American Science: My View from the Bench

By Barbara Ruben Migeon

In this insiders account of university science in America, Barbara Migeon focuses on how an influx of new technologies empowered scientists to make groundbreaking discoveries on the nature of hereditary diseases.

She begins her story with an account of how she began her research career before delving into a broader discussion of what scientists do, what they must deal with, and the changing face of biomedical science over the last half century.

This is a fascinating, insightful and thought-provoking book, beautifully written by an excellent scientist, a pioneering female in a strongly male-centric field. Her personal history of this remarkable era of biomedical science is a must read for anyone males, females, scientists and non-scientists curious about the process of scientific discovery and progress toward gender equity. Her account shows how science is shaped by deep commitment and insights, complex human interactions, and public policy.
Barbara Sollner-Webb. Professor Emerita,
Department of Biological Chemistry,
The Johns Hopkins University

I was captivated by Migeons ability to synthesize the personal, political, scientific, and academic strands of her life over the past half-century. To her credit, this historian speaks forthrightly; while her research clearly has been a source of deep joy, she also exposes the institutional problems (including sexism). Her inclusion of selected material from a personal journal she kept over the years is a welcome addition to a book that offers a fresh perspective to scientists as well as non-scientists, men as well as women.
Evelyn Torton Beck, Professor Emerita,
Womens Studies, University of Maryland

• Language: English
• Publisher: Archway Publishing
• Release date: Sep 28, 2016
• ISBN: 9781480832121

Barbara Ruben Migeon

Barbara Ruben Migeon is a physician Scientist in the McKusick Nathans Institute of Genetic Medicine at Johns Hopkins School of Medicine. A graduate of Smith College and the University of Buffalo Medical School, she was the founding director of the Ph.D. Program in Human Genetics at Hopkins. She is the author of Females are Mosaics: X Inactivation and Sex Differences in Disease.

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Copyright © 2016 Barbara R. Migeon, M.D.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-4808-3210-7 (sc)

ISBN: 978-1-4808-3211-4 (hc)

ISBN: 978-1-4808-3212-1 (e)

Library of Congress Control Number: 2016948694

Archway Publishing rev. date: 9/28/2016

For my father and my husband, who made it all possible

Acknowledgements

I am indebted to many:

To My Family,

This book is dedicated to the two men in my life who made my story possible: The first is William Saul Ruben, who as a general practitioner of medicine and a father of the best kind inspired me, and literally pushed me into the field of medicine. Recently, to honor my having orchestrated a solution to her family’s enigmatic genetic problem, a young woman in rural China asked me to name her healthy newborn boy. I suggested the name William or Bill, explaining that they were my father’s names, and I would never have become a doctor without him. She thought Bill a fine name, and I am pleased that my father has a Chinese namesake.

The other, Claude Jean Migeon, my extraordinary husband, whose love of science, medicine and his wife enabled me to do whatever I wanted to do. Claude was attracted to me in part, because I was a physician, who could share his scientific ideas and help support our family. Strongly believing in my need to pursue my own career as a scientist, he did all that he could to help me do it.

I owe a large debt to my children, Jacques, Jean-Paul and Nicole, who never complained about life with a non-traditional mother, and despite years of maternal neglect grew up into adults whom I greatly admire.

To My Readers:

The first of this invaluable group were Kelly Carty and Asiwome Addae, two premedical students at Johns Hopkins University with remarkable literary skills. For our tutorial, they read two chapters a week and wrote critiques of each one, which we discussed in nine weekly meetings – the highlight of my week. The book benefitted enormously from their attention to political correctness and their responses to what they had read. Their interest in the material encouraged me to continue.

I am also indebted to subsequent readers, my cytogenetics colleagues Dr. Patricia A Jacobs and Dr. Orlando J Miller, high school science teacher Kim Mudge, my sister, Sheila R Markin, my daughter, Nicole A Migeon, and my husband, Claude, who suggested revisions that I took to heart. I am grateful to Professor Evelyn Torton Beck for her heartwarming support. The science writer Lynne Lamberg deserves much gratitude for her excellent suggestions and powerful encouragement. I am especially grateful to my Hopkins colleague, Dr. Barbara Sollner Webb, for her meticulous reading and for the insightful discussions that followed. We discovered that our experiences at Johns Hopkins differed somewhat because she belonged to a basic science department, and I, to a clinical department. I submitted some of the chapters to my fellow students in Mary Knudson’s superb class that teaches physicians how to write about science for non-scientists. I appreciate all their advice, which has colored the content of the book.

