Women of Courage in Public Health.

Mike Magee MD

Le Moyne College: December 2, 2020

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To attempt to cover the combined achievements and contributions of 9 ordinary women over a century and half – defining who they are, where they come from, who opposed them, what they accomplished, and why they’re remembered – would be, of course, a fool’s errand. But to do the same for 9 remarkable women scientists who overcame incredible odds and changed our world in fundamental and important ways would be unwise in the extreme…but, that is what I am about to do.

In the second half of the 19th century, there were two Alice’s. They arrived 12 years apart – one in 1869, the other 1881. The world that greeted them was hostile to women in general. Humans of their kind had no vote, no security, no safety, no justice, no rights, no health, – and for many, no future!

But Alice Hamilton – born on February 27, 1869 – grew up in a family of privilege in Fort Wayne, Indiana. This was the beginning of the industrial age.  A railroad connected Fort Wayne to the rest of America. Alice had the means, the intelligence, and the ambition to achieve greatness. And what she chose was medicine.

Many years later, she reflected that, “I chose medicine not because I was scientifically-minded, for I was deeply ignorant of science. I chose it because as a doctor I could go anywhere I pleased — to far-off lands or to city slums — and be quite sure I could be of use anywhere.”

Alice was one of four sisters, all close and lifelong companions. They, and their single brother, would all become accomplished scholars. The family’s wealth came from land holdings in Indiana. That included the family compound on the bottom right corner of this slide. It occupied three square blocks in downtown Fort Wayne. They also maintained strong New England connections. All of the girls attended the famous “finishing school, “Miss Porter’s School” in Farmington, CT, and two would later serve as Head Mistresses at the newly opened Bryn Mawr College. In those years Alice was described as “Fastidious but disliking conflict.”

When she returned from Miss Porter’s School, Alice enrolled first at the Fort Wayne College of Medicine and then transferred to the University of Michigan. During this period, at the age of 20, she became fascinated by the concept of Settlement Houses, the first of which – The Hull House” – was created by the social reformer, Jane Addams. Alice first met Ms. Addams in 1902, during an extended visit. There, around the dinner table, she was exposed to the likes of Frances Perkins, Florence Kelly, Margaret Sanger, John Dewey, Eugene Debs and Upton Sinclair.”

Jane Addams’ focus when she opened the Hull House in 1893 was to “preserve cultural heritage while assisting immigrants in assimilating.” This women-directed environment stressed early childhood development, life skills, literacy, and progressive and social democracy – that meant paying special attention to sanitation, clean environment, safe working conditions, and justice under the law as critical social determinants of health.

During this period Alice completed advanced training in pathology and epidemiology in Europe and at Johns Hopkins. Addams kept in touch, seeing Alice as a potential ally and resident physician and industrial health researcher for the settlement.

In the Hull House, Alice found the home she was searching for and remained a resident from 1897 to 1919. Jane was her role model. Addams secured protections against child labor exploitation and won support for the first Juvenile Court System. Viewed as a “Public philosopher” and a “radical pragmatist, she helped create the international Women’s Peace Party and received the Nobel Peace Prize. Along the way, she established the academic discipline of Sociology and the American Civil Liberties Union or ACLU. Alice was her constant ally and collaborator in programming and publications. She couldn’t have had a better role model!

In her first years at the Hull House, Alice began to draw a line between disease and occupation, and the role of poverty. As she entered her second decade, while managing a well-baby clinic, she began to see infants with a “wrist-drop”, a classic sign of lead palsy. Her first instinct was to engage her male colleagues in the medical community, but she wasn’t taken seriously. “When I talked to my medical friends about the strange silence on this subject [lead poisoning] in American medical magazines and textbooks, I gained the impression that here was a subject tainted with Socialism or with feminine sentimentality for the poor.”

Illinois state officials were listening though and they hired Alice in 1910 as the lead Medical Investigator for the Illinois Commission on Occupational Disease. Staffed with 23 physicians and an ample budget, within one year she gained access to 304 manufacturing sites and uncovered 70 different poisons including 578 cases of lead poisoning.

That was enough to draw the attention of the US Commissioner of Labor, Charles O’Neill, who ordered a national investigation in 1912. Within a year, the Department of Labor was established. At the time, Alice continued to chase down cases of lead poisoning, but also arsenic, brass, zinc, carbon monoxide, and cyanide, as her reputation spread. As one colleague noted, “At five foot three dressed in tweeds and black, she looked harmless, but she was not.”

