow of distrust if anyone looked different or behaved differ-
ently. The first few generations of Jewish Americans, determined to fit in, often
discarded their traditions, so that they would not be overtly different. They became
secular Jews who put up Christmas trees and Christmas decorations, feasted on
Christmas day, and did not make a fuss about not getting Jewish holidays. The
neighborhood that John grew up in had Christmas trees in every home, including his
own. The family never went to synagogue, since they needed neither the compan-
ionship nor the moral guidance it offered, nor did they believe in God. John was
completely unaware that he was Jewish until he was 6 years old when he went to the
country club for the birthday party of a “little girlfriend”. He thought the country
club with its tennis courts and swimming pool was a wonderful place and asked his
mother why they did not join. His mother said, “Well we’re Jewish and they don’t
allow Jews”, to which John replied, “Well if that’s what being Jewish means, I don’t
want any part of it”.5 He came to associate Judaism with food because his grand-
mother Sophie occasionally brought out Jewish dishes on Jewish holidays: matzah
ball soup, gefilte fish and “charley roose”. He disliked them all except the “charley
roose”, which was a simple adaptation of the French dessert Charlotte Russe con-
sisting of sponge cake, cream, chocolate (if you were lucky) and Maraschino cher-
ries, which he found sweet and delicious. There was never any mention of what the
holiday meant or was even called, so as far as John was concerned, it just meant
food. The Loeser family may have been exceptionally emancipated, since his friends
remember their first taste of pizza, Chinese takeaway and Friday night movies in the
Loeser house.6
5
JDL to JCB 21st August 2021.
6
Tony Levy to JCB 16th September 2021 Tony Levy is one of John’s childhood friends and not
related despite the Levy name.
2 Child. Draft 17
Rhoda, John’s mother, went to college for 1 year, and after college worked for a
while as a librarian. However, after marrying, she never did a paid job again. That
did not mean she was inactive or passive. In fact, the opposite was true: she was a
strong, independent woman and an activist. She probably took her stripes from her
father, who was a staunch and vocal supporter of the underdog. Rhoda’s mother
Sophie was the gentle member of the family whom John remembers would sit with
him for hours, talking, reading and playing board games with him if he was ill in
bed. Rhoda was very active in socially significant organizations, protesting preju-
dice of any kind. She was extremely liberal, like her father, and to her dying day was
interested in politics and joined various campaigns for equal rights.7 Much later,
after Lewis had become a highly successful neurologist/psychiatrist (the two always
being combined at the time), Rhoda’s early activism threatened to derail him. He
had a “carriage house” practice, meaning he treated the upper echelons of society,
which included a senator’s wife. He donated his time to Newark City Hospital,
where he was chief of neurology/psychiatry, and he was also the chief of neurology/
psychiatry and the local Veterans Administration (VA) hospital. At the time, VA
physicians were unpaid and gave their time to the VA, as they did to city hospitals,
as a civic duty. A new VA hospital was opened much closer to his home in East
Orange, but to transfer to the new VA, Lewis needed security clearance, which was
denied. This was 1952, at the height of McCarthyism. He immediately contacted the
senator, and before he knew it, the decision to deny security clearance had been
reversed. However, Lewis was not satisfied. He wanted to know why security clear-
ance had been denied in the first place. Only then was it revealed that Rhoda was the
problem because way back in 1936 she had picketed Bamberger’s Department Store
with a group of ladies who were members of the Urban League of the Oranges (later
deemed a communist front organization), protesting that they would not hire African
Americans. A communist was far from what she actually was.
John was as happy as can be in his childhood homes. From the moment he could
read, he became a prodigious reader. Since the homes were always full of books, he
had plenty with which to keep himself fascinated. John was a natural student, and
that meant that when school began to get serious, he was in his element, loved it, and
excelled. But he was by no means all work and no play. He had lots of interests, was
gregarious, and had many friends. He shared his father’s love of photography. Rhoda
had warned Lewis that now that he was a father, he was required to stay at home and
not gallivant off playing golf and tennis. The result was, as was the family joke, if
you wanted to spend time with Lewis, you had to go down to the basement. John did
spend much of his bonding time with his father in a dark room. John was not a natu-
ral athlete, but he enjoyed the comradery of sports. He and all his friends belonged
to the Cub Scouts, which had a baseball team and a football team. Because John was
big and slow, he was mostly used behind the plate in baseball and as an interior line-
man in football.8 He had many freedoms since the neighborhood was safe. He could
7
JDL to JCB 21st August 2021.
8
JDL to JCB 14th September 2021.
18 2 Child. Draft
walk to school unless it was raining, in which case there was a public bus. He could
go in and out of his friends’ houses, and they were in and out of his. The community
swimming pool was off limits because of the polio epidemics, but there was plenty
of outdoor space and a ravine nearby to muck around in, and family decamped to
the Jersey shore every summer. The only chores required of him, when the family
lived in a large drafty house with many open fireplaces, were to bring in and distrib-
ute the firewood weekly and deal with the screens and storm windows at the start of
summer and winter.
That John would always consider his childhood to have been heaven is testament
to his parents’ parenting since certain events threatened their own happiness. John
was blissfully unaware that his mother gave birth to stillborn twins just 2 years after
his own birth. He only discovered this when returning home from college in a taxi
from the South Orange Railroad station, and the taxi driver insisted he had taken his
mother to the Jersey shore when she was pregnant in 1937. John insisted he had
been born in 1935, but the taxi driver insisted this had been 1937. John then chal-
lenged his parents on the matter, and it was only then that he was told of the still-
birth.9 But for the parents, it had been a devastating event, especially for Rhoda,
who carried her grief for years. It had been so unexpected since she was young and
healthy, had a physician father and husband, and had access to the best medical
care.10 Whether it was grief or medical cause that prevented Lewis and Rhoda from
having another child, 4 years later they adopted Jane. John was too young to under-
stand that the more usual entry of a sibling into his world would have been tapping
his mother’s tummy to be told his little brother or sister was on the way. As far as he
was concerned, Jane just arrived, and he was told to help keep her safe. Jane’s story
is a difficult one. Before she was adopted, she had been passed from foster home to
foster home and abused.11 She arrived in the Loeser household a frightened 4-month-
old baby. The adoption placed her in the household of intellectual people living an
upper middle-class life, and she was never able to enter that world.12 The more the
parents tried to get her to conform, the worse things got. As John increasingly fit the
mold of his parents’ ideal, the more the tension built. But again, John was largely
protected because his parents shielded him from their problems and encouraged his
independence. Credit for this is also due to John himself, who, even as a child, was
determined that Jane’s problems were not going to interfere with his own ambitions.
As it turns out, this was a wise choice since the person the unfettered John became
was his parents’ greatest source of happiness and pride.
John and Jane had different lives, even as children. They were 4 years apart in
age. They went to different schools, different summer camps, had different friends,
and had completely different enthusiasms. In adult life, they were virtually estranged,
although John checks in on Jane periodically to this day. A rather nice coda to Jane’s
9
John Loeser’s recollections written for his children in 2015.
10
Tony Levy to JCB 16th September 2021.
11
Debbie Tauber (Jane’s daughter) to JCB.
12
Tony Levy to JCB 16th September 2021.
2 Child. Draft 19
story is that her first child Debbie sought refuge with Rhoda when she was 12 years
old and lived with her grandmother throughout her teenage years. Rhoda had been
recently widowed, and the arrangement provided great comfort and companionship
for both.
The second event that threatened John’s parents’ happiness was the Second
World War. Lewis enlisted in the Army Medical Corps soon after the start of the
war. He trained at Fort Rucker in Enterprise, Alabama, which John and his mother
visited once, for a week. He subsequently visited the family in New Jersey just once
more before being sent to England to be the commanding officer of an army neuro-
psychiatric hospital, first near Exeter in the south of England, then in Staffordshire
in the landlocked West Midlands. That was 1943, and John next saw his father in
1946. Lewis studied homosexuality in the military and wrote a seminal article on
the subject that is still cited today.13. Although he saw homosexuality as an aberra-
tion, in line with the thinking of the time, at the same time he believed that homo-
sexuals should be allowed to serve in the military ahead of his time. By the time he
left the army, Lewis had built a reputation in his field and had reached the rank of
Lieutenant Colonel.
John was only 8 years old when his father left for England and had reached the
age of 11 by the time he came home. These were formative years, and the only
communication John had with his father was by V-mail (Fig. 2.1). V-mail was an
aerogram lookalike used by the military that had limited space for writing. Each
was opened by a counter spy agency and then photographed so that what was
received was a 4″ × 6″ photograph of the letter. The V-mails to John were quite
perfunctory and usually ended: “look after your mother and sister”. John thought it
was strange that his 8-year-old self was being asked to look after his mother
and sister.
There were letters also to Rhoda, but letters were no substitute for being together
for any of them. Yet the separation would have been far worse if it was not for the
fact that Rhoda’s parents, Julius and Sophie, moved in with Rhoda to help her with
the children. The grandparents lived with the family throughout the war and for
several years after.
That the Levy grandparents were able to live with their daughter and grandchil-
dren turned a bad situation into a good situation. Grandmother Sophie brought a
sweet, gentle and comforting presence into the home. Grandfather Julius provided a
strong male presence as compensation for John’s father’s absence. It is hard to
imagine how Rhoda could have managed her two very different children with very
different needs without her parents. For John, it meant he grew up with two impor-
tant male role models: grandfather Levy and his father Lewis. There were plenty of
others, but these two inevitably dominated because of their large presence in John’s
young life.
Julius Levy had been to Princeton and then the College of Physicians and
Surgeons at Columbia University. He chose pediatrics as his specialty, and his life
13
Loeser, Lewis H. The sexual psychopath in the military service. Am. J. Psychiatr. 1945;102:92–101.
20 2 Child. Draft
Fig. 2.1 Aerogram to John from his father
was dedicated to the care of children. He rose through the ranks, and by the time
John knew him, he was a public health pediatrician for the state of New Jersey. He
was reputed to be one of the founders of the Beth Israel Hospital in Newark, where
John was later born. He was a man of highly liberal views and was jokingly described
by his children as an illiberal liberal, meaning he was tolerant of everyone except
people who were not tolerant. He had many aphorisms that influenced John, one of
which was “whatever you do, do not be average”. He was committed to social
2 Child. Draft 21
change and egalitarian social policies, established public and free well-baby care in
Newark, and hired some nurses of color. Those mothers who objected were told to
“move on”. That was 1908! He despised bigotry and popery, especially extreme
religious stances on abortion and other female freedoms. When Jane married an
observant Jew who insisted that a rabbi conduct the proceedings, Julius sat in the
front row and ostentatiously removed his hearing aids so that he was not subjected
to what he perceived as religious twaddle.
You would think Lewis Loeser was the son of Julius Levy, so similar were his
views, his motivations and his career path. Like his father-in-law, he went through
life working hard and amassing achievements. He went to a combined undergradu-
ate and medical school at Tufts University in Boston. He completed a psychiatry
residency in Massachusetts and residency in neurology at Mt. Sinai in New York
city in approximately 1928, at a time when any sort of formal training in psychiatry
was unusual. He was said to be the first private practice psychiatrist in New Jersey
to have received formal training. Despite history’s crediting of the birth of American
neurology to American Civil War physicians and intellectual giants such as Silas
Weir Mitchell and William A. Hammond, American neurology still had a hard time
breaking away from internal medicine.
During the early twentieth century, neurology as an independent specialty was
struggling, while psychoanalysis and psychiatry enjoyed most of the popularity.14.
Therefore, it made sense to combine disorders of the brain, and the American Board
of Psychiatry and Neurology was finally established in 1935. In that same year,
Lewis was instrumental in establishing a New Jersey neurological and psychiatric
organization. The American Board of Psychiatry and Neurology did not separate
into two fields until 1948, just after Lewis left the army and returned to civilian life,
and his practice in New Jersey. He was still actively practicing and advancing ideas
ahead of their time when he died tragically early at the age of 69 of a sudden and
massive heart attack.
He had spent the last years of his life advocating for low-cost psychological ser-
vices for the “emotionally troubled, mentally ill and retarded”.15 A Freudian psy-
choanalyst who had fled Hitler’s Germany joined Lewis’s practice at a time when
the medical association decreed that no physician should have a professional rela-
tionship with a PhD psychologist. The restriction was later lifted, but again, Lewis
Loeser was well ahead of his time. She later became a good friend of the family.
Lewis was honored after his death by the naming of a center for low-cost psycho-
therapy the Lewis H. Loeser Center for Low Cost Psychotherapy.
Although his Loeser grandparents, David and Estelle, were less in evidence, they
were still important to the family. David retired in 1938, when John was 3 years old,
so he was not known to John in a working role. He was a quiet man who loved
A revisionist history of American neurology. Stephen T. Casper. Brain 2010;133:638–642.

