Villa Serbelloni, Bellagio, Lake Como, Italy

Wendy on the patio, Villa Serbelloni, Bellagio, Lake Como, November 1992 - On a day of "mists and mellow fruitfulness"

Lake Como in the Italian lake district is the most beautiful of the lakes in that region, a Y-shaped lake with the small city of Como at the western end, St Moritz in Switzerland above the mountains at the eastern end, Lecco to the south, and the town of Bellagio in the apex of the “Y,” where there are views of all three arms of the Lake. It is a setting of great beauty but little if any strategic importance. There has been a settlement there since very ancient times, always sought out and usually occupied by the rich and powerful. At the height of the Roman Empire, Pliny the younger, a scholar who had strong aesthetic sensibilities, built a villa here and his statue remains in the grounds of the Villa Serbelloni to this day. After the end of the Roman supremacy, the site was occupied by a succession of powerful families including the Sforza dynasty until it passed into the possession of the minor but wealthy Serbelloni family, who sold it to a Swiss hotelier who in turn sold it to Ella Walker of the American liquor family of Hiram Walker. She married into the Italian aristocracy and became a principessa (princess) so during the lifetime of her husband the property was again in the possession of the Italian nobility. She was childless. At her death which was many years after her husband’s, she bequeathed the Villa Serbelloni and its lands to the Rockefeller Foundation, and it was made it into a prestigious international study and conference centre.   

I have had three visits to the Villa Serbelloni, two to conferences and the third time, as a scholar in residence. The first conference I attended was in September 1982, to join one of the working groups preparing the 10^th revision of the International Classification of Diseases.  I was back at the Villa Serbelloni for another conference in May 1985, where the theme was the future of health and health care services. My third visit to the Villa was as a scholar in residence, where I planned and wrote the first draft of a monograph on ethical problems that can arise in epidemiological practice and research. (Parts of this have subsequently been published as chapters in books and as free-standing papers in peer-reviewed journals but the book was never published in its entirety).

The main building of the Villa Serbelloni occupies a level clearing close to the heights in the extensive grounds, which descend to the lake shore on the south (Lecco arm) of Lake Como and east. It is a 17^th Century palace that was completely renovated when the Rockefeller Foundation assumed ownership. It has several commodious rooms and suites – library, dining and sitting rooms, a music room, others upstairs set up for conferences, and a few spacious bed sitting rooms for guests. The out-buildings include a 17^th century tower with a large bedroom on each of its three floors, and next to it, the Sfondrata, a longer, lower building with more rooms for guests. About half way up the hill to the Villa, another building, the 17^th century Maranese, contains studio suites for scholars in residence and conference guests. On my first visit I had the room at the top of the tower, and was lulled to sleep each night by the gentle lapping of water against the base of the tower and awoke each morning to the same lovely water music. It was a splendid place to be for a week, although low water pressure made the shower function poorly, or not at all if anyone on one of the lower floors turned on a tap.  I was rapporteur for the conference, which meant that at the end of each session I had to write up the proceedings.  Then at the end of the afternoon session, I had to dash down the hill to the tower, have another shower and dress formally for dinner, missing most of the aperativi and preprandial conversation.  On my second visit, my room was in the Maranese, and although Wendy was not allowed to stay at the Villa Serbelloni with me, she stayed in a small hotel in Bellagio so we could enjoy this extraordinarily beautiful part of the world together during my time off, and she was allowed to dine once or twice as my guest.

When I returned as a scholar in residence accompanied by Wendy in November 1992, we had just come from a final visit to my dying father in Malta and throughout our stay each international phone call for me (for some reason there were many) induced a premonition that he had died. As it turned out, he survived until New Year’s Day, two weeks after we got home to Ottawa. We began our brief period in residence in the Maranese but were uncomfortable there, especially walking to and from meals on frosty mornings and cold dark evenings, so we moved to a studio suite in the main Villa after a few days when a room became available. Our windows gave us a superb view of the western arm of Lake Como with the steep mountains on the Swiss side to the right and the hills of northern Italy to the left, the blue waters of Lake Como in the middle.  There are several smaller out-buildings on the high ground above the Villa, including two set up for artists and composers, equipped with a grand piano.  Wendy spent some time in one of these suites composing a piece of music during our stay, and occasionally used the other to touch up the pictures she was painting of the spectacular scenery.  She was experimenting with oil pastels and produced a dozen or so vivid sketch paintings of the Villa, its grounds, and views across the lake to each shore in the distance.. When we got home I had several of her pictures framed and I have three of them on the wall of my home office as a permanent reminder of that lovely place and an all-too-brief interlude in our lives.

