Immortal Women Essays In Medical Eponyms Ii

Special Article

Immortal Women: Essays in Medical EponymsPart II

Andrew G. Östör, M.D., F.R.C.P.A.

“Every discovery, however important and apparentlyepoch-making, is but the natural and inevitable outcomeof a vast mass of work, involving many failures, by ahost of different observers.”—Starling

Part I of this series42 was devoted to women whoinspired medical eponyms from mythology, literature,and art as well as patients themselves. The followingparts are devoted to real female scientists and physicianswho first described a technique or disease, which nowbears their names. They are considered strictly in alpha-betical order.

A rare congenital metabolic disorder,3 now calledglycogen storage disease Type IV, was described byDorothy Andersen (1901–1963) (Fig. 1), U.S. pediatri-cian and pathologist. She also described the triad of cys-tic fibrosis of the pancreas (mucoviscidosis), celiac dis-ease, and vitamin A deficiency.2 Dr. Andersen was bornin Asheville, North Carolina. Her father migrated to theUnited States from the Danish island of Bornholm (itselfan eponymous locality) when he was 8 years old. Hermother was from Chicago but of old New England stock.Dorothy graduated from the Johns Hopkins MedicalSchool and received her Doctorate of Medical Sciencefrom Columbia University, where she became fullProfessor of Pathology. She later held appointments atBabies and Presbyterian Hospitals, both as a pathologistand pediatrician. Although best known for her work inendocrine pathology, she also contributed significantly todelineation of congenital malformations of the heart. De-spite her numerous friends, whom she entertained lav-ishly, Dorothy was a shy and perhaps even lonely person.Her great joy was her farm, about which she wrote: “Mychief hobby is my ‘farm,’ a primitive retreat well hidden

in the Kittitinny Range of northern New Jersey. Myguests find some of the entertainment strenuous, for theyshared in building the fireplace, the kitchen chimney andin doing carpentry and other manual labor around theplace. It is also a good place for sketching, photography,birds, flowers, cooking, eating and conversation.” Sheherself was an expert carpenter, stone mason, and cabi-netmaker. Dorothy’s appearance at work was casual, hercoiffure was dishevelled, and she very often had a ciga-rette dangling from her mouth. During conversation shewas usually too preoccupied to dispose of the ash whichthen became part of her costume. Each year theChristmas season officially began at Babies Hospitalwith Dorothy’s glüg party, held in her laboratory. Sheconcocted the drop herself: a hot, aromatic brew madeof burgundy, cognac, cinnamon, and cloves, and asDamrosch puts it “and Thor knows what else.” She diedcourageously of cancer of the lung.22,32

In 1953 a method of assessing the physical status of aninfant at birth was developed. The Apgar score,5 devisedby Virginia Apgar (1909–1974) (Fig. 2), is so widelyused that “every baby born in a modern hospital any-where in the world is looked at first through the eyes ofVirginia Apgar.”6 Apgar attended Mount HolyokeCollege and Columbia University and became Professorof Anesthesia at New York Columbia-PresbyterianMedical Center, the first woman to hold this position.She was also an accomplished violinist and cellist.4 In1994 the U.S. Postal Service issued a commemorativestamp in her honor. At a March of Dimes Meetingshortly before her death she is quoted to have said that hergreatest regret was devising the score (apparently becauseof its abuse, Mendelawitz, personal communication, 2000).

Ashby techniques are nonradioisotope methods for de-termining red cell volume and red cell life span by in-jecting innocuous but different types of red blood cells inthe recipient and following the rates of disappearance ofthe respective cell types over time.7 This method is still

From the Departments of Pathology and Obstetrics and Gynaecol-ogy, University of Melbourne, Melbourne, Australia.