14
15
https://jhsnj-archives.org/?a=d&d=A19811029-NewJerseyJewishNews-19811029-01.1.28&e
=en-20%2D%2D1%2D%2Dtxt-txIN%7ctxTA%7ctxCO%7ctxTY%7ctxTI%7ctxRG%7ctxSG%
7ctxSE%7ctxSB%7ctxCT%7ctxIE%7ctxIT%7ctxTE%7ctxLA%7ctxSU%7ctxSP%7ctxDS%7ct
xAD%7ctxPR%7ctxTR%7ctxFI.
22 2 Child. Draft
reading, whereas Estelle was more loquacious. The opposite to the Levy grandpar-
ents. They lived in an apartment in East Orange, where John remembers that David
had a “nice little study”, and Estelle played Chopin on the piano. Every winter, they
would escape the cold and travel to the southwest, ending up somewhere around
Arizona. David would play golf at every stop, and Estelle would send John a post-
card from every city they stopped at. John and his mother plotted their course on a
map of the U.S. Their daughter Mildred and her husband Jules Newman, who had
been Lewis’s roommate in medical school, also lived close by. John’s uncle Jules
was another physician role model. He was a plastic surgeon who worked tirelessly
night and day on trauma victims, including traffic accident victims from the large
state turnpike nearby. Like Lewis, he joined the army at the start of WWII. His post-
ings were first in Virginia and then in Missouri, and his family went with him on the
postings.16 Jules and Mildred’s son James (Jim) became one of John’s closest
friends. The Newman children, Richard and Jim, spent a lot of time with the Loeser
children and were all quite comfortable in each other’s houses (and refrigerators)!17
They also spent the summers together, first in a rental house in Monmouth Beach on
the Jersey Shore. Later, both families built small riverfront houses on the Navesink
River in Rumson, New Jersey. Even after the Second World War ended, the families
continued spending much time together—especially the children. When it proved
impossible for the Levy grandparents to find accommodation because of quotas that
favored returning veterans over those already housed, Lewis bought a large house,
described by all as a mansion. The grandparents had their own suite on the second
floor, an arrangement that lasted another 3 years before an apartment was found for
the grandparents, and Lewis sold the property and bought a smaller house that the
family lived in throughout John’s high school years. But for years, the extended
family lived in a mansion, which also had an acre of land, a barn and a silo. As Jane
put it, they could have kept a cow.18 John was 15 years old and entering high school
when they left the big house, which had been a magnet for friends and family.
John had no shortage of remarkable role models during his childhood and
beyond, but the person he chose to emulate was his father. John worshiped his father
and set out to please him in any way that he could. It began when his father left for
military service overseas and charged his 8-year-old son with being the man of the
house and looking after his mother and sister, a request repeated frequently, and a
responsibility John took to heart. Once he was home again after the war, Lewis
determined to spend as much time as he could with his family. Even though he had
a busy professional life, he always came home for dinner, joined the family for
vacations, and spent time with John setting up his beloved model trains, mucking
about at the beach or in the small boat they owned, or teaching John how to develop
photographs. However, despite Lewis’s obvious affection for his family, he was
described as rather cold and unemotional, including by John himself. But was that
16
Jim Newman to JCB first October 2021.
17
ibid.
18
Jane Ransom to JCB 20th September 2021.
2 Child. Draft 23
just a protective front that belied a soft underbelly? Lewis’s own childhood could
not have been easy. However, by his teenage years, his parents had established
themselves back in Montclair New Jersey, where Lewis and his two younger sib-
lings had been born, much of his childhood before that had been spent in uncer-
tainty. His father David first sought a living in Wagoner, Oklahoma, and there “lost
his shirt”, according to Lewis. The family moved to Chicago and St Louis before
they were finally able to get back to New Jersey, where his father eventually had
some luck, things stabilized, and they became comfortably off. The young Lewis
Loeser probably learned to be tough during those years. While the adult Lewis
Loeser may have come across as remote, his relationships and achievements suggest
that beyond that remoteness, there must have been a very warm and emotional man.
While John may have learned his forthrightness from the Levy side of the family,
it was his father who taught him humility. He taught John how to live in a world in
which most people were not as bright as himself. As he later said, “If everyone else
had your brain and motivation, they would have your job.”19 He taught him to respect
and admire people for their contributions, whatever their level of ability. He taught
him to be kind to people who were struggling. He taught him that the greatest source
of happiness was giving, not taking. He taught him to be grateful for what society,
and particularly America, had given him. He taught him patriotism. It is all what
made John a good doctor, a leader in his chosen profession and a good parent.
When John was 11 years old, Lewis started taking him on Saturday ward rounds.
So began John’s fascination with the mind. He once took a pickled human brain into
the classroom and discovered that his classmates were not as intrigued by the speci-
men as he was. When he was 13 years old, his father took him to see an autopsy of
a patient who had died after a mysterious brain illness. As John later wrote, “I can
still see the pathologist with his scalpel and saw incising the scalp and then the skull
and then taking the brain out. It was sliced, and an intrinsic brain tumor was identi-
fied as the cause of death. I told my father then and there that I intended to become
a neurosurgeon so I could look inside the skull before someone dies and effect better
treatments”.20 And that is exactly what he did.
19
JDL “RECOLLECTIONS” 2015.
20
ibid.
Chapter 3
Draft. The Decorated War Hero
Why on Earth was John in Vietnam? Couldn’t he get out of it, as had so many of his
peers? He almost managed to run the clock, but not quite. In 1953, his last year in
high school, he requested deferment from the Korean War so that he could go to
college. By the time of his second deferment in 1957, the war in Korea had ended,
but there was a war in Vietnam. He deferred so that he could go to medical school.
In 1962, he deferred yet again, this time to do his residency in neurosurgery. In
1967, toward the end of his residency, he received a letter stating that he was going
to be offered a commission, but not quite yet. He needed a job, so he accepted a
position as neurosurgeon in the newly created UC Irvine Medical School, California,
working in the affiliated Long Beach Veterans Administration (VA) Hospital. The
family, John, his wife Susan who was pregnant, his daughter Sally who was 4, and
his son Tom who was 1, moved from Seattle to Long Beach. It was understood all
around, including by his employers, that he might be called upon to serve any day.
In December 1967 it came: notice that his commission would be activated on
January 20th. It was a 20-year war that ended in 1975, the last draft call being in
1972. John was 33 years old when he was commissioned and would have been too
old for recruitment at 36. He had almost got away with it.
When he received his commission, John was just a few months into his first
Post-residency job, and his third child Derek had been born only months before. He
was opposed to the war,1 but by the time the commission arrived, the options were
not very good for doing anything other than accept. The draft board letter said, “We
are prepared to offer you a commission as a captain. If you choose not to accept this
commission, we will draft you as a private in the infantry”. He could have moved
to Canada for the rest of his life, which many people did. He could have gone to jail
1
In 1967, John joined an anti-war group founded by John Kerry, Vietnam Veterans Against the War
(VVAW), to oppose the United States policy and participation in the Vietnam War. VVAW is
widely considered to be among the most influential anti-war organizations of the American
Vietnam War era.

