Colin K.L. Phoon, MPhil, MD, FAHA, FASE
New York University School of Medicine and Langone Medical Center, United States

Helen B. Taussig
Licensed under Fair use via Wikipedia 

On November 29, 1944, a landmark operation arose from the collaboration of three pioneers:. Alfred Blalock, Helen Taussig, and Vivien Thomas.1 Now carrying the eponym of the Blalock-Taussig shunt, this was the first “blue baby” operation done during a remarkable early era of heart surgery. Its concept and success resulted in large part from the pioneering clinical efforts of Dr. Taussig, a woman in the largely male-dominated medical profession of the time.

Helen Brooke Taussig was born on May 24, 1898, daughter of Frank and Edith Taussig. When her mother died when she was a small child, young Helen was nurtured – though by no means coddled – by her father, an eminent Harvard economics professor and one of the founders of the Harvard Graduate School of Business Administration. He also helped her overcome dyslexia. Like her mother, Taussig matriculated at Radcliffe College, but after two years chose to finish her undergraduate education at the University of California, Berkeley,  where she graduated in 1921. She hoped to study medicine at Harvard Medical School, but women were not admitted there at the time. During a gap year at Boston University, she met Dr. Alexander Begg, who steered her towards research on mammalian cardiac muscle strips, generating her first paper.2 He also advised her to seek admission to the Johns Hopkins Medical School, which had admitted women on an equal basis since its opening, its founding having been made possible in part by an extraordinary donation by a group of prominent Baltimore women, funds that bridged an unanticipated shortfall. Taussig gained admission and matriculated in 1923.

After graduating from Hopkins, Taussig interned in the department of pediatrics, which was led by one of her future mentors, Dr. Edwards Park. In the early 20th century, rheumatic heart disease formed the major part of clinical cardiology work, while congenital heart defects were considered hopeless curiosities. Nevertheless, a great step forward was taken through Dr. Maude Abbott’s work at McGill University. Abbott’s great opus, Atlas of Congenital Cardiac Disease,3 was the first systematic categorization of congenital heart defects. Contradicting prevailing opinion, Park foresaw the need to develop specialty clinics that provided better care for children with chronic illnesses, and placed Taussig in charge of the Children’s Cardiac Clinic. Equipped with her clinical skills and probing mind, an electrocardiograph, a chest x-ray machine, and a fluoroscope, Taussig began to collect samples and gain extensive clinical experience caring for children with congenital heart disease. Sadly for her patients, she was also often equipped with data from their autopsies. She may also have benefitted from contact and correspondence with Abbott.4 Despite progressive hearing loss, she developed the clinical acumen to diagnose specific heart defects in the living child, but had little at her disposal to improve their conditions. Then, Dr. Robert Gross at Children’s Hospital in Boston attained the first major milestone in cardiac surgery by successful ligating the patent ductus arteriosus.5 Taussig had observed that cyanotic children with persistent ducts were less cyanotic, and lived longer and better. She logically approached Dr. Gross with the idea of constructing an artificial duct. He turned her away, and Harvard thus spurned Taussig a second time!

Taussig returned to Hopkins to await the arrival of Blalock from Vanderbilt. Despite some controversy about who originated the idea of creating an artificial duct or a connection between the aorta and pulmonary artery, most agree that this was Taussig’s concept. Blalock sent his laboratory technician, Thomas, to develop the necessary surgical approach in the dog labs. In 1944, the team felt they were ready. Born prematurely weighing only 1105 grams, Eileen Saxon was a frail and dying 15 month old, severely cyanotic from Tetralogy of Fallot; now at 4 kg, she would be their first surgical patient. Despite a stormy post-operative course, Saxon survived and was discharged from the hospital almost two months after operation. The team operated on two other children before publishing their small case series in 1945.1 The operation was an immediate success, and drew patients and trainees from all over the world to the Hopkins – to Taussig and Blalock. It is interesting to note that Harvard Medical School did not start admitting women until 1945, the year that the procedure was published in the Journal of the American Medical Association (JAMA). In 1947, Taussig published her textbook, Congenital Malformations of the Heart,6 which became the “bible” of pediatric cardiology. The book was dedicated to her father and the foreword was written by Park.