One of those who noticed was David Edsall, Dean of Harvard Medical School. In 1919, he approached Alice with an offer to be the first woman professor at Harvard. But the offer came with several catches. First, she would never be offered tenure nor advanced beyond an assistant professor. Second, no access to the all-male Harvard Club, and no walking in commencement robes. And finally, in the most severe perceived slight, no tickets to the Harvard football games.

For the supremely confident Dr. Hamilton, none of these were deal breakers. As she later said, “I have never doubted the wisdom of my decision to … devote myself to work which has been scientific only in part, but human and practical in greater measure.”

She went on to establish the field of Industrial Medicine, and performed the world’s first systematic studies of industrial radiation poisoning, examined mercury poisoning in felt hat makers, and became an outspoken opponent of leaded gasoline. Her dogged pursuit of the truth embodied the finest traditions of investigative journalism. But as the science writer Edna Yost wrote of her in 1943, “Alice Hamilton has done her big work so quietly that many Americans have never heard of her.”

Of our second Alice, Alice C. Evans, her fans like to say, “The next time you pour a glass of milk, raise a toast to Alice Catherine.” For this Alice, born in 1881, all roads lead through Cornell. She was the daughter of a Welsh farming family in Scranton, PA. The family had adequate resources, but couldn’t compete with the Indiana Hamilton’s. But their educational pedigree was strong. Her father’s nickname was “Professor” and her grandfather, Evan William Evans, was the 1st chair of mathematics at Cornell.

When Alice Evans graduated from high school, money was tight and she took a job teaching for four years – long enough to know she didn’t want to be a teacher but rather a scientist. She entered Cornell’s land grant College of Agriculture tuition-free and specialized in bacteriology. She performed well enough to earn a free ride to the University of Wisconsin’s School of Agriculture for her Masters.

When she graduated in 1910, she chose employment over a PhD, and was hired in Madison and charged with the humble task of improving the flavor of cheddar cheese.  When a position became open at the US Dairy Division Laboratory in Washington in 1913, she applied on a lark. To her surprise, She got the job.

As she later recounted,  “At age 32, I was on my way to Washington where I had not wanted to go and where I was not wanted…The course that was open for my ship to sale was rough at times, but there were stretches of clear sailing too.”

When she arrived at headquarters, her new boss, George McKoy, was surprised to learn that A. Evans was a female. But he stuck to his agreement and hired her. The needs for a skilled dairy bacteriologist at the time couldn’t have been greater. The country, and notably New York City, was in the middle of a “Milk War.” The casualties were primarily infants whose mortality rate in NYC at the time was 240 deaths per 1000 live births. Many of these would be traced back to milk infected with TB, typhoid, Strep induced Scarlet Fever and Diphtheria.

The process of heating liquid to purify it, or pasteurization, was discovered by Louis Pasteur in 1856, not with milk but with wine. It’s use on a broad scale to purify milk first gained serious traction in 1878 after Harper’s Weekly published an expose’ on “Swill Milk” – cows infected by ingesting swill, a byproduct of whiskey distillation, produced milk that was thin and diseased. But major producers and distributors resisted regulation until 1913 when a massive typhoid epidemic from infected milk killed thousands of New York infants. With enforced pasteurization, infant mortality dropped from 240 to 71 per 1000 live births by 1921.

As the first female scientist at the new Public Health Service’s Hygienic Laboratory in 1917, Alice Evans found herself in the middle of the milk controversy. Her mentor, George McKay, asked her to explore the links between raw milk and “undulant fever” first tagged “Malta Fever.” She quickly established that the bacteria causing the disease was the same bacteria that caused cows to prematurely abort their calves.

Bernard Bang and his Bang’s Bacillus, discovered in 1897, was widely credited with identifying the cause of the cow disease. Sir David Bruce was credited with uncovering the bacteria causing Malta or undulant fever, offering his own name in 1887 to the new Bruce Bacillus.

Neither was pleased with Alice’s discovery that they were the same bacteria, renamed Brucella, and the combined disease, Brucellosis. If they were upset the big Milk Manufacturers (now the 3rd leading commodity in sales in the US) were even less impressed and employed Harvard Epidemiologist Theobald Smith to defame Alice Evans.

Alice prevailed. On the back end of Brucellosis, she led the charge for sanitation standards enacted in the 1920s that required barns for dairy herd owners to be as clean as kitchens, complete with concrete floors, plastered walls, new steel equipment, and improved ventilation systems. By 1930, national pasteurization was the law. Ultimately the farmers thanked Evans. Her discovery reduced breeding inefficiency, and livestock loses declined over 70 years from $400 million to less than $1 million. It also saved thousands of lives.