Switzerland AG 2023
26 3 Draft. The Decorated War Hero
for 5 years, but then he would not be able to practice medicine when he got out of
jail. There truly was not much choice other than to accept. He rationalized his
acceptance, despite his profound opposition to the war, by saying to himself, “I’m
going over there to take care of the wounded and injured, and that’s an OK thing to
do. Those kids over there, they’re taking a risk, and somebody needs to take care of
them. They’re loyal to their country. They don’t want to be there any more
than I do.”2
Was it Like MASH the Movie?
I asked John if it was like MASH the movie and the television comedy series. Were
there high jinks, and was the atmosphere similar? Yes, he said, it was exactly like
MASH. There were differences, of course. It was Vietnam and not Korea. It was hot
and humid and not cold and dry. It was not a mobile unit (Mobile Army Surgical
Hospital); it was an evacuation hospital. The hospital was not in tents but in a
T-shaped building that had been a school. The receiving rooms, labs and operating
rooms were downstairs, and the wards were upstairs. Yet the atmosphere was very
much like the MASH depicted by the film makers. And, yes, when the medics were
not working, there were high jinks. John arrived in Vietnam by ship.3 The men
scrambled down the cargo nets into the landing crafts in Danang and were taken to
tents where they stayed for 5 days. The hospital the army had intended for John’s
group was not going to be ready for months, so the army had to decide what to do
with the medical team in the meantime. They decided to distribute the personnel and
equipment around the existing hospitals. In fact, in the end, the new hospital was
never built. John was sent to the 67th evacuation hospital on the coast halfway
between Danang and Saigon. He arrived by plane at dusk and was shown to his
room in the bachelor officers quarters. The building was a long wooden construction
with multiple small units, with bathrooms in a separate building. The units had a bed
and a little dresser, and nothing else. The walls were paper thin. John was exhausted,
plopped down his duffle bag, and tried to fall asleep. However, he soon realized it
would be difficult to sleep because the officer in the next room was having very
noisy sex with his girlfriend, all night! In the morning, John and the officer next
door stepped out of their rooms and looked at each other. They had been in high
school together, and here they were in Vietnam, 20 years later. The schoolfriend was
2
JDL to JCB 11th October 2022.
3
Why did they go by ship and not get flown out? The ship was primarily used to transport Korean
mercenaries to Vietnam. However, it was periodically sent back to the U.S. for refurbishing. It was
in Long Beach and had to get back to Vietnam, but it was not going to be sent empty. Therefore,
the army put 5000 soldiers on the ship, including two complete hospitals. The ship had been built
for American President Lines, but it wallowed so much, the company refused to accept it. So it
became a US Navy transportation ship. It still wallowed, and everyone on the ship was sick. They
spent the 26 days of the trip either lying in the dark or out on deck looking out to sea.
Was it Like MASH the Movie? 27
a general surgeon known as Lurch on account of his height (6 foot, 6 inches) and the
fact that he lurched as he walked. His girlfriend was a nurse known as the Big Red
One4 on account of her beautiful long red hair. So from night one, it seemed that this
truly was going to be a MASH experience.
We all know that if you put a group of hot-blooded young men into a war zone,
away from home, and away from female company, they are going to spend much
of their leisure time thinking about and seeking out sex. One of the jobs John and
the other officers were required to do was patrol the beach and try and keep the
enlisted men away from nurses. The enlisted men would use their leave to go into
Thailand, Hong Kong or Australia, and it was not for fine dining or casinos. John
was not remotely interested in these outings. He just wanted to be with his wife
and children. He saved up his leave so that he could spend time with them and had
a wonderful week with the family in the Halekalani Hotel in Waikiki on O’ahu.
Six months later, he spent a week touring Japan with just Susan, while his mother
babysat the children back home in Seattle. Still, John was no prude. He was
amused by, even if not engaged in, some of the more raunchy antics of his fellow
soldiers. When it came to partying, he was as willing a participant as any. Since
the surgeon’s shifts were 24-h shifts, congregating to play cards and imbibe was
a good way to stay awake long enough to then sleep through the morning heat.
Alcohol was easy to obtain on base, and it was cheap. The airfield commander
lived in an air-conditioned trailer not far from the bachelor officers quarters. This
made him very popular with the medical officers who had to suffer the tropical
heat in their quarters, which did not have air-conditioning. The airfield com-
mander had a nasty habit of visiting the brothels downtown, and he did not want
anything in his medical record about that. Therefore, the docs provided him with
antibiotics obtained from the pharmacy as prophylaxis against venereal disease
in exchange for the use of his trailer for partying. If you were clever, which they
were, you could exchange alcohol for beef, lobster tails, chicken and pork. They
even obtained a walk-in freezer for their booty so that they would have a ready
supply of half-decent (compared with canteen food) meat, chicken and lobster
for barbeques. When the hospital commanding officer was on leave, a group of
medics, including John, painted FTA, which is code for f*** the army, on the top
of his trailer, in large white letters. The commanding officer did not notice this
until he was up in a helicopter months later. But when he did, he was furious. He
sent a detail of G.I.’s up to his roof to whitewash the letters, to the applause of
the docs.
Some of the medical officers did not want to go off base because they felt safer
on base. However, John wanted to experience all he could of the beautiful country
in which he found himself, even if he had not chosen to be there. When he could, he
went out on navy swift boat patrols around the South China Coast. The patrols were
4
The Big Red One has special meaning in the army, hence the humor. It is the nickname given to
the 1st Infantry Division on account of its shoulder patch, which was red. The 1st Infantry Division
was formed in 1917 during WWI and has seen continuous service since then. There is also an epic
war film released in 1980 called The Big Red One.
used to collect intelligence, using the docs who provided basic medical care to the
Vietnamese in their villages as a front. It was risky, but worth it to John because he
felt he was contributing something valuable to the people, not just shooting at them,
and the countryside and coastline were spectacular. There were also rather risky ‘joy
rides’ with the airfield commander, who had to fly a certain number of hours to keep
up his credentials. He would borrow a plane that was temporarily parked at the air-
field and go for a ride, doing ‘touch and go’5 at all the airfields around. Two or three
times a year, John volunteered to go to the local leprosarium to provide medical care
to the lepers.6 The leprosarium was a half hour helicopter ride south of the airfield.
The team consisted of nurses, surgeons and an anesthesiologist. Most of the surger-
ies were wound cleaning procedures, open wounds being common in lepers since
the disease destroys their sensory nerves. The leprosarium was run by French nuns,
who in exchange for medical care fed the doctors a splendid French lunch with fine
wines on an open veranda looking out over the South China Sea. That was an unfor-
gettable treat in the middle of a war zone. A lovely place, with children running
around (since it was whole families that lived in the leper colony), and they were all
so grateful. Another memorable occasion was the wedding of one of the nurses to a
