Mildred Thornton Stahlman, pioneer in neonatology

Corey Nason Reese
Nashville, Tennessee (Spring 2016)

 

Mildred Stahlman, Professor of Pediatrics and Pathology, Vanderbilt University School of Medicine holds a newborn infant. She was the director of the division of Neonatology 1961-1989. This photo was taken in the 1980s at Vanderbilt Medical Center in Nashville, TN.

In the 1950s and early 1960s, Mildred Thornton Stahlman, MD, began practicing medicine during a unique period in pediatrics when her chosen subspecialty was in its infancy. She was one of a small group of physicians around the world whose every discovery was new and had a significant impact. Combining a single-minded drive with the ability to clearly and adamantly articulate her strongly held opinions, this petite woman never married, demanded excellence from herself and others, and devoted her entire life to her career. She is credited with creating one of the first modern neonatal intensive care nurseries in the U.S.1

Her focus was on lung development and assisted ventilation for newborn infants with apnea or severe respiratory distress, and later on establishing an effective and efficient regionalization system that improved the transportation of premature and sick infants. Her research would yield more than 150 peer-reviewed publications, 50 invited chapters and articles and continuous national and local grants for more than four decades. She would also dedicate nearly forty years to addressing the collective ethical considerations of modern perinatal treatment.

Stahlman trained in pediatric cardiology and physiology. Her early research was on the lung and hyaline membrane disease in particular in sheep. The seminal crisis that tested her findings occurred in 1961, shortly after she had established the new premature infant nursery at Vanderbilt. A baby girl was born at Vanderbilt Hospital two months premature with little hope of surviving. Stahlman had worked with an engineer to design a scaled-down respirator, similar to those that had been used to treat polio, but there were serious reservations.As a last effort, however, she suggested putting the baby in the respirator.2

She described the event, “Within a few weeks of opening our laboratory, an infant was born in our hospital with severe hyaline membrane disease. It happened to be the baby of a senior medical student. We thought the infant would surely die, despite oxygen by mask and scalp-vein buffer, which were the extent of our therapeutic armamentarium at that time. We offered to put the baby in our negative – pressure tank-respirator, if the parents were willing. They agreed and after placing an umbilical venous catheter in the left atrium [sic] (we were unable to enter an artery), the baby was sealed in the tank where she remained for five very tiring, but enormously instructive days. She was successfully weaned from her ventilatory assistance, and much to our relief, her umbilical catheter could be removed, and she is now a beautiful twenty-year-old girl with an I.Q of 140.”2

Stahlman later said, “If that baby hadn’t survived, I think I would have quit and done something else.” 3

Born in Nashville, Tennessee, in 1922, Stahlman was the daughter of James Geddes Stahlman, a nationally prominent wealthy philanthropist and controversial publisher of the conservative evening city newspaper The Nashville Banner. From an early age, she wanted to be a doctor, which in the nineteen-thirties in the southern United States was uncommon for a girl.  She was given a microscope when she was about eleven. “I looked at flies wings and bugs,” she recalled. “A cousin of mine had a chemistry set, which I envied greatly.”1

Stahlman was a gifted and diligent scholar and attended her father’s alma mater, Vanderbilt University, in 1940. World War II accelerated the pace of her education and she completed her undergraduate degree in three years, graduating Phi Beta Kappa in 1943. Proceeding directly to medical school, Stahlman was one of four women in her medical class of fifty and graduated Alpha Omega Alpha in 1946.

Upon graduation, she was accepted for an internship at Lakeside Hospital in Cleveland, Ohio and was the only woman in her class. Throughout her career, she was often a minority among men. However, for her, equality as a woman was simply an afterthought. She asked only to be considered on her merits.

Stahlman was drawn to pediatrics and applied for a second internship.  In 1947, the Children’s Hospital in Boston, Massachusetts accepted her in their pediatric internship class, and again she was the only woman. In 1948, Stahlman returned to Vanderbilt to complete her residency in pediatrics. The next year she was selected as the first exchange fellow between the Karolinska Institute in Stockholm, Sweden and Vanderbilt. “This was where Dr. Stahlman received her early stimulation and accumulation of techniques in Dr. (John) Lind’s laboratory with Petter Karlberg which resulted in her neonatal studies here,” wrote Dr. Amos Christie, Vanderbilt Pediatric Chairman, 1943-1968.4

After her year in Sweden, Stahlman completed six months as a cardiac resident at La Rabida Sanitarium in Chicago, Illinois in 1951. She returned to Vanderbilt as an instructor in pediatrics and acting cardiologist, but did not enjoy cardiology. Frustrated, she was unexpectedly given an opportunity that would change her life and career. Vanderbilt’s Chairman of Physiology, Elliott V. Newman, MD, invited her to join his laboratory. She proceeded to spend most her time studying physiology during 1954-61, researching and teaching. “It was there I developed the techniques that I carried to the nursery. I had a grant from 1954 on hyaline membrane disease,” Stahlman said.3

