American medicine, at its best, is the envy of the world.

 

"A Scientific Revolution

By Ralph H. Hruban and Will Linder

Pegasus, 311 pages, $29.95

Grounded in research and cultivating inquiry, American medicine, at its best, is the envy of the world.

Patients from around the globe -- with the means to afford it -- travel to centers of excellence like the Massachusetts General Hospital and the Cleveland Clinic seeking the latest in clinical care.

 Yet a mere century and a half ago, American medicine was principally guided by hoary tradition, not evidence and exploration; medical schools were little more than for-profit trade schools, populated by young men "too stupid for the Bar" and "too immoral for the Pulpit," as one critic put it. The transformation of American medicine into the science-driven discipline we know today is largely attributable to a single institution, Baltimore's Johns Hopkins University School of Medicine, and to the women and men who breathed life into it. Their stories form the center of "A Scientific Revolution," an uplifting if gauzy collection of biographical vignettes by Hopkins pathologist Ralph Hruban and writer Will Linder, both affectionate Hopkins alumni.

The Johns Hopkins Medical School first opened its doors in 1893, 17 years after the university itself. Its leader was an innovative pathologist, William Welch, who had been attracted by the chance to "develop my field in Baltimore unhampered by traditions." His laboratory, we learn, was uncommonly inclusive, welcoming women as well as men. Clinical medicine at Hopkins was headed by the brilliant, quotable William Osler, "generally regarded as the greatest physician North America has produced," according to the authors.

Osler taught students that medicine was "an art, not a trade; a calling, not a business."

He emphasized the need for showing respect to both patients and colleagues and urged students to compare clinical observations and pathological findings, the better to understand the origins of disease.

He taught at the bedside, explaining that "the best book in medicine is the book of Nature, as writ large in the bodies of men," and encouraged his trainees to "listen to the patient, he is telling you the diagnosis."

The sketches drawn by Dr. Hruban and Mr. Linder can feel like cinematic shorthand. We meet John Shaw Billings, the indefatigable military surgeon whose drive to organize medical information led directly to today's National Library of Medicine and the extensive PubMed database; his devotion to work at the expense of family, we learn, left his son embittered. There is William Halsted, who championed the use of opioid painkillers in surgery and, in the process, fell victim to a devastating addiction. Vivien Thomas, an African-American surgical technician, helped devise many of the operations and instruments used by Alfred Blalock, Hopkins's chief of surgery; yet Thomas was rarely included as a co-author on scientific papers and was invited to the departmental parties that Blalock hosted only as a waiter or bartender, never as a guest.

The most striking vignettes in "A Scientific Revolution" present three determined women whose shared struggles offer a disquieting social portrait of late 19th-century America. We first meet Mary Elizabeth Garrett, who was denied college admission to Hopkins in 1876 after Daniel Coit Gilman, the university's president, determined that women shouldn't be "exposed to the rougher influences" on campus. After Garrett inherited a fortune from her father, a railroad executive, she met twice monthly with a group of like-minded women from other prominent Baltimore families to advance equality in education. In the late 1880s, they saw their chance: Hopkins planned to open a medical school yet was running low on funds. Garrett and her confederates offered to provide the resources -- if the medical school would admit women on equal terms with men. Gilman declined at first but ultimately accepted her terms.

Changing the culture of medicine proved even more challenging than altering admission criteria. Dorothy Reed was a student in the fourth class at Hopkins, one of only 14 women. She had attended Smith as an undergraduate and discovered biology. To pick up the additional science she needed to be considered for Hopkins, she took classes at MIT, where her classmates, the authors tell us, would stand when she came into the room "out of respect for her delicate nature" yet apparently "had no qualms about stealing her laboratory equipment and sabotaging her experiments." The day Reed arrived in Baltimore, a man followed her from the streetcar, asked if she was going to medical school and then told her: "Don't. Go home." Yet that same man -- who turned out to be William Osler, the physician in chief -- would in time become one of her greatest advocates. Reed went on to study Hodgkin's lymphoma in William Welch's pathology lab, identifying the cancer's signature cell, which still bears her name. Even so, she was denied a faculty appointment and had to resume her career elsewhere.

A quarter century later, progress for aspiring female doctors remained agonizingly slow. Helen Taussig, the daughter of a prominent Harvard economist, graduated from Berkeley in 1921 and yearned for a career in medicine, but Harvard Medical School was still male-only. Her father suggested public health; the dean of the Harvard School of Public Health told her that she was welcome to enroll but could not earn a degree. When she asked who would accept those terms, he replied: "No one, I hope." She eventually found her way to Hopkins, where she graduated but was denied an internship: There was space for only one woman and a classmate had a slightly higher grade average. She instead pursued research and pediatrics. Her insights into the origins of "blue baby" syndrome, resulting from congenital anomalies of the heart, led to a collaboration with Alfred Blalock and Vivien Thomas and to the development of an operation that, as the authors note, would transform "the lives of hundreds, if not thousands," of afflicted children.

Dr. Hruban and Mr. Linder's portraits capture an inflection point in American medicine: the ambition and excitement of it, the sense of moment experienced by those who were leading the revolution. The opportunity "to have seen a new birth of science, a new dispensation of health," as Dr. Osler marveled, "is not given to every generation."

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Dr. Shaywitz is a physician-scientist at Takeda Pharmaceuticals, a lecturer at Harvard and an adjunct fellow at the American Enterprise Institute." [1]

1. REVIEW --- Books: From Lab To Bedside, A New View
Shaywitz, David A. 
Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 16 July 2022: C.8.