helicopter pilot. Several helicopters came and landed at the hospital and picked up
the bride, bridesmaids and the wedding guests, which included John. The helicop-
ters flew them to the helicopter base where everything was set up for the wedding,
including a minister and champagne. They had a splendid celebration and were then
flown back to the hospital.
The stories are numerous. A neurosurgeon boarded the ship that was taking the
hospital crew out to Vietnam with three five-gallon Clorox bottles hanging from his
rucksack. The others wondered what sort of a nut job he was, until they got under-
way when he opened the bottles and poured Martinis for everyone. At the airfield,
cargo planes would deliver supplies to the hospital. On one occasion, the crew chief
got off the large C130 Hercules cargo plane that had taxied over to the hospital car-
rying a box. The box was an Armed Forces Institute of Pathology specimen box
specifically constructed to keep pathological specimens cold. It had a timer on top,
and when the timer went off, whoever was in charge was supposed to open it up and
put in more dry ice. That plane had come from Washington DC via Japan. When the
crew chief entered the receiving room, he asked to see one of the surgeons who he
knew from back home, who happened to be the other neurosurgeon working with
John at the time.7 The neurosurgeon looked at the crew chief and at the box and said,
5
As part of keeping their credentials, they had to land and take off a number of times. Straight fly-
ing in the air was not enough.
6
For some reason, the Vietcong did not touch the leprosarium. Most likely because they feared the
disease, they did not understand that since the development of antibiotics, leprosy has been easily
treated and not caught from treated people. Or maybe because attacking the nuns would leave the
Vietnamese lepers without care.
7
Since they worked 24-h shifts, there were usually 2 neurosurgeons on base at any one time.
Occasionally, however, there was only one, and the other surgeons had to step in on the neurosurgi-
cal cases.
The Negatives 29
“great, come on guys, we’re going to have a party”. They went to the recovery room,
opened the box, and it was full of lox, bagels and cream cheese. Nothing else. They
must have been the most expensive bagels ever.
The Negatives
It was not the work that was stressful to John, as much as just being there. In fact,
as anyone who has been involved in both trauma and routine surgery can attest, it
is the routine surgery that is the more stressful, and in the 67th evacuation hospital,
it was all trauma surgery. When performing routine surgery, the patient is not
already harmed, so the pressure not to cause harm is immense. The trauma patient,
on the other hand, is already harmed, by somebody else, and you are just doing
your best to fix things, or in some cases to save a life. “If a patient died, you didn’t
feel as bad about it because you didn’t injure him. It was completely different.”8
What was far more stressful for John than the work was being away from his fam-
ily. He loved his wife and little children, and he truly missed them. He had always
tried so hard to fit his family into his busy schedule, to the extent that when his
firstborn, Sally, was young enough to have her sleep manipulated, he and Susan
kept their baby awake in the evenings so that John could spend time with her after
he finally left the operating room. Of course, that couldn’t last once she was older,
and once the other babies came along, but he still tried to spend as much time as he
possibly could with his children. John being commissioned in the army was the
start of a period of great instability for the family. Even after he had accepted his
commission, the army wasn’t sure where to send him. The family drove from Long
Beach to Fort Sam Houston, San Antonio Texas, for John’s 3-week basic army
training. Then, they drove, as directed, to Fort Bragg, North Carolina. However,
John was told he was not needed yet, so he was ordered take 3 weeks leave. They
drove down to Miami to see Susan’s parents, sold John’s car, and then flew to New
Jersey to spend time with John’s family. They then flew to Seattle so that Susan
could set up home there, since she did not want to live in Long Beach without John,
and had friends already in Seattle where they had lived during John’s residency. He
had to return to Long Beach immediately to be shipped out to Vietnam. Susan
found that year incredibly hard with three small children to look after, and a hus-
band in Vietnam whose safety she feared for. John found it equally hard because he
could not be with them. Separation was difficult for both of them. A real low point
for John was when he went to Hawaii on leave to join his family, and his baby son
Derek, who was 15 months old by that time, did not recognize him. This really
bothered John.
Being in the army medical corps in a hospital was not as dangerous as being in
the field, but it was not completely safe either. The airfield was surrounded by a
8
JDL to JCB 11th October 2022.
barbed wire fence, with guard towers periodically with armed men in them. The
Vietcong would sometimes overrun the American bases, and although they would
not touch the hospital, they would try and get to the fuel dump and blow that up.
All that separated the doctors in their beds from the Vietcong outside the base was
a dormitory wall that was a mere 20 yards from the barbed wire fence. The fence
was on a direct route from the fuel dump to the nearest Vietnamese village. It
seemed to John that safety did not seem to be an issue, that the docs must be con-
sidered cheap since they could just be drafted. He kept his army issue 45 caliber
pistol under his pillow and 2 hand grenades on the lintel over his door. He also kept
a 38 special revolver that he had confiscated from a wounded G.I. in his locker in
the operating room. If anyone without a U.S. uniform had come near him, he would
have thrown a grenade or shot him, aware that the Vietcong would kill any
Caucasian, whoever they were. And John was a very able marksman. When he was
in basic training at Fort Sam, he qualified for a sharpshooter award. But he was
denied a medal because, he was told, they do not give combat awards to medical
officers. John threatened to write in protest to his senator. He had not crawled
around under barbed wire and under machine gun bullets to be told he did not war-
rant a medal he had earned. So they put the award on his paperwork, but he still did
not get the medal. Other than protecting himself as best he could, John did not
actually think about his own safety very much, he was too busy for that. But doubt-
less, being in constant danger was another reason he longed to get home. He
counted the days, which were thankfully shorter than they need have been (360
minus 26) because the army in its wisdom had decided to ship rather than fly him
out, and that meant 26 fewer days in Vietnam!
The Positives
Nobody would pretend that going into a war, especially one that one did not sup-
port, would be a happy experience. However, there were some good things about
it. Probably at the top of the list would be the comradery John found in Vietnam.
“I have told many people that I have never worked with a finer group of people
than the docs in the 67th evacuation hospital. The physicians were the most
motivated, intensely work-oriented, caring docs. And the corpsmen9 and the
people who were supporting what we were doing, the motivation to take care of
the patients was unbelievable. It was just something else. It was real tight com-
radery. I mean absolutely. Everyone would pitch in to help. We never gave up.
And partly that’s because these were all young kids who survived all sorts of
things that you and I wouldn’t survive.”10 The experience was unlike anything he
had ever experienced before. When he took his first case, he found himself the
9
Enlisted members of the military medical unit.
10
JDL to JCB, 10th October 2022.
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xl Texte.
A cil a qui trop as meffait