Alice Evans became the first president of the American Society of Bacteriologists, which today has 40,000 members. She died in 1975 at age 94, and her tombstone was inscribed, “The gentle hunter, having pursued and tamed her quarry, crossed over to a new home.”

A new home was what our next heroine dreamed of – and with good reason. The site where she was born was described by one biographer as “hell with the lid off.” Another noted “She was an unlikely heroine. She grew up with her two siblings in a log cabin in rural Pennsylvania and was not well off. Her environment was spoiled by the toxic gases that spewed from two coal-fired electric plants and the American Glue Factory as it incinerated slaughtered horses down river from their home.”

Of her famous book, David McCollough would say in 1993, in the introduction to his “American Experience” TV show, “A single book changes history only rarely.  There was Harriet Beecher Stowe’s “Uncle Tom’s Cabin”, Upton Sinclair’s “The Jungle”, and Ralph Nader’s “Unsafe at Any Speed”.  And then there was Rachel Carson’s “Silent Spring”

Her father was in and out of work. One sister did shift work at the power plant nearby. But her mother, the daughter of a Presbyterian minister, saw great promise in the little girl from the beginning. So the mother focused on Rachel, made sure she was educated, and encouraged her to try for college. Immediately after graduation, she landed a 6-week internship at Woods Hole, Massachusetts. Then, focusing on Zoology, she gained a Master’s degree from Johns Hopkins University.

 Economics being what they were, she took what she could get, a part-time job with the U.S. Fish and Wildlife Service. She also freelanced for the Baltimore Sun and Atlantic Monthly, writing popular articles on natural history to earn extra money. She used the name R.T. Carson, thinking that readers would take her more seriously if they thought she was a man.

In 1941, a well-received article in The Atlantic Monthly magazine, titled “Undersea”, led to her first book, “Under the Sea-Wind.”  It traced the life and migration of a coastal birds, but had the bad luck of being released on the day of the bombing of Pearl Harbor. Still the path was set, and in 1949, she took a 10-day trip off the coast of Maine, out of which came the blockbuster book, “The Sea Around Us”. It took off, selling at a rate of 4000 copies a day by Christmas that year.

Now a celebrity and financially independent, popular and beloved, a woman science writer without a rough edge, she had successfully penetrated the man-controlled world of science and she was unapologetic. As she said, “…this notion that ‘science’ is something that belongs in a separate compartment of its own, apart from everyday life, is one that I should like to challenge. …Science is part of the reality of living; it is the what, the how, and the why of everything in our experience.”

Her long time natural science mentor, Edwin Way Teale, encouraged her activism. In 1958, Carson informed him of her intention to write a book on DDT, a subject that was his specialized area of interest.  Teale had advised the Army during WW II that mass spraying of DDT to fight malaria in the South Pacific carried with it long-term damage to the environment.

With the help of Teale, she spent the next four years compiling the research,. She proceeded despite the fact that, in early 1960, she was diagnosed with breast cancer, a fact that she intentionally hid.

During these years, she had many supporters including Supreme Court Justice, William O. Douglas, and the junior senator from Massachusetts, soon to be President of the United States, John F. Kennedy. In 1960, all three shared deep concern for the Cape Cod seacoast. Jacqueline Kennedy was especially taken by the opening chapter of her new book, Silent Spring, and hand-delivered a copy to JFK. It catalogued the growing chemical injuries to life on Earth.

Of course, the chemical industry was more than equal in its opposition – none more than Monsanto. Monsanto sprung to life in St. Louis, Missouri, in 1901. The founder was an industrious middle aged, family man, named John Francis Queeny.

He married a wealthy young sugar-baron heiress, the daughter of Spanish aristocratic parents, who had emigrated to St. Thomas. Her name was Olga Mendez Monsanto. He was so smitten with her, that when he decided to start a company on his own in 1901, he named the company, Monsanto, after her.

His love for her may have been equally matched by his love for her father-in-law and his deep connections to sugar and the Coca Cola Company. Not only was his start up company originally financed by a St. Louis soda bottler, but also the companies first, second and third products – saccharine, caffeine, and vanillin – were all essential ingredients of none other than Coca-Cola.

In 1921, he saw an opportunity in basic industrial chemicals and he never looked back. The first two big hits were the notorious sulfuric acid and the not yet well known Polychlorinated biphenyl – which most of us know simply by the initials PCB. That product would share the mantle for “most environmentally destructive” products in history with two other Monsanto success stories – DDT , and Agent Orange.

Monsanto and the USDA – when it came to insects and pests – were on the same page. Modernity required Industrial Technology.  For example, the USDA consumer brochure in March, 1947, perfectly aligned with the company’s view of the world. Titled “DDT…For Control Of Household Pests”, it’s front cover featured a lovely late 1940’s American housewife, in apron, spraying DDT into a kitchen cabinet with a calm smile on her face.