Address correspondence and reprint requests to Andrew G. Östör,MD, 48 Anderson Road, Hawthorn East, 3123, Melbourne, Victoria,Australia; e-mail: [email protected]

The American Journal of Surgical Pathology 25(10): 1326–1333, 2001 © 2001 Lippincott Williams & Wilkins, Inc., Philadelphia

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described in current hematology texts. Winifred Ashby(1879–1975) (Fig. 3), pathologist, was born in London,England, and when 14 years old migrated with her par-ents to the United States. She graduated BS fromChicago University in 1903 and MS from WashingtonUniversity, St. Louis, in 1905, studied malnutrition in thePhilippines, and then returned to the United States whereshe taught school physics and chemistry. She began aFellowship at the Mayo Clinic where she became thefirst person to establish the correct red cell life span. Shemade contributions to the diagnosis of syphilis and stud-ied carbonic anhydrase in the brain. She was a giftedmusician and composer. She left the Mayo Clinic in 1924and worked at St. Elizabeth Hospital, Washington, DC,until her retirement.21,30 According to Dacie,21 “…shewas ahead of her time; her papers remained on libraryshelves largely unread and her technique was relativelyunused until the late 1930s.” She is remembered now,but much of her career was spent in obscurity.

A new syndrome of X-linked mental retardation wasdescribed by Joan Atkin and Katherine Flaitz8 and col-leagues, known as the Atkin–Flaitz syndrome. Addi-tional features include short stature, macrocephaly,“coarse” facial appearance, but normal chromosomes.Both women are geneticists who worked at the time inVirginia and Iowa, respectively.

The Epstein–Barr virus (EBV) was named afterYvonne Barr (Balding) (Fig. 4) and Anthony Epstein,who discovered the virus in 1964.25–27 Dr. Barrwas born in Conlow, Republic of Ireland. She was headprefect at Banbridge Academy Secondary School andgraduated, with honors, from Trinity College, Dublin,majoring in zoology. After various research appoint-ments she received her PhD from the University ofLondon. Working in Epstein’s laboratory, the virus thatultimately bears their names was discovered (Bert Achong,from Trinidad, was the third collaborator). “The progress

FIG. 1. Dorothy Andersen. Portrait by Frank Slater. (Re-produced with permission from the Journal of Pediatrics1964;65:476–9.)

FIG. 2. Virginia Apgar. Courtesy of A.C. Long Health Sci-ences Library, Columbia University, New York, NY.

FIG. 3. Winifred Ashby. (By permission of the MayoFoundation.)

FIG. 4. Yvonne Barr.

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Am J Surg Pathol, Vol. 25, No. 10, 2001

of science is littered with happy coincidences, chanceobservations and meetings that mark the beginning ofsuccessful lines of research. But few have involved asmuch serendipity in their early stages as the EBV,” wroteJohn Galloway celebrating the 25th anniversary of itsdiscovery.31 The search, which led ultimately to the dis-covery of the virus, was set in train on March 22, 1961.On that day an unknown English “bush surgeon” fromUganda, Denis Burkitt, gave at the Middlesex Hospital inLondon the first account outside Africa of an unusual,malignant childhood lymphoma, which now bears hisname.10 His first publication in 1958 had attracted noattention at all. According to Epstein, “it was a fortunatechance, therefore, which took me to the talk in whichBurkitt described how he came to realize in the course ofhis surgical work that the many seemingly different lym-phoid cancers of children in Africa were not disparateentities, but all facets of a single, hitherto unrecognisedtumour syndrome, commoner in endemic regions than allother children’s cancers added together.”28 The diseaseappeared to have a characteristic geographic distributionrelated to climate, which suggested transmission by aninsect vector. Epstein decided the cause must be an on-cogenic virus. Although viruses were known to causetumors in animals for decades, there was no evidencethat they caused cancers in humans. Deep-frozen biopsymaterial was flown from Uganda to London, and after along series of failures a successful procedure for cultur-ing Burkitt’s lymphoma tumor cells was evolved and anew virus demonstrated by thin-section electron micros-copy (it could not be demonstrated by any other tech-nique). Dr. Barr left the team the year after the discoverywhen she married an Australian and has lived in

Melbourne ever since (in a suburb neighboring the au-thor’s). While raising two children she obtained aDiploma of Education and taught biology in secondaryschools for 20 years. She is now retired and enjoys em-broidery, crafts, theatre, and traveling (personal commu-nication, 1999). Serendipity has also played a major partin the “finding” of Dr. Barr who preferred living incog-nito, away from the limelight (rather like the “finding” ofLivingstone by Stanley, who was never really lost).

