Conversations with Ralph Hruban and Will Linder: Ten medical renegades and “A Scientific Revolution” in America.

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There is no disputing the preeminent role Johns Hopkins University has played in the history of American medicine. Established in 1893, it remains one of the preeminent medical schools in the nation. When it first opened its doors, medicine was a rough-and-ready trade, but it would soon evolve into a rigorous science. It was nothing short of a revolution and Johns Hopkins would be at the center of the movement.

A Scientific Revolution: Ten Men and Women Who Reinvented American Medicine (Pegasus Books) by Dr. Ralph H. Hruban and Will Linder recounts the stories of John Shaw Billings, Max Brödel, Mary Elizabeth Garrett, William Halsted, Jesse Lazear, Dorothy Reed Mendenhall, William Osler, Helen Taussig, Vivien Thomas, and William Welch. Their lives tell a compelling tale not just of their individual struggles, but how personal and social issues went hand-in-hand with the advancement of medicine.

Dr. Ralph H. Hruban and Will Linder, the authors of A Scientific Revolution, discussed their book with SCINQ.

Where did the idea for this book come from?

RALPH HRUBAN: I’m a professor at Johns Hopkins where I study cancer of the pancreas. When the pandemic hit, Johns Hopkins University approached me about giving a talk for a program called “Hopkins At Home.” I had a fun time putting together four lectures and they were well received. Will Linder was among the audience. 

When I finished giving the lectures, I thought to myself, it would be great to get the word out even more about the people I discussed in my talks. The arcs of each of the ten are so extraordinary. Eventually, Will reached out to me and said, “Hey, would you be interested in partnering to write a book about them?” We did, and it’s just been a wonderful partnership. 

We each bring something unique to the book. I love to tell stories; Will is an extraordinarily gifted writer who can take those stories and translate them onto the page. I love the 50,000 foot view; he’s more detail oriented. It’s really been a wonderful partnership. 

WILL LINDER: What made it even more surprising is that Ralph and I knew each other through some alumni work for Hopkins. During the whole course of research and writing of the book, we were never able to sit down together due to the pandemic. We did the whole thing on Zoom and the phone, trading images and texts back and forth. It gave us an added degree of focus. On top of that, we draw some lessons from the pandemic as well.

I think that’s a critical thing. The goal of the book is to tell stories that bring us together, that unite us during the pandemic through our shared stories. It’s important that it brings people together.

It took you roughly a year and a half to write. The amount of historical detail that’s in A Scientific Revolution makes it feel like it should have taken a lot longer. You researched it during a global pandemic. Were libraries and archives open? What was that process like?

HRUBAN: Researching the book was complicated because of the pandemic, but two things really helped. One is that two of our main sources, the Chesney Medical Archives and the Max Brödel Archives, which are here at Hopkins opened up for me during the pandemic. That was very generous of them.

The second thing that helped was that a number of the sources that we needed are now online. The Walter Reed collection is an example at the University of Virginia. All the letters you can go through are online. Similarly, many of Mary Elizabeth Garrett’s letters at the Bryn Mawr school are available online. 

We did run into one or two problems though. 

LINDER: Smith College had some images about Dorothy Reed Mendenhall that we were anxious to see and write about, but they had shut down. It was a couple of months before somebody at the collection actually was able to retrieve them electronically and send them to us.

HRUBAN: I had a placeholder in the book. We hoped that they would open up in time because a lot of the fun is to be in the stacks holding the letters yourself that these people have written.

Prior to the establishment of Johns Hopkins Hospital and Medical School what were schools like in the United States?

HRUBAN: There’s a quotation – I think it’s in the Flexner Report – that medical schools were filled with students who are too stupid for the bar and to immoral for the pulpit, which I think says a lot about them. The schools were “fee for service”. You didn’t have to have even a high school diploma to go to medical school. You paid money to your teachers, and that’s where the teachers’ salary came from. They didn’t want to make it hard for the students because they were your employers, if you will. 

Second year, often repeated the first year. Most of the schools were just two years because of the expectation you’re going to fail some of your classes. They really were churning out generations of physicians who were not qualified to practice medicine.

LINDER: It was my understanding that at most of these for-profit institutions, students during their two years in medical school never saw a patient. They might have some sort of apprenticeship after they graduated with a practicing doctor at best, but the notion of bedside teaching and patient centered education just simply didn’t exist.

How did you go about choosing who to include and who to exclude from A Scientific Revolution? That must have been complicated.

