Do we really need medical students learning about birth from mute robots? Really?
Here, just in time for Mother's Day, is a little known story about the enterprise that has set the bar for the practice of medicine in America. When all was said and done, it was women who served as midwives for the dream.
And, it was a woman who insisted on the high standards that have made Johns Hopkins Medicine the paragon it has been.
Women attended medical school in the 19th century; there were even medical schools just for women. However, women had a hard time being taken seriously at most of the top medical schools -- and that is an understatement.
The exception was Johns Hopkins, where three women were part of the first class, and where women have been part of the student body straight through to the present -- very unusual, given all the changes that occurred in medical education early in the 20th century. (More on that in future posts.)
What made the difference? At a crucial point, a savvy, determined group of women held the pursestrings.
The money earmarked for construction of the medical school was underwritten with stock in the Baltimore & Ohio Railroad. In 1888, when the value of that stock plummeted, the fate of the school was uncertain.
Martha Carey Thomas, Mary Elizabeth Garrett, Elizabeth King, Mary Gwinn and Julia Rogers -- the so-called "Friday Evening Group" -- were wealthy Baltimore feminists, friends, stellar fund-raisers and (except for Rogers) daughters of members of the original board of trustees. They pledged $500,000 to Johns Hopkins Medicine, but only if women were allowed to attend the school. Opposition was fierce, but the women got what they had asked for.
Garrett, who contributed the bulk of the money herself, further demanded that medical-school candidates have a college degree with a concentration in basic science, and be able to speak and read French, German and Latin.
William Welch himself had proposed these requirements years before but they had been dismissed as unrealistic. Now every Hopkins undergraduate, male and female, would have to meet them. As William Osler joked to Welch, "It is lucky that we got in as professors; we could never enter as students."
Of the women in that first class, one quit to become a Christian Scientist and one married her anatomy professor. Only Mary Packard became a doctor. Years later, though, Welch wrote, "We regard co-education a success; those of us who were not enthusiastic at the beginning are now sympathetic and friendly."
Painting by John Singer Sargent
The founding faculty of Johns Hopkins School of Medicine comprised some of the most respected medical men of their era. All were innovators with rigorous standards of practice, research and training.
They set the bar high for other medical schools, and many of their graduates went on to establish or transform other programs around the country.
William Welch, who helped the university's president, Daniel Coit Gilman, assemble the team, was a pathologist; William Osler, the internist who oversaw the department of medicine, was a Canadian considered the finest doctor practicing in the United States; William Stewart Halsted headed up surgery; and Howard Kelly, gynecology and obstetrics.
At a time when individual doctors could be institutions unto themselves, Osler introduced the concept of the medical residency, and Welch a training program in advanced techniques for full-fledged doctors that resembled a modern post-doctoral course. Welch also founded the country's first school of public health. Kelly established his own cancer clinic.
Halsted taught his students to operate at a new level of skill and care, and was responsible for introducing the use of surgical gloves, which in beginning were meant merely to protect doctors' and nurses' hands.
The Society for Maternal Fetal Medicine held its annual conference in Chicago last week, and I went to a few sessions. The physicians, who specialize in the health of mothers and their babies, spent up to six days in meetings, so I got a canape-size serving compared to theirs.
Research teams from all over the country, and from other countries as well, reported on their investigations into conditions that jeopardize mothers' and babies' health in pregnancy. Several important findings came out of the meeting. Here are just a few:
* A simple new urine test with a cool name, the "Congo Red Dot Test," appears to be able to predict and diagnose preeclampsia, a condition that can kill mothers and babies, cause birth defects, and is a major contributor to pre-term birth. A research team from the Yale University School of Medicine found that the test accurately predicted preeclampsia in 347 women in their study. Preeclampsia symptoms include hypertension and protein in the urine. The condition affects 5 to 10 percent of pregnancies. It is commonly treated by delivering the baby.
* One of every three pre-term births is caused by a "silent" infection inside the uterus. Now it appears some women and babies are genetically more susceptible to inflammatory infections, according to a study led by Roberto Romero MD, Chief of the Perinatology Research Branch at the National Institute of Child Health and Human Development. The study won an award from the March of Dimes, a nonprofit group that works to prevent birth defects, premature birth and infant mortality.