Blog Post October 10, 2017

Women in Science: Helen Taussig (1898-1986)

Dr. Helen Brooke Taussig was born May 24, 1898 in Cambridge, Massachusetts. Her father was Frank W. Taussig, a distinguished professor of economics at Harvard University, and served as the chair of the US Tariff Commission at the end of the First World War. Helen Taussig’s mother was Edith Thomas Guild, one of the first women to study at Radcliffe College. Edith shared her love of botany and zoology with Helen, instilling a lifelong appreciation of nature. Taussig’s childhood was marred by several difficulties, including the tragic death of Edith from tuberculosis when Helen was only 11 years old.

As an adolescent Taussig struggled with dyslexia, a disability that impairs reading comprehension.  Dyslexia was not well understood at the time, and there were no treatments readily available. She grew close to her father, who supported her education and helped her succeed despite her reading disability. However, Taussig would struggle with reading and writing for years to come.

In 1917 Taussig began undergraduate studies at Radcliffe University, but after a trip to California with her father she decided to transfer to UC Berkley. She thrived in the new environment, developing into a determined and independent woman. Following her graduation in 1921, Taussig returned to Boston with the goal of studying at the Harvard School of Public Health. Although her primary interest was medicine, her father had suggested she study public health instead, as “public health was more of a field for women than medicine.”

She met with the Dean, who informed her that she was welcome to take the pre-requisite courses and complete the public health program, but she would never receive a degree. Women simply weren’t granted degrees from Harvard University at this time, and the Dean was in full agreement with this policy. She left the meeting feeling angry, frustrated, and humiliated. Later in life, she commented that,

“It was one of those times in life when what seemed to be disappointment... later proved to be a great opportunity.”

To her father’s chagrin, Taussig decided to attend medical school. She took premedical courses at both Harvard and Boston University. Unlike Harvard, Boston University allowed women to participate in laboratory courses. Dr. Alexander Beggs took note of her talent and allowed her to help with his research on mammalian cardiac muscle contraction. She was an author on a paper published in American Journal of Physiology before she even attended medical school.

Her mentors at Boston University urged Taussig to attend Johns Hopkins University School of Medicine, which accepted both men and women into degree-granting programs.* She graduated in 1927, but failed to earn the sole internship position reserved for women in internal medicine at Johns Hopkins.

Luckily, her genius had not gone unnoticed. Taussig had been working in the adult heart clinic run by Dr. Edward Perkins Carter. When she was denied the internship, Carter offered her an extra year at the heart clinic, where she improved her knowledge and skills in cardiology. During this time Dr. Edwards Park became the Chair of Pediatrics at Hopkins, and offered Taussig a residency position in pediatric medicine. Two years later Dr. Park named Taussig head of the pediatric cardiac clinic at the Harriet Lane Home of Johns Hopkins, a position she would maintain until her retirement in 1963.

Taussig was seemingly unstoppable. At 32 years old she was running one of the first pediatric cardiac clinics at one of the best hospitals in the country. It was at this point in her life that she began to lose her hearing, and was robbed of the ability to listen to her patients’ heartbeat.

Although many of her efforts, including hearing aids and lip reading, helped improve communications with her patients, there wasn’t a good substitute for the standard stethoscope in the 1930s. Taussig eventually learned to “listen” with her hands, gently placing her fingers on a child’s chest and feeling for murmurs. When she was older she had surgery to partially restore her hearing, but she still preferred to feel for heartbeats rather than rely on a stethoscope.

At the start of her tenure at the clinic, Dr. Park suggested that Taussig focus her research on congenital heart defects. With the advent of fluoroscopy, chest radiographs, and electrocardiograms (ECG), Taussig became interested in the distinct symptoms associated with specific heart malformations. She took great care in recording the results of each clinical test, and correlated these findings with the structural abnormalities observed in patients during autopsies. This allowed Taussig to use fluoroscopy and ECG to accurately diagnose heart defects in living patients, and she began comparing symptoms from children with similar heart problems.

Taussig was particularly interested in “blue baby syndrome,” or cyanotic patients, named for the blue-toned color of their skin. These children often died as infants, and those that survived were confined to wheelchairs. Blue baby syndrome is commonly caused by the tetralogy of Fallot, a congenital heart defect that reduces the amount of oxygenated blood being pumped throughout the body. Using fluoroscopy, Taussig observed that these children had decreased pulmonary blood flow to the lungs, which reduced the amount of blood available for oxygenation.

She also found that many of her cyanotic patients worsened following the closure of the ductus arteriosus (DA), which is an extra opening in the heart that automatically closes after birth. When the DA is open, it gives blood another route to travel to the lungs to be oxygenated. For Taussig’s blue baby patients, this extra opening meant the difference between life and death.

Taussig saw a potential solution in another heart defect. In patients with patent ductus arteriosus the DA fails to close properly. In a normal patient, this causes too much blood to be cycled to the lungs; but in a cyanotic patient, the patent ductus arteriosus would be extremely beneficial. In 1939, Dr. Robert Gross surgically corrected patent ductus arteriosus by ligating, or closing, this connection. In Taussig’s mind, if you could remove a duct, why couldn’t you create one?

