Leslie Brent and the Mysterious German Surgeon

In a 3 and a half page article in the October 3, 1953, issue of Nature,¹ and more extensively in 1956 in the Philosophical Transactions of the Royal Society of London,² Billingham, Brent, and Medawar reported the successful transplantation in mice of the immune cells (leukocytes) that make up the normal bone marrow, spleen, and lymph nodes. The donor cells were obtained from adult mice and infused intravenously into unaltered newborn mouse recipients whose immune system was not yet sufficiently developed to reject the cells. When the recipient mice grew up, they could freely accept skin and other tissues from the original cell donor, but from no other donor. These world's first examples of acquired transplantation tolerance led to Medawar's corecipiency (with F. Macfarlane Burnet) of the 1960 Nobel Prize. Medawar shared his portion of the cash award with Billingham and Brent.

The sobriquet “holy trinity” was applied to Billingham, Brent, and Medawar when their 1953 observations escalated during the next 15 years to clinical bone marrow and organ transplantation. Peter Brian Medawar, the senior author of their seminal paper, was a 38-year-old zoologist, who in World War II-related duties had demonstrated a dozen years earlier that the barrier to successful transplantation is a donor-specific immune response.³ The rank order of authorship in all publications by Medawar's research group was determined alphabetically. Accordingly, the lead author of the 1953 Nature article was 32-year-old Rupert Billingham, who had spent the war as a lieutenant on antisubmarine escort vessels. Five years after completing their famous 3-author paper, Billingham moved to the Wistar Institute in Philadelphia and developed a fruitful collaboration with the future University of Pennsylvania surgery chairman, Clyde Barker, before moving to the University of Texas (Dallas) as Chairman of the Department of Cell Biology and Anatomy. Medawar died in 1987 (at 71 years) and Billingham in 2002 (81 years).

The third author, Leslie Brent, was the youngest. Brent was born on July 25, 1925 (his birth name was Lothar Baruch) in Köslin, a small German market town that is now a thriving Polish city of 110,000 (spelled Koszalin). Because of being persecuted in the predominantly non-Jewish local schools, his family placed him in a Jewish orphanage in Berlin in 1936 (Fig. 1); his parents and sister moved to Berlin the following year. After the Kristallnacht pogrom of November 8–10, 1938 (“the night of broken glass”), the young Brent escaped to England in the Kindertransport operation that saved 10,000 Jewish children from extermination. Neither his parents nor anyone else in his immediate family survived the Holocaust. After a stint in the British infantry between ages 18 and 22 (1943–1947, final rank captain; Fig. 2), he became Medawar's student and later his associate (Fig. 3). In 1969, he was appointed Professor of Immunology at St. Mary's Hospital and Medical School, London, a position held with distinction until his retirement in 1990 (Fig. 4).

FIGURE 1. Leslie Baruch at the age of 10, before entry into the Jewish orphanage in Berlin.

FIGURE 2. Leslie Brent, the 21-year-old infantry officer whose adopted name was registered in England as an antigenocide precaution in the event of capture.

FIGURE 3. Leslie Brent approximately 40 years old, with his scientific mentor/colleague, Peter Medawar.

FIGURE 4. Leslie Baruch Brent in his 80th year (photo by Z. Pacholski Liszalin, Poland). The birth name, Baruch, was officially restored (as Brent's middle name) in the late 1990s.

Brent made no secret of his early difficult life, but it was not a subject upon which he cared to dwell. Recently, he authorized me to make public my correspondence with him that took place during 1996–1997, along with my related correspondence with 2 distinguished German surgeons. One of the surgeons was Rudolf Pichlmayr, Dhc, MD, Professor and Chairman, Department and Clinics of Abdominal and Transplantation Surgery, Hannover University Medical School. An Honorary Fellow of the Royal College of Surgeons (Eng) and of the American College of Surgeons, Pichlmayr was the principal speaker at the transplantation session of the World Congress of Surgery in Acapulco, Mexico, on August 29, 1997. During an early morning swim, he apparently was caught in an undertow and drowned. He had just turned 65 years old and was deeply mourned throughout Germany and the world.

The other surgeon was Michael Trede, BA, MD, BChir, Professor and Chairman of the Mannheim Surgical Clinics and University of Heidelberg Medical School. Trede was a major figure after World War II in restoring Germany's place in international surgery. He is an Honorary Fellow of all 4 British Royal Surgical Colleges; an honorary member of the American Surgical Association and American College of Surgeons; and coeditor Emeritus of the World Journal of Surgery. Trede recently published a German-language autobiography⁴ in which the same events are described as in the following self-explanatory letters.

April 16, 1996: From Thomas Starzl (TES) to Leslie Brent

Dear Leslie, I was in Berlin last week to give a talk to the Deutsche Gesellschaft für Chirurgie. Rudi Pichlmayr is this year's president, and he assigned me the topic, “The Epoch of Organ Transplantation.” Because I began this epoch with your 1953 article, I showed pictures of you, Billingham, and Medawar—including one of you that was taken before you left Köslin [age 11 years]. After I had finished, an old man approached me and said that he had been your youthful classmate, adding that he knew you by your birth name, Lothar Baruch.

