Posts Tagged ‘McGill University’

The women who saved us: Abbott and Taussig

July 5, 2010

“Tonight I’ve seen someone with no legs stay standing, Dad, and someone with no voice keep shouting.”C.J. Cregg, The West Wing

From the late 1800’s until the 1950’s, the field of Pediatric Cardiology was dominated by women. In fact, women were working in Pediatric Cardiology before anyone had ever named the specialty. Because Pediatric Cardiology wasn’t really a medical specialty – it was where kids (and medical careers) went to die. And no one who had any sense wanted anything to do with it.

This was the state of medicine when Canadian Maude Abbott became a doctor in 1894. The number of female doctors at the time – in both Canada and America – could be counted on one hand. The male dominated medical profession viewed a female doctor as little more than a well-educated nurse. Even female patients were leery of a woman doctor.

Born in 1869, Abbott had decided on a medical career and graduated from Bishop’s College medical school in 1894. Abbott had gotten her undergraduate degree from McGill College and had applied to their medical school, only to find that they didn’t want her. McGill was one of the many medical schools that did not admit women.

Unable to find a job that suited her, Doctor Abbott toured Europe. She returned to Canada in 1987, opening a practice in Montreal. Before long, a fellow doctor (and her less than successful practice) had convinced her to take a research job at Royal Victoria Hospital. While at Royal Victoria, Abbott became interested in hearts and did ground breaking research on heart murmurs. The paper was good enough to be accepted by the Montreal Medical Society for presentation to the Society at their annual meeting. But Abbott would not be able to present it; the Society did not allow female membership.

If the work were to be presented, a male member of the Society would have to do it. Reluctantly, Abbott turned over her work and the paper was presented. But when the paper appeared in the Medical Society journal, it was assumed by readers that the gentleman was the author. Time passed and people forgot; it wasn’t until the early 1970’s that the M. E. Abbott, MD listed on the title sheet was recognized as the actual writer.

By late 1898 Maude Abbott was back at McGill. Stung by the fact that they had turned away someone who would eventually be recognized by the Montreal Medical Society (even if she was just a girl) McGill wanted her… but they didn’t have any job to give her. Finally they appointed Dr. Abbott as Assistant Curator of the Medical Museum with a promise to promote her when the Curator retired.

A 19th century medical museum was not what you might expect. Its primary job was to help doctors learn, and the museum was full of preserved body parts. Even with preservation, the “exhibits” would wear out and new items were constantly being sought out. A good museum also had any number of unusual or diseased specimens – things doctors might not see very often. These were very much desired as medical training of the day was more hands on, and a good museum would have plenty of normal and unusual items to study.

McGill was not a good medical museum. Things were misplaced, mislabeled, or had disappeared. There wasn’t even a catalogue and no one seemed to know where anything was. Even worse, the employees had no medical training; you could refer to something by its scientific name and no one knew what you were talking about. Obviously the first job would be the hardest – catalog and organize everything, give it some sense of order.

Abbott’s boss looked at the calender – three weeks to his retirement. No way did he want to get involved in a major project this close to leaving. But if you want to, go right ahead. So Maude got busy.

And that is when she found it.  A preserved heart in a glass jar. But was this thing really a heart – there were what looked like two Atriums, but only one Ventricle. A deeper study revealed a second Ventricle, one so small that it was barely noticable. Two of the valves drained into the larger Ventricle, and she couldn’t tell what fed the other Ventricle. The label on the container read Ulcerative Endocarditis, but that had to be the cause of death. Endocarditis could not do this to a heart.

As expected, no one knew anything about the heart. Abbott knew someone who might; Dr. William Osler was a McGill graduate and an old friend. Osler was living in the United States and building Johns Hopkins into the institution that it would become. Abbott wrote Dr. Osler, describing the heart and asking if he knew anything about it.

Osler did know – he gave details that Abbott hadn’t noticed and he called it the “Holmes Heart” – so called because it had been donated to the medical museum by Andrew Holmes, that Medical School Director in 1822. The heart was so grossly deformed that an article about it appeared in the Edinburgh Medical Journal. (Experts surmise that the Holmes Heart very well may have been a Cor Triloculare Biatriatum heart, a very rare defect indeed.)

Curious still, Abbott searched for the issue of the Edinburgh Medical Journal that contained the research paper about the heart. She was shocked to discover that the heart was removed from a 22-year-old man during his autopsy. This heart had worked for twenty-two years? HOW? With that thought in her head, Doctor Maude Abbott decided to try to find out exactly how a defective heart worked… and perhaps one day, fix them.

And in that moment Congenital Cardiology was born.