In June, 1962, after four years of work, the words of Rachel Carson’s “Silent Spring” first saw the light of day in the form of the first of four serial offerings in the June 16, 1962  issue of the New Yorker.

The reaction of the Chemical Industry was immediate. When the dust finally settled, years later, after Rachel Carson’s death in 1965, of the 12 chemicals that earned a mention in her book, 8 were banned in the U.S.

A little over a month after The New Yorker release, the New York Times set the tone with a screaming headline on page 1 that read, “’Silent Spring’ Is Now Noisy Summer: Pesticides Industry Up in Arms Over a New Book. Rachel Carson Stirs Conflict – Producers Are Crying ‘Foul’”.

When Silent Spring was chosen as the October, 1962 offering of the Book-of-the-Month-Club (with a special introduction by Supreme Court Justice, William O. Douglas), the attacks turned more personal. The industry now energized its’ academic allies. One Vanderbilt professor wrote an article titled, “Silence, Miss Carson”. 

Many were intensely personal and referenced her gender, her single status, her mental state, calling her a “nature nut”, and a “hysterical woman”. But equal numbers, – like respected Cornell chemist, LeMont Cole – defended her.

As the battle fully engaged, Monsanto, at the time one of the major producers of DDT, took the lead. Their writers mockingly mirrored Carson’s style in widely distributed parodies.

Monsanto grossly miscalculated who they were up against. For one thing, Carson was a highly successful student of the new medium of television. On April 3, 1963, in an appearance on “CBS Reports” hosted by veteran TV personality Eric Sevareid, she demolished a stiff, white coated, Robert White-Stevens, from American Cyanamide, while at the same time letting the American public know that the industry was dumping 900 million pounds of insecticides into our air, soil and water each year.

Carson appeared on air, in a wig, to hide her hair loss from chemotherapy. Her tumor had widely metastasized by then, and she was in decline. But the last thing she wanted to do was let industry know she had cancer for fear of opening another line of attack.

On August 29, 1962, at a live Press Conference, a reporter had asked JFK, “There appears to be a growing concern among scientists as to the possibility of dangerous long-term side effects from the use of DDT. Is this being investigated?” Kennedy response? “Yes, and I know they already are.  I think particularly, of course, since Miss Carson’s book, but they are examining the matter.”

The release of an official report in May, 1963 began with a statement signed by the President of the United States. It read, “This report on the use of pesticides has been prepared for me by my Science Advisory Committee. I have already requested the responsible agencies to implement the recommendations in the report.” Period. That was a slam dunk. The Christian Science Monitor’s headline the next day said it all: “Rachel Carson Stands Vindicated!”

Eleven months after the publication, Rachel Carson died in Silver Springs, Maryland.

On June 9, 1980, President Jimmy Carter posthumously awarded her the Presidential Medal of Freedom. While Rachel didn’t live long enough to be publically honored by President Kennedy, another woman scientist did. Her name was Francis Oldham Kelsey.

While a good deal shyer than her contemporary, she was no less determined. Born in Canada in 1914, Francis was an early standout graduating at age 19 from McGill and earning her PhD in Pharmacology from the University of Chicago five years later. Here she met and married her husband, a PhD in Pharmacology as well, and together they raised two girls.

By age 36, she had earned an MD as well, and together she and her husband assumed roles as peer reviewers for the Journal of the American Medical Association. Her special expertise, gained in wartime experiences, was the assessing of drugs that cross the maternal-placental barrier and injure unborn children.

In 1960, she was hired by the FDA, one of only 7 physician reviewers at the time. Her first candidate for review, a drug called thalidomide, did not on the surface seem controversial. It had been available over-the-counter by then for nearly two years in Europe, Australia, and Africa, and was heavily promoted for a wide variety of conditions – including for the nausea associated with pregnancy.

The drug had been discovered 16 years earlier by the Germans in 1944 who were seeking an antidote to Sarin gas. By 1953, the Swiss pharmaceutical firm, CIBA, had conducted disappointing clinical trials on the drug and sold the patent rights to the German company, Chemie Gruenthal. They in turn sold US licensing rights to Smith Kline & French. In 1956, they initiated a clinical study on 875 Americans that included a pregnant woman. Less than 2 years later, they abruptly halted the study and dropped the product. Chemie Gruenthal then leased the US rights to generic drug manufacturer Merrill-Richardon. Nearly 50 years later, a lawsuit would reveal that the S K & F study included a pregnant woman who gave birth to a limbless child – and the company knew about it.