Qui ne s’en peult venger de fait
Ne t’y fies/ car mal en prent
La mort achilles le t’aprent
xl Glose.
Achilles fist moult de griefz aux troiens & au roy priam occist
plusieurs de ses enfans hector troylus & autres dont haÿr le devoit/
non obstant ce achilles se fya en la royne hecuba femme priam a qui
il eut occis ses enfans par trahison et alla par nuit parler a elle pour
traicter du mariage de polixene sa fille et de luy & la fut occis par
paris & ses compaignons par le commandement de la royne sa mere
au temple apolin pour ce dit au bon chevalier que ne se doibt fyer en
son ennemy a qui trop a meffait sans faire a luy paix ne aulcune
amende. A ce propos dit ung sage/ garde toy des aguetz de ton
ennemy qui vengier ne se peult.
xl Allegorie.
Comme en celluy a qui as meffait ne te doibs fier. Nous

prendrons que comme nous devons doubter les vengances de dieu
soit necessaire tenir le commandement qui dit. Tu ne feras de
meschief/ c’est a dire de adultere ne de fornicacion/ et si est defendu
ce dit ysodore toute illicite couple charnelle qui n’est en cas de
mariage et tout desordonné usage des membres genitales. A ce
propos dit la loy.
Morte moriantur mechus et adultera levitici. xx. ca.