I thank those who gave me permission to use their letters, intellectual materials, and photographs, which include Dean Michael M.E. Johns, Dr. Alan Beggs, Dr. Carola Eisenberg, Professor Evelyn Torton Beck, the American Society of Human Genetics and the Archives of the Johns Hopkins School of Medicine.

I am most grateful to the role models I have had: the positive ones, my mentors, who showed me the way by their own inspiring deeds, and the negative ones who showed me the footsteps, I did not want to follow.

Barbara Ruben Migeon

Contents

Prologue: Why This Book?

1   The Learning Years

2   Getting a Job and a Research Project

3   Having It All

4   Life as a Medical Researcher

5   Peer Review: No Science without it!

6   Grantsmanship: The Funding of Research

7   The Publishing Game and the Censorship of Science

8   Climbing the Academic Ladder: Rules of the Game

9   The Scientific Meeting

10   Training Scientists

11   Crimes and Peccadilloes

12   Big Science: Making Science Pay

13   The Philosophy and Politics of American Science

14   Changing the Equation of Gender Dynamics: XX≠ XY

15   Endings & Beginnings

16   Epilog: Looking Back, Dreaming Forward

PROLOGUE

Why This Book?

I am one of a small number of American women of my generation who chose biomedical research as a career. Having participated in a half-century of modern American Science, I have a story to tell.

I want to relate the experiences of a woman physician-scientist, embedded in academic medicine and genetics long enough to witness a scientific evolution – an insider, working in an institution that has been a trailblazer in the field of genetics. Arriving on the scene at the beginning of the genetic revolution I was present at the birth of technological advances that have transformed human genetics from a field struggling to justify its existence to one at the cutting edge of medicine. I watched as these genetic innovations came to revolutionize medical research and provide novel approaches to health care.

The story begins with how I obtained training in pediatrics and genetics, and established my own laboratory, so that I could study the X chromosome and sex differences in disease. It tells of how I became the sixth women in the history of the medical school to attain a professorship. Yet, this book is not intended to be an autobiography, nor a book only about women. Just enough relevant biographical material is included to provide the framework and springboard for a broader discussion of what scientists do, what they must deal with, and the changing face of biomedical science over the last half century.

This book is my view of American Science as a medical scientist – working much of the time at a laboratory bench. The bench is a concept found in many professions. Only in the context of athletics does it denote a seat used by non-participating game players. In its legal context, it is a desk used by the Judge and other active players. It is the worktable for carpenters. The scientific bench – originally of soap-stone, and usually higher than desk level – is the work space used by the scientists who perform experiments; it houses the small electrical equipment, laboratory glassware and notebooks used for these studies.

My view from the bench provides an eye-witness account of biomedical science in an academic institution, during the second half of the twentieth century and the beginning of this one – at a time when geneticists became empowered by the influx of new methods that are permitting us to identify the nature of hereditary diseases. Although much of what I write applies to both men and women, I cannot ignore the differences in the treatment of males and females by the medical school establishment, by grant providers, by scientific journals and prize givers, and the special issues that women face in balancing their professional activities with other aspects of their lives.

One might rightfully ask why I consider myself an authority on the subject of American Science. One answer is that I have the right credentials. I have been a physician scientist at the Johns Hopkins School of Medicine for more than fifty years, during the reign of seven deans of the medical school. I have been recipient as well as reviewer of research grants, author as well as reviewer of research papers, student as well as teacher of medical science in the clinic and at the bench, and founding director of an innovative graduate program in human genetics.

I am completing this book at the end of my research career, but it has been on my mind, and in process for much longer. Scattered throughout the text are dated entrees from my own journal, which are in italics to distinguish them from the text. These entrees, not always in chronological order, were written at the time that events were occurring. I include them with slight editing, and updating, because they accurately reflect my feelings at the time, and, they illustrate and enhance what is written in the text.

