Shelley Co
Touro College of Osteopathic Medicine, New York, New York, United States

Johns Hopkins

It was at the site of a former insane asylum and at the discretion of a man named Johns Hopkins, a banker, philanthropist, and abolitionist, that the Johns Hopkins Hospital opened in 1889 in Baltimore, Maryland.1 Hopkins died on Christmas Eve 1873 at age seventy-eight, and in his will left $7 million to form the Johns Hopkins University and the Johns Hopkins Hospital.2 It was the largest philanthropic donation at the time in the United States.2 Several years before his death Hopkins had selected twelve trustees to oversee the formation of the hospital and medical school.2 He hoped that the hospital would provide medical care for the Baltimore's poor and become an integral part of the education of students at the medical school.3 Therefore, in discussing the history of the Johns Hopkins Hospital, it is also vital to discuss the beginnings of the Johns Hopkins School of Medicine. Both the hospital and the medical school have been the locale for many medical advancements and innovations in medical education. 

Johns Hopkins University became the first medical school in the United States to accept women.4 In 1893, there were three women in Hopkins' first medical class.4 However, the decision to admit women to the school was prompted by a shortage of funds needed to open the school.4 The women agreed to raise the desired funds if the school agreed to admit qualified women.4 It did, and this was one of many firsts for the Johns Hopkins School of Medicine. 

Crucial to the development of the medical school were the faculty, consisting of the pathologist William Welch, the internist William Osler, the surgeon William Halsted, and the gynecologist Howard Kelly, known collectively as the "Big Four."3 Osler helped to organize postgraduate medical training into a "residency" system where newly graduated physicians would live or "reside" in hospital-based housing and receive specialized training in treating patients.5 Osler also practiced bedside teaching with medical students and initiated the concept of rounds, believing that students should interact with real patients.5

The Flexner Report, which was published in 1910 and examined the status of medical education in the United States and Canada, praised the medical school at Johns Hopkins.6 It based its medical education recommendations on the structure of the Johns Hopkins medical school, which required that medical students had an undergraduate degree before admission to the medical school.6 Its curriculum for students consisted of two years of studying the basic sciences as well as clinical training in the hospital.5 

While the medical school was prospering, its hospital also became the site of many accomplishments. Several medical specialties had their origins at the Johns Hopkins Hospital; these include neurosurgery, child psychiatry, and cardiac surgery. Harvey Cushing, now recognized as the father of neurosurgery, completed his surgical residency at Johns Hopkins Hospital under William Halsted,7 was made associate professor of surgery at Hopkins in 1901, and during his time there focused on pituitary tumors and neurological surgery.8 At Hopkins, Cushing saw a patient whom he would describe as having an endocrine disorder involving the pituitary gland.8 He published his ideas in 1932 under the title "The Basophil Adenomas of the Pituitary Body and Their Clinical Manifestations: Pituitary Basophilism,"9 now known as Cushing's Syndrome.8  Cushing also became involved in the surgical treatment of trigeminal neuralgia, exploring new approaches to excising the Gasserion ganglion to counteract bleeding and later on utilizing sensory root avulsion.10 

Johns Hopkins Hospital also served as the starting point for child psychiatry under the psychiatrist Leo Kanner, who developed the first child psychiatry department at the hospital and, in 1930, became the director of the department.11  Kanner was the first person to identify autism in his 1943 paper, "Autistic Disturbances of Affective Contact," where he discussed eleven children under the age of eleven years old.12 He mentioned the similar behavior exhibited by these children, in that they seemed to prefer solitude and did not respond to outside stimuli and people.12  Kanner also noted that the children were the products of educated parents who worked as doctors, lawyers, professors, or nurses  and who seemed to be more engrossed in their work than in their children.12 In doing so, Kanner became the first to suggest that parents played a role in triggering their children's disease, which would form the basis of the "refrigerator mother" theory of autism.13  Although the idea that a cold, emotionless parent could bring about autism in a child would prove false, it was an interesting hypothesis popularized by the cultural and societal norms of the time.14

Alfred Blalock was another important figure at Johns Hopkins Hospital. In 1941, he became surgeon-in-chief of the hospital and professor of surgery at the medical school.15 At Hopkins, Blalock along with his surgical assistant Vivien Thomas made several innovations in cardiac surgery in the 1940s, pioneering a technique in which the subclavian artery was anastomosed to the pulmonary artery to help treat Tetralogy of Fallot.16  The partnership between Blalock and Thomas spanned almost three and a half decades,17 being a unique collaboration that transcended racial boundaries and the world of Jim Crow laws in that Blalock was white and Thomas African American. Blalock insisted that Thomas accompany him on the initial surgeries involving the patients diagnosed with Tetralogy of Fallot.18 Thomas, however, was not paid well and was forced to work as a bartender for extra pay and sometimes would have to awkwardly work at parties hosted by Blalock.17 Despite the inequities, Thomas was influential in the training of several surgeons in the 1940s and clearly played a monumental role in developing the field of cardiac surgery along with Blalock.17  

Other achievements at the Johns Hopkins Hospital include the discovery of the three types of polio virus by David Bodian, Isabel Morgan, and Howard Howe, published as the “Differentiation of Types of Poliomyelitis Viruses” in the American Journal of Hygiene in 1949. Their team was able to inoculate monkeys with a killed-virus vaccine,19 which Howe later tested on children with physical and intellectual disabilities, the ethics of which are questionable (even though Howe did obtain permission from the children's parents or guardians).20 Likewise, although the HeLa line developed by Dr. George Otto Gey at Johns Hopkins became an important part of several scientific feats, that story also raises ethical questions. The HeLa cell line originated in 1951 from a woman named Henrietta Lacks, an African American woman who came from a poor family of tobacco farmers in Virginia. While she was undergoing treatment for cervical cancer, her cancer cells were taken without her consent.21 The cells from the HeLa line were then distributed and marketed to various scientists and researchers, which helped Jonas Salk develop the polio vaccine in 1952.24  As a result, issues of property and commercialization came to light. 

