A Scientific Revolution: Ten Men and Women Who Reinvented American Medicine

Abstract

In A Scientific Revolution: Ten Men and Women Who Reinvented American Medicine, eminent pathologist Ralph Hruban, M.D., and seasoned writer/editor Will Linder, M.B.A., M.L.A., recount in engaging detail the unique and critical role that John Hopkins University School of Medicine (Baltimore, Maryland) played in transforming American medicine from a primitive trade to a rigorous science. The woeful state of medical education in the United States before the opening of Johns Hopkins School of Medicine in 1893 is encapsulated by the irascible pundit, Daniel Drake, arguably the most vocal 19th century critic of American medicine, who stated that medical schools were populated with young men “too stupid for the Bar” and “too immoral for the Pulpit.”1 Abraham Flexner immortalized these words 80 yr later in his withering Flexner report.2The authors, both of whom are Hopkins alumni, reveal the extraordinary contributions made by three women and seven men during the fin de siècle and the first half of the 20th century. Hruban and Linder do not restrict their selection of featured individuals to physicians; the book is richer for this wise decision. Moreover, despite the authors’ justifiable pride in their alma mater, they neither conceal nor airbrush some unsavory facets of the institution’s past.When he died in 1873, Johns Hopkins bequeathed $7 million to establish a university, a hospital, and a medical school. At the time, his gift was the largest philanthropic donation in American history. The first of these three interconnected institutions, the university, opened in 1876. While construction of the Johns Hopkins Hospital began in 1877, work was not completed until 1889. Severe financial pressures, however, jeopardized Hopkins’s dream of establishing a medical school. Without Mary Elizabeth Garrett (1854 to 1915), who saw an opportunity to practice “coercive philanthropy,” the legendary medical school would not have materialized. The heiress agreed to donate the munificent sum of $500,000 provided certain unalterable conditions were met. Committed to the principles of equity and excellence, Garrett insisted that her gift was contingent upon allowing women students to matriculate “on the same terms as men.” In an era when sexism, racism, and other forms of prejudice did not require camouflage, this demand was not enthusiastically received.Aware of the abysmal state of medical education in the United States, when many students did not possess even a high school diploma and graduated after a 2-yr “medical education” that did not include exposure to patient care, Garrett further stipulated that the school of medicine must be exclusively a graduate school, providing a 4-yr course to the degree of doctor of medicine. In addition, entering students must have studied physics, chemistry, and biology and have a reading knowledge of French and German. With these requisites, the tenacious Garrett ignited the revolution that began when the School of Medicine opened in 1893.The polymath John Shaw Billings (1838 to 1913) was a surgeon, Civil War hero, and master bibliographer who organized the design and construction of Johns Hopkins Hospital, incorporating the most advanced concepts about patient care and infection control. Importantly, Dr. Billings was instrumental in recruiting William Welch, the medical school’s first dean and head of the pathology department, as well as William Osler, the first chief of medicine.The brilliant pathologist William Welch (1850 to 1934) was an inspired choice as the founding dean. Admired for his towering intellect and beloved for his character and emotional intelligence, Dr. Welch was a charismatic leader who displayed an extraordinary capacity to amicably influence his colleagues and peers. Affectionately called “Popsy” by his students, Welch was an inspirational teacher who mentored wisely and compassionately. He became the face of American medicine and recruited the accomplished surgeon William S. Halsted to Hopkins as the first chair of surgery.William Osler (1849 to 1919), an extraordinary clinician/diagnostician, educator, and philosopher of medicine, is widely regarded as the greatest physician North America has produced. In addition to his landmark text, The Principles and Practice of Medicine, Osler forever changed the way medical students are educated, and he defined the ethical principles and human values physicians should exemplify. Given his humanistic approach to the practice of medicine, it was troubling to learn that, in concert with the times, Osler could be racially biased in his comments about Black and Native Americans.William Stewart Halsted (1852 to 1922) has been called the most innovative and influential surgeon America has produced. From his introduction, in 1896, of sterile surgical gloves and strict asepsis to reduce the likelihood of infection, to promulgation of meticulous and innovative surgical techniques that incorporated scrupulous attention to hemostasis, to introduction of rigorous residency training for surgeons, Dr. Halsted transformed surgery. His