In this book, I write about the way in which we obtain grants to support our laboratories, the way we report our scientific findings and the way we move up the academic ladder. I also consider the subject of research misconduct – the consequence of the competition for journal space, research support and promotion. I relate my view of the advent of Big Genomic Science – the group science that is replacing the prototypic individual investigator, as genetics and genomics evolved. One of sixteen chapters is devoted to the special issues that women face in their attempt to balance work with other aspects of their lives. In this case, my view is informed by my roles as the wife of a physician scientist and mother of three. However, much of what is said is gender neutral. Men as well as women can identify with it.

At the time I began to write in earnest, there were a handful of books by women scientists about their experiences – most published more than a century ago – or by women physicians, reporting their adventures during residency training. More recently, an edited book has been published with chapters written by women scientists about their careers ¹, another reports the experiences of five women doctors in corporate medicine², the third chronicles the pioneering career of an endocrinologist ³. Even with the new autobiographical material, little has been written by women, or men for that matter, about how we do science in this country. My story will also contribute to knowledge of the dynamic scientific era that I have lived through.

I am writing this book because I feel compelled to do so. I am eager to convey to future scientists the joy of devoting one’s life to asking questions and finding answers that may contribute to solving medical problems. I want them to know what fun it was, and what fun it can be. I also want to alert my non-scientist readers to the potential dangers of the paradoxical decrease in the level of support for the scientific endeavor at a time of expanding need, and how important it is to maintain adequate support for medical research so as to keep the innovations coming, and a critical mass of young investigators at the bench.

Although based on my personal experience, the book is enriched by conversations with colleagues, and by articles in the scientific and lay literature. My tale is full of tribulations, as pursuing a career in science is challenging for most of us. The rewards, however, are enormous. I would gladly make a deal with the devil to do it all over again.

1

The Learning Years

There were four women in our class of seventy-five medical students – just enough to share one cadaver. That might have been the plan of the admissions committee, when choosing the members of their class of 1956. Instead, in my anatomy class, I worked with three male classmates. In retrospect, I might have had a broader educational experience with the girls, because my lab partners, embryonic surgeons, did not let me do any dissecting. My role was to sit on a stool and read the directions from the lab manual to them, while they worked. I had to search my lab coat pockets for anatomical parts that would appear there from time to time. By the time the anatomy course was over, I had married one of my lab partners. The marriage lasted only to the end of our first year, but it had a longer influence on the course of future events.

The medical education that I experienced was essentially the same as that of my father, twenty-nine years earlier. The building was the same. The deaner⁴, who provided janitorial assistance to the various departments, remembered him, but my dad’s teachers were no longer there. Yet, we smoked the same drums in physiology⁵, sat on the same benches in an amphitheater for lectures, and used the same mnemonic devices to memorize the bones of the wrist⁶.

Dr. William Ruben: It was my father who nudged me into medical school. When I was seven, I informed him that one day I would be a nurse. This career choice did not surprise him, as he was an old fashioned family doctor, who worked from an office within our home, accessed from both our living room and kitchen. He knew I was well aware of his clinical activities.

His reply surprises me, even now: Why work so hard to be a glorified housemaid? Work just a little harder and you can be a doctor.

Whereas his response remains memorable, I remember less well when I became convinced that medicine was my calling – perhaps not until I was admitted to medical school. My father, however, persisted in pushing the idea, and I am sure that his persistence is largely responsible for my medical career.

To this day, I am amazed that he had such expectations for me. At that time there were few women physicians. Most women were fully occupied at home. If they had a vocation, most likely it was as a teacher because other careers were effectively not open to them. Furthermore, there was no tradition of medicine in our family. My father, one of eight children born to poor Russian Jewish immigrants, was the only one to attend college. It was his sheer determination and grit that got him admitted to the two-year medical school in Tuscaloosa Alabama, and that enabled him to transfer for his last two years of training to the University of Buffalo, where he received his medical degree on June 9, 1927. On the same day, two years later, he acquired a wife, and soon after, opened his office on the first floor of our two-story home on a busy boulevard in Rochester, New York.