In 1959, Richardson Merrill delivered their file to the FDA’s newly arrived  reviewer. Her first reaction was that the file seemed incomplete, and she requested additional information. They pushed back – 58 times over the next 19 months – trying repeatedly to get her fired. But Kelsey refused to give in, and her boss FDA Commissioner, George Larrick, backed her up.

Rumors were beginning to surface about the drug. In 1962, Kelsey received support from two people she didn’t know. The first was a pediatrician – but not just any pediatrician. Helen Taussig was the founder of Pediatric Cardiology in the United States and had helped design the first effective operation to cure Blue Babies born with congenital heart defects. In a few years she would become the first woman president of the American Heart Association. But at the time, she was visiting Europe and tracking down why over 300 babies in Germany had been born recently without limbs.

Writing from Europe, she filed a paper in JAMA titled: “A study of the German outbreak of phocomelia. The thalidomide syndrome.” At the same time, she got on the phone with Senator Estes Kefauver who had been struggling unsuccessfully to get legislation approved that would force the FDA to have iron-clad safety data on a drug before approving it. Kefauver then picked up the phone and dialed veteran Washington Post reporter Morton Mintz, explaining his call from Taussig and her account of the actions of Frances Kelsey.

On July 15, 1962, Mintz filed this front page headliner: “Heroine of FDA Keeps Bad Drug Off of Market.” Its’ opening line read: “This is the story of how the skepticism and stubbornness of a Government physician prevented what could have been an appalling American tragedy, the birth of hundreds or indeed thousands of armless and legless children.”

Three weeks later, JFK opened his press conference by asking “Every woman in this country, I think, must be aware that it is most important that they check their medicine cabinet, that they do not take this drug, that they turn it in”. Eight days later, LIFE magazine’s cover read “The Full Story of Thaliodomide”, and two months after that Kefauver’s signature FDA safety legislation passed with bipartisan support.

Kelsey retired in 2005 at age 90. Ten years later, she passed away in her native Canada with her children at her side. Helen Taussig, the pediatrician and president of the AHA, served as a full Professor at Johns Hopkins and died at 88. As serious as these two advocates were, two other courageous public health servants of the same era can only be described as “Happy Warriors.”

The first was Trudy Elion, born on January 3, 1918, the beloved daughter of Robert Elion, a first generation Lithuanian dentist from Brooklyn, and Polish born Bertha Cohen, intelligent and fully committed to their bright young daughter. Trudy’s charmed existence came tumbling down in 1929 when the Stock Market crash eliminated the family savings overnight. Shortly thereafter Trudy lost her treasured grandfather.

As she later explained, that loss changed her life. She said: “He was taken to the hospital and, after awhile, I was allowed to visit him. Seeing him there, I remember how shocked I was at his change in appearance. It was the first time I really understood how awful disease could be. In the hope I could do something to combat disease, I decided to become a scientist.”

Money now was tight. Trudy graduated at age 15 and earned a free ride to Hunter College where she graduated Summa Cum Laude in chemistry. She later told young science students, “Don’t let others discourage you or tell you that you can’t do it. In my day I was told women didn’t go into chemistry. I saw no reason why we couldn’t.”

Not that her course forward was easy. In fact, when she applied for jobs, she was rejected as a distraction to the male scientists. So she taught in high school and nursing school, did secretarial work on the side to pay her bills, and went to night school at NYU for a Masters in Science in 1941.

She was joyful and happy that year, in part because she had met the love of her life, a fellow student named Leonard Canter. And then suddenly after several weeks of a sore throat, he developed rheumatic fever, and within days was dead. Trudy’s brother said, “She never fully recovered.” But others believe that “Her loss reinforced her decision to help people through science.”

Now with a Masters, she was able to land her first lab job as a food chemistry analyst in 1942. But let’s face it, it wasn’t ideal. As she said at the time, “I tested the acidity of pickles, the mold in frozen strawberries; I checked the color of egg yolk going into mayonnaise. It wasn’t exactly what I had in mind but it was a step in the right direction.”

One day in 1944, Trudy was visiting her father’s dentist office and ran into a detail man from Burroughs Wellcome. He said they were hiring research scientists in their new research facility in Tuckahoe, NY.  She interviewed 1 week after D-Day, at age 26, and was hired on the spot as an “assistant biochemist” for $50 a week. She stayed there for the next 39 years.

Her boss, partner, and eventual co-recipient of the Nobel Prize in Chemistry was Dr. George Hitchins. From the beginning, Hitchins supported Trudy Elion’s active mind. She immediately embraced Hitchins notion of Rational Drug Design. Rather than simply guess for cures by blind trial and error, why not attempt to mimic human chemical processes?

