Taussig, Helen Brooke (1898–1986)

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Taussig, Helen Brooke (1898–1986)

Renowned pediatric cardiologist and authority on congenital cardiac malformations who helped develop a surgical procedure that saved the lives of thousands of children. Pronunciation: TOE-sig. Born Helen Brooke Taussig on May 24, 1898, in Cambridge, Massachusetts; died in an automobile accident in Kennett Square, Pennsylvania, on May 21, 1986; daughter of Frank William Taussig (a professor of economics at Harvard University) and Edith (Guild) Taussig; graduated from the Cambridge School for Girls in 1917; attended Radcliffe College, 1917–19; graduated from the University of California at Berkeley, 1921; took graduate courses at Harvard University, 1921; studied and did research at Boston University, 1922–24; graduated from the Johns Hopkins University School of Medicine, 1927; never married; no children.

Honorary doctorates from 20 institutions, including Boston University School of Medicine (1948); Northwestern University (1951); Columbia University (1951); Women's Medical College of Pennsylvania (1951); University of Athens (Greece, 1956); Harvard University (1959); Göttingen University (Germany, 1960); University of Vienna (Austria, 1965); University of Massachusetts (1966); Jefferson Medical College and Medical Center (1967); Duke University (1968); Medical College of Wisconsin (1972).

Awards:

more than 40 national and international awards, including Chevalier Légion d'Honneur (France, 1947); Passano Award (1948); American College of Chest Physicians, Honorary Medal (1953); Feltrinelli Prize (Italy, 1954); Albert Lasker Award (1954); Eleanor Roosevelt Achievement Award (1957); American Heart Association Award of Merit (1957); Gairdner Foundation Award of Merit (Canada, 1959); American College of Cardiology Honorary Fellowship (1960); American Heart Association Gold Heart Award (1963); Medal of Freedom of the United States, presented by President Lyndon B. Johnson (September 14, 1964); American College of Cardiology, The Theodore and Susan Cummings Humanitarian Award (1965); Carl Ludwig Medal of Honor (Germany, 1967); The VII Interamerican Award of Merit (Peru, 1968); Presidential Medal of the Republic of Peru, presented by President Fernando Belaunde Terry (1968); American Pediatric Society Howland Award (1971); Tokyo Society of Medical Sciences and Faculty of Medicine Plaque (Japan, 1971); American College of Physicians Mastership (1972); American Heart Association, James B. Herrick Award of the Council of Clinical Cardiology (1974); The Johns Hopkins University Milton S. Eisenhower Gold Medal (1976); American College of Cardiology Presidential Citation (1980).

Published first scientific article while in medical school (1925); was a fellow in cardiology and intern in pediatrics, Johns Hopkins Hospital (1927–29); was physician-in-charge, Harriet Lane Home Cardiac Clinic, Johns Hopkins Hospital (1930–63); first operated on a blue baby, Johns Hopkins Hospital (1944); became instructor in pediatrics, Johns Hopkins University School of Medicine (1930–46), associate professor of pediatrics (1946–59), professor of pediatrics (1959–63), professor emeritus (1963–86); published Congenital Malformations of the Heart (NY: The Commonwealth Fund, 1947, rev. ed., 1960); was founding member of the Board of Pediatric Cardiology (1960); began investigation of birth deformities caused by thalidomide and other drugs (1962); served as president of the American Heart Association (1965–66); published 100 articles in scientific journals.

More than any other person, Helen Brooke Taussig was responsible for the development of pediatric cardiology as a medical specialty. Before 1940, pediatricians knew little about the various congenital malformations of the infant heart. It was Taussig who developed the observations that helped differentiate malformations by their specific clinical signs. And she managed to do this despite two major inhibiting dysfunctions—loss of hearing that began after medical school and dyslexia that had plagued her since childhood.

She was born in 1898 in Cambridge, Massachusetts. As a child, she was humiliated in school by her dyslexia, since she was never able to read aloud in class with the same ease as other students. For Taussig, to read even a few lines was a struggle, and her instructors were not supportive. Because so little was known about dyslexia during the early 1900s, her teachers insisted that she could read if she really tried. At home, however, Helen was constantly encouraged by her father Frank Taussig, an eminent professor of economics at Harvard. She later recalled with gratitude that her father had never ridiculed her or told her she could do better, though after she failed reading and spelling several times, he privately feared she would not pass grade school. Once when Taussig became particularly discouraged, he cheered her with, "Helen, spelling is not logical. You're a very logical girl; no wonder you can't spell!" But Taussig had an ability to maintain an intense focus. Determined to overcome her impediment, she persevered, and her reading gradually improved; but reading would always remain a chore for her rather than a pleasure.