In many ways my father was not an enlightened man. My sister (a year younger than me) considered him a male chauvinist as she remembers that he did not encourage her to do anything. He considered my mother, a stay-at-home housewife, someone to make his life easier, expecting her to wait on him at meals, and to be there, whenever he needed her.

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Figure 1.1. The three of us with cart. 1939.

Left to right: Robby (2 yr.), Barbara (8 yr.) and Sheila (7 yr.)

For me, the eldest of his three children (Figure 1.1), he was very special: an avid reader, a talented raconteur of Shakespeare’s plays and of movies he had seen, a devoted physician to his patients, an excellent diagnostician, who poured over his medical books to identify the disorder confronting him (Figure 1.2). I treasured the letters that he wrote to me when I was away at summer camp as he had a marvelous way with words; sometimes he was quite poetic. Most of all, I loved going with him as he made house calls, patiently waiting in the car for him to return to tell me what he had seen and done. I cherish the memory of him, calling on his patients during a snowstorm, toting his medical bag on our toy sled. He would eagerly discuss the details of his medical interventions with us all at supper. My sister’s response to all of this was to firmly decide never to marry a doctor; mine was to study medicine.

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Figure 1.2. William Ruben M.D., examining a child, assisted by a nurse, Emma Aldrich.

Smith College: In the middle of my junior year of high school, the prospect of being left behind, when my friends who were seniors went away to college, prompted me to consider other options. I decided to skip my senior year and try for early admission to college. My father suggested that I tell the principal of my high school that the year saved would be more usefully spent as a medical intern. I may have done as he said, but in fact, at that time medical school did not loom large in my plans. In any case, I managed to graduate early, and to be enrolled as a prospective freshman at Smith College in Northampton Massachusetts.

My choice of Smith College, the largest of the women’s colleges, was the outcome of years in a repressive co-educational environment. As a female in a large public high school, I was well aware that girls were second-class citizens, whose role in student government and other extracurricular activities was limited to that of recording secretary. To have a social life, girls needed to hide their academic talents. Not hiding it well enough, I had little after-school contact with my male classmates – dating only boys from other schools, who had never seen me perform in class.

As a member of the Class of 1952 at Smith College, I was astonished to see that women could do almost everything, comfortably taking on the roles traditionally held by men. Women were the editors of newspapers, the heads of radio stations, student government and judicial boards, and they were the first-rate athletes and musicians.

Even though the talent of Smith women was undeniable, it seemed to me that members of the college administration and faculty considered us to have less potential than men for the careers that society valued. Insidiously, they urged us to become wives and mothers of the best kind. The only vocation we were urged to pursue was teaching, because the hours and summer vacations were most compatible with raising children. We were also encouraged to go to Katie (Katherine) Gibbs, to acquire secretarial skills⁷.

My fellow Smith alumna, Gloria Steinem ’56, the human rights activist, in her address to the 1971 graduating class noted that among the information that the College Employment Office sent to potential employers was how many words a minute we could type. She said, The Dark Fifties, I am afraid, were not brightened much by the encouragement of women to be ambitious or autonomous – to dream unfeminine dreams. She added, A more representative question was asked me by a vocational adviser when I brought up the subject of law school. ‘Why study three extra years and end up in the back room of some law firm doing research and typing,’ she said with good sense, ‘when you can graduate from Smith College and do research and typing right away? ⁸

At that time, the Smith Quarterly, the magazine that the college sends to alumnae, included a feature called Reflected Glory, which reported the accomplishments of the husbands and sons of its graduates. On the other hand, the major I chose was called Premedical Science, so there were expectations that some of us might invade male dominated professions.

And what a marvelous major it was, enabling me to take the bare minimum of science courses required for medical school, and to sample a great deal of the liberal arts. The origins of my lifelong interest in art and in politics were rooted in courses like Art History and Political Parties, and they certainly enriched my life. Eleven of us from a class of six-hundred elected this pre-med major, and I believe that almost all of us went to medical school.

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Figure 1.3. Washburn House Formal Dinner, Smith College 1952.

Author, back row center.