In 1951, Trudy hit pay dirt with the discovery of the biologically active 6-Mercapto Purine or 6MP. It almost immediately became the go-to drug for universally fatal childhood leukemias . Cures today exceed 80%. In 1957, this was followed by Immuran made transplants possible by blocking organ rejection.

Together the two focused on developing drugs that would disable cells diseased by cancer, bacteria, or viruses without harming the normal ones.  A parade of breakthrough drugs for gout, for bacterial and fungal illnesses, and ultimately the first drug for HIV-AIDS followed. And then in 1988, the Nobel Prize.

Through it all, Gertrude Elion insisted happily that she was not in it for awards. One of her biographers stated that “Gertrude always considered herself to be more of a humanist than a scientist. Her life was devoted to helping others, and although she was often rewarded with various honors, she didn’t need them to feel she had achieved great things.”

Mirroring this world view was another “Happy Warrior”, a woman of science born nine years before Trudy, 10 miles to the east, across the Hudson River, in Westfield, NJ. A supporter wrote, “When she talks to you, you know she’s talking to you – more important, listening to you… Her warmth and interest give you the feeling that her arms are around you, even though she never touches you.”

Virginia Apgar’s family never sat down. There lives were filled with music and science. Her father was in finance but his great love was experimenting with radio waves and writing a regular column for the Radio Amateur News. Like Trudy, Virginia was a brilliant student and the family had the resources to send her to Mount Holyoke College where she focused on science and the violin.

When she graduated, she was accepted at Columbia Presbyterian Medical School in 1929, and then entered their surgical residency as one of the pioneering early women in Surgery. The legendary head of the program, Dr. Allen Whipple, called her aside in her second year and suggested a different road was opening up, one he thought she should pursue.

At the time, new intravenous anesthetic drugs like thiopental sulfate were just appearing and challenging open drop ether for both safety and effectiveness. Nurses dominated the administration of anesthesia, and surgeons were not anxious to have doctors in that role fearing they might challenge the surgeon’s dominance in the operating theater. But times were changing. And Whipple was friends with Ralph Waters who had three years earlier launched a residency in Anesthesiology at the University of Wisconsin.

With just a bit of encouragement, Dr. Apgar headed off to Madison, Wisconsin in 1935, as the only woman in the residency. She and her fellow residents thrived under the gentle guidance of Waters. In fact, they would continue to gather once a year for the next three decades as part of an alumni club they dubbed the “Aqualumni.” During this period as well, Virginia indulged in a wide range of hobbies including her chamber music, nature photography, fishing, stamp collecting and baseball.

Whipple wasted no time bringing her back to Columbia to head up the new Department of Anesthesiology, and within a few years she specialized in Obstetrical Anesthesia. She still had time for her hobbies and loved pranks and a bit of mischief. One of her patients, a professional instrument maker, took her under her wing, and eventually guided her through the steps in creating her own cello. During the process, Columbia’s central telephone booth mysteriously lost its’ burly maple shelf one evening. It subsequently was spotted – now the backbone to Dr. Apgar’s splendid new cello.

By 1949, Virginia had witnessed over 17,000 births. For the infants she monitored heart rate, breathing, muscle tone, reactibility, and skin color. To assess these children as a group, however, she needed a measurement tool.

That system became known as the Apgar Score. Measuring appearance (A), pulse (P), grimace (G), activity (A) and respiration (R), each child received 0,1,or 2 on each of the five measures and the scores were then added together. Measures were taken 1 minute after birth, and 5 minutes after birth. The system quickly took off and became the national standard.

By 1959, Apgar seized the opportunity for a sabbatical and enrolled at Johns Hopkins where she earned a Masters in Public Health. From there, she assumed the top medical position at the March of Dimes, splitting time between that and her many hobbies, most notably as the charter fan of the NY Mets from their beginnings in 1962. She died in 1974, five years after the Mets, led by pitcher Tom Seaver, won the World Series.

When the Mets won the World Series by defeating the heavily favored Baltimore Orioles 4 games to 1 in 1969, it earned them the nickname “Amazing Mets.” 1969 was their first winning season since joining the National League in 1962.

1962 was also the year that the Harlem Youth Opportunities Unlimited Project, the model for LBJ’s Head Start program, was launched. At the helm was a 45-year old African American woman, the first woman recipient of a PhD from Columbia University. Her roots were not in Harlem, but rather in the highly segregated and always controversial town of Hot Springs, Arkansas.