contributions are even more remarkable given his valiant battle with addiction to cocaine and morphine.In addition to the Hopkins founding faculty, all of whom benefitted from postgraduate study in Europe, where they absorbed a more scientific approach to medicine than was taught in American schools at the time, the other five luminaries highlighted in the book are more than deserving of inclusion. After graduation in 1900 from the School of Medicine, Dr. Dorothy Reed (1874 to 1964) completed a prestigious internship in medicine under Osler. Next, she accepted a fellowship in Welch’s pathology lab and began studying Hodgkin lymphoma. She quickly disproved the hypothesis that Hodgkin disease was caused by the tubercle bacterium, and she observed that Hodgkin disease was characterized by immunologic incompetence. Reed also identified characteristic giant cells containing one or more large nuclei, now named Reed–Sternberg cells, that were pathognomonic of Hodgkin disease. Her reward for these important scientific discoveries was to be denied a faculty position at Hopkins because of her sex. After leaving Hopkins, despite the discrimination and adversity that repeatedly complicated her life, Dorothy Reed Mendenhall forged an impactful career as a physician–scientist and an advocate for women and children.Although Helen Taussig (1898 to 1986) entered the School of Medicine in 1924, more than a quarter century after Dorothy Reed Mendenhall, she encountered similar sexist obstacles. When Taussig was denied a coveted medical internship, she accepted instead a research fellowship in an adult cardiac clinic conducting physiology research. She subsequently trained in pediatrics at the Hopkins-associated Harriet Lane Home. After several years of caring for cyanotic babies, she conceptualized the life-saving “blue baby operation,” the Blalock–Taussig procedure, performed by Dr. Alfred Blalock in 1944, which involved anastomosing the subclavian artery to the pulmonary artery. Dr. Taussig received belated recognition for her pioneering achievements, including the Presidential Medal of Freedom and induction into the National Academy of Sciences. (Not surprisingly, Blalock had been inducted 27 yr earlier for their joint work on the blue baby operation.)When Blalock arrived from Vanderbilt as chief of surgery at Hopkins in 1941, he brought with him Vivien Thomas (1910 to 1985), his exceptionally talented longtime surgical technician. Thomas, a Black man, had only a high school education but was to prove indispensable to the development of the Blalock–Taussig shunt. After laboring for months in the dog lab, Thomas performed the first successful canine blue baby operation in 1943. Blalock had assisted Thomas on only one canine shunt procedure before he performed his first human blue baby operation on November 29, 1944. Blalock insisted that Thomas stand by his side in the operating room on that historic day and for at least the first 50 of these procedures subsequently, frequently seeking Thomas’s advice. Nevertheless, when Blalock and Taussig published their seminal account of the surgical management of specific cardiac malformations,3 Thomas’s name was absent. This blatant injustice was compounded by the fact that, as Hruban and Linder argue, the “‘Blalock–Taussig shunt’ should rightly have been called the ‘Blalock–Thomas–Taussig shunt.’” The appalling unfairness is best “explained” by the fact that Johns Hopkins was thoroughly segregated from the mid-1890s until desegregation began in the 1950s.Long-overdue recognition of Vivien Thomas finally began in 1971, when his portrait was hung opposite Blalock’s in the Blalock Clinical Science Building. In 1976, Hopkins awarded Thomas an honorary Doctor of Laws degree and soon afterward appointed him to the faculty as an instructor in surgery. Posthumously, one of the four colleges in the medical school was named after Thomas and, in 2021, the Vivien Thomas Scholars Initiative was funded by a $150 million gift from Bloomberg Philanthropies. These belated accolades, however, cannot eradicate the sorry history that preceded them.Spatial constraints do not allow an accounting of the exceptional contributions of Dr. Jesse Lazear, who sacrificed his life to establish yellow fever’s cause and method of transmission, and Max Brödel, a German immigrant who harnessed the power of his superb medical illustrations to promulgate the medical and surgical discoveries made at Hopkins. The omission of their inspirational stories should provide all the more incentive to purchase (or borrow) this outstanding, compelling, and methodically researched volume. The lucid and lively prose is supplemented with beautiful illustrations, color plates, and historic photographs. I enthusiastically recommend A Scientific Revolution to all with an interest in history, progress, and the human condition.The author received no funding for this article. During the past 36 months, she has received money from the Accreditation Council for Graduate Medical Education, Current Reviews in Clinical Anesthesia, and UpToDate. These financial relationships, however, are not relevant to this book review.