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Houston's evolution into the fourth largest city in the United States was propelled by four seminal events. First was the Great Galveston Hurricane of 1900, which destroyed the city port of Galveston and led to the realization that Houston could become a viable and safer deep-water port; this led to the widening of the Ship Channel to offer direct access to Houston. Second was the discovery of oil at Spindletop in Beaumont, Texas in 1901. This prompted the development of the oil industry in Texas and transformed Houston from a small town into a large city. Third was (of course) the commercialization of air conditioning in 1950's, which made Houston (and many Southern cities of the United States) more livable. And lastly, the allocation of land for the Texas Medical Center created the largest medical center in the world with one of the highest densities of clinical facilities for patient care, basic science, and translational research. The Texas Medical Center is a major contributor to Houston's economy and growth.

Several additional factors contributed to the creation of The University of Texas MD Anderson Cancer Center in Houston and its development into one of the most important cancer centers in the world. First was the generous philanthropy of visionary Texans such as Monroe Dunaway Anderson (Fig. 1) (his nephew died of leukemia in 1936) and his partner Will Clayton, who founded the charitable MD Anderson Foundation, which helped create the Texas Medical Center in 1945.

The charter of the Anderson Foundation did not specify how the money should be used, but Mr. Anderson's trustees and close friends—Colonel William Bates, John Freeman and Horace Williams—leaned strongly in favor of health care. Soon after taking possession of the estate from its executors, the trustees turned to Dr. Ernest Bertner (Fig. 2) for advice. Dr. Bertner was a prominent Houston surgeon and gynecologist who was well known to the trustees because of his care for cancer patients, despite inadequate facilities and treatment options (he was later called the "father of the Texas Medical Center").

The trustees and Dr. Bertner noted that the 1941 Texas legislature authorized the University of Texas to create a hospital for cancer research and treatment, allocating $500,000 for the purpose. Today, that figure would be approximately $8 million. The Anderson trustees, with Dr. Bertner's guidance, seized the opportunity and offered to match the $500,000 legislative appropriation, if the hospital was to be named for Monroe Dunaway Anderson and located in Houston. The legislature accepted their offer. The trustees then purchased 134 acres of mosquito-infested land to create the Texas Medical Center, stating that the new cancer hospital would be located there. They made it known that the new state hospital should be an academic institution. In fact, MD Anderson was the first comprehensive cancer hospital to be associated with a major university as an independent free-standing unit.

In 1942, The University of Texas Board of Regents appointed Dr. Bertner as the director of the new hospital. A 6-acre property near downtown was purchased from the estate of Captain James A. Baker, grandfather of former Secretary of State James Baker III, and became the first campus of the hospital. An empty carriage house became the office and stables were the research laboratories. Twelve surplus army barracks were procured for patient clinics (Figs. 3A, B, C). With the addition of 22 leased beds at Hermann Hospital, the dream became realityA small faculty of physicians and scientists was recruited from the University of Texas Medical Branch in Galveston, and cancer patients finally had a home. The name proposed in 1941 was the "Texas State Cancer Hospital and the Division of Cancer Research", which was changed to "M.D. Anderson Hospital for Cancer Research of The University of Texas" (to acknowledge the donation of M.D. Anderson). The name was again changed in 1955 to "The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston" (to avoid the word "cancer" which elicited fear and avoidance). In 1988 the name was finally changed to its current "The University of Texas MD Anderson Cancer Center".

In 1946, Dr. Bertner persuaded Dr. Randolph Lee Clark, a native Texan, to become president of what was to become The University of Texas MD Anderson Cancer Center. Dr. Clark, a widely recognized surgeon, concentrated on recruiting an excellent surgical faculty and then set upon acquiring all the basic and clinical scientists and clinicians. From the outset, all efforts, whether administrative, clinical or research, were focused on developing excellence in research-driven cancer care. Forty-six patients were receiving treatment in these early quarters when the hospital moved to its current site in March 1954 (Figs. 4A and B).

Additional resources to expand the MD Anderson infra-structure (Fig. 5) and research capacities came from several venues: (1) generous donations from the oil industry; (2) the visionary research and administrative leadership under its five presidents, Drs. Randolph Lee Clark (1946–1978) (Fig. 6A), Charles A. LeMaistre (1978–1996) (Fig. 6B), John Mendelsohn (1996–2011) (Fig. 6C), Ronald DePinho (2011–2017) (Fig. 6D), and Peter WT Pisters (2017-present) (Fig. 6E); (3) the recruitment of world-renowned cancer research pioneers (some of the early legends included Drs. Emil J. Freireich, Emil Frei, Gilbert Fletcher, James Butler, Felix Rutledge, Gerald Dodd, and Sidney Wallace); and (4) the relentless research efforts of the cancer experts on the MD Anderson's faculty.

Today, MD Anderson is one of the largest cancer centers in the world, with more than 21,000 employees and 1800 faculty; serving more than 150,000 patients with cancer in Houston every year; operating a 700-bed cancer hospital; and being ranked as the No. 1 hospital for cancer care by the U.S. News and World Report in 11 of the past 14 years. The MD Anderson Cancer Center research has resulted in numerous discoveries that became standards of care across many types of cancers, and that have saved the lives and/or improved survivals and outcomes of millions of patients with cancer around the world.

One component of MD Anderson's mission is to spread its knowledge about cancer research and discoveries across the globe. This educational mission is furthered by the hematology/oncology fellowship that currently trains more than 40 medical hematology-oncology cancer specialists on its premises. The MD Anderson Manual of Medical Oncology, created as part of our educational mission, is often written by our fellows as first authors (many of whom later join the MD Anderson faculty) and supported in depth by senior tumor specialty faculty as co-authors. We envision this fourth edition expanding into a continuously updated electronic version that educates and spreads knowledge and discoveries in cancer research and therapy rapidly and widely.

Hagop M. Kantarjian, MD
Robert A. Wolff, MD
Alyssa G. Reiber, MD

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