Mamie Phipps Clark – intelligent, likeable,  and well-to-do – was born in 1917. As she herself admitted, “It was a very privileged childhood.” Her father was the town’s black doctor, a member of a very elite club – the 1.5% of black men at the time who held professional positions. Hot Springs, with its gambling and prostitution, was a favorite destination of gangsters like Al Capone. Dr Harold Phipps was not only a doctor, but also the owner with his wife Katherine of the town’s sole black hotel, the Pythian Hotel and Bath House, built out of the ashes of a 1913 fire that destroyed the town.

Mamie and her only brother, Harold Jr. who would later become a dentist, graduated from the segregated Langston High School. Mamie chose the historical Black College, Howard University, to continue her education, arriving by overnight train under the watchful eyes of an armed guard her father had hired to ensure her safety in transit.

Howard was an awakening. As Mamie later recounted, “The school (referring to her segregated high school) was poor, and later I realized how much we didn’t learn. For example, there was one point when I realized I had learned no English grammar-none. And I had learned no history. But those gaps, you weren’t aware of when you were coming through high school.”

She caught up quickly and in her junior year signed up for a course in Abnormal Psychology taught by a young Master’s candidate, Richard Clark. By Spring the next year, the two – against the wishes of her parents – eloped. They then returned to campus where Mamie graduated magna cum laude one month later. That summer, Mamie worked for a young NAACP lawyer named Thurgood Marshall triggering a spirit for advocacy that would remain her hallmark in the decades ahead.

A Master’s followed the next year with a thesis that ultimately enshrined her role in Civil Rights history. Its’ title was, “The Development of Consciousness of Self in Negro Pre-School Children.” As 1940 approached, Richard and Mamie decamped to New York City where both enrolled in Columbia’s PhD program in Psychology.

The ever confident and somewhat contrarian academic, Mamie surprised everyone by choosing Henry E. Garret, chairman of the department and an avowed segregationist, as her adviser. Mamie welcomed the challenge and also valued Garret’s intellect and reputation as a remarkable statistician.  In 1943, she became the first African-American woman to be granted a PhD from Columbia.

It was during this period that she and Richard collaborated on what would become known as “The Dolls Test.” At a local Woolworth’s in Harlem, the couple purchased four dolls – 2 white, and 2 black. They then enrolled 119 black elementary students from an integrated school in Springfield, Massachusetts, and 134 black elementary students from a segregated school in Little Rock, Arkansas.

Each child was asked six questions:

1. “Give me the doll that looks like a white child.”

2. “Give me the doll that looks like a colored (Negro) child.”

3. “Give me the doll that looks like you.”

4. “Show me the doll that you like the best or that you’d like to play with.”

5. “Show me the doll that is the ‘nice’ doll.”

6. “Show me the doll that looks ‘bad.'”

Both groups of black children in the majority favored the white doll as “nice” and a preferred playmate, and the black doll as “bad.”  What distinguished the two groups however was the integrated children were upset by the questions and in some cases began to cry, while the segregated children were unfazed – one young boy famously pointing to the brown doll and proclaiming without emotion, “That a nigger. I’m a nigger.”

By 1951, 17 southern and border-states required racial segregation of public schools – the anchor of their segregated societies. Thurgood Marshall, on behalf of the NAACP, represented the Brown family of Topeka Kansas (and 6 other families around the country) in the Supreme Court case Brown v. Board of Education.

In deciding the case, the majority of Justices leaned heavily on the Clark’s research and effectively ended legal segregation in the United States with this statement, “To separate [African-American children] from others of similar age and qualifications solely because of their race generates a feeling of inferiority as to their status in the community that may affect their hearts and minds in a way unlikely ever to be undone.”

Mamie Phipps Clark was not the only African American woman born in the South in the early 1900’s who would earn a PhD and leave an indelible mark on American society. 953 miles due east on Christmas Day in 1904 in Henderson, NC, another baby girl was born, the 7th of 9 children. Her name was Flemmie Kittrell, and like Mamie she stood out early for her intelligence, ambition and drive.

Lacking the wealth that aided Mamie’s rise, Flemmie first step up the ladder of Public Health was funded by an anonymous donor when she was 15. It accompanied a request for admission to the Hampton Institute and testified to the youngster’s “diplomacy and persistence.” By the time she left in 1929, she had completed high school and college.

She had fully embraced the four ideals of Hampton Institute – morality, citizenship, sanitation, and vocation. She possessed a missionary zeal, and had committed herself to understanding the role of nutrition in child development. At the time, the most famous school for a new burgeoning field called Home Economics by some and Human Ecology by others was the land grant Agricultural College at Cornell.