It is the policy of the Rockefeller Foundation to mix scholars in residence from diverse disciplines, the humanities, creative arts, natural and biological sciences, philosophy and so forth. Those with whom Wendy and I shared our time at the Villa were probably a rather typical mixture. They were all interesting people – some unforgettable. One was the writer Jonathan Franzen, a youthful novelist of great promise. His prize-winning novel The Corrections, may have been born there although he was ostensibly working on a different book. Another was the historian of colonial America, Bill Chafe.  The book on which he was working (political chicanery in early 19^th century USA) came out a year or so later to receive high praise and several awards. The (adopted) Australian visual artist Merilyn Fairskye, at the time resident in New York, was a rather beautiful young woman, perhaps of Armenian heritage I think. She and a youngish Brazilian philosopher had a brief but quite torrid romantic liaison.  There were several others – a composer and his wife, another musician, from the University of Indiana at Bloomington, Indiana, two poets, a husband-wife combination from Oregon; two urban sociologists, one from Stanford, the other from NYU, who were jointly writing a monograph on alienated youth in the counter-culture; and  a woman with middle-eastern roots who had a rich knowledge of Farsi (Iranian) literature and culture (but rather repulsive table manners – she had a partial set of dentures that she removed and put on the table beside her to eat parts of her meals).  In the evenings we all came together for general conversations about life, the universe and everything.  It was among the most mind-expanding and memorable experiences I’ve ever had, and it inspired Wendy to compose a piece of music and to paint some excellent little pictures.

Although the days were short by that time of the year, the weather was fine and sunny almost all the time we were there, cool but not cold nights, warm but not hot sunny days.  I worked moderately hard but allowed enough time off for a couple of cruises on Lake Como, once into Como itself, the other to the nearby lakeside towns of Mennagio and Varenna.  The alpine region of Northern Italy is very beautiful, this part perhaps the most beautiful of all. Ideally, I think we would both have preferred to be there entirely on holiday but my conscience would not allow me to do this, so I had to leave much of the sight-seeing and exploring to Wendy while I sat at my desk gazing at the beautiful view out the window, thinking beautiful thoughts and attempting to capture them in bad prose on floppy disks. There was abundant time, however, for leisurely walks on the paths through the grounds of the Villa Serbelloni, where the late autumn fruits, notably bright red persimmons and a few plums, were ripe for the plucking.  We strolled down to the lake shore beside the tower where I had stayed on my first visit, around the paths higher up on the east side towards the Swiss mountains, and down on the other side towards and into the village of Bellagio. Some days after lunch we sunned ourselves on a patio outside the dinning room.  I have a fine photograph of a group of us relaxing there one sunny day, with the Swiss mountains glistening in fresh-fallen snow as a back-drop.

South facade of Villa Serbelloni  and approach drive to front entrance on opposite side of Villa

Alas, too soon it was all over. We came back into the town of Como in the Villa’s limousine, caught the train to Lugano through the spectacular network of tunnels through the St Bernard Pass, and on to Zurich, whence we flew home to Ottawa barely ten days before Christmas of 1992.     

Phone calls

Wendy and I were among the first to get our phone number on a "Do Not Call" list that ought to have protected us from what are best described as junk phone calls. These irritating calls habitually come at meal times. It didn't do any good. Junk phone calls are as obtrusive as ever, but now most speak with recognizably American accents, revealing their origin beyond the reach of Canadian regulators. "This is Lisa calling to warn you are paying too much interest on your credit card account..." Lisa still calls, but never gets beyond "This is Lisa...", or just "This..." before I hang up. There's no way to block these calls because Call Display tells me they come from an unlisted number. It's the same with a few other irritating calls, the caller is immune to call-blocking.

Not all unexpected phone calls are unwelcome. I reflected on this recently when I had a half dozen irritating calls one day, including one from Lisa or one of her family.  When the phone rang again  and Call Display told me it was a government number, fortunately I didn't snarl "What is it this time!" but politely saluted the caller in my usual fashion. That call came from the Governor General's office and was to inform me that I had been admitted to the Order of Canada.  It was the latest of a dozen or more life-affirming phone calls I can recall with the good news that I've been selected as recipient of an award, and a confirmatory letter will follow.