When Taussig, the youngest of four children, was 11 years old, her mother Edith Guild Taussig died of tuberculosis. Helen contracted a mild form of the disease and attended school only for half days over a two-year period. After Edith's death, Helen's bond with her father became even closer.

Every summer the Taussig family moved to a beach house overlooking Nantucket Sound in Cotuit on Cape Cod, where the children were encouraged to participate in outdoor activities, but only after they had spent the mornings studying. For the rest of her life, even when she had her own vacation home on the Cape, Taussig would continue to devote mornings to her studies. Guests were instructed to fix their own breakfasts and not to expect her to join them until lunch time.

After her graduation from the Cambridge School for Girls in 1917, Taussig enrolled in Radcliffe College, associated with Harvard,

where she was known as Frank Taussig's daughter. During her two years there, she played in tennis tournaments and was on the varsity basketball team, but she was not particularly happy. After a trip to California with her father, she decided to transfer to the University of California at Berkeley where she would feel less in her father's shadow. The fact that Frank had remarried in 1918 and moved to Washington probably encouraged her desire for independence. Frank Taussig gave his permission for the transfer provided she finish her second year at Radcliffe.

When Helen graduated from the University of California in 1921, she was undecided about a career. Medicine was mildly appealing to her, but she had not taken the required premedical courses. Frank recommended public health as "a very good field for women" and suggested that she apply to the new School of Public Health at Harvard. But Harvard was not progressive in its admission policies, and women were not accepted as degree candidates. In an interview, Taussig was told by the dean of the School of Public Health that all students there "should have two years of medicine and then we will permit women to study but we will not admit them as candidates for degrees." Taussig made it clear to the dean that she considered such a proposal absurd. The interview did, however, strengthen her inclination to study medicine.

She began her medical studies at Harvard in 1921 when she was given special permission to take histology, provided that she sat apart from the male students in the lecture hall. During laboratory sessions with the microscope, she had to sit in another room where, she recalled, she "wouldn't contaminate" the men. (Harvard would not admit women as regular medical students until 1945.) Despite the school's policy of discrimination against women, Taussig's histology professor recognized her ability. Dr. Bremer urged her to enroll at Boston University where she could take other courses and receive credit for her work.

At Boston University, after her anatomy professor, Dr. Begg, suggested that she "get interested in one of the larger organs of the body" by studying the heart, Taussig spent hours meticulously dissecting beef hearts. Following months of careful experiments on heart tissue from humans and other mammals, she was the first to show that heart tissue from mammals would contract rhythmically, as did tissue from cold-blooded animals, when immersed in a special solution. Taussig reported these significant findings in her first scientific paper, published in 1925 in the Journal of Physiology.

It was Dr. Begg who suggested that Taussig apply to the Johns Hopkins Medical School in Baltimore, Maryland, where women had been accepted since its opening in 1893. When Begg mentioned that one letter from Harvard would get her in, Taussig asked Dr. Walter Cannon, a family friend and professor of physiology at Harvard, for a recommendation. Cannon wrote to Johns Hopkins: "I have had the opportunity to watch her work and if women were admitted to Harvard I would enthusiastically vote for her admission. As you are more liberal than we, I hope you will admit her." Taussig was admitted in 1924 and graduated in 1927. She would spend her entire career at Johns Hopkins.

After two years as a fellow in cardiology and an intern in pediatrics, Helen Taussig came under the influence of Dr. Edwards A. Park, the new chair of pediatrics, who became her mentor. In 1930, when Park established a pediatric cardiac clinic at Johns Hopkins, he asked Taussig to be the director. Many children were brought to the clinic with complications from rheumatic fever. Others were cyanotic (blue babies) who struggled to breathe because their malformed hearts were not pumping enough blood to the lungs for it to become saturated with oxygen. Little could be done for the cyanotic children, but Taussig learned much from examining them.