I was surrounded by 30 or 40 people at the time and before I could extricate myself or find out his name, the man was gone. I had the impression that he was moved to find that someone he had admired and liked 60 years or longer ago was alright. He indicated that he would be writing you.

April 23, 1996: From Leslie Brent to TES

Dear Tom, Your anecdote about the old man who was a classmate of mine (presumably in Berlin??) was astounding and I dearly would like to know who it was. I do hope that he will write to me. If you happen to have a list of participants, that could conceivably solve the problem if you could send me a copy. What made you show the picture of me as a boy in the first place?? What a good thing you did, though.

The mysterious threads of life are coming together in other ways for me, too. My former secretary Gill lent me a book written about, and partly by, a man who came to England from Germany in 1939 to be adopted by a well-known couple. In a throw-away line, he mentioned that his brother (who died with the rest of his family) had been a tutor in a Berlin orphanage. It took Carol's prodding [Brent's wife] before the penny dropped: I do remember his brother as a teacher in the orphanage in which I spent 2 years before leaving Germany! Unfortunately, this man, who became a highly respected teacher himself, died a few years ago.

May 1, 1996: From TES to Leslie Brent

Dear Leslie, I was so relieved to realize from your letter of April 23 that my report from Berlin had not reawakened painful memories. I can add only a few details. First, it seemed to me that the old man had tears in his eyes at the time of our encounter. Second, he told me that you were a “great sportsman,” which led me to believe that he knew you toward the end of your stay in Germany. He obviously was proud of this.

Rudi Pichlmayr was the chairman of the session, and was close to me at the time of the encounter. Although I do not have a list of the Deutsche Gesellschaft für Chirurgie membership, I am going to write Rudi and ask for his help in identifying the mysterious stranger. Perhaps I should mention that I showed 4 pictures of you—when you were a youngster, with Medawar on a veranda, with Billingham hovering over a mouse, and recently.

May 1, 1996: From TES to Rudolf Pichlmayr With a Follow-up Note

Dear Rudi, I hope that you can help me solve a minor mystery that surfaced during my stay in Berlin. As you will remember, I showed some pictures of Leslie Brent during the talk, which resulted in a contact immediately after with an old man as I described in 2 letters to Leslie. In his response to the first of these letters, Leslie asked me for help in locating the person who spoke to me.

Do you think that you could help in running down this person? I was anxious to talk further with him, but I was already late for the press conference and was whisked away. If you could be a catalyst in establishing the connection between these boyhood friends, I am sure that Leslie would be grateful for the rest of his life.

Follow-up note dated May 8, 1996: This is a P.S. to my earlier letter [of May 1], with some details about the mysterious stranger. He was about 70 years old and about my height. Although he was of relatively slender build, he had the look of an old athlete which would fit his admiring description of Leslie Brent as a “great sportsman.” I believe that he had white hair, which at one time could have been blond. He may have had a mustache.

Leslie responded to my account of the encounter. It is obvious that he would really like to trace this thread to his early life back to the source. I do not know of anyone other than you who can make this happen.

May 7, 1996: From Leslie Brent to TES

Dear Tom, Thank you so much for contacting Pichlmayr. It's just possible that “the old man” (God, that makes me one, too!) was with me at school in Kent after arriving in England. It's a mystery I would love to solve.

May 8, 1996: From TES to Leslie Brent

Dear Leslie, The mysterious stranger in Berlin was definitely German, although he spoke good English. I am absolutely certain that he knew you as a schoolmate in Germany, rather than in England. It seemed to me that he knew as a child that you were in deadly peril, and that his emotional reaction came from the news that you had escaped. I wrote some other details in a second note to Rudi. If I know Rudi, he will not rest until the issue is resolved.

May 22, 1996: From Michael Trede to TES

Dear Thomas Starzl, Today I received copies of your letters to Rudi Pichlmayr concerning the “old man” who spoke to you about Leslie Brent at the end of your excellent lecture at the recent congress in Berlin.

Let me solve this mystery for you: I am the old man! And although I do not really feel all that old, and though I am not yet 70 (only 67!), I was really quite flattered by your excellent description of that person (but then, what would you expect from an observant surgeon?).

Anyway, I am very touched by the trouble you took to tell Leslie about our encounter and I am also very grateful to you because now I have his address and I am going to write to him directly this evening.

But while I have your attention and before I close this letter, I have a final request: Like many other “old men,” I am beginning to write my memoirs. But before I do, I simply must read yours! … Somehow I have never got hold of a copy while I was in the States.

May 28, 1996: From Leslie Brent to TES

Dear Tom, The mystery of the “old man” in Berlin has been solved—I imagine that Rudi Pichlmayr must have been in touch with him. I had a letter from him a few days ago together with a 2-page extract from his diary (1942!) describing in great detail a relay race in which I had taken part and in which I was overtaken by the best runner in the school by a fraction of a second ….