These matters would also become relevant once Daniel Nathans and Kathleen Danna discovered the utility of restriction enzymes in 1971 at Johns Hopkins.22 Nathans became a part of the microbiology department at the Johns Hopkins School of Medicine in 1962, and Danna was his graduate student.23,24 Nathans and Danna found that the restriction enzyme, endonuclease R, could generate fragments of simian virus 40 (SV40) DNA, a pioneering achievement that helped set the foundation for modern molecular biology and biotechnology. 

Since the death of Mr. Johns Hopkins almost a century and a half ago, the hospital and medical school that he helped establish have been home to many influential scientists and physicians, and to many achievements that have been truly revolutionary in the history of medicine.

References
 
1. What Hopkins Built, and Where.  http://www.hopkinsmedicine.org/about/history/history2.html.  Accessed December 9, 2014. 
2. What's With That Pesky "S"?  http://www.hopkinsmedicine.org/about/history/history1.html.  Accessed December 9, 2014.
3. Revolution in American Medicine.  http://www.hopkinsmedicine.org/about/history/history3.html.  Accessed December 9, 2014. 
4. Women - Or the Female Factor.  http://www.hopkinsmedicine.org/about/history/history6.html.  Accessed December 9, 2014. 
5. The Four Founding Physicians.  http://www.hopkinsmedicine.org/about/history/history5.html.  Accessed December 10, 2014. 
6. Thomas Duffy.  "The Flexner Report - 100 Years Later."  Yale Journal of Biology and Medicine 84, no 3 (2011): 269-276.  
7. Harvey Cushing and the Cushing Center.  http://cushingcenter.medicine.yale.edu/cc/history.  Accessed December 11, 2014. 
8. Scott Kutz and Patrick O'Leary.  Harvey Cushing: A Historical Vignette. http://www.medschool.lsuhsc.edu/neurosurgery/nervecenter/cushing.html.  Accessed December 11, 2014. 
9. Harvey Cushing.  "The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism)."  Bulletin of the Johns Hopkins Hospital 50, no 4 (1932): 137-195.
10. Hadie Adams et al.,  "Harvey Cushing's case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon's quest to advance the treatment of the 'suicide disease'."  Acta Neurochirurgica 153, no 5 (2011): 1043-1050.
11. Leo Kanner Collection.  The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions. http://www.medicalarchives.jhmi.edu/papers/kanner.html.  Accessed December 12, 2014. 
12. Leo Kanner, Autistic Disturbances of Affective Contact. Nervous Child 1943; 2: 248-250.
13. Leo Kanner, "Problems of Nosology and Psychodynamics of Early Infantile Autism." The American Journal of Orthopsychiatry  19,  no 3 (1949): 425.
14. MH Nadesan, Constructing Autism: Unravelling the 'Truth' and Understanding the Social. (New York: Routledge, 2005): 82-97.
15. C.R. Hatcher.  "Profiles in Cardiology: Alfred Blabock."  Clinical Cardiology 9, no 4 (1986): 172-175.
16. Vivien T. Thomas, L.L.D. http://www.medicalarchives.jhmi.edu/vthomas.htm.  Accessed December 13, 2014.
17. "Almost a Miracle."  Dome 54, no 1 (2003), http://www.hopkinsmedicine.org/dome/0301/close_up.cfm
18. Vivien Theodore Thomas: Surgical Technician.  https://webfiles.uci.edu/mcbrown/display/thomas.html.  Accessed December 13, 2014. 
19. Steven Lehrer.  Explorers of the Body: Dramatic Breakthroughs in Medicine from Ancient Times to Modern Science.  (Lincoln: iUniverse, 2006), 395.
20. Paul Lombardo.  "Of Utmost National Urgency: The Lynchburg Hepatitis Study, 1942."  in In the Wake of Terror: Medicine and Morality in a Time of Crisis, ed. Jonathan D. Moreno, (MIT Press, 2004),  5.
21. Rebecca Skloot, The Immortal Life of Henrietta Lacks.  (New York: Broadway Paperbacks, 2010).
22. Richard J. Roberts.  "How restriction enzymes became the workhorses of molecular biology."  Proceedings of the National Academy of the Sciences 102, no 17 (2005): 5905-5908.   
23. Daniel Nathans.  http://www.britannica.com/EBchecked/topic/404195/Daniel-Nathans.  Accessed December 28, 2014. 
24. Christen Brownlee.  "Danna and Nathans: Restriction enzymes and the boon to modern molecular biology."  Proceedings of the National Academy of the Sciences 102, no 17 (2005): 5909. 

 


Shelley Co is a third year medical student at the Touro College of Osteopathic Medicine in Harlem, New York.