The clinic was outfitted with a fluoroscope, a new device similar to an X-ray machine, that for the first time allowed imaging of cardiac abnormalities. While Taussig's tiny patients turned slowly in front of the fluoroscope tube, their beating hearts could be visualized for a few seconds at a time. When cyanotic children died, Taussig followed up by studying their hearts at autopsy, carefully correlating her findings with her clinical observations. Gradually, she began to discover that certain malformations created specific clinical signs and symptoms in children. This was a major step in the understanding of congenital malformations of the heart.

For a physician in 1930, especially a pediatrician needing to listen to the delicate sounds of a baby's abnormal heart, the stethoscope was indispensable. When Taussig began to lose her hearing in 1930 and realized that her ability to distinguish sounds with a stethoscope was diminished, it was a severe blow, because hearing aids were clumsy and inadequate. She confronted this obstacle squarely, however, by teaching herself to lip-read and training her fingers to "hear" by feeling vibrations. She practiced listening with her hands by placing them on cushions during radio concerts and feeling the amplified vibrations. At the clinic, she examined the children with her hands resting gently on their chests to feel the pulsations. As her skill increased, she often surprised her colleagues by detecting problems they had been unable to identify with the stethoscope.

Taussig was aided in her study of the heart by the work of Dr. Maude Abbott , a Canadian physician acknowledged during that period as the authority on congenitally malformed hearts. Taussig spent a short time in Toronto learning from Abbott, who generously shared her knowledge, showing Taussig her X-rays and autopsy specimens of various malformations.

As a result of her clinical findings and research, Taussig became convinced that a way should be found to surgically open a duct between the heart and lungs in cyanotic children so that sufficient blood could flow to the lungs for oxygenation. In 1939, a pediatric surgeon in Boston was considered a hero after he successfully operated to close a duct, called the ductus arteriosus, leading from the heart in a baby whose ductus had not closed naturally as it should have after birth. Taussig believed that if a ductus could be closed, then it might be possible to create an open ductus to carry blood to the lungs.

By the time Dr. Alfred Blalock came to the Johns Hopkins Hospital in 1941 as chair of the department of surgery, he had already performed three operations to close the ductus arteriosus. Taussig observed one such operation and told him: "I stand in awe and admiration of your surgical skill, but the really great day will come when you build a ductus for a cyanotic child, not when you tie off a ductus for a child who has a little too much blood going to his lungs." Replied Blalock: "When that day comes, this will seem like child's play."

Blalock was intrigued by Taussig's challenge and arranged for his male laboratory assistant, Vivien Thomas, to experiment with dogs to create an artificial ductus by joining two arteries. Anna, the first dog to undergo the Blalock-Taussig anastomosis, lived for years after the procedure and became a minor celebrity in Baltimore. Over the next two years, Thomas operated successfully on more than 200 dogs, often with Blalock observing. But before Blalock was able to experiment with the procedure unassisted by Thomas, Taussig presented the case of a child who was near death, struggling for air whenever she was removed from her oxygen tent. The Blalock-Taussig procedure was the child's only hope.

On November 29, 1944, 15-month-old Eileen Saxon , weighing just 9½ pounds, underwent the operation that Taussig had envisioned years before. She watched from the head of the operating table as Blalock and several associates created a new pathway to the lungs no larger than a matchstick. Two months later, after the child had recovered sufficiently to return home, the Blalock-Taussig procedure was performed on an 11-year-old girl, and in February 1945 a 9-year-old boy underwent the surgery. These three children were the subject of an article written by Blalock and Taussig that gave a detailed account of the procedure, noting that "each of the patients appears to be greatly benefitted." Denton Cooley, one of Blalock's young associates who assisted at the operations, later called the three operations "the dawn of heart surgery."

News of the operations spread throughout the world. Desperate parents besieged Taussig's clinic, sometimes arriving unexpectedly with their cyanotic children. After thorough examination, Taussig and her associates often decided that a cyanotic child would not benefit from surgery, but over the years she recommended more than 1,000 children to Blalock. When other surgeons began performing the procedure, at least 12,000 children were eventually saved before advances in cardiac surgery reduced the need for the Blalock-Taussig procedure. Years later, Taussig recalled the "great thrill" of "seeing a child change from blue to pink." Taussig kept in touch with many of her former patients, who usually went on to live healthy, productive lives. She considered "her babies" part of her extended family.

