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MAXWELL FINLAND
March I5, I902-October 25, 1987
BY FREDERICK C. ROBBINS
DR. FINLAND, KNOWN TO most people as Max, was a giant
in the field! of infectious diseases, although physically
he was far from a giant, his height being not much over 5
feet. He was a prodigious worker en c! his bibliography in-
cluclec! more than 800 scientific articles en c! a large num-
ber of chapters in books, meeting proceedings, en c! various
reports. Some of his studies on the natural history en c! patho-
genesis of infectious diseases were classics, such as his se-
ries of reports on pneumonia. He was a pioneer in the
assessment of antibiotics, inclucling their use en c! misuse, in
recognizing the significance of antibiotic resistance, en c! in
pointing out the importance of hospital infections en c! their
control. He was an exemplar of the icleal academic physi-
cian, who, in aciclition to conclucting research, was a teacher
and a superb physician.
This paragon was born in a small town in the Ukraine in
1902. His forebears incluclec! a great-grancifather who was
the grant! rabbi of Krakow en c! a grandfather who was can-
tor in Zashkov. In spite of this impressive backgrounc! he
clic! not seem to have much involvement in formal religion.
At the age of four he came with his family to live in Boston.
Like so many immigrants, Max's family valucc! education.
He gracluatec! from Boston English High, ranker! seconc! in
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BIOGRAPHICAL MEMOIRS
his class, en c! was acceptec! at Harvarc! College with a schol-
arship. He thrives! in the exciting environment of Harvarc!
of that clay. He hac! such stimulating professors at lames
Bryant Conant (chemistry en c! later presiclent), Louis Fiezer
(chemistry), Richarc! Cabot (social ethics), Zachariah Chaffee
C. ( constitutional law), ant! Winthrop John Vanleuven
Osterhout (botany). Max en c! some other students estab-
lishec! a club for Hebrew speakers where they heart! reports
from Israel. He also taught in a Hebrew school, for which
he receiver! some pay. IncleecI, by one means or another he
largely supporter! himself throughout his education.
In 1922 Max enterer! Harvarc! Meclical School. There he
came uncler the influence of Hans Zinsser, chairman of the
Department of Microbiology, en c! Milton Rosenau, chair-
man of preventive medicine en c! hygiene. Rosenau was an
impressive figure en c! Zinsser was an exceptionally dynamic
en c! charismatic incliviclual. lames Howarc! Means, chief of
medicine at the Massachusetts General Hospital was also
influential. After graduation, Max became an intern on the
2nd Medical Service at the Boston City Hospital (BCH). At
that time the situation at BCH was almost icleal for some-
one interested in academic medicine. The Harvarc! Mecli-
cal Unit incluclec! two meclical wards (the 2nc! en c! 4th) en c!
the Thornclike Memorial Laboratory. In aciclition, there was
the excellent Pathology Unit, heaclec! by Mallory, en c! the
South Department, which was the Contagious Disease Hos-
pital. In aciclition to Harvard, both Tufts en c! Boston Uni-
versities concluctec! teaching units at the hospital. The
Harvarc! Unit must have been a heacly environment for a
young man. The Thornclike Laboratory en c! the clinical ser-
vices were essentially one unit en c! extensive clinical research
was being conducted there. Max apparently had planned to
go into practice, but as it turned out he found the environ
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105
ment at BCH so highly compatible that he spent almost his
entire career there as a member of its Harvarc! Unit.
After his internship Max acceptec! the position of pneu-
monia resident at BCH, but he also worker! in Rosenau's
department, where anti-pneumococcal serum was being pro-
clucecI. In 1929 FinIanc! was asker! by Dr. Nye to join his
laboratory at the Thornclike. Thus began one of the most
remarkable careers in the field! of infectious diseases.
The first studies concluctec! by Max en c! his associates
clealt with pneumonia. At that time the only treatment for
pneumococcal pneumonia was administration of type-spe-
cific antiserum. The process of treating patients was cum-
bersome, to say the least. A naso-pharyngeal swab was taken
en c! placer! in a tube containing culture meclium. After a
few hours of incubation when enough bacteria hac! prolif-
eratecI, material from the culture was exposer! to type-spe-
cific antisera. If there was a match between the antiserum
en c! the chemical composition of the polysaccharicle on the
surface of the bacterium, the capsule wouic! swell en c! it
conic! be seen with an ordinary light microscope (known as
the Quellung reaction). If Quellung occurred, the corre-
sponcling antiserum (horse or rabbit) was aciministerec! to
the patient. The patients usually survives! the infection, but
they invariably sufferer! from serum sickness, which conic!
be most unpleasant. FinTanc! en c! his fellows clic! a series of
studies on the treatment of pneumococcal infection con-
cluctec! with meticulous care, a hallmark of FinIancl's re-
search throughout. When sulfonamicles became available
the infectious disease group at the Thornclike was among
the first to concluct systematic clinical studies with the backup
proviclec! by the Thornclike laboratories.