Fast forward in time…

The situation was almost the same for Dr. Helen Taussig. By 1930, there were still very few female doctors, and opinion of them had not improved. Taussig was about to get a job at Johns Hopkins Hospital because she had gone to medical school there – it would be a bit difficult for the Hopkins Administration to award Taussig an MD and then claim that she wasn’t good enough to do the job. Helen wasn’t doing anything to discourage that thinking, because she had a little known secret: Helen Taussig, MD was losing her hearing.

Hopkins put her in charge of the Cardiac Care Unit of the Harriet Lane Home for Invalid Children, the dreaded Pediatric Cardiology department. In the 1930’s children with heart problems fell into two categories. One group had hearts weakened by Rheumatic Fever; these children would often recover but be left weakened by the disease’s attack on the heart valves; and children with Congenital Heart Defects (CHDs). CHDs were incurable with very few treatment options. If you were lucky a heart defect let you live until you were a teenager, but it always won in the end. 100% fatality rate – with luck, you could slow it down, but that was it.

Taussig was a natural-born researcher and could see only one way to try to figure out how heart defects worked. Nearly every day she sat down with grieving parents and asked a terrible question: May I conduct an autopsy on your child? She wouldn’t leave the job to others, Taussig would do the autopsy herself, and often she would remove and preserve the heart. In a few years her office was an unofficial medical museum, made up almost exclusively of hearts. Word started getting around about what she was doing and other doctors started complaining. Taussig’s boss and former mentor in medical school, Dr. Edwards Park, had to tell her to try to be a little more discrete several times. Taussig could make a bad situation worse by wanting to slice up a child, and by now her hearing loss was obvious. But the Cardiac Clinic was also producing some results, and most of the new ideas came from Taussig. Heart Defects (“Congenital Malformations”, as Taussig always called them) still won all the battles, but they were helping the kids live longer and better. If your child has a heart problem, doctors around the country were telling parents, get them to Hopkins.

Taussig had overcome her hearing problem with a special stethoscope that worked with a hearing aid (it was huge, the amplifier case is visible IN THIS PHOTO. Look for the black box balanced on the edge of the wheelchair) and by teaching herself to feel a heartbeat with her fingertips (CLICK HERE for a close up photo of her fingertip technique). But despite all this, there was nothing she could do. Children were living a little longer, and that was it.

Taussig observed what she called the “Fallot Squat,” when children with Tetralogy of Fallot (ToF) would squat deeply, folding their knee joints as much as possible. After thinking about this activity Taussig was able to determine that the children with low blood oxygen were actually suffocating, despite breathing deeply. Further investigation and reasoning gave her an idea: Heart surgery had never been tried before, but what if the blood vessels near the heart were moved around? Rearrange them to deliver more blood to the lungs and oxygenate it better. Would that work? Taussig thought that it would – but she wasn’t a surgeon, and couldn’t convince any of the Hopkins surgeons to try it.

A new Chief of Surgery arrived in late 1942, a man named Blalock from Vanderbilt University. It wasn’t love at first sight; in fact, the two disliked each other. The new doctor… well, he was a typical surgeon, thought the entire world revolved around him. His way or the highway. She wouldn’t admit to it, but Taussig could be stubborn herself. You didn’t mess with her patients, even a little bit. Add to that the fact that her deafness robbed her of a lot of opportunities for human interaction, and Helen Taussig was a loner. Her clinic, her patients, her research, her world. And very few people were admitted to that world.

It finally came to a head in the Hopkins Cafeteria. Legend has it that Taussig barged into a conversation between Blalock and Parks and took over. Working fast because she knew she’d have only one chance, Taussig convinced Blalock that she knew what she was talking about: an operation to direct more blood to the lungs of kids with defective hearts might work.

An additional year of research was frustrating, but necessary. Blalock and his research assistant, Vivien Thomas, had considered a similar idea while at Vanderbilt but had never progressed to human testing. Meanwhile, Helen was still doing autopsies. She didn’t like it, but moving too fast could ruin the entire project.

On November 29, 1944 they still weren’t ready but they tried anyway. Eileen Saxon was near death and could not wait much longer. Entering through an incision in her side, Blalock clamped the Subclavian Artery, cut it, and sewed it into the Pulmonary Artery. When the clamps were removed the surgical team watched in amazement as her blue lips slowly turned pink.

Even though all three of them have passed, Taussig, Blalock, and Thomas live on. The Blalock-Taussig shunt is still used today, and the entire field of Congenital Cardiac Surgery exists because of  them. “These children are my crossword puzzles,” Helen Taussig once said. “And one day I shall solve them.”

The Holmes Heart

September 18, 2009

This is probably the moment when the study of defective hearts began: a day in 1899 when Canadian physician Maude Abbott found an unusual medical specimen and wondered What in the world is this?

Recently named Assistant Curator of the Medical Museum of the McGill University Medical School, Abbott was appalled at what she found. A properly organized Medical Museum was a valuable resource to a medical school of the 19th century. Students could go down to the museum and study preserved organs and cadavers to learn about the workings of the human body. McGill’s facility hardly deserved the title; it was more like a giant linen closet full of surplus body parts.