Like Mamie, she became the first African American woman at her university to earn a PhD. Her career would carry her back to Mamie’s Howard University where she served for over two decades and founded their School of Human Ecology. With the end of WW II, and a well earned reputation by then as a “Nutritional Political Scientist”, she took the lead for the State Department during the Marshall Plan visiting Liberia, India, Japan, West Africa, Central Africa, Guinea, and Russia among others, and uncovering pockets of what she called “hidden hunger” in developing nations.

Together, Flemmie and Mamie are remembered today as national resources whose knowledge of the interface between human development, family health, food habits and advocacy expanded human possibility for millions of Americans. Mamie turned a laser focus on her community and the Northside Center in Harlem where as she said, “Children rise up and thrive.” Flemmie in contrast was a world traveler, who carried the richness of her experiences back to her Howard University community in Washington, DC – never forgetting where she began in Henderson, NC, but connecting her rich array of friendships and learnings around the world to the betterment of all she touched.

This missionary zeal, an ability to confidently strike out into the world, and to find your place, your way, your purpose were qualities shared by our final public health hero.

By her own account, “… I was a chubby baby, born with a mark, a capillary hemangioma on my forehead. It wasn’t pretty or fascinating, like Harry Potter’s lightening bolt. My mark was dark, the size of a golf ball, and near my hairline.” She was special from the start, name by Haji, her grandfather, “Muna” (later Americanized to Mona) meaning hope, wish, desire.

Her birth in the UK was a temporary stopover for the family that was fleeing Sadam Hussein’s Iraq. Her father, an engineer, rejected the idea of designing weapons of war, and set his family’s sights, and his own career future, on America.

Born on November 24, 1976, she and her brother, Marc, moved to Michigan as young children, eventually becoming American citizens along with their parents. As with our other heroes, she was recognized early for her intellect and drive, likeable and multi-talented.

She became a pediatrician and managed a small hospital clinic in Flint, Michigan, married now, with two children of her own. As with most citizens of the city, she took little notice when the Mayor authorized switching the city’s water source from the Detroit River to the Flint River in April, 2014. But within months, she began to notice the same symptoms in her young patients as Alice Hamilton had more than a century ago. And when she ran the tests, she began picking up elevated blood lead levels in some of the children.

At the same time, an activist parent named LeeAnn Waters was doing her own testing. Her family’s water looked and tasted different, and she was worried. But the city department kept saying everything was fine. So on her own, she contacted the regional head of the Environmental Protection Agency, Miguel Del Toral, and he shared her concern. But when he approached city and state officials, he was stonewalled as well.

But Del Toral had a friend, a water chemistry professor at Virginia Tech, 554 miles due south of Flint. And he called to ask for help. In response, the professor, Marc Edwards, called a meeting of his students, and asked them what they’d like to do. Word spread, and by the next day, over 30 students gathered for the follow-up meeting and offered to volunteer.

Edwards and the students then diverted $150,000 in research funds, and over the next several months made the 8 hour trip north multiple times to collect 861 water samples for testing back at the college. But to do the study, they needed to connect cause and effect. Luckily, Del Toral and Lee Ann Waters both knew a pediatrician at Hurley’s Children Hospital who was already testing the children on her own. Her name was Mona Hanna-Attisha.

On September 24, 2015, Dr. Hanna-Attisha appeared with Profressor Marc Edwards at a Press Conference in Flint to announce that the water tests revealed lead levels 130 times the allowable EPA limits for lead. Mona shared a graph that proved that the incidence of lead poisoning in area children had doubled since the switch in Flint River water. And the students revealed that documents they received through the Freedom of Information Act proved a massive cover-up by city and state authorities.

Mona reinforced that day, with LeeAnn in attendance, that the local water was unsafe to drink. A Federal emergency was declared, and those involved in the cover-up prosecuted. Largely as a result of Mona’s testimony before Congress, $100 million in Federal funds was added to $250 million the state awarded for the clean up.

Mona’s clinic at Hurley Children’s Hospital has broadened its programming along the lines of Mamie Clark’s Harlem Northside Center. And she and Marc Edwards helped the student volunteers publish their study and results. In that study the e students write, “ We are worried that a reward structure has developed that supports mainly self-promotion and dissuades the altruistic motives to do science for the public good that attracted many of us to the profession in the first place.”

Their final comment: “We affirm Virginia Tech’s motto, ‘Ut prosim,’ which means, ‘That I may serve.’” – is a fitting place to end this hour.

Nine women scientists, over more than a century, overcame remarkable odds, and achieved lasting gains for this nation and her citizens. They did so, not in pursuit of either fame or wealth, but simply in the desire to share their God given talents, and to serve in the finest sense of the word.

Thank you.