xli Texte.
Ne ressembles mie busierres

Qui trop plus mauvais que lierres
Sa cruaulté fait a reprendre
A telz faitz ne te vueilles prendre
xli Glose
Busierres fut ung roy de merveilleuse cruaulté et moult se

delectoit en l’occision des hommes/ et de fait luymesmes en ses
temples les occisoyt de couteaulz et en faisoit sacrifice a ses dieux.
Pour ce dit au bon chevalier que nullement ne se doit delecter en
l’occision de humaine creature. Car telle cruaulté est contre dieu
contre nature et contre toute bonté. A ce propos dit socrates au bon
conseillier se ton prince est cruel tu le dois amoderer par bons
exemples.
xli Allegorie.
Busierres qui fut homicide & contraire a humaine nature/ pouons

noter la defence que nous fait le commandement qui dit/ tu ne feras
point larcin/ et si est defendu ce que dit Sainct augustin toute illicite
usurpacion des choses d’aultruy tout sacrilege toute rapine toute
chose tollue par force/ & par seigneurie sur le peuple sans raison. A
ce propos dit saint pol l’apostre.
Qui furabatur jam non furetur. ad epheseos. iiii. ca.

xlii Texte
N’ayes pas si chier ta plaisance

Que trop mettes en grant balance
Ta vie/ que tu doibs aymer
Lehander est peri en mer.
xlii Glose
Lehander fut ung damoisel qui trop aymoit de grant amour Hero
la belle/ & comme il y eust ung bras de mer entre les manoirs aux
deux amans le passoit lehander tout a nage par nuyt moult
souventesfois pour sa dame veoir qui pres du rivage avoit son
chasteau affin que leur amour ne fust apperceue/ mais il advint que
ung grant orage de temps leva qui par plusieurs jours dura la marine
qui destournoyt la joye des amans. Si advint une nuyt que lehander
contraint de trop grant desir se mist en la mer au temps de l’orage &
la fut sy loing porté par les vagues perilleuses que il luy convint perir
piteusement/ Hero qui fut de l’autre part en grant soucy pour son
amy quant elle veit le corps venir flotant au rivage adonc estrainte
d’une merveilleuse douleur se getta en la mer & en embrassant le
corps pery elle fut noyee. Pource dit au bon chevalier que tant ne
doibt aymer son delit que pour ce doye mettre sa vie en trop grant
aventure. Si dit ung sage. je me esmerveille de ce que je voy tant de
perilz souffrir pour le delit du corps/ & faire si petite pourveance a
l’ame qui est perpetuelle.
xlii Alegorie.
Comme l’auctorité deffend que il n’ait si chiere sa plaisance peult

estre entendu le commandement qui dit. Tu ne parleras point faulx
tesmoignages contre ton prochain. Et si est deffendu ce dit sainct
augustin toute faulse accusation/ murmuration/ detraction/ tout faulx
rapport/ & diffamation d’aultruy & est assavoir ce dit ysodore que le
faulx tesmoing fait villanie a trois parties/ c’estassavoir a dieu que il
despite en le parjurant/ au juge que il desçoyt en mentant/ & a son
prochain que il blesse en faulcement contre luy deposant. Et pour ce
dit l’escripture.
Testis falsus non erit impunitus/ & qui loquitur mendacia non
effugiet. Proverbiorum. xix. capitulo.
xliii Texte
Rens helaine s’on la demande

Car en grant meffait gist amende
Et mieulx vault tost paix consentir
Que tard venir au repentir
xliii Glose.
Helayne fut femme au roy menelaus & ravie par paris en grece/ &
quant les grecz furent venus sur troye a grant armee pour la
vengeance d’icelluy fait/ ains qu’ilz meffeissent a la terre ilz requirent
que helayne leur fust rendue & amende leur fust faicte de celle
offence ou si non ilz destruiroient le pays/ et pource que riens n’en
voulurent faire les troyens s’en ensuyvit le grant meschief qui depuis
leur advint/ pour ce veult dire au bon chevalier que se il a folie
encouvenancee mieulx lui vault la delaisser & faire paix que la
poursuyvre que mal ne luy en aviengne. pour ce dit le philosophe
Platon. Se tu as fait injure a qui que ce soit tu ne doibs estre aise
jusques a tant que tu soyes a luy accordé et fait paix.
xliii Alegorie.
Helayne qui doit estre rendue peult estre entendu le

commandement qui dit. Tu ne desireras point la femme de ton
prochain par quoy est deffendu ce dit sainct augustin la pensee & la
voulenté de faire fornication dont le fait est deffendu devant par le.
vi. commandement/ car dit nostreseigneur en l’evangile.
Qui viderit mulierem ad concupiscendam eam jam mechatus