On a sunny summer Saturday in 1964 when we were living in Burlington Vermont,  Stuart Morrison phoned me from Scotland. Wendy and the kids were already in the car, we were about to set off somewhere exciting. I almost didn't bother going back indoors when I heard the phone ringing. Stuart was calling  to invite me to join the staff of the Usher Institute of Public Health at the University of Edinburgh. By then we had been living in the USA long enough to know beyond dispute that though we were happy in Vermont, we didn't want to settle for life in the USA, didn't want our kids to become American, to acquire American values and customs. That call gave us the opportunity to choose between moving to the Johns Hopkins School of Hygiene and Public Health in Baltimore, and Edinburgh, where both of us had lived for a while before we met and married. It was a no-brainer, despite the much lower salary in Edinburgh.

Two other phone calls out of  the blue were invitations to edit important books. Both calls are engraved in my cerebral cortex. One day in late winter of 1977 Steve Jonas phoned me from New York to tell me that the selection committee of which he was chairman had ranked me first among the candidates to become editor in chief of the Maxcy-Rosenau reference textbook of public health. I wasn't even aware that I was a candidate. I felt unqualified to edit a massive reference book I regarded as quintessentially American. Reluctantly, after much arm-twisting, I agreed.  Everyone seemed well pleased with the result and despite being more aware than anybody else of gaps and defects in the book (no chapter on health economics for instance) I'm happy with it.  It gave me a platform from which I made statements on important issues in public health practice, science, and policy. Some of my statements have become part of the language and lore of public health. This book consolidated my position as an internationally recognized authority on public health and led to other invitations, most of which also started with phone calls. The best of these was from Kerr White, at the time the president of the International Epidemiological Association. He called one day in 1982 to invite me to become the compiler and editor of a Dictionary of Epidemiology, to be sponsored by the IEA and published by Oxford University Press. Working on this was probably my most pleasurable professional activity. It put me at the centre of a worldwide network of aficionados, people who care deeply about precision and accuracy in use of technical terms.  Interestingly, more than half don't have English as their mother tongue.

On balance, despite junk calls and long-winded bores, I'm grateful to Alexander Graham Bell for his useful invention.

Valuable community roles

Long ago, probably in 1956, I was jeered at a medical meeting. A pompous family doctor with more hubris than competence or charisma had boasted that his job was the most important in the community, and he ought to be paid accordingly. I, also a family doctor at the time, followed him to the podium, and before beginning my prepared talk, sought to restore a sense of proportion. I said we wouldn't win friends by boasting about our own importance; in a complex industrial society, many play essential roles. Garbage collectors, bus drivers, telephone linesmen, many others, are just as important. If one occupational group was the most important, it was school teachers, especially teachers of very young children. Without them, our culture, would collapse, I don't think I mentioned kindergarten teachers: in Australia in1956 most children's education began in Grade 1. In an ideal world, I said, primary school teaching would be the highest paid occupation. The audience, almost all family doctors, booed, hissed, even shouted their outrage. At the coffee break, a woman doctor much older than I said she agreed with me, but I wouldn't win friends with remarks like mine. I've said the same again rather often since 1956, and sometimes have even been applauded. Now I'm delighted that my grandson's lady love is a kindergarten teacher and I am eager to meet her.

Hamilton and NOTL

It is heart-warming to have friends with whom I feel as comfortable and relaxed as I would if they were members of my own family.  It's like this with Karen Trollope Kumar and her husband Pradeep Kumar who have been living in Hamilton since they returned from the Himalayan foothills in the late 1990s. I flew to Toronto island airport last Friday and home to Ottawa yesterday, Monday. Karen drove to the airport to collect me and again to drop me off.  On Saturday and Sunday we drove to Niagara on the Lake, known and pronounced as NOTL by many of its aficionados. We saw two light frothy comedies, very suitable summer fare, especially in the stifling heat wave conditions we have endured lately: a Noel Coward play, Present Laughter, on Saturday, and on Sunday His Girl Friday, a play based on a marvellous screwball movie comedy that in turn was based on a successful Broadway play called The Front Page. Karen's 90-year-old mother, Bernice Trollope, joined us on Saturday and we met David and Desre as well.  Conversation revealed that Bernice Trollope's late husband and Desre's father were engineering students in the same year at Witwatersrand University in Johannesburg. It's a small world.