HRUBAN: The people who had an extraordinary arc to their lives were selected. They had to be interesting people. There are some people who do great science but there’s not much of a story to them. It’s much more compelling with someone like William Stewart Halsted who was this gregarious athletic guy, the belle of the town in New York all the while operating day and night. Then one day he reads a paper by Carl Koller and Sigmund Freud that says that if you put cocaine in the eye you can touch it. 

Halsted gathered all his students and colleagues together and they started injecting each other with cocaine. When you go to the dentist now, it’s because Halsted injected the nerve with cocaine allowing you to pull the tooth. Tragically, he becomes addicted and institutionalized in an insane asylum. Like the mythical Phoenix, he comes out and is reborn at Hopkins, a completely changed person. There’s such an extraordinary arc to Halsted’s life. 

So the arc to their lives is important because  that’s where lessons come for us. When they have challenging lives maybe there’s something we can learn from them. 

The second factor is they had to contribute something meaningful to medicine and play a role in its critical transition. 

Third, we also wanted to highlight diversity and the importance of diversity. Whether it’s sexual orientation – several of our characters were almost certainly gay – whether it’s race, whether it’s gender… We didn’t want it just to be an old white man’s story. 

LINDER: As part of what makes them fascinating is that they had to battle these obstacles, some of their own making like Halsted and his addiction to cocaine and morphine. 

In the case of a figure like Vivian Thomas, who was a high school-educated laboratory technician, he battled constantly against the racism of institutions like Vanderbilt University and Johns Hopkins, which simply weren’t prepared to deal with a black man who had huge skills and accomplishments in surgery. 

There are two of the elephants in the room – Johns Hopkins and Howard Atwood Kelly – both of whom were not included. Why exclude them?

HRUBAN: Looking at the arc of Johns Hopskins’ life, I don’t think it’s that interesting. There are questions whether he was himself a slaveholder. It was controversial when it came out, but the census shows that there were slaves at his house, whether he employed them or whether he held them and enslaved people. 

There was his philanthropy and his instructions on how he wanted his money spent that he wanted the hospital and the medical school to be together. But he wasn’t that visionary otherwise.

Excluding Howard Atwood Kelly is probably due to my personal bias. He was a very unusual man. He loved snakes and kept poisonous snakes all over his house. He was a very religious man but would charge his patients exorbitant fees and then would go and use the money on the street to try and convert prostitutes to Christianity. Before surgery he would get down on his hands and knees – in sterile conditions – and would say “Let us pray.” He was also an amazingly gifted surgeon and certainly someone we could have included. 

Non-medical people have played major roles in the development of medicine in the United States. For Johns Hopkins and Mary Elizabeth Garrett, philanthropy allowed them to play a big role in the establishment of medical institutions. Can you just discuss that a little? I think it’s important.

HRUBAN: I love it that Garrett was denied an education herself, yet that’s where her philanthropy went. She had a physical problem, the problem with her leg and it had to have a brace, yet when she builds the Bryn Mawr School for Girls, she makes sure they have an extraordinary gymnasium. She has that wonderful unique vision to go beyond herself, not in a self-serving way. 

LINDER: One thing that was fascinating to me was that we think of philanthropy usually in terms of an altruistic gift bestowed on a deserving institution and certainly that was in the case. But it was also motivated or informed by an incredible hardball attitude. She had been her father’s business secretary and learned the ropes of dealing with powerful people. 

When she went to the Hopkins trustees, she essentially gave them an all or none proposition of admitting women and raising standards. I think that that’s an interesting view of philanthropy that we try to convey. 

Can you discuss how using rubber gloves during surgery was first introduced and its links to Johns Hopkins?

HRUBAN: That’s a great story. At the time, in order to prevent the transmission of infection from the surgeon to the patient, they would wash their hands for a long time — around15 minutes — soaking them in harsh chemicals and scrubbing them. Obviously, this was not easy on your hands. At the time, Halsted was romantically interested in his scrub nurse and she broke out with a terrible reaction to it. 

Halsted wrote to the Goodyear Rubber Company and asked, Can you make gloves for this remarkably talented young woman? They made gloves for her, which were more like gauntlets compared to today’s rubber gloves. This allowed her to continue working with Halsted.

Max Brödel was a great example of the risks involved. When he was doing a dissection, he cut his hand and developed an infection. This is before antibiotics, of course. His infection started spreading down Max Brödel’s hands and his arm, and almost certainly meant meeting his death. What did he do? He drew 20 sketches of it.

Getting back to Halsted and the rubber gloves, we can’t forget the flip side of it, which is it also protects the surgeon. Other doctors around him saw the gloves and had more made for themselves. Of course, this reduced the transmission of infection from the surgeon to the patient. It also had the benefit of the surgeons not acquiring an infection from the patient.  It is a wonderful medical advance based on a romantic interest.


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