est in corde suo. Matthei. vi. capitulo.
xliiii Texte
Ne ressemble pas la deesse

Aurora qui rent grant leesse
Aux aultres quant vient a son heure
Et pour soy tient tristesse & pleure.
xliiii Glose.
Aurora c’est le point du jour & disent les fables que c’est une
deesse et que elle eut ung sien filz occis en la bataille de troye qui
cinus fut nommé & pour ce que deesse estoit elle avoit la puissance
de ce faire elle mua le corps de son filz en ung cinne & de la vindrent
les premiers cinnes. Celle dame estoit de sy grant beaulté que elle
resjouissoit tous ceulx qui la veoyent/ mais toute sa vie ploura son
filz cinnus qui fut mort & encore le plore ce dit la fable/ car la rousee
qui chiet au point du jour disent que c’est aurora qui plore son filz
cinnus/ Pource dit que le bon chevalier qui par ses bonnes vertus
resjouist les aultres ne doibt estre triste mais joyeux & moderé
gratieusement/ pource dit Aristote a Alixandre le grant/ quelque
tristesse que ton cueur ait doibs tousjours monstrer lyé visage
devant ta gent.
xliiii Alegorie
Aurora qui pleure pouons entendre que nul desir ne doibt plourer
en nous par couvoiter chose non deue. Et par ce pouons nous noter
le .x. et derrenier commandement qui dit. Tu ne couvoiteras pas la
maison de ton prochain/ ne son beuf/ ne son asne/ ne chose que il
ait/ parquoy ce dit sainct Augustin est deffendue la voulenté de faire
larrecin ou rapine/ dont le fait est deffendu devant par le .vii.
commandement/ et a ce propos dit David en son psaultier.
Nolite sperare in iniquitate. Rapinas nolite concupiscere.

xlv Texte.
Pour tant se pasiphé fut folle

Ne vueilles lire en ton escolle
Que telles soyent toutes femmes
Car il est maintes vaillans dames
xlv Glose.
Pasiphé fut une royne et disent aucunes fables que elle fut
femme de grant dissolution & mesmement que elle ayma ung
thoreau et que mere fut mynothaurus qui fut moitié homme & moitie
thoreau qui est a entendre que elle acointa ung homme de vile
condicion de qui elle conceut ung homme qui estoit de grant cruaulté
& de merveilleuse force/ et pource qu’il eut forme de homme &
nature de thoreau & ce que il fut fort et de grant aspreté et si
mauvais que tout le pays essilloit/ disrent les poetes par fiction que il
fut moitié homme et moitié toreau et pour ce se ceste dame fut de
vile condicion veult dire au bon chevalier que il ne doit dire ne
souffrir qu’il soit dit que toutes femmes soient semblables comme la
verité soit manifeste au contraire. Galien aprint la science de
medecine de une moult vaillante femme & sage appellee clempare
qui luy aprint a congnoistre maintes bonnes herbes et leurs
proprietez.
xlv Allegorie.
Pasiphé qui fut folle pouons entendre l’ame retournee a dieu. Et

dit saint gregoire es omelies que plus grant joye est menee aux
cieulx d’une ame retournee a dieu que de ung qui a tousjours esté
ainsi comme le capitaine en la bataille ayme mieulx le chevalier qui
s’en estoit fuy et puis est retourné/ & apres son retour a fort navré
l’ennemy que cellui qui n’a fait nul beau fait. et comme le laboureur
aime mieulx la terre qui apres les espines porte abondamment fruit
que celle qui n’eut oncques nulles espines & n’a point porté fruit. A
ce propos dit dieu par le prophete.
Revertatur unusquisque a via sua pessima & propicius ero

iniquitati & peccato ipsorum. Hieremie. xxvi. ca.
xlvi Texte
Se filles as a marier
Et tu les veulx aparier
A hommes dont ne mal te vienne
Du roy adrastus te souvienne
xlvi Glose.
Adrastus fut roy de arges & moult puissant & preudhoms deux
chevaliers errans l’un appelle polmites & l’autre thideus se
combatoient par nuyt obscure soubz le portail de son palais dont l’un
calengoit le logis de l’autre pour cause du fort temps & de la grosse
pluye qui les avoit toute nuit tormentez & la s’estoient d’aventure
embatus/ A celle heure le roy se leva qui avoit ouy la noise de
espees sur les escus & vint departir les deux chevaliers. Polmites
estoit filz au roy de thebes & thideus a ung aultre roy de grece mais
de leurs terres furent exillez/ grandement honnora Adrastus les deux
barons puis leur donna en mariage deux moult belles filles que il
avoit/ apres pour mettre polmites au droit de sa terre que ethiocles
son frere tenoit fist grant armee le roy adrastus & sur thebes allerent
a grant ost desconfitz & mors & prins y furent tous & les deux
gendres du roy mortz/ & les freres dont le descord estoit s’entre
occirent en la bataille & ne demeura de tous fors adrastus luy tiers
de chevaliers/ & pour ce que a gens exillez remettre en leurs droictz
a moult affaire dit au bon chevalier que en tel cas doibt avoir conseil
& se doibt mirer en la dicte aventure/ & comme Adrastus eut songé
une nuyt que il donnoit ses deux filles par mariage a ung lyon & a
ung dragon qui ensemble se combatoient/ dit l’expositeur des
songes que songe vient de la fantasie qui peult estre demonstrance
de bonne ou de male aventure qui doibt advenir aux creatures.
xlvi Alegorie
Ou il est dit que se filles a a marier que il garde a qui il les

donnera/ nous pouons entendre que le bon esperit chevalereux a
dieu doibt bien regarder a qui il s’acompaigne s’il advient qu’en
compaignie vueille aller comme fist le bon thobie/ aussi doit toutes
assigner ses pensees en sainctes meditations & dit sainct augustin
en ung epistre que ceulz qui ont aprins de nostreseigneur a estre
debonnaire & humbles proffitent plus en meditant & en priant que ilz
ne font en lysant & en oyant/ pource disoit david en son psaultier.
Meditabar in mandatis tuis que dilexi.

xlvii Texte
De cupido/ se jeune & cointes

Es/ assez me plaist que t’acointes
Par mesure comment qu’il aille
Il plaist bien au dieu de bataille.
xlvii Glose
Cupido c’est le dieu d’amours/ & pource qu’il ne messiet point a

jeune chevalier estre amoureux de dame qui soyt vaillable/ ains en
pevent mieulx valoir ses condicions mais que le moyen y sache
garder & qui est chose assez advisant aux armes/ dit au bon
chevalier que elle consent assez que de cupido s’acointe/ & dit ung
philosophe que aymer de bon courage vient de noblesse de cueur.
xlvii Alegorie
Que bien plaist au dieu de bataille que de cupido s’acointe peult

estre entendue penitance se le bon esperit repentant de ses pechez
batailleur contre les vices est jeune & nouvel entré la droicte voye
bien plaist au dieu de bataille c’est jesuchrist que il s’acointe de
penitence & que jesuchrist par sa digne bataille fut nostre
redempteur dit sainct bernard/ quel mot dit il de plusgrant
misericorde peult on dire au pecheur qui estoit damné que la ou il
s’estoit vendu par peché a l’ennemy d’enfer & n’avoit de quoy se
racheter dieu le pere dist pren mon filz & le baille pour toy & le filz
dist pren moy & te rachete par moy. Cecy ramentoit sainct pierre
l’apostre en sa premiere epistre.
Non corruptibilibus auro vel argento redempti estis : sed

precioso sanguine quasi agni incontaminati et immaculati jesu
christi. prima petri. i. ca.
xlviii Texte
N’occis pas corinis la belle