Taussig was responsible for attracting many young medical graduates to the field of pediatric cardiology, which she virtually created through her clinical work and her landmark textbook Congenital Malformations of the Heart, published in 1947. One of her former students later said that the book "provided the basis on which the discipline of pediatric cardiology was built." One pediatrician recalled that in the late 1940s he "held cardiac clinic with a stethoscope in one hand and Dr. Taussig's book in the other."

Students who trained with her as fellows for two years were known as the "Loyal Knights of Taussig," and they were indeed loyal to their mentor. The fellows became friends who supported her on her often difficult path as a women in the male medical establishment. She trained 123 men and women as pediatric cardiologists, and worked with many physicians from around the world who trained with her briefly. Every other year, Taussig held a reunion of all her fellows at her home in Baltimore or at Cape Cod, where they picnicked, played, reminisced, and held a two-day scientific program in pediatric cardiology. For Taussig, who never married, these former students were as much a part of her extended family as her former patients.

In the late 1940s, Taussig began to receive many honors. It pained her, however, that Blalock was elected to the prestigious National Academy of Sciences in 1945 and she was not. Taussig also felt discrimination at Johns Hopkins. She was not made an associate professor until 1946, two years after the first "blue baby" operation, and had to wait until 1959 to be made a full professor of pediatrics. After her retirement, she mentioned how disappointed she was that it took her so long to be promoted to the rank of professor. "A man would have had the promotion long before I got mine," she said. One of her former fellows wrote that "one cannot describe the real life of Helen Taussig without recalling the turmoil, the resentments, envy and bitterness that more than counterbalanced any recognition of her work. For many years she was constantly under siege, but she knew her course and fought back. She was aggressive, defensive, combative, sometimes triumphant and often defeated. She suffered." Most of the time, said another colleague, "she was a marvelous, gracious lady" who "demanded excellence." With sick children and their families, however, she was always patient and compassionate, and she impressed upon her fellows the importance of easing the burdens of the people who sought their help.

Taussig's influence expanded in 1962 after she took a short leave from Johns Hopkins to investigate an outbreak of severe birth defects in Germany. Many babies were being born with misshaped legs and flipperlike appendages for arms, a rare deformity known as phocomelia or "seal limb." Some investigators thought that an over-the-counter sedative and treatment for morning sickness called thalidomide might be the cause. After traveling through Germany and Great Britain, asking questions and studying the findings of other investigators, Taussig was soon convinced that thalidomide, taken between the 20th and 42nd day of pregnancy, interrupted limb development. Even one thalidomide tablet taken in this time period was enough to cause the deformity. Fortunately, Dr. Frances O. Kelsey , head of the Food and Drug Administration, had fought against approval of the drug in the United States. When Taussig returned home, she publicized her conclusions in scientific articles, in medical meetings, and before the Kefauver Committee in Congress. She was concerned not only about the effect of thalidomide but also about the possible effects of any drug that could result in birth defects. Her testimony helped ensure passage of legislation mandating careful testing of medications used during pregnancy.

Following her retirement from Johns Hopkins in 1963, at age 65, Taussig continued to be involved in activities that affected the welfare of children. As a prominent pediatric cardiologist, she promoted the public's awareness of this important medical specialty. In 1965, she became the first woman and the first pediatric cardiologist to be elected president of the American Heart Association. Over the next 20 years, she attended scientific meetings around the world, published over 40 scientific papers, and continued her research into the causes of malformations of the heart.

In the last years of her life, Taussig lived at a retirement home in Kennett Square, Pennsylvania, and studied cardiac malformations in wild birds at the Delaware Museum of Natural History. Her last paper, completed early in 1986, described her examination of the tiny hearts of warblers. Taussig was killed that year in an automobile accident on her way to cast a vote. One of her young colleagues summarized her final hour: "She died wanting to change the world."

sources:

Baldwin, Joyce. To Heal the Heart of a Child: Helen Taussig, M.D. NY: Walker, 1992.

Gilbert, Lynn, and Gaylen Moore. Particular Passions: Talks with Women Who Have Shaped Our Lives. NY: Clarkson N. Potter, 1981, pp. 51–57.

McNamara, Dan G., James A. Manning, Mary Allen Engle, et al. "Helen Brooke Taussig: 1898 to 1986," in Journal of the American College of Cardiology. Vol. 10, 1987, pp. 662–671.

Neill, Catherine. "Profiles in Pediatrics II: Helen Brooke Taussig," in The Journal of Pediatrics. Vol. 125, 1994, pp. 499–502.