Every time I travel along the Queen Elizabeth Way from Hamilton to NOTL I'm distressed to see how that once bountiful orchard and vineyard district, the Niagara Peninsula, is being relentlessly eaten up by exurban sprawl and industrial development. I've been travelling that road since the early 1970s, close to 40 years and the change in this period is depressing. Since I last passed that way about 4 years ago, some spectacular architectural structures have appeared, but they are no substitute for the fruit trees and vineyards that they have replaced.  Bricks and mortar and paved parking lots can never replace fruit trees. Instead we import fruit, and grapes, and increasing quantities of wine, from South America, with no thought for the carbon fuels combusted to fly produce all the way to Canada. It's all adding to the climate forcing that is  pushing the world closer to a tipping point from which there will be no return. This whole north east sector of North America is also afflicted this year by unprecedented heat and drought conditions. The country everywhere is dry and parched, like South Australia in high summer, not a blade of green grass  to be seen in many lawns. The grape vines near NOTL look good, but they are heavily irrigated.

It is worrying, and a sign of the corrupt times we live in, that the government of Canada, in thrall to the oil industry in Alberta, has systematically dismantled the data gathering and monitoring systems that in some cases have been operating for over 50 years; they do not want evidence of environmental damage and deterioration to impede the political decision to accelerate development of  the environmentally destructive tar sands. This ultra-conservative government is so scientifically illiterate that they don't understand that greenhouse gas emissions and stratospheric ozone depletion are two entirely different processes. They have shut down not only carbon dioxide monitoring but UV radiation detection services in the high Arctic, the early warning system that can advise all north Americans when UV radiation levels are becoming dangerously high. As for the tar sands, an area about the size of Florida has already been devastated and emissions from the refineries and extraction plants is the largest single contributor to fossil fuel emissions on earth. We know this only because the Canadian government can't stifle data sources outside Canadian jurisdiction. Their policy is enriching oil companies and the ultra-conservative party now running affairs in Canada. For the sake of future generations here and elsewhere on earth, I hope this government is soon swept from office, but I fear that their appeal to simple-minded people to reduce taxes could keep them in office until it is too late to save the world from passing through the climatic tipping point that will lead to irreversible changes, perhaps to mass extinctions, including extinction of many humans. As Aeschylus put it in Medea, "Those whom the gods would destroy, they first make mad."

How did I ramble off on that tirade? I've said nothing about how splendid it was to see and stay with Karen and Pradeep, and to have conversations with them and with their two splendid young adult offspring, Sonia and Raman, both of whom are students at McMaster University, Sonia about to start her MBA, Raman half way through his medical course.  I feel optimistic about the future after talking to these two bright youngsters.

Voices from the past

Here are excerpts from some of the messages I've had from former students. All but one of these came from people with whom I've virtually lost touch, so they reopened a welcome line of communication:



Congratulations on receiving the Order of Canada. It is well deserved! I often think of how much you supported me and helped me to organize my year of electives trip around the world during medical school. Thank you so much...I think it was one of the best things that I ever did. Now my daughter is hoping to study medicine and I hope that she does it with a global perspective. As I  am slowing down my work at the hospital I am doing more teaching in the developing world. I was teaching in Uganda and Haiti last year and am planning to go to Tanzania in October.  Wishing you all the best!  



John so very very pleased to hear that you have been appointed as an
Officer of the Order of Canada. So well deserved - your contributions to
epidemiology here and abroad have been stellar. I am proud to have been
your student - lo those many years ago. Congratulations! 

I read the Ottawa Citizen this morning with great pleasure and pride of your achievements, and your admission into the Order of Canada.  I cannot think of a more deserving recipient.  I feel truly privileged to know you, have had you as a teacher and mentor,  and to have learned so much from you over the years.

Congratulations on your Order of Canada award – it is well deserved!  You are truly a role model for young physicians, and have made a lasting contribution to the field of epidemiology.  The Citizen article was lovely but didn’t tell the half of what a wonderful person you really are.

I must say you have always been a "GIANT" to myself and Christopher, and we are both delighted that Canada has chosen to recognize you!   Congratulations, on an absolutely fantastic achievement - and fit and deserving emblem of your life's work. 

It is very sad that you aren't able to share this with Wendy, and I am not deeply religious, but I am spiritual - and I believe she will be there with you in spirit when you receive it.  How could she not be?  After spending your whole lives together she is a part of you.


And here's one more that came to the Dean, and was forwarded to me on July 17:


Please forward my congratulations to Dr. John Last.  Dr. Last was very influential personally to me during my studies at the Faculty of Medicine from 1975-1979.  