Julia Bell, (1879–1979) (Fig. 5) (yes, she lived to be100!), was a pioneer of human genetics and gave hername to the Martin–Bell syndrome (also known as the“fragile X” syndrome), X-linked mental retardation,macro-orchidism, and a characteristic but variable fa-cies.34 Dr. Bell was educated at Nottingham Girls’ HighSchool and Girton College, Cambridge. At that timewomen were not eligible for a degree at CambridgeUniversity, and she therefore graduated in mathematicsat Trinity College, Dublin. Bell spent the next 6 yearsinvestigating solar parallax at Cambridge Observatoryand then moved to University College, London, whereshe was employed as an assistant in statistics. In 1914,prompted by her mentor Pearson, she commenced medi-cal studies at the London School of Medicine for Women(Royal Free Hospital) and St. Mary’s Hospital, qualify-ing in 1920 and being elected to the fellowship of theRoyal College of Physicians in 1938. The major portionof Bell’s career was spent at the Galton Laboratory,University College, where she was a member of the per-manent staff of the Medical Research Council. Her Trea-sury of Human Inheritance was the first systematic at-tempt to document the distribution of human diseasewithin families. Bell received the Weldon medal fromOxford University for her contributions to biometric sci-ence. She was the author of many classic papers, includ-ing an article with J. B. S. Haldane on linkage of thegenes for color blindness and hemophilia. This was thefirst demonstration “that the principles of linkage whichhave been worked out for other animals also hold goodfor man.” Age did not impede her academic activities,and she wrote an original article on rubella and preg-nancy at 80. Bell retired when she was 86, having out-lived three Galton professors: Pearson, Fisher, andPenrose. She had been a proponent of Women’s Suffragein her youth, although she was never involved in militantactivity. She remained unmarried but had the compan-ionship and affection of many relatives and friends. Bellkept in touch with genetics until her death.36,37,45

The Call–Exner body, in the follicular cells of theovary, is named after Emma Call (1847–1937) (Fig. 6)and Siegmund Exner.11 Call was one of the first womenphysicians in the United States. She was born inMassachusetts and studied medicine at the University ofMichigan, graduating in 1873. In response to a surveyconducted by the University of Michigan Alumnae

FIG. 5. Julia Bell. Courtesy of C.V. Mosby, St. Louis, MO.

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Council, she wrote of her college days in 1924: “I en-tered the Medical Department of the University the firstyear that women were admitted. The first class of women15 in number were naturally the objects of much attrac-tion critical or otherwise (especially critical) so that inmany ways it was quite an ordeal.” [Courtesy of theBentley Historical Library, University of Michigan.] Aspart of her postgraduate studies she went to Vienna andstudied the rabbit ovary with Siegmund Exner. She re-turned to America and practiced at the New EnglandHospital for Women and Children from 1875 to 1917 asan attending physician and consultant obstetrician.38 Shewas the first woman to be admitted to the MassachusettsMedical Society in 1884. This was the culmination ofwhat was called the “Ten year debate,” during which thechief opponent of women’s membership, a Dr. W. W.Wellington, held that women “were not fitted to practiceby reason of their sex characteristics.”47 She was alsoactive in church and philanthropic work for many years.Her work on the ovary was her sole contribution to themedical literature. Call–Exner bodies are also found ingranulosa cell tumors of the ovary, where they are pa-thognomonic. When she died, she left no immediaterelatives.

A syndrome characterised by alopecia, nail dystrophy,pigmentation, diffuse intestinal polyposis, protein-losingenteropathy, osteomalacia, and malabsorption,18 isnamed after L. Cronkhite and Wilma Canada (Diner)(Fig. 7). Wilma was born in West Virginia and raised inKentucky, where she was told that little girls did notgrow up to be doctors. She dispelled that myth by earn-ing her medical degree from Duke University in 1950and becoming a radiologist, serving on the staff of theUniversity of Arkansas for Medical Sciences from 1956

to 1997. For 15 of those years she was the Director of theRadiology Residency Programme, where that librarybears her name. It was during her residency at theMassachusetts General Hospital, Boston, that she recog-nized, with Dr. Cronkhite, a resident in Medicine, thesyndrome that bears their names.1 She also met her fu-ture husband Jack Diner, who was studying medical il-lustration. Dr. Diner successfully balanced her medicalcareer with motherhood, raising two sons and a daughter.Since her retirement she has kept busy with volunteerwork, inter alia, teaching English and Hebrew. TheDiners also established the Wilma and Jack DinerStudent Art Acquisition Fund to support student artists.She finds it amusing that she was once introduced at anational radiology meeting as a pathologist (personalcommunication, 1999).