Taussig asked Gross for his help, but he was not interested in developing a procedure. In 1942, Dr. Alfred Blalock performed the patent ductus arteriosus ligation at Johns Hopkins, and Taussig was in the packed gallery to watch the surgery. Afterward, she made sure to congratulate him, but also offered a challenge:

“Dr. Blalock, you’ve done a very nice job closing this ductus; why can’t you build a ductus?... To some of our cyanotic children, it would mean a life for them.”

This led to the serendipitous collaboration between Dr. Taussig, Dr. Blalock, and Vivien Thomas, Dr. Blalock’s surgical technician. In fact, Dr. Blalock and Thomas had been working on surgical procedures to create animal models of pulmonary hypertension, which involved techniques similar to those needed in Taussig’s patients. Vivien Thomas recalls their first meeting in his autobiography:

“Helen passionately described her patients and their plight and that no known medical treatment existed. She went on to suggest that their only hope was a type of surgical approach to ‘get more blood to the lungs, as a plumber changes the pipes around.’”

The first operation was performed in November 1944, on a cyanotic 15-month old child. No one expected this surgery to work. It was an incredibly delicate, complicated procedure, involving the joining of the pulmonary artery to a systemic artery carrying oxygenated blood. Vivien Thomas was the only person that had performed the entire procedure, and he had been practicing on dogs with vessels twice the size of the sick child.

In the immediate aftermath, it seemed to have worked; the child’s skin became pink, and pulmonary blood flow was restored. But the little girl died during a follow-up surgery two months later. After two more successful surgeries, Blalock and Taussig wrote up their results and published “The Surgical Treatment of Malformations of the Heart” in the May 1945 issue of The Journal of the American Medical Association.

Sadly, Thomas was not included as a co-author, and was not given public recognition for his pivotal role in the development of the technique. As a black man in the 1940s, he was pushed aside, his heroic acts forgotten in the aftermath of their success. But let’s be absolutely clear: Although Taussig suggested the surgery, and Blalock performed it, the surgery never would have happened without Thomas’ rigorous research and surgical expertise.**

Taussig, along with Dr. Blalock, travelled throughout Europe and the United States giving lectures and teaching surgeons the new technique. By 1954 the surgery was a standard treatment for babies with tetralogy of Fallot, and is now known as the Blalock-Thomas-Taussig shunt. This procedure gave children with a fatal congenital heart defect a second chance at life. Today the method is fairly standard and has a very low (<3%) mortality rate.

Following her work on blue baby syndrome, Taussig kept incredibly busy. She wrote a textbook; she continued her research on congenital heart defects; she helped establish the Sub-Board of Pediatric Cardiology, solidifying pediatric cardiology as a specialty separate from adult cardiology. Finally, in 1959, she was appointed professor of pediatrics at Johns Hopkins University.

But Dr. Helen Taussig had more work to do.

In the late 1950s there was an epidemic across Europe of children born with severe defects in limb development. These children had shortened or absent arms and legs, a condition known as Phocomelia Syndrome. A former medical fellow related this predicament to Taussig, and she went to Germany to help research the underlying causes of these birth defects.

Through her studies, Taussig helped establish the teratogenic effects of thalidomide during pregnancy. Thalidomide was marketed as a sedative, and many women had been taking the drug to combat morning sickness and nausea associated with pregnancy. The consequences of taking thalidomide while pregnant were unknown, as it was not standard to screen drugs for effects on fetal development in the 1950s. The drug was released as an over-the-counter medication in 1957. By the early 1960s, thousands of babies had been born with thalidomide-related birth defects, and only 40% of these children survived.

Upon returning to the United States in 1962, Taussig published her findings and testified before the American College of Physicians and Congress on the dangers of thalidomide. Thanks to Taussig’s research and persuasive testimony, thalidomide was never approved in the United States. Her work also spurred President Kennedy and the FDA to develop new drug testing programs to analyze the effects of pharmaceuticals on congenital defects.

Although she officially retired from her position at Hopkins in 1963, she continued her research, and was a tireless advocate for pediatric cardiology. In 1964 President Lyndon Johnson presented her with the Medal of Freedom for her work in the treatment and prevention of children’s heart disease. In 1965, she became the first woman and first pediatric cardiologist to serve as president of the American Heart Association. And she was elected to the National Academy of Arts and Sciences in 1976.

Dr. Taussig died following a tragic car accident in 1986, just prior to celebrating her 88th birthday. As a woman in science, she left an indelible mark on the world. Taussig grew up in a country where “…it wasn’t worth educating women because they would get married and give up medicine.” Taussig proved these baseless assumptions wrong, and stands as a powerful role model for the education and advancement of women in science.

*This is actually an interesting story. Johns Hopkins University School of Medicine was founded in large part on donations from women philanthropists, whose monetary gifts were dependent on the acceptance of women to the Medical School.

**Regretfully, I cannot cover Vivien Thomas’ full story in this article. But I encourage you to read this review and watch the HBO movie based on Thomas’ autobiography, Something the Lord Made.