With the advent of penicillin, again the FinIanc! group
clic! many of the funciamental studies of the antibacterial
spectrum, pharmacokinetics, en c! to some extent mecha
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BIOGRAPHICAL MEMOIRS
nism of action. This was repeater! as the various broacI-spec-
trum antibiotics were clevelopecI. The studies involves! care-
ful clinical observations integratec! with laboratory investi-
gations en c! were examples of what the BCH unit macle
possible.
FinIanc! early recognizec! that bacteria were cleveloping
resistance to the antibiotics in general use. He reaTizec! the
implications of this en c! that the indiscriminate use of anti-
biotics in the hospital en c! in the community was important
in promoting the clevelopment of resistance. He recom-
menclec! the reservation of certain antibiotics for use only
in special circumstances in order to preserve their availabil-
ity for emergencies. He also was one of the first to sounc!
the alarm about the frequency en c! importance of infec-
tions acquirer! in the hospital.
Although the contributions just mentioned were impor-
tant, they by no means reflect the scope of his interests. In
fact, he en c! his collaborators (mainly fellows) explorer! al-
most every aspect of infectious diseases that one could men-
tion. The infectious diseases division of Thorndike, headed
by Finland for most of its existence, was tremendously pro-
cluctive. As aireacly mentioned, FinTancl's personal bibliog-
raphy inclucles more than 800 scientific papers en c! an acI-
clitional 20 to 30 chapters of books en c! contributions to
publisher! proceedings of meetings en c! symposia.
FinIanc! hac! a great attraction for young physicians who
came to work with him. He took a personal interest in each
one en c! was careful to see that they were recognizes! for
their contributions. Characteristic of him is the history he
wrote of the Division of Infectious Diseases. The descrip-
tion of each project begins by identifying the fellow or fel-
lows involvecI. It is not clear just how many fellows passer!
through his division, but it probably exceeclec! 100. The
author of this memoir recognized 27 as leaders in the field
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M A XW E L L F I N L A N D
107
throughout this country en c! abroad. It inclucles such names
as Wesley Spink, Lowell Ran tz, John Dingle, Charles
Rammelkamp, George Gee Jackson, Lewis Thomas, Calvin
Kunin, Theodore Eickhoff, en c! Edward! Kass, to name a few.
FinIanc! spent most of his career at BCH in the Harvarc!
Meclical Unit. His home base was the Thornclike Memorial
Laboratory, a key element in the Harvarc! Unit. Before re
tirement in 1968 he hac! become its director en c! the clirec-
tor of the Harvarc! Unit. The Thornclike was an extraorcli-
nary organization. It was heaclec! by such luminaries as Francis
Peabody, George Minot, William Castle, en c! Max FinIancI.
On the staff were such well-known figures as Chester Keefer
(later to move to Boston University), Soma Weiss, Charles
Davidson, Joseph Wearn, en c! Thomas Hale Ham. Although
the Thorndike was not very impressive physically, this re-
markable group of people was immensely productive, en c!
it influencec! a large belly of young men en c! women who
collectively hac! a profounc! impact on meclical care, re-
search, en c! teaching for several generations. The famous
statement by Francis Peabody in his paper "The Care of the
Patient," "The secret of the care of the patient is in caring
for the patient," governec! the behavior of the Harvarc! Unit.
Although the close relationship between the Thornclike en c!
the Harvarc! clinical services was exploitee! to the benefit of
clinical investigation, the patients were always treater! with
respect, even though they were almost exclusively from the
poorer segment of society. When I was a fourth-year Harvarc!
student on the Harvarc! service, George Minot was our visi-
tant. Of course, I regarclec! him with awe. However, I was
most impressed when on rounds we were examining a woman
who was in for pneumonia or some acute illness. She worker!
as a waitress, was single, en c! hac! many personal problems.
Minot sat clown by her becisicle en c! spent 10 to 15 minutes
discussing her personal clifficulties with evident concern
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BIOGRAPHICAL MEMOIRS
for this aspect of her life. To him she was not just a case of
pneumonia. This macle quite an impact on the students
en c! seemec! to exemplify Dr. Peabocly's dictum in action.
In 1973 the Thornclike Memorial Laboratory severer! its
relationship with BCH en c! mover! to the Beth Israel Hospi-
tal, a major Harvarc! affiliate locater! about one block from
the Basic Sciences quadrangle. Indeed, Harvard severed all
relationships with BCH when the governing belly of BCH
cleciclec! to affiliate with a single meclical school en c! chose
Boston University. This decision was the result of a number
of factors, inclucling the shrinking patient population at
the hospital en c! the close proximity of the Boston Univer-
sity Hospital to BCH. In any case, it enclec! a 50-year rela-
tionship between Harvarc! en c! the hospital, which hac! been
remarkably productive en c! one in which Max FinIanc! hac!
played such a key role.