History was soon to be made. When the grant was up for renewal in 1959, Newman encouraged her to reapply for the $11,000 grant she currently held, but also for a $125,000 supplement. Stahlman was awarded the grants and with those funds set up the premature nursery at Vanderbilt. “We began to study babies with respiratory distress, and I talked to each one of those families. I personally came in and admitted each one of those babies at midnight or on weekends or whenever it happened to be. And actually for the first four or five years, I put in every catheter.”3

During the next fifteen years, she and her collaborators published more than fifty manuscripts on hyaline membrane disease, assisted respiration and research findings in her sheep lab. With the help of two of her first faculty members, Hakan W. Sundell from the Karolinska Institute (1965) and Robert B. Cotton, a fellow who later joined the faculty, (1973) and would become her successor as director of the division, she established a fellowship program. In all, Stahlman trained 84 U.S. born and international fellows from more than 20 countries before she retired as director of neonatology in 1989.

As news of Stahlman’s nursery spread in the 1970s, the transport of babies from other hospitals increased. “As we began to expand and get more babies from outside hospitals, they would come in here half-dead – cold, in shock, terribly acidotic,” she said.3 Stahlman gained funding in part through a regional grant to create the Angel Transport mobile intensive care unit for newborns. By 1974 she, her staff and faculty had built a successful system of referral communities and after a year, outborn neonatal mortality dropped.5

Stahlman also proved to be an effective leader beyond the nursery and laboratory. She was a founding member and inaugural president of the Southern Society for Pediatric Research (1961-62). She served as president of the American Pediatric Society (1984-85) and was a member of Neonatal/Perinatal Medicine sub-board for the American Board of Pediatrics that wrote the inaugural subspecialty board examination. She also helped found the International Perinatal Collegium (1971), which brought together international neonatologists biannually to present their scientific discoveries.

Retiring as Neonatal Division Director in 1989, she remained highly active in her research endeavors over the next twenty-five years.  Beginning in 1992 and continuing until 2010, Stahlman collaborated with Jeffrey A. Whitsett, M.D., chief of the Section of Neonatology, Perinatal and Pulmonary Biology at Cincinnati Children’s Hospital to publish thirty-one peer-reviewed manuscripts, primarily on his award-winning work with surfactant.

Throughout her lengthy career, perinatal/neonatal ethical issues remained a constant concern for Stahlman.  She addressed such topics as when to discontinue or withhold treatment; the role of physicians, nurses and parents in decision-making; allocation of limited resources; and limits of viability. From 1972 until 2001 she spoke at conferences, participated in symposiums and televised broadcasts, and wrote numerous editorials for prestigious journals.

She wrote that “As a consequence of technology, very-low-birth-weight infants have survived and medical and surgical problems previously viewed as hopeless have become amenable to treatment, but not without a price… Somewhere along this long and hazardous journey questions inevitably arise as to the quality of life.”6

Her awards and honors included the Virginia Apgar Award, given in recognition of outstanding contributions to Perinatal Medicine by the American Academy of Pediatrics (1987). She was inducted as a member of the Royal Swedish Academy of Sciences (1989), the Institute of Medicine (1991), and received the highest award from the American Pediatric Society, the John Howland Award (1996).

Stahlman continued to work daily until the age of ninety and today lives a quiet life in her authentic log cabin home in a suburb of Nashville. In spite of her highly touted accomplishments and notable honors, she has remained humble about her place in history. “Many people did much more than I did,” she said.  “My idea of science is that everything is built on the backs of somebody else.”1

 

References

1.         Snyder B. Intensive Caring: Stahlman Has Always Demanded Excellence from Herself, Others. Vanderbilt Medical Center. 2005;2016(March 31). http://www.mc.vanderbilt.edu:8080/reporter/index.html?ID=3747.
2.         Stahlman M. Assisted Ventilation in Newborn Infants. Neonatalogy on the Web. 1980. http://www.neonatology.org/classics/mj1980/ch15.html. Accessed March 1, 2016.
3.         Karzon DT. Interview with Stahlman M. Late 1990s.
4.         Christie A. As I Remember It. A Narrative Story of the Vanderbilt Pediatric Department. Vanderbilt Medical Center, Nashville, Tennessee. 1971.
5.         Skelton MA, Perkett EA, Major CW, Vaughan RL, Stahlman MT. Transport of the neonate. South Med J. 1979;72(2):144-148.
6.         Stahlman M. Implications of research and high technology for neonatal intensive care. Jama. 1989;261(12):1791.

 


 

Corey Nason Reese is a freelance journalist who concentrates her writing and editing skills on healthcare, education, and medical history. She writes about various aspects of cancer and cancer survivors. She also writes and edits articles related to pediatrics. Recently, telling the history of older physicians has become a passion. For the past  15 years, she has served as the communications director for the Kansas Association of Independent and Religious Schools. Married to Jeff Reese, a neonatologist, she has three grown children and resides in Nashville, Tennessee. She is a graduate of the University of Kansas.

 

Hektorama  | Birth, Pregnancy, & Obstetrics