Today’s Pediatric Anesthesia Article of the Day is written by Dr. Mark Rockoff, Associate Anesthesiologist-in-Chief, Professor of Anaesthesia, the Harvard Medical School is a change of pace for the PAAD. For those of you who haven’t had the good fortune of working with or meeting him, Mark was a past president of the Society for Pediatric Anesthesia and the American Board of Anesthesiology. Together with 2 other past SPA presidents, Drs. Steve Hall (also a past ABA president) and Frank McGowan, Mark, Steve, and Frank were the primary movers that made the sub-Board certification in Pediatric Anesthesiology possible. We all owe all 3 of them a heartfelt thankyou. Aside from Mark’s many contributions, particularly in neuroanesthesia, he is a noted medical historian and as a change of pace, I’ve asked him to write a piece for the PAAD on giants in medical history. Myron Yaster MD
As a college student in the late 1960s, I was hitchhiking across the Massachusetts Avenue Bridge from Cambridge to Boston when I was picked up by a kind, middle-aged man. I was going to the Massachusetts General Hospital where I was working once a week in the blood bank. He said he was headed there as well and Dr. John Knowles, the General Director of the MGH, then introduced himself!
I will never forget that experience. It was a time when hitchhiking was common and (relatively) safe, and strangers seemed friendlier and more willing to help. In addition, because of my experience as the sole staffer at night in a blood bank cross-matching and releasing blood to hospital personnel, sometimes urgently for trauma patients, I gained exposure to how hospitals and their staff functioned. Therefore, when I recently noticed an article about Dr. Bernard Lown and his experiences as a medical student working in the blood bank at the Johns Hopkins Hospital in the early 1940s, it caught my attention.
For those not familiar with him, Dr. Bernard Lown was a truly remarkable man. A Jewish refugee from Eastern Europe just before the Holocaust, he was well aware of racial discrimination. However, his description of “colored” and “white” blood being segregated at the time, and how he responded to it, is astounding. Knowing that there was no good reason for blood to be separated in this manner, he simply changed the labels on bags of blood so White patients would receive needed blood transfusions from Black donors when these were more readily available. As soon as this was discovered, Alfred Blalock, the renowned Chief of Surgery at the hospital, prohibited him from working in the blood bank. Worse yet, he was expelled from medical school! Fortunately, the local chapter of the Association of Interns and Medical Students (a national activist organization) at Hopkins was militant and threatened work stoppages, press conferences, and other activities that would alert the community to the blatant racism practiced by the hospital. He was soon reinstated in the school, but not in the blood bank. Unfortunately, segregation of blood continued at Johns Hopkins Hospital for another decade.
In addition, it is worthwhile noting that many medical schools at the time had strict quotas for the number of minority (and Jewish) applicants who would be admitted. Furthermore, several did not admit women at all. Harvard, for example, did not accept women in its medical school until the latter part of WWII when there were not enough qualified men available. Thus, Helen Taussig, who was from the Boston area and whose father taught at Harvard, could not obtain her medical education there and attended Hopkins instead. This was because several daughters of the founding trustees of Johns Hopkins School of Medicine specified that their considerably philanthropy was contingent upon women being admitted along with men. Taussig stayed at Hopkins to complete residency training and became the founder of the field of pediatric cardiology.
Johns Hopkins Hospital and its School of Medicine, located in Baltimore, had a longstanding history of racial discrimination. When Lown was there, patients were segregated in wards by race, there were separate dining facilities, water fountains, and blood banks for Whites and Blacks, and there were no Black doctors or nurses. The story of Vivien Thomas, Alfred Blalock’s extraordinarily talented, Black lab technician, who was instrumental in developing what was initially known as the Blalock/Taussig shunt, is another example of attitudes when Lown was in medical school. Blalock did not acknowledge Thomas for his vital contributions to the development of this procedure, and only recently has it been referred to as the Blalock/Thomas/Taussig shunt.
By the time I entered Hopkins as a medical student in 1969, things were much better. Vivien Thomas led the hospital’s Surgical Research Laboratories as well as the dog lab where all medical students were first introduced to surgery and anesthesia. He would later receive an honorary doctorate from the institution and have his portrait prominently displayed there right next to Blalock’s portrait. However, my class of just over a hundred students included less than ten women and fewer Blacks.
Dr. Lown went on to become a distinguished cardiologist in Boston whose many accomplishments included helping introduce direct cardiac defibrillation into clinical practice and establishing one of the first coronary care units. In 1961, he founded Physicians for Social Responsibility and in 1985, he and his Russian colleague, Yevgeniy Chazov, accepted the Nobel Peace Prize for their work with International Physicians for the Prevention of Nuclear War. Dr. Lown also began what has become the Lown Institute to promote cardiovascular health around the world; it now addresses a broad spectrum of important healthcare issues including medical overuse and underuse, health equity, and the cost and availability of care.
Dr. Lown died last year at the age of 99. The article available on the Lown Institute website (https://lowninstitute.org/lessons-from-lown-the-story-of-white-and-colored-blood/) is one of several about this remarkable individual. Please read it to see how far we have advanced in overcoming discrimination in medicine – and consider how much more remains to be done.