He was at school with me in Kent (a boarding school) and, being only half Jewish, eventually returned to Germany. His name is Prof. Dr. med. Dr. h.c. (WOW!) Michael Trede and he is still a practicing surgeon. He is 67 and continues to climb mountains up to 5000 meters, and found your description of him as an old man (Rudi must have passed that on) rather touching. He is an old friend of Rudi's and happened to sit next to him when you showed the slide of yore.

I shall visit him some time, probably next February if I am invited to the Austrian meeting again. So thank you very much for being instrumental in putting us in touch with each other after all those years.

June 7, 1996: From TES to Michael Trede

I was honored to belatedly realize that the person I was talking with was you. I have come across your work many times in past years, and now I realize that we belong to some of the same organizations. I hope that we will meet again and have a chance to exchange notes about memoirs.

Thank you again for coming to the podium after my talk in Berlin, and especially for the trouble you took to follow up. What a splendid pair of pioneers you and Leslie Brent have been.

P.S.: You may know that Leslie won the Medawar Prize in 1994, the highest distinction of the international Transplantation Society. I had the honor of presenting him (remarks enclosed).

June 7, 1996: From TES to Rudolf Pichlmayr

Dear Rudi, This is just a note to tell you how much I appreciated your efforts on behalf of Leslie Brent. I have heard from Leslie that Professor Trede contacted him (thanks to your detective work), and then from Professor Trede himself with a very friendly letter. I am sure that no one involved will ever forget the extra steps that you took to bring about what promises to be a wonderful reunion of these 2 old friends.

June 17, 1996: From Michael Trede to TES

Dear Tom, You will be pleased to hear that we are having Leslie Brent as our guest lecturer for a combined meeting of the Mannheim and Heidelberg Surgical Clinics in June [one year hence, 1997].

It will be my task to introduce him and as you can imagine, I would like to fit in that amusing story, of how you helped to connect us one with the other again. Do you think you could very kindly send me copies of the slides you showed at that lecture in Berlin (April 1996) of Leslie as a very young man and in the laboratory with Billingham and Medawar?

I was sorry to have missed you at the American Surgical Association Meeting in Quebec. It was an excellent meeting. Looking forward to seeing you some other place soon, I am … Sincerely yours.

July 1, 1997: From Leslie Brent to TES

Dear Tom, The “old man” —a description that seems to have cut him to the quick (well, not really) —is 3 years younger than I am and that of course explains that we were never close friends at school, although we remember each other extremely well. I am not sure whether to thank you for letting him have copies of your slides of me: the applause I had in the packed, steeply raked lecture theater in Heidelberg was probably the most intense and prolonged I have ever had, but I couldn't be sure whether it was an expression of sympathy for my murky past or genuine appreciation of my lecture! Probably a combination of the two.

Professor Herfarth first introduced the 2 of us in an extremely well-meant little tear jerker (he is very nice and well-disposed man), and Michael's introduction of me was charming and generous to a fault but left me “naked” before this German audience in a way that has never happened to me before. Well, dear Tom, I suppose you started it all in Kyoto with your historical “nose,” and I am, of course, not complaining.

There are certain parallels in the lives of Michael and myself, though also great differences, in that he came to England with his mother … a violin teacher who managed to get him a scholarship to a public school (in the English sense) after a few years in Bunce Court school and from there he went on to Cambridge. He later did his national service in the British Army as a fully fledged doctor and eventually left with the rank of captain. His return to Germany was at least partly due to the fact that he fell in love with Ursula, his wife, who is a wholly delightful and exceedingly gifted pianist and organist.

Both Carol and I got on like a house on fire with both Michael and Ursula and hope to see them over here before too long. Naturally, there was no end of reminiscing about our school days, as for both of us Bunce Court school was an extremely important part of our young lives. By the way, I have a German-made film about the origins of the school in Germany and its subsequent history, in which I appear among many others, and you might conceivably be interested in seeing the English version some time when you are over here (as you can't play the video on the American system and it wouldn't be worth having it changed over). It is a rather extraordinary story.

In succeeding years, Trede and Brent visited each other and exchanged correspondence about which I was periodically informed. In my last letter from Brent (November 25, 2005), he described spending a multiple-event week in the preceding July during which he was the guest of honor of the Lord Mayor of Koszalin, the town of his early childhood that now was part of Poland. The house where Brent had lived with his parents and sister was one of the few buildings that had survived the intervening 70 years. In the closing sentence of his letter, he wrote: “The wheel has certainly turned full circle for me, and I have come to realize that there is something to be said for living to a ripe old age (I had my 80th birthday in July).”

In late 1945, much of Europe had lain in ruins. Almost immediately, transcontinental exchanges began between surgical departments. The healing that took place through these connections was more than the flesh and bones of patients. The most common smoldering illness of the war's survivors was of the soul. One cannot help being warmed by the thought that the swift actions taken by the surgeons, Professors Pichlmayr and Trede, helped bring emotional closure to Leslie Baruch Brent, one of the world's best-known scientists.