As mentionec! before, Max was a small man physically,
but this never seemec! to affect his behavior. From the time
Max enterer! Harvarc! College he was associates! with Harvarc!
en c! its meclical school until his cleath in 1987. He was loyal
to the institution en c! clisplayoc! this in many ways inclucling
sizeable contributions from his personal resources. He was
also influential in stimulating others to contribute, en c! it is
estimatec! that he was responsible for contributions of ap-
proximately $6 million. In recognition of his many contri-
butions to Harvarc! en c! to the health of the public, the Max
Finland professorship in clinical pharmacology was funded at
Harvarc! Meclical School. The other institutions that commanclec!
his loyalty were the BCH, the Harvarc! Meclical Unit, en c! in
particular the Thorndike Laboratory.
Max never married, but he had a devoted extended fam-
ily in his many friends and the large number of young people
for whom he served as mentor, teacher, and friend. He was
a prodigious worker, but he always had time to discuss a
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109
problem with colleagues, inclucling fellows or even house
officers en c! students. He enjoyoc! the symphony, usually
taking along a frienc! or fellow. He also entertained at the
Athens Restaurant or a favorite Chinese restaurant (Ye Hong
Gucy's). My wife and I had the pleasure of joining him a
couple of times at the Chinese restaurant, en c! they were
convivial occasions, with Max the perfect host.
In 1968 Max retiree! en c! became the Minot professor
emeritus en c! shortly thereafter he mover! his office to the
Channing Laboratory heaclec! by Edward! Kass. He contin-
ucc! to publish en c! to supervise fellows. He was also given
an appointment at the Veterans Administration Hospital.
Thus, Max continues! to clisplay one of his main attributes:
a remarkable capacity for hare! work. One of the prodigious
tasks he undertook in his retirement was the ecliting of a
three-volume history of the Harvarc! Meclical Unit at Bos-
ton City Hospital. The history inclucles brief statements by
many of the young physicians who spent some time in the
unit en c! who represent a large proportion of the impor-
tant contributors to academic medicine for over half a cen
tury.
FinTanc! receiver! many honors. He was a member of the
National Academy of Sciences en c! recipient of the Kober
Mecial of the Association of American Physicians, the Bristol
Awarc! of the Infectious Diseases Society of America, the
Chapin Awarc! of the City of Providence, the Philips Awarc!
of the American College of Physicians, the Oscar B. Hunter
Awarc! of the American Society of Clinical Pharmacology
en c! Therapeutics, en c! the Sheen Awarc! of the American
Meclical Association. He receiver! honorary degrees from
Western Reserve en c! Thomas Jefferson Universities. In 1982
FinIanc! was awarclec! a cloctor of science (honoris cause)
clegre e from Harvarc! University, some thing Harvarc! clo es
not often clo for its own faculty. The citation reacts: "The
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BIOGRAPHICAL MEMOIRS
University hails a clistinguishec! en c! loyal son, who for sixty
years as physician, teacher, en c! scholar has given wisclom,
energy, en c! substance to the advancement of clinical mecli-
cine. "
As a fitting enc! to this memoir I quote from the presen-
tation of FinIancl's goof! frienc! en c! associate Charles Davidson
when he presented the Kober Mecial: "We honor tociay a
man who, with a friencIly smile en c! a quiet en c! moclest
manner, has achiever! great distinction not only because of
his extraordinary contributions to American medicine but
also because of his beneficial influence on so many pa-
tients, students, colleagues, en c! friends."
REFERENCES
Davidson, C. S. 1978. Presentation of the George M. Kober Medal
for 1978 to Maxwell Finland. Trans. Assoc. Am. Phys. 91:51-62.
Finland, M. 1982-83. The Harvard Medical Unit at Boston City Hospital,
Harvard Medical School vols. I, II, and III. Distributed by the Uni-
versity Press of Virginia for the Francis A. Countway Library of
Medicine.
Peabody, F. W. 1927. The care of the patient. 7. Am. Med. Assoc.
88:877-82.
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SELECTED BIBLIOGRAPHY
1930
111
Serum treatment of lobar pneumonia. N. Engl. /. Med. 202:1244-47.
1931
With W. D. Sutliff. Type 1 lobar pneumonia treated with concen-
trated pneumococci antibody (Felton). 7. Am. Med. Assoc. 96:1465.
With W. D. Sutliff. Specific cutaneous reaction and circulatory anti-
bodies in course of lobar pneumonia. No serum. 7. Exp. Med.