“Let’s organize and catalog our exhibits,” Abbott suggested. “Find out exactly what we have.” Her boss glanced at the calender on the wall, figured three weeks before his retirement was not the time to begin a major project, and said no. He wasn’t interested, but if Maude wanted to, go right ahead. And that was what Maude Abbott was doing when she found it.

What in the world is this? It was a heart, obviously, but it was unlike any heart she had ever seen. There were two Atriums but only one Ventricle. No, there were two Ventricles, but one was so tiny that she almost missed it. Two valves drained into the same ventricle, leaving the other one isolated.  The specimen container was labeled Ulcerative Endocarditis. That was almost certainly what led to the owners death; experts have speculated that the specimen was a  Cor Triloculare Biatraitum heart, a very rare defect.

No one knew anything about this heart, other than the fact that it was obviously deformed. Abbott thought of someone who might know, Dr. William Osler. Now a major figure at the new Johns Hopkins Hospital in America and one of the world’s most respected doctors, Osler had graduated from McGill. She had met him in Baltimore the year before, perhaps he would answer a letter from someone at his old medical school.

Not only did Osler answer, he seemed to know the item Abbott had asked about.  Osler described the heart and referred to it as the “Holmes Heart” because it had been donated to the museum in 1822 by the Dean of the medical school, Dr. Andrew Holmes. Holmes had also documented the heart in an article that had appeared in the Edinburgh Medical Journal.

Abbott began to search for that issue of the EMJ. Finding a 75 year old medical journal wasn’t easy, but she located one. She was stunned to read that the heart had been removed during the autopsy of a 22 year old man. Someone had lived 22 years with this heart? How?

Since the heart had been “lost” for an unknown amount of time, Abbott revised the article, documented the recovery of the heart, and submitted it to the McGill Medical Journal under her own name.

But she was left with this strange heart and the thought that someone had actually lived to adulthood with it beating inside their body. It must have struggled to produce every beat. Already an noted expert on hearts who had produced a major work on heart murmurs, Abbott decided to study defective hearts in more detail.

And this could have been the starting point of Congenital Cardiology  – a malformed heart floating in a sealed glass container, sitting on a shelf for over 70 years.

Before Taussig: Maude Abbott

April 29, 2009

Maude Abbott was born in 1869 in a small town in  Quebec, Canada. After graduating from McGill University in Montreal, she applied to McGill’s medical school. Like most medical schools of the 1890’s, McGill did not accept female students into its medical school.

Maude applied to Bishop’s College (Now Bishop’s University) and with a little arm twisting, was admitted to the medical program. She graduated in 1894 as the only woman in her class.

She hit the road after graduating in 1897, studying medicine all over Europe. Returning to Montreal, she set up her own practice. It wasn’t long before a colleague offered her a position doing research at the Royal Victoria Hospital. Her research on heart murmurs was accepted by a Montreal medical society, but a male doctor had to present her paper because women were not allowed to join the society.

She applied to McGill for a teaching position in 1899. While not ready to hire a female teacher, McGill wanted her bad enough that they felt they had to offer her something… so she was named assistant curator at the McGill Medical Museum.

A turn of the century medical museum was an important tool. Organs, body systems, and even entire bodies were preserved and kept in the museum. Without many of the visual aids used today, medical students often found themselves at the museum, studying the inner workings of the body. A well stocked medical museum also featured deformed organs – sometimes the stranger the better. Doctors just didn’t get to see such things that often, so if possible, obtaining a deformed organ was very valuable. It would strike most people as more than a little disturbing, but that is the way it was done.

A heart specialist with an entire medical museum at her command, Maude began requesting defective hearts. It wasn’t long before she had plenty – there was no way to correct a heart defect, so no one really had any reason to keep them. Although she had no way to repair a defective heart, Maude studied her samples and tried to figure out exactly what was wrong with them. If she could, she would classify them and group them together by their similarities.

During her first few years at McGill, Maude was in Washington, DC and met Dr. William Osler – another Canadian doctor who was turning Johns Hopkins University into the premier United States medical school. He was also working on a major book about medicine and invited Abbott to write the chapter on Congenital Heart Defects. When it was published in 1907 she was recognized as the leading authority on defective hearts. In 1936, she published her greatest work: The Atlas of Congenital Cardiac Disease. Maude Abbott passed away in September of 1940, four years before Alfred Blalock, Helen Taussig, and Vivien Thomas attempted to correct a Congenital Heart Defect with surgery.

It had to be frustrating – although Maude was learning what was wrong with the hearts and how it affected the body, she could offer no way to correct them. Little did she know (or perhaps she did know) that she was laying the groundwork for people who would come later – people who had actually developed ways to fix broken hearts and would look back to Maude Abbott’s work as their guide.