Perhaps reflecting that Harvard⁹, Yale and Princeton Universities were off-limits to women at the time, it is nonetheless a credit to the education afforded by Smith College that two of the five women, who preceded me as professors at the Hopkins medical school were Smith graduates: Florence Sabin, the first woman to be named a professor (in 1917) and Caroline Bedell Thomas, the third women (in 1970).

Most of my classmates expected to marry shortly after graduation, and in our senior year the most popular topic of conversation was the engagement ring (Figure 1.3). Swept up in this desire for coupling, I found myself considering marriage to a student at Harvard Law School; I accepted a position as a laboratory technician at the Massachusetts General Hospital, assisting Dr. J. B. Stanbury in his research on thyroid disease. In fact, this was my response to the rejection letter from the University of Rochester’s School of Medicine, the only medical school for which I had completed the application process. Considering the economics of attending graduate school, that medical school was most attractive because it was in my hometown, and I could live at home.

Having good academic credentials, I expected to obtain an acceptance. However, during my interview with the Dean of the medical School, Dr. George Whipple, I became aware for the first time that being female was a decided disadvantage for those seeking a career in medicine.

Dean Whipple asked me why I thought I should be a physician. I told him: I loved science; I knew about being a physician from my experiences with a physician father; I had good grades; I was willing to work hard. The dean advised me to first become a nurse, or work a year and reapply the following year. I later learned that he had given the same advice to the three other girls in my medical school class, and that they, like me, decided not to take it.

Many years later, as a visiting professor in the Department of Medical Genetics at the University of Rochester, I learned that my being a short woman was also a problem; Whipple, a very tall man, thought that physicians should have the stature of a father figure¹⁰.

Prodded by my father once again, I applied to his - medical school, the University of Buffalo, now called the Jacobs School of Medicine. I did so without much conviction that this is what I was meant to do, and now with some doubt that I would be accepted. The uncertainty about my future plans stimulated the search for a job in Boston, and thoughts of marriage. However, when I received the letter from Buffalo, accepting me into the medical class of ‘56, I knew that of the choices at hand, medical school was the most attractive. Canceling my alternative plans, I prepared to follow in my father’s footsteps.

Medical School: Looking back, I do not recall any ill will towards the four of us, because we were women. Accepted so well by faculty and fellow medical students, I believed that my opportunities were unlimited. However, I was given special attention and was intensely pursued by a married professor; I did not know how to deal with him because of his power to influence my future. Perhaps because I had been married he thought I was fair game. I certainly did not think of reporting him to the administration. Even now, I believe that it would not have been a wise thing to do. I am deeply empathetic with Anita Hill ¹¹, and others like her, who delay reporting their difficult experiences.

Like many medical students, I found most everything about medicine fascinating, but I was drawn to surgery. With the help of George Thorn, a professor of medicine at Harvard and a graduate of my medical school, I spent the summer after my third year, working as a surgical extern at the Massachusetts General Hospital in Boston. This externship was enjoyable and enlightening. I scrubbed-in with world-renowned surgeons: the gynecologist Joe Vincent Meigs, the parathyroid surgeon Oliver Cope and the esophageal surgeon Sir Richard Sweet. My fellow externs, fourth-year Harvard medical students, all fervently seeking a surgical internship at the Massachusetts General Hospital, became my good friends, and together, we took excursions to the beaches on the Capes during our weekends off. Yet, while I relished this marvelous introduction to surgery, all the evidence clearly indicated that women were not accepted as surgeons. Aside from a woman anesthesiologist, I encountered no surgeon-role models, and our patients always thought I was a nurse. By the time I returned to Buffalo, I was convinced that pediatrics would be a better career choice.

In pursuit of a pediatric internship I interviewed at the Strong Memorial Hospital in Rochester, the Children’s Hospital in Boston and the Grace New Haven Hospital. My grades in pediatrics were outstanding and I had excellent recommendations, so I was surprised to receive rejections from all of them.