54:637.
With W. D. Sutliff. Specific cutaneous reaction and circulatory anti-
bodies in course of lobar pneumonia. Serum. 7. Exp. Med. 54:653.
1933
With W. D. Sutliff. Immunity reaction of human subjects to strains
of pneumococci other than 1, 2, and 3. 7. Exp. Med. 57:95.
1935
With J. M. Ruegsegger. Immunization of human subjects with spe-
cific carbohydrates of Type 3 and related Type 8 pneumococcus.
/. Clin. Invest. 14:829-32.
1936
With R. C. Tilghman. Bacteriological and immunologic studies in
families with pneumococcal infections; development of type spe-
cific antibodies in healthy contact carriers. 7. Clin. Invest. 15:501.
1939
Specific treatment of pneumococci pneumonia analysis of results of
serum therapy and chemotherapy at BCH from July 1938 through
June 1939. Ann. Intern. Med. 13:1567-93.
1942
Spread of pneumococcal and streptococcal infections in hospital
wards and in families. Aerobiology, pp. 212-22.
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BIOGRAPHICAL MEMOIRS
1944
With M. Meads, H. W. Harris, and B. A. Samper. Treatment of
meningococcal meningitis with penicillin. N. Engl. I. Med. 231:509-
17.
1945
Cold agglutinins; cold iso hemogglatins in primary atypical pneu-
monia of unknown etiology with rate on occurrence of hemolytic
anemia in these cases. 7. Clin. Invest. 24:458-73.
1946
With C. S. Davidson and S. M. Levenson. Chemotherapy and con-
trol of infection among victims of Coconut Grove disaster. Surg.
Gynec. Obst. 82:151-73.
With R. Murray, L. Kilham, and C. Wilcox. Development of strepto-
mycin resistance of gram negative bacilli in vitro and during treatment.
Proc. Soc. Exp. Biol. Med. 63:470-74.
1947
Use of penicillin in infection other than bacterial endocarditis. Adv.
Intern. Med. 2:350.
1968
With F. F. Barrett and J. I. Casey. Infections and antibiotic use
among patients at Boston City Hospital, February 1967. N. Engl.
J. Med. 278 (1) :5-9.
1970
With F. F. Barrett, J. I. Casey, and C. Wilcox. Bacteriophage types
and antibiotic susceptibility of Staphylococcus aureus. Boston City
Hospital, 1967. Arch. Intern. Med. 125~5~:867-73.
1973
Excursions into epidemiology: Selected studies during the past four
decades at Boston City Hospital. 7. Infect. Dis. 128 ~ 1 ~ :76-124.
1974
With J. E. J. McGowan. Infection and antibiotic usage at Boston City
Hospital: Changes in prevalence during the decade 1964-1973. J.
Infect. Dis. 1 2 9 ~ 4 ): 42 1 -2 8 .
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1975
113
With J. E. J. McGowan and M. W. Barnes. Bacteremia at Boston City
Hospital: Occurrence and mortality during 12 selected years (1935-
1972), with special reference to hospital-acquired cases. 7. Infect.
Dis. 132 (3) :316-35.
Relationships of antibiotics in animal feeds and salmonellosis in
animals and man. 7. Anim. Sci. 40 ~ 6~: 1222-40.
1976
With C. Garner, C. Wilcox, and L. D. Sabath. Susceptibility of "en-
terobacteria" to aminoglycoside antibiotics: comparisons with tet-
racyclines, polymyxins, chloramphenicol, and spectinomycin. 7.
Infect. Dis. 134(suppl.~:57-74.
1977
With M. W. Barnes. Changes in occurrence of capsular serotypes of
Streptococcus pneumonias at Boston City Hospital during selected
years between 1935 and 1974. 7. Clin. Microbiol. 5~2~:154-66.
1979
Pneumonia and pneumococcal infections, with special reference to
pneumococcal pneumonia. The 1979 J. Burns Amberson lecture.
Am. Rev. Respir. Dis. 120 ~ 3 ~ :481 -502.
Emergence of antibiotic resistance in hospitals, 1935-1975. Rev. In-
fect. Dis. 1 (1) :4-22.
1984
With E. Strauss and O. L. Peterson. Landmark article June 14, 1941:
Sulfadiazine. Therapeutic evaluation and toxic effects on four
hundred and forty-six patients. By Maxwell Finland, Elias Strauss,
and Osler L. Peterson. 7. Am. Med. Assoc. 251 ~ 11 ~ :1467-74.
With M. A. Barry and D. E. Craven. Serotypes of Streptococcus pneumonias
isolated from blood cultures at Boston City Hospital between
1979 and 1982. 7. Infect. Dis. 149~3~:449-52.
Representative terms from entire chapter:
city hospital