Taussig’s accomplishments in the field of pediatric cardiology alone would have cemented her place in the annals of medical history. But her career was not over yet. In the early 1960s, she heard from a former fellow about a possible connection between the sedative thalidomide and birth defects, specifically phocomelia. After traveling to Germany to gather data, she returned to the United States to warn Congress and the public about its possible teratogenic effects.7,8 Largely because of her advocacy, thalidomide was banned in the US and Europe. For her work, Taussig was awarded the Presidential Medal of Freedom, the highest honor bestowed upon a civilian.

Taussig trained many fellows from around the world. Remarkable for that era, women flocked to the field of pediatric cardiology, presaging the current trend of women comprising more than 70% of starting residents in general pediatrics. Her influence extended to Maude Abbott as mentioned above; Janet Baldwin and later, Eugenie Doyle (NYU); Ruth Whittemore (Yale) and Mary Allen Engle (Cornell); and Charlotte Ferencz and Catherine Neill, both at Hopkins.

Retiring in 1963 and only four years after her promotion to full professor – only the second woman at Hopkins to break this glass ceiling at the time – Taussig went on to publish 40 of her 100 papers thereafter. A compleat academic clinician, Taussig pioneered several aspects of the clinical care of congenital heart patients, including long-term follow-up and quality of life,9 biomedical ethics,10 and the origin of congenital heart defects. Her last paper investigated congenital heart malformations in birds, with the hypothesis that heart defects are largely due to evolutionary causes and less so from environmental exposures. Sadly, Taussig was killed in an automobile accident just 3 days shy of her 88th birthday. Her paper, “Evolutionary origin of cardiac malformations” was completed by several former fellows and published posthumously.11

Taussig is remembered as being feisty at times, yet always persevering. Although she never married or had children of her own, she was a champion of children everywhere. She formed a global network of colleagues and former trainees, and was deeply loyal to all of them, and they to her. Dr. Helen Taussig overcame challenges of dyslexia and hearing loss – and not the least, being a woman – to forge a singularly accomplished academic career whose legacy continues to this day.

References

  1. Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or atresia. JAMA. 1945; 128:189-202.
  2. Taussig HB, Merserve FL. Rhythmic contractions in isolated muscle strips of mammalian ventricle. Am J Physiol. 1925; 72:89-98.
  3. Abbott M. Atlas of Congenital Cardiac Disease. New York: American Heart Association, 1936.
  4. Evans WN. The relationship between Maude Abbott and Helen Taussig: connecting the historical dots. Cardiol Young. 2008; 18:557-564.
  5. Gross RE. Surgical management of the patent ductus arteriosus: with summary of four surgically treated cases. Ann Surg. 1939; 110:321-356.
  6. Taussig HB. Congenital Malformations of the Heart. New York: The Commonwealth Fund, 1947.
  7. Taussig HB. Thalidomide. A study of the German outbreak of phocomelia. JAMA 1962; 104:111-113.
  8. Taussig HB. The Thalidomide syndrome. Sci Am. 1962; 207:29-35.
  9. Taussig HB, Kallman CH, Nagel D, Baumgardner R, Memberger N, Kirk H. Long-term observations on the Blalock-Taussig operation. VIII. 20-28 year follow-up on patients with a tetralogy of Fallot. Johns Hopkins Med J. 1975; 137:13-19.
  10. Wanzer SH, Adelstein SJ, Cranford RE, Federman DD, Hook ED, Moertel CG, Safar P, Stone A, Taussig HB, van Eys J. The physician's responsibility toward hopelessly ill patients. N Engl J Med. 1984; 310:955-959.
  11. Taussig HB. Evolutionary origin of cardiac malformations. J Am Coll Cardiol. 1988; 12:1079-1086.

 


Colin K. L. Phoon, MPhil (Cantab), MD, FAHA, FASE, is an Associate Professor of Pediatrics at New York University School of Medicine and a clinical pediatric cardiologist, who is also active in student and house officer teaching and in research. An imaging specialist of both mice and men (well, children), he is Director of the Pediatric & Fetal Echocardiography Laboratory at NYU Langone Medical Center. Varied interests include mitochondria in the developing heart, history of cardiology, amateur radio, and lacrosse.