Myrtelle Canavan (née Moore, 1879–1953) (Fig. 8)was born in St. John’s, Michigan, and became the firstwoman neuropathologist in New England. In 1898 sheentered Michigan State College and the year after theUniversity of Michigan. She obtained her M.D. in 1905from the Women’s Medical College of Pennsylvania,one of 36 women to graduate that year. Upon graduationshe married a fellow doctor. In 1907 she became a labo-ratory assistant at the Danvers State Hospital inHawthorne, Massachusetts, where she subsequently be-came Head of Laboratories, and where she met ElmerErnest Southand, Professor of Neuropathology atHarvard Medical School and Director of the BostonPsychiatric Hospital. This association was to foster her in-terest in neuropathology, which led to many meticulousdescriptions of brain and spinal cord pathology in a varietyof diseases.29 Among her 79 articles was the syndrome offamilial spongy degeneration in infants, to which her

FIG. 7. Wilma Canada.

FIG. 6. Emma Call. Courtesy of Bentley HistoricalLibrary, University of Michigan, Ann Arbor.



name was given.12 Although her paper might be criti-cized for identifying her case as Schilder disease, it mustbe remembered that each of Schilder’s four cases in hisoriginal report was different and surely represented dif-ferent disease processes (Raymond D. Adams, personalcommunication, 2000). Despite extensive studies ofspongy degeneration of the nervous system, it was onlyrecently that a biochemical basis for this disorder hasbeen suggested.35 Another notable study reported on1000 autopsy cases in institutionalized patients. In 1924she became curator of the Warren Anatomical Museumat Harvard University Medical School, a position sheheld until her retirement. Dr. Canavan added hundreds ofneuropathologic specimens to the museum and also ini-tiated various programs to effectively use the large ex-hibit area. She concurrently was appointed AssociateProfessor of Neuropathology at the Boston UniversitySchool of Medicine. She was highly respected inthe Boston community of neurologists. Canavan wasinnovative, saw health care trends, and advocated co-educational medical education. She died in Boston ofParkinson disease.

Progressive infantile cerebral poliodystrophy was de-scribed by Erna Christensen (1906–1967) (Fig. 9) andK. H. Krabbe.13 She was born on the “smiling and lovelyDanish island of Fyn.”44 She decided to become a doctorat the age of 6 years when she was operated on forappendicitis at the Hospital Hyborg, and was taken careof by an admired lady physician. It is ironic that her lifeended in the same hospital from a malignant disease atthe comparatively early age of 61. Being a farmer’s

daughter, her character was distinguished by the tradi-tional industriousness, solidity, and modesty of an oldrural family. She graduated from medical school in 1931,her doctoral thesis being on subdural hematoma, re-garded as a classic in Danish medical literature. It washer rotation in neurosurgery that proved to be the begin-ning of her life work as a neuropathologist and neuro-surgeon. One of her mentors was Dorothy Russell inLondon. With her indefatigable application, her fineskill, and her intuitive understanding, she contributed tothe many fields of neuropathology, attested to by her 99publications on the subject. Being dually qualified, shewas skilled in clinicopathologic correlation. She hadfirmly held views and demanded high standards from hercoworkers, but she was most demanding on herself. Atdinner parties in her beautiful home she was an amiablehostess. Her good temper and good humor were highlyappreciated. During the summer of 1967 she sufferedmetastases from a previously excised carcinoma of thebreast. Despite her knowledge of the nature of her ill-ness, she strove to complete her preparations for the VIthInternational Congress of Neuropathology, planned forCopenhagen, of which she was the President, and in thisshe persisted to within a few weeks before her death.44,46

In an obituary Van Bogaert writes: “None of us couldhave suspected at the time that this lady, so so affable, sovivacious and so full of good humor with a determinationfor the Congress to be a success was already sufferingfrom a terminal illness”9 (author’s translation).