Pour le raport & la nouvelle
Du corbel/ car se l’occioyes
Apres tu t’en repentiroyes.
xlviii Glose
Corinis fut une damoiselle comme dit une fable que phebus ayma
par amours le corbel qui adonc le servoit luy apporta qu’il avoit veu
corinis s’amye gesir avec ung aultre damoisel/ de celle nouvelle fut
tant dolent phebus que il occist s’amye des que il la veit mais a
merveilles s’en repentit apres dont le corbel qui guerdon attendoit a
avoir de son seigneur pour ce bien fait en fut mauldit & chassé & la
plume que il souloit avoir blanche comme nege luy mua phebus en
noire en signe de douleur & l’ordonna phebus des lors porteur &
anonceur de males nouvelles/ & peult estre entendue l’exposition
que le serviteur d’aulcun puissant homme luy raporta semblables
nouvelles dont il fut chassé & deffait. Pour ce veult dire que le bon
chevalier ne se doibt avansser de dire a son prince nouvelles dont il
ait le cueur couroussé/ car a la fin ne luy en pourroit bien venir/ &
aussi ne doibt croire raport qui luy soit fait par flaterie. A ce propos
dit le philozophe hermes. Ung raporteur ou controuveur de nouvelles
ou il ment a celuy a qui il les raporte ou il est faulz a celuy de qui il
les dit.
xlviii Alegorie
Corinis qui ne doibt estre occise nous entendrons nostre ame

que nous ne devons occire par peché mais bien la garder. Et dit
sainct augustin que l’ame doibt estre gardee comme le coffre qui est
plain de tresor & comme le chastel qui est assiegé des ennemys &
comme le roy qui se repose en sa chambre de retrait et doibt estre
ceste chambre close de cinq portes qui sont les cinq sens de nature
& n’est aultre chose clorre ses portes sinon que retraire les
delectations des cinq sens et s’il advient que l’ame doye yssir par
ses portes a ses operations foraines elle doibt meurement &
rassisement & en discretion yssir & ainsi comme les princes quant ilz
veullent yssir de leurs chambres ou ilz ont huyssiers devant eulx
tenans maces pour faire voye en la presse/ ainsi quant l’ame doit
yssir a veoyr ouyr/ parler/ & sentir/ elle doibt avoir devant soy paour
pour huyssier qui doibt avoir pour mace la consideration des peines
d’enfer & du jugement de dieu/ & de ainsi garder son ame
amonneste le sage.
Omni custodia serva tuum cor quoniam ex ipso vita procedit.

Proverbiorum. iiii. capitulo.

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John Loeser: The Man Who Reimagined

Pain Jane C. Ballantyne

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The Man Who Didn't Fly Margot Bennett

The Duke Who Loved Me Jane Ashford

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The Man Who Wrote the Perfect Novel: John Williams,

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Knowing our limits Ballantyne

John Haynes: The Man Behind the Manuals Ned Temko

ISBN 978-3-031-39046-3 ISBN 978-3-031-39047-0 (eBook)

Paper in this product is recyclable.

research—that remains in my view a concept deeply relevant to all fields concerned

There is something down-to-earth and accessible in John Loeser’s style that

Emeritus of Literature David Brown Morris

Seattle, WA, USA Jane C. Ballantyne

Asgaard, George N 1914–1997 Dean of UW Medical School

Ellenbogen, Richard G. Professor and Theodore S. Roberts Endowed Chair of

White, James C. 1896–1981. Professor, Harvard, Massachusetts General

Appendix A: List of Photos ������������������������������������������������������������������������������ 135

Appendix B Timeline ���������������������������������������������������������������������������������������� 155

Appendix C Characters ������������������������������������������������������������������������������������ 157

Appendix D List of Delegates and Speakers—International

© The Author(s), under exclusive license to Springer Nature 1

The Clinic to Which They Flocked

Fordyce tells a rather self-deprecating story about how it all began.7

The Loeser Onion

Fig. 1.1 Loeser onion

© The Author(s), under exclusive license to Springer Nature 13

Fig. 2.1 Aerogram to John from his father

A revisionist history of American neurology. Stephen T. Casper. Brain 2010;133:638–642.

© The Author(s), under exclusive license to Springer Nature 25

Was it Like MASH the Movie?

A cil a qui trop as meffait

Comme en celluy a qui as meffait ne te doibs fier. Nous

Morte moriantur mechus et adultera levitici. xx. ca.

Ne ressembles mie busierres

Busierres fut ung roy de merveilleuse cruaulté et moult se

Busierres qui fut homicide & contraire a humaine nature/ pouons

Qui furabatur jam non furetur. ad epheseos. iiii. ca.

N’ayes pas si chier ta plaisance

Comme l’auctorité deffend que il n’ait si chiere sa plaisance peult

Rens helaine s’on la demande

Helayne qui doit estre rendue peult estre entendu le

Qui viderit mulierem ad concupiscendam eam jam mechatus

Ne ressemble pas la deesse

Nolite sperare in iniquitate. Rapinas nolite concupiscere.

Pour tant se pasiphé fut folle

Pasiphé qui fut folle pouons entendre l’ame retournee a dieu. Et

Revertatur unusquisque a via sua pessima & propicius ero

Ou il est dit que se filles a a marier que il garde a qui il les

Meditabar in mandatis tuis que dilexi.

De cupido/ se jeune & cointes

Cupido c’est le dieu d’amours/ & pource qu’il ne messiet point a

Que bien plaist au dieu de bataille que de cupido s’acointe peult

Non corruptibilibus auro vel argento redempti estis : sed

N’occis pas corinis la belle

Corinis qui ne doibt estre occise nous entendrons nostre ame

Omni custodia serva tuum cor quoniam ex ipso vita procedit.

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Seattle, WA, USA Jane C. Ballantyne

Appendix A: List of Photos �� 135

Appendix B Timeline �� 155

Appendix C Characters �� 157

Appendix D List of Delegates and Speakers—International

The Clinic to Which They Flocked

The Loeser Onion

Was it Like MASH the Movie?