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Figure 1.4. Barbara Ruben M.D., 1956

In retrospect, I have some sense of what went wrong. As I learned later from a member of the Yale pediatric faculty at the time, they considered me emotionally immature having entered and left a marriage so precipitously. In Boston, I was again a victim of a sexual harassment. The married chief resident took me to dinner, and then told me that I could have the job if I spent the night with him. My response was immature; I cried. Again, I did not report this incident to anyone, not really believing that it would influence the decision process. No doubt, my short-lived marriage also played a role in Rochester. These three programs participated in the matching plan for internships¹² used to correlate the choices of potential interns with those of the medical institutions. I had made them my first, second and third choices, knowing that if needed, I would have a place at the Buffalo Children’s Hospital, which did not participate in the matching-plan. As none of my choices chose me, I was unmatched.

Needless to say I was embarrassed and devastated. Fortunately, one of my professors checked to see what pediatric department had failed to fill all of its positions. Fortuitously, the one at Johns Hopkins Hospital had at least one available position, most likely because their Chairman of Pediatrics had died unexpectedly, and his replacement had not been named at the time prospective interns made their choices. A phone call from an advisor to Dr. Robert Cooke at Yale, who by then had been appointed the Chairman-elect of Pediatrics at Hopkins, gave me the opportunity to train in this outstanding department. As a stroke of fate, I managed to get perhaps the most prestigious internship of anyone in my class. At the time of my graduation (Figure 1.4), I had a great sense of satisfaction with my accomplishments, perhaps for the first time.

The Harriet Lane Home: My three years in the pediatric residency program at Hopkins were intense, often challenging, at times exhausting, yet on the whole, invigorating. All the Pediatric activities took place in a building known as The Harriet Lane Home for Invalid Children – separate from, but attached by a long corridor to the main hospital.¹³ (Figure 1.5). It opened in 1912, as the nation’s first freestanding pediatric hospital affiliated with an academic research institution. Baltimore banker Henry Johnston and his wife, Harriet Lane Johnston, gave the funds in memory of their sons, who died in childhood from rheumatic fever¹. Their investment paid off, when in 1930 Harriet Lane clinicians discovered that sulfa drugs could prevent the cardiac damage that caused death from rheumatic fever.

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Figure 1.5. Harriet Lane Home for Invalid Children, exterior view, circa 1915.

The Harriet Lane home had five floors: The top floor was a hub of research activity. The middle three floors were home to the inpatients. And the first floor housed the emergency room, the outpatient department and diagnostic labs. It also included a little annex used for the children’s specialty clinics – such as cardiology and endocrinology.

When I arrived in the summer of 1956, the hospital had the reputation of being at the forefront of American pediatric medicine and of delivering world-class care for the sickest children. It was also renown for its pioneering research, excellent training programs, and flourishing specialty clinics, fostered by Edwards Park from 1927-1946, when he was director of the Harriet Lane Home.

Among the illustrious pediatricians on hand at my arrival was Helen Taussig, the renowned cardiologist who helped develop the surgical shunt that brought oxygen to the blood of babies, who were cyanotic because of congenital heart malformations (the so-called blue-babies); she had been recruited by Dr. Park to direct his pediatric cardiac clinic (Figure 1.6) Also on hand was the child psychiatrist Leo Kanner – already famous for his unique insights into a child’s psyche and his pioneering studies of autistic children. Lawson Wilkins had established an endocrine clinic, and had devised methods of diagnosis and treatment that were widely used to treat children with hormonal deficiencies. These celebrated individuals were the reason that so many patients from distant states, and from Europe and South America, came to the Harriet Lane clinics.

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Figure 1.6. The Harriet Lane Staff (1957) gathered on the steps of the Harriet Lane Home: (1) Lawson Wilkins, (2) Robert Cook (3) Helen Taussig, (4) Harriet Guild, (5) Leo Kanner, (6) Barton Childs, (7) Leon Eisenberg, (8) Mary Ellen Avery, (9) Claude Migeon, (10) Barbara Ruben, (11) Janet Hardy.

The faculty provided a remarkable academic environment that I found irresistible. My feelings about the Harriet Lane Home were echoed by Leo Kanner, then 81 yrs old, when during its ceremonial closing in 1974 he reminisced, My colleagues and I … may have grumbled at times about small budgets, poor equipment, and shabby quarters, but we were grateful for the one magnificent gift which outweighed everything else—the opportunity to work unhampered, to develop and pursue our curiosities, to test our theories, and at all times to be true to ourselves.