The cryopathic hemolytic syndrome14 was describedby the American hematologists Mildred Clough (née

FIG. 8. Myrtelle Canavan. Courtesy of the Harvard Medi-cal Alumni.

FIG. 9. Erna Christensen. Portrait by Ingeborg Høyrup,painted for her 60th birthday, which now hangs in theNeuropathology Laboratory of the Institute of MolecularPathology, University of Copenhagen, Copenhagen, Den-mark. Courtesy of Professor Folmer Elling.

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Clark, 1888–1938) and Ina Richter. Clough was born inNewtonville, Massachusetts. After graduating fromWellesley College with honors she obtained her MDfrom the Johns Hopkins Medical School. As holder ofthe Mary Putnam Jacobi Fellowship, Dr. Clough pub-lished research, mostly in bacteriology, and later wasappointed instructor in medicine. Subsequently, she con-tinued her work in the outpatient department and in pri-vate practice. Ill health, however, had forced her to cur-tail her work. She died of pneumonia and was interred inher native Massachusetts. She was married to Dr. PaulClough, Associate Professor of Medicine at Hopkins,and had two children. (Courtesy of the Alan MasonChesney Medical Archives of the Johns HopkinsMedical Institution).

The metabolism of glycogen (the Cori cycle)15 andglycogen storage diseases Types I and II16,17 were de-scribed by Gerty Cori (née Radnitz, 1896–1957) (Fig.10) and her husband Carl. She was born in Prague, theeldest of three sisters, her father having been the directorof a sugar company. She received her medical degreefrom the German University of Prague in 1920, the yearshe married Carl, a fellow student. The association thusstarted was a lasting and happy one from the humanpoint of view and, in terms of what it meant to science,one of the most fruitful and successful on record.41 TheCoris emigrated to the United States in 1922 to work atthe New York State Institute for the Study of MalignantDiseases, thus helping to initiate a great movement ofscientists from the Old World to the New, in search ofthat freedom of teaching and research without which ourcivilization will not survive. During this period Gertyand Carl were advised to end their research collaborationbecause it would be detrimental to his career. In 1931

they moved to Washington University in St. Louis: Carlas Chairman of the Department of Pharmacology andGerty as a research associate (a usually dead-end posi-tion typically allotted to wife-assistants throughout thescientific establishment). This collaboration neverthelesselucidated the metabolism of glycogen and resulted inthe Nobel Prize in Medicine and Physiology in 1947 forthe pair and Argentinian B. A. Houssay (being the thirdtime this was awarded to a woman; see below). In thesame year she was abruptly promoted to Professor ofBiochemistry.43 Soon after she contracted myelofibrosis.This, however, did not dampen her indomitable spirit,and she went on to describe glycogen storage diseases,which was the first proof that a defect in an enzyme wasthe cause of a human genetic disease.43 She died of renalfailure, never giving up work until the very end. Accord-ing to Ochoa,40 “she was not only a scientist of enormousstature but a human being of great spiritual depth, en-dowed with the most precious gifts that can adorn humannature. She was modest, kind, generous and affectionateto a superlative degree and a lover of nature and art…”

Much has been written about the French Curie family,two generations of which played a prominent role in thedevelopment of modern chemistry and physics. It com-prised Pierre and Marie Curie,33 their daughter Irène, andher husband (Jean) Frédéric Joliot, all recipients of theNobel Prize. Suffice it to say Marie (1867–1934) (Fig.11), born Mariya Sklodowska in Warsaw, Poland, is byfar the most famous woman scientist and the onlywoman to have received the Nobel Prize twice, the firstfor physics in 1903 (with Pierre and Henry Becquerel)for their discovery of radioactivity by studying pitch-blend in 1898.20 She received the second in chemistry in1911, for her discovery of radium and polonium (the

FIG. 11. Marie Curie.