He enabled me to do an elective rotation in Sri Lanka in pediatrics as well as in Public Health.  It was the highlight of my medical studies and even though I eventually became a plastic surgeon, it enabled me to be much more appreciative of different cultures and customs in patients as well as people I have met throughout my life.

I have always been indebted to Dr. Last for this wonderful experience, and am thrilled that he has received this honor.

unexpected and welcome benefit of OC

After the news that I had been appointed an Officer of the Order of Canada became public, there was a blizzard of emails, a hurricane of phone calls and even a few letters by old fashioned snail mail. Among all these there were a few from very old friends and former students with whom I had lost contact long ago. This was an unexpected and most welcome bonus. I think I've responded to all of these messages now, and the email addresses are safely stored in my address book.

Among those I heard from with congratulations is a frequent correspondent, my friend Ron Laporte from Pittsburgh.  Ron asked me to write a few sentences for his Supercourse newsletter. I don't think there is a copyright on the sentences I dashed off and sent straight back to him, so I'll repeat them here:

When I was a pimply 13 years old, I wanted to be a writer.  I’d read Somerset Maugham and a few others who’d moved on from medical school to become successful writers, so I decided to aim for medical school.  By the time I was 15 or 16, poised to start in medical school at 17 because there was a world war going on, I realized I couldn’t invent plots or develop characters, and had a tin ear for dialogue, so a career as a creative writer wasn’t for me. In time I became a tolerably competent clinician, then an epidemiologist.  But love of words and writing bubbled away below the surface. I found a way to combine my medical background and my love of words, composing definitions for the Dictionary of Epidemiology, the Dictionary of Public Health, writing Public Health and Human Ecology, editing Public Health and Preventive Medicine (“Maxcy-Rosenau-Last”), the Canadian Journal of Public Health, and sundry other journals and books.  During all this time, I was corrupting the innocent young minds of medical students with the subversive notion that discovering and accentuating the determinants of good health was a career aim at least as worthy as exploring arcane details of serum electrolyte levels or genomic structure of an individual patient. In part of my spare time I counseled medical students about career options, emphasizing that it is important to keep open as many options as possible for as long as possible, thereby avoiding the hazard of overspecializing. Paleontologists demonstrated that species which overspecialize risk extinction when conditions change rapidly. That can happen in medicine too. In epidemiology, it’s valuable to have more than a nodding acquaintance with the Big Picture, rather than focusing on the fine detail in one little corner of the picture.  This perspective makes it easier to connect the dots – which can come from any number of disparate scholarly and applied fields – and thereby make a new picture altogether, a picture that explains important truths which had previously been obscure and mysterious. The great discovery I have made is that it is enormous fun doing this, and even more fun when there’s an opportunity to infect students with enthusiasm to do it too.   

Perhaps the greatest privilege I enjoy is that the work I do is fun.  Only a tiny minority of humanity can honestly say this: my work is fun to do.  I wouldn't keep on doing it as I race towards my 86th birthday if it wasn't fun.

Shameless self-promotion

The temptation to post this was irresistible! And why not a bit of self-promotion?  Normally I'm rather shy and self-effacing, but there are times when it's appropriate to come out into the limelight briefly.  This, I feel, is one of the times.

The Ottawa Citizen reporter did a reasonably good job I think.  He got a few details slightly wrong, but overall his story was reasonably accurate.  I was a pimply-faced brand new teen ager of 13 or thereabouts, not a young man, when I had aspirations to write novels.  I'd discovered by the time I was 15 or 16 that although I could write quite well, I lacked the imagination to create plots, I had a tin ear for dialogue, and I couldn't create characters.  Novel-writing would have been an uphill struggle without these fundamental skills. I demonstrated my ineptitude in a few short stories I wrote when I was a medical student. Two or three were published in Phoenix, the Adelaide University magazine and two others, now lost without trace, got into a men's magazine, either Man, or Men Only, I forget which. All I remember is that the less said about them the better.

But I can write.  I can express complex concepts in clear and plain language that others tell me they find  easy and even entertaining to read.  I've put that skill to good use writing textbooks of my own and chapters in other people's books, and in composing definitions for the Dictionary of Epidemiology and the Dictionary of Public Health.  The Ottawa Citizen's photographer skillfully posed me in front of the row of big fat textbooks of public health that I edited, and asked me to hold a copy of Public Health and Human Ecology, my very own book, the one I'm proudest of.  I couldn't have asked for better.