Although our patients came from all over the world, most of them lived in the neighborhood. Once considered prime real estate, the eastern section of Baltimore had changed remarkably over the years. When I arrived at the famous Johns Hopkins Hospital on a sweltering day late in June, I found a complex of non-air-conditioned, low-rise red brick hospital buildings surrounded by hundreds of dilapidated row houses. Full of toxic lead paint, these houses were occupied predominantly by poor, black families – for whom we were the primary care physicians.

Immediately on arriving in Baltimore, I realized that I was in a Southern city, reflecting its position below the Mason Dixon Line. Although, remaining in the Union during the Civil War, many Marylanders sympathized with the South. I was distressed to see that the Johns Hopkins Hospital was still a segregated facility. The nurseries in the Women’s Clinic (Obstetrical Department) separated the black newborns from the white ones, like the wards separated their mothers. And the blood in the blood bank was also segregated. Although I could understand why sick newborns might be isolated from the healthy ones, I could not see the logic of segregating newborns by their color. Although racial segregation did not take place in the Harriet Lane Home during my training, it had been in effect in the pediatric wards earlier. At least on the fourth floor (children under two years old), the east-ward was reserved for white children and the west-ward for African American children, until this segregation was terminated by Edwards Park, when he was director of the Harriet Lane Home. ¹

On the first night of my internship, I found myself on the overnight-shift (seven in the evening until seven in the morning) in the Harriet Lane emergency suite, far away from the adult emergency room. I was alone, except for the nurses’ aide, a mature black woman. My first patient, a ten-year old girl, was brought in by ambulance, in midst of an epileptic seizure, with several of her limbs in involuntary motion. I was awe-stricken and virtually paralyzed. If not for the aide, who asked, Doctor, do you want a tongue depressor and some phenobarbital?, the patient might not have fared as well as she did. Such experiences made me eternally grateful to the aides and nurses who help neophyte physicians learn the ropes.

During my three years of training, I lived within the main hospital in a small residence that provided single, dormitory–like rooms for unmarried women house staff from all departments. There were only a handful of us; we all ate together in the Doctors Dining Room, joined by all the members of the Hopkins house staff, who also received full board in lieu of salaries. In this large comfortable dining room with high ceiling and tall windows, there were many round tables for eight, as well as two long rectangular tables for the distinguished faculty who would eat there at lunch. In this way I got to know most of the residents and interns from a variety of departments, a feat now impossible. Although the food was institutional, there were always fresh linens on the table. At lunch, the topics of conversation were the patients we had seen that morning. It also provided the opportunity for informal consults with those who knew more than I did about my patients’ medical problems.

The pediatric house staff consisted of about twenty young physicians, enough to care for the fifty-seven hospitalized patients (inpatients), the newborns in Women’s Clinic, and the myriads of outpatients who visited our pediatric clinics all day, everyday, and the emergency room 24/7. Each of us was on duty every other night and weekend. I remember one winter when due to a flu epidemic, we organized into two shifts, one working days, the other at night. In our first year, we spent time in the general outpatient clinic, and on the wards, and in our second year we rotated through specialty outpatient clinics, including the popular cardiac and endocrine clinics. During our third year, we supervised the interns as they took care of their patients on the wards.

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Figure 1.7a. Children asleep on a bench in the Harriet Lane Clinic 1950s. Photo taken by Dr. Francis Schwenker. Barton gave me this photo, taken by the fourth chief of the Harriet Lane, as a Chanukah gift to remind me of my year in the pit. Families spent long hours waiting to be seen by a physician.

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Figure 1.7b. Harriet Lane Home Outpatient Clinic. Drawing by Aaron Sopher.

I remember feeling that these were my patients and I wanted to take care of them, myself. I cannot help but contrast the passion we, house physicians, had for our ward patients – even returning after a movie on our night off to see how they were doing – with the now obligatory handing off of patients by our current counterparts, sharply at the hour when the rules indicate they must go home.

Much of my training took place in the outpatient department¹⁴. As the primary care doctors for the neighborhood, the Harriet Lane Outpatient Department was always full of patients. At all hours one could see children sitting or sleeping on wooden benches (Figures 1.7a and 1.7b). I was