FIG. 10. Gerty Cori. Courtesy of the Anderson MedicalLibrary, Washington University, St. Louis, MO.



latter named after her native country). She also becamethe first female professor at the Sorbonne. She was to-tally devastated after Pierre’s death (he died crossing aroad in Paris on a rainy day, when he slipped and fellunder the wheels of a heavy horse-drawn wagon) whenshe was only 42. Nevertheless, she went on with herresearch while raising her two daughters in a generallyhostile male-dominated scientific clique. The epic biog-raphy (made into a TV series by the BBC in 1978),written by Eve, her other daughter,19 has made public herstruggles for scientific recognition. Like many of theearly workers in radioactivity, Curie had no idea of thedangers of these penetrating rays to the body. She died ofleukemia, almost certainly brought on by prolonged ex-posure to the concentrated radioactivity of the ore shewas purifying. The curie is a measure of radiation oremission.

In 1923 Gladys Dick (née Henry, 1881–1963) (Fig.12) was born in Pawnee City, Nebraska, daughter of abanker/landowner/grain dealer. After taking her BS fromthe University of Nebraska (1900), she overcame hermother’s objections and attended Johns Hopkins MedicalSchool. Turning to biomedical research, specifically toblood chemistry, she went to the University of Chicago(1911) where she met her future husband, GeorgeFrederick Dick, who was working on the etiology ofscarlet fever. In 1914 the newly married Dicks joinedChicago’s John R. McCormick Memorial Institute forInfectious Diseases where she remained until her retire-ment in 1953. The Institute was founded with a grantfrom John D. Rockefeller, who made the gift for researchinto scarlet fever after one of his grandsons died of thedisease. Working together, they made major contribu-tions to the prevention and treatment of scarlet fever24 by

identifying the Streptococcus bacillus as the cause, de-veloping a skin test, later known as the “Dick test” forsusceptibility or immunity,23 and developing a vaccine.As a result they received the prestigious Cameron Prizegranted by the University of Edinburgh in 1933, given“to a person who, in the course of the five years imme-diately preceding, has any highly important and valuableaddition to practical therapeutics.” The discovery of theskin test unfortunately led to a long series of lawsuitsover their attempts to receive patents for their methods ofproducing toxins and antitoxins (which some believecost them the Nobel Prize), even though they were toderive no personal gain. She was also active in childwelfare and founded the Cradle Society in Evanston,Illinois, one of the first medical professional organiza-tions to facilitate the adoption of children39 (also, cour-tesy of the Alan Mason Chesney Medical Archives of theJohns Hopkins Medical Institution).

POSTSCRIPT

The author was delighted to hear from “Jane” ofOphelia syndrome (see Part I). She writes: “I find itmildly amusing to be ‘immortal’ in the literature, butunder a pseudonym and a literary reference. I hope ithelps someone else’s family.” She goes on: “I hope yourealise that you’re one of a very few people who has evergot away with calling my Dad English. I suppose theequivalent slander in your part of the world is to mistakea New Zealander for an Aussie!” (personal communica-tion, 2000: he is Scottish). Mea culpa. �

Acknowledgments

The author thanks Miranda Francis, and Michael Watson(the latter two having been inadvertently omitted from Part I)for library assistance, Josephine Morrison for checking the ref-erences, Virgil Fairbanks, MD, Robert Scully, MD, ThomasWright, MD, Robert Young, MD, Bert di Paola and Lloyd Ellisfor the photography.

ADDENDA

1. Cowden syndrome, which did not make the deadlinefor Part I, is a rare autosomal dominant illness char-acterized by mucocutaneous stigmata, colorectal pol-yps, and an increased incidence of neoplasia in vari-ous sites. It was named after Rachel Cowden, thepropositus.

Lloyd KM, Dennis M. Cowden’s disease: a pos-sible new symptom complex with multiple systeminvolvement. Ann Intern Med 1963;58:136–42.

2. In this age of acronyms the following “synthetic” ep-onym was brought to my attention by my son, AndrewJames Östör, M.D.: Sapho syndrome (synovitis, acne,

FIG. 12. Gladys Dick. Courtesy of the Alan Mason Ches-ney Medical Archives of the Johns Hopkins Medical Insti-tution, Baltimore, MD.

A. G. ÖSTÖR1332


palmoplantar pustulosis, hyperostosis, and osteitis).Sappho (c 610–580 BC), Lesbos, Asia Minor, a lyricpoet, was celebrated throughout the ages for the beautyof her writings. The word “lesbian” of course derivesfrom the Greek island where she lived (apropos, there isno evidence that she was a lesbian).

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Immortal Women